Poverty, Substance Use, and Stigma in Four Organizations

描述（由申请人提供）：穷人或患有与酒精或药物使用有关的问题的人在寻求医疗保健时可能会遇到负面的社会耻辱。与贫穷或药物使用问题有关的耻辱可能对受影响的个人造成负面后果，包括延误或避免所需的医疗服务、可治疗的疾病恶化、疼痛和痛苦增加以及医疗费用增加。更好地了解医疗机构如何产生和/或改善与贫困和药物使用问题相关的耻辱感，可能会导致积极的干预措施，以减少这些弱势群体的耻辱感。

DESCRIPTION (provided by applicant): Individuals who are poor or who suffer from problems related to alcohol or drug use can encounter negative social stigma when seeking medical care. Stigma related to poverty or substance use problems may result in negative consequences for affected individuals including delay or avoidance of needed medical care, exacerbation of treatable conditions, increased pain and suffering, and higher healthcare costs. A better understanding how healthcare organizations generate and/or ameliorate stigma associated with poverty and substance use problems may lead to positive interventions to reduce stigmatization of these vulnerable populations. The objective of this exploratory and developmental project is to examine how different healthcare organizations shape the stigma experiences of patients who are poor or have substance use problems. Qualitative research methods will be used to document how patients manage stigma and examine how these management strategies are affected by stigma processes in healthcare organizations. This study develops theoretical propositions to guide future research by identifying characteristics of healthcare organizations that affect stigmatization. The specific aims are: 1) to use ethnographic research in four healthcare organizations to describe how the behaviors of care-providers generate and/or ameliorate stigma related to poverty and substance use problems, 2) to use interviews with patients to describe how their interactions at each study clinic affect their strategies for managing stigma related to poverty and substance use problems, and 3) to identify the characteristics of healthcare organizations that are salient in the generation and/or amelioration of stigma related to poverty and substance use problems.