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Trial registered on ANZCTR

Registration number

ACTRN12622000919718

Ethics application status

Approved

Date submitted

17/06/2022

Date registered

28/06/2022

Date last updated

31/01/2023

Date data sharing statement initially provided

28/06/2022

Type of registration

Prospectively registered

Titles & IDs

Public title

Acceptability, feasibility, and potencial efficacy of a multicomponent intervention on internalized stigma in people diagnosed with severe mental disorder.

Scientific title

Acceptability, feasibility, and potencial efficacy of a multicomponent intervention on internalized stigma in people diagnosed with severe mental disorder: a mixed pilot trial.

Secondary ID [1]

None

Universal Trial Number (UTN)

U1111-1279-5070

Trial acronym

Linked study record

Health condition

Health condition(s) or problem(s) studied:

internalized stigma

Condition category

Condition code

Mental Health

Other mental health disorders

Intervention/exposure

Study type

Interventional

Description of intervention(s) / exposure

The Internalized Stigma Reduction Program: EncontrándoME, belonging to Igual-Mente: stigma reduction program, considers the levels at which stigma manifests itself. Interventions to reduce stigma and its typology should be by levels since the processes that generate and maintain it differ in each. Since a multilevel or ecological perspective was assumed in understanding stigma, the intervention's impact at the intrapersonal or individual level may have repercussions at other levels.
The interventions that served as the basis for the design of EncontrándoME were developed in high-income countries. For this reason, the activities from these interventions that were incorporated into the design of EncontrándoME were contextualized and adapted to the local reality, considering cultural values and meanings. Regarding the latter, what is threatened by stigma in the local context is the possibility of working and the feeling of usefulness that this generates in people with a mental disorder (MD). Therefore, the intervention considers the cultural aspects of mental disorders (MDs) and stigma.
Multiple interventional techniques were incorporated into account the integrative approach on which the intervention is based. Among them is narrative development, derived from narrative therapy, which has proven effective in getting individuals with MDs to create new stories that consider the challenges and positive aspects of their lives. Another technique is cognitive restructuring as part of cognitive-behavioral therapy, which was considered because it has been widely used to restructure negative beliefs about oneself and the MD. In addition, self-concept is addressed since it has been suggested that interventions should help individuals with hidden stigmatized identities to develop a positive self-concept. Training in coping strategies for stigma (education, deviance, and disclosure of MD) was incorporated since these are strategies that individuals with MDs have reported as valuable and effective. Finally, work will be done to enhance the recovery process of individuals with MDs because the more they are confident that recovery is possible and feasible, the less stigma will be internalized.
Regarding the materials used in the intervention, the facilitators have the administration manuals, pencils, markers, attendance sheets, labels to facilitate the identification of participants, cardboard cards, a ball, and a ball of yarn for the development of some activities, flip charts or a computer with a projector to present the content worked on in some sessions, as well as the certificates of participation that will be delivered at the end of the intervention. On the other hand, participants will be given a folder where they can keep the exercises and tasks of each session for later reference, as well as markers, pencils, erasers, crayons, glue, and scissors, in order to be able to carry out the exercises oriented in the sessions. A more detailed description of these materials can be found in the intervention administration manual for facilitators and co-facilitators.
Regarding the procedures, the intervention consists of 10 group sessions lasting 90 minutes each, administered to a group of 17 people once a week and in person (total duration: 2 months and 15 days). The number of sessions and their frequency are fixed. The intervention will take place in a room of the Family Mental Health Community Center (COSAM, for its acronym in Spanish) Leonor Mascayano (public health center belonging to primary care), located in Chile, Biobío Region, Concepción, so that it will take place in the same place as the recruitment of participants and data collection.
The sessions have a welcome, homework check, central activity/s, orientation to do the next week's homework, closing, and evaluation. Before each session, the facilitator should review the intervention administration manual and arrive 15 minutes early to set up the space and ensure everything is in order. He/she should set up the chairs in a circular fashion, test the equipment to be used and place the session materials on a table next to the work circle. At the beginning of each session, and as participants enter the meeting room, they should put on a name tag, which they will give to the facilitator at the end of each session to be used at the next session. Participants must complete a minimum of 7 sessions and fulfill the total number of hours required to obtain a certificate of participation at the end of the program (participants may only leave each session 10 minutes before the end of the program). The facilitator must send an email, WhatsApp, or phone call (previously agreed with each participant) one day before the session to remind them of their attendance. Likewise, the facilitator should call those participants who do not attend a session to give them a summary and encourage them to attend the next session. The intervention administration manual details the activities to be carried out in each session.
The intervention is administered by two facilitators (psychologist, psychiatrist, nurse, social worker, or other social science professional) with previous experience in group management and psychosocial interventions, as well as in working with individuals with MDs, which will be verified by direct consultation with the facilitators. An experienced expert in mental health (a person diagnosed with a mental disorder) will accompany the facilitators in two sessions. The facilitators and the experienced expert will receive prior training in the administration of the intervention by the responsible researcher, they will be recruited specifically for the study, and they will receive monetary compensation for developing the intervention (this compensation is not necessary to replicate the intervention). Training will be conducted face-to-face in a workshop format in the weeks before the administration of each session.
The intervention is planned to be tailored to the characteristics of the participants. This implies that the exercises for each session can be done in written form or through a drawing or collage. Two aspects will assess the fidelity of the intervention delivery; through the observation of each session, using a checklist by a professional external to the research team, and through a semi-structured interview with the facilitators one week after the end of the intervention. The checklists and the semi-structured interview are included in the intervention administration manual.

