scholarly journals Assessing the prospect of a common health-related stigma reduction response: Cross-perspectives of people living with stigmatised health conditions in Indonesia

2020 ◽  
pp. 1-14
Author(s):  
Sarju Sing Rai ◽  
Elena V. Syurina ◽  
Ruth M.H. Peters ◽  
Irwanto Irwanto ◽  
Denise Naniche ◽  
...  
Keyword(s):  
Health Conditions ◽  
Stigma Reduction ◽  
Related Stigma ◽  
Health Related

scholarly journals Validation of the Health-Related Felt Stigma and Concealment Questionnaire

2020 ◽  
Vol 45 (5) ◽  
pp. 509-520
Author(s):  
Kelsey T Laird ◽  
Craig A Smith ◽  
Steven D Hollon ◽  
Lynn S Walker
Keyword(s):  
Factor Model ◽  
Pain Catastrophizing ◽  
Mental Healthcare ◽  
Physical Symptoms ◽  
Self Report ◽  
Health Conditions ◽  
Functional Abdominal Pain ◽  
Related Stigma ◽  
Health Related ◽  
Mental Healthcare Utilization

Abstract Objective Stigma is associated with many health conditions, including chronic pain. Research on health-related stigma is limited by the lack of validated instruments that distinguish among various stigma-related constructs. We aimed to develop and validate such a measure for pediatric functional abdominal pain (FAP). Felt stigma (FS) was defined as comprising both perceived and internalized stigma. Stigma concealment (SC) was defined as efforts by stigmatized individuals to prevent others from learning of their condition. Methods Using a theory-driven approach, we adapted items from existing self-report measures of stigma to construct the health-related FS and Concealment Questionnaire (FSC-Q). Patients with FAP (N = 179, ages 11–17) completed the preliminary FSC-Q and health-related measures hypothesized to be associated with stigma. Cognitive interviewing and exploratory factor analysis (EFA) informed the final version of the measure. Results EFA identified a 2-factor model comprised of FS and SC. The FS and SC scales exhibited good internal consistency and construct validity. Consistent with study hypotheses, both factors were significantly associated with anxiety, depression, pain catastrophizing, pain threat, physical symptoms, and pain interference/disability. Higher FS was associated with higher mental healthcare utilization. The subset of participants meeting criteria for irritable bowel syndrome (IBS) reported higher FS and SC compared with those without IBS. Conclusion The FSC-Q may help advance research on health-related stigma in FAP and other chronic health conditions by allowing for assessment of distinct stigma-related constructs.

scholarly journals Intersectionality and health-related stigma: insights from experiences of people living with stigmatized health conditions in Indonesia

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Sarju Sing Rai ◽  
Ruth M. H. Peters ◽  
Elena V. Syurina ◽  
Irwanto Irwanto ◽  
Denise Naniche ◽  
...  
Keyword(s):  
Social Inequalities ◽  
Health Conditions ◽  
Self Confidence ◽  
Co Morbidity ◽  
Societal Actors ◽  
Framework Approach ◽  
Related Stigma ◽  
Comprehensive Picture ◽  
Health Related ◽  
Micro Level

Abstract Background Health-related stigma is a complex phenomenon, the experience of which intersects with those of other adversities arising from a diversity of social inequalities and oppressive identities like gender, sexuality, and poverty – a concept called “intersectionality”. Understanding this intersectionality between health-related stigma and other forms of social marginalization can provide a fuller and more comprehensive picture of stigma associated with health conditions. The main objective of this paper is to build upon the concept of intersectionality in health-related stigma by exploring the convergence of experiences of stigma and other adversities across the intersections of health and other forms of social oppressions among people living with stigmatized health conditions in Indonesia. Methods This qualitative study interviewed 40 people affected by either of four stigmatizing health conditions (HIV, leprosy, schizophrenia, and diabetes) in Jakarta and West Java, Indonesia between March and June 2018. Data was analyzed thematically using an integrative inductive-deductive framework approach. Results The main intersectional inequalities identified by the participants were gender and socioeconomic status (n = 21), followed by religion (n = 13), age (n = 11), co-morbidity (n = 9), disability (n = 6), and sexuality (n = 4). Based on these inequalities/identities, the participants reported of experiencing oppression because of prevailing social norms, systems, and policies (macro-level), exclusion and discrimination from societal actors (meso-level), and self-shame and stigma (micro-level). While religion and age posed adversities that negatively affected participants in macro and meso levels, they helped mitigate the negative experiences of stigma in micro level by improving self-acceptance and self-confidence. Conclusion This study uncovered how the experience of health-related stigma intersects with other oppressions originating from the various social inequalities in an individual’s life. The findings highlight the importance of acknowledging and understanding the multi-dimensional aspect of lives of people living with stigmatized health conditions, and warrant integrated multi-level and cross-cutting stigma reduction interventions to address the intersectional oppressions they experience.

