Ending Discrimination Against People with Mental and Substance Use Disorders The Evidence for Stigma Change (2016) / Chapter Skim
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5 Research Strategies
5 Research Strategies
Pages 93-112
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The chapter concludes with suggested areas for future research and evaluation. FORMATIVE RESEARCH Launching a large-scale stigma change strategy can imbue an organization with a sense of urgency and excitement.
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Community-Based Participatory Research Beyond conducting an assessment of the potential audience, formative research is a way to facilitate relationships between the researchers and their intended audience. Incorporating formative research in the design phase of a multicomponent national strategy can ensure that the strategy is targeted to the most appropriate populations or subgroups; and that the voices of stakeholders, particularly those with lived experience, are included in the planning and evaluation of the interventions.
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One way to understand what influences local communities and to tailor research and interventions to local areas is to involve local opinion leaders in the design and evaluation of interventions. In keeping with a "grassroots" approach to designing their national stigma reduction initiative, "Opening Minds," the Mental Health Commission of Canada evaluated the outcomes of many local initiatives and invested in scaling-up and replicating those that demonstrated effectiveness (Pietrus, 2013)
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. Program evaluators assessing outcomes of addictions stigma change efforts often rely on measures that have been adapted or developed specifically for studies about substance use (Pearson, 2015)
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For example, an instrument or scale may be intended to measure public, self, or structural stigma; perceived attitudes of other people or one's own attitudes; or discrimination that is experienced or anticipated. Findings related to construct validity in stigma research are mixed.
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This section briefly covers designs for evaluating the effectiveness of interventions and issues that could affect the research designs, including social desirability, external validity, and fidelity or internal validity. Research Designs Research designs used for evaluating the effectiveness of stigma reduction interventions are the same as those used in other social and behavioral sciences.
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. This can introduce bias in measures, and it can also pose problems in research designs that include pre- and posttest assessment or repeated measure designs when study participants may anticipate the desired response (Corrigan and Shapiro, 2010)
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Consumers' stories about their mental health problems and of their contact with a range of services had the greatest impact on the target audiences in terms of reducing mental illness stigma. External Validity Studies designed to understand social phenomena and to assess social interventions are often conducted with restricted populations (e.g., college students)
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. Monitoring Changes in Social Norms at the Population Level In earlier chapters, we presented findings from studies that examined social norms (public attitudes, beliefs, and behaviors)
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. Due to the low cost and relative ease of use, researchers need to continue to explore social media platforms for monitoring behavioral health conditions, assessing public attitudes toward people with the conditions, and delivering anti-stigma messages (Jashinsky et al., 2014; Korda and Itani, 2013)
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. Constructs of the lived experience of stigma include perceived public stigma, experienced and anticipated discrimination, self-devaluation, and stigma avoidance (Brohan et al., 2010; Luoma, et al., 2013)
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While some comparative stigma research suggests that there are common elements across stigmatized conditions (Fife and Wright, 2000; Pescosolido et al., 2010) , more work is needed to identify the unique dimensions of stigma related to substance use disorders and what it has in common with mental illness and other stigmatizing conditions.
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From page 105... ...
Examples include discriminatory legislation that places restrictions on jury service, voting, holding political office, and parental custody rights; and health datasets that document negative outcomes of structural stigma on individuals, including treatment utilization, chronicity, or persistence of symptoms (e.g., Hatzenbuehler and Link, 2014; Hatzenbuehler et al., 2014)
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. Results of a national survey examining the prevalence of mental disorders and treatment utilization found that approximately 10 percent of people who reported not seeking treatment avoided treatment for their disorders because they were afraid it would have negative impacts on neighbors and their jobs (Substance Abuse and Mental Health Services Administration [SAMHSA]
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. Public stigma also influences a family's previous experiences with treatment providers and with others in wider family and social circles.
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• Do early childhood, school-based stigma change initiatives influ ence the development of negative behavioral health social norms later in life? • Given that many contact-based, anti-stigma initiatives come from within peer and activist communities, what are the factors that contribute to success of contact-based programs?
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Also important, longitudinal data would support efforts to monitor stigma change over time in the United States, including change across
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SAMHSA will identify other research questions concerning its previous initiatives to improve behavioral health social norms. SAMHSA has articulated its strategic program initiatives in areas of prevention of substance abuse and mental illness, health care and health systems integration, trauma and justice, recovery support, health information technology, and workforce development (Substance Abuse and Mental Health Services Administration, 2014)
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RESEARCH STRATEGIES 111 perspectives at the national, regional, or local level; how it fills a gap in the knowledge base; how it addresses an urgent or longer term needs; feasibility given existing resources, including the level of financial investment and risk; and potential value added in terms of economics, benefits to the end users, or support of other mission goals and objectives. Subsequent steps involve publishing the selection criteria; developing a process for submitting proposals for future research projects; soliciting input from all stakeholders and all levels of organizations; developing a prioritized list of research projects that are based on the selection criteria and fit with mission, vision, and goals; and finally the identification of potential tradeoffs and alternate scenarios based on potential or varying levels of investments.
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