Understanding the disconnect between lifestyle advice and patient engagement: a discourse analysis of how expert knowledge is constructed by patients with CHD

OBJECTIVE

Adherence to healthy lifestyle advice is effective in prevention of non-communicable diseases like coronary heart disease (CHD). Yet patient disengagement is the norm. We take a novel discursive approach to explore patients' negotiation of lifestyle advice and behaviour change.

METHOD

A discourse analysis was performed on 35 longitudinal interviews with 22 heterosexual British people in a long-term relationship, where one had a diagnosis of CHD. The analysis examined the relationships between patients' constructions of expert knowledge and the implications of these accounts for patients' dis/engagement with lifestyle advice.

RESULTS

Expert knowledge was constructed in four ways: (1) Expert advice was valued, but adherence created new risks that undermined it; (2) expert knowledge was problematised as multiple, contradictory, and contested and therefore difficult to follow; (3) expert advice was problematised as too generalised to meet patients' specific needs; and (4) expert advice was understood as limited and only one form of valued knowledge.

CONCLUSION

Patients and partners simultaneously valued and problematised expert knowledge, drawing on elaborate lay epistemologies relating to their illness which produced complex patterns of (dis)engagement with expert lifestyle advice. Recognition of the multiple and fluid forms of knowledge mobilised by CHD patients could inform more effective interventions.

'Does anyone else have this?' The role of emotion in forum discussions about medical conditions affecting sex characteristics

When people experience rare medical conditions or variations, searching online may be the only way to find others with similar experiences. This study examines what happens when people do just that. The dataset for the research has been generated from online posts by people living with variations of sex characteristics, which some call intersex variations. Our analysis focuses on how emotion appears in online posts, how affect becomes embodied in digital contexts, and how norms are negotiated as people relate to one another about the variations that some of them experience. We offer an analysis grounded in digital affect theory to contribute to health research literature. We suggest how health researchers and healthcare providers might develop more nuanced understandings of the emotional realities of people living with variations of sex characteristics.

Dating apps as public health 'problems': cautionary tales and vernacular pedagogies in news media

ABSTRACT In this paper we examine how popular media reporting positions dating and hookup app use as a 'social problem' that impacts on health and wellbeing. The paper adopts a mixed-methods media studies approach to create and analyse a dataset of over 6,000 international news articles published within a 12-month period, drawing on thematic content analysis and inductive and deductive techniques. These analyses are framed in relation to online consultations with Australian sexual health professionals and app users. Applying Briggs and Hallin's theory of biocommunicability (2007) - which proposes that contemporary health professionals' scientific framing of public health problems are, in part, shaped by popular media discourses - we identify a significant category of supportive discussions of safer app use within social news and lifestyle reporting. This discursive space features what we have termed 'vernacular pedagogies' of app use, revealing app users' safety strategies, and their experiences of pleasure and playfulness. We argue that an analysis of popular media can provide valuable insights into how everyday experiences of safety, risk and wellbeing are being shaped and contested with dating and hookup app use, and that these