The long and short of it: a qualitative descriptive analysis of self-identifying fat people’s experiences of Aotearoa New Zealand’s COVID-19 vaccination centres
Erica Stolte 1 , George Parker 1 , Lesley Gray
2 *
1
2
Abstract
Healthcare systems historically fail to deliver adequate and appropriate size- inclusive health care to the fat community with implications for fat people’s health and human rights. The COVID-19 vaccination rollout was, and continues to be, an important part of Aotearoa New Zealand’s (NZ) response to the COVID-19 pandemic. People with high body mass were identified as a priority group for early vaccination.
To investigate self-identified fat people’s experiences of COVID-19 vaccination centres in NZ.
Qualitative descriptive analysis of free-text responses provided by self-identified fat people residing in NZ as part of a international online survey implemented during the COVID-19 pandemic.
Of the 761 NZ survey respondents, 210 respondents provided open-ended and free-text comments about their first COVID-19 vaccination, 169 commented on their experiences of second or subsequent vaccination, and 198 commented on their overall experiences concerning COVID-19 vaccination. Two themes were identified: Navigating challenges in the vaccination centre environment and Advocating for the use of long needles.
Findings highlighted healthcare inequities experienced by fat people when accessing COVID-19 vaccination centres and thin privilege at structural and interactional levels, despite identified priorities for vaccinating people with high body mass.
Keywords: body size, COVID-19, equity, population health, programme design, qualitative descriptive analysis, qualitative research, vaccination.
| WHAT GAP THIS FILLS |
| What is already known: Weight stigma and lack of size inclusion are widespread in healthcare systems and society. People with high body mass index were prioritised for COVID-19 vaccinations and a long needle was recommended for this population group. |
| What this study adds: Despite prioritisation, findings from people with high body mass included in this study show that this population group was not routinely factored into the design or implementation of vaccination centres that could accommodate their needs. This included lack of suitable seating, barriers to physical access within vaccination centres, and inconsistency in the use of long needles for vaccinations. The findings of this study should inform strategies to enhance inclusivity and equity for future population health programmes. |
Introduction
Healthcare systems have previously failed to deliver adequate and appropriate size-inclusive health care to people with high body mass.1,2 The weight-based paradigm in health that has pathologised and problematised fatness is increasingly challenged philosophically and functionally.2–5 Healthcare environments have historically excluded many minority groups from their design.6 Similarly, healthcare spaces may not be accessible to fat individuals7 and healthcare equipment may not be fit-for-purpose for fat people.8,9 Power differentials between health professionals and patients also shape health interaction experiences,10 as does epistemic injustice when health professionals do not engage with fat people’s health knowledge.11–13
In this paper, we use the terms ‘fat’, ‘fatness’ or ‘big bodied’ individuals/people. These are preferred terms for many fat scholars, activists and participants of this study with lived experience due to the neutrality of the term in comparison with the more pathologising ‘obese’, ‘obesity’ and ‘overweight’.14,15
Despite calls for health care to be size inclusive,5 and assurance that the COVID-19 vaccinations are effective for fat individuals,4,16 the global COVID-19 pandemic resulted in an invigoration of anti-fat narratives. Fat people were positioned as more likely to contract COVID-19, and to experience higher mortality and morbidity. General rhetoric posited that fat individuals were less worthy of prioritisation for COVID-19 treatment and protection,4 and within this context, fat people had to navigate the double bind of understanding themselves to be at higher need to access COVID-19 vaccination and at the same time being framed in media and political discourse as less deserving of the protection it may offer.17
The COVID-19 vaccination rollout was an important part of the NZ response to the COVID-19 pandemic, with fat individuals included in early roll out of the vaccination programme. General vaccination guidelines in NZ specify that a long needle is recommended for this population group, with a 38-mm needle recommended for a ‘very large or obese person’.18 The current population of NZ has approximately 5.2 million people, of which one-in-three adults are classified with obesity (body mass index of 30 kg/m2 or above); when looking at ethnicity, this is as many as one-in-two for Māori and nearly two-in-three for Pacific populations.19
Considering complex discourse surrounding fat people in COVID-19 pandemic responses,4,17,20 this qualitative descriptive study sought to document and analyse fat people’s self-reported experiences of COVID-19 vaccination centres in NZ.
