Impact of Service User Video Presentations on Explicit and Implicit Stigma toward Mental Illness among Medical Students in Nepal: A Randomized Controlled Trial

Tergesen, Cori; Gurung, Dristy; Dhungana, Saraswati; Risal, Ajay; Basel, Prem; Tamrakar, Dipesh; Amatya, Archana; Park, Lawrence P.; Kohrt, Brandon A.

doi:10.3390/ijerph18042143

Cited by 42 publications

(28 citation statements)

References 63 publications

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“…The Implicit Association Test (IAT) 59 is a computer-based implicit measure of stigma adapted for use with stimuli appropriate for Nepali health care clinicians. 60 The mhGAP Knowledge Assessment is a 26-item true-false and multiple-choice test. 61 Clinical competency in common factors of mental health care was evaluated with the Enhancing Assessment of Common Therapeutic Factors (ENACT) tool.…”

Section: Methodsmentioning

confidence: 99%

Collaboration With People With Lived Experience of Mental Illness to Reduce Stigma and Improve Primary Care Services

et al. 2021

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IMPORTANCE Collaboration with people with lived experience of mental illness (PWLE), also referred to as service users, is a growing priority to reduce stigma and improve mental health care. OBJECTIVE To examine feasibility and acceptability of conducting an antistigma intervention in collaboration with PWLE during mental health training of primary care practitioners (PCPs). DESIGN, SETTING, AND PARTICIPANTSThis pilot cluster randomized clinical trial was conducted from February 7, 2016, to August 10, 2018, with assessors, PCPs, and patients blinded to group assignment. The participants were PCPs and primary care patients diagnosed with depression, psychosis, or alcohol use disorder at primary care facilities (the cluster unit of randomization) in Nepal. Statistical analysis was performed from February 2020 to February 2021. INTERVENTIONS In the control group, PCPs were trained on the World Health Organization Mental Health Gap Action Programme-Intervention Guide (mhGAP-IG). In the Reducing Stigma Among Healthcare Providers (RESHAPE) group, the mhGAP-IG trainings for PCPs were cofacilitated by PWLE who presented recovery testimonials through photographic narratives. MAIN OUTCOMES AND MEASURES Prespecified feasibility and acceptability measures were adequacy of randomization, retention rates, intervention fidelity, data missingness, and safety. Outcome measures for PCPs included the Social Distance Scale (SDS), accuracy of diagnoses of mental illness in standardized role-plays using the Enhancing Assessment of Common Therapeutic factors tool (ENACT), and accuracy of diagnosis with actual patients. The primary end point was 16 months posttraining. RESULTS Among the overall sample of 88 PCPs, 75 (85.2%) were men and 67 (76.1%) were upper caste Hindus; the mean (SD) age was 36.2 (8.8) years. Nine of the PCPs (10.2%) were physicians, whereas the remaining 79 PCPs (89.8%) were health assistants or auxiliary health workers. Thirtyfour facilities were randomized to RESHAPE or the control group. All eligible PCPs participated: 43 in RESHAPE and 45 in the control group, with 76.7% (n = 33) and 73.3% (n = 33) retention at end line, respectively. Due to PCP dropout, 29 facilities (85.3%) were included in end line analysis. Of 15 PWLE trained as cofacilitators, 11 (73.3%) participated throughout the 3 months of PCP trainings. Among PCPs, mean SDS changes from pretraining to 16 months were −10.6 points (95% CI, −14.5 to −6.74 points) in RESHAPE and −2.79 points (−8.29 to 2.70 points) in the control group. Role-play-based diagnoses with ENACT were 78.1% (25 of 32) accurate in RESHAPE and 66.7% (22 of 33) in the control group. Patient diagnoses were 72.5% (29 of 40) accurate by PCPs in RESHAPE compared with 34.5% (10 of 29) by PCPs in the control group. There were no serious adverse events.(continued) Key Points Question Does involvement of people with lived experience of mental illness in cofacilitation of trainings for primary care practitioners reduce stigma and improve mental health services? Findings In this pilot cluster r...

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Section: Methodsmentioning

confidence: 99%

Collaboration With People With Lived Experience of Mental Illness to Reduce Stigma and Improve Primary Care Services

et al. 2021

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“…In one recent study, testimony from patients who benefited from treatment for mental illness reduced stigma among medical students. Such approaches could help improve the likelihood and quality of mental healthcare delivery [6].…”

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Choosing appropriate language to reduce the stigma around mental illness and substance use disorders

Volkow

Gordon

Koob

2021

Neuropsychopharmacol.

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“…In-person testimonials from PWLEs in RESHAPE may encourage PCPs to listen to and spend more time with their patients to build rapport. Notably, the personal testimonials appear to only be effective in changing attitudes across different types of mental illnesses when performed in-person; in an RCT performed in Nepal with video-taped testimonials from PWLEs, there were mixed results, with stigma worsening for video testimonials of people living with psychosis [ 48 ].…”

Section: Discussionmentioning

confidence: 99%

Treatment Preferences for Pharmacological versus Psychological Interventions among Primary Care Providers in Nepal: Mixed Methods Analysis of a Pilot Cluster Randomized Controlled Trial

Bhardwaj

Gurung

Rai

et al. 2022

IJERPH

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There is increasing evidence supporting the effectiveness of psychological interventions in low- and middle-income countries. However, primary care providers (PCPs) may prefer treating patients with medication. A secondary exploratory analysis of a pilot cluster randomized controlled trial was conducted to evaluate psychological vs. pharmacological treatment preferences among PCPs. Thirty-four health facilities, including 205 PCPs, participated in the study, with PCPs in 17 facilities assigned to a standard version of the mental health Gap Action Programme (mhGAP) training delivered by mental health specialists. PCPs in the other 17 facilities received mhGAP instruction delivered by specialists and people with lived experience of mental illness (PWLE), using a training strategy entitled Reducing Stigma among HealthcAre ProvidErs (RESHAPE). Pre- and post- intervention attitudes were measured through quantitative and qualitative tools. Qualitative interviews with 49 participants revealed that PCPs in both arms endorsed counseling’s benefits and collaboration within the health system to provide counseling. In the RESHAPE arm, PCPs were more likely to increase endorsement of statements such as “depression improves without medication” (F = 9.83, p < 0.001), “not all people with depression must be treated with antidepressants” (χ2 = 17.62, p < 0.001), and “providing counseling to people who have alcohol abuse problems is effective” (χ2 = 26.20, p < 0.001). These mixed-method secondary findings from a pilot trial suggest that in-person participation of PWLE in training PCPs may not only reduce stigma but also increase PCPs’ support of psychological interventions. This requires further investigation in a full-scale trial.

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Impact of Service User Video Presentations on Explicit and Implicit Stigma toward Mental Illness among Medical Students in Nepal: A Randomized Controlled Trial

Cited by 42 publications

References 63 publications

Collaboration With People With Lived Experience of Mental Illness to Reduce Stigma and Improve Primary Care Services

Collaboration With People With Lived Experience of Mental Illness to Reduce Stigma and Improve Primary Care Services

Choosing appropriate language to reduce the stigma around mental illness and substance use disorders

Treatment Preferences for Pharmacological versus Psychological Interventions among Primary Care Providers in Nepal: Mixed Methods Analysis of a Pilot Cluster Randomized Controlled Trial

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