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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.
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.
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.
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2. Link BG, Phelan JC: Conceptualizing stigma. Annu Rev Sociol 2001;27:363–85.
3. Kassam A, Papish A, Modgill G, Patten S. The development and psychometric properties of a new scale to measure mental illness related stigma by healthcare providers: The Opening Minds Scale for Healthcare Providers (OMS-HC). BMC Psychiat 2012;12:62. Available at: http://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-12-62.
4. Abbey S, Charbonneau M, Tranulis C, Moss P, et al. Stigma and discrimination. Can J Psychiatr 2012;56(10):1–9.
5. Knaak S, Ungar T, Patten S. Mental illness stigma as a quality of care problem. Lancet Psychiatr 2015;2:863–4.
6. Knaak S, Mantler E, Szeto A. Mental illness-related stigma in healthcare: Barriers to access and care and evidence-based solutions. Healthc Manag Forum 2017 (in press).
7. Henderson C, Noblett J, Parke H, et al. Mental health-related stigma in healthcare and mental health-care settings. Lancet Psychiatr 2014;1:467–82. Available at: https://www.ncbi.nlm.nih.gov/pubmed/26361202.
8. Stuart H, Arboleda-Flórez J, Santorius N. Paradigms lost: Fighting stigma and the lessons learned. New York: Oxford University Press; 2012.
9. Thornicroft G, Rose D, Kassam A. Discrimination in health care against people with mental illness. International Rev Psychiatr 2007;19(2):113–22.
10. Corrigan P, Druss B, Perlick D. the impact of mental illness stigma on seeking and participating in mental health care. Psychol Sci Public Interest 2014;15:37–70. DOI: 10.1177/1529100614531398. Available at : http://journals.sagepub.com/doi/pdf/10.1177/1529100614531398.
11. Jones S, Howard L, Thornicroft G. ‘Diagnostic overshadowing:’ worse physical care for people with mental illness. Acta Psychiatr Scand 2008;118:169–71.
12. Ross C, Goldner E. Stigma, negative attitudes and discrimination towards mental illness within the nursing profession: A review of the literature. J Psychiatr Health Nurs 2009;16:558–67. Available at: https://wisewisconsin.org/wp-content/uploads/Stigma-in-Nursing.pdf.
13. Schulze, B. Stigma and mental health professionals: A review of the evidence on an intricate relationship. Internat Rev Psychiatr 2007;19(2):137–55.
14. Wallace JE. Mental health and stigma in the medical profession. Health 2012;16:3. DOI: 10.1177/1363459310371080.
15. Adams EF, Lee AJ, Pritchard CW, et al. What stops us from healing the healers: A survey of help-seeking behavior, stigmatisation and depression within the medical profession. Int J Soc Psychiatr 2010;56(4):359–70.
16. Knaak S, Karpa J, Robinson R, Bradley L. They are us - we are them’: Transformative learning though nursing education leadership. Healthc Manag Forum 2016;May:1–5. DOI: 10.1177/0840470416628880. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4853810/.
17. Horsfall J, Cleary M, Hunt G. Stigma in mental health: clients and professionals, Iss Mental Health Nurs 2010;31:450–55.
18. Modgill G, Patten SB, Knaak S, Kassam A, Szeto AC. Opening minds stigma scale for healthcare providers (OMS-HC): examination of psychometric properties and responsiveness. BMC Psychiatr 2014;14(1):120. Available at : http://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-14-120.
19. Stuart H, Chen SP, Christie R, Dobson K, et al. Opening minds in Canada: Background and rationale. Can J Psychiatr 2014;59(10 Suppl 1):S8–S12. Available at: https://www.ncbi.nlm.nih.gov/pubmed/25565705.
20. Stuart H, Chen SP, Christie R, Dobson K, et al. Opening minds in Canada: Targeting change. Can J Psychiatr 2014;59(10 Suppl 1):S13–S18. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4213747/.
21. Knaak S, Modgill G, Patten S. Key ingredients of anti-stigma programs for health care providers: A data synthesis of evaluative studies. Can J Psychiatr 2014;59(10 Suppl 1):S19–S28. Available at: https://www.ncbi.nlm.nih.gov/pubmed/25565698.
