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Women in the Netherlands with non-western migration backgrounds experience domestic violence at the intersection of culture and gender, and visit their general practitioners (GPs) with health concerns related to the violence. Drawing on semi-structured interviews with GPs, this paper illuminates how GPs navigate the process of decision-making around intervention in domestic violence, with particular attention to the role of autonomy. Patient autonomy is a core principle in Dutch general practice. The term refers to the principle that GPs must respect that competent adults can make autonomous decisions about the care they do and do not want, and that GPs must respect patients' views, choices, and ways of life. The interview data shows great variation in how GPs respond in situations of domestic violence against women with non-western migration backgrounds. Deploying 'somatechnics of perception', this paper explores how GPs' perceptions of their patients' autonomy are both the agent and effect of a complex and embodied negotiation of gender, race, culture, ethnicity, medical ethics, and morality. In highlighting how these patients' autonomy is rendered (un)intelligible and (il)legible in contextually specific ways, this paper sheds light on how GPs in the Netherlands can better assist women with non-western migration backgrounds who experience domestic violence. [ABSTRACT FROM AUTHOR]

This paper considers matters of time in online mental health peer support. Significant evidence of the value of peer support exists, with new digital platforms emerging as part of the digitisation of mental health support. This paper draws from a project exploring the impact of digital platforms on peer support through interviews with users of a major UK-based online peer support platform. Drawing on Gilles Deleuze's concept of the 'living present', the paper highlights how notions of past, present and future operate as co-existing dimensions of the present. The analysis highlights how the immediacy of digital platforms elicits expectations of peer support being 'on tap', which creates challenges when support is not received synchronously. Unlike in-person support, digital platforms facilitate the archiving of support, which can (re)enter the present at any moment through asynchronous communication. Anticipations of the future feature as dimensions of the present in terms of feelings regarding when support may no longer be needed. The paper offers potential implications for social scientific understanding of digital peer support, which include valuable insight for mental health services designing and delivering digital peer support. [ABSTRACT FROM AUTHOR]

Globally, traumatic brain injury (TBI) has been recognised as a serious health issue not only because of the immediate impacts at the time the injury occurs but even more so due to the longstanding impacts. Even though TBI is a globally recognised condition, the research is disproportionately focused on its incidence in, and immediate and long-term effects on men. A growing body of research suggests that generally, women who experience family violence are at high risk of TBI and suffer its impacts in ways that reflect gendered differences in the patterns and frequency of violence. In Australia, the social and physical costs of TBI are multiplied for Indigenous women, whose experience of disability and access to healthcare lies at the intersection of gender and race in the historical context of settler colonialism. The present study addresses the need for research into the sociodemographic inequalities that affect access to culturally appropriate hospital care, timely response systems, and flexible, safe and engaged social services. This paper draws on data from interviews and focus groups with Indigenous women, hospital staff and community-based service providers and suggests potential pathways for further research in settler-colonial settings elsewhere in the world. [ABSTRACT FROM AUTHOR]

This paper focuses on the omnipresent yet analytically almost invisible role of memory and bodily experiences in childhood vaccination. Previous scholarship on the sociocultural aspects of vaccination has primarily focused on the individual and sociodemographic factors underpinning vaccine hesitancy, the role of healthcare professionals and the politicisation or mediatisation of vaccination. Social practices considering vaccination were primarily explored as a matter of the present. Only little consideration was given to the past, individual biographies and sociohistorical temporalities. To complement this body of work, we focus on cognitively-based, embodied and emotionally-experienced memory related to vaccination. Based on a qualitative study of childhood vaccination conducted in Czechia between 2017 and 2019 consisting of ethnographic observations, in-depth interviews and a document review, we identified three interconnected forms of vaccination memory: bio-immune, social-collective and lived experience. Bio-immune memory refers to the body's physical memory, gained to protect itself from diseases. Social-collective memory focuses on socially shared narratives about diseases and vaccination in the past. The memory of lived experience refers to feelings, embodied knowledge and pain. Our findings may inspire further analysis of childhood vaccination in other geographical contexts and amidst the reconfiguration of attitudes and newly established memories following the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Mental health services are increasingly employing peer workers (PWs), individuals who have lived experiences with mental health problems, to support patients and be part of mental health care teams. While the employment of PWs continues to increase, little is known about how the function unfolds in practice. This paper explores the broader context in which the PWs navigate and the concrete outcomes and everyday issues that exist at the individual level. Methodologically, the paper draws on 22 interviews with PWs employed in the mental health services in Denmark. Theoretically, it combines Lipsky's (1980) theory on street-level bureaucrats with sociological discussions concerning the lay-expert divide. The analysis shows that PWs experience both role ambiguity and goal uncertainty and that they use substantial discretion in determining the nature, amount and quality of their peer practices. This – combined with the PWs' diverse lived experiences – calls for a heterogeneous understanding of peer work and therefore the analysis presents three categories of peer workers: PWs as (1) a representative of patients' lifeworld, (2) an interdisciplinary professional and (3) an 'expert by experience'. These categories display PWs different enactments of their lived experiences and reveal ambiguities tied to the lay-expert divide. [ABSTRACT FROM AUTHOR]

Recent political processes have rendered people with dementia an increasingly surveilled population. Surveillance is a contentious issue within dementia research, spanning technological monitoring, biomarker research and epidemiological data gathering. This paper explores surveillance in the relationships of people affected by dementia, how older relatives both with and without diagnoses are surveilled in everyday interactions, and the importance of expectations in guiding surveillance. This paper presents data from 41 in-depth interviews with people affected by dementia living in the community in the United Kingdom. Agedness was a key contributor to expectations that a person may have dementia, based on previous experiences, media accounts and wider awareness. Expectations provoked surveillance in interactions, with participants looking for signs of dementia when interacting with older relatives. Older people also enacted self-surveillance, monitoring their own behaviour. Various actions could be attributed to dementia because interpretation is malleable, partly vindicating expectations while leaving some uncertainties. Expectant surveillance transformed people's experiences because they organised their own actions, and interpreted those of others, in line with pre-existing meanings. The ability to interpret behaviours to fit expectations can bring coherence to uncertainties of ageing, cognition and dementia, but risks ascribing dementia to many older people who straddle those uncertainties. [ABSTRACT FROM AUTHOR]

