Stigma Attitudes Research Articles

A clinical study to assess disability and stigma associated with psoriasis

<p class="abstract"><strong>Background: </strong>Psoriasis relatively common, chronic, inflammatory and hyper-proliferative skin disease that affects 1.4% to 2.0 % of the population. Pateints with psoriasis have to face severe problems with stigmatization, discrimination and negative attitudes in general among the public, and often bear the brunt of public rejection.</p><p class="abstract"><strong>Methods: </strong>A cross-sectional observational study was carried out on psoriasis patients attending dermatology outpatient department of Era’s Lucknow medical college and hospital between November 2018 and November 2020. Patients with pustular psoriasis, mycosis fungoides, pityriasis rubra pilaris, and other severe medical conditions like heart failure, liver cirrhosis were excluded from the study.</p><p class="abstract"><strong>Results: </strong>Present study included 170 (aged 16 to 76 years; mean age 37.74±13.70 years; 62.4% males) clinically diagnosed patients of Psoriasis. P-score was observed with increase in Body Surface area, maximum for cases with BSA ≥25%. There was a strong positive significant linear correlation between stigmatization scores and disability scores (r=0.746; p<0.001), thus indicating that with increase in p scores there was a significant increase in PDI scores and vice versa.</p><p class="abstract"><strong>Conclusions:</strong> Present study showed that feeling of stigmatization and disability was highly prevalent in psoriasis patients. It was seen that stigmatization and disability showed a strong correlation. The findings of study showed that there is need to create awareness regarding psoriasis as a non-communicable disease in order to increase the acceptance of psoriasis patients in society and to reduce their stigmatization.</p><p class="abstract"> </p>

Exploring the soft side of success: non-cognitive and social factors impacting attitudes towards adult education for GED students

ABSTRACT Adult education centres provide a final opportunity for adult learners who have transitioned out of mainstream schools to earn a high school degree. These centers overwhelmingly serve low-income, African-American and Latinx students whose needs were not met by traditional schools. Adult Education Centers are underfunded, under-resourced and challenged with high attrition rates. Little is known about factors that promote adult education persistence in the adult education context. To address this, the authors conducted a cross-sectional study examining the relationship between social support, coping through emotional processing and expression, stigma consciousness and attitudes towards participation in adult education. Results indicate that higher levels of self-reported coping (via emotional processing) and social support improve attitudes towards adult education and higher levels of self-reported stigma consciousness increase negative attitudes towards adult education. Study findings have significant policy implications for constructing student centred supports for adult education students who experience multiple levels of social inequality.

Cracks in the ice: a digital health initiative disseminating evidence-based information about ‘ice’

Abstract Background Crystal methamphetamine (‘ice') causes significant societal harm and attracts a high level of concern in Australia. Cracks in the Ice (CITI: cracksintheice.org.au) is a digital public health initiative that was developed as part of a national response to concerns about ice. CITI is the first centralised national online portal for evidence-based information and resources about ice in Australia. It provides targeted information and resources for health workers, people who use ice, their family and friends, community groups and schools. CITI was developed collaboratively with input from drug and alcohol experts and over 500 Australian community members, including people with lived experience. A national online survey was conducted to evaluate whether CITI is meeting the needs of the Australian community. Methods Eligible participants were Australian residents aged 18 years and over, and were recruited via the CITI website, email direct marketing, and social media. The survey assessed participants' perceptions of CITI (e.g., usability, navigation, utility) and their knowledge and attitudes about ice. Results 2110 participants completed the survey, including people who use ice, affected family members, health workers, and general community members. Participants' response to CITI was overall positive and their knowledge of ice was generally good, but many held negative or stigmatising attitudes towards ice and people who use it. Conclusions Digital public health initiatives stand to overcome structural, geographical, and attitudinal barriers to alcohol and other drug (AOD) prevention efforts. CITI ensures evidence-based information about the drug ice is readily available across all of Australia. Community evaluations have shown that CITI is meeting the needs of the Australian community. Key messages Crystal methamphetamine (‘ice’) attracts a high level of concern in Australia. CITI is the first centralised national online portal for evidence-based information and resources about ice. Digital health initiatives stand to overcome structural, geographical, and attitudinal barriers to AOD prevention. Community evaluations ensure these initiatives meet the needs of their end-users.

