Femininity, responsibility, and the technological imperative: discourses on breast cancer in the Australian press

Subject positions in screening mammography and implications for informed choice

OBJECTIVE

Screening mammography has potential benefits as well as harms, but these are not always communicated to women. We therefore explored how women discuss screening mammography, the subject positions made available in their discourse, and the implications of these for informed choice. Design: We conducted 16 individual interviews with women aged 44-72 years who were attenders (n = 11) and non-attenders (n = 5) of screening, and analysed transcripts through Foucauldian Discourse Analysis. Main Outcome Measures: A semi-structured interview guide, informed by literature and researcher expertise, was used to collect data. Results: The women constructed screening mammography as either helpful or potentially harmful. We identified three subject positions-The Responsible Woman (who attends screening), The Irresponsible Woman (who does not attend screening), and the Judicious Woman (who engages in alternate breast health practices). Conclusion: These subject positions have the potential to limit women's choices, constrain shared decision-making with health professionals, and restrict women's engagement in risk-reducing behaviours. An expanded range of options ultimately offers an alternate future in which women's autonomy to control their own bodies is better supported.

"Your Brain Matters": Issues of Risk and Responsibility in Online Dementia Prevention Information

The Internet has been argued to provide diverse sites for health communication and promotion, including issues that constitute major public health priorities such as the prevention of dementia. In this study, discursive psychology is used to examine how information about dementia risk prevention was presented on the websites of the most prominent English-language, nonprofit dementia organizations. We demonstrate how information about dementia risk and its prevention positions audiences as at-risk of developing dementia and constructs preventive behavior as a matter of individual responsibility. Websites represented participation in certain lifestyle practices as normative and emphasized audience members' personal responsibility for managing dementia risk. It is argued that such representations promote a moral identity in regard to brain health in which an ethic of self-responsibility is central. The implications of such identity construction in a context of increasing prevalence of dementia diagnosis are discussed.

Mental Health Messages in Prominent Mental Health Apps

PURPOSE

Many who seek primary health care advice about mental health may be using mobile applications (apps) claiming to improve well-being or relieve symptoms. We aimed to identify how prominent mental health apps frame mental health, including who has problems and how they should be managed.

METHODS

We conducted a qualitative content analysis of advertising material for mental health apps found online in the United States, the United Kingdom, Canada, and Australia during late 2016. Apps were included if they explicitly referenced mental health diagnoses or symptoms and offered diagnosis and guidance, or made health claims. Two independent coders analyzed app store descriptions and linked websites using a structured, open-ended instrument. We conducted interpretive analysis to identify key themes and the range of messages.

RESULTS

We identified 61 mental health apps: 34 addressed predominantly anxiety, panic, and stress (56%), 16 addressed mood disorders (26%), and 11 addressed well-being or other mental health issues (18%). Apps described mental health problems as being psychological symptoms, a risk state, or lack of life achievements. Mental health problems were framed as present in everyone, but everyone was represented as employed, white, and in a family. Explanations about mental health focused on abnormal responses to mild triggers, with minimal acknowledgment of external stressors. Therapeutic strategies included relaxation, cognitive guidance, and self-monitoring. Apps encouraged frequent use and promoted personal responsibility for improvement.

CONCLUSIONS

Mental health apps may promote medicalization of normal mental states and imply individual responsibility for mental well-being. Within the health care clinician-patient relationship, such messages should be challenged, where appropriate, to prevent overdiagnosis and ensure supportive health care where needed.

Representations of Young Cancer Survivorship: A Discourse Analysis of Online Presentations of Self

BACKGROUND

More young people are surviving treatment for cancer than ever before. Survival can have an adverse impact on their transition to adulthood. Discourses of cancer are applied to cancer survivors of all ages, but they manifest differently for young people.

OBJECTIVE

The aim of this study was to describe practices of self-representation in an online Web site that supports young Australian cancer survivors.

METHOD

We conducted a discourse analysis of images and text produced by young cancer survivors (aged 18-35 years) on a public cancer charity Web site.

RESULTS

The dominant subject position of participants published on this web site is one of empowered, beautiful cancer survivor. This applies to young people who have learned to embrace their cancer as providing a positive influence on their lives. However, this discourse can marginalize those whose cancer experience remains a source of distress or shame.

CONCLUSION

Web based media can provide a valuable forum for some young people to celebrate their cancer survival and to affirm the constructive influence that their cancer experience has had on their lives. However, we ponder the apparent unsuitability of some forums for young cancer survivors who have not yet found cause for celebration.

IMPLICATIONS FOR PRACTICE

Nurses have the opportunity to contribute to the development of supportive structures that meet the specific needs of different groups of young cancer survivors. This might mean assisting young cancer survivors who are struggling to find meaning in their cancer experience to negotiate the establishment of a new normal that they can embrace.

