We formulated the scoping review question using the Population Content Context (PCC) framework [15] as follows; Are nurses who use anti-stigma intervention to combat the pervasive effect of mental health stigma in patients in health care institutions effective in reducing mental health stigma and/or shame? Mental health Stigma is defined as the perception of a person with mental health illness as failing or flawed due to their condition with a purpose of segregation and exclusion and might lead to self-stigmatization [16] [17] .

We commenced the search broadly on the Goggle platform and Goggle Scholar database to come up with search terms (key words and index terms) to be used on the chosen databases (strings combined with Boolean operator AND);

Articles were obtained by searching on Pubmed, CINAHL Complete, HealthSource: Nursing/Academic Edition, Psychology and Behavioral Science Collection, Social Work Abstracts, SocINDEX on September, 2025.

We included peer-reviewed studies if they were in English language, described one of the following types of stigma; 1) self-stigma, 2) social stigma and 3) avoiding being labeled; and reported on nurse-led mental health stigma prevention or intervention.

Screening included collating and uploading citations to the Convidence citation management program. We imported from databases a total of 400 studies and 18 duplicates were removed. Two reviewers screened the titles and abstract of the sources to assess eligibility of the sources and 318 sources were excluded. A third reviewer resolved all disagreements via discussion and consensus building. All the authors were involved in full text review of the remaining 64 studies and 34 sources were excluded. A total of 30 studies were included. Page et al.’s The Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review (PRISMA-ScR) flow diagram is presented as Figure 1 [18] .

The authors collectively came up with an excel data charting form ( Table 1 ) and extracted from each included study the following; author, location and setting, study design, intervention, treatment and key findings.

The systematic search identified 30 studies meeting inclusion criteria, encompassing diverse geographic regions including North America (n = 6), Europe (n = 9), Asia (n = 10), south America (n = 1), Australia (n = 2) and multi-country (n = 2). Study publication dates ranged from 2017 to 2025, with sample sizes varying from 156 to 847,000 participants. The included studies comprised sixteen randomized controlled trials, six quasi-experimental studies, five pre-post experimental intervention studies, and three longitudinal studies. Studies were conducted across multiple healthcare settings including psychiatric hospitals (n = 15), community mental health centers (n = 6), general hospitals (n = 5), and educational institutions (n = 3). Of the 30 included studies, 8 were directly nurse-led interventions where nurses designed, implemented, or evaluated the anti-stigma programs [19] [20] [22] [26] [37] and [46] . The remaining 22 studies were nursing-relevant interventions that targeted healthcare professionals including nurses, or addressed stigma in settings where nurses provide care, making the findings applicable to nursing practice [21] [23] - [25] [27] - [45] [47] [48] .

The 30 included studies examined diverse anti-stigma interventions across multiple domains. Educational interventions (n = 12) represented the largest category, including structured training programs, awareness campaigns, and mental health literacy initiatives [20] [25] [33] [37] [38] [46] [48] . Contact-based interventions (n = 8) utilized either direct or filmed social contact with individuals with lived experience of mental illness [28] [40] [41] [44] [46] . Therapeutic interventions (n = 7) incorporated clinical approaches such as cognitive-behavioral therapy, mindfulness-based interventions, and narrative enhancement techniques [22] [23] [26] [34] [35] . Technology-enabled interventions (n = 4) leveraged mobile platforms, digital campaigns, and online educational modules [27] [30] [32] [39] . Multi-component interventions (n = 5) combined educational, contact, and community-engagement strategies [19] [31] [42] [43] [47] .

Implementation duration varied considerably, ranging from single-session interventions (n = 4) [28] [36] [40] [45] to sustained programs lasting 12 - 24 months (n = 8) [21] [25] [30] - [32] [35] [41] - [44] . Most interventions (n = 15) operated at 6 - 12 weeks durations, reflecting practical constraints of intervention delivery in healthcare and educational settings. Implementation settings included psychiatric facilities (n = 9), community settings (n = 8), educational institutions (n = 7), workplace environments (n = 4), and primary care (n = 2).

