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

Abstract

While stigmatisation is universal, stigma research in low- and middle-income countries (LMIC) is limited. LMIC stigma research predominantly concerns health-related stigma, primarily regarding HIV/AIDS or mental illness from an adult perspective. While there are commonalities in stigmatisation, there are also contextual differences. The aim of this study in DR Congo (DRC), as a formative part in the development of a common stigma reduction intervention, was to gain insight into the commonalities and differences of stigma drivers (triggers of stigmatisation), facilitators (factors positively or negatively influencing stigmatisation), and manifestations (practices and experiences of stigmatisation) with regard to three populations: unmarried mothers, children formerly associated with armed forces and groups (CAAFAG), and an indigenous population. Group exercises, in which participants reacted to statements and substantiated their reactions, were held with the ‘general population’ (15 exercises, n = 70) and ‘populations experiencing stigma’ (10 exercises, n = 48). Data was transcribed and translated, and coded in Nvivo12. We conducted framework analysis. There were two drivers mentioned across the three populations: perceived danger was the most prominent driver, followed by perceived low value of the population experiencing stigma. There were five shared facilitators, with livelihood and personal benefit the most comparable across the populations. Connection to family or leaders received mixed reactions. If unmarried mothers and CAAFAG were perceived to have taken advice from the general population and changed their stereotyped behaviour this also featured as a facilitator. Stigma manifested itself for the three populations at family, community, leaders and services level, with participation restrictions, differential treatment, anticipated stigma and feelings of scapegoating. Stereotyping was common, with different stereotypes regarding the three populations. Although stigmatisation was persistent, positive interactions between the general population and populations experiencing stigma were shared as well. This study demonstrated utility of a health-related stigma and discrimination framework and a participatory exercise for understanding non-health related stigmatisation. Results are consistent with other studies regarding these populations in other contexts. This study identified commonalities between drivers, facilitators and manifestations—albeit with population-specific factors. Contextual information seems helpful in proposing strategy components for stigma reduction.

Reducing stigma impacting children and adolescents in low- and middle-income countries: The development of a common multi-component stigma reduction intervention

“…effective [2,27,48] and; (v) be implementable by non-specialists to increase its usability [54,55]. The conclusions on cross-stigma applicability and the need for a socio-ecological response were confirmed by qualitative research carried out in DR Congo, which additionally highlighted the need for a simplified contexualisation tool [43].…”

“…This intervention intended to (i) have children and adolescents both as target and impact group; (ii) be applicable across stigmas, increasing its relevance as set out in recent research that advocates for moving away from stigma-siloed approaches [ 48 , 50 ]; (iii) apply a combination of promising and often-used stigma reduction ingredients such as social contact [ 25 ], knowledge and awareness raising [ 51 ], popular opinion leaders [ 52 ] and empowerment of PWLE [ 53 ]; (iv) address stigma at multiple levels within the community–from targeting PWLE to strengthen their stigma resistance and coping to the community at large—to be most effective [ 2 , 27 , 48 ] and; (v) be implementable by non-specialists to increase its usability [ 54 , 55 ]. The conclusions on cross-stigma applicability and the need for a socio-ecological response were confirmed by qualitative research carried out in DR Congo, which additionally highlighted the need for a simplified contexualisation tool [ 43 ].…”

“…War Child embarked on an iterative process of stigma reduction intervention development with four main steps (see Fig 1 ). In this paper we aim to present the development of the intervention, drawing on previously conducted formative research and systematic review (steps 1 and 2) [ 42 , 43 ] described in this introduction section, followed by stakeholder consultation and preliminary field-testing of intervention components (steps 3 and 4), reported within this paper.…”

“I Don’t Know Where I Have to Knock for Support”: A Mixed-Methods Study on Perceptions and Experiences of Single Mothers Raising Children in the Democratic Republic of Congo

“…Single motherhood due to premarital childbirth may also result in negative community perceptions and stigma. A recent study conducted in the DRC suggested that there was a degree of stigma toward both adolescent and unmarried adult mothers For instance, community members expressed a fear of losing social status or being disliked if they associated with single mothers, perceiving out-of-wedlock childbirth to be immoral and regarding single mothers as having a low value and contribution to society [ 14 ].…”