The importance of mental health literacy in times of crisis: Adolescent mental health during the COVID-19 pandemic

Abstract Many adolescents do not seek appropriate help when they experience mental health problems (MHP). Especially during the COVID-19 pandemic, this has become an increasingly pressing public health problem as more adolescents experience MHP due to social isolation, problematic home environments, and lack of future outlooks. Strengthening adolescents' competencies to cope with MHP (so called mental health literacy (MHL)) has the potential to prevent worsening of problems and delayed help-seeking. However, the implementation of MHL interventions remains absent or short-lived. To stimulate its implementation, this study explored attitudes of adolescents regarding mental health, help-seeking, and MHL interventions. We used a mixed-methods design including online focus group discussions and interviews, and surveys. Data collection took place since April ‘20. Participants were recruited online, through social media. So far, 58 adolescents (ages 13 and 19) attending secondary school in the Netherlands participated in this study. The data collected includes mental health status pre-, during, and post-lockdown as well as attitudes on mental health support and education. Our qualitative data analysis follows the principles of thematic analysis. We found that adolescents experience a lack of attention for mental health in secondary education as well as stigma and negative attitudes towards mental health treatment and help-sources, in general and during COVID-19. The participants voiced that they would like to know more about mental health and illness, help-sources and normalize the conversation of mental health. The attitudes of adolescents aided in shaping ideas for the implementation of mental health education. Our preliminary findings suggest that MHL and its related competencies are necessary to be able to (self-)manage one's own and others mental health especially in situations of crisis (e.g. COVID). This may decrease the disadvantageous characteristics of long-term MHP.

HIV/AIDS stigma among University students in Ancona (Italy) and Novi Sad (Serbia)

Abstract Background Sigma associated with HIV/AIDS can be a considerable barrier to HIV prevention. The aim of the study was to assess factors associated with stigmatizing attitudes among university students. Methods The study was conducted as a cross-sectional study among 1305 university students in Ancona (Italy) and Novi Sad (Serbia) from October to December 2020 (67.7% females). The mean age of participants was 21.94 ± 2.45. The instrument of the study was an online questionnaire that included socio-demographic data and questions about attitudes toward HIV/AIDS. Stigma was analyzed using five questions and the stigma score was calculated (a lower score indicated a higher stigma attitude). Results Among University students 89.7% would share a classroom with a student with HIV/AIDS, 2.5% of students think that students with HIV/AIDS should have separate classes and 5.8% are not sure if they should be in separate classes. Only half of the students (50.1%) said that they would share a bathroom with HIV/AIDS positive students and 80.4% said that they would buy fruits from a HIV/AIDS positive person. Every second student (55.1%) thinks that HIV-positive women should have children. The mean stigma score of the respondents in this study was 3.66 ± 1.26. Stigma score was lowest among youngest participants and among students at lower study year. The stigmatizing attitude was less present among students of medicine (4.09), comparing to other faculties (3.33) (p < 0.001). There were no statistical differences according to gender, data about who they live with, material status of the family and between Universities. Conclusions Results of this study showed that there are some negative attitudes toward people living with HIV/AIDS among university students. The stigmatizing attitude was more common among younger students. Key messages Stigmatizing attitude toward HIV/AIDS is still present among younger generations. Need for more health promotion activities among students from both countries.

Australian paramedic students’ mental health literacy and attitudes towards mental health

PurposeAustralian paramedics regularly encounter patients experiencing mental illness. However, some paramedics hold negative attitudes towards the use of emergency services in providing care for these patients. Thus, the purpose of the present study was to examine the mental health literacy (MHL) of Australian paramedic students, and the training and experiential factors associated with MHL.Design/methodology/approachA cross-sectional online survey was delivered to paramedic students across Australia. A total of 94 paramedic students completed the survey examining MHL, mental health first aid (MHFA) intentions, confidence in providing help, personal and perceived stigma and willingness to interact with a person experiencing mental illness.FindingsParticipants generally had poor MHFA intentions in spite of good recognition of mental health disorders and good knowledge about mental health. Participants also demonstrated low stigmatising attitudes towards mental illness; however, they expressed a lack of willingness to interact with a person experiencing mental illness.Originality/valueOur findings propose a combination of work-based experience and specific MHFA training may be beneficial to paramedic students to improve care for patients experiencing mental illness.

Comparison of the Effects of a Genetic, a Mild Encephalitis, and a Psychosocial Causal Explanation of Schizophrenia on Stigmatizing Attitudes - a Pilot Study With a Quasi-Experimental Design.