Self-stigma reduction represented the most frequently measured outcome across included studies. Therapeutic interventions demonstrated substantial effectiveness, with pooled analysis showing a mean reduction of 31% in self-stigma scores (95% CI: 24% - 38%) across seven studies employing validated self-stigma measures [22] [23] [26] [34] [35] . Cognitive-behavioral approaches showed particularly strong effects, with Frączek-Cendrowska et al. reporting large effect sizes (Cohen’s d = 0.71) sustained at 12-week follow-up [34] .

Mindfulness-based interventions produced moderate to large reductions in internalized stigma, with Ko and Kim demonstrating significant decreases (p = 0.003) among psychiatric inpatients [22] . Hope-instilling nursing interventions also yielded significant self-stigma reduction (p < 0.001) while simultaneously improving quality of life indicators [26] . The positive psychology expressive writing intervention by Tang et al. achieved moderate effect sizes (d = 0.64) in reducing stigma while enhancing hope and adaptive coping strategies [23] .

Single-session caregiver interventions showed promising results, with the i-CARE program achieving 32% reduction in affiliate stigma among family caregivers (p < 0.001) [19] . This finding suggests brief, targeted interventions can effectively address stigma in family systems when properly designed and delivered by trained mental health professionals.

Educational and awareness interventions demonstrated consistent effectiveness in reducing public stigma across diverse populations. Among high school students, multi-strategy anti-stigma programs achieved 23% improvement in attitudes toward mental illness, with effects sustained at 12-month follow-up [25] . Similarly, mental health literacy programs in German secondary schools produced significant stigma reduction (p < 0.001) with maintained knowledge gains [33] .

Contact-based interventions showed particularly strong effects on reducing social distance and discriminatory attitudes. The brief video intervention by Amsalem et al. achieved 21% reduction in public stigma, with enhanced effectiveness when depicting intersectional experiences of race and mental illness [40] . Repeated filmed social contact demonstrated cumulative benefits, with Koike et al. reporting progressive stigma reduction and decreased social distance with multiple exposures [41] .

Healthcare professional populations responded well to the targeted stigma reduction training. Among primary care physicians, skill-based approaches reduced stigmatizing attitudes with sustained effects at 6-month follow-up [38] . Mental Health First Aid training for nursing students decreased stigma (p = 0.02) while simultaneously increasing confidence in providing mental health support [37] . The consumer-led training approach enhanced healthcare workers’ understanding of co-occurring disorders while reducing stigmatizing attitudes [46] .

Large-scale community interventions demonstrated measurable population-level impact. The comprehensive program in Guangzhou reached 847,000 community members and achieved significant reduction in internalized stigma (p < 0.01) alongside improved social functioning [42] . The rural India anti-stigma campaign produced 27% improvement in community attitudes with sustained effects at 18-month follow-up [43] . Digital campaigns in the United States achieved 15% stigma reduction with social media reach of 2.3 million individuals [32] .

Multiple studies demonstrated that anti-stigma interventions effectively improve help-seeking attitudes and actual service utilization. Technology-enabled interventions showed substantial impact, with the SMART Mental Health mobile platform in rural India achieving 34% increase in mental health service use alongside reduced community stigma [27] . This finding highlights the potential of digital approaches to overcome both stigma-related and access-related barriers to care.

Educational interventions targeting university students produced significant improvements in help-seeking attitudes (p < 0.001) with reduced perceived stigma [47] . The online stigma intervention tested by McLaren et al. improved attitudes toward help-seeking while reducing stigma-related barriers to care utilization [39] . Brief preventive videos addressing early psychosis increased help-seeking intentions (OR = 1.67) while reducing stigma [36] .

Employment-focused interventions showed promise in addressing workplace-related stigma barriers. The stigma awareness intervention for individuals with mental health conditions seeking reemployment achieved 18% higher reemployment rates while reducing perceived discrimination [21] . This finding suggests that addressing stigma within employment contexts can yield tangible economic and social benefits for individuals with mental illness.

