Table 1.
Author year country | Target | Level | Rationale | Theory base | Contents | Hours | Methods | Trainers |
---|---|---|---|---|---|---|---|---|
Allen et al. (2013) Australia | Nursing students | Interpersonal | Nurses are not able to directly overcome many structural barriers to health, such as poverty and low socio-economic status. However, nurses are able to provide culturally appropriate anti-discriminatory health care and understand the complex effects of the social determinants of health | Social constructivist model of health, (Baum, 2011) theory of transcultural nursing (Leininger & McFarland, 2002) | Knowledge on stigma and social conditionings of health, anti-stigma project, advocacy skills, direct contact (clinical placement). | 72 h | Self-reflection, class discussion, small group discussion, case-scenarios, written assignment, clinical placement. | Faculty |
Bakshi et al. (2015), USA | Medical students | Structural | Prioritizes engagement with local underserved communities, focusing on collaborations with community-based organizations Aims to equip the next generation of physicians with the ideals, peer support, knowledge, and skills to help eliminate health inequities through systems-level change |
Social justice as defined by American Board of Internal Medicine | Human rights knowledge, condition knowledge, social justice knowledge, advocacy skills, career development knowledge, research skills. | 8 weeks | Interactive lecture, class discussion, mentorship, personal projects (research and advocacy), practical experience (clinical rotation) | Faculty, expert speakers, older students |
Boutain (2008) USA | Nursing students | Structural | The commitment to social justice is core in the nursing field There is a lack of evaluation of social justice in practice – there is a need for a tool to do so |
Social justice | Social justice knowledge, advocacy skills, direct contact. | Not reported | Interactive lecture, essay writing, practical experience, self-reflection | Faculty |
Burdett et al. (2010) UK | Nursing students | Interpersonal | Not reported | “Old people champion” program | Knowledge on stigma. Direct contact (speaker), indirect contact (video), advocacy skills, anti-stigma interventions. | 6 hours | Simulation, case- scenario, small group discussions, poster presentation, video. | Trained faculty |
O’Carroll and O’Reilly (2019) UK | GP | Interpersonal | It has been established that GPs who work with deprived or marginalised populations require context-specific knowledge and skills appropriate to the morbidity and mortality profile of those populations and that current medical education programmes fail to address these educational needs | Allport′s contact theory (Allport, 1954) | Knowledge on social determinants of health and trauma informed care. Self- care skills, direct contact (clinical placement), identify own bias skill, advocacy skills, recognize stigma. | 128 h | Clinical placement, self- reflection, interactive lectures, theatre workshop, class discussion. | North Dublin GP training programme staff |
Crawford et al. (2017) Australia | Occupational therapy students | Interpersonal, Structural | Client groups seen by occupational therapists do not have their rights fulfilled Occupational therapists require knowledge and confidence regarding human rights if they are to work effectively Occupational therapists can, and should, drive social change |
Human rights (Hocking et al., 2021) | Human rights knowledge, Communication skills (including social media), cultural competence knowledge, advocacy skills, personal project. |
13 wk | Interactive lecture, self-reflection, case-scenarios, anti-stigma project. | Faculty |
DallaPiazza et al. (2018) USA | Medical students | Interpersonal | Teaching medical professionals about structural racism and how to recognize and address bias in clinical encounters has become increasingly imperative. | Jones Tripartite Model of Racism (Jones, 2000) | Knowledge on stigma, social determinants of health and trauma-informed care. Skills to address stigma, mnemonic frameworks to address personal unconscious bias and external microaggressions | 11 h | Interactive lecture, small group case-based discussion, self-reflection, brainstorm, video | Faculty, student peers guided discussions |
Delashmutt and Rankin (2005) USA | Nursing students | Interpersonal, structural | To be effective care givers, nurses must have an understanding of the complex nature of poverty, especially the multifaceted health challenges faced by the poor. | Empowerment | Knowledge on stigma, human rights and legislation. Direct (clinical placement, speaker), indirect contact (video) identify self-bias skill, advocacy skills. | 32 h | Class discussion, interactive lectures, self-reflection, written assignment, video, clinical placement. | Faculty |
