DŽveloppement d'un cadre d'indicateurs pour le changement de culture en faveur de l'accessibilitŽ et de l'inclusion des personnes handicapŽes Rapport final 23 mars 2022 Nom du vendeur : Institute for Work & Health Adresse : 400 University Avenue, Suite 1800 Toronto, Canada M5G 1S5 Chercheur principal : Dr. Emile Tompa ƒconomieÊde la santŽ et du travail Co chercheur : Dr. Amir Mofidi BoursierÊpostdoctoral Co chercheur : Emma Irvin Directrice desÊopŽrations de recherche Co chercheur : Dr. Rebecca Gewurtz SciencesÊde la rŽadaptation Ce projet a ŽtŽ financŽ par Emploi et DŽveloppement Social Canada. Sommaire SOMMAIRE EXƒCUTIF 5 Le changement de culture vers l'accessibilitŽ et l'inclusion des personnes handicapŽes 5 MŽthodologie dÕensemble 5 RŽsumŽ des rŽsultats 6 Conclusions et recommandations 9 Recommandations pour les recherches futures 9 Structure du rapport 11 DŽfinitions des termes clŽs 12 Liste des acronymes 14 INTRODUCTION 16 Contexte 16 PrincipalesÊquestions de recherche 17 METHODOLOGIE 18 MŽthodologie dÕensemble 18 Examen de la portŽe 19 ƒtape 1. Identifier la question de recherche 19 ƒtape 2. Effectuer la recherche documentaire pour identifier les Žtudes pertinentes 20 ƒtape 3. SŽlection des Žtudes 21 ƒtape 4. Sources supplŽmentaires 22 Analyse environnementale 23 Entretiens avec des informateurs clŽs 23 RŽsumŽ, analyse et rapport 25 RƒSULTATS DE L'ƒTUDE 25 Constatations gŽnŽrales 26 Qu'est-ce que le changement de culture ? 28 Cadres pour l'Žlaboration, le suivi et l'Žvaluation des initiatives de changement de culture 32 Application des cadres 32 Types de cadres 33 Modle de mesure des initiatives de changement de culture 38 Initiatives visant ˆ faire Žvoluer la culture de diffŽrentes populations 43 Plateformes pour les initiatives de changement de culture 43 Niveaux des initiatives de changement de culture 45 Exemples d'initiatives visant ˆ changer les attitudes 46 Mesurer les progrs et l'atteinte des objectifs gr‰ce aux initiatives de changement de culture 52 Enqutes et outils de mesure pour l'accessibilitŽ et l'inclusion 52 Aperu des indicateurs 59 Indicateurs permettant de mesurer le changement de culture par rapport ˆ la LCA et au-delˆ 62 Analyse des lacunes des donnŽes 75 CONCLUSIONS ET RECOMMANDATIONS 78 REFERENCES 80 ANNEXES 96 Annexe I. Directives d'extraction des donnŽes 96 Annexe II. RŽsumŽ des rŽsultats de l'entretien avec les informateurs clŽs 99 Indicators Identified by Key Informants 99 Frameworks and Approaches for Culture Change 103 Annexe III. Exemples d'application des cadres 107 Conceptual Framework for Culture Change Initiatives 107 Results Framework for Improved Quality of Health Services 108 Logical Framework for an HIV Voluntary Counseling and Testing Program 108 Annexe IV. Niveaux des initiatives de changement de culture 110 Public Health Agency of Canada Framework 110 CrossÕs Stigma Intervention Matrix 111 JavedÕs Framework for Reducing Stigma of Mental Health Disorders 112 Annexe V. Examen approfondi de quelques initiatives de changement de culture ˆ grande Žchelle 113 Opening Minds (Canada) 113 Time to Change (England) 114 Beyondblue (Australia) 116 Like Minds, Like Mine (New Zealand) 117 Annexe VI. Initiatives visant ˆ changer les attitudes ˆ l'Žgard des personnes handicapŽes au Canada 118 Annexe VII. Outils de mesure identifiŽs pour les attitudes envers les personnes handicapŽes 121 Annexe VIII. RŽsumŽ de la littŽrature identifiŽe 124 Scoping Review of Publication from 2020-2021 124 Snowballing Search of Peer-Reviewed literature and Environmental Scan 125 Liste des tableaux Tableau 1. Thme gŽnŽral du projet de recherche (cadre P.I.C.O.) 18 Tableau 2. Ressources identifiŽes lors des diffŽrentes Žtapes et incluses dans l'Žtude 23 Tableau 3. RŽsumŽ des entretiens avec les informateurs clŽs (N = 17) 24 Tableau 4. Types de cadres et leurs applications 30 Tableau 5. Matrice du cadre logique standard et dŽfinitions de la terminologie 37 Tableau 6. Exemple de matrice de cadre logique pour l'initiative "Time to Change" (Angleterre) 38 Tableau 7. Initiatives visant ˆ changer les attitudes envers les personnes handicapŽes 43 Tableau 8. ƒtudes visant ˆ mesurer divers domaines culturels liŽs ˆ l'accessibilitŽ et ˆ l'inclusion des personnes handicapŽes 50 Tableau 9. DiffŽrences entre les indicateurs de suivi et d'Žvaluation 57 Tableau 10. Indicateurs pour Žvaluer le changement de culture en faveur de l'accessibilitŽ et de l'inclusion des personnes handicapŽes 59 Tableau 11. Analyse des lacunes des donnŽes canadiennes 70 Liste des figures Figure 1. MŽthodologie dÕensemble 16 Figure 2. Organigramme PRISMA 2020 pour l'examen de la portŽe 19 Figure 3. ƒtapes de l'Žlaboration de stratŽgies de changement de culture 28 Figure 4. Cadre conceptuel pour guider le changement de culture 31 Figure 5. Exemple d'un cadre de rŽsultats utilisant l'initiative " Time to Change " en Angleterre 32 Figure 6. Exemple de cadre logique pour l'initiative "Time to Change" en Angleterre 34 Figure 7. Type d'indicateurs de suivi et d'Žvaluation 56 Annexes Annexe I. Directives d'extraction des donnŽes 91 Annexe II. RŽsumŽ des rŽsultats de l'entretien avec les informateurs clŽs 94 Annexe III. Exemples d'application des cadres 102 Annexe IV. Niveaux des initiatives de changement de culture 105 Annexe V. Examen approfondi de quelques initiatives de changement de culture ˆ grande Žchelle 108 Annexe VI. Initiatives visant ˆ changer les attitudes ˆ l'Žgard des personnes handicapŽes au Canada 113 Annexe VII. Outils de mesure identifiŽs pour les attitudes envers les personnes handicapŽes 116 Annexe VIII. RŽsumŽ de la littŽrature identifiŽe 119 SOMMAIRE EXƒCUTIF Le changement de culture vers l'accessibilitŽ et l'inclusion des personnes handicapŽes Le terme ÇÊcultureÊÈ peut avoir plusieurs significations et est utilisŽ diffŽremment selon les contextes. Au sens large, la culture est dŽfinie comme un ensemble d'attitudes, de valeurs, et d'aspirations, et un sentiment d'efficacitŽ personnelle. Dans les milieux de la politique publique, le terme est le plus souvent utilisŽe pour dŽsigner l'ensemble des influences sur la faon dont les individus, les groupes et la sociŽtŽ voient le monde et y rŽagissent. La culture est importante car elle a un effet d'orientation essentiel sur les actions que les gens entreprennent et le comportement qu'ils manifestent dans la vie. De nombreux rŽsultats politiques dŽpendent de la faon dont les gens - en tant qu'individus et groupes - se comportent. Nous savons que les objectifs relatifs ˆ l'accessibilitŽ et ˆ l'inclusion des personnes handicapŽes dŽpendent autant des facteurs culturels que des actions gouvernementales. MalgrŽ l'importance des facteurs culturels pour l'accessibilitŽ et l'inclusion des personnes handicapŽes, peu d'Žtudes ont ŽtŽ publiŽes dans ce domaine, notamment en ce qui concerne le dŽveloppement, le suivi et l'Žvaluation de ces initiatives/programmes. L'objectif principal de cette Žtude est d'identifier les connaissances permettant de soutenir le dŽveloppement de cadres et d'un ensemble fiable d'indicateurs pour le suivi et l'Žvaluation du changement de culture dans le domaine de l'accessibilitŽ et de l'inclusion. Il s'agit d'une Žtape essentielle pour Žvaluer les progrs dans la bonne direction et dŽterminer o les efforts sont plus ou moins fructueux. Cette Žtude identifie un tel cadre et des indicateurs ˆ utiliser pour suivre les initiatives de changement de culture en matire d'accessibilitŽ et d'inclusion des personnes handicapŽes. Les deux principales questions de recherche abordŽes par cette Žtude sont les suivantes : 1. Qu'est-ce que le changement de culture et comment peut-il tre opŽrationnalisŽ afin dÕtre utilisŽ dans le domaine de l'accessibilitŽ et de l'inclusion des personnes handicapŽes dans la sociŽtŽÊ? 2. Quelles donnŽes et mesures sont disponibles pour reprŽsenter la culture et le changement de culture dans les domaines pertinents pour les personnes handicapŽesÊ? MŽthodologie dÕensemble Nous avons entrepris deux sous-Žtudes pour produire des informations qui ont ŽtŽ directement intŽgrŽes dans le processus de dŽveloppement du cadre et des indicateurs. Tout d'abord, nous avons entrepris une revue de la littŽrature ŽvaluŽe par les pairs sur les initiatives de changement de culture en relation avec l'accessibilitŽ et l'inclusion. Dans la deuxime sous-Žtude, nous avons entrepris une analyse environnementale de la littŽrature grise, des enqutes nationales et internationales existantes et des sources de donnŽes. Dans cette section, nous avons Žgalement interrogŽ des informateurs clŽs sur leur connaissance d'un cadre et d'indicateurs pour le suivi et l'Žvaluation des initiatives de changement de culture en matire d'accessibilitŽ et d'inclusion. Comme les intervenants canadiens sont la cible principale de ce projet, l'analyse est axŽe sur les juridictions dont l'Žconomie, le marchŽ du travail et les programmes sont similaires ˆ ceux du Canada, par exemple le Royaume-Uni, l'Australie, la Nouvelle-ZŽlande, les ƒtats-Unis, les Pays-Bas et d'autres pays d'Europe du Nord. Dans l'ensemble, cette Žtude comprend cinq composantes principales. Les rŽsultats de 1. l'examen de la portŽe et 2. l'analyse environnementale nous ont aidŽs ˆ Žclairer l'Žlaboration des composantes 3 ˆ 5 de ce projet, ˆ savoir : 3. lÕidentification d'un cadre conceptuel du changement de culture en relation avec l'accessibilitŽ et l'inclusion des personnes handicapŽes, 4. lÕidentification d'initiatives prometteuses pour promouvoir le changement de culture parmi diffŽrentes populations en relation avec l'accessibilitŽ et l'inclusion, et 5. l'identification d'indicateurs pour mesurer les progrs et la rŽalisation des objectifs lancŽs par les initiatives de changement de culture. Enfin, nous avons synthŽtisŽ les indicateurs identifiŽs pour les diffŽrents domaines prioritaires de la Loi canadienne sur lÕaccessibilitŽ (LCA) et au-delˆ. RŽsumŽ des rŽsultats Les conclusions de notre examen de la portŽe et de l'analyse environnementale ont rŽvŽlŽ de multiples Žtudes du monde entier visant des initiatives de changement de culture en relation avec l'accessibilitŽ et l'inclusion des personnes handicapŽes. Au total, 238 sources ont ŽtŽ incluses dans l'examen, dont 58 ont ŽtŽ identifiŽes par un examen de la portŽe des articles ŽvaluŽs par les pairs et publiŽs entre 2020 et 2021 dans Embase, PsycINFO et ABI INFORM. Via Google Scholar, 65 Žtudes ont ŽtŽ identifiŽes par une recherche en boule de neige de la littŽrature ŽvaluŽe par les pairs. De plus, 115 sources, y compris des rapports, des enqutes et des sites Web d'organisations gouvernementales et non gouvernementales, etc., ont ŽtŽ identifiŽes par le biais de la recherche sur Google et enrichies par les commentaires des informateurs clŽs. Nous avons classŽ les Žtudes identifiŽes dans les catŽgories dŽcrites dans les sections suivantes : Entretiens avec des informateurs clŽs Dix-sept entretiens approfondis ont ŽtŽ menŽs avec des chefs de file du savoir du monde entier sur le thme du changement de culture en faveur de l'accessibilitŽ et de l'inclusion des personnes handicapŽes. Les informateurs clŽs provenaient du Canada, des ƒtats-Unis, du Royaume-Uni et de l'Australie. Plusieurs thmes sont ressortis des entretiens avec les informateurs clŽs. Il a ŽtŽ notŽ que le changement d'attitude est difficile ˆ mesurer, mais que les changements de comportement peuvent tre mesurŽs et refltent les changements d'attitude. Plusieurs indicateurs tangibles et moins tangibles du changement de culture ont ŽtŽ suggŽrŽs dans les domaines des connaissances, des attitudes, des comportements et des pratiques qui refltent le processus sous-jacent et les voies vers le changement de culture, aux niveaux individuel, institutionnel, communautaire et autres. Les informateurs clŽs ont notŽ que dans certains cas, le changement de culture se fait du haut vers le bas, et dans d'autres, du bas vers le haut. Les indicateurs du changement de culture sont en fin de compte plus tangibles, plus clairs et plus objectifs s'ils mesurent les rŽsultats et les impacts par rapport aux diverses facettes de la qualitŽ de vie des personnes handicapŽes. Les dŽfenseurs des personnes handicapŽes ont indiquŽ que ce qui compte le plus, ce sont les rŽsultats, par exemple le nombre de personnes employŽes, le niveau de vie, l'expŽrience de la violence, l'accs aux services, l'accs ˆ l'emploi et l'accs au logement. Les informateurs clŽs ont identifiŽ plusieurs cadres, approches et principes directeurs. Il s'agit de : 1) l'Žducation basŽe sur le contact, 2) le cadre IDEAL, 3) le cadre des rŽsultats de la stratŽgie australienne en matire de handicap, 4) le modle de maturitŽ d'inclusion de QuakerLab, 5) le cadre pour un lieu de travail psychologiquement sain et 6) la Lutte contre la stigmatisation : vers un systme de santŽ plus inclusif. Un rŽsumŽ des conclusions de l'entretien avec les informateurs clŽs se trouve ˆ l'annexe II. Cadre du changement de culture en relation avec l'accessibilitŽ et l'inclusion des personnes handicapŽes Nous avons ŽtŽ surpris de ne pas trouver de cadres complets pour dŽvelopper, suivre et Žvaluer les initiatives de changement de culture en relation avec l'accessibilitŽ et l'inclusion des personnes handicapŽes. NŽanmoins, les cadres peuvent tre d'une aide prŽcieuse pour comprendre les buts et objectifs d'un programme et dŽlimiter les ŽlŽments internes et externes qui peuvent affecter le succs du programme. L'Žtude la plus prometteuse dont nous ayons connaissance est un cadre pour le suivi et l'Žvaluation de la stratŽgie australienne en matire de handicap, rŽcemment publiŽ par le ministre australien des services sociaux en 2021. Pour combler le manque de dŽveloppement de cadre pour ce domaine d'enqute, nous avons Žlargi notre champ de recherche sur les initiatives de changement de culture dans d'autres domaines. Par exemple, nous avons explorŽ les initiatives de changement de culture visant ˆ lutter contre la violence envers les femmes. Nous Žtudions Žgalement les initiatives de changement de culture en matire de prŽvention du VIH et les activitŽs de lutte contre la traite des tres humains. En nous appuyant sur ces Žtudes, nous avons identifiŽ diffŽrents cadres qui ont ŽtŽ utilisŽs principalement pour suivre et Žvaluer les initiatives de changement de culture. MalgrŽ certaines incohŽrences terminologiques dans la littŽrature, nous avons identifiŽ trois types de cadres couramment utilisŽs dans les domaines du changement de culture : les cadres conceptuels, les cadres de rŽsultats et les cadres logiques. Nous donnons un aperu de chaque type de cadre et en illustrons quelques exemples. Nous pensons qu'un cadre logique serait un outil pratique pour dŽvelopper, suivre et Žvaluer les initiatives de changement de culture dans les domaines de l'accessibilitŽ et de l'inclusion des personnes handicapŽes, ce qui est conforme au cadre rŽcemment publiŽ par le ministre australien des services sociaux. Initiatives visant ˆ promouvoir le changement de culture en matire d'accessibilitŽ et d'inclusion des personnes handicapŽes Nos recherches ont rŽvŽlŽ de nombreuses initiatives canadiennes et internationales visant ˆ amŽliorer la culture en matire d'accessibilitŽ et d'inclusion des personnes handicapŽes. Ces initiatives utilisent de multiples plateformes (activitŽs) pour accro”tre la sensibilisation ou changer les attitudes, les valeurs, les croyances et les comportements des gens. Parmi les plateformes les plus courantes figurent l'Žducation, les stratŽgies basŽes sur le contact, les services par les pairs, la protestation et la dŽfense des droits, et les approches de marketing social. Ces initiatives ont ŽtŽ mises en Ïuvre par une variŽtŽ d'organisations gouvernementales et non gouvernementales. Selon le niveau de mise en Ïuvre, les initiatives sont classŽes en trois groupes : niveau personnel, organisationnel et gouvernemental. Les initiatives au niveau personnel visent ˆ changer les attitudes des individus envers les personnes handicapŽes. Elles font appel ˆ des ŽlŽments, souvent combinŽs, tels que l'information, l'Žducation, la formation, une reprŽsentation positive des personnes handicapŽes et des possibilitŽs de contact entre personnes handicapŽes et non handicapŽes. Les initiatives au niveau organisationnel s'attaquent aux barrires comportementales dans des domaines tels que l'emploi, l'Žducation et les services de santŽ. Elles comprennent des formations, des mŽcanismes de plainte et des programmes d'information ciblŽs. Elles cherchent ˆ attŽnuer les dŽsavantages de pouvoir subis par les personnes handicapŽes en modifiant le comportement et les attitudes des personnes non handicapŽes. Les initiatives gouvernementales se concentrent souvent sur l'obligation lŽgale de changer les comportements. La lŽgislation anti-discrimination et l'Žducation inclusive en sont des exemples. Dans cette section, nous ŽnumŽrons de nombreuses initiatives visant ˆ amŽliorer la culture en matire d'accessibilitŽ et d'inclusion des personnes handicapŽes. En outre, nous fournissons une vue approfondie de quatre initiatives nationales ˆ grande Žchelle et largement connues : Open Mind (Canada), Time to Change (Angleterre), Beyondblue (Australie) et Like Minds, Like Mine (Nouvelle-ZŽlande). Indicateurs permettant de mesurer les progrs et la rŽalisation des objectifs gr‰ce aux initiatives de changement de culture Au cours de notre analyse, nous avons identifiŽ diverses enqutes utilisŽes pour mesurer diffŽrents domaines de la culture en relation avec l'accessibilitŽ et l'inclusion. La plupart de ces enqutes ont ŽtŽ utilisŽes par les services gouvernementaux chargŽs des questions de handicap, tandis que certaines ont ŽtŽ utilisŽes par des universitŽs et des centres de recherche. Le terme "changement de culture" a rarement ŽtŽ utilisŽ dans les enqutes. La plupart des enqutes mesurent plut™t l'attitude ˆ l'Žgard des personnes handicapŽes. Certaines mesurent la stigmatisation, d'autres se concentrent sur la discrimination et les comportements discriminatoires, etc. Certaines enqutes Žvaluent la sensibilisation des personnes par rapport aux organisations, ˆ la lŽgislation et aux initiatives liŽes au handicap. Ces enqutes couvrent un large Žventail de contextes, notamment les attitudes ˆ l'Žgard des personnes handicapŽes dans l'Žducation, le secteur de l'emploi et le niveau gŽnŽral de confort de vie ˆ proximitŽ des personnes handicapŽes. En termes de population cible, certaines enqutes ont ŽtŽ conues pour recueillir des donnŽes auprs de la population gŽnŽrale, tandis que d'autres visaient ˆ mesurer les attitudes d'acteurs spŽcifiques tels que les employeurs, les clients, les prestataires de services de santŽ, etc. Nous notons Žgalement que de multiples questionnaires ont ŽtŽ dŽveloppŽs et validŽs pour mesurer divers domaines liŽs ˆ la culture en termes d'accessibilitŽ et d'inclusion des personnes handicapŽes. Les dŽtails sont fournis dans l'annexe VI. Nous avons catŽgorisŽ les indicateurs utilisŽs pour mesurer le changement de culture en matire d'accessibilitŽ et d'inclusion des personnes handicapŽes dans divers domaines o il existe des obstacles ˆ leur capacitŽ ˆ tre confiants, indŽpendants et connectŽs avec les autres. Pour ce faire, nous nous sommes inspirŽs des sept domaines prioritaires de la LCA, qui a reu la sanction royale au printemps 2019. Nous avons Žgalement pris en compte d'autres domaines, au-delˆ des domaines prioritaires de la LCA, comme l'Žducation, les services de santŽ, les services aux premiers intervenants et la vie communautaire. Les indicateurs identifiŽs couvriraient les neuf domaines de participation ˆ la vie sociale dŽfinis par la Classification internationale du fonctionnement, du handicap et de la santŽ (CIF). La liste finale des domaines considŽrŽs est la suivante : 1. l'emploi, 2. l'environnement b‰ti, 3. le transport, 4. les technologies de l'information et de la communication, 5. la communication autre que les technologies de l'information et de la communication, 6. l'acquisition de biens, de services et d'installations, 7. la conception et la prestation de programmes et de services, 8. le secteur de l'Žducation, 9. le secteur des soins de santŽ, 10. les services de premiers rŽpondants, 11. la vie communautaire. Conclusions et recommandations Les cadres et les indicateurs pour le changement de culture en matire d'accessibilitŽ et d'inclusion des personnes handicapŽes peuvent tre extrmement utiles pour les gouvernements, les organisations communautaires, les prestataires de services, les entreprises, les universitaires et les autres parties prenantes, car ils peuvent tre utilisŽs pour identifier les obstacles culturels, trouver des solutions, suivre et Žvaluer l'impact des efforts, tels que la lŽgislation, les politiques, les programmes et les pratiques visant ˆ amŽliorer l'accessibilitŽ et l'inclusion dans divers domaines de la sociŽtŽ, ainsi que pour aider ˆ identifier les prioritŽs et les possibilitŽs d'action. En nous appuyant sur des sources nationales et internationales, nous avons identifiŽ les connaissances permettant de soutenir le dŽveloppement de cadres et d'un ensemble fiable d'indicateurs pour suivre et Žvaluer diffŽrentes initiatives de changement de culture visant ˆ faire progresser l'accessibilitŽ et l'inclusion des personnes handicapŽes dans un contexte diffŽrent. Ces cadres et indicateurs peuvent tre adaptŽs aux gouvernements, aux organisations communautaires et aux autres parties prenantes. Les initiatives identifiŽes peuvent Žgalement servir ˆ informer le dŽveloppement d'initiatives dans le contexte canadien au niveau local, rŽgional et national pour promouvoir le changement de culture en relation avec l'accessibilitŽ et l'inclusion dans diffŽrents domaines et populations. Nous avons Žgalement identifiŽ des lacunes en matire de donnŽes qui pourraient tre comblŽes dans le cadre de futurs efforts de collecte de donnŽes par les parties prenantes afin de faire progresser le suivi et l'Žvaluation des initiatives de changement de culture. Recommandations pour les recherches futures Concevoir et mettre en Ïuvre une enqute au niveau national pour Žvaluer les attitudes envers les personnes handicapŽes. Il est possible de remŽdier au manque de donnŽes de base et de suivi en concevant et en mettant en Ïuvre une enqute ˆ grande Žchelle et reprŽsentative de la population sur une base pŽriodique, similaire ˆ celle menŽe dans d'autres pays, comme l'enqute britannique sur les attitudes sociales (BSAS) au Royaume-Uni, l'enqute sur les attitudes de la communautŽ envers les personnes handicapŽes en Australie et l'enqute sur les attitudes envers les personnes handicapŽes en RŽpublique d'Irlande. Il est important qu'une telle enqute soit conue et mise en Ïuvre de manire ˆ permettre une bonne comprŽhension de l'attitude ˆ l'Žgard des personnes handicapŽes dans diffŽrents systmes, tels que l'emploi, l'environnement b‰ti, les transports, les technologies de l'information et de la communication, la communication autre que les technologies de l'information et de la communication, l'acquisition de biens, de services et d'installations, la conception et la mise en Ïuvre de programmes et de services, l'Žducation, les services de santŽ, les services de premiers secours et la vie communautaire. L'enqute sur les attitudes du public envers les personnes handicapŽes peut tre dŽveloppŽe dans le cadre d'une des enqutes existantes. Par exemple, les Žtudes de recherche sur l'opinion publique (ROP) pourraient dŽvelopper un module axŽ sur le changement de culture concernant les personnes handicapŽes. DŽvelopper un cadre de rŽsultats au niveau national pour le suivi et l'Žvaluation de l'accessibilitŽ et de l'inclusion Un cadre de rŽsultats complet en matire d'accessibilitŽ et d'inclusion devrait contenir des indicateurs objectifs et subjectifs. Alors que les indicateurs objectifs, tels que l'emploi, la rŽussite sur le marchŽ du travail, les revenus, etc. fournissent des informations prŽcieuses sur le statut socio-Žconomique actuel des personnes handicapŽes, les indicateurs subjectifs, qui sont basŽs sur les sentiments des individus et leurs normes de vie attendues, pourraient expliquer les moteurs sous-jacents de ces comportements ˆ des degrŽs divers. Les chercheurs dans le domaine des indicateurs sociaux soulignent de plus en plus l'intŽrt d'obtenir des indicateurs ˆ la fois subjectifs et objectifs. Il est intŽressant de constater que de nombreux cadres de rŽsultats dans le domaine des initiatives de changement de culture bŽnŽficient de cette intŽgration. Par exemple, dans un cadre de rŽsultats rŽcemment ŽlaborŽ pour la stratŽgie australienne en matire de handicap, des indicateurs subjectifs et objectifs ont ŽtŽ intŽgrŽs. Cela peut Žgalement tre observŽ dans les initiatives de changement de culture dans d'autres domaines tels que les programmes de lutte contre la violence ˆ l'Žgard des femmes et des filles, et les programmes de prŽvention du VIH pour les populations les plus ˆ risque. La liste exhaustive des indicateurs subjectifs identifiŽs dans cette recherche pour les diffŽrentes prioritŽs de la LCA et au-delˆ, peut tre utilisŽe comme un complŽment aux indicateurs objectifs pour suivre et Žvaluer les initiatives de changement de culture en relation avec l'accessibilitŽ et l'inclusion des personnes handicapŽes au Canada. Collecter et intŽgrer les dossiers de discrimination Les plaintes pour discrimination, considŽrŽes comme des indicateurs tardifs de la culture en matire d'accessibilitŽ et d'inclusion, sont limitŽes dans les systmes actuels de collecte de donnŽes. Notre Žtude a rŽvŽlŽ que de telles donnŽes peuvent tre trouvŽes ˆ diffŽrents endroits, tels que les commissions des droits de la personne fŽdŽrales, provinciales et territoriales, et les donnŽes administratives sur les plaintes relatives au transport accessible, ainsi que dans diffŽrentes enqutes, y compris la discrimination parmi les personnes handicapŽes par l'Enqute sur la santŽ dans les collectivitŽs canadiennes en 2013, et l'Enqute sociale gŽnŽrale sur la victimisation en 2009. La collecte et l'intŽgration des dossiers de discrimination constituent une ressource inestimable pour le suivi et l'Žvaluation du changement de culture en matire d'accessibilitŽ et d'inclusion des personnes handicapŽes. Structure du rapport La premire partie du rapport fournit quelques informations de base sur l'importance de l'accessibilitŽ et de l'inclusion et prŽsente les questions de recherche de l'Žtude. La section sur la mŽthodologie dŽcrit comment les informations ont ŽtŽ recueillies par le biais d'un examen de la portŽe et d'une analyse environnementale. Dans les conclusions, nous classons les ressources identifiŽes en quatre sections afin de fournir des preuves concernant chaque question de l'Žtude. Tout d'abord, nous donnons un aperu d'un cadre stratŽgique pour le changement de culture, en nous appuyant principalement sur une Žtude de lÕUnitŽ de stratŽgie du Cabinet office britannique. Nous avons Žgalement examinŽ certains cadres qui ont ŽtŽ utilisŽs pour dŽvelopper, suivre et Žvaluer les initiatives de changement de culture dans les domaines de l'accessibilitŽ et de l'inclusion des personnes handicapŽes et au-delˆ. Dans la deuxime section, nous avons prŽsentŽ quelques initiatives de changement de culture dans le monde liŽes ˆ l'accessibilitŽ et ˆ l'inclusion des personnes handicapŽes. Dans la troisime section, nous avons passŽ en revue certaines Žtudes visant ˆ mesurer les progrs et la rŽalisation des objectifs par le biais d'initiatives de changement de culture en matire d'accessibilitŽ et d'inclusion. Dans la quatrime section, nous ŽnumŽrons les indicateurs que nous proposons pour Žvaluer le changement de culture dans des domaines pertinents pour la LCA et au-delˆ. Dans cette section, nous fournissons Žgalement une analyse des lacunes en matire de donnŽes dans le contexte canadien. En conclusion, nous proposons quelques recommandations pour les recherches futures. GLOSSAIRE DES DƒFINITIONS ET ACRONYMES DŽfinitions des termes clŽs ActivitŽ Ð Une t‰che importante considŽrŽe comme une Žtape essentielle pour atteindre un rŽsultat. Ce sont les actions proposŽes pour atteindre le rŽsultat (OIM, 2009). Aspiration Ð Le dŽsir, le but ou l'ambition de rŽaliser quelque chose (UK Cabinet Office, 2008). Attitude - La position tenue envers un fait ou une action comprenant des ŽlŽments de connaissance, Žmotionnels et de motivation (UK Cabinet Office, 2008). Comportement Ð ??Action ou rŽaction spŽcifique d'un individu ou d'un groupe, motivŽe par l'interaction de facteurs culturels avec des incitations, une rŽglementation, une lŽgislation et des niveaux d'information et de sensibilisation (UK Cabinet Office, 2008). Cadres conceptuels Ð Diagrammes qui illustrent les relations entre les facteurs organisationnels, individuels et autres facteurs pertinents qui peuvent influencer un programme et la rŽussite de la rŽalisation des buts et objectifs (Frankel et al., 2007). Capital culturel - Attitudes, valeurs, aspirations et sentiment d'efficacitŽ personnelle - est important car il a un effet d'orientation important sur les actions ou les comportements que nous pouvons choisir dans la vie (UK Cabinet Office, 2008). Changement de culture Ð DŽsigne 1. les interventions visant ˆ influencer les attitudes, les valeurs et les aspirations sous-jacentes et la faon dont celles-ci se manifestent dans le comportement, 2. le processus dynamique par lequel les modles de comportement s'Žtablissent dans le cadre des attitudes et des valeurs (UK Cabinet Office, 2008). Indicateurs Ð Repres quantitatifs ou qualitatifs qui fournissent une base simple et fiable pour Žvaluer les rŽalisations, les changements ou les performances. Ils permettent d'analyser et de suivre les caractŽristiques des opŽrations, des services et des processus, ainsi que leur mise en Ïuvre. En outre, ils peuvent Žgalement tre utilisŽs pour mesurer, surveiller, Žvaluer et amŽliorer les performances (IOM, 2009). Cadres logiques Ð Diagrammes qui illustrent une interprŽtation linŽaire et logique de la relation entre les intrants, les activitŽs, les extrants, les rŽsultats et les impacts par rapport aux objectifs et buts (Frankel et al., 2007). Cadres de rŽsultats Ð Diagrammes qui illustrent une relation causale directe entre les rŽsultats supplŽmentaires des activitŽs clŽs jusqu'ˆ l'objectif global et le but de l'intervention (Frankel et al., 2007). Parties prenantes Ð Il s'agit d'agences, d'organisations, de groupes ou d'individus qui ont un intŽrt direct ou indirect dans le sujet, et qui affectent ou sont positivement ou nŽgativement affectŽs par le sujet. Les parties prenantes pourraient inclure les gouvernements, les communautŽs de donateurs, les partenaires de mise en Ïuvre, les entreprises et les bŽnŽficiaires du projet (OIM, 2009). Stigmatisation - La stigmatisation comprend les croyances nŽgatives et les perceptions hostiles envers les autres, la honte et l'auto-stigmatisation, les pratiques discriminatoires dans l'embauche, la promotion et la reconnaissance des personnes handicapŽes, ainsi que les politiques et processus structurels et organisationnels qui entra”nent des inŽgalitŽs pour les personnes handicapŽes (Dobson et al., 2021). ThŽorie du changement - Une thŽorie du changement dŽfinit les ŽlŽments et les Žtapes nŽcessaires pour atteindre un objectif ˆ long terme donnŽ, en d'autres termes, elle 1. DŽmontre la voie ˆ suivre pour aller d'ici ˆ lˆ, 2. NŽcessite que les suppositions sous-jacentes soient dŽtaillŽes de manire ˆ pouvoir tre testŽes et mesurŽes, 3. Met l'accent d'abord sur ce que l'organisation veut rŽaliser plut™t que sur ce qu'elle fait (ONU-Femmes, 2013). Liste des acronymes A Measurement Tool for Assessment of Multiple Systematic Reviews (AMSTAR) LÕAccessibilitŽ pour les personnes handicapŽes de l'Ontario (LAPHO) LÕAgence allemande pour la coopŽration internationale (GIZ). LÕAgence amŽricaine pour le dŽveloppement international (USAID) LÕAgence canadienne de dŽveloppement international (ACDI) Americans with Disabilities Act (ADA) Approche du cadre logique (ACL) Association for Behavioral Health and Wellness (ABHW) Association Lavalloise du Transport AdaptŽ (ALTA) Attitude Toward Disabled Persons (ATDP) Attitudes Toward Persons with an Intellectual Disability (ATTID) Attitudes Toward Seeking Professional Psychological Help (ATSPPH) Attribution Questionnaire (AQ) Australian Bureau of Statistics (ABS) Autism Spectrum Disorder (ASD) Autism Survey Questionnaire (ASQ) California Assessment of Stigma Change Scale (CASC) Fondation canadienne de recherche en psychiatrie (FCRP) Conseil de la radiodiffusion et des tŽlŽcommunications canadiennes (CRTC) Centre canadien d'Žtudes sur le handicap (CCDS) Classification of Functioning, Disability and Health (ICF) Commission canadienne des droits de la personne (CCDP) Community Attitudes Toward the Mentally Ill (CAMI) Consumer Experiences of Stigma Questionnaire (CESQ) Convention on the Rights of Persons with Disabilities (CRPD) Dementia Knowledge Assessment Scale (DKAS) Department of Education, Employment and Workplace Relations (DEEWR) Disability Employment Awareness Month (DEAM) Disability Social Relationship Scale (DSR) Disabled Persons Scale (IDP) Disabled Persons Transport Advisory Committee (DPTAC) EmployeesÕ Views About Persons with Mental Disorders Questionnaire (EVMD) Emploi et DŽveloppement social Canada (EDSC) Employment Fears Scale (EFS) Employment Value Scale (EVS) Empowerment (BUES) Enqute britannique sur les attitudes sociales (BSAS) Enqute canadienne sur le handicap (ECD) LÕEnqute sur la santŽ dans les collectivitŽs canadiennes (ESCC) Frequency of Contact Scale (FCS) Implicit Association Task (IAT) Information Technology (IT) Intended Behavior Scale (RIBS) Internalized Stigma (ISMI) Joint United Nations Program on HIV/AIDS (UNAIDS) Loi canadienne sur l'accessibilitŽ (LCA) Non-Governmental Organizations (NGOs) Maxwell and Sullivan Attitude Scale (MSAS) Mental Health Commission of Canada (MHCC) Mental Health Knowledge Schedule (MAKS) Mental Retardation Attitude Inventory-Revised (MRAI-R) Ministre britannique du dŽveloppement internationalÊ(DFID) Multidimensional Attitudes Scale (MAS) Multifaceted Life Satisfaction Scale (MLSS) National Disability Authority (NDA) Office des transports du Canada (OTC) Opening Minds (OM) Openness Scale (OS) LÕOrganisation de coopŽration et de dŽveloppement Žconomiques (OCDE) Programme des Nations Unies pour le dŽveloppement (PNUD)Ê Questionnaire on Student Attitudes Toward Schizophrenia (QSAS) Recovery Attitudes Questionnaire (RAQ) Service international d'aideʈ la recherche agricole nationale (ISNAR) Social Distance Scale (SDS) Stigma Scale (SS) The Working Mind First Responders (TWMFR) Trouble dŽficitaire de l'attention/hyperactivitŽ (TDAH) Working Mind (TWM) INTRODUCTION Contexte Le terme culture peut avoir diffŽrentes significations et est utilisŽ diffŽremment selon les contextes. Au sens large, la culture a ŽtŽ dŽfinie comme un ensemble d'attitudes, de valeurs, d'aspirations et d'un sentiment d'auto-efficacitŽ des personnes. Dans les cercles de politique publique, il est le plus souvent utilisŽ pour dŽsigner l'ensemble des influences sur la faon dont les individus, les groupes et la sociŽtŽ voient le monde et y rŽagissent (UK Cabinet Office, 2008). La culture est importante parce qu'elle a un effet d'orientation vital sur les actions que les gens entreprennent et sur le comportement qu'ils adoptent dans la vie. De nombreux rŽsultats politiques dŽpendent de la faon dont les gens Ð en tant qu'individus et groupes Ð se comportent. Nous savons que les objectifs relatifs ˆ l'accessibilitŽ et ˆ l'inclusion des personnes handicapŽes dŽpendent autant de facteurs culturels que des actions gouvernementales. Les rŽponses du public aux personnes handicapŽes influencent la probabilitŽ de succs ou d'Žchec des politiques visant ˆ accro”tre leur inclusion sociale (Scior et al., 2011). Les statistiques ont mis en Žvidence que les rŽponses sociŽtales nŽgatives constituent un obstacle majeur pour de nombreuses personnes handicapŽes dans leur capacitŽ ˆ tre confiantes, indŽpendantes et connectŽes avec les autres. Le SecrŽtariat de l'accessibilitŽ d'Emploi et DŽveloppement social Canada (EDSC) a commandŽ une Žtude en 2018 afin de mesurer la sensibilisation et l'expŽrience des Canadiens en matire d'accessibilitŽ et de handicap (Gouvernement du Canada, 2019). Dans le cadre de cette enqute, on a demandŽ aux rŽpondants handicapŽs ˆ quelle frŽquence ils avaient rencontrŽ des obstacles comportementaux. Prs de neuf sur 10 (88 %) ont dŽclarŽ avoir rencontrŽ ce type d'obstacle ˆ un moment donnŽ, 11 % disant toujours, 30 % disant en avoir rencontrŽ souvent, 28 % parfois et 17 % rarement. Dans une autre Žtude, rŽalisŽe par la Commission canadienne des droits de la personne (CCDP), les personnes handicapŽes continuent d'tre marginalisŽes dans la sociŽtŽ canadienne. La CCDP a estimŽ que la moitiŽ de toutes les plaintes de discrimination dŽposŽes au Canada sont liŽes ˆ un handicap. Selon un rapport de la CCDP entre 2009 et 2013, 41 728 plaintes de discrimination ont ŽtŽ dŽposŽes auprs des commissions et tribunaux des droits de la personne ˆ travers le Canada. De ce nombre, 49 % (20Ê615 plaintes) ont ŽtŽ dŽposŽes en raison d'un handicap (CCDP, 2015). Des Žtudes menŽes en Australie, au Royaume-Uni, au Canada et dans d'autres pays montrent un rŽsultat similaire. Par exemple, ces Žtudes ont indiquŽ que de nombreux employeurs hŽsitent ˆ embaucher des personnes handicapŽes (CCDS, 2001Ê; DEEWR 2008Ê; UK Prime Minister's Strategy Unit 2005), en particulier celles qui ont des problmes de santŽ mentale, des troubles d'apprentissage ou la cŽcitŽ (Zissi et al., 2007). Pour rŽsoudre le problme des barrires culturelles, des organisations gouvernementales et non gouvernementales du monde entier ont mis en Ïuvre divers programmes visant ˆ changer la culture envers les personnes handicapŽes (Fisher et al., 2017). Celles-ci incluent des politiques qui impliquent un contact direct avec les personnes handicapŽes ; des campagnes d'information et de sensibilisation ; l'Žducation et la formation sur le handicap ; et l'application de la lutte contre la discrimination. Ces programmes sont ciblŽs ˆ diffŽrents niveaux, y compris le niveau personnel (comme la sensibilisation et la reprŽsentation positive)Ê; le niveau organisationnel (tel que l'Žducation, l'emploi et la santŽ) et le niveau gouvernemental (tel que le secteur de l'emploi et de la santŽ) pour changer les attitudes envers les personnes handicapŽes (Scior et al., 2011). MalgrŽ l'importance des facteurs culturels dans l'accessibilitŽ et l'inclusion des personnes handicapŽes, peu d'Žtudes ont ŽtŽ publiŽes dans ce domaine, notamment en ce qui concerne le dŽveloppement, le suivi et l'Žvaluation de telles initiatives. Disposer d'un cadre et d'un ensemble d'indicateurs fiables pour le suivi et l'Žvaluation des initiatives de changement de culture est essentiel pour Žvaluer les progrs et dŽterminer o les efforts sont plus ou moins fructueux. Dans cette Žtude, nous visons ˆ identifier les connaissances pour soutenir le dŽveloppement d'un tel cadre et d'indicateurs ˆ utiliser pour suivre le changement de culture en ce qui concerne l'accessibilitŽ et l'inclusion des personnes handicapŽes. PrincipalesÊquestions de recherche Les principales questions de recherche abordŽes par cette Žtude sont les suivantes : 3. Qu'est-ce que le changement de culture et comment peut-il tre opŽrationnalisŽ afin dÕtre utilisŽ dans le domaine de l'accessibilitŽ et de l'inclusion des personnes handicapŽes dans la sociŽtŽÊ? 