Fuzzy Modeling of the Enactment of Stigma by Healthcare Personnel Toward People Living with HIV in the Frame of Counterfactual Thinking: A Mixed-Method Approach

Existing research on HIV stigma has not thoroughly studied the healthcare providers' (HCP) judgment toward people living with HIV (PLHIV). The goal of this article is to conceptualize formation of stigma within attitudes of HCP through their judgmental process by using the Fairness Theory. The study is also aimed to develop a model for cognitive patterns of HCPs' stigmatizing judgments toward PLHIV by applying fuzzy logic. We applied a mixed method in two phases, including qualitative method and fuzzy analytical modeling. A sample of 17 physicians and 9 nurses from 6 hospitals in Tehran were recruited and saturation was achieved after 21 in-depth interviews. Then, the answers of six HCPs were selected for defining the fuzzy sets and membership functions' curve. Six patterns of HCPs' judgments emerged that were used for the fuzzy analysis. These patterns are outcomes of assessment on various aspects of fairness of stigmatization that is impacted by HCPs' counterfactual prototypes. Moral codes, hospital and medical rules, and also constraints imposed from the workplace environment are the references of counterfactual prototypes that affected the HCPs' judgment. Health policy makers can design more effective HIV stigma reduction interventions based on the six patterns of HCPs' judgment.