22. Knaak S, Patten S. A grounded theory model for reducing stigma in health professionals in Canada. Acta Psychiatr Scand 2016: 134(Suppl.446):53–62. DOI: 10.1111/acps.12612.
23. Corrigan P, Morris S, Michaels P, Rafacz J, Rüsch N. Challenging the public stigma of mental illness: A meta-analysis of outcome studies. Psychiatr Serv 2012;63:963–73. Available at: https://wisewisconsin.org/wp-content/uploads/Corrigan-et-al.-Challenging-the-Public-Stigma-of-Mental-Illness-A-Meta-Analysis-of-Outcome-Studies.pdf.
24. Maranzan KA. Interprofessional education in mental health: An opportunity to reduce mental illness stigma. J Interprof Care 2016 30:370–77. DOI: 10.3109/13561820.2016.1146878.
25. Pettigrew T, Tropp L. A meta-analytic test of intergroup contact theory. J Personalit Soc Psychol 2009;90:751–83.
26. Agrawal S, Capponi P, López J, et al. From surviving to advising: A novel course pairing mental health and addictions service users as advisors to senior psychiatry residents. Acad Psychiatr 2016;40:475. DOI:10.1007/s40596-016-0533-z.
27. Ungar T, Knaak S, Szeto A. Theoretical and practical considerations for combating mental illness stigma in healthcare. Communit Mental Health J 2015;51(5). (DOI) 10.1007/s10597-015-9910-4. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4805707/.
28. Kassam A, Patten S. Quantitative analysis of the ‘Mental Illness and Addictions: Understanding the Impact of Stigma’ Program. Calgary: Mental Health Commission of Canada; 2011. Available at: http://www.mentalhealthcommission.ca/English/initiatives/11874/opening-minds.
29. Szeto A and Hamer A. Central LHIN Phase 2 Report. Calgary: Mental Health Commission of Canada; 2013. Available at: http://www.mentalhealthcommission.ca/English/initiatives/11874/opening-minds.
30. Kassam A, Papish A, Modgill G, Patten S. The development and psychometric properties of a new scale to measure mental illness related stigma by healthcare providers: The Opening Minds Scale for Healthcare Providers (OMS-HC). BMC Psychiatr 2012;12:62. Available at: http://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-12-62.
31. Kopp B, Knaak S, Patten S. Evaluation of IWK’s ‘Understanding the Impact of Stigma’ Program. Calgary, AB: Mental Health Commission of Canada; 2013. Available at: http://www.mentalhealthcommission.ca/English/initiatives/11874/opening-minds.
32. Knaak S, Potts A, Patten S. Lakeridge Health Opening Minds Evaluation Report. Calgary AB: Mental Health Commission of Canada; 2012. Available at: http://www.mentalhealthcommission.ca/English/initiatives/11874/opening-minds.
33. Stata Corporation. Stata (version 12). College Station, TX; 2012.
34. Knaak S, Hawke L, Patten S. That’s Just Crazy Talk Evaluation Report. Calgary, AB: Mental Health Commission of Canada; 2013. Available at: http://www.mentalhealthcommission.ca/English/initiatives/11874/opening-minds.
35. Knaak S, Patten S. North Bay Mental Health Orientation with PhotoVOICE: Evaluation Report. Calgary: Mental Health Commission of Canada; 2013. Available at: http://www.mentalhealthcommission.ca/English/initiatives/11874/opening-minds.
36. Knaak S, Szeto ACH, Fitch K, Modgill G, Patten S. Stigma towards borderline personality disorder: effectiveness and generalizability of an anti-stigma program for healthcare providers using a pre-post randomized design. Borderline Personalit Disord Emot Dysreg 2015;2:9. DOI 10.1186/s40479-015-0030-0. Available at: http://pubmedcentralcanada.ca/pmcc/articles/PMC4579503/.
37. Knaak S. Patten S. CBIS Program: Final Evaluation Report. Calgary: Mental Health Commission of Canada; 2013. Available at: http://www.mentalhealthcommission.ca/English/initiatives/11874/opening-minds.
38. Szeto AC and Dobson KS. Reducing the stigma of mental disorders at work: A review of current workplace anti-stigma intervention programs. Appl Prevent Psychol 2010; 14: 41–56.