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This study analyzed media framing of athletes who have suffered mental ill health. The mass media play a crucial role in shaping public attitudes and perceptions surrounding mental health, and the present study aimed to examine the media reporting of athletes' mental ill health and to further explore how this reporting has changed over time. We examined the reporting of elite athletes in three U.K. media outlets between January 2000 and December 2019, identifying 75 athletes from 26 different sports. From analysis, four themes were developed to consider the content of media reporting and how it has changed over three time phases. The analysis revealed that media reporting of mental ill health has increased over time, and changes were observed in terms of the specific terminology used, with greater depth in the articles, such as journalists speaking to other professionals to construct the articles. This study contributes toward our growing understanding of the reporting of mental ill health by providing empirical evidence of the increased attention to the topic and increasingly responsible reporting in the media. [ABSTRACT FROM AUTHOR]

Benefits of parental gender-affirming behaviors on the mental health and well-being of the broader gender-expansive youth population have been extensively documented. However, the nature and impact of these behaviors have not been explored by centering Black and Latine transgender/non-binary youth (BLTY). This article offers a new framework called the "Parental Gender Affirmation Model." This framework conceptualizes parental gender-affirming behaviors toward BLTY through the lenses of intersectional stigma and cultural gender norms and uses the Theory of Planned Behavior and Modified Gender Affirmation Model as foundational frameworks. We analyzed qualitative data from 43 interviews with BLTY, parents of BLTY, and Black and Latine transgender/non-binary young adults from California in the United States to develop the framework. The "Parental Gender Affirmation Model" starts with behavioral antecedents and ends with impacts of these behaviors on BLTY's well-being. This framework will inform the development of critically needed, culturally-informed interventions to support parental gender affirmation of BLTY.

Interpersonal management of homophobic stigma (e.g., selectively constructing ones social network; confronting stigma) is an understudied area of resilience among sexual minority people. Among a sample of cisgender sexual minority men (SMM; N = 798) in midlife and older adulthood, we assessed the psychometric properties and characterized the sociodemographic differences of our newly developed, theory-informed homophobia management scale. Data come from the Healthy Aging substudy of the Multicenter AIDS Cohort Study, which is a prospective longitudinal study implemented to evaluate the natural trajectories of HIV risk and treatment among sexual minority men. Guided by the proactive coping processes model, the Healthy Aging team proposed eight items to measure homophobia management, which were included at four waves of survey data collection completed at semiannual study visits. Using factor analyses and linear regressions, we assessed our scales construct validity, convergent validity, and internal consistency, and characterized scores by age, race/ethnicity, sexual orientation, and HIV status. Factor analyses yielded a six-item scale with adequate construct validity and acceptable internal consistency (Cronbachs alpha = .69). Our final scale exhibited convergent validity given its statistically significant inverse association with internalized homophobia and positive association with psychological connections to the gay community. Bivariate differences in homophobia management emerged by age, race/ethnicity, and sexual orientation but were not statistically significant in multivariable analyses. Our study provides a validated, unidimensional scale to assess homophobia management among SMM in midlife and older adulthood. We provide recommendations to improve the implementation of our scale in future surveillance.

BACKGROUND: To address needs for emotional well-being resources for Californians during the COVID-19 pandemic, the Together for Wellness/Juntos por Nuestro Bienestar (T4W/Juntos) website was developed in collaboration with multiple community partners across California, funded by the California Department of Health Care Services Behavioral Health Division federal emergency response. OBJECTIVE: This qualitative study was designed to explore and describe the perspectives of participants affiliated with California organizations on the T4W/Juntos website, understand their needs for web-based emotional health resources, and inform iterative website development. METHODS: After providing informed consent and reviewing the website, telephone interviews were conducted with 29 participants (n=21, 72% in English and n=8, 28% in Spanish) recruited by partnering community agencies (October 2021-February 2022). A 6-phase thematic analysis was conducted, enhanced using grounded theory techniques. The investigators wrote reflexive memos and performed line-by-line coding of 12 transcripts. Comparative analyses led to the identification of 15 overarching codes. The ATLAS.ti Web software (ATLAS.ti Scientific Software Development GmbH) was used to mark all 29 transcripts using these codes. After examining the data grouped by codes, comparative analyses led to the identification of main themes, each with a central organizing concept. RESULTS: Four main themes were identified: (1) having to change my coping due to the pandemic, (2) confronting a context of shifting perceptions of mental health stigma among diverse groups, (3) Feels like home-experiencing a sense of inclusivity and belonging in T4W/Juntos, and (4) Its a one-stop-shop-judging T4W/Juntos to be a desirable and useful website. Overall, the T4W/Juntos website communicated support and community to this sample during the pandemic. Participants shared suggestions for website improvement, including adding a back button and a drop-down menu to improve functionality as well as resources tailored to the needs of groups such as older adults; adolescents; the lesbian, gay, bisexual, transgender, and queer community; police officers; and veterans. CONCLUSIONS: The qualitative findings from telephone interviews with this sample of community members and service providers in California suggest that, during the COVID-19 pandemic, the T4W/Juntos website was well received as a useful, accessible tool, with some concerns noted such as language sometimes being too professional or clinical. The look, feel, and content of the website were described as welcoming due to pictures, animations, and videos that showcased resources in a personal, colorful, and inviting way. Furthermore, the content was perceived as lacking the stigma typically attached to mental health, reflecting the commitment of the T4W/Juntos team. Unique features and diverse resources, including multiple languages, made the T4W/Juntos website a valuable resource, potentially informing dissemination. Future efforts to develop mental health websites should consider engaging a diverse sample of potential users to understand how to tailor messages to specific communities and help reduce stigma.

