IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v250y2020ics027795362030071x.html
   My bibliography  Save this article

Reducing mental illness stigma in healthcare settings: Proof of concept for a social contact intervention to address what matters most for primary care providers

Author

Listed:
  • Kohrt, Brandon A.
  • Turner, Elizabeth L.
  • Rai, Sauharda
  • Bhardwaj, Anvita
  • Sikkema, Kathleen J.
  • Adelekun, Adesewa
  • Dhakal, Manoj
  • Luitel, Nagendra P.
  • Lund, Crick
  • Patel, Vikram
  • Jordans, Mark J.D.

Abstract

Initiatives for integration of mental health services into primary care are underway through the World Health Organization's mental health Gap Action Programme (mhGAP) and related endeavors. However, primary healthcare providers' stigma against persons with mental illness is a barrier to success of these programs. Therefore, interventions are needed to reduce stigma among primary healthcare providers. We developed REducing Stigma among HealthcAre ProvidErs (RESHAPE), a theoretically-grounded intervention that draws upon the medical anthropology conceptual framework of “what matters most.” RESHAPE addresses three domains of threats to what matters most: survival, social, and professional. In a proof-of-concept study, mental health service users and aspirational healthcare providers (primary healthcare providers actively incorporating mental health services) were trained to co-facilitate the RESHAPE intervention embedded within mhGAP training in Nepal. Two trainings with the RESHAPE anti-stigma component were held with 41 primary healthcare providers in Nepal. Evaluation of the training included four focus groups and 25 key informant interviews. Stigmatizing attitudes and role play-based clinical competency, assessed with the ENhancing Assessment of Common Therapeutic factors tool (ENACT), were evaluated pre-training and followed-up at four and 16 months. The study was conducted from February 2016 through June 2017. In qualitative interviews, primary healthcare providers described changes in perceptions of violence (survival threats) and the ability to treat mental illness effectively (professional threats). Willingness to interact with a person with mental illness increased from 54% pre-training to 81% at 16 months. Observed clinical competency increased from 49% pre-training to 93% at 16-months. This proof-of-concept study supports reducing stigma by addressing what matters most to healthcare providers, predominantly through mitigating survival and professional threats. Additional efforts are needed to address social threats. These findings support further exploration of service user and aspirational figure involvement in mhGAP trainings based on a “what matters most” conceptual framework

