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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]

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 production of sociological knowledge in Australian universities is explored through an empirical study of research papers published in a selection of academic outlets between 1960 and 2011. Drawing on theories concerning scholarly practices, institutional formation and the sociology of knowledge, questions are posed about the factors that shape and structure the production of sociological knowledge about health and medicine. The concept of intellectual schools is examined, with evidence sought for the presence of these 'knowledge networks' in the Australian context. The study suggests the formation and maintenance of schools are subject to structural factors within the university sector, specifically the relative wealth and prestige of the university and the dictates of the higher education market. [ABSTRACT FROM AUTHOR]

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

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]

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

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

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

This paper presents findings from a UK mixed-method study that aimed to understand parents/carers' views and experiences of support received from health services for primary school age (4–11) gender diverse children and their families. Data was collected via an e-survey including 10 open-ended questions with 75 parents/carers addressing experiences with (i) primary health services, including general practice (GP) clinics and child and adolescent mental health services (CAMHS) (ii) specialist gender identity development services (GIDS) (iii) non-health related support including transgender groups and online resources. Findings are organised into four themes: 'journey to health service provision', 'view on health services used', 'waiting' and 'isolation'. Discourses about gender diversity, childhood and the validity of trans healthcare shape parental experiences, including their desire for better information, more certainty in healthcare pathways and more expedient access to support services to reduce anxiety, distress and isolation. The emotional costs of waiting are compounded by the material costs of accessing the limited number of specialist services. Experiences could be improved through ensuring GPs and CAMHS are better prepared, expanding access to trans-specific support groups for those caring for children and young people, and exploring the provision of school-based support for gender diverse primary-age children. [ABSTRACT FROM AUTHOR]

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

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

This paper draws upon literature from economics, and the human capital and equity fields in order to present a theoretical framework for a new multidimensional measure of poverty for Australia. Poverty is about having low living standards; but its measurement has traditionally focused only on an individual's income or on other dimensions of living standards that are not appropriate for contemporary Australian society, such as calorie intake. There are two additional capabilities individuals require for adequate living standards: health and education. Each of these is required for basic functioning within modern society, but have traditionally been ignored by measures of poverty. This paper argues that health is a basic capability people need for a fulfilling life, allowing individuals to participate in activities essential in modern society, and that education can also be seen in this light. As such it is vital that health and education be included in measures of poverty. In order to move Australian poverty measurement forward and build upon the work of the past, poverty measurement must move its focus away from only looking at low income, and take a holistic focus on the living standards of individuals by incorporating assessments of health and education. [ABSTRACT FROM AUTHOR]

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

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

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

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 draws on focus groups with young Australian males across a range of social demographics and ages in primary school years (5-12 years). It investigates the role of physical activity and dietary behaviours in the lives of young males. The paper will articulate the way in which young males come to perceive physical activity and dietary behaviours, including broader constructions of health, within the context of their lives. Understanding the decision making of young males' around physical activity and dietary behaviours will play a significant role in the health outcomes of adult men by through improved targeted health education and health promotion programs for this cohort. [ABSTRACT FROM AUTHOR]

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

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

In recent years, 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]

Australia is rapidly becoming home to an increasing number of Polynesians. While the Maori/Pacific Islander 'economic migrant' may appear fit and healthy, statistically the incidence of diabetes, hypertension and cardiovascular disease is extremely high. When this profile is coupled with family reunion migration of older relatives who are living longer, it represents an escalation of current and future outlay for Australian health services. Qualitative semi-structured interviews were conducted with 67 Polynesian migrants in regard to their perceptions of health and illness, and their experience of health services in Sydney and the Hunter region of New South Wales. Three key respondents, all Polynesian nurses practising in Australia, were also interviewed. The findings indicate a concentration of disadvantage concerning educational achievement, skill levels and health literacy that reinforce the process whereby social disadvantage impacts on health outcomes. This study also reveals a nexus of issues around cultural behaviours and poverty that contribute to the incidence of obesity-related illness and limit compliance with recommended preventative measures and treatments. This paper includes a discussion of the socio-political context of health delivery to Maori and Pacific Islander migrants and how the contraction of services under neoliberal 'belt tightening' undermines potential capacity to treat culturally and linguistically diverse (CALD) populations effectively. As Australian scholarship has traditionally concentrated on Melanesia, there is very little research on Polynesians who are one of our burgeoning migrant groups. This study therefore makes a timely contribution to redressing the lack of literature on Polynesian health, cultural practices and socio-economic positioning in this country. [ABSTRACT FROM AUTHOR]

