This document provides an overview of stigma reduction strategies and interventions that have been implemented for various health conditions. It begins by defining the key concepts of strategies and interventions, noting that interventions derive from strategies. It then reviews stigma reduction strategies that have been used for HIV/AIDS, leprosy, tuberculosis, mental illness, epilepsy, and disability. Common strategies include education, contact, counseling, advocacy, and legal/policy reforms. The document concludes that while many interventions have been implemented, there is still limited evidence on the effectiveness of the strategies, and more evaluation work needs to be done.
The social worker plays an important role in addressing the psycho-social and emotional needs of patients and families in the intensive care unit (ICU). This includes providing education about the medical condition, helping families cope with strong emotions like grief, reducing distress, and connecting patients and families to resources for support. The social worker aims to improve quality of life and facilitate end-of-life decision making through counseling, addressing practical needs, and collaborating with the healthcare team.
Introduction to stigma and stereotypes: people with problematic substance useWorkingwithsubstanceabuse
This document discusses stigma related to substance use. It defines stigma as a "stain or attribute" that marks someone as unacceptable and leads to prejudice and discrimination. Negative labels used to describe those with substance use issues are stigmatizing and promote judgmental attitudes. This stigma can fuel a vicious cycle where people use drugs or alcohol to cope with feeling shamed and stereotyped. Health practitioners are key to breaking this cycle by adopting a growth mindset that believes anyone is capable of change with the right help, rather than thinking some people cannot be helped. The document advocates for person-centered care where service users can work in partnership with practitioners through good communication and tailored information.
This document discusses reducing stigma and discrimination against those with mental illnesses or substance use disorders. It defines stigma and discrimination, and explores protections under the Americans with Disabilities Act (ADA). Several common stereotypes and their negative effects are described. The document advocates challenging stereotypes through education, advocacy, and speaking openly about mental health. It also discusses protections against discrimination in housing and education.
Psychiatric social work applies social work methods and practices in psychiatry settings. It is both a science and an art that treats patients through psychological and social means as psychiatric illness can disturb social conditions. Early psychiatric social workers collected case histories and acted as intermediaries between patients and families. Over time, psychiatric social work developed as a distinct profession with roles in hospitals, the military, and creating public awareness of mental health issues. In India, psychiatric social work began in 1937 with child guidance clinics and has since expanded, with specialized training beginning in the 1950s. Social work methods like casework, group work, and community organization are important in psychiatric services to help patients and families adjust.
Scope of Social Work in the Mental Health sector.pptxssuser94ea49
Mental health care in Nepal is increasingly prioritized through policies and plans. The National Mental Health Strategy and Action Plan 2020 aims to integrate mental health services into primary health care across the country for free. It also describes the roles of NGOs and INGOs in promoting mental health. While progress has been made in policy and planning, fully integrating mental health into other public health programs has yet to be achieved.
unit 5 Culture, prejudice, stigmatization, and discriminationsherkamalshah
This document discusses culture, prejudice, stigmatization, and discrimination. It defines key terms like stigma, prejudice, and discrimination. Stigma refers to a mark of disgrace that sets people apart. Prejudice involves negative beliefs or feelings towards a group. Discrimination involves behaviors that treat some groups less favorably than others. The document examines how stigma impacts individuals with stigmatized diseases through public stigma of others and self-stigma. It discusses the stereotypes, prejudice, and discrimination that comprise public and self-stigma. Strategies are needed to enhance acceptance of individuals with stigmatized diseases.
Mental illness stigma ppt slides - cultural infoJoe Tinkham
This document discusses mental illness stigma in several non-Western cultures. It finds that most cultures exhibit somatization of emotional distress and idioms of distress that are culturally specific. Treatment often focuses on pharmacotherapy due to stigma, and families prefer to keep mental illness private. While biomedical views are more common in urban areas, traditional beliefs involving spirit possession or witchcraft remain influential, especially rurally. Integrating biomedical and traditional views into mental healthcare may help reduce stigma.
The social worker plays an important role in addressing the psycho-social and emotional needs of patients and families in the intensive care unit (ICU). This includes providing education about the medical condition, helping families cope with strong emotions like grief, reducing distress, and connecting patients and families to resources for support. The social worker aims to improve quality of life and facilitate end-of-life decision making through counseling, addressing practical needs, and collaborating with the healthcare team.
Introduction to stigma and stereotypes: people with problematic substance useWorkingwithsubstanceabuse
This document discusses stigma related to substance use. It defines stigma as a "stain or attribute" that marks someone as unacceptable and leads to prejudice and discrimination. Negative labels used to describe those with substance use issues are stigmatizing and promote judgmental attitudes. This stigma can fuel a vicious cycle where people use drugs or alcohol to cope with feeling shamed and stereotyped. Health practitioners are key to breaking this cycle by adopting a growth mindset that believes anyone is capable of change with the right help, rather than thinking some people cannot be helped. The document advocates for person-centered care where service users can work in partnership with practitioners through good communication and tailored information.
This document discusses reducing stigma and discrimination against those with mental illnesses or substance use disorders. It defines stigma and discrimination, and explores protections under the Americans with Disabilities Act (ADA). Several common stereotypes and their negative effects are described. The document advocates challenging stereotypes through education, advocacy, and speaking openly about mental health. It also discusses protections against discrimination in housing and education.
Psychiatric social work applies social work methods and practices in psychiatry settings. It is both a science and an art that treats patients through psychological and social means as psychiatric illness can disturb social conditions. Early psychiatric social workers collected case histories and acted as intermediaries between patients and families. Over time, psychiatric social work developed as a distinct profession with roles in hospitals, the military, and creating public awareness of mental health issues. In India, psychiatric social work began in 1937 with child guidance clinics and has since expanded, with specialized training beginning in the 1950s. Social work methods like casework, group work, and community organization are important in psychiatric services to help patients and families adjust.
Scope of Social Work in the Mental Health sector.pptxssuser94ea49
Mental health care in Nepal is increasingly prioritized through policies and plans. The National Mental Health Strategy and Action Plan 2020 aims to integrate mental health services into primary health care across the country for free. It also describes the roles of NGOs and INGOs in promoting mental health. While progress has been made in policy and planning, fully integrating mental health into other public health programs has yet to be achieved.
unit 5 Culture, prejudice, stigmatization, and discriminationsherkamalshah
This document discusses culture, prejudice, stigmatization, and discrimination. It defines key terms like stigma, prejudice, and discrimination. Stigma refers to a mark of disgrace that sets people apart. Prejudice involves negative beliefs or feelings towards a group. Discrimination involves behaviors that treat some groups less favorably than others. The document examines how stigma impacts individuals with stigmatized diseases through public stigma of others and self-stigma. It discusses the stereotypes, prejudice, and discrimination that comprise public and self-stigma. Strategies are needed to enhance acceptance of individuals with stigmatized diseases.
Mental illness stigma ppt slides - cultural infoJoe Tinkham
This document discusses mental illness stigma in several non-Western cultures. It finds that most cultures exhibit somatization of emotional distress and idioms of distress that are culturally specific. Treatment often focuses on pharmacotherapy due to stigma, and families prefer to keep mental illness private. While biomedical views are more common in urban areas, traditional beliefs involving spirit possession or witchcraft remain influential, especially rurally. Integrating biomedical and traditional views into mental healthcare may help reduce stigma.
The research report Presentation addresses the stigma related to the mental health in our society. This study was intended to increase understanding of peoples’ views of mental illness by developing and administering measures of knowledge and attitudes of people toward mental illnesses.
The research conducted through questionnaires regarding the mental health stigma is reviewed and analyzed that indicates that the majority of the general public holds negative stereotypes towards people with psychological problems.
Hence, a model has been proposed to illustrate what are the peoples’ attitudes towards and knowledge about the mental health, why is it a taboo to talk about this topic, how can this stigma prevent the people from getting help for the psychological difficulties and solutions for reducing and dealing with the mental health stigma are discussed.
FAST-NU
COMPUTER SCIENCE DEPARTMENT
PSYCHOLOGY
COURSE INSTRUCTOR: Miss sumarah rashid
Section: GR-4
Group members:
Taban Shaukat 16K3937
Huzaifah Punjani 16K3924
Anas Bin Faisal 16K4064
Abeer Zehra 16K4068
Maria Ahmed 16K4058
This document discusses the use of theories in social work education and practice. It notes that there are approximately 30 theories taught from other disciplines like psychology, sociology, economics, etc. but there is no consensus on a distinct "social work theory." Theories are grouped into broad categories but are taught discretely rather than as a coherent course. Some argue theories have limited value for the complex realities of social work practice while others believe theories should inform practice. The document examines different perspectives on clinical versus macro-level social work and criticisms that some theories have taken over practice rather than guided it.
Traditional and alternative medical systems power pointMoranodi Moeti
Medical sociology examines health, illness, and healing from social, cultural, and behavioral perspectives rather than only medical views. It studies how social factors influence health and the distribution of illness. Medical sociology analyzes the social causes and consequences of health and illness, incorporating research on communities, patients' social dimensions, and policy development. The field has roots in both sociology and medicine and encompasses topics like the social construction of health and the influence of culture, economics, and social structures on disease processes.
Stern: Stigma and Mental Illness – A Barrier to Health Seekinghenkpar
Wonca Working Party on Mental Health
World mental Health Day
presentation Dr Anthony Stern (USA)
Stigma and Mental Illness – A Barrier to Health Seeking
1. The document discusses the process of social diagnosis, which involves gathering data about a client's social and psychological situation to understand the nature and causes of their problems.
2. Data is collected through interviews, records, reports, and direct observation to analyze factors like physical health, psychology, social environment, and their relationships.
3. The diagnostic process involves gathering data, studying the problem areas, evaluating the nature of issues and contributing factors, and determining the client's capacity and appropriate treatment.
The document outlines various fields of social work including child welfare, family welfare, health, corrections, schools, and community welfare. Child welfare services focus on protecting children's rights and facilitating their development through direct services like assistance in the home or foster care and indirect services like funding and coordination. Family welfare aims to strengthen and support families in meeting their needs through programs that improve parenting, marriage, and access to resources. Health social work addresses the social and psychological factors that can cause or exacerbate illness through work in hospitals, mental health agencies, and with those with disabilities.
The document provides an overview of social casework, including its historical development, principles, stages, components, and techniques. It discusses how social casework evolved from early charitable organizations in the 19th century to become a more professionalized field. The main principles of social casework are described as acceptance, communication, individualization, participation, and confidentiality. The stages are intake, study, assessment, treatment, evaluation, and termination. Key components are the person, problem, place, and process. Techniques used include supportive methods like acceptance and building self-confidence, as well as counseling approaches like advice, motivation, and modeling.
The document outlines objectives and concepts related to health, wellness, and disease. It discusses various definitions and models of health, including the World Health Organization's definition of health as complete physical, mental and social well-being. It describes dimensions of wellness, factors influencing health, and differences between illness and disease. Stages of illness and approaches to health maintenance are also summarized. Key health indicators in Pakistan like infant mortality rate and life expectancy are listed.
Social Case work in De-addiction CentreZaeem Jifri
A presentation on social case work in De-Addiction Center.
Addiction is a psychological and physical inability to stop consuming a chemical, drug, activity, or substance, even though it is causing psychological and physical harm.
Mental illnesses like schizophrenia, depression, and bipolar disorder are legitimate medical conditions, not character flaws. They are caused by genetic and biological factors and can be effectively treated. However, stigma and lack of understanding prevent many from seeking help. Myths that those with mental illnesses are dangerous or that conditions like depression are simply weakness perpetuate social stigma. In reality, around 1 in 4 people will experience a mental health problem in their lifetime, and conditions like depression result in significant economic costs due to lost productivity. Increased education is needed to reduce the stigma around mental illnesses.
This document discusses the social construction of health and illness. It introduces sociological theories of illness such as Talcott Parsons' sick role and Eliot Freidson's types of illness. The sick role refers to the behaviors expected of those who are ill, including being exempt from normal duties but also obligated to seek treatment. Freidson identified conditional, legitimate, and illegitimate sick roles depending on the seriousness and stigma of different illnesses. The social construction of health and illness has changed over time and varies between cultures.
This document outlines strategies for challenging mental health stigma. It begins with definitions of stigma and discusses the causes and manifestations of stigma, including ignorance, fear, and negative media portrayals. The document then describes different types of stigma such as self-stigma and enacted stigma. It notes that stigma can lead to discrimination and negative consequences for those with mental illness, including reluctance to seek treatment. The three most effective ways to challenge stigma identified are education to promote facts over misperceptions, contact with those experiencing mental illness, and protest against negative media portrayals.
The document summarizes the history and origin of psychiatric social work. It begins with a brief overview of the history of psychiatry from ancient to modern times. It then discusses the origins of psychiatric social work in the context of deinstitutionalization in the 1800s-1900s and the role of social workers in assisting former patients transition back to their communities. The document also notes the expansion of psychiatric social work during World War I to help soldiers experiencing shell shock. Finally, it discusses the development of psychiatric social work in India beginning in the 1930s-1940s and the establishment of training programs and professional associations to support the field.
The document discusses the social aspects of health and illness. It addresses common questions people have when they feel ill, like why they are sick and what can be done. It also discusses consulting others for advice or care, as well as common risk factors for chronic diseases like smoking, poor diet, stress, and more. The document then covers how cultural beliefs can influence explanations for behaviors and health patterns. Overall, it examines how social life and society can impact health outcomes.
This document provides an overview of basic counselling skills for school staff. It discusses what counselling is, the importance of school staff using counselling skills, and core counselling skills like active listening, empathy, and being non-judgemental. Active listening is emphasized as a key skill, with advice on body language, minimal encouragers, reflecting feelings, rephrasing, questioning, and summarizing to aid understanding for both the speaker and listener. An activity is suggested for staff to practice these skills in triads and receive feedback to improve.
The document discusses stigma associated with mental illness. It notes that stigma involves negative stereotypes and attitudes that label people with mental illness as less worthy. These attitudes are perpetuated by misrepresentations in media and a lack of understanding. The document outlines various factors that contribute to stigma, including fear, economic issues, lack of treatment facilities, and cultural beliefs. It also discusses the negative impacts of self-stigma, discrimination, and social exclusion that people with mental illness often face. Interventions like social contact and education are mentioned as ways to potentially help address stigma.
The document discusses several models of health behavior:
1) The Basic Risk Perception Model focuses on likelihood and severity of harm from not acting. Higher risk perception predicts greater motivation to act.
2) The Health Belief Model includes perceived susceptibility, severity, benefits, and barriers in predicting preventive health behaviors. Perceived barriers are the strongest predictor.
