Health Sociology Review最新文献

Although health services in Australia have an aim to provide inclusive care for their patients/clients, this study highlights how barriers to care can lie at the centre of patient-provider interactions. Racial microaggression is a subtle form of racism that can occur in health settings, leading to further exclusion for First Nations Australians, immigrants and refugees. This paper is guided by Derrida's approach to deconstructionism by unpacking how language is used by health professionals - as holders of organisational power - and how they construct 'truths' or discourses about clients that historically have been marginalised by health services and system. Data comprise 21 interviews with staff from two rural health services. It identified three racial microaggressions were used to justify the challenges of providing care to people from First Nations, immigrant and refugee backgrounds: (1) Participants problematised culture(s) of service users; (2) participants implied cultural superiority in their conceptualisation of 'other' cultures; and (3) participants shared stories of inactions, discomfort and relegating of responsibility. The findings identified these discourses as forms of racial microaggression that can potentially lead to further exclusion of people seeking services and support.

Mental health services are increasingly employing peer workers (PWs), individuals who have lived experiences with mental health problems, to support patients and be part of mental health care teams. While the employment of PWs continues to increase, little is known about how the function unfolds in practice. This paper explores the broader context in which the PWs navigate and the concrete outcomes and everyday issues that exist at the individual level. Methodologically, the paper draws on 22 interviews with PWs employed in the mental health services in Denmark. Theoretically, it combines Lipsky's (1980) theory on street-level bureaucrats with sociological discussions concerning the lay-expert divide. The analysis shows that PWs experience both role ambiguity and goal uncertainty and that they use substantial discretion in determining the nature, amount and quality of their peer practices. This - combined with the PWs' diverse lived experiences - calls for a heterogeneous understanding of peer work and therefore the analysis presents three categories of peer workers: PWs as (1) a representative of patients' lifeworld, (2) an interdisciplinary professional and (3) an 'expert by experience'. These categories display PWs different enactments of their lived experiences and reveal ambiguities tied to the lay-expert divide.

Informal interprofessional interactions have gained interest in recent interprofessional care, education, health services and social sciences research literature. Some of the established benefits associated with these interactions include enhanced communication, teamwork, research translation and the provision of safer care. Limited evidence about how informal interprofessional interactions are perceived by the allied health workforce, exists. The survey conducted at a large Australian health service explored allied health clinicians' perceptions of the benefits, challenges and enablers of informal interprofessional interactions and their recommendations to improve opportunities for these workplace interactions. Sixty-four responses were analysed descriptively (for close-ended questions) and using a framework analysis approach, informed by Bourdieu's social space theory (for open-ended questions). Perceived benefits were aligned with three themes: teams and organisations, individual clinicians and service-users. Challenges to, and enablers of, informal interprofessional interactions were identified according to five themes: socio-cultural practices, physical environment, timing-related factors, individual and organisational factors. Participant recommendations to increase opportunities for informal interprofessional workplace interactions for allied health reflected three of the aforementioned themes: socio-cultural practices, physical environment and organisational factors. This theoretically-informed analysis may aid in the development of strategies to support these types of workplace interactions and realise the benefits identified.

Alcohol consumption is a significant public health concern in Australia, with men disproportionately represented in treatment for health issues related to heavy drinking. Despite this, little is known about the experiences of these men or the gender dynamics that may shape heavy drinking. Increasingly, the treatment of alcohol and other drug-related issues, including those related to heavy drinking, is based on a biopsychosocial approach. Within this framework, heavy drinking is understood as a symptom of individual pathology in the context of various social 'factors' that influence individual capacity to exercise agency. Following the work of Karen Barad, this article employs a feminist science studies account of agency to formulate heavy drinking as a gendered 'phenomenon': enacted and sustained through the 'intra-action' of other phenomena. Drawing on interviews with men who drink heavily, our analysis explores how the phenomenon of men's heavy drinking materialises through the intra-actions of gender, isolation and healthcare. We argue that heavy drinking is not a sign of failed individual agency but an expression of entangled agencies. In concluding, we suggest it is possible to enhance the well-being of men who drink heavily by addressing specific gendered intra-actions in the making of heavy drinking.

This study analysed how Polish medical students are socialised to cooperate with the pharmaceutical industry via informal, hidden, and null curricula. Nine focus groups were run with medical students in their second year and upwards at three Polish medical universities. Initially, most students had difficulty in discerning pharmaceutical companies' presence in their education, but on reflection they all recognised this presence. Students said that they were surrounded by small medical gifts provided by companies, met pharmaceutical representatives, and took part in events for physicians organised and/or sponsored by the pharmaceutical industry. Nevertheless, they did not think they were the main target of the industry's marketing activities, saying that these were largely aimed at practicing doctors, and that they were only targeted as opportunities arose. Students' statements make it clear that their socialisation takes place within a culture which consents to medical professionals' cooperation with the industry. Medical students come to perceive cooperation with the industry as natural, and benefits from the industry as a privilege of doctors. Medical schools can prevent this by introducing guidelines, conflict of interest polices, and changing the formal curriculum, but the need for such measures is not currently recognised in Poland.