Exploring the Contemporary Stage and Scripts for the Enactment of Dying Roles: A Narrative Review of the Literature

This narrative review explores the literature regarding the drama of dying from several academic perspectives. Three key themes were identified including "The impact of blurred boundaries on roles and transitions," "The orchestration of death and dying through time," and "Contemporary dying and new machinery of control." This review reveals the manner in which tightly scripted dying roles serve the needs of the living to a greater extent than those of the dying, by ensuring the depiction of both dying and death as phenomena which have been brought under the control of the living, thereby countering death anxiety. An incongruence between the actual experience of dying and contemporary dying scripts is also highlighted. The authors argue that this incongruence is hidden from the broader societal audience through the maintenance of a dying role that demands serenity and acceptance, thus downplaying or even hiding the actual end-of-life experiences of the dying themselves.

The breast cancer fanfare: Sociocultural factors and women's health in Ghana

Traditional notions of the "full" woman and sociocultural beliefs about gender roles contribute to a unique experience of breast cancer in Africa. I used the critical feminist lens to analyze dis-courses about breast cancer in mainstream Ghanaian media. I found that breast cancer awareness is promoted amidst fanfare and that cultural notions of the female breasts, including their sexual appeal, are implied in breast cancer discourse. This obscures a nuanced understanding of the disease and women's health globally, limits the power of women to name their experiences, and contributes to the late presentation of the dis-ease in sub-Saharan Africa. I discuss the implications of the findings for international, interdisciplinary scholarship.

Pregnancy and Working: A Critical Reading of Advice and Information on Pregnancy and Employment

As more women remain in paid employment during pregnancy, women's public role as worker is enacted in parallel with the transition to the private role of mother. Cultural resources, such as books, magazines and other literature, may support this transition and help to identify the expectations of new and changing roles. Information and advice about working contained in such publications may also be implicated in the continuation of public and private beliefs about pregnancy and employment. Investigation of the representations of work in literature available to pregnant women suggests several topics with-in which material on working can occur; these are health, rights, and work and home. This coverage is discussed in relation to the different discourses of pregnancy, particularly a discourse of responsibility, and how these may position women as workers or mothers.

Testicular Cancer: Medicine and Machismo in the Media (1980–94)

Testicular cancer is the most common cause of death for men aged 19–35 in North America. The mass print and other media are important sources of ‘information’ about a variety of treatment and health-related matters. This article explores the portrayal of testicular cancer in the mass print media from 1980–94. The analysis is both manifest and latent. The manifest analysis indicates the emphasis on early detection. The latent analysis indicates that the disease is described primarily through three different discourses: medical, machismo and social support. Stories of men with testicular cancer emphasize early detection and medical treatment; sports and competitiveness, sexuality, financial acumen, sexual and physical attractiveness and desirability, as well as war and battles; and the importance of social support.

(Con)textualizing Toxic Shock Syndrome: selected media representations of the emergence of a health phenomenon 1979–1995

Societal understandings of health risk, and attitudes towards health and illness, are influenced and shaped by the ways in which print-based media, including popular magazines, represent health issues. The study reported here explores the way in which a relatively new health phenomenon, Toxic Shock Syndrome, has been represented in selected articles in Australian print-based media between 1979 and 1995. By exploring the discourses framing the discussion in these articles, changing and different representations of Toxic Shock Syndrome and related women's health issues and risks are uncovered.

Biotechnology, Political Rationality and Discourses on Health Risk

Using the results of a study to investigate women’s accounts of risks for breast cancer as a case study, this article examines the phenomenological, social and political implications of prevailing discourses on risk. The study is situated within the critical social science literature that argues that ‘risk’ has become one of the defining cultural characteristics of western society. As in other areas of life, the notion of risk has become central to discourses related to individual health; that is, ‘risk’ has become a common construct around which health in western society is described, organized and practised, both personally and professionally. This article argues that women’s health experiences, and the discourses on risk that shape those experiences, are produced within the same ideological context within which particular diagnostic/screening technologies are developed and deployed. Using governmentality as a framework, it is argued that current discourses on risk both make possible and are made possible by particular diagnostic/screening technologies. These discourses on risk also both reflect and reproduce notions of the ‘entrepreneurial subject’ and are, thus, consistent with a prevailing neo-liberal political rationality. The article concludes with a discussion of some of the questions for further research which are raised by this analysis.

Social Realities of Loss and Suffering Following Mastectomy

This article draws on personal accounts of women’s thoughts and feelings following mastectomy. The analysis of the material obtained in multiple, focused interviews has revealed two major themes in these accounts: on the one hand, the loss of bodily symmetry (one of the basic cultural criteria of physical beauty) was deeply felt; and on the other, peace of mind (a characteristic of psychological beauty) was permanently disturbed by the fear of the recurrence of cancer and the possibility of death. While the asymmetrical body is a potentially (socially) visible problem of presentation and representation, the fear of recurrence is a fear of the workings of the body that are not visible and not knowable. A woman who has had a breast removed will concern herself, usually in isolation, with her secret unpredictable interior. This fear will be her very own preoccupation, not only because in our society death and disease are deemed threatening and ugly – but also because the uncertainty of the health-status of a woman following mastectomy is socially (as well as medically) veiled by discourse which assumes that she is ‘well’. Though a woman may feel well, she fears that her body may not be well; yet her fear is necessarily silenced through both social denial and incongruity with experience. The article explores in some detail the nature of the stress that inevitably results in this ill-understood, complex situation.

