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Using Habermas’ theory of communicative action to transform sociological analyses of evidence-based policy 运用哈贝马斯的交往行为理论改造循证政策的社会学分析
IF 2.8 3区 医学 Q1 Medicine Pub Date : 2023-04-21 DOI: 10.1080/09581596.2023.2204182
C. Bonell, G. Melendez‐Torres
ABSTRACT Many sociological analyses of evidence-based policy frame it as contributing to the rationalisation of social relations, and being constructed through and implicated in systems of knowledge/power. These analyses are based on social theory placing insufficient emphasis on the emancipatory potential of evidence, and the possibility of rational adjudication of truth claims. We argue sociological engagement with evidence-based policy could be transformed by being informed by the work of Habermas. Habermas’ work could enable a more nuanced view of EBP in terms of whether or not this leads to rationalisation in the form of de-politicisation or marginalisation of citizens’ voices. Habermas’ work on knowledge-constitutive interests could inform a reconstructed view of evidence, disabused of positivist assumptions and with increased emancipatory potential. Habermas’ notion of the ideal speech situation as a procedural basis for truth could function as a standard for exploring how EBP is affected by power asymmetries, as well as for adjudicating truth claims.
许多基于证据的政策的社会学分析将其框架为有助于社会关系的合理化,并且通过知识/权力系统构建并涉及其中。这些分析是基于社会理论,对证据的解放潜力和对真理主张的理性裁决的可能性重视不够。我们认为,社会学对基于证据的政策的参与可以通过哈贝马斯的工作来改变。哈贝马斯的工作可以让我们对EBP有一个更细致入微的看法,即这是否会以公民声音的去政治化或边缘化的形式导致合理化。哈贝马斯关于知识构成利益的工作可以为重建证据的观点提供信息,消除实证主义假设的滥用,并具有更大的解放潜力。哈贝马斯关于理想言语情境作为真理的程序基础的概念,可以作为探索EBP如何受到权力不对称影响的标准,也可以作为裁决真理主张的标准。
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引用次数: 1
Using discursive approaches to examine the utility and functions of language in public health and health promotion: highlighting social constructions of e-cigarettes 使用话语方法考察语言在公共卫生和健康促进中的效用和功能:突出电子烟的社会结构
IF 2.8 3区 医学 Q1 Medicine Pub Date : 2023-04-19 DOI: 10.1080/09581596.2023.2201658
G. Wilson, J. Keenan, L. Porcellato, I. Gee, B. Gough, S. Grogan
ABSTRACT This article uses discursive approaches to examine the utility and functions of language in public health, focusing on social constructions of e-cigarettes. Due to the ambiguity surrounding the use of e-cigarettes, understanding may be negotiated collaboratively through co-construction in talk. Ten participants, three men and seven women aged 26–47 years, took part in two focus groups in Manchester, UK, where they discussed e-cigarettes. Data were analysed using blended discourse analysis, with a view to identifying dominant repertoires used by speakers. Participants drew from two discursive frameworks to communicate perceptions of e-cigarettes: (1) uncertainty and risk and (2) the social acceptability and stigma spectrum. The ambiguity surrounding e-cigarettes was reflected in the linguistic devices used in talk. This article demonstrates the value of drawing on discourse analysis to better understand the impact of health-related communication by providing insight into how existing messages are interpreted, co-constructed, and assigned meaning through shared interactions.
