Table 1.
Multi-level stigma interventions
| Author | Title | Country | Condition | Intervention targets | Strategy/intensity | Levels | Stigma measures | Effectiveness |
|---|---|---|---|---|---|---|---|---|
| 1. Batey, Whitfield, Mulla, Stringer, Durojaiye, McCormick, Turan, Nyblade, Kempf, Turan, 2016 [27] | Adaptation and Implementation of an Intervention to Reduce HIV-Related Stigma Among Healthcare Workers in the United States: Piloting of the FRESH Workshop | US | HIV | 17 health care workers (HCW) 19 People living with HIV (PLWH) |
Education, contact, coping/counseling; 1.5 days |
Intrapersonal Interpersonal |
Multi-country Validated Measures for HCW and PLWH at pre- and post-intervention | Non-significant; CI Not Given; ES Not Given |
| 2. Bhana, Mellins, Petersen, Alicea, Myeza, Holst, Abrams, John, Chhagan, Nestadt, Leu, McKay, 2014 [28] | The VUKA family program: Piloting a family-based psychosocial intervention to promote health and mental health among HIV infected early adolescents in South Africa | South Africa | HIV | 65 adolescents and their caregivers/family | Education, problem solving, communication; 10 sessions over 3 months |
Intrapersonal Interpersonal |
US-Validated Measure of Epilepsy Stigma for Adolescents at pre-, 2 weeks post-intervention, 3 months post-intervention | Non-significant; CI not given; ES not given |
| 3. Bogart, Hemmesch 2016 [29] |
Benefits of support conferences for parents of and people with Moebius syndrome | US | Moebius | 47 People with (PW) Moebius and 48 caregivers/family | Education, contact, social support; 3-day conference | Intrapersonal Interpersonal |
US-Validated Measure of Visible Differences at pre- and post- conference attendance | Non-significant; CI not given; ES d = 0.5 and r = − 0.15 |
| 4. Brown 2009 [18] | Faith-based mental health education: A service-learning opportunity for nursing students | US | Mental illness (MI) | 55 nursing students, 38 community members | Education; 90-min workshop | Interpersonal Community |
Multi-Country Validated Measure of Mental Illness Stigma at pre- and post-workshop | Significant; CI not given; ES d = 0.4 |
| 5. Chidrawi, Greeff, Termane, Doak 2016 [30] | HIV stigma experiences and stigmatisation before and after an intervention | South Africa | HIV | 18 PLWH, 60 caregivers/family | Education, contact, problem solving; 5-month intervention with workshops and group projects | Intrapersonal, Interpersonal |
Multi-country Validated HIV Stigma Measure at pre-intervention and quarterly for 1 year | Significant; CI not given; ES d = 0.11 (caregivers) d = 2.51 (PLWH) |
| 6. Dadun, Van Brakel, Peters, Lusli, Zweekhorst, Bunders, Irwanto 2017 [14] | Impact of socio-economic development, contact and peer counselling on stigma against persons affected by leprosy in Cirebon, Indonesia - a randomized controlled trial | Indonesia | Leprosy | 237 PW leprosy, 213 and 375 community | Contact Socio-economic Coping/counseling; 5 counseling sessions; 2 years with community |
Intrapersonal Interpersonal Community |
Multi-country Validated Leprosy Stigma Scale at pre- and post-intervention | Significant; CI not given; ES d = 1.57 |
| 7. Hawke, Michalak, Maxwell, Parikh 2014 [31] | Reducing stigma toward people with bipolar disorder: impact of a filmed theatrical intervention based on a personal narrative | Canada | MI | 48 PW MI and caregivers/family, 29 community, 60 HCW | Education contact (filmed); 50 min | Intrapersonal Interpersonal Community |
Multi-country Validated Stigma/Social Distance of MI Scales at pre-, post- and 1-month post- intervention | Significant; CI not given; ES Eta squared 0.32 |
| 8. Henderson, Corker, Lewis-Holmes, Hamilton, Flach, Rose, Williams, Pinfold, Thornicroft 2012 [32] | England’s Time to Change antistigma campaign: One-year outcomes of service user–rated experiences of discrimination | UK | MI | 1584 community | Social marketing; 12 months | Interpersonal Community |
