Exploring stigma of physical health conditions across low and lower-middle income countries: a secondary analysis of a global systematic review

IntroductionStigma undermines health equity by impeding engagement in care and worsening outcomes. Systematic reviews of stigma are primarily from high-income countries, focus on specific conditions, especially mental illness, and employ heterogeneous stigma measures. Despite bearing a disproportionate burden of disease, low-income (LIC) and lower-middle-income (LMIC) countries remain underrepresented in existing reviews. This study characterizes stigma definitions, measures, impacts, and interventions in physical health conditions across LICs and LMICs.MethodsThis secondary analysis included 137 publications, previously identified through a global systematic review, reporting on patient or caregiver stigma of physical health conditions among LIC/LMIC populations. Data on definitions, measurements, and interventions were utilized from a primary review. Two reviewers extracted supplemental data regarding the study’s conceptualization and outcomes and conducted a quality appraisal.ResultsAmong the 137 studies (32 LIC, 105 LMIC), 75.2% used cross-sectional designs, 67.2% focused on adults, and 75.9% included populations with communicable diseases, including HIV, TB, and leprosy. Stigma definitions and measures varied widely, with uneven coverage of stigma dimensions. Negative mental health outcomes were commonly associated with stigma related to physical conditions (57.7%). Only 13.1% of studies evaluated stigma interventions, primarily including social support or health education, with heterogenous intervention designs, outcome definitions, and follow-up periods. Our quality appraisal demonstrated limited use of population-validated and culturally adapted stigma tools.ConclusionStigma research in LIC/LMICs has primarily been conducted in middle-income countries and focused on adults with communicable diseases, leaving gaps for stigma research in non-communicable diseases and pediatric populations. Future work should prioritize development of culturally adapted stigma frameworks and measures to improve patient outcomes in LIC/LMICs.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD42023433176.