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Abstract: Abstract The initial outbreak response to the 2014–2016 Ebola Virus Disease (EVD) in West Africa was met with resistance in Liberia. In part, this was because responders failed to account for how the country's colonial history and sociocultural circumstances influenced attitudes and perceptions of the population. We argue that understanding the relationship between the broader structural influences and the subjective aspects–the lived experience of people in the region–is crucial to developing more effective outbreak measures. In this light, we adopt and refine the concept of “riskscape” to highlight how the resistance to response teams shifted as the EVD outbreak unfolded. To illustrate our argument, we consider how the particular historical, cultural, and political forces constituted a postcolonial riskscape, influencing evolving perceptions of risk and trust in the context of the outbreak response in the West Point informal settlement located influcing Liberia's capital, Monrovia. As part of that discussion, we demonstrate how the adoption of a bottom-up community-based strategy by response officials, stimulated changes in the riskscape that helped pave the way for the adoption of an improved response strategy that resulted in a relatively swift decrease in EVD prevalence. PubDate: 2023-09-05
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Abstract: Abstract Opinion surveys have consistently shown that the British public does not support National Health Service (NHS) privatisation, but we know less about why this is. Studies in this area have been limited, despite the importance of the topic for healthcare, its associated workforces, public health, inequalities, (de)politicisation and democracy. We analyse the first open-ended representative survey of UK citizens’ motivations for opposing privatisation. Public opinion is contrasted with previous academic assumptions—supported by quasi-market theory—that opposition to privatisation is overwhelmingly concerned with services being free at the point of delivery. Instead, we find the largest single reason for dissent is the extraction of profits. Drawing on political governance perspectives, which advocate a wider scope of actors be included in such analyses, we consider public sphere institutions that previous studies have neglected. Thus, we examine our evidence in relation to patient representatives and health think-tank policies. Furthermore, we assess trade unions’ political communications strategies and their ‘public service approach’, in the light of our results. Our findings raise significant challenges for actors, such as non-executive commissioners. There are important implications for public sphere policy here in acknowledging the full extent of the public’s discursive, reasoned, concerns about privatisation. PubDate: 2023-09-01
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Abstract: Abstract The article examines the factors and conditions that affect street-level bureaucrats in health service delivery and how the street-level bureaucrats cope with their working conditions in rural Ghana. It draws insight from Lipsky’s street-level bureaucracy theory. The study argues that street-level bureaucrats coping strategies are not necessarily out of job frustrations but due to motivational factors. It further argues that street-level bureaucrats’ behaviour towards subscribers matters most in healthcare service delivery. The research design is a qualitative comparative case study approach. It compares public and private health facilities' street-level bureaucrats’ behaviour/actions and coping strategies in healthcare service delivery. The data are obtained from in-depth interviews, focus group discussions, document reviews and direct observations and some statistics from census, health insurance claims and health facilities attendance. The sample size is 65 and data are analysed using thematic analysis. The results show that private health facilities exhibit more positive attitudes/behaviour towards health insurance subscribers than their public counterparts. The results imply that the private health facilities coping strategies are ‘moving towards clients’ rather than ‘moving away’ or ‘against clients’. It recommends future research may adopt a quantitative research design with larger samples and with a rural–urban comparative study. PubDate: 2023-09-01
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Abstract: Abstract Sexually transmitted infections (STI) are a group of illnesses that disproportionately impact emerging adults, ages 18–25, African Americans, and men. The current study serves to contextualize race and sex-based trends by testing for the impact of gender traits, or sex roles. Data come from the Longitudinal Study of Adolescent and Adult Health (ADD Health) and includes White and African American respondents ages 18–25. Results of regression analyses showed (1) male sex and African American race increases the likelihood of condom use, (2) employment decreases the likelihood of condom use, and (3) African American race and masculine gender traits predict greater numbers of sexual partners. This study suggests social psychological aspects of race and gender promote sexual risk taking in emerging adulthood and should be considered in future studies and related interventions. PubDate: 2023-09-01
