Reducing Stigma Toward Mental Illness and Substance Use Issues in Primary Health Care in Chile
- Conditions
- StigmatizationMental HealthSubstance Abuse
- Interventions
- Other: Developing teams of Local LeadersOther: Analysis of Internal Policies, Procedures and ProtocolsOther: Raising AwarenessOther: Innovative Contact-Based EducationOther: Recovery-Based Arts
- Registration Number
- NCT05578066
- Lead Sponsor
- Pontificia Universidad Catolica de Chile
- Brief Summary
This research project aims to determine the effectiveness of a comprehensive anti-stigma intervention in reducing stigmatizing attitudes and behaviours among Primary Health Care (PHC) providers toward individuals with mental illness and/or substance use issues (MISUI) in the Chilean context, using Centros de de Salud Familiar (CESFAMs) as the point of intervention.
- Detailed Description
The intervention model will be culturally adapted with CESFAM PHC provider and user input to be relevant and valid to Chile. The 18-month intervention includes five (5) components that are simultaneously implemented in CESFAMs: (1) Develop a Team of Local Champions in each intervention CESFAM, comprising PHC providers and users; (2) Analysis of Internal CESFAM Policies, Procedures, and Protocols to determine areas of improvement in service delivery for individuals with MISUI; (3) Raising Awareness of stigma toward MISUI using various forms of media within the CESFAM; (4) Innovative Contact-Based Education workshops on anti-stigma and recovery principles, co-lead by academic/clinical trainers and a person with lived experience of MISUI; and (5) Recovery-Based Arts, a multi-week arts workshop for PHC providers and users to produce artwork related to MISUI and recovery, culminating in an exhibition to showcase artwork for the CESFAM providers, users, and community.
Due to Coronavirus disease of 2019 (COVID-19) sanitary context some of the interventions may be developed remotly dependind on each primary healthcare center needs and capability. This interventions will be implemented in years two and three of the study and the final year of the study is dedicated to integrated data analysis, a 6-month follow-up data collection, and dissemination of results.
If the intervention proves to be effective, control CESFAMs will be provided with an anti-stigma initial training and protocols for intervention implementation.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 16
- CESFAM must serve a registered population of at least 15,000 people
- CESFAM have at least 50 staff employed
- CESFAM being part of another antistigma program.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Intervention group Raising Awareness The experimental group will be composed by aproximately 8 CESFAM with 36 Primary Health Care providers that are currently employed with a total of 288 providers per arm. And some PHC users that have received care there for Mental Health Abuse Issues in the three months prior to study participation. The interventions include a comprehensive, 18-month, recovery-oriented anti-stigma intervention is composed by five components. 1. Developing a Team of Local Champions 2. Analysis of Internal Policies, Procedures and Protocols 3. Raising Awareness 4. Innovative Contact-Based Education 5. Recovery based Arts. Teams of leaders developed as part of the first component will assist the research team with the implementation of the anti-stigma intervention at their respective CESFAM. Intervention group Analysis of Internal Policies, Procedures and Protocols The experimental group will be composed by aproximately 8 CESFAM with 36 Primary Health Care providers that are currently employed with a total of 288 providers per arm. And some PHC users that have received care there for Mental Health Abuse Issues in the three months prior to study participation. The interventions include a comprehensive, 18-month, recovery-oriented anti-stigma intervention is composed by five components. 1. Developing a Team of Local Champions 2. Analysis of Internal Policies, Procedures and Protocols 3. Raising Awareness 4. Innovative Contact-Based Education 5. Recovery based Arts. Teams of leaders developed as part of the first component will assist the research team with the implementation of the anti-stigma intervention at their respective CESFAM. Intervention group Innovative Contact-Based Education The experimental group will be composed by aproximately 8 CESFAM with 36 Primary Health Care providers that are currently employed with a total of 288 providers per arm. And some PHC users that have received care there for Mental Health Abuse Issues in the three months prior to study participation. The interventions include a comprehensive, 18-month, recovery-oriented anti-stigma intervention is composed by five components. 