4. Quelles donnŽes et mesures sont disponibles pour reprŽsenter la culture et le changement de culture dans les domaines pertinents pour les personnes handicapŽesÊ? ƒtant donnŽ la base documentaire modeste, nous avons rŽalisŽ qu'il y avait beaucoup de nouveaux terrains ˆ explorer en termes de cadres et d'indicateurs. Pour faciliter le processus, nous avons adoptŽ une approche ˆ plusieurs volets. Plus prŽcisŽment, nous avons entrepris deux sous-Žtudes pour produire des idŽes qui ont ŽtŽ directement intŽgrŽes au processus d'Žlaboration du cadre et des indicateurs. Dans la premire sous-Žtude, nous avons entrepris un examen de la portŽe de la littŽrature ŽvaluŽe par des pairs sur les initiatives de changement de culture en relation avec l'accessibilitŽ et l'inclusion. Dans la deuxime sous-Žtude, nous avons entrepris une analyse environnementale de la littŽrature grise, des enqutes nationales et internationales existantes et des sources de donnŽes. Dans le cadre de cette deuxime sous-Žtude, nous avons Žgalement interrogŽ des informateurs clŽs sur leurs rŽflexions sur l'Žlaboration d'un cadre et d'indicateurs pour le suivi et l'Žvaluation des initiatives de changement de culture en matire d'accessibilitŽ et d'inclusion. Dans les sections suivantes, nous rŽsumons d'abord la mŽthodologie de l'Žtude, puis nous rŽsumons la littŽrature identifiŽe dans diffŽrentes sections pour fournir des preuves concernant chaque question de l'Žtude. Nous avons examinŽ quelques exemples d'initiatives, de cadres, d'indicateurs et de mesures de changement de culture qui ont ŽtŽ utilisŽs dans le monde. Cette Žtude propose un examen narratif d'initiatives tirŽes de diffŽrents pays pour illustrer des exemples prometteurs ou des meilleures pratiques dans le domaine. Bien qu'il ne fournisse pas un examen exhaustif ou systŽmatique de ces programmes, il sŽlectionne plut™t les programmes pour les ŽlŽments qui illustrent le mieux les points soulevŽs. Enfin, nous nous concentrons sur la conception d'un cadre de suivi et d'Žvaluation des interventions de changement de culture et des indicateurs connexes, qui pourraient servir de contribution au suivi et ˆ l'Žvaluation des progrs rŽalisŽs au niveau des pays au fil du temps s'ils sont exŽcutŽs pŽriodiquement. Nous avons Žgalement identifiŽ des lacunes dans les donnŽes qui pourraient tre prises en compte dans les futurs efforts de collecte de donnŽes par les organismes fŽdŽraux et provinciaux pour aider ˆ mieux comprendre les changements culturels liŽs ˆ l'accessibilitŽ et ˆ l'inclusivitŽ. METHODOLOGIE MŽthodologie dÕensemble La figure 1 indique l'ensemble de la mŽthodologie de l'Žtude. Dans l'ensemble, cette Žtude comprend cinq volets principaux. L'examen de la portŽe et lÕanalyse environnementale sont les plateformes pour l'identification des initiatives, des cadres et des indicateurs de diffŽrents pays. Les trois dernires composantes de ce projet ont ŽtŽ synthŽtisŽes sur la base des donnŽes probantes de l'examen de la portŽe et de lÕanalyse environnementale. Nous notons que les indicateurs de changement de culture sont souvent liŽs ˆ des initiatives spŽcifiques visant le changement au sein de certaines populations. Par consŽquent, nous passons Žgalement en revue les initiatives identifiŽes dans la littŽrature. Dans le paragraphe suivant, nous expliquons comment nous nous appuyons sur une gamme de sources acadŽmiques et professionnelles ˆ cet Žgard. Figure 1. MŽthodologie dÕensemble Examen de la portŽeÊ Nous suivons la mŽthodologie d'examen de la portŽe proposŽe par Arksey et al. (2005) et affinŽ par Levac et al. (2010). Selon ce cadre, il y a plusieurs Žtapes pour entreprendre un examen de la portŽeÊ: (1) identifier la ou les questions de rechercheÊ; (2) identifier les Žtudes pertinentes ; (3) sŽlectionner des Žtudes ; (4) sources supplŽmentaires. Dans les sections suivantes, nous fournissons plus de dŽtails concernant chaque Žtape. ƒtape 1. Identifier la question de recherche Voici les questions et les enjeux de recherche qui sous-tendront les travaux de ce projet. 1. Qu'est-ce que le changement de culture et comment peut-il tre opŽrationnalisŽ pour tre utilisŽ dans le domaine de l'accessibilitŽ et de l'inclusion des personnes handicapŽes dans la sociŽtŽÊ? a. Quel travail thŽorique a ŽtŽ fait pour conceptualiser la culture et le changement de culture ? b. Quel travail appliquŽ a ŽtŽ fait pour mesurer la culture et le changement de cultureÊ? c. Ë quoi ressemble un cadre conceptuel fondŽ sur le changement de culture qui traiterait des domaines pertinents ˆ la Loi canadienne sur l'accessibilitŽ (LCA) et fondŽ sur la thŽorie et la pratiqueÊ? 2. Quelles donnŽes et mesures sont disponibles pour reprŽsenter la culture et le changement de culture dans les domaines pertinents pour les personnes handicapŽesÊ? a. Quels sont les domaines clŽs et comment sont-ils dŽfinis au mieux ? b. Quelles mesures qualitatives et quantitatives sont disponibles pour reprŽsenter les domaines dans le cadre conceptuelÊ? c. Quelles sont les lacunes dans les donnŽes et les mesures, et comment pourraient-elles tre comblŽes ? d. Comment le cadre conceptuel et les mesures pourraient-ils tre mis en Ïuvre pour mesurer la culture et le changement de culture au Canada ? e. Comment le cadre conceptuel, les mesures et le plan de mise en Ïuvre cadrent-ils avec la stratŽgie et les initiatives du gouvernement fŽdŽral ? ƒtape 2. Effectuer la recherche documentaire pour identifier les Žtudes pertinentes Bases de donnŽes, chronologie et langue Nous prenons en compte la littŽrature ŽvaluŽe par des pairs pour identifier les Žtudes potentiellement pertinentes. Pour accŽder ˆ la littŽrature ŽvaluŽe par des pairs et Žgalement respecter la chronologie (2020-2021), nous effectuons des recherches dans les bases de donnŽes bibliographiques Žlectroniques suivantes pour l'annŽe dernire en utilisant des mots-clŽs et des termes de vocabulaire contr™lŽ spŽcifiques ˆ la base de donnŽesÊ: Embase (Excerpta Medica Database) : Une base de donnŽes biomŽdicale et pharmacologique. PsycINFO : Une base de donnŽes bibliographique Žlectronique fournissant des rŽsumŽs et des citations de la littŽrature scientifique dans les sciences psychologiques, sociales, comportementales et de la santŽ ABI/INFORM : Une base de donnŽes de recherche commerciale. Les recherches sont limitŽes ˆ l'anglais et au franais. Un ensemble de termes de recherche pour chaque catŽgorie a ŽtŽ dŽveloppŽ par le bibliothŽcaire de l'Žquipe en consultation avec l'Žquipe de recherche et les responsables du projet et informŽ par les stratŽgies de recherche de revue prŽcŽdentes pertinentes pour notre question de recherche. StratŽgie de recherche Le tableau 1 prŽsente la stratŽgie testŽe par l'Žquipe et avec les responsables du projet. Nous utilisons le thme de recherche gŽnŽral qui sous-tend ce projet et le P.I.C.O. (Population, Intervention, Comparaison, RŽsultat) pour guider la stratŽgie de recherche. Le vocabulaire contr™lŽ diffre considŽrablement d'une base de donnŽes ˆ l'autre. Par consŽquent, les termes de recherche sont personnalisŽs pour chaque base de donnŽes. Les termes de chaque catŽgorie sont combinŽs avec un opŽrateur boolŽen OU et les deux catŽgories principales sont ensuite combinŽes ˆ l'aide d'un opŽrateur boolŽen ET. Tableau 1. Thme gŽnŽral du projet de recherche (cadre P.I.C.O.) Person/Patient Intervention Comparison Outcome exp disability/ exp mental disease/ mental health/ policy/ public health campaign/ marketing/ law/ intervention study/ education/ education program/ Program/ Initiative/ Plan/ national.ti,ab. (organization or organisation).ti,ab. employer.ti,ab. community.ti,ab. individual#.ti,ab. person#.ti,ab. public.ti,ab. Government/ federal/ provincial/ municipal/ sectoral/ industry/ healthcare stigma/ attitude/ aptitude/ perception/ behavior/ social discrimination/ employment/ social participation/ knowledge/ capital/ cultural/ engagement/ awareness/ prejudice/ recruiting/ barrier/ belonging/ autonomy/ political/ economic outcomes * Terms in red provided by ESDC 4/06/21. P.I.C.O: Population, Intervention, Comparison, Outcome. ƒtape 3. SŽlection des Žtudes Nous avons dŽveloppŽ un ensemble standard de critres d'inclusion/exclusion ˆ appliquer uniformŽment ˆ toutes les rŽfŽrences afin de dŽterminer leur pertinence pour rŽpondre ˆ nos questions de recherche. Les critres d'ŽligibilitŽ proposŽs sont les suivants : Questions clŽs pour l'inclusion et la catŽgorisation 1. L'article porte-t-il sur le changement de culture et est-il pertinent pour les personnes handicapŽes ou sur un sujet connexe (par exemple, les initiatives de rŽduction de la stigmatisation)Ê? NBÊ: Les Žtudes peuvent utiliser les termes stigmatisation ou changement de culture, mais ne pas porter sur la manire de modifier les normes au sein d'un groupe ou d'un domaine social particulier. Ce dernier est un ŽlŽment important pour une Žtude ˆ inclure. RŽponses : oui, incertain, non Si oui ou incertain, rŽpondez aux questions suivantes pour classer l'Žtude dans la ou les catŽgories appropriŽes ˆ utiliser dans le projet. 1. L'article dŽcrit-il la thŽorie du changement de culture ou un cadre conceptuel pour le changement de cultureÊ? 2. L'article dŽcrit-il ou Žvalue-t-il une initiative de changement de cultureÊ? 3. L'article identifie-t-il/dŽcrit-il des indicateurs pour mesurer le changement de cultureÊ? 4. L'article aborde-t-il l'un des sept domaines prioritaires de la LCAÊ? La figure 2 indique lÕorganigramme PRISMA 2020 que nous avons utilisŽ pour notre examen de la portŽe (Page et al., 2020). Nous avons examinŽ les titres et les rŽsumŽs de la recherche d'un an (2020-2021) sans termes de comparaison entrepris dans Embase, PsycINFO et ABI INFORM. La recherche a donnŽ 1 861 titres et rŽsumŽs uniques. Un examen de ces titres et rŽsumŽs a identifiŽ 58 articles ˆ considŽrer. Voici un tableau des rŽsultats de recherche. Figure 2. Organigramme PRISMA 2020 pour l'examen de la portŽeÊ ƒtape 4. Sources supplŽmentaires Ë partir de ces Žtudes, nous avons utilisŽ une approche boule de neige pour identifier les Žtudes et les rapports supplŽmentaires, en tant que recherche complŽmentaire. Nous avons parcouru les rŽfŽrences de ces articles. Nous avons Žgalement recherchŽ la littŽrature ŽvaluŽe par des pairs de chefs de file dans le domaine. Les listes de rŽfŽrences de cette section comprenaient des articles qui ont ŽtŽ scannŽs pour des rŽfŽrences non saisies auparavant. Analyse environnementale Dans ce module, nous avons effectuŽ une analyse environnementale de l'initiative, du cadre, des indicateurs et des mesures de changement de culture existants dans le monde. Ce module se compose de deux sections : recherche de littŽrature grise et entretien avec des informateurs clŽs. ƒtant donnŽ que les intervenants canadiens sont la cible principale de ce projet, l'analyse se concentre sur les juridictions dont les Žconomies, les marchŽs du travail et les programmes sont similaires ˆ ceux du Canada, p. ex. le Royaume-Uni, lÕAustralie, la Nouvelle-ZŽlande, les ƒtats-Unis, les Pays-Bas et autres pays d'Europe du Nord. Ces derniers pays nordiques sont inclus pour diverses raisons : ce sont des dŽmocraties sociales avancŽes avec des traditions d'Žvaluation des politiques et des programmes bien dŽveloppŽes, et une grande partie de leur travail est publiŽe en anglais. Dans ce qui suit, nous fournissons plus de dŽtails concernant la mŽthodologie de chaque section. Recherche de littŽrature grise La littŽrature grise se compose de documents non publiŽs commercialement ou indexŽs par les principales bases de donnŽes. La capture de la littŽrature grise est importante, car les publics cibles les plus courants pour les produits de la littŽrature grise sont souvent les dŽcideurs politiques, les journalistes, les agences fŽdŽrales et Žtatiques, les fondations, les chercheurs et les bŽnŽficiaires. La littŽrature grise est parfois difficile ˆ localiser et prend du temps ˆ rechercher. Nous avons menŽ des recherches sur la littŽrature grise en recherchant des sites Web nationaux et internationaux d'agences gouvernementales, de centres de recherche, d'initiatives communautaires, de sources de donnŽes et de portails en ligne qui recueillent des informations sur des sujets pertinents. Les sites sont mis en signet et les documents pertinents tŽlŽchargŽs (si possible) et organisŽs par juridiction (Irvin et al., 2018). Au sein de chaque juridiction, le point de dŽpart est les sites Web officiels des organisations travaillant dans le domaine de l'accessibilitŽ et de l'inclusion. Lorsque les ressources semblent pertinentes pour le projet, les sections pertinentes sont extraites textuellement et enregistrŽes dans un tableau. Entretiens avec des informateurs clŽs Au cours de la pŽriode du 1er fŽvrier 2022 au 28 fŽvrier 2022, nous avons menŽ des entretiens approfondis avec des chefs de file du savoir sur le sujet du changement de culture vers l'accessibilitŽ et l'inclusion des personnes handicapŽes. Plusieurs entretiens avec des informateurs clŽs ont ŽtŽ rŽalisŽs afin d'identifier les domaines clŽs pertinents pour le changement de culture. Une liste initiale d'informateurs clŽs a ŽtŽ identifiŽe par les chercheurs de l'Žquipe du projet, puis un Žchantillonnage en boule de neige a ŽtŽ effectuŽ pour Žlargir la liste des participants potentiels (c'est-ˆ-dire les recommandations faites par les informateurs clŽs initiaux d'autres personnes ˆ contacter). Les chefs de file du savoir qui ont participŽ aux entretiens ont ŽtŽ invitŽs ˆ identifier d'autres participants qui seraient prts ˆ contribuer ˆ notre analyse de l'environnement. Des entrevues en profondeur ont ŽtŽ menŽes avec des informateurs clŽs dans les diverses juridictions o des connaissances pertinentes sur le terrain ont ŽtŽ identifiŽes, afin de contextualiser davantage les informations recueillies sur les sites Web. Des entretiens semi-structurŽs ont eu lieu par tŽlŽphone ou en ligne et ont durŽ entre 30 et 60 minutes. Nous avons demandŽ aux participants d'Žlaborer sur les impacts des initiatives de changement de culture et sur la faon dont ils ont ŽtŽ mesurŽs. Les questions de l'entretien portaient sur des initiatives spŽcifiques de changement de culture en relation avec l'accessibilitŽ et l'inclusion des personnes handicapŽes. Les participants ont Žgalement ŽtŽ interrogŽs sur le cadre, les mesures ou les indicateurs du changement de culture en relation avec l'accessibilitŽ et l'inclusion dans leurs contextes respectifs. Tous les entretiens ont ŽtŽ enregistrŽs (avec le consentement des participants) pour en assurer l'exactitude, et des notes Žcrites dŽtaillŽes ont ŽtŽ prises par l'enquteur. Les thmes clŽs ont ŽtŽ extraits des notes d'entretien et des enregistrements et directement intŽgrŽs dans nos conclusions. Au cours de nos entretiens, nous avons posŽ aux participants une sŽrie de questions comme indiquŽ ci-dessous : Question 1. Veuillez me parler du travail que vous faites en relation avec les personnes handicapŽes. Votre travail s'est-il concentrŽ sur le changement de culture en matire d'accessibilitŽ et d'inclusion ? Question 2. Avez-vous ŽtŽ impliquŽ dans ou avez-vous entendu parler d'initiatives de changement de culture en relation avec l'accessibilitŽ et l'inclusion des personnes handicapŽes ? Il peut s'agir d'une initiative gouvernementale ou non gouvernementale, axŽe sur des organisations, des communautŽs, des entreprises, des universitŽs, des secteurs industriels, des gouvernements, etc.) Questions d'approfondissement * Veuillez dŽcrire l'initiative. * S'est-elle concentrŽe sur des types particuliers de handicaps ? * Sur quelles populations ou groupes de personnes s'est-elle concentrŽe ? * Quels niveaux de la sociŽtŽ ciblait-elle (par exemple, les individus, les communautŽs, le secteur de l'Žducation, les services gouvernementaux, les services de santŽ) ? * O et quand a-t-elle eu lieu ? * Connaissez-vous des sites Web, des rapports ou des Žtudes qui nous permettraient d'en savoir plus ? * Y a-t-il des personnes en particulier ˆ qui vous suggŽreriez que nous en parlions ? Question 3. Quels sont les signes, mesures ou indicateurs de changement de culture en matire d'accessibilitŽ et d'inclusion que vous avez vus utilisŽs dans diffŽrents domaines de la sociŽtŽ ? Il peut s'agir d'initiatives que vous avez mentionnŽes ci-dessus ou d'autres. Questions d'approfondissement * LÕindicateur est-il utile et pertinent pour mesurer l'efficacitŽ ? * Envisageriez-vous de les rŽviser si possible ? * Quelles sources de donnŽes ont-ils utilisŽes ? * Dans quelle mesure ont-elles ŽtŽ utilisŽes ? * Connaissez-vous des sites Web, des rapports ou des Žtudes o l'on peut en apprendre davantage ˆ leur sujet ? * Avez-vous classŽ les indicateurs en catŽgories, par exemple en processus et en rŽsultats ? * Y a-t-il des personnes en particulier ˆ qui vous suggŽreriez que nous en parlions ? Question 4. Connaissez-vous un cadre dont nous pourrions nous inspirer et qui concerne le changement de culture en matire d'accessibilitŽ et d'inclusion des personnes handicapŽes ? Si non, en connaissez-vous d'autres que nous pourrions adapter ˆ cette fin ? Questions d'approfondissement * Avez-vous des suggestions d'autres domaines de changement de culture en relation avec l'accessibilitŽ et l'inclusion dans la sociŽtŽ ˆ explorer (par exemple, l'Žducation, les soins de santŽ, les services publics, le lieu de travail, les services d'urgence) ? * Connaissez-vous des sites Web, des rapports ou des Žtudes o nous pouvons en apprendre davantage ˆ ce sujet ? * Y a-t-il des personnes en particulier ˆ qui vous suggŽreriez que nous parlions de ce sujet ? RŽsumŽ, analyse et rapport Les donnŽes des Žtudes pertinentes ont ŽtŽ extraites pour rŽpondre aux questions de lÕexamen de la portŽe en utilisant un formulaire normalisŽ de consignation des donnŽes. Ces formulaires ont ŽtŽ prŽparŽs et ont fait l'objet d'un essai pilote pour s'assurer qu'ils soient utilisŽs de manire cohŽrente. Nous avons demandŽ l'avis de notre comitŽ consultatif de projet sur les informations les plus pertinentes ˆ extraire. Les informations dŽtaillŽes qui ont ŽtŽ consignŽes comprennent (sans s'y limiter) : l'auteur, l'annŽe, le titre, le pays, le type d'Žtude, le type d'intervention, le public cible, le contexte, le type de handicap, l'objectif de l'Žtude, les rŽsultats de l'Žtude (primaires/secondaires), les indicateurs clŽs, l'alignement des questions de recherche du projet, les informateurs clŽs potentiels et les organisations. L'annexe I fournit plus de dŽtails sur les directives d'extraction des donnŽes. En raison des contraintes de temps, chaque article a ŽtŽ consignŽ par un examinateur, mais un contr™le de qualitŽ de 10 % a ŽtŽ effectuŽ conformŽment ˆ l'outil AMSTAR (A Measurement Tool for Assessment of Multiple Systematic Reviews) (Shea et al., 2007). Les examinateurs nÕont pas consignŽ de donnŽes sur les Žtudes qu'ils ont consultŽes, dont ils sont les auteurs ou les co-auteurs. Notre analyse comprend une analyse descriptive de la littŽrature pertinente. GuidŽs par l'apport des responsables du projet, les donnŽes relatives aux aspects pertinents des Žtudes ont ŽtŽ analysŽes de manire narrative. RƒSULTATS DE L'ƒTUDE Constatations gŽnŽrales Le tableau 2 fournit un rŽsumŽ de la variŽtŽ de la littŽrature identifiŽe dans l'examen de la portŽe et l'analyse environnementale qui ont ŽtŽ inclus dans l'Žtude. Au total, 217 sources rŽpondaient aux critres d'inclusion. Parmi celles-ci, 58 ont ŽtŽ identifiŽes par l'examen de la portŽe dÕarticles ŽvaluŽs par des pairs et publiŽs entre 2020 et 2021. Soixante-sept autres Žtudes ont ŽtŽ identifiŽes par une recherche en boule de neige de la littŽrature ŽvaluŽe par les pairs identifiŽe par le biais de Google Scholar. Enfin, 92 sources (y compris des sites Web d'organisations gouvernementales et non gouvernementales) ont ŽtŽ identifiŽes par une recherche sur Google et enrichies par les commentaires d'informateurs clŽs. Tableau 2. Ressources identifiŽes lors des diffŽrentes Žtapes et incluses dans l'Žtude Search steps Data sources Count Scoping review of publication from 2020-2021 Embase PsycINFO ABI/INFORM 58 Snowballing search of peer-reviewed literature Google Scholar 65 Environmental scan Grey literature, including reports and surveys Governmental and non-governmental websites Google search, Key informantsÕ interviews 115 60 55 Overall 238 Note. Embase (Excerpta Medica Database): A biomedical and pharmacological database, PsycINFO: An electronic bibliographic database providing abstracts and citations to the scholarly literature in the psychological, social, behavioral, and health sciences, ABI/INFORM: A business research database. Nos rŽsultats ont rŽvŽlŽ de multiples initiatives gouvernementales et non gouvernementales ˆ travers le monde visant ˆ promouvoir la culture dans le domaine de l'accessibilitŽ et de l'inclusion des personnes handicapŽes. Nous avons Žgalement identifiŽ diverses enqutes et outils de mesure utilisŽs pour Žvaluer diffŽrents domaines de la culture, tels que l'attitude, la stigmatisation, la discrimination et les comportements envers les personnes handicapŽes. Au cours de la pŽriode du 1er fŽvrier 2022 au 4 mars 2022, dix-sept entretiens approfondis ont ŽtŽ menŽs avec des chefs de file du savoir du monde entier sur le thme du changement de culture en faveur de l'accessibilitŽ et de l'inclusion des personnes handicapŽes. Les informateurs clŽs venaient du Canada, des ƒtats-Unis, du Royaume-Uni et de l'Australie. Voir le tableau 3 pour plus de dŽtails. Les informateurs clŽs comprenaient des reprŽsentants du gouvernement, de la communautŽ, des organisations nationales, des institutions acadŽmiques, des entreprises et d'autres parties prenantes. Les entretiens semi-structurŽs ont eu lieu en ligne et ont durŽ entre 30 et 60 minutes. Les thmes clŽs ont ŽtŽ extraits des notes et des enregistrements des entretiens et sont directement intŽgrŽs ˆ nos conclusions. Tableau 3. RŽsumŽ des entretiens avec les informateurs clŽs (N = 17) Category Number Interview Status 17 Completed Country 9 Canada, 5 United States, 2 Australia, 1 United Kingdom Occupation 6 Professors, 6 Directors, 4 Managers/Coordinators, 1 Vice President Organization 7 Universities, 6 Community Groups, 2 United States Government, 1 Australian Government, 1 Crown Corporation Gender 10 females, 7 males Plusieurs thmes sont ressortis des propos des informateurs clŽs. Il a ŽtŽ notŽ que le changement d'attitude est difficile ˆ mesurer, mais que les changements de comportement peuvent tre mesurŽs et refltent les changements d'attitude. Plusieurs indicateurs tangibles et moins tangibles du changement de culture ont ŽtŽ suggŽrŽs dans les domaines des connaissances, des attitudes, des comportements et des pratiques qui refltent le processus sous-jacent et les voies vers le changement de culture, aux niveaux individuel, institutionnel, communautaire et autres. Les informateurs clŽs ont notŽ que dans certains cas, le changement de culture se fait du haut vers le bas, et dans d'autres, du bas vers le haut. Les indicateurs du changement de culture sont en fin de compte plus tangibles, plus clairs et plus objectifs s'ils mesurent les rŽsultats et les impacts par rapport aux diverses facettes de la qualitŽ de vie des personnes handicapŽes. Les dŽfenseurs des personnes handicapŽes ont indiquŽ que ce qui compte le plus, ce sont les rŽsultats, par exemple le nombre de personnes employŽes, le niveau de vie, l'expŽrience de la violence, l'accs aux services, l'accs ˆ l'emploi et l'accs au logement. Les informateurs clŽs ont identifiŽ plusieurs cadres, approches et principes directeurs, que nous dŽcrivons en dŽtail ci-dessous. Il s'agit de : 1) l'Žducation basŽe sur le contact, 2) le cadre IDEAL, 3) le cadre des rŽsultats de la stratŽgie australienne en matire de handicap, 4) le modle de maturitŽ d'inclusion de QuakerLab, 5) le cadre pour un lieu de travail psychologiquement sain et 6) la lutte contre la stigmatisation : vers un systme de santŽ plus inclusif. Un rŽsumŽ des conclusions de l'entretien avec les informateurs clŽs se trouve ˆ l'annexe II. Dans les sections suivantes, nous donnons d'abord un aperu de haut niveau du processus de changement de culture, puis nous avons classŽ les Žtudes identifiŽes dans les domaines suivants : * Cadres utilisŽs pour dŽvelopper, suivre et Žvaluer les initiatives de changement de culture dans le domaine de l'accessibilitŽ et de l'inclusion des personnes handicapŽes et au-delˆ. o Application des cadres o Types de cadres o Modle de mesure des initiatives de changement de culture * Initiatives visant ˆ promouvoir un changement de culture parmi les diffŽrentes populations en matire d'accessibilitŽ et d'inclusion, ˆ amŽliorer les attitudes envers les personnes handicapŽes et ˆ rŽduire la stigmatisation et la discrimination. o Plateformes pour les initiatives de changement de culture o Niveaux des initiatives de changement de culture o Exemples d'initiatives visant ˆ changer les attitudes o Examen approfondi de certaines initiatives nationales de changement de culture * ƒtudes visant ˆ mesurer les progrs et la rŽalisation des objectifs gr‰ce ˆ des initiatives de changement de culture dans le domaine de l'accessibilitŽ et de l'inclusion o Enqutes et outils de mesure pour l'accessibilitŽ et l'inclusion des personnes handicapŽes. o Indicateurs permettant d'Žvaluer le changement de culture par rapport ˆ la LCA et au-delˆ. o Analyse des lacunes dans les donnŽes canadiennes relatives ˆ la culture dans le domaine de l'accessibilitŽ et de l'inclusion. Qu'est-ce que le changement de culture ? Les gouvernements ont traditionnellement utilisŽ une combinaison d'incitations, de lŽgislation et de rŽglementation pour tenter d'encourager et de persuader le public d'adopter des comportements diffŽrents (Cabinet Office du Royaume-Uni, 2008). Dans de nombreux cas, ces mesures se sont avŽrŽes efficaces. Cependant, il est de plus en plus reconnu que les facteurs du "capital culturel" - nos attitudes, nos valeurs, nos aspirations et notre sentiment d'efficacitŽ personnelle - sont Žgalement des dŽterminants importants de notre comportement. Dans ce qui suit, nous donnons un bref aperu d'un cadre stratŽgique ŽlaborŽ pour aider ˆ comprendre le processus de changement de culture. Il s'inspire largement de l'unitŽ stratŽgique du Cabinet Office du Royaume-Uni (2008). Compte tenu de l'objectif de cette Žtude, nous n'avons pas l'intention de nous plonger dans la thŽorie de la culture du changement, de sorte que les lecteurs peuvent se rŽfŽrer au document original pour plus de dŽtails. La figure 3 prŽsente une stratŽgie en sept phases pour la mise en Ïuvre et l'Žvaluation des initiatives de changement de culture (UnitŽ stratŽgique du Cabinet Office du Royaume-Uni, 2008). Dans la plupart des cas, il est utile de suivre ces Žtapes dans l'ordre o elles sont prŽsentŽes, bien que le processus ne se veuille pas mŽcanique. Par exemple, dans certains cas, il peut tre plus appropriŽ de comprendre les moteurs des attitudes avant de segmenter les populations cibles. 1. Identifier si le changement de culture est pertinent pour le domaine politique en utilisant une sŽrie de critres de filtrage initiaux. Ces critres fournissent une liste de contr™le pratique pour identifier les questions appropriŽes ˆ une Žtude plus approfondie. Par exemple, une autoritŽ gouvernementale peut avoir pour objectif de rŽduire la discrimination ˆ l'Žgard des personnes handicapŽes dans l'Žducation, l'emploi ou la formation. 2. ƒtablir les objectifs politiques dans le domaine considŽrŽ et Žvaluer la raison d'tre de l'intervention du gouvernement, y compris toute information sur les cožts et les avantages probables. La deuxime Žtape exige de clarifier les objectifs, de comprendre pourquoi ils sont importants et de dŽfinir le r™le appropriŽ du gouvernement. Le Guide de survie de la stratŽgie prŽsente certaines questions communes qui devraient tre posŽes ˆ ce stade de tout projet : 1. Quel est le problme que nous essayons de rŽsoudre ? 2. Pourquoi est-il important ? 3. Pouvons-nous articuler clairement le rŽsultat souhaitŽ ? 4. Identifier et segmenter les groupes de population pertinents et fixer des objectifs appropriŽs pour chacun. 5. Qu'est-ce qui a ŽtŽ fait jusqu'ˆ prŽsent dans ce domaine ? 6. Quelle en a ŽtŽ l'efficacitŽ ? 7. Quelle est la raison d'tre de l'intervention du gouvernement ? 8. Que savons-nous des cožts et avantages probables (en considŽrant idŽalement les cožts et avantages directs, indirects et intangibles) ? 9. Comment pouvons-nous mesurer ce que nous essayons d'atteindre ? 10. Quel est le mandat du projet ? 11. Pouvons-nous identifier un commanditaire appropriŽ pour ce travail ? 3. ƒvaluer les moteurs des attitudes et des comportements dans la rŽgion en identifiant les relations entre les attitudes, les intentions comportementales et les comportements. La troisime Žtape est relativement plus complexe et nŽcessite d'tre capable de segmenter les populations cibles pour adapter l'intervention en consŽquence. Les techniques de segmentation rassemblent un ensemble de disciplines pour identifier les attitudes et les motivations des individus et personnaliser la rŽponse politique en consŽquence. Elles combinent souvent des mŽthodes traditionnelles telles que le profilage dŽmographique ou ŽpidŽmiologique avec des techniques psychologiques afin d'Žlaborer une carte dŽtaillŽe de ce qui motive les gens et de la manire dont ils rŽagissent ˆ diffŽrentes interventions. 4. DŽterminer l'adŽquation des diffŽrentes interventions politiques, y compris l'identification de l'efficacitŽ des incitations, de la lŽgislation, de la rŽglementation et des approches d'information, ainsi que l'efficacitŽ des interventions visant ˆ aborder le dŽveloppement des attitudes, des valeurs et des aspirations. Il s'agit d'une Žtape mŽthodologique cruciale qui nŽcessite d'Žvaluer le r™le relatif du capital culturel dans le comportement, ainsi que l'influence des incitations, de la lŽgislation, de la rŽglementation, de l'information et de l'engagement dans la traduction de ces ŽlŽments en comportement rŽel. L'objectif est d'identifier l'origine d'un Žventuel "blocage" du comportement. Il faut pour cela Žtablir une carte dŽtaillŽe du parcours comportemental de chaque groupe d'utilisateurs identifiŽ ˆ l'Žtape 3. Les sources de donnŽes peuvent inclure des enqutes sociales, des sondages d'opinion, des recherches psychologiques, des Žtudes d'auto-Žvaluation et des modŽlisations statistiques. 5. DŽterminer la meilleure faon de contr™ler l'efficacitŽ, y compris la mesure dans laquelle les objectifs sont atteints, les opinions des parties prenantes et les preuves de la rentabilitŽ obtenue. Cette Žtape nŽcessite de passer de la comprŽhension de ce qui motive le comportement ˆ la manire dont les interventions politiques peuvent effectivement l'influencer. La dŽtermination des endroits o les interventions peuvent tre les plus efficaces doit tre basŽe sur deux facteurs. Premirement, l'importance relative des diffŽrents facteurs de comportement (selon l'Žtape 4). Deuximement, la mesure dans laquelle les interventions ont dŽmontrŽ leur efficacitŽ ˆ influencer ces moteurs. 6. DŽployer et mettre en Ïuvre les interventions prŽfŽrŽes, notamment en clarifiant la responsabilitŽ de la prestation, en identifiant les risques et en crŽant des espaces sžrs pour tester, essayer et innover. La mise en place d'un systme de suivi de l'efficacitŽ des interventions est une Žtape essentielle ˆ entreprendre avant le dŽploiement effectif des programmes. Cela signifie : 1. dŽterminer la base de rŽfŽrence appropriŽe et, si possible, un groupe de contr™le ˆ tester. 2. DŽfinir comment Žvaluer si les objectifs ont ŽtŽ atteints. 3. DŽterminer comment les impacts financiers, les cožts et les avantages seront ŽvaluŽs. 