Although health services in Australia have an aim to provide inclusive care for their patients/clients, this study highlights how barriers to care can lie at the centre of patient-provider interactions. Racial microaggression is a subtle form of racism that can occur in health settings, leading to further exclusion for First Nations Australians, immigrants and refugees. This paper is guided by Derrida's approach to deconstructionism by unpacking how language is used by health professionals – as holders of organisational power – and how they construct 'truths' or discourses about clients that historically have been marginalised by health services and system. Data comprise 21 interviews with staff from two rural health services. It identified three racial microaggressions were used to justify the challenges of providing care to people from First Nations, immigrant and refugee backgrounds: (1) Participants problematised culture(s) of service users; (2) participants implied cultural superiority in their conceptualisation of 'other' cultures; and (3) participants shared stories of inactions, discomfort and relegating of responsibility. The findings identified these discourses as forms of racial microaggression that can potentially lead to further exclusion of people seeking services and support. [ABSTRACT FROM AUTHOR]

Disproportionately high numbers of Aboriginal young people access residential alcohol and other drug programs in Australia. While demand is high, these programs often have low numbers of Aboriginal staff. Residential programs, however, generally offer supports that reflect features of Aboriginal health care – holistic, group-based, connected to local communities, and addressing determinants of health. The qualitative research outlined in this paper was a collaboration between a mainstream residential therapeutic community program and two Aboriginal community-controlled organisations, and Aboriginal young people and researchers, with Aboriginal research leadership. It used an Aboriginal healing framework to understand the experiences of 12 young Aboriginal people in the program, triangulated with 19 key informant interviews. This provided an opportunity to understand how Indigenous knowledge about healing related to mainstream programs and the experiences of Aboriginal young people. This moves beyond individualist and deficit-focused conceptions of youth alcohol and drug use and centres Aboriginal cultures as healing. Findings point to the need for critically self-reflective mainstream organisations, a larger Aboriginal workforce with leadership roles, partnerships with Aboriginal Elders and organisations, and an investment in Aboriginal community-controlled alcohol and other drug services. [ABSTRACT FROM AUTHOR]

Incentivisation of general practitioners (GPs) by pharmaceutical companies is thought to affect prescribing practices, often not in patients' interest. Using a Bourdieusian lens, we examine the socially structured conditions that underpin exchanges between pharmaceutical companies and GPs in Pakistan. The analysis of qualitative interviews with 28 GPs and 13 pharmaceutical sales representatives (PSRs) shows that GPs, through prescribing medicines, met pharmaceutical sales targets in exchange for various incentives. We argue that these practices can be given meaning through the concept of 'field' – a social space in which GPs, PSRs, and pharmacists were hierarchically positioned, with their unique capacities, to enable healthcare provision. However, structural forces like the intense competition between pharmaceutical companies, the presence of unqualified healthcare providers in the healthcare market, and a lack of regulation by the state institutions produced a context that enabled pharmaceutical companies and GPs to use the healthcare field, also, as space to maximise profits. GPs believed the effort to maximise incomes and meet socially desired standards were two key factors that encouraged profit-led prescribing. We conclude that understanding the healthcare field is an important step toward developing governance practices that can address profit-led prescribing. [ABSTRACT FROM AUTHOR]

This study examines the association between educational attainment, relative to that of an intimate partner, and all-cause mortality for men and women in different-sex relationships. Research suggests some health benefits for partnered adults that arise from economic benefits and improved access to health-promoting tools. One way these benefits could be gained is through the pairing of the highly educated. While high individual educational attainment lowers mortality risk, less is known about the risks of mortality associated with one's education, relative to their partner's education. Using National Health Interview Survey Linked Mortality Files (NHIS-LMF) for the years 1999–2014 with prospective mortality follow-up through December 2015 (N = 347,994), we document the association between relative educational attainment and mortality for men and women with different-sex partners in the United States. Fully adjusted Cox proportional hazard models revealed a higher risk of all-cause mortality for men and women who have more education than their partner, relative to those having the same education as their partner. For women only, having less education than their male partner was associated with a lower risk of all-cause mortality. A better understanding of relative status within different-sex partnerships provides insights into partnered adult's mortality risks. [ABSTRACT FROM AUTHOR]

In recognition of the broader relational aspects of viral infections, family support is considered important when someone is diagnosed with a blood-borne virus (BBV), such as HIV, hepatitis C (HCV) and hepatitis B (HBV). However, families' own support needs are often not a priority in service provision within the BBV sector. In this article, we draw on qualitative interviews with 20 key informants working in various professional capacities in health, social policy, care and advocacy sectors in Australia, and explore their experiences and perspectives on family inclusivity in their services. Overall, key informants acknowledged the diversity of what constitutes family, and consistently viewed family engagement as beneficial to both diagnosed individuals and the wider familial networks affected by a diagnosis. However, prioritising individual care in support services presented barriers to engaging families, which are further complicated by the role of stigma in shaping the social realities of living with a BBV. Increasing understanding in service provision settings that serodiscordance can be a family experience has the potential to widen this analytic lens to consider the support needs of families in their own right. [ABSTRACT FROM AUTHOR]

Historical sociological perspectives posit professional identity to emerge from socialisation and attainment of 'traits' considered unique to and distinguishing of a profession. Such essentialist understandings, however, cannot account for group heterogeneity, nurses' lived experiences, nor the fluidity of professional and personal identity. This article conceptualises professional identity as being both individual and collective, influenced by context, involving subjective meaning-making, and membership to a specific professional group. Drawing on ethnographic data gathered through participant observation and semi-structured interviews with Critical Care Nurses in an Intensive Care Unit in regional Australia, we identify four themes that reveal different aspects of professional identity: conceptualising professional identity; professional identity as a title and legislative requirement; professional identity as qualifications and training; and professional identity as a social performance. The findings demonstrate that Critical Care Nurses hold multifaceted perceptions of professional identity. While they collectively distinguish their nursing training, knowledge, and practice from other nurses, they struggle to articulate what professional identity is, while creating boundaries between different forms of nursing education and qualifications to construct their professional identity. These uncertain and diverse meanings of professional identity contribute to nurse identity ambiguity, while also reflecting the necessity of flexible individual and collective nursing identities. [ABSTRACT FROM AUTHOR]

