title: Enacted and implied stigma for dementia in a community in south-west Nigeria.
abstract: BACKGROUND
  Dementia is a chronic progressive disease that mostly affects the elderly. There is often a stigma surrounding dementia patients because of poor awareness about the disease. In Nigeria, this stigma and related attitudes have not been fully explored. In this study, we assessed the attitude of people towards demented individuals in a transitional community in Nigeria.
  
  
  METHODS
  The study used a mixed methods approach. Focused group discussions exploring the concept of dementia were conducted among six community groups, and quantitative data was obtained from an interviewer-administered questionnaire. A total of 313 respondents were selected with a cluster sampling technique.
  
  
  RESULTS
  Only 212 respondents (67.7%) were aware of dementia. 'Memory loss disease', 'ageing disease', 'disease of insanity', 'brain disorder', 'disease of forgetfulness', and 'dull brain' are the common names used to describe dementia in the community. Enacted stigma was evident as 36% of respondents felt dementia was associated with shame and embarrassment in the community. Implied stigma was evident in another third that opined that demented individuals would prefer not to know or let others know that they have the disease. Also, 28% were of the opinion that people do not take those with dementia seriously. Of the 22 (10.4%) that reported having received structured information about dementia, 16 (72.7%) got the information from health facilities. Qualitative data revealed the presence of enacted stigma in the community as some referred to affected individuals by derogatory names such as 'madman'. Some statements from the focus group discussion participants also gave useful insights into the scorn with which demented individuals are sometimes treated.
  
  
  CONCLUSIONS
  The presence of enacted and implied stigma related to dementia within the community calls for concern. More research efforts are needed to unravel the burden of stigma within communities and best practice for stigma-reducing interventions.
authors.affiliation: Department of Preventive Medicine and Primary Care, University of Ibadan, Ibadan, Nigeria.
authors.forename: Akindele O
authors.initials: AO
authors.lastname: Adebiyi
authors.affiliation: Department of Community Medicine, University College Hospital, Ibadan, Nigeria.
authors.forename: Motunrayo A
authors.initials: MA
authors.lastname: Fagbola
authors.affiliation: IDEA Project, Institute of Advanced Medical Research, University of Ibadan, Ibadan, Nigeria.
authors.forename: Olaide
authors.initials: O
authors.lastname: Olakehinde
authors.affiliation: Department of Internal Medicine, University of Ibadan, Ibadan, Nigeria.
authors.forename: Adesola
authors.initials: A
authors.lastname: Ogunniyi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001364:Awareness; D055812:Community-Based Participatory Research; D003430:Cross-Sectional Studies; D003704:Dementia / Q000523:psychology*; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009549:Nigeria; D036301:Qualitative Research; D012111:Residence Characteristics; D057545:Social Stigma; D011795:Surveys and Questionnaires
keywords: aged; amnesia; dementia; memory disorder; shame