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The day program multiple: Noncoherence and ontological politics. 日间节目的多重性:非一致性与本体论政治。
IF 1.9 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-01-01 Epub Date: 2022-07-29 DOI: 10.1177/13634593221116501
Holly Symonds-Brown, Christine Ceci

Globally, day programs are increasingly proposed in policy as one way to address the support needs of people living at home with dementia and their families. Day programs represent a kind of space that can meet multiple interests and ideologies concerned with sustaining care at home for people living with dementia. In this paper, we draw on findings from an ethnographic study of how day programs work as care in the community for people living with dementia to argue that day programs' ontological status in research as a "simple location" of care contributes to the ambiguous outcomes and limited evidence available for improving their design and delivery. Using one program as an illustrative case, we demonstrate the multiplicity of a day program and the ontological politics through which the potentialities for care emerge. Robert Cooper's proximal analysis of organizing's and Annemarie Mol's work on ontological politics inform this analysis. Of note in this analysis are the different enactments of a day program and their modes of coordination. We show when these enactments hang together well and when they do not and consider the effects of these politics for care. Of particular concern is how some versions of a day program are easily displaced by the interests of administrative versions and managerial logics. We argue for approaches to research and planning that acknowledge the "day program multiple" and precarious nature of care.

在全球范围内,政策中越来越多地提议将日间项目作为满足居家老年痴呆症患者及其家人支持需求的一种方式。日间项目代表着一种空间,它可以满足多种利益和意识形态,这些利益和意识形态都与在家中持续照顾痴呆症患者有关。在本文中,我们通过对日间项目如何在社区中为痴呆症患者提供照护的人种学研究结果,指出日间项目在研究中的本体地位是一种 "简单的照护场所",这导致了其结果的模糊性,以及在改进其设计和实施方面的证据的有限性。我们以一个日间项目为例,展示了日间项目的多重性和本体论政治,通过这种政治,护理的潜力得以显现。罗伯特-库珀(Robert Cooper)对组织化的近端分析和安玛莉-莫尔(Annemarie Mol)对本体论政治的研究为本分析提供了参考。在这一分析中,值得注意的是日间项目的不同表现形式及其协调模式。我们展示了这些模式在什么情况下能很好地结合在一起,什么情况下不能,并考虑了这些政治对护理的影响。特别值得关注的是,日间项目的某些版本是如何轻易地被行政版本和管理逻辑的利益所取代的。我们主张研究和规划的方法应承认 "日间项目的多重性 "和护理的不稳定性。
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引用次数: 0
Information gaps in persuasion knowledge: The discourse regarding the Covid-19 vaccination. 说服知识中的信息差距:关于 Covid-19 疫苗接种的讨论。
IF 1.9 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-01-01 Epub Date: 2022-07-19 DOI: 10.1177/13634593221113208
Tamar Israeli, Ariela Popper-Giveon, Yael Keshet

Persuasion knowledge is personal knowledge about persuasion attempts that has an effect on the way people respond to these attempts. Persuasion attempts are made to effectively handling the Covid-19 pandemic, which is dependent on high public compliance with vaccination programs. Drawing on the idea of persuasion knowledge, we aimed at elaborating the various categories of perceived information gaps experienced by vaccine hesitants during the Covid-19 vaccination campaign. At the beginning of 2021 we conducted 20 in-depth interviews with Israelis who had decided not to be vaccinated against Covid-19. Analysis of the interviews revealed three main categories of information gaps experienced by the interviewees: missing information, manipulated information, and discrepant information. We analyzed how these are associated with distrust and may impair the persuasion efforts of governments and health authorities. Perceived information gaps, as part of persuasion knowledge, may increase negative responses, and therefore constitute an important factor in persuasion campaigns.

