A New Podcast for Reducing Stigma Against People Living With Complex Mental Health Issues: Co-design Study
Background: Mental illness stigma refers to damaging stereotypes and emotional responses around the experience of mental health issues. Media-based interventions have the potential to reduce the public's stigmatizing attitudes by improving mental health literacy, emotional appeal, and the intimacy of address. As audio-based media facilitating storytelling, podcasts show potential for reducing stigma" however, it is unclear what features could make a podcast effective or engaging.
Objective: The Co-Design and Anti-Stigma Podcast Research (CASPR) study aimed to collaborate with key target audience members to inform the development of a new podcast. This podcast primarily aims to reduce listeners' stigmatizing attitudes toward people living with complex mental health issues.
Methods: This study was adapted from Experience-Based Co-Design methodology. The first part, information gathering, involved a web-based mixed methods survey with 629 Australian podcast listeners to explore their interest and concerns around podcasts. Then, a series of focus groups were held with a purposive sample of 25 participants to explore the potential benefits and challenges of the podcast format. Focus group participants included people with lived experience of complex mental health issues, media and communications professionals, health care professionals, and people interested in workplace mental health. The second part, co-design, constituted 3 meetings of a co-design committee with 10 participants drawn from the focus groups to design the podcast using brainstorming and decision-making activities.
Results: Most survey respondents (537/629, 85.3%) indicated a willingness to listen to a podcast about experiences of mental illness stigma" participants indicated preference for semistructured episodes and a mixture of light and serious content. Focus group participants identified potential challenges with appealing to listeners, making the content emotionally resonant and engaging, and translation to listeners' attitude change. The co-design committee collaborated to achieve consensus on the focus of individual episodes: domains where stigma and discrimination are common, such as workplaces and health care settings" the structure of individual episodes: storyboards that centralize guests with lived experience, featuring explicit discussions around stigma and discrimination" and overarching content principles, including a sincere, empathetic, and hopeful tone" using plain language" having clear calls to action" and providing listener resources.
Conclusions: The co-design process informed a podcast design that features lived experience narratives with an explicit focus on stigma and discrimination, highlighting the realities of stigma while acknowledging progress in the space and how listeners can contribute toward social change. This study allowed for an in-depth discussion around the strengths and limitations of such a podcast according to different target audience members. The co-design committee designed key elements of a podcast that has the potential to minimize the limitations of the format while embracing the benefits of podcast-based storytelling. Once produced, the podcast will be evaluated for its impact on attitude change.
The Wavelengths Study: A Randomized Controlled Trial Assessing the Effectiveness of a Codesigned Podcast on Mental Illness Stigma
On the Same Wavelength is a codesigned podcast (Carrotte, 2023) featuring people with lived experience of complex mental health issues, who discuss how stigma and discrimination have affected their lives. This randomized controlled trial aimed to understand whether listening to the podcast could impact on listeners' attitudes toward people living with complex mental health issues. University students (N = 163) were randomized to listen to three episodes of On the Same Wavelength or a control podcast. Participants completed the Community Attitudes Toward the Mentally Ill Scale (CAMI-27) and the Social Distance Scale at baseline, post experiment, and after a 4-week follow-up period, plus the State Empathy Scale immediately after listening to each episode. Linear mixed-effects models, adjusting for baseline scores and socially desirable response style, found more positive attitudes on the CAMI-27 Prejudice subscale for those who listened to On the Same Wavelength compared to control postexperiment (t = −2.47, p = .015), but this was not maintained at follow-up. There were no significant differences between groups for other CAMI-27 scores or the Social Distance Scale. Participants who listened to On the Same Wavelength experienced a significantly higher degree of empathy compared to control after Episode 2 (t = −1.99, p = .048) but not after listening to other episodes. Generalizability was limited by the university student sample, who demonstrated positive attitudes at baseline. On the Same Wavelength shows promise for improving short term prejudicial attitudes, though further research is needed to understand how podcast-based messaging could be more effective for longer term stigma reduction.
Podcasts, Mental Health, and Stigma: Exploring Motivations, Behaviors, and Attitudes Among Listeners
Podcasts are increasingly utilized in mental health contexts, such as communicating advice around improving wellbeing, guided meditations, psychoeducation, and translating research findings. This study aimed to explore demographics, motivations, behaviors, and attitudes of podcast listeners regarding podcasts dealing with content and themes related to mental health. Adult Australian podcast listeners (N = 629) completed a cross-sectional online survey including the Acquisition Questionnaire (AQ-9), the Mental Health Knowledge Schedule (MAKS) and the Internalised Stigma of Mental Illness scale (ISMI-9). Approximately one third had listened to a mental health themed podcast in the last 12 months. Logistic regression models showed people who listened to a mental health-themed podcast held fewer stigmatizing attitudes toward people experiencing mental health issues on the AQ-9 (OR 1.0, 95% CI 0.9–1.0, p < .001), and had higher levels of mental health knowledge on the MAKS (OR 1.1, 95% CI 1.0–1.2, p < .01). However, there was no significant relationship with internalized stigma on the ISMI-9 (OR 1.4, 95% CI 0.9–2.3, p = .2). Future research is needed to determine if such podcasts indeed impact listeners' attitudes and behaviors, and, if they do, how podcasts can be used for effective communication around mental health content.