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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]

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]

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]

Using data from the Nairobi Urban Health and Demographic Surveillance System (NUHDSS), this paper seeks to understand the characteristics of adolescent girls who are circumcised in Kenya. The paper discusses the determinants of female circumcision in two Nairobi informal settlements. It is based on detailed information collected from young persons aged 12-24 targeting major transition events such as first sex, childbirth, marriage, and circumcision. Out of 4058 adolescents and young people interviewed 2010 were adolescent girls and young women. Out of the total number of interviewees, the 527 girls and young women on whom this paper is based are from ethnic communities that practice circumcision. We used the life-table technique to estimate the median age at circumcision and logistic regression to analyse the relationship between female circumcision and adolescent sexuality, controlling for other characteristics. The type of stay within the demographic surveillance area (DSA), religion, ethnicity, residential location and mother's education were associated with being circumcised. Current school attendance was not associated with being circumcised but if one had never attended school then they were more likely to be circumcised. For policy making, it is imperative to explore the nature of social networks within which circumcision decisions are taken and enforced. [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 explores which measures of health accurately reflect the functional capabilities of individuals -- that is, in what measures of health do those classified as having poorer health actually have poorer functional outcomes. Using the 2003 Survey of Disability, Ageing and Carers, cross-tabulations, chi-squared analysis, and logistic regression models were used to identify the relationship between functional outcomes (core activity limitations and employment and education participation) and various measures of health and disability (composite disability measure, health utility scores and general health assessment). Both the composite disability measure and the health utility score accurately capture individual functional capacity -- with both measures being related to employment participation, employment and education restrictions, and core activity imitations. The health utility scores can also be divided into a categorical measure and still reflect this functional capacity. The general health assessment measure is also related to functional capacity and can potentially be used in the place of both the composite disability measure and the health utility score. [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 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 this paper we report on the findings from six focus groups conducted with Australian medical students. The focus groups discussed students' perceptions of conflicts of interest and the influence of commercial values in health care and medical education. Our research revealed that students were aware of a number of structural influences that affected the medical education they received and that had the potential to shape their attitudes and practices as they progressed in becoming a doctor. We found that the pressures of educational workload and anticipated career trajectories tended to have an individualising effect that limited the perceived possibility of collective action and response to structural influences. We interpreted these findings through the lens of neoliberal governmentality to articulate the way commercial interests are negotiated and normalised by medical students. Based on these findings, we suggest that medical education should not only explicitly alert students to effects of political and commercial influences on the healthcare system, but also encourage the collective agency of students and strategies that do not place unrealistic expectations on individuals to effect structural change. [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 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 paper explores how the structuring of places and time influence Aboriginal and Torres Strait Islander patient and carer experiences of health services. Face-to-face in-depth interviews were conducted with urban Aboriginal and Torres Strait Islander people with diabetes, chronic heart failure or chronic obstructive pulmonary disease as well as family carers (N = 19). Content analysis was undertaken. Participants report that each element of the time spent in Aboriginal Medical Services is seen as more valuable and worthwhile than in mainstream health services, from social and health sharing experiences in the waiting room to health care in clinical places; and that users feel they can rely on sufficient time and respectful care in their clinical consultation. Purposeful design of both physical and temporal aspects of health services is called for. We suggest re-introducing opportunities for spatiotemporal design in health care that have been limited by the segmented 'person as illness' design features of Australia's current mainstream health system. [ABSTRACT FROM AUTHOR]

Dementia education and management is a major challenge nationally. However in the remote Aboriginal context, where the prevalence of dementia is five times greater than the national rate, the challenge is made more complex by cultural and linguistic differences between providers and consumers. Tins paper presents findings from the evaluation of a targeted dementia awareness resource piloted in three Aboriginal languages as well as English. It focuses on the intercultural communication aspects of the evaluation adding to the limited body of knowledge about communications with speakers of Australian Aboriginal languages. It identifies elements of effective intercultural communication in dementia education, implications for health literacy and considers the difference that culturally safe intercultural communication can make to a single issue such as dementia awareness. [ABSTRACT FROM AUTHOR]

