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Theresia I, Sani TP, Evans-Lacko S, Farina N, Augustina L, Turana Y. Experiences of caregivers of people with dementia in Indonesia: A focus group study. Int J Geriatr Psychiatry 2023; 38:e6038. [PMID: 38110288 DOI: 10.1002/gps.6038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 11/28/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Many people with dementia are reliant on family caregivers to provide daily care to maintain quality of life and dignity. As a result, caregivers can experience increased burden, poorer health outcomes and increased stigma. To date, the experiences of caregivers of people with dementia has not been explored within an Indonesian context. AIMS This study aims to understand the experience of caregivers of people with dementia in Indonesia and better understanding of the stigma associated with dementia. MATERIALS AND METHODS This qualitative study is embedded within the Strengthening Responses to Dementia in Developing Countries project. Focus Group Discussions were held with dementia caregivers residing in Jakarta, Indonesia. Inductive thematic analysis was used to analyse the transcripts. RESULTS Nineteen caregivers of people with dementia participated in the Focus Group Discussions. Themes identified included: (1) Understanding of dementia, (2) Reaction to care, and (3) Seeking a diagnosis. DISCUSSION A perceived lack of understanding about dementia amongst the caregivers, ultimately shaped caregivers experience of care. This included negative reactions to care leading to internalised stigma (e.g., fear and shame). Misconceptions that dementia was due to spiritual and mystical reasons were particularly stigmatising. CONCLUSION In Indonesia, families are providing care to people with dementia in an environment in which there is a lack of understanding that can lead to misdiagnosis, feelings of fear and shame. Efforts to raise address stigma and misunderstanding among the general public and healthcare professionals could be of particular value to support people with dementia and reduce the fear and shame that they can experience.
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Affiliation(s)
| | | | - Sara Evans-Lacko
- Department of Health Policy, Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Nicolas Farina
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Lydia Augustina
- School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Yuda Turana
- Alzheimer's Indonesia, Jakarta, Indonesia
- School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
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Votruba N, Praveen D, Mellers L, Rajan E, Thout SR, Arora V, Malik Y, Kashyap A, Majumdar S, Hirst J, Maulik PK. SMARThealth PRegnancy And Mental Health study: protocol for a situational analysis of perinatal mental health in women living in rural India. Front Glob Womens Health 2023; 4:1143880. [PMID: 37575961 PMCID: PMC10416114 DOI: 10.3389/fgwh.2023.1143880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 07/11/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction The situation for women experiencing mental health problems during pregnancy and postpartum in rural India is critical: a high burden of disease, a high estimated number of women are undiagnosed and untreated with mental health problems, a substantial gap in research on women's perinatal health, and severe stigma and discrimination. The SMARThealth Pregnancy study is a cluster randomised trial using a digital intervention to identify and manage anaemia, hypertension, and diabetes in the first year after birth in rural India. Within this study, the SMARThealth Pregnancy and Mental Health (PRAMH) study is a situational analysis to understand mental health problems during pregnancy and in the first year following birth in this population. Methods/design This situational analysis aims to analyse and to assess the context of perinatal mental health, health services, barriers, facilitators, and gaps in Siddipet district of Telangana state in India, to develop an implementation framework for a future intervention. A tested, standardised situational analysis tool will be adapted and applied to perinatal mental health in rural India. A desktop and policy review will be conducted to identify and analyse relevant mental health and pregnancy care policies at the national and state levels. We will conduct in-depth interviews with policymakers, planners, mental health professionals and other experts in perinatal mental health (n = 10-15). We will also conduct focus group discussions with key stakeholders, including women with perinatal mental health problems, their families and carers, and community health workers (n = 24-40). A theory of change workshop with key stakeholders will be conducted which will also serve as a priority setting exercise, and will clarify challenges and opportunities, priorities, and objectives for a pilot intervention study. The analysis of qualitive data will be done using thematic analysis. Based on the data analysis and synthesis of the findings, an implementation framework will be developed to guide development, testing and scale up of a contextually relevant intervention for perinatal mental health. Discussion The situational analysis will help to establish relationships with all relevant stakeholders, clarify the context and hypotheses for the pilot intervention and implementation.
