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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]

The provision of gender affirming hormone therapy for transgender and non-binary people is a rapidly developing area of gender affirming healthcare. While research indicates the benefits of providing gender affirming hormone therapy through interdisciplinary primary care-based models, less is known about how service users and providers construct their understandings of affirmative approaches. In this paper, we present findings from a discourse analysis of four service users' and four healthcare professionals' talk about a primary care-based pilot clinic providing gender affirming hormone therapy in Aotearoa New Zealand. Participants employed notions of pathologisation, time, and agency in their talk to construct the clinic as a personal setting which gave service users time to make their own health decisions, while constructing hospitals as impersonal with lengthy wait times. The assessment-driven nature of best practice guidelines that governed clinicians' decision-making was constructed as constraining users' agency. Findings highlight the ongoing importance of aligning gender affirming hormone therapy with other non-disease types of healthcare, and suggest new ways for achieving this through affirmative approaches to healthcare. [ABSTRACT FROM AUTHOR]

In the past decades, public health has increasingly addressed what has been called the children's obesity 'epidemic', most notably through large-scale initiatives promoting physical activity. Through a discourse analysis the current paper critically examines such efforts in Canadian and Australian public health. Public health websites in Canada and Australia were examined for information concerning children's health, physical activity and obesity and explored for how these issues were represented in the discourse. Bacchi's (2009) 'What's the problem represented to be?' approach to discourse analysis guided our interrogation of the taken-for-granted assumptions underlying Canadian and Australian public health discourse, the ideological and political influences involved in its construction, and the knowledge base upon which it rests. The article calls for critical reflection on how children's physical and leisure activities are being advanced. [ABSTRACT FROM AUTHOR]

Nurse practitioners were introduced into Australia in 1990 to improve access to health care in isolated communities where medical doctors are scarce. The slow uptake of nurse practitioners in these areas has largely been the result of legislation not affording them access to provider numbers through the Medicare Australia Act 1973. This has denied nurse practitioners the opportunity to become primary care providers because they cannot prescribe medications and order diagnostic tests at rebated costs. Recently this Act changed, making provision for nurse practitioners. Ironically the enactment of the new legislation still prevents nurse practitioners from practicing effectively. This paper describes the discursive practices in legislation, driven by traditional power brokers, which perpetuate the traditional role of nurses as care givers and fails to support the evolution of nurse practitioners as care providers. These continued practices effectively prevent nurse practitioners from working to their potential, despite government reassurance under recent health care reform in Australia. [ABSTRACT FROM AUTHOR]

Much of the medical literature on patient compliance explores why patients fail to follow practitioners' instructions. This paper explores perspectives on 'compliance' expressed in online discussion groups for kidney patients. Discourse analysis was used to investigate how contributors conceptualise knowledge and the role of the renal patient. In the discussion groups, patients were sometimes seen to have better understanding of the details of their illness than some practitioners, a focus born of inhabiting their situation and therefore having more at stake. Some patients set themselves the task of supervising their own care, double checking the work of practitioners. This did not threaten biomedical knowledge, but these counter-discourses challenge professional boundaries by making it the prerogative of patients to obtain biomedical knowledge. I explore issues of surveillance and frustration, and the potential usefulness of patients' overseeing their own safety, while flagging the potential plight of less 'empowered' or motivated patients. [ABSTRACT FROM AUTHOR]

With the commodification of healthcare in general and of private health in particular, it is difficult not to acknowledge the growing influence of competition and 'the market' in shaping the way that nurses' work is managed by private hospitals and by nurses themselves. This paper explores the discourses shaping nurses' work in private healthcare, drawing upon data from an ethnographic study conducted in one Australian acute care private hospital. The framework for analysis relies on an exploration of the mentalities and governance of nurses' work in such a setting. The study shows how marketing and performance measures are believed to ensure the viability of the enterprise while simultaneously commodifying nurses' caring work. It is this work that remains invisible to the healthcare system and the hospitals where they work. [ABSTRACT FROM AUTHOR]

