Fostering equitable change in health services: Using critical reflexivity to challenge dominant discourses in low back pain care in Australia.

IF 1.9 4区 医学 Q3 HEALTH POLICY & SERVICES Journal of Health Services Research & Policy Pub Date : 2024-01-01 Epub Date: 2023-08-08 DOI:10.1177/13558196231193862
Karime Mescouto, Rebecca E Olson, Nathalia Costa, Kerrie Evans, Miriam Dillon, Kelly Walsh, Niamh Jensen, Paul W Hodges, Kathryn Lonergan, Megan Weier, Jenny Setchell
{"title":"Fostering equitable change in health services: Using critical reflexivity to challenge dominant discourses in low back pain care in Australia.","authors":"Karime Mescouto, Rebecca E Olson, Nathalia Costa, Kerrie Evans, Miriam Dillon, Kelly Walsh, Niamh Jensen, Paul W Hodges, Kathryn Lonergan, Megan Weier, Jenny Setchell","doi":"10.1177/13558196231193862","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>Justice and equity-focused practices in health services play a critical but overlooked role in low back pain (LBP) care. Critical reflexivity - the ability to examine and challenge power relations, and broader social issues embedded in everyday life - can be a useful tool to foster practices that are more socially just. No research has yet explored this approach in back pain health services. This study sought to understand how clinicians construct LBP in relation to broader socio-cultural-political aspects of care and explore if those constructions changed when clinicians engaged with critically reflexive dialogues with researchers.</p><p><strong>Methods: </strong>Using critical discourse analysis methods, this qualitative study explored institutionalised patterns of knowledge in the construction of LBP care. We conducted 22 critically reflexive dialogues with 29 clinicians from two health services in Australia - a private physiotherapy clinic and a public multidisciplinary pain clinic.</p><p><strong>Results: </strong>Our analyses suggested that clinicians and services often constructed LBP care at an individual level. This dominant individualistic discourse constrained consideration of justice-oriented practices in the care of people with LBP. Through dialogues, discursive constructions of LBP care expanded to incorporate systems and health service workplace practices. This expansion fostered more equitable clinical and service practices - such as assisting patients to navigate health care systems, considering patients' socioeconomic circumstances when developing treatment plans, encouraging staff discussion of possible systemic changes to enhance justice, and fostering a more inclusive workplace culture. Although such expansions faced challenges, incorporating broader discourses enabled recommendations to address LBP care inequities.</p><p><strong>Conclusions: </strong>Critical reflexivity can be a tool to foster greater social justice within health services. By expanding constructions of LBP care beyond individuals, critical reflexive dialogues can foster discussion and actions towards more equitable workplace cultures, services and systems.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":null,"pages":null},"PeriodicalIF":1.9000,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Health Services Research & Policy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/13558196231193862","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/8/8 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"HEALTH POLICY & SERVICES","Score":null,"Total":0}
引用次数: 0

Abstract

Objectives: Justice and equity-focused practices in health services play a critical but overlooked role in low back pain (LBP) care. Critical reflexivity - the ability to examine and challenge power relations, and broader social issues embedded in everyday life - can be a useful tool to foster practices that are more socially just. No research has yet explored this approach in back pain health services. This study sought to understand how clinicians construct LBP in relation to broader socio-cultural-political aspects of care and explore if those constructions changed when clinicians engaged with critically reflexive dialogues with researchers.

Methods: Using critical discourse analysis methods, this qualitative study explored institutionalised patterns of knowledge in the construction of LBP care. We conducted 22 critically reflexive dialogues with 29 clinicians from two health services in Australia - a private physiotherapy clinic and a public multidisciplinary pain clinic.

Results: Our analyses suggested that clinicians and services often constructed LBP care at an individual level. This dominant individualistic discourse constrained consideration of justice-oriented practices in the care of people with LBP. Through dialogues, discursive constructions of LBP care expanded to incorporate systems and health service workplace practices. This expansion fostered more equitable clinical and service practices - such as assisting patients to navigate health care systems, considering patients' socioeconomic circumstances when developing treatment plans, encouraging staff discussion of possible systemic changes to enhance justice, and fostering a more inclusive workplace culture. Although such expansions faced challenges, incorporating broader discourses enabled recommendations to address LBP care inequities.

Conclusions: Critical reflexivity can be a tool to foster greater social justice within health services. By expanding constructions of LBP care beyond individuals, critical reflexive dialogues can foster discussion and actions towards more equitable workplace cultures, services and systems.

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
促进医疗服务的公平变革:使用批判性反身性挑战澳大利亚腰背痛护理中的主流话语。
目标:在腰背痛(LBP)治疗中,医疗服务中以公正和公平为重点的实践发挥着至关重要但却被忽视的作用。批判性反思--审视和挑战权力关系以及日常生活中更广泛的社会问题的能力--可以成为促进更具社会公正性的实践的有用工具。目前还没有研究探讨过背痛医疗服务中的这种方法。本研究旨在了解临床医生如何将枸橼酸背痛症与护理中更广泛的社会文化政治方面联系起来进行构建,并探讨当临床医生与研究人员进行批判性反思对话时,这些构建是否会发生变化:这项定性研究采用批判性话语分析方法,探讨了枸杞多糖症护理构建中的制度化知识模式。我们与来自澳大利亚两家医疗服务机构(一家私人物理治疗诊所和一家公立多学科疼痛诊所)的 29 名临床医生进行了 22 次批判性反思对话:结果:我们的分析表明,临床医生和医疗服务机构通常从个人层面构建枸杞多糖症护理。这种占主导地位的个人主义话语限制了在为腰椎间盘突出症患者提供护理时考虑以公正为导向的做法。通过对话,枸杞多糖症护理的话语构建扩展到了系统和医疗服务工作场所的实践。这种扩展促进了更公平的临床和服务实践--例如,帮助患者了解医疗保健系统,在制定治疗计划时考虑患者的社会经济状况,鼓励员工讨论可能的系统变革以提高公正性,以及培养更具包容性的工作场所文化。尽管这种扩展面临挑战,但纳入更广泛的论述有助于提出解决枸杞多糖症护理不平等问题的建议:结论:批判性反思可以作为一种工具,在医疗服务中促进更大的社会公正。通过将枸杞多糖症护理的构建扩展到个人之外,批判性反思对话可以促进讨论和行动,从而实现更公平的工作场所文化、服务和系统。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
CiteScore
4.40
自引率
4.20%
发文量
39
期刊介绍: Journal of Health Services Research & Policy provides a unique opportunity to explore the ideas, policies and decisions shaping health services throughout the world. Edited and peer-reviewed by experts in the field and with a high academic standard and multidisciplinary approach, readers will gain a greater understanding of the current issues in healthcare policy and research. The journal"s strong international editorial advisory board also ensures that readers obtain a truly global and insightful perspective.
期刊最新文献
How can specialist investigation agencies inform system-wide learning for patient safety? A qualitative study of perspectives on the early years of the English healthcare safety investigation branch. What can the era of big data and big data analytics mean for health services research? Collaborative and integrated working between general practice and community pharmacies: A realist review of what works, for whom, and in which contexts. Public perspectives on the benefits and harms of lung cancer screening: A systematic review and mixed-method integrative synthesis. Rapid evidence assessment of student-assisted assessment and brief intervention clinics: Addressing the gaps in rural and remote health care.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1