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. Keywords: chronic obstructive pulmonary disease, COPD, stigma, shame, smoking, integrative review