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Antimicrobial resistance (AMR) is now recognised as a social, cultural, economic and political phenomenon, positioning the social sciences as central in responding to this global health threat. Yet efforts to address AMR within hospital settings, for example through antimicrobial stewardship (AMS) programs, continue to focus primarily on the prescribing practices of individual clinicians, often with little effect. There has been less attention to the role of healthcare administration, and managerialism therein, in explaining the limited progress to date in reining in antimicrobial misuse. To explore this, drawing on interviews with senior executives and managers from two Australian hospitals, we examine how these stakeholders navigate between management practice and AMR solutions, revealing that antimicrobial optimisation is frequently obscured by accountability structures attuned to other agendas. This has led, we argue, to the institutionalisation of micro-improvements that frequently 'tick the box' of having an AMS program, yet do little to effectively counteract rising AMR. Our analysis illustrates how sociological attention to the structural and ideological settings within which prescribing behaviour is carried out will be crucial to any attempts to successfully rein in AMR. • Behavioural approaches to antimicrobial misuse are having only minimal effects. • Managerial principles are ubiquitous in healthcare service provision. • Current accountability structures lend themselves to micro-improvements. • Ideology must front and centre of the examination of continued rise of AMR. [ABSTRACT FROM AUTHOR]

This article draws on a study of 80 National Health Service cancer patients and their experiences of using the Internet within disease and treatment processes. It focuses on the role the Internet plays in the context of potential or actual engagement with complementary and alternative medicine (CAM). The results depart from previous conceptualizations of the Internet as a major source of CAM knowledge, and second, as a major pathway to patient CAM usage. Moreover, the results highlight significant anxiety as patients attempt to process vast amounts of complex biomedical diagnostic and prognostic information online. For patients attempting to embrace alternative therapeutic models of cancer care, exposure to prognostic data may pose considerable risks to individual well-being and engagement with healing practices. On the basis of these results we problematize social theorizations of the Internet as contributing to such things as: the democratization of knowledge; the deprofessionalization of medicine; and patient empowerment. We emphasize, instead, the potential role of the Internet in reinforcing biomedicine's paradigmatic dominance in cancer care. [ABSTRACT FROM AUTHOR]

Drawing on in-depth interviews with cancer patients, this article examines patients' perspectives on the nature of evidence and the degree to which different understandings of evidence inform decision-making about complementary and alternative medicine (CAM) and biomedical cancer treatments. Results illustrate the ways in which many cancer patients critically engage with questions about the nature of knowledge and the potential pitfalls of science. Their accounts can largely be characterized by a dialectical tension between individuation (espoused by many CAM therapies) and depersonalization (implicit in biomedical care); a tension mediated by individual cancer patient's prognosis and age. On the basis of the results we argue for a re-focusing of social theory to embrace an understanding of grass-roots ontological tensions seen in the experiences of individual cancer patients. The problematic nature of maintaining a narrowly defined 'evidence-base' policy on CAM and cancer is also discussed in light of the data. [ABSTRACT FROM AUTHOR]

There are increasing calls from global health organisations for the promotion of traditional medicines (TM) as one method of addressing the health needs of populations in poorer countries. However, little research has been done to explore the interactions (and potential conflicts between) traditional healthcare systems and biomedical services. Drawing on semi-structured interviews with 46 cancer patients in Lahore, Pakistan, this article examines patients' experiences of the inter-professional dynamics associated with the range of traditional and biomedical cancer treatments. Results illustrate a complex set of 'cross sectoral' relationships. On the one hand, significant professional distancing was identified between certain traditional healers and biomedical clinicians, as was the deployment of discursive and regulatory gate-keeping tactics at a grassroots level. However, there was also evidence of selective strategic alliance between one traditional practice — Dam Darood, and biomedicine; a relationship deeply embedded in shared religious beliefs and their seemingly compatible therapeutic objectives. It is concluded that, for the development of culturally-appropriate health policy, there is the need for a multifaceted understanding of the socio-cultural processes underpinning the relationships between different treatment modalities. [ABSTRACT FROM AUTHOR]

Abstract: High levels of use of complementary and alternative medicine (CAM) have been consistently reported amongst cancer patients over recent years. This is occurring in the context of an apparent increase in sources of information on therapeutic alternatives and a growth in the range of those claiming professional expertise in the field. To date there has been little research on patient experience of discussions about CAM with biomedical cancer specialists in this increasingly complex social environment. This paper addresses three issues: patient experience with cancer specialists; the significance of that experience for patient engagement with CAM; and the nature and significance of inter-professional dynamics. It draws on the results of a qualitative study with cancer patients in the UK. In-depth interviews with 80 purposively sampled patients, incorporating a range of disease types and stages, were conducted. Patients reported three main types of approach by oncologists: explicit or implicit negativity; supportive ambivalence; and, pragmatic acceptance. Crucially, patients’ accounts suggest that the type of approach adopted influences (though does not determine) patient action. Specialist cancer nurses emerged as potentially powerful mediators between oncologists and patients. Despite the apparent potential for influence from multiple information sources and ‘experts’, on the basis of this study we would argue that oncologists remain crucial to patient engagement with CAM. However, this is not to argue that the influence is a simplistic one. Where patient and medical perspectives diverge, strategic alignment with specialist nurses may help patients make choices which conflict with perceived advice. [Copyright &y& Elsevier]

Cancer is the second leading cause of death in Pakistan. There is increasing evidence that patients are using a range of (biomedical and nonbiomedical) therapeutic options for cancer treatment. To date there has been no sociologically informed research into the engagement of cancer patients in Pakistan with available modalities. In this article, the authors present findings from the first such study. They purposively sampled 46 cancer patients from four hospitals in Lahore and conducted semistructured interviews with them. They argue that individuals are actively mediating therapeutic possibilities by drawing on, and at times being constrained by, personal, social, and cultural resources. It is the authors' contention that this can be conceptualized by an appreciation of individuals' active engagement with three temporally and spatially specific dimensions: structural and practical constraint; pragmatic experimentation; and cultural and religious affiliation. The negotiation (and varying power) of these dimensions is crucial to the process. [ABSTRACT FROM AUTHOR]

