Behavioral Nudges and Help-Seeking Behavior in High-Stigma Professions: Experimental Evidence from Honduras

Our stigma-reduction interventions aim to reduce anticipated stigma—that is, the fear of being perceived as weak or incompetent or of being treated unfairly by peers or supervisors—which can be a significant barrier to seeking mental health care among police officers. The interventions focus on three key elements: providing information, sharing destigmatizing content, and displaying institutional support from the highest-ranking authorities in the force.

We evaluate whether standardized messages designed to reduce mental health stigma can increase police officers’ willingness to seek mental health services. We test two information-based nudges:

Treatment Arm 1 (T1): Information-based destigmatization. This message is designed to reduce stigma through the normalization of mental health issues and the use of mental health support by their peers. It emphasizes that working in the national police requires significant strength and often involves exposure to psychological stressors. As such, experiencing mental health challenges is framed as a normal human response. The message also notes that addressing mental health concerns can improve professional performance. It concludes by sharing the proportion of officers who have already accessed mental health services offered by our partner Glasswing International and encourages others to do the same if needed. The exact message is as follows:

"Dear police officer,
Serving in the National Police is an honor and a responsibility that requires strength, discipline, and commitment. It also involves constant exposure to high-stress situations. Assessments conducted with officers show that many experience symptoms of stress, anxiety, or emotional distress. This is not a personal failure, but a normal human response to the challenging work they do.

When left unaddressed, mental health problems can affect concentration, decision-making, and relationships with colleagues and the public. Recognizing and addressing these issues is essential not only for personal well-being but also for operational performance and safety.

By 2025, nearly 3,000 police officers in Honduras will have received mental health training through a program called SanaMente. This means that police officers now have tools for emotional regulation and use self-care strategies to support their well-being."

Treatment Arm 2 (T2): Leadership endorsement. This message builds on the content of T1 but adds an endorsement from one of the highest-ranking officer—the Vice Minister for Security and Human Rights Prevention. Like T1, it normalizes mental health challenges as a response to job-related stress. Additionally, the Vice Minister explicitly expresses his support for mental well-being and promotes a culture in which seeking help is considered responsible and courageous. He directly encourages officers to make use of the available mental health services. The exact message is as follows:

"Dear Police Officer,

Serving in the National Police is an honor and a responsibility that requires strength, discipline, and commitment. It also involves constant exposure to high-stress situations. Feeling emotionally overwhelmed, anxious, or distressed at times is not a sign of weakness, but a normal human response to the challenging work we do.

As the Vice Minister of the Honduran Ministry of Security, I recognize the importance of mental health and am committed to fostering a culture in which seeking support is seen as a responsible and courageous step.

If you are going through situations of stress, anxiety, or other emotional difficulties, I want you to know that you are not alone and that you have our full support. Asking for help is not only accepted—it is something we in the National Police encourage. We hope you feel safe and supported in doing so.

Sincerely,
Attorney Hugo Suazo Ortíz
Vice Minister for Security and Human Rights Prevention"

2025-05-01

2025-06-30

Willingness to receive mental health support
Willingness to pay for mental health services
Help-seeking behavior
Perceived stigma related to peer pressure

Willingness to receive mental health support:
Measured through the question: “Are you willing to participate in a mental health support session with a trained professional?”

Willingness to pay for mental health services:
Measured using the question: “Assume that you are experiencing some mental health issues and you decide to receive support from a trained professional. How much would you be willing to pay for a session (in lempiras)?”

Help-seeking behavior:
This outcome will be an indicator variable that takes the value 1 if the officer provides their contact information to receive additional information on mental health services from trained professionals at the NGO Glasswing International.

Perceived stigma related to peer pressure:
This outcome will be measured using questions about preferences for different characteristics of mental health services, such as attending a virtual versus in-person session or participating in an individual versus group-based session.

In addition to the primary outcomes, the PIs are negotiating access to administrative data from police officers who consent to participate in the study. These data will include information on work performance, health records (including the use of mental health services), and other behavior-related indicators. We will assess the impact of the interventions on these additional outcomes, conditional on the results of this negotiation with the Honduras Security Secretariat.

Sample recruitment for this randomized controlled trial will be conducted in collaboration with the Honduran Security Secretariat and the NGO Glasswing International. We will invite police officers stationed in various departments across the country. The final sample agreed upon with our partners comprises 1,777 police officers who consent to participate in the study.

After providing consent, each officer will receive a tablet from the field team to self-administer the survey. The survey includes two sections. The first section, conducted prior to the information treatments, will collect data on the following domains: physical and emotional well-being; mental health status (including depression, anxiety, and stress); stigma-related attitudes toward seeking mental health care and mental health conditions more broadly; interpersonal relationships; job satisfaction and performance; risk preferences; and basic sociodemographic and economic characteristics.

Upon completing the first section, participants will be randomly assigned—via the survey software—to one of three groups: Treatment Arm 1 (T1), Treatment Arm 2 (T2), or a control group. Participants in T1 and T2 will view the treatment messages described in the “Intervention” section. Those in the control group will not receive any message.

Immediately following the treatment message (or after the first survey section for the control group), officers will complete the second section of the survey. This section includes questions on preferences for features of mental health interventions, willingness to participate in mental health services, and willingness to pay for such services. These responses will be used to construct the primary outcomes described in the “Primary Outcomes” section.

In addition to estimating average treatment effects, we will examine heterogeneous treatment effects along the following dimensions: gender, rank, attitudes toward mental health, baseline mental health status, perceived work performance, and risk preferences.

After assessing the initial results, the team will discuss findings with police stakeholders and request access to administrative records on work performance, mental health service use, and other behavioral outcomes. We will link these records to our survey data. An amendment to this pre-analysis plan will be submitted following an agreement with the partners and prior to any data linkage or analysis.

Finally, the team will collect data using the first part of the survey from an additional sample of approximately 1,000 police officers. These officers will not participate in the experimental component. However, their data will be combined with the experimental sample and used to (i) document the mental health status of police officers in Honduras and (ii) explore correlations between mental health status and other variables collected in the first part of the survey (including attitudes toward mental health, perceived work performance, and risk preferences), as well as performance-related outcomes obtained from the administrative records under negotiation with the authorities.

Randomization will be implemented in the field through the survey software. The research team will program the survey to assign each respondent to one of the three study groups—Treatment 1, Treatment 2, or Control—with equal probability. Randomization will occur automatically upon completion of the first section of the survey.

Randomization will be conducted at the individual level. An expected total of 1,777 police officers who consent to participate in the study will be individually randomized into one of the three study arms.

No

NA

1,777 police officers who consent to participate in the experimental study. As mentioned before, the team will also collect data from an additional sample of approximately 1,000 police officers who will not participate in the experimental component. Data from both groups—totaling 2,777 officers—will be used to produce a diagnostic assessment of officers’ mental health and its association with performance and other outcomes.

1/3 of 1,777 police officers will be allocated to T1
1/3 of 1,777 police officers will be allocated to T2
1/3 of 1,777 police officers will be allocated to the comparison group.