{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T08:39:34Z","timestamp":1793695174251,"version":"4.5.1"},"reference-count":70,"publisher":"SAGE Publications","issue":"4-5","license":[{"start":{"date-parts":[[2025,3,27]],"date-time":"2025-03-27T00:00:00Z","timestamp":1743033600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,3,27]],"date-time":"2025-03-27T00:00:00Z","timestamp":1743033600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100021734","name":"Leprosy Research Initiative","doi-asserted-by":"publisher","award":["36 708.20.12\/LRI"],"award-info":[{"award-number":["36 708.20.12\/LRI"]}],"id":[{"id":"10.13039\/501100021734","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Qual Health Res"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:p>\n                    Leprosy-related stigma in Nepal adversely affects socioeconomic and health outcomes. The cultural shaping of stigma is often overlooked in stigma (reduction) research. Therefore, this study aimed to (i) identify cultural capabilities in daily life that \u201cmatter most\u201d for men and women; (ii) extend and corroborate perspectives and experiences of leprosy-related stigma; and (iii) explore how \u201cwhat matters most\u201d (WMM) intensifies or protects against leprosy-related stigma in Far-Western Nepal. We performed a directed content analysis of 38 interviews and 8 focus group discussions with a total of 80 men and women affected by leprosy, family members, and healthcare workers\u2014directed by the WMM framework. WMM included key personal and family capabilities, centered around personal and family honor and prestige (\n                    <jats:italic toggle=\"yes\">ijjat<\/jats:italic>\n                    ). Stigma was rooted in cultural beliefs of leprosy as\n                    <jats:italic toggle=\"yes\">karma<\/jats:italic>\n                    or\n                    <jats:italic toggle=\"yes\">divine punishment<\/jats:italic>\n                    leading to\n                    <jats:italic toggle=\"yes\">apahelana<\/jats:italic>\n                    (disrespect or disregard) and social exclusion, indicating a loss of personhood. This hinders attainment of WMM in both family and community settings which can negatively affect self-confidence and (mental) health, exacerbating stigma. The study supports the applicability of WMM to leprosy and found that family support and involvement alongside treatment could mitigate some powerful aspects of stigma attached to leprosy. Given its dual role found in this study, family support should be leveraged for stigma reduction efforts enabling families to facilitate WMM for persons affected by leprosy. This study advances the work on WMM and stigma by exploring an infectious condition historically associated with deeply rooted misconceptions, fear, and exclusionary practices.\n                  <\/jats:p>","DOI":"10.1177\/10497323251318604","type":"journal-article","created":{"date-parts":[[2025,3,27]],"date-time":"2025-03-27T20:11:27Z","timestamp":1743106287000},"page":"440-455","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Cultural Mechanisms of Leprosy-Related Stigma: A Gendered Analysis Using the What Matters Most Framework in Far-Western Nepal"],"prefix":"10.1177","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-2734-6543","authenticated-orcid":false,"given":"Marlies J.","family":"Visser","sequence":"first","affiliation":[{"name":"Vrije Universiteit"},{"name":"Amsterdam Public Health Research Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eliza A.","family":"KC","sequence":"additional","affiliation":[{"name":"Vrije Universiteit"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3282-3680","authenticated-orcid":false,"given":"Yoslien","family":"Sopamena","sequence":"additional","affiliation":[{"name":"Vrije Universiteit"},{"name":"Universitas Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pirt B.","family":"Bist","sequence":"additional","affiliation":[{"name":"Far Western University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sita","family":"Bist","sequence":"additional","affiliation":[{"name":"Far Western University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madhusudan","family":"Subedi","sequence":"additional","affiliation":[{"name":"Patan Academy of Health Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nand Lal","family":"Banstola","sequence":"additional","affiliation":[{"name":"NLR Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5914-1471","authenticated-orcid":false,"given":"Sarju S.","family":"Rai","sequence":"additional","affiliation":[{"name":"Vrije Universiteit"},{"name":"Amsterdam Public Health Research Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence H.","family":"Yang","sequence":"additional","affiliation":[{"name":"New York University"},{"name":"Duke University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"family":"Dadun","sequence":"additional","affiliation":[{"name":"Universitas Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth M. 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