Making 'Context' concrete: a dialogical approach to the society-health relation

Precarious engagements and the politics of knowledge production: Listening to calls for reorienting hegemonic social psychology

In this paper, we invite psychologists to reflect on and recognize how knowledge is produced in the field of social psychology. Engaging with the work of decolonial, liberation and critical psychology scholars, we provide a six-point lens on precarity that facilitates a deeper understanding of knowledge production in hegemonic social psychology and academia at large. We conceptualize knowledge (re)production in psychology as five interdependent 'cogs' within the neoliberal machinery of academia, which cannot be viewed in isolation; (1) its epistemological foundations rooted in coloniality, (2) the methods and standards it uses to understand human thoughts, feelings and behaviours, (3) the documentation of its knowledge, (4) the dissemination of its knowledge and (5) the universalization of psychological theories. With this paper we also claim our space in academia as early career researchers of colour who inhabit the margins of hegemonic social psychology. We join scholars around the world in calling for a much-needed disciplinary shift that centres solutions to the many forms of violence that are inflicted upon marginalized members of the global majority. To conclude, we offer four political-personal intentions for the reorientation for the discipline of hegemonic social psychology with the aim to disrupt the politics of knowledge production and eradicate precarity.

Patterns of Sex Work Client Solicitation Settings and Associations with HIV/STI Risk Among a Cohort of Female Sex Workers in Baltimore, Maryland

Female sex workers' (FSWs) risk for HIV/STIs is influenced by their work environments. While previous research has characterized vulnerability in a single workplace, many FSWs solicit clients from multiple settings. Using latent class analysis (LCA), we examined client solicitation patterns and associated HIV/STI-related behaviors (consistent condom use with clients, asking clients about HIV/STIs, and past 6-month HIV/STI testing) among 385 FSWs in Baltimore, Maryland. The LCA yielded a three-class solution: predominantly street (61.2%), mixed street/venue (23.7%), and multisource (street, venue, and online) (15.1%). Consistent condom use differed significantly (p < 0.01) by class, with the mixed street/venue having the lowest (40.6%) rate and the multisource having the highest (70.6%). Classes differed on HIV/STI testing (p < 0.01), with the predominantly street class having the lowest testing rate (56.2%) and multisource with the highest (85.7%). These findings underscore the importance of considering how solicitation patterns are linked to HIV/STI susceptibility of FSWs and adapting interventions accordingly.

Comprehensive sexuality education is 'not for us': Rethinking 'cultural relevance' through Young Tanzanians' identifications with/against intervention knowledge

The need for comprehensive sexuality education (CSE) to be culturally relevant and inclusive is increasingly recognised as a fundamental aspect of supporting young people to live healthy sexual lives. Nevertheless questions remain about how to represent cultures and difference without subtly reinforcing inequalities. This paper makes a case for the need to explore this issue through analyses of how different gendered and demographic groups of young Tanzanian attendees of culturally relevant CSE, identify with (or against) intervention knowledge[s]. Grounded in dialogical social psychological theorising, we present a methodological approach for exploring how processes of belonging and Othering structure young people's negotiations of culturally relevant CSE amongst other knowledges. An adapted version of the 'story completion' method was used with university students and urban-poor young people (aged 18-34) to instigate dialogues about how a fictional protagonist might think, feel, and act in their relationship, looking to see if, and how, young people incorporated CSE knowledge. Twelve single-gendered focus-group discussions were held in September 2014 with 48 young people, and then findings from these were discussed further with 27 returning young people through three mixed-gendered workshops in August 2015. The analyses highlight how young Tanzanians explicitly Other CSE interventions, positioning their knowledge as 'not for us'. More implicitly, difference is also constructed around ideas about change and gendered development, along with trust and support in relationships. The devices used to Other shifted and differed across demographic groups, ranging from complete denials of intervention knowledge to viewing it as unrealistic, dangerous, or self-stigmatised for not being able to use it. We propose that these findings highlight the need to rethink how both 'culture' and 'relevance' are conceptualised in CSE, most specifically necessitating greater recognitions of poverty, transnationality, and the lasting legacies of colonialism and behaviour change interventions that communicated through fear and morality.

