Scales for Assessing Attitudes of Medical Students and Health Professionals Toward Mental Illness and Psychiatry: A Scoping Review

Abstract

Purpose of the Review:

Attitudes toward mental illness and psychiatry (ATMIP) have been widely studied, and various instruments have been developed to assess them. However, the characteristics and psychometric properties of these instruments have not been comprehensively reviewed, leaving researchers uncertain about which scale to use in specific contexts. This review aims to synthesize the features of these scales, including their psychometric properties.

Collection and Analysis of Data:

Following Arksey and O’Malley’s scoping review framework, a comprehensive search was conducted across Scopus, PubMed, Cochrane, and Google Scholar. Studies reporting scales designed to assess ATMIP among medical students and healthcare professionals (HCPs) were included. Data were extracted on scale characteristics, domains, psychometric evaluation, and cultural adaptations. Twenty-two scales were eligible for inclusion. Most originated in Western contexts and were primarily developed for medical students and HCPs. The majority used Likert-type items or vignette-based assessments, and 19 scales (86.3%) reported psychometric evaluation. While most scales were initially developed in English and global south setting and later adapted to non-Western settings, contextual sensitivity and cultural validity varied. Overall, despite frequent reporting of psychometric properties, the applicability of these instruments across diverse cultural and educational contexts remains uncertain.

Conclusions:

This review provides researchers and educators with a consolidated understanding of existing scales, guiding informed use, adaptation, and potential development of culturally relevant instruments for ATMIP assessment. Careful selection and adaptation to local needs are essential to accurately assess attitudes toward psychiatry globally.

Keywords

Medical education psychiatry attitude towards mental illness review scale development psychometrics

The attitudes of medical students (students, henceforth) and Healthcare Professionals (HCPs) toward mental illness and psychiatry play a critical role in psychiatry teaching, students’ motivation to learn psychiatry, and pursuing it as a career.^1,2 Poor knowledge about mental illness and associated stigma often create barriers to the identification of mental health conditions and the care delivery, emphasizing the need to explore attitudes of students and HCPs within healthcare settings.³ Studies suggest that students and HCPs face several barriers to seeking mental health support, with mental health-related stigma being a significant factor.^4,5 Even among senior students, worries about social judgment and stigma are widely prevalent, showing how negative attitudes toward mental illness can reduce help-seeking and affect engagement with psychiatry.⁴ Concerns about confidentiality, uncertainty about where to get help, financial issues, and fear of negative academic or professional consequences often prevent students from seeking care.⁵

Regular assessment of these attitudes among students and HCPs and their changes following an educational/antistigma intervention is crucial in terms of reducing mental health or psychiatry-related stigma. Furthermore, understanding the nuances of the students’ or HCPs’ knowledge, attitude, and practice toward mental illness and psychiatry in general can help gauge the problem and effectively address it.

Stigmatization is a complex social process that operates on multiple levels and often involves labelling, stereotyping, separation, loss of social status, and discrimination, usually within situations of unequal power.⁶ It can be categorized into four main types: self-stigma, which occurs when individuals with mental health conditions internalize society’s negative beliefs about them; stigma by association, which affects family members or mental health professionals through the attribution of negative stereotypes; public and interpersonal stigma, which includes societal knowledge, negative attitudes, and discriminatory behaviors directed toward people with mental health conditions; and structural stigma, which is embedded in policies or institutional practices that disadvantage stigmatized groups.⁶

Public stigma related to mental illness and psychiatry can be understood through three related elements: knowledge, attitudes, and behaviors. Limited or inaccurate knowledge contributes to misconceptions about mental health; attitudes mainly reflect negative emotional responses or prejudiced feelings toward individuals with mental health conditions; and discriminatory behaviors lead to social exclusion or other harms.⁶ Literature on the medical students’ knowledge and attitude assessment toward mental illness or psychiatry, including scales developed to measure the same, often explores the issue in terms of stigma or negative attitude toward mental illness or psychiatry.

For assessment of stigma or negative attitudes (henceforth, attitude) toward mental illness and psychiatry (ATMIP), and subsequent intervention, reliable and validated tools are the cornerstone.⁷ Various instruments or scales (henceforth, scales) have been developed to assess these attitudes, each with its unique methodologies, theoretical foundations, structure, targeted domains, and populations.⁸ While some scales have been designed specifically for the students of health professions and HCPs, others have adapted tools initially designed for the general population.⁹ Hence, evaluating the development, theoretical framework, characteristics, and psychometric properties of these scales is vital to use them in the proper context, thereby ensuring their utility in healthcare and medical institutional settings and for generating reliable and valid results.

Despite the significance of scales in studying ATMIP, with vast array of tools available to assess the same, a comprehensive review the same is lacking. More so, the ones primarily focusing on medical students and HCPs. The primary objective of this scoping review is to review and document characteristics of original scales developed to measure the medical students’ and healthcare professionals’ ATMIP.

The secondary objectives of this review are twofold: (a) to highlight the development process and psychometric properties (reliability and validity) of these scales, and (b) to explore the domains of these scales, including their relevance to assess attitudes and perceptions of medical students and HCPs towards mental illness and psychiatry.

Methods

In this review, we followed Arksey and O’Malley’s framework for scoping reviews,¹⁰ which comprises five steps: (a) identifying the objectives, (b) identifying relevant studies, (c) study selection, (d) data charting, and (e) summarizing and reporting the results. This review was further guided by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) Checklist.¹¹ The completed checklist is uploaded as Supplementary Online Material.

Eligibility Criteria

We included original studies (quantita tive/qualitative/mixed-method), involving medical students (undergraduate or postgraduate trainees), and HCPs as the study population; based on instruments being developed/used to measure ATMIP; available in English, with full-text available. We did not apply any restriction on the publication period. Further, systematic reviews summarizing the development of such scales were also included. However, studies that used preexisting scales without reporting their development process or addressing unrelated psychiatric topics were excluded.

Information Sources

We conducted comprehensive literature searches using PubMed, Scopus, and Cochrane Library; Google Scholar search and bibliographic search were also performed to identify additional eligible studies, including gray literature.

Search Strategy

A systematic search strategy was employed using search terms such as “scale,” “tool,” “questionnaire” (for the instrument); “attitude,” “perception” (for attitude); and “mental illness,” “psychiatry”; and “medical students,” Healthcare Professionals (for medical students and HCPs). We also adapted these terms to the specific indexing systems of each database. (refer to Supplementary File A). Two investigators (first author and second author) independently searched each database to ensure reliable and accurate retrieval of relevant studies.

