Risk factors of the stigma towards psychiatric patients among primary healthcare workers in China: a county study

Is distance education obligatory or a new trend? The effect of psychiatric nursing e-course on stigma

PURPOSE

To examine the effects of psychiatric nursing e-course taught by distance learning on students' beliefs about mental illnesses.

DESIGN AND METHODS

This study was conducted as a pretest, posttest, and follow-up quasi-experimental study with 147 nursing students.

FINDINGS

The results showed that the psychiatric nursing e-course significantly reduced the stigmatization total and dimension scale scores of the participants, and the effect continued in the follow-up measurement. The difference between the pretest and posttest stigmatization scores of the students who concentrated during virtual classes and those who found student-instructor interaction and virtual course materials sufficient was statistically significant.

PRACTICE IMPLICATIONS

Our results have shown that the psychiatric nursing e-course is effective on beliefs regarding stigmatization, and distance education is promising for nursing education to continue effectively.

Attitudes toward mental illness among medical students and impact of temperament

BACKGROUND

Mental health-related stigma is a serious problem that has undesirable consequences for individuals with mental disorders including physical health disparities, increasing mortality, and social dysfunction. Besides, these individuals frequently report feeling 'devalued, dismissed, and dehumanized' when encountering health professionals who are also perpetrators of stigmatizing attitudes and discriminatory behaviors.

AIMS

The present study concentrates on attitudes, and behavioral responses of medical students and junior doctors toward individuals with a mental illness and explores factors associated with stigma including temperament.

METHODS

A cross-sectional study was conducted among medical students and junior doctors from medical schools of universities in Tunisia. All participants were invited to complete a brief anonymous electronic survey administered on the google forms online platform. Data were collected using self-administered questionnaires, Stigma Measurement, Mental Illness: Clinicians' Attitudes (MICA), Assessment of Affective Temperament, TEMPS-A scale.

RESULTS

A total of 1,028 medical students and junior doctors were recruited. The completion of a psychiatry clerkship for medical students didn't improve significantly the level of stigma toward people with a mental illness. Students in the fourth year had significantly the lowest MICA scores comparing to other students. Psychiatrists had significantly lower scores of explicit stigma attitudes than the other groups (Mean score = 0.42). As for other specialties, surgical residents had more stigmatizing attitudes than those who had medical specialties. 70% of participants believed that people with a mental illness are more dangerous than the other patients. Hyperthymic temperament was significantly associated with decreased stigma attitudes toward patients with mental illness.

CONCLUSION

A combination of medical school experiences of psychiatry's theoretical learning and clerkship and wider societal beliefs are important factors that shape students. Awareness of this will enable educators to develop locally relevant anti-stigma teaching resources throughout the psychiatry curriculum to improve students' attitudes toward mental illnesses.

Effect of a contact-based education intervention on reducing stigma among community health and care staff in Beijing, China: Pilot randomized controlled study

The aim was to assess the feasibility of an intervention to reduce stigma among primary care and community healthcare staff in Beijing, China through a contact-based education intervention. Participants were randomly assigned to: (i) "education only" group, a lecture-based education; or (ii) "education and contact" group, lectures plus contact with people with lived experience of mental illness. Each participant completed an assessment of mental health stigma related: knowledge (mental health knowledge schedule, MAKS); attitudes (mental illness: clinicians' attitudes scale, MICA-4); and behavior (reported and intended behavior scale, RIBS) before and after the intervention, with follow up at 1 month and 3 months after the intervention. A total of 121 healthcare staff were recruited. Both "education only" group and "education and contact" group showed improved knowledge after the intervention, MAKS scores increased by 1.77 ± 3.15 VS 2.46 ± 2.49 (both p < 0.001), respectively. There was no between-group difference in MAKS score. The "education and contact" group showed a significantly greater improvement for MICA and RIBS score than the "education only" group: the MICA score decreased by 4.43 ± 9.42 VS 8.41 ± 7.48 (p = 0.027), and the RIBS score increased by 2.28 ± 3.89 VS 4.57 ± 3.53 (p = 0.003), in the "education only" and the "education and contact" groups respectively, but the between group differences disappeared at 1 month and 3 months follow-up points. The positive effects on stigma levels (knowledge, attitudes and behaviours) in both groups were sustained at 3 months. The intervention to reduce stigma among the primary and community healthcare staff through a contact-based education intervention was feasible in Beijing.

Mental health-related stigma and attitudes toward patient care among providers of mental health services in a rural Chinese county

BACKGROUND AND AIMS

The increasing prevalence of mental illness and low treatment rate presents a pressing public health issue in China. Pervasive stigma is a significant barrier to mental health recovery and community inclusion. In particular, stigmatizing or supportive attitudes held by healthcare providers could either perpetuate or mitigate self-stigma of people with mental illness. Moreover, mental health resources are unevenly distributed in China, with most of them concentrated in urban centers and provincial capitals. This study explores healthcare providers' attitudes toward mental illness and the challenges they faced at work in a rural Chinese county.

METHOD

Four focus groups were conducted with 36 healthcare providers from a three-tier mental healthcare system in a rural county in southwestern China. Focus group discussions were recorded and transcribed verbatim. The team employed a conventional content analysis approach for data analysis. All transcripts were double-coded by three bilingual team members who are native Chinese speakers. Coding discrepancies were resolved by consensus.

