'Through a kaleidoscope': A Foucauldian discourse analysis of Belgian policy regarding patients with a migration background and depression in general practices.

IF 1.9 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Health Pub Date : 2024-11-01 Epub Date: 2023-12-04 DOI:10.1177/13634593231211519
Camille Wets, Piet Bracke, Katrijn Delaruelle, Melissa Ceuterick
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Abstract

A higher prevalence of depression is found among patients with a migration background within the Belgian population. Nevertheless, this group is underrepresented in ambulant and residential mental health care services. Since general practitioners (GPs) have a crucial gatekeeping role, this led some researchers to investigate the possibility of a provider bias influencing GPs' assessment and referral of depressed patients with a migration background. However, GPs' accounts may be influenced by wider professional discourses present at the policy level, which are inevitably linked to institutions regulating the conduct of GPs. Therefore, this study applied a Foucauldian discourse analysis (a) to identify broader professional discourses in Belgian policy documents regarding patients with a migration background and depression in general practices, (b) to examine how patients with a migration background are discursively positioned and (c) to investigate which different balances of power in the relationship between GPs and patients with a migration background are demonstrated in the identified discourses. We identified three recurring discourses: (a) the othering discourse, (b) the health literacy discourse, and (c) the person-centred discourse. Our analysis demonstrated that the former two discourses illustrate the perpetuation of a biomedical discourse. While the last discourse is aligned with a counter-discourse associated with the person-centred care model in health care. Consequently, our analysis demonstrated the construction of a contradictory discursive framework throughout the various policy documents on which GPs might rely when speaking about patients with a migration background suffering from depression.

“通过万花筒”:福柯式话语分析比利时关于移民背景和抑郁症患者的政策。
比利时人口中具有移民背景的患者患抑郁症的比例较高。然而,这一群体在流动和住院精神卫生保健服务中的代表性不足。由于全科医生(全科医生)具有关键的把关作用,这导致一些研究人员调查提供者偏见影响全科医生评估和转诊具有移民背景的抑郁症患者的可能性。然而,全科医生的账户可能会受到政策层面上更广泛的专业话语的影响,这不可避免地与规范全科医生行为的机构联系在一起。因此,本研究运用了福柯语篇分析(a)来识别比利时政策文件中关于移民背景患者和一般实践中的抑郁症的更广泛的专业语篇,(b)来检查具有移民背景的患者是如何被话语定位的,(c)来调查在确定的语篇中,全科医生和移民背景的患者之间的关系中,哪些不同的权力平衡得到了证明。我们确定了三种反复出现的话语:(a)其他话语,(b)健康素养话语,和(c)以人为本的话语。我们的分析表明,前两个话语说明了生物医学话语的延续。而最后一种论述与卫生保健中以人为中心的护理模式相关的反论述是一致的。因此,我们的分析表明,在谈到患有抑郁症的移民背景患者时,全科医生可能依赖的各种政策文件中,构建了一个相互矛盾的话语框架。
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来源期刊
Health
Health Multiple-
CiteScore
4.90
自引率
0.00%
发文量
0
期刊介绍: Health: is published four times per year and attempts in each number to offer a mix of articles that inform or that provoke debate. The readership of the journal is wide and drawn from different disciplines and from workers both inside and outside the health care professions. Widely abstracted, Health: ensures authors an extensive and informed readership for their work. It also seeks to offer authors as short a delay as possible between submission and publication. Most articles are reviewed within 4-6 weeks of submission and those accepted are published within a year of that decision.
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