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
12 affiliations
- 1Transcultural Psychosocial Organization Nepal (TPO), Kathmandu, Nepal
- 2University of New Haven (UNH), West Haven, Connecticut, United States of America
- 3Center for Global Mental Health Equity, Department of Psychiatry and Behavioral Health, George Washington School of Medicine and Health Sciences, Washington, District of Columbia, United States of America
- 4Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- 5Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- 6Centre for Mental Health Policy and Evaluation, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- 7Centre for Equitable Global Health Research, Department of Global Health and Infection, Brighton and Sussex Medical School, University of Brighton and University of Sussex, Brighton, United Kingdom
- 8Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
- 9The George Institute for Global Health, Imperial College London, London, United Kingdom
- 10Centre for Global Mental Health, Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- 11Razi University Hospital, La Manouba, Tunisia
- 12Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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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BibTeX
@article{subedi2026multilevel,
title = {{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}},
author = {Bhawana Subedi and Kalpana Bhattarai and Brandon A. Kohrt and Claire Henderson and Elaine Brohan and Graham Thornicroft and Ioannis Bakolis and Maya Semrau and Nicole Votruba and Petra C. Gronholm and Uta Ouali and Dristy Gurung},
journal = {PLOS Mental Health},
year = {2026},
month = sep,
doi = {10.1371/journal.pmen.0000638},
url = {https://journals.plos.org/mentalhealth/article?id=10.1371/journal.pmen.0000638},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - 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
AU - Bhawana Subedi
AU - Kalpana Bhattarai
AU - Brandon A. Kohrt
AU - Claire Henderson
AU - Elaine Brohan
AU - Graham Thornicroft
AU - Ioannis Bakolis
AU - Maya Semrau
AU - Nicole Votruba
AU - Petra C. Gronholm
AU - Uta Ouali
AU - Dristy Gurung
PY - 2026
DA - 2026/09/08
JO - PLOS Mental Health
DO - 10.1371/journal.pmen.0000638
UR - https://journals.plos.org/mentalhealth/article?id=10.1371/journal.pmen.0000638
AB - 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.
SN - 2837-8156
ER -