Through education: reducing stigma and building more inclusive care environments

In health care and aged care, the pursuit of excellence cannot be separated from the pursuit of inclusion. As Dr ROSHMEEN AZAM, Chief Medical Officer of Altura Learning, explains, the way we educate our workforce determines not only the quality of clinical outcomes, but also the dignity with which those outcomes are achieved.

Stigma remains one of the most persistent barriers to equitable care. It is rarely explicit. More often, it is embedded in the small, habitual moments of care, a hesitation to make eye contact, a label applied too quickly, an assumption that limits someone’s potential to participate in their own decisions. These quiet biases can shape the experiences of people living with disability, dementia and mental illness, or from culturally and linguistically diverse and LGBTQIA+ communities.

Education, when purposefully designed, has the capacity to challenge those patterns, dismantle stigma and enable the creation of truly inclusive care environments.

Understanding the mechanisms of change

The relationship between education and inclusion is not linear; it is dynamic. Education changes attitudes not simply by imparting knowledge, but by shaping the internal processes through which individuals interpret differences.

There are four primary mechanisms through which education reduces stigma in care environments:

1. Awareness through reflection

Effective learning programs move beyond transmission of facts. They invite reflection, asking healthcare professionals to consider their own perceptions and biases, and how those influence their clinical judgment and interpersonal interactions. Reflection is the bridge between knowledge and empathy.

2. Exposure through lived experience

Stigma often thrives in distance. Education that incorporates the voices and experiences of people receiving care narrows that gap. Hearing directly from those who have been marginalised shifts care from being about patients to being about people.

3. Competence through skills

Empathy without skill can leave practitioners uncertain about how to act inclusively. Education must equip learners with practical competencies, language, frameworks and evidence-based strategies that translate empathy into effective practice.

4. Reinforcement through culture

Sustained education normalises inclusion as professional behaviour. Ongoing learning, mentorship and reflective supervision reinforce inclusion until it becomes an organisational norm rather than an individual effort.

From awareness to cultural transformation

It is tempting to see stigma as a personal failing, the product of prejudice in individuals. Yet in healthcare systems, stigma is often systemic. It is reinforced by structural constraints, outdated protocols and power imbalances.

Education therefore must target more than the individual learner. It must engage the entire ecosystem in which care is delivered: policy, leadership, language and team dynamics.

A truly inclusive learning framework positions inclusion as a clinical competence, not a soft skill. It treats the ability to provide non-judgmental, person-centred care as an indicator of professional excellence.

When inclusion is reframed in this way, education becomes a quality improvement tool — directly linked to outcomes such as adherence to treatment, patient satisfaction and staff wellbeing.

Designing education for impact

The most effective education for reducing stigma is multi-layered and evidence-informed. Several principles underpin this approach:

• Contextual relevance: training must speak to the real environments in which care is delivered — the time pressures, emotional demands and workforce diversity of modern health and aged care. Generic or abstract content fails to resonate.
• Reflective practice: learning that integrates guided reflection allows staff to connect theory to personal experience. Reflection nurtures humility and the capacity to listen — both prerequisites for inclusion.
• Psychological safety: staff must feel safe to acknowledge their biases without fear of judgment. Psychological safety is not indulgence; it is the condition under which genuine learning occurs.
• Leadership modelling: culture shifts when leaders participate visibly in learning, share their reflections and demonstrate inclusive decision-making. Leadership behaviour is the strongest predictor of sustained change.
• Measurement and feedback: inclusion should be monitored and evaluated like any other aspect of clinical governance. Data on satisfaction, engagement and incident trends can illuminate the impact of educational initiatives.

The evidence for inclusive education

Emerging international and Australian studies increasingly underscore the link between stigma-reduction education and care quality. In dementia care, a recent review of staff education interventions reported consistent positive effects on learning, behaviour and satisfaction outcomes, noting that training improved staff confidence in communication, person-centred care, and competence to respond to complex needs.¹ In mental health, a systematic review of workplace stigma interventions found moderate effect sizes in reducing stigmatising attitudes among employees following structured training programs, with improvements in knowledge, attitudes and reported intentions to intervene.²

