Paterson Amy, Jones Benjamin, Kabajaasi Olive, Cheyne Ashleigh, Tulunay Harun, Hadson Kkunsa, Stolow Jeni, Gobat Nina, Olliaro Piero, Rojek Amanda
Pandemic Sciences Institute, University of Oxford, Old Road Campus, Roosevelt Drive, Oxford, OX3 7DQ, UK.
Nuffield Department of Medicine, Health Systems Collaborative, Oxford, UK.
Sci Rep. 2025 May 2;15(1):15339. doi: 10.1038/s41598-025-98995-w.
Stigma is widely observed during (re)emerging infectious disease outbreaks, contributing to psychological distress, social isolation, and care-seeking hesitancy. Despite this, it is often inadequately addressed in public health responses, partly due to the lack of a fit-for-purpose approach. The objective of this study was to develop a conceptual model to facilitate structured consideration of stigma during (re)emerging disease outbreaks. We conducted 34 in-depth interviews with international stakeholders across 25 outbreak-prone diseases, including emergency response leaders, frontline responders, researchers, and community advocates. We analysed transcripts using thematic analysis, integrating insights from social and behavioural theories to refine the model. We introduce the hourglass stigma model, a theory-informed conceptualisation of stigma in outbreaks. The model consists of five domains (major themes): context, thoughts, emotions, manifestations, and impact. Within each domain there are key considerations, such as the influence of response measures on concealability (context), the association of certain diseases with 'dirtiness' due to hygiene-dominant messaging (thoughts), the negative effects of fear-based appeals (emotions), the enactment of stigma due to unconscious bias (manifestations), and the enduring consequences of (mis)trust in institutions (impact). The hourglass model can be used to inform operational tools, ensuring stigma is adequately addressed in outbreak preparedness and response activities.
在（再）发传染病暴发期间，污名化现象普遍存在，会导致心理困扰、社会隔离和寻求治疗的犹豫。尽管如此，在公共卫生应对措施中，污名化问题往往没有得到充分解决，部分原因是缺乏适用的方法。本研究的目的是开发一个概念模型，以便在（再）发疾病暴发期间对污名化进行结构化考量。我们对涉及25种易暴发疾病的国际利益相关者进行了34次深入访谈，这些利益相关者包括应急响应领导人、一线响应者、研究人员和社区倡导者。我们使用主题分析法对访谈记录进行分析，整合社会和行为理论的见解以完善该模型。我们引入了沙漏污名模型，这是一种基于理论的疾病暴发期间污名化概念化模型。该模型由五个领域（主要主题）组成：背景、想法、情绪、表现和影响。每个领域都有一些关键考量因素，例如应对措施对隐蔽性的影响（背景）、由于以卫生为主的信息传递导致某些疾病与“肮脏”的关联（想法）、基于恐惧的呼吁的负面影响（情绪）、无意识偏见导致的污名化行为（表现）以及对机构的（误）信任的持久后果（影响）。沙漏模型可用于为操作工具提供信息，确保在暴发防范和应对活动中充分解决污名化问题。
