الفهرس 
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Abstract
SUMMARY
eprosy is a slowly progressive chronic granulomatous
disease caused by the intracellular parasite Mycobacterium
leprae. M. Leprae mainly affects peripheral nerves and skin
cells and is viable for up to 36 hours in an optimal environment.
The time of incubation is usually between two and seven years,
Leprosy, also known as Hansen’s disease. However, reports
have been made of incubations of up to 20 years.
Factors such as gender, race and age have no effect on
the occurrence of leprosy. Those who are primarily at risk of
being infected are people living in low socioeconomic
conditions and those with weak immune status. The disease is
transmitted via droplets from the nose and mouth during close
contact with infected people who are untreated.
Stigma is the social process that drives from a situation
of power imbalance, separation, status and discrimination
occur. The world health Organization world Health Report
describes Stigma as one of the remaining great’s obstacles to
the treatment of mental illness.
Coping is defined as ”the cognitive, behavioral and
emotional efforts to manage particular external and/or internal
demands that are appraised as taxing or exceeding the resources
of the person. Patients with leprosy in endemic countries also
suffer from marked economic and social dependency and
L
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inferiority, despite assuming enormous responsibility of the
family. Thus being away from the family for hospitalization
generates much stigma which must be suitable addressed by
every health care professional, especially nurses, who are
largely responsible for hospital care.
Significance of the study:
Reports received from 115 countries and territories for
the first quarter of 2013, showed that the registered prevalence
of leprosy worldwide amounted to 189,018 cases. Thus
Leprosy and disability produce significant change and
consequently psychosocial problems. So stigma and coping
patterns among patients having leprosy need to be assessed to
describe patients suffering.
Aim of the Study
This study aimed to assess stigma and coping patterns
among patients having leprosy.
Research questions:
How can describe stigma facing patients with leprosy?
What are coping patterns among patients with leprosy?
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Subjects and methods:
Research Design:
A descriptive cross-sectional design was utilized in this study.
Setting:
The study was conducted in the leprosy Colony Hospital
in El-Khanka City.
Subjects:
A simple random sample of 80 patients of both sexes,
different age groups, medically diagnosed as having leprosy,
with no psychotic problems and willing to participate in the
study were selected from the outpatient clinics of the previously
mentioned study setting.
Tools of the study:
1- Interview questionnaire: It included the socio-demographic
data of the study subjects such as code number, age, sex,
marital states, residence, monthly income, occupation and
educational level.
2- Medical history of the patients which included, time of
beginning the disease, time of beginning treatment, type of
treatment and number of hospital admission.
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3- Stigma scale: The scale was used to assess perception of
leprosy patients for stigma which it contained physical,
psychological and social factors.
4- Coping scale: It was developed to assess thoughts and
actions that individuals use to cope with stressful
encounters of the leprosy patient with the stigma. It
included social, psychological, educational and spiritual
coping items.
Pilot study:
The pilot study included 10 from leprosy patients who
were fulfilling the previously mentioned criteria. According to
the results of the pilot study, simple modifications were done as
rephrasing questions and removing one question. Those who
shared in the pilot study were included in the main study
sample.
The findings of the present study reached to the following:
• The mean ±SD age of the studied patients was (41.43±17.22
years); slightly more than half (57%) were males; less than
half (46.3%) were single & (35.0%) were married; about
two thirds (65%) were resident in urban areas; slightly less
than three fourth (73.8%) were living with their families; the
majority of them (96.3%) didn’t have enough monthly
income; more than half (57.5%) were un-employed & one
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forth (25%) were housewives; and about one third (35%)
had primary education & 21.3% of them were illiterate.
• The majority (87.5%) of the studied cases didn’t have
physical illness; half (50%) of them had illness onset five
years and more; all (100%) of them had taking
pharmacological drugs & none of them (0.0%) had
psychotropic drugs; and nearly to half (47.5%) had once
time hospital admission while 40% of them were hospital
admitted more than three times.
