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Sociology of Health & Illness

Impact factor: 1.735 5-Year impact factor: 2.442 Print ISSN: 0141-9889 Publisher: Wiley Blackwell (Blackwell Publishing)

Subjects: Sociology, Public, Environmental & Occupational Health, Biomedical Social Sciences

Most recent papers:

  • Rejecting, reframing, and reintroducing: trans people's strategic engagement with the medicalisation of gender dysphoria.
    Austin H. Johnson.
    Sociology of Health & Illness. November 28, 2018
    --- - |2 Abstract This article uses ethnographic methods to explore how transgender people engage the medicalisation of transgender experience in a U.S. context under the purview of the American Psychiatric Association. Building on sociological literature related to medicalisation, this paper argues that the lived experience of medicalisation is a non‐linear, complex process whereby individual engagement with medical authority is both empowering and constraining in the lives of trans people. Inductive qualitative analysis of 158 hours of participant observation and 33 in‐depth interviews with members of a transgender community organisation revealed that transgender individuals (i) reject a medical frame for gender dysphoria, (ii) embrace and stress the importance of gender‐affirming medical technologies for individual identity development and social interaction and (iii) strategically reintroduce medical logics and embrace medical authority in order to facilitate medical and social recognition, validation and acceptance. - 'Sociology of Health &Illness, EarlyView. '
    November 28, 2018   doi: 10.1111/1467-9566.12829   open full text
  • ‘No one is as invested in your continued good health as you should be:’ an exploration of the post‐surgical relationships between weight‐loss surgery patients and their home bariatric clinics.
    Zoë C. Meleo‐Erwin.
    Sociology of Health & Illness. November 25, 2018
    --- - |2 Abstract This article traces the post‐surgical relationship between weight‐loss surgery (WLS) patients and their home bariatric clinics. Following surgery, there is substantive drop off in patient attendance at both follow‐up appointments and support groups. While barriers to follow‐up are often discussed with the bariatric literature, patients themselves are typically defined as the problem. Based upon a thematic analysis of 217 blog posts and comments in two top patient‐led online forums, I demonstrate that bariatric patients tell a more complex story about their post‐surgical lives. I argue that WLS patients constitute a population with highly specialised medical needs that is caught between the requirements for living with surgically altered digestive systems and a lack of sufficient post‐operative follow‐up care from their home bariatric clinics. Although online forums provide spaces for patients to examine these post‐operative social and clinical experiences in critical terms, seek information and get support, ultimately the conversations serve to underline the value of personal responsibility for post‐operative outcomes–a framing that echoes that of the bariatric profession. This framing should be understood within a larger climate of weight‐based stigma and discrimination as well as neoliberal healthism. - 'Sociology of Health &Illness, EarlyView. '
    November 25, 2018   doi: 10.1111/1467-9566.12823   open full text
  • ‘Treat them into the grave’: cancer physicians’ attitudes towards the use of high‐cost cancer medicines at the end of life.
    Miriam Wiersma, Narcyz Ghinea, Ian Kerridge, Wendy Lipworth.
    Sociology of Health & Illness. November 20, 2018
    --- - |2 Abstract The prescribing of high‐cost cancer medicines at the end of life has become a focus of criticism, due primarily to concerns about the safety, efficacy and cost‐effectiveness of these medicines in this clinical context. In response to these concerns, a number of interventions have been proposed – frequently focused on improving physician–patient communication at the end of life. Underpinning these strategies is the assumption that the prescribing of high‐cost cancer medicines at the end of life is primarily the result of poor communication on the part of cancer physicians. In this paper, we explore the factors perceived by cancer physicians to be driving the use of high‐cost cancer medicines at the end of life. Drawing on semi‐structured interviews with 16 Australian oncologists and haematologists, we demonstrate that these physicians believe that the use of high‐cost medicines at the end of life is driven by multiple factors – including individual, interpersonal, socio‐cultural and public policy influences. We conclude that these factors, and their interactions, need to be taken into account in the development of public policy and clinical interventions to address the use of high‐cost medicines at the end of life. - 'Sociology of Health &Illness, EarlyView. '
    November 20, 2018   doi: 10.1111/1467-9566.12830   open full text
  • Habermasian communication pathologies in do‐not‐resuscitate discussions at the end of life: manipulation as an unintended consequence of an ideology of patient autonomy.
    Elizabeth Dzeng.
    Sociology of Health & Illness. November 20, 2018
    --- - |2 Abstract The focus on patient autonomy in American and increasingly British medicine highlights the importance of choice. However, to truly honour patient autonomy, there must be both understanding and non‐control. Fifty‐eight semi‐structured in‐depth interviews were conducted with internal medicine physicians at three hospitals in the US and one in the UK. At hospitals where autonomy was prioritised, trainees equated autonomy with giving a menu of choices and felt uncomfortable giving a recommendation based on clinical knowledge as they worried that that would infringe upon patient autonomy. Employing Habermas's Theory of Communicative Action, this paper explores how physician trainees’ communication practices of using purposefully graphic descriptions of resuscitation to discourage that choice prevent greater understanding and compromise non‐control. Central to this problem are also issues of colonisation of the life‐world by the system. Physicians are fully inculcated in their respect for autonomy but unintentionally resort to strategic forms of communication that prevent patients from adequately understanding their situation because trainees feel constrained against making recommendations. However, if the ideal of autonomy is to be realised, physicians might have to move towards practices that embrace a more authentic autonomy that fosters open communication that allows for co‐creation of consensus between doctors and patients. - 'Sociology of Health &Illness, EarlyView. '
    November 20, 2018   doi: 10.1111/1467-9566.12825   open full text
  • Household collectives: resituating health promotion and physical activity.
    Julie Bønnelycke, Catharina Thiel Sandholdt, Astrid Pernille Jespersen.
    Sociology of Health & Illness. November 20, 2018
    --- - |2 Abstract In this article, we situate the practices of health and physical activity in household collectives, and conceptualise everyday health ‘behaviour’ and lifestyle as complex, collective practices. Based on an ethnographic study on everyday family life and health practices, we provide a framework for understanding the household as a collective, where the household collective may take precedence over individual preferences, and individual behaviour has collective implications. We describe the household as a node for practices, gathered by the activities that draw together and align actors in collective practices of everyday life. In the everyday efforts of the households to live up to ideals and balance conflicting practices, healthy living is about more than simple, individual choices about whether to follow health recommendations or not. It is also dependent on pragmatic negotiations, the distribution of roles and tasks and conflicts between ideals and what is feasible in the everyday management and maintaining of the household. We suggest that engaging with these collectives could serve as a useful point of departure for health promotion activities, situating health promotion in the here and now of collectives, tinkering with their specific constellations, values and identities in the entangledness of multiple household practices. - 'Sociology of Health &Illness, EarlyView. '
    November 20, 2018   doi: 10.1111/1467-9566.12832   open full text
  • “He looks gorgeous” – iuMR images and the transforming of foetal and parental identities.
    Mabel Lie, Ruth Graham, Stephen C Robson, Paul D Griffiths.
    Sociology of Health & Illness. November 18, 2018
    --- - |2 Abstract The MERIDIAN study examined whether in‐utero MRI (iuMRI) improves the accuracy of diagnosis of foetal brain abnormalities, when used as an adjunct to ultrasound anomaly scanning. A diagnostic iuMRI differs from routine ultrasound screening because of its infrequent use and scanning procedure. Nested within this trial, this sociological study explored the acceptability of iuMRI as a technology and its contribution to parental decision‐making. Our sociological interpretation of the role of iuMR images in prenatal diagnosis draws on narrative interviews with women (and some partners) who underwent MRI imaging at three different centres. Overall, participants found iuMRI helpful in decision‐making because it either confirmed or disconfirmed previous results, or provided additional information. Expectant couples experienced the iuMR imaging process as informative, but also as having emotive and practical value. Our paper extends the existing sociological literature on antenatal testing and visualising the foetus, by using iuMR diagnostic imaging to further explore the concept of the unborn entity. Our data suggest that alongside the iuMR images, the ‘parental gaze’ and accompanying commentary are used by parents to construct and transform foetal and parental identities despite ongoing uncertainties about, and shifting social contexts to their pregnancy. - 'Sociology of Health &Illness, EarlyView. '
    November 18, 2018   doi: 10.1111/1467-9566.12831   open full text
  • Why do farm accidents persist? Normalising danger on the farm within the farm family.
    Sally Shortall, Annie McKee, Lee‐Ann Sutherland.
    Sociology of Health & Illness. November 18, 2018
    --- - |2 Abstract In the western world, farming is the most dangerous occupation with the highest rates of accidents and fatalities. Farming remains largely a family business and most accidents happen to family members. Why do safety campaigns have such limited success and why do farm families bring this terrible grief on themselves? This article argues that farm accidents are a persistent social pattern requiring analysis of how families are socialised to interact with the farming space. Based on qualitative data gathered for a Scottish study, it is argued that within farm families there is a socialisation and normalisation of danger. Accidents are to be expected. Two key arguments are advanced. First, danger is normalised and children are socialised to undertake risky behaviour. Second, it is suggested that when women do take up farming, they consciously undertake dangerous farming activities to prove that they are ‘authentic’ farmers. No previous research has considered women's approach to danger, and the existing literature suggests women are more safety conscious. This is not supported by our findings. We argue that farm accidents and fatalities are a persistent social problem because family members socialise each other to accept danger as the norm. - 'Sociology of Health &Illness, EarlyView. '
    November 18, 2018   doi: 10.1111/1467-9566.12824   open full text
  • Is HIV prevention creating new biosocialities among gay men? Treatment as prevention and pre‐exposure prophylaxis in Canada.
    Gabriel Girard, San Patten, Marc‐André LeBlanc, Barry D. Adam, Edward Jackson.
    Sociology of Health & Illness. November 18, 2018
    --- - |2 Abstract The advancements of “treatment as prevention” (TasP), “undetectable viral load” (UVL) and “pre‐exposure prophylaxis” (PrEP) are redefining HIV prevention standards. Relying on the concept of biosociality, this article explores how gay men rally around, debate, and sometimes disagree about these emerging HIV prevention technologies. This article is based on data from the Resonance Project, a Canadian community‐based research project. Twelve focus groups (totalling 86 gay and bisexual men) were held in three Canadian cities (Montreal, Toronto, Vancouver) in 2013–2014. Respondents view UVL and PrEP through the prism of their generational experience of HIV prevention. In this respect, biosocialities highlight an experiential dimension that is tied to the context of the HIV epidemic. The biosocialities of HIV prevention are also built around serological identities. However, our study shows the diversity of these positions. Analysis grounded in biosocialities is useful for better understanding how scientific information circulates, is made sense of, and generates debate among gay men. - 'Sociology of Health &Illness, EarlyView. '
    November 18, 2018   doi: 10.1111/1467-9566.12826   open full text
  • Valuing height: diagnosis, valuation and the case of idiopathic short stature.
    Michael Morrison.
    Sociology of Health & Illness. November 16, 2018
    --- - |2 Abstract This paper proposes a ‘valuographic’ approach to diagnosis, exploring how values and valuation practices are implicated in the contested diagnostic category of idiopathic short stature (ISS). ISS describes children who are ‘abnormally’ short but do not have any other detectable pathology. In the USA growth‐promoting hormone therapy has been approved for ISS children, since 2003. However, no other jurisdiction has approved this treatment and the value of ISS as a diagnostic category remains disputed among healthcare professionals. Drawing on qualitative interviews with paediatric endocrinologists in the UK and the US, this study presents a historical snapshot illustrating how the problematisation of ISS as a diagnosis involved multiple registers of value including epistemic, economic and moral calculations of worth. Contestation of the diagnosis was not just about what counts but about what ought to be counted, as respondents’ accounts of ISS gave differential weight to a range of types of evidence and methods of assessment. Ultimately what was at stake was not just the value of increased height for short patients, but what it meant to properly practice paediatric endocrinology. Consideration is then given to how a valuographic approach can be applied to sociological studies of diagnosis more broadly. - 'Sociology of Health &Illness, EarlyView. '
    November 16, 2018   doi: 10.1111/1467-9566.12828   open full text
  • ‘It's just an excuse to slut around’: gay and bisexual mens’ constructions of HIV pre‐exposure prophylaxis (PrEP) as a social problem.
    Mark Pawson, Christian Grov.
    Sociology of Health & Illness. November 06, 2018
    --- - |2 Abstract Since the 2012 FDA approval of HIV Pre‐exposure Prophylaxis (PrEP) as a method to prevent HIV, its uptake among gay and bisexual men has been met with conflict. Drawing on discussions of PrEP from focus groups with gay and bisexual men in New York City (N = 5 groups, n = 32 participants), we sought to make meaning of the moral debate surrounding the implementation of biomedical HIV prevention medications. Grounded in the constructionist perspective on social problems, this case study focuses on the competing claims making activities gay and bisexual men engage in when framing PrEP and PrEP users. As HIV prevention is a communicative endeavour, analysing the micro level social problems work on PrEP provides key insight into the subcultural norms and values that shape sexual health practices and beliefs within gay and bisexual communities. - 'Sociology of Health &Illness, Volume 40, Issue 8, Page 1391-1403, November 2018. '
    November 06, 2018   doi: 10.1111/1467-9566.12765   open full text
  • ‘Who does this patient belong to?’ boundary work and the re/making of (NSTEMI) heart attack patients.
    Helen Cramer, Jacki Hughes, Rachel Johnson, Maggie Evans, Christi Deaton, Adam Timmis, Harry Hemingway, Gene Feder, Katie Featherstone.
    Sociology of Health & Illness. November 06, 2018
    --- - |2 Abstract This ethnography within ten English and Welsh hospitals explores the significance of boundary work and the impacts of this work on the quality of care experienced by heart attack patients who have suspected non‐ST segment elevation myocardial infarction (NSTEMI) /non‐ST elevation acute coronary syndrome. Beginning with the initial identification and prioritisation of patients, boundary work informed negotiations over responsibility for patients, their transfer and admission to different wards, and their access to specific domains in order to receive diagnostic tests and treatment. In order to navigate boundaries successfully and for their clinical needs to be more easily recognised by staff, a patient needed to become a stable boundary object. Ongoing uncertainty in fixing their clinical classification, was a key reason why many NSTEMI patients faltered as boundary objects. Viewing NSTEMI patients as boundary objects helps to articulate the critical and ongoing process of classification and categorisation in the creation and maintenance of boundary objects. We show the essential, but hidden, role of boundary actors in making and re‐making patients into boundary objects. Physical location was critical and the parallel processes of exclusion and restriction of boundary object status can lead to marginalisation of some patients and inequalities of care (A virtual abstract of this paper can be viewed at: https://www.youtube.com/channel/UC_979cmCmR9rLrKuD7z0ycA). - 'Sociology of Health &Illness, Volume 40, Issue 8, Page 1404-1429, November 2018. '
    November 06, 2018   doi: 10.1111/1467-9566.12778   open full text
  • Digital health – a new medical cosmology? The case of 23andMe online genetic testing platform.
    Paula Saukko.
    Sociology of Health & Illness. November 06, 2018
    --- - |2 Abstract This article argues that commercial digital health platforms and devices commodify participatory features of the digital creating a new medical cosmology. Drawing on sociology on medical cosmologies, research on digital media and marketing and an analysis of the 23andMe online genetic testing platform, I identify three features of this cosmology. First, digital health seeks to foment ‘flow’ or enjoyable, continuous immersion in health. Second, digital health configures its consumers as ‘co‐creators’ of health data and knowledge together with companies and other consumers. Third, digital health frames medical knowledge as tentative, up for revision and scepticism by expert and lay science. The way in which digital health configures consumers as immersed, creative and sceptical gives it an open‐ended and participatory air. However, the conceptual discussion and the analysis of the 23andMe platform highlight that these features represent commercial capture of the lifeworld, even if they appear radical against classical medical cosmologies. - 'Sociology of Health &Illness, Volume 40, Issue 8, Page 1312-1326, November 2018. '
    November 06, 2018   doi: 10.1111/1467-9566.12774   open full text
  • Agency, activation and compatriots: the influence of social networks on health‐seeking behaviours among Sri Lankan migrants and Anglo‐Australians with depression.
    Josefine Antoniades, Danielle Mazza, Bianca Brijnath.
    Sociology of Health & Illness. November 06, 2018
    --- - |2 Abstract The nexus between social networks and illness behaviours is important in uptake of health care, however scant research has explored this relationship in South Asian migrants living with mental illness. We explored the interplay between culture, social networks and health seeking in Sri Lankan migrants and Anglo‐Australians living with depression. Forty‐eight in‐depth interviews were conducted and data were analysed through the theoretical prism of the network episode model. Results showed that social networks were important in negotiating care. Decisions to initiate care occurred along a continuum of choice and agency; some took charge of their care, others were coerced into care, however some Sri Lankan migrants were led through various informal channels of care. Selective activation of compatriots – those perceived to understand mental illness‐became increasingly important to participants through their illness careers. Compatriots were considered of greater benefit as participants progressed through depression than otherwise meaningful social networks based on ethnicity, culture and kinship. We argue that the role of social networks is pivotal in uptake of formal care, and engaging with communities to improve responses of social networks to mental illnesses may provide a bottom‐up avenue for improving uptake of mental health services in migrant communities. - 'Sociology of Health &Illness, Volume 40, Issue 8, Page 1376-1390, November 2018. '
    November 06, 2018   doi: 10.1111/1467-9566.12764   open full text
  • Reasonableness: legitimate reasons for illegitimate presentations at the ED.
    Marius Wamsiedel.
    Sociology of Health & Illness. November 06, 2018
    --- - |2 Abstract Most studies on gatekeeping at the emergency department (ED) have emphasised the assessment of clients in terms of perceived legitimacy and deservingness, showing that lay considerations lead to exclusionary practices, and the ED contributes to the social reproduction of inequality. Some recent works have challenged this representation, providing compelling evidence of staff's concern for the access to care of the most vulnerable users. I extend this perspective by presenting the criterion of reasonableness of the visit to the ED that nurses in Romania commonly use during the triage admission interview. Reasonableness constitutes an acceptable departure from the mission of the ED that offsets the negative evaluation in terms of legitimacy. Patients deemed to have legitimate reasons for making illegitimate claims for admission escape staff's disciplining efforts. However, the staff‐devised understanding of reasonableness is restrictive and does not attend to most cultural and structural barriers in access to quality health care. I argue that reasonableness indexes structural sensitivity, a fragmentary, tacit, and imperfectly consistent orientation to structural deficiencies in the organisation and provision of primary care. - 'Sociology of Health &Illness, Volume 40, Issue 8, Page 1347-1360, November 2018. '
    November 06, 2018   doi: 10.1111/1467-9566.12776   open full text
  • The transformative role of interaction rituals within therapeutic communities.
    Jenelle M. Clarke, Justin Waring.
    Sociology of Health & Illness. November 06, 2018
    --- - |2 Abstract Mental health settings are fraught with emotion as clients address difficult life experiences and relational patterns. Clients spend a substantial amount of time together outside of structured therapy, but little is known about how these moments are potentially therapeutic, especially as sites of emotional change. We draw on interaction ritual chain theory to explore how negative emotions in situations outside of formal therapy can be transformed into positive emotions and facilitate personal change. The research is based upon a narrative ethnography of two therapeutic communities for individuals with a diagnosis of personality disorder. Despite the presence of negative transient emotions in these rituals, clients experienced positive feelings of solidarity and belonging, and the majority of clients reported increased feelings of confidence and positive change. Conversely, dynamics between clients showed clients were not always supportive of one another and at times, could exclude others, resulting in isolation and alienation. We argue interactions that generate feelings of inclusion or exclusion over time are a key component in whether clients gain positive or negative emotional feeling and experience personal change. - 'Sociology of Health &Illness, Volume 40, Issue 8, Page 1277-1293, November 2018. '
    November 06, 2018   doi: 10.1111/1467-9566.12773   open full text
  • ‘Saying no to organ donation’: an empirical typology of reluctance and rejection.
    Larissa Pfaller, Solveig L. Hansen, Frank Adloff, Silke Schicktanz.
    Sociology of Health & Illness. November 06, 2018
    --- - |2 Abstract In Germany, as well as in other countries, organ shortages are usually explained by a relative unwillingness to donate among a population which is assumed to be caused by a lack of information and mistrust of the system. As we can see in the data of our qualitative research (focus groups and interviews), lack of information or mistrust are not the only reasons for people to be reluctant to agree to the donation of their organs after death. In fact we can identify four positions: (1) information deficit; (2) mistrust; (3) no killing; and (4) bodily integrity. The first and second are the two prominent explanations in the public discourse about low donation rates. The third and the fourth instead have neither been adequately articulated nor been discussed as a proper argument. Therefore, by means of sociology of critique, we discuss their contribution to the discourse as comprehensible reasons for reluctance and present them as credible positions of criticism: These two positions illuminate fundamental and universal values of the inviolability of the person and human dignity. Thus, both positions are consistent and morally justifiable and should be addressed with sensitivity. - 'Sociology of Health &Illness, Volume 40, Issue 8, Page 1327-1346, November 2018. '
    November 06, 2018   doi: 10.1111/1467-9566.12775   open full text
  • The enduring legacy of black lung: environmental health and contested illness in Appalachia.
    Thomas E. Shriver, Aysha Bodenhamer.
    Sociology of Health & Illness. November 06, 2018
    --- - |2 Abstract Over the past twenty years there has been a deadly resurgence of coal workers’ pneumoconiosis (CWP), commonly known as black lung disease. While increased prevalence of the disease is alarming, these data only capture cases where CWP has been officially recognised. We argue that many more cases of the disease are going unreported. Drawing from contested environmental illness literature, we examine issues surrounding diagnostic uncertainty and medical surveillance. We draw from qualitative data on black lung that includes in‐depth interviews, observation and document analysis. Findings indicate ongoing ambiguity and contestation over diagnosis of the disease, ranging from clinical and legal debates to concerted efforts to limit official recognition. While health screenings are currently available to miners, our results indicate low participation rates based on disincentives for early detection, logistical problems, and economic fears. Miners fear workplace discrimination and retaliation for participation in black lung screening programmes. Implications for public health policy and future research are discussed. - 'Sociology of Health &Illness, Volume 40, Issue 8, Page 1361-1375, November 2018. '
    November 06, 2018   doi: 10.1111/1467-9566.12777   open full text
  • Social practice, plural lifestyles and health inequalities in the United Kingdom.
    Jens Kandt.
    Sociology of Health & Illness. November 06, 2018
    --- - |2 Abstract Persistent health inequalities pose a continued research and policy challenge in the United Kingdom and elsewhere. Current approaches to health research and promotion are predicated on a distinction between wider, social structural causes and individual, health‐related behaviours often conceived of as lifestyle choices. Drawing on Bourdieu's theory of social practice, this paper develops an integrated perspective by observing associations between health and structured lifestyle practices. Using the UK Understanding Society household survey, a taxonomy of eight lifestyle clusters is identified, which exhibit significant health inequalities on a number of indicators. But the plurality of practices and subjective orientations inherent in the taxonomy reveals a finer, more complex differentiation of the social gradient in health. In addition, lifestyle appears to at least in parts mediate the relationship between social, material conditions and health. A feature of the taxonomy is that it admits a relational and contextual apprehension of health‐relevant, behavioural aspects within a more holistic notion of lifestyles. Based on this view, strategic approaches can be developed that respond to group‐specific situations and pathways and their varying roots in upstream or downstream domains of policy. - 'Sociology of Health &Illness, Volume 40, Issue 8, Page 1294-1311, November 2018. '
    November 06, 2018   doi: 10.1111/1467-9566.12780   open full text
  • The cycle of uncertainty: parents’ experiences of childhood epilepsy.
    Michelle Webster.
    Sociology of Health & Illness. October 23, 2018
    --- - |2 Abstract Uncertainty has been highlighted as an important aspect of experiences of chronic conditions generally and epilepsy in particular. However, there is little research exploring the extent to which uncertainty features in the experiences of family members or the form that this uncertainty may take. Drawing on in‐depth semi‐structured interviews with 27 parents who had a child with epilepsy, this article explores parents’ experiences of uncertainty and the way in which their views on childhood and epilepsy interacted and contributed to the uncertainties they experienced. It is argued that the occurrence of epilepsy during childhood shaped parents’ experiences as they used their ‘social clocks’ in order to interpret symptoms. Furthermore, parents described what has been termed a ‘cycle of uncertainty’. Indeed, the combination of epilepsy (a condition with various inherent forms of uncertainty) and childhood (a period in the life course that is seen as a time of development) meant that parents could not be sure which changes in their child were a result of the condition and which were a normal part of the ageing process. Overall, this article demonstrates that it is important to contextualise experiences of chronic conditions in relation to different stages in the life course. - 'Sociology of Health &Illness, EarlyView. '
    October 23, 2018   doi: 10.1111/1467-9566.12815   open full text
  • Understanding therapeutic massage as a form of bodywork: knowing and working on the (energy) body.
    Jennifer Lea.
    Sociology of Health & Illness. October 22, 2018
    --- - |2 Abstract Bodywork – as work which takes the body as its immediate site of labour – includes forms of service work, healthcare and caring. While work on bodywork has undeniably foregrounded the body, at the same time it has worked with a relatively limited understanding of bodily knowledges and practices. This article uses a theoretical framework taken from writing on Non‐Representational Theory, by Human Geographers, in order to take seriously ‘alternative’ body knowledge such as energy. The article draws on data from in‐depth interviews conducted with therapeutic massage practitioners in order to take seriously the ways in which energy directs and shapes the work that these bodyworkers do, adding new empirical understandings of what working with energy entails. It makes a broader conceptual contribution to bodywork literatures, advocating the importance of extending analysis beyond social constructionist approaches and questioning the taken‐for‐granted understandings of materiality that are most often drawn upon in order to attend to the kinds of knowledge that are less easy to formalise, anomalous, or that push at the fringes of the definite or the limits of the believable, but which are nonetheless central to many different kinds of bodywork contemporarily. - 'Sociology of Health &Illness, EarlyView. '
    October 22, 2018   doi: 10.1111/1467-9566.12814   open full text
  • Denny, E. Pain: A Sociological Introduction. Cambridge: Polity Press. 2017. 208pp £15.99 (pbk) ISBN 978‐0‐745‐65555‐0.
    Anu Vaittinen.
    Sociology of Health & Illness. October 13, 2018
    --- - - Sociology of Health & Illness, EarlyView.
    October 13, 2018   doi: 10.1111/1467-9566.12821   open full text
  • Kreager, P. and Bochow, A. Fertility, Conjuncture, Difference: Anthropological Approaches to the Heterogeneity of Modern Fertility Declines. New York: Berghahn Books. 2017. 358pp $130 (pbk) ISBN 978‐1‐78533‐604‐1.
    Sumaira Rashid.
    Sociology of Health & Illness. October 11, 2018
    --- - - Sociology of Health & Illness, EarlyView.
    October 11, 2018   doi: 10.1111/1467-9566.12822   open full text
  • Medicalisation, pharmaceuticalisation, or both? Exploring the medical management of sleeplessness as insomnia.
    Catherine Coveney, Simon J. Williams, Jonathan Gabe.
    Sociology of Health & Illness. September 21, 2018
    --- - |2 Abstract In this paper we examine the medical management of sleeplessness as ‘insomnia’, through the eyes of general practitioners (GPs) and sleep experts in Britain. Three key themes were evident in the data. These related to (i) institutional issues around advocacy and training in sleep medicine (ii) conceptual issues in the diagnosis of insomnia (iii) and how these played out in terms of treatment issues. As a result, the bulk of medical management occurred at the primary rather than secondary care level. These issues are then reflected on in terms of the light they shed on relations between the medicalisation and the pharmaceuticalisation of sleeplessness as insomnia. Sleeplessness, we suggest, is only partially and problematically medicalised as insomnia to date at the conceptual, institutional and interactional levels owing to the foregoing factors. Much of this moreover, on closer inspection, is arguably better captured through recourse to pharmaceuticalisation, including countervailing moves and downward regulatory pressures which suggest a possible degree of depharmaceuticalisation in future, at least as far prescription hypnotics are concerned. Pharmaceuticalisation therefore, we conclude, has distinct analytical value in directing our attention, in this particular case, to important dynamics occurring within if not beyond the medicalisation of sleeplessness as insomnia. - 'Sociology of Health &Illness, EarlyView. '
    September 21, 2018   doi: 10.1111/1467-9566.12820   open full text
  • When patients’ invisible work becomes visible: non‐adherence and the routine task of pill‐taking.
    Caroline Huyard, Harm Haak, Luc Derijks, Louis Lieverse.
    Sociology of Health & Illness. September 16, 2018
    --- - |2 Abstract While the biographical dimensions of chronic illness have been well researched, the concrete dimensions of patients’ work have not been as thoroughly investigated as yet. With the growing concern for self‐management, such research would be timely. This study aims to better understand patients’ invisible work by highlighting the causes of unintentional non‐adherence as well as strategies for adherence. For this purpose, it defines medical treatment adherence as the repetition of the pattern of tasks through which a patient succeeds, in a technical sense, in taking the right medication at the right time, in the right amount, for the right duration. Applying a failure modes and effects analysis approach to 48 semi‐structured interviews with Dutch patients, it shows the negative impact of schedule changes, pressure, positioning changes, lack of backup pills and lack of verification tools. Symmetrically, it highlights the role of anchoring, sequencing, positioning, cueing, correcting and verifying. This result points to the need for an analytical approach of patients’ work and treatment adherence that would build on the role of routines in organisations and in the workplace. - 'Sociology of Health &Illness, EarlyView. '
    September 16, 2018   doi: 10.1111/1467-9566.12806   open full text
  • Ethics as ritual: smoothing over moments of dislocation in biomedicine.
    Heidrun Åm.
    Sociology of Health & Illness. September 10, 2018
    --- - |2 Abstract Applications of biomedical R&D currently imply substantial societal concerns. This paper explores, based on semi‐structured interviews with scientists in Norway, how biomedical researchers experience and tackle such concerns in their daily work. It shows how ritualised routine responses to dislocatory moments help maintain order in the daily work of the interviewed scientists; they do not address directly but instead smooth over concerns by a ritualised way of using ethics. This may foreclose substantive reflection and function as a stabiliser for ‘business as usual’. Overall, the current way of responding to concerns as described by the interviewees may contribute to a depoliticisation of important issues. The paper contributes to sociological work on ethics by linking it to recent discussions on Responsible Research and Innovation (RRI) and by the empirical research presented. The insights can also help improve science policies such as RRI. - 'Sociology of Health &Illness, EarlyView. '
    September 10, 2018   doi: 10.1111/1467-9566.12818   open full text
  • Issue Information.

    Sociology of Health & Illness. September 09, 2018
    --- - - Sociology of Health & Illness, Volume 40, Issue 7, Page 1111-1112, September 2018.
    September 09, 2018   doi: 10.1111/1467-9566.12516   open full text
  • Comparing contemporary medical treatment practices aimed at intersex/DSD bodies in Israel and Germany.
    Limor Meoded Danon.
    Sociology of Health & Illness. September 05, 2018
    --- - |2 Abstract Recently, new laws and medical guidelines in many countries have prohibited early genital surgeries and irreversible medical treatment for intersexed babies. Following the passing of the German law that allows parents to register intersexed babies with no sex/gender, and after the establishment of new medical guidelines for intersexed patients in Israel, this study aims to examine the current medical policies regarding intersexed bodies at DSD centres and hospitals in Israel and Germany. How, if at all, have they changed the previous medical guidelines? This is a narrative study that includes 62 in‐depth interviews with medical professionals, parents and intersexed people from Germany and Israel. Three main controversial themes are examined, including the situated diagnostic medical gaze, the surgical practices for normalising intersexed bodies and the concealment of intersexed bodies. I find that in Israeli hospitals, early irreversible surgeries for ‘ambiguous genitals’ and the removal of internal sex organs are taking place frequently, whereas in Germany, the three DSD centres examined offer psychological counselling for parents instead of early surgeries for their babies. While in Israel concealment practices are embodied in the medical policy, the DSD centres in Germany encourage openness and peer group support. - 'Sociology of Health &Illness, EarlyView. '
    September 05, 2018   doi: 10.1111/1467-9566.12812   open full text
  • Linking process and effects of intersectoral action on local neighbourhoods: systemic modelling based on Actor–Network Theory.
    Angèle Bilodeau, Marilène Galarneau, Chantal Lefebvre, Louise Potvin.
    Sociology of Health & Illness. September 04, 2018
    --- - |2 Abstract After 25 years of intersectoral practice to increase health promotion resources, there is little scientific literature linking analysis of processes to observation of effects. Applying Actor–Network Theory, this article examines how the effects of intersectoral action are produced and can be attributed to its processes. A prospective multiple case study (2013–2016) was conducted on Neighbourhood Committees (NCs) in Montreal (Canada). Three NCs were studied using four kinds of data: direct observation notes of meetings and events, documents, logbooks and interviews. Systemic modelling of local intersectoral action was used for data collection and analysis. The results show that the transformations in living environments were produced by sequences of a limited number of ‘transitory outcomes’ that mark the progression of intersectoral action up to its effects. The list of transitory outcomes identified make up three functions in the production of change: (i) network setup and governance; (ii) self‐representing and influencing others; (iii) aligning necessary actors and resources. The production of effects follows a systemic model wherein unique configurations of transitory outcomes, adapted to the different contexts where interactions are occurring, represent the change processes that lead to the effects. - 'Sociology of Health &Illness, EarlyView. '
    September 04, 2018   doi: 10.1111/1467-9566.12813   open full text
  • Digitising psychiatry? Sociotechnical expectations, performative nominalism and biomedical virtue in (digital) psychiatric praxis.
    Martyn Pickersgill.
    Sociology of Health & Illness. September 02, 2018
    --- - - 'Sociology of Health &Illness, EarlyView. '
    September 02, 2018   doi: 10.1111/1467-9566.12811   open full text
  • Gestating bodies: sensing foetal movement in first‐time pregnancy.
    Emily Ross.
    Sociology of Health & Illness. August 31, 2018
    --- - |2 Abstract A large body of literature engages with personal accounts of pregnancy to illustrate the subjugation of women's embodied experience by practices of biomedicine. This article explores this issue through women's accounts of sensing initial foetal movement, drawn from qualitative interviews with 15 women resident in the UK. Participants depict this aspect of pregnant embodiment as ambiguous and indefinite, in contrast to clinical and popular representations of foetal movement. In highlighting the uncertainties characteristic of this corporeal event, the article adds to literature destabilising understandings of pregnant women's and foetal bodies as bounded and distinct. Ambiguous experiences of foetal movement arise in the context of sociocultural framings of pregnancy as ‘at risk’, and in turn, may be seen to contribute to these representations, with some participants articulating that uncertain sensations could provoke anxiety. In this article, perceptions of foetal movement are emphasised as valuable to women, and as inextricable from the social settings in which they emerge. This research has implications for sociological and feminist discussions of pregnancy, and work exploring the mutual shaping of corporeality and sociocultural contexts more widely. - 'Sociology of Health &Illness, EarlyView. '
    August 31, 2018   doi: 10.1111/1467-9566.12809   open full text
  • Patients’ accounts of memory lapses in interactions between neurologists and patients with functional memory disorders.
    Marc Alexander, Daniel Blackburn, Markus Reuber.
    Sociology of Health & Illness. August 31, 2018
    --- - |2 Abstract One of the most commonly made diagnoses in secondary care memory services is functional memory disorder (FMD). FMD is non‐progressive and characterised by persistent worries about memory failures without objective evidence of cognitive impairment. This study explores how patients with FMD present their memory concerns. Utilizing video recordings of consultations between patients and neurologists in a memory clinic, we show that FMD patients account for their memory deficits as significant disruptions to their daily lives. Resonating with research which identified a dissonance between self‐reports of memory functioning by FMD patients and the outcome of neuropsychological assessments, we demonstrate that, in giving a detailed account of their perceived memory problems, patients provide objective conversational evidence of their cognitive and memory capacity, implicitly undermining the claim of an objective problem. Using conversation analysis, we examine three of the more prominent interactional practices FMD patients draw on when attempting to communicate memory deficits to the doctor – they are (i) contrasts with a standard of ‘normal’; (ii) third‐party observations; and (iii) direct reported speech. These interactional features are recurrent devices for displaying memory concerns as legitimate problems, embedded within patients’ accounts of their day‐to‐day lives. - 'Sociology of Health &Illness, EarlyView. '
    August 31, 2018   doi: 10.1111/1467-9566.12819   open full text
  • Altruism, solidarity and affect in live kidney donation and breastmilk sharing.
    Rhonda M. Shaw.
    Sociology of Health & Illness. August 28, 2018
    --- - |2 Abstract Social scientists have recently diverged from mainstream bioethical discussion on the topic of the medical use of human biological materials for therapeutic, reproductive and research purposes. Rather than justifying the donation and provision of biological materials solely in terms of alleviating physical, psychological and social suffering, saving or enhancing life, and advancing biomedical knowledge, this work looks beyond humanist bioethics to take a social justice approach to questions of the life sciences. In this article, I draw insight from these accounts to propose an approach to the sociology of live kidney and breastmilk donation that is situated at the interface of the new sociology of morality and affect studies. To do so, I examine the moral economy of tissue provision with respect to its organisation around the discourse of altruism and the gift. I then turn to recent work on tissue economies, which are in the business of creating and producing biovalue, to discuss the manipulation of affect and the entanglement of new forms of bio‐intimacy in the production and reproduction of somatic life. The aim of the article was to contribute to the study of the sociology of donation as a substantive field of specialisation within sociology. - 'Sociology of Health &Illness, EarlyView. '
    August 28, 2018   doi: 10.1111/1467-9566.12805   open full text
  • The brain as an agentic system: how the brain is articulated in the field of neuroenhancement.
    Jonna Brenninkmeijer.
    Sociology of Health & Illness. August 28, 2018
    --- - |2 Abstract This article analyses the material of a European Project on Responsible Research and Innovation in Neuroenhancement (NERRI) to explore how the brain is articulated in this field. Since brains are closely connected to ideas of self, responsibility, free will and being human, and since brain metaphors have important effects on research practices and perspectives, it also matters how people talk about and use the brain. In the NERRI project, the brain is articulated as an agent interacting with or substituting the self; as a system that can, cannot or should not be analysed; and as the part of oneself that can potentially change human nature in positive and negative ways. Since most of the material analysed was produced by neuroscientists or other neuroenhancement experts, this article emphasises the responsibility of the experts in this process. By showing what brain images are disseminated within the field of neuroenhancement, and analysing how this depiction is related to ideas of self or being human, this article does not only intend to contribute to a more empirically based and societally relevant neuroenhancement debate, but also to a more realistic and societally relevant idea of the brain. - 'Sociology of Health &Illness, EarlyView. '
    August 28, 2018   doi: 10.1111/1467-9566.12810   open full text
  • Equality, efficiency and effectiveness: going beyond RCTs in A. L. Cochrane's vision of health care.
    Susanna Trnka, Tereza Stöckelová.
    Sociology of Health & Illness. August 26, 2018
    --- - |2 Abstract A. L. Cochrane's Effectiveness and Efficiency frequently appears as a key reference in debates over, and a justification for, contemporary evidence‐based medicine. Cochrane's concern in this text with the equality of care as the ultimate rationale for why effectiveness and efficiency of cure are needed has, however, largely disappeared from debate. In this article, we reconsider Cochrane's approach through the use of case studies of plural forms of medicine in the Czech Republic, namely traditional Chinese medicine, homeopathy and spa care. In addition to bringing equality back into the picture, we also identify four expansions to Cochrane's original vision arising from the difficulties of separating cure from care; the overlap between prevention and cure; the complex actions of some multi‐faceted therapies; and recent reconceptualisations of the placebo effect. In conclusion, we suggest that instead of the widely used strictly vertical “evidence pyramid”, a descriptor of the horizontal and additive ordering of evidence might be more appropriate. We also argue that in healthcare systems characterised by a multiplicity of approaches, if we want to truly benefit from this heterogeneity, we must take seriously each medical tradition's approaches to prevention, cure, care, as well as efficiency, efficacy and equality. - 'Sociology of Health &Illness, EarlyView. '
    August 26, 2018   doi: 10.1111/1467-9566.12817   open full text
  • The moral orders of work and health: a case of sick leave due to burnout.
    Korhonen Maija, Komulainen Katri.
    Sociology of Health & Illness. August 26, 2018
    --- - |2 Abstract Being on sick leave due to burnout entails a high level of accountability. Persons suffering from burnout do not automatically play a legitimate sick role because of the fuzziness of the burnout concept. In addition, while being on sick leave, they are in a non‐working position, which is against the ideals of work‐centred society. Therefore, they are required to explain their ‘deviant’ situation. Drawing on the interview data, the article explores how sick leave is explained and justified in narrative accounts by Finnish burnout sufferers. Results show that sick leave makes the moral orders of work, health and illness visible. Sick leave as a process involves negotiation of one's status and worth in the categories of ‘respectable employee’ and ‘credible patient’. A transition to sick leave requires causal explanations of burnout, which aim to legitimate ill‐being. Being on sick leave creates an obligation for activity and productivity that is ‘work‐like’ management of health. The study shows the fundamental level at which work structures everyday life, routines, and habits in the work‐centred society. In this context, burnout sufferers struggle to legitimise their work‐related distress and absence from work and restore their morally worthy identities. - 'Sociology of Health &Illness, EarlyView. '
    August 26, 2018   doi: 10.1111/1467-9566.12816   open full text
  • (Un)contested evidence: scientific literature, systematic reviews and the politics of evidence in the introduction of HPV vaccines in Colombia.
    Oscar J. Maldonado Castañeda.
    Sociology of Health & Illness. August 23, 2018
    --- - |2 Abstract This paper analyses the tensions between scientific literature and systematic reviews in the production of evidence in healthcare. Systematic reviews are devices developed – within evidence‐based medicine – to navigate the complexities of scientific literature promising a clear and simple account of the knowledge on a particular issue. However, in practice, systematic reviews have a more complex relation with literature. Systematic reviews are shaped according to the interest of the local groups that produce them. In this paper, I explore the formatting, making and managing of systematic reviews of evidence relating to HPV vaccines in Colombia. This case shows the ways in which systematic reviews mediate between the requirement of presenting the evidence that emerges from the international literature and the necessity of having data locally relevant. - 'Sociology of Health &Illness, EarlyView. '
    August 23, 2018   doi: 10.1111/1467-9566.12808   open full text
  • Gender dynamics in the donation field: human tissue donation for research, therapy and feeding.
    Julie Kent, Maria Fannin, Sally Dowling.
    Sociology of Health & Illness. August 13, 2018
    --- - |2 Abstract This paper examines how gender dynamics shape human tissue donation for research and for human health. Drawing on research investigating the donation of different types of bodily tissues including blood, plasma, breastmilk, cord blood, foetal tissue and placentae we consider how and why women and men are viewed as different kinds of donors. We situate these donation practices within a broader understanding of gender difference to explain why any sociology of donation needs to take account of gender. In so doing we explore how tissue derived from the bodies of women acquires value in distinctive ways and for distinctive purposes and reasons. Within these gendered bioeconomies of donation, the supply and demand for tissue is structured by social understandings of maternity, parental responsibility, and risk, which in turn affect the experiences of donors. - 'Sociology of Health &Illness, EarlyView. '
    August 13, 2018   doi: 10.1111/1467-9566.12803   open full text
  • Chatterjee, S.C. and Sengupta, S. Death and Dying in India: Ageing and End‐of‐Life Care of the Elderly, London and New York: Routledge. 2017. 162 pp. £105.00 (hbk) ISBN: 9780415403177 £20 (eBook) ISBN: 9781315228884.
    Sangeeta Chattoo.
    Sociology of Health & Illness. August 07, 2018
    --- - - Sociology of Health & Illness, EarlyView.
    August 07, 2018   doi: 10.1111/1467-9566.12802   open full text
  • Everyday and unavoidable coproduction: exploring patient participation in the delivery of healthcare services.
    Abigail Baim‐Lance, Daniel Tietz, Hazel Lever, Madeleine Swart, Bruce Agins.
    Sociology of Health & Illness. August 06, 2018
    --- - |2 Abstract The financial and capacity pressures facing healthcare systems call for new strategies to deliver high‐quality, efficient services. ‘Coproduction’ is a concept gaining recognition as an approach to create patient partnerships that enable better functioning healthcare systems. Yet, this framing obscures coproduction's ‘everyday and unavoidable’ character, already part of healthcare service delivery. This paper aims to understand these everyday and unavoidable dimensions of coproduced healthcare services by drawing upon thematic and process analyses of a 15‐month ethnography of 45 patients in three HIV clinics in New York. A ‘health practices’ approach guided exploring patients’ activities, their effects on clinical processes, and the conditions surrounding their performances. By constructing a typology of activity types – Building, Accepting, and Objecting – and tracing patients’ descriptions of activity performances, the paper shows how coproduction is forged by making and relying upon clinic‐based relationships, and for patients also with a broader human community. These dynamics reveal how patients’ bodily and temporal understandings are brought into and shape coproduced services. From these insights, we recommend that healthcare practitioners incorporate into their coproduction analytic methods and perspectives to engage patients as capable and aware individuals, who can support clinic efficiencies while producing new delivery possibilities. - 'Sociology of Health &Illness, EarlyView. '
    August 06, 2018   doi: 10.1111/1467-9566.12801   open full text
  • The infrastructure of telecare: implications for nursing tasks and the nurse‐doctor relationship.
    Niels Christian Mossfeldt Nickelsen.
    Sociology of Health & Illness. August 03, 2018
    --- - |2 Abstract Telecare can offer a unique experience of trust in patient‐nurse relationships, embracing new standards for professional discretion among nurses, but also reflects an increasingly complicated relationship between nurses and doctors. The study uses ethnographic methodology in relation to a large 5 million euro project at four hospitals caring for 120 patients with COPD. Twenty screen‐mediated conferences were observed and two workshops, centring on nurses’ photo elucidation of the practice of telecare, were conducted with a focus on shifting tasks, professional discretion, responsibility and boundaries between nurses and doctors. Analytically, the study draws on Star's notion of ‘infrastructure’ and Mol, Moser and Pols's ideas of care as ‘tinkering’. Infrastructure is understood as human and non‐human conduct that is embedded into wider organisational conventions, sites and structures. The analysis demonstrates and proposes that, in telecare, greater accountability, discretion and responsibility are imposed on the nurse, but that they also have less access to the means of clinical decision‐making, namely, doctors. The article explores how relational infrastructures ascribe the professions they constitute (nurses and doctors) functions of power and accountability and highlights the ethical problem of the nurse being given greater responsibility while simultaneously becoming more dependent on the doctor. - 'Sociology of Health &Illness, EarlyView. '
    August 03, 2018   doi: 10.1111/1467-9566.12781   open full text
  • Ehlers, N. and Hinkson, L.R. (eds) Subprime Health: Debt and Race in U.S. Medicine. Minneapolis: University of Minnesota Press. 2017. 256pp £83 (hbk) £19 (ebk) ISBN: 9781517901493.
    Tanisha Jemma Rose Spratt.
    Sociology of Health & Illness. August 03, 2018
    --- - - Sociology of Health & Illness, Volume 40, Issue 7, Page 1268-1269, September 2018.
    August 03, 2018   doi: 10.1111/1467-9566.12785   open full text
  • Generating the perception of choice: the remarkable malleability of option‐listing.
    Merran Toerien, Markus Reuber, Rebecca Shaw, Roderick Duncan.
    Sociology of Health & Illness. August 03, 2018
    --- - |2 Abstract The normative view that patients should be offered more choice both within and beyond the UK's National Health Service (NHS) has been increasingly endorsed. However, there is very little research on whether – and how – this is enacted in practice. Based on 223 recordings of neurology outpatient consultations and participants’ subsequent self‐reports, this article shows that ‘option‐listing’ is a key practice for generating the perception of choice. The evidence is two‐fold: first, we show that neurologists and patients overwhelmingly reported that choice was offered in those consultations where option‐listing was used; second, we demonstrate how option‐listing can be seen, in the interaction itself, to create a moment of choice for the patient. Surprisingly, however, we found that even when the patient resisted making the choice or the neurologist adapted the practice of option‐listing in ways that sought acceptance of the neurologist's own recommendation, participants still agreed that a choice had been offered. There was only one exception: despite the use of option‐listing, the patient reported having no choice, whereas the neurologist reported having offered a choice. We explore this deviant case in order to shed light on the limits of option‐listing as a mechanism for generating the perception of choice. - Sociology of Health & Illness, Volume 40, Issue 7, Page 1250-1267, September 2018.
    August 03, 2018   doi: 10.1111/1467-9566.12766   open full text
  • Waggoner, M. The Zero Trimester: Pre‐Pregnancy Care and the Politics of Reproductive Risk. Oakland, CA: University of California Press. 2017. 270 pp £66 (hbk) £17 (pbk) ISBN: 978‐0520288065.
    Gillian Love.
    Sociology of Health & Illness. August 03, 2018
    --- - - Sociology of Health & Illness, EarlyView.
    August 03, 2018   doi: 10.1111/1467-9566.12804   open full text
  • Lifestyle drift and the phenomenon of ‘citizen shift’ in contemporary UK health policy.
    Oli Williams, Simone Fullagar.
    Sociology of Health & Illness. August 02, 2018
    --- - |2 Abstract Despite political change over the past 25 years in Britain there has been an unprecedented national policy focus on the social determinants of health and population‐based approaches to prevent chronic disease. Yet, policy impacts have been modest, inequalities endure and behavioural approaches continue to shape strategies promoting healthy lifestyles. Critical public health scholarship has conceptualised this lack of progress as a problem of ‘lifestyle drift’ within policy whereby ‘upstream’ social contributors to health inequalities are reconfigured ‘downstream’ as a matter of individual behaviour change. While the lifestyle drift concept is now well established there has been little empirical investigation into the social processes through which it is realised as policies are (re)formulated and implementation is localised. Addressing this gap we present empirical findings from an ethnography conducted in a deprived English neighbourhood in order to explore: (i) the local context in the process of lifestyle drift and; (ii) the social relations that reproduce (in)equities in the design and delivery of lifestyle interventions. Analysis demonstrates how and why ‘precarious partnerships’ between local service providers were significant in the process of ‘citizen shift’ whereby government responsibility for addressing inequity was decollectivised. - 'Sociology of Health &Illness, EarlyView. '
    August 02, 2018   doi: 10.1111/1467-9566.12783   open full text
  • Gendered imaginaries: situating knowledge of epigenetic programming of health.