说服知识是关于说服尝试的个人知识,会影响人们对这些尝试的反应。说服尝试是为了有效处理 Covid-19 大流行病,而这取决于公众对疫苗接种计划的高度遵从。借鉴说服知识的理念,我们旨在阐述在 Covid-19 疫苗接种活动中,疫苗接种犹豫者所感受到的各类信息差距。2021 年初,我们对决定不接种 Covid-19 疫苗的以色列人进行了 20 次深入访谈。对访谈的分析表明,受访者经历的信息缺口主要分为三类:缺失信息、被操纵的信息和不一致的信息。我们分析了这些信息缺口如何与不信任联系在一起,并可能损害政府和卫生当局的说服工作。作为说服知识的一部分,感知到的信息差距可能会增加负面反应,因此是说服活动中的一个重要因素。
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引用次数: 0
"Time work": An analysis of temporal experiences and agentic practices in the "good" doctor-patient relationship in general practice. "时间工作":分析全科 "良好 "医患关系中的时间体验和代理实践。
IF 1.9 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-01-01 Epub Date: 2022-07-29 DOI: 10.1177/13634593221116504
Elisabeth Assing Hvidt

This article contributes to social health research by presenting an analysis of the temporal dimensions of the "good" doctor-patient relationship as perceived and enacted by patients and general practitioners (GPs). The empirical data derive from ethnographic fieldwork comprising participant observation in four general practice clinics in Denmark, and semi-structured interviews with 27 patients and eight GPs. The analysis draws from Michael Flaherty's sociology of time: notions of temporal agency and "time work" are used as analytical tools to demonstrate that the "good" doctor-patient relationship is constructed in a tension between external temporal structures and internal temporal experiences that are the result of GPs' and patients' agentic practices of "doing time." Thus, the findings illustrate how temporal determinism and self-determinism are equally interwoven when GPs and patients talk about, enact and seek meaningful temporal experiences within the doctor-patient relationship, while resisting and avoiding others that undermine the relationship. The results challenge 1. deterministic conceptions of time demands in today's healthcare systems that are said to control healthcare providers' behavior and 2. the taken-for-granted understanding of continuity as a resource in itself.

本文分析了患者和全科医生(GPs)对 "良好 "医患关系的时间维度的感知和理解,为社会健康研究做出了贡献。实证数据来自人种学实地调查,包括对丹麦四家全科诊所的参与观察,以及对 27 名患者和 8 名全科医生的半结构化访谈。分析借鉴了迈克尔-弗莱厄蒂(Michael Flaherty)的时间社会学:时间代理和 "时间工作 "的概念被用作分析工具,以证明 "良好的 "医患关系是在外部时间结构和内部时间体验之间的紧张关系中构建的,而内部时间体验是全科医生和患者 "做时间 "的代理实践的结果。因此,研究结果表明,当全科医生和患者在医患关系中谈论、制定和寻求有意义的时间体验,同时抵制和避免其他破坏医患关系的时间体验时,时间决定论和自我决定论是如何交织在一起的。研究结果对以下两方面提出了质疑:1.当今医疗保健系统对时间需求的决定论观念,据说这种观念控制着医疗保健提供者的行为;2.对连续性本身作为一种资源的想当然的理解。
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引用次数: 0
Stigma, shame and family secrets as consequences of mental illness in previous generations: A micro-history approach. 耻辱、羞耻和家庭秘密是上一代人患精神疾病的后果:微观历史方法。
IF 1.9 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-01-01 Epub Date: 2022-08-01 DOI: 10.1177/13634593221114751
Eileen Clark, Jennifer Munday, Alison Watts

In this article we evaluate micro-history as a method for investigating the meaning of stigma, shame and family secrets through generations. We present micro-histories of two Australian soldiers who developed mental illness years after serving in World War 1 and were committed to a psychiatric hospital where they died. Data were drawn from publicly available records and interviews with family members. The contrasting stories held by the families of each man illustrate the transmission of stigma and secrets through families. We explore possible reasons for the differences between the families related to the wider literature on stigma and mental health and show why the family stories people present should be considered social constructions rather than facts. We also address ethical issues that arose during the research, and which have relevance for researchers investigating sensitive or potentially stigmatising topics.

