A Structured Intervention for Medical Students Significantly Improves Awareness of Stigmatisation in Visible Chronic Skin Diseases: A Randomised Controlled Trial

Authors

  • Rachel Sommer German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, DE-20246 Hamburg, Germany
  • Natascha-Alexandra Weinberger
  • Regina von Spreckelsen
  • Ulrich Mrowietz
  • Maximilian C. Schielein
  • Claudia Luck-Sikorski
  • Matthias Augustin

DOI:

https://doi.org/10.2340/actadv.v101.894

Keywords:

stigmatisation, visible skin diseases, intervention, randomised controlled trial

Abstract

People with visible skin diseases often experience stigmatisation. The aim of this study was to develop and evaluate a new intervention for medical students to counter the stigmatisation of people with skin diseases. The intervention was evaluated using a randomised controlled design. Effectiveness was assessed at 3 time points. Data from 127 participants were analysed. Regarding the outcome “social distance”, a significant difference between the measurement points was observed for the intervention group (χ2(2) = 54.32, p < 0.001), which also showed a significant effect on agreement with negative stereotypes (F(1.67, 118.67) = 23.83, p < 0.001, partial η2 = 0.25). Regarding the outcome “agreement with disease-related misconceptions”, a significant difference between the measurement time points was observed for the intervention group (χ2(2) = 46.33, p < 0.001); similar results were found for the outcome “stigmatising behaviour” (F(1.86, 131.89) = 6.16, p = 0.003, partial η2 = 0.08). The results should encourage medical faculties to invest in such courses in order to prevent stigmatisation of people with skin diseases.

Downloads

Download data is not yet available.

References

Augustin M, Herberger K, Hintzen S, Heigel H, Franzke N, Schäfer I. Prevalence of skin lesions and need for treatment in a cohort of 90 880 workers. Br J Dermatol 2011; 165: 865-873.

https://doi.org/10.1111/j.1365-2133.2011.10436.x DOI: https://doi.org/10.1111/j.1365-2133.2011.10436.x

Kage P, Simon J-C, Treudler R. Atopic dermatitis and psychosocial comorbidities. J Dtsch Dermatol Ges 2020; 18: 93-102.

https://doi.org/10.1111/ddg.14029 DOI: https://doi.org/10.1111/ddg.14029

Misitzis A, Goldust M, Jafferany M, Lotti T. Psychiatric comorbidities in patients with hidradenitis suppurativa. Dermatol Ther 2020; 33: e13541.

https://doi.org/10.1111/dth.13541 DOI: https://doi.org/10.1111/dth.13541

Dalgard FJ, Gieler U, Tomas-Aragones L, Lien L, Poot F, Jemec GBE, et al. The psychological burden of skin diseases: a cross-sectional multicenter study among dermatological out-patients in 13 European countries. J Invest Dermatol 2015; 135: 984-991.

https://doi.org/10.1038/jid.2014.530 DOI: https://doi.org/10.1038/jid.2014.530

Sommer R, Topp J, Mrowietz U, Zander N, Augustin M. Perception and determinants of stigmatisation of people with psoriasis in the German population. J Eur Acad Dermatol Venereol 2020; 34: 2846-2855.

https://doi.org/10.1111/jdv.16436 DOI: https://doi.org/10.1111/jdv.16436

Link BG, Phelan JC. Conceptualizing stigma. Annu Rev Sociol 2001; 27: 363-385.

https://doi.org/10.1146/annurev.soc.27.1.363 DOI: https://doi.org/10.1146/annurev.soc.27.1.363

Dalgard FJ, Bewley A, Evers AW, Gieler U, Lien L, Sampogna F, et al. Stigmatisation and body image impairment in dermatological patients: protocol for an observational multicentre study in 16 European countries. BMJ Open 2018; 8: e024877.

https://doi.org/10.1136/bmjopen-2018-024877 DOI: https://doi.org/10.1136/bmjopen-2018-024877

Sommer R, Augustin M, Mrowietz U, Topp J, Schäfer I, Spreckelsen R von. Stigmatisierungserleben bei Psoriasis - qualitative Analyse aus Sicht von Betroffenen, Angehörigen und Versorgern. Hautarzt 2019; 70: 520-526.

https://doi.org/10.1007/s00105-019-4411-y DOI: https://doi.org/10.1007/s00105-019-4411-y

