Stigma,Silence,and the Nurse's Voice: Reshaping Dementia Care in Zimbabwe

Abstract

Dementia is an emerging public health concern in Zimbabwe, yet it remains widely misunderstood, often attributed to aging, madness, or spiritual causes such as witchcraft. These cultural beliefs contribute to stigma, silence, delayed diagnosis, and lack of care for individuals and families affected by dementia. Nurses, as trusted professionals embedded within communities, are well-positioned to challenge these narratives and lead a transformative shift in dementia care. However, systemic gaps in education, training, and policy have limited their visibility and influence in dementia discourse. This commentary explores how Zimbabwean nurses can reclaim their voice and take on expanded roles as educators, advocates, cultural mediators, and policy influencers. Strategies include integrating dementia care into nursing curricula, promoting culturally sensitive public education, implementing community-based nursing models, and engaging in ethical leadership and policy advocacy. The article highlights the importance of reflective practice and the need for investment in specialist training, partnerships, and nursing-led research. By addressing stigma and promoting dignity, nurses can reshape how dementia is understood and experienced in Zimbabwe.

Introduction

Dementia is a growing global health challenge, with the World Health Organization (2021) projecting over 150 million cases by 2050: 68% in low- and middle-income countries like Zimbabwe. Yet in many African contexts, dementia remains under-recognized and misunderstood. In Zimbabwe, it is often attributed to aging, madness, or spiritual causes such as witchcraft, leading to silence, shame, and harmful practices (Banda & Munemo, 2023). These cultural interpretations contribute to delayed diagnoses, inadequate care, and limited policy attention.

Nurses, as trusted professionals embedded within communities, are well-placed to challenge these harmful narratives. They have the potential to educate families, influence community attitudes, and deliver person-centred care that promotes dignity (Gibson et al., 2020). However, their voices remain largely absent from dementia discourse in Zimbabwe.

This commentary explores how Zimbabwean nurses can lead in reshaping dementia care by confronting stigma and embracing a culturally grounded, community-based approach.

Brief Review

In Zimbabwe, dementia is often not recognized as a medical condition but is instead viewed as a result of aging, madness, or spiritual affliction (Mudzingwa, 2023). Cognitive decline is frequently seen as a “normal” part of aging or, more troublingly, as a sign of being bewitched or possessed. These beliefs, especially prevalent in rural communities, are deeply rooted in cultural and spiritual worldviews that influence how illness is understood (Banda & Munemo, 2023; Nzima & Maharaj, 2020). Symptoms such as memory loss, confusion, and behavioral changes are rarely linked to clinical causes but are often attributed to ancestral displeasure or malevolent forces.

This results in a pervasive and complex stigma. Silence is common as families may avoid seeking help due to fear of judgment or social exclusion (Memeza, 2025). People with dementia are sometimes hidden from public view or subjected to neglect. Misdiagnosis is frequent, with dementia often mistaken for mental illness or dismissed by under-trained personnel (Nhiwatiwa, 2016). In extreme cases, individuals, especially elderly women have been accused of witchcraft and subjected to violence (Marsden, 2024; Mudzingwa, 2023).

Such stigma delays diagnosis, prevents access to care, and increases emotional and financial stress for caregivers (Orgeta et al., 2025; Banda). People living with dementia face isolation, loss of dignity, and reduced quality of life (Hungwe, 2022). The absence of formal dementia care systems exacerbates these challenges.

Amid these realities, nurses are strategically positioned to lead change. By raising awareness, challenging harmful beliefs, and supporting families, Zimbabwean nurses can play a transformative role in breaking the silence and reshaping dementia care.

Current Insights and Interpretations

Despite their vital role in health systems and communities, nurses in Zimbabwe have remained largely absent from national and local discussions on dementia (Chasokela, 2001). This silence is not always intentional, it often stems from systemic gaps in nursing education, leadership, and empowerment. Dementia remains marginal in nursing curricula, with few training programs equipping nurses to recognize symptoms, understand psychosocial impacts, or engage in culturally sensitive conversations around the condition (Mapanga & Mapanga, 2000).

As a result, nurses have limited visibility in dementia advocacy, community awareness, and policy development. Dementia is often deprioritized in clinical settings, overshadowed by acute and infectious diseases, reinforcing the belief that cognitive decline is a natural or untreatable part of aging (Guerchet et al., 2017).

The implications of this silence are profound. Missed opportunities for early identification and intervention are common. Families are left without guidance, while harmful cultural narratives persist unchallenged (Hungwe, 2022). Most critically, this silence sustains the stigma that nursing is well-placed to dismantle; stigma that dehumanizes and marginalizes those living with dementia.

Reshaping dementia care in Zimbabwe requires empowering nurses to speak, act, and lead in ways that confront stigma and support families. Nurses must reclaim their voice across education, advocacy, service delivery, and policy to create a compassionate and culturally responsive care environment for people living with dementia.

A foundational step is integrating dementia into nursing education and continuous professional development (CPD). Most nursing programs in Zimbabwe offer minimal exposure to gerontology, and even less to dementia-specific training. Embedding dementia modules into pre-service training and CPD can enhance nurses’ ability to recognize early symptoms, communicate effectively, and provide person-centered care (Sunjaya et al., 2025).

