Brazil is an upper-middle-income-country with a total population of approximately 214 million people (Brazilian Institute of Geography and Statistics, 2022; The World Bank, 2020), of which 57% are women, and almost 16% are aged 60 and over (Brazilian Institute of Geography and Statistics, 2019). The country is divided into five geographical regions (North, South, Northeast, Southeast, and Mid-west) and is diverse in terms of culture and socioeconomic profiles. Population ageing in Brazil is occurring at one of the fastest rates worldwide, resulting in an increased number of people living with chronic diseases, including dementia (Melo et al., 2020; The World Bank, 2011). Estimates from 2019 reveal 1.8 million people living with dementia in the country (GBD, 2022).
Stigma and discrimination toward people living with dementia and their carers are present in Brazil at various levels, including among healthcare professionals (Oliveira et al., 2021) in addition to members of the public and families of people living with dementia (Oliveira et al., 2021).
As a result, people living with dementia are often socially isolated, and carers are often impacted. Increasing knowledge and awareness in dementia among people in Brazil is necessary. Therefore, targeted anti-stigma efforts could help reduce negative views toward dementia.
Aim
To improve knowledge and attitudes, and reduce stigma and discrimination related to dementia among community health workers.
Why community health workers?
Primary care services are the first point of access for people experiencing any physical or mental health problem in Brazil. In most regions of the country, Primary Care Units are part of a program (Family Health Strategy) of which community health workers are a key part of the health teams. These professionals are responsible for health promotion and disease prevention activities, and as such, community health workers directly help to scale access to primary health care nationally.
Most of the training offered to community health workers in Brazil is focused on the control of communicable diseases and non-communicable physical diseases such as diabetes and hypertension with less focus on mental health needs.
Intervention
The intervention consists of three group sessions, held on three consecutive days, lasting three hours each, involving all participating community health workers from each Primary Care Unit in each session (total = 9 hours over three days for all community health workers).
The intervention uses audio-visual and printed materials, containing for example, videos of people with dementia and carers sharing their personal experiences, reflexive activities, group discussion, and Power Point® presentations.
One focus of the intervention is to experience how it would be like to live with dementia.
DAY 1 Building knowledge and changing beliefs: starting the transformation process The first session begins with a post-it session. Community health workers are asked to reflect on their beliefs and doubts, as well as those of their colleagues and to answer the following questions:
Then, we go through responses together as a group, use further exercises to develop rapport , and finally ask participants to consider:
“Have you ever reflected on what your life would be like if you received a diagnosis of dementia?”
DAY 2 Breaking stereotypes and building a new view We present educational/theoretical content on stigma, discrimination, stereotype, and language in order to sensitise the community health workers about how other people's thoughts, feelings, attitudes, and behaviours can affect people living with dementia. Then, we show short testimonial videos of people living with dementia, and at the end, we conduct a dynamic discussion to help participants develop empathy about everyday issues experienced by people living with dementia.
DAY 3 Integrate social contact element and discuss ways of relating with others, acting, and feeling
We also share narratives about the daily lives of people living with dementia and caregivers, based on real-life situations.
We teach the community health workers positive verbal and non-verbal communication strategies, and stimulate reflections and debates on how to apply these communication strategies in their professional environment. Community health workers are requested to try to identify inappropriate speech and behaviours, and think of possibilities of how each situation could be positively changed by applying the positive communication strategies previously learned.
Closure and reflections on how anti-stigma messages could be integrated into their clinical practice
Group discussion/reflection about how community health workers could improve their practice to provide better care to people living with dementia and their families.
Note: A link to the manual and intervention protocol can be found here. https://bmjopen.bmj.com/content/12/7/e060033 We are currently evaluating the intervention and will update this resource with the results once they are ready.
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Oliveira, D., Mata, F. A. F. D., Mateus, E., Musyimi, C. W., Farina, N., Ferri, C. P., & Evans-Lacko, S. (2021). Experiences of stigma and discrimination among people living with dementia and family carers in Brazil: Qualitative study. Ageing & Society, 1–22. https://doi.org/10.1017/S0144686X21000660
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