Understanding Stigma: A Pooled Analysis of a National Program Aimed at Health Care Providers to Reduce Stigma towards Patients with a Mental Illness

Abstract

Background and Objective:
 The problem of mental illness-related stigma within healthcare is an area of increasing attention and concern. Understanding Stigma is an anti-stigma workshop for healthcare providers that uses social contact as a core teaching element, along with educational and action-oriented components. The objective of our study was to determine the impact of this program on healthcare providers’ attitudes and behavioural intentions towards patients with a mental illness, and also to ascertain whether various participant and program characteristics affected program outcomes. Our paper reports the results of a pooled analysis from multiple replications of this program in different Canadian jurisdictions between 2013 and 2015.
 Material and Methods:
 We undertook a pooled analysis of six separate replications of the Understanding Stigma program. All program replications were evaluated using a non-randomized quasi experimental pre- post- follow-up design. The Opening Minds Scale for Health Providers (OMS-HC) was used as the main assessment tool. Study-level and individual-level meta-analysis methods were used to synthesize the data. First, the ‘metan’ command was used to show outcomes by study, using a forest plot. Then, a pooled dataset was produced and analyzed using a random intercept linear mixed model approach with each program being modelled as a random effect. Program and participant characteristics were examined as independent variables using this approach. These were each entered individually. Individual tests included pre to post change by program version (original or condensed), by occupation (nurses versus other healthcare providers), by gender, age, and previous diagnosis of a mental illness.
 Results:
 Program effect sizes ranged from .19 to .51 (Cohen’s d), with an overall combined effect size of .30. The results of the mixed model analysis showed the improvement from pre to post intervention was statistically significant for the total scale and subscales. Analysis of program and participant factors found that version type, healthcare provider type, gender, and previous diagnosis of a mental illness were all non-significant factors on program outcomes. A significant inverse association was revealed between increasing age and score change. Results also showed a significant positive linear relationship between baseline score and improvement from pre to post intervention. Maintenance of scores at follow-up was observed for participants who attended a booster session.
 Conclusion: 
 The results are promising for the effectiveness of this brief intervention model for reducing stigmatizing attitudes and improving behavioural intentions among nurses and other healthcare providers.

The Working Mind: A Meta-Analysis of a Workplace Mental Health and Stigma Reduction Program

“…Supplementary materials or booster sessions in this domain may be indicated. 21 Further research that distinguishes among the various dimensions of stigma will also help to discern if cultural change is not a linear process. 22,23 Many of the respondents who provided comments at the follow-up assessment indicated that the program had benefits and that they were using the skills that had been learned.…”

Mental Health Stigma: Explicit and Implicit Attitudes of Canadian Undergraduate Students, Medical School Students, and Psychiatrists

“…This approach has been widely endorsed by researchers and has been shown to be effective. [31][32][33][34][35][36] It is important to note, however, that implicit attitudes are much harder to change and may not be affected by simple contactbased interventions. [37][38][39][40] We found that "disclosure/help-seeking" scores were significantly higher than mean "attitudes toward people with mental illness" scores, similar to previous findings by Kassam et al 21 Negative attitudes towards disclosure and helpseeking can lead to negative consequences and if an individual applies these attitudes to themselves and their behaviour, it could lead to self-stigma.…”

Efficacy of an Intervention to Reduce Stigma Beliefs and Attitudes Among Primary Care and Mental Health Professionals: Two Cluster Randomized-Controlled Trials

“…At the primary care level, many people do not get the treatment they need since many health professionals attribute somatic symptoms to the mental health problems. Cases have been reported in which this "diagnostic overshadowing" has meant that heart attacks could not be detected correctly, or transplantation have been delayed or even denied [12]. In the case of mental health, many people delay coming to these services due to fear of stigma and discrimination [4].…”

“…Although there was some freedom in the format of the interventions, given the vast experience of the recovery and anti-stigma movements in Canada, all used a unified assessment methodology with a unique measurement instrument [11]. A pooled analysis of their impact has shown statistically significant decreases, especially for younger professionals with higher initial levels of stigma [12]. Additionally, through a qualitative analysis, the campaign has produced a synthesis of the six structural ingredients key to the success of such interventions.…”