Stigma is a well-documented barrier to health seeking behavior, engagement in care and adherence to treatment across a range of health conditions globally. In order to halt the stigmatization process ...and mitigate the harmful consequences of health-related stigma (i.e. stigma associated with health conditions), it is critical to have an explicit theoretical framework to guide intervention development, measurement, research, and policy. Existing stigma frameworks typically focus on one health condition in isolation and often concentrate on the psychological pathways occurring among individuals. This tendency has encouraged a siloed approach to research on health-related stigmas, focusing on individuals, impeding both comparisons across stigmatized conditions and research on innovations to reduce health-related stigma and improve health outcomes. We propose the Health Stigma and Discrimination Framework, which is a global, crosscutting framework based on theory, research, and practice, and demonstrate its application to a range of health conditions, including leprosy, epilepsy, mental health, cancer, HIV, and obesity/overweight. We also discuss how stigma related to race, gender, sexual orientation, class, and occupation intersects with health-related stigmas, and examine how the framework can be used to enhance research, programming, and policy efforts. Research and interventions inspired by a common framework will enable the field to identify similarities and differences in stigma processes across diseases and will amplify our collective ability to respond effectively and at-scale to a major driver of poor health outcomes globally.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Despite efforts to recruit and retain more women, a stark gender disparity persists within academic science. Abundant research has demonstrated gender bias in many demographic groups, but has yet to ...experimentally investigate whether science faculty exhibit a bias against female students that could contribute to the gender disparity in academic science. In a randomized double-blind study (n = 127), science faculty from research-intensive universities rated the application materials of a student—who was randomly assigned either a male or female name—for a laboratory manager position. Faculty participants rated the male applicant as significantly more competent and hireable than the (identical) female applicant. These participants also selected a higher starting salary and offered more career mentoring to the male applicant. The gender of the faculty participants did not affect responses, such that female and male faculty were equally likely to exhibit bias against the female student. Mediation analyses indicated that the female student was less likely to be hired because she was viewed as less competent. We also assessed faculty participants’ preexisting subtle bias against women using a standard instrument and found that preexisting subtle bias against women played a moderating role, such that subtle bias against women was associated with less support for the female student, but was unrelated to reactions to the male student. These results suggest that interventions addressing faculty gender bias might advance the goal of increasing the participation of women in science.
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BFBNIB, NMLJ, NUK, PNG, SAZU, UL, UM, UPUK
Androcentrism refers to the propensity to center society around men and men’s needs, priorities, and values and to relegate women to the periphery. Androcentrism also positions men as the ...gender-neutral standard while marking women as gender-specific. Examples of androcentrism include the use of male terms (e.g., he), images, and research participants to represent everyone. Androcentrism has been shown to have serious consequences. For example, women’s health has been adversely affected by over-generalized medical research based solely on male participants. Nonetheless, relatively little is known about androcentrism’s proximate psychological causes. In the present review, we propose a social cognitive perspective arguing that both social power and categorization processes are integral to understanding androcentrism. We present and evaluate three possible pathways to androcentrism deriving from (a) men being more frequently instantiated than women, (b) masculinity being more “ideal” than femininity, and/or (c) masculinity being more common than femininity.
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The present review seeks to bridge research on accents, stigma, and communication by examining the empirical literature on nonnative accents, considering the perspectives of both speakers and ...listeners. The authors suggest that an accent, or one’s manner of pronunciation, differs from other types of stigma. They consider the role of communicative processes in the manner in which accents influence people and identify social and contextual factors related to accents that affect the speaker, the listener, and the interaction between them. The authors propose a framework of stigma of accents and possible future avenues of research to examine the social psychological and communicative effects of accents. They also discuss implications for stigma of other types of accents (e.g., other native, regional, and ethnic). Understanding how stigma of accents and communication affect each other provides a new theoretical approach to studying this type of stigma and can eventually lead to interventions.
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Classic research on the contact hypothesis focused on the direct relationship between the antecedents (conditions under which contact occurs) and the outcomes (primarily, the reduction of prejudice) ...of intergroup contact. Recent work has taken a broader view of contact processes and effects. We review key developments over the past 20 years, identifying different forms of contact, factors that mediate and moderate the effects of contact, and both the nature and temporal stage and the varied outcomes of contact. We then identify several research directions to address pressing theoretical and practical issues. These issues concern (a) group processes and intergroup relations, (b) intergroup contact in the context of multiple categorization, (c) structural- and individual-level processes, (d) a broader range of individual-level outcomes (e.g., health), and (e) impact on social change. Contact theory and research provides a comprehensive conceptual foundation, allied to a range of powerful empirical techniques, for important new advances and practical applications for improving intergroup relations and producing more equitable outcomes across groups.
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Throughout the world, groups that are socially disadvantaged have poorer health compared to groups that are more advantaged. This book examines the role that stigma and discrimination play in ...creating and sustaining these group health disparities. Stigma is a social construction in which people who are distinguished by a “mark” are viewed as deviant, socially excluded, and devalued. Stigma and the discrimination it engenders negatively affect health through multiple mechanisms operating at several different levels of influence. Collectively, these shape both the orientations of people toward members of stigmatized groups and the experiences, and often the self-concepts, of members of groups targeted by stigma. Stigma affects individual-level affective, cognitive, behavioral, and physiological responses that increase stress in the lives of stigmatized groups. Stigma also restricts access to social and community-level resources relevant to good health and exposes individuals to more toxic environments. All act to erode the health of people who are stigmatized. This volume provides a cutting edge, multidisciplinary, multilevel analysis of health and health disparities through the integrative lens of stigma. It brings together the research of leading social and health psychologists, sociologists, public health scholars, and medical ethicists who study stigma and health. It integrates independent literatures on the health-related outcomes of stigma and discrimination and the diverse pathways and processes by which stigma and discrimination affect multiple health outcomes. The book is also forward-looking: It discusses the implications of these themes for policy, interventions, and health care, as well as identifies the most important directions for future research.
