Stigma in health facilities undermines diagnosis, treatment, and successful health outcomes. Addressing stigma is fundamental to delivering quality healthcare and achieving optimal health. This correspondence article seeks to assess how developments over the past 5 years have contributed to the state of programmatic knowledge—both approaches and methods—regarding interventions to reduce stigma in health facilities, and explores the potential to concurrently address multiple health condition stigmas. It is supported by findings from a systematic review of published articles indexed in PubMed, Psychinfo and Web of Science, and in the United States Agency for International Development’s Development Experience Clearinghouse, which was conducted in February 2018 and restricted to the past 5 years. Forty-two studies met inclusion criteria and provided insight on interventions to reduce HIV, mental illness, or substance abuse stigma. Multiple common approaches to address stigma in health facilities emerged, which were implemented in a variety of ways. The literature search identified key gaps including a dearth of stigma reduction interventions in health facilities that focus on tuberculosis, diabetes, leprosy, or cancer; target multiple cadres of staff or multiple ecological levels; leverage interactive technology; or address stigma experienced by health workers. Preliminary results from ongoing innovative responses to these gaps are also described. The current evidence base of stigma reduction in health facilities provides a solid foundation to develop and implement interventions. However, gaps exist and merit further work. Future investment in health facility stigma reduction should prioritize the involvement of clients living with the stigmatized condition or behavior and health workers living with stigmatized conditions and should address both individual and structural level stigma.

Declines in health service use during the Coronavirus Disease 2019 (COVID-19) pandemic could have important effects on population health. In this study, we used an interrupted time series design to assess the immediate effect of the pandemic on 31 health services in two low-income (Ethiopia and Haiti), six middle-income (Ghana, Lao People’s Democratic Republic, Mexico, Nepal, South Africa and Thailand) and high-income (Chile and South Korea) countries. Despite efforts to maintain health services, disruptions of varying magnitude and duration were found in every country, with no clear patterns by country income group or pandemic intensity. Disruptions in health services often preceded COVID-19 waves. Cancer screenings, TB screening and detection and HIV testing were most affected (26–96% declines). Total outpatient visits declined by 9–40% at national levels and remained lower than predicted by the end of 2020. Maternal health services were disrupted in approximately half of the countries, with declines ranging from 5% to 33%. Child vaccinations were disrupted for shorter periods, but we estimate that catch-up campaigns might not have reached all children missed. By contrast, provision of antiretrovirals for HIV was not affected. By the end of 2020, substantial disruptions remained in half of the countries. Preliminary data for 2021 indicate that disruptions likely persisted. Although a portion of the declines observed might result from decreased needs during lockdowns (from fewer infectious illnesses or injuries), a larger share likely reflects a shortfall of health system resilience. Countries must plan to compensate for missed healthcare during the current pandemic and invest in strategies for better health system resilience for future emergencies.

Background Interventions to alleviate stigma are demonstrating effectiveness across a range of conditions, though few move beyond the pilot phase, especially in low- and middle-income countries (LMICs). Implementation science offers tools to study complex interventions, understand barriers to implementation, and generate evidence of affordability, scalability, and sustainability. Such evidence could be used to convince policy-makers and donors to invest in implementation. However, the utility of implementation research depends on its rigor and replicability. Our objectives were to systematically review implementation studies of health-related stigma reduction interventions in LMICs and critically assess the reporting of implementation outcomes and intervention descriptions. Methods PubMed, CINAHL, PsycINFO, and EMBASE were searched for evaluations of stigma reduction interventions in LMICs reporting at least one implementation outcome. Study- and intervention-level characteristics were abstracted. The quality of reporting of implementation outcomes was assessed using a five-item rubric, and the comprehensiveness of intervention description and specification was assessed using the 12-item Template for Intervention Description and Replication (TIDieR). Results A total of 35 eligible studies published between 2003 and 2017 were identified; of these, 20 (57%) used qualitative methods, 32 (91%) were type 1 hybrid effectiveness-implementation studies, and 29 (83%) were evaluations of once-off or pilot implementations. No studies adopted a formal theoretical framework for implementation research. Acceptability (20, 57%) and feasibility (14, 40%) were the most frequently reported implementation outcomes. The quality of reporting of implementation outcomes was low. The 35 studies evaluated 29 different interventions, of which 18 (62%) were implemented across sub-Saharan Africa, 20 (69%) focused on stigma related to HIV/AIDS, and 28 (97%) used information or education to reduce stigma. Intervention specification and description was uneven. Conclusion Implementation science could support the dissemination of stigma reduction interventions in LMICs, though usage to date has been limited. Theoretical frameworks and validated measures have not been used, key implementation outcomes like cost and sustainability have rarely been assessed, and intervention processes have not been presented in detail. Adapted frameworks, new measures, and increased LMIC-based implementation research capacity could promote the rigor of future stigma implementation research, helping the field deliver on the promise of stigma reduction interventions worldwide. Electronic supplementary material The online version of this article (10.1186/s12916-018-1237-x) contains supplementary material, which is available to authorized users.

