Feasibility and Acceptability of a Psychological Intervention for Internalized Health-Related Stigma Among Adults...

Health-related stigma is widely acknowledged as a threat to public health and a barrier to managing chronic health conditions. Internalized stigma is a particularly strong predictor of poor health outcomes across health conditions, yet few evidence-based interventions are available. Peer support and counseling have been investigated as interventions for reducing internalized stigma. Typically, these interventions are developed and tested in disease-specific research, focusing on one health condition in isolation from others. This approach may limit knowledge and dissemination of support for health-related stigma across health conditions. Recent work has highlighted the need for research that breaks down traditional silos by using cross-cutting approaches to understand and reduce stigma.

This study aimed to determine the feasibility and acceptability of a new group-based psychological intervention designed to reduce internalized health-related stigma among adults with different stigmatized chronic physical health conditions.

A group intervention that was initially designed to address internalized weight stigma was adapted to be generalizable to other forms of internalized health-related stigma. This was done with input from Advisory Board members living with different stigmatized chronic health conditions and health professionals who specialized in these conditions. Adults with obesity, diabetes, HIV, skin diseases, chronic pain, or cancers were recruited to attend 12 weekly online group meetings. The average session attendance rate was computed with and without makeup sessions. A treatment acceptability questionnaire was completed at week 12. Primarily for feasibility testing, participants completed pre- and post-treatment questionnaires that assessed internalized health-related stigma and other relevant aspects of mental health and health-related quality of life. At baseline, participants were also asked to report reasons for perceived discrimination. Data collection occurred from December 2023 through April 2024.

In total, 10 adults were recruited within approximately 6 weeks, of whom 8 attended at least 1 treatment session and completed post-treatment questionnaires, with a 80% retention. The average session attendance rate was 95.8% with makeup sessions and 83.3% for those without makeup. Treatment acceptability ratings were high, with an overall acceptability rating of approximately 6.5 (SD 0.5) out of 7. Medium to large effect sizes were observed for changes in internalized stigma and some aspects of mental health. Almost all (n=7, 87.5%) of participants reported experiencing discrimination due to their health conditions, which accompanied a wide range of other reasons for perceived discrimination.

Results showed high feasibility and acceptability of a transdiagnostic, online group psychological intervention for internalized health-related stigma delivered to adults with different types of stigmatized chronic physical health conditions. Given the small sample size and limited generalizability, testing in a large efficacy trial is needed to determine intervention benefits.