Stigma reduction interventions for children and adolescents in low- and middle-income countries: Systematic review of intervention strategies

Abstract

Stigmatisation and discrimination are common worldwide, and have profound negative impacts on health and quality of life. Research, albeit limited, has focused predominantly on adults. There is a paucity of literature about stigma reduction strategies concerning children and adolescents, with evidence especially sparse for low-and middle-income countries (LMIC). This systematic review synthesised child-focused stigma reduction strategies in LMIC, and compared these to adultfocused interventions.Relevant publications were systematically searched in July and August 2018 in the following databases; Cochrane, Embase, Global Health, HMIC, Medline, PsycINFO, PubMed and WorldWideScience.org, and through Google Custom Search. Included studies and identified reviews were cross-referenced. Three categories of search terms were used: (i) stigma, (ii) intervention, and (iii) LMIC settings. Data on study design, participants and intervention details including strategies and implementation factors were extracted.Within 61 unique publications describing 79 interventions, utilising 14 unique stigma reduction strategies, 14 papers discussed 21 interventions and 10 unique strategies involving children. Most studies targeted HIV/AIDS (50% for children, 38% for adults) or mental illness (14% vs 34%) stigma. Community education (47%), individual empowerment (15%) and social contact (12%) were most employed in child-focused interventions. Most interventions were implemented at one socio-ecological level; child-focused interventions mostly employed community-level strategies (88%). Intervention duration was mostly short; between half a day and a week.

Reducing stigma and discrimination associated with COVID-19: early stage pandemic rapid review and practical recommendations

“…Additional evidence on stigma reduction was included in relation to COVID-19 (American Psychological Association, 2020 ; Asmundson and Taylor, 2020 ; Centres for Disease Control and Prevention, 2020 ; Devakumar et al ., 2020 ; Earnshaw, 2020 ; IASC Inter-Agency Standing Committee, 2020 ; Lin 2020 ; Logie and Turan, 2020 ; Nature, 2020 ; World Health Organization, 2020a , 2020b ), SARS (Person et al ., 2004 ), influenza (Barrett and Brown, 2008 ; Earnshaw and Quinn, 2013 ), Ebola (Davtyan et al ., 2014 ; IASC Reference Group on Mental Health and Psychosocial Support, 2015 ; Mayrhuber et al ., 2017 ), tuberculosis (Chang and Cataldo, 2014 ), leprosy (Topp et al ., 2019 ), HIV/AIDS (Mak et al ., 2017 ; Hartog et al ., 2020 ), mental illness (Thornicroft et al ., 2016 ; Janoušková et al ., 2017 ; Nyblade et al ., 2019 ) and mixed conditions (Mak et al ., 2006 , 2009 ; Fischer et al ., 2019 ; Rao et al ., 2019 ; World Health Organization, 2019 ). These additional materials represented a mixture of editorials, commentaries, opinion pieces, correspondence and narrative reports; technical guidance, or briefing papers/reports; data-based studies reporting on stigma experiences; systematic reviews (that were not selected as key evidence for this review, or that did not meet criteria for inclusion as evidence); and one scoping review.…”

Stigma and psychological distress among pediatric participants in the FD/MAS Alliance Patient Registry

“…While there is extensive research on the illness experience of children with craniofacial deformities and an effort to develop a specific quality of life instrument [ 39 – 42 ], more attention has been focused on how stigma affects adults with chronic illnesses than children [ 43 ]. Recent studies have found that chronically ill adolescents report feeling different at school and experiencing isolation and exclusion from peer activities [ 44 ], especially when their conditions were visible and limiting.…”

Understanding Stigmatisation: Results of a Qualitative Formative Study with Adolescents and Adults in DR Congo

“…Albeit carefully, as stigmatisation is a sensitive topic, the limited knowledge on what specifically works to address stigmatisation succesfully and durably, and the need to temper the findings due to the study limitations, we reflect on how this study can potentially inform stigma reduction strategies, by understanding the drivers, facilitators and manifestations. We do so from the perspective of a socio-ecological stigma reduction strategy framework (Heijnders and VanderMeij 2006;Hartog et al 2019). Depending on the contextual information, strategies can be applied and adjusted for each population.…”

“…The study further combined and compared perceptions from the general population and populations experiencing stigma, women and men and adults and adolescents alike. While adolescents were participants, they were underrepresented, as in many other studies regarding stigma (Hartog et al 2019;Kane et al 2019). As the study was facilitated by an NGO, participants were identified through familiar channels and community groups, potentially creating selection bias.…”

“…While 90% of the world's children and adolescents live in LMIC (Kieling et al 2011), stigma research has prioritised adults, and rarely integrated the perspective of children and adolescents (Chambers et al 2015;Kane et al 2019) or targeted children in interventions (Hartog et al 2019). Children however have unique stigmatisation risks, given their lower social status compared to adults in many LMIC (Mukolo et al 2010).…”