Social Science & Medicine最新文献

{"title":"Anticipating, experiencing, and responding to disenfranchising talk: The experiences of people with type 1 diabetes","authors":"Brooke H. Wolfe ,&nbsp;Olivia Watson ,&nbsp;Elizabeth A. Hintz","doi":"10.1016/j.socscimed.2025.118099","DOIUrl":"10.1016/j.socscimed.2025.118099","url":null,"abstract":"<div><div>This interpretive study applies the theory of communicative (dis)enfranchisement to analyze 290 narratives authored by people diagnosed with type 1 diabetes (T1D). Using thematic co-occurrence analysis, we identified interrelationships both among and across types of anticipated and experienced (dis)enfranchising talk (DT) and participants’ responses to DT. Specifically, participants anticipated a lack of understanding and being accused of seeking pity or being incompetent in managing T1D. Participants experienced pressure from healthcare providers, unwanted intrusions, financial barriers, and negative self-talk. Participants responded to DT via denial, learning from others, and creating enfranchising messages. Utilizing a data matrix tool, we identify two theoretical relationships across types of DT and types of responses – a relationship between inability to manage T1D and experiencing unwanted intrusions from others, and between financial barriers and creating enfranchising messages. We offer theoretical implications and practical suggestions for people with T1D and their families, healthcare providers, and public health officials.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"377 ","pages":"Article 118099"},"PeriodicalIF":4.9,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143882835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are we gatekeeping trauma? A conceptual model to expand criterion A for invisible, identity-based, and systemic traumas","authors":"Tanya C. Saraiya ,&nbsp;Alexandria G. Bauer ,&nbsp;Devin E. Banks ,&nbsp;Delisa G. Brown ,&nbsp;Amber M. Jarnecke ,&nbsp;Chantel T. Ebrahimi ,&nbsp;Donte L. Bernard","doi":"10.1016/j.socscimed.2025.118090","DOIUrl":"10.1016/j.socscimed.2025.118090","url":null,"abstract":"<div><div>Since the inception of the criterion A framework into the posttraumatic stress disorder (PTSD) diagnosis in DSM-III, what qualifies as traumatic has been a fieldwide debate. Historically, social movements coinciding with advances in research have spurred improvements in the definition of criterion A, often by expanding the breadth of experiences that are considered trauma exposure. Contemporary issues of ongoing racial discrimination, ethno-violence, public health pandemics, warfare, oppression, and climate change warrant a re-examination of the criterion A definition. This critical review builds on prior critiques of criterion A and addresses (1) the limitations to the current criterion A definition in DSM-5 in capturing the experience of minoritized individuals; (2) three categories of trauma that are under-recognized in the current criterion A definition; and (3) the implications of expanding criterion A on clinical and research practice. We critically review three trauma categories that disproportionately affect minoritized individuals—invisible traumas, identity-based traumas, and systemic traumas. Evidence to date suggests that several traumatic experiences in these categories rise to the level of being traumatic, are associated with PTSD symptoms, and are prevalent among minoritized individuals. We discuss the implications of these traumas being omitted from criterion A and call for future work to critically examine the definition of criterion A in the PTSD diagnostic framework. Overall, this critical review captures traumas which remain undertreated, underdiagnosed, and under-represented by our current psychiatric nosology.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"375 ","pages":"Article 118090"},"PeriodicalIF":4.9,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143859719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abrasion: a phenomenological study of inequity in workplace-based assessment in pediatrics","authors":"Hannah L. Kakara Anderson ,&nbsp;Layla Abdulla ,&nbsp;Pricilla Cabral ,&nbsp;Marjan Govaerts ,&nbsp;Dorene F. Balmer ,&nbsp;Jamiu O. Busari","doi":"10.1016/j.socscimed.2025.118092","DOIUrl":"10.1016/j.socscimed.2025.118092","url":null,"abstract":"<div><div>Despite the centrality of workplace-based assessments in medical education and practice, there is troubling evidence that workplace-based assessments are inequitable. This study investigated the experience of inequity in workplace-based assessment via a phenomenological study with learners (resident physicians) and assessors (physician supervisors) in one specialty in the United States, general pediatrics, from August 2023-June 2024. The authors used critical phenomenology to prompt and