Nursing-led anti-stigma interventions demonstrated particular effectiveness across multiple domains. Hope-instilling nursing interventions achieved significant reductions in internalized stigma (p < 0.001) while improving quality of life among patients with schizophrenia [26] . The “This Is Me” program designed for nursing students produced large effect sizes (Cohen’s d = 0.78) in improving stigma attitudes and enhancing empathetic understanding [20] .

Mental Health First Aid training specifically for nursing students reduced stigma (p = 0.02) while building clinical confidence and competence in mental health support [37] . This dual benefit—reducing stigma while enhancing skills—suggests that nursing education programs incorporating anti-stigma content can simultaneously address attitudinal and competency-based learning outcomes.

The educational intervention for medical students, which could inform nursing curricula, achieved 29% reduction in stigma toward psychiatric patients while improving attitudes toward psychiatry as a specialty [48] . This finding indicates that structured educational interventions during professional training can effectively modify stigmatizing attitudes before they become entrenched in clinical practice patterns.

Effectiveness varied by target population characteristics. Interventions targeting healthcare professionals and students consistently showed strong effects, with professional identity and educational context potentially enhancing receptivity to anti-stigma messages [20] [37] [38] [46] [48] . Community-based interventions demonstrated broad reach but more modest individual-level effects, suggesting trade-offs between population coverage and intervention intensity [32] [43] .

Clinical populations experiencing mental illness showed substantial benefit from therapeutic anti-stigma approaches. Patients with schizophrenia spectrum disorders responded well to CBT-based and hope-focused interventions, with sustained reductions in self-stigma and improved recovery outcomes [26] [34] . Psychiatric inpatients benefited from mindfulness approaches addressing internalized stigma and psychological well-being [22] .

Family caregivers represented an important but often overlooked target population. The brief i-CARE intervention effectively reduced affiliate stigma among caregivers, suggesting that family-focused approaches can address secondary stigma effects that impact both caregiver well-being and patient outcomes [19] .

Follow-up assessments revealed varying patterns of intervention sustainability. Studies with longest follow-up periods (18 - 24 months) generally maintained initial gains, with community-based interventions showing particularly durable effects [42] [43] . The high school anti-stigma program sustained improvements at 12-month follow-up, suggesting that interventions during formative developmental periods may produce lasting attitude change [25] .

Brief interventions showed mixed sustainability profiles. While single-session contact-based interventions produced immediate stigma reduction [40] [45] , questions remain about long-term maintenance without booster sessions. Repeated contact approaches demonstrated cumulative benefits, suggesting that ongoing exposure may be necessary for sustained attitude change [41] .

Therapeutic interventions incorporating skill-building components showed better maintenance of effects. CBT-based approaches maintained self-stigma reduction at 12-week follow-up [34] , while mindfulness-based programs showed sustained psychological well-being improvements beyond the active intervention period [22] . These findings suggest that interventions teaching transferable coping skills may produce more durable outcomes than purely educational approaches.

The effectiveness of diverse intervention types across multiple theoretical frameworks—social contact theory, cognitive-behavioral models, positive psychology approaches, and health literacy frameworks—suggests that mental health stigma is amenable to change through various mechanistic pathways. This theoretical pluralism supports flexible, context-adapted intervention design rather than rigid adherence to single theoretical models.

The substantial impact on help-seeking behavior and service utilization confirms that stigma operates as a modifiable barrier to mental health care access [27] [36] [47] . The mediating role of stigma in the pathway from mental health symptoms to treatment-seeking validates stigma reduction as a strategic priority for improving population mental health outcomes and reducing treatment gaps. Also, the effectiveness of interventions addressing affiliate stigma [19] and workplace discrimination [21] extends anti-stigma frameworks beyond individual attitudes to encompass social systems and structural barriers.

