"只需谷歌"--生殖年龄妇女在使用丁丙诺啡治疗阿片类药物使用障碍时的污名化经历定性研究。

IF 2.8 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Dominique Bulgin, Velma McBride Murry, Tamarra McElroy, David Schlundt, Kemberlee Bonnet, Stephen W Patrick
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引用次数: 0

摘要

导言:阿片类药物危机对女性的影响越来越大,而获得丁丙诺啡治疗阿片类药物使用障碍(OUD)的机会受到了授权配药医疗机构数量的限制。污名化可能是获得治疗阿片类药物使用障碍药物的另一个障碍。我们对门诊丁丙诺啡提供者的随机模拟患者现场实验的定性数据进行了分析:我们的首要目标是分析妇女在寻求丁丙诺啡治疗 OUD 时遇到的障碍,以考虑到基于怀孕状况、种族/民族和保险状况的不同经历。我们的次要目标是确定潜在的干预策略,以改善获得治疗 OUD 药物的机会:我们采用了 "健康羞辱与歧视 "框架来指导我们对寻求 OUD 治疗的妇女所遇到的障碍进行研究。代表白人、西班牙裔和黑人女性声音特征、模拟 25-30 岁女性的呼叫者被随机分配,以代表公共/私人保险和怀孕/未怀孕特征的组合。来电者联系了 5,944 个提供丁丙诺啡的医疗机构,要求预约以获得治疗 OUD 的药物。有 15,358 条自由文本评论回复了 "请客观地逐一描述这次对话中发生的事情 "的提示。我们采用归纳-演绎迭代法对数据进行了编码和分析。我们咨询了六位社区专家,她们都是曾寻求过 OUD 治疗的女性,为我们的研究结果提供了参考,并找出了以患者为导向的解决方案来解决障碍:研究结果表明,人际间的污名化经历与制度性障碍有关,如制度文化和规范性实践中的污名化行为。主要结果表明,种族/民族、怀孕状况和保险状况会影响鄙视经历。例如,黑人和拉美裔来电者报告说,他们经历了基于种族的微词攻击,而孕妇则面临更多的评判,获得治疗的机会也减少了。定性研究结果和社区专家的见解强调,有必要采取反污名化政策和措施,以方便不同社会生态层面的人获得治疗 OUD 的药物:研究结果表明,有必要采取多层次干预措施,以改善妇女获得治疗 OUD 药物的机会。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
"Just Google It"-A Qualitative Study of Reproductive-Age Women's Stigmatizing Experiences When Accessing Buprenorphine for Opioid Use Disorder.

Introduction: The opioid crisis is increasingly impacting women, and access to buprenorphine to treat opioid use disorder (OUD) is limited by the number of providers authorized to dispense it. Stigma can represent an additional barrier to accessing medication for OUD. Qualitative data were analyzed from a randomized simulated patient field experiment of outpatient buprenorphine-waivered providers.

Objectives: Our primary objective was to analyze descriptions of barriers women encountered when seeking buprenorphine to treat OUD to account for differential experiences based on pregnancy status, race/ethnicity, and insurance status. Our secondary objective was to identify potential intervention strategies to improve access to medications for OUD.

Methods: The Health Stigma and Discrimination framework was applied to guide our study of barriers encountered by women seeking OUD treatment. Callers representing vocal features of white, Hispanic, and Black women and simulating ages 25-30 were randomized to represent combinations of public/private insurance and pregnant/not pregnant characteristics. Callers contacted 5,944 buprenorphine-waivered providers requesting to make an appointment to obtain medications to treat OUD. There were 15,358 free-text comments in response to the prompt "Please give an objective play-by-play of the description of what happened in this conversation." Data were coded and analyzed using an iterative inductive-deductive approach. We consulted six community experts, women who had sought treatment for OUD, to inform our study findings and identify patient-driven solutions to address barriers.

Results: Findings revealed that experiences of interpersonal stigma were connected to systemic barriers such as stigmatizing behaviors within institutional cultures and normative practices. Key results indicate that race/ethnicity, pregnancy status, and insurance status influence experiences of stigma. For instance, Black and Hispanic callers reported experiencing race-based microaggressions, and pregnant women faced additional judgment and reduced access to treatment. Qualitative findings and community experts' insights underscored the necessity for the adoption of anti-stigma policies and practices that facilitate easier access to medications for OUD across socioecological levels.

Conclusions: The findings demonstrate a need for multilevel interventions to improve women's access to medications for OUD.

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来源期刊
CiteScore
4.50
自引率
6.20%
发文量
97
审稿时长
32 days
期刊介绍: Women"s Health Issues (WHI) is a peer-reviewed, bimonthly, multidisciplinary journal that publishes research and review manuscripts related to women"s health care and policy. As the official journal of the Jacobs Institute of Women"s Health, it is dedicated to improving the health and health care of all women throughout the lifespan and in diverse communities. The journal seeks to inform health services researchers, health care and public health professionals, social scientists, policymakers, and others concerned with women"s health.
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