Over the years, Sea Change worked with dozens of organizations, artists, and activists, and we learned about a lot of different strategies for shifting culture. Below, we categorize these culture change strategies, summarize their aims, and offer some examples.
Contact interventions put people who are not stigmatized in contact with people who are stigmatized, and are one of the most effective ways to reduce stigma.
What is the goal?
Contact interventions are generally developed to address negative attitudes, beliefs, and behaviors that affect the stigmatized. In situations where the stigma is not visible, contact can increase visibility for people who are stigmatized and increase awareness among the public about who is harmed by stigma. For people who are stigmatized, contact may also help reduce feelings of shame and isolation and can normalize their experience.
What are some examples?
Nearly every culture uses stories to convey social norms, taboos, morals, and values. When it comes to experiences that are stigmatized and silenced, storytelling can be especially important for contesting norms and reshaping perspectives. Abortion storytelling may involve first person narratives of abortion experiences, supporting a person who needs an abortion, or other experiences that have shaped a person’s values around abortion. Storytelling often includes “contact” with a person who has experienced stigma (see above), but does not have to.
What is the goal?
Storytelling strategies are often used to reshape social norms, taboos, morals and values in the culture. Stories can be used to surface the negative attitudes, beliefs and behaviors that affect the stigmatized, increase visibility for people who are stigmatized, and increase awareness among the public about who is harmed by stigma. For people who are stigmatized, storytelling can be an empowering way to take control of their own narrative and experience.
What are some examples?
Counseling and peer support programs can provide healthcare information, emotional support, and empowerment to people who experience stigma. This can happen in the context of healthcare but also may happen through community agencies and self-help groups. People with stigmatized health conditions are more likely to use the internet for health information and access health care based on what they learn. The assurance of anonymity or confidentiality may improve one’s ability to cope with a stigmatized condition.
What is the goal?
Counseling and peer support programs aim to reduce the stigma that individuals experience, by: reducing feelings of shame, guilt, and self-judgment; normalizing the experience; helping stigmatized individuals develop resilience; helping stigmatized individuals make decisions about disclosure; addressing myths and misperceptions; and increasing confidence in decision-making.
What are examples?
Art and design may combine several or none of the other strategies listed here to generate creative, challenging, engaging works of art focused on stigma reduction.
What is the goal?
Art and design approaches increase the visibility of people who have experienced stigma, model openness, and ask us to reimagine our understanding of stigmatized experiences.
What are examples?
Service integration is the integration of stigmatized health services into non-stigmatized health services, for example bringing abortion care into primary care settings. For abortion care, service integration includes expanding training opportunities for abortion care or expanding professional roles to provide abortion care or referrals.
What is the goal?
The goal of service integration can be multifaceted. Expanding service provision can increase the diversity of the workforce, cultural competency, and stigma-informed care. It can also expand access to quality care for underserved communities. Since professionals are often agents of stigma reduction themselves, service integration can also build leaders who can shift attitudes, norms and beliefs through contact and storytelling.
What are examples?
These strategies focus on engaging people with different perspectives and working to transform stigmatizing beliefs, attitudes and behavior.
What is the goal?
Transformational conversations can have many goals including sharing stories based in lived experiences, surfacing contradictory attitudes and beliefs, learning about different perspectives, or finding common ground across difference.
What are examples?
Advocacy is an activity by an individual or group that aims to influence decisions within political, economic, and social systems and institutions. Stigma advocacy can target companies, public individuals, the media, and politicians. Stigma advocacy focused on companies may seek improved services for people who experience stigma. Stigma advocacy focused on media generally demands that art and media content accurately represent the experiences and concerns of the stigmatized group. Stigma advocacy focused on politicians generally demands that policies and institutions meet the needs of people who experience stigma. Advocacy tactics can include in-person and online protest, pledges, lobbying, Op-Eds, petitions, publicity events, and more.
What is the goal?
Stigma advocacy aims to draw attention to stigma, increase the power, visibility and pride among stigmatized people, and build accountability into culture change efforts.
What are examples?
Educational interventions include workshops, classroom education, and workforce training aimed at building knowledge about a stigmatized issue, dispelling myths about stigmatized people, building skills for interacting with stigmatized people, and changing stigmatizing behavior.
What is the goal?
The goal of educational interventions often depends on the audience. For individuals affected by stigma, these interventions can increase uptake of services and reduce internalized stigma. Educational interventions with a skill-building component can be effective at addressing negative attitudes and beliefs in the workforce and improving healthcare experiences for clients.
What are examples?