IF 1.9 4区医学

Health Pub Date : 2025-04-30 DOI: 10.1177/13634593251336175

Tracy Morison, Catriona Ida Macleod, Yanela Ndabula

{"title":"The unravelling of person-centred care: The value and necessity of analysing power relations in contraceptive services.","authors":"Tracy Morison, Catriona Ida Macleod, Yanela Ndabula","doi":"10.1177/13634593251336175","DOIUrl":"https://doi.org/10.1177/13634593251336175","url":null,"abstract":"Global research indicates ongoing challenges in delivering person-centred contraceptive care. Much of the contraceptive research investigates this issue using systems-focussed approaches to map institutional constraints (e.g. institutional or health system barriers to accessing contraception). The assumption underlying this research approach is that simply removing structural barriers can address issues and enhance contraceptive autonomy, but this is not the case. Our research shows how discursively constructed power relations undermine bodily integrity and contraceptive agency even as contraceptive providers endorse the principles of patient-centred care. Using a synthetic narrative/discourse approach to analyse provider interviews in South Africa and New Zealand, we draw on Foucauldian analytics of biopower to show how an idealised person-centred care narrative collapses under the weight of discourses of medicalised risk, protectionism, and biomedical expertise, signalling practices of power through confession, responsibilisation and surveillance. Our findings highlight an essential perspective frequently missing in systems-focussed research on contraceptive care: the crucial dimension of power and reproductive politics. Thus, we argue for the necessity of investigating this dimension, in addition to systemic challenges. Our work demonstrates the value of frameworks that illuminate power dynamics, such as the Foucauldian analytics of biopower we undertook. Expanding the range of research perspectives in contraceptive research can deepen understandings of how systems constraints and power relations together undermine relational person-centred contraceptive care.","PeriodicalId":12944,"journal":{"name":"Health","volume":" ","pages":"13634593251336175"},"PeriodicalIF":1.9,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007941","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}

引用次数: 0

Oncogene-driven advocacy: Collective expertise and therapeutic actionability. 癌基因驱动倡导：集体专业知识和治疗可操作性。

IF 1.9 4区医学

Health Pub Date : 2025-04-28 DOI: 10.1177/13634593251336521

Pascale Bourret, Madeleine Akrich, Florence Paterson, Alberto Cambrosio

{"title":"Oncogene-driven advocacy: Collective expertise and therapeutic actionability.","authors":"Pascale Bourret, Madeleine Akrich, Florence Paterson, Alberto Cambrosio","doi":"10.1177/13634593251336521","DOIUrl":"https://doi.org/10.1177/13634593251336521","url":null,"abstract":"This paper is intended as a contribution to the social science literature on Patient Advocacy Groups (PAGs). It examines the recent emergence and development of cancer patient organizations that self-define as \"oncogene-focused,\" that is, as centered on tumor-driving genetic mutations that offer novel therapeutic opportunities for tumors to be targeted by precision drugs. Drawing on qualitative methods including interviews with representatives of oncogene focused PAGs, analysis of the groups' publications (biomedical journals, eNewsletters), websites, and social media activity, the paper explores the characteristics of these PAGs' forms of activism. It shows that their common denominator is a focus on patient survival. This shared goal translates into a form of activism that centers on therapeutic actionability, that is, a set of initiatives aiming at the articulation of research, clinical trials, and care to improve the patients' quality of life and maximize survival thanks to awareness of and access to the latest therapies. Beyond individual differences between PAGs, we observe the increasingly seamless entanglement of their activities. Their mutually supportive interventions result in the establishment of an ecosystemic form of activism that also succeeds in mobilizing clinicians and researchers at the increasingly porous interface between research and care.","PeriodicalId":12944,"journal":{"name":"Health","volume":" ","pages":"13634593251336521"},"PeriodicalIF":1.9,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962134","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}

引用次数: 0

'I'm very open about it if people ask': Selective sharing, seeking community and careful censoring in women's epistemic practices surrounding childbirth experiences. “如果有人问我，我会非常开放”：有选择地分享，寻求社区，仔细审查女性在分娩经历方面的认知实践。

IF 1.9 4区医学

Health Pub Date : 2025-04-21 DOI: 10.1177/13634593251332891

Lea Høj Høstrup, Lea Cordes, Julie Grøn Corneliussen, Jeanette Ørskov Pedersen, Kia Cecilie Korsgaard Sørensen, Nicole Thualagant, Katja Schrøder, Astrid Janssens