iteratively analyze participants' experiences with inequity in workplace-based assessment and their lifeworlds. To understand participants' lifeworlds, the authors applied Collins' domains of power framework to examine participants’ varied and unique locations within intersecting power relations. Participants described the phenomenon of inequity in workplace-based assessment as a type of abrasion, that is, an injury caused by friction that occurred when a workplace-based assessment excoriated their sense of self. Abrasion had three dimensions: physical, affective, and temporal. These findings suggest that inequity in workplace-based assessment cannot be tracked solely by measuring disparities in numbers, grades, differences in narrative language used in comments, and other common measures of inequity, rather, it can be characterized as an experienced, felt, phenomenon that has essential dimensions. These findings have major implications for how inequity is conceptualized and intervened upon in medical education.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"375 ","pages":"Article 118092"},"PeriodicalIF":4.9,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143848744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experiential caring and the mobilisation of peerhood in group clinics","authors":"Jackie van Dael,&nbsp;Sara Shaw,&nbsp;Chrysanthi Papoutsi","doi":"10.1016/j.socscimed.2025.118107","DOIUrl":"10.1016/j.socscimed.2025.118107","url":null,"abstract":"<div><div>The concept of ‘peer support’ has generated much interest in mainstream health services. In policy discourse, peer-based initiatives are often described as ‘empowering’ and seen as contributing to more ‘democratic’ and ‘holistic’ forms of care. Focusing on group clinics as one such example, this article challenges the assumption that peer-based initiatives represent a straightforward and unequivocal ‘good’ when embedded in clinical care. We draw on qualitative data from three studies (2016–2025), including 118 interviews and ethnographic observation in 59 in-person, remote, and hybrid group clinics for diabetes and menopause at 5 primary and secondary care sites in England. Adopting a sociomaterial lens, we uncover how different forms and practices of peerhood emerge (or not) in the circumstances through which these clinics are materialised. We show how biomedical artefacts (e.g. diabetes test results, menopause symptom lists) used as part of consulting play a key role in constituting forms of affiliation and differentiation between patients, in turn determining whether and what forms of peer ‘support’ (e.g. disciplinary, affirmative) are accomplished. We go on to explore how being presented as a peer as part of clinical consulting brings about new roles and responsibilities for patients, and introduce the term ‘experiential caring’ to denote a new mode of consulting that mobilises roles, practices, and subjectivities associated with peerhood.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"377 ","pages":"Article 118107"},"PeriodicalIF":4.9,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143882836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical education as liberatory praxis: Experiences from the UCLA \"structural racism and health equity\" curriculum","authors":"Cydni Baker,&nbsp;Stephanie Bueno,&nbsp;Lizeth Carrillo,&nbsp;Elizabeth Flores,&nbsp;Matthew Hing,&nbsp;Guneet Kaur,&nbsp;Daniel Kennedy,&nbsp;Kathley LeTran,&nbsp;Dailyn Rodriguez,&nbsp;Shamsher Samra,&nbsp;Hanin Sheikh,&nbsp;Lindsay Wells","doi":"10.1016/j.socscimed.2025.118094","DOIUrl":"10.1016/j.socscimed.2025.118094","url":null,"abstract":"<div><div>This paper describes the origins and initial experiences of an innovative student-led, faculty-supported, and community-accountable ongoing experiment in structurally competent anti-racist medical training: the UCLA Structural Racism and Health Equity (SRHE) Curricular Thread. As critical locations of social reproduction for the medical profession and the broader medical-industrial complex, medical schools present opportunities for disrupting professional identities that further settler-colonialism, racial capitalism, and extractive abandonment, and for instead constructing a liberatory health praxis. Scholars have proposed integrating structural analysis into medical training to examine harmful aspects of clinical medicine and medical epistemology that become naturalized and inscribed through professionalization. Coalitions of trainees, faculty, health workers, and community organizers have also long participated in productive disruptions of medical education as usual through creative intra- and extra-institutional pedagogical efforts that reimagine the profession and call attention to medical institutions’ responsibility towards racial and social justice. Drawing on these genealogies, SRHE provides medical education that (1) deconstructs hidden structures that produce and sustain health inequities and (2) imagines liberatory futures for the medical profession that challenge community/clinical binaries and notions of “medical expertise” itself.