Embodying health behaviours in everyday life: the social and gendered practices of female senior managers

Objective: This article extends current theorising around health behaviours using insights from a study with women working in senior management positions in Switzerland. The study aimed to explore the meanings they attached to their everyday activities and examine implications for health and wellbeing by drawing on 1) social practices theory, 2) a socio-constructionist approach to gender, and 3) conceptualisations of embodiment.Design: Twenty female senior managers were interviewed at two time points six months apart: the first interview elicited highly-detailed, descriptive accounts of activities during the previous day, while in the second interview participants reflected on their previous accounts and discussed the meanings they ascribed to their activities. A thematic and narrative analysis of both sets of transcripts was conducted.Results: Three main themes captured the ways female senior managers talked about their everyday behaviours, all focused around their bodies: 'Functional bodies: Being on-the-go and meeting responsibilities'; 'Limiting bodies: Threats to everyday activities'; and 'Intentional bodies: Activities for wellbeing'.Conclusions: Results are considered in terms of contemporary postfeminist/neoliberal discourses in Western societies, how these are shaping and affecting everyday practices and subjectivities, and their consequences for women's health and wellbeing at work.

The Endurance and Contestations of Colonial Constructions of Race Among Malaysians and Singaporeans

Psychological literature on race has discussed in depth how racial identities are dialogically constructed and context dependent. However, racial identity construction is often not compared across different socio-political contexts. By researching racial identity construction in three different multicultural countries, Malaysia, Singapore, and the United Kingdom, we examined how three racial identities, Chinese, Malay, and Indian, are constructed among Malaysians and Singaporeans in this qualitative study comprised of 10 focus group discussions (N = 39). We applied Dialogical Analysis to the data. This paper shows that both racial ingroups and outgroups constructed all three racial identities, with ingroups constructing their identities more heterogeneously compared to outgroups. Participants also engaged with colonial constructions of the three racial identities. The geographical locations, and therefore their perceptual contexts, of the participants differed. Yet, colonial constructions of race endured in contemporary identity construction and were contested in the group settings. We conclude that the socio-political context as understood by the context of colonialism and post-coloniality influenced their racial identity constructions. Participants, regardless of differences in geographical location, used similar colonial constructions of Malay, Chinese, and Indian identities to position themselves as well as Others in their group interactions. These findings show that there is value in conceptualising the context beyond that which individuals are immediately presented with, and that psychologists should consider the inclusion of cultural legacies of colonialism in their conceptualisation of the present context.

Complex adaptive systems: a new approach for understanding health practices

This article explores the potential of complex adaptive systems (CAS) theory to inform behaviour change research. A CAS describes a collection of heterogeneous agents interacting within a particular context, adapting to each other's actions. In practical terms, this implies that behaviour change is (1) socially and culturally situated; (2) highly sensitive to small baseline differences in individuals, groups, and intervention components; and (3) determined by multiple components interacting 'chaotically'. Two approaches to studying CAS are briefly reviewed. Agent-based modelling is a computer simulation technique that allows researchers to investigate 'what if' questions in a virtual environment. Applied qualitative research techniques, on the other hand, offer a way to examine what happens when an intervention is pursued in real-time, and to identify the sorts of rules and assumptions governing social action. Although these represent very different approaches to complexity, there may be scope for mixing these methods - for example, by grounding models in insights derived from qualitative fieldwork. Finally, I will argue that the concept of CAS offers one opportunity to gain a deepened understanding of health-related practices, and to examine the social psychological processes that produce health-promoting or damaging actions.

Towards dynamic and interdisciplinary frameworks for school-based mental health promotion

Purpose

The purpose of this paper is to scrutinise two ostensibly disparate approaches to school-based mental health promotion and offer a conceptual foundation for considering possible synergies between them.

Design/methodology/approach

The paper examines current conceptualisations of child and youth mental health and explores how these inform school-based prevention and intervention approaches. The dominance of discrete, “expert-driven” psychosocial programmes as well as the potential of critical pedagogy is explored using frameworks provided by contemporary dynamic systems theories. These theories call for a situated and holistic understanding of children’s development; and they look beyond static characteristics within individuals, to view well-being in relation to the dynamic social and historical contexts in which children develop.