    Luca Chiapperino, Francesco Panese.
    Sociology of Health & Illness. July 31, 2018
    --- - |2 Abstract Our paper explores the value‐laden and epistemic resources that scientists working in epigenetics and developmental programming of health and disease (DOHaD) mobilise to produce scientific representations of pregnancy and parenthood, which in turn imagine norms, values, and responsibilities for the protection of future generations. In order to do so, we first describe the place of questions regarding the relative weight of paternal and maternal influences on the health of the offspring in the discursive formalisation of this research in scientific publications. This enables us to identify the mutual constitution of ‘prototypes’ (i.e. experimental designs, settings, techniques) and ‘stereotypes’ (i.e. social meanings, beliefs, norms and values) of parental roles in DOHaD and epigenetic biomedical sciences, by means of a specific gendered figuration of paternal influences: the ‘father‐as‐sperm’. Second, and drawing from a set of interviews (N = 15), we describe a tension between this dominant, objectifying molecular discourse and the perspective of individual scientists. The situated perspective of individual researchers provides in fact evidence for a conflictual (moral and epistemic) economy of gendered engagements with parental figurations in DOHaD and epigenetic research, and consequently suggests a more fine‐grained, as well as conflictual web of socio‐political positioning of this ‘knowledge’ in its societal circulation. - Sociology of Health & Illness, Volume 40, Issue 7, Page 1233-1249, September 2018.
    July 31, 2018   doi: 10.1111/1467-9566.12779   open full text
  • Constructing queer mother‐knowledge and negotiating medical authority in online lesbian pregnancy journals.
    Sierra Holland.
    Sociology of Health & Illness. July 26, 2018
    --- - |2 Abstract Medical interactions around reproduction are increasingly extending beyond the physician's office and onto the Internet, where negotiation with medical authority occurs in complex and dynamic ways. Recently, scholars have noted the Internet's potential for creating spaces where women can dialogue with and reconstruct medical authority, yet this growing body of work is overwhelming heteronormative. This paper thus interrogates how lesbian women use the Internet to challenge, deploy, and rework medical authority around reproduction while navigating the transition to parenthood. I draw from 17 online journals authored by lesbian couples during the conception, pregnancy, and birth of their first child, each spanning between 18 months and 2 years, in order to understand how the transition process unfolds over time. I argue that lesbian couples engage with medical authority when seeking affirmation and normalisation yet discard and publicly reject the heteronormative assumptions that accompany reproductive medicine. Further, they chart a new process that I term ‘constructing queer mother‐knowledge’, in which they critique and balance knowledges from institutionalised medicine, their own bodies, and their queer communities. With this new concept, I complicate understandings of lesbian mothers‐to‐be and their interactions with medical authority as they build subversive families. - 'Sociology of Health &Illness, EarlyView. '
    July 26, 2018   doi: 10.1111/1467-9566.12782   open full text
  • Lynch, R. and Farrington, C. Quantified Lives and Vital Data: Exploring Health and Technology Through Personal Medical Devices. Basingstoke: Palgrace Macmillan. 2018. 298pp £89.99 (hbk) ISBN 978‐1‐349‐95235‐9.
    Lisa Hinton.
    Sociology of Health & Illness. July 04, 2018
    --- - - Sociology of Health & Illness, EarlyView.
    July 04, 2018   doi: 10.1111/1467-9566.12784   open full text
  • Taee, J. The Patient Multiple: An Ethnography of Healthcare and Decision‐Making in Bhutan. New York and Oxford: Berghahn Books. 2017. 242 pp $110/£78 (hbk) ISBN 978‐1‐78533‐394‐1.
    Miriam Sang‐Ah Park.
    Sociology of Health & Illness. June 27, 2018
    --- - - Sociology of Health & Illness, Volume 40, Issue 7, Page 1270-1271, September 2018.
    June 27, 2018   doi: 10.1111/1467-9566.12758   open full text
  • Tang, L. Recovery, Mental Health, and Inequality: Chinese Ethnic Minorities as Mental Health Service Users. Oxford: Routledge. 2017. 194 pp £105 (hbk) ISBN 9781138849976.
    Donald W. Light.
    Sociology of Health & Illness. June 25, 2018
    --- - - Sociology of Health & Illness, Volume 40, Issue 7, Page 1272-1273, September 2018.
    June 25, 2018   doi: 10.1111/1467-9566.12759   open full text
  • Han, S., Betsinger, T.K. and Scott, A.B. (eds.) The Anthropology of the Fetus: Biology, Culture, and Society. New York: Berghahn. 2018. 298 pp £85 (hbk) ISBN 978 178 533 6911.
    Josie Hamper.
    Sociology of Health & Illness. June 23, 2018
    --- - - Sociology of Health & Illness, EarlyView.
    June 23, 2018   doi: 10.1111/1467-9566.12767   open full text
  • Kraus, F. and Boldt, J. Care in Healthcare: Reflections on Theory and Practice. eds. Basingstoke: Palgrave Macmillan. 2018. 298 pp. €51.95 (hbk) ISBN 978‐3‐319‐61291‐1.
    Melissa‐Jane Belle.
    Sociology of Health & Illness. June 22, 2018
    --- - - Sociology of Health & Illness, EarlyView.
    June 22, 2018   doi: 10.1111/1467-9566.12770   open full text
  • Lupton, D. Digital Health: Critical and Cross‐Disciplinary Perspectives. London and New York: Routledge. 2018. 170pp £34.99 (pbk) ISBN 978‐1‐138‐12345‐8.
    Richard Milne.
    Sociology of Health & Illness. June 22, 2018
    --- - - Sociology of Health & Illness, EarlyView.
    June 22, 2018   doi: 10.1111/1467-9566.12772   open full text
  • Wahlberg, A. and Gammeltoft, T. (eds) Selective Reproduction in the 21st Century. Basingstoke: Palgrave Macmillan. 2018. 198pp £72.00 (hbk) ISBN 978‐3‐319‐58219‐1.
    Andri Christoforou.
    Sociology of Health & Illness. June 22, 2018
    --- - - Sociology of Health & Illness, EarlyView.
    June 22, 2018   doi: 10.1111/1467-9566.12769   open full text
  • Petersen, A., Munsie, M., Tanner, C., MacGregor, C. and Brophy, J. Stem Cell Tourism and the Political Economy of Hope. London: Palgrave Macmillan. 2017. 218pp £79.99 (hbk) ISBN 978‐1‐137‐47042‐3 £63.99 (ebk) ISBN 978‐1‐137‐47043‐0.
    Michael Morrison.
    Sociology of Health & Illness. June 22, 2018
    --- - - Sociology of Health & Illness, EarlyView.
    June 22, 2018   doi: 10.1111/1467-9566.12768   open full text
  • Davies, J. Living Before Dying. Imagining and Remembering Home. Oxford: Berghahn Books. 2017. 172 pp £120/£85 (hbk) ISBN 978‐1‐78533‐614‐0.
    Renske Visser.
    Sociology of Health & Illness. June 22, 2018
    --- - - Sociology of Health & Illness, EarlyView.
    June 22, 2018   doi: 10.1111/1467-9566.12760   open full text
  • Trnka, S. One Blue Child: Asthma, Responsibility, and the Politics of Global Health. Stanford: Stanford University Press. 2017. 280pp £74 (hbk) £22.99 (pbk) ISBN: 978‐1503601130.
    Dr Efua Tembisa Prah.
    Sociology of Health & Illness. June 21, 2018
    --- - - Sociology of Health & Illness, Volume 40, Issue 7, Page 1269-1270, September 2018.
    June 21, 2018   doi: 10.1111/1467-9566.12771   open full text
  • Introducing the idea of ‘assumed shared food narratives’ in the context of social networks: reflections from a qualitative study conducted in Nottingham, England.
    Paul Bissell, Marian Peacock, Michelle Holdsworth, Katie Powell, John Wilcox, Angie Clonan.
    Sociology of Health & Illness. June 19, 2018
    --- - |2 Abstract This study explores the ways in which social networks might shape accounts about food practices. Drawing on insights from the work of Christakis and Fowler () whose claims about the linkages between obesity and social networks have been the subject of vigorous debate in the sociological literature, we present qualitative data from a study of women's’ accounts of social networks and food practices, conducted in Nottingham, England. We tentatively suggest that whilst social networks in their broadest sense, might shape what was perceived to be normal and acceptable in relation to food practices (and provide everyday discursive resources which normalise practice), the relationship between the two is more complex than the linear relationship proposed by Christakis and Fowler. Here, we introduce the idea of assumed shared food narratives (ASFNs), which, we propose, sheds light on motive talk about food practices, and which also provide practical and discursive resources to actors seeking to protect and defend against ‘untoward’ behaviour, in the context of public health messages around food and eating. We suggest that understanding ASFNs and the ways in which they are embedded in social networks represents a novel way of understanding food and eating practices from a sociological perspective. - Sociology of Health & Illness, Volume 40, Issue 7, Page 1142-1155, September 2018.
    June 19, 2018   doi: 10.1111/1467-9566.12746   open full text
  • Unpacking the lunchbox: biopedagogies, mothering and social class.
    Benedetta Cappellini, Vicki Harman, Elizabeth Parsons.
    Sociology of Health & Illness. June 19, 2018
    --- - |2 Abstract This study investigates how mothers respond to school surveillance of their children's packed lunches. In a context where increasing attention is focused on healthy eating, we adopt a biopedagogical approach to illustrate different positions and strategies which mothers occupy in relation to feeding their children in the school setting. We use photo‐elicitation interviews and focus groups to trace both the discursive and practical significance of these biopedagogies. We find that the subjective experiences of feeding children at school are infused with classed notions of mothering in public. Our analysis highlights two broad positions. Firstly, there were those with strong distinctions between home‐food and school‐food, which was associated more clearly with middle class families. Secondly, there were those with more fluid boundaries between home‐food and school‐food. This was more commonly encapsulated by working class mothers who were seen to place more emphasis on their children as autonomous decision‐makers. Overall the findings document localised and classed practices of resisting the school's normalising gaze. - Sociology of Health & Illness, Volume 40, Issue 7, Page 1200-1214, September 2018.
    June 19, 2018   doi: 10.1111/1467-9566.12751   open full text
  • Bonner, A. Social Determinants of Health: An Interdisciplinary Approach to Social Inequality and Wellbeing. Bristol: Policy Press. 2018. xxii + 351 pp £80.00 (hbk) £28.99 (pbk) ISBN 978‐1447336853.
    Mick Carpenter.
    Sociology of Health & Illness. June 06, 2018
    --- - - Sociology of Health & Illness, EarlyView.
    June 06, 2018   doi: 10.1111/1467-9566.12757   open full text
  • Plemons, E. The Look of a Woman: Facial Feminization Surgery and the Aims of Trans‐ Medicine. Durham, NC: Duke University Press. 2017. 208 pp $23.95 (pbk) ISBN 978‐0‐8223‐6914‐1.
    Paula Martin.
    Sociology of Health & Illness. June 06, 2018
    --- - - Sociology of Health & Illness, EarlyView.
    June 06, 2018   doi: 10.1111/1467-9566.12761   open full text
  • Corman, M.K. Paramedics On and Off the Streets: Emergency Medical Services in the Age of Technological Governance. Toronto: University of Toronto Press. 2017. 219pp £20.99 (pbk) 978‐1442629875.
    Holly C. Standing.
    Sociology of Health & Illness. June 06, 2018
    --- - - Sociology of Health & Illness, EarlyView.
    June 06, 2018   doi: 10.1111/1467-9566.12756   open full text
  • The categorisation of resistance: interpreting failure to follow a proposed line of action in the diagnosis of autism amongst young adults.
    Gregory Hollin, Alison Pilnick.
    Sociology of Health & Illness. May 23, 2018
    --- - |2 Abstract Many characteristics typical of autism, a neurodevelopmental condition characterised by socio‐communicative impairments, are most evident during social interaction. Accordingly, procedures such as the Autism Diagnosis Observation Schedule (ADOS) are interactive and intended to elicit interactional impairments: a diagnosis of autism is given if interactional difficulties are attributed as a persistent quality of the individual undergoing diagnosis. This task is difficult, first, because behaviours can be interpreted in various ways and, second, because conversation breakdown may indicate a disengagement with, or resistance to, a line of conversation. Drawing upon conversation analysis, we examine seven ADOS diagnosis sessions and ask how diagnosticians distinguish between interactional resistance as, on the one hand, a diagnostic indicator and, on the other, as a reasonable choice from a range of possible responses. We find evidence of various forms of resistance during ADOS sessions, but it is a resistance to a line of conversational action that is often determined to be indicative of autism. However, and as we show, this attribution of resistance can be ambiguous. We conclude by arguing for reflexive practice during any diagnosis where talk is the problem, and for a commitment to acknowledge the potential impact of diagnostic procedures themselves upon results. - Sociology of Health & Illness, Volume 40, Issue 7, Page 1215-1232, September 2018.
    May 23, 2018   doi: 10.1111/1467-9566.12749   open full text
  • A licence to drive? Neurological illness, loss and disruption.
    Melissa Stepney, Susan Kirkpatrick, Louise Locock, Suman Prinjha, Sara Ryan.
    Sociology of Health & Illness. May 22, 2018
    --- - |2 Abstract The sense of freedom and independence that being able to drive generates may be taken for granted by many until it is threatened by illness. Drawing on the ‘mobility turn’ in social sciences that emphasises the social and emotional significance of the car (Sheller and Urry , ), this article presents secondary analysis of narratives of driving and its significance across four neurological conditions (epilepsy, Parkinson's disease, transient ischaemic attack and motor neurone disease). Taking an interactionist approach we explore how the withdrawal of a driving licence can represent not just a practical and emotional loss of independence, but also loss of enjoyment; of a sense and feeling of ‘normal’ adulthood and social participation; and of an identity (in some cases gendered) of strength and power. Conversely the ability to keep driving can maintain an unbroken thread of narrative, for example enabling people with speech difficulties to feel and look normal behind the wheel. Moments of pleasure and normality illuminate the importance of examining the micro‐strands of disruption illness can cause. - Sociology of Health & Illness, Volume 40, Issue 7, Page 1186-1199, September 2018.
    May 22, 2018   doi: 10.1111/1467-9566.12754   open full text
  • de Rond, M. Doctors at War: Life and Death in a Field Hospital. Ithaca, NY: Cornell University Press. 2017. 176pp (hbk) $21.95 ISBN 9781501705489.
    Lorena Nunez Carrasco.
    Sociology of Health & Illness. May 21, 2018
    --- - - Sociology of Health & Illness, Volume 40, Issue 7, Page 1273-1274, September 2018.
    May 21, 2018   doi: 10.1111/1467-9566.12755   open full text
  • Eating practices among low‐income overweight /obese Brazilian mothers: a Bourdieusian approach.
    Priscila Morais Sato, Mariana Dimitrov Ulian, Ramiro Fernandez Unsain, Fernanda Baeza Scagliusi.
    Sociology of Health & Illness. May 16, 2018
    --- - |2 Abstract We investigated the eating practices of socially vulnerable overweight and obese Brazilian mothers, exploring the relationships between eating practices, capitals, fields and excess‐weight. We conducted a qualitative study involving in‐depth interviews of 21 women living in three vulnerable urban regions. Content analyses were performed and codes were used to locate actors in relation to each other in terms of ‘capitals' and ‘fields’, forming a typology based on Bourdieu's theory with five groups. Socioeconomic conditions during childhood and liking to cook were the main characteristics related to each group's distinct eating practices. While socioeconomic conditions during childhood were related to region of origin and food tastes, liking to cook worked as a type of cultural capital, called culinary capital, which produced pleasure and status. For each pattern of eating practices, different factors seemed to contribute to participants’ excess weight, including liked foods, enjoying cooking, and financial constraints. One group combined a highly vulnerable economic situation and health problems, shedding light onto a habitus that demands special attention from public health studies and interventions. This study illustrates the complexity of practices within a seemingly homogeneous group and reinforces that health studies should not assume homogeneity within a group of overweight/obese low‐income women. - Sociology of Health & Illness, Volume 40, Issue 7, Page 1172-1185, September 2018.
    May 16, 2018   doi: 10.1111/1467-9566.12748   open full text
  • Harmless, friendly and lethal: antibiotic misuse in relation to the unpredictable bacterium Group A streptococcus.
    Hedvig Gröndal.
    Sociology of Health & Illness. April 29, 2018
    --- - |2 Abstract Evidence‐based treatment guidelines for managing infections in health care are promoted as tools to prevent unnecessary use of antibiotics. Antibiotic misuse has been examined as regards the doctor‐patient relation and the social context of medical practice. Less attention has been paid to how the very conceptualisation of human‐microbial relations may influence understandings of antibiotic misuse. The article examines a medical controversy concerning guidelines for managing throat infection and antibiotic treatment in Sweden. It demonstrates how this controversy unfolds around two different ways of relating to a specific bacterium – Group A Streptococcus. The analysis shows how two ‘microbiopolitics’, involving different understandings of human‐microbial relations, are created in the controversy and how different antibiotic prescribing practices are justified. By focusing on Group A Streptococcus, which is commonly observed, but also unpredictable and potentially dangerous, the article provides new insights into the relations between bacteria, humans and policy in an age of antimicrobial resistance. It argues, in particular, that the definition of antibiotic misuse is unstable and consequently that policy measures aimed at reducing misuse must be related to how specific infections and bacteria are conceptualised in the actual context the policy addresses. - Sociology of Health & Illness, Volume 40, Issue 7, Page 1127-1141, September 2018.
    April 29, 2018   doi: 10.1111/1467-9566.12742   open full text
  • ‘Ingredients’ of a supportive web of caring relationships at the end of life: findings from a community research project in Austria.
    Klaus Wegleitner, Patrick Schuchter, Sonja Prieth.
    Sociology of Health & Illness. April 27, 2018
    --- - |2 Abstract In accordance with the pluralisation of life plans in late modernity, the societal organisation of care at the end of life is diverse. Although the public discourse in western societies is dominated by questions about optimising specialised palliative care services, public health approaches, which take into account the social determinants and inequalities in end‐of‐life care, have gained in importance over the last decade. Conceptual aspects, dimensions of impact and benefit for the dying and their communities are well discussed in the public health end‐of‐life care research literature. Our research focuses on the preconditions of a supportive caring web in order to understand how communities can build on their social capital to deal with existential uncertainty. As part of a large‐scale community research project, we carried out focus groups and interviews with community members. Through dispositive analysis, we generated a set of care‐web ‘ingredients’, which constitute and foster a caring community. These ‘ingredients’ need to be cultivated through an ongoing process of co‐creation. This requires: (i) a focus on relationships and social systems; (ii) the creation of reflective spaces; and (iii) the strengthening of social capital, and d) the addressing of inequalities in care. - 'Sociology of Health &Illness, EarlyView. '
    April 27, 2018   doi: 10.1111/1467-9566.12738   open full text
  • ‘Essentially it's just a lot of bedrooms’: architectural design, prescribed personalisation and the construction of care homes for later life.
    Sarah Nettleton, Christina Buse, Daryl Martin.
    Sociology of Health & Illness. April 27, 2018
    --- - |2 Abstract This article draws on ethnographic data from a UK Economic and Social Research Council (ESRC) funded study called ‘Buildings in the Making’. The project aims to open up the black box of architectural work to explore what happens between the commissioning of architectural projects through to the construction of buildings, and seeks to understand how ideas about care for later life are operationalised into designs. Drawing on recent scholarship on ‘materialities of care’ and ‘practising architectures’, which emphasise the salience of material objects for understanding the politics and practices of care, we focus here on ‘beds’. References to ‘beds’ were ubiquitous throughout our data, and we analyse their varied uses and imaginaries as a ‘way in’ to understanding the embedded nature of architectural work. Four themes emerged: ‘commissioning architectures and the commodification of beds’; ‘adjusting architectures and socio‐spatial inequalities of beds’; ‘prescribing architectures and person‐centred care beds’; and ‘phenomenological architectures and inhabiting beds’. We offer the concept prescribed personalisation to capture how practising architectures come to reconcile the multiple tensions of commodification and the codification of person centred care, in ways that might mitigate phenomenological and serendipitous qualities of life and living in care settings during later life. - Sociology of Health & Illness, Volume 40, Issue 7, Page 1156-1171, September 2018.
    April 27, 2018   doi: 10.1111/1467-9566.12747   open full text
  • Translating value‐based health care: an experiment into healthcare governance and dialogical accountability.
    Morten Bonde, Claus Bossen, Peter Danholt.
    Sociology of Health & Illness. April 19, 2018
    --- - |2 Abstract This article analyses an experiment into healthcare governance in Denmark inspired by principles of value‐based health care and intended to re‐orient the focus of healthcare governance from ‘productivity’ to ‘value for the patient’. The region in charge of the experiment exempted nine hospital departments from activity‐based financing and accountability based on diagnosis‐related groups, which allegedly incentivised hospitals in ‘perverse’ and counterproductive ways. Instead, the departments were to develop new indicators from their local practices to support and account for quality and value for the patient. Drawing on the actor‐network theory concept of ‘translation’, this article analyses how the experiment was received and put into practice in the nine departments, and how it established new kinds of accountability relations. We argue that the experiment provides fruitful inspiration for future governance schemes in healthcare to embrace the local complexities of clinical practices. In particular, we argue that the locally developed indicators facilitated what we call ‘dialogical accountability’, and we discuss whether this represents a feasible way forward for value‐based health care. - Sociology of Health & Illness, Volume 40, Issue 7, Page 1113-1126, September 2018.
    April 19, 2018   doi: 10.1111/1467-9566.12745   open full text
  • From waste product to blood, brains and narratives: developing a pluralist sociology of contributions to health research.
    Anne‐Marie R. Boylan, Louise Locock, Laura Machin.
    Sociology of Health & Illness. March 01, 2018
    --- - |2 Abstract The aim of this paper is to examine the meaning of the concept of donation in health research. Drawing on a set of narrative interviews with people invited to donate biosamples for research and a range of other studies, we identify several conceptual themes that speak to the complexity of the current landscape of critical thinking about donation. These conceptual themes are: the language of ‘donation’; a hierarchy of biosamples; alternative informational value; narratives as donation; coincidental donation, convenience and degree of invasiveness; and rights, consent and benefits of research participation. We call for a reconceptualisation of research donation to encompass not only the numerous types of sample readily classed as donations, but also other types of data and contributions, including narrative interviews, psychometric data, patient‐reported outcome measures, record‐linkage, and time and effort. We argue for the development of a pluralist sociology of research donations, and suggest that a ‘sociology of research contributions’ might better capture this complexity. - 'Sociology of Health &Illness, EarlyView. '
    March 01, 2018   doi: 10.1111/1467-9566.12715   open full text
  • Understanding lay perspectives on socioeconomic health inequalities in Britain: a meta‐ethnography.
    Katherine E. Smith, Rosemary Anderson.
    Sociology of Health & Illness. October 17, 2017
    The links between socioeconomic circumstances and health have been extensively studied in Britain but surprisingly few studies consider lay perspectives. This is problematic given popular efforts to reduce health inequalities appear to be based on assumption that public understanding is limited (this is evident in efforts to raise awareness of both ‘upstream’ causes of health inequalities and health‐damaging behaviours). The results of this meta‐ethnography, involving 17 qualitative studies, fundamentally challenge this assumption. We show, first, that people who are living with socioeconomic disadvantage already have a good understanding of the links between socioeconomic hardship and ill‐health. Indeed, participants’ accounts closely mirror the research consensus that material‐structural factors represent ‘upstream’ determinants of health, while ‘psychosocial’ factors provide important explanatory pathways connecting material circumstances to health outcomes. Despite this, people living in disadvantaged circumstances are often reluctant to explicitly acknowledge health inequalities, a finding that we suggest can be understood as an attempt to resist the stigma and shame of poverty and poor health and to (re)assert individual agency and control. This suggests that work to increase public awareness of health inequalities may unintentionally exacerbate experiences of stigma and shame, meaning alternative approaches to engaging communities in health inequalities discussions are required.
    October 17, 2017   doi: 10.1111/1467-9566.12629   open full text
  • Managing, making sense of and finding meaning in advanced illness: a qualitative exploration of the coping and wellbeing experiences of patients with lung cancer.
    Emily Harrop, Simon Noble, Michelle Edwards, Stephanie Sivell, Barbara Moore, Annmarie Nelson.
    Sociology of Health & Illness. October 16, 2017
    Coping plays an essential role in maintaining the wellbeing of patients with cancer. A number of different coping responses and strategies have been identified in the literature. The value and relevance of meaning based coping theory has also been emphasised, including Antonovosky's Sense of Coherence (SoC) theory. Ten patients with advanced lung cancer were interviewed up to three times. A total of twenty in depth interviews were carried out, fully transcribed and data were analysed following a methodology of Interpretative Phenomenological Analysis. Three broad domains were identified to categorise the core life concerns of participants; making sense of and managing one's illness; maintaining daily life and relationships and confronting the future. Within these domains multiple coping themes are identified, which to varying degrees help to maintain patient wellbeing and quality of life. This article considers the relevance of SoC theory for understanding the coping experiences of patients with advanced cancer, and identifies resources and factors likely to support patient coping, with implications for health and social care services.
    October 16, 2017   doi: 10.1111/1467-9566.12601   open full text
  • ‘Everyone assumes a man to be quite strong’: Men, masculinity and rheumatoid arthritis: A case‐study approach.
    Caroline Flurey, Alan White, Karen Rodham, John Kirwan, Robert Noddings, Sarah Hewlett.
    Sociology of Health & Illness. October 15, 2017
    Current literature has overlooked the impact of chronic illness on masculine identity. We therefore aimed to investigate the impact of rheumatoid arthritis (a long term condition, affecting more women than men) on masculine identity. Six focus groups with 22 men with rheumatoid arthritis (RA) (data reported elsewhere) followed by five one‐to‐one interviews with men (English, mean age: 59 years) sampled to reflect a heterogeneous experience of life with RA based on knowledge gained from the focus groups. Transcripts were analysed using thematic analysis and are presented as individual case studies. Whilst the case studies provide five distinct experiences, common themes can be drawn across them, such as the importance of paid work. The men needed to renegotiate their masculine identity to deal with their RA. Two dealt with this by pushing through pain to retain masculine activities, two replaced masculine roles they could no longer do with other roles, and one rejected masculinity completely. Men with long term conditions may need to re‐write their masculinity scripts to enable them to accept and adapt to their condition. However, some men struggle with this, which should be taken into consideration when designing self‐management services for men with long term conditions.
    October 15, 2017   doi: 10.1111/1467-9566.12628   open full text
  • Hybrid bodies and the materiality of everyday life: How people living with pacemakers and defibrillators reinvent everyday routines and intimate relations.
    Nelly Oudshoorn.
    Sociology of Health & Illness. October 15, 2017
    Technologies inside bodies pose new challenges in a technological culture. For people with pacemakers and defibrillators, activities such as passing security controls at airports, using electromagnetic machines, electrical domestic appliances and electronic devices, and even intimate contacts with their loved ones can turn into events where the proper functioning of their device may be at risk. Anticipation of potentially harmful events and situations thus becomes an important part of the choreography of everyday life. Technologies inside bodies not only pose a challenge for patients living with these devices but also to theorising body‐technology relations. Whereas researchers usually address the merging of bodies and technologies, implants ask us to do the opposite as well. How are we to understand human‐technology relations in which technologies should not entangle with bodies because they serve other purposes? Based on a study of the daily life practices of people with pacemakers and defibrillators in the Netherlands and the US, I argue that disentanglement work, i.e. work involved to prevent entanglements with objects and people that may inflict harm upon implanted devices, is key to understanding how hybrid bodies can survive in today's densely populated technological landscape.
    October 15, 2017   doi: 10.1111/1467-9566.12626   open full text
  • Siblings' caring roles in families with a child with epilepsy.
    Michelle Webster.
    Sociology of Health & Illness. October 11, 2017
    Despite large amounts of care for chronic conditions being provided within the family, information regarding the extent to which siblings contribute to informal care practices in families where a child has a chronic condition is limited. This article draws on multiple perspective data from 24 families that had a child with epilepsy. In doing so, the article illustrates siblings' significant contribution to caring for their brother or sister and further develops the alert assistant concept. Two additional distinct caring roles that the siblings took on are also outlined – the substitute parent and parenting assistant roles. The relationship between siblings' socio‐demographic characteristics and their caring responsibilities is also explored. The paper's findings are that siblings who were older, female and those in families with a higher child to parent ratio took on more caring responsibilities. Consequently, this article contributes to the currently limited literature on siblings who care for a chronically ill brother or sister by increasing understandings of different caring roles and experiences of chronic illness in families.
    October 11, 2017   doi: 10.1111/1467-9566.12627   open full text
  • The context of coping: a qualitative exploration of underlying inequalities that influence health services support for people living with long‐term conditions.
    Caroline M. Potter, Laura Kelly, Cheryl Hunter, Ray Fitzpatrick, Michele Peters.
    Sociology of Health & Illness. October 11, 2017
    Coping with chronic illness encapsulates both practical and emotional aspects of living life in relation to one's long‐term health condition(s). Dominant health psychology approaches for understanding coping, which underpin a more recent policy discourse on ‘self‐management’, focus sharply on the person affected by illness and potentially mask the influence of overarching social structure. In this paper we draw on qualitative interviews with 48 people living with long‐term conditions (LTCs), in order to highlight the role that structural configurations such as healthcare systems may play in either helping or hindering people's efforts to cope with chronic illness. We argue that coping is a social process in which health and related services, situated within their wider political‐economic contexts, play an active role in shaping people's attempts to live well with LTCs. More specifically, health systems are sites of social and cultural capital exchange that can differentially mobilise coping resources through access, continuity of care, and coordination across services. Whilst it is essential to recognise the personal agency of people living with chronic illness, it is also vital to acknowledge the underlying inequalities that affect the ways in which services can support such resourcefulness.
    October 11, 2017   doi: 10.1111/1467-9566.12624   open full text
  • Causal narratives in public health: the difference between mechanisms of aetiology and mechanisms of prevention in non‐communicable diseases.
    Michael P. Kelly, Federica Russo.
    Sociology of Health & Illness. October 11, 2017
    Research in the health sciences has been highly successful in revealing the aetiologies of many morbidities, particularly those involving the microbiology of communicable disease. This success has helped form a narrative to be found in numerous public health documents, about interventions to reduce the burden of non‐communicable diseases (e.g., obesity or alcohol related pathologies). These focus on tackling the purported pathogenic factors causing the diseases as a means of prevention. In this paper, we argue that this approach has been sub‐optimal. The mechanisms of aetiology and of prevention are sometimes significantly different and failure to make this distinction has hindered efforts at preventing non‐communicable diseases linked to diet, exercise and alcohol consumption. We propose a sociological approach as an alternative based on social practice theory. (A virtual abstract for this paper can be found at: https://www.youtube.com/channel/UC_979cmCmR9rLrKuD7z0ycA).
    October 11, 2017   doi: 10.1111/1467-9566.12621   open full text
  • Navigating the new, transplanted self: how recipients manage the cognitive risks of organ transplantation.
    Nicholas R. Cormier, Selina R. Gallo‐Cruz, Renee L. Beard.
    Sociology of Health & Illness. October 10, 2017
    The physiological risks of organ transplantation are well documented, but more poorly understood are the sociological ways in which organ recipients redefine themselves in reaction to physiological risks and social changes accompanying transplantation. This article analyses transplantation as a procedure that is not only physiologically risky but also poses risk to the social identity of the recipient, and explores how transplant recipients cognitively navigate transplantation surgery from waiting for to recovering after a transplant. It builds on previous sociological exploration of risk as a socially constructed process mediating experiences of health and illness with a focused contribution on explaining how individuals navigate risks posed to their social identities by major biophysical transformations. This article pointedly analyses narratives of fourteen organ recipients and the four dominant phases of identity management that emerged to create what we have coined as the new ‘transplanted self’, indicating the varied ways the individual social self emerges in response to the social risks of transplantation. We conclude that a better understanding of the recipient experience will contribute to improved care in the transplantation field.
    October 10, 2017   doi: 10.1111/1467-9566.12610   open full text
  • Exploring parkrun as a social context for collective health practices: Running with and against the moral imperatives of health responsibilisation.
    G. R. Wiltshire, Simone Fullagar, Clare Stevinson.
    Sociology of Health & Illness. October 08, 2017
    Critiques of public health policies to reduce physical inactivity have led to calls for practice‐led research and the need to reduce the individualising effects of health promotion discourse. The purpose of this paper is to examine how parkrun – an increasingly popular, regular, community‐based 5 km running event – comes to be understood as a ‘health practice’ that allows individuals to enact contemporary desires for better health in a collective social context. Taking a reflexive analytical approach, we use interview data from a geographically diverse sample of previously inactive parkrun participants (N = 19) to explore two themes. First, we argue that parkrun offers a space for ‘collective bodywork’ whereby participants simultaneously enact personal body projects while they also experience a sense of being ‘all in this together’ which works to ameliorate certain individualising effects of health responsibilisation. Second, we examine how parkrun figures as a health practice that makes available the subject position of the ‘parkrunner’. In doing so, parkrun enables newly active participants to negotiate discourses of embodied risk to reconcile the otherwise paradoxical experience of being an ‘unfit‐runner’. Findings contribute to sociological understandings of health and illness through new insights into the relation between health practices and emerging physical cultures, such as parkrun.
    October 08, 2017   doi: 10.1111/1467-9566.12622   open full text
  • The concept of chronicity in action: everyday classification practices and the shaping of mental health care.
    Milena D. Bister.
    Sociology of Health & Illness. October 05, 2017
    For almost half a century social scientists have explored the phenomenon of chronic illness. In this paper, I examine how the concept of chronicity participates in present‐day mental health care settings. Using ethnomethodology and material‐semiotic theory within science and technology studies, I investigate how the classification ‘chronically mentally ill’ interacts with the everyday socio‐material shaping of public mental health care in the context of professional institutions. Drawing on ethnographic fieldwork in a psychiatric day hospital and in a community day care centre in Berlin, Germany, I demonstrate how the classification of chronicity acts as a tool of description (of people or their conditions), regulation (of therapy, health care or administration), and connection to infrastructures of care (practised technologies or standards of various kinds). In these ways, I argue, the classification engages in actions of producing treatability, arranging resources, demarcating responsibilities, practicing accountability, and doing presence. Notably, community mental health care has developed into a designated territory of the concept: explicitly arranged for ‘the chronically mentally ill’ as a human kind, we can take everyday life in these institutions as instructive of how chronicity is defined in daily practice.
    October 05, 2017   doi: 10.1111/1467-9566.12623   open full text
  • From loss to repair. A study of body narratives in patient claims for medical injury.
    Myriam Winance, Janine Barbot, Isabelle Parizot.
    Sociology of Health & Illness. October 04, 2017
    In this article we examine the body's status in the complaints that patients filed with a compensation agency. Taking a corpus of letters, we analyse the way in which the patients mobilise their bodily experience from the angle of the damage for which they demand compensation. To this end, we articulate an approach in terms of the sociology of complaint with an approach rooted in the sociology of medicine, health and illness. To analyse the body narratives, we use the notion of loss. We highlight the manner in which patients approach their losses as ‘losses in practice’. These losses are defined by the patients putting forward the concrete experience of a body harmed by the treatment received, and by their formulation of expectations in terms of compensation. We therefore identify four ways in which the reality of the damaged body is given a form in terms of expectations of repair: the ‘body‐producer’, the ‘body‐ecological’, the ‘body‐help’ and the ‘body‐self‐image’. Our analysis adds to studies on the status of the body in care and in complaint by showing: the specific influence of the enunciative situation, the plurality of patient evaluations and their temporal dynamic.
    October 04, 2017   doi: 10.1111/1467-9566.12620   open full text
  • Body weight, perceived weight stigma and mental health among women at the intersection of race/ethnicity and socioeconomic status: Insights from the modified labelling approach.
    Gabriele Ciciurkaite, Brea L. Perry.
    Sociology of Health & Illness. October 04, 2017
    With increasing rates of obesity in the United States, attention to life chances and psychological consequences associated with weight stigma and weight‐based discrimination has also intensified. While research has demonstrated the negative effects of weight‐based discrimination on mental health, little is known about whether different social groups are disproportionately vulnerable to these experiences. Drawing on the modified labelling theory, the focus of this paper is to investigate the psychological correlates of body weight and self‐perceived weight‐based discrimination among American women at the intersection of race/ethnicity and socioeconomic status (SES). Analyses use data from the National Health Measurement Study (NHMS), a national multi‐stage probability sample of non‐institutional, English‐speaking adults, ages 35 to 89 in 2005–2006. Our findings demonstrate that the effect of weight‐based discrimination on psychological well‐being is highly contingent on social status. Specifically, the psychological consequences of discrimination on Hispanic women and women in the lowest household income group is significantly greater relative to White women and women with higher household income, controlling for obesity status and self‐rated health. These results suggest that higher social status has a buffering effect of weight stigma on psychological well‐being.
    October 04, 2017   doi: 10.1111/1467-9566.12619   open full text
  • Ideology and resistance in young people's experiences of health under the ‘imperative of enjoyment’.
    Kathrine Vitus.
    Sociology of Health & Illness. September 17, 2017
    This article explores upper secondary school students’ understandings and experiences of health in Denmark, where public health promotions appeal to pleasure. Health promotion thereby taps into capitalist society's ‘imperative of enjoyment’, which reproduces ideological fantasies about the fulfilment of desires through the consumption of health. Based on qualitative empirical material produced through participatory and visual methods during fieldwork conducted in 2012, the analysis shows that relations between healthiness and pleasure are conflated and paradoxical: the students try to fit into society not only by being healthy, but also by enjoying healthiness; but if they fail pleasure, they fail healthiness and experience a loss of individual social value. Although the ‘enjoyment society’ has the potential to produce individualisation and marginalisation, the students in this study actively attempt to subvert its double bind by insisting that collective experiences with peers constitutes the foundation of enjoyable healthiness. Nevertheless, public health promotions that reproduce enjoyment as an imperative, even in the pursuit of health, risk reinforcing young people's resistance towards health.
    September 17, 2017   doi: 10.1111/1467-9566.12611   open full text
  • Managing risk and patient involvement in choosing treatment for cancer: an analysis of two communication practices.
    Francesca Alby, Marilena Fatigante, Cristina Zucchermaglio.
    Sociology of Health & Illness. August 21, 2017
    Drawing on conversation analyses of oncology consultations collected in Italy, the article examines the communication practices used to recommend treatments. We found that the oncologist formulates the treatment recommendation (TR) for high‐risk patients in terms of a ‘mandatory’ choice and for low‐risk patients as an ‘optional’ type of decision. In the first case the doctor presses to reach a decision during the visit while in the second case leaves the decision open‐ended. Results show that high‐risk patients have less time to decide, are pressured towards choosing an option, but have more opportunities for involvement in TR during the visit. Low‐risk patients instead have more time and autonomy to make a choice, but they are also less involved in the decision‐making in the visit time. Moreover, we document that TR is organised through sequential activities in which the oncologist informs the patient of alternative therapeutic options while at the same time building a case for the kind of treatment she/he believes to be best for the patient's health. We suggest that in this field risk plays a key role in decision‐making which should be better understood with further studies and taken into account in the debate on shared decision‐making and patient‐centred communication.
    August 21, 2017   doi: 10.1111/1467-9566.12598   open full text
  • The role of alcohol in identity construction among LGBT people: a qualitative study.
    Carol Emslie, Jemma Lennox, Lana Ireland.
    Sociology of Health & Illness. August 19, 2017
    Research suggests that alcohol use and misuse are higher among lesbian, gay and bisexual than heterosexual populations, yet the social context of drinking in sexual minority communities has rarely been examined. To explore lesbian, gay, bisexual and transgender (LGBT) people's relationship with alcohol, we conducted seven focus groups (N = 33) with pre‐existing groups of friends and work colleagues (18 to 52 years) in Scotland, UK. We identified and analysed patterns in our data using thematic analysis. Respondents perceived heavy drinking as central to the commercial gay scene. Choice of drink and drinking vessel was an important part of identity construction. Respondents discussed the perception that gay men would drink alcopops and cocktails while lesbians would drink pints of beer. Even when stereotypes were dismissed as inaccurate, they were still thought to pressure people to drink ‘appropriately’. Respondents who did not identify as male or female, and those who used drag, were particularly aware of their choice of drink as a means to express identity or to challenge people's preconceptions about gender. Researchers developing interventions to reduce alcohol‐related harm in sexual minority populations need to take account of the central role of identity construction in LGBT drinking practices.
    August 19, 2017   doi: 10.1111/1467-9566.12605   open full text
  • The gas that fuels the engine: Individuals’ motivations for medicalisation.
    Ann V. Bell.
    Sociology of Health & Illness. August 16, 2017
    It is well established that the drivers of medicalisation have shifted alongside changes in the institution of medicine. The process of medicalisation is no longer incited by macro processes of institutional prestige or control; rather, individual patients/consumers are pushing the process forward. The present study complicates this neat transition and examines the relationship between structure and agency using the case of assisted reproductive technology (ART), specifically the medicalisation of lesbian reproduction in the US. I explore individuals’ influence on and motivations towards medicalisation through 24 in‐depth interviews with women in same‐sex relationships who had ever attempted to become pregnant. In centring on their experiences, I find that while individual consumers may now propel medicalisation forward, oftentimes consumers’ motivations for doing so reside in the prestige and control of medicine. In other words, consumers now seek medicalisation precisely because of the process's previous institutional drivers. In exploring what fuels the engine of medicalisation, the findings reveal its nuance and complexity.
    August 16, 2017   doi: 10.1111/1467-9566.12607   open full text
  • Dynamics between doctors and managers in the Italian National Health Care System.
    Giovanna M. Vicarelli, Emmanuele Pavolini.
    Sociology of Health & Illness. August 03, 2017
    This article focuses on the changes in the Italian NHS by concentrating on patterns in the managerialisation of doctors. It addresses a series of shortcomings in studies on the response by doctors to managerialisation. The first is a shortcoming of theoretical and analytical nature. It is necessary to adopt a broader perspective whereby analysis considers not only the interaction between doctors and managers, but also the public control and regulation agencies that operate in that field. The second shortcoming is a methodological one. The literature on managerialisation is more theoretical than applied. It is necessary to adopt a strategy based on a plurality of methodologies and sources in order to focus attention on a national case (Italy in the present study), discussing the changes over time (from the beginning of managerialisation until today) and considering different groups within the medical profession. The outcome is a complex picture of the dynamics between doctors and managers which foregrounds the managerial co‐optation processes of a small group of national health service doctors, the transition from strategic adaptation to forms of resistance against managerialisation by the majority of Italian NHS doctors, and the emergence of restratification processes among self‐employed doctors working with the NHS.
    August 03, 2017   doi: 10.1111/1467-9566.12592   open full text
  • Falling into a routine: from habits to situated practices.
    Simon Cohn, Rebecca Lynch.
    Sociology of Health & Illness. July 21, 2017
    In line with the concept of ‘nudging’ people to change their behaviour, there has been increased attention on habit as a focus for psychologically‐based health interventions. It is hoped that behaviours initiated by interventions not only become so regular that they are normalised into people's everyday lives, but that through repetition they may eventually become fixed and habitual. In this paper we draw on people's accounts of participating in a trial designed to encourage greater physical activity, and attend to the ways they describe their engagement with interventions within wider narratives of their everyday lives. In contrast to the idea that habit refers to automatic behaviour cued by external stimuli and governed by unconscious cognitive processes, our study describes how people identify many diverse elements that are felt to have equal significance in achieving a routine. Paradoxically, the sense of stability derives not from exact repetition, but from the ability for an assemblage of elements to be configured slightly differently each time. We consequently argue that attending to the diverse range of contextual elements bracketed off from interventions designed to be tested in trials, and the idea that continuity might emerge from variation, demands a reconceptualisation of the concept of habit adopted within many areas of current health psychology.
    July 21, 2017   doi: 10.1111/1467-9566.12597   open full text
  • Putting public health infrastructures to the test: Introducing HPV vaccination in Austria and the Netherlands.
    Katharina T. Paul, Iris Wallenburg, Roland Bal.
    Sociology of Health & Illness. July 17, 2017
    This article presents two cases of policymaking concerning the vaccine against Human Papilloma Virus (HPV), which is sexually transmitted and carcinogenic. Our analysis focuses on its introduction in Austria and the Netherlands. In both contexts, we find prevention and screening to be at once complementary and competing public health logics and we draw on the concept of ‘infrastructure’ to understand their roles in shaping the reception of the vaccine. We reveal how the HPV vaccine had to be made ‘good enough’, much like the Pap smear (Casper and Clarke ), by means of diverse tinkering practices that transformed both the technology and the infrastructures in which they emerged. At the same time, it was important that the vaccine would not come to problematise Pap smear‐based screening. The article points to the contextually contingent nature of policymaking around new medical technologies, and the skillful care with which public health infrastructures such as immunisation and screening programmes are handled and tinkered with.
    July 17, 2017   doi: 10.1111/1467-9566.12595   open full text
  • Exchanging implements: the micro‐materialities of multidisciplinary work in the operating theatre.
    Christian Heath, Paul Luff, Marcus Sanchez‐Svensson, Maxim Nicholls.
    Sociology of Health & Illness. July 14, 2017
    Surgical procedures rely upon an array of commonplace tools, implements and materials that mediate practice and disciplinary collaboration within the operating theatre. Substantial time is dedicated to the issue and provision of these artefacts and their timely exchange is critical to the successful accomplishment of surgical procedures. In this article, we consider the practice, knowledge and agency that informs how particular implements and materials are passed by the scrub nurse to the surgeon that in turn enables their deployment with regard to the particular procedure and the contingencies ‘at hand’. We address the technicalities of these ‘non‐technical skills’ and examine how they rely upon a disciplinary vision and interactional organisation that informs both the scrutiny of action and the ways in which implements and materials are handled and exchanged. We explore the implications of our analysis for our understanding of agency in action and the growing interest in developing robots or autonomous agents to support work and collaboration in health care.
    July 14, 2017   doi: 10.1111/1467-9566.12594   open full text
  • Now or never: smoking cessation discussions in the face of serious illness.
    Clara Iversen.
    Sociology of Health & Illness. July 06, 2017
    Sociological research on medical discussions of lifestyle suggests that smoking patients may be seen as knowingly causing their medical problems. Therefore, it may be interactionally problematic for doctors to raise the issue of smoking cessation in relation to patients’ serious health problems. While a serious illness can be expected to bring to the fore the relevance of smoking cessation advice, it may also give rise to questions about patients’ right to treatment. This study uses conversation analysis to explicate how patients and doctors manage issues of responsibility in smoking cessation discussions in the face of a serious medical problem that strongly correlates with smoking. The findings show that whilst ill health can be referred to in a confrontational manner, it can also give smoking cessation a ‘now or never’ status that downplays patients’ responsibility for not having quit before. Based on these findings, the paper concludes that for warranting further smoking cessation advice, how doctors and patients verbalise the link between smoking and a serious medical problem matters more than whether they do so.
    July 06, 2017   doi: 10.1111/1467-9566.12588   open full text
  • On the advancement of therapeutic penality: therapeutic authority, personality science and the therapeutic community.
    Ruari‐Santiago McBride.
    Sociology of Health & Illness. June 23, 2017
    In this article I examine the advancement of therapeutic penality in the UK, a penal philosophy that reimagines prison policy, practices and environments utilising psychological knowledge. Adopting a historical approach, I show how modern therapeutic penality is linked to the emergence of personality science in the nineteenth century and the development of the democratic therapeutic community (DTC) model in the twentieth century. I outline how at the turn of the twenty‐first century a catalytic event generated a moral panic that led the British government to mobilise psychological knowledge and technologies in an attempt to manage dangerous people with severe personality disorder. Tracing subsequent developments, I argue psychological ways of talking, thinking and acting have obtained unparalleled salience in domains of penality and, in turn, radically transformed the conditions of imprisonment.
    June 23, 2017   doi: 10.1111/1467-9566.12583   open full text
  • A ‘movement for improvement’? A qualitative study of the adoption of social movement strategies in the implementation of a quality improvement campaign.
    Justin Waring, Amanda Crompton.
    Sociology of Health & Illness. June 21, 2017
    Given the difficulties of implementing ‘top‐down’ quality improvements, health service leaders have turned to methods that empower clinicians to co‐produce ‘bottom‐up’ improvements. This has involved the adoption of strategies and activities associated with social movements, with clinicians encouraged to participate in collective action towards the shared goal of improvement. This paper examines the adoption of social movement methods by hospital managers as a strategy for implementing a quality improvement ‘campaign’. Our case study suggests that, despite the claim of empowering clinicians to develop ‘bottom‐up’ improvements, the use of social movement methods can be more narrowly concerned with engaging clinicians in pre‐determined programmes of ‘top‐down’ change. It finds a prominent role for ‘hybrid’ clinical leaders and other staff representatives in the mobilisation of the campaign, especially for enrolling clinicians in change activities. The work of these ‘hybrids’ suggests some degree of creative mediation between clinical and managerial interests, but more often alignment with the aspirations of management. The study raises questions about the translation of social movement's theories as a strategy for managing change and re‐inventing professionalism.
    June 21, 2017   doi: 10.1111/1467-9566.12560   open full text
  • Pathways to professionalism? Quality improvement, care pathways, and the interplay of standardisation and clinical autonomy.
    Graham P. Martin, David Kocman, Timothy Stephens, Carol J. Peden, Rupert M. Pearse,.
    Sociology of Health & Illness. June 21, 2017
    Care pathways are a prominent feature of efforts to improve healthcare quality, outcomes and accountability, but sociological studies of pathways often find professional resistance to standardisation. This qualitative study examined the adoption and adaptation of a novel pathway as part of a randomised controlled trial in an unusually complex, non‐linear field – emergency general surgery – by teams of surgeons and physicians in six theoretically sampled sites in the UK. We find near‐universal receptivity to the concept of a pathway as a means of improving peri‐operative processes and outcomes, but concern about the impact on appropriate professional judgement. However, this concern translated not into resistance and implementation failure, but into a nuancing of the pathways‐as‐realised in each site, and their use as a means of enhancing professional decision‐making and inter‐professional collaboration. We discuss our findings in the context of recent literature on the interplay between managerialism and professionalism in healthcare, and highlight practical and theoretical implications.