INTRODUCTION: Stigma has inhibited public health practitioners influence during the COVID-19 pandemic. We explore the experienced and anticipated stigma of people affiliated with a large university in the United States, using the Health Stigma and Discrimination Framework. METHODS: We conducted a qualitative secondary substudy of 20 people who tested SARS-CoV-2 positive and 10 who tested negative in the summer of 2020, selected from a study of 3,324 university students and employees. FINDINGS: No participants reported anticipated stigmatization prior to testing positive. However, eight of 20 participants recounted stigma marking (being marked by COVID-19 diagnosis or membership in a high-risk group) or manifestations of stigma after testing positive, including feelings of guilt or shame, and concerns about being judged as selfish or irresponsible. Three described being denied services or social interactions as a result of having had COVID-19, long after their infectiousness ended. Participants noted that clear public health messaging must be paired with detailed scientific information, rather than leaving people to resort to non-experts to understand the science. DISCUSSION: Public health messaging designed to mitigate spread of SARS-CoV-2 and protect the community may perpetuate stigma and exacerbate inequities. As a result, people may avoid testing or treatment, mistrust public health messaging, or even use risk-increasing behavior as coping mechanisms. IMPLICATIONS FOR PRACTICE: Intentional use of language that promotes equity and deters discrimination must be high priority for any COVID-19-related public health messaging. Partnership with community leaders to co-create programs and disseminate messaging is a critical strategy for reducing stigma, especially for historically mistreated groups.

ObjectiveThis study investigated women living with HIV/AIDS (WLHA)'s practices and decision-making regarding disclosure of HIV status in healthcare settings in Vietnam. Introduction: Disclosure of HIV status in healthcare settings is under-studied.MethodsWe conducted in-depth interviews with 30 WLHA in Hanoi, Vietnam. Thematic analysis was conducted to investigate the patterns, considerations, and consequences of HIV disclosure. Results: Most participants chose a selective disclosure strategy based on the type of procedure and healthcare setting. They considered several factors: concerns about stigma/discrimination, risks of confidentiality breach, relevance to healthcare provision, and altruism towards protecting providers and other patients. Selective disclosure or non-disclosure often prevented participants from accessing comprehensive care. Conclusion: The study underscores the need to prepare WLHA to make informed decisions regarding disclosure and provide them with service navigations and support. It also highlights the necessity of reducing stigma and enhancing confidentiality protection to ensure safe disclosure in healthcare settings.

Stigma toward menstruation is closely linked to a lack of knowledge about menstrual health taboos and negative attitudes toward sex and bodies. The menstrual cup (MC), an alternative menstrual product to pads and tampons, may mitigate these negative perceptions through the high levels of body contact and menstrual and anatomical knowledge required to use it. Hence, the current study examines the relationship between MC usage and 1) knowledge about menstruation and reproductive anatomy, 2) personal comfort with sexuality, and 3) attitudes toward menstruation. This study utilized a quantitative survey to investigate the attitudes and experiences of 180 menstruators ages 19-34 and the menstrual products they use. As predicted, more frequent MC usage was associated with higher knowledge, greater comfort with sexuality, and lower disgust and shame toward menstruation.

As a proposed mediator between stigma-related stressors and negative mental health outcomes, HIV-related shame has been predictive of increased rates of substance use and difficulties adhering to antiretroviral treatment among people with HIV. These downstream manifestations have ultimately impeded progress toward national goals to End the HIV Epidemic, in part due to limited success of conventional psychotherapies in addressing HIV-related shame. In a pilot clinical trial (N = 12), receipt of psilocybin-assisted group therapy was associated with a large pre-post decrease in HIV-related shame as measured by the HIV and Abuse Related Shame Inventory, with a median (IQR) change of - 5.5 (- 6.5, - 3.5) points from baseline to 3-months follow-up (Z = - 2.6, p = 0.009, r = - 0.75). A paradoxical exacerbation of sexual abuse-related shame experienced by two participants following receipt of psilocybin raises critical questions regarding the use of psilocybin therapy among patients with trauma. These preliminary findings carry potential significance for the future of HIV care.

BackgroundHuman Immunodeficiency Virus (HIV) remains a significant public health concern worldwide. Women living with HIV/AIDS (WLHA) have the additional and unique need to seek sexual and reproductive health services. WLHA's maternal health journeys can be shaped by the cultural norms and resources that exist in their society. This study sought to understand if and how WLHA's family planning, pregnancy, and motherhood experiences could be influenced by the patriarchal culture, gender roles, and HIV stigma in Vietnam, specifically.MethodsBetween December 2021 and March 2022, 30 WLHA with diverse socioeconomic backgrounds and childbirth experiences were interviewed in Hanoi, Vietnam. These semi-structured interviews covered topics including HIV stigma, gender norms, pregnancy experiences, and child-rearing challenges. Interviews were audio recorded, transcribed, and analysed using ATLAS.ti.ResultsQualitative analyses of participant quotes revealed how limited information on one's health prospects and reproductive options posed a significant challenge to family planning. Societal and familial expectations as well as economic circumstances also influenced reproductive decision-making. WLHA often encountered substandard healthcare during pregnancy, labor, and delivery. Stigma and lack of provider attentiveness resulted in cases where women were denied pain relief and other medical services. Communication breakdowns resulted in failure to administer antiretroviral therapy for newborns. Motherhood for WLHA was shadowed by concerns for not only their own health, but also the wellbeing of their children, as HIV stigma affected their children at school and in society as well. Many WLHA highlighted the constructive or destructive role that family members could play in their childbirth decision-making and care-giving experiences.ConclusionsOverall, this study underscores the complex ways that cultural expectations, family support, and stigma in healthcare impact WLHA. Efforts to educate and engage families and healthcare providers are warranted to better understand and address the needs of WLHA, ultimately improving their reproductive and maternal health.

