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Andreassen P, Jensen SD, Bruun JM, Sandbæk A. Managing the new wave of weight loss medication in general practice: A qualitative study. Clin Obes 2024; 14:e12666. [PMID: 38660941 DOI: 10.1111/cob.12666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 03/19/2024] [Accepted: 03/27/2024] [Indexed: 04/26/2024]
Abstract
In early 2023, a new type of weight loss medication, Wegovy (semaglutide), was made available in Denmark. Both subsequent media coverage and public demand were huge. Wegovy is only available by prescription, primarily via general practitioners. However, there is very little knowledge about how healthcare professionals (HCPs) in general practice might deal with the great demand for and attention surrounding a new weight loss drug. The aim of this qualitative study was, therefore, to explore how Wegovy is managed and negotiated in general practice, particularly in terms of prescribing and follow-up. We conducted a focused ethnography study based on direct observation of consultations and both formal and informal interviews with seven doctors and four nurses from three general practices in Denmark. Using discourse analysis, we identified four central discourses revolving around trust in medicine, individual responsibility for health, the cost of weight loss medication, and the importance of shared decision-making. This study shows that the availability of a new, sought-after weight loss medication presents both opportunities and challenges for HCPs in general practice. The management of Wegovy involves numerous factors, including medical, economic, organizational, interpersonal and moral concerns.
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Affiliation(s)
| | - Sissel Due Jensen
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Jens M Bruun
- The Danish National Center for Obesity, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Annelli Sandbæk
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Research Unit of General Practice, Aarhus, Denmark
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Schumann M. Are we speaking the same language? Exploring the impact of translation on discourse analysis in health professions education. MEDICAL EDUCATION 2024. [PMID: 38639215 DOI: 10.1111/medu.15406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 04/08/2024] [Indexed: 04/20/2024]
Affiliation(s)
- Marwa Schumann
- Dieter Scheffner Center for Medical Education und Educational Research, Dean's Office for Study Affairs, Charité-Universitätsmedizin Berlin, Berlin, Germany
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3
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Christensen RVK, Bentsen NS. Discourse developments within the public agenda on Danish nature management 2016-2021: Animal welfare ethics as a barrier to rewilding projects. AMBIO 2024; 53:637-652. [PMID: 38070061 PMCID: PMC10920536 DOI: 10.1007/s13280-023-01964-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/21/2023] [Accepted: 11/10/2023] [Indexed: 03/09/2024]
Abstract
Prompted by the increasing public focus on environmental policy and the continuous inability of States to reach environmental targets agreed upon in the context of the United Nations and the European Union, we explore the development of discourses within the Danish public agenda regarding nature management 2016-2021. This is done through a mixed-methods framework of discourse analysis and structural topic modeling based on documents from the Danish Parliament's Environmental committee 2016-2021, estimating topic prevalence, and analyzing the discourses within each topic, resulting in a qualitative overview of 21 identified topics and their associated discourses and an overview of how the different topic proportions changed over time. A shift in the public agenda was found: a change from discussions about untouched forest focused on trade-offs between timber extraction and biodiversity, to a discussion about different understandings of animal welfare in the context of large grazers in nature national parks in Denmark.
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Affiliation(s)
| | - Niclas Scott Bentsen
- Department of Geosciences and Natural Resource Management, University of Copenhagen, Rolighedsvej 23, 1958, Frederiksberg C, Denmark.
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4
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Phillips P, Cassidy T. Social Representations and Symbolic Coping: A Cross-Cultural Discourse Analysis of the COVID-19 Pandemic in Newspapers. HEALTH COMMUNICATION 2024; 39:451-459. [PMID: 36710515 DOI: 10.1080/10410236.2023.2169300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
This study used a framework grounded in social representations theory to investigate cross-cultural variation and consistency in the discursive construction of the COVID-19 pandemic by the mass media, in the week following WHO's declaration of a global pandemic in March 2020. News reports from media outlets in the United Kingdom and China were sourced, with articles from the most popular media sources selected for analysis. Four discourses were identified to be the most prominent representations present throughout these accounts: war; other illnesses; a general emergency; an unknown situation. The findings demonstrated consistency with past research, highlighting how the sociogenesis of social representations in the case of the COVID-19 pandemic followed a similar pattern to other novel infectious disease outbreaks. Consistency between UK and Chinese media accounts was identifiable throughout the construction of these discourses; however, variation was detectable regarding use of culturally relevant anchors for existing illness representations, along with Chinese media accounts constructing images of a comparatively optimistic local situation, whilst depicting the rest of the world as in the midst of a global emergency. Future research has the potential to build on these findings by going beyond media representations to explore actual lay population beliefs, attitudes, and opinions, considering how they compare to the representations portrayed in mass-mediated news reports.
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Affiliation(s)
- Peter Phillips
- School of Psychology, Psychology Research Institute, Ulster University
| | - Tony Cassidy
- School of Psychology, Psychology Research Institute, Ulster University
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Azios JH, Lee JB, Sigur A, Archer B, Elman RJ. Online Aphasia Groups: Navigating Issues of Voice and Identity. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:333-348. [PMID: 38085656 DOI: 10.1044/2023_ajslp-23-00186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
PURPOSE Participation in aphasia groups is associated with increased communication, reduced feelings of social isolation, and increased quality of life. Despite the growing popularity of online aphasia groups, little is known about how to manage conversation in this format. We examined online aphasia book club sessions to examine how the facilitator supported group members' participation in conversation. METHOD Interactional sociolinguistic discourse analysis was used to analyze the behaviors and actions of the facilitator and group members. Qualitative data for this study were drawn from four recorded online aphasia book club sessions held through a university's free aphasia clinic on the Zoom web-conferencing platform. RESULTS Sociolinguistic discourse analysis revealed strategic facilitator behaviors that served to (a) give members with varying levels of verbal language abilities voice, (b) foreground or background aspects of voice, and (c) minimize her own voice to promote interactional symmetry between herself and group members. CONCLUSIONS Identity formed the backdrop for facilitators' actions when leading online groups, guiding decisions about who got to talk, when, for how long, through what modality, and about what topics. A better understanding of the interactions that occur online, such as how to develop and protect the identities of group members, could equip facilitators with the tools necessary for facilitating positive, engaging aphasia therapy groups online.
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Wets C, Bracke P, Delaruelle K, Ceuterick M. 'Through a kaleidoscope': A Foucauldian discourse analysis of Belgian policy regarding patients with a migration background and depression in general practices. Health (London) 2023:13634593231211519. [PMID: 38049974 DOI: 10.1177/13634593231211519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
A higher prevalence of depression is found among patients with a migration background within the Belgian population. Nevertheless, this group is underrepresented in ambulant and residential mental health care services. Since general practitioners (GPs) have a crucial gatekeeping role, this led some researchers to investigate the possibility of a provider bias influencing GPs' assessment and referral of depressed patients with a migration background. However, GPs' accounts may be influenced by wider professional discourses present at the policy level, which are inevitably linked to institutions regulating the conduct of GPs. Therefore, this study applied a Foucauldian discourse analysis (a) to identify broader professional discourses in Belgian policy documents regarding patients with a migration background and depression in general practices, (b) to examine how patients with a migration background are discursively positioned and (c) to investigate which different balances of power in the relationship between GPs and patients with a migration background are demonstrated in the identified discourses. We identified three recurring discourses: (a) the othering discourse, (b) the health literacy discourse, and (c) the person-centred discourse. Our analysis demonstrated that the former two discourses illustrate the perpetuation of a biomedical discourse. While the last discourse is aligned with a counter-discourse associated with the person-centred care model in health care. Consequently, our analysis demonstrated the construction of a contradictory discursive framework throughout the various policy documents on which GPs might rely when speaking about patients with a migration background suffering from depression.