    June 21, 2017   doi: 10.1111/1467-9566.12585   open full text
  • Women, weight, poverty and menopause: understanding health practices in a context of chronic disease prevention.
    Mélisa Audet, Alex Dumas, Rachelle Binette, Isabelle J. Dionne.
    Sociology of Health & Illness. June 10, 2017
    Socioeconomic inequalities in health persist despite major investments in illness prevention campaigns and universal healthcare systems. In this context, the increased risks of chronic diseases of specific sub‐groups of vulnerable populations should be further investigated. The objective of this qualitative study is to examine the interaction between socioeconomic status (SES) and body weight in order to understand underprivileged women's increased vulnerability to chronic diseases after menopause. By drawing specifically on Pierre Bourdieu's sociocultural theory of practice, 20 semi‐structured interviews were conducted from May to December of 2013 to investigate the health practices of clinically overweight, postmenopausal women living an underprivileged life in Canada. Findings emphasise that poor life conditions undermine personal investment in preventive health and weight loss, showing the importance for policy makers to bring stronger consideration on upstream determinants of health.
    June 10, 2017   doi: 10.1111/1467-9566.12593   open full text
  • Ageing and memory medication: social rationales and consumption practices.
    Noémia Lopes, Elsa Pegado, Joana R. Zózimo.
    Sociology of Health & Illness. June 09, 2017
    This article focuses on the social rationales underlying the consumption or rejection of medication for memory by the elderly. Our analysis is set within the wider frame of the current use of psychopharmaceuticals for the enhancement of everyday performance, discussing its relationship to new cultures of ageing. Our results, from a recently concluded study, point to different patterns of investment in memory in old age. On the one hand, we found a willingness to consume medication for memory – a heterogeneous disposition split between the imaginary of disease and that of performance enhancement. On the other hand, we found a cultural resistance and scepticism towards the use of psychopharmaceuticals for performance purposes. This suggests that a new frame of psychopharmaceuticalization of old age – represented by memory medication – is prompting different rationales, ranging from consumption to resistance.
    June 09, 2017   doi: 10.1111/1467-9566.12586   open full text
  • Contingent maternities? Maternal claims‐making in third party reproduction.
    Katherine M. Johnson.
    Sociology of Health & Illness. June 08, 2017
    The new reproductive technologies have significantly impacted definitions of motherhood. Historically, mothers were defined through the act of giving birth, but egg donation, embryo donation, and surrogacy disrupt this. Now multiple women can potentially claim maternity through gestational, genetic, legal, and social ties. Although there is some legal precedent for designating parentage, there is no simple solution to identify the ‘true’ mother. I address maternal claims‐making in third party reproduction via a content analysis of US patient literature for infertile women. Major tensions arise over which link to privilege, especially regarding genetic versus gestational ties in egg donation versus surrogacy; however, adding embryo donation to the analysis illuminates another crucial dimension previously overlooked – that heterosexual women's maternal claims are supported by their partner's paternity claims. Ultimately, I argue that although reproductive organisational discourse carefully constructs credible options for maternal claims‐making, contemporary reproductive medicine does not define maternity through assisted reproduction as a truly autonomous connection. Rather, maternity is highly contingent and thus potentially discreditable.
    June 08, 2017   doi: 10.1111/1467-9566.12589   open full text
  • The silencing effects of the childhood innocence ideal: the perceptions and practices of fathers in educating their children about sexuality.
    Clare Bennett, Jane Harden, Sally Anstey.
    Sociology of Health & Illness. June 07, 2017
    This study employed Interpretative Phenomenological Analysis to explore eight fathers’ perceptions and practices in talking to their ten year old children about puberty, relationships and reproduction. The fathers participated in face to face interviews which were analysed idiographically initially, followed by analysis at the group level. Interpretations were then developed through critical application of a Foucauldian lens of governmentality and biopower. The results revealed a tension between the fathers’ cognitions, accounts and behaviours. Their practices were largely characterised by silence yet they reported positive attitudes towards children's sexuality education and perceived themselves as equipped and willing to take on the role of sexuality educator. They also reported enjoying open relationships with their children. Interpretations centred on contradictions and conflict between the majority of the fathers’ aspirations and the compelling nature of the childhood innocence discourse as a technology of governmentality. Whilst all of the fathers felt that it was in their children's interests to learn about sexuality, all but one adhered to hegemonic protective discourses and unquestioningly integrated their normalising effects into their fathering practices which, it is argued, may paradoxically render their children more vulnerable both now and in the future.
    June 07, 2017   doi: 10.1111/1467-9566.12591   open full text
  • Market‐driven production of biospecimens and the role of NHS hospital‐led biobanks.
    Stephen Timmons, Paraskevas Vezyridis.
    Sociology of Health & Illness. May 27, 2017
    Biobanks are vital for biospecimen production in research, despite the regulatory, recruitment and commercial difficulties they face. We conducted interviews with clinicians, researchers, volunteers who recruit biobank participants, regulators and NHS managers about the integration of a biobank into an NHS hospital. We show that medical waste collected for biomedical research acquires its socio‐ethical and economic value from the level of integration (both technologically and organisationally) of the biobank into the NHS hospital. There is extensive investment in a range of intellectual and commercial relationships and labour among stakeholders involved in the production of biospecimens. It is not only the boundaries of research, clinical care and commercialisation of biospecimens that blur but also those of volunteerism and citizenship. Hospital‐led biobanks provide an opportunity to study the intertwining of biomedical innovation and healthcare.
    May 27, 2017   doi: 10.1111/1467-9566.12584   open full text
  • The everyday risk work of Dutch child‐healthcare professionals: Inferring ‘safe’ and ‘good’ parenting through trust, as mediated by a lens of gender and class.
    Gerlieke Veltkamp, Patrick Brown.
    Sociology of Health & Illness. May 24, 2017
    Amidst intensifying policy concerns with children's wellbeing and development, healthcare professionals are required not only to assess risk of abuse and neglect, but to manage risk of ‘poor parenting’ more broadly. Drawing on 15 in‐depth interviews and non‐participant observations of 61 professional‐family interactions, across four preventative public health services for children in the Netherlands, we explored how professionals accomplished such risk work amid intractable uncertainties. Building inferences from brief encounters with families, professionals gauged the extent to which they trusted parents to care ‘appropriately’. This trust developed most readily with parents experienced as ‘familiar’ by the largely middle‐class female professionals. Harnessing Schutzian phenomenology, we analyse the related manifestations of social structure within the interactional‐dynamics and lifeworlds of risk assessment. We argue that social structures of gender, class and ethnicity can be seen as influential both through the differing potential for ‘we‐relationships’ to be formed and via the generalising and stereotyped knowledge applied in their absence.
    May 24, 2017   doi: 10.1111/1467-9566.12582   open full text
  • The company you keep: Is socialising with higher‐status people bad for mental health?
    Min‐Ah Lee, Ichiro Kawachi.
    Sociology of Health & Illness. May 24, 2017
    Socialising with higher‐status individuals can be hypothesised to exert opposing influences on the mental health of the ego. On the one hand, socialising with higher‐status alters might enable individuals to access valuable resources. On the other hand, status‐discrepant friendships could be detrimental to mental health by engendering feelings of unfairness. We sought to examine the impact of status‐discrepant social relationships on depressive symptoms in the 2012 Korean General Social Survey (KGSS), a nationally representative sample. We show that socialising with higher‐status people is positively associated with depressive symptoms. There is no significant difference between those socialising with equivalent‐status or with lower‐status alters. Perceived unfairness also increase depressive symptoms. Respondents socialising with higher‐status alters tend to report greater depressive symptoms as their perceived unfairness increases. Gender‐stratified analyses reveal that the detrimental impact of status‐discrepant relationships are observed for men only, not for women. These findings suggest that socialising with higher‐status people can be a net detriment for mental wellbeing by increasing stress/frustration or decreasing psychological resources such as self‐esteem, and that these effects are more pronounced for individuals who perceive that society is unfair. This pattern appears stronger for men, which might be associated with gender roles internalised through gender socialisation processes.
    May 24, 2017   doi: 10.1111/1467-9566.12580   open full text
  • Balancing medical accuracy and diagnostic consequences: diagnosing medically unexplained symptoms in primary care.
    Erik B. Rasmussen.
    Sociology of Health & Illness. May 18, 2017
    Focusing on the case of medically unexplained symptoms (MUS), this article explores diagnostic classification in the absence of biomedical evidence or other strong medical warrants for diagnosis. The data are from three focus group interviews with Norwegian general practitioners (GPs) conducted in 2015, that centred on the issue of what diagnoses to use (or not) for MUS. The qualitative analysis reconstructs the logic underlying GPs’ diagnostic accounts, which centred on the meaning of diagnostic categories and on anticipating how ‘generalised others’ would respond to those meanings (called ‘diagnosing by anticipation’). The analysis suggests that GPs confer diagnoses by balancing unwarranted medical accuracy and anticipated harmful diagnostic consequences; the goal of diagnosis was finding categories in the International Classification of Primary Care that would yield acceptable results, without making a liar of the GP in the process. Drawing on the distinction between diagnosis as colligation and classification, the findings and their relevance for medical sociology are discussed. Counter to frequent descriptions as ‘illness that cannot be diagnosed’, the analysis shows how GPs can diagnose MUS in the bureaucratic sense of diagnosis as classification – a sense that has been missing from sociological view.
    May 18, 2017   doi: 10.1111/1467-9566.12581   open full text
  • Wanting to work: managing the sick role in high‐stake sickness insurance meetings.
    Marie Flinkfeldt.
    Sociology of Health & Illness. May 15, 2017
    This article respecifies and develops Parsons's sick role theory, focusing on the postulate that the sick person must ‘want’ to get well. Using conversation analysis and discursive psychology to study how the psychological term ‘want’ is used in high‐stake, multi‐professional meetings with sickness benefit claimants in Sweden, the article shows how establishing that one ‘wants’ to get well requires extensive interactional work. In the examined meetings, the sick person's ‘want’ formulations make explicit the relationship between ‘wants’ and illness or inabilities, thus allowing for motivational character to be established without committing to its implications, and without appearing strategic or biased. By contrast, professional parties in the meetings invoke the sick person's ‘wants’ either to hold them accountable, or for establishing a desired course of recovery, confirming the centrality of such ‘wants’ in this setting as well as the risks associated with expressing them. The article suggests that analysing psychological matters as they are oriented to by participants renders sick role theory relevant for a wide range of settings and respecifies criticism of the model.
    May 15, 2017   doi: 10.1111/1467-9566.12567   open full text
  • The concept of medicalisation reassessed: a response to Joan Busfield.
    Simon J. Williams, Catherine Coveney, Jonathan Gabe.
    Sociology of Health & Illness. April 20, 2017
    There is no abstract available for this paper.
    April 20, 2017   doi: 10.1111/1467-9566.12576   open full text
  • Dream homes and dead ends in the city: a photo essay experiment.
    Danya Fast.
    Sociology of Health & Illness. April 20, 2017
    Research focused on the relationship between place and health demonstrates that it is complex and shifting, as overlapping social, historical, institutional and political and economic processes continually transform the landscapes in which lived experiences are embedded. Understanding this relationship requires knowledge of the situated meanings and local worlds that ethnographic methods are well suited to investigate. However, even conventional ethnographic methods can be inadequate to capture the embodied, lived experience of place – experiences in which the sensory and inner processes of memory and imagination are often privileged. Accessing these experiences and processes can require more experimental methodological approaches. In this article, I present work from a series of photo essays created between 2011 and 2016 by 15 young people who inhabit the social, spatial and economic margins of Vancouver, Canada, and discuss some of the challenges and opportunities presented by this methodology. Created over 5 years, and broadly focused on how they understood, experienced and navigated their ‘place’ in the city in the midst of poverty, addiction, violence and physical and mental health crises, the photo essays young people produced are embedded with personal biographies and trajectories, as well as shared experiences of geography, precarity and possibility in Vancouver.
    April 20, 2017   doi: 10.1111/1467-9566.12563   open full text
  • Engaging conceptions of identity in a context of medical pluralism: explaining treatment choices for everyday illness in Niger.
    Kelley Sams.
    Sociology of Health & Illness. April 20, 2017
    This article uses ethnographic research to reflect upon how the treatment of ‘everyday’ illnesses in Niger engages concepts of social identity. Inspired by Bourdieu's concept of social distinction, as well as Appadurai's edited volume on the ‘social lives’ of ‘things’, I present an analysis of how medications are understood by their users in terms of social and ideological meaning in one rural Hausa village. Decisions about medication choice were framed by three main themes: belonging to the ‘modern’ world, ‘traditional’ Hausa culture, and religious identity. This article does not argue that these notions of identity fully explain medication use, nor necessarily predict treatment choices. The purpose of this paper is to reflect on the dynamic meanings given to treatment decisions after they have been made, attributed to the medications themselves and negotiated through their circulation in a context where multiple medical systems are drawn from to manage illness. Producers and sellers of medication also engage these meaning‐centred concepts, which have theoretical and practical interest for the social sciences and public health. A virtual abstract for this paper can be viewed at: https://www.youtube.com/channel/UC_979cmCmR9rLrKuD7z0ycA
    April 20, 2017   doi: 10.1111/1467-9566.12564   open full text
  • Beyond guidelines: discretionary practice in face‐to‐face triage nursing.
    Lars E.F. Johannessen.
    Sociology of Health & Illness. April 20, 2017
    This article draws on ethnographic data from a Norwegian emergency primary care clinic (EPCC) to explore nurses’ discretionary application of guidelines. Specifically, it analyses nurses’ discretionary use of the Manchester Triage System (MTS) when performing face‐to‐face triage, that is, assessing the urgency of patients’ complaints. The analysis shows how nurses assessed patients at odds with MTS prescriptions by collecting supplementary data, engaging in differential diagnostic and holistic reasoning, relying on emotion and intuition, and allowing colleagues and patients to influence their reasoning. The findings also show how nurses’ reasoning led them to override guidelines both overtly and covertly. Based on this evidence, it is argued that nurses’ assessments relied more on internalised ‘triage mindlines’ than on codified triage guidelines, although the MTS did function as a support system, checklist and system for supervisory control. The study complements existing research on standardisation in nursing by providing an in‐depth analysis of nurses’ methods for navigating guidelines and by detailing how deviations from those guidelines spring from their clinical reasoning. The challenges of imposing a managerial logic on professional labour are also highlighted, which is of particular relevance in light of the drive towards standardisation in modern healthcare.
    April 20, 2017   doi: 10.1111/1467-9566.12578   open full text
  • ‘It seems like you're going around in circles’: recurrent biographical disruption constructed through the past, present and anticipated future in the narratives of young adults with inflammatory bowel disease.
    Benjamin Saunders.
    Sociology of Health & Illness. April 20, 2017
    Biographical disruption and related concepts continue to be widely drawn upon in explaining how individuals experience chronic illness. Through in‐depth examination of the narrative experiences of two young adults with inflammatory bowel disease (IBD), this article aims to contribute to the continuing theoretical elaboration of biographical disruption, and in turn offer new insights into how young adults experience this condition. The cases are analysed from an interaction‐based, constructionist perspective, through which it is argued that the relapse‐remission nature of IBD can give rise to a particular form of recurrent biographical disruption, constructed in narrative through a complex configuration of past, present and anticipated future experiences. The two young adults are found to give different meaning to this recurrent disruption in terms of its significance and consequences – whilst Samuel represents an ongoing cycle of profound disruption and biographical reinstatement, Edith normalises the cycle of disruption and its role in her ongoing biography. Therefore, moving beyond the notion of ‘normal illness’ observed in previous research literature, the concept of ‘normal recurrent disruption’ is proposed. Finally, it is argued that this recurrent biographical disruption may be experienced particularly severely in young adulthood owing to the unique pressures and expectations of this lifestage.
    April 20, 2017   doi: 10.1111/1467-9566.12561   open full text
  • Molecularisation and metaphor.
    David Armstrong.
    Sociology of Health & Illness. April 20, 2017
    This article explores the molecularisation of medicine thesis by investigating reports on genetics and molecular medicine in the New England Journal of Medicine. While there has indeed been a large increase in the number of references to molecules in the context of genetics over the last few decades these are mostly embedded in a framework of explanatory metaphors, namely (gene) expressivity, penetrance, regulation and pathways. As most of these metaphors are drawn from the social world it would appear that the molecularisation thesis – that social life is becoming dominated by the molecular – needs to be tempered by the ways in which understanding of that molecular world is itself a reflection of social life.
    April 20, 2017   doi: 10.1111/1467-9566.12579   open full text
  • Keeping out and getting in: reframing emergency department gatekeeping as structural competence.
    Mara Buchbinder.
    Sociology of Health & Illness. April 19, 2017
    Sociologists have tended to frame medical gatekeeping as an exclusionary social practice, delineating how practitioners and clerical staff police the moral boundaries of medicine by keeping out patients who are categorised as ‘bad’, ‘deviant’, or otherwise problematic. Yet medical gatekeeping, understood more broadly, can include not only keeping patients out of particular clinical settings, but also redirecting them to alternative sources of care. In this article, I draw on qualitative analysis of audio‐recorded patient‐provider interactions in a United States emergency department (ED) to illustrate medical gatekeeping as a two‐step process of, first, categorising certain patient complaints as unsuitable for treatment within a particular setting, and second, diverting patients to alternative sites for care. I refer to these as the restrictive and facilitative components of medical gatekeeping to denote how each relates to patients’ access to care, recognising that both components of medical gatekeeping are part of a coordinated organisational strategy for managing resource scarcity. By illustrating how ED providers reveal intimate knowledge of structural vulnerabilities in diverting socioeconomically disadvantaged patients with chronic back pain to clinical sites that are better equipped to provide care, I suggest that we rethink the emphasis on restrictive practices in sociological accounts of medical gatekeeping.
    April 19, 2017   doi: 10.1111/1467-9566.12566   open full text
  • Remains of care: opioid substitution treatment in the post‐welfare state.
    Anna Leppo, Riikka Perälä.
    Sociology of Health & Illness. April 19, 2017
    This article examines how the amplified role of pharmaceutical substances in addiction treatment affects the everyday realisation of care, particularly the relationship between workers and patients, in so called austere environments. Theoretically the article draws firstly on the literature that links pharmaceuticalisation to the neoliberal undoing of central public structures and institutions of care, and secondly on Anne‐Marie Mol's concept of the logic of care. Based on an ethnographic analysis of the everyday life at a Finnish opioid substitution treatment clinic we show the mechanisms through which the realisation of pharmacotherapy can, in the current political climate, result in a very narrow understanding of drug problems and minimal human contact between patients and professionals. Our analysis manifests an important shift in the logic of addiction treatment and health‐care policy more broadly; namely, a growing tendency to emphasise the need for patients to care for themselves and make good choices with limited help from formal care institutions and professionals. We call this new ethos the logic of austerity.
    April 19, 2017   doi: 10.1111/1467-9566.12550   open full text
  • ‘Fundamental causes’ of inequalities in mortality: an empirical test of the theory in 20 European populations.
    Johan P. Mackenbach, Caspar W.N. Looman, Barbara Artnik, Matthias Bopp, Patrick Deboosere, Chris Dibben, Ramune Kalediene, Katalin Kovács, Mall Leinsalu, Pekka Martikainen, Enrique Regidor, Jitka Rychtaříková, Rianne Gelder.
    Sociology of Health & Illness. March 31, 2017
    The ‘fundamental causes’ theory stipulates that when new opportunities for lowering mortality arise, higher socioeconomic groups will benefit more because of their greater material and non‐material resources. We tested this theory using harmonised mortality data by educational level for 22 causes of death and 20 European populations from the period 1980–2010. Across all causes and populations, mortality on average declined by 2.49 per cent (95%CI: 2.04–2.92), 1.83% (1.37–2.30) and 1.34% (0.89–1.78) per annum among the high, mid and low educated, respectively. In 69 per cent of cases of declining mortality, mortality declined faster among the high than among the low educated. However, when mortality increased, less increase among the high educated was found in only 46 per cent of cases. Faster mortality decline among the high educated was more manifest for causes of death amenable to intervention than for non‐amenable causes. The difference in mortality decline between education groups was not larger when income inequalities were greater. While our results provide support for the fundamental causes theory, our results suggest that other mechanisms than the theory implies also play a role.
    March 31, 2017   doi: 10.1111/1467-9566.12562   open full text
  • Bridging the discursive gap between lay and medical discourse in care coordination.
    Rod Sheaff, Joyce Halliday, Richard Byng, John Øvretveit, Mark Exworthy, Stephen Peckham, Sheena Asthana.
    Sociology of Health & Illness. March 28, 2017
    For older people with multiple chronic co‐morbidities, strategies to coordinate care depend heavily on information exchange. We analyse the information‐sharing difficulties arising from differences between patients’ oral narratives and medical sense‐making; and whether a modified form of ‘narrative medicine’ might mitigate them. We systematically compared 66 general practice patients’ own narratives of their health problems and care with the contents of their clinical records. Data were collected in England during 2012–13. Patients’ narratives differed from the accounts in their medical record, especially the summary, regarding mobility, falls, mental health, physical frailty and its consequences for accessing care. Parts of patients’ viewpoints were never formally encoded, parts were lost when clinicians de‐coded it, parts supplemented, and sometimes the whole narrative was re‐framed. These discrepancies appeared to restrict the patient record's utility even for GPs for the purposes of risk stratification, case management, knowing what other care‐givers were doing, and coordinating care. The findings suggest combining the encoding/decoding theory of communication with inter‐subjectivity and intentionality theories as sequential, complementary elements of an explanation of how patients communicate with clinicians. A revised form of narrative medicine might mitigate the discursive gap and its consequences for care coordination.
    March 28, 2017   doi: 10.1111/1467-9566.12553   open full text
  • Contract care in dentistry: sense‐making of the concept and in practice when multiple institutional logics are at play.
    Ylva Ulfsdotter Eriksson, Karin Berg, Ulla Wide Boman, Magnus Hakeberg.
    Sociology of Health & Illness. March 23, 2017
    In 2009 contract dental care was introduced into Sweden's Public Dental Service under a programme called Dental Care for Health (DCH). Previous research has revealed a possible dilemma whereby dental care professionals had the role of insurance agent foisted upon them, as they were assigned the task of ‘selling contracts’. Using qualitative interviews, this study explores how these professionals make sense of contract dental care today. Drawing on the concepts of occupational and organisational professionalism, in combination with the institutional logics perspective, we discern that dental care professionals are entangled in multiple rationalities when reasoning about and dealing with DCH. A professional logic comes into play over health issues and preventive care, while market and corporate logics are present in relation to selling contracts and taking responsibility for the financial aspects of DCH, all of which creates tensions in these professionals. Overall, dental care professionals in the welfare sector respond both to an organisational and an occupational professionalism.
    March 23, 2017   doi: 10.1111/1467-9566.12543   open full text
  • Margins of freedom: a field‐theoretic approach to class‐based health dispositions and practices.
    Patrick John Burnett, Gerry Veenstra.
    Sociology of Health & Illness. March 23, 2017
    Pierre Bourdieu's theory of practice situates social practices in the relational interplay between experiential mental phenomena (habitus), resources (capitals) and objective social structures (fields). When applied to class‐based practices in particular, the overarching field of power within which social classes are potentially made manifest is the primary field of interest. Applying relational statistical techniques to original survey data from Toronto and Vancouver, Canada, we investigated whether smoking, engaging in physical activity and consuming fruit and vegetables are dispersed in a three‐dimensional field of power shaped by economic and cultural capitals and cultural dispositions and practices. We find that aesthetic dispositions and flexibility of developing and established dispositions are associated with positioning in the Canadian field of power and embedded in the logics of the health practices dispersed in the field. From this field‐theoretic perspective, behavioural change requires the disruption of existing relations of harmony between the habitus of agents, the fields within which the practices are enacted and the capitals that inform and enforce the mores and regularities of the fields. The three‐dimensional model can be explored at: http://relational-health.ca/margins-freedom
    March 23, 2017   doi: 10.1111/1467-9566.12544   open full text
  • Music‐making for health and wellbeing in youth justice settings: mediated affordances and the impact of context and social relations.
    Norma Daykin, Nick Viggiani, Yvonne Moriarty, Paul Pilkington.
    Sociology of Health & Illness. March 23, 2017
    Young people in the criminal justice system experience significant health and wellbeing issues that often stem from poverty and disadvantage and, in turn, are linked with offending and reoffending behaviour. There is ongoing interest in interventions such as participatory music programmes that seek to foster social reintegration, support mental wellbeing and equip young offenders with life skills, competencies and emotional resilience. However, there is a need for a situated understanding of both positive and negative experiences that shape potential outcomes of music projects. This article reports on a research study undertaken between 2010 and 2013 with 118 young people aged 13–21 years across eight youth justice settings in England and Wales. Using mixed methods we explored the experiences of young people and their responses to a participatory music programme led by a national UK arts charity. Here, we explore the impact of young people's encounters with music and musicians with reference to the notion of ‘musical affordances’ (DeNora , ). We examine the ways that such affordances, including unintended outcomes, are mediated by features of the youth justice environment, including its rules and regulations, as well as issues of power, identity and social relations.
    March 23, 2017   doi: 10.1111/1467-9566.12549   open full text
  • Digital atmospheres: affective practices of care in Elefriends.
    Ian M. Tucker, Lewis Goodings.
    Sociology of Health & Illness. March 22, 2017
    This article develops the concept of digital atmosphere to analyse the affective power of social media to shape practices of care and support for people living with mental distress. Using contemporary accounts of affective atmospheres, the article focuses on feelings of distress, support and care that unfold through digital atmospheres. The power of social media intersects with people's support and care‐seeking practices in multiple ways and not in a straightforward model of ‘accessing or providing support’. Indeed, we find that the caring relations developed through social media often need to be cared for themselves. The article draws on online and interview data from a larger project investigating how practices of care and support are (re)configured in the mental health‐related social media site Elefriends. Users have to negotiate the disruption of moving support online, as well as the possibility of becoming subject to a fragility in care, in which caring for oneself becomes bound up in the ambiguities of caring for others. We argue that understanding how experiences of distress are shaped by social media is essential for understanding the implications of the increased digitisation of mental healthcare.
    March 22, 2017   doi: 10.1111/1467-9566.12545   open full text
  • Ultrasound as a technology of reassurance? How pregnant women and health care professionals articulate ultrasound reassurance and its limitations.
    Gareth M. Thomas, Julie Roberts, Frances E. Griffiths.
    Sociology of Health & Illness. March 22, 2017
    The premise that ultrasound technologies provide reassurance for pregnant women is well‐rehearsed. However, there has been little research about how this reassurance is articulated and understood by both expectant mothers and health care professionals. In this article, we draw on two qualitative UK studies to explore the salience of ultrasound reassurance to women's pregnancy experiences whilst highlighting issues around articulation and silence. Specifically, we capture how expectant parents express a general need for reassurance and how visualisation and the conduct of professionals have a crucial role to play in accomplishing a sense of reassurance. We also explore how professionals have ambiguities about the relationship between ultrasound and reassurance, and how they subsequently articulate reassurance to expectant mothers. By bringing two studies together, we take a broad perspectival view of how gaps and silences within the discourse of ultrasound reassurance leave the claims made for ultrasound as a technology of reassurance unchallenged. Finally, we explore the implications this can have for women's experiences of pregnancy and health care professionals’ practices.
    March 22, 2017   doi: 10.1111/1467-9566.12554   open full text
  • Two regimes of HIV/AIDS: The MMWR and the socio‐political construction of HIV/AIDS as a ‘black disease’.
    Kevin M. Moseby.
    Sociology of Health & Illness. March 09, 2017
    Over the course of the HIV/AIDS epidemic, black Americans have become a central target of US public health prevention efforts. And today, HIV/AIDS is understood to disproportionately affect black Americans. This markedly contrasts with knowledge about the disease and efforts to prevent it in the first decade of the epidemic in the US, when expert and lay understandings and responses centred on white gay males. This article demonstrates that explaining these historical reversals as purely reflective of epidemiological data – or best knowledge available – is insufficient. Drawing on the concept disease regimes and utilising a discursive analysis of epidemiological results and editorial commentary published from 1981 to 1994 in the Morbidity and Mortality Weekly Reports (MMWR), this article argues for a socio‐political explanation for the changing colour of HIV/AIDS. That is, it scrutinises institutional and discursive practices that within the HIV/AIDS prevention field and disease discourse constituted a ‘regime of black American exclusion’ (1981–1992) and a ‘regime of black American inclusion (1993–present day).
    March 09, 2017   doi: 10.1111/1467-9566.12552   open full text
  • Have we seen the geneticisation of society? Expectations and evidence.
    Kate Weiner, Paul Martin, Martin Richards, Richard Tutton.
    Sociology of Health & Illness. March 08, 2017
    Abby Lippman's geneticisation thesis, of the early 1990s, argued and anticipated that with the rise of genetics, increasing areas of social and health related activities would come to be understood and defined in genetic terms leading to major changes in society, medicine and health care. We review the considerable literature on geneticisation and consider how the concept stands both theoretically and empirically across scientific, clinical, popular and lay discourse and practice. Social science scholarship indicates that relatively little of the original claim of the geneticisation thesis has been realised, highlighting the development of more complex and dynamic accounts of disease in scientific discourse and the complexity of relationships between bioscientific, clinical and lay understandings. This scholarship represents a shift in social science understandings of the processes of sociotechnical change, which have moved from rather simplistic linear models to an appreciation of disease categories as multiply understood. Despite these shifts, we argue that a genetic imaginary persists, which plays a performative role in driving investments in new gene‐based developments. Understanding the enduring power of this genetic imaginary and its consequences remains a key task for the social sciences, one which treats ongoing genetic expectations and predictions in a sceptical yet open way.
    March 08, 2017   doi: 10.1111/1467-9566.12551   open full text
  • The limits of intensive feeding: maternal foodwork at the intersections of race, class, and gender.
    Joslyn Brenton.
    Sociology of Health & Illness. March 08, 2017
    Despite experiencing numerous barriers, mothers today confront increasing social pressure to embody perfection through their foodwork. A growing body of social science research identifies how gender and class inequality shape women's perceptions of food and their feeding strategies, but this research is thus far limited in its understanding of the roles that race and ethnic identity play in a mother's food landscape. Drawing on 60 in‐depth interviews with a racially and economically diverse group of mothers, this paper examines how feeding young children is intertwined with contemporary ideas about child health as well as women's efforts to negotiate race, class, and gender hierarchies. Extending Hays' concept of intensive mothering, rich descriptions of feeding children reveal how mothers in this study are discursively engaged with what I call an ‘intensive feeding ideology’ – the widespread belief that good mothering is synonymous with intensive food labour. Drawing on intersectional theory, this article discusses the limits of an intensive feeding ideology, particularly for poor and middle‐class mothers of colour. The findings contribute to an understanding of how power relations are embedded within food ideologies and how mothers of young children attempt to negotiate them.
    March 08, 2017   doi: 10.1111/1467-9566.12547   open full text
  • ‘It's like taking a bit of masculinity away from you’: towards a theoretical understanding of men's experiences of infertility.
    Alan Dolan, Tim Lomas, Tarek Ghobara, Geraldine Hartshorne.
    Sociology of Health & Illness. March 08, 2017
    In the UK, nearly half of all cases of infertility involve a ‘male‐factor’. Yet, little empirical work has explored how men as men negotiate this terrain. Three interrelated concepts; ‘hegemonic masculinity’, ‘embodied masculinity’ and the linkages between ‘masculinities’ and male help‐seeking, provide the theoretical framework that guided a qualitative study conducted with 22 men experiencing infertility. The paper explores men's propensity to delay their help‐seeking in relation to infertility despite their desire for children. It also demonstrates how, in the context of infertility, the male body can be defined as both a failed entity in itself (unable to father a child) and a subordinated social entity (unable to measure up to hegemonic ideals) that characterises men's masculine identities. The paper also illustrates how men appear willing to accept responsibility for their infertility and adopt aspects of hitherto subordinate masculine practice. This does not, however, constitute the total unravelling of well understood and accepted expressions of masculinity. Finally, the paper demonstrates how infertility is perceived as having the potential to fracture current and even future relationships. Moreover, regardless of how well men measured up to other hegemonic ideals, ultimately they can do little to counteract the threat of other (fertile) men.
    March 08, 2017   doi: 10.1111/1467-9566.12548   open full text
  • ‘Betwixt and between’; liminality in recovery stories from people with myalgic encephalomyelitis (ME) or chronic fatigue syndrome (CFS).
    Brian Brown, Kate Huszar, Rosemary Chapman.
    Sociology of Health & Illness. February 27, 2017
    This paper explores experiences of 16 people claiming to have recovered from Myalgic Encephalomyelitis (ME) or Chronic Fatigue Syndrome (CFS) using the concept of liminality. Liminality describes the status of those falling between socially recognised and medically sanctioned categories, and illuminates both the experience of illness and the process of recovery from ME/CFS. The liminality experienced during illness was akin to that described by Turner with a degree of communitas among sufferers. As recovery progressed, participants stressed the percentage to which they had improved, and compared themselves with peers and themselves prior to the illness. Recovery did not mean transition into a post‐liminal phase, but involved a new liminality, characterised by straddling boundaries between illness and wellness. Participants continued strategies such as rest, pacing and meditation. This second liminal state included difficulty in communicating the experience convincingly, and estrangement from the ME/CFS community. Thus, recoverees moved from the liminality of illness to a second, and less legible state of sustained liminality in recovery, described as having one foot in the ill world, one foot in the well world. This suggests that more needs to be understood about the recovery experience to assist those making the transition toward wellness.
    February 27, 2017   doi: 10.1111/1467-9566.12546   open full text
  • Contesting lifestyle risk and gendering coronary candidacy: lay epidemiology of heart disease in Finland in the 1970s.
    Mikko Jauho.
    Sociology of Health & Illness. February 24, 2017
    This study addresses two issues currently under critical discussion in the epidemiology of cardiovascular diseases (CVD), the relative neglect of women and the individualised nature of key risk factors. It focuses on the North Karelia project (NKP), a community programme aimed at coronary heart disease (CHD) prevention in a predominantly rural Finnish region in the early 1970s, that is, during a period when the epidemiological understanding of CVD still was relatively new and actively promoted. Adopting the notions of lay epidemiology and coronary candidacy, culturally mediated explanatory models lay people use to assess who is likely to develop heart disease and why, the study shows that locals targeted by the project critically engaged with both of these bias. Based on the rich materials resulting from project activities the study shows, first, how many locals subsumed the individualised and lifestyle‐based approach to CHD prevention promoted by NKP under a more general framework emphasising the health effects of ongoing structural changes in the area, and second, how women constructed themselves as viable coronary candidates. The case supports the position in the current discussions on lay expertise that wants to integrate lay experiences more firmly into epidemiological studies and public health.
    February 24, 2017   doi: 10.1111/1467-9566.12542   open full text
  • Narrative collisions, sociocultural pressures and dementia: the relational basis of personhood reconsidered.
    Edward Tolhurst, Bernhard Weicht, Paul Kingston.
    Sociology of Health & Illness. February 08, 2017
    The concept of personhood developed by Tom Kitwood highlights that the experience of dementia has relational dimensions that transcend the neurodegenerative impacts of the condition. This relational focus, however, has been narrowly conceptualised, with the impact of broader sociocultural factors on experience underplayed. The empirical exploration of interaction also requires reinforcement: a tendency for dyadic studies to portray findings in an individualised format hinders the interrogation of interpersonal negotiations. This article draws upon qualitative research that employed a joint interview approach, interviewing men with dementia and their spousal carers together. The focus on a dyadic case study from this research enables methodical exploration of the experience of living with dementia. This is realised by considering the socially‐framed perspective of each person, and then how their perspectives are interwoven within interactional exchanges. This provides a platform for the evaluation of the current decontextualised notion of personhood and its implications. It is concluded that a sociologically‐informed perspective can help to reinforce the academic understanding of personhood.
    February 08, 2017   doi: 10.1111/1467-9566.12523   open full text
  • Power, empowerment, and person‐centred care: using ethnography to examine the everyday practice of unregistered dementia care staff.
    Kezia Scales, Simon Bailey, Joanne Middleton, Justine Schneider.
    Sociology of Health & Illness. February 08, 2017
    The social positioning and treatment of persons with dementia reflects dominant biomedical discourses of progressive and inevitable loss of insight, capacity, and personality. Proponents of person‐centred care, by contrast, suggest that such loss can be mitigated within environments that preserve rather than undermine personhood. In formal organisational settings, person‐centred approaches place particular responsibility on ‘empowered’ direct‐care staff to translate these principles into practice. These staff provide the majority of hands‐on care, but with limited training, recognition, or remuneration. Working within a Foucauldian understanding of power, this paper examines the complex ways that dementia care staff engage with their own ‘dis/empowerment’ in everyday practice. The findings, which are drawn from ethnographic studies of three National Health Service (NHS) wards and one private care home in England, are presented as a narrative exploration of carers’ general experience of powerlessness, their inversion of this marginalised subject positioning, and the related possibilities for action. The paper concludes with a discussion of how Foucault's understanding of power may help define and enhance efforts to empower direct‐care staff to provide person‐centred care in formal dementia care settings.
    February 08, 2017   doi: 10.1111/1467-9566.12524   open full text
  • Precarity in late life: rethinking dementia as a ‘frailed’ old age.
    Amanda Grenier, Liz Lloyd, Chris Phillipson.
    Sociology of Health & Illness. February 08, 2017
    Approaches to ageing that are organised around productivity, success, and active late life have contributed to views of dementia as an unsuccessful, failed or ‘frailed’ old age. Operating through dominant frameworks, socio‐cultural constructs and organisational practices, the ‘frailties’ of the body and mind are often used to mark the boundaries of health and illness in late life, and shape responses accordingly. Our concern is that both the taken for granted and the ‘imagined’ can further marginalise persons who occupy the locations of dementia and disablement. This article analyses the extent to which frailty and dementia are better understood in the context of new forms of insecurity affecting the life course. Drawing on the concept of ‘precarity’, this article shifts debates on the ‘fourth age’ away from age or stage‐based thinking, into a recognition of the shared vulnerability and responsibilities for care. The argument of this article is that ‘precarity’ represents a ‘new form of ageing’, notably as regards its impact on the upper extremes of the life course. The article concludes with a call for a response that is grounded in an acknowledgement of the fragility and limitations which affect human lives, this requiring grounding in inclusive forms of citizenship.
    February 08, 2017   doi: 10.1111/1467-9566.12476   open full text
  • Social class, dementia and the fourth age.
    Ian Rees Jones.
    Sociology of Health & Illness. February 08, 2017
    Research addressing social class and dementia has largely focused on measures of socioeconomic status as causal risk factors for dementia and in observed differences in diagnosis, treatment and care. This large body of work has produced important insights but also contains numerous problems and weaknesses. Research needs to take account of the ways in which ageing and social class have been transformed in tandem with the economic, social and cultural coordinates of late modernity. These changes have particular consequences for individual identities and social relations. With this in mind this article adopts a critical gaze on research that considers interactions between dementia and social class in three key areas: (i) epidemiological approaches to inequalities in risk (ii) the role of social class in diagnosis and treatment and (iii) class in the framing of care and access to care. Following this, the article considers studies of dementia and social class that focus on lay understandings and biographical accounts. Sociological insights in this field come from the view that dementia and social class are embedded in social relations. Thus, forms of distinction based on class relations may still play an important role in the lived experience of dementia.
    February 08, 2017   doi: 10.1111/1467-9566.12520   open full text
  • When walking becomes wandering: representing the fear of the fourth age.
    Katherine Brittain, Cathrine Degnen, Grant Gibson, Claire Dickinson, Louise Robinson.
    Sociology of Health & Illness. February 08, 2017
    Dementia is linked to behavioural changes that are perceived as challenging to care practices. One such behavioural change is ‘wandering’, something that is often deeply feared by carers and by people with dementia themselves. Understanding how behavioural changes like wandering are experienced as problematic is critically important in current discussions about the behavioural and psychological symptoms of dementia. In this article we draw on our secondary analysis of qualitative interviews and focus groups with carers of people with dementia to critically question ‘when does walking become wandering’? Drawing on theoretical perspectives from anthropology, sociology and human geography to explore experiences of carers and of people with dementia, we argue that a conceptual shift occurs in how pedestrian activity, usually represented as something purposeful, meaningful and healthy (walking) is seen as something threatening that needs managing (wandering). We demonstrate how this shift is connected to cultural assumptions about the mind‐body relationship in both walking and in dementia. We further argue that the narratives of carers about wandering challenge the notion of ‘aimless’ walking in the fourth age. This is because, as these narratives show, there are often pronounced links to specific areas and meaningful places where people with dementia walk to.
    February 08, 2017   doi: 10.1111/1467-9566.12505   open full text
  • Dichotomising dementia: is there another way?
    Patricia McParland, Fiona Kelly, Anthea Innes.
    Sociology of Health & Illness. February 08, 2017
    This article discusses the reduction of the complex experience of dementia to a dichotomised ‘tragedy’ or ‘living well’ discourse in contemporary Western society. We explore both discourses, placing them in the context of a successful ageing paradigm, highlighting the complex nature of dementia and the risks associated with the emergence of these arguably competing discourses. Specifically, we explore this dichotomy in the context of societal understandings and responses to dementia. We argue for an acceptance of the fluid nature of the dementia experience, and the importance of an understanding that recognises the multiple realities of dementia necessary for social inclusion to occur. Such an acceptance requires that, rather than defend one position over another, the current discourse on dementia is challenged and problematised so that a more nuanced understanding of dementia may emerge; one that fully accepts the paradoxical nature of this complex condition.
    February 08, 2017   doi: 10.1111/1467-9566.12438   open full text
  • Institutionalising senile dementia in 19th‐century Britain.
    Emily Stella Andrews.
    Sociology of Health & Illness. February 08, 2017
    This article explains how old, poor people living with dementia came to be institutionalised in 19th‐century Britain (with a focus on London), and how they were responded to by the people who ran those institutions. The institutions in question are lunatic asylums, workhouses and charitable homes. Old people with dementia were admitted to lunatic asylums, workhouses and charitable homes, but were not welcome there. Using the records of Hanwell lunatic asylum, published texts of psychiatric theory, and the administrative records that all of these institutions generated at local and national levels, this article argues that ‘the senile’ were a perpetual classificatory residuum in the bureaucracy of 19th‐century health and welfare. They were too weak and unresponsive to adhere to the norms of the asylum regime, yet too challenging in their behaviour to conform to that of the workhouse, or the charitable home. Across all of these institutions, old people with dementia were represented as an intractable burden, many decades before the ‘ageing society’ became a demographic reality.
    February 08, 2017   doi: 10.1111/1467-9566.12452   open full text
  • Shifting dementia discourses from deficit to active citizenship.
    Linda Birt, Fiona Poland, Emese Csipke, Georgina Charlesworth.
    Sociology of Health & Illness. February 08, 2017
    Within western cultures, portrayals of dementia as ‘a living death’ are being challenged by people living with the diagnosis. Yet dementia remains one of the most feared conditions. The sociological lens of citizenship provides a conceptual framework for reviewing the role of society and culture in repositioning dementia away from deficit to a discourse of agency and interdependence. Awareness of cognitive change, and engaging with the diagnostic process, moves people into a transitional, or ‘liminal’ state of uncertainty. They are no longer able to return to their previous status, but may resist the unwanted status of ‘person with dementia’. Drawing on qualitative studies on social participation by people with dementia, we suggest that whether people are able to move beyond the liminal phase depends on acceptance of the diagnosis, social capital, personal and cultural beliefs, the responses of others and comorbidities. Some people publicly embrace a new identity whereas others withdraw, or are withdrawn, from society to live in the shadow of the fourth age. We suggest narratives of deficit fail to reflect the agency people with dementia can enact to shape their social worlds in ways which enable them to establish post‐liminal citizen roles. (A Virtual Abstract of this paper can be viewed at: https://www.youtube.com/channel/UC_979cmCmR9rLrKuD7z0ycA)
    February 08, 2017   doi: 10.1111/1467-9566.12530   open full text
  • Relational citizenship: supporting embodied selfhood and relationality in dementia care.
    Pia Kontos, Karen‐Lee Miller, Alexis P. Kontos.
    Sociology of Health & Illness. February 08, 2017
    We draw on findings from a mixed‐method study of specialised red‐nosed elder‐clowns in a long‐term care facility to advance a model of ‘relational citizenship’ for individuals with dementia. Relational citizenship foregrounds the reciprocal nature of engagement and the centrality of capacities, senses, and experiences of bodies to the exercise of human agency and interconnectedness. We critically examine elder‐clown strategies and techniques to illustrate how relational citizenship can be supported and undermined at the micro level of direct care through a focus on embodied expressions of creativity and sexuality. We identify links between aesthetic enrichment and relational practices in art, music and imagination. Relational citizenship offers an important rethinking of notions of selfhood, entitlement, and reciprocity that are central to a sociology of dementia, and it also provides new ethical grounds to explore how residents’ creative and sexual expression can be cultivated in the context of long‐term care.
    February 08, 2017   doi: 10.1111/1467-9566.12453   open full text
  • ‘Doing good by proxy’: human‐animal kinship and the ‘donation’ of canine blood.
    Vanessa Ashall, Pru Hobson‐West.
    Sociology of Health & Illness. February 06, 2017
    This article demonstrates the relevance of animals to medical sociology by arguing that pet owners’ accounts of veterinary decision‐making can highlight key sociological themes which are important to both human and animal health. Based on semi‐structured interviews, the article argues that interspecies ‘kinship’ allows for the extension of sociological claims regarding altruism, self‐interest and mutuality from human blood donation to companion animal blood ‘donation’. Furthermore, this study extends sociological understanding of the human‐animal bond by showing how the dog's status as kin meant they were expected to donate blood, and that the act of donation itself represents an important opportunity for family ‘display’. However, owners who do not or cannot donate blood themselves describe pet blood donation as an opportunity to lessen associated feelings of guilt or obligation through ‘doing good by proxy’. These findings raise critical sociological and ethical questions concerning the risks and benefits of donation, and for how we understand third‐party decision making. Finally, the article argues for the close entanglement of human and animal health, and concludes that sociologists of health and medicine should explore the radical possibility that decision‐making in healthcare more generally might be influenced by experiences at the veterinary clinic, and vice versa. (A Virtual Abstract of this paper can be viewed at: https://www.youtube.com/channel/UC_979cmCmR9rLrKuD7z0ycA)
    February 06, 2017   doi: 10.1111/1467-9566.12534   open full text
  • The concept of medicalisation reassessed.
    Joan Busfield.
    Sociology of Health & Illness. January 04, 2017
    Medicalisation has been an important concept in sociological discussions of medicine since its adoption by medical sociologists in the early 1970s. Yet it has been criticised by some sociologists, in part because it seems too negative about medicine, and modified or replaced by others with concepts deemed more relevant like biomedicalisation and pharmaceuticalisation. My aim in this paper is to reassess the concept and consider whether it still has value in exploring significant aspects of the role of medicine in present‐day society. I start with an archaeology of the concept's development and the different ways it has been used. This covers some familiar ground but is essential to the main task: examining criticisms of the concept and assessing its value. I conclude that the concept continues to have a crucial and productive place in sociological analyses of medicine and that the process of medicalisation is still a key feature of late‐modern social life and culture.
    January 04, 2017   doi: 10.1111/1467-9566.12538   open full text
  • Obesity, bodily change and health identities: a qualitative study of Canadian women.
    Andrea E. Bombak, Lee F. Monaghan.
    Sociology of Health & Illness. December 24, 2016
    Medicalised concerns about an obesity crisis persist yet more needs to be learnt about everyday orientations to weight (loss). This article reports and analyses data generated using qualitative methods, including repeated interviews and fieldwork conducted over one year in Canada with women (n = 13) identifying as (formerly) obese. Three ideal types are explored using empirical data: (1) hopeful narratives; (2) disordered eating distress; and (3) weight‐cycling or stagnation. Core themes include women's desire to embody a thin(ner) future and the good life, the harms of intentional weight‐loss, and resignation to living as a fat woman whilst nonetheless challenging stigma. The article contributes to critical studies of weight/fatness, the sociology of bodily change and the embodiment of health identities. In concluding, we call for reflexive change in bodies of health knowledge, policy and practice.
    December 24, 2016   doi: 10.1111/1467-9566.12537   open full text
  • Neither ‘foolish’ nor ‘finished’: identity control among older adults with HIV in rural Malawi.
    Emily Freeman.
    Sociology of Health & Illness. December 24, 2016
    Prevalence of HIV after age 50 is considerable, especially in southern Africa. Negative social constructions of HIV in older age, and the health consequences of ageing with the virus, mean that having HIV presents a challenge for many people's roles and social memberships, threatening to disrupt their sense of self. Using constructivist grounded theory and qualitative data from rural Malawi, this paper describes how older men and women deal with these identity challenges. Drawing on a symbolic interactionist framework, it uses identity control theory to explore how the study's participants presented their post‐diagnosis behaviours in ways that maintained their most significant pre‐diagnosis identities as ‘adults’, a label they gave to the core identity of being a person who belongs in the social world. Considering the processes through which older people with HIV navigated challenges to their identities in light of the intersectional influences of HIV and age‐related stigma and illness, provides insight into how older people might experience HIV, as well as informing theoretical understandings of identity formation and maintenance in light of chronic and/or stigmatising illness more broadly.
    December 24, 2016   doi: 10.1111/1467-9566.12531   open full text
  • Mapping the illness trajectories of insomnia: a biographical disruption?
    Janet M.Y. Cheung, Bandana Saini, Delwyn J. Bartlett, Tracey‐Lea Laba, Paul H. Mason.
