BACKGROUND AND OBJECTIVE

Stigma remains a profound barrier to public health, particularly in managing diseases such as Hepatitis B, which is highly prevalent in hyperendemic regions like the Philippines. The social stigma associated with such health conditions can severely limit access to care and hinder adherence to treatment, exacerbating the overall disease burden. Despite the critical impact of stigma on health outcomes, there is a notable gap in the systematic evaluation of the tools used to measure stigma related to health conditions like Hepatitis B. This study aims to fill this gap by reviewing existing instruments for their methodologies, reliability, and validity to inform the development of a refined tool tailored to the Philippine context.

A systematic search was conducted across six databases, including PubMed, Cochrane Database of Systematic Reviews, Open Grey, DissOnline, Philippine Health Research Registry (PHRR), and Health Research and Development Information Network (HERDIN), following PRISMA guidelines. The search strategy focused on identifying quantitative and mixed-methods studies using questionnaires to measure HBV-related stigma and discrimination. Studies published between January 1, 1992, and December 31, 2023, were considered. The selection process involved screening for duplicates, reviewing titles and abstracts, and performing a full-text review based on predetermined eligibility criteria.

The initial search yielded 1,198 articles, with 24 duplicates removed. After title and abstract screening, 28 articles were considered for full-text review, resulting in 17 relevant articles in the final analysis with 15 unique instrumentations. The majority of studies employed cross-sectional designs (n=8), with a significant concentration in Asian countries (n=11), indicating a regional focus in HBV stigma research. The review identified a range of questionnaire methodologies, but most studies lacked specificity regarding the type of stigma measured. The Likert Scale was the most commonly used measurement tool, yet few studies provided cut-off values for stigma levels. Validity and reliability testing was reported in 12 articles, including pilot studies, Cronbach’s alpha, and factor analysis.

The lack of a universal methodology and specificity in existing instruments underscores the importance of developing a refined tool that can accurately capture the nuances of stigma and discrimination associated with HBV. The urgent need for standardized, reliable, and culturally sensitive questionnaires is evident, underscoring their importance in developing effective public health strategies and improving treatment outcomes for individuals living with HBV, especially in the Philippines.

OBJECTIVE

To determine the perceptions of persons with tuberculosis (TB) and health workers on Care TB – a mobile application for the community-led monitoring (CLM) of TB services.

We used a qualitative research method. Six people with tuberculosis and ten health workers were chosen through purposive sampling for semi-structured interviews. The narrative data produced from the interviews were subjected to qualitative content analysis in order to uncover salient themes and patterns.

The community-led monitoring mobile application was shown to be acceptable both to TB healthcare providers and patients. It enhances information access and streamlines the process of reporting care barriers. The application also allows persons with TB to interact with one another, potentially eliminating stigma and discrimination. Potential challenges to implementing the CLM program include issues with internet connectivity, costs, and human resources.

This study provides preliminary evidence of the acceptability and perceived feasibility of a mobile application for the community-led monitoring of TB services. For the CLM initiative to be scaled up across the country, more financial and technical support is required.

OBJECTIVE

To assess the knowledge, attitudes, and practices of Barangay Health Workers (BHWs) in Marawi City regarding Hansen’s Disease (HD).

A cross-sectional study was conducted among the Barangay Health Workers of Marawi City. This study was conducted in two phases. Phase 1 was questionnaire development where the knowledge, attitudes, and practices (KAP) questionnaire was formulated and administered to six Barangay Health Workers for pre-testing. Phase 2 of the study included the survey and focus group discussion (FGD). A questionnaire comprising of 27 questions was administered to BHWs to assess knowledge, attitude, and practices regarding HD.

A total of 49 BHWs underwent the Phase 2 survey and six BHWs joined the FGD. The mean age of all the survey participants was 34.9 ± 19.3 years. Among the 49 participants, 40 (81.6%) were females. The knowledge of BHWs was found to be adequate only in six (12%) BHWs. Positive attitude was observed in 12 (24.5%) and adequate practices regarding HD were observed in 33 (67.3%) BHWs. First-hand experience of diagnosing HD patients was significantly associated with adequate knowledge (p < 0.001) and positive attitude of BHWs (p < 0.001). There was a significant association between > 5 years of experience as BHWs (p = 0.027) and first-hand experience in diagnosing leprosy (p = 0.005) with adequate practices of BHWs regarding HD. In the FGD, BHWs expressed their lack of training which highlighted the need for refresher courses on HD.