4. DŽfinir un plan pour suivre systŽmatiquement les avis des professionnels, du public et des parties prenantes. Ces mesures devraient permettre d'amŽliorer continuellement chaque projet et de diffuser et dŽployer les connaissances ailleurs. ƒtant donnŽ la nature probablement ˆ plus long terme des initiatives de changement de culture, il peut tre nŽcessaire d'utiliser davantage les objectifs et les Žvaluations intermŽdiaires ˆ des fins d'Žvaluation (Cabinet Office du Royaume-Uni, 2008). Figure 3. ƒtapes de l'Žlaboration de stratŽgies de changement de culture Source: Cabinet Office du Royaume-Uni, 2008 Cadres pour l'Žlaboration, le suivi et l'Žvaluation des initiatives de changement de culture Dans le cadre de notre examen de la portŽe et de l'analyse environnementale, nous avons examinŽ les diffŽrents cadres qui ont ŽtŽ utilisŽs pour les initiatives/programmes de changement de culture dans le domaine de l'accessibilitŽ et de l'inclusion. Il convient de noter qu'il n'existe que quelques Žtudes dans ce domaine. Un cadre rŽcent ŽlaborŽ par le ministre australien des services sociaux en 2021, fournit une plateforme pour le suivi et l'Žvaluation de la stratŽgie australienne en matire de handicap (ministre australien des services sociaux, 2021). Une autre Žtude de Dupuis et al, (2016), dŽcrit une initiative de changement de culture en cours au Canada, l'Alliance ÇÊPartnerships in Dementia CareÊÈ (PiDC), qui fournit quelques informations sur les fondements thŽoriques et philosophiques de leur initiative. ƒtant donnŽ le nombre limitŽ d'Žtudes contenant des dŽtails sur les cadres sous-jacents du changement de culture dans le domaine de l'accessibilitŽ et de l'inclusion, nous avons Žlargi notre recherche de cadres ˆ d'autres domaines. Par exemple, nous avons explorŽ une initiative de changement de culture visant ˆ lutter contre la violence ˆ l'Žgard des femmes (PATH, 2011 ; Casals et al., 2009 ; Hagemann-White et al., 2008 ; Lobby europŽen des femmes, 2002). Nous avons Žgalement explorŽ une initiative de changement de culture en matire de prŽvention du VIH (ONUSIDA, 2008 ; 2010), et une autre dans le domaine des activitŽs de lutte contre la traite des tres humains (OIM, 2009). L'objectif de cette section est de fournir un aperu des diffŽrents cadres qui ont ŽtŽ utilisŽs pour dŽvelopper, suivre et Žvaluer les initiatives de changement de culture. Pour ce faire, nous donnons d'abord un aperu de l'application de ces cadres. Ensuite, nous prŽsentons trois types de cadres qui ont ŽtŽ utilisŽs dans les initiatives de changement de culture, et enfin, nous illustrons quelques exemples de cadres que nous avons identifiŽs dans le cadre de notre Žtude et qui ont ŽtŽ utilisŽs pour dŽvelopper et soutenir des initiatives de changement de culture. Application des cadres Un cadre bien conu peut grandement aider ˆ rŽflŽchir aux programmes (initiatives), aux objectifs et aux activitŽs prŽvues, ainsi qu'ˆ Žvaluer si les programmes sont effectivement les plus appropriŽs ˆ mettre en Ïuvre. En outre, un cadre peut aider ˆ mieux comprendre les buts et les objectifs d'un programme, ˆ dŽfinir les relations entre les facteurs clŽs de la mise en Ïuvre et ˆ dŽlimiter les ŽlŽments internes et externes qui pourraient affecter son succs. Dans l'ensemble, les cadres aident ˆ : * Identifier les programmes visant ˆ aborder le changement de culture et les activitŽs connexes * Articuler les buts et les objectifs du programme * DŽfinir des objectifs mesurables ˆ court, moyen et long terme * DŽfinir les relations entre les intrants, les activitŽs, les extrants, les rŽsultats et les impacts * Clarifier la relation entre les activitŽs du programme et les facteurs externes * DŽmontrer comment les activitŽs mneront aux rŽsultats et impacts souhaitŽs (Frankel et al., 2007). Types de cadres Notre examen a rŽvŽlŽ que le terme " cadres " a ŽtŽ utilisŽ de nombreuses faons diffŽrentes et ˆ des fins diffŽrentes. NŽanmoins, nous avons identifiŽ les trois types de cadres les plus courants utilisŽs pour soutenir la comprŽhension des initiatives de changement de culture : les cadres conceptuels, les cadres de rŽsultats et les cadres logiques (PATH, 2011). Le tableau 4 donne plus de dŽtails sur ces cadres et leurs applications (Frankel et al., 2007). Tableau 4. Types de cadres et leurs applications Type of framework and brief description Initiatives /programs management Basis for monitoring and evaluation Conceptual Interaction of various factors Determines which factors the program will influence No: can help to explain the result Result Logically linked initiative objectives Show the causal relationship between program objectives Yes: at the objective level Logical Logically linked inputs, process, output and outcomes Show the causal relationship between input ad the objectives Yes: At all stages of initiatives/ programs from input to process to outputs to outcome/ objectives Source: Frankel et al., 2007. Cadres conceptuels Les cadres conceptuels sont souvent prŽsentŽs sous forme de diagrammes qui illustrent les relations entre les facteurs organisationnels, individuels et autres qui peuvent influencer un programme et la rŽalisation des buts et objectifs. Ils dŽterminent quels facteurs (c'est-ˆ-dire les facteurs culturels, Žconomiques et sociopolitiques sous-jacents) influenceront le programme et identifient comment chacun de ces facteurs pourrait tre liŽ aux rŽsultats et les affecter. Elles ne constituent pas la base des activitŽs de suivi et d'Žvaluation mais peuvent contribuer ˆ expliquer les rŽsultats du programme. Notez que diffŽrents types d'interventions (changement de politique, campagnes de sensibilisation, mobilisation communautaire, amŽlioration de la prestation de services et de la rŽponse) nŽcessiteront diffŽrents types de cadres, d'outils et d'indicateurs. * ThŽorie du changement : Les cadres conceptuels illustrent la thŽorie du changement et refltent le processus sous-jacent et les voies par lesquelles le changement espŽrŽ (dans les connaissances, le comportement, les attitudes ou les pratiques, au niveau individuel, institutionnel, communautaire ou autre) est censŽ se produire. * Population cible : Qui sera exposŽ directement ˆ l'initiative ? Qui recevra une formation ? Qui va entendre/voir/participer ˆ la campagne ? Qui pourrait tre exposŽ indirectement ˆ l'intervention ? Qui sera exposŽ ˆ certaines des idŽes, mme s'il ne participe pas directement ? * DŽlai pour le changement de comportement : Alors que les changements de connaissances peuvent tre faciles ˆ rŽaliser, les changements d'attitudes et de comportements, en particulier avec les normes au niveau de la communautŽ, nŽcessitent un processus beaucoup plus long. * Mesure des changements : Les cadres conceptuels identifient les mesures appropriŽes pour le type de changement attendu. La figure 4 fournit un exemple d'application d'un cadre conceptuel pour un processus de changement de culture, en s'inspirant de l'initiative "Alliance PiDC " au Canada (Dupuis et al., 2016). Dans ce cadre, le changement de culture est considŽrŽ comme un parcours qui comprend le rŽexamen des valeurs, des croyances, des attitudes, du langage, des pratiques et des politiques. Dans le contexte de l'accessibilitŽ et de l'inclusion, il comprend l'ensemble des efforts nŽcessaires pour transformer la culture d'une communautŽ afin que chacun s'Žpanouisse. L'Alliance PiDC note la nŽcessitŽ de mettre en place des initiatives de changement de culture reposant sur des bases thŽoriques solides. L'Alliance PiDC a identifiŽ des cadres et des modles clŽs dont le cÏur est constituŽ de relations d'interdŽpendance et de collaboration. Figure 4. Cadre conceptuel pour guider le changement de cultureSource: Dupuis et al., 2016. Cadres de rŽsultats Les cadres de rŽsultats identifient les relations causales directes entre les rŽsultats progressifs des activitŽs clŽs et l'objectif global de l'initiative. Ce type de cadre aide ˆ dŽterminer ˆ quel moment de l'initiative on peut s'attendre ˆ diffŽrents types de rŽsultats, de sorte que des mesures appropriŽes puissent tre identifiŽes pour le suivi et l'Žvaluation. Les cadres de rŽsultats comprennent un but gŽnŽral, un objectif stratŽgique et des rŽsultats intermŽdiaires. Un objectif stratŽgique est un rŽsultat qui est le rŽsultat le plus ambitieux qui peut tre atteint et dont l'organisation est prte ˆ tre tenue responsable. Un rŽsultat intermŽdiaire est un rŽsultat isolŽ ou un rŽsultat qui est nŽcessaire pour atteindre un objectif stratŽgique. Remarquez que le but et l'objectif stratŽgique apparaissent en haut du cadre. Avant d'atteindre cet objectif stratŽgique plus large, il faut d'abord atteindre un ensemble de rŽsultats intermŽdiaires "de niveau infŽrieur". Sous chaque rŽsultat intermŽdiaire se trouvent des rŽsultats intermŽdiaires subordonnŽs qui se rapportent directement aux rŽsultats intermŽdiaires (Frankel et al., 2007). La figure 5 donne un exemple de cadre de rŽsultats appliquŽ ˆ l'initiative "Time to Change" en Angleterre. Cette initiative visait ˆ changer la faon dont les gens pensent et agissent ˆ propos des problmes de maladie mentale (Henderson et al., 2016 ; 2020). Nous nous sommes inspirŽs de cette initiative non seulement en raison de la disponibilitŽ des donnŽes, mais aussi parce qu'elle s'aligne sur le sujet de cette Žtude. Notez que les rŽsultats intermŽdiaires (RI1 et RI2) et les rŽsultats intermŽdiaires subordonnŽs doivent tre mesurables. En d'autres termes, des indicateurs peuvent tre dŽveloppŽs pour eux, et des donnŽes peuvent tre collectŽes pour les calculer (Menon, 2009). L'annexe III fournit d'autres exemples pour illustrer l'application des cadres logiques. Ces exemples ont ŽtŽ sŽlectionnŽs dans des domaines autres que le handicap, principalement parce que nous n'avons pas ŽtŽ en mesure de trouver des exemples liŽs au handicap. Figure 5. Exemple d'un cadre de rŽsultats utilisant l'initiative " Time to Change " en Angleterre Source: AdaptŽ de Henderson et al., 2016; 2020. Cadres logiques Les cadres logiques fournissent une interprŽtation linŽaire et logique de la relation entre les intrants, les activitŽs, les extrants, les rŽsultats et les impacts par rapport aux objectifs et aux buts. Ces cadres fournissent une relation de cause ˆ effet. En fait, ces cadres dŽcrivent les intrants spŽcifiques nŽcessaires ˆ la rŽalisation des activitŽs/processus pour produire des extrants spŽcifiques qui se traduiront par des rŽsultats et des impacts spŽcifiques. Ces cadres constituent la base des activitŽs de suivi et d'Žvaluation pour toutes les Žtapes d'une initiative ou d'un programme. > Intrants : Les ressources investies dans un programme - par exemple, l'assistance technique, les ordinateurs, les prŽservatifs ou la formation. > ActivitŽs : Les activitŽs menŽes pour atteindre les objectifs du programme. > Extrants : Les rŽsultats immŽdiats obtenus au niveau du programme gr‰ce ˆ l'exŽcution des activitŽs. > RŽsultats : L'ensemble des rŽsultats ˆ court terme ou intermŽdiaires au niveau de la population obtenus par le programme gr‰ce ˆ l'exŽcution des activitŽs. > Impacts : Les effets ˆ long terme, ou rŽsultats finaux, du programme - par exemple, les changements dans l'Žtat de santŽ. Dans ce contexte, le terme "impact" fait rŽfŽrence ˆ l'Žtat ou aux conditions de santŽ que le programme est censŽ influencer en fin de compte (mortalitŽ, morbiditŽ, fertilitŽ, etc.), tel que mesurŽ par des indicateurs appropriŽs. La figure 6 fournit un exemple de cadre logique, s'inspirant une fois de plus de l'initiative " Time to Change " en Angleterre (Henderson et al., 2016 ; 2020). Ce cadre prŽsente une vision directe d'une initiative conue pour amŽliorer la faon dont les gens pensent et agissent face aux problmes de maladie mentale. L'annexe III fournit d'autres exemples pour illustrer l'application des cadres logiques, dans des domaines autres que le handicap. Figure 6. Exemple de cadre logique pour l'initiative "Time to Change" en Angleterre Goal: To change the way people think and act about mental health problems Source: AdaptŽ de Henderson et al., 2016; 2020. Les cadres logiques ne sont pas destinŽs ˆ prendre en compte tous les facteurs qui peuvent influencer le fonctionnement et les rŽsultats d'un programme. Ils se concentrent plut™t sur les intrants, les activitŽs et les rŽsultats du programme. Cette focalisation Žtroite aide les gestionnaires et les planificateurs de programmes ˆ clarifier les relations directes entre les ŽlŽments d'intŽrt particulier d'un programme spŽcifique. Dans l'ensemble, ces cadres sont un outil prŽcieux pour : 1. La planification et le dŽveloppement de programmes : La structure du modle logique aide ˆ rŽflŽchir ˆ une stratŽgie de programme pour aider ˆ clarifier o en est le programme et o il devrait tre. 2. La gestion du programme : Parce qu'il " relie les points " entre les ressources, les activitŽs et les rŽsultats, un modle logique peut servir de base ˆ l'Žlaboration d'un plan de gestion plus dŽtaillŽ. Gr‰ce ˆ la collecte de donnŽes et ˆ un plan d'Žvaluation, le modle logique permet de suivre et de surveiller les opŽrations afin de mieux gŽrer les rŽsultats. Il peut servir de base ˆ la crŽation de budgets et de plans de travail. 3. La communication : Un modle logique bien construit est un outil de communication puissant. Il peut montrer aux parties prenantes, en un coup d'Ïil, ce qu'un programme fait (activitŽs) et ce qu'il rŽalise (rŽsultats), en soulignant le lien entre les deux. Modle de mesure des initiatives de changement de culture Dans cette section, nous prŽsentons un outil d'analyse et de gestion efficace appelŽ Approche du cadre logique (ACL) qui a ŽtŽ utilisŽ dans des initiatives culturelles. Pour ce faire, nous prŽsentons d'abord le contexte de l'ACL, puis nous expliquons le format et le processus de prŽparation. Enfin, nous illustrons une application de ce cadre ˆ une initiative de changement de culture, en nous inspirant de l'initiative "Time to Change" en Angleterre (Henderson et al., 2016 ; 2020). L'ACL est maintenant utilisŽe par la plupart des agences d'aide multilatŽrales et bilatŽrales, des organisations non gouvernementales (ONG) internationales et par de nombreux gouvernements pour aider ˆ dŽvelopper et ˆ gŽrer des projets (Delevic et al. 2011). L'ACL a ŽtŽ adoptŽe officiellement comme outil de planification des activitŽs de dŽveloppement ˆ l'Žtranger par l'Agence amŽricaine pour le dŽveloppement international (USAID) au dŽbut des annŽes 1970. Depuis lors, elle a ŽtŽ adoptŽe et adaptŽe par un grand nombre d'agences impliquŽes dans l'aide au dŽveloppement. Il s'agit notamment du ministre britannique du DŽveloppement international (DFID), de l'Agence canadienne de dŽveloppement international (ACDI), du Groupe d'experts sur l'Žvaluation de l'aide de l'Organisation de coopŽration et de dŽveloppement Žconomiques (OCDE), du Service international pour la recherche agricole nationale (ISNAR), de lÕAusAIDÊ(Agence australienneÊpour le dŽveloppement international) et de l'Agence allemande pour la coopŽration internationale (GIZ). LÕACL contribue ˆ : * ƒtablir un lien de causalitŽ entre les intrants, les activitŽs, les rŽsultats et le but et l'objectif global, * DŽfinir les suppositions sur lesquelles repose la logique du projet, * Identifier les risques potentiels pour atteindre le but et l'objectif, * ƒtablir un systme de suivi et d'Žvaluation de la performance du projet, et * ƒtablir un processus de communication et d'apprentissage entre les parties prenantes. Format et processus de prŽparation Le tableau 5 fournit une visualisation du cadre logique standard et dŽfinit la terminologie utilisŽe. La matrice du cadre logique fournit un rŽsumŽ d'un projet jusqu'au niveau de l'activitŽ. Elle se compose de quatre colonnes et de quatre lignes (ou plus), rŽsumant les ŽlŽments clŽs d'un projet, comme suit : * La hiŽrarchie des objectifs du projet (description du projet ou logique d'intervention du projet), * Comment les rŽalisations du projet seront suivies et ŽvaluŽes (Indicateurs et sources de vŽrification), * L'environnement du projet et les principaux facteurs externes essentiels ˆ la rŽussite du projet (Suppositions). DŽfinir l'objectif global auquel votre projet contribue : L'objectif/but global est l'objectif d'ordre supŽrieur que l'on cherche ˆ atteindre par le biais d'un projet, souvent en combinaison avec d'autres. Il se rapporte gŽnŽralement ˆ un programme ou ˆ un secteur. Trs souvent, un groupe de projets partagera une dŽclaration d'objectif global commune. DŽfinir le but ˆ atteindre par le projet : L'objectif spŽcifique/la finalitŽ dŽcrit les effets escomptŽs du projet (finalitŽ du projet), l'objectif immŽdiat pour les bŽnŽficiaires directs, comme une condition future ŽnoncŽe avec prŽcision. Il doit tre exprimŽ en termes d'avantages pour le groupe cible. Essentiellement, il rŽsume l'impact que le projet aura. Il peut dŽcrire la manire dont le monde sera changŽ suite ˆ l'obtention des rŽsultats du projet. L'objectif dŽcrit souvent un changement dans le comportement des bŽnŽficiaires du projet. DŽfinir les rŽsultats de la rŽalisation de l'objectif : Les rŽsultats/extrants sont exprimŽs comme les cibles que le projet doit atteindre. Leur impact combinŽ doit tre suffisant pour atteindre l'objectif immŽdiat. Ils doivent tre exprimŽs en termes de rŽsultat tangible livrŽ/produit/rŽalisŽ, etc. DŽfinir les activitŽs pour atteindre chaque rŽsultat : Les activitŽs sont exprimŽes comme des processus, au prŽsent commenant par un verbe actif, comme "prŽparer, concevoir, construire, rechercher, etc." ƒvitez de dŽtailler les activitŽs ; indiquez la structure de base et la stratŽgie du projet. Les activitŽs dŽfinissent la manire dont l'Žquipe va rŽaliser le projet. En gŽnŽral, il s'agit de fournir une liste indicative des activitŽs qui doivent tre mises en Ïuvre pour atteindre chaque rŽsultat. Identifier les suppositions liŽes ˆ chaque niveau de la logique d'intervention : Les suppositions sont des facteurs externes qui ont le potentiel d'influencer (voire de dŽterminer) le succs d'un projet, mais qui Žchappent au contr™le direct des gestionnaires de projet. Les suppositions font partie de la logique verticale dans le cadre logique. Commencez par le bas de la matrice et travaillez vers le haut. Tableau 5. Matrice du cadre logique standard et dŽfinitions de la terminologie Project Description (Intervention Logic, Objective Hierarchy) Performance Indicators (Objectively Verifiable Indicators, Targets) Monitoring Mechanisms (Means of Verification, Source of Verification-information) Assumptions (External Factors) Overall Objective What is the overall objective that the project will contribute to? What indicators are linked to overall objective? Means of verification indicate where and in what form information on the achievement of objectives and results can be found (e.g., reports of ministries, project reports, laws, statistics, assessments, etc.) Not required for overall objective Purpose What is the purpose of project to be realized by the project? Indicators showing the extent to which project purpose has been achieved? Above mentioned Factors and conditions not under direct project control, but necessary to achieve the overall project objective? Results What are concrete visible results to contribute to realization of project purpose? What are the indicators showing whether expected results have been achieved? What are the indicators showing whether expected results have been achieved? Above mentioned above Activities What activities are required and in what order in order to achieve the expected results? Means What resources are required for implementation of listed activities? Costs What are the costs for each of the means? Above mentioned above Source: Delevic et al., 2011. Tableau 6. Exemple de matrice de cadre logique pour l'initiative "Time to Change" (Angleterre) Project Description (Intervention Logic, Objective hierarchy) Performance Indicators (Objectively Verifiable Indicators, Targets) Monitoring Mechanisms (Means of Verification, Source of Verification-information) Assumptions (External Factors) Overall Objective To change the way people, think and act about mental health problems Changes in public discriminatory behaviors Admin Data Not required for overall objective Purpose Enhance mental health-related knowledge among general public in England targeted middle-income groups aged 25Ð45 between 2009 and 2016 Changes in public: * Mental health-related knowledge * Mental health-related attitudes * Desire for social distance Survey of a nationally representative sample using: * Mental Health Knowledge Schedule (MAKS) * Community Attitudes towards the Mentally Ill scale (CAMI) * Reported and Intended Behavior Scale (RIBS) NA Results * Number of events * Number of content in social media Public awareness about of Time to Change campaign * Admin Data * Survey NA Activities * Social marketing campaign using traditional and social media * Local community events to bring people with and without mental health problems together Means * Human resources * Financial resources Costs * Time to challenge social marketing campaign budget: £8,311,066 * Time to challenge online resource budget: £196,049 NA Source: Adapted from Delevic et al., 2011, Henderson et al., 2016; 2020. Initiatives visant ˆ faire Žvoluer la culture de diffŽrentes populations Dans cette section, nous avons passŽ en revue de multiples initiatives visant ˆ changer la culture par rapport aux personnes handicapŽes et en particulier ˆ rŽduire la stigmatisation et la discrimination. Les dŽtails ont ŽtŽ tirŽs des informations recueillies lors de lÕexamen de la portŽe et complŽtŽs par les donnŽes de l'analyse environnementale. Bien que cette liste ne soit en aucun cas exhaustive, elle vise ˆ fournir une introduction ˆ la littŽrature pertinente. Dans ce qui suit, nous donnons d'abord un bref aperu de certaines des plateformes couramment utilisŽes pour changer la culture et les attitudes envers les personnes handicapŽes. Ensuite, nous fournissons une liste des nombreuses initiatives canadiennes et internationales visant ˆ changer les attitudes envers les personnes handicapŽes. Dans la dernire sous-section, nous donnons un aperu de certaines initiatives de changement de culture largement connues. Plateformes pour les initiatives de changement de culture Notre examen a rŽvŽlŽ que les initiatives de changement de culture ont utilisŽ de multiples plateformes pour accro”tre la sensibilisation ou pour changer les valeurs, les attitudes, les croyances, les comportements, etc. Certaines plates-formes sont de niveau macro, comme les initiatives nationales, tandis que d'autres sont ˆ plus petite Žchelle, comme un cadre Žducatif. Nous fournissons une brve explication pour chaque plateforme, en nous concentrant sur celles qui ont ŽtŽ utilisŽes prŽcŽdemment dans le domaine de l'accessibilitŽ et de l'inclusion des personnes handicapŽes. > ƒducationÊ: Les initiatives Žducatives de lutte contre la stigmatisation prŽsentent des informations factuelles sur la maladie stigmatisŽe dans le but de corriger les informations erronŽes ou de contredire les attitudes et les croyances nŽgatives. Elles contrent les stŽrŽotypes ou les mythes inexacts en les remplaant par des informations factuelles (National Academies of Sciences, Engineering, and Medicine, 2016). > Contact : Dans un large Žventail de conditions stigmatisantes, les personnes qui n'en sont pas atteintes ont peu de contacts significatifs avec celles qui en sont atteintes. Le manque de contact favorise l'inconfort, la mŽfiance et la peur. Les interventions basŽes sur le contact visent ˆ surmonter ce fossŽ interpersonnel et ˆ faciliter une interaction et une connexion positives entre ces groupes. Dans les interventions anti-stigmatisation de la santŽ comportementale basŽes sur le contact, les personnes ayant une expŽrience vŽcue de la maladie mentale ou des troubles de la toxicomanie interagissent avec le public, dŽcrivant leurs difficultŽs et leurs rŽussites. Ces stratŽgies visent ˆ rŽduire la stigmatisation publique de personne ˆ personne, mais il a Žgalement ŽtŽ dŽmontrŽ qu'elles Žtaient bŽnŽfiques pour l'auto-stigmatisation en crŽant un sentiment d'autonomisation et en renforant l'estime de soi (National Academies of Sciences, Engineering, and Medicine, 2016). > Services par les pairs : ƒtant donnŽ que les stratŽgies basŽes sur le contact peuvent tre utilisŽes pour rŽduire ˆ la fois la stigmatisation publique et l'auto-stigmatisation, il existe un large Žventail de cibles d'intervention potentielles. L'une des approches permettant d'intŽgrer les interventions basŽes sur le contact dans les activitŽs quotidiennes est le recours aux services de pairs. Les prestataires de services pairs sont des personnes ayant une expŽrience vŽcue qui travaillent en tant que membres d'une Žquipe et favorisent la fourniture de services sans jugement et sans discrimination tout en identifiant ouvertement leurs propres expŽriences. Lorsqu'ils sont intŽgrŽs aux Žquipes de prestation de services, les pairs peuvent aider les autres ˆ identifier les problmes et ˆ suggŽrer des stratŽgies d'adaptation efficaces (National Academies of Sciences, Engineering, and Medicine, 2016). > Protestation et dŽfense des droits : Les stratŽgies de protestation sont ancrŽes dans l'avancement des programmes de droits civils. Dans le contexte de cette Žtude, la protestation est une objection formelle aux reprŽsentations nŽgatives des personnes handicapŽes. Les protestations sont souvent menŽes au niveau de la base par ceux qui ont ŽtŽ victimes de discrimination et par les dŽfenseurs de leur cause. Les stratŽgies font gŽnŽralement appel ˆ la rŽdaction de lettres, au boycottage de produits ou ˆ des manifestations publiques. Les messages de protestation et la dŽfense des droits peuvent aider ˆ engager et ˆ activer les "rŽfractaires" - les personnes qui ont un certain investissement dans le changement de stigmatisation comportementale, mais qui ont des connaissances limitŽes sur la faon de traduire leurs convictions en actions. Un appel ˆ l'action peut Žgalement dynamiser les parties prenantes non engagŽes en les sensibilisant aux effets nŽfastes de la stigmatisation (National Academies of Sciences, Engineering, and Medicine, 2016). > Marketing social : Le marketing social est une approche couramment utilisŽe pour tenter d'influencer les attitudes de la communautŽ et de rŽduire la stigmatisation ou de crŽer un changement social (Randle et al. 2017). L'utilisation de techniques de marketing traditionnelles sensibilise ˆ un problme ou une cause donnŽe et vise ˆ convaincre un public de modifier ses comportements. Le marketing social promeut un comportement ou un mode de vie qui profite ˆ la sociŽtŽ, afin de crŽer le changement souhaitŽ (Huhn et al., 2019). Il existe peu d'Žvaluations accessibles au public des campagnes de marketing social visant ˆ lutter contre la stigmatisation et les attitudes nŽgatives ˆ l'Žgard de l'inclusion des personnes handicapŽes. Parmi celles qui ont ŽtŽ ŽvaluŽes, certaines des plus rŽussies sont la campagne " Time to Change " au Royaume-Uni, la campagne " Like Minds, Like Mine " en Nouvelle-ZŽlande et la campagne " See Me " en ƒcosse, qui ont toutes atteint une forte pŽnŽtration du marchŽ pour influencer positivement les attitudes. Ces campagnes ont bŽnŽficiŽ d'une exposition nationale et ont utilisŽ de multiples canaux de communication et un Žventail de stratŽgies crŽatives (Randle et al. 2017). > Simulation : La simulation est une forme d'expŽrience clinique alternative qui expose les Žtudiants ˆ un apprentissage expŽrientiel en utilisant des stratŽgies technologiques ou non technologiques. Lors de la phase de prŽ-breffage de la simulation, les Žtudiants ont l'occasion de discuter du sujet et de l'objectif de la simulation. La simulation est la mise en Ïuvre d'un scŽnario rŽaliste, suivie d'un dŽbreffage au cours duquel les Žtudiants rŽflŽchissent ˆ leurs sentiments et ˆ leurs pensŽes concernant l'expŽrience (Burns et al., 2017). > Simulation virtuelle : La simulation virtuelle est une mŽthode Žmergente permettant d'illustrer une question ˆ travers le point de vue d'un acteur. Il existe de multiples faons de favoriser la prise de recul. La mŽthode la plus courante consiste peut-tre ˆ demander simplement aux gens d'imaginer les pensŽes et les sentiments d'une autre personne dans un scŽnario particulier (c'est-ˆ-dire des incitations ˆ l'imagination), ce qui s'est avŽrŽ augmenter la catŽgorisation intergroupe inclusive, les attitudes positives et les comportements d'aide. D'autres chercheurs ont utilisŽ des films pour dŽpeindre le point de vue d'une cible stigmatisŽe, ce qui a entra”nŽ une acceptation sociale et des perceptions d'appartenance ˆ un groupe. Les expŽriences virtuelles simulŽes permettent ˆ un individu de devenir un acteur stigmatisŽ virtuel et de tenter de contr™ler ses actions en temps rŽel. En effet, le cerveau d'un individu devrait commencer ˆ rŽguler et ˆ contr™ler le comportement de l'acteur stigmatisŽ de la mme manire que son propre corps, en crŽant sa propre simulation incarnŽe de l'environnement pertinent (virtuel ou rŽel). La reprŽsentation et la prŽdiction des actions, des concepts et des Žmotions dans les environnements rŽels et virtuels par les mmes mŽcanismes dans le cerveau devraient encourager la prise de perspective dans les simulations virtuelles (Sarge et al., 2020). Niveaux des initiatives de changement de culture Notre examen a rŽvŽlŽ que les initiatives de changement de culture ont souvent ŽtŽ catŽgorisŽes en diffŽrents niveaux. Par exemple, Fisher et al. (2017) ont classŽ les initiatives de changement de culture en trois groupes - niveau personnel, organisationnel et gouvernemental. Cette catŽgorisation est cohŽrente avec de nombreuses autres Žtudes telles que l'Agence de la santŽ publique du Canada (2019b), Cross et al, (2011) et Javed et al, (2021). De plus amples dŽtails concernant ces Žtudes sont prŽsentŽs ˆ l'annexe IV. * Les initiatives au niveau personnel visent ˆ modifier l'attitude des individus ˆ l'Žgard des personnes handicapŽes. Elles font appel ˆ des ŽlŽments, souvent combinŽs, tels que l'information, l'Žducation, la formation, la reprŽsentation positive des personnes handicapŽes et le soutien aux possibilitŽs de contact entre personnes handicapŽes et non handicapŽes. * Les initiatives au niveau organisationnel concernent les obstacles comportementaux dans des domaines tels que l'emploi, l'Žducation et la santŽ. Les types de politiques comprennent la formation, les mŽcanismes de plainte et les programmes d'information ciblŽs, qui cherchent ˆ attŽnuer les dŽsavantages de pouvoir subis par les personnes handicapŽes, en modifiant le comportement et les attitudes des personnes non handicapŽes. Dans le mme temps, ces politiques tentent de donner aux personnes handicapŽes les moyens de revendiquer leurs droits ˆ l'ŽgalitŽ d'accs et de participation. * Les initiatives au niveau gouvernementale imposent lŽgalement un changement de comportement. Ces politiques sont initiŽes par les gouvernements et tentent d'influencer les attitudes en imposant un changement de comportement. Ce niveau comprend les dŽclarations politiques et les lois qui dŽfinissent les actions reflŽtant des attitudes positives, ainsi que les moyens de mise en Ïuvre et de suivi. La lŽgislation anti-discrimination et l'Žducation inclusive en sont des exemples (Fisher et al., 2017). Exemples d'initiatives visant ˆ changer les attitudes Le tableau 7 Žnumre plusieurs initiatives visant ˆ changer les attitudes envers les personnes handicapŽes. Chaque intervention a ŽtŽ ŽvaluŽe en fonction des objectifs, du niveau de politique, de la population cible, du type de handicap, ainsi que de la plateforme/approche d'intervention, c'est-ˆ-dire si elle impliquait l'Žducation, et le contact direct ou l'Žducation basŽe sur le contact. Cette liste a ŽtŽ identifiŽe gr‰ce ˆ des recherches sur les sites Web d'organisations gouvernementales et non gouvernementales du monde entier. Il est important de noter qu'il existe des centaines d'initiatives dans le monde qui ont une telle portŽe. Par exemple, rien qu'en Australie, il existe plus de 61 programmes/initiatives en cours qui visent ˆ rŽduire la stigmatisation et la discrimination (Morgan et al., 2021). Par consŽquent, cette liste ne se veut pas exhaustive. Elle vise plut™t ˆ fournir des informations sur certaines initiatives plus importantes visant ˆ changer les attitudes envers les personnes handicapŽes et ˆ rŽduire la stigmatisation et la discrimination. Pour plus de dŽtails, le lecteur peut se reporter aux annexes. L'annexe V fournit une vue approfondie de certaines initiatives nationales de grande envergure et largement connues visant ˆ changer la culture. L'annexe VI fournit des dŽtails sur les initiatives au niveau provincial qui ont ŽtŽ identifiŽes lors de notre analyse du contexte. Tableau 7. Initiatives visant ˆ changer les attitudes envers les personnes handicapŽes Author(s) Year Initiatives/Programs Objective(s) Country Target Population Type of Disability Platform/approach Centre for Addiction and Mental Health (CAMH) NA Addressing Stigma. Mental Health 101: Understanding Stigma to reduce stigma associated with mental health Canada General population Mental illness Education and increasing awareness Mental health commission of Canada (MHCC) 2017 Working Mind (TWM) designed to promote mental health and reduce the stigma around mental illness in the workplace Canada Workplace employees, managers, and employers) Mental illness Evidence-based education program Mental health commission of Canada (MHCC) 2017 The Working Mind First Responders (TWMFR), formerly known as Road to Mental Readiness (R2MR) designed to address and promote mental health and reduce the stigma of mental illness in a first-responder setting. Canada First-responder setting Mental illness Education and increasing awareness Holland Bloorview Kids Rehabilitation Hospital 2017 Dear Everybody Campaign aims to reduce stigma, discrimination of kids, youth with disabilities Canada Teachers, employers and health-care providers Kids and youth with disabilities Mass media advertising (i.e.: Radio and television) Department of National Defense in Canada 2016 Road to Mental Readiness (R2MR) is mental health resilience education and training for Canadian Armed Forces members and their families Canada Military personal Mental illness NA Bell Canada's 2015 Let's Talk to open a public dialogue about mental illnesses Canada General population Mental illness Uses technology and social media Mental health commission of Canada (MHCC) Since 2007 Opening Minds (OM) anti-stigma initiative Anti-Stigma Initiative to improvements day-to-day lives of those living with a mental illness Canada 1) health care providers, 2) youth, 3) Workforce, 4) media Mental illness Contact-based education Government of Canada 2006 A way with Words and Images: Suggestions for the Portrayal of People with Disabilities This booklet seeks to promote a fair and accurate portrayal of people with disabilities. It recommends current and appropriate terminology to help you reach this goal Canada General population All PWDs Publication Canadian Psychiatric Research Foundation (CPRF) 2004 Imagine Campaign NA Canada General population Mental illness Mass media advertising (i.e.: Publication, radio and television) BC Association of Broadcasters 2003Ð04 Award-winning campaigns was presented by the BC Schizophrenia Society Reduce towards schizophrenia Canada General population Mental illness Mass media advertising (i.e.: Television) Canadian Mental Health AssociationÕs BC Division 1998-99 Humanity Award campaigns Change attitude towards mental illness Canada General population Mental illness Bus shelter posters, radio and television Government of Canada Since 1988 National Access Awareness Week (NAAW) 1) to celebrate contributions of PWD, 2) to remove barriers to accessibility and inclusion, 3) ongoing work we all have to do to counter discrimination against PWD Canada General population All PWDs Varies Author(s) Year Initiatives/Programs Objective(s) Country Target Population Type of Disability Platform/approach Kim et al., (Dementia Australia Ltd.) 2021 Dementia Stigma Reduction (DESeRvE) reducing the general public dementia-related stigma Australia General population Mental illness Education and contact Burns et al. 2017 Mental Health First Aid to teaches members of the public how to provide mental health first aid to others and enhances mental health literacy Australia Nursing students Mental illness Contact, education, simulation Beyondblue 2015 Beyondblue to improve the knowledge and skills of primary care practitioners and other health professionals regarding mental health problems Australia youths aged 12-18, health care providers, employers and the workforce, news media Mental illness contact-based education programs Koh et al., (The Dax Centre) 2014 Exhibition Program Program of art by people with lived experience open to the general public Australia General population Mental illness Education Victorian Office for Disability 2010 Picture this increasing the cultural participation of PWDs in Victoria Community Australia Community All PWDs Education Australian Rotary Health Since 2000 Mental health awareness forums to discuss all aspects of mental health Australia General population Mental illness Contacts, Protest/ Advocacy Likeminds 2016 Like Minds, Like Mine to increase social inclusion and reduce stigma and discrimination against people with experience of mental illness and distress New Zealand General population Mental illness Social marketing campaign TV, community workshops, internet resources and disability provider training Henderson et al. 2020 Time to Change program to reduce mental health-related stigma and discrimination England General population Mental illness Social marketing campaign using traditional and social media Walker et al. 2013 Tackling stigma intervention To tackling stigma associated with intellectual disability among the general public England