Selection Process

The selection process for potentially eligible studies was conducted in two stages. First, all search results were imported into reference management software, Rayyan, for organization and de-duplication. At this stage, two independent reviewers (first author and second author) screened the identified records based on the eligibility criteria. At the second stage, full-text reviews were conducted for shortlisted studies (initially by the first author, subsequently verified by the second author).

Data Charting

Data extraction was performed using a predefined charting form; variables were co-designed by the investigators to capture the details of each study. Extracted information included general information (e.g., scale's name, country of origin, year of publication), scale-specific details (e.g., number of items, domains, scoring system, availability in different languages), target population characteristics, strengths and limitations (as highlighted by the scale developer), and remarks by the current investigators (Refer to Table 1).

Table 1.

Summary of Key Findings from Included Studies on Instruments Assessing Attitudes Toward Mental Illness and Psychiatry (ATMIP).

Scale	Population	Scale/Questionnaire Characteristics (Items, Scoring System, Language)	Domains	Psychometric Properties	Strength	Limitation	Remark
ATP 30 (Attitude Towards Psychiatry; 1982) (CANADA).⁷	Medical undergraduates	The questionnaire was generated based on items on the following areas: (1) Attitude towards Psychiatric Patients, (2) Psychiatric Illness, (3) Psychiatrists, (4) Psychiatric Knowledge, (5) Psychiatric Career Choice. (6) Psychiatric Treatment, (7) Psychiatric Institutions, and (8) Psychiatric Teaching. 30 Items 5 Point Likert Scale (1 - Agree Strongly to 5 - Disagree Strongly). English Language (German, Spanish, Chinese, Arabic, French, Turkish, Portuguese, Japanese, etc. translations. A higher score represents a better attitude.	None	Psychometrically tested: Test-retest control period (r = 0.87); test-retest treatment period (r = 0.69); test-retest 2nd-3rd year med. (r = 0.64); test-retest 3rd-4th year med. (r = 0.51). Face and construct validity established.	Used in various professional groups & settings. Comprehensive in terms of stigma/attitude domain coverage.	Not mentioned	Comprehensive assessment tool. Cross-culturally validated tool that has been used across the settings, cultures, and professional groups.
MICA 2 (Mental Illness Clinicians Attitudes; 2010) (medical student version) (UK).⁸	Healthcare professionals	16-item; uses a 1–6 scale (1 = strongly agree, 6 = strongly disagree), self-administered survey. Reverse scoring is required for some items. A high overall score indicates a more negative attitude. Available in English Language (Italian, French, Portuguese, Spanish, Thai, etc. translations)	Public and health providers’ attitudes about people with mental illness, recovery of people with severe mental illness, perceptions about psychiatry in medical education, practice, and diagnostic overshadowing among general practitioners.	Psychometrically tested: Reliability- internal consistency (Cronbach’s alpha coefficient of 0.79); test–retest reliability (concordance coefficient = 0.80). Validity established.	Scale stands out for its ease of administration and suitability for medical students, both before and after interventions targeting mental illness stigma. Demonstrating good responsiveness and exhibiting satisfactory internal consistency, along with strong face and construct validity.	Uses or inquiries for “mental illness” rather than specific diagnoses.	Robust psychometric properties. The validity has been established in longitudinal studies as well.
CAMI (Community Attitudes Towards Mentally Ill; 1981) (CANADA).⁹	General population	40 items, 5-point Likert Scale. English Language (Spanish, Italian, Swedish, French, Portuguese, Greek, Persian, Chinese, etc. translations. Constructed using OMI, CMHI, and the Custodial Mental Illness Ideology Scale (CMI).	Authoritarianism, benevolence, social restrictiveness, and community mental health ideology	Psychometrically tested: Reliability: - CMHI (alpha = 0.88), social restrictiveness (alpha = 0.80), benevolence (alpha = 0.76), and authoritarianism (alpha = 0.68). Construct validity established.	This scale is a contextual amalgamation of four validated scales. Theoretical and practical value is evident in the role in explaining and predicting individual and community responses to mental health facilities.	Cross-sectional study; therefore, the sensitivity of the scale for the attitudinal changes can’t be ascertained. It only assesses behavioral intentions; the link with actual behavior remains uncertain.	A longitudinal study is required to establish the external validity of the scale. Predictive validity of the scales for actual behavior with respect to both the mentally ill and the mental health facilities.
RIBS (Reported and Intended Behaviour Scale); 2011 (UK).¹²	General population	Based on the Star Social Distance Scale, reported (past and current) and intended (future) behavioral discrimination among the general public. 8 items, 1st four items gauge reported behavior with PwMI (yes; no; don’t know), 2nd four items inquire about their intended behavior (6-point Likert Scale). English Language (Dutch, Traditional Chinese, Swedish, Japanese, Kannada, Italian, Arabic, French, Hungarian, Portuguese etc. translations)	(1) living with, (2) working with, (3) living nearby and (4) continuing a relationship with someone with a mental health problem.	Psychometrically tested: Test–retest reliability was 0.75; internal consistency (Cronbach’s alpha 0.85). Strong content validity among the stakeholders.	It is a concise and practical tool with strong reliability (alpha = 0.85) and internal consistency, validated on a heterogeneous, population-based sample. It effectively tracks trends in intended behaviors, offering valuable insights into their potential impact on actual behaviors over time.	It is limited by potential social desirability bias and broad definitions of mental health issues that may not reflect actual behavior changes. Reported behaviors may be influenced by external factors, and the tool’s reliance on self-reports poses challenges for accuracy.	Among the limited tools that focus on the discriminatory behavior on part of the respondents toward PwMI. Had a sound development basis, including tool development & pilot testing. Useful to assess the effectiveness of the anti-stigma intervention for the general population. brief, feasible and psychometrically robust measure, however, its contrast & criterion validity have not been tested.
OMI (Opinions about Mental Illness) scale; 1962 (US).¹³	Healthcare professionals	Derived from Custodial Mental Illness Ideology (CMI) Scale (Gilbert & Levinson, 1956), the California F Scale (Struening, 1957), and Nunnally’s (1957) work on popular conceptions of mental health. 70 items set, 6-point Likert Scale (0- total disagree to 5 - total agree).	Authoritarianism, benevolence, mental hygiene ideology, social restrictiveness & interpersonal etiology	Psychometrically tested: Reliability established; face & construct validity established; factor validity established.	Not mentioned	Not mentioned	The scale has been developed and validated for severe mental illness. Its utility for other mental health conditions have not been explored.
AMIQ (Attitudes to Mental Illness Questionnaire 5); 2006 (UK).¹⁴	General population	5 items, 5-point Likert scale (maximum +2, minimum -2) with blank questions, ‘neutral’ and ‘don’t know’ being scored 0. The score for the five questions was added giving a total score for each vignette between −10 and +10. English Language & Italian. Construct- respondents were asked to read a short vignette describing one of five imaginary individuals and then answer five questions. Three of the vignettes were chosen deliberately to produce a strongly negative or positive response to test the face validity of the questionnaire.	Not mentioned	Psychometrically Tested: Test-retest validity (Pearson’s correlation coefficient was 0.702); content validity and reliability is high, as indicated by Cronbach’s alpha score & factor analysis.	AMIQ was validated against Corrigan’s attributions questionnaire that has been specifically validated to assess people’s attitudes toward patients with mental illness.	It was not possible to distinguish between respondents recruited by newspaper advertisements and those recruited directly from the postal survey. The large circulation of the newspapers also precludes any estimate of the overall response rate.	The scale is vignette-based, hence, can assess the response on more real life (though hypothetical cases) scenarios. The response lacks personal viewpoint or belief system (except items 2 & 3), rather captures what in general people would do. Therefore, the accuracy of the response in terms of the personal attitude is doubtful.
