“超越秤重”:普通科门诊中肥胖患者经历体重污名化的影响之定性研究。
'Beyond the Scale': A Qualitative Exploration of the Impact of Weight Stigma Experienced by Patients With Obesity in General Practice.
机构信息
School of Psychology, University of Galway, Galway, Ireland.
School of Communication and Media, Ulster University, Belfast, Northern Ireland.
出版信息
Health Expect. 2024 Jun;27(3):e14098. doi: 10.1111/hex.14098.
OBJECTIVE
Obesity is a complex, chronic, relapsing disease that requires an individualised approach to treatment. However, weight stigma (WS) experienced in healthcare settings poses a significant barrier to achieving person-centred care for obesity. Understanding the experiences of people living with obesity (PwO) can inform interventions to reduce WS and optimise patient outcomes. This study explores how patients with obesity perceive WS in general practice settings; its impact on their psychological well-being and health behaviours, and the patients suggestions for mitigating it.
METHODS
In-depth semistructured interviews were conducted with 11 PwO who had experienced WS in general practice settings in Ireland. The interviews were conducted online via Zoom between May and August 2023; interviews lasted between 31 and 63 min (M = 34.36 min). Interviews were audio-recorded, transcribed verbatim and analysed using inductive reflexive thematic analysis.
RESULTS
Three overarching themes specific to participants' experience of WS in general practice were generated: (1) shame, blame and 'failure'; (2) eat less, move more-the go-to treatment; (3) worthiness tied to compliance. A fourth theme: (4) the desire for a considered approach, outlines the participants' suggestions for reducing WS by improving the quality of patient-provider interactions in general practice.
CONCLUSION
The findings call for a paradigm shift in the management of obesity in general practice: emphasising training for GPs in weight-sensitive communication and promoting respectful, collaborative, and individualised care to reduce WS and improve outcomes for people with obesity.
PATIENT OR PUBLIC CONTRIBUTION
PPI collaborators played an active and equal role in shaping the research, contributing to the development of the research questions, refining the interview schedule, identifying key themes in the data, and granting final approval to the submitted and published version of the study.
目的
肥胖是一种复杂的、慢性的、易复发的疾病,需要针对个体进行治疗。然而,在医疗保健环境中经历的体重污名化(WS)对实现以患者为中心的肥胖护理构成了重大障碍。了解肥胖患者(PwO)的体验可以为减少 WS 和优化患者结局提供信息。本研究探讨了肥胖患者如何普遍感知一般实践环境中的 WS;其对他们心理健康和健康行为的影响,以及患者减轻 WS 的建议。
方法
对 11 名在爱尔兰一般实践环境中经历过 WS 的肥胖患者进行了深入的半结构化访谈。访谈于 2023 年 5 月至 8 月期间通过 Zoom 在线进行;访谈时长为 31 至 63 分钟(M=34.36 分钟)。访谈内容进行了音频录制、逐字转录,并采用归纳式反思性主题分析进行了分析。
结果
产生了三个与参与者在一般实践中经历 WS 相关的总体主题:(1)羞耻、指责和“失败”;(2)少吃多动——首选治疗方法;(3)与依从性相关的价值感。第四个主题:(4)渴望采取深思熟虑的方法,概述了参与者通过改善一般实践中医患互动的质量来减少 WS 的建议。
结论
研究结果呼吁在一般实践中对肥胖症的管理进行范式转变:强调对全科医生进行体重敏感沟通方面的培训,并促进尊重、协作和个体化的护理,以减少 WS 并改善肥胖患者的结局。
患者或公众贡献
PPI 合作者在塑造研究方面发挥了积极和平等的作用,为研究问题的提出、访谈提纲的完善、数据中关键主题的确定以及对提交和发表的研究版本的最终批准做出了贡献。
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