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"376 ","pages":"Article 118094"},"PeriodicalIF":4.9,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143877561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Equal before luck? Well-being consequences of personal deprivation and transition","authors":"Joan Costa-Font ,&nbsp;Anna Nicińska ,&nbsp;Melcior Rossello Roig","doi":"10.1016/j.socscimed.2025.117975","DOIUrl":"10.1016/j.socscimed.2025.117975","url":null,"abstract":"<div><div>Past trauma resulting from personal life shocks, especially during periods of particular volatility such as regime transition (or regime change), can give rise to significant long-lasting effects on people’s health and well-being. We study this question by drawing on longitudinal and retrospective data to examine the effect of past exposure to major individual-level shocks (specifically hunger, persecution, dispossession, and exceptional stress) on current measures of an individual’s health and mental well-being. We examine the effect of the timing of the personal shocks, alongside the additional effect of ‘institutional uncertainty’ resulting from regime change in post-communist European countries. Our findings are as follows. First, we document evidence of the detrimental effects of shocks on a series of relevant health and well-being outcomes. Second, we show evidence of more pronounced detrimental consequences of such personal shocks experienced by individuals living in formerly communist countries (which accrue to about 8% and 10% in the case of persecution and hunger, respectively) than in non-communist countries. The effects are robust and take place in addition to the direct effects of regime change and exposure to personal shocks.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"376 ","pages":"Article 117975"},"PeriodicalIF":4.9,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143864332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Passing on the flame: Do mega sports events promote health behaviours?","authors":"Christian Krekel ,&nbsp;Georgios Kavetsos ,&nbsp;Nicolas R. Ziebarth","doi":"10.1016/j.socscimed.2025.117921","DOIUrl":"10.1016/j.socscimed.2025.117921","url":null,"abstract":"<div><div>To justify billion-dollar public expenditures on mega sports events, proponents often suggest lasting improvements in health behaviours among the general public. To estimate the returns to health behaviours from hosting the 2012 London Olympics, we collected panel data on more than 19,000 respondents across two European capitals, London and Paris, between 2011 and 2013. Using a difference-in-differences design with Paris as counterfactual, we find an increase in physical activity by six percentage points among the inactive, from a baseline of 34%. Activation, however, lasts only for about 100 days. Although we also find suggestive evidence for reduced alcohol and tobacco consumption during the event, a cost–benefit analysis suggests that staging mega sports events is not a cost-effective policy to promote lasting health behaviour change.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"377 ","pages":"Article 117921"},"PeriodicalIF":4.9,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143887363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measurement invariance and differential item functioning of a care staff proxy measure of nursing home resident dementia-specific quality of life (DEMQOL-CH): do care aides' first language, and care aides' and residents’ ethno-cultural background matter?","authors":"Matthias Hoben ,&nbsp;Sevilay Kilmen ,&nbsp;Janice Keefe ,&nbsp;Hannah M. O'Rourke ,&nbsp;Sube Banerjee ,&nbsp;Carole A. Estabrooks","doi":"10.1016/j.socscimed.2025.118089","DOIUrl":"10.1016/j.socscimed.2025.118089","url":null,"abstract":"<div><div>Quality of life (QoL) is a priority goal of dementia care, but measuring QoL becomes increasingly difficult as a person's ability to self-report declines. QoL measurement is particularly challenging among Nursing home (NH) residents, due to their often advanced cognitive impairment. The DEMQOL-CH is a validated tool to assess NH residents' QoL, using care staff proxy reports. Care staff and residents often have diverse ethno-cultural backgrounds, which may affect the measurement of QoL. Our objective was to assess measurement invariance and differential item functioning (DIF) of the DEMQOL-CH based on care staff ethno-cultural background, language, and resident ethno-cultural background. In a convenience sample of 9 NHs in the Canadian province of Alberta, research