Health Sociology Review最新文献

This study explored how people who use drugs (PWUD) experience and respond to stigma in biomedical chronic non-cancer pain management. Thematic analysis of in-depth interviews with PWUD (n = 26) who had sought care for chronic non-cancer pain in public hospitals in Uyo, Nigeria, drew on the idea of stigma as process of social reproduction and the concept of borderwork. Accounts framed stigma as a normalised feature of healthcare that emerged under different circumstances and operated to position chronic non-cancer pain patients who were PWUD as illegitimate subjects underserving of care. Stigma was widely seen as something to be expected, and was often tolerated by PWUD due to its ubiquity. However, they enacted borderwork marking-off stigma experiences that violated values of fairness and humaneness as well as those that spurned traditional gender norms. Participants responded to intolerable stigma through various acts of resistance, including dropping out of care. Stigma creates barriers to adequate pain management and establishes a context where basic care is accessed at the cost of fundamental human rights and dignity. Routine toleration of stigma helps to naturalise the phenomenon and render it invisible. Resistance to stigma provides a basis for interventions to address all forms of stigma in healthcare.

This paper examines whether the motivations and experiences of 'anti-diet' dietitians and psychologists represent a paradigm shift in healthcare. We conducted four 2-hour, discipline-specific focus groups with a total of 16 female participants residing in Australia. Our reflexive thematic analysis generated four themes that we consider to be stages of a weight-neutral paradigm shift: (1) a recognition of a mismatch between one's weight-centred training and one's lived experience of diet culture, which subsequently informs (2) gut feelings that influence their decision to reject the weight-centric paradigm, thereby leading to (3) exploring the anti-diet knowledge base and then subsequently (4) promoting or advocating for the weight neutral paradigm. Our findings represent a four-stage paradigm shift in action; emphasising the significance of lived experience in the weight-neutral turn, as well as differences in symbolic power between health professionals. Future research should focus on potential ruptures or conflicts within the weight-neutral paradigm itself, and look more deeply into the experiences of other health professionals who are critical of the weight-centred approach.

The consumption of performance and image-enhancing drugs (PIEDs) is commonly pathologised in public health discourse as stemming from an unhealthy relationship to masculinity, and is often framed as intrinsically 'risky' and fundamentally at odds with 'good health'. This article examines Australian health promotion materials on PIEDs to analyse their role in shaping notions of good health, normal gender and appropriate self-improvement. To do so, it draws on the work of Butler, Law and Latour to consider how these materials co-constitute men and their health, often in problematic ways. First, we examine the ways in which PIEDs are constituted via a politics of the 'natural', then consider how the health promotion materials on PIEDs participate in the regulation of appropriate, healthy masculinity, and conclude by examining how adolescent masculinity is co-constituted with PIEDs. We observe a key tension between health promotion's avowed interest in improvement and optimisation and its treatment of PIED consumers as aberrant, vulnerable and insecure subjects whose drive to enhance and optimise is characterised by pathology and addiction. We conclude by arguing that health promotion materials on PIEDs fail to acknowledge the exceedingly normative character of enhancement practices in contemporary society.

Global drug policy is in a period of change. Human rights can play an important role in such change, but more work is needed to understand the how rights work and why they might come to matter. Drawing on insights from a major study on drug policy and human rights, I argue that important new dynamics in respect of how drugs are thought to relate to health are emerging, including a conceptualisation of some drugs as capable of generating or improving health, rather than undermining it. Drugs are in some cases coming to be understood not as the origin of social problems but as the solution for them. I introduce the concept of 'solutionisation' as a tool for understanding the mechanisms by which human rights shapes ontologies, positioning 'solutionisation' as corollary and counterpart to Carol Bacchi's work on policy 'problematisation' (Bacchi [2009]. Analysing Policy: What is the Problem Represented To Be? Pearson). I argue that both 'problematisation' and 'solutionisation' have value for sociological analyses of human rights and that we need to pay careful attention to the co-constitutive dimensions of drugs and human rights, to understand how norms about health, self and subjects are made, sustained, and brought under pressure.

This article aims to explore pharmaceuticalisation processes in professional work contexts. The approach focuses on identifying patterns of medicine and dietary supplement use for managing work performance, and on discussing the relationship between these consumption practices and work-related pressure factors. This analysis adapts the notions of 'normalisation' to understand the extent of cultural acceptability of these practices, and the notion of 'differentiated normalisation' to capture the tension between the trend towards normalisation of such consumption and its partial social (in)visibility within work settings. Empirical support for this analysis is based on a sociological study conducted in Portugal on professions under high performance pressures. The study involved three professional groups - nurses, journalists and police officers. A mixed methods approach was used, including focus groups, questionnaires and semi-structured interviews. Overall, the results show a trend towards the use of medicines and supplements for performance management, which reveals itself as a cultural response to work-related social pressures. Such consumption coexists with irregular patterns of either occasional or long-term use, as well as heterogeneous processes of 'normalisation' and 'hidden' consumption. Conclusions point to a social interconnection between the intensification of work pressures and the pharmaceuticalisation of work performance.