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Ho EY, Karliner LS, Leung G, Harb R, Aguayo Ramirez G, Garcia ME. "How's your mood": Recorded physician mental health conversations with Chinese and Latino patients in routine primary care visits. PATIENT EDUCATION AND COUNSELING 2023; 114:107850. [PMID: 37364381 PMCID: PMC10528172 DOI: 10.1016/j.pec.2023.107850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/24/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE Patient-physician communication patterns may influence discussions around depressive symptoms and contribute to engagement in depression care among racial/ethnic minority adults. We examined patient-physician communication about depressive symptoms during routine primary care visits with Chinese and Latino patients with and without language barriers. METHODS We examined 17 audio-recorded conversations between primary care physicians and Chinese (N = 7) and Latino (N = 10) patients who discussed mental health during their visit and reported depressive symptoms on a post-visit survey. Conversations (in English, Cantonese, Mandarin, Hoisan-wa, Spanish) were transcribed and translated by bilingual/bicultural research assistants and analyzed using inductive and deductive thematic and discourse analysis. RESULTS Patients initiated mental health discussion in eleven visits. Physicians demonstrated care in word choice and sometimes avoided openly mentioning depression; this could contribute to miscommunication around symptoms and treatment goals. Interpreters had difficulty finding single words to convey terms used by either patients or physicians. CONCLUSION Patients and doctors appeared willing to discuss mental health; however, variability in terminology presented challenges in mental health discussions in this culturally and linguistically diverse sample. PRACTICE IMPLICATIONS Further understanding patient preferred terminology about mental health symptoms and interpreter training in these terms could improve patient-physician communication about depressive symptoms and treatment preferences.
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Affiliation(s)
- Evelyn Y Ho
- Department of Communication Studies, University of San Francisco, San Francisco, CA, USA; Asian American Research Center on Health, University of California, San Francisco, San Francisco, CA, USA.
| | - Leah S Karliner
- Multiethnic Health Equity Research Center, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA; Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Genevieve Leung
- Department of Rhetoric and Language, University of San Francisco, San Francisco, CA, USA
| | - Raneem Harb
- Department of Communication Studies, University of San Francisco, San Francisco, CA, USA
| | - Giselle Aguayo Ramirez
- Multiethnic Health Equity Research Center, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA; Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Maria E Garcia
- Multiethnic Health Equity Research Center, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA; Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
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Dhillon S, Stroinska M, Moll S, Solomon P. Texts influencing the accommodation process of students with disabilities in professional rehabilitation programs: an analysis of discourse. Disabil Rehabil 2023; 45:176-184. [PMID: 34927519 DOI: 10.1080/09638288.2021.2017027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE Students with disabilities have lower enrollment and higher attrition than their non-disabled peers. They identify negative attitudes from educators in their accommodation experiences within professional programs, such as occupational therapy and physiotherapy. Educators in these accredited programs must address a myriad of requirements through curriculum delivery. The documents or "texts" containing program requirements include discourses or dominant understandings of reality. The purpose of this study is to identify these discourses and the resulting positions of educators, to better understand the tensions in accommodating students with disabilities. METHODS A critical discourse analysis study was conducted. Key informants and inclusion criteria led to the collection of 9 texts, which were subsequently analyzed using Norman Fairclough's three-dimensional conception of discourse. RESULTS Three discourses were identified. "Rights and responsibilities" was the most salient discourse, followed by "normative assumptions" and then "inclusion and equity." The associated educator positions are "navigator," "gatekeeper" and "advocate," respectively. CONCLUSIONS The discourses and resulting educator positions are varied and in conflict with one another. There is a potential for change in the social practices related to accommodating students with disabilities. However, these changes need to be conscious and deliberate to ensure inclusivity within the occupational therapy and physiotherapy professions.Implications for RehabilitationCritical discourse analysis is a methodology that can raise awareness of implicit assumptions embedded in texts that reflect and potentially perpetuate inequities and power imbalances.Conflicting discourses in the accommodation process provide a valuable opportunity for educators to critically reflect on personal and professional values and beliefs.Critical reflection on unconscious bias while writing policies and practices could ensure a more diverse pool of applicants for professional programs, thereby enriching rehabilitation professions.
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Affiliation(s)
- Shaminder Dhillon
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Magda Stroinska
- Linguistics and Languages, McMaster University, Hamilton, Canada
| | - Sandra Moll
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Patricia Solomon
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
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“Shelly” DeBiasse MA, Peters SM, Bujiriri B. Dress codes written for dietetics education programs: A Foucauldian discourse analysis. FEMINISM & PSYCHOLOGY 2022. [DOI: 10.1177/09593535221126797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Organized in the US in 1917, dietetics emerged from the discipline of home economics as an “acceptable” area of study for women. Since its inception, dietetics has lacked diversity; most dietetics professionals identify as white, cisgender, heterosexual, middle to upper-middle-class women. In the supervised practice setting, interns are expected to dress “professionally” and follow health/safety protocols. Given the field’s history, it is reasonable to suspect that dress codes—rules/expectations regarding what employees/participants can/cannot wear—for dietetics programs may be problematic. To explore this, we conducted a discourse analysis using a Foucauldian feminist approach, drawing on the notion of governmentality. Eighty-five dietetics dress codes, supplemented with survey questions, from US-based accredited dietetics education programs were analyzed. Three primary discursive effects were identified: “Invisibilizing” informs dietetics students/interns how to be professional and modest. “Protecting” highlights dress to promote health and safety. “Normalizing” privileges conforming to thin, cisgender, white European women of higher SES. These findings show how the dress codes reify a “model” dietitian and privilege/oppress/discipline some bodies over others, supporting criticisms of dietetics dress codes as discriminatory and oppressing/privileging select societal groups. Recommendations are provided to address biases and prevent dress codes from negatively impacting diversity/inclusion in the profession.
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Sud A, Strang M, Buchman DZ, Spithoff S, Upshur REG, Webster F, Grundy Q. How the Suboxone Education Programme presented as a solution to risks in the Canadian opioid crisis: a critical discourse analysis. BMJ Open 2022; 12:e059561. [PMID: 35820738 PMCID: PMC9277368 DOI: 10.1136/bmjopen-2021-059561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Pharmaceutical industry involvement in medical education, research and clinical practice can lead to conflicts of interest. Within this context, this study examined how the 'Suboxone Education Programme', developed and delivered by a pharmaceutical company as part of a federally regulated risk management program, was presented as a solution to various kinds of risks relating to opioid use in public documents from medical institutions across Canada. SETTING These documents were issued during the Canadian opioid crisis, a time when the involvement of industry in health policy was being widely questioned given industry's role in driving the overprescribing of opioid analgesics and contributing to population-level harms. DESIGN A critical discourse analysis of 69 documents collected between July 2020 and May 2021 referencing the Suboxone Education Program spanning 13 years (2007-2021) from medical, nursing and pharmacy institutions sourced from every Canadian province and territory. Discursive themes were identified through iterative and duplicate analyses using a semistructured data extraction instrument. RESULTS Documents characterised the Programme as addressing iatrogenic risks from overprescribing opioid analgesics, environmental risks from a toxic street drug supply and pharmacological risks relating to the dominant therapeutic alternative of methadone. The programme was identified as being able to address these risks by providing mechanisms to surveil healthcare professionals and to facilitate the prescribing of Suboxone. Medical institutions legitimised the Suboxone Education Programme by lending their regulatory, epidemiological and professional authority. CONCLUSIONS Addressing risk is considered as a central, moral responsibility of contemporary healthcare services. In this case, moral imperatives to address opioid crisis-related risks overrode other ethical concerns regarding conflicts of interest between industry and public welfare. Failing to address these conflicts potentially imperils efforts of mitigating population health harms by propagating an important driving force of the opioid crisis.
