Abstract
BACKGROUND: Affiliate stigma (AS) is self-stigma in caregivers, having three salient components: affective, behavioral, and cognitive. High caregiver AS causes concealment of mental illness and has negative consequences. Appropriate intervention for AS can offset such consequences. AIM: To develop a pragmatic, affordable, and tentatively effective mental health intervention that targets AS. METHODS: We formulated Intervention for Caregiver Affiliate stigma REduction (i-CARE) after the thorough literature review, mental health expert and caregiver feedback (for face validation), and a pilot study (for feasibility and preliminary effectiveness). Throughout, the focus was on simplicity (single session of 25 min), feasibility, and applicability across different settings (outpatient, inpatient, online) and modalities (face-to-face/direct intervention, video consultation/remote intervention) suitable for the North Indian cultural context. It incorporated anti-stigma components of psychoeducational and contact-based intervention. The study was registered at CTRI (2022/01/039333). RESULTS: i-CARE took about 4 months to develop. Expert suggestions, such as issues of medication adherence, functional recovery, and most importantly, an individualized session of doubt clarification, were included. The caregivers assessed the clarity, comprehension, and usefulness of the intervention. The final components included introductory interaction, multimedia-based audio-visual content, printed IEC material, and a one-to-one clarification session. We used lived caregiving experience through audio-visual content to target contact-based anti-stigma approaches, psychoeducational approaches through multimedia and flyers, and personalized sessions for individualized approaches. Pilot testing of i-CARE suggested its feasibility in administration and effectiveness in the immediate post intervention period. CONCLUSION: We developed and validated i-CARE through an iterative process, keeping pragmatics and cultural contextuality in mind. We plan to test its efficacy in a robustly designed study.