Abstract
Stigma is a mark of disgrace emerging from shared sets of negative attitudes and inaccurate beliefs. To be stigmatized is to be identified as ‘less-than,’ to be ‘disapproved of,’ to be the focus of often-uninformed criticism. Workplace bullying victims, those individuals targeted by bullies in their workplaces and inveigled/taken in by their bully counterparts’ subtly demeaning affronts, simultaneously become victims of stigma (Dzurec et al., 2014). Recent study data (Howard et al., under review) suggest that for victims, bullies’ affronting behaviors may, ultimately, override personal beliefs. Bullies’ stories come to own those victimized, acting surreptitiously and imperceptibly to direct and constrain victims’ day-to-day beliefs, actions, and behaviors.
Evidence documenting the effectiveness of anti-bullying interventions is in short supply (Gillen et al. 2017). One potential avenue for strengthening understanding of interventions’ effectiveness is consideration of ‘structural stigma’ (Knaak et al., 2019, Sukhera et al., 2020; Hatzenbuehler, 2016), that is, stigma generated through organizational beliefs and practices. Structural stigma serves to benefit some groups over others, subtly fostering and perpetuating power asymmetries that threaten the safety and wellbeing of non-dominant group members—people of color, indigenous peoples, and, in the case of this presentation, workplace bullying victims. Practices established to encourage reporting of bullying affronts, for example, may actually disadvantage bullying victims. Ultimately, structural stigma may contribute significantly to workplace bullying victims’ lived experience of feeling enduringly ‘less-than.’
One useful approach for studying structural stigma is realist review (Pawson et al., 2005; Pearsons et al., 2023; Sukhera et al., 2022), a research approach that unpacks subtle, dynamic organizational processes that contribute to structural stigma. Because realist review focuses on the ways dynamic processes act to affect planned interventions, it extends the benefits of systematic review (Pearsons, et al.), offering insights into why interventions under consideration might ultimately succeed or fail. More specifically, realist review focuses on features of organizational context; behavioral and policy-related mechanisms of action toward those stigmatized; and subsequent outcomes (CMO). The realist review process incorporates five stages: (1) defining the review’s scope and purpose; (2) developing an initial evidence-based theory that articulates a proposed relationship among contextual features, mechanisms of action, and observed outcomes contributing to structural stigma; (3) searching for and appraising published evidence; (4) extracting and synthesizing relevant data and themes; and (5) drawing inferential conclusions to support follow-up recommendations (Pawson, 2005). Realist review offers “an iterative, theory-driven approach to help understand how and for whom and under what conditions an intervention works” (Pearsons et al., 2023, p. 107).
This presentation overviews one phase of the investigators’ realist review process, describing how structural stigma interrupts planned bullying prevention interventions, ultimately prolonging workplace bullying victims’ stigmatizing experiences. Data for the phase of the review presented here were collected from the reported bullying prevention interventions described by Gillen and colleagues in their 2017 Cochrane review. As it clarifies the impact of organizationally generated structural stigma on workplace bullying victims’ experiences, this presentation serves to advocate for healthier patient and staff environments.
Notes
References:
Dzurec, L. C., Kennison, M., & Albataineh, R. (2014). Unacknowledged threats proffered ‘in a manner of speaking:’ Recognizing workplace bullying as shaming. Journal of Nursing Scholarship, 46, 281-291. DOI: 10.1111/jnu.12080
Gillen, P. A., Sinclair, M., Kernohan, W. G., Begley, C. M., & Luyben, A. G. (2017). Interventions for prevention of bullying in the workplace (Review). PMID: 28134445 PMCID: pmc6464940. Https://europepmc.org/articles/pmc6464940
Hatzenbuehler, M. L. (2016). Structural stigma: Research evidence and implications for psychological science. American Psychologist, 71, 742-751. Doi: 10.1037/amp0000068.
