Sick but healthy: bariatric patients and the social construction of illness and disability

Bariatric (weight loss) surgery modifies the digestive system, which produces impairments and symptoms which might be considered illness or disability. Bariatric patients, however, do not view themselves as ill or disabled, but healthier than before surgery. For this study, 35 bariatric patients - from a clinic located in the Midwestern United States - were interviewed to investigate how moral and medical discourses surrounding obesity impact how patients experience their bodies after bariatric surgery. While previous literature on bariatric patients has explored discourses of medicine, stigma and discipline, fewer have analysed how patients interpret physiological symptoms. Patients often reduce or discontinue medications for chronic illness after bariatric surgery, then replace them with a strict regimen of dietary supplements. Even though these supplements are taken to manage an impaired digestive system, they do not carry the same moral weight as medications for chronic illness. Patients also experience painful and humiliating symptoms after bariatric surgery. Bariatric patients interpret symptoms not as illness, but as important disciplinary tools to lose weight. These findings have implications for the social construction and experience of illness and disability in the context of fat stigma, health morality and biomedicalisation.

Social Constructions of Rape at Columbia University and Barnard College, 1955-90

Sex on college campuses has fascinated scholars, reporters, and the public since the advent of coeducational higher education in the middle of the nineteenth century. But the emergence of rape on campus as a public problem is relatively recent. This article reveals the changing social constructions of campus rape as a public problem through a detailed examination of newspaper reporting on this issue as it unfolded at Columbia University and Barnard College between 1955 and 1990. Adapting Joseph R. Gusfield's classic formulation of public problem construction, we show the ways police and other judicial and law enforcement authorities, feminists, university faculty, student groups, university administrators, and health professionals and institutions have struggled over ownership of how the problem should be defined and described, attribution of responsibility for addressing the problem, and prescriptions for what is to be done. Our findings show how beginning in the late 1960s and early 1970s, the simultaneous swelling of the women's liberation movement and the exponential integration of women into previously male-dominated institutions of higher education and medicine catalyzed the creation of new kinds of knowledge, institutions, and expertise to address rape and sexual violence more broadly on college campuses. New actors-feminists and health professionals-layered frames of gender and health over those of crime and punishment to fundamentally transform how we understand rape on campus, and beyond.

Users' and researchers' construction of equity in research collaboration

BACKGROUND

Equity is described as an ideal in user involvement in research and is mentioned in the health service literature and in several guidelines. However, equity is described as being difficult to obtain and the concept is rarely clarified or concretized. Equity can be socially constructed.

OBJECTIVE

This study explored users' and researchers' constructions of equity in research processes.

DESIGN AND METHOD

The study had a qualitative research design. Constructions of equity were analysed through the lens of positioning theory. Two focus group interviews consisting of both users and researchers were conducted.

FINDINGS

The thirteen users and four researchers considered 'equity' as an important part of user involvement in research. Storylines about norms, responsibility, language, knowledge and usefulness evolved in the discussions. These storylines elucidated unequal access to rights and duties.

DISCUSSION AND CONCLUSION

Users and researchers constructed equity in user involvement differently, but the difference was masked by an apparent agreement. Users and researchers drew on different storylines. The researchers emphasized the scientific discourse and although users acknowledged this discourse, they attempted to oppose this dominant discourse by drawing on a lay discourse. The identified constructions and negotiations of equity may contribute in new understandings of an equal collaboration in user involvement in research.

Social media trends in dermatology, dermatopathology, and pathology publications: The social construction of medical subdisciplines

BACKGROUND

An increase in the number of publications on social media has paralleled the growth of social media use in the past decade. Our study examined the trends in these publications relating to the fields of dermatology, pathology, and dermatopathology.

METHODS

PubMed was searched for relevant literature from 2009 to present, using the following key terms: "social media", "dermatology", "dermatopathology", and "pathology." Topics of articles, years of publication, countries of origin, and contributing journals were compiled and analyzed.

RESULTS

A total of 99 publications was retrieved during the period between January 2009 and November 2019. Top publication years included 2019 (n = 21), 2018 (n = 24), 2017 (n = 20), and 2016 (n = 13). The most common topic areas noted were related to dissemination of information (n = 17; 17.2%), knowledge exchange for physicians (n = 16; 16.2%), and social networking (n = 15; 15.2%).

