Search

Background: Clinical reasoning is a critical skill for healthcare professionals, vital for making accurate diagnoses and effective treatment decisions. This study focuses on enhancing collaborative clinical reasoning (CCR) among multidisciplinary healthcare teams in a neurosurgery intensive care unit (NICU) in Taiwan. The study utilizes video-reflexive ethnography (VRE) to examine the factors influencing CCR, the cognitive processes involved, and the efficacy of VRE in promoting CCR., Methods: The study employed a qualitative research design, utilizing VRE. Participants included 17 healthcare professionals from a NICU, comprising attending physicians, residents, nurses, and respiratory therapists. Data collection involved video recordings of daily ward rounds, field observations, and reflexive interviews where participants reviewed video clips of their interactions. Thematic analysis was conducted on the transcripts of video recordings and interview., Results: Thematic analysis revealed seven key themes in CCR: information sharing, active verbal and behavioral information gathering, information processing and recall, modification and discussion, short-term indications, and management plans and goals. Information sharing was fundamental, with team members frequently exchanging patient data to ensure a common understanding. Active information gathering, both verbal and behavioral, was crucial for obtaining real-time patient insights. Cognitive processing involved synthesizing data to form initial hypotheses, while modification and discussion highlighted the iterative nature of CCR., Conclusions: This study underscores the importance of effective communication, active information gathering, and iterative discussions in enhancing CCR. VRE proved to be a valuable tool for promoting self-awareness and continuous improvement among healthcare teams. The findings suggest that education programs should focus on developing teamwork and communication skills, and interventions should aim to optimize information flow and foster a culture of open communication. By enhancing CCR, healthcare teams can improve patient outcomes and ensure safer healthcare delivery., Clinical Trial Number: Not required, as this is not a clinical trial and does not involve any healthcare interventions with human participants., Competing Interests: Declarations. Ethics approval and consent to participate: Written informed consent was obtained from all individual participants included in the study. This study was carried out in accordance with relevant guidelines and regulations, and approved by the Chang Gung Medical Foundation Institutional Review Board on Feb 19, 2021 (Ref.: 202002453B0). Consent for publication: Not required as all figures and tables within the manuscript were created by the research team. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Ninety-eight percent of neonatal deaths worldwide occur in low- and middle-income countries (LMICs), yet there is little bereavement care guidance available for these settings., Objectives: To explore parents', families' and healthcare professionals' experiences of care after neonatal death in healthcare facilities in LMICs., Search Strategy and Selection Criteria: Four databases were searched for peer-reviewed literature, meeting the inclusion criteria of qualitative studies exploring the experiences of people who provided or received bereavement care following neonatal death in a LMIC healthcare setting., Data Collection and Analysis: Data were collected by two independent reviewers, collated through line-by-line coding and then reciprocal and refutational translation, and analysed through Noblit and Hare's seven-step meta-ethnography approach to create first-, second- and third-order themes., Main Results: Seven first-order themes extracted from the literature included emotional responses, social relationships, staff and systems, religion, connecting with the baby, coping strategies and economic concerns. From these data, three third-order themes arose: The individual, the healthcare setting and the community/context., Conclusions: Overarching themes in bereavement care shape grief responses and are often similar across geographical locations. Analysing these similarities allows a deeper understanding of the important elements of bereavement care and may be helpful to inform the creation of high-quality, bereavement care guidelines suitable for use in LMIC settings., (© 2024 The Author(s). BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)

This study explores the implementation of biosecurity measures by farm workers through daily work routines on dairy cattle farms in Spain. The implementation of biosecurity measures on dairy cattle farms is mainly decided by farmers and veterinarians, but it is carried out by both farmers and farm workers. However, farm workers may be affected by socio-employment factors such as the precariousness of their work such that implementation of biosecurity measures may be context dependent and may differ from official recommendations. An ethnographic approach was used through observations and conversations on four farms in two regions of Spain, two in Galicia (north-west) and two in Catalonia (north-east) to explore these factors. The profiles of participants were farmer-family workers, internal worker-employees and external worker-employees. Results showed that there were social differences, particularly communicative and hierarchical differences, between workers and farmers that influenced the implementation of biosecurity measures. Workers implemented biosecurity practices incompletely, differently or incorrectly from their supervisors' instructions. Workers also relied on what the authors called an anthropomorphic approach to implementing biosecurity measures, which deviated from farm guidelines. In order to improve the implementation of biosecurity measures on dairy cattle farms, it is necessary to consider workers as key stakeholders in biosecurity. Such consideration could also help to professionalise workers, reduce their turnover and increase their permanence on these farms., Competing Interests: Declaration of Competing Interest The authors declare that the research was conducted in the absence of any commercial or financial relationship that could be construed as a potential conflict of interest. Conflict of interest The authors declare that the research was conducted in the absence of any commercial or financial relationship that could be construed as a potential conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

This article provides an analysis of the negotiation process surrounding in vitro fertilisation (IVF) decisions in contemporary China, based on an ethnography conducted in Beijing. Building on the theoretical framework of applying a 'reprolens' and scholarly debates on the transforming family landscape in contemporary China, I delineate the complex dynamics through which women negotiate their choice of IVF with their families, documenting the ways in which power is distributed. I highlight not only individual-family power dynamics but also the intricate gendered ones within the family. I argue that family relationships shape the desire for IVF and the decision to pursue it; this journey, in turn, can reshape family dynamics. I propose the term familial bargaining to suggest a relational and dynamic perspective for examining how IVF negotiation is bound up with family relationships. At the intersection of biology and technology, IVF also affects the choreography of familial bargaining, as its different aspects serve as bargaining chips. Further, familial bargaining offers a nuanced perspective that helps to unveil the tensions and micro-politics between the gendered individual and the family in a broader sense., (© 2025 Foundation for the Sociology of Health & Illness.)

Introduction: Medication safety in healthcare settings is a persistent problem, and children may be at greater risk of harm than adults. Most existing research examining medication safety for hospitalised children is from the perspective of healthcare professionals and organisations. This study aimed to ethnographically explore parent and staff perspectives on the role of parents in medication safety in the paediatric hospital setting., Methods: 230 h of ethnographic observation and 19 semi-structured interviews with clinical staff and parents were conducted over paediatric wards in three acute hospitals in Northern England between October 2020 and May 2022. Data was organised and coded using NVivo and analysed thematically., Results: Three main themes were identified: (1) Capacity and Capability: Parents were often assumed to be incompetent by organisational policies and managers but at the same time were co-opted to undertake medication processes to meet operational needs. Parental experience was often ignored or judged negatively. When things went wrong parents were sometimes blamed. (2) Communication: parents were seldom meaningfully involved in decisions about their children's medication or provided with appropriate information unless requested. Parental medication histories were treated with suspicion and validated against inaccurate records. (3) Agency and Autonomy: parents often wanted to participate in their child's care but were expected to be passive observers., Conclusions: Medication safety for children is a social phenomenon involving healthcare professionals and parents. However, parents are often relegated to a passive role by healthcare staff. We posit that this represents an example of epistemic injustice in the way parents are assumed to be incompetent outsiders with no understanding of the medical care of their children, despite them offering resilience for medicines safety. We recommend further exploration of how parents contribute to resilience and safety for children in hospital and the barriers to this, and how health services can safely support increased engagement and involvement of parents in the care of their children while in hospital., Patient or Public Contribution: Parents contributed to the analysis and interpretation of the data collection and have contributed to the preparation of the manuscript., (© 2025 The Author(s). Health Expectations published by John Wiley & Sons Ltd.)

This collaborative autoethnography explores the experiences of women academics and mothers who received late diagnoses of Attention Deficit Hyperactivity Disorder (ADHD). Due to the historical underdiagnosis of women, little research has focused on this specific demographic. We shed light on how ADHD presents in women, interweaving our stories with extant literature and emphasizing the need to understand this demographic's experiences better. This piece discusses our process of seeking diagnosis and treatment, the communicative disenfranchisement we faced, and the stigma associated with ADHD. Our narratives highlight the generational impact of ADHD, with family members often sharing our diagnosis. Through divulging our experiences, we hope to contribute to the destigmatization of ADHD, particularly for women and academics.