This paper explores the contemporary relevance of sociological theorisations centred on medical power, including the medical dominance and deprofessionalisation theses. To achieve this it examines two issues that have been tentatively linked to the relative decline of the power and autonomy of biomedicine - complementary and alternative medicine (CAM) and the Internet-informed patient. Drawing on these two different but interconnected social phenomena, this paper reflects on the potential limitations of power-based theorisations of the medical profession and its relationship to patients and other non-biomedically situated professional groups. It is argued that power-based conceptual schemas may not adequately reflect the non-linear and complex strategic adaptations that are occurring among professional groups. [ABSTRACT FROM AUTHOR]

In the context of health service delivery, deprofessionalization denotes a trend towards a demystification of medical expertise and increasing lay scepticism about health professionals, suggesting a decline in the power and status of the medical profession. This process has been linked to increasing consumerism, the rise of complementary medicine and the emergence of the Internet. Drawing on data from in-depth interviews with prostate cancer specialists, this article explores their experiences of the Internet user within the context of the medical consultation. Results suggest that the deprofessionalization thesis is inadequate for capturing the complex and varying ways in which specialists view, and respond to, the Internet-informed patient. It is argued that the ways in which these specialists are adapting to the Internet and the Internet user should be viewed as strategic responses, rather than reflecting a breakdown in their authority or status. `Enlistment' and `translation' are presented as useful conceptual tools for understanding specialists' experiences of the Internet. [ABSTRACT FROM AUTHOR]

In the current study, the author explores the complex effects and contradictory roles of the Internet as a source of empowerment and control, and as a site of "risk management." Drawing on a study of the Internet usage of Australian men with prostate cancer, the author investigates how access to information and online support affects men's experiences of disease and, in particular, the possible implications of Internet-informed patients for the doctor-patient relationship. The data reveal that accessing information and/or support online can have a profound effect on men's experiences of prostate cancer, providing a method of taking some control over their disease and limiting inhibitions experienced in face-to- face encounters. However, it is also clear that some medical specialists view Internet-informed patients as a challenge to their power within medical encounters and, as a result, employ disciplinary strategies that reinforce traditional patient roles and alienate patients who use the Internet. [ABSTRACT FROM AUTHOR]

This article argues that experiences of, and attitudes towards, online communities are deeply embedded in understandings of masculinity, the perceived character of the Internet, and changes in the roles of the patient and the expert within decision-making processes. Drawing on the accounts of a group of Australian men with prostate cancer and prostate cancer specialists, this qualitative study explores experiences of online support groups. Results point to three unexplored and important factors influencing how both patients and clinicians perceive and experience online support. First, online support groups provide some men with a method of managing constraints posed by dominant constructions of masculinity within their experiences of prostate cancer, allowing for increased sharing and intimacy by limiting inhibitions associated with face-to-face encounters. However, other men view online support groups as havens for deception and misinformation, and computer-mediated communication as a highly problematic form of social interaction. Finally, this article shows how some medical specialists experience online support groups as a threat to their expert status and control over decision-making processes, outlining the nature and possible implications of their responses to this threat. [ABSTRACT FROM AUTHOR]

This article examines the relationship between cultural constructions of masculinity and men's experiences of prostate cancer in Australian society. Drawing on the results of a qualitative study involving in-depth interviews with 33 men with prostate cancer, this article focuses on the difficulties posed by prostate cancer for these men's gender identities. Findings illustrate how investigative, diagnostic, and treatment procedures pose significant difficulties for many men, especially in relation to their desires to perform idealised constructions of masculinity. Although a minority viewed the potential challenge posed to their masculinity as insignificant in the wider context of terminality and mortality, the majority considered these factors as fundamental in shaping their experience of disease and influential in making a treatment decision. It is argued that gaining a better understanding of the influence of cultural codes of masculinity on experiences of disease and treatment processes is essential for maximising the quality of care provided to men with prostate cancer. [ABSTRACT FROM AUTHOR]

The landscape of cancer is changing, with earlier detection and the emergence of new treatment options signalling the potential reconfiguration of cancer (for some) as a chronic condition. Cancer is increasingly experienced in terms of chronicity, incorporating both ongoing episodes of acute treatment alongside the long-term management of disease, symptoms, and side effects. This emphasis refocuses attention toward living-with, as well as beyond, cancer. Yet, how cancer chronicity is understood and experienced by both patients and healthcare professionals remains underexplored. While sociological scholarship has critically analysed how chronic illness has been positioned as a problem of/for the person and/or the healthcare system, less attention has been paid to instances like cancer, where chronicity might be viewed as reflective of forms of success (e.g. through the deferral of mortality even in the absence of 'cure'). In this paper we draw on qualitative interview data from a large study of cancer survivorship including patients, their family carers and health professionals, across two Australian hospitals. We critically analyse the dimensions of chronicity in the cancer sphere, understanding cancer-as-chronicity as producing a particular form of subjectivity, shaped by the everyday management and experience of treatment, impairment, symptoms, and side-effects. We posit that constructions of cancer as chronic, and associated imperatives linked to longevity, commitment, and resilience, are placing new demands on patients, family carers, and professionals alike. [ABSTRACT FROM AUTHOR]

Being diagnosed with a life-limiting illness entails a fundamental reshaping of one's relationship with the future. From ‘bucket lists’ of destinations and experiences to ‘flights of hope’ for experimental or specialised medical care, diagnoses of serious illness are deeply entwined with travel in Australian cultural narratives. In this paper, we draw on a thematic analysis of interviews with cancer patients and their carers to ask what meanings are attached to narratives of travel – whether completed or constrained, imagined or interrupted – in the context of a cancer diagnosis. Focusing on narratives of travel draws attention to themes of disruption, resilience, autonomy and living a meaningful life within the precarious timescape of cancer. Through this analysis of time and travel, we examine how normative expectations of how to live with or beyond cancer can produce tensions, particularly in the uncertain but precariously hopeful landscape of precision cancer treatments. [ABSTRACT FROM AUTHOR]

Although a diagnosis of a life‐limiting cancer is likely to evoke emotions, such as fear, panic and anxiety, for some people it can also provide an opportunity to live life differently. This article is based on research undertaken in Aotearoa New Zealand on the topic of exceptional cancer trajectories. Eighty‐one participants who had been identified as living with a cancer diagnosis longer than clinically expected were interviewed, along with 25 people identified by some of the participants as supporters in their journey. For some participants the diagnosis provided the opportunity to rethink their lives, to undertake lifestyle and consumption changes, to be culturally adventurous, to take up new skills, to quit work and to change relationships with others. The concepts of biographical disruption and posttraumatic growth are considered in relation to these accounts, and it is argued that the event of a cancer diagnosis can give license for people to breach social norms. [ABSTRACT FROM AUTHOR]

