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Adugna MB, Ghahari S, Lysaght R. Disability stigma and the pursuit of inclusion among children with physical disabilities in northwest Ethiopia. Disabil Rehabil 2024:1-11. [PMID: 38832395 DOI: 10.1080/09638288.2024.2356016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 05/12/2024] [Indexed: 06/05/2024]
Abstract
PURPOSE Globally, many children with physical disabilities (CwPDs) are excluded from their education and social life, mainly due to stigma and its effects. However, information on disability stigma is scarce in low-and middle-income countries like Ethiopia. The purpose of this study, therefore, was to explore the lived experience of stigma from the perspective of CwPDs and their caregivers in northwest Ethiopia. METHODS The study incorporated a constructivist grounded theory approach. Data were gathered through observations, in-depth interviews, and key informant interviews. Inductive and iterative grounded theory techniques were used to code and categorize data through constant comparison. FINDINGS The study showed that CwPDs are bullied and talked about, subject to pity, socially excluded, and held in contempt at home, in their neighborhood, and at school. They live in fear and uncertainty and struggle with stigma. These factors affect their emotions, social relationships, and educational activities. CONCLUSIONS This study makes theoretical and practical contributions to understanding and addressing disability stigma and can help to introduce inclusive education policy, school practice, and disability advocacy. The study results highlight the need for disability awareness-raising programs, interventions for empowerment, and informing disability policy and practice.
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Affiliation(s)
| | - Setareh Ghahari
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Rosemary Lysaght
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
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Krupa T, Lysaght R, Yehuala YS, Aldersey HM, Adugna MB, Kessler D, Batorowicz B, Montagnese J, Kolomitro K. Activity and participation experiences of people with disabilities in Ethiopia. Afr J Disabil 2022; 11:1002. [PMID: 36246483 PMCID: PMC9558741 DOI: 10.4102/ajod.v11i0.1002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/29/2022] [Indexed: 11/01/2022] Open
Affiliation(s)
- Terry Krupa
- School of Rehabilitation Therapy, Queen’s University, Kingston, Canada
| | - Rosemary Lysaght
- School of Rehabilitation Therapy, Queen’s University, Kingston, Canada
| | - Yetnayet S. Yehuala
- Institute of Public Health, University of Gondar, Gondar, Ethiopia
- School of Kinesiology and Health Studies, Queen’s University, Kingston, Canada
| | - Heather M. Aldersey
- School of Rehabilitation Therapy, Queen’s University, Kingston, Canada
- International Centre for the Advancement of Community Based Rehabilitation, Queen’s University, Kingston, Canada
| | | | - Dorothy Kessler
- School of Rehabilitation Therapy, Queen’s University, Kingston, Canada
| | - Beata Batorowicz
- School of Rehabilitation Therapy, Queen’s University, Kingston, Canada
| | - Jasmine Montagnese
- International Centre for the Advancement of Community Based Rehabilitation, Queen’s University, Kingston, Canada
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Ferguson L, Gruskin S, Bolshakova M, Yagyu S, Fu N, Cabrera N, Rozelle M, Kasoka K, Oraro-Lawrence T, Stackpool-Moore L, Motala A, Hempel S. Frameworks and measures for HIV-related internalized stigma, stigma and discrimination in healthcare and in laws and policies: a systematic review. J Int AIDS Soc 2022; 25 Suppl 1:e25915. [PMID: 35818866 PMCID: PMC9274352 DOI: 10.1002/jia2.25915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 04/28/2022] [Indexed: 12/21/2022] Open
Abstract
Introduction There is strong global commitment to eliminate HIV‐related stigma, and work in this area continues to evolve. Wide variation exists in frameworks and measures used. Methods Building on the existing knowledge syntheses, we carried out a systematic review to identify frameworks and measures aiming to understand or assess internalized stigma, stigma and discrimination in healthcare, and in law and policy. The review addressed two questions: Which conceptual frameworks have been proposed to assess internalized stigma, stigma and discrimination experienced in healthcare settings, and stigma and discrimination entrenched in national laws and policies? Which measures of these different types of stigma and discrimination have been proposed and what are their descriptive properties? Searches, completed on 6 May 2021, cover publications from 2008 onwards. The review is registered in PROSPERO (CRD42021249348), the protocol incorporated stakeholder input, and the data are available in the Systematic Review Data Repository. Results and discussion Sixty‐nine frameworks and 50 measures met the inclusion criteria. Critical appraisal figures and detailed evidence tables summarize these resources. We established a compendium of frameworks and a catalogue of measures of HIV‐related stigma and discrimination. Seventeen frameworks and 10 measures addressed at least two of our focus domains, with least attention to stigma and discrimination in law and policy. The lack of common definitions and variability in scope and structure of HIV‐related frameworks and measures creates challenges in understanding what is being addressed and measured, both in relation to stigma and efforts to mitigate or reduce its harmful effects. Having comparable data is essential for tracking change over time within and between interventions. Conclusions This systematic review provides an evidence base of current understandings of HIV‐related stigma and discrimination and how further conceptual clarification and increased adaptation of existing tools might help overcome challenges across the HIV care continuum. With people living with HIV at the centre, experts from different stakeholder groups could usefully collaborate to guide a more streamlined approach for the field. This can help to achieve global targets and understand, measure and help mitigate the impact of different types of HIV‐related stigma on people's health and quality of life.