Research on the lived experiences of HIV survivors, including young people living with HIV, has primarily emphasized broader sociocultural concerns, such as stigmatization and cultural attitudes toward sexuality and gender, while giving less attention to the interconnectedness of these issues with the mental well-being of those affected by the illness. This study, drawing on relational ethnography including observations and interviews at four antiretroviral-administering healthcare facilities in Enugu State, southeast Nigeria, explores how young people living with HIV strive toward viral suppression and how they develop collaborative psychosocial support along with the global efforts in eradicating the HIV epidemic. We found that, in and between themselves, young people living with HIV weave for themselves a network of relationships, though discreetly, to foster and encourage survivorship. Such relatedness, where mutual trust and support have emerged and rebuilt HIV survivors' faith in a livable life, forms what we conceptualize as "sero-kinship." That is, sero-kinship, which focuses on how people create and change meanings in their everyday lives that ultimately contribute to controlling HIV and treatment management, forms an essential foundation on which a life with HIV becomes thinkable, bearable, then manageable, and acceptable., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This paper examines the concept of 'suboptimal health' (subhealth, ), a term popularised by traditional Chinese medicine (TCM) professionals and widely used in public health discourses in China at the turn of the century. Despite criticisms of it being a commercial buzzword, subhealth provides a unique lens for individuals to articulate their health experiences concerning work and life pressures. Through virtual ethnography on Chinese social media such as Weibo and interviews, this study explores the usage and implications of subhealth in everyday life. It particularly focuses on how young Chinese people employ this concept to navigate and express health-related issues. Drawing on Leder's concept of the lived body, as well as literature on illness narratives and the sociology of diagnosis and risk, the study argues that attention to the everyday narratives of subhealth could potentially open up a space for a greater range of narratives of embodiment and might even offer a space for collective critique in a context often dominated by individual responsibility narratives. In some cases, it also enables private and public narratives that critique lifestyle factors detrimental to health. Ultimately, this paper hints at the conceptualisation of "subhealth narratives" as a research framework., (© 2025 The Author(s). Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for the Sociology of Health & Illness.)

Huntington's disease is a genetic neurodegenerative condition with wide physical and psychological impacts. Children of a parent with the condition have a 50% chance of carrying the gene expansion and developing the condition themselves. This systematic review and meta-ethnography presents a synthesis of the qualitative research on the experiences of young people growing up in a family with Huntington's disease. The MEDLINE, PsycINFO, and CINAHL databases were systematically searched, and 13 papers met the inclusion criteria. Through the process of meta-ethnography, four themes were identified highlighting aspects of childhood that were stolen and fought for: thief of relationships, thief of self, thief of transparency, and search for reclamation. Within the themes, the complex challenges young people faced when growing up in a HD family were explored such as the impact of adverse childhood experiences and the possible effects of HD on attachment and social relationships. Clinical implications are considered, and recommendations are made for future research., (© 2024 The Authors. Journal of Genetic Counseling published by Wiley Periodicals LLC on behalf of National Society of Genetic Counselors.)

Introduction: Health inequities disproportionately affect people from ethnic minority communities and require a comprehensive effort across healthcare disciplines to tackle them. Ethnically minoritised populations continue to be underserved, despite the growing awareness of the detrimental link between ethnicity and poorer health- and medication-outcomes. Pharmacy has been recognised as an accessible and inclusive healthcare setting, with the ability to meet diverse patient needs. Yet, there still remain distinct gaps in knowledge of how to best design, implement and deliver culturally centred pharmacy services for members of ethnic minority communities., Methods: A systematic literature search was undertaken in November 2023, across four databases: MEDLINE, Embase, CINAHL and PsycINFO. Qualitative studies were included if they addressed barriers, enablers and interventions aimed at tackling medicines- and health service inequalities affecting people from ethnic minority communities. Study quality was assessed using the Joanna Briggs Institute critical appraisal checklist. Data were synthesised using a meta-ethnographic approach, according to Noblit and Hare, forming a qualitative evidence synthesis to further understanding., Results: This meta-ethnographic systematic review synthesised data from 13 international studies eligible for inclusion. Four overarching third-order constructs (termed 'themes') were developed through reciprocal translation and focused on: (i) navigating pharmacy systems across the globe; (ii) understanding cultural needs and beliefs that may influence medicine use; (iii) strengthening relationships with pharmacists and other healthcare providers and (iv) addressing possible language and communication barriers., Conclusion: Pharmacists and policymakers should aim to raise awareness of pharmacy services, increase the provision of cultural competency training within the profession, build stronger relationships with minority communities, and facilitate access to interpretation services. A template of recommendations has been developed to further implement and deliver such services on an individual pharmacy-, community- and profession-basis. Future research should seek to utilise lived-experience narratives and participatory co-design methods to further explore ways to address wider healthcare accessibility inequalities for this minoritised population., Patient or Public Contribution: Public contributors and authors (inequity research champions, G.K. and T.G.) informed and shaped this project during study design and conceptualisation; they helped to ensure that the study was conducted, and the findings were reported, with sensitivity., (© 2025 The Author(s). Health Expectations published by John Wiley & Sons Ltd.)

Objective: This paper, using video-reflexive ethnography (VRE) as a case study, explores the prospects for and possibilities of observational research in workplace learning., Methods: Focusing on VRE methodology and drawing on its principles of care, collaboration, exnovation (paying attention to existing strengths) and reflexivity, we elaborate the prospects for and scope of possibilities for observational research., Results: VRE's flexibility and participatory nature enable researchers and participants to understand the complexities of learning in situ and the dynamic interactions between learning and work practice. We emphasise the importance of considering participants' (e.g., clinicians) lived experiences and recommend prioritising their engagement, reflexivity and knowledge co-creation in observational research to inform processes of learning through work practice. This participatory approach enables capturing and articulating diverse perspectives on these learning processes and, importantly, embraces the diverse perspectives of participants and researchers informing this situational approach to learning., Conclusion: The case study of VRE illustrates the potential and prospects of observational approaches in improving our understanding and facilitation of learning through practice in health professions education, highlighting its flexibility and innovation. By foregrounding participants' perspectives and fostering a collaborative research environment, VRE offers fresh insights into the complexities of learning in clinical settings. This research contributes to the broader discourse on educational methodologies, suggesting that VRE can significantly advance research in workplace learning., (© 2024 John Wiley & Sons Ltd and The Association for the Study of Medical Education.)

Objective: This exploratory study examined campus attitudes toward vaccines to guide subsequent development of context-relevant interventions for increasing vaccine acceptance and uptake. Participants: We gathered ethnographic data on a convenience sample of campus community members (students, faculty, staff) at a public university over six weeks in spring 2022. Methods: Student researchers conducted a rapid ethnographic assessment across campus locations. Weekly team debriefs enabled ongoing, iterative refinement of instruments and supplemented observational fieldnotes. Data analysis was inductive and oriented toward practical recommendations for intervention development. Results: Four themes, and attendant recommendations, emerged: 1) social identities and social roles influence health-related beliefs, including vaccination; 2) vaccine knowledge influences vaccination behaviors; 3) language surrounding vaccines (sometimes) matters; 4) vaccines aren't considered part of general health and wellness and can't be forced. Conclusions: Findings highlight the need to address individual, social, and institutional contexts when designing campus-based behavioral interventions for vaccine uptake.

Background: Depression is a global crisis and a major concern in mental health interventions, particularly in low- and middle-income countries (LMICs), where it significantly impacts disability, quality of life, and economic stability. These chronic stressors have been used to argue for scaling up the detection and treatment of depression as a public health and development priority., Aim: This study aimed to explore illness narratives of depression among patients' and to gain insights into multifaceted suffering, its impact on persons' lives, and help seeking. This study is part the broader study which examined global mental health, biopolitics, and depression in Ethiopia, conducted in hospice setting to explore the conception of depression in Bahirdar city, Northern Ethiopia, among patients and health care providers. In this study, we focus on patients' accounts of depression., Method: We employed an ethnography method using in-depth interviews, fieldnotes, and observation to collect the data. A thematic analysis was used to analyze the data. Drawing from cross-cultural and critical psychiatry perspectives, we situate depression within its cultural-eco social framework., Results: The study revealed that patients' experiences and conception of depression are deeply intertwined with Ethiopia's sociocultural, economic, and spiritual context. Depression was often described as a state of being 'impaired in life', reflecting the complex interplay of individual struggles and societal pressures. Integrating quotes from patients, we demonstrated in this analysis the ways in which biographically specific challenges, societal pressures, and mental well-being are understood by study participants in accordance with Ethiopian cultural and religious norms., Conclusion: The study suggests moving beyond narrow interpretative frameworks in GMH praxis to understand and address the complex dimensions of depression in Ethiopia and similar contexts. The study advocates for a cultural-ecosocial approach to depression, emphasizing the need for mental health interventions that consider the broader social and cultural factors contributing to mental distress.