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Affiliation(s)
- Nicole Votruba
- Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
- The George Institute for Global Health, Imperial College London, London, United Kingdom
| | - Devarsetty Praveen
- The George Institute for Global Health India, New Delhi, India
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Lucy Mellers
- Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Eldho Rajan
- The George Institute for Global Health India, New Delhi, India
| | | | - Varun Arora
- Post Graduate Institute of Medical Science, Rohtak, India
| | - Yogender Malik
- Department of Psychiatry, Institute of Mental Health (IMH), University of Health Sciences PGIMS, Rohtak, India
| | - Aditya Kashyap
- SVS Institute of Neurosciences, Government Medical College, Siddipet, India
| | - Sreya Majumdar
- The George Institute for Global Health India, New Delhi, India
| | - Jane Hirst
- Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
- The George Institute for Global Health, Imperial College London, London, United Kingdom
| | - Pallab K. Maulik
- The George Institute for Global Health India, New Delhi, India
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
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Rani A, Raman KJ, Ammapattian T, Antony S, Prabhu SG, Basavarappa C. Lived Experiences of Persons with Chronic Schizophrenia Living in the Community. Indian J Psychol Med 2023; 45:374-382. [PMID: 37483575 PMCID: PMC10357909 DOI: 10.1177/02537176221084500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
Background Each individual with schizophrenia experiences life uniquely, despite the sameness in their diagnosis. Understanding their experiences is vital for their better community integration and social work practice. Method We used the interpretative phenomenological approach. Persons with schizophrenia seeking outpatient services at a tertiary care institute in Bengaluru, India, were recruited through purposive sampling. In-depth interviews were conducted with six participants. Results Some of the meta-themes and subthemes identified were as follows: (a) perception about self (struggling with the sense of self, desire for normalcy, wanting to be in control of self and desire to live independently), (b) relationship with others (feeling supported by others and feeling rejected by others), (c) coping with consequences of illness (coping with disruptions in personal life and coping with disruptions in family life), and (d) experience of seeking treatment (reasons for seeking treatment, being on medication, and behavior of mental health professionals). The participants tried to find meaning in their lives by making sense of their illness. Family and community can have a significant impact on how persons with schizophrenia perceive their lives. Conclusion Mental health professionals need to encourage persons' and their families' greater participation in treatment planning and clinical interventions, which will enhance persons integration within the community and will help decrease the feeling of isolation commonly experienced when one lives with chronic mental illnesses.
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Affiliation(s)
- Akanksha Rani
- Dept. of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Kalayasundram Janaki Raman
- Dept. of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Thirumoorthy Ammapattian
- Dept. of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Sojan Antony
- Dept. of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Sphoorthi G. Prabhu
- Dept. of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Chethan Basavarappa
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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Oliveira D, da Mata F, Mateus E, Musyimi CW, Farina N, Ferri CP, Evans-Lacko S. Experiences of stigma and discrimination among people living with dementia and family carers in Brazil: Qualitative study. AGEING & SOCIETY 2023; 43:447-468. [PMID: 37920698 PMCID: PMC10621398 DOI: 10.1017/s0144686x21000660] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This study aimed to understand stigma in relation to people living with dementia in Sao Paulo, Brazil. Critical Narrative Inquiry methodology was used. Semi-structured interviews were conducted between January and March 2020 with six people living with dementia and 15 family carers. Inductive and deductive techniques were used. The latter was informed by Link and Phelan's (2001) sociological theory of stigma. Dementia was commonly viewed by people living with dementia as part of ageing and carers reported low levels awareness about the condition. To avoid negative reactions from people, people living with dementia managed the negative views of dementia by minimising and normalising the condition, by expressing their ability to live an active life, and by emphasising the positive impacts of dementia in their lives. Fear of negative reactions appeared to lead to a selective disclosure of their diagnosis. Among carers, stigmatising attitudes coincided with a strong willingness to provide good care, to protect the person cared for, as well as to understand and validate their caring experiences, rather than to cause harm. In doing so, however, carers ended up depersonalising and infantilising people living with dementia, underestimating their capacities, demanding 'obedience', and restricting their freedom. There is a need to increase awareness about dementia and to provide support and training on person-centred care for carers in Brazil.
