Culture, Gender, and Health Care Stigma in Parkinsonism

描述（由申请人提供）：拟议研究的总体目标是了解帕金森病（PD）运动障碍在医疗保健从业者对患者心理特征的评估、患者与从业者关系以及制定干预建议中的污名化作用。该研究的第一个具体目的是阐明运动刻板印象的运作对医生对帕金森病患者的印象和结论的影响。第二个具体目标是记录表达性掩蔽（正常运动的减少）与性别和文化对耻辱结果的相互作用。第三个具体目标是确定从业者的专业知识在多大程度上缓和了表达性掩蔽对从业者对患者的看法和结论的污名化作用。第四个具体目标是从专家从业者的角度评估研究结果的临床效用。 12 名台湾患者（6 名女性和 6 名男性）和 12 名美国患者（6 名女性和 6 名男性）将在各自祖国接受标准化医疗保健采访时被录像。每组 6 名患者（性别与文化交叉）中，将有 3 名患者具有高表达掩蔽，3 名患者具有正常表达运动。由此产生的 24 盘磁带的摘录将向台湾和美国的专家和新手医疗保健从业者展示，他们将评估患者的社交和心理能力以及建立成功治疗关系的潜力。此外，从业人员还将提出生活质量干预建议。研究结果将提交给焦点小组的专家从业者，他们将评估研究结果的临床效用，并提出干预措施建议，以减少从业者的耻辱反应。预计具有表达性掩蔽的 PD 将比不具有掩蔽的 PD 更具耻辱性，尤其是新手与专家从业者相比的结果表明。还预计，由于这些群体中与运动表达相关的规范不同，女性患者和美国患者比台湾患者的掩蔽负面结果会更大。

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.