Methods
This study explores 210 fat people’s experiences of COVID-19 vaccination centres in NZ. The data for this study were collected as part of a larger international survey, with quantitative findings reported by Parker et al.21 This study focuses on the open-ended and free-text responses of self-identifying fat people’s experiences of long needle use, who were resident in NZ at the time of the survey.
Participants and recruitment
The population for this study were self-identified fat people over the age of 18 years. Self-identification was chosen over other commonly used criteria, such as the body mass index (BMI), which has been found to be problematic and stigmatising.22 To ensure validity of this inclusion criteria, a guide was provided for respondents. This included statements of common experiences that fat people are routinely faced with; for example, having to shop in plus size clothing stores, being told to lose weight to be healthy and experiencing discomfort when sitting in standard chairs with arms. Global data collection ended with a total of 14,598 valid respondents from a wide range of countries. Of these, 761 respondents identified as being vaccinated in NZ, and of those, 210 provided additional free-text comments about their experiences.
Data collection
Data collection was conducted through the use of closed-ended, open-ended questions and free-text spaces constructed and administered with QualtricsXM© (www.qualtrics.com), an online survey platform. Open-ended and free-text responses are useful when asking about complex topics that are not well defined or may receive a variety of responses that are not easily captured in closed-ended questions.23 Open-ended questions asked about fat people’s broader experiences of vaccination centres such as the physical environment of vaccination centres and the interactions they had inside centres. Demographic questions included country of vaccination, age and gender. Ethnicity was not one of the demographics sought in the international survey, although place of residence was captured. Additional questions asked where the respondents received their vaccinations and when they received them. The survey covered both the initial COVID-19 vaccination and the boosters that were available at the time, though not all respondents had received booster shots at the time of the survey (between 1 October 2021 and 15 November 2021). At the end of each segment of the survey, there was a free-text box where respondents could provide any additional comments.
Data analysis
Qualitative descriptive analysis24 was applied to analyse the data. The research team are fat studies scholars and did not meet personally with the respondents. Recruitment was advertised through fat studies and fat community networks. The data were handled in a sensitive and non-stigmatising manner. Data were anonymised prior to analysis, and the online survey and associated documents were stored on a University computer with password protection. Data were initially analysed by ES, with data verification involving all authors.
Our commitment in researching a stigmatised topic within a stigmatised community was to ‘stay close’ to the data, centring respondents’ descriptions about their vaccination experiences as true accounts worthy of understanding and attention.25 As a flexible, rigorous and low inference approach, qualitative descriptive analysis24 was suited to this task providing us with ‘factual responses to questions about how people feel about a particular space, what reasons they have for using features of the space, who is using particular services or functions of a space, and the factors that facilitate or hinder use’ (p. 17).24 Because of the fat community investment in the findings of our survey, we also wanted to produce results in everyday, factual language that were widely accessible beyond an academic audience, and qualitative descriptive analysis24 is ideally suited to this goal. The open-ended and free-text responses were first read through to familiarise and form broad categories based on connections within the data coding. This was followed by a second reading that further narrowed the categories. Responses were then read within these categories to allow for more meaningful connections and subcategories to be formed. A final analysis of the data was conducted within these themes and their subsequent subcategories to organise and answer the research question.24 Supplementary File S1 provides a checklist for the reporting of qualitative research.
Results
Two main themes were identified from analysis: navigating challenges in COVID-19 vaccination centre environments; advocating for the use of long needles. These are described with illustrative quotations below.