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Affiliation(s)
- Abhimanyu Sud
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Bridgepoint Collaboratory for Research and Innovation, Sinai Health System, Toronto, Ontario, Canada
| | - Matthew Strang
- Department of Sociology, York University, Toronto, Ontario, Canada
| | - Daniel Z Buchman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Bioethics Program, University Health Network, Toronto, Ontario, Canada
| | - Sheryl Spithoff
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Women's College Hospital, Toronto, Ontario, Canada
| | - Ross E G Upshur
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Bridgepoint Collaboratory for Research and Innovation, Sinai Health System, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Fiona Webster
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Quinn Grundy
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Imafuku R, Saiki T, Woodward-Kron R. Revisiting discourse analysis in medical education research. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2022; 13:138-142. [PMID: 35640066 PMCID: PMC9902170 DOI: 10.5116/ijme.6278.c1b7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 05/09/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Rintaro Imafuku
- Medical Education Development Center, Gifu University, Japan
| | - Takuya Saiki
- Medical Education Development Center, Gifu University, Japan
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Sukhera J, Goez H, Brown A, Haddara W, Razack S. Freedom from discrimination or freedom to discriminate? Discursive tensions within discrimination policies in medical education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:387-403. [PMID: 35025019 PMCID: PMC8757400 DOI: 10.1007/s10459-022-10090-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 01/05/2022] [Indexed: 06/14/2023]
Abstract
The importance of advancing equity, diversity, and inclusion for all members of the academic medical community has gained recent attention. Academic medical organizations have attempted to increase broader representation while seeking structural reforms consistent with the goal of enhancing equity and reducing disproportionality. However, efforts remain constrained while minority groups continue to experience discrimination. In this study, the authors sought to identify and understand the discursive effects of discrimination policies within medical education. The authors assembled an archive of 22 texts consisting of publicly available discrimination and harassment policy documents in 13 Canadian medical schools that were active as of November 2019. Each text was analysed to identify themes, rhetorical strategies, problematization, and power relations. Policies described truth statements that appear to idealize equity, yet there were discourses related to professionalism and neutrality that were in tension with these ideals. There was also tension between organizations' framing of a shared responsibility for addressing discrimination and individual responsibility on complainants. Lastly, there were also competing discourses on promoting freedom from discrimination and the concept of academic freedom. Overall, findings reveal several areas of tension that shape how discrimination is addressed in policy versus practice. Existing discourses regarding self-protection and academic freedom suggest equity cannot be advanced through policy discourse alone and more substantive structural transformation may be necessary. Existing approaches may be inadequate to address discrimination unless academic medical organizations interrogate the source of these discursive tensions and consider asymmetries of power.
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Affiliation(s)
- Javeed Sukhera
- Chair/Chief of Psychiatry, Institute of Living, Hartford Hospital, Terry Building, 200 Retreat Avenue, 06102, Hartford, Connecticut, USA.
| | - Helly Goez
- Chair/Chief of Psychiatry, Institute of Living, Hartford Hospital, Terry Building, 200 Retreat Avenue, 06102, Hartford, Connecticut, USA
- Department of Pediatrics, Faculty of Medicine and Dentistry, College of Health Sciences University of Alberta, Edmonton, Canada
| | - Allison Brown
- Chair/Chief of Psychiatry, Institute of Living, Hartford Hospital, Terry Building, 200 Retreat Avenue, 06102, Hartford, Connecticut, USA
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Wael Haddara
- Chair/Chief of Psychiatry, Institute of Living, Hartford Hospital, Terry Building, 200 Retreat Avenue, 06102, Hartford, Connecticut, USA
- Department of Medicine and Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
| | - Saleem Razack
- Chair/Chief of Psychiatry, Institute of Living, Hartford Hospital, Terry Building, 200 Retreat Avenue, 06102, Hartford, Connecticut, USA
- Department of Paediatrics and Institute for Health Sciences Education, McGill University, Montreal, Canada
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Zafir S, Jovanovski N. The weight of words: Discursive constructions of health in weight-neutral peer-reviewed journal articles. Body Image 2022; 40:358-369. [PMID: 35149443 DOI: 10.1016/j.bodyim.2022.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 11/30/2022]
Abstract
Weight-neutral approaches to health, like the Health at Every Size® (HAES®) approach arose in response to emerging evidence showing the negative health consequences of weight-focused approaches through the effects of stigma and marginalization in many settings, including healthcare. While the discourses of dominant 'weight-normative' approaches are well-researched and described, little is known about how language and discourse is creating certain 'truths' about weight-neutral approaches. The aim of this study was to explore how academic discourses create truths about weight-neutral approaches to health. A discourse analysis of 63 academic journal articles was conducted. We found that the language used in academic literature is creating confusing and contradictory messages about weight and weight-neutral approaches to health (like the HAES® approach) through: (i) the continued use of stigmatising and normative labels like 'overweight' and 'obese', (ii) paradoxical language like 'flexible restraint', and (iii) a focus on individual responsibility and blame for health and weight without acknowledgement of broader societal and systemic factors. More research is needed to characterize weight-neutral approaches and develop a clearer framework for researchers wishing to engage with the weight-neutral paradigm of health.
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Affiliation(s)
- Shoa Zafir
- Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia.
| | - Natalie Jovanovski
- Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia.
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Arabadjis SD, Sullivan EE. Data and HIT systems in primary care settings: an analysis of perceptions and use. J Health Organ Manag 2021; ahead-of-print. [PMID: 33354961 DOI: 10.1108/jhom-03-2020-0071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE Electronic Health Records (EHRs) and other Health Information Technologies (HITs) pose significant challenges for clinicians, administrators and managers in the field of primary care. While there is an abundance of literature on the challenges of HIT systems in primary care, there are also practices where HITs are well-integrated and useful for care delivery. This study aims to (1) understand how exemplary primary care practices conceptualized data and HIT system use in their care delivery and (2) describe components that support and promote data and HIT system use in care delivery. DESIGN/METHODOLOGY/APPROACH This paper is a sub-analysis of a larger qualitative data set on exemplary primary care in which data was collected using in-depth interviews, observations, field notes and primary source documents from week-long site visits at each organization. Using a combination of qualitative analysis methods including elements of thematic analysis, discourse analysis, and qualitative comparison analysis, we examined HIT-related data across six exemplary primary care organizations. FINDINGS Three key components were identified that underlie engagement with data and HIT systems: data audience identification, defined data purpose and structures for participation in both data design and maintenance. ORIGINALITY/VALUE Within the context of primary care, these findings have implications for effective integration of HIT systems into primary care delivery.
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Affiliation(s)
- Sophia D Arabadjis
- Geography, University of California Santa Barbara, Santa Barbara, California, USA
| | - Erin E Sullivan
- Sawyer Business School, Suffolk University, Boston, Massachusetts, USA.,Center for Primary Care, Harvard Medical School, Boston, Massachusetts, USA
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Hinton L, Chisholm A, Jakubowski B, Greenfield S, Tucker KL, McManus RJ, Locock L. "You Probably Won't Notice Any Symptoms": Blood Pressure in Pregnancy-Discourses of Contested Expertise in an Era of Self-Care and Responsibilization. QUALITATIVE HEALTH RESEARCH 2021; 31:1632-1644. [PMID: 34116606 PMCID: PMC8438769 DOI: 10.1177/10497323211003067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Pregnancy is not a disease or illness, but requires clinical surveillance as life-threatening complications can develop. Preeclampsia, one such potentially serious complication, puts both mother and baby at risk. Self-monitoring blood pressure in the general population is well established, and its potential in pregnancy is currently being explored. In the context of self-monitoring, the information and guidance given to women regarding hypertension, and the literature they themselves seek out during pregnancy, are vital to perceptions of disease risk and subsequent responses to, and management of, any symptoms. Drawing on online, offline, official, and unofficial sources of information, discourses are examined to provide analysis of how self-responsibilization is reflected in contemporary information, advice, and guidance drawn from multiple sources. A paradox emerges between the paternalistic and lay discourses that seek to challenge and regain control. Findings are discussed in the context of Foucault's governmentality and medical power.
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Affiliation(s)
- Lisa Hinton
- University of Cambridge, Cambridge, United Kingdom
- Lisa Hinton, The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, Clifford Allbutt Building, Cambridge Biomedical Campus, Cambridge CB2 0AH, UK.
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Collins JC, MacKenzie M, Schneider CR, Chaar BB, Moles RJ. A mixed-method simulated patient approach to explore implicit bias in health care: A feasibility study in community pharmacy. Res Social Adm Pharm 2021; 17:553-559. [DOI: 10.1016/j.sapharm.2020.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/29/2020] [Accepted: 05/02/2020] [Indexed: 11/16/2022]
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Professional Medical Discourse and the Emergence of Practical Wisdom in Everyday Practices: Analysis of a Keyhole Case. HEALTH CARE ANALYSIS 2020; 28:137-157. [PMID: 31583498 DOI: 10.1007/s10728-019-00385-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Recent publications have argued that practical wisdom is increasingly important for medical practices, particularly in complex contexts, to stay focused on giving good care in a moral sense to each individual patient. Our empirical investigation into an ordinary medical practice was aimed at exploring whether the practice would reveal practical wisdom, or, instead, adherence to conventional frames such as guidelines, routines and the dominant professional discourse. We performed a thematic analysis both of the medical files of a complex patient and her daughter's diary. We did find practical wisdom, but only sporadically, whereas it has proved to be essential for professional care. This deficit appeared to result from several factors like: the organization of the practice; established routines; a hierarchical culture; and a traditional medical discourse. Moreover, we discerned various negative consequences. More empirical research into practical wisdom in everyday medical practices is needed for the benefit of professional and morally good care for every patient.
