The Wall of Stigma—A Qualitative Study on the Health Perceptions of Socially Marginalised Patients

BACKGROUND: Socially marginalised people face several health-related challenges as they have a high burden of co-existing social issues and chronic diseases, and lack resources to self-manage their care needs. Research has shown that patients experience more individualised treatment and care when supported by a social nurse during hospitalisation. However, knowledge of socially marginalised people's health perceptions is needed to understand what is important to them when receiving healthcare. AIM: To explore the health perceptions of socially marginalised patients and how they perceive themselves in a frame of healthcare. METHODS: A qualitative study was performed with a phenomenological and hermeneutic approach. Data were collected at a hospital in Southern Denmark between January 2023 and March 2023. Purposive sampling was done to include adult patients who had contact with a social nurse during hospital admission. Participants were interviewed once at the hospital and again 7-22 days after discharge. The analysis was performed by systematic text condensation using NVivo 12 for data storage and coding. ETHICAL APPROVAL: The study is registered with the Danish Data Protection Agency (22/47509). The participants gave informed consent to participate. RESULTS: Sixteen patients participated in the study. Three themes were identified: (1) The circle of lifestyles, living conditions and health behaviour, (2) Feeling unwelcome in the healthcare system and (3) The personal impact of stigmatisation. The participants' perceptions of health were closely linked to their ability to participate in their everyday life. Furthermore, participants experienced low-quality healthcare due to their social circumstances and were stigmatised by healthcare professionals. CONCLUSION: This study demonstrates that socially marginalised patients' healthcare needs are complex, and they perceive their health in the context of their daily life. Furthermore, stigmatisation negatively impacted their self-esteem and self-efficacy required for self-care. Understanding the health perceptions of socially marginalised patients and how they view themselves within the healthcare system is crucial for addressing their healthcare needs.