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Table 1 Study and intervention characteristics, stigma drivers, evaluation methods, and quality assessment score

From: Stigma in health facilities: why it matters and how we can change it

First author, publication year, country, health condition

Intervention population, sample size

Stigma reduction approaches, duration

Brief intervention description

Stigma drivers targeted

Evaluation methods, quality score, effect on stigma

Aggarwal [103], 2013, USA, MI

Students, 250

PL, C; 2 h

Panel presentation and discussion

Attitudes, knowledge of stigma

QE/NC, 14/27, decreased

Bamgbade [104], 2017, USA, MI

Students, 120

I, PL, C; 2.5 h over 2 days

Presentations, videos, discussion and active-learning exercises

Attitudes, fear, knowledge of condition, knowledge of stigma

QE/NC, 15/27, decreased

Bamgbade [105], 2016, USA, MI

Students, 120

I, PL, C; 2.5 h over 2 days

Presentations, videos, discussion and active-learning exercises

Attitudes, knowledge of condition, knowledge of stigma

QE/NC, 16/27, mixed

Batey [74], 2016, USA, HIV

HCPs and PLHIV, 38

I, SB, PL, C, E; 1.5 day

Workshop

HCPs: attitudes, fear, knowledge of stigmaPLHIV: coping

QE/NC and qualitative, 13/27, mixed

Beaulieu [106], 2017, Canada, MI

HCPs, 111

I, PL, C; 3 3.5-h sessions over 2 months

Training modules led by consumer

Unclear

RCT, 22/27, Mixed

Bingham [107], 2018, New Zealand, MI

Students, 45

SB, PL, C; 12 h over 3 weeks

Guided clinical practice and discussion focused on attitudes and beliefs

Attitudes, fear, ability to manage condition

QE/NC, 10/27, mixed

Clarke [71], 2015, UK, MI

HCPs, 100

I, SB; 2 days over 2 weeks

Workshop

Attitudes, knowledge of condition, ability to manage condition

RCT and qualitative, 18/27, mixed

Economou [108], 2017, Greece, MI

Students, 678

I, SB, C; 120 h over 4 weeks

Lectures and clinical placement

Knowledge of condition, ability to manage condition, unclear

QE/NC, 18/27, decreased

Feeney [65], 2013, Ireland, substance abuse

Students, 119

SB, PL, C; 6 weeks

Clinic posting, patient presentations, discussion, assignments

Knowledge of condition, ability to manage condition

RCT and qualitative, 20/27, decreased

Fernandez [66], 2016, Malaysia, MI

Students, 102

I, PL, C; 3 h

Lecture, video or face-to-face presentation, discussion

Fear, knowledge of condition, knowledge of stigma

RCT, 17/27, decreased

Flanagan [67], 2016, USA, MI, substance abuse

HCPs, 27

C, PL; 1 h

Multimedia in-person performance by people living with a mental disorder

Fear, knowledge of stigma

RCT, 20/27, decreased

Friedrich [109], 2013, England, MI

Students, 1452

I, SB, PL, C; n/a

Lecture, testimonials, discussion, role-play providing clinical care

Knowledge condition, knowledge of stigma, ability to manage condition

QE/C, 15/27, mixed

Geibel [75], 2016, Bangladesh, HIV

HCPs, 300

I, SB, PL; 3 days

Workshop with lectures, discussion, participatory activities, & role-play providing clinical care

Attitudes, fear, knowledge of condition, knowledge of stigma, ability to manage condition