1. Developing a Team of Local Champions 2. Analysis of Internal Policies, Procedures and Protocols 3. Raising Awareness 4. Innovative Contact-Based Education 5. Recovery based Arts. Teams of leaders developed as part of the first component will assist the research team with the implementation of the anti-stigma intervention at their respective CESFAM. Intervention group Developing teams of Local Leaders The experimental group will be composed by aproximately 8 CESFAM with 36 Primary Health Care providers that are currently employed with a total of 288 providers per arm. And some PHC users that have received care there for Mental Health Abuse Issues in the three months prior to study participation. The interventions include a comprehensive, 18-month, recovery-oriented anti-stigma intervention is composed by five components. 1. Developing a Team of Local Champions 2. Analysis of Internal Policies, Procedures and Protocols 3. Raising Awareness 4. Innovative Contact-Based Education 5. Recovery based Arts. Teams of leaders developed as part of the first component will assist the research team with the implementation of the anti-stigma intervention at their respective CESFAM. Intervention group Recovery-Based Arts The experimental group will be composed by aproximately 8 CESFAM with 36 Primary Health Care providers that are currently employed with a total of 288 providers per arm. And some PHC users that have received care there for Mental Health Abuse Issues in the three months prior to study participation. The interventions include a comprehensive, 18-month, recovery-oriented anti-stigma intervention is composed by five components. 1. Developing a Team of Local Champions 2. Analysis of Internal Policies, Procedures and Protocols 3. Raising Awareness 4. Innovative Contact-Based Education 5. Recovery based Arts. Teams of leaders developed as part of the first component will assist the research team with the implementation of the anti-stigma intervention at their respective CESFAM.
- Primary Outcome Measures
Name Time Method Survey for PHC Providers (Scale 2) 2 years Mental Illness: Clinicians' Attitudes (MICA 7; overall scores range from a minimum of 16 to a maximum of 96, with higher scores indicating more stigmatizing and negative attitudes toward mental illness).
Survey for PHC Providers (Scale 3) 2 years Modified Bogardus Social Distance Scale (scores from 9 to 36, higher scores represent greater social distance) or Grandon Social Distance Scale (scores from 5 to 25, higher scores represent less social distance)
Identify critical barriers and opportunities for its implementation in PHC 2 years To evaluate implementation of the intervention, qualitative interviews will be held with two PHC providers (local champions) and one CESFAM authority per intervention site at baseline, mid-point, and end-point. In addition, at least one local champion from the community will be interviewed to explore his/her experience as a leader, pros and cons of the intervention and how it could be improved. Questions will relate to implementation outcomes for the intervention: acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, coverage and sustainability.
The Consolidated Framework for Implementation Research (CFIR) will be considered to guide the process.Survey for PHC Providers (Scale 4) 2 years Recovery Assessment Scale for Providers (Score range: 13 -least negative attitudes toward recovery- to 117 -most negative attitudes regarding recovery-).
Survey for PHC Providers (Scale 1 - main scale) 2 years A self-administered questionnaire will be used to examine stigma directed at persons with MISUI among health professionals. This questionnaire will be completed at four time-points (baseline, mid-point, end-point, and 6-month follow-up). It will collect data related to two main components: (1) socio-demographic and other relevant general variables (see Appendix 1.10 for variables); and (2) attitudes toward MISUI stigma and recovery. The end-point questionnaire will also include a third component focusing on the intervention and its implementation.
The main scale to measure stigma toward MISUI to include in the questionnaire is the Opening Minds Scale for Health Care Providers (OMS-HC6). This 20-item instrument can result in a possible score of 20 to 100, with a higher score indicating more stigmatizing attitudes and behavioral intentions. Some items in the scale require reverse coding. There is also a 15-item version.
In addition, complementing, four other scales are considered.Survey for PHC Users 2 years A face-to-face survey assisted by a research team member be used to examine how users perceive stigmatizing attitudes and behaviours among CESFAM PHC providers. The questionnaire will include four main components: (1) socio-demographic and other relevant general variables; (2) perceived stigmatizing attitudes and behaviours among CESFAM PHC providers; (3) perceived recovery-oriented practices by CESFAM PHC providers; and (4) accessing healthcare at their CESFAM. The questionnaire will take approximately 30 minutes to complete. The Perceived Devaluation-Discrimination Scale will be used to assess the extent to which users believe that other people devalue or discriminate against someone with MISUI. And adapted version of the Discrimination Experience Subscale of the 29-item Internalized Stigma of Mental Illness (ISMI).
- Secondary Outcome Measures
Name Time Method
Trial Locations
- Locations (1)
Cesfam Chuchunco
🇨🇱Santiago, Chile