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

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Published: Mar 3, 2017
DOI: https://doi.org/10.22374/jmhan.v1i1.19
Keywords:
health care quality, access, and evaluation, health education, mental disorders, meta-analysis, evaluation studies

Main Article Content

Stephanie Knaak
Mental Health Commission of Canada University of Calgary
Andrew C H Szeto
University of Calgary Mental Health Commission of Canada
Aliya Kassam
University of Calgary
Arla Hamer
Mental Health Commission of Canada (MHCC)
Geeta Modgill
Alberta Health Services
Scott Patten
University of Calgary Mental Health Commission of Canada

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.


 

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Article Details

Issue
Vol. 1 No. 1 (2017)
Section
Articles
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Author Biographies

Stephanie Knaak, Mental Health Commission of Canada University of Calgary

Stephanie Knaak, PhD is a Research Associate with Opening Minds at the Mental Health Commission of Canada. Dr Knaak specializes in research on mental illness stigma, including research on key ingredients and best practices associated with combatting stigma in health care environments and among youth. Since 2012, she has written and published widely on the topic of stigma reduction, including more than 12 academic articles on anti-stigma interventions across Canada.

 Previous to her work with the MHCC, Dr. Knaak’s research concentrated on maternal mental health, including the adjustment to motherhood, experiences of postpartum depression, and exploring the connections between modern parenting culture and mental wellbeing. She holds a Ph.D. in Sociology from the University of Alberta. In her free time she blogs for Huffington Post Canada and thisgoldenlife.ca

 

Dr. Knaak is also an assistant progessor (adjunt) in the Deparment of Psychiatry at the University of Calgary

Andrew C H Szeto, University of Calgary Mental Health Commission of Canada

PhD

Director, Mental Health Strategy, Office of the Provost, U of C

Assistant Professor, Department of Psychology, U of C

Aliya Kassam, University of Calgary

PhD, MSc

Assistant Professor, Department of Community Health Sciences

Cumming School of Medicine,  University of Calgary 

Arla Hamer, Mental Health Commission of Canada (MHCC)

MSW, RSM

Consultant to the MHCC

Geeta Modgill, Alberta Health Services

MSc.

Research Associate, Population, Public and Indigenous Health

Alberta Health Services

Scott Patten, University of Calgary Mental Health Commission of Canada

MD, PhD

Professor, Department of Community Health Sciences, Department of Psychiatry, and Mathison Centre for Mental Health Research & Education, University of Calgary

Principal Investor, healthcare programs, Opening Minds, MHCC

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