Table 2.
Adapted Stigma Reduction Intervention Framework (based on Heijnders & Van Der Meij, 2006) including references to included studies.
| Intervention strategy | Intervention sub-strategies, if applicable | Description | Studies describing this (sub)-strategy |
|---|---|---|---|
| Intrapersonal strategies to reduce stigmatisation | |||
| Individual Counselling | IC | Individual counselling on topics as stress management, positive reframing, challenging dysfunctional beliefs and uncertainty about the future, accompanying person in the stigmatised group to appointments | (Tshabalala and Visser, 2011; Nyamathi et al., 2013; Sermrittirong et al., 2014; Go et al., 2017; Li et al., 2018) |
| IC-CBT | Cognitive Behaviour Therapy: a structured approach in which patients are trained to identify and modify negative beliefs and negative interpretations | (Lusli et al., 2016)b and (Tshabalala and Visser, 2011; Li et al., 2018) | |
| Empowerment | Empowerment - Contact | Facilitated contact between stigmatised, learning from other stigmatised persons | Nambiar et al. (2011) |
| Empowerment – Education | Information for persons from the stigmatised population to understand their condition and to improve it, such as proper nutrition, responsible disclosure management | (Elafros et al., 2013; Chidrawi et al., 2014)b and (Cornish, 2006; Nambiar et al., 2011; Nyamathi et al., 2013; Doosti-Irani et al., 2017; Lyons et al., 2017; Shamsaei et al., 2018) | |
| Empowerment – Livelihood | Strengthening of the economic position of persons from the stigmatised population through monthly supplies, loans or business/agriculture training, basic needs support | (Dalen, 2009; Jain et al., 2013)b and (Cross and Choudary, 2005; Apinundecha et al., 2007; Nyamathi et al., 2013; Sermrittirong et al., 2014; Dadun et al., 2017) | |
| Empowerment – Social Skills | Strengthening the capacity of the persons from the stigmatised population on self-management, social communication skills, reintegration to society | (Ritterbusch, 2016)a and (Augustine et al., 2012; Lyons et al., 2017; Li et al., 2018) | |
| Empowerment – Service User Involvement | Intended and active service user involvement in the stigma reduction intervention strategies | (Uys et al., 2009; Doosti-Irani et al., 2017; Rai et al., 2018) | |
| Empowerment – Value Added | Representatives of the stigmatised population proactively contribute to the wider community | Cross & Choudary (2005) | |
| Group counselling | Sharing, discussing with a group about topic as shared experience, positive identity change, internal stigma, disclosure and coping | (Dalen, 2009; Lusli et al., 2016)b and (Koen et al., 2010; Shilling et al., 2015; Dadun et al., 2017; Go et al., 2017) | |
| Self-help, advocacy, support groups | Mutual support and information exchange, share life experiences, exchange problem-solving advice, encouraging peers to continue or adhere to treatment, collective action | (Elafros et al., 2013)b and (Cross and Choudary, 2005; Cornish, 2006; Macq et al., 2008; Elafros et al., 2013; Sermrittirong et al., 2014; Prinsloo and Greeff, 2016) | |
| Interpersonal strategies to reduce stigmatisation | |||
| Care and support (C&S) | Capacity strengthening of people close to the stigmatised population (e.g. family) about the condition, how to mobilise resources, how to care. | (Lusli et al., 2016)b and (Raju et al., 2008; Sermrittirong et al., 2014; Doosti-Irani et al., 2017) | |
| Home care teams (HCT) | Teams that visit persons from the stigmatised population on a regular basis to strengthen home and self-care | (Macq et al., 2008; Sermrittirong et al., 2014) | |
| Community based rehabilitation (CBR) | Community development for rehabilitation, focusing on reintegration of people from the stigmatised population by organising screening camps, strengthening referral system and follow up of cases, monitoring barriers to treatment adherence | (Arole et al., 2002; Raju et al., 2008; Nyamathi et al., 2013) | |
| Organisational/Institutional strategies to reduce stigmatisation | |||
| Training Programmes within organisations | Training Programme – One Way | Learning takes place through a one-way (one direction) method such as through pamphlets, PowerPoint presentation | (Geibel et al., 2017)b and (Altindag et al., 2006; ÜÇOk et al., 2006; Finkelstein et al., 2008; Macq et al., 2008; Bayar et al., 2009; Uys et al., 2009; Li et al., 2014; Monteiro, 2014; Shah et al., 2014; Pulerwitz et al., 2015; Kutcher et al., 2016; Geibel et al., 2017; Lyons et al., 2017; Nyblade et al., 2018) |