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Abstract: Abstract This paper addresses some conceptual and organizational questions which bear on the issue of whether those designated mad can produce knowledge from, about, and beyond their experience. Ideas encapsulated in concepts such as lack of reason and epistemic justice are deployed as well as the individuation that characterizes both the clinical encounter and services generally. It is argued that these prevent such knowledge making in itself and dissipate the structures which would enable it. The paper looks at ways in which the silencing of the mad has been broken and at responses which suppress or recuperate such developments. It argues, nonetheless, that counter-narratives are being established that resist these responses. Several empirical studies provide evidence to support the argument. PubDate: 2023-07-31
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Abstract: Abstract In this study, we analyse how collective illness identities are created and sustained among people with type 1 diabetes using sociological perspectives on identity formation and symbolic boundaries. Drawing on 24 in-depth interviews, we show how collective illness identities are established and maintained through both inclusionary and exclusionary mechanisms. Informants discussed their collective illness identity by invoking common experiences and interests while also establishing experiential, biomedical and moral boundaries that distinguished them from other social groups. In particular, we highlight how the informants distanced themselves from type 2 diabetes on the basis of the latter’s status as a ‘lifestyle disease’. Our findings demonstrate the importance of boundary work for collective illness identity formation and the management of stigma, and the ambivalent relationship between illness identities and biomedical knowledge. PubDate: 2023-06-01 DOI: 10.1057/s41285-022-00182-8
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Abstract: Abstract Scholars have documented tensions that develop as a result of the integration of complementary and alternative medical practices (CAM) into conventional medicine, but few studies have analyzed the process of integration. I use the Mindfulness-Based Stress Reduction program (MBSR), an increasingly popular CAM intervention, as a case study to investigate this process. Drawing on interviews and salient texts, I argue that MBSR leaders (MBSR teachers, doctors, and researchers) have fostered a cultural environment that allows the paradigms of alternative and conventional medicine to coexist: a new epistemological pluralism. Rather than exclusively defining MBSR as either CAM or conventional medicine, MBSR leaders strategically moved back and forth across contradictory epistemological paradigms, enabling them to maintain the integrity of mindfulness and its approach to “healing” while simultaneously conforming to the structural constraints of conventional medical institutions. This study contributes to theoretical research on institutions by suggesting that although this process may look like institutional isomorphism with CAM therapies conforming to the standards of conventional medical institutions, institutional actors’ comfort with contradictions and hybridized views supports institutional heterogeneity and possibly even divergence. PubDate: 2023-06-01 DOI: 10.1057/s41285-022-00180-w
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Abstract: Abstract Local health systems are increasingly tasked to play a more central role in driving action to reduce social inequalities in health. Past experience, however, has demonstrated the challenge of reorienting health system actions towards prevention and the wider determinants of health. In this review, I use meta-ethnographic methods to synthesise findings from eleven qualitative research studies that have examined how ambitions to tackle social inequalities in health take shape within local health systems. The resulting line-of-argument illustrates how such inequalities continue to be problematised in narrow and reductionist ways to fit both with pre-existing conceptions of health, and the institutional practices which shape thinking and action. Instances of health system actors adopting a more social view of inequalities, and taking a more active role in influencing the social and structural determinants of health, were attributed to the beliefs and values of system leaders, and their ability to push-back against dominant discourses and institutional norms. This synthesised account provides an additional layer of understanding about the specific challenges experienced by health workforces when tasked to address this complex and enduring problem, and provides essential insights for understanding the success and shortcomings of future cross-sectoral efforts to tackle social inequalities in health. PubDate: 2023-06-01 DOI: 10.1057/s41285-022-00176-6
