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Negotiating substance use stigma: the role of cultural health capital in provider-patient interactions

机译：谈判物质使用的污名：文化卫生资本在医患互动中的作用

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摘要

Diverse aspects of life and lifestyles, including stigmatised attributes and behaviors are revealed as providers and patients discuss health. In this article, we examine how the stigma associated with substance use issues shapes clinical interactions. We use the theoretical framework of cultural health capital (CHC) to explain how substance use stigma is created, reinforced and sometimes negotiated as providers and patients engage in health interactions. We present two main findings using examples. First, two theoretical concepts - habitus and field - set the social position and expectations of providers and patients in ways that facilitate the stigmatisation of substance use. Second, we found both providers and patients actively exchanged CHC as a key strategy to reduce the negative effects of stigma. In some clinical encounters, patients possessed and activated CHC, providers acknowledged patient's CHC and CHC was successfully exchanged. These interactions were productive and mutually satisfying, even when patients were actively using substances. However, when CHC was not activated, acknowledged and exchanged, stigma was unchallenged and dominated the interaction. The CHC theoretical framework allows us to examine how the stigma process is operationalized and potentially even counteracted in clinical interactions.
机译：当提供者和患者讨论健康状况时，生活和生活方式的各个方面（包括被污名化的属性和行为）都会被发现。在本文中，我们研究了与物质使用相关的污名如何塑造临床相互作用。我们使用文化卫生资本（CHC）的理论框架来解释当提供者和患者进行卫生互动时，如何创建，强化甚至有时通过协商来确定物质使用的污名。我们通过示例介绍两个主要发现。首先，两个理论概念-习惯和田地-以促进对药物使用的污名化的方式设定提供者和患者的社会地位和期望。其次，我们发现提供者和患者都积极交换CHC是减少耻辱感负面影响的关键策略。在某些临床情况下，患者拥有并激活了CHC，提供者承认患者的CHC和CHC已成功交换。这些相互作用既富有成效，又相互满足，即使患者正在积极使用药物。但是，当未激活，确认和交换CHC时，污名就不会受到挑战，并主导了互动。 CHC理论框架使我们能够检查柱头过程是如何操作的，甚至可能在临床相互作用中抵消。

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