Mental health is crucial throughout life and significantly influences overall well-being, yet it is often overlooked and stigmatized. Mental health issues among men are a significant public health concern due to societal norms that discourage emotional vulnerability and seeking help, leading to underreporting and inadequate access to necessary services. While research has explored these connections, a gap exists in understanding how these factors influence the mental health of young men specifically. The study was conducted in the college department of an institution in Malaybalay City, Bukidnon. It utilized an explanatory sequential research design, beginning with quantitative data collection to measure 106 male students' experiences with mental health expression and stigma, followed by qualitative methods to explore the experiences of 5 male students in-depth regarding their mental health expression. This study examines the factors influencing male students' willingness to communicate mental health expression. The study shows a strong positive correlation between adverse experiences and higher-level stigma, underscoring how societal attitudes discourage open communication. Moreover, the qualitative findings reveal that societal norms, personal experiences, and coping mechanisms play a role. Themes like stereotyping, social anxieties, and feelings of isolation emerged, highlighting students' challenges in seeking support. These qualitative insights support the quantitative data, which shows a high prevalence of stigma surrounding mental health. The study emphasizes the need to address these cultural and structural barriers to create a more supportive environment that reduces stigma and encourages help-seeking behavior among male students. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Stigma surrounding mental health persists as a significant impediment to adequate support and help-seeking behaviors in Slovenia, despite advancements in psychiatric care and education. This study investigates stigma among first-year medical students at the University of Maribor, Slovenia and how the stigma changes after completing a course in mental health literacy. PARTICIPANTS: Participants were first-year medical students at the University of Maribor in the academic year 2023/2024. A total of 116 students participated in the baseline study, with 66 students participating in the follow-up study. STUDY METHOD: The intervention involved implementing the "Transitions" program, aimed at enhancing mental health literacy and reducing stigma. We conducted a baseline study and a follow-up study, then used Wilcoxon signed rank test for repeated measures to compare the differences in ranks before and after implementation of the program. FINDINGS: There was a significant reduction in stigma after intervention (Wilcoxon Z = −3.06, P <.01), suggesting a positive impact of the educational program. This reduction aligns with findings from similar programs globally, suggesting the efficacy of educational interventions in mitigating mental health stigma. CONCLUSIONS: The study emphasizes the importance of integrating mental health education into medical curricula to foster stigma reduction and enhance mental health literacy among future medical doctors. [ABSTRACT FROM AUTHOR]

Miscarriages, stillbirths and neonatal deaths have received limited attention in global health programmes and research, even though pregnancy loss is common, traumatic and stigmatised. This paper seeks to illuminate lived experiences of pregnancy loss in southern Malawi, drawing on findings from semi-structured interviews and focus groups with women who have experienced loss, health professionals and community members, and observations of maternity care. Combining thematic and discourse analysis, we show how societal and medical discourses frame women as responsible for (failed) reproduction, and restrict possibilities to speak about, and respond to, loss. Some accounts and (care) practices invisibilise loss and associated suffering. However, invisibilisation may also be intended as support, and underscores rather than denies the social significance of parenthood. Other accounts (e.g. women emphasising faith and acceptance) constitute moral survival strategies to avoid the acquisition of a 'spoiled identity'. We conclude that societal and medical discourses of loss enact stigmatised, subaltern subject positions for women experiencing pregnancy loss, create social suffering, and amount to a form of structural violence. Programmes and interventions should change these discourses. [ABSTRACT FROM AUTHOR]

Background Buruli ulcer disease (BUD) is a neglected tropical disease of the skin, subcutaneous tissue and bone caused by Mycobacterium ulcerans , with various disabling and stigmatising sequelae. Patients face a range of adverse impacts owing to the disease as most are unable to relate effectively with their communities, battling stigma and fear of discrimination. This study aimed to explore the stigma associated with the lived experiences of BUD in patients in Nigeria. Methods This was a cross-sectional qualitative study that employed a focus group discussion (FGD) and key informant interviews in Enugu State, Nigeria. A random sampling of communities was followed by a purposive selection of FGD participants and key informants. A total of six key informants and eight FGD participants took part in the study. Data were collected over 6 wk from December 2022 to February 2023. The NVivo application was used to analyse transcripts and compute themes of quotes. Results Patients experienced stigma owing to the condition. The most reported experiences by participants were shame and culpability, isolation and social exclusion, including maltreatment from family members. Conclusions Identifying the stigma experienced by patients owing to BUD helps in the provision of psychosocial management services and support for patients. [ABSTRACT FROM AUTHOR]

Radical public history relies on reflective practices that include formal and experientially acquired knowledge within a broad interdisciplinary framework. Using material culture methodologies from history and anthropology, we present the AIDS Memorial Quilt as an example of radical public history in action. We recount the history and meaning of the Quilt and share quantitative survey information based on college students' responses to six Quilt blocks displayed with supplemental informational banners. Embracing a core pillar of radical public history—shared authority—our authors include interdisciplinary academic and non-academic community partners whose combined skills, lived experiences, and expertise are critical to this movement and this paper. We finish with insights for those wishing to host Quilt blocks in their community. [ABSTRACT FROM AUTHOR]

AbstractObjectiveDesign and study sampleResultsConclusionsThe aim of this study was to use Ecological Momentary Assessment (EMA) to capture how stigma-induced identity threat is experienced by adults with hearing loss and how they respond to such threats in daily life.Twenty adults with hearing loss from 53 to 88 years (mean age of 69.4 years) completed a range of demographic and stigma questionnaires in the laboratory and, over a two-week period, answered daily EMA surveys.A total of 633 EMA surveys were collected. Five participants reported 13 listening events in which they experienced stigma. These events were typically when conversing with family or friends who were aware of the adults’ hearing loss.The number of individual stigma experiences captured by EMA were low, when viewed across a large number of social interactions. However, as a group, a quarter of the participants in this study experienced stigma over a two-week period, typically from others close to them. This suggests that stigma experiences may be a regular occurrence for some adults with hearing loss. [ABSTRACT FROM AUTHOR]

Family members of incarcerated persons may experience grief related to the incarceration. We examined laypeople's perceptions of family members grieving the loss of an individual to incarceration. Participants (N = 1095) were randomized to read vignettes that varied by grief trajectory (prolonged vs. resilient), race (Black vs. White vs. Latine), and crime type (violent vs. non-violent). Participants answered questions assessing grief response appropriateness, comfort providing support to the grieving person, beliefs that the grieving person should seek therapy, and how severe they believed the incarcerated person's crime was. Results indicated that prolonged grief trajectories and greater perceived crime severity were associated with decreased ratings of grief response appropriateness. Participants were more likely to endorse the need for therapy-seeking for individuals with prolonged grief (vs. resilience). Participants were less likely to recommend therapy for Black (vs. White) individuals, and women were more likely to recommend seeking therapy than men. The results suggest stigma might exist toward family members grieving the loss of individuals who committed crimes perceived to be more severe by laypeople, which could contribute to negative bereavement outcomes. [ABSTRACT FROM AUTHOR]