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Ericksonian Hypnotherapy Resemblances in Solution Focused Brief Therapy. CONTEMPORARY FAMILY THERAPY 2020. [DOI: 10.1007/s10591-020-09539-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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19
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Tran BQ, Sweeny K. Correlates of Physicians' and Patients' Language Use during Surgical Consultations. HEALTH COMMUNICATION 2020; 35:1248-1255. [PMID: 31155962 DOI: 10.1080/10410236.2019.1625001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A multi-method approach was used to explore correlates of technical and complex language use within 145 audio-recorded physician-patient interactions. When discussing the prospect of surgery, physicians used more technical and complex language (more jargon, larger words, longer sentences) than patients on average. Patients' demographic characteristics (education, health literacy, English fluency) and markers of health (condition severity) inconsistently predicted physicians' and patients' use of complex and technical language. Interactions with happier and more hopeful patients involved less technical and complex language, but physicians' language use was unrelated to patients' emotions following the consultation. Finally, physicians' use of more technical language predicted greater patient satisfaction following the consultation, and physicians' use of more complex language at the initial consultation predicted better adherence by patients following surgery. Our results highlight the nuanced role of language use within healthcare interactions and identifies language complexity as a novel target for health communication research.
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Affiliation(s)
- Brandon Q Tran
- Department of Psychology, University of California , Riverside
| | - Kate Sweeny
- Department of Psychology, University of California , Riverside
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Couchman E, Lempp H, Naismith J, White P. The family physician’s role in palliative care: Views and experiences of patients with cancer. PROGRESS IN PALLIATIVE CARE 2019. [DOI: 10.1080/09699260.2019.1680127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Emilie Couchman
- Department of Population and Health Sciences, King’s College London, London, UK
| | - Heidi Lempp
- Department of Inflammation Biology, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | | | - Patrick White
- Department of Population and Health Sciences, King’s College London, London, UK
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Zulu JM, Blystad A, Haaland MES, Michelo C, Haukanes H, Moland KM. Why teach sexuality education in school? Teacher discretion in implementing comprehensive sexuality education in rural Zambia. Int J Equity Health 2019; 18:116. [PMID: 31558168 PMCID: PMC6764121 DOI: 10.1186/s12939-019-1023-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/21/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Reproductive health problems such as HIV, unwanted pregnancy and unsafe abortion among adolescents are closely linked to insufficient knowledge about sexuality and reproduction and lack of access to contraceptives. Supported by international agencies, Zambia has introduced an ambitious nation-wide program for comprehensive sexuality education (CSE) to be implemented into ordinary school activities by teachers. The curriculum is firmly based in a discourse of sexual and reproductive rights, not commonly found in the public debate on sexuality in Zambia. This paper explores how teachers perceive the curriculum and practice discretion when implementing the CSE in mid-level schools in Nyimba district in Zambia. METHODS Using a case study design, data were collected through in-depth interviews with 18 teachers and analyzed thematically drawing upon theories of discretion and policy implementation. RESULTS Individual teachers make decisions on their own regarding what and when to teach CSE. This discretion implies holding back information from the learners, teaching abstinence as the only way of preventing pregnancy or cancelling sexuality education sessions altogether. Teachers' choices about the CSE program were linked to lack of guidance on teaching of the curriculum, especially with regards to how to integrate sexuality education into existing subjects. Limited prioritization of CSE in the educational sector was observed. The incompatibility of CSE with local norms and understandings about adolescent sexuality combined with teacher-parent role dilemmas emerged as problematic in implementing the policy. Limited ownership of the new curriculum further undermined teachers' motivation to actively include CSE in daily teaching activities. Use of discretion has resulted in arbitrary teaching thus affecting the acquisition of comprehensive sexual and reproductive health knowledge among learners. CONCLUSION The CSE had limited legitimacy in the community and was met with resistance from teachers tasked with its' implementation. In order to enhance ownership to the CSE program, local concerns about the contents of the curriculum and the parent-teacher role dilemma must be taken into consideration. Not addressing these challenges may undermine the policy's intention of increasing knowledge about sexuality and reproduction and empowering adolescents to access contraceptive services and avoid unwanted pregnancies.
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Affiliation(s)
| | - Astrid Blystad
- Centre for international Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway
| | - Marte E. S. Haaland
- Centre for international Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway
| | - Charles Michelo
- School of Public Health, University of Zambia, Lusaka, Zambia
| | - Haldis Haukanes
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
| | - Karen Marie Moland
- Centre for international Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway
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Rozbroj T, Lyons A, Lucke J. The mad leading the blind: Perceptions of the vaccine-refusal movement among Australians who support vaccination. Vaccine 2019; 37:5986-5993. [PMID: 31451326 DOI: 10.1016/j.vaccine.2019.08.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/10/2019] [Accepted: 08/15/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Vaccine refusal is shaped by the social ecology in which it occurs. How people who refuse vaccines are communicated to and treated may affect the nature and strength of their negative vaccine beliefs, and their responsiveness to health promotion messages. Yet little is known about how people who refuse vaccines are perceived by the public. Our research examined perceptions among pro-vaccine Australians of the vaccine-refusal movement. METHODS Descriptions of the vaccine-refusal movement by 2666 pro-vaccine Australians were analysed using thematic discourse analysis. Descriptive themes were identified via inductive, iterative coding. Discourse analysis techniques were then used to interpret latent beliefs about the vaccine-refusal movement. RESULTS Participants had negative and stigmatising perceptions of the vaccine-refusal movement. They believed the movement is dangerous, misinformed, and comprised of charlatans and fools who are unintelligent, selfish, overly emotional, conspiratorial and scientifically illiterate. Discursive analysis showed that these perceptions were underpinned by beliefs that people would have to be defective in some way to believe anti-vaccine rhetoric. Furthermore, perceptions were underpinned by beliefs that the movement spreads not only disease, but also dangerous ideas that were seen to attack the social order, institutions, values and reason. Participants' intensely-negative views related to their inability to imagine why someone would refuse vaccines. CONCLUSIONS This research provides a focused, qualitative account of public perceptions of the vaccine-refusal movement. The findings are concerning: stigma towards vaccine-refusing people may adversely affect their wellbeing and entrench their negative vaccine beliefs. The research suggests that more compassionate, nuanced discussion of vaccine refusal in the public sphere is needed. It also supports the need to systematically examine public attitudes towards vaccine refusal as a determinant of vaccine confidence.
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Affiliation(s)
- T Rozbroj
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, VIC 3086, Australia.
| | - A Lyons
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, VIC 3086, Australia
| | - J Lucke
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, VIC 3086, Australia; School of Public Health, The University of Queensland, St Lucia, QLD 4072, Australia
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Frost J, Gibson A, Ukoumunne O, Vaidya B, Britten N. Does a simple web-based intervention facilitate the articulation of patients' unvoiced agenda for a consultation with their diabetologists? A qualitative study. BMJ Open 2019; 9:e026588. [PMID: 31203240 PMCID: PMC6588975 DOI: 10.1136/bmjopen-2018-026588] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To explore whether a preconsultation web-based intervention enables patients with diabetes to articulate their agenda in a consultation in the hospital outpatient clinic with their diabetologist. METHODS AND DESIGN A qualitative study embedded in a pragmatic pilot randomised controlled trial. SETTING Two city outpatient departments in England. PARTICIPANTS 25 patients attending a follow-up consultation and 6 diabetologists. INTERVENTION The PACE-D, a web-based tool adapted for patients with diabetes to use before their consultation to generate an agenda of topics to discuss with their diabetologist. DATA COLLECTION 25 participants had their consultation with their diabetologist audio-recorded: 12 in the control arm and 13 in the intervention arm; 12 of the latter also had their PACE-D intervention session and a consultation recorded. Semi-structured interviews with 6 diabetologists, and 12 patients (6 in the intervention group and 6 in the control group). ANALYSIS Thematic discourse analysis undertaken with patient representatives trained in qualitative data analysis techniques. RESULTS We identified four consultation types: diabetologist facilitated; patient identified; consultant facilitated and patient initiated and patient ignored. We also identified three critical aspects that explained the production and utilisation of the agenda form: existing consultative style; orientation to the use of the intervention and impact on the consultation. Where patients and diabetologists have a shared preference for a consultant-led or patient-led consultation, the intervention augments effective communication and shared decision making. However, where preferences diverge (eg, there is a mismatch in patients' and diabetologists' preferences and orientations), the intervention does not improve the potential for shared decision making. CONCLUSION A simple web-based intervention facilitates the articulation of patients' unvoiced agenda for a consultation with their diabetologist, but only when pre-existing consultation styles and orientations already favour shared decision making. More needs to be done to translate patient empowerment in the consultation setting into genuine self-efficacy. TRIAL REGISTRATION NUMBER ISRCTN75070242.
