IF 2.1 4区医学

Health Pub 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":"https://doi.org/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":"13634593241238857"},"PeriodicalIF":2.1,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Bright-siding stigma: Older adults' experiences at a higher weight in Atlantic Canada. 亮边耻辱：加拿大大西洋地区老年人体重增加的经历。

IF 2.1 4区医学

Health Pub Date : 2024-03-19 DOI: 10.1177/13634593241238869

Andrea E Bombak, Norma Chinho, Lisa Thomson, Courtney Burk, Sumaiya Akhter, Kathleen O'Keefe, Lee Turner

{"title":"Bright-siding stigma: Older adults' experiences at a higher weight in Atlantic Canada.","authors":"Andrea E Bombak, Norma Chinho, Lisa Thomson, Courtney Burk, Sumaiya Akhter, Kathleen O'Keefe, Lee Turner","doi":"10.1177/13634593241238869","DOIUrl":"https://doi.org/10.1177/13634593241238869","url":null,"abstract":"The lived experiences of higher-weight people vary; homogenous samples may fail to capture this diversity. This study develops an in-depth understanding of the lived experiences of higher-weight (Body Mass Index ⩾ 30) older adults (⩾60 years of age) in a Canadian Atlantic province. Participants (n = 11) were interviewed face-to-face using a semi-structured interview guide twice at 2-to-3-month intervals regarding their perceived treatment in social and health situations; how positive and negative healthcare experiences affected their health, lifestyles and healthcare seeking-behaviour; and recommendations in terms of patient experiences, access and inclusion. Participants infrequently reported negative experiences; however, participants' experiences were informed by uptake of moralistic, neoliberal discourses. Thematic content analysis identified two major themes: active citizenship (participants demonstrated internalisation of the imperative for weight loss, healthy lifestyles and active ageing) and bright-siding (participants expressed that a positive attitude could prevent/help cope with stigma). Results suggest that individualistic, rather than collective, political solutions to health and stigma have been taken up by higher-weight older adults in a Canadian Atlantic province, which may hinder attempts at structural reforms addressing stigma.","PeriodicalId":12944,"journal":{"name":"Health","volume":" ","pages":"13634593241238869"},"PeriodicalIF":2.1,"publicationDate":"2024-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140158019","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

Beyond the neoliberal label: A historical perspective on sexual actors and responsibility in HIV prevention in England (1986-2023). 超越新自由主义标签：从历史角度看英格兰预防艾滋病的性行动者和责任（1986-2023 年）。

IF 2.1 4区医学

Health Pub Date : 2024-03-18 DOI: 10.1177/13634593241238862

Alvaro Martinez-Lacabe

{"title":"Beyond the neoliberal label: A historical perspective on sexual actors and responsibility in HIV prevention in England (1986-2023).","authors":"Alvaro Martinez-Lacabe","doi":"10.1177/13634593241238862","DOIUrl":"https://doi.org/10.1177/13634593241238862","url":null,"abstract":"Framed across three distinct periods of the history of neoliberalism and the HIV epidemic in England, this article conducts a detailed examination of the concept of personal responsibility and its contested uses within HIV prevention. The article questions the theoretical potential of neoliberal subjectivities to comprehend behaviours related to the pharmaceuticalised governance (or lack thereof) of gay men's sexual health, exploring the gap between theories emphasising individual responsibility and the practical experiences of gay men. The analysis draws on testimonials from gay men in oral history interviews and archival sources. The article illustrates how the pervasive notion of personal responsibility in England has been co-opted by neoliberal ideologies, leading to the stigmatisation of gay men whose sexual behaviours diverge from public health mandates. The widespread stigmatisation resulting from this ideology underscores a significant limitation in the theoretical framework of neoliberal subjectivities. This constraint extends beyond merely failing to grasp the complexity of sexual behaviours; it also reflects a lack of understanding of any other behaviour related to public health. Therefore, the article concludes by advocating the necessity of employing and constructing alternative theoretical frameworks to comprehend the pharmaceutical governance or lack thereof of gay men's sexual health. Through a concise autoethnography of the authors' pharmaceutical sexual health governance, the article introduces the concept of biocommesuration as an illustrative analysis that transcends the limitations of neoliberal subjectivities.","PeriodicalId":12944,"journal":{"name":"Health","volume":" ","pages":"13634593241238862"},"PeriodicalIF":2.1,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140143264","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