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Affiliation(s)
- Laura Ferguson
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, California, USA
| | - Sofia Gruskin
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, California, USA
| | - Maria Bolshakova
- Southern California Evidence Review Center, Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Sachi Yagyu
- Southern California Evidence Review Center, Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Ning Fu
- School of Economics, Shanghai University of Finance and Economics, Shanghai, China
| | - Nicky Cabrera
- Southern California Evidence Review Center, Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Mary Rozelle
- Southern California Evidence Review Center, Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | | | | | | | - Aneesa Motala
- Southern California Evidence Review Center, Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Susanne Hempel
- Southern California Evidence Review Center, Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
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Stevens ME, Parsons JA, Read SE, Bond V, Solomon P, Nixon SA. The relationship between stigma and a rehabilitation framework [international classification of functioning, disability and health (ICF)]: three case studies of women living with HIV in Lusaka, Zambia. Disabil Rehabil 2019; 43:2149-2156. [PMID: 31766899 DOI: 10.1080/09638288.2019.1693640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To explore how the International Classification of Functioning, Disability and Health, a rehabilitation framework, can provide a holistic understanding of stigma experiences of three women living with human immunodeficiency virus in Lusaka, Zambia. METHODS A secondary analysis of three cases by drawing on interview transcripts collected as part of a larger longitudinal study with eighteen women living with the virus. The interview tool used the rehabilitation framework to ask questions about the impact of the virus on the body, daily activities, social participation and the future. Vignettes were produced for each of the eighteen women including information on stigma and the rehabilitation framework. Three case studies were developed from women who provided comprehensive accounts of stigma and the International Classification of Functioning, Disability and Health. RESULTS Stigma experiences aligned well with three dimensions of the International Classification of Functioning, Disability and Health: participation restrictions, environmental and personal factors. These domains were used to understand stigma in three forms (i.e. enacted, self and structural stigma) as experienced by these women. CONCLUSIONS More research is needed to ascertain how stigma and rehabilitation are related in other environments and populations and to explore how to mitigate stigma within the rehabilitation context.IMPLICATIONS FOR REHABILITATIONRehabilitation professionals deal with aspects of stigma and discrimination in their clinical work and this analysis offers a way to consider HIV-related stigma within rehabilitation in an organized and theoretically-informed way.The insights from this study are important for the field of HIV and for advancing understanding of the complexities of stigma in the context of rehabilitation more broadly.This analysis offers guidance to rehabilitation providers about the nuanced and multi-faceted ways that stigma can occur in the context of rehabilitation, including within their own clinical practice.
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Affiliation(s)
- Marianne E Stevens
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,International Centre for Disability and Rehabilitation, University of Toronto, Toronto, ON, Canada
| | - Janet A Parsons
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.,Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Stanley E Read
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Virginia Bond
- Department of Global and Health Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.,Zambart, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Patricia Solomon
- School of Rehabilitation Science, Institute for Applied Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Stephanie A Nixon
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,International Centre for Disability and Rehabilitation, University of Toronto, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
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Rossettini G, Carlino E, Testa M. Clinical relevance of contextual factors as triggers of placebo and nocebo effects in musculoskeletal pain. BMC Musculoskelet Disord 2018; 19:27. [PMID: 29357856 PMCID: PMC5778801 DOI: 10.1186/s12891-018-1943-8] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 01/15/2018] [Indexed: 12/18/2022] Open
Abstract
Placebo and nocebo effects are embodied psycho-neurobiological responses capable of modulating pain and producing changes at different neurobiological, body at perceptual and cognitive levels. These modifications are triggered by different contextual factors (CFs) presented in the therapeutic encounter between patient and healthcare providers, such as healing rituals and signs. The CFs directly impact on the quality of the therapeutic outcome: a positive context, that is a context characterized by the presence of positive CFs, can reduce pain by producing placebo effects, while a negative context, characterized by the presence of negative CFs, can aggravate pain by creating nocebo effects. Despite the increasing interest about this topic; the detailed study of CFs as triggers of placebo and nocebo effects is still lacked in the management of musculoskeletal pain. Increasing evidence suggest a relevant role of CFs in musculoskeletal pain management. CFs are a complex sets of internal, external or relational elements encompassing: patient’s expectation, history, baseline characteristics; clinician’s behavior, belief, verbal suggestions and therapeutic touch; positive therapeutic encounter, patient-centered approach and social learning; overt therapy, posology of intervention, modality of treatment administration; marketing features of treatment and health care setting. Different explanatory models such as classical conditioning and expectancy can explain how CFs trigger placebo and nocebo effects. CFs act through specific neural networks and neurotransmitters that were described as mediators of placebo and nocebo effects. Available findings suggest a relevant clinical role and impact of CFs. They should be integrated in the clinical reasoning to increase the number of treatment solutions, boosts their efficacy and improve the quality of the decision-making. From a clinical perspective, the mindful manipulation of CFs represents a useful opportunity to enrich a well-established therapy in therapeutic setting within the ethical border. From a translational perspective, there is a strong need of research studies on CFs close to routine and real-world clinical practice in order to underline the uncertainty of therapy action and help clinicians to implement knowledge in daily practice.
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Affiliation(s)
- Giacomo Rossettini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona. Via Magliotto, 2, 17100, Savona, Italy
| | - Elisa Carlino
- Department of Neuroscience, University of Turin Medical School, Turin, Italy
| | - Marco Testa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona. Via Magliotto, 2, 17100, Savona, Italy.
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