Knowledge about HD is low among Marawi BHWs due to their inadequate training. The attitudes and practices of BHWs are also affected because of deficient knowledge regarding etiology and transmission of HD. There is a need for adequate training and refresher courses on HD to increase the knowledge of BHWs regarding HD.

INTRODUCTION: Stigmatizing attitudes are barriers to treatment of mental health disorders. The burden of stigma has not been established locally. This study aimed to assess the stigma in the community by determining the knowledge, attitudes and behaviors of barangay residents towards mental health and persons with mental health illness. METHODS: A total of 422 participants were included using convenience sampling. Participants were given self-administered questionnaires that consisted of the Mental Health Knowledge Schedule (MAKS), Community Attitudes Towards the Mentally Ill (CAMI), and Reported and Intended Behavior Scale (RIBS) tools. The mean scores and percentages were computed and compared across the sociodemographic data of the respondents. RESULTS: Knowledge levels were relatively high with a mean score of 26.63. Depression, stress, bipolar disorder and drug addiction were recognized as mental illnesses by the majority of the participants. Scores in the stigmatizing ideologies authoritarianism (3.07) and social restrictiveness (2.58) were low, while the positive ideologies benevolence (3.76) and community health ideology (3.85) had higher scores. Participants were reluctant to work with mentally-ill people (3.18) but were willing to be friends with them (3.87). CONCLUSION This study concludes that the respondents were generally knowledgeable about mental health illness. There was a general acceptance and less stigmatizing attitude, and a willingness to interact with people with mental illness.
psychiatry ; Mental health ; Social Stigma

PURPOSE: This study examined the mediating effects of self-esteem and resilience on the relationship between internalized stigma and quality of life in people with schizophrenia.METHODS: The participants were 123 people with schizophrenia (mean age = 41.87 years; 62.6% men) recruited from Soonchunhyang university hospital, a mental health center, and daytime rehabilitation facilities located in Seoul and Gyeonggi Province in South Korea. Using a cross-sectional survey, participants completed structured questionnaires with psychometric adequacy. The regression method of Baron and Kenny was used to test the mediating effects of self-esteem and resilience on the relationship between internalized stigma and quality of life.RESULTS: Self-esteem and resilience were found to be full and partial mediators, respectively, in the relationship between internalized stigma and quality of life.CONCLUSION: The findings of this study imply that effective future intervention strategies should target improvements in self-esteem and resilience to reduce the negative impact of internalized stigma on the quality of life of people with schizophrenia.
Cross-Sectional Studies ; Gyeonggi-do ; Korea ; Mental Health ; Methods ; Negotiating ; Psychometrics ; Quality of Life ; Rehabilitation ; Resilience, Psychological ; Schizophrenia ; Seoul ; Social Stigma

PURPOSE: The purpose of this study was to identify factors related to family health and develop a prediction model with an ability to explain family health in families of patients with schizophrenia.METHODS: A hypothesized model with twelve pathway forms was developed based on literature review. Family stress and social stigma were included as two exogenous variables; whereas family resilience, family empowerment, self-esteem, community integration, and family health were included as endogenous variables. Data were collected using a self-report questionnaire from 206 families of patients with schizophrenia living in Republic of Korea. Data were analyzed with PASW/WIN 18.0 and AMOS 18.0 programs.RESULTS: Social stigma had a negatively indirect and total effect on family health. Family resilience, self-esteem, and community integration had positive and direct and overall effects on family health.CONCLUSION: A prediction model for families of patients with schizophrenia is proposed and social stigma, family resilience, self-esteem, and community integration are presented as predicting factors for family health. Nursing interventions and support programs should be developed to overcome social stigma and improve family resilience, self-esteem, and community integration.
Community Integration ; Family Health ; Humans ; Nursing ; Power (Psychology) ; Republic of Korea ; Schizophrenia ; Social Stigma

PURPOSE: The aim of this study was to examine the effect of self-assertive training applying the reality therapy techniques (SATART) on self-esteem and internalized stigma of schizophrenia patients. METHODS: This study was a non-equivalent control group pretest-posttest design and enrolled 55 people with schizophrenia (experimental group=27, control group=28) from two community mental health centers. The SATART was offered twice a week for 6 weeks in a total 12 sessions. Data were collected from February to April, 2017, using the Korean version of the Internalized Stigma of Mental Illness Scale and Rosenberg Self-Esteem Scale. The collected data was analyzed using χ2 test, independent t-test, one-way ANCOVA, and repeated measures ANOVA with using the SPSS/WIN 22.0 program. RESULTS: The experimental group showed significant improvements in self-esteem and recudction of internalized stigma compared to the control group. However, there was no significant improvement on stigma resistance measurement among the subscales of internalized stigma between two groups. CONCLUSION: The findings indicate that the SATART program is effective and could be recommended as a psychosocial intervention for self-esteem enhancement and internalized stigma reduction of people with schizophrenia.
Assertiveness ; Community Mental Health Centers ; Humans ; Reality Therapy ; Schizophrenia ; Self Concept ; Social Stigma

