Mittal Dinesh, Corrigan Patrick, Drummond Karen L, Porchia Sylvia, Sullivan Greer
Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA University of Arkansas for Medical Sciences, Little Rock, AR, USA
Illinois Institute of Technology, Chicago, IL, USA.
Health Educ Behav. 2016 Oct;43(5):577-83. doi: 10.1177/1090198115614316. Epub 2015 Oct 31.
Interventions involving contact with a person who has recovered from mental illness are most effective at reducing stigma. This study sought input from health care providers to inform the design of a contact intervention intended to reduce provider stigma toward persons with serious mental illness. Using a purposive sampling strategy, data were collected from providers at five Veterans Affairs hospitals in the southeastern United States. Seven focus groups were conducted, and 83 health care providers participated. A semistructured interview guide was used to elicit providers' opinions about the target group of a contact intervention for providers, what providers would consider a credible contact, the preferred format for delivery, the usefulness of potentially tailoring the intervention to a specific facility, and how to measure change in clinical behaviors. Focus group data were analyzed using rapid data analysis techniques. Participants uniformly recommended a broad target audience for the stigma-reduction intervention, including all primary care and specialist providers. They suggested that the person providing the "lived experience" for the contact intervention should be either a health care provider or a patient with serious mental illness. Face-to-face presentation was favored, but video presentation was considered more feasible. Participants stated that information about local disparities in care rendered to patients with or without mental illness would convince providers of how stigma may be a contributing factor to these disparities. Multiple training opportunities were favored, while mandatory training was disliked. Standard stigma-reduction interventions with subgroups of the general public (e.g., providers) may need to be modified for optimum subgroup effectiveness.
涉及与从精神疾病中康复的人接触的干预措施在减少污名方面最为有效。本研究征求了医疗服务提供者的意见，以指导一项旨在减少医疗服务提供者对严重精神疾病患者污名的接触干预措施的设计。采用目的抽样策略，从美国东南部五家退伍军人事务医院的医疗服务提供者那里收集数据。进行了七个焦点小组讨论，83名医疗服务提供者参与其中。使用半结构化访谈指南来征求医疗服务提供者对针对医疗服务提供者的接触干预目标群体的看法、医疗服务提供者认为可信的接触对象、首选的交付形式、针对特定机构量身定制干预措施的有用性，以及如何衡量临床行为的变化。焦点小组数据采用快速数据分析技术进行分析。参与者一致建议减少污名干预措施的目标受众应广泛，包括所有初级保健和专科医疗服务提供者。他们建议为接触干预提供“亲身经历”的人应该是医疗服务提供者或患有严重精神疾病的患者。面对面介绍受到青睐，但视频介绍被认为更可行。参与者表示，关于为有或没有精神疾病的患者提供的当地护理差异的信息将使医疗服务提供者相信污名可能是这些差异的一个促成因素。多个培训机会受到青睐，而强制培训则不受欢迎。针对一般公众亚群体（如医疗服务提供者）的标准减少污名干预措施可能需要进行修改，以实现最佳的亚群体效果。