Beyond formal education, nurses can act as community educators offering accessible, stigma-free information to families through health talks, clinics, or local radio. By framing dementia as a brain condition rather than a curse, nurses can help demystify the illness and promote timely help-seeking (Rwafa-Madzvamutse, 2023; Zinyuke, 2024).

Stigma reduction begins with cultural understanding. Traditional beliefs heavily shape perceptions of illness in Zimbabwe, making it essential for nurses to work with community leaders, faith-based institutions, and influencers. Rather than dismissing spiritual beliefs, nurses can provide respectful, alternative explanations that align with cultural values (Fon, 2022).

Using local languages, proverbs, and storytelling, nurses can explain dementia in ways that resonate with communities thereby reducing resistance and creating space for empathy (Jenkins & Smythe, 2024).

While dementia care is gaining visibility within Zimbabwe's broader health discourse, nurse-led public campaigns that explicitly address dementia-related stigma remain notably scarce. Most existing initiatives such as the Ingutsheni Central Hospital Campaign, “Putting Mental Health on the Radar” (CITEZW News, 2019) and the WHO Zimbabwe Mental Health Investment Case Dissemination (2023), are spearheaded and strongly supported by nurses, yet their primary focus lies in general mental health awareness and destigmatization. These campaigns have made significant strides in elevating mental health as a national priority and in mobilizing community engagement, but they seldom differentiate dementia from other psychiatric conditions, leaving a gap in targeted advocacy and culturally sensitive education around aging, cognitive decline, and caregiving.

Effective dementia care must move beyond hospitals. In rural and underserved areas, where stigma is often strongest, nurses can lead community-based approaches that meet people where they are (MOHCC, 2025). Leveraging rural clinics, mobile outreach, and home visits, nurses can identify cases early, support carers, and provide follow-up care (Sizolwethu Mobile Health, 2025).

Initiatives such as caregiver support groups or memory cafés can reduce isolation and build trust, while positioning nurses as compassionate, visible champions of dementia care (Lamech et al., 2021).

Nurses also have a critical role in shaping dementia-related policy. As frontline professionals, they can advocate for dementia to be recognized as a public health and human rights issue (Panagiotidou et al., 2024; WHO, 2012). By engaging with policymakers, civil society, and nursing associations, they can influence investment in dementia services, training, and community support. Nurses’ voices must be central to any effort aimed at building a just, inclusive system of dementia care.

Zimbabwe currently lacks a dedicated national dementia strategy, though mental health is included as a component of the National Health Strategy (2021–2025) and the Mental Health Policy (Ministry of Health and Child Care, 2021). However, dementia-specific guidance remains limited. Nurses, while numerous and widely trusted, are not formally empowered to lead dementia initiatives within existing policy frameworks. The Nurses Council of Zimbabwe (n.d.) governs nursing regulation, but its strategic plans do not explicitly address dementia. The Council is yet to establish certification for dementia or gerontological nurse specialists. This policy vacuum limits nurses’ formal influence, though their proximity to communities places them in an ideal position to advocate for the integration of dementia into primary healthcare and national training curricula.

Conclusions/Importance to Nursing Profession

The role of nurses in dementia care must evolve in response to the rising burden of cognitive decline and the deeply rooted stigma surrounding it in Zimbabwe. Reclaiming the nurse's voice is not only a professional obligation but it is essential for improving health outcomes, promoting dignity, and addressing systemic gaps in care.

The implementation of nurse-led dementia care in Zimbabwe faces significant challenges. Many nurses lack access to ongoing professional development in gerontology or mental health due to funding constraints and training gaps (Hungwe, 2022). Institutional resistance is another barrier, as national health priorities continue to favor communicable diseases and maternal-child health over noncommunicable conditions like dementia (Dementia Association of Zimbabwe, n.d.). Additionally, stigma may also be internalized within the healthcare system itself, where even health workers may misunderstand or fear dementia (Karrer et al., 2020). There is a need for policy support, sustained investment, and phased implementation strategies that align with Zimbabwe's health resource landscape in the case of nurse-led dementia care.

Nursing practice must expand beyond traditional bedside care to include advocacy, education, and cultural mediation. Nurses are uniquely positioned to bridge the gap between health systems and communities (Hassmiller & Wakefield, 2022). By promoting dementia awareness in both clinical and community settings, they can challenge misconceptions and foster culturally safe environments for dialogue and support. This shift requires a broader understanding of nursing competence, valuing communication, empathy, and leadership as much as clinical expertise.

Reflective practice is also vital. Many nurses may unintentionally reinforce stigma due to internalized cultural beliefs. Structured reflection through peer discussions or supervision can help identify biases and align practice with values of respect and inclusion (Stubbe, 2020).

Progress will also depend on investment in specialist dementia training, community partnerships, and nursing-led research. Equipping nurses with targeted skills, fostering collaboration with local leaders and NGOs, and supporting research can lead to more responsive, evidence-based, and culturally relevant dementia care. Nurses must be empowered as key agents of change in the fight against dementia stigma.