Why don't health care frontline professionals do more for segregated Roma? Exploring mechanisms supporting unequal care practices
Why don't health care frontline professionals do more for segregated Roma? Exploring mechanisms supporting unequal care practices
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DOI：
10.1016/j.socscimed.2019.112739
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发表时间：
2020-02-01
影响因子：
5.4
通讯作者：
Reijneveld, Sijmen A.
中科院分区：
文献类型：
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作者：
Belak, Andrej;Bobakova, Daniela Filakovska;Reijneveld, Sijmen A.
理由：不平等地提供保健服务是中欧和东欧被隔离的罗姆人健康状况不佳的原因之一。背后的驱动程序和机制的研究是lacked.Objective：我们探讨了什么样的不符合标准的做法医疗一线专业人员从事有关隔离罗姆人和什么机制支持这种做法在专业人员的职业生涯在护理service.Methods：在三个月的时间内在五个不同的地点在斯洛伐克，我们采访和观察43一线专业人员服务隔离罗姆人。接下来，通过定性内容分析，我们在数据中确定了3个关于各种不合格做法的主题和22个关于支持机制的主题。我们组织这些主题到一个解释性的框架，借鉴心理模型的歧视和群体间的contact.Results：一线工作人员不合格的做法大多涉及不合格的沟通和承诺的照顾，但也有一些明显的种族歧视。这些做法得到了五个机制的支持：工作人员与被称为“问题罗姆病人”的人打交道的负面经历;工作人员对被隔离的罗姆人的负面态度;不利的组织方面;不利的居住隔离方面;以及国家在种族主义方面的治理不善。在他们的职业生涯中，许多专业人士首先感到有义务和勤奋的隔离罗姆人的病人，然后失败，装备不足，被遗弃，并最终沮丧和辞职的平等标准的护理towards the group.Conclusions：卫生保健一线工作人员对隔离罗姆人的做法往往是不合标准的。这种低于标准的护理背后的心理过程得到了具体的个人、组织和治理特征的支持。这些机制导致许多一线专业人员在其职业生涯中逐渐对被隔离的罗姆人持怀疑态度。应向保健工作人员提供技能和工具，以有效处理他们自己和他人的种族主义、患者的文化反弹和结构性脆弱性以及有关公平的专业期望。
Rationale: Unequal provision of health care contributes to the poor health status of segregated Roma in Central and Eastern Europe. Studies on the drivers and mechanisms behind this are lacking.Objective: We explored what kinds of substandard practices health care frontline professionals engage in regarding segregated Roma and what mechanisms support such practices during the professionals' careers in care services.Methods: Over a three-month period at five different locations in Slovakia we interviewed and observed 43 frontline professionals serving segregated Roma. Next, through qualitative content analysis we identified in the data three themes regarding kinds of substandard practices and 22 themes regarding supporting mechanisms. We organized these themes into an explanatory framework, drawing on psychological models of discrimination and intergroup contact.Results: The frontline staffs substandard practices mostly involved substandard communication and commitment to care, but also some overt ethnic discrimination. These practices were supported by five mechanisms: the staffs negative experiences with people labelled "problematic Roma patients"; the staffs negative attitudes regarding segregated Roma; adverse organizational aspects; adverse residential-segregation aspects; and poor state governance regarding racism. In the course of their careers, many professionals first felt obliged and diligent regarding segregated Roma patients, then failing, unequipped and abandoned, and ultimately frustrated and resigned regarding the equal standard of care towards the group.Conclusions: Health care frontline staffs practices towards segregated Roma are frequently substandard. The psychological processes underlying this substandard care are supported by specific personal, organizational and governance features. These mechanisms cause many frontline professionals gradually to become cynical regarding segregated Roma over the course of their careers. Health care staff should be supported with skills and tools for effectively handling their own and others' racism, the culturebound and structural vulnerabilities of patients as well as related professional expectations regarding equity.