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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...

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Autores principales: Bohren, Meghan A., Vazquez Corona, Martha, Odiase, Osamuedeme J., Wilson, Alyce N., Sudhinaraset, May, Diamond-Smith, Nadia, Berryman, Jim, Tunçalp, Özge, Afulani, Patience A.
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
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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.
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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
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