Stigma training is widely used in healthcare, but evidence of its longer-term impact remains limited. A systematic review of 41 studies, published in the Journal of Mental Health, examined approaches to anti-stigma education and advocacy among healthcare professionals, including how programs were designed, delivered and evaluated.
The findings offer useful insights into where current approaches fall short and how training could be strengthened to support meaningful change in healthcare.
Here are five lessons for anyone developing, delivering or commissioning stigma training.
1. Make stigma a professional responsibility
Healthcare professionals are expected to provide equitable, respectful care. Yet stigma can influence how patients are treated and the care they receive.
In the review, Guerrero and colleagues found that 14 of the 41 studies connected training goals to “the vision of the curriculum or the role of the professional themselves.”
The idea was that addressing stigma should be “core to their knowledge in their profession”, rather than separate from everyday practice.
Drawing on previous research, the authors suggest that connecting training to healthcare professionals' ethical responsibilities may support longer-term change.
They point to social accountability, which connects professional responsibilities to the needs of patients and the communities they serve.
Practical takeaway: Build stigma training around existing professional responsibilities, using examples that show how discrimination can undermine standards of care.
2. Give people the skills to challenge stigma
The review found that relatively few programs directly addressed participants' existing biases.
As the authors observed, “Few studies focus on addressing the participants’ biases and stigma directly.”
Although all programs introduced ways to combat stigma, “not as many provide specific methods and skills.”
Some offered practical approaches. One program taught medical students how to recognise and respond to biased comments through recorded role-play. Others incorporated advocacy skills, case scenarios and projects addressing discrimination.
These approaches give participants opportunities to practise responding to situations they may encounter at work, rather than relying on knowledge alone.
Practical takeaway: Make training highly practical. Use case studies, role-plays and other interactive activities that allow participants to practise recognising and challenging bias, responding to discrimination and advocating for change.
3. Don't overlook organisational stigma
One criticism of stigma training can be that it focuses too heavily on individual attitudes and behaviours, without addressing the systems and structures that allow discrimination to continue.
Some of the programs examined in the review recognised that stigma can be embedded in healthcare systems and that changing individual attitudes and behaviours alone is not enough to address it.
As the researchers explain, some programs recognised the need for healthcare professionals to “actively fight against organizational stigma”.
Despite this, the authors found that fewer programs provided specific practical skills to challenge stigma, a gap they highlighted as particularly important when addressing structural stigma.
Practical takeaway: Design training that goes beyond individual attitudes and behaviours. Help participants recognise discriminatory policies, practices and organisational cultures, and develop practical skills to challenge them. Training should also be supported by organisational action to address structural stigma, rather than placing responsibility for change on individual healthcare professionals.
4. Always,always, involve people with lived experience
As the authors put it, “when it comes to experiences of stigma people with lived experience should be considered the experts” and “the creation of a program which does not include people with lived experience input could be considered stigmatizing in and of itself.”
Yet the review found that few studies incorporated patient perspectives into the design or content of their training programs.
The researchers warned that without this input, training risks becoming paternalistic.
Some programs demonstrated a more collaborative approach. One involving nurses across five African countries included projects developed alongside people living with HIV. Others involved students working directly with communities to develop projects aimed at reducing stigma.
Practical takeaway: Involve people with lived experience from the outset, including in decisions about training content, delivery and intended outcomes. Their expertise should truly shape the program and never be limited to simply sharing personal stories.
5. Measure what changes
Although the review identified encouraging outcomes, much of the evaluation focused on changes in knowledge and attitudes, with limited evidence of sustained behavioural change or improvements in patients' experiences.
The researchers highlighted the need for longer-term evaluation to understand whether training leads to meaningful changes in healthcare practice.
They also recommended looking beyond knowledge and attitudes to measure practical skills, behaviour and patient outcomes.
Practical takeaway: Build evaluation into training from the outset, with clear measures of success that go beyond knowledge and attitudes. Plan for ongoing learning, reinforcement and follow-up to assess whether participants are applying their skills, organisational practices are changing and patients are experiencing better care.
Source: Guerrero Z, Iruretagoyena B, Parry S, Henderson C. Anti-stigma advocacy for health professionals: a systematic review. Journal of Mental Health. 2024;33(3):394–414.