Challenge Stigma Research Articles

Mothers' experience of Intensive Interaction.

There is limited research into parents' experiences of Intensive Interaction. Despite this, there are parents who use it and may hold unique experiences. Exploring this could provide insight into how to support parents using Intensive Interaction. Six mothers, who used Intensive Interaction with their children with intellectual disabilities and/or autism, were interviewed. Results were analysed using interpretative phenomenological analysis. The analysis yielded 10 subordinate themes which were organised into 4 superordinate themes: 'The Connection', 'Bittersweet', 'Fighting for Support' and 'Challenging Underlying Low Expectations & Stigma'. Intensive Interaction was found to help some mothers feel connected with their child; they appeared to indicate that accessing timely support with Intensive Interaction was beneficial. Intensive Interaction was also perceived to challenge assumptions and stigma, but these factors were also perceived to be potential barriers to using the approach.

Ocular manifestations of pregnancy induced hypertension

Background: Pregnancy Induced Hypertension (PIH) is a challenging stigma in the field of obstetrics and one of the major contributors to maternal and perinatal mortality. Hence; the present study was undertaken for assessing ocular manifestations in patients with pregnancy induced hypertension. Materials & Methods: A total of 100 patients with pregnancy induced hypertension were enrolled. Patients with the chronic hypertension, preexisting renal diseases, diabetes mellitus, hematological disorders, infectious diseases and any prior ocular diseases were excluded. Anterior segment examination was carried out with torch light. Pupils were dilated with tropicamide and fundus examination was carried out with indirect ophthalmoscope. All the results were recorded and analysed by SPSS software. Results: Defective vision was seen in 19 percent of the patients. Macular oedema was seen in 11 percent of the patients. Lid oedema and choroidal infarcts were seen in 2 percent and 3 percent of the patients respectively. Arteriolar narrowing was seen in 14 percent of the patients. Conclusion: Ocular symptoms were seen in 32% of preeclampsia. Frequent and prompt screening of retina in PIH patients is indicated.

Challenging stigma attached to mental disorders: A psychosocial perspective

Stigma attached to mental disorders represent one of the main obstacles to patients’ full recovery and empowerment. In the last decades, many anti-stigma programmes have been implemented worldwide, but stigma still represents a major obstacle for people with severe mental disorders, their family members, friends and also healthcare professionals. Stigma is a complex social phenomenon, which entails a lack of knowledge, discriminating attitudes and excluding behaviours in the general population, which deserves a multi-level approach. In particular, anti-stigma strategies combining the three most common approaches, including contact, education, and organization of protest activity, are the most effective. Interventions should contain age-appropriate information and should be provided at an early age (e.g., in schools). Interdisciplinary approaches are recommended. In particular, contact strategies are important to reduce prejudice and change attitudes towards people with mental disorders and may be implemented either by video (interviews/personal testimonies), but ideally in person with affected individuals, reporting their real life experiences. In this workshop, the role of advocacy associations together with all stakeholders of mental health will be discussed in the process of fighting stigma according to a psychosocial perspective.DisclosureNo significant relationships.

Patient Priorities in Autoimmune Hepatitis: The Need for Better Treatments, More Education and Challenging Stigma

Background: Recent data show that patients with autoimmune hepatitis have significantly reduced quality of life and that corticosteroids (still central to therapy) carry marked side effects. This study explored the patients’ experience of autoimmune hepatitis and its treatments; aspects that are key to understanding how we can develop safe and effective new approaches to therapy. Methods: An anonymised, internet-based survey was conducted between December 2019 and January 2020. Data were collected about patient demographics, treatments, side effects, impact on day-to-day life, sources of support and attitudes towards autoimmune hepatitis. Semi-structured interviews were then conducted with 13 patients to further explore their support networks, treatment experiences and health priorities. Descriptive and quantitative analyses were undertaken using R and free text responses were subject to thematic analysis. Findings: A total of 270 survey responses were received (median age 55 years and 94% female). Perceived medication side effects were reported by 66% (169/257) and 73% responded negatively about their experience of corticosteroids. The majority (62·3% [(109/175]) would ‘definitely’ or ‘probably’ consider clinical trial participation to improve their care with new and/or improved treatments. Only 18·7% (31/166) reported access to a specialist liver nurse and nearly half were involved in support groups. Data from the interviews and survey suggested that major issues were stigma in liver disease, loss of control and fatigue. Interpretation: This study provides insights into the realities of living with autoimmune hepatitis. There are clear issues with lack of support networks, need for patient empowerment and stigma surrounding liver disease. Patient priorities are better therapies to slow disease progression, avoiding corticosteroids and minimising side effects. The willingness of patients to participate in clinical trials is a positive finding and suggests that trials are achievable provided they have the right design and clinical endpoints. Funding: No funding to declare. Declaration of Interest: Dr Jessica Katharine Dyson has received speaker fees from Dr Falk Pharma and Intercept Pharmaceuticals. MISSING ALL OTHER AUTHORS. Ethical Approval: MISSING

