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Table 1 Multi-level stigma interventions

From: A systematic review of multi-level stigma interventions: state of the science and future directions

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
  1. 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’
  2. 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