JMIR Publications

ABSTRACT

Background:

Mental illness stigma has been a concerning issue globally due to its adverse effects on the recovery of people with mental illness and may delay help-seeking for mental health out of the concern of being stigmatized. With technological advancement, Internet-based mental health stigma reduction interventions have been developed to combat mental illness stigma and the effects have been promising.

Objective:

The present study aimed to examine the differential effects of Internet-based storytelling programs varied on level of interactivity and stigma content in reducing mental illness stigma.

Methods:

This study compared the effects of four storytelling websites varied on levels of interactivity and stigma content using an experimental design. Specifically, the conditions included an interactive website with stigma-related content (COMBO condition), a non-interactive website with stigma content (STIGMA condition), an interactive website without stigma-related content (INTERACT condition) and a non-interactive website without stigma-related content (CONTROL condition). Participants were recruited via mass emails to all students and staff of a public university and social networking sites. Eligible participants were randomized into four conditions: COMBO (n=67), STIGMA (n=65), INTERACT (n=64) or CONTROL (n=67). Participants viewed the respective Web page at their own pace. Public stigma, microaggression, and social distance were measured online at pre-experiment, post-experiment, and 1-week follow-up. Perceived autonomy and immersiveness as mediators were assessed at post-experiment.

Results:

Both COMBO (n=66) and STIGMA (n=65) conditions were efficacious in reducing public stigma and microaggression towards people with mental illness at post- and 1-week follow-up. However, none of the conditions had significant time x condition effects in reducing social distance from people with mental illness. INTERACT condition (n=64) can significantly reduce public stigma at post- but not 1-week follow-up. CONTROL condition (n=67) was not significant in reducing all mental illness stigma outcomes. Perceived autonomy was found to mediate the effect of public stigma, and immersiveness mediated the effect of microaggression.

Conclusions:

Internet-based storytelling program with stigma-related content and interactivity elicited the largest effects in stigma reduction, including reductions in public stigma and microaggression, although its difference with Internet-based storytelling programs with stigma-related content only was not statistically significant. In other words, although interactivity could strengthen the stigma reduction effect, stigma-related content was a more critical element than interactivity in reducing stigma. Future stigma reduction efforts should place higher priority in producing effective stigma content in a Web page, followed by considering the value of incorporating interactivity in future Internet-based storytelling programs. Clinical Trial: Trial Registration: ClinicalTrials.gov NCT05333848