Health最新文献

{"title":"Implementation of patient participation in rehabilitation: An approach caught between different ideologies.","authors":"Elin Margrethe Aasen, Marianne Kjelsvik, Lindis Katrine Helberget, Elisabeth Dahlborg","doi":"10.1177/13634593251374321","DOIUrl":"https://doi.org/10.1177/13634593251374321","url":null,"abstract":"<p><p>The definition of specialised rehabilitation in Europe has changed from a focus on patients' bodily functions and work tasks to a patient-centred focus prioritising patients' wishes, allowing patients to actively collaborate and set their own goals. This study aimed to explore interprofessional healthcare teams' discursive practice regarding the implementation of patient participation in specialised rehabilitation units in Norway. Data were collected from three focus groups with seven different health professions, totalling 18 healthcare professionals. A corpus-assisted critical discourse analysis outlined by Fairclough was used to analyse the data. Three interdiscursive discourses based on different and opposing ideologies were found: (1) the discourse of standardisation, in which healthcare professionals used international models for rehabilitation goal setting; (2) the discourse of interprofessional experts, in which healthcare professionals constructed themselves as experts; and (3) the discourse of patient responsibility, in which the patients were constructed as having rights and autonomy. The sociocultural practice of implementing patient participation in specialised rehabilitation in Norway highlighted a hegemonic struggle between standardisation; paternalistic and autonomy ideologies; ethical dilemmas between healthcare professionals' knowledge and use of standardised goals; and patients' autonomy, knowledge, and will.</p>","PeriodicalId":12944,"journal":{"name":"Health","volume":" ","pages":"13634593251374321"},"PeriodicalIF":2.3,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Narrative, moral and institutional effects of childhood ADHD: Listening to teachers and mothers of diagnosed children.","authors":"Galia Plotkin-Amrami, Talia Fried","doi":"10.1177/13634593251358035","DOIUrl":"https://doi.org/10.1177/13634593251358035","url":null,"abstract":"<p><p>Building on research on the critical role of laypeople in medicalization and the multi-dimensional character of this process, this study explores the effects and meanings of the ADHD category for mothers and teachers of diagnosed children. Based on interviews with 27 schoolteachers from two different schools and 42 mothers of children diagnosed with ADHD, we show that despite the growing acceptance of ADHD as a medical diagnosis, it exhibits only minor narrative, institutional, and moral effects in school and family arenas. The diagnostic label attributed to children does not resolve blame games and uncertainty about the source of children's difficulties and does not provide many pragmatic benefits for either mothers or teachers. We argue that these limited narrative, moral and institutional effects are shaped by the moral positionings available to mothers and teachers, the institutional status of ADHD as a category of disability, and educational policy. We distinguish medicalization's institutional and interpersonal dimensions and explore their complex interrelations. Our analysis resonates with recent moves in medical sociology toward more pragmatic and practice-based analyses of the effects of medical categories, particularly when enacted outside traditional healthcare settings.</p>","PeriodicalId":12944,"journal":{"name":"Health","volume":" ","pages":"13634593251358035"},"PeriodicalIF":2.3,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Individuals with chronic pain using opioids: Challenging treatment choices, shared decision-makers, or risk-makers? A critical discourse analysis of Belgian policy documents.","authors":"Lena De Bonte, Justine Vanbavinckhove, Liesbet Goubert, Fleur Baert, Peter Pype, Sam Schelfout, Sónia Bernardes, Bart Morlion, Melissa Ceuterick","doi":"10.1177/13634593251377102","DOIUrl":"https://doi.org/10.1177/13634593251377102","url":null,"abstract":"<p><p>Chronic pain, defined as pain persisting for more than three months, affects one in four Belgian adults. Treating chronic pain comprises challenges for patients and clinicians as the term encompasses diverse conditions such as fibromyalgia, migraine, and long-term pain without a known biomedical cause. Additionally, growing evidence highlights the limited efficacy of opioids in managing chronic non-cancer pain. This has prompted critical policy changes in pain management, including shifts away from opioid use. This study explores how Belgian policy documents