ICRAAS key research themes

Stigma models and approaches
Most articles on stigma and discrimination refer to the work of Goffman and many also to the dichotomy of felt and enacted stigma developed by Scambler. First regarded as a label, stigma has recently come to be seen as dynamic and socially constructed.

Efforts to reduce stigma must engage the wider context in which it occurs. Many root causes of stigma can be identified and determinants or factors leading to stigma can be recognized. The first key research theme is to identify causes and determinants of stigma and to develop an operationally useful concept or model of health-related stigma.

Stigma assessment and measurement
Different approaches have been used or recommended to assess health-related stigma. Within each of these, different research methods have been used, including questionnaires, qualitative methods, indicators and scales.

Despite enormous cultural diversity across the world, the areas of life affected are remarkably similar. They include marriage, interpersonal relationships, employment, education, mobility, leisure activities and attendance at social and religious functions. This suggests that a set of instruments to assess health-related stigma among different health conditions could be developed. Adapting, developing and/or testing instruments to assess key features of stigma and discrimination is the second key research theme.

Effective stigma reduction interventions and strategies
Stigma reduction interventions and strategies are being implemented at several levels. These are the intrapersonal, interpersonal, organizational/institutional, community and governmental/structural level. Although a lot of work has been carried out on stigma and stigma reduction, not much work has been done on assessing the effectiveness of stigma reduction strategies.

Strategies identified as effective mainly concentrated on the individual and the community level. The evidence so far shows that these approaches appear effective at least in the short term and on a small scale. In order to reduce health-related stigma and discrimination significantly, single level and single-target group approaches are not enough. What is required are multi-faceted, multi-level and long-term programmes. The third key theme of the ICRAAS is therefore to identify crosscutting strategies and models for interventions for reducing health-related stigma at the various levels of implementation.

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