Understandings of culture and multiculture are broad and deeply embedded in every day talk and practices. In an increasingly globalised world, how we understand and work with these terms affects how parents and their families experience health care services and the support intended by health care professionals. This is particularly important for parents who are new to Australia. In this paper we report on findings from an ethnographic study undertaken across two community child and family health nursing sites in South Australia. Using examples, we explore how child and family health nurses appear to understand and use constructs of culture and multiculture during everyday, intercultural communication with parents who are new to Australia and Australian health services. By analysing these understandings through postcolonial and feminist theories we found pervading evidence that neo-colonial constructs of a white western monoculture shaped intercultural communication practice. We conclude by reflecting on how these constructs might be addressed to improve intercultural communication in child and family health settings. [ABSTRACT FROM AUTHOR]

The emphasis on a sexualised muscular body ideal in gay social and cultural settings has been described as facilitating body image dissatisfaction among gay men. Drawing on a concept of reflexive embodiment, this paper uses qualitative interviews to analyse gay men's embodiment practices in relation to discourses and norms that can be found across and beyond any coherent notion of 'gay subculture'. The findings reveal body image to be more complex than a limited focus on subculture or dissatisfaction can account for. In particular, gay men negotiate a gay pride discourse in which the muscular male body generates both social status and self-esteem, and deploy notions of everyday masculinity that imply rationality and control to resist gendered assumptions about gay men's body image relationships. [ABSTRACT FROM AUTHOR]

Over the past decade, consumers in Australia and elsewhere have increasingly been confronted with a fast growing number of health food products. This profusion of health foods is accompanied by a proliferation in popular culture of professional nutritional advice on 'what is good to eat'. The genre of lifestyle magazines is one popular medium via which healthy eating practices and health foods are frequently reported. In this paper we use a visual discourse analysis of food-related editorial and advertorial content sourced from the long running and popular The Australian Women's Weekly to investigate how lifestyle magazines have been one important locus for constituting health conscious consumers. Taking up a Foucauldian governmentality perspective we trace how this active, responsible conceptualisation of the consumer, which we refer to as 'healthy food consumer', has increased in prevalence in the pages of The Australian Women's Weekly over time. Based on our analysis we suggest that the editorial and advertorial content offers models of conduct to individuals about what possible preventative activities in which to engage, and plays an important role in shaping how we think about taking care of our health through eating. [ABSTRACT FROM AUTHOR]

This paper develops discourse analysis of Australian press representations of dying during the operation of the Northern Territory of Australia's Rights of the Terminally Ill Act 1995 (McInerney 2006). Operating in tandem, the discourses of aesthetics and embodiment constructed contemporary dying as an intolerable corporeal state. The body in disarray is attractive to media imperatives of drama and crisis, and dominated press reports during the analysed period. Such images functioned as absolute justification for a medicallyinduced requested death. Modern equating of physical integrity and personal dignity supports such responses to dying. The requested death interventions of euthanasia and physician-assisted suicide were depicted as halting the physical deteriorations associated with terminal illness and thereby redeeming the dying person, by providing them with the opportunity to reclaim the social status lost via their progressive corporeal decline. [ABSTRACT FROM AUTHOR]

Routinely positioned as the 'first-line option' for contraceptive choice-making, long-acting reversible contraception (LARC) promotion efforts have come under critical scrutiny by reproductive justice advocates for the extent to which public health actors' preference for LARC devices may override potential users' ability to freely (not) choose to use contraception among an array of options. We identify LARC promotion discourse as constituting 'The Age of LARC': multifarious strategies for producing responsible sexual citizens whose health behaviours are empowered via a LARC-only approach to contraceptive use. We suggest that immediate postpartum LARC insertion policies, which have proliferated in the U.S. since 2012, exemplify the new era of LARC hegemony, in which urgency, efficiency, cost-effectiveness, and outcomes dominate both health policy and clinical practice around these contraceptive technologies. By following these efforts to facilitate access to and use of immediate postpartum LARC, we find a discourse on sexual citizenship that paradoxically constructs sexual health freedom through the use of a single class of contraceptive technologies. [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]