Findings

Psychosocial interventions and critical pedagogies have strengths but also a number of limitations. Traditional psychosocial interventions teach important skill sets, but they take little account of children’s dynamic socio-cultural contexts, nor acknowledge the broader inequalities that are frequently a root cause of children’s distress. Critical pedagogies, in turn, are committed to social justice goals, but these goals can be elusive or seem unworkable in practice. By bringing these seemingly disparate approaches into conversation, it may be possible to harness their respective strengths, in ways that are faithful to the complex, emergent nature of children’s development, as well as committed to correcting inequalities.

Originality/value

The current paper is unique in bringing together contemporary psychological theory with critical pedagogy perspectives to explore the future of school-based mental health promotion.

(Re)politicising and (re)positioning prevention: community mobilisations and AIDS prevention in the new AIDS era

An increasing focus on the relationship between AIDS prevalence and socio-economic inequality signals the need for a revaluation of the role of "politics" and "power" in AIDS prevention. This revaluation bears great significance when considering the future trajectories of the AIDS prevention efforts that target highly marginalised populations with high prevalence rates. An emphasis on intersecting forms of inequality has direct implications for the future of AIDS prevention practice. This study explores the experiences of participants, facilitators and local stakeholders applying the United Nations Development Programme (UNDP) Community Capacity Enhancement-Community Conversations (CCE-CC) approach to AIDS prevention in the Eastern Cape province of South Africa. It uses the political narrative analysis of life histories and semi-structured interviews as a means to interrogate the lived experiences of local actors participating in or influenced by this popularised form of community mobilisation used throughout sub-Saharan Africa. Findings suggest the need for a more explicit and intentional valuation for the intersection between the social and political determinants of health in programmes that use community mobilisation as prevention. They also signal a need to critically re-evaluate "community mobilisation" as an AIDS prevention tradition. Intersecting social and political power dynamics play a significant role in both opening up and constraining community mobilisation efforts. This paper proposes the need for a pedagogical turn to "deep organising" and "participatory forms of democracy", as a necessary frontier for programmes working with highly marginalised populations with high prevalence rates. Programmes need to more explicitly support, protect, and advocate for the ability of affected communities to engage in political processes, discourse and long-term organising.

Towards a Global Health Contribution for Critical Health Psychology

The ability of critical health psychology to deliver on its implicit promise to link social and biological processes is compromised by: (1) a morally superior stance of being critical of rather than being critical for other disciplines; (2) insufficient pluralism in its concepts and methods; and (3) unwillingness to engage with more ‘distant’ disciplines that are salient to its goals; particularly economics, management and law. The global health movement offers critical health psychology an avenue to develop its project, especially in low-income countries, where a pragmatic approach to the interconnectedness of poor health and inequality is needed.

Why is patient safety so hard in low-income countries? A qualitative study of healthcare workers' views in two African hospitals

BACKGROUND

The views of practitioners at the sharp end of health care provision are now recognised as a valuable source of intelligence that can inform efforts to improve patient safety in high-income countries. Yet despite growing policy emphasis on patient safety in low-income countries, little research examines the views of practitioners in these settings. We aimed to give voice to how healthcare workers in two East African hospitals identify and explain the major obstacles to ensuring the safety of patients in their care.

METHODS

We conducted in-depth, face to face interviews with healthcare workers in two East African hospitals. Our sample included a total of 57 hospital staff, including nurses, physicians, technicians, clinical services staff, administrative staff and hospital managers.

RESULTS

Hospital staff in low-income settings offered broadly encompassing and aspirational definitions of patient safety. They identified obstacles to patient safety across three major themes: material context, staffing issues and inter-professional working relationships. Participants distinguished between the proximal influences on patient safety that posed an immediate threat to patient care, and the distal influences that generated the contexts for such hazards. These included contexts of severe material deprivation, but also the impact of relational factors such as teamwork and professional hierarchies. Structures of authority, governance and control that were not optimally aligned with achieving patient safety were widely reported.