Multi-country Validated Stigma of MI Scale | Significant; CI not given; ES not given |
| 9. Jürgensen, Sandoy, Michelo, Fylkesnes 2013 [13] | Effects of home-based Voluntary Counselling and Testing on HIV-related stigma: Findings from a cluster-randomized trial in Zambia | Zambia | HIV | 1694 community | Voluntary counseling and testing over 2 months | Interpersonal Community |
Multi-country Validated HIV Stigma Measure at pre- and 6 months post-intervention | Significant; CI (− 1.08, − 0.054); ES R2 = 0.02 |
| 10. Li, Wu, Liang, Lin, Zhang, Guo, Rou, Li 2013 [15] | An intervention targeting service providers and clients for methadone maintenance treatment in China: A cluster-randomized trial | China | Substance abuse | 41 HCW, 179 people using heroin on methadone | Education (3 group sessions), motivational interviewing (2 sessions) | Intrapersonal Institutional |
Chinese Validated Perceived Stigma of Addictions Care at pre-, 3, 6, 9 months post intervention. | Non-significant; CI 3 months (− 3.36, 3.01); 6 months (− 6.96, 1.21); 9 months (− 6.39, 2.66); ES Not Given |
| 11. Lusli, Peters, van Brakel, Zweekhorst, Iancu, Bunders, Irwanto, Regeer 2016 [16] | The impact of a rights-based counseling intervention to reduce stigma in people affected by leprosy in Indonesia | Indonesia | Leprosy | 124 PW leprosy | Coping/counseling, 5 sessions | Intrapersonal Interpersonal |
Adapted from a Multi-Country Validated Measure of HIV Stigma at pre- and post-intervention | Significant; CI not given; ES not given |
| 12. Maulik, Kallakuri, Devarapalli, Vadlamani, Jha, Patel 2017 [33] | Increasing use of mental health services in remote areas using mobile technology: A pre- post evaluation of the SMART Mental Health project in rural India | India | MI | 238 community, 23 HCW | Education, drama, psychiatric treatment, 8 weeks in community; 3 months with HCW | Intrapersonal Interpersonal Community |
Multi-Country Validated Care Access and Stigma Scale at pre- and post- intervention | Significant; CI not given; ES not given |
| 13. Michaels, Corrigan, Buchholz, Brown, Arthur, Netter, MacDonald-Wilson 2014 [11] | Changing stigma through a consumer-based stigma reduction program | US | MI | 127 PW MI, 131 HCW | Education, contact, 4 workshops each 2–3 h in duration | Intrapersonal Interpersonal |
Multi-Country Validated Scale for MI Stigma at pre- and post-intervention | Significant; CI not given; ES Eta squared 0.08 |
| 14. Michalak, Livingston, Maxwell, Hole, Hawke, Parikh 2014 [34] | Using theatre to address mental illness stigma: A knowledge translation study in bipolar disorder | Canada | MI | 80 PW MI, 84 HCW | Contact, drama; 50-min performance and 30-min question and answer session | Intrapersonal Community |
Multi-Country Validated Scale for MI Stigma at pre-, post-, and 3–4 months after intervention | Significant; CI not given; ES Eta squared 0.11 |
| 15. Ngoc, Weiss, Trung 2016 [12] | Effects of the family schizophrenia psychoeducation program for individuals with recent onset schizophrenia in Viet Nam | Vietnam | MI | 59 PW MI and caregivers/family | Education; 3, 1.5-h sessions | Intrapersonal Interpersonal |
Adapted Validated Scale for MI Stigma at pre- and 6 months post-intervention | Significant; CI not given; ES Eta squared 0.13 and 0.18 |
| 16. Orkibi 2014 [35] | The effect of drama-based group therapy on aspects of mental illness stigma | Israel | MI | 5 PW MI, 7 community | Drama (therapy); 20 weekly, 2-h sessions | Intrapersonal Community |
Multi-Country Validated MI Stigma scales at each of 14 session2 | Significant; CI not given; ES not given |
| 17. Patalay, Annis, Sharpe, Newman, Main, Ragunathan, Parkes, Clarke 2017 [17] | A Pre-Post Evaluation of OpenMinds: a Sustainable, Peer-Led Mental Health Literacy Programme in Universities and Secondary Schools | UK | MI | 234 community, 40 HCW | Education; 2 workshops over 3 weeks | Interpersonal Community |
Social Distance Measure used in the UK at pre-and post-intervention | Significant; CI not given; ES odds ratio: 0.85 |
