Effect of a Contact-Based Education Intervention on Reducing Stigma Among Community Health and Care Staff In Beijing, China: Pilot Randomized Controlled Study
Authors: Zhang Wufang , Henderson Claire , Magnusdottir Erla , Chen Weiran , Ma Ning , Ma Hong , Thornicroft Graham 
Published: February 2021

Abstract
Background Increasing evidence suggests that the stigma associated with mental illness is a powerful barrier to accessing mental health care worldwide. Consistent findings in high-income countries have shown that contact with people with mental illness is the most effective intervention to reduce stigma. However, little evidence is available at present on how to reduce stigma in low- and middle-income countries, including China. In this context the aim of this paper is to report the findings of a pilot study to assess the feasibility of an intervention to reduce stigma among primary care and community healthcare staff in Beijing, China through a contact-based education intervention. Methods Community healthcare staff were recruited including primary health care staff and community administrators. They were randomly assigned to: (i) “education only” group, a lecture-based education (the control condition); or (ii) “education and contact” group, lectures plus contact with people with mental illness (the experimental condition). Each participant completed an assessment of mental health stigma related: knowledge (mental health knowledge schedule, MAKS); attitudes (mental illness: clinicians’ attitudes scale, MICA-4); and behavior (Reported and intended behavior scale, RIBS) before and after the intervention, with follow up at 1 month and 3 months after the intervention.Results A total of 121 community staff were recruited, including 67 workers in primary health care and 54 community workers. Both “education only” group and “education and contact” group showed improved knowledge after the intervention, MAKS scores increased by 1.77± 3.15 VS 2.46±2.49, respectively. There was no between–group difference in MAKS score. The “education and contact” group showed a significantly greater improvement for MICA and RIBS score than the “education only” group: the MICA score decreased by 4.07± 8.38 VS 8.41±7.48 (p=0.003), and the RIBS score increased by 2.28± 3.89 VS 4.57±3.53 (p=0.001), in the “education only” and the “education and contact” groups respectively, but the between group differences disappeared at 1 month and 3 months follow-up points. The positive effects on behaviour in both groups were sustained at 3 months.Conclusion The intervention to reduce stigma among the primary and community healthcare staff through a contact-based education intervention was feasible in Beijing. There is initial evidence from this study that contact based education with people with mental illness (including using recovery stories) appears to be an effective intervention for stigma-related attitudes and behavior. This approach needs to be replicated with longer follow-up to examine sustained changes over time. Trial Registration: ISRCTN13779136, https://doi.org/10.1186/ISRCTN13779136, Effect of a contact-based education intervention on reducing stigma among community health and care staff in Beijing, China