Whitley Rob
a Department of Psychiatry , Douglas Mental Health University Institute, McGill University , Perry Pavilion E-3108, 6875 Lasalle Blvd., Montreal , Quebec , Canada H4H 1R3.
Anthropol Med. 2013;20(3):232-43. doi: 10.1080/13648470.2013.853597.
Little anthropological research has been conducted on the health care perspectives of homeless people in rural areas. The aim of the present study is to elicit health-care beliefs, and examine overall health experience among a sample of current or recently homeless people in rural New Hampshire. Thirteen qualitative interviews were conducted, 11 with single men. Interviews were audio-recorded and transcribed, and analyzed using thematic analysis. Despite a massive burden of disease and illness, almost all participants reported an abiding aversion to doctors, hospitals and professional health care. Participants reported numerous negative encounters with doctors and health care professionals, often of a demeaning and disparaging nature. Participants noted that these encounters resulted in frequent cases of misdiagnosis and iatrogenesis. In contrast, participants spoke more fondly of other social and voluntary services, for example homeless organizations. Like other rural New Englanders, participants made their own individual efforts to maintain and promote health, for example by pursuing hobbies or prayer. The findings are contextualized within literature suggesting that these perspectives are generally shared by other poor rural people. Consistent with this literature, the findings suggest that homelessness in rural areas is often temporary and episodic. As such, this paper brings into question the distinctiveness and overall utility of the concept: 'the rural homeless'. The key determinant of negative attitudes to health care may not be recent homelessness. It may be entrenched socio-economic marginalization, and the resultant social stigma, that are shared amongst the rural poor, regardless of their current housing status.
针对农村地区无家可归者的医疗保健观念，几乎没有开展过人类学研究。本研究旨在了解他们的医疗保健信念，并调查新罕布什尔州农村地区当前或近期无家可归者样本的整体健康体验。我们进行了13次定性访谈，其中11次是与单身男性进行的。访谈进行了录音和转录，并采用主题分析法进行分析。尽管疾病负担沉重，但几乎所有参与者都表示对医生、医院和专业医疗保健始终怀有反感。参与者报告了与医生和医疗保健专业人员的多次负面接触，这些接触往往带有贬低和轻蔑的性质。参与者指出，这些接触导致了频繁的误诊和医源性疾病。相比之下，参与者对其他社会和志愿服务，比如无家可归者组织，评价更高。和其他新英格兰农村居民一样，参与者也会通过追求爱好或祈祷等方式，自行努力维持和促进健康。这些研究结果在相关文献的背景下进行了分析，这些文献表明其他农村贫困人口也普遍持有这些观点。与这些文献一致，研究结果表明农村地区的无家可归现象往往是暂时的、偶发的。因此，本文对“农村无家可归者”这一概念的独特性和整体实用性提出了质疑。对医疗保健持负面态度的关键决定因素可能并非近期的无家可归状态。可能是根深蒂固的社会经济边缘化以及由此产生的社会耻辱感，这些是农村贫困人口共有的，无论他们目前的住房状况如何。
