Browsing by Author "Samuels, Tresan"
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- ItemHealthcare providers’ stigma towards people with psychogenic non-epileptic seizures(Stellenbosch : Stellenbosch University, 2023-03) Samuels, Tresan; Pretorius, Chrisma; Stellenbosch University. Faculty of Arts and Social Sciences. Department of Psychology.ENGLISH ABSTRACT: Psychogenic Non-Epileptic Seizures (PNES) is a mental health condition through which seizures are somatically manifested as a result of psychological distress. Owing to PNES, patients presenting with seizures which are of a psychological, rather than a physiological origin, are often perceived to be unpredictable and less deserving of care by healthcare providers (HCPs). This is mainly related to the general attitude held within the wider healthcare system that PNES should not be regarded as a clinical entity, as well as HCPs’ relative limited knowledge about the condition. As a result, PNES patients face a high degree of stigma from HCPs, which thus has a negative effect on their diagnostic and treatment procedures. Moreover, there is limited awareness about stigma towards people with PNES. The majority of PNES studies have been conducted within well-resourced settings, and not enough attention has been paid to stigma directed towards these patients. Additionally, very little is known about the PNES population within South Africa. However, what is known, is that multiple barriers exist for healthcare services in South Africa, inclusive of a lack of resources and accessibility of HCPs, which may, in turn, heighten stigma. This study thus aimed to explore HCPs’ stigma towards people with PNES. Particular focus was given to understanding HCPs’ experience and knowledge of PNES, discovering the attitudes held by HCPs towards working with PNES as a mental health condition, and exploring HCPs’ views of how their stigma manifests towards people with PNES. Thirteen HCPs, who are specialised in the diagnosis and/or treatment and management of PNES, were recruited through purposive and snowball sampling, and formed the final participant group. Semi-structured individual interviews with broad open-ended questions were utilised to obtain in-depth information from the HCPs. Their responses were analysed through a reflexive thematic process. All themes that were identified during the data analysis stage were conceptualised according to The Health Stigma and Discrimination Framework (Stangl et al., 2019). Particularly, six main themes were identified, namely: (i) contextual factors (which indirectly influence stigma); (ii) HCPs’ frustration with PNES patients; (iii) HCPs’ relative level of knowledge; (iv) diagnostic terms; (v) stigma, and (vi) strategies to reduce stigma. The findings suggest that HCPs tended to be overwhelmed with their work schedule owing to limited aid and support, and, in turn, were unable to provide sufficient services to their patients. Subsequently, the HCPs believed that their patients would perceive them as being unfair and stigmatising. Additionally, the HCPs expressed that they experienced great degrees of frustration with their PNES patients, owing to their patients’ inability to accept their diagnosis and overall personality. This unfortunately resulted in them developing negative feelings towards their patients. Furthermore, when the HCPs did not have an adequate understanding of PNES, they were less able to shield themselves from non-factual and stigmatising beliefs about the condition. A pertinent problem identified was the use of inappropriate diagnostic terms, as well as the inability to agree on a single diagnostic term for PNES, which consequently led to patients’ symptoms being disregarded or misunderstood. In addition, the HCPs presented with mixed reviews about their own personal stigma, with many of them also viewing their colleagues as the actual stigmatising individuals. Some HCPs reported that a hospital setting contributed towards stigma, whereas others did not hold this belief. The HCPs also disclosed that many HCPs, in general, tend to be dismissive and display negative attitudes towards their PNES patients. It was often noted that HCPs would refer their patients, as they no longer wished to engage with them. Many HCPs also questioned if their patients’ symptoms were real. Whilst the HCPs were able to share their perspectives on stigma towards people with PNES, they also provided valuable insights in relation to strategies to reduce stigma, thus demonstrating their genuine interest in wanting the best outcomes for their patients. This current study is the first to explore stigma towards people with PNES within South Africa. Further research is needed in relation to this topic in order to raise more awareness about PNES and stigma.