Stigma of addiction and mental illness in healthcare: The case of patients' experiences in dental settings.
Stigma of addiction and mental illness in healthcare: The case of patients' experiences in dental settings.
复制标题
DOI：
10.1371/journal.pone.0177388
复制
发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Donnelly L
中科院分区：
文献类型：
--
作者：
Brondani MA;Alan R;Donnelly L
探讨有成瘾史和精神病史的患者在医疗保健和牙科环境中经历耻辱的方式。录音，半结构化的访谈，有目的地选择方便的样本居民从两个社区治疗中心在温哥华，加拿大进行。访谈指南包含有关寻求健康和牙科护理的经验的问题，并基于现有的标签，陈规定型观念，排斥，歧视和权力不平衡的框架。访谈内容逐字记录，以便进行编码和专题分析。25名年龄在23岁至67岁之间的参与者接受了采访，其中17名为男性。大多数人都有自我报告的抑郁症病史，并伴有酒精和可卡因的使用;他们中的大多数人只在紧急情况下寻求牙科护理。对300多页转录访谈的文本分析显示，参与者在健康和牙科护理系统中互动时，被负面刻板印象为“不值得”，被贴上“不同”的标签，被排除在决策过程之外，受到歧视，“受到不公平对待”，并感到无能为力。相反，积极的经验的特点是同情，放心和良好的沟通，这是授权的病人。当与耻辱感联系在一起时，精神疾病和成瘾对获得保健和牙科护理有负面影响。从参与者的角度来看，医护人员对他们的生活状况缺乏了解似乎是污名的根源。我们建议，提高社会对这些健康问题的认识，加强当前和未来的卫生和牙科保健专业人员，以帮助改善护理经验，为这个边缘化的人口。
To explore the ways in which stigma is experienced in healthcare and dental settings by patients with a history of addiction and mental illness. Audio-recorded, semi-structured interviews with a purposefully selected convenience sample of residents from two community treatment centres in Vancouver, Canada were conducted. The interview guide contained questions about experiences while seeking health and dental care and was based on an existing framework of labeling, stereotyping, exclusion, discrimination, and power imbalance. Interviews were transcribed verbatim for coding and thematic analysis. Twenty-five participants between 23 and 67 years of age were interviewed; 17 were males. Most had a self-reported history of depression combined with use of alcohol and crack-cocaine; most of them only sought dental care for emergency purposes. Textual analysis of more than 300 pages of transcribed interviews revealed that participants perceived stigma when they were negatively stereotyped as ‘unworthy’, labeled as ‘different’, excluded from the decision-making process, discriminated against, ‘treated unfairly’, and felt powerless when interacting in the heath and dental care systems. Conversely, positive experiences were characterized by empathy, reassurance and good communication, which were empowering for patients. When associated with stigma, mental illness and addictions have negative implications for accessing health and dental care. From our participants’ perspectives, it seems that the lack of understanding about their life conditions by the healthcare professionals was the origin of stigma. We suggest that an increased social awareness of these health issues be enhanced among current and future health and dental care professionals to help improve care experiences for this marginalized population.