AQ 27 (Attribution Questionnaire 27); 2003 (US).¹⁵	General population and students. Also available for children age 10–18 (AQ-8-C). Shorter version is AQ9.	Paper-and-pencil measure of public stigma toward people with mental illness designed for use with adults. 27 items, 9-point Likert scale (1 - not at all to 9 - very much). Items follow a clinical case scenario. Higher scores indicate greater endorsement of the corresponding belief or attitude. Based on the attributional model of public stigma. English Language (Also in Portuguese, Turkish, Spanish and Italian etc. translations). Constructed from AQ 21 Scale.	Dangerousness, fear, avoidance, coercion, segregation, help, blame, pity, anger	Psychometrically tested: Test-retest reliabilities for the nine subscales ranged from alpha = 0.55 (responsibility/blame) to alpha = 0.87 (dangerousness). Validity established.	Effective in detecting changes in stigmatizing attitudes following anti-stigma programs and has been successfully used with diverse adult groups, including healthcare students, professionals, and individuals with mental illness.	Lack of research on its adaptation to measure stigma toward other mental illnesses, such as depression. Published norms are not available for the AQ-27 at this time.	Cross-culturally validated tools that have been used across the settings, cultures, & professional groups. Have been used extensively in measuring the impact on anti-stigma interventions on the students’ & health professional attitude/beliefs toward PwMI. Flexibility in application - can be self-administered or as a part of the semi-structured interview.
ACIP (Attitudes and Confidence in Integration of Psychiatry in Medicine) scale; 2017 (US).¹⁶	Medical students	14 items, Range: 1 [not important at all] to 7 [extremely important] (point ordinal scale)	Attitude and confidence	Psychometrically tested: Internal consistency (Cronbach’s alpha=0.88); test-retest reliability (Cronbach’s alpha = 0.90). Content, face validity established.	The ACIP scale uniquely measures attitudes and confidence in integrating psychiatry with other medical fields, addressing both attitudes and clinical skills based on the intervention’s focus. It stands out as the first tool assessing medical students’ views on psychiatry’s integration into broader medical contexts.	Lack of external validation to confirm alignment of self-perceived competence with actual skills and a scoring system that emphasizes attitudes over confidence, which may not suit all programs.	The tool not only assesses the attitude toward the need for psychiatry integration with other disciplines and confidence in detecting psychiatric conditions in other disciplines’ patients, also students’ intention to do so. It is a unique scale that assesses integration of psychiatry with other disciplines, therefore, has utility in medical education. The scale, however, lacked construct and criterion validity and cross-cultural validity.
ARS (Affective Reaction Scale); 1987 (US).¹⁷	General population	7 Social distance items; Vignette based; (4-point Likert scale; 0 - definitely willing to 3 - definitely unwilling) & 8 perceived dangerousness of mental patients’ items (6-point Likert scale; 0 - strongly agree to 5 - strongly disagree)	Not mentioned	Psychometrically tested: Internal consistency (Cronbach’s alpha = 0.85). Items show face and construct validity.	In this study, vignettes provide clear, specific details, unlike daily interactions where information often comes from mixed or contradictory sources, creating ambiguity. Labeling effects may differ or become more significant in such uncertain contexts.	Questionnaire not validated. The theoretical background behind development of the questionnaire is lacking.	Compares the attitude of the health professionals toward mental illnesses with other physical health conditions. However, the scale development process lacks robustness, including lacking in the assessment of the psychometric properties.
Scale by S.M. Lawrie et al., 1998 (UK).¹⁸	Healthcare professionals	Case vignettes-based questionnaire incorporating 13 attitudinal statements of four different health conditions - Schizophrenia, Depression, Diabetes & Healthy (read & law, 1999); 6-point Likert Scale (0 - total disagree to 5 - total agree)	Not mentioned	Not validated.	Not mentioned	Not mentioned	Validity is not established, limiting its cross-cultural utility.
Attitudes to Mental Illness Questionnaire; 1987 (UK).²⁰	Nurses	Based on contact hypothesis. 24 items, 5-point Likert Scale (1 - Agree Strongly to 5 - Disagree Strongly). Higher numbers represent favorable attitudes.	Not mentioned	Psychometrically tested: Reliability (Cronbach’s alpha value = 0.79). Factor structure and validity data is lacking.	Not mentioned	Not mentioned	The scale has not been validated, including cross-sectional validation. The lack of the factor structure limits it’s contextual utility. It has limited utility to study the impact of anti-stigma or educational interventions for the nurses or health professionals. The positive side is it is among the limited scale that has specifically focused on nurses’ attitude toward PwMI.
CMI (Custodial Mental Illness Ideology); 1956 (US).²¹	Medical & non-medical individuals	Framework - custodialism-humanism” continuum. Categories - the nature and causes of mental illness, conditions in the hospital, patient-staff relations. 20 statements (17 custodial, 3 humanistic) Grade: +3 (strongly agree) to -3 (strongly disagree). English Language and other languages. Relation of score with attitude or domain under study	Not mentioned	Psychometrically tested: Reliability (Split half correlation = 0.85) and concurrent validity (product moment correlation = .70 with F scale) established.	Not mentioned	Not mentioned	Sound theoretical background for scale development in custodial setting
ATAMHS 33 (Attitudes Towards Acute Mental Health Scale); 2005 (UK).²²	Healthcare professionals	64 items originally (48 Likert scale and 16 semantic differentials) Later reduced to 33. Developed from items of 4 scales - Mental Health Locus of Control (MHLC) Scale (Hill, 1980), ATP30 (Burra et al., 1992), AMI-20 (Singh, 1998) & 33 items; Likert scales (7 point) & semantic differentials (10 point);	Care or control, semantic differentials, therapeutic perspectives, hard to help and positive attitudes	Psychometrically tested: Internal reliability (Cronbach’s alpha of 0.81).; Kaiser–Meyer–Olkin (KMO) measure of sample adequacy 0.47; Construct, content & factor validity established.	Not mentioned	It measures attitudes but does not assess whether positive attitudes translate into behavior.	Validity is not established, limiting its cross-cultural utility. The behavior pattern based on this attitude scale can’t be ascertained.
BMI (Beliefs toward Mental Illness Scale); 2000 (US).²³	College students (psychology)	Beliefs toward mental illness scale & its relationship with treatment seeking. 21 items, 6-point Likert scale (0 - totally disagree to 5 - totally agree)	3 Factors (dangerousness, poor social skill & in curability). Construct validity & criterion validity established.	Psychometrically tested: Reliability (Cronbach’s alpha = 0.82). Cross cultural validity is established. Construct and concurrent validity are also established.	Reliability analysis showed moderate to high internal consistency for the BMI across both American and Asian groups. Item-total correlations were also moderate to high, confirming the BMI as a reliable measure for both populations.	This self-reported questionnaire assesses treatment-seeking preferences of the participants rather than actual behavior, making it unclear if the predictions can reflect participants’ real actions.	The scale only covers psychiatric illness and treatment. It does not explore psychiatrists, significance of psychiatry as a discipline, and psychiatry as a career. The treatment seeking part is not assessed through this scale. Therefore, the utility of this scale for behavioral response of the participants toward mental illness, including treatment, is limited.