Scientific-bureaucratic medicine (SBM) has been the dominant discourse on evidence-based medicine in the English National Health System (NHS). It has being claimed that SBM has led to new forms of medical professionalism with an emphasis on organisational values and the control of autonomy. This paper explores the medical professions' response to SBM, where SBM is manifested in the form of National Institute of Health and Clinical Excellence (NICE) guidelines. Seventy-four face-to-face informal interviews were carried out with clinicians and managers between 2007 and 2009. Three major themes emerged from the analysis each of which was linked to doctors' receptiveness to NICE guidelines implementation. The first emphasised organisational values, which accounted for conditional acceptance of NICE guidelines. The second was proactive professionalism or entrepreneurial professionalism, which was linked to the rejection of NICE guidelines and the emergence of alternative forms of introducing new ideas for the expansion of their clinical practice. The third was related to the prominence of clinical autonomy linked with doctors' resistance to the use of NICE guidelines. It is argued that this evidence does not reflect a significant emergence of new forms of professionalism but the development of multiple occupational identities. [ABSTRACT FROM AUTHOR]

This paper draws parallels between the market trend in the English NHS and Polanyi's (1957) The Great Transformation: The political and economic origins of our time, Beacon Press: Boston (originally published in 1944 in the United States as The Great Transformation, Rinehart: and Co: New York, and in 1945 in England as Origins of our time, Gollancz: London) account of how the rise of markets provokes a self-protective counter-reaction that tries to re-embed economic relations in social relations. We report findings from a qualitative study of NHS contracting, which examines the recent move to harder-edged contracts with greater use of financial penalties and incentives. In practice, use of these techniques tended to be confined to nationally-mandated sections of the contract rather than emerging from local bilateral agreements, and when things went wrong the parties relied more on cooperative behaviour than on the provisions of the contract to find solutions. Making the current contracting system work depended more on existing relational networks than on the incentive structures created by recent 'marketisation' initiatives, but the inability of the market to evolve as expected has encouraged policy makers to publish plans for further radical reforms. [ABSTRACT FROM AUTHOR]

The increased use of information technology in health care allows researchers to generate data on rates of medication use among population groups, raising questions as to whether these rates are too high or too low. This paper presents findings from a study of records of all prescription medication dispensed in one New Zealand region (Te Tāirawhiti) over a one year period. The study examined patterns of psychotropic medication use amongst older people, by age, gender, ethnicity and socio-economic position. It concludes that the chances of being defined as needing psychotropic medication, that is, of being 'medicalised', are not evenly spread through the elderly population. Gender, age and ethnicity impacted significantly on whether prescriptions were received. Our results suggest the need for a nuanced understanding of the medicalisation of unhappiness and deviant behaviour amongst the elderly which takes into account barriers to treatment for some social groups. [ABSTRACT FROM AUTHOR]

Despite almost two decades of reform under Australia's National Mental Health Strategy, the life circumstances of many people with mental illness seem little improved. While lack of rehabilitation, housing and community support services have been blamed for policy shortfalls, there is also concern that mental health services may impede rather than facilitate recovery from mental illness. To explore this particular concern, this paper reports data from a project which evaluated a group mentorship programme for new graduate nurses working in an Australian public mental health service. Prominent among the problems raised in mentorship group discussions were: the arduous nature of mental health work; the uncaring attitudes and practices of many veteran nursing staff; and the maltreatment and neglect of service users. These participants characterised mental health facilities as tough security-minded places, where staff act more as risk-managers rather than therapists, and all service users are treated as if they might be dangerous. They also perceived a connection between the dismissive ways in which they were often treated by veteran colleagues and the widespread mistreatment of service users. [ABSTRACT FROM AUTHOR]

This paper reports on a qualitative study of UK mental health practitioners' experiences of working with the contested condition, dangerous and severe personality disorder (DSPD). Our interviews focused on the issues of treatability, risk assessment and decision-making in multi-disciplinary teams. We discuss the approach of values-based medicine (VBM) as a useful framework for interpreting the data: respondents cited both explicit values (based on occupational training) and implicit values (based on personal beliefs and subjective perceptions). There was evidence of conflicting values -- within individuals, between occupational groups, and between individuals in occupational groups -- which led to widespread uncertainty and caution about whether and how those with 'dangerous' personality disorders could be treated. These disputes were resolved by a 'slide to pragmatism', whereby practitioners, reluctantly acknowledging their own empowerment in the process, sought to make whichever choice was least risky for their own professional reputation, and most pragmatic, given the resources available. [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]

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]