Alpsoy E, Polat M, FettahlıoGlu-Karaman B, Karadag AS, Kartal-Durmazlar P, YalCın B, et al. Internalized stigma in psoriasis: a multicenter study. J Dermatol 2017; 44: 885-891.

https://doi.org/10.1111/1346-8138.13841 DOI: https://doi.org/10.1111/1346-8138.13841

Temel AB, Bozkurt S, Alpsoy E. Internalized stigma in acne vulgaris, vitiligo and alopecia areata. Journal of Investigative Dermatology 2017; 137: 197.

https://doi.org/10.1016/j.jid.2017.07.125 DOI: https://doi.org/10.1016/j.jid.2017.07.125

Titeca G, Goudetsidis L, Francq B, Sampogna F, Gieler U, Tomas-Aragones L, et al. 'The psychosocial burden of alopecia areata and androgenetica': a cross-sectional multicentre study among dermatological out-patients in 13 European countries. J Eur Acad Dermatol Venereol 2020; 34: 406-411.

https://doi.org/10.1111/jdv.15927 DOI: https://doi.org/10.1111/jdv.15927

Włodarek K, Głowaczewska A, Matusiak Ł, Szepietowski JC. Psychosocial burden of Hidradenitis Suppurativa patients' partners. J Eur Acad Dermatol Venereol 2020; 34: 1822-1827.

https://doi.org/10.1111/jdv.16255 DOI: https://doi.org/10.1111/jdv.16255

Germain N, Augustin M, François C, Legau K, Bogoeva N, Desroches M, et al. Stigma in visible skin diseases - a literature review and development of a conceptual model. J Eur Acad Dermatol Venereol 2021; 35: 1493-1504.

https://doi.org/10.1111/jdv.17110 DOI: https://doi.org/10.1111/jdv.17110

Schmid-Ott G, Künsebeck H-W, Jecht E, Shimshoni R, Lazaroff I, Schallmayer S, et al. Stigmatization experience, coping and sense of coherence in vitiligo patients. J Eur Acad Dermatol Venereol 2007; 21: 456-461.

https://doi.org/10.1111/j.1468-3083.2006.01897.x DOI: https://doi.org/10.1111/j.1468-3083.2006.01897.x

Koumaki D, Efthymiou O, Bozi E, Katoulis AC. Perspectives on perceived stigma and self-stigma in patients with hidradenitis suppurativa. Clin Cosmet Investig Dermatol 2019; 12: 785-790.

https://doi.org/10.2147/CCID.S180036 DOI: https://doi.org/10.2147/CCID.S180036

Topp J, Andrees V, Weinberger NA, Schäfer I, Sommer R, Mrowietz U, et al. Strategies to reduce stigma related to visible chronic skin diseases: a systematic review. J Eur Acad Dermatol Venereol 2019; 33: 2029-2038.

https://doi.org/10.1111/jdv.15734 DOI: https://doi.org/10.1111/jdv.15734

Augustin M, Mrowietz U, Luck-Sikorski C, Kiedrowski R von, Schlette S, Radtke MA, et al. Translating the WHA resolution in a member state: towards a German programme on 'Destigmatization' for individuals with visible chronic skin diseases. J Eur Acad Dermatol Venereol 2019; 33: 2202-2208.

https://doi.org/10.1111/jdv.15682 DOI: https://doi.org/10.1111/jdv.15682

Vetrova MV, Cheng DM, Bendiks S, Gnatienko N, Lloyd-Travaglini C, Jiang W, et al. HIV and substance use stigma, intersectional stigma and healthcare among HIV-positive PWID in Russia. AIDS Behav 2021; 25: 2815-2826.

https://doi.org/10.1007/s10461-021-03172-5 DOI: https://doi.org/10.1007/s10461-021-03172-5

Mitchell AJ, Malone D, Doebbeling CC. Quality of medical care for people with and without comorbid mental illness and substance misuse: systematic review of comparative studies. Br J Psychiatry 2009; 194: 491-499.

https://doi.org/10.1192/bjp.bp.107.045732 DOI: https://doi.org/10.1192/bjp.bp.107.045732

Henderson C, Noblett J, Parke H, Clement S, Caffrey A, Gale-Grant O, et al. Mental health-related stigma in health care and mental health-care settings. Lancet Psychiatry 2014; 1: 467-482.

https://doi.org/10.1016/S2215-0366(14)00023-6 DOI: https://doi.org/10.1016/S2215-0366(14)00023-6

