Testing Effectiveness of a Peer-Led Intervention to Enhance Community Integration
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 192
- 试验地点
- 1
- 主要终点
- Approaches to Coping With Stigma, Change in Coping With Stigma
研究概览
简要总结
We are conducting a randomized clinical trial (RCT) comparing the 10-week peer-led Photovoice program to services as usual (SAU) at a large publicly funded community mental health agency in Massachusetts. The control SAU condition will be enhanced with a 60-minute peer-led group educational session about understanding and coping with prejudice and discrimination. The 10-session, peer-led Photovoice program, designed to empower individuals with serious mental illness (SMI) to confront public prejudice and discrimination and reduce personal stigma (self-stigma and perceived stigma), was developed and pilot tested at our Center, with primary contributions from staff with a lived experience of mental illness. Development of the Photovoice program was guided by an adaptation of the stress-coping model, informed by recent research and conceptualizations of the effects of stigma on people with SMI. The stress-coping model explicates the mechanisms by which public stigma about mental illness can lead to personal stigma, which in turn has a negative impact on the person's mental health and psychosocial functioning. This model also identifies critical factors that contribute to personal stigma or protect against it, as well as more vs. less adaptive coping responses, that are the primary focus of the Photovoice program.
详细描述
We are conducting a RCT comparing the 10-week peer-led Photovoice program to services as usual (SAU) enhanced with a 60-minute peer-led group discussion session. The RCT will be at a large publicly funded community mental health agency in Massachusetts. A total of 192 participants or 96 participants per group will be recruited over a period of 36 months across the three clubhouses of the agency where the intervention will take place. We plan to have randomization cohorts of 16 individuals per delivery of the Photovoice program at each of the three clubhouses. Given the projected sample size of 192 participants, we will have 12 randomization cohorts - 4 at each clubhouse implemented at 6-month intervals. Participants will be randomized to either the Photovoice program (plus usual services) or the enhanced SAU. Participants will be assessed by a blinded rater at baseline, post-treatment, 3-month and 6-month follow-ups on a range of primary and secondary outcomes related to personal stigma, coping, and functioning. Primary analyses will test the hypotheses that the Photovoice program will lead to significantly greater reductions in self-stigma and perceived stigma, greater improvements in proactive coping with psychiatric prejudice and discrimination, and greater improvements in community functioning and integration than the enhanced SAU. Secondary analyses will evaluate whether the Photovoice program leads to greater gains than SAU in psychological adjustment, including wellbeing, personal growth and recovery. Individuals randomized to the enhanced SAU will be able to join the 10-week Photovoice program once they complete their 6-month follow up for the study.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Other
- 盲法
- Single (Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Age 18years and older
- •Diagnosis of serious mental illness
- •Receiving services at agency where study is taking place
- •Willing and able to give written consent
- •Conversant in English
排除标准
- •Prior exposure to Photovoice
- •Cognitive disability
研究组 & 干预措施
Photovoice
Participants in this arm will attend a 10-week peer-led Photovoice program conducted in group format.
干预措施: Photovoice (Behavioral)
Enhanced Control
Participants in this arm will attend a 60-minute peer-led group discussion on stigma and discrimination, and be eligible to participate in the 10-week Photovoice program after completing all study assessments.
干预措施: Enhanced Control (Behavioral)
结局指标
主要结局
Approaches to Coping With Stigma, Change in Coping With Stigma
时间窗: Baseline, post-treatment, 3 months post-treatment, 6 months post-treatment
is a 27-item, 4-point scale ranging from 1-4 (strongly disagree to strongly agree) measuring strategies to cope with stigma: secrecy, withdrawal, distancing, educating others, and challenging others. The average score of the items in the first three subscales will represent the index for Avoidant Coping and the average score of the items in the last two subscales - the index for Proactive Coping with Stigma. Internal consistency for subscales range: .63-.84. Lower scores are better on Avoidant Coping and higher scores are better on Proactive Coping.
Internalized Stigma of Mental Illness Scale, Change in Internalized Stigma
时间窗: Baseline, post-treatment, 3 months post-treatment, 6 months post-treatment
a 29-item, 4-point scale (strongly disagree to strongly agree) assesses behaviors, thoughts and feelings that are self-stigmatizing and includes alienation, stereotype endorsement, discriminatory experiences, social withdrawal, and stigma resistance subscales. Internal consistency is .9 and test-retest reliability is .92. Lower scores are better. The scale score is the average score on the 29 items, which are scored from 1-4. Lower scores signify less internalized stigma.
The Stigma Scale, Change in Perceptions of Stigma
时间窗: Baseline, post-treatment, 3 months post-treatment, 6 months post-treatment
is a 28 item, 5 point scale ranging from 0-4 (strongly disagree to strongly agree) measuring experienced and anticipated stigma. Internal consistency ranges from .85-.87 and test-retest reliability from .4 to .7. The scale score is the average score on all items. Lower scores are better.
Heinrich's Quality of Life Scale-Client Version, Change in Quality of Life
时间窗: Baseline, post-treatment, 3 months post-treatment, 6 months post-treatment
This is a 21 item, semi-structured interview-based, rating of an individual's psycho-social functioning and satisfaction with various life domains. The score on each item ranges from 0-6 with higher scores indicating better functioning. The subscale scores are computed based on the average score of items included. We report below on the interpersonal functioning and intrapsychic foundations subscales.
Temple University Community Participation Scale, Change in Community Participation
时间窗: Baseline, post-treatment, 3 months post-treatment, 6 months post-treatment
is a 26 item instrument measuring frequency of participation and importance of various community activities (e.g., movies, library). Test-retest reliability is .7 and internal consistency is .9. Higher scores are better. We provide below the results for cumulative days of participation in the last 30 days across the 26 activities included in the measure (tcpm_days_participated). The possible range for this measure is 0-780.
次要结局
- Scales of Psychological Well-Being, Change in Well-being(Baseline, post-treatment, 3 months post-treatment, 6 months post-treatment)
- Maryland Assessment of Recovery, Change in Perceptions of Recovery(Baseline, post-treatment, 3 months post-treatment, 6 months post-treatment)
- Brief Psychiatric Rating Scale, Change in Psychiatric Symptoms(Baseline, post-treatment, 3 months post-treatment, 6 months post-treatment)
- Personal Growth and Recovery Scale, Change in Perceptions of Growth and Recovery(Baseline, post-treatment, 3 months post-treatment, 6 months post-treatment)
研究者
Zlatka Russinova
Research Associate Professor
Boston University Charles River Campus