Breast Cancer: Feminism, Representations and Resistance – a Commentary on Dorothy Broom’s ‘Reading Breast Cancer’

In this commentary, I identify two sets of coercive ‘discourses and practices’ which typically oppress women with breast cancer: the imperative of concealment and the notion of personal blame and responsibility for their illness. I examine how a feminist analysis can support and encourage resistance to such coercive ‘discourses and practices’, and I argue for a thoroughgoing feminist approach to breast cancer more generally.

Cancer in the News: Religious Themes in News Stories about People with Cancer

The prevalence of religious themes in 258 news stories of 382 people with cancer is reported in a study of the anglophone press. Such themes are rare, even in news reports from the USA, where other indicators suggest a high level of religiosity in the population. For the 35 people where religious themes are present, religion is portrayed as a marginal set of beliefs. Thus religious belief is associated with membership of a minority ethnic group, outmoded traditional authority, a matter of last resort after medicine has failed, or as childlike. Nevertheless, people with cancer are portrayed as preoccupied with issues of responsibility and moral character that have traditionally been addressed in religious discourse. The view that these preoccupations are addressed by depicting cancer as a psychological journey is considered.

Constructing Agency in Treatment Decisions: Negotiating Responsibility in Cancer

People belonging to cancer patient support groups participated in focus groups concerning their experiences of orthodox and complementary medicine. Their accounts of treatment decisions for cancer were analysed through discourse analysis. Accounts of both complementary and orthodox medicine addressed an ideological dilemma concerning the positioning of individuals as active or passive. Active positions were congruent with the everyday value of autonomy and responsible individuality, but conflicted with the established expertise of the medical profession in cancer and entailed being accountable for one’s health. Passive positions reversed this situation. Complementary medicine provided an opportunity for people with cancer to negotiate active positions in a limited domain of health care. The responsibility for health associated with taking active treatment decisions was problematic in accounts of both orthodox and complementary medicine.

Reading Breast Cancer: Reflections on a Dangerous Intersection

Because breast is the most common female cancer, it is no surprise that it has prompted lobbying and extensive clinical research. Many women have written autobiographical accounts of their diagnosis and treatment, but there has been little effort to apply the perspectives of feminist or other social theory to our understandings of breast cancer. I propose that breast cancer is located at a meeting point between (at least) four sets of discourses and practices: those relevant to all life-threatening illness, those surrounding most or all cancers, those informing female-specific conditions and conditions of the breast specifically. This article considers how each of those domains defines and informs experiences of breast cancer and its treatment. I offer a reflection on that four-way intersection, and a move towards specifying how sociocultural fears about death, disease, sexuality and femininity converge to isolate and silence women who are diagnosed, to frame their choices and experiences, and to shape their stories.

Examining Media Representations: Benefits for Health Psychology

Health psychology has tended to undervalue analyses of media representations of health, disease and illness. In this article I argue that critical approaches to media texts and images are valuable for health psychologists because:

(1) individuals are socially located and gain their beliefs about health and illness from the discourses and constructions that are available to them;

(2) media representations of health, illness and disease produce and reproduce meaning concerning health and illness, for lay people and professionals alike; and

(3) media representations mediate individuals’ lived experiences. These arguments are illustrated throughout with examples from critical and feminist research on representations of women, menopause and midlife. I go on to argue that critical approaches are particularly important in analysing media representations because they explicitly examine the social, cultural and political context of health and illness. Critical approaches increase awareness of control and power issues surrounding dominant representations and also provide possibilities for change and resistance.

Discursive constructions of youth cancer: findings from creative methods research with healthy young people

PURPOSE

As part of work to understand the experiences of young people who had cancer, we were keen to examine the perspectives of peers who share their social worlds. Our study aimed to examine how cancer in young people, young people with cancer and young cancer survivors are represented through language, metaphor and performance.

METHODS

We generated data using creative activities and focus group discussions with three high school drama classes and used Foucauldian discourse analysis to identify the discursive constructions of youth cancer.

RESULTS

Our analysis identified two prevailing discursive constructions: youth cancer as an inevitable decline towards death and as overwhelming personhood by reducing the young person with cancer to 'cancer victim'.

CONCLUSIONS

If we are to understand life after cancer treatment and how to support young people who have been treated for cancer, we need a sophisticated understanding of the social contexts they return to. Discourses shape the way young people talk and think about youth cancer; cancer as an inevitable decline towards death and as overwhelming personhood is a key discursive construction that young people draw on when a friend discloses cancer.

IMPLICATIONS FOR CANCER SURVIVORS

The way cancer is constructed shapes how friends react to and relate to a young person with cancer. These constructions are likely to shape challenging social dynamics, such as bullying, that many young cancer survivors experience. Awareness of these discursive constructions can better equip young cancer survivors, their family and health professionals negotiate life after cancer.