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Affiliation(s)
- Julia Frost
- Medical School, University of Exeter, Exeter, UK
| | - Andy Gibson
- Health and Social Sciences, University of the West of England, Bristol, Bristol, UK
| | - Obioha Ukoumunne
- NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
| | - Bijay Vaidya
- Macleod Diabetes Centre, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- Institute for Health Service Research, University of Exeter Medical School, Exeter, UK
| | - Nicky Britten
- Institute for Health Service Research, University of Exeter Medical School, Exeter, UK
- PenCLAHRC: National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsula, University of Exeter Medical School, Exeter, UK
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Castro-Sánchez E, Iwami M, Ahmad R, Atun R, Holmes AH. Articulating citizen participation in national anti-microbial resistance plans: a comparison of European countries. Eur J Public Health 2019; 28:928-934. [PMID: 29982459 DOI: 10.1093/eurpub/cky128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background National action plans determine country responses to anti-microbial resistance (AMR). These plans include interventions aimed at citizens. As the language used in documents could persuade certain behaviours, we sought to assess the positioning and implied responsibilities of citizens in current European AMR plans. This understanding could lead to improved policies and interventions. Methods Review and comparison of national action plans for AMR (NAP-AMR) obtained from the European Centre for Disease Prevention and Control (plans from 28 European Union and four European Economic Area/European Free Trade Association countries), supplemented by European experts (June-September 2016). To capture geographical diversity, 11 countries were purposively sampled for content and discourse analyses using frameworks of lay participation in healthcare organization, delivery and decision-making. Results Countries were at different stages of NAP-AMR development (60% completed, 25% in-process, 9% no plan). The volume allocated to citizen roles in the plans ranged from 0.3 to 18%. The term 'citizen' was used by three countries, trailing behind 'patients' and 'public' (9/11), 'general population' (6/11) and 'consumers' (6/11). Increased citizen awareness about AMR was pursued by ∼2/3 plans. Supporting interventions included awareness campaigns (11/11), training/education (7/11) or materials during clinical encounters (4/11). Prevention of infection transmission or self-care behaviours were much less emphasized. Personal/individual and social/collective role perspectives seemed more frequently stimulated in Nordic countries. Conclusion Citizen roles in AMR plans are not fully articulated. Documents could employ direct language to emphasise social or collective responsibilities in optimal antibiotic use.
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Affiliation(s)
- Enrique Castro-Sánchez
- NIHR Health Protection Research Unit in Healthcare Associated Infection & Antimicrobial Resistance at Imperial College London, London, UK
| | - Michiyo Iwami
- NIHR Health Protection Research Unit in Healthcare Associated Infection & Antimicrobial Resistance at Imperial College London, London, UK
| | - Raheelah Ahmad
- NIHR Health Protection Research Unit in Healthcare Associated Infection & Antimicrobial Resistance at Imperial College London, London, UK.,Health Group, Management Department, Imperial College Business School, London, UK
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Global Health Systems Cluster, Boston, MA, USA
| | - Alison H Holmes
- NIHR Health Protection Research Unit in Healthcare Associated Infection & Antimicrobial Resistance at Imperial College London, London, UK
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Ashcroft R, Kennedy L, Van Katwyk T. An Exploration of the Methods of Communication between Policy Makers and Providers that Help Facilitate Implementation of Primary Health Care Reforms. SOCIAL WORK IN PUBLIC HEALTH 2019; 34:370-382. [PMID: 31033424 DOI: 10.1080/19371918.2019.1606756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Policy reforms targeting organizational structure, expansion of interprofessional teams, inclusion of collaborative practices, and shifting provider remuneration models have resulted with substantial change for providers and leaders with primary health care settings in Canada, USA, and elsewhere. Discourse analysis provides a theoretical lens that can help build an understanding about the implications of different modes of communication on the implementation of new policy initiatives like new models of primary health care. This study applies discourse analysis to determine the modes of communication that were used to relay policy expectations underpinning a newly emerging interprofessional model of primary health care. We conducted a secondary analysis of a qualitative study conducted between 2010 and 2011 with primary health care leaders and policy informants during a period of health care reform in Canada. In-depth semi-structured interviews were conducted with seven key policy informants (PIs) and 29 primary health care leaders (physicians, executive directors, and non-physician clinical leaders). Discourse analysis is useful in the investigation of the meanings of health, health policy, and health care settings.
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Affiliation(s)
- Rachelle Ashcroft
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , Ontario , Canada
| | - Lauren Kennedy
- b School of Social Work , Renison University College, University of Waterloo , Canada
| | - Trish Van Katwyk
- b School of Social Work , Renison University College, University of Waterloo , Canada
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26
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Sherlock R, Wood F, Joseph-Williams N, Williams D, Hyam J, Sweetland H, McGarrigle H, Edwards A. "What would you recommend doctor?"-Discourse analysis of a moment of dissonance when sharing decisions in clinical consultations. Health Expect 2019; 22:547-554. [PMID: 30916446 PMCID: PMC6543150 DOI: 10.1111/hex.12881] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 01/31/2019] [Accepted: 03/01/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Proven benefits of Shared Decision Making (SDM) include improved patient knowledge, involvement and confidence in making decisions. Although widely advocated in policy, SDM is still not widely implemented in practice. A common patient-reported barrier is feeling that "doctor knows best"; thus, patients often defer decisions to the clinician. OBJECTIVE To examine the nature of the discourse when patients ask clinicians for a treatment recommendation during consultations when treatment decisions are being shared and to examine clinicians' strategies used in response. DESIGN, SETTING AND PARTICIPANTS Theme-orientated discourse analysis was performed on eight audio-recordings of breast cancer diagnostic consultations in which patients or their partners attempted to defer treatment decisions to the clinician. Clinicians were trained in SDM. RESULTS Tension was evident in a number of consultations when treatment recommendations were requested. Clinicians responded to recommendation requests by explaining why the decision was being shared (personal nature of the decision, individual preferences and equivalent survival outcomes of treatment options). There was only one instance where a clinician gave a treatment recommendation. DISCUSSION AND CONCLUSIONS Strategies for clinicians to facilitate SDM when patients seem to defer decisional responsibility include being clear about why the decision is being shared, acknowledging that this is difficult and making patients feel supported. When patients seek guidance, clinicians can provide a recommendation if grounded in an understanding of the patient's values.
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Affiliation(s)
- Rebecca Sherlock
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Fiona Wood
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | | | - Denitza Williams
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Joanna Hyam
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | | | | | - Adrian Edwards
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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27
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Blackburn M, Stathi A. Moral discourse in general practitioners' accounts of obesity communication. Soc Sci Med 2019; 230:166-173. [PMID: 31030008 DOI: 10.1016/j.socscimed.2019.03.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/23/2019] [Accepted: 03/21/2019] [Indexed: 10/27/2022]
Abstract
Obesity is not addressed with a large proportion of patients presenting in general practice. An increasing body of evidence suggests that health professionals view body weight as a sensitive topic to include in routine consultations and face barriers in initiating weight loss discussions. This study examined the discursive power relations that shape how general practitioners (GPs) understand and talk about obesity using a novel methodology to elicit responses from GPs about raising the topic of weight. Twenty GPs from the South West of England reflected upon novel trigger films simulating doctor-patient interactions, in which a doctor either acknowledged or ignored their patient's body weight. Underpinned by a discourse analytic approach, our findings suggest that GPs both reproduce and resist moral discourse surrounding body weight. They construct obesity as an individual behavioural problem whilst simultaneously drawing on socio-cultural discourse which positions body weight as central to social identity, situating obesity within a context of stigma and positioning patients as powerless to lose weight. Our findings highlight a need for increased reflexivity about competing discursive frameworks at play during medical consultations about obesity, which we suggest, contribute to increased tension and powerlessness for GPs. Trigger films are an innovative method to elicit information and discuss competing discourses.