摘要本文采用话语的方法来考察语言在公共卫生中的效用和功能,重点关注电子烟的社会结构。由于电子烟的使用存在歧义,可以通过对话中的共建来协商理解。10名参与者,3男7女,年龄26-47岁 多年来,他参加了英国曼彻斯特的两个焦点小组,在那里他们讨论了电子烟。使用混合话语分析对数据进行分析,以确定演讲者使用的主要曲目。参与者从两个话语框架中交流对电子烟的看法:(1)不确定性和风险;(2)社会可接受性和污名谱。围绕电子烟的歧义反映在谈话中使用的语言手段上。本文通过深入了解如何通过共享互动来解释、共同构建和分配现有信息,展示了利用话语分析更好地理解健康相关沟通的影响的价值。
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引用次数: 1
Patient engagement in drug development: configuring a new resource for generating innovation 患者参与药物开发:配置产生创新的新资源
IF 2.8 3区 医学 Q1 Medicine Pub Date : 2023-03-17 DOI: 10.1080/09581596.2023.2188140
O. Zvonareva
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引用次数: 0
Can White allyship contribute to tackling ethnic inequalities in health? Reflections on the experiences of diverse young adults in England 白人同盟能帮助解决健康方面的种族不平等吗?对英国不同年轻人经历的反思
IF 2.8 3区 医学 Q1 Medicine Pub Date : 2023-03-13 DOI: 10.1080/09581596.2023.2188139
S. Ejegi-Memeh, S. Salway, V. McGowan, N. Villarroel-Williams, S. Ronzi, M. Egan, K. Gravenhorst, D. Holman, C. Rinaldi
ABSTRACT Ethnic diversity and racism have not featured strongly in English research, policy or practice centred on understanding and addressing health inequalities. However, the COVID-19 pandemic and the Black Lives Matter movement have shone fresh light on deep-rooted ethnic inequalities and mobilised large segments of the population into anti-racist demonstration. These recent developments suggest that, despite strong counterforces within national government and the mainstream media, there could be a shift towards greater public awareness of racism and potentially a willingness to take individual and collective action. This paper addresses these developments, and specifically engages with the contested notion of ‘allyship’. We bring together the experiences of 25 young adults living across England and prior literature to raise questions about whether and how racialized White individuals can play a role in dismantling systemic racism and reducing ethnic inequalities in health. Our analysis reveals a variety of complexities and obstacles to effective and widespread allyship. Findings suggest the need to nurture contingent, responsive and reflexive forms of allyship that can attend to the harms inflicted upon racially minoritized people as well as push for systemic transformation. White allyship will need to take a variety of forms, but it must be underpinned by an understanding of racism as institutional and systemic and a commitment to tackling interlocking systems of oppression through solidarity. The issues addressed are relevant to those occupying public health research, policy and practice roles, as well as members of the public, in England and other multi-racial settings.
在以理解和解决健康不平等为中心的英语研究、政策或实践中,种族多样性和种族主义并没有很强的特色。然而,2019冠状病毒病大流行和“黑人的命也重要”运动为根深蒂固的种族不平等现象提供了新的视角,并动员了大量人口参加反种族主义示威。这些最近的事态发展表明,尽管国家政府和主流媒体内部有强大的反对力量,但公众对种族主义的认识可能会有所提高,并可能愿意采取个人和集体行动。本文讨论了这些发展,并特别涉及有争议的“盟友关系”概念。我们汇集了生活在英格兰各地的25名年轻人的经历和之前的文献,提出了关于种族化的白人是否以及如何在消除系统性种族主义和减少健康方面的种族不平等方面发挥作用的问题。我们的分析揭示了有效和广泛的盟友关系的各种复杂性和障碍。研究结果表明,有必要培养偶然的、反应迅速的、反射性的盟友关系,以应对对少数族裔造成的伤害,并推动系统性变革。白人盟友关系需要采取多种形式,但其基础必须是理解种族主义是制度性和系统性的,并承诺通过团结解决相互关联的压迫系统。所讨论的问题与那些在英国和其他多种族环境中担任公共卫生研究、政策和实践角色的人以及公众成员有关。
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引用次数: 1
Evidence-based medicine and physicians’ institutional agency in Russian clinical settings 俄罗斯临床环境中的循证医学和医生机构
IF 2.8 3区 医学 Q1 Medicine Pub Date : 2023-02-20 DOI: 10.1080/09581596.2023.2180608
E. Borozdina
ABSTRACT In 1990s’ Russia, a wave of internationalization brought an evidence-based medical paradigm to Russian healthcare. Whilst there has been considerable critical commentary on the consequences of adopting this paradigm for medical decision-making, much of this relates to specific contexts in Europe, north America and Australasia, with little research addressing post-Soviet clinical practice. Drawing on semi-structured qualitative interviews with Russian physicians, this article explores the entanglements between the introduction of evidence-based medicine (EBM) in the country and the transformation of post-socialist medical professionalism. I single out physicians’ efforts to reconcile the EBM paradigm with organizational constraints as indicative of professionals’ ground-level agency. I define the following components of such agency: (1) selective application of guidelines and use of foreign clinical recommendations; (2) establishing local professional solidarity; (3) developing relationships based on personalized trust with the patients. The study employs two sets of data (gathered in 2018 and in 2020) to trace the EBM-related agency of medical professionals both before and during COVID-19 pandemic. By offering analytical insights from post-socialist healthcare, where doctors’ discretion has historically been limited by excessive state control, the article contributes to academic debate on medical professionals’ autonomy and agency in the era of EBM-related standardization.