À sombra do aborto: o debate social sobre a anticoncepção de emergência na mídia impressa brasileira (2005-2009)

Trata-se de pesquisa socioantropológica que discute premissas centrais do debate social sobre a Anticoncepção de Emergência (AE) no Brasil, mediante análise de 131 textos publicados nos jornais Folha de S. Paulo (SP) e O Globo (RJ), de 2005 a 2009, orientada pelos descritores: pílula do dia seguinte, contracepção de emergência e AE. A Igreja Católica e o Ministério da Saúde são os principais interlocutores, identificados por um discurso baseado em metáforas bélicas, consoante à terminologia da saúde pública. Os textos pouco reproduzem argumentos de defesa dos direitos sexuais e reprodutivos. O posicionamento contrário da Igreja Católica baseia-se em argumentos biomédicos que consideram o método abortivo por ser usado pós-coito, equiparando a AE ao misoprostol (Cytotec) e à pílula RU486. O Ministério da Saúde e profissionais defendem que a AE pode evitar abortos inseguros, mas seu mecanismo de ação não é bem discutido, e o tema aborto termina sendo central.

Jade and the journalists: media coverage of a young British celebrity dying of cancer

In contemporary western societies, dying usually occurs in old age, out of sight in hospitals and institutions; how then do lay people learn what dying is like? Since the 1970s, one source of information in Anglophone societies has come from individuals who have chosen to publicise their dying of cancer. This article examines the most high profile case of this to date in the UK; in 2009, celebrity Jade Goody publicised in tabloid newspapers and celebrity magazines the final weeks of her dying of cervical cancer. What did she and her media say and write about dying? This article examines the print coverage of her final weeks, and four different voices are identified: those of Goody, of journalists, of her publicist, and of photographers, each representing her dying somewhat differently. Two major themes are discussed: Jade's struggles to retain autonomy (challenged by her disease and by other people), and the framing of her final weeks not primarily as a typical media cancer story of heroism, but as one of redemption in which she attained social respectability through dying.

Holistic sickening: breast cancer and the discursive worlds of complementary and alternative practitioners

This paper introduces the concept of holistic sickening to the sociological literature on illness narratives. Drawing on interviews with 46 Boston-area complementary and alternative medicine (CAM) practitioners who treat breast cancer patients, we found that the CAM practitioners redefine their patients' breast cancer diagnoses in ways that expand and transform their illness, sometimes into a lifetime journey. The practitioners, for the most part, espouse broad and complex etiological frameworks that help give meaning to the woman's cancer. They tend to speak about breast cancer as a symptom of problems that exceed the cancer itself, at times suggesting that women are responsible, to some extent, for their own breast cancer. The practitioners articulate holistic philosophies that describe healing as open-ended with correspondingly expansive definitions of what it means to be healed, rarely articulating clear ways of conceptualising or measuring the efficacy of their own treatments. Their use of expansive and detailed etiological frameworks alongside vague and unelaborated efficacy frameworks make up the holistic sickening phenomenon described in this paper.

Collective memory, candidacy, and victimisation: community epidemiologies of breast cancer risk

Collectively shared ideas of community may be equally relevant for the study of health disparities as quantifying the relationship between community structures and health. Data from focus groups (N = 18) that explored understandings of breast cancer and breast cancer risk in African American neighbourhoods revealed three conceptual domains where shared ideas of community informed responses: collective memory, community candidacy, and community victimisation by external aggressors. Reading the focus group responses in terms of these domains identified perceptions of risk and of candidacy that may be overlooked by individualised or quantitative approaches to studying breast cancer risk perceptions and related behaviours. These include novel perceived risks, such as the 'risk of knowing', as well as community-level constructions of breast cancer candidacy. 'Lay epidemiologies' of breast cancer within this population might therefore be better understood as 'community epidemiologies', where community is central to the interpretation and operationalisation of breast cancer risk. Paying attention to such community epidemiologies of breast cancer provides theoretical insights for studying breast cancer disparities and risk perceptions as well as useful guidance for designing interventions.

'Taking charge of your health': discourses of responsibility in English-Canadian women's magazines

This article presents an examination of the ways in which responsibility for health is constructed in popular English-Canadian women's magazines. Women's magazines are a unique media form, acting as guidebooks for women on matters relating to feminine gender roles and are important to examine as part of the corpus of societal discourses which frame our understandings of what it means to be healthy and how good health is achieved. Using discourse analysis several techniques were found which reinforce women's individual responsibility to create and maintain good health for themselves and their families. The magazines instruct women/readers directly about their health-related responsibilities and outline the negative consequences of inaction or incorrect action. The magazines also use the traditional discursive technique of women's personal accounts as both cautionary tales and inspirational stories to encourage readers to actively pursue healthy behaviours. Reflecting and reinforcing the discourse of healthism, women's magazines consistently present health as an important individual responsibility and a moral imperative which creates an entrepreneurial subject position for women. The article concludes by discussing the implications for women's magazine audiences within the ongoing feminist debate about this cultural industry.