    Sociology of Health & Illness. December 07, 2016
    The insomnia illness experience can be conceptualised as a form of biographical disruption. Using a critical interpretive phenomenological lens 51 in‐depth semi‐structured interviews were conducted with patients from specialist sleep and psychology clinics (n = 22) and the general community (n = 29). Patients’ narratives revealed key phases of their illness trajectories as they recognise, rethink and respond to insomnia. Their biographical events served as reference points for both patient groups to make sense of their illness experiences as they transitioned from a perceived state of sleeplessness to clinical insomnia. The innate biological process of sleep at night and the sleep‐dependent daytime psychosocial function exerted a negative bi‐directional effect, creating a continuous circuit of disruption. Coping mechanisms were inspired by the participants’ immediate social environment and centred on sociocultural motifs of relaxation and alertness to break the ‘circuit’. Access to specialist clinic services appeared to be contingent on the richness of resources in one's social network and surrounding environment rather than the clinical severity of the disease alone. Treatment that can simultaneously target the night time and daytime consequences of insomnia resonates closely with participants’ depiction of insomnia as both a physiological and a psychosocial phenomenon.
    December 07, 2016   doi: 10.1111/1467-9566.12525   open full text
  • Constructing and enacting kinship in sister‐to‐sister egg donation families: a multi‐family member interview study.
    Hanna Van Parys, Veerle Provoost, Kristin Zeiler, Petra De Sutter, Guido Pennings, Ann Buysse.
    Sociology of Health & Illness. December 05, 2016
    Although intra‐familial egg donation has been practiced for more than 15 years in several countries, little is known about family relationships in this family type. Framed within the new kinship studies, this article focuses on the experiential dimension of kinship in sister‐to‐sister egg donation families: how is kinship ‘unpacked’ and ‘reconstructed’ in this specific family constellation? Qualitative data analysis of interviews with receiving parents, their donating sisters and the donor children revealed six themes: (1) being connected as an extended family; (2) disambiguating motherhood; (3) giving and receiving as structuring processes; (4) acknowledging and managing the ‘special’ link between donor and child; (5) making sense of the union between father and donor; and (6) kinship constructions being challenged. This study showed the complex and continuous balancing of meanings related to the mother‐child dyad, the donor‐child dyad and the donor‐father dyad. What stood out was the complexity of, on the one hand cherishing the genetic link with the child allowed by the sisters’ egg donation, while, on the other, managing the meanings related to this link, by, for instance, acknowledging, downsizing, symbolising, and differentiating it from the mother‐child bond. (A Virtual Abstract of this paper can be accessed at: https://www.youtube.com/channel/UC_979cmCmR9rLrKuD7z0ycA)
    December 05, 2016   doi: 10.1111/1467-9566.12533   open full text
  • Disturbing sleep and sleepfulness during recovery from substance dependence in residential rehabilitation settings.
    Sarah Nettleton, Robert Meadows, Joanne Neale.
    Sociology of Health & Illness. December 05, 2016
    There is evidence that poor sleep mitigates recovery from substance dependence and increases risk of relapse. However, to date research literature is located within biomedical, clinical and psychological paradigms. To complement the extant work, this article offers a sociological exploration of sleep in the context of recovery from dependence on alcohol and/or other drugs. Drawing on qualitative data generated through interviews with 28 men and women living in residential rehabilitation settings in England, we provide a detailed exploration of sleep practices focusing on how these are enacted throughout the night. We offer the concept of ‘sleepfulness’ to suggest that sleep should not be understood simply as being other than awake; rather it involves a myriad of associations between diverse actants – human and non‐human – that come to ‘fill up’, enable and assemble sleep. Together these empirical insights and conceptualisations disturb the ontology of sleep and point to the fulsome dimensions of the category.
    December 05, 2016   doi: 10.1111/1467-9566.12528   open full text
  • Might constraint be compatible with care? Home care as a situational ethics.
    Antoine Hennion, Pierre A. Vidal‐Naquet.
    Sociology of Health & Illness. December 05, 2016
    Respecting the autonomy and will of people has legitimately led to strictly control the use of constraint in care activities, and promote a care ethics centred around people's needs and wills. But constraint is underlying in any action aiming at making people do something, even with their consent, especially when their ability to evaluate what is best for them may be altered. Ceaselessly present in care, this ordinary, silent constraint should not be only deemed as a necessary evil to be prevented. In contrast with this legally‐based view, the paper adopts a pragmatic perspective. Leaning on minute case studies carried out at disable people's homes, the empirical section takes up some key troubling moments between caregivers and patients as trials capable of revealing ‘constraint in practice’: a situation of uncertainty, doubt, hesitations on the appraisal of what is happening and how to deal with it, banning any clear‐cut distinction between technical gestures and moral values. Having outlined the characters of such a ‘situational ethics’, the authors argue in conclusion that, provided caregivers are never quits with its use, constraint is compatible with care, and assume that care theories could fruitfully support this advocacy to ‘maintaining the trouble’ in care practices.
    December 05, 2016   doi: 10.1111/1467-9566.12529   open full text
  • Gestating times: women's accounts of the temporalities of pregnancies that end in abortion in England.
    Siân M. Beynon‐Jones.
    Sociology of Health & Illness. December 02, 2016
    Tensions between the ‘clock time’ of medicine and the embodied times of its subjects are central to feminist writing concerning Western obstetric practice. In this article, I expand the focus of this literature by addressing the temporal dynamics of another site of reproductive healthcare: abortion provision. Echoing obstetric accounts of birth, time in legal, healthcare and social scientific discourse on abortion is routinely conceptualised as a finite resource contained within the pregnant/foetal body, which can be measured using clocks and calendars. I argue that women's interview accounts of their experiences of ending their pregnancies offer opportunities for critical reflection on this characterisation of pregnancy as linear ‘gestational time’. First, participants in this study re‐position the significance of gestational time by articulating its embodied meaning. Second, they provide alternative accounts of the temporality of pregnancy as a process which emerges through, and is disrupted by, the dynamics of socio‐material relations. The article considers the broader implications of women's accounts of pregnancy times for legal, healthcare and social scientific accounts of ‘later’ abortion.
    December 02, 2016   doi: 10.1111/1467-9566.12522   open full text
  • A day in the life of a Ménière's patient: understanding the lived experiences and mental health impacts of Ménière's disease.
    Sarah L. Bell, Jessica Tyrrell, Cassandra Phoenix.
    Sociology of Health & Illness. December 02, 2016
    Concepts of social practice are increasingly being used to understand experiences of everyday life, particularly in relation to consumption and healthy lifestyles. This article builds on this in the context of lives disrupted and reshaped by chronic illness. It uses social practice theory to examine the lived experiences of individuals with Ménière's disease; a long‐term progressive vestibular disorder, defined by episodes of severe and debilitating vertigo, aural fullness, tinnitus and sensorineural hearing loss. Drawing on the findings of 20 in‐depth narrative interviews with Ménière's patients, and eight spousal/partner interviews, we explore the impacts of the condition on sensory, temporal, spatial and social dimensions of the body. In doing so, we highlight the intensely embodied sensory and emotional work required to maintain connections between the ‘competences’, ‘materials’ and ‘meanings’ that constitute and sustain the performance of both mundane and meaningful social practices over time. As connections between these elements of social practice are disrupted during more active phases of the condition, affected individuals may be defected from old practices and recruited to new ones, often requiring both time and social support to find meaning or pleasure in these alternative ways of being in the world.
    December 02, 2016   doi: 10.1111/1467-9566.12527   open full text
  • At the margins of biomedicine: the ambiguous position of ‘Registered Medical Practitioners’ in rural Indian healthcare.
    Papreen Nahar, Nanda Kishore Kannuri, Sitamma Mikkilineni, G.V.S. Murthy, Peter Phillimore.
    Sociology of Health & Illness. December 02, 2016
    This analysis challenges a tendency in public health and the social sciences to associate India's medical pluralism with a distinction between biomedicine, as a homogeneous entity, and its non‐biomedical ‘others’. We argue that this overdrawn dichotomy obscures the important part played by ‘informal’ biomedical practice, an issue with salience well beyond India. Based on a qualitative study in rural Andhra Pradesh, South India, we focus on a figure little discussed in the academic literature – the Registered Medical Practitioner (RMP) – who occupies a niche in the medical market‐place as an informal exponent of biomedical treatment. We explore the significance of these practitioners by tracking diagnosis and treatment of one increasingly prominent medical ‘condition’, namely diabetes. The RMP, who despite the title is rarely registered, sheds light on the supposed formal‐informal sector divide in India's healthcare system, and its permeability in practice. We develop our analysis by contrasting two distinctive conceptualisations of ‘informality’ in relation to the state in India – one Sarah Pinto's, the other Ananya Roy's.
    December 02, 2016   doi: 10.1111/1467-9566.12521   open full text
  • The evolution of weak standards: the case of the Swedish rheumatology quality registry.
    Anna Essén, Michael Sauder.
    Sociology of Health & Illness. November 23, 2016
    Research in sociology suggests that the effects of standards are not nearly as straightforward or as homogenising as they first appear. The present study extends these insights by demonstrating how even standards designed simply to collect data can produce extensive and unanticipated effects in medical fields as their uses evolve across actors and contexts. We draw on an embedded case study exploring the multifaceted consequences of the use of a practice‐driven voluntary documentation standard: the Swedish rheumatology quality registry from 1995–2014. Data collection included document analysis; 100 interviews with specialists, patients and stakeholders in the field; fieldwork; and observations of physician‐patient encounters. Our findings show that the scope and influence of the registry increased over time, and that this standard and its evolution contributed to changes in rheumatologist clinical practice, research practice, and governmental practice. These findings suggest that even initially ‘weak’, voluntary forms of standardisation can generate far‐reaching and unpredictable consequences for the performance and delivery of care as well as for the development of a medical field. Future work about how standards can contribute both to uniformity and diversity is warranted.
    November 23, 2016   doi: 10.1111/1467-9566.12507   open full text
  • Assembling activity/setting participation with disabled young people.
    Barbara E Gibson, Gillian King, Gail Teachman, Bhavnita Mistry, Yani Hamdani.
    Sociology of Health & Illness. November 21, 2016
    Rehabilitation research investigating activity participation has been largely conducted in a realist tradition that under‐theorises the relationship between persons, technologies, and socio‐material places. In this Canadian study we used a post‐critical approach to explore activity/setting participation with 19 young people aged 14 to 23 years with complex communication and/or mobility impairments. Methods included integrated photo‐elicitation, interviews, and participant observations of community‐based activities. We present our results using the conceptual lens of assemblages to surface how different combinations of bodies, social meanings, and technologies enabled or constrained particular activities. Assemblages were analysed in terms of how they organised what was possible and practical for participants and their families in different contexts. The results illuminate how young people negotiated activity needs and desires in particular ‘spacings’ each with its own material, temporal, and social constraints and affordances. The focus on assemblages provides a dynamic analysis of how dis/abilities are enacted in and across geotemporal spaces, and avoids a reductive focus on evaluating the accessibility of static environmental features. In doing so the study reveals possible ‘lines of flight’ for healthcare, rehabilitation, and social care practices.
    November 21, 2016   doi: 10.1111/1467-9566.12496   open full text
  • What is wrong with ‘being a pill‐taker’? The special case of statins.
    Louisa Polak.
    Sociology of Health & Illness. November 16, 2016
    In an interview study of decision‐making about statins, many participants said they took pills regularly, yet described themselves as ‘not really pill‐takers’. This paper explores this paradox and its implications. The practice of pill‐taking itself can constitute a challenge to the presentation of moral adequacy, beyond the potential for rendering stigmatised illnesses visible. Meeting this challenge involves a complex process of calibrating often‐conflicting moral imperatives: to be concerned, but not too concerned, over one's health; to be informed, but not over‐informed; and deferential but not over‐deferential to medical expertise. This calibration reflects a broader tension between rival tropes: embracing medical progress and resisting medicalisation. Participants who take statins present them as unquestionably necessary; ‘needing’ pills, as opposed to choosing to take them, serves as a defence against the devalued identity of being a pill‐taker. However, needing to take statins offers an additional threat to identity, because taking statins is widely perceived to be an alternative strategy to ‘choosing a healthy lifestyle’. This perception underpins a responsibilising health promotion discourse that shapes and complicates the work participants do to avoid presenting themselves as ‘pill‐takers’. The salience of this discourse should be acknowledged where discussions of medicalisation use statins as an example.
    November 16, 2016   doi: 10.1111/1467-9566.12509   open full text
  • Public challenge and endorsement of sex category ambiguity in online debate: ‘The sooner people stop thinking that gender is a matter of choice the better’.
    Helen Sweeting, Matthew William Maycock, Laura Walker, Kate Hunt.
    Sociology of Health & Illness. November 16, 2016
    Despite academic feminist debate over several decades, the binary nature of sex as a (perhaps the) primary social classification is often taken for granted, as is the assumption that individuals can be unproblematically assigned a biological sex at birth. This article presents analysis of online debate on the BBC news website in November 2013, comprising 864 readers' responses to an article entitled ‘Germany allows ‘indeterminate’ gender at birth’. It explores how discourse reflecting Western essentialist beliefs about people having one sex or ‘the other’ is maintained in debates conducted in this online public space. Comments were coded thematically and are presented under five sub‐headings: overall evaluation of the German law; discussing and disputing statistics and ‘facts’; binary categorisations; religion and politics; and ‘conversations’ and threads. Although for many the mapping of binary sex onto gender was unquestionable, this view was strongly disputed by commentators who questioned the meanings of ‘natural’ and ‘normal’, raised the possibility of removing societal binary male‐female distinctions or saw maleness–femaleness as a continuum. While recognising that online commentators are anonymous and can control their self‐presentation, this animated discussion suggests that social classifications as male or female, even if questioned, remain fundamental in public debate in the early 21st century.
    November 16, 2016   doi: 10.1111/1467-9566.12490   open full text
  • Disentangling patient and public involvement in healthcare decisions: why the difference matters.
    Mio Fredriksson, Jonathan Q. Tritter.
    Sociology of Health & Illness. November 11, 2016
    Patient and public involvement has become an integral aspect of many developed health systems and is judged to be an essential driver for reform. However, little attention has been paid to the distinctions between patients and the public, and the views of patients are often seen to encompass those of the general public. Using an ideal‐type approach, we analyse crucial distinctions between patient involvement and public involvement using examples from Sweden and England. We highlight that patients have sectional interests as health service users in contrast to citizens who engage as a public policy agent reflecting societal interests. Patients draw on experiential knowledge and focus on output legitimacy and performance accountability, aim at typical representativeness, and a direct responsiveness to individual needs and preferences. In contrast, the public contributes with collective perspectives generated from diversity, centres on input legitimacy achieved through statistical representativeness, democratic accountability and indirect responsiveness to general citizen preferences. Thus, using patients as proxies for the public fails to achieve intended goals and benefits of involvement. We conclude that understanding and measuring the impact of patient and public involvement can only develop with the application of a clearer comprehension of the differences.
    November 11, 2016   doi: 10.1111/1467-9566.12483   open full text
  • Changing tastes: learning hunger and fullness after gastric bypass surgery.
    Line Hillersdal, Bodil J. Christensen, Lotte Holm.
    Sociology of Health & Illness. November 05, 2016
    Gastric bypass surgery is a specific medical technology that alters the body in ways that force patients to fundamentally change their eating habits. When patients enrol for surgery, they enter a learning process, encountering new and at times contested ways of sensing their bodies, tasting, and experiencing hunger and fullness. In this paper, we explore how patients begin to eat again after gastric bypass surgery. The empirical data used here are drawn from a Danish fieldwork study of individuals undergoing obesity surgery. The material presented shows how the patients used instructions on how to eat. We explore the ways in which diverse new experiences and practices of hunger and fullness are part of the process of undergoing surgery for severe obesity. New sensory experiences lead to uncertainty; as a result, patients practice what we term mimetic eating, which reflects a ‘sensory displacement’ and hence a rupture in the person's sense of self and social relations. We suggest that eating should be conceptualised as a practice that extends beyond the boundaries of our bodies and into diverse realms of relations and practices, and that changing the way we eat also changes the fundamentally embodied experience of who we are.
    November 05, 2016   doi: 10.1111/1467-9566.12504   open full text
  • The articulation of neoliberalism: narratives of experience of chronic illness management in Bulgaria and the UK.
    Ivaylo Vassilev, Anne Rogers, Elka Todorova, Anne Kennedy, Poli Roukova.
    Sociology of Health & Illness. November 04, 2016
    The shift from social democratic to a neoliberal consensus in modern welfare capitalist states is characterised by an emphasis on individual responsibility, consumer choice, market rationality and growing social inequalities. There has been little exploration of how neoliberalism has shaped the environment within which chronic illness is experienced and managed. This article explores the different articulations of neoliberalism manifest in the arena of personal illness management in Bulgaria and the UK. People with type 2 diabetes discussed their experiences in terms of struggling with diet, diabetes as a personal failure, integrating illness management and valued activities, and the trustworthiness of the healthcare system. The UK narratives were framed within an individual responsibility discourse while in Bulgaria lack of resources dominated discussions, which were framed as structurally generated and unrelated to individual capabilities and choices. Respondents faced personal management challenges related to consumer and healthcare market failures in both countries. Differences in market regulation and emerging stakeholder and interest coalitions influenced users' expectations and their navigation and adaption to market failures in managing their everyday illnesses. The UK and Bulgarian articulations of neoliberalism can be described differently: the first as a logic of managed choice and the second as a logic of unmanaged consumerism.
    November 04, 2016   doi: 10.1111/1467-9566.12488   open full text
  • Family social capital and health – a systematic review and redirection.
    Elena Carrillo Alvarez, Ichiro Kawachi, Jordi Riera Romani.
    Sociology of Health & Illness. November 03, 2016
    The level (or scale) at which social capital can be conceptualised and measured ranges potentially from the macro‐level (regional or country level), to the meso‐level (neighbourhoods, workplaces, schools), down to the individual level. However, one glaring gap in the conceptualisation of social capital within the empirical literature has been the level of the family. Our aim in this review is to examine the family as the ‘missing level’ in studies on social capital and health. To do so, we conducted a systematic review on the use and measurement of this notion in the health literature, with the final intention of articulating a direction for future research in the field. Our findings are consistent with the notion that family social capital is multidimensional and that its components have distinct effects on health outcomes. Further investigation is needed to understand the mechanisms through which family social capital is related to health, as well as determining the most valid ways to measure family social capital.
    November 03, 2016   doi: 10.1111/1467-9566.12506   open full text
  • Writing the patient down and out: the construal of the patient in medical certificates of disability.
    Guri Aarseth, Bård Natvig, Eivind Engebretsen, Eva Maagerø, Anne Helene Kveim Lie.
    Sociology of Health & Illness. November 01, 2016
    We analysed a set of medical certificates to investigate how GPs portray patients who seek disability benefits in Norway, focusing on patient centredness, agency and involvement. We performed a qualitative linguistic analysis of 33 medical certificates collected throughout Norway that were strategically selected based on the patients’ sex, age and diagnosis. We found that patients were represented as passive carriers of symptoms, in whom agency was low, failed, conditional or non‐existing, or as passive objects of the actions of impersonalised others. Conversely, symptoms were foregrounded as independent and powerful actors. The patient's experience of illness was sometimes reported, but the perspective of the GP tended to be doctor oriented, rather than patient centred. The policy of the social services, which emphasises patient involvement, patient centredness and work, rather than social benefits, was almost completely absent from these medical certificates. If medical certificates are to be a valid basis for decisions within the social services, we suggest that doctor paternalism in these documents must give way to considering the patient as an involved and co‐responsible individual in the processes of disability assessment.
    November 01, 2016   doi: 10.1111/1467-9566.12481   open full text
  • A narrative analysis of the birth stories of early‐age mothers.
    Anna Carson, Cathy Chabot, Devon Greyson, Kate Shannon, Putu Duff, Jean Shoveller.
    Sociology of Health & Illness. October 28, 2016
    The telling of birth stories (i.e. stories that describe women's experiences of giving birth) is a common and important social practice. Whereas most research on birth narratives reflects the stories of middle‐class, ‘adult’ women, we examine how the birth stories told by early‐age mothers interconnect with broader narratives regarding social stigma and childbearing at ‘too early’ an age. Drawing on narrative theory, we analyse in‐depth interviews with 81 mothers (ages 15–24 years) conducted in Greater Vancouver and Prince George, Canada, in 2014–15. Their accounts of giving birth reveal the central importance of birth narratives in their identity formation as young mothers. Participants’ narratives illuminated the complex interactions among identity formation, social expectations, and negotiations of social and physical spaces as they narrated their experiences of labour and birth. Through the use of narrative inquiry, we examine the ways in which re‐telling the experience of giving birth serves to situate young mothers in relation to their past and future selves. These personal stories are also told in relation to a meta‐narrative regarding social stigma faced by ‘teenage’ mothers, as well as the public's ‘gaze’ on motherhood in general – even within the labour and delivery room.
    October 28, 2016   doi: 10.1111/1467-9566.12518   open full text
  • Nanomedicine and personalised medicine: understanding the personalisation of health care in the molecular era.
    Mathieu Noury, José López.
    Sociology of Health & Illness. October 26, 2016
    Globally supported by public policy and investment, nanomedicine is presented as an ongoing medical revolution that will radically change the practice of health care from diagnostic to therapeutic, and everything in between. One of nanomedicine's major promises is that of personalised medicine, enabling diagnostics and therapeutics tailored to individual needs and developing a truly ‘patient‐friendly’ medical approach. Based on qualitative interviews with nanomedicine researchers in Canada, this article explores the emerging concept of personalised medicine as it becomes entangled with nanomedical research. More precisely, drawing on insights from science studies and the sociology of expectations, it analyses researchers’ perceptions of personalised medicine in the cutting edge of current nanomedicine research. Two perceptions of personalisation are identified; a molecular conception of individuality and a technical conception of personalisation. The article concludes by examining the relationship between the two conceptions and contrasts them with the normative reflex of a more expansive conception of personalised medicine.
    October 26, 2016   doi: 10.1111/1467-9566.12502   open full text
  • Ageing, masculinity and Parkinson's disease: embodied perspectives.
    Grant Gibson, Ciara Kierans.
    Sociology of Health & Illness. October 26, 2016
    Parkinson's disease (PD) presents as an illness which predominantly affects older men. However older men's lived experiences of PD, including how they are influenced by age and gender relations has seen little empirical study. Drawing on Watson's male body schema, this paper explores how men engage with masculinities and ageing in order to make sense and meaning from PD. Data is presented from 30 narrative and semi structured interviews with 15 men of various ages who were living with PD. Findings suggest that PD threatens a visceral embodiment located in the body's basic movements and intimate functions; a pragmatic embodiment expressed through men's everyday occupations and an experiential embodiment concerned with emotions and sensations felt within and through the body. In addition, each dimension of men's embodiment also intersected with the ageing process, a process also shaped in turn by broader social and cultural concerns regarding the positions and possibilities of men's lives as they move through the life course. This paper concludes by discussing the implications of gender and ageing in understanding men's experiences of PD
    October 26, 2016   doi: 10.1111/1467-9566.12508   open full text
  • Enabling and controlling parenthood in publicly provided maternity healthcare: becoming a parent in Finland.
    Riikka Homanen.
    Sociology of Health & Illness. October 22, 2016
    This article discusses practices of parental support in the maternity healthcare provided by the welfare state. Drawing on ethnographic material from clinics in Finland, I discuss maternity healthcare practices and processes as the specific contexts of subjectification to parenthood in the Nordic welfare state. The analysis shows that in both nurses’ (work) experience‐based knowledge and population‐statistical knowledge, parental competence is achieved largely through the ‘natural’ process of experiencing pregnant life. Care practices can be seen as enabling parenthood through respect for this process. Clinics encourage parents‐to‐be to self‐reflect and be self‐reliant. Emphasis on self‐reflection and self‐reliance has previously been interpreted as the state adoption of therapy culture, and as a response to market demands for the welfare state to offer to and require of its citizens more autonomy and choice. I argue, however, that the parental subject emerging from the practices of this welfare service cannot be reduced to a neoliberal reflexive individual for whom parenthood is an individual project and who is to blame for individual shortcomings. Equally, they are no mere disciplined product of governmentality being pushed to conform to an idealised parent figure derived from collective ideas of good parenthood.
    October 22, 2016   doi: 10.1111/1467-9566.12491   open full text
  • Death in the clinic: women's perceptions and experiences of discarding supernumerary IVF embryos.
    Sheryl Lacey.
    Sociology of Health & Illness. October 22, 2016
    Perspectives on the status of human embryos and whether they should be discarded differ globally. Some countries protect embryos in law while in other countries embryos ‘die’ or ‘succumb’ in assisted reproductive technology clinics on a daily basis. This study analyses interview data drawn from a larger qualitative study conducted in South Australia from 2004–2007. 21 women and 12 of 21 partners were interviewed about the decision they made to discard their embryos. The analysis reported here sought to examine the ways in which women constructed and experienced the decision to discard embryos. The article highlights the ways in which embryo discard is a contested discursive space. Embryo death is sequestered through their confinement in the laboratory and their invisibility to the naked eye. The clinic treated embryo discard as disposal of biological waste and failed to acknowledge the meaning of the event. By contrast women experienced emotional bereavement described as similar to early pregnancy loss, and described experiences of attachment and grief. For sensitive and compassionate care these differences in perceptions of embryo discard need to be addressed.
    October 22, 2016   doi: 10.1111/1467-9566.12497   open full text
  • To what extent does diagnosis matter? Dementia diagnosis, trouble interpretation and caregiving network dynamics.
    Baptiste Brossard, Normand Carpentier.
    Sociology of Health & Illness. October 22, 2016
    Contemporary research into health and mental health treats diagnosis as a central step in understanding illness management and trajectory; consequently, in the last two decades, sociology of diagnosis has attained increasing influence within medical sociology. Deeply embedded in social constructionism, the set of research divides between those who focus on the social and historical construction of diagnoses as categories, and those who see diagnosis as a process. Regarding the latter, this approach explores the constitution of the medical production, highlighting how it constitutes a starting point for entering a ‘sick role’, for being labelled, for naming one's problem and by extension, for framing one's illness narrative.
    October 22, 2016   doi: 10.1111/1467-9566.12501   open full text
  • How adults with a profound intellectual disability engage others in interaction.
    Charles Antaki, Rebecca J. Crompton, Chris Walton, W.M.L. Finlay.
    Sociology of Health & Illness. October 20, 2016
    Using video records of everyday life in a residential home, we report on what interactional practices are used by people with severe and profound intellectual disabilities to initiate encounters. There were very few initiations, and all presented difficulties to the interlocutor (support staff; the recording researcher); one (which we call ‘blank recipiency’) gave the interlocutor virtually no information at all on which to base a response. Only when the initiation was of a new phase in an interaction already under way (for example, the initiation of an alternative trajectory of a proposed physical move) was it likely to be successfully sustained. We show how interlocutors responded to initiations verbally, as if to neuro‐typical speakers – but inappropriately for people unable to comprehend, or to produce well‐fitted next turns. This mis‐reliance on ordinary speakers’ conversational practices was one factor that contributed to residents abandoning the interaction in almost all cases. We discuss the dilemma confronting care workers.
    October 20, 2016   doi: 10.1111/1467-9566.12500   open full text
  • Nurses and electronic health records in a Canadian hospital: examining the social organisation and programmed use of digitised nursing knowledge.
    Marie L. Campbell, Janet M. Rankin.
    Sociology of Health & Illness. October 10, 2016
    Institutional ethnography (IE) is used to examine transformations in a professional nurse's work associated with her engagement with a hospital's electronic health record (EHR) which is being updated to integrate professional caregiving and produce more efficient and effective health care. We review in the technical and scholarly literature the practices and promises of information technology and, especially of its applications in health care, finding useful the more critical and analytic perspectives. Among the latter, scholarship on the activities of economising is important to our inquiry into the actual activities that transform ‘things’ (in our case, nursing knowledge and action) into calculable information for objective and financially relevant decision‐making. Beginning with an excerpt of observational data, we explicate observed nurse‐patient interactions, discovering in them traces of institutional ruling relations that the nurse's activation of the EHR carries into the nursing setting. The EHR, we argue, materialises and generalises the ruling relations across institutionally located caregivers; its authorised information stabilises their knowing and acting, shaping health care towards a calculated effective and efficient form. Participating in the EHR's ruling practices, nurses adopt its ruling standpoint; a transformation that we conclude needs more careful analysis and debate.
    October 10, 2016   doi: 10.1111/1467-9566.12489   open full text
  • Complete tooth loss as status passage.
    Barry John Gibson, Philip V. Sussex, Ruth P. Fitzgerald, William Murray Thomson.
    Sociology of Health & Illness. October 10, 2016
    The aim of this article is to add to the literature on the sociology of oral health and dentistry by presenting the relevance of status passage to the study of complete tooth loss. The article reports on an analysis of data taken from participants residing in the Nelson region of New Zealand. In total the data include interviews from 20 participants, all of whom had their remaining natural teeth removed before 1960. In total, 12 women and eight men were interviewed. All were from a European background with an age range of 71 to 101 years. Following a narrative approach, participants were interviewed on the nature of the social factors that resulted in complete tooth loss by starting with their family history and then focusing on the factors and events leading up to their total tooth loss. Data were analysed using the methods and techniques of grounded theory. This article provides an outline of the importance of scheduling, prescribing, social factors, ‘compound awareness contexts’ and reversibility to the status passage into complete tooth loss. We conclude by arguing that the theory of status passage may enable a detailed analysis of the ‘time‐space extensionality’ of trajectories into complete tooth loss.
    October 10, 2016   doi: 10.1111/1467-9566.12492   open full text
  • Parental involvement in neonatal critical care decision‐making.
    Chloe Shaw, Elizabeth Stokoe, Katie Gallagher, Narendra Aladangady, Neil Marlow.
    Sociology of Health & Illness. September 25, 2016
    The article analyses the decision‐making process between doctors and parents of babies in neonatal intensive care. In particular, it focuses on cases in which the decision concerns the redirection of care from full intensive care to palliative care at the end of life. Thirty one families were recruited from a neonatal intensive care unit in England and their formal interactions with the doctor recorded. The conversations were transcribed and analysed using conversation analysis. Analysis focused on sequences in which decisions about the redirection of care were initiated and progressed. Two distinct communicative approaches to decision‐making were used by doctors: ‘making recommendations’ and ‘providing options’. Different trajectories for parental involvement in decision‐making were afforded by each design, as well as differences in terms of the alignments, or conflicts, between doctors and parents. ‘Making recommendations’ led to misalignment and reduced opportunities for questions and collaboration; ‘providing options’ led to an aligned approach with opportunities for questions and fuller participation in the decision‐making process. The findings are discussed in the context of clinical uncertainty, moral responsibility and the implications for medical communication training and guidance.A Virtual Abstract of this paper can be accessed at: https://www.youtube.com/watch?v=MyuymxDNupk&feature=youtu.be
    September 25, 2016   doi: 10.1111/1467-9566.12455   open full text
  • Unmasking the enterprising nurse: migrant care workers and the discursive mobilisation of productive professionals.
    Antero Olakivi.
    Sociology of Health & Illness. September 09, 2016
    Public care work organisations in Northern Europe often seek to increase their economic efficiency in ways that care workers criticise for reducing both their professional autonomy and the quality of care. Recently, the ideal of ‘enterprising nursing’ has emerged as a political belief according to which economic efficiency, care workers' autonomy and the quality of care can be improved in tandem by cultivating care workers' agential abilities. This article examines the reception of this belief among migrant care workers in Finland. Drawing on research interviews, the analysis demonstrates how migrant care workers may have difficulties in aligning themselves with the enterprising ideals but also in protesting them. Ethnicity, and the status of a migrant, can offer resources for both constructing enterprising subjectivities and reframing care workers' agency, and their organisational environment, in more critical terms.
    September 09, 2016   doi: 10.1111/1467-9566.12493   open full text
  • Organ donation agency: A discourse analysis of correspondence between donor and organ recipient families.
    Dariusz Galasiński, Magi Sque.
    Sociology of Health & Illness. September 06, 2016
    Studies about the psychosocial issues concerning organ donation and transplantation tend to focus on the experiences of donor or recipient families. Little is known about the part played by correspondence exchanged between these two groups; in particular how they perceive the agency of organ donation. This is the first analysis to address the representation of the act of donation from the viewpoint of both donor and recipient families through interrogation of archived correspondence data, using linguistic techniques. The data was drawn from a collection of letters, from four USA organ procurement organisations, exchanged between donor and transplant recipient families. Donor families consistently linguistically ascribed agency and accountability for donation to the person who died, the donor. For the recipient families, on the other hand, the ‘giver’ was mainly implied, ambiguous or ascribed to the donor family.
    September 06, 2016   doi: 10.1111/1467-9566.12478   open full text
  • ‘Sometimes, it's easier to write the prescription’: physician and patient accounts of the reluctant medicalisation of sleeplessness.
    Mairead Eastin Moloney.
    Sociology of Health & Illness. September 04, 2016
    The medicalisation of sleep is a rich and growing area of sociological interest. Previous research suggests that medicalisation is occurring within the context of physician office visits, but the inner workings remain unclear. This study is the first to provide perspectives on the office visit interaction from both sleepless patients (n = 27) and the physicians (n = 8) who treat them. Analyses of semi‐structured qualitative interviews reveal that sleep‐related conversations are typically patient‐initiated in routine office visits. Physicians and patients conceptualised insomnia as a symptom of another issue (depression), an everyday problem of living (stress) or the result of a natural life process (aging). Lack of sleep was not necessarily linked to daytime impairment. Even though sleep aids were routinely requested and prescribed, patients and physicians consistently expressed attitudes of reluctance toward the use of sedative hypnotics. I call this a case of ‘reluctant medicalisation’ and highlight the liminal space between pathology and normalcy inhabited by patients and physicians. I also build on recent work acknowledging the dynamics between macro and micro levels of medicalisation and illustrate the influence of multilevel ‘engines’ (consumerism, biotechnology, managed care and physicians) in patients’ and physicians’ accounts. A virtual abstract of this paper can be viewed at: https://youtu.be/7uLHOJPHF0I
    September 04, 2016   doi: 10.1111/1467-9566.12485   open full text
  • Care in place: A case study of assembling a carescape.
    Dara Ivanova, Iris Wallenburg, Roland Bal.
    Sociology of Health & Illness. August 31, 2016
    In this article we analyse the process of the multiple ways place and care shape each other and are co‐produced and co‐functioning. The resulting emerging assemblage of this co‐constituent process we call a carescape. Focusing on a case study of a nursing home on a Dutch island, we use place as a theoretical construct for analysing how current changes in healthcare governance interact with mundane practices of care. In order to make the patterns of care in our case explicit, we use actor‐network theory (ANT) sensibilities and especially the concept of assemblage. Our goal is to show – by zooming in on a particular case – how to study the co‐constituent processes of place‐ and care‐shaping, revealing the ontological diversity of place and care. Through this, we contribute a perspective of the heterogeneity and multiplicity of care in its dynamic relationship of co‐production with place.
    August 31, 2016   doi: 10.1111/1467-9566.12477   open full text
  • From medicalisation to riskisation: governing early childhood development.
    Fan‐Tzu Tseng.
    Sociology of Health & Illness. August 31, 2016
    This study investigates the transformation of the regime of governing child developmental conditions in Taiwan. With the shift from a medicalised regime of disabilities to a riskised regime of developmental delays, early childhood development has become the primary focus of governance. Drawing upon a multi‐sited ethnography to follow the process by which the ideas and practices of early intervention are imported and adapted to local conditions, I elucidate how and why the new subject, that is, children with developmental risks and their families, emerged with the concomitant re‐configuration of governance. By using three riskisation strategies, namely, the truth claim of prevalence rate of developmental delays, mass screening with standardised instruments, and identification of risky families, child development is problematised collectively and surveilled individually. Within this new regime, every young child is no longer considered either normal or disabled but is rather located within a developmental risk continuum and subject to relentless medical and social interventions. While ‘returning to normal’ becomes the predominant goal of early intervention for developmentally delayed children, disabilities are increasingly enacted negatively and considered embodying an undesirable state of being. These changing delimitations and subsequent interventions have profoundly reshaped our understanding of the child, normality and disability.
    August 31, 2016   doi: 10.1111/1467-9566.12484   open full text
  • Between stigma and pink positivity: women's perceptions of social interactions during and after breast cancer treatment.
    Diane Trusson, Alison Pilnick.
    Sociology of Health & Illness. August 31, 2016
    This study explores women's perceptions of social interaction during and after their treatment for early stage breast cancer. An analysis of interviews with 24 women between 6 months and 29 years post‐diagnosis reveals that interactions can be influenced by conflicting public discourses surrounding breast cancer. For example, there is the continuing association of cancer with death and the resulting potential for a stigmatised identity. In contrast is the ultra‐positive discourse around cancer survivorship, with breast cancer in particular being associated with pink campaigning and a push towards positive thinking. Participants described managing conversations during treatment; sometimes playing down their private suffering and presenting a positive (public) image rather than risk alienating support. After treatment they were encouraged to move on and get back to ‘normal’. While other breast cancer patients and survivors were often good sources of support, there was also a danger of assuming that all experiences would be the same. We present data to illustrate that women often present public accounts that are driven by an expectation of positivity and fear of stigmatisation at all stages of breast cancer treatment and beyond.
    August 31, 2016   doi: 10.1111/1467-9566.12486   open full text
  • ‘Good’ patient/‘bad’ patient: clinical learning and the entrenching of inequality.
    Eeva Sointu.
    Sociology of Health & Illness. August 31, 2016
    This article develops sociological understanding of the reproduction of inequality in medicine. The material is drawn from a longitudinal study of student experiences of clinical learning that entailed 72 qualitative in‐depth interviews with 27 medical students from five medical schools in the USA. To highlight the subtle, yet powerful, ways in which inequality gets entrenched, this article analyses ideas of the ‘good’ and the ‘bad’ patient. Bad patients question not only biomedical knowledge but also medical students’ commitment to helping people. Good patients engage with medical students in a manner that upholds biomedical knowledge and enables students to assume the role of the healer and the expert. At the same time, good patients possess cultural skills that align with those of medical practitioners. This alignment is, furthermore, central to definitions of the good patient. Distinctions drawn between good and bad patients thus both embody as well as enforce social inequality. The subtle reproduction of inequality is, however, difficult to discern because judgements about patients entwine with emotion.
    August 31, 2016   doi: 10.1111/1467-9566.12487   open full text
  • Determinants of dietary compliance among Italian children: disentangling the effect of social origins using Bourdieu's cultural capital theory.
    Filippo Oncini, Raffaele Guetto.
    Sociology of Health & Illness. August 30, 2016
    Making use of Bourdieu's threefold conceptualisation of cultural capital, this paper examines and disentangles the association between social origins and children's food consumption. The aim of the work is twofold. Using data from the Multipurpose survey on daily life conducted by Istat (2009–2012), we first show that children's compliance with dietary advice is indeed influenced by their social origins, but more so in terms of familial cultural resources than economic ones. All types of cultural capital enhance the quality of children's nutrition. Second, we concentrate on the role of the school canteen as a child‐centred investment strategy intended to reduce health inequalities by providing a wholesome lunch for all children. Although the school meal effectively improves the degree of dietary compliance, the results indicate that this public service is less often used by children from lower social origins. Moreover, we do not find any equalising effect of the school meal on the diets of disadvantaged children. These findings are discussed in light of future research on sociology of health stratification and health promotion programmes.
    August 30, 2016   doi: 10.1111/1467-9566.12482   open full text
  • Among friends: a qualitative exploration of the role of peers in young people's alcohol use using Bourdieu's concepts of habitus, field and capital.
    Georgie J. MacArthur, Nina Jacob, Pandora Pound, Matthew Hickman, Rona Campbell.
    Sociology of Health & Illness. August 30, 2016
    Drinking is viewed by young people as a predominantly social activity which provides an opportunity for entertainment and bonding with friends. Using Bourdieu's concepts of habitus, field and capital, this article explores young people's attitudes and beliefs around alcohol use, influences on behaviour, and the role of peers, with a view to informing the development of preventive interventions. Semi‐structured interviews were conducted with 28 young people aged 18–20 in the south west of England. We describe how friends were integral in drinking experiences, and drinking with friends was equated with fun and enjoyment. In this way, the desire for social and symbolic capital appeared to be a key motivator for adolescent drinking. Critically, however, wider cultural norms played the predominant role in shaping behaviour, via the internalisation of widely accepted practice and the subsequent externalisation of norms through the habitus. Applying Bourdieu's theory suggests that population‐level interventions that regulate alcohol consumption, and thus disrupt the field, are likely to facilitate behaviour change among young people by driving a response in habitus.
    August 30, 2016   doi: 10.1111/1467-9566.12467   open full text
  • The changing body work of abortion: a qualitative study of the experiences of health professionals.
    Carrie Purcell, Sharon Cameron, Julia Lawton, Anna Glasier, Jeni Harden.
    Sociology of Health & Illness. August 28, 2016
    ‘Body work’ has emerged at the nexus of sociologies of work and bodies as a means of conceptualising work focusing on the bodies of others. This article utilises this analytical tool in the context of contemporary abortion work. Abortion provision in Britain has seen significant change in the last 25 years, paralleling developments in medical methods, and the option for women under nine weeks' gestation to complete the abortion at home. These shifts raise questions around how abortion work is experienced by those who do it. We apply the conceptual lens of body work to data drawn from in‐depth interviews with 37 health professionals involved in abortion provision, to draw out the character, constraints and challenges of contemporary abortion work. We explore three key themes: the instrumental role of emotional labour in facilitating body work; the temporality of abortion work; and bodily proximity, co‐presence and changes in provision. By drawing on the conceptual frame of body work, we illuminate the dynamics of contemporary abortion work in Britain and, by introducing the idea of ‘body work‐by‐proxy’, highlight ways in which this context can be used to expand the conceptual boundaries of body work.
    August 28, 2016   doi: 10.1111/1467-9566.12479   open full text
  • ‘Constrained collaboration’: Patient empowerment discourse as resource for countervailing power.
    Alexandra H. Vinson.
    Sociology of Health & Illness. August 28, 2016
    Countervailing powers constrain the authority and autonomy of the medical profession. One countervailing power is patient consumerism, a movement with roots in health social movements. Patient empowerment discourses that emerge from health social movements suggest that active patienthood is a normative good, and that patients should inform themselves, claim their expertise, and participate in their care. Yet, little is known about how patient empowerment is understood by physicians. Drawing on ethnographic fieldwork in an American medical school, this article examines how physicians teach medical students to carry out patient encounters while adhering to American cultural expectations of a collaborative physician–patient relationship. Overt medical paternalism is characterised by professors as ‘here's the orders’ paternalism, and shown to be counterproductive to ‘closing the deal’ – achieving patient agreement to a course of treatment. To explain how physicians accomplish their therapeutic goals without violating cultural mandates of patient empowerment I develop the concept of ‘constrained collaboration’. This analysis of constrained collaboration contrasts with structural‐level narratives of diminishing professional authority and contributes to a theory of the micro‐level reproduction of medical authority as a set of interactional practices.
    August 28, 2016   doi: 10.1111/1467-9566.12480   open full text
  • The development of healthcare use among a cohort of Finnish social assistance clients: testing the social selection hypothesis.
    Maria Vaalavuo.
    Sociology of Health & Illness. August 23, 2016
    This article examines the association between healthcare use and receipt of social assistance. It focuses on asking to what extent the use of healthcare (seen as a proxy for health status) leads to social assistance. This is answered by describing the use of healthcare services among a cohort of Finnish social assistance clients before, during and after the first receipt of benefit by means of fixed‐effects logistic regression. Using register data, the study follows a group of social assistance recipients from 2005 to 2011 and compares their use of healthcare to those not claiming social assistance during this same period and analyses how their use of health services develops over time. The results show that recipients use public healthcare clearly more than non‐recipients, but they do so already prior to the first social assistance receipt. This partly confirms the social selection hypothesis according to which health problems lead to low income. However, the results do not exclude the existence of social causation. The causality is most likely bi‐directional. The findings of the descriptive analyses are corroborated by a fixed‐effects logistic regression analysis: the use of healthcare services increases the probability of receiving social assistance in the following month.
    August 23, 2016   doi: 10.1111/1467-9566.12458   open full text
  • Understanding the meaning and role of gifts given to Ugandan mothers in maternity care settings: ‘The help they give when they've seen how different you are’.
    Sarah Rudrum, Helen Brown, John L. Oliffe.
    Sociology of Health & Illness. August 23, 2016
    The provision of gifts to new mothers in Uganda is laden with significance that varies by the social location of the giver and receiver and the context and conditions under which the gift is made available. Here, we examine the act of gift giving and receiving within a Ugandan maternity care setting, describing the connections between these material objects and social relations. A study investigating the social organisation of maternity care in post‐conflict northern Uganda found that gift‐giving to new mothers functioned to create a material and discursive context wherein women's desire to access these goods was leveraged to create an incentive to attend formal maternity care during pregnancy and for delivery. In this article we describe the material and discursive processes surrounding gift‐giving to new mothers in this global South health care setting. This article contributes critical analyses of the function of gifts in healthcare settings as constructing shared identities, social differences and normative values about health citizenship, and an incentive politic that affects equitable access to maternity care. Drawing on intersectional theory and analysis of how specific practices function ideologically to reward or incentivise pregnant women, we integrate material culture studies into the sociology of women's reproductive health.
    August 23, 2016   doi: 10.1111/1467-9566.12456   open full text
  • Assembling the salon: Learning from alternative forms of body work in dementia care.
    Richard Ward, Sarah Campbell, John Keady.
    Sociology of Health & Illness. August 22, 2016
    This article explores the labour and experiences of a hitherto entirely overlooked section of the dementia care workforce: care‐based hairdressers. Reporting on findings from the ESRC‐funded ‘Hair and Care’ project, the analysis and discussion focus upon the ‘doing of hair’ in the context of dementia care. The authors challenge existing assumptions and approaches to the management of appearance in dementia care, arguing for greater recognition of the subjective and culturally meaningful qualities of a visit to the salon. The article draws upon a wider debate on body work as a framework for the discussion, and considers the employment and working conditions of this largely hidden group of workers in the care system. The article offers an account of the praxis of care‐based hairdressing, with particular attention paid to narrative, intercorporeal and place‐making practices in the salon, showing how a particular approach to the body shapes the labour, relationships and activities that unfold within it. The authors argue that as an alternative form of body work much can be learned from hairdressing that can inform and enhance the provision of dementia care.
    August 22, 2016   doi: 10.1111/1467-9566.12461   open full text
  • Repertoires of responsibility for diabetes management by adults with intellectual disabilities and those who support them.
    Lorna Rouse, W.M.L. Finlay.
    Sociology of Health & Illness. August 22, 2016
    The limited existing research on diabetes management and intellectual disabilities (ID) highlights the need for further exploration of the concept of responsibility. This study explored repertoires of responsibility in accounts of managing diabetes for adults with ID. Fourteen semi‐structured interviews were conducted in the UK with seven adults with mild/moderate ID and type 1 or 2 diabetes and seven people who they nominated as supporting their diabetes management. A discursive psychological analysis found that interpretative repertoires relating to competence, independence and accountability were drawn on to construct multiple and sometimes conflicting versions of responsibility. Within these repertoires people with ID were positioned in conflicting ways; as competent, personally responsible, and entitled to independence and choice, but as also lacking competence, dependent on others and incapable of overall accountability. People with ID often took up empowering positions defending against an incompetent identity. Supporters built accounts which negotiated dilemmatic repertoires on the dual responsibilities of empowering adults with ID to self‐manage and managing risk to support good and safe care. The implications of available discursive resources and the ways in which they are mobilised are considered.
    August 22, 2016   doi: 10.1111/1467-9566.12454   open full text
  • The nuanced negative: Meanings of a negative diagnostic result in clinical exome sequencing.
    Debra Skinner, Kelly A. Raspberry, Martha King.
    Sociology of Health & Illness. August 19, 2016
    Genomic sequencing technology is moving rapidly from the research setting into clinical medicine but significant technological and interpretive challenges remain. Exome sequencing (ES) in its recent clinical application provides a genetic diagnosis in about 25 per cent of cases (Berg 2014). While this diagnostic yield is substantial, it also indicates that in a majority of cases, patients are receiving negative results (i.e. no explanatory genetic variant found) from this technology. There are a number of uncertainties regarding the meaning of a negative result in the current context of ES. A negative result may be due to current technological limitations that hinder detection of disease‐causing variants or to gaps in the knowledge base that prohibit accurate interpretation of their pathogenicity; or it may indicate that there is not a genetic etiology for the disorder. In this paper we examine the uncertainties and nuances of the negative result from genome sequencing and how both clinicians and patients make meaning of it as revealed in ethnographic observations of the clinic session where results are returned, and in interviews with patients. We find that clinicians and patients construct the meaning of a negative result in ways that are uncertain, contingent, and multivalent; but invested with optimism, promise, and potentiality.
    August 19, 2016   doi: 10.1111/1467-9566.12460   open full text
  • The dispositions of things: the non‐human dimension of power and ethics in patient‐centred medicine.
    John Gardner, Alan Cribb.
    Sociology of Health & Illness. July 27, 2016
    This article explores power relations between clinicians, patients and families as clinicians engage in patient‐centred ethical work. Specifically, we draw on actor‐network theory to interrogate the role of non‐human elements in distributing power relations in clinical settings, as clinicians attempt to manage the expectations of patients and families. Using the activities of a multidisciplinary team providing deep brain stimulation to children with severe movement disorders as an example, we illustrate how a patient‐centred tool is implicated in establishing relations that constitute four modes of power: ‘power over’, ‘power to’, “power storage” and “power/discretion”. We argue that understanding the role of non‐human elements in structuring power relations can guide and inform bioethical discussions on the suitability of patient‐centred approaches in clinical settings.
    July 27, 2016   doi: 10.1111/1467-9566.12431   open full text
  • Breast‐cancer‐isation explored: Social experiences of gynaecological cancer in a Norwegian context.
    Kari Nyheim Solbrække, Geir Lorem.
    Sociology of Health & Illness. July 27, 2016
    This article's point of departure is recent claims that breast cancer survivorship displaying positivity and self‐growth represents the gold standard for all forms of cancer survivorship in English‐speaking Western cultures. An interview study of Norwegian women regarding gynaecological cancer followed by hysterectomy is used to explore whether this process is taking place beyond this setting. Results show that the women's experiences of having to display survivorship in this manner are not as notable as found in English‐speaking Western countries, neither is their experience of social othering. Reasons for this may be strong norms of social egalitarianism marking Norwegian culture and breast cancer informational campaigns that have not yet totally defined Norwegian norms for how to survive cancer. At the clinic and in the public sphere, however, the women experience gynaecological cancer as clearly having lower status than breast cancer, leading to a strong sense that the bodily site of their disease is taboo. Hence, as found in English‐speaking cultures, the complex embodied nature of having gynaecological cancer and life beyond treatment seems to be silenced by the media and medical institutions. Finally, implications for future research and health care related to cancer survivorship are also discussed.