CONCLUSION

The number of published articles on social media in these specialties has increased since 2009, signifying the widespread use of social media for professional networking, knowledge exchange, real-time communication with patients and colleagues, and patient care. Social media in the areas of dermatology, dermatopathology, and pathology has undergone social construction during the past decade because of changes in technology and ideologies surrounding the use of social media within medicine.

"Doing" Intergenerational Friendship: Challenging the Dominance of Age Homophily in Friendship

This article challenges the dominance of age homophily in the literature on friendship. Using findings from a recent study on intergenerational friendship, we put forward a new conceptualization of a homophily of doing-and-being in friendships between adults who are of different generations. This research took a qualitative approach using constructivist grounded theory methodology. Homophily of doing-and-being has three components: being "friends in action" (pursuing interests and leisure activities, or simply spending time together), being "not only old" (sharing identities beyond age), and sharing attitudes and approaches to friendship and life. Additionally, "differences" were an important element of interest between the intergenerational friends. Our discovery of the centrality of doing-and-being, and the relative insignificance of age homophily, constitute a novel way of looking at friendship, and a new way of conceptualizing how and why (older) adults make and maintain friendships.

Maintaining Social Connections in Dementia: A Qualitative Synthesis

The clinical symptoms of dementia include difficulty with speech, poor short-term memory, and changes in behavior. These symptoms can affect how the person with dementia understands and performs in social interactions. This qualitative review investigated how people with mild to moderate dementia managed social connections. A systematic search of social science databases retrieved 13 articles; data were synthesized using thematic analysis. Results established the work undertaken by people with dementia to maintain and present a social persona seen as socially acceptable. Interpretations are contextualized within Goffman and Sabat's theories on "self." People with dementia were agentic in impression management: undertaking work to maintain recognized social roles, while being aware of when their illness led to others discrediting them. Wider recognition of strategies used to maintain a social self could inform interventions designed to increase capability and confidence in co-managing social connections following dementia diagnosis.

Beyond the Revolving Door: Long-Term Lived Experience of Eating Disorders and Specialist Service Provision

In this study, we undertook a narrative analysis of participants' long-term lived experience of eating disorders and specialist service provision. Eight participants were recruited with service experience across five National Health Service (NHS) Trusts in the United Kingdom. All participants had a minimum of 10 years self-reported experience living with an eating disorder. The data are presented across different temporal stages that demonstrate the development of participants' self-construct in relation to their first contact with specialist services, what had happened in their lives for this to become necessary, and their current relationships with services, before exploring what participants need from services to help them feel heard going forward. Findings suggest that current methods of service delivery result in delayed and inappropriate supports and a consequent "battling" against professionals, which can provide an obstacle to compassionate and collaborative working and promote "revolving door" experiences.

Constructions of sexuality and HIV risk among young people in Venda, South Africa: implications for HIV prevention

The study explored constructions of sexuality among young people of Venda in Limpopo, South Africa, and cultural practices that can be used to develop context-specific HIV prevention programmes. HIV prevention can be promoted by including some cultural practices in prevention programmes and changing some aspects of culture that may contribute negatively to health. Six focus group discussions were held with school-going young people (Grades 10 to 12) in urban and rural areas to explore their constructions of sexuality and HIV risk. Four focus group discussions were held with community leaders in the same areas to explore their constructions of young people's sexuality and cultural practices relevant to HIV prevention. Through discourse analysis, the following dominant discourses that influence young people's sexual risk behaviour were identified: rite of passage, the male sexual drive discourse (sex is natural and unavoidable); discourse of hegemonic masculinity (sex to prove masculinity); sex as a commodity; non-adherence to cultural practices; and HIV is normalised (AIDS is like flu). Some alternative constructions and shifts in gender norms were noticed, especially among female participants. The constructions of young people were not culture-specific but similar to those identified in other South African cultures. Community leaders identified a few cultural practices that could be considered in HIV prevention, for example, reinstating the rite of passage to provide age-appropriate sex and HIV education (behavioural intervention), and promoting traditional male circumcision (biological intervention). Cultural practices that contribute negatively to health should be challenged such as current constructions of gender roles (masculinity and femininity) and the practice that parents do not talk to young people about sex (both structural interventions).