Heart disease and gender in mass print media

Heart disease is a major cause of death, disease and disability in the developed world for both men and women. Nevertheless, the evidence suggests that women are under-diagnosed both because they fail to visit the doctor with relevant symptoms and because doctors tend to dismiss the seriousness of women's symptoms of heart disease. This study examines the way that popular mass print media present the possible links between gender and heart disease. The findings suggest that the 'usual candidates' for heart disease are considered to be high achieving and active men for whom the 'heart attack' is sometimes seen as a 'badge of honour' and a symbol of their success. In contrast, women are less often seen as likely to succumb, but they are portrayed as if they are and ought to be worried about their husbands. Women's own bodies are described as so problematic as to be perhaps useless to diagnose, because they are so difficult to understand and treat.

Mass print media depictions of cancer and heart disease: community versus individualistic perspectives?

This paper is based on a critical discourse content analysis of 40 stories from the 20 highest circulating English-language mass magazines available in Canada and published in Canada or the USA in 2001. It examines the presence or absence of the social determinants perspective in the portrayal of the two most significant causes of morbidity and mortality in these countries: cancer and heart disease. The media analysis documents an absence of reflection of the social determinants viewpoint on these, the most important causes of disease and death. Thus, magazine stories ignore the role of such considerations as income, education level, ethnicity, visible minority or, Aboriginal status, early life experiences, employment and working conditions, food accessibility and quality, housing, social services, social exclusion, or unemployment and employment security in explaining health. Instead, the magazine articles underscore an individualistic approach to disease that assumes that health care is accessible and available to all, and that these diseases are preventable and treatable through individual lifestyle choices in combination with the measures prescribed through conventional medicine. Although cancer and heart disease are framed by a medical discourse, articles tended to emphasise the independence, freedom and power of the individual within the medical care system. The research documents a continuation of the dominance of conventional medicine buttressed by individualism in media stories. Theoretical and methodological issues are discussed. Some of the practical consequences for policy-makers and professionals are noted.

Death denial: obstacle or instrument for palliative care? An analysis of clinical literature

As a society and as individuals, we have come to recognize ourselves as 'death-denying', a self-characterisation particularly prominent in palliative care discourse and practice. As part of a larger project examining death attitudes in the palliative care setting, a Medline search (1971 to 2001) was performed combining the text words 'deny' and 'denial' with the subject headings 'terminal care', 'palliative care' and 'hospice care'. The 30 articles were analysed using a constant comparison technique and emerging themes regarding the meaning and usage of the words deny and denial were identified. This paper examines the theme of denial as an obstacle to palliative care. In the articles, denial was described as an impediment to open discussion of dying, dying at home, stopping 'futile' treatments, advance care planning and control of symptoms. I suggest that these components of care together constitute what has come to be perceived as a correct 'way to die'. Indeed, the very conceptualisation of denial as an obstacle to these components of care has been integral to building and sustaining the 'way to die' itself. The personal struggle with mortality has become an important instrument in the public problem of managing the dying process.

Keeping healthy! Whose responsibility is it anyway? Vietnamese Canadian women and their healthcare providers' perspectives

Understanding how healthcare responsibility is distributed will give insight on how health-care is delivered and how members of a society are expected to practice health-care. The raising cost of health-care has resulted in restructuring of the existing Canadian healthcare system toward a system that controls costs by placing more healthcare responsibility on the individual. This shift might create more difficulty for immigrants and refugees to obtain equitable health-care and put blame on them when they experience illness. This paper is drawn from the results of a larger qualitative study exploring Vietnamese Canadian women's breast cancer and cervical cancer screening practices. Interview data were gathered from 15 Vietnamese Canadian women and six healthcare providers. We will demonstrate that (a) despite the strong influence of individualism, Vietnamese women and their healthcare providers value both individual liberty and the interrelationship between individual and society; (b) limited funding and unequal distribution of healthcare resources impacted how immigrant and refugee women practice health-care. Thus, motivating and fostering immigrant and refugee women's healthcare practice require both individual and institutional effort. To foster immigrant and refugees' healthcare practices, healthcare policy makers and providers need to consider how to distribute healthcare resources that meet immigrants' and refugees' healthcare needs in the most equitable way.

Chinese-Australian women's beliefs about cancer: implications for health promotion

Ethnicity and culture play significant roles in determining how an individual is likely to understand and explain cancer, which, in turn, is posited to have an impact on cancer screening behavior. Chinese women in Western countries are consistently reported to have low participation rates in mammographic screening. This may be related to the fact that women of Chinese ancestry have different images and beliefs about cancer, which can have implications for participation in health promotion programs regarding cancer prevention and early detection. To investigate this issue, a qualitative study involving in-depth interviews with 20 Chinese-Australian women was conducted. Embedded in the women's images of cancer were notions associated with fear, mystery, contagion, and stigma. Based on information provided by the women who participated in this study, 6 domains of folk explanations about the causes of cancer were identified: lifestyle, stress, environment, genes, unknown causes, and destiny. These beliefs should be considered in the design of breast health promotion programs because they are likely to have a bearing on Chinese-Australian women's attitudes regarding the value they perceive of cancer screening.