Suggested Citation

  • Kohrt, Brandon A. & Turner, Elizabeth L. & Rai, Sauharda & Bhardwaj, Anvita & Sikkema, Kathleen J. & Adelekun, Adesewa & Dhakal, Manoj & Luitel, Nagendra P. & Lund, Crick & Patel, Vikram & Jordans, Ma, 2020. "Reducing mental illness stigma in healthcare settings: Proof of concept for a social contact intervention to address what matters most for primary care providers," Social Science & Medicine, Elsevier, vol. 250(C).
    • Handle: RePEc:eee:socmed:v:250:y:2020:i:c:s027795362030071x
    DOI: 10.1016/j.socscimed.2020.112852
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S027795362030071X
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2020.112852?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Olafsdottir, Sigrun & Pescosolido, Bernice A., 2011. "Constructing illness: How the public in eight Western nations respond to a clinical description of "schizophrenia"," Social Science & Medicine, Elsevier, vol. 73(6), pages 929-938, September.
    2. Pescosolido, B.A. & Medina, T.R. & Martin, J.K. & Long, J.S., 2013. "The "backbone" of stigma: Identifying the Global core of public prejudice associated with mental illness," American Journal of Public Health, American Public Health Association, vol. 103(5), pages 853-860.
    3. Moses, Tally, 2010. "Being treated differently: Stigma experiences with family, peers, and school staff among adolescents with mental health disorders," Social Science & Medicine, Elsevier, vol. 70(7), pages 985-993, April.
    4. Yang, Lawrence Hsin & Kleinman, Arthur & Link, Bruce G. & Phelan, Jo C. & Lee, Sing & Good, Byron, 2007. "Culture and stigma: Adding moral experience to stigma theory," Social Science & Medicine, Elsevier, vol. 64(7), pages 1524-1535, April.
    5. Yang, Lawrence H. & Chen, Fang-pei & Sia, Kathleen Janel & Lam, Jonathan & Lam, Katherine & Ngo, Hong & Lee, Sing & Kleinman, Arthur & Good, Byron, 2014. "“What matters most:” A cultural mechanism moderating structural vulnerability and moral experience of mental illness stigma," Social Science & Medicine, Elsevier, vol. 103(C), pages 84-93.
    6. Pescosolido, Bernice A. & Martin, Jack K. & Lang, Annie & Olafsdottir, Sigrun, 2008. "Rethinking theoretical approaches to stigma: A Framework Integrating Normative Influences on Stigma (FINIS)," Social Science & Medicine, Elsevier, vol. 67(3), pages 431-440, August.
    7. Crick Lund & Mark Tomlinson & Mary De Silva & Abebaw Fekadu & Rahul Shidhaye & Mark Jordans & Inge Petersen & Arvin Bhana & Fred Kigozi & Martin Prince & Graham Thornicroft & Charlotte Hanlon & Ritsuk, 2012. "PRIME: A Programme to Reduce the Treatment Gap for Mental Disorders in Five Low- and Middle-Income Countries," PLOS Medicine, Public Library of Science, vol. 9(12), pages 1-6, December.
    8. Clair, Matthew & Daniel, Caitlin & Lamont, Michèle, 2016. "Destigmatization and health: Cultural constructions and the long-term reduction of stigma," Social Science & Medicine, Elsevier, vol. 165(C), pages 223-232.
    9. Yang, Lawrence H. & Purdie-Vaughns, Valerie & Kotabe, Hiroki & Link, Bruce G. & Saw, Anne & Wong, Gloria & Phelan, Jo C., 2013. "Culture, threat, and mental illness stigma: Identifying culture-specific threat among Chinese-American groups," Social Science & Medicine, Elsevier, vol. 88(C), pages 56-67.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Anvita Bhardwaj & Dristy Gurung & Sauharda Rai & Bonnie N. Kaiser & Cori L. Cafaro & Kathleen J. Sikkema & Crick Lund & Nagendra P. Luitel & Brandon A. Kohrt, 2022. "Treatment Preferences for Pharmacological versus Psychological Interventions among Primary Care Providers in Nepal: Mixed Methods Analysis of a Pilot Cluster Randomized Controlled Trial," IJERPH, MDPI, vol. 19(4), pages 1-17, February.
    2. Yoeli, Heather & Dhital, Ranjita & Hermaszewska, Susannah & Sin, Jacqueline, 2022. "A meta-ethnography of participatory health research and co-production in Nepal," Social Science & Medicine, Elsevier, vol. 301(C).
    3. Cori L. Tergesen & Dristy Gurung & Saraswati Dhungana & Ajay Risal & Prem Basel & Dipesh Tamrakar & Archana Amatya & Lawrence P. Park & Brandon A. Kohrt, 2021. "Impact of Service User Video Presentations on Explicit and Implicit Stigma toward Mental Illness among Medical Students in Nepal: A Randomized Controlled Trial," IJERPH, MDPI, vol. 18(4), pages 1-23, February.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Timmermans, Stefan & Tietbohl, Caroline, 2018. "Fifty years of sociological leadership at Social Science and Medicine," Social Science & Medicine, Elsevier, vol. 196(C), pages 209-215.
    2. Gaddis, S. Michael & Ramirez, Daniel & Hernandez, Erik L., 2018. "Contextualizing public stigma: Endorsed mental health treatment stigma on college and university campuses," Social Science & Medicine, Elsevier, vol. 197(C), pages 183-191.