Pursuing Well-Being Among Rural-Dwelling Adults With Disabilities

Through this constructivist grounded theory study, it was our purpose to create a substantive theory to explain how rural-dwelling, working-age adults with disabilities define and pursue well-being. Twelve rural-dwelling participants were interviewed up to 3 times to understand the processes involved in defining and pursuing well-being. From this exploration, we suggest that well-being is not a set state to be achieved and then enjoyed, rather well-being results from establishing and maintaining membership in the rural community. Membership facilitated access to the array of material and psychological supports needed for a sense of well-being. Findings support the assumption that urban models of care are insufficient for rural areas. This study also provides an understanding of how individuals in this population mobilize resources to overcome functional limitations and environmental barriers to establish group membership and create a sense of well-being. Implications for health care practice and policy are discussed.

"The Poor Carer": Ambivalent Social Construction of the Home Care Worker in Elder Care Services

In this article, we examine the social construction of the home care worker from the perspective of various professionals in the elder care sector in Ireland. The research, using the Grounded Theory method, involved focus groups with 31 participants comprising health and social work professionals as well as care agency managers and policy planners. The social construction of the elder care worker is characterised by ambivalence. We connect the concept of ambivalence at the micro level of human relationships to structural factors that are driving the ambivalence. Ambivalence towards home care workers is shaped by structural factors including the precariousness of care work, the commodification of time, and the stipulated personalisation of services. The irreconcilable contrasts between portrayals of care workers as both 'good' and 'bad' are indicative of deep contradictions in the expectations that contemporary care systems direct at paid caregivers. Ambivalence arises from the commodified and dispensable status of care workers, and fundamental transformations in their training, working conditions and pay are required to move away from this ambivalence and towards care workers' equal status with professionals in the care sector.

Risk society online: Zika virus, social media and distrust in the Centers for Disease Control and Prevention

While social construction of illness research has examined the redefinition of medically defined illness as non-illness by laypersons, nothing has considered this process alongside emerging infectious diseases (EIDs). Using Gidden's notion of modern risk society and distrust in expert authority, this paper examines how social media posts construct Zika virus as nonhazardous while displaying a distrust in research and prevention. Using qualitative content analysis, we examine 801 posts on the Centers for Disease Control and Prevention's (CDC) Facebook page to highlight the interplay between risk, the social construction of Zika and trust in experts. Three themes are discussed, including Zika: (i) as legitimate public health threat; (ii) as product of CDC corruption and (iii) used to question medical expertise. We find the latter two themes supportive of Gidden's focus on risk and distrust in expert authority and discuss the danger of constructing EIDs as products of corrupt expert authority on public health social media platforms.

"We Cannot Let Them Die": Undocumented Immigrants and Media Framing of Health Deservingness in the United States

Based on a systematic qualitative analysis of articles published by The New York Times (2009-2017), this article presents the main media frames that support the access to government-sponsored health care by undocumented immigrants, just before and after passage of the U.S. Affordable Care Act in 2010. Under the umbrella of "selective inclusion," this study highlights a "compassionate frame" that conveys sympathy toward severely ill, undocumented immigrants. This approach is reinforced by a "cost-control" frame that underlines the economic benefits of providing health care to the undocumented immigrant population in the United States. Supported by both humane and market-based approaches, these frames make a compelling case for the inclusion of particular groups into the U.S. health care safety net. Ultimately, these findings contribute to our understanding of the media framing of undocumented immigrants' right to health care on the basis of deservingness.

Sherry: "inclusion" interpreted through a life-story lens

In the United States, educational inclusion of students with intellectual disabilities is relatively new. It was not until 1975 that the right to a "free appropriate public education" for children with disabilities was recognized, and not until 1990 that adults with disabilities were granted equal employment opportunities. Arguably, systems still exist that exclude and oppress individuals with significant intellectual disabilities. This study is about the life of one person with an intellectual disability who was born before federal laws existed in the United States and who was not granted a "free and appropriate public education" in her home community, leading to a life experience quite atypical than the lives experienced by many adults with disabilities residing in the United States. Two primary findings are shared. First, the lives of people with intellectual disabilities can be meaningful and filled with dignity, yet society's lack of support, norms for behavior, and low expectations around disability act as a perpetual barrier. Second, "inclusion" represents much more than the sharing of a physical space.