Prescribing of antimicrobial agents for respiratory infections is one of the highest volume area of hospital antibiotic prescribing, accounting for circa 16% of hospital antimicrobial prescriptions in Australia and international studies. 1 In a global environment of escalating antimicrobial resistance, limited new antibiotic development and a desire to reduce antimicrobial misuse, there is an increasing imperative to optimize across all settings to preserve options for the future. Yet, despite increasing regulatory requirements, antibiotic restrictions and enhanced surveillance measures, management of respiratory infections in hospitals commonly involves inappropriately long durations of antimicrobial therapy and broader spectrum treatment than is required. The reasons for this are complex and have been relatively opaque, but an emerging body of evidence supports the significant influence of social factors on antimicrobial prescribing in respiratory infections, which may potentially be difficult to shift with the traditional ‘diffusion 'model of knowledge dissemination (i.e. strategies focusing on surveillance, education and regulatory approaches to antimicrobial optimisation).This model of optimization—dominating current approaches in many hospital contexts—may not account for key contextual factors which can act as significant barriers to practice change, such as perceptions of risk and hierarchical relationships within hospitals. [ABSTRACT FROM AUTHOR]

Male suicide is a significant issue globally, and implicated are men's challenges around help-seeking and engagement with peer or professional mental health care. While men's reticence for help-seeking predominates as an explanatory gendered dimension for male suicide, there are significant caveats and complexities to fully understanding those practices in the context of men's mental illness and suicidality. The current photo-voice study offers considerable insight into such issues – through the eyes of the bereaved – retrospectively exploring accounts of the deceased's mental health help-seeking prior to the death. Using an interpretive design, and based on semi-structured individual photo-elicitation interviews with 20 men who had lost a male friend, family member or partner to suicide, three key dimensions were identified: 1) Entrapped by secrecy and concealing the need for help, in which the deceased hid their suicide risk and need for peer or professional mental health care; 2) Overwhelming illness that couldn't be helped, wherein the deceased had previously connected with an array of social supports and medical services but was estranged from peer and professional help ahead of the suicide, and 3) Services and systems providing ineffectual help , whereby the deceased was connected with mental health care shortly before the suicide. These themes reveal complex relations to help, and help-seeking in men lost to suicide, as well as bereaved men's reliance on normative masculinities as an explanatory framing of these practices. Discussed within a critical masculinities framework, the current study highlights the need to destigmatize men's mental illness and help-seeking as well as address significant health inequities to aid the efficiencies of men's suicide prevention programs. • Bereaved men offer important insights to male help-seeking prior to suicide. • Masculinities can intersect with health inequities to increase suicide risk. • Men who are seemingly in care can be high risk for suicide. • Masculine cultures and norms are key considerations for suicide prevention. • Norming men's help-seeking may reduce suicide. [ABSTRACT FROM AUTHOR]

Informal caring at the end of life is often a fraught experience that extends well beyond the death of the person receiving care. However, analyses of informal carers' experiences are frequently demarcated relative to death, for example in relation to anticipatory grief (pre-death) or grief in bereavement (post-death). In contrast to this tendency to epistemologically split pre- and post-death experiences, we analyse informal caring across two separate qualitative interviews with 15 informal carers in one metropolitan city in Australia—one before and one after the death of the person for whom they cared. In doing so, we focus on accounts of care across dying and bereavement including: the evolving ambivalence of carers' social relations at the end of life and beyond; dying and death as a challenge to the ideal of authenticity; and, the potential for misrecognition and social estrangement in caring relations at the end of life. We draw on social theory addressing the themes of ambivalence, authenticity and recognition to enhance our understanding of caring as a social practice that occurs across dying and bereavement, rather than as structured primarily by the context of one or the other. • The temporality of caring for the dying has been under-explored. • Carers' experiences often evolve before and after death. • This raises challenges of authenticity, ambivalence and recognition for carers. [ABSTRACT FROM AUTHOR]

While a significant health concern for sexual minority women, there is little qualitative research investigating their experiences of childhood trauma and suicidality. In this study, we used photovoice methods and an intersectionality framework. Drawing on qualitative interviews, we inductively derived three themes (a) Traumatized and discredited, (b) Cascading marginality, estrangement, and suicidality, (c) Reconstruction and reclaiming resilience. In Traumatized and discredited, we describe the sense of abandonment flowing from childhood trauma heightened by a lack of protection and neglect on the part of parents/guardians. The lack of support to deal with childhood trauma and the layering effects of marginality characterizes the theme Cascading marginality, estrangement, and suicidality. In the third theme, we discuss strategies for reconstruction and reclaiming resilience as participants worked to overcome these challenging experiences. Our study findings offer guidance to suicide prevention counseling programs for sexual minority women and affirm actions to address health inequities. [ABSTRACT FROM AUTHOR]

Background: Antimicrobial therapy for intra‐abdominal infections is often inappropriately prolonged. An intervention addressing factors influencing the duration of intravenous antibiotic use was undertaken. This study reports the antibiotic prescribing patterns before and after the intervention and a qualitative analysis of the experience of the intervention. Methods: Quantitative: A retrospective audit of patients with complicated intra‐abdominal infection before and after a multifaceted persuasive intervention was performed. Qualitative: Semi‐structured interviews were performed to evaluate which elements of the intervention were perceived to be effective. Results: An intervention including collaborative inter‐specialty and inter‐professional educational meetings, and education of all professional streams was undertaken. Quantitative: Twenty‐three patients before and 22 patients after the intervention were included. The total duration of antibiotics decreased significantly following the intervention (9.2 versus 6.6 days P = 0.02). The duration of intravenous antibiotics did not change significantly (5.4 versus 4.5 days, P = 0.06). Qualitative: Eighteen health‐care professionals participated. Thematic analysis indicated that a collaborative approach between senior surgical and infectious disease specialists in the pre‐intervention stage led to perceived ownership and leadership of the intervention by the surgical team, which was thought critical to the success of the intervention. Conversely, the ability of nurses and pharmacists to influence antibiotic practice was considered limited and a poster promoting the intervention was perceived as ineffective. Conclusion: Consultant leadership and specialty ownership of the process were perceived to be critical in the success of the intervention. Antibiotic stewardship programs which address social factors may have greater efficacy to optimize antimicrobial prescribing. [ABSTRACT FROM AUTHOR]

