Table 3 Summary of Themes from Interviews with Trained Primary Care Providers at 5-months post-training (N = 28)
Overall findings | Differences by training arm1 | |
|---|---|---|
Societal context of stigma | • People with MI laughed at, teased in society • People don’t talk about MI because of stigma • Seek care for MI far away where don’t know people | |
Reported attitudes and behaviors before training | • Used stigmatizing language (e.g., “mad”) • Avoided, feared MH patients • Lacked knowledge, experience, confidence with MH • Lack of or negative prior encounters with MH patients | • TAU providers more often reported having considered MH patients violent • RESHAPE providers more often reported thinking MI was not treatable |
Attitude changes after training | • Anyone can have MI; they are “like us” • MI is treatable; patients can return to “normal” • Should treat patients with care, empathy, respect | • As in the overall quantitative sample, RESHAPE interview participants more likely to experience large decrease in stigmatizing attitudes • RESHAPE providers referred to recovery narratives in describing changed understanding |
Willingness to treat after training | • Motivation, confidence, enthusiasm to treat MI • Confidence attributed to increased knowledge, skills • Motivation attributed to greater understanding of causation of MI • Responsibility, desire to help return to “normal” | • RESHAPE providers more likely to express willingness to treat • RESHAPE providers more often described specific skills learned (e.g., how to interact, promote safety, and encourage openness) |
Patient encounters during and after training | • Treatment provision/success → greater patient openness → greater provider confidence and openness → treatment provision/success (positive feedback loop) | • RESHAPE providers described positive impact of personal testimony from service users, caregivers, and aspirational figures (current MH providers) |
Providers’ experience of being stigmatized after training | • All except 1 reported not having experienced stigma • Mixed expectations regarding stigma if they were to advertise MH services |