A systematic review of multi-level stigma interventions: state of the science and future directions
Open accessAbstract
BACKGROUND: Researchers have long recognized that stigma is a global, multi-level phenomenon requiring intervention approaches that target multiple levels including individual, interpersonal, community, and structural levels. While existing interventions have produced modest reductions in stigma, their full reach and impact remain limited by a nearly exclusive focus targeting only one level of analysis. METHODS: We conducted the first systematic review of original research on multi-level stigma-reduction interventions. We used the following eligibility criteria for inclusion: (1) peer-reviewed, (2) contained original research, (3) published prior to initiation of search on November 30, 2017, (4) evaluated interventions that operated on more than one level, and (5) examined stigma as an outcome. We stratified and analyzed articles by several domains, including whether the research was conducted in a low-, middle-, or high-income country. RESULTS: Twenty-four articles met the inclusion criteria. The articles included a range of countries (low, middle, and high income), stigmatized conditions/populations (e.g., HIV, mental health, leprosy), intervention targets (e.g., people living with a stigmatized condition, health care workers, family, and community members), and stigma reduction strategies (e.g., contact, social marketing, counseling, faith, problem solving), with most using education-based approaches. A total of 12 (50%) articles examined community-level interventions alongside interpersonal and/or intrapersonal levels, but only 1 (4%) combined a structural-level intervention with another level. Of the 24 studies, only 6 (25%) were randomized controlled trials. While most studies (17 of 24) reported statistically significant declines in at least one measure of stigma, fewer than half reported measures of practical significance (i.e., effect size); those that were reported varied widely in magnitude and were typically in the small-to-moderate range. CONCLUSIONS: While there has been progress over the past decade in the development and evaluation of multi-level stigma interventions, much work remains to strengthen and expand this approach. We highlight several opportunities for new research and program development.
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Multi-level stigma interventions are rare.
“Additionally, multi-level stigma interventions are rare [96]”
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- Authors
- Rao, D., Elshafei, A., Nguyen, M., Hatzenbuehler, M. L., Frey, S., & Go, V. F.
- Affiliations
- University of Washington (US)
- University of North Carolina at Chapel Hill (US)
- Columbia University (US)
- Corresponding author
- Rao, Deepa
- Venue
- BMC Medicine
- Published
- 2019-02-15
- Volume
- 17
- Issue
- 1
- Pages
- 41-41
- ISSN
- 1741-7015 (ISSN-L)
- PMC
- PMC6377735
- OpenAlex
- W2919458617
- Cited by
- 331
- References
- 45
- Citations by year
- 2026: 42 · 2025: 45 · 2024: 53 · 2023: 46 · 2022: 58 · 2021: 47 · 2020: 34 · 2019: 6
- FWCI
- 5.56
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Medicine (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (acceptedVersion)
- Columbia Academic Commons (Columbia University)
- Funders
- Fogarty International Center
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Social Sciences › Sociology and Political Science › Social and Intergroup Psychology
- Keywords
- stigma reduction, multilevel interventions, stigma reduction interventions, community-level interventions, interpersonal interventions, structural stigma, HIV stigma, mental health stigma, leprosy stigma, contact interventions, social marketing, healthcare workers, educational intervention, low- and middle-income countries
- MeSH terms
- Humans, Social Stigma
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