The stigma of smoking among women: A systematic review.

BACKGROUND: Smoking stigma has been well documented, but little is known regarding its specific features and effects on women. Notably, women face unique social, cultural, and economic challenges that may interact with smoking stigma and impact health outcomes. This review investigates the extent to which smoking women encounter and internalise stigma, while examining the various coping mechanisms they employ to manage these negative experiences. METHODS: In November 2022, major databases were systematically searched with no time restrictions. After applying inclusion and exclusion criteria, 23 studies (three quantitative and 20 qualitative) met our criteria. We conducted a quality assessment and summarised the findings pertaining to public stigma, self-stigma, and coping strategies. RESULTS: The stigma about smoking emerges from a variety of sources, such as family, healthcare providers, or internet forums. Women smokers are universally aware of the negative image they have in society. Yet, their experiences and management of the stigma of smoking are shaped by other variables such as cultural background, social class, or motherhood status. Smoking stigma produces ambivalent effects, such as concealment, reduced usage of support services, and to a lesser extent, smoking cessation motivation. CONCLUSIONS: These results indicate that smoking stigma is an important social justice and public health issue and that further research is needed to better prevent its effects on women's well-being and health behaviours.

Healthcare providers perception of therapeutic patient education efficacy according to patient and healthcare provider characteristics.

OBJECTIVES: Therapeutic patient education improves numerous health and psychological outcomes in patients with chronic diseases. However, little is known about what makes a therapeutic patient education intervention more effective than another one. This study aims to identify in healthcare professionals the perceived determinants of therapeutic patient education efficacy at the individual level. METHODS: Semi-structured individual interviews have been conducted with healthcare professionals (HCP, n=28, including 20 nurses) involved in therapeutic patient education programs (n=14) covering various chronic conditions (kidney and cardiovascular diseases, chronic pain, diabetes, etc.). A thematic content analysis following an inductive approach was used (Nvivo.11 software). RESULTS: Five themes were retrieved for patient characteristics: understanding and education, personality, readiness and motivation, social environment, and misinformation and beliefs. Four themes were retrieved for healthcare professionals' characteristics: medical knowledge, appropriate attitude and relational skills, pedagogical skills, and training. DISCUSSION: Patient personality is rarely discussed in the literature. Patients who are introverted, lack curiosity, or are not compliant might benefit from specific therapeutic patient education practices or formats. All these potential determinants regarding patients and healthcare professionals should be routinely assessed in future studies about therapeutic patient education efficacy to understand precisely what makes an intervention successful.

Evaluation of teachers' knowledge and attitudes regarding the school inclusion of autistic children: Validation of a brief assessment toolkit.

BACKGROUND: Teachers' level of knowledge regarding autism and their attitudes towards inclusion are major levers for the successful schooling of autistic students. However, there are currently insufficient validated tools for evaluating these two concepts among teachers that are adapted to the French context and to the constraints of the classroom setting. AIMS: This study was designed to test both the validity of The Autism Knowledge Screening Scale (AKSS) and of the Autism Attitude Scale for Teachers (AAST) among French teachers. SAMPLE: Our final sample consisted of 307 French teachers (50.5% primary school teachers and 49.5% secondary school teachers). METHODS: First, confirmatory factor analyses were conducted to test the two initial factor structures and an exploratory factor analysis was conducted regarding the AKSS. Second, criterion validity was assessed for each of the two scales. RESULTS: Concerning knowledge of autism, a two-factor model (8 items) explaining 53% of the variance was observed. The first factor represented knowledge about aetiology and the second represented knowledge about symptoms. Concerning attitudes towards autism, a one-factor model (14 items) exhibited good model fit (χ2 /df = 1.71, RMSEA = .048, AGFI = .979, SRMR = .068, CFI = .987, NNFI = .984). As expected, participants who were specialized teachers, had training, and a high degree of contact with autism had more knowledge (regarding aetiology but not regarding symptoms) and more positive attitudes. CONCLUSIONS: This study validated two quick-to-use tools for making an initial diagnosis of teachers' knowledge and attitudes regarding the school inclusion of autistic children. The use of these tools could help to fine-tune the content of training programs for teachers and test their efficacy, particularly in France where the inclusion of autistic children is still far from international standards.

The Pregnant Smoker Stigma Scale - Public Stigma (P3S-PS): development and validation in general French population.

While pregnancy smoking stigma is widely acknowledged, no psychometrically sound tool to measure it exists. This study was designed to build the Pregnant Smoker Stigma Scale - Public Stigma (P3S-PS) for assessing the stigma of pregnancy smoking in the general French population. A total of 342 adults were recruited online to take the P3S-PS and some items (condemnation/rejection, and support for punitive actions) from other scales. Exploratory factor analysis was performed. Measurement invariance was tested according to gender and smoking status. Temporal reliability was checked after two weeks (n = 72). The P3S-PS has 26 items and four dimensions: "derogatory cognitions," "negative emotions and behaviors," "personal distress," and "information provision." All dimensions were correlated (r = .36 to .75) and have good internal consistency (α.>.70), temporal reliability (ICC>.75), and measurement invariance. Validity is exhibited through the P3S-PS's association with condemnation and rejection (r = .32 to .53), support for punitive actions (r = .35 to .65), and presence of pregnant smokers in the close circle (r = -.23 to -.40). The P3S-PS is a promising tool that exhibits good psychometric qualities. This scale will be useful to trigger research regarding the stigma of smoking while pregnant.