Abstract: Aim: A viable and sustainable medical oncology profession is integral for meeting the increasing demand for quality cancer care. The aim of this study was to explore the workforce‐related experiences, perceptions and career expectations of early‐career medical oncologists in Australia. Methods: A mixed‐methods design, including a survey (n  =  170) and nested qualitative semistructured interviews (n  =  14) with early‐career medical oncologists. Recruitment was through the Medical Oncology Group of Australia. Qualitative data were thematically analyzed and for the survey results, logistic regression modeling was conducted. Results: Early‐career medical oncologists experienced uncertainty regarding their future employment opportunities. The competitive job market has made them cautious about securing a preferred job leading to a perceived need to improve their qualifications through higher degree training and research activities. The following themes and trends were identified from the qualitative and quantitative analyses: age, career stage and associated early‐career uncertainty; locale, professional competition and training preferences; participation in research and evolving professional expectations; and workload and career development opportunities as linked to career uncertainty. Conclusion: Perceived diminished employment opportunities in the medical oncology profession, and shifting expectations to be “more qualified,” have increased uncertainty among junior medical oncologists in terms of their future career prospects. Structural factors relating to adequate funding of medical oncology positions may facilitate or inhibit progressive change in the workforce and its sustainability. Workforce planning and strategies informed by findings from this study will be necessary in ensuring that both the needs of cancer patients and of medical oncologists are met. [ABSTRACT FROM AUTHOR]

In this paper we consider early maternal distress and clinical care, drawing on narratives of women interviewed to populate an Australian health information website. We consider the notion of ‘care barriers’, which has become popular in the biomedical literature as a means of explaining why ‘not enough’ women seek out clinical care. As an alternative to barriers we propose ‘care entanglements’, offering a way of conceptualizing socioculturally situated and biographically embedded formalized care. In part we argue that clinical encounters are ‘haunted’ by women’s biographies, circulating discourses, and the relational clinical moment, which accounts for why some women reject formalized care. However we also contend that many women have in fact already ‘slipped through’ to the clinic, whether this be in their adoption of medical language to describe their distress, or in their enactments in designated clinical spaces. Finally we reflect more broadly on the maternal, care and distress. [ABSTRACT FROM AUTHOR]

Introduction: This study compares the experiences of high school students with visual impairments (that is, those who are blind or have low vision) in and out of school. Methods: Twelve visually impaired high school students completed the same in-the-moment survey seven times daily for seven consecutive days. The frequencies of their activities, interactions, and ratings of internal variables (fitting in, acceptance, loneliness, and enjoyment) were compared across three contexts: home, school, and other (neither home nor school) contexts. Results: Participants spent much of their time out of school alone at home. They rated leisure and structured recreation in "other" locations as their most enjoyable activities. Doing nothing at school was the least positively rated activity. Participants fitted in significantly less and felt significantly less accepted at school than elsewhere. A large proportion of school interactions involved receiving help; few involved giving help. Participants with additional disabilities reported more school social challenges than their peers who were only visually impaired. Discussion and implications for practitioners: This study highlights the subjective dimensions of choice in everyday life. The social impact of doing nothing at school provides an imperative for staff members to ensure that adolescents with visual impairments can participate in lessons. Staff may also need to facilitate opportunities for these students to reciprocate with peers. Adolescents with visual impairments highly value activities with friends out of home and, as with most adolescents, may need to lean on their families for assistance in this area until they can participate in such activities independently. [ABSTRACT FROM AUTHOR]

While mental illness is a significant health challenge worldwide, the availability of specialists is limited, especially in rural areas and for psychiatric emergencies. Although tele-psychiatry, via real-time videoconferencing (VC), is used to provide consultative services in areas that lack psychiatrists, there are a paucity of studies on the use of VC for psychiatric emergencies . We examine how VC matters for patient involvement and professional practice in the first Norwegian emergency tele-psychiatric service. Through a decentralised on-call system, psychiatrists are accessible 24/7 by telephone and VC for patients and nurses in regional psychiatry centres. Based on 29 interviews with patients, psychiatrists and nurses, this article addresses how participation is fostered by VC, and how it may change the social dynamics of therapeutic emergency encounters. We identified four contributions of the ‘video-mediated gaze’ in the therapeutic encounter including those of the: (1) immediacy of assessment, (2) increased transparency, (3) sense of access to the ‘real’ expert, and (4) fostering of the patient's ‘voice’ in therapeutic decisions. These VC inflections of the therapeutic encounter are a mix of the pragmatic (1 and 2) and the symbolic (3 and 4), assembling in these contexts to foster patient-centeredness. With a sociological approach to video-conferenced emergency psychiatry, the identification of symbolic affordances adds necessary nuances to the application of new technologies into fragile therapeutic communication. [ABSTRACT FROM AUTHOR]

An abstract of the study "Marginalization and Companionable Silence: CAM Practitioners' Perspectives of Their Interprofessional Relationships With Maternity Care Providers" by Amie Steel and colleagues is presented.

Background: Back pain is an increasingly prevalent health concern amongst Australian women for which a wide range of treatment options are available, offered by biomedical, allied health and complementary and alternative medicine (CAM) providers. Although there is an emerging literature on patterns of provider utilisation, less is known about the reasons why women with back pain select their chosen practitioner. In this paper we explore the influences on back pain sufferers' decision-making about treatment seeking with practitioners for their most recent episode of back pain.Methods: Drawing on 50 semi-structured interviews with women aged 60-65 years from the Australian Longitudinal Study on Women's Health (ALSWH) who have chronic back pain, we focus on the factors which influence their choice of practitioner. Analysis followed a framework approach to qualitative content analysis, augmented by NVivo 9 qualitative data analysis software. Key themes were identified and tested for rigour through inter-rater reliability and constant comparison.Results: The women identified four predominant influences on their choice of practitioner for back pain: familiarity with treatment or experiences with individual practitioners; recommendations from social networks; geographical proximity of practitioners; and, qualifications and credentials of practitioners. The therapeutic approach or evidence-base of the practices being utilised was not reported by the women as central to their back pain treatment decision making.Conclusions: Choice of practitioner appears to be unrelated to the therapeutic approaches, treatment practices or the scientific basis of therapeutic practices. Moreover, anecdotal lay reports of effectiveness and the 'treatment experience' may be more influential than formal qualifications in guiding women's choice of practitioner for their back pain. Further work is needed on the interpersonal, collective and subjective underpinnings of practitioner choice, particularly over time, in order to better understand why women utilise certain practitioners for back pain. [ABSTRACT FROM AUTHOR]

