背景:在COVID-19大流行期间,英国(UK)的医护人员(HCWs)面临许多挑战,其中一些源于他们的社会地位。现有文献阐述了这些挑战(例如,缺乏合适的PPE,重新部署,人员不足)强调了基于种族的HCW如何经历这些不平等,性别或,工作角色。在本文中,我们先走一步,研究这些社会地位的交集如何影响医护人员在大流行期间的挑战经历。
方法:我们收集了定性数据,使用访谈和焦点小组,来自不同种族的164名医护人员,性别,工作角色,迁移状态,以及2020年12月至2021年7月期间英国(UK)的地区。访谈和焦点小组在网上或通过电话进行,并在参与者许可下记录。转录记录,并采用混合主题分析方法,将归纳数据驱动的代码与交叉框架提供的演绎代码相结合,以分析转录本。
结果:对转录本的主题分析确定了无授权,缺点和,歧视是HCWs挑战经历的三个主要主题,基于它们的相交身份(例如,种族性别,和/或迁移状态)。我们的分析还承认,HCWs面临的劣势与微观的系统性和结构性因素有关,中观和宏观生态系统水平。这种以交叉性为基础并考虑生态系统水平的分析合并被称为“内部主义”。
结论:我们的研究表明,内部透镜如何帮助更好地了解医疗保健队伍中各个层面存在的不同形式的相互促进的不平等,以及这些影响来自某些背景的HCW面临更大的劣势,歧视和剥夺权力,特别是在像COVID-19大流行这样的危机时期。
BACKGROUND: Healthcare workers (HCWs) in the United Kingdom (UK) have faced many challenges during the COVID-19 pandemic, some of these arising out of their social positions. Existing literature explicating these challenges (e.g., lack of appropriate PPE, redeployment, understaffing) have highlighted inequities in how these have been experienced by HCWs based on ethnicity, gender or, job role. In this paper, we move a step ahead and examine how the intersection of these social positions have impacted HCWs\' experiences of challenges during the pandemic.
METHODS: We collected qualitative data, using interviews and focus groups, from 164 HCWs from different ethnicities, gender, job roles, migration statuses, and regions in the United Kingdom (UK) between December 2020 and July 2021. Interviews and focus groups were conducted online or by telephone, and recorded with participants\' permission. Recordings were transcribed and a hybrid thematic analytical approach integrating inductive data-driven codes with deductive ones informed by an intersectional framework was adopted to analyse the transcripts.
RESULTS: Thematic analysis of transcripts identified disempowerment,
disadvantage and, discrimination as the three main themes around which HCWs\' experiences of challenges were centred, based on their intersecting identities (e.g., ethnicity gender, and/or migration status). Our analysis also acknowledges that disadvantages faced by HCWs were linked to systemic and structural factors at the micro, meso and macro ecosystemic levels. This merging of analysis which is grounded in intersectionality and considers the ecosystemic levels has been termed as \'intrasectionalism\'.
CONCLUSIONS: Our research demonstrates how an intrasectional lens can help better understand how different forms of mutually reinforcing inequities exist at all levels within the healthcare workforce and how these impact HCWs from certain backgrounds who face greater
disadvantage, discrimination and disempowerment, particularly during times of crisis like the COVID-19 pandemic.