Objective: This research aimed to determine the stigma toward people with mental illness among mental health personnel and identify individual, professional, and contextual predictors. Methods: A descriptive, cross-sectional, and correlational design was used. The sample consisted of 218 mental health personnel working in Outpatient Psychiatric Units belonging to hospitals and Community Mental Health Centers in Chile. Stigma was evaluated using a scale of humanized treatment, a scale of social distance, and a scale of attitudes in health personnel. In addition, sociodemographic and professional information was collected from mental health personnel and contextual information, particularly the type of outpatient mental health center and the technical-administrative unit that groups all the health centers in a territory. Results: It was found that mental health personnel, in general terms, present low levels of stigma expressed in behaviors of comfort and support toward users, a desire for closeness and social interaction, and reduced stigmatizing beliefs and attitudes of infantilization toward individuals with MHPs. However, intimacy and trust were lower than expected. Only educational levels and health centers were related to stigma. Conclusions: The low levels of stigma may be due to the evolution of this phenomenon and the country's mental health policies. [ABSTRACT FROM AUTHOR]

Background: Stigma is a relevant aspect of Parkinson's disease (PD). Specific stigma tools are needed to address the complex construct of stigma in PD comprehensively. Objective: To test the dimensionality and psychometric properties of the newly developed Parkinson's Disease Stigma Questionnaire (PDStigmaQuest). Methods: In this multi-center, cross-sectional study including PD patients and healthy controls, the dimensionality of the PDStigmaQuest was examined through exploratory factor analysis. Acceptability and psychometric properties were investigated. PDStigmaQuest scores of patients and healthy controls were compared. Results: In total, 201 PD patients and 101 healthy controls were included in the final analysis. Results suggested high data quality of the PDStigmaQuest (0.0001% missing data for patients). The exploratory factor analysis produced four factors: felt stigma, hiding, enacted stigma: rejection, and enacted stigma: patronization, explaining 47.9% of variance. An optional work domain for employed patients was included. Moderate floor effects and skewness, but no ceiling effects were found. Cronbach's alpha of 0.85 indicated high internal consistency. Calculated item-total correlations met standard criteria. Test-retest reliability was high (rs = 0.83). PDStigmaQuest scores correlated significantly with other stigma measures (rs = 0.56–0.69) and were significantly higher in patients than in healthy controls and higher in patients with depressive symptoms than in those without. Conclusions: The patient-reported 18-item PDStigmaQuest showed strong psychometric properties of validity and reliability. Our results suggest that the PDStigmaQuest can be used to assess and evaluate stigma comprehensively in PD, which will improve our understanding of the construct of PD stigma. [ABSTRACT FROM AUTHOR]

Aim: To qualitatively explore the experiences of individuals with Gestational Diabetes Mellitus (GDM) in Australia, and to recognise opportunities for leveraging digital health to enhance the support of GDM management. Method: A cross sectional online survey assessed the experiences of individuals with GDM, the healthcare system and their digital health usage. Respondents (recruited via a national diabetes registry or social media) were adults receiving GDM care within Australia in the last 5 years, who responded to any of three open‐ended questions (n = 815) exploring positive, negative and other GDM experiences. Thematic analysis was utilised, and themes were mapped to the socio‐ecological systems framework. Results: At a system level, themes related to (1) accessibility of care including the value of digital health and the inflexible or inconsistent perception of the (2) implementation of guidelines. At an interpersonal level, themes covered the need for adequate (3) health information provision, and (4) supportive care, as well as highlighting (5) experiences of stigma including a desire for greater awareness of GDM. Individual‐level themes included: (6) differential barriers to accessing care; (7) negative emotional burden; (8) internalisation of stigma; (9) dietary freedom and social impact and (10) opportunity for change derived from having GDM. Conclusion: Findings suggest a demand for more supportive, person‐centred GDM care, improved information provision and individualised implementation of clinical guidelines. Such mechanisms may support reduced barriers to accessing care or negative psychosocial impacts of GDM. Though not central to the identified experiences, digital health tools may help address the need for optimised GDM care. [ABSTRACT FROM AUTHOR]

Aim: To explore the lived experiences of patients with severe obesity during hospital admissions. Design: Qualitative study design. Methods: Semi‐structured individual interviews with 14 participants with severe obesity from Norway were conducted between May and October 2021. A qualitative phenomenological hermeneutical approach inspired by Paul Riceour was used to analyse the data. Results: The following three themes were identified through the analysis of the lived experiences of patients with severe obesity during hospital admissions: blaming my weight, being prejudged and feeling different. The participants shared various emotional experiences of encounters with healthcare professionals at hospitals. They struggled to be recognized and welcomed like everyone else and found it difficult to be judged by someone who did not know them. The various experiences resulted in a vicious circle, ultimately leading to a fear of future hospitalization. Conclusion: Being a patient with obesity in a hospital setting can present various challenges, leading to feelings of shame and guilt. Experiences of stigma may not necessarily be related to the overall hospital context but rather to encounters with healthcare professionals who may be unfamiliar with the patient's history, which can lead to stigmatizing behaviours. Impact: Understanding how patients with severe obesity experience their hospital admissions and the importance of familiarizing themselves with the individual patients to avoid stigmatizing behaviours is important for healthcare professionals caring for obese patients. Reporting Method: Consolidated Criteria for Reporting Qualitative Research. Patient or Public Contribution: No patient or public contribution. Impact Statement: Patients with obesity often encounter stigmatization and negative attitudes from healthcare professionals, particularly in primary care settings.Patients with severe obesity experienced various challenging encounters with healthcare professionals during hospital admissions, resulting in a vicious circle, ultimately leading to a fear of future hospitalization.It is crucial for healthcare professionals involved in the care of patients with obesity to acquaint themselves with individual patients to prevent stigmatizing behaviours. [ABSTRACT FROM AUTHOR]