Background: Previous research has shown that the endorsement of biogenetic causal explanations of schizophrenia is associated with stronger stigmatizing attitudes against people with schizophrenia than the endorsement of psychosocial explanations. However, little is known about whether different biogenetic causal explanation beliefs differentially affect stigmatizing attitudes. This is particularly valid for the endorsement of the mild encephalitis hypothesis of schizophrenia.Aim: To examine to what extent different causal explanations of schizophrenia influence the desire for social distance from persons with schizophrenia.Methods: A study with a prospective, quasi-experimental design was carried out with students in Germany (N = 333). A case vignette depicting a person with schizophrenia-typical symptoms was presented, and a social distance scale (SDS) was used to measure the stigmatizing attitude against the person described. Participants were randomly assigned to one of three groups receiving different causal explanations of schizophrenia (genetic, mild encephalitis hypothesis, or psychosocial) without treatment information.Results: A one-way ANOVA showed that the mean SDS was lowest in the group with the mild encephalitis hypothesis explanation, followed by the genetic explanation group, and highest in the psychosocial explanation group. However, the differences between the groups were small and not significant. A subanalysis revealed a significant interaction between gender and causal explanation. Women showed a significantly lower desire for social distance than men when receiving the mild encephalitis hypothesis. Neither the study discipline nor the number of semesters of study had significant effects on the mean SDS. The differences between the mean SDS scores for the different items were much bigger than the differences for the different causal explanations. Regardless of the causal explanation, the extent of the desired social distance depends strongly on social proximity.Conclusion: The present study fits into previous research, which has found that biogenetic beliefs were either associated with more social distance or did not yield a statistically significant association. Although we found a small gender-specific effect of the endorsement of the mild encephalitis hypothesis, we do not recommend gender-specific anti-stigmatization campaigns because they might rightly raise suspicions of dishonesty and manipulation. Rather we support recovery-oriented messages focusing on effective treatments.

Can an online mental health training programme improve physician supervisors' behaviour towards trainees?

Physician trainees have elevated rates of psychological distress, mental disorders and suicide. Physician supervisors can support the mental health needs of trainees. To test the feasibility and acceptability of a tailored online mental health training programme and to ascertain the potential effectiveness of the programme to alter the confidence and behaviours of physician supervisors. Thirty Australian hospital-based physicians who were supervising physician trainees participated in this quasi-experimental pre-post pilot study. All received the intervention that comprised 12 5-min modules to complete over a 3-week period. Baseline and post-intervention data were collected. The primary outcome evaluated participants' confidence to respond to trainees experiencing mental ill-health and promote a mentally healthy workplace. Secondary outcomes evaluated change in self-reported behaviour, mental health knowledge and stigmatising attitudes. Differences in mean scale scores for each outcome measure from baseline and post-intervention were compared using paired sample t-tests. Thirty physicians completed the baseline assessment and 23 (76.7%) completed all programme modules. Most participants found the programme engaging, interesting and useful. Post-intervention data, available for 25 (83.3%) participants, showed a significant increase in participants' knowledge of their role in supporting trainees under their supervision (P = 0.002), confidence to initiate conversations about mental health with staff (P < 0.001), and application of preventive and responsive supervisory behaviours to support the mental health needs of those they supervise (P < 0.001). This online mental health training programme for physician supervisors was feasible and associated with improved confidence and behaviour to support the mental health needs of trainees they supervised.

Attitudes towards people with mental illness among medical students: A qualitative research

Psychiatric illnesses affect more than 450 million people worldwide, with several consequences for those who are affected, along with the presence of high numbers of discrimination, stigmatization, and negative attitudes of the general population. These negative attitudes have been observed even in health professionals, negatively impacting on the quality of care, adherence to treatment and well-being of affected users. This study describes attitudes of medical students towards people with psychiatric illness from a qualitative perspective, through the analysis of thematic content of 12 semi-structured interviews conducted with first- to fourth-year medical students. Among the results, a diversity of identified attitudes outstands, including empathy, frustration, indifference and rejection, uncertainty and fear, tolerance and social acceptance. As a discussion, it is stated that most of the findings were consistent with the international literature, however there are new findings that are not described, highlighting the attitude of fear of being harmed and the rejection towards people with psychiatric pathologies. The design and implementation of educative interventions that facilitate contact with users, in order to reduce stigma and negative attitudes in future medical professionals, is concluded as an urgent challenge. Finally, it is proposed for future research to develop longitudinal and comparative studies that consider measuring the effectiveness of these interventions.

