A Study On The Measurement And Formation Mechanism Of Contemporary Chinese Physician Occupational Stigma

Objective:Occupational stigma refers to the negative consequences of labeling a group of people in an occupation derogatorily and insultingly by people in a dominant position or a majority in society,which can lead to damage of identity,loss of status,discrimination,and exclusion of the related practitioners.It is possible that nearly any profession can be stigmatized.Physicians,typically a highly prestigious profession,are rarely the target of stigmatization.However,the stigmatization remarks of physicians may generate through the collective impact of health care policies,hospital management systems,negative social events,and propaganda media.Stigma can affect not only the professional development and physical and mental health of physicians but also the health and well-being of patients and the construction of a harmonious doctor-patient relationship in a negative way.It is of theoretical significance and practical value to accurately measure physicians’occupational stigma,analyze its causes,and put forward reasonable suggestions.To this end,this study analyzed the current situation,influencing factors,and formation mechanisms of physicians’occupational stigma through eight sub-studies.Specifically,Study 1 aimed to examine the situation of positive and negative stereotypes held by the public toward physicians in China.To offer assessment tools for the related quantitative researches,Study 2 to Study 4 separately developed the Patients toward Physician Occupational Stigma Scale（PPOSS）,the Public Stigma toward Physician Scale（PSPS）,and the Physician Internalized Occupational Stigma Scale（PIOSS）.Study 5 to Study 8 separately discussed the influence of individuals’implicit health theory,intolerable uncertainty,the concept of family members,and different types and content of news reports on physician occupational stigma.Methods:This study can be divided into three components.The first part adopted the word-free association method（Study 1）,conducted questionnaire surveys among 497 medical students and 124 residents,and analyzed their stereotypical perceptions of physicians.The second part was an analysis of the measurement and situation of physicians’occupational stigma among doctors,mainly including three studies.Study 2 to Study 4 respectively conducted questionnaire surveys in samples of 645 outpatients,1195 university students and 765 residents,and 702 physicians.The PPOSS,PSPS,PIOSS were developed and made reliability and validity test.The third part analyzed the psychological formation mechanism of physicians’occupational stigma,including 4 studies（Study 5 to Study 8）.Study 5 used a single-factor between-subject experimental design with 196 college students to examine the effects of implicit health theories（entity theory and incremental theory）on physicians’occupational stigma and to explore the mediating role of moral judgment and anger toward physicians.Study 6 administered questionnaires to fathers,mothers,and children in 377 families to examine the effects of parental intolerance of uncertainty on children’s physician occupational stigma and explored the mediating effect.Study 7 used a mixed experimental design of 4（report content:physician responsibility group,patient responsibility group,physician status group,and control group）×2（report format:paper report group,video report group）×2（measurement time:pre-test,post-test）to examine the effects of different types and contents of news reports on physician occupational stigma with 339 college students as study participants.Study 8 used a 2（enthusiasm:high enthusiasm,low enthusiasm）×2（ability:high ability,low ability）between-subjects experimental design with 221 college students as study subjects to examine the effects of news reports related to physicians’enthusiasm and ability on individual’s physician occupational stigma.Results:Study 1 found that positive stereotypes outnumbered negative stereotypes among both medical students and the public,and the percentages of negative stereotypes were 15.22%and 31.03%,respectively.In addition,the negative stereotypes of medical students toward physicians mainly show as"stressful","disputes",and"boring";however,the negative stereotypes of the public toward physicians mainly show as"stressful","indifferent",and"disputes".The second part showed the result that the PPOSS,PSPS,and PIOSS have good reliability and validity.Study 2 discovered that the PPOSS consisted of 19 items divided into three dimensions:stereotype,prejudice and discrimination.The total PPOSS score and the scores of each dimension were significantly negatively correlated with the Wake Forest Physicians Trust Scale（WFPTS）total scores and had a significantly positive correlation with the Intolerance of Uncertainty Scale-12（IUS-12）and Brief Illness Perception Questionnaire（BIPQ）.The Cronbach’sαcoefficients for the total scale and dimensions of the PPOSS ranged from 0.87 to 0.94,and the split-half reliability coefficients ranged from0.84 to 0.93.In addition,the PPOSS had measurement equivalence in the male and female population.Study 3 found that the PSPS consisted of 20 items divided into three dimensions:stereotype,prejudice,and discrimination.The total PSPS score and the scores of each dimension were significantly negatively correlated with the WFPTS and the Patients’Presupposed Trust Scale（PPTS）and had a significant positive correlation with the Intergroup Anxiety Scale（IAS）.The Cronbach’sαcoefficients for the total PSPS score and each dimension ranged from 0.91 to 0.96,and the split-half reliability coefficients ranged from 0.93 to 0.96.Moreover,PPOSS showed its measurement equivalence for male and female.Study 