In this longitudinal study of students with concealable chronic health conditions (CCHCs), we applied components of interpersonal disclosure process models to investigate how illness disclosures and perceived partner responsiveness conferred health and social benefits during the COVID-19 pandemic. Students with CCHCs and in relationships completed online surveys at the beginning, middle, and end of the academic year in which they returned to campus amid the COVID-19 pandemic (n Time1 = 101, n Time2 = 52, n Time3 = 54). Mixed models showed students with greater illness disclosures and perceived partner responsiveness had better physical health, engaged in less health-compromising behaviors, felt less worried and stressed about the COVID-19 pandemic, and experienced lower illness-related stigma, discrimination, and social isolation. Over time, students' greater illness self-disclosures predicted lower health-compromising behaviors and illness-related discrimination. Notably, perceived partner responsiveness connected greater illness self-disclosures to better health, COVID-related, and social-contextual outcomes. These findings demonstrate the health and social benefits of talking openly about concealable illnesses with partners and, in turn, feeling cared for, validated, and understood amid the COVID-19 pandemic. This study provides new evidence on relational pathways to better social and health outcomes among those with heightened health risks. [ABSTRACT FROM AUTHOR]

Purpose: To test the validity of a COVID-19 public stigma scale and an attributional model of stigma during the early stages of the pandemic. Design: We administered a cross-sectional survey that included scales related to COVID-19 stigma to U.S. adults. Setting: We used Amazon MTurk online survey panel to recruit participants in June 2020. Subjects: U.S. adults (N = 170) participated in the study. Participants were average age of 37 and majority were men (61.2%) and White (77.6%). Measures: The Stigma Towards Disease Scale (SDS) was adapted to measure public stigma directed towards COVID-19 (SDS-C19). Additional stigma-related measures were adapted for this study. Analysis: Factorial structure of SDS-C19 was assessed using confirmatory factor analysis (CFA). Validity of SDS was examined using Pearson correlations with other stigma measures. We evaluated the attributional model of stigma using structural equation modeling. Results: Internal consistency of SDS-C19 was high and a three-factor model reflecting cognitive, affective, and behavioral factors was supported (χ2 [71, N = 170] =140.954, P =.00, CFI=.946, TLI =.931, RMSEA =.076, SRMR =.087). The SDS-C19 had strong correlations with other stigma-related measures. A blame-mediated attribution model was supported (χ2 [8, N = 170] = 21.793, P =.00, CFI =.976, TLI =.956, RMSEA =.101, SRMR =.058). Conclusion: The SDS-C19 is a valid tool for assessing COVID-19 stigma. SDS-C19 and the attribution model can guide public health communication. [ABSTRACT FROM AUTHOR]

About 40 years after the reforms leading to the closure of psychiatric hospitals (Ospedale Psichiatrico [OP]) in Italy in favor of a widespread model with a strong rehabilitation emphasis, Italy has chosen to close High Security Hospitals as well (Ospedale Psichiatrico Giudiziario [OPG]). The new forensic treatment model is expected to be more respectful of the person, including the perpetrators of violent crimes, and aims to be less stigmatizing and more rehabilitative. Despite the favorable premises of the reform (Law n. 81/2014), Italian psychiatrists are now obliged to answer calls to give evidence on strictly legal issues such as the social dangerousness of the mentally ill offender drawing on evidence or paradigms that many believe do not belong to medical knowledge. Psychiatrists must now learn to communicate about the relationship between psychiatry and society as required by law. This public expression engages with the cultural climate of society. Otherwise, the risk is of increasing the level of complexity leading to real misunderstandings that paradoxically may feed the stigma. The Italian reform provides an opportunity for reflection on some issues concerning psychiatric action, on how the public perceives the mentally ill and their psychiatrists, on the relationship between psychiatry and the world of law, on clinical methodologies for structured professional judgment, on public communication regarding severe mental illness, and the risk that psychiatrists may inadvertently be blamed for conveying an unwelcome message about mental illness and social dangerousness—we have called this social sensitivity against psychiatrists "hermanoia," blaming the messenger. The authors do not provide certain solutions but propose good practices. [ABSTRACT FROM AUTHOR]

People on the autism spectrum can learn about autism from various sources, likely differing in the information, portrayal, and discussion they offer. The present study investigates where autistic people learn about autism, and whether their information source is associated with their level of autism knowledge, perceptions of stigma, and development and expression of an autism identity. A survey of 198 Australian adults with an autism diagnosis showed that learning about autism from conventional sources (e.g., professionals, parents) was associated with more internalised stigma, lower endorsement of special abilities and autism identity, whereas online blogs and social media showed the opposite pattern as well as more accurate knowledge of autism. The findings raise questions about how authoritative sources of information discuss autism. [ABSTRACT FROM AUTHOR]

Background: The influx of patients in the acute care setting with opioid use disorder (OUD) has outpaced many hospitals' ability to educate interprofessional staff. This creates distressing experiences for interprofessional staff and patients, leading to moral distress and burnout in staff and poor patient outcomes. Objective: The purpose of this study was to improve interprofessional staff knowledge, attitudes, and perceptions toward working with patients who have OUD using a blended classroom-simulation-based curriculum. Methods: A preintervention and postintervention design was selected. Interprofessional staff (n=46) participated in a blended classroom-simulation educational intervention focused on the neurobiology of OUD, stigma reduction, pain management, and harm reduction principles, followed by 3 high-fidelity simulation scenarios. Participants completed the Drug and Drug Problems Perceptions Questionnaire to measure staff self-perceived knowledge, skills, and attitudes when working with patients who use drugs before, immediately after, and again 3 and 6months postintervention. Results: Most respondents were nurses with an average of 7.6 (SD, 9.6) years of experience. The majority did not have prior training in substance use disorder before (75.6%). There was a statistically significant decrease in mean Drug and Drug Problems Perceptions Questionnaire scores across the total score mean: 55.2 (95% confidence interval, 52.2-58.3) versus 45.5 (95% confidence interval, 43.9-47.1), P<.001. Decreased score indicates improved attitude and perception. Discussion: A curriculum consisting of a blended classroom-simulation intervention was successful at improving several domains regarding perceptions of caring for patients with OUD. This educational intervention can serve as a model for health care systems with goal of improving patient outcomes and staff well-being. [ABSTRACT FROM AUTHOR]

