ArticlePLOS mental health2026
Multi-level mental health-related stigma interventions in healthcare systems through the involvement of people with lived experiences: Mixed-methods pilot findings from international study of discrimination and stigma outcomes (INDIGO) study in Nepal.
Article in PLOS mental health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Mental health-related stigma is a barrier to access to mental health services. This mixed-methods pre-post pilot feasibility study aimed to adapt and pilot-test a multi-level anti-stigma intervention across three levels of the health system to assess its feasibility and potential to reduce mental health-related stigma in Nepal. Contact-based interventions integrating people with lived experience in mental health and stigma training packages were adapted and implemented, targeting female community health volunteers (n = 19), primary healthcare workers (n = 9), and psychiatrists and psychiatric nurses (n = 9). Stigma-related knowledge, attitudes, and competency were measured pre- and post-training with follow-up at 3 and 6 months. Qualitative interviews were conducted with 43 participants across levels. In INDIGO Local, knowledge score increased from 20.43 (95% CI: 20.0-20.9) at pre-training to 25.11 (95% CI: 23.83-26.17) at six months. In INDIGO Primary, the intended behavior increased from 16.67 (95% CI: 14.73-19.27) at pre-training to 18.88 (95% CI: 17.69-20.31) at post-training, while SDS mean score decreased from 39.26 to 20.62. The PCP's helpful behavior increased, and harmful behavior decreased. The knowledge and OSCE mean score in INDIGO READ-MH increased from 12.67 (95% CI: 10.36 -14.97) at baseline to 14.67 (95% CI: 13.28-16.05) at the post-training and from 2 (95% CI: 1.62-2.38) at pre-training to 9 (95% CI: 7.56-10.44) at post- training, respectively. The ASTAD subscale increased at three months, except for motivation and work satisfaction, which decreased at post-training. Qualitative data highlighted the positive attitudinal shift following the interventions, with strong emphasis on PWLE involvement. Overall, the providers perceived the training as feasible and appropriate within Nepal's health system. However, whilst they reported more positive perceptions towards persons with mental health conditions following the interventions, they also identified barriers to effective mental health care, such as insufficient availability of medicines, limited human resources, or separate counseling rooms.
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