Keeping People <i>Down</i> , <i>In (Line)</i> and <i>Out</i> : Structural Stigma and Missingness In Health Care

Recent years have seen the development of conceptualisations of stigma which have moved beyond individual-level analyses towards exploring how stigma operates across multiple levels. While empirical research has examined the impact of stigma across various domains, there remains scant research exploring the lived experience of <i>structural stigma</i>. In this article, we examine structural stigma as a driver of multiple missed appointments, or 'missingness', in health care. We draw on qualitative data from 61 interviews with health and social care professionals and experts-by-experience of missingness in the United Kingdom, focusing on three stigmatised statuses: people from marginalised racial and ethnic groups, including those in the asylum system; people with mental health conditions; and people experiencing problem substance use. We adapt Link and colleagues' schema of stigma outcomes-keeping people <i>down</i>, <i>in,</i> and <i>away</i>-to explore how structural stigma shapes access to and experiences of health care. Our findings demonstrate a range of such processes through which barriers to effective engagement occur, and suggest that a focus on structural stigma will benefit policy, practice, and future research in this area.