scholarly journals How do Positive Deviants Overcome Health-Related Stigma? An Exploration of Development of Positive Deviance Among People With Stigmatized Health Conditions in Indonesia

2021 ◽  
pp. 104973232110581
Author(s):  
Sarju Sing Rai ◽  
Elena V. Syurina ◽  
Ruth M. H. Peters ◽  
Annisa Ika Putri ◽  
Irwanto Irwanto ◽  
...  
Keyword(s):  
Psychological Empowerment ◽  
Positive Deviance ◽  
Constructivist Grounded Theory ◽  
Health Conditions ◽  
Theory Approach ◽  
Component Development ◽  
Related Stigma ◽  
Health Related ◽  
Self Discovery ◽  
Grounded Theory Approach

A constructivist grounded theory approach was used to understand how some people living with stigmatized health conditions develop positive deviance to overcome stigma. We examined interviews from 13 identified positive deviants living with four different stigmatized health conditions (HIV, leprosy, schizophrenia, and diabetes) in Indonesia. Positive deviance develops in the form of psychological empowerment through improvement of self-belief and perception (intrapersonal component), development of understanding and skill to exert control in life (interactional component), and self-discovery of successful behaviors and strategies to avert stigma (behavioral component). Positive deviants, after being empowered, start empowering others affected by sharing their knowledge and fostering social awareness and acceptance. The findings revealed the presence of problem-solving ability and agency within the community of stigmatized individuals in Indonesia and warrant researchers to partner with the community to expedite the diffusion of transferable positive deviant strategies within and outside the communities.

scholarly journals Qualitative Exploration of Experiences and Consequences of Health-related Stigma among Indonesians with HIV, Leprosy, Schizophrenia and Diabetes

2020 ◽  
Vol 15 (1) ◽  
pp. 7
Author(s):  
Sarju Sing Rai ◽  
Irwanto Irwanto ◽  
Ruth M.H. Peters ◽  
Elena V. Syurina ◽  
Annisa Ika Putri ◽  
...  
Keyword(s):  
Social Interactions ◽  
Negative Impact ◽  
Health Conditions ◽  
Public Health Programs ◽  
Individual Level ◽  
Related Stigma ◽  
Health Related ◽  
Enacted Stigma ◽  
Anticipated Stigma ◽  
Qualitative Exploration

Health-related stigma causes a negative impact on the lives of affected people and undermines the effectiveness of public health programs. This study aimedto explore experiences and consequences of stigma among people affected by four health conditions relevant in Indonesia– HIV (Human ImmunodeficiencyVirus), leprosy, schizophrenia and diabetes. In this qualitative study 40 people affected by the four health conditions in Jakarta and West Java, Indonesia–,were interviewed between March and June 2018. Data were analyzed thematically by following an integrative inductive-deductive approach. The experiencesand consequences of people with stigma were similar, but such experience were more severe among people affected by HIV, leprosy, and schizophrenia.Those with diabetes either experienced no or less severe stigma. The participants revealed that they experienced enacted stigma in healthcare, employment,and social interactions in the structural and interpersonal levels. They also experience the stigma in the form of internalized and anticipated stigma at an individual level. Incidences of human rights violations were evident. Social, behavioral, psychological, and medical consequences were also reported.

scholarly journals Understanding Stigmatisation: Results of a Qualitative Formative Study with Adolescents and Adults in DR Congo

2020 ◽  
Author(s):  
Kim Hartog ◽  
Ruth M. H. Peters ◽  
Mark J. D. Jordans
Keyword(s):  
General Population ◽  
Population Group ◽  
Armed Forces ◽  
Positive Interactions ◽  
Framework Analysis ◽  
Dr Congo ◽  
Stigma Reduction ◽  
Unmarried Mothers ◽  
Related Stigma ◽  
Health Related

Abstract While stigmatisation is universal, stigma research in low- and middle-income countries (LMIC) is limited. LMIC stigma research predominantly concerns health-related stigma, primarily regarding HIV/AIDS or mental illness from an adult perspective. While there are commonalities in stigmatisation, there are also contextual differences. The aim of this study in DR Congo (DRC), as a formative part in the development of a common stigma reduction intervention, was to gain insight into the commonalities and differences of stigma drivers (triggers of stigmatisation), facilitators (factors positively or negatively influencing stigmatisation), and manifestations (practices and experiences of stigmatisation) with regard to three populations: unmarried mothers, children formerly associated with armed forces and groups (CAAFAG), and an indigenous population. Group exercises, in which participants reacted to statements and substantiated their reactions, were held with the ‘general population’ (15 exercises, n = 70) and ‘populations experiencing stigma’ (10 exercises, n = 48). Data was transcribed and translated, and coded in Nvivo12. We conducted framework analysis. There were two drivers mentioned across the three populations: perceived danger was the most prominent driver, followed by perceived low value of the population experiencing stigma. There were five shared facilitators, with livelihood and personal benefit the most comparable across the populations. Connection to family or leaders received mixed reactions. If unmarried mothers and CAAFAG were perceived to have taken advice from the general population and changed their stereotyped behaviour this also featured as a facilitator. Stigma manifested itself for the three populations at family, community, leaders and services level, with participation restrictions, differential treatment, anticipated stigma and feelings of scapegoating. Stereotyping was common, with different stereotypes regarding the three populations. Although stigmatisation was persistent, positive interactions between the general population and populations experiencing stigma were shared as well. This study demonstrated utility of a health-related stigma and discrimination framework and a participatory exercise for understanding non-health related stigmatisation. Results are consistent with other studies regarding these populations in other contexts. This study identified commonalities between drivers, facilitators and manifestations—albeit with population-specific factors. Contextual information seems helpful in proposing strategy components for stigma reduction.