MIDUS (Mental Illness Disorder Understanding Scale); 2003 (JAPAN).²⁴	General population, health volunteers, staff of the institution	15 items, 5-point Likert Scale (0 - strongly agree, 1 - tend to agree, 2 - neither agree nor disagree, 3 - tend to disagree, and 4 - strongly disagree)	“Treat ability of illness”, “Efficacy of medication”, and “Social recognition of illness”	Psychometrically tested: Internal consistency (Cronbach α = 0.78); criterion based, face, content, convergent, discriminant & construct validity established.	The MIDUS is a concise tool designed for assessing awareness campaigns, using affirmative statements to minimize bias and excluding reverse-scored items. Its practicality makes it ideal for pre- and post-campaign evaluations of mental illness understanding.	Not mentioned	A validity tool that can be used across the population and setting to assess attitude toward mental illness. Other dimensions of psychiatry and mental illness, such as psychiatry as career option, psychiatrists’ attributes, and the aetiology are not covered, therefore, can’t be explored.
OMS-HC (Opening Minds Stigma Scale for Health Care Providers); 2014 (CANADA).²⁶	Healthcare professionals & trainees	Self-report questionnaire, assess attitude & behavior change toward PwMI. 15 items, 5-point Likert Scale (1 - strongly agree, 2 - tend to agree, 3 - neither agree nor disagree, 4 - tend to disagree, and 5 - strongly disagree), range from 20 (least stigmatizing) to 100 (most stigmatizing).	Attitudes factor, helping/disclosure factor, and social distance factor	Psychometrically tested: Internal consistency (α = 0.74 to 0.79) and corresponding subscales (α = 0.67 to 0.68; Kaiser-Meyer-Olkim (KMO) measure of sampling adequacy was 0.841; Bartlett’s Test of Spehericity (χ² = 3969.47, p <.001) was statistically significant; good construct validity.	This study’s strengths include using EFA methods and evaluating change sensitivity in a large, representative sample of targeted healthcare providers. The 15-item version showed good internal consistency, construct validity, responsiveness, and a clear factorial structure.	Scales like OMS-HC, while reflecting beliefs behind behavioral attitudes, may not accurately capture actual behaviors and could be influenced by social desirability bias.	The scale is unique in the sense that it has a proven utility to measure responsiveness / change following anti-stigma interventions. Has been used across the healthcare providers (physician, trainees, nurses). Incorporates both attitudinal and potential behavior component of stigma, therefore, provides more comprehensive assessment of the stigma.
AC Nielson and Eaton Questionnaire 1981 (US).²⁷	Medical students	22 items, 5-point Likert Scale (1 - agree strongly to 5 - disagree strongly), Both open-ended (Responding to the open-ended question, “What was best about the teaching of psychiatry at your school?”) and forced-choice Likert-style questions are included.	Overall merits of the field of psychiatry, efficacy, role definition and functioning of psychiatrists, possible abuses and social criticisms, career and personal rewards	Validity of the questionnaire seemed good.	The questionnaire demonstrated strong overall validity, with good construct validity supported by inter-correlations between attitude questions and interest in psychiatry. Open-ended responses further reinforced the key dimensions studied.	Paper-and-pencil attitude questions may not accurately capture behavior, as students might respond differently in non-anonymous contexts. Additionally, the cross-sectional design limits understanding of changes in psychiatric recruitment over time, emphasizing the need for longitudinal studies.	Allows both quantitative and qualitative aspects of responses, hence greater insights into the subject matter. Cross-cultural validation is lacking
ATP 29 (Attitude Towards Psychiatry); 1999 (US).²⁸	Medical students	29 items (12 from Nelson Eaton and 17 new), 5-point Likert Scale (1 - agree strongly to 5 - disagree strongly)	Overall merits of psychiatry, efficacy, role definition and functioning of psychiatrists, possible abuse and social criticism, career and personal reward, specific medical school factors	Not validated.	Improved on the available validated scales with more contextual items included.	Not mentioned	Ability of the scale to assess the change in attitude/belief following the intervention is lacking. Lack of validity data, including cross-cultural validation.
ATP 18 (Attitude Towards Psychiatry); 1983 (UK).³²	Medical students	18 items (9 items for Positive view; 9 items for negative view), 4 Point Scale (1 ‘strongly agree’, to 4 ‘strongly disagree’, no neutral response). An item on general attitude to psychiatry with scoring ranging from favorable, unfavorable, and mixed. Individual items concerned attitudes to psychiatrists, psychiatry, psychiatric patients and psychiatric treatment. English Language and other languages.	Two factor structure - an interest in psychiatry & antipathy for psychiatry	Face validity and construct validity have been established.	Not mentioned	Cross-cultural validity is lacking.	Cross-cultural validity is lacking.
MICA 4 (Mental Illness Clinicians Attitudes); 2013 (UK).³³	Students and healthcare professionals	16 items, 6-point Likert Scale (0 - total disagree to 5 - total agree), English Language (Japanese, Portuguese (Portugal), Portuguese (Brazil), Kannada, Italian, Spanish (Chile/Bolivia/Cuba), German, Nepali, Hungarian, Kiswahili, Gujarati, Hebrew, Luganda, Slovak, Creole, French etc. translations are available.	Not mentioned	Psychometrically tested: Internal consistency (Cronbach’s alpha value = 0.72); (Item-total correlations were > 0.2); significantly correlated with the RIBS scale (r = 0.49, p <.01, n = 182); PCA: a five-factor structure accounting for 53.07% of the total variance; acceptability of the instrument has also been established, with Flesch–Kincaid Grade level score being (9.6); face and construct validity established.	It is a quick, simple, and cost-effective tool for assessing attitudes toward mental illness among students and professionals across various healthcare disciplines. Its ease of administration and scoring make it ideal for stigma reduction training interventions without requiring extensive staff training.	A restricted sample of nursing students in their foundation year, limiting generalization to other student and professional groups. Issues relevant to students, such as learning about mental health, may not apply to qualified staff, and certain items may be less applicable to senior professionals. Test-retest reliability was not assessed, and the choice of principal component analysis over exploratory factor analysis may have influenced the factor structure results.	The theoretical background of the instrument is not provided. Cross-cultural validation is required
AMI (Attitudes to Mental Illness Questionnaire); 1998 (UK).³⁴	Medical students	20 items, 5-point Likert Scale (1 - agree strongly to 5 - disagree strongly). Higher score represents a more positive attitude toward mental illness.	Not mentioned	Not validated	Not mentioned	The tool has not been validated	The tool is not validated therefore its cross-cultural use, including usage for the anti-stigma intervention is limited.
Scale by Sergio Valdivieso et al., 2013 (CHILE).³⁵	Medical students	32 items (8 Original, 20 AMI, 4 ATP), 5-point Likert scale, ranging from strongly agree (1 point) to strongly disagree (5 points) with a higher score suggesting a more unfavorable attitude. A score of 160 represented the maximum negative attitude for all 32 items.	Not mentioned	Psychometrically tested: Cronbach’s alpha of internal consistency = 0.714. Not validated.	Not mentioned	Attitudes questionnaire items were aligned with those of the AMI and ATP questionnaires, it has not been validated.	Validity is not established, limiting its cross-cultural utility.