Evidence-based medicine (EBM) has been one of the most important movements in clinical medicine and public health in recent years. At the heart of the EBM movement lies the Cochrane Collaboration, an infl uential organisation that produces systematic assessments of healthcare interventions known as Cochrane reviews. Although Cochrane methods were initially designed to test the efficacy of medical therapies, the desire for 'evidence-based' practice has pushed the movement far beyond its initial scope into the assessment of complex social phenomena. Through an examination of one particular Cochrane review -- Physician advice for smoking cessation -- this paper highlights the limitations of EBM 'creep', and some of the more problematic conceptions of human nature underwriting Cochrane principles and methodologies. [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]

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]

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]

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]

Contemporary health policy increasingly positions responsibility for the management of health with the individual which reflects newer neo-liberal discourses of health. Such an approach can be seen as problematic in the context of men's health, with men tending to be seen as largely 'irresponsible' towards their own health. This paper addresses this question by drawing on qualitative data on how men conceptualise responsibility for health. Whilst the desire to be responsible for health was borne by most of the men in the study, this was not always reflected in practice. There was also evidence of strategies that men adopted for either divesting themselves of responsibility for health or for legitimising lack of responsibility. In some instances, acting 'irresponsibly' was what defined participants as 'real men'. The implications of these findings for men's health policy are discussed with specific reference to the recent publication of Ireland's National Men's Health Policy. [ABSTRACT FROM AUTHOR]

This article explores the contexts, processes and motivations behind the administration of sedatives (minor tranquilisers) in the time around perinatal loss. Using a mixed methods design, an online survey of 796 women and 13 narrative interviews were conducted. The participants had experienced a stillbirth or termination of pregnancy from 16 weeks or a neonatal death in Spanish hospitals. The quantitative (univariate and CHAID decision-tree) and qualitative (narrative-linguistic) analysis found that sedative administration was pervasive across care contexts and appears to be naturalised despite contradicting practice recommendations. Sedative administration was associated with emotional control and avoidance of loss, lack of accompaniment and on occasion with managing disruptive patients. Lack of informed consent was very common, with little explanation of side-effects prior to administration. In the participants' narratives, health professionals tended to construct sedatives as benign, but for some women the effects were counterproductive to loss and grief and related to persistent regrets about decisions. The study concludes that, in the context of perinatal loss, sedative administration was highly integrated into the fabric of medicalised care. As a socio-political and cultural practice underscored by gender-based care dynamics, there seems to be an imbalance between benefit and risk to women's welfare. [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]

Collaborative approaches to knowledge translation seek to make research useful and applicable, by centring the perspectives and concerns of healthcare actors (rather than researchers) in problem formulation and solving. Such research thus involves multiple actors, in interaction with pre-existing ecologies of knowledge and expertise. Although collaboration is emphasised, conflict, dissonance, and other tensions, may arise from the multiplicity of perspectives and power dynamics involved. Our article examines knowledge translation in this space, as both empirical focus and research methodology. Drawing from practice theory and critical pedagogy, we describe knowledge translation as a situated and social process of transformative learning, enabled by reflexive dialogue about practice, and supported by care. With examples from five studies across two countries, we show that practice-based knowledge translation can be mediated by researchers, using video-reflexive ethnography. We describe the importance (and features) of practices of care in these studies, that created psychological safety for transformative learning. We argue that attempts to transform and improve healthcare must account for sustained and reciprocal care, both for, and between, those made vulnerable in the process, and that knowledge translation can, and should, be a process of capacity strengthening, with care as a core principle and practice. [ABSTRACT FROM AUTHOR]

Food security is an evolving concept with various definitions and associated meanings. The way food security is understood by policy-makers impacts on how it gets addressed in public policy. This research uses an interpretive approach to uncover how food security is represented by stakeholders. Semi-structured interviews were conducted with 24 stakeholders in South Australia between June and September 2010. The findings reveal four dominant representations for food security that locate responsibility for the issue across different stakeholders, namely individuals, governments, communities and private enterprise. These representations hold different underlying assumptions about the role of government in addressing the issue; the neo-liberal perspective supports a reduced role for government whereas the social determinants of health perspective calls for greater government intervention. Food security activists may need a greater awareness of how they represent the issue in order to change public policy action in this area. The approach taken in this research is relevant to other public policy problems and contexts. [ABSTRACT FROM AUTHOR]

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

The 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]

