Flourishing and health in critical perspective: An invitation to interdisciplinary dialogue

Living ethics: a stance and its implications in health ethics

Moral or ethical questions are vital because they affect our daily lives: what is the best choice we can make, the best action to take in a given situation, and ultimately, the best way to live our lives? Health ethics has contributed to moving ethics toward a more experience-based and user-oriented theoretical and methodological stance but remains in our practice an incomplete lever for human development and flourishing. This context led us to envision and develop the stance of a "living ethics", described in this inaugural collective and programmatic paper as an effort to consolidate creative collaboration between a wide array of stakeholders. We engaged in a participatory discussion and collective writing process known as instrumentalist concept analysis. This process included initial local consultations, an exploratory literature review, the constitution of a working group of 21 co-authors, and 8 workshops supporting a collaborative thinking and writing process. First, a living ethics designates a stance attentive to human experience and the role played by morality in human existence. Second, a living ethics represents an ongoing effort to interrogate and scrutinize our moral experiences to facilitate adaptation of people and contexts. It promotes the active and inclusive engagement of both individuals and communities in envisioning and enacting scenarios which correspond to their flourishing as authentic ethical agents. Living ethics encourages meaningful participation of stakeholders because moral questions touch deeply upon who we are and who we want to be. We explain various aspects of a living ethics stance, including its theoretical, methodological, and practical implications as well as some barriers to its enactment based on the reflections resulting from the collaborative thinking and writing process.

Psychosocial well-being after stroke in Aotearoa New Zealand: a qualitative metasynthesis

PURPOSE

Psychosocial well-being is key to living well after stroke, but often significantly affected by stroke. Existing understandings consider well-being comes from positive mood, social relationships, self-identity and engagement in meaningful activities. However, these understandings are socioculturally located and not necessarily universally applicable. This qualitative metasynthesis examined how people experience well-being after a stroke in Aotearoa New Zealand.

MATERIAL AND METHODS

This metasynthesis was underpinned by He Awa Whiria (Braided Rivers), a model which prompts researchers to uniquely engage with Māori and non-Māori knowledges. A systematic search identified 18 articles exploring experiences of people with stroke in Aotearoa. Articles were analysed using reflexive thematic analysis.

RESULTS

We constructed three themes which reflect experiences of well-being: connection within a constellation of relationships, being grounded in one's enduring and evolving identities, and being at-home in the present whilst (re)visioning the future.

CONCLUSION

Well-being is multi-faceted. In Aotearoa, it is inherently collective while also deeply personal. Well-being is collectively achieved through connections with self, others, community and culture, and embedded within personal and collective temporal worlds. These rich understandings of well-being can open up different considerations of how well-being is supported by and within stroke services.

A mixed methods PAR study investigating social capital as a resource for Black and other racially minoritised communities in the UK: A study protocol

Understanding how different Black and other racially minoritised communities thrive is an emerging priority area in mental health promotion. Literature demonstrates health benefits of social capital (social resources embedded within social networks). However, its effects are not always positive, particularly for certain subpopulations who are already disadvantaged.The CONtributions of social NEtworks to Community Thriving (CONNECT) study will use Participatory Action Research (PAR) to investigate social capital as a resource that benefits (or hinders) racially minoritised communities and their mental health. The CONNECT study was designed within a partnership with community organisations and responds to local policy in two South-East London Boroughs, thereby providing potential channels for the action component of PAR. Taking an anti-racism lens, we acknowledge the underpinning role of racism in creating health inequities. We apply an intersectional framework to be considerate of overlapping forms of oppression such as age, gender, socioeconomic status, and sexual orientation as an essential part of developing effective strategies to tackle health inequities. Key components of this mixed methods PAR study include (1) involving racialised minority community members as peer researchers in the team (2) collecting and analysing primary qualitative data via interviews, photovoice, and community mapping workshops, (3) developing relevant research questions guided by peer researchers and collaborating organisations and analysing secondary quantitative data accordingly, (4) integrating qualitative and quantitative phases, and (5) working closely with community and policy partners to act on our findings and use our research for social change.The PAR approach will allow us to engage community (voluntary sector and government) and academic partners in decision making and help address imbalances in power and resource allocation. Knowledge generated through this collaborative approach will contribute to existing community initiatives, policies, and council strategies. This will ensure the views and experiences of racially minoritised communities drive the changes we are collaboratively committed to achieving.