3) Protection Motivation Theory assesses threat and coping appraisal processes. Response costs have the strongest impact on health behaviors and attitudes.
4) The Transtheoretical Model proposes stages of change and processes of change to explain behavior progression. Decisional balance and self-efficacy also predict stage of change.
The strengths perspective is a social work framework that focuses on clients' strengths rather than deficits or problems. It emerged from psychiatric and custodial settings as an alternative to viewing clients as having pathologies. The strengths perspective mobilizes clients' talents, knowledge, and capacities to help them achieve their goals and improve their quality of life on their own terms. It is based on five principles: adopting an optimistic attitude, focusing on clients' assets, collaborating with clients, empowering clients long-term, and creating community.
Social work is considered an art that requires compassion, courage, creativity, and sound judgment. The key factors that comprise the art of social work include building meaningful professional relationships through empathy, warmth, and genuineness. Social workers must also infuse the change process with hope and energy while navigating personal and professional values. Developing an effective professional style is important for applying knowledge and skills in a unique way appropriate to each situation and client.
The document discusses the health belief model, which is a theoretical framework used in healthcare to guide health promotion plans and disease prevention. It has five stages: precontemplation, contemplation, preparation, action, and maintenance. The model focuses on perceived susceptibility, severity, benefits, and confidence. It can be used to understand behaviors like substance abuse in youth. Barriers to implementing it include lack of resources. Benefits are improving health knowledge and behaviors.
ADVANCED NURSING RESEARCH
1
ADVANCED NURSING RESEARCH 2
Evidence Based Practice Grant Proposal
Table of Contents
3
4
5
6
6
7
8
8
9
9
9
11
11
11
11
12
12
13
14
14
19
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Grant Proposal-Assessing the role of stigma towards mental health patients in help seeking
Study problem
There are several studies that have shown that stigmatization towards mental health patients have been present throughout history and even despite the evolution in modern medicine and advanced treatment. For example, Verhaeghe et al., (2014), captures in a publication in reference to a study that he conducted that stigmatization towards mental health patients has been there even as early is in the 18th Century. People were hesitant to interact with people termed or perceived to have mental health conditions.
Stigmatization has resulted from the belief that those with mental problem are aggressive and dangerous creating a social distance (Szeto et al., 2017). Also, mental health-related stigma has become of major concern as it creates crucial barriers to access treatment and quality care since it not only influences the behaviour of the patients but also the attitude of the providers hence impacting help-seeking. Timmermann, Uhrenfeldt and Birkelund (2014), have identified stigma as a barrier that is of significance to care or help seeking while the extent to which it still remains a barrier have not been reviewed deeply. Therefore, this study will assess the role contributed by stigma in help seeking in depth. 1. Purpose
The intention of the research study is to review the association between stigma, mental illness and help seeking in order to formulate ways in which the stigma that is around mental health is done away with to enable as many people suffering from mental health complications to seek medical help.2. Background
Mental health is crucial in every stage of life. It is defined as the state of psychological well-being whereby the individual realizes a satisfactory integration instinctual drive acceptable to both oneself and his or her social setting (Ritchie & Roser, 2018). The status of mental health influences physical health, relationships, and most importantly day-to-day life. Mental health problems arise when there is a disruption in mental well-being.
The risk factors to mental health problems are not limited and therefore everyone is entitled to the problem irrespective of gender, economic status, and ethnic group. For example, data shows that in America one out of five individuals experience mental health problems annually; with mental disorders being recognized as the leading cause of disability not only in the United States but also globally (Ritchie & Roser, 2018). Mental health disorders are seen to be complex and of many forms such as anxiety, mood, and schizophren.
The research report Presentation addresses the stigma related to the mental health in our society. This study was intended to increase understanding of peoples’ views of mental illness by developing and administering measures of knowledge and attitudes of people toward mental illnesses.
The research conducted through questionnaires regarding the mental health stigma is reviewed and analyzed that indicates that the majority of the general public holds negative stereotypes towards people with psychological problems.
Hence, a model has been proposed to illustrate what are the peoples’ attitudes towards and knowledge about the mental health, why is it a taboo to talk about this topic, how can this stigma prevent the people from getting help for the psychological difficulties and solutions for reducing and dealing with the mental health stigma are discussed.
FAST-NU
COMPUTER SCIENCE DEPARTMENT
PSYCHOLOGY
COURSE INSTRUCTOR: Miss sumarah rashid
Section: GR-4
Group members:
Taban Shaukat 16K3937
Huzaifah Punjani 16K3924
Anas Bin Faisal 16K4064
Abeer Zehra 16K4068
Maria Ahmed 16K4058
This document discusses the use of theories in social work education and practice. It notes that there are approximately 30 theories taught from other disciplines like psychology, sociology, economics, etc. but there is no consensus on a distinct "social work theory." Theories are grouped into broad categories but are taught discretely rather than as a coherent course. Some argue theories have limited value for the complex realities of social work practice while others believe theories should inform practice. The document examines different perspectives on clinical versus macro-level social work and criticisms that some theories have taken over practice rather than guided it.
Traditional and alternative medical systems power pointMoranodi Moeti
Medical sociology examines health, illness, and healing from social, cultural, and behavioral perspectives rather than only medical views. It studies how social factors influence health and the distribution of illness. Medical sociology analyzes the social causes and consequences of health and illness, incorporating research on communities, patients' social dimensions, and policy development. The field has roots in both sociology and medicine and encompasses topics like the social construction of health and the influence of culture, economics, and social structures on disease processes.
Stern: Stigma and Mental Illness – A Barrier to Health Seekinghenkpar
Wonca Working Party on Mental Health
World mental Health Day
presentation Dr Anthony Stern (USA)
Stigma and Mental Illness – A Barrier to Health Seeking
1. The document discusses the process of social diagnosis, which involves gathering data about a client's social and psychological situation to understand the nature and causes of their problems.
2. Data is collected through interviews, records, reports, and direct observation to analyze factors like physical health, psychology, social environment, and their relationships.
3. The diagnostic process involves gathering data, studying the problem areas, evaluating the nature of issues and contributing factors, and determining the client's capacity and appropriate treatment.
The document outlines various fields of social work including child welfare, family welfare, health, corrections, schools, and community welfare. Child welfare services focus on protecting children's rights and facilitating their development through direct services like assistance in the home or foster care and indirect services like funding and coordination. Family welfare aims to strengthen and support families in meeting their needs through programs that improve parenting, marriage, and access to resources. Health social work addresses the social and psychological factors that can cause or exacerbate illness through work in hospitals, mental health agencies, and with those with disabilities.
The document provides an overview of social casework, including its historical development, principles, stages, components, and techniques. It discusses how social casework evolved from early charitable organizations in the 19th century to become a more professionalized field. The main principles of social casework are described as acceptance, communication, individualization, participation, and confidentiality. The stages are intake, study, assessment, treatment, evaluation, and termination. Key components are the person, problem, place, and process. Techniques used include supportive methods like acceptance and building self-confidence, as well as counseling approaches like advice, motivation, and modeling.
The document outlines objectives and concepts related to health, wellness, and disease. It discusses various definitions and models of health, including the World Health Organization's definition of health as complete physical, mental and social well-being. It describes dimensions of wellness, factors influencing health, and differences between illness and disease. Stages of illness and approaches to health maintenance are also summarized. Key health indicators in Pakistan like infant mortality rate and life expectancy are listed.
Social Case work in De-addiction CentreZaeem Jifri
A presentation on social case work in De-Addiction Center.
Addiction is a psychological and physical inability to stop consuming a chemical, drug, activity, or substance, even though it is causing psychological and physical harm.
Mental illnesses like schizophrenia, depression, and bipolar disorder are legitimate medical conditions, not character flaws. They are caused by genetic and biological factors and can be effectively treated. However, stigma and lack of understanding prevent many from seeking help. Myths that those with mental illnesses are dangerous or that conditions like depression are simply weakness perpetuate social stigma. In reality, around 1 in 4 people will experience a mental health problem in their lifetime, and conditions like depression result in significant economic costs due to lost productivity. Increased education is needed to reduce the stigma around mental illnesses.
This document discusses the social construction of health and illness. It introduces sociological theories of illness such as Talcott Parsons' sick role and Eliot Freidson's types of illness. The sick role refers to the behaviors expected of those who are ill, including being exempt from normal duties but also obligated to seek treatment. Freidson identified conditional, legitimate, and illegitimate sick roles depending on the seriousness and stigma of different illnesses. The social construction of health and illness has changed over time and varies between cultures.
This document outlines strategies for challenging mental health stigma. It begins with definitions of stigma and discusses the causes and manifestations of stigma, including ignorance, fear, and negative media portrayals. The document then describes different types of stigma such as self-stigma and enacted stigma. It notes that stigma can lead to discrimination and negative consequences for those with mental illness, including reluctance to seek treatment. The three most effective ways to challenge stigma identified are education to promote facts over misperceptions, contact with those experiencing mental illness, and protest against negative media portrayals.
The document summarizes the history and origin of psychiatric social work. It begins with a brief overview of the history of psychiatry from ancient to modern times. It then discusses the origins of psychiatric social work in the context of deinstitutionalization in the 1800s-1900s and the role of social workers in assisting former patients transition back to their communities. The document also notes the expansion of psychiatric social work during World War I to help soldiers experiencing shell shock. Finally, it discusses the development of psychiatric social work in India beginning in the 1930s-1940s and the establishment of training programs and professional associations to support the field.
The document discusses the social aspects of health and illness. It addresses common questions people have when they feel ill, like why they are sick and what can be done. It also discusses consulting others for advice or care, as well as common risk factors for chronic diseases like smoking, poor diet, stress, and more. The document then covers how cultural beliefs can influence explanations for behaviors and health patterns. Overall, it examines how social life and society can impact health outcomes.
This document provides an overview of basic counselling skills for school staff. It discusses what counselling is, the importance of school staff using counselling skills, and core counselling skills like active listening, empathy, and being non-judgemental. Active listening is emphasized as a key skill, with advice on body language, minimal encouragers, reflecting feelings, rephrasing, questioning, and summarizing to aid understanding for both the speaker and listener. An activity is suggested for staff to practice these skills in triads and receive feedback to improve.
The document discusses stigma associated with mental illness. It notes that stigma involves negative stereotypes and attitudes that label people with mental illness as less worthy. These attitudes are perpetuated by misrepresentations in media and a lack of understanding. The document outlines various factors that contribute to stigma, including fear, economic issues, lack of treatment facilities, and cultural beliefs. It also discusses the negative impacts of self-stigma, discrimination, and social exclusion that people with mental illness often face. Interventions like social contact and education are mentioned as ways to potentially help address stigma.
The document discusses several models of health behavior:
1) The Basic Risk Perception Model focuses on likelihood and severity of harm from not acting. Higher risk perception predicts greater motivation to act.
2) The Health Belief Model includes perceived susceptibility, severity, benefits, and barriers in predicting preventive health behaviors. Perceived barriers are the strongest predictor.
3) Protection Motivation Theory assesses threat and coping appraisal processes. Response costs have the strongest impact on health behaviors and attitudes.
4) The Transtheoretical Model proposes stages of change and processes of change to explain behavior progression. Decisional balance and self-efficacy also predict stage of change.
The strengths perspective is a social work framework that focuses on clients' strengths rather than deficits or problems. It emerged from psychiatric and custodial settings as an alternative to viewing clients as having pathologies. The strengths perspective mobilizes clients' talents, knowledge, and capacities to help them achieve their goals and improve their quality of life on their own terms. It is based on five principles: adopting an optimistic attitude, focusing on clients' assets, collaborating with clients, empowering clients long-term, and creating community.
Social work is considered an art that requires compassion, courage, creativity, and sound judgment. The key factors that comprise the art of social work include building meaningful professional relationships through empathy, warmth, and genuineness. Social workers must also infuse the change process with hope and energy while navigating personal and professional values. Developing an effective professional style is important for applying knowledge and skills in a unique way appropriate to each situation and client.
The document discusses the health belief model, which is a theoretical framework used in healthcare to guide health promotion plans and disease prevention. It has five stages: precontemplation, contemplation, preparation, action, and maintenance. The model focuses on perceived susceptibility, severity, benefits, and confidence. It can be used to understand behaviors like substance abuse in youth. Barriers to implementing it include lack of resources. Benefits are improving health knowledge and behaviors.
ADVANCED NURSING RESEARCH
1
ADVANCED NURSING RESEARCH 2
Evidence Based Practice Grant Proposal
Table of Contents
3
4
5
6
6
7
8
8
9
9
9
11
11
11
11
12
12
13
14
14
19
19
21
32
34
Grant Proposal-Assessing the role of stigma towards mental health patients in help seeking
Study problem
There are several studies that have shown that stigmatization towards mental health patients have been present throughout history and even despite the evolution in modern medicine and advanced treatment. For example, Verhaeghe et al., (2014), captures in a publication in reference to a study that he conducted that stigmatization towards mental health patients has been there even as early is in the 18th Century. People were hesitant to interact with people termed or perceived to have mental health conditions.
Stigmatization has resulted from the belief that those with mental problem are aggressive and dangerous creating a social distance (Szeto et al., 2017). Also, mental health-related stigma has become of major concern as it creates crucial barriers to access treatment and quality care since it not only influences the behaviour of the patients but also the attitude of the providers hence impacting help-seeking. Timmermann, Uhrenfeldt and Birkelund (2014), have identified stigma as a barrier that is of significance to care or help seeking while the extent to which it still remains a barrier have not been reviewed deeply. Therefore, this study will assess the role contributed by stigma in help seeking in depth. 1. Purpose
The intention of the research study is to review the association between stigma, mental illness and help seeking in order to formulate ways in which the stigma that is around mental health is done away with to enable as many people suffering from mental health complications to seek medical help.2. Background
Mental health is crucial in every stage of life. It is defined as the state of psychological well-being whereby the individual realizes a satisfactory integration instinctual drive acceptable to both oneself and his or her social setting (Ritchie & Roser, 2018). The status of mental health influences physical health, relationships, and most importantly day-to-day life. Mental health problems arise when there is a disruption in mental well-being.
The risk factors to mental health problems are not limited and therefore everyone is entitled to the problem irrespective of gender, economic status, and ethnic group. For example, data shows that in America one out of five individuals experience mental health problems annually; with mental disorders being recognized as the leading cause of disability not only in the United States but also globally (Ritchie & Roser, 2018). Mental health disorders are seen to be complex and of many forms such as anxiety, mood, and schizophren.
