Cargando…
Strategies to reduce stigma and discrimination in sexual and reproductive healthcare settings: A mixed-methods systematic review
Stigma and discrimination are fundamental causes of health inequities, and reflect privilege, power, and disadvantage within society. Experiences and impacts of stigma and discrimination are well-documented, but a critical gap remains on effective strategies to reduce stigma and discrimination in se...
Autores principales: | , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10021469/ https://www.ncbi.nlm.nih.gov/pubmed/36962453 http://dx.doi.org/10.1371/journal.pgph.0000582 |
_version_ | 1784908492817039360 |
---|---|
author | Bohren, Meghan A. Vazquez Corona, Martha Odiase, Osamuedeme J. Wilson, Alyce N. Sudhinaraset, May Diamond-Smith, Nadia Berryman, Jim Tunçalp, Özge Afulani, Patience A. |
author_facet | Bohren, Meghan A. Vazquez Corona, Martha Odiase, Osamuedeme J. Wilson, Alyce N. Sudhinaraset, May Diamond-Smith, Nadia Berryman, Jim Tunçalp, Özge Afulani, Patience A. |
author_sort | Bohren, Meghan A. |
collection | PubMed |
description | Stigma and discrimination are fundamental causes of health inequities, and reflect privilege, power, and disadvantage within society. Experiences and impacts of stigma and discrimination are well-documented, but a critical gap remains on effective strategies to reduce stigma and discrimination in sexual and reproductive healthcare settings. We aimed to address this gap by conducting a mixed-methods systematic review and narrative synthesis to describe strategy types and characteristics, assess effectiveness, and synthesize key stakeholder experiences. We searched MEDLINE, CINAHL, Global Health, and grey literature. We included quantitative and qualitative studies evaluating strategies to reduce stigma and discrimination in sexual and reproductive healthcare settings. We used an implementation-focused narrative synthesis approach, with four steps: 1) preliminary descriptive synthesis, 2) exploration of relationships between and across studies, 3) thematic analysis of qualitative evidence, and 4) model creation to map strategy aims and outcomes. Of 8,262 articles screened, we included 12 articles from 10 studies. Nine articles contributed quantitative data, and all measured health worker-reported outcomes, typically about awareness of stigma or if they acted in a stigmatizing way. Six articles contributed qualitative data, five were health worker perspectives post-implementation and showed favorable experiences of strategies and beliefs that strategies encouraged introspection and cultural humility. We mapped studies to levels where stigma can exist and be confronted and identified critical differences between levels of stigma strategies aimed to intervene on and evaluation approaches used. Important foundational work has described stigma and discrimination in sexual and reproductive healthcare settings, but limited interventional work has been conducted. Healthcare and policy interventions aiming to improve equity should consider intervening on and measuring stigma and discrimination-related outcomes. Efforts to address mistreatment will not be effective when stigma and discrimination persist. Our analysis and recommendations can inform future intervention design and implementation research to promote respectful, person-centered care for all. |
format | Online Article Text |
id | pubmed-10021469 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-100214692023-03-17 Strategies to reduce stigma and discrimination in sexual and reproductive healthcare settings: A mixed-methods systematic review Bohren, Meghan A. Vazquez Corona, Martha Odiase, Osamuedeme J. Wilson, Alyce N. Sudhinaraset, May Diamond-Smith, Nadia Berryman, Jim Tunçalp, Özge Afulani, Patience A. PLOS Glob Public Health Research Article Stigma and discrimination are fundamental causes of health inequities, and reflect privilege, power, and disadvantage within society. Experiences and impacts of stigma and discrimination are well-documented, but a critical gap remains on effective strategies to reduce stigma and discrimination in sexual and reproductive healthcare settings. We aimed to address this gap by conducting a mixed-methods systematic review and narrative synthesis to describe strategy types and characteristics, assess effectiveness, and synthesize key stakeholder experiences. We searched