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In health decision-making, the distinctions between manipulation, persuasion and coercion are easily blurred. Manipulation, viewed through a bioethics lens is problematic only when it affects a person's ability to make autonomous decisions. In contrast, in critical discourse analysis (CDA), manipulation usually has negative connotations. This article uses childhood MMR (measles, mumps and rubella) vaccine information as a case study in manipulative discourse. Online vaccine information across three organisations was analysed using CDA methodology. Each organisation used manipulative discourse in their vaccine information but with varying degrees of transparency. The less transparent an organisation's motivations are, the less compatible it is with autonomous decision-making. This paper argues for adding further nuance to how discursive manipulation is defined within CDA, particularly in the field of public health. In this setting, manipulation is not necessarily immoral or unfair, but it may be, depending on whether it controls a person's ability to make an autonomous, informed decision. [ABSTRACT FROM AUTHOR]

How diagnosis fits within the overall activity structure of surgical consultations remains under-researched. We set out to contribute to this developing area of research with a particular focus on responses to diagnosis as an achievement of patient agency. We identified 26 diagnostic sequences in a collection of 35 video recorded surgical consultations and examined these in detail using conversation analysis. The activity of diagnosis and the transition to treatment recommendation appear to be structured somewhat differently in surgeon-patient consultations than has been reported for primary care settings. In particular, patient responses to diagnosis are more frequent and more likely to be extended. The analysis provides evidence that both parties orient to surgeons' accountability for their own diagnostic reasoning, and also the medical authority of the referring doctor and the subjective experience of the patient. In delivering the diagnosis, the surgeon must be cognizant of the opinions of both the patient and the referring doctor, which may align to a greater or lesser extent with their own diagnosis. [ABSTRACT FROM AUTHOR]

Although information provision is a prerequisite of informed decision making in surgical consultations, research has shown that patients' understanding of such information is often limited. We use conversation analysis to illustrate patients' and surgeons' management of interactivity, intersubjectivity, and progressivity during information provision, which frequently takes the form of extended tellings. In the midtelling phase of extended tellings, the surgeon is the primary speaker and patients orient to the temporary suspension of the usual turn-taking system. On the rare occasions that patients do take the floor midtelling, it is overwhelmingly following surgeons' self-repeats-as-unit-ends, which include gist formulations. We argue that surgeons' self-repeats-as-unit-ends are a practice for encouraging interactivity during extended tellings and as a consequence for facilitating shared understanding of decision-relevant information. Data are in English. [ABSTRACT FROM AUTHOR]

This paper reports on the reflections from members of the evaluation team – both allies and service user academics – about a co-produced approach to evaluation of the pilot of a youth-integrated therapies mental health intervention (co-evaluation). The co-evaluation is being facilitated particularly well through numerous service user academics being involved in the evaluation, and the commitment to co-production and active attendance to the responsibilities of allies by allies. However, multiple challenges still exist with significant implications for allyship. These include the need for us to 'deepen our thinking and approaches to best accomplish authentic and effective engagement' (Daya et al., 2020, 300) in support of co-production specific to the context of individual projects, the fluidity of the allyship position and the need for allies to consistently reinforce their commitment in word and in deed to it. We have also identified the need to acknowledge and respect the distinction between people in roles who happen to have experience and people in roles because they have experience. [ABSTRACT FROM AUTHOR]

Young people born with variations in sex characteristics (VSC) or disorders of sex development (DSD) face numerous challenges in navigating issues relating to identity and to their lived and embodied experience. There is limited published research amplifying the voices of young people with a VSC, especially from Aotearoa/New Zealand. This qualitative study provides an up-to-date picture of the lived experience of 10 young people with a VSC in Aotearoa/New Zealand. The research was conducted in collaboration with the advocacy group, Intersex Youth Aotearoa, and explored the level of support provided by health services, peers and advocacy groups in relation to the ways the participants viewed themselves and their bodies, and their health related decision-making. Findings reveal the pressure on young people with a VSC to conform to cultural and societal norms, specifically, heteronormative and traditional constructs of how male and female bodies should look in Aotearoa/NZ society. Such views, often held and perpetuated by health professionals and parents, contributed to complexities surrounding identity, agency and acceptance of difference experienced by these young people. The implications of these findings are discussed, including the need for better psychological and peer support for young people. [ABSTRACT FROM AUTHOR]

New Zealand research suggests that CAM use by GPs has decreased, while referral to CAM practitioners by GPs has increased, and that patients often do not tell their health practitioners when they are using CAM. The New Zealand Medical Council has developed guidelines for GPs who use CAM. However, there is no research in New Zealand that looks at how patients and GPs respond to CAM issues in the consultation. This paper uses data collected for two research projects on doctor-patient interaction. For this research, consultations between 105 patients and nine GPs were video-recorded. In this data set, all doctors but one were 'orthodox' and to some degree reserved judgement on CAM, albeit remaining cautious in how they made this evident. Patients on the other hand demonstrated a variety of strategies to get CAM on the agenda, and GPs were careful to couch any criticism in such a way as to protect the 'face' of patients. [ABSTRACT FROM AUTHOR]