The First session in the Epidemiology Lecture Series
Defining Epidemiology. Keywords in the definition. Aims of Epidemiology, Epidemiological Approach & Reasoning
ADVANCED NURSING RESEARCH
1
ADVANCED NURSING RESEARCH 2
Evidence Based Practice Grant Proposal
Table of Contents
31.Purpose
42.Background
5Research objectives
6Theoretical framework
63.EBP Model
74.Proposed Change
85.Outcomes
86.Evaluation Plan
97.Dissemination Plan
9Tools to be Used
9Peer review tools for the proposal
11Grant Request
11Proposed Tasks
11Task 1: Case study- Reviewing existing literature on stigma around mental health complications
11Task 2: Interviewing clinicians that have dealt with the study topic
12Task 3: Interviewing patients of mental health
12Schedule
13Budget
148.Appendices
14a.Informed Consent
19Certificate of Consent
19Signature or Date
21b.Literature Matrix
32c.Tools and equipment to be used
34References
Grant Proposal-Assessing the role of stigma towards mental health patients in help seeking
Study problem
There are several studies that have shown that stigmatization towards mental health patients have been present throughout history and even despite the evolution in modern medicine and advanced treatment. For example, Verhaeghe et al., (2014), captures in a publication in reference to a study that he conducted that stigmatization towards mental health patients has been there even as early is in the 18th Century. People were hesitant to interact with people termed or perceived to have mental health conditions.
Stigmatization has resulted from the belief that those with mental problem are aggressive and dangerous creating a social distance (Szeto et al., 2017). Also, mental health-related stigma has become of major concern as it creates crucial barriers to access treatment and quality care since it not only influences the behaviour of the patients but also the attitude of the providers hence impacting help-seeking. Timmermann, Uhrenfeldt and Birkelund (2014), have identified stigma as a barrier that is of significance to care or help seeking while the extent to which it still remains a barrier have not been reviewed deeply. Therefore, this study will assess the role contributed by stigma in help seeking in depth. 1. Purpose
The intention of the research study is to review the association between stigma, mental illness and help seeking in order to formulate ways in which the stigma that is around mental health is done away with to enable as many people suffering from mental health complications to seek medical help.2. Background
Mental health is crucial in every stage of life. It is defined as the state of psychological well-being whereby the individual realizes a satisfactory integration instinctual drive acceptable to both oneself and his or her social setting (Ritchie & Roser, 2018). The status of mental health influences physical health, relationships, and most importantly day-to-day life. Mental health problems arise when there is a ...
Running Head ADVANCED NURSING RESEARCH1ADVANCED NURSING RES.docxtoddr4
Running Head: ADVANCED NURSING RESEARCH
1
ADVANCED NURSING RESEARCH
4
Advanced Nursing Research (Research Study)
Student Name
Institution-Affiliated
Different Parts of a Research Study
Research topic
A systematic review of the association between stigma and or on help-seeking among mental health patients.
Research Problem
Stigma or the process of labelling, discrimination and prejudice towards individuals suffering from mental health problems is considered to have numerous adverse consequences compared to the health conditions themselves according to Thornicroft, Mehta, Clement, Evans-Lacko, Doherty, Rose & Henderson, (2016). In addition, research has found stigma to be responsible for the failure of numerous individuals suffering from mental health to seek help from both their close relatives or trusted individuals and from healthcare providers (Clement, Schauman, Graham, Maggioni, Evans-Lacko, Bezborodovs, Thornicroft, 2015).
Given an increase in mental health disorders and the challenges that such disorders pose to both individuals and society, numerous studies have been conducted to examine the association between stigma and help-seeking among mental health patients. However, research has largely focused on the attitudes that constitute stigma towards mental health patients and little on the interventions required to reduce or eradicate stigma. Moreover, since the failure to reduce stigma prevents mental health patients from seeking help and hence worsening their conditions, there is need for further studies regarding the association between stigma and help-seeking and the need to reduce stigma making the study not only relevant but significant.
Research purpose
The purpose of this paper is to explore the association between stigma and help-seeking among mental health patients and to identify proven strategies or actionable recommendation for reducing stigma.
Research objectives
The objective of the study will be to (1) Explore the extent to which stigma posses a barrier to help-seeking among mental health patients, (2) Identify whether stigma affects certain populations more than others and (3) propose strategies that can help reduce stigma.
Research question
The study will aim to answer the following questions (1) What is the association between stigma towards mental health patients and help-seeking? (2) To what extent does stigma constitute a barrier to the search for help among mental health patients and (3) Are there populations that are more deterred from seeking help due to stigma?
Research hypothesis
Ho: Stigma towards mental health patients deters them from seeking help
Ha: There is no association between stigma and the search for help among mental health patients.
In addition, the study hypothesizes that a reduction in stigma would result in increased help-seeking among mental health patients.
References
Clement, S., Schauman, O., Graham, T., Maggioni, F., Evans-Lacko, S., Bezborodovs, N., ... & Thornicroft, G. (2.
Prevention, characteristics of counsellingBimal Antony
This document discusses prevention strategies in mental health at the primary, secondary, and tertiary levels. Primary prevention aims to reduce incidence and risk factors through universal, selective, and indicated measures. Secondary prevention focuses on early detection and treatment to reduce duration and severity. Tertiary prevention aims to reduce disability through prompt treatment and rehabilitation. The document outlines examples of prevention efforts at each level, from prenatal care to community mental health centers and crisis intervention.
This document provides an overview of key concepts and principles of health education. It discusses health determinants and factors that influence health, such as social, economic, environmental and behavioral elements. It also outlines three levels of disease prevention - primary, secondary and tertiary prevention. Additionally, it describes philosophies that can be applied to health education, including behavioral change, cognitive-based, decision-making, freeing/functioning, social change and eclectic philosophies. Each philosophy aims to promote better health and well-being through different approaches.
Psychiatric-mental health nurse practitioner Student Nam.docxsimonlbentley59018
Psychiatric-mental health nurse practitioner
Student Name
Institution Affiliation
1
Introduction
The primary role of a psychiatric-mental health nurse practitioner is providing psychotherapy and educating patients and families.
One of the problems that has been experienced in psychiatry is stigma, discrimination and prejudice.
This issue has presented certain effects like delay in seeking help, burnout among health care providers and poor services.
One of the theories that is relevant to the specialty is the modelling and role modelling theory.
Psychiatric-mental health nurse practitioners usually play a key role in promoting health care. Their primary role is providing psychotherapy and educating patients and families. However, patients and health care providers are facing various issues particularly stigma, discrimination and prejudice which has negatively affected the provision of health care services. The modelling and role modelling theory is one of the theories that is relevant and can greatly help to deal with the problem and may be used as a framework to guide evidence-based practice.
2
Modelling and Role Modelling Theory
It was developed by Helen Erickson, Evelyn Tomlin and Mary Anne and was published in 1983.
This theory helps health care providers to care for and nurture every patient based on their needs.
Commonalities in the theory include attachment and loss, basic needs, holism and cognitive stages.
Differences in the theory include self-care, stress, adaptation, model of the world and inherent endowment.
The modelling and role modelling theory was developed by Helen Erickson, Evelyn Tomlin and Mary Anne and was published in 1983. This is a crucial theory in nursing because it helps health care providers to care and nurture patients while upholding the awareness and respect of every patient’s uniqueness (Smith, 2019). Due to that, this theory is considered to support clinical practices that concentrate on the needs of patients. The theory looks at certain elements like attachment and loss, holism, basic needs and cognitive stages. It focuses on certain differences amongst people including stress, self-care, adaptation, model of the world and inherent endowment.
3
Relevance of the Theory
Modelling involves health care providers seeking to know and understand patients’ personal model of their world.
Health care providers learn to appreciate the value of patients’ personal model of the world and its importance.
This theory acknowledges that all human beings have unique perspectives about their world.
Health care providers are able to develop an image and understanding of patients’ perspective and personal model of the world.
The modelling and role modelling theory is relevant to my nurse practitioner specialty since it entails crucial aspects that promote the well-being of patients. During the modelling process, nurses are able to find out and comprehend the personal model of patients and learn how t.
Preventing Intimate Partner Violence Across the Lifespan: A Technical Package...InstitutodeEstadstic
Preventing Intimate Partner Violence
Across the Lifespan: A Technical Package of
Programs, Policies, and Practices
Developed by:
Phyllis Holditch Niolon, PhD
Megan Kearns, PhD
Jenny Dills, MPH
Kirsten Rambo, PhD
Shalon Irving, PhD
Theresa L. Armstead, PhD
Leah Gilbert, PhD
2017
Division of Violence Prevention
National Center for Injury Prevention and Control
Centers for Disease Control and Prevention
Atlanta, Georgia
This document analyzes how peers label and stigmatize other youth with mental illness using Modified Labeling Theory. It finds that self-labeling predicts negative outcomes for youth but some refuse clinical labels. Anti-stigma campaigns using contact with those with mental illness and youth-led initiatives show effectiveness, though effects may decline after the program ends. The theory is then used to evaluate components of anti-stigma campaigns.
Lay health beliefs refer to non-medical beliefs about health that individuals hold based on factors like culture, experiences, and socioeconomic status. These beliefs influence how individuals interpret symptoms and seek treatment. Several influential theories aim to understand lay health beliefs and illness behaviors, including attribution theory, the sick role, stigma, health-seeking behavior models, and illness cognition models. The health belief model also seeks to explain health behaviors based on individuals' perceptions of threats, benefits, and their ability to act.
This systematic review and meta-analysis examines the evidence for the effectiveness of psychological interventions in reducing internalized stigma among adults with schizophrenia spectrum disorders. The review identified 27 studies that met eligibility criteria. Meta-analysis of 18 studies found a statistically significant overall effect in lowering internalized stigma. Subgroup analysis found Narrative Enhancement and Cognitive Therapy to have a statistically significant and highly homogenous effect. In conclusion, most psychological interventions are successful in reducing internalized stigma, especially NECT, and combining multiple therapies may be more beneficial.
This document discusses prevention psychiatry and outlines various prevention strategies. It defines prevention psychiatry as identifying risk factors and applying evidence-based interventions to reduce mental disorders. Primary prevention aims to reduce incidence, secondary prevention aims to reduce prevalence through early detection and treatment, and tertiary prevention aims to reduce disability. The document provides examples of prevention interventions targeting different populations and behaviors, such as parenting programs, counseling for new mothers, and motivational interviewing for college students. It discusses identifying risk and protective factors and implementing interventions to modify risk factors and enhance protective factors.
Just take a look at this rn capstone project example, you can use this example for writing yours .For more samples visit . https://www.capstonepaper.net/our-capstone-papers/capstone-nursing-paper-writing-services/
Running Head FINDINGS USED TO MAKE PUBLIC HEALTH PLANNING AND POL.docxcowinhelen
Running Head: FINDINGS USED TO MAKE PUBLIC HEALTH PLANNING AND POLICY DECISIONS 5
Findings Used to Make Public Health Planning and Policy Decisions
Unit 4 - HA560
March 28, 2016
There has been increased concern among policy makers, scientists and communities that health is greatly affected by a number of factors that occur in a person’s lifetime and in multi levels. Prevention is sententious to curb occurrence of any disease within the population, and it has to come first even if access to quality healthcare services is provided. To adequately promote health and prevent diseases, certain policies and factors need to be addressed mostly factors that are related to health behaviors.
Social psychology is all about understanding individuals’ behavior specifically in a social setting. Basically, social psychology focuses on factors that influence people to behave in certain ways in presence of others. The two greatest contributors in the field of social psychology were Allport (1920) and Bandura (1963). To begin with, according to Allport; he argued that the interaction of individuals with others or the presence of social groups can encourage the development of certain behaviors (Kassin, 2014). This is what Allport referred to as social facilitation, in his research he identified that an audience will facilitate the performance of an actor in a well learnt and understood task; however the performance of the same actor will decrease in performance on difficult tasks which are newly learnt, and this is contributed by social inhibition. The second contributor in the field of social psychology is Bandura (1963), in his work he developed a notion that behavior in the social world could be possibly modeled, and this is what he referred to as social learning theory. He gave his explanation with three groups of children who were watching a video where in the video an adult showed aggressiveness towards a “bobo doll” and the adults who displayed such behavior were awarded by another adult or were just punished. Therefore Bandura found that children who saw the adult being rewarded were found to be more likely to imitate that adult’s behavior.
Certain theories plays important roles in health assessment, and a theory is defined as a collection of concepts in specific area of concern or interest in the world that need explanations, intervening and prediction. Theories need to be backed up with evidence that tend to explain why things will happen in relation to current situations, and followed with some actions to turn situations in certain desirable ways. Health assessment can be defined as a plan of care that recognizes specific person’s health needs and how such needs will be addressed by healthcare system or any other health institutions (Jarvis, 2008). Generally, health assessment is the evaluation of health status through examination of physical and psychological concerns after looking at the health history of the victim assess ...
Application Of The Health Belief Model (HBM) In HIV Prevention A Literature ...Jody Sullivan
This document provides a literature review on the application of the Health Belief Model (HBM) as a framework for HIV prevention. It discusses the key components and assumptions of the HBM. The HBM proposes that health behaviors are influenced by perceptions of susceptibility, severity, benefits and barriers. It has been widely used in health behavior research and HIV prevention. The review examines several studies that applied the HBM to understand factors like condom use. It concludes the HBM is a useful theoretical model for exploring health behaviors and guiding HIV prevention interventions.
The job is just to read each individual peer post that I put there.docxarmitageclaire49
The job is just to read each individual peer post that I put there and respond to them with a response of 3-4 sentences long
Peer #1
For the Research Assignment, I have chosen to focus on an area of Healthcare that rarely gets the
attention it deserves Mental health. I
chose this topic because I am personally effected by it and so are many millions of Americans. Mental illness is also one of the leading causes of
death in our nation and one life is lost as a result of suicide, abuse or incarceration every 17mins in the United States. Mental illness has been my
area of focus throughout this program and the advocacy and participatory philosophy will be useful for the final project because it suggests that “
that research inquiry needs to be intertwined with politics and a political agenda” (Creswell, p.9). I do believe that mental health has a specific
agenda for a study and that there has been constant aim for reform in healthcare and mental health. This social issue is definitely pertinent right
now and topics that address it such as “empowerment, inequality, oppression, domination, suppression, and alienation” (Creswell, p.9), and are
really the focus of the study. The goal of this project for me, is to provide a voice to participants and give them the ability address the concerns that
will lead to reform.
According to Kemmis and Wilkinson (1998) this philosophy offers four key features of the advocacy/participatory framework of inquiry:
1. Participatory actions are focused on bringing about change, and at the end of this type of study, researchers create an action agenda for change.