Dharamsi et al. (2010) Canada | Medical students | Structural | Students should respond to the broader determinants of health by linking core concepts from the humanities and social sciences with the clinical and basic sciences. Help students appreciate first-hand the impact of social determinants on health outcomes |
Canadian Medical Education Directions for Specialists (CanMEDS) health advocate role | Social determinants of health, applied advocacy skills | 8 wk | Practical experience (over-seas placement), personal project, essay writing, self-reflection (reflective journal) | Faculty and clinical staff |
Ezedinachi et al. (2002) Nigeria | Health workers at general hospital | Interpersonal | Health professionals should take the lead in the protection of human rights Addresses issues of stigmatization and human rights as integral to appropriate care of people with HIV disease, and the link between stigma and HIV |
Not reported | HIV information, stigma knowledge, human rights knowledge. | 2 d | Interactive lectures, role plays, small group discussion, group discussions, videos. | Experts, influential role models trained in initial workshops. |
Fisher et al. (2017) USA | Social workers | Interpersonal | Not reported | Biopsychosocial factors under racism. Interracial interaction (Kratzke & Bertolo, 2013; Sue et al., 2009) microaggressions (Boysen, 2012) | Knowledge on stigma and biopsychosocial model of health. Anti- stigma skill. | 3 h | Small group discussion, class discussion, role play, brainstorming | Multiracial facilitators |
Fisher-Borne (2009) USA | Health care professional (Disease intervention specialist) | Interpersonal | A key strategy in addressing health disparities is promoting cultural competency among health professionals. | Theory of cultural humility, Campinha-Bacote model of cultural competence (Campinha-Bacote, 1999) | Knowledge on race, MSM/LGBT, cultural competence and stigma. Identify own bias, advocacy skills, communication skills, indirect contact (video), direct contact (speaker). Resource manual with LGBT specific local and state-wide resources |
16 h | Role playing, case-scenarios, brainstorm, self-reflection, dynamic, paired-sharing. | Project STYLE staff |
Flatt-Fultz and Phillips (2012) USA | Healthcare professional working with people with intellectual disabilities | Interpersonal | Empowerment is the first important step for agencies that support people with intellectual and developmental disabilities. Training focused explicitly on empowerment was not investigated before | Cattaneo and Chapman empowerment (Cattaneo & Chapman, 2010) | Indirect contact (video) | 0.5 h | Video, group discussion. | Not reported |
Geibel et al. (2017) Bangladesh | Healthcare professional working in sexual and reproductive health and rights | Interpersonal | Working with health providers to reduce stigma and discrimination in the healthcare setting is one strategy to improve service utilization and quality of care | Not reported | Knowledge on stigma, human rights and HIV. Advocacy skills at an interpersonal and structural level. | 24 h | Interactive lecture, group discussion, self-reflection, use of pictures, game, role-play, personal project. | Specialized trainers (Link up project) |
Gonzalez et al (2015) USA | Medical students | Interpersonal, Structural | Curricula which instructs students on reducing health disparities both within clinical practice and within their communities. Promote medical students’ awareness of their own potential to contribute to health disparities and to provide them with clinical and advocacy skills to reduce systemic causes of health disparities. |
Not reported | Anti-stigma project, advocacy skills, health disparities knowledge, social determinants of health knowledge, implicit bias knowledge (IAT test), communication skills, Advocacy skills (strategic planning, grassroots organizing, meeting with legislators, and media communications) |
19.5 h | Interactive lectures, group discussions, role play, small group discussion, case scenarios, personal project. | Faculty |