CONCLUSIONS

As in high-income countries, the accounts of healthcare workers in low-income countries provide sophisticated and valuable insights into the challenges of patient safety. Though the impact of resource constraints and weak governance structures are particularly marked in low-income countries, the congruence between accounts of health workers in diverse settings suggest that the origins and solutions to patient safety problems are likely to be similar everywhere and are rooted in human factors, resources, culture and behaviour. While additional resources are essential to patient safety improvement in low-income settings, such resources on their own will not be sufficient to secure the changes needed.

Health behavior change models for HIV prevention and AIDS care: practical recommendations for a multi-level approach

Despite increasing recent emphasis on the social and structural determinants of HIV-related behavior, empirical research and interventions lag behind, partly because of the complexity of social–structural approaches. This article provides a comprehensive and practical review of the diverse literature on multi-level approaches to HIV-related behavior change in the interest of contributing to the ongoing shift to more holistic theory, research, and practice. It has the following specific aims: (1) to provide a comprehensive list of relevant variables/factors related to behavior change at all points on the individual–structural spectrum, (2) to map out and compare the characteristics of important recent multi-level models, (3) to reflect on the challenges of operating with such complex theoretical tools, and (4) to identify next steps and make actionable recommendations. Using a multi-level approach implies incorporating increasing numbers of variables and increasingly context-specific mechanisms, overall producing greater intricacies. We conclude with recommendations on how best to respond to this complexity, which include: using formative research and interdisciplinary collaboration to select the most appropriate levels and variables in a given context; measuring social and institutional variables at the appropriate level to ensure meaningful assessments of multiple levels are made; and conceptualizing intervention and research with reference to theoretical models and mechanisms to facilitate transferability, sustainability, and scalability.

A queer-theoretical approach to community health psychology

Queer-theoretical resources offer ways of productively rethinking how central concepts such as 'person-context', 'identity' and 'difference' may be understood for community health psychologists. This would require going beyond consideration of the problems with which queer theory is popularly associated to cautiously engage with the aspects of this work relevant to the promotion of collective practice and engaging with processes of marginalisation. In this article, we will draw upon and illustrate the queer-theoretical concepts of 'performativity' and 'cultural intelligibility' before moving towards a preliminary mapping of what a queer-informed approach to community health psychology might involve.

Community organizing practices in a globalizing era: Building power for health equity at the community level

In the postindustrial era, global economic processes have constrained the ability of local agencies, service providers, and civic groups to respond to systemic challenges in public health. Community health psychology can benefit by focusing on interventions through mediating structures that develop innovative methods of leveraging power in the context of globalizing economic forces. Promising methods include careful analysis of power within targeted policy domains and developing strategic alliances with others, so as to exercise social power to affect policy change. The case of ISAIAH, an organizing group based in Minnesota, illustrates innovative avenues for intervention in the context of globalization.

Nuclear brinkmanship: a study in non-linguistic communication

This article examines meaning making with nuclear bombs and military manoeuvres. The data is verbatim audio recordings from the White House during the Cuban Missile Crisis. The analysis uses concepts from impression management and dialogism. It is found that actions often speak louder than words and that even non-linguistic communication with nuclear weapons is often oriented to third-parties, in this case, world opinion. A novel process of 'staging the other' is identified, that is, when one side tries to create a situation which will force the other side to act in a way which will create a negative impression on world opinion. Staging the other is a subtle form of meaning making for it entails shaping how third parties will view a situation without those third parties being aware of the intentionality of the communication.

Reimagining community health psychology: maps, journeys and new terrains

This special issue celebrates and maps out the 'coming of age' of community health psychology, demonstrating its confident and productive expansion beyond its roots in the theory and practice of small-scale collective action in local settings. Articles demonstrate the field's engagement with the growing complexity of local and global inequalities, contemporary forms of collective social protest and developments in critical social science. These open up novel problem spaces for the application and extension of its theories and methods, deepening our understandings of power, identity, community, knowledge and social change - in the context of evolving understandings of the spatial, embodied, relational, collaborative and historical dimensions of health.