Aim: The focus of this paper is to provide a detailed ethnographic exploration of rural nurses' experiences of their resuscitation preparedness and the subsequent post-resuscitation period., Design: An ethnographic study across two small rural hospital sites in New South Wales, Australia., Methods: Fieldwork was undertaken between December 2020 and March 2022 and included over 240 h of nonparticipant observation, journalling and interviews. Data were analysed using reflexive thematic analysis., Results: The first key theme-'Sense of Preparedness'-included three subthemes: 'Gaining experience', 'Issues with training and education' and 'Lack of warning'. The second key theme 'Aftermath' comprised two subthemes: 'Getting on with it' and 'Making sense of the resus'., Conclusion: This study has highlighted the intricate relationship between resuscitative preparedness and the post-resuscitation period in shaping rural nurse's experiences and their well-being. Rural nurses are asking for an authentic and contextually relevant training experience that mirrors the unique rural challenges they experience. In the absence of frequent resuscitation presentations, the post-resuscitation period should be viewed as a crucible moment that can be leveraged as a valuable learning opportunity enhancing rural nurses' sense of preparedness and the provision of quality resuscitation care., Impact: Having a greater level of insight into the challenges that rural nurses experience in the pre- and post-resuscitation period is critical. This insight opens the door for fortifying policies and work processes that will better support rural nurses in the resuscitation environment., Reporting Method: Reporting complied with COREQ criteria for qualitative research., No Patient or Public Contribution: This study explored the experiences of rural nurses. No patient data were collected., (© 2024 The Author(s). Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

This article uses autoethnography to explore the author's lived experiences of mental distress and how she has conceptualised and explained these symptoms to herself using both the biomedical and recovery models of care. Autoethnography is a process of personal reflection that enables connection between the personal and the political. Experiences of mental distress are recounted alongside the decision to reduce medication. This personal experience is then explored in the context of limited evidence base on the effectiveness of reducing medication and the situation in which prescribers often feel reluctant to recommend and support service users in these choices. Shared decision-making in medication management is introduced which is an approach which draws on the models of recovery and co-production challenging traditional biomedical approaches which locate the prescriber as expert. Moreover, the radical service user led model is highlighted, within which, the Hearing Voices Network and Open Dialogue offer alternative approaches which promote co-production and empowerment. The author connects the personal to the political and reflects on her dual identity as an expert-by-experience and social work academic. She details how she has drawn on biomedical explanations to describe her distress yet has been challenged by the recovery model throughout her journey of recovery. She concludes that her own position, in identifying herself as an academic and expert-by-experience is an important step in challenging notions of expertise and approaches to mental health care., (© 2024. The Author(s).)

Background: Traditional ecological knowledge embedded in cultural practices is vital for biodiversity conservation but is increasingly under threat from modernization and globalization. This study investigates the role of Chinese folk ritual music in promoting biodiversity conservation, with a focus on Cantonese Opera and agricultural rituals in the Lingnan region of southern China., Methods: We employed literature review, qualitative fieldwork, and ethnographic analysis, including interviews with local musicians and community members, to investigate how Cantonese Opera and agricultural rituals contribute to ecological sustainability by integrating cultural narratives with environmental stewardship., Results: The findings reveal three main ways in which Chinese folk ritual music supports biodiversity conservation: (1) fostering ecological understanding through symbolic representations, such as the carp and water buffalo; (2) promoting sustainable practices, including traditional farming techniques and the conservation of wetland ecosystems; and (3) enhancing community cohesion and the transmission of ecological values across generations. Notably, 70% of interviewees highlighted the role of symbolic animals in raising awareness of ecological sustainability., Conclusions: The study underscores the potential of integrating traditional ecological knowledge with modern conservation strategies. Cultural traditions, such as Cantonese Opera and agricultural rituals, not only preserve biodiversity but also provide a framework for sustainable resource management. These findings highlight the importance of protecting and revitalizing cultural practices to ensure both cultural and ecological resilience in the face of global challenges., Competing Interests: Declarations. Ethics approval and consent to participate: This study did not involve animal or human clinical trials. All information obtained was preceded by an individual previous informed consent. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Objective: To conceptualise the cognitive processes of early expert decision-making in urgent care., Background: Expert clinicians in the UK frequently determine suitable urgent care patient pathways via telephone triage. This strategy is promoted by policymakers but how it is performed, and its effectiveness has not been evaluated. Evaluation of early senior decision-making requires knowledge of decision-processes, influences, and goals. Previous research has focused on diagnostic decision-making and rarely studied clinicians in the field., Method: We triangulated analytic autoethnography of early expert decision-making with focused ethnography of experts and trainee doctors performing the task. The study took place in a medium-sized Acute Medical Unit which provided internal medical emergency care for a mixed urban and rural population in the UK. A grounded theoretical model of expert decision-making was created via Gioia Methodology. Decision types were categorised to identify differences in solutions as well as decision processes., Results: The hallmarks of intuitive decision-making were found in most expert decisions. Experts made intuitive use of pattern-matching to extract key data from large volumes of information which triggered the spontaneous manifestation of solutions. Solutions were holistic and usually solitary. Upon manifestation solutions were consciously tested for viability with emotional affect playing a key role. Expert solutions were previously applied ones but were frequently entirely novel. Novel solution generation was not a feature of trainee decisions but moments of intuition were. Expert goals varied between optimal care for individual patients, system-wide efficiency, and equity of care. The decision environment had a large influence upon experts., Conclusion: Expert clinicians employ intuitive decision-making supported by rational analysis in early urgent care decision-making. Expert solutions generated in this manner are pragmatic rather than optimal, context dependent, and seek to achieve goals which vary from moment-moment. Findings are crucial to inform research evaluating the effectiveness of early expert decision-making in urgent care as it is a high cost strategy. They also have implications for methodological approaches in future studies of expert clinical decision-making, developing artificial expert systems, and clinician training., Competing Interests: No competing interest., (Copyright: © 2025 Irvine et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: The purpose of the study was to investigate the various aspects of employees' work environment, including their job characteristics; the level of support provided by supervisors, job coaches and coworkers; and their perceptions of job performance and productivity from the perspectives of both employees and supervisors in the context of sustainable employability in supported employment interventions. This study was part of the Finnish Work Ability Programme Evaluation Study (2020-2024)., Methods: This study is theoretically informed by the concepts of specific work ability and sustainable employability, as well as how health affects productivity at the task level-approach. The research is based on qualitative data obtained through ethnographic fieldwork, nonparticipating observing with interaction at work, which includes observing employed individuals in their workplaces. Additionally, we recorded discussions, took photos at work, and conducted interviews with supervisors and job coaches., Results: The main findings were that persons with disability or decreased work ability were employed in precarious low-productivity work, with limited opportunities for more sustainable employment. Several means from public employment services to decrease the employer's personnel costs were used. The supervisors appeared to have a strong grasp of each employee's task-specific productivity level. Supervisors had to adapt their usual tasks to provide extra support for employees, often focusing more on work performance. The role of coworkers and the work community as whole was also important. The personal support of job coaches during the employment phase was crucial, but their role in the workplace was unclear, especially to employers., Conclusions: To strengthen sustainable careers, the matching of jobs and individuals should be promoted through closer and productivity-oriented cooperation with employers and work communities in vocational rehabilitation and re-employment. The chosen qualitative research strategy, ethnographic fieldwork at work and multi-perspective data collection provided new interpretations of the possibilities for sustainable employability using the Supported Employment method. From the perspectives of both enabling prolonged working careers for employees and providing a clear understanding of task-performance-based productivity to employers, there is a need for more microlevel data on what happens in work and workplaces, particularly the social mechanisms through which results are achieved., Competing Interests: Declarations. Ethics approval and consent to participate: This study was performed in line with the ethical principles of the Declaration of Helsinki. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964, as revised in 2024. The ethical preliminary evaluation of this study was performed by the Ethics Committee of the Finnish Institute of Occupational Health in January 2020 (ID 95666). All participants were recruited in accordance with the principle of informed consent. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Older adults with intellectual disabilities are not adequately prepared for ageing and show anxiety and uncertainty regarding the future. Therefore, the two-year educational intervention "Good Life in Old Age" was implemented to improve their understanding of ageing and enhance their well-being. This study aimed to explore the meaning of ageing during and after the intervention from the perspective of older adults with mild intellectual disability. The ethnographic design included participant observations, field notes, group interviews, and individual follow-up interviews with 20 adults aged 44-75 (mean 63.2) with intellectual disabilities. The main findings are expressed in four themes; Awareness of ageing with intellectual disabilities, Strengthened as a person through empowering community, Awareness of vulnerability as an older adult, and The educational intervention as a resource to manage vulnerability. The education programme created a social network for healthy ageing with an atmosphere of mutual support fostering greater mental strength and self-confidence. Individual retirement plans should be created to foster socialisation, involving adapted activities and conversations about bereavement and death. There is a need to disseminate and continue developing promising education programmes for older adults with intellectual disabilities to reduce their anxiety about retirement and loneliness and facilitate healthy ageing.