Structured abstract: Introduction: This study explores the social experiences in high school of students with visual impairments. Methods: Experience sampling methodology was used to examine (a) how socially included students with visual impairments feel, (b) the internal qualities of their activities, and (c) the factors that influence a sense of inclusion. Twelve students, including three with additional disabilities, completed the Psychological Sense of School Membership (PSSM) questionnaire as a measure of inclusion. They were subsequently asked to complete an in-the-moment survey seven times daily for one week using an iOS device. This survey asked about activities and ratings of internal variables: fitting in, acceptance, loneliness, awareness, and enjoyment. Each student was also interviewed. Z-scores were created for internal variables and correlations calculated to examine relationships between experiences, PSSM, and demographic variables. Results: This group felt included as measured by the PSSM (m = 4.24, SD .67). Students' most frequent activity was classwork. Doing nothing rated most negatively and was described as time wasting. Out-of-class activities were rated most positively. In the three participants with additional disabilities, it appeared that the presence of this additional disability negatively influenced a sense of inclusion (rb = .67, p ≤ .05), fitting in (rb = -.86, p ≤ .05), enjoyment (rb = -.65, p ≤ .05), and loneliness (rb = .88, p ≤.05). Interviews revealed a lack of common ground between adolescents with both visual impairments and additional disabilities and their peers. Discussion and implications for practitioners: These students worked hard to maintain parity with peers and found school more enjoyable if they fit in. It is important to provide discreet and timely access to the curriculum. Friendships require time, common interests, and reciprocity. There may be potential to further explore out-of-class clubs as a means of supporting friendship development. In addition, findings suggest that students with additional disabilities are not likely to feel included. Because this population comprises the majority of visually impaired students, this result has serious implications for practitioners and should be examined in future research. [ABSTRACT FROM AUTHOR]

This study examined factors influencing decision-making on complementary and alternative medicine ( CAM) use for back pain and back pain sufferers' communication about CAM use. A cross-sectional postal survey was conducted in 2011/2012 as a sub-study of the Australian Longitudinal Study on Women's Health ( ALSWH). The sample contained 1620 women from the 1945-1951 cohort of the ALSWH, aged 60-65 years who were eligible for the sub-study, as they had experienced back pain during 12 months prior to the survey. Of these, 1310 (80.9%) returned completed questionnaires. A significant proportion of women consulted a CAM practitioner (76%, n = 1001) and/or had self-prescribed CAM treatment (75%, n = 985). Of the women who used CAM for their back pain, 20% consulted their general practitioner ( GP) prior to using CAM and 34% always informed their GP following CAM use. Forty-three per cent of the women were influenced by their doctors, 39% by friends/colleagues, 36% by family/relatives, 33% by their partner, 30% by a CAM practitioner, 20% by a pharmacist, 16% by a book/magazine, 11% by mass media, 10% by an allied health worker and 6% by the Internet. Our results show that information sources used by women for their decision-making on CAM use differed according to the symptoms. While non-professional information sources (e.g. family/relatives) positively influenced women in their decision to use CAM for a range of back pain-related symptoms (e.g. headaches/migraines), doctors and allied health workers (e.g. nurses) negatively influenced women in their decision to consult a CAM practitioner for a range of back pain-related symptoms (e.g. headaches/migraines, neck pain). Women seek information from a wide range of professional and non-professional sources with regard to their decision-making around CAM use for back pain. Back pain care providers need to ensure effective communication with their back pain patients regarding safe, effective and co-ordinated back pain care options. [ABSTRACT FROM AUTHOR]

Precision oncology holds an increasingly powerful social function. In the era of precision, how people encounter, live with, and experience cancer, how they imagine their lives, how they navigate treatment regimens, and experience side effects, have been radically transformed. Innovations in oncology – in this case precision-related – are always more-than-clinical; their circulation exceeds the laboratory and the hospital, but what this 'circulation of innovation' produces has been thus far opaque. To begin to comprehend what is emergent at the cancer-precision nexus in people's everyday lives, we draw on qualitative interviews with twenty people diagnosed with metastatic non-small cell lung cancer undergoing immunotherapy and/or targeted therapy and we discuss how precision inflects survivorship, entangles subjects in chronic living, and induces novel temporalities. Through such inflections of survivorship, precision innovation re-shapes expectations and possibilities, and sometimes enacts new, unexpected (or, for some, unwanted) futures. Such illness and survivorship narratives indicate the importance of orientating the social science scholarship toward considerations of temporality and entanglements for comprehending precision innovation in oncology. And in doing so, provide a nuanced account of how innovations unsettle and recast, rather than unravel, the normative scene of cancer. • Analyses how people experience precision oncology for advanced lung cancer. • Draws on 20 in-depth interviews with patients in Australia. • Applies the theoretical lenses of entanglement and temporality. • Unique contribution to understanding how people live with precision oncology. [ABSTRACT FROM AUTHOR]

The objective of the authors in this study was to determine if prior visits to a complementary and alternative medicine (CAM) practitioner were associated with CAM use during pregnancy. The study sample comprised the Australian Longitudinal Study on Women’s Health. Women were surveyed prior to pregnancy in 2006, and then again in 2010 if they were pregnant or had recently given birth, and asked a range of questions relating to demographic variables, health status, and use of CAM. A multivariable analysis identified significant covariates associated with visits to specific CAM practitioner modalities during pregnancy. Of the 447 women who consulted a CAM practitioner prior to pregnancy, 62.4% (n = 279) continued this use during pregnancy. Prior use of massage therapy, acupuncture, herbalist/naturopath, or chiropractor was related to use of the same service during pregnancy. Higher income and working full-time were associated with the continued use of massage, while continued visits to a chiropractor were associated with having depressive symptoms, a urinary tract infection, and living in a rural community. Prior use of CAM was highly related to continuing use during pregnancy. Further research is required to elucidate the benefits women attain from a CAM-model of care that they do not get from their conventional maternity care providers alone. [ABSTRACT FROM PUBLISHER]

BackgroundMany people with intellectual disability have limited sexual knowledge. Several assessment tools have been developed to assess the sexual knowledge of people with intellectual disability. This paper examines how clinicians’ are using these tools. MethodThis research uses a constructivist grounded theory approach. Semistructured qualitative interviews were conducted with clinicians who use sexual knowledge assessment tools. Findings and DiscussionAssessment of sexual knowledge is not routine in disability service provision. Sexual knowledge is typically only assessed when there has been an incident of problematic sexualised behaviour. This reactive approach perpetuates a pathological sexual health discourse. ConclusionsClinicians using assessment tools said that they need the tools to support work they do in relation to sexual health of people with intellectual disability. However, they also reported that the tools have gaps and are not fully meeting their needs or the needs of people with intellectual disability. [ABSTRACT FROM PUBLISHER]

