# Effectiveness of stigma reduction interventions and outbreak response adaptations in infectious disease outbreaks: a systematic review

## TL;DR

This paper reviews how to reduce stigma during infectious disease outbreaks, finding that health communication and community involvement are promising strategies.

## Contribution

The study systematically evaluates stigma reduction interventions across multiple infectious disease outbreaks, identifying effective strategies.

## Key findings

- Five studies reported reductions in stigma through anti-stigma messaging and community involvement.
- Four studies showed mixed or null results, and two reported increased stigma.
- Promising strategies include health communication, psychosocial support, and participatory community engagement.

## Abstract

Stigma is a common and recurring feature of infectious disease outbreaks where it may have detrimental effects on individual wellbeing and undermine outbreak response. This systematic review explores stigma reduction interventions in infectious disease outbreaks.

Eligible studies were searched for in Medline, Embase, PsycINFO, and Global Health databases and through reference screening. Risk of bias was assessed using study design-specific tools and the results of included studies underwent narrative synthesis.

Eleven studies conducted across coronavirus disease 2019 (COVID-19), Ebola disease, mpox, severe acute respiratory syndrome (SARS), and a hypothetical infectious-disease scenario, met the inclusion criteria. Five studies reported reductions in stigma, four reported mixed or null results, and two reported increases in stigma. The most promising strategies for outbreak-related stigma reduction were embedding anti-stigma messaging within health communication, providing psychosocial support, and fostering genuinely participatory community involvement.

Evidence on how to effectively reduce stigma during outbreaks remains limited. Strengthening the theoretical foundations, measurement tools, and evaluation designs of stigma-reduction interventions will be essential to inform evidence-based outbreak preparedness and response policies. This would help decision-makers ensure that risk communication, community engagement, and service delivery minimise stigma and improve uptake of testing, care, and preventive measures.