Examining the impacts of the COVID-19 pandemic on the well-being and virtual care of patients with epilepsy

Examining the impacts of the COVID-19 pandemic on the well-being and virtual care of patients with epilepsy

\u2018They are my future\u2019: childbearing desires and motivations among women with disabilities in Ghana - implications for reproductive healthcare

BackgroundPrevious research has highlighted widespread public mis/perceptions that portray women with disabilities (WWDs) as asexual, less likely to marry, and often not interested in childbearing. However, evidence from high-income settings shows that many WWDs are sexually active and do have or want to have children. Notwithstanding this, very few studies have focused on understanding childbearing desires and motivations among WWDs in low-income settings. This qualitative research explored childbearing desires and motivations among WWDs in Ghana.MethodsA cross-sectional qualitative study was conducted with WWDs aged 18–49 years in Northern Ghana. The distribution of participants by disability types were as follows: physical disability/impairment (n = 37); visual impairment (n = 11); speech and hearing impairment (n = 14); epilepsy (n = ten); and albinism (n = five). A pre-tested open-ended thematic topic guide was designed and used to conduct in-depth interviews. Interviews were tape-recorded and later transcribed for analysis. Transcripts were coded using QSR NVivo 11 software. Thematic content analysis techniques were used to analyse and present the data.ResultsNearly all the WWDs interviewed were sexually active, desiring to have children, and intended to have as many children as they could support. Strong desire to experience the joy of motherhood; fear of social insecurity; fear of old age economic insecurity; desire to challenge stigma and negative stereotypes about disability, sexuality and motherhood; and desire for self-actualisation, were key motivations for childbearing.ConclusionOur findings challenge existing negative public perceptions about the status of WWDs in relation to sexuality, childbearing and motherhood. More importantly, our findings suggest that if the Sustainable Development Goals related to universal access to sexual and reproductive healthcare are to be attained, WWDs must be targeted with quality sexual and reproductive healthcare information and services.

Challenging mental illness stigma in healthcare professionals and students: a systematic review and network meta-analysis

Objective Stigma among healthcare professionals may lead to poor quality of healthcare services for patients with mental illness. This study conducts a network meta-analysis to estimate the relative efficacy between different types of anti-stigma interventions for healthcare professionals. Design Network meta-analysis. Main Outcome Measures The attitudes and behavior intension of healthcare professionals toward mental illness. Results A total of 18 studies (22 trials) from 9 countries are included in the analysis. In the network meta-analysis, rank probabilities show interventions with indirect contact plus lecture (SUCRA = 81.5%), direct contact plus problem-based learning workshop (SUCRA = 77.4%), and indirect contact (SUCRA = 72.2%) having the highest probability of being ranked first, second, and third, respectively. Conclusion Our findings suggest that education combining social contact is the most effective anti-stigma intervention, which can be implemented in clinical practices to help reduce this stigma and improve healthcare services for patients with mental illness.