How the context of reception affects the meaning of RCT evidence. 接受环境如何影响 RCT 证据的意义。

IF 1.9 4区医学

Health Pub Date : 2024-03-01 Epub Date: 2022-11-05 DOI: 10.1177/13634593221134011

Simon Carmel

{"title":"How the context of reception affects the meaning of RCT evidence.","authors":"Simon Carmel","doi":"10.1177/13634593221134011","DOIUrl":"10.1177/13634593221134011","url":null,"abstract":"This article takes as a case study a set of disagreements in the early 2000s about randomised controlled trial (RCT) evidence for a newly developed drug in the field of intensive care medicine. The interpretation of RCT findings - and in particular, the application of these findings to clinical practice - were contested among research-active intensive care doctors, despite their shared professional and epistemic values. I examine the arguments about scientific interpretation and application to clinical practice advanced by two readily identifiable groups. The analysis documents how four particular aspects of scientific knowledge were perceived and portrayed differently by the two groups, and notes how each group was associated with different kinds of routine work practices and external networks. My argument is that these differences give rise to distinctive hermeneutic frames and orientations towards the scientific results and disparities in their consequential judgements regarding the legitimate use of the newly developed drug, and I extend Stones and Turner's concept situationally specific habitus to make the link between context and hermeneutic frames and orientations. The analysis has implications for furthering our understanding of how the clinical meaning attributed to scientific evidence is affected by the context of reception of results, even where epistemic and professional values are shared.","PeriodicalId":12944,"journal":{"name":"Health","volume":" ","pages":"253-271"},"PeriodicalIF":1.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10900864/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10837493","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

Epistemic racism in the health professions: A qualitative study with Black women in Canada. 卫生专业中的认识论种族主义：对加拿大黑人妇女的定性研究。

IF 1.9 4区医学

Health Pub Date : 2024-03-01 Epub Date: 2022-12-07 DOI: 10.1177/13634593221141605

Brenda L Beagan, Stephanie R Bizzeth, Kaitlin R Sibbald, Josephine B Etowa

{"title":"Epistemic racism in the health professions: A qualitative study with Black women in Canada.","authors":"Brenda L Beagan, Stephanie R Bizzeth, Kaitlin R Sibbald, Josephine B Etowa","doi":"10.1177/13634593221141605","DOIUrl":"10.1177/13634593221141605","url":null,"abstract":"Systemic racism within health care is increasingly garnering critical attention, but to date attention to the racism experienced by health professionals themselves has been scant. In Canada, anti-Black racism may be embodied in structures, policies, institutional practices and interpersonal interactions. Epistemic racism is an aspect of systemic racism wherein the knowledge claims, ways of knowing and 'knowers' themselves are constructed as invalid, or less credible. This critical interpretive qualitative study examined the experiences of epistemic racism among 13 healthcare professionals across Canada who self-identified as Black women. It explores the ways knowledge claims and expert authority are discredited and undermined, despite the attainment of professional credentials. Three themes were identified: 1. Not being perceived or portrayed as credible health professionals; 2. Requiring invisible labour to counter professional credibility 'deficit'; and 3. Devaluing knowledge while imposing stereotypes. The Black women in our study faced routine epistemic racism. They were not afforded the position of legitimate knower, expert, authority, despite their professional credentials as physicians, nurses and occupational therapists. Their embodied cultural and community knowledges were disregarded in favour of stereotyped assumptions. Adopting the professional comportment of 'Whiteness' was one way these health care providers strived to be perceived as credible professionals. Their experiences are characteristic of 'misogynoir', a particular form of racism directed at Black women. Anti-Black epistemic racism constitutes one way Whiteness is perpetuated in health professions institutions.","PeriodicalId":12944,"journal":{"name":"Health","volume":" ","pages":"203-215"},"PeriodicalIF":1.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10900862/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10361244","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

'Madness' after the war in Bosnia and Herzegovina - challenging dominant understandings of distress. 波斯尼亚和黑塞哥维那战后的 "疯狂"--挑战对痛苦的主流理解。

IF 1.9 4区医学

Health Pub Date : 2024-03-01 Epub Date: 2022-12-07 DOI: 10.1177/13634593221139717