Mediating effect of stigma on the relationship between mental health literacy and help-seeking attitudes among university students in South Korea

Recent evidence demonstrates that improved mental health literacy and decreased stigma are two essential components to facilitate help-seeking behaviors and early identification of mental disorders. This study aimed at examining whether social and self-stigma mediated the level of mental health literacy on help-seeking attitudes among university students in South Korea. In this cross-sectional survey, 305 students from six universities in South Korea (female: 59%, age: 21.76 ± 3.11) joined the study. The survey included self-report measures of mental health literacy, social stigma, self-stigma, and help-seeking attitudes, as well as socio-demographic measures. Findings revealed that social and self-stigma partially mediated the association between the level of mental health literacy and mental health help-seeking attitudes among South Korean university students. Based on results, the importance of education and campaign to enhance mental health literacy and decrease stigma regarding mental health problems among university students in South Korea was highlighted.

Exploring public attitudes towards men with depression: a thematic analysis

Background/Aims Men with depression often experience stigmatising attitudes from the general public, which can cause distress and affect their help-seeking behaviours. This study aims to expand the research on public stigma by exploring public attitudes towards men with depression. Methods Five women and two men who had not experienced depression personally were recruited to this study and took part in semi-structured interviews. Thematic analysis was employed to analyse their data. Results The main themes that emerged concerned awareness, depression as a gendered phenomenon and the generational divide. The participants conveyed that older generations exhibit greater stigmatising attitudes, that awareness in men's experience of depression is lacking and that public stigma is intrinsically linked to societal expectations of how a man should behave. Conclusions These themes highlight areas for further research, and the themes that have been identified should be taken into consideration when creating destigmatisation materials aimed at the general public.

COVID-19-related stigma and its influencing factors: a nationwide cross-sectional study during the early stage of the pandemic in China

ObjectivesTo describe the situation of COVID-19-related stigma towards patients with COVID-19 and people from the city of Wuhan in China and to assess the associations between COVID-19-related stigma, health literacy...

Effectiveness of a structured short intervention against stigmatisation in chronic visible skin diseases: Results of a controlled trial in future educators.

BackgroundChronic visible skin diseases are highly prevalent, and patients affected frequently report feeling stigmatised. Interventions to reduce stigmatisation are rare.ObjectivesThis study aimed to evaluate the effectiveness of a structured short intervention in reducing stigmatising attitudes towards psoriasis in future educators.MethodsThe intervention consisted of four components: (1) self‐reflection, (2) education on skin diseases, (3) contact between participants and a person with psoriasis and (4) practising of knowledge via case studies. A quasi‐experimental, pre–post study design was chosen with a nonrandomized contemporaneous control group that attended regular lessons. The main outcomes were participants' desire for social distance, stereotype endorsement, illness‐related misconceptions and intended behaviour. Intervention effects were analysed using mixed repeated‐measures analysis of variance, with Bonferroni post‐hoc tests for pairwise comparisons.ResultsThe sample consisted of 221 students attending vocational training as educators (n = 118 intervention group, n = 103 control group). While no effect of the intervention was found in social distance, small to large effect sizes were observed for intended behaviour (r = .14), illness‐related misconceptions (r = .28) and stereotype endorsement (r = .42). The intervention group reported significantly higher satisfaction with the seminar compared to the control group.ConclusionsOverall, the short intervention was effective at reducing stigmatising attitudes in future educators. In perspective, revised versions could help in reducing stigmatisation in various demographics and promote patient empowerment by acknowledging and including them as experts on their own behalf.Patient or Public ContributionPatient advocate groups were consulted and involved in the superordinate destigmatization research programme and intervention.