在这篇文章中,我们将微观历史作为一种研究耻辱、羞耻和家庭秘密的意义的方法,对其进行世代相传的评估。我们介绍了两名澳大利亚士兵的微观历史,他们在第一次世界大战中服役多年后罹患精神疾病,被送进精神病院并在那里去世。数据来自公开的记录和对家庭成员的访谈。每个人的家人所讲述的故事截然不同,说明了耻辱和秘密通过家庭的传播。我们探讨了造成这些家庭之间差异的可能原因,这些原因与更广泛的关于耻辱和心理健康的文献有关,并说明了为什么人们所讲述的家庭故事应被视为社会建构而非事实。我们还探讨了研究过程中出现的伦理问题,这些问题对于调查敏感或可能造成污名化话题的研究人员具有现实意义。
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引用次数: 0
'Engaging on a slightly more human level': A qualitative study exploring the care of individuals with back pain in a multidisciplinary pain clinic. 在更人性化的层面上参与":一项定性研究,探索多学科疼痛诊所对背痛患者的护理。
IF 1.9 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-01-01 Epub Date: 2022-11-26 DOI: 10.1177/13634593221127817
Karime Mescouto, Rebecca E Olson, Nathalia Costa, Kerrie Evans, Miriam Dillon, Niamh Jensen, Kelly Walsh, Megan Weier, Kathryn Lonergan, Paul W Hodges, Jenny Setchell

Chronic low back pain is characterised by multiple and overlapping biological, psychological, social and broader dimensions, affecting individuals' lives. Multidisciplinary pain services have been considered optimal settings to account for the multidimensionality of chronic low back pain but have largely focused on cognitive and behavioural aspects of individuals' pain. Social dimensions are usually underexplored, considered outside or beyond healthcare professionals' scope of practice. Employing Actor Network Theorist Mol's concept multiplicity, our aim in this paper is to explore how a pain service's practices bring to the fore the social dimensions of individuals living with low back pain. Drawing on 32 ethnographic observations and four group exchanges with the service's clinicians, findings suggest that practices produced multiple enactments of an individual with low back pain. Although individuals' social context was present and manifested during consultations at the pain service (first enactment: 'the person'), it was often disconnected from care and overlooked in 'treatment/management' (second enactment: 'the patient'). In contrast, certain practices at the pain service not only provided acknowledgement of, but actions towards enhancing, individuals' social contexts by adapting rules and habits, providing assistance outside the service and shifting power relations during consultations (third enactment: 'the patient-person'). We therefore argue that different practices enact different versions of an individual with low back pain in pain services, and that engagement with individuals' social contexts can be part of a service's agenda.

慢性腰背痛的特点是生物、心理、社会和更广泛的层面多重重叠,影响个人生活。多学科疼痛服务被认为是考虑慢性腰背痛多维性的最佳环境,但主要集中在个人疼痛的认知和行为方面。社会层面通常未得到充分探索,被认为不属于或超出了医护人员的实践范围。本文采用了行动者网络理论家莫尔(Mol)的多重性概念,旨在探讨疼痛服务机构的实践是如何将腰背痛患者的社会维度凸显出来的。通过 32 次人种学观察和与该服务机构临床医生的 4 次小组交流,研究结果表明,服务实践产生了腰背痛患者的多重表现。虽然个人的社会背景在疼痛服务机构的咨询过程中存在并表现出来(第一种表现:"人"),但它往往与护理脱节,并在 "治疗/管理 "中被忽视(第二种表现:"病人")。与此相反,疼痛服务机构的某些做法不仅承认了个人的社会背景,而且还通过调整规则和习惯、在服务机构之外提供帮助以及在咨询过程中转变权力关系(第三种表现形式:"病人-个人")来改善个人的社会背景。因此,我们认为,在疼痛服务中,不同的实践会形成不同版本的腰背痛患者,与个人的社会环境接触可以成为服务议程的一部分。
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引用次数: 0
Conducting member checking within a qualitative case study on health-related behaviours in a large European city: Appraising interpretations and co-constructing findings. 在一项关于欧洲大城市健康相关行为的定性案例研究中进行成员核查:评估解释并共同构建研究结果。
IF 1.9 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-01-01 Epub Date: 2022-07-13 DOI: 10.1177/13634593221109682
Ignacio de Loyola González-Salgado, Jesús Rivera-Navarro, Marta Gutiérrez-Sastre, Paloma Conde, Manuel Franco

