Perception of Stigma on Continuity of Care Among Women Living with Chronic Pain in Accra, Ghana

Abstract Title: Perception of Stigma on Continuity of Care Among Women Living with Chronic Pain in Accra, Ghana

Background:

Perceived social stigma among women with chronic pain conditions may be a significant barrier in effective pain management and lead to poor patient compliance.1 Women are also less likely to be taken seriously regarding their pain,2 which can lead to pain mismanagement and social stigma. While there are many studies involving chronic pain and related stigma in the United States and other parts of the world, there is insufficient research on the topic in developing countries like Ghana, despite the magnitude of women who may be living with chronic pain and are experiencing stigma. 

My project aims to fill a gap in the literature and produce important scholarship regarding chronic pain management among women in Ghana.

 
 

Purpose/Objectives:

The aim of this study is to examine the relationship between perceived social stigma and continuous adherence to care in Ghanaian women living with chronic pain.

While women are more likely to report chronic pain, pain research is dominated by male animals and humans.3 As a consequence, chronic pain conditions that almost exclusively affect women are poorly understood and can lead to pain mismanagement and social stigma. Thus, it is vital that current research efforts address gender bias and include women in chronic pain research. Perceived stigma from healthcare workers, family members and other members of society can make the person living with chronic pain feel isolated or ashamed. It is important to investigate the effect that perceived stigma has on chronic pain conditions because perceived stigma has been linked to reduced life quality and treatment adherence.4

 



Method:

An analytical cross-sectional study was conducted in June 2022 at the Korle Bu Teaching Hospital in Accra, Ghana. The pain clinic nurse recruited thirty-eight (38) participants for the study and obtained informed consent prior to enrollment.

Inclusion Criteria:

Female patients 18 years old and above with chronic pain conditions.

Female patients who have been attending the pain clinic for more than 6 months.

Female patients who consent to participate.

Structured interviews were used to collect data on the socio-demographic characteristics and appointment adherence of female patients with chronic pain conditions.

Adherence was classified as continuous or non-continuous. Continuous adherence was defined as attending all scheduled chronic pain-related appointments over a 6-month period.

Explanatory Model Interview Catalogue (EMIC) stigma scale to assess the stigma associated with participants’ chronic pain condition.

Results:

Thirty-eight (38) participants were recruited into the study with the mean age of 54(±16.4).  Lower back pain was the most common chronic pain condition (78.9%) presented to the pain clinic. Adherence to care was continuous among 55% of participants and non-continuous among 45%. The mean EMIC stigma scores were higher for non-continuous adherence compared to the continuous adherence to care (7.1 ±1.4 vs 5.0±0.8; p-value =0.168). There was no significant association between adherence to care and EMIC stigma score (OR 0.91; 95% CI0.79-1.04).

Conclusions: We conclude that women with chronic pain who experience social stigma are less likely to continuously adhere to pain care.
However, the results of this study should be considered in the context of its limitations. It was a small study (n=38) conducted over a short period of time. Therefore, it should be considered an exploratory study.
Study recruitment was conducted by a trusted pain clinic nurse, who then referred eligible participants to the study team for enrollment. Thus, it is important to note that this study represents a convenience sample of those in care and selection bias could be present.
Additionally, given that the study took place at the pain clinic, the perspectives of patients who were lost to follow up care were not represented in this study.
Further research is needed to explore the impact of stigma on continuous pain care engagement in Ghana.

References: 1. Khan N, Kausar R, Khalid A, Farooq A. Gender differences among discrimination & stigma experienced by depressive patients in Pakistan. Pak J Med Sci. 2015;31(6):1432-1436. doi:10.12669/pjms.316.8454
2. Samulowitz A, Gremyr I, Eriksson E, Hensing G. "Brave Men" and "Emotional Women": A Theory-Guided Literature Review on Gender Bias in Health Care and Gendered Norms towards Patients with Chronic Pain. Pain Res Manag. 2018;2018:6358624. Published 2018 Feb 25.
3. Miller A. Gender Bias and the Ongoing Need to Acknowledge Women’s Pain. Pract Pain Manag. 2018;18(5).
4. Khan N, Kausar R, Khalid A, Farooq A. Gender differences among discrimination & stigma experienced by depressive patients in Pakistan. Pak J Med Sci. 2015;31(6):1432-1436. doi:10.12669/pjms.316.8454