The effectiveness of a multipronged approach to tackle stigma against people with mental, neurological and substance use disorders in Kilifi, Kenya
Keywords: participatory videos
participatory approaches
mental health stigma
Kenya
stigma reduction interventions

Low and middle-income settings bear a larger burden of disability and mortality associated with mental, neurological and substance use disorders (MNSD). Stigma in MNSD is a barrier to good health and overall life outcomes for people with these disorders. Stigma occurs at all levels of the ecosystem, including individual, interpersonal, organizational, community and public policy levels. Until recently, methodologically acceptable evidence of stigma reduction interventions was mainly from high-income settings. Data from low-resource settings like sub-Saharan Africa are scarce.
A multipronged stigma reduction intervention was conducted to address public and structural stigma in Kilifi, Kenya. The intervention comprised: (i) participatory videos (PV) and face-to- face contact between people with MNSD and the general population to target public stigma (n=420) and (ii) a two-week training of primary healthcare workers on the use of the mental health Gap Action Programme Intervention Guidelines (mhGAP-IG) to address structural stigma (n=121).
Before implementing the interventions, a psychometric validation of Kiswahili versions of three stigma scales was conducted (n=620). Kiswahili versions of the original Reported and Intended Behaviours Scale (RIBS) and Mental Awareness Schedule Scale (MAKS) and a modified version of the Community Attitudes towards the Mentally Ill Scale (CAMI) were psychometrically appropriate for Kilifi’s general population.
The PV and face-to- face contact intervention was the first study in a low- and middle-income country to demonstrate that PV was feasible and effective in lowering stigma as measured by improved knowledge, attitudes and intended behaviour immediately after the intervention at a four month follow up. A qualitative evaluation of the drivers of this change established that the PV plus contact lowered stigma because (i) contact with people with lived experience in MNSD made the target population’s experiences real, (ii) the videos provided directions or solutions to long held questions about MNSD and (iii) the videos evoked emotions and made the participants reflect on their own experiences.
Primary healthcare workers’ stigma scores improved after the mhGAP-IG training. Patients level data (n=103) which were collected over a total period of 9 months showed that: (i) quality of life, as measured by the WHOQOL-Bref tool, improved over time, (ii) levels of disability as measured by the WHODAS- 12 scale, were reduced over time and (iii) severity of illness as measured by the Clinical Global Impression scale improved over time. Together, these findings provided evidence of effectiveness of a multipronged approach in tackling MNSD stigma among the public, patients, and primary healthcare workers, including a novel concept (PV) in a low resource setting. Additionally, they demonstrated that capacity building of primary healthcare workers can contribute to patient recovery, which is a key facilitator of stigma reduction.