Health‐related stigma of noncommunicable neurological disease in rural adult populations: A scoping review

Abstract

Stigma is a widely recognised public health issue. Many people with neurological disease and their families experience stigmatisation, adding to their burden of illness. Rural populations are typically small, lack anonymity, and often have a higher proportion of older adults with inadequate access to specialised services and resources. Although generally isolated, rural areas can offer benefits such as a sense of familiarity and interconnectedness. The purpose of this scoping review was to map the existing evidence on stigma associated with non‐communicable neurological disease in rural adult populations and identify key findings and gaps in the literature. Our literature search of peer‐reviewed English language articles published from 1 January 1992 to 22 June 2017 was conducted across five databases yielding 8,209 results. After duplicate removal, pairs of reviewers independently screened 6,436 studies according to inclusion criteria developed a priori; 36 articles were identified for inclusion in this review. Study characteristics were described and illustrated by frequency distribution, findings were grouped thematically, and each of the five types of stigma were identified (social, self, health professional, associative, structural). Four factors influencing stigma (knowledge, familiarity, beliefs, and rurality) and four overarching stigma‐related themes (concealment; exclusion; disempowerment, discrimination, and unequal opportunities; and issues related to healthcare systems and providers) emerged. In urban‐rural comparison studies, rural residents were generally less knowledgeable about the neurological disease and more stigmatised. The impact of other factors (i.e., gender, age, and education) on stigma varied and are stated where associations were reported. Three main gaps were identified including: low attention to stigma related to neurological diseases other than epilepsy, limited cross‐cultural comparisons of stigma related to neurological disease, and inclusion of gender as a variable in the analysis of stigma‐related outcomes in only half of the reviewed studies. Further research is recommended.

The burden of neurological disorders across the states of India: the Global Burden of Disease Study 1990–2019

“… 37 A number of demand-related factors also hinder care services, including low perceived need for care among the public, distance to health facilities, and high costs of treatment, care, and rehabilitation, which also cause underuse of existing neurology services. 37 , 40 , 41 Consequently, the burden associated with neurological disorders is higher than it could be if neurological services were more accessible and demand-related factors were favourable.…”

Non-Communicable Diseases-Related Stigma: A Mixed-Methods Systematic Review

“…Only few studies have explored stigma associated with the other prevalent non-communicable conditions, such as CVDs, CRDs, and diabetes [ 9 , 12 , 28 , 34 ]. Further, there are some reviews that have specifically focused on stigma related to specific NCDs like sickle cell disease [ 43 ], dementia [ 44 ] and other neurological diseases [ 45 ], respiratory diseases [ 42 ], and mental illnesses [ 46 , 47 ]. However, a comprehensive and wide-reaching understanding of NCD-related stigma is still needed to develop effective strategies to best respond to the growing epidemic of NCDs.…”

COVID-19-related stigma and its' influencing factors: a rapid nationwide study in China

“…Stigma can be de ned as a social label associating an individual with characteristics of prejudice and discrimination [1,2]. Individuals suffering from stigma often feel shamed, stressed and isolated, leading to negative changes in their health behaviors [3,4]. For example, individuals being stigmatized for a health condition may delay or avoid treatment, and may not seek access to health services, which compromises the outcome of their medical condition [5].…”