General population Mental illness Indirect contact interventions Myers et al. 2009 See Me campaign (end mental health discrimination) Against the stigma and discrimination associated with mental health Scotland General population Mental illness Social marketing campaign Sarge et al. 2020 Auti-Sim to reduce public stigma associated with autism spectrum disorder US General population Mental illness Virtual simulation engagement; Observation of simulation engagement DASH 2020 Disability Awareness Starts Here (DASH) to educate the community about why and how good access makes sense for everyone US General population All PWDs Education and increasing awareness Stamp Out stigma 2021 Association for Behavioral Health and Wellness (ABHW) reduce the stigma surrounding mental illness and substance use disorders US General population Mental illness Campaign in order to by encouraging people to talk about mental illness and substance use disorders NAMI 2021 National Alliance of Mental Illness A nationÕs largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness US General population Mental illness Education and increasing awareness Alison M. Since 2003 Active Minds to reduce the stigma surrounding mental health issues US Students in universities Mental illness Empowering students to speak openly about their mental health problems through student-run mental health awareness, education, and advocacy Close G et al. Since 2010 Bring Change to Mind (BC2M) to launch a national dialogue about mental health through Public Service Announcements (PSAs), and evidence-based, peer-to-peer high school and undergraduate programs US General population Mental illness -Leveraged the power of celebrity and media -Creating national advocacy and awareness campaigns, -Developing a national student-led high school club program, -Building a storytelling movement that works to end the stigma in US Mesurer les progrs et l'atteinte des objectifs gr‰ce aux initiatives de changement de culture Cette section se compose de quatre parties. Premirement, nous donnons un aperu d'une poignŽe d'enqutes rŽalisŽes dans le monde entier pour mesurer divers domaines culturels liŽs ˆ l'accessibilitŽ et ˆ l'inclusion des personnes handicapŽes. Deuximement, nous fournissons des informations gŽnŽrales sur les diffŽrents types d'indicateurs et les critres de sŽlection des indicateurs appropriŽs pour le suivi et l'Žvaluation d'une initiative ou d'un programme de changement de culture. Troisimement, nous avons catŽgorisŽ une batterie d'indicateurs qui ont ŽtŽ utilisŽs pour mesurer le changement de culture en relation avec les domaines prioritaires de la LCA et au-delˆ. Ces indicateurs ont ŽtŽ tirŽs des connaissances recueillies lors d'un examen approfondi de la portŽe et de l'analyse environnementale. Enfin, nous entreprenons une analyse des lacunes dans les donnŽes, en fournissant une liste d'ŽlŽments de donnŽes pour lesquels nous avons eu du mal ˆ trouver une source, et qui pourraient tre inclus dans les futurs efforts de collecte de donnŽes des autoritŽs fŽdŽrales et provinciales. Enqutes et outils de mesure pour l'accessibilitŽ et l'inclusion Le tableau 8 rŽsume les Žtudes qui dŽcrivent les instruments mis en Ïuvre pour mesurer divers domaines culturels liŽs ˆ l'accessibilitŽ et ˆ l'inclusion des personnes handicapŽes. Nous fournissons des dŽtails sur la rŽgion o ils ont ŽtŽ utilisŽs, le service qui a initiŽ l'enqute, les objectifs, les outils de mesure, la population cible et les types de handicaps considŽrŽs. Plusieurs ŽlŽments mŽritent d'tre soulignŽs concernant les Žtudes identifiŽes : * La plupart dŽcrivent des instruments qui ont ŽtŽ mis en Ïuvre par un service gouvernemental chargŽ des handicaps, tandis que certains ont ŽtŽ mis en Ïuvre par des universitŽs et des centres de recherche. * En termes d'objectifs, certaines Žtudes mesurent les attitudes, la stigmatisation, la discrimination et les comportements discriminatoires, etc. D'autres Žvaluent la sensibilisation des personnes aux organisations, ˆ la lŽgislation et aux initiatives liŽes au handicap. Les rŽsultats de ces Žtudes couvrent un large Žventail de contextes, y compris les attitudes envers les personnes handicapŽes dans l'Žducation, le secteur de l'emploi, ou le niveau gŽnŽral de confort de vie ˆ proximitŽ des personnes handicapŽes. * De nombreux instruments ont ŽtŽ conus et validŽs pour mesurer divers domaines culturels liŽs ˆ l'accessibilitŽ et ˆ l'inclusion. * En ce qui concerne les populations cibles, certaines Žtudes ont ŽtŽ conues pour recueillir des donnŽes auprs de la population gŽnŽrale, tandis que d'autres visaient ˆ mesurer les attitudes d'acteurs spŽcifiques tels que les employeurs, les clients, les services de santŽ, etc. * En termes de types de handicap, certaines Žtudes Žtaient gŽnŽriques, prenant en compte tous les types de handicap, tandis que d'autres se concentraient sur certains types, comme les personnes souffrant d'un handicap mental ou intellectuel. Nous avons classŽ les Žtudes en deux grandes catŽgories : celles qui considrent toutes les personnes handicapŽes, et celles qui se concentrent sur les personnes ayant un handicap mental. L'annexe VII se concentre spŽcifiquement sur les outils de mesure qui ont ŽtŽ dŽveloppŽs et validŽs au cours des deux dernires dŽcennies pour Žvaluer diffŽrents domaines liŽs ˆ l'attitude envers les personnes handicapŽes. Ces outils mesurent diffŽrents aspects de la culture et des normes tels que la stigmatisation, les attitudes, les perceptions, la sensibilisation, la distance, le niveau de confort, etc. envers les personnes handicapŽes dans diffŽrentes populations. L'annexe constitue une source d'information prŽcieuse pour la prochaine Žtape de la recherche dans le domaine du changement de culture, en particulier pour la conception d'une enqute nationale au Canada visant ˆ mesurer divers domaines culturels liŽs ˆ l'accessibilitŽ et ˆ l'inclusion des personnes handicapŽes. Tableau 8. ƒtudes visant ˆ mesurer divers domaines culturels liŽs ˆ l'accessibilitŽ et ˆ l'inclusion des personnes handicapŽes Author(s) Year Survey Title Country Department Objective(s) Measurement tools Target Population Sample Size Type of disability Bollier et al. 2021 National Survey of Community Attitudes towards People with Disability in Australia Australia Victorian Government+ and Centre of Research Excellence in Disability and Health Focused on attitudes that impact the social and economic participation of people with disability of all ages Questionnaire: Developed based on 1. British Social Attitudes Survey, 2. Attitudes to Disability Scale, developed by Power et al. (2009) General population 2,000 All Reavley et al. 2012 Stigmatising Attitudes Towards People with Mental Disorders: Changes in Australia over 8 years Australia Centre, Centre for Youth Mental Health, University of Melbourne To investigate whether stigmatising attitudes towards people with mental disorders have changed over 8-year period Telephone interviews: 1. personal and perceived stigma, 2. social distance, 3. perceived discrimination General population 4,000 Mental Australian Government 2011 Employer Perspectives on Recruiting Persons with Disabilities and The Role of Disability Employment Australia Department of Education, Employment and Workforce relation Measures employersÕ attitudes toward hiring people with disability and other groups Questionnaire developed by author supplemented by qualitative data from an online discussion forum Employers 2,744 All Woodley et al. 2012 Employer attitudes towards employing disabled people New Zealand Ministry of Social Development To better understand New Zealand employersÕ attitudes towards employing disabled people Questionnaire developed by authors Employers 106 All UK Government 2021 UK Disability Survey England Disability Unit and Policy Lab Designed as a vehicle for disabled people, carers of disabled people, and members of the general public with an interest in disability, to share their lived experiences or views with the Disability Unit to inform the development of the National Disability Strategy Questionnaire developed by authors General population 14,491 All Evans-Lacko et al. 2013 Public knowledge, attitudes and behaviour regarding people with mental illness in England 2009-2012 England The Time to Change evaluation was funded by the Big Lottery Fund, Comic Relief and Shifting Attitudes to Mental Illness (SHiFT), UK government Department of Health To investigate whether public knowledge, attitudes and behaviour in relation to people with mental health problems have improved among the English population since the inception of the Time to Change programme in 2009 Questionnaire: 1. UK Department of Health Attitudes to Mental Illness, 2. Reported and Intended Behaviour Scale (RIBS), 3. Mental Health Knowledge Schedule (MAKS) General population 1,700 Mental Office for Disabilities Issues 2009 Public Perceptions of Disabled People: British Social Attitudes Survey (BSAS) England Office for Disability Issues (ODI) The aim of these questions was to measure public attitudes towards disabled people and disability Face-to-face survey and Questionnaire developed by authors General population 3,600 All Reid et al. 2013 Attitudes to Mental Health in Scotland: Scottish Social Attitudes (SSA) survey Scotland Scottish Government Social Research To provides a detailed picture of public attitudes towards mental health problems. It examines the extent to which individuals with mental health problems are able to live free from stigma, discrimination, injustice and inequality, and also explores attitudes to recovery among those who identified themselves as having or having had a mental health problem Face-to-face interviews with respondents and a self-completion section developed by authors General population 1,500 Mental National Disability Authority (NDA) 2002 Survey on Attitudes towards People with Disabilities in the Republic of Ireland Ireland National Disability Authority of Ireland The study is the first of its kind in this State and allows for comparison with attitudes in other countries where such surveys have been a standard exercise for some time Face-to-face interview using ÒThe Irish Social Omnibus Survey (ISOS)Ó which developed by Research and Evaluation Services (RES) (i.e.: an independent research organization) General population 1,000 All Frank et al. 2018 Canadian Community Health Survey Cycle 1.2 Ð Mental Health and Well-being (CCHS-MH Civilian) and its corresponding Canadian Forces Supplement (CCHS-MH) Canada Statistics Canada Aimed to assess the independent contribution of mental and physical health on both enacted stigma (discriminatory behaviour) and felt stigma (feelings of embarrassment) Questionnaire developed by Canadian Community Health General population Military (1900)+ civilian (2960) Mental Angermeyer et al. 2005 Causal beliefs and attitudes to people with schizophrenia: trend analysis based on data from two population surveys in Germany Germany Former Federal Republic of Germany. To examine how the German publicÕs causal attributions of schizophrenia and their desire for social distance from people with schizophrenia developed over 1990s Structured interview, developed by authors General population 5,025 Mental Zissi et al. 2007 Greek employersÕ attitudes to employing people with disabilities: Effects of the type of disability Greece Department of Sociology, University of the Aegean The aim of this cross-sectional study was to answer two central research questions: (i) what are Greek employersÕ attitudes to employing people with a range of disabilities; and (ii) do employersÕ attitudes differ according to the type of disability? Face to-face interviews, developed by authors Employers 102 All Goreczny et al. 2011 Attitudes toward individuals with disabilities: Results of a recent survey and implications of those results USA Chatham University to investigate attitudes of a group of 129 individuals attending a state-wide conference aimed toward improving quality of life of persons with disabilities Questionnaire developed by authors General population 129 All Domzal et al. 2008 Survey of Employer Perspectives on the Employment of People with Disabilities USA United States Department of Labor, Office of Disability Employment Policy The objective of this nationally representative survey was to inform the development and promotion of policy and practice by comparing employer perspectives across various industries and within companies of varying sizes Telephone interview, questions developed by authors Employers 3,797 All Siperstein et al. 2006 A national survey of consumer attitudes towards companies that hire people with disabilities USA University of Massachusetts To measure consumer attitudes toward companies that hire individuals with disabilities were assessed through a national public survey. Telephone interview, questions developed by authors Consumers 803 All Aperu des indicateurs Qu'est-ce qu'un indicateur ? Les indicateurs sont des signes de progrs - ils sont utilisŽs pour dŽterminer si une initiative/un programme est en voie d'atteindre ses objectifs et son but. Une fois que l'objectif gŽnŽral, le but du projet, les rŽsultats et les activitŽs ont ŽtŽ identifiŽs, il faut dŽterminer comment mesurer les progrs (OIM, 2009). * Un indicateur est une caractŽristique spŽcifique, observable et mesurable qui peut tre utilisŽe pour montrer les changements ou les progrs rŽalisŽs par une initiative ou un programme pour atteindre un rŽsultat spŽcifique. * Un indicateur doit tre ciblŽ, clair et spŽcifique. Le changement mesurŽ par l'indicateur doit reprŽsenter le progrs qu'une initiative est censŽe rŽaliser. * Un indicateur doit tre dŽfini en termes prŽcis, sans ambigu•tŽ, qui dŽcrivent clairement ce qui est mesurŽ. Dans la mesure du possible, l'indicateur doit donner une idŽe relativement prŽcise des donnŽes requises et de la population visŽe par l'indicateur. * Les indicateurs ne devraient pas mesurer un niveau de rŽalisation particulier, mais plut™t mesurer des changements de toute ampleur, y compris positifs et nŽgatifs (UNWomen, 2013). Critres de sŽlection des indicateurs Le dŽfi de la sŽlection des indicateurs est de trouver des mesures qui peuvent saisir de manire significative les changements clŽs, en combinant ce qui est un reflet substantiellement pertinent du rŽsultat souhaitŽ avec ce qui est pratiquement rŽaliste en termes de collecte et de gestion des donnŽes (Sandhu-Rojon et al., 2003). Nous avons ŽnumŽrŽ ci-dessous quelques critres importants pour la sŽlection des indicateurs : * Valides : Une mesure prŽcise du comportement, de la pratique, de la t‰che qui est le produit ou le rŽsultat attendu de l'intervention. * Fiables : Mesurable de manire cohŽrente dans le temps, de la mme manire par diffŽrents observateurs. * PrŽcisÊ: DŽfini opŽrationnellement en termes clairs. * Mesurables : Quantifiable en utilisant les outils et la mŽthode disponibles. * Opportuns : Fournit une mesure ˆ des intervalles de temps pertinents et appropriŽs en termes d'objectifs et d'activitŽs du programme. * Importants du point de vue du programme : LiŽ ˆ l'initiative ou ˆ la rŽalisation des objectifs (Gage et al., 2009). Types d'indicateurs La figure 7 illustre les deux principaux types d'indicateurs utilisŽs pour le suivi et l'Žvaluation : 1) les indicateurs de processus et 2) les indicateurs de rŽsultats. Les indicateurs de processus sont utilisŽs pour contr™ler le nombre et les types d'activitŽs rŽalisŽes. Par exemple, le nombre de personnes formŽes, le nombre et le type de matŽriel produit, et le nombre de services fournis pendant une initiative d'accessibilitŽ Žducative. Les indicateurs de rŽsultat visent ˆ Žvaluer si une activitŽ a atteint les objectifs prŽvus. Les indicateurs de rŽsultat se composent de trois sous-catŽgories principales : les extrants, les rŽsultats et les indicateurs d'impact. Les indicateurs dÕextrants mesurent le changement directement liŽ aux activitŽs entreprises dans le cadre d'une initiative, par exemple, le nombre de personnes ayant suivi la formation sur la culture de l'accessibilitŽ. Les indicateurs de rŽsultats mesurent le changement qui rŽsulte d'une initiative ˆ moyen ou long terme, par exemple, si et dans quelle mesure les connaissances, les attitudes, les perceptions et les pratiques des participants ont changŽ aprs une initiative Žducative sur l'accessibilitŽ. Les indicateurs d'impact mesurent l'effet ˆ long terme d'une initiative, par exemple, si et dans quelle mesure la prŽvalence de la discrimination envers les personnes handicapŽes a ŽtŽ rŽduite aprs une initiative Žducative. Un suivi et une Žvaluation complets doivent intŽgrer diffŽrents types d'indicateurs. Figure 7. Type d'indicateurs de suivi et d'Žvaluation Source: AdaptŽ de Bott et al., 2004. Indicateurs de suivi et d'Žvaluation L'objectif du suivi et de l'Žvaluation est de suivre systŽmatiquement la mise en Ïuvre et les rŽsultats et de mesurer l'efficacitŽ des initiatives de changement de culture. Il permet de dŽterminer quand une initiative est sur la bonne voie et quand des ajustements sont nŽcessaires. * Le suivi : Il peut tre dŽfini comme une fonction continue qui utilise la collecte systŽmatique de donnŽes sur des indicateurs spŽcifiques pour fournir ˆ la direction et aux parties prenantes des indications sur les progrs et la rŽalisation des objectifs (OIM, 2009). * LÕŽvaluation : L'apprŽciation systŽmatique et objective d'une initiative, d'un projet ou d'un programme en cours ou achevŽ, ainsi que de sa conception, de sa mise en Ïuvre et de ses rŽsultats. Le but est de dŽterminer la pertinence et la rŽalisation des objectifs, l'efficience du dŽveloppement, l'efficacitŽ, l'impact et la durabilitŽ (OIM, 2009). Les indicateurs de suivi et d'Žvaluation peuvent tre utilisŽs pour dŽmontrer qu'une initiative a eu un impact mesurable sur les rŽsultats attendus et a ŽtŽ mise en Ïuvre de manire efficace. Il sert ˆ soutenir les gestionnaires, les planificateurs, les responsables de la mise en Ïuvre, les dŽcideurs et les donateurs en leur fournissant les donnŽes et la comprŽhension dont ils ont besoin pour prendre des dŽcisions ŽclairŽes sur les opŽrations. Le suivi et l'Žvaluation fournissent les donnŽes nŽcessaires pour guider la planification stratŽgique, la conception et la mise en Ïuvre des initiatives, des programmes et des projets, et pour Žclairer les dŽcisions d'affectation et de rŽaffectation des ressources. Tableau 9. DiffŽrences entre les indicateurs de suivi et d'Žvaluation Monitoring Evaluation Why? Check progress, Inform decision and remedial action, Update project plans, Support accountability Assess progress and worth, Identify lessons and recommendations for longer-term planning, Provide accountability When? Ongoing during initiative Periodic and after an initiative Who? Internal, involving initiative implementers Can be internal or external to an organization Link to logical hierarchy Focus on input, activities, outputs and shorter-term outcomes Focus on outcomes and overall goal Source: CSNM, 2020. Indicateurs permettant de mesurer le changement de culture par rapport ˆ la LCA et au-delˆ Le tableau 10 rŽsume les indicateurs qui ont ŽtŽ utilisŽs pour mesurer le changement de culture par rapport ˆ l'accessibilitŽ et ˆ l'inclusion des personnes handicapŽes. Ces indicateurs ont ŽtŽ tirŽs des connaissances recueillies lors d'un examen approfondi de la portŽe et de l'analyse environnementale. Nous avons tentŽ de catŽgoriser les indicateurs en fonction des situations de vie o des obstacles ˆ l'accessibilitŽ et ˆ l'inclusion peuvent survenir et compromettre la capacitŽ des personnes handicapŽes ˆ tre confiantes, indŽpendantes et connectŽes avec les autres. Nous nous sommes inspirŽs des sept domaines prioritaires de la LCA qui a reu la sanction royale au printemps 2019. Nous avons ajoutŽ d'autres domaines au-delˆ des domaines prioritaires de la LCA, comme l'Žducation, les services de santŽ, les services de premiers rŽpondants et la vie communautaire. Ces ajouts ont ŽtŽ distillŽs ˆ partir de l'analyse documentaire. Nous avons tentŽ de nous assurer que ces indicateurs couvrent les neuf domaines de participation ˆ la vie sociale dŽfinis par la Classification internationale du fonctionnement, du handicap et de la santŽ (CIF), ˆ savoir : 1) l'apprentissage et l'application des connaissances, 2) les t‰ches et exigences gŽnŽrales, 3) la communication, 4) la mobilitŽ, 5) l'autonomie, 6) la vie domestique, 7) les interactions et relations interpersonnelles, 8) les principaux domaines de la vie et 9) la vie communautaire, sociale et civique (CDC, 2010). Les domaines considŽrŽs sont les suivants : 1. Emploi ; 2. Environnement b‰ti ; 3. Transports ; 4. Technologies de l'information et de la communication ; 5. Communication autre que les technologies de l'information et de la communication ; 6. Acquisition de biens, de services et d'installations ; 7. Conception et prestation de programmes et de services ; 8. ƒducation ; 9. Services de santŽ ; 10. Services aux premiers rŽpondants ; 11. Vie communautaire. Nous avons fourni une brve dŽfinition pour chaque indicateur et, dans certains cas, des exemples dans les notes de bas de page. Les indicateurs identifiŽs ont ŽtŽ ŽtiquetŽs comme indicateurs de processus (P) ou de rŽsultat (R). Les indicateurs de rŽsultat se rŽpartissent en trois catŽgories : production, rŽsultat et impact. En ce qui concerne les sources de donnŽes pour les indicateurs, nous avons identifiŽ les enqutes et la mŽthodologie dans des colonnes sŽparŽes. La dernire colonne identifie la disponibilitŽ des donnŽes canadiennes pour les indicateurs. Chaque indicateur a ŽtŽ classŽ dans l'un des trois groupes suivants : 1) structurel - structures sociales, politiques et lŽgislations discriminatoires ; 2) intrapersonnel - ignorance/mŽsinformation (problme de connaissances), prŽjugŽs (problme d'attitude) et comportement discriminatoire ; et 3) intrapersonnel - auto-stigmatisation et internalisation de la stigmatisation. Les rŽfŽrences pour chaque indicateur sont indiquŽes entre parenthses. Tableau 10. Indicateurs pour Žvaluer le changement de culture en faveur de l'accessibilitŽ et de l'inclusion des personnes handicapŽes a) Employment (ACA) Indicators Definition Type Existing Surveys Methodology CAN Data Availability Attitudes of employers towards PWDs (Interpersonal) EmployersÕ attitudes towards o Work performance of PWDs o Social acceptability of PWDs o Cost of workplace accommodations (Woodley et al., 2012; Randle et al. 2017)1 R/O o Employer Attitudes Towards the Work Inclusion of PWDs (Nota et al., 2014) o Pilot Public Opinion Research Survey on Accessibility (Government of Canada, 2019) o New Zealand Survey on Employer Attitudes Towards Employing PWDs (Woodley et al., 2012) o British Social Attitudes Survey (Office for Disabilities Issues, 2009) o Australian National Survey of Employers' Recruitment Experiences (DEEWR, 2010; Australian Government, 2011) o Survey of Employer Perspectives on the Employment of People with Disabilities (Domzal et al., 2008) o Questionnaire Developed by Authors o Questionnaire Developed by Authors o Questionnaire Developed by Authors o Attitudes to Disability Scale (ADS) o Questionnaire developed by Department of Education, Employment and Workplace Relations o Questionnaire developed by US Department of Labor, Office of Disability Employment Policy o Pilot Public Opinion Research Survey on Accessibility (Government of Canada, 2019) Attitudes of co-workers and customers towards PWD (Interpersonal) Perception on PWDs o Productivity (Office for Disabilities Issues, 2009; Bollier et al., 2021) o Perceived exploitability2 (Bollier et al., 2021) o Future prospects3 (Bollier et al., 2021) o Burden stereotypes4 (Bollier et al., 2021) R/O o Survey of Employer Perspectives on the Employment of PWDs (Domzal et al., 2008) o A National Survey of Consumer Attitudes Towards Companies That Hire PWDs (Siperstein et al., 2006) o Findings from a National Survey of Community Attitudes Toward People with Disability in Australia (Bollier et al., 2021) o Questionnaire developed by US Department of Labor, Office of Disability Employment Policy o Questionnaire Developed by Authors Attitudes to Disability Scale (ADS) o Data is not available Self-stigma among PWD (Intrapersonal) o Self-stigma and fears of employment among PWDs R/O o Self-stigma and Fears of Employment Among Adults with Psychiatric Disabilities Using Employment Fears Scale and an Employment Values Scale (Hielscher et al., 2017) o Employment Fears Scale (EFS) o Stigma Scale (SS) o Consumer Experiences of Stigma Questionnaire (CESQ) o Employment Value Scale (EVS) o Data is not available Reported discrimination towards PWD o Complaints received by the ground of discrimination towards PWDs R/I o Canadian Human Rights Commission (CHRC, 2015) o Admin data o Survey o Federal, provincial, territorial human right commission o Labour Force Discrimination (LFD), (CSD, 2017) b) Built Environment (ACA) Indicators Definition Type Existing Surveys Methodology CAN Data Availability Inclusivity culture in design (strutural) o Presence of disability perspective in inclusive urban planning and strategies planning o Presence of trained and inclusion respecting architects and designers in built environment projects (Rebernik et al., 2020; Terashima et al., 2021) R/I o Disability Inclusion Evaluation Tool (DIETool) used in two European Cities (Rebernik et al., 2020) o Questionnaire Developed by Authors o Data is not available c) Transportation (ACA) Indicators Definition Type Existing Surveys Methodology CAN Data Availability Attitudes of transport staff (Interpersonal) o Attitudes of transport staff towards passengers with disabilities o Awareness of transport staff about needs of passengers with disability (DPTAC, 2002) R/O o Attitudes of Disabled People to Public Transport (DPTAC, 2002) Questionnaire Developed by Authors o Data is not available Fear as a passenger with disabilities (Intrapersonal) o Proportion of passengers with disabilities afraid: * being stigmatized * that services do not meet their needs * discriminatory behavior (Field, 2007) o Attitudes of other passengers (Rosenbloom et al., 2007; Bezyak et al., 2017) R/O o Travel Fair (SCOPE, 2019) Questionnaire Developed by Authors o Data is not available Reported discrimination towards PWD o Reported discrimination complaint toward PWDs in public transit R/I o NA o Admin data o Questionnaire o Accessible Transportation Complaints (CTA, 2020) d) Information and Communication Technologies (ICT) (ACA) Indicators Definition Type Existing Surveys Methodology CAN Data Availability Attitudes of ICT staff (Interpersonal) o Attitudes of staff towards PWDs o Awareness of staff about needs of PWD R/O o Diversity, Equity, and Inclusion in the IT Workforce (Gierdowski, 2019) o Questionnaire Developed by Authors o Data is not available Inclusive content (strutural) o Inclusive, non-discriminating contents o Proportion of anti-stigmatising content o Awareness-raising campaigns, projects about inclusion and disability P o Newspaper coverage of mental illness in England 2008-2011 (Thornicroft et al., 2013) o Toward a more balanced representation of disability a content analysis (Goethals, 2018) o Representations of disability in the Canadian news media: a decade of change (Devotta et al., 2013) o The Place of News Media Analysis within Canadian Disability Studies (Haller, 2012) o Content Analysis o Data is not available Self-stigma (Intrapersonal) o PWDs perceived stigma of assistive devices (Santos et al., 2020) o PWDs awareness of what ICTs can do to facilitate their inclusion (ITU, 2013) R/O o Aesthetics and the Perceived Stigma of Assistive Technology for Visual Impairment (Santos et al., 2020) o Questionnaire Developed by Authors o Data is not available Reported discrimination towards PWD o Number of reported complaints on the basis of discrimination toward PWDs R/I o NA o NA o Federal, provincial, territorial human right commission e) Communication, other than ICT (ACA) Indicators Definition Type Existing Surveys Methodology CAN Data Availability Attitudes of Communication staff, other than ICT (Interpersonal) o Attitudes of staff towards PWDs o Awareness of staff about needs of PWDs R/O o NA o NA o Data is not available Inclusive content (strutural) o Inclusive, non-discriminating contents o Proportion of anti-stigmatising content o Awareness-raising campaigns, projects, articles about inclusion and disability P o Newspaper coverage of mental illness in England 2008-2011 (Thornicroft et al., 2013) o Toward a more balanced representation of disability a content analysis (Goethals, 2018) o Representations of disability in the Canadian news media: a decade of change (Devotta et al., 2013) o The Place of News Media Analysis within Canadian Disability Studies (Haller, 2012) o Content Analysis o Data is not available Reported discrimination towards PWD o Number of reported complaints on the basis of discrimination toward PWDs R/I o NA o Admin data o Questionnaire o Canadian Radio-television and Telecommunications Commission (CRTC, 2020) f) Procurement of Goods, Services and Facilities (ACA) Indicators Definition Type Existing Surveys Methodology CAN Data Availability Attitudes of staff (Interpersonal) o Attitudes of staff towards PWDs o Awareness of staff about needs of PWDs o Available services of assistance for PWDs (Rebernik et al., 2020) R/O o Disability Inclusion Evaluation Tool (DIETool) used in two European Cities (Rebernik et al., 2020) Questionnaire Developed by Authors o Data is not available g) Design and Delivery of Programs and Services (ACA) Indicators Definition Type Existing Surveys Methodology CAN Data Availability Attitudes of staff (Interpersonal) o Attitudes of staff towards PWDs o Awareness of staff about needs of PWDS o Available services of assistance for PWDs (Rebernik et al., 2020) R/O o Disability Inclusion Evaluation Tool (DIETool) used in two European Cities (Rebernik et al., 2020) Questionnaire Developed by Authors o Data is not available Presence and incorporation of PWDs (strutural) o Participation of PWDs in * strategic planning and design * legislation design * enforcement of disability legislation o Presence and incorporation of disability inclusion principles in overall legislation (Rebernik et al., 2020) P o Disability Inclusion Evaluation Tool (DIETool) used in two European Cities (Rebernik et al., 2020) Questionnaire Developed by Authors o Data is not available h) Healthcare Sector Indicators Definition Type Existing Surveys Methodology CAN Data Availability Attitudes of healthcare professionals towards PWDs (Interpersonal) o Healthcare professionalsÕ attitudes toward PWD o Healthcare professionalsÕ awareness about needs of PWDs R/O o Stigma and Discrimination Related to Mental Health and Substance Use Issues In Primary Health Care In Toronto, Canada (Murney et al., 2020) o Reducing Mental Illness Stigma In Healthcare Settings (Kohrt et al., 2020) o Targeting Stigma of Mental Illness Among Primary Care Providers (Mittal Et A., 2020) o Physiotherapists' Attitudes Towards Working with People Living with Dementia (Hunter et al., 2020) o Changing Healthcare Professionals' Attitudes Towards Voice Hearers (Reddyhough et al., 2021) o Interviews o Focus groups o Interviews o Attribution Questionnaire (AQ-9) o Social Distance Scale (SDS) o Questionnaire Developed by Authors o The Knowledge in Dementia Scale o Social Distance Scale (SDS) o Attribution Questionnaire (AQ-20) o level of Contact Report (LCR) o Public Health Agency of Canada (2019a; 2019b) o Stigma and Discrimination related to mental health and substance use issues in primary health care in Toronto, Canada (Murney et al., 2020) Reported discrimination towards PWD o Number of discrimination among PWDs in healthcare setting R/I o NA o Admin data o Questionnaire o Public Health Agency of Canada (2019a; 2019b) o Federal, provincial, territorial human right commission i) Educational Sector Indicators Definition Type Existing Surveys Methodology CAN Data Availability Attitudes of students towards student with disabilities (Interpersonal) o Student's attitude towards school and university students with disabilities o Student's attitude towards help-seeking o Student's knowledge of mental health (Waqas et al., 2020) R/O o Nursing Students' Attitudes Toward Seeking Professional Psychological Help Before and After Attending a Mental Health Course (Abuhammad et al., 2020) o A Comparative Analysis of two Alternative Programs to Counter Stigma and Discrimination Associated with Mental Illness Delivered to Medical Students (Gordon et al., 2021) o Controlled Study of the Impact of a Virtual Program to Reduce Stigma Among University Students Toward People with Mental Disorders (Rodr’guez-Rivas et al., 2021) o The Potential Impact of An Anti-Stigma Intervention on Mental Health Help-Seeking Attitudes Among University Students (Shahwan et al., 2020) o Attitudes Toward Seeking Professional Psychological Help (ATSPPH) scale o Recovery Attitudes Questionnaire (RAQ) o Opening Minds Stigma Scale for Health Care Providers (OMS-HC-20) o Questionnaire on Student Attitudes Toward Schizophrenia (QSAS) o Attribution Questionnaire (AQ) o Inventory of Attitudes toward Seeking Mental o Health Services (IASMHS) scale o Data is not available Attitudes of teachers towards student with disabilities (Interpersonal) o Teachers attitude towards student with disabilities among the school and university students with disabilities o Teachers' awareness about needs of school and university students with disabilities R/O o Field testing an Australian model of practice for teaching young school-age students on the autism spectrum (Beamish et al., 2021) o Attitudes toward disability: Teacher education for inclusive environments in an Australian university (Tait et al., 2000) o Advancing research to eliminate mental illness stigma: An interventional study to improve community attitudes towards depression among university students in Singapore (Goh et al., 2021) o A Review of School-Based Interventions to Reduce Stigma towards Schizophrenia (Flanigan et al., 2020) o Interviews o Disabled Persons Scale (IDP) o Community Attitudes towards Mental Illness (CAMI) scale o Questionnaire on Student Attitudes Toward Schizophrenia (QSAS) o Public Stigma Scale o Social Distance Scale (SDS) o Knowledge Test Ð32-items on factual knowledge of schizophrenia o Alberta Pilot Site Questionnaire Toolkit o Data is not available j) First Responders (police officer, firefighter, paramedic, etc.) Indicators Definition Type Existing Surveys Methodology CAN Data Availability Attitudes of first responders toward PWDs (Interpersonal) o First respondersÕ attitudes toward PWDs o First respondersÕ awareness about needs of PWDs R/O o Police Officers' Attitudes Toward and Decisions about Persons with Mental Illness (Watson et al., 2004) o It's all window dressing: Canadian police officers' perceptions of mental health stigma in their workplace (Bikos et al., 2020) o Stigma, Pluralistic Ignorance, and Attitudes Toward Seeking Mental Health Services Among Police Officers (Karaffa et al., 2016) o Recognition of, and attitudes towards, people with depression and psychosis with/without alcohol and other drug problems: results from a national survey of Australian paramedics (McCann et al., 2018) o Attribution Questionnaire (AQ) o Interviews o Questionnaire Developed by Authors o Questionnaire Developed by Authors o Public perceptions of the police in CanadaÕs provinces (Ibrahim D, 2019) o It's all window dressing: Canadian police officers' perceptions of mental health stigma in their workplace (Bikos et al., 2020) k) Community Life Indicators Definition Type Existing Surveys Methodology CAN Data Availability Attitudes of community on PWDs autonomy (Interpersonal) Community awareness (Interpersonal) Community engagement (Interpersonal) PWDs Belonging, and participation (Interpersonal) o PWDs autonomy over their lives (Thomson et al., 2010) o PWDs choice of housemates (Bollier et al., 2021) o PWDs right to raise children (Bollier et al., 2021) o Public awareness about PWDs needs, issues, and experiences in community (Thomson et al., 2010) o Relationships between communities and PWDs (Thomson et al., 2010) o Acceptance levels in neighborhoods (Rebernik et al., 2020) o Getting involved in society (Bollier et al., 