Mothers' Understanding of Infant Feeding Guidelines and Their Associated Practices: A Qualitative Analysis

There is limited evidence to describe Australian mothers’ understanding of the Australian Infant Feeding Guidelines (AIFG). A qualitative inductive methodological approach was used in this study to explore experiences with the introduction of solid food. Seven focus groups with 42 mothers of children aged 4–18 months were conducted in disadvantaged areas in Perth, Australia. The mean age of infants was 9.6 months and mean age of introduction of solid food was 4.3 months (range 1.2 to 7.5 months). Almost half of the mothers in this study were aware of the AIFG however, only half again could correctly identify the recommended age for introducing solid food. Four themes and nine subthemes emerged from the analysis. Themes were (1) Every child is different (judging signs of readiness); (2) Everyone gives you advice (juggling conflicting advice); (3) Go with your gut—(being a “good” mother); and (4) It’s not a sin to start them too early or too late (—guidelines are advice and not requirements). The findings indicated that in spite of continued promotion of the AIFG over the past ten years achieving the around six months guideline is challenging. Professionals must address barriers and support enablers to achieving infant feeding recommendations in the design education materials and programs.

"Little Tablets of Gold": An Examination of the Psychological and Social Dimensions of PrEP Among LGBTQ Communities

There are significant psychological, social, and cultural dimensions to the HIV epidemic in the United States, especially among lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities. Biomedical HIV treatment has been shown to impact these dimensions. However, there is little understanding of the real-world psychosocial and sociocultural effects of the latest biomedical HIV prevention strategy, HIV pre-exposure prophylaxis (PrEP). This study explored the psychosocial and sociocultural dimensions of PrEP use among LGBTQ adults. We interviewed 23 LGBTQ adults who were current or former users of PrEP. Results included that PrEP users' experiences were shaped by multiple forms of stigma. Participants were highly motivated to challenge PrEP stigma and to support PrEP use among other community members. Lastly, participants described positive impacts on their individual well-being and their sexual partnerships. Findings suggest that PrEP has significant impacts beyond biomedical outcomes for both the individuals who use PrEP and their communities.

The Impossibility of Criminal Justice Ethics: Toward a Phenomenology of the Possible

Regardless the specific theoretical perspective, all ethical formulations for criminal justice practice in some way construct the ontological character of the offender, which, in turn, situates both epistemology and method. How this ethical process ultimately constructs the offender will likely help to establish the degree of ethical worth such an individual is deemed worthy to receive. Whether based upon the seriousness of the crime or based upon the specific configuration of the architecture of incarceration, the very possibility of legitimate ethical practice is greatly compromised. Such results can be better avoided when the ethical import of the individual is ontologically situated within the very definition of what it means to be human.¹ By situating this discussion within the context of the analytic psychology of Carl Jung and his concept of the shadow and the originary ethics of Martin Heidegger found in Being and Time, a more ontologically configured possibility for a criminal justice ethics can be recognized.

Something Borrowed, Something New: A Governance and Social Construction Framework to Investigate Power Relations and Responses of Diverse Stakeholders to Policies Addressing Antimicrobial Resistance

While antimicrobial resistance (AMR) has rapidly ascended the political agenda in numerous high-income countries, developing effective and sustainable policy responses in low- and middle-income countries (LMIC) is far from straightforward, as AMR could be described as a classic ‘wicked problem’. Effective policy responses to combat AMR in LMIC will require a deeper knowledge of the policy process and its actors at all levels—global, regional and national—and their motivations for supporting or opposing policies to combat AMR. The influence of personal interests and connections between for-profit organisations—such as pharmaceutical companies and food producers—and policy actors in these settings is complex and very rarely addressed. In this paper, the authors describe the role of policy analysis focusing on social constructions, governance and power relations in soliciting a better understanding of support and opposition by key stakeholders for alternative AMR mitigation policies. Owing to the lack of conceptual frameworks on the policy process addressing AMR, we propose an approach to researching policy processes relating to AMR currently tested through our empirical programme of research in Cambodia, Pakistan, Indonesia and Tanzania. This new conceptualisation is based on theories of governance and a social construction framework and describes how the framework is being operationalised in several settings.

