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Van Scoy LJ, Snyder B, Miller EL, Toyobo O, Grewal A, Ha G, Gillespie S, Patel M, Zgierska AE, Lennon RP. 'Us-Versus-Them': Othering in COVID-19 public health behavior compliance. PLoS One 2022; 17:e0261726. [PMID: 35073346 PMCID: PMC8786185 DOI: 10.1371/journal.pone.0261726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 12/08/2021] [Indexed: 11/26/2022] Open
Abstract
Objective We explored public perceptions about the COVID-19 pandemic to learn how those attitudes may affect compliance with health behaviors. Methods Participants were Central Pennsylvania adults from diverse backgrounds purposively sampled (based on race, gender, educational attainment, and healthcare worker status) who responded to a mixed methods survey, completed between March 25–31, 2020. Four open-ended questions were analyzed, including: “What worries you most about the COVID-19 pandemic?” We applied a pragmatic, inductive coding process to conduct a qualitative, descriptive content analysis of responses. Results Of the 5,948 respondents, 538 were sampled for this qualitative analysis. Participants were 58% female, 56% with ≥ bachelor’s degree, and 50% from minority racial backgrounds. Qualitative descriptive analysis revealed four themes related to respondents’ health and societal concerns: lack of faith in others; fears of illness or death; frustration at perceived slow societal response; and a desire for transparency in communicating local COVID-19 information. An “us-versus-them” subtext emerged; participants attributed non-compliance with COVID-19 behaviors to other groups, setting themselves apart from those Others. Conclusion Our study uncovered Othering undertones in the context of the COVID-19 pandemic, occurring between groups of like-minded individuals with behavioral differences in ‘compliance’ versus ‘non-compliance’ with public health recommendations. Addressing the ‘us-versus-them’ mentality may be important for boosting compliance with recommended health behaviors.
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Affiliation(s)
- Lauren Jodi Van Scoy
- Department of Medicine, Penn State College of Medicine, Hershey, PA, United States of America
- Department of Humanities, Penn State College of Medicine, Hershey, PA, United States of America
- Department of Public Health Sciences, Penn State College of Medicine Hershey, Hershey, PA, United States of America
- Qualitative and Mixed Methods Core, Penn State College of Medicine, Hershey, Hershey, PA, United States of America
- * E-mail:
| | - Bethany Snyder
- Department of Medicine, Penn State College of Medicine, Hershey, PA, United States of America
- Qualitative and Mixed Methods Core, Penn State College of Medicine, Hershey, Hershey, PA, United States of America
| | - Erin L. Miller
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, United States of America
| | - Olubukola Toyobo
- Penn State College of Medicine, Hershey, PA, United States of America
| | - Ashmita Grewal
- Department of Public Health Sciences, Penn State College of Medicine Hershey, Hershey, PA, United States of America
| | - Giang Ha
- Penn State College of Medicine, Hershey, PA, United States of America
| | - Sarah Gillespie
- Penn State College of Medicine, Hershey, PA, United States of America
| | - Megha Patel
- Penn State College of Medicine, Hershey, PA, United States of America
| | - Aleksandra E. Zgierska
- Department of Public Health Sciences, Penn State College of Medicine Hershey, Hershey, PA, United States of America
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, United States of America
- Department of Anesthesiology and Perioperative Medicine, Penn State College of Medicine, Hershey, PA, United States of America
| | - Robert P. Lennon
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, United States of America
- Penn State Law, Pennsylvania State University, University Park, PA, United States of America
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Karimi-Dehkordi M, Spiers J, Clark AM. An evolutionary concept analysis of "patients' values". Nurs Outlook 2019; 67:523-539. [PMID: 31072646 DOI: 10.1016/j.outlook.2019.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 02/27/2019] [Accepted: 03/15/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients' values are everywhere and nowhere in nursing: frequently invoked and associated with effective nursing care but seldom explicitly defined or subject to dedicated analysis. Clarification of the concept of patients' values is pivotal because respecting and supporting patients' values are widely recognized as crucial for ethical nursing care. Despite this and the pervasive employment of the term patients' values in theories, approaches, and clinical guidelines, the concept remains ambiguous. PURPOSE We sought to understand the key elements of the concept by investigating its use in theoretical and empirical literature. METHOD This study used Rodgers' evolutionary concept analysis approach. FINDINGS We found that values are core individual beliefs that function in hierarchical systems; however, in the context of disease, the priority assigned to values by the individual may change. This is important, given that values play a foundational role in health-related decisions, such as in the context of chronic diseases. DISCUSSION Values are influenced by both individual intrinsic needs and the social context, but importantly, are involved in guiding decision-making. The attributes of the values may vary according to the context of the disease, the type of disease, and the decision at hand.