Background: Explicit and implicit cultural patterns are critical cultural norms, beliefs, and practices that determine women's health-seeking behaviour. These cultural patterns could limit women's use of maternal health services, resulting in maternal health complications. The study aims to provide an in-depth understanding of explicit and implicit cultural patterns, their meanings and how they influence women's use of maternal health services among Igala women in Nigeria., Methods: Roper and Shapira's (2000) focused ethnography was employed with 43 women aged 18-43 years recruited using the purposive and snowballing technique. The study was conducted with 21 women for one-on-one interviews and two focus group discussions with six women in the rural area and seven women in the urban area. In addition, participant observation of nine women from the third trimester to birth was conducted, yielding 189 h of observation in two primary healthcare facilities in rural and urban areas. Data analysis was conducted using Roper and Shapira's (2000) method., Result: Three themes were generated using the PEN3 cultural model: perceptions, enabler, and nurturers. Subthemes generated under the theme of perception were, Belief in witchcraft, Pregnancy announces itself, I cannot tell people I am in labour, and Unspoken acquiescence to the culture. Under the theme of nurturer, Home birth was found to limit access to maternal health services. The theme of enabler yielded subthemes such as You are not woman enough; I want my placenta and Rising matriarchs., Conclusion: Implicit and explicit cultural patterns significantly influence women's use of maternal health services. Given the complexity of culture and its influence on women's use of maternal health services, multifaceted strategies tailored to the cultural needs of communities are needed to enhance the realization of Sustainable Development Goal #3:1 in Nigeria., Competing Interests: Declarations. Ethics approval and consent to participate: This study was approved by the University of Saskatchewan Behavioural Research Ethics Board (ID/4003) and the Ministry of Health, Kogi State, Nigeria (MOH/PRS/465/V.1/60). Informed consent was also obtained from study participants after due explanation of study protocols. Overall, the study was carried out in accordance with the stipulation of relevant guidelines and regulations related to Roper and Shapira (2000). Consent for publication: Not applicable Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Global re-emergence of the zoonotic viral disease, Mpox (Monkeypox) has drawn global attention, leading to its declaration as a Public Health Emergency of International Concern (PHEIC) by World Health Organisation (WHO) in July 2022. Nigeria is a spotlight identified for the viral disease outbreak, with attention drawn on its transmission to non-endemic nations. With the country's healthcare challenges, care seeking practices particularly amongst low-income urban informal settlement populations are diverse - presenting challenges to both case identification and management during an outbreak. In this study, we examine the social, economic, and behavioural context of Mpox therapeutics., Methods: This was an ethnographic study conducted between September 2022 and March 2023, with the purposive selection of urban informal settlements and interlocutors in Oyo, Ogun and Lagos States. We interviewed a total of 28 interlocutors who were either confirmed or suspected cases of Mpox or parents of children who are confirmed or suspected Mpox cases identified by the public health workers. Data were elicited through In-depth interviews and observations technique on the interlocutor's local knowledge and their lived experiences on the therapeutics of Mpox. Analysis of the transcript was done inductively using thematic analysis process., Findings: The study revealed awareness and vague knowledge of Mpox. Furthermore, the behavioural practices on how ailments are understood and managed revealed a commonality in their social actions in terms of local diagnosis and management. Mpox was perceived to be a mild disease, and this had implications on the local characteristics of the PHEIC in the endemic regions., Conclusion: Our paper contributes to a more nuanced understanding of not only the health care access barriers, but the complex geographical, economic, and sociocultural factors that shape how and when people seek care for Mpox within the context of urban informal settlements. This further draws attention to behavioral dispositions to the nomenclature of what is perceived as PHEIC. Thus, the global health and security paradigm should give room to local context, expertise, and global politics in shaping epidemic responses., Competing Interests: Declarations. Ethics approval and consent to participate: Ethical approvals were obtained from the National Health Research Ethics Committee of Nigeria (NHREC) NHREC/01/01/2007-26/09/2022. , and the State Ministry of Health in Oyo, Ogun and Lagos States. Oyo State Ministry of Health Research Ethics Committee (HREC) NHREC/OYOSHRIEC/10/11/22; Ogun State Health Research Ethics Committee OGHREC/467/007 and Lagos State Primary Health Care Board Ethical Approval LS/PHCB/DPRS/256/VOL.1/094. In addition, the Lagos State Primary Health Care Board also gave their ethical approval LS/PHCB/DPRS/256/VOL.1/094. . Ethical principle was adhered to in accordance with the 1964 Helsinki Declaration. Also, informed consent to participate were obtained from the interlocutors Consent for publication: There is informed consent for publication. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Disabled bodies have been historically marginalised in sporting arenas and spectacles. Assistive technologies have been increasingly featuring in, and changing, sporting landscapes. In some ways recent shifts have made disability more present and visible across many (para) sporting cultures, and yet sport continues to operate on a tiered system that assumes a normative able body. This paper responds to this moment by offering imaginaries of future hybrid performances that critically engage with the politics and possibilities of novel technologies in sporting arenas and their wider impact on disability futures. These were generated from a collaborative ethnography that centred on becoming spectators of the Cybathlon Games. The Cybathlon Games began in 2016 as a global event where people with disabilities compete with technologies such as Brain-Computer Interfaces or robotic Prosthesis. Our imaginings are presented as three speculative fragments in the form of pages ripped from a comic book series, The In/Visibles These fragments and critical reflections are grounded on themes generated through watching the Games together. The purpose of this paper is not to offer predictions or even visions of desirable futures. Rather we present future technologised sporting bodies and spectacles with a view to extend critical posthuman discussions to these arenas. Through this we highlight: (1) The arbitrariness of where to draw the between un/natural performances; (2) The absurdities of unrestricted and open use of performance technologies when hybrid forms and functions are judged through current sporting-humanist values; and (3) The need to stay alert to socioeconomic and political drivers of sporting and disability futures. We offer these three zones of friction to guide further research when navigating the complex and shifting relations between sport, technology and the (dis)abled body now and into the future., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Inspired by Freud's "Mourning and Melancholia" and expanding upon his notions within the social context, this article proposes an innovative concept called "age melancholy" to describe the multifaceted elements of social loss experienced by empty nest older adults. While most studies emphasize a psychological-individualist approach to this phenomenon, age melancholy frames older age as a process marked by a loss of social engagements. The findings are grounded in anthropological fieldwork conducted from 2010 to 2013 in a lower-income neighborhood of Tel Aviv. They are based on deductive comprehension of social melancholy, combined with inductive qualitative analyses of 29 meetings within a designated narrative group of older Mizrahi women-Jewish immigrants from Islamic countries. The results reveal that empty nest older adults perceive their loneliness, fragile health, and approaching death as interrelated aspects of social detachment, leading to melancholy. However, whereas their emotional experiences are tainted by age melancholy, it is temporal and contextual and may be mitigated through social support., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This ethnographic study examines the challenges associated with forensic psychiatric care for patients with a migration background in Dutch Centre for Transcultural Psychiatry Veldzicht. As a result of their criminal offence, these patients, translated here as 'TBS foreigners', have been declared 'unwanted' by the Dutch immigration services and face repatriation to their country of origin. Through contextual policy-analysis, participant observation and fifteen semi-structured interviews conducted between February and May 2023, we found that professional conduct on TBS foreigners' wards is increasingly curtailed by the Dutch legal infrastructure and the clinic's socio-material environment. This paper highlights how socio-therapists understand and navigate good care on wards where contrasting transcultural, forensic and psychiatric care objectives converge. Notably, 'good' transcultural care has become fraught in light of mandatory repatriation, in which we divide socio-therapists' approaches into static, dynamic and experiential. We argue those with a static approach to cultural differences with patients are most stuck in their daily work, because their goal of adopting a non-assumptive attitude has become intertwined with preparing a patients' return to society, which in these cases requires practical knowledge about a foreign country. Still, socio-therapists can find professional purpose and empowerment by focusing on each patient's humanity and creating meaningful activities within the available limits. This paper uniquely unravels lived experiences and resourcefulness of professionals providing transcultural care in forensic psychiatry, an intersection which is a growing area of concern globally. Hereby, we ensure such complex care settings can be discussed and potentially strengthened through institutional and/or national policy., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

