PERCEIVED STIGMA REGARDING MENTAL ILLNESS AMONG

CAREGIVER ATTENDING TERTIARY HOSPITAL

T.U. Registration No.: 4-2-35-77- 2020

A Research Proposal Submitted for the Partial Fulfillment of the Requirements of

Bachelor of Nursing Science Programme from Tribhuvan University Institute of
Medicine
 1.1Background of the study
A mental disorder is characterized by a clinically significant disturbance in an individual’s
cognition, emotional regulation, or behaviour. It is usually associated with distress or
impairment in important areas of functioning{World Health Organization(WHO), 2022}

Globally, 1 in every 8 people in the world lived with mental disorder (World Health organization
2022). The prevalence rate of mental disorders among adults and children in Nepal was 13.2%
and 11.2% respectively ,(Jha et al., 2019).

Globally, more than 70% of people with mental illness don’t receive treatment from health
institution, (Clarie hendersion, 2013).
Mental disorder are the most commonly Stigmatized disorder across the world wide

More than half of the population don’t receive help for their disorder often people avoid or delay
treatment due to concern about being treated. That’s because stigma and discrimination. (APA
2017-2019)

Perceived stigma is unjustifiably belief, feelings and behavior towards mentally ill patients. In
most of the Ethiopian societies it is believed that mental illness is a punishment by god and
linked with evil possession which affects the daily activities and lives of people,(Asrat,
Ayenalem &yimer, 2018).

The prevalence of perceived stigma in Ethiopia was found 89.3% in female, rural residency with
lack of social support, long duration of relationship with the patient and currently not married
were found associated with the perceived stigma of caregivers, (Ergetie et al., 2018).

Myths and misconception about mental illness can contribute to the stigma which leads to
prevent from health seeking behavior of mentally ill patient, (Kishore et al., 2011).

A study done in India shows that mentally ill people most of the time suffer from stigmatization,
discrimination, and human right abuses, (Sonalika,2023).

The prevalence of perceived stigma patient with schizophrenia was 62.6% (Tesfaw et al.,2020)

Negative attitude towards people suffering from mental illness due to lack of knowledge and
education. Globally for long time advocating related to perceived stigma of mental illness is
widespread and however there is no change has been observed . The lack of awareness and
stigma is still very evident in many developing Asian countries including Nepal
( Nepal,Rayemajhi ,Shrestha & Aryal ,2020)
People with psychiatric illness are facing multiple problem related to their illness .which is
directly associated with low self-esteem and delay treatment seeking behavior.

In India, mental illness patients, 76.3% and 85.53%, respectively, reported moderate-to-high
levels of perceived stigma. 152 caregivers , 40.13% and 25.65%, respectively, stated that they
felt that patients and families were stigmatized to a moderate to high degree. (Bipeta, R.,
Yerramilli, S. S., & Pillutla 2020).

Statement of the problem

The mental illness stigma in Nepal is thought to be the result of punishment of God, (Pardan et
al., 2013). Similarly, research conducted in Patan Academy of Health Science, mental disease is
brought on by supernatural causes, (Thapa et al., 2019). In a study done in Pokhara shows that,
there is 72.9% correlation between the perceived stigma on mental illness and delay in seeking
medical attention which leads to deterioration of their mental health, (B. Bhattarai & Ojha 2020).

According to research, mental illness stigma in Nepal is thought to be the result of punishment of
God, (Pardan et al., 2013). Similarly research done at the Patan Academy of Health Science,
mental disease is brought on by supernatural causes, (Thapa et al., 2019).
1.3Objectives of the Study
General Objective
The general objective of the study is to assess the perceived stigma regarding mental illness
among caregivers.
Specific Objectives
1. To assess level of perceived stigma.
2. To find out the association between selected variables and level of perceived stigma.

1.4 Significance of the Study.

The study findings might be useful to get information about level of perceived stigma of
caregivers.
Future researcher who wants to carry out study on health seeking behavior and perceived
stigma.

1.5 Research Question

What is the level of perceived stigma among care givers of patient with mental illness?
What is the association between health seeking behavior and perceived stigma?

Socio demographic Characteristics

Age
Sex Perceived Low perceived stigma
Marital Status stigma High perceived stigma
Religion
Family Type
Education
Occupation
Family monthly income

1.7 Variables of the Study

1.7.1 Dependent variables
Perceived stigma
High level perceived stigma
Low level perceived stigma
1.7.2 Independent variables
Socio-demographic Characteristics:
Age/ Sex
Marital status
Religion
Family type
Education
Occupation
Family monthly income
Information obtained from
Family
Friends
Social Media/ mass media
Course contents
Health/ personnel
Perceived stigma regarding mental illness : Perceived stigma is characterized by rejection
blame or exclusion as a result of adverse social judgement about a person with a mental
disorder .Discrimination of person with mental illness have effect on many aspects of their
lives, including housing, employment ,assess of services and interpersonal relationship.

