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Established seller since Seller Inventory LQ Seller Inventory BTE Book Description Routledge. Seller Inventory Delivered from our UK warehouse in 4 to 14 business days. Book Description Taylor and Francis , London, Seller Inventory ING Condition: Brand New. In Stock. Seller Inventory x Deborah Bray Preston; Anthony R. Deborah Bray Preston ; Anthony R. Publisher: Routledge , This specific ISBN edition is currently not available. View all copies of this ISBN edition:. The Berger Stigma Scale was designed to measure stigma as perceived by PLHIV organized along four underlying factors, including personalized stigma 18 items ; disclosure concerns 12 items ; negative self-image 9 items ; and concern with public attitudes about people with HIV 12 items [ 24 ].
To develop the scale, Berger et al. The actual scale items were selected and developed from a review of literature and expert consultation, field tested in the USA, and subjected to factor analysis. While quite lengthy, the scale has since been widely used and adapted both in a range of settings and for conditions other than HIV [ 50 , 51 , 52 , 53 ]. The ISMI scale was developed to measure the subjective experience of stigma, especially the internalization of stigma [ 44 ].
The ISMI was developed together with people with mental illnesses. The instrument comprises 29 Likert items. The ISMI was originally validated among mental health outpatients. Results showed that the ISMI had high internal consistency and test-retest reliability.
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Construct validity was supported by positive correlations with measures of stigma beliefs and depressive symptoms, and negative correlations with measures of self-esteem, empowerment, and recovery orientation. More recently, a brief version of the ISMI was developed and validated [ 54 ]. Information-based interventions are very likely the most common approach to addressing public stigma against any condition. However, they differ in content across conditions because they often address condition-specific knowledge gaps, stereotypes, fears, and other drivers of stigma; not infrequently, these are the only strategies used.
However, while knowledge or education is often an essential part of stigma reduction, it is insufficient on its own [ 55 , 56 , 57 ]. Many authors have reviewed stigma reduction strategies and interventions from either a disease-specific or generic perspective [ 11 , 57 , 58 , 59 , 60 , 61 , 62 , 63 ]. Evidence of effectiveness from well-designed studies using larger samples, particularly of longer-term impact, is scarce [ 58 , 62 ].
However, available evidence suggests that stigma should be tackled at multiple levels, by using multiple strategies and the interventions must be context specific and continued or repeated to achieve a lasting impact [ 6 , 8 , 11 , 64 , 65 , 66 ]. Information-based strategies are often used to reduce negative attitudes and perceived stigma in the community public stigma.
Information-based interventions try to fill gaps in knowledge about the condition and dispel myths and demonstrate that stereotypes are often not true. An example is information about the availability of medical treatment for a given infectious disease; such information is assumed to contribute to reduction of stigma against that disease [ 68 ]. The second example is educating people with scientific facts, e.
It is crucial that education messages and campaigns take the local worldview, culture, language, and specific fears and beliefs into account [ 65 , 66 , 70 ]. Facilitating contact between persons affected by a particular condition and members of the general public or healthcare workers has been shown to be effective in improving attitudes and in changing negative stereotypes [ 71 ].
This is based on the principle that attitudes can only be changed or replaced by positive attitudes when they have been shown to be dysfunctional [ 72 ]. The contact intervention has been used in different forms, either by facilitating direct, live contact or through electronic media.
Opportunities for discussion are also an important element. The hypothesis is that, when such POLs display positive attitudes, spread a non-stigmatizing message, or even fight enacted stigma in a social group, they model a new behavior and thus alter the perception and eventually even the social norm. The latter on-going trial is the first attempt to apply the POL strategy to implement a cross-cutting, and thus not disease specific, stigma-reduction intervention Rau et al.
When community members identify themselves as the members who are influential in a stratified manner, for example, by asking randomly selected respondents to nominate influential community members or by asking gatekeepers village or organization heads to recommend popular individuals [ 78 ], and when these potential POLs are then adequately trained, increasing knowledge as well as adapting behavior, this approach has the potential to be a suitable cross-cutting strategy applicable to a wide range of stigmatized conditions [ 76 ].
Peer counselling is an intervention in which suitable persons with the same condition are selected and offered training in counselling [ 81 ]; this focuses on listening and problem-solving skills, as well as increasing knowledge about the condition and, as in the case of a study in Indonesia [ 82 ], about human rights.