Intervention code [1]

Treatment: Other

Intervention code [2]

Rehabilitation

Intervention code [3]

Behaviour

Comparator / control treatment

It will correspond to the usual treatment administered by the treating health team at the Family Mental Health Community Center (COSAM, for its acronym in Spanish). The usual treatment includes a follow-up consultation with the psychiatrist and one with the nurse to receive medication for psychiatric diagnosis, both once a month.

Control group

Active

Outcomes

Primary outcome [1]

Changes in levels of internalized stigma as measured by the "Internalized Stigma of Mental Illness Scale".

Timepoint [1]

Before the start of the first session of the intervention and after the last session of the intervention.

Secondary outcome [1]

Changes in levels of self-esteem as measured by the "Rosenberg Self-Esteem Scale".

Timepoint [1]

Before the start of the first session of the intervention and after the last session of the intervention.

Secondary outcome [2]

Changes in levels of hopelessness as measured with the "Beck Hopelessness Scale".

Timepoint [2]

Before the start of the first session of the intervention and after the last session of the intervention.

Secondary outcome [3]

Changes in levels of recovery as measured by the "Recovery Assessment Scale".

Timepoint [3]

Before the start of the first intervention session and after the last intervention session.

Secondary outcome [4]

Changes in levels of empowerment as measured by the "Personal Empowerment Scale".

Timepoint [4]

Before the start of the first intervention session and after the last intervention session.

Secondary outcome [5]

Changes in identity characteristics associated with mental disorder as measured by the "Self and reflexive assessment scale of stigmatizing characteristics associated with the mental disorder identity".
Self and reflexive assessments scale be analysed together as a composite outcome. Both measure changes in identity characteristics associated with mental disorder.

Timepoint [5]

Before the start of the first intervention session and after the last intervention session.

Secondary outcome [6]

Perception of effectiveness of the interventional strategies as measured by the "Scale to assess the perception of effectiveness of the interventional strategies".
It was designed specifically for this study (4-point Likert scale).

Timepoint [6]

After the last session of the intervention.

Eligibility

Key inclusion criteria

-Persons over 18 years of age.
-Persons with a diagnosis of TMG confirmed by the treating health team: Diagnoses of Schizophrenia; Schizotypal Disorder; Disorder of persistent delusional ideas; Disorder of induced delusional ideas; Schizoaffective Disorder; Non-organic psychosis; Non-organic psychosis without specification; Manic episode; Bipolar Disorder Type II; Major depressive episode with psychotic symptoms; Recurrent depressive disorder, a current severe episode with psychotic symptoms or other non-organic psychotic disorders, according to ICD-10.
-Clinically compensated according to the treating health team.
-Have more than one year of treatment in health centers for the current diagnosis.
-Capacity to consent assessed by a psychologist external to the treating health team using the Capacity for Treatment Assessment Tool (MacCAT-T).

Minimum age

18 Years

Maximum age

No limit

Sex

Both males and females

Can healthy volunteers participate?

Key exclusion criteria

-Presence of organic deterioration indicated by the treating health team.
-Presence of comorbidity with substance abuse and dependence; does not include tobacco and alcohol, indicated by the treating health team.

Study design

Purpose of the study

Treatment

Allocation to intervention

Non-randomised trial

Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)

Allocation is not concealed.

Methods used to generate the sequence in which subjects will be randomised (sequence generation)

Masking / blinding

Open (masking not used)

Who is / are masked / blinded?

The people receiving the treatment/s

The people assessing the outcomes
The people analysing the results/data

Intervention assignment

Parallel

Other design features

Phase

Not Applicable

Type of endpoint/s

Efficacy

Statistical methods / analysis

Considering a design with a d=0.4, the number of participants per arm for the pilot trial should be 15 for 90% power and 5% bilateral significance in the final RCT. Considering that there could be a 10% eventual sample loss, 17 individuals will finally be selected for each arm.

A reflexive thematic analysis of the interviews will be carried out for qualitative data. For quantitative variables, the sociodemographic and clinical characteristics of the participants will be described using the mean and standard deviation for continuous variables and the raw value and percentage for categorical variables.
To respond to the primary and secondary objectives of the pilot trial, descriptive analyzes (mean, standard deviation, frequencies, proportions, percentages, and cut-off point analysis) and the estimation of the 95% confidence interval (CI) for the mean score difference.
The missing values will be declared, and the treatment given to them will be based on the multiple imputation methods. Intention-to-treat analysis of allocation effects will also be taken into account.