“Before I Saw a Gas Canister, Now I See a Person”: Post Obesity-Intervention Body Acceptance and Responses to Weight Stigma among Urban Brazilian Gorda Women

Weight stigma is reportedly globalizing, but there is limited evidence of how concerns around weight change are impacting those in many places. Additionally, few studies to date have considered how weight stigma operates in the context of interventions that purposefully eschew from a focus on weight itself. We have used qualitative analysis to examine body acceptance and responses to weight stigma among urban Brazilian gorda women participating in two forms of Health at Every Size® (HAES®) interventions: an intensive HAES® program (I-HAES®, n=26), which directly addressed weight stigma and a traditional, less-intensive HAES® program (CTRL, n=13). Individual, semi-structured interviews regarding how participants felt about their bodies were conducted post-intervention. Exploratory content analysis followed an inductive approach. The I-HAES®-group was more prone to accept their bodies, to feel well-being, to do new things, and to give proactive responses to weight stigma, while the CTRL-group internalized and accepted stigma, reported a lack of body acceptance, and indicated they were less able to challenge stigma in their lives. Interdisciplinary, intensive HAES® interventions appear able to meaningfully tackle responses to weight stigma and promote body acceptance, important in contexts where stigma is a major component of how women experience their weight.

Grassroots Mental Health Groups' Use of Advocacy Strategies in Social Media Messaging.

Mental health concerns are a public health crisis. Stigma is the primary reason why individuals do not disclose or seek treatment. Stigma is constructed communicatively, and destigmatization efforts-such as advocacy messaging-are also communicative. I employ a case study approach to describe how two mental health groups use advocacy strategies in their social media messaging to help audience members mitigate mental health concerns and challenge stigma. I found content creators use a variety of advocacy strategies in their messaging, including awareness-raising, support of policy initiatives, and the promotion of diversity and inclusivity. Although not the primary goal of these groups' messaging, advocacy strategies were important to content creators and audience members, and 80% of audience members interviewed engaged in advocacy work for the organizations. I provide a nuanced view of mental health communication advocacy strategies, make recommendations for health communication professionals, and demonstrate the need for future studies.

Psychological distress and self-harm in a religiously diverse sample of Lebanese students

ABSTRACT Drawing on identity process theory, this study explores the protective and risk factors of psychological distress and self-harm in a religiously diverse sample of heterosexual and non-heterosexual students in Lebanon. A convenience sample of 209 undergraduate students participated in a cross-sectional survey and completed measures of religiosity, identity threat, psychological distress and self-harm. Results indicated that non-heterosexual participants exhibited higher levels of psychological distress, were more likely to report self-harm, and reported lower levels of religiosity than their heterosexual counterparts. It was shown that religiosity was protective against psychological distress, and that sexual orientation distress predicted self-harm. In order to reduce the risk of psychological distress and self-harm, it will be necessary to challenge stigma towards sexual minorities, to promote engagement with a broader range of social identity categories (other than just religion), and to ensure the availability of effective counselling support to all who need it.

Civic engagement and mental health system strengthening in Indonesia: a qualitative examination of the views of health professionals and national key stakeholders

BackgroundMental health services in Indonesia are developing rapidly in response to national and global health policy to support people living with psychosis. This presents a unique opportunity for civic engagement, the active involvement of patients, carers and communities in mental health care, to shape emergent services. In-depth explorations of the views of professionals and other key stakeholders in mental health care on the use of civic engagement in Indonesia are lacking which contributes to a limited understanding of its potential in this regard. The study aimed to explore contemporary professionals’ and other key stakeholders’ perspectives on the current use of and potential for civic engagement to strengthen mental health systems in Indonesia.MethodsQualitative interviews were undertaken and analysed using thematic analysis underpinned by a critical realist approach. Eighteen multi-disciplinary professionals and lay health workers involved in mental health care in Jakarta and Bogor and 10 national key stakeholders were recruited.ResultsDespite high levels of awareness of and support for civic engagement amongst mental health professionals and policy makers combined with a nascent grass roots movement, analysis revealed unstructured and insufficient mechanisms for civic engagement which resulted in ad-hoc and mostly superficial levels of involvement activity. Civic engagement was thought to require a marked shift in existing practices as well as organisational and societal cultures. Challenging stigma is a key feature of civic engagement and our analysis highlights the relevance of social contact methods which are locally and culturally contextualised in this regard. Our findings point to a need to expand current definitions of civic engagement which focus on indivdiual enablement to ones that also encompass environmental and organisational enablement to optimise the future use of civic engagement in mental health settings.ConclusionsKey mental health stakeholders have identified that central aspects of Indonesian culture are well aligned to the ethos of civic engagement which has the potential to facilitate the enactment of recent global health policy. However, full realisation is likely to be impeded by prevailing paternalistic cultures in mental health services and high levels of stigma and discrimination towards those with mental illness in Indonesia without intervention.