Indigenous knowledge systems embody a holistic, inclusive view of the world and foreground interconnectedness for the promotion of life. Through reflective engagement with the author's positioning as an Indigenous researcher, this article explores Indigenous knowledges of sexual, reproductive health and motherhood shared by Basotho women. It draws on the life stories of twenty never-married women and uses decolonial African feminist approaches to challenge the assumed universality of conceptions of sexual and reproductive health that are both deeply embedded and produced within specific relations of power. It illuminates the Indigenous pitiki space as an Indigenous knowledge hub purposed to empower Basotho women's sexual and reproductive health. Within this space, Indigenous knowledges and skills are shared amongst women, with the elderly imparting knowledges to the young women. In the context of unsurmountable health disparities, the article shows how Indigenous knowledge-sharing outside the exclusive 'westernised' health systems enables communal support for the well-being of women and children in African contexts. It emphasises the need for inclusive and expansive knowledge production systems not only to better inform equitable health solutions for Indigenous communities but also for epistemic redress in the discipline of Sociology. [ABSTRACT FROM AUTHOR]

Genital fashioning practices, such as Brazilian waxing and female genital cosmetic surgery, have become increasingly prevalent within contemporary western societies. This paper explores the role of genital fashioning in the construction of contemporary femininity. It uses in-depth interviews and focus groups with Australian women aged 18–30 to investigate female genitalia as a site of alteration. Drawing on broader understandings of the body as socially mediated, this paper contends that multiple modification practices are employed to produce genital appearance. It departs from previous investigations which consider genital fashioning practices in isolation. In identifying the scope of genital fashioning, this research reveals a continuum of genital fashioning practices, both physically and discursively mobilised by women to negotiate their identity, sexuality, and femininity. [ABSTRACT FROM AUTHOR]

While medical sociologists have explored how teachers aid the medicalisation process of Attention Deficit Hyperactivity Disorder (ADHD), there is a paucity of work investigating the role of neighbourhood-level social class. This paper has two main aims. First, to explore how teachers discuss ADHD with parents, and second, to understand how these discussions differ based upon neighbourhood-level social class. To achieve these aims, I utilise grounded theory and interviews with thirty-four elementary school teachers. Emergent themes describe the following process: (a) reifying biological causation of ADHD, (b) evidence gathering, and (c) furtive diagnosis. Findings suggest teachers in upper-class areas skipped steps in the process or easily managed each step while discussing ADHD with parents. Teachers in lower-class areas were met with barriers that affected the likelihood of children receiving a furtive diagnosis from teachers, thus reducing the likelihood of meeting with a medical professional and receiving medical intervention. Findings explain disparities in medication use for ADHD by neighbourhood-level social class and help to explain the social reproduction of social class. By building on the literature regarding cultural capital and mental health literacy, I conceptualise 'medicalisation lag' as integral to the medicalisation process and to the social reproduction of social class. [ABSTRACT FROM AUTHOR]

Complementary and alternative medicine (CAM) degrees in Australian and British universities have come under attack from sceptics who argue that such courses teach only 'pseudoscience'. Moreover, CAM academics have themselves been publicly labelled 'quacks'. Comparatively little is known about this group of health professionals who span the two worlds of CAM practice and academia. How do they navigate between these domains, and how are their collective and individual professional identities constructed? Drawing on 47 semi-structured interviews, this paper explores the professional identities of academics working in three university-based CAM disciplines in Australia and the UK: osteopathy, chiropractic and Chinese medicine. By analysing these individuals' accounts, and building on prior research on health professions in the academy, the paper contributes to understanding how contests about professionalism and professional knowledge take place against the academic-practice divide. By focussing on a domain where knowledge claims are conspicuously contested, it highlights the salience of navigating 'epistemic stress' for both group and individual professional identity. [ABSTRACT FROM AUTHOR]

Hook-up apps are an increasingly popular way for women to meet other people for sex, dating, relationships, and more. As a mundane and habitual form of media, the multiple uses of hook-up apps allow for the production of intimacy in surprising and complex ways. This paper draws on narrative interviews with 15 self-identifying women to explore how dating and hook-up apps help produce 'intimate publics' for women. The field of intimate publics available to women users of hook-up apps is broader than those afforded by in-app interactions; there is an entire network of intimacy, sociality, and publicity that forms around hook-up apps. Our findings show that while both queer and straight women use hook-up apps to find sex, hook-ups, dates, and relationships, they are also central to building community, friendship, and sociality between women. [ABSTRACT FROM AUTHOR]

Diabetes presents a challenge to healthcare services worldwide. Diabetes educators work with individuals and communities to reduce the impact of diabetes. In Australia, diabetes educators derive from one of several primary qualifications including nursing, medicine or a specified allied health background, and have an accredited postgraduate qualification in diabetes education. The peak professional body, the Australian Diabetes Educators Association (ADEA), promotes equivalence of all diabetes educators in terms of their scope of practice. However, in practice, there is evidence of inequities, particularly between those from nursing and allied health backgrounds. This paper uses a neo-Weberian lens to explore the interprofessional role dynamics of a 'postprofessional' group of practitioners, who adopt a common role and title to create a professional identity at post-qualifying level. Data were collected via individual interviews with 19 stakeholders and analysed using an abductive template approach. Differential role boundaries between nurse and allied health diabetes educators were established and reinforced in several ways. Diabetes education is considered a sub-specialty of nursing only; access to education and credentialing has been restricted for allied health; reinforcement of professional stereotypes and perceived professional values; and perceived legislative differences in access to medication management for nurse and allied health diabetes educators. [ABSTRACT FROM AUTHOR]

