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