Although member checking is a well-established strategy for appraising credibility, there is a lack of research reporting procedures and outcomes when using this strategy. In recent years, scholars have implemented new member checking strategies along with several epistemological stances. In this work, researchers conducted member checking in three neighbourhoods with different socioeconomic status in Madrid, Spain. Attendance at member checking meetings was lower than expected. Member checking meetings were conducted in public halls within each neighbourhood and lasted approximately 2 hours. During the first hour, researchers introduced the aim of the meetings and shared summarized research findings with attendees using a slideshow. During the second hour, attendees had the opportunity to comment on any aspect of the research. Researchers used grounded theory coding strategies and a constructivist approach informed the analysis of the transcribed member checking meetings. One core category emerged, and it was named 'Co-constructing findings and side effects of the interaction between researchers and participants in member checking'. Member checking attendees contributed to co-constructing findings by means of underscore and disagreement. It is possible that these meetings might have caused side effects such as unintended comparisons between neighbourhoods and negative health-related behaviours. Attendees wondered how the findings could improve their neighbourhoods. The meetings allowed interaction between participants and researchers and resulted in appraising and co-constructing qualitative research findings. More research is needed to advance knowledge about member checking.

虽然成员核对是一种成熟的可信度评估策略,但缺乏对使用这一策略的程序和结果的研究报告。近年来,学者们在实施新的成员核对策略的同时,也采取了一些认识论立场。在这项工作中,研究人员在西班牙马德里三个社会经济地位不同的社区进行了成员核查。成员核查会议的出席率低于预期。成员核查会议在每个社区内的公共大厅举行,持续约两个小时。在第一个小时中,研究人员介绍了会议的目的,并通过幻灯片与与会者分享了研究成果摘要。在第二个小时中,与会者有机会就研究的任何方面发表意见。研究人员采用基础理论编码策略和建构主义方法对成员检查会议的记录进行了分析。其中出现的一个核心类别被命名为 "研究人员与成员核查参与者之间互动的共同建构结果和副作用"。成员核对会议的与会者通过强调和分歧的方式共同构建了研究结果。这些会议可能会产生一些副作用,如无意中对不同社区和与健康有关的负面行为进行比较。与会者想知道研究结果如何能够改善他们的社区。这些会议让参与者和研究人员进行了互动,并对定性研究结果进行了评估和共同建构。需要开展更多的研究,以增进对成员检查的了解。
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引用次数: 0
The critical (micro)political economy of health: A more-than-human approach. 健康的关键(微观)政治经济学:超越人类的方法。
IF 1.9 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-01-01 Epub Date: 2022-07-22 DOI: 10.1177/13634593221113212
Nick J Fox

The critical political economy of health offers different explanations for the social causes of health and the social factors determining the distribution of these causes. However, the relational, post-anthropocentric and monist ontology of the new materialisms overcomes this complexity, while retaining a critical focus. In this perspective, the social, economic and political relations of capitalism act upon bodies and other matter in everyday events, rather than as 'social structures'. Using a conceptual toolkit of 'affect', 'assemblage', 'capacity' and 'micropolitics', the paper asks the question: 'what does capitalism do?' The re-analysis of the social and economic relations of capitalism in terms of a production-assemblage and a market-assemblage reveals not only the workings of capitalist accumulation, but also how previously-unremarked more-than-human affects in these assemblages simultaneously produce uncertainty, waste and inequalities. This micropolitical economy of health is illustrated with examples from recent research, including a critical assessment of health inequalities during the Covid-19 pandemic.

关于健康的批判性政治经济学对健康的社会原因以及决定这些原因分布的社会因素做出了不同的解释。然而,新唯物主义的关系、后人类中心主义和一元论本体论克服了这种复杂性,同时保留了批判性的重点。在这一视角下,资本主义的社会、经济和政治关系作用于日常事件中的身体和其他物质,而不是 "社会结构"。本文利用 "影响"、"组合"、"能力 "和 "微观政治学 "等概念工具包,提出了 "资本主义做什么?从生产--组合和市场--组合的角度重新分析资本主义的社会和经济关系,不仅揭示了资本主义积累的运作方式,还揭示了这些组合中以前未曾注意到的超越人类的情感是如何同时产生不确定性、浪费和不平等的。本文通过近期研究的实例,包括对科维德-19 大流行病期间健康不平等现象的批判性评估,来说明这种健康微观政治经济学。
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引用次数: 0
Narratives about distributed health literacy during the COVID-19 pandemic. 讲述 COVID-19 大流行期间的分布式健康知识。
IF 2.1 4区 医学 Q1 Social Sciences Pub Date : 2023-12-14 DOI: 10.1177/13634593231215715
Susana Silva, Helena Machado, Ilaria Galasso, Bettina M Zimmermann, Carlo Botrugno