{"title":"'I'm very open about it if people ask': Selective sharing, seeking community and careful censoring in women's epistemic practices surrounding childbirth experiences.","authors":"Lea Høj Høstrup, Lea Cordes, Julie Grøn Corneliussen, Jeanette Ørskov Pedersen, Kia Cecilie Korsgaard Sørensen, Nicole Thualagant, Katja Schrøder, Astrid Janssens","doi":"10.1177/13634593251332891","DOIUrl":"https://doi.org/10.1177/13634593251332891","url":null,"abstract":"This study sought to explore which possibilities for voicing childbirth experiences women who have given birth experience having, and what types of knowledge they share in different social contexts. With an interpretative phenomenological analysis, conducted in collaboration between academic researchers and The Birthing Experience Panel, the study explores nine Danish women's accounts of articulating and sharing experiential childbirth knowledge. The analysis presents two main themes and six subthemes: (1) Women differentiate practices of voicing of their childbirth experiences by dosing details: by relational proximity, by listener's insight, and by the expertise of health professionals and (2) Women maneuver sharing experiential knowledge, through seeking community, considering countering experiences and careful censoring, differentiated by the childbirth experiences held by the listener. We lean on concepts from feminist epistemology as we discuss how individual epistemic practices rely on cultural perceptions of the value of experiential childbirth knowledge. The detailed understanding of how experiential childbirth knowledge is shared and valued in women's daily lives can contribute to broader discussions on efforts to build collective knowledge resources and include experiential knowledge in the organization of reproductive health care.","PeriodicalId":12944,"journal":{"name":"Health","volume":" ","pages":"13634593251332891"},"PeriodicalIF":1.9,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143983379","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}

引用次数: 0

Navigating residual diagnostic categories: The lived experiences of women diagnosed with autism and ADHD in adulthood. 导航剩余诊断类别：成年后被诊断为自闭症和多动症的女性的生活经历。

IF 1.9 4区医学

Health Pub Date : 2025-04-21 DOI: 10.1177/13634593251336163

Emma Craddock

{"title":"Navigating residual diagnostic categories: The lived experiences of women diagnosed with autism and ADHD in adulthood.","authors":"Emma Craddock","doi":"10.1177/13634593251336163","DOIUrl":"https://doi.org/10.1177/13634593251336163","url":null,"abstract":"This article conceptualises a combined autism and ADHD (AuDHD) diagnosis as a residual category not formally represented in diagnostic systems, addressing a critical gap in neurodiversity research. Using Interpretative Phenomenological Analysis of email interviews with six women diagnosed in adulthood, it examines the ambivalence arising from inhabiting this liminal diagnostic space. Residuality generates conflicting feelings about autism, ADHD, and the self, resulting in fragmented identities shaped more by societal narratives than by interpersonal perceptions. Themes include the contradictions between autism and ADHD ('two separate parts of my brain'), their sometimes-complementary relationship ('two sides of the same coin'), and the tension between neurodiversity and medicalisation narratives ('autism is a part of me, ADHD is an add-on'). To resolve this ambivalence, participants sought an objective understanding of their conditions and distinguished between neurodivergent and neurotypical identities. Collectively, their narratives reveal a fluid and dynamic understanding of AuDHD. As the first study to explore the lived experiences of adults diagnosed with both autism and ADHD, it makes an original contribution by developing an AuDHD phenomenology and analytical framework. By amplifying the voices of women historically marginalised, the findings underscore the need for integrated diagnostic processes and tailored support to foster cohesive self-identity. This article contributes to neurodiversity literature, broadens understandings of categorical systems, and illuminates the complexities of navigating residual diagnostic spaces.","PeriodicalId":12944,"journal":{"name":"Health","volume":" ","pages":"13634593251336163"},"PeriodicalIF":1.9,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994178","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}

引用次数: 0

Producing non-communicable diseases(NCD's) as health 'problems' in Botswana: A critical analysis of the NCD strategy (2018-2023). 将非传染性疾病作为博茨瓦纳的健康“问题”：对非传染性疾病战略的批判性分析（2018-2023年）。

