Stigma related to mental illness among healthcare providers at Moi Teaching and Referral Hospital, Eldoret, Kenya

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.