Unjudge Someone: Human Library as a Tool to Reduce Prejudice toward Stigmatized Group Members

Designing a Library of Lived Experience for Mental Health: integrated realist synthesis and experience-based co-design study in UK mental health services

OBJECTIVE

Living Library events involve people being trained as living 'Books', who then discuss aspects of their personal experiences in direct conversation with attendees, referred to as 'Readers'. This study sought to generate a realist programme theory and a theory-informed implementation guide for a Library of Lived Experience for Mental Health (LoLEM).

DESIGN

Integrated realist synthesis and experience-based co-design.

SETTING

Ten online workshops with participants based in the North of England.

PARTICIPANTS

Thirty-one participants with a combination of personal experience of using mental health services, caring for someone with mental health difficulties and/or working in mental health support roles.

RESULTS

Database searches identified 30 published and grey literature evidence sources which were integrated with data from 10 online co-design workshops conducted over 12 months. The analysis generated a programme theory comprising five context-mechanism-outcome (CMO) configurations. Findings highlight how establishing psychological safety is foundational to productive Living Library events (CMO 1). For Readers, direct conversations humanise others' experiences (CMO 2) and provide the opportunity to flexibly explore new ways of living (CMO 3). Through participation in a Living Library, Books may experience personal empowerment (CMO 4), while the process of self-authoring and co-editing their story (CMO 5) can contribute to personal development. This programme theory informed the co-design of an implementation guide highlighting the importance of tailoring event design and participant support to the contexts in which LoLEM events are held.

CONCLUSIONS

The LoLEM has appeal across stakeholder groups and can be applied flexibly in a range of mental health-related settings. Implementation and evaluation are required to better understand the positive and negative impacts on Books and Readers.

TRIAL REGISTRATION NUMBER

PROSPERO CRD42022312789.

Reducing stigma impacting children and adolescents in low- and middle-income countries: The development of a common multi-component stigma reduction intervention

INTRODUCTION

Stigmatisation impedes health and quality of life. Evidence regarding stigma reduction interventions is, albeit growing, limited. There is a gap in the availability and evidence of interventions for reducing stigma among children and adolescents, especially in low- and middle-income countries. This paper describes the process that led to a stigma reduction intervention impacting children and adolescents in low- and middle-income countries, following previously conducted formative research.

METHODS

In this study, we conducted (i) online stakeholder consultations (FGD) (n = 43), including a survey assessing intervention acceptability, appropriateness, feasibility and scalability (n = 16); and (ii) preliminary field-testing of intervention content online and in a refugee settlement in Uganda.

FINDINGS

Stakeholder consultation showed the initial version of STRETCH (Stigma Reduction to Trigger Change for Children), albeit positively received, required adaptations. We made adjustments to i) take into account implementation duration, intervention flexibility and intersectionality; (ii) strengthen the involvement of individuals, including adolescents/youth, with lived stigma experience; (iii) target people close to individuals with lived stigma experience; and (iv) address feasibility and sustainability concerns. Preliminary field-testing simplified STRETCH while adding a community outreach component and revisiting the intervention setup, to ensure STRETCH can also be applied from a modular perspective.

CONCLUSION

We conducted a process to develop a child-focused multi-component stigma reduction intervention, with intended applicability across stigmas and settings. This paper provides an overview of the intervention development process, generating intervention-specific learnings with generic value. STRETCH aims to reduce stigmatisation at the implementing organisation, create community-wide reflection and stigma reduction demand, and reduce stigmatisation among various target groups.

Practical Tips for using a Human Library approach In medical education

A Human Library is a structured event that brings people from different groups together. It simulates the format of a customary library, with 'Readers' borrowing 'Books', who are human volunteers sharing their lived experiences and perspectives. Rooted in principles of social psychology, Human Libraries provide opportunities for Books and Readers to interact in meaningful dialogue. The goal of each interaction is to give the Reader new understanding of the Book's life. The Human Library was originally developed as a strategy to challenge prejudice through conversation and personal connection, but the approach is remarkably versatile. We repurposed it for a medical education context in order to provide learners in medical school with information and inspiration, particularly about rural life and rural medicine. We organized and held two Human Library events where pre-medical and undergraduate medical students (Readers) engaged in dialogue with rural physicians (Books). However, the strategy could be used to address a wide variety of challenging subjects where the potential Readers are biased or lack experience. This article draws upon research literature and our own experiences of running Human Library events to give practical advice for other organizations who might want to use this novel approach in medical education.

Operation, development, opportunities and challenges of a human library in Taiwan

Purpose

Human libraries are special libraries that give access to real persons known as “human books.” Readers “check out” human books by attending reading sessions organized by the human library. The majority of previous studies focus on reporting the achievement of human libraries, especially on reducing prejudice and promoting social inclusion. There is a dearth of research to investigate how a human library serves and interacts with society. In this regard, this study aims at examining the operation, development, opportunities and challenges of the New Taipei City Human Library (NTCHL), the first and largest human library in Taiwan.

Design/methodology/approach

This study adopts a triangulation methodology to collect and analyze a multitude of data. Participatory observation intends to understand the operation of the NTCHL. In-depth interview is conducted to collect the opinions of the staff of the NTCHL to identify the challenges and opportunities of the human library. Content analysis on relevant documents is performed to review the development and performance of the NTCHL.

