A Chinese culture-specific intervention to decrease nursing students’ stigma towards schizophrenia: a pilot feasibility randomised controlled trial

Background: The stigmatisation of mental illness is affected by culture, beliefs, and empathy; however, researchers rarely take these factors into consideration when developing interventions to reduce stigma. Nursing professionals represent the largest group of healthcare workers globally and are responsible for the care and recovery of individuals with schizophrenia. However, people with schizophrenia face serious stigmatisation. Studies findings show that nursing students express unfavourable attitudes towards people with schizophrenia, indeed more severely than medical students express such attitudes. As nursing students are future healthcare providers for individuals with schizophrenia, addressing their existing stigmas is essential for providing high-quality care for people with schizophrenia. Methods: The study was a single-center, two-arm, parallel, open-label, pilot randomized controlled trial conducted in a hospital without a psychiatry department. The study intervention was implemented online from February 20, 2023 to June 20, 2023. Sixty fourth-year nursing students were included according to this study’s inclusion criteria through convenience sampling and randomised into the experimental and control groups equally. The intervention training program was developed through a systematic review, focus group interviews with nursing students, expert panel, and consultation with nursing students. The experimental group received a 4-week intervention training program, whereas the control group received instructions to read a book. The feasibility and acceptability were assessed. The efficacy of the intervention was evaluated by the Knowledge about Schizophrenia Test (KAST), the Mental Illness Clinicians’ Attitudes Scale (MICA), the Reported and Intended Behavior Scale (RIBS), and the Jefferson Scale of Empathy (JSE) at baseline (T1), post-intervention (T2), and 3-month follow-up (T3). The analyses included paired T-tests, chi-square tests for nominal variables, Wilcoxon signed-rank tests, and generalized estimating equations (GEE). Results: The recruitment, retention, and intervention attendance rates indicate that the intervention was both feasible and acceptable. The experimental group showed significant improvements in KAST scores (knowledge of schizophrenia) at T2 and T3, along with notable improvements in the RIBS score (intended behaviour) at T2 and a significant decrease in the MICA score (negative attitudes) at T2 and T3. Furthermore, there was a significant increase in JSE-NSR score (empathy) at T3. The control group displayed no significant changes in the MICA, RIBS or JSE-NSR scores at T2 and T3. GEE test showed that the experimental group had a more significant decrease in MICA scores at T2 and T3, a substantial enhancement in JSE score at T3 and a more significant decrease in RIBS at T2 compared to the control group. Conclusion: The results of this study revealed that the Chinese culture-specific online intervention was both feasible and well-received among fourth-year nursing students for reducing schizophrenia stigma. Trial registration: The study was prospectively registered at ClinicalTrials.gov (Identifier: NCT05413408) on 10 June 2022. https://www.clinicaltrials.gov/study/NCT05413408?term=MICA&rank=10.