Stigma and discrimination and its homeless and health system contexts in south London: an ethnographic case study
Stigma and discrimination and its homeless and health system contexts in south London: an ethnographic case study
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伦敦南部的耻辱和歧视及其无家可归者和卫生系统背景：民族志案例研究
DOI：
10.1016/s0140-6736(23)02059-7
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Guise A
中科院分区：
文献类型：
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作者：
Guise A
背景污名和歧视被广泛认为是健康的核心社会决定因素。在理解如何在社会和系统层面进行干预以解决污名化问题方面存在差距。本研究的目的是理论化如何特定的护理和支持系统的形状的耻辱的经验，因为它涉及到无家可归，然后制定系统级interventions.MethodsWe目前的调查结果从一个正在进行的纵向人种学研究，开始于2022年6月，在南伦敦。数据收集包括与管理、提供和使用无家可归服务的人进行访谈（n=41次访谈，两个重点小组）;在一系列服务环境中进行参与者观察（>70小时，主要在五个地点），以及文献分析。受试者和研究中心提供了知情同意书。该研究以布迪厄的社会实践理论为框架，该理论围绕个人在特定社会背景下拥有的权力和资源进行数据收集和分析。我们做了分析，使用专题和接地的方法，定性data.FindingsWe发现，在无家可归者和医疗服务有深入的认识的耻辱和歧视，但集体，我们是“陷入困境”在应对耻辱。一个直接的挑战是各系统对所涉问题的性质的明确性和一致性有限。更深入的分析还表明，无家可归和卫生系统内的具体组织结构和思维方式限制了集体讨论和对污名化的社会和系统反应的协议。我们还收集了关于污名化是如何经历的数据，描述了不同形式的污名化和歧视，以及它们在哪里和如何形成，重点是制定，预期和内化的污名化。我们还探讨了如何积极管理和克服污名化，以及不平等系统的不同交叉点如何产生不同形式的污名化和歧视。InterpretationOur study provides insight into how stigma and discrimination could potentially be addressed systemically within homelessness and health systems.对羞辱和歧视的现有集体认识为产生系统性变革提供了具体机会。研究的局限性包括对英国一个地理区域的关注，尽管我们反思了如何将我们的研究结果推广到其他环境。
BackgroundStigma and discrimination are widely recognised as core social determinants of health. There is a gap in understanding how to intervene at societal and systems level to address stigma. This study aims to theorise how particular care and support systems shape experiences of stigma as it relates to homelessness, and to then develop systems-level interventions.MethodsWe present findings from an ongoing longitudinal ethnographic study, which started June 2022, in south London. Data collection included interviews with people managing, delivering, and using homelessness services (n=41 interviews, two focus groups); participant observation across a range of service settings (>70 h, principally in five sites), and documentary analysis. Participants and research sites gave informed consent. The study was framed by Bourdieu's social practice theory, which structures data collection and analysis around the power and resources individuals have within particular social contexts. We did the analyses using thematic and grounded approaches to qualitative data.FindingsWe found that across homeless and health services there was in-depth awareness of stigma and discrimination, but that, collectively, we are "stuck in a rut" in responding to stigma. A proximate challenge was limited clarity and agreement across systems on the nature of the issues involved. A deeper analysis also suggested specific organisational structures and ways of thinking within homelessness and health systems that limit collective discussion and agreement on social and systemic responses to stigma. We also collected data on how stigma was experienced, delineating different forms of stigma and discrimination and where and how they take shape, focusing on enacted, anticipated, and internalised stigma. We also explored how stigma was actively managed and overcome, and how different intersections of systems of inequality produce varying forms of stigma and discrimination.InterpretationOur study provides insight into how stigma and discrimination could potentially be addressed systemically within homelessness and health systems. The existing collective awareness of stigma and discrimination offers specific opportunities for generating systemic change. Study limitations include the focus on one geographic area of the UK, although we reflect on how our findings could be generalised to other settings.FundingUK Research and Innovation.