GPs, stigma and the timely diagnosis of dementia : a qualitative exploration. The implications of general practitioners' perceptions of dementia as a stigma for timely diagnosis.

Abstract

Background The focus of this study is on how far GPs¿ perceptions of dementia map onto the components and contributing factors to stigma as described by Link and Phelan (2001; 2006) and Jones et al. (1984). Aim The study explores GPs¿ perceptions of dementia as a stigma, develops a specific conceptualization of the stigma of dementia and considers implications for timely diagnosis. Methods Data from twenty-three GPs in northern England were collected by semistructured telephone interviews. Within the context of a qualitative design, a combined process of grounded theory and framework analysis was adopted to collect and analyse data. Results The findings reveal that GPs¿ perceptions of dementia map onto Link and Phelan and Jones¿ identification of contributing factors and components of stigma and may hinder timely diagnosis. Three themes emerged reflecting a dynamic process of making sense of dementia, relating perceptions to oneself and considering the consequences of dementia. Within those themes, certain categories had particular salience for GPs, namely the characteristics of the attribute, existential anxiety and discrimination. The themes and categories are inter-related and can be considered as parts of a system. Perceived lack of reciprocity could be detected in most categories which suggests that it is influential in the social construction of the stigma of dementia. Conclusion The data suggest that current conceptualizations of stigma are insufficient to fully account for the stigma of dementia. A specific conceptualization of the stigma of dementia is proposed and the implications of GPs¿ perceptions for timely diagnosis are discussed.