Background In rural areas of low- and middle- income countries, mental health care is often unavailable and inaccessible, and stigma is a major barrier to treatment. Destigmatization can increase treatment-seeking attitudes, community support, and acceptance of individuals suffering from mental illness. This study’s primary objective was to evaluate the impact of a community-led, theater-based destigmatization campaign for mental illness conducted in the Busoga region of Eastern Uganda. Methods One hundred residents of the Busoga region were randomly selected via cluster sampling to complete a structured questionnaire assessing mental health stigma. Four focus groups were conducted for qualitative data on mental health stigma. Common misconceptions and specific points of stigma were identified from these responses, and local village health team personnel developed and performed a culturally-adapted theatrical performance addressing these points. Changes in perceptions of mental illness were measured among 57 attendees using two measures, the Broad Acceptance Scale (designed to reflect factors that contribute to structural stigma) and Personal Acceptance Scale (designed to reflect factors that contribute to interpersonal, or public stigma), before and after the performance. Results There was a significant increase in acceptance according to the Broad Acceptance Scale (p < .001) and Personal Acceptance Scale (p < .001). Qualitative responses from play attendees also indicated a decrease in stigma and an increased sense of the importance of seeking treatment for mentally ill patients. Conclusion This study shows community-led, theater intervention may be an effective tool for the destigmatization of mental illness in rural areas of Uganda. Larger studies are needed to further test the efficacy of this approach and potential for longer-term scalabilityand sustainability.

BackgroundThe WHO recommends training lay first responders (LFRs) as the first step towards establishing emergency medical services (EMS) in low-income and middle-income countries. Understanding social and financial benefits associated with responder involvement is essential for LFR programme continuity and may inform sustainable development.MethodsA mixed-methods follow-up study was conducted in July 2019 with 239 motorcycle taxi drivers, including 115 (75%) of 154 initial participants in a Ugandan LFR course from July 2016, to evaluate LFR training on participants. Semi-structured interviews and surveys were administered to samples of initial participants to assess social and economic implications of training, and non-trained motorcycle taxi drivers to gauge interest in LFR training. Themes were determined on a per-question basis and coded by extracting keywords from each response until thematic saturation was achieved.ResultsThree years post-course, initial participants reported new knowledge and skills, the ability to help others, and confidence gain as the main benefits motivating continued programme involvement. Participant outlook was unanimously positive and 96.5% (111/115) of initial participants surveyed used skills since training. Many reported sensing an identity change, now identifying as first responders in addition to motorcycle taxi drivers. Drivers reported they believe this led to greater respect from the Ugandan public and a prevailing belief that they are responsible transportation providers, increasing subsequent customer acquisition. Motorcycle taxi drivers who participated in the course reported a median weekly income value that is 24.39% higher than non-trained motorcycle taxi counterparts (p<0.0001).ConclusionsA simultaneous delivery of sustained social and perceived financial benefits to LFRs are likely to motivate continued voluntary participation. These benefits appear to be a potential mechanism that may be leveraged to contribute to the sustainability of future LFR programmes to deliver basic prehospital emergency care in resource-limited settings.

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Purpose Evaluate the long-term effectiveness of a community-led theatrical intervention in reducing mental health stigma in a low-income setting in Uganda. Methods A follow-up survey of study participants was conducted 12 months after the initial community-led theatrical intervention measuring the primary outcomes of mental illness stigma using the Broad Acceptance Scale (BAS) and the Personal Acceptance Scale (PAS). Results Of the initial 57 participants, 46 (80%) completed the follow-up survey. The average improvement in Broad Acceptance Scale and Personal Acceptance Score observed from baseline to twelve months after the intervention was 1.435 (95% CI: 0.826–2.044, p < 0.0001, SD: 1.64) and 2.152 (95% CI: 1.444–2.860, p < 0.0001, SD: 1.93), respectively. Both effect sizes were within the confidence intervals of the average improvement observed one week after the intervention. Conclusion Exposure to the community-led theatrical intervention continued to confer a significant and substantial reduction in mental illness stigma.

Introduction The goal of this study was to identify use of family planning (FP) in the Buyende district of Uganda, and what factors influence its use or lack of use. Methods Study participants included 60 women from 18 to 49 years old who lived in the Buyende District of Uganda. This was a mixed-methods study. Descriptive statistics and chi-squared analysis were performed on the survey data to identify factors associated with modern FP use. Qualitative analysis, consisting of an iterative coding process, was used to identify themes that arose in focus groups regarding barriers to FP use. Results Most participants were 20-24 years old (26.7%), married (86.7%), had a primary education (86.7%), and had a mean parity of 5.23 (range 0 to 14). One third of survey participants were currently using a form of modern contraception, and women who spoke to a healthcare provider in the last 12 months about FP were significantly more likely to be using a form of modern contraception (46.2% vs 10.5%, p=0.016). The most common barriers to FP use were side effects (71%), fear of husband disapproval (19.4%), and lack of access (16.1%). Qualitative analysis of focus groups demonstrated 9 major themes that emerged as barriers to FP: misinformation/misconceptions about FP; concerns about side effects; negative community perceptions of FP; lack of education; male opposition to FP; use of traditional methods; distance to health facilities; financial concerns; FP going against religious beliefs. Discussion It is important to continue to address not only the material access to FP and lack of education, but also the gender inequalities that are foundational to the lack of usage where desired.