Lawson Health Research Institute, London, ON, Canada.
Arthur Labatt Family School of Nursing, Western University, London, ON, Canada.
Front Public Health. 2024 Feb 13;12:1279477. doi: 10.3389/fpubh.2024.1279477. eCollection 2024.
As part of a larger mixed-methods study into harm reduction in the hospital setting and people with lived experience of methamphetamine use, stigma was found to be a prominent issue. The aim of this secondary analysis was to investigate the issue of stigma.
Participants completed a one-time qualitative interview component to assess their experiences in the hospital setting.
The study setting included secondary and tertiary care in Southwestern Ontario, Canada. Participants who had received care from these settings were also recruited from an overdose prevention site, a primary healthcare center, a national mental health organization, an affordable housing agency, and six homeless-serving agencies between October 2020 and April 2021.
A total of 104 individuals completed the qualitative component of a mixed-methods interview. Sixty-seven participants identified as male, thirty-six identified as female, and one identified as non-binary. Inclusion criteria included past or current use of methamphetamine, having received services from a hospital, and being able to communicate in English.
Open-ended questions regarding experiences in the hospital setting were asked in relation to the lived experience of methamphetamine. A secondary analysis was conducted using a thematic ethnographic approach due to prominent perceptions of stigma.
Three themes were identified. The first theme identified that substance use was perceived as a moral and personal choice; the second theme pertained to social stigmas such as income, housing and substance use, and consequences such as being shunned or feeling less worthy than the general patient population; and the third theme highlighted health consequences such as inadequate treatment or pain management.
This study revealed that stigma can have consequences that extend beyond the therapeutic relationship and into the healthcare of the individual. Additional training and education for healthcare providers represents a key intervention to ensure care is non-stigmatizing and patient-centered, as well as changing hospital culture.
作为一项更大规模的混合方法研究的一部分，该研究旨在探讨减少医院环境中与美沙酮使用相关的危害以及具有美沙酮使用经验的人所面临的问题，研究发现耻辱感是一个突出的问题。本二次分析旨在调查耻辱感问题。
参与者完成了一次性定性访谈部分，以评估他们在医院环境中的经历。
该研究地点包括加拿大安大略省西南部的二级和三级保健机构。参与者是从一个过量预防点、一个初级保健中心、一个国家心理健康组织、一个经济适用房机构和六个为无家可归者提供服务的机构招募的，招募时间为 2020 年 10 月至 2021 年 4 月。
共有 104 人完成了混合方法访谈的定性部分。67 名参与者为男性，36 名参与者为女性，1 名参与者为非二元性别。纳入标准包括过去或目前使用过美沙酮、曾在医院接受过服务，并且能够用英语交流。
根据美沙酮使用的生活经历，提出了一些关于在医院环境中经历的开放性问题。由于耻辱感的明显感知，使用主题民族志方法进行了二次分析。
确定了三个主题。第一个主题是将药物使用视为道德和个人选择；第二个主题涉及社会污名，如收入、住房和药物使用，以及被回避或感觉不如普通患者群体更有价值等后果；第三个主题强调了健康后果，如治疗不足或疼痛管理不善。
这项研究表明，耻辱感的后果不仅限于治疗关系，还会延伸到个人的医疗保健。为医疗保健提供者提供额外的培训和教育是确保护理无污名化和以患者为中心的关键干预措施，以及改变医院文化。