    July 27, 2016   doi: 10.1111/1467-9566.12459   open full text
  • Stratified, precision or personalised medicine? Cancer services in the ‘real world’ of a London hospital.
    Sophie Day, R Charles Coombes, Louise McGrath‐Lone, Claudia Schoenborn, Helen Ward.
    Sociology of Health & Illness. July 27, 2016
    We conducted ethnographic research in collaboration with a large, research‐intensive London breast cancer service in 2013–2014 so as to understand the practices and potential effects of stratified medicine. Stratified medicine is often seen as a synonym for both personalised and precision medicine but these three terms, we found, also related to distinct facets of treatment and care. Personalised medicine is the term adopted for the developing 2016 NHS England Strategy, in which breast cancer care is considered a prime example of improved biological precision and better patient outcomes. We asked how this biologically stratified medicine affected wider relations of care and treatment. We interviewed formally 33 patients and 23 of their carers, including healthcare workers; attended meetings associated with service improvements, medical decision‐making, public engagement, and scientific developments as well as following patients through waiting rooms, clinical consultations and other settings. We found that the translation of new protocols based on biological research introduced further complications into an already‐complex patient pathway. Combinations of new and historic forms of stratification had an impact on almost all patients, carers and staff, resulting in care that often felt less rather than more personal.
    July 27, 2016   doi: 10.1111/1467-9566.12457   open full text
  • Speculating on health: public health meets finance in ‘health impact bonds’.
    Rachel Rowe, Niamh Stephenson.
    Sociology of Health & Illness. July 17, 2016
    Where modern public health developed techniques to calculate probability, potentiality, risk and uncertainty, contemporary finance introduces instruments that redeploy these. This article traces possibilities for interrogating the connection between health and financialisation as it is arising in one particular example – the health impact bond. It locates the development of this very recent financial innovation in an account of public health's role within governance strategies over the 20th century to the present. We examine how social impact bonds for chronic disease prevention programmes bring two previously distinct ways of thinking about and addressing risk into the same domain. Exploring the derivative‐type properties of health impact bonds elucidates the financial processes of exchange, hedging, bundling and leveraging. As tools for speculation, the functions of health impact bonds can be delinked from any particular outcome for participants in health interventions. How public health techniques for knowing and acting on risks to population health will contest, rework or be subsumed within finance's speculative response to risk, is to be seen.
    July 17, 2016   doi: 10.1111/1467-9566.12450   open full text
  • I am just a ‘maae’ (mother): experiences of mothers injecting drugs in Thailand.
    Niphattra Haritavorn.
    Sociology of Health & Illness. July 15, 2016
    Mothers who use drugs face much discriminatory action as society in general finds female drug users’ modes of caring for their children unacceptable. In this article, I explore the ways in which Thai women's injecting practices revolve around the role of mother ‘maae’ and the ways they employ tactics to challenge the motherhood discourse. This article draws on in‐depth interviews with 30 Thai mothers injecting drugs. Thai mothers injecting drugs struggled with stigma and self‐blame. They internalise the values of the mother ‘maae’, that is, what the mother is supposed to be; attempting to combine their drug use with their parental responsibilities. Having a child is treated as a means for many women to manage the hostile social impacts of being an addict mother as well as anxieties about the future of their children. To maintain identity as a mother, as gender norms dictates, the mothers employ several tactics to defend that identity from the threats. In conclusion, the findings have implications for harm reduction and reproductive services for women using drugs in Thailand; health care providers need to appreciate the ramifications of the lived experiences of the women who take drugs.
    July 15, 2016   doi: 10.1111/1467-9566.12448   open full text
  • Standardisation or resilience? The paradox of stability and change in patient safety.
    Kirstine Zinck Pedersen.
    Sociology of Health & Illness. July 11, 2016
    This article explores an apparent paradox of stability and change in patient safety thinking and practice. The dominant approach to patient safety has largely been focused on closing ‘safety gaps’ through standardisation in seemingly stable healthcare systems. However, the presupposition of system stability and predictability is presently being challenged by critics who insist that healthcare systems are complex and changing entities, thereby shifting focus towards the healthcare organisation's resilient and adaptive capacities. Based on a close reading of predominant patient safety literature, the article analyses how a separation between stability and change is articulated in ontological, historical, and situated terms, and it suggests the way in which predetermining healthcare settings as either stable or unstable paves the way for a system engineering approach to patient safety that pre‐empts certain types of safety solutions. Drawing on John Dewey's influential ideas about the interconnectedness of stability and change, this prescriptive perspective is discussed and challenged. It is suggested that only by rethinking the relationship between change and stability can patient safety efforts begin to address the uncertainty of medical practice as well as the necessary competences of healthcare professionals to act with ‘safety dispositions’ as a precondition for delivering safe care.
    July 11, 2016   doi: 10.1111/1467-9566.12449   open full text
  • Reproducing politics: the politicisation of patients' identities and assisted reproduction in Poland and Sweden.
    Jenny Gunnarsson Payne, Elżbieta Korolczuk.
    Sociology of Health & Illness. June 06, 2016
    This article examines how discourses on assisted reproductive technologies are locally appropriated, translated or contested in the specific cultural and political contexts of Poland and Sweden. The aim is to investigate how two national patients' organisations, namely the Polish association Nasz Bocian and the Swedish organisation Barnlängtan, articulate rights claims in the context of reproductive technologies. To this end, we investigate how these organisations utilise specific context‐dependent and affectively laden political vocabularies in order to mobilise politically, and discuss how each of these two groups gives rise to a different set of politicised reproductive identities. In order to trace which political vocabularies the respective organisations utilise to mobilise their respective rights claims, we draw primarily on political discourse theory and concepts of political grammars and empty signifiers. Lastly, we discuss which political reproductive identities emerge as a result of these different versions of political mobilisation around assisted reproductive technologies.
    June 06, 2016   doi: 10.1111/1467-9566.12433   open full text
  • Re‐imagining dementia in the fourth age: the ironic fictions of Alice Munro.
    Marlene Goldman.
    Sociology of Health & Illness. June 06, 2016
    This paper analyses two stories by Alice Munro to explore how her fiction interrogates the prevailing social imaginary of the fourth age. Drawing on the theory of Gilleard and Higgs, I show how Munro's stories rely on irony and surreal imagery to subvert the logic that engenders and normalises the opposition between the third and fourth ages, and, by extension, the social death of people coping with later‐life dementia. Ultimately, I argue that Munro's fiction does not so much reveal the Truth about the fourth age, as expose the reader's complicity in the construction of the prevailing gothic social imaginary.
    June 06, 2016   doi: 10.1111/1467-9566.12439   open full text
  • Patient resistance as a resource: candidate obstacles in diabetes consultations.
    Josh Barton, Kevin Dew, Anthony Dowell, Nicolette Sheridan, Timothy Kenealy, Lindsay Macdonald, Barbara Docherty, Rachel Tester, Debbie Raphael, Lesley Gray, Maria Stubbe.
    Sociology of Health & Illness. June 04, 2016
    This study uses conversation analysis to explore ‘candidate obstacles’, a practice observed in sequences of patient resistance to lifestyle advice within health professional consultations. This article presents illustrative analyses of selected data excerpts drawn from audio‐visual recordings of 116 tracked consultations between health professionals and 34 patients newly diagnosed with type 2 diabetes mellitus in New Zealand. The analysis shows that in consultations where health promotion activities are central, patient resistance can provide space for patients to identify obstacles to their compliance with lifestyle advice. Identifying candidate obstacles provides opportunities for health professionals to align advice with concerns of patients and potentially improve patient outcomes.
    June 04, 2016   doi: 10.1111/1467-9566.12447   open full text
  • How differences matter: tracing diversity practices in obesity treatment and health promotion.
    Ulrike Felt, Kay Felder, Michael Penkler.
    Sociology of Health & Illness. June 03, 2016
    Diversity has become a buzzword in medical care, denoting a re‐evaluation of what it means to attend to differences among human bodies and lives. Questions about what types of differences matter and how they should be defined have become important normative and analytical challenges. Drawing on two case studies, we show how differences between patients and patient‐collectives are not simply waiting to be recognised and addressed but also enacted within situated healthcare practices. Although concerns with diversity are present in both cases, they take different forms. In a Viennese health–promotion project for obese clients, care practices are both based on and reproduce large‐scale categories that divide the population into distinct subgroups with specific needs. Conversely, in an outpatient clinic for bariatric surgery patients, a technical fix‐oriented procedure leads to concerns over diversity becoming an add‐on realised by tending to each patient's idiosyncrasies and personal stories. By tracing the practices of diversity and the tensions they produce, we show how classifications and understandings of human difference are based on infrastructures that enable and constrain them. Furthermore, we discuss how they become consequential in healthcare, thereby indicating the importance of remaining reflexive about the political implications of diversity discourse and practice.
    June 03, 2016   doi: 10.1111/1467-9566.12446   open full text
  • Troubled families and individualised solutions: an institutional discourse analysis of alcohol and drug treatment practices involving affected others.
    Anne Schanche Selbekk, Hildegunn Sagvaag.
    Sociology of Health & Illness. June 02, 2016
    Research shows that members of the families with patients suffering from alcohol and other drug‐related issues (AOD) experience stress and strain. An important question is, what options do AOD treatment have for them when it comes to support? To answer this, we interviewed directors and clinicians from three AOD treatment institutions in Norway. The study revealed that family‐oriented practices are gaining ground as a ‘going concern’. However, the relative position of family‐orientation in the services, is constrained and shaped by three other going concerns related to: (i) discourse on health and illness, emphasising that addiction is an individual medical and psychological phenomenon, rather than a relational one; (ii) discourse on rights and involvement, emphasising the autonomy of the individual patient and their right to define the format of their own treatment; and (iii) discourse on management, emphasising the relationship between cost and benefit, where family‐oriented practices are defined as not being cost‐effective. All three discourses are connected to underpin the weight placed on individualised practices. Thus, the findings point to a paradox: there is a growing focus on the needs of children and affected family members, while the possibility of performing integrated work on families is limited.
    June 02, 2016   doi: 10.1111/1467-9566.12432   open full text
  • Grasping physical exercise through recreational running and non‐representational theory: a case study from Sofia, Bulgaria.
    Andrew Barnfield.
    Sociology of Health & Illness. May 31, 2016
    To become and maintain being physically active encompasses more than purely mindful and rational decision‐making. Physical activity requires theoretical‐methodological approaches that provide more subtle understandings of the variety of contextual factors. Nettleton and Green have recently argued persuasively for the need for the sociology of public health to embrace social practices. It is also necessary to think about the spaces, affects and technologies of engagement in physical exercise. This article examines the practices of recreational runners in Sofia, the capital of Bulgaria. The article has three aims; (i) to draw attention to the promise of non‐representational theory as an additive for health research and the contextual factors of health practices, (ii) to examine recreational runner's practices and techniques of engagement in light of non‐representational theory, and (iii) to highlight how interventions in Sofia and beyond can incorporate elements of non‐representational theory into their strategies for improved public health. In drawing attention to the promise of non‐representational theory and social practices this article concludes by emphasising their importance for public health interventions in physical activity strategies.
    May 31, 2016   doi: 10.1111/1467-9566.12434   open full text
  • Is educational differentiation associated with smoking and smoking inequalities in adolescence? A multilevel analysis across 27 European and North American countries.
    Katharina Rathmann, Irene Moor, Anton E. Kunst, Nico Dragano, Timo‐Kolja Pförtner, Frank J. Elgar, Klaus Hurrelmann, Lasse Kannas, Tibor Baška, Matthias Richter.
    Sociology of Health & Illness. May 23, 2016
    This study aims to determine whether educational differentiation (i.e. early and long tracking to different school types) relate to socioeconomic inequalities in adolescent smoking. Data were collected from the WHO‐Collaborative ‘Health Behaviour in School‐aged Children (HBSC)’ study 2005/2006, which included 48,025 15‐year‐old students (Nboys = 23,008, Ngirls = 25,017) from 27 European and North American countries. Socioeconomic position was measured using the HBSC family affluence scale. Educational differentiation was determined by the number of different school types, age of selection, and length of differentiated curriculum at the country‐level. We used multilevel logistic regression to assess the association of daily smoking and early smoking initiation predicted by family affluence, educational differentiation, and their interactions. Socioeconomic inequalities in both smoking outcomes were larger in countries that are characterised by a lower degree of educational differentiation (e.g. Canada, Scandinavia and the United Kingdom) than in countries with higher levels of educational differentiation (e.g. Austria, Belgium, Hungary and The Netherlands). This study found that high educational differentiation does not relate to greater relative inequalities in smoking. Features of educational systems are important to consider as they are related to overall prevalence in smoking and smoking inequalities in adolescence.
    May 23, 2016   doi: 10.1111/1467-9566.12420   open full text
  • Rehabilitative bodywork: cleaning up the dirty work of homecare.
    Agnete Meldgaard Hansen.
    Sociology of Health & Illness. May 02, 2016
    Care work for elderly people has been characterised as dirty work, owing to its proximity to the (dys)functions and discharges of aged bodies and the notions of disease, decay and death associated with the idea of old age. However, a wave of reform programmes in Danish municipalities promoting rehabilitative care practices aiming to empower, train and activate elderly citizens provides opportunities for homecare workers to renegotiate their status and reconstruct their work and occupational identities with a cleaner and more optimistic image. Drawing on ethnographic fieldwork in two Danish homecare units, this article analyses how rehabilitative care practices, drawing on a narrative of the third age, provide an optimistic and anti‐ageist framing of homecare work that informs the development of new occupational identities for care workers as coaches rather than carers in relation to citizens. Furthermore, rehabilitation efforts change the bodywork of care, rendering it more distanced and physically passive, and rehabilitation efforts also involve extensive motivational work aiming to help citizens to see themselves as capable, resourceful and self‐reliant. However, while rehabilitation efforts become a new resource in care workers’ taint management; they also entail potentially negative consequences in terms of responsibilising and disciplinary approaches to elderly citizens.
    May 02, 2016   doi: 10.1111/1467-9566.12435   open full text
  • ‘They won't change it back in their heads that we're trash’: the intersection of sex work‐related stigma and evolving policing strategies.
    Andrea Krüsi, Thomas Kerr, Christina Taylor, Tim Rhodes, Kate Shannon.
    Sociology of Health & Illness. April 26, 2016
    In Vancouver, Canada, there has been a continuous shift in the policing of sex work away from arresting sex workers, which led to the implementation of a policing strategy that explicitly prioritised the safety of sex workers and continued to target sex workers’ clients. We conducted semi‐structured interviews with 26 cisgender and five transgender women street‐based sex workers about their working conditions. Data were analysed thematically and by drawing on concepts of structural stigma and vulnerability. Our results indicated that despite police rhetoric of prioritising the safety of sex workers, participants were denied their citizenship rights for police protection by virtue of their ‘risky’ occupation and were thus responsiblised for sex work related violence. Our findings further suggest that sex workers’ interactions with neighbourhood residents were predominantly shaped by a discourse of sex workers as a ‘risky’ presence in the urban landscape and police took swift action in removing sex workers in the case of complaints. This study highlights that intersecting regimes of stigmatisation and criminalisation continued to undermine sex workers citizenship rights to police protection and legal recourse and perpetuated labour conditions that render sex workers at increased risk for violence and poor health.
    April 26, 2016   doi: 10.1111/1467-9566.12436   open full text
  • Parenting work and autism trajectories of care.
    Jennifer S. Singh.
    Sociology of Health & Illness. April 25, 2016
    This study investigates the work and care associated with raising a child with disabilities in the United States. Based on in‐depth interviews with parents who have a child with autism, it develops the notion of parenting work and trajectories of care to investigate how parents navigate and coordinate the challenges of getting an autism diagnosis, obtaining educational services, and re‐contextualising the possibilities for the future. I argue that parents embody a complex mix of love, hope, and responsibility in parenting work and trajectories of care that expands temporal and social elements of illness work and trajectories initially developed by Anselm Strauss and colleagues. This type of parenting work changes over time and is influenced by social structural forces and relationships in which the care takes place. The re‐articulation of these analytic tools also begins to untangle the intricate mix of both medical and social models of disability that parents embrace and continuously negotiate. This study demonstrates how parents accept the medical model of disability by seeking and pushing for a clinical autism diagnosis and subsequent treatments, while at the same time challenge the limits placed on their children by providing them with opportunities, possible futures, and a sense of personhood. A Virtual Abstract of this paper can be accessed at: https://www.youtube.com/watch?v=x0UmGvpcjeQ
    April 25, 2016   doi: 10.1111/1467-9566.12437   open full text
  • Normalising desistance: contextualising marijuana and cocaine use careers in young adults.
    Aaron Roussell, Marisa Omori.
    Sociology of Health & Illness. April 01, 2016
    Although there is a vast literature on drug use and addiction, there is little work that addresses the long‐term use of drugs within the general population. We take a more contextual look in examining longitudinal drug use patterns over the course of 14 years for a representative sample of young adults in their late teens and early twenties in the United States using the National Longitudinal Survey of Youth (NLSY). We use a growth trajectory modelling approach for cocaine and marijuana users to determine general use careers. Using contextual and life‐course variables, we then estimate a multinomial logistic regression model to predict group membership. In addition to establishing general use career groups, we ask how well mainstream theories comport with our findings and how the different chemical makeup of cocaine and marijuana influence our findings. We find four general use career groups: (i) high use/late desistance; (ii) peaked use/strong desistance; (iii) low use; and (iv) stable use/gradual desistance. Our results suggest similar careers for users of both drugs, with desistance over time as the rule for all groups. We also find some support for life‐course and contextual factors in drug using patterns, but our findings challenge other psychological and criminological theories.
    April 01, 2016   doi: 10.1111/1467-9566.12421   open full text
  • The post‐2015 landscape: vested interests, corporate social responsibility and public health advocacy.
    Clare Herrick.
    Sociology of Health & Illness. April 01, 2016
    This paper explores the tensions between UN calls for private sector engagement in the post‐2015 landscape and public health opposition to those ‘harm industries’ that are ‘corporate vectors of disease’ for the mounting global non‐communicable disease burden. The UN's support for public‐private partnership has provided industries with ‘vested interests’ in the propagation of unhealthy behaviours with new opportunities for the strategic alignment of their corporate social responsibility (CSR) endeavours with the post‐2015 sustainable development agenda. This has galvanised public health advocates to place pressure on the World Health Organisation to formalise their ambiguous stance towards private sector involvement in public policy formation and the resultant ‘conflicts of interest’. This paper critically examines the ‘gathering storm’ between this ‘anti‐corporate movement’ and the alcohol industry in the increasingly politicised domain of CSR. Drawing on the example of SABMiller's Tavern Intervention Program, the paper argues that CSR represents a profound threat to the sanctity and moral authority of the public health worldview. Questions therefore need to be asked about whether the public health‐led path of industry non‐association will necessarily result in health improvements or just a further retrenchment of the ideological faultlines explored in the paper.
    April 01, 2016   doi: 10.1111/1467-9566.12424   open full text
  • The social dynamics of safe sex practices among Canadian sex industry clients.
    Chris Atchison, Patrick John Burnett.
    Sociology of Health & Illness. March 28, 2016
    Much of what we know about the safe sex practices of people who pay for sexual services (clients) remains firmly grounded in empirical and interpretive tendencies to overemphasise the causal link between social, cultural or individual characteristics and sexual decision‐making. In this study we apply Adam Green's Bourdieu‐inspired sexual fields theory to examine the ways in which safe sex practices are interdependently shaped by social, personal and interpersonal forces. Using data from 697 questionnaires and 24 semi‐structured interviews with Canadian clients, we implemented a series of six additive logistic regression models and contextualised the results with the interview data to reveal the relational interdependencies of intra‐psychic, macro, meso and micro‐level factors related to safe sex practices. The questionnaire responses and interview data used in the study were gathered from a diverse sample of clients who were over the age of 19, had paid money for sexual services on one or more occasions during their lifetime and who resided in Canada at the time of participation. Our results illustrate the ways in which factors related to the venue where sexual acts take place, clients' relationships with commercial and non‐commercial partners and personal choices related to substance use interdependently inform safe sex practices.
    March 28, 2016   doi: 10.1111/1467-9566.12416   open full text
  • The social meaning of disability: a reflection on categorisation, stigma and identity.
    Jan Grue.
    Sociology of Health & Illness. March 28, 2016
    As disability becomes an ever more salient concept in international political and legal discourse, its social meaning must be better understood. Traditionally defined in medical terms and as an individual problem, it has for the last several decades increasingly become a socio‐politically defined phenomenon. Disability pride has emerged as a social movement patterned after ethnic minority and sexual orientation movements. The one billion people who count as disabled nevertheless have illnesses and impairments that are largely understood as medical problems. Medicine continues to exert great influence on the social meaning of disability in general and the social valuation of various illnesses and impairments in particular. Whereas specific conditions may be socially valued, the overall category and label of disability connotes marginality and stigma. Under these conditions, disability policy, which ought to be a universal concern, risks being construed as a marginal and special‐interest issue rather than a broadly relevant topic; this has potentially negative consequences for the majority of disabled people.
    March 28, 2016   doi: 10.1111/1467-9566.12417   open full text
  • The benefits of respectful interactions: fluid alliancing and inter‐occupational information sharing in primary care.
    Barbara DiCicco‐Bloom, Benjamin DiCicco‐Bloom.
    Sociology of Health & Illness. March 28, 2016
    Though inter‐occupational interactions in health care have been the focus of increasing attention, we still know little about how such interactions shape information sharing in clinical settings. This is particularly true in primary care where research on teams and collaboration has been based on individual perceptions of work (using surveys and interviews) rather than observing the interactions that directly mediate the inter‐occupational flow of information. To explore how interactions shape information sharing, we conducted a secondary analysis of ethnographic data from 27 primary care practices. Ease of information sharing among nurses and doctors is linked to the degree to which practices feature respectful interactions, with practices in the sample falling into one of three categories (those with low, uneven, and high degrees of respectful interactions). Those practices with the highest degree of respectful interactions demonstrate what we describe as fluid‐alliancing: flexible interactions between individuals from different occupational groups in which bidirectional information sharing occurs for the benefit of patients and the efficacy of the practice community. We conclude by arguing that this process unlocks the strengths of all practice members, and that leadership should encourage respectful interactions to augment organisational efficacy and the ability of individual practice members to provide quality patient care.
    March 28, 2016   doi: 10.1111/1467-9566.12418   open full text
  • Do overeducated individuals have increased risks of ill health?: a Swedish population‐based cohort study.
    Hanna Hultin, Michael Lundberg, Andreas Lundin, Cecilia Magnusson.
    Sociology of Health & Illness. March 28, 2016
    Previous studies indicate that the increasing educational level in many post‐industrial nations may imply that subgroups of the population work in occupations for which they are overeducated. We aimed to investigate whether overeducation is associated with future self‐rated health and psychological distress. The analytical sample consisted of 21,159 participants from the Stockholm Public Health Cohort. Individuals with upper secondary or university education, who in 2006 or 2007 had occupations requiring less education, were considered overeducated. The outcomes were self‐rated health (SRH) and psychological distress in 2010. Overeducated women had an increased risk of less than good SRH, compared to university‐educated women in matching occupations (adjusted odds ratios (OR): 2.44 confidence intervals (CI): 1.32–4.51 for overeducated women with secondary school education), but not compared to less educated women in the same occupational class (adjusted OR: 0.87 CI:0.32–2.38 for overeducated women with secondary school education). We found no increased risk of less than good SRH for overeducated men, and no association between overeducation and psychological distress for either sex. The results indicate that overeducation is not per se associated with onset of less than good SRH or psychological distress in a short‐term perspective, and the findings support education expansion as a means of improving public health.
    March 28, 2016   doi: 10.1111/1467-9566.12419   open full text
  • Disordered eating and the contradictions of neoliberal governance.
    Iain Pirie.
    Sociology of Health & Illness. February 20, 2016
    The last decade has seen the development of an important literature on the contradictions between neoliberal norms of corporal citizenship and the forms of consumption that market‐based food systems promote. This paper seeks to contribute to the literature by exploring the relationship between these contradictions and the increased prevalence of particular eating disorders (binge eating disorder (BED) and bulimia nervosa). Within contemporary neoliberal food systems bingeing is increasingly normalised and consumption temporally disorganised. At the same time, neoliberal public health policy, and the wider ‘health’ entertainment media it legitimates, focuses on the promotion of ‘correct’ forms of consumer agency. Individuals who fail to manage consumption ‘appropriately’ are stigmatised. The growth of bulimia and BED can be related to the contradictory pressures that the food system and regime of corporal governance place on individuals. The paper also seeks to explore how the increased medicalisation and biomedicalisation of eating since the 1980s fits within a broader neoliberal governance strategy. By medicalising key social problems the neoliberal state depoliticises these issues. Medicalisation and biomedicalisation obscure the role of capitalism in generating these problems and encourage a focus on individual dysfunction.
    February 20, 2016   doi: 10.1111/1467-9566.12408   open full text
  • The wounded blogger: analysis of narratives by women with breast cancer.
    Gerard Coll‐Planas, Mariona Visa.
    Sociology of Health & Illness. February 19, 2016
    The purpose of this article is to analyse the representation of the body in seven blogs by Spanish women with breast cancer. Using both texts and images, we analyse how they reproduce modern and postmodern logic to represent the wounded body. Based on Frank's proposals, this article draws the conclusion that the women bloggers mainly reproduce the modern logic (characterised by the restitution narrative and a predictable, disassociated and monadic body), but there are elements which break with this logic (the quest narrative, the body presented as associated, dyadic and full of desire, and the acceptance of contingency). After applying Frank's categories, we suggest that the contemporary way of experiencing illness may question the clarity of the modern/postmodern divide.
    February 19, 2016   doi: 10.1111/1467-9566.12405   open full text
  • Time to manage: patient strategies for coping with an absence of care coordination and continuity.
    Tanisha Jowsey, Simone Dennis, Laurann Yen, M. Mofizul Islam, Anne Parkinson, Paresh Dawda.
    Sociology of Health & Illness. February 12, 2016
    This paper examines how people with chronic illnesses respond to absences of continuity and coordination of care. Little work has been done on how the ill person might mitigate flaws in a less than optimal system. Our qualitative research, carried out among 91 participants in Australia, reveals that people with chronic illnesses create strategies to facilitate the management of their care. These strategies included efforts to improve communication between themselves and their health care practitioners; keeping personal up‐to‐date medication lists; and generating their own specific management plans. While we do not submit that it is patients’ responsibility to attend to gaps in the health system, our data suggests that chronically ill people can, in and through such strategies, exert a measure of agency over their own care; making it effectively more continuous and coordinated. Participants crafted strategies according to the particular social and bodily rhythms that their ongoing illnesses had lent to their lives. Our analysis advances the view that the ill body itself is capable of enfolding the health system into the rhythms of illness – rather than the ill body always fitting into the overarching structural tempo. This entails an agent‐centric view of time in illness experience. A Virtual Abstract of this paper can be found at: https://youtu.be/UwbxlEJOTx8
    February 12, 2016   doi: 10.1111/1467-9566.12404   open full text
  • ‘You're looking for different parts in a jigsaw’: foetal MRI (magnetic resonance imaging) as an emerging technology in professional practice.
    Kate Reed, Inna Kochetkova, Susan Molyneux‐Hodgson.
    Sociology of Health & Illness. February 11, 2016
    Magnetic resonance imaging (MRI) was first introduced into clinical practice during the 1980s. Originally used as a diagnostic tool to take pictures of the brain, spine, and joints, it is now used to visualise a range of organs and soft tissue around the body. Developments in clinical applications of the technology are rapid and it is often viewed as the ‘gold standard’ in many areas of medicine. However, most existing sociological work on MRI tends to focus on the profession of radiology, little is known about the impact of MRI on a broader range of clinical practice. This article focuses on MRI use in pregnancy, a relatively new application of the technology. Drawing on empirical research with a range of health professionals (from radiologists to pathologists) in the North of England, this article asks: how do different types of health professionals engage with the technology and to what end? It will argue that MRI use in pregnancy offers an increasingly important piece of the diagnostic jigsaw, often acting as a bridging technology between medical specialties. The implications of this will be explored in the context of broader sociological debates on the ‘visualisation’ of medicine and its impact on professionals.
    February 11, 2016   doi: 10.1111/1467-9566.12398   open full text
  • Hope is a four‐letter word: riding the emotional rollercoaster of illness management.
    Alexandra C.H. Nowakowski.
    Sociology of Health & Illness. February 11, 2016
    In this autoethnography, I explore the process and emotional experience of trying a new drug to improve my quality of life. In so doing, I synthesise personal history with extant research on chronic illness by analysing ways in which my experiences reflect and reject social norms. I also incorporate perspectives from research on aspirations and attainment, and the mental health consequences of cyclical disappointment. By weaving together lessons from each of these literatures, I articulate an integrative psychosocial understanding of the micro‐level processes and experiences involved in illness management as well as the ways that experiences of illness management may require integration of varied sociological insights concerning health. In closing, I draw out theoretical implications for understanding the integration and variation of insights from many areas of health research in the lived experiences of people with chronic conditions. A Virtual Abstract of this article can be seen at: https://youtu.be/5aoaWGItDgM
    February 11, 2016   doi: 10.1111/1467-9566.12403   open full text
  • Families dealing with the uncertainty of genetic disorders: the case of Neurofibromatosis Type 1.
    Daniele Carrieri, Hannah Farrimond, Susan Kelly, Peter Turnpenny.
    Sociology of Health & Illness. February 11, 2016
    Some scholars contend that genetic medicine is transforming the experience of illness and the social category of the family – bringing future risks into the present, and potentially strengthening familial biological bonds in light of these shared genetic risks. However, research has shown that genetic information is interpreted and acted upon through a rich repertoire of adaptable social, cultural and familial factors which pre‐exist and interact with biomedical knowledge. This paper reports research into families living with Neurofibromatosis Type 1 (NF1), a highly uncertain condition the manifestation of which can vary considerably also within the same family and, for this reason, has been defined as a ‘condition without parameters’. These characteristics make NF1 a particularly informative condition for the examination of family dynamics around genetic information. The study and the methodology are based on the exploration of family networks and allow us to investigate the interrelation of individual and familial constructions of the uncertainty of NF1. This also allows both theoretical and policy claims to be made about the danger of reductionist thinking about the transformative potential of genetic technologies.
    February 11, 2016   doi: 10.1111/1467-9566.12401   open full text
  • ‘Coz football is what we all have’: masculinities, practice, performance and effervescence in a gender‐sensitised weight‐loss and healthy living programme for men.
    Christopher Bunn, Sally Wyke, Cindy M. Gray, Alice Maclean, Kate Hunt.
    Sociology of Health & Illness. February 11, 2016
    In this paper we use a social practice approach to explore men's experience of Football Fans in Training (FFIT), a group‐based weight management programme for men that harnesses men's symbolic attachment to professional football clubs to engage them in lifestyle change. FFIT is delivered by community coaches in clubs’ stadia and is gender‐sensitised in relation to context, content and style of delivery. Using a ‘toolkit’ of concepts from the work of Bourdieu, Goffman and Durkheim we analysed data from 13 focus group discussions with participants, and fieldwork notes from programme observations to investigate the appeal and success of FFIT, and how it worked to support change. Our analysis builds on our work on the importance of shared symbolic commitment to the football club and being with ‘men like me’ to understand how the interaction context facilitated ‘effervescent’ experiences. These experiences encouraged men to make changes to their diet and physical activity, talk about them, practice performing them and implement them in their lives. Thus a social practice approach illuminated the social processes through which lifestyle change was achieved, and we argue that it can deepen and enrich both intervention design and evaluation.
    February 11, 2016   doi: 10.1111/1467-9566.12402   open full text
  • The sociology of childbirth: an autobiographical journey through four decades of research.
    Ann Oakley.
    Sociology of Health & Illness. February 09, 2016
    The sociology of childbirth emerged in the 1970s largely as a result of influences from outside sociology. These included feminism, maternity care activism, the increasing medicalisation of childbirth, and evidence‐based health care. This paper uses the author's own sociological ‘career’ to map a journey through four decades of childbirth research. It demonstrates the importance of social networks and interdisciplinary work, particularly across the medical‐social science divide and including cross‐cultural perspectives, argues that the study of reproduction has facilitated methodological development within the social sciences, and suggests that childbirth remains on the periphery of mainstream sociological concerns.
    February 09, 2016   doi: 10.1111/1467-9566.12400   open full text
  • An exploration of integrated data on the social dynamics of suicide among women.
    Sharon Mallon, Karen Galway, Lynette Hughes, Janeet Rondón‐Sulbarán, Gerard Leavey.
    Sociology of Health & Illness. February 08, 2016
    The gender‐based nature of suicide‐related behaviour is largely accepted. However, studies that report exclusively on female suicides are rare. Here we demonstrate how female suicide has effectively been ‘othered’ and appears incidental in studies which compare female and male behaviour. We highlight how recent studies of suicide have tended to be dominated by male‐only approaches, which increasingly link issues of masculinity with male death by suicide. Drawing on data collected from the general practitioner and coroner's office, we then apply the sociological autopsy approach to a cohort of 78 deaths recorded as suicides in the UK between 2007 and 2009. By focusing on females in isolation from males, we demonstrate that, as in male‐only suicide studies, it is similarly possible to draw out issues associated with the feminine identity, which can be linked to death by suicide. We find that bereavement, sexual violence and motherhood could all be linked to the lives and help‐seeking of the females who died. In closing, we suggest that a reorientation towards sociological analytic approaches of female suicide may help to produce further reductions in the rate of female death by suicide. A Virtual Abstract of this paper can be found at: https://www.youtube.com/watch?v=a0w9KKMFdIQ
    February 08, 2016   doi: 10.1111/1467-9566.12399   open full text
  • Between disruption and continuity: challenges in maintaining the ‘biographical we’ when caring for a partner with a severe, chronic illness.
    Gunvor Aasbø, Kari Nyheim Solbrække, Ellen Kristvik, Anne Werner.
    Sociology of Health & Illness. February 08, 2016
    Chronic obstructive pulmonary disease (COPD) is a progressive illness that changes the lives of patients and their spouses dramatically. The aim of this paper is to show how spouses of COPD patients integrate their tasks as informal carers with their role as spouses and the tensions and challenges involved in this. The study draws on qualitative interviews with spouses of COPD patients, recruited from the patient pool of ambulatory pulmonary services of two hospitals in Oslo, Norway. The spouses described their great efforts to re‐establish normality and continuity in their everyday lives. Accomplishing this was a delicate process because they faced several dilemmas in this work. They balanced the need to sustain the independence and integrity of both parties against the need to ensure safety and deal with the progression of the illness. We propose ‘biographical we’ as a concept that can highlight the great effort spouses put into establishing a sense of continuity in their lives. In times when healthcare policy involves mobilising informal caregiving resources, an awareness of the complexity of caregiving relationships is crucial when developing appropriate support for informal carers.
    February 08, 2016   doi: 10.1111/1467-9566.12396   open full text
  • Walking as a social practice: dispersed walking and the organisation of everyday practices.
    Tim Harries, Ruth Rettie.
    Sociology of Health & Illness. February 07, 2016
    This paper uses social practice theory to study the interweaving of walking into everyday practices and considers how greater awareness of everyday walking can influence its position within the organisation and scheduling of everyday life. Walking is of policy interest because of its perceived benefits for health. This paper asserts that increased awareness of everyday walking allows users to become more active without having to reschedule existing activities. Using Schatzki's distinction between dispersed and integrative practices, it argues that increasing awareness of dispersed walking can enlist walking into the teleoaffective organisation of some social practices and prompt the performance of new ‘health practices’ within everyday domains of life such as shopping and employment. While this analysis offers useful insights for the design of behaviour change strategies, it also points to some unintended consequences of using digital feedback to increase walking awareness. In directing the gaze of participants at one particular element of their daily practices, the paper suggests, digital walking feedback provides a ‘partial’ view of practices: by highlighting the exercise value of walking at the expense of other values it can prompt feedback recipients to pass moral judgements on themselves based on this partial view. A Virtual Abstract of this paper can be found at: https://youtu.be/WV7DUnKD5Mw
    February 07, 2016   doi: 10.1111/1467-9566.12406   open full text
  • Social inclusion and the Fatosphere: the role of an online weblogging community in fostering social inclusion.
    Marissa Dickins, Colette Browning, Susan Feldman, Samantha Thomas.
    Sociology of Health & Illness. January 22, 2016
    Overweight and obesity are one of the most salient issues within society today, and the stigmatisation of overweight individuals is prevalent and widespread. Utilising interviews with 44 individuals who blog within an online fat acceptance community known as the Fatosphere, participants’ perceptions of inclusion and exclusion were examined within their offline and online environments. Additionally, the effect this had on their offline lives was examined. Participants described a profound sense of exclusion within their offline lives through three agencies: the medicalisation of ‘fatness’, the weight loss industry and the media, which echoed descriptions of moral judgement. Furthermore, a sense of inclusion was described within the Fatosphere through the protection and support that they found within this ‘safe space’. The effects of the Fatosphere influenced their lives in both negative and positive ways, allowing them to better deal with stigma and discrimination, but sometimes effecting their offline relationships in a negative manner. The Fatosphere provides a unique opportunity for corpulent individuals to engage in a community that is removed from the prominent weight‐related discourse within modern society.
    January 22, 2016   doi: 10.1111/1467-9566.12397   open full text
  • ‘I don't consider a cup performance; I consider it a test’: masculinity and the medicalisation of infertility.
    Ann V. Bell.
    Sociology of Health & Illness. December 19, 2015
    Researchers have deemed medicalisation a ‘gendered’ theory, yet the incorporation of men and masculinity in medicalisation literature is sparse. Recently, however, medicalisation scholarship has begun studying men. This burgeoning literature heavily emphasises sexuality and is beginning to focus on medicalised masculinities in which traits associated with masculinity are deemed a health risk. Such research has demonstrated how masculinities shape men's lived experiences of health, but how does health itself shape masculinity? I explore this question using the case of infertility. Through thirty in‐depth interviews, I find that men use medicine as a way to achieve rather than diminish their sense of masculinity in the feminised context of reproduction. By perpetuating the stereotype that infertility is a woman's problem, the medical establishment has caused men to not necessarily see themselves as infertile. Additionally, even if men do claim the infertility status, they do not perceive it as negative. The legitimating effects of medicalisation objectify the ailment and separate its connection with sexuality. In centring men's voices, the study not only reveals men as active players in the reproductive process, but also incorporates them into understandings of medicalisation.
    December 19, 2015   doi: 10.1111/1467-9566.12395   open full text
  • ‘We needed to change the mission statement of the marriage’: biographical disruptions, appraisals and revisions among couples living with endometriosis.
    Nicky Hudson, Lorraine Culley, Caroline Law, Helene Mitchell, Elaine Denny, Nick Raine‐Fenning.
    Sociology of Health & Illness. December 17, 2015
    The concept of biographical disruption has been widely applied in sociological explorations of chronic illness and has been subject to much theoretical scrutiny, reflection and development. However, little attention has been given to the impact of biographical disruption beyond the individual level. This article explores the concept from a dyadic perspective, utilising data from an exploratory, qualitative study (ENDOPART) that investigated the impact of endometriosis on women and their male partners. In total, 22 couples participated in in‐depth, semi‐structured, face‐to‐face interviews. The women and their partners were interviewed separately and, in most cases, simultaneously, by different interviewers. Data analysis was informed by an interpretivist relational approach, foregrounding the meanings participants applied to their experiences, treating interviews as accounts, and exploring partners’ accounts in relation to one another. Two analytic approaches generated several themes for exploration in the context of the concept of biographical disruption: sex and intimacy; planning for and having children; working lives and social lives. The article argues that biographical disruptions are social and inter‐relational processes and discusses how couples living with endometriosis negotiated these disruptions, how they were appraised and how lives and expectations were revised as a result.
    December 17, 2015   doi: 10.1111/1467-9566.12392   open full text
  • Con‐forming bodies: the interplay of machines and bodies and the implications of agency in medical imaging.
    Lisa A. Wood.
    Sociology of Health & Illness. November 24, 2015
    Attending to the material discursive constructions of the patient body within cone beam computed tomography (CBCT) imaging in radiotherapy treatments, in this paper I describe how bodies and machines co‐create images. Using an analytical framework inspired by Science and Technology Studies and Feminist Technoscience, I describe the interplay between machines and bodies and the implications of materialities and agency. I argue that patients’ bodies play a part in producing scans within acceptable limits of machines as set out through organisational arrangements. In doing so I argue that bodies are fabricated into the order of work prescribed and embedded within and around the CBCT system, becoming, not only the subject of resulting images, but part of that image. The scan is not therefore a representation of a passive subject (a body) but co‐produced by the work of practitioners and patients who actively control (and contort) and discipline their body according to protocols and instructions and the CBCT system. In this way I suggest they are ‘con‐forming’ the CBCT image. A Virtual Abstract of this paper can be found at: https://youtu.be/qysCcBGuNSM.
    November 24, 2015   doi: 10.1111/1467-9566.12389   open full text
  • Prescriptions and proscriptions: moralising sleep medicines.
    Jonathan Gabe, Catherine M. Coveney, Simon J. Williams.
    Sociology of Health & Illness. November 20, 2015
    The pharmaceuticalisation of sleep is a contentious issue. Sleep medicines get a ‘bad press’ due to their potential for dependence and other side effects, including studies reporting increased mortality risks for long‐term users. Yet relatively little qualitative social science research has been conducted into how people understand and negotiate their use/non‐use of sleep medicines in the context of their everyday lives. This paper draws on focus group data collected in the UK to elicit collective views on and experiences of prescription hypnotics across different social contexts. Respondents, we show, drew on a range of moral repertoires which allowed them to present themselves and their relationships with hypnotics in different ways. Six distinct repertoires about hypnotic use are identified in this regard: the ‘deserving’ patient, the ‘responsible’ user, the ‘compliant’ patient, the ‘addict’, the ‘sinful’ user and the ‘noble’ non user. These users and non‐users are constructed drawing on cross‐cutting themes of addiction and control, ambivalence and reflexivity. Such issues are in turn discussed in relation to recent sociological debates on the pharmaceuticalisation/de‐pharmaceuticalisation of everyday life and the consumption of medicines in the UK today.
    November 20, 2015   doi: 10.1111/1467-9566.12383   open full text
  • Category attribution as a device for diagnosis: fitting children to the autism spectrum.
    Jason Turowetz, Douglas W. Maynard.
    Sociology of Health & Illness. November 20, 2015
    The practice of medicine involves applying abstract diagnostic classifications to individual patients. Patients present with diverse histories and symptoms, and clinicians are tasked with fitting them into generic categories. They must also persuade patients, or family members, that the diagnosis is appropriate and elicit compliance with prescribed treatments. This can be especially challenging with psychiatric disorders such as autism, for which there are no clear biomarkers. In this paper, we explicate a discursive procedure, which we term category attribution. The procedure juxtaposes a narrative about the child with a claim about members of a clinically relevant category, in this case, either children with autism or typically/normally developing children. The attribution procedure carries the implication that the child does or does not belong to that category. We show that category attributions are organised in a recurrent interactional sequence. Further, we argue that category attributions encode normative expectations about child development, such that the child is rendered typical or atypical relative to clinical and social norms. Accordingly, such categorisation devices have a moral dimension as well as a clinical one.
    November 20, 2015   doi: 10.1111/1467-9566.12382   open full text
  • The self as capital in the narrative economy: how biographical testimonies move activism in the Global South.
    Marian Burchardt.
    Sociology of Health & Illness. November 19, 2015
    This article analyses and theorises the practice of biographical storytelling of HIV‐positive AIDS activists in South Africa. Combining research in illness narratives, studies of emotions in social activism and analysis of global health institutions in Africa, I explore how biographical self‐narrations are deployed to facilitate access to resources and knowledge and thus acquire material and symbolic value. I illustrate my argument through the analysis of the case of an AIDS activist who became a professional biographical storyteller. Based on the analysis which I claim to represent wider dynamics in human‐rights‐based health activism in the Global South, I propose the concept of narrative economies by which I mean the set of exchange relationships within which biographical self‐narrations circulate and produce social value for individuals and organisations.
    November 19, 2015   doi: 10.1111/1467-9566.12381   open full text
  • Together we have fun: native‐place networks and sexual risk behaviours among Chinese male rural‐urban migrants.
    Xiaozhao Yousef Yang, Brian C. Kelly, Tingzhong Yang.
    Sociology of Health & Illness. November 19, 2015
    Some scholars argue that the maintenance of social networks contributes to the lower prevalence of deviant behaviours and fewer adverse health effects among migrants. But others suggest that if migrants are embedded in homogeneous networks, such networks may enable the formation of a deviant subculture that promotes risk taking. Facing this dilemma, the present study investigates how native‐place networks influence sexual risk behaviours (SRBs), specifically the pursuit of commercial sex and condomless sex with sex workers, for male rural‐urban migrants. Using a multi‐stage sample of 1,591 male rural‐urban migrants from two major migrant‐influx cities within China, we assessed migrants’ general friend network ties and native place networks (townsmen in migrants’ local networks) and tested their associations with SRBs. Multiple logistic regression analyses indicate that native‐place network ties are associated with paying for sex (OR = 1.33, p < 0.001) and condomless sex with sex workers (OR = 1.33, p < 0.001), while general friendship network ties reduce such risks (OR = 0.74, p < 0.001; OR = 0.84, p < 0.01) even after controlling for demographic background, housing conditions, length of stay, health beliefs and behaviours, and spousal companionship. Our findings suggest that native‐place networks among Chinese male rural‐urban migrants are associated with SRBs because homogenous networks may serve as a platform for the emergence of a deviant subculture that promotes risk behaviours. A Virtual Abstract of this paper is available at: https://www.youtube.com/watch?v=3Wg20I6j8XQ.
    November 19, 2015   doi: 10.1111/1467-9566.12380   open full text
  • Epistemic asymmetries in psychotherapy interaction: therapists' practices for displaying access to clients' inner experiences.
    Elina Weiste, Liisa Voutilainen, Anssi Peräkylä.
    Sociology of Health & Illness. November 17, 2015
    The relationship between a psychotherapist and a client involves a specific kind of epistemic asymmetry: in therapy sessions the talk mainly concerns the client's experience, which is unavailable, as such, to the therapist. This epistemic asymmetry is understood in different ways within different psychotherapeutic traditions. Drawing on a corpus of 70 audio‐recorded sessions of cognitive psychotherapy and psychoanalysis and using the method of conversation analysis, the interactional practices of therapists for dealing with this epistemic asymmetry are investigated. Two types of epistemic practices were found to be employed by therapists while formulating and interpreting the client's inner experience. In the formulations, the therapists and clients co‐described the client's experience, demonstrating that the client's inner experience was somewhat similarly available to both participants. In the interpretations, the therapists constructed an evidential foundation for the interpretation by summarising the client's talk and using the same descriptive terms as the client. Clients held therapists accountable for this epistemic work: if they failed to engage in such work, their right to know the client's inner experience was called into question.
    November 17, 2015   doi: 10.1111/1467-9566.12384   open full text
  • Whatever happened to the Norwegian Medical Need Clause? Lessons for current debates in EU pharmaceutical regulation.
    Eleanor Brooks, Robert Geyer.
    Sociology of Health & Illness. November 13, 2015
    Until 1994, pharmaceutical products seeking market authorisation in Norway were required to demonstrate a fulfilment of unmet medical need. This clause enabled the national regulator to dramatically limit the number of products on the market whilst encouraging price competition to keep drug expenditure low and was credited with encouraging the development of drugs with genuine added therapeutic value and reducing the incidence of antimicrobial resistance. Norway was forced to abandon its Medical Need Clause (MNC) when it joined the European Economic Area as it was incompatible with the acquis communautaire of the European Union. This article reviews Norway's experience with its MNC in light of contemporary debates in European health policy. It discusses the potential contribution of an MNC‐style regulation to improving health, reducing illness, ensuring sustainable health systems and fostering pharmaceutical innovation. It concludes by asking how these findings can inform current European Union debates over the growing cost of prescription drugs and direction of pharmaceutical development.
    November 13, 2015   doi: 10.1111/1467-9566.12379   open full text
  • Emotion in obesity discourse: understanding public attitudes towards regulations for obesity prevention.
    Lucy C. Farrell, Megan J. Warin, Vivienne M. Moore, Jackie M. Street.
    Sociology of Health & Illness. November 13, 2015
    Intense concern about obesity in the public imagination and in political, academic and media discourses has catalysed advocacy efforts to implement regulatory measures to reduce the occurrence of obesity in Australia and elsewhere. This article explores public attitudes towards the possible implementation of regulations to address obesity by analysing emotions within popular discourses. Drawing on reader comments attached to obesity‐relevant news articles published on Australian news and current affairs websites, we examine how popular anxieties about the ‘obesity crisis’ and vitriol directed at obese individuals circulate alongside understandings of the appropriate role of government to legitimise regulatory reform to address obesity. Employing Ahmed's theorisation of ‘affective economies’ and broader literature on emotional cultures, we argue that obesity regulations achieve popular support within affective economies oriented to neoliberal and individualist constructions of obesity. These economies preclude constructions of obesity as a structural problem in popular discourse; instead positioning anti‐obesity regulations as a government‐endorsed vehicle for discrimination directed at obese people. Findings implicate a new set of ethical challenges for those championing regulatory reform for obesity prevention.
    November 13, 2015   doi: 10.1111/1467-9566.12378   open full text
  • Women's experience of HIV as a chronic illness in South Africa: hard‐earned lives, biographical disruption and moral career.
    Edwin Wouters, Katinka De Wet.
