Analysing interventions designed to reduce tuberculosis-related stigma: A scoping review

Abstract

Stigma is a critical barrier for TB care delivery; yet data on stigma reduction interventions is limited. This review maps the available literature on TB stigma reduction interventions, using the Health Stigma and Discrimination framework and an implementation analysis to identify research gaps and inform intervention design. Using search terms for TB and stigma, we systematically searched PubMed, EMBASE and Web of Science. Two independent reviewers screened all abstracts, full-texts, extracted data, conducted a quality assessment, and assessed implementation. Results were categorized by socio-ecological level, then sub-categorized by the stigma driver or manifestation targeted. After screening 1865 articles, we extracted data from nine. Three studies were implemented at the individual and interpersonal level using a combination of TB clubs and interpersonal support to target internal and anticipated stigma among persons with TB. Two studies were implemented at the interpersonal level using counselling or a video based informational tool delivered to households to reduce stigma drivers and manifestations. Three studies were implemented at the organizational level, targeting drivers of stigma among healthcare workers (HW) and enacted stigma among HWs. One study was implemented at the community level using an educational campaign for community members. Stakeholder consultation emphasized the importance of policy level interventions and education on the universality of risk to destigmatize TB. Review findings suggest that internal and anticipated TB stigma may be addressed effectively with interventions targeted towards individuals using counselling or support groups. In contrast, enacted TB stigma may be better addressed with information-based interventions implemented at the organizational or community level. Policy level interventions were absent but identified as critical by stakeholders. Implementation barriers included the lack of high-quality training and integration with mental health services. Three key gaps must be addressed in future research: consistent stigma definitions, standardized stigma measurement, and measurement of implementation outcomes.

“This is an illness. No one is supposed to be treated badly”: Community-based stigma assessments in South Africa to inform TB stigma intervention design

“…While empowering PWTB through counselling can help them mitigate internal and anticipated stigma, interviews emphasized the parallel need to address discrimination and enacted stigma by health workers and community members. Our data support systematic and scoping review recommendations that suggest internal and anticipated stigma may be addressed effectively with interventions targeted at individuals using counselling or support groups, whereas enacted stigma may be better addressed with information-based interventions targeted at the organisational or community level ( 31 , 32 ).…”

“As a patient I do not belong to the clinic, I belong to the community.” Co-developing a multi-level, person-centred tuberculosis stigma intervention in Cape Town, South Africa

“…In a recent systematic review we considered how stigma reduction interventions were implemented at each level of the socio-ecological model. 21 Existing interventions -all in the pilot stage -typically targeted one or possibly two levels; for example, TB support groups or clubs (individual/interpersonal), [40][41][42] home visits (individual/interpersonal), 42,43 education for patients/caregivers (individual/interpersonal), 44 health worker training (institutional), [45][46][47] and community-volunteer led education (community) 48 . This highlights a tension whereby, given limited resources, trade-offs are made between interventions at different levels of the socio-ecological model.…”

“…Two recent scoping reviews on TB stigma interventions reported major gaps in existing literature, including inconsistent application of stigma de nitions, variable non-standardised measurement approaches, and incomplete reporting of intervention design and outcomes. 20,21 Furthermore, the quality of these studies was low, and no studies of psychological interventions measured stigma as a primary outcome. 20,21 Another review of interventions to address health-related stigma for diseases including TB and HIV highlighted that stigma interventions have hitherto focused on a single socio-ecological level (most often that of the individual), which limits their impact given that stigma drivers and experiences are pervasive across levels including individual, interpersonal, institutional, community, and policy.…”

“…20,21 Furthermore, the quality of these studies was low, and no studies of psychological interventions measured stigma as a primary outcome. 20,21 Another review of interventions to address health-related stigma for diseases including TB and HIV highlighted that stigma interventions have hitherto focused on a single socio-ecological level (most often that of the individual), which limits their impact given that stigma drivers and experiences are pervasive across levels including individual, interpersonal, institutional, community, and policy. 22 To develop effective TB stigma reduction interventions, participatory approaches that put TB-affected communities at the centre of the research process hold great promise.…”

Strategi pendidikan kesehatan dan penurunan stigma TB di masyarakat: A systematic review

“…Salah satunya dengan memberikan pengetahuan yang benar kepada masyarakat agar terjadi peningkatan pengetahuan terkait TB, sehingga mengurangi stigma pada kelompok masyarakat tertentu. Kemudian, intervensi yang diberikan kepada individu di rumah tangga atau lingkungan sosial yang terkena dampak dapat mengurangi stigma, seperti mengurangi rasa menyalahkan dan kesalahpahaman penyebab TB secara medis (Foster, Galloway, Human, Anthony, Myburgh, Vanqa, Wademan, Makanda, Tisile, Schoeman, Hoddinott, & Nathavitharana, 2022). Pendidikan kesehatan, seperti berbagi pengetahuan, kampanye tentang TB merupakan strategi efektif untuk mengurangi stigma TB.…”