Preliminary impact of the say no to stigma intervention on attitudes toward mental illness: A pilot randomized clinical trial among primary school students in Uganda

Background: Mental health stigma is a critical barrier to help-seeking behaviors among youth struggling with mental health challenges. However, studies examining the impact of mental health literacy and anti-stigma interventions in sub-Saharan Africa are limited. In this study, we examined the preliminary impact of the Say No to Stigma intervention, a set of visuals co-created with school-going children in Uganda, on reducing mental health stigma in school settings. Methods: We analyzed longitudinal data from a 1-year two-arm pilot randomized clinical trial that recruited 100 children (ages 8–13) from two public primary schools in Uganda. Each school was randomly assigned to either the intervention or the control group. We utilized mixed-effects linear regression analysis to examine the effect of the intervention on social distance and attitudes toward mental illness at 3 months post-intervention initiation. Results: The mean age was 11.4 years, and 58 % of the participants were females. At 3 months post-intervention initiation, results from the mixed effects model showed that the main effect for the group was statistically significant (χ²(1) = 5.56, p < 0.018) for social distance. On the other hand, the group main effects were not statistically significant for attitudes toward mental illness. However, the intervention-time interaction effect for attitudes toward mental illness was statistically significant (χ²(1) = 5.02, p = 0.025). Conclusions: The study results provide a compelling rationale for testing the Say No to Stigma intervention in a larger randomized clinical trial.