Developing STRETCH and Understanding Stigmatisation

War Child conducted a formative study in the Democratic Republic of the Congo (DR Congo) during summer 2018 to gather insights into processes of stigmatisation. Stigma research is often conducted on health-related stigma such as HIV/AIDS or mental health - yet other drivers of stigmatisation persist.

A conceptual framework was developed by researchers to strengthen research and programmatic responses to stigmatisation. In DR Congo, a qualitative study was undertaken to see whether this conceptual framework was also valid for non-health related stigmas.

That turned out to be the case - which provides a promising insight into the development of a common stigma reduction approach. The results of this research have now been published in a new academic paper - and four key insights are shared below.

Research overview

The research was undertaken to learn more about processes of stigmatisation and ultimately to inform the development of a common stigma reduction intervention

Location: Village setting, Kalehe Territory, South Kivu, DR Congo

Timeframe: June and July 2018

Participants: People from the general population (70 participants) and people affected by stigma (48 participants) were included in this study. In total there were 118 participants.

People affected by stigma included in the study: Unmarried mothers, children formerly associated with armed forces and groups, and local indigenous people.

Research design: Qualitative design with Reaction-Based Group Exercise workshops. The data was analysed using the Health Stigma and Discrimination Framework.

The processes of stigma we examined

The Triggers: Commonalities and differences of drivers, or perceptions that underpin stigma

The Facilitators: The contributing or mitigating factors which influence stigmatisation.

The Manifestations: Practices and experiences of stigmatisation

Four key insights into stigmatisation

1. Perceived danger features as the main driver of stigma for all groups in this study. This implies the general population hold beliefs about unmarried mothers, children formally associated with armed forces and an indigenous population that frame these groups as dangerous. Danger can be seen in multiple forms - not only physical danger but also the danger to take up the other person’s behaviour.
2. A crucial factor that contributes to or mitigates stigma is livelihood. Within the village in Kalehe Territory the ability to generate a liveable income mitigated stigma, while experiencing poverty or needing to depend on others is a factor that exacerbated stigma.
3. People experiencing stigma feel devalued, neglected and treated inequitably. All groups included in the study are stereotyped by the general population and experience restrictions accessing health services, paid work and legal support - negatively affecting their quality of life.
4. Despite many experiences of stigmatisation, positive experiences and messages were also shared during the research - again confirming that stigmatisation is not homogeneous within a community.

Common stigma reduction approach

Though there are stigma-specific differences, there are commonalities in stigmatisation in all three groups. This finding, as well as the systematic review conducted by our team (Hartog et. al, 2020), encourages the development of a common stigma reduction approach which is applicable across multiple stigmas.

For further information about our ongoing research into stigmatisation contact lead researcher Kim Hartog.

This research was undertaken as part of the process of developing an evidence-based common stigma reduction approach called STRETCH, consisting of strategies at multiple socio-ecological levels, delivered by non-professionals. STRETCH is an enabling component of our Care System.