Effect of Stigmatisation on Self-Concept Among Clients Recovering From Substance Use in Selected Rehabilitation Centres in Kiambu County

Abstract

The purpose of this study was to examine the effect of stigmatisation on the self-concept among clients recovering from substance use in Kiambu County, Kenya. The first objective was examine the prevalence of stigmatisation among clients recovering from substance use in selected rehabilitation centres in Kiambu County. The second objective was explore how stigmatisation influences self-concept of clients in selected rehabilitation centres in Kiambu County. Thirdly, the study sought to analyse the relationship between perceived stigmatisation and self-concept among clients in the selected rehabilitation centres in Kiambu County. The final objective was to assess the influence of stigmatisation on self-concept and treatment outcomes. A cross-sectional research design, incorporating mixed methods, guided the collection of data from 113 participants, including individuals in treatment and 12 professionals from accredited rehabilitation centres in Kiambu County. Purposive and random sampling approaches formed the basis for the selection of individuals for the inclusion into the sample. Different validated data collection instruments, including the PSAS - Perceived Stigma of Substance Abuse Scale (PSAS), Recovery Assessment Scale (RAS), and Substance Use Stigma Mechanisms Scale (SU-SMS) provided a foundation for the development and operationalisation of the data collection instrument. A semi-structured interview guide was included to collect qualitative data. Quantitative data was analysed using SPSS version 26 and presented using tables, graphs, and texts. Thematic analysis formed the basis for the processing of identifying recurring themes in the qualitative data. Word clouds and text narratives formed the basis for presenting the qualitative data showing frequency of key themes and verbatim quotes from the participants and interpretations. Pretesting through a pilot study in Mathari Hospital helped assess the validity and reliability of the data collection instruments. To ensure ethical conduct during the research process, it was first important to obtain approval from Nazarene University. Additionally, the researcher obtained informed consent and voluntary participation from the participants. Further, implementing various security measures ensured that all the data was private and confidential. The study found a high prevalence of perceived stigmatisation among clients in rehabilitation. Most of the participants reported feeling judged (66.0%), experiencing negative societal views (79.4%), and facing stigma in personal relationships (65.0%), while 59.8% reported discrimination related to substance use. Despite this, fewer felt ashamed to share their recovery journey (32.9%), with 44.3% feeling comfortable sharing. Perceived stigma showed significant associations with self-concept indicators, including confidence in maintaining recovery (τ = .303, p = .001) and belief in goal potential (τ = .344, p < .001), while perceived treatment support demonstrated protective effects by reducing stigma-related barriers to help seeking (τ = −.279, p = .001). There was a consensus that reducing stigma can

potentially lower relapse risk (Mdn=5). However, stigma is common and can harm self- concept, self-worth, and recovery outcomes. As such, it is critical for all stakeholders,

including professionals and policymakers to provide a support environment, social support systems, and empowerment to foster the development of a positive identity, which could result in better engagement and outcomes. Rehabilitation efforts should be stigma-sensitive, and more particularly, supportive treatment, which could improve engagement and reduces relapse.