Gonzalez et al. (2020) USA | Medical students | Interpersonal | Curricula usually emphasize increase awareness of implicit bias but don’t provide opportunities for skill development and practice. | Conceptual framework by Teal and colleagues explaining individual’s progression through various stages related to IBRM (Teal et al., 2010)Transformative learning theory. | Implicit bias knowledge, implicit bias recognition skills, communication skills, advocacy skills, address biased comments skills in clinical and teaching encounters, skills to manage own bias. | 13.5 h | Interactive lecture, contact, videos of popular culture, write personal narratives, self-reflection on students own implicit bias and lived experience, race implicit association test, debrief, case-scenarios, recorded role-play with “do-over”, brainstorm. | Not reported |
Griffith and Kohrt (2016) USA | Psychiatry residents | Interpersonal | Not reported | Social psychology and social neuroscience | Knowledge on stigma and recovery. Anti-stigma project, skill aid coping with stigma skill, framework for anti-stigma strategies. | 12 h | Small group discussion, interactive lectures, case- scenarios, role-play, readings, games | Faculty |
İnan et al. (2018) Turkey | Nursing students | Interpersonal | Nurses who are in contact with patients, their relatives, and other members of society have the opportunity to be role models for creating positive attitudes. | Not reported | Knowledge on mental illness and stigma. Direct contact (placement, visit) and indirect contact (video). Anti-stigma campaign. Skills on communication and aiding in coping with stigma. | 32 h | Group discussion, interactive lectures, personal project, videos, article review. Clinical placement and observership | Faculty and stigma expert |
Jindal et al. (2022) USA | Pediatric residents | Interpersonal, structural | Medical education should build provider knowledge and capacity to address racism. | Not reported | Self-reflection and implicit bias, historical trauma, structural racism, | 1 h | Interactive lecture, group discussion, role-playing | Faculty |
Jones and Smith (2014) USA | Nursing students | Structural | The American Association of Colleges of Nursing (2008) states that advocacy “is a fundamental aspect of nursing practice”. Preparing nurses for leadership in areas of advocacy and policy development allows them to develop a vision for how nurses contribute to creating healthy communities. | Not reported | Knowledge on health disparities, human rights, social justice and marginalized populations. Advocacy skills. Assignment on advocate for current issue affecting vulnerable population (policy statement). Indirect contact (video) | Nor reported | Group discussion, interactive lecture, class presentation of assignment, video | Faculty |
Knaak (2018) Canada | Nurses in general hospitals | Interpersonal, Structural | Healthcare professionals can be stigmatizing Healthcare professionals report that they lack the skills to help someone with a mental health issue, which also contributes to stigma. |
Not reported | Stigma knowledge, strategies to address stigma, recovery model knowledge, social determinants of health knowledge, advocacy skills. | Not reported | Self-reflection, case-scenarios, web-based. | Not reported |
Lax et al. (2019) USA | Residents | Interpersonal, Structural | Needs assessment showed that healthcare professionals do not know how to address social determinants of health Pilot study: Implementation of an advocacy teaching- module enabled residents to screen for and document social determinants of health consistently |
Health advocacy (Wright et al., 2005) | Advocacy skills, framework, community resources, legislative knowledge. | Not reported | Case-scenarios, interactive lectures, class discussion, case-scenarios, interactive lectures, small group discussion, practical experience. | Faculty-resident pair. Experts speaker guests. |
Li et al. (2013) China | Health care professional in general hospital | Interpersonal, structural | Stigma in the general population has been well‐documented, but its impact is also felt in healthcare settings, where it can lead to testing avoidance, barriers to health counselling and a lack of adherence to antiretroviral therapies. | Not reported | Knowledge on HIV and stigma, indirect contact (video), communication skills, advocacy skills, identify bias. | 10.5 h | Group discussion, games, role- playing, pair-sharing, demonstrating, case- scenarios, video. | Trained local health educators, AIDS specialists, project staff |
Li et al. (2015) China | Community mental health staff | Interpersonal | Interventions are needed to address the stigma of mental healthcare professionals | Not reported | Condition knowledge, public health knowledge, stigma knowledge, legislative knowledge, rehabilitation knowledge. | 14 d | Clinical practice, interactive lectures. | Not reported |
