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Domestic violence against women is a complex social phenomenon and a widely recognised issue of public health, which requires that all sectors of society, including the health sector, take the necessary action to prevent and address it. This paper aims to contribute to the discussion on the role of the primary health care in addressing domestic violence against women, by analysing health professionals' perceptions of their practice as well as the difficulties they experience in providing healthcare to victims. To fulfil this aim, a qualitative approach was chosen, using focus groups with health professionals working in the area of primary health care in an inland region of Portugal. The main findings point to the lack of a specific protocol and insufficient information and skills to respond to domestic violence situations, which hinders health professionals' confidence to intervene and tends to orientate them towards a more medical response. Resulting from these findings, implications for practice are discussed: the need for clear and specific orientations to guide health professionals' intervention; the need to offer training that enables them to provide appropriate healthcare to women experiencing domestic violence; and the need to position themselves in the context of an integrated, multi-sectoral intervention. [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]

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]

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]

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]

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]

Health promotion, as one tool of hospital managers to reorient hospitals towards more client-oriented healthcare services, has been emphasized for almost three decades. Yet, it is recognized that change in hospitals is challenging and is more desired than substantially enacted. To overcome organizational challenges, health promotion has, so far, adapted organizational change strategies primarily applied in business organizations. However, in this paper, it is argued that such strategies do not adequately reflect the nature of hospitals as 'professional organizations'. To gain a better understanding of the challenges for health promotion reorientation, this paper combines well-established theories from the sociology of professions and organizational science. These theories provide a useful framework that advances the role of professionals as powerful agents within any reorientation efforts in hospitals. This framework guided the narrative review of empirical literature on critical dimensions along which professionals engage with reorientation efforts in hospitals. Accordingly, specific managerial strategies to facilitate health promotion reorientation are formulated. With its theoretical underpinnings and related empirical studies, the paper offers a new perspective on the challenges of implementing health promotion and proposes strategies that may help hospital managers to push forward health promotion reorientation in their organizations. [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 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]

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]

Many healthcare workers are 'on the move' as part of their employment, travelling often great distances to such places as patients'/clients' homes and community clinics. Healthcare workers' experiences of this employment-related geographic mobility have been relatively invisible even though mobility is necessary for home and community care. Interviews with professional (e.g. nurses) and paraprofessional (e.g. personal care assistants) healthcare workers in Nova Scotia (Canada) found that mobility includes safety risks, and health and economic costs, although a few professionals had employment contracts that helped to protect them against such risks and costs. Paraprofessionals appear to be most impacted by the economic costs given their lower incomes. Many healthcare workers also experienced travel positively, as time away from fixed sites, and associated this time with freedom. The risks of mobility were understood by some workers as part of a duty to care, but a few suggested that the health and economic costs are an undue burden, pointing to an opening for challenging these conditions. There is a need for regulations to ensure all healthcare workers are safe as they are mobile to and from fixed sites, and do not have to shoulder the health or economic costs of mobility. [ABSTRACT FROM AUTHOR]

Individuals’ perception of their work as meaningful contributes to their sense of identity. While individual processes of identity development through work have been studied extensively, we know little about how social processes may contribute to this development. This article seeks to better understand social processes of professional identity development through work by examining nurses’ reactions to changes in their end of shift reports. Field observations were conducted with two healthcare teams on the internal medicine ward of a Swiss teaching hospital. During the observation period, organisational changes in end of shift reports, a crucial time in nurses’ shift, were introduced to the teams and then implemented. Before the changes, nurses used individual and collective strategies to make their work meaningful and to affirm their professional identity. Individually, nurses sought recognition from their co-workers during end of shift reports. Collectively, nurses resorted to professional values and discourses that set them apart from other professional groups. However, changes in shift reports threatened these strategies. This article shows how nurses make their work meaningful in the eyes of others and how others’ recognition contributes to nurses’ sense of professional identity. [ABSTRACT FROM AUTHOR]

A research-to-practice gap was identified in a study on knowledge sharing regarding future cardiovascular disease (CVD) risk associated with a previous diagnosis of pre-eclampsia (PE) during pregnancy, where 41% of healthcare practitioners did not inform patients of increased risk more than 50% of the time. Employing an empirical, sociological lens, we conducted interviews with women and healthcare providers from the same sample as that study. In this article, we analyse participants' perceptions of and attitudes towards the relationship between PE and CVD risk, assessing how relationships between research findings, risk, pregnancy, and women's health are understood and acted upon in Canadian healthcare. Relating empirical observations to larger debates surrounding knowledge sharing practices, we argue that structural, practical, and ideological barriers impede knowledge sharing between healthcare practitioners and patients. Patient perceptions and experiences of the knowledge sharing gap must be addressed in practical and structural changes to healthcare. [ABSTRACT FROM AUTHOR]

The Complementary and Alternative medicine sector has grown enormously since 1980. Western Herbal Medicine (WHM), located within this domain, is a traditional therapeutic system that has enjoyed this recent public acceptance. Scientific evidence supporting therapeutic actions of plants employed in WHM has inspired public confidence. Today the herbal product industry is big business, employing sophisticated pharmaceutical manufacturing processes and competitive marketing strategies for phytomedicines with little resemblance to living plants. The literature reports a divergence of views among practitioners seeking to identify central tenets of contemporary WHM and cites herbalists who are resisting the commodification of herbal medicine. This study employs qualitative research methods to examine the blogosphere for evidence of this group using a combined purposive sampling approach and thematic analysis of blogs meeting predetermined inclusion criteria. The search revealed a group of bloggers who voice concerns about the direction WHM is taking and are ethically responsive to global environmental pressures. They share the common value that WHM should remain a healthcare option that empowers and supports the community and suggest this is best achieved by maintaining and sharing fundamental skills of plant identification, simple herbal product manufacturing and incorporating both science and tradition in their herbal practice. [ABSTRACT FROM AUTHOR]

In France, the last decade has been marked by an extensive development of public interventions in the field of mental health. The political investment in mental health has been the object of a public debate in which prevention was perceived by professional opinion leaders as a mean for politics to implement social control policies. However, it seems that the vigor of these condemnations has jeopardized the opportunity to initiate a debate on the ethical, sociological and epistemological foundations of prevention in mental health. Aim and method: EPIONE study was set up to meet the need for psychosocial research to evaluate the social representations of prevention in mental health professionals in charge of prevention, within the French context. Using one open-ended question ('What do you think about prevention in mental health?'), representations from 616 professionals were analyzed through a computer-assisted process (Alceste software) and according to Denise Jodelet and Serge Moscovici models of social representations. Results: Results pointed out an important discrepancy between the political discourse and the social representations of professionals, who understand the field of prevention as intimately related to curative practices. Professionals do not seem concerned by preventive 'top-down' policies, which they perceive as technocrats' issues. Finally, only a third of the total responses was related to the criticisms addressed to prevention, suggesting that mistrust toward prevention was not as developed among field professionals as it might seem when reading the most visible critical publications. Conclusion: We suggest that, in order to adapt public health and prevention policies, decision makers will have to rely on professionals' background and on the field reality, as well as the epistemological, sociological and ethical problems raised by public prevention in mental health. [ABSTRACT FROM AUTHOR]