QE/NC, 15/27, decreased

Gulati [110], 2014, India, MI

Students, 135

SB, C; 2 weeks

Clinic posting

Ability to manage condition

Post, with control; 16/27; mixed

Happell [68], 2014, Australia, MI

Students, 201

SB, C; 12 weeks

Lecture delivered by stigmatized individual

Ability to manage condition

QE/C, 14/27, decreased

Hawke [89], 2014, Canada, MI

HCPs, students, clients, 137

C, PL; 50 min

Video performance and discussion

Knowledge of the condition

QE/NC and qualitative, 15/27, decreased

Iheanacho [111], 2014, Nigeria, MI

Students, 82

I, SB, PL; 4 days

lLctures, discussions, role-play providing clinical care

Knowledge of the condition

QE/NC, 15/27, mixed

Itzhaki [112], 2017, Israel, MI

Students, 101

I, SB, PL, C; 70 h over academic semester

Lectures, contact w/people with mental health disorders, skill building exercised, video on coping

Fear, knowledge of condition, ability to manage condition

QE/NC, 14/27, decreased

Jarvie [90], 2013, Canada, MI

Students, 49

PL, C; 2.5 h

Comedy show and discussion

Unclear

QE/NC, 16/27, mixed

Jaworsky [91], 2016, Canada, MI

Students, 67

SB, C; 2 h

Observed provision of HIV testing with PLHIV and testimonies

Ability to manage condition

QE/NC and qualitative, 14/27, decreased

Knaak [58], 2013, Canada, MI

HPCs and students, 58

I, PL, C; 2 h

Pamphlet, video screening of a play, discussion

Knowledge of condition

QE/NC, 13/27, decreased

Knaak [69], 2015, Canada, MI

HCPs, 230

I, SB, PL, C; 1 day

Workshop with lectures, skills training and testimonials

Attitudes, knowledge of condition, ability to manage condition

QE/NC, 13/27, decreased

Li [61], 2015, China, HIV

HCPs, 1760

I, PL, S; 12 months

Participatory training of champions from each hospital and provided universal precaution materials

Attitudes, fear, knowledge of condition, knowledge of stigma, ability to manage condition

RCT, 21/27, decreased

Li [62], 2013, China, HIV

HCPs, 1760

I, PL, S; 12 months

Participatory training of champions from each hospital and provided universal precaution materials

Attitudes, fear, knowledge of condition, knowledge of stigma, ability to manage condition

RCT, 22/27, decreased

Li [63], 2013, China, HIV

HCPs, 1760

I, PL, S; 12 months

Participatory training of champions from each hospital and provision of universal precaution materials

Attitudes, fear, knowledge of condition, knowledge of stigma, ability to manage condition

RCT, 23/27, decreased

Li [60], 2013, China, HIV

HCPs, 1760

I, PL, S; 12 months

Participatory training of champions from each hospital and provided universal precaution materials

Attitudes, fear, knowledge of condition, knowledge of stigma, ability to manage condition

RCT, 24/27, decreased

Li [63], 2013, China, HIV

HCPs, 1760

I, PL, S; 12 months

Participatory training of champions from each hospital and provided universal precaution materials

Attitudes, fear, knowledge of condition, knowledge of stigma, ability to manage condition

