Evidence for effective interventions to reduce mental Healthrelated stigma and discrimination in the medium and long term : Systematic review

Publisher Copyright: Copyright © 2015 The Royal College of Psychiatrists, unless otherwise stated.Background Most research on interventions to counter stigma and discrimination has focused on shortterm outcomes and has been conducted in highincome settings. Aims To synthesise what is known globally about effective interventions to reduce mental illnessbased stigma and discrimination, in relation first to effectiveness in the medium and long term (minimum 4 weeks), and second to interventions in lowand middleincome countries (LMICs). Method We searched six databases from 1980 to 2013 and conducted a multilanguage Google search for quantitative studies addressing the research questions. Effect sizes were calculated from eligible studies where possible, and narrative syntheses conducted. Subgroup analysis compared interventions with and without social contact. Results Eighty studies (n = 422 653) were included in the review. For studies with medium or longterm followup (72, of which 21 had calculable effect sizes) median standardised mean differences were 0.54 for knowledge and-0.26 for stigmatising attitudes. Those containing social contact (direct or indirect) were not more effective than those without. The 11 LMIC studies were all from middleincome countries. Effect sizes were rarely calculable for behavioural outcomes or in LMIC studies. Conclusions There is modest evidence for the effectiveness of antistigma interventions beyond 4 weeks followup in terms of increasing knowledge and reducing stigmatising attitudes. Evidence does not support the view that social contact is the more effective type of intervention for improving attitudes in the medium to long term. Methodologically strong research is needed on which to base decisions on investment in stigmareducing interventions.Peer reviewe

GPs’ Interactional Styles in Consultations with Dutch and Ethnic Minority Patients

The aim of this study was to examine interactional styles of general practitioners (GPs) in consultations with Dutch patients as compared to ethnic minority patients, from the perspective of level of mutual understanding between patient and GP. Data of 103 transcripts of video-registered medical interviews were analyzed to assess GPs’ communication styles in terms of involvement, detachment, shared decision-making and patient-centeredness. Surveys were used to collect data on patients’ characteristics and mutual understanding. Results show that overall, GPs communicate less adequately with ethnic minority patients than with Dutch patients; they involve them less in decision-making and check their understanding of what has been discussed less often. Intercultural consultations are thus markedly distinguishable from intracultural consultations by a lack of adequate communicative behavior by GPs. As every patient has a moral and legal right to make informed decisions, it is concluded that GPs should check more often whether their ethnic minority patients have understood what has been said during the medical consultation

Cancer patients’ experiences of using an Interactive Health Communication Application (IHCA)

Interactive Health Communication Applications (IHCAs) are increasingly used in health care. Studies document that IHCAs provide patients with knowledge and social support, enhance self- efficacy and can improve behavioural and clinical outcomes. However, research exploring patients’ experiences of using IHCAs has been scarce. The aim of this study was to explore cancer patients’ perspectives and experiences related to the use of an IHCA called WebChoice in their homes. Qualitative interviews were conducted with infrequent, medium and frequent IHCA users—six women and four men with breast and prostate cancer. The interviews were transcribed and analyzed inspired by interactionistic perspectives. We found that some patients’ perceived WebChoice as a “friend,” others as a “stranger.” Access to WebChoice stimulated particularly high frequency users to position themselves as “information seeking agents,” assuming an active patient role. However, to position oneself as an “active patient” was ambiguous and emotional. Feelings of “calmness”, “normalization of symptoms”, feelings of “being part of a community”, feeling “upset” and “vulnerable”, as well as “feeling supported” were identified. Interaction with WebChoice implied for some users an increased focus on illness. Our findings indicate that the interaction between patients and an IHCA such as WebChoice occurs in a variety of ways, some of which are ambivalent or conflicting. Particularly for frequent and medium frequency users, it offers support, but may at the same time reinforce an element of uncertainty in their life. Such insights should be taken into consideration in the future development of IHCAs in healthcare in general and in particular for implementation into patients’ private sphere

They are not all same: variations in Asian consumers' value perceptions of luxury brands