Factors associated with condom use negotiation by female sex workers in Bangladesh

Negotiation for condom use by female sex workers with their male clients can enhance condom use. A cross-sectional study was conducted among 1395 female sex workers; 439 from two brothels, 442 from 30 hotels, and 514 from streets of two cities in Bangladesh to determine the predictors of condom use negotiation. Consistent condom use rates in the 7 days prior to interview were reported to be 16.2%, 21.7%, and 4.5% among the brothel, hotel, and street-based female sex workers, respectively. Overall, 28.1% of female sex workers negotiated for condom use with their clients. Participation in behaviour change communication (BCC) programmes (AOR, 1.5; 95% CI, 1.2-2.0) and self-perceived risk of human immunodeficiency virus infection (AOR, 1.8 95% CI, 1.6-2.1) were positive predictors for condom negotiation. Compared to the hotel-based female sex workers, street (AOR, 0.6; 95% CI, 0.4-0.9) and brothel-based female sex workers (AOR, 0.7; 95% CI, 0.5-0.9) were less likely to negotiate for condom use. Female sex workers in Bangladesh are at high risk for sexually transmitted infection / human immunodeficiency virus infection because of low overall negotiation for condom use. Participation in BCC programmes had positive effect on condom negotiation by female sex workers, and should be strengthened in commercial sex venues.

Method and explanation in history and in social representations

A commonly held point of view defines a discipline as a science if it uses inductive and/or deductive methods in studying phenomena in question, because these methods, it is believed, will enable generalization of findings. Both history and theory of social representations study unique phenomena and therefore, for these disciplines, induction and deduction are unsuitable methods of exploration. History and theory of social representations treat a historical event and a social psychological phenomenon, respectively, as dynamic, systemic and one of its kind. Using relational epistemologies, these disciplines produce context-dependent and context-specific knowledge. Whilst similarities among historical, as well as among social psychological occurrences do exist, they do not yield themselves to inductive generalization. Studies of unique cases require different kinds of generalization; rather than generalising to populations, they pose questions about generalizability, or transferability, with respect to theories of other historical events or social psychological phenomena.

Sexual partnership types as determinant of HIV risk in South African MSM: an event-level cluster analysis

While individual determinants of HIV risk among MSM have been widely studied, there is limited understanding of how relational characteristics determine sexual risk. Based on data collected among 300 South African men who have sex with men (MSM) and using cluster analysis, this study developed a typology of four partnership types: the "Race-Economic Similar," "Age-Race-Economic Discordant," "Non-regular Neighbourhood," and "Familiar" partnership types. Support for the meaningfulness of these types was found through associations of these partnership types with participant characteristics and characteristics of the last anal sex event. Furthermore, in a multivariate analysis, only partnership type independently predicted whether the last anal sex event was unprotected. Findings of the study illustrate the importance of taking into account the relational context in understanding unprotected sexual practices and present ways to target intervention efforts as well as identify relationship specific determinants of unprotected sex.

Contextual influences on safer sex negotiation among female sex workers (FSWs) in Hong Kong: the role of non-governmental organizations (NGOs), FSWs' managers, and clients

Despite social-cognitive interventions to increase safer sex awareness, condom use among female sex workers (FSWs) continued to be inconsistent. To account for the possible influences of contextual factors that may hinder or promote FSWs' safer sex negotiation and condom use, the present study examined the effects of non-governmental organizations (NGOs), FSWs' managers, and clients on FSWs' negotiation efficacy and condom-use efficacy, and the effects of efficacy on condom use. One hundred and nineteen FSWs in Hong Kong completed a questionnaire that focused on their perceived influences of NGOs, managers, and clients toward safer sex negotiation and condom use. Hierarchical regression results showed that whereas NGOs' influence and clients' support were positively related to negotiation self-efficacy, managers' pressure, and clients' pressure were negatively related to negotiation self-efficacy. Managers' pressure was negatively related to condom-use self-efficacy. Logistic regression results showed that FSWs with high condom-use self-efficacy was 24 times more likely to use condom in the previous six months than their counterparts. The present study indicated the importance of social contexts in affecting FSWs' safer sex negotiation and condom-use self-efficacy. Implications on preventive programs for FSWs, managers, and clients were discussed.

