Interventions: Research on Reducing Stigma
Authors: Mitchell G. Weiss, M.D., Ph.D., and Jayashree Ramakrishna, Ph.D., M.P.H.
The term stigma has many associations and implications rooted in history, social science, and public health, but the historical concept of physical stigmata and the sociological framework of deviance and social interactions fall short of research needs for guiding desirable public health interventions to reduce stigma. For that, a working definition of stigma is required that recognizes the distinctive features of particular diseases and particular social and cultural contexts. Research needs include documenting the burden from the stigma of various health problems; comparing both the magnitude and character of stigma for different conditions and in different social and cultural settings; identifying distinctive features of stigma that may guide intervention programs; and evaluating changes in the magnitude and character of stigma over time and in response to interventions and social changes. Such research benefits by examining stigma from various vantage points, considering the experience of stigma among persons with a designated health problem, laypersons in the community, and health care providers or other designated subgroups of the community (eg, teachers and policymakers) who have a substantial impact on health. Research on stigma should also consider questions of social policy as they relate to human rights, access to health care, and social services for particular groups. Our review of health research issues and studies considers the role of stigma in specific mental health problems and tropical diseases, mainly in low- and middle-income countries. We also discuss the limitations of this research and the need for complementary quantitative, qualitative, problem-specific, and culture-specific approaches to study of stigma.
September 2001