Feasibility, acceptability, and initial efficacy of a knowledge-contact program to reduce mental illness stigma and improve mental health literacy in adolescents

https://doi.org/10.1016/j.socscimed.2011.04.006Get rights and content

Abstract

The purpose of this school-based cluster-randomized trial was to determine the initial acceptability, feasibility, and efficacy of an existing community-based intervention, In Our Own Voice, in a sample of US adolescent girls aged 13–17 years (n = 156). In Our Own Voice is a knowledge-contact intervention that provides knowledge about mental illness to improve mental health literacy and facilitates intergroup contact with persons with mental illness as a means to reduce mental illness stigma. This longitudinal study was set in two public high schools located in a southern urban community of the U.S. Outcomes included measures of mental illness stigma and mental health literacy. Findings support the acceptability and feasibility of the intervention for adolescents who enrolled in the study. Findings to support the efficacy of In Our Own Voice to reduce stigma and improve mental health literacy are mixed. The intervention did not reduce mental illness stigma or improve mental health literacy at one week follow up. The intervention did not reduce mental illness stigma at 4 and 8 weeks follow up. The intervention did improve mental health literacy at 4 and 8 weeks follow up. Previous studies have assessed the preliminary efficacy In Our Own Voice among young adults; rarely has In Our Own Voice been investigated longitudinally and with adolescents in the United States. This study provides initial data on the effects of In Our Own Voice for this population and can be used to further adapt the intervention for adolescents.

Introduction

Reducing mental illness stigma and improving mental health literacy are national health objectives that are necessary to enhance the health outcomes of adolescents and future generations of young adults (President’s New Freedom Commission on Mental Health, 2003, U.S. Department of Health and Human Services, 1999, U.S. Department of Health and Human Services, 2000). Prior research has confirmed that adolescents report moderate levels of mental illness stigma and low mental health literacy (Chandra and Minkovitz, 2006, Pinto-Foltz et al., 2010). Adolescents with mental illness fear the discovery of their mental illness by their peers, school personnel, and others in their social network (Moses, 2010). Only 30% of the adolescents with mental illness enter mental health treatment (U.S. Department of Health and Human Services, 1999, U.S. Department of Health and Human Services, 2000). Of the adolescents who enter mental health treatment, high mental illness stigma and low mental health literary are key factors that contribute to premature termination of mental health treatment (Corrigan, 2004, U.S. Department of Health and Human Services, 1999, U.S. Department of Health and Human Services, 2000). However, most adolescents will continue to forgo beneficial and life-saving mental health treatment unless barriers to mental health treatment, mental illness stigma and mental health literacy, are addressed (Institute of Medicine, 2002).

Among adolescents in high school, mental health treatment seeking is significantly influenced by the opinions of peers and influential adults in the adolescent’s social network (Moses, 2010). Developmental theories, like Erikson’s stages of psychosocial development (1980) and Bronfrenbrenner’s bioecological model (1979), underscore the contributions of peers and influential adults on adolescent help seeking behavior. Within the context of mental illness stigma, Pescosolido, Martin, Lang, and Olafsdottir’s (2008) Framework Integrating Normative Influences on Stigma (FINIS) illustrates the multiple levels, beyond the individual, that influence mental illness stigma. Studies among adolescents find that adolescents prefer to discuss mental health issues with their peers, but are reluctant to do so because they anticipate negative and stigmatizing responses (Marcell and Halpern-Felsher, 2007, Pinto-Foltz et al., 2010, Wisdom and Agnor, 2007). Social interactions are necessary for mental illness stigma to occur and the adolescent’s social network is influential (Pescosolido & Martin, 2007). Thus, utilizing a universal approach that includes adolescent peers with and without mental illness may effectively promote an inclusive adolescent peer environment that fosters help seeking for mental illness (Crosnoe & McNeely, 2008).

Section snippets

Intervention studies with adults

Research studies that investigate the efficacy of interventions to reduce mental illness stigma and improve mental health literacy have been conducted with adults (Pinto-Foltz & Logsdon, 2009a). A variety of approaches to improve these constructs have been proposed. Studies that focus on mental illness stigma have been primarily based on Allport’s (1954) intergroup contact theory. Intergroup contact theory suggests that contact under optimal conditions—equal status between groups, common goals,

Design

This school-based study utilized a non-blinded cluster-randomized trial design. Since adolescents interact with other adolescents within their grade levels, randomization of subjects into treatment groups was not feasible and increased the risk of diffusion of treatment (Murray, 1998). For this study, there were four groups. For the first school, all ninth grade participants at one school formed the intervention group, while all tenth grade participants at the same school formed the control

Results

A total of 156 female adolescents volunteered for the study: 95 in the intervention groups and 61 in the control groups. Overall, our sample consisted of mostly (69%) white females with a mean age of 15 years (SD = .67) of moderate to high socioeconomic level, and living in two parent homes.

