Reducing Health-Related Stigma in Adults Living with Chronic Non-Communicable Diseases: A Systematic Review And Meta-Analysis.

Purpose The purpose of this systematic review was to synthesize the components of interventions that are aimed at reducing stigma among adults living with chronic non-communicable diseases (NCDs). A secondary objective was to assess the effectiveness of interventions in reducing health-related stigma. Methods A search was conducted on OVID MEDLINE, OVID APA PsycINFO, EBSCO CINAHL Complete, Web of Science, and Cochrane Central in July 2023 for articles that report the development and/or testing of health-related stigma-reduction interventions among adults with NCDs. The quality of included studies was assessed using the Joanna Briggs Institute critical appraisal checklists. Intervention components were narratively synthesized. The DerSimonian-Laird random effect model was used to pool standardized mean differences across studies. Results Nineteen articles were included in the review. Interventions addressed individual level (intrapersonal and interpersonal) and structural level stigmas. Components of intrapersonal interventions included cognitive exercises, stress reduction, promoting self-efficacy, developing communication skills, and listening to other patients’ stories. Contact-based interventions were used in many interpersonal interventions. Structural interventions included mass media campaigns and training for healthcare professionals. Pooled intervention effects indicated a significant reduction in stigma levels post-intervention for both persons with NCD (Hedge’s g = -1.13; 95% CI: -1.66, -0.60, I2 = 85%, N=6 studies) and those without (Hedge’s g = -2.45, 95% -4.84, -0.06; I2 = 97%, N= 2 studies). Conclusion Interventions to address NCD stigma, although multifaceted, are often not multilevel. Future studies are needed to design and test multilevel NCD stigma-reduction interventions.