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. 2024 Nov 18;18(1):35.
doi: 10.1186/s13033-024-00649-3.

Reducing stigma and improving access to care for people with mental health conditions in the community: protocol for a multi-site feasibility intervention study (Indigo-Local)

Maya Semrau  1 , Petra C Gronholm  2   3 , Julian Eaton  4   5 , Pallab K Maulik  6   7   8 , Bethel Ayele  9 , Ioannis Bakolis  3   10 , Gurucharan Bhaskar Mendon  11 , Kalpana Bhattarai  12 , Elaine Brohan  2 , Anish V Cherian  11 , Mercian Daniel  6 , Eshetu Girma  9 , Dristy Gurung  3   12 , Ariam Hailemariam  9 , Charlotte Hanlon  2   13 , Andy Healey  14 , Sudha Kallakuri  6 , Jie Li  15 , Santosh Loganathan  16 , Ning Ma  17 , Yurong Ma  15 , Amani Metsahel  18   19 , Uta Ouali  18 , Nahel Yaziji  14 , Yosra Zgueb  18   19   20 , Wufang Zhang  17 , Xiaotong Zhang  17 , Graham Thornicroft  2   3 , Nicole Votruba  21   22
Affiliations

Reducing stigma and improving access to care for people with mental health conditions in the community: protocol for a multi-site feasibility intervention study (Indigo-Local)

Maya Semrau et al. Int J Ment Health Syst. .

Abstract

Background: Stigma and discrimination towards people with mental health conditions by their communities are common worldwide. This can result in a range of negative outcomes for affected persons, including poor access to health care. However, evidence is still patchy from low- and middle-income countries (LMICs) on affordable, community-based interventions to reduce mental health-related stigma and to improve access to mental health care.

Methods: This study aims to conduct a feasibility (proof-of-principle) pilot study that involves developing, implementing and evaluating a community-based, multi-component, awareness-raising intervention (titled Indigo-Local), designed to reduce stigma and discrimination and to increase referrals of people with mental health conditions for assessment and treatment. It is being piloted in seven sites in five LMICs-China, Ethiopia, India, Nepal and Tunisia-and includes several key components: a stakeholder group workshop; a stepped training programme (using a 'Training of Trainers' approach) of community health workers (or similar cadres of workers) and service users that includes repeated supervision and booster sessions; community engagement activities; and a media campaign. Social contact and service user involvement are instrumental to all components. The intervention is being evaluated through a mixed-methods pre-post study design that involves quantitative assessment of stigma outcomes measuring knowledge, attitudes and (discriminatory) behaviour; quantitative evaluation of mental health service utilization rates (optional, where feasible in sites); qualitative exploration of the potential effectiveness and impact of the Indigo-Local intervention; a process evaluation; implementation evaluation; and an evaluation of implementation costs.

Discussion: The output of this study will be a contextually adapted, evidence-based intervention to reduce mental health-related stigma in local communities in five LMICs to achieve improved access to healthcare. We will have replicable models of how to involve people with lived experience as an integral part of the intervention and will produce knowledge of how intervention content and implementation strategies vary across settings. The intervention and its delivery will be refined to be feasible and ready for larger-scale implementation and evaluation. This study thereby has the potential to make an important contribution to the evidence base on what works to reduce mental health-related stigma and discrimination and improve access to health care.

Keywords: Access to care; Community awareness; Low- and middle-income countries; Mental health; Protocol; Stigma.

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Conflict of interest statement

Declarations Ethics approval and consent to participate The Indigo-Local study has full ethics approval from the PNM Research Ethics Subcommittee of King’s College London as part of the Indigo Partnership Research Programme (reference number HR-19/20–17252), as well as local ethics approvals in each of the seven Indigo Partnership sites. The research is being carried out in accordance with the Declaration of Helsinki. All participants are required to give their informed consent to participate in the study. Consent for publication Not applicable. Competing interests The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Overview of Indigo-Local intervention and its proposed pathways with outcomes
Fig. 2
Fig. 2
Example timeline and sequence for the key components of the Indigo-Local intervention
See this image and copyright information in PMC

Update of

References

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