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von Kalckreuth N, Feufel MA. Influence of Disease-Related Stigma on Patients' Decisions to Upload Medical Reports to the German Electronic Health Record: Randomized Controlled Trial. JMIR Hum Factors 2024; 11:e52625. [PMID: 38598271 PMCID: PMC11043923 DOI: 10.2196/52625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 02/12/2024] [Accepted: 02/21/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND The rollout of the electronic health record (EHR) represents a central component of the digital transformation of the German health care system. Although the EHR promises more effective, safer, and faster treatment of patients from a systems perspective, the successful implementation of the EHR largely depends on the patient. In a recent survey, 3 out of 4 Germans stated that they intend to use the EHR, whereas other studies show that the intention to use a technology is not a reliable and sufficient predictor of actual use. OBJECTIVE Controlling for patients' intention to use the EHR, we investigated whether disease-specific risk perceptions related to the time course of the disease and disease-related stigma explain the additional variance in patients' decisions to upload medical reports to the EHR. METHODS In an online user study, 241 German participants were asked to interact with a randomly assigned medical report that varied systematically in terms of disease-related stigma (high vs low) and disease time course (acute vs chronic) and to decide whether to upload it to the EHR. RESULTS Disease-related stigma (odds ratio 0.154, P<.001) offset the generally positive relationship between intention to use and the upload decision (odds ratio 2.628, P<.001), whereas the disease time course showed no effect. CONCLUSIONS Even if patients generally intend to use the EHR, risk perceptions such as those related to diseases associated with social stigma may deter people from uploading related medical reports to the EHR. To ensure the reliable use of this key technology in a digitalized health care system, transparent and easy-to-comprehend information about the safety standards of the EHR are warranted across the board, even for populations that are generally in favor of using the EHR.
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Affiliation(s)
- Niklas von Kalckreuth
- Division of Ergonomics, Department of Psychology and Ergonomics, Technische Universität Berlin, Berlin, Germany
| | - Markus A Feufel
- Division of Ergonomics, Department of Psychology and Ergonomics, Technische Universität Berlin, Berlin, Germany
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Adekoya P, Lannap FD, Ajonye FA, Amadiegwu S, Okereke I, Elochukwu C, Aruku CA, Oluwaseyi A, Kumolu G, Ejeh M, Olutola AO, Magaji D. Experiences of Stigmatization and Discrimination in Accessing Health Care Services Among People Living with HIV (PLHIV) in Akwa Ibom State, Nigeria. HIV AIDS (Auckl) 2024; 16:45-58. [PMID: 38406768 PMCID: PMC10891273 DOI: 10.2147/hiv.s447551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/01/2024] [Indexed: 02/27/2024] Open
Abstract
Background Recent advances in care and treatment have turned HIV into a "chronic but manageable condition". Despite this, some people living with HIV (PLHIV) continue to suffer from stigma and discrimination in accessing health care services. This study examined the experience of stigma and discrimination and access to health care services among PLHIV in Akwa Ibom State. Methods The Center for Clinical Care and Clinical Research (CCCRN), implementing a USAID-funded Integrated Child Health and Social Services Award (ICHSSA 1) project, conducted a community-based cross-sectional survey in 12 randomly selected local government areas in Akwa Ibom State, Nigeria. A structured quantitative questionnaire was used for data collection. In total, 425 randomly selected PLHIV were interviewed after providing informed consent. Descriptive statistics and bivariate analyses were conducted using the data analytical application Stata 14. Results The study revealed that 215 PLHIV (50.4%) had been denied access to health care services, including dental care, because of their HIV status in Akwa Ibom State. Respondents reported being afraid of: gossip (78%), being verbally abused (17%), or being physically harassed or assaulted because of their positive status (13%). Self-stigmatization was also evident; respondents reported being ashamed because of their positive HIV status (29%), exhibiting self-guilt (16%), having low self-esteem (38%), and experiencing self-isolation (36%). Women, rural residents, PLHIV with no education, unemployed, single, young people aged between 19 and 29 years, and older adults were more likely to experience HIV-related stigmatization. Conclusion Data from the study revealed that the percentage of PLHIV who experience health-related stigmatization because of their HIV status is high in Akwa Ibom State. This finding calls for the prioritization of interventions to reduce stigma, enhance self-esteem, and promote empathy and compassion for PLHIV. It also highlights the need for HIV education for family and community members and health care providers, to enhance the knowledge of HIV and improve acceptance of PLHIV within families, communities, and health care settings.