Transition from Paediatric to adult health services: Aspirations and practices of human flourishing

BACKGROUND

Transition from paediatric to adult care is challenging for youths with a chronic condition. Most transition programmes place high value in autonomy and independence. We undertook a qualitative study to: (1) identify the needs and aspirations of youths and (2) better understand the well-being and flourishing of youths.

METHODS

Semi-structured interviews were conducted with youths, parents of youths and healthcare professionals recruited from four clinics. Thematic analysis focused on: (1) perceptions of transition; (2) key aspects of human flourishing during transition; and (3) salient concerns with respect to the transition and dimensions of human flourishing.

RESULTS

54 interviews were conducted. Perceptions of transition clustered around: (1) apprehension about adult care; (2) lack of clarity about the transition process; (3) emotional attachment to paediatric healthcare professionals; (4) the significance of the coinciding transition into adulthood. Fourteen salient concerns (e.g., Knowledge and information about the transition, Parental involvement in healthcare) were identified with corresponding recommendations. Salient concerns related to important dimensions of human flourishing (e.g., environmental mastery, autonomy).

DISCUSSION AND CONCLUSION

The flourishing of youths is affected by suboptimal transition practices. We discuss the implications of our findings for environmental mastery, contextual autonomy, and the holistic and humanistic aspects of transition.

A brief measure of complete subjective well-being in Germany: A population-based validation of a German version of the Flourish Index (FI) and the Secure Flourish Index (SFI)

Measuring subjective well-being in a multidimensional, valid, reliable, and parsimonious way is important for both social science research and social policy. Here, we present an efficient measure of distinct domains of subjective well-being and overall flourishing. The Flourishing Index (FI) consists of five sub-domains: 1. happiness and life satisfaction, 2. physical and mental health, 3. meaning and purpose, 4. character and virtue, and 5. close social relationships. The Secure Flourishing Index (SFI) adds the sub-domain financial and material stability, which is thought to be necessary to sustain the other domains over time. We developed a German version of these measures in a multi-stage translation and scale testing process. The results of an exploratory factor analysis in Study 1 (N = 192) suggest a unidimensional structure of the FI and a two-dimensional structure of the SFI. Moreover, both indices (and most sub-domains) revealed acceptable to good reliability. The factor structures were confirmed in Study 2 (N = 13,268). We provide indications for measurement invariance of both indices with regard to gender and age. We furthermore examined inter-correlations with related constructs such as importance of health, self-efficacy, and social support. Study 3 (N = 317) finds evidence for high convergent validity of both the FI and the SFI with overall well-being as well as sub-scores of the PERMA-Profiler. These results suggest that the FI and the SFI are efficient measures of distinct domains of subjective well-being and overall flourishing. Our translation of the FI and SFI, along with the empirical relationships that we found among the measures that we reviewed, will help scholars in Germany (and beyond) explore an expanded range of domains of well-being, including the comparatively neglected domains of character and virtue, physical health, and financial and material stability.

The Impact of Socially Assistive Robots on Human Flourishing in the Context of Dementia: A Scoping Review

Socially assistive robots are being developed and tested to support social interactions and assist with healthcare needs, including in the context of dementia. These technologies bring their share of situations where moral values and principles can be profoundly questioned. Several aspects of these robots affect human relationships and social behavior, i.e., fundamental aspects of human existence and human flourishing. However, the impact of socially assistive robots on human flourishing is not yet well understood in the current state of the literature. We undertook a scoping review to study the literature on human flourishing as it relates to health uses of socially assistive robots. Searches were conducted between March and July 2021 on the following databases: Ovid MEDLINE, PubMed and PsycINFO. Twenty-eight articles were found and analyzed. Results show that no formal evaluation of the impact of socially assistive robots on human flourishing in the context of dementia in any of the articles retained for the literature review although several articles touched on at least one dimension of human flourishing and other related concepts. We submit that participatory methods to evaluate the impact of socially assistive robots on human flourishing could open research to other values at stake, particularly those prioritized by people with dementia which we have less evidence about. Such participatory approaches to human flourishing are congruent with empowerment theory.