• Most of leprosy patients under the study had agreed on the
variables of stigma, “People seeing me as an infectious
person, people refusing me to marry from them, people do
not recognize my opinions, people not accepting me to get
the medical care with them at the same health facility and
people not accepting to make friendship relation with me,
people showing bad behavior to leprosy patients, I am
avoiding the friends because they are laughing at them”
(52.5%, 43.8%, 43.8%, 43.8, 42.5%, 45%, 53.8%,
respectively). While most of them were disagree on the
stigma variables “people are disgusting me, employers
refusing to employ the leprosy patient or had leprosy disease
before, friends changing their relation with me after they
knew I had leprosy disease before, leprosy patients
obligatory resigning from their jobs, I am refusing marriage
because I am a leprosy patient, I prefer to be a friend with
other leprosy patients, When I get my treatment, I refuse to
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go out with my friends and I refuse to leave my work if the
other people said that” (42.5%, 45.0%, 52.5%, 65%, 72.5%,
53.8%, 50% & 40% respectively). Although most of them
were strongly agreed on, “Leprosy patients hiding their
disease, leprosy patient re-thinking more than once before
he telling anyone about his disease and leprosy patient
masking information about his disease when he filling an
application form, I am trying to change my friends’ point of
view about their conception of leprosy patients, I can
complain to the responsible authorities if there is a lack in
the treatment, I can complain or ask for help from agencies
or organizations who look after the leprosy patients and I
participate in social activities that are related to leprosy
patients as (teach people what the leprosy disease is”
(48.8%, 46.3% & 47.5%, 45.0%, 52.5%, 61.3% & 45.0%
respectively). Whereas While more than one third of them
(37.5%) were equally disagreed and strongly agreed on the
third variable of stigma “Health care providers treating
badly leprosy patients when they come to the health facility
as well as, more or less one third (36.3%, 30.0% & 33.8%)
of leprosy patients under the study were disagreed, agreed
and strongly agreed on the variable of stigma “I am refusing
to apply for any job, when I know the employer does not
employ any leprosy patients” respectively.
• Almost all (98.8%) the leprosy patients always “asking
Allah to recover from leprosy disease”. Most (58.8%,
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45.0%, 52.5%, 48.8%, 48.8%, 47.5%, 40.0%, 51.3%,
67.5%, 52.5% & 45%) of leprosy patients under the study
were sometimes utilizing coping strategies’ items “Talking
with family about the feeling towards the problem of
disease, talking with the close friends about the feelings
towards the problem, crying reduce the severity of
psychological problems, taking the superiors’ advice to
solve the problem, get information from the colleagues to
solve problem, adapting with the problem, trying to change
the lifestyle routine to adaptive, looking for new information
to treat with problem, making new friends to deal with their
health problem, avoiding the psychological pressure &
positively thinking with them-selves” respectively. Also,
around one third of leprosy patients (26.2%, 38.8% &
35.0%) were (rarely never, sometimes & always)
respectively “Seeing the problem in a positive way”. But on
the other hand, about half (50% & 55%) of them were rarely
never “Practicing the exercises to reduce the psychological
stress & getting a vacation to escape from the looks of
others” respectively. Moreover, three fourths (75.0%) of
them were rarely never “living in a daydreams” and slightly
more than half (51.3% & 53.8%) of them were rarely never
“taking psychiatric therapist advice to adapt with their
health problem & hiding the inside feelings” respectively.
• There was a highly positive correlation between stigma
scale and total score of coping (r= 0.495, p-value=0.000);
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also, there was a highly positive correlation between leprosy
patients’ age and coping scale pattern (r= 0.326, pvalue=
0.003); but on the other hand there was a negative
insignificant correlation between leprosy patients’ age and
scale of their stigma (r= -0.118, p-value=0.298).
• There was a highly significant relation between stigma
grades and scale of coping pattern grades (F= 34.9, pvalue<
0.001).
• There was a statistical significant relation between total score
of stigma scale and socio-demographic of leprosy patients
under the study as regards the working conditions and the
physical illnesses (t = 4.32, p-value= 0.016 & t = -2.51, pvalue=
0.0308) respectively. Moreover, there was a highly
statistical significant relation between total score of stigma
scale and socio-demographic of leprosy patients under the
study as regards the onset of illness (t = 5.55, p-value= 0.005).
• There was a significant relation between total score of
coping scale and socio-demographic characteristics of
leprosy patients under the study as regards the working
conditions and number of hospital admission (t = 4.32, pvalue=
0.0167 & t = -2.32, p-value=0.0232) respectively. In
addition, it reveals that, there was a highly significant
relation between total score of coping scale and sociodemographic
characteristics of leprosy patients under the
study as regards the gender and illness onset (t = -3.02, pvalue=
0.0345 & t = 22.43, p-value=0.0001) respectively
In the light of the study findings, the following were
recommended
1- Designing and conducting a national-level mass campaign
of health education for the general public. The general
public should be made aware that Hansen’s disease is not a
genetic disorder, it is totally curable, and the patients need
social support.
2- Encouraging a better coordination between all healthcare
partners like leprologists, dermatologists, psychiatrists, and
healthcare workers to settle all the issues and to help in
achieving the eradication goals of leprosy disease.
3- Improving psychological rehabilitation, increasing emotional
stability and self-worth of the discharged leprosy patients
should be encouraged to maintain stable married life for them.
Also as a step to reduce depression, loneliness, discrimination
and rejection common among discharged patients.
4- Highlighting the need to encourage the discharged patients
to be active in all religious activities.
5- The family members of discharged patients should be health
educated on the benefits of providing emotional support to
leprosy patients. They should be enlightened on the need to
assist leprosy patients to combat the problem of stigma in
the communities.