2. It is focused on freeing individuals from societal constraints, which is why the study begins with an important issue currently in society.
3. It aims to create a political debate so that change will occur.
4. Since advocacy/participatory researchers engage participants as active contributors to the research, it is a collaborative experience.
Research Problem Statement
My Vision is to Provide members of the community with the opportunities and education needed to prevent death due to suicide, acts of self-harm
and the traumatic impact of mental illness. By promoting resilience, the enhancement of community resources, conflict resolution and support for
individuals, families and the communities of those who suffer with mental disorders, illness or have a sudden mental health crisis. The target
population includes all individuals within Chatham County, with unmet mental health needs. These individuals are currently not being served by
traditional methods due to financial, structural, and personal barriers including access and stigma. Untreated mental health issues of these
individuals put them at risk for exacerbation of physical health problems, suicide attempts, premature moves to long-term care se.
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
How to Fix the Import Error in the Odoo 17Celine George
An import error occurs when a program fails to import a module or library, disrupting its execution. In languages like Python, this issue arises when the specified module cannot be found or accessed, hindering the program's functionality. Resolving import errors is crucial for maintaining smooth software operation and uninterrupted development processes.
Executive Directors Chat Leveraging AI for Diversity, Equity, and InclusionTechSoup
Let’s explore the intersection of technology and equity in the final session of our DEI series. Discover how AI tools, like ChatGPT, can be used to support and enhance your nonprofit's DEI initiatives. Participants will gain insights into practical AI applications and get tips for leveraging technology to advance their DEI goals.
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
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His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
How to Add Chatter in the odoo 17 ERP ModuleCeline George
In Odoo, the chatter is like a chat tool that helps you work together on records. You can leave notes and track things, making it easier to talk with your team and partners. Inside chatter, all communication history, activity, and changes will be displayed.
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1. Draft
The fight against stigma
Stigma reduction strategies and interventions
A paper prepared for the international
stigma workshop to be held at
Soesterberg,
From 28-11 to 2-12, 2004.
Suzanne van der Meij
Miriam Heijnders
November 2004.
1
2. Abstract
3
Introduction
4
The concept of stigma
5
The impact of stigma
6
Methodology
8
HIV/AIDS
9
Education
9
Contact
10
Coping skills acquisition
11
Counselling, Care and support
11
Advocacy
11
Legal and policy interventions
12
Leprosy
14
Education
14
Community Based Rehabilitation
15
Group counselling
16
Conclusion
16
Tuberculosis
17
Conclusion
18
Mental Illness
19
Protest
19
Education
20
Contact
20
Conclusion
22
Epilepsy
24
Education
24
Individual support
25
Conclusion
26
Disability
28
Conclusion
29
Discussion, differences and similarities
30
Individual level
30
Societal level
30
Structural level
32
Appendix 1 Working definitions
34
Appendix 2. An overview of the consequences of stigma and discrimination in different fields of public
health.
37
Appendix 3: Overview of strategies and interventions implemented.
39
Reference List
42
2
3. Abstract
Many people with mental illnesses, leprosy, HIV/AIDS, disability, epilepsy,
tuberculosis and other conditions are severely affected by health-related stigma and
discrimination. This paper is one out of three background papers prepared for the
international workshop on health-related stigma, 2004 and concerns stigma reduction
strategies and interventions. This paper aims to give an overview of the (effective)
strategies that are being implemented.
A substantial amount of work has been conducted on health-related stigma and related
issues; unfortunately not much work has been done on the effectiveness of stigma
reduction strategies. Within HIV/AIDS most interventions derive from education,
contact, coping skills acquisition, counselling and care and support, advocacy, and
legal and policy interventions. A multi-strategy however, is seen as a more promising
strategy. In the leprosy field, most interventions derive from education, community
based rehabilitation, and group counselling. The last two strategies are increasingly
being implemented as they are regarded as promising strategies. Within TB there have
been very few projects that aimed to reduce stigma. The articles that did describe
attempts to reduce stigma dealt with interventions based on education. For mental
illness, three strategies clearly appeared from the literature found; protest, education
and contact. Evaluations of protest studies showed very limited effects; education and
contact were more successful. Here also, a combination of strategies is suggested to
be more effective. Stigma reduction in the epilepsy field is based on education and
individual support. Here, the focus has mainly been on the patient and his
experiences, whether perceived or enacted, with stigma. Finally, within the broad field
of disability, interventions found were based on education and focused on the
individual level.
From these findings it becomes clear that not much evidence exist for the
effectiveness of many of the stigma reduction strategies found, therefore there is still a
lot of work that needs to be carried out.
3
4. Stigma Reduction Strategies and Interventions
Introduction
Many people with mental illnesses, leprosy, HIV/AIDS, disability, epilepsy,
tuberculosis and other conditions are severely affected by health-related stigma and
discrimination. Stigma is increasingly recognised to have a major impact on public
health interventions. Occasionally, this impact is positive, but usually stigma and (fear
of) discrimination lead to delay in presentation to the health services, prolonged risk
of transmission, poor treatment adherence and increased risk of disability and drug
resistance. A substantial amount of research has been done on stigma and related
issues in each of these health fields, but little effort has been made to synthesise all
this work and the experiences that have been collected over the years. Great potential
exists in pooling these research findings and experiences. From the 28th of November
till the 2nd of December 2004 a workshop will be organised in which work done on
stigma in the public health fields mentioned above, will be reviewed and in which
experiences and research findings will be shared. The workshop will bring together
the lessons learnt in these different fields of public health and aims to 1) develop a
joint and operationally useful concept and model of health-related stigma, 2) identify
crosscutting strategies and models of interventions for reducing health related stigma
at different levels, and 3) develop or adapt test instruments to assess key features of
stigma and discrimination. Prior to the workshop three background papers have been
written, all reviewing the literature on health related stigma and discrimination. The
contents of these papers are: concepts and theoretical frameworks, stigma assessment
tools and stigma reduction strategies and interventions. This paper concerns the
stigma reductions strategies and interventions and aims to give an overview of the
(effective) strategies that are being implemented.
Before proceeding, we must clarify the difference between interventions and
strategies. According to the Oxford Dictionary a ‘strategy’ is defined as ‘a plan, or
policy designed to achieve a particular goal’; an ‘intervention’ is defined as ‘the
interference to prevent something or to change the result’. Interventions derive from
strategies. Several strategies for stigma reduction often re-occur in the literature.
4
5. These strategies are included in the table below. Within these strategies, numerous
interventions, each with specific target groups, content and duration are being
implemented. Interventions and strategies can be implemented at different levels in
society: the individual (infected and affected) level, societal level and structural level
(Hulscher et al. 2000). Each level has specific strategies, which can overlap. Some
strategies tackle stigma directly while others crate an enabling environment to do so.
Table 1: Stigma Reduction Strategies1
Level
Individual Level
Societal Level
Structural Level
Strategies
Treatment
Protest
Care and Support
Education
Legal and Policy
Interventions
Empowerment
Contact
Institutional
Interventions
Counselling
Coping Skills
Acquisition
Rights-based
Approach
Community Based
Rehabilitation
Advocacy
Many programs have used stigma-reduction strategies and have implemented specific
interventions to reduce stigma. However, the effectiveness and impact of these
strategies and interventions are rarely evaluated. This paper aims to bring together
different strategies and interventions that have been used in the field of HIV/AIDS,
leprosy, TB, mental health, epilepsy and disability, and tries to identify differences
and similarities in the approaches used to reduce stigma.
The concept of stigma
In many health conditions stigma is receiving increasing attention. Following
Goffman (1963) many authors define stigma as an undesirable or discrediting attribute
reducing an individual’s status in the eyes of society (Brown et al., 2001; Link &
Phelan, 2001; Weiss, 2001). Several authors have tried to revise the concept. Link and
Phelan proposed a definition of stigma that includes the context in which stigma
originates and exists. Stigma exists when: “… elements of labelling, stereotyping,
1
Definitions of these strategies can be found in appendix 1
5
6. separation, status loss, and discrimination occur together in a power situation that
allows them” (Link & Phelan, 2001:377). Stigma is a powerful discrediting and
tainting social label that radically changes the way individuals view themselves and
are viewed as persons. People who are stigmatised are usually considered deviant or
shameful for some reason or other, and as a result are shunned, avoided, rejected, or
discriminated. As such, stigma is an expression of social and cultural norms, shaping
relationships among people according to those norms. Stigma must be regarded as a
social process in which people out of fear of the disease want to maintain social
control by contrasting those who are normal with those who are different (Parker &
Aggleton, 2001). Stigma and discrimination produce thus social inequality. Stigma
marks the boundaries a society creates between "normals" and "outsiders," between
"us" and "them." (Link & Phelan, 2001) Stigma builds upon, and reinforces, existing
prejudices (Herek & Glunt, 1988). It also plays into, and strengthens, existing social
inequalities – especially those of gender, sexuality and race (Brown et al. 2001;
Nyblade et al. 2003; Heijnders, 2004).
The impact of stigma
Important life areas that are commonly affected by stigma are people’s dignity, social
status, employment opportunities or job security, marriage, family relationships and
friendships. Stigma may be ‘enacted’, as in the case of overt discrimination or
‘perceived’. ‘Perceived’ stigma (also called ‘felt’ or self-stigma) has widespread and
powerful effects. It is sometimes based on enacted stigma observed in others, but
more often on past images of the disease and stereotypical thinking (de Stigter, de
Geus, & Heynders, 2000; Scambler, 1998; Green, 1995; Jacoby, 1993). Selfstigmatising behaviour may even enforce enacted stigma, by creating a ‘victim’
attitude and response (Valencia, 1989). Perceived stigma is fuelled by fear and may
result in the same restrictions of social participation as ‘enacted’ stigma or
discrimination. Importantly, fear of stigma may also jeopardise a person’s
participation in public health programmes. They may delay to present to the health
services, increasing their risk of disability and continuing to be a potential source of
infection in the community. Concealment is also common after diagnosis
(Engelbrektsson, 1999; Heijnders, 2002). In HIV/AIDS, stigma links in with denial of
risk. Since the activities that put someone at risk are perceived as “immoral and bad”,
most people would deny their risk on the basis that they do not want to be considered
6
7. “bad” (WHO, 2002; Nyblade et al. 2003). However, continuation of these activities
exposes them to infection and prolongs the risk of themselves and their partners. Fear
of ‘being found out’ and its possible consequences may lead to discontinuation of
treatment ( Hyland 1993; Heijnders 2002). Similarly, stigma may lead to noncompliance with self-care routines in e.g. leprosy and diabetes, leading to worsening
of impairments. In contrast, however, Heijnders ( 2002) found that fear of
stigmatisation also strongly motivated some people to continue treatment, because
they related the treatment with the prevention of visual symptoms of the disease and
thus prevention of stigmatisation. The consequences of stigma and discrimination are
summarised in appendix 2.
7
8. Methodology
A literature review was conducted to identify work done to date on effectiveness of
stigma reduction strategies and interventions. The references were found using
ScienceDirect, Pubmed and PsychInfo, with stigma, the specific health field, and
interventions as main keywords. The bibliographies of relevant papers were reviewed,
and an Internet search was conducted using the same keywords. Other keywords like
strategies, implementation, project* and effectiveness* were used to either generate
more results or to narrow down the search. Studies with no element of evaluation
were not included. Reviews were given priority. If no reviews existed we included
original articles. The search was limited to English and Dutch documents published in
peer-reviewed journals after 1990. For the field of disability we had to include
documents published before 1990.
We will first look at the different health fields and the strategies that have been used
to implement stigma-reduction interventions. Where possible we will look at the
effectiveness of the specific interventions. In the discussion we will present an
overview of main findings and compare the differences and similarities between the
health fields discussed.
8
9. HIV/AIDS
Ever since the first case of HIV/AIDS was detected and the epidemic began to
spread, stigma has surrounded this disease. Twenty years later the Global Campaign
‘Live and Let Live!’ stated: ‘Despite 20 years since the discovery of AIDS and the
scientific advances gained, there is still much denial, discrimination, fear and stigma
all over the world - even in countries where large numbers of people are infected’
(WHO, 2002). The most devastating effect of stigma in the field of HIV/AIDS is the
failure of preventive measures, causing continued transmission. An advantage of
fighting stigma is that it would help reduce HIV-transmission (Brimlow et al, 2003).
We will look at these strategies mainly focusing on the work of Brown et al. (2003),
as this was the only review found. Where needed we have complemented their
findings with some of the articles found through our literature search. Brown et al.
(2003) found that multi-strategy and multi-level approaches are more effective in
raising knowledge and reducing stigmatising attitudes, than single approaches, like
education and contact. Below, the strategies that dominate the literature on stigma
reduction strategies in the field of HIV/AIDS are discussed.
Education
The first strategy found is education. This strategy is often the first step in stigma
reduction and is often combined with other strategies. Education includes
interventions that aim to inform the general public and health professionals by
replacing false assumptions with accurate information. Information given is mostly
about the modes of transmission, treatment, etc.
Most studies gave mixed results on attitude change (Brown et al, 2003). Only four
studies are described in which only educational approaches were used and these
studies all had a positive effect measured as an increased tolerance of people living
with HIV/AIDS (PLWHA). However, most studies gave mixed results on attitude
change. For example the study by Ashworth et al. (1994) aimed at poor black women
applying for certification in a Women, Infant and Children programme in the U.S.
showed that their increased knowledge did not lead to long-term changes (Ashworth
et al. 1994). This failure to reduce fear through education was also noted in
interventions aimed at health workers. Herek et al. (2002) found mixed results for
9
10. educational interventions. He found that educational efforts were effective in
improving knowledge on HIV/AIDS transmission but the efforts did not convince the
general public that HIV/AIDS could not be transmitted through casual contact.
Education as a strategy is often documented in the literature (e.g. Monico et al, 2001;
Foreman et al, 2003; Kidd & Clay, 2003; Nyblade, 2003; Siyam’Kela, 2003;
Crompton, 2004; Hikuam, 2004; Morrison & Cuadra, 2004; Morrison et al. 2004;
Savariaud, 2004). Education can be regarded as an important strategy, one, however,
that is not always effective. The review of Brown showed that the effectiveness of
educational approaches can be best increased in combination with other approaches,
like contact and skills building.