Several aspects of social psychological science shed light on how unexamined racial/ethnic biases contribute to health care disparities. Biases are complex but systematic, differing by racial/ethnic ...group and not limited to love-hate polarities. Group images on the universal social cognitive dimensions of competence and warmth determine the content of each group's overall stereotype, distinct emotional prejudices (pity, envy, disgust, pride), and discriminatory tendencies. These biases are often unconscious and occur despite the best intentions. Such ambivalent and automatic biases can influence medical decisions and interactions, systematically producing discrimination in health care and ultimately disparities in health. Understanding how these processes may contribute to bias in health care can help guide interventions to address racial and ethnic disparities in health.
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CEKLJ, DOBA, FSPLJ, IZUM, KILJ, NUK, ODKLJ, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
We examined the dynamics of minority‐directed police violence by considering how our White participants' empathy for Black victims may be influenced by critical intragroup differences related to ...racial stereotyping. Although the role of stereotyping in reactions to Black Americans accused of crime is well‐established, we explore the influence of pejorative Black stereotypes on reactions to Black victims of police violence. Specifically, we investigated the roles of individual differences in the endorsement of the Black criminal stereotype among White observers and manipulated the crime‐unrelated stereotypicality (i.e. stereotypical, counterstereotypical) of Black victims of police violence. White US MTurk participants read about a White policeman shooting a Black man (Study 1, n = 140) or sexually assaulting a Black woman (Study 2, n = 166). Across both studies, strong stereotype endorsers reported relatively low empathy for stereotypical victims, mediated by greater blame towards those victims. This finding demonstrates the relevance of heretofore untested motivated reasoning processes in the outgroup empathy deficits literature. Weak stereotype endorsers showed relatively high empathy and low victim blame regardless of Black victim stereotypicality, indicating limited sensitivity to outgroup member suffering is not inevitable. We consider the practical implications of the findings for policing and for citizenship education.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Optimizing access to HIV pre-exposure prophylaxis (PrEP), an evidence-based HIV prevention resource, requires expanding healthcare providers' adoption of PrEP into clinical practice. This qualitative ...study explored PrEP providers' firsthand experiences relative to six commonly-cited barriers to prescription-financial coverage, implementation logistics, eligibility determination, adherence concerns, side effects, and anticipated behavior change (risk compensation)-as well as their recommendations for training PrEP-inexperienced providers. U.S.-based PrEP providers were recruited via direct outreach and referral from colleagues and other participants (2014-2015). One-on-one interviews were conducted in person or by phone, transcribed, and analyzed. The sample (n = 18) primarily practiced in the Northeastern (67%) or Southern (22%) U.S. Nearly all (94%) were medical doctors (MDs), most of whom self-identified as infectious disease specialists. Prior experience prescribing PrEP ranged from 2 to 325 patients. Overall, providers reported favorable experiences with PrEP implementation and indicated that commonly anticipated problems were minimal or manageable. PrEP was covered via insurance or other programs for most patients; however, pre-authorization requirements, laboratory/service provision costs, and high deductibles sometimes presented challenges. Various models of PrEP care and coordination with other providers were utilized, with several providers highlighting the value of clinical staff support. Eligibility was determined through joint decision-making with patients; CDC guidelines were commonly referenced but not considered absolute. Patient adherence was variable, with particularly strong adherence noted among patients who had actively sought PrEP (self-referred). Providers observed minimal adverse effects or increases in risk behavior. However, they identified several barriers with respect to accessing and engaging PrEP candidates. Providers offered a wide range of suggestions regarding content, strategy, and logistics surrounding PrEP training, highlighting sexual history-taking and sexual minority competence as areas to prioritize. These insights from early-adopting PrEP providers may facilitate adoption of PrEP into clinical practice by PrEP-inexperienced providers, thereby improving access for individuals at risk for HIV.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Objective:
This article considers how the social psychology of intergroup processes helps to explain the presence and persistence of health disparities between members of socially advantaged and ...disadvantaged groups.
Method:
Social psychological theory and research on intergroup relations, including prejudice, discrimination, stereotyping, stigma, prejudice concerns, social identity threat, and the dynamics of intergroup interactions, is reviewed and applied to understand group disparities in health and health care. Potential directions for future research are considered.
Results:
Key features of group relations and dynamics, including social categorization, social hierarchy, and the structural positions of groups along dimensions of perceived warmth and competence, influence how members of high status groups perceive, feel about, and behave toward members of low status groups, how members of low status groups construe and cope with their situation, and how members of high and low status groups interact with each other. These intergroup processes, in turn, contribute to health disparities by leading to differential exposure to and experiences of chronic and acute stress, different health behaviors, and different quality of health care experienced by members of advantaged and disadvantaged groups. Within each of these pathways, social psychological theory and research identifies mediating mechanisms, moderating factors, and individual differences that can affect health.
Conclusions:
A social psychological perspective illuminates the intergroup, interpersonal, and intrapersonal processes by which structural circumstances which differ between groups for historical, political, and economic reasons can lead to group differences in health.
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CEKLJ, FFLJ, NUK, ODKLJ, PEFLJ, UPUK
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