assistants conducted structured interviews with 119 care staff between July and September 2021 to complete DEMQOL-CH assessments of 612 residents. We performed confirmatory factor analyses, multiple group item response theory analyses, and DIF analyses. Measurement of the overall DEMQOL-CH score was affected by care staff ethno-cultural background and language (lack of scalar measurement invariance), but not by resident ethno-cultural background. Six of the 31 DEMQOL-CH items had DIF based on both, care staff ethno-cultural background and language, 2 items had DIF based on care staff ethno-cultural background, 4 items had DIF based on care staff language. Resident ethno-cultural background did not lead to DIF. The lack of measurement invariance and the presence of DIF affects the comparability of DEMQOL-CH assessments collected from care staff with diverse ethno-cultural and/or language backgrounds. However, the extent of the issues identified is small and the tool's other psychometric properties are robust. Therefore, we suggest that it is reasonable to continue to use the DEMQOL-CH in its current form, with careful consideration of methods to deal with and adjust for measurement invariance.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"375 ","pages":"Article 118089"},"PeriodicalIF":4.9,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143844043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Declaring racism a public health crisis","authors":"Claire Laurier Decoteau ,&nbsp;Cal Lee Garrett ,&nbsp;Tirza Ochrach-Konradi","doi":"10.1016/j.socscimed.2025.118086","DOIUrl":"10.1016/j.socscimed.2025.118086","url":null,"abstract":"<div><div>Since 2019, a growing number of local governments in the United States (US) have made declarations that racism is a public health crisis. These resolutions proliferated in the wake of the COVID-19 pandemic. The resolutions recognize the conjunctural nature of racism in the US and institute organizational changes and new policies but often fail to implement meaningful change in racial and health inequalities on the ground. Comparing the cases of Milwaukee, Wisconsin and Chicago, Illinois and drawing on theories of biopower and stratified biomedicalization, this paper argues that these declarations instigate a shift in public health governance. Public health authority is expanded across multiple government domains, widening the scope of its jurisdiction and massifying the process of biomedicalization, combined with an economization of downstream programming by triaging resources via epidemiological metrics of vulnerability. Public health departments shift from providing services to becoming policy “strategists,” which entails efforts to reduce organizational bias and a devolution of programming to communities. As a result, the biomedicalization of racism through these declarations enables an uneven and intermittent public health response that fails to attend to the lived experience of racism on the ground.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"377 ","pages":"Article 118086"},"PeriodicalIF":4.9,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143882837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“I will prove that ‘disabled’ is just a word”: Phenomenology, adaptive athletes and the adaptabilities model of disability","authors":"Norah Anita Schwartz,&nbsp;Christine Alysse von Glascoe","doi":"10.1016/j.socscimed.2025.118091","DOIUrl":"10.1016/j.socscimed.2025.118091","url":null,"abstract":"<div><div>Involvement in adaptive athletics, including adaptive adventure sports, has been steadily increasing over the past few decades. With this growth, a new model of disability that addresses the intersection of athletics and impairment among bio-divergent athletes is called for. In this article, we use reflexive phenomenology to explore the active creation of social meaning among athletes with physical, developmental and neurological impairments. Five salient categories emerged from open-ended, in-depth interviews and immersed participant observation including: life interrupted, liminal spaces, post-traumatic growth/biographical renewal, mental fortitude, and living life aside from disability. Results demonstrate the transformative power of adaptive athletics and the concept of adaptability. Building upon the affirmative model of disability and the results of this study, we developed the ‘adaptabilities model of disability’, which rests upon a social values base of inclusion, diversity, accessibility, inclusivity, interdependence and leadership within the context of the adaptive athletic community.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"377 ","pages":"Article 118091"},"PeriodicalIF":4.9,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143900235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}