Investigating new opportunities to combat stigma in healthcare through a “universal” approach: findings from a longitudinal study of healthcare workers in Mombasa, Kenya

Résumé

Stigma plays a significant role in health and healthcare. To date, anti-stigma efforts have primarily focused on specific individual domains (e.g., mental health, HIV), resulting in fragmented efforts to address many different “stigmas.” Theorists now advocate for shifting toward a universal framework to understand and respond to stigma. To empirically test the potential utility of stigma as a universal concept, we analyzed data from 453 healthcare workers participating in a prospective cohort in Mombasa, Kenya. Across four waves comprising 925 points of data (June 2023–December 2024), we found strong correlations between all stigma domains. For example, stigma toward abortion was positively correlated with stigma toward mental health and vice versa ( ρ = 0.53, 95% CI: 0.47, 0.56). Using structural equation modeling, we tested two models for organizing stigma domains. In the best-fitted model, stigma domains were organized into two thematic categories: conditions & experiences (mental health, abortion, sexual violence, early pregnancy) and behaviors & identities (sex work, drug use, sexual and gender minorities). These two domains were then further organized into stigma as an overarching latent variable, with strong independent associations ( β = 0.65, 95% CI: 0.57, 0.73 and β = 0.61, 95% CI: 0.54, 0.68, respectively). Further, stigma as a latent variable was independently associated with healthcare workers’ individual dispositions, including agreeableness ( B = −0.19, 95% CI: −0.34, −0.05) and acceptance of others ( B = −0.28, 95% CI: −0.39, −0.18). These results support stigma as a “universal” heuristic among healthcare workers. Anti-stigma interventions should reduce domain-specific activities toward a “universal precautions” approach targeting larger worldviews, which can improve scalability and resource-efficiency.

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