Risk Factors of Stigma Related to Leprosy- a Systematic Review Abstract
Total Page：16
File Type：pdf, Size：1020Kb
Original Article Risk factors of stigma related to leprosy- A Systematic Review Abstract The studies reviewed indicate that leprosy stigma is still a global phenomenon, Bipin Adhikari*, occurring in both endemic and non-endemic countries. The consequences of stigma can Nils Kaehler *, range from the psychosocial dysfunction to isolation, rejection and participation restriction. Shristhi Raut **, Despite the variation in prevalence of different types of stigma, its severity and nature, Sujan Babu the risk factors associated with stigma are remarkably similar. They include visible Marahatta*** impairments, disability, low socioeconomic status, low education and the various perceptions Kapil Ggyanwali****, regarding leprosy. This suggests that risk factors contributing to the development of stigma Robert S. Chapman* are perhaps of a similar nature thus indicating that management of stigma in diverse *College of Public culture is possible by implementing related stigma-reduction strategies to counteract the Health Sciences, various risk factors in various settings. Nonetheless, establishing the particular risk factors Chulalongkorn that contribute to stigma in different settings can further aid the design of specific University, Thailand. interventional programs to address the different determinants followed by the evaluation **Department of and monitoring of the stigma interventions at different levels and settings. Microbiology, Key words: Stigma, Risk factor, Leprosy, Disability. Manipal College of Medical Sciences, Nepal. Introduction ***Department of Community Medicine, Leprosy has long been seen as the epitome functions. In Nepal including other South Manmohan Memorial of stigmatization and has become a Asian countries,a strong culture of belonging Medical College metaphor for degradation in colloquial to ones family bears an essential value to ****Faculty of Public English [1]. The most common notion of an individual rather than the independent Health, Mahidol stigma however, still refers to peoples and individualized identity prevalent in west. University, Thailand. fear of dealing with leprosy-affected For leprosy affected person to lose * Corresponding people. This is in most cases due to a lack attachment to their family members Author: Bipin of scientific knowledge and suspicious potentially bears much grave psychosocial Adhikari, College of ideas about the disease [2]. Considering consequences than losing their fingers and Public Health the severity in terms of human suffering, toes [5]. Sciences, the consequences of stigma in leprosy Chulalongkorn often outweigh the burden of physical The well-being and the self-esteem of a University, Institute afflictions, [3] different causes like fear, person are inextricably linked to their income building 3 (10th unattractiveness, unease of how to deal generation and their ability to secure 11th floor), with leprosy affected person and the employment. In a culture where a person Chulalongkorn soi 62, varying stereotypes of the societies [4]. is valued by the ability to support their Phyathai Rd., Bangkok dependents, unemployment because of 10330 Thailand Leprosy and its stigma have a pervading Leprosy can have an enduring effect not (e-mail: effect on a patients life, affecting [email protected]) marriage, interpersonal relationships, only economically but psychosocially too employment, leisure activities as well as [6]. In severe cases, stigma may even lead attendance at religious and social to complete rejection or banishment by communities, insults and hate [7]. 3-JMMIHSISSN: 2091-1041 | VOLUME 1 | ISSUE 2 |2013 JMMIHS-3 Original Article Risk Factors and Its Implications: leprosy. This article reviews all kinds of factors from socio-demographic to the clinical characteristics of the Risk factor has been defined as an environmental, disease which have been associated with stigma in behavioral or biological factor confirmed by temporal leprosy. sequence which if present directly increases the probability of a disease occurring and if absent or Definition of Terms removed reduces the probability [8]. Various risk factors Impairment: Impairment is referred to as a contributing to the development of stigma in different problem in body function or structure, such Range cultural settings may bear diverse origin, however, of factors that determine the outcome of the disease. understanding the differences and similarities of risk This includes 1.The social and economic environment. 2. factors can have a significant contribution to direct the The physical environment 3.The persons individual stigma reduction strategies and programs. The similarities characteristics and behaviors [14]. Participation in the existence of risk factors of stigma imply the restriction: Participation refers to the involvement in life possibilities of globally applicable psychosocial needs to situations. When an individual experiences problems in leprosy affected persons. In a study conducted in South participation, it is referred to as participation restriction Africa, the needs that were similar to the rest of the [15].Activity limitation: When an individual experiences world were the need for self-acceptance, need for social difficulties in executing activities [Ibid] acceptance and the need for acceptance by the Material and Methods community [9]. To review the articles related to the stigma of Various studies intended to assess the impacts leprosy and its risk factors, a literature study was done. of interventions to reduce stigma have recommended References were collected through a PubMed (Medline) possible ways in which stigma can be reduced. Social search on the keywords leprosy combined with skills trainings along with counseling have been found stigma, risk factors KAP or attitude. A total of to be effective in reducing self-perceived stigma in a 187 papers were displayed by the PubMed (Medline) study done in India [10]. Similarly, Ebenso et al found search. 67 out of 187 papers were selected based on the improved self-esteem, happiness and skills acquisition issues of stigma addressed by them. Out of the 67 papers in leprosy affected persons with the aid of socio-economic addressing issues of stigma, a thorough review of each rehabilitation (SER) [11]. article was done to select only those articles which dealt Addressing stigma reduction interventions are with the risk factors of stigma related to leprosy by challenging considering the diversity of risk factors, original research. Seventeen articles were extensively however, a literature review on stigma reduction reviewed to extract the types of stigma and the risk strategies and interventions suggest that single-level and factors contributing to the development of stigma. We single-target group approaches are not enough. A patient included articles that were published between 2000 and centered approach targeting to reduce stigma in affected 18th July 2012.Both qualitative and quantitative studies individuals, empowerment of affected persons and the were included into our review. involvement of affected persons in the development and Results implementations of stigma reduction programs at Studies that involve the assessment of stigma can different levels were suggested to be the effective [12]. be broadly categorized into two groups: (i) studies that This further highlights the method of effective assess the effects of stigma on the person affected and interventions and the need to assess the level of stigma (ii) studies that assess attitudes and/or practices towards and the pertinent risk factors. people affected by leprosy. In addition, studies can be There are various studies addressing the issues further categorized into different groups depending on of stigma related to leprosy, however, rarely the types of stigma that have been assessed. Most of havesystematic reviews been done to extract the risk the studies have assessed all kinds of stigma with or factors contributing to the development of stigma in without specifying the particular stigma; however, our review has extracted the types of stigma from the studies. 4-JMMIHS ISSN: 2091-1041 | VOLUME 1 | ISSUE 2 |2013 Original Article There are three kinds of stigma, perceived stigma, enacted stigma [22]. Similarly, in a study at eastern Nepal, stigma stigma and self- stigma. towards leprosy in 300 community members were assessed where overall community stigma was found to 1. Perceived stigma is also called anticipated stigma be 52% [7]. or felt stigma. It is the perception, expectation or fear of discrimination and the awareness of negative There were two qualitative studies conducted for attitudes or practices in society [16, 17]. perceived stigma in India and Nepal. In Nepal, 19 in- 2. Enacted stigma is also called discrimination or depth interviews were conducted where perception, experienced stigma. This occurs when any member beliefs and behavior were assessed [23]. Similarly in a of society, healthcare provider or person in the study conducted in India where the difference in self- surrounding behaves negatively or discriminates by stigma and community stigma was assessed between some means to the affected person [17-18]. the communities with integrated and the communities with vertical health program approach was implemented. 3. Self-stigma is also called internalized stigma. This Integrated health approach refers to the health approach kind of stigmatization occurs when a person start which was commonly implemented for all health believing what others think and say about him.