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Affiliation(s)
- Peters Adekoya
- Centre for Clinical Care and Clinical Research, Abuja, Nigeria
| | - Faith D Lannap
- Centre for Clinical Care and Clinical Research, Abuja, Nigeria
| | | | | | | | | | | | | | - Grace Kumolu
- Centre for Clinical Care and Clinical Research, Abuja, Nigeria
| | - Michael Ejeh
- Centre for Clinical Care and Clinical Research, Abuja, Nigeria
| | | | - Doreen Magaji
- United States Agency for International Development, Abuja, Nigeria
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McNally GA, Roy M, Etland C, Carr E. Stigma, Communication, and Clinical Oncology Care: Three Case Studies. Clin J Oncol Nurs 2024; 28:52-62. [PMID: 38252860 DOI: 10.1188/24.cjon.52-62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND Health-related stigma can contribute to health inequities and poor outcomes. To address stigma-related issues in clinical oncology care, healthcare providers can identify stigma in clinical practice and apply strategies that reduce stigma. OBJECTIVES The aim is to identify stigma-related issues experienced by patients with cancer and to present strategies that address stigma-associated barriers to quality clinical oncology care. METHODS This article presents three case studies that illustrate stigma-associated issues and strategies to address those issues in clinical oncology care. FINDINGS Identifying intersectional stigmas in clinical care, each case study includes the patient's background information, a social assessment, and a clinical update, as well as an example of dialogue between the nurse and patient. Each case study ends with commentary and questions to further illustrate stigma-related issues in clinical oncology care. Finally, supporting the case studies, the toolbox includes inclusive language; principles of universal precautions to apply to stigma in clinical oncology care; and communication components, strategies, and resources to reduce stigma in clinical oncology care.
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Affiliation(s)
- Gretchen A McNally
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
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Abstract
Stigma has been associated with delays in seeking treatment, avoiding clinical encounters, prolonged risk of transmission, poor adherence to treatment, mental distress, mental ill health and an increased risk of the recurrence of health problems, among many other factors that negatively impact on health outcomes. While the burdens and consequences of stigma have long been recognized in the health literature, there remains some ambiguity about how stigma is experienced by individuals who live with it. The aim of this paper is to elucidate the phenomenology of stigma, or to describe how it is that stigma shows up in the first-person experience of individuals who live with stigma and its burdens. Exploring the relationship between shame and stigma, I argue that shame anxiety, or the chronic anticipation of shame, best characterises the experience of living with a health-related, or health-relevant, stigma. Understanding the experiential features, or phenomenology, of shame anxiety will give healthcare professionals a greater sensitivity to stigma and its impacts in clinical settings and encounters. I will conclude by suggesting that 'shame-sensitive' practice would be beneficial in healthcare.
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Affiliation(s)
- Luna Dolezal
- Wellcome Centre for Cultures and Environments of Health, University of Exeter, Exeter, UK
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Varallo G, Pingani L, Musetti A, Galeazzi GM, Pizza F, Castelnuovo G, Plazzi G, Franceschini C. Portrayals of narcolepsy from 1980 to 2020: a descriptive analysis of stigmatizing content in newspaper articles. J Clin Sleep Med 2022; 18:1769-1778. [PMID: 35332869 DOI: 10.5664/jcsm.9966] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The media are the primary source of information about health for the public. The media portrayal of narcolepsy might contribute to the stigmatization of people affected by this condition. This study aimed to describe how narcolepsy is portrayed in newspapers. METHODS We collected 257 newspaper articles from the digital archive of "La Stampa" published between 1980 and 2020 that mentioned key search terms. The content was assessed using an ad-hoc coding schema developed to evaluate the presence of sensationalistic title, negative language, stigmatizing content, stereotypical description, disclosure of a person diagnosed with narcolepsy, person with narcolepsy described as dangerous, presence of an accurate diagnosis, identifiable symptoms, indications about diagnostic and treatment services. The Chi-squared analysis was performed to identify changes over time in the type of content. RESULTS In 10.9% of the articles, there was a sensationalistic title; inappropriate, negative, and outdated language appeared in 10.5% of the articles. Stigmatizing and stereotypical content were reported in 19.5% and 14.8% of the articles, respectively. In 62.3% of the articles, it was disclosed that a person has narcolepsy, and in 5.1% of the articles patients with narcolepsy are described as dangerous. 30.4% of the articles referred to the presence of an accurate diagnosis, while 16.7% described identifiable symptoms. Services for diagnosis and treatment were mentioned in 24.1% of the articles. Changes over time in the content of articles are discussed. CONCLUSIONS Our findings highlight areas for improvement in the media portrayal of narcolepsy and could help guide the development of new targeted antistigma campaigns.