Theme one: navigating challenges in the COVID-19 vaccination centre environments
Environmental factors are important influences in peoples’ experiences of healthcare settings and include both the physical space they occupy and move through, as well as the interactions between people that occur within the healthcare settings.26 Survey respondents reported mixed experiences relating to both the physical environment and interactions with staff in COVID-19 vaccination centres that shaped their overall COVID-19 vaccination experience. Respondents described multiple ways in which the physical environment of the vaccination centres impacted on their access to and the experience of being vaccinated against COVID-19. Adequate seating has been identified as a core component of healthcare physical environments that facilitate patient-centred care.26 The inadequacy of seating provided to respondents in both vaccination centre waiting areas and when receiving their vaccines was widely reported by survey respondents. Seating was commonly reported as both flimsy and uncomfortable, with respondents describing their anxiety that the chairs provided would not hold their weight, along with physical discomfort resulting from the arms of the chairs digging into thighs and legs. Respondents describing feelings of nervousness and embarrassment in response to inadequate seating, placing them additionally on-edge during their vaccination encounter. Some respondents reported that they did not want to/did not sit in the provided seating due to fear that they would not be able to fit or would break the seat:
The chairs. The chairs made me nervous. They were plastic with sides, and I didn’t fit. I was so scared to sit down. Petrified in fact. And I had to sit on one after my jab for 20 min, panicking. (respondent 743)
The chairs had arms on the side that cut into my leg. (respondent 28)
Some respondents described seating as weight bearing but still uncomfortable for their size:
Plastic chairs had smaller curving seats which weren’t very comfortable, but they were reasonably sturdy. (respondent 76)
Others identified that staff helped provide suitable seating:
I asked for a chair without arms … the person coordinating had already identified one for me. (respondent 164)
Another challenging feature of the physical environment of vaccination centres for survey respondents was the layout and spacing provided in the centres. No overcrowding is another key aspect of patient-centred health service design,26 which assumed added importance during the COVID-19 pandemic due to physical distancing requirements.27 Many respondents reported insufficient spacing in vaccination centres to account for their size leading to increased fear of viral transmission and a lack of privacy, especially when having to remove layers of clothing to access the correct part of the arm for vaccination.
First dose happened before the country moved into [another] full lockdown, so we were crammed in like sardines… (respondent 31)
There were a lot of people sitting very close together and the chairs were not in orderly lines. It was hard to move along the rows. (respondent 192)
Entry to and exit from the vaccination centre was concerning for a number of respondents, who described hindered ability to enter the vaccination centre.
I had to walk up 6 flights of fire escape stairs to get to the room the vaccination was in. I made it up the stairs but hid puffing outside the door of the room because I was scared about comments I’d get for being a fat person that found the stairs difficult. (respondent 664)
Multiple respondents mentioned that accessibility problems were not due to their weight but rather their disability, suggesting that some temporary vaccination centres had not considered access for disabled people either:
Did not provide mobility parking… I told them I needed room and they had cars park right beside me blocking me in. (respondent 49)
Accessibility was a second thought. (respondent 75)
The majority of respondents who had a positive experience attributed this to warm or affirming interactions with the vaccination centre staff. Respondents noted that when staff engaged with them in a way that felt welcoming and inclusive, they were happier with their experience:
Both times the nurse just said “hold on while I get the longer needle, it’s recommended” then went and got it. No fuss, no stigmatisation, very positive experiences. (respondent 550)
I would say that I am one of the lucky ones to have been seen promptly by my own GP practice and they knew about the longer needles. (respondent 33)
Some respondents reported negative interactions that significantly diminished their vaccination experience. These respondents felt that the vaccination staff were rude or not welcoming, and described experiences of fat-phobia and stigmatisation from vaccination centre staff.