While recognition of transgender people has increased in Vietnam, this population continues to face significant stigma and discrimination within their families and in public, including in medical settings. Understanding of transgender health is limited, especially regarding the provision of care to transgender people. This paper explores providers' preparedness for delivering transgender care using data from qualitative interviews with twelve healthcare professionals in Hanoi and Ho Chi Minh City. Drawing on the socio-ecological model, we illustrated multi-level factors that influenced the provision of medical services to transgender people, including restrictive legislation (policy level); shortage of transgender-specific services, and lack of training and guidelines (organisational level); and ambiguous perceptions, inappropriate provider-patient communication, and medical knowledge gaps (individual level). Overall, our study has identified a healthcare environment that is under-prepared to meet the complex health needs of transgender individuals. With this study, we call for intervention strategies beyond individual-level support and emphasise the urgency of allowing medical institutions to provide transgender-specific health services including gender-affirming surgery and hormonal treatments. [ABSTRACT FROM AUTHOR]

Rates of lung cancer in China are rising rapidly, creating an urgent need for prevention. Effective prevention measures require understanding local beliefs and perceptions about the risk for developing lung cancer. This article explores the explanations that Chinese lung cancer patients and their families give about the aetiology of their disease. Fifty-three interviews were conducted among lung cancer patients and their family members at a large tumour hospital in southern China. Participants presented a complex multifactorial explanation of lung cancer associating their disease with risks like tobacco use, occupational exposures, environmental pollution, lifestyle changes, and personal characters. While these are all standard risk factors commonly associated with lung cancer, participants presented them within a larger contextual frame of structural issues that impede their ability to change their behaviours. Using a social ecological model, we demonstrate how China's socio-cultural environment shapes assumptions about the risk of lung cancer with particular reference to work, home, social situations, and the natural environment. [ABSTRACT FROM AUTHOR]

This paper, based on data taken from in-depth interviews with senior midwives and obstetricians and conducted as part of a critical ethnographic study, argues for a greater appreciation of person-centred, value-led midwifery practice. The paper begins with a discussion of the way midwifery practice is shaped by encoded and embodied knowledge. The paper subsequently focuses on an emergent practice-based leadership using an adapted Aristotelian conceptual framework derived from MacIntyre [(2007). After virtue (3rd ed.). London: Duckworth]. Professional dissonance is highlighted as a difficulty experienced by repositioned managers who are also expected to be leaders in their field. Using data gathered from indepth interviews it is contended that establishing person-centred care might be better achieved through the development of practice-based leadership (rather than solely by adherence to organisational requirements). This type of leadership could potentially nurture a professional environment that promotes qualities such as agency, commitment and high levels of competence among midwives. Such leadership is central to UK government priorities and is applicable to a global practice development agenda. [ABSTRACT FROM AUTHOR]

Despite the frequent occurrence of unwanted disclosure of HIV status in Australia, there is little understanding of its determinants and consequences. This paper offers an analysis of lived experiences of unwanted disclosure amongst 28 people with HIV in urban settings in Australia. Of the 28 individuals interviewed, 17 men and 8 women had experienced unwanted disclosure of their HIV status by other people in work, health, social and other settings. Through the lenses provided by the concepts of habitus and agentic practice, this paper focuses on unintentional and deliberate practices of unwanted disclosure, and the consequences that may arise from this. Findings reveal how unwanted disclosure may lead to reflexive and agentic action among people with HIV as they struggle to reclaim control over their lives and how they are perceived. Despite what is sometimes assumed, the negative social responses the HIV epidemic has given rise to persist in Australia. Some 30 years into the epidemic, findings highlight the need to establish a social climate that is intolerant of unwanted disclosure, and which recognises the damage it may cause. [ABSTRACT FROM AUTHOR]

In England there has been substantial policy development and an academic drive to promote the goal of 'living well' for people with dementia and their family members. This article critically evaluates the feasibility of this intention, with reference to the experience of those caring for people with the condition. Qualitative data are utilised from a study which explored how couples negotiate relationships and care. The focus of this paper is the perspectives of spousal carers and the challenges they encounter within their caring role. Views were obtained via semi-structured joint interviews where the carer participated alongside the person with dementia. The extent to which living well with dementia is a credible aspiration for carers is examined via three themes: identity subsumed under care responsibilities; the couple as an isolated family unit; and barriers to professional support. The findings highlight that experience of caring is highly complex and fraught with multiple practical, emotional and moral pressures. It is asserted that research into dementia and care relationships must avoid a zero sum situation, prompted by living well discourses, where attempts to bolster the position of people with dementia compound the marginalisation and stigmatisation of informal carers. [ABSTRACT FROM AUTHOR]

Increasingly, people live longer with advanced cancer, despite having no prospect of full recovery. Ongoing survival is owed to early detection and effective disease management, yet experienced as highly precarious. In this article we explore how cancer chronicity brings into effect a pre-occupation with time, what time is to people with advanced cancer, and what socio-cultural norms inflect everyday practices. We analyse 20 interviews conducted in Queensland, Australia with 11 participants with advanced cancer, to trace the intersections of what time means, what people do with time, and what time feels like. Drawing on scholarship on the moralities around ill health, we discuss how awareness of time emerges in cancer chronicity and raises moral questions on how to live well. Here, imperatives of optimisation (urging people with advanced cancer to make the most of limited time) intersect with imperatives of authenticity (marked by emphasis on how to live one's own best life). These dynamics reveal expressions of living with advanced cancer in morally viable ways. Such ontological processes have implications for the lived experience of people with advanced cancer, their families and oncological care. [ABSTRACT FROM AUTHOR]