IF 1.9 4区医学

Health Pub Date : 2025-04-12 DOI: 10.1177/13634593251332879

Tebogo B Sebeelo

{"title":"Producing non-communicable diseases(NCD's) as health 'problems' in Botswana: A critical analysis of the NCD strategy (2018-2023).","authors":"Tebogo B Sebeelo","doi":"10.1177/13634593251332879","DOIUrl":"https://doi.org/10.1177/13634593251332879","url":null,"abstract":"Non-communicable diseases (NCD's) have recently become a focus of attention for policymakers in Botswana. In line with the global community, the country has been intentional about dealing with the challenges posed by NCD's and the potential threat it poses to the population. Although the concern with NCD's is legitimate, it is relatively unknown how NCD's have been constructed as policy 'problems' in Botswana. More importantly, the genealogy of NCD's and the politics of their emergence has largely been outside the scope of mainstream policymaking. This paper draws from Carol Bacchi's 'What's the Problem Represented to Be' (WPR), a poststructural analytic approach to examine how the Botswana Multi-Sectoral Strategy for Prevention and Control of Non-Communicable Diseases (2018-2023) represents the NCD 'problem' in Botswana. The paper argues that the NCD strategy in Botswana is framed from a neoliberal approach that place emphasis on individual responsibility and neglect larger social forces. Furthermore, the paper highlights that the use of international 'experts' and consultants bring along international tropes of evidence that might undermine local knowledge systems. The NCD strategy essentially neglects the socio-cultural factors that shape NCD risk in Botswana. The paper provides a critical analysis of how the construction of NCD 'problems' might undermine the everyday experiences of the people of Botswana. Alternative conceptualisations of the NCD 'problem' identified by the WPR analysis is outlined in the conclusion of the paper.","PeriodicalId":12944,"journal":{"name":"Health","volume":" ","pages":"13634593251332879"},"PeriodicalIF":1.9,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144003154","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}

引用次数: 0

Differences as potentials: A posthuman re-envisioning of disability and mobility. 作为潜力的差异：后人类对残疾和行动能力的重新设想。

IF 1.9 4区医学

Health Pub Date : 2025-03-25 DOI: 10.1177/13634593251329489

Barbara E Gibson, Carla Rice, Brenda M Gladstone, Julia Gray, Evadne Kelly, Donya Mosleh, Bhavnita Mistry

{"title":"Differences as potentials: A posthuman re-envisioning of disability and mobility.","authors":"Barbara E Gibson, Carla Rice, Brenda M Gladstone, Julia Gray, Evadne Kelly, Donya Mosleh, Bhavnita Mistry","doi":"10.1177/13634593251329489","DOIUrl":"https://doi.org/10.1177/13634593251329489","url":null,"abstract":"Drawing on a posthuman onto-epistemology, this paper explores movements of bodies labelled-as-disabled as creative 'choreographies' that are coproduced through the coming together of multiple material, social, discursive and affective forces across time-spaces. The purpose is to challenge thinking as usual towards re-envisioning differences as potentials rather than deficits. To do so, we consider how disability can move deficit-thinking and how mobility can be put to work to rethink disability. Movement and mobility in relation to disability are frequently discussed in terms of bodily deficits and/or disabling access barriers. Deficit-thinking separates people into categories of disabled or so-called 'abled' wherein reforms are oriented to erasure of differences through providing disabled people with access to a normal/ized life. In this posthuman analysis we advance an affirmative way of thinking about differences by recursively retheorizing disability through movement and retheorizing movement through disability. To do so we present three 'mobility experiments' generated from a recent study conducted with five youth partners who identified as disabled. Within the experiments, we position creative mobilities as micro-activist becomings that suggest avenues for celebrating differences towards instigating radical change. We conclude with a discussion of posthuman disability ethics and the implications of our analysis for thinking and doing differently in healthcare and beyond.","PeriodicalId":12944,"journal":{"name":"Health","volume":" ","pages":"13634593251329489"},"PeriodicalIF":1.9,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709711","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}

引用次数: 0

Navigating uncertainty in low back pain care through an ethic of openness: Learnings from a post-critical analysis. 通过开放伦理引导腰痛护理中的不确定性：从后批判分析中学习。

IF 1.9 4区医学

Health Pub Date : 2025-03-13 DOI: 10.1177/13634593241310383

Nathalia Costa, Rebcca Olson, Miriam Dillon, Karime Mescouto, Prudence Butler, Roma Forbes, Jenny Setchell

{"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":"https://doi.org/10.1177/13634593241310383","url":null,"abstract":"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.","PeriodicalId":12944,"journal":{"name":"Health","volume":" ","pages":"13634593241310383"},"PeriodicalIF":1.9,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Agency, sex and drug education: Examining the response-ability of education responses to consumption, sex and harm. 机构，性和毒品教育：检查教育对消费，性和伤害的反应能力。