2021) o Participation and belonging of PWDs in community (Thomson et al., 2010) R/O o Public attitudes towards people with mental illness in England and Scotland (Mehta et al., 2009) o National survey of community attitudes toward PWDs in Australia (Bollier et al., 2021) o Public perceptions of disabled people. Evidence from the British Social Attitudes Survey (BSAS) (Office for Disabilities Issues, 2009) o Stigma doesnÕt discriminate: physical and mental health and stigma in Canadian military personnel and Canadian civilians (Frank et al., 2018) o Attitudes toward people with intellectual disabilities: An Australian perspective (Yazbeck et al. 2004) o Public attitudes to disability in the Republic of Ireland (National Disability Authority, 2002) o Causal beliefs and attitudes to people with schizophrenia: trend analysis based on data surveys in Germany (Angermeyer et al. 2005) o Attitudes toward individuals with disabilities: Results of a recent survey and implications of those results (Goreczny et al., 2011) o Stigmatizing attitudes towards people with mental disorders: findings from an Australian National Survey of Mental Health Literacy and Stigma (Reavley et al., 2012) o Community Attitudes Toward the Mentally Ill Scale (CAMI) o Attitudes to Disability Scale (ADS) o Attitudes to Disability Scale (ADS) o Questionnaire Developed by Authors o Social Distance Scale (SDS) o Questionnaire Developed by Authors o Interviews o Questionnaire Developed by Authors o Interviews o Victimization- Cycle 23 (GSS, 2009) o Mental Health and Well-being (CCHS-MH Civilian) and its corresponding Canadian Forces Supplement (CCHS-MH) (Frank et al., 2018) o Public Health Agency of Canada (2019a; 2019b) o Mental health commission of Canada (MHCC, 2015) Community safety and support (Interpersonal) o Physical and psychological safety and wellness among PWDs * Safe public spaces and public transportation * SOS system for PWD * Safe houses for women and children with disabilities o Domestic and non-domestic violence towards PWDs5 (Thomson et al., 2010; UK Government, 2021) R/O o Violent victimization of women with disabilities (GSS, 2014) (Cotter, 2018) o Personal Safety Survey (PSS) in Australia (ABS, 2016) o Violence against People with Disability in England and Wales: Findings from a National Cross-Sectional Survey, British Crime Survey (Khalifeh et al., 2013) o US National Survey on Abuse of PWDs (Baladerian et al., 2013) o Questionnaire Developed by Authors o Questionnaire Developed by Authors o Questionnaire Developed by Authors o Questionnaire Developed by Authors o Violent victimization of women with disabilities (GSS, 2014) (Cotter, 2018) o Criminal victimization in Canada (Perreault et al. 2015) o Trends in self?reported spousal violence in Canada (Burczycka et al., 2016) o Family violence in Canada: A statistical profile (Burczycka et al., 2018) o Self?reported sexual assault in Canada (Conroy et al., 2017) Discrimination towards PWD o Number of discrimination among PWDs o Inappropriate behavior toward PWDs (Bollier et al., 2021)6 o Comfort with expressing prejudice towards PWDs (Office for Disabilities Issues, 2009) R/I o British Social Attitudes Survey (BSAS) (Office for Disabilities Issues, 2009) o Canadian Community Health Survey, Rapid response module (CCHS, 2013) o A national survey on violence and discrimination among PWD, Danish national survey (Dammeyer et al., 2018) o UK Disability Survey (UK Government, 2021) o Discrimination and avoidance due to disability in Australia: evidence from a National Cross-Sectional Survey (Temple et al., 2018) o Questionnaire Developed by Authors o Everyday Discrimination Scale o Questionnaire Developed by Authors o Questionnaire Developed by Authors o Survey of Disability, Ageing and Carers in Australia o Canadian Community Health Survey, rapid response module- everyday discrimination scale (CCHS, 2013) o Federal, provincial, territorial human right commission Note. P: process indicator, R/O: result outcome/output indicator, R/I: result impact indicator. ACA: Accessible Canada Act. Stigma level: structural- discriminatory social structure, policies and legislation, poor and inadequate quality of mental health services. Intrapersonal- ignorance/ misinformation (problem in knowledge), prejudice (problem in attitude), discriminatory behavior. Intrapersonal- self-stigma, internalization of stigma. Analyse des lacunes des donnŽes Le tableau 11 fournit une liste d'ŽlŽments de donnŽes pour mesurer le changement de culture pour lesquels nous avons eu du mal ˆ identifier une source. On pourrait envisager d'inclure ces ŽlŽments de donnŽes dans les futurs efforts de collecte de donnŽes des autoritŽs fŽdŽrales et provinciales. Bien que nous sachions que, pour certains indicateurs, il n'y a pas toujours de donnŽes de bonne qualitŽ disponibles, nous avons parfois ŽtŽ surpris par l'absence de certaines donnŽes d'indicateurs clŽs, par exemple, une enqute sur l'attitude du public envers les personnes handicapŽes. Tableau 11. Analyse des lacunes des donnŽes canadiennes Priority Areas Available Database (Surveys) Data Gaps Employment o Pilot Public Opinion Research Survey on Accessibility (Government of Canada, 2019) o Labour Force Discrimination (LFD) (CSD, 2017) o Federal, provincial, territorial human right commission o EmployersÕ attitudes towards work performance of PWDs o EmployersÕ attitudes towards social acceptability of PWDs o EmployersÕ attitudes about cost of workplace accommodations Built Environment o Data is not available o Presence of disability perspective in inclusive urban planning and strategies planning o Presence of trained and inclusion respecting architects and designers in built environment projects Transportation o Accessible Transportation Complaints (CTA, 2020) o Attitudes of transport staff towards passengers with disabilities o Awareness of transport staff about needs of passengers with disability o Proportion of passengers with disabilities afraid: - being stigmatized - that services do not meet their needs - discriminatory behavior o Attitudes of other passengers Information and Communication Technologies (ICT) o Discrimination record in Federal, provincial, territorial human right commission o Attitudes of staff towards PWDs o Awareness of staff about needs of PWD o Inclusive, non-discriminating contents o Proportion of anti-stigmatising content o Awareness-raising campaigns, projects about inclusion and disability Communication, other than ICT o Discrimination record on Canadian Radio-television and Telecommunications Commission (CRTC, 2020) o Discrimination records in Federal, provincial, territorial human right commission o Attitudes of staff towards PWDs o Awareness of staff about needs of PWDs o Inclusive, non-discriminating contents o Proportion of anti-stigmatising content o Awareness-raising campaigns, projects, articles about inclusion and disability Procurement of Goods, Services and Facilities o Data is not available o Attitudes of staff towards PWDs o Awareness of staff about needs of PWDs o Available services of assistance for PWDs Design and Delivery of Programs and Services o Data is not available o Attitudes of staff towards PWDs o Awareness of staff about needs of PWDs o Available services of assistance for PWDs o Participation of PWDs in * strategic planning and design * legislation design * enforcement of disability legislation o Presence and incorporation of disability inclusion principles in overall legislation Health Services o Public Health Agency of Canada (2019a; 2019b) o Federal, provincial, territorial human right commission o No particular data gaps identified Educational Sector o Data is not available o Student's attitude towards school and university students with disabilities o Student's attitude towards help-seeking o Student's knowledge of mental health o Teachers attitude towards student with disabilities among the school and university students with disabilities o Teachers' awareness about needs of school and university students with disabilities First Responders o Public perceptions of the police in CanadaÕs provinces (Ibrahim D, 2019) o It's all window dressing: Canadian police officers' perceptions of mental health stigma in their workplace (Bikos et al., 2020) o First respondersÕ attitudes toward PWDs o First respondersÕ awareness about needs of PWDs Community Life o Victimization- Cycle 23 (GSS, 2009) o Mental Health and Well-being (CCHS-MH Civilian) and its corresponding Canadian Forces Supplement (CCHS-MH) (Frank et al., 2018) o Public Health Agency of Canada (2019a; 2019b) o Mental health commission of Canada (MHCC, 2015) o Violent victimization of women with disabilities (GSS, 2014) (Cotter, 2018) o Criminal victimization in Canada (Perreault et al. 2015) o Trends in selfreported spousal violence in Canada (Burczycka et al., 2016) o Family violence in Canada: A statistical profile (Burczycka et al., 2018) o Selfreported sexual assault in Canada (Conroy et al., 2017) o Everyday discrimination scale, rapid response module (CCHS, 2013) o Federal, provincial, territorial human right commission o Public attitudes towards PWDs o Public awareness about PWDs needs, issues, and experiences in community o Relationships between communities and PWDs o Acceptance levels in neighborhoods o Participation and belonging of PWDs in community o PWDs autonomy over their lives CONCLUSIONS ET RECOMMANDATIONS Les cadres et les indicateurs pour le changement de culture en matire d'accessibilitŽ et d'inclusion des personnes handicapŽes peuvent tre extrmement utiles pour les gouvernements, les organisations communautaires, les prestataires de services, les entreprises, les universitaires et les autres parties prenantes, car ils peuvent tre utilisŽs pour suivre et Žvaluer l'impact des efforts, tels que la lŽgislation, les politiques, les programmes et les pratiques visant ˆ amŽliorer l'accessibilitŽ et l'inclusion dans divers domaines de la sociŽtŽ, ainsi que pour aider ˆ identifier les prioritŽs et les possibilitŽs d'action. En nous appuyant sur des sources nationales et internationales, nous avons identifiŽ des cadres et des indicateurs qui peuvent tre utilisŽs pour dŽvelopper, suivre et Žvaluer les initiatives de changement de culture visant ˆ faire progresser l'accessibilitŽ et l'inclusion des personnes handicapŽes dans un contexte diffŽrent. Les initiatives identifiŽes peuvent Žgalement servir ˆ informer le dŽveloppement d'initiatives dans le contexte canadien au niveau local, rŽgional et national afin de promouvoir le changement de culture en relation avec l'accessibilitŽ et l'inclusion dans diffŽrents domaines et populations. Nous avons Žgalement identifiŽ des lacunes dans les donnŽes qui pourraient tre comblŽes dans le cadre de futurs efforts de collecte de donnŽes par les parties prenantes afin de faire progresser le suivi et l'Žvaluation des initiatives. Voici quelques recommandations pour les recherches futures : Concevoir et mettre en Ïuvre une enqute au niveau national pour estimer les attitudes envers les personnes handicapŽes. Il est possible de remŽdier au manque de donnŽes de base et de suivi en concevant et en mettant en Ïuvre une enqute de population ˆ grande Žchelle, reprŽsentative et pŽriodique, similaire ˆ celle menŽe dans d'autres pays, comme l'enqute britannique sur les attitudes sociales (BSAS) au Royaume-Uni, l'enqute sur les attitudes de la communautŽ envers les personnes handicapŽes en Australie et l'enqute sur les attitudes envers les personnes handicapŽes en RŽpublique d'Irlande. Il est important qu'une telle enqute soit conue et mise en Ïuvre de manire ˆ bien comprendre l'attitude ˆ l'Žgard des personnes handicapŽes dans diffŽrents systmes, tels que l'emploi, l'environnement b‰ti, les transports, les technologies de l'information et de la communication, les communications autres que les technologies de l'information et de la communication, l'acquisition de biens, de services et d'installations, la conception et la mise en Ïuvre de programmes et de services, l'Žducation, les services de santŽ, les services de premiers secours et la vie communautaire. L'enqute sur les attitudes du public envers les personnes handicapŽes peut tre dŽveloppŽe dans le cadre d'une des enqutes existantes. Par exemple, les Žtudes de recherche sur l'opinion publique (ROP) pourraient dŽvelopper un module axŽ sur le changement de culture concernant les personnes handicapŽes. ƒlaborer un cadre de rŽsultats au niveau national pour le suivi et l'Žvaluation de l'accessibilitŽ et de l'inclusion Un cadre de rŽsultats complet en matire d'accessibilitŽ et d'inclusion doit contenir des indicateurs objectifs et subjectifs. Alors que les indicateurs objectifs, tels que l'emploi, l'accs au marchŽ du travail, les revenus, etc., fournissent des informations prŽcieuses sur le statut socio-Žconomique actuel des personnes handicapŽes, les indicateurs subjectifs, qui sont basŽs sur les sentiments des individus et leurs normes de vie attendues, pourraient expliquer les moteurs sous-jacents de ces comportements ˆ des degrŽs divers. Les chercheurs dans le domaine des indicateurs sociaux soulignent de plus en plus l'intŽrt d'obtenir des indicateurs ˆ la fois subjectifs et objectifs (Macku et al., 2020). Il est intŽressant de constater que de nombreux cadres de rŽsultats dans le domaine des initiatives de changement de culture bŽnŽficient de cette intŽgration. Par exemple, dans un cadre de rŽsultats rŽcemment ŽlaborŽ pour la stratŽgie australienne en matire de handicap, des indicateurs subjectifs et objectifs ont ŽtŽ intŽgrŽs. Cela peut Žgalement tre observŽ dans les initiatives de changement de culture dans d'autres domaines tels que les programmes de lutte contre la violence ˆ l'Žgard des femmes et des filles, et les programmes de prŽvention du VIH pour les populations les plus ˆ risque. La longue liste d'indicateurs subjectifs identifiŽs pour les diffŽrentes prioritŽs de la Loi canadienne sur lÕaccessibilitŽ (LCA) et au-delˆ, peut tre utilisŽe en complŽment des indicateurs objectifs pour suivre et Žvaluer les initiatives de changement de culture en matire d'accessibilitŽ et d'inclusion des personnes handicapŽes au Canada. Recueillir et intŽgrer les dossiers de discrimination Les plaintes pour discrimination, considŽrŽes comme des indicateurs tardifs de la culture en matire d'accessibilitŽ et d'inclusion, sont limitŽes dans les systmes actuels de collecte de donnŽes. Notre Žtude a rŽvŽlŽ que de telles donnŽes peuvent tre trouvŽes ˆ diffŽrents endroits, tels que les commissions des droits de la personne fŽdŽrales, provinciales et territoriales, et les donnŽes administratives sur les plaintes relatives au transport accessible, ainsi que dans diffŽrentes enqutes, notamment la Discrimination parmi les personnes atteintes de troubles mentaux de l'Enqute sur la santŽ dans les collectivitŽs canadiennes (ESCC) en 2015, et l'Enqute sociale gŽnŽrale sur la victimisation en 2009. La collecte et l'intŽgration de donnŽes sur la discrimination peuvent constituer une ressource inestimable pour le suivi et l'Žvaluation du changement de culture en matire d'accessibilitŽ et d'inclusion des personnes handicapŽes. REFERENCES ABS (Australian Bureau of Statistics) (2016). Personal Safety, Australia Statistics for family, domestic, sexual violence, physical assault, partner emotional abuse, child abuse, sexual harassment, stalking and safety. Link: https://www.abs.gov.au/statistics/people/crime-and-justice/personal-safety-australia/latest-release#data-download Abuhammad S, Hamaideh S. Nursing Students' Attitudes Toward Seeking Professional Psychological Help Before and After Attending a Mental Health Course. Nursing Education Perspectives. 2021 Mar 5. Adams RJ, Smart P, Huff AS. Shades of grey: guidelines for working with the grey literature in systematic reviews for management and organizational studies. International Journal of Management Reviews. 2017 Oct;19(4):432-54. Akrami N, Ekehammar B, Claesson M, Sonnander K. Classical and modern prejudice: Attitudes toward people with intellectual disabilities. Research in developmental disabilities. 2006 Nov 1;27(6):605-17. Algahtani H, Shirah B, Alhazmi A, Alshareef A, Bajunaid M, Samman A. Perception and attitude of the general population towards AlzheimerÕs disease in Jeddah, Saudi Arabia. Acta neurologica Belgica. 2020 Apr;120(2):313-20. Alison (2003). Active Minds. Link: https://www.activeminds.org/about-us/our-story/ Angermeyer MC, Matschinger H. Causal beliefs and attitudes to people with schizophrenia: trend analysis based on data from two population surveys in Germany. The British Journal of Psychiatry. 2005 Apr;186(4):331-4. Antonak, R. F. (1994). Development and psychometric analysis of an indirect measure of attitudes toward persons with mental retardation using the error-choice method. Mental Retardation, 32, 347Ð355. Arksey H, OÕMalley L. Scoping studies: Towards a Methodological Framework. Int J Soc Res Methodol. 2005;8(1):19-32. Australia Department of Social Services (2021). AustraliaÕs Disability Strategy 2021-2031. Outcomes Framework. Link: https://apo.org.au/sites/default/files/resource-files/2021-12/apo-nid315397_2.pdf Australian Government (2011). Employer perspectives on recruiting persons with disabilities and the role of Disability Employment. Link: https://disabilityemployment.org.au/static/items/EmployerServicing2011.pdf Australian Rotary (2000). Health. Evaluation of the national Mental Health Awareness Campaign Baladerian, N, Coleman T, Steam, J, Abuse of People with Disabilities, Victims and their Families Speak out, A Report on the 2012 National Survey on Abuse of People with Disabilities, Spectrum Institute, Los Angeles, CA, 2013. Link: https://ncvc.dspacedirect.org/handle/20.500.11990/998 BC Association of Broadcasters. Award-winning campaigns was presented by the Canadian Mental Health AssociationÕs BC Division. Link: https://deareverybody.hollandbloorview.ca/ Beamish W, Taylor A, Macdonald L, Hay S, Tucker M, Paynter J. Field testing an Australian model of practice for teaching young school-age students on the autism spectrum. Research in Developmental Disabilities. 2021 Jun 1;113:103942. Bell Canada's (2015). Let's Talk. Link: http://www.letstalk.bell.ca Bell S. Suspicious minds: A mixed methods study of police officer and police staff attitudes to mental ill health in England and Wales. Liverpool John Moores University (United Kingdom); 2020. Beyondblue (2000). beyondblue: the national depression initiative. Link: https://www.beyondblue.org.au/ Bezyak JL, Sabella SA, Gattis RH. Public transportation: an investigation of barriers for people with disabilities. Journal of Disability Policy Studies. 2017 Jun;28(1):52-60. Bikos LJ. It's all window dressing: Canadian police officers' perceptions of mental health stigma in their workplace. Policing: An International Journal. 2020 Dec 4. Link: https://www.cipsrt-icrtsp.ca/en/publication/its-all-window-dressing-canadian-police-officers-perceptions-of-mental-health-stigma-in-their-workplace Bollier AM, Sutherland G, Krnjacki L, Kasidis V, Katsikis G, Ozge J & Kavanagh AM. (2021). Attitudes Matter: Findings from a national survey of community attitudes toward people with disability in Australia. Centre of Research Excellence in Disability and Health, The University of Melbourne. Link: https://credh.org.au/projects/community-attitudes-towards-people-with-disability Borsatto J, Buchanan L, Pineault L. Aphasia friendly Canada: The aphasia friendly business campaign. Aphasiology. 2021 Jan 7:1-20. Bott S, Guezmes A, Claramunt MC. Improving the health sector response to gender-based violence: a resource manual for health care professionals in developing countries. International Planned Parenthood Federation (IPPF); 2004. Link: http://www.dmeforpeace.org/peacexchange/wp-content/uploads/2016/11/Pages-from-GBV_cdbookletANDmanual_FA_FINAL.pdf Buckwitz V, Porter PA, Bommes JN, Schomerus G, Hinshaw SP. Continuum beliefs and the stigma of depression: An online investigation. Stigma and Health. 2021 Feb;6(1):113. Bunch G, Valeo A. Student attitudes toward peers with disabilities in inclusive and special education schools. Disability & Society. 2004 Jan 1;19(1):61-76. Burczycka, M. 2016. Trends in self?reported spousal violence in Canada, 2014. Family violence in Canada: A statistical profile, 2014. Juristat. Statistics Canada Catalogue no. 85?002?X. Link: https://www150.statcan.gc.ca/n1/pub/85-002-x/2016001/article/14303/01-eng.htm Burczycka, M. 2018. Stalking in Canada, 2014. Family violence in Canada: A statistical profile, 2017. Juristat. Statistics Canada Catalogue no. 85?002?X. Link: https://www150.statcan.gc.ca/n1/pub/85-002-x/2018001/article/54978-eng.htm Burns S, Crawford G, Hallett J, Hunt K, Chih HJ, Tilley PJ. WhatÕs wrong with John? a randomised controlled trial of Mental Health First Aid (MHFA) training with nursing students. BMC Psychiatry. 2017;17(1):111. Canadian Psychiatric Research Foundation (CPRF). ÒImagine...Ó campaign (2004). Link: https://www.heretohelp.bc.ca/visions-stigma-and-discrimination-vol2/canadian-anti-stigma-campaigns Casals MC. (2009) Proposal of new indicators to measure the effects of gender violence. Link: http://www.surt.org/docs/publicats/2009/gvei_proposta_indicadors_en.pdf CCDS (Canadian Centre for Disability Studies) (2001). Building Bridges Between the Corporate Sector and the Disability Community: 2000Ð2001. Manitoba: Canadian Centre on Disability Studies. CCHS (Canadian Community Health Survey) (2013). Annual Component. Questionnaire: Everyday Discrimination Scale / Component: Rapid Response Ð EDS. Link: https://www23.statcan.gc.ca/imdb/p3Instr.pl?Function=getInstrumentList&Item_Id=149959&UL=1V Centre for Addiction and Mental Health (CAMH) (2020). Addressing Stigma. Mental Health 101: Understanding Stigma. Link: https://www.camh.ca/en/driving-change/addressing-stigma Chadd EH, Pangilinan PH. Disability attitudes in health care: a new scale instrument. American journal of physical medicine & rehabilitation. 2011 Jan 1;90(1):47-54. CHRC (Canadian Human Rights Commission) (2015). Persons with disabilities continue to be marginalized in Canadian society: CHRC. Link: https://www.canada.ca/en/human-rights-commission/news/2015/12/persons-with-disabilities-continue-to-be-marginalized-in-canadian-society-chrc.html Close G et al (2010). Bring Change to Mind (BC2M). LetÕs talk about mental health. Link http://bringchange2mind.org Conroy, S. and Cotter, A. 2017. Self?reported sexual assault in Canada, 2014. Juristat. Statistics Canada Catalogue no. 85?002?X. Link: https://www150.statcan.gc.ca/n1/pub/85-002-x/2017001/article/14842-eng.htm Cotter A. (2018). Violent victimization of women with disabilities, 2014. General Social Survey (GSS). Link: https://www150.statcan.gc.ca/n1/pub/85-002-x/2018001/article/54910-eng.htm Cross HA, Heijnders M, Dalal A, Sermrittirong S, Mak S. Interventions for stigma reductionÐpart 2: practical applications. Disability, CBR & Inclusive Development. 2011;22(3):71-80. CRTC (Canadian Radio-television and Telecommunications Commission) (2020). How to make a broadcasting complaint. Link: https://crtc.gc.ca/eng/info_sht/g8.htm#filing CSD (Canadian Survey on Disability) (2017). Canadian Survey on Disability-Definitions, data sources and methods Questionnaires. Link: https://www23.statcan.gc.ca/imdb/p3Instr.pl?Function=assembleInstr&lang=en&Item_Id=348023#qb353525 CSNM (2020). 2. Project Monitoring & Evaluation. Module 5. M&E in Project Cycle Management. Link: https://csnm.kku.ac.th/learning/course/module/lesson/116-me-project-cycle-management CTA (Canadian Transportation Agency) (2020). Accessibility complaints about transportation services. Link: https://otc-cta.gc.ca/eng/accessibility-complaints-about-transportation-services Dammeyer J, Chapman M. A national survey on violence and discrimination among people with disabilities. BMC public health. 2018 Dec;18(1):1-9. de la Higuera-Romero J, Candelas-Mu–oz A, JimŽnez-Gonz‡lez A, Casta–eda-JimŽnez C, Fuica-Pereg P, Zurita-Carrasco M, Mart’nez-Fernandez-Repeto E, Sen’n-Calder—n C. Spanish adaptation and validation of the Peer Mental Health Stigmatization Scale (PMHSS-24). Revista de Psiquiatria y Salud Mental. 2020 Jul 21. DEEWR (Australian Government Department of Education, Employment and Workplace Relations) (2008). Employer Attitudes to Employing People with Mental Illness. Canberra: Commonwealth of Australia. https://docs.employment.gov.au/system/files/doc/other/employer_attitudes_to_employing_people_with_mental_illness.pdf Delevic et al., (2011). Guide To the Logical Framework Approach. A key tool for project cycle management. Second edition. European Integration Office. Link: http://www.evropa.gov.rs/Evropa/ShowDocument.aspx?Type=Home&Id=525#:~:text=The%20Logical%20Framework%20Approach%20(LFA,a%20project%20or%20programme%20idea Department of National Defense in Canada (2016). Road to Mental Readiness (R2MR). Link: https://theworkingmind.ca/sites/default/files/workplace_antistigma_programs-part1.pdf Devotta K, Wilton R, Yiannakoulias N. Representations of disability in the Canadian news media: A decade of change?. Disability and Rehabilitation. 2013 Oct 1;35(22):1859-68. Disability Awareness Starts Here (DASH). DASH Project Ð voice for all people with disabilities Link: https://www.dashproject.org Dobson K, Stuart H. The Stigma of Mental Illness: Models and Methods of Stigma Reduction. Oxford University Press; 2021 Dec 7. Domzal C, Houtenville A, Sharma R. Survey of employer perspectives on the employment of people with disabilities: Technical report. Office of Disability Employment Policy, Department of Labor; 2008. Link: https://www.dol.gov/sites/dolgov/files/odep/research/surveyemployerperspectivesemploymentpeopledisabilities.pdf DPTAC (Disabled Persons Transport Advisory Committee) (2002). Attitudes of disabled people to public transport. Link: https://trimis.ec.europa.eu/sites/default/files/project/documents/20060811_110503_45123_UG395_Final_Report.pdf Driscoll D, Mathew L, Engelhardt D, Moran?Peters J, Eckardt S. Evaluating mental illnessÐsubstance abuse stigmatic perceptions through education: A libraryÐnursing initiative. Public Health Nursing. 2021 Jun 10. Dupuis S, McAiney CA, Fortune D, Ploeg J, Witt LD. Theoretical foundations guiding culture change: The work of the Partnerships in Dementia Care Alliance. Dementia. 2016 Jan;15(1):85-105. Link: https://pubmed.ncbi.nlm.nih.gov/24419355/ Eldridge-Smith ED, Loew M, Stepleman LM. The adaptation and validation of a stigma measure for individuals with multiple sclerosis. Disability and rehabilitation. 2021 Jan 16;43(2):262-9. Engel CS, Sheppard E. Can cartoons which depict autistic characters improve attitudes towards autistic peers?. Journal of autism and developmental disorders. 2020 Mar;50(3):1007-17. Epps F, Foster K, Alexander K, Brewster G, Chester M, Thornton J, Aycock D. Perceptions and Attitudes Toward Dementia in Predominantly African American Congregants. Journal of Applied Gerontology. 2021 Jan 24:0733464820987350. European WomenÕs Lobby (2002). towards a common European framework to monitor progress in combating violence against women. Link: https://www.womenlobby.org/IMG/pdf/ewl_2002_towards_common_european_framework.pdf Evans-Lacko S, Henderson C, Thornicroft G. Public knowledge, attitudes and behaviour regarding people with mental illness in England 2009-2012. The British Journal of Psychiatry. 2013 Apr;202(s55):s51-7. Farina N, Hughes LJ, Jones E, Parveen S, Griffiths AW, Galvin K, Banerjee S. Evaluation of a dementia awareness programme in UK schools: A qualitative study. Public health. 2020 Aug 1;185:348-55. Field MJ, Jette AM, editors. The Future of Disability in America. Institute of Medicine (US) Committee on Disability in America; Washington (DC): National Academies Press (US); 2007. G, Transportation Patterns and Problems of People with Disabilities. Link: https://www.ncbi.nlm.nih.gov/sites/books/NBK11420/ Findler L, Vilchinsky N, Werner S. The multidimensional attitudes scale toward persons with disabilities (MAS) construction and validation. Rehabilitation Counseling Bulletin. 2007 Apr;50(3):166-76. Fisher KR, Purcal C. Policies to change attitudes to persons with disabilities. Scandinavian Journal of Disability Research. 2017 Apr 3;19(2):161-74. Flanigan LK, Climie EA. A review of school-based interventions to reduce stigma towards schizophrenia. Psychiatric Quarterly. 2020 Dec;91:983-1002. Frank C, Zamorski MA, Colman I. Stigma doesnÕt discriminate: physical and mental health and stigma in Canadian military personnel and Canadian civilians. BMC psychology. 2018 Dec;6(1):1-1. Frankel N, Gage A. (2007). M&E fundamentals: A self-guided minicourse. United States Agency for International Development (USAID), Washington, DC. Link: https://www.measureevaluation.org/resources/publications/ms-07-20-en/at_download/document Fung K, Liu JJ, Sin R, Shakya Y, Guruge S, Bender A, Wong JP. Examining different strategies for stigma reduction and mental health promotion in Asian men in Toronto. Community Mental Health Journal. 2021 May;57(4):655-66. Gaebel W, Ršssler W, Sartorius N, editors. The stigma of mental illness-end of the story?. Cham: Springer International Publishing; 2017. Gaebel W, ZŠske H, Hesse K, Klingberg S, Ohmann C, Grebe J, Kolbe H, Icks A, Schneider F, Backes V, Wolff-Menzler C. Promoting stigma coping and empowerment in patients with schizophrenia and depression: results of a cluster-RCT. European archives of psychiatry and clinical neuroscience. 2020 Aug;270(5):501-11. Gage A, Dunn M. (2009). Monitoring and evaluating gender-based violence prevention and mitigation programs. US Agency for International Development, MEASURE Evaluation, Interagency Gender Working Group, Washington DC. Link: https://www.igwg.org/wp-content/uploads/2017/07/gbv-me-handouts.pdf Gallego J, Cangas AJ, Aguilar JM, Trigueros R, Navarro N, Galv‡n B, Smyshnov K, Gregg M. Education students' stigma toward mental health problems: a cross-cultural comparison. Frontiers in psychiatry. 2020 Nov 5;11:1138. Gandhi S, Jayaraman S, Sivakumar T, John AP, Joseph A, Prathyusha PV. Can employment in a cafŽ change Clientele Attitude towards the staff when they are Persons with Mental Illness?. International Journal of Social Psychiatry. 2021 Jan 28:0020764021990068. Gierdowski, Dana C., and D. Christopher Brooks. Diversity, Equity, and Inclusion in the IT Workforce, 2019. Research report. Louisville, CO: ECAR, August 2019. Link: https://library.educause.edu/-/media/files/library/2019/8/hedei19.pdf?la=en&hash=4EDD93EE29647C3AEBE603CB7759534567BD2925 Ginevra MC, Vezzali L, Camussi E, Capozza D, Nota L. Promoting positive attitudes toward peers with disabilities: The role of information and imagined contact. Journal of Educational Psychology. 2021 May 27. Goethals T, Mortelmans D, Van Hove G. Toward a more balanced representation of disability? A content analysis of disability coverage in the Flemish print media. Journal of Human Development, Disability, and Social Change. 2018;24(1):109-20. Goh CM, Shahwan S, Lau JH, Ong WJ, Tan GT, Samari E, Kwok KW, Subramaniam M, Chong SA. Advancing research to eliminate mental illness stigma: an interventional study to improve community attitudes towards depression among University students in Singapore. BMC psychiatry. 2021 Dec;21(1):1-2. Gordon SE, Kininmonth LA, Newton-Howes G, Purdie GL, Gardiner T. A comparative analysis of two alternative programmes to counter stigma and discrimination associated with mental illness delivered to medical students. Australasian Psychiatry. 2020 Nov 24:1039856220971935. Goreczny AJ, Bender EE, Caruso G, Feinstein CS. Attitudes toward individuals with disabilities: Results of a recent survey and implications of those results. Research in developmental disabilities. 2011 Sep 1;32(5):1596-609. Government of Canada (1988), Department of the Secretary of State. National Access Ability Week Ð May 30 to June 5, 2021. Link: https://www.canada.ca/en/employment-social-development/campaigns/national-accessability-week.html Government of Canada (2006). A way with Words and Images: Suggestions for the Portrayal of People with Disabilities. Human Resources and Skills Development Canada. www.hrsdc.gc.ca/eng/disability_issues/reports/way_with_words/2007/ Government of Canada (2019). Pilot Public Opinion Research Survey on Accessibility. Link: http://publications.gc.ca/collections/collection_2020/edsc-esdc/Em4-24-2019-1-eng.pdf GSS (General Social Survey) (2009). Cycle 23: Victimization, Public Use Microdata Files. Link: https://www23.statcan.gc.ca/imdb/p2SV.pl?Function=getSurvey&Id=49195 Hagemann?White C. Measuring progress in addressing violence against women across Europe. International Journal of Comparative and Applied Criminal Justice. 2008 Sep 1;32(2):149-72. Haller B, Rioux M, Dinca-Panaitescu M, Laing A, Vostermans J, Hearn P. The place of news media analysis within Canadian disability studies. Canadian Journal of Disability Studies. 2012;1(2):43-74. Hansen A, McGarry D, Johnson A, Roche MA. The impact of an undergraduate students' culture on their learning about mental health: A scoping review. Nursing & Health Sciences. 2021 Apr 1. Hapuarachchi RB, Herath JC, Ranasinghe PK. Self Stigma Among Caregivers Of People With Schizophrenia. Inaustralian And New Zealand Journal Of Psychiatry 2021 May 1 (Vol. 55, No. 1_ SUPPL, pp. 111-111). 1 OLIVERS YARD, 55 CITY ROAD, LONDON, ENGLAND: SAGE PUBLICATIONS LTD. Hearst MO, Adelli R, Hepperlen R, Biggs J, DeGracia D, Ngulube E, Maluskiku-Mwewa B, Johnson DE, Rabaey P. Community-based intervention to reduce stigma for children with disabilities in Lusaka, Zambia: A pilot. Disability and Rehabilitation. 2020 Oct 13:1-0. Heijnders M, Van Der Meij S. The fight against stigma: an overview of stigma-reduction strategies and interventions. Psychology, health & medicine. 2006 Aug 1;11(3):353-63. Henderson C, Potts L, Robinson EJ. Mental illness stigma after a decade of Time to Change England: inequalities as targets for further improvement. European journal of public health. 2020 Jun 1;30(3):497-503. Henderson C, Robinson E, Evans?Lacko S, Corker E, Rebollo?Mesa I, Rose D, Thornicroft G. Public knowledge, attitudes, social distance and reported contact regarding people with mental illness 2009Ð2015. Acta Psychiatrica Scandinavica. 2016 Aug;134:23-33. Hielscher E, Waghorn G. Self-stigma and fears of employment among adults with psychiatric disabilities. British journal of occupational therapy. 2017 Dec;80(12):699-706. Holland Bloorview Kids Rehabilitation Hospital. Campaign aims to reduce stigma, discrimination of kids, youth with disabilities. Link: https://www.independentliving.org/docs2/daakit32.html#anchor1298850 Huhn et al., (2019). What is Social Marketing? (With 7 Stellar Examples). Link: https://www.business2community.com/digital-marketing/what-is-social-marketing-with-7-stellar-examples-02236451 Hung L, Hudson A, Gregorio M, Jackson L, Mann J, Horne N, Berndt A, Wallsworth C, Wong L, Phinney A. Creating Dementia-Friendly Communities for Social Inclusion: A Scoping Review. Gerontology and Geriatric Medicine. 2021 May;7:23337214211013596. Hunter SW, Divine A. Understanding the factors influencing physiotherapistsÕ attitudes towards working with people living with dementia. Physiotherapy theory and practice. 2020 Jan 23:1-8. Ibrahim D. (2019). Public perceptions of the police in CanadaÕs provinces. Canadian Centre for Justice and Community Safety Statistics. Link: https://www150.statcan.gc.ca/n1/pub/85-002-x/2020001/article/00014-eng.htm IOM (International Organization for Migration). (2009). Handbook on Performance Indicators for Counter-Trafficking Projects. Link: https://documentation.lastradainternational.org/doc-center/2174/the-iom-handbook-on-performance-indicators-for-counter-trafficking-projects ITU (International Telecommunications Union) (2013). The ICT Opportunity for a Disability-Inclusive Development Framework. Link: https://www.itu.int/en/action/accessibility/Documents/The%20ICT%20Opportunity%20for%20a%20Disability_Inclusive%20Development%20Framework.pdf Janssens KM, van Weeghel J, Dewa C, Henderson C, Mathijssen JJ, Joosen MC, Brouwers EP. Line managersÕ hiring intentions regarding people with mental health problems: a cross-sectional study on workplace stigma. Occupational and Environmental Medicine. 