Stigma Experiences in People with Chronic Obstructive Pulmonary Disease: An Integrative Review.

Background People with chronic obstructive pulmonary disease (COPD) are stigmatized by smoking history. Although little is known about COPD-related stigma, it can adversely affect self-management and quality of life. Objective To synthesize relevant scientific literature exploring stigma experiences and their impacts on people with COPD. Methods CINAHL/PsycINFO/PubMed/Scopus were searched for relevant studies. Findings were organized using Major et al's conceptual model. Results Fifteen studies documented COPD-related stigma processes: enacted, felt, internalized, and anticipated. Moderating factors included visibility, origin, and illness perception. Individual-level stigma responses included emotional distress, limited social interactions, and negative effects on medication adherence and help-seeking. Social/community-level stigma experiences included healthcare provider and employer behaviors. Smoking is interwoven throughout all domains of stigma processes and responses to stigma. Conclusion Substantial evidence documents processes, moderating factors, and individual and social/community responses to the complex phenomenon of COPD-related stigma; however, prevalence of COPD-related stigma and its health effects are unclear.