Vaccinator made me feel slightly uncomfortable and spent excessive amounts of time looking at my stomach and arms – also made a comment “please only take one sweet so others can have some too”. (respondent 353)
Theme two: advocating for the use of long needles
The need for fat community advocacy to ensure long needles were available and offered where appropriate for COVID-19 vaccination, was widely reported by respondents. Respondents described the need for their own self-advocacy and advocacy on their behalf by fat community leaders, to ensure general NZ guidance about the use of long needles18 was followed. The response from vaccination staff to this advocacy was key in either establishing or undermining confidence in the COVID-19 vaccination experience.
Many respondents noted that long needle use was rarely discussed with them in vaccination clinics and many respondents were not aware of the long needle recommendation until after their first COVID-19 vaccinations.
I found out after my second shot that a longer needle was required… I do not believe I had the longer needle in either of my two shots as the person who gave me the vaccine had the needle and dose in a tray prior to knowing I was next in line for the shot. (respondent 249)
Respondents described a mixture of reactions from vaccinators to their self-advocacy for the use of a long needle, most commonly meet with negativity and resistance. Respondents described instances where they had to insist on the use of a long needle, along with dismissals of their requests from some vaccinators and refusal to change needle from others. These encounters left respondents feeling that they were not ‘even listened to’ (respondent 75).
I requested a longer needle like I did the first time, and I was again told it wasn’t needed and that I was being unreasonable. (respondent 114)
A number of respondents described experiences where their vaccinators did not appear to know about the long needle recommendation, whereas some respondents reported positive reactions to their self-advocacy:
They didn’t know about the longer needles, but their supervisor did, agreed I needed one and happily fetched it. (respondent 312)
After requesting a longer needle, the vaccinator seemed to not know what I was talking about and said the needle she had should be fine [although] I believe I should’ve been given a longer one. I didn’t argue with her (respondent 537).
I mentioned needing a longer needle and the vaccinator agreed and got another vaccine set with a longer needle. (respondent 362)
One of the important implications for respondents when long needle guidelines were inconsistently followed (or appeared to not be followed at all) was an undermining of their confidence that they were adequately protected from COVID-19:
I asked [the] vaccinator if I needed the longer needle. He said ‘oh that’s not necessary’. I worry about the effectiveness of my vaccine now. (respondent 423)
Respondents also reflected a lack of confidence in the vaccination programme and its ability to provide size-inclusive care:
I had an interesting experience, when I brought up the concept of a longer needle, pharmacy staff said they had phoned the local doctor to ask if I should have a long needle or not and decided I didn’t need one, which at a size 26 I felt was an interesting outcome. (respondent 685)
Beyond long needle use, self-advocacy also occurred when respondents could see the physical environment was not suitable for their needs:
Of the three different seating areas I needed to use, I had to ask for a suitable chair (no armrests) for the 15 min waiting period post vaccine. This was provided for me quickly and kindly. (respondent 442)
Affirming responses to respondents’ efforts at self-advocacy were described as building trust and reassurance, as well as providing a sense of relief in the vaccination experience:
No shame, no one else would have been aware. I was so relieved. (respondent 284)
Despite the inclusion of fat people in priority group three for COVID-19 vaccination being government mandated and widely advertised in NZ, respondents reported that some vaccination staff were not aware of this priority, leading to a few of the respondents having to justify their eligibility:
Phoning to make the appointment and having to justify why I was in group 3 was the worst part. (respondent 68)
Respondents described the discomfort and anxiety resulting from a need to justify to the vaccination staff that they were meant to be able access their vaccination because of their body size.