Reima Ana Maglajlic, Halida Vejzagić, Jasmin Palata, China Mills

{"title":"'Madness' after the war in Bosnia and Herzegovina - challenging dominant understandings of distress.","authors":"Reima Ana Maglajlic, Halida Vejzagić, Jasmin Palata, China Mills","doi":"10.1177/13634593221139717","DOIUrl":"10.1177/13634593221139717","url":null,"abstract":"This article reports on the findings from a small-scale co-produced qualitative study on experiences of distress caused by the war in Bosnia and Herzegovina (BiH). Inspired by the emerging interdisciplinary field of Mad Studies, the study is novel and unique in two ways. First, it prioritises social understanding and interpretation of madness and distress. Second, an emphasis is placed on experiential knowledge. Beyond interviews with 20 people who experienced distress due to political conflict, this included contextualisation of the study in the knowledge generated through survivor research and within the field of Mad Studies. Study findings highlight the social causes and consequences of distress caused by conflict, such as war-related violence, gender-based violence, experiences of poverty and corruption. Participants stressed the importance of safety and support within their own home, mutual and supportive relationships with their families, friends, other people who experienced distress, the broader community and opportunities to do everyday activities they enjoy. In terms of professional support, the findings suggest that poverty alleviation and protection of people's right to self-determination through access to human rights advocacy and representation may be as relevant as non-coercive community-based services. This indicates that support for distress caused by political conflict need not be different from any other support for people who experience distress. Emphasis should be placed on survivor-run initiatives and non-coercive, community-based support which addresses social causes of distress and enables people to exercise self-determination.","PeriodicalId":12944,"journal":{"name":"Health","volume":" ","pages":"216-234"},"PeriodicalIF":1.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10900853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10370498","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

Constructing therapeutic support and negotiating competing agendas: A discourse analysis of vocational advice provided to individuals who are absent from work due to ill-health. 构建治疗支持和协商相互竞争的议程：对向因健康状况不佳而缺勤的个人提供的职业建议进行话语分析。

IF 1.9 4区医学

Health Pub Date : 2024-03-01 Epub Date: 2023-04-24 DOI: 10.1177/13634593221148446

Benjamin Saunders, Carolyn Chew-Graham, Gail Sowden, Kendra Cooke, Karen Walker-Bone, Ira Madan, Vaughan Parsons, Cathy H Linaker, Gwenllian Wynne-Jones

{"title":"Constructing therapeutic support and negotiating competing agendas: A discourse analysis of vocational advice provided to individuals who are absent from work due to ill-health.","authors":"Benjamin Saunders, Carolyn Chew-Graham, Gail Sowden, Kendra Cooke, Karen Walker-Bone, Ira Madan, Vaughan Parsons, Cathy H Linaker, Gwenllian Wynne-Jones","doi":"10.1177/13634593221148446","DOIUrl":"10.1177/13634593221148446","url":null,"abstract":"Work participation is known to benefit people's overall health and wellbeing, but accessing vocational support during periods of sickness absence to facilitate return-to-work can be challenging for many people. In this study, we explored how vocational advice was delivered by trained vocational support workers (VSWs) to people who had been signed-off from work by their General Practitioner (GP), as part of a feasibility study testing a vocational advice intervention. We investigated the discursive and interactional strategies employed by VSWs and people absent from work, to pursue their joint and respective goals. Theme-oriented discourse analysis was carried out on eight VSW consultations. These consultations were shown to be complex interactions, during which VSWs utilised a range of strategies to provide therapeutic support in discussions about work. These included; signalling empathy with the person's perspective; positively evaluating their personal qualities and prior actions; reflecting individuals' views back to them to show they had been heard and understood; fostering a collaborative approach to action-planning; and attempting to reassure individuals about their return-to-work concerns. Some individuals were reluctant to engage in return-to-work planning, resulting in back-and-forth interactional negotiations between theirs and the VSW's individual goals and agendas. This led to VSWs putting in considerable interactional 'work' to subtly shift the discussion towards return-to-work planning. The discursive strategies we have identified have implications for training health professionals to facilitate work-orientated conversations with their patients, and will also inform training provided to VSWs ahead of a randomised controlled trial.","PeriodicalId":12944,"journal":{"name":"Health","volume":" ","pages":"185-202"},"PeriodicalIF":1.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10900846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9743168","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