A longstanding body of public enquiries and research identifies people living with dementia experience systemic inequalities within hospital settings, concluding a focus on improving care cultures is required. Drawing on a 3-year multi-sited hospital ethnography, this paper examines everyday cultures of care in NHS acute hospital wards to interrogate how ethnicity, gender and social class intersects to shape the care of people living with dementia. Drawing on Collins' concept of intersectionality and the relational nature of power, the analysis reveals that while cared for by diverse teams of healthcare professionals, a patients' age, ethnicity, gender and social class, as interconnected categories, influences the tightening of ward rules for some people living with dementia and the granting of significant privileges for others. Focussing on walking within the ward, with a large number of people living with dementia classified as 'wandering', we explore ways in which intersectional identities informed who was granted privileges to leave the bedside and 'wander' the ward, and who experienced further control. The paper concludes that institutional racism and attitudes to gender, social class and ageing permeate the routine organisation and delivery of care within NHS acute hospital wards to significantly impact people living with dementia, and in turn, increases the consideration of care pathways that emphasise their discharge to institutional settings., (© 2025 The Author(s). Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for the Sociology of Health & Illness.)

There is a disparity between contemporary scientific investigations into psychedelic phenomena and their 20 th -century counterparts, notably the lack of examination of psychedelic experiences within group settings. Whereas early research studies from the 1950s to the 1970s explored communal settings in psychedelic-assisted therapy (PAT), today's resurgence of scholarship in the field primarily considers individualised, often clinical, settings. Consequently, there is an absence of empirical research and theoretical innovation on collective psychedelic contexts, for example, how social connectedness occurs relationally and what its impacts are. This paper addresses this gap by revisiting and applying Emile Durkheim's theory of "collective effervescence." By analysing interview data from participants of a group-based weeklong PAT retreat and supplementing it with ethnographic data, this study highlights the usefulness of incorporating sociological theory to examine and explain the social dynamics and therapeutic outcomes of collective psychedelic experiences. In doing so, this research study contributes to bridging the divide between psychedelic science, psychedelic studies and the social sciences by offering sociological insight into the transformative yet hitherto neglected potential of group-based psychedelic events for therapeutic benefits., (© 2024 Foundation for the Sociology of Health & Illness.)

Additive manufacturing (3D printing) is increasingly utilized in healthcare. Some rehabilitation professionals employ 3D printing for orthoses, prostheses, and assistive technologies (AT). However, anecdotal evidence suggests that many practitioners have reservations about adopting 3D printing into their practices, and empirical research in this area is limited. The aim of the study was to document my experience while learning 3D printing. In this autoethnographic study, journal entries and photos of the artifacts were collected during the process of learning 3D printing. These data were analyzed using reflexive thematic analysis. Three themes were identified: Being motivated to learn 3D printing, Experiencing challenges and implementing possible solutions, and Achieving developmental milestones in learning 3D printing. These milestones offered practical insights and solutions for new learners by providing a roadmap for navigating the journey of learning 3D printing. This personal experience offered opportunities and posed challenges in the context of learning to use 3D printing in the rehabilitation field. It is hoped that this study will inspire others to explore 3D printing and potentially contribute to the development of 3D printing training programs for students and rehabilitation professionals.

Purpose: Living with risk is a salient part of everyday living and although risk affects everyone, older adults are often regarded as a high-risk group, particularly older adults who are aging with a disability, such as vision loss. A prominent focus within low vision rehabilitation is the provision, and training, of older adults in the use of low vision assistive devices as a strategy to manage risks in both the home and community environment. This study aimed to unpack the influence of assistive technologies on experiences of risk among eleven older adults (aged 65+) with age-related vision loss., Materials and Methods: This critical ethnographic study used home tours, the go-along method, and a semi-structured in-depth interview., Results: The study identified five prevailing themes including: 1) Moving away from the individualization of risk; 2) The cost of assistive technologies as a risk contributor; 3) Practicing 'responsible living'; Technology as an adaptive strategy to risk taking; 4) Resisting the label of 'at risk'; The influence of technology on self-identity; and 5) Technology as a substitution versus supplement for social connectedness., Conclusions: The study findings highlight the importance of moving beyond a technico-scientific perspective of risk, in which risk is framed as an objective phenomenon located in older adults' bodies, and instead framing risk within a broader sociocultural perspective which moves our attention to those contextual or environmental factors that shape experiences of risk for older adults with vision loss.

Background: There is growing global awareness of the importance of matters of equity and social justice. In health professions education (HPE), research has focused at undergraduate level and on health sciences curricula. Increasingly, health care professionals engage in HPE Master's and doctoral studies, where they are educated as curriculum designers and 'producers' of knowledge through their research. Considering their role in shaping what (and how it) is taught in health sciences curricula, questions can be asked about the extent to which postgraduate pedagogies are mindful of matters of social justice. As supervisors of postgraduate HPE students and as directors of such programmes, we interrogated and juxtaposed our perspectives on social justice and how these perspectives influence our postgraduate HPE supervisory and directing practices in our respective contexts., Methodology: Utilising a duo-ethnographic approach, in which we each represented a site of enquiry, we generated data through written reflections and dialogic engagement framed around research questions about (1) our understanding of social justice, (2) how this influenced our practices as postgraduate supervisors and (3) how this influenced our practices and policies as directors of postgraduate studies. We recorded and transcribed our data generation meetings. Based on open coding of the transcriptions and written reflections, we constructed a conversation around our research questions. We integrated our reflexive journals in the conversation., Findings and Discussion: Our conversations were characterised by three sets of ideas involving the terminology around social justice, the complex nature of social justice, and the individual and social justice. These played out differently in our contexts, but they caution both of us against assumptions and encourage us to create time for conversations with our students, to consider what we 'teach' them, how we guide them and how we avoid gatekeeping their entry into the disciplinary space., (© 2024 The Author(s). Medical Education published by Association for the Study of Medical Education and John Wiley & Sons Ltd.)