Furthermore, attention was given to the scale’s development process (theories, domains, etc.) and its psychometric properties (reliability and validity). The charting form was piloted on five studies under the supervision of a senior researcher involved in medical education and tool development (corresponding author) to ensure consistency and accuracy in data extraction and handling missing information. In case of any discrepancies among the reviewers, the issues were sorted through mutual discussion.

Synthesis and Presentation

We provided a detailed overview of the original scales developed to measure ATMIP. Also, scales’ critical aspects, including their development process, psychometric properties, domains, and intended applications, were synthesized and systematically evaluated. Subsequently, we provided our remarks on the individual scale (Refer to Table 1). For scales whose psychometric properties were not reported and where the original authors did not explicitly state that these indices were not assessed, we contacted the authors directly to request the missing information. Any details received were incorporated into our review to ensure completeness and accuracy of the data.

Results

Study Selection

A literature search yielded 3,510 articles. After removing duplicates, title and abstract screening, followed by a full-text screening and a bibliographic search, a total of 22 original papers were identified. We followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for the screening process (Refer to Figure 1).¹¹

Figure 1.

PRISMA Flow Diagram.

Temporal and Geographical Distribution

Scale development was concentrated in the United Kingdom (n = 9) and North America (United States, n = 8; Canada, n = 3). However, we found one scale each from Japan and Chile, underscoring a global trend to evaluate ATMIP among HCPs and medical students.

Target Population and Adaptation for Other Populations

Out of the 22 scales, 16 (73%) were originally designed for medical students and HCPs. The remaining scales were initially developed for the general population and were subsequently adapted for medical students and HCPs.

Scale Characteristics

The scales varied widely in their structure and content. All were initially designed for pen-and-paper use except the Reported and Intended Behavior Scale (RIBS) (Online).¹² The item numbers ranged from 70 (Opinions about Mental Illness (OMI) scale)¹³ to as few as five (Attitudes to Mental Illness Questionnaire (AMIQ)).¹⁴ Some scales were derived from earlier tools, for example, Community Attitudes Toward the Mentally Ill (CAMI),⁹ which was constructed using the OMI and Community Mental Health Ideology Scale (CMHI); similarly, Attribution Questionnaire 27 (AQ-27)¹⁵ evolved from the Attribution Questionnaire 21 (AQ-21).

All scales used a Likert scoring pattern, with the number of points differing across instruments. Ten (45.45%) of these scales specifically employed a standard 5-point Likert scale, allowing for a balanced range of responses. Notably, Attitudes and Confidence in the Integration of Psychiatry (ACIP)¹⁶ used a 7-point ordinal scale.

It is emphasized that tool developers have frequently used reverse scoring to test participants’ negative reaction or unfavorable ATMIP (e.g., Attitude Towards Psychiatry (ATP 30) and Mental Illness Clinicians’ Attitudes (MICA 2)), ensuring accuracy and minimization of response bias.

The Affective Reaction Scale (ARS) also employed a vignette-based approach. Additionally, it incorporated information such as income, grooming, and work behavior, along with general aspirations such as the desire to meet young women and secure a better-paying job. This approach is particularly valuable, adding validity to the assessment, given that some researchers have argued that labelling effects are most pronounced when minimal information is available for evaluation.¹⁷

Another vignette-based questionnaire, the AMIQ,¹⁴ further explores qualitative responses. Respondents are presented with a short vignette describing one of five imaginary individuals (for example, diabetes, depression, schizophrenia, substance abuse, etc.) and then asked to answer five follow-up questions. Authors observed that vignettes describing highly stigmatized individuals (e.g., a convicted criminal) consistently produced negative scores. In contrast, vignettes depicting non-stigmatized individuals (e.g., a Christian or a diabetic) resulted in positive scores, further supporting face validity.

