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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]

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]

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]

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]

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]

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]

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]

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 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]

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 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]

This article presents an analysis of interviews with Australian women who had smoked or were currently smoking during pregnancy. It explores how they spoke about their experiences of smoking, cessation and harm minimisation during pregnancy. Eighteen women underwent a single in-depth interview, these were analysed using an iterative thematic method. We found that smoking, cessation and harm minimisation by pregnant women are complex social practices. Participants viewed smoking as a potential risk to fetal health and as an actual risk to their own health and described feeling embarrassed and ashamed of smoking when pregnant. Their opinions about the relative seriousness of health risks posed by smoking when pregnant were often informed by their own personal observations and experiences. Participants used this knowledge to engage in lay epidemiological processes as they rationalised and made sense of the relative risks of smoking, quitting or cutting down. They also sought legitimacy for their claims about the safety of quitting or cutting down in two potentially contradictory ways. These were personal experience/observations and medical advice. Our findings contribute to sociological understanding about lay responses to medical advice on smoking in pregnancy and will be of value to healthcare professionals who work with pregnant women. [ABSTRACT FROM AUTHOR]

In the context of persisting health inequities within many multicultural and socially diverse countries like Australia, there is a call for health services to implement culturally inclusive systems and practices. Nowhere is this more important than in regional, rural and remote Australia where consumers are diverse, health services are scarce, and services designed for particular groups of the population are lacking. Drawing on interviews with 20 staff of a rurally-based, mainstream community health service, this article examines the role of discourse in the transition to a culturally inclusive health centre. In doing so, the power struggles inherent in such a process are highlighted. The article contends that improvements in the health outcomes of First Nation and culturally Other groups within the Australian population is contingent upon systematic resistances that disrupt and re-arrange existing dominant discourses. This calls for a disruption of current race relations in both broader social fields as well as those supporting biomedical assumptions about the delivery of healthcare in the mainstream health sector. Alternative discourses must be promoted in both these fields. [ABSTRACT FROM AUTHOR]

Cancer is a multifaceted entity with recent developments in treatment only increasing this diversification. Yet, some cancers are less common, lesswell understood, and receive less attention. Taking neuroendocrine tumours (NETs) as a case study, we explore the lived experience of people with a type of cancer that is virtually unknown among the general population. Drawing on interviews with 30 people living with NETs in Australia, we explored how their experiences are shaped by social and cultural understandings of cancer, and the tensions between chronicity and terminality. We found that people with NETs draw on common narratives around cancer to make sense of their diagnosis. However, NETs were understood as atypical, because they are often incurable, slowly progressing and not associated with treatment side effects such as hair or weight loss. The embodied effects of NETs made them unrecognisable as cancer to participants and community. The specificities of the NET illness experience resulted in the need to reframe narratives around agency and positivity. This hindered social recognition but also provided opportunities to bracket illness and gain some control over the illness experience. The findings of this study highlight the importance of recognising multiple modes of living with cancer. [ABSTRACT FROM AUTHOR]

Hepatitis C (HCV) is a stigmatised disease due, in part, to an association with injecting drug use. Aboriginal Australians, a stigmatised group, are over-represented in patterns of HCV infections. We examined the experience of Aboriginal Australians living with HCV using qualitative in-depth interviews, paying particular attention to instances where multiple stigma mechanisms (relating to HCV, injecting drug use and Aboriginal identity) overlapped. Stigma held a central role in the experience of most of the 39 participants with reports of exclusion and alienation from families and communities. HCV-related stigma was accompanied by the notion of 'shame' which holds deep cultural significance for Aboriginal people. Participants' accounts revealed overlapping stigma in their perception that others 'automatically' expect Aboriginal people to have a stigmatised disease such as HCV. HCV as a contemporary expression of colonisation was also woven into accounts of HCV-related stigma. Interventions to reduce HCV stigma should be specifically designed for minority populations to account for multiple, overlapping sources of stigma. [ABSTRACT FROM AUTHOR]

This article discusses some emerging issues that arose during a much wider evaluative investigation of the Western Australian Health Department's bed-sharing policy and how effectively health professionals provided advice to parents. The broader evaluation report was developed for a clinical and health bureaucratic, policy-making audience. In contrast, this article adopts an approach that is more sociologically informed to tease out some of the social and cultural discourses that influence how bed-sharing advice was interpreted and used by the mothers interviewed for the study. We ponder the influence of current parenting discourses on parental decision-making, including those that construct fathers as 'involved' and mothers as 'intensive', as well as the theory of 'attachment parenting', which has enjoyed something of a resurgence in Australia. We also touch on and alert to the differences in responses to this information reported by the Aboriginal and non-Aboriginal women interviewed for the study. This article highlights areas that may require further consideration and investigation by social and health researchers in maternal and child health, as well as practitioners involved in the development or delivery of bed-sharing information for parents. [ABSTRACT FROM AUTHOR]

Many doctors migrate to find work opportunities elsewhere. Before being allowed to practice, these doctors, commonly referred to as International Medical Graduates (IMGs), must gain local registration, which can take considerable time. During this process many IMGs linger on the margins of hospitals, without medical employment. We follow this understudied group of IMGs in Melbourne, Australia, to understand their life on the margins of medicine. This takes us into hospital places on the fringes of clinical activity: a cafeteria, tutorial room and hospital library. We argue that these places are important for the doctors in retaining and strengthening their sense of professional identity in precarious circumstances. The IMGs find creative ways to inhabit familiar settings, creating their own pathways, to find their way into the local medical system. This analysis is in contrast to more common Foucauldian interpretations of hospitals that present the institution as having a structured, disciplining effect on its inhabitants. [ABSTRACT FROM AUTHOR]