Discontents surrounding depression are many, and include concerns about a creeping appropriation of everyday kinds of misery; divergent opinions on the diagnostic category(ies); and debates about causes and appropriate treatments. The somewhat mixed fortunes of antidepressants – including concerns about their efficacy, overuse and impacts on personhood – have contributed to a moral ambivalence around antidepressant use for people with mental health issues. Given this, we set out to critically examine how antidepressant users engage in the moral underpinnings of their use, especially how they ascribe legitimacy (or otherwise) to this usage. Using a modified constant comparative approach, we analyzed 107 narrative interviews (32 in UKa, 36 in UKb, 39 in Australia) collected in three research studies of experiences of depression in the UK (2003–4 UKa, and 2012 UKb) and in Australia (2010–11). We contend that with the precariousness of the legitimacy of the pharmaceutical treatment of depression, participants embark on their own legitimization work, often alone and while distressed. We posit that here, individuals with depression may be particularly susceptible to moral uncertainty about their illness and pharmaceutical interventions, including concerns about shameful antidepressant use and deviance (e.g. conceiving medication as pseudo-illicit). We conclude that while people's experiences of antidepressants (including successful treatments) involve challenges to illegitimacy narratives, it is difficult for participants to escape the influence of underlying moral concerns, and the legitimacy quandary powerfully shapes antidepressant use. [ABSTRACT FROM AUTHOR]

Gay men living with HIV represent a particularly high risk group for suicide; however, little is known about suicidality, specifically, resiliencies in the context of suicidality among this particular group of men. The current study draws on photovoice and grounded theory methods to examine the processes that underpin survival for gay men living with HIV who have experienced suicidality. Twenty‐two Canadian‐based gay men participated, taking photographs to depict and discuss their perspectives on resiliencies. Analyses revealed three processes that supported men's survival: (1) connecting to key supports, (2) finding sanctity in the outdoors, and (3) giving help as purposeful value‐adding. Connecting to key supports highlighted the utility of connection and therapeutic communication, listening and support provided by friends, family and professionals. Finding sanctity in the outdoors emphasised the healing capacity of outdoor green spaces, and giving help as purposeful value‐adding illustrated the meaning and purpose men derived from supporting others. These findings can inform public health and primary care interventions to foster gay men's resilience and coping, and ultimately suicide prevention efforts. [ABSTRACT FROM AUTHOR]

Encouraging men to open‐up about their feelings is a new cultural directive, yet little is known about how this works in practice, including to promote mental health. Ideals of hegemonic masculinity may be increasingly tolerating expressions of vulnerability in some areas of social life. However, the expression of vulnerability in paid work and/or career situations is regulated by organisational ideals and circumstances that may also produce distress. To address uncertainty in the literature, we investigated the experiences of men in traditionally male dominated professions, namely first responders (police, paramedics, and firefighters/rescue). Twenty‐one UK based men of diverse ranks and experience currently working within first responder services participated in semi‐structured telephone interviews. Distress was positioned as an inevitable part of the work. Yet, striking differences in institutionalised ways of expressing vulnerabilities differentiated the experiences of frontline workers, contributing to a wide spectrum of men's silence right through to relative openness about vulnerability, both in the workplace and domestic spheres. The findings provide importanat insights into how vulnerability is institutionally regulated, illuminating and contrasting how the possibilities for male vulnerabilities are socially produced. [ABSTRACT FROM AUTHOR]

Objectives: Up to 87% of women are using some form of complementary and alternative medicine (CAM) during their pregnancy, and this study was conducted to investigate the information sources that these women find influential in relation to such use. Design: The study sample was obtained via the Australian Longitudinal Study on Women's Health. This article is based on a substudy of 1835 pregnant women who were surveyed in 2010. The women answered questions about CAM use, pregnancy-related health concerns, and influential information sources in relation to CAM use. Logistic regression models were used to determine the information sources that women reported as influential in their decision making regarding CAM use. Results: Of the respondents ( n=1835, 79.2% response rate), 48.1% ( n=623) of the pregnant women consulted a CAM practitioner and 91.7% ( n=1485) used a CAM product during pregnancy. The results show that, of the women who used CAM, nearly half (48%, n=493) were influenced by their own personal experience of CAM and 43% ( n=423) by family and friends. Other popular sources of information were general practitioners 27% ( n=263), the media (television, radio, books, magazines, newspapers) 22% ( n=220), obstetricians 21% ( n=208) and midwives 19% ( n=190). Numerous statistically significant associations between influential information sources and pregnancy-related health conditions were identified. Conclusions: Women utilize a wide variety of information sources regarding their CAM use during pregnancy. Nonprofessional sources of information were found to be particularly influential, and maternity health care professionals need to have a nonjudgmental and open discussion with women about their CAM use during pregnancy in order to ensure safe and effective maternal outcomes. [ABSTRACT FROM AUTHOR]

This article explores male perceptions and attitudes toward violence against women in Indonesia. It analyzes interview data from Indonesian men collected as part of a large multimethod Australian government–funded project on masculinities and violence in two Asian countries. Reluctance to talk about violence against women was evident, and the accounts of those men who did respond referred to three justificatory discourses: denial, blaming the victim, and exonerating the male perpetrator. The findings support continuation of government and nongovernmental organization (NGO) projects aimed at both empowering women and reeducating men. [ABSTRACT FROM PUBLISHER]

Background Sexual health remains one of the most overlooked areas of life for people with intellectual disability. In recent years there has been an increasing expectation that this issue will be addressed by disability service providers. In this paper we examine the barriers to sexual health provision of people with intellectual disability as experienced by disability service providers and clinicians. Method This research uses a constructionist grounded theory approach. It was conducted in 2 phases using semistructured qualitative interviews to collect data from disability service managers and clinicians working with people with intellectual disability in New South Wales, Australia. Findings and Discussion Key themes within the interviews -- including funding shortages and a lack of policy guidelines -- were identified as significant administrative barriers to sexual health provision. Myths about the sexual health of people with intellectual disability, family attitudes, and lack of staff training were also identified as barriers. [ABSTRACT FROM AUTHOR]

