Department of Family Medicine, Division of Health Care Delivery Research, Robert D. & Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, Minnesota
Center for Health Equity and Community Engaged Research, Mayo Clinic, Jacksonville, Florida.
Ann Fam Med. 2023 Feb;21(Suppl 2):S56-S60. doi: 10.1370/afm.2924.
Stigma related to mental health is well documented and a major barrier to using mental and physical health care. Integrated behavioral health (IBH) in primary care, in which behavioral/mental health care services are located within a primary care setting, may reduce the experience of stigma. The purpose of this study was to assess the opinions of patients and health care professionals about mental illness stigma as a barrier to engagement with IBH and to gain insight into strategies to reduce stigma, encourage discussion of mental health, and increase uptake of IBH care.
We conducted semistructured interviews with 16 patients referred to IBH in a prior year and 15 health care professionals (12 primary care physicians and 3 psychologists). Interviews were transcribed and inductively coded separately by 2 coders for common themes and subthemes under the topic headings of barriers, facilitators, and recommendations.
We identified 10 converging themes from interviews with patients and the health care professionals, representing important complementary perspectives, with respect to barriers, facilitators, and recommendations. Barriers included professionals, families, and the public as sources of stigma, as well as self-stigma or avoidance, or internalizing negative stereotypes. Facilitators and recommendations included normalizing discussion of mental health and mental health care-seeking action, using patient-centered and empathetic communication strategies, sharing by health care professionals of their own experiences, and tailoring the discussion of mental health to patients' preferred understanding.
Health care professionals can help reduce perceptions of stigma by having conversations with patients that normalize mental health discussion, use patient-centered communication, promote professional self-disclosure, and are tailored to patients' preferred understanding.
心理健康相关污名化现象已有大量记载，是阻碍人们使用精神和身体健康护理服务的主要障碍。初级保健中的综合行为健康（IBH）将行为/心理健康护理服务置于初级保健环境中，可能会降低污名化体验。本研究旨在评估患者和医疗保健专业人员对精神疾病污名作为参与 IBH 的障碍的看法，并深入了解减少污名化、鼓励讨论心理健康以及增加 IBH 护理服务使用的策略。
我们对前一年转诊至 IBH 的 16 名患者和 15 名医疗保健专业人员（12 名初级保健医生和 3 名心理学家）进行了半结构化访谈。访谈记录由两名编码员分别进行转录和归纳编码，以确定主题标题下的常见主题和子主题，这些主题标题为障碍、促进因素和建议。
我们从患者和医疗保健专业人员的访谈中确定了 10 个趋同主题，代表了重要的互补观点，涉及障碍、促进因素和建议。障碍包括专业人员、家庭和公众是污名的来源，以及自我污名或回避，或内化负面刻板印象。促进因素和建议包括使心理健康讨论正常化和寻求心理健康护理的行为，使用以患者为中心和富有同理心的沟通策略，医疗保健专业人员分享自己的经验，以及根据患者的偏好理解调整心理健康讨论。
医疗保健专业人员可以通过与患者进行对话来帮助减少污名化的看法，使心理健康讨论正常化，使用以患者为中心的沟通方式，促进专业自我披露，并根据患者的偏好理解进行调整。
