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Table 3 Included studies (n = 35) and associated interventions (n = 29) by year of publication

From: Implementation science and stigma reduction interventions in low- and middle-income countries: a systematic review

Study

Intervention

First Author Citation

Year

Design

Study Type

Imp. Stage

Study Population

Imp. Outcome(s)

Imp. Outcome Score

Other Outcome(s)

Key Findings

Description

Name

Country

Stigmatizing Condition

TIDieR Score

el-Setouhy [43]

2003

CS; PPwoC

Type 1

Pi

Co

Ac

40%

S

Children liked the comic book and its contents and found this book easy to understand

Comic book for Egyptian schoolchildren

n/s

Egypt

LF

55%

Norr [44]

2004

Qual; PPwC

Eff

Pi

Co

Su

0%

S O

Leaders continued to offer intervention post-funding

Peer group intervention

n/s

Botswana

HIV; STDs

64%

Witter [45]

2004

Qual; Econ

Type 1

Sc

Co Pa

Ac Ad C Fe Su

20%

S H O

Acceptable and effective tool with low costs, though participants still cannot bear cost; hard to keep momentum and extend coverage

Book of family background, memories, hopes

Memory Book

Uganda

HIV

55%

Lawoyin [46]

2007

Qual; PPwoC

Type 1

Pi

Co

Ac

20%

S

Satisfaction with content and appreciation for social support

Life skills education

n/s

Nigeria

HIV

64%

Boulay [47]

2008

CS

Type 1

Sc

Co

Pe

50%

S

51% of men and 53% of women recalled hearing or seeing the slogan; broadcast media reached the greatest number of men and women

Mass media, promotional materials, training for local religious leaders

Reach Out, Show Compassion

Ghana

HIV

55%

Finkelstein [48]

2008

Qual; iRCT

Type 1

Pi

Co

Ac Fe

40%

S

Students liked how program worked; none had problems operating the program Content, user interface, and learning process could be improved

Anti-stigma computer program and print materials

Computer Assisted Education system

Russia

MH

36%

Khumalo-Sakutukwa [49]

2008

cRCT; QI/QA

Type 1

Pi

Co Pr

Fi Pe

40%

SD

4-fold increase in testing in intervention vs. control communities; 95% adherence to intervention

Community mobilization, community HIV voluntary counselling and testing, and post-test support services

Project Accept

Tanzania, Zimbabwe, South Africa, Thailand

HIV

91%

Lapinski [50]

2008

Qual; CS; iRCT

Type 1

Pi

Co

Ac Ap

40%

S SD

Enjoyment was high and men and women did not differ in their enjoyment of the film or perception of credibility

Film

Starting Over

Nigeria

HIV

55%

Pappas-DeLuca [51]

2008

CS

Type 1

Sc

Co

Pe

75%

S SD O

Nearly one half reported listening each week, 15% for 1 year or longer, and 19% talking to someone about Makgabaneng in past 3 months

Serial radio drama

Makgabaneng

Botswana

HIV

64%

Zeelen [52]

2010

Qual

Imp

Pi

Pa Pr

Ac Fe

25%

 

Storytelling seen as useful; some listeners distracted by other people; some had to see provider and missed story message

Clinic waiting room storytelling

n/s

South Africa

HIV

55%

Gurnani [53]

2011

M&E

Imp

Sc

Co Po

Pe

50%

SD O

Increase in FSW population reached from 40% to 85%; 61.5% of police force received training; crisis management teams supported 92% of rights violations in redress

Advocacy, legal empowerment, police and media sensitization

n/s

India

HIV

45%

Watt [54]

2011

Qual

Type 1

Pi

Co Pa

Ac Fi

60%

S SD H O

Patients judged usefulness 4.76 out of 5; intervention was delivered as intended in the manual – all 20 sectionscovered in each session

Support group for antiretroviral therapy patients

Zinduka

Tanzania

HIV

64%

Denison [55]

