Our project is divided into different work packages (WP). Followinga mixed-methods-approach, we are investigating a wide range of aspects and perspectives to gain a comprehensive overview of stigmatisation processes during the coronavirus pandemic.
WP 1: Perspective of those affected
In this work package we examine people's experiences of personal and public stigmatisation in the context of the coronavirus pandemic. The perceived risk and protective factors for stigmatisation are analysed and the psychological, social and professional consequences are examined. The aim is to develop a model of the Health stigma Discrimination Framework (Ransing et al., 2020; Stangl et al., 2019) for covid-related stigmatisation in Germany. This model aims to validate international research and help identify opportunities for interventions. Data will be collected through focus groups and individual interviews and analysed using content analysis. The resulting information will be used to inform the survey (WP 4) and the online study (WP 6) as well as to develop recommendations for action, particularly for the strategic support of anti-stigma interventions and research in Germany (WP 7).
Goals
- assessing the experience of stigmatisation of those directly and indirectly affected by stigma during the corona pandemic
- mapping the interaction between self- and public stigmatisation abbilden
- reconstructing and validating the Health stigma Discrimination Framework
WP 2: Perspective of the institutions
To collect information on anti-stigma interventions that have been implemented during the COVID-19 pandemic, we will be interviewing representatives of relevant institutions involved in anti-stigma work. Furthermore, currently and prospectively planned anti-stigma initiatives and their implementation conditions will be analysed. On the institutional level, knowledge and competence requirements for a successful implementation are assessed. We will finally systemise those requirements according to the RE-AIM framework (Glasgow et al., 1999).
Goals
- capturing the practice of anti-stigma work during the COVID-19 pandemic
- identifying effective anti-stigma strategies from an institutional perspective
- investigating knowledge and expertise requirements for sustainable implementation
WP 3: Analysing anti-stigma interventions
The anti-stigma interventions identified through interviews from WP2 will be complemented by a systematic literature review. The effectiveness of the interventions will be examined using a meta-analysis according to PRISMA (Moher et al., 2009; Page et al., 2021). As an addition to previous research, particular attention will be paid to the aspects of Intersectionality and Double Stigma which have been insufficiently investigated to date. As part of the meta-analysis, messages, components and strategies described for changing attitudes and behaviour of the interventions will be analysed in order to identify optimisation potential for the RCT (WP 6). The strategies are classified according to the Behaviour Change Taxonomy (Wood et al., 2015).
Goals
- creating an overview of anti-stigma interventions in Germany (systematic literature analysis)
- analysing the effectiveness of anti-stigma interventions (meta-analysis)
- investigating components, messages, described strategies of attitude and behaviour change of anti-stigma interventions (content analysis)
WP 4: Representative survey of the German population
In this WP, a representative survey will be conducted among the German population in three waves (October 2023, 2024 and 2025), investigating the prevalence of stigmatising attitudes, double stigma and intersectional stigma in the context of the pandemic. This provides a basis for comparison with previous representative population surveys on (double) stigma in Germany, for example with regard to mental illness and socio-demographics (e.g., von dem Knesebeck et al., 2017). For this purpose, each year of the project period a survey is conducted (approx. n=1000 people per year) to identify trends in the development of stigmatisation processes. The preparation of the survey is, inter alia, supported by the focus groups and interviews with those affected (WP 1).
Goals
- Determine the prevalence of stigmatising attitudes in the German population over time
- Identify risk and protective factors of stigmatisation and determinants of public stigmatisation
WP 5: Elaborating target group-specific measurement instruments
Through a systematic literature search we aim to identify published measurement instruments that have been used and developed to assess stigmatising attitudes and processes in the context of the COVID-19 pandemic. The identified instruments will be systematically evaluated in a review according to PRISMA (Page et al., 2021). This review provides a foundation for the population survey in WP 4 and the evaluation of the interventions in WP 6.
Goal
- mapping of validated measurement tools for stigmatising attitudes and processes in the context of the pandemic
WP 6: Online RCT on the effectiveness of optimised interventions
Identified interventions (WP 3) will be optimised based on the perspectives of persons affected by stigma (WP 1). In an online randomised controlled trial we will be testing their effectiveness in reducing stigmatisation in various target groups of the general population. The findings on effectiveness and the optimisation approaches will be incorporated into the recommendations for action and communication strategies (WP 7).
Goal
- examining the effectiveness of optimised anti-stigma interventions
WP 7: Recommending actions and communication strategies
Recommendations and communication strategies that combine key project findings and perspectives will be developed. This includes the adaptation of the HSDF for the German population, the dissemination of effective interventions and communication strategies for practice, developing suitable measuring instruments for further research on trends in stigmatising attitudes in the population and, finally, recommendations for actions on the long-term design and promotion of anti-stigma work and stigma research, which are aimed at political decision-makers.
Goals
- creating guidelines for research, practice and political decision-makers on the topic of stigma in pandemic situations
- dissemination of project results and discourse to the general public, the scientific community and relevant actors in the field of anti-stigma work
Literature
Glasgow, R.E., Vogt, T.M., Boles, S.M. (1999). Evaluating the public health impact of health promotion interventions: the RE-AIM framework. American journal of public health, 89(9), 1322-1327.
Knesebeck, O., Kofahl, C., Makowski, A.C. (2017) Differences in depression stigma towards ethnic and socio-economic groups in Germany – Exploring the hypothesis of double stigma. Journal of Affective Disorders.
Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS medicine, 6(7).
Page, M.J., McKenzie, J.E., Bossuyt, P.M., Boutron, I., Hoffman, T.C., Mulrow, C.D., Shamseer, L., Tetzlaff, J.M., Akl, E.A., Brennan, S.E., Chou, R., Glanville, J., Grimshaw, J.M., Hróbjartsson, A., Lalu, M.M., Li, T., Loder, E.W., Mayo-Wilson, E., McDonald, S.,…McGuinness, L.A. (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ.
Ransing, R., Ramalho, R., de Filippis, R., Ojeahere, M.I., Karaliuniene, R., Orsolini, L., da Costa, M.P., Ullah, I., Grandinetti, P., Bytyçi, D.G., Grigo, O., Mhamunkar, A., El Hayek, S., Essam, L., Larnaout, A., Shalbafan, M., Nofal, M., Soler-Vidal, J., Pereira-Sanchez, V., Adiukwu, F. (2020). Infectious disease outbreak related stigma and discrimination during the COVID-19 pandemic: drivers, facilitators, manifestations, and outcomes across the world. Brain, Behavior, and Immunity.
Stangl, A.L., Earnshaw, V.A., Logie, C.H., van Brakel, W., Simbayi, L.C., Barré, I., & Dovidio, J.F. (2019). The health stigma and discrimination framework: a global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas. BMC Medicine, 17(1), 1-13.
von dem Knesebeck, O., Kofahl, C., & Makowski, A. C. (2017). Differences in depression stigma towards ethnic and socio-economic groups in Germany–Exploring the hypothesis of double stigma. Journal of Affective Disorders, 208, 82-86. https://doi.org/10.1016/j.jad.2016.08.071
Wood, C. E., Richardson, M., Johnston, M., Abraham, C., Francis, J., Hardeman, W., & Michie, S. (2015). Applying the behaviour change technique (BCT) taxonomy v1: a study of coder training. Translational Behavioral Medicine, 5(2), 134-148. https://doi.org/10.1007/s13142-014-0290-z
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