Contact
Contact, used within the field of HIV/AIDS, refers to all interactions between the
public and persons affected or infected by HIV/AIDS with the specific objective to
reduce stigmatising attitudes. Contact can either by direct and face-to-face, or
vicariously (e.g. through the media). Interventions derived from the contact strategy
can be targeted at groups, individuals and as some authors have proposed, even to an
entire nation, demonstrated by the influence of the ‘coming out’ of influential,
popular people like Magic Johnson (Herek et al. 2002). Contact interventions can use
these types of media images, but also video-presentations and individual encounters
with persons infected with HIV. According to the WHO (2002) personal contact with
someone affected by or infected with HIV can help dispel myths about the disease,
and generate empathy and understanding. The review by Brown et al. (2001; 2003)
describes the potential positive outcomes of contact as a strategy. However, there are
no results given that confirm this expectation. They argue that a more personal
relationship with a person affected by HIV or hearing of a testimonial will demystify
and dispel misinformation and generate empathy. They further conclude that a
contact strategy in combination with an educational approach is one of the most
promising approaches. In a project in the UK an artist educates schoolchildren about
HIV with art. After several lessons he discloses that he has HIV himself. Through
education, acceptance and their friendship with him, the children develop a bond and
regard HIV-positive people as normal (Leigh, 2004).
10
11. Coping skills acquisition
Interventions derived from coping skills acquisition strategies aim to teach skills for
diffusing conflicting situations at the individual or group level (Brown et al. 2003).
Two studies used a combination of education and coping skills acquisition. One
study aimed at primary school children in Tanzania (Klepp et al. 1997), the other
study aimed at physical therapy students in New York (Held, 1992). Coping skill
acquisition consisted of discussions about risk reduction and perceptions of HIV risk
factors. Attitudes towards people affected by HIV/AIDS had in both studies
improved.
Counselling, Care and support
The care and support strategy includes interventions aimed at the infected or affected
individual or group that aim to empower. Brown et al (2003), did not mention care
and support as a strategy though their counselling strategies are related. For these
they found that in combination with educational interventions they generated a
positive effect. Two studies found a reduction in anxiety and distress, three other
studies found an increase in disclosure of one’s positive status and improved
community attitudes.
The care and support strategy can also aim at the community and health workers.
Nyblade et al. (2003) argue that while people with HIV/AIDS do get care from their
family, community volunteers, and the health care providers, this care can come with
stigma. It is therefore important to educate those caring and supporting HIV affected
persons about the language they use, available resources, possible care and support
and to mobilize the communities to come into action (Kidd, 2003).
Advocacy
No study was found which looked into the effectiveness of advocacy approaches
within HIV/AIDS. Advocacy programmes work towards provision of an enabling
environment, address governments to influence them to change policies and
discriminatory laws, and to better access to treatment and care for persons with
HIV/AIDS. Advocacy interventions go beyond education, they try to seek support,
commitment and recognition from policy and decision-makers and the general public
about the problem (Hamand, 2001). The International Planned Parenthood
Federation (IPPF) has published an Advocacy Guide (Hamand, 2001), in which
11
12. numerous advocacy activities and projects are described in detail. Another
organisation, which is concerned with advocacy activities, is ACORD. Their projects
in Uganda and Burundi recognised care and advocacy strategies as the key strategies
to challenge HIV/AIDS- related stigma and discrimination (Hadjipateras, 2004).
Legal and policy interventions
Legal and policy interventions make up a strategy since they all aim to enforce the
protection of rights of people suspected to be or people infected with HIV/AIDS. The
WHO mentions setting policy guidelines and confidentiality, strengthening the legal
framework and mandatory testing and encouraging political, community and
religious leaders to provide leadership as possible interventions. According to the
authors: “Policies on discrimination, access to prevention and care, confidentiality of
care and individual’s rights can make a significant impact” (WHO, 2002). Though
interventions on this level are widely implemented (e.g. Foreman et al, 2003; Monico
et al, 2001; Mahendra & Gilborn, 2004; Samaras, 2004) there are no evaluations
found.
In this regard, Parker and Aggleton (2003) aim to present a new framework to
understand HIV/AIDS-related stigma and its effects, which also highlights the
limitations of individualistic modes of stigma alleviation and proposes a new
approach to reduce stigma in the future. According to them: “… our collective
inability to more adequately confront stigmatization, discrimination and denial in
relation to HIV and AIDS is linked to the relatively limited theoretical and
methodological tools available to us” (Parker & Aggleton, 2003:14). They stress that
stigma and discrimination take place in specific cultures and contexts and as a result
generalised strategies to reduce stigma might not be effective. They especially
criticise individual level interventions which: “… could never be scaled up in the
manner required for an efficacious response throughout Africa, Asia, Central and
Southern America” (Parker & Aggleton, 2003:21). Such interventions should be
complemented with other modes of stigma reduction and the authors propose to look
for interventions that address community mobilisation and social transformation.
Ultimately, together with a new emphasis on community mobilization aimed at
unleashing resistance to stigmatization and discrimination, structural interventions
aimed at developing a rights-based approach to reducing HIV and AIDS-related
12
13. stigmatisation and discrimination should be a high priority in order to create a
transformed social climate in which stigmatisation and discrimination will no longer
be tolerated (Parker & Aggleton, 2003).
Conclusion
Though a lot has been done, only a limited number of HIV/AIDS stigma reduction
interventions have been evaluated. Most of the studies reviewed by Brown et al.
(2003) used some form of multi-strategy design to stigma reduction. The strategy of
education in combination with coping skill acquisition and contact is the most
promising approach. These approaches appear effective at least in the short term and
on a small scale. However, actual evidence of long-term effects is weak or lacking.
One reasons is a lack of appropriate tools to measure stigma. Studies to develop such
tools are underway and several instruments are now available for piloting (Siyam’kela,
2003). Ideally, a multi-strategy and multi-level approach would give the best results in
the fight against stigma and discrimination (Brown et al, 2003; Foreman et al 2003;
Parker & Aggleton, 2003). If interventions are being implemented it is imperative that
they will be evaluated. The development of clear stigma indicators should be made
available for this purpose.
13
14. Leprosy
A number of articles describe interventions to reduce stigma related to leprosy. Three
articles originally came out of our search on effective interventions to reduce leprosyrelated stigma (Awofeso, 1992; 1996; Floyd-Richard & Gurung, 2000). A handsearch of relevant bibliographies resulted in another six articles (Gershon &
Srinivasan, 1992; Raju & Kopparty, 1995; Opala & Boillot, 1996; Croft & Croft,
1999; Nash, 1999; Lynch, 2000; Arole et al. 2002).
Education
Awofeso studied ways to diminish leprosy stigma, starting with education and later
adding socio-economic reintegration. His first article described the knowledge and
attitudes of Nigerian nurses towards leprosy. He found that, due to a lack of
knowledge, the nurses feared leprosy, resulting in stigmatising attitudes (Awofeso,
1992). To increase awareness and decrease stigma, the author proposed to include
leprosy in the basic training of nurses.
Education has been considered successful in reducing leprosy-related stigma by a
number of authors (Awofeso, 1992; 1996; Croft & Croft, 1999; Floyd-Richard &
Gurung, 2000; Lynch, 2000; Arole et al., 2002). The effect of education has been
subject of discussion. In their study on the impact of knowledge on the attitudes
towards leprosy patients, Raju and Kopparty (1995) pointed out that the knowledge of
the community about leprosy correlated poorly with attitudes towards people affected.
Opala and Boillot (1996) discussed in detail the failure of education campaigns aimed
at achieving attitude and/or behaviour change at the community level. They describe a
Leprosy Control Programme among the Limba in Sierra Leone that managed to
change behaviour towards treatment and people affected by leprosy, but failed to
change the traditional beliefs about the disease. They emphasised the importance of
taking into account the underlying world-view of the target group in messages about
leprosy. Education messages should be meaningful in the context of culture: “… as
long as the traditional world view persists largely unchanged, some changes in
behaviour are very difficult to effect. The only way health workers can overcome
those limits is by appealing to their patients within the framework of their world view
– by shaping a message consistent with their traditional way of thinking” (Opala &
14
15. Boillot, 1996:17). The National Leprosy Elimination Campaign in Nepal is a good
example. This campaign was initiated by the WHO but acted out by national
organisations, companies, celebrities and most importantly; people affected by
leprosy. The campaign created a more positive image of people affected by leprosy,
more people reported voluntary at the health posts and those working in the field of
leprosy felt very encouraged (Lynch; 2000). This was confirmed on a more general
scale in the evaluation of learning materials by Nash (Nash, 1999). She concluded that
learning materials are tools that should be well adjusted to their end-users. These
observations plead for improved educational interventions or, as several authors have
mentioned, an integrated approach to reduce stigma (Floyd-Richard & Gurung, 2000;
Arole et al., 2002).
The second article by Awofeso (1996) addressed factors that lead to leprosy-related
stigma in Nigeria and looked at several ways of minimising it. At national level, for
example, policies should restructure rehabilitation programmes and legal protection
should be provided to people with leprosy. At the community level, leprosy control
should not only be integrated into the primary health care services, but focus on
rehabilitation. Awofeso further emphasised that health education should focus on
better communication between patients and health workers and that the latter should
be better trained. The integrated approach to reduce leprosy-related stigma has been
evaluated by Arole et al. (2002). They compared the influence of integrated versus
vertical care approaches to the level of stigma faced by people with leprosy and their
families in India. The results of the study indicated that an integrated approach leads
to a reduction in the level of stigma and has helped the treatment of leprosy as well.
People in communities where the vertical programme had been continued showed
pervasive negative attitudes and a lack of knowledge as signs of high levels of stigma.
Community Based Rehabilitation
Gershon and Srinivasan (1992) studied the effect of community-based rehabilitation
(CBR) in the city of Madras, India.The outcomes of their study showed that CBR had
positive effects on the reactions of patients and their families towards leprosy and had
an even larger effect on people’s occupational and economic status. However, the
study did not identify the specific factors that had particular relevance to these
changes and how these changes relate to stigma reduction
15
16. Group counselling
Group counselling is another intervention that has been proposed to reduce leprosyrelated stigma. Floyd-Richard and Gurung (2000) conducted a pilot study on the
effect of this type of intervention. Though the outcome of such an intervention is hard
to measure, this study led the authors to claim positive results. They concluded that
group counselling is a time-efficient and productive method of counselling to reduce
the effects of stigma on the lives of people with leprosy but that counselling alone
will not eradicate stigma. Other interventions like economic rehabilitation and health
education are also seen as necessary.
Conclusion
Most interventions to reduce leprosy-related stigma have been implemented on the
community level and are derived from the educational strategy. Attention for
individual interventions, such as counselling and empowerment, is increasing. The
question of how knowledge influences behaviour was raised in the leprosy field also
and deserves more attention. Future research should establish the effectiveness of
education and individual support strategies. Interventions derived from other
strategies should be implemented and tested. The experience of community-based
rehabilitation provides new possibilities both within and outside the field of leprosy.
16
17. Tuberculosis
A number of authors have reported stigma related to TB (Farmer, 1997; Jaramillo,
1999; Ogden, 2000; Family Health International, 2001; Hoang Long et al. 2001;
Demissie et al. 2003; Hoa et al. 2004). However, examples of and studies on effective
interventions to reduce TB-related stigma are difficult to find. For this paper we found
two articles describing specific interventions. The first article describes the
effectiveness of “TB Clubs” in Ethiopia in improving compliance with TB treatment
and their impact in improving societal attitudes towards people with TB (Demissie et
al, 2003). The second article evaluated the impact of health education in Vietnam
(Hoa et al. 2004). We include one article addressing the relation between knowledge
and TB-related stigma (Jaramillo, 1999) and one report addressing a combined
approach towards AIDS and TB, in which education plays an important role (Family
Health International, 2001).
The TB Clubs studied by Demissie et al. focused their activities on mutual support
and information exchange to enhance patient compliance and to improve societal
attitudes towards TB. Mutual support consisted of encouraging and supporting fellow
patients to adhere to their treatment. The educational component included sharing
experiences among club members and exchanging information with the general public
through public readings and the dissemination of educational materials.
Demissie et al. found that the clubs had positive effects on the attitudes of patients,
health workers and community members. Patients’ reactions to the first diagnosis
improved, misconceptions on the cause and treatment were reduced, social isolation
of patients lessened and compliance to treatment increased. The authors recommended
further large-scale studies to see whether this approach can be scaled up to the
national level and to other countries.
Hoa et al. (2004) described a study on patients’ knowledge of TB, to evaluate the
impact of the health education provided by the Vietnamese National Tuberculosis
Programme. This programme registers newly diagnosed patients and offers them
treatment and education. Health workers, who are especially trained for this task,
provide the education. Materials are produced in local languages, some especially
designed to reach ethnic minorities. The study showed that the level of education of
the participants and the manner in which the information was provided influenced the
17
18. knowledge level of participants. Knowledge about the cause and modes of
transmission was limited and the authors relate this to a higher level of social stigma.
To reduce stigma, health education should not only provide basic facts on TB, it
should also try to counter the false assumptions on which stigma is based. The authors
recommend an ongoing health education programme designed to increase the
knowledge level throughout the population. Unfortunately, the authors did not discuss
the content of information or the best manner to provide this information.
Jaramillo (1999) looked at the predictors of prejudice towards people with TB, testing
the hypothesis that people’s beliefs about mechanisms of TB transmission are the
main predictors of TB-related stigma. Verifying this hypothesis, Jaramillo also found
that the respondent’s age and level of fear of people with TB were of influence.
Jaramillo concluded that, if early diagnosis, and affordable treatment become
available, these can, together with health education, reduce the burden of stigma as
they decrease the false beliefs on TB transmission and the disease progression
(Jaramillo, 1999).
The Family Health International (FHI) report on TB in high HIV prevalent areas
(FHI, 2001) showed the link between HIV and TB, and the common grounds of
stigma related to these diseases; lack of knowledge. It also mentioned that the stigma
related to HIV increases the stigma related to TB. The report proposed to create a
better understanding of both diseases that should reduce the impact of stigma and help
the prevention of these diseases. Unfortunately no evaluations of such interventions
by FHI are published yet.
Conclusion
Very few studies have addressed the social consequences of TB and the related
stigma. The available studies on stigma reduction plead for more and better education
as they have shown that improved knowledge has a positive impact on attitudes and
that knowledge is an important predictor of prejudice towards people with TB. The
study in Ethiopia showed that integrating education in the health system is a very
effective way of disseminating information and creating a better understanding
between patient and practitioner. From these studies it also becomes clear that more
research is needed on how knowledge influences stigma and how information can best
be provided.