Tweeting about mental health to honor Carrie Fisher: How #InHonorOfCarrie reinforced the social influence of celebrity advocacy

Tweeting about mental health to honor Carrie Fisher: How #InHonorOfCarrie reinforced the social influence of celebrity advocacy

Identity, stigma, and HIV risk among transgender women: a qualitative study in Jiangsu Province, China

BackgroundTransgender women have multiple disparities globally, including social rejection and stigma, HIV infection and untreated mental health problems. However, few data on transgender women are available in China. Therefore, this study aimed to explore transgender women’s experiences on gender identity, disclosure, discrimination, transgender-specific medical care, and perceptions of HIV and sexually transmitted infections (STI) risk in China.MethodsA qualitative study was conducted in Nanjing and Suzhou city, China in 2018. Key informant interviews (n = 14) and focus group discussions (n = 2) with diverse transgender women were implemented. Text was transcribed and translated, and Dedoose™ software was used for coding, analysis and interpretation by the research team.ResultsChinese transgender women share experiences with transgender women worldwide, including a long and challenging identity search, stigma and discrimination, poor access to trans-specific services and unmet needs for mental health care. Features unique to them include terms used for self-identification, culturally-shaped expectations for reproduction, and ideals of placing the familial and societal welfare over personal fulfillment. Social networks of this population appear sparse, scattered, and underground. Familial rejection was experienced by nearly all respondents. Perceptions of HIV and STI risk and history of HIV testing were notably low.ConclusionsTransgender women in China face high social rejection and discrimination along with unmet need for various types of healthcare. Scaling up transgender-specific services including gender-affirming medical care, mental health care and HIV/STI prevention are warranted to address the social, medical and mental health of transgender women in China.

Screening and supporting through schools: educational experiences and needs of adolescents living with HIV in a South African cohort

BackgroundMany adolescents living with HIV remain disconnected from care, especially in high-prevalence settings. Slow progressors–adolescents infected perinatally who survive without access to lifesaving treatment–remain unidentified and disconnected from heath systems, especially in high-prevalence settings. This study examines differences in educational outcomes for ALHIV, in order to i) identify educational markers for targeting HIV testing, counselling and linkages to care, and ii) to identify essential foci of educational support for ALHIV.MethodsQuantitative interviews with N = 1063 adolescents living with HIV and N = 456 HIV-free community control adolescents (10–19 year olds) included educational experiences (enrolment, fee-free school, school feeding schemes, absenteeism, achievement), physical health, cognitive difficulties, mental health challenges (depression, stigma, and trauma), missing school to attend clinic appointments, and socio-demographic characteristics. Voluntary informed consent was obtained from adolescents and caregivers (when adolescent < 18 years old). Analyses included multivariate logistic regressions, controlling for socio-demographic covariates, and structural equation modelling using STATA15.ResultsALHIV reported accessing educational services (enrolment, free schools, school feeding schemes) at the same rates as other adolescents (94, 30, and 92% respectively), suggesting that school is a valuable site for identification. Living with HIV was associated with poorer attendance (aOR = 1.7 95%CI1.1–2.6) and educational delay (aOR1.7 95%CI1.3–2.2). Adolescents who reported educational delay were more likely to be older, male, chronically sick and report more cognitive difficulties. A path model with excellent model fit (RMSEA = 0.027, CFI 0.984, TLI 0.952) indicated that living with HIV was associated with a series of poor physical, mental and cognitive health issues which led to worse educational experiences.ConclusionSchools may provide an important opportunity to identify unreached adolescents living with HIV and link them into care, focusing on adolescents with poor attendance, frequent sickness, low mood and slow learning. Key school-based markers for identifying unreached adolescents living with HIV may be low attendance, frequent sickness, low mood and slow learning. Improved linkages to care for adolescents living with HIV, in particular educational support services, are necessary to support scholastic achievement and long-term well-being, by helping them to cope with physical, emotional and cognitive difficulties.

