|Causes and Impact of Stigma in Chronic Obstructive Pulmonary Disease: A Qualitative Meta-Synthesis
|A. Healy R. Cahalan
|University of Limerick
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|Asthma and COPD
COPD is a leading cause of morbidity and mortality internationally. The number of people with COPD around the world is growing, causing an increase in the socioeconomic burden of the disease. Stigmatisation negatively impacts healthcare utilisation and quality of life for people with COPD (pwCOPD). Although COPD-associated stigma has been explored in several small-scale studies, evidence on its causes and implications has not yet been synthesised.
This study aims to explore the phenomenon of stigma in COPD through its causes and impact on pwCOPD.
A qualitative meta-synthesis was conducted and reported in line with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) statement. Studies for screening were identified by systematic searching of CINAHL, MEDLINE, EMBASE and PubMed plus hand checking reference lists of relevant articles. The CASP tool was used for quality appraisal. NVivo Plus software facilitated use of Braun and Clarke’s thematic analysis framework for data synthesis.
Nine high-quality studies were included in the synthesis. Three themes were identified as causes of COPD-related stigma: 1) visibility of COPD; 2) link between cigarette smoking and COPD; 3) feeling discredited by society. PwCOPD reported that the obviousness of their disease symptoms and their requirement for assistive equipment in public caused them to be stigmatised. The close causative link between cigarette smoking and COPD led to the perception of COPD as a self-inflicted disease, generating further stigmatisation. Results highlighted that stigmatisation also stemmed from a societal disapproval of COPD which was perpetuated by the behaviours of members of the public and healthcare professionals, plus the undesirable portrayal of pwCOPD in smoking cessation campaigns.
An additional three themes described the impact of stigma on pwCOPD: 1) loss of previous societal role; 2) a changed sense of self; 3) the adopting of strategies to avoid stigmatisation. PwCOPD described the reduced social interaction and limited employment prospects that they experienced secondary to COPD-related stigma, as others did not wish to employ or associate with an individual who was visibly unwell. Stigma negatively impacted the identity, self-image and self-worth of pwCOPD. Participants of included studies adjusted their lifestyle to avoid stigmatisation, including camouflaging their physical limitations and volunteering personal information to strangers to avoid speculation.
Stigmatisation of COPD stems from society’s negative perceptions of the disease and people with the disease and has several adverse psychosocial and lifestyle implications for pwCOPD. Future research, including mixed-methods studies, would facilitate the comparison of the qualitative and quantitative components of COPD-related stigma, and the varied levels of stigma experienced by people living with lifestyle mediated and non-lifestyle mediated diseases.