Knowledge and attitudes toward epilepsy among people in Sfax region, Tunisia

IntroductionEpilepsy is one of the most stigmatizing disorders. Stigma and negative attitudes associated with epilepsy are due to poor public awareness and knowledge. This study evaluated knowledge, awareness, and attitude toward epilepsy among Tunisian general population. MethodsThis was a cross-sectional study conducted between 2017 and 2019. On national epilepsy day on February and during awareness campaigns at Sfax Tunisia, we asked people who visited the epilepsy stand to anonymously answer a 31-item questionnaire on epilepsy. ResultsFive hundred and four participants have been included. About 43.6% of participants had personal or familial history of epilepsy. More than seventy percent of subjects thought that epilepsy is a neurological disease and 34.1% believed it is psychiatric. Majority (92.1%) of our population believed that epilepsy is non-contagious but 37.7% thought it is hereditary and 55.8% thought it causes intellectual deficiency. EEG was the most reported diagnostic method (61.7%). The two most popular therapeutic modalities reported in our population were drug treatment alone (85.3%) and associated with Quran (35.3%). Most (91.1%) of people thought that a person with epilepsy can get married. A person with epilepsy is able to study according to 92.7% of respondents, but 66.3% assumed that he/she suffers from difficulty concentrating. Subjects younger than 45 years were more aware of the ability of people with epilepsy to study and get married. We did not find any significant differences in knowledge and attitudes between subjects familiar with epilepsy and the rest of the population. ConclusionThe public knowledge and attitudes toward epilepsy were acceptable with regard to this study. However, negative attitudes and misunderstanding still exist.

Stigmatizing Attitudes Toward Depression Among Male and Female, Medical and Non-medical Major College Students.

Background: Stigma is often reported to be a barrier to the treatment and rehabilitation of depression. However, little is known about stigma toward people with depression among college students in China.Methods: Using a questionnaire with a case vignette describing depression, a total of 1,056 students from nine colleges/universities in Hunan Province of China were included in this study. The questionnaire addressed the attitudes toward depression and the desire for keeping a distance from depressed individuals. The current study explored the stigma attitudes of college students toward people with depression and the desire for social distancing, as well as the gender (male and female) and major (medical and non-medical) differences.Results: Over half of the respondents agreed that people described in the vignette were “dangerous” (60.7%) and “could snap out of the problem” (58.7%). Compared with female students, males were more likely to agree that “If I had this problem, I would not tell anyone” (7.0 vs. 13.2%, p = 0.001); compared with non-medical students, medical students were more likely to agree that “The problem is a sign of personal weakness” (38.0 vs. 50.0%, p < 0.001). A lot of respondents would be unwilling to “marry into the family of people with depression” (71.1%) or “work closely with them” (45.1%). Compared with male students, females were more unwilling to “work closely with them” (40.3 vs. 47.5%, p = 0.026).Conclusion: This study found that a high proportion of Chinese college students showed stigma toward and desire for social distancing from people with depression, male students and medical major students showed higher stigma in some subscale items toward people with depression. The present results suggest that more anti-stigma interventions should be applied for Chinese college students to help prevent or reduce stigma attitudes toward people with depression.

An investigation of college student-athletes’ mental health stigma, help-seeking attitudes, depression, anxiety, and life stress scores using structural equation modeling

ABSTRACT The purpose of this study was to investigate the directional relationship between student-athletes’ (N = 621) degree of mental health stigma, help-seeking attitudes, and levels of depression, anxiety, and life stress. The results of the structural equation model (SEM) analyses identified that student-athletes’ amount of mental health stigma contributed to help-seeking attitudes (25.6% of the variance), but not levels of depression (.16% of the variance), anxiety (.09% of the variance), or life stress (.81% of the variance). Specifically, student-athletes’ mental health stigma shared a strong negative relationship with attitudes towards seeking psychological help (β = −.506, p < .001) and the mediation models identified that personal stigma mediates the relationship between public stigma and help-seeking attitudes. Implications purport the need to address the stigma of mental health at the societal level in order to mitigate personal stigma and promote a positive sport culture surrounding mental health and health help-seeking within athletes.

Suicide literacy, suicide stigma, and psychological help seeking attitudes among Arab youth.

