Bibliographic record
Abstract
Health-related stigma—characterised by stereotyping, prejudice, and discrimination in contexts of power—is a widespread issue that affects people across the globe, in both high- and low-income settings. It operates not only at the individual level but also through relationships, families, communities, organisations, and institutions, including legal and policy systems. While research on health-related stigma is proliferating, it remains unclear how stigma may be shaped and impact people differently depending on their social and cultural context. Additionally, we still lack a clear understanding of how stigma operates across different social levels, from personal experiences and interpersonal dynamics to broader social and structural forces. This thesis aims to explore how health-related stigma is characterised and manifests in the daily lives of men and women in context, focusing specifically on cultural and gendered interactions within and across socioecological levels (intra-, interpersonal and structural). By uncovering these mechanisms, this thesis seeks to offer recommendations for contextually tailored stigma assessment and reduction strategies. Using a qualitative case study design, this thesis presents research on two specific stigmatised health conditions in the field of mental and physical health: ADHD and leprosy. Studies set out to collect and analyse perspectives and experiences various stakeholder groups on health-related stigma towards men and women, including persons affected by stigmatised conditions, family members, educational and health professionals as well as stigma researchers, using semi-structured interviews, FGDs and survey research complemented by literature review and researcher reflections. Both case studies illustrate differences in drivers and characterisations of stigma, including variations in the explicitness or subtlety of stigma related to ADHD and leprosy. However, there are common stigma manifestations – encompassing social exclusion, rejection, and reduced support and care. In terms of stigma assessment, the findings highlight the need for improved stigma assessment tools, including better measurement properties sensitive to cultural nuances and measuring actual differential treatment rather than reported behaviours (e.g., explicit stigma), among others. In terms of stigma reduction, case studies reveal how key cultural and/or gendered interactions contribute to shaping stigma, revealing critical intervention points per context (e.g., accessible and personalised (peer) support services for ADHD in the Netherlands and family support and engagement in health care for leprosy in Nepal). Overall, these findings underscore the critical need for accessible and quality health and support services, as well as the involvement of key stakeholder groups such as individuals with lived experiences, family members, and professionals in mitigating health-related stigma. Finally, the thesis offers recommendations for exploring and addressing contextual and cultural nuances of health-related stigma in the future.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.007 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.013 | 0.031 |
| Scholarly communication | 0.014 | 0.008 |
| Open science | 0.001 | 0.015 |
| Research integrity | 0.004 | 0.005 |
| Insufficient payload (model declined to judge) | 0.017 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".