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Effectiveness and confusion of the Time to Change anti-stigma campaign

  • Abu Abraham (a1), Joby M. Easow (a2), Palanisamy Ravichandren (a3), Salman Mushtaq (a4), Linda Butterworth (a4) and Jason Luty (a4)...
Abstract
Aims and method

Several national anti-stigma campaigns have been devised in the UK, including the current Time to Change campaign in England. Our aim was to assess whether the campaign promotional materials were likely to have any effect on public attitudes towards mental illness. Postcards, leaflets and bookmarks promoting the campaign were posted to 250 participants recruited from a representative panel of members of the public. Two weeks later a questionnaire was sent to assess the impact the campaign materials had.

Results

The response rate was 78%. Only 23% of participants recognised the Time to Change logo after 2 weeks and only 20% correctly reported that one in four people were affected by mental health problems when presented with five alternative responses. Almost as many participants thought the campaign was promoting a British political party rather than discrimination against mental illness.

Clinical implications

A single exposure to Time to Change campaign materials is unlikely to be effective. The title of the campaign is likely to be confused with political campaigning in Britain.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Jason Luty (sl006h3607@blueyonder.co.uk)
Footnotes
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Declaration of interest

None.

Footnotes
References
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Effectiveness and confusion of the Time to Change anti-stigma campaign

  • Abu Abraham (a1), Joby M. Easow (a2), Palanisamy Ravichandren (a3), Salman Mushtaq (a4), Linda Butterworth (a4) and Jason Luty (a4)...
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eLetters

Comment on the Evaluation of the Time to Change Anti-Stigma Campaign

Sara E. Evans-Lacko, Postdoctoral Researcher
05 August 2010

Comment on the Evaluation of the Time to Change Anti-Stigma Campaign

Sara Evans-Lacko, Diana Rose, Claire Henderson, Graham Thornicroft

The study by Abraham et al suggests that a single exposure to selected Time to Change (TTC) campaign material (those including the ‘1 in 4’ message) delivered via post was not effective at improving attitudes towards people with mental illness. Findings were based on a sample of 250 adults recruited through various adverts. The study showed that attitudes were not significantly better than a group of the UK general public previously recruited for scale validation.

We are undertaking the overall evaluation of the TTC programme. Our evaluation design is based on a conceptual framework which describes stigma as problems of knowledge (ignorance/misinformation), attitudes (prejudice), and behaviour (discrimination) (1). Therefore, in addition to measuring prompted campaign awareness, our evaluation included measures of mental health-related knowledge (measured by the Mental Health Knowledge Schedule), attitudes (measured by the Community Attitudes towards Mental Illness scale) and behaviour (measured by the Reported and Intended Behaviour Scale) (2). To address the multifaceted nature of the TTC programme we employ several levels of evaluation including assessments of: the overall programme at a national level, specific target groups (e.g., medical students, trainee teachers) and regional and local interventions (3).

Our initial evaluation of the TTC campaign in Cambridge used a pre/post evaluation design among the campaign target population (2). These findings suggested modest but significant changes among the campaign target demographic group. An important finding was that although campaign awareness was not sustained following the first phase of activity, significant and sustained shifts occurred for knowledge items 2 weeks following the campaign. Following the campaign, there was a 24% (p<0.001) increase in persons agreeing with the statement: If a friend had a mental health problem, I know what advice to give them to get professional help and a 10% rise in people agreeing with the statement: Medication can be an effective treatment for people with mental health problems (p=0.05). Over this short term activity, changes were not evident for attitudinal or behaviour-related questions.

Another difference between our evaluation and that of Abraham et al is that we found familiarity with mental illness to be associated with less stigmatising responses. Therefore, our findings suggest the possibility of significant further progress via more openness, disclosure and social contact. It is clear from these studies that further investigation is needed to address the most effective dissemination and communication of anti-stigma messages (4). Additionally, evaluation of the maintenance of changes over time and the additive effect of subsequent bursts of TTC activity will help us understand more about the effectiveness of this campaign in the long term. We are currently analysing data collected over the first year of TTC, which we shall publish in the near future.

The authors also cite our paper comparing public attitudes in England and Scotland (5), and state: "Unfortunately, there have been reports that national anti-stigma campaigns are not particularly effective." In fact this paper shows the opposite, namely that ‘the results are consistent with early positive effects for the See Me anti-stigma campaign in Scotland.’

Yours sincerely

Sara Evans-Lacko, Diana Rose, Claire Henderson, & Graham Thornicroft

Corresponding Author:

Sara Evans-Lacko King's College LondonInstitute of PsychiatryHealth Services and Population Research Department Box P029De Crespigny ParkLondon SE5 8AFUnited KingdomTelephone: + 44 (0) 20 7848 0619Fax: + 44 (0) 20 7277 1462 Email: Sara.Evans-Lacko@iop.kcl.ac.uk

Author Information:

Diana RoseSenior LecturerKing's College LondonInstitute of PsychiatryHealth Services and Population Research Department

Claire HendersonSenior Lecturer King's College LondonInstitute of PsychiatryHealth Services and Population Research Department

Graham Thornicroft Professor of Community PsychiatryHead of the Health Services Research Department, Institute of Psychiatry, King's College LondonConsultant Psychiatrist, South London and Maudsley NHS TrustDirector of Research and Development, South London and Maudsley NHS Trust King's College LondonInstitute of PsychiatryHealth Services and Population Research Department

Declaration of Interest

GT has received grants for research purposes for stigma related research in the last 5 years from Lundbeck UK and from the National Institute for Health Research, and has acted as a consultant to the UK Office of the Chief Scientist. SEL, DR, CH and GT are part of the independent Time to Change Evaluation Team and are supported by a grant from Big Lottery, Comic Relief and Shift. The funding sources (Big Lottery, Comic Relief and Shift) had no role in the writing of this Comment.

References

(1) Thornicroft G, Rose D, Kassam A, Sartorius N. Stigma: ignorance, prejudice or discrimination? Br J Psychiatry 2007 Mar;190:192-3.(2) Evans-Lacko S, London J, Little K, Henderson C, Thornicroft G. Evaluation of a brief anti-stigma campaign in Cambridge: do short-term campaigns work? BMC Public Health 2010;10:339.(3) Henderson C, Thornicroft G. Stigma and discrimination in mental illness: Time to Change. Lancet 2009 Jun 6;373(9679):1928-30.(4) Clement S, Jarrett M, Henderson C, Thornicroft G. Messages to use in population-level campaigns to reduce mental health-related stigma: consensus development study. Epidemiol Psichiatr Soc 2010 Jan;19(1):72-9.(5) Mehta N, Kassam A, Leese M, Butler G, Thornicroft G. Public attitudes towards people with mental illness in England and Scotland, 1994-2003. Br J Psychiatry 2009 Mar;194(3):278-84.
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Conflict of interest: None Declared

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