Culture, Gender, and Health Care Stigma in Parkinsonism

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DESCRIPTION (provided by applicant): The overall goal of the proposed research is to understand the stigmatizing role of the movement disorder of Parkinson's disease (PD) in health care practitioners' assessment of patient psychological traits, in the patient-practitioner relationship, and in the development of intervention recommendations. The first specific aim of the research is to elucidate the consequences of the operation of movement stereotypes on practitioner impressions of and conclusions about patients with PD. The second specific aim is to document the interaction of expressive masking (the diminishment of normal movement) with gender and culture on stigma outcomes. The third specific aim is to determine the degree to which practitioner expertise moderates the stigmatizing role of expressive masking on practitioner perceptions of and conclusions about patients. The fourth specific aim is to evaluate the clinical utility of the findings from the perspective of expert practitioners. Twelve Taiwanese patients (6 females and 6 males) and 12 American patients (6 females and 6 males) will be videotaped during a standardized health care interview in their respective homelands. Within each group of 6 patients (gender crossed with culture), there will be 3 patients with high expressive masking and 3 patients with normal expressive movement. Excerpts from the resulting 24 tapes will be shown to expert and novice health care practitioners in Taiwan and the U.S. who will assess patients' social and mental competence and potential for entering into a successful therapeutic relationship. In addition, the practitioners will make quality-of-life intervention recommendations. The results of the study will be presented to expert practitioners, in focus groups, who will evaluate the clinical utility of the findings and make recommendations for interventions to reduce practitioners' stigma responses. It is anticipated that PD with expressive masking will be more stigmatizing than PD without masking, especially as demonstrated in outcomes for novice compared to expert practitioners. It is also anticipated that negative outcomes of masking will be greater for female than male and American than Taiwanese patients because of different norms associated with movement expression in these groups.