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Table 2 Future directions for multi-level stigma interventions

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

Addressing research gaps
 Most multi-level stigma intervention research has focused on the individual/interpersonal level; thus, more research is needed to incorporate community-, organizational-, and structural-level influences into such interventions.
 Most multi-level stigma intervention research has utilized education-based strategies (either alone or in combination with other strategies, like contact) to reduce stigma. Thus, more research is needed across a wider range of stigma-reducing strategies.
 Only a handful of stigmatized groups have been the focus of multi-level stigma reduction interventions, with primary focus on HIV and mental health. Thus, more research is needed to expand the range of groups that are evaluated with these interventions.
Methods and measurement
 More methodologically rigorous methods are needed to test the efficacy of multi-level stigma interventions, including randomized controlled trials and quasi-experiments.
 New measurement approaches are needed to evaluate synergistic and reciprocal relations of stigma reduction interventions across levels of analysis.
 Multi-level stigma interventions need to more fully engage with several key areas in intervention science, such as implementation science.
Research questions
 How do changes at one level of stigma (e.g., intrapersonal) impact other levels of stigma (e.g., community)?
 How do multi-level stigma interventions compare to stigma interventions at a single level in terms of efficacy in reducing stigma and/or its negative consequences?
 What are the mechanisms of change? That is, when multi-level stigma interventions are effective, why are they effective?
 How are multi-level stigma interventions that are found effective translated or disseminated? What interpersonal-, community-, and structural-level factors promote or undermine their effective dissemination?