Alcohol consumption is a significant public health concern in Australia, with men disproportionately represented in treatment for health issues related to heavy drinking. Despite this, little is known about the experiences of these men or the gender dynamics that may shape heavy drinking. Increasingly, the treatment of alcohol and other drug-related issues, including those related to heavy drinking, is based on a biopsychosocial approach. Within this framework, heavy drinking is understood as a symptom of individual pathology in the context of various social 'factors' that influence individual capacity to exercise agency. Following the work of Karen Barad, this article employs a feminist science studies account of agency to formulate heavy drinking as a gendered 'phenomenon': enacted and sustained through the 'intra-action' of other phenomena. Drawing on interviews with men who drink heavily, our analysis explores how the phenomenon of men's heavy drinking materialises through the intra-actions of gender, isolation and healthcare. We argue that heavy drinking is not a sign of failed individual agency but an expression of entangled agencies. In concluding, we suggest it is possible to enhance the well-being of men who drink heavily by addressing specific gendered intra-actions in the making of heavy drinking. [ABSTRACT FROM AUTHOR]

There is increasing pressure on complementary and alternative medicine (CAM) to follow the evidence-based approach promoted in allied health and medicine, in which the randomised control trial represents the evidence gold standard. However, many CAM advocates see these methods as undermining the holism of CAM practice. This paper explores how such tensions are managed in CAM university departments – settings in which particular forms of knowledge and evidence are given 'official' imprimatur by CAM educators and researchers. By comparing two types of CAM, the paper also unpacks differences within this broad category, asking whether CAM academic disciplines comprise different 'epistemic cultures' (Knorr-Cetina, K. (1999). Epistemic cultures: How the sciences make knowledge. Cambridge, MA: Harvard University Press). Interviews were conducted with 20 lecturers in Chinese medicine and osteopathy, across five Australian universities, and augmented with observation in two degree programs. Findings reveal contrasting ontological and epistemological perspectives between the two academic fields. Chinese medicine lecturers had largely adopted bioscientific models of research, typically conducting laboratory work and trials, although teaching included traditional theories. Osteopathy academics were more critical of dominant approaches and were focused on reframing notions of evidence to account for experiences, with some advocating qualitative research. The study illustrates CAM's 'epistemic disunity' while also highlighting the particular challenges facing academic CAM. [ABSTRACT FROM AUTHOR]

Despite the increased diversification of Australian families, the nuclear family formed through reproductive heterosex continues to be treated as the norm. This paper argues that this norm impacts negatively upon families formed in other ways, by exposing them to increased scrutiny. Drawing on interviews with 60 participants from four cohorts (families formed through reproductive heterosex, intercountry adoption, long-term foster care, or surrogacy), a comparative thematic analysis is presented in which two key themes are elaborated: (1) the impact of government policies and practices, and (2) the degree to which families are treated as public property. Findings suggest that families formed through reproductive heterosex were the least regulated and scrutinised; families formed through either adoption or surrogacy received a considerable degree of regulation and scrutiny; and foster families were the most scrutinised and negatively impacted by government policies. The paper concludes by considering what is required to engender more inclusive and supportive responses to all families. [ABSTRACT FROM AUTHOR]

Drawing on Foucault's conceptualisation of power, this paper examines public health as a distinctly modern regime of governance. An account of the historical regulation of drug use is traced in order to examine socio-historical shifts and lines of continuity in contemporary technologies of harm reduction. Using qualitative interview data, we examined practices of power in the context of contemporary drug use, including self-governance using techniques of monitoring, self-management and self-tracking. Participants' accounts revealed that they were encouraged to self-govern their drug use through a variety of reformist technologies that are embedded in harm-reduction programs. It is argued that participants' subjectivity is formed at the intersection of authoritative governance and self-governance, through ethical practices of the self which have emerged from disciplinary health practices, and incorporate the body as the site of power. We illustrate this by drawing a distinction between hygienist and sanitationist practices of public health. These governmental practices, which are embedded in public health programs, encourage people who use drugs to transform themselves into moral citizens, aligning their ethical practices with governing interests. [ABSTRACT FROM AUTHOR]

There has been much talk in sociological circles of bodies as 'projects' or 'choices,' but surprisingly little examination of how these projects and choices are experienced. Consumer culture has been described as heralding a new era in body-self relations, but few have explored the experience of body-self relations. Body-self relations emerged as central to understanding in this study of the experience of the body at different ages (20-30, 45-55 and 70+ years), demonstrating the utility of empirical investigations in this area. This paper describes an orientation to the body that was common to the sample of 20 young people (aged 20-30 years) interviewed as part of this study. This orientation informed their health-related behaviours such as diet and exercise, but some participants found it to be problematic. Their voices demonstrate that bodily 'choices' may actually be experienced as irrational and even psychopathological compulsions. This experiential perspective suggests that normality may be continuous with pathology, and that differences are of degree rather than kind. The findings have implications for the treatment and prevention of eating disorders and obesity. [ABSTRACT FROM AUTHOR]

This paper discusses mediation in the patient–provider relationship arising from the introduction of digital technology for a specific form of monitoring: 'clinical self-tracking'. Focusing on the management of type 1 diabetes, a condition that requires significant self-management by patients, we describe how the actors negotiated a new ICT-mediated relationship in three hospital departments. The analysis followed a qualitative design and was carried out by interviewing patients, clinicians and technology developers and by analysing messages exchanged through the ICT tool. We first show how each department customised the system by drawing on already existing care practices, organisational goals and representations of the department's desired relationship with the patients. We then focus on patient–provider relationships, showing that, while the clinical self-tracking sometimes followed the path desired by the providers, at other times, it developed in unexpected ways. We distinguish among three emerging categories of self-tracking: self-tracking for remote management, self-tracking for e-learning and self-tracking as boundary setting. The analysis reveals how the new patient–provider relationship arises from an open-ended process. Providers can push self-tracking practices but cannot steer them; and patients, through an unexpected use of the self-tracking technologies, are able to negotiate a desired relationship with providers. [ABSTRACT FROM AUTHOR]

