Evaluation of a Pilot, Community-Led Mental Illness De-stigmatization Theater Intervention in Rural Uganda

Abstract

Background In rural areas of low- and middle- income countries (LMICs), 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 mentally ill individuals. 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. Common misconceptions and points of stigma were identified from these responses, and local village health team personnel (VHTs) 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 (BAS) and Personal Acceptance Scale (PAS), before and after the performance. Results There was a significant increase in acceptance according to the BAS (p < .001) and PAS (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. Conclusions This study shows community-led, theater intervention may be an effective tool for the destigmatization of mental illness in rural areas of Uganda. Further, larger studies are needed to test its effectiveness, and potential for scale up and sustainment.

Community perspectives to inform the development of a radio program to destigmatize mental illness in rural Uganda: a qualitative study

“…This study, and a previously published analysis of the theater intervention from which the radio program was derived, are the first to explore the perspectives of community members exposed to arts programs, whether through radio or in-person theater, designed to reduce mental illness stigma in rural Uganda. 18 This study differs from the theater intervention impact evaluation in its reliance on qualitative methods to explore how the radio program was experienced by its listeners. The richness of the qualitative data provided us with greater insight into how the radio program could potentially yield changes in mental illness stigma and mental health care-seeking behavior.…”

“…The 45-minute radio program was created by adapting a previously-developed community-led theater intervention. 18,19 It was produced by community health workers, known as Village Health Teams (VHTs), who produced the original theater intervention. The radio program describes a man whose symptoms of psychosis initially result in his exclusion from the village until his family helps him obtain treatment at a health center providing mental healthcare, after which he is socially reintegrated into village life.…”

“…Prior research in Uganda showed that a theatrical production, coupled with a brief psychoeducation session, significantly reduced mental illness stigma by portraying a man's journey with psychosis from social exclusion to successful treatment and societal re-integration. 18,19 We sought to adapt this intervention to an audio format for eventual dissemination through radio programming. This adaptation is particularly well-suited for scalability given radio's widespread reach in Uganda, where 78% of the population regularly listens to radio programming.…”