The General Practitioners’ Attitudes to Psychiatric and Medical Illness Scale, developed by SM Lawrie et al., also followed a similar approach (Table 1).¹⁸

Theoretical Basis of the Scales

Many studies described the underlying theoretical background for the tool domains. For instance, the ARS scale¹⁷ is based on Scheff’s Labeling Theory, which suggests that individuals with history of psychiatric illness face stigmatization and rejection when reintegrating into society.¹⁹ Following a vignette-based approach, it examines the interaction between labeling, perceptions of dangerousness, and social rejection, offering insights into mental health stigma.

The CAMI Scale (Community Attitudes Toward the Mentally Ill) is grounded on the theoretical framework proposed by Dear and Taylor, which suggests that ATMIP are shaped by personal characteristics (socioeconomic status, life stage, beliefs, and values) of the community members.⁹ Moreover, their attitudes toward Persons with mental illness (PwMI) strongly influence their reactions to mental health facilities. The CAMI Scale comprises the public’s attitudes across four key domains related to PwMI and mental health facilities: Authoritarianism (viewing individuals with mental illness as inferior and in need of strict control), Benevolence (reflects a sympathetic and compassionate perspective, emphasizing care and support), Social Restrictiveness (captures fear and discomfort with PwMI, advocating for limited integration of individuals with mental illness into society), and Community Mental Health Ideology (supports community-based treatment and social inclusion of PwMI).

Likewise, the Weller and Grunei Attitudes to Mental Illness Questionnaire is based on the Contact Hypothesis, which suggests that group interaction can reduce prejudice under certain conditions. It assumes that mutual acquaintance fosters understanding, making it applicable not only to racial and ethnic relations but also to attitudes toward PwMI. Here, the authors have studied HCP-patient interactions in influencing stigma within mental healthcare settings.²⁰

Furthermore, the Custodial Mental Illness (CMI) Scale is based on the distinction between custodial and humanistic orientations in mental healthcare.²¹ This framework aligns with theories of authoritarian and equalitarian personality structures.

Domains Assessed by Scales

Among the studies reviewed, only a subset has provided details on the domains assessed and their theoretical underpinnings. For instance, ATP 30 contains domains such as attitudes toward psychiatric patients, psychiatric illness, psychiatrists, psychiatric knowledge, psychiatric career choice, psychiatric treatment, psychiatric institutions, and psychiatric teaching (however, no such clusters emerged during the factor analysis).⁷

The CAMI includes authoritarianism, benevolence, social restrictiveness, and community mental health ideology.⁹ AQ27 covers dangerousness, fear, avoidance, coercion, segregation, help, blame, pity, and anger.¹⁵ OMI includes authoritarianism, benevolence, mental hygiene ideology, social restrictiveness, and interpersonal etiology.¹³ Attitudes Towards Acute Mental Health Scale (ATAHMS) assesses care or control, semantic differentials, therapeutic perspectives, hard-to-help, and positive attitudes.²² The Beliefs Toward Mental Illness Scale (BMI) includes dangerousness, poor social skills, and incurability.²³ (See Table 1 for more details).

These domains reflect a broad spectrum of attitudes and beliefs, offering insights into various mental illnesses and psychiatric facets. For instance, AQ27 addresses the theory of public stigma (stereotypes, prejudice, and discrimination). It highlights the psychosocial consequences of public stigma, such as social rejection and restricted access to employment and housing. The scale emphasizes the importance of accurate assessments of public stigma to evaluate the effectiveness of anti-stigma programs.¹⁵

Involving Qualitative Components in Tool Development

Although most scales followed quantitative measures to assess medical students’ and HCPs’ knowledge and ATMIP, two scales also incorporated qualitative aspects.^12,24 Qualitative interviews can help in the development of quantitative measures by identifying key themes for rating scales, uncovering essential aspects of a topic that might otherwise be overlooked, or supplementing the quantitative measures for a comprehensive assessment of a phenomenon or a well-grounded theory.²⁵ Moreover, it helps content validate existing tools through cognitive interviews.

For instance, the Opening Minds Stigma Scale for Health Care Providers (OMS-HC) is part of the anti-stigma program by the Mental Health Commission of Canada, embedded in a larger national initiative aimed at reducing stigma.²⁶ The scale was developed by involving various stakeholders (sociologists, psychiatrists, and an anti-stigma campaign manager) to generate initial item pools, which were subsequently validated through cognitive interviews and by involving HCP, medical trainees, and persons with lived experience.

Similarly, RIBS underwent a rigorous development process. The initial items were selected based on expert review. This was followed by pre-pilot testing through cognitive interviews involving laypersons. Subsequent testing and validation followed a three-stage empirical testing process: Stage 1 involved face-to-face interviews with the participants representing the general population, Stage 2 included surveys involving participants of Stage 1, and Stage 3 refined the scale based on feedback from earlier stages, with online surveys used to test the final version.¹²

Psychometric Validation and Language

A total of 19 scales (86%) were psychometrically tested in their original studies. Reliability assessment included test-retest reliability and internal consistency (commonly calculated as Cronbach’s alpha). Scales such as MICA-4 and MIDUS underwent rigorous tool development processes, for example, factor analysis (principal component analysis), reliability (internal consistency), validity (convergent validity, face validity) assessment, and acceptability, thereby establishing their broad utility for the concerned research.

All 22 scales were available in English, with several scales, such as Attitude Towards Psychiatry (ATP 30), MICA 2, MICA 4, RIBS, etc., also available in regional languages (e.g., Dutch, Chinese, Swedish, Japanese, Italian, Arabic, French, Hungarian, Portuguese) (Table 1). Many of these translated versions have also undergone validation (content validity and construct validity) and reliability testing to ensure their cross-cultural utility.

We also found that most of the scales used to measure ATMIP lack longitudinal reliability or validity, limiting their ability to measure change over time, including following anti-stigma interventions and exposure to psychiatry as a subject.

Importantly, scales such as ATP30, RIBS, MICA-2, and OMS-HC have undergone longitudinal psychometric assessment, underscoring their utility in this regard. The OMS-HC scale is unique in the sense that it has been widely used among HCPs (physicians, trainees, and nurses). It incorporates both attitudinal and behavioral aspects of stigma, allowing it to capture not just implicit biases but also potential discriminatory behaviors.