摘要20世纪90年代的俄罗斯,国际化浪潮为俄罗斯医疗带来了循证医学范式。虽然对采用这种模式进行医疗决策的后果有相当多的批评性评论,但其中大部分与欧洲、北美和澳大拉西亚的具体情况有关,很少有针对后苏联临床实践的研究。本文通过对俄罗斯医生的半结构化定性访谈,探讨了在该国引入循证医学与后社会主义医学专业化转型之间的纠葛。我指出,医生们努力调和循证医学范式与组织约束,这表明了专业人员的基层代理。我定义了该机构的以下组成部分:(1)选择性应用指南和使用外国临床建议;(2) 建立地方职业团结;(3) 与患者建立基于个性化信任的关系。该研究采用了两组数据(2018年和2020年收集)来追踪新冠肺炎大流行之前和期间医疗专业人员的EBM相关机构。这篇文章通过提供后社会主义医疗保健的分析见解,为医学专业人员在循证医学相关标准化时代的自主权和代理权的学术辩论做出了贡献。
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引用次数: 0
Socialism as the way forward: updating a discourse analysis of the social determinants of health 社会主义是前进的道路:更新对健康的社会决定因素的话语分析
IF 2.8 3区 医学 Q1 Medicine Pub Date : 2023-02-15 DOI: 10.1080/09581596.2023.2178387
D. Raphael, T. Bryant
ABSTRACT In 2011 Raphael identified seven discourses on the social determinants of health (SDH). These discourses ranged from ‘SDH as identifying those in need of health and social services’ to ‘SDH and their distribution result from the power and influence of those who create and benefit from health and social inequalities’. Developments since then have led us to identify an eighth: ‘SDH and their distribution result from the processes inherent to capitalism – capital accumulation, competition, and exploitation’. We identify scholarship espousing the view that quality and equitable distribution of SDH will require the creation of a post-capitalist socialist state. While the form this state will take remains uncertain, means of moving towards it are available. Specific steps the public health community can undertake are identified.
摘要2011年,拉斐尔确定了七篇关于健康的社会决定因素(SDH)的论述。这些论述从“SDH是识别那些需要卫生和社会服务的人”到“SDH及其分布源于那些制造卫生和社会不平等并从中受益的人的权力和影响”。自那时以来的发展使我们确定了第八个:“SDH及其分布源于资本主义固有的过程——资本积累、竞争和剥削”。我们发现学术界支持这样一种观点,即SDH的质量和公平分配将需要创建一个后资本主义社会主义国家。虽然这种状态将采取的形式仍不确定,但可以采取各种手段来实现它。确定了公共卫生界可以采取的具体步骤。
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引用次数: 4
Weighing up the future: a meta-ethnography of household perceptions of the National Child Measurement Programme in England 权衡未来:英国国家儿童测量计划家庭观念的元民族志
IF 2.8 3区 医学 Q1 Medicine Pub Date : 2023-02-08 DOI: 10.1080/09581596.2023.2169599
Meredith K. D. Hawking, C. Dezateux, D. Swinglehurst
ABSTRACT The English National Child Measurement Programme (NCMP) is a nationally mandated public health programme. It provides data for child excess weight indicators in the Public Health Outcomes Framework, part of the government’s approach to reducing childhood obesity. Drawing on a meta-ethnographic synthesis of household members’ experiences of the programme, we conceptualise the NCMP as a ‘technique of futuring’ to generate new insights into how it (re)shapes and (re)imagines past, present, and future responsibilities and practices for overweight children, parents, and carers, in potentially harmful ways. For children categorised by the NCMP as overweight, the NCMP is an emotionally significant event, driving new bodily practices, new food practices and changed relationships with peers. This paper outlines how parents come to resist and reframe the programme and its results, to protect their children from a weight-focused future. They consider the potential risks of bullying, dysfunctional eating, and mental health consequences more important than future risks of overweight. We show how parents of children categorised as overweight preserve their claim to ‘responsible’ and ‘good’ parenting amongst peers, whilst shifting the blame for childhood obesity to other, ‘irresponsible’ parents, thus reproducing moralising and responsibilising discourses inherent within the ‘behaviour change’ messaging of the NCMP and associated research. Finally, we consider a central paradox of this programme and the use of NCMP population level monitoring data to (re)shape lives at the individual and social level – the children it sets out to help are the most likely to experience harm as a result of it.