depict patients, healthcare providers, and therapeutic relationships within the context of opioid use in the treatment of chronic non-cancer pain. A critical discourse analysis of 32 Belgian Dutch-language policy documents was performed using Fairclough's framework. This approach examines how language in texts reflects and shapes social power dynamics and ideologies, and allows us to gain insight into the policy discourses surrounding opioid use for chronic pain. Based on our analysis, we suggest that written policy texts about the use of opioids to manage chronic pain are constructed through the deployment of three discourses: a medical authority discourse, a patient empowerment discourse, and a high-risk medication discourse. While all discourses are rooted in the biopsychosocial pain model, they prioritize different aspects of chronic pain management. Whereas the medical authority discourse emphasizes the decision-making role of physicians, the patient empowerment discourse shifts attention to patients' experiences and preferences. Lastly, the high-risk medication discourse underscores opioids' addictive potential. These discourses reflect varying perspectives on chronic pain management and have different implications for clinical practice. The findings offer valuable insights into how Belgian policy documents discursively construct or challenge therapeutic relationships and stigma.</p>","PeriodicalId":12944,"journal":{"name":"Health","volume":" ","pages":"13634593251377102"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Affective gaps in eHealth communication: Exploring patient experiences with health data on the eHealth platform sundhed.dk.","authors":"Martina Skrubbeltrang Mahnke","doi":"10.1177/13634593251374317","DOIUrl":"https://doi.org/10.1177/13634593251374317","url":null,"abstract":"<p><p>The exploratory study examines how patients in Denmark experience health data on the eHealth platform <i>sundhed.dk</i>. The study takes its starting point in the communicative process taking place between patients as platform users and the eHealth platform as a communicative agent. In dialogue with literature at the intersection of eHealth and communication studies, it develops the analytical lens of affective gaps, connecting Peters notion of communicative gaps with Lupton's concept of affective atmospheres. Empirically, the study unpacks the complex, often conflicting experiences that arise when patients attempt to make meaning of and engage with their health data. Building on 24 in-depth, purposefully sampled interviews, the article presents a thorough thematic analysis, showing that patients need to simultaneously deal with states of being (1) informed and insecure, (2) confident and frustrated, and (3) in control and in doubt. Receiving health data on eHealth platforms is a complex and often challenging process for patients, provoking profound and at times unsettling experiences, oftentimes creating vulnerabilities. While gaps and uncertainty have always been a part of health communication, eHealth platforms amplify and reconfigure these dynamics, thus presenting novel challenges for patient-healthcare professional communication. In conclusion, the article calls for further research into the communicative user-platform relations that shape patient experiences with health data, positioning patients as the primary receivers of eHealth communication.</p>","PeriodicalId":12944,"journal":{"name":"Health","volume":" ","pages":"13634593251374317"},"PeriodicalIF":2.3,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Femtech in context: A critical conceptual (re)view.","authors":"Danica Facca, Jodi Hall, Gail Teachman, Joanna Redden, Lorie Donelle","doi":"10.1177/13634593251371327","DOIUrl":"https://doi.org/10.1177/13634593251371327","url":null,"abstract":"<p><p>Emerging as a commercial category in 2016, 'femtech' has been publicly celebrated as a category of consumer-based digital health technologies designed to support the unmet and systemically marginalized health needs of women in areas such as menstruation, fertility, pregnancy, postpartum, and menopause, through data-driven apps, wearables, and self-diagnostic tools. Since its emergence, the term femtech has become culturally significant and has taken on a life of its own across commercial, public, and healthcare discourses. Despite the growth of femtech scholarship, clarity is lacking on how different disciplines have challenged the assumptions about sex, gender, health, technology, and innovation that shape dominant understandings of 'who' femtech is for (i.e. fem) and 'what' it constitutes (i.e. tech). Motivated by this research gap, a critical conceptual review was conducted