Increasing our understanding of breast self-examination: women talk about cancer, the health care system, and being women

The author engaged 13 women, aged 30 to 59, in a collaborative research project over several months to explore the meaning of breast self-examination (BSE) to them. Through a series of 11 group discussions, the women developed a critical consciousness of the commonality of their personal experiences in relation to BSE. Although these women valued BSE, their reluctance to perform it was influenced by their perceptions of breast cancer as a lethal disease, the perceived threat it posed to their femininity, and their ability to negotiate an increasingly medical and technological health care system. This study provides insight into the importance of the social environment and shared understandings in influencing women's individual behavioral choices for BSE. It also illustrates the particular value of collaborative health research.

The portrayal of HIV/AIDS in two popular African American magazines

Mainstream magazines and other media have been found to both reflect and influence existing values and beliefs regarding health and medicine. Little is known about how media directed toward specific cultural or other market groups may differ. The present study examined how HIV and AIDS are portrayed within a specific ethnocultural medium, the two highest circulating magazines directed toward African American and African Canadian readers. The portrayal of HIV/AIDS from January 1997 to October 2001 in Ebony and Essence magazines was examined through manifest and latent content analysis. African American people were described paradoxically both as powerless victims in the face of the disease and as members of a strong and identifiable community of "sisters" and "brothers" available to respond to prevent and cope with the disease. Polarization between Blacks and Whites was accomplished by frequent emphasis on the higher rates of HIV/AIDS amongst Black Americans. Both the church and spirituality were highlighted as means of prevention education and coping.

Canadian Aboriginal people's experiences with HIV/AIDS as portrayed in selected English language Aboriginal media (1996–2000)

This paper describes the portrayal of HIV/AIDS in 14 mass print newspapers directed towards the Canadian Aboriginal population and published between 1996 and 2000. Based on qualitative content analysis the research examines both manifest and latent meanings. Manifest results of this study indicate that women and youth are under represented as persons with HIV/AIDS. The latent results note the frequent references to Aboriginal culture, and the political and economic position of Aboriginal Canadians when discussing the disease, the person with the disease, the fear of the disease and the reaction of the community to the person with the disease. Unlike mainstream media where the medical frame is dominant, HIV/AIDS are here contextualized by culture, identity, spirituality and political-economic issues.

Portrayals of treatment decision-making on popular breast and prostate cancer web sites

The objective of this study was to describe the messages about treatment decision-making on popular cancer web sites, with particular reference to gender differences. The two most popular UK based web sites for breast and prostate cancer were chosen. Qualitative and quantitative comparative content analysis of the two case study web sites were performed. Web site portrayals of treatment decision-making by men with prostate cancer emphasize the obligation to be decisive, using information derived from medical sources, with minimal consultation with families and friends. Portrayals of treatment decision-making by women with breast cancer emphasize their family obligations, their need to make decisions about matters other than treatment, their right to opt out of decision-making, to take time, sometimes change their minds, consult with families and friends, and thereby take non-medical factors into account. This study will help health care practitioners understand the different factors that men and women feel obliged to consider when making decisions about their cancer treatments, and the role of the Internet in reinforcing gender differences.

New directions for critical internet health studies: representing cancer experience on the web

Studies of health representations on the internet have been preoccupied with the assessment of their (medically-defined) accuracy and quality. This contrasts with studies of health representations in 'old' media, where critical sociological analyses are common. Medical sociologists have been concerned to establish the potential of web information in transforming professional-client relations. A case study of breast and prostate cancer web sites provides evidence of the increasing convergence of the 'new' medium of the internet and old media such as newspapers and television. Large institutions are now consolidating their presence on the web so that users experience increasingly similar messages across media platforms. Search engines and links to the web from old media sources direct people to heavily resourced, mainstream health sites where, in the case of cancer, representations of gender are strikingly similar to those found in studies of old media sources. The media convergence thesis contrasts with earlier celebrations of the internet as a new medium that would promote a diversity of perspectives on health. Using existing methods for analysing media texts and developing new methods where appropriate, sociologists and media analysts interested in health need to develop more critical perspectives on this important new medium.

Assessing illness representations of breast cancer: a comparison of patients with healthy and benign controls

OBJECTIVE

Illness representations of cancer may comprise inaccurate information, misconceptions, or negative conceptualizations of the disease, which may influence screening behaviors. This study examined the differences between healthy women's and breast cancer patients' representations of breast cancer.

METHODS

The cross-sectional design involved 147 consecutive women free from breast diseases, or with benign breast conditions, and 102 patients with breast cancer recruited from the outpatient breast clinic of a public cancer hospital. Respondents completed a modified version of the Illness Perception Questionnaire (IPQ) that assessed six dimensions of illness representations of breast cancer.

RESULTS

Multiple comparison tests revealed that nonmalignant women's illness representations were characterized by weak beliefs concerning breast cancer curability/controllability, combined with an overestimation of the negative physical, social, and economic consequences of breast cancer. Moreover, these women held stronger beliefs about the role of environmental factors (radiation exposure, diet, and pollution) in breast cancer causation and expressed greater disagreement on the role of chance in the onset and course of the illness.

CONCLUSION

Illness representations of breast cancer appear to play a significant role in determining the unfavorable and exaggerated way in which laywomen perceive breast cancer. This is discussed within the framework of the social construction of the disease, which portrays breast cancer as a fatal and disfiguring disease, and the strong influence lay literature and the media exert on it.

