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肥胖患者在医疗保健环境中所经历的体重歧视:定性证据综合分析。

Weight stigma experienced by patients with obesity in healthcare settings: A qualitative evidence synthesis.

机构信息

School of Psychology, University of Galway, Galway, Ireland.

Irish Coalition for People Living with Obesity (ICPO), Dublin, Ireland.

出版信息

Obes Rev. 2023 Oct;24(10):e13606. doi: 10.1111/obr.13606. Epub 2023 Aug 2.

Abstract

Weight stigma research is largely focused on quantifiable outcomes with inadequate representation of the perspectives of those that are affected by it. This study offers a comprehensive systematic review and synthesis of weight stigma experienced in healthcare settings, from the perspective of patients living with obesity. A total of 1340 studies was screened, of which 32 were included in the final synthesis. Thematic synthesis generated three overarching analytical themes: (1) verbal and non-verbal communication of stigma, (2) weight stigma impacts the provision of care, and (3) weight stigma and systemic barriers to healthcare. The first theme relates to the communication of weight stigma perceived by patients within patient-provider interactions. The second theme describes the patients' perceptions of how weight stigma impacts upon care provision. The third theme highlighted the perceived systemic barriers faced by patients when negotiating the healthcare system. Patient suggestions to reduce weight stigma in healthcare settings are also presented. Weight stigma experienced within interpersonal interactions migrates to the provision of care, mediates gaining equitable access to services, and perpetuates a poor systemic infrastructure to support the needs of patients with obesity. A non-collaborative approach to practice and treatment renders patients feeling they have no control over their own healthcare requirements.

摘要

体重歧视研究主要集中在可量化的结果上,而对受其影响的人的观点的代表性不足。本研究从肥胖患者的角度出发,对医疗环境中经历的体重歧视进行了全面的系统回顾和综合分析。共筛选出 1340 项研究,其中 32 项研究纳入最终综合分析。主题综合分析产生了三个总体分析主题:(1)言语和非言语的歧视交流,(2)体重歧视影响医疗服务的提供,(3)体重歧视和医疗保健的系统性障碍。第一个主题涉及患者在医患互动中感知到的体重歧视交流。第二个主题描述了患者对体重歧视如何影响医疗服务提供的看法。第三个主题强调了患者在协商医疗体系时面临的感知到的系统性障碍。还提出了患者对减少医疗环境中体重歧视的建议。人际互动中经历的体重歧视会转移到医疗服务的提供上,影响到公平获得服务的机会,并使支持肥胖患者需求的不良系统基础设施永久存在。非协作的实践和治疗方法使患者感到他们对自己的医疗需求无法控制。

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