Academic journal article American Journal of Pharmaceutical Education

Emphasizing Bloom's Affective Domain to Reduce Pharmacy Students' Stigmatizing Attitudes

Academic journal article American Journal of Pharmaceutical Education

Emphasizing Bloom's Affective Domain to Reduce Pharmacy Students' Stigmatizing Attitudes

Article excerpt

Objective. To create a learning environment using Bloom's affective domain as a framework that would reduce third-year pharmacy students' stigmatizing attitudes toward patients with mental illness.

Design. Prior to the start of the module, students were asked to complete the 27-question Attribution Questionnaire Short Form (AQ-27). The teaching approach and in-class activities were designed to allow students' to experience the major categories within Bloom's affective domain. The module used patient cases, interactive-learning activities, and reflective discussions to augment pharmacological and therapeutic knowledge with a humanistic understanding of mental illness. Students were asked to retake the AQ-27 after completing the module.

Assessment. Paired responses on the AQ-27 were reported for 74 of 104 students, which represents a response rate of 71.2%. Students' scores changed significantly on nine of the 27 questions. Students' attitudes pre- to post-module revealed a significant increase in the help construct, while there was a significant decrease in the dangerousness and fear constructs.

Conclusion. Designing and implementing a course along the continuum of Bloom's affective domain resulted in appropriate changes in students' attitudes toward patients with mental illness.

Keywords: affective domain, stigma, psychiatry, mental illness, reflective discussion


Health care providers' stigmatizing attitudes toward patients can create an insurmountable barrier to effective patient interactions, if not completely detach the patient's beliefs, motivations, and feelings from the provision of care. (1,2) Patients with a psychiatric or substance use disorders, for example, may cause health care providers to feel uncomfortable, which, in turn, can lead them to endorse negative stereotypes, desire greater social distance, and espouse negative attitudes. (3-5) The pharmacy literature has documented this occurrence, reporting that pharmacy students and pharmacists hold suboptimal attitudes regarding working with these patients, possess stereotypical beliefs, and feel less confident providing them with medication counseling. (2,6,7) Therefore, it is imperative for pharmacy schools to address these attitudinal components of learning, in addition to developing knowledge and technical skills, in order to challenge and shape students' attitudes.

Bloom's taxonomy, a widely accepted categorization of knowledge, skills, and attitudes, offers guidance in addressing attitudes and values. The taxonomy describes learning in three domains: cognitive, psychomotor, and affective. According to this taxonomy, the cognitive domain relates to mental skills, the psychomotor domain to physical skills, and the affective domain to feelings and emotions. (8) The affective domain, though not a typical focus in scientific fields, is of extreme importance for pharmacy students because it deals with how individuals manage the emotional context of situations involving people. Karthwhol and colleagues described the characteristics within this domain as listening to and respecting others (receiving phenomena), being open to revising judgments and accepting of ideas that may be inconsistent with original values (internalizing values), and having sensitivity toward individual and cultural differences (valuing). (9) A major aspect of the affective domain involves the process of self-reflection as a means to resolve dissonance or conflicts regarding feelings toward a specific topic or individual. (8) If not reflected upon and shared in discussion, one's beliefs can solidify, manifesting as ingrained behaviors.

Health professions programs, including medicine, (10) nursing, (11) physician assistant, (12) and pharmacy, (13) recognize the importance of fostering interpersonal and humanistic qualities in their students so they can engage and empower patients in their own care. Pharmacy educational organizations support the development of characteristics classified in the affective domain. …

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