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Setchell J.1,2
1University of Queensland, Physiotherapy, Brisbane, Australia, 2Bloorview Research Institute, University of Toronto, Toronto, Canada
Background: Research including clinicians and students has identified weight stigma as pervasive and consequential in physiotherapy. Despite clear findings of weight stigma, and its negative implications for physiotherapy clients, there has been no direct consideration of how this stigma might be addressed in physiotherapy.
Purpose: The study aimed to design and trial a theoretically and empirically informed intervention to reduce weight stigma in physiotherapy. The focus of this presentation is twofold: first to demonstrate how critical social theory can inform the development of an intervention, and second to present findings of an exploratory trial of the intervention.
Methods: The method had two parts.
Part 1: Using a critical post-structuralist perspective, I examined and built on existing theoretical and empirical research on weight stigma and physiotherapy, and devised an intervention based on these findings. I drew together three bodies of literature to do this:
1) stigma related theories of sociologist Goffman and philosopher Foucault,
2) weight stigma specific research, including that directly about physiotherapy, and
3) critical physiotherapy theory that investigated the assumptions and practices of the profession relevant to weight stigma.
Part 2: based on these theoretical findings, I trialled an intervention which addressed the theoretical issues I identified. Participants were 8 purposively sampled clinical physiotherapists. The intervention spanned four months and involved faciliated learning about weight and its related stigma in group discussions, individual interviews and weekly reflexive diaries. Data produced from these were analysed qualitatively using a critical methodology to develop relevant focal points.
Results: Results of Part 1: Stigma is complex and embedded (and created) in specific environments and includes embodied and social aspects and is intricately entrenched within current ways of thinking. Interventions to reduce weight stigma have generally been unsuccessful and it is likely that this lack of success is due to insufficient consideration of the complexity of the many underlying causes of weight stigma. Further, interventions generally have lacked, but should include, the ability to address the specific environment in which weight stigma is situated: in this case physiotherapy.
Results of Part 2: In the exploratory trial, the intervention developed from this theory was assessed qualitatively. Relevant data was grouped into focal points which indicated that the intervention was promising in changing weight stigmatising attitudes and clinical behaviours of participating physiotherapists. Analysis highlighted the following four promising focal points:
1) interactions with patients became less stigmatising,
2) professional reflexivity was developed,
3) skills in discussing difficult topics improved, and
4) weight stigma understandings improved.
Conclusion(s): It is likely that culturally embedded attitudes like weight stigma in physiotherapy are difficult to change and require complex, long term and contextually embedded interventions. The intervention proposed in this study offers an intervention methodology that takes this issue seriously and shows promising results in the physiotherapists studied.
Implications: To change deeply embedded attitudes in physiotherapy practice complex, situated, long term interventions are likely to be required. The proposed intervention in this study offers a promising methodology for weight stigma change in physiotherapy.
Funding acknowledgements: This study was part of my PhD which was partially funded by a Margaret Mittleheuser Fellowship from the FFI Inc.
Topic: Health promotion & wellbeing/healthy ageing
Ethics approval: Ethics approval was granted by the ethics board of School of Psychology at The University of Queensland.
All authors, affiliations and abstracts have been published as submitted.