scholarly journals Reducing Mental Health Stigma in Primary Healthcare Workers in a Rural Chinese County: a Contact-based Family-centric Approach

2021 ◽  
Author(s):  
An-Li Wang ◽  
Selinda Qiu ◽  
Tian-Ming Zhang ◽  
Yuer Deng ◽  
Mao-Sheng Ran ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Training Program ◽  
Primary Healthcare ◽  
Healthcare Workers ◽  
Stigma Reduction ◽  
People With Mental Illness ◽  
Related Stigma ◽  
Health Related ◽  
Stigmatizing Attitudes

Abstract Background: Mental health-related stigma is a key deterrent to help-seeking in people with mental illness. However, effective stigma reduction interventions are sparse, let alone ones adapted to the cultural context of mental health systems. The aims of the present study were to demonstrate the feasibility and to evaluate the impact of a culturally adapted brief contact-based family-centric training program on reducing mental health-related stigma in primary healthcare workers (PHW) in a Chinese rural county. Methods: The one-day stigma reduction training program was developed based on the Opening Minds Anti-Stigma Initiative. The program included didactic lectures, case studies (two audio-taped testimonies of patient-caregiver dyads) and communication skills training (role-playing). Ten township-level and ten village-level PHW participated in separate one-day training sessions. Mental health knowledge, stigmatizing attitudes and behaviors, and provider empathy were measured before and after the training. Results: The intervention was favorably rated and considered acceptable among PHW. Compared to measures at baseline, participants’ stigmatizing attitudes reduced, their willingness to engage in relationship with people with mental illness increased, and their empathetic response toward patients improved post-intervention.Conclusions: Social contact-based family-centric training is a promising and feasible method of reducing stigma among rural Chinese PHW.

Prescribing stigma in mental disorders: A comparative study of Portuguese psychiatrists and general practitioners

2021 ◽  
pp. 002076402110025
Author(s):  
Bárbara Almeida ◽  
Ana Samouco ◽  
Filipe Grilo ◽  
Sónia Pimenta ◽  
Ana Maria Moreira
Keyword(s):  
Mental Health ◽  
Mental Disorder ◽  
General Practitioners ◽  
Psychiatric Patients ◽  
Self Report ◽  
Cross Sectional ◽  
Medical Speciality ◽  
Diagnostic Overshadowing ◽  
Related Stigma ◽  
Health Related

Background: Physicians, including psychiatrists and general practitioners (GPs), have been reported as essential sources of stigma towards people diagnosed with a mental disorder (PDMDs), which constitutes an important barrier to recovery and is associated with poorer clinical outcomes. Therefore, psychiatrists and GPs are key populations where it is crucial to examine stigma, improve attitudes and reduce discrimination towards psychiatric patients. Aims: This study is the first to explore mental health-related stigma among Portuguese psychiatrists and GPs, examining the differences between these two specialities and assessing whether sociodemographic and professional variables are associated with stigma. Method: A cross-sectional study was performed between June 2018 and August 2019. A consecutive sample of 55 Psychiatrists and 67 GPs working in Porto (Portugal) filled a 25-item self-report questionnaire to assess their attitudes towards PDMDs in clinical practice. The instrument was designed by the authors, based on previous mental health-related stigma studies and validated scales. The questionnaire includes 12 stigma dimensions ( Autonomy, Coercion, Incompetence, Dangerousness, Permanence, Pity, Responsibility, Segregation, Labelling, Diagnostic Overshadowing, Shame and Parental Incompetence), and its total score was used to measure Overall Stigma (OS). Sample characteristics were examined using descriptive statistics, and the factors affecting stigma were assessed through regression analysis. Results: GPs exhibit significantly higher OS levels than psychiatrists, and present higher scores in the dimensions of dangerousness, parental incompetence, diagnostic overshadowing and responsibility. Besides medical speciality, several other sociodemographic variables were associated with sigma, including age, gender, having a friend with a mental disorder, professional category, agreement that Psychiatry diverges from core medicine and physician’s interest in mental health topics. Conclusions: Our data suggest that both psychiatrists and GPs hold some degree of stigmatizing attitudes towards PDMDs. Overall, these results bring new light to stigma research, and provide information to tailor anti-stigma interventions to Portuguese psychiatrists and GPs.

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