Research Unit for General Practice, Uni health, Uni Research, Bergen, Norway.
Int J Qual Stud Health Well-being. 2011;6(4). doi: 10.3402/qhw.v6i4.8404. Epub 2011 Nov 22.
To synthesize research findings on experiences and attitudes about obesity and stigma in health care.
We compiled qualitative studies and applied Noblitt & Hare's meta ethnography to identify, translate, and summarize across studies. Thirteen qualitative studies on experiences and attitudes about obesity and stigma in health care settings were identified and included.
The study reveals how stigmatizing attitudes are enacted by health care providers and perceived by patients with obesity. Second-order analysis demonstrated that apparently appropriate advice can be perceived as patronizing by patients with obesity. Furthermore, health care providers indicate that abnormal bodies cannot be incorporated in the medical systems-exclusion of patients with obesity consequently happens. Finally, customary standards for interpersonal respect are legitimately surpassed, and patients with obesity experience contempt as if deserved. Third-order analysis revealed conflicting views between providers and patients with obesity on responsibility, whereas internalized stigma made patients vulnerable for accepting a negative attribution. A theoretical elaboration relates the issues of stigma with those of responsibility.
Contradictory views on patients' responsibility, efforts, knowledge, and motivation merge to internalization of stigma, thereby obstructing healthy coping and collaboration and creating negative contexts for empowerment, self-efficacy, and weight management. Professionals need to develop their awareness for potentially stigmatizing attitudes towards vulnerable patient populations.
综合有关医疗保健中肥胖和污名经验和态度的研究结果。
我们编译了定性研究，并应用 Noblitt 和 Hare 的元民族志方法，对研究进行识别、翻译和总结。确定并纳入了 13 项关于医疗环境中肥胖和污名的经验和态度的定性研究。
该研究揭示了医疗保健提供者如何实施污名化态度，以及肥胖患者如何感知这些态度。二阶分析表明，看似恰当的建议可能会被肥胖患者视为居高临下。此外，医疗保健提供者表示，异常的身体无法融入医疗系统，因此肥胖患者会被排斥。最后，人际尊重的惯常标准被合法超越，肥胖患者会感到被轻视，好像这是应得的。三阶分析揭示了提供者和肥胖患者之间在责任方面的观点存在冲突，而内化的污名将患者置于接受负面归因的脆弱地位。理论阐述将污名问题与责任问题联系起来。
患者责任、努力、知识和动机的观点存在冲突，导致污名内化，从而阻碍了健康应对和协作，并为赋权、自我效能和体重管理创造了负面环境。专业人员需要提高对弱势患者群体潜在污名化态度的认识。