Social cohesion and socioeconomic status (SES) have been widely considered important factors influencing health services utilisation, but little is known about the association between social cohesion and health services utilisation across different SES groups. Based on a nationally representative survey, this study explores the influence of social cohesion on basic public health services utilisation in Chinese internal migrants at different SES levels. It is observed that objective and subjective cohesion forms have different effects on health record establishment and health education receipt. The positive effect of objective cohesion on health services utilisation is significantly larger than that of subjective cohesion, but two cohesion forms show similar effect sizes on health services utilisation among poor-SES migrants. With the promotion of SES, the effect size of objective cohesion gradually increases while that of subjective cohesion declines, showing a distribution of 'scissors gap'. For basic public health services utilisation, migrants not only have the agency to receive but are constrained by their SES. For migrants with poor SES, strong structural constraints hinder the utilisation of basic public health services. [ABSTRACT FROM AUTHOR]

There are numerous ways that researchers can creatively approach social research and translation. This article discusses elements from the first stages of a novel project that centres social research translation in the form of a public exhibition. 'Creative Approaches to Health Information Ecologies' is a project by a multidisciplinary research team in collaboration with an Australian health consumer organisation. The project uses creative workshop methods to explore how people learn, think, and feel about their bodies and health states, and brings attention to the significance of communities, places, spaces, objects, and other living things – the 'ecologies' of health information. It then builds on these insights to create an interactive exhibition of materials designed for public engagement. This reflexive article unpacks how this creative translation-centred collaboration contributed to the make-up of the project team, the project's research methods, and the process of making exhibition materials. We discuss what the research team learned from the process about creative collaboration, research-creation, and research translation. [ABSTRACT FROM AUTHOR]

Sociological theories seldom inform public health interventions at the community level. The reasons for this are unclear but may include difficulties in finding, understanding or operationalising theories. We conducted a study to explore the feasibility of locating sociological theories within a specific field of public health, adolescent risk-taking, and to consider their potential for practical application. We identified a range of sociological theories. These explained risk-taking: (i) as being due to lack of social integration; (ii) as a consequence of isolation from mainstream society; (iii) as a rite of passage; (iv) as a response to social constraints; (v) as resistance; (vi) as an aspect of adolescent development; (vii) by the theory of the 'habitus'; (viii) by situated rationality and social action theories; and (ix) as social practice. We consider these theories in terms of their potential to inform public health interventions for young people. [ABSTRACT FROM AUTHOR]

By applying a posthuman perspective to the analysis of care for older people (COP), we analyse the agential cuts (together/apart) enacted by humans (mainly caregivers and older people) and more-than-humans (a camera intra-acting with other objects) whose agential entanglement configures and reconfigures the political economy of the caring apparatus. Our study identifies 'targeting', 'monitoring', and 'aligning' as interrelated caring practices, thus contributing to advance a posthuman understanding of welfare technology, and advancing a critical use of the possibilities enacted by technologies. [ABSTRACT FROM AUTHOR]

Social, educational and health related equality is an ideal in the Nordic welfare states. However studies have shown that wellpositioned patients achieve better treatment and more services, for example time and examinations, than others do. This article examines how patients and relatives mobilise resources in decision-making in a stroke unit. In particular, it focuses on the challenges in optimising the rehabilitation process faced by patients and relatives, and the strategies they use. Data were generated using participant observation and semi-structured interviews. Qualitative content analysis was applied to investigate the patients' and relatives' experiences of decision-making. We present a field-specific form of capital: An individual or a family's resources that are valued in the field of rehabilitation as physical, behavioural and cognitively embedded attitudes and practices. Rehabilitation capital consists of four closely interrelated components: Performative Participation (Cognitively Embedded Performance and Self-initiating Activities), Bodily Progression, Institutional Acceptance and Institutional Potential. It is a resource potentially benefitting patients and relatives during inpatient rehabilitation and may provide patients with an advantage, to ensure the best rehabilitation. The possession of Rehabilitation capital (high or low) contributes explanations for unequal practices and treatments at a micro-level in healthcare institutions. [ABSTRACT FROM AUTHOR]

