Harm reduction principles for healthcare settings
Open accessAbstract
BACKGROUND: Harm reduction refers to interventions aimed at reducing the negative effects of health behaviors without necessarily extinguishing the problematic health behaviors completely. The vast majority of the harm reduction literature focuses on the harms of drug use and on specific harm reduction strategies, such as syringe exchange, rather than on the harm reduction philosophy as a whole. Given that a harm reduction approach can address other risk behaviors that often occur alongside drug use and that harm reduction principles have been applied to harms such as sex work, eating disorders, and tobacco use, a natural evolution of the harm reduction philosophy is to extend it to other health risk behaviors and to a broader healthcare audience. METHODS: Building on the extant literature, we used data from in-depth qualitative interviews with 23 patients and 17 staff members from an HIV clinic in the USA to describe harm reduction principles for use in healthcare settings. RESULTS: We defined six principles of harm reduction and generalized them for use in healthcare settings with patients beyond those who use illicit substances. The principles include humanism, pragmatism, individualism, autonomy, incrementalism, and accountability without termination. For each of these principles, we present a definition, a description of how healthcare providers can deliver interventions informed by the principle, and examples of how each principle may be applied in the healthcare setting. CONCLUSION: This paper is one of the firsts to provide a comprehensive set of principles for universal harm reduction as a conceptual approach for healthcare provision. Applying harm reduction principles in healthcare settings may improve clinical care outcomes given that the quality of the provider-patient relationship is known to impact health outcomes and treatment adherence. Harm reduction can be a universal precaution applied to all individuals regardless of their disclosure of negative health behaviors, given that health behaviors are not binary or linear but operate along a continuum based on a variety of individual and social determinants.
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Several study participants viewed suicidal ideation as a reason to grant, rather than refuse MAiD MI-SUMC, considering it a better, more dignified option to the painful and uncertain death by suicide for those intent on ending their life.
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- Authors
- Hawk, M., Coulter, R. W. S., Egan, J. E., Fisk, S., Reuel Friedman, M., Tula, M., & Kinsky, S.
- Affiliations
- University of Pittsburgh (US)
- Allegheny Health Network (US)
- University of Pittsburgh Medical Center (US)
- Corresponding author
- Hawk, Mary
- Venue
- Harm Reduction Journal
- Published
- 2017-10-24
- Volume
- 14
- Issue
- 1
- Pages
- 70-70
- ISSN
- 1477-7517 (ISSN-L)
- PMC
- PMC5655864
- OpenAlex
- W2765694451
- Cited by
- 487
- References
- 29
- Citations by year
- 2026: 64 · 2025: 68 · 2024: 79 · 2023: 83 · 2022: 67 · 2021: 50 · 2020: 48 · 2019: 20 · 2018: 6
- FWCI
- 15.84
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Harm Reduction Journal (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- University of Pennsylvania
- National Institutes of Health (TL1TR001858)
- National Institute on Drug Abuse (F31DA037647)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Keywords
- harm reduction, healthcare settings, HIV clinics, provider-patient relationship, patient autonomy, incrementalism, humanism, pragmatism, individualism, health risk behaviors, substance use, syringe exchange, medication adherence
- MeSH terms
- Attitude of Health Personnel, Health Personnel, Health Promotion, Humans, Interviews as Topic, United States, Harm Reduction
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