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An Incognito Standardized Patient Approach for Measuring and Reducing Intersectional Healthcare Stigma: A Pilot

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A stigma reduction training for healthcare providers improved care for men who have sex with men (MSM) but showed less impact for people living with HIV (PLWH). Future training should enhance clinical skills for PLWH management.

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Area of Science:

  • Public Health
  • Medical Education
  • Health Equity

Background:

  • Stigma significantly hinders healthcare access for people living with HIV (PLWH) and men who have sex with men (MSM).
  • Provider behaviors contributing to stigma were observed through incognito standardized patient (SP) visits.
  • A stigma reduction training was developed based on these direct observations.

Purpose of the Study:

  • To evaluate the impact of a stigma reduction training for healthcare providers.
  • To assess the feasibility, acceptability, and preliminary efficacy of the intervention.
  • To quantify stigma as differences in care quality across patient scenarios.

Main Methods:

  • A pilot cluster randomized controlled trial was conducted in sexually transmitted infection clinics in Guangzhou, China.
  • Incognito standardized patients presented standardized cases, varying HIV status and sexual orientation.
  • Linear fixed effects regression was used to assess the impact after the training intervention.

Main Results:

  • The training was feasible and acceptable, with no adverse events.
  • Improvements were noted in HIV testing for HIV-negative MSM and diagnostic effort for HIV-positive MSM.
  • Patient-centered care improved for HIV-positive heterosexual cases, but all estimates lacked statistical precision.

Conclusions:

  • The training demonstrated a reduction in stigma across several care domains.
  • The intervention showed the least impact for people living with HIV (PLWH).
  • Future training should incorporate more clinical content to improve care for PLWH.