Research on cultural capital mobilised in healthcare largely focuses on how patients of low-socioeconomic status or ethnic minority groups struggle in the healthcare field. This study examines how providers, care coordinators, and administrators use their own cultural capital resources to bolster equity in health services, and explores the limitations of such efforts. Thirty-five hours of interviews with Hispanic and non-Hispanic White personnel at U.S. community health centres are used to explore how individuals on the 'supply-side' of healthcare may exhibit flexible expectations of patient cultural capital. Participants acknowledge how factors such as immigration status and family roles affect patient ability to exhibit traditionally high-value cultural capital in clinical interactions. Yet, providers' flexible expectations and cultural knowledge alone cannot deliver comprehensive care to indigent patients of colour. Persistent systemic barriers like high costs and limited public programs require healthcare workers to navigate care outside of interactions with patients. Participants describe the precarious process of drawing favours from professional social networks to coordinate access for patients facing multiple forms of social marginalisation. While acknowledging the importance of cross-cultural skills, this research explains processes impeding professional cultural training interventions in their ability to correct health service inequities on a broad scale. [ABSTRACT FROM AUTHOR]

The purpose of this research was to explore the phenomenon of the emergence of ethno-medical organisations among traditional healers from the late twentieth century. A case study was carried out on the Bolivian organisation Kallawayas sin Fronteras (KASFRO). According to the findings, KASFRO has been founded to demand formal recognition and inclusion in the national health system. Following historical discrimination against traditional medical heritage and the supremacy of the allopathic medical system, new trends of worldwide legitimisation of indigenous people's rights, as well as the worldwide acceptance of non- Western medical systems, were identified as crucial factors in the emergence of KASFRO. As a civil society organisation, KASFRO has been found to be a platform of social capital development which enables both, bonding within the Kallawaya community as well as with other traditional healer organisations (THO's), and bridging with governmental entities, which eventually led to the recognition of traditional doctors as professionals in Bolivia. These findings corroborate the roles of nongovernmental and nonprofit organisations as agents of political and social change, serving the preservation of medical ancestral cultures. [ABSTRACT FROM AUTHOR]

In this article, we provide an account of Fitbit, a wearable sensor device, using two complementary analytical approaches: auto-ethnography and media analysis. Drawing on the concept of biopedagogy, which describes the processes of learning and training bodies how to live, we focus on how users learn to self-care with wearable technologies through a series of micropractices that involve processes of mediation and the sharing of their own data via social networking. Our discussion is oriented towards four areas of analysis: data subjectivity and sociality; making meaning; time and productivity and brand identity. We articulate how these micropractices of knowing one's body regulate the contemporary 'fit' and healthy subject, and mediate expertise about health, behaviour and data subjectivity. [ABSTRACT FROM AUTHOR]

In many contemporary healthcare systems, individuals are expected to be rational actors – weighing up available knowledge and making choices about their healthcare needs. In the policy context, this has been most explicitly applied to the financing of healthcare where there is encouragement for the purchase of private health insurance. However, perceptions of public and private healthcare provision, knowledge about healthcare needs, and the types of services people choose, are far from straightforward. Drawing on Bourdieu's concepts of habitus, field, and capital, and a study of individual experiences of choice in Australian healthcare, we explore the knowledges used by people as they navigate through the healthcare system. Such navigation takes place in a milieu where authoritative medical knowledge intersects with knowledge from other sources, including the Internet and lived experience. However, our study reveals that navigation of healthcare is assisted most of all by the capacity to draw on 'system knowledge'. System knowledge takes two, sometimes overlapping, forms. First, acquired system knowledge is produced through drawing on experience, formal knowledge and the capacity to undertake research (primarily cultural capital). Second, assumed system knowledge enables navigation of the healthcare system through accessing and utilising networks of privilege (primarily economic and social capital). [ABSTRACT FROM AUTHOR]

This article explores processes of legitimising health knowledge in three different spaces: the clinic, the home and the multidisciplinary meeting. It considers the ways in which categorisation work, health understandings and therapeutic actions are intertwined. The analysis draws on ethnomethodology and actor-network theory to suggest that in the clinic consultation room, a number of interactional elements in talk about side effects and talk about unorthodox interventions attempt to stabilise the categories used by health experts. In contrast, the household is a centre of knowledge production that may subvert, manipulate or align with expert systems. Fixed and stable expert knowledge becomes flexible and hybridised inside the home. In the multidisciplinary team meeting different forms of authority are called upon in hospital-based cancer care meetings, where health professionals mix scientific understandings with other ways of knowing in determining treatment options. From these empirical observations it is argued that therapeutic actions are not subject in any simplistic way to a dominant mode of understanding, but there are many means of understanding that selectively come into play in relation to the specifics of the interaction that is occurring between patients, health professionals and therapeutic spaces. [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]