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Abstract: Abstract Access to healthcare and health seeking behaviours of rural people often hinge on the existing relationships between healthcare providers and (prospective) healthcare users. However, rich micro-level health professional-healthcare user relationships and the unique relational context of rural settings are largely missing from dominant rural healthcare access conceptual frameworks. We argue rural healthcare access conceptualisations require revisiting from a relational perspective to ensure future healthcare access policy accounts for the relational nature of healthcare in rural contexts. Ethics of care is a moral theory informed by feminism which rejects liberal individualist notions and emphasises interdependence. We used Held’s ethics of care characteristics to examine Russell and colleagues’ healthcare access framework and dimensions for rural and remote populations. This process revealed Held’s ethics of care characteristics are only somewhat evident across Russell et al.’s dimensions: most evident in the acceptability and accommodation dimensions, and most absent in the availability and affordability dimensions. Future rural healthcare access frameworks need to pay further attention to the relational aspects of rural healthcare, particularly around the availability and affordability of healthcare, to bolster future efforts to improve healthcare access for rural people. PubDate: 2023-06-01 DOI: 10.1057/s41285-022-00181-9
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Abstract: Abstract Foucault’s argument that a major break occurred in the nature of power in the European Eighteenth century—an unprecedented socialization of medicine and concern for the health of bodies and populations, the birth of biopolitics—has become since the 1990s a dominant narrative among sociologists but is rarely if ever scrutinized in its premises. This article problematizes Foucault’s periodization about the politics of health and the way its story has been solidified into an uncritical account. Building on novel historiographic work, it challenges the modernist bias of histories of biopolitics and public health and considers an earlier and more plural history of collective practices of health of which the story told by Foucault is just one important episode. Finally, it discusses the implications of this revised model for wider sociological debates on the link between modernity, health and the body. PubDate: 2023-06-01 DOI: 10.1057/s41285-022-00177-5
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Abstract: Abstract Since the beginning of the 2000s, the reduction of coercive methods has been a tendency in psychiatric care in Finland. Combined with the transforming ideas of healing, the reduction has changed practices in the institutions of forensic mental health care, by encouraging efforts to increase self-determination and individual responsibility. This article addresses the coexistence of the previous and current bodily regimes, and the resulting complex and contested spatial and bodily arrangements. We combine the discussions on biopower and bodily regimes in our analysis of the practices and negotiations related to the alternative methods to coercion (special observation and restricting garments), mundane practices (eating and exercising), and negotiations related to touch and sexuality. As our study shows, bodily regimes and care practices are constantly under negotiation, during which there may be inconsistences in what is or is not allowed. Moreover, what seems to be a positive tendency towards increased self-determination has led to new forms of pressure, resulting from the increased possibility to protest by using one’s own body (e.g. by ignoring hygiene), or from the diminishing self-determination of the nurses (e.g. during special observation). PubDate: 2023-03-30 DOI: 10.1057/s41285-023-00193-z
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Abstract: Abstract This paper considers the experience of informal carers for people with mental health problems from the point of view of social epistemology, where human knowledge is seen as a social achievement and people’s social position informs the kinds of knowledge they accumulate and deploy. Based on interviews with 31 carers for people with mental health problems, three areas of localised, specified epistemological activity were identified. First, the management of knowledge involved in shaping the situation to gain professionals’ recognition. Relatedly, the second theme concerned the participants’ construction of what it was that the professionals knew but which was felt to be withheld from carers. Finally, there were aspects of being a carer, such as dealing with the emotional friction in the caring relationship which either ‘nobody tells you about’ or which ‘you can’t tell anyone’. Examining these experiences through the lens of social epistemology highlights the interactive and personal work that carer participants did to create, shape and manage both knowledge itself and their relationships with health professionals and the cared-for person. PubDate: 2023-03-01 DOI: 10.1057/s41285-021-00172-2
