Health care-seeking experiences for people who inject drugs with hepatitis C: Qualitative explorations of stigma.
Health care-seeking experiences for people who inject drugs with hepatitis C: Qualitative explorations of stigma.
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DOI：
10.1016/j.jsat.2021.108684
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发表时间：
2022-06
影响因子：
3.9
通讯作者：
Williams, Emily C.
中科院分区：
文献类型：
--
作者：
Austin, Elizabeth J.;Tsui, Judith, I;Barry, Michael P.;Tung, Elyse;Glick, Sara N.;Ninburg, Michael;Williams, Emily C.
注射吸毒者（PWID）有复杂的健康需求，往往会经历不良的健康结果。对于PWID，耻辱和其他社会脆弱性的交叉经历可能会影响他们的医疗护理体验。我们对收集的定性访谈数据进行了有针对性的亚组分析，以了解PWID中丙型肝炎（HCV）社区药师护理模式的发展，以探索对医疗保健寻求经验的交叉影响。该研究招募了来自华盛顿西雅图社区组织的参与者，如果他们在3个月内报告注射毒品并患有HCV，则参与者有资格。研究人员进行了半结构化的访谈和两个独立的编码转录，并初步分析他们使用快速评估过程，由实施研究的综合框架的指导。出现了关于耻辱和社会脆弱性的交叉点的主题;因此，我们在基本原因理论和Earnshaw等人的指导下进行了有针对性的子分析。的污名框架。40名参与者（65%男性; 47%非白人）报告了多种社会脆弱性（例如，住房不稳定和粮食不安全）。定性分析确定，在社会脆弱性的背景下接受医疗保健具有挑战性和负担（主题1）;医疗保健的相互作用充满了来自交叉脆弱性的耻辱（主题2）;以及需要放弃使用毒品以证明值得照顾的信念（主题3）。PWID描述了经历多种社会漏洞（例如，未满足的基本需求），这使得寻求医疗保健成为负担。与卫生保健团队的互动进一步加强了参与者对吸毒的羞耻感，这影响了参与者如何表达他们的护理偏好，并感受到提供者的倾听。当PWID在医疗保健中导航时，他们觉得他们作为活跃吸毒者的身份被用来控制，有时强迫他们获得服务，阻止PWID寻求所需的护理。污名和社会脆弱性在PWID寻求医疗保健的经历中发挥着普遍和交叉的作用，并对他们导航和接受所需护理的能力产生负面影响。多层面的循证减少耻辱干预措施，加上以人为本的护理提供方法，可能有助于减轻负面影响。
People who inject drugs (PWID) have complex health needs and often experience poor health outcomes. For PWID, intersectional experiences of stigma and other social vulnerabilities may influence their experiences navigating medical care. We conducted a targeted subanalysis of qualitative interview data collected to inform development of a community-pharmacist care model for hepatis C (HCV) among PWID to explore intersectional influences on health care–seeking experiences. The study recruited participants from community organizations in Seattle, Washington, and participants were eligible if they reported injection drug use within 3 months and having HCV. Study staff conducted semi-structured interviews and two independent coders transcribed and initially analyzed them using a Rapid Assessment Process, guided by the Consolidated Framework for Implementation Research. Themes emerged regarding intersections of stigma and social vulnerabilities; thus, we conducted a targeted subanalysis guided by Fundamental Cause Theory and Earnshaw et al.’s Stigma Framework. Forty participants (65% male; 47% non-white) reported multiple social vulnerabilities (e.g., regarding unstable housing and food insecurity). Qualitative analysis identified that receiving health care in the context of social vulnerability is challenging and burdensome (Theme 1); health care interactions are fraught with stigma stemming from intersectional vulnerabilities (Theme 2); and the belief that abstaining from drug use is needed to prove worthiness for care (Theme 3). PWID described experiencing multiple social vulnerabilities (e.g., unmet basic needs) that made seeking health care burdensome. Interactions with health care teams further reinforced participants’ feelings of shame about their drug use, which influenced how participants expressed their care preferences and felt heard by providers. And as PWID navigated health care, they felt that their status as an active drug user was used to control and sometimes coerce their access to services, discouraging PWID from seeking needed care. Stigma and social vulnerabilities play a pervasive and intersecting role in the health care–seeking experiences of PWID and negatively impact their ability to navigate and receive care they need. Evidence-based stigma reduction interventions at multiple levels, coupled with person-centered approaches to care delivery, may help to mitigate negative impacts.
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