To date, very little is known about the current situation of suicide and its effects on psychological help-seeking attitudes in Arab countries. Therefore, this study aimed to assess the levels of suicide literacy and suicide stigma and their relationships with attitudes towards seeking psychological help among a sample of Arab youth in Jordan. A descriptive, correlational, cross-sectional study was conducted using an anonymous online self-report survey to collect data. This study included a total of 707 Arab youth aged 16–24 years (mean = 18.60, SD = 1.95). Most of the participants were male (n = 398, 56.3%). The participants were found to have very low suicide literacy levels, relatively high suicide stigma levels, and negative attitudes towards seeking psychological help. Family members, relatives, and friends were the most frequently reported sources of psychological help, while mental healthcare professionals were the least frequently reported sources. A significant negative correlation was found between attitudes towards seeking psychological help and both stigmatization and glorification subscales of suicide stigma. While a significant positive correlation was found between attitudes towards seeking psychological help and suicide literacy. The predictors of attitudes towards seeking psychological help were gender, suicide literacy, and glorification of suicide stigma among Arab youth. The results of this study confirm the presence of an urgent need for designing and implementing educational programs and awareness campaigns on suicide and mental health among youth in schools and universities. Such interventions may increase knowledge, decrease stigma, change psychological help-seeking attitudes, and hence improve the use of mental health services and may prevent suicide among this age group.

How Self-Disclosure in Online Postings Affects Female Readers’ Stigmatisation Towards Mothers with a Disability

Self-disclosure of a health problem or a disability in online environments can be helpful to reduce stigmatisation and to empower marginalised individuals. Although stigmatisation leads to adverse health outcomes, it is still unclear which factors reduce readers’ stigmatising attitudes. This 2 × 2 × 3 × 2 online-experiment with 715 female participants examined how the depiction of self-disclosure of a mother’s disability, her coping with a stressful situation, and the child’s type of disability and sex in a fictional blog post affect female readers’ stigma-related attitudes. The role of readers’ perspective taking is also studied in this regard. A MANOVA yielded two main effects: Disclosure of the mother’s disability reduced social distance compared to the control condition (no disability). Female respondents with a high ability for perspective taking reported less stigmatising attitudes than female respondents scoring low in this regard. Both effects are also reflected in a four-way interaction with mother’s coping and child’s sex. Overall, results indicate a high potential of self-disclosures for anti-stigma communication. Implications for blogging about a disability and future health communication research are discussed.

English

BACKGROUND Mental and behavioural disorders are prevalent in all societies. The stigma and poor attitude towards mental illness and those with mental illness is well known. Similarly, there also exists poor opinions about psychiatrists and psychiatric medications among people. Non psychiatric doctors act as a bridge between the psychiatrists and mentally ill people. This study was conducted to evaluate the attitudes of non-psychiatric doctors towards psychiatrists, psychiatric medications, and mental illness. METHODS The study design was cross sectional, conducted in a town of Andhra Pradesh. A structured proforma was used to capture the sociodemographic details and to measure attitudes towards psychiatrists and psychiatric medications. We used a questionnaire used by Zieger et al. Similarly, to measure the attitudes towards mental illness, belief towards mental illness (BTMI) used by Hirai and Clum was used. The data was analysed using R language, and results obtained were tabulated and discussed. Data was analysed using non parametric tests. RESULTS There were no significant negative attitudes of non-psychiatrists towards psychiatrists and mental illness. But we found significant negative attitudes expressed by medical specialists (P = 0.035) and those in academic settings (P = 0.020) towards psychiatric medications. On comparing the other demographic details there were no significant negative attitudes towards psychiatric medications. CONCLUSIONS Previous studies have found negative attitudes among non-psychiatrists towards psychiatry, psychiatrists and mental illness. But our study found that there are positive attitudes expressed by non-psychiatric doctors towards psychiatrists and mental illness which is a good sign. We believe this is a changing trend towards positive side when compared to past studies. Future studies should be longitudinal and to keep in focus the new curriculum changes. KEYWORDS Attitudes of Health Personnel, Psychiatry, Mental Disorders

A qualitative study of autism services and supports in Singapore: Perspectives of service providers, autistic adults and caregivers.

Because autism is a lifelong and complex condition, autistic people may need a range of supports cutting across different sectors (e.g. health, education and social care) at different stages of their lives. Studies in some countries have shown that autistic people and their families face difficulties accessing the services they need, but no research has been done on this topic in Singapore. To start addressing this gap, we interviewed 21 service providers, autistic adults and caregivers/parents of autistic children to find out their perceptions and experiences of autism services and supports in Singapore. Our participants told us that beyond improving access to autism-specific services, they also hoped to see more flexible supports in an inclusive environment and a broader change in societal attitudes. This study highlights that autism service provision should be informed by autistic voices and not only focus on impairment but also recognise the strengths of autistic people alongside their very real needs. The whole of society - including policymakers, professionals, employers, educators, families and autistic people themselves - needs to work together to fight autism stigma and discrimination.