Building and Delivering Successful Anti-stigma Programs for Healthcare Providers: Results of a Qualitative Study

Purpose

Opening Minds coordinated and funded a series of evaluation projects of anti-stigma programs for healthcare providers, one of OM’s key target groups, with the purpose of determining program outcomes (Pietrus, 2013). While OM’s partner programs in general have shown overall evidence of positive change, there has been considerable variation among the programs in terms of their effectiveness. As well, among the programs that have had the strongest results, they were not uniform with respect to their target audience, program content, program length, type of social contact provided or program setting (see Knaak, Modgill & Patten, 2014; Pietrus, 2013).

As such, a qualitative investigation was undertaken to examine programs in greater depth and detail. The purpose of the qualitative research was to identify best practices and strategies among OM’s partner programs, to identify key program ingredients for effective stigma reduction, to better understand why some programs were more successful than others and to gain further theoretical insight to the process of building successful anti-stigma programs for healthcare providers.

Methodology

The purpose of the research was to explicate the process for designing and delivering successful antistigma programs for healthcare providers. This included identifying critical components related to program design (i.e., content ingredients necessary for stigma reduction), critical components related to program delivery and other key ingredients, strategies, practices or processes integral to a program’s success. A qualitative approach was decided as the most suitable as we were seeking to understand programs in greater depth and detail, and were also interested in learning about the whats, hows and whys of anti-stigma programming for healthcare providers from the perspectives and experiences of program stakeholders themselves. The specific methodology chosen for the research was that of grounded theory, as it is a good methodological fit for questions of process and where inductive theorybuilding is a main research goal (Charmaz, 2006; Strauss & Corbin, 1988).

The primary source of data was in-depth interviews with stakeholders from OM’s partner programs (see for details about partner programs included in this research). A total of 23 such interviews were conducted — 17 with program leads and 6 with persons with lived experience of a mental illness involved in program delivery. The purpose of these interviews was to gather information about the program, solicit opinions about best practices, key ingredients, as well as challenges and successes in program implementation. Interviews were tape recorded with respondents’ informed consent and transcribed by the researcher. All interviews were conducted with a promise of confidentiality and anonymity in any reporting of results.

In addition to in-depth interviews with program stakeholders, the following supplementary data sources were used:

• direct program observation (n=8; 4 programs were observed in person via site visits; 4 programs were observed via video);
• document inventory and review (n=48) including facilitator’s manuals, PowerPoint presentations, speaker recruitment/training packages, course syllabi, handouts, videos/links to videos, partnerproduced reports, marketing materials, and other program materials;
• analysis of qualitative feedback (i.e., open ended questions on evaluation surveys) from program participants across the various programs (n=1812);
• supplementary follow-up/clarification interviews to glean additional program details or information needed for saturation of emerging categories and themes (n=12).

Data collection activities took place between January 2013 and November 2013. Data analysis proceeded via grounded theory’s constant comparison method, which is characterized by a specific procedure for coding. Open (line-by-line) coding was first undertaken to identify themes and key ideas in the data. Axial coding was then employed to specify the thematic categories and to describe each theme to the point of theoretical saturation.Then, selective and theoretical coding was used to identify the relations among the categories/themes. A single coder was used. The analysis led to the generation of a model articulating the process for building and delivering successful anti-stigma programs for healthcare providers. This process, along with its accompanying steps, strategies and imbedded best practices, is described below.

Key Findings

The findings from this research led to the generation of a theoretical model articulating the process of designing and delivering successful anti-stigma programming to healthcare providers. This includes both practicing healthcare providers as well as healthcare providers-in-training (i.e., students). As some differences emerged between student and practicing healthcare provider programs with respect to key practices and strategies for successful programming, two versions of the process model were generated – one for designing and delivering successful anti-stigma programs for practicing healthcare providers (Figure 1) and one for designing and delivering successful anti-stigma programs for student healthcare providers (Figure 2).

As the key elements for both models are highly similar and overlapping, findings are discussed together, with differences noted where applicable. As highlighted in the model(s), the process for designing and delivering successful anti-stigma programming for healthcare providers can be described through the following main themes or ‘stages’:

• identifying key learning needs;
• preparing and planning effectively;
• getting leadership on board (practicing healthcare provider programs only);
• maximizing participation (practicing healthcare provider programs only);
• building the program using key ingredients for effective stigma reduction;
• delivering the program in a way that maximizes audience receptivity;
• maintaining the momentum using best practices and strategies for program sustainability; and
• being aware of/attending to external factors and ongoing challenges.
• Each of the key themes or stages have a number of embedded best practices, strategies and/or activities that were identified by respondents as being important for program success.