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Abstract: Abstract The college-level pathway to medical school (i.e., the “premed path”) includes all coursework, extra-curriculars, shadowing, volunteering, high-stakes examination (e.g., MCAT®), and application-related processes. Although medical school admission committees routinely insist their interest in diverse and “well-rounded” applicants, the premed path (PMP), through formal and informal mechanisms, is constructed to favor those from high in socioeconomic status (SES) privileged backgrounds, and those majoring in typical premed majors such as in the Biological Sciences. In these respects, the PMP is an example of Discriminatory Design—an entity constructed and sustained in a manner that (un)intentionally discriminates against certain groups of individuals. We begin this paper by providing a brief description of the PMP (within the U.S. specifically) and conceptual and theoretical overview of the discriminatory design framework. We then explore how the PMP is an example of discriminatory design through the distinct but related role(s) of financial, social, cultural, and (what we term) (extra)curricular capital. Using data gleaned from interviews with premedical students, content analyses of the curricular structure of particular majors and publicly available data on the various “costs” associated with the PMP, we detail how the PMP is reflective of discriminatory design, spotlighting specific barriers and hurdles for certain groups of students. Given the persistent lack of representation of students from minoritized groups as well as those from diverse academic backgrounds within medical schools, our goal is to spotlight key features and processes within the PMP that actively favor the pursuit of certain majors and students from more privileged backgrounds. In turn, we conclude by offering medical schools and undergraduate institutions specific recommendations for remediating these barriers and hurdles. PubDate: 2023-03-01 DOI: 10.1057/s41285-022-00175-7
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Abstract: Abstract The relationship between social position and health is a central issue in medical sociology. While researchers typically agree that health inequalities are ultimately determined by structural factors, the concept of ‘structure’ is often unspecified and vaguely understood. This paper contributes to our understanding of structure by clarifying and critiquing two main understandings of structure within health inequality research, respectively, ‘structure’ as synonymous with socioeconomic inequality and ‘structure’ as an arrangement of pre-given components. Inspired by the concept of structuration, I then outline a more practice-oriented conception hinging on a threefold distinction between structural determinants, structuring practices and structural outcomes. A model is then presented in which ‘structure’ is understood as the evolving conditions and outcome of practices in which actors produce, distribute and consume resources according to social schemas. The conclusion discusses the concept’s implications for researchers aiming to examine and reduce social inequalities in health. PubDate: 2023-03-01 DOI: 10.1057/s41285-021-00163-3
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Abstract: Abstract Socially disadvantaged ischemic heart patients are more likely to report poor patient satisfaction and problematic patient-provider communication than patients without social disadvantages. These inequalities are often understood with the use of concepts emphasising the individual’s cognitive abilities, such as health literacy. This study aims to explore Danish socially disadvantaged ischemic heart patients’ lived experiences of healthcare interactions through the lens of cultural health capital, and thereby further our understanding of more underlying structural, social and interpersonal factors shaping social inequalities in cardiac treatment. The study was carried out as a nationwide critical hermeneutic study in Denmark between October 2018 and August 2019. Data consist of qualitative interviews with 30 participants and supplementary observations. The findings showed that the healthcare interactions were characterised by unequal power balances. The healthcare professionals dominated the norms of the clinical encounter and thereby what kind of cultural health capital that held the highest exchange value. Furthermore, the participants felt inferior compared to patients with a higher social status who managed to display valued parts of the cultural health capital, and thereby receive more attentive treatment. The findings indicate that treatment of this group of patients should acknowledge the patients’ habitus and life circumstances. PubDate: 2023-03-01 DOI: 10.1057/s41285-021-00173-1