Recent political processes have rendered people with dementia an increasingly surveilled population. Surveillance is a contentious issue within dementia research, spanning technological monitoring, biomarker research and epidemiological data gathering. This paper explores surveillance in the relationships of people affected by dementia, how older relatives both with and without diagnoses are surveilled in everyday interactions, and the importance of expectations in guiding surveillance. This paper presents data from 41 in-depth interviews with people affected by dementia living in the community in the United Kingdom. Agedness was a key contributor to expectations that a person may have dementia, based on previous experiences, media accounts and wider awareness. Expectations provoked surveillance in interactions, with participants looking for signs of dementia when interacting with older relatives. Older people also enacted self-surveillance, monitoring their own behaviour. Various actions could be attributed to dementia because interpretation is malleable, partly vindicating expectations while leaving some uncertainties. Expectant surveillance transformed people's experiences because they organised their own actions, and interpreted those of others, in line with pre-existing meanings. The ability to interpret behaviours to fit expectations can bring coherence to uncertainties of ageing, cognition and dementia, but risks ascribing dementia to many older people who straddle those uncertainties.

Increasingly, people live longer with advanced cancer, despite having no prospect of full recovery. Ongoing survival is owed to early detection and effective disease management, yet experienced as highly precarious. In this article we explore how cancer chronicity brings into effect a pre-occupation with time, what time is to people with advanced cancer, and what socio-cultural norms inflect everyday practices. We analyse 20 interviews conducted in Queensland, Australia with 11 participants with advanced cancer, to trace the intersections of what time means, what people do with time, and what time feels like. Drawing on scholarship on the moralities around ill health, we discuss how awareness of time emerges in cancer chronicity and raises moral questions on how to live well. Here, imperatives of optimisation (urging people with advanced cancer to make the most of limited time) intersect with imperatives of authenticity (marked by emphasis on how to live one's own best life). These dynamics reveal expressions of living with advanced cancer in morally viable ways. Such ontological processes have implications for the lived experience of people with advanced cancer, their families and oncological care.

Increasingly, people turn to online sources for health information, creating human-non-human relationalities. Health websites are considered accessible in scope and convenience but can have limited capacity to accommodate complexities. There are concerns about who gets to 'assemble' with these resources, and who is excluded. Guided by Ahmed's socio-political theories of emotions, we questioned our feelings as we intra-acted with a consumer information website about back pain (MyBackPain). This encouraged us to approach resource evaluation in a way that alters conventional rational/cognitive judgement processes. Our inquiry was 'supra-disciplinary' involving public health, sociology, allied health and consumer collaborators. Specifically, we considered relationality - the feelings circulating between bodies/objects and implicated in MyBackPain's affective practices; impressions - the marks, images or beliefs MyBackPain makes on bodies/objects; and directionality - how these intra-actions pushed in some directions and away from others. Although Ahmed would likely not consider herself 'post-humanist', we argue that her socio-political theories of how objects and emotions entangle are of great interest to furthering critical post-human understandings of health. Rather than threatening decision-making, we suggest that feelings (and their affects) are central to it. The article demonstrates the productive potential of critical post-human inquiry in identifying/countering 'othering' possibilities, and catalysing a 'nomadic shift' towards new human-non-human formations.

In this article, I develop a feminist posthumanist account of biomedical policymaking as a material-discursive intervention that shapes the emergence of phenomena in the scientific laboratory. The setting is United States (U.S.) biomedicine, where a recent policy of the National Institutes of Health has mandated the consideration of sex in basic and preclinical research. Called Sex as a Biological Variable (SABV), the mandate configures cell lines and animal models as the next frontier in the project of advancing gender equity in biomedical research. Given sex and gender are increasingly recognised as having complex, entangled, and dynamic effects on human health and illness, how do laboratory animals respond to their attempted enrolment in this regulatory intervention? Through a qualitative analysis of this policy domain, I show how laboratory animals reveal the context-specific character of sex, its multiplicity and elusiveness as a so-called biological variable, and the considerable work needed to shore up human ideologies of sex as a pervasive cross-species form of binary difference. I suggest that while regulatory interventions constrain patterns of mattering, they also serve as agential openings in which laboratory animals can 'kick back' and reconfigure the pursuit of knowledge, particularly as it relates to difference and health.