Discussion

This study examined the feasibility, acceptability, and efficacy of a widely used and existing community-based knowledge-contact intervention. Study findings support the feasibility of retaining adolescents over 10 weeks and administering the intervention to adolescents who enrolled in the study. The ability to enroll participants was less feasible. The requirement of parental consent was an artifact of the research process and needed to administer the intervention and collect outcome data.

Acknowledgments

We would like to thank our community partners the National Alliance on Mental Illness-Tennessee, Jefferson County Public Schools, and Lisa and Michael Corbin. We would also like to thank Drs. Robert Topp, Paige Hertweck, and Peggy El-Mallakh for their thoughtful feedback on the project and Dr. Valerie McCarthy and Ms. Laura Flamini for assistance with data collection.This study was funded by the Midwest Nursing Research Society Dissertation Research Grant and Sigma Theta Tau International, Iota

References (71)

  • U. Bronfenbrenner

    The ecology of human development: Experiments by nature and design

    (1979)
  • P. Bruckenthal et al.

    Assessing treatment fidelity in pilot studies assist in designing clinical trials: an illustration from a nurse practitioner community-based intervention for pain

    Advances in Nursing Science

    (2007)
  • A. Chandra et al.

    Stigma starts early: gender differences in teen willingness to use mental health services

    Journal of Adolescent Health

    (2006)
  • C. Chang

    Increasing mental health literacy via narrative advertising

    Journal of Health Communication

    (2008)
  • M.E. Coles et al.

    Addressing patient needs: The role of mental health literacy

    American Journal of Psychiatry

    (2008)
  • V.S. Conn et al.

    Publishing pilot intervention work

    Western Journal of Nursing Research

    (2010)
  • P. Corrigan

    How stigma interferes with mental health care

    American Psychologist

    (2004)
  • P. Corrigan et al.

    Prejudice, social distance, and familiarity with mental illness

    Schizophrenia Bulletin

    (2001)
  • P. Corrigan et al.

    Will filmed presentations of education and contact diminish mental illness stigma?

    Community Mental Health Journal

    (2007)
  • P. Corrigan et al.

    Mental illness stigma: problem of public health or social justice?

    Social Work

    (2005)
  • R. Crosnoe et al.

    Peer relations, adolescent behavior, and public health research and practice

    Family Community Health

    (2008)
  • J. DeSocio et al.

    Teaching children about mental health and illness: a school nurse health education program

    Journal of School Nursing

    (2006)
  • E.H. Erickson

    Identity and the life cycle

    (1980)
  • V. Essler et al.

    Using a school-based intervention to challenge stigmatizing attitudes and promote mental health in teenagers

    Journal of Mental Health

    (2006)
  • W.R. Fisher

    Human communication as narration: Toward a philosophy of reason, value, and action

    (1987)
  • J.N. Giedd et al.

    Anatomical brain magnetic resonance imaging of typically developing children and adolescents

    Applied Brain Imaging

    (2009)
  • E.P. Holmes et al.

    Changing attitudes about schizophrenia

    Schizophrenia Bulletin

    (1999)
  • A.F. Jorm et al.

    Mental health literacy: a survey of the public’s ability to recognize mental disorders and their beliefs about the effectiveness of treatment

    Medical Journal of Australia

    (1997)
  • C.M. Kelly et al.

    Improving mental health literacy as a strategy to facilitate early intervention for mental disorders

    Medical Journal of Australia

    (2007)
  • S.S. Leff et al.

    Intervention integrity: new paradigms and applications

    School Mental Health

    (2009)
  • B.G. Link et al.

    Public conceptions of mental illness: labels, causes, dangerousness, and social distance

    American Journal of Public Health

    (1999)
  • B.G. Link et al.

    Measuring mental illness stigma

    Schizophrenia Bulletin

    (2004)
  • C.E. Mann et al.

    Putting the person back into psychopathology: an intervention to reduce mental illness stigma in the classroom

    Social Psychiatry and Psychiatry Epidemiology

    (2008)
  • F.J. Molnar et al.

    Does analysis using “last observation carried forward” introduce bias in dementia research?

    Canadian Medical Association Journal

    (2008)
  • Cited by (0)

    View full text