to provide new entry points into critical debates. This article novelly adapts 'diffractive reading' as a methodological approach to bring disciplinary perspectives on femtech into conversation with one another across anthropology, computer science, cultural studies, gender studies, information studies, law, media studies, medicine, and science and technology studies. This article focuses on insights drawn between critiques of femtech which trouble the ideologies, discourses, and practices that shape dominant understandings of 'fem' and 'tech'. In thinking through and with the conceptual boundaries of femtech, this review underscores the ongoing need to examine femtech's role in shaping global dynamics of reproductive, labor, and environmental justice, in addition to neoliberal approaches to healthcare more broadly.</p>","PeriodicalId":12944,"journal":{"name":"Health","volume":" ","pages":"13634593251371327"},"PeriodicalIF":2.3,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A bad migrant: An autoethnographic case study of racism in Australian HIV care.","authors":"Satrio Nindyo Istiko","doi":"10.1177/13634593241306578","DOIUrl":"10.1177/13634593241306578","url":null,"abstract":"<p><p>Australia is world renowned when it comes to its successful response to HIV prevention, but their HIV epidemiological trend has shifted towards the increase of new HIV diagnoses among migrants. This paper reveals a neglected determinant of migrants' health within Australian HIV care, and that is: racism. To provoke a debate on the saliency of racism, I used autoethnographic case study to analyse my encounter with racism in Australian HIV care. I argue migrants who live with HIV can be racially classified by health care professionals into 'good' or 'bad migrants' based on biomedical measures, neoliberal values and dehumanising health care provision. A migrant patient becomes a bad migrant if the person is perceived to be incapable of taking personal responsibility over their treatment, is a burden to the health system and deserving of poor HIV care. Decolonising HIV care is a necessity to stop the subtle yet insidious social reproduction of racism.</p>","PeriodicalId":12944,"journal":{"name":"Health","volume":" ","pages":"676-692"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Narrative and obesity: Managing weight stigma associated with bariatric surgery.","authors":"Álvaro Sicilia, María-Luisa Socías-Serrano, Mark D Griffiths, Elena Martínez-Rosales, Enrique G Artero","doi":"10.1177/13634593241310129","DOIUrl":"10.1177/13634593241310129","url":null,"abstract":"<p><p>The present study examined how individuals who have been clinically diagnosed as obese explain their decision to undergo bariatric surgery and how they deal with the stigmatization that such a decision may entail. A total of 23 participants (15 women and 8 men) who were awaiting bariatric surgery within the Spanish healthcare system, were interviewed about their weight trajectory and their decision to undergo this surgery. In order to examine the participants' stories, a narrative analysis of the interviews was conducted, with attention to both content (<i>what</i> they told) and structure (<i>how</i> they told) and examining the stories in line with the socially and culturally available narratives that they had access to, and the context in which the stories were produced. The participants explained their weight trajectory through the origin of their weight, the failure to control it, and their decision to have surgery to solve the weight problem. The narrative of a sick body that needs to be restored appeared to function as a schema or script through which participants attempted to defend themselves from anti-fat narratives that assume personal failure while at the same time presenting themselves as deserving to be operated on. Through their narratives, they positioned themselves as undeserving of stigma but did not challenge the stigma itself.</p>","PeriodicalId":12944,"journal":{"name":"Health","volume":" ","pages":"633-651"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Legitimacy and professional boundaries: An institutional analysis of Chinese Medicine in Mainland China and Hong Kong.","authors":"Xiaoli Tian, Sai Zhang","doi":"10.1177/13634593241303612","DOIUrl":"10.1177/13634593241303612","url":null,"abstract":"<p><p>The legitimacy of complementary and alternative medicines (CAMs) and their integration into mainstream healthcare have long been a topic in sociological discussions. This study examines the institutional influences on Chinese medicine (CM), an important CAM in mainland China and Hong Kong. In-depth interviews with practitioners and observations in public