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Affiliation(s)
- Giorgia Varallo
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Luca Pingani
- Department of Biomedical, Metabolic and Neural Sciences, Università degli Studi di Modena e Reggio Emilia, Modena, Italy.,Department of Health Professions, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Department of Mental Health, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alessandro Musetti
- Department of Humanities, Social Sciences and Cultural Industries, University of Parma, Parma, Italy
| | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, Università degli Studi di Modena e Reggio Emilia, Modena, Italy.,Department of Mental Health, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Gianluca Castelnuovo
- Department of Psychology, Catholic University of Milan, Milan, Italy.,Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Verbania, Italy
| | - Giuseppe Plazzi
- Department of Biomedical, Metabolic and Neural Sciences, Università degli Studi di Modena e Reggio Emilia, Modena, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
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Ebenso B, Newell J, Emmel N, Adeyemi G, Ola B. Changing stigmatisation of leprosy: an exploratory, qualitative life course study in Western Nigeria. BMJ Glob Health 2019; 4:e001250. [PMID: 30997168 PMCID: PMC6441294 DOI: 10.1136/bmjgh-2018-001250] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/29/2018] [Accepted: 02/10/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction Renewed interest in health-related stigma has invigorated calls to understand factors and processes underlying stigma. However, few empirical studies explore the influences of structural discrimination and moral status on leprosy-related stigma. We investigated how sociocultural context and organisational policies and practices influenced the connotations of leprosy, sources of stigma and the changing social responses to leprosy in Western Nigeria. Methodology Ethnographic research conducted between 2008 and 2012 combined documents review with life history interviews of 21 individuals affected by leprosy and semistructured interviews with 26 community members in Western Nigeria. Interviews were audiotaped, transcribed verbatim and coded. Theoretical frameworks used to deepen social understandings of leprosy and responses to stigma included Link’s and Phelan’s conceptualisation of stigma and the concepts of structural discrimination and moral status. Results Findings showed that connotations of leprosy in Yorùbá culture included the following: (i) perception of leprosy as the most shameful and detested condition and (ii) symbolic association with filth and immoral behaviour that is dishonouring to Yorùbá identity. Secondary analysis of archival materials revealed four sources of stigma: cultural beliefs about leprosy, health promotion messages embedded in primary school books, religious teachings about leprosy and campaigns conducted by the leprosy service in 1950s. Contrary to the portrayal of Yorùbá attitudes to leprosy as entirely negative, we identified that people affected by leprosy were creating new life courses to counter existing cultural accounts of marginalisation. Emerging narratives of inclusion outlined five facilitators of acceptance namely, antileprosy treatment, good moral character, supportive family networks, livelihoods, and contribution to community survival. Conclusion Gaps highlighted by this study suggest that the global target of zero stigma and discrimination of leprosy will remain unattainable without better understanding of cultural significance(s) of leprosy and the local sources and underlying drivers of stigma that are crucial for developing context-specific stigma reduction interventions.
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Affiliation(s)
- Bassey Ebenso
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - James Newell
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Nick Emmel
- Social Sciences Building, University of Leeds, School of Sociology and Social Policy, Leeds, UK
| | - Gbenga Adeyemi
- Faculty of Social Sciences, Federal University Oye Ekiti, Department of Demography and Social Statistics, Ekiti, Nigeria
| | - Bola Ola
- Faculty of Clinical Sciences, Lagos State University, Department of Behavioural Medicine, Ikeja, Nigeria
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Dean J, Fenton NE, Shannon S, Elliott SJ, Clarke A. Disclosing food allergy status in schools: health-related stigma among school children in Ontario. Health Soc Care Community 2016; 24:e43-e52. [PMID: 25939442 DOI: 10.1111/hsc.12244] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/19/2015] [Indexed: 06/04/2023]
Abstract
In 2006, 3 years after the tragic death of 13-year-old Sabrina Shannon, the Province of Ontario (Canada) passed Sabrina's Law ushering in a new era of focus and concern for severe food allergic children at risk of anaphylaxis. Questions were raised at the time regarding the potential of doing more harm than good with the new legislation. This paper reports the experiences of health-related stigma among food allergic children at risk of anaphylaxis who were required to disclose their health status under this new legislation. In 2008, in-depth interviews were conducted with 20 children and youth and their parents in order to explore the experiences living with a severe food allergy. This particular study explores their experiences of felt and enacted stigma in the school setting as a result of the disclosure process. Interviews were tape recorded with permission and transcribed for subsequent thematic analysis using NVIVO, a qualitative analysis software package. Results indicate that participants were stigmatised as a result of protective school policies under the law, and that created tension between their physical safety and social well-being. Sabrina's Law also led to a cultural shift in awareness of food allergies that resulted in some participants normalising their health status, offering promising directions for the future.
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Affiliation(s)
| | | | | | | | - Ann Clarke
- University of Calgary, Calgary, AB, Canada
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