2021 Feb 4. Javed A, Lee C, Zakaria H, Buenaventura RD, Cetkovich-Bakmas M, Duailibi K, Ng B, Ramy H, Saha G, Arifeen S, Elorza PM. Reducing the stigma of mental health disorders with a focus on low-and middle-income countries. Asian journal of psychiatry. 2021 Feb 13:102601. Jones SC, Akram M, Gordon CS, Murphy N, Sharkie F. Autism in Australia: Community Knowledge and Autistic PeopleÕs Experiences. Journal of autism and developmental disorders. 2021 Jan 3:1-3. Kalargyrou V, Pettinico W, Chen PJ. Attitudes toward people with physical disabilities: An examination of social context, discipline, disability type, and demographics. Journal of Vocational Rehabilitation. 2021(Preprint):1-7. Karaffa KM, Koch JM. Stigma, pluralistic ignorance, and attitudes toward seeking mental health services among police officers. Criminal Justice and Behavior. 2016 Jun;43(6):759-77. Khalifa G, Sharif Z, Sultan M, Di Rezze B. Workplace accommodations for adults with autism spectrum disorder: a scoping review. Disability and rehabilitation. 2020 Apr 23;42(9):1316-31. Khalifeh H, Howard LM, Osborn D, Moran P, Johnson S. Violence against people with disability in England and Wales: findings from a national cross-sectional survey. PloS one. 2013 Feb 20;8(2):e55952. Kim S, Richardson A, Werner P, Anstey KJ. Dementia stigma reduction (DESeRvE) through education and virtual contact in the general public: A multi-arm factorial randomised controlled trial. Dementia. 2021 Jan 31:1471301220987374. Koh E. The Cunningham Dax Collection: a unique mental health resource. Austr Psychiatry. 2014;22(1):41Ð3. Kohrt BA, Turner EL, Rai S, Bhardwaj A, Sikkema KJ, Adelekun A, Dhakal M, Luitel NP, Lund C, Patel V, Jordans MJ. Reducing mental illness stigma in healthcare settings: proof of concept for a social contact intervention to address what matters most for primary care providers. Social Science & Medicine. 2020 Apr 1;250:112852. KrahŽ B, Altwasser C. Changing negative attitudes towards persons with physical disabilities: An experimental intervention. Journal of Community & Applied Social Psychology. 2006 Jan;16(1):59-69. Kumar P, Patel VK, Kanabar BR, Vasavada DA, Bhatt RB, Tiwari DS. Changing Attitude and Stigma towards Mental Illness through Education among the Rural School Students. Journal of Indian Association for Child & Adolescent Mental Health. 2021 Apr 1;17(2). Levac D, Colquhoun H, O'Brien KK. Scoping studies: advancing the methodology. Implement Sci. 2010;5:69. Liang J, Jang Y, Aranda MP. Stigmatising beliefs about AlzheimerÕs disease: Findings from the Asian American Quality of Life Survey. Health & Social Care in the Community. 2020 Oct 22. Likeminds (2016). Like Mine programme. New Zealand. Link: https://www.likeminds.org.nz/ Link BG, Phelan JC. Conceptualizing stigma. Annual review of Sociology. 2001 Aug;27(1):363-85. Luelmo P, Kasari C, Fiesta Educativa, Inc. Randomized pilot study of a special education advocacy program for Latinx/minority parents of children with autism spectrum disorder. Autism. 2021 Apr 16:1362361321998561. Mac C‡rthaigh S, L—pez B. Factually based autism awareness campaigns may not always be effective in changing attitudes towards autism: Evidence from British and South Korean nursing students. Autism. 2020 Jul;24(5):1177-90. Macku K, Caha J, P‡szto V, Tu?ek P. Subjective or objective? How objective measures relate to subjective life satisfaction in Europe. ISPRS International Journal of Geo-Information. 2020 May;9(5):320. Magliano L, Affuso G, Prisco N, Arpino A, Romano L. Improving employeesÕ views about persons with mental disorders as potential workmates: A 2-year partially controlled study. American Journal of Orthopsychiatry. 2021;91(1):66. Maki Y, Takao M, Hattori H, Suzuki T. Promoting dementia?friendly communities to improve the well?being of individuals with and without dementia. Geriatrics & gerontology international. 2020 Jun;20(6):511-9. Marsh, David. 1999. Results Frameworks & Performance Monitoring: A Refresher (ppt). Link: http://www.childsurvival.com/tools/Marsh/sld001.htm Mascayano F, Toso-Salman J, Ho YC, Dev S, Tapia T, Thornicroft G, Cabassa LJ, Khenti A, Sapag J, Bobbili SJ, Alvarado R. Including culture in programs to reduce stigma toward people with mental disorders in low-and middle-income countries. Transcultural psychiatry. 2020 Feb;57(1):140-60. McCann TV, Savic M, Ferguson N, Cheetham A, Witt K, Emond K, Bosley E, Smith K, Roberts L, Lubman DI. Recognition of, and attitudes towards, people with depression and psychosis with/without alcohol and other drug problems: results from a national survey of Australian paramedics. BMJ open. 2018 Dec 1;8(12):e023860. McLeroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health education quarterly. 1988 Dec;15(4):351-77. Mehta N, Kassam A, Leese M, Butler G, Thornicroft G. Public attitudes towards people with mental illness in England and Scotland, 1994Ð2003. The British Journal of Psychiatry. 2009 Mar;194(3):278-84. Menon S, Karl J, Wignaraja K. Handbook on planning, monitoring and evaluating for development results. UNDP Evaluation Office, New York, NY. 2009;68(3):10. Link: http://web.undp.org/evaluation/handbook/documents/english/pme-handbook.pdf Mental Health Commission of Canada (MHCC) (2009). Opening Minds (OM). Link: https://www.mentalhealthcommission.ca/English/opening-minds Mental Health Commission of Canada (MHCC) (2015). Informing the Future: Mental Health Indicators for Canada. Link: https://www.mentalhealthcommission.ca/wp-content/uploads/drupal/Informing%252520the%252520Future%252520-252520Mental%252520Health%252520Indicators%252520for%252520Canada_0.pdf Mental Health Commission of Canada (MHCC). (2017). The Working Mind First Responders (TWMFR), formerly known as Road to Mental Readiness (R2MR). Link: https://theworkingmind.ca/working-mind-first-responders Mental Health Commission of Canada (MHCC). (2017). Working Mind (TWM). Link: https://theworkingmind.ca/working-mind Mittal D, Owen RR, Ounpraseuth S, Chekuri L, Drummond KL, Jennings MB, Smith JL, Sullivan JG, Corrigan PW. Targeting stigma of mental illness among primary care providers: Findings from a pilot feasibility study. Psychiatry research. 2020 Feb 1;284:112641. Morgan AJ, Wright J, Reavley NJ. Review of Australian initiatives to reduce stigma towards people with complex mental illness: what exists and what works?. International journal of mental health systems. 2021 Dec;15(1):1-51. Morin D, Crocker AG, Beaulieu?Bergeron R, Caron J. Validation of the attitudes toward intellectual disabilityÐATTID questionnaire. Journal of Intellectual Disability Research. 2013 Mar;57(3):268-78. Murney MA, Sapag JC, Bobbili SJ, Khenti A. Stigma and discrimination related to mental health and substance use issues in primary health care in Toronto, Canada: A Qualitative Study. International journal of qualitative studies on health and well-being. 2020 Jan 1;15(1):1744926. Myers F. Evaluation of'see Me'-the National Scottish Campaign Against the Stigma and Discrimination Associated with Mental Health. Social Research; 2009. Link: https://silo.tips/downloadFile/health-and-community-care-5 NAMI (2021). National Alliance of Mental Illness. Link: https://www.nami.org/About-NAMI National Academies of Sciences, Engineering, and Medicine (2016). Ending discrimination against people with mental and substance use disorders: The evidence for stigma change. National Academies Press; 2016 Sep 3. Link: https://www.ncbi.nlm.nih.gov/books/NBK384914/ National Disability Authority (NDA) (2002). Public attitudes to disability in the Republic of Ireland. Link: http://nda.ie/ndasitefiles/attitude.pdf Newton-Howes G, Senior J, Beaglehole B, Purdie GL, Gordon SE. Does a comprehensive service user-led education programme effect more positive attitudes towards recovery and less stigmatising attitudes towards people with lived experience of mental distress in medical students? A comparative cohort study. Australian & New Zealand Journal of Psychiatry. 2021 Jan 17:0004867420987886. Niewohner J, Pierson S, Meyers SJ. ÔLeave no one behindÕ? The exclusion of persons with disabilities by development NGOs. Disability & Society. 2020 Aug 8;35(7):1171-6. Nota L, Santilli S, Ginevra MC, Soresi S. Employer attitudes towards the work inclusion of persons with disabilities. Journal of Applied Research in Intellectual Disabilities. 2014 Nov;27(6):511-20. Nowicki, EA. (2005). Understanding childrenÕs perceptions of intellectual and physical disabilities: Attitudes, knowledge, and social cognition. Exceptionality Education Canada, 15(3), 21Ð39. Office for Disabilities Issues (2009). Public perceptions of disabled people. Evidence from the British Social Attitudes Survey (BSAS) in 2009. Link: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/325989/ppdp.pdf Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372:n71. doi: 10.1136/bmj.n71 Parker LR, Monteith MJ, South SC. Dehumanization, prejudice, and social policy beliefs concerning people with developmental disabilities. Group Processes & Intergroup Relations. 2020 Feb;23(2):262-84. PATH (2011). Monitoring and evaluation of initiatives on violence against women and girls. Link: https://www.endvawnow.org/uploads/browser/files/me_asset_english_nov_2011__final.pdf Perreault S. (2015). Criminal victimization in Canada, 2014. Juristat. Statistics Canada Catalogue no. 85?002?X. Link: https://www150.statcan.gc.ca/n1/pub/85-002-x/2015001/article/14241-eng.pdf Pescosolido BA, Perry BL, Krendl AC. Empowering the next generation to end stigma by starting the conversation: bring change to mind and the college toolbox project. Journal of the American Academy of Child & Adolescent Psychiatry. 2020 Apr 1;59(4):519-30. Peter LJ, Schindler S, Sander C, Schmidt S, Muehlan H, McLaren T, Tomczyk S, Speerforck S, Schomerus G. Continuum beliefs and mental illness stigma: a systematic review and meta-analysis of correlation and intervention studies. Psychological medicine. 2021 Apr 8:1-1. Power MJ, Green AM, WHOQOL?DIS Group. The Attitudes to Disability Scale (ADS): development and psychometric properties. Journal of Intellectual Disability Research. 2009 Sep;54(9):860-74. Public Health Agency of Canada (2019a). Addressing Stigma: Towards a More Inclusive Health System. Link: https://www.canada.ca/en/public-health/corporate/publications/chief-public-health-officer-reports-state-public-health-canada/addressing-stigma-toward-more-inclusive-health-system.html Public Health Agency of Canada (2019b). Addressing Stigma: Towards a More Inclusive Health System Ð What We Heard Report. Link: https://www.canada.ca/en/public-health/corporate/publications/chief-public-health-officer-reports-state-public-health-canada/addressing-stigma-what-we-heard.html Ran MS, Hall BJ, Su TT, Prawira B, Breth-Petersen M, Li XH, Zhang TM. Stigma of mental illness and cultural factors in Pacific Rim region: a systematic review. BMC psychiatry. 2021 Dec;21(1):1-6. Randle M, and Reis D. (2017) Changing community attitudes toward greater inclusion of persons with disabilities. A Rapid Literature Review. Link: https://www.facs.nsw.gov.au/__data/assets/file/0008/372608/Rapid-Review-V3-interactive.pdf Reavley NJ, Jorm AF. Stigmatising attitudes towards people with mental disorders: Changes in Australia over 8 years. Psychiatry research. 2012 May 30;197(3):302-6. Rebernik N, Szajczyk M, Bahillo A, Goli?nik Maru?i? B. Measuring disability inclusion performance in cities using Disability Inclusion Evaluation Tool (DIETool). Sustainability. 2020 Jan;12(4):1378. Reddyhough C, Locke V, Paulik G. Changing healthcare professionalsÕ attitudes towards voice hearers: An education intervention. Community Mental Health Journal. 2021 Jul;57(5):960-4. Reid S, Hinchliffe S, Waterton J. Attitudes to Mental Health in Scotland: Scottish Social Attitudes Survey 2013. Scottish Government Social Research; 2014. Link: https://www.gov.scot/publications/attitudes-mental-health-scotland-scottish-social-attitudes-survey-2013/ Rillotta F, Nettelbeck TE. Effects of an awareness program on attitudes of students without an intellectual disability towards persons with an intellectual disability. Journal of intellectual and developmental disability. 2007 Mar 1;32(1):19-27. Rodr’guez-Rivas ME, Cangas AJ, Fuentes-Olavarr’a D. Controlled study of the impact of a virtual program to reduce stigma among university students toward people with mental disorders. Frontiers in psychiatry. 2021;12. Rosenbloom S (2007). Transportation Patterns and Problems of People with Disabilities. Link: https://www.ncbi.nlm.nih.gov/books/NBK11420/ Rossetto A, Potts LC, Reavley NJ, Henderson C. Perceptions of positive treatment and discrimination toward people with mental health problems: Findings from the 2017 and 2019 attitudes to mental illness surveys. Stigma and Health. 2020 Feb 13. Sandhu-Rojon R. Selecting Indicators for impact evaluation. United Nations Development Programme (UNDP). 2003 Mar;7:2004. Santos AD, Ferrari AL, Medola FO, Sandnes FE. Aesthetics and the perceived stigma of assistive technology for visual impairment. Disability and Rehabilitation: Assistive Technology. 2020 Jun 2:1-7. Sarge MA, Kim HS, Velez JA. An Auti-Sim Intervention: The Role of Perspective Taking in Combating Public Stigma with Virtual Simulations. Cyberpsychology, Behavior, and Social Networking. 2020 Jan 1;23(1):41-51. Sartorius N. Fighting stigma: theory and practice. World Psychiatry. 2002 Feb;1(1):26. Schnitzler M. The political economy of disability in South Africa, between social grants and job-creation programmes. Review of African Political Economy. 2020 Jul 2;47(165):432-48. Scior K. Public awareness, attitudes and beliefs regarding intellectual disability: A systematic review. Research in developmental disabilities. 2011 Nov 1;32(6):2164-82. SCOPE (2019). Equity for disabled people. Travel Fair. Link: https://www.scope.org.uk/scope/media/files/campaigns/travel-fair-report.pdf Shahin S, Reitzel M, Di Rezze B, Ahmed S, Anaby D. Environmental factors that impact the workplace participation of transition-aged young adults with brain-based disabilities: a scoping review. International journal of environmental research and public health. 2020 Jan;17(7):2378. Shahwan S, Lau JH, Goh CM, Ong WJ, Tan GT, Kwok KW, Samari E, Lee YY, Teh WL, Seet V, Chang S. The potential impact of an anti-stigma intervention on mental health help-seeking attitudes among university students. BMC psychiatry. 2020 Dec;20(1):1-4. Shea BJ, Grimshaw JM, Wells GA, Boers M, Andersson N, Hamel C, Porter AC, Tugwell P, Moher D, Bouter LM. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC medical research methodology. 2007 Dec;7(1):1-7. Link: https://amstar.ca/docs/AMSTARguideline.pdf Siperstein GN, Romano N, Mohler A, Parker R. A national survey of consumer attitudes towards companies that hire people with disabilities. Journal of Vocational Rehabilitation. 2006 Jan 1;24(1):3-9. Stamp Out stigma (2021). Association for Behavioral Health and Wellness (ABHW). Link: http://www.stampoutstigma.com/contact-us/ Suaidi MT, Wong PK, Mohd Tahir NA, Chua EW. Community PharmacistsÕ Knowledge, Attitude, and Practice in Providing Self-Care Recommendations for the Management of Premenstrual Syndrome. Medicina. 2020 Apr;56(4):181. Tachibana, T., & Watanabe, K. (2004). Attitudes of Japanese adults toward persons with intellectual disability: Relationship between attitudes and demographic variables. Education and Training in Developmental Disabilities, 39, 109Ð126. Tait K, Purdie N. Attitudes toward disability: Teacher education for inclusive environments in an Australian university. International Journal of Disability, Development and Education. 2000 Mar 1;47(1):25-38. Temple JB, Kelaher M, Williams R. Discrimination and avoidance due to disability in Australia: evidence from a National Cross-Sectional Survey. BMC public health. 2018 Dec;18(1):1-3 Terashima M, Clark K. The precarious absence of disability perspectives in planning research. Urban Planning. 2021 Feb 24;6(1):120-32. Tervo RC, Azuma S, Palmer G, Redinius P. Medical students' attitudes toward persons with disability: a comparative study. Archives of physical medicine and rehabilitation. 2002 Nov 1;83(11):1537-42. Thomson M, Planning S. (2010). Literature review: Outcomes and indicators of welcoming and inclusive communities and workplaces initiatives. Prepared for Welcome BC Immigrant Integration Brance of the Ministry of Advanced Education and Labour Market Development. Vancouver: Social Planning and Research Council of BC. Link: http://www.amssa.org/wp-content/uploads/2015/05/WelcomeBC_report.pdf Thornicroft A, Goulden R, Shefer G, Rhydderch D, Rose D, Williams P, Thornicroft G, Henderson C. Newspaper coverage of mental illness in England 2008-2011. The British journal of psychiatry. 2013 Apr;202(s55):s64-9. UK Cabinet Office (2008). Achieving Culture Change: A Policy Framework. Link: https://crawford.anu.edu.au/sparc/pdf/2010/achieving_culture_change.pdf UK Government (2021). Research and analysis UK Disability Survey research report. Link: https://www.gov.uk/government/publications/uk-disability-survey-research-report-june-2021/uk-disability-survey-research-report-june-2021 UK Prime MinisterÕs Strategy Unit (2005). Improving the Life Chances of Disabled People. London: Department for Work and Pensions, the Department of Health, the Department for Education and Skills, and the Office of the Deputy Prime Minister. A Joint Report. UNAIDS (Joint United Nations Programme on HIV/AIDS). (2008). A framework for monitoring and evaluating HIV prevention programmes for most-at-risk populations. Link: https://www.unaids.org/sites/default/files/sub_landing/17_Framework_ME_Prevention_Prog_MARP_E.pdf UNAIDS (Joint United Nations Programme on HIV/AIDS). (2010). Indicator Standards: Operational Guidelines for Selecting Indicators for the HIV Response. Link: https://www.unaids.org/sites/default/files/sub_landing/files/4_3_MERG_Indicator_Standards_2.pdf UNWomen (2013). Ending Violence against Women and Girls Programming Essentials 102. Link: https://www.endvawnow.org/en/articles/336-indicators.html Victorian Office for Disability (2010). Picture this: increasing the cultural participation of people with a disability in VictoriaÑliterature review and analysis. Link: https://www.vgls.vic.gov.au/client/en_AU/search/asset/1161971/0 Waqas A, Malik S, Fida A, Abbas N, Mian N, Miryala S, Amray AN, Shah Z, Naveed S. Interventions to reduce stigma related to mental illnesses in educational institutes: a systematic review. Psychiatric Quarterly. 2020 Sep;91(3):887-903. Walker J, Scior K. Tackling stigma associated with intellectual disability among the general public: A study of two indirect contact interventions. Research in developmental disabilities. 2013 Jul 1;34(7):2200-10. Watson AC, Corrigan PW, Ottati V. Police officers' attitudes toward and decisions about persons with mental illness. Psychiatric services. 2004 Jan;55(1):49-53. Werner S, Corrigan P, Ditchman N, Sokol K. Stigma and intellectual disability: A review of related measures and future directions. Research in developmental disabilities. 2012 Mar 1;33(2):748-65. Wilson MC, Scior K. Attitudes towards individuals with disabilities as measured by the Implicit Association Test: A literature review. Research in developmental disabilities. 2014 Feb 1;35(2):294-321. Wilson, Erin, Nick Hagiliassis, Kelli Nicola-Richmond, Anne Mackay and Robert Campain. 2008. Defining and measuring outcomes of inclusive communities. Presentation for National Disability Services, Australia. Link: http://www.nds.org.au/wa/Archive/2008/LW08-Wilson1.pdf Woodley A, Metzge N (2012) Employer attitudes towards employing disabled people. Ministry of Social Development. New Zealand. Link:https://www.odi.govt.nz/assets/Guidance-and-Resources-files/Employers-Research.pdf Yazbeck M, McVilly K, Parmenter TR. Attitudes toward people with intellectual disabilities: An Australian perspective. Journal of Disability Policy Studies. 2004 Sep;15(2):97-111. Zissi A, Rontos C, Papageorgiou D, Pierrakou C, Chtouris S. Greek employersÕ attitudes to employing people with disabilities: Effects of the type of disability. Scandinavian Journal of Disability Research. 2007 Jan 1;9(1):14-25. ANNEXES Annexe I. Directives d'extraction des donnŽes Table AI.1. Data Extraction Guidelines Column Title Cell Content Explanation Examples/Details Author Free text First author name, no punctuation Beamish Year Free text Year of publication 2021 Title Free text Full title of reference The adaptation and validation of a stigma measure for individuals with multiple sclerosis Country / Region Free text Specify as much as possible the specific study area. United Kingdom (England, Wales, Scotland, Northern Ireland) Peer-reviewed Drop down Category: Yes/No Specify if the study is peer-reviewed Yes, No Study Type Drop down category, check the one category only that best fits the value of this study for our project Descriptive study of a beliefs, values, attitudes and behaviours, etc. toward PWDs among different populations Study can draw on secondary data sources or primary data collection using surveys, questionnaires, interviews, observation, focus groups. Study of initiative, program, or intervention Studies that describe and/or evaluate an initiative, program, or intervention. It may also include an environmental scan of programs, initiatives or interventions Literature review/evidence synthesis studies Literature review, evidence synthesis studies such as systematic review, rapid review, scoping review, meta-analysis, etc. (Adams et al., 2017). Measurement protocol development and/or evaluation Include all studies that develop and/or evaluate measurement protocols (tools, scale, assessment framework, and guidelines, etc.) Best practice guidance Best-practices guidance related to culture change, framework for development, monitoring, and evaluation, etc. Type of Intervention Free text If study type is an intervention, specify type of intervention as much as possible Educational intervention, Contact based intervention, etc. Target Audience Free text Specify as much as possible the specific study area. University students, General Public, Healthcare workers, etc. Context Free text Which context intervention has been implemented Healthcare, University, School, workplace, public, etc. Note: for review studies, selected varies if it is multiple. Type of Disability Drop down Category, check all that are specified in the study 1. Sensory 2. Pain 3. Mobility 4. Learning 5. Intellectual 6. Mental Health 7. Autism Spectrum Disorder (ASD) 8. ADHD 9. Other, specify below 10. Not Specified Sensory Ð Blindness /deafness Pain Ð Chronic or episodic pain Mobility Ð e.g. Wheelchair users, amputees, etc. Learning Ð Difficulty acquiring a specific skill/competency (Dyslexia, dysgraphia, etc.) Intellectual Ð related to cognitive function, often determined via IQ assessment Mental Health Ð mood and psychotic disorders such as depression, anxiety, PTSD, schizophrenia, or BPD. Autism Spectrum Disorder (ASD) ADHD Other, specify below Ð See next row Not Specified Ð The study does not specify what disabilities they are referring to. Study Objective Free text One sentence explaining the key objectives of the study. Cut and past from PDF if possible. Òto determine the public perception and attitude towards Alzheimer diseaseÓ Study Outcomes (primary/ secondary) Free text One sentence explaining the key objectives of the study. Cut and past from PDF if possible. ÒChange perception of the general publicÓ Key Indicators Free text Name of measures developed/used to determine outcomes ÒMental Health Knowledge Schedule (MAKS)Ó Study Results/ findings Free text One sentence explaining the key objectives of the study. Cut and past from PDF if possible. ÒA significant difference was found between pretest and post-test means for three of the four subscalesÓ Sample Size Free text Study sample size Number Abstract including Findings and Outcomes Free text Cut and past from PDF if possible. Use abstract if available, if not, extract the most relevant part from the introduction or executive summary. Project Research Questions Alignment Drop down Category, check all that apply (Q1-Q5) Q1: Is the article about culture change and relevant to persons with disabilities or a related topic (e.g., stigma reduction initiatives)? Q2: Does the article describe culture change theory or a conceptual framework for culture change Q3: Does the article describe or evaluate a culture change initiative Q4: Does the article identify/describe indicators to measure culture change Q5: Do the article address one of the seven ACA priority areas Related to Q5: ACA priority areas are: * Employment * Built Environment * Transportation * Information and Communication Technologies * Communication, Other than Information and Communication Technologies * Procurement of Goods, Services and Facilities * Design And Delivery of Programs and Services Potential Key Informant & Organizations Free text Cut and past from document if possible Individuals, organizations, companies Annexe II. RŽsumŽ des rŽsultats de l'entretien avec les informateurs clŽs Indicators Identified by Key Informants Several themes emerged from the key informants. It was noted that attitude change is difficult to measure, however behavioral changes can be measured and reflects attitude changes. Several tangible and less-tangible indicators of culture change were suggested in the areas of knowledge, attitudes, behaviors and practices that reflect the underlying process and pathways towards culture change, at the individual, institutional, community and other levels. Key informants noted that in some instances culture change happens from the top down, and in others, from the bottom up. Indicators of culture change were ultimately more tangible, clear and objective if they measured outcomes and impacts in relation to various facets of the quality of life of persons with disabilities. There was feedback from disability advocates that what matters most is outcomes, e.g., how many people are employed, the standard of living, experience with violence, access to services, access to jobs, and access to housing. Employment Rates Several key informants suggested that a clear indicator of culture change was an increase in the employment rate of persons with disabilities in meaningful jobs, rather than attitudinal changes in workplaces. An increase in the hiring of persons with disabilities in meaningful jobs and internships, and an improvement in the employment rate of persons with disabilities, particularly in meaningful jobs, is reflective of a culture change. The Australia Disability Strategy (ADS) (Australia Government, 2021a) developed an Outcomes Framework (Australia Government, 2021b), which is currently tracking outcomes on employment. They indicated that the best measure of culture change is the number of persons with disabilities in workplace and in meaningful jobs. A key informant noted that if there are more persons with disabilities in that workplace in meaningful jobs, it is because their managementÕs attitudes have changes, and furthermore, that coworkersÕ attitudes have also change. Sustained Employment Sustained employment is an indicator used by the Employment Works program (Worktopia, 2022). Retaining work that was meaningful to persons with disabilities was considered a measure of culture change (6). The host organization and researchers in 12 to 15 communities across Canada administered surveys as part of the program. This was an effective way to measure how employer perspectives were changing. Measures included the number of participants still working after 6, 12, 18 months post-program and where they were at in their employment situation. A year after program ended, program administrators canvassed participants about persons with disabilities that were hired to see if they were still working. Internships for Persons with Disabilities A good indicator of culture change in the workplace is the practice of hiring persons with disabilities in internship programs, as it increases the probably of a person being hired for longer-term employment. One key informant spoked about how their organization encourages companies to have internships for persons with disabilities. There was mention of a study entitled Disability-Inclusive Employer Practices and Hiring of Individuals with Disabilities that found that companies who have internships for persons with disabilities are six times more likely to hire persons with disabilities for longer-term employment (Erickson et al., 2014). Built Environment The development and improvements of the built environment was suggested as an indicator that an organization had changed it norms in relation to accessibility and inclusion. Of note were changes such as building wheelchair ramps for persons with mobility impairments. Other examples of improvement in the built environment noted by key informants include crosswalks, and braille on elevator buttons. Implementation of Legislation and Policies Application of legislation and policy changes across services within large-scale organizations and the public sector emerged a common theme across key informants. One example is the Equality Act 2010 in UK in the health care services (15). Applying equality legislation across services is a good indicator of culture change. In general, legislation that includes persons with disabilities in day-to-day life in broad terms was considered important. Workplace policies, practices and educational efforts can also serve as a marker of change and can be evaluated and tested. Implementation of legislation on training for managers about the duty to accommodate was also noted. Changing policies and practices is a means to changing systemic behavior and culture. Reduction in Disability Claims One key informant noted that disability-confident champions in corporate culture did their own training and assessment of mental health status and return to work, and in time, cases of disability claims and health care leaves decreased, stigma decreased, and after two years a significant economic benefit was observed. Their return on investment in training became a significant advantage. Disability-Confident Workplaces Organizations becoming disability confidant was noted by key informants as an important indicator of culture change. Proxy measures include improvement to the built environment and use of universal and inclusive design principles, top management involvement culture change initiatives, and improvements in access to employment opportunities for job candidates with disabilities. Some of these proxy measures are detailed below. Employment Process: Website, Application and Interview Improving accessibility of websites for job candidates and accessibility of the application and interview process were identified as proxies for organizational culture change. The accessibility of the employment process should be part of the conversation on inclusion of persons with disabilities at many levels. Indicators of website accessibility include improving accessibility of overlays (a piece of code that creates a skin on a website) that can prevents the use of assistive technology (e.g., use of a screen reader that is interrupted when downloading something, so that a person must turn one off to use the other). Top Management It was noted that without the support and involvement of top management, changing the culture at an organizational can be very difficult. Thus, involvement and commitment by top management was a key indicator. If the senior management of organizations sent out statements showing their commitment to equity, diversity and inclusion, this would suggest leadership was promoting accessibility and inclusions. A diverse board of directors or senior management that included the presence of persons with disabilities was also noted as an indicator of an inclusive culture. Bottom-up Culture Change Culture change can also happen from the bottom up by persons of influence, or culture carriers. Culture carriers are persons who have accrued influence, a nexus of attitude and behavior, ideally influencing positive change. The person does not have to be senior in the organization to be an influencer. Change in Language Changes in the use of language and use of labels was noted as a sign of attitudinal and behavioral change. Language use is supportive if persons feel included, not labeled, and vocabulary used to describe them is not stigmatizing. Changes in language can be observed in recruitment advertisements, calls for applications for research grants, and in the interactions with colleagues who have been on sick or disability leave. In terms of the latter, support language would be to say, ÒIt is great to see you againÓ, ÓIÕm so glad youÕre backÓ, rather than asking if they feel better. Small shifts in language can have a huge impact on workplace culture. Language used by the media has an impact on public opinion. Not perpetuating stereotypes can lead to reductions in isolation and discrimination of marginalized populations such as persons with mental illness. Medical Documentation for Accommodations or Sick Leave Eliminating or reducing the need for doctorsÕ notes as evidence for illness and disability can reduce barriers to accommodations. For example, not requiring medical evidence from students requesting accommodations for exams, was suggested as an indicator of inclusive culture. DoctorsÕ notes can be costly for students and workers and are not needed for all accommodation requests. Workplace Supports A good indicator of culture change is increasing access to supports such as counseling, professional support, Employee/Family Assistance Program, community supports, and accommodations. Having supports available promotes change in help-seeking behaviors. Indicators can be collected through engagement surveys that have an option to self-identify as a person with a disability. Engagement surveys provide a sense of how people feel about an organization and, through repeated cycles, can be used for monitoring and evaluation of progress over time. Promoting Accommodation Dialogue Making accommodations part of conversations between managers and workers was seen as a way to create comfort with disclosure. Questions about accommodation needs could be part of annual reviews, so that workers understand that it is acceptable to need accommodations. It should also be made part of the dialogue in the hiring and onboarding processes. Identify comfort levels with accommodation conversations can be assessed through anonymous health and well-being surveys. Training and Education Mental health training for managers and other workplace parties was noted as important for promoting inclusion. Mental health training and promoting support seeking were noted as critically important for first responders, as they are at substantially higher risk for post-traumatic stress injury. Many first responders now having specialized teams who deal with mental health issues. Training improves mental health literacy and results in greater awareness of mental health issues at all levels with and beyond the organization (e.g., with family members and in the community). Sense of Belonging and Relational Indicators A sense of belonging and feeling connected were noted as an important outcomes. Belonging provides a feeling of security and being valued. It can protect against stigma, discrimination and ableism experience every day by persons with disabilities. Indicators of a sense of belonging included people knowing a personÕs name, not because it is the right thing to do, but because the person is welcome. Belonging means that if a person is not there, somebody wonders where they are. It can be difficult to measure a sense of belonging, however some survey with questions such as ÒI feel part of communityÓ, ÒI feel sense of belongingÓ, ÒI feel supportedÓ, ÒI feel have friendsÓ are used in some surveys. Additional indicators of belonging and connectedness include questions such as ÒWould you be friends with someone with depression?,Ó ÒWould you date someone with depression?,Ó ÒWould you introduce someone with depression to your family?Ó and ÒWould you share an apartment with someone with depression?