The level of perceived stigma will be divided into two categories.

Low perceived stigma
High perceived stigma

Information obtained from

Family
Friends
Social Media/ mass media
Course contents
Health/ personnel

CHAPTER III
RESEARCH METHODOLOGY

3.1 Research design

A descriptive, cross-sectional research design will be used to find out the level of perceived
stigma of caregivers of patients with mentall illness attending at tertiary hospital.

3.2 Study setting: The study setting will be OPD of psychiatric department of TU teaching
Hospital. according to OPD register the client flow in this OPD 60-120 per day.

3.3 Study population: All the caregivers of mentally ill patients in tertiary hospital will be
included.
3.3Sampling Technique: Non- probability purposive sampling technique will be used where
patent is entered I took a opd card and then fi…….

3.4 Inclusion criteria: Care givers who is 20 or above 20 years old who has been staying with 3
month or above. patient and actively involved in his/her care. gives information about patient all
activities carried out during treatment of mental illness.

3.4Sampling
3.4.1 Sample Size
Where z is the tabulated value of Z score at a level of significance, at 95%, its value was 1.96
P is prevalence of Traditional healer was 54.44%(0.544)

q= 1-p hence,
q=1-0.544=0.456
d is the marginal error set at 10% or 0.1
Hence substituting the formula
N=Z2pq/d2

3.84×54.44(1-54.44%)/(0.1)2
3.84×0.544×0.456/0.01
95.25
96

3.4.2Sampling Technique: Non- probability purposive sampling technique will be used… ….

3.6 Research Instrumentation

Semi-structured questionnaire will develop with the guidance of research advisor and after
reviewing of related literature for collection of data on socio-demographic variables, Professional
Related variables, Sources of information related variables And standardized tool (Affiliate
stigma scale ) will be used to find out the heath seeking behavior and level perceived stigma .

Part: I It consist of Socio-demographic information of the respondents/ PATENT

INFORMATION
Part II: Question related to Patient related information
Part III Question related to perceived stigma among caregivers.
Validity of instrument; The researcher adopted following measures to maintain the validity of the
test instrument
Consultation with the researcher advisor
Consultation with the expert in the field of psychology and mental health peer’s review
Necessary modification was done according to Consultation and suggestion
Reliability of the instrument:
The researcher maintained the reliability of the instrument by pre testing of the instrument in 10
percentage of total sample size that is 10 number outpatient in TUTH.
Pre - testing of the instrument :
Before conducting the study the instrument will pre test from five respondents in outpatient in
TUTH. The sample used for pre testing were excluded from study during data collection. After
pre testing a necessary modification was done.

Plan for data collection: The Objective of the study was explained before collecting data
Formal and informal permission from the concerned authority was taken.
Written consent from each participant will be taken.
The tool were used for respondents in simple Nepali language. The interview method was used.
3.5 Ethical Consideration Research proposal approval will be taken from research department of
Maharajgunj Nursing Campus, IOM, TU. Then the ethical clearance will be taken from
Institutional Review Committee (IRC) of Institute Of Medicine (IOM).
Formal permission will be obtained from the concerned Department for data
collection .Written consent was taken from each Respondent.The purpose of data collection was
briefly informed. Confidentiality was maintained during and after data collection.
The principle of human justice was maintained and purpose of the study was explained at the
same time.. The objective of research will be explained to Patient caregivers and informed
consent of each respondents will be taken prior to data collection. The respondents decision to
withdraw participation in the study will be respected. Privacy will be maintained by assigning
codes instead of filling names. The respondents queries will be addressed. Similarly,
confidentiality will be ensured by keeping the filled questionnaire safely, maintaining non-
disclosure and using obtained information for research purpose only.

3.6 Plan for data Collection

The study will be conducted after the research proposal approval from research committee of
Maharajgunj Nursing Campus and Institutional Review Committee (IRC).The Written
permission will be obtained from the principle of concerned department for data collection. The
researcher will request the department of head to allocate the time for data collection. Then on
the next day, the researcher will be on time on OPD then greet, introduce self . The objective of
the study will be explained to the caregiver questionnaire will be around 20-25. The
questionnaire will be asked through interview. Respondents will be assured that the information
gathered from this study will be used for the study purpose only. Decision to withdraw
participation in the study will be respected.
3.7 plan for data collection
Data will be analyzed on the basis of research objectives. Collected data will be reviewed,
organized and coded. Data will be stored safely and accurately .Coding and organizing of the
information will be done before data entry. Statistical package for Social Science (SPSS) version
16 will be used to analyze data. The data will be analyzed by using both descriptive statistics and
inferential statistics to measure association between knowledge on emergency contraception and
socio-demographic variable.