Living with mental illness often subjects individuals to stigma and exclusion. While leisure plays an important role in supporting inclusion and mental health recovery, we know little about leisure initiatives designed explicitly to promote inclusion by countering stigma and exclusion. This study examined participant experiences in a leisure-based initiative known as a living library. This initiative provides opportunities for individuals living with mental illness to become living books and talk openly about their experiences of illness and recovery. Findings highlight participants' initial feelings of fear and uncertainty around sharing their stories, their perceptions of the living library as an effective method of education, and their newfound willingness to embrace identities as individuals living with mental illness who are proud of their lived experiences. These findings advance our thinking about storytelling as a powerful tool for recovery and suggest leisure initiatives supporting connection and understanding set the stage for inclusion. [ABSTRACT FROM AUTHOR]

Background: Peer support has been shown to reduce the incidence and severity of mental health disorders among firefighters. This pilot project had two aims: (1) to assess training satisfaction and knowledge, self-efficacy, and skills development of Texas firefighters participating in the International Association of Fire Fighters (IAFF) Peer Support Training, and (2) to determine if newly trained peer support specialists would use monthly phone supervision. Methods: The study included 14 Texas firefighters who enrolled in the IAFF Peer Support Training. Pre- and post-tests were administered to evaluate training satisfaction, skills development, self-efficacy, and behavioral health knowledge of participants. Use of phone supervision over 6 months following the training was also recorded. Results: Overall, participants reported high satisfaction with the training provided. While self-efficacy regarding detection of mental health issues and therapeutic empathy skills significantly improved following the training, participants did not show a significant improvement in knowledge regarding mental health. Attendance of participants to supervision calls was less than expected, although 71% attended at least one supervision call. Conclusions: This project was successful in increasing firefighters' self-efficacy and therapeutic empathy skills, and participants were highly satisfied with the training. However, further research on follow-up supervision of peer support trainees is needed. [ABSTRACT FROM AUTHOR]

Objective: Discriminatory practices in mental health care undermine the right to health of marginalized service users. Intersectional approaches enable consideration of multiple forms of discrimination that occur simultaneously and remain invisible in single-axis analyses. The authors reviewed intersectionality-informed qualitative literature on discriminatory practices in mental health care to better understand the experiences of marginalized service users and their evaluation and navigation of mental health care. Methods: The authors searched EBSCO, PubMed, MEDLINE, and JSTOR for studies published January 1, 1989–December 14, 2022. Qualitative and mixed-methods studies were eligible if they used an intersectional approach to examine discrimination (experiences, mechanisms, and coping strategies) in mental health care settings from the perspective of service users and providers. A qualitative evidence synthesis with thematic analysis was performed. Results: Fifteen studies were included in the qualitative evidence synthesis. These studies represented the experiences of 383 service users and 114 providers. Most studies considered the intersections of mental illness with race, sexual and gender diversity, or both and were performed in the United States or Canada. Four themes were identified: the relevance of social identity in mental health care settings, knowledge-related concerns in mental health care, microaggressions in clinical practice, and service users' responses to discriminatory practices. Conclusions: Discriminatory practices in mental health care lead to specific barriers to care for multiply marginalized service users. Universities and hospitals may improve care by building competencies in recognizing and preventing discrimination through institutionalized training. [ABSTRACT FROM AUTHOR]

Objective: Transgender youths are more likely than cisgender youths to need mental health care because of their high exposure to discrimination and victimization, including within health care systems. Accordingly, transgender youths have low care satisfaction and high rates of treatment dropout, further exacerbating existing mental health inequities. To reduce these inequities, mental health providers need knowledge and skills to enhance transgender youths' treatment engagement and benefits. However, a comprehensive set of practices addressing the needs of transgender youth patients and their providers does not exist. The authors developed gender-affirming psychotherapy (GAP), an evidence-informed set of skills and principles to augment mental health treatments for transgender youths. Methods: GAP was developed by using a human-centered design, a methodological approach for creating interventions that prioritize the needs of key stakeholders, which in this study included mental health providers and transgender youths and their parents (N=36). A scoping review of the literature and stakeholder focus groups were conducted to create GAP, which encompasses core principles and skills to enhance mental health services for transgender youths. Results: GAP encompasses 27 principles and 38 skills, organized within 10 domains. All principles and skills were designed to be relevant for various provider types (e.g., psychiatrists and social workers) and to be flexibly adapted to meet diverse patient needs. Conclusions: GAP offers a scalable and flexible approach to addressing the growing mental health care needs of transgender youths. The findings of this study suggest that a human-centered design is a feasible and efficient method for developing interventions to address health inequities. [ABSTRACT FROM AUTHOR]

Aims: Beyond causing physical discomfort, overactive bladder (OAB) is distressing to patients across a variety of psychosocial domains. In this qualitative component of a larger mixed methods study, we explore patients' lived experience with OAB to understand how this condition impacts individuals on a personal and social level, as well as their experiences interacting with the health care system. Methods: A total of 20 patients and 12 physicians completed a questionnaire and semi‐structured interview. The interview guide, developed in an iterative fashion by the authors, included questions about treatment decision making as well as experiences living with or treating OAB; this manuscript focuses on the questions probing lived experiences and interactions between patients and physicians. The interviews were recorded, transcribed and inductively coded and analyzed according to the principles of interpretive description to develop themes. Results: Analysis of patient and physician interviews yielded five key themes: isolation due to OAB diagnosis, social stigma associated with noticeable OAB symptoms, embarrassment from interactions with the health care system, feeling invalidated and dismissed by physicians, and OAB patients as a "vulnerable" population with "desperation" for cure. Conclusions: OAB causes patients marked distress beyond their physical symptoms; it causes feelings of isolation from friends and family and makes them feel embarrassed to discuss their condition with loved ones and physicians alike. Efforts to destigmatize OAB, validate patient experiences, and improve access to OAB care may help diminish the psychosocial burden of OAB. [ABSTRACT FROM AUTHOR]