Stigma Attached to Smoking Pregnant Women: A Qualitative Insight in the General French Population.

INTRODUCTION: Cigarette consumption during pregnancy has major health consequences for women and unborn children. The stigma of smoking during pregnancy might hinder mothers-to-be's access to adequate healthcare and smoking cessation, especially in disadvantaged groups. This qualitative study was designed to describe extensively the public stigma associated with smoking during pregnancy. AIMS AND METHODS: Participants were French adults recruited from the general population through social networks (N = 100). They were asked to answer three pairs of open-ended questions regarding cognitions, emotions, and behaviors elicited in the general population by pregnant smoking women. An inductive thematic analysis was performed and interjudge agreement was computed on 30% of the corpus analyzed deductively. Finally, independence (chi-square) between themes and gender, education, parenthood, and smoking status was tested. RESULTS: Themes (n = 25) were defined regarding cognitions (n = 9, eg, irresponsible, thoughtless, and unmindful), emotions (n = 8, eg, anger and disgust), and behaviors, (n = 8, eg, inform and persuade, and moralize and blame). Global interjudge agreement was strong (κ = .8). No difference was observed in themes according to gender, parental status, or education, indicating a heterogenous awareness of stigma. However, some differences were observed according to smoking status (χ 2 = 69.59, p = .02) (eg, nonsmokers more frequently stressed immorality). CONCLUSIONS: The stigma associated with smoking during pregnancy includes various components that might be measured and targeted in interventions to improve access to adequate healthcare and smoking cessation in this specific population. IMPLICATIONS: This qualitative study explores the stigma that the general French population attaches to pregnant women who smoke. Themes regarding cognitions (eg, irresponsible, thoughtless, and unmindful), emotions (eg, anger and disgust), and behaviors (eg, inform and persuade, and moralize and blame) were identified. These themes could guide further research regarding scale development and antistigma interventions to support smoking cessation.

Tailored patient therapeutic educational interventions: A patient-centred communication model.

BACKGROUND: Tailoring therapeutic education consists of adapting the intervention to patients' needs with the expectation that this individualization will improve the results of the intervention. Communication is the basis for any individualization process. To our knowledge, there is no guide or structured advice to help healthcare providers (HCPs) tailor patient education interventions. OBJECTIVES: We used a data-driven qualitative analysis to (1) investigate the reasons why HCPs tailor their educational interventions and (2) identify how this tailoring is effectively conducted. The perspective aimed to better understand how to individualize therapeutic patient education and to disentangle the different elements to set up studies to investigate the mechanisms and effects of individualization. DESIGN: Individual semistructured interviews with 28 HCPs involved in patient education were conducted. The present study complied with the COREQ criteria. RESULTS: Why individualization is necessary: participants outlined that the person must be thought of as unique and that therapeutic education should be adapted to the patient's personality and cognitive abilities. The first step in the individualization process was formalized by an initial patient assessment. Several informal practices were identified: if needed, giving an individual time or involving a specific professional; eliciting individual objectives; reinforcing the relationship by avoiding asymmetrical posture; focusing on patients' concerns; leading sessions in pairs; and making the patient the actor of decisions. CONCLUSION: From our thematic data analysis, a model for tailoring patient education interventions based on the Haes and Bensing medical communication framework is proposed. The present work paves the way for evaluation, then generation of recommendations and finally implementation of training for individualization in educational interventions. SHORT INFORMATIVE: Tailoring in therapeutic education consists of an adaptation to patients' needs. Communication is the basis for any individualization process. There is no model of patient-centred communication in educational interventions. From semistructured interviews with HCPs, we propose a patient-centred communication model for tailoring patient education intervention.

Another step to school inclusion: Development and validation of the Children's Attitudes Toward Autism Questionnaire.

LAY ABSTRACT: Research has shown that negative attitudes toward a different child can appear very early in development. Unfortunately, these negative attitudes are one of the most important barriers to the school inclusion of children with autism. Despite the increasing amount of research, no tool reliably measures these attitudes among young students. The objective of this study was to develop and validate a questionnaire (Children's Attitudes Toward Autism Questionnaire) to evaluate attitudes of students in elementary school toward their peers with autism. Elementary school students (N = 204) completed the Children's Attitudes Toward Autism Questionnaire and two other scales assessing behavioral intentions toward peers with a mental disability (Shared Activities Questionnaire-B) and familiarity with disability and autism. Results first showed that the Children's Attitudes Toward Autism Questionnaire reliably measured the concept of attitude through three sub-dimensions (namely, the cognitive, affective, and behavioral dimensions). Second, analyses confirmed that the Children's Attitudes Toward Autism Questionnaire corresponds with previous knowledge on this topic, namely, that attitudes were more positive in girls, older children, and children familiar with disability. In conclusion, the Children's Attitudes Toward Autism Questionnaire is the first scale (1) to assess all the dimensions of attitudes toward autism among elementary school children (from the age of 6 years old) and (2) to show theoretical and statistical relevance. From now on, the Children's Attitudes Toward Autism Questionnaire can be used to assess attitudes of young children toward their peers with autism. This is an important step forward, in particular for evaluating the effects of anti-stigma programs that are increasingly implemented in schools.