"Too soft for real psychiatry"? Gendered boundary-making between coercion and dialog in Italian wards. "对真正的精神病学来说太软弱"？意大利病房中强制与对话之间的性别边界划分。

IF 2.1 4区医学

Health Pub Date : 2024-02-26 DOI: 10.1177/13634593241234479

Eleonora Rossero, Raffaella Ferrero Camoletto

{"title":"\"Too soft for real psychiatry\"? Gendered boundary-making between coercion and dialog in Italian wards.","authors":"Eleonora Rossero, Raffaella Ferrero Camoletto","doi":"10.1177/13634593241234479","DOIUrl":"https://doi.org/10.1177/13634593241234479","url":null,"abstract":"Psychiatric practice has always entailed a coercive dimension, visible not only in its formal expressions (e.g. compulsory treatment) but in many informal and implicit forms. In fact, contemporary psychiatric practices are characterized by an interplay of coercion and dialog to be interpreted not as binary categories but as extremes of a spectrum. Within this perspective, it becomes crucial to draw boundaries attributing meaning to professional identities and practices in psychiatric work. This is particularly relevant in acute wards: to explore this issue, we selected two cases according to a most-different-cases design, one ward with a mechanical-restraint approach compared to one with no-mechanical-restraint. We argue that gender, mobilized to performatively draw distinctions and hierarchies in order to define and justify different approaches to psychiatric crises along the continuum between coercion and dialog, is a key dimension in the boundary-making process. The analysis identifies two main dimensions of drawing gendered boundaries: inter-gender boundaries (overlapping the binary distinction between masculinity and femininity with a more coercive or relational-dialogic approach to crisis) and intra-gender boundaries (distinguishing and ranking of different masculinities and femininities), associating a less coercive orientation with a devirilized masculinity.","PeriodicalId":12944,"journal":{"name":"Health","volume":" ","pages":"13634593241234479"},"PeriodicalIF":2.1,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139971660","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

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 2.1 4区医学

Health Pub Date : 2024-02-26 DOI: 10.1177/13634593241234491

Marjo Kolehmainen

引用次数: 0

Involuntary psychiatric treatment and the erosion of consent: A critical discourse analysis of mental health legislation in British Columbia, Canada. 非自愿精神病治疗与同意的侵蚀：加拿大不列颠哥伦比亚省精神卫生立法的批判性话语分析。

IF 1.9 4区医学

Health Pub Date : 2023-11-01 Epub Date: 2022-05-09 DOI: 10.1177/13634593221096241

Maja Kolar, Colleen Varcoe, Helen Brown, Rochelle Einboden

{"title":"Involuntary psychiatric treatment and the erosion of consent: A critical discourse analysis of mental health legislation in British Columbia, Canada.","authors":"Maja Kolar, Colleen Varcoe, Helen Brown, Rochelle Einboden","doi":"10.1177/13634593221096241","DOIUrl":"10.1177/13634593221096241","url":null,"abstract":"The Mental Health Act (1996) is legislation that directs voluntary and involuntary psychiatric treatment for people experiencing mental health issues in British Columbia (BC), Canada. This critical discursive analysis explores how BC's Mental Health Act (1996) and the Guide to the Mental Health Act (2005) structure involuntary psychiatric treatment and illustrates how the discourses within these texts constitute people experiencing mental health issues as passive recipients of care. Understandings of people experiencing mental health issues as pathological, incapable, vulnerable and dangerous justify their need for protection and the protection of others. Protection is identified as a central legitimising discourse in the use of involuntary psychiatric treatment. Further, these texts define the roles and responsibilities of police, physicians and nurses in authorising and implementing involuntary psychiatric treatment. This analysis describes how this legislation erodes consent and entrenches social marginalisation. Alternatively, discourses of equity have potential to transform health care practices and structures that reproduce discourses of deficit, vulnerability and dangerousness, shifting towards promotion of the rights and safety of people experiencing mental health issues and crises.","PeriodicalId":12944,"journal":{"name":"Health","volume":"27 6","pages":"1076-1095"},"PeriodicalIF":1.9,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10588262/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49676912","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

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