In recent years, society has witnessed a proliferation of digital technologies facilitate new ways to monitor young people's health. This paper explores a group of English adolescent girls' understandings of 'health' promoted by health and fitness related technologies. Five focus group meetings with the same 8 girls, aged between 14 and 17, were conducted to explore their experiences of using health and fitness apps. The girls' understandings of the digitised body are examined through a Foucauldian lens, with particular attention to conceptualisations of bio-power and technologies of the self. The data reveal how the girls negotiated, and at times critiqued, the multiple health discourses that are manifest through digital health technologies and performative health culture. The results emphasise that individual-based applications (apps) remove the social and interactive elements of physical activity valued by the girls. This research highlights the possibilities digital technologies provide for health promotion, yet also illuminates the limitations of these technologies if used uncritically and inappropriately. [ABSTRACT FROM AUTHOR]

Amphetamine Type Stimulants (ATS) are increasingly used drugs globally. There is limited evidence about what shapes ATS use at critical turning points located within drug using pathways. Using turning point theory, as part of a life course approach, the ATTUNE study aimed to understand which social, economic and individual factors shape pathways into and out of ATS use. Qualitative, semi-structured interviews (n = 70) were undertaken with individuals who had used ATS, or had been exposed to them at least once. Our findings show that turning points for initiation were linked to pleasure, curiosity, boredom and declining mental health; increased use was linked to positive effects experienced at initiation and multiple life-stressors, leading to more intense use. Decreased use was prompted by pivotal events and sustained through continued wellbeing, day-to-day structure, and non-using social networks. We argue that the heterogeneity of these individuals challenges stereotypes of stimulant use allied to nightclubs and 'hedonism'. Further, at critical turning points for recovery, the use of services for problematic ATS consumption was low because users prioritised their alcohol or opioid use when seeking help. There is a need to develop service provision, training, and better outreach to individuals who need support at critical turning points. [ABSTRACT FROM AUTHOR]

The large number of international medical graduates (IMGs) working in Australia, and many other countries around the world, has received significant attention from the media, governments and academia. These institutions utilise a number of classificatory schemes in order to categorise IMGs. Such classification is often stigmatising, yet goes largely unquestioned. In this paper I show that the 'official naming' of IMGs in Australia, as well as the naming of IMGs by staff in hospitals, is historically, politically and socially produced. Following Bourdieu's call to also study how the classified classify, the paper goes on to examine ways in which IMGs name and categorise each other, drawing on ethnographic research. I argue that IMGs use classification themselves, strategically, in order to modify their marginalised position within the 'social space' of the hospital. The article questions taken-for-granted assumptions about classified groups such as IMGs and leaves an opening for change. [ABSTRACT FROM AUTHOR]

In this article, we examine the ways transitions are constructed and represented within healthcare settings vis-à-vis lived experiences. Drawing on in-depth interviews with transgender people and data from a document analysis, we examine how transgender peoples' experiences fit within conceptualisations of transition(s) in healthcare guidance documents used in England. We take up Pearce's ([2018]. Understanding trans health. Bristol: Policy Press) suggestion to (re)think trans beyond 'condition', and rather as 'movement', to view being trans as a social identity rather than a defect. Our findings show how trans people and transitions are imagined through often linear narratives of movement in/out of transition. Through this framing, fluidity and gender liminal spaces are made invisible, where health care is imagined for certain transitions but not others. Our analysis attends to tensions that emerge in the complexity of transition(s) as well as the intricate ways in which transgender people are responding to often restrictive ontologies of medical transition. As a conceptual tool, 'trans as movement' can be used to create space for more expansive ontologies of gender that confront the harms and restrictions imposed by the gender binary, and offer alternative ways of (re)imagining multiplicity in transition trajectories and futures for both those in healthcare delivery, and for trans patients. [ABSTRACT FROM AUTHOR]

Access to medical care is significant for many transgender young people and their families, which involves interactions with healthcare professionals. While a trans affirming model is used across Australian paediatric gender clinics, this does not automatically mean that all transgender young people and their parents experience the care they receive as affirming. This article considers the experiences and views of transgender young people (aged 11–17) and their parents in relation to healthcare professionals inside and outside of gender clinics in Australia. Ten qualitative interviews were conducted with parent–child dyads in two Australian states. Key themes relating to healthcare professionals were: differing levels of healthcare professional knowledge and affirmation, quality of service is dependent on individual healthcare professionals, and lack of connected services and referral pathways. The discussion explores specific issues arising from the findings that suggest implications for training for healthcare professionals so as to be better equipped to provide trans affirming clinical care. [ABSTRACT FROM AUTHOR]

The need for the poor, the marginalised and socially excluded to live healthier and longer lives has in recent times become paramount in the development literature and policy discussions seeking to achieve the Millennium Development Goals (MDGs). In response to this, attempts are being made to redirect the research focus to examine socio-economic factors underpinning disease occurrence and ill health for health planning policies and practices to benefit the poor and vulnerable in society. Tliis paper explores the relationship between socio-economic conditions and health outcomes. It identifies and examines through participatory rural assessment techniques, basic socio- economic factors acting as significant pathways through which poverty increases the susceptibility of rural households to diseases. It seeks to address the reasons why the poor are poorer in health in rural communities of the Amansie West district of Ghana. This paper thus emphasises how social stratification and inequalities could affect quality of life of people in any given society, hence supporting the theory of social suffering and its implications on societal health. [ABSTRACT FROM AUTHOR]

This paper examines the differential incorporation of acupuncture and homeopathy into the medical establishment in Portugal. While the former has been incorporated into the medical establishment, the latter is still banned by the Medical Council, yet remains in practice by medical doctors in the country. Drawing on the insider viewpoints of medical doctors committed to these two therapies, the findings of this paper suggest that the rhetoric of insufficient scientific evidence of homeopathy still prevails within the medical establishment. However, two other factors were emphasised: the medical prejudice or 'resistance to innovation' of the Portuguese Medical Council and the idiosyncrasies of acupuncture and homeopathy, which have made them amendable to biomedicine (or not). This paper argues that the differential responses of the Portuguese medical establishment to acupuncture and homeopathy are due to reasons beyond that given of the medical rhetoric of insufficient scientific evidence for homeopathy, and which extend to issues of professional status and power. This paper suggests that the emerging commercial interest of the pharmaceutical industry in homeopathy's pharmacopeia worldwide could enhance homeopathy's status in the country and could therefore pressurise the medical orthodoxy to redress its position towards this therapy. [ABSTRACT FROM AUTHOR]

