HealthPub Date : 2024-05-01Epub Date: 2023-02-27DOI: 10.1177/13634593231156822
Elina Weiste, Melisa Stevanovic, Lise-Lotte Uusitalo, Hanna Toiviainen
{"title":"Peer support for accepting distressing reality: Expertise and experience-sharing in psychiatric peer-to-peer group discussions.","authors":"Elina Weiste, Melisa Stevanovic, Lise-Lotte Uusitalo, Hanna Toiviainen","doi":"10.1177/13634593231156822","DOIUrl":"10.1177/13634593231156822","url":null,"abstract":"<p><p>Peer-based interventions are increasingly used for delivering mental health services to help people with an illness re-examine their situation and accept their illness as part of their life story. The role of the peer supporter in these interventions, known as experts-by-experience (EbE), is situated between mutual peer support and semi-professional service delivery, and they face the challenge of balancing an asymmetric, professional relationship with a reciprocal, mutuality-based, equal relationship. This article investigates how EbEs tackle this challenge when responding to clients' stories about their personal, distressing experiences in peer-based groups in psychiatric services. The results show how the EbEs responded to their clients' experience-sharing with two types of turns of talk. In the first response type, the EbEs highlighted reciprocal experience-sharing, nudging the clients toward accepting their illness. This invoked mutual affiliation and more problem-talk from the clients. In the second response type, the EbEs compromised reciprocal experience-sharing and advised clients on how to accept their illness in their everyday lives. This was considered less affiliative in relation to the client's problem description, and the sequence was brought to a close. Both response types involved epistemic asymmetries that needed to be managed in the interaction. Based on our analysis, semi-professional, experience-based expertise involves constant epistemic tensions, as the participants struggle to retain the mutual orientation toward peer-based experience-sharing and affiliation.</p>","PeriodicalId":12944,"journal":{"name":"Health","volume":" ","pages":"450-469"},"PeriodicalIF":1.9,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11041083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9358562","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}
HealthPub Date : 2024-05-01Epub Date: 2023-03-13DOI: 10.1177/13634593231156811
Ariela Popper-Giveon, Yael Keshet
{"title":"Layers of senses: Experiencing intercorporeality in teletherapy.","authors":"Ariela Popper-Giveon, Yael Keshet","doi":"10.1177/13634593231156811","DOIUrl":"10.1177/13634593231156811","url":null,"abstract":"<p><p>Teletherapy, namely, therapy that uses technology for communication between patients and therapists, is challenged by the impersonal nature of remote and digital communication. Using Merleau-Ponty's theoretical concept of intercorporeality, which refers to the perceived reciprocity between two people's bodies during communication, this article aims to elaborate on spiritual caregivers' experience of interacting with patients during teletherapy. Semi-structured in-depth interviews were conducted with 15 Israeli spiritual caregivers who use various forms of teletherapy (Zoom, FaceTime, phone calls, WhatsApp messages, etc.). Interviewees emphasized their physical presence with the patient as a main principle in spiritual care. They indicated the involvement of nearly all senses in physical presence therapy, which allows for joint attention and compassionate presence. When making use of various communication technologies in teletherapy, they reported the involvement of fewer senses. The more senses involved in the session and the clearer it is that space and time are shared by both caregiver and patient, the stronger the caregiver's presence with the patient. Interviewees experienced teletherapy as eroding the multisensory joint attention and intercorporeality and, hence, the quality of care. This article points at the advantages of teletherapy for therapists in general and spiritual caregivers in particular but claims, nonetheless, that it challenges the main principles of therapy. Joint attention in therapy is, fundamentally, a multisensory phenomenon that may be understood as intercorporeality. Our use of the notion of intercorporeality sheds light on the reduction of the senses involved in remote interpersonal communication and its impact on care and, more generally, the interpersonal communication experienced during telemedicine. This article's findings may also contribute to the field of cyberpsychology and to therapists engaged in telepsychology.</p>","PeriodicalId":12944,"journal":{"name":"Health","volume":" ","pages":"470-486"},"PeriodicalIF":1.9,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9099605","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}
HealthPub Date : 2024-03-01Epub Date: 2022-11-05DOI: 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":"<p><p>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 <i>situationally specific habitus</i> 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.</p>","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}
HealthPub Date : 2024-03-01Epub Date: 2022-12-07DOI: 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":"<p><p>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.</p>","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}
HealthPub Date : 2024-03-01Epub Date: 2022-12-07DOI: 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":"<p><p>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.</p>","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}
HealthPub Date : 2024-03-01Epub Date: 2023-04-24DOI: 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":"<p><p>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.</p>","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}