[The Process of Healing Child Physical Abuse: Sprouting and Twining]

BACKGROUND

Child physical abuse impacts the physical and psychological health of survivors. Healing child abuse is an essential process that helps survivors reorganize the meaning of the trauma and pursue a normal life. Considering the trauma of child physical abuse within the social context allows the experiences of individual survivors to be reflected in their process of healing.

PURPOSE

To explore the social interaction and construction process of healing experienced by survivors of child physical abuse.

METHODS

A qualitative research design using grounded theory was applied. Purposive and theoretical sampling was used to recruit survivors of childhood physical abuse who had experienced healing. Semi-structured, in-depth interviews were used and data were analyzed using open, axial, and selective coding.

RESULTS

The process of healing child physical abuse in this study was a process of sprouting and twining. Three core categories emerged: thriving, relationships, and ethics. The healing process was analogous to a seed growing in poor soil, sprouting out from the ground, and striving to live by seeking support. The survivors constantly established interactive relationships with their selves and with others and struggled to keep family bonds grounded and growing within the frame of ethics.

CONCLUSIONS / IMPLICATIONS FOR PRACTICE

The healing process of sprouting and twining for child physical abuse survivors in Taiwan integrates thriving, relationships, and ethics. Professionals working with child-physical-abuse survivors must recognize conflicts in ethics. Strategies should be developed to assist survivors to cope with the impact of childhood trauma in order to facilitate the healing process.

A "Different Economy of Bodies and Pleasures"?: Differentiating and Evaluating Sex and Sexual BDSM Experiences

This study examines how BDSM participants understand sexual experiences. Data are drawn from 32 in-depth, semistructured interviews and discussion-board threads from a large BDSM community Web site. The analysis suggests that many BDSM participants perceive sexual BDSM experiences as not only significantly different from but also better than mainstream or "vanilla" sex. Three primary differentiation mechanisms are identified. First, BDSM participants constructed sex as requiring genital contact, while framing sexual BDSM as creating sexual fulfillment not requiring normative indicators of sexual experiences (e.g., orgasm). Second, participants constructed sexual BDSM as centered on emotional and mental experiences, while perceiving sex as being centered on physical experiences. Third, participants perceived sexual BDSM experiences as facilitating deeper interpersonal connections than those available in sex. Importantly, these mechanisms serve not only a differentiating but also an evaluative function. Most participants in this study reported a strong preference for sexual BDSM over sex.

Working with Stories: Street-Level Bureaucrats and Their Work with Individuals with Psychiatric Disability Exposed to Interpersonal Violence

The focus of our attention is the meeting between street-level bureaucrats and individuals with psychiatric disability exposed to interpersonal violence. Based on 11 interviews, we illustrate how stories are understood, used, and made meaningful to the street-level bureaucrat. The contribution of this article is first of all that of being a framework, from a storytelling point of view, for the work and organizational experiences of street-level bureaucrats. Second, by paying attention to the story part of these relationships, we can better understand the situation of individuals with psychiatric disability exposed to interpersonal violence given their interaction with different street-level bureaucrats.

Why People Who Inject Drugs Voluntarily Transition Off Methadone in Ukraine

Methadone maintenance therapy (MMT) treats opioid use disorder among people who inject drugs (PWID). To understand why PWID may voluntarily discontinue MMT, we analyzed data from 25 focus groups conducted in five Ukrainian cities from February to April 2013 with 199 participants who were currently, previously, or never on MMT. Using constant comparison method, we uncovered three themes explaining why PWID transition off MMT: (a) purposeful resistance to rigid social control associated with how MMT is delivered and to power asymmetries in provider-patient relationships, (b) self-management of a PWID's "wounded identity" that is common in socially stigmatized and physically sick persons-MMT serves as a reminder of their illness, and (c) the quest for a "normal life" uninterrupted by daily MMT site visits, harassment, and time inefficiencies, resources, and social capital. Focusing on holistic principles of recovery would improve addiction treatment and HIV prevention in Ukraine and globally.