Similarly, the development process of the ATP30 scale involving medical students showed positive ATMIP following a direct and sustained exposure to psychiatric patients.⁷

Qualitative Responses

In addition to quantitative assessment, one scale (AC Nielsen and Eaton et al.)²⁷ incorporates qualitative responses (open-ended questions, e.g., “what was best about the teaching of psychiatry at your school?”) with a Likert scale-based (forced-choice questions), allowing for qualitatively emerged themes to validate the forced-choice questions and to explore students’ opinions in greater detail.

Discussion

In this scoping review, we reviewed and documented the characteristics of the original scales and their development processes, including psychometric properties. Importantly, we explored the scale’s domains and factor structures, particularly in relevance to medical students’ and HCPs’ ATMIP. The latter has a crucial role in determining students’ or HCPs’ knowledge, attitude, and behavior concerning mental illness, PwMI, psychiatry, and considering it as a career.

We analyzed 22 original studies that developed scales to assess ATMIP. Most of these studies were conducted in developed nations, highlighting the need for further research in other geographical regions, particularly in developing countries, to capture diverse perspectives. Future research can focus on developing new scales tailored to the specific cultural and societal context of these regions or adapting and translating existing scales to ensure their cross-cultural validity.

Among the identified scales, 72.7% (n = 16) were specifically designed for medical students and HCPs. At the same time, the remaining six were initially developed for the general population but have since been adapted for use in medical education and healthcare settings. A key finding of our review is that 19 (86.3%) of the scales underwent psychometric assessment. However, ATP 29, AMI, and the scale by SM Lawrie et al. lacked formal psychometric testing despite their extensive use in research, thereby limiting their findings’ robustness and overall utility.^18,28

While all scales were initially developed in English, many scales, for example, ATP 30, MICA 2, MICA 4, and RIBS, have been translated and validated in multiple languages, making them more versatile for cross-cultural research. It must be highlighted here that before developing a scale for cross-cultural settings, it is essential to understand whether the targeted construct reflects a culturally independent phenomenon and can be reliably assessed.^29,30 Studies show that this can be achieved through techniques, such as conducting a literature review and engaging in qualitative research with the target population across different contexts.²⁹ In some cases, specific constructs, measures, or items may not hold universal relevance but are highly significant in specific settings. In such instances, the scale may be adapted to suit the context. Additionally, original scales often need to be translated into the relevant target languages to ensure accessibility and accuracy.²⁹

In terms of format, most scales use Likert-type responses, allowing for quantitative measurement of attitudes. However, scales like the one by Lawrie et al. employ qualitative assessment methods. Qualitative data-based scales provide deeper insights into individual perspectives on mental illness and psychiatry, complementing traditional quantitative methods. Research should incorporate qualitative nuances to assess students’ or HCPs’ ATMIP.³⁰

We found that only two-thirds of studies explicitly defined the constructs/domains (the idea, characteristic, or underlying behavior that a study aims to explore) of their scales. It is essential to clearly define and establish this domain before developing any scale. A well-defined domain helps create a clear understanding of the topic, sets its boundaries, and makes the process of designing relevant questions and content validation much smoother.³⁰

Our study also explored the theoretical basis underlying many of these instruments. Understanding the conceptual framework behind each scale is crucial for researchers selecting the most appropriate tool for their specific research and study population.³¹

The strength of this review lies in its findings grounded in a comprehensive literature review using multiple databases, ensuring the incorporation of a wide range of available scales. A key strength of our study is the systematic review of the identified scales by two independent reviewers (first and second author), under the supervision of a senior reviewer (corresponding author). We adhered to established guidelines for scoping reviews to ensure that the data were presented in a structured, objective, and unbiased manner. We conducted an extensive and transparent search, making the process reproducible.

We opted for a scoping review rather than a systematic review, as our objective was to identify and compile all potential tools available for assessing medical students’ and HCPs’ ATMIP, thereby informing researchers to take up a more systematic approach to review this topic and identify the most suitable scale for their intended research. Additionally, we examined the theoretical framework, domains, and applicability of individual scales, allowing for a nuanced understanding of their strengths and limitations. It also provides valuable insights into the constructs measured by each scale, which can assist readers in interpreting the scales’ findings, including their psychometric properties.

Our work lays a strong foundation for the evolution of better-validated, cross-culturally applicable, and longitudinally tested instruments in the field of ATMIP. Finally, we not only summarized the strengths and limitations of each scale but also provided critical insights about it. This will be particularly useful for future researchers looking to select the most suitable instrument, identify research gaps in the existing scales, and develop new, more robust scales on ATMIP among medical students/professionals that are longitudinally validated and incorporate cultural contexts.

Limitations

We only included scales originally developed in English; they may have been translated into regional languages later. Although this approach ensured a standardized approach to review the topic, it may have led to the omission of some relevant scales developed in non-English-speaking regions. Additionally, our review focused only on the original and initial research in which each scale was developed; we did not include (or analyze) papers on its subsequent adaptations, modifications, or validations of these scales in later research. This means that scales' limitations identified in the original studies might have been addressed in later versions, but these revisions were not captured in our review. As a result, our findings may not fully reflect the most updated form of the scale and its applicability in contemporary research and practice.

Conclusions

Our review reveals that most scales used to measure medical students’ or HCPs’ ATMIP greatly vary in their characteristics, theoretical underpinnings, psychometric robustness, and importantly, societal and cultural context. Therefore, their applicability across diverse cultural and educational settings needs to be contextualized. Careful scale selection and adaptation to local needs are essential for accurate assessment of attitudes toward psychiatry globally.

This work can inform researchers and educationists to utilize the available scales on ATMIP more methodically, adapt the existing scales, and develop new scales to address the research question.

Supplemental Material

Supplemental material for this article available online.

Supplemental Material

Supplemental material for this article available online.

Footnotes

Appropriate Permissions from the Concerned Authorities

Not applicable.

Data Sharing Statements

This is a review article and does not contain any studies with human or animal participants.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Declaration Regarding the Use of Generative AI

None used.

Ethics Committee Details

As this was a synthesis of data available in the literature, no patient consent or ethics committee approval was sought.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Informed Consent/Assent

This article does not contain any studies with human or animal participants.

Prior Presentations

Not presented.

PROSPERO/CTRI Details

Not registered.

Registration

Not applicable for a scoping review.

Simultaneous Submission to Another Journal or Resource

Not submitted to any other journal or resource.

Status of Your Study (for Study Protocol)

Not applicable.

