A universal approach to reducing stigma in healthcare: a program logic for The Stigma-Free Standard

Stigma is a global challenge to the delivery of quality health services, better health outcomes. Stigma can result in restricted, denied, or sub-standard care. People living with conditions, identities, or practices that are stigmatised may avoid or delay healthcare because of well-founded concerns about how they may be treated, which contributes to poorer health outcomes, health inequity. Efforts to reduce stigma in healthcare present many challenges (including feasibility), due to the diversity, complexity, breadth of health-related stigmas. Previously, we argued for the development of a “universal precautions” approach to stigma reduction in healthcare, hypothesising that stigma reduction efforts can usefully be approached by assuming that most people may be affected by stigma. This paper outlines the development of a prototype of a “universal” stigma reduction intervention, The Stigma-Free Standard, drawing on the existing literature, foundational research and co-design. The Stigma-Free Standard is an online intervention package designed for use in a range of health services to address stigma in a feasible and sustainable way by moving away from a condition-by-condition approach. We present the program logic that underpins The Stigma-Free Standard using a new conceptualisation of stigma that cuts across conditions, identities, and practices, and our approach to evaluating the initial implementation of the intervention. A new conceptualization of a “universal” approach to stigma reduction for implementation in health services is a significant undertaking. This paper aims to provide a transparent and robust account of this new intervention to support the interrogation of findings from impending evaluations, and as a resource for future stigma reduction efforts.