In aged care, while rigorous intervention trials remain rare, workforce literature from Australia and globally points to the crucial role of education and training in mitigating turnover. A systematic review of factors influencing aged care worker retention identified that on-the-job training and development opportunities correlate strongly with lower attrition and higher job satisfaction.³ In Australian residential aged care, a cross-sectional staff survey found that job satisfaction is closely associated with staff retention and with better care outcomes, including fewer resident disturbances and better patient satisfaction metrics.⁴

While few studies directly quantify reductions in complaints or direct causal shifts in patient satisfaction resulting from inclusion training, the alignment is compelling: organisations that prioritise staff learning, psychological safety and reflective education report healthier cultures, more engaged teams and lower turnover trajectories. When individuals feel seen, respected and supported, compliance, engagement and wellbeing improve not by accident, but as the necessary outcome of inclusive education.

Moreover, this evidence is consonant with national and regulatory imperatives. In Australia, stigma and discrimination notably affect healthcare access and patient experience across numerous settings (as documented in the National Survey of Mental Health-Related Stigma and Discrimination, involving over 7800 Australians)⁵, and reviews of stigma-reduction initiatives in Australia emphasise the centrality of educational contact with lived experience voices as a best practice approach⁶. In this light, inclusive education is not optional, it is aligned with our ethical and regulatory responsibility to uphold dignity, autonomy and equality in every care interaction.

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Translating learning into everyday practice

For education to influence care environments, it must move beyond the classroom. Reflection must become part of routine clinical dialogue, during handovers, debriefs and team meetings.

Supervisors should be supported to facilitate conversations about inclusion, exploring questions such as:

• “Whose voice might be missing from this decision?”
• “How might cultural or cognitive factors shape this interaction?”
• “What assumptions are we making?”
   

These conversations do not require additional resources; they require intent. Over time, they cultivate a workforce that is attuned to diversity and responsive to individual needs.

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A shared responsibility

Reducing stigma through education is not solely the responsibility of educators or trainers. It is a collective professional duty, one that sits at the intersection of ethics, safety and quality.

Every member of the healthcare team contributes to shaping culture, from senior clinicians to new graduates. The language we use, the questions we ask, the empathy we show all signal what we value as a profession.

When we educate ourselves and others to understand difference not as a challenge but as a dimension of human experience, we lay the groundwork for inclusion to flourish.

Towards a more inclusive future

The future of health care and aged care demands more than technical proficiency. It demands emotional intelligence, cultural literacy and moral courage. Education is the mechanism through which these qualities are cultivated.

Reducing stigma is not an ancillary task; it is central to delivering safe, compassionate and effective care.

As clinicians and leaders, we must ensure that every learning encounter from induction to continuing professional development reaffirms one message: inclusion is not optional. It is integral to the integrity of care itself.

Education is how we uphold that integrity. It is how we turn our values into practice, and our intentions into impact.

Dr Roshmeen Azam is Chief Medical Officer of Altura Learning.

^{1. Rasmussen BM, Andersen PT, Waldorff FB, Berg-Beckhoff G. Effectiveness of dementia education for professional care staff and factors influencing staff-related outcomes: an overview of systematic reviews. Int J Nurs Stud. 2023;142:104469. doi: 10.1016/j.ijnurstu.2023.104469}

^{2. Tóth MD, Ihionvien S, Leduc C, et al. Evidence for the effectiveness of interventions to reduce mental health related stigma in the workplace: a systematic review. BMJ Open. 2023;13(2):e067126. doi: 10.1136/bmjopen-2022-067126}

^{3. Thwaites C, McKercher JP, Fetherstonhaugh D, et al. Factors impacting retention of aged care workers: a systematic review. Healthcare (Basel). 2023;11(23):3008. doi: 10.3390/healthcare11233008}

^{4. Cameron E, Noble N, Bryant J, et al. Job satisfaction and regulation in the aged care sector: staff perspectives. BMC Health Serv Res 2023;23:1421. doi: 10.1186/s12913-023-10472-0}

^{5. Commonwealth of Australia, Department of the Prime Minister and Cabinet, National Survey of Mental Health-Related Stigma and Discrimination. https://www.pmc.gov.au/sites/default/files/2025-06/stigma-survey-report.pdf}

^{6. Morgan AJ, Wright J, Reavley NJ. Review of Australian initiatives to reduce stigma towards people with complex mental illness: what exists and what works? Int J Ment Health Syst. 2021;15(1):10. doi: 10.1186/s13033-020-00423-1}

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