References

Rehm

and Shield

. Global burden of disease and the impact of mental and addictive disorders. Curr Psychiatry Rep, 2019; 21(2): 10.

Lien

, Lin

, Tsai

, . Changes in attitudes toward mental illness in healthcare professionals and students. Int J Environ Res Public Health, 2019; 16(23): 4655.

Knaak

, Mantler

and Szeto

Mental illness-related stigma in healthcare: Barriers to access and care and evidence-based solutions. Healthc Manage Forum, 2017; 30(2): 111–116.

Menon

, Sarkar

and Kumar

A cross-sectional analysis of barriers to health-care seeking among medical students across training period. J Ment Health Hum Behav, 2017; 22(2): 97–103. DOI: 10.4103/jmhhb.jmhhb_34_17.

Grover

, Dua

, Shouan

, . Perceived stress and barriers to seeking help from mental health professionals among trainee doctors at a tertiary care centre in North India. Asian J Psychiatr, 2019; 39: 143–149. DOI: 10.1016/j.ajp.2018.12.020.

Thornicroft

, Sunkel

, Alikhon

Aliev A

, . The Lancet Commission on ending stigma and discrimination in mental health. Lancet, 2022; 400(10361): 1438–1480. DOI: 10.1016/S0140-6736(22)01470-2.

Burra

, Kalin

, Leichner

, . The ATP 30: A scale for measuring medical students’ attitudes to psychiatry. Med Educ, 1982; 16(1): 31–38.

Kassam

, Glozier

, Leese

, . Development and responsiveness of a scale to measure clinicians’ attitudes to people with mental illness (medical student version). Acta Psychiatr Scand, 2010; 122(2): 153–161.

Taylor

and Dear

. Scaling community attitudes toward the mentally ill. Schizophr Bull, 1981; 7(2): 225–240.

10.

Arksey

and O’Malley

. Scoping studies: Towards a methodological framework. Int J Soc Res Methodol, 2005; 8(1): 19–32.

11.

Tricco

, Lillie

, Zarin

, . PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation. Ann Intern Med, 2018; 169: 467–473.

12.

Evans-Lacko

, Rose

, Little

, . Development and psychometric properties of the reported and intended behavior scale (RIBS): A stigma-related behavior measure. Epidemiol Psychiatr Sci, 2011; 20(3): 263–271.

13.

Cohen

and Struening

. Opinions about mental illness in the personnel of two large mental hospitals. J Abnorm Soc Psychol, 1962; 64: 349–360.

14.

Luty

, Fekadu

, Umoh

, . Validation of a short instrument to measure stigmatized attitudes towards mental illness. Psychiatr Bull, 2006; 30(7): 257–260.

15.

Corrigan

, Markowitz

, Watson

, . An attribution model of public discrimination towards persons with mental illness. J Health Soc Behav, 2003; 44(2): 162–179.

16.

Fiedorowicz

, Dantz

and Blazek

. Attitudes and confidence in the integration of psychiatry scale. Acad Psychiatry, 2016; 40(2): 218–223.

17.

Link

, Cullen

, Frank

, . The social rejection of former mental patients: Understanding why labels matter. Am J Sociol, 1987; 92(6): 1461–1500.

18.

Lawrie

, Martin

, McNeill

, . General practitioners’ attitudes to psychiatric and medical illness. Psychol Med, 1998; 28(6): 1463–1467.

19.

Scheff

. The labeling theory of mental illness. Am Sociol Rev, 1974; 39(3): 444–452.

20.

Weller

and Grunes

Does contact with the mentally ill affect nurses’ attitudes to mental illness?

Br J Med Psychol, 1988; 61(3): 277–284.

21.

Gilbert

and Levinson

. Ideology, personality, and institutional policy in the mental hospital. J Abnorm Psychol, 1956; 53(3): 263–271.

22.

Baker

, Richards

and Campbell

Nursing attitudes towards acute mental health care: Development of a measurement tool. J Adv Nurs, 2005; 49(5): 522–529.

23.

Hirai

and Clum

. Development, reliability, and validity of the beliefs toward mental illness scale. J Psychopathol Behav Assess, 2000; 22: 221–236.

24.

Tanaka

. Development of the mental illness and disorder understanding scale. Int J Jpn Sociol, 2003; 12: 95–107.

25.

Olshansky

, Lakes

, Vaughan

, . Enhancing the construct and content validity of rating scales for clinical research: Using qualitative methods to develop a rating scale to assess parental perceptions of their role in promoting infant exercise. Int J Educ Psychol Assess, 2012; 10(1): 36–50.

26.

Modgill

, Patten

, Knaak

, . Opening minds stigma scale for health care providers (OMS-HC): Examination of psychometric properties and responsiveness. BMC Psychiatry, 2014; 14: 120.

27.

Nielsen

3rd and Eaton

Jr . Medical students’ attitudes about psychiatry: Implications for psychiatric recruitment. Arch Gen Psychiatry, 1981; 38(10): 1144–1154.

28.

Balon

, Franchini

, Freeman

, . Medical students’ attitudes and views of psychiatry. Acad Psychiatry, 1999; 23: 30–36.

29.

Zhao

, Summers

, Gathara

, . Conducting cross-cultural, multilingual or multicountry scale development and validation in health care research: A 10-step framework based on a scoping review. J Glob Health, 2024; 14: 04151.

30.

Boateng

, Neilands

, Frongillo

, . Best practices for developing and validating scales for health, social, and behavioral research: A primer. Front Public Health, 2018; 6: 149.

31.

Luft

, Jeong

, Idsardi

, . Literature reviews, theoretical frameworks, and conceptual frameworks: An introduction for new biology education researchers. CBE Life Sci Educ, 2022; 21(2): es3.

32.

Wilkinson

, Greer

and Toone

. Medical students’ attitudes to psychiatry. Psychol Med, 1983; 13(1): 185–192.

33.

Gabbidon

, Clement

, van Nieuwenhuizen

, . Mental illness clinicians’ attitudes (MICA) scale – Psychometric properties of a version for healthcare students and professionals. Psychiatry Res, 2013; 206(1): 81–87.

34.

Singh

, Baxter

, Standen

, . Changing the attitudes of ‘tomorrow’s doctors’ towards mental illness and psychiatry: A comparison of two teaching methods. Med Educ, 1998; 32(2): 115–120.

35.

Valdivieso

, Sirhan

, Aguirre

, . Attitudes of medical students toward psychiatry in a Chilean medical school. Acad Psychiatry, 2014; 38(3): 309–311.

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