Asian markets are steadily becoming key growth regions for luxury brands. However, despite the growth, many luxury brand firms are unable to obtain the desired economic returns through their marketing strategies in Asia. Often these firms treat consumers across Asian markets as homogenous groups, which could lead to inaccurate luxury brand management strategy. Additionally, there is limited understanding of consumer value perceptions toward luxury brands across the Asian markets. Employing impression management theory and the horizontal/vertical collectivistic cultural distinctions, this study examines differences and similarities in constituent luxury value perceptions across three prominent Asian markets, namely China, India, and Indonesia. The results of a quantitative survey conducted with 626 real luxury consumers in these three countries identify variations in perceptions of symbolic, experiential, and functional value of luxury brands. The study contributes to knowledge on constituent luxury value perceptions, along with providing theoretical explanations for the differences between consumers across Asian markets. With the emerging novel insights on Asian consumers, luxury brand firms can align their marketing strategies to respective markets by leveraging the similarities and differences in consumer value perceptions. This approach, informed by empirical evidence, will enhance luxury brands’ competitiveness and profit opportunities in the high-growth Asian markets. The study identifies a number of future research directions

Physical and mental health correlates of status incongruence

The report explored the relationship between status incongruence, the degree of similarity of rankings on paired status variables, and diverse interview-based measures of physical and mental health. The subjects in the study were some 169 adult men; one half of them came from a national survey sample, while the other half represented an arthritis clinic sample with patients and controls. Data on education, occupation, income, and perceived social class (PSC) were used to construct several status incongruence indices. The major findings were: 1. Neither rheumatoid arthritis nor ulcer were related to status incongruence. 2. Education-occupation incongruence showed by far the strongest association with poor mental health. Among the two types of incongruence, education > occupation and occupation > education, the former had particularly poor mental health. 3. Education-PSC, occupation-PSC, education-income, and occupation-income types of incongruence showed weaker associations. Direction of incongruence made a difference in the education-PSC comparison: the education > PSC incongruent group had poorer mental health than the PSC > education incongruent group. Ce rapport étudie la relation entre la discordance du status («status incongruence»), le degré de similitude d'évaluation de variables couplées du status et diverses mesures de la santé physique et mentale basées sur des interviews. Les sujets de l'étude étaient 169 hommes adultes dont la moitié provenait d'un échantillon d'une investigation nationale, tandis que l'autre moitié représentait un échantillon d'une clinique d'arthritiques avec des patients et des cas de contrôle. Des données sur l'éducation, l'occupation, le revenu et la classe sociale (perceived social class = PSC) furent utilisées pour l'élaboration de divers indices de discordance de status. Les résultats principaux furent: 1) Ni l'arthrite rhumatoïde ni l'ulcère n'étaient reliés à la discordance du status. 2) La discordance éducation-occupation était de loin la plus étroitement associée à une santé mentale défaillante. Parmi les deux types de discordance, éducation > occupation et occupation > éducation, le premier était caractérisé par une santé mentale particulièrement mauvaise. 3) Les types de discordance éducation-PSC, occupation-PSC, éducation-revenu et occupationrevenu étaient plus faiblement associés. La direction de la discordance faisait une différence dans la comparaison éducationPSC: le groupe de discordance éducation > PSC se distinguait par une santé mentale moins bonne que le groupe de discordance PSC > éducation. Der Bericht gibt die Untersuchung der Beziehung zwischen der Unausgeglichenheit innerhalb des Sozialstands, dem Ausmaß der Ähnlichkeit von Einstufungen durch vorgegebene Gegensatzpaare von Statusmerkmalen und verschiedenen, auf Interviewbasis begründeten Einschätzungen der körperlichen und seelischen Gesundheit wieder. Die Probanden der Studie waren 169 erwachsene Männer; die Hälfte von ihnen stammte aus einer staatlichen Begutachtungsgruppe, die andere Hälfte verkörperten Patienten und Kontrollpersonen aus einer Arthritisklinik. Daten über Erziehung, Beruf, Einkommen und beurteilte Sozialklasse (perceived social class = PSC) wurden verwandt, um mehrere Indices für Statusinkongruenz zu bilden. Die Hauptergebnisse waren: 1) Weder rheumatische Arthritis noch Ulcus standen in Beziehung mit Statusinkongruenz. 2) Ein Mißverhältnis zwischen Erziehung und Beruf zeigte bei weitem die engste Beziehung zu schlechter seelischer Gesundheit. Von den beiden Inkongruenztypen, Erziehung > Beruf und Beruf > Erziehung, hatte der erste eine besonders schlechte seelische Gesundheit. 3) Mißverhältnisse zwischen Erziehung und PSC, Beruf und PSC, Erziehung und Einkommen und Beruf und Einkommen zeigten schwächere Beziehungen. Die Richtung der Inkongruenz bewirkte einen Unterschied im Vergleich zwischen Erziehung und PSC: die inkongruente Gruppe Erziehung > PSC war bei schlechterer seelischer Gesundheit als die inkongruente Gruppe PSC > Erziehung.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41742/1/127_2004_Article_BF00584107.pd