Objectives: This study aimed to explore the policy implementation of non-specific symptom pathways within the English National Health Service., Methods: A multi-site ethnographic project was conducted in four hospitals that contained non-specific symptom pathways between November 2021 and February 2023. The research involved observation (44 h), interviews ( n = 54), patient shadowing, and document review., Results: The study examined how the policy concept of 'holistic' care was understood and put into practice within four non-specific symptom pathways. Several challenges associated with providing holistic care were identified. One key challenge was the conflict between delivering holistic care and meeting timed targets, such as the Faster Diagnosis Standard, due to limited availability of imaging and diagnostic tools. The interpretation of a holistic approach varied among participants, with some acknowledging that the current model did not recognise holistic care beyond cancer exclusion. The findings also revealed a lack of clarity and differing opinions on the boundaries of holistic care, resulting in wide variation in NSS pathway implementation across health care providers. Additionally, holistic investigation of non-specific symptoms in younger patients were seen to pose difficulties due to younger patients' history of health anxiety or depression, as well as concerns over radiological risk exposure., Conclusions: The study highlights the complexity of implementing non-specific symptom pathways in light of standardised timed cancer targets and local cancer policies. There is a need for appropriately funded organisational models of care that prioritise holistic care in a timely manner over solely meeting cancer targets. Decision-makers should also consider the role of non-specific symptom pathways within the broader context of chronic disease management, with a particular emphasis on expanding diagnostic capacity., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Amidst the difficulty and contentiousness of improving hospitals, a relatively new approach is the Relational Model of Organizational Change (RMOC). However, this approach has its own challenges, including reports that its focus on communication and relationships is undervalued despite evidence supporting its use to facilitate practice improvements in hospitals. Research suggests power dynamics in hospitals influences how the RMOC is used, but the precise mechanisms through which this occurs have not been fully examined., Purpose: The purpose of this study was to examine how power dynamics shaped the implementation of a program using the RMOC in a hospital: the QPH RC Program., Methodology: Institutional ethnography was applied to explicate textually mediated ruling relations (power dynamics) and examine how they exerted their influence on the QPH RC Program. This involved interviewing people and analyzing texts embedded in work processes that organized the implementation of the program., Results: The QPH RC Program was embedded in a cluster of ruling relations comprising an economic rationalist and scientific discourse and project management methodology. These ruling relations exerted their power via textually mediated social processes that influenced the focus and management of the program., Conclusion: The ruling relations functioned to align the QPH RC Program with the priorities of the hospital, suggesting that financial objectives were prioritized over objectives to improve communication or culture., Practice Implications: Future research and practice change should include investigating and addressing the intersection of institutional contexts and the application of the RMOC to facilitate practice improvements in health care organizations, particularly hospitals., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Controlled organ donation after circulatory death (DCD) was re-introduced in the UK in 2008, in efforts to increase rates of organs for transplant. Following reintroduction, there were debates about the ethics of DCD, including whether potential DCD donors receive end-of-life care which is in their best interests. Since this time, DCD has become a routine donor pathway in the NHS. In this article, we present findings from an ethnographic study examining the everyday practices of DCD in two English Trusts. Drawing on the concept of death brokering and Bea's (2020) call to consider organ donation as embedded and routine practice within health care, we look at how DCD is integrated into end-of-life care in intensive care units. We show how DCD is made routine at the end-of-life via the practices of health professionals who create an active separation between discussions about death and donation; reproduce usual ways of doing things in end-of-life care; and respect the distinction between patient/donor, dying and death. In doing so, we argue these function to preserve the patienthood of the potential donor, ensuring DCD operates as an integrated part, and culturally accepted form of, good end-of-life care for potential donors, their relatives, and health professionals alike., (© 2024 The Author(s). Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for the Sociology of Health & Illness.)

This study suggests the term tooth shame and explores it as a phenomenon encompassing deep entanglements between emotional experiences, social interactions, and care work practices. Drawing on shame research concerning the body, health, and class, juxtaposed with odontological research on the social implications of oral health issues, it investigates how tooth shame appears in Danish elderly care. In Denmark, oral health is notably impaired among older people depending on professional care, with significant repercussions for general health and social life. The study stems from the Lifelong Oral Health project, which identifies barriers to oral health and examines the potential to improve it in Danish elderly care. It is based on ethnographic fieldwork in nursing homes, home care units, and a rehabilitation center in two Danish municipalities. As self-derogative statements and self-limiting behaviors regarding oral health issues stood out as a general finding in interviews with older people, the focus on tooth shame emerged from this fieldwork. The study contributes to recent shame discussions with a social-material understanding of tooth shame, emphasizing that it is more than an individual feature. It is a collectively distributed phenomenon that expands among people and situations, and that interferes with vital caring practices. The study suggests that tooth shame appears through the performance of tooth shame choreographies, highlighting its implications in a socio-material setting. First, it demonstrates that tooth shame can make older people adapt to oral health issues, for example, by avoiding social interactions, dental care, and oral treatments. Second, it identifies tooth shame as a collectively distributed and expanding phenomenon, as it draws, for example, care workers into sensitive shame situations. Third, it explores how tooth shame interferes with daily dental care practices, professional considerations, and ethical dilemmas within elderly care systems., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Although disability inclusion in medical education is gaining interest internationally, scholarship and policy recommendations on this topic largely hail from the US, Canada, Australia and the UK. Existing scholarship, while calling for medical education to enact cultural and attitudinal change related to disability, has yet to exemplify how educators might critically examine their understandings., Approach: As two medical educators and researchers, one based in New Zealand and the other based in Saudi Arabia, we took a duoethnographic approach to explore tensions, possibilities and assumptions regarding disability and disability inclusion in medical education. Through a year-long synchronous and asynchronous dialogue, we examined our experiences in relation to literature from critical disability studies and disability inclusion in medical education., Findings: We present recurrent themes from our dialogue. We consider what disability means, explore definitions and models of disability in our contexts, as well as our lived curriculum of disability. We grapple with the applicability of disability inclusion practices across borders. We explore the complexity of supporting access without a clear roadmap, while recognising educators' potential in this work. Finally, we recognise that, if disability is relational, we have the power and responsibility to address ableism in medical education. Throughout, we return to the importance of local consultation with disabled people (learners, physicians) to better understand how services ought to be oriented., Conclusion: Duoethnographic dialogue is a fruitful approach to critically examine understandings of disability with others and represents a necessary start to work in education that seeks to advance justice. We share possible actions to take the work forward beyond dialogue and suggest that readers engage in such dialogues with others in their own contexts., (© 2024 The Author(s). Medical Education published by Association for the Study of Medical Education and John Wiley & Sons Ltd.)

Abstract: The return of a migrant partner can negatively impact the sexual health of women who stayed in their communities. Understanding their sexual health needs is crucial for developing targeted interventions and support systems. Our study used a critical ethnographic approach in Agua Dulce, a rural community in Mexico, involving 50 key informants: women who stayed behind ( n = 20), returnees ( n = 12), community leaders ( n = 12), and health care professionals ( n = 6). We used participant observation, policy analysis, and interviews, using purposeful and snowball sampling methods. A gender-based thematic analysis revealed economic hardships and early separations affect the sexual well-being of women who stay behind. Infidelity, discovered through social media or calls, causes emotional distress and family disruptions. Male migrants spend an average of 8.85 years abroad, leading to fears of risky sexual behaviors. Our study highlights the urgent need for specialized support centers and comprehensive health interventions., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of Association of Nurses in AIDS Care.)

This research highlights the ways by which processes of caring for our environments can contribute to health and well-being for the minded body. Drawing upon rich ethnographic accounts of urban cultivation practices and experiences, this research unfolds in the birthplace of the 'Healthy City' concept-Kuching, Malaysia-which is an ethnically diverse city home to Chinese, Malay, Indigenous and other groups. Building from situated political ecologies-and more specifically, emotional political ecology and the political ecology of religion-I examine the relational values produced through practices of urban cultivation and related benefits for mind-body-environments. I find spirituality, religion, gender, generation, class, and ethnicity are embodied in socionatural relationships facilitated through urban agriculture. Through affective encounters with non-human animals, spiritual meanings inferred from the materiality of plants, and strengthened socionatural relationships with friends, family, even strangers, and the divine, practices of urban cultivation can nurture minds, bodies, and environments in deeply interconnected ways. This adds to a growing literature that reveals the importance of relational values for well-being and argues that socionatural relationships of care can contribute to a meaningful life. With a careful attention to relational dynamics and differentiated embodied experiences, I show that cultivators engage in the production of ecologies of care that confront neoliberal modes of interacting with themselves and others. Recognizing that care is embodied, situated and political can foster more nuanced understandings of the politics of socioecological transformation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author. Published by Elsevier Ltd.. All rights reserved.)

The aim of the paper is to understand what drives private general practitioners (GPs) to introduce digital technologies, and to use them extensively. While prior research has highlighted barriers to adoption for practitioners when digital tools are introduced by managers and policy makers, we explore how GPs having their own practice introduce digital innovation and how they integrate them into their practices. Our qualitative study focuses on liberal emergency medicine in France, providing a unique context to examine how GPs at the front lines of health system failures and changes introduce and adopt digital technologies. Through in-depth ethnographic research conducted from 2021 to 2023, we reconstruct three sequences of digital innovation since the 1990s and observe current digital tool usage among GPs. We put forward two major findings. First, the introduction of digital tools is driven in this context by the organization of GPs as a professional group that aims to enhance its capacity for action and gain recognition for its expertise. Second, the adoption of digital innovations depends on how the changes in practices involved align with the professional culture of these doctors. Tensions between the most recent digital innovation initiatives that take place during and post-Covid 19 crisis, and doctors' understanding of practicing medicine as an "art", leads to the weak adoption and even contestation among GPs., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The archipelago of Puerto Rico has faced multiple natural disasters, including hurricanes and earthquakes, disrupting the mental health and daily lives of its residents. These disasters, combined with socio-political abandonment, have led to the deterioration of the electrical grid, exacerbating health disparities. This study aimed to explore the linkages between natural and structural disasters, mental health, and energy independence in Puerto Rico. In this setting, the community organization Casa Pueblo has installed solar panels in the homes of people with chronic health conditions. Through ethnographic fieldwork in the town of Adjuntas and qualitative interviews with 45 individuals with different levels of access to solar power, we explore the implications of ongoing natural and structural disasters on the mental health of individuals and how access to solar energy could help mitigate their effects. Results indicate that participants with direct and indirect access to solar panels held positive and hopeful narratives regarding their mental well-being and quality of life. This innovative model of communal energy security through solar power for climate adaptation holds promises for enhancing mental health in the town of Adjuntas and potentially in other regions., (Copyright © 2025 Elsevier Ltd. All rights reserved.)