The promotion of health literacy was a key public health strategy during the COVID-19 pandemic. However, the role of social networks and relationships for support with health literacy-related tasks in the context of the COVID-19 pandemic is scarcely understood. Moving beyond traditional notions of health literacy, which focus on individual skills and knowledge, this study uses the concept of distributed health literacy to explore how individuals make meaning of and respond to health literacy and make their literacy skills available to others through their relational and socially situated and lived experiences of the COVID-19 pandemic. Drawing on 89 semi-structured interviews conducted in three European countries (Italy, Portugal, and Switzerland) between October and December 2021, we found narratives of stabilization, hybridization, and disruption that show how health literacy concerning COVID-19 is a complex social construct intertwined with emotional, cognitive, and behavioral responses distributed among individuals, communities, and institutions within socioeconomic and political contexts that affect their existence. This paper opens new empirical directions to understand the critical engagement of individuals and communities toward health information aimed at making sense of a complex and prolonged situation of uncertainty in a pandemic.

在 COVID-19 大流行期间,促进健康知识普及是一项重要的公共卫生策略。然而,在 COVID-19 大流行的背景下,人们对社会网络和关系在支持健康素养相关任务方面所起的作用知之甚少。传统的健康素养概念侧重于个人的技能和知识,而本研究则超越了这一概念,采用分布式健康素养的概念来探讨个人如何通过他们在 COVID-19 大流行中的关系、社会环境和生活经历来理解健康素养的意义并对其做出回应,以及如何将自己的素养技能提供给他人。根据 2021 年 10 月至 12 月期间在三个欧洲国家(意大利、葡萄牙和瑞士)进行的 89 次半结构式访谈,我们发现了关于稳定、混合和破坏的叙述,这些叙述显示了有关 COVID-19 的健康素养是如何与情感、认知和行为反应交织在一起的复杂社会建构,这些反应分布在影响其生存的社会经济和政治背景下的个人、社区和机构中。本文开辟了新的实证研究方向,以了解个人和社区对健康信息的关键参与,从而理解大流行病中复杂而漫长的不确定状况。
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引用次数: 0
"You kind of blame it on the alcohol, but. . .": A discourse analysis of alcohol use and sexual consent among young men in Vancouver, Canada. "你会把这归咎于酒精,但是......":.":对加拿大温哥华年轻人饮酒和同意性行为的话语分析。
IF 2.1 4区 医学 Q1 Social Sciences Pub Date : 2023-12-14 DOI: 10.1177/13634593231214942
Trevor Goodyear, John L Oliffe, Hannah Kia, Emily K Jenkins, Rod Knight

There is growing awareness about issues of sexual consent, especially in autonomy-compromising or "non-ideal" contexts, including sex involving alcohol. Understanding the conditions needed for consensual sex to occur in this emergent milieu is critically important, especially for young men (ages 18-30 years) who normatively combine drinking alcohol with sex and are most often perpetrators of sexual violence. This study offers a discourse analysis of young men's alcohol use and sexual consent. Data are drawn from qualitative interviews with 76 young men (including gay, bisexual, queer, and straight men) in Vancouver, Canada, from 2018 to 2021. Informed by Kukla's non-ideal theory of sexual consent and critical and inclusive masculinities, this analysis identified three discursive frames: careful connections, watering it down, and blurred lines. In careful connections young men discussed their efforts to actively promote sexual and decisional autonomy for themselves and their sexual partners when drinking. Yet, in watering it down young men invoked discourses of disinhibition, deflection, and denial to normalize alcohol use as being somewhat excusatory for sexual violence, downplaying the role and responsibility of men. Lastly, men operationalized blurred lines through a continuum of consent and of "meeting (masculine) expectations" when discussing sexual violence and victimization while intoxicated. Together, these discursive frames provide insights into the gendered nature of sexual violence and the extent to which idealized notions of sexual consent play out in the everyday lives of young men who use alcohol with sex. Findings hold philosophical and pragmatic implications for contemporary efforts to scaffold sexual consent.

