Describing nurses’ stigmatising attitudes towards persons with mental disorders in a selected district hospital setting in Rwanda.

Abstract

Aim The purpose of this study was to describe mental disorder stigmatising attitudes held by nurses, in a selected district hospital in Rwanda, and to analyse the potential mediating effects of person variables, specifically familiarity, on these stigmatising attitudes. Methodology The stigma process framework informed a quantitative, non-experimental, descriptive research design. A self-report questionnaire included person variables (age, gender, nursing qualification, nursing category and years of nursing experience) and two scales; Level of Contact Scale (LOC) and Community Attitudes towards Mental Illness - Swedish version (CAMI-S). A sample of one hundred and two (n=102) was achieved. Ethical approval was obtained from educational institutions, University of KwaZulu-Natal in SA and Kigali Health institute in Rwanda, and at local health care service level in Rwanda. Data were analyzed using the Statistical Package for Social Sciences (SPSS) Version 21. Analysis includes descriptive statistics and multivariate analysis; associations between scale scores and person variables, inter-correlations between CAMI-S subscales and total scores and correlations of CAMI-S and LOC scale scores. Non parametric tests were used, Mann–Whitney U Test, Kruskal-Willis H Test and Spearman’s rho correlation coefficient test and significance was determined by Cohen’s guide lines (Cohen, 1988) cited in Pallant (2010; 2013). Results Although participants reported negative stereotypes in all items on the CAMI-S, related to persons with a mental disorder in keeping with previous international (Griffiths, Nakane, Christensen, Yoshioka, Jorm, & Nakane, 2006; Veer, Kraan, Drosseart & Moddle, 2006; Putman, 2008) and local studies (Smith & Middleton, 2010), the extent of contradiction within participant responses suggests social desirability bias. Results suggest that, while participants acknowledge community integration of mental health services in principle, their desire for social distance from persons with a mental disorder was strongly evident in responses to proximity of living arrangements and support of segregation. Statistical results indicated no associations between negative stereotypes and participants’ gender, category of nurses or level of education. However, associations between negative stereotypes and the younger age group and the less experienced participants are reported as statistically significant. There was high levels of familiarity amongst participants, more than half of participants (57.8%, n=59) scored levels of familiarity at 9, A friend of my family has a mental disorder, and above. A negative correlation is reported between familiarity and stigmatizing attitudes. Conclusion and recommendation Results suggest familiarity has a positive mediating effect on negative stereotypes. In addition older more experienced nurses are reported to have less stigmatising attitudes towards persons with a mental disorder. Despite these results, contradictions within participants’ responses on the CAMI-S suggest that additional research and intervention studies, specifically with general health care practitioners, are recommended to clarify the contradictions and obtain empirical data about effectiveness of contact with persons with a mental disorder. Key words: Stigma, negative stereotypes, mental disorder, district hospital