In this paper, we conceptualize the days of mourning that followed the passing of Queen Elizabeth II. as constituting a liminal occasion, a moment of in-betweenness through which we can explore sense-making in times of transition. How do people navigate through liminal occasions, and are they always transformative? Through a rapid response ethnography (N interviews  = 64, N participants  = 122), we were able to capture the raw moments within which a collective comes together, as part of a national ritual, to transition from 'here' to 'there'. In our data, liminality prompted participants to strategically define British national identity and its future by positioning the Queen as representative of Britishness, her loss as a national identity loss. No longer taken for granted, participants reasserted the value of the monarchy as an apolitical and unifying feature in an otherwise divided society, characterizing the continuity of the institution as an essential part of British identity and society. The analysis illustrates how liminality offers a useful conceptual tool for addressing how temporality and change are negotiated in relation to a shared identity, and how navigating transitional moments brings with it political implications for the future., (© 2024 The Author(s). British Journal of Social Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

Background: The increase in non-communicable disease burdens and aging populations has led to a rise in the need for palliative care across settings. In resource-limited settings such as Indonesia, however, notably in rural areas, there is a lack of professional palliative care. Little is known about specific palliative care navigation, as previous studies have mostly focused on cancer care navigation. A locally tailored approach is crucial., Aim: To explore how patients and families navigate palliative care and the problems they experience., Design: An ethnographic study using in-depth interviews and observations, analyzed using reflexive thematic analysis., Setting/participants: Interviews with 49 participants (patients, family caregivers, and health professionals) and 12 patient-family unit observations in Banyumas, Indonesia., The Analysis: Patients and families navigated palliative care through different strategies: (1) helping themselves, (2) utilizing complementary and alternative medicine, (3) avoiding discussing psychological issues, (4) mobilizing a compassionate and advocating community, and (5) seeking spiritual care through religious practices., Conclusions: Our participants used intricate care networks despite limited resources in navigating palliative care. Several problems were rooted in barriers in the healthcare system and a lack of palliative care awareness among the general public. Local primary health centers could be potential palliative care leaders by building upon pre-existing programs and involving community health volunteers. Cultivating a shared philosophy within the community could strengthen care collaboration and support., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Goal setting is an essential step in the clinical reasoning process of speech and language therapists (SLTs) who provide care for children, adolescents and adults with communication disorders. In the light of person-centred care, shared or collaborative goal setting between the SLT and client is advised in (inter)national guidelines. SLTs face challenges in implementing (shared) goal setting as theoretical frameworks and practical interventions are scarce and less applicable to use with a wide range of communication vulnerable populations., Aims: A first step in developing theory and practical interventions is to explore first-hand experiences of SLTs and clients about day-to-day goal-setting practice. This study was guided by the following research question: What are the perspectives and needs of SLTs and persons with communication disorders regarding (shared) goal setting in routine SLT services?, Methods & Procedures: The qualitative study was carried out in the setting of routine speech-language therapy services in community practices, primary education and neurological rehabilitation in the Netherlands. Data collection followed the principles of video-reflexive ethnography, using video footage of goal-setting conversations to facilitate semi-structured, reflexive interviews. Data analysis was based on reflexive thematic analysis. A total of 12 interviews were conducted with client-SLT dyads, covering perspectives from children, parents and adults with a range of communication difficulties and their SLTs., Outcomes & Results: Data analysis resulted in four themes, of which two contain subthemes. Each theme represents a central organizing concept found in SLT and client interviews. The themes were identified as: (1) goal setting is a complex process; (2) goal talk needs to be communication accessible; (3) communicative participation goals are hard to grasp; and (4) the importance of relationships. Topics such as power imbalance, communication vulnerability, effective communication strategies, and motivation and trust are explored under these themes., Conclusions & Implications: SLTs are encouraged to view shared goal setting as a process that needs to be explicitly planned and communicated with clients regardless of their age or communication vulnerability. SLTs have expert knowledge and skills when it comes to supporting communication and applying these skills during goal talks might strengthen shared goal setting and foster a therapeutic relationship. There is a need to concretely conceptualize and embed shared goal setting in policy and clinical guidelines. The themes reported have tentative clinical implications for developing such policy, and shared goal-setting interventions for SLT practice, under the condition that SLTs and people with communication disorders are continuously involved., What This Paper Adds: What is already known on the subject SLTs want to set meaningful goals together with their patients but lack theory and resources to effectively shape the goal-setting process. Few studies have directly reported on the perspectives and needs of SLTs and patients regarding goal setting. Patients generally perceive goal setting as a vague activity in which they minimally participate. SLTs want to involve patients in the goal-setting process and describe the potential benefits, but they also want to report barriers on the systemic and professional competence level. What this paper adds to the existing knowledge SLTs and patients perceive shared goal setting as a multifaceted process, rather than a one-off conversation. This process holds potential vulnerabilities for SLTs and patients alike, and the themes in this study propose potentially helpful ingredients to mediate this vulnerability and shape the goal-setting process. What are the potential or clinical implications of this work? To take the first steps towards effective shared goal setting, SLTs should embrace the element of discovery in goal setting and apply their expert knowledge in supporting communication. To develop practical interventions for SLTs, shared goal setting needs to be further conceptualized and embedded in policy and clinical guidelines., (© 2024 The Author(s). International Journal of Language & Communication Disorders published by John Wiley & Sons Ltd on behalf of Royal College of Speech and Language Therapists.)

Background: Gestational diabetes mellitus (GDM) is an abnormal glucose metabolism diagnosed during pregnancy that can have serious adverse consequences for mother and child. GDM is an exceptional health condition, as its management serves not only as treatment but also as prevention, reducing the risk of future diabetes in mother and child., Objectives: This qualitative study aimed to explore how pregnant women experience and respond to GDM, focusing particularly on the role of the family environment in shaping women's experiences., Methods: The research was carried out in Vietnam's Thái Bình province in April-May 2023. We conducted in-depth ethnographic interviews with 21 women with GDM, visiting them in their homes. Our theoretical starting point was phenomenological anthropology, and the data were analysed using a thematic analysis approach., Results: At the centre of women's experiences was the contrast between GDM as a biomedical and a social condition. Whereas GDM was biomedically diagnosed and managed in the healthcare system, it was often deemed insignificant or non-existent by family members. This made GDM a biomedically present but socially absent health condition. This paradox posed challenges to women's GDM self-care, placing them in pioneering social positions., Conclusions: The biomedical presence yet social absence of GDM turned women into pioneers at biomedical, digital, epidemiological, and family frontiers. This article calls for appreciation of pregnant women's pioneering roles and for health systems action to involve women and families in the development of GDM policies and programmes at a time of sweeping global health changes.

Globally, COVID-19 had an immense impact on mental health systems, but research on how community mental health (CMH) systems and services contributed to the pandemic mental health response is limited. We conducted a systematic review and meta-ethnography to understand the roles of CMH services, determinants of the quality of CMH care, and dynamics within CMH systems during COVID-19. We searched and screened across five databases and appraised study quality using the CASP tool, which yielded 27 qualitative studies. Our meta-ethnographic process used Noblit and Hare's approach for synthesizing findings and applying interpretive analysis to original research. This identified several key themes. Firstly, CMH systems played the valuable pandemic role of safety nets and networks for the broader mental health ecosystem, while CMH service providers offered a continuous relationship of trust to service users amidst pandemic disruptions. Secondly, we found that the determinants of quality CMH care during COVID-19 included resourcing and capacity, connections across service providers, customized care options, ease of access, and human connection. Finally, we observed that power dynamics across the CMH landscape disproportionately excluded marginalized groups from mainstream CMH systems and services. Our findings suggest that while the pandemic role of CMH was clear, effectiveness was driven by the efforts of individual service providers to meet demand and service users' needs. To reprise its pandemic role in the future, a concerted effort is needed to make CMH systems a valuable part of countries' disaster mental health response and to invest in quality care, particularly for marginalized groups.