Rural Australian youth exhibit high rates of mental ill-health, exacerbated by reduced access to mental health services. While the need for innovative solutions is well-established rural youth themselves are frequently excluded from the dialogue, creating a significant gap in evidence and the development of relevant service provision that reflects young people's lived experiences. Drawing on the concepts of individualism and healthism and research highlighting the continuing importance of relationships and trust in the lives of young people in a digital society, we aim to better understand how rural youth understand mental health and navigate mental health services and information. Using a qualitative methodology, we held 2 small focus groups with a total of 8 young people in rural Tasmania to identify aspects of rural mental healthcare that require improvement and to contribute to developing new and innovative solutions. Findings indicate that rural Tasmanian youth face numerous structural, social, and cultural barriers to positive mental health. Rural self-reliance and generational differences in attitudes towards mental health can negatively affect youths' help-seeking behaviours. Findings from this study suggest a need to combine technology-and community-based approaches creating a multi-generational approach to combat mental ill-health among rural youth.

Established research supports collaborative patient-clinician communication as a means of improving pain management and decreasing opioid use by patients with chronic pain. However, much of this scholarship emphasises clinicians' capacities to shape and improve communication; limited research investigates patients' roles in this process. Drawing on 40 ethnographic observations of patient-clinician interactions, clinical spaces and case conferences within one specialist pain clinic in Brisbane, Australia, this paper investigates how and why patients present themselves in particular ways within consultations. Our theoretical lens combines concepts from Goffman on patienthood and stigma with Foucauldian theories of pastoral and disciplinary power. Findings suggest that elements of the clinical environment - namely posters - usher patients towards presenting in what we conceptualise as the 'good pain patient' role. In this role, patients demonstrate that they are moral, responsible, and contributing members of society. Yet, such a role is problematic to opening communication, with the role constraining what is socially acceptable for patients with chronic pain to say, do, or feel. In recognising how clinical contexts facilitate problematic good pain patient presentations, this paper directs attention to the spatial and relational nature of implicit clinical expectations and constrained good pain patient presentations.

Language is important in health policy development. Policy changes in Australia to increase cervical screening offers a timely case example to explore the function of inclusive language in health policy. Gender and sexuality diverse people with a cervix have been largely invisible within health promotion programs, which has led to reduced awareness of, and access to, cervical screening. Twenty-eight semi-structured interviews were conducted with 29 key informants between April and October 2022 about the role of inclusive language in cervical screening policy, promotion, and delivery in the context of a national program to promote cervical screening. Three themes were identified from what key informants believed to be the role of inclusive language: (1) the common goal of inclusive language as policy advocacy for broader inclusivity; (2) the inevitable partiality of inclusive language in policy as an opportunity to start conversation; and (3) policy as a bridge between essential but diffuse components of the health sector with multidirectional influences. Inclusive language was seen to operationalise equity in health policy within the broader aim of eliminating cervical cancer among under-screened populations.

This article aims to provide an illustrated account of layered stigmatisation processes and consequences for those who experience chronic pain and accompanying suicidality. Using constructivist grounded theory, I draw from 20 in-depth interviews conducted from 2022 to 2023 to explore how chronic pain and suicidality operate within people's social worlds. Findings demonstrate how layered stigmatising processes, occurring based on chronic pain and suicidality, operate consistently across multiple social arenas to create interactional troubles, which result in enduring negative social, emotional, and financial impacts. Three themes were constructed, including (1) self-stigma and the multiple roles of the family, (2) missed connections, and (3) anticipated stigma and workplace discrimination. Taken together, themes support the overarching category, 'interactional troubles'. Findings suggest a need for attunement to stigmatising processes' omnipresence and the depth of their consequences. Clinical interventions may benefit from emphasizing participants' social worlds and incorporating the complexity of navigating social arenas given layered stigmatisation. Moreover, policies that support those with chronic pain and mental illness could offset the long-term negative economic consequences of discrimination.

This article focuses on the workplace experiences of peer workers with a diagnosis of borderline personality disorder (BPD) in mental healthcare settings in Australia. Our article is located at the intersection of political, social, cultural, and legislative forces that have fostered the development of peer work as a paid profession. We draw on the concept of stigma to analyse findings from qualitative interviews with peer workers conducted in [state], Australia. By examining peer work in the broader context of lifeworlds of BPD, we address the interplay of work and professional identity, and the experience of a profoundly stigmatised diagnosis at this intersection.Our findings demonstrate the physical and emotional effects of stigma and how it produces boundaries and inequalities between peer workers and other health practitioners. These boundaries are reinforced by invisible markers that delineate what is expected, 'normal' and deemed professional in the workplace. Moreover, these same medico-socio-political relations help shape peer workers' identities and experiences. The development of peer workforces in mental healthcare service delivery is a prominent area of reform in Australia and internationally. Our research highlights the urgency of efforts to transform current socio-cultural-political relations that inhibit peer workers in their roles and impact workplace experiences.