Flourishing with chronic illness(es) and everyday stress: Experiences from Soweto, South Africa

The pursuit of flourishing, or living a good life, is a common human endeavor with different meanings across individuals and contexts. What is needed is a further exploration of the relationship between flourishing and health, particularly chronic illness, which affects individuals across the life course and is affected by experiences of stress derived from social and structural vulnerability. Drawing on data from the Soweto Syndemics study, including a locally derived stress scale and in-depth interviews, we explore the connections between flourishing and health for those living with multiple chronic illnesses in Soweto, South Africa within a syndemic of communicable and non-communicable disease. Rather than drawing on Western-centric notions of flourishing (which place emphasis on an individual's capabilities or capacities to thrive), we draw on previous ethnographic work on flourishing in Soweto, South Africa, which described how ukuphumelela, or "becoming victorious," as a social or communal affair. This conceptualization reflects local values and priorities for people's lives and the ways in which their lives are deeply intertwined with each other. We contribute to a more robust understanding of flourishing in context, of how chronic illness is experienced, and of how the role of a patient is transcended in spaces where individuals are part of a social or faith community. As people living with chronic illness(es) actively pursue the good life, health care systems must consider these pursuits as valid parts of the human experience that also challenge narrow definitions of health.

Social media use and adolescents' well-being: A note on flourishing

Background

Several large-scale studies and reviews have reported both negative and positive associations of social media use with well-being, suggesting that the findings are more complex and need more nuanced study. Moreover, there is little or no exploration of how social media use in adolescence influences flourishing, a more all-encompassing construct beyond well-being, including six sub-domains (i.e., happiness, meaning and purpose, physical and mental health, character, close social relationships, and financial stability). This paper aims to fill this gap by understanding how adolescents might flourish through social media activities by fulfilling the basic needs pointed out by the Self-Determination Theory, i.e., relatedness, autonomy, and competence.

Methods

The study is drawn on cross-sectional data collected from 1,429 Swiss adolescents (58.8% females, M_age = 15.84, SD_age = 0.83) as part of the HappyB project in Spring 2022. Self-reported measures included the Harvard Adolescent Flourishing scale, positive and negative online social experiences, self-disclosure on social media, and social media inspiration. Control variables included, among others, self-esteem, ill-being, and personality.

Results

After applying Bonferroni's correction, results of the hierarchical regression analyses showed that positive social media experiences (β = 0.112, p < 0.001) and social media inspirations from others (β = 0.072, p < 0.001) and for others (β = 0.060, p = 0.003) were positively associated with flourishing. Flourishing was inversely associated with negative social media experiences (β = -0.076, p < 0.001). Among covariates, self-esteem (β = 0.350, p < 0.001), ill-being (β = -0.252, p < 0.001), perceived school environment (β = 0.138, p < 0.001), self-reported level of physical activity (β =0.109, p < 0.001), and perceived socio-economic status (β = -0.059, p = 0.001) were all related to flourishing. In contrast, gender, high school year, age, perceived stress, and personality (extraversion and neuroticism) were not.

Conclusion

Using a well-being framework to investigate social media use in adolescents is needed to go beyond the ill-being perspective. Our results align with the needs pointed out by the Self-Determination Theory. Carrying out social media activities in a way that promotes-rather than diminishes-flourishing should be included as an additional good habit influencing adolescents' development. We suggest that interventions aiming to foster adolescents' flourishing should include curricula aiming to promote a good use of social media through positive online social relationships and inspirational contents.