A framework for developing employer’s disability confidence

PurposeMany employers lack disability confidence regarding how to include people with disabilities in the workforce, which can lead to stigma and discrimination. The purpose of this paper is to explore the concept of disability confidence from two perspectives, employers who hire people with a disability and employees with a disability.Design/methodology/approachA qualitative thematic analysis was conducted using 35 semi-structured interviews (18 employers who hire people with disabilities; 17 employees with a disability).FindingsThemes included the following categories: disability discomfort (i.e. lack of experience, stigma and discrimination); reaching beyond comfort zone (i.e. disability awareness training, business case, shared lived experiences); broadened perspectives (i.e. challenging stigma and stereotypes, minimizing bias and focusing on abilities); and disability confidence (i.e. supportive and inclusive culture and leading and modeling social change). The results highlight that disability confidence among employers is critical for enhancing the social inclusion of people with disabilities.Originality/valueThe study addresses an important gap in the literature by developing a better understanding of the concept of disability from the perspectives of employers who hire people with disabilities and also employees with a disability.

Information needs of people after a suicide attempt: A thematic analysis

Information needs of people after a suicide attempt: A thematic analysis

Community-based arts research for people with learning disabilities: challenging misconceptions about learning disabilities

This article presents some of the community-based artwork of a group of men with learning disabilities, who aimed to challenge some of the misconceptions associated with learning disabilities. People with learning disabilities regularly face many forms of direct and indirect stigma. The consequences of such negative perceptions may affect individuals’ social relationships and ensure that barriers are strengthened which prevent their full inclusion. The men in this project used a series of visual and creative methods to challenge some of these misconceptions by telling stories through art, demonstrating skill through photography, using poetry to talk about sexual identity and improvising drama and filmmaking to challenge stigma, and through sculpture expressed their voices. Thus, by doing so, they were able to challenge some of the stigma associated with learning disabilities, indicating that community-based arts research is a valuable way in which to promote the voices of people with learning disabilities.

Ocular Fundus changes in pregnancy induced hypertension – A case series study

<strong>Back ground:</strong> Pregnancy Induced Hypertension is a challenging stigma in the field of obstetrics and one of major contributors to maternal and perinatal mortality. PIH is a hypertensive disorder in pregnancy that occurs after 20 weeks of pregnancy in the absence of other causes of elevated blood pressure.

Qualitative cross-country comparison of whether, when and how people diagnosed with lung cancer talk about cigarette smoking in narrative interviews

ObjectivesTo compare and examine whether, when and how patients with lung cancer in three countries, with different survival rates, talk about cigarette smoking and its relationship with help-seeking.DesignA qualitative cross-country...

Experiences and perceptions of social constraints and social change among lesbian, gay, bisexual and transgender persons in Lesotho

Lesbian, gay, bisexual, transgender and other sexually and gender diverse persons negotiate for their identities, create communities and advocate for their rights throughout the world. However, there are limited data about the perceptions of social change among sexually and gender diverse persons in contexts where same-sex sexual practices have been recently decriminalised, such as in 2010 in Lesotho. We conducted semi-structured in-depth interviews with sexually and gender diverse persons (n = 46) and six key informants. Findings were analysed using Social Worlds Theory. Participants discussed social constraints and marginalisation across structural (legal systems, employment, education), community (beliefs that sexual and gender diversity are incongruent with Basotho culture; stigma), and familial (tensions with religion and cultural gendered economic traditions) dimensions. The narratives also revealed perceived change across structural (changing norms in legal, employment and education spheres), community (larger community and LGBT community change), familial (negotiating acceptance), and internal (active resistance) domains. The findings reported here can inform multi-faceted programmes to challenge stigma, violence and gender inequity; build social capital; and address the health and human rights priorities of sexually and gender diverse persons in Lesotho.