This paper explores the intersection of gender and class concerning welfare clients with medically unexplained symptoms. The study is conducted in Denmark using qualitative interviews with welfare officers and clients. The paper's focus is on how issues of gender and class intersect in the negotiation of illness among welfare officers and clients. The particular client group in question consists of individuals that are defined by their lack of a bio-medical diagnosis. Their 'lack' of identity accentuates how gender and class become central in the categorisation practices, constructing the ill person as either bio-medically sick or as a person who may be suffering but only from diffuse psychological problems. The paper shows that it is predominantly poorly educated women without a bio-medical diagnosis that welfare officers describe as suffering from psychological problems despite the fact that the women themselves focus on physical ailments in their illness stories. Men and better-educated women are described by the welfare officers as tired and exhausted or truly stressed after a long working life. [ABSTRACT FROM AUTHOR]

The relationship of parents and infants is ruptured at birth in the context of urgent issues such as congenital heart defects. The infants referred to in 10 semi-structured interviews had undergone cardiac surgery in a children's hospital in Australia and were participating in a new programme known as Heart Beads instigated by the cardiac ward nurses. Within the biomedical context infants are often alienated from their parents and treated as isolated bodies. The paper discusses the social implications of an ill or deformed child and the role of narrative in addressing social demands and the problems faced by parents in infant intensive care contexts. It is argued that theorising the infant within a relational framework allows agency to be attributed to the infant and parents while also recognising the importance of the intimate social world and interactional context that it is expressed within. The paper draws on Nick Crossley's relational sociology to highlight the importance of the relational embodiment that encompasses infants within a social world preceding them and enveloping them. The narrative is developed by parents in order to facilitate the social expression and integration of their child and thus plays a particularly social role in the context of infant surgery, rather than serving to adjust the individual to new circumstances. Exploring the role of narrative in this social relational sense is important for bringing the mother and the family back into the context and survival of the infant both physically and socially. [ABSTRACT FROM AUTHOR]

This paper reports the results of a study of experiences of Victorian State school teachers undergoing the Victorian WorkCover Authority's stress claim process. The claimants reported experiencing the process as alienating and disempowering. The injured teachers found the claims process overly procedural and impersonal. The study evidences perceptions of a power and resource imbalance from the claimants' viewpoint. These imbalances rendered navigation of claims processes problematic. This paper argues for reform for less bureaucratic and less hierarchically intimidating processes, facilitating experiences that are less marginalising, dehumanising and more efficacious for injured teachers. [ABSTRACT FROM AUTHOR]

Aboriginal and Torres Strait Islander people are the Indigenous people of Australia. The prevalence and burden of chronic disease among them is significantly higher than that of non-Indigenous Australians. This paper describes the chronic illness experiences of 19 Aboriginal and Torres Strait Islander people living in urban areas in terms of their strategic representations of self. Participants in this study used techniques of revealing and concealing chronic illness. These strategies were employed in multiple arenas - among family, among broader community, and in specific spaces including health care services. They highlight tensions that arise through the intersection between the desire to preserve family and community life, and the ways in which the physical body manifests chronic illness. In this paper we bring together notions of time (drawing on Zimbardo's time perspectives theory) and biography (drawing on Bury's disrupted biography theory). Through an analysis of shifting boundaries we conduct an exploratory investigation of the ways in which urban Aboriginal and Torres Strait Islander people in this study weave together elements of both past and future perspectives to mobilise modes of self-representation and agency in their management of chronic illness. We then consider some options for primary health care. [ABSTRACT FROM AUTHOR]

This paper starts from the premise that embodied knowledge is critical to understanding health policy implementation. We explore this notion through a qualitative investigation of the way that knowledge has functioned in the implementation of an Australian mental health policy, Partners in Recovery (PIR). Analysis uses the theoretical lens of interpretive policy analysis and the 'embodied, inscribed, enacted' knowledge schema developed by Freeman and Sturdy [(2014a). Introduction: Knowledge in policy – embodied, inscribed, enacted. In R. Freeman & S. Sturdy (Eds.), Knowledge in policy: Embodied, inscribed, enacted (pp. 1–19). Bristol: Policy Press]. Our analysis reveals a policy problem centred around difficulties of coordination where the inscribed solution lies in individuals who must implement the PIR program in local areas. Our interviews with PIR consortium members and stakeholders show that this implementation happens through the enactment of embodied knowledge. However this implementation is not straightforward and we point to difficulties arising from the centrality of embodied processes in implementation, related to the localisation of systems knowledge in individuals and structural devaluation of certain types of knowledge over others. [ABSTRACT FROM AUTHOR]

The HIV epidemic in the Philippines has been expanding rapidly, with most newly diagnosed cases occurring among 'men who have sex with men' (MSM). New social contexts of HIV are evident in the evolving phenomenon of more MSM seeking partners online via social networking applications ('apps'). This study examines findings from a virtual ethnography of app use among MSM, focus group discussions with community-based healthcare workers, and key informant interviews with healthcare workers, policymakers and researchers in Metro Manila. We argue that participants viewed the expanding epidemic and apps as intimately linked, regarding the apps as 'risky spaces' for 'risky behaviour'. However, such narratives neglected the agentive capabilities of the apps and how they have transformed sexual practice, creating new ways of being as sexual subjects, while perpetuating old imaginaries among healthcare workers of 'hard-to-reach' populations. Such narratives of 'risk' have led to new interventions by healthcare workers on the apps, viewing these technologies as opportunities to reach more MSM for health promotion. However, the interventions have created new complexities by reconfiguring boundaries with target populations. By conducting community-based outreach through encouraging behaviour change in one-to-one interactions with app users, the potential impact of these interventions is limited. [ABSTRACT FROM AUTHOR]