RCT, 24/27, decreased

Li [61], 2015, China, MI

HCPs, 77

I, SB, C; 85 h

Lectures, clinical placement,

Knowledge of condition, knowledge of stigma, ability to manage condition

QE/C, 18/27, decreased

Li [92], 2014, China, MI

HCPs, 99

I, PL, C; 1 day

Discussion and activities

Knowledge of condition, knowledge of stigma

QE/NC, 14/27, decreased

Lohiniva [93], 2016, Egypt, MI

HCPs, 347

I, SB, PL, C; 25 h over 4 months

Lectures, discussions, activities, training on universal precautions

Knowledge of condition, fear, knowledge of stigma

QE/C, 15/27, decreased

Lyons [113], 2015, Australia, MI

Students, 151 baseline, 161 follow-up

I, SB, C; 8 weeks

Lectures and clinical clerkship

Knowledge of condition, ability to manage condition

QE/NC, 15/27, decreased

MacCarthy [114], 2013, Canada, MI

HCPs, n/a

I, SB, PL; 1 day

Live or video lectures, discussion, and role-play service provision

Knowledge of condition, ability to manage condition

QE/NC, 7/27, decreased

Mak [72], 2015, Hong Kong, HIV

Students, 88

I, PL, or C; 1.5 h

Lecture and interactive game or in-person sharing session lead by PLHIV

Attitudes, knowledge of condition, knowledge of stigma

QE/NC, 17/27, decreased

Marzan-Rodriquez [115], 2016, Puerto Rico, HIV

Students, 20

I, SB, PL; 9 h over 3 days

Lectures, discussion, activities

Attitudes, knowledge of condition, knowledge of stigma

Process and qualitative, n/a

Michaels [116], 2014, USA, MI

HCPs, 131

I, PL; 3 h

Discussion, activities, video performance

Knowledge of condition, knowledge of stigma

RCT, 16/27, decreased

Morawska [117], 2013, Australia, MI, substance abuse

HPCs, educators, clients, 458

I, SB; 2 days

Workshop

Knowledge of condition, ability to manage condition

QE/NC, 13/27, decreased

Moxam [118], 2016, Australia, MI

Students, 79

PL, C; 5 days

Immersive camp outside of clinical setting

Unclear

QE/C, 15/27, decreased

Muzyk [119], 2017, USA, MI

Students, 74

I, PL; 6 sessions over 2 weeks

Discussion-based lectures with small group activities

Attitudes, knowledge of condition, knowledge of stigma

QE/NC, 12/27, mixed

Ng [27], 2017, Malaysia, MI

HCPs, 206

I, C; 5 min

Video

Fear, knowledge of condition

QE/NC, 17/27, decreased

Odeny [60], 2013, Kenya, HIV

PLHIV, 295

S; 12 months

Integration of HIV care with primary health care services

Institutionalized procedures

Repeated cross-sectional surveys, 17/27, mixed

Papish [70], 2013, Canada, MI

Students, 90

I, SB, PL, C; 4 weeks

Lecture, discussion, observed clinical care provision, videos, presentations

Attitudes, knowledge of condition, ability to manage condition

RCT, 21/27, decreased

Pulerwitz [64], 2015, Vietnam, HIV

Health facility staff, HCPs, 795

I, SB, PL, C; 1.5–2 days

Discussion, participatory activities, universal precaution skills building, development of a code of practice

Attitudes, fear, knowledge of condition, knowledge of stigma

QE/NC, 20/27, decreased

Shah [76], 2014, India, HIV

Students, 99

I, PL, C; 2 h over 2 weeks

Lectures, discussion, testimony

Attitudes, fear, knowledge of condition, knowledge of stigma

QE/C and process, 17/27, decreased

Shen [120], 2014, China, MI

Students, 325

SB, C; 8 week

Clinical clerkship

Ability to manage condition

QE/C, 14/27, decreased

Uebel [59], 2013, South Africa, HIV

HCPs and PLHIV, n/a

S; n/a

Integration of HIV care into primary health care

Institutionalized procedures

Process and Qualitative, n/a

Wakeman [121], 2017, USA, substance abuse

HCPs, 149

I, S; 1 year

Addition of services to improve care for substance abuse and an educational curriculum for providers

Knowledge about condition, unclear

QE/NC, 15/27, mixed

Winkler [73], 2017, Czech Republic, MI

Students, 60

I, PL, C; leaflet: n/a; in-person: 45 min; video: 7 min

Brochure, seminar discussion, or video

Attitudes, knowledge about condition, knowledge about stigma

RCT, 22/27, mixed

  1. Abbreviations: C contact, E empowerment, HCPs health care providers, HIV human immunodeficiency virus, I information-based, MI mental illness, PL participatory learning, PLHIV people living with HIV, QE/C quasi-experimental with a control group, QE/NC quasi-experimental with no control group, RCT randomized controlled trial, S structural, SB skills building; students, students receiving healthcare training