2012

CS; Econ

Type 1

Sc

Co

C

60%

S O

Total annual cost of US $501,516; average annual cost per school of US $8222; Adolescent Sexual and Reproductive Health Life Skills Education pillar had highest cost (US $2197)

Volunteer peer educators, youth resource center, extracurricular activities, community events, teacher training

School HIV/AIDS Education Program

Zambia

HIV

64%

Rice [56]

2012

cRCT

Type 1

Pi

Co

Pe

100%

S O

Rise in communication about intervention messages in the intervention Chinese markets was at first moderate and then substantial

Training market vendors, community-popular opinion leaders

n/s

China

HIV; STDs

64%

Al-Iryani [57]

2013

Qual

Type 1

Pi

Co Pr Po

Ac Fe

60%

SD

76.6% of students considered intervention beneficial; program was acceptable because it was framed as ‘life skills’, did not take away from academics, and was supported by school staff

School peer education program

n/s

Yemen

HIV

73%

Catalani [58]

2013

Qual; PPwoC

Type 1

Pi

Co

Ac

75%

S

Storyline seemed believable and possible; participants responded positively to each medium

Film

Prarambha

India

HIV

64%

Li [59]

2013

cRCT

Type 1

Pi

Pr

Ac

20%

 

Approach accepted by providers; messages were relevant to provider self-interests

Training providers as popular opinion leaders

n/s

China

HIV

73%

Li [60]

2013

cRCT

Type 1

Pi

Pr

Fe

0%

S

Intervention appropriately covered key issues relevant to provider daily practice

Murray [61]

2013

Qual; PPwoC

Type 1

Pi

Co Pa Pr Po

Ap

100%

SD H

Preference for treatment that serves both children and adolescents; treatment that addressed traumatic grief; cross-cultural appropriateness and/or flexibility to adapt; and evidence of effectiveness

Psychosocial therapy for orphans and vulnerable children

Trauma-Focused Cognitive Behavioral Therapy

Zambia

MH

100%

Murray [62]

2013

QI/QA; PPwoC

Type 1

Pi

Pa

Fi

40%

S SD H

Treatment conducted with fidelity due to close monitoring built into Apprenticeship model

Murray [63]

2014

Qual

Type 1

Pi

Co Pa Pr

Ac Fe

75%

 

Counselors liked structure and flexibility, reported positive changes in clients, and discussed cultural adaptation around activities and language; children and caregivers stated positive changes attributed to trauma-focused cognitive behavioral therapy

French [64]

2014

Qual

Type 1

Pi

Co Pa

Ac

75%

S

Taking on projects was difficult but empowering

Training people living with HIV and peers to conduct community projects

n/s

South Africa

HIV

55%

French [65]

2015

Qual

Type 1

Pi

Co Pa

Ac Fe

20%

S

Some struggled with their projects; many found projects challenging and exhausting, yet interesting and exciting

Shah [66]

2014

PPwC

Type 1

Pi

Co

Ac Fe

60%

S

Both sessions rated highly; few participants said materials made them uncomfortable; most felt that they could be honest about their beliefs and behaviors

Stigma reduction curriculum for nurses

n/s

India

HIV

64%

Lusli [67]

2015

Qual

Type 1

Pi

Pr

Ap Fe

50%

SD

Effective communication skills were important; physically disabled counsellors had challenges making contact and providing counselling; distance between clients was challenging

Rights-based counselling of people with leprosy by peer and lay counsellors

Stigma Assessment and Reduction of Impact: Counselling

Indonesia

Lepr.

73%

Lusli [68]

2016

Qual; cRCT

Type 1

Pi

Co Pa

Ac Fe

50%

S SD O

Participants appreciated counselling; counsellors needed intense supervision; not easy to manage client conditions and characteristics; peer counselors were preferred; family counselling preferred overall, but integrating family, individual, and group counselling was best approach

Peters [69]

2015

Qual; cRCT

Type 1

Pi

Co

Fe

0%

S SD

Challenges related to convincing key of value of contact event, logistics (weak audio system, inappropriate venue, too many people and limited time), audience (tired, less involved), and Stigma Assessment and Reduction of Impact team (cancelations, delayed)

Contact events using testimonies, participatory videos, and comics

Stigma Assessment and Reduction of Impact: Contact and Video

Indonesia

Lepr.