摘要英国国家儿童测量计划(NCMP)是一项国家授权的公共卫生计划。它在公共卫生成果框架中提供了儿童超重指标的数据,这是政府减少儿童肥胖方法的一部分。根据家庭成员对该计划经历的元人种学综合,我们将NCMP概念化为一种“未来技术”,以产生新的见解,了解它如何以潜在的有害方式(重新)塑造和(重新)想象超重儿童、父母和看护人过去、现在和未来的责任和做法。对于被NCMP归类为超重的儿童来说,NCMP是一个具有情感意义的事件,它推动了新的身体实践、新的饮食实践以及与同龄人关系的改变。这篇论文概述了父母是如何抵制和重新制定该计划及其结果的,以保护他们的孩子免受以体重为中心的未来的影响。他们认为欺凌、饮食失调和心理健康后果的潜在风险比未来超重的风险更重要。我们展示了被归类为超重儿童的父母如何在同龄人中保持他们对“负责任”和“良好”育儿的主张,同时将儿童肥胖的责任转移到其他“不负责任”的父母身上,从而再现了NCMP和相关研究的“行为改变”信息中固有的道德和责任话语。最后,我们考虑到该计划的一个核心矛盾,即使用NCMP人口层面的监测数据来(重新)塑造个人和社会层面的生活——它旨在帮助的儿童最有可能因此受到伤害。
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引用次数: 1
Exploring the Political Economy Nexus of Tobacco Production and Control: A Case Study from Zambia. 探索烟草生产与控制之间的政治经济联系:赞比亚案例研究》。
IF 2.8 3区 医学 Q1 Medicine Pub Date : 2023-01-01 Epub Date: 2022-02-03 DOI: 10.1080/09581596.2021.1981540
Arne Ruckert, Ronald Labonté, Raphael Lencucha, Fastone Goma, Jeffrey Drope
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引用次数: 2
Self-identified fat people’s understanding of the need for, and use of, long needles when being vaccinated against COVID-19: findings from a international online exploratory survey 自认为肥胖的人对接种COVID-19疫苗时需要和使用长针的理解:一项国际在线探索性调查的结果
IF 2.8 3区 医学 Q1 Medicine Pub Date : 2022-12-26 DOI: 10.1080/09581596.2022.2159789
George Parker, Cat Pausé, Ashlea Gillon, L. Gray
ABSTRACT This short report presents the findings of an online survey of self-identified fat people in eight countries identified as having guidelines for the use of long needles in SARS-CoV-2 novel coronavirus (COVID-19) vaccination programmes. The survey captures fat people’s understanding of the need for, and knowledge about the use of, a long needle when being vaccinated against COVID-19. Our findings identified a knowledge gap amongst fat people about the need for long needles and whether they are being used in practice. Respondents reported a lack of information and discussion about the need for long needles and most did not know if they had been used. We cannot determine whether long needle guidelines are being followed in practice in the absence of information and discussion with fat people about their use. We make recommendations for updating training and practice to ensure the vaccinator workforce is implementing long needle guidelines and has the skills and resources to initiate conversations with fat people about their use. This will help ensure vaccine confidence and vaccine equity.
