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Table of Contents
Year : 2016  |  Volume : 12  |  Issue : 1  |  Page : 31-34

Effectiveness of role play on attitude towards mental illness among adolescents

1 Head, Dept. of Mental Health Nursing, M.S. Ramaiah Institute of Nursing Education and Research, Bangalore, India
2 Assistant professor ESIC college of Nursing, Indiranagar, Bangalore, India

Date of Web Publication17-Jun-2019

Correspondence Address:
M Vijayarani
Assistant professor ESIC college of Nursing, Indiranagar, Bangalore, India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2231-1505.260546

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The lack of substantial knowledge concerning mental disorders is conductive to emerging of stereotypes and discrimination against the mentally ill. A pre-experimental study was conducted to assess the effectiveness of Role-play on attitude towards mental illness among adolescents studying in a selected high school at, Bettahalasoor, Bangalore, Karnataka, India” with the AimTo find the effectiveness of Role-play on attitude towards mental illness among adolescents.A Socio Demographic tool and attitude scale was used to assess the attitude. Pre-test was conducted followed with 45 min of Role-playwhich was conducted by the IV year BSc Nursing students regarding the attitude towards mental illness. The post test was conducted after 7 days. The results revealed that mean attitude prior to the role-play (66.93+8.765) and after the role-play (73.33+7.545) was statistically significant. (t=3.132, p=0.004). Male adolescents (70.69+10.012) are having higher attitude than female (63.94+6.823) counterparts (t=2.197, p=0.036). Thus the study reveals that role-play is an effective method to change the quality of attitude towards mental illness among adolescents.

Keywords: Attitude, opinion, Adolescents, school children, Role-play, and Mental illness

How to cite this article:
Balamurugan G, Vijayarani M. Effectiveness of role play on attitude towards mental illness among adolescents. Indian J Psy Nsg 2016;12:31-4

How to cite this URL:
Balamurugan G, Vijayarani M. Effectiveness of role play on attitude towards mental illness among adolescents. Indian J Psy Nsg [serial online] 2016 [cited 2023 May 28];12:31-4. Available from: https://www.ijpn.in/text.asp?2016/12/1/31/260546

  Introduction Top

The problem of stigmatization of mental illnesses is one of the reasons for exclusion from the social life of ill people. The lack ofsubstantial knowledge concerning mental disorders is conductive to emergingof stereotypes and discrimination against the mentally ill[1]. Decades of research have established that the public holds negative beliefs about persons with mental illnesses, among them that such individuals are dangerous,unpredictable, unattractive, and unworthy and are unlikely to be productive members of their communities[2]. Moreover, these negative perceptions have been remarkably constant despite advances in scientific understanding of mental illnesses and extensive efforts to improve public understanding[3],[4].

It is unlikely that these negative attitudes and misperceptions emerge full blown in adulthood, rather, they are likely to have their roots in childhood and develop gradually through childhood and adolescence. Children with Psychiatric disorder, then, may face misunderstandings and negative attitudes by their peers. Ostracism, rejection, teasing, and damage to self-esteem, as well as reluctance to seek or accept mental health treatment, are among the possible consequences[5],[6]. These consequences may be particularly relevant during adolescence andPreadolescence, a period in which onset of a variety of psychiatric disorders.

Overall, seemed to indicate that even young children view mental illnesses assomehow less desirable than other kinds of health conditions[2]. Role of education has been cited as integral to reducestigma towards mentally ill[7]. Psychoeducation is among the most effective of the evidence-based practices that have emerged in both clinical trials and community settings. Because of the flexibility of the model, which incorporates both illness-specific information and tools for managing related circumstances, psychoeducation has broad potential for many forms of illnesses and varied life challenges[8].

Education is integral to reduce stigma toward the mentally ill. Nurse educators have a key role in delivering education that reduces that stigma.It is well established that experimental methods of teaching are more effective than instructional methods and are preferred by the students[9]. The effect of roleplay simulations with patients and actors has been considered in several studies[10].

There were no studies that explored whether roleplay had an impact onadolescents of high school. In the light of the importance of stigma with in mental health and the dearth of evidence related to both how educational experiences influence attitudinal; development and the effect of role-play, hence researcher decided to explore further the effects that role-play has on attitude of adolescents. The wide spread use of roleplaying for teaching and the fact that these sessions were judged to be memorable to students further indicated that this was an appropriate focus.This study was intended to increase understanding of schoolchildren’ views of mental illness by demonstrating a role play for the high school students toward mental Illnesses.

  Materials and Methods Top

Pre-experimental research design was used for the study to accomplish the following objectives.

  • ▪To find the effectiveness of Roleplay on attitude towards mental illness among adolescents.
  • ▪To find relationship between selected socio demographic variables and the quality of attitude.

Bettahalasur is small village located around 50 km away from Bangalore. This village has population of 3573 residing in 900 families, in which around 20% were adolescents. Moreover it has higher literacy rate compared to Karnataka. In 2011, literacy rate of Bettahalasur village was 82.80 % compared to 75.36 % of Karnataka[11]. The required sample size 30 was estimated by G*Power version based on a of 0.05, power of 0.95 and with the effect size of 0.7. Random table was used to select 10th standard students studying in selected high school at Betthalsur, Bangalore, and Karnataka.

