Experiencing and Responding to Dual Stigma: A Focus Group Study with Caregivers of Children Living with Disabilities in Freetown, Sierra Leone

Background Stigma by association refers to the process by which individuals connected to someone with a stigmatized condition, such as caregivers of children living with disabilities (CLWDs), are themselves marginalized or discredited. In Sierra Leone, cultural beliefs frame certain disabilities, especially congenital or early-onset conditions, as curses or moral failings, leading to blame and a dual burden of social exclusion. This study explores how caregivers experience and respond to this dual form of stigma by association and the social support they encounter or desire. Method We conducted six focus group discussions with 37 caregivers of CLWDs in Freetown, Sierra Leone, recruited through hospitals and an NGO providing therapeutic services. Discussions were guided by a semi-structured interview protocol and analyzed using qualitative content analysis. Results Caregivers reported experiencing stigma by association through labeling, avoidance, societal blame, and coercion into traditional practices. Stigma was deeply rooted in cultural narratives that attribute disability to supernatural causes, often extending blame to caregivers. Participants employed three overarching strategies to navigate stigma: withdrawing, coping (e.g., spiritual reframing, focusing on positive interactions), and resisting (e.g., challenging superstitious beliefs, advocating for inclusion). Despite some positive experiences of empathy and social inclusion, caregivers expressed a strong need for more practical support, community awareness, and holistic interventions to reduce stigma and foster understanding. Discussion This study illuminates the complex interplay of cultural beliefs and social stigma shaping the experiences of caregivers of CLWDs. While caregivers demonstrated resilience and adaptive strategies, the dual stigma of association and societal blame underscores the urgent need for inclusive policies and community-based interventions. Amplifying the voices of caregivers and addressing their needs holistically are essential steps toward reducing stigma and creating supportive environments. This study contributes to the broader discourse on caregiving and stigma, offering insights for research and interventions in similar cultural contexts. Trial registration N/A