Howard, M., Embree, J., Kennison, M., & Dzurec, L., (under review). For ‘victims,’ bullies stories define personal reality: Furthering findings of prior metasynthesis. Frontiers in Psychology
Knaak S, Christie R, Mercer S, Stuart H. (2019). Harm reduction, stigma and the problem of low compassion satisfaction. Journal of Mental Health Addiction Nursing, 3 (1), e8-e21. DOI: https://doi.org/10.22374/jmhan.v3i1.37
Pawson R, Greenhalgh T, Harvey G, Walshe K. (2005). Realist review—a new method of systematic review designed for complex policy interventions. Journal of Health Services Research, 10, 21-34. DOI: 10.1258/1355819054308530
Pearsons, A., Neubeck, L. S., Hendriks, J. M., & Hanson, C. L. (2023). Justification, rationale and methodological approaches to realist reviews. European Journal of Cardiovascular Nursing, 22, 107-122. https://doi.org/10.1093/eurjcn/zvac068
Sukhera, J., Miller, K., Scerbo, C., Milne, A., Lim, R., & Watling, C. (2020). Implicit stigma recognition and management for health professionals. Academic Psychiatry, 44(1), 59–63. DOI: 10.1007/s40596-019-01133-8
Sukhera, J., Knaak, S., Ungar, T., & Rehman, M. (2022). Dismantling structural stigma related to mental health and substance use: An educational framework. Academic Medicine, 97, 175-181. DOI: 10.1097/ACM.0000000000004451
Sigma Membership
Eta Beta
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Other
Keywords:
Workplace Violence, Bullying, Social Stigma, Psychological Stress, Work Environment, Victims -- Psychosocial Factors
Recommended Citation
Dzurec, Laura; Embree, Jennifer L.; Kennison, Monica; and Howard, Matthew S., "Realist Review: A Tool for Interpreting the Impact of Structural Stigma on Workplace Bullying-Associated Trauma" (2026). Creating Healthy Work Environments (CHWE). 79.
https://www.sigmarepository.org/chwe/2024/presentations_2024/79
Conference Name
Creating Healthy Work Environments
Conference Host
Sigma Theta Tau International
Conference Location
Washington, DC, USA
Conference Year
2024
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-02-23
Realist Review: A Tool for Interpreting the Impact of Structural Stigma on Workplace Bullying-Associated Trauma
Washington, DC, USA
Stigma is a mark of disgrace emerging from shared sets of negative attitudes and inaccurate beliefs. To be stigmatized is to be identified as ‘less-than,’ to be ‘disapproved of,’ to be the focus of often-uninformed criticism. Workplace bullying victims, those individuals targeted by bullies in their workplaces and inveigled/taken in by their bully counterparts’ subtly demeaning affronts, simultaneously become victims of stigma (Dzurec et al., 2014). Recent study data (Howard et al., under review) suggest that for victims, bullies’ affronting behaviors may, ultimately, override personal beliefs. Bullies’ stories come to own those victimized, acting surreptitiously and imperceptibly to direct and constrain victims’ day-to-day beliefs, actions, and behaviors.
Evidence documenting the effectiveness of anti-bullying interventions is in short supply (Gillen et al. 2017). One potential avenue for strengthening understanding of interventions’ effectiveness is consideration of ‘structural stigma’ (Knaak et al., 2019, Sukhera et al., 2020; Hatzenbuehler, 2016), that is, stigma generated through organizational beliefs and practices. Structural stigma serves to benefit some groups over others, subtly fostering and perpetuating power asymmetries that threaten the safety and wellbeing of non-dominant group members—people of color, indigenous peoples, and, in the case of this presentation, workplace bullying victims. Practices established to encourage reporting of bullying affronts, for example, may actually disadvantage bullying victims. Ultimately, structural stigma may contribute significantly to workplace bullying victims’ lived experience of feeling enduringly ‘less-than.’
One useful approach for studying structural stigma is realist review (Pawson et al., 2005; Pearsons et al., 2023; Sukhera et al., 2022), a research approach that unpacks subtle, dynamic organizational processes that contribute to structural stigma. Because realist review focuses on the ways dynamic processes act to affect planned interventions, it extends the benefits of systematic review (Pearsons, et al.), offering insights into why interventions under consideration might ultimately succeed or fail. More specifically, realist review focuses on features of organizational context; behavioral and policy-related mechanisms of action toward those stigmatized; and subsequent outcomes (CMO). The realist review process incorporates five stages: (1) defining the review’s scope and purpose; (2) developing an initial evidence-based theory that articulates a proposed relationship among contextual features, mechanisms of action, and observed outcomes contributing to structural stigma; (3) searching for and appraising published evidence; (4) extracting and synthesizing relevant data and themes; and (5) drawing inferential conclusions to support follow-up recommendations (Pawson, 2005). Realist review offers “an iterative, theory-driven approach to help understand how and for whom and under what conditions an intervention works” (Pearsons et al., 2023, p. 107).
This presentation overviews one phase of the investigators’ realist review process, describing how structural stigma interrupts planned bullying prevention interventions, ultimately prolonging workplace bullying victims’ stigmatizing experiences. Data for the phase of the review presented here were collected from the reported bullying prevention interventions described by Gillen and colleagues in their 2017 Cochrane review. As it clarifies the impact of organizationally generated structural stigma on workplace bullying victims’ experiences, this presentation serves to advocate for healthier patient and staff environments.
Description
With every study conducted, we learn more about workplace bullying. This presentation summarizes important insights gained through the investigators' recent mixed-methods study, and, on the basis of those findings, proposes an important research direction for the future.