Respondents recognised and appreciated the advocacy of fat community leaders in raising awareness about long needles and supporting fat people to access COVID-19 vaccines. A common form of advocacy by and for the fat community was through social media platforms such as Instagram, Twitter and Facebook. This played a role in raising respondent awareness about the recommended needle length:
Not many people are aware of the [longer] needle, and I’ve only seen it mentioned in passing in the online fat social media community, and by Dr Cat [Pausé] on the radio which is how I knew to ask for it. (respondent 72)
I don’t know if my vaccinator would have given it to me without me asking but I’d like to think she would have as she was also fat, such a rarity in a medical setting! (respondent 81)
Discussion
This study explored self-identified fat people’s experiences of COVID-19 vaccination centres in NZ. The findings suggest that, despite being identified as a priority population for vaccination, fat people were not routinely considered or accounted for in the design and implementation of NZ’s COVID-19 vaccination programme. This aligns with a breadth of research that has demonstrated the systemic under-serving of fat people in health care, leading to inequitable access and outcomes for this population.3,5 Access, space and seating considerations in a range of COVID-19 vaccination clinics fell short of requirements for this priority group.7–9 Although in part, the environmental challenges experienced by respondents in COVID-19 vaccination centres can be attributed to the temporary nature of many of the centres, it also reflects broader trends in community healthcare settings and is a significant oversight considering fat people were identified as a priority group for COVID-19 vaccination.
The impact of ill-fitting seating is well documented as a consistent barrier to social inclusion in the built environment for fat people, including within healthcare spaces.8 The expectation for fat people to adapt to a physical environment that has not been designed for them or their bodies increases stress and anxiety and places the onus to adapt on the individual rather than the environment.8
The inconsistent application and interpretation of long needle guidelines and the lack of information easily available to fat people and apparently to some vaccinators is concerning. In addition, some vaccinators told respondents that there was a lack of availability of long needles; this raises questions around vaccinator ability to implement NZ guidance with the relevant knowledge and equipment. Whatever the reasons, the mass vaccination COVID-19 campaign only delivered 2.06% of all COVID-19 vaccine doses with a longer needle, when at least 30% of the adult population were potentially eligible.18,19 The underutilisation of long needles in this particular campaign communicates a system of privileging thinness and the subsequent disregard for fat people and their health needs during the COVID-19 pandemic, and adds to concerns about healthcare equipment often reported as being ill-fitting for fat people.9,28 Recently, the Medical Research Institute of New Zealand (MRINZ) reported study findings that the standard 25-mm needle may fail to ensure successful intramuscular (IM) arm deposition of vaccines in a significant number of adults.29 The MRINZ are currently conducting a randomised controlled trial to explore whether the use of a short needle provided adequate COVID-19 vaccine protection for fat individuals.30
The failure to engage fat people in decision-making concerning their own health care (eg around the use of long needles) underscored issues of power and epistemic injustice in fat people’s healthcare encounters that have been reported elsewhere.10–12 The power relations described in theme two, whereby respondents’ self-advocacy for the use of a long needle to administer their COVID-19 vaccination can be viewed as a form of what Fricker13 described as a testimonial injustice. Testimonial injustice occurs when a speaker is assigned ‘a prejudicially deflated degree of credibility’ (p. 69)13 based on the hearers preconceptions of their social identity and privilege.12 Respondents in our study reported feeling broadly dismissed in their advocacy efforts for long needle usage, suggesting a deflated credibility assigned to them as speakers in their vaccination encounter.
The epistemic injustice of fat knowledge in this study also raises a question around informed consent. Informed consent requires the provision of information to support people’s own self-determination and autonomy and is not only an ethical value in healthcare, but is also a legislated health consumer right in NZ.31,32 Reflecting on this, the findings from this study suggest that fat individuals attending for COVID-19 vaccinations in NZ did not have the ability to have open discussions with vaccinators about long needle use and therefore lacked opportunities to give informed, self-determined consent about appropriate needle length. This is a concern for the delivery of equitable public health preventive programmes and suggests a lack of public health workforce confidence in discussing issues related to weight and size in a constructive manner.
Mutual respect has been affirmed as a key foundation in building trust between healthcare professionals and clients. For mutual respect to be obtained, healthcare professionals need to listen more attentively to their clients.10
Strengths and limitations
A key strength of the research is the number of respondents and the topical nature of the study.