18
19. Mental Illness
Within the literature on stigma and mental illness we found six relevant reviews on
stigma-reduction strategies and interventions (Couture & Penn, 2003; Hayward &
Bright, 1997; Corrigan & Penn, 1999; Cathoor et al., 2003; Smith, 2002). One was a
meta-analytic review on contact interventions (Kolodziej & Johnson, 1996). Mainly
three stigma reduction strategies are described in these reviews. These are protest,
education and contact.
Protest
The first strategy to reduce stigma in the field of mental illness is protest. Corrigan and
Penn state that protest as a stigma reduction strategy aims to suppress stigmatising
attitudes towards mental illness. Examples of interventions within this strategy are
advocacy activities, educational support groups and patients empowerment groups
(Corrigan & Penn, 1999). In their review of studies conducted in Europe and the
United States, Corrigan and Penn found that protest interventions can contain two
messages, one addressing inaccurate representations of mental illness, the other
addressing negative beliefs about mental illness. There is little research on the impact
or effectiveness of this strategy. With evidence from the field of social psychological
research Corrigan and Penn do show that protest interventions generated only shortterm effects on attitude change (Corrigan & Penn, 1999).
Protest interventions have two important limitations. The first is that, in most protest
interventions the negative stereotypes are not replaced with other attitudes or beliefs.
A second limitation is the occurrence of the rebound effect. This effect is a negative
consequence of suppression of prejudice, where: “suppression of targeted ideas leads
to the same psychological reactions as active thought about these ideas” (Corrigan &
Penn, 1999: 768). Following Wegner and Erber (1992), the authors explain that
suppression has an adverse effect, making negative attitudes more persistent. Repeated
instructions to suppress a stereotype could prevent this rebound effect. Protest appears
to be a legitimate intervention but the actual effect on stigma-reduction seems minimal
and needs further research.
19
20. Education
The second strategy is education which aims to increase knowledge about mental
illness and provides facts that counter false assumptions on which stigma is based.
Educational interventions can present these facts through presentations, discussions,
simulations, audiotapes, and films, targeting specific populations.
Studies examining the effects of education have found mixed results. Some studies
show that participation in brief courses on mental illness and treatment result in
improved attitudes towards persons affected by mental illness, other studies fail to
show this effect of education on attitudes (Corrigan & Penn, 1999). For example,
information on acute symptoms was reported to increase stigma, while information on
post treatment living arrangements and perceived dangerousness were reported to
reduce stigma (Corrigan & Penn, 1999).
The interventions reviewed showed that education is limited because many stereotypes
are resilient to change (Corrigan & Penn, 1999). Disconfirmation of negative
stereotypes has been undermined by the consistency – confirmation effect: people
recall social information consistent with pre-existing – negative – stereotypes,
allowing new ideas and information to get lost. Corrigan and Penn conclude that:
These findings suggest that participants in an education program may easily recall
information that confirms mental illness stigma about dangerousness and may ignore
information that challenges these stigmas (Corrigan & Penn, 1999).
.
However, they concluded that education programmes might lead to diminished
discrimination even if dramatic changes in stereotypes were not observed (Corrigan &
Penn, 1999) and argue that future studies should examine the effects of educational
interventions on behaviour change and the long-term impact on attitude and behaviour
change.
Contact
Contact aims to challenge public attitudes about mental illness through direct
interactions with persons affected. The review article by Couture and Penn (2003) only
included contact interventions whereby contact involved direct, face-to-face
interactions. The reviewed studies showed that contact interventions are associated
with improved attitudes, the strongest association was found in the context of general
undergraduate training, i.e. situations in which contact occurred on a more equal and
20
21. voluntary level (Couture et al, 1997; Hayward & Bright, 1997; Corrigan & Penn,
1999; Kolodziej & Johnson, 1996).
The effectiveness of contact to reduce stigma has been studied using retrospective and
prospective reports of contact. Couture et al. (1997) suggest that the effectiveness of
contact-interventions can best be studied prospectively because of the memory bias in
retrospective studies. They show that prospective studies in a laboratory, classroom or
presentation setting can be effective in reducing negative attitudes towards persons
affected.
Kolodziej and Johnson (1996) conducted a meta-analytic review of studies dealing
with contact in the United States and Canada. In these studies, contact occurred either
in the context of general student training, specialized student training or mental health
employee training. Specialised student training included nurses, medical students, and
pharmacy students. The reason for contact ranged from informal, social activities to
formal health care settings. In line with the contact hypothesis, this certainly had an
effect on the outcome of the interventions. The informal, general student training,
where people were less authorative and restrictive, resulted in more positive attitude
changes than the other settings. Not in line with the expected outcome was the
influence of contact duration: “Although prolonged contact ideally should be
associated with more positive attitudes towards persons with psychiatric disorders, our
data suggest that this is not necessarily the case” (Kolodziej & Johnson, 1996).
Couture and Penn (2003) argue that studies that examined contact in a more real-world
setting, like job training, did not show an increase in positive attitudes. This could
have been because many of these contacts were doctor-patient interactions and
therefore had no equal status between patient and practitioner. Contact in volunteering
situations had a more positive effect. Several studies showed that the impact of contact
interventions increased under specific conditions namely, an equal status between
participants, cooperative interaction, institutional support for contact, frequent contact
with individuals who mildly disconfirm the stereotype, high levels of intimacy and
real-world opportunities to interact (Kolodziej & Johnson, 1996; Hayward & Bright,
1997; Corrigan & Penn, 1999; Couture & Penn, 2003).
Couture and Penn concluded that future research should pay more attention to the
issue of individual and other factors that influence attitude change, looking at what
factors are necessary and sufficient for contact to work and what mechanisms cause
attitude and/or behavioural change.
21
22. All these reviews were limited to strategies for changing public attitudes and
behaviours. Corrigan and Penn (1999) emphasised that people with mental illness are
not passive agents in the stigma reduction process. People affected by stigma can use a
number of methods to cope with the impact of stigma, like selective disclosure of
one’s mental health history, joining support groups, and consumer services.
Hayward and Bright (1997) proposed, for this reason, a holistic conception of mental
illness in which patients are encouraged to develop their skills and talents, to increase
their self-efficacy and personal worth.
Smith (2002) proposed a rights-based approach that would counter stigma and
discrimination by monitoring and enforcing equal access to health care, housing,
employment and justice (Smith, 2002:318). One advantage of this approach is that it
does not require the general public to be familiar with mental illness. This approach
allows one to insist on the enforcement of rights, and according to Smith, involves
practical interventions with measurable outcomes. Creating acceptance through
normalisation could be achieved by the ‘medicalisation’ of mental illness. Smith
illustrates the influence of this process with examples of stigma reduction in the field
of tuberculosis and cancer. According to Smith both TB and cancer became less
stigmatised as scientific knowledge and medical treatment improved.
Conclusion
The literature on mental health and stigma focuses on three main strategies: protest,
education and contact. These strategies have mainly been applied to the community
level, with a high number of studies targeting specific groups like students and health
workers. Protest has not been found to generate a high impact on stigmatising
attitudes or behaviours. Most research that has been done, however, has looked only
at the short-term impact and most authors suggest to evaluate its long-term impact,
both on attitudes as well as behaviour because one important advantage of this
strategy is that, especially using media campaigns, a large audience can be reached
(Corrigan & Penn, 1999). Different kinds of educational interventions have shown
mixed effects on stigma reduction. The type of information offered and the context,
in which the intervention is carried out, have an important influence on the outcome.
The positive effect of education has caused most authors to conclude that education
is and can be an effective strategy to reduce stigma. Overall, contact is seen as the
most effective or most promising strategy. Given the right conditions it can have
22
23. considerable positive effects. One important limitation is that reducing stigma
through contact is time-consuming and may be cost-inefficient (Cathoor et al, 2003).
A combination strategy of education and contact is therefore proposed (Cathoor et al,
1999; Kolodziej & Johnson, 1996). However:
Empirical research must provide us with more definite information regarding the
extent to which educational and persuasive messages contribute to the effectiveness of
contact interventions (Kolodziej & Johnson, 1996).
Finally, Couture and Penn (2003) concluded that a challenge lies in translating
attitude change into behaviour change and in investigating which level of behaviour
is conceptually linked to specific attitudes (Couture & Penn, 2003; Corrigan & Penn
1999).
23
24. Epilepsy
We found six articles (Jacoby, 1994; Jilek-Aall et al., 1997; Baker et al., 2002; Ablon,
2002; Austin et al., 2004; Snead, 2004) and one review (MacLeod & Austin, 2003)
addressing interventions to reduce stigma in epilepsy. Since hardly any studies have
been carried out on the effectiveness of stigma reduction interventions, most articles
deal with the literature available to summarise what is known, to identify gaps in the
literature and to suggest directions for future research (MacLeod & Austin, 2003).
In the field of epilepsy it has been shown very important to distinguish perceived from
enacted stigma. Several authors have indicated that few people with epilepsy can
recall an actual instance of stigma while they do perceive their illness as one against
which there are different forms of prejudice (Scambler & Hopkins, 1986). Jacoby
points out that:
Individuals did not generally come to see their epilepsy as stigmatising because of
experiencing discrimination: most often, felt stigma was the product of stigma
coaching by key individuals such as parents, and preceded rather than resulted from
episodes of enacted stigma (Jacoby, 1994, italics in original).
Education
The first study addressing education is a psychosocial study on epilepsy in Tanzania,
by Jilek-Aall et al. (1997). The study was conducted in two communities in Tanzania.
In one of these communities an epilepsy-clinic was based that has been providing
medication and treatment for more than 36 years. In the last four years the clinic had
started educating the larger community on epilepsy through public education. The
other community had no such interventions. The study therefore can be used to look at
the effect of the education offered by the clinic on the perspectives of individuals in
that community. One limitation of this article is that the content of the educational
messages was not given.
The research team conducted several selected focus group discussion with patients
and controls in the two communities. The results of these discussions led the
researchers to conclude that the two communities differed markedly and that the more
positive attitude towards epilepsy and people with epilepsy was due to the presence of
the clinic. In the ‘clinic community’, traditional beliefs were less influential and the
attitudes and behaviours towards people with epilepsy had been changed positively.
24
25. The people from the second community still held beliefs that epilepsy was caused by
evil spirits or witchcraft, resulting in unwillingness to talk about epilepsy and more
specifically a loss of confidence and self-efficacy in patients and their families. From
this study it becomes clear that better treatment as well as education could serve as
interventions to reduce stigma and discrimination. It remains unclear which
intervention, better treatment or education, had the strongest impact on reducing
epilepsy-related stigma or that it was the combination of these two interventions that
generated the success.
Baker et al. (2002) did not specifically describe an intervention but aimed to assess
the possible contribution knowledge can have on reported levels of stigma. In a large
European sample the authors tried to determine the relationship between knowledge
and stigma correlating the outcomes of the Epilepsy Stigma Scale (ESS) with the
Epilepsy Knowledge Questionnaire (EKQ). Of all respondents, 46% reported feeling
stigmatised, with marked differences between the respondents in the different
countries. Baker et al. also found that, along with seizure frequency, knowledge was
an important predictor of stigma. These findings suggest that the education of patients
might lead to lower levels of perceived stigma.
Austin et al. (2002) looked at education without addressing a specific intervention and
tried to identify the link between knowledge and attitudes among adolescents in the
general population. Their sample of 19441 high school students indicated that stigma
and a lack of knowledge on epilepsy were still common features in the social
environments of adolescents with epilepsy. The authors proposed that the general lack
of knowledge and familiarity about epilepsy among adolescents indicates the need to
teach children and adolescents with epilepsy to cope with their disease and the stigma
related to it.
Individual support
Ablon (2002) proposed to offer more support to people with epilepsy to cope with
their illness and the related stigma, increasing attention to individual empowerment:
Individuals with stigmatized medical conditions, including epilepsy may benefit from
support groups that can help enhance their confidence. By focusing on the social and
political resources and recourses available to them, such individuals can make
substantial strides toward gaining their freedom from stigma (Ablon, 2002).
25
26. This individual approach can also be used with people indirectly affected by the
disease, like close relatives.
The article by Snead et al. (2004) did not specifically address stigma but the quality of
life of adolescents with epilepsy in general, stating that perceived stigma could play
an important role in this. Snead et al. (2004) described the development and initial
implementation of a 6-week structured psycho-educational group intervention for
adolescents with epilepsy and their parents. They used five educational topics: (a) the
medical aspects of epilepsy, (b) healthy behaviours and attitudes, (c) stress
management, (d) social concerns and opportunities and, (e) dealing with family, peers,
and others. In these content areas, related to the quality of life in general, ideas and
concepts can be identified that relate to interventions to reduce stigma. For example,
educating patient and relatives, and teaching adolescents with epilepsy to cope with
the disease and to deal with the possible negative views held by their environment.
The methods and interventions used in this study, or more specifically, the psychoeducational group interventions, might be very relevant for developing group
interventions to reduce stigma related to epilepsy and other illnesses.
Conclusion
The above results shown that, within the field of epilepsy, especially in the US and
UK, considerable attention goes to the individual patient and his/her ways to deal with
the disease. Interventions to reduce stigma are therefore mostly aimed at the
individual, educating the individual and teaching him or her how to cope with their
disease. Next to that, attention is paid to the close environment of the patient,
including health practitioners and family. The education strategy focuses on the
individual, ‘patient’ level and their close environment and to a lesser extent on the
community level. Given the limited number of articles describing effective
interventions to reduce stigma, it becomes clear that research on stigma in epilepsy
has just recently been implemented. In their review, MacLeod & Austin (2003) state
that to develop interventions to decrease the impact of stigma, it is important to
understand how people with epilepsy experience and cope with the stigma related to
their disease. This is especially important for adolescents, who are in a critical period
for identity formation and self-definition, and for whom it is crucial to understand
how experiences with stigma influence their present and future psychosocial wellbeing.
26
27. According to Macleod & Austin, the few studies conducted and published have led to
a lack in understanding on the concept of stigma and the social context in which
stigma occurs. This could explain the lack of interventions and programs to reduce
stigma, because only when: “… we understand the peer social environment,
interventions and programs can be developed to help rectify misinformation about
epilepsy and promote more understanding and tolerance of difference” (MacLeod &
Austin, 2003). Currently, a collaborative research project on epilepsy stigma (CREST)
is being implemented, that aims to fill in these gaps. The project has just started with
rapid appraisal studies in Vietnam and China and anticipates that the findings from
these studies will bring about a more thorough understanding of epilepsy-related
stigma (CREST poster presentation, 2004).