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Affiliation(s)
- Maxine Blackburn
- University of Bath, Department for Health, Bath, BA2 7AY, UK; University of Edinburgh, Usher Institute of Population Health Sciences and Informatics, Edinburgh, EH8 9AG, UK.
| | - Afroditi Stathi
- University of Bath, Department for Health, Bath, BA2 7AY, UK; University of Birmingham, School of Sport, Exercise and Rehabilitation Sciences, Birmingham, B15 2TT, UK.
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Koenig CJ, Wenger M, Graham GD, Asch S, Rongey C. Managing professional knowledge boundaries during ECHO telementoring consultations in two Veterans Affairs specialty care liver clinics: A theme-oriented discourse analysis. J Telemed Telecare 2018. [PMID: 29514547 DOI: 10.1177/1357633x18756454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Consultations are the traditional method of communication between generalist and specialist providers managing patients with specialty care needs. Traditional written consultations have limitations, including inadequate clinical information and inappropriate, or unclear consultation questions. Teleconsultations minimize these limitations through real-time communication between generalist and specialist providers to actively manage professional knowledge boundaries about specialty care problems. METHODS We video-recorded 37 teleconsultation sessions, resulting in 115 consultations between generalist and specialty care providers participating in Veterans Affairs (VA) Extension for Community Healthcare Outcomes (ECHO) liver clinics. Data were collected at two US sites across nine months to observe consultation communication among 33 primary care generalists and three liver specialists. Video recordings were transcribed verbatim and analysed using theme-oriented discourse analysis to characterize consultation question content and format. RESULTS Generalists' consultation question content addressed a range of topics, including treatment, diagnosis, interpreting results, patient communication, screening and surveillance, and care coordination. Some generalists relied on descriptive narratives rather than a specific question to convey complex patient cases. Consultation question format showed nearly even division between targeting general medical knowledge and specialty care knowledge domains, including specialty care, medical, organizational, and experiential knowledge. DISCUSSION Timely access to specialists through teleconsultation has the potential to transform specialty care delivery. This article examines provider-to-provider interactions to understand how the communication process contributes to knowledge management during teleconsultations. Video studies of health information technology use provide a rich opportunity for analysing real-time communication that may help improve cross-specialty collaboration and the coordinated management of patients with specialty care needs.
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Affiliation(s)
- Christopher J Koenig
- 1 San Francisco State University, San Francisco, CA, USA.,2 Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA.,3 San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Matthew Wenger
- 3 San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Glenn D Graham
- 3 San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA.,4 Specialty Care Services, VA Central Office, Washington, DC, USA
| | - Steven Asch
- 2 Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA.,5 Division of General Medical Disciplines, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Catherine Rongey
- 6 University of California, San Francisco, San Francisco, CA, USA.,7 Kaiser Permanente, Vallejo, CA, USA
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Hughes CA, Breault RR, Hicks D, Schindel TJ. Positioning pharmacists' roles in primary health care: a discourse analysis of the compensation plan in Alberta, Canada. BMC Health Serv Res 2017; 17:770. [PMID: 29169360 PMCID: PMC5701384 DOI: 10.1186/s12913-017-2734-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 11/16/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND A comprehensive Compensation Plan for pharmacy services delivered by community pharmacists was implemented in Alberta, Canada in July 2012. Services covered by the Compensation Plan include care planning services, prescribing services such as adapting prescriptions, and administering a drug or publicly-funded vaccine by injection. Understanding how the Compensation Plan was framed and communicated provides insight into the roles of pharmacists and the potential influence of language on the implementation of services covered by the Compensation Plan by Albertan pharmacists. The objective of this study is to examine the positioning of pharmacists' roles in documents used to communicate the Compensation Plan to Albertan pharmacists and other audiences. METHODS Publicly available documents related to the Compensation Plan, such as news releases or reports, published between January 2012 and December 2015 were obtained from websites such as the Government of Alberta, Alberta Blue Cross, the Alberta College of Pharmacists, the Alberta Pharmacists' Association, and the Blueprint for Pharmacy. Searches of the Canadian Newsstand database and Google identified additional documents. Discourse analysis was performed using social positioning theory to explore how pharmacists' roles were constructed in communications about the Compensation Plan. RESULTS In total, 65 publicly available documents were included in the analysis. The Compensation Plan was put forward as a framework for payment for professional services and formal legitimization of pharmacists' changing professional roles. The discourse associated with the Compensation Plan positioned pharmacists' roles as: (1) expanding to include services such as medication management for chronic diseases, (2) contributing to primary health care by providing access to services such as prescription renewals and immunizations, and (3) collaborating with other health care team members. Pharmacists' changing roles were positioned in alignment with the aims of primary health care. CONCLUSIONS Social positioning theory provides a useful lens to examine the dynamic and evolving roles of pharmacists. This study provides insight into how communications regarding the Compensation Plan in Alberta, Canada positioned pharmacists' changing roles in the broader context of changes to primary health care delivery. Our findings may be useful for other jurisdictions considering implementation of remunerated clinical services provided by pharmacists.
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Affiliation(s)
- Christine A Hughes
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, 3-171 Edmonton Clinic Health Academy, 11405 87 Avenue NW, Edmonton, AB, T6G 1C9, Canada
| | - Rene R Breault
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, 3-171 Edmonton Clinic Health Academy, 11405 87 Avenue NW, Edmonton, AB, T6G 1C9, Canada
| | - Deborah Hicks
- School of Library, Archival and Information Studies, The University of British Columbia, 470 1961 East Mall, Vancouver, BC, V6T 1Z1, Canada
| | - Theresa J Schindel
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, 3-171 Edmonton Clinic Health Academy, 11405 87 Avenue NW, Edmonton, AB, T6G 1C9, Canada.
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Experiences with online consultation systems in primary care: case study of one early adopter site. Br J Gen Pract 2017; 67:e736-e743. [PMID: 28993306 PMCID: PMC5647916 DOI: 10.3399/bjgp17x693137] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 05/18/2017] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND There is a strong policy drive towards implementing alternatives to face-to-face consultations in general practice to improve access, efficiency, and cost-effectiveness. These alternatives embrace novel technologies that are assumed to offer potential to improve care. AIM To explore the introduction of one online consultation system (Tele-Doc) and how it shapes working practices. DESIGN AND SETTING Mixed methods case study in an inner-city general practice. METHOD The study was conducted through interviews with IT developers, clinicians, and administrative staff, and scrutiny of documents, websites, and demonstrator versions of Tele-Doc, followed by thematic analysis and discourse analysis. RESULTS Three interrelated themes were identified: online consultation systems as innovation, managing the 'messiness' of general practice consultations, and redistribution of the work of general practice. These themes raise timely questions about what it means to consult in contemporary general practice. Uptake of Tele-Doc by patients was low. Much of the work of the consultation was redistributed to patients and administrators, sometimes causing misunderstandings. The 'messiness' of consultations was hard to eliminate. In-house training focused on the technical application rather than associated transformations to practice work that were not anticipated. GPs welcomed varied modes of consulting, but the aspiration of improved efficiency was not realised in practice. CONCLUSION Tele-Doc offers a new kind of consultation that is still being worked out in practice. It may offer convenience for patients with discrete, single problems, and a welcome variation to GPs' workload. Tele-Doc's potential for addressing more complex problems and achieving efficiency is less clear, and its adoption may involve unforeseeable consequences.