Limitations include that these data were not collected through in-depth interviews, which limits the depth and richness of qualitative analysis. Another limitation is that this study only collected the views of self-identified fat individuals and may have missed the views of relevant people who did not self-identify this way and/or did not participate in the study. The parent survey did not collect ethnicity demographics and so this eliminates the ability to analyse data in this study concerning ethnicity. This study did not seek the views of vaccinators themselves. The two senior authors are currently engaged in a funded project to explore the enablers and barriers of long needle selection in NZ from a vaccinator perspective.
Conclusion
COVID-19 vaccination centres did not provide consistency in access to long needles for fat people and presented barriers in physical access to and movement through these critical healthcare spaces for a group prioritised for access to early vaccination. Health NZ, health organisations and vaccinators should plan for and deliver size-inclusive vaccination programmes involving discussion and decision-making with fat people.
Data availability
The data that support this study cannot be publicly shared due to ethical or privacy reasons and may be shared upon reasonable request to the corresponding author if appropriate.
Acknowledgements
The authors would like to thank the NZ respondents who completed the online survey. The authors dedicate this paper to the memory and legacy of Dr Cat Pausé who was one of the investigators of the original international study and a tireless champion for the rights and wellbeing of fat people.
References
1 Ryan L, Coyne R, Heary C, et al. Weight stigma experienced by patients with obesity in healthcare settings: a qualitative evidence synthesis. Obes Rev 2023; 24(10): e13606.
| Crossref | Google Scholar | PubMed |
2 Bacon L, Aphramor L. Weight science: evaluating the evidence for a paradigm shift. Nutr J 2011; 10(1–13): 9.
| Crossref | Google Scholar | PubMed |
3 O’Hara L, Gregg J. Human rights casualties from the “war on obesity”: why focusing on body weight is inconsistent with a human rights approach to health. Fat Stud 2021; 1(1): 32-46.
| Crossref | Google Scholar |
4 Pausé C, Parker G, Gray L. Resisting the problematisation of fatness in COVID-19: in pursuit of health justice. Int J Disaster Risk Reduct 2021; 54: 102021.
| Crossref | Google Scholar | PubMed |
5 Ballantyne A, Steers D, Gray L. Prompting lifestyle interventions to promote weight loss is safe, effective and patient-centred: No. J Prim Health Care 2023; 15(4): 385-387.
| Crossref | Google Scholar | PubMed |
6 Lee JA, Pausé CJ. Stigma in practice: barriers to health for fat women. Front Psychol 2016; 2016 7: 2063.
| Crossref | Google Scholar | PubMed |
7 Morgan S, Mihlar S, Wood E, et al. Sizing up General Practice environments for big-bodied patients: an environmental assessment of three facilities in Aotearoa New Zealand. HERD 2024; 19375867241238442.
| Crossref | Google Scholar | PubMed |
8 Owen L. Living fat in a thin-centric world: effects of spatial discrimination on fat bodies and selves. Fem Psychol 2012; 22(3): 290-306.
| Crossref | Google Scholar |
9 Ferrante JM, Fyffe DC, Vega ML, et al. Family physicians’ barriers to cancer screening in extremely obese patients. Obesity (Silver Spring) 2010; 18(6): 1153-1159.
| Crossref | Google Scholar | PubMed |
10 Odero A, Pongy M, Chauvel L, et al. Core values that influence the patient—healthcare professional power dynamic: steering interaction towards partnership. Int J Environ Res Public Health 2020; 17(22): 8458.
| Crossref | Google Scholar | PubMed |
11 Kost C, Jamie K, Mohr E. “Whatever I said didn’t register with her”: medical fatphobia and interactional and relational disconnect in healthcare encounters. Front Sociol 2024; 9: 1303919.
| Crossref | Google Scholar | PubMed |
12 Shaw RM, Fehoko E. Epistemic injustice and body mass index: examining Māori and Pacific women’s access to fertility treatment in Aotearoa New Zealand. Fat Stud 2023; 12(2): 338-352.
| Crossref | Google Scholar |
13 Fricker M Epistemic injustice: power and the ethics of knowing. Oxford, UK: Oxford Academic; 2007. 10.1093/acprof:oso/9780198237907.001.0001.