hospitals facilitate a comparison of the professional boundaries, statuses, and jurisdictions of CM in the two regions. In mainland China, CM has a high degree of state-granted legitimacy with blurred professional boundaries between CM and Western medicine (WM) in a highly integrated healthcare system. However, these blurred boundaries have had the following unintended consequences: (i) devaluation of traditional knowledge in CM education and practices, (ii) biomedicalisation of CM practices wherein a substantial reliance on WM has decreased the utilisation of healing principles in CM and (iii) ambiguity in the efficacy of CM due to the co-use of CM and WM. In contrast, the demarcated professional boundaries in Hong Kong have allowed CM to maintain its knowledge base, even though CM is practised within strict parameters. This study reveals that institutional requirements (on efficiency, accountability and profitability) prioritise the biomedical model and drive the biomedicalisation of CM. Therefore, the lack of clear professional boundaries in the current integrative medical system in mainland China have eroded the knowledge base of CM and undermined the efficacy-based legitimacy of CM.</p>","PeriodicalId":12944,"journal":{"name":"Health","volume":" ","pages":"743-762"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating uncertainty in low back pain care through an ethic of openness: Learnings from a post-critical analysis.","authors":"Nathalia Costa, Rebcca Olson, Miriam Dillon, Karime Mescouto, Prudence Butler, Roma Forbes, Jenny Setchell","doi":"10.1177/13634593241310383","DOIUrl":"10.1177/13634593241310383","url":null,"abstract":"<p><p>Theoretical and practical guidance on how to navigate uncertainties in healthcare are scarce. Here, we draw from Gibson's ethic of openness to explore clinicians' experiences navigating uncertainty with individuals who experience low back pain (LBP) and provide guidance on avenues for navigating uncertainty in LBP and healthcare more broadly. Our analysis suggests that clinicians practice within different philosophical commitments when providing care for individuals with LBP, with some of them aligning with a (post)positivist approach with pre-determined endpoints and others an ethic of openness, with no fixed endpoints and consideration of multiple options and perspectives. Based on our analysis, an ethic of openness may help to surface these philosophical commitments, creating space for possibilities other than denying uncertainty and oversimplifying (evidence-based) practice. We argue that an ethic of openness may assist clinicians to navigate uncertainty in fruitful ways - embracing uncertainty, engaging in reflexivity and creativity, moving clinicians to directions that are likely to best meet the needs of patients.</p>","PeriodicalId":12944,"journal":{"name":"Health","volume":" ","pages":"609-632"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12357978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inegalitarian effects on access to vaccines of delegating Covid-19 vaccination to a private online appointment platform: The French case.","authors":"Selma Ghomari, Charlotte Serrano, Amélie Beaugrand, Maud Gelly","doi":"10.1177/13634593241306574","DOIUrl":"10.1177/13634593241306574","url":null,"abstract":"<p><p>A great deal of research has shown that health inequalities are the product of socially unequal wear and tear of bodies, socially differentiated use of the healthcare system and unequal access to care, as well as healthcare professionals' differentiating practices. However, public policies are rarely the focus of recent investigations on the production of health inequalities. How can public policies produce or even amplify health inequalities, but also reduce them, or fail to do so? This study aims to investigate the impact of online appointment booking on effective access to Covid-19 vaccination. Through a quantitative survey of the first weeks of vaccination against Covid-19 in 2021 in an undeserved French suburb called Seine-Saint-Denis, this paper shows how the vaccination policy has contributed to reproducing and amplifying inequalities towards Covid-19: middle and upper classes are significantly more represented among people vaccinated (67%) than in the population of Seine-SaintDenis (41%), and working classes are significantly less represented (33%) than in Seine-Saint-Denis (59%). The people vaccinated are more highly educated and more often French than the population of SeineSaint-Denis. Online appointment favoured more educated people.</p>","PeriodicalId":12944,"journal":{"name":"Health","volume":" ","pages":"712-724"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}