HealthPub Date : 2023-11-01Epub Date: 2022-05-09DOI: 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":"<p><p>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.</p>","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}
HealthPub Date : 2023-11-01Epub Date: 2022-05-24DOI: 10.1177/13634593221094701
Maarit Lehtinen, Liisa Voutilainen, Anssi Peräkylä
{"title":"'Is it in your basic personality?' Negotiations about traits and context in diagnostic interviews for personality disorders.","authors":"Maarit Lehtinen, Liisa Voutilainen, Anssi Peräkylä","doi":"10.1177/13634593221094701","DOIUrl":"10.1177/13634593221094701","url":null,"abstract":"<p><p>What does it mean to claim that somebody's personality is disordered? The aim in this paper is to examine how the process of diagnosing personality disorders (PD) unfolds on a practical level. We take an in-depth look at PD interviews, paying close attention to the occasional discrepancies in the clinicians' and the patients' approaches to generalising the behaviour of patients to describe their personality. Clinicians are guided by the medical model and structured interviews in their approach. We regard the interview situation as interplay between the institution, the clinician and the patient - and the final diagnosis as an interactional construction between them. Our data consists of video-recorded interviews in Finland with 10 adult patients and three psychiatric nurses. The collection was compiled from 22 excerpts in which the participants orient differently to the generalisability of personality traits. Our observations show that, in these interviews, patients frequently make sense of their behaviour differently from what is expected - not as a reflection of their personality traits, but as an outcome of many situational factors. Our understanding leads us to emphasise the importance of making visible the practices that shape the diagnostic process in psychiatry.</p>","PeriodicalId":12944,"journal":{"name":"Health","volume":"27 6","pages":"1033-1058"},"PeriodicalIF":2.1,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10588267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49676913","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}
HealthPub Date : 2023-11-01Epub Date: 2022-05-18DOI: 10.1177/13634593221093503
Francesco Miele
{"title":"On care infrastructures and health practices: How people in health promotion programmes try to change their everyday life.","authors":"Francesco Miele","doi":"10.1177/13634593221093503","DOIUrl":"10.1177/13634593221093503","url":null,"abstract":"<p><p>This paper contributes to challenging common behavioural or cognitive explanations for health and wellbeing outcomes, focussing on social practices through which people, with the help of other subjects, try to improve their health conditions. To renew the debate about health promotion, my work is placed at the intersection between the sociology of health and illness and science and technology studies, adopting the concepts of care infrastructures and health practices that are introduced in the next section. With this goal, my paper draws on a qualitative study concerning a Workplace Health Promotion programme aimed at reducing the risks of Type-2 diabetes and cardiovascular diseases among sedentary workers. The findings illustrate how a care infrastructure in the field of health promotion is designed, put to work, repaired and 'put aside' in relation to two health practices ('doing physical activity' and 'following the Mediterranean diet'). Drawing on the presented case, I show how the change in daily habits in the fields of nutrition and physical activity is a collective effort involving different spheres of life, connecting human and non-human elements and bringing out affective intensities among them.</p>","PeriodicalId":12944,"journal":{"name":"Health","volume":"27 6","pages":"980-997"},"PeriodicalIF":2.1,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49676915","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}
HealthPub Date : 2023-11-01Epub Date: 2022-06-08DOI: 10.1177/13634593221099103
Timothy Moore, Laetitia Zeeman
{"title":"A psychosocial exploration of resistances to service user involvement in United Kingdom National Health Service (NHS) mental health services.","authors":"Timothy Moore, Laetitia Zeeman","doi":"10.1177/13634593221099103","DOIUrl":"10.1177/13634593221099103","url":null,"abstract":"<p><p>Policy promotes the active participation of those with lived experience of mental health difficulties in UK NHS mental health services, from the level of collaborative care-planning to service delivery, leadership and development. However, research indicates different forms of resistance to the implementation of such service user involvement. This article reports the findings of a qualitative, interview-based study which used Foucauldian discourse analysis and psychoanalytic theory to understand how resistances are produced through the interplay of clinical mental health professionals' subjectivity and their organisational context. Service user involvement was found to highlight conflicts within clinicians' roles. Central to this conflict was an ambivalent relationship to the power associated with these roles. Power could protect professionals from work related stresses, but could also be used to dominate, silence and coerce service users in ways that conflicted with the core function of providing care. Whilst important, raising awareness of such conflict will arouse discomfort and resistance where psychological defences are challenged. A parallel is drawn with psychotherapeutic change, in which resistance must be understood and worked with as part of meaningful change.</p>","PeriodicalId":12944,"journal":{"name":"Health","volume":"27 6","pages":"1096-1114"},"PeriodicalIF":2.1,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49676908","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}