Mason and Miller (2006) USA | Social work students | Interpersonal | Students need an in-depth under- standing of mental health disorders so they may provide balanced and focused treatment for each client’s unique abilities and growth potential. | Not reported | Knowledge on stigma. Indirect contact (video), direct contact (clinical placement in group and individual sessions targeting auto-stigma with patients), skills to aid coping with stigma, recognize own bias, social isolation. | Not reported | Interactive lecture, role play, group discussion, educational videos, clinical placement. | Faculty |
McAllister (2008) Australia | Nursing students | Interpersonal | Clinicians need cultural and social skills to influence public opinion, enhance tolerance, deepen understanding, explode myths, and work to effect social change. critical literacy is an important cognitive skill, effective in raising consciousness about inequity and injustice. | Critical literacy | Knowledge on mental health, social justice, and stigma. Skills on advocacy and critical literacy, indirect contact (video), framework for critical literacy | 120 h | Interactive lectures, readings, video, textual analysis of different sources (musical representations, film, news). | Faculty |
Nelson et al. (2015) USA | Medical residents | interpersonal | Physicians receive little to no training on the topic of race and racism, yet this is one of the largest barriers to health equity. | Not reported | Knowledge on stigma. Advocacy skills, identify own bias skill. Framework ("interrupt and educate") for addressing racism, commitment to address racism. | 6 h | Group discussion, interactive lectures, video. | Faculty |
Potts et al. (2022) UK | Medical residents | Interpersonal | Healthcare professionals should be a main target of anti-stigma campaigns as they can be highly stigmatizing towards their patients, however healthcare professionals could also be those who aid anti-stigma efforts | Recovery oriented | Knowledge on stigma, anti-stigma skills, direct (speaker) | 2.5 h | Interactive lecture, group discussion, video | Psychiatrist, people with lived experience |
Üstün and İnan (2018) Turkey | Nursing students | Interpersonal, systemic | Knowledge transmission on stigma is not enough, there is a need to use different educational methods to raise awareness and impart change. | Not reported | Anti-stigma project, stigma knowledge, identify own bias skills. | 16 h | Personal project, class discussion, video, interactive lectures, case-scenario, brainstorm | Not reported |
Shah et al. (2014) India | Nursing students | Interpersonal | Across multiple studies, stigma toward PLHIV has been found to be high among health care workers, including nurses and ward attendant | Not reported | Knowledge on HIV and stigma. Direct contact (speaker), strategies to decrease stigmatizing behaviours in hospital. | 2 h | Interactive lecture, brainstorm, group discussion. | 4th year medical student, PLHA |
Sheely-Moore and Kooyman (2011) USA | Mental health students | Interpersonal, structural | It is imperative for counsellor educators and trainers of mental health professionals to infuse instructional strategies that promote multicultural and social justice competencies for trainees. | Multicultural competences (Arredondo et al., 1996). Lee’s (2018) model of self- exploration for social justice. | Knowledge on stigma, anti-stigma project, direct contact (visits), advocacy skills, identify own stigma. | Not reported | Class discussion, self- reflection, modelling, case scenarios, role play, simulation, videos, obervership. | Faculty |
Sherman et al. (2019) USA | Family medicine residents | Interpersonal, structural | There is a need for a health professionals curriculum that will move beyond simply identifying implicit biases through self-reflection to (a) provide insight into how such insidious biases perpetuate institutional inequities and potentially exacerbate structural racism, and (b) empower health care professionals with skills for managing instances of racism and other implicit biases in their professional lives. | Not reported | Knowledge on race-culture, stigma and implicit bias. Emotion regulation skills, commitment, self bias recognition skill, tools to address barriers for health care. | 1.5 h | Interactive lectures, group discussion, self-reflection, video. | National experts on implicit bias |
Sukhera et al. (2020) Canada | Health professionals | Interpersonal | Traditional stigma reduction education programs often fail to confront the implicit nature of stigmatizing attitudes. | Implicit bias | Knowledge on stigma. Communication skills, identify own bias skills, “facilitating awareness through dissonance” dynamic. | 4 h | Interactive lecture, group discussion, small group discussion, role play, case-scenario, self-reflection, debrief | Physician and nurse facilitator |