人们越来越意识到性同意的问题,尤其是在有损自主权或 "非理想 "的情况下,包括涉及酒精的性行为。了解在这一新兴环境中发生双方同意的性行为所需的条件至关重要,尤其是对年轻男性(18-30 岁)而言,他们通常将饮酒与性行为结合在一起,而且往往是性暴力的实施者。本研究对年轻男性的饮酒和性同意进行了话语分析。数据来自 2018 年至 2021 年对加拿大温哥华 76 名年轻男性(包括男同性恋、双性恋、同性恋和异性恋男性)的定性访谈。根据库克拉(Kukla)关于性同意的非理想理论以及批判性和包容性男子气概,本分析确定了三种话语框架:谨慎联系、淡化和模糊界限。在谨慎联系中,年轻男性讨论了他们在饮酒时积极促进自己和性伴侣的性自主和决定自主的努力。然而,在 "淡化"(watering it down)中,年轻男性引用了抑制、转移和否认的话语,将饮酒正常化,认为饮酒在某种程度上可以为性暴力开脱,淡化了男性的角色和责任。最后,在讨论醉酒后的性暴力和受害问题时,男性通过 "同意 "和 "满足(男性)期望 "的连续统一体来模糊界限。总之,这些话语框架提供了关于性暴力的性别本质以及理想化的性同意概念在酗酒和性行为的年轻男性日常生活中的表现程度的见解。研究结果对当代为性同意提供支架的努力具有哲学和实用意义。
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引用次数: 0
'Is it in your basic personality?' Negotiations about traits and context in diagnostic interviews for personality disorders. “这是你的基本性格吗?”人格障碍诊断访谈中关于特征和背景的谈判。
IF 2.1 4区 医学 Q1 Social Sciences Pub Date : 2023-11-01 Epub Date: 2022-05-24 DOI: 10.1177/13634593221094701
Maarit Lehtinen, Liisa Voutilainen, Anssi Peräkylä

What does it mean to claim that somebody's personality is disordered? The aim in this paper is to examine how the process of diagnosing personality disorders (PD) unfolds on a practical level. We take an in-depth look at PD interviews, paying close attention to the occasional discrepancies in the clinicians' and the patients' approaches to generalising the behaviour of patients to describe their personality. Clinicians are guided by the medical model and structured interviews in their approach. We regard the interview situation as interplay between the institution, the clinician and the patient - and the final diagnosis as an interactional construction between them. Our data consists of video-recorded interviews in Finland with 10 adult patients and three psychiatric nurses. The collection was compiled from 22 excerpts in which the participants orient differently to the generalisability of personality traits. Our observations show that, in these interviews, patients frequently make sense of their behaviour differently from what is expected - not as a reflection of their personality traits, but as an outcome of many situational factors. Our understanding leads us to emphasise the importance of making visible the practices that shape the diagnostic process in psychiatry.

声称某人的人格紊乱意味着什么?本文的目的是检验人格障碍(PD)的诊断过程是如何在实践层面展开的。我们深入研究了PD访谈,密切关注临床医生和患者在概括患者行为以描述其个性方面偶尔出现的差异。临床医生的方法以医学模式和结构化访谈为指导。我们将访谈情境视为机构、临床医生和患者之间的相互作用,而最终诊断则视为他们之间的互动结构。我们的数据包括在芬兰对10名成年患者和3名精神科护士的视频采访。该系列由22个摘录汇编而成,其中参与者对个性特征的普遍性有不同的定位。我们的观察结果表明,在这些访谈中,患者对自己的行为的理解往往与预期不同——这不是他们性格特征的反映,而是许多情境因素的结果。我们的理解使我们强调了在精神病学中塑造诊断过程的实践的重要性。
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引用次数: 0
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