The Information Requirements of People With Cancer

Information is crucial for people with cancer for both successful treatment and rehabilitation and to facilitate user involvement and informed decision making. Research has tended to concentrate on biomedical sources, such as hospital-produced information. There have been few inductive investigations of patients' use of information available outside this environment, despite the media and Internet being identified as pervasive sources of cancer information. This article reports on a study that utilized naturalistic inquiry to explore the extent and manner in which the media and Internet are utilized as information sources by people with cancer. Results confirm that the media was used considerably by the study sample and was an important contributor to knowledge and facilitator for decision making. Participants were not passive receivers of media messages but interpreted it depending on their particular needs or their rating of the media source. Consumption of media-produced information was constrained by certain factors, such as the participants' physical inability to access sources, and needs were not always satisfied because media discourse and "newsworthiness" restricted the reporting of what was sought. The study highlights the importance of the media and Internet as an information source for people with cancer and calls for a greater awareness of this phenomenon.

Denial of impending death: a discourse analysis of the palliative care literature

Terminally ill patients and their families are often referred to as being "in denial" of impending death. This study uses the qualitative method of discourse analysis to investigate the usage of the term "denial" in the contemporary hospice and palliative care literature. A Medline search (1970-2001) was performed combining the text words "deny" and "denial" with the subject headings "terminal care", "palliative care" and "hospice care," and restricted to English articles discussing death denial in adults. The 30 articles were analysed using a constant comparison technique and emerging themes regarding the meaning and usage of the words "deny" and "denial" identified. This paper focusses on the theme of denial as an individual psychological process. Three dominant subthemes were distinguished: denial as an unconscious "defence mechanism", denial as "healthy" and denial as temporary. The analysis focusses on the intertextuality of these themes with each other and with previous texts on the denial of death. Elements of the psychoanalytic definition of denial as an unconscious defence mechanism are retained in the literature but are interwoven with new themes on patient choice. The result is an overall discourse that is conflictual and at times self-contradictory but overall consistent with the biomedical model of illness. I suggest that the representation of death denial elaborated in these articles may be related to a larger discourse on dying in contemporary Western society, which both invites patients to participate in the planning of their death and labels those who do not comply.

A comparison of breast, testicular and prostate cancer in mass print media (1996–2001)

This paper compares the portrayal of breast, testicular and prostate cancer in mass print English language magazines in the United States and Canada from 1996 to 2001. It is a follow-up of three papers that examined each of these three diseases separately in high circulating magazines up to 1995. It includes both quantitative and qualitative analyses of magazine stories and notes the continuing dominance of a medical perspective regarding disease as well as the association of each type of cancer examined with stereotypically individualized yet feminine and masculine characteristics and pursuits. It notes the conflation of breast cancer, since the discovery of BRCA1 and BRCA2, with the family. To be a 'feminine' woman is to be vulnerable to breast cancer and to be a 'masculine' man is to be vulnerable to testicular cancer when young and prostate cancer when older. The association of disease not just with personhood but also with the specifics of stereotyped masculinity and femininity may construct a more intimate, more personal link between disease and identity. This close attachment of gender and disease may shore up and exacerbate a fear reaction. It may also serve to diminish the awareness of other, more prevalent, causes of death for men and women. The social control consequences of potentially exacerbated disease-specific fear are discussed.

The quality of medical care at the end-of-life in the USA: existing barriers and examples of process and outcome measures

CONTEXT

Cancer is a leading cause of morbidity and mortality in the USA and despite many recent advances in detection and treatment, over half a million cancer patients in this country will die from their disease each year.

OBJECTIVE

Using cancer as a prototype, we provide a conceptual framework to identify and review barriers to optimal end-of-life care and propose examples of linked process and outcome measures that could be used to evaluate whether standards of optimal end-of-life care are being achieved.

METHODS

We propose a conceptual model of end-of-life care and use this model to review the published literature to identify the key goals of optimal end-of-life care and summarize existing barriers to optimal end-of-life care. We then provide examples of process and outcome measures linked to the goals of optimal end-of-life care and domains within the conceptual framework.

RESULTS

Within all components of care at the end-of-life--societal attitudes, health care system(s), providers, and patients and their families--there are significant barriers to the quality of care. Some of the most critical barriers to optimal care at the end-of-life in the USA are limited availability, and coverage of, co-ordinated service delivery; poor provider communication and diagnostic skills; limited opportunities for training in palliative care; patient fears and attitudes towards the sick role, and a lack of, or inadequate health insurance. Proposed patient, provider, and system level measures of the quality of care were guided by goals of optimal end-of-life care, and focus on communication about prognosis and risks and benefits of treatment, development of clear and informed treatment goals, delivery of services consistent with treatment goals, and promotion of quality of life.

CONCLUSIONS

At present, there are substantial societal, health care system, provider, and patient barriers to obtaining optimal cancer care at the end-of-life. Ongoing discussions about appropriate measures of the quality of end-of-life care are gaining momentum, however. The proposed process and outcome measures for assessing optimal end-of-life care use cancer as a prototype, but are broadly applicable to other patient populations with life-threatening disease.