The implementation of electronic health records facilitates information sharing which can create challenges for stigma management and disclosure during the clinical encounter. Building on theories of stigma management, we analysed 30 in-depth interviews of sexual minority men in the USA to explore how they perceived the role of electronic health records in the clinical encounter in general and for disclosure in particular. Participants expressed concerns about privacy but also saw potential benefits to electronic health records. Similarly, while some thought electronic health records improved communication with providers, others experienced the electronic health record as a barrier to open and trusting communication. New information technologies are changing health-care encounters, but present a double-edged sword that underscores the challenge of negotiating health care for stigmatised individuals. It remains to be seen if information technology will enhance care for all or further alienate already apprehensive health seekers from disclosing personal health information. [ABSTRACT FROM AUTHOR]

Living kidney donation is an alternative treatment option for end-stage renal failure. Prospective donors are protected from risk by counselling and assessment processes, to ensure they are fully informed about all the stages of donation. Drawing on in-depth interviews with 25 living kidney donors from across New Zealand, this article discusses donors' experience of the pre-donation screening process, donation workup coordination, psychological preparation, and post-operative follow-up care and support. In particular, the article examines donor perceptions of the informed consent process. The findings indicate that donors' experience of the consent process may be at odds with the New Zealand Code of Health and Disability Services Consumers' Rights 1996. Instead of a primary healthcare focus on the threshold elements of informed consent, this study indicates that more effort should be made to adequately inform donors and to clearly spell out each stage of the donation process to better meet donors' needs. [ABSTRACT FROM AUTHOR]

Combining work and family can be a significant source of tension and conflict. For young dual-earner couples especially it is a challenge to find a balance. We examine the impact of negative work-to-family and family-to-work spillover on feelings of depression and life satisfaction, as well as crossover effects between partners. Of particular interest are differences between married and cohabiting partners. Dyadic data stemming from a subsample of the Belgian survey 'Relationships in Flanders' (2010) are used (N newlywed couples = 376, N recently cohabiting couples = 344). Regressions confirm that both work-to-family and family-to-work spillover are major stressors. In line with gender role theories, men seem somewhat more affected by family-to-work spillover; women by work-to-family spillover, also when their partner allows work to interfere with family. Overall, the cohabiting do not feel more distressed, but do feel less satisfied with life. Moreover, interesting differences appear when comparing both groups. [ABSTRACT FROM AUTHOR]

Whilst 'biographical disruption' remains important for explaining how people rebuild biography following the onset of chronic illness, it does not self-evidently explain the problem of managing a fluctuating chronic condition such as non-specific low back pain. Chronic illness rarely leads to long-term improvement; the trajectory is not always linear, and sudden or gradual improvements alongside deterioration are commonly experienced. In the case of low back pain, self-management often involves utilisation of non-pharmaceutical approaches, personal resources for accommodating pain and disability, as well as managing symptoms with clinical treatments to relieve pain. Such a multifaceted approach -- not only concerned with the reduction of symptoms -- shifts focus beyond the 'disease' state and a single point of disruption, drawing attention to the use of 'health maintenance actions' to facilitate a proactive response to illness management. We propose this new approach as an alternative way of understanding the experience of patients with fluctuating health conditions such as low back pain. [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]

The recent commitment to investment in continuing care services demands a sound grasp of workforce utilization in continuing care facilities. This article examines workforce utilization in continuing care as a key component of effective service delivery. We used a case study design with three continuing care facilities in Alberta, Canada. Data were collected over one year through interviews, group discussions and observations. The data revealed workforce issues around staff mix, responsibilities and role clarity that negatively affect staff and residents. Using an ecological framework, we developed 'upstream' workforce strategies targeting barriers that can be influenced by the three facilities. Limited research exists on how regulated and unregulated healthcare providers are organized and deployed in different continuing care environments. In our sociological analysis of workforce utilization at three continuing care facilities, we illuminated the relations between staff and the contextual elements surrounding them. [ABSTRACT FROM AUTHOR]

