{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T11:57:59Z","timestamp":1792065479690,"version":"4.4.0"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>\n                    Stigma plays a significant role in health and healthcare. To date, anti-stigma efforts have primarily focused on specific individual domains (e.g., mental health, HIV), resulting in fragmented efforts to address many different \u201cstigmas.\u201d Theorists now advocate for shifting toward a universal framework to understand and respond to stigma. To empirically test the potential utility of stigma as a universal concept, we analyzed data from 453 healthcare workers participating in a prospective cohort in Mombasa, Kenya. Across four waves comprising 925 points of data (June 2023\u2013December 2024), we found strong correlations between all stigma domains. For example, stigma toward abortion was positively correlated with stigma toward mental health and vice versa (\n                    <jats:italic>\u03c1<\/jats:italic>\n                    \u202f=\u202f0.53, 95% CI: 0.47, 0.56). Using structural equation modeling, we tested two models for organizing stigma domains. In the best-fitted model, stigma domains were organized into two thematic categories: conditions &amp;amp; experiences (mental health, abortion, sexual violence, early pregnancy) and behaviors &amp;amp; identities (sex work, drug use, sexual and gender minorities). These two domains were then further organized into stigma as an overarching latent variable, with strong independent associations (\n                    <jats:italic>\u03b2<\/jats:italic>\n                    \u202f=\u202f0.65, 95% CI: 0.57, 0.73 and\n                    <jats:italic>\u03b2<\/jats:italic>\n                    \u202f=\u202f0.61, 95% CI: 0.54, 0.68, respectively). Further, stigma as a latent variable was independently associated with healthcare workers\u2019 individual dispositions, including agreeableness (\n                    <jats:italic>B<\/jats:italic>\n                    \u202f=\u202f\u22120.19, 95% CI: \u22120.34, \u22120.05) and acceptance of others (\n                    <jats:italic>B<\/jats:italic>\n                    \u202f=\u202f\u22120.28, 95% CI: \u22120.39, \u22120.18). These results support stigma as a \u201cuniversal\u201d heuristic among healthcare workers. Anti-stigma interventions should reduce domain-specific activities toward a \u201cuniversal precautions\u201d approach targeting larger worldviews, which can improve scalability and resource-efficiency.\n                  <\/jats:p>","DOI":"10.3389\/fpubh.2026.1910801","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T04:35:57Z","timestamp":1790224557000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Investigating new opportunities to combat stigma in healthcare through a \u201cuniversal\u201d approach: findings from a longitudinal study of healthcare workers in Mombasa, Kenya"],"prefix":"10.3389","volume":"14","author":[{"given":"Ahmed","family":"Adam","sequence":"first","affiliation":[{"name":"Mombasa County Department of Health","place":["Mombasa, Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Owira","sequence":"additional","affiliation":[{"name":"International Center for Reproductive Health Kenya","place":["Mombasa, Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nick","family":"Olsen","sequence":"additional","affiliation":[{"name":"Stats Central, Mark Wainwright Analytical Centre, University of New South Wales","place":["Sydney, NSW, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Kirongo","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res Mombasa Project","place":["Mombasa, Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace","family":"Mwendar","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res Mombasa Project","place":["Mombasa, Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Makobu","family":"Kimani","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute","place":["Kilifi, Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Khabala","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res Mombasa Project","place":["Mombasa, Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hakima","family":"Masud","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res Mombasa Project","place":["Mombasa, Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celina","family":"Kithinji","sequence":"additional","affiliation":[{"name":"Mombasa County Department of Health","place":["Mombasa, Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masha","family":"Pastrana","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res Switzerland","place":["Geneva, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Guadarrama","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res Switzerland","place":["Geneva, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imani","family":"Blessings","sequence":"additional","affiliation":[{"name":"Hope Trans Initiative","place":["Mombasa, Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Omache","sequence":"additional","affiliation":[{"name":"Youth Advisory Champions for Health","place":["Mombasa, Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Broady","sequence":"additional","affiliation":[{"name":"University of New South Wales","place":["Sydney, NSW, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iza","family":"Ciglenecki","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res Switzerland","place":["Geneva, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denton","family":"Callander","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res Mombasa Project","place":["Mombasa, Kenya"]},{"name":"University of New South