Ovarian cancer affects many women globally, having numerous physical and psychosocial implications. However, misconceptions abound, symptoms are often overlooked, and diagnosis frequently occurs in advanced stages. As one step to addressing these issues, this research explores the social construction of ovarian cancer in women's magazines to identify the ideas and discourses surrounding this illness and interpret their explicit and implicit meanings. A constructivist discourse analytic approach guided analysis of 62 print and online articles from 8 women's magazines available in Canada over a 20-year period. Analysis resulted in identification of three discourses pertaining to: self-responsibility for health, ovarian cancer as uncertain and inevitably fatal, and ovarian cancer as a heroic endeavour. Critical interpretation highlights misinformation, contradictory beliefs, and unrealistic expectations surrounding this illness, which have implications for healthy and affected women. The findings emphasise the importance of identifying and challenging these discursive constructions to expose inconsistencies, minimise harm to women's well-being, and promote authentic portrayals of ovarian cancer. [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]

Book prescription schemes and healthy reading schemes are public mental health initiatives that are inspired by the bibliotherapeutic principle of 'the guided use of reading, always with a therapeutic outcome in mind' (Katz & Watz, 1992). These initiatives were originally developed in the UK as an example of care in the community for the treatment of mild to moderate mental health problems. This involves the creation of a collection of self-help books in a local library which members of the public can access free of charge to help with their recovery from mental illness. Ireland's first Book Prescription Scheme was established in Dublin City in 2007. This article presents a critical assessment of the contribution that these reading schemes offer the treatment of mental illness in Ireland. While advocates commend this new service, a critical discourse analysis of Irish self-help reading schemes reveals that offering guided reading for the treatment of mental illness provides an individualistic and neo-liberal construction of mental illness and well-being. [ABSTRACT FROM AUTHOR]

Age and ill-health have long been identified as being intrinsically intertwined, however the boundary between the discourses of ageing and chronic illness is not easy to demarcate. It is possible, however, to shed some light on the interplay between the ageing body and chronic illness by considering how differing cultures of ageing play a key role in articulating a dichotomy between seeing chronic illness as an aspect of health or of ill-health and age-related decline. Using knee pain as an example we argue that to understand how the interplay between ageing and chronic illness influences the interpretation of knee pain as 'ageing well' or as a sign of impending decline and physical dependency, then we need to employ a discursive methodological approach which explores talk as a form of action designed for its local interactional context and pays attention to what statements mean in the context in which they occur. [ABSTRACT FROM AUTHOR]

Signifi cant transformations of the health care services sector over the past three decades have seen an increasing reliance on the private provision of health care services mediated through private health insurance. In countries such as Australia and the UK, private health insurance is promoted as providing a greater choice for individuals and easing the burden on the public system. While these claims, the policy contexts and the decision-making processes of individual consumers have attracted some sociological attention, little has been said about the role of private insurers. In this article we present a comparative analysis of the websites of private health insurers in Australia and the UK. Our analysis highlights adoption by private health insurers of neoliberal discourses of choice and individual responsibility, partnership and healthy lifestyles. In these respects, similarities between the discourses over-ride national differences which might otherwise be expected given their contrasting health care traditions and contexts. [ABSTRACT FROM AUTHOR]

This qualitative study into Australian manhood featured 63 men discussing 'acceptable' masculinity. Homophobic humour emerged as central to the formation of Australian male identity, but it had the potential to induce violence and emotional damage when the 'humour' moved along a malleable continuum from good-natured banter to abuse. Significantly, it was men of all sexualities who were targeted, indicating that it was non-conformity to gender norms as well as sexuality being policed, as boys and men used humour to control and humiliate each other. Recollections of these instances ranged from 'it was just a joke' for some perpetrators, to 'orchestrated cruelty' for men who had been victimised. Some of the latter group reported depression extending into their adult lives based on their youthful experiences. Understanding the impact when humour goes 'beyond a joke' is important for policy makers, educators and healthcare workers, as a potential for emotional damage and physical violence is highlighted. The study highlights the importance of understanding masculinity as an influence on men's health and wellness. [ABSTRACT FROM AUTHOR]