Recruitment

Recruitment status

Completed

Date of first participant enrolment

Anticipated

4/07/2022

Actual

20/09/2022

Date of last participant enrolment

Anticipated

Actual

5/10/2022

Date of last data collection

Anticipated

Actual

12/01/2023

Sample size

Target

Accrual to date

Final

Recruitment outside Australia

Country [1]

Chile

State/province [1]

Bobío Region/Concepción

Funding & Sponsors

Funding source category [1]

Government body

Name [1]

National Agency for Research and Development (ANID SCHOLARSHIPS/NATIONAL DOCTORATE 21190228)

Address [1]

Moneda 1375, Santiago de Chile, Chile. Postal code: 8320000.

Country [1]

Chile

Primary sponsor type

Individual

Name

Dany Fernández

Address

Universidad de Concepción, Faculty of Social Sciences, Psychology Department, Barrio Universitario s/n. Box 160-C, Mailbox 3, Concepción, Biobío, Chile. Postal code: 4030000.

Country

Chile

Secondary sponsor category [1]

Individual

Name [1]

Pamela Grandón

Address [1]

Universidad de Concepción, Faculty of Social Sciences, Psychology Department, Barrio Universitario s/n. Box 160-C, Mailbox 3, Concepción, Biobío, Chile. Postal code: 4030000.

Country [1]

Chile

Ethics approval

Ethics application status

Approved

Ethics committee name [1]

Scientific Ethics Committee of the Health Service of Concepción

Ethics committee address [1]

O´Higgins 297, Concepción, Biobío, Chile. Postal Code: 4030000.

Ethics committee country [1]

Chile

Date submitted for ethics approval [1]

Approval date [1]

24/05/2022

Ethics approval number [1]

CEC-SSC:21-06-31

Ethics committee name [2]

Ethics, Bioethics and Biosafety Committee of the Vice-Rector for Research and Development of the University of Concepción

Ethics committee address [2]

Barrio universitario s/n, Edificio Empreudec, Casilla 160 C – Correo 3, Concepción, Biobío, Chile. Postal Code: 4030000

Ethics committee country [2]

Chile

Date submitted for ethics approval [2]

Approval date [2]

01/09/2020

Ethics approval number [2]

CEBB 765-2020

Summary

Brief summary

The study seeks to evaluate a multicomponent pilot intervention's acceptability, feasibility, and potential effectiveness in reducing internalized stigma in people diagnosed with a severe mental disorder.

Trial website

Trial related presentations / publications

Public notes

Contacts

Principal investigator

Name

Mr Dany Fernández

Address

Universidad de Concepción, Faculty of Social Sciences, Psychology Department, Barrio Universitario s/n. Box 160-C, Mailbox 3, Concepción, Biobío, Chile. Postal code: 4030000.

Country

Chile

Phone

+56412204301

Fax

[email protected]

Contact person for public queries

Name

Dany Fernández

Address

Universidad de Concepción, Faculty of Social Sciences, Psychology Department, Barrio Universitario s/n. Box 160-C, Mailbox 3, Concepción, Biobío, Chile. Postal code: 4030000.

Country

Chile

Phone

+56412204301

Fax

[email protected]

Contact person for scientific queries

Name

Dany Fernández

Address

Universidad de Concepción, Faculty of Social Sciences, Psychology Department, Barrio Universitario s/n. Box 160-C, Mailbox 3, Concepción, Biobío, Chile. Postal code: 4030000.

Country

Chile

Phone

+56412204301

Fax

[email protected]

Data sharing statement

Will individual participant data (IPD) for this trial be available (including data dictionaries)?

Yes

What data in particular will be shared?

Individual participant data underlying published results only.

When will data be available (start and end dates)?

Immediately following publication; no end date.

Available to whom?

Case-by-case basis at the discretion of Primary Sponsor.

Available for what types of analyses?

Only to achieve the aims in the approved proposal.

How or where can data be obtained?

Access subject to approvals by Principal Investigator ([email protected]).

What supporting documents are/will be available?

Doc. No.	Type	Citation	Link	Email	Other Details	Attachment
16404	Study protocol	Fernández, D.; Grandón, P.; Bustos, C. (2023). A multicomponent intervention to reduce internalized stigma in persons with a diagnosis of severe mental disorder: protocol of a pilot randomized mixed trial. International Journal of Clinical Trials, 10(1), 45-55. DOI: 10.18203/2349-3259.ijct20230050	https://www.ijclinicaltrials.com/index.php/ijct/article/view/642	[email protected]

Results publications and other study-related documents

Documents added manually

No documents have been uploaded by study researchers.

Documents added automatically

No additional documents have been identified.

Trial Review

Documents added manually

Documents added automatically