Wales","place":["Sydney, NSW, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"813","DOI":"10.2105\/AJPH.2012.301069","article-title":"Stigma as a fundamental cause of population health inequalities","volume":"103","author":"Hatzenbuehler","year":"2013","journal-title":"Am J Public Health"},{"key":"ref2","volume-title":"Stigma: Notes on the Management of Spoiled Identity","author":"Goffman","year":"2009"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1146\/annurev.soc.27.1.363","article-title":"Conceptualizing stigma","volume":"27","author":"Link","year":"2001","journal-title":"Annu Rev Sociol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1016\/j.socscimed.2013.07.035","article-title":"Stigma power","volume":"103","author":"Link","year":"2014","journal-title":"Soc Sci Med"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1186\/s12916-019-1256-2","article-title":"Stigma in health facilities: why it matters and how we can change it","volume":"17","author":"Nyblade","year":"2019","journal-title":"BMC Med"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1016\/j.socscimed.2013.09.023","article-title":"Intervening within and across levels: a multilevel approach to stigma and public health","volume":"103","author":"Cook","year":"2014","journal-title":"Soc Sci Med"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1177\/2372732214548862","article-title":"A multilevel analysis of stigma and health: implications for research and policy","volume":"1","author":"Richman","year":"2014","journal-title":"Policy Insights Behav Brain Sci"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1017\/S0033291714000129","article-title":"What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies","volume":"45","author":"Clement","year":"2015","journal-title":"Psychol Med"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"18640","DOI":"10.7448\/IAS.16.3.18640","article-title":"Impact of HIV-related stigma on treatment adherence: systematic review and meta-synthesis","volume":"16","author":"Katz","year":"2013","journal-title":"J Int AIDS Soc"},{"key":"ref10","doi-asserted-by":"crossref","DOI":"10.1093\/oxfordhb\/9780190243470.001.0001","volume-title":"The Oxford Handbook of Stigma, Discrimination, and Health","author":"Major","year":"2018"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1554072","DOI":"10.3389\/fpubh.2025.1554072","article-title":"Public mental health stigma and suicide rates across Europe","volume":"13","author":"Oblak","year":"2025","journal-title":"Front Public Health"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1016\/j.socscimed.2017.06.045","article-title":"Meta-analysis and systematic review of studies on the effectiveness of HIV stigma reduction programs","volume":"188","author":"Mak","year":"2017","journal-title":"Soc Sci Med"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1186\/1758-2652-12-15","article-title":"Combating HIV stigma in health care settings: what works?","volume":"12","author":"Nyblade","year":"2009","journal-title":"J Int AIDS Soc"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"467","DOI":"10.1016\/S2215-0366(14)00023-6","article-title":"Mental health-related stigma in health care and mental health-care settings","volume":"1","author":"Henderson","year":"2014","journal-title":"Lancet Psychiatry"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1016\/j.socscimed.2007.03.015","article-title":"Meta-analysis of stigma and mental health","volume":"65","author":"Mak","year":"2007","journal-title":"Soc Sci Med"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1019","DOI":"10.2105\/AJPH.2009.159491","article-title":"Obesity stigma: important considerations for public health","volume":"100","author":"Puhl","year":"2010","journal-title":"Am J Public Health"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1093\/socpro\/spw012","article-title":"Stigma as social control: gender-based violence stigma, life chances, and moral order in Kenya","volume":"63","author":"Barnett","year":"2016","journal-title":"Soc Probl"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1363\/48e8516","article-title":"Abortion stigma: a systematic review","volume":"48","author":"Hanschmidt","year":"2016","journal-title":"Perspect Sex Reprod Health"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1016\/S2213-8587(23)00347-9","article-title":"Bringing an end to diabetes stigma and discrimination: an international consensus statement on evidence and recommendations","volume":"12","author":"Speight","year":"2024","journal-title":"Lancet Diabetes Endocrinol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1664","DOI":"10.1080\/10826084.2016.1188951","article-title":"Internalized stigma among people who inject drugs","volume":"51","author":"Cama","year":"2016","journal-title":"Subst Use Misuse"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"451","DOI":"10.1177\/0146167217741313","article-title":"The burden of stigma on health and well-being: a taxonomy of concealment, course, disruptiveness, aesthetics, origin, and peril across 93 stigmas","volume":"44","author":"Pachankis","year":"2018","journal-title":"Personal Soc Psychol Bull"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1438","DOI":"10.1016\/S0140-6736(22)01470-2","article-title":"The lancet commission on ending stigma and discrimination in mental health","volume":"400","author":"Thornicroft","year":"2022","journal-title":"Lancet"},{"key":"ref23","volume-title":"World Mental Health Report","year":"2022"},{"key":"ref24","volume-title":"Kenya Mental Health Action Plan 2021\u20132025","year":"2020"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"102612","DOI":"10.1016\/j.eclinm.2024.102612","article-title":"Anti-stigma interventions in low-income and middle-income countries: a systematic