Intervention mapping as a guide to developing, implementing, and evaluating stigma reduction interventions

Stigmatization is a complex and deeply ingrained process, not easily amenable to change. The field of systematic behavior change can offer guidance for the improvement of stigma reduction efforts. In this article, we describe Intervention Mapping as a relevant approach for designing stigma reduction interventions. We demonstrate that, for stigma reduction to be effective, a number of actions are essential. We must (1) ascertain, at various socioecological levels, relevant and changeable determinants of stigmatizing behavior and target them specifically in our interventions; (2) delineate exactly what change our stigma reduction interventions aim to achieve at the level of determinants; (3) ensure that the methods employed to reduce stigmatization are aligned with the determinants of stigmatizing behavior and that the theoretically defined conditions under which those methods are most effective are considered, along with characteristics of the target population and intervention context; (4) pretest and pilot test newly developed interventions, and ensure budgetary capacity for these; (5) consider intervention adoption, implementation, and maintenance right from the outset, and approach these systematically as well; and (6) measure, in our evaluations of interventions, not only the desired endpoint (i.e., stigma reduction) but also more direct intervention objectives and changes in the determinants of stigmatizing behavior, and complement effect evaluations with process evaluations that assess implementation reach, completeness, and fidelity. For each of the six Intervention Mapping steps, we provide concrete examples and discuss the current stigma and behavior change literature. Importantly, we also summarize a number of evidence-based stigma reduction methods.