The potential of ecological theory for building an integrated framework to develop the public health contribution of health visiting

In line with recent UK and Scottish policy imperatives, there is increasing pressure for the health visiting service to assume an enhanced role in improving public health. Although health visiting has so far maintained its unique position as a primarily preventive service within the UK health service, its distinctive contribution now appears under threat. The continuing absence of a comprehensive and integrated conceptual basis for practice has a negative impact on the profession's ability to respond to current challenges. Establishing an integrative framework to conceptualise health visiting practice would enable more sensitive, focused and appropriate research, education and evaluation in relation to practice. Work in this area could thus usefully contribute to the future development of the service at a difficult time. Our paper aims to make such a contribution. In support of our conceptual aims, we draw on a study of health visiting practice undertaken within a large conurbation in central Scotland. The study used a mixed method, collaborative approach involving 12 audio-recorded and observed health visitor-client interactions, semi-structured interviews with the 12 HVs and 12 clients, examination of related documentation and workshops with the HV participants. We critically consider prevalent models of health visiting practice and describe the more integrative conceptual approach provided by Bronfenbrenner's ecological, 'person-in-context' framework. The paper subsequently explores relationships between this framework and understandings of need demonstrated by health visitors who participated in our study. Current policy emphasises the need to focus on public health and social inclusion in order to improve health. However, if this policy is to be translated into practice, we must develop a more adequate understanding of how practitioners work effectively with families and individuals in a sensitive and context-specific manner. Bronfenbrenner's framework appears to offer a promising means of building on the current strengths of the health visiting service to further develop a 'person-in-context' approach to health improvement that is mindful of and responsive to multiple, inter-related influences on health. We therefore recommend further research to directly test the utility of this framework.

Let's get real (with a small 'r'): for a health psychology that prioritizes the concrete

Depending on which kind of philosophy of science we espouse, health psychology can be a relatively concrete or relatively abstract activity. Estacio, I suggest, prioritizes the concrete, by foregrounding real social phenomena. I argue that prioritizing the concrete has two particular benefits: it increases the social relevance of health psychology, and it increases the validity of our analyses, by ensuring that they are close to reality. To further the pursuit of the concrete, I suggest that critical health psychology is in particular need of exemplars of critical health psychology in action, rather than reflexive commentary on critical health psychology itself.

The female sex work typology in India in the context of HIV/AIDS

OBJECTIVE

To conduct a critical review of the typology of female sex work in India.

METHOD

Published and unpublished studies (1986-2008) were identified through electronic databases, hand searching and contacting experts.

RESULTS

The review assesses the appropriateness of the existing typologies from a programmatic perspective and identifies their strengths and limitations. It indicates there is conceptual confusion around the typology and that none of the existing typologies are exhaustive, in that none includes all types of sex work documented in India. The typology developed by the National AIDS Control Organization (NACO) is the most comprehensive. The typology is based on the primary place of solicitation and categorizes female sex workers (FSWs) as brothel-based, street-based, home-based, lodge-based, dhaba-based and highway-based FSWs. However, this typology has its limitations. First, it does not include all categories of FSWs documented in the literature, such as indirect-primary (primarily solicit clients at their places of work, which are venues where facilitating sex work is their main purpose e.g. massage parlours, bars), indirect-secondary (primarily solicit clients at their places of work, which are in non-sex work related industries e.g. agriculture, construction) and phone-based FSWs (primarily solicit clients through phones). Second, the methodology used to develop the typology proposed by NACO or by any other researchers is not explicit. In addition, the extent to which the typology captures the HIV risk variability between FSWs types is not explored.

CONCLUSION

There is a need to develop an evidence-based, inclusive typology which takes account of HIV risk for researchers and programmers.

Health inequalities and homelessness: considering material, spatial and relational dimensions

Homelessness is a pressing health concern involving material hardship, social marginalization and restrained relationships between homeless and housed people. This article links relational aspects of homelessness, and its health consequences, with material and spatial considerations through the use of photo-elicitation interviews with 12 rough sleepers in London. We highlight the relevance of embodied deprivation for a health psychology that is responsive to the ways in which social inequalities can get under the skin of homeless people and manifest as health disparities.