MEDLINE, CINAHL, Global Health, and grey literature. We included quantitative and qualitative studies evaluating strategies to reduce stigma and discrimination in sexual and reproductive healthcare settings. We used an implementation-focused narrative synthesis approach, with four steps: 1) preliminary descriptive synthesis, 2) exploration of relationships between and across studies, 3) thematic analysis of qualitative evidence, and 4) model creation to map strategy aims and outcomes. Of 8,262 articles screened, we included 12 articles from 10 studies. Nine articles contributed quantitative data, and all measured health worker-reported outcomes, typically about awareness of stigma or if they acted in a stigmatizing way. Six articles contributed qualitative data, five were health worker perspectives post-implementation and showed favorable experiences of strategies and beliefs that strategies encouraged introspection and cultural humility. We mapped studies to levels where stigma can exist and be confronted and identified critical differences between levels of stigma strategies aimed to intervene on and evaluation approaches used. Important foundational work has described stigma and discrimination in sexual and reproductive healthcare settings, but limited interventional work has been conducted. Healthcare and policy interventions aiming to improve equity should consider intervening on and measuring stigma and discrimination-related outcomes. Efforts to address mistreatment will not be effective when stigma and discrimination persist. Our analysis and recommendations can inform future intervention design and implementation research to promote respectful, person-centered care for all. Public Library of Science 2022-06-15 /pmc/articles/PMC10021469/ /pubmed/36962453 http://dx.doi.org/10.1371/journal.pgph.0000582 Text en © 2022 Bohren et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Bohren, Meghan A. Vazquez Corona, Martha Odiase, Osamuedeme J. Wilson, Alyce N. Sudhinaraset, May Diamond-Smith, Nadia Berryman, Jim Tunçalp, Özge Afulani, Patience A. Strategies to reduce stigma and discrimination in sexual and reproductive healthcare settings: A mixed-methods systematic review |
title | Strategies to reduce stigma and discrimination in sexual and reproductive healthcare settings: A mixed-methods systematic review |
title_full | Strategies to reduce stigma and discrimination in sexual and reproductive healthcare settings: A mixed-methods systematic review |
title_fullStr | Strategies to reduce stigma and discrimination in sexual and reproductive healthcare settings: A mixed-methods systematic review |
title_full_unstemmed | Strategies to reduce stigma and discrimination in sexual and reproductive healthcare settings: A mixed-methods systematic review |
title_short | Strategies to reduce stigma and discrimination in sexual and reproductive healthcare settings: A mixed-methods systematic review |
title_sort | strategies to reduce stigma and discrimination in sexual and reproductive healthcare settings: a mixed-methods systematic review |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10021469/ https://www.ncbi.nlm.nih.gov/pubmed/36962453 http://dx.doi.org/10.1371/journal.pgph.0000582 |
work_keys_str_mv | AT bohrenmeghana strategiestoreducestigmaanddiscriminationinsexualandreproductivehealthcaresettingsamixedmethodssystematicreview AT vazquezcoronamartha strategiestoreducestigmaanddiscriminationinsexualandreproductivehealthcaresettingsamixedmethodssystematicreview AT odiaseosamuedemej strategiestoreducestigmaanddiscriminationinsexualandreproductivehealthcaresettingsamixedmethodssystematicreview AT wilsonalycen strategiestoreducestigmaanddiscriminationinsexualandreproductivehealthcaresettingsamixedmethodssystematicreview AT sudhinarasetmay strategiestoreducestigmaanddiscriminationinsexualandreproductivehealthcaresettingsamixedmethodssystematicreview AT diamondsmithnadia strategiestoreducestigmaanddiscriminationinsexualandreproductivehealthcaresettingsamixedmethodssystematicreview AT berrymanjim strategiestoreducestigmaanddiscriminationinsexualandreproductivehealthcaresettingsamixedmethodssystematicreview AT tuncalpozge strategiestoreducestigmaanddiscriminationinsexualandreproductivehealthcaresettingsamixedmethodssystematicreview AT afulanipatiencea strategiestoreducestigmaanddiscriminationinsexualandreproductivehealthcaresettingsamixedmethodssystematicreview |