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Clinical trials have shown that providing advice and support for people with excess weight can lead to meaningful weight loss. Despite this evidence and guidelines endorsing this approach, provision in real-world clinical settings remains low. We used Strong Structuration Theory (SST) to understand why people are often not offered weight management advice in primary care in England. Data from policy, clinical practice and focus groups were analysed using SST to consider how the interplay between weight stigma and structures of professional responsibilities influenced clinicians to raise (or not) the issue of excess weight with patients. We found that general practitioners (GPs) often accounted for their actions by referring to obesity as a health problem, consistent with policy documents and clinical guidelines. However, they were also aware of weight stigma as a social process that can be internalised by their patients. GPs identified addressing obesity as a priority in their work, but described wanting to care for their patients by avoiding unnecessary suffering, which they were concerned could be caused by talking about weight. We observed tensions between knowledge of clinical guidelines and understanding of the lived experience of their patients. We interpreted that the practice of 'caring by not offering care' produced the outcome of an absence of weight management advice in consultations. There is a risk that this outcome reinforces the external structure of weight stigma as a delicate topic to be avoided, while at the same time denying patients the offer of support to manage their weight. • Guidelines recommend weight management be offered routinely in primary care. • Despite evidence of effectiveness, many patients are not offered weight management. • Strong structuration theory enables interactional analysis of weight stigma and clinical practice. • Avoiding the topic of weight, and the associated stigma, can be understood as a form of caring. • In attempting to avoid causing distress, healthcare professionals fail to offer support. [ABSTRACT FROM AUTHOR]

It is widely recognized that contemporary tourism mobility, notably flying, is incompatible with sustainability goals. Fundamental changes in travel behaviour are required. Research shows that environmental values have little impact on tourists' travel decisions and that voluntary behaviour change is unlikely. Therefore, policies encouraging transitions to sustainable tourism require a deeper and more context-specific understanding of factors influencing current carbon-intensive travel patterns. This paper responds to this need by adopting a social practice perspective to explore the gap year phenomenon, an increasingly popular activity for the British youth, often involving multiple long-haul flights. The social practice approach positions young people's travel decisions as not being simply individual, but shaped by existing conventions, normative expectations and facilitated/constrained by available resources. The paper draws on the findings from a multi-sited ethnographic study in England, which involved over 30 in-depth interviews with students and other relevant actors, content analysis of gap year materials and participant observation at gap year-related events. Social influences that shape the current long-haul character of gap year travel are examined, and a number of important actors involved in developing, sustaining and reproducing unsustainable behaviours are identified. The implications for policy strategies aimed at changing mobility behaviour are discussed. [ABSTRACT FROM AUTHOR]

Abstract: In 2004, the English Department of Health introduced a technology (Choose and Book) designed to help general practitioners and patients book hospital outpatient appointments. It was anticipated that remote booking would become standard practice once technical challenges were overcome. But despite political pressure and financial incentives, Choose and Book remained unpopular and was generally used reluctantly if at all. Policymakers framed this as a problem of ‘clinician resistance’. We considered Choose and Book from a sociological perspective. Our dataset, drawn from a qualitative study of computer use in general practice, comprised background documents, field notes, interviews, clinical consultations (directly observed and videotaped) and naturally occurring talk relating to referral to hospital in four general practices. We used strong structuration theory, Giddens' conceptualisation of expert systems, and sensitivity to other sociological perspectives on technology, institutions and professional values to examine the relationship between the external environment, the evolving technology and actions of human agents (GPs, administrators, managers and patients). Choose and Book had the characteristics of an expert system. It served to ‘empty out’ the content of the consultation as the abstract knowledge it contained was assumed to have universal validity and to over-ride the clinician's application of local knowledge and practical wisdom. Sick patients were incorrectly assumed to behave as rational choosers, able and willing to decide between potential options using abstracted codified information. Our analysis revealed four foci of resistance: to the policy of choice that Choose and Book symbolised and purported to deliver; to accommodating the technology's socio-material constraints; to interference with doctors' contextual judgements; and to adjusting to the altered social relations consequent on its use. We conclude that ‘resistance’ is a complex phenomenon with socio-material and normative components; it is unlikely to be overcome using the behaviourist techniques recommended in some health informatics and policy literature. [Copyright &y& Elsevier]

Building on existing research from a zemiological approach, this article seeks to contribute to a more ontological understanding of the production and reproduction of harms associated with wrongful imprisonment in England and Wales. Drawing from Anthony Giddens's theory of structuration, it is argued that whilst the harms of wrongful imprisonment are both complex and devastating, victims need not be perceived as entirely passive. Rather, victims of wrongful imprisonment can be viewed as knowledgeable agents with the intrinsic capacity and agency to strategically cope with and even survive the harms that they experience. The article concludes with personal accounts by victims of wrongful imprisonment that form an identifiable 'survivor' discourse to highlight some of the key critical factors that are vital in helping victims of wrongful imprisonment to re-structure their lives after release. [ABSTRACT FROM AUTHOR]

The paper is based on original empirical research into the lifestyle migration of European migrants, primarily British, to Thailand and Malaysia, and of Hong Kong Chinese migrants to Mainland China. We combine strong structuration theory (SST) with Heideggerian phenomenology to develop a distinctive approach to the interplay between social structures and the lived experience of migrants. The approach enables a rich engagement with the subjectivities of migrants, an engagement that is powerfully enhanced by close attention to how these inner lives are deeply interwoven with relevant structural contexts. The approach is presented as one that could be fruitfully adopted to explore parallel issues within all types of migration. As is intrinsic to lifestyle migration, commitment to a better quality of life is central to the East Asian migrants, but they seek an uncomplicated, physically enhanced texture of life, framed more by a phenomenology of prosaic well-being than of self-realization or transcendence. In spite of possessing economic and status privileges due to their relatively elite position within global structures the reality for a good number of the lifestyle migrants falls short of their prior expectations. They are subject to particular kinds of socio-structural marginaliszation as a consequence of the character of their migration, and they find themselves relatively isolated and facing a distinct range of challenges. A comparison with research into various groups of migrants to the USA brings into relief the specificities of the socio-structural positioning of the lifestyle migrants of the study. Those East Asian migrants who express the greatest sense of ease and contentment seem to be those who have responded creatively to the specific challenges of their socio-structural situation. Often, this appears to have been achieved through understated but active involvements with their new settings and through sustaining focused transnational connections and relationships., (© London School of Economics and Political Science 2018.)