This document discusses the concept of stigma in healthcare. It defines stigma as a social process involving labeling, stereotyping, devaluation, and discrimination. There are three main types of stigma discussed: internalized stigma which involves negative beliefs about oneself, experienced stigma which involves perceptions of discrimination from others, and anticipated stigma which involves expectations of future discrimination. Stigma can act as a barrier to healthcare access and is associated with decreased quality of life. Interventions to reduce stigma include education, skills building, participatory learning, contact with stigmatized groups, empowerment approaches, and structural/policy changes.
3. Stigma
Stigma is conceptualized as a complex social process of
labeling, othering, devaluation, and discrimination
involving an interconnection of cognitive, emotional, and
behavioural components.
Stigma /stig·ma/ n ciri negatif yang menempel pada
pribadi seseorang karena pengaruh lingkungannya; tanda
(KBBI)
4. Stigma in
healthcare
services
(Stigma dalam
pelayanan kesehatan)
• Stigma – social devaluation or discrediting
due to their illness (Goffman, 1963).
• Social stigma in the context of health is the
negative association between a person or
group of people who share certain
characteristics and a specific disease (WHO)
• Asosiasi negative pada individu atau
sekelompok orang yang mempunyai
karakteristik dan penyakit tertentu.
5. Discussion
• Can you provide example of diseases that usually stigmatized or have
negative association in it?
7. Internalized stigma
Internalized stigma is the extent to which people endorse negative beliefs
and feelings associated with their stigmatized attribute and apply them to
the self (Link, 1987).
(sejauh mana seseorang mempunyai kepercayaan atau perasaan negative tentang
sesuatu dan menerapkannya kepada dirinya sendiri)
People living with chronic illnesses report feeling shame, guilt, and
diminished self-worth; embarrassed and odd; responsibility for their illness;
and even dirty and diseased
(orang orang dengan penyakit kronis merasa malu, bersalah, dan merasa tidak
berharga, dan ada pula yang merasa ‘kotor’ dan penyakitan)
8. Internalized stigma
Another example: a person living with epilepsy reported feeling that
‘basically, I’m one of nature’s rejects’ (Kilinc and Campbell, 2009: 669).
Notably, internalized stigma is an intrapersonal phenomenon.
(Perasaan/kepercayan negative dari dalam dirinya sendiri, hal ini dapat
terbawa pada berbagai aspek sosial termasuk pelayanan Kesehatan).
Internalized Stigma (stigma yang dipersepsikan sendiri): negative
beliefs and feelings about themselves because of their disease
9. Experienced stigma
Experienced stigma, is the extent to which people perceive that they have
experienced stereotyping, prejudice, and discrimination directed at them
from others (Scambler and Hopkins, 1986)
(sejauh mana seseorang merasakan bahwa mereka mengalami stereotyping,
prejudice, dan diskriminasi yang ditujukan pada dirinya dari orang lain)
In contrast to internalized stigma, experienced stigma is perceived by people
within their interpersonal interactions, including those that occur with
healthcare workers
(stigma yang dirasakan seseorang dalam interaksi individu dengan orang lain,
termasuk dengan petugas kesehatan)
10. Experienced stigma
Misal: orang-orang dengan penyakit kronis melaporkan perlakukan di-
stigmatisasi pada kehidupan sehari hari.
People living with HIV/AIDS (PLWHA), for example, report receiving poor care,
being denied care, and being blamed for their illness by healthcare workers
(Sayles et al., 2007).
People living with other illness-related stigmas report that healthcare workers
feel frustrated with them, complaining of their ‘noncompliance’ (Rogge et al.,
2004), and treat them differently or unfairly (Conrad et al., 2006).
12. Anticipated
stigma
• Anticipated stigma is the extent to
which people expect to
experience stereotyping,
prejudice, and discrimination
directed at them from others in
the future (Markowitz, 1998).
• Sejauh mana seseorang
memprediksi akan mengalami
stereotyping dan diskriminasi.
13. Stereotype
• In social psychology, a stereotype is over generalized belief about a
particular group or class of people.
• Stereotypes can be based on race, ethnicity, age, gender, sexual
orientation—almost any characteristic.
• Penilaian terhadap seseorang hanya berdasarkan persepsi generalisasi
terhadap kelompok di mana orang tersebut dapat dikategorikan.
• Example: what do you think when you meet older people?
14. Prejudice
Prejudice refers to the beliefs, thoughts, feelings, and attitudes
someone holds about a group. A prejudice is not based on experience;
instead, it is a prejudgment, originating outside actual experience.
biased thinking
Contoh: racism, colorism
15. Discrimination
• consists of actions against a group of people. Discrimination
can be based on age, religion, health, and other indicators;
race-based laws against discrimination strive to address this
set of social problems.
16. Impact of stigma?
Internalized, experienced, and anticipated stigma within healthcare settings likely
act as barriers to care access.
Stigma menjadi hambatan akses kepada layanan kesehatan, penurunan kualitas
hidup
Both internalized and experienced stigma are associated with decreased quality of
life
Quality of life is defined by the World Health Organization (1998) as an individual’s
subjective evaluation of their life as it relates to their own values and goals.
18. What can we do?
• The first is providing interventions that include myth busting or a
transformative learning focus to target unconscious biases and
correct false beliefs that may be negatively impacting care.
• The second is demonstrating/emphasizing and showing ways in
which healthcare providers play an impactful role in that process.
• Combating Stigma
• The working mind program
19.
20. • Nearly all participants reported experiencing stigma and discrimination by their
healthcare providers in a variety of contexts. Participants perceived that their
healthcare providers' fear of being infected with HIV, coupled with religious and
negative value-based assumptions about PLHIV, led to high levels of stigma.
• Participants mentioned at least four major forms of stigma: (1) refusal of care; (2)
sub-optimal care; (3) excessive precautions and physical distancing; and (4)
humiliation and blaming.
• The participants' healthcare-seeking behavioural reactions to perceived stigma
and discrimination included avoiding or delaying seeking care, not disclosing HIV
status when seeking healthcare, and using spiritual healing. In addition,
emotional responses to perceived acts of stigma included feeling undeserving of
care, diminished motivation to stay healthy, feeling angry and vengeful, and
experiencing emotional stress.
21. Discussion
• Do you have any experience relate to stigma?
• Ada yang punya pengalaman seputar stigma, stereotype, prejudice
atau diskriminasi?
22. Discussion
• Kasus kasus penyakit apa yang mempunyai stigma tertentu?
• Apa yang bisa kita lakukan untuk mengurangi stigma di pelayanan
kesehatan?
23. Interventions to reduce stigma
1.“Provision of information” consisted of teaching participants about the condition
itself or about stigma, its manifestations, and its effect on health.
2.“Skills-building activities” involved creating opportunities for healthcare providers
to develop the appropriate skills to work directly with the stigmatized group.
3.“Participatory learning” approaches required participants (health facility staff or
clients or both) to actively engage in the intervention.
4.“Contact with stigmatized group” relied on involving members of the stigmatized
group in the delivery of the interventions to develop empathy, humanize the
stigmatized individual, and break down stereotypes.
5.An “empowerment” approach was used to improve client coping mechanisms to
overcome stigma at the health facility level.
6.“Structural” or “policy change” approaches included changing policies, providing
clinical materials, redress systems, and facility restructuring.
