Reducing stigma toward mental illness and substance use issues in primary health care in Chile: Protocol of a cluster controlled trial study.

Background: Chile is implementing a Community Mental Health Model with a strong role of primary health care (PHC). PHC has great potential to early detection and provision of accessible and coordinated services to people who present mental illness and/or substance use issues (MISUI). However, stigma toward people with MISUI among PHC professionals is a significant barrier to accessing good quality of care. A wealth of literature supports the importance of reducing stigma for this population. The main goal of this research project is to determine the effectiveness of a comprehensive anti-stigma intervention in reducing stigmatizing attitudes and behaviors among PHC providers toward individuals with MISUI in the Chilean context, using Centros de Salud Familiar (CESFAMs) as the point of intervention. Methods: The intervention is based on an initiative that was previously developed in Canada and then also pilot-tested in Lima, Peru, with the Center for Addiction and Mental Health (Ontario, Canada). The model will be culturally adapted with CESFAM PHC provider and user inputs to be relevant and valid to Chile. The 18-month intervention includes five (5) components that are simultaneously implemented in CESFAMs: (1) Develop a Team of Local Champions in each intervention CESFAM, comprising PHC providers and users; (2) Analysis of Internal CESFAM Policies, Procedures, and Protocols to determine areas of improvement in service delivery for individuals with MISUI; (3) Raising Awareness of stigma toward MISUI using various forms of media within the CESFAM; (4) Innovative Contact-Based Education workshops on anti-stigma and recovery principles, co-lead by academic/clinical trainers and a person with lived experience of MISUI; and (5) Recovery-Based Arts, a multi-week arts workshop for PHC providers and users to produce artwork related to MISUI and recovery, culminating in an exhibition to showcase artwork for the CESFAM providers, users, and community. The expected intervention outcomes are the following: Participation in the experimental group will result in a significant decrease in stigmatizing attitudes among PHC providers toward individuals with MISUI compared with the control group as measured by the Chilean version of the Opening Minds Scale for Health Care Providers Scale (OMS-HC); Participation in the experimental group will result in a significant decrease of PHC users experiences of stigma conveyed by PHC providers compared with the control group as measured by the Internalized Stigma of Mental Illness (ISMI) scale, validated for the Chilean population. The changes in attitudes and behaviors within the experimental group will be sustained over time as measured at 6 months-follow-up. To evaluate the effectiveness of this 18-month intervention, a 4-year, two-arm, cluster-randomized controlled trial is proposed, with CESFAMs being the unit of randomization (or "cluster"). Implementation Science approach will be taken to measure relevant implementation outcomes for each component of the intervention, and through qualitative data collection with CESFAM providers and authorities. Data analysis will be carried out using SAS 9.4 (specifically, using POC MIXED and PROC GENMOD) and R 3.5. Mixed-effect modeling will used for both PHC provider and user data, which will include individuals and CESFAMs as random effects and group (intervention/control) as fixed effects. Discussion: This study represents a new stage of relevant and innovative research in mental health and stigma in Chile that will contribute to improving access and quality of care for people with MISUI. Evaluating the impact of the intervention model and its implementation will provide the necessary tools to scale the intervention up to other CESFAMs across Chile. Clinical trial registration: [www.ClinicalTrials.gov], identifier [NCT05578066].

Tobacco smoking in urban neighborhoods: exploring social capital as a protective factor in Santiago, Chile.

INTRODUCTION: Research examining the relationship between social capital and health in Latin America has been limited. The aim of this study is to evaluate the association between social capital and tobacco use in four low-income neighborhoods in Santiago, Chile. METHODS: A multistage probability sample was used to select households in 4 of the 10 poorest neighborhoods in the district of Puente Alto, in Santiago, Chile. A cross-sectional survey of 781 participants (81.2% response rate for households) included sociodemographic variables, questions pertaining to neighborhood social capital, and questions pertaining to tobacco. Main analyses were carried out at the individual level by performing a multiple logistic regression of individual tobacco use on individual perceptions of community social capital. RESULTS: The prevalence of smoking was 43.9% of the surveyed population. A five-factor structure for social capital was identified, including "perceived trust in neighbors," "perceived trust in organizations," "reciprocity within the neighborhood," "neighborhood integration," and "social participation." An inverse relationship between trust in neighbors and tobacco smoking was statistically significantly with an adjusted odds ratio of 0.95 (95% CI: 0.91-0.99). Trust in neighbors was also significantly inversely associated with the number of cigarettes smoked. DISCUSSION: Tobacco control remains a significant challenge in global health, requiring innovative strategies that address changing social contexts as well as the changing epidemiological profile of developing regions.

[Social capital and mental health in low income urban communities in Santiago, Chile]. / Capital social y salud mental en comunidades urbanas de nivel socioeconómico bajo, en Santiago, Chile: Nuevas formas de entender la relación comunidad-salud.

BACKGROUND: Many studies suggest that social capital, defined as those intangible resources of a society or community (trust, participation and reciprocity), that might facilitate collective action, can be associated with positive health effects. AIM: To explore the relationship between social capital an the level of mental health, in urban communities of Santiago, Chile. MATERIAL AND METHODS: In a qualitative-quantitative cross-sectional design, two low income neighborhoods in the municipality of Puente Alto were selected. Interviews to key agents and focus groups, as well as surveys (407) to adults from a representative random sample of households, were conducted, measuring social capital, using a locally devised questionnaire and mental health using the General Health Questionnaire (GHQ-12 instrument). A qualitative analysis based on the grounded theory and a quantitative analysis through correlations and simple and logistic regression models were applied. RESULTS: The quantitative analysis found an association between female gender, education and having a chronic disease, with low levels of mental health. At the same time, the trust component of social capital might be associated with a better mental health status. Qualitatively, all the components of social capital were identified as important for a better mental health. CONCLUSIONS: This study suggests the existence of a positive relationship between social capital and mental health. Developing trust in a community might be a useful tool to work in mental health at the community level.

Capital social y salud mental en comunidades urbanas de nivel socioeconómico bajo, en Santiago, Chile: Nuevas formas de entender la relación comunidad-salud / Social capital and mental health in low income urban communities in Santiago, Chile

Many studies suggest that social capital, defined as those intangible resources of a society or community (trust, participation and reciprocity), that might facilitate collective action, can be associated with positive health effects. Aim: To explore the relationship between social capital an the level of mental health, in urban communities of Santiago, Chile. Material and methods: In a qualitative-quantitative cross-sectional design, two low income neighborhoods in the municipality of Puente Alto were selected. Interviews to key agents and focus groups, as well as surveys (407) to adults from a representative random sample of households, were conducted, measuring social capital, using a locally devised questionnaire and mental health using the General Health Questionnaire (GHQ-12 instrument). A qualitative analysis based on the ®grounded theory¼ and a quantitative analysis through correlations and simple and logistic regression models were applied. Results: The quantitative analysis found an association between female gender, education and having a chronic disease, with low levels of mental health. At the same time, the trust component of social capital might be associated with a better mental health status. Qualitatively, all the components of social capital were identified as important for a better mental health. Conclusions: This study suggests the existence of a positive relationship between social capital and mental health. Developing trust in a community might be a useful tool to work in mental health at the community level.