Globally there is an urban/rural divide in relation to health and healthcare access. A key strategy for addressing general practitioner shortages in rural areas is GP vocational training in rural places, as this may aid in developing practitioners' scope, values and community orientation, and increase propensity for rural practice. This creates a need for deeper understanding of the nature and quality of this training. Rural GPs are well-positioned to reflect on vocational learning in 'place'. We aimed to explore rural GPs' perceptions and experiences of GP vocational learning in relation to rural places. Semi-structured interviews were conducted with 25 GPs based in smaller rural communities in Tasmania. Inductive and theoretical thematic analysis was undertaken. Rural places provide learning opportunities for GP registrars, which shape the relationships between GPs and registrars and their communities. Rural GPs are committed to developing the next generation and improving access to primary care for their communities. Rural places provide unique learning environments for general practice, including rich learning, relationships and community commitment. [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]

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]

Although issues of health have been thoroughly analysed in the field of migration studies, there are still very few studies that seek to understand the reproductive health of women in migratory processes. This article analyses the reproductive health of Bolivian migrant women living in the city of Córdoba, Argentina, through an analysis focused on the community assets that migrants deploy in the health-disease-care process within restrictive contexts of access to the health system. The research consisted of an exploratory study using in-depth interviews with Bolivian migrant women and health professionals through the implementation of semi-structured guidelines. The work shows that, in an environment characterised by a health system that acts to exclude, migrant women develop a series of rational strategies where they draw on community assets embodied in forms of selfcare of the body and in community networks. Based on a process of reframing memories related to health practices in the Andean world, these women incorporate these assets and more easily confront the obstacles that they must overcome as migrants in different stages of their reproductive health. [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 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]

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]

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 the last few years, various international public health organizations such as the World Health Organization or the European Commission have recommended the worldwide dissemination of evidence-based mental health prevention programs. This public health ideal, relying on new scientific disciplines, is at the origin of multiple controversies in a number of countries. This article contributes to bring a reflection on the ways political experts, researchers and practitioners have integrated these new preventive strategies. More precisely, the objective is to present and to discuss the results of a qualitative study on French professionals' representations and theoretical perspectives with regards to evidence-based parenting programs. Results are based on ethnographical inquiries in French public health institutions and on 12 semi-structured interviews with professionals. The results demonstrate three ways to conceive parenting support, themselves attached to distinct anthropological, socio-political and interventional models. [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]

This article addresses the issue of the autonomy of patients who are not treated in standard situations of hospitalisation in institutions, but who receive ambulatory care. Academic and institutional discourses both suggest that the development of out-of-hospital care delivery models promotes patient autonomy. Through a qualitative study based on semi-structured interviews of cancer patients treated using ambulatory chemotherapy in a French hospital we show that some of the constraints usually encountered by patients receiving care in institutions are also observed in patients receiving ambulatory care. They experience a form of cognitive isolation regarding access to information about their health, and their social life appears to be institutionalised. [ABSTRACT FROM AUTHOR]

This manuscript outlines the multiple methods utilized in a long-term follow-up of a non-traditional population: Homeless substance abusers in New Orleans. This article addresses qualitative mental health research by outlining steps taken to explore both qualitative and quantitative data sources. By way of qualitative and quantitative methods, this research examines the life course of a sample of New Orleans homeless substance abusers from the time they entered into treatment (1991) until the present and observes the quality of their social bonds and their long-term outcomes. By making use of mixed methods, this research gives a more thorough understanding of mental health, specifically examined through homelessness and substance abuse. [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]

Interviewing about death and loss can bring up unexpected emotions for respondents and interviewers. Positivist social scientific research methods often either ignore the emotions of the researcher, or argue that emotional expressions are to be avoided in research, even when the topic is thought to inspire intense feelings - like death and dying. This article argues for taking an alternative position toward emotions in death and dying research. Using data from over two years of participant observation and 34 semi-structured interviews with hospice workers, I illustrate one potential way to productively and ethically share emotions during a research interview. This approach includes learning and being open to the 'moderated cry', which involves minimal tears, the absence of sobbing and an overt acknowledgment of the emotional reaction. This article illustrates the ways respondents in this research used the moderated cry as well as the value of reconsidering prohibitions on emotions in research. [ABSTRACT FROM AUTHOR]

This study explored Aboriginal perspectives of child health and wellbeing in an urban area in partnership with Aboriginal people and organisations. In depth interviews were conducted with 25 grandparents, parents, aunties or uncles of Aboriginal children. Interviews were transcribed and thematically analysed. A major conceptual theme was related to social, historical, and political factors seen by participants as influencing urban Aboriginal child health and wellbeing. This theme was called 'Strengths and Challenges: Harder for Koori Kids/Koori Kids Doing Well'. Increased challenges to achieving good health and wellbeing faced by Aboriginal children due to factors in their social, historical and political environment were emphasised. Many of these factors can be related back to historical and contemporary forms of racism. On the other hand, there was also a clear call to recognise and celebrate that many Aboriginal children were doing well in the context of these added challenges. [ABSTRACT FROM AUTHOR]