Primary Health Care Center, Iran University of Medical Science, Shahryar, Iran.
Student Research Committee, School of Medicine, Shirza University of Medical Sciences, Shiraz, Iran.
Int J Equity Health. 2023 Dec 18;22(1):263. doi: 10.1186/s12939-023-02078-z.
There are many dimensions regarding autism that are closely connected to social structures, policies, and power dynamics, silently impacting the well-being of individuals within the autism spectrum. This research aims to explore these overlooked aspects using a theoretical framework called "structural violence."
The study was conducted in Kurdistan, Iran, and a qualitative longitudinal approach was chosen. A purposive sampling method was employed to select the participants, with 11 parents taking part. The study data comprised 29 interviews using a topic guide conducted over a span of 2 years. Thematic analysis and a matrix-based approach were utilized for data analysis. To enhance the scientific rigor of this research, four criteria, including Guba and Lincoln's principles, were implemented to ensure methodological accuracy.
The research findings highlight four primary forms through which structural violence impacts children on the autism spectrum and their families: access to healthcare, geographic disparities, awareness and stigma, and poverty and financial burden. Additionally, the study identified 11 subthemes related to structural violence in the context of autism and families.
We illustrated how structural forces create barriers to accessing adequate healthcare services, exacerbate discrimination based on ethnicity and geography, perpetuate stigma, and contribute to poverty and the inability to meet basic needs. These factors not only worsen health issues but also deepen existing disparities in healthcare access and outcomes for children on the autism spectrum and families. We emphasize the urgent need for systemic changes to address these issues. It is essential to promote public awareness, provide better access to health and support services, and address economic and political factors that contribute to these inequalities.
自闭症有许多方面与社会结构、政策和权力动态密切相关，这些方面悄然影响着自闭症谱系内个体的福祉。本研究旨在使用一种名为“结构性暴力”的理论框架来探索这些被忽视的方面。
该研究在伊朗库尔德斯坦进行，采用了定性纵向方法。采用目的抽样法选择参与者，有 11 名家长参与。研究数据包括 29 次访谈，使用主题指南进行，历时 2 年。采用主题分析和基于矩阵的方法进行数据分析。为了提高这项研究的科学严谨性，我们实施了包括古巴和林肯原则在内的四项标准，以确保方法的准确性。
研究结果突出了结构性暴力通过以下四种主要方式影响自闭症谱系儿童及其家庭：获得医疗保健、地理差异、意识和耻辱感、贫困和经济负担。此外，该研究还确定了与自闭症和家庭背景下的结构性暴力相关的 11 个亚主题。
我们说明了结构性力量如何在获取足够的医疗保健服务方面设置障碍，加剧基于族裔和地理位置的歧视，延续耻辱感，并导致贫困和无法满足基本需求。这些因素不仅使健康问题恶化，而且加深了自闭症谱系儿童及其家庭在获得医疗保健方面的现有差异。我们强调迫切需要进行系统性变革来解决这些问题。必须提高公众意识，提供更好的健康和支持服务，并解决导致这些不平等的经济和政治因素。