| 18. Pinfold, Thornicroft, Huxley, Farmer 2005 [36] | Active ingredients in anti-stigma programs in mental health | UK | MI | PW MI, community (109 police, 78 adults, 472 school students) | Education, social marketing, contact; 2, 2-h sessions; 2, 50-min school sessions; | Intrapersonal Interpersonal Community |
Multi-Country Validated social distance scales at pre- and post-intervention | Significant; CI not given; ES not given |
| 19. Smith Fawzi, Eustache, Oswald, Louis, Surkan, Scanlan, Hook, Mancuso, Mukherjee 2012 [37] | Psychosocial support intervention for HIV-affected families in Haiti: implications for programs and policies for orphans and vulnerable children | Haiti | HIV | 168 PLWH, 130 caregivers/family | Social support, coping/counseling of 14 and 15 caregiver support group sessions with and without youth. | Intrapersonal Interpersonal |
Multi-Country Validated HIV Stigma Scale at ore- and post-intervention assessment | Significant; CI not given for Stigma Scale; ES not given |
| 20. Snead, Ackerson, Bailey, Schmitt, Madan-Swain, Martin 2004 [38] | Taking charge of epilepsy: the development of a structured psychoeducational group intervention for adolescents with epilepsy and their parents | US | Epilepsy | 7 PW epilepsy and caregivers/family | Education; 6-week group intervention | Intrapersonal Interpersonal |
Multi-Country Validated Scale for Epilepsy Stigma at pre- and post-intervention | Non-significant; CI not given; ES not given |
| 21. Stuhlmiller 2003 [39] | Breaking down the stigma of mental illness through an adventure camp: A collaborative education initiative | Australia | MI | 100 PW MI, 200 community | Education, outdoor adventure over 2 days | Intrapersonal Interpersonal |
Unpublished Scale of MI Stigma at pre- and post-intervention | Not significant (no inferential statistics); CI not given; ES not given |
| 22. Thurman, Jarabi, Rice 2012 [40] | Caring for the caregiver: Evaluation of support groups for guardians of orphans and vulnerable children in Kenya | Kenya | Orphans/vulnerable children | 766 caregivers/family and 1028 orphans/vulnerable children | Social support; Support groups provided in the community | Intrapersonal Interpersonal |
Caregiver marginalization scale used in Rwanda, Validation Information Not Given | Significant; CI not given; ES standardized beta −0.22 |
| 23. Uys, Chirwa, Kohi, Greeff, Naidoo, Makoae, Dlamini, Durrheim, Cuca, Holzemer 2009 [41] | Evaluation of a health setting-based stigma intervention in five African countries | 5 African countries | HIV | 41 PLWH, 177 HCW | Contact, coping/counseling, education in a 2-day workshop | Intrapersonal Community |
Multi-Country HIV Stigma Scale for HCW at 3 months pre- and within 1 month post-intervention. | Significant; CI not given; ES not given |
| 24. Yotsumoto, Hirose, Hashimoto 2010 [42] | An awareness program: the significance of lectures delivered by individuals with mental disabilities | Japan | MI | 12 PW MI, 844 community | Contact, education; 2–5 lectures per person | Intrapersonal Community |
Multi-Country Validated Stigma Scale at post-intervention | Non-significant; CI not given; ES not given |
Notes: We categorized findings in terms of statistical significance (at least 1 measure of stigma used showed statistically significant reduction at p < 0.05) and non-significance (no statistical significance found or no inferential statistics used). We calculated effect size (ES) when enough information was provided to calculate Cohen’s d or Eta squared. Unstandardized test statistics were labeled as ‘ES Not Given’
Abbreviations: CI confidence interval, ES effect size, HCW health care workers, HIC high-income country, HIV human immunodeficiency virus, LMIC low- and middle-income country, MI mental illness, PLWH people living with HIV, PRISMA Preferred Reporting Items for Systematic Reviews, PW people with, RCT randomized controlled trial, US United States