    Sociology of Health & Illness. November 13, 2015
    This article presents findings from a longitudinal qualitative study (48 in‐depth interviews with 12 women on antiretroviral treatment (ART)) exploring the experience of living with HIV as a chronic illness in South Africa by applying the structural and interactionist perspectives on chronic illness. The structural perspective indicates that the illness experience needs to be contextualised within the wider framework of the women's hard‐earned lives: throughout the interviews, the women tended to refuse singularising HIV/AIDS and continuously framed the illness within the context of general hardship and adversity. Employing an interactionist perspective, the repeated interviews demonstrated the partial applicability of the concept of biographical disruption to the illness experience: most women experienced feelings of denial and disbelief upon diagnosis, but the availability of ART clearly mitigated the impact of HIV on their biographies. In addition, our findings demonstrate that the interaction between structural aspects, (stigmatising) social relations, and the illness (and its treatment) determines the never‐ending cycle of identity appraisals, revisions and improvements, rendering the moral career of the HIV‐positive women on ART a continuous work in progress.
    November 13, 2015   doi: 10.1111/1467-9566.12377   open full text
  • Infections and interaction rituals in the organisation: Clinician accounts of speaking up or remaining silent in the face of threats to patient safety.
    Julia E. Szymczak.
    Sociology of Health & Illness. November 04, 2015
    Clinician silence in the face of known threats to patient safety is a source of growing concern. Current explanations for the difficulties clinicians have of speaking up are conceptualised at the individual or organisational level, with little attention paid to the space between – the interaction context. Drawing on 103 interviews with clinicians at one hospital in the United States this article examines how clinicians talk about speaking up or not in the face of breaches in infection prevention technique. Accounts are analysed using a microsociological lens as stories of interaction, through which respondents appeal to situational and organisational realities of medical work that serve to justify speaking up or remaining silent. Analysis of these accounts reveals three influences on the decision to speak up, shaped by background conditions in the organisation; mutual focus of attention, interactional path dependence and the presence of an audience. These findings suggest that the decision to speak up in a clinical setting is dynamic, highly context‐dependent, embedded in the interaction rituals that suffuse everyday work and constrained by organisational dynamics. This article develops a more sophisticated and distinctly sociological understanding of the reasons why speaking up in health care is so difficult.
    November 04, 2015   doi: 10.1111/1467-9566.12371   open full text
  • What is the role of individual accountability in patient safety? A multi‐site ethnographic study.
    Emma‐Louise Aveling, Michael Parker, Mary Dixon‐Woods.
    Sociology of Health & Illness. November 04, 2015
    An enduring debate concerns how responsibility for patient safety should be distributed between organisational systems and individual professionals. Though rule‐based, calculus‐like approaches intended to support a ‘just culture’ have become popular, they perpetuate an asocial and atomised account. In this article, we use insights from practice theory – which sees organisational phenomena as accomplished in everyday actions, with individual agency and structural conditions as a mutually constitutive, dynamic duality – along with contributions from the political science and ethics literature as a starting point for analysis. Presenting ethnographic data from five hospitals, three in one high‐income country and two in low‐income countries, we offer an empirically informed, normative rethinking of the role of personal accountability, identifying the collective nature of the healthcare enterprise and the extent to which patient safety depends on contributions from many hands. We show that moral responsibility for actions and behaviours is an irreducible element of professional practice, but that individuals are not somehow ‘outside’ and separate from ‘systems’: they create, modify and are subject to the social forces that are an inescapable feature of any organisational system; each element acts on the other. Our work illustrates starkly the structuring effects of the broader institutional and socioeconomic context on opportunities to ‘be good’. These findings imply that one of the key responsibilities of organisations and wider institutions in relation to patient safety is the fostering of the conditions of moral community.
    November 04, 2015   doi: 10.1111/1467-9566.12370   open full text
  • Can a pill prevent HIV? Negotiating the biomedicalisation of HIV prevention.
    Ingrid Young, Paul Flowers, Lisa McDaid.
    Sociology of Health & Illness. October 26, 2015
    This article examines how biomedicalisation is encountered, responded to and negotiated within and in relation to new biomedical forms of HIV prevention. We draw on exploratory focus group discussions on pre‐exposure prophylaxis (PrEP) and treatment as prevention (TasP) to examine how the processes of biomedicalisation are affected by and affect the diverse experiences of communities who have been epidemiologically framed as ‘vulnerable’ to HIV and towards whom PrEP and TasP will most likely be targeted. We found that participants were largely critical of the perceived commodification of HIV prevention as seen through PrEP, although this was in tension with the construction of being medical consumers by potential PrEP candidates. We also found how deeply entrenched forms of HIV stigma and homophobia can shape and obfuscate the consumption and management of HIV‐related knowledge. Finally, we found that rather than seeing TasP or PrEP as ‘liberating’ through reduced levels of infectiousness or risk of transmission, social and legal requirements of responsibility in relation to HIV risk reinforced unequal forms of biomedical self‐governance. Overall, we found that the stratifying processes of biomedicalisation will have significant implications in how TasP, PrEP and HIV prevention more generally are negotiated.
    October 26, 2015   doi: 10.1111/1467-9566.12372   open full text
  • Violence in general practice: a gendered risk?
    Mary Ann Elston, Jonathan Gabe.
    Sociology of Health & Illness. October 26, 2015
    This article focuses on the extent to which violence against family doctors in England is experienced in gendered terms. It draws on data from two studies: a postal survey of 1,300 general practitioners (GPs) (62% response rate) and in‐depth interviews with 26 doctors who have been assaulted or threatened; and 13 focus groups with primary care teams and 19 in‐depth interviews with GPs who had expressed an interest in the topic of violence against doctors. Most GPs, regardless of gender, reported receiving verbal abuse over the last two years, often interpreted as a consequence of declining deference to professionals, while actual physical assaults and threats were much rarer and more likely to be reported by men. Overall, women GPs were much more likely to express concern about violence and to take personal precautions, although younger male GPs working in inner‐city practices also had high levels of concern. The study shows how some aspects of family doctors’ work has been organised on gendered lines and how these contribute to the differences in experience of violence. We suggest that the increasing proportion of women among family doctors may have implications for these, often tacit, organisational routines.
    October 26, 2015   doi: 10.1111/1467-9566.12373   open full text
  • 24th Sociology of Health and Illness Monograph.

    Sociology of Health & Illness. October 16, 2015
    There is no abstract available for this paper.
    October 16, 2015   doi: 10.1111/1467-9566.12386   open full text
  • Navigating the field of temporally framed care in the Danish home care sector.
    Pernille Tufte, Hanne Marlene Dahl.
    Sociology of Health & Illness. October 16, 2015
    The organisational and temporal framing of elderly care in Europe has changed in the wake of new public management reforms and standardised care services, the strict measurement of time and work schedules have become central aspects of care work. The article investigates the crafting of care in this framing: how care workers approach the services specified in their rotas and navigate between needs, demands and opportunities in the daily performance of duties. Applying feminist theory on time and anthropological theory on social navigation, it examines the practice of home care work in two Danish municipalities. Data are derived predominantly from participant observation. The article identifies two overarching temporal dilemmas in different home care situations: one where process time prevails over clock time and another where the care workers balance the two. Focusing on how care workers respond to these dilemmas in practice, the article identifies various navigation tactics, including leaving time outside, individualised routinisation, working on different paths simultaneously and postponing tasks. By assessing care workers' performance in the temporal framing of work and focusing on care workers' mediation between different time logics, this study provides an in‐depth perspective on the broader feminist literature on the dilemmas of care.
    October 16, 2015   doi: 10.1111/1467-9566.12343   open full text
  • Advice, authority and autonomy in shared decision‐making in antenatal screening: the importance of context.
    Alison Pilnick, Olga Zayts.
    Sociology of Health & Illness. October 05, 2015
    Shared decision‐making (SDM) has been widely advocated across many branches of healthcare, yet there is considerable debate over both its practical application and how it should be examined or assessed. More recent discussions of SDM have highlighted the important of context, both internal and external to the consultation, with a recognition that decisions cannot be understood in isolation. This paper uses conversation analysis (CA) to examine how decision‐making is enacted in the context of antenatal screening consultations in Hong Kong. Building on previous CA work (Collins et al. , Toerien et al. 2013), we show that, whilst previously identified formats are used here to present the need for a decision, the overriding basis professionals suggest for actually making a decision in this context is the level of worry or concern a pregnant woman holds about potential foetal abnormality. Professionals take an unknowing ‘epistemic stance’ (Heritage ) towards this worry, and hence step back from involvement in decision‐making. We argue that this is linked to the non‐directive ethos that prevails in antenatal screening services, and suggest that more research is needed to understand how the enactment of SDM is affected by wider professional contexts and parameters.
    October 05, 2015   doi: 10.1111/1467-9566.12346   open full text
  • ‘We usually just start dancing our Indian dances’: Urban American Indian (AI) female youths’ negotiation of identity, health and the body.
    Shannon Jette, Erica Blue Roberts.
    Sociology of Health & Illness. September 29, 2015
    In this article, we utilise qualitative research techniques to explore how 14 urban American Indian (AI) females (aged 11–17) living in the state of Maryland discursively construct and experience health and the body, as well as how/if traditional culture shapes their understandings. In doing so, we address a significant gap in the knowledge base concerning the health beliefs of urban AI youth, and build upon research utilising a decolonising approach. Using a two‐step process of thematic analysis and poststructuralist discourse analysis, we arrived at three key findings: (1) while youths are taught (and learn) mainstream lessons about health and bodily norms (mostly at school), they negotiate these lessons in complex and at times contradictory ways; (2) they do not view their AI status as conferring more or less risk upon them or their community; and (3) AI identity appears to be fluid in nature, becoming more salient, even a resource, in certain situations. We conclude with a discussion of the importance of spaces within the urban context in shaping youths' embodied subjectivities, and in particular, contrast the space of the school with that of the urban AI community centre.
    September 29, 2015   doi: 10.1111/1467-9566.12349   open full text
  • Reducing symbolic‐violence in the research encounter: collaborating with a survivor of domestic abuse in a qualitative study in UK primary care.
    Alice Malpass, Kim Sales, Gene Feder.
    Sociology of Health & Illness. September 24, 2015
    This paper explores ideas of symbolic violence inherent in the research encounter (Bourdieu 1999). After defining symbolic violence and how the concept enters into domestic violence and abuse (DVA) research, we discuss the challenges arising from a (DVA) survivor taking on the role of interviewer in a qualitative study nested within a UK primary care based trial: IRIS (Identification and Referral to Improve Safety). KS, a survivor of DVA, conducted interviews with 12 women who had been referred to a domestic violence agency by primary care clinicians taking part in the IRIS trial in two UK cities (Bristol and east London) during 2009. Field notes were kept during all of the research meetings with KS and these were included in analysis. Our analysis maps the research pathway of ‘non‐violent communication’ and discusses the role of social symmetry and proximity in the research encounter. We conclude that while a welcoming disposition, empathy and active listening are all generic skills to qualitative research; if a researcher can enter fieldwork with a claim of social proximity and symmetry, their use of these generic skills is enhanced through a process of shared objectification and empowerment talk. We explore the limitations of social proximity, its relationship to feminist and anthropological theories of ‘insider’ research and its relevance to primary care research.
    September 24, 2015   doi: 10.1111/1467-9566.12352   open full text
  • The emergence of trust in clinics of alternative medicine.
    Inge Kryger Pedersen, Vibeke Holm Hansen, Kristina Grünenberg.
    Sociology of Health & Illness. September 24, 2015
    Demands for alternative medicine have increased since the 1970s in nations in which western scientific evidence has become the basis for health care. This paradox has been the impetus to examine how trust emerges in clinics of alternative medicine. Alternative practitioners are self‐regulated and the clients pay out of their own pockets to attend non‐authorised treatments with very limited scientific evidence of their effects. Trust is a key issue in this context. However, only a few studies have dealt with the ways in which alternative practitioners win their clients’ trust. Drawing on three qualitative studies and informing the empirical findings with a sociological concept of trust, this article provides new empirical insights on how trust emerges in Danish clinics of acupuncture, reflexology and homeopathy. The analysis demonstrates how trust is situational and emerges through both clients’ susceptibility and practitioners’ individual skill development and strategies, as well as from objects, place and space. Trust is developed on relational and bodily as well as material grounds. It is argued that the dynamics and elements of trust identified do not only minimalise uncertainties but sometimes convert these uncertainties into productive new ways for clients to address their ailments, life circumstances and perspectives.
    September 24, 2015   doi: 10.1111/1467-9566.12338   open full text
  • Tobacco denormalisation and representations of different tobacco users in Norway: A cross‐sectional study.
    Gunnar Saebo.
    Sociology of Health & Illness. September 19, 2015
    This study asks whether representations of different typical tobacco users vary in line with established stereotypes and by social group membership (especially tobacco user status). Social identity theory posits that representations differ due to varying identification with product users on the basis of personal use, while distinction theory suggests representations will be structured by proximity and distance to user groups. Using principal component analysis to identify representations and regression analysis to determine variances in representations, we find that four of five groups of typical tobacco users (snus users, pipe, cigarette, and cigar smokers) can be classified according to three similar representations: socially secure, culturally marginal and unappealing. Respondents who themselves use a certain tobacco product are more likely to consider a ‘typical’ user from their own group as more ‘socially secure’ and less ‘culturally marginal’ and ‘unappealing’ than non‐users. Former smokers tend to side with non‐smokers, which suggests their ‘smoker identity’ is on the wane. At the representational level, then, socio‐historical distinctions between different tobacco products seem to have diminished in favour of a largely dual classification, with users expressing positive and non‐users negative representations, of any typical user. This is a likely consequence of persistent tobacco denormalisation policies.
    September 19, 2015   doi: 10.1111/1467-9566.12348   open full text
  • Antiretroviral therapy and changing patterns of HIV stigmatisation in Entebbe, Uganda.
    Steve Russell, Flavia Zalwango, Stella Namukwaya, Joseph Katongole, Richard Muhumuza, Ruth Nalugya, Janet Seeley.
    Sociology of Health & Illness. September 18, 2015
    Antiretroviral therapy (ART) has the potential to change processes of HIV stigmatisation. In this article, changing processes of stigmatisation among a group of people living with HIV (PLWH) on ART in Wakiso District, Uganda, are analysed using qualitative data from a study of PLWH's self‐management of HIV on ART. There were 38 respondents (20 women, 18 men) who had been taking ART for at least 1 year. They were purposefully selected from government and non‐government ART providers. Two in‐depth interviews were held with each participant. Processes of reduced self‐stigmatisation were clearly evident, caused by the recovery of their physical appearance and support from health workers. However most participants continued to conceal their status because they anticipated stigma; for example, they feared gossip, rejection and their status being used against them. Anticipated stigma was gendered: women expressed greater fear of enacted forms of stigma such as rejection by their partner; in contrast men's fears focused on gossip, loss of dignity and self‐stigmatisation. The evidence indicates that ART has not reduced underlying structural drivers of stigmatisation, notably gender identities and inequalities, and that interventions are still required to mitigate and tackle stigmatisation, such as counselling, peer‐led education and support groups that can help PLWH reconstruct alternative and more positive identities.A video abstract of this article can be found at: https://youtu.be/WtIaZJQ3Y_8
    September 18, 2015   doi: 10.1111/1467-9566.12341   open full text
  • The social practice of rescue: the safety implications of acute illness trajectories and patient categorisation in medical and maternity settings.
    Nicola Mackintosh, Jane Sandall.
    Sociology of Health & Illness. September 18, 2015
    The normative position in acute hospital care when a patient is seriously ill is to resuscitate and rescue. However, a number of UK and international reports have highlighted problems with the lack of timely recognition, treatment and referral of patients whose condition is deteriorating while being cared for on hospital wards. This article explores the social practice of rescue, and the structural and cultural influences that guide the categorisation and ordering of acutely ill patients in different hospital settings. We draw on Strauss et al.'s notion of the patient trajectory and link this with the impact of categorisation practices, thus extending insights beyond those gained from emergency department triage to care management processes further downstream on the hospital ward. Using ethnographic data collected from medical wards and maternity care settings in two UK inner city hospitals, we explore how differences in population, cultural norms, categorisation work and trajectories of clinical deterioration interlink and influence patient safety. An analysis of the variation in findings between care settings and patient groups enables us to consider socio‐political influences and the specifics of how staff manage trade‐offs linked to the enactment of core values such as safety and equity in practice.
    September 18, 2015   doi: 10.1111/1467-9566.12339   open full text
  • Diet and identity: being a good parent in the face of contradictions presented by the ketogenic diet.
    Michelle Webster, Jonathan Gabe.
    Sociology of Health & Illness. September 18, 2015
    The ketogenic diet is a high‐fat diet used to treat drug‐resistant childhood epilepsy. Given that negative meanings tend to be attached to fatty foods and children's food consumption is seen to be the responsibility of parents, the ketogenic diet may be problematic for parenting identity. This article draws upon in‐depth semi‐structured interviews with 12 parents from 10 families that have a child whose epilepsy is being treated with the ketogenic diet. The main focus of the article is the meanings these parents attached to foods and how they were drawn upon or altered to overcome some of the contradictions presented by the diet. It will be argued that the diet was medicalised and parents came to view food as medicine. When viewing food in this way, negative associations with fat were reversed. Furthermore, parents also used food as a symbol of inclusion and prioritised portion size or the child's enjoyment of food in order to use food as a symbol of love. In turn this enabled parents to feel they were being good parents. Overall, it seems that diet can be medicalised and the identity of the good parent maintained if dietary treatment is successful.
    September 18, 2015   doi: 10.1111/1467-9566.12330   open full text
  • HIV stigma and the experiences of young men with voluntary and routine HIV testing.
    Rod Knight, Will Small, Jean A. Shoveller.
    Sociology of Health & Illness. September 18, 2015
    As routine HIV testing approaches are implemented to enhance participation rates in HIV testing, it is often widely believed that these approaches are socially and ethically justifiable given the underlying assumption that these practices will result in the widespread reduction of HIV‐related stigma. Nonetheless, a variety of empirical and theoretical gaps on how HIV testing practices may impact on HIV stigma remain, raising questions about the social underpinnings of the public health rationale. We draw on 50 interviews with 18–24 year‐old men to determine how HIV‐related stigma is experienced differentially across subgroups of young men in relation to both voluntary and routine testing practices. The men's experiences with routine testing highlight how (mis)interpretations of universal, routine testing practices may serve to (unintentionally) burden disadvantaged subgroups of men; however, when these practices are adequately explicated, the universal dimension of a routine offer greatly diminished these concerns. These findings also show that, under the right conditions, a routine offer can provide transformative opportunities for individuals to reconceptualise their expectations over HIV and HIV‐related stigma.
    September 18, 2015   doi: 10.1111/1467-9566.12345   open full text
  • Negotiating substance use stigma: the role of cultural health capital in provider–patient interactions.
    Jamie Chang, Leslie Dubbin, Janet Shim.
    Sociology of Health & Illness. September 18, 2015
    Diverse aspects of life and lifestyles, including stigmatised attributes and behaviors are revealed as providers and patients discuss health. In this article, we examine how the stigma associated with substance use issues shapes clinical interactions. We use the theoretical framework of cultural health capital (CHC) to explain how substance use stigma is created, reinforced and sometimes negotiated as providers and patients engage in health interactions. We present two main findings using examples. First, two theoretical concepts – habitus and field – set the social position and expectations of providers and patients in ways that facilitate the stigmatisation of substance use. Second, we found both providers and patients actively exchanged CHC as a key strategy to reduce the negative effects of stigma. In some clinical encounters, patients possessed and activated CHC, providers acknowledged patient's CHC and CHC was successfully exchanged. These interactions were productive and mutually satisfying, even when patients were actively using substances. However, when CHC was not activated, acknowledged and exchanged, stigma was unchallenged and dominated the interaction. The CHC theoretical framework allows us to examine how the stigma process is operationalized and potentially even counteracted in clinical interactions.
    September 18, 2015   doi: 10.1111/1467-9566.12351   open full text
  • On social plasticity: the transformative power of pharmaceuticals on health, nature and identity.
    Johanne Collin.
    Sociology of Health & Illness. September 11, 2015
    This article proposes a theoretical framework on the role of pharmaceuticals in transforming perspectives and shaping contemporary subjectivities. It outlines the significant role drugs play in three fundamental processes of social transformation in Western societies: medicalisation, molecularisation and biosocialisation. Indeed, drugs can be envisaged as major devices of a pharmaceutical regime, which is more akin to the notion of dispositif, as used by Foucault, than to the sole result of high‐level scheming by powerful economic interests, a notion which informs a significant share of the literature. Medications serve as a key vector of the transformation of perspective (or gaze) that characterises medicalisation, molecularisation and biosocialisation, by shifting our view on health, nature and identity from a categorical to a dimensional framework. Hence, central to this thesis is that the same underlying mechanism is at work. Indeed, in all three processes there is an evolving polarity between two antinomic categories, the positions of which are constantly being redefined by the various uses of drugs. Due to their concreteness, the fluidity of their use and the plasticity of the identities they authorise, drugs colonise all areas of contemporary social experiences, far beyond the medical sphere. A video abstract of this article can be found at: https://www.youtube.com/watch?v=djIBY7DHKW4&feature=youtu.be
    September 11, 2015   doi: 10.1111/1467-9566.12342   open full text
  • ‘The world has changed’: Pharmaceutical citizenship and the reimagining of serodiscordant sexuality among couples with mixed HIV status in Australia.
    Asha Persson.
    Sociology of Health & Illness. September 11, 2015
    In this article, I revisit the question of whether HIV can ever be reimagined and re‐embodied as a potentially non‐infectious condition, drawing on a current qualitative study of couples with mixed HIV status (serodiscordance) in Australia. Recent clinical trials have consolidated a shift in scientific understandings of HIV infectiousness by showing that antiretroviral treatment effectively prevents the sexual transmission of HIV. Contrary to common critiques, I explore how the increasing biomedicalisation of public health and the allied discourse of ‘normalisation’ can in fact de‐marginalise stigmatised relationships and sexualities. Invoking Ecks's concept of ‘pharmaceutical citizenship’, I consider whether the emerging global strategy of HIV ‘treatment‐as‐prevention’ (TasP) can open up new trajectories that release serodiscordant sexuality from its historical moorings in discourses of risk and stigma, and whether these processes might re‐inscribe serodiscordant sexuality as ‘normal’ and safe, potentially shifting the emphasis in HIV prevention discourses away from sexual practice toward treatment uptake and adherence.
    September 11, 2015   doi: 10.1111/1467-9566.12347   open full text
  • Pathways linking drug use and labour market trajectories: the role of catastrophic events.
    Lindsey Richardson, Will Small, Thomas Kerr.
    Sociology of Health & Illness. September 11, 2015
    People affected by substance use disorders often experience sub‐optimal employment outcomes. The role of drug use in processes that produce and entrench labour market precarity among people who inject drugs (PWID) have not, however, been fully described. We recruited 22 PWID from ongoing prospective cohort studies in Vancouver, Canada, with whom we conducted semi‐structured retrospective interviews and then employed a thematic analysis that drew on concepts from life course theory to explore the mechanisms and pathways linking drug use and labour market trajectories. The participants' narratives identified processes corresponding to causation, whereby suboptimal employment outcomes led to harmful drug use; direct selection, where impairment, health complications or drug‐seeking activities selected individuals out of employment; and indirect selection, where external factors, such as catastrophic events, marked the initiation or intensification of substance use concurrent with sudden changes in capacities for employment. Catastrophic events linking negative transitions in both drug use and labour market trajectories were of primary importance, demarcating critical initiation and transitional events in individual risk trajectories. These results challenge conventional assumptions about the primacy of drug use in determining employment outcomes among PWID and suggest the importance of multidimensional support to mitigate the initiation, accumulation and entrenchment of labour market and drug‐related disadvantage.
    September 11, 2015   doi: 10.1111/1467-9566.12344   open full text
  • Understanding snacking through a practice theory lens.
    Richard Twine.
    Sociology of Health & Illness. August 18, 2015
    This article approaches snacking from a practice theory perspective in order to understand how this reframing may afford new insights. In doing so it also contributes to sociological thinking on eating practices and their reproduction as well as reflecting upon the ontological assertions of practice theory and its theory of social change. In particular this article argues that the re‐conceptualisation serves to clarify a sociological research agenda for eating practices associated with snacking. It is argued that setting snacking within routine temporalities and spatialities and as bound up in the recursivity between practices and relations is especially important for thinking about snacking sociologically. In common with applications of practice theory in the field of sustainability transitions the aim is to move beyond individualistic assumptions of behaviour change and instead situate snacking as an eating practice with health implications that has emerged within the social, temporal, economic and cultural organisation of everyday life.
    August 18, 2015   doi: 10.1111/1467-9566.12310   open full text
  • Spatio‐temporal elements of articulation work in the achievement of repeat prescribing safety in UK general practice.
    Suzanne Grant, Jessica Mesman, Bruce Guthrie.
    Sociology of Health & Illness. August 18, 2015
    Prescribing is the most common healthcare intervention, and is both beneficial and risky. An important source of risk in UK general practice is the management of ‘repeat prescriptions’, which are typically requested from and issued by non‐clinically trained reception staff with only intermittent reauthorisation by a clinical prescriber. This paper ethnographically examines the formal and informal work employed by GPs and receptionists to safely conduct repeat prescribing work in primary care using Strauss's (1985, 1988, 1993) concept of ‘articulation work’ across eight UK general practices. The analytical lens of articulation work provided an investigative framing to contextually map the informal, invisible resources of resilience and strength employed by practice team members in the achievement of repeat prescribing safety, where risk and vulnerability were continually relocated across space and time. In particular, the paper makes visible the micro‐level competencies and collaborative practices that were routinely employed by both GPs and receptionists across different socio‐cultural contexts, with informal, cross‐hierarchical communication usually considered more effective than the formal structures of communication that existed (e.g. protocols). While GPs held formal prescribing authority, this paper also examines the key role of receptionists in both the initiation and safe coordination of the repeat prescribing routine.
    August 18, 2015   doi: 10.1111/1467-9566.12308   open full text
  • Enacting corporate governance of health care safety and quality: a dramaturgy of hospital boards in England.
    Tim Freeman, Ross Millar, Russell Mannion, Huw Davies.
    Sociology of Health & Illness. August 04, 2015
    The governance of patient safety is a challenging concern for all health systems. Yet, while the role of executive boards receives increased scrutiny, the area remains theoretically and methodologically underdeveloped. Specifically, we lack a detailed understanding of the performative aspects at play: what board members say and do to discharge their accountabilities for patient safety. This article draws on qualitative data from overt non‐participant observation of four NHS hospital Foundation Trust boards in England. Applying a dramaturgical framework to explore scripting, setting, staging and performance, we found important differences between case study sites in the performative dimensions of processing and interpretation of infection control data. We detail the practices associated with these differences ‐ the legitimation of current performance, the querying of data classification, and the naming and shaming of executives – to consider their implications.
    August 04, 2015   doi: 10.1111/1467-9566.12309   open full text
  • Gaining control over breast cancer risk: Transforming vulnerability, uncertainty, and the future through clinical trial participation – a qualitative study.
    Christine Holmberg, Katie Whitehouse, Mary Daly, Worta McCaskill‐Stevens.
    Sociology of Health & Illness. August 03, 2015
    Concepts of disease risk and its management are central to processes of medicalisation and pharmaceuticalisation. Through a narrative perspective, this paper aims to understand how such macro‐level developments may (or may not) be experienced individually, and how an algorithm that is used for recruitment into a clinical trial may structure individual notions of being ‘at risk’ and ‘in need of treatment’. We interviewed 31 women participating in the Study of Tamoxifen and Raloxifene (STAR), a chemoprevention trial conducted in the US between 1999 and 2006. Interviews were thematically analysed. Women in the study had experienced the threat of breast cancer and felt vulnerable to developing the disease prior to STAR participation. The diagnosis of ‘being at risk’ for cancer through an algorithm that determined risk‐eligibility for STAR, opened up the possibility for the women to heal. The trial became a means to recognise and collectivise the women's experiences of vulnerability. Through medication intake, being cared for by study coordinators, and the sense of community with other STAR participants, trial participation worked to transform women's lives. Such transformative experiences may nevertheless have been temporary, enduring only as long as the close links to the medical institution through trial participation lasted.
    August 03, 2015   doi: 10.1111/1467-9566.12307   open full text
  • Anxious? Depressed? You might be suffering from capitalism: contradictory class locations and the prevalence of depression and anxiety in the USA.
    Seth J. Prins, Lisa M. Bates, Katherine M. Keyes, Carles Muntaner.
    Sociology of Health & Illness. August 03, 2015
    Despite a well‐established social gradient for many mental disorders, there is evidence that individuals near the middle of the social hierarchy suffer higher rates of depression and anxiety than those at the top or bottom. Although prevailing indicators of socioeconomic status (SES) cannot detect or easily explain such patterns, relational theories of social class, which emphasise political‐economic processes and dimensions of power, might. We test whether the relational construct of contradictory class location, which embodies aspects of both ownership and labour, can explain this nonlinear pattern. Data on full‐time workers from the National Epidemiologic Survey on Alcohol and Related Conditions (n = 21859) show that occupants of contradictory class locations have higher prevalence and odds of depression and anxiety than occupants of non‐contradictory class locations. These findings suggest that the effects of class relations on depression and anxiety extend beyond those of SES, pointing to under‐studied mechanisms in social epidemiology, for example, domination and exploitation.
    August 03, 2015   doi: 10.1111/1467-9566.12315   open full text
  • Pharmaceutical direct‐to‐consumer advertising and US Hispanic patient‐consumers.
    Kristin K. Barker, Cirila Estela Vasquez Guzman.
    Sociology of Health & Illness. August 03, 2015
    Hispanic Americans use prescription medications at markedly lower rates than do non‐Hispanic whites. At the same time, Hispanics are the largest racial‐ethnic minority in the USA. In a recent effort to reach this underdeveloped market, the pharmaceutical industry has begun to create Spanish‐language direct‐to‐consumer advertising (DTCA) campaigns. The substantive content of these campaigns is being tailored to appeal to the purported cultural values, beliefs and identities of Latino consumers. We compare English‐language and Spanish‐language television commercials for two prescription medications. We highlight the importance of selling medicine to a medically under‐served population as a key marketing element of Latino‐targeted DTCA. We define selling medicine as the pharmaceutical industry's explicit promotion of medicine's cultural authority as a means of expanding its markets and profits. We reflect on the prospects of this development in terms of promoting medicalisation in a US subgroup that has heretofore eluded the pharmaceutical industry's marketing influence. Our analysis draws on Nikolas Rose's insights concerning variations in the degree to which certain groups of people are more medically made up than others, by reflecting on the racial and ethnic character of medicalisation in the USA and the role DTCA plays in shaping medicalisation trends. A video abstract of this article can be found at: https://www.youtube.com/watch?v=ZabCle9-jHw&feature=youtu.be
    August 03, 2015   doi: 10.1111/1467-9566.12314   open full text
  • Educational mismatch and mortality among native‐born workers in Sweden. A 19‐year longitudinal study of 2.5 million over‐educated, matched and under‐educated individuals, 1990–2008.
    Anthony M. Garcy.
    Sociology of Health & Illness. August 03, 2015
    This study tests the hypothesis that a disjuncture between an individual's attained level of education and that held by average workers in the individual's occupation leads to higher mortality among those with a prolonged mismatched status. Swedish register data are used in a 19‐year longitudinal mortality follow‐up study of all causes and specific causes of mortality. Participants were all men and women born between 1926 and 1985 who were alive on 1 September 1990, who had concurrent information on their attained level of education and the specific occupation or industry they were employed in during this period for at least a consecutive year. An objective measure of educational and occupational mismatch was constructed from these data. Those with a stable, over‐educated matched, or under‐educated employment status are included in the final analysis (N = 2,482,696). Independent of social, family, employers’ characteristics and prior health problems, the findings from a multivariate, stratified Cox regression analysis suggest there is excessive mortality among the over‐educated, and a protective effect of under‐education among native‐born Swedish men and women.
    August 03, 2015   doi: 10.1111/1467-9566.12312   open full text
  • Treatment, deterrence or labelling: mentally disordered offenders’ perspectives on social control.
    Jeremy Dixon.
    Sociology of Health & Illness. August 03, 2015
    Mentally disordered offenders are a group of service users who experience substantial amounts of control and supervision. This article uses theories of social control to analyse the way in which mechanisms of control are understood by this group. Semi‐structured interviews with mentally disordered offenders in England who were subject to a restriction order under the Mental Health Act 1983 (as amended by the Mental Health Act 2007) provided the empirical basis for this study. The offenders had a number of perspectives on the restriction order. Firstly, it was seen as a mechanism for identifying those suffering from a mental disorder and for providing appropriate treatment. Secondly, the restriction order was viewed as a form of disciplinary control through which societal norms might be internalised. Thirdly, it was seen as labelling offenders in a manner that was experienced as limiting and oppressive. A number of research participants were aware that the order acted to limit staff actions. These participants saw the order as a means by which they might shape the support that they received in order to further their own aims.A video abstract of this article can be found at: https://www.youtube.com/watch?v=qwIwDI2sOTY&feature=youtu.be
    August 03, 2015   doi: 10.1111/1467-9566.12313   open full text
  • Meeting pragmatism halfway: making a pragmatic clinical trial protocol.
    Alexander Rushforth.
    Sociology of Health & Illness. August 03, 2015
    Pragmatic clinical trials (PCTs) are today an increasingly prominent means of measuring the ‘effectiveness’ of healthcare interventions in ‘real world’ clinical settings, in order to produce evidence on which to base regulatory and clinical decision‐making. Although several sociological studies have shown persuasively how PCTs are co‐constructed within particular healthcare systems in which they are based, they have tended to focus on relatively later stages in careers of trials. The paper contributes to literature by considering how the ‘real world’ of the UK National Health Service (NHS) is incorporated into the design of a research protocol. Drawing on a meeting held just prior to patient recruitment for a PCT in maternal health, the paper analyses a trial collective's efforts to purify the messy domain of NHS clinical care into the orderly confines of the protocol (Law 2004), which meant satisfying demands for both scientific and social robustness (c.f. Nowotny et al. 2001). The findings show how efforts to inscribe robustness into the PCT protocol were themselves mediated through epistemic and regulatory conventions surrounding protocols as devices in healthcare research. Finally it is argued that meetings constitute an important epistemic instrument through which to settle various emerging tensions in PCT protocol design.
    August 03, 2015   doi: 10.1111/1467-9566.12311   open full text
  • Context and complexity: the meaning of self‐management for older adults with heart disease.
    Lucy Moore, Julia Frost, Nicky Britten.
    Sociology of Health & Illness. August 03, 2015
    Self‐management policies have presented opportunities for patients with long‐term conditions to take control and actively improve their health. However, the work of self‐management appears to be packaged in the form of essential and desirable skills and attributes required for success. This article presents the findings of a qualitative study, employing longitudinal diary interviews with 21 patients aged between 60 and 85 years diagnosed with coronary heart disease from three contrasting general practice areas. Drawing on concepts of the care of the self and the reflexive self, this article presents the diversity of self‐management practices by older patients in the context of their lifeworld. Illustrated through individual case studies, it clearly identifies where patients are engaged self‐managers with the agency, knowledge and self‐discipline to modify their behaviour for an improved health outcome. This study highlights their life and illness perspectives as well as those of patients who are burdened with emotional insecurity, comorbidities and caring responsibilities. It shows the spectrum of relationships with health professionals that influence engaged self‐management. We suggest that policy initiatives that favour behavioural change neglect social context and the individualised practices that are a necessary response to structural and psychosocial constraints.
    August 03, 2015   doi: 10.1111/1467-9566.12316   open full text
  • Not all hours are equal: could time be a social determinant of health?
    Lyndall Strazdins, Jennifer Welsh, Rosemary Korda, Dorothy Broom, Francesco Paolucci.
    Sociology of Health & Illness. July 15, 2015
    Time can be thought of as a resource that people need for good health. Healthy behaviour, accessing health services, working, resting and caring all require time. Like other resources, time is socially shaped, but its relevance to health and health inequality is yet to be established. Drawing from sociology and political economy, we set out the theoretical basis for two measures of time relevant to contemporary, market‐based societies. We measure amount of time spent on care and work (paid and unpaid) and the intensity of time, which refers to rushing, effort and speed. Using data from wave 9 (N = 9177) of the Household, Income and Labour Dynamics of Australia Survey we found that time poverty (> 80 h per week on care and work) and often or always rushing are barriers to physical activity and rushing is associated with poorer self‐rated and mental health. Exploring their social patterning, we find that time‐poor people have higher incomes and more time control. In contrast, rushing is linked to being a woman, lone parenthood, disability, lack of control and work–family conflicts. We supply a methodology to support quantitative investigations of time, and our findings underline time's dimensionality, social distribution and potential to influence health.
    July 15, 2015   doi: 10.1111/1467-9566.12300   open full text
  • Chronic illness as biographical contingency? Young people's experiences of asthma.
    Lee F. Monaghan, Jonathan Gabe.
    Sociology of Health & Illness. July 03, 2015
    Much research on chronic illness, which views the experience as disruptive, is adult‐focused though there is an emerging literature on children's and young people's experiences. Drawing on 31 interviews conducted with young people diagnosed with asthma in south‐west Ireland, this article contributes to this literature. The sample includes boys (n = 15) and girls (n = 16) aged between 5 and 17 from the Irish Traveller community and the larger settled community. The study also explores the potential value of what might be called biographical contingency. This concept refers to the way in which a chronic illness may be an ‘only sometimes’ problem and takes account of the ‘now you see it, now you don't’ nature of a condition that varies in terms of its symptoms, meanings and consequences. In concluding, we consider the uses and limitations of this concept and the interpretivist paradigm that typically informs qualitative research on the illness experience.
    July 03, 2015   doi: 10.1111/1467-9566.12301   open full text
  • The moral experience of illness and its impact on normalisation: Examples from narratives with Punjabi women living with rheumatoid arthritis in the UK.
    Tessa Sanderson, Michael Calnan, Kanta Kumar.
    Sociology of Health & Illness. July 03, 2015
    The moral component of living with illness has been neglected in analyses of long‐term illness experiences. This article attempts to fill this gap by exploring the role of the moral experience of illness in mediating the ability of those living with a long‐term condition (LTC) to normalise. This is explored through an empirical study of women of Punjabi origin living with rheumatoid arthritis (RA) in the UK. Sixteen informants were recruited through three hospitals in UK cities and interviews conducted and analysed using a grounded theory approach. The intersection between moral experience and normalisation, within the broader context of ethnic, gender and socioeconomic influences, was evident in the following: disruption of a core lived value (the centrality of family duty), beliefs about illness causation affecting informants’ ‘moral career’, and perceived discrimination in the workplace. The data illustrate the importance of considering an ethnic community's specific values and beliefs when understanding differences in adapting to LTCs and changing identities.
    July 03, 2015   doi: 10.1111/1467-9566.12304   open full text
  • Work or welfare after cancer? Explorations of identity and stigma.
    Suzanne Moffatt, Emma Noble.
    Sociology of Health & Illness. July 03, 2015
    With increasing numbers of people living with cancer, a greater focus is required on the social consequences of the disease. This article explores the connections between cancer and employment and the constraints imposed by ill health and wider structural conditions. Narrative data from 23 people of working age with cancer in north‐east England collected longitudinally over 16 months highlight the impact of financial strain caused by temporary or permanent interruption to employment, and the positive benefits of an upstream welfare rights intervention in enabling participants to claim benefit entitlements and boost incomes. Returning to work, for those who were able, helped repair the disruption caused by the illness. For those unable to work, reliance on welfare benefits, while necessary, conferred a stigmatised identity that compounded the disruption wrought by cancer. While stigma occurs at the individual level, the structural dimensions of stigma need to be acknowledged in order to analyse the forces that cause, maintain and perpetuate the stigma associated with claiming welfare while ill. We conclude that current UK policies and welfare reforms to reduce sickness‐related welfare claims will lead to greater hardship during periods of ill health and increase inequalities.
    July 03, 2015   doi: 10.1111/1467-9566.12303   open full text
  • Contesting modernity: Tobacco use and romanticism among older Dai farmers in Xishuangbanna, China.
    Xiang Zhao, Gareth Davey.
    Sociology of Health & Illness. July 03, 2015
    The majority of research about tobacco use in China focuses on Han Chinese, the main ethnic group comprising over 90 per cent of the population, and a paucity of research exists on ethnic minorities. The present study elucidates tobacco use among the Dai people, an ethnic group in Yunnan Province, Southwest China. The study design consisted of interviews and grounded theory methodology in a symbolic interactionist theoretical framework. The categories of the grounded theory revealed tobacco consumption was weaved in a complex web of meanings: social practices, perceptions of health, and work lives as agriculturalists, situated in Dai cultural and social milieu. An important finding was the stage‐managing of tobacco as a symbol of ‘tradition’ versus ‘modernity’: Through a process of contested modernity, the older men championed long‐standing tobacco customs as representative of Dai heritage and thus their own tobacco use as upholding traditions amid encroaching cultural and societal change in China. These findings are important because little is known about Dai people's tobacco use and how they are responding to social change. There are also implications for the development of culturally‐appropriate tobacco control strategies.
    July 03, 2015   doi: 10.1111/1467-9566.12305   open full text
  • ‘Rule your condition, don't let it rule you’: young adults’ sense of mastery in their accounts of growing up with a chronic illness.
    Janet Heaton, Ulla Räisänen, Maria Salinas.
    Sociology of Health & Illness. July 03, 2015
    Poor control of chronic illness is often attributed to patients’ non‐adherence to medical advice and treatment. Policy and practice has traditionally focused on improving adherence, assuming that the more patients comply, the better their control and outcomes will be. Drawing on complexity theory, we question this logic in a secondary analysis of qualitative data from studies of young adults’ experiences of growing up with a chronic illness. Examining their sense of mastery of their condition, we found they valued both being in medical control of their condition and having autonomy but had different ideas about how to achieve these goals. While some young adults mostly shared the traditional medical view that achieving good control was the key to retaining their autonomy, others saw control and autonomy as independent, non‐linear and potentially conflicting goals. The latter endeavoured to achieve both goals by striking a balance, variously adopting strategies of engagement with and resistance to their regime in the changing social contexts of their lives. We suggest that policy and practice needs to do more to promote autonomy and adaptive capacity, rather than simply maximising adherence and control, recognising the mundane complexity of living with and managing a chronic illness.
    July 03, 2015   doi: 10.1111/1467-9566.12298   open full text
  • Shining trinkets and unkempt gardens: on the materiality of care.
    Annemarie Hout, Jeannette Pols, Dick Willems.
    Sociology of Health & Illness. June 24, 2015
    The increasing use of telecare will profoundly change nursing care. How to understand these changes is, however, far from clear. This is because (i) studies on telecare seldom consider the situation it replaces, and (ii) current concepts and methods used to study the impact of telecare may not allow us to fully grasp these changes. We suggest that an analysis of the changing materiality of care practices is a suitable way to articulate and reflect on possible concerns. It allows us to compare care practices in the same terms before and after telecare has been introduced. To demonstrate this, we study the materiality of the classical care setting, the nursing house call, to map the situation before telecare is introduced. Building on science and technology studies, we apply four categories as heuristics to analyse materiality in care: signs, dis/enablers (or scripted things), tools and practical arrangements. We leave open the question of how material arrangements could or should be matters of concern in nursing care, and instead argue for studies that give insights into the everyday tinkering with the materiality of care that both nurses and patients need to engage in.
    June 24, 2015   doi: 10.1111/1467-9566.12302   open full text
  • Risk and resilience: health inequalities, working conditions and sickness benefit arrangements: an analysis of the 2010 European Working Conditions survey.
    Kjetil A. Wel, Clare Bambra, Nico Dragano, Terje A. Eikemo, Thorsten Lunau.
    Sociology of Health & Illness. June 22, 2015
    In this article we ask whether the level of sickness benefit provision protects the health of employees, particularly those who are most exposed to hazardous working conditions or who have a little education. The study uses the European Working Condition Survey that includes information on 20,626 individuals from 28 countries. Health was measured by self‐reported mental wellbeing and self‐rated general health. Country‐level sickness benefit provision was constructed using spending data from Eurostat. Group‐specific associations were fitted using cross‐level interaction terms between sickness benefit provision and physical and psychosocial working conditions respectively, as well as those with little education. The mental wellbeing of employees exposed to psychosocial job strain and physical hazards, or who had little education, was better in countries that offer more generous sickness benefit. These results were found in both men and women and were robust to the inclusion of GDP and country fixed effects. In the analyses of self‐reported general health, few group‐specific associations were found. This article concludes that generous sickness benefit provision may strengthen employee's resilience against mental health risks at work and risks associated with little education. Consequently, in countries with a generous provision of sickness benefit, social inequalities in mental health are smaller.
    June 22, 2015   doi: 10.1111/1467-9566.12293   open full text
  • Between stigma and mother‐blame: blind mothers' experiences in USA hospital postnatal care.
    Angela Frederick.
    Sociology of Health & Illness. April 30, 2015
    This study examines instances of discrimination that blind mothers in the USA have experienced at the hands of doctors, nurses and social workers during hospital postnatal care. The author identifies postnatal care as the time when blind mothers are likely to face the most stigmatising interactions with medical staff, as it is when scepticism about their competence as mothers is at its height. The author argues these interactions must be understood within their institutional context in which ideologies of risk and mother‐blame are embedded in hospital postnatal practices.
    April 30, 2015   doi: 10.1111/1467-9566.12286   open full text
  • For society, state and self: juggling the logics of professionalism in general practice appraisal.
    Tom Entwistle, Elaine Matthews.
    Sociology of Health & Illness. April 25, 2015
    Sociologists repeatedly appeal to notions of altruism, bureaucratisation and self interest in their efforts to explain the changing place of the professions in contemporary society. We treat these three readings as institutional logics that are key to understanding the way in which doctors respond to the appraisal system at the heart of the UK's approach to revalidation. Our analysis of a survey of 998 general practitioners (GPs) working in Wales finds an altruistic commitment to learning and improvement, bureaucratic demands for reporting information and self‐regarding resentment of changes in the occupational package provided by general practice. But the data also demonstrate that the maintenance of the appraisal regime is dependent on the preparedness and capacity of individual GPs to do micro‐level institutional work on all fronts.
    April 25, 2015   doi: 10.1111/1467-9566.12287   open full text
  • Stigma, deviance and morality in young adults' accounts of inflammatory bowel disease.
    Benjamin Saunders.
    Sociology of Health & Illness. June 03, 2014
    For young adults with inflammatory bowel disease (IBD), perceived stigma has been found to be a salient concern. Drawing on interviews with individuals with IBD aged 18–29 (n = 16), this article uses rhetorical discourse analysis to explore how stigma is discursively constructed by young adults, with a focus on the moral underpinnings of the participants' talk. Their representations showed both felt stigma and enacted stigma; principally related to the perceived taboo surrounding the symptoms of their condition, which often led to the non‐disclosure or concealment of the condition. The different ways in which stigma is manifested in the accounts present a challenge to recent arguments questioning the relevance of this concept in chronic illness research, though it was found that it is not adequate to look at stigma alone and, given the unstable nature of IBD, negotiating stigma in relation to possible charges of deviance is a pertinent issue for these young adults. For instance, non‐disclosure because of shame could result in individuals experiencing blame. Accounts were constructed through a range of discursive strategies, allowing the participants to present themselves in morally appropriate ways throughout. Suggestions are made about future directions in addressing stigma and deviance in relation to this cohort.
    June 03, 2014   doi: 10.1111/1467-9566.12148   open full text
  • Do those over 80 years of age seek more or less medical help? A qualitative study of health and illness beliefs and behaviour of the oldest old.
    Tania Elias, Karen Lowton.
    Sociology of Health & Illness. June 03, 2014
    Increasing longevity and prevalence of long‐term conditions contribute to older adults being the greatest users of health services. However, relatively little is known about the health and illness beliefs of the oldest old or how they decide to seek help in response to symptoms. Through analysis of in‐depth interviews with day centre attendees aged 80–93, we find that a moral, hierarchical approach to health problems and help‐seeking exists; similar to Cornwell's () findings among 50–60 year‐olds of a similar social group 30 years ago. However, when acting independently, those in their eighties and nineties report modifying their health and illness beliefs and behaviour, in response to their own perceived old age. Some health problems are ‘demedicalised’, being increasingly attributed to age and by being self‐managed. Others are perceived as potentially more serious, leading to increased consultation with medical services. When obliged to act outside their moral belief–behaviour framework by others, the participants expressed feelings of disempowerment, yet resisted modifying their moral beliefs. This may represent resistance to adopt the ‘sick role’, while seeking to maintain control over uncertain health as functional dependence and frailty increases. This study furthers theoretical understanding of the health and illness beliefs and behaviour of the oldest old, with important practical implications.
    June 03, 2014   doi: 10.1111/1467-9566.12129   open full text
  • Health journalism in the service of power: ‘moral complacency’ and the Hebrew media in the Gaza–Israel conflict.
    Daphna Birenbaum‐Carmeli.
    Sociology of Health & Illness. May 20, 2014
    The power of health news as a vehicle in the production of meaning in the service of power is the core of this article. Tracking the media coverage of a medical service, it shows how a routine practice can be invoked at a time of armed conflict so as to enhance a benevolent state image. The case at hand is the medical treatment of Gaza children in Israeli hospitals. A series of Internet searches revealed a group of publications on the subject in the Hebrew media, during and shortly after Israel's assault on Gaza in the winter of 2008–2009. In the press articles the treatments were invariably constituted as the epitome of Israel's compassion towards the enemy's children. This image relied, however, on a simultaneous silencing of other aspects of these treatments, which would have challenged this image. The monolithic depictions give rise to the notion of reversed moral panic or ‘moral complacency’, wherein the media amplifies a little‐known social phenomenon into an epitome of societal values and charges it with significance on a national scale. The article ends with considering some features that possibly render health news an especially convenient domain for state‐supportive media presentations.
    May 20, 2014   doi: 10.1111/1467-9566.12090   open full text
  • ‘Bourdieu’, medical elites and ‘social class’: a qualitative study of ‘desert island’ doctors.
    Ruth McDonald.
