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Structural stigma significantly drives missed health care appointments for marginalized groups. Understanding these systemic barriers is crucial for improving health equity and patient engagement.

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Area of Science:

  • Sociology of Health and Illness
  • Public Health
  • Health Services Research

Background:

  • Stigma research has evolved from individual-level analyses to multi-level conceptualizations.
  • Empirical research on stigma's impact is extensive, yet the lived experience of structural stigma remains under-explored.
  • Structural stigma is increasingly recognized as a critical determinant of health inequities.

Purpose of the Study:

  • To examine structural stigma as a key driver of missed health care appointments ('missingness').
  • To explore how structural stigma influences access to and experiences within health care settings.
  • To adapt existing stigma outcome frameworks to understand the mechanisms of structural stigma.

Main Methods:

  • Qualitative study employing 61 in-depth interviews.
  • Participants included health and social care professionals and individuals with lived experience of missingness in the UK.
  • Focus on three stigmatized groups: marginalized racial/ethnic groups (including asylum seekers), individuals with mental health conditions, and those with problem substance use.

Main Results:

  • Structural stigma creates significant barriers to effective health care engagement for stigmatized populations.
  • Findings illustrate how structural stigma operates through mechanisms that keep individuals 'down,' 'in,' and 'away' from care.
  • Identified specific processes through which systemic discrimination impacts appointment adherence and health care experiences.

Conclusions:

  • Structural stigma is a critical, yet under-researched, factor contributing to missed health care appointments.
  • Addressing structural stigma is essential for developing effective policies and practices to improve health care access and equity.
  • Future research should prioritize understanding and mitigating the impact of structural stigma on vulnerable populations.