Ó Universal/Inclusive Design in the Educational Sector In higher education, proactive accommodations for visual barriers, auditory barriers, sensory barriers, mobility barriers, etc. are indicators of universal design. Embedding broader principles of inclusive design in the overall curriculum is important, e.g., exam accommodations such as options to record responses to questions that are same length as written answers, getting extra time as needed for assignments. Progress can be measured within faculties on the sort of accessibility initiatives that have been embedded within the course by looking at the course outline, e.g., ÒHas the instructor integrated and included accessibility principles without knowing they have students with disabilities?Ó Another indicator would be to have mandatory training for instructors on universal/inclusive design and accommodating persons with disabilities. An audit tool could include questions such as ÒHow many professors are involved in EDI principles?,Ó ÒWhat training is received as part of onboarding at university to provide inclusive practices?,Ó and ÒDo instructors have an open door policy for students who require accommodations?Ó Even with a universal design approach, it is important to realize that one size does not fits all. Frameworks and Approaches for Culture Change Several frameworks, approaches and guiding principles were identified by key informants, which we describe in detail below. Contact-Based Education A running theme that emerged was the concept of contact-based education and exposure. The concept of contact-based education was noted by several people, where able bodies persons are exposed to persons with lived experience, in the workplace, school or community settings, to increase compassion and understanding of those with disabilities and to normalize the presence of diverse persons in different social roles. Exposure to persons with disabilities helps to normalize having diverse persons in the community and normalizes having accommodations. Contact based education is a key tool for de-stigmatization, providing opportunities for telling stories of lived experiences and narrative of recovery. Storytelling by persons with lived experiences also helps others to understand those with episodic disabilities, an approach used in a training workshop spearheaded by Realize, and specifically for mental health in the Opening Minds anti-stigma initiative for youths called Inquiring Minds, influences culture change. Theater and plays were used to create awareness in dementia care environments for persons with dementia. Role models and contact-based education increases exposure, social contact and empathy with persons with lived experiences and breaks down social distance. Role models reduce stigma. A program called HeadStrong, part of the Opening Minds initiative, uses contact-based education to reduce stigma of mental illness among young persons by exposing them to powerful stories, sometimes by celebrities, to show support and how to get help they need. It was a successful program across all demographic groups, including Indigenous communities and immigrant communities. The youth then take home what they learn and talk about it with their parents. Contact-based education teaches people how to seek help and also helps provide them with the tools and training to know how to support their peers, i.e., if a young person is having suicidal ideations, even if they promised not tell anybody or go to parent or teacher, they are confident in knowing how to help a person. RealizeÕs IDEAL Framework The IDEAL (Inclusion, Diversity, Equity, Accessibility, Leading to Belonging) framework was developed by Realize to address accessibility and inclusion. The framework goes beyond Equity, Diversity and Inclusion (EDI). The framework has guided Realize, informing the way they approach all their projects and activities. It defines their identity as an organization and their work going forward. Guiding questions for the IDEAL Framework are as follows: 1. Who is at the table? Who is not at the table, when being considered in things? 2. How do we center, appreciate and learn from different voices and lived experience in our process of developing this framework? 3. How do we go beyond the current norms in the sector, and recognize that broad range of lived experiences and voices in all of the aspects of our own work? 4. What kind of barriers are being faced by people? 5. What impactful measures can be implemented by our organization to address some of the barriers that individuals from under-represented groups are facing? 6. What physical, architectural, technological, information, communication, and attitudinal barriers, or anything that may be a result of a policy or practice, that might hinder the full and equal participation of people with any kind of impairment, i.e., physical, mental, intellectual, cognitive, learning, communication or sensory, to involving themselves and engage with the work that we do? 7. What can we do to remove the barriers and better facilitate that full and equitable participation? 8. Belonging piece: Do individuals involved with the organization feel empowered, and feel that they are invited to reach their full potential in their involvement with our organization? Measures used include: * Ensuring the right people are at the table; * The approach taken with projects and activities; and * Ensuring there follow up on commitments. For all new products, online courses, workshops, etc. Realize has a consultant who works in the context of disability, discrimination and race, that ensures they are following through on the commitments made. The success of their framework is partly seen in the diverse makeup of their board and staff. Australia Disability Strategy (ADS) Outcomes Framework The Australia Disability Strategy (ADS) includes an Outcomes Framework which tracks, reports and measures the outcomes for persons with disability across all seven Outcome Areas of the Strategy, in the hopes of driving change (Australia Government, 2021a; 2021b). The Outcomes Framework will be used to track progress of the ADS. Outcomes range from employment and financial security; inclusive homes and communities; safety, rights and justice; personal and community support; education and learning; health and wellbeing, and community attitudes. In addition, a longitudinal survey on attitude change is being designed by Australian National University. QuakeLab Inclusion Maturity Model The QuakeLab Inclusion Maturity Model is a framework for use by an organization to assess and measure their progress in relation to EDI culture change (described as the diversity, equity, and inclusion (DEI) journey) (QuakeLab, 2020). An organizationÕs maturity is categorized into four levels: * Level 1: Internal assessment and action * Level 2: Embedded action and looking externally * Level 3: Innovation inclusion * Level 4: Dismantle the system The model is designed to go beyond the focus of diversity with the workplace to encapsulating efforts to rigorously investigate historical systems of oppression. Mental Health Commission of Canada - Framework for a Psychosocially Health Workplace The Mental Health Commission of Canada, in partnership with Ottawa Public Health, adapted content from The Mindful Employer (2020), to develop a series of short, animated videos that aim to raise awareness about the 13 factors that can impact the mental health of employees in the workplace. It is intended to encourage conversations on methods for promoting psychologically safe places to work. Indicators of a psychosocially health workplace, can be found at the following link: 13 Factors: Addressing Mental Health in the Workplace (MHCC, 2022). Addressing Stigma: Towards a More Inclusive Health System A key informant, who was not available for an interview, sent along the Chief Public Health OfficerÕs Report on the State of Public Health in Canada 2019, which included an Action Framework for Building an Inclusive Health System (Table 2, p. 41) (Public Health Agency of Canada, 2019). Emphasis is given to the need for training front-line health care providers (i.e., nurses, doctors, allied health care workers, pharmacists, receptionists, etc.) on how to interact with and support persons with disabilities. Additional References Introduced by Key Informants Australia Government (2021a). Australia Disability Strategy (ADS). Link: https://www.disabilitygateway.gov.au/ads/strategy Australia Government (2021b). Outcomes Framework. Link: https://www.disabilitygateway.gov.au/document/3121 Erickson, William A.; von Schrader, Sarah; Bruyre, M.; VanLooy, Sara A.; Matteson, S. (2014). Disability-Inclusive Employer Practices and Hiring of Individuals with Disabilities. Link: https://www.ingentaconnect.com/content/springer/rrpe/2014/00000028/00000004/art00007 MHCC (Mental Health Commission of Canada) (2022). 13 Factors: Addressing Mental Health in the Workplace. Link: https://mentalhealthcommission.ca/13-factors-addressing-mental-health-in-the-workplace/ Public Health Agency of Canada (2019). Action Framework for Building an Inclusive Health System. Link: https://www.canada.ca/content/dam/phac-aspc/documents/corporate/publications/chief-public-health-officer-reports-state-public-health-canada/addressing-stigma-what-we-heard/stigma-eng.pdf QuakeLab (2020). QuakeLab Inclusion Maturity Model. Link: https://quakelab.ca/blog/quakelab-inclusion-maturity-model The Mindful Employer Canada (2020). The Mindful Employer Canada: Working Towards a Healthy Future. Link: https://www.mindfulemployer.ca/ Worktopia (2022). Employment Works program. Link: https://worktopia.ca/ Annexe III. Exemples d'application des cadres Conceptual Framework for Culture Change Initiatives Figure AII.1. illustrates the cycle of culture change. This has been published by the UK Cabinet Office back in 2008 to sets out the state of knowledge about Òculture changeÓ and a framework to show how this can be practically used to inform policy development. The authors mentioned in understanding behavior we should start by looking at the development of our cultural capital. This arises from our interaction with both the very immediate world around us and broader society-wide forces. Cultural capital forms the behavioral intentions we have in regard to the specific decisions and choices we can make. For example, an individual may have the attitude that it is sensible to remain in education or training after the age of 16; this would form a specific behavioral intention to seek opportunities to do so. In some cases, cultural capital will have a very strong influence on our behavioral intentions, in other cases less so. It is then how these behavioral intentions interact with the incentives, legislation, regulation, and level of information and engagement we face in any given situation that determines our actual behavior. Over time our behavioral patterns regularize into our new default. Over the long term, this feeds back into our cultural capital Ð for example in forming new attitudes or values about the choices we have experienced. Figure AII.1. Conceptual framework for culture change initiative/programs Sources: UK Cabinet Office, 2008. Results Framework for Improved Quality of Health Services Figure AII.2. provides an example of a results framework showing results factors that lead to improved quality of health services. As you can see under intermediate results 2 (IR2), the information system, training and supervision of clinicians, and provider performance are factors that lead to improved quality of health services. Notice that intermediate results and sub- intermediate results need to be measurable; in other words, indicators can be developed for them, and data can be collected to calculate them (Menon, 2009). Figure AII.2. Example of results framework showing results factors that lead to improved quality of health services Source: Marsh et al., 1999; Frankel et al., 2007. Logical Framework for an HIV Voluntary Counseling and Testing Program Figure AII.3 provides another example, is a small portion of a logic model for an HIV voluntary counseling and testing (VCT) program. It is important to remember that, within a program, several activities can have their own inputs and outputs. Collectively, the outputs of the activities contribute to the programÕs outcomes and impacts. In some cases, the output of one program activity could be an input for another activity. For example, if an activity is to develop guidelines, the output of that activity is the guidelines, which can then be an input (VCT protocols) in this overall logic model for VCT service delivery. Using frameworks is one way to develop a clearer understanding of the goals and objectives of a project, with an emphasis on identifying measurable objectives, both short-term and long-term (Frankel et al., 2007). Figure AII.3. Example of a logical framework for a HIV voluntary counseling and testing program Source: Frankel et al., 2007. Annexe IV. Niveaux des initiatives de changement de culture Public Health Agency of Canada Framework Figure AIII.1. represents a framework designed by Public Health Agency of Canada for building an inclusive health system. They provide a high-level summary of types of interventions that can be considered when addressing stigma in the health system. This framework provides direction on developing multi-level and comprehensive approaches that respect differences across stigma experiences while offering the potential for lasting effects across stigmas. Figure AIII.1. Framework for building an inclusive health system Source: Public Health Agency of Canada, 2019b. CrossÕs Stigma Intervention Matrix Figure AIII.2. presents a tool for the planning and management of stigma interventions (Cross et al., 2011). It is a matrix that provides an approach for cross-checking intervention plans with greater precision. The Intervention Matrix incorporates levels of stigma as suggested by McLeroy and colleagues, and the components of stigma as suggested specifically by Link and Phelan, but also indirectly by Sartorius and others (McLeroy et al, 1988; Link et al., 2001; Sartorius, 2002) Figure AIII.2. Stigma intervention matrix *Consider at which level of stigma the intervention is intended to have an impact at **Consider how the intervention addresses each component of stigma at the level of stigma targeted Source: Cross et al., 2011. JavedÕs Framework for Reducing Stigma of Mental Health Disorders Figure AIII.3. present stigmatization of mental health could manifests at the level of the individual (intrapersonal), society (interpersonal) and health systems (structural). This is the framework presented by Javed et al., (2021). They explore various aspects of stigma towards mental health with a focus on Low- and middle-income countries (LMICs) and assesses measures to increase help-seeking and access to and uptake of mental health services. Stigma impacts persons living with mental illness, their families and caregivers and healthcare professionals (mental health professionals, non-psychiatric specialists and general practitioners) imparting mental health care. Figure AIII.3. Multiple levels of stigmatization of mental health Sources: Javed et al., 2021. Annexe V. Examen approfondi de quelques initiatives de changement de culture ˆ grande Žchelle In this section, drawing on previous literature, we provide an in-depth view of some large-scale widely known national-level initiatives aimed to change the culture toward PWDs and to reduce stigma and discrimination. These examples were selected mainly because of data availability regarding the InitiativeÕs input, activities, output, target population. Following information, we mainly drew on the National Academies of Sciences, Engineering, and Medicine, (2016) and Gaebel et al. (2017). Opening Minds (Canada) Overview ¥ Seeks to change behaviors and attitudes toward people living with mental illness to ensure they are treated fairly and as full citizens ¥ Established by the Mental Health Commission of Canada (MHCC) ¥ Started in 2009 (ongoing) ¥ Grassroots contact-based education programs aimed at: o youths aged 12-18 o health care providers o employers and the workforce o news media o research and evaluation (Mental Health Commission of Canada, 2009)7 What Did They Do: The commission began Opening Minds with a small, public education media campaign designed to communicate positive messages about people with mental illness. The results were disappointing, and the commission decided against a costly, long-term social media campaign. Instead, the project team issued a request for interest. It was distributed to a wide network of government agencies, universities, stakeholders, and existing grassroots anti-stigma programs across Canada. These initiatives shared one thing in common: they all used some form of contact-based education. The project team linked them with Opening Minds researchers for evaluation and scale-up of effective programs. Work focused on four target groups: youths aged 12-18, health care providers, the workforce or employers, and the news media. Principal investigators were recruited from leading Canadian universities for each target group. The project teams used similar evaluation strategies so that researchers could compare outcomes across settings to help determine which program activities would yield the greatest effects. The goal was to develop effective, evidence-based models that could be replicated and disseminated to other communities and stakeholders who want to begin anti-stigma efforts (National Academies of Sciences, Engineering, and Medicine, 2016). Examples of Activities: One activity is ÒHEADSTRONG,Ó a program targeting youth. This activity brings together youth from local high schools to a regional summit where they participate in exercises, learn about the problems created by stigma, and hear stories from people with lived experiences of mental health problems or mental illnesses. Equipped with toolkits and examples of anti-stigma activities, these students go back to their schools and lead anti-stigma efforts bringing mental health awareness along with messages of hope and recovery. The youth champions are also supported by a coordinator who links them with a coalition of community groups. Another activity was ÒUnderstanding StigmaÓ, an anti-stigma program aimed at health care professionals that emerged as one of Opening Mind's most effective anti-stigma programs. The program comprises a 2-hour workshop that includes six key ingredients such as a PowerPoint show of famous people with mental illness that also functions as an introduction to stigma; a group exercise comparing earaches with depression to illustrate the need for timely treatment and social support; a short discussion of the definition of stigma as a form of prejudice and discrimination; along with locally made films, myth-busting (countering myths about mental illness), and a keynote speech by a person with mental illness that engenders discussion among participants. Workshops were originally developed for use by emergency room staff, but they were later adapted for other groups. The program objectives are to raise awareness among health professionals of their own attitudes; to provide them with an opportunity to hear personal stories of mental illness, hope, and recovery from people with mental illness; and to demonstrate that health care providers can make a positive difference. The program also includes pre- and posttests as well as take-home resources and the opportunity to sign an anti-stigma commitment. Opening Minds has also produced a guide for media reporting on mental health. Mindset: Reporting on Mental Health includes sections that help journalists distinguish among various mental disorders (stressing that mental illness is a broad category and reporting should specify diagnoses), and guidelines for interviewing people with and about mental illness, and appropriate language to use when reporting on mental illness, suicide, and addiction (National Academies of Sciences, Engineering, and Medicine, 2016). Time to Change (England) Overview ¥ A social movement to change the way people think and act about mental illness ¥ Co-funded by Comic Relief, the Department of Health and the Big Lottery Fund ¥ Started in 2007 and ended in March 2021 ¥ Intervention components: o Social marketing and mass media activity o Local community events to bring people with and without mental illness together o A grant scheme to fund grassroots projects led by people with mental illness o A program to empower a network of people experiencing mental illness to challenge discrimination o Targeted work with stakeholders to improve practice and policy (Henderson et al., 2016; 2020)8 What Did They Do: Time to Change is England's largest-ever program to reduce stigma and discrimination against people with mental health problems. The project began in 2008 and is ongoing. funding covered the development and implementation of the anti-stigma activities, as well as evaluation activities, including the collection of nationally representative baseline data and follow-on surveys of the English population from which progress could be measured in the future. Between 2008 and 2015, the project received £40 million ($60 million US) to design and deliver a multiphase, multifaceted campaign that included: * social marketing and mass media activity at the national level to raise awareness of mental health issues; * local community events to bring people with and without mental health problems together; * a grant program to fund grassroots projects led by people with mental health problems, * a program to empower a network of people with experience of mental health problems to challenge discrimination, * targeted work with stakeholders, for example, medical students, teachers in training, employers, and young people. * Funding also allowed the campaign to do formative research during the first year involving more than 4,000 people with direct experience of mental health problems to provide input on stigma and discrimination and specific targets for change, which then guided the campaign (National Academies of Sciences, Engineering, and Medicine, 2016). Examples of Activities: Based on insight from the developmental phase, the mass media campaign (including national television, print, radio, and outdoor and online advertisement and social media as well as cinema) targeted specific groups of individuals. The film Schizo,9 one component of the national-level campaign, was shown in movie theatres across the country, and later adapted for use in the United States. Nationally representative surveys of the general public concerning knowledge, attitudes, and behavior in relation to people with mental health problems were used to assess change over time. At the community and grassroots levels, the project included varied activities based on the theme Òstart a conversation.Ó Community-level social contact included ÒLiving LibrariesÓ where, instead of borrowing only books, library visitors could borrow a person and hear about firsthand experiences of stigma discrimination from those with lived experience of mental illness. Data were collected at the community level during these social contact events in different cities across England to assess the relationship between the quality of the social contact and intended stigmatizing behavior and campaign engagement. Grassroots-level components also included volunteer-led activities (contact-based and peer-service programs) at college campuses and other public places that provided data on the impact of disclosure of mental or substance use disorders on self-stigma and the sense of well-being and empowerment, again through the use of validated tools (National Academies of Sciences, Engineering, and Medicine, 2016). Beyondblue (Australia) Overview * Improve the knowledge and skills of primary care practitioners and other health professionals regarding mental health problems * Largely funded by the Australian national government and some of the territorial (state) governments, with some financial and in-kind support from nongovernmental source * Started in 1990s. The organization began its work in 2000 as a 5-year initiative yet it continues. * Intervention components: o Increasing awareness of depression and anxiety o Reducing stigma and discrimination o Improving help-seeking for people with depression and anxiety (and more o recently, for those at risk of suicide) o Reducing the impact and disability associated with these conditions (Beyondblue, 2000)9 What Did They Do: beyondblue is an Australian not-for-profit organization that began as Òbeyondblue: the national depression initiativeÓ but now addresses both depression and anxiety. The initiative aimed to improve the knowledge and skills of primary care practitioners to address mental health problems. The goal of the mental health literacy campaign was to raise awareness of the importance of the public's knowledge, beliefs, and skills related to mental disorders, including prevention and treatment. There were five priority areas: community awareness and de-stigmatization, consumer and caregiver support, prevention and early intervention, primary care training and support, and applied research. Information was disseminated and messages conveyed over multiple media platforms, including television, radio, the internet, and print media. beyondblue partnered with an organization called Schools Television to raise awareness and provide information about mental illness and engaged well-known actors to talk openly about their personal experiences with mental illness. The activities are largely funded by the Australian national government and some of the territorial (state) governments, with some financial and in-kind support from nongovernmental sources (National Academies of Sciences, Engineering, and Medicine, 2016). Examples of Activities: There were many varied activities including mass-media advertising, sponsorship of events, community education programs, training of prominent people as champions, and web and print information. Mental Health First Aid training was developed in Australia in 2000 by Betty Kitchener starting as a small volunteer effort that has now been replicated in many other countries. Other prominent interventions included Mind Matters, programs in high school that are incorporated into regular lessons; RUOK DayÑpeople ask others about their mental well-being ÒAre you OK?Ó; Rotary community forums on mental illness across the country that involve elected officials and average citizens; and Mindframe, a national media initiative that includes training programs and guidelines for responsible reporting about suicide. The campaign also provides funding to initiate and continue research on depression and anxiety, and over the course of the campaign, the funded research activities have grown in number and been more aligned with stakeholder-identified priorities (National Academies of Sciences, Engineering, and Medicine, 2016). Like Minds, Like Mine (New Zealand) Overview ¥ One of the first comprehensive national campaigns in the world to counter stigma and discrimination associated with mental illness ¥ Funded by the Ministry of Health and Health Promotion Agency ¥ Started in 1997 (ongoing), with multiple National Plans including First (1999Ð2001), Second (2001Ð2003), Third (2003Ð2005), Fourth (2007Ð2013), Fifth (2014Ð2019) ¥ Intervention components: o Changing public attitudes through advertising campaigns, radio shows, creative art initiatives o Changing behaviors through educational workshops o Changing policy and Law o Empowering people with lived experience to challenge stigma and discrimination (Likeminds, 2016)10 What Did They Do: Like Minds, New ZealandÕs program to combat stigma and discrimination, has now been in existence for 17 years. It has not been a straightforward journey but one full of twists and turns, changes in focus and direction. The underlying philosophy of the program has drawn on health promotion and public health, on human rights and the disability movement, and the voice of lived experience. Like Minds has been a program of social change, and social change evolves over time and requires commitment. Social change does not always sit easily with being a government funded program sitting within the health sector whose core business is the provision of health services. However, Like Minds has been responsible for changes in the way people with experience of mental illness are viewed, and changed the New Zealand social environment for the better. The work of social change is not complete, and there remains a place for concerted and coordinated efforts focused specifically on addressing and reducing discrimination associated with mental illness (Gaebel et al., 2017). Examples of Activities: Like Minds has aligned its work to the strategies of contact, protest and education, with a strong focus on contact as the central and most effective strategy for change. These strategies have been used to work towards four key outcomes: changing public attitudes towards people with mental illness, changing the behavior of those in most contact with people with experience of mental illness, changing policy and law to combat discrimination and empowering people with experience of mental illness to challenge discrimination and self-stigma (Gaebel et al., 2017) Annexe VI. Initiatives visant ˆ changer les attitudes ˆ l'Žgard des personnes handicapŽes au Canada Figure AV.1. Initiatives aimed at changing attitudes toward persons with disabilities in different provinces across Canada Province Initiative/ program Organizer(s) Link British Columbia Disability Employment Awareness Month (DEAM) Provincial government https://news.gov.bc.ca/releases/2020SDPR0043-001615 British Columbia Diversity Includes Inclusion BC https://inclusionbc.org/our-campaigns/diversity-includes/ British Columbia COVID Disability Inclusion BC https://inclusionbc.org/our-campaigns/covid19disability/ British Columbia Kids CanÕt Wait Inclusion BC https://inclusionbc.org/our-campaigns/kids-cant-wait/ British Columbia All Students Belong Inclusion BC https://inclusionbc.org/our-campaigns/inclusive-education/ British Columbia Inclusive Housing for All Inclusion BC https://inclusionbc.org/our-campaigns/inclusive-housing-for-all/ British Columbia Ending Poverty Inclusion BC https://inclusionbc.org/our-campaigns/ending-poverty/ British Columbia campaigns to raise awareness, including - ACCESS AWARENESS DAY - Say Yes to Access SPARC BC https://www.sparc.bc.ca/areas-of-focus/accessibility-and-inclusion/campaigns/ British Columbia Different activity including events Disability Alliance BC https://www.facebook.com/DisabilityAllianceBC/ British Columbia GET LOUD Campaign Canadian Mental Health Association https://www.getloudbc.ca/ Ontario Disability Employment Awareness Month (DEAM) Community Living Toronto https://cltoronto.ca/october-is-disability-employment-awareness-month-deam/ Ontario NA (New Campaign) Government https://www.ontario.ca/page/ministry-community-safety-and-correctional-services-2016-accessibility-report Ontario Learning Disability (LD) Awareness month Learning Disabilities Associations of Ontario https://www.ldao.ca/ld-awareness-month-october-2021-press-kit/ Alberta Disability Employment Awareness Month (DEAM) Government https://www.deamalberta.com/ Alberta Disability Employment Awareness Month (DEAM) City of Calgary https://www.calgaryemploymentfirst.ca/deam/ Alberta ACCDs Campaign for Barrier Free Health and Medical http://www.ccdonline.ca/en/socialpolicy/access-inclusion/ACCD-Video Saskatchewan Disability Employment Awareness Month (DEAM) Provincial government https://www.saskatchewan.ca/government/news-and-media/2016/october/01/province-declares-disability-employment-awareness-month-in-october Quebec Quebec's disability awareness Association Lavalloise du Transport AdaptŽ (ALTA) and SociŽtŽ de transport de Laval (STL) https://www.newswire.ca/news-releases/quebec-week-for-disabled-persons-stl-to-provide-accessible-transportation-to-disabled-women-fleeing-domestic-violence-865585423.html Quebec QuŽbec Week for Disabled Persons Office des personnes handicapŽes du QuŽbecÕs https://www.curateur.gouv.qc.ca/cura/en/outils/nouvelles/20190603b.html Quebec Quebec Intellectual Disability Week Quebec https://www.sqdi.ca/en/quebec-intellectual-disability-week/#:~:text=The%20next%20Quebec%20Intellectual%20Disability, March%2020%20to%2026%2C%202022. Quebec Skills Link program FNHRDCQ https://www.cdrhpnq-fnhrdcq.ca/inclusion?lang=en Manitoba Disability Matters Vote (DMVote) DMVote https://www.dmvote.ca/ Manitoba initiative of Abilities Manitoba Abilities Manitoba https://abilitiesmanitoba.org/ Manitoba Barrier Free Manitoba Barrier Free Manitoba https://www.barrierfreemb.com/home Manitoba MarketAbilities Campaign Provincial government https://news.gov.mb.ca/news/print,index.html?archive=&item=4896 Nova Scotia Disability Employment Awareness Month (DEAM) Provincial government https://www.halifax.ca/about-halifax/diversity-inclusion/national-employer-disability-awareness-month Nova Scotia Access Awareness Week (AAW) in Nova Scotia Partnership for Access Awareness Nova Scotia (PAANS) https://www.halifaxpubliclibraries.ca/blogs/post/access-awareness-week-2021-a-virtual-celebration/ Nova Scotia Paper Egg Campaign More than able https://www.easterseals.ns.ca/2020/03/papereggs2020/ Newfoundland and Labrador Learning Disabilities Awareness Month Provincial government https://www.gov.nl.ca/releases/2021/education/1013n03/ Newfoundland and Labrador I Can Too! Eastersealsnl https://eastersealsnl.ca/what-we-do/career-and-educational-services/i-can-too/ Newfoundland and Labrador 'Be Kind' campaign https://www.saltwire.com/nova-scotia/news/be-kind-campaign-raises-awareness-about-disabled-people-in-newfoundland-and-labrador-who-cant-wear-a-mask-506960/ New Brunswick Disability Awareness Week Provincial government https://www2.gnb.ca/content/gnb/en/departments/pcsdp/daw2021.html New Brunswick Summer Awareness Campaign Learning Disabilities Association of New Brunswick https://www.ldanb-taanb.ca/ New Brunswick HIRE for TALENT Awareness Campaign Hirefortalent https://hirefortalent.ca/main/toolkit/customized-employment/2-general Prince Edward Island Disability Employment Awareness Month (DEAM) Provincial government NA Prince Edward Island Easter Seals Society of PEI Rotary Club of Charlottetown in partnership with the Rotary Club of Montague and the Rotary Club of Summerside. https://eastersealspei.org/about-us/#:~:text=Rotary%20Club%20of%20Charlottetown%20in%20partnership%20with%20the%20Rotary%20Club%20of%20Montague%20and%20the%20Rotary%20Club%20of%20Summerside. Annexe VII. Outils de mesure identifiŽs pour les attitudes envers les personnes handicapŽes Table AVII.1. Measurement tools for attitudes towards persons with disabilities Author(s) Year Measurement tools title Objective Country Type of disability Nota et al. 2014 Work for people with disability questionnaire Employer attitudes towards work inclusion of persons with disabilities Italy All KrahŽ et al. 2006 Questionnaire about Attitudes towards the Physically Disabled11 Attitudes towards persons with physical disabilities Germany Physical Bunch et al. 2004 Guide questions framed interviews Student attitudes toward peers with disabilities in inclusive and special education schools Canada All Chadd et al. 2011 University of California, Los Angeles Geriatrics Scale Attitudes towards PWDs in healthcare sector USA All Chadd et al. 2011 Maxwell and Sullivan Attitude Scale (MSAS) Attitudes towards PWDs in healthcare sector USA All Tait et al. 2000 Disabled Persons Scale (IDP) Attitudes toward disability Australia All Yazbeck et al. 2004 The Scale of Attitude Toward Mental Retardation, The Mental Retardation Attitude Inventory, The Community Living Attitudes Scale Mental Retardation Attitudes toward person with intellectual disabilities Australia Mental Tervo et al. 2002 Attitude Toward Disabled Persons (ATDP) Scale Attitudes toward PWDs USA All Tervo et al. 2002 Scale of Attitudes Toward Disabled Persons (SADP) Attitudes toward PWDs USA All Tervo et al. 2002 Rehabilitation Situations Inventory (RSI) Perception of the difficulty of typical rehabilitation situations USA All Power et al. 2009 Attitudes To Disability Scale (ADS) Assess the personal attitudes of individuals with either physical or intellectual disabilities UK Mental Rillotta et al. 2007 Attitudes Toward