    3. Gavan, Luana & Hartog, Kim & Koppenol-Gonzalez, Gabriela V. & Gronholm, Petra C. & Feddes, Allard R. & Kohrt, Brandon A. & Jordans, Mark J.D. & Peters, Ruth M.H., 2022. "Assessing stigma in low- and middle-income countries: A systematic review of scales used with children and adolescents," Social Science & Medicine, Elsevier, vol. 307(C).
    4. Yang, Lawrence H. & Chen, Fang-pei & Sia, Kathleen Janel & Lam, Jonathan & Lam, Katherine & Ngo, Hong & Lee, Sing & Kleinman, Arthur & Good, Byron, 2014. "“What matters most:” A cultural mechanism moderating structural vulnerability and moral experience of mental illness stigma," Social Science & Medicine, Elsevier, vol. 103(C), pages 84-93.
    5. Lucy, Meghann, 2024. "“Fighting demons”: Stigma and shifting norms in explicit mention of overdose in obituaries, 2010–2019," Social Science & Medicine, Elsevier, vol. 350(C).
    6. Billings, Katie R. & Cort, David A. & Rozario, Tannuja D. & Siegel, Derek P., 2021. "HIV stigma beliefs in context: Country and regional variation in the effects of instrumental stigma beliefs on protective sexual behaviors in Latin America, the Caribbean, and Southern Africa," Social Science & Medicine, Elsevier, vol. 269(C).
    7. Xi Chen & Jingjing Su & Daniel Thomas Bressington & Yan Li & Sau Fong Leung, 2022. "Perspectives of Nursing Students towards Schizophrenia Stigma: A Qualitative Study Protocol," IJERPH, MDPI, vol. 19(15), pages 1-12, August.
    8. Pinto-Foltz, Melissa D. & Logsdon, M. Cynthia & Myers, John A., 2011. "Feasibility, acceptability, and initial efficacy of a knowledge-contact program to reduce mental illness stigma and improve mental health literacy in adolescents," Social Science & Medicine, Elsevier, vol. 72(12), pages 2011-2019, June.
    9. Brewis, Alexandra A. & Hruschka, Daniel J. & Wutich, Amber, 2011. "Vulnerability to fat-stigma in women's everyday relationships," Social Science & Medicine, Elsevier, vol. 73(4), pages 491-497, August.
    10. Clair, Matthew & Daniel, Caitlin & Lamont, Michèle, 2016. "Destigmatization and health: Cultural constructions and the long-term reduction of stigma," Social Science & Medicine, Elsevier, vol. 165(C), pages 223-232.
    11. Daniel Walsh & Juliet Foster, 2022. "Charting an Alternative Course for Mental Health-Related Anti-Stigma Social and Behaviour Change Programmes," IJERPH, MDPI, vol. 19(17), pages 1-21, August.
    12. Krupchanka, D. & Chrtková, D. & Vítková, M. & Munzel, D. & Čihařová, M. & Růžičková, T. & Winkler, P. & Janoušková, M. & Albanese, E. & Sartorius, N., 2018. "Experience of stigma and discrimination in families of persons with schizophrenia in the Czech Republic," Social Science & Medicine, Elsevier, vol. 212(C), pages 129-135.
    13. Duan, Wenjie & Bu, He & Chen, Zheng, 2020. "COVID-19-related stigma profiles and risk factors among people who are at high risk of contagion," Social Science & Medicine, Elsevier, vol. 266(C).
    14. Koschorke, Mirja & Padmavati, R. & Kumar, Shuba & Cohen, Alex & Weiss, Helen A. & Chatterjee, Sudipto & Pereira, Jesina & Naik, Smita & John, Sujit & Dabholkar, Hamid & Balaji, Madhumitha & Chavan, An, 2014. "Experiences of stigma and discrimination of people with schizophrenia in India," Social Science & Medicine, Elsevier, vol. 123(C), pages 149-159.
    15. Cori L. Tergesen & Dristy Gurung & Saraswati Dhungana & Ajay Risal & Prem Basel & Dipesh Tamrakar & Archana Amatya & Lawrence P. Park & Brandon A. Kohrt, 2021. "Impact of Service User Video Presentations on Explicit and Implicit Stigma toward Mental Illness among Medical Students in Nepal: A Randomized Controlled Trial," IJERPH, MDPI, vol. 18(4), pages 1-23, February.
    16. Cort, David A. & Tu, Hsin Fei, 2018. "Safety in stigmatizing? Instrumental stigma beliefs and protective sexual behavior in Sub-Saharan Africa," Social Science & Medicine, Elsevier, vol. 197(C), pages 144-152.
    17. Dako-Gyeke, Mavis, 2018. "Courtesy stigma: A concealed consternation among caregivers of people affected by leprosy," Social Science & Medicine, Elsevier, vol. 196(C), pages 190-196.
    18. Monica Zolezzi & Maha Alamri & Shahd Shaar & Daniel Rainkie, 2018. "Stigma associated with mental illness and its treatment in the Arab culture: A systematic review," International Journal of Social Psychiatry, , vol. 64(6), pages 597-609, September.
    19. Brewis, Alexandra A., 2014. "Stigma and the perpetuation of obesity," Social Science & Medicine, Elsevier, vol. 118(C), pages 152-158.
    20. Persson, Petra & Qiu, Xinyao & Rossin-Slater, Maya, 2021. "Family Spillover Effects of Marginal Diagnoses: The Case of ADHD," IZA Discussion Papers 14020, Institute of Labor Economics (IZA).

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:250:y:2020:i:c:s027795362030071x. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.