Masks emerged as one of the few means of responding to the COVID-19 pandemic. A significant minority of Americans, however, resisted the emergent mask wearing norm. This study seeks to examine the ways that constructions of mask use as an appropriate alleviation of the threat posed by COVID-19 was disrupted in public discourse. It does so by employing a qualitative content analysis of comments made on Twitter, Reddit, and YouTube in response to a mask burning rally held in Boise, Idaho in March 2021. Guided by the literature on aligning activity, this analysis identifies four of the processes by which the positive definition of mask wearing was undermined. Through fragmentation, neutralization, dilution, and displacement, the official definition of mask use was complicated by competing definitions of conduct and also contested evaluations of identities. These findings provide further understanding of the obstacles to coordination during COVID-19 and the role that aligning activity plays as an obstacle to the social construction of danger in the absence of established norms. [ABSTRACT FROM AUTHOR]

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In Jamaica, stigma experiences of sex workers (SW), gay men and other men who have sex with men (MSM), and transgender women living with HIV remain understudied. To address this gap, we explored experiences of stigma and linkages with the HIV care cascade among key populations living with HIV in Jamaica, including cisgender women SW, MSM, and transgender women. This qualitative study involved n = 9 focus groups (FG), n = 1 FG per population living with HIV (SW, MSM, transgender women) in each of three sites (Kingston, St. Ann, Montego Bay). We also conducted key informant (KI) interviews. We applied thematic analysis informed by the Health Stigma and Discrimination (HSD) Framework. FG participants (n = 67) included SW (n = 18), MSM (n = 28), and trans women (n = 21); we interviewed n = 10 KI (n = 5 cisgender women, n = 5 cisgender men). Participant discussions revealed that stigma drivers included low HIV treatment literacy, notably misinformation about antiretroviral therapy (ART) benefits and HIV acquisition risks, and a lack of legal protection from discrimination. Stigma targets health (HIV) and intersecting social identities (sex work, LGBTQ identities, gender non-conformity, low socio-economic status). Stigma manifestations included enacted stigma in communities and families, and internalized stigma—including lateral violence. HIV care cascade impacts included reduced and/or delayed HIV care engagement and ART adherence challenges/disruptions. Participants discussed strategies to live positively with HIV, including ART adherence as stigma resistance; social support and solidarity; and accessing affirming institutional support. In addition to addressing intersecting stigma, future research and programing should bolster multi-level stigma-resistance strategies to live positively with HIV. [ABSTRACT FROM AUTHOR]

HIV prevalence among transgender women (TW) in Tijuana, Mexico is estimated at 22%. Pre-exposure prophylaxis (PrEP) reduces the risk of HIV acquisition by > 90%, though uptake in Tijuana has been low due to limited availability. The interplay between PrEP and gender stigmas may also serve as a barrier to PrEP uptake among TW in Tijuana. Experiences of gender- and PrEP- stigmas were assessed quantitatively (Quan) among 110 HIV-negative TW and qualitatively (Qual) among 17 TW through semi-structured interviews guide by the Health Stigma and Discrimination Framework. Qual findings were triangulated with Quant data to identify factors that may support gender affirmation and reduce PrEP stigma in an explanatory sequential Quan → Qual fashion. Most participants were < 40 years of age (80%), while approximately half had at least a high school education (48.2%) and were accessing gender-affirming hormone therapy (56.4%). Mean expectations of gender stigma were greatest for endorsing negative future expectations from others (M = 17.69; possible range 0–36). PrEP stigma was prominent among those who associated negative stereotypes with PrEP users, such as poor judgment (M = 45.91; possible range 14–70) and high personal risk attributes (M = 28.61; possible range 12–60). While PrEP knowledge was low among the qualitative sample, participants identified gender-, PrEP-, and intersectional- stigmas as potential barriers to PrEP uptake. Participants suggested that resilience strategies used to combat gender stigma could also mitigate PrEP stigma. Enhancing resilience skills at the intersection of gender and PrEP stigma may reduce these barriers, facilitating greater PrEP uptake as it becomes more available in Mexico. [ABSTRACT FROM AUTHOR]

Embracing diversity and promoting inclusion is a critical challenge for marketers to meet the diverse consumers' needs and have a positive social impact. Despite increasing attention to diversity and inclusion, and calls to address inequalities, there appears to be a lack of a thorough understanding of diversity and inclusion in consumer research, and how marketing can effectively contribute to an inclusive and equity‐oriented society. Previous reviews and conceptual articles often focus on specific types of diversity or contexts. This study aims to provide a comprehensive examination of diversity and inclusion in consumer research through a systematic literature review of 52 articles combined with the theory, context, characteristics, and methodology (TCCM) framework. Our findings highlight that companies can actively foster inclusion and enhance equity through their policies, also by addressing stigmatization and marginalization. A conceptual framework outlines the impacts of these policies on individuals, society, and company performances, followed by a detailed research agenda for future studies. This article emphasizes the role of marketing in fostering inclusion but also stimulates practitioners to contribute through policies beyond representation and advertising, such as service and product design, and ensuring vulnerable consumers access to resources. [ABSTRACT FROM AUTHOR]

Objectives: People living with HIV are aging. This study aimed to assess the factors influencing the requirements for geriatric nursing of older adults living with HIV (OALHIV). Methods: Convenience sampling was used to conduct a survey on the 295 OALHIV aged over 50 in Luzhou, China. Results: OALHIV had few needs for living care needs. Most people indicate a requirement for reducing medical costs. Regarding psychological comfort needs, disease privacy and confidentiality were the greatest requirement. Multivariable regression analyses found that social support had a positive influence on the requirements for geriatric nursing. Conclusion: It is necessary to provide more social support for OALHIV. Most importantly, China should incorporate OALHIV into national pension security plan, integrate various resources and improve social security for them. [ABSTRACT FROM AUTHOR]