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Affiliation(s)
| | - Jude Spiers
- University of Alberta, Faculty of Nursing, Edmonton, AB, Canada
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Meadowcroft J. Just healthcare? The moral failure of single-tier basic healthcare. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2015; 40:152-68. [PMID: 25663683 DOI: 10.1093/jmp/jhu077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This article sets out the moral failure of single-tier basic healthcare. Single-tier basic healthcare has been advocated on the grounds that the provision of healthcare should be divorced from ability to pay and unequal access to basic healthcare is morally intolerable. However, single-tier basic healthcare encounters a host of catastrophic moral failings. Given the fact of human pluralism it is impossible to objectively define "basic" healthcare. Attempts to provide single-tier healthcare therefore become political processes in which interest groups compete for control of scarce resources with the most privileged possessing an inherent advantage. The focus on outputs in arguments for single-tier provision neglects the question of justice between individuals when some people provide resources for others without reciprocal benefits. The principle that only healthcare that can be provided to everyone should be provided at all leads to a leveling-down problem in which advocates of single-tier provision must prefer a situation where some individuals are made worse-off without any individual being made better-off compared to plausible multi-tier alternatives. Contemporary single-tier systems require the exclusion of noncitizens, meaning that their universalism is a myth. In the light of these pathologies, it is judged that multi-tier healthcare is morally required.
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Brown P, Calnan M. NICE technology appraisals: working with multiple levels of uncertainty and the potential for bias. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2013; 16:281-293. [PMID: 22198480 PMCID: PMC3617347 DOI: 10.1007/s11019-011-9376-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
One of the key roles of the English National Institute for Health and Clinical Excellence (NICE) is technology appraisal. This essentially involves evaluating the cost effectiveness of pharmaceutical products and other technologies for use within the National Health Service. Based on a content analysis of key documents which shed light on the nature of appraisals, this paper draws attention to the multiple layers of uncertainty and complexity which are latent within the appraisal process, and the often socially constructed mechanisms for tackling these. Epistemic assumptions, bounded rationality and more explicitly relational forms of managing knowledge are applied to this end. These findings are discussed in the context of the literature highlighting the inherently social process of regulation. A framework is developed which posits the various forms of uncertainty, and responses to these, as potential conduits of regulatory bias-in need of further research. That NICE's authority is itself regulated by other actors within the regulatory regime, particularly the pharmaceutical industry, exposes it to the threat of regulatory capture. Following Lehoux, it is concluded that a more transparent and reflexive format for technological appraisals is necessary. This would enable a more robust, defensible form of decision-making and moreover enable NICE to preserve its legitimacy in the midst of pressures which threaten this.
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Affiliation(s)
- Patrick Brown
- Department of Sociology and Anthropology, University of Amsterdam, Oudezijds Achterburgwal 185, 1012 DK, Amsterdam, The Netherlands.
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Taylor JS. Market-based reforms in health care are both practical and morally sound. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2012; 40:537-546. [PMID: 23061582 DOI: 10.1111/j.1748-720x.2012.00687.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In this paper I argue that the free-market provision of health care is both practical and morally sound, and is superior in both respects to its provision by the State. The State provision of health care will be inefficient compared to its free-market alternative. It will thus provide less health care to persons for the same amount of expenditure, and so save fewer lives and alleviate less suffering for two reasons: state actors have no incentive to husband their resources effectively, and that in a non-market setting, special interest groups can capture resources through lobbying, perverting them away from their efficient allocation. Given these considerations of efficiency a utilitarian should morally prefer the free-market provision of health care to its State-based rival. Furthermore, even if one is not a utilitarian, the free-market provision of health care will be more morally sound than its State-based alternative because it will likely better respect the autonomy of persons, and will better refrain from imposing values upon persons. With these points in hand, I address two prominent objections to a free market system of health care.
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Iltis AS, Cherry MJ. First do no harm: critical analyses of the roads to health care reform. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2009; 33:403-15. [PMID: 18840849 DOI: 10.1093/jmp/jhn024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Health care reform poses numerous challenges. A core challenge is to make health care more efficient and effective without causing more harm than benefit. Additionally, those fashioning health-care policy must encourage patients to exercise caution and restraint when expending scarce resources; restrict the ability of politicians to advance their careers by promising alluring but costly entitlements, many of which they will not be able to deliver; face the demographic challenges of an aging population; and avoid regulations that create significant inefficiencies and restrict access to health care. Given such real-world challenges, how should health care be reformed in the United States or elsewhere? This number of The Journal of Medicine and Philosophy examines many of the complex issues that must be considered in reforming a health-care system.
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Affiliation(s)
- Ana Smith Iltis
- Health Care Ethics, St. Louis University, 221 North Grand Boulevard, St. Louis, MO 63103, USA.
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