A Socio Demographic tool was constructed by the investigators, which consists of 11 items. To assess thequality of attitude towards mental illness among adolescents, an attitude scale (likert type) was constructed by the investigators and was validated by the experts.The scale contains ten positive and ten negative items.For the items the responses given were totally disagree, almostdisagree, neutral, almost agree and totally agree which was scored as 1, 2, 3, 4, and 5 respectively for the positive items whereas reverse scoring was done for the negative items.Total score ranges from 20 - 100 and is categorized into negative, neutral and positive attitude in the range of 20 – 40, 41 – 60 and 61 - 100 respectively.

After obtaining the formal permission from the concerned school authorities, pre-test was conducted followed with 45 min of Roleplay regarding the attitude towards mental illness. The post test was conducted after 7 days. Collected data were analysed with appropriate descriptive and inferential statistics.

  Results Top

Sociodemographic details

Half of the subjects were aged 15 years, and majority of 57% of them were females. An overwhelming percentage of about 90% of them belonged to Hindu religion and had nuclear family type. Only two percent of the subject has a family history of mental illness.

Effectiveness of Roleplay

[Table 1] show that the enhancement of mean attitude before the role-play (66.93+8.765) and after the role-play (73.33+7.545) is statistically significant (t=3.132, p=0.004). Similarly 73% of subject had positive attitude before the role-play and the same was increased to 97% after the role-play [Figure 1]. It revealed that the Role-play is an effective method to change the quality of attitude towards mental illness among adolescents.
Table 1: Mean, SD,‘t’ value of attitude before and after Roleplay n = 30

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Figure 1: Quality of attitude towards mental illness before and after roleplay

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Quality of Attitude before and after roleplay

  Discussion Top

Mental illness still generates misunderstanding, prejudice, confusion and fear and some people with mental illness report that the stigma is at times worse than the illness itself. People may be less willing to offer support and empathy if someone is suffering from a mental illness rather than a physical health problem. For someone with a mental disorder, the consequences of stigma can be devastating - in some cases, worse than the illness itself. Some of the harmful effects of stigma include “strategies” such as trying to pretend nothing is wrong, refusal to seek treatment, rejection by family and friends, work problems or discrimination, difficulty finding housing, being subjected to physical violence or harassment and inadequate health insurance coverage of mental illnesses. The presence in a family of a person with a severe mental disorder is often associated with a significant subjective and objective burden on other family members[12]. Results from different studies indicate that the adolescents had some understanding of mental illness as a problem of the brain with biological and psychosocial causes. But their knowledge about the treatment was insufficient, as well as their confidence about many aspects of mental illness[12]. The present study result revealsthat 73 % of adolescents who had positive attitude in the pre-test,similar finding was reported by Otto et al 2012, whereinthere was a high agreement on many items indicating positive attitudes toward mental illness[2]. Also 90% of students agreed that people with mental illness deserve respect and more efforts should be done to help people with mental illnessget better, and that jokes about mental illness are hurtful and the students also expressed strong acceptance of people with mental illness.Similarly Milovancevic M P et al identified that an antistigma program in Serbia was made a positive changes in the adolescents attitude[12]. Watson, Amy C conducted a study in 16 states of USA and identified that incorporating the Science of mental illness curriculum in the middle schools were modified the students attitude positively[13]. Michael G. Madianos found that the completion of training in psychiatry influenced the nursing students’ opinions about mental illness; they expressed less authoritarianism and discriminatory beliefs as well as positive views about social integration of mentally ill persons[14].

After the role-play the positive attitude of adolescents was increased from 73% to 97 %, similarly the neutral attitude was decreased from 27% to 3%. Thus any educational program with the specific aim to educate on mental health, mental illness and stigma could produce significant improvements in attitudes of adolescents. Findings suggest that a brief educational program can be an effective intervention to improve attitudes about mental illness and stigma connected to it[12].This result is contradictory to Roberts L M , 2008[15], wherein he reported that Single high-intensity routine teaching sessions such as role-play involving

Male adolescents (70.69+10.012) were having higher attitude than female (63.94+6.823) counterparts (t=2.197, p=0.036).This study finding was contradicted by Aleksandra Wolska, where in it was identified that there was no influence of gender on attitude1. Roberts L M 2008 identified in his study that female undergraduate students have more positive attitude towards mental illness than males[15]. Remaining other socio demographic variables were not associating with attitude. This study finding was supported by findings of the study done by Aleksandra Wolska[1].

  Conclusion Top

The role play improved more positive attitude of adolescents towards mental disorders. In addition to this, it was observed that adolescents expressed an increased need to take care of the affected people, significantly increasing their understanding of basic etiological factors leading to mental disorders, whereby they were moreready to provide help in social integration.This study reveals that the Roleplay is an effective method to change the quality of attitude towards mental illness among adolescence.