The ageing of the HIV population is unfolding within the context of a politicised history of medical care, medical breakthroughs changing HIV from a fatal to a chronic illness, and a long-standing treatment partnership between medical professionals and HIV patients. This article draws on in-depth interviews with those living with HIV in later life (aged 50 and over), as well as those working with them, to uncover how these various actors understand the nature and consequences of this new phenomenon, and whether their understandings and approaches vary according to the individual's connection to it. All informants described the interaction between ageing and HIV as complex and incompletely understood, and accounted for their own uncertainties about this interplay as due to a global knowledge gap produced by the novelty of ageing with HIV. In these data, working in the area of, or being personally affected by, ageing with HIV emerged as 'experiments in living,' with those variously involved in the phenomenon forced to take tentative, exploratory steps while navigating 'uncharted territory.' Yet, the poorly-understood nature of the ageing/HIV interplay was framed differently, with clinicians and scientists constructing it as a temporary gap in technical knowledge (a scientific puzzle), and non-medical stakeholders and older people living with HIV describing it as an anxiety-provoking source of chronic uncertainty permeating daily life. These differences and similarities can help us to reformulate what medical sociology has often constructed as a static 'gulf' between the clinical and the lifeworlds as, instead, gravitational pulls towards clinical and experiential dimensions of chronic illness as it unfolds in later life. [ABSTRACT FROM AUTHOR]

This article draws upon research involving in-depth interviews with 60 mothers of young children about the home healthcare in which they engage when promoting their children's health and dealing with their illnesses, allergies or developmental problems. The study found that a series of often interconnected discourses were evident in the women's accounts. These included the discourses of health states as controllable, good health as an outcome of good management and the child's body as vulnerable. Other discourses were related to the concept of the 'good mother'. The interviewees also employed the discourses of home healthcare as emotionally distressing and as hard work and of children's illness as a mother's loss of control. As this suggests, such caring was often an intensely embodied and negative emotional experience for the mothers, particularly if they felt as if they had lost control over their children's bodies. [ABSTRACT FROM AUTHOR]

Australia leads the world in the mass adoption of Human Papillomavirus (HPV) vaccines, a new frontier in mass vaccination programmes. This article reports on participatory workshops with the first generation of young Australian women to participate in the HPV mass vaccination programme. In particular, it addresses the themes of trust and confidence. A substantial literature highlights the growing realm of active trust at the expense of habitual confidence in 'risk society'. Another line of inquiry highlights the preference of governments for policies designed to enhance confidence rather than trust. This study finds that participants were guided by confidence in their adoption of the HPV vaccine, at the expense of trust. Participants readily transferred their confidence in the existing vaccination regime to the HPV mass vaccination programme, notwithstanding its novel features. Yet participants expressed growing misgivings about their informed consent and the 'marketing' of the vaccine in the course of workshops, reflecting failure to achieve their active trust. [ABSTRACT FROM AUTHOR]

'Virtual memorials' intended to memorialize the lives of children imply significant shifts in the conceptualization of death, particularly for grieving parents. Created by parents in memory of their deceased children, on-line memorials constructed using templates reflect strong cultural beliefs about the nature of childhood deaths, grief and the development of a kind of digital afterlife. Virtual memorials create a new social value for the deceased, and shift death and bereavement from private into more public experiences. Building upon this work, we describe a kind of 'on-line immortality' created through virtual memorials where the virtual presence of the deceased in text and images, and practices intended to sustain a relationship with the deceased, can extend bereavement and the social lives of the dead indefinitely. While such memorials can offer solace, they also potentiate business opportunities for those hoping to create lasting customers. As such, they may also extend mourning indefinitely. This may be especially true for certain kinds of deeply problematic deaths, such as those of children. [ABSTRACT FROM AUTHOR]