In recent years, Talcott Parsons' work has come under renewed scrutiny by sociologists who argue that his concept of the sick role has a role to play in current accounts of health and illness. In this paper we describe the ways in which Australian women who had undergone elective risk-reducing breast surgery (with or without ovarian surgery) spoke about their convalescence. Women presented two contrasting recovery narratives in describing their experiences, with the negative effects of breast surgery either minimised or emphasised. In an effort to explain these differences, we draw upon the Parsonian concept of the sick role and argue that the extent to which women either embraced or rejected the sick role in their accounts was related to the amount of external legitimation they had received from healthcare professionals. We conclude that the concept of the sick role may provide useful insight into women's experiences of risk-management today. [ABSTRACT FROM AUTHOR]

This study examines experiences of living with chronic illness for haemodialysis patients. In order to understand these experiences the paper takes an existential-phenomenological approach. Interviews of seven participants (five males, two females) were collected in a haemodialysis clinic. Based upon the participants experiences three core themes emerged: (1) the challenges of living with chronic renal failure; (2) body changes and embodiment; (3) their illness experience and social relationships. The findings suggest that the illness experience of chronic renal failure is an on-going struggle to attain a sense of control. We suggest that where a sense of control is limited this can create a sense of powerlessness. Further, the illness experience was not solely restricted to the individual, but also affected wider social relationships. It is only through taking into account the context of patients experience of illness that clinicians/nurses can meaningfully draw on all aspects of evidence to reach integrated clinical judgement. [ABSTRACT FROM AUTHOR]

The branding of ayurveda as a market strategy for the health consumer has become an important factor in the creation of 'New Age orientalist desire'. Using Vedic Village as a case, this paper shows how new age orientalism has been spread in modern India to middle class professionals, entrepreneurs and overseas health tourists. With this representation, ayurveda has become a wellness therapy instead of a means to restore health, and affluent people can now buy a package of 'ayurvedic healthy life' without changing their lifestyles. In addition to Euro-American health tourists, emerging middle class professionals and entrepreneurs in modern India have also become an integral part of the process of 'new age orientalization'. This paper concludes that the commodijied version of ayurveda, which has been developed in the West as part of 'wellness and spa culture', has become popular among the affluent middle class in India and abroad today, and through this the West has claimed and justifies authority over Eastern medicine. [ABSTRACT FROM AUTHOR]

This paper presents the findings of a qualitative study of the impact of casualised and independent contractor work place arrangements on the psycho-social health of 72 workers in regional Victoria. It contributes to our understanding of the crisis in rural Australia in its use of qualitative methods focusing on the impact of work on health and well-being. There is some evidence in the literature that casualised work arrangement enhance the health and well-being of workers by giving them a sense of autonomy and freedom to negotiate their conditions of work. On the other hand, these arrangements may make an already vulnerable group even more vulnerable to uncertain work conditions, poor pay and uncertainty for their future with a significantly negative impact on their health and wellbeing. The results of these interviews support this latter perspective and show that these workers do not experience freedom and autonomy, but rather lowered social status, insecurity and serious limitations to their ability to manage their health, psychological wellbeing and social relations. [ABSTRACT FROM AUTHOR]

This paper reports on a qualitative study of the onset of acquired hearing impairment. The focus of attention is why a person seeks treatment. The Danish welfare state serves the population 'in need' such as those with an audiological need and gives them guidance on becoming hearing aid wearers in order to rehabilitate them back to 'normalcy'. However, within audiological research, noncompliance has attracted much attention as investigations have shown that more than 20 percent of hearing aids are very seldom, if ever, in use and 19 percent are used only occasionally. As shown in the paper the form a problem takes is in large part a product of micro-political struggles. Hence, at the onset 'need' is often embedded in social pressure from significant others. The paper examines these two discursive frameworks and their constitution of (hearing) problems and concludes that norms of disease are complex and epistemologically contested and can help explain why noncompliance is dominant when it comes to hearing rehabilitation for hearing impaired adults. [ABSTRACT FROM AUTHOR]

When a person experiences a severe stroke, their relatives must assume the role of partners in the rehabilitation process. Drawing on Bourdieu's field theory, we investigated the potential gap between the subjective expectations of relatives in terms of the assistance and care they can offer patients with severe brain injuries and the objective constraints of a healthcare field. Using data from observations, as well as interviews with relatives and official documents, our study shows how some relatives, reliant on their habitus, bring to their collaboration with healthcare professionals an expectation that the healthcare field will be able to take care of their multiple individual needs. However, due to hysteresis – a gap between their dispositions and the objective possibilities of the transformed healthcare field – these relatives are not equipped to recognise, grasp and occupy their new field position. We conclude that Bourdieu's theoretical concept of hysteresis may help to understand how changes in the healthcare field may lead to a mismatch between the field and the habitus manifested in interactions between patients, relatives and healthcare professionals, so that the ill-adjusted habitus of relatives leads to missed chances in relation to the opportunities objectively offered by the field. [ABSTRACT FROM AUTHOR]

The broadening of access to HIV pre-exposure prophylaxis (PrEP) in Australia has rekindled debates about which types of clinicians are best suited to deliver HIV prevention innovations: specialist HIV services or primary care physicians and general practitioners (GPs). We conducted 21 semi-structured qualitative interviews in 2017 with Australian HIV sector experts working across policy, advocacy, clinical service provision, research, and health promotion. These interviews took place before a national policy commitment to subsidising access to PrEP was achieved. We explored how participants conceptualised PrEP, patients and GPs at this key turning point in the history of HIV prevention. Participants expressed varied views regarding GPs' anticipated ability to successfully navigate the potential complexities associated with PrEP roll-out. While participants were supportive of greater patient access to PrEP, they expressed concerns about non-specialist GPs' cultural competence and expertise regarding sexuality and clinical practice, and the potential for patients to experience discrimination and homophobia from non-expert GPs. This study has broad implications for thinking about experts and expertise, the implementation of previously specialised medicine into mainstream settings, and the anticipated challenges of LGBTIQ+ inclusive healthcare. [ABSTRACT FROM AUTHOR]