Doctoral Dissertation Research:Improved Modeling of Medical Decision-Making around Maternal Health Care

本研究旨在提高对导致对主流医学和科学知识不信任的变量的科学理解。研究表明，在社会、经济和政治上往往强大的社区中，对主流医学的不信任正在增加，这些信念在某些情况下与公共卫生事件有关，例如疫苗可预防疾病的爆发。更好地理解社会因素如何使对医学权威的抵抗具有吸引力，可以发现更好地理解、预测和更广泛地解决医学和科学不信任的方法。该项目提供了一套可扩展的方法和理论创新，旨在了解对主流医学的耐药性，这将提供框架，帮助研究人员更好地了解其他社区的医疗不信任。除了在定性和定量数据收集方法和人类学理论方面培训博士生外，这项研究的结果将广泛传播给学术、医学和非专业团体。具体而言，该项目侧重于怀孕、分娩、婴儿期和幼儿期（必须解决常规疫苗接种问题）的医疗决策，在一个历史上没有受到生物医学研究虐待的社区中，但在先前的研究中观察到医疗不信任。它将调查在分娩时偏爱非主流护理和更普遍地不信任主流医学之间的潜在重叠。调查人员使用人种学、堆分类和调查方法来检查拒绝主流医学权威的医疗决定是否以及如何由共同的、主观的和当地的本体论塑造，是否存在将不信任社区与其他社区区分开来的社会和认识论特征，以及哪些特征可能使怀孕和幼儿期的医疗干预更多或更少地被接受。这个项目的发现将提高人类学对抵抗医学权威的理解，人们如何做出医疗决定，以及群体如何感知和参与（或不参与）主流医学和其他强大的社会机构。该奖项反映了美国国家科学基金会的法定使命，并通过使用基金会的知识价值和更广泛的影响审查标准进行评估，被认为值得支持。

This research aims to improve scientific understanding of the variables that contribute to the distrust of mainstream medical and scientific knowledge. Research has shown that mistrust in mainstream medicine is increasing among communities who tend to be socially, economically, and politically powerful, and that these beliefs are associated in certain contexts with public health events, such as outbreaks of vaccine-preventable diseases. An improved understanding of how social factors can render resistance to medical authority attractive can uncover ways to better understand, predict, and address mistrust in medicine and science more broadly. This project provides a scalable set of methodological and theoretical innovations aimed at understanding resistance to mainstream medicine that will provide frameworks to help researchers better understand medical mistrust in other communities. In addition to training a doctoral student in qualitative and quantitative data collection methods and anthropological theory, the results of this research will be disseminated broadly to scholarly, medical, and lay communities. Specifically, this project focuses on medical decision-making during pregnancy, birth, infancy, and early childhood (when questions of routine vaccinations must be addressed), among a community that has not been historically mistreated by biomedical research, but where medical mistrust has been observed in prior research. It will investigate potential overlap between preferring non-mainstream care during birth and being mistrustful of mainstream medicine more generally. Investigators use ethnographic, pile sorts, and survey methodologies to examine whether and how medical decisions that reject the authority of mainstream medicine might be shaped by shared, subjective, and local ontologies, whether there are social and epistemological characteristics that distinguish mistrustful communities from others, and what characteristics might make medical interventions in pregnancy and early childhood more, or less, acceptable. Findings from this project will improve anthropological understandings about resistance to medical authority, how people make medical decisions, and how groups perceive and engage (or not) with mainstream medicine and other powerful social institutions.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.