Persons with an Intellectual Disability Questionnaire (ATTID) Unidimensional scale measuring student's attitudes toward persons with intellectual disabilities Australia Mental Antonak et al. 1994 Mental Retardation Attitude Inventory-Revised (MRAI-R) Multidimensional scale composed of 4 subscales to measure attitudes toward individuals with mental retardation USA Mental Tachibana et al. 2004 Tachibana and Watanabe's scale Attitudes of Japanese adults toward persons with intellectual disability: Relationship between Japan Mental Nowicki et al. 2005 Pictographic Scale Measures affective aspects of attitudes by tapping into children's feelings about a target child Canada Mental Akrami et al. 2006 Modern and Classical Attitudes Scales Toward People with intellectual disabilities Attitudes toward people with intellectual disabilities Sweden Mental Findler et al. 2007 Multidimensional Attitudes Scale Toward Persons with Disabilities (MAS) Develop scale toward persons with disabilities Israel Mental Morin et al. 2013 Attitudes Toward Intellectual Disability Questionnaire (ATTID) New questionnaire for tapping into the general population's attitudes toward individuals with intellectual disability Canada Mental Henderson et al. 2020 Mental Health Knowledge Schedule (MAKS) An instrument to assess stigma-related mental health knowledge among the general public England Mental Kohrt et al. 2020 Social Distance Scale (SDS) To measure people's willingness to participate in social contacts of varying degrees of closeness to PWDs Nepal All Rossetto et al. 2020 Mental Health Knowledge Schedule (MAKS), Community Attitudes Toward the Mentally Ill (CAMI) scale, Intended Behavior Scale (RIBS) Perceptions of positive treatment and discrimination toward people with mental health problems England Mental Sarge et al. 2020 CohenÕs Identification scale, Attribution Questionnaire (AQ), Societal Attitudes Towards Autism (SATA), Helping Behavioral Intention scale Public stigma with virtual simulations US Mental Mittal et al. 2020 Attribution Questionnaire (AQ) Stigma of mental illness among primary care providers US Mental Higuera-Romero et al. 2020 Mental Health Stigmatization Scale (PMHSS-24) Stigmatizing attitudes towards mental health Spain Mental Mac Carthaigh et al. 2020 Autism Survey Questionnaire (ASQ), Openness Scale (OS), Frequency of Contact Scale (FCS), Adult Autism-spectrum Quotient Attitudes towards autism England Mental Shahwan et al. 2020 Attitudes towards Seeking Mental Health Services (IASMHS) Stigma toward people with mental disability Singapore Mental Abuhammad et al. 2021 Attitudes Toward Seeking Professional Psychological Help (ATSPPH) Scale To measure general attitudes toward seeking professional psychological help Jordan Mental Goh et al. 2021 Community Attitudes towards Mental Illness (CAMI) scale To evaluate attitudes towards depression Singapore Mental Gordon et al. 2021 Opening Minds Stigma Scale for Health Care Providers (OMS-HC-20) To measure stigma in health care provider populations New Zealand Mental Kalargyrou et al. 2021 Disability Social Relationship Scale (DSR) To measure attitudes toward PWD Austria All Kim et al. 2021 Dementia knowledge assessment scale (DKAS) To measure of dementia knowledge for diverse populations Australia Mental Kumar et al. 2021 California Assessment of Stigma Change Scale (CASC) attitude and stigma towards mental illness India Mental Magliano et al. 2021 EmployeesÕ Views About Persons with Mental Disorders Questionnaire (EVMD) employees' views about persons with mental disorders as potential workmates Italy Mental Newton-Howes et al. 2021 Recovery Attitudes Questionnaire (RAQ), Opening Minds (OM) Scale Attitudes towards recovery and less stigmatizing attitudes towards people with mental distress New Zealand Mental Reddyhough et al. 2021 Implicit Association Task (IAT), Social Distance Scale (SDS) To measure Implicit and Explicit Stigma Australia Mental Rodr’guez-Rivas et al. 2021 Questionnaire on Student Attitudes, Toward Schizophrenia (QSAS), Attribution Questionnaire (AQ-27) Stigma toward mental illness Spain Mental Annexe VIII. RŽsumŽ de la littŽrature identifiŽe Scoping Review of Publication from 2020-2021 Table AVIII.1. provides a high-level summary of the 58 articles identified through the journal database in scoping review. Specifically, data on region, study type, policy type, policy level, target population and type of disability are presented. Studies identified provide insights into areas of relevance in terms of culture change in relation to inclusion and accessibility. Following are key summary points from the identified studies: > Among the 58 articles, most are primary data collection and analysis studies (45), several are literature reviews, specifically simple reviews (3), scoping reviews (5), systematic reviews (3), and a couple are about the development of a measurement tools for estimating stigma toward PWDs (2). > The articles report on studies that have been implemented in different countries, including US (14), Australia (6), Canada (8), England (7), Germany (2), India (2), Italy (2), Japan (1), Austria (1), Jordan (1), Malaysia (1), Nepal (1), Netherlands (1), New Zealand (2), Pakistan (1), Saudi Arabia (1), Singapore (2), South Africa (1), Spain (2), Sri Lanka (1), Zambia (1). > Most studies are about persons with mental health conditions and cognitive/learning disabilities (52) (i.e., general mental health (30), autism (6), dementia (6), aphasia (1), autism (1), depression (1), developmental disabilities (1), schizophrenia (3), Alzheimer (2), and multiple sclerosis (1)Ñ5 studies address other types of disabilities and only 1 study specifically address physical disabilities. > The articles report on studies that target a wide variety of populations, including the general public (11), university students (11), PWDs (7), healthcare professionals (6), students (5), children (2), Caffe staff (1), caregivers (1), community pharmacists (1), employees (3), library staff (1), low- and middle-income countries (2), police staff (1), managers (1), parents (1), Asian Torontonians (1), African Americans (1), Asian Americans (1), and international NGOs (1). > Some studies (either primary analysis or review studies) evaluated the impact of interventions (e.g., interventions to reduce stigma, improve attitudes) (37), whereas others were descriptive, reporting on the results from surveys about attitudes towards PWDs (21). > Studies that evaluated impacts of interventions considered a wide variety of interventions, including awareness campaigns (1), combining information with imagined contacts (1), continuum interventions (1), educational interventions (17), environmental factors (1), models of practice (1), school-based schizophrenia stigma interventions (1) workplace accommodations (1), cartoons which depict autistic characters (1), contact and educational interventions (1), face-to-face programs, online resources, awareness campaigns, and advocacy work (1), exposure interventions (1), active involvement of people with dementia, environmental design, public education, raising awareness and customized strategies (1), virtual simulation engagement and observation of simulation engagement (1), job creation programs (1), contact interventions (1), culture in programs (1), dementia friendly communities (1), acceptance and commitment therapy, contact-based empowerment education and mixed interventions (1), multi-component programs (1), inclusive mental health policies and legislations, awareness programs, capacity building of mental health workforce and improved access to mental health services (1). > Several measurement tools, such as questionnaires and interviews, have been employed in order to evaluate the target outcome of studies. Evaluations of anti-stigma interventions typically assess knowledge and attitudes and rarely measure behavior toward PWDs. Although some studies assess social distance, prejudice, stereotyping, ignorance and misunderstanding toward PWDs. Most of the studies employed pre standardized questionnaires, while some has developed their own measurement tools. > Overall, identified articles provide invaluable insights into areas of relevance for culture change theory, frameworks, initiatives and indicators. Snowballing Search of Peer-Reviewed literature and Environmental Scan A high-level summary of all other identified resources through the snowballing search of peer-reviewed literature and environmental scan are available in attach excel file. Table AVIII.1. High-level summary of the 58 articles identified through the journal database search for 2020-2021 Country (Region) Study Type Policies (includes program and various types of intervention) Target Population Type of Disability US (14), Australia (6), Canada (8), England (7), Germany (2), India (2), Italy (2), Japan (1), Austria (1), Jordan (1), Malaysia (1), Nepal (1), Netherlands (1), New Zealand (2), Pakistan (1), Saudi Arabia (1), Singapore (2), South Africa (1), Spain (2), SriLanka (1), Zambia (1) Primary data collection (45), Review (3), Scoping review (5), Systematic review (3), measurement tools development (2) Awareness campaigns (1), Combining information with imagined contact (1), Continuum intervention (1), Educational intervention (17), Environmental factors (1), Model of Practice (1), School-based schizophrenia stigma interventions (1) Workplace accommodations (1), Cartoons which depict autistic characters (1), Contact Intervention, Educational intervention (1), Face-to-face programs, Online resources, Awareness campaigns, Advocacy work (1), Exposure intervention (1), Active involvement of people with dementia; Environmental design, Public education; Raise awareness; Customized strategies (1), Virtual simulation engagement; Observation of simulation engagement (1), Job creation programs (1), Contact intervention (1), Culture in programs (1), Dementia friendly community (1), Acceptance and Commitment Therapy; Contact-based Empowerment Education; combined (1), Multi-component program (1), Inclusive mental health policies and legislations; Awareness programs; capacity building of mental health workforce; improved access to mental health services (1), NA (21) General Public (11), University Students (11), PWDs (7), Healthcare Professionals (6), Students (5), Children (2), Caffe Staff (1), Caregivers (1), Community Pharmacists (1), Employees (3), Library Staff (1), Low- and Middle-Income Countries (2), Police Staff (1), Managers (1), Parents (1), Asian Torontonians (1), African American (1), Asian American (1), International NGOs (1) Health (30), Autism (6), Dementia (6), Aphasia (1), Autistic (1), Depression (1), Developmental Disabilities (1), Schizophrenia (3), Alzheimer (2), Multiple Sclerosis (1), Physical Disabilities (1), (2), All Types (5) Table AVIII.2. Identified literature from journal database search for 2020-2021 No Authors Year Country Study Type Type of Initiative Context Target population Type of Disability Objective Target outcomes Key indicators12 1 Abuhammad S. 2021 Jordan Study of initiative, program, or intervention Educational intervention University University Students Mental Health to compare the attitudes of nursing students in Jordan toward seeking professional psychological help, before and after taking part in a mental health course. Attitudes Toward Seeking Professional Psychological Help subscales Attitudes Toward Seeking Professional Psychological Help (ATSPPH) Scale 2 Algahtani. 2020 Saudi Arabia Descriptive study of a beliefs, values, attitudes and behaviours, etc. toward PWD among different populations NA NA General population Alzheimer to determine the public perception and attitude towards AlzheimerÕs disease Perception of the general public Self-administered questionnaire with 40 items 3 Beamish W. 2021 Australia Study of initiative, program, or intervention Model of Practice Schools Students Autism investigated the experiences and perceptions of Australian mainstream teachers who field-tested a validated Model of Practice designed to support their daily work with young schoolaged students on the spectrum. teacher perceptions of knowledge, confidence, and self-efficacy Semi-structured interviews and surveys 4 Borsatto J. 2021 Canada Study of initiative, program, or intervention Educational intervention Workplace Employees Aphasia to increase awareness of aphasia in businesses and to test the efficacy of our approach. employeesÕ declarative knowledge regarding aphasia and their perceived self-efficacy in the workplace Occupational Self-Efficacy Scale 5 Buckwitz V. 2021 US Study of initiative, program, or intervention Continuum intervention NA General population Depression We examined the impact of the continuum perspective on mental illness stigma (social distance, negative stereotypes) regarding MDD, hypothesizing that an increased endorsement of the continuum perspective would be associated with lower levels of stigma stigma toward individuals with depression, continuum beliefs Continuum-beliefs measure and stigma-related questionnaires 6 Eldridge-Smith ED. 2021 US Descriptive study of a beliefs, values, attitudes and behaviours, etc. toward PWD among different populations NA NA Person with disabilities Multiple Sclerosis to adapt the Reece Stigma Scale for use with this specific population and examine its reliability and validity adherence, depression, anxiety, quality of life, self-efficacy, and post-traumatic growth Reece Stigma Scale 7 Engel CS. 2020 England Study of initiative, program, or intervention Cartoons which depict autistic characters NA Children Autistic to assess the efficacy of two cartoons which depict autistic characters in improving attitudes towards autistic peers in two separate studies attitudes and knowledge about autism Chedoke-McMaster Attitudes Towards Children with Handicaps 8 Epps F. 2021 US Study of initiative, program, or intervention Educational intervention NA African American Dementia to identify the perceptions and attitudes of African American congregants toward dementia before and after attending a dementia-focused workshop perceptions and attitudes toward dementia Free association assessment exercises 9 Farina N. 2020 England Study of initiative, program, or intervention Educational intervention Schools Students Dementia to explore adolescents' reaction to of a Dementia Friends information session and how it affected their perceptions of dementia. raise awareness of dementia Dementia scale 10 Flanigan LK. 2020 Canada Literature review/evidence synthesis studies School-based schizophrenia stigma interventions Schools Students Schizophrenia to review and critically analyze the most recent (2003-present) school-based schizophrenia stigma interventions, with seven studies identified review review 11 Fung K. 2021 Canada Study of initiative, program, or intervention Acceptance and Commitment Therapy; Contact-based Empowerment Education; combination of these two Population Asian Toronto Mental Health evaluates three intervention approaches to reduce stigma of mental illness among Asian men in Toronto, Canada reduce stigma of mental illness Self-report measures on stigma (CAMI, ISMI) and social change (SJS) 12 Gaebel W. 2020 Germany Study of initiative, program, or intervention Educational intervention Healthcare Person with disabilities Schizophrenia to promote stigma coping and empowerment (STEM) was developed and tested for efficacy in patients with schizophrenia or depression Primary outcome was improvement in quality of life (QoL), secondary outcome measures (symptoms, functioning, compliance, internalized stigma, self-esteem, empowerment) quality of life (WHO-QOL-BREF), internalized stigma (ISMI), empowerment (BUES), selfesteem (Rosenberg SES), and general symptoms (SCL-27) 13 Gallego J. 2020 Canada Descriptive study of a beliefs, values, attitudes and behaviours, etc. toward PWD among different populations NA NA Students Mental Health analyzes the existing stigma among University Education students in three countries with different education systems and cultures, namely Spain, Russia, and Canada stigma Questionnaire on StudentsÕ Attitudes toward Schizophrenia (QSAS) 14 Ginevra MC. 2021 Italy Study of initiative, program, or intervention Combining information with imagined contact Public Children All Types examined the effectiveness of an intervention providing information about peers with sensory disability, intellectual disability, and behavioral difficulties (cognitive intervention), an intervention using imagined contact with peers with these disabilities attitudes; stereotypes; feelings toward and intentions to engage in contact with peers with disabilities; Behavioral Intentions Questionnaire developed by Nota et al., 15 Goh CMJ. 2021 Singapore Study of initiative, program, or intervention Educational intervention University University Students Mental Health to evaluate the effects of an anti-stigma intervention on attitudes towards depression in university students attitudes Community Attitudes towards Mental Illness (CAMI) scale 16 Gordon SE. 2021 New Zealand Study of initiative, program, or intervention Educational intervention University University Students Mental Health To assess and compare attitudes of medical students in response to two service-user-led anti-stigma and discrimination education programmes Attitudes Opening Minds Stigma Scale for Health Care Providers (OMS-HC-20) 17 Hapuarachchi RB. 2021 Sri Lanka Descriptive study of a beliefs, values, attitudes and behaviours, etc. toward PWD among different populations NA NA Caregivers Schizophrenia to describe perceived stigma among care givers of patients with schizophrenia attending outpatient clinics of NIMH stigma Self-administered 10-item questionnaire 18 Hearst MO. 2020 Zambia Study of initiative, program, or intervention Educational intervention Schools General population All Types to reduce stigma towards children with disabilities living in family-based care reduce community-level stigma towards children with disabilities Kusamala?was a feasible, acceptable and broad reach with limited program impact. 19 Henderson C. 2020 England Study of initiative, program, or intervention Educational intervention Public General population Mental Health This study investigates changes in stigma-related public knowledge, attitudes and desire for social distance in England since Time to Change began in 2008G‚™19 and for 2017G‚™19 measure of attitudes; measures of knowledge and desire for social distance Mental Health Knowledge Schedule (MAKS), Community Attitudes towards the Mentally ill scale (CAMI), Star Social Distance Scale 20 Hunter SW. 2020 England Descriptive study of a beliefs, values, attitudes and behaviours, etc. toward PWD among different populations NA NA Healthcare Professionals Dementia to assess personal, educational, and clinical experiences on physiotherapists' attitudes toward working with people with dementia dementia knowledge, confidence, and attitudes Questionnaire covered seven domains 21 Janssens KME. 2021 Netherlands Descriptive study of a beliefs, values, attitudes and behaviours, etc. toward PWD among different populations NA NA Managers Mental Health to evaluate line managers' knowledge and attitudes concerning job applicants with mental health problems (MHP), and to assess which factors are associated with the intention (not) to hire an applicant with MHP knowledge, attitudes and experiences concerning applicants/employees with MHP Questionnaire developed fitting the purpose of this study 22 Javed A. 2021 Pakistan Literature review/evidence synthesis studies Inclusive mental health policies and legislations; Awareness programs; capacity building of mental health workforce; improved access to mental health services Public Low- and middle-income countries Mental Health This paper explores various aspects of stigma towards mental health with a focus on LMICs and assesses measures to increase help-seeking and access to and uptake of mental health services. review review 23 Jones SC. 2021 Australia Descriptive study of a beliefs, values, attitudes and behaviours, etc. toward PWD among different populations NA NA General population Autism explored community attitudes to autism in Australia; and autistic people and their families' perspectives of community attitudes community attitudes to autism Questionnaire developed fitting the purpose of this study 24 Kalargyrou V. 2021 Austria Descriptive study of a beliefs, values, attitudes and behaviours, etc. toward PWD among different populations NA NA University Students Physical disabilities First, the study seeks to examine how social context (i.e., work, dating, marriage) influences attitudes toward people with physical disabilities (PWPDs). Second, it examines potential influence of participant characteristics (i.e., gender, major, disability education, and frequency of contact). Third, it explores whether attitudes vary across different disability types. attitudes toward people with physical disabilities Disability Social Relationship Scale (DSR) 25 Kim S. 2021 Australia Study of initiative, program, or intervention Educational intervention Public General population Dementia To examine the efficacy of the Dementia Stigma Reduction (DESeRvE) programme, aimed at reducing the general public dementia-related stigma utilising 'education' and 'contact' approaches. dementia-related stigma Dementia Knowledge Assessment Scale 26 Kohrt BA. 2020 Nepal Study of initiative, program, or intervention Contact intervention Healthcare Healthcare Professionals Mental Health We employed the Ôwhat matters mostÕ conceptual framework and findings from social psychology to design an intervention for reducing primary care providers stigma against patients with mental illness. We conducted a proof-of-concept testing in rural Nepal including qualitative and quantitative evaluations. stigma against persons with mental illness Social Distance Scale (SDS), knowledge assessment, attitudes assessment, ENhancing Assessment of Common Therapeutic factors (ENACT) 27 Kumar P. 2021 India Study of initiative, program, or intervention Educational intervention School Students Mental Health aimed at a change in attitude and reducing stigma related to mental illness through education attitude towards mental illness California Assessment of Stigma Change Scale 28 Liang J. 2020 US Descriptive study of a beliefs, values, attitudes and behaviours, etc. toward PWD among different populations NA NA Asian American Alzheimer study examined the prevalence and predictors of three stigmatising beliefs about Alzheimer's Disease (AD) (beliefs that associate AD with a normal process of ageing, family embarrassment and social avoidance) using a sample of Asian Americans Stigmatising beliefs about Alzheimer's Disease (AD) Self made questions 29 Magliano L. 2021 Italy Study of initiative, program, or intervention Educational intervention Workplace Employees Mental Health study explored whether the participation of people with MDs in a job-training course would positively influence employees' opinions about workmates with these disorders employees' opinions about workmates with these disorders EmployeesÕ Views About Persons with Mental Disorders Questionnaire (EVMD) 30 Mascayano F. 2020 US Literature review/evidence synthesis studies Culture in programs Healthcare Low- and middle-income countries Mental Health how much stigma reduction interventions are effective and are culturally sensitive review review 31 Mittal D. 2020 US Study of initiative, program, or intervention Contact Intervention, Educational intervention Healthcare Healthcare Professionals Mental Health our primary aim is to test the feasibility, and preliminary implementation of two interventions (contact and education) to help change provider attitudes and behavior. Stigmatizing attitudes among primary care Opening Minds Scale, Attribution Questionnaire, Social Distance Scale 32 Morgan AJ. 2021 Australia Literature review/evidence synthesis studies Face-to-face programs, Online resources, Awareness campaigns, Advocacy work Varies Healthcare Professionals Mental Health To inform implementation of this policy, this review aimed to identify and examine the effectiveness of existing Australian programs or initiatives that aim to reduce stigma and discrimination. review review 33 Murney MA. 2020 Canada Descriptive study of a beliefs, values, attitudes and behaviours, etc. toward PWD among different populations NA Healthcare Healthcare Professionals Mental Health examines health providers' understandings and experiences regarding stigma towards mental health and substance use (MHSU) issues, as well as their ideas for an effective intervention to address stigma and discrimination, in three CHCs in Toronto, Ontario experiences regarding stigma towards mental health and substance use interviews 34 Beaulieu M. 2020 US Literature review/evidence synthesis studies NA NA University Students All Types This study provides a comprehensive review of the published literature on this topic, which summarizes the clinical and practice relevance of the attitudes held by preprofessional students in the United States. review review 35 Bell S. 2021 England Descriptive study of a beliefs, values, attitudes and behaviours, etc. toward PWD among different populations NA NA Police staff Mental Health to quantifiably measure police attitudes to mental ill health and benchmark them against the public alongside qualitative data gleaned from survey responses and interviews. Ê Ê 36 Higuera-Romero J. 2020 Spain Measurement protocol development and/or evaluation NA NA Person with disabilities Mental Health aims to adapt and validate the scale of stigmatizing attitudes towards mental health among peers (Peer Mental Health Stigmatization Scale PMHSS-24) stigmatizing attitudes towards mental health Mental Health Stigmatization Scale (PMHSS-24) 37 Driscoll D. 2021 US Study of initiative, program, or intervention Educational intervention Public libraries Library staff Mental Health to identify any changes in stigmatic perceptions among public library staff regarding mental health and substance abuse, post 3-day educational sessions stigmatic perceptions Self designed survey intended to measure general stigmatic perceptions related to mental health and substance abuse collectively 38 Gandhi S. 2021 India Study of initiative, program, or intervention Exposure intervention Workplace Caffe staff Mental Health to explore and understand how and whether perception about Mental Illness (PwMI) changes when they are seen working like persons without mental illness among those availing services of ROSes cafe at NIMHANS, Bengaluru clientele attitude towards staff with mental illness Community Attitude toward Mentally Ill (CAMI) 39 Hansen A. 2021 Australia Literature review/evidence synthesis studies NA NA University Students Mental Health addressed the question: 'What is the impact of an undergraduate student's culture on their learning about mental health? review review 40 Hung L. 2021 Canada Literature review/evidence synthesis studies Active involvement of people with dementia; Environmental design; Public education; Raise awareness; Customized strategies Public Person with disabilities Dementia explores key strategies of creating inclusive dementia-friendly communities that support people with dementia and their informal caregiver. Background(s): Social exclusion is commonly reported by people with dementia review review 41 Khalifa G. 2020 Canada Literature review/evidence synthesis studies Workplace accommodations Varies Employees Autism To identify workplace accommodations that can contribute to obtaining or maintaining employment for adults with autism spectrum disorder in the peer- reviewed literature review review 42 Luelmo P. 2021 US Study of initiative, program, or intervention Educational intervention Public Parents Autism a randomized controlled pilot intervention study examining the effectiveness and feasibility of a low-intensity (i.e. three sessions), low-cost, parent advocacy intervention review review 43 Mac Carthaigh S. 2020 England Study of initiative, program, or intervention Awareness campaigns University University Students Autism explored the relationship between autism knowledge, autistic traits, frequency of contact with autistic people and attitudes towards these individuals in British and South Korean student nurses and whether these relationships were affected by the presence of autistic traits attitudes towards autistic people Autism Survey Questionnaire (ASQ), Openness Scale (OS), Frequency of Contact Scale (FCS), Adult Autism-spectrum Quotient (AQ) 44 Maki Y. 2020 Japan Literature review/evidence synthesis studies Dementia friendly community Public Person with disabilities Dementia This article discusses promoting dementia-friendly community from the perspective of human relationships within a community review review 45 Suaidi MT. 2020 Malaysia Descriptive study of a beliefs, values, attitudes and behaviours, etc. toward PWD among different populations NA NA Community Mental Health to understand the level of knowledge and attitudes of community pharmacists regarding mental health as well as to barriers to delivering effective counselling to patients with the mental illness role, knowledge, perception and barrier Questionnaire from Watkins, et al. (2017) and Owusu-Daaku et al. (2010) 46 Newton-Howes G. 2021 New Zealand Study of initiative, program, or intervention Educational intervention University University Students Mental Health to investigate the impact of a service user-led anti-stigma and discrimination education programme, encompassing numerous interventions focused on facilitating multiple forms of social contact, the promotion of recovery, and respect for human rights, on medical student attitudes attitudes Recovery Attitudes Questionnaire, Opening Minds Scale for Healthcare Providers 47 Niewohner J. 2020 US Descriptive study of a beliefs, values, attitudes and behaviours, etc. toward PWD among different populations NA NA International NGOs All Types idendify reasons that many private international non-governmental organizations (NGOs) have failed to develop disability inclusive policies Reasons for exclusion of PWD NA 48 Parker LR. 2020 US Descriptive study of a beliefs, values, attitudes and behaviours, etc. toward PWD among different populations NA NA General population Developmental disabilities investigated the nature of prejudice toward people with developmental disabilities, its potential roots in dehumanization, its implications for social policy beliefs affecting this target group, and strategies for reducing prejudice toward people with developmental disabilities nature of prejudice toward people with developmental disabilities prejudice took a hostile or ambivalent (both hostile and benevolent components), dehumanization 49 Pescosolido BA. 2020 US Descriptive study of a beliefs, values, attitudes and behaviours, etc. toward PWD among different populations NA NA University Students Mental Health To examine outcomes in a 4-year college pilot program built on stigma change research attitudes, behavioral predispositions emerged College-Specific Social Distance,General and College-Specific Prejudice, College-Specific Social Distance, Perceptions of Campus Mental Health (MH) 50 Peter LJ. 2021 Germany Literature review/evidence synthesis studies NA Varies General population Mental Health examines whether continuum beliefs are associated with lower stigma, and whether continuum interventions reduce stigma review review 51 Ran MS. 2021 US Literature review/evidence synthesis studies NA NA General population Mental Health to investigate: 1) the cultural factors related to stigmatizing beliefs about mental illness in Pacific Rim region, and 2) culture-specific measures and interventions on stigma of mental illness review review 52 Reddyhough C. 2021 Australia Study of initiative, program, or intervention Educational intervention Healthcare Healthcare Professionals Mental Health examined the efficacy of an education intervention in changing the explicit and implicit stigma held by healthcare professionals towards voice hearers explicit and implicit stigma Implicit Stigma: Implicit Association Task (IAT), Explicit Stigma: Social Distance Scale (SDS) 53 Rodr’guez-Rivas ME. 2021 Spain Study of initiative, program, or intervention Multi-component program University University Students Mental Health study focused on an online multi-component program on reducing stigma toward mental illness that included project-based learning, clinical simulations with standardized patients and E-Contact with real patients stigma toward mental illness Questionnaire on Student Attitudes Toward Schizophrenia (QSAS), Attribution Questionnaire (AQ-27) 54 Rossetto A. 2020 England Descriptive study of a beliefs, values, attitudes and behaviours, etc. toward PWD among different populations NA NA General population Mental Health findings on perceived and self-reported avoidance, discrimination, and positive treatment from the 2017 and 2019 Attitudes to Mental Illness surveys, which evaluate EnglandÕs Time to Change program. perceived and self-reported avoidance, discrimination Mental Health Knowledge Schedule (MAKS), Community Attitudes Toward the Mentally Ill (CAMI) scale, Intended Behavior Scale (RIBS) 55 Sarge MA. 2020 US Study of initiative, program, or intervention Virtual simulation engagement; Observation of simulation engagement public General population Autism examines the short-term effectiveness of engagement with a virtual simulation, Auti-Sim, to combat stigma by giving lay people a first-person experience of sensory overload perspective taking, emotional concern, helping intentions, willingness to volunteer, Positive attitudes CohenÕs Identification scale, Attribution Questionnaire (AQ), Societal Attitudes Towards Autism (SATA) scale, Helping Behavioral Intention scale 56 Schnitzler M. 2020 South Africa Study of initiative, program, or intervention Job creation programmes NA Person with disabilities All Types examines the interface between disability, social welfare and the labour market in the post-apartheid society employment NA 57 Shahin S. 2020 Canada Literature review/evidence synthesis studies Environmental factors Workplace Person with disabilities Mental Health to investigate environmental facilitators and barriers relevant to workplace participation for transition-aged young adults aged 18-35 with brain-based disabilities review review 58 Shahwan S. 2020 Singapore Study of initiative, program, or intervention Educational intervention University University Students Mental Health to examine the potential impact of an anti-stigma intervention that includes education about depression, information about help-seeking as well as contact with a person with lived experience, on help seeking attitudes. impact of an anti-stigma intervention Attitudes towards Seeking Mental Health Services (IASMHS) 1 Some common employerÕs stigma: Employing PWDs is a hassle, PWDs take more time off work, it costs more to employ PWDs, Employing PWDs require big, disruptive or expensive changes to workplace, PWDs are less productive (Woodley et al., 2012). Persons with mental illnesses are unpredictable and potentially dangerous, persons with an intellectual disability are less capable than they actually are due to lack of knowledge (Randle et al. 2017). 2 Perceived exploitability: ItÕs easier to take advantage of PWD 3 PWDs less look forward than others 4 PWDs are burden on families/society 5 e.g.: over half of PWDs worry about being insulted or harassed in the street, and 45% worry about being physically attacked by strangers (UK Government, 2021) 6 e.g.: Impatience with PWD, making fun of disabilities, ignoring PWD, treating PWDs like they have no feelings (Bollier et al., 2021). 7 https://mentalhealthcommission.ca/opening-minds/ 8 https://www.time-to-change.org.uk/about-us 9 https://www.beyondblue.org.au/ 10 https://www.health.govt.nz/publication/minds-mine-national-plan-2014-2019 11 Fragebogen zur Einstellung gegenu¬ber Ko¬rperbehindertenÕ In German 12 measures developed/used to determine outcomes --------------- ------------------------------------------------------------ --------------- ------------------------------------------------------------ Page 2 of 2 Page 2 of 2 Page 2 of 2