Developing a universal precautions approach to stigma reduction in health care: Insights from clinical and non-clinical health workers

Amid calls for stigma reduction approaches that go beyond one condition, identity or practice and growing evidence of stigma as a common experience in the general population, we explored the possibility of a “universal precautions” approach. That is, that all people who attend for health care should be considered as worried about how they might be judged. To further develop this approach, semi-structured interviews were conducted with 30 health workers in clinical and non-clinical roles in Australia. Participants were generally supportive of a “universal” approach to stigma reduction (“there’s 1000 s of stigmas out there”) and wanted opportunity for all workers to participate in any programs. Participants were typically aware of the impact of stigma and drew on their own experience or that of family or friends to explain the long legacy of stigma for people’s interactions with health care systems. An element of misconception around stigma (what it looks like and why it can be damaging) was apparent in relation to practices that health workers engage in an effort to protect or care for their colleagues through communications that include irrelevant or judgemental information about patients. Health worker values of non-judgemental care and reflective practice were seen as important to draw upon to frame stigma reduction interventions which needed organisational support and leadership. Using quality standards and accreditation systems to drive further action on stigma reduction was also highlighted. These data will contribute to scoping potential approaches and limitations of a “universal precautions” approach to stigma reduction in health care.