Implicit Stigma Recognition and Management for Health Professionals

  • Javeed SukheraEmail author
  • Kristina Miller
  • Christina Scerbo
  • Alexandra Milne
  • Rod Lim
  • Chris Watling
In Brief Report



Stigma against individuals with mental illness has disastrous consequences for patient outcomes. Better approaches to reducing stigma in health care professionals are required. Implicit stigma education is an emerging area of research that may inform the design and implementation of stigma reduction programs. In this “in brief report,” the authors describe the evaluation of a novel implicit stigma reduction workshop for health professionals.


The authors conducted a realist evaluation using a longitudinal multiple case study approach. Once a conceptual model was established, three case studies were conducted on physicians and nurses (n = 69) at an academic health sciences center. Within each case, pre- and post-attitudinal scales and qualitative data from semi-structured interviews were used. Consistent with realist evaluation principles, context-mechanism-outcome configuration patterns were analyzed.


An implicit stigma recognition and management workshop produced statistically significant changes in participant attitudes in two out of three contexts. The qualitative evaluation described the perceptions of sustainable changes in perspective and practice. The degree to which individual participants learned with and worked among inter-professional teams influenced outcomes.


Implicit stigma recognition and management is a useful educational strategy for reducing stigma among health professionals. Once stigma is recognized, curricular interventions may promote behavioral change by encouraging explicit alternative behaviors that are sustained through social reinforcement within inter-professional teams.


Stigma Education Implicit bias Realist 



The authors would like to thank Saad Chahine for his assistance with this evaluation.

Funding Information

This work was supported by grants from the Academic Medical Organization of Southwestern Ontario, London Health Sciences Centre Children’s Health Foundation, and Associated Medical Services.

Compliance with Ethical Standards

This work describes a project evaluation, and was therefore exempt from ethics review board approval.


On behalf of all authors, the corresponding author states that there is no conflict of interest.


  1. 1.
    Corrigan PW. Research and the elimination of the stigma of mental illness. Br J Psychiatry. 2012;201(1):7–8.CrossRefGoogle Scholar
  2. 2.
    Schomerus G, Angermeyer MC. Stigma and its impact on help-seeking for mental disorders: what do we know? Epidemiol Psychiat Sci. 2008;17(1):31–7.CrossRefGoogle Scholar
  3. 3.
    Erickson CD. On the stigma of mental illness: practical strategies for research and social change. Psychiatric Services. 2006;57(7):1048.CrossRefGoogle Scholar
  4. 4.
    Dovidio JF, Gaertner SL, Kawakami K. Intergroup contact: The past, present, and the future. Group Proc Intergroup Relat. 2003;6(1):5–21.CrossRefGoogle Scholar
  5. 5.
    Sukhera J, Miller K, Milne A, Scerbo C, Lim R, Cooper A, et al. Labelling of mental illness in a paediatric emergency department and its implications for stigma reduction education. Perspect Med Educ. 2017;6(3):165–72.CrossRefGoogle Scholar
  6. 6.
    Ashburn-Nardo L. The importance of implicit and explicit measures for understanding social stigma. 2010.CrossRefGoogle Scholar
  7. 7.
    Gershan D. Explicit and implicit stigma of mental illness in mental healthcare settings. Norfolk: College of William & Mary; 2013.Google Scholar
  8. 8.
    Gaertner SL, Dovidio JF. The aversive form of racism. San Diego: Academic Press; 1986.Google Scholar
  9. 9.
    Sukhera J, Watling C. A Framework for integrating implicit bias recognition into health professions education. Acad Med. 2018;93(1):35–40.CrossRefGoogle Scholar
  10. 10.
    Greenwald AG, McGhee DE, Schwartz JL. Measuring individual differences in implicit cognition: the implicit association test. J Pers Soc Psychol. 1998;74(6):1464.CrossRefGoogle Scholar
  11. 11.
    Sukhera J, Milne A, Teunissen PW, Lingard L, Watling C. The actual versus idealized self: exploring responses to feedback about implicit bias in health professionals. Acad Med. 2018;93(4):623–9.CrossRefGoogle Scholar
  12. 12.
    Sukhera J, Wodzinski M, Rehman M, Gonzalez C. The implicit association test in health professions education: a meta-narrative review. Perspect Med Educ. 2019;18:1–9.Google Scholar
  13. 13.
    Tilley N, Pawson R. Realistic evaluation. London: Sage, 1997.Google Scholar
  14. 14.
    Gabbidon J, Clement S, van Nieuwenhuizen A, Kassam A, Brohan E, Norman I, et al. Mental Illness: Clinicians’ Attitudes (MICA) scale-psychometric properties of a version for healthcare students and professionals. Psychiatry Res. 2013;206(1):81–7.CrossRefGoogle Scholar
  15. 15.
    Sukhera J, Chahine S. Reducing mental illness stigma through unconscious bias-informed education. MedEdPublish. 2016;5.Google Scholar
  16. 16.
    Wong G, Westhorp G, Manzano A, Greenhalgh J, Jagosh J, Greenhalgh T. RAMESES II reporting standards for realist evaluations. BMC Med. 2016;14(1):96.CrossRefGoogle Scholar
  17. 17.
    Knaak S, Mantler E, Szeto A. Mental illness-related stigma in healthcare: barriers to access and care and evidence-based solutions. Healthc Manage Forum. 2017;30(2):111–6.CrossRefGoogle Scholar
  18. 18.
    FitzGerald C, Martin A, Berner D, Hurst S. Interventions designed to reduce implicit prejudices and implicit stereotypes in real world contexts: a systematic review. BMC Psychol. 2019 Dec;7(1):29.CrossRefGoogle Scholar
  19. 19.
    Corrigan PW, Markowitz FE, Watson AC. Structural levels of mental illness stigma and discrimination. Schizophr Bull. 2004;30(3):481–91.CrossRefGoogle Scholar
  20. 20.
    Sukhera J, Milne A, Teunissen PW, Lingard L, Watling C. Adaptive reinventing: implicit bias and the co-construction of social change. Adv Health Sci Educ. 2018 Aug 1;23(3):587–99.CrossRefGoogle Scholar

Copyright information

© Academic Psychiatry 2019

Authors and Affiliations

  1. 1.Schulich School of Medicine and DentistryWestern UniversityLondonCanada
  2. 2.London Health Sciences CentreLondonCanada

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