Stigma towards mental illness and addictive disorders is a global problem and one of the main obstacles in tackling this issue remains the effective integration of mental health services into primary health care (PHC). In Latin America, information has significantly increased on the existence of stigma; however, little is known about effective interventions to prevent stigma and promote recovery-oriented practices in PHC. The aim of this study is to understand the existing evidence regarding mental health stigma in PHC with a special focus on the Latin American region. A scoping review of the literature related to mental health stigma in PHC was conducted. Two hundred and seventeen articles were evaluated; 74 met inclusion criteria and 14 additional articles were selected from references of search results. Results were subdivided into five different perspectives: users, family members and significant others, health professionals, contextual factors, and potential effective interventions. Only nine studies were based in Latin America, and only one described an intervention to reduce stigma in mental health services, not specifically in PHC. We found an urgent need to develop interventions to understand and reduce stigma in PHC settings, especially in Latin America.

Background Recognising the significant extent of poor-quality care and human rights issues in mental health, the World Health Organization launched the QualityRights initiative in 2013 as a practical tool for implementing human rights standards including the United Nations Convention on Rights of Persons with Disabilities (CRPD) at the ground level. Aims To describe the first large-scale implementation and evaluation of QualityRights as a scalable human rights-based approach in public mental health services in Gujarat, India. Method This is a pragmatic trial involving implementation of QualityRights at six public mental health services chosen by the Government of Gujarat. For comparison, we identified three other public mental health services in Gujarat that did not receive the QualityRights intervention. Results Over a 12-month period, the quality of services provided by those services receiving the QualityRights intervention improved significantly. Staff in these services showed substantially improved attitudes towards service users (effect sizes 0.50–0.17), and service users reported feeling significantly more empowered (effect size 0.07) and satisfied with the services offered (effect size 0.09). Caregivers at the intervention services also reported a moderately reduced burden of care (effect size 0.15). Conclusions To date, some countries are hesitant to reforming mental health services in line with the CRPD, which is partially attributable to a lack of knowledge and understanding about how this can be achieved. This evaluation shows that QualityRights can be effectively implemented even in resource-constrained settings and has a significant impact on the quality of mental health services. Declaration of interest None.

The holistic policy and intervention framework for global mental health reflects an iterative learning process that can be applied and scaled up across different settings through appropriate modifications.

The paper presents a theoretical exercise regarding health care evaluation in an effort to define several concepts. The multi-dimensional aspects of quality in health are emphasized in addition to the differences between quality evaluation and qualitative evaluation. The implications of not distinguishing between these two concepts are also discussed. Health care is analyzed as a material expression of interpersonal relations in this field and as an object of evaluation, highlighting its intricate relation with integrality and humanization. It is affirmed that quality evaluation and qualitative evaluation are not interchangeable labels, but rather political choices connected to health policies that can not be juxtaposed. Therefore, understanding this distinction is necessary for constructing evaluation proposals that surpass traditional and exclusionary perspectives.

This manuscript is aimed at discussing the plural nature of the main conceptual, theoretical and methodological features of the social representations in their various manifestations. As a base to discuss the topics, we used the main texts that amalgamated the vision of the main researchers of psychology, sociology and nursing. According to Moscovici, social representations correspond to acts of thoughts in which subjects relate to the object, and that object through some process is replaced by symbols, turning it into a representation in the subject's mind. This process involves different mechanisms of contextualization, processing, construction and interpretation by sociocultural and linguistic aspects. In the transdisciplinary perspective, social representations emerge as a multidimensional field that permits questioning the nature of knowledge and the relationship individual-society, implanted in the main post-modern epistemological currents. ASPECTOS TEÓRICOS E METODOLÓGICOS DAS REPRESENTAÇÕES SOCIAISRESUMO: Este estudo convida a refletir sobre a natureza plural dos principais aspectos conceituais, teóricos e metodológicos das representações sociais nas suas diferentes manifestações. Utilizaram-se como base para discussão dos tópicos os principais textos que amalgamam a visão de pesquisadores reconhecidos na Psicologia, Sociologia e Enfermagem. Segundo Moscovici, as representações sociais correspondem a atos de pensamento nos quais os sujeitos se relacionam com o objeto e diante vários mecanismos esse objeto é substituído por símbolos, fazendo com que ele seja representado na mente do sujeito. Esse processo de representação implica diferentes processos de contextualização, transformação, construção e interpretação mediados por aspectos socioculturais e linguísticos. Na perspectiva transdisciplinar, as representações sociais emergem como um campo multidimensional que possibilita questionar a natureza do conhecimento e a relação indivíduo-sociedade, inserindo-se nas principais correntes epistemológicas pós-modernas para criar entidades operativas de comunicação e atuação cotidiana. DESCRITORES:Representações sociais. Psicologia social. Pesquisa. Conhecimento epistemológico. ASPECTOS TEÓRICOS Y METODÓLOGICOS DE LAS REPRESENTACIONES SOCIALESRESUMEN: Este manuscrito invita a discutir la naturaleza plural de los principales aspectos conceptuales, teóricos y metodológicos de las representaciones sociales en sus diferentes manifestaciones. Se utilizaron como base para la discusión de los tópicos los principales textos que amalgaman la visión de investigadores reconocidos de la Psicología, Sociología y Enfermería. Según Moscovici, las representaciones sociales corresponden a actos de pensamientos en los cuales los sujetos se relacionan con el objeto, y mediante algunos mecanismos ese objeto es substituido por símbolos, transformándolo en representación en la mente del sujeto. Ese proceso de representación implica diferentes procesos de contextualización, transformación, construcción e interpretación media...