Abstract:
Background: Mental illness related stigma is the negative stereotype towards people
with mental illness. The manifestation of stigma in healthcare can range from denial
of care, long waiting times, provision of sub-standard care, and physical or verbal
abuse. 10.7% of the world‟s population suffers from a form of mental illness and 45%
of the individuals in Western Kenya were diagnosed with mental illness at a point in
their lives. Low health seeking behavior observed in Makueni among people with
mental illness was a consequence of high stigmatizing attitudes found in nurses and
community health volunteers.
Objectives: To determine the level of stigma, attitudes and perceptions towards
people with mental illness and to determine how demographic variables correlated
with stigma among healthcare providers (HCPs) at Moi Teaching and Referral
Hospital, Eldoret.
Methods: The study utilized a cross-sectional study design with 407 HCPs.
Stratification of the study population was done proportionate to cadre size. Random
sampling was done to achieve the desired sample size within each cadre. Structured
questionnaire was used to obtain socio-demographic data. Data on attitudes was
collected using the Mental Illness: Clinicians‟ Attitudes Scale version 4 (MICA-4).
Reported and Intended Behavior (RIBS) questionnaire was used to evaluate HCP‟s
intended behavior towards people with mental illness. These tools have been validated
and used globally, regionally and locally by other studies. Analysis was done using
STATA version 16. T-test, analysis of variance (ANOVA) and post-hoc analysis
methods were used for data analysis.
Results: Out of the 407 participants, 53.32% were female with a MICA-4 mean score
of 41.95 (SD = 9.96) and a RIBS mean score of 16.1 (SD=3.5). Findings show a
significant association between level of education and stigmatizing attitudes (p =
0.004). Results from the t-tests and ANOVA tests revealed a significant relationship
between cadre and HCP‟s stigmatizing attitudes towards people with mental illness (p
= 0.004). On further post-hoc analysis, nurses (M = 44.4, SD = 9.8) had higher
stigmatizing attitudes towards people with mental illness compared to medical
officers (M = 37.7, SD = 7.7), consultants (M = 37.6, SD = 8.9), and occupational
therapists (M = 38.9, SD = 12.9). MICA scores were negatively correlated with RIBS
scores (r = - 0.0340, p < 0.001). This showed that higher MICA-4 score were
associated with lower RIBS score.
Conclusions: A significant proportion of HCPs at MTRH had low stigma levels
towards PWMI. HCPs with previous interactions with PWMI had lower negative
stereotypes as compared to those without. Nurses and certificate holders were more
likely to have high levels of stigma.
Recommendations: Stigma reduction campaigns are recommended through
continuous medical education and HCP-PWMI care rotations and case management.
Kenya‟s ministry of education should expand its mental health nursing curricula on
mental illness in tertiary institutions to reduce stigma.