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

Abstract

This systematic review examines and consolidates existing evidence on stigma associated with the top four non-communicable diseases (NCDs)—cancers, cardiovascular diseases, chronic respiratory diseases, and diabetes—and its impact on the lives of people affected. We conducted a systematic literature search in PubMed, PsycINFO, JSTOR, Science Direct, and Web of Science for original research in English that explored health-related stigma among people living with either of the four NCDs. A three-step integrative synthesis of data was conducted. Twenty-six articles (qualitative = 15; quantitative = 11) were selected, with most (n = 15) related to cancers, followed by diabetes (n = 7), chronic respiratory diseases (n = 3), and cardiovascular diseases (n = 1). Blame, shame, and fear were the main causes of stigma, the origin and nature of which differed according to the disease-specific features. The manifestations (enacted and felt stigma) and consequences (social, behavioral, psychological, and medical) of stigma across NCDs were similar. Inconsistencies existed in the conceptualization of stigma processes. To fill this gap, we developed an NCD-related stigma framework. People living with NCDs can experience stigma, which can negatively impact their health, management of their disease, and quality of life. The new framework can help in improving the understanding of the processes and experiences of stigma related to NCDs.

The Perspectives of Patients with Chronic Diseases and Their Caregivers on Self-Management Interventions: A Scoping Review of Reviews

“…Toye et al [180] described how patients with chronic pain tended to perceive their life as "impoverished and confined" and as being in a "constant battle against their body". Similarly, our findings identified a risk of isolation for some patients because of the burden of symptoms [41,50,56,74], the physical limitations as a consequence of disease progression [35,42,43,49,51,52,54,55,61,72,73] and complications [62,63,78,[102][103][104], and the impact of perceived or experienced stigma [37,41,81,88,89,91,100]. One overview of qualitative reviews also explored patients' and caregivers' experiences of care with chronic diseases and included two of our selected diseases (HF and COPD) [181].…”

“…We included 148 reviews, distributed as follows: T2DM ( n = 53 [35.8%]), obesity ( n = 20 [13.5%]), COPD ( n = 32 [21.6%]), HF ( n = 38 [25.7%]), and those with more than one chronic disease ( n = 5 [3.4%]). Three included both COPD and HF [ 34 – 36 ], one included both T2DM and COPD [ 37 ], and one included COPD, HF, and T2DM [ 38 ] (Table 1 ; ESM 3). Overall, almost half of the reviews were published after 2015 ( n = 70 [47.3%]), were qualitative evidence synthesis ( n = 78 [52.7%]), and included ≤20 studies ( n = 81 [54.8%]).…”

“…In patients with T2DM, obesity, or COPD, external stigma included experiences of blame or negative judgement from healthcare professionals or others. Stigma was associated with severed relationships; social isolation; reduced work opportunities; and distress, depression, anxiety, and lowered self-esteem, self-worth, and patient self-efficacy [ 37 , 41 , 81 , 88 , 89 , 91 , 100 ]. In patients with T2DM, the perceived stigma was related to their experience of insulin self-injection [ 37 , 76 , 79 , 101 ]; in patients with COPD, the internalised stigma was evident when they described their disease as “self-inflicted” [ 41 ].…”

“…We included 148 reviews, distributed as follows: T2DM (n = 53 [35.8%]), obesity (n = 20 [13.5%]), COPD (n = 32 [21.6%]), HF (n = 38 [25.7%]), and those with more than one chronic disease (n = 5 [3.4%]). Three included both COPD and HF [34][35][36], one included both T2DM and COPD [37], and one included COPD, HF, and T2DM [38] (Table 1…”

Estigmatización de la obesidad: un problema a erradicar

“…Desafortunadamente, la estigmatización ha estado presente desde épocas remotas; en siglos pasados, las personas que padecían enfermedades infecciosas (por ejemplo, lepra o el virus de la inmunodeficiencia humana) eran las más propensas a sufrir un proceso de estigmatización debido a las actitudes y creencias negativas que se tenían sobre dichas enfermedades 3 . Sin embargo, este hecho no es un fenómeno que sólo sucedió en épocas anteriores, sino que hoy en día, a pesar de contar con evidencia científica que muestra las causas, la presencia y las consecuencias de la estigmatización sigue estando presente en diversas patologías tanto transmisibles como no transmisibles 4,5 .…”