Systematic review of interventions for reducing stigma experienced by children with disabilities and their families in low and middle-income countries: state of the evidence.
OBJECTIVES: To identify and assess the evidence for interventions to reduce stigma experienced by children with disabilities and their families in low and middle-income settings.
METHODS: Systematic review of seven databases (MEDLINE, EMBASE, Global Health, PsycINFO, Social Policy and Practice, CINAHL, IBSS) for studies of interventions that aimed to reduce stigma for children with disabilities published January 2000 to April 2018. Data were extracted on study population, study design, intervention level(s) and target group, and type(s) of stigma addressed. A narrative approach was used to synthesise the results.
RESULTS: Twenty studies were included. The majority (65%) of interventions targeted enacted stigma (negative attitudes) and the most common intervention approach was education/training (63%). Over half (54%) of interventions were delivered at the organisational/ institutional level and only four studies targeted more than one social level. The most common disability targeted was epilepsy (50%) followed by intellectual impairment (20%). The majority of studies (n=18/20, 90%) found a reduction in a component of stigma, however most (90%) studies had a high risk of bias.
CONCLUSIONS: This review highlights the lack of quality evidence on effective stigma-reduction strategies for children with disabilities. Validation and consistent use of contextually relevant scales to measure stigma may advance this field of research. Studies that involve people with disabilities in the design and implementation of these strategies are needed.