Women's experiences of discrimination and the impact on health: research

Annex B: One-to-one interviews semi-structured topic guide

This interview is on discrimination and health. This research is being carried out as part of the Scottish Government's Women's Health Plan, in which the plan and its associated work is inclusive of women, girls, and all those who access women's health services. We are interested in any and all experiences you are comfortable sharing on this topic. There are no right or wrong answers and if you don't understand anything or we aren't clear, do say, as you probably aren't the only one thinking it.

Let's get started then. We'll begin with some questions about the terms used.

Definitions questions

What comes to mind when you think about your health and being 'healthy'?

What things do you think impact on your health?

One of the things that potentially impacts on your health is discrimination. What does the word 'discrimination' mean to you?

One definition of discrimination is we found is: the unfair treatment of people based on certain characteristics including their sex, gender, race/ethnicity, disability, age, religion, education level, where you live, language and sexual orientation. This might be something experienced through an interaction with a person, an institution (like a workplace, school/college or the NHS) or a public space or environment. So we aren't just talking about obvious instances of discrimination, they might be more subtle or hidden, and someone may experience several forms of discrimination at one time. This doesn't mean all the negative experiences you have had, but the things that have happened to you specifically because of your background or belonging to a certain group.

Based on what you've told me and this definition, can tell me about a particular event when you experienced or witnessed discrimination? I won't interrupt, go into as much detail as you like.

Do you think that experience impacted on yours/the person's health in any way?

Probing question: do you have any reflections on why you think that was happening?

Probing question: can you think of any other examples in/out of a healthcare setting? In an education/work setting? (depending on which area they have focused on)

Do you think any of these situation of discrimination you've described relate to specific parts of your identity (e.g. gender, race, age, sexual orientation, social class or anything else)?

Probing: Why/why not? What do you think is happening there?

Probing: In the situation you mentioned, is there one identity that is more important than the others? For example, do you think it's because of your [e.g. gender] more so, your [e.g. race] more so, or is it both?

Thinking about your description of health and being healthy, can you tell me what kinds of things you think make it easier or harder to be 'healthy'?

• Location
• Finances
• Options for activities (e.g. different kinds of sports)
• Services (health, education, transport)
• Local environment (green space, air quality)
• Behaviours (activity, diet)
• People (friends, peers, family, community, online influencers etc.)

Do you think the characteristics we spoke about (e.g. gender, race, disability, sexual orientation) have any impact on your ability to do those things/be healthy? Can you give an example?

If there is time: Before the interview, had you thought that discrimination could impact on your health?

General probing questions throughout:

• Why do you think that is?
• What do you think might be happening there?

Examples of different forms of discrimination – only used if nobody can think of any examples themselves:

Certain institutions (e.g. work places, schools, NHS) or places may have policies that discriminate against people. For instance, if NHS mental health support clinics take place every Friday, people who practise certain religions will not be able to attend as this is their day of worship. Or, another example is if a new mothers' social group meets in a centre with no step-free access, this activity discriminates against new mothers with access needs.

Some people may not be listened to, taken seriously or generally treated very well by medical professionals because of who they are (or assumptions about who they are). For instance, a teenager is assumed to be exaggerating their symptoms due to the perception they are inexperienced and unknowledgeable. Another example might be on a hospital ward, where more attention may be given to white patients than patients from ethnic minority backgrounds.

Discrimination can also occur according to where a person lives. For example, during lockdown restrictions of the COVID-19 pandemic, there were visible inequalities in who had access to green space/outdoor space and who didn't. Those who lived in areas with private gardens were able to access outdoor space at all times during the pandemic, whereas those who live in areas without any private outdoor-space may have had to choose between staying indoors or going to a busy public park (where for a while, these spaces could be used for physical activity only).

Another example of discrimination in relation to neighbourhood/where you live is the accessibility of public transport. For those who rely on public transport to commute to workplaces, education, and healthcare settings, discrimination can occur if the transport system is inaccessible, unaffordable, or unreliable to those who need to use it. This can result in people then missing shifts, school/college/university classes, or healthcare appointments, which directly impacts on their health and opportunities.