This paper reports the results of risk reframing, an intervention to offer parents and educators a context for building new and complex perceptions of risk in children’s outdoor free play. Our objective was to alter these adults’ perceptions of risk to increase the sustainability of an innovative child-centred playground intervention. Qualitative data in the form of audio-recordings of risk-reframing sessions, brief participant evaluations and field notes kept by project staff were collected and either transcribed in their entirety or summarised in brief written reports. These data were subjected to constant comparative analysis to identify emergent themes. Results suggest that educators and parents benefit from opportunities to share risk perceptions and discuss the costs and benefits for offering outdoor free play to children to achieve their common goals for children: health, happiness and resilience. [ABSTRACT FROM AUTHOR]

Individual choice is valorised as a core social value; yet the necessity and desirability of making choices takes on new significance for people living with incurable cancer who are required to make often difficult decisions about treatment, care and family life, amidst considerable vulnerability and precariousness. There has been comparatively little exploration of how choice is negotiated and made meaningful under the spectre of incurability and a contracted future. In this paper, drawing on multiple qualitative interviews with 38 women with metastatic breast cancer, we explore how they experience and give meaning to choice in relation to their health (and beyond) in their daily lives. Our analysis highlights that while exercising choice was sometimes a concealed or silent pursuit, choice was always a socially negotiated and temporally unfolding process, nested within relational and interpersonal dynamics. Choices were also often constrained, even foreclosed, due to situational and relational dynamics. Yet even in the absence of choice, the idea of choice-as-control was discursively embraced by women. We argue that greater attention is needed to the affective, temporal and economic dimensions of choice, and how treatment decisions are asymmetrically structured when considered within the normative context of cancer. • Choice is a socially negotiated and temporally unfolding process. • Choices can be constrained or foreclosed by situational and relational dynamics. • In the absence of choice, the idea of choice-as-control is discursively embraced. • Choice is situated within gendered dynamics of care for self and others. • Treatment decisions asymmetrically structured within the normative cancer context. [ABSTRACT FROM AUTHOR]

This study aims to describe the prevalence of health care utilization (including conventional medicine, self-care and complementary medicine treatments) for the management of asthma by women aged 45 years and over and their associated out-of-pocket expenditure. A self-reported mail survey of 375 Australian women, a cohort of the national 45 and Up Study, reporting a clinical diagnosis of asthma. The women were asked about their use of health care resources including conventional medicine, complementary medicine, and self-prescribed treatments for asthma and their associated out-of-pocket spending. Spearman's correlation coefficient, student's t-test and chi-square test were used as appropriate. Population level costs were created by extrapolating the costs reported by participants by available national prevalence data. Survey respondents (N = 375; response rate, 46.9%) were, on average, 67.0 years old (min 53, max 91). The majority (69.1%; n = 259) consulted at least one health care practitioner in the previous 12 months for their asthma. Most of the participants (n = 247; 65.9%) reported using at least one prescription medication for asthma in the previous 12 months. The total out-of-pocket expenditure on asthma treatment for Australian women aged 50 years and over is estimated to be AU$159 million per annum. The breadth of conventional and complementary medicine health care services reported in this study, as well as the range of treatments that patients self-prescribe, highlights the challenges of coordinating care for individuals living with asthma. [ABSTRACT FROM AUTHOR]

Men account for three‐quarters of suicide deaths in the UK, yet we know little about how at‐risk men construct their experiences of moving towards – and then subsequently stepping back from – suicide, nor the part played by relational factors therein. An inductive thematic analysis was used to examine narrative interviews with eleven UK men who self‐reported serious thoughts, plans and up‐to and including suicide attempts in progress, but who consciously decided against carrying out an attempt. Their accounts suggest a highly social process of movements towards and away from suicide (e.g. frustrated help‐seeking). Stepping back from suicide represents not a discrete issue, but a linked process in suicidality and wider recovery. Here, the use of military metaphors in particular (e.g. waging war, fighting back) highlights the gendered nature of the issue. Additionally, our article illuminates a range of social relations and forces that circulate in and around suicidality, which itself is embedded in varying forms of relationality, normativity and gendered practices. [ABSTRACT FROM AUTHOR]

Depression is a common comorbidity in patients with cardiovascular conditions. This study aims to assess the association between comorbid depression and health-promoting behavior in middle-aged and older Australian women with hypertension or heart disease. Data are from a subset of 45 and Up Study participants with diagnosed chronic illness (n = 1,925). Health behaviors including smoking status, alcohol consumption, and physical activity were assessed. Associations of depression with health behaviors in women with hypertension or heart disease were analyzed using unadjusted and adjusted (for chronic conditions and demographic measures) logistic regression models. A total of 666 women with hypertension and 220 women with heart disease were included in the analysis. In adjusted analyses, women with hypertension and comorbid depression were 2.36 (95% confidence interval, 1.02–5.46) times more likely to be risky or high-risk drinkers and 55% (adjusted odds ratio, 0.45; 95% confidence interval, 0.27–0.73) less likely to be highly physically active, compared with women without depression. Women with heart disease and comorbid depression were 65% (adjusted odds ratio, 0.35; 95% confidence interval, 0.12–0.95) less likely to be highly physically active, compared with women without depression. This study provides the first data indicating that depression may be a barrier to health-promoting behavior in middle-aged and older women with hypertension or heart disease. Given that physical inactivity and risky alcohol consumption are important risk factors for aggravation of cardiologic conditions, health-promoting behaviors should be specifically targeted in the treatment of women with comorbid depression. [ABSTRACT FROM AUTHOR]

Although gay, bisexual, and two-spirit men (GBTSM) experience high rates of suicidality, there have been few empirical studies of prevention initiatives and policies that could address or reverse this major social problem. This article reports on a photovoice study of 29 GBTSM who had a history of suicidality or lost a fellow GBTSM to suicide. We focused our analysis on participants' perspectives on suicide prevention. Participants described four key considerations for GBTSM suicide prevention: (a) recognizing and addressing enduring homophobia, biphobia, and mental illness stigma; (b) provision of low-barrier, long-term, and GBTSM-affirming counseling; (c) de-isolation through peer support and community connection; and (d) fostering creativity and cultural resilience. By engaging GBTSM affected by suicide through photographs that depict their experiences and points of view, in this study, we offer concrete recommendations to reduce suicidality among GBTSM. [ABSTRACT FROM AUTHOR]