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Abstract: Abstract This paper seeks to examine whether knowledge about treatment, mental well-being and socio-demographic variables can predict patients’ trust in surgeons. A cross-sectional study was conducted in Norway. A total of 147 participants completed a questionnaire with items on knowledge, mental well-being, socio-demographic background, and trust in doctors in elective surgery. Our findings indicate that knowledge about treatment was a significant predictor of trust, and that the lowest levels of knowledge were associated with lower levels of trust. Most participants reported moderate/high well-being, however, patients with the lowest well-being scores had significantly lower trust in surgical doctors. We discuss these findings in the context of other relevant research and provide a theoretical discussion on the issue using Luhmann’s theory of trust. We argue that both knowledge and trust have forward-looking aspects, meaning that knowledge is to some extent acquired to cope with the future and trust is also related to expectations of the future. This theoretical approach can provide a framework for understanding our empiric findings. As knowledge was a significant predictor of trust, and is related to future expectations, information given to patients should focus on issues that may affect their personal future health. PubDate: 2023-03-01 DOI: 10.1057/s41285-021-00171-3
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Abstract: Abstract Rooted in a Durkheimian functionalist reading of religion, in this article, we present and discuss the results of a scoping study of on-line sources on the delivery of spiritual care during the COVID-19 pandemic in England. Spiritual care highlights the bond between healthcare and religion/spirituality, particularly within the growing paradigm of holistic and humane care. Spiritual care is also an area where the importance of the physical presence of receivers and providers is exceptionally important, as a classic anthropological understanding of the religious ritual would maintain. Three themes were found, which speak to changes brought about by the pandemic. These revolve around disembodiment, solitude, and technology in spiritual care, of religious and non-religious nature. A fourth theme encapsulates the ambivalence in the experience of spiritual care delivery, whereby distant and virtual care could only partially compensate for the impossibility of physical presence. On the one hand, we draw from anthropology of the ritual and phenomenology to make the case for the inalienability of intercorporeality in being there for the other. On the other hand, relying on digital religious studies and post-human theories, we argue for an opening up to new ways of conceptualising the body, being there, and being human. PubDate: 2023-02-06 DOI: 10.1057/s41285-022-00192-6
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Abstract: Abstract The analysis of factors and actors that lead to the increasing medicalisation of common mental health issues is generally focused on the healthcare system (the medical profession, in particular) or other related fields (the pharmaceutical industry, the media, or governments, among others). In this article, I in turn examine how and which processes in a society as a whole might drive to unpleasant emotions of everyday life being managed through medical and, particularly, pharmaceutical solutions, rather than employing other resources. Using reflexive thematic analysis and drawing upon Elias’s process sociology, I present the analysis of 21 in-depth interviews with healthcare providers and users of services who are or have been treated for depression or anxiety disorders in Spain. It is concluded that the trends of scientisation and individualisation, coupled with demands for emotional self-control, enable the growing medicalisation of emotions. Professional help seeking represents rationalisation, whereas suffering unpleasant (yet non-disordered) emotions is viewed as irrational. PubDate: 2022-12-01 DOI: 10.1057/s41285-021-00165-1
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Abstract: Abstract Chinese medicine came to Canada during the twentieth century in the hands of ethnic Chinese immigrants. This paper investigates the key features of professionalized Chinese medicine practice in the city of Vancouver, which lies in the Canadian province of British Columbia. The methodology adopted for this research involved face-to-face interviews with practitioners and the scrutinizing of webpages of various institutes and clinics offering Chinese medical services. In order to comply with regulatory requirements, the practice of Chinese medicine has been professionalized according to western biomedicine, ignoring the historical development and cultural connotations of this ancient system of health and wellness. Many practitioners in Vancouver do not speak Chinese, share Chinese culture, and have never been to China. The education and service delivery under Chinese medicine specialties have focused exclusively on curative care and have disregarded the preventive and moral regimen. A consumer class has developed across the city and the holistic content of Chinese medicine has become a selling point. This paper concludes that the commodified version of Chinese medicine that has so far been developed in Vancouver as part of its professionalization echoes neo-orientalism. The West has intervened in the formalization process of Chinese medicine practice, justifying authority through the process of non-disputed inclusion. This is, however, an ahistorical proponent fulfilling new age desires and contaminating eastern healing in the west for profit maximization. PubDate: 2022-11-09 DOI: 10.1057/s41285-022-00191-7
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