The Era of Digital Interventions: Combating intellectual Disability Stigma in Africa | By Deborah Odukoya and Winnie Chege, UCL

In September of 2016, over 1000 Kenyans and Nigerians took part in research studies that tested if a film based e-intervention could contribute to efforts to raise awareness and tackle intellectual disability stigma. Participants were recruited through social media and asked to watch a 6-minute film designed to increasing awareness of intellectual disability and its causes, and to challenge stigmatising beliefs commonly found in African countries. Using attitudinal questionnaires, data were collected at three time points; baseline, immediately post-intervention and at one month follow-up to measure the impact of the film on attitudes. The findings indicate that despite existing barriers to conducting digital interventions and research in African countries (e.g. poor internet connectivity and limited internet coverage), this method of delivery is an acceptable and achievable way to run anti-stigma initiatives and research. Attitudes in both countries were shown to be more favourable after the film intervention.

 

Why We Targeted African Countries

Within African communities, intellectual disability is commonly linked to superstitious causes that contribute to the exclusion, disregard and marginalisation of people with intellectual disabilities. For example, it is not uncommon for people with intellectual disabilities to be seen as possessed by spirits, a curse or punishment from God or a malicious act by an enemy – as a result this group are often hidden from the wider community to avoid shame and ridicule. Also, they are often believed to lack the abilities to contribute to society, and as such are given few or no opportunities to be included within their communities.

 

What We Know About Combating Stigma

Different approaches have been developed to challenge stigma, namely education and contact. Education approaches challenge misconceptions and inaccurate information by replacing it with factual and accurate information. Contact approaches facilitate direct contact between members of the stigmatised group and the outgroup, i.e. the wider community. However, securing direct contact on a large scale can prove difficult and can limit control over the quality of contact. Indirect contact via film, as an anti-stigma intervention in itself or as a component of a multi-faceted anti-stigma programme, is potentially more promising as it can reach much larger audiences. Evidence suggests that the combination of education and indirect contact can produce lasting improvements in attitudes.

 

A Digital Anti-stigma Film based Intervention

Intellectual Disability: Stepping Out from the Margins consists of two 6-minute films that were created in Kenya and Nigeria respectively. Using a combination of education and contact, the films provide factual information about intellectual disability, and through 1st hand accounts by persons with intellectual disabilities that highlight the harsh inequalities they face in these countries, as well as their capabilities, humanity, sense of humour, and contributions to society.

The Kenyan film was recorded in Nairobi, Kenya, in collaboration with Jacaranda Workshop, a non-profit organisation that offers training and employment to people with intellectual disabilities. The Nigerian film was made in Lagos, Nigeria, in collaboration with two not-for-profit organisations: Down Syndrome Foundation Nigeria and Children’s Developmental Centre. All people with intellectual disabilities and experts featured in the film gave consent to being recorded. The videos can be viewed on our YouTube channel:  https://www.youtube.com/channel/UCe6PD7Ekef4DvxWbsW6TfFA

 

Evaluating the Impact of the Films

The studies measured three attitudinal components: cognition, affect, and behavioural intentions. The cognitive aspect was measured by assessing participants’ knowledge about the causes of intellectual disability, and the rights and capabilities of people with intellectual disabilities. The affective dimension refers to emotional responses to a ‘target subject’ and was measured here by asking participants about feelings of discomfort and sensitivity (pity and sadness) towards people with intellectual disabilities. Lastly the behavioural component was measured by assessing participants’ willingness to interact with people with intellectual disabilities in everyday life. Participants were randomly allocated to watch the intervention film or a film on an unrelated topic of a similar length (‘control film’), in order to allow us to detect if any changes were the result of the film based intervention or other factors.

 

Our Findings

In both Kenya and Nigeria, participants who had watched the films focused on intellectual disability showed more positive attitudes on all three attitude components compared to baseline and these changes were maintained at 1-month follow-up. There were no such changes in participants who watched the control film. In Kenya, the film had little effect on superstitious beliefs, and in Nigeria it did not increase knowledge of causes and rights.

In both studies, despite participants reporting difficulties with internet connectivity and streaming of the film, 90 per cent rated the study design and film length and content as good or excellent.

 

Conclusion

Overall these studies show that a brief e-intervention that involves indirect contact and education can make a positive contribution to efforts to challenge the stigma people with intellectual disabilities and their families face in Kenya and Nigeria. It also highlights areas of attitudes that require more research (i.e. cognitive aspects of attitudes) when conducting research in African countries.

 

Many thanks to: all persons with intellectual disabilities featured in the film: all persons with intellectual disabilities featured in the film, Jacaranda Workshop, Dr Frank Njenga, Bishop Peter Njenga, Rose Mordi, Founder and President of Down Syndrome Foundation Nigeria (http://downsyndrome-ng.org), Dr Olayinka Akindayomi, Director of the Children’s Developmental Centre (https://cdcafrica.org.ng/),  and Robin Hammond/Witness Change for their contributions and support in the making of this film.

By Deborah Odukoya and Winnie Chege, UCL