RESULTS

Healthcare providers recruited from the county, township, and village levels varied in educational background, professional qualification, and experience of working with people with mental illness. Five thematic categories identified across four groups include (1) barriers to mental healthcare delivery, (2) keys to mental health recovery, (3) providers' attitudes toward providing care, (4) providers' perception toward patients and family members, and (5) providers' perception of training needs.

CONCLUSIONS

This is a unique study that included healthcare providers from a three-tier healthcare system. Findings signal the importance of understanding healthcare practitioners' experiences and views to inform the design of training initiatives in rural or low-resource communities.

Factor structure of The Opening Minds Stigma Scale for Health Care Providers and psychometric properties of its Hungarian version

BACKGROUND

The Opening Minds Stigma Scale for Health Care Providers (OMS-HC) is a widely used questionnaire to measure the stigmatising attitudes of healthcare providers towards patients with mental health problems. The psychometric properties of the scale; however, have never been investigated in Hungary. We aimed to thoroughly explore the factor structure of the OMS-HC and examine the key psychometric properties of the Hungarian version.

METHODS

The OMS-HC is a self-report questionnaire that measures the overall stigmatising attitude by a total score, and three subscales can be calculated: Attitude, Disclosure and Help-seeking, and Social Distance. Our study population included specialists and trainees in adult and child psychiatry (n = 211). Exploratory and confirmatory factor analyses were performed, and higher-order factors were tested. We calculated the test-retest reliability on a subgroup of our sample (n = 31) with a follow-up period of 1 month. The concurrent validity of the scale was measured with the Mental Illness: Clinician's Attitudes-4 scale (MICA-4).

RESULTS

Three factors were extracted based on a parallel-analysis. A bifactor solution (a general factor and three specific factors) showed an excellent model-fit (root mean square error of approximation = 0.025, comparative fit index = 0.961, and Tucker-Lewis index = 0.944). The model-based reliability was low; however, the general factor showed acceptable reliability (coefficient omega hierarchical = 0.56). The scale demonstrated a good concurrent validity with the MICA-4 [intraclass correlation coefficient (ICC) = 0.77]. The test-retest reliability was excellent for the general factor (ICC = 0.95) and good for the specific factors (ICC = 0.90, 0.88, and 0.84, respectively).

CONCLUSIONS

The three dimensions of the OMS-HC was confirmed, and the scale was found to be an adequate measure of the stigmatising attitude in Hungary. The bifactor model is more favourable as compared to the three correlated factor model; however, despite the excellent internal structure, its model-based reliability was low.

Psychometric Properties of the Chinese Version of Short-Form Community Attitudes Toward Mentally Illness Scale in Medical Students and Primary Healthcare Workers

OBJECTIVE

To assess the psychometric properties of the short form Community Attitudes toward Mentally Illness (SF-CAMI) scale among medical students and primary healthcare workers in China.

METHODS

Original English version CAMI was translated following a standard procedure. and then short-form CAMI developed through the multistage procedure. The psychometric properties were tested among two separate samples which contained 1,092 primary healthcare workers and 1,228 medical students. Reliability was assessed by internal consistency reliability and test-retest reliability. Exploratory factor and confirmatory factor analyses were performed to determine the structure and to assess the validity of the scale.

RESULTS

The Chinese version of SF-CAMI consists of 20 items and with three subscales: Benevolence, Fear and Exclusion, and Support and Tolerance. The confirmatory factor analysis indicated good fitting models for medical students and primary healthcare workers. The Cronbach α of total scale for both samples was good (0.82 for medical students and 0.85 for primary healthcare workers), and acceptable test-retest reliability was found (intraclass correlation coefficient is 0.62 for medical students and 0.60 for primary healthcare workers).

CONCLUSION

The Chinese version of SF-CAMI performed good reliability and validity among both primary healthcare workers and medical students, provide more feasible and available tools for assessing the effect of mental health service programs in China.

Stigma towards people who use drugs: A case vignette study in methadone maintenance treatment clinics in China

BACKGROUND

Drug use stigma among service providers has been recognized as a barrier to improving the accessibility and outcomes of addiction treatment. This study examined the stigmatizing attitudes towards people who use drugs (PWUD) among service providers in methadone maintenance treatment (MMT) clinics in China and its associated factors.

METHODS

The cross-sectional study used the baseline data of a randomized intervention trial conducted in China, and the data were collected from January 2012 to August 2013. A total of 418 MMT service providers were included in the study. Stigma towards PWUD was measured via a 10-item scale embedded in two case vignettes (PWUD and non-PWUD). The Wilcoxon signed-rank test was performed to evaluate the vignette difference for each item of the scale. The linear mixed model was used to identify the adjusted association between drug use stigma and other interested variables including demographics, professional background, and MMT knowledge of the service providers.

RESULTS

The Wilcoxon signed-rank tests showed that the participants had a higher level of stigmatizing attitudes towards PWUD than non-PWUD (p-value<0.001 for all items of the stigma scale). The linear mixed model identified that the reception of national MMT training was associated with a lower degree of drug use stigma (estimate=-1.79; 95% CI: -3.13, -0.45; p-value = 0.009).

CONCLUSION

The findings of the study provide evidence of the existence of drug use stigma among MMT providers in China. The expansion of national-level training and the development of stigma reduction interventions are needed to address this issue.