64%

Peters [70]

2016

Qual

Type 1

Pi

Pa

Ac Ap Fe

25%

S

Support of video process; some participants had physical limitations and needed additional technical training in videography

Salmen [71]

2015

Qual

Type 1

Pi

Co Pa

Ac

50%

S O

Participants found testimonials and role-modeling to be encouraging and gave them courage to disclose, though some concerns about group testing and disclosure process were expressed

Microclinic of neighbors, relatives, and friends trained to provide psychosocial, nutritional, and adherence support

n/s

Kenya

HIV

64%

Figueroa [72]

2016

CS

Type 1

Sc

Co

Pe

50%

S O

Almost two-thirds (63%) of the control group said that they had heard of TT; exposure to TT was higher among those in the intervention group

Facilitated community dialogues and radio magazines

Tchova Tchova Histórias de Vida: Diálogos Comunitários

Mozambique

HIV

55%

Tekle-Haimanot [73]

2016

Qual; PPwoC

Type 1

Pi

Pr

Ap

60%

S

Providers suggested comic be distributed among school children and felt it was easy to read and understand, well presented and illustrated for a non-medical person

Comic book for Ethiopian schoolchildren

We’ll Make It

Ethiopia

Epil.

55%

Tora [74]

2016

Qual

Type 1

Pi

Co Pa

Fi

0%

S O

Weaknesses observed during training and household education sessions; some educators provided superficial presentations, improper use of supplementary examples, and incomplete messages

Lay health educator-delivered educational modules and booster sessions

Inherited susceptibility education module

Ethiopia

Pod.

82%

Wilson [75]

2016

Qual; PPwoC

Type 1

Pi

Co Pa Pr

Ac Fe

50%

H O

DVD players did not have high volume; few electrical outlets; participants identified with the Salvadorian patients and understood video content; short duration of video not disruptive to TB clinic schedules

Educational video

n/s

El Salvador

TB

64%

Lyons [76]

2017

CS; Coh

Type 1

Pi

Co

Ac Fe

40%

S H

63.9% of MSM and 82.5% of FSW agreed that the workshops were effective in addressing stigma; 68.0% of MSM and 81.6% of FSW self-reported that the workshops helped them think about how to cope with stigma

Peer-led group sessions, training health workers, and web-based referral system

n/s

Senegal

HIV

64%

Oduguwa [77]

2017

PPwC

Type 1

Pi

Co

Ac

40%

O

Most participants liked the program because it increased their awareness about mental illness; some noted that hearing about mental illness created fear; majority affirmed that the program benefited them, the school, and the family

Mental health awareness training

n/s

Nigeria

MH

64%

  1. Designs: CS cross-sectional, Coh cohort, M&E monitoring and evaluation, PPwC non-randomized pre/post study with control, PPwoC non-randomized pre/post study without control, iRCT individual randomized controlled trial, cRCT cluster randomized controlled trial, Qual qualitative, QI/QA quality improvement/quality assurance
  2. Study types: Eff effectiveness, Type 1 type 1 hybrid effectiveness-implementation, Imp implementation
  3. Implementation stages: Pi pilot/once-off implementation, Sc sustained implementation at scale
  4. Study populations: Co community members, Pa patients, Pr providers, Po policy-makers
  5. Implementation outcomes: Ac acceptability, Ap appropriateness, Ad adoption, C costs, Fe feasibility, Fi fidelity, P penetration, S sustainability
  6. Other outcomes: S stigma, SD service delivery, H patient health, O other outcome
  7. Stigmatizing conditions: Epil epilepsy, Lepr leprosy, LF lymphatic filariasis, MH mental health, Pod podoconiosis, STD sexually transmitted disease, TB tuberculosis
  8. FSW female sex worker, MSM men who have sex with men, n/s not specified, TT Tchova Tchova Histórias de Vida