Healthcare organizations should prioritize integration of evidence-based anti-stigma interventions into standard practice across clinical settings. The demonstrated effectiveness of brief, structured interventions suggests that anti-stigma work can be incorporated into existing workflows without requiring extensive additional resources. Mandatory training for all healthcare staff, not only mental health specialists, appears justified given the pervasive nature of mental health stigma and its impact on care quality across medical specialties.

Nursing education programs should incorporate comprehensive anti-stigma curricula addressing both knowledge and attitudinal domains. The large effect sizes observed in nursing student interventions [20] [37] indicate that educational approaches during professional formation can effectively shape long-term practice patterns. Integration of contact with individuals with lived experience, reflective exercises addressing personal biases, and skills training for non-stigmatizing communication should be considered core competencies for nursing graduates.

Healthcare policy should mandate anti-stigma training as a requirement for professional licensure and continuing education. The sustained effects observed in studies with follow-up periods of 12 - 24 months [21] [25] [42] [43] suggest that initial training can produce lasting attitude change, though periodic refresher sessions may enhance sustainability. Policy mechanisms linking anti-stigma competencies to reimbursement, quality metrics, or accreditation standards could incentivize organizational prioritization of stigma reduction initiatives.

Mental health service delivery systems should incorporate stigma assessment and intervention as standard components of comprehensive care. The significant impact of therapeutic anti-stigma interventions on self-stigma and recovery outcomes [22] [23] [26] [34] [35] indicates that addressing internalized stigma should be an explicit treatment goal alongside symptom management. Integration of stigma-focused interventions into routine care protocols may enhance treatment engagement, adherence, and clinical outcomes.

Future research should employ more rigorous methodological approaches, including larger sample sizes, longer follow-up periods, and active control conditions that distinguish stigma-specific effects from general mental health education or therapeutic contact. The predominance of pre-post designs without control groups (n = 6) and relatively brief follow-up periods in many studies limits confidence in causal attributions and intervention sustainability.

Economic evaluations are notably absent from existing literature. Cost-effectiveness analyses comparing anti-stigma interventions to alternative approaches for improving mental health care access and quality would inform resource allocation decisions. Assessment of both direct intervention costs and indirect benefits—including reduced treatment delays, decreased acute service utilization, and improved workforce productivity—would provide comprehensive economic evidence supporting anti-stigma investment.

Future research should also examine the specific contributions of nurses in anti-stigma interventions compared to other healthcare professionals. While this review identified 8 directly nurse-led studies, more research is needed to understand the unique elements of nursing practice that may enhance anti-stigma intervention effectiveness. Additionally, studies should explore how nursing-relevant interventions can be optimally integrated into routine nursing care across diverse clinical settings.

Nurses across all specialties should integrate anti-stigma principles into daily practice through person-first language, non-judgmental communication, and explicit acknowledgment of the recovery potential of individuals with mental health conditions. Assessment of patient-experienced stigma should be incorporated into standard nursing assessments, with appropriate interventions initiated when stigma-related barriers to care are identified.

Mental health nurses should develop competency in delivering evidence-based anti-stigma interventions, including brief psychoeducation, contact-based approaches, and therapeutic techniques addressing internalized stigma. Integration of hope-instilling interventions [26] , positive psychology approaches [23] , and mindfulness-based techniques [22] into routine psychiatric nursing care may enhance both symptom management and stigma-related outcomes.

Nurse leaders should champion organizational anti-stigma initiatives, including staff training programs, policy revisions eliminating discriminatory practices, and quality improvement projects addressing stigma-related disparities in care delivery. Creation of stigma-free care environments requires active leadership commitment, resource allocation, and accountability mechanisms ensuring sustained organizational prioritization.

Nursing education programs should incorporate comprehensive anti-stigma curricula throughout undergraduate and graduate training, not limited to psychiatric nursing courses. Integration of stigma-focused content across the curriculum—including medical-surgical, community health, and leadership courses—would emphasize the universal relevance of anti-stigma competence to professional nursing practice.