Trusting technology: women aged 40-49 years participating in screening for breast cancer--an exploratory study

OBJECTIVE

This paper reports key findings from an exploratory study of factors associated with women's decision to participate in mass mammography screening in Tasmania. In particular, we explored factors that contribute to the choice to participate in screening by women who are outside the primary target group, and for whom the evidence of benefit remains contentious.

METHODS

Semi-structured interviews were conducted with a small sample of women aged between 40 and 49 years in rural Tasmania who had participated in mammography screening.

RESULTS

Key ideas that appeared to shape participation included the fear of breast cancer, trust in technology, and taking responsibility for health. Information provision is also an important factor in shaping participation patterns.

CONCLUSIONS AND IMPLICATIONS

In order to facilitate informed consent, information provision in this area should take account of the dominant ideas that shape the decision to participate in breast cancer screening.

Unraveling the mysteries of timing: women's perceptions about time to treatment for cardiac symptoms

Women in the USA are at disproportionate risk of dying from a myocardial infarction (MI), of suffering disabilities following an MI, and of reinfarcting and dying within a year of their initial MI. Various explanations, including women's older age at clinical manifestation of coronary heart disease (CHD) and higher likelihood of co-morbidities, have been offered for women's heightened risk of poor outcomes. Less frequently, research has focused on examining women's prolonged time elapse between symptom onset and biomedical treatment, a phenomenon that renders women less likely to undergo lifesaving reperfusion strategies. [1] To explore factors and circumstances that may shape CHD time to treatment, 40 middle age and older women living in Kentucky, USA, half with diagnosed CHD and half with chronic conditions considered to be risk factors for CHD, participated in a series of in-depth interviews. While much of the existing CHD literature implicates individual responsibility as the determining feature in time to treatment, these women's narratives suggested that treatment decisions inextricably are linked to broader social and structural constraints. Such supra-individual forces that shape the CHD experiences of women include the social construction of "standard" cardiac symptoms based on male norms that ultimately confuse symptom detection, women's negative encounters with health care providers who discount their knowledge, the competing social demands women face when threatened by a serious illness, and structural barriers delimiting women's health care choices.

Being female: the portrayal of women's health in print media

In this article, we examine the portrayal of women's health issues in two of Melbourne's print media: The Age and the Herald Sun. In particular, we aim to examine the patterns of coverage of women's health and the underlying message in articles on women's health issues. We employed an unobtrusive method, and the study was conducted over a three-month period: May to July 1998. We found that many of the articles and public reactions centred on women and reproduction. This implies that women are still seen in relation to their reproductive role in Australian society. In addition, there are many issues regarding women and their health missing from the media's publication during the research period. The message emerging from the analysis implies that if women do not fit into the "ideal women" framework of the society, their health needs are given little attention by the print media and, therefore, their health is likely to suffer. This can be interpreted as one form of women's oppression in Australian society.

A retrospective study of the accuracy of cancer information in Ontario daily newspapers

CONTEXT

Studies suggest that the mass media is a common source of cancer information for the public. However, the quality of cancer information through various print outlets has not been extensively investigated.

OBJECTIVES

To assess the accuracy of cancer information in a retrospective sample of Ontario daily newspapers as well as to determine the amount of mobilizing (enabling) information about community resources for cancer.

METHODS AND RESULTS

Of 1,027 articles on cancer for 1991, drawn from the 5 highest and 5 lowest circulating newspapers, a random 30% sample (306 articles) was obtained. Only 40 articles had traceable citations (journal name, name of researcher, name of educational institution, or direct quotes from identifiable sources). Of these, 47.5% had misleading titles and 55% included erroneous information or omitted important study results. Only 13 (6.9%) included mobilizing information regarding prevention, diagnosis, treatment or support.

INTERPRETATION

Cancer information in newspapers contain frequent inaccuracies and fail to provide mobilizing information. Inaccurate newspaper information about cancer is of concern if the public relies on this channel for at least part of their health knowledge.

Patient-blaming and representation of risk factors in breast cancer images

Media coverage of some cancers in the past often equated cancer with a death sentence. Breast cancer coverage in 1990s magazines, however, has become less fatalistic, more frequent, and discusses a broader range of issues than before. This study examined whether the visual images accompanying magazine articles about breast cancer have also evolved. We used Goffman's (1976) rituals of subordination to measure patient-blaming and subordinating, disempowering images. We also analyzed race/ethnicity, body type, and age of females in the images to gauge whether these demographic risk factors were represented in a random sample of images from nine magazines over a 30-year period. Magazines analyzed represented three genres-women's magazines, fashion/beauty, and general news. Findings suggest that patient-blaming images have decreased in some categories and women portrayed are slightly more representative of risk factors of age and race/ethnicity. Magazine images tended to reinforce stereotyped portrayals of femininity to the detriment of cancer patients. Fashion/beauty magazines, aimed at younger women, were most likely to portray breast cancer images in stereotyped, patient-blaming ways, with the least representative images of risk factors. The social construction of feminine beauty seems to overpower accuracy in creating these images.