14 Satinsky S, Ingraham N. At the intersection of public health and fat studies: critical perspectives on the measurement of body size. Fat Stud 2014; 3(2): 143-154.
| Crossref | Google Scholar |
16 Butsch WS, Hajduk A, Cardel MI, et al. COVID-19 vaccines are effective in people with obesity: a position statement from The Obesity Society. Obesity (Silver Spring) 2021; 29(10): 1575-1579.
| Crossref | Google Scholar | PubMed |
17 McPhail D. The ventilator and the vaccine: necropolitics and fat in the Covid-19 pandemic. J Crit Public Health 2024; 1(1): 20-34.
| Crossref | Google Scholar |
18 Ministry of Health. Immunisation handbook, version 7. Wellington: Ministry of Health NZ; 2024. Available at https://www.tewhatuora.govt.nz/for-health-professionals/clinical-guidance/immunisation-handbook
19 Ministry of Health. Body size (including obesity) 2023/2024. New Zealand Health Survey. Wellington: Ministry of Health NZ; 2024. Available at https://minhealthnz.shinyapps.io/nz-health-survey-2023-24-annual-data-explorer/_w_e2eb184b/#!/explore-indicators
20 Kupietz K, Gray L. Fear, history, stigma and bias in the COVID-19 pandemic. J Emerg Manag 2021; 18(7): 177-182.
| Crossref | Google Scholar | PubMed |
21 Parker G, Pausé C, Gillon A, et al. Self-identified fat people’s understanding of the need for, and use of, long needles when being vaccinated against COVID-19: findings from a international online exploratory survey. Crit Public Health 2023; 33(3): 375-382.
| Crossref | Google Scholar |
22 Anderson J. Whose voice counts? A critical examination of discourses surrounding the body mass index. Fat Stud 2012; 1(2): 195-207.
| Crossref | Google Scholar |
23 Drisko J, Maschi T Content analysis. Oxford, UK: Oxford University Press; 2016. 10.1093/acprof:oso/9780190215491.001.0001.
24 Colorafi KJ, Evans B. Qualitative descriptive methods in health science research. HERD 2016; 9(4): 16-25.
| Crossref | Google Scholar | PubMed |
25 Gabbidon K, Chenneville T. Strategies to minimize further stigmatization of communities experiencing stigma: a guide for qualitative researchers. Stigma Health 2021; 6(1): 32.
| Crossref | Google Scholar |
26 LaVela SL, Etingen B, Hill JN, et al. Patient perceptions of the environment of care in which their healthcare is delivered. HERD 2016; 9(3): 31-46.
| Crossref | Google Scholar | PubMed |
27 New Zealand Government. Reducing the spread of COVID-19. Wellington: New Zealand Government; 2021. Available at https://www.healthandsafety.govt.nz/assets/Uploads/Employee-Resource-Reducing-Spread-of-COVID19.pdf
28 Pausé C. Die another day: the obstacles facing fat people in accessing quality healthcare. Narrat Inq Bioeth 2014; 4(2): 135-141.
| Crossref | Google Scholar | PubMed |
29 Doppen M, Kearns C, Hills T, et al. Intramuscular vaccination needle length: a call to arms. Lancet 2024; 403(10426): 528-529.
| Google Scholar |
30 Medical Research Institute of New Zealand. COVID-19 Needle Length Study. 2024. Available at https://www.mrinz.ac.nz/needle-length-study
31 Legislation New Zealand. Health and Disability Commissioner (Code of Health and Disability Services Consumers’ Rights) Regulations 1996. Wellington: New Zealand Government; 2021. Available at https://www.legislation.govt.nz/regulation/public/1996/0078/latest/whole.html
32 Parmet WE. Informed consent and public health: are they compatible when it comes to vaccines. J Health Care Law Policy 2005; 8: 71.
| Google Scholar | PubMed |
