Weight stigma can lead to discrimination and negative outcomes in health care. However, few studies have examined patients’ experiences of stigma in health care settings. Our objective is to design a survey examining patients’ experiences of stigma in health care settings in several domains, including verbal interactions, physical examination, and the built environment.
This pilot study consists of field pre-testing and will include online pre-testing. We compiled and modified available surveys on weight stigma, and added questions based on expert opinion. The study population consists of a convenience sample of patients age > 18 with BMI > 30 obtained from clinics in a Midwest academic health system. Each patient was asked to complete 10-11 questions out of a total of 32 questions. We used cognitive interviewing methods to assess how patients understood our survey questions. Based on these responses we implemented significant revisions to our survey. Prior to Obesity Week 2019, we will also have data from an online sample of >300 participants.
We interviewed 48 respondents. Several common themes emerged from our study. 1) Patients preferred reporting experiences of stigma in terms of frequency of occurrence rather than an “agree/disagree” format. 2) Respondents preferred milder terminology, such as “distaste” rather than “disgust.” 3) Preliminary data suggest that patients had negative experiences in the emergency department, surgery clinics, and with radiology equipment and hospital gowns. 4) Patients uniformly objected to the terms “obesity” and “morbid obesity.” We will have additional survey data for Obesity Week 2019 from our online pilot testing.
This study demonstrates the importance of employing cognitive interviewing methods when designing surveys, as many of our initial questions needed extensive revision. Preliminary data suggest that to reduce weight-based stigma, our organization should target medical equipment, and specific departments.