Findings

Results indicate that the NTCHL has successfully developed a good collection of human books. The NTCHL not only provides an alternative channel of learning, but also helps build connections between community members. The number of book loans and readers has substantially increased since NTCHL' inception, indicating an increasing demand for human library services in Taiwan. While the NTCHL strives for providing readers with better and diversified services, the issues of limited involvement and commitment of human books, heavy workload and the difficulty to establish a good collection of human books need to be addressed.

Research limitations/implications

This study investigates a human library in Taiwan, but human libraries in different places are different in some aspects because those human libraries' social contexts are different. Future studies are recommended to compare the similarities and differences between different human libraries systematically. Furthermore, this study identifies the benefits of the human library but human library's effectiveness is not quantified and evaluated. Future studies may conduct quantitative assessments to fill the research gap.

Practical implications

Human libraries must strive for providing better and diversified services to readers, but there are implications for workload and administration. The experience of the NTCHL may cast light on the future development of human libraries in Taiwan and other countries around the world.

Social implications

This study shows that the NTCHL has brought a couple of benefits to the society of Taiwan. First, the NTCHL provides readers with an alternative experience of reading. This is an effective way to transmit informal or tacit knowledge. Second, building connections between community members was another benefit of the NTCHL. As modern people are becoming more accustomed to virtual life on the internet which suppresses interpersonal communication, the NTCHL represents an effective platform for communication and sharing of interpersonal experiences.

Originality/value

The novelty of this study is the use of triangulation methodology to investigate the operation, development, opportunities and challenges of the first and largest human library in Taiwan. The findings of this study may cast light on the future development of human libraries in Taiwan and other countries.

A Systematic Narrative Review of Implementation, Processes, and Outcomes of Human Library

First started in Denmark in 2000, Human Library (HL) has been adopted by different communities around the world. It is an innovative approach that engages "readers" from the general public to have collaborative conversations with "books" from minority or marginalized communities to learn about their lived experiences and reduce public stigma and stereotypes. While the HL is popularized, its research base and implementation structure remain limited. This systematic narrative review aims to review the HL literature to (1) summarize the design, implementation, processes, and outcomes of existing HL programs and (2) synthesize recommendations for future implementation of more effective, ethical, and sensible HL. A systematic search in eight electronic databases yielded 23 journal articles and book chapters about HL published from 2010 to 2022. The identified literature demonstrated variations in format, venue, scale, preparation, and recruitment. A wide range of books with different social identities and from different cultural groups were reported, while readers were mostly from university and school communities. Reduced prejudices and improved attitudes were reported in readers, while both readers and books reported various facets of personal growth. Future HL using implementation guidelines with clearly articulate ethical considerations and diverse rigorous research methodologies are recommended.

Feasibility of communication platforms to empower transgender cultural competence among human immunodeficiency virus screeners: A qualitative analysis

Background

Human immunodeficiency virus (HIV) screeners have limited experience of interacting with trans people. The application of communication platforms between them to empower HIV screeners' trans-related cultural competence remains unknown.

Objective

This study aims to qualitatively explore the follow-up interviews of HIV screeners regarding their opinions on the feasibility of an online platform group discussion and web page to enhance communication between them and trans people and to explore their perspectives on how these components enhanced their promotion of cultural competence.

Methods

This study was conducted between October 2020 and June 2021. Purposive and snowball sampling were applied to recruit 6 trans persons and 11 HIV screeners. Six online platform group discussions were held on weekday evenings, each group meeting for 60 min, 360 min in total within 3 months, via a video chat room of Google Meet; this was supplemented by a closed web page. The major results were presented through content analysis of the HIV screeners' follow-up interviews.

Results

The HIV screeners identified the facilitators of participating in the communication platforms, which included a reminder message, easy-to-use interface, visible-audible and readable interaction, recalled and reviewable content and group belonging; the barriers included time and space limitation, device restrictions and operation problem. Two categories of trans-related cultural competence - trans awareness and action taken - were revealed, from which five major themes emerged: provoked to ask questions, improved cognition, reflection, trans-sensitive communication and self-enhancement.

Conclusion

The results revealed that the communication platforms could facilitate the mutual and vivid discussion between HIV screeners and trans people and empower the trans-related cultural competence of HIV screeners. The highly feasible intervention design of this research can be applied to digital training courses related to gender diversity issues.

The Family Transmission of Ethnic Prejudice: A Systematic Review of Research Articles with Adolescents

Ethnic prejudice is one of the most studied topics in social psychology. Empirical research on its development and intergenerational transmission is increasing but still scarce. This systematic review collected and analyzed psychosocial studies focused on the transmission of ethnic prejudice within families with adolescents. Specifically, it aimed at addressing the following research questions: (a) To what extent is there a vertical (between parents and children) and horizontal (between siblings) transmission of ethnic prejudice within the family? (b) Is this process unidirectional (from parents to children) or bidirectional (between parents and children)? (c) Which individual and/or relational variables influence this process? (d) Can adolescents’ intergroup contact experiences affect the family influence on adolescents’ ethnic prejudice? The literature search of four databases (Ebsco, Scopus, PubMed, and Web of Science), carried out from February 2021 to May 2021, following the PRISMA guidelines, yielded 22 articles that matched the eligibility criteria. The findings highlighted a moderate bidirectional transmission of ethnic prejudice between parents and adolescents, which was influenced by several individual and relational variables (e.g., the adolescents’ age and sex and the family relationship quality). Moreover, the adolescents’ frequent and positive contacts with peers of different ethnicities reduced the parents’ influence on the adolescents’ ethnic prejudice. The findings are discussed, and their limitations and implications for intervention and future research are considered.