IF 1.9 4区医学

Health Pub Date : 2025-03-12 DOI: 10.1177/13634593251326285

Adrian Farrugia

{"title":"Agency, sex and drug education: Examining the response-ability of education responses to consumption, sex and harm.","authors":"Adrian Farrugia","doi":"10.1177/13634593251326285","DOIUrl":"https://doi.org/10.1177/13634593251326285","url":null,"abstract":"This article examines how drug education professionals understand and respond to the relationship between alcohol and other drug consumption, sex and harm. While recent research examines how these issues are addressed in drug education curriculum, little is known about the perspectives of professionals involved in education design and delivery. Research suggests that agency is centrally important for understanding experiences of harmful, pleasurable or ambiguous sexual encounters in consumption settings. I analyse understandings of the relationship between agency, drug consumption, sex and harm generated during in-depth interviews with drug education professionals. Informed by Karen Barad's relational concepts of agency and response-ability, I examine the agencies that these professionals constitute as the locus of harms related to consumption and sex. Some focus on individual human agency, while others position alcohol and drugs as the primary agents of harm. Throughout the analysis I argue that both approaches offer an impoverished account of drug consumption and sex and inform education approaches that struggle to respond to other significant agencies such as gender. I also examine accounts that grapple with agencies beyond people and drugs. Overall, I argue for drug education approaches that are more response-able to the multiple agencies that together constitute experiences of drug consumption and sex.","PeriodicalId":12944,"journal":{"name":"Health","volume":" ","pages":"13634593251326285"},"PeriodicalIF":1.9,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143614693","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}

引用次数: 0

Clinical context and communication in shared decision-making about major surgery: Findings from a qualitative study with colorectal, orthopaedic and cardiac patients. 大手术共同决策中的临床环境与沟通：对结肠直肠癌、骨科和心脏病患者的定性研究结果。

IF 1.9 4区医学

Health Pub Date : 2025-03-01 Epub Date: 2024-03-21 DOI: 10.1177/13634593241238857

Gemma Hughes, Timothy J Stephens, Lucas M Seuren, Rupert M Pearse, Sara E Shaw

{"title":"Clinical context and communication in shared decision-making about major surgery: Findings from a qualitative study with colorectal, orthopaedic and cardiac patients.","authors":"Gemma Hughes, Timothy J Stephens, Lucas M Seuren, Rupert M Pearse, Sara E Shaw","doi":"10.1177/13634593241238857","DOIUrl":"10.1177/13634593241238857","url":null,"abstract":"Increasing numbers of older people undergo major surgery in the United Kingdom (UK), with many at high risk of complications due to age, co-morbidities or frailty. This article reports on a study of such patients and their clinicians engaged in shared decision-making. Shared decision-making is a collaborative approach that seeks to value and centre patients' preferences, potentially addressing asymmetries of knowledge and power between clinicians and patients by countering medical authority with greater patient empowerment. We studied shared decision-making practices in the context of major surgery by recruiting 16 patients contemplating either colorectal, cardiac or joint replacement surgery in the UK National Health Service (NHS). Over 18 months 2019-2020, we observed and video-recorded decision-making consultations, studied the organisational and clinical context for consultations, and interviewed patients and clinicians about their experiences of making decisions. Linguistic ethnography, the study of communication and interaction in context, guided us to analyse the interplay between interactions (during consultations between clinicians, patients and family members) and clinical and organisational features of the contexts for those interactions. We found that the framing of consultations as being about life-saving or life-enhancing procedures was important in producing three different genres of consultations focused variously on: resolving problems, deliberation of options and evaluation of benefits of surgery. We conclude that medical authority persists, but can be used to create more deliberative opportunities for decision-making through amending the context for consultations in addition to adopting appropriate communication practices during surgical consultations.","PeriodicalId":12944,"journal":{"name":"Health","volume":" ","pages":"200-219"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11894849/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140184261","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}

引用次数: 0

Vibrant Screens: Remote therapy and counselling through the lens of digital materiality. 充满活力的屏幕：通过数字物质的视角进行远程治疗和咨询。

IF 1.9 4区医学

Health Pub Date : 2025-03-01 Epub Date: 2024-02-26 DOI: 10.1177/13634593241234491

Marjo Kolehmainen

引用次数: 0

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