Wechsler D, Schomerus G, Mahlke C, Bock T. Effektivität einer kontaktbasierten Kurzintervention zum Abbau stigmatisierender Einstellungen unter MedizinstudentInnen: Ergebnisse einer randomisierten, kontrollierten Studie. Neuropsychiatr 2020; 34: 66-73.

https://doi.org/10.1007/s40211-020-00337-x DOI: https://doi.org/10.1007/s40211-020-00337-x

Pearl RL, Wan MT, Takeshita J, Gelfand JM. Stigmatizing attitudes toward persons with psoriasis among laypersons and medical students. J Am Acad Dermatol 2019; 80: 1556-1563.

https://doi.org/10.1016/j.jaad.2018.08.014 DOI: https://doi.org/10.1016/j.jaad.2018.08.014

Evans-Lacko S, Rose D, Little K, Flach C, Rhydderch D, Henderson C, et al. Development and psychometric properties of the reported and intended behaviour scale (RIBS): a stigma-related behaviour measure. Epidemiol Psychiatr Sci 2011; 20: 263-271.

https://doi.org/10.1017/S2045796011000308 DOI: https://doi.org/10.1017/S2045796011000308

Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001; 16: 606-613.

https://doi.org/10.1046/j.1525-1497.2001.016009606.x DOI: https://doi.org/10.1046/j.1525-1497.2001.016009606.x

van Beugen S, Maas J, van Laarhoven AIM, Galesloot TE, Rinck M, Becker ES, et al. Implicit stigmatization-related biases in individuals with skin conditions and their significant others. Health Psychol 2016; 35: 861-865.

https://doi.org/10.1037/hea0000404 DOI: https://doi.org/10.1037/hea0000404

World Health Organization. Global report on psoriasis; 2016 [cited 2020 Jun 16]. Available from: https://apps.who.int/iris/bitstream/handle/10665/204417/9789241565189_eng.pdf.psoriasis?sequence=1.

Peters RMH, Dadun, Zweekhorst MBM, Bunders JFG, Irwanto, van Brakel WH. A cluster-randomized controlled intervention study to assess the effect of a contact intervention in reducing leprosy-related stigma in Indonesia. PLoS Negl Trop Dis 2015; 9: e0004003.

https://doi.org/10.1371/journal.pntd.0004003 DOI: https://doi.org/10.1371/journal.pntd.0004003

Dadun D, van Brakel WH, Peters RMH, Lusli M, Zweekhorst MBM, Bunders JGF, et al. Impact of socio-economic development, contact and peer counselling on stigma against persons affected by leprosy in Cirebon, Indonesia - a randomised controlled trial. Lepr Rev 2017; 88: 2-22.

https://doi.org/10.47276/lr.88.1.2 DOI: https://doi.org/10.47276/lr.88.1.2

Krishnatray PK, Melkote SR. Public communication campaigns in the destigmatization of leprosy: a comparative analysis of diffusion and participatory approaches. A case study in Gwalior, India. J Health Commun 1998; 3: 327-344.

https://doi.org/10.1080/108107398127148 DOI: https://doi.org/10.1080/108107398127148

Corrigan PW, Morris SB, Michaels PJ, Rafacz JD, Rüsch N. Challenging the public stigma of mental illness: a meta-analysis of outcome studies. Psychiatr Serv 2012; 63: 963-973.

https://doi.org/10.1176/appi.ps.201100529 DOI: https://doi.org/10.1176/appi.ps.201100529

Korszun A, Dinos S, Ahmed K, Bhui K. Medical student attitudes about mental illness: does medical-school education reduce stigma? Acad Psychiatry 2012; 36: 197-204.

https://doi.org/10.1176/appi.ap.10110159 DOI: https://doi.org/10.1176/appi.ap.10110159

Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. Int J Nurs Stud 2013; 50: 587-592.

https://doi.org/10.1016/j.ijnurstu.2012.09.010 DOI: https://doi.org/10.1016/j.ijnurstu.2012.09.010

Published

2022-01-31

How to Cite

Sommer, R., Weinberger, N.-A., von Spreckelsen, R., Mrowietz, U., Schielein, M. C., Luck-Sikorski, C., & Augustin, M. (2022). A Structured Intervention for Medical Students Significantly Improves Awareness of Stigmatisation in Visible Chronic Skin Diseases: A Randomised Controlled Trial. Acta Dermato-Venereologica, 102, adv00641. https://doi.org/10.2340/actadv.v101.894