Classism and dehumanization in chronic pain: A qualitative study of nurses’ inferences about women of different socio‐economic status

Abstract

Objectives. Class-based dehumanization in health is poorly investigated. Beliefs about social class are often shared across cultures, with people of lower socio-economic status (SES) being typically dehumanized. This study specifically examined how nurses' perceptions of pain patients' SES were associated with (more or less) dehumanizing inferences about their pain and different treatment recommendations.Design. Sequential mixed methods including Similitude Analysis (statistical analysis of qualitative data) and a Thematic Analysis. Fifty female nurses watched short videos of two white women of different SES (low vs. middle) and similar levels of pain behaviours. Afterwards, nurses were asked to complete (1) a Free Association Task (associating characteristics and a profession to the women) and (2) a Story-Completion Task (writing a story describing women's lives, pain, and recommending treatments). Data were analysed with Similitude and Thematic Analysis.Results. The women's SES was recognized, linked to distinct professions, and associated with distinct inferences. The middle-SES woman was depicted with both Uniquely Human (e.g., autonomous) and Human Nature (e.g., communicative) traits, positive future prospects, and competence to self-manage pain. The low-SES woman was associated with Human Nature traits (hard-working) but denied Uniquely Human traits associated with competence; she was imagined as passive towards pain, with poor future prospects and referred to psychoeducation.Conclusion. Findings reveal the role of class-based cultural belief systems in pain care, showing how nurses' recognition of low SES is associated with dehumanizing inferences and recommendations, which may contribute to reproducing pain care disparities. Theoretical implications of these findings for social and health psychology are drawn.

Self- and Other-Dehumanization Processes in Health-Related Contexts: A Critical Review of the Literature

“…Indeed, very few studies have looked at men or older adults as victims of dehumanization, even though older people are more often dehumanized than young people (Boudjemadi, Demoulin, & Bastart, 2017) and men may also be denied humanness (Capozza, Falvo, Trifiletti, & Pagani, 2014; Fasoli et al, 2016). This trend is at odds with most social psychology studies that typically focus on social minority groups, who are at an increased risk of dehumanization (Diniz, Castro, Bousfield, & Bernardes, under review; Haslam, 2006; Haslam & Loughnan, 2014; Haslam & Stratemeyer, 2016; Volpato, Andrighetto, & Baldissarri, 2017). Research has also been typically performed in Anglo-Saxon countries (71.3%), leaving other cultural contexts underexplored.…”

Qualitative story completion for counseling psychology research: A creative method to interrogate dominant discourses.

“…To date, almost all qualitative SC research has used some form of thematic analysis (TA), or its close cousin qualitative content analysis (Hsieh & Shannon, 2005), for data analysismost commonly Braun and Clarke's (2006) reflexive TA approach (e.g., Auðardóttir & Rúdólfsdóttir, 2020;Beres et al, 2014;Clarke et al, 2015;Diniz et al, This document is copyrighted by the American Psychological Association or one of its allied publishers.…”

“…Mixed methods study designs are also possible (Hanson, Creswell, Clark, Petska, & Creswell, 2005). Livingston and Testa (2000), for example, used SC in an experimental design, and Diniz, Castro, Bousfield, and Bernardes (2020) in a sequential mixed methods design. It is important to note that while these elements of qualitative SC may be familiar from quantitative research, they do not result from positivist assumptions.…”

What does person‐centred care mean, if you weren't considered a person anyway: An engagement with person‐centred care and Black, queer, feminist, and posthuman approaches

“…A thorough analysis of the links between PCC, neoliberalism, and inequality would exceed the space of this paper–for example, Pistor and Lachmann (2022) show how law produces inequality as a result of creating capital. The classist assumption that nurses implicitly occupy can decrease access to healthcare intervention, contribute to a lower life expectancy, and reproduce care disparities (Diniz et al, 2020). Diniz et al (2020) looked at how nurses conceptualize patients of different socioeconomic status (SES) and found that while patients with middle SES were depicted mostly with positive (autonomous and communicative), patients with low‐SES were also imagined with dehumanizing traits such as “passive towards pain, with poor future prospects and referred to psychoeducation” (Diniz et al, 2020, p. 152).…”