4 discovered that PIOSS consisted of 19 items divided into three dimensions:label identification,status loss,and career denial.The total PIOSS score and the scores of each dimension have a significant negative correlation with the Career Commitment Scale（CCS）and the Workplace Well-Being Scale（WWBS）total scores.There existed a significant positive correlation between PIOSS and the Scale for the Doctor with Patient-Doctor Relationship（DDPRQ-10）,Intent to Leave Scale（ILS）and Occupational Disidentification Scale（ODS）.The PIOSS total scale and Cronbach’sαcoefficients for each dimension ranged from 0.78 to 0.91,and the split-half reliability coefficients ranged from 0.80 to 0.93.Furthermore,the PIOSS showed its measurement equivalence for male and female..The third part presented the influence of individuals’implicit health theory,intolerable uncertainty,parental occupational stigma toward physicians,and different types and content of news reports on individuals’physician occupational stigma.Specifically,Study 5discovered that the total score on Moral Judgment Scale（MJS）was significantly higher in the incremental group than in the entity group（t=2.59,p=0.010）;the entity group had significantly higher scores on the total score of the Medical Anger Scale（AS）（t=2.38,p=0.019）and the total score of PSPS（t=4.82,p<0.001）,and stereotype（t=3.79,p<0.001）,prejudice（t=4.82,p<0.001）,and discrimination dimension（t=3.94,p<0.001）scores than the incremental group.Mediated model analysis revealed that implicit health theory could indirectly influence physician occupational stigma through the mediating role of moral judgment and anger.Study 6 found that intolerance of uncertainty and the physician occupational stigma showed intergenerational effects.The results of the APIM model analysis illustrated that subject effects of both fathers’and mothers’intolerance of uncertainty on physician occupational stigma held,and only objective effects of mother’s held.In addition,the results of the mediation model analysis showed that in the impact of father’s intolerance of uncertainty on child’s physician occupational stigma,the stigma of a father’s physician occupational stigma and his children’s intolerance of uncertainty played a mediating role.While,in the impact of mother’s intolerance of uncertainty on child’s physician occupational stigma,the stigma of mother’s and father’s physician occupational stigma and his children’s intolerance of uncertainty played a mediating role.Study 7 found significant main effects of measurement time(F_1,330=25.25,η²=0.071,p<0.001)and reported content(F_3,330=3.18,η²=0.028,p=0.024)in the effect of the types and content of news reports on physician occupational stigma.After post-hoc testing,it was found that the total score of PSPS（M=40.66,SD=0.63）was higher than that of the baseline measurement（M=38.15,SD=0.68）,and the difference was significant（p<0.001）.The PSPS total score was significantly higher in the physician responsibility group（M=41.21,SD=1.18）and the physician status reporting group（M=41.26,SD=1.22）than in the patient responsibility group（M=37.17,SD=1.18）with significant difference（p=0.015,0.015）.The total score of PSPS in the physician responsibility group and the physician identity group was higher than that in the control group（M=38.03,SD=1.28）,and the difference reached marginal significance（p=0.070,0.069）.Moreover,the interaction effect of measurement time and reported content was significant(F_3,330=10.61,η²=0.088,p<0.001).Further simple effects analysis revealed no significant changes in the patient responsibility group(F_1,330=0.01,p=0.915)and control group(F_1,330=0.20,p=0.66)on pre-test and post-test without significant difference,while the physician responsibility group(F_1,330=41.71,p<0.001)and physician status reporting group(F_1,330=16.87,p<0.001)showed higher physician occupational stigma on the post-test.Study 8 revealed that the high and low enthusiasm groups did not differ significantly in physician occupational stigma(F_1,213=0.18,p=0.671,η²=0.001)and physician trust(F_1,213=1.03,p=0.312,η²=0.005);the low ability group had significantly higher physician occupational stigma than the high ability group(F_1,213=70.14,p<0.001,η2=0.248),while physician trust was significantly higher in the high-competence group than in the low-competence group(F_1,213=45.52,p<0.001,η²=0.176).And neither enthusiasm reports nor competence reports had a significant effect on the interaction between physician professional stigma and physician trust.In addition,high competence-related news coverage reduced physician occupational stigma and subsequently increased trust in physicians compared to low competence-related news reports of physicians.Conclusion:Public stereotypes toward physicians are overall positive.The physician occupational stigma from the public is conducive to reducing individual trust in physicians,increasing perceptions of illness,and enhancing levels of inter-group contact anxiety.In addition,the internalized occupational stigma of physicians can improve their propensity to leave their jobs,professional disapproval,reduce professional commitment,and job well-being,and undermine the doctor-patient trust relationship.The formation of physician occupational stigma can be influenced by their implicit health theory,parental intolerance of uncertainty and physician occupational stigma,the content of news reports,and reports of related physicians’competence.The exploration of the measurement and formation mechanism of physicians’occupational stigma can provide a theoretical reference for the accurate identification and intervention practice of physicians’occupational stigma and is a crucial way to reshape the harmonious and trustful patient-physician relationship.