Hepatitis C (HCV) is a disease of the liver with a range of potentially debilitating symptoms, the severity of which differ from person to person. HCV is a major public health challenge. Globally an estimated one in 12 persons is affected by the virus, and substantial new transmissions occur each year. The vast majority of new transmissions occur among people who inject drugs, particularly through practices such as sharing of needles, syringes and other injecting equipment. Behavioural surveillance data suggest that the majority of equipment sharing occurs between intimate partners. Despite this, very little research has focussed on intimate partnerships as a site of hepatitis C transmission or prevention. This is in part because people who inject drugs are conventionally represented as lacking capacity for romantic love and intimacy; also, drug 'addiction' is produced as the antithesis of voluntarity, autonomy and authenticity, all of which feature strongly in Western understandings of romantic love. This study aims to fill existing gaps in the literature about the relationship between romantic love and injecting drug use (IDU) and to explore injecting drug practices among partners in intimate relationships. Fifteen people who inject drugs, currently in long-term heterosexual relationships, were recruited for in-depth interviews, which were recorded, transcribed verbatim and analysed thematically. The main findings of this study are that romantic love and intimacy figure prominently in the lives of people who inject drugs, and that romantic notions such as commitment, trust, care and support shape how individuals who inject drugs talk about serostatus with their partners and how they account for injecting practices. Moreover, injecting practices are co-produced within intimate relationships, shaped by perceptions of risk within and outside the relationship, ideas of intimacy, and the specific levels of skill and expertise within these relationships. These findings have important implications for harm reduction strategies, which, we suggest, have largely failed to take into account the intimate relationship as a source of practice. We conclude with suggestions for future work in this area. [ABSTRACT FROM AUTHOR]

Health and wellbeing is defined internationally as a multi-dimensional and holistic concept, particularly within Indigenous worldviews. However, in Australia there is a lack of detailed frameworks supporting such definitions that are founded on Aboriginal knowledges. Tins study aimed to explore Aboriginal perspectives of child health and wellbeing in an urban setting. Qualitative interviews with 25 care-givers of Aboriginal children living in Melbourne, Australia were conducted. Aboriginal people and community controlled organisations were collaborative partners in all stages of the research. A conceptual fiamework of Aboriginal child health and wellbeing in an urban setting was developed comprising four main themes: Strong Culture; Strong Child; Strong Environment; and Strengths and Challenges. Aboriginal conceptions of culture are considered central to Aboriginal child health and wellbeing in an urban context. A holistic framework that privileges Aboriginal knowledge of child health and wellbeing has not previously been available. Further exploration of socio-ecological models within Aboriginal child health and wellbeing contexts is needed. This study identifies dimensions for further exploration in research, policy and practice. [ABSTRACT FROM AUTHOR]

Since the mid-nineteenth century, the American Medical Association's code of ethics has mandated that physicians provide charity care. However managerialism has threatened the likelihood of physicians' providing charity care. Specifically, physicians who recently became employees, or whose revenue became predominantly pre-paid, also became less likely to provide free care. Moreover, physicians with an increased proportion of revenue from Medicaid, or in counties with high Medicaid managed care penetration, were less likely to provide charity, perhaps due in part to a reduced ability to cost-shift. Despite upcoming health reform, managerial strategies that employ or pre-pay physicians are likely to leave many millions of uninsured without access to charity care from physicians. [ABSTRACT FROM AUTHOR]

Peer support is a fast growing type of service provision within the mental health sector. This study draws on interviews with peer supporters and peer support managers to explore the ways that risks of violence, suicide and self-harm are managed within peer support settings in Aotearoa New Zealand. Drawing on Nikolas Rose and other theorists, who define risk thinking as an attempt to 'discipline uncertainty', we argue that the philosophy of peer support is in tension with a 'risk consciousness' because it sees crisis as a learning opportunity. We contend that peer supporters are pulled towards the 'risk consciousness', which pervades the mental health sector, and that they address this by managing risk in various ways. Finally, we show that peer supporters challenge this risk consciousness by working with risk through a philosophy of engagement and relationship. As peer support becomes more integrated into the wider health system, the challenge will be to continue the development of risk practices which work within a strong peer support philosophy. [ABSTRACT FROM AUTHOR]

Organ donation and transplantation has the potential to save lives. Organ transfer also raises a number of ethical and emotional issues, especially in discussions around anonymity protocol and in relation to the invisible but tangible presence of shared corporeality in the course of organ transfer. In this article, which is based on in-depth interviews with organ transplant recipients and members of donor families, these issues are addressed from the perspective of a sociologist interviewing people about their experiences in this domain. In particular, the article examines what it means to do sociological research on sensitive topics with vulnerable groups in light of institutional ethics guidelines that require protecting the emotional safety of researchers and research participants during the research process. In so doing, I identify several problems with formal ethics approval procedures for researchers engaging with vulnerable groups such as organ donor family members and transplant recipients, and some of the risks associated with taking an empathic approach to social research interviewing. [ABSTRACT FROM AUTHOR]