Sexual Orientation in State Hate Crime Laws: Exploring Social Construction and Criminal Law

Several studies have described and analyzed the development and diffusion of hate crime laws in the United States, but none specifically examined state-level differences in protected categories. Forty-five of the 50 states have a hate crime statute, but only 30 of those include sexual orientation. In this study the social construction framework is applied to the hate crime policy domain in order to determine whether or not variations in the social and political status of gays and lesbians are associated with the inclusion of sexual orientation in state hate crime laws. Content analysis of daily newspapers in six states revealed that a positive social construction is associated with groups seeking hate crime law protections, and that political influence may also be a key factor.

Formulations in Psychotherapy: Admission Interviews and the Conversational Construction of Diagnosis

In this article, we contribute to understanding the interactional aspects of making clinical diagnosis in mental health care. We observe that therapists, during the "problem presentation" sequence in clinical encounters, often use a specific form of diagnostic formulations to elicit more diagnostically relevant information. By doing so, they often substitute one type of verb with another, following a diagnostic hypothesis. Specifically, in interviews that arrive at a diagnosis of neurosis, therapists formulate with behavioral verbal processes; in interviews that arrive at a diagnosis of psychosis, they do so with material ones. Such formulations often prove useful to define clinical diagnoses. They can, however, also be dangerous in that they may favor the therapist's agenda over the patient's. Our analysis helps therapists not only better understand the diagnostic process but also reflect upon their own use of diagnostic formulations and become aware of the clinical effects of their interactional performance.

The HIV Prison Paradox: Agency and HIV-Positive Women's Experiences in Jail and Prison in Alabama

Incarcerated women face significant barriers to achieve continuous HIV care. We employed a descriptive, exploratory design using qualitative methods and the theoretical construct of agency to investigate participants' self-reported experiences accessing HIV services in jail, in prison, and post-release in two Alabama cities. During January 2014, we conducted in-depth interviews with 25 formerly incarcerated HIV-positive women. Two researchers completed independent coding, producing preliminary codes from transcripts using content analysis. Themes were developed iteratively, verified, and refined. They encompassed (a) special rules for HIV-positive women: isolation, segregation, insults, food rationing, and forced disclosure; (b) absence of counseling following initial HIV diagnosis; and (c) HIV treatment impediments: delays, interruption, and denial. Participants deployed agentic strategies of accommodation, resistance, and care-seeking to navigate the social world of prison and HIV services. Findings illuminate the "HIV prison paradox": the chief opportunities that remain unexploited to engage and re-engage justice-involved women in the HIV care continuum.

"The complaining women": health professionals' perceptions on patients with fibromyalgia in Spain

PURPOSE

The aim of this study is twofold: (1) to explore health service providers' perceptions regarding fibromyalgia patients in Spain and (2) to analyze possible consequences of these perceptions in terms of how health service providers construct the disease and treat their patients.

DESIGN

Qualitative study.

SUBJECTS/PATIENTS

Twelve health service providers (eight men, four women) involved in the care of fibromyalgia patients. Providers were from different disciplines and included general practitioners, rheumatologists, occupational doctors, psychologists, psychiatrists, physiotherapists and behavioral specialists from Spain.

METHOD

We performed individual semistructured interviews, which were recorded and transcribed to conduct a qualitative content analysis supported by Atlas.ti-7.

RESULTS

We identified three categories from the interviews: (1) the fibromyalgia patient prototype: the complaining woman, (2) fibromyalgia is considered a women's health issue, but male patients are a privileged minority, and (3) health professionals' attitudes toward fibromyalgia patients: are they really suffering or pretending?

CONCLUSION

The uncertainty surrounding fibromyalgia together with the fact that those affected are primarily women, seem to influence professional practice in terms of lack of recognition of Fibromyalgia as a severe disease. Increased training of all health professionals is essential to improving the support and attention given to patients suffering from fibromyalgia. Implications for rehabilitation   Fibromyalgia   • In order to improve fibromyalgia patients´ attention, health providers should learn how to assist patients without prejudices.   • Training programs for health providers should include sensitization about the severity of fibromyalgia.   • Health providers should be aware of the existence of stereotypes about women suffering from fibromyalgia.   • Fibromyalgia protocols should give skills to health providers to avoid offering a gender-biased attention to patients.