    Sociology of Health & Illness. April 21, 2014
    Sociologists of professions draw on Weberian theories of closure. However they have tended to ignore Bourdieu's work, which rejects Weberian notions of class and status groups as distinct ideal types and sees these concepts as inextricably linked. Bourdieu emphasises the importance of a class‐based habitus which generates orientations, inclinations and dispositions that organise practices and the perception of practice. For Bourdieu, because individuals perceive one another primarily through the status that attaches to their practices (through a symbolic veil of honour) they fail to perceive the real basis of these practices: the forms of capital that underlie the different habitus and enable their realisation. This article draws on interviews with 17 elite doctors appearing on a national (UK) radio show during which they choose eight discs to take to a desert island. According to Bourdieu, ‘nothing more clearly affirms one's “class”, nothing more infallibly classifies, than one's taste in music’. An analysis of the doctors' musical tastes and their mode of acquisition (largely, for these elites, via their family and education at independent schools), as well as other insights into their cultural capital reveals the importance of linking class and status when exploring professional status and prestige.
    April 21, 2014   doi: 10.1111/1467-9566.12121   open full text
  • Creeping edgework: carnivalesque consumption and the social experience of health risk.
    James M. Cronin, Mary McCarthy, Alan Collins.
    Sociology of Health & Illness. April 21, 2014
    This article contributes to an understanding of voluntary health risk based on the regular, excessive intake of food and alcohol in the micro‐cultural setting. By drawing on and extending edgework theory our aim is to conceptualise the riskiness of carnivalesque consumption as a medium for expression and performance in two separate community contexts. Using ethnographic research methods, we explore the consumption of calorie‐dense, low nutrient food for gamers and the use of alcohol for hipsters. Our findings are reported over four key themes. The first and last consider how carnivalesque consumption provides sensations for multi‐sensory loss of self and a shared emancipation from day‐to‐day moderation. The second and third explore how community members prepare and exercise control over their consumption to manage risks related to an ‘immediate edge’. We discuss how carnivalesque behaviour, when ritualised, establishes a trajectory that creeps towards a more ‘distant edge’ characterised by longer term health consequences. We argue that the transcendental experiences that are part and parcel of edgework can be enacted by products that are traditionally conceptualised as mundane and that the risks of consuming them are largely accumulative rather than instantaneous. Implications for health interventions are included.
    April 21, 2014   doi: 10.1111/1467-9566.12155   open full text
  • African American women's preventative care usage: the role of social support and racial experiences and attitudes.
    Erin Pullen, Brea Perry, Carrie Oser.
    Sociology of Health & Illness. April 21, 2014
    Research suggests that African Americans are less likely to utilise preventative care services than Americans of European descent, and that these patterns may contribute to racial health disparities in the United States. Despite the persistence of inequalities in preventative care utilisation, culturally relevant factors influencing the use of these gateway health services have been understudied among marginalised groups. Using a stratified sample of 205 low‐income African American women, this research examines the predictors of receiving a physical exam, with a particular emphasis on how differing levels of social support from friend and family networks and experiences of racial discrimination and cultural mistrust shape utilisation. The findings underscore the importance of traditional predictors of utilisation, including insurance status and having a usual physician. However, they also indicate that supportive ties to friendship networks are associated with higher predicted rates of having an annual physical exam, while social support from family and sentiments of cultural mistrust are associated with lower rates of utilisation. Broadly, the findings indicate that even as traditional predictors of help‐seeking become less relevant, it will be critical to explore how variations in discrimination experiences and social relationships across marginalised groups drive patterns of preventative care utilisation.
    April 21, 2014   doi: 10.1111/1467-9566.12141   open full text
  • Whistle‐blowing and workplace culture in older peoples' care: qualitative insights from the healthcare and social care workforce.
    Aled Jones, Daniel Kelly.
    Sociology of Health & Illness. April 10, 2014
    Inquiries in the UK into mistreatment of older people by healthcare employees over the last 30 years have focused on introducing or supporting employee whistle‐blowing. Although whistle‐blowers have made an important contribution to patient safety it remains a controversial activity. The fate of whistle‐blowers is bleak, often resulting in personal and professional sacrifices. Here we draw on the views of healthcare and social care employees working with older people to explore perceptions of whistle‐blowing as well as alternative strategies that may be used to raise concerns about the mistreatment of patients by co‐workers. Whistle‐blowing was perceived as a negative term. Managers said they promoted open cultures underpinned by regular team meetings and an open‐door ethos. Others described workplace norms that were somewhat at odds with these open culture ideals. Whistle‐blowing was considered risky, and this led to staff creating informal channels through which to raise concerns. Those who witnessed wrongdoing were aware that support was available from external agencies but preferred local solutions and drew upon personal ethics rather than regulatory edicts to shape their responses. We argue that the importance of workplace relationships and informal channels for raising concerns should be better understood to help prevent the mistreatment of vulnerable groups.
    April 10, 2014   doi: 10.1111/1467-9566.12137   open full text
  • Achieving visibility? Use of non‐verbal communication in interactions between patients and pharmacists who do not share a common language.
    Fiona Stevenson.
    Sociology of Health & Illness. March 19, 2014
    Despite the seemingly insatiable interest in healthcare professional–patient communication, less attention has been paid to the use of non‐verbal communication in medical consultations. This article considers pharmacists' and patients' use of non‐verbal communication to interact directly in consultations in which they do not share a common language. In total, 12 video‐recorded, interpreted pharmacy consultations concerned with a newly prescribed medication or a change in medication were analysed in detail. The analysis focused on instances of direct communication initiated by either the patient or the pharmacist, despite the presence of a multilingual pharmacy assistant acting as an interpreter. Direct communication was shown to occur through (i) the demonstration of a medical device, (ii) the indication of relevant body parts and (iii) the use of limited English. These connections worked to make patients and pharmacists visible to each other and thus to maintain a sense of mutual involvement in consultations within which patients and pharmacists could enact professionally and socially appropriate roles. In a multicultural society this work is important in understanding the dynamics involved in consultations in situations in which language is not shared and thus in considering the development of future research and policy.
    March 19, 2014   doi: 10.1111/1467-9566.12102   open full text
  • Renegotiating inter‐professional boundaries in maternity care: implementing a clinical pathway for normal labour.
    Billie Hunter, Jeremy Segrott.
    Sociology of Health & Illness. March 19, 2014
    This article presents findings from a study of a clinical pathway for normal labour (Normal Labour Pathway) implemented in Wales, UK. The study was conducted between 2004 and 2006. The pathway aimed to support normal childbirth and reduce unnecessary childbirth interventions by promoting midwife‐led care. This article focuses on how the pathway influenced the inter‐professional relationships and boundaries between midwives and doctors. Data are drawn from semi‐participant observation, focus groups and semi‐structured interviews with 41 midwives, and semi‐structured interviews with five midwifery managers and six doctors, working in two research sites. Whereas some studies have shown how clinical pathways may act as ‘boundary objects’, dissolving professional boundaries, promoting interdisciplinary care and de‐differentiating professional identities, the ‘normal labour pathway’ was employed by midwives as an object of demarcation, which legitimised a midwifery model of care, clarified professional boundaries and accentuated differences in professional identities and approaches to childbirth. The pathway represented key characteristics of a professional project: achieving occupational autonomy and closure. Stricter delineation of the boundary between midwifery and obstetric work increased the confidence and professional visibility of midwives but left doctors feeling excluded and undervalued, and paradoxically reduced the scope of midwifery practice through redefining what counted as normal.
    March 19, 2014   doi: 10.1111/1467-9566.12096   open full text
  • Gay men and intimate partner violence: a gender analysis.
    John L. Oliffe, Christina Han, Estephanie Sta. Maria, Maria Lohan, Terry Howard, Donna E. Stewart, Harriet MacMillan.
    Sociology of Health & Illness. March 19, 2014
    Though intimate partner violence (IPV) is predominately understood as a women's health issue most often emerging within heterosexual relationships, there is increasing recognition of the existence of male victims of IPV. In this qualitative study we explored connections between masculinities and IPV among gay men. The findings show how recognising IPV was based on an array of participant experiences, including the emotional, physical and sexual abuse inflicted by their partner, which in turn led to three processes. Normalising and concealing violence referred to the participants’ complicity in accepting violence as part of their relationship and their reluctance to disclose that they were victims of IPV. Realising a way out included the participants’ understandings that the triggers for, and patterns of, IPV would best be quelled by leaving the relationship. Nurturing recovery detailed the strategies employed by participants to mend and sustain their wellbeing in the aftermath of leaving an abusive relationship. In terms of masculinities and men's health research, the findings reveal the limits of idealising hegemonic masculinities and gender relations as heterosexual, while highlighting a plurality of gay masculinities and the need for IPV support services that bridge the divide between male and female as well as between homosexual and heterosexual.
    March 19, 2014   doi: 10.1111/1467-9566.12099   open full text
  • Technological affordances of risk and blame: the case of the electronic prescription service in England.
    Dimitra Petrakaki, Justin Waring, Nicholas Barber.
    Sociology of Health & Illness. March 19, 2014
    Information and communication technology (ICT) is often presented by health policymakers and software designers as a means for reducing clinical risk, leading to safer clinical practice. Studies have challenged this view, showing how technology can produce new or unanticipated risks. Although research seeks to objectively identify these risks, we recognise that technological risks are socially constructed through the interaction of technology and practice. The aim of this article is to explore how technology affords opportunities for the social construction and control of risk in health care settings. Drawing upon a study of the electronic prescription service introduced in the National Health Service in England, we make three arguments. Firstly, as technology interacts with social practice (for example, through policy and the design and use of ICT) it affords opportunities for the construction of risk through its interpretive flexibility, transformative capacity and materiality. Secondly, social actors interpret these risks within and across professional boundaries and cultures. Thirdly, the social construction of risk affords certain implications to policymakers, designers and users of health ICT, specifically a reordering of power and responsibility and a recasting of questions of blame. These, in turn, raise questions concerning the boundaries and bearers of responsibility.
    March 19, 2014   doi: 10.1111/1467-9566.12098   open full text
  • Long‐term ill health and the social embeddedness of work: a study in a post‐industrial, multi‐ethnic locality in the UK.
    Kaveri Qureshi, Sarah Salway, Punita Chowbey, Lucinda Platt.
    Sociology of Health & Illness. March 19, 2014
    Against the background of an increasingly individualising welfare‐to‐work regime, sociological studies of incapacity and health‐related worklessness have called for an appreciation of the role of history and context in patterning individual experience. This article responds to that call by exploring the work experiences of long‐term sick people in East London, a post‐industrial, multi‐ethnic locality. It demonstrates how the individual experiences of long‐term sickness and work are embedded in social relations of class, generation, ethnicity and gender, which shape people's formal and informal routes to work protection, work‐seeking practices and responses to worklessness. We argue that this social embeddedness requires greater attention in welfare‐to‐work policy.
    March 19, 2014   doi: 10.1111/1467-9566.12128   open full text
  • Lost in translation? ‘Evidence’ and the articulation of institutional logics in integrated care pathways: from positive to negative boundary object?
    Davina Allen.
    Sociology of Health & Illness. March 17, 2014
    This article examines the translation of a clinical governance concept – integrated care pathways (ICPs) – into an infrastructural technology. Building on previous work, the application of boundary object theory is extended in this article to argue that stakeholder enrolment in pathway methodology may be less thoroughgoing than originally assumed. Pathways have effectively aligned management and nursing interests around a quality agenda and nurses have emerged as the leaders in this field, but doctors have rather lower levels of engagement. It is suggested that the contradictory logics inherent in pathway philosophy (primarily as these relate to ‘evidence’) and the social organisation of ICP development foster a transformation of the concept when this is translated into the technology, creating a negative boundary object from the perspective of doctors. Medicine is a powerful actor in health care, which is consequential for whether pathways, as designated boundary objects, become boundary objects‐in‐use. It also has implications for the diffusion of the concept as a mechanism of clinical governance and the credibility of nurses as emergent leaders in this field. Qualitative case studies of ICP development processes undertaken in the UK National Health Service and ethnographic research on the ICP community provide the empirical foundations for the analysis.
    March 17, 2014   doi: 10.1111/1467-9566.12111   open full text
  • Risks, dangers and competing clinical decisions on venous thromboembolism prophylaxis in hospital care.
    Olga Boiko, Rod Sheaff, Susan Child, Christian A. Gericke.
    Sociology of Health & Illness. March 17, 2014
    Drawing on wider sociologies of risk, this article examines the complexity of clinical risks and their management, focusing on risk management systems, expert decision‐making and safety standards in health care. At the time of this study preventing venous thromboembolism (VTE) among in‐patients was one of the top priorities for hospital safety in the English National Health Service (NHS). An analysis of 50 interviews examining hospital professionals' perceptions about VTE risks and prophylaxis illuminates how National Institute for Health and Clinical Excellence (NICE) guidelines influenced clinical decision‐making in four hospitals in one NHS region. We examine four themes: the identification of new risks, the institutionalisation and management of risk, the relationship between risk and danger and the tensions between risk management systems and expert decision‐making. The implementation of NICE guidelines for VTE prevention extended managerial control over risk management but some irreducible clinical dangers remained that were beyond the scope of the new VTE risk management systems. Linking sociologies of risk with the realities of hospital risk management reveals the capacity of these theories to illuminate both the possibilities and the limits of managerialism in health care.
    March 17, 2014   doi: 10.1111/1467-9566.12127   open full text
  • Enjoy your food: on losing weight and taking pleasure.
    Else Vogel, Annemarie Mol.
    Sociology of Health & Illness. February 15, 2014
    Does healthy eating require people to control themselves and abstain from pleasure? This idea is dominant, but in our studies of dieting in The Netherlands we encountered professionals who work in other ways. They encourage their clients to enjoy their food, as only such joy provides satisfaction and the sense that one has eaten enough. Enjoying one's food is not easy. It depends on being sensitive. This does not come naturally but needs training. And while one kind of hunger may be difficult to distinguish from another, feeling pleasure may open the doors to feeling pain. What is more, sensitivity is not enough: enjoying one's food also depends on the food being enjoyable. A lot of care is required for that. But while engaging in such care is hard work, along the way clients are encouraged to no longer ask ‘Am I being good?’ but to wonder instead ‘Is this good for me?’ Both these questions are normative and focus on the person rather than on her socio‐material context. However, in the situations related here the difference is worth making. For it entails a shift from externally controlling your behaviour to self‐caringly enjoying your food.
    February 15, 2014   doi: 10.1111/1467-9566.12116   open full text
  • Providers’ constructions of pregnant and early parenting women who use substances.
    Cecilia Benoit, Camille Stengel, Lenora Marcellus, Helga Hallgrimsdottir, John Anderson, Karen MacKinnon, Rachel Phillips, Pilar Zazueta, Sinead Charbonneau.
    Sociology of Health & Illness. February 15, 2014
    The research literature indicates that problematic substance use as a form of health behaviour is poorly understood, being sometimes viewed as deviance, at other times as a disease, and most often as a combination of these states. The use of substances by women who are pregnant or new parents is often conceptualised within an individualised framework. Yet drinking alcohol and using other drugs during pregnancy and early parenthood cuts across social divisions and is shaped by socio‐structural contexts including health care. There is a growing body of literature that critically examines public health interventions that are aimed at implementing harm reduction and health promotion techniques in service delivery to help pregnant and early parenting women who are identified as problem substance users. We examine qualitative data from representatives of a recent harm reduction intervention, focusing, in particular, on providers’ individual conceptualisations of the problematic behaviour. Our results show that most study participants regard any substance use during pregnancy, birth and the postpartum period as fundamentally unacceptable. This framing of problematic substance use is accomplished via gendered responsibilisation of women as foetal incubators and primary caregivers of infants. We discuss our results in light of the current literature and suggest policy implications.
    February 15, 2014   doi: 10.1111/1467-9566.12106   open full text
  • Thinking about changing mobility practices: how a social practice approach can help.
    Sarah Nettleton, Judith Green.
    Sociology of Health & Illness. February 15, 2014
    Policy efforts directed at encouraging physical activity have had minimal success to date. Drawing on Bourdieu's theory of practice, we suggest that a social practice framing might provide useful ways of thinking about why and how some practices do and could change. This article takes three case studies of transformations in mobility practices to explore conditions of possibility for change, using a secondary analysis of qualitative data from studies on cycling in London and fell running in the English Lake District. Three modes of transformation: unthinkable, thwarted and resisted, are rooted in differential interrelationships of field, habitus and doxa in these contrasting cases. We suggest that the notion of tacit, practical knowledge is more useful to understanding why change is thinkable or unthinkable than participants’ reasoned accounts of their practice; that where new social fields are available that are congruent with habitus, change is possible and that where field and habitus are tightly aligned, the conditions of possibility for change are reduced. Efforts directed at changing practice might usefully focus not on behaviour or environments but on identifying the social fields in which mobility practices are likely to be malleable. The sociology of public health needs to focus less on health behaviour and more on social practice.
    February 15, 2014   doi: 10.1111/1467-9566.12101   open full text
  • Behaviour change and social blinkers? The role of sociology in trials of self‐management behaviour in chronic conditions.
    Bie Nio Ong, Anne Rogers, Anne Kennedy, Peter Bower, Tom Sanders, Andrew Morden, Sudeh Cheraghi‐Sohi, Jane C. Richardson, Fiona Stevenson.
    Sociology of Health & Illness. February 15, 2014
    Individual‐focused self‐management interventions are one response to both an ageing society and the purported increase in chronic conditions. They tend to draw on psychological theories in self‐management interventions, but over‐reliance on these theories can reinforce a narrow focus on specified attitudinal and behavioural processes, omitting aspects of living with a chronic condition. While advances have been made in health behaviour change theory and practice, scant attention has been paid to the social, with the question of social context remaining under‐theorised and under‐explored empirically. This is particularly noticeable in trials of behaviour change interventions for self‐management. The common sociological critique is that these ignore context and thus no explanation can be given as to why, for whom and under what circumstances a treatment works. Conversely, sociologists are criticised for offering no positive suggestions as to how context can be taken into account and for over‐emphasising context with the risk of inhibiting innovation. This article provides an overview of these issues and provides examples of how context can be incorporated into the rigid method of trials of self‐management for chronic conditions. We discuss modifications to both trial interventions and design that make constructive use of the concept of context.
    February 15, 2014   doi: 10.1111/1467-9566.12113   open full text
  • Why behavioural health promotion endures despite its failure to reduce health inequities.
    Fran Baum, Matthew Fisher.
    Sociology of Health & Illness. February 15, 2014
    Increasing rates of chronic conditions have resulted in governments targeting health behaviour such as smoking, eating high‐fat diets, or physical inactivity known to increase risk for these conditions. In the process, many have become preoccupied with disease prevention policies focused excessively and narrowly on behavioural health‐promotion strategies. These aim to improve health status by persuading individuals to change their health behaviour. At the same time, health promotion policy often fails to incorporate an understanding of the social determinants of health, which recognises that health behaviour itself is greatly influenced by peoples’ environmental, socioeconomic and cultural settings, and that chronic diseases and health behaviour such as smoking are more prevalent among the socially or economically disadvantaged. We identify several reasons why behavioural forms of health promotion are inadequate for addressing social inequities in health and point to a dilemma that, despite these inadequacies and increasing evidence of the social determinants of health, behavioural approaches and policies have strong appeal to governments. In conclusion, the article promotes strategies addressing social determinants that are likely to reduce health inequities. The article also concludes that evidence alone will not result in health policies aimed at equity and that political values and will, and the pressure of civil society are also crucial.
    February 15, 2014   doi: 10.1111/1467-9566.12112   open full text
  • Staying ‘in the zone’ but not passing the ‘point of no return’: embodiment, gender and drinking in mid‐life.
    Antonia C. Lyons, Carol Emslie, Kate Hunt.
    Sociology of Health & Illness. January 22, 2014
    Public health approaches have frequently conceptualised alcohol consumption as an individual behaviour resulting from rational choice. We argue that drinking alcohol needs to be understood as an embodied social practice embedded in gendered social relationships and environments. We draw on data from 14 focus groups with pre‐existing groups of friends and work colleagues in which men and women in mid‐life discussed their drinking behaviour. Analysis demonstrated that drinking alcohol marked a transitory time and space that altered both women's and men's subjective embodied experience of everyday gendered roles and responsibilities. The participants positioned themselves as experienced drinkers who, through accumulated knowledge of their own physical bodies, could achieve enjoyable bodily sensations by reaching a desired level of intoxication (being in the zone). These mid‐life adults, particularly women, discussed knowing when they were approaching their limit and needed to stop drinking. Experiential and gendered embodied knowledge was more important in regulating consumption than health promotion advice. These findings foreground the relational and gendered nature of drinking and reinforce the need to critically interrogate the concept of alcohol consumption as a simple health behaviour. Broader theorising around notions of gendered embodiment may be helpful for more sophisticated conceptualisations of health practices.
    January 22, 2014   doi: 10.1111/1467-9566.12103   open full text
  • Sustained multiplicity in everyday cholesterol reduction: repertoires and practices in talk about ‘healthy living’.
    Catherine M. Will, Kate Weiner.
    Sociology of Health & Illness. January 21, 2014
    This article is concerned with talk about and the practices of healthy living in relation to cholesterol reduction. It draws on qualitative interviews with 89 people who are current or former users of either cholesterol‐lowering functional foods or statins for cardiovascular risk reduction. Focusing on data about everyday activities including food preparation, shopping and exercise, we illustrate four repertoires that feature in talk about cholesterol reduction (health, pleasure, sociality and pragmatism). Using Gilbert and Mulkay's notion of a ‘reconciliation device’, we suggest ways in which apparently contradictory repertoires are combined (for example, through talk about moderation) or kept apart. We suggest that, in contrast to the interactiveness of the repertoires of health and pleasure, a pragmatic repertoire concerning food provisioning, storage and cooking as well as the realities of exercise, appears distinct from talk about health and is relatively inert. Finally we consider the implications of these discursive patterns for daily practices. Our data suggest there is little emphasis on coherence in people's practices and illustrate the significance of temporal, spatial and social distribution in allowing people to pursue different priorities in their everyday lives. Rather than the calculated trade‐offs of earlier medical sociology we draw on Mol to foreground the possibility of sustained multiplicity in daily practices.
    January 21, 2014   doi: 10.1111/1467-9566.12070   open full text
  • A relational approach to health practices: towards transcending the agency‐structure divide.
    Gerry Veenstra, Patrick John Burnett.
    Sociology of Health & Illness. January 21, 2014
    Many health scholars find that Pierre Bourdieu's theory of practice leaves too little room for individual agency. We contend that, by virtue of its relational, field‐theoretic underpinnings, the idea of leaving room for agency in Bourdieu's theory of practice is misguided. With agency manifested in interactions and social structures consisting of relations built upon relations, the stark distinction between agency and structure inherent to substantialist thinking is undermined, even dissolved, in a relational field‐theoretic context. We also contend that, when treated as relationally bound phenomena, Bourdieu's notions of habitus, doxa, capital and field illuminate creative, adaptive and future‐looking practices. We conclude by discussing difficulties inherent to implementing a relational theory of practice in health promotion and public health.
    January 21, 2014   doi: 10.1111/1467-9566.12105   open full text
  • A socially situated approach to inform ways to improve health and wellbeing.
    Christine Horrocks, Sally Johnson.
    Sociology of Health & Illness. January 21, 2014
    Mainstream health psychology supports neoliberal notions of health promotion in which self‐management is central. The emphasis is on models that explain behaviour as individually driven and cognitively motivated, with health beliefs framed as the favoured mechanisms to target in order to bring about change to improve health. Utilising understandings exemplified in critical health psychology, we take a more socially situated approach, focusing on practicing health, the rhetoric of modernisation in UK health care and moves toward democratisation. While recognising that within these new ways of working there are opportunities for empowerment and user‐led health care, there are other implications. How these changes link to simplistic cognitive behavioural ideologies of health promotion and rational decision‐making is explored. Utilising two different empirical studies, this article highlights how self‐management and expected compliance with governmental authority in relation to health practices position not only communities that experience multiple disadvantage but also more seemingly privileged social actors. The article presents a challenge to self‐management and informed choice, in which the importance of navigational networks is evident. Because health care can become remote and inaccessible to certain sections of the community, yet pervasive and deterministic for others, we need multiple levels of analysis and different forms of action.
    January 21, 2014   doi: 10.1111/1467-9566.12114   open full text
  • How do values shape technology design? An exploration of what makes the pursuit of health and wealth legitimate in academic spin‐offs.
    Pascale Lehoux, Geneviève Daudelin, Myriam Hivon, Fiona Alice Miller, Jean‐Louis Denis.
    Sociology of Health & Illness. January 21, 2014
    By actively supporting cooperation between academia, clinical settings and industry, several policy initiatives assume that the two policy agendas of health and wealth can be reconciled through the development of health technology. Our goal in this article is to shed light on the way the concurrent pursuit of health and wealth operates in practice by examining the valuation schemes, actions and decisions that shaped technology development in three Canadian spin‐offs. Drawing on the sociology of judgement, our analytical framework conceives of technology development as a purposive collective action that unfolds in a normatively heterogeneous context (one pervaded with both corporate and public service mission values and norms). Our qualitative empirical analyses explore four valuation schemes and their corresponding regimes of engagement that characterise why and how technology developers commit themselves to addressing certain clinical, interactional, organisational and economic concerns throughout the development process. Our discussion suggests that the ability to reconcile health and wealth goals is to be found in the moral repertoires that provide meaning to, and render coherent technology developers' participation in corporate activities driven by economic growth.
    January 21, 2014   doi: 10.1111/1467-9566.12097   open full text
  • The commodification of patient opinion: the digital patient experience economy in the age of big data.
    Deborah Lupton.
    Sociology of Health & Illness. January 21, 2014
    As part of the digital health phenomenon, a plethora of interactive digital media platforms have been established in recent years to elicit lay people's experiences of illness and health care. The overt function of these platforms is to provide forums where patients and caregivers can share their experiences with others, benefit from the support and knowledge of other users and contribute to large aggregated data archives as part of developing better medical treatments and services and conducting medical research. However, what may not always be readily apparent to the users of these platforms are the growing commercial uses by many of the platforms’ owners of the data they contribute. This article examines this phenomenon of what I term ‘the digital patient experience economy’. Such aspects of this economy as prosumption (the combination of content consumption and production that is characteristic of the use of Web 2.0 technologies), the valorising of big data, the discourse and ethic of sharing and the commercialisation of affective labour are discussed. It is argued that via these online platforms patients’ opinions and experiences may be expressed in more diverse and accessible forums than ever before, but simultaneously they have become exploited in novel ways.
    January 21, 2014   doi: 10.1111/1467-9566.12109   open full text
  • Presuming the influence of the media: teenagers' constructions of gender identity through sexual/romantic relationships and alcohol consumption.
    Jane E K Hartley, Daniel Wight, Kate Hunt.
    Sociology of Health & Illness. January 21, 2014
    Using empirical data from group discussions and in‐depth interviews with 13 to 15‐year olds in Scotland, this study explores how teenagers’ alcohol drinking and sexual/romantic relationships were shaped by their quest for appropriate gendered identities. In this, they acknowledged the influence of the media, but primarily in relation to others, not to themselves, thereby supporting Milkie's ‘presumed media influence’ theory. Media portrayals of romantic/sexual relationships appeared to influence teenagers’ constructions of gender‐appropriate sexual behaviour more than did media portrayals of drinking behaviour, perhaps because the teenagers had more firsthand experience of observing drinking than of observing sexual relationships. Presumed media influence may be less influential if one has experience of the behaviour portrayed. Drinking and sexual behaviour were highly interrelated: sexual negotiation and activities were reportedly often accompanied by drinking. For teenagers, being drunk or, importantly, pretending to be drunk, may be a useful way to try out what they perceived to be gender‐appropriate identities. In sum, teenagers’ drinking and sexual/romantic relationships are primary ways in which they do gender and the media's influence on their perceptions of appropriate gendered behaviour is mediated through peer relationships.
    January 21, 2014   doi: 10.1111/1467-9566.12107   open full text
  • Assessing child welfare under the Human Fertilisation and Embryology Act 2008: a case study in medicalisation?
    Ellie Lee, Jan Macvarish, Sally Sheldon.
    Sociology of Health & Illness. January 04, 2014
    This article reports on a study with staff working in assisted conception clinics in the UK about making welfare of the child (WOC) assessments pre‐conception. This aspect of infertility treatment is obligatory under section 13(5) of the Human Fertilisation and Embryology Act, which was amended in 2008. The aim of the study was to find out how this change to the law had impacted on practice. In describing what we found, we also make a contribution to scholarship about the medicalisation of reproduction. S13(5) has often been discussed as a prime example of medicalisation, giving clinics power to grant or deny access to treatment on child welfare grounds, encompassing far more than purely clinical considerations. Yet, while such medicalisation may be entrenched in the law, our findings suggest this power is used with a very light touch. Further, while our interviewees offered near‐universal support for the need to consider child welfare, this is now justified by concerns that address not only family form (e.g. the need for a father figure) but also the quality of interactions between parents and children. In this light we suggest that the concept of medicalisation may offer a rather blunt tool for understanding a far more complex reality.
    January 04, 2014   doi: 10.1111/1467-9566.12078   open full text
  • Actors, patients and agency: a recent history.
    David Armstrong.
    Sociology of Health & Illness. December 28, 2013
    This article examines the history of patients’ behaviour since the middle of the 20th century. It describes a number of strategies that have served to encourage patients to exercise increasingly autonomous behaviour. The effect has been to instil a sense of agency in previously passive patients.
    December 28, 2013   doi: 10.1111/1467-9566.12100   open full text
  • The pursuit of preventive care for chronic illness: turning healthy people into chronic patients.
    Meta J. Kreiner, Linda M. Hunt.
    Sociology of Health & Illness. December 28, 2013
    Preventive health care has become prominent in clinical medicine in the US, emphasising risk assessment and control, rather than addressing the signs and symptoms of pathology. Current clinical guidelines, reinforced by evidence‐based decision aids and quality of care assessment, encourage clinicians to focus on maintaining rigid test thresholds that are based on population norms. While achieving these goals may benefit the total population, this may be of no benefit or even harmful to individual patients. In order to explore how this phenomenon is manifested in clinical care and consider some factors that promote and sustain this trend, we analysed observations of over 100 clinical consultations, and open‐ended interviews with 58 primary care clinicians and 70 of their patients. Both clinicians and patients equated at‐risk states with illness and viewed the associated interventions not as prevention, but as treatment. This conflation of risk and disease redefines clinical success such that reducing the threat of anticipated future illness requires the acceptance of aggressive treatments and any associated adverse effects in the present. While the expanding emphasis on preventive medicine may improve the health profile of the total population, the implications of these innovations for the wellbeing of individual patients merits careful reconsideration.
    December 28, 2013   doi: 10.1111/1467-9566.12115   open full text
  • Organisational innovation and control practices: the case of public–private mix in tuberculosis control in India.
    Nora Engel, Harro Lente.
    Sociology of Health & Illness. December 28, 2013
    Partnerships between public and private healthcare providers are often seen as an important way to improve health care in resource‐constrained settings. Despite the reconfirmed policy support for including private providers into public tuberculosis control in India, the public–private mix (PPM) activities continue to face apprehension at local implementation sites. This article investigates the causes for those difficulties by examining PPM initiatives as cases of organisational innovation. It examines findings from semi‐structured interviews, observations and document analyses in India around three different PPM models and the attempts of innovating and scaling up. The results reveal that in PPM initiatives underlying problem definitions and different control practices, including supervision, standardisation and culture, continue to clash and ultimately hinder the scaling up of PPM. Successful PPM initiatives require organisational control practices which are rooted in different professions to be bridged. This entails difficult balancing acts between innovation and control. The innovators handle those differently, based on their own ideas of the problem that PPM should address and their own control practices. We offer new perspectives on why collaboration is so difficult and show a possible way to mitigate the established apprehensions between professions in order to make organisational innovations, such as PPM, sustainable and scalable.
    December 28, 2013   doi: 10.1111/1467-9566.12125   open full text
  • Environmental justice and health practices: understanding how health inequities arise at the local level.
    Katherine L. Frohlich, Thomas Abel.
    Sociology of Health & Illness. December 23, 2013
    While empirical evidence continues to show that people living in low socio‐economic status neighbourhoods are less likely to engage in health‐enhancing behaviour, our understanding of why this is so remains less than clear. We suggest that two changes could take place to move from description to understanding in this field; (i) a move away from the established concept of individual health behaviour to a contextualised understanding of health practices; and (ii) a switch from focusing on health inequalities in outcomes to health inequities in conditions. We apply Pierre Bourdieu's theory on capital interaction but find it insufficient with regard to the role of agency for structural change. We therefore introduce Amartya Sen's capability approach as a useful link between capital interaction theory and action to reduce social inequities in health‐related practices. Sen's capability theory also elucidates the importance of discussing unequal chances in terms of inequity, rather than inequality, in order to underscore the moral nature of inequalities. We draw on the discussion in social geography on environmental injustice, which also underscores the moral nature of the spatial distribution of opportunities. The article ends by applying this approach to the ‘Interdisciplinary study of inequalities in smoking’ framework.
    December 23, 2013   doi: 10.1111/1467-9566.12126   open full text
  • Touching moments: phenomenological sociology and the haptic dimension in the lived experience of motor neurone disease.
    Jacquelyn Allen‐Collinson, Amanda Pavey.
    Sociology of Health & Illness. November 28, 2013
    Currently, there is a relative research lacuna in phenomenological research into the lived experience of motor neurone disease. Based on a sociological research project in the UK, involving 42 participants diagnosed with MND, this article explores the potential of a phenomenological sociology for analysing experiences of this drastically life‐limiting neurological disorder. Calls have been made for sociological researchers to analyse more fully and deeply the sensory dimension of the lived body, and this article also contributes to this newly developing body of literature. While the social sciences have been accused of a high degree of ocularcentrism, here we take forward the literature by specifically focusing upon the haptic dimension, given that touch – and particularly the loss of key elements of the haptic dimension– emerged as salient in MND patients' accounts. To illustrate the potential of our phenomenologically inspired theoretical perspective, we consider two specific haptic themes: (i) being out of touch: the loss of certain forms of touch within MND and (ii) unwelcome touch by medical staff.
    November 28, 2013   doi: 10.1111/1467-9566.12104   open full text
  • Interpreting genetics in the context of eating disorders: evidence of disease, not diversity.
    Michele Easter.
    Sociology of Health & Illness. November 28, 2013
    How is genetic involvement interpreted for disorders whose medicalisation is contested? Framing psychiatric and behavioural disorders in terms of genetics is expected to make them seem more medical. Yet a genetic aetiology can also be used to frame behaviour as acceptable human variation, rather than a medical problem (for example, sexual orientation). I analyse responses to the idea that there is a genetic component in anorexia and bulimia nervosa (AN or BN) via semi‐structured interviews with a sample of 50 women diagnosed with an eating disorder (25 had recovered). All but three volunteered that genetics would medicalise AN or BN by (i) making eating disorders seem more like ‘real diseases’; implying that these disorders need (ii) professional treatment or (iii) a biologically based treatment. The results also indicate there are several counter‐logics by which genetic framing could support non‐medical definitions of AN or BN. I argue that genetic framing reduces perceived individual responsibility, which can support definitions of behaviour as either a reflection of disease (which entails intervention) or a reflection of normal human diversity (which does not). In the context of public scepticism as to the ‘reality’ of AN or BN, genetic involvement was taken as evidence of disease in ongoing negotiations about the medical and moral status of people with eating disorders.
    November 28, 2013   doi: 10.1111/1467-9566.12108   open full text
  • Developing biographies: the experiences of children, young people and their parents of living with a long‐term condition.
    Lucy Bray, Sue Kirk, Peter Callery.
    Sociology of Health & Illness. November 28, 2013
    This article reports on data from a qualitative interview study that sought to understand the experiences, choices and actions of children and young people undergoing surgery for a long‐term condition and that of their parents. Using the concept of biography the article examines how the biographies of children, young people and their parents can be influenced by surgery and the ongoing management of a long‐term continence condition. This article challenges previous work that characterises the presence of a condition from birth as a continuous and normal part of the illness experiences of these patients. Although this may be the case in some instances, children, young people and their parents can experience diverse and changing experiences associated with ongoing condition management as well as surgery. Biographical continuity, enrichment and disruption are all relevant concepts for such patients living with a long‐term continence condition. These can be influenced by their previous experiences of their condition, their expectations, and dynamics with parents, including changes associated with development and the increasing independence of young people.
    November 28, 2013   doi: 10.1111/1467-9566.12110   open full text
  • Beyond professional boundaries: relationships and resources in health services' modernisation in England and Wales.
    Guro Huby, Fiona M Harris, Alison E. Powell, Tara Kielman, Aziz Sheikh, Sian Williams, Hilary Pinnock.
    Sociology of Health & Illness. November 25, 2013
    This article draws on theories of social capital to understand ways in which the negotiation of professional boundaries among healthcare professionals relates to health services change. We compared reconfiguration of respiratory services in four primary care organisations (PCOs) in England and Wales. Service development was observed over 18 months during a period of market‐based reforms. Serial interviews with key clinicians and managers from hospital trusts and PCOs followed progress as they collaborated around, negotiated and contested developments. We found that professionals work to protect and expand their claims to work territory. Remuneration and influence was a catalyst for development and was also necessary to establish professional boundaries that underpinned novel service arrangements. Conflict and contest was less of a threat to change than a lack of engagement in boundary work because this engagement produced relationships based on forming shifting professional allegiances across and along boundaries, and these relationships mediated the social capital needed to accomplish change. However, this process also (re)produced inequalities among professions and prevented some groups from participation in service change.
    November 25, 2013   doi: 10.1111/1467-9566.12067   open full text
  • Infant mental health promotion and the discourse of risk.
    Angela Lawless, John Coveney, Colin MacDougall.
    Sociology of Health & Illness. November 25, 2013
    The field of infant mental health promotion has rapidly developed in academia, health policy and practice. Although there are roots in earlier childhood health and welfare movements, recent developments in infant mental health promotion are distinct and different. This article examines the development and practice of infant mental health promotion in South Australia. A regional, intersectoral forum with a focus on families and young children was used as a case study. In‐depth interviews with forum members were analysed using a governmentality lens. Participants identified a range of risks to the healthy development of the infant. The study suggests that the construction of risk acts as a technique of governing, providing the rationale for intervention for the child, the mother and the public's good. It places responsibility on parents to self‐govern. Although the influence of broader social contexts is acknowledged, the problematisation of mothering as risk shifts the focus to individual capacity, rather than encompassing the systems and social conditions that support healthy relationships. This research suggests that the representations of risk are a pervasive and potent influence that can act to undermine health promotion efforts that seek to empower and enable people to have more control over their own health.
    November 25, 2013   doi: 10.1111/1467-9566.12074   open full text
  • Caring for persons with schizophrenia at home: examining the link between family caregivers' role distress and quality of life.
    Stella Quah.
    Sociology of Health & Illness. November 25, 2013
    This article re‐examines the link between role distress and quality of life of family caregivers of a loved one with schizophrenia by exploring the impact of role overload (defined as spending 7 or more hours daily looking after the care recipient). Role theory and symbolic interactionism provide the conceptual background to this study. The research question is: under what conditions does role distress reduce quality of life? The answer helps us identify circumstances under which caregivers may be able to carry out their stressful caregiving role while minimising a decline in their quality of life. The data are from a purposive sample of 47 family caregivers in Singapore who were interviewed in person using a semi‐structured questionnaire. The data analysis includes non‐parametric tests, exploratory factor analysis and relative risks estimates. The findings show that the inverse association between role distress and quality of life found in most studies of family caregivers changes when hours of care are taken into consideration. While role distress is found among all family caregivers it only reduces the family caregiver's quality of life in situations of role overload. The implications for the situation of family caregivers are discussed.
    November 25, 2013   doi: 10.1111/1467-9566.12091   open full text
  • Therapeutic journeys: the hopeful travails of stem cell tourists.
    Alan Petersen, Kate Seear, Megan Munsie.
    Sociology of Health & Illness. November 25, 2013
    The recent growth of so‐called stem cell tourism reflects the high optimism that currently surrounds stem cell science. Stem cell treatments for various conditions are increasingly advertised over the Internet as being available at hospitals and clinics around the world. However, most are clinically unproven. Despite numerous warnings from scientists about the dangers posed by such treatments, many individuals are evidently prepared to take the risk, sometimes on more than one occasion. This article explores the dynamics of hope that underpin stem cell tourism. Drawing on ideas from the sociology of hope, as applied to biomedicine, the article explores how hope is constructed and shapes actions in relation to stem cell treatments. Making reference to the findings from an Australian study of patients and carers who travelled overseas to receive stem cell treatments, it is argued that hope has an ambiguous significance in the context of deregulated health care. As we explain, this has implications for patients' and carers' treatment decisions and experiences. The findings are discussed in light of current responses to stem cell tourism.
    November 25, 2013   doi: 10.1111/1467-9566.12092   open full text
  • ‘What help can you get talking to somebody?’ Explaining class differences in the use of talking treatments.
    Daniel Holman.
    Sociology of Health & Illness. November 06, 2013
    Talking treatments are underused in England by working‐class people: their higher rates of common mental disorders compared with their middle‐class counterparts are not matched by an increased use of these treatments. Given that, overall, talking treatments are effective in tackling depression and anxiety, understanding their underuse is important. Based upon semi‐structured interview data I argue that a framework centred on individuals' cultural dispositions towards treatment can help with this task. Following Bourdieu, such dispositions can be traced to social structural conditioning factors, together comprising the habitus. Four key dispositions emerge from the data: verbalisation and introspection, impetus for emotional health, relation to medical authority and practical orientation to the future. In turn, these dispositions are rooted in the material, health, occupational and educational characteristics of working‐class circumstances. Tracing these circumstances offers suggestions for increasing the use of this service.
    November 06, 2013   doi: 10.1111/1467-9566.12082   open full text
  • Frail bodies: geriatric medicine and the constitution of the fourth age.
    Susan Pickard.
    Sociology of Health & Illness. November 06, 2013
    Clinical discourses of frailty are central both to the construction of the social category of the fourth age and to the role and identity of hospital geriatric medicine. However, the influence of such clinical discourses is not just from science to the social sphere and nor do these discourses have their source in a putative truth of the old body but emerge from an interplay between physiological facts, discourses of governmentality, productive processes associated with late modern capitalism and the professional ambitions of geriatric medicine. The article explores this interplay in the two key discourses of frailty that have emerged in the clinical literature during the past 15 years, that of the phenotype and the accumulation of deficits, respectively. Outlining the development of the discourse of senescence from its origins to the more recent emergence of a nosological category of frailty the article explores how these key discourses capture the older body according to particular sets of norms. These norms link physiological understanding with broader discourses of governmentality, including the professional project of geriatric medicine. In particular, metaphorical representations in the discourses of frailty convey key cultural and clinical assumptions concerning both older bodies and old age more generally.
    November 06, 2013   doi: 10.1111/1467-9566.12084   open full text
  • Constructing notions of healthcare productivity: the call for a new professionalism?
    Fiona Moffatt, Paul Martin, Stephen Timmons.
    Sociology of Health & Illness. November 06, 2013
    Improving performance is an imperative for most healthcare systems in industrialised countries. This article considers one such system, the UK's National Health Service (NHS). Recent NHS reforms and strategies have advocated improved healthcare productivity as a fundamental objective of policy and professional work. This article explores the construction of productivity in contemporary NHS discourse, analysing it via the Foucauldian concept of governmentality. In this manner it is possible to investigate claims that the commodification of health work constitutes a threat to autonomy, and counter that with an alternative view from a perspective of neoliberal self‐governance. Contemporary policy documents pertaining to NHS productivity were analysed using discourse analysis to examine the way in which productivity was framed and how responsibility for inefficient resource use, and possible solutions, were constructed. Data reveals the notion of productivity as problematic, with professionals as key protagonists. A common narrative identifies traditional NHS command/control principles as having failed to engage professionals or having been actively obstructed by them. In contrast, new productivity narratives are framed as direct appeals to professionalism. These new narratives do not support deprofessionalisation, but rather reconstruct responsibilities, what might be called ‘new professionalism’, in which productivity is identified as an individualised professional duty.
    November 06, 2013   doi: 10.1111/1467-9566.12093   open full text
  • Careful science? Bodywork and care practices in randomised clinical trials.
    Astrid P. Jespersen, Julie Bønnelycke, Hanne H. Eriksen.
    Sociology of Health & Illness. November 06, 2013
    Concern about obesity has prompted numerous public health campaigns that urge people to be more physically active. The campaigns often include normative statements and attempt to impose restrictions on individuals' lives without considering the complexities of daily life. We suggest that broadening the focus to reflect everyday practices would foster better targeted public health campaigns. This article is based on our participation in FINE, a multidisciplinary Danish research project. The core methodology of FINE was a randomised controlled trial in which 61 moderately overweight men were put into different exercise groups. In this article we analyse the scientific work of the trial as representing entangled processes of bodywork, where data are extracted and objectified bodies are manipulated and care practices address the emotional, social and mundane aspects of the participants' everyday lives. Care practices are an inherent part of producing scientific facts but they are removed from the recognised results of scientific practice and thus from common public health recommendations. However, knowledge about the strategic use of care practices in lifestyle interventions is important for public health initiatives and future efforts should incorporate this aspect.
    November 06, 2013   doi: 10.1111/1467-9566.12094   open full text
  • Embodiment without bodies? Analysis of embodiment in US‐based pro‐breastfeeding and anti‐male circumcision movements.
    Harmony D. Newman, Laura M. Carpenter.
    Sociology of Health & Illness. November 05, 2013
    This article uses the cases of pro‐breastfeeding and anti‐circumcision activism to complicate the prevailing conceptualisation of embodiment in research on embodied health movements (EHMs). Whereas most EHM activists draw on their own bodily experiences, in the breastfeeding and circumcision movements, embodiment by proxy is common. Activists use embodiment as a strategy but draw on physical sensations that they imagine for other people's bodies, rather than on those they experience themselves. Pro‐breastfeeding activists, who seldom disclose whether they were themselves breastfed, target mothers, encouraging them to breastfeed rather than to formula feed their children in order to reduce their child's risk of disease. Anti‐circumcision activists, only some of whom are circumcised men, urge parents to leave their sons' penises intact in order to avoid illness and disfigurement and to preserve the sons' rights to make their own informed decisions as adults. In both movements activists use embodiment as a persuasive strategy even though they themselves do not necessarily embody the risks of the negative health outcomes with which they are concerned. Future research on EHMs should reconceptualise EHMs to include embodiment by proxy and examine whether this important phenomenon systematically affects movement strategies and outcomes.
    November 05, 2013   doi: 10.1111/1467-9566.12095   open full text
  • Hospital consultations and jurisdiction over patients: consequences for the medical profession.
    Hyeyoung Oh.
    Sociology of Health & Illness. October 28, 2013
    Advances in biomedical technologies and the increased specialisation of the medical profession have made collaborations among specialty physicians integral to care delivery. As physicians increasingly must share patients, how does this shape the jurisdiction that physicians hold? The sociological literature has extensively documented inter‐professional jurisdictional claims and conflicts to maintain the professional power of physicians in relation to allied occupational groups. However, less is known of intra‐professional avoidance and resolution of conflict over jurisdiction. This case study considers how jurisdictions are shared, maintained and challenged in a single profession. Drawing from ethnographic and interview data collected from September 2010 to October 2012 on the internal medicine service of a teaching hospital in the USA, I demonstrate the variation in jurisdictional conflicts that emerge between internal medicine and other specialties during the consultation process. Ignoring shared jurisdictions and refusing to accept jurisdiction of patients generate disputes among the principal medical and specialist teams. These disputes ensue due to blurred boundaries dividing the various specialties. To avoid conflicts, internal medicine physicians adopt strategies behind the scenes to facilitate smooth consultations.
    October 28, 2013   doi: 10.1111/1467-9566.12087   open full text
  • ‘Your whole life is lived through your teeth’: biographical disruption and experiences of tooth loss and replacement.
    Nikki Rousseau, Jimmy Steele, Carl May, Catherine Exley.
    Sociology of Health & Illness. October 28, 2013
    The experience and meaning of tooth loss and replacement has varied historically and culturally but has received relatively little attention from social scientists. Our study set out to understand these experiences in the context of the arrival of newer, dental implant treatments. Semi‐structured qualitative interviews were carried out with 39 men and women who had experienced tooth loss and replacement. A thematic analysis was sensitised by previous sociological work on chronic illness, particularly Bury's notion of biographical disruption. We found that while for some individuals the loss of a tooth was relatively insignificant, for others it was devastating and disruptive. In seeking to understand this difference, the concept of biographical disruption was a helpful analytical tool. Our analysis identified two forms of disruption. The first related to the meanings of tooth loss (the neglected mouth) and denture wearing (a marker of old age). The second, embodied, disruption concerned the relationship between the self and mouth in those wearing dentures (the invaded, unreliable mouth) and could occur even where tooth loss and denture wearing had been biographically anticipated.
    October 28, 2013   doi: 10.1111/1467-9566.12080   open full text
  • Diagnostic diversity: The role of social class in diagnostic experiences of infertility.
    Ann V. Bell.
    Sociology of Health & Illness. October 22, 2013
    Research in the area of the sociology of diagnosis has recently expanded. Despite this development, the foundations of the social aspects of diagnoses, including race, class and gender, are relatively unexplored. Understanding such diversity is important, however, as researchers have shown that diagnoses have significant repercussions on the illness experience. This article is an effort to overcome this gap in the literature by examining class diversity in interpretations and understandings of diagnoses. Using the medicalised condition of infertility as a case example of class differences around diagnoses, I conducted 58 in‐depth interviews with infertile women of various class backgrounds in the USA. By comparing the lived experiences of infertility between higher and lower class women, I explore differences in the understanding, interpretation and outcomes of diagnoses, specifically. Furthermore, among lower class women, I examine how they understand infertility outside the medical diagnostic framework. The findings reveal how interpretations and experiences of diagnoses vary depending on an individual's social location. In other words, the study demonstrates that class matters in terms of diagnoses and their understanding.
    October 22, 2013   doi: 10.1111/1467-9566.12083   open full text
  • Practical compassions: repertoires of practice and compassion talk in acute mental healthcare.
    Brian Brown, Paul Crawford, Paul Gilbert, Jean Gilbert, Corinne Gale.