Tucker et al. (2020) USA | Medicine students | Interpersonal | It is key to understand the impact of mental illness on individuals and their families and increase patient-centered and collaborative care in emergency and routine practice settings | Not reported | Understanding the experience of mental illness, supporting predictable emotions and needs, empathy’s role in effective treatment, psychological elements of collaborative care, and applying collaborative treatment principles | 15 h | Interactive lecture | It is led by a team of three trained facilitators, as follows: (1) a person living well in recovery from SMI, (2) a family member of someone with SMI, and (3) a healthcare provider with personal or family experience with SMI. |
Uys et al. (2009) Lesotho, Malawi, S. Africa, Swaziland Tanzania | Nurses | Interpersonal | Not reported | Empowerment by Cross and Choudhary (Cross & Choudhary, 2005) | Knowledge on stigma, anti-stigma project, direct contact (develop project together), aid coping with stigma skills, advocacy skills | 24 h | Group discussion, interactive lectures, person project | Nurse, PWLA |
Wagaman et al. (2019) USA | Social work students | Interpersonal, structural | Transformational models of teaching and learning are needed to explore and expand the preparation of students to address race and racism in practice | Critical race theory (Abrams & Moio, 2009) , liberation theory (Brigham, 1977) | Knowledge on stigma and social justice. Recognize own bias, direct contact (community visit), advocacy skill, commitment, resources to extend work in community. | 8 h | Interactive lecture, small group discussion, brainstorm, self-reflection, group discussion, observership. | Community worker |
Webb and Sergison, (2003) UK | Health care and social worker in child health services | Interpersonal | Not reported | Not reported | Knowledge on race and stigma. Empathy skills, communication skills, indirect contact (video). | 8 h | Case scenarios, videos, interactive lectures, group discussion. | Multidisciplinary group, experts in antidiscrimination |
Werkmeister Rozas and Garran (2016) USA | Social work students | Interpersonal, structural | Recently, in the USA, there have been more concerted efforts to infuse human rights throughout social work curricula and, as a result, there is a call for ways to evaluate and/or measure student outcomes | Not reported | Knowledge on stigma, advocacy skills, anti-racism project, identify stigma skills | Not reported | Interactive lectures, class discussion | Faculty |
White-Davis et al. (2018) USA | Healthcare professionals | Interpersonal | While teaching health care professionals about racism reduces biases, few curricula. for medical education exist. | Jones Tripartite Model of Racism (Jones, 2000) | Knowledge on stigma. Anti-racism commitment. Toolkit for exploring racism. | 1.5 h | Interactive lecture, small group discussion, case-scenario, group discussion, video | Multicultural health faculty (multiracial, multidisciplinary team) |
Wu et al. (2019) USA | Healthcare professionals of various settings | Interpersonal structural | Even if individual health care professionals are knowledgeable, institutional support is needed to facilitate constructive discourse and enact broad change. Without foundational knowledge and institutional policies, trainees and providers can be subject to a “silent curriculum” of the health care system, in which biased behaviours and values are internalized and perpetuated | Anti-oppressive practice (Larson, 2008) social justice (Sensoy & DiAngelo, 2012) Jones Tripartite Model of Racism (Jones, 2000) | Stigma knowledge, advocacy skills, identify own bias skill, compassion, emotion regulation skill, anti-racism commitment. Step up/step back framework for addressing racism. | 3 h | Small group discussion, interactive lectures, group discussion, brainstorm, case- scenarios, self-reflection, interactive activities | 2 authors |
Zäske et al. (2014) Germany | Mental health providers at psychiatric hospital | Interpersonal | There is a strong power dynamic between psychiatric staff and patients. Which may lead to high levels of institutional stigma. It is important to work with psychiatric staff as they can become role models both within and outside of their institution when it comes to detecting and addressing stigma | Not reported | Knowledge on stigma and professional role, direct contact (speaker), anti-stigma skills. | 16 h | Role playing, group discussion, interactive lectures, short- essay writing. | Trainer experienced in education and people with lived experience |