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Affiliation(s)
- Déborah Oliveira
- Universidade Federal de Sao Paulo (UNIFESP), Escola Paulista de Medicina, Department of Psychiatry, Sao Paulo, Brazil
| | - Fabiana da Mata
- Universidade Federal de Sao Paulo (UNIFESP), Escola Paulista de Medicina, Department of Psychiatry, Sao Paulo, Brazil
| | - Elaine Mateus
- Federação Brasileira das Associações de Alzheimer (FEBRAZ), Parana, Brazil
- Universidade Estadual de Londrina (UEL), Applied Linguistics, Department of Modern Languages, Parana, Brazil
| | - Christine W. Musyimi
- Africa Mental Health Research and Training Foundation, Research Department, Kenya
| | - Nicolas Farina
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Cleusa P. Ferri
- Universidade Federal de Sao Paulo (UNIFESP), Escola Paulista de Medicina, Department of Psychiatry, Sao Paulo, Brazil
- Hospital Alemão Oswaldo Cruz, Sao Paulo, Brazil
| | - Sara Evans-Lacko
- Care Policy and Evaluation Centre, London School of Economics, London, United Kingdom
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Vidales CA, Vogel DL, Levant RF. The Self-Stigma of Seeking Help (SSOSH) Scale: Measurement Invariance Across Men from Different Backgrounds. MEASUREMENT AND EVALUATION IN COUNSELING AND DEVELOPMENT 2023. [DOI: 10.1080/07481756.2022.2160356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Negotiating Multiple Stigmas: Substance Use in the Lives of Women Experiencing Homelessness. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-021-00560-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Warner L, Kurtiş T, Adya A. Navigating Criticisms of Intersectional Approaches: Reclaiming Intersectionality for Global Social Justice and Well-Being. WOMEN & THERAPY 2020. [DOI: 10.1080/02703149.2020.1729477] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Leah Warner
- School of Social Science and Human Services, Ramapo College of New Jersey, Mahwah, New Jersey
| | - Tuğçe Kurtiş
- MA Program in Critical Psychology and Human Services, Prescott College, Prescott, Arizona
| | - Akanksha Adya
- Department of Psychology, University of West Georgia, Carrollton, Georgia
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Turan JM, Elafros MA, Logie CH, Banik S, Turan B, Crockett KB, Pescosolido B, Murray SM. Challenges and opportunities in examining and addressing intersectional stigma and health. BMC Med 2019; 17:7. [PMID: 30764816 PMCID: PMC6376691 DOI: 10.1186/s12916-018-1246-9] [Citation(s) in RCA: 348] [Impact Index Per Article: 69.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 12/19/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND 'Intersectional stigma' is a concept that has emerged to characterize the convergence of multiple stigmatized identities within a person or group, and to address their joint effects on health and wellbeing. While enquiry into the intersections of race, class, and gender serves as the historical and theoretical basis for intersectional stigma, there is little consensus on how best to characterize and analyze intersectional stigma, or on how to design interventions to address this complex phenomenon. The purpose of this paper is to highlight existing intersectional stigma literature, identify gaps in our methods for studying and addressing intersectional stigma, provide examples illustrating promising analytical approaches, and elucidate priorities for future health research. DISCUSSION Evidence from the existing scientific literature, as well as the examples presented here, suggest that people in diverse settings experience intersecting forms of stigma that influence their mental and physical health and corresponding health behaviors. As different stigmas are often correlated and interrelated, the health impact of intersectional stigma is complex, generating a broad range of vulnerabilities and risks. Qualitative, quantitative, and mixed methods approaches are required to reduce the significant knowledge gaps that remain in our understanding of intersectional stigma, shared identity, and their effects on health. CONCLUSIONS Stigmatized identities, while often analyzed in isolation, do not exist in a vacuum. Intersecting forms of stigma are a common reality, yet they remain poorly understood. The development of instruments and methods to better characterize the mechanisms and effects of intersectional stigma in relation to various health conditions around the globe is vital. Only then will healthcare providers, public health officials, and advocates be able to design health interventions that capitalize on the positive aspects of shared identity, while reducing the burden of stigma.
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Affiliation(s)
- Janet M. Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL 35294 USA
| | | | - Carmen H. Logie
- Factor-Inwentash Faculty of Social Work, Toronto, ON Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON Canada
| | - Swagata Banik
- Department of Public Health & Prevention Sciences, Baldwin Wallace University, Berea, OH USA
| | - Bulent Turan
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL USA
| | - Kaylee B. Crockett
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL USA
| | | | - Sarah M. Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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Triandafilidis Z, Ussher JM, Perz J, Huppatz K. An Intersectional Analysis of Women's Experiences of Smoking-Related Stigma. QUALITATIVE HEALTH RESEARCH 2017; 27:1445-1460. [PMID: 27738259 DOI: 10.1177/1049732316672645] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In this article, we explore how young women encounter and counter discourses of smoking-related stigma. Twenty-seven young Australian women, smokers and ex-smokers, took part in interviews. A sub-sample of 18 participants took photographs to document their smoking experience, and took part in a second interview. Data were analyzed through Foucauldian discourse analysis. Four discourses were identified: "smoking as stigmatized," "the smoking double standard," "smoking as lower class," and "smokers as bad mothers." The women negotiated stigma in a variety of ways, shifting between agreeing, disagreeing, challenging, and displacing stigma onto "other" smokers. These experiences and negotiations of smoking-related stigma were shaped by intersecting identities, including gender, cultural background, social class, and mothering, which at times, compounded levels of stigmatization. It is concluded that tobacco control measures should consider the negative implications of smoking-related stigma, and the potential for women to experience compounding levels of stigma.
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Affiliation(s)
| | - Jane M Ussher
- 1 Western Sydney University, Penrith, New South Wales, Australia
| | - Janette Perz
- 1 Western Sydney University, Penrith, New South Wales, Australia
| | - Kate Huppatz
- 1 Western Sydney University, Penrith, New South Wales, Australia
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