District Hospital Trauma Mental Health Screening Stigma Priming From Clinic Signage and Post-Traumatic Stress Disorder Disclosure in Kenyan Referral Facilities: A Cluster-Randomised Evaluation of Cue Exposure

Clinic signage is a taken-for-granted element of hospital infrastructure, yet it may function as a stigma prime that shapes whether trauma survivors disclose post-traumatic stress symptoms during screening. The indicator was drawn from 35 African countries across 109 country-survey observations between 1990 and 2023, with a mean of 9.018 and a standard deviation of 12.67. Signage operates through a priming mechanism that activates stereotype threat and anticipated discrimination, and that this mechanism is plausible enough to warrant formal evaluation. The contribution is a testable framework linking environmental cues to disclosure behaviour, with implications for screening protocol design in Kenyan referral facilities.