  References Top

Wolska A, Pietrulewicz B. Attitudes toward People with Mental in the Intercultural Context. : 213-40. Available from: http://www.test.grupamerlin.pl/euhe/media/_js/filemanager/user files/wydawnictwo/Polish_08/Attitudes_Toward_People_with_ Mental_Illness_stigma_in_the_Intercultural_Context1.pdf  Back to cited text no. 1
Otto Wahl, Janet Susin, Amy Lax, Lorraine Kaplan DZ. Knowledge and Attitudes about Mental Illness: A Survey of Middle School Students. PsychiatrServ [Internet]. 2012; 6 3 ( 7 ) : 6 4 9 - 54. Available from: http://ps.psychiatryonline.org/doi/pdf/10.1176/appi.ps.2011003 58  Back to cited text no. 2
Link BG, Phelan JC, Bresnahan M, Stueve A, Pescosolido B. Public conceptions of mental illness: Labels, causes, dangerousness, and social distance. Am J Public Health. 1999; 89(9):1328-33.  Back to cited text no. 3
Pescosolido B a., Martin JK, Long JS, Medina TR, Phelan JC, Link BG. “A disease like any other”χ a decade of change in public reactions to schizophrenia, depression, and alcohol dependence. Am J Psychiatry [Internet]. 2010; 167(11):1321 -30. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4429867/pdf/nih ms687376.pdf  Back to cited text no. 4
Crocker J, Major B. Social stigma and self-esteem: The self-protective properties of stigma. Psychol Rev [Internet]. 1989; 9 6 ( 4 ) : 6 0 8 - 30. Available from: http://citeseerx.ist.psu.edu/viewdoc/downloadxdoi= 9967&rep=rep1&type=pdf  Back to cited text no. 5
Ahmedani BK. Mental Health Stigma: Society, Individuals, and the Profession. J Soc Work values ethics2 [Internet]. 2011; 8 ( 2 ) : 4 1 - 6. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3248273/pdf/nih ms342711.pdf  Back to cited text no. 6
Yadav T, Arya K, Kataria D, Balhara YPS. Impact of psychiatric education and training on attitude of medical students towards mentally ill: A comparative analysis. Ind Psychiatry J [Internet]. 2012; 2 1 ( 1 ) : 2 2 - 31. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgixartid=367 8174&tool=pmcentrez&rendertype=abstract  Back to cited text no. 7
Lukens EP, McFarlane WR. Psychoeducation as Evidence-Based Practice: Considerations for Practice, Research, and Policy. Br Treat CrisInterv [Internet]. 2004;4(3):205-25. Available from: http://btci.edina.clockss.org/cgi/reprint/4/3/205.pdf  Back to cited text no. 8
Aspegren K. BEME Guide No. 2: Teaching and learning communication skills in medicine-a review with quality grading of articles. Med Teach [Internet]. 1999;21(6):563-70. Available from www.bemecollaboration.org/downloads/1168/BEME02.pdf  Back to cited text no. 9
Mino Y, Yasuda N, Tsuda T, Shimodera S. Effects of a one-hour educational program on medical students’ attitudes to mental illness. Psychiatry ClinNeurosci [Internet]. 2001; 55(5):501-7. Available from: http://onlinelibrary.wiley.com/doi/10.1046/j.1440-1819.2001.00896.x/pdf  Back to cited text no. 10
Census. Bettahalasur Population - Bangalore, Karnataka [Internet]. 2011. Available from: http://www.census2011.co.in/data/village/612895-bettahalasur- karnataka.html  Back to cited text no. 11
Pejovi M, Tenjovi L, Popovi S, Dragani S. Changing Attitudes of High School Students Towards. 2009; 21(2):213-9. Available from http://www.hdbp.org/psychiatria_danubina/pdf/dnb_vol 21_no2/dnb_vol21_no2_213.pdf  Back to cited text no. 12
Watson AC, Otey E, Westbrook AL, Gardner AL, Lamb T a, Corrigan PW, et al. Changing middle schoolers’ attitudes about mental illness through education. Schizophr Bull [Internet]. 2004; 3 0 ( 3 ) : 5 6 3 - 72. Available from: http://www.researchgate.net/profile/Patrick_Corrigan2/publicati on/8100273_Changing_middle_schoolers’_attitudes_about_m ental_illness_through_education/links/02e7e5162f9e9c934100 0000.pdf  Back to cited text no. 13
Madianos MG, Priami M, Alevisopoulos G, Koukia E, Rogakou E. Nursing students’ attitude change towards mental illness and psychiatric case recognition after a clerkship in psychiatry. Issues Ment Health Nurs. 2005; 26(2):169-83.  Back to cited text no. 14
Roberts LM, Wiskin C, Roalfe A. Effects of exposure to mental illness in role-play on undergraduate student attitudes. Fam Med [Internet]. 2008; 40(7):477-83. Available from: http://mail.fmdrl.org/fmhub/fm2008/July/Lesley477.pdf  Back to cited text no. 15


  [Figure 1]

  [Table 1]


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