Principle of gradient rationality: Revisiting stigma and conceptualizing its guiding mechanism

Tomar, Nikhil; Thornicroft, Graham

doi:10.1016/j.socscimed.2019.112716

Cited by 3 publications

(1 citation statement)

References 29 publications

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“…56 Although stigma is often discussed in terms of individual attitudes that can be addressed through individual-focused interventions such as health care provider education, 57 stigma has long been conceptualized as a system-level phenomenon linked to structural power dynamics in society. 58 Some studies have traced opioid-related stigma to structural roots such as the criminalization of drug use [59][60][61] and lack of addictions education. 56 Some literature highlights fostering autonomy in stigmatized individuals as an important solution.…”

Section: Discussionmentioning

confidence: 99%

Bridging the Macro-micro Divide: A Qualitative Meta-synthesis on the Perspectives and Experiences of Health Care Providers on the Extramedical Use and Diversion of Buprenorphine

Gamage

Tejpar

Majid

et al. 2022

Journal of Addiction Medicine

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Objectives: Opioid agonist therapy using buprenorphine is one of the most effective treatments for opioid use disorder. However, concerns regarding its extramedical use and diversion, such as adverse patient outcomes and damage to the legitimacy of addictions practice, are persistent. The aim of this review is to synthesize the perspectives and experiences of health care providers around the extramedical use of buprenorphine. Methods: A qualitative meta-synthesis was conducted based on a systematic search of 8 databases. All primary qualitative and mixedmethods studies relating to the views of health care providers on the extramedical use of buprenorphine were included. A qualitative analysis informed by the constant comparative method was conducted, using NVivo for data management. Results: Sixteen studies were included in this review. Findings were organizedunder 2 key themes: (1) Harm-producing versus harmreducing effects of extramedical buprenorphine use and (2) driving forces of and responses to extramedical buprenorphine use. Conclusions:The studies included in our review identified a disconnect-health care providers noted that macro, health care system-level challenges drove extramedical use whereas the recommended solutions for prevention and management were primarily aimed at the micro, individual level. This study emphasizes the critical role that health care providers can play, in partnership with patients, in informing appropriate policies and health care system design to optimize the care for people with opioid use disorder.

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Section: Discussionmentioning

confidence: 99%

Bridging the Macro-micro Divide: A Qualitative Meta-synthesis on the Perspectives and Experiences of Health Care Providers on the Extramedical Use and Diversion of Buprenorphine

Gamage

Tejpar

Majid

et al. 2022

Journal of Addiction Medicine

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The future of community psychiatry and community mental health services

Rosen

Gill

Salvador‐Carulla

2020

Current Opinion in Psychiatry

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Purpose of review The aim of this article is to provide a framework and analysis of a series of critical components to inform the future design, development, sustaining, and monitoring of community mental health services. Recent findings Many mental health services remain too hospital-centric, often without adequate outreach services. On the basis of outcome evidence, we need to shift the balance of mental health services from hospital-centered with community outreach when convenient for staff, to community-centered and mobile, with in-reach to hospital only when necessary. Too few training programs emphasize the macroskills of public advocacy, working with service users, families, social movements, and the media to improve mental health and wellbeing of regional and local communities. Summary We should adopt a health ecosystems approach to mental healthcare and training, encompassing nano to macrolevels of service in every region. Catchment mental health services should be rebuilt as community-centric mental health services, integrating all community and inpatient components, but led and integrated from community sites. Community psychiatrists and mental health professionals of the future will need to be well trained in the nano to macroskills required to take responsibility for the mental health and wellbeing of their catchment communities and to provide leadership in service-planning, management, and continuing revision on the basis of rigorous evaluation. These approaches should be the core of all training in psychiatry and all mental health professions prior to any subspecialization.

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Investigating AVHs narratives through text analysis: the proposal of Dialogic Science for tackling stigmatization

Bassi,

Orrù,

Moro

et al. 2024

BMC Psychol

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Background Auditory verbal hallucinations (AVHs) are a significant symptom of various psychological conditions, often stigmatized and misunderstood. Moving beyond traditional psychological, psychotherapeutic and psychiatric approaches, recent research shifts focus on understanding AVHs through community perspectives and the resulting stigmatization. This research approach is crucial for better support and understanding of AVHs, however it still suffers from the lack of a rigorous and shared methodology for studying and reducing stigma. Methods Our study, part of the Italian “PsicoVoice” project, aims to investigate community discourses on AVHs, in order to observe whether and to what extent they are drivers of stigmatisation processes. Engaging 268 participants with direct (hearers) and indirect (such as relatives and professionals) experiences of AVHs, the research analyzes a corpus of 54,320 instances using MADIT: a text analysis methodology which is both qualitative and quantitative. MADIT allows for an innovative examination of the rhetorical-argumentative structures within narratives, producing an index for measuring the narratives’ practical impact on people’ interactions around AVHs. Results The analysis revealed that the overall community discourses are predominantly shaped by absolute and personal belief-driven modalities. This way of conveying sense, even with non-necessarily-judgmental words, contributes to a stigmatizing environment for individuals with AVHs, cementing a static representation dominated by personal opinions and reducing the potential for more nuanced, diverse interactions about AVHs. Conclusion The study’s findings underscore the importance of addressing the narrative structures within community discourses. By intervening in these narratives, there is potential to shift towards a less stigmatizing social construction of AVHs. Thus, the article concludes using the results to provide some insights on how to generate these interventions. This approach could significantly impact how communities understand and interact with individuals experiencing AVHs, promoting more inclusive and supportive environments and interventions.

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Principle of gradient rationality: Revisiting stigma and conceptualizing its guiding mechanism

Cited by 3 publications

References 29 publications

Bridging the Macro-micro Divide: A Qualitative Meta-synthesis on the Perspectives and Experiences of Health Care Providers on the Extramedical Use and Diversion of Buprenorphine

Bridging the Macro-micro Divide: A Qualitative Meta-synthesis on the Perspectives and Experiences of Health Care Providers on the Extramedical Use and Diversion of Buprenorphine

The future of community psychiatry and community mental health services

Investigating AVHs narratives through text analysis: the proposal of Dialogic Science for tackling stigmatization

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