27
28. Disability
Disability is an umbrella term encompassing many conditions, from birth defects to
post-traumatic conditions (ICF, 2001). In many countries, several of the conditions
discussed above, e.g. HIV/AIDS, mental illness, epilepsy and leprosy, are included as
a disability category. In this paper therefore, we will restrict ourselves largely to
locomotor disability. We found only few articles that discussed the effectiveness of
interventions to reduce stigma explicitly in this field. This could be due to the fact
that, within the field of disability the focus is on quality of life, and not on stigma.
However, quality of life is a concept strongly influenced by stigma. The impact of
stigma reduction at the individual level could be measured in terms of quality of life.
This review is based on 5 articles, describing studies specifically on physical
impairments, hearing impairments, and on disability in general. Most studies aimed to
reduce stigma through coping skills and protest interventions at the individual level,
followed by or alongside education at all levels.
Richardson (1971) described preference rankings of children towards other children
with or without physical handicaps. From the results the author identified stigma, and
proposed two interventions to reduce the effect of stigma related to various types of
physical appearance and handicap. The first intervention aimed at the individual level
of the ‘disabled’ child, teaching the child skills in interpersonal relationships and
specific social techniques to overcome and break through the problem of ‘presenting
others with the visible cues of physical handicapping’ (1971). The second aimed at
the social environment surrounding the child, teaching peers how to deal with
disability and handicaps. The individual level interventions were also brought
forward in the articles by Becker et al. (1981), Susman (1993), and Summers et al.
(2004).
Anspach (1979) described the use of political activism to elevate the self-esteem of
participants. Political activism can be seen as an intervention on the individual level
and an empowerment strategy, as it aims to increase a sense of belonging and to
elevate self-esteem. According to the author, the political movement of the time in
which the research was conducted did not seek to modify patient’s own behaviour in
conformance to a pre-existing normative mould, but to influence the behaviour of
28
29. others. Seen in this way, political activism could be regarded as a protest intervention,
aiming to tackle false assumptions and stigmatising attitudes.
Becker (1981) focused in his article on individual coping techniques. He studied 200
deaf people over the age of 60 and found that their creation of a deaf identity and the
development of a social support system influenced their management of the stigma
attached to being deaf, in a positive manner. He discusses ‘normalisation’, as a
strategy of social interaction in which the interaction with group members enhances a
sense of normality, increasing people’s self esteem. Susman (1993) also addressed
normalisation in her article on ‘disability, stigma and deviance’ and showed how the
concept has moved from a strategy to adjust to society to a way of interacting with
others in that society. Following Davis (1961), she discussed the strategy of ‘deviance
disavowal’. This strategy involves the recognition, rather than the denial, of disabling
conditions and can therefore also be seen as a normalising strategy. The recognition of
the disabling condition, however, is done in such a way as to prevent disability from
becoming central or disruptive. The strategy aims not to ignore differences, but to
show that these differences can be overcome or that they are not vital to the
interactions of disabled people with others.
Conclusion
Looking at these articles, most interventions to reduce disability-related stigma have
been aimed at the individual and their close social environment, i.e. the family and
peers or people with the same disability. Most authors have recognised the need to
educate the larger community, but interventions to do so were not discussed. The
effect of the interventions aimed at individuals and their close social environment was
not described or even measured and work on this topic remains a recommendation for
future research.
29
30. Discussion, differences and similarities
In the health fields discussed, stigma and stigma reduction have a lot in common. At
the same time there are differences in the scope of work that has been done and the
aspects of stigma that have been addressed. We will discuss the similarities and
differences of the strategies related to the levels they were implemented in.
Individual level
Strategies to reduce stigma at the individual level have been defined differently within
the health fields discussed, also its emphasis varied. In the field of HIV/AIDS,
strategies implemented were counselling, care and support and empowerment, in
epilepsy individual interventions focused on empowerment and within leprosy and
mental illness on treatment. Other interventions encountered used terms like
advocacy, coping and support or self-help groups. The effect of these types of
interventions is generally positive. According to Ablon (2002), who discussed support
groups, this type of intervention can help individuals with stigmatised conditions to
enhance their confidence, cope with the stigma they face and make an effort to
eliminate the stigma encountered. The study of Floyd-Richard et al. (2000) on the
effect of group counselling of people affected by leprosy confirms this. Unfortunately
no other studies on the effectiveness of these interventions were found.
Societal level
In the literature found, societal level approaches were described most. The most
common discussed strategies were protest and advocacy, education and contact.
Protest and advocacy
This group of strategies aims to suppress stigmatising attitudes, to emphasise the
equality of the people affected and to assert their individual or collective rights. Most
interventions in this group are found in the field of HIV/AIDS, mental illness and
disability. Protest interventions have been largely evaluated within mental health and
it has been shown that the effect of these interventions is limited. First, the
interventions do not replace the misconceptions they are trying to eradicate and
30
31. second, the effect of rebound. Several authors have proposed to use protest
interventions along with other strategies and a general recommendation is to look at
its effect in the long term.
Education
Education is a strategy that includes interventions aiming to supplement lacking
knowledge, to replace incorrect beliefs and to modify stigmatising attitudes and
behaviours. These interventions are found in every field and therefore share common
ground. The differences between the health fields lie in the content of the information
provided and the groups at which the messages are targeted. Especially within the
field of HIV/AIDS, TB, leprosy and mental health, we have seen that information and
education has been largely targeted at the wider public through mass campaigns.
Though this type of education has the benefit of reaching a large audience, it has also
received criticism for not reaching specific target groups and for spreading a too broad
and general message. Experiences from the field of mental illness have shown that
education has achieved mixed results. Some authors even found a rise in stigmatising
attitudes after giving information on acute symptoms of mental illness (Corrigan &
Penn, 1999). Though these results were not related to mass education campaigns, the
critique can be useful. Several authors have stated that the content of educational
messages should be carefully considered. In the field of leprosy, Opala and Boillot
(1996) have emphasised that educational messages should be shaped consistent with
people’s traditional ways of thinking and Nash (1999) proposed to carefully look at
the end-users of each type of educational approach. In general, the content of
educational messages should be well adjusted to the context in which an individual
with a stigmatised disease finds him or herself, for stigmatisation itself is a product of
that particular context.
Where education has been aimed at individuals affected by a particular condition, it
has often been as part of treatment and in combination with another approach as part
of a larger strategy. This is especially the case in epilepsy. Two studies in this field
(Baker et al. 2000; Austin et al. 2004) have illustrated this by identifying the link
between knowledge and attitudes and suggesting that improved knowledge in patients
might lead to lower levels of perceived stigma. Overall, education is seen as an
effective strategy. To improve its effectiveness, most authors have concluded that
31
32. more research is needed on the effects of education at different levels, and the most
effective ways of presenting information.
Contact
There are several interventions that derive from the contact strategy. The most
important difference is whether contact has to be face-to-face or not. Within the
mental health field, the contact interventions studied were face-to-face, while in the
field of HIV/AIDS this was not a prerequisite. Though there have been only few
evaluations of these interventions, most articles from the fields where the strategy is
used, i.e. HIV/AIDS, epilepsy and mental health, indicated positive results. Especially
in the field of mental health, researchers have tried to identify the most favourable
condition in which contact should occur. Voluntary and high levels of confidentiality
seem to influence the effect in a positive manner while contact duration did not
influence the outcome of the intervention (Kolodziej and Johnson, 1996).
Contact, however, is still regarded as a promising strategy. More research should be
done, especially on how to effectively scale up these kinds of interventions, in a cost
and time efficient manner.
Structural level
All the above-mentioned strategies and interventions will have more effect when
different legislative and policy frameworks support them. These strategies have also
contributed to a decrease in stigma, especially through suppressing stigmatising
attitudes and behaviours.
Legal and policy interventions
Especially in the field of HIV/AIDS, great importance is placed on legal and policy
interventions that protect PLWHA and that counter stigma. Legal and policy
interventions as a strategy relate closely to the rights based approach used by the
disability movement. Many authors see these interventions as essential components of
the societal response to stigma and discrimination (Klein et al. 2002). There has been
little research on the effects of legal and policy interventions in reducing stigma.
According to Haghighat (2001) it is very likely that people will hold on to their
negative stigmatising attitudes and change their behaviour according to the new laws
32
33. and regulations. It will then only suppress stigmatising attitudes and behaviours and
not reduce them.
Overall, we have seen that a lot of work has been carried out on stigma and stigma
reduction. There still needs a lot to be done especially related to the monitoring and
evaluation of interventions. It remains unclear what really works. As some authors
have proposed to use an integrated, multilevel approach, e.g. a combination of
education and contact in the field of HIV/AIDS and mental illness, and the integration
of education in health care and treatment in the field of leprosy, more research is
certainly needed.
33
34. Appendix 1 Working definitions
Stigma:
(1)
A social process, which exists when elements of labelling, stereotyping,
separation, status loss, and discrimination occur in a power situation that allows them
(Link & Phelan).
(2)
A social process or related personal experience characterised by exclusion,
rejection, blame or devaluation that results from experience or reasonable anticipation
of an adverse social judgement about a person or group. In health related stigma, this
judgment is based on an enduring feature of identity conferred by a health problem or
health related condition. (Weiss and Ramakrishna).
Stereotype: A belief that all members of a group possess the same characteristics or
traits exhibited by some members of that group.
Strategy: a plan or policy designed to achieve a particular goal.
Intervention: the interference to prevent something or to change the result.
Protest: Suppressing stigmatising attitudes and behaviours.
The rights-based approach or legal and policy interventions: a strategy that counters
stigma and discrimination by monitoring and enforcing equal access to health care,
housing, employment and justice.
Education: aims to replace false assumptions that induce stigma with accurate
information about the disorders.
Contact: all interactions between the public and persons affected or infected by a
particular health condition with the specific objective to reduce stigmatising attitudes.
34
35. Community Based Rehabilitation: A strategy within community development for the
rehabilitation, equalization of opportunities and social integration of all people with
disabilities. CBR draws on the resources and efforts of people with disability, their
families, and their communities, as well as government agencies and nongovernmental organizations to improve the lives and opportunities of people with
disability.
Counselling: Strategy designed to assist PLWHA to increase support and self-efficacy
through the use of conflict resolution methods in dealing with family members,
spouses, and communities in a safe environment.
Coping skills acquisition: A strategy that aims to teach skills for diffusing conflicting
situations at the individual or group level.
Empowerment:
(1)
The process by which individuals, groups and/or communities become able to
take control of their circumstances and achieve their own goals thereby being able to
work towards maximising the quality of their lives (Adams, 1990).
(2)
Making it possible for people to have power and to have more control over
their own lives (Croft and Beresford, 1993).
Advocacy:
(1)
involves either an individual or a group, or their representatives, pressing their
case with influential others, about situations which either affect them directly or, and
more usually, trying to prevent proposed changes that will leave them worse off
(Brandon and Hawkes, 1997).
(2)
Is a process of communication, which is different from the mere dissemination
of information and education (IEC). Advocacy goes beyond this, and first seeks
support. Commitment and recognition from policy and decision makers and the
general public about the problem. Advocacy provides solutions and support in
tackling issues (International Planned Parenthood Federation IPPF, 2001).
35
36. Care and Support: all care provided to a person affected by a particular illness, outside
regular treatment
Quality of life: The perception by individuals of their position in life, in the context of
culture and value systems in which they live and in relation to their goals,
expectations, standards and concerns (WHO, 2001).
36
37. Appendix 2. An overview of the consequences of stigma and discrimination in
different fields of public health.
Leprosy
HIV/AIDS
TB
Mental
illness
Epilepsy
Disability
Buruli
ulcer
Oncho
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Effect on the individual and/or community
Emotional stress
and anxiety
Problems in
marriage or in
getting married
Problems in
friendships and
social
relationships
Problem with
employment or
in getting a job
Reduced
educational
opportunities
Increased
inequities
between those
affected and
those who are
not
Concealment of
the disease after
diagnosis
Poor(er)
prognosis
Other
participation
restrictions (e.g.
economic
dependency,
denied access to
loans and credit,
etc.)
Isolation
(Increased)
psychological
and psychiatric
morbidity
Lack of
motivation to
continue
treatment, or
Motivation to
continue
treatment
Increased
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
37
38. disability
Empowerment,
e.g. positive self
image and
confidence
developed in
resistance to
discrimination
X
X
X
X
X
Effect on public health programmes and interventions
Delay in
presentation for
treatment
Poorer treatment
prognosis; more
complicated and
more expensive
treatment
Continued
transmission
Failure of
prevention
Poor adherence
and default
Risk of drug
resistance
Increased
burden on the
health services
Poor image of
the public health
programme
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
38
39. Appendix 3: Overview of strategies and interventions implemented. Not yet finished
Country
Author
Date
Target
group
Strategy
Intervention
Measures
The
Collaborative
Research on
Epilepsy
Stigma
Project.
2004
Snead et al.
2004
General
Population
Education
Adolescents
with
epilepsy
and their
parents
Counselling
Educational
session on a
specific topic.
Group
discussion
Distribution of
different
teaching
materials
Results/Recommendations
A positive
trend for
quality of life
improvement
Epilepsy
Vietnam
and China
US
Not yet implemented
Tanzania
Jilek-Aall et
al.
1997
Village
community
Education
Public
education
Focus group
discussions
US
Joan Ablon
2002
Empowerment
Support groups
-
Country
Author
Date
Individuals
with
stigmatising
medical
conditions
Target
group
A significant change in
notions about epilepsy, in
attitudes toward and in the
social status of people with
epilepsy.
-
Strategy
Intervention
Measures
Results/Recommendations
Leprosy
Nigeria
Awofeso
1992
Nurses
India
Gershon &
Srinivasan
1992
Nigeria
Awofeso
1996
Community
and
individual
level
National
and
community
level
Community
Based
rehabilitation
There was a general lack of
knowledge on leprosy
among the nurses. Taking
up leprosy in the training
curriculum is
recommended.
Education
Rehabilitation
Legal and
policy
39
40. interventions
Bangladesh
Croft &
Croft
1999
General
population
–
Community
level
People with
leprosy
Education
Information,
education and
communication
(IEC) activities
Nepal
FloydRichard &
Gurung
2000
Empowerment
Group
counselling
Nepal
Lynch
Entire
Education
2000
nation
Author
Date
Target
group
Strategy
Mass media
campaign with
TV/Radio
spots,
programmes,
posters,
pop/folk songs,
school
materials and
commissioned
articles.
Intervention
Bangladesh
Croft &
Croft
1999
Education
Information,
education and
communication
(IEC) activities
Ethiopia
Demissie et
al.
2003
General
population
–
Community
level
Community
level
Care and
Support
Education
“TB-Clubs”
Vietnam
Hoa et al.