Background: Notwithstanding the global goal of inclusive universal health coverage, and the notion of migrant-sensitive health systems, limited healthcare access or the exclusion of migrants from national health systems persists. South Africa has a rights-based constitution, but there is an inability or a failure of the health system to recognise and address the health needs of migrants., Objective: To explore the intersection of the environment of healthcare provision for migrants and the everyday practices and behaviours of health workers and patients in the Gauteng province of South Africa., Methods: The conceptual frameworks of health system responsiveness and social exclusion informed this institutional ethnographic study at 13 healthcare facilities in Gauteng province. We developed an observation guide to explore the intersection of culture and environment and its influence on healthcare provision to patients, especially migrants. Following ethics approval, we observed the facilities for 234 person-days. We used thematic analysis to analyse the data., Results: Busy, frantic or nervous spaces, and contestations between patients and health workers, and among health workers formed part of the social and cultural environment of healthcare provision. The presence of migrant patients during busy periods served as a detonator for rude or discriminatory remarks, exacerbated by staff shortages and language barriers. Simultaneously, migrants exercised their agency by rebutting or confronting rude health workers. We also observed encouraging examples of kindness, caring and professionalism of health workers., Conclusion: The study has implications for achieving a migrant-sensitive health system in South Africa.

Background: Communities in which adolescent pregnancy and safe abortion care are taboo may benefit from culturally appropriate information, education, and communication., Objective: This ethnographic and participatory action research (PAR) elicited community members' perceptions to adolescent pregnancy: which then informed dialogue-drama development in Burmese and Karen language for undocumented migrants on the Thailand-Myanmar border., Methods: PAR was conducted in Karen and Burmese language. Interviews and discussions elicited perceptions of community members about adolescent pregnancy. These were analysed for themes and using the fishbone technique, to determine the objectives for the drama. After developing the structure and content of the drama it was piloted, revised, and performed in communities. Responses and impact of the drama were recorded. The team reflected on the drama as a method for health messaging., Results: In 2022, themes of responsibility, communication, and experiences of adolescent pregnancy emerged from 10 interviews and 6 discussions with community members. The fishbone technique established three dramatic objectives, woven into a teenage love story with an unplanned pregnancy, to raise community awareness of i) adolescent pregnancy, ii) contraception, and iii) choice in unexpected pregnancy. Post-drama feedback from 11 migrant communities (1,238 participants) was positive although some community members voiced concerns. Given the logistical challenges of conducting the drama in person, a film will be created for wider dissemination., Conclusions: Participatory action research resulted in a culturally-nuanced performance, with communities requesting further performances and awareness on adolescent pregnancy and safe abortion care. Video is likely to be a more sustainable option.

Background: Although home-based end-of-life care is more in line with the preferences of people living with dementia, operationalizing this ideal remains challenging. Many people living with dementia are still unable to die at home or receive end-of-life care at home. This review aims to apply meta-ethnography to synthesize existing qualitative studies, to identify the facilitators and barriers of home-based end-of-life care for people living with dementia., Methods: This review will use the meta-ethnography method to systematically synthesize and analyze qualitative studies. The seven stages described by Noblit and Hare (1988) will serve as the framework for this review. The systematic literature search will comprehensively cover the following databases: PubMed, MEDLINE, EMBASE, Cochrane Library, PsycINFO, CINAHL, and Web of Science. Inclusion criteria are: (A) qualitative research design; (B) participants are people living with dementia, family caregivers, or healthcare providers; (C) discussion of barriers and facilitators affecting home end-of-life care for people living with dementia; (D) original peer-reviewed studies in English. The included studies will be quality assessed using the CASP quality assessment form. The entire research process will refer to the meta-ethnography reporting guidelines (eMERGe) and the PRISMA statement to ensure the scientific and systematic nature of the results., Discussion: This review will synthesize and analyze the results of different qualitative studies, transforming different perspectives through an iterative process of comparison, translation, and synthesis to generate new insights, and will form a comprehensive and insightful interpretive framework. This will promote a more comprehensive and in-depth understanding of the facilitators and barriers to the implementation of home-based end-of-life care for people living with dementia. In addition, the results of this review will guide the development and improvement of home-based end-of-life care interventions for people living with dementia, and guide policymakers and practitioners to optimize relevant policies and services., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Yin et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: The proportion of people having home dialysis for kidney disease varies considerably by treating centre, socioeconomic deprivation levels in the area and to some extent ethnicity. This study aimed to gain in-depth insights into cultural and organisational factors contributing to this variation in uptake., Design: This is the first ethnographic study of kidney centre culture to focus on home dialysis uptake. The NASSS (non-adoption, abandonment, scale-up, spread, and sustainability) framework was used to map factors that influence the use of home dialysis., Setting: We conducted focused ethnographic fieldwork in four kidney centres in England, with average or high rates of home dialysis use, selected to represent geographic, ethnic and socioeconomic diversity., Participants: Observations of patient consultations, team meetings, patient education and training sessions (n=34); and interviews with staff, patients and carers (n=72)., Results: We identified three themes that can support the decision to pursue home dialysis: (a) Encouraging patient voice and individualised support . Kidney care teams engaged with people's psychosocial needs and cultural contexts, and valued peer support as part of patient education; (b) Ensuring access to home dialysis . Transparency about all treatment options, minimisation of eligibility assumptions and awareness of inequities of access; (c) Achieving sustained change based on benefits for patients . This included organisational cultures which adopted quality improvement approaches and worked with wider stakeholders to shape future policy and practice., Conclusions: Willingness to pursue dialysis at home relied on patients' and carers' ability to place their confidence in their kidney care teams rather than how services were organised. Our study of kidney centre culture has identified approaches to patient empowerment, access to treatment and readiness for improvement and change that could be incorporated into a service delivery intervention., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ Group.)

This study aims to analyze the configuration of inequalities in one of Argentina's most significant production zones for fresh vegetables and cut flowers, located in Greater La Plata, Buenos Aires Province. This ongoing anthropological research, initiated in 2021, employs methods such as participant observation, interviews, food mapping, and digital ethnography. Among the main findings, we highlight that this production zone exhibits, in both its origins and daily operations, certain racist dynamics that are not solely generated by the host society toward migrants but are disseminated throughout the social fabric, including by migrant producers themselves. Positive valuations of ultra-processed foods by those living and working in the area reflect the importance of belonging to the host society, running parallel to strategies for preserving food preparations from before migration. These include the recreation of a "food identity" and the proliferation of "legumbrerías" (legume shops) and "paisano eateries" (restaurants serving traditional food). These transformations are intertwined with the productive changes migrants have experienced, shifting from peasant economies in their places of origin to intensive production in Greater La Plata.

Background: As the population ages, more people will be diagnosed with cancer, and they will live longer due to receiving better treatment and optimized palliative care. Family members will be expected to take on more responsibilities related to providing palliative care at home. Several countries have expressed their vision of making home death an option, but such a vision can be more challenging in rural areas. There is a lack of synthesized research providing an in-depth understanding of rural family caregiving for people with cancer at the end of life. Thus, the purpose of this study was to synthesize and reinterpret the findings from qualitative research on rural family caregivers of adult cancer patients at the end of life., Methods: We conducted a meta-ethnography following Noblit and Hare's approach. A systematic literature search of four databases and extensive manual searches were completed in April 2022. The final sample included twelve studies from six different countries published in 2011-2022., Results: Based on the translation and synthesis of the included studies, four themes were developed (1) providing family care at the end of life in rural areas-a challenging endeavour; (2) the heavy responsibility of rural caregiving-a lonesome experience; (3) working on and behind the scenes; and (4) the strong and weak spots of community connectedness in rural areas. An overarching metaphor, namely, "ambivalent and heavy burdened wanderers on a road less travelled", provides a deeper understanding of the meaning of rural family caregiving at the end of life., Conclusions: This study provides valuable insights into end-of-life cancer care for rural families on four continents. It is crucial to prepare family caregivers for the demanding role of palliative caregiving in rural areas. To address the long distances and poor access related to specialized health care services, outpatient palliative teams tailored to the families' individual needs should be provided. In addition, more telehealth services, palliative units, or beds in local nursing facilities may reduce the number of exhausting trips that need to be made by caregivers and patients. Healthcare workers in rural areas need further education in palliative care., Trial Registration: The study was registered in PROSPERO., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)