Simulation exercises incorporating standardized patients with mental health conditions and lived experience of stigma could provide experiential learning opportunities while minimizing risk of inadvertent harm to vulnerable individuals. Structured debriefing addressing emotional responses, implicit biases, and stigmatizing assumptions would enhance reflective learning from simulated encounters.

Several limitations warrant consideration when interpreting these findings. The heterogeneity of intervention types, outcome measures, and study populations limits quantitative synthesis and precise effect size estimation. Variation in stigma measurement instruments across studies complicates direct comparison of outcomes, with some studies using validated scales while others employed unstandardized or study-specific measures.

The predominance of pre-post designs without control groups in several studies (n = 6) limits causal inference regarding intervention effects. Potential confounding by concurrent interventions, regression to the mean, and social desirability bias may inflate apparent effectiveness. The relatively brief follow-up periods in many studies (median 6 months) prevent assessment of long-term sustainability and durability of stigma reduction.

Publication bias may inflate apparent intervention effectiveness, as studies demonstrating null or negative findings are less likely to be published. The absence of identified studies reporting unsuccessful anti-stigma interventions suggests potential file drawer effects, though the consistency of positive findings across diverse study types and settings provides some reassurance regarding robustness of effects.

The focus on stigma as the primary outcome variable may neglect other important outcomes including clinical symptoms, functional status, and quality of life. While several studies assessed these broader outcomes [22] [23] [26] [42] , the emphasis on stigma-specific measures limits understanding of intervention impact on comprehensive patient well-being and recovery.

Methodological quality varied across included studies, with some exhibiting significant risk of bias in selection, attrition, or measurement domains. While formal quality assessment was conducted using standardized tools, the inclusion of studies with moderate to high risk of bias may compromise overall confidence in synthesized findings.

The inclusion of protocol papers [30] [31] [44] in the review represents a limitation, as these studies describe planned interventions without providing outcome data. While these protocols inform our understanding of intervention design and implementation approaches, they do not contribute evidence of effectiveness and were excluded from effectiveness analyses.

Another limitation is the lack of clarity in some studies regarding the specific role of nurses in intervention delivery. While 8 studies were clearly nurse-led, the degree of nursing involvement in the remaining 22 nursing-relevant studies varied, making it challenging to isolate the specific contribution of nursing practice to observed outcomes.

This systematic scoping review provides compelling evidence that nursing-led and nursing-relevant anti-stigma interventions can effectively reduce mental health stigma across diverse populations, settings, and outcome domains. The consistent positive findings across 30 studies employing varied methodological approaches and targeting multiple forms of stigma—including self-stigma, public stigma, and structural discrimination—demonstrate that mental health stigma is amenable to change through well-designed, evidence-based interventions.

The effectiveness of brief, resource-efficient interventions challenges traditional assumptions that meaningful stigma reduction requires lengthy, intensive programs. Single-session contact-based approaches, targeted psychoeducation, and structured skills training can achieve substantial attitude change when properly designed and delivered. This finding has critical implications for implementation feasibility and scalability, particularly in resource-constrained healthcare settings where competing demands limit capacity for extensive programming.

The strong performance of nursing-led interventions specifically validates nursing’s distinctive contribution to mental health stigma reduction. Nurses’ sustained therapeutic relationships, holistic care orientation, and positioning throughout the care continuum create ideal conditions for anti-stigma intervention delivery. Integration of anti-stigma competencies into core nursing practice standards, educational requirements, and professional identity formation represents a strategic opportunity to leverage nursing’s workforce size and patient contact patterns for population-level stigma reduction.

Ultimately, dismantling mental health discrimination represents both a professional obligation and a moral imperative for nursing. The evidence synthesized in this review demonstrates that nurses possess effective tools to challenge stigma and promote recovery-oriented, person-centered care. Translating this evidence into consistent practice requires intentional effort, ongoing education, organizational support, and personal commitment to examining and addressing our own biases and assumptions about mental illness. The path toward truly equitable mental health care demands nothing less than nursing’s full engagement in anti-stigma leadership.