Reducing mental illness stigma in healthcare settings: Proof of concept for a social contact intervention to address what matters most for primary care providers
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Initiatives for integration of mental health services into primary care are underway through the World Health Organization's mental health Gap Action Programme (mhGAP) and related endeavors. However, primary healthcare providers' stigma against persons with mental illness is a barrier to success of these programs. Therefore, interventions are needed to reduce stigma among primary healthcare providers. We developed REducing Stigma among HealthcAre ProvidErs (RESHAPE), a theoretically-grounded intervention that draws upon the medical anthropology conceptual framework of "what matters most." RESHAPE addresses three domains of threats to what matters most: survival, social, and professional. In a proof-of-concept study, mental health service users and aspirational healthcare providers (primary healthcare providers actively incorporating mental health services) were trained to co-facilitate the RESHAPE intervention embedded within mhGAP training in Nepal. Two trainings with the RESHAPE anti-stigma component were held with 41 primary healthcare providers in Nepal. Evaluation of the training included four focus groups and 25 key informant interviews. Stigmatizing attitudes and role play-based clinical competency, assessed with the ENhancing Assessment of Common Therapeutic factors tool (ENACT), were evaluated pre-training and followed-up at four and 16 months. The study was conducted from February 2016 through June 2017. In qualitative interviews, primary healthcare providers described changes in perceptions of violence (survival threats) and the ability to treat mental illness effectively (professional threats). Willingness to interact with a person with mental illness increased from 54% pre-training to 81% at 16 months. Observed clinical competency increased from 49% pre-training to 93% at 16-months. This proof-of-concept study supports reducing stigma by addressing what matters most to healthcare providers, predominantly through mitigating survival and professional threats. Additional efforts are needed to address social threats. These findings support further exploration of service user and aspirational figure involvement in mhGAP trainings based on a "what matters most" conceptual framework.
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Interventions are often enhanced by having task-sharing providers with strong existing community ties and credibility, shared lived experience, and non-stigmatizing attitudes.
“Interventions s are often enhanced by having task-sharing providers with strong existing community ties and credibility, shared lived experience, and non-stigmatizing attitudes [91, 92].”
From Barriers and facilitators to implementation of evidence-based task-sharing mental health interventions in low- and middle-income countries: a systematic review using implementation science frameworks (2022) · cites this paper as [92]
The Methods section (Component 2; page unavailable) describes local primary care providers chosen as role models for their positive attitudes toward service users and quality of care. The intervention also included service users sharing recovery experiences (Methods, Component 1; page unavailable). The paper does not establish that the task-sharing providers had strong existing community ties or shared lived experience, or that these combined attributes often enhance interventions. (LLM, conf=0.84)
Experimental — accuracy not yet measuredInvolvement of individuals with similar lived experience as clients, such as peer support services, is increasingly recognized as a potentially powerful task-sharing strategy to increase acceptability and help clients navigate and resist sources and drivers of stigma.
“In particular, the involvement of individuals with similar lived experience as the clients (e.g., peer support services) is increasingly recognized as a potentially powerful task-sharing strategy to both increase the acceptability of the intervention for clients and help them navigate and resist sources and drivers of stigma [92, 93].”
From Barriers and facilitators to implementation of evidence-based task-sharing mental health interventions in low- and middle-income countries: a systematic review using implementation science frameworks (2022) · cites this paper as [92]
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Experimental — accuracy not yet measuredThe improved knowledge and perspectives regarding stigma among trainees are in line with qualitative and quantitative evidence from other LMICs on the impact of mhGAP-IG training.
“The improved knowledge and perspectives regarding stigma among trainees, which were a main focus of our study, are in line with qualitative and quantitative evidence from other LMICs on the impact of mhGAP-IG training [53–55].”
Based on a mixed qualitative-quantitative analysis of this proof of concept, training mental health patients to provide photographic narratives of recovery has potential to improve knowledge, attitudes and clinical competence of PHC workers in mhGAP training.
“Based on a mixed qualitative–quantitative analysis of this proof concept, this approach has potential to improve knowledge, attitudes and clinical competence of PHC workers in mhGAP training.42”
From Process evaluation of a district mental healthcare plan in Nepal: a mixed-methods case study (2020) · cites this paper as [42]
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- Authors
- Kohrt, B. A., Turner, E. L., Rai, S., Bhardwaj, A., Sikkema, K. J., Adelekun, A., Dhakal, M., Luitel, N. P., Lund, C., Patel, V., & Jordans, M. J. D.
- Affiliations
- Duke University (US)
- University of Washington (US)
- Johns Hopkins University (US)
- University of California, Los Angeles (US)
- University of Cape Town (ZA)
- Harvard University (US)
- King's College London (GB)
- Corresponding author
- Kohrt, Brandon A.
- ORCID
- Venue
- Social Science & Medicine
- Publisher
- Elsevier BV
- Published
- 2020-04
- Volume
- 250
- Pages
- 112852
- ISSN
- 0277-9536 (ISSN-L)
- PMC
- PMC7429294
- OpenAlex
- W3005548587
- Cited by
- 177
- References
- 64
- Citations by year
- 2026: 15 · 2025: 24 · 2024: 20 · 2023: 17 · 2022: 36 · 2021: 20 · 2020: 43 · 2015: 1
- FWCI
- 31.70
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Social Science & Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- UvA-DARE (University of Amsterdam) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- Duke University (Pro00055042)
- Nepal Health Research Council (110/2014, 133/2016)
- George Washington University (051725)
- DFID
- National Institute of Mental Health (K01MH104310)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
- Social Sciences › Psychology › Clinical Psychology › Psychology and Mental Health
- Keywords
- mental health stigma, primary care providers, mental health integration, Mental Health Gap Action Programme, medical anthropology, service user involvement, clinical competence, stigmatizing attitudes, role play
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