Measuring aspects of stigma cultures in healthcare settings.

IF 3.6 2区 医学 Q1 PSYCHIATRY Social Psychiatry and Psychiatric Epidemiology Pub Date : 2024-12-10 DOI:10.1007/s00127-024-02780-5
Heather Stuart, Stephanie Knaak
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Abstract

Purpose: Stigma cultures in healthcare settings are the organizational-level norms values, assumptions, physical façades, and practices that govern day to day activities and interactions. Aspects include poor quality of care, coercive care, a punitive and patronizing atmosphere, and disempowerment to make treatment decisions. To evaluate the effectiveness of interventions to reduce stigma cultures in healthcare settings, valid and reliable measures are needed. This paper describes the development and preliminary testing of a measure to assess mental illness related stigma in healthcare cultures from the perspectives of service users.

Methods: Item generation was grounded in the lived experiences of people with a mental or substance use disorder (n = 20) reflecting their personal experiences with physical or mental healthcare encounters. Wherever possible, items were adapted from existing scales. Items were rated on a 4-point agreement scale with higher scores indicating higher stigma. Following the qualitative analysis, survey data (n = 2,476) were collected and exploratory and confirmatory factor analysis on split halves of the sample were conducted.

Results: The analyses provided statistical support for a 23-item unidimensional scale that could be used in any healthcare setting to assess key aspects of stigma cultures such as poor quality of care or lack of person-centered care. Reliability was high (0.92) and aggregated scale scores (ranging from 0 to 92) were approximately normal.

Conclusions: Though further testing is needed, the resulting Stigma Cultures in Healthcare scale is intended to be used across a range of physical and mental healthcare settings to assess the extent to which key aspects of care are experienced as stigmatizing by clients with mental or substance use disorders.

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在卫生保健环境中测量病耻感文化的各个方面。
目的:医疗环境中的病耻感文化是组织层面的规范、价值观、假设、身体状况和管理日常活动和互动的做法。这些方面包括护理质量差、强制性护理、惩罚性和居高临下的气氛,以及剥夺作出治疗决定的权力。为了评估在卫生保健环境中减少病耻感文化的干预措施的有效性,需要有效和可靠的措施。本文描述了从服务使用者的角度评估卫生保健文化中与精神疾病相关的耻辱的措施的发展和初步测试。方法:项目生成以精神或物质使用障碍患者(n = 20)的生活经历为基础,反映了他们在身体或精神卫生保健方面的个人经历。在可能的情况下,项目根据现有的比例尺进行调整。项目按照4分的一致性量表进行评分,得分越高表明污名越严重。在定性分析之后,收集了调查数据(n = 2476),并对样本的两半进行了探索性和验证性因素分析。结果:分析为23项单向度量表提供了统计支持,该量表可用于任何医疗保健环境,以评估耻辱文化的关键方面,如护理质量差或缺乏以人为本的护理。信度高(0.92),综合量表得分(范围从0到92)大致正常。结论:虽然需要进一步的测试,但由此产生的医疗保健中的污名文化量表旨在用于一系列身体和精神卫生保健环境,以评估精神或物质使用障碍患者在护理的关键方面经历污名的程度。
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来源期刊
CiteScore
8.50
自引率
2.30%
发文量
184
审稿时长
3-6 weeks
期刊介绍: Social Psychiatry and Psychiatric Epidemiology is intended to provide a medium for the prompt publication of scientific contributions concerned with all aspects of the epidemiology of psychiatric disorders - social, biological and genetic. In addition, the journal has a particular focus on the effects of social conditions upon behaviour and the relationship between psychiatric disorders and the social environment. Contributions may be of a clinical nature provided they relate to social issues, or they may deal with specialised investigations in the fields of social psychology, sociology, anthropology, epidemiology, health service research, health economies or public mental health. We will publish papers on cross-cultural and trans-cultural themes. We do not publish case studies or small case series. While we will publish studies of reliability and validity of new instruments of interest to our readership, we will not publish articles reporting on the performance of established instruments in translation. Both original work and review articles may be submitted.
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