review","volume":"72","author":"Majeed","year":"2024","journal-title":"EClinicalMedicine"},{"key":"ref26","volume-title":"National Multisectoral HIV Prevention Acceleration Plan 2023\u20132030","year":"2023"},{"key":"ref27","volume-title":"Global AIDS Strategy 2021\u20132026: End Inequalities. End AIDS","year":"2021"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"18881","DOI":"10.7448\/IAS.16.3.18881","article-title":"Global action to reduce HIV stigma and discrimination","volume":"16","author":"Grossman","year":"2013","journal-title":"J Int AIDS Soc"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"e001587","DOI":"10.1136\/bmjgh-2019-001587","article-title":"A quality improvement approach to the reduction of HIV-related stigma and discrimination in healthcare settings","volume":"4","author":"Ikeda","year":"2019","journal-title":"BMJ Glob Health"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1146\/annurev-soc-071312-145702","article-title":"The stigma complex","volume":"41","author":"Pescosolido","year":"2015","journal-title":"Annu Rev Sociol"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"866","DOI":"10.1093\/heapro\/daz080","article-title":"Applying intersectionality theory in health promotion research and practice","volume":"35","author":"Heard","year":"2019","journal-title":"Health Promot Int"},{"key":"ref32","volume-title":"On Intersectionality: Essential Writings","author":"Crenshaw","year":"2017"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1186\/s12916-018-1246-9","article-title":"Challenges and opportunities in examining and addressing intersectional stigma and health","volume":"17","author":"Turan","year":"2019","journal-title":"BMC Med"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1186\/s12954-022-00658-w","article-title":"A universal precautions approach to reducing stigma in health care: getting beyond HIV-specific stigma","volume":"19","author":"Treloar","year":"2022","journal-title":"Harm Reduct J"},{"key":"ref35","volume-title":"Bridging the Gap: Strengthening Health Systems through a Resilient and Equitable Health Workforce in Africa","author":"Donfouet","year":"2024"},{"key":"ref36","volume-title":"Accelerating Progress towards Universal Health Coverage: Clinical Guidelines for Management and Referral of Common Conditions at Level 2 and 3","year":"2024"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"1","DOI":"10.29115\/sp-2017-0026","article-title":"Improving upon Bogardus: creating a more sensitive and dynamic social distance scale","volume":"10","author":"Mather","year":"2017","journal-title":"Surv Pract"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1177\/0013164493053002011","article-title":"Measuring social desirability: short forms of the Marlowe-Crowne social desirability scale","volume":"53","author":"Fischer","year":"1993","journal-title":"Educ Psychol Meas"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1016\/j.jrp.2006.02.001","article-title":"Measuring personality in one minute or less: a 10-item short version of the big five inventory in English and German","volume":"41","author":"Rammstedt","year":"2007","journal-title":"J Res Pers"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1002\/1097-4679(195407)10:3<269::AID-JCLP2270100318>3.0.CO;2-E","article-title":"Acceptance of self and others, and its relation to therapy-readiness","volume":"10","author":"Fey","year":"1954","journal-title":"J Clin Psychol"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1186\/s12916-019-1271-3","article-title":"The health stigma and discrimination framework: a global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas","volume":"17","author":"Stangl","year":"2019","journal-title":"BMC Med"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"1356430","DOI":"10.3389\/fpubh.2024.1356430","article-title":"HIV-related stigma and associated factors: a systematic review and meta-analysis","volume":"12","author":"Dessie","year":"2024","journal-title":"Front Public Health"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1016\/j.jad.2023.04.013","article-title":"Prevalence, risk, and protective factors of self-stigma for people living with depression: a systematic review and meta-analysis","volume":"332","author":"Du","year":"2023","journal-title":"J Affect Disord"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1038\/s41380-021-01295-8","article-title":"A systematic review and meta-analysis on the prevalence of stigma in infectious diseases, including COVID-19: a call to action","volume":"27","author":"Yuan","year":"2022","journal-title":"Mol Psychiatry"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1080\/15487768.2012.703553","article-title":"The contribution of previous contact and personality traits to severe mental illness stigma","volume":"15","author":"Brown","year":"2012","journal-title":"Am J Psychiatr Rehabil"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"358","DOI":"10.1186\/s12888-018-1932-3","article-title":"Direct and moderating effects of personality on stigma towards mental illness","volume":"18","author":"Yuan","year":"2018","journal-title":"BMC Psychiatry"}],"updated-by":[{"DOI":"10.3389\/fpubh.2026.2019690","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000}}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1910801\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T11:32:13Z","timestamp":1792063933000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1910801\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,24]]},"references-count":46,"alternative-id":["10.3389\/fpubh.2026.1910801"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1910801","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,24]]},"article-number":"1910801"}}