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The Castlegar and District Health Centre, which is part of the Interior Health Authority of British Columbia, responded to a Request for Interest (RFI) issued by Opening Minds in the spring of 2009. OM was looking for existing programs aimed at reducing stigma among its initial target groups of healthcare providers or youth. The Interior Health Authority did not have an existing anti-stigma program, but key staff had become aware of the need for one in its hospital and healthcare settings in the area, and offered their locations as test sites if an anti-stigma program could be identified.
The Ontario Central Local Health Integration Network (LHIN) also responded to the RFI. It had created and delivered a promising anti-stigma training program and helped make arrangements for OM to evaluate its effectiveness at reducing stigma in the winter of 2010. The program was delivered to healthcare workers in hospital and clinic locations north of Toronto, and upon completion of the evaluation, proved to be successful at reducing stigma. In responding to OM’s request, the Central LHIN was willing to share its curriculum and materials with other organizations in Canada. As a result, B.C.’s Interior Health Authority made arrangements to deliver this program at hospitals and healthcare facilities in seven communities in the central and south eastern region of British Columbia.
The program itself included a PowerPoint presentation, several activities to engage participants and help them begin to think of their attitudes towards mental illness, as well as a particular type of education called contact-based education, which has been shown internationally to be successful at reducing stigma. Contact-based education involves an individual with a mental illness sharing his/her personal story with the audience and then answering questions.
The program in B.C. was arranged and delivered by Cheryl Whittleton, RN BSN, from Castlegar during the fall of 2010. To provide contact-based education to participants, Cheryl worked with a woman from Penticton who has a mental illness and was willing to tell her personal story. The two of them traveled to all identified locations. The training sessions were approximately 1.5 hours in length, and targeted multidisciplinary healthcare teams working within the emergency and acute departments, including nursing staff and physicians.
The goal was to educate 450 employees in the identified trial locations: Castlegar and District Health Center and Emergency Department (CDHC), Kelowna General Hospital (KGH), Penticton Regional Hospital (PRH), Cranbrook Regional Hospital (EKRH), Shuswap Lake General Hospital (SLGH), Cariboo Memorial Hospital (CMH), and Kamloops Royal Inland Hospital (RIH). The selection of emergency departments for this pilot was based on the desire to have a cross section of facilities that represented Interior Health’s wide geographic area and also included representation from larger tertiary sites and smaller community health centres. Among the participants who received the program, the largest numbers were from Cranbrook (30%) and Kamloops (23%) followed by Kelowna (15%), Castlegar (11%), Penticton (8%) Williams Lake (7%) and Salmon Arm (6%).
Participants were asked to complete a short survey before their training session began and a post survey when the session was complete. The survey included 19 questions which were measured with a 5-point Likert scale pertaining to attitudes towards people with mental illness. Six additional questions measured attitudes towards recovering from mental illness, and another three questions compared stigma related to mental health/illness in comparison to stigma related to diabetes. Type II Diabetes is a chronic physical condition which healthcare providers (HCPs) are taught may be partially controlled and even preventable by changes in lifestyle. There is a common perception among healthcare providers that mental illness can also be prevented by lifestyle changes, thus comparable to lack of self-control among people with diabetes.
To create scale scores, items were summed across all surveys having complete data. The pre/post-test Chronbach’s alpha for the 19 questions about attitudes toward mental illness were good (0.84 and 0.81 respectively) indicating a sound level of reliability in the psychometric test score for the sample of respondents that completed the survey. A paired t-test was used to analyze mean scores. A low score for the attitude scale indicated less stigma. A McNemar-Bowker exact test of symmetry was used to analyze the categorical item by item scores. For the latter analysis, the original five Likert responses were recorded into three categories (strongly agree and agree, unsure, strongly disagree and disagree). A threshold was created to measure success, defined as, the proportion of respondents who obtained 80% or more correct (non-stigmatizing) answers on the post-test who had been below this threshold on the pre-test (see Figure 1). For those who moved across the threshold, the majority (at least 80%) of their answers were non-stigmatizing.
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