The paper investigates reactions of Jews to the perceived risk of antisemitic incidents in Germany by using a mixed-methods design. First, findings from qualitative interviews with 21 German Jews are presented: They perceive Jewishness as a stigmatized identity which ‘spoils’ everyday interactions, often simply because it is linked to the ‘weight’ of German history. We derive two analytical types of reaction to perceptions of stigmatization: defensive efforts to hide one’s Jewish identity and intervening engagement to actively combat antisemitism. In the second part of the paper, we report the findings of a quantitative survey of 295 Jews living in Germany to answer the question who choses which type of reaction. Especially the characteristics of the area where Jews live and the specifics of their Jewish identity are important correlates for explaining variance in their reactions. [ABSTRACT FROM AUTHOR]

Background: Children with obesity may experience weight-based discrimination as a result of weight bias and stigma, which can have deleterious effects on their health and wellbeing, including increased risk of dysregulated, maladaptive, and disordered eating such as restriction, purging, and binging. Prior work has shown that weight bias occurs from healthcare workers caring for adults, but less is known about the prevalence of weight bias in the pediatric healthcare setting. Methods: We aimed to determine what proportion of pediatric healthcare professionals had attitudes of weight bias at our own institution by constructing a survey with questions from validated weight bias survey tools. Results revealed nearly half of all respondents had witnessed another healthcare professional make negative remarks about a patient with obesity, and many shared that they lacked the proper education/training and equipment to properly care for patients with obesity. Based on survey results, we created an electronic-based training module to educate healthcare professionals on weight bias and discrimination and how they may negatively affect care provided to children and families with obesity at our institution. Engagement with hospital leadership was a key strategy to ensure participation from medical and nursing/allied health staff in the survey, although only nursing/allied health leadership required the online training module resulting in limited physician engagement. Results: Feedback received regarding the training module was overwhelmingly positive. Conclusions: Our efforts illustrate that weight bias and discrimination exist in pediatric institutions, and that participation in a tailored electronic-based training module may be viewed as a helpful tool to raise awareness of how weight-based discrimination and bias can negatively affect patient care. Plain English Summary: Weight bias and discrimination are present in pediatric healthcare settings and can lead to negative health effects for children with obesity, including increased risk of dysregulated, maladaptive, and disordered eating such as restriction, purging, and binging. Scientific studies on development of methods to address weight bias among child healthcare professionals is limited. In this article, we describe how we measured weight bias among clinical providers and staff in a large pediatric teaching hospital, and how this helped us obtain approval from hospital leaders to create training to help these child healthcare professionals understand the harmful effects of weight bias. [ABSTRACT FROM AUTHOR]

Confidence in the police, a significant concern of sex workers across the globe, is an important gauge of their views of the legitimacy of law enforcement and their likelihood to seek help when in harms’ way. The purpose of this study is to explore sex worker confidence in police in one Canadian city after the enactment of the dramatically revised prostitution law in 2014, the Protection of Communities and Exploited Persons Act. In 2017–2018, a cross-section of active sex workers (N = 60) from Victoria, Canada, were interviewed about their personal and work lives under the criminal code law. Thematic analysis was carried out using the participants’ answers to these questions: (1) You said you have _____ confidence in the police. Please elaborate on why you feel this way about the police; (2) You said you had _____ interactions with police in the last 12 months? What happened, when, where, why, etc.? Have your interactions with the police changed in recent years? Our findings show the police’s treatment of sex workers is influenced by intersecting stigmas and structural factors that shape the confidence sex workers’ have in law enforcement. We provide greater contextualisation related to the confidence sex workers have in police, why lack of confidence may not always be synonymous with negative experiences, and why their distrust of the ‘institution of policing’ highlights the importance of having public policies that address the fundamental causes of sex worker victimisation and stigmatisation. [ABSTRACT FROM AUTHOR]

ABSTRACT This study focuses on Latino fathers and investigates the role that cultural concepts and fatherhood identity play in the stigma associated with having a child with a disability. Disability stigma is a widely held concept that acknowledges the role of culture; however, there is a lack of information on Latino fathers. Using a panel survey provider a US cross‐sectional survey was completed by 92 Latino fathers who had a child with a disability. Multiple regression was used to investigate the relationship of cultural Latino constructs (personalismo, machismo, caballerismo and respeto) and fatherhood identity on the stigma experiences of Latino fathers who have a child with a disability while controlling for the child's age and acculturation (R2 = 0.43, p < 0.001). Latino fathers with higher levels of personalismo (p = 0.05), and fatherhood identity (p < 0.001) had lower levels of stigma. Latino fathers with high levels of machismo had high levels of stigma (p < 0.001). There was no significant relationship between caballerismo and respeto towards stigma. Specific recommendations for Latino fathers include (1) the development of personalismo by focusing on the child–parent relationship; (2) a re‐frame of machismo to focus instead on caballerismo characteristics to de‐emphasize harmful effects on stigma experiences; and (3) heightening the identity as a father as a protective mechanism to strengthen resilience from stigma. [ABSTRACT FROM AUTHOR]

ABSTRACT The Victorian government's Alcohol and other drugs (AOD) workforce policy calls for greater recruitment of alcohol and other drugs nurse practitioners (AODNPs). However, frontline organisations in Victoria report several systemic barriers to their recruitment and retention. Additionally, there is scant Australian literature that examines the experiences of AODNP in opioid agonist treatment (OAT) provision in regional/rural areas. This research aims to address this gap by examining the AODNP workforce issues in delivering pharmacotherapy treatments in regional/rural areas of Victoria. Using an interpretative phenomenological approach, we conducted qualitative, in‐depth interviews with 11 OAT prescribing AODNP's working in regional or rural Victoria. We analysed transcripts using reflective thematic analysis and generated three themes: (1) Professional motivations and values, (2) Enablers to professional role and (3) Barriers to professional role. The findings suggest that AODNPs in regional/rural areas are a dedicated workforce who provide holistic and integrated care for OAT clients. AODNPs play an important role in reducing and providing timely and subsidised health care for OAT clients living in regional/rural locations. AODNPs face many systemic and organisational barriers. These include inadequate funding for AODNP positions to prescribe pharmacotherapy treatments, lack of understanding of the AODNP professional role at the executive/management level within organisations and irregular access to supervision, mentoring, training and education. Also, endemic stigma in the health system acts as a barrier in recruiting and supporting AODNP positions that focus on care for OAT clients. [ABSTRACT FROM AUTHOR]