这份简短的报告介绍了一项在线调查的结果,调查对象是8个国家中自认为肥胖的人,这些国家被确定为在SARS-CoV-2新型冠状病毒(COVID-19)疫苗接种计划中使用长针的指南。这项调查反映了胖人在接种COVID-19疫苗时对长针的必要性和使用知识的理解。我们的研究结果表明,胖人对长针的必要性以及是否在实践中使用长针的认识存在差距。受访者报告说,缺乏关于长针必要性的信息和讨论,大多数人不知道是否使用过长针。在缺乏信息和与肥胖人群讨论的情况下,我们无法确定长针指南在实践中是否被遵循。我们提出了更新培训和实践的建议,以确保疫苗接种人员执行长针指南,并具备技能和资源,与肥胖者就长针的使用展开对话。这将有助于确保疫苗信心和疫苗公平。
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引用次数: 0
Getting to the heart of the matter: a research partnership with Aboriginal women in South and Central Australia 进入问题的核心:与澳大利亚南部和中部土著妇女的研究伙伴关系
IF 2.8 3区 医学 Q1 Medicine Pub Date : 2022-12-22 DOI: 10.1080/09581596.2022.2147417
K. McBride, C. Franks, V. Wade, Veronica King, J. Rigney, Nyunmiti Burton, Anna Dowling, J. Mitchell, G. van Kessel, Natasha J. Howard, C. Paquet, S. Hillier, Stephen J. Nicholls, A. Brown
ABSTRACT Within the vast majority of qualitative health research involving Indigenous populations, Indigenous people have been marginalised from research conceptualisation and conduct. This reflects a lack of regard for Indigenous ways of knowing, being, and doing, has served to perpetuate deficit narratives of Indigenous peoples’ health and wellbeing, and contributes to failure in addressing inequities as a result of ongoing colonisation and institutionalised oppression and racism. There is a need to place Indigenous voices and ways of doing at the centre of research by working in intercultural partnership, bringing together Indigenous and Western knowledges. This paper explores how such an approach can be applied, demonstrating a reflective process of conceptualisation and conduct that brings together Indigenous ways of working with grounded theory with Aboriginal communities in Australia. Furthermore, it supported a non-Indigenous researcher to learn ways of working respectfully, guided by community protocols. A six-stage research process was developed, overseen by an Aboriginal Women’s Advisory Group. Research conceptualisation and conduct centred on three principles: bringing together Aboriginal ways of working with Western research methodology; using women’s own voices to develop a narrative of cardiovascular health and wellbeing; and ensuring that tangible outcomes were delivered to women and communities in the spirit of partnership and reciprocity. This approach, guided at all steps by Indigenous women, demonstrates a way of adapting qualitative Western methodology to ensure values and principles of ethical guidelines of conduct are upheld to unravel constructs of colonisation, redress past wrongdoing, and reverse deficit narratives.
在绝大多数涉及土著人口的定性健康研究中,土著居民在研究的概念化和实施中被边缘化。这反映了缺乏对土著认识、存在和行动方式的尊重,使土著人民健康和福祉的叙述长期存在缺陷,并导致无法解决因持续的殖民化、制度化的压迫和种族主义而导致的不平等问题。有必要通过跨文化伙伴关系,将土著和西方知识结合起来,将土著的声音和行事方式置于研究的中心。本文探讨了如何应用这种方法,展示了一个概念化和行为的反思过程,该过程将澳大利亚土著社区与扎根理论的土著工作方式结合在一起。此外,它还支持一名非土著研究人员在社区协议的指导下学习尊重工作的方法。在土著妇女咨询小组的监督下,制定了一个分六个阶段的研究程序。研究概念和行为以三个原则为中心:将土著的工作方式与西方的研究方法结合起来;利用妇女自己的声音,发展心血管健康和福祉的叙述;并确保本着伙伴关系和互惠精神向妇女和社区提供切实成果。这种方法在所有步骤中都由土著妇女指导,展示了一种适应西方定性方法的方法,以确保价值观和道德行为准则的原则得到维护,以解开殖民主义的结构,纠正过去的错误,并扭转赤字叙述。
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引用次数: 0
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Critical Public Health
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