A qualitative investigation of self-stigma focussed music workshops for people with mental health disorders in urban Zimbabwe

This project will explore the process and showcase of creativity in Zimbabwe, and will use creative outlets as a medium for individuals with mental health issues to form their narratives. The hope is that this will develop their identity and confidence to express their experiences in a safe environment, within the overall aim of having a positive impact on internalised stigma. Mental health stigma is widespread globally, particularly in lower income settings, inhibiting access to, and engagement with, mental health care and treatment. Embedded traditional beliefs about mental health are linked to the stigma and discrimination experienced in a Zimbabwean setting. There has been a large body of evidence growing for stigma-reduction techniques, but most of this has taken place in high-income countries and within white populations, and is therefore ineffective and invalid for other settings.

Creativity (within 'health humanities') has shown multiple benefits within mental health care, including therapeutic effect, enabling expression, community cohesion and positive media coverage. Furthermore, in the Shona culture (of Zimbabwe) though mental health illness has negative connotations culturally (linked with evil spirits), creativity is linked with 'good spirits' - therefore creative strategies in reducing mental health stigma is an appropriate theme to explore within this context.

This research will add to the limited understanding of appropriate stigma-reduction techniques in an African context as well as the use of a health humanities approach for mental health in the Zimbabwean culture specifically.

A coproduction model will be used to carry out this mixed method research, with the qualitative aspect being the focus, to explore the following questions:
- How does stigma manifest itself in Zimbabwean culture?
- What impact does stigma have on individuals with mental health issues and their families?
- How does creative outlet support the individual's ability to share their narrative to others? Does this impact on internalised stigma?
- What are the individual's perceptions toward sharing their experiences of mental health through creative expressions?

A series of focus groups and creative workshops will be run in partnership with Tariro Negitare who, as well as being a Zimbabwean musician, runs a Creative Arts Hub in local communities and has successfully done this within a research context recently with young people with an HIV diagnosis. The study will aim to recruit 30 participants.
Focus groups will enable the following: the exploration of the nature of mental health stigma in the Shona culture (which will be used to create a quantitative assessment tool); the planning and delivery of the creative expression showcase; and the identification of suitable creative formats. For the duration of the focus groups, participants will be supported to express themselves creatively and form a narrative around their creations. Qualitative interviews will be used to consider the impact of the showcase on internalised stigma, through individual pre and post semi-structured interviews with the participants involved in the focus groups and showcase. The assessment tool will then be used pre and post the showcase event for measuring stigma.