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氏病(PD)运动障碍在卫生保健从业者对患者心理特征的评估中、在患者与从业者之间的关系中以及在制定干预建议方面的污名作用。这项研究的第一个具体目的是阐明操作动作刻板印象对从业者对帕金森氏症患者的印象和结论的影响。第二个具体目标是记录表情掩饰(正常运动的减少)与性别和文化对污名结果的交互作用。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情掩饰对从业者对患者的看法和结论的污名作用。第四个具体目标是从专家从业者的角度评估这些发现的临床实用价值。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)将在各自的祖国进行标准化的卫生保健访谈期间进行录像。在每组6例患者中(性别与文化交叉)，将有3例高表达掩蔽患者和3例正常表达运动患者。24盘录像带的摘录将被展示给台湾和美国的专家和新手卫生保健从业者，他们将评估患者的社会和心理能力以及进入成功治疗关系的潜力。此外，从业者还将提出生活质量干预建议。研究结果将以重点小组的形式提交给专家从业者，他们将评估研究结果的临床效用，并就减少从业者耻辱反应的干预措施提出建议。预计有表达掩蔽的帕金森病将比没有掩蔽的帕金森病更具污名化，特别是在新手与专家从业者的结果中。也可以预期，由于这些群体中与运动表达相关的不同规范，掩饰的负面结果对女性患者比男性患者更大，对美国患者比台湾患者更大。

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.