Masculinity frameworks in men's health research have focused on masculine ideals and norms to describe men's health practices. However, little attention has been paid to inductively deriving insights about what constitutes health-related masculine values among young men. A sequential exploratory mixed-methods design, comprising a qualitative lead to derive health-related masculine values with a follow-up quantitative arm to test the items, was used. Drawing on a sample of 15-29-year-old Canadian male interview participants (n = 30) and survey respondents (n = 600), 5 health-related masculine values were highlighted: (a) selflessness, (b) openness, (c) well-being, (d) strength, and (e) autonomy. Selflessness was characterized by caring for and helping others. Openness included the willingness to gain exposure from new experiences, ideas, and people. Well-being was linked to fitness and masculine body ideals and aesthetics. In terms of strength, men endorsed intellectual, emotional, and physical strength. Regarding autonomy, there was consensus men should be self-sufficient and decisive, whereas being independent drew less endorsement. Highlighting the interdependency of these domains, exploratory factor analysis yielded 2 overarching reliable quantitative dimensions characterized by domains of being inclusive (openness and selflessness; α = .88) and empowered (well-being and autonomy; α = .85). Some inductively derived and pilot-tested values ran counter to long-standing claims that young men are typically hedonistic, hypercompetitive, and estranged from self-health. Study findings are discussed detailing how the evaluation of specific health-related masculine values in subgroups of men might advance masculinities-focused men's health research and inform the next generation of targeted gendersensitized services. [ABSTRACT FROM AUTHOR]

This study explored the drivers of suicidality from the perspectives of gay, bisexual, and two-spirit men (GB2SM) with a history of suicidality. Twenty-one GB2SM participated in this photovoice study taking photographs to depict and discuss their previous suicidality. Data were collected from in-depth individual interviews in which participants discussed their photographs and in turn offered verbal/narrative accounts of suicidality. Drawing on intersectionality, analyses of the photographs and interview data revealed three interconnected themes. First, adverse childhood events and negative adolescent experiences were described as the root causes of mental health struggles and suicidality. Second, violence and homophobia had disrupted these men's education and employment opportunities and some participants detailed how their lack of capital and challenges for maintaining employment shaped their suicidality. Third, a sociality of stigma and sense of isolation compounded experiences of suicidality. The three themes overlapped and were shaped by multiple intersectional axes including sexuality, class, ethnicity, and mental health status. The findings have implications for services and health professionals working with GB2SM who need to thoughtfully consider life-course trajectories and multiple social axes when assessing and treating GB2SM experiencing suicidality. More so, because these factors relate to social inequities, structural and policy changes warrant targeted attention. [ABSTRACT FROM AUTHOR]

This paper explores how distinctions between 'intended' and 'side' effects are troubled in personal narratives of taking psychotropic medications. Grounded in interviews with 29 participants diagnosed with mental illness in Victoria, Australia between February and December 2014, we consider how people interpret pharmaceutical compounds beyond their desired or intended effects, and how such effects shape and transform subjectivity and their relationship with their bodies. This paper contributes to recent discussions of mental illness and medication effects, informed by feminist science studies. It emphasises the co-constitution of social, affective and material relations in the context of 'taking' psychotropic medication. This paper discusses three key themes as important to the phenomenology of the nexus of illness and psychotropic medication: movement, ambivalence, and sociality. Our analysis demonstrates how psychotropic drugs are productive of subjectivity through their promises and potential, their unexpected harms and the institutions from which they are inseparable. • Analyses accounts of mental illness using feminist science and technology studies. • Focus on experiences of taking psychotropic drugs and impact on subjectivity. • Moves beyond distinctions between 'therapeutic' and 'side' effects of drugs. • Unique contribution to understandings of experiences of taking psychotropic drugs. [ABSTRACT FROM AUTHOR]

As photovoice continues to grow as a method for researching health and illness, there is a need for rigorous discussions about ethical considerations. In this article, we discuss three key ethical issues arising from a recent photovoice study investigating men’s depression and suicide. The first issue, indelible images, details the complexity of consent and copyright when participant-produced photographs are shown at exhibitions and online where they can be copied and disseminated beyond the original scope of the research. The second issue, representation, explores the ethical implications that can arise when participants and others have discordant views about the deceased. The third, vicarious trauma, offers insights into the potenial for triggering mental health issues among researchers and viewers of the participant-produced photographs. Through a discussion of these ethical issues, we offer suggestions to guide the work of health researchers who use, or are considering the use of, photovoice. [ABSTRACT FROM AUTHOR]

Background: A wide range of health care options are utilised by pregnant women in Australia. The out-of-pocket costs of maternity care in Australia vary depending on many factors including model of care utilised, health insurance coverage, and women's decision to access health services outside of conventional maternity care provision.Methods: Women from the 1973-78 cohort of the Australian Longitudinal Study on Women's Health (ALSWH) who identified as pregnant or as recently having given birth in 2009 were invited to complete a sub-study questionnaire investigating health service utilisation during their most recent pregnancy.Results: A total of 1,835 women agreed to participate in the sub-study. The majority of women (99.8%) consulted with a conventional health care practitioner during pregnancy, 49.4% consulted with a complementary and alternative medicine practitioner at least once during pregnancy and 89.6% of the women used a complementary and alternative medicine product. Women reported an average of AUD$781.10 in out-of-pocket expenses for consultations with conventional health care practitioners, AUD$185.40 in out-of-pocket expenses for consultations with complementary and alternative medicine practitioners and AUD$179.60 in out-of-pocket expenses for complementary and alternative medicine products. From the study data we estimate Australian pregnant women spend over AUD$337 M on out-of-pocket health services.Conclusion: While the majority of pregnant women in Australia may obtain health services via the publically-funded health care system and/or private health insurance coverage, our analysis identifies substantial out-of-pocket expenditure for health care by pregnant women - a trend in public spending for maternity care of importance to policy makers, health administrators, and health professionals. [ABSTRACT FROM AUTHOR]

The article discusses a study on the usefulness and usability of tools designed to assess the sexual knowledge of people with intellectual disability (ID). Topics covered include the limited sexual knowledge of people with ID serving as a barrier to sexual health, the preference by clinicians for using sexual knowledge assessment tools to support their work, and the concerns among clinicians about response bias and acquiescence associated with sexual knowledge assessment tools.

The article focuses on the health policy reforms in Australia. Particular focus is given to maternity health services, changes in the legislative policies, and the trends in maternity care. Other topics addressed include details of the National Health Act 1953, use of complementary medicines, and the role of midwives in maternity care.