In the case of peer counsellors, the counsellor can also serve as a role model to the counselee. However, these do not necessarily engage HIV-positive peers as educators, but rather a variety of other peers such as students in schools e. Interventions for socioeconomic development or improvement of the livelihoods of persons affected can be seen as economic empowerment [ 84 , 85 ]. By enabling persons who are stigmatized to find a job or improve their income, self-esteem and the feeling of self-worth are improved [ 86 ].
Importantly, people get hope that there is a way out of their predicament. Collateral-free individual or group micro-credit loans are then given from the collective savings or by the bank or institution [ 88 ].
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People may start a small business or invest the loan in agricultural activities. Being able to contribute to the family income or to the community in this way often helps greatly in regaining identity and respect, either reducing public stigma or offering additional resilience to cope with it [ 72 , 89 ]. Table 1 shows examples of stigma instruments that have been used across several conditions to measure attitudes and perceived and enacted stigma among the public or community.
The SDS has a long history and was originally designed to assess willingness to associate with persons of different ethnic backgrounds [ 46 ]. Link et al. Lee et al. Peters et al. The EMIC-CSS has been used across conditions most often, including in a study assessing attitudes and perceived behavior against persons with onchocerciasis [ 93 ], mental health conditions [ 49 ], Buruli ulcer [ 94 ], tuberculosis [ 95 ], and leprosy [ 43 , 96 , 97 ].
Additionally, the cultures were very diverse, including four countries in Africa and four in Asia.
In the same way, instruments used to assess stigma experienced by persons affected across a range of conditions are shown in Table 2. The Berger Stigma Scale, originally designed to measure perceived and experienced stigma among PLHIV [ 24 ], was successfully adapted for use in leprosy [ 98 ] and meticillin-resistant Staphylococcus aureus [ 53 ].
The ISMI was used most frequently, with no less than 81 papers covering 42 completed translations [ 13 ]. Most studies used the instrument in mental health, but other studies demonstrated the usefulness of the ISMI among persons with substance abuse, leprosy, HIV, and inflammatory bowel disease [ 96 , 99 , , ].
Originally designed to measure the impact of leprosy on the mental health of persons affected [ 45 ], it has since been used to measure experienced stigma related to mental health conditions, including depression, schizophrenia and bi-polar disorder [ , , ], onchocerciasis [ ], Buruli ulcer [ 94 ], HIV [ ], TB [ ], and leprosy [ 96 ].
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Table 3 shows examples of information-based interventions being used to address attitudes of college students towards persons with mental health conditions in the USA [ ], general public attitudes towards HIV in Ghana [ ], and community attitudes to leprosy in Indonesia [ ]. Another very commonly used stigma intervention is the contact intervention, which was used with success to improve attitudes to mental illness among college students in the USA [ ], attitudes towards PLHIV among nurses in Hong Kong [ ], and attitudes of community members towards persons affected by leprosy in Indonesia [ 74 , ].
Education about the condition and related beliefs and fears, and contact between persons with the concerned conditions and members of the community or other target group are often used together; this combination of interventions has been shown to work across conditions and cultures [ 11 , 60 , 62 , , , ].
Interventions to mitigate the impact of stigma have addressed the mental wellbeing of the persons affected, their resilience, self-efficacy and sense of self-worth, and ability to speak up for themselves through empowerment, skills building, and participation in the actual interventions. Nuwaha et al. Conner et al. Across the globe, Lusli et al.
Their approach, which included building resilience, restoring dignity, and awareness of human rights, was shown to be effective in reducing stigma, improving social participation, and improving quality of life among the counselees [ ]. Skills building and empowerment of persons who are stigmatized is another strategy shown to be effective across conditions and cultures.
The Stigma Elimination Project in south Nepal trained a small group of persons with visible signs of leprosy who showed leadership potential [ 76 ], who became leaders of a rapidly growing number of SHGs. After 3 years, the level of social participation of SHG members was at the level or better than that of a community control group. Dalal [ 72 ] reported empowerment of persons with disabilities in north India to be very successful in overcoming shame, increasing social participation, and improving health outcomes as well as in changing community attitudes towards disability. Uys et al.
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