| Training Programme – interactive | Learning takes place through interactive games or discussion methods such as gaming, role plays, movies, drama | (Geibel et al., 2017)b and (ÜÇOk et al., 2006; Finkelstein et al., 2007; Wu et al., 2008; Li et al., 2013; Monteiro, 2014; Sermrittirong et al., 2014; Shah et al., 2014; Pulerwitz et al., 2015; Lohiniva et al., 2016; Geibel et al., 2017; Hofmann-Broussard et al., 2017; Lyons et al., 2017; Nyblade et al., 2018) | |
| Training Programme – Popular Opinion Leader | Strategically making use of influential local leaders to share messages | Li et al. (2013) | |
| Contact | Contact – Direct | Short-term contact within the organisation between staff and people with lived experience to share information and ask questions | (Altindag et al., 2006; Monteiro, 2014; Shah et al., 2014; Hofmann-Broussard et al., 2017; Nyblade et al., 2018) |
| Contact – Direct Cooperation | Interaction or collaboration in the organisation between staff and people with lived experience is facilitated | (Uys et al., 2009; Rai et al., 2018) | |
| Contact – Indirect | Organisational staff has indirect contact with people with lived experience through paper-written, movie-based testimonies or fictional stories | (Altindag et al., 2006; Finkelstein et al., 2008; Wu et al., 2008; Nyblade et al., 2018) | |
| Patient-centred policies | Actions to improve the policy/environment of institutions, such as code of stigma-free practice, better medical environment, universal procedures, confidential referral and integration of services | (Arole et al., 2002; Neema et al., 2012; Li et al., 2013; Pulerwitz et al., 2015; Doosti-Irani et al., 2017; Lyons et al., 2017) | |
| Community strategies to reduce stigmatisation | |||
| Education | Education - One Way | Education through one-way information, such as side slow, lecture, PowerPoint and pamphlets | (Raizada et al., 2004; Alemayehu and Ahmed, 2008)a and (Jain et al., 2013)b and (Apinundecha et al., 2007; Raju et al., 2008; Sermrittirong et al., 2014; Dharitri et al., 2015; Prinsloo and Greeff, 2016; Ahuja et al., 2017; Maulik et al., 2017) |
| Education - Interactive | Education in an interactive manner, such as comic book, role plays, discussion groups, edutainment, theatre | (El-Setouhy and Rio, 2003; Raizada et al., 2004; Alemayehu and Ahmed, 2008)a and (Zeelen et al., 2010; Creel et al., 2011; Jain et al., 2013; Chidrawi et al., 2014)b (Francis and Hemson, 2006; Lapinski and Nwulu, 2008; Raju et al., 2008; Catalani et al., 2013; Sermrittirong et al., 2014; Dharitri et al., 2015; Peters et al., 2015; Prinsloo and Greeff, 2016; Ahuja et al., 2017; Go et al., 2017; Maulik et al., 2017; Logie et al., 2019) | |
| Education - Media | Education through the use of mass media, such as radio and television | (O’Leary et al., 2007; Creel et al., 2011)b and (Boulay et al., 2008; Maulik et al., 2017) | |
| Education - Campaign | In the community going door to door, organising a community walk or awareness raising workshops, community mobilisation | (Dalen, 2009; Jain et al., 2013)b and (Boulay et al., 2008; Doosti-Irani et al., 2017; Go et al., 2017; Maulik et al., 2017) | |
| Education - Popular Opinion Leaders | Local leaders, such as religious leaders, proactively speak out to improve the situation of the stigmatised population through churches or in other places within the community | (Apinundecha et al., 2007; Boulay et al., 2008) | |
| Contact | Contact - Direct | Short-term contact between the general population and representation from the stigmatised population to share information and ask questions | (Jain et al., 2013)b and (Raju et al., 2008; Jain et al., 2013; Chidrawi et al., 2014; Peters et al., 2015; Prinsloo and Greeff, 2016; Ahuja et al., 2017; Dadun et al., 2017; Doosti-Irani et al., 2017) |
| Contact – Direct Cooperation | Interaction or collaboration between the general population and the stigmatised population is facilitated | (Chidrawi et al., 2014)b and (Apinundecha et al., 2007; Raju et al., 2008; Prinsloo and Greeff, 2016) | |
| Contact – Indirect | Community members have indirect contact through paper-written, movie-based testimonies or fictional stories | (Creel et al., 2011)b and (Lapinski and Nwulu, 2008; Creel et al., 2011; Catalani et al., 2013; Peters et al., 2015; Doosti-Irani et al., 2017; Go et al., 2017; Maulik et al., 2017) | |
| Social Consensus | Building on the social consensus theory, aiming to change attitudes by sharing in-/out-group/neutral perceptions | (Yan et al., 2018)b | |
| Advocacy/Protest | Protest campaigns or advocacy actions that aim to influence discriminatory laws through organising conferences, having meetings with policy makers, | (Ritterbusch, 2016)a and (Cornish, 2006; Doosti-Irani et al., 2017) | |
a Strategies or sub-strategies also employed in child-focused interventions.
b Strategy added to Heijnders and Van Der Meij’s framework or further refined through sub-strategies.