2004
TB patients
Individual
level
Education
Country
Author
Date
Target
group
Strategy
Country
Health education can make
a large contribution to
community attitudes
Self-image
Group counselling is time
efficient and productive,
though it cannot reduce
stigma alone. Other
strategies like economic
rehabilitation and health
education are also needed.
Measures
Results/Recommendations
Tuberculosis
Intervention
Health education can make
a large contribution to
community attitudes
Compliance
to treatment
Societal
attitudes
associated
with TB
Measures
The TB club approach
improves patients’
compliance and builds
positive attitudes and
practices in the community.
An ongoing health
education programme to
increase levels of
knowledge in the whole
population appears
warranted.
Results/Recommendations
Disability
40
42. REFERENCES
Ablon, J. The nature of stigma and medical conditions. Epilepsy Behav. 3 (6S2):2-9,
2002
Aggleton, P. HIV and AIDS-related stigmatization, discrimination and denial.
UNAIDS. 2000. www.unaids.org
Anspach, R. R. From stigma to identity politics: political activism among the
physically disabled and former mental patients.
Soc.Sci.Med.[Med.Psychol.Med.Sociol.] 13A (6):765-773, 1979.
Arole, S. & R. Premkumar, & R. Arole, & M. Maury, & P. Saunderson. Social
stigma: a comparative qualitative study of integrated and vertical care approaches to
leprosy. Lepr.Rev. 73 (2):186-196, 2002.
Austin, J. K. Impact of epilepsy in children. Epilepsy and Quality of Life, 2000.
Austin, J. K. & P. O. Shafer, & J. B. Deering. Epilepsy familiarity, knowledge, and
perceptions of stigma: report from a survey of adolescents in the general population.
Epilepsy Behav. 3 (4):368-375, 2002.
Austin, J. K. & J. MacLeod, & D. W. Dunn, & J. Shen, & S. M. Perkins. Measuring
stigma in children with epilepsy and their parents: instrument development and
testing. Epilepsy Behav. 5 (4):472-482, 2004.
Awofeso, N. Appraisal of the knowledge and attitude of Nigerian nurses toward
leprosy. Lepr.Rev. 63 (2):169-172, 1992.
N. Awofeso. Stigma and socio-economic reintegration of leprosy sufferers in Nigeria.
Acta Leprol. 10 (2):89-91, 1996.
Bainson, K. A. & B. van den Borne. Dimensions and process of stigmatization in
leprosy. Lepr.Rev. 69 (4):341-350, 1998.
Baker, G. A. & J. Brooks, & D. Buck, & A. Jacoby. The stigma of epilepsy: a
European perspective. Epilepsia 41 (1):98-104, 2000.
Baker, G. A. People with epilepsy: what do they know and understand, and how does
this contribute to their perceived level of stigma? Epilepsy Behav. 3 (6S2):26-32,
2002.
Becker, G. Coping with stigma: lifelong adaptation of deaf people. Soc.Sci.Med. 15B
(1):21-24, 1981.
Bickenbach, J. & S Chatterji, & E. M. Badley, & T. B. Ustun. Models of disablement,
universalism and the international classification of impairments, disabilities and
handicaps. 1999.
Brimlow, D. L. Stigma and AIDS: a review of the literature. 2003.
42
43. Bollinger,L. Stigma: literature review of general and HIV-related stigma. 2002.
Mexico, POLICY project.
Brown,L., Trujillo,L., & Macintyre,K. Interventions to reduce HIV/AIDS stigma:
What have we learned? 2001. Horizons Project.
Brown,L., Macintyre,K., & Trujillo,L. (2003). Interventions to reduce HIV/AIDS
stigma: what have we learned? AIDS Education and Prevention 15(1), 9-69.
Busza, J. Challenging HIV-related stigma and discrimination in Southeast Asie: Past
successes and future priorities. Anonymous. Anonymous. 1999.
www.popcouncil.com
Byrne,P. (2000). Stigma of mental illness and ways of diminishing it. Advances in
Psychiatric treatment 6 65-72.
Catthoor,K., De Hert,M., & Peuskens,J. (2003). Stigma bij schizofrenie. Tijdschrift
voor psychiatrie 45 87-95.
Corrigan,P.W., & Penn,D.L. (1999). Lessons from social psychology on discrediting
psychiatric stigma. American Psychologist 54(9), 765-776.
Corrigan, et al. (2001). Three strategies for changing attributions about severe mental
illness. Schizofrenia Bulletin 27(2), 187-195.
Couture,S.M., & Penn,D.L. (2003). Interpersonal contact and the stigma of mental
illness: a review of the literature. Journal of mental health 12(3), 291-305.
CREST, poster presentation. 2004
Croft, R. P. and R. A. Croft. Knowledge, attitude and practice regarding leprosy and
tuberculosis in Bangladesh. Lepr.Rev. 70 (1):34-42, 1999.
Crompton,B.C. (2004). Messaging HIV/AIDS. Global Aids Link June/July 18-19.
Demissie, M., H. Getahun, and B. Lindtjorn. Community tuberculosis care through
"TB clubs" in rural North Ethiopia. Soc.Sci.Med. 56 (10):2009-2018, 2003.
Ellis, N., D. Upton, and P. Thompson. Epilepsy and the family: a review of current
literature. Seizure. 9 (1):22-30, 2000.
Farmer, P. Social scientists and the new tuberculosis. Soc.Sci.Med. 44 (3):347-358,
1997.
Foreman,M., Lyra P., & Breinbauer,C. Understanding and responding to HIV/AIDSrelated stigma and discriminaiton in the health sector. 2003. Pan American Helath
Organization.
Floyd-Richard, M. and S. Gurung. Stigma reduction through group counselling of
persons affected by leprosy--a pilot study. Lepr.Rev. 71 (4):499-504, 2000.
43
44. Gershon, W. and G. R. Srinivasan. Community-based rehabilitation: an evaluation
study. Lepr.Rev. 63 (1):51-59, 1992.
Gilmore,N., & Somerville,M.A. (1994). Stigmatization, scapegoating and
discrimination in sexually transmitted diseases: overcoming '
them' ' . SSM
and us'
39(9), 1339-1358.
Green,G. (1995). Attitudes towards people with HIV: are they as stigmatizing as
people with HIV perceive them to be? SSM 41(4), 557-568.
Green, S. E. The impact of stigma on maternal attitudes toward placement of children
with disabilities in residential care facilities. Soc.Sci.Med. 59 (4):799-812, 2004.
Haghighat,R. (2001). A unitary theory of stigmatisation. Br J of Psychiatry 178 207215.
Hayward,P., & Bright,J.A. (1997). Stigma and mental illness: A review and critique.
Journal of mental health 6(4), 345-354.
Heimlich, T. E., L. E. Westbrook, J. K. Austin, J. A. Cramer, and O. Devinsky. Brief
report: Adolescents'
attitudes toward epilepsy: further validation of the Child Attitude
Toward Illness Scale (CATIS). J.Pediatr.Psychol. 25 (5):339-345, 2000.
Heijnders, M.L. (2002). Understanding adherence in leprosy. PhD, South Bank
University, London.
Heijnders, M.L. (2004). The dynamics of stigma in leprosy. Int. Journal of Leprosy.
In press.
Herek,G.M., & Capitanio,J.P. (1993). Public reactions to AIDS in the United States: a
second decade of stigma. American Journal of Public Health 83 574-577.
Herek, G. M.. AIDS and Stigma. American Behavioural Scientist 42 (7):1106-1116,
1999.
Herek,G.M., Capitanio,J.P., & Widaman,K.F. (2002). HIV-related stigma and
knowledge in the United States: prevalence and trends, 1991-1999. American Journal
of Public Health 92(3), 371-377
Hikuam,F. (2004). Global action against HIV/Aids-related stigma and discrimination.
"Truth about AIDS: Pass it on...". Sexual Health Exchange(2), 8-9.
Hoa, N. P., V. K. Diwan, N. V. Co, and A. E. Thorson. Knowledge about tuberculosis
and its treatment among new pulmonary TB patients in the north and central regions
of Vietnam. Int.J.Tuberc.Lung Dis. 8 (5):603-608, 2004.
Hong,K.T., Anh,N.T.V., & Ogden,J. Understanding HIV and AIDS-related stigma
and discrimination in Vietnam. 2004. Washington, ICRW.
Jacoby,A. (1994). Felt versus enacted stigma: a concept revisited. SSM 38(2), 269274.
44
45. Jacoby,A. (2002). Stigma, epilepsy, and quality of life. Epilepsy and Behavior 3(2),
10-20.
Jaramillo, E. Tuberculosis and stigma: predictors of prejudice against people with
tuberculosis. Journal of Health Psychology, 1999.
Jilek-Aall, L., M. Jilek, J. Kaaya, L. Mkombachepa, and K. Hillary. Psychosocial
study of epilepsy in Africa. Soc.Sci.Med. 45 (5):783-795, 1997.
Kaplan, D. The definition of Disability. www.accessiblesociety.org 2004.
Kidd,R., & Clay,S. (2003). Understanding and challenging HIV stigma: Toolkit for
action. Washinton: CHANGE project.
Kolodziej, M.E., & Johnson,B.T. (1996). Interpersonal contact and acceptance of
persons with psychiatric disorder: a research synthesis. Journal of consulting and
clinical psychology 64(6), 1387-1396.
Link,B.G., & Phelan,J.C. (2001). Conceptualizing stigma. Annu Rev Sociol 27 363385.
Long, N. H., E. Johansson, V. K. Diwan, and A. Winkvist. Fear and social isolation as
consequences of tuberculosis in VietNam: a gender analysis. Health Policy 58 (1):6981, 2001.
MacLeod,J.L., & Austin,J.K. (2003). Stigma in the lives of adolescents with epilepsy:
a review of the literature. Epilepsy and Behavior 4(2), 112-117.
Mahendra,V.S., & Gilborn,L. (2004). PLWHA-friendly hospitals in India: reducing
AIDS-related stigma and discrimination. Sexual Health Exchange(2), 13-14.
Monico,S.M., Tanga,E.O., & Nuwagaba,A. Uganda: HIV and AIDS-related
discrimination, stigmatisation and denial. 2001. UNAIDS Best Practice Collection.
Morrison,K., Brito,A., & Figueroa,M. (2004). Machismo and the virgin: media and
stigma in Mexico. Global Aids Link June/July 9.
Morrison,K., & Cuadra,S.M. (2004). HIV-related stigma and discrimination in
Mexican health services. Sexual Health Exchange 2 12-13.
Navon,L. (1996). Beyond constructionism and pessimism: theoretical implications of
leprosy destigmatisation campaigns in Thailand. Soc of Health and Illness.
Nyblade,L., Pande,R., & al,e. Disentangling HIV and Aids stigma in Ethiopia,
Tanzania and Zambia. 2003. International centre for research on women.
Ogden, J. The resurgence of tuberculosis in the tropics. Improving tuberculosis
control--social science inputs. Trans.R.Soc.Trop.Med.Hyg. 94 (2):135-140, 2000.
Opala, J. and F. Boillot. Leprosy among the Limba: illness and healing in the context
of world view. Soc.Sci.Med. 42 (1):3-19, 1996.
45
46. Parker,R., & Aggleton,P. HIV/AIDS-related stigma and discrimination: a conceptual
framework and an agenda for act. 2002. Horizons project.
Parker,R., & Aggleton,P. (2003). HIV and AIDS-related stigma and discrimination: a
conceptual framework and implications for action. SSM 57(1), 15-24.
Raju, M. S. and J. V. Reddy. Community attitude to divorce in leprosy. Indian J.Lepr.
67 (4):389-403, 1995.
Reis,R. (2000). Explanatory concepts and stigmatisaiotn: the case of epilepsy in
Swaziland. Zeitschrift Behinderung und Dritte Welt 2 44-48.
Reis,R. (2002). ILAE/WHO "Out of the shadows campaign" Stigma: does the flag
identify the cargo? Epilepsy and Behavior December 33-37.
Richardson, S. A. Research report. Handicap, appearance and stigma. Soc.Sci.Med. 5
(6):621-628, 1971.
Samaras,T. (2004). Building the legal capacity to fight discrimination. Global Aids
Link(June/July), 16-17.
Sartorius,N. Some strategies to tackle stigmatisation and discrimination.
Sartorius,N. (1998). Stigma: what can psychiatrist do about it? The Lancet 352 10581059.
Savariaud,S. (2004). Staying alive in Senegal. Global Aids Link June/July 10-11.
Scambler, G. and A. Hopkins. Generating a model of epileptic stigma: the role of
qualitative analysis. Soc.Sci.Med. 30 (11):1187-1194, 1990.
Schulze, & al,e. (2003). Crazy? So what! Effects of a school project on students'
attitudes towards people with schizofrenia. Acta Psychiatr Scan 107 142-150.
Siyam'
Kela Reference groups. Siyam'
Kela. Measuring HIV/AIDS-related stigma.
Tackling HIV/AIDS stigma: guildelines for enhancing the interaction of people living
with HIV/AIDS with the media. 2003.
Siyam'
Kela Reference groups. Siyam'
Kela. Measuring HIV/AIDS related stigma.
Tackling HIV/AIDS stigma: Guidelines for faith based organisations. 2003.
Siyam'
kela. HIV/AIDS-related stigma: a literature review. 2003. South Africa,
POLICY project.
Smith, M. Stigma. Advances in Psychiatric Treatment 8:317-325, 2002.
Snead,K., & al,e. (2004). Taking charge of epilepsy: the development of a structured
psychoeducational group intervention for adolescents with epilepsy and their parents.
Epilepsy and Behavior.
46
47. Summers, J. A., S. K. Behr and A. P. Turnbull. Positive adaption and coping strenghts
of families who have children with disabilities.. Anonymous. www.beachcenter.org ,
2004. www.beachcenter.org
Susman, J. Disability, stigma and deviance. Soc.Sci.Med. 38 (1):15-22, 1994.
Thompson,A.H., et al (2002). Attitudes about schizophrenia from the pilot site of the
WPA worldwide campaign against the stigma of schizophrenia. Soc Psychiatr
Epidemiol 37 475-482.
UNAIDS. HIV and AIDS. Stigmatization, discriminiton and denial: forms, contexts
and determinants. BP103. 2001. UNAIDS, Geneva. Best Practice Collection.
Wahl,O.F. (2003). Depictions of mental illness in children' media. J of Mental
s
Health 12(3), 249-258.
Weiss,M.G., Jadhav,S., & etal (2001). Psychiatric stigma across cultures: local
validation in Bangalore and London. Anthropology and Medicine 8(1), 71-87.
WHO. World AIDS day 2002 Advocacy kit. www.who.org 2002.
47