Out of the silos: identifying cross-cutting features of health-related stigma to advance measurement and intervention
Out of the silos: identifying cross-cutting features of health-related stigma to advance measurement and intervention
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DOI：
10.1186/s12916-018-1245-x
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发表时间：
2019-02-15
期刊：
影响因子：
9.3
通讯作者：
Yang, Lawrence H.
中科院分区：
文献类型：
--
作者：
Brakel, Wim H. van;Cataldo, Janine;Yang, Lawrence H.
许多被认为具有传染性、危险性或无法治愈的健康状况，或导致明显可见症状的健康状况，都有一个共同的特征-与耻辱和歧视有关。虽然成见的根源可能因条件不同而不同，有时因文化背景不同而不同，但成见和歧视的表现形式和心理社会后果却非常相似。然而，绝大多数的研究测量耻辱或通过干预措施解决耻辱采用疾病的具体approach.The目前的文件反对这种孤立的方法，并提倡一个通用的概念，“健康相关的耻辱”的耻辱测量和耻辱干预。本文采用韦斯的概念模型，通过考察社会距离量表、解释性模型访谈目录、内化精神疾病污名和Berger污名量表等污名测量工具，以及信息化方法、与受影响者接触、（同伴）咨询、以及技能建设和赋权，在各种情况下被成功地用于衡量或解决污名化问题。研究结果表明，“健康相关污名”是一个可行的概念，具有清晰可识别的特征，这些特征在非常不同的文化中的各种污名化健康状况中具有相似性。允许对各种情况进行比较，并承认许多类型的成见是相互交织的。需要进一步的研究来建立更多的证据，证明跨条件方法的优势和有效性的耻辱测量和干预。
Many health conditions perceived to be contagious, dangerous or incurable, or resulting in clearly visible signs, share a common attribute - an association with stigma and discrimination. While the etiology of stigma may differ between conditions and, sometimes, cultural settings, the manifestations and psychosocial consequences of stigma and discrimination are remarkably similar. However, the vast majority of studies measuring stigma or addressing stigma through interventions employ a disease-specific approach.The current paper opposes this siloed approach and advocates a generic concept of 'health-related stigma' in both stigma measurement and stigma interventions. Employing a conceptual model adapted from Weiss, the current paper demonstrates the commonalities among several major stigmatized conditions by examining how several stigma measurement instruments, such as the Social Distance Scale, Explanatory Model Interview Catalogue, Internalized Stigma of Mental Illness, and Berger stigma scale, and stigma reduction interventions, such as information-based approaches, contact with affected persons, (peer) counselling, and skills building and empowerment, were used successfully across a variety of conditions to measure or address stigma. The results demonstrate that 'health-related stigma' is a viable concept with clearly identifiable characteristics that are similar across a variety of stigmatized health conditions in very diverse cultures.A more generic approach to the study of health-related stigma opens up important practical opportunities - cross-cutting measurement and intervention tools are resource saving and easier to use for personnel working with multiple conditions, allow for comparison between conditions, and recognize the intersectionality of many types of stigma. Further research is needed to build additional evidence demonstrating the advantages and effectiveness of cross-condition approaches to stigma measurement and interventions.