    Sociology of Health & Illness. October 11, 2013
    This article reports an exploratory study of the concept of compassion in the work of 20 mental health practitioners in a UK Midlands facility. Using notions of practice derived from phenomenology and Bourdieusian sociology and notions of emotional labour we identify two contrasting interpretive repertoires in discussions of compassion. The first, the practical compassion repertoire, evokes the practical, physical and bodily aspects of compassion. It involves organising being with patients, playing games, anticipating disruption and taking them outside for cigarettes. Practitioners described being aware that these practical, bodily activities could lead to patients ‘opening up’, disclosing their interior concerns and enabling practical, compassionate mental health work to take place. In contrast, the second, organisational repertoire, concerns organisational constraints on compassionate practice. The shortage of staff, the record‐keeping and internal processes of quality control were seen as time‐greedy and apt to detract from contact with patients. The findings are discussed in relation to Bourdieu and Merleau‐Ponty's phenomenological accounts of practice and habit and set in context in the growing interest in placing compassion centrally in healthcare. We also explore how the exercise of compassion in the way our participants describe it can afford the more effective exercise of medical power.
    October 11, 2013   doi: 10.1111/1467-9566.12065   open full text
  • Knowledge is power? The role of experiential knowledge in genetically ‘risky’ reproductive decisions.
    Felicity K. Boardman.
    Sociology of Health & Illness. September 23, 2013
    Knowledge of the condition being tested for is increasingly acknowledged as an important factor in prenatal testing and screening decisions. An analysis of the way in which family members living with an inheritable condition use and value this knowledge has much to add to debates about whether and how this type of knowledge could be made available to prospective parents facing screening decisions. This article reports on in‐depth interviews (conducted between 2007 and 2009) with 61 people with a genetic condition, spinal muscular atrophy (SMA) in their family. Many participants reported that their intimate familial knowledge of SMA offered them valuable insights with which they could imagine future lives. Other participants, however, found themselves trapped between their experiential knowledge of SMA and their (often) competing responsibility to maintain the wellbeing of their family. Still, others established a hierarchy of knowledge to rank the authenticity of different family member's accounts of SMA in order to discredit or justify their decisions. This article highlights the way in which experiential knowledge of the condition being tested for cannot be unproblematically assumed to be a useful resource in the context of prenatal testing decisions and may actually constrain reproductive decisions.
    September 23, 2013   doi: 10.1111/1467-9566.12048   open full text
  • Work–family conflict, health services and medication use among dual‐income couples in Europe.
    Wendy Christiaens, Piet Bracke.
    Sociology of Health & Illness. September 23, 2013
    Combination pressure or work–life imbalance is linked to adverse health. However, it remains unclear how work–family conflict is related to healthcare utilisation. Does work–family conflict function as a barrier or as a facilitator in relation to the use of health services and prescription medication? Lack of time may prevent people from visiting a doctor when they feel unwell. However, combination pressure can also be expected to intensify the use of health services, as the need for a quick fix is prioritised. Further, do women and men differ in their susceptibility to medicalisation and time pressure resulting from work–life imbalance? This article investigates the use of health services and prescription medication of dual‐income couples with children, based on data from 23 countries in the European Social Survey round 2 (Nwomen = 3755; Nmen = 3142). It was found that medical services and prescription medications are used more frequently in dual‐income couples experiencing work‐to‐family spillover, but for women only this is irrespective of their self‐reported health. Family‐to‐work spillover does not result in increased health service or medication use for either men or women. While women opt for a medical response to work–life imbalance, men's reluctance to seek formal health support is confirmed.
    September 23, 2013   doi: 10.1111/1467-9566.12049   open full text
  • Defining an epidemic: the body mass index in British and US obesity research 1960–2000.
    Isabel Fletcher.
    Sociology of Health & Illness. September 23, 2013
    Between the 1970s and the mid‐1990s the body mass index (BMI) became the standard means of assessing obesity both in populations and in individuals, replacing previously diverse and contested definitions of excess body weight. This article draws on theoretical approaches from the sociology of standards and science and technology studies to describe the development of this important new standard and the ways in which its adoption facilitated the development of obesity science, that is, knowledge about the causes, health effects and treatments of excess body weight. Using an analysis of policy and healthcare literatures, I argue that the adoption of the BMI, along with associated standard cut‐off points defining overweight and obesity, was crucial in the framing of obesity as an epidemic. This is because, I suggest, these measures enabled, firstly, the creation of large data sets tracking population‐level changes in average body weight, and, secondly, the construction of visual representations of these changes. The production of these two new techniques of representation made it possible for researchers in this field, and others such as policymakers, to argue credibly that obesity should be described as an epidemic.
    September 23, 2013   doi: 10.1111/1467-9566.12050   open full text
  • The genesis of collective health in Brazil.
    Ligia Maria Vieira‐da‐Silva, Patrice Pinell.
    Sociology of Health & Illness. September 23, 2013
    During the 1970s in Brazil a social space directed towards health problems on the population level, called collective health, was created and institutionalised. To what extent did this Brazilian invention correspond to a specific socio‐historical practice? The works published on this topic have considered social medicine as a homogeneous phenomenon without empirically studying the specificities of national experiences. To bridge this gap, a historical study on the genesis of collective health in Brazil was carried out based on Bourdieu's field theory. The interaction between the paths of the founders and the conditions of historical possibilities were researched through documentary and bibliographical sources, as well as through in‐depth interviews of the founders. This social space originated from a meeting of agents with different social backgrounds but who interconnected, creating a structure that was independent of each agent considered individually. One of the components of this establishment was the joining of theoretical production and the implementation of health reforms that resulted in the organisation of a universal health system. This study attempts to show how the international political situation and the contradictions of the national crisis created a universe of possibilities, allowing for the genesis of this sui generis space in Brazil.
    September 23, 2013   doi: 10.1111/1467-9566.12069   open full text
  • Decision‐making and accountability: differences of distribution.
    Dawn Goodwin.
    Sociology of Health & Illness. September 20, 2013
    The cognitive and individual framing of clinical decision‐making has been undermined in the social sciences by attempts to reframe decision‐making as being distributed. In various ways, shifts in understanding in social science research and theorising have wrested clinical decision‐making away from the exclusive domain of medical practice and shared it throughout the healthcare disciplines. The temporality of decision‐making has been stretched from discrete moments of cognition to being incrementally built over many instances of time and place, and the contributors towards decision‐making have been expanded to include non‐humans such as policies, guidelines and technologies. However, frameworks of accountability fail to recognise this distributedness and instead emphasise independence of thought and autonomy of action. In this article I illustrate this disparity by contrasting my ethnographic accounts of clinical practice with the professional codes of practice produced by the General Medical Council and the Nursing and Midwifery Council. I argue that a ‘thicker’ concept of accountability is needed; one that can accommodate the diffuseness of decision‐making and the dependencies incurred in collaborative work.
    September 20, 2013   doi: 10.1111/1467-9566.12042   open full text
  • Complexities and contingencies conceptualised: towards a model of reproductive navigation.
    Erica Sijpt.
    Sociology of Health & Illness. September 20, 2013
    Current international attention to reproductive health behaviour is inspired by a western celebration of individual rights, autonomous action and rational choice. A predominant idea is that individuals should be free to act in accordance with their reproductive intentions and that, in doing so, they will attain their desired (and quantifiable) fertility outcomes. Yet such a framework leads to a misrepresentation of the reproductive dynamics on the ground, because individual fertility intentions are often not a priori defined, decisions are often not the result of rational calculation and reproductive happenings do not exist in a social vacuum. This article provides sociocultural evidence for a different conceptualisation of reproductive health behaviour. On the basis of long‐term anthropological fieldwork in the East Province of Cameroon, I will analyse the complexities of fertility‐related decision‐making. Two case studies from the field will show that reproductive happenings are often characterised by indeterminacy and contingency. In order to understand the complex ways in which women give direction to these uncertainties, I propose an encompassing framework of reproductive navigation that explicitly acknowledges the influence of sociality and corporeality on fertility aspirations and actions.
    September 20, 2013   doi: 10.1111/1467-9566.12064   open full text
  • Thinking about think tanks in health care: a call for a new research agenda.
    Sara E Shaw, Jill Russell, Trisha Greenhalgh, Maja Korica.
    Sociology of Health & Illness. September 20, 2013
    Little sociological attention has been given to the role of think tanks in health policy and planning. Existing work in political science and public administration tends to define and categorise think tanks and situate them as a disinterested source of policy expertise. Despite the increasingly visible presence of think tanks in the world of health care, such work has done little to reveal how they operate, by whom and to what ends. Our article seeks to redress this firstly by examining why they have remained relatively hidden in academic analyses and secondly by advocating an interpretive approach that incorporates think tanks within the wider landscape of health policy and planning. In contrast to most existing literature, an interpretive approach acknowledges that much of the messy business of healthcare policy and planning remains hidden from view and that much can be gleaned by examining the range of organisations, actors, coalitions, everyday activities, artefacts and interactions that make up the think tank stage and that work together to shape health policy and planning. Given the paucity of research in this area, we urge the medical sociology community to open the field to further academic scrutiny.
    September 20, 2013   doi: 10.1111/1467-9566.12071   open full text
  • ‘Why must I wait?’ The performance of legitimacy in a hospital emergency department.
    Alexandra Hillman.
    Sociology of Health & Illness. September 20, 2013
    This article examines the processes of negotiation that occur between patients and medical staff over accessing emergency medical resources. The field extracts are drawn from an ethnographic study of a UK emergency department (ED) in a large, inner city teaching hospital. The article focuses on the triage system for patient prioritisation as the first point of access to the ED. The processes of categorising patients for priority of treatment and care provide staff with the opportunities to maintain control over what defines the ED as a service, as types of work and as particular kinds of patients. Patients and relatives are implicated in this categorical work in the course of interactions with staff as they provide reasons and justifications for their attendance. Their success in legitimising their claim to treatment depends upon self‐presentation and identity work that (re)produces individual responsibility as a dominant moral order. The extent to which people attending the ED can successfully perform as legitimate is shown to contribute to their placement into positive or negative staff‐constituted patient categories, thus shaping their access to the resources of emergency medicine and their experience of care.
    September 20, 2013   doi: 10.1111/1467-9566.12072   open full text
  • Kinscapes, timescapes and genescapes: families living with genetic risk.
    Paul Atkinson, Katie Featherstone, Maggie Gregory.
    Sociology of Health & Illness. August 20, 2013
    This article synthesises recent research examining how families live with genetic risk and the processes of genetic decision‐making and disclosure among family members who have been or are at risk of transmitting a familial genetic condition. Its aim is to generate substantive theory that can inform our understanding of the interactional processes at work in the distribution of mutual knowledge and awareness of genetic risk in families. The article is structured around three interrelated concepts. Kinscape refers to the constellation of relations and relatedness that are recognised practically; timescape to the multiple temporal frames of social relations and their transformation and genescape to the constellation of knowledge, belief and practice surrounding genetic inheritance. All three concepts are simultaneously natural and cultural. Their intersections create the conditions of kinship and genetics.
    August 20, 2013   doi: 10.1111/1467-9566.12034   open full text
  • Dialectics of gender and health: the case of HIV serodiscordance.
    Robert Wyrod.
    Sociology of Health & Illness. August 20, 2013
    The relationship between gender and health is a deeply interdependent one. Yet research in this area has focused primarily on how gender relations determine health behaviour and health outcomes. This article advocates a more holistic approach that conceptualises gender and health as fully intertwined and mutually constitutive. This interplay is explored through the case of HIV serodiscordance in which one person in a relationship is HIV positive and the other HIV negative. Drawing on in‐depth research with discordant couples in urban Uganda, this study indicates that living with discordance can both reinforce and challenge normative gender power dynamics in relationships. This study, therefore, illustrates how significant health problems can influence gender relations. As such, it reveals the dialectical relationship between gender and health and also provides important insights for HIV prevention in the new era of antiretroviral treatment as prevention.
    August 20, 2013   doi: 10.1111/1467-9566.12038   open full text
  • Men managing cancer: a gender analysis.
    Lisa M. Wenger, John L. Oliffe.
    Sociology of Health & Illness. August 20, 2013
    As researchers consider gendered patterns in men's prostate cancer experiences, little attention has been devoted to how men manage ‘cancer’, more generally. Drawing on the experiences of 30 Canadian men with a variety of cancer types, this article details how men engaged illness self‐management and help‐seeking activities with lay and professional support persons. Results indicate three broad responsive strategies: fortifying resources, maintaining the familiar, and getting through. In these pursuits, the participants drew on a variety of performances to respond to social contexts demanding that men embody masculine ideals including strength, control, and stoicism. Considering gendered dynamics in how men manage the challenges of cancer, this article broadens understandings about men's cancer experiences by highlighting the drivers orienting participants' responsive efforts and challenging assumptions of help‐seeking as essentially problematic for men in Western society.
    August 20, 2013   doi: 10.1111/1467-9566.12045   open full text
  • Managing sleep and wakefulness in a 24‐hour world.
    Catherine M. Coveney.
    Sociology of Health & Illness. August 20, 2013
    This article contributes to literature on the sociology of sleep by exploring the sleeping practices and subjective sleep experiences of two social groups: shift workers and students. It draws on data, collected in the UK from 25 semi‐structured interviews, to discuss the complex ways in which working patterns and social activities impact upon experiences and expectations of sleep in our wired awake world. The data show that, typically, sleep is valued and considered to be important for health, general wellbeing, appearance and physical and cognitive functioning. However, sleep time is often cut back on in favour of work demands and social activities. While shift workers described their efforts to fit in an adequate amount of sleep per 24‐hour period, for students, the adoption of a flexible sleep routine was thought to be favourable for maintaining a work–social life balance. Collectively, respondents reported using a wide range of strategies, techniques, technologies and practices to encourage, overcome or delay sleep(iness) and boost, promote or enhance wakefulness/alertness at socially desirable times. The analysis demonstrates how social context impacts not only on how we come to think about sleep and understand it, but also how we manage or self‐regulate our sleeping patterns.
    August 20, 2013   doi: 10.1111/1467-9566.12046   open full text
  • ‘We had to do what we thought was right at the time’: retrospective discourse on the 2009 H1N1 pandemic in the UK.
    Mark Davis, Paul Flowers, Niamh Stephenson.
    Sociology of Health & Illness. August 20, 2013
    For a few weeks in 2009 it was not certain whether the world faced a lethal influenza pandemic. As it turned out, the H1N1 pandemic was less severe than anticipated, though the infection did affect groups not usually susceptible to influenza. The deep uncertainties of this pandemic moment were associated with immense practical, scientific and political challenges for public health agencies around the world. We examine these challenges by drawing on the sociology of uncertainty to analyse the accounts given by UK public health practitioners who managed local responses to the pandemic. We discuss the retrospective and mitigating discourse; ‘we had to do what we thought was right at the time’, used by interviewees to explain their experience of articulating plans for a severe pandemic influenza with one that turned out to be mild. We explore the importance of influenza's history and imagined future for pandemic management and, relatedly, how pandemic response and control plans disrupted the normal ways in which public health exercises its authority. We conclude by suggesting that difficulties in the management of pandemic influenza lie in its particular articulation of precautions, that is, securing a safe future against that which cannot be predicted.
    August 20, 2013   doi: 10.1111/1467-9566.12056   open full text
  • Descriptions of euthanasia as social representations: comparing the views of Finnish physicians and religious professionals.
    Leila Jylhänkangas, Tinne Smets, Joachim Cohen, Terhi Utriainen, Luc Deliens.
    Sociology of Health & Illness. August 20, 2013
    In many western societies health professionals play a powerful role in people's experiences of dying. Religious professionals, such as pastors, are also confronted with the issues surrounding death and dying in their work. It is therefore reasonable to assume that the ways in which death‐related topics, such as euthanasia, are constructed in a given culture are affected by the views of these professionals. This qualitative study addresses the ways in which Finnish physicians and religious professionals perceive and describe euthanasia and conceptualises these descriptions and views as social representations. Almost all the physicians interviewed saw that euthanasia does not fit the role of a physician and anchored it to different kinds of risks such as the slippery slope. Most of the religious and world‐view professionals also rejected euthanasia. In this group, euthanasia was rejected on the basis of a religious moral code that forbids killing. Only one of the religious professionals ‐ the freethinker with an atheist world‐view ‐ accepted euthanasia and described it as a personal choice, as did the one physician interviewed who accepted it. The article shows how the social representations of euthanasia are used to protect professional identities and to justify their expert knowledge of death and dying.
    August 20, 2013   doi: 10.1111/1467-9566.12057   open full text
  • Chronic illness: a revisionist account.
    David Armstrong.
    Sociology of Health & Illness. August 05, 2013
    This article challenges the generally accepted thesis that the emergence and dominance of chronic illness over the last half century is due to the receding tide of acute infectious diseases and an ageing population. Instead, through an analysis of contemporary reports in the Journal of the American Medical Association, it is argued that the construct of chronic illness emerged as part of a new focus on the downstream consequences of disease and as a means of transferring what had been seen as the natural processes of ageing and senescence into an explanatory model based on pathological processes. The widely accepted idea of an epidemiological transition in illness prevalence has served to conceal the ways in which medicine has extended its remit and suppressed alternative explanatory frameworks.
    August 05, 2013   doi: 10.1111/1467-9566.12037   open full text
  • Home as a hybrid centre of medication practice.
    Kevin Dew, Kerry Chamberlain, Darrin Hodgetts, Pauline Norris, Alan Radley, Jonathan Gabe.
    Sociology of Health & Illness. August 05, 2013
    This article presents research that explores how medications are understood and used by people in everyday life. An intensive process of data collection from 55 households was used in this research, which included photo‐elicitation and diary‐elicitation interviews. It is argued that households are at the very centre of complex networks of therapeutic advice and practice and can usefully be seen as hybrid centres of medication practice, where a plethora of available medications is assimilated and different forms of knowledge and expertise are made sense of. Dominant therapeutic frameworks are tactically manipulated in households in order for medication practices to align with the understandings, resources and practicalities of households. Understanding the home as a centre of medication practice decentralises the role of health advisors (whether mainstream or alternative) in wellness practices.
    August 05, 2013   doi: 10.1111/1467-9566.12041   open full text
  • Overeducation and depressive symptoms: diminishing mental health returns to education.
    Piet Bracke, Elise Pattyn, Olaf dem Knesebeck.
    Sociology of Health & Illness. August 05, 2013
    In general, well‐educated people enjoy better mental health than those with less education. As a result, some wonder whether there are limits to the mental health benefits of education. Inspired by the literature on the expansion of tertiary education, this article explores marginal mental health returns to education and studies the mental health status of overeducated people. To enhance the validity of the findings we use two indicators of educational attainment – years of education and ISCED97 categories – and two objective indicators of overeducation (the realised matches method and the job analyst method) in a sample of the working population of 25 European countries (unweighted sample N = 19,089). Depression is measured using an eight‐item version of the CES‐D scale. We find diminishing mental health returns to education. In addition, overeducated people report more depression symptoms. Both findings hold irrespective of the indicators used. The results must be interpreted in the light of the enduring expansion of education, as our findings show that the discussion of the relevance of the human capital perspective, and the diploma disease view on the relationship between education and modern society, is not obsolete.
    August 05, 2013   doi: 10.1111/1467-9566.12039   open full text
  • Negotiating access to medical treatment and the making of patient citizenship: the case of hepatitis C treatment.
    Tim Rhodes, Magdalena Harris, Anthea Martin.
    Sociology of Health & Illness. May 24, 2013
    Drawing on qualitative interview accounts with people who have injected drugs, we deploy ideas of biological and therapeutic citizenship to explore how the negotiation of access to hepatitis C treatment enacts patient citizenship potential. We find that the patient citizenship made through hepatitis C treatment divides those who are deserving from those who are not, largely in relation to their presentations of self‐control, responsibility and recovery regarding drug use. Accessing treatment requires that patients negotiate their entitlement by reflexively producing the patient citizen role expected of them. In this context of rationed treatment expectation, access to treatment is constructed in relation to gratitude rather than entitlement. Rationed treatment expectation also interplays with a utilitarian approach to hepatitis C expertise. Accounts of the bio‐effects of hepatitis C and its treatment as uncertain further weaken the potential for shared illness identity and biosocial membership as well as contributing to treatment delay. We conclude that the construction of hepatitis C treatment as a negotiation of ‘recovery towards normality’ positions people who continue to use or inject drugs as beyond patient citizenship. Our findings underscore the situated limits of therapeutic and biological citizenship, emphasising that these processes are unavoidably forces of governance.
    May 24, 2013   doi: 10.1111/1467-9566.12018   open full text
  • Time and its uses in accounts of conditional discharge in forensic psychiatry.
    Michael Coffey.
    Sociology of Health & Illness. April 18, 2013
    Time is a recurring feature of storied accounts of health and social care. This article addresses the use of time in accounts of conditionally discharged patients and workers in forensic psychiatry. This study contributes new knowledge about time and its uses by a seldom heard group. An analysis of time‐relevant discourse taken from 59 in‐depth interviews with patients and their workers is provided to show regularities and discontinuities in schedules of post‐discharge supervision in community living. Regularities included timed phases for achieving discretionary permission for greater liberty from services. Discontinuities indicate mismatches between hospital and community time and patient and professional time. Benchmarking by patients is an important resource and allows comparisons and measurements of stages in the discharge process. The discharged patients showed awareness of deviance and implicated time as an important resource in claiming ordinary identities. The participants produced progressive stories to show their incremental movement towards recovery and, ultimately, establish their non‐deviant identities. The workers use time as just one part of a complex display of professional judgement of continued risk status. Fixed periods of elapsed time are necessary but not sufficient criteria for workers to reduce surveillance. Time remains a useful resource for patients to chart their way towards more routine identities.
    April 18, 2013   doi: 10.1111/1467-9566.12036   open full text
  • ‘If you feel that nobody wants you you'll withdraw into your own’: Gypsies/Travellers, networks and healthcare utilisation.
    David Smith, Annmarie Ruston.
    Sociology of Health & Illness. April 10, 2013
    Gypsies and Travellers are the unhealthiest group in British society, suffering from higher levels of physical and mental illness, lower life expectancy and with low levels of healthcare utilisation. They also continue to experience the highest level of prejudice and discrimination in society. While studies indicate that social networks play an important role in shaping health beliefs and the response to symptoms, evidence on the influence of networks on health is unclear and contradictory. This article draws on social network theory and research into the relation between discrimination and health to critically examine how networks mediate between collective experiences of racism and health‐related behavior. Qualitative interviews with 39 adult Gypsies and Travellers were conducted in the South‐East of England to explore the wider structural and institutional context and the influence those contexts play in shaping health beliefs and decisions whether to access formal health services. The findings indicate that the influence networks play in shaping health behaviour is dependent on the particular social context of the group and its status in relation to wider social structures, making generalization problematic.
    April 10, 2013   doi: 10.1111/1467-9566.12029   open full text
  • Negotiating identity at the intersection of paediatric and genetic medicine: the parent as facilitator, narrator and patient.
    Rebecca Dimond.
    Sociology of Health & Illness. April 10, 2013
    This article identifies a significant transformation in the role and identity of parents accompanying their child to clinic. This shift is a product of the intersection between paediatric and genetic medicine, where parents play a critical role in providing information about their child, family and ultimately, about themselves. To provide a context for this matrix, two broad areas of sociological inquiry are highlighted. The first is explanations of the role a parent plays in paediatric medicine and the second is the diagnostic process in paediatric genetics and the implications for parent and child identities. Drawing from an ethnographic study of clinical consultations, attention is paid to the changing role of parenthood and the extended role of patienthood in paediatric genetic medicine.
    April 10, 2013   doi: 10.1111/1467-9566.12035   open full text
  • Undoing gender? The case of complementary and alternative medicine.
    Joslyn Brenton, Sinikka Elliott.
    Sociology of Health & Illness. April 10, 2013
    Despite a rich body of sociological research that examines the relationship between gender and health, scholars have paid little attention to the case of complementary and alternative medicine (CAM). One recent study (Sointu 2011) posits that men and women who use CAM challenge traditional ascriptions of femininity and masculinity through the exploration of self‐care and emotions, respectively. Drawing on 25 in‐depth interviews with middle‐class Americans who use CAM, this article instead finds that men and women interpret their CAM use in ways that reproduce traditional gendered identities. Men frame their CAM use in terms of science and rationality, while simultaneously distancing themselves from feminine‐coded components of CAM, such as emotions. Women seek CAM for problems such as abusive relationships, low self‐esteem, and body image concerns, and frame their CAM use as a quest for self‐reinvention that largely reflects and reproduces conventional femininity. Further, the reproduction of gendered identities is shaped by the participants' embrace of neoliberal tenets, such as the cultivation of personal control. This article contributes to ongoing theoretical debates about the doing, redoing and undoing of gender, as well as the literature on health and gender.
    April 10, 2013   doi: 10.1111/1467-9566.12043   open full text
  • ‘I'm just a walking eating disorder’: the mobilisation and construction of a collective illness identity in eating disorder support groups.
    Jessica Powers Koski.
    Sociology of Health & Illness. April 10, 2013
    The increasing visibility of support groups has prompted a flurry of sociological investigation, much of which explores how groups benefit participants. What researchers have failed to consider is the group itself. Bringing social movement theory to bear on the case of eating disorder support groups, this study seeks to explore how support groups attract and sustain adequate participation. Participant observation in an eating disorder support group reveals that broad diagnostic and prognostic frames, coupled with strong motivational framing and collective identification on the basis of a shared disordered self, promote support group participation. The very processes that enable support groups' successful mobilisation, however, simultaneously construct a collective illness identity, which in turn serves as the basis for participants' individual‐level identity work. More specifically, support group mobilisation processes construct eating disorders as highly consequential, highly symptomatic, chronic, rooted in the self, and uncontrollable. Such findings suggest that support groups may have unanticipated and potentially adverse consequences for participants and thus build on previous work highlighting the unintended health consequences of framing processes. Such findings further contribute to our understanding of how macro‐social forces shape illness experience.
    April 10, 2013   doi: 10.1111/1467-9566.12044   open full text
  • The family meal panacea: exploring how different aspects of family meal occurrence, meal habits and meal enjoyment relate to young children’s diets.
    Valeria Skafida.
    Sociology of Health & Illness. April 02, 2013
    The general consensus in the research to date is that family meals are linked to healthier eating habits in children, compared to not eating with the family. Yet, few studies explore what it is about commensality which leads to better food choices among children. Using a representative Scottish sample of five‐year‐old children, this research explores the extent to which family meal occurrence, meal patterns regarding where, when and with whom children eat and perceived meal enjoyment predict the quality of children’s diets after controlling for indicators of maternal capital that influence both meal rituals and taste preferences. Eating the same food as parents is the aspect of family meals most strongly linked to better diets in children, highlighting the detrimental effect in the rise of ‘children’s food’. Although theoretical and empirical work pointed to the important health advantage in children eating together with parents, the results suggested that eating together was a far less important aspect of family meals. In evaluating the importance of the family meal, this article redirects attention away from issues of form and function towards issues of food choice. Policy implications and the importance for public health to recognise the way eating habits are defined by and reproduce social and cultural capital are discussed.
    April 02, 2013   doi: 10.1111/1467-9566.12007   open full text
  • Biographical value: towards a conceptualisation of the commodification of illness narratives in contemporary healthcare.
    Fadhila Mazanderani, Louise Locock, John Powell.
    Sociology of Health & Illness. April 02, 2013
    Illness narratives play a central role in social studies of health and illness, serving as both a key theoretical focus and a popular research method. Despite this, relatively little work has gone into conceptualising how and why illness narratives – be they in books, websites, television or other media – are commodified in contemporary healthcare and its social environment; namely, how distinctive forms of value are generated in the production, circulation, use and exchange of illness narratives. In this article we propose the notion of biographical value as a first step towards conceptualising the values attributed to illness narratives in this context. Based on a secondary analysis of 37 interviews with people affected by 15 different health conditions in the UK (all of whom have shared their illness experiences across various media) and drawing on understandings of value in research on the bioeconomy and the concept of biovalue in particular, we sketch out how epistemic, ethical and economic forms of value converge and co‐constitute each other in the notion of biographical value and in broader economies of illness experiences.
    April 02, 2013   doi: 10.1111/1467-9566.12001   open full text
  • Initiating decision‐making in neurology consultations: ‘recommending’ versus ‘option‐listing’ and the implications for medical authority.
    Merran Toerien, Rebecca Shaw, Markus Reuber.
    Sociology of Health & Illness. April 02, 2013
    This article compares two practices for initiating treatment decision‐making, evident in audio‐recorded consultations between a neurologist and 13 patients in two hospital clinics in the UK. We call these ‘recommending’ and ‘option‐listing’. The former entails making a proposal to do something; the latter entails the construction of a list of options. Using conversation analysis (CA), we illustrate each, showing that the distinction between these two practices matters to participants. Our analysis centres on two distinctions between the practices: epistemic differences and differences in the slots each creates for the patient’s response. Considering the implications of our findings for understanding medical authority, we argue that option‐listing – relative to recommending – is a practice whereby clinicians work to relinquish a little of their authority. This article contributes, then, to a growing body of CA work that offers a more nuanced, tempered account of medical authority than is typically portrayed in the sociological literature. We argue that future CA studies should map out the range of ways – in addition to recommending – in which treatment decision‐making is initiated by clinicians. This will allow for further evidence‐based contributions to debates on the related concepts of patient participation, choice, shared decision‐making and medical authority.
    April 02, 2013   doi: 10.1111/1467-9566.12000   open full text
  • The innovation journey of genomics and asthma research.
    Lise Bitsch, Dirk Stemerding.
    Sociology of Health & Illness. April 02, 2013
    This article concerns the transformative potential of medical genomics for common disease research. We analysed 13 review articles in asthma research in the period 1999 to 2008. Our aim was to understand how genomics has emerged in this research field, and the attendant changes. Motivated by Lippman’s geneticisation thesis, we use the concept of an ‘innovation journey’ to trace how expectations of improved understanding, prevention, diagnosis and treatment structure a dynamic co‐evolutionary process through which a genome‐based discourse emerges. We show how the asthma researchers involved continuously struggle to define their contribution to asthma research, as well as to clinical practice. Along the way, the researchers propose changes to both the definition and the aetiological model of asthma, thus highlighting gene–gene and gene–environment interactions. It is, however, difficult to characterise this discourse as one of geneticisation. With increasing attention being given to epigenetics, metabolomics, proteomics and systems biology, the emerging picture suggests an important, but much less deterministic, role for genes.
    April 02, 2013   doi: 10.1111/1467-9566.12028   open full text
  • Identity and stammering: negotiating hesitation, side‐stepping repetition, and sometimes avoiding deviation.
    Clare Butler.
    Sociology of Health & Illness. April 02, 2013
    Individuals who experience speech dysfluency are often stigmatised because their speech acts differ from the communicative norm. This article is located in and seeks to further the identity debates in exploring how individuals who are subject to the intermittent emergence of a stigmatised characteristic manage this randomised personal discrediting in their identity work. Through a series of focus groups and semi‐structured interviews participants grudgingly report their management approaches which include concealing, drafting in unwitting others, role‐playing and segregating self from their stammer. In describing how they manage their stammer they detail their use of the social space in a number of ways, including as a hiding place; a site for ‘it’ (the stammer); a gap in which to switch words; and a different area in which to perform. This study offers important insights, increasing our understanding of the often hidden negotiations of identity work and the sometime ingenious use of space in the management of a social stigma.
    April 02, 2013   doi: 10.1111/1467-9566.12025   open full text
  • Suicide rates and socioeconomic factors in Eastern European countries after the collapse of the Soviet Union: trends between 1990 and 2008.
    Kairi Kõlves, Allison Milner, Peeter Värnik.
    Sociology of Health & Illness. February 11, 2013
    After the collapse of the Soviet Union the various Eastern European (EE) countries adapted in different ways to the social, political and economic changes. The present study aims to analyse whether the factors related to social integration and regulation are able to explain the changes in the suicide rate in EE. A separate analysis of suicide rates, together with the undetermined intent mortality (UD), was performed. A cross‐sectional time‐series design and applied a panel data fixed‐effects regression technique was used in analyses. The sample included 13 countries from the former Soviet bloc between 1990 and 2008. Dependent variables were gender‐specific age‐adjusted suicide rates and suicide plus UD rates. Independent variables included unemployment, GDP, divorce rate, birth rate, the Gini index, female labour force participation, alcohol consumption and general practitioners per 100,000 people. Male suicide and suicide or UD rates had similar predictors, which suggest that changes in suicide were related to socioeconomic disruptions experienced during the transition period. However, male suicide rates in EE were not associated with alcohol consumption during the study period. Even so, there might be underestimation of alcohol consumption due to illegal alcohol and differences between methodologies of calculating alcohol consumption. However, predictors of female suicide were related to economic integration and suicide or UD rates with domestic integration.
    February 11, 2013   doi: 10.1111/1467-9566.12011   open full text
  • Breast milk and labour support: lactation consultants’ and doulas’ strategies for navigating the medical context of maternity care.
    Jennifer M.C. Torres.
    Sociology of Health & Illness. February 11, 2013
    This article provides a comparison of two occupational groups working in maternity care: International Board Certified Lactation Consultants, who assist women with breastfeeding, and DONA International certified birth doulas, who provide physical, emotional and informational support to birthing women. Using interviews with 18 lactation consultants and 16 doulas working in the USA, I compare these two groups’ strategies for gaining entrance to the maternity care team and their abilities to create change in maternity care practices. Due to the organisation of occupational boundaries in maternity care and differences between the influence of the medicalisation of breastfeeding versus that of childbirth on those boundaries, lactation consultants are able to utilise a front‐door entrance to the medical maternity system, entering as lactation specialists and advocates, while doulas use a back‐door entrance, emphasising their care work and downplaying their advocacy. These different strategies result in different methods being available to each for effecting change. Lactation consultants create formal change, such as changing hospital policies and practices to be more pro‐breastfeeding. Doulas create change informally, ‘one birth at a time’, by creating space for natural birth to occur in the hospital, as well as exposing medical providers to non‐medical ways of giving birth.
    February 11, 2013   doi: 10.1111/1467-9566.12010   open full text
  • Co‐construction of chronic illness narratives by older stroke survivors and their spouses.
    Eloise Radcliffe, Karen Lowton, Myfanwy Morgan.
    Sociology of Health & Illness. February 11, 2013
    Illness narratives have mainly focused on individual patients’ accounts, and particularly those of people experiencing the onset of chronic illness in mid‐life. However, a growing number of older people are spending their later life with their partner, with both experiencing complex morbidities. We examine the shared creation of meanings among older stroke survivors and their spouses and the implications for individual and couple identity. Joint biographical narrative interviews were held with 13 stroke survivors aged 75–85 and their spouses. The analysis examined both narrative content and narrative style. Three main types of co‐presentation of identity were identified. The ‘united couple’ described couples who pulled together and emphasised their accommodation of the stroke and normality as a couple, despite often considerable disability, and was strongly underpinned by collaborative interaction in interviews. Caring relationships were distinguished as ‘positive’, involving self‐reliant couples who took pride in how they managed and ‘frustrated’ in couples who emphasised the difficulties of caring and hardships experienced and were characterised by a conflictual style of narrative. We argue that joint interviews provide new forms of data that extend notions of how illness is lived and demonstrates how the marital relationship can mediate the experience of chronic illness and disability and its impact on identity.
    February 11, 2013   doi: 10.1111/1467-9566.12012   open full text
  • Neuroscientists’ everyday experiences of ethics: the interplay of regulatory, professional, personal and tangible ethical spheres.
    Caragh Brosnan, Alan Cribb, Steven P. Wainwright, Clare Williams.
    Sociology of Health & Illness. February 11, 2013
    The ethical issues neuroscience raises are subject to increasing attention, exemplified in the emergence of the discipline neuroethics. While the moral implications of neurotechnological developments are often discussed, less is known about how ethics intersects with everyday work in neuroscience and how scientists themselves perceive the ethics of their research. Drawing on observation and interviews with members of one UK group conducting neuroscience research at both the laboratory bench and in the clinic, this article examines what ethics meant to these researchers and delineates four specific types of ethics that shaped their day‐to‐day work: regulatory, professional, personal and tangible. While the first three categories are similar to those identified elsewhere in sociological work on scientific and clinical ethics, the notion of ‘tangible ethics’ emerged by attending to everyday practice, in which these scientists’ discursive distinctions between right and wrong were sometimes challenged. The findings shed light on how ethical positions produce and are, in turn, produced by scientific practice. Informing sociological understandings of neuroscience, they also throw the category of neuroscience and its ethical specificity into question, given that members of this group did not experience their work as raising issues that were distinctly neuro‐ethical.
    February 11, 2013   doi: 10.1111/1467-9566.12026   open full text
  • Risk, governance and the experience of care.
    Alexandra Hillman, Win Tadd, Sian Calnan, Michael Calnan, Antony Bayer, Simon Read.
    Sociology of Health & Illness. January 29, 2013
    Drawing on perspectives from the governmentality literature and the sociology of risk, this article explores the strategies, tools and mechanisms for managing risk in acute hospital trusts in the United Kingdom. The article uses qualitative material from an ethnographic study of four acute hospital trusts undertaken between 2008 and 2010 focusing on the provision of dignified care for older people. Extracts from ethnographic material show how the organisational mechanisms that seek to manage risk shape the ways in which staff interact with and care for patients. The article bridges the gap between the sociological analysis of policy priorities, management strategy and the organisational cultures of the NHS, and the everyday interactions of care provision. In bringing together this ethnographic material with sociological debates on the regulation of healthcare, the article highlights the specific ways in which forms of governance shape how staff care for their patients challenging the possibility of providing dignified care for older people.
    January 29, 2013   doi: 10.1111/1467-9566.12017   open full text
  • Life in and after the Armed Forces: social networks and mental health in the UK military.
    Stephani L. Hatch, Samuel B. Harvey, Christopher Dandeker, Howard Burdett, Neil Greenberg, Nicola T. Fear, Simon Wessely.
    Sociology of Health & Illness. January 29, 2013
    This study focuses on the influence of structural aspects of social integration (social networks and social participation outside work) on mental health (common mental disorders (CMD), that is, depression and anxiety symptoms, post‐traumatic stress disorder (PTSD) symptoms and alcohol misuse). This study examines differences in levels of social integration and associations between social integration and mental health among service leavers and personnel still in service. Data were collected from regular serving personnel (n = 6511) and regular service leavers (n = 1753), from a representative cohort study of the Armed Forces in the UK. We found that service leavers reported less social participation outside work and a general disengagement with military social contacts in comparison to serving personnel. Service leavers were more likely to report CMD and PTSD symptoms. The increased risk of CMD but not PTSD symptoms, was partially accounted for by the reduced levels of social integration among the service leavers. Maintaining social networks in which most members are still in the military is associated with alcohol misuse for both groups, but it is related to CMD and PTSD symptoms for service leavers only.
    January 29, 2013   doi: 10.1111/1467-9566.12022   open full text
  • Politics of love: narrative structures, intertextuality and social agency in the narratives of parents with disabled children.
    Halvor Hanisch.
    Sociology of Health & Illness. January 29, 2013
    Recent research has highlighted how parental narratives can be important in the resistance against disabling processes. This article contains analyses of enabling language in narratives published by Scandinavian disability rights organizations. First, drawing on the work of Fisher and Goodley, I point out that the material constitute a threefold: normality narratives, resistance narratives, and narratives that demonstrate an appreciation of the present and the child’s individual alterity. Second, I demonstrate that the last narrative draws on Romanticism rather than linguistic resources from disability culture. Third, I show that these narratives are hyperboles – texts that strengthen and emphasise the valuation to the point where the narrative structure transcends narrative consistency. Fourth, drawing on the work of Kristeva, I argue that this form of narration constitutes an intimate politics of love.
    January 29, 2013   doi: 10.1111/1467-9566.12027   open full text
  • Security and subjective wellbeing: the experiences of unaccompanied young people seeking asylum in the UK.
    Elaine Chase.
    Sociology of Health & Illness. January 10, 2013
    This article considers the relevance of the notion of ontological security – a sense of order, stability, routine and predictability to life – to contemporary conceptualisations of wellbeing. Drawing on in‐depth interviews with unaccompanied young people seeking asylum in the UK, it demonstrates how a positive sense of self and being able to visualise a place and role in the world into the future were integral to their notion of wellbeing, offering an important counter to the pervasive sense of living in limbo. The article argues that this fundamental need for a projected self is largely neglected in contemporary discussions on wellbeing. To date the idea of security as a determinant of wellbeing has been primarily constructed around the notion of protection from harm and the provision of the requirements for physical, emotional, economic and social wellbeing in the here and now. Findings from this research suggest that those providing services and support to young people who have experienced trauma need to consider how they might best nurture in them a sense of place, belonging and security into the future. Equally, they have implications for how we conceptualise and operationalise wellbeing more generally.
    January 10, 2013   doi: 10.1111/j.1467-9566.2012.01541.x   open full text
  • Chronic care infrastructures and the home.
    Henriette Langstrup.
    Sociology of Health & Illness. January 10, 2013
    In this article I argue that attention to the spatial and material dimensions of chronic disease management and its place‐making effects is necessary if we are to understand the implications of the increased mobilisation – technologically or otherwise – of the home in chronic disease management. Analysing home treatment in asthma and haemophilia care, I argue that in relation to chronic disease management the home is not only always connected to the clinic but moreover, what the home is in part depends on the specificities of these attachments. Drawing primarily on the work of Susan Leigh Star and scholars of human geography I propose the concept of chronic care infrastructures designating the often inconspicuous socio‐material elements (such as medication, control visits, phone calls, doses and daily routines), which are embedded in everyday life (of both the clinic and the home) and participate in producing the effect of treatment but also the effect of home. These chronic care infrastructures demand the emplacement of various objects and activities in everyday life and thus relate to negotiations of ‘keepings’– what to keep and care for and where to grant it room vis á vis other ‘keepings’.
    January 10, 2013   doi: 10.1111/1467-9566.12013   open full text
  • Charismatic authority in modern healthcare: the case of the ‘diabetes specialist podiatrist’.
    Dawn Bacon, Alan M. Borthwick.
    Sociology of Health & Illness. December 20, 2012
    Professional specialisation is broadly considered to result from increased complexity in professional knowledge and to be linked to specialist education, formalised credentials and registration. However, the degree of formal organisation may vary across professions. In healthcare, although medical specialisation is linked to rigorous selection criteria, formal training programmes and specialist registration, some forms of specialisation in the allied health professions are much less formal. Drawing on Weber’s concept of charismatic authority, the establishment of a specialist role in podiatry, the ‘diabetes specialist podiatrist’, in the absence of codified or credentialed authority, is explored. ‘Charismatic’ leaders in podiatry, having attracted a following of practitioners, were able to constitute a speciality area of practice in the absence of established career pathways and acquire a degree of legitimacy in the medical field of diabetology.
    December 20, 2012   doi: 10.1111/1467-9566.12024   open full text
  • Non/infectious corporealities: tensions in the biomedical era of ‘HIV normalisation’.
    Asha Persson.
    Sociology of Health & Illness. December 20, 2012
    In the contemporary HIV epidemic, antiretroviral treatments are increasingly considered so effective at viral suppression that they render people with HIV sexually non‐infectious. With its radical implications for global HIV prevention, this emerging paradigm is invested with the potential to turn the epidemic around and to ‘normalise’ one of the most feared infectious diseases in history, thus echoing wider trends of ‘biomedicalisation’. What remains unexamined is whether this paradigm shift will bring about a parallel shift in the embodied experiences of being HIV‐positive. This article explores the nascent trajectory from infectious to non‐infectious corporeality against the backdrop of the discursive history of HIV, with particular focus on the landmark Swiss Consensus Statement, and in the context of research with heterosexuals with HIV in Australia. In‐depth interviews revealed that HIV corporeality was not a stable, homogenised experience across participants and time, nor did it simply follow medical discourses. Instead, HIV corporeality emerged as a contingent set of tensions between conflicting discourses of infectiousness that were negotiated and made sense of within situated and embodied life histories. These findings pose challenges to the imperative of HIV normalisation and the related tendency in HIV prevention to universalise the notion of ‘infectiousness’.
    December 20, 2012   doi: 10.1111/1467-9566.12023   open full text
  • The ‘window of opportunity’ for death after severe brain injury: family experiences.
    Jenny Kitzinger, Celia Kitzinger.
    Sociology of Health & Illness. December 20, 2012
    This article builds on and develops the emerging bioethics literature on the ‘window of opportunity’ for allowing death by withholding or withdrawing treatment. Our findings are drawn from in‐depth interviews with 26 people (from 14 different families) with severely brain injured relatives. These interviews were specifically selected from a larger study on the basis of interviewees’ reports that their relatives would not have wanted to be kept alive in their current condition (e.g. in vegetative or minimally conscious states). Our analysis tracks the decision‐making processes that have led to the situation in which life‐sustaining treatments continue to be delivered to these patients – maintaining them in a state that some families describe as a ‘fate worse than death’. We show how the medico‐legal ‘window of opportunity’ for allowing the patient to die structures family experience and fails to deliver optimal outcomes for patients. We end with some suggestions for change.
    December 20, 2012   doi: 10.1111/1467-9566.12020   open full text
  • The importance of father’s and own education for self‐assessed health across Europe: an East–West divide?
    Christiaan W.S. Monden, Nan Dirk de Graaf.
    Sociology of Health & Illness. December 20, 2012
    How are one’s own education, father’s education, and especially the combination of the two, related to self‐assessed health across European societies? In this study, we test hypotheses about differences in self‐assessed health between 16 post‐socialist countries in Central and Eastern Europe and 17 Western European countries. We find substantial cross‐national variation in the (relative) importance of own and father’s education for self‐assessed health. Over 65 per cent of this cross‐national variation is accounted for by the East–West divide. This simple dichotomy explains cross‐national differences better than gross domestic product or income inequality. An individual’s father’s education is more important, both in absolute and relative terms, for self‐assessed heath in Eastern Europe than in Western Europe. Intergenerational mobility moderates the relative effects of one’s own and one’s father’s education. In Eastern Europe the relative importance of one’s father’s education is greater than it is in Western Europe – particularly for those who are downwardly mobile and have a father with tertiary education. The results are sometimes contradictory to initial expectations; the theoretical implications are discussed.
    December 20, 2012   doi: 10.1111/1467-9566.12015   open full text
  • Functional foods and the biomedicalisation of everyday life: a case of germinated brown rice.
    Hyomin Kim.
    Sociology of Health & Illness. November 01, 2012
    Germinated brown rice (GBR) is a functional food, whose benefits for chronic diseases have been demonstrated by scientific research on a single constituent of GBR, gamma aminobutyric acid. This article examines the processes through which the emphasis on biomedical rationality made during the production and consumption of functional foods is embedded in the complicated social contexts of the post‐1990s. In the case of GBR, the Korean government, food scientists, mass media and consumers have added cultural accounts to the biomedical understanding of foods. In particular, consumers have transformed their households and online communities into a place for surveillance medicine. Functional foods are embedded in multiple actors’ perspectives on what healthy foods mean and how and where the risks of chronic diseases should be managed.
    November 01, 2012   doi: 10.1111/j.1467-9566.2012.01533.x   open full text
  • Brain talk: power and negotiation in children’s discourse about self, brain and behaviour.
    Ilina Singh.
    Sociology of Health & Illness. October 25, 2012
    This article examines children’s discourse about self, brain and behaviour, focusing on the dynamics of power, knowledge and responsibility articulated by children. The empirical data discussed in this article are drawn from the study of Voices on Identity, Childhood, Ethics and Stimulants, which included interviews with 151 US and UK children, a subset of whom had a diagnosis of attention deficit/hyperactivity disorder. Despite their contact with psychiatric explanations and psychotropic drugs for their behaviour, children’s discursive engagements with the brain show significant evidence of agency and negotiated responsibility. These engagements suggest the limitations of current concepts that describe a collapse of the self into the brain in an age of neurocentrism. Empirical investigation is needed in order to develop agent‐centred conceptual and theoretical frameworks that describe and evaluate the harms and benefits of treating children with psychotropic drugs and other brain‐based technologies.
    October 25, 2012   doi: 10.1111/j.1467-9566.2012.01531.x   open full text
  • Ageing with telecare: care or coercion in austerity?
    Maggie Mort, Celia Roberts, Blanca Callén.
    Sociology of Health & Illness. October 25, 2012
    In recent years images of independence, active ageing and staying at home have come to characterise a successful old age in western societies. ‘Telecare’ technologies are heavily promoted to assist ageing‐in‐place and a nexus of demographic ageing, shrinking healthcare and social care budgets and technological ambition has come to promote the ‘telehome’ as the solution to the problem of the ‘age dependency ratio’. Through the adoption of a range of monitoring and telecare devices, it seems that the normative vision of independence will also be achieved. But with falling incomes and pressure for economies of scale, what kind of independence is experienced in the telehome? In this article we engage with the concepts of ‘technogenarians’ and ‘shared work’ to illuminate our analysis of telecare in use. Drawing on European‐funded research we argue that home‐monitoring based telecare has the potential to coerce older people unless we are able to recognise and respect a range of responses including non‐use and ‘misuse’ in daily practice. We propose that re‐imagining the aims of telecare and redesigning systems to allow for creative engagement with technologies and the co‐production of care relations would help to avoid the application of coercive forms of care technology in times of austerity.
    October 25, 2012   doi: 10.1111/j.1467-9566.2012.01530.x   open full text
  • Splitting bodies/selves: women’s concepts of embodiment at the moment of birth.
    Deborah Lupton, Virginia Schmied.
    Sociology of Health & Illness. October 24, 2012
    Little sociological research has focused specifically on the moment of birth. In this article we draw upon interview data with women who had very recently given birth for the first time to explore the ways in which they described both their own embodiment and that of their infants at this time. We use the term ‘the body‐being‐born’ to describe the liminality and fragmentation of the foetal/infant body as women experience it when giving birth. The study found that mode of birth was integral to the process of coming to terms with this body during and following birth. The women who gave birth vaginally without anaesthesia experienced an intense physicality as they felt their bodies painfully opening as the ‘body‐being‐born’ forced its way out. In contrast the women who had had a Caesarean section tended to experience both their own bodies and those of their infants as absent and alienated. Most of the women took some time to come to terms with the infant once it was born, conceptualising it as strange and unknown, but those who delivered by Caesarean section had to work even harder in coming to terms with the experience.
    October 24, 2012   doi: 10.1111/j.1467-9566.2012.01532.x   open full text