BACKGROUND: This study aimed to analyze the barriers affecting the utilization of antenatal care (ANC) among Senegalese mothers. METHODS: Health facility staffs were surveyed to examine the availability coverage of ANC (infrastructural capacity of health posts to handle maternal and newborn healthcare). A total of 113 women of childbearing age were surveyed to identify factors associated with the accessibility coverage (physical, economic, and information accessibility factors), acceptability coverage (socio-cultural features, social acceptance, and language), and effectiveness coverage (ratio of mothers having completed 4 visits) of ANC. Further, to identify the socio-cultural factors and the specific characteristics of the barriers, 5 focus group discussions were conducted with women of childbearing age, their husbands and mothers-in-law, community health workers, and health facility staff. The effectiveness coverage of ANC was analyzed by reviewing materials from the District Health Information System 2 of Senegal. RESULTS: Key barriers of ANC utilization were associated with acceptability coverage. ANC during early pregnancy was avoided owing to the negative social stigma surrounding miscarriage. The survey results indicated an extremely high miscarriage rate of 30.9% among the participants. The social stigma towards unmarried mothers caused them to hide their pregnancy, which deterred ANC utilization. The husband was the final decision maker and social supporter on ANC utilization. CONCLUSION: To promote the utilization of ANC services among pregnant women in Senegal, it is important to alleviate the social stigma towards miscarriages and unmarried mothers, and to provide greater social support for pregnancies and newborn deliveries within family.
Abortion, Spontaneous ; Community Health Workers ; Female ; Focus Groups ; Health Facilities ; Health Information Systems ; Humans ; Illegitimacy ; Infant Health ; Infant, Newborn ; Maternal Health ; Mothers ; Patient Acceptance of Health Care ; Pregnancy ; Pregnant Women ; Senegal ; Social Distance ; Social Stigma ; Spouses

Successful treatment is very high in patients with first episode schizophrenia (FES). On the other hand, the problem is a frequent relapse often caused by non-compliance. The non-compliance rate in patients with FES is 40–60% within 1 year. The causes of non-compliance are diverse, such as poor insight, drug side effects, attitude of caregiver, social stigma, etc. Clinicians should be able to provide appropriate psychosocial intervention and long acting injectable antipsychotics (LAI) to overcome non-compliance. Recently, there is solid and accumulating evidence demonstrating superiority of LAI over oral medication in terms of reducing relapse or rehospitalization. In particular, a substantial portion (approximately 30–50%) of patients and caregivers prefer LAI to oral medication. Shared decision-making is the process that clinicians and patients/caregiver should go through in order to obtain the full benefits from LAI.
Antipsychotic Agents ; Caregivers ; Compliance ; Decision Making ; Drug-Related Side Effects and Adverse Reactions ; Hand ; Humans ; Recurrence* ; Schizophrenia* ; Social Stigma

PURPOSE: The aim of this study was to identify the mediating effects of perceived stigma and family strength on the relationship between family stress and adaptation in family members of patients with mental illness. METHODS: Participants were 189 primary family caregivers of persons with mental illness in G city, C, G, and J provinces. Data were collected from May to June 2018 using the FILE (Family Inventory of Life Events and Changes), K-ISMI (Korean Version of Internalized Stigma of Mental Illness Scale), FAS III (Family Adaptability Scale III), and KFSS-II (Korea Family Strengths Scale). Collected data were analyzed with t-tests, one-way ANOVAs with Scheffé' test, Pearson's correlation coefficients, and PROCESS macro mediation analysis. Mediators were tested by calculating bias-corrected 95% confidence intervals using bootstrapping with 5,000 resampling. RESULTS: Family stress was directly associated with family adaptation. Family strengths had a partially mediating effect on the relationship between family stress and adaptation, but perceived stigma did not. CONCLUSION: Based on our study findings, developing a nursing intervention program focused on improving family strengths might be necessary to facilitate family members' successful adaptation to persons with mental illness.
Adaptation, Psychological ; Caregivers ; Humans ; Mental Disorders ; Negotiating ; Nursing ; Social Stigma