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VanderKaay S, Moll SE, Gewurtz RE, Jindal P, Loyola-Sanchez A, Packham TL, Lim CY. Qualitative research in rehabilitation science: opportunities, challenges, and future directions. Disabil Rehabil 2016; 40:705-713. [PMID: 27973927 DOI: 10.1080/09638288.2016.1261414] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Qualitative research has had a significant impact within rehabilitation science over time. During the past 20 years the number of qualitative studies published per year in Disability and Rehabilitation has markedly increased (from 1 to 54). In addition, during this period there have been significant changes in how qualitative research is conceptualized, conducted, and utilized to advance the field of rehabilitation. The purpose of this article is to reflect upon the progress of qualitative research within rehabilitation to date, to explicate current opportunities and challenges, and to suggest future directions to continue to strengthen the contribution of qualitative research in this field. METHODS Relevant literature searches were conducted in electronic data bases and reference lists. Pertinent literature was examined to identify current opportunities and challenges for qualitative research use in rehabilitation and to identify future directions. RESULTS Six key areas of opportunity and challenge were identified: (a) paradigm shifts, (b) advancements in methodology, (c) emerging technology, (d) advances in quality evaluation, (e) increasing popularity of mixed methods approaches, and (f) evolving approaches to knowledge translation. Two important future directions for rehabilitation are posited: (1) advanced training in qualitative methods and (2) engaging qualitative communities of research. CONCLUSION Qualitative research is well established in rehabilitation and has an important place in the continued growth of this field. Ongoing development of qualitative researchers and methods are essential. Implications for Rehabilitation Qualitative research has the potential to improve rehabilitation practice by addressing some of the most pervasive concerns in the field such as practitioner-client interaction, the subjective and lived experience of disability, and clinical reasoning and decision making. This will serve to better inform those providing rehabilitation services thereby benefiting patients that are utilizing these services. Changes over time in how qualitative research is conceptualized, conducted, and utilized to advance rehabilitation science have resulted in a number of unique opportunities and challenges in using qualitative research that must be considered within this field. Advances in methodology and increased expectations for evaluation must be considered to ensure quality and credibility of qualitative rehabilitation research within rehabilitation. Improved quality and credibility may increase likelihood of research dissemination and use by clinicians intervening within the rehabilitation process in order to improve clinical practice. In order to maximize opportunities and mitigate challenges there are two principal future directions for rehabilitation scientists to consider: (1) advancing training in qualitative methods to adequately prepare future rehabilitation scientists and (2) engaging qualitative communities of research.
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Affiliation(s)
- Sandra VanderKaay
- a School of Rehabilitation Science , McMaster University , Hamilton , Ontario , Canada
| | - Sandra E Moll
- a School of Rehabilitation Science , McMaster University , Hamilton , Ontario , Canada
| | - Rebecca E Gewurtz
- a School of Rehabilitation Science , McMaster University , Hamilton , Ontario , Canada
| | - Pranay Jindal
- a School of Rehabilitation Science , McMaster University , Hamilton , Ontario , Canada
| | | | - Tara L Packham
- c Hamilton Health Sciences , Hand Therapy Clinic , Hamilton , Ontario , Canada
| | - Chun Y Lim
- d Department of Child Development , KK Women's And Children's Hospital , Singapore
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Abstract
This article provides an overview of political decisions that led up to the implementation of the Ontario Family Health Team (FHT) model. FHTs have broadened primary health care in Ontario by bringing together family physicians with various interdisciplinary professionals. Political decisions have long influenced the shape and need for the FHT model. Knowledge of historically imbedded elements in the FHT model helps to strengthen current and future policy and decision-making. This article is informed by qualitative data collected from interviews with seven policy informants and 29 FHT leaders.
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Koenig CJ, Ho EY, Trupin L, Dohan D. An exploratory typology of provider responses that encourage and discourage conversation about complementary and integrative medicine during routine oncology visits. PATIENT EDUCATION AND COUNSELING 2015; 98:857-63. [PMID: 25865412 PMCID: PMC4430387 DOI: 10.1016/j.pec.2015.02.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 01/24/2015] [Accepted: 02/22/2015] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To characterize how providers respond to patient mentions of complementary and integrative medicine (CIM) during routine oncology visits. METHODS Ethnographic methods were used over a two and a half year period with 82 advanced cancer patients and their providers across four oncology clinics. Participant observation fieldnotes were analyzed using Discourse Analysis. RESULTS CIM was mentioned in 78/229 (34%) of the total observed visits. Patients initiated talk about CIM (76%) more than providers (24%). Patients mentioning CIM may indicate a preference for or interest in non-pharmacological adjunctive treatment options. Providers' responses inhibited further talk in 44% of observations and promoted talk in 56% of observations. CONCLUSION How providers respond may indicate their willingness to discuss a range of treatment options and to collaboratively engage in treatment decision-making. Provider responses that inhibited CIM conversation passed on the opportunity to discuss patient preferences, and responses that promoted further conversation helped counsel patients about appropriate CIM use. Promoting discussion did not require additional time or extensive knowledge about CIM. PRACTICE IMPLICATIONS Providers can facilitate high quality communication without endorsing CIM to help patients make treatment decisions and to evaluate CIM appropriateness in response to patient values and preferences.
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Affiliation(s)
- Christopher J Koenig
- Department of Medicine, San Francisco Veterans Affairs Health Care System, San Francisco, USA; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, USA.
| | - Evelyn Y Ho
- Department of Communication Studies, University of San Francisco, San Francisco, USA
| | - Laura Trupin
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, USA
| | - Daniel Dohan
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, USA
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Padfield D, Zakrzewska JM, de C Williams AC. Do photographic images of pain improve communication during pain consultations? Pain Res Manag 2015; 20:123-8. [PMID: 25996763 PMCID: PMC4447153 DOI: 10.1155/2015/145964] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Visual images may facilitate the communication of pain during consultations. OBJECTIVES To assess whether photographic images of pain enrich the content and⁄or process of pain consultation by comparing patients' and clinicians' ratings of the consultation experience. METHODS Photographic images of pain previously co-created by patients with a photographer were provided to new patients attending pain clinic consultations. Seventeen patients selected and used images that best expressed their pain and were compared with 21 patients who were not shown images. Ten clinicians conducted assessments in each condition. After consultation, patients and clinicians completed ratings of aspects of communication and, when images were used, how they influenced the consultation. RESULTS The majority of both patients and clinicians reported that images enhanced the consultation. Ratings of communication were generally high, with no differences between those with and without images (with the exception of confidence in treatment plan, which was rated more highly in the image group). However, patients' and clinicians' ratings of communication were inversely related only in consultations with images. Methodological shortcomings may underlie the present findings of no difference. It is also possible that using images raised patients' and clinicians' expectations and encouraged emotional disclosure, in response to which clinicians were dissatisfied with their performance. CONCLUSIONS Using images in clinical encounters did not have a negative impact on the consultation, nor did it improve communication or satisfaction. These findings will inform future analysis of behaviour in the video-recorded consultations.
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Affiliation(s)
- Deborah Padfield
- Slade School of Fine Art, University College London, London, United Kingdom
| | - Joanna M Zakrzewska
- Consultant and Facial Pain Unit Lead, Eastman Dental Hospital, UCLH NHS Foundation Trust, London, United Kingdom
| | - Amanda C de C Williams
- Research Dept of Clinical, Educational & Health Psychology, University College London, London, United Kingdom
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Ashcroft R. Health promotion and primary health care: examining the discourse. SOCIAL WORK IN PUBLIC HEALTH 2015; 30:107-16. [PMID: 25375065 DOI: 10.1080/19371918.2014.938395] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The health promotion discourse is comprised of assumptions about health and health care that are compatible with primary health care. An examination of the health promotion discourse illustrates how assumptions of health can help to inform primary health care. Despite health promotion being a good fit for primary health care, this analysis demonstrates that the scope in which it is being implemented in primary health care settings is limited. The health promotion discourse appears largely compatible with primary health care-in theory and in the health care practices that follow. The aim of this article is to contribute to the advancement of theoretical understanding of the health promotion discourse, and the relevance of health promotion to primary health care.
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Affiliation(s)
- Rachelle Ashcroft
- a School of Social Work, Renison University College , University of Waterloo , Waterloo , Canada
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Koenig CJ, Maguen S, Monroy JD, Mayott L, Seal KH. Facilitating culture-centered communication between health care providers and veterans transitioning from military deployment to civilian life. PATIENT EDUCATION AND COUNSELING 2014; 95:414-420. [PMID: 24742536 DOI: 10.1016/j.pec.2014.03.016] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 02/03/2014] [Accepted: 03/22/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To describe returning veterans' transition experience from military to civilian life and to educate health care providers about culture-centered communication that promotes readjustment to civilian life. METHODS Qualitative, in-depth, semi-structured interviews with 17 male and 14 female Iraq and Afghanistan veterans were audio recorded, transcribed verbatim, and analyzed using Grounded Practical Theory. RESULTS Veterans described disorientation when returning to civilian life after deployment. Veterans' experiences resulted from an underlying tension between military and civilian identities consistent with reverse culture shock. Participants described challenges and strategies for managing readjustment stress across three domains: intrapersonal, professional/educational, and interpersonal. CONCLUSIONS To provide patient-centered care to returning Iraq and Afghanistan veterans, health care providers must be attuned to medical, psychological, and social challenges of the readjustment experience, including reverse culture shock. Culture-centered communication may help veterans integrate positive aspects of military and civilian identities, which may promote full reintegration into civilian life. PRACTICE IMPLICATIONS Health care providers may promote culture-centered interactions by asking veterans to reflect about their readjustment experiences. By actively eliciting challenges and helping veterans' to identify possible solutions, health care providers may help veterans integrate military and civilian identities through an increased therapeutic alliance and social support throughout the readjustment process.
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Affiliation(s)
- Christopher J Koenig
- San Francisco Veterans Administration Medical Center, San Francisco, USA; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, USA; Department of Medicine, University of California, San Francisco, San Francisco, USA.
| | - Shira Maguen
- San Francisco Veterans Administration Medical Center, San Francisco, USA; Department of Psychiatry, University of California, San Francisco, San Francisco, USA
| | - Jose D Monroy
- San Francisco Veterans Administration Medical Center, San Francisco, USA; Department of Psychology, San Francisco State University, San Francisco, USA
| | - Lindsay Mayott
- San Francisco Veterans Administration Medical Center, San Francisco, USA; Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Karen H Seal
- San Francisco Veterans Administration Medical Center, San Francisco, USA; Department of Psychiatry, University of California, San Francisco, San Francisco, USA; Department of Medicine, University of California, San Francisco, San Francisco, USA
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Whitehead C, Kuper A, Freeman R, Grundland B, Webster F. Compassionate care? A critical discourse analysis of accreditation standards. MEDICAL EDUCATION 2014; 48:632-643. [PMID: 24807439 DOI: 10.1111/medu.12429] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 10/15/2013] [Accepted: 01/13/2014] [Indexed: 06/03/2023]
Abstract
CONTEXT We rely upon formal accreditation and curricular standards to articulate the priorities of professional training. The language used in standards affords value to certain constructs and makes others less apparent. Leveraging standards can be a useful way for educators to incorporate certain elements into training. This research was designed to look for ways to embed the teaching and practice of compassionate care into Canadian family medicine residency training. METHODS We conducted a Foucauldian critical discourse analysis of compassionate care in recent formal family medicine residency training documents. Critical discourse analysis is premised on the notion that language is connected to practices and to what is accorded value and power. We assembled an archive of texts and examined them to analyse how compassionate care is constructed, how notions of compassionate care relate to other key ideas in the texts, and the implications of these framings. RESULTS There were very few words, metaphors or statements that related to concepts of compassionate care in our archive. Even potential proxies, notably the doctor-patient relationship and patient-centred care, were not primarily depicted in ways that linked them to ideas of compassion or caring. There was a reduction in language related to compassionate care in the 2013 standards compared with the standards published in 2006. CONCLUSIONS Our research revealed negative findings and a relative absence of the construct of compassionate care in our archival documents. This work demonstrates how a shift in curricular focus can have the unintended consequence of making values that are taken for granted less visible. Given that standards shape training, we must pay attention not only to what we include, but also to what we leave out of formal documents. We risk losing important professional values from training programmes if they are not explicitly highlighted in our standards.
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Affiliation(s)
- Cynthia Whitehead
- Department of Family and Community Medicine, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
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Koenig CJ, Ho EY, Yadegar V, Tarn DM. Negotiating complementary and alternative medicine use in primary care visits with older patients. PATIENT EDUCATION AND COUNSELING 2012; 89:368-73. [PMID: 22483672 PMCID: PMC3630233 DOI: 10.1016/j.pec.2012.02.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 02/12/2012] [Accepted: 02/29/2012] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To empirically investigate the ways in which patients and providers discuss Complementary and Alternative Medicine (CAM) treatment in primary care visits. METHODS Audio recordings from visits between 256 adult patients aged 50 years and older and 28 primary care physicians were transcribed and analyzed using discourse analysis, an empirical sociolinguistic methodology focusing on how language is used to negotiate meaning. RESULTS Discussion about CAM occurred 128 times in 82 of 256 visits (32.0%). The most frequently discussed CAM modalities were non-vitamin, non-mineral supplements and massage. Three physician-patient interactions were analyzed turn-by-turn to demonstrate negotiations about CAM use. Patients raised CAM discussions to seek physician expertise about treatments, and physicians adopted a range of responses along a continuum that included encouragement, neutrality, and discouragement. Despite differential knowledge about CAM treatments, physicians helped patients assess the risks and benefits of CAM treatments and made recommendations based on patient preferences for treatment. CONCLUSION Regardless of a physician's stance or knowledge about CAM, she or he can help patients negotiate CAM treatment decisions. PRACTICE IMPLICATIONS Providers do not have to possess extensive knowledge about specific CAM treatments to have meaningful discussions with patients and to give patients a framework for evaluating CAM treatment use.
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Greenhalgh T, Procter R, Wherton J, Sugarhood P, Shaw S. The organising vision for telehealth and telecare: discourse analysis. BMJ Open 2012; 2:bmjopen-2012-001574. [PMID: 22815469 PMCID: PMC3401833 DOI: 10.1136/bmjopen-2012-001574] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To (1) map how different stakeholders understand telehealth and telecare technologies and (2) explore the implications for development and implementation of telehealth and telecare services. DESIGN Discourse analysis. SAMPLE 68 publications representing diverse perspectives (academic, policy, service, commercial and lay) on telehealth and telecare plus field notes from 10 knowledge-sharing events. METHOD Following a familiarisation phase (browsing and informal interviews), we studied a systematic sample of texts in detail. Through repeated close reading, we identified assumptions, metaphors, storylines, scenarios, practices and rhetorical positions. We added successive findings to an emerging picture of the whole. MAIN FINDINGS Telehealth and telecare technologies featured prominently in texts on chronic illness and ageing. There was no coherent organising vision. Rather, four conflicting discourses were evident and engaged only minimally with one another's arguments. Modernist discourse presented a futuristic utopian vision in which assistive technologies, implemented at scale, would enable society to meet its moral obligations to older people by creating a safe 'smart' home environment where help was always at hand, while generating efficiency savings. Humanist discourse emphasised the uniqueness and moral worth of the individual and tailoring to personal and family context; it considered that technologies were only sometimes fit for purpose and could create as well as solve problems. Political economy discourse envisaged a techno-economic complex of powerful vested interests driving commodification of healthcare and diversion of public funds into private business. Change management discourse recognised the complicatedness of large-scale technology programmes and emphasised good project management and organisational processes. CONCLUSION Introduction of telehealth and telecare is hampered because different stakeholders hold different assumptions, values and world views, 'talk past' each other and compete for recognition and resources. If investments in these technologies are to bear fruit, more effective inter-stakeholder dialogue must occur to establish an organising vision that better accommodates competing discourses.
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Affiliation(s)
- Trisha Greenhalgh
- Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Rob Procter
- Manchester e-Research Centre, University of Manchester, Manchester, UK
| | - Joe Wherton
- Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Sara Shaw
- Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Abstract
The role of theory in qualitative research is often underplayed but it is relevant to the quality of such research in three main ways. Theory influences research design, including decisions about what to research and the development of research questions. Theory underpins methodology and has implications for how data are analyzed and interpreted. Finally, theory about a particular health issue may be developed, contributing to what is already known about the topic that is the focus of the study. This paper will critically consider the role of theory in qualitative primary care research in relation to these three areas. Different approaches to qualitative research will be drawn upon in order to illustrate the ways in which theory might variably inform qualitative research, namely generic qualitative research, grounded theory and discourse analysis. The aim is to describe and discuss key issues and provide practical guidance so that researchers are more aware of the role theory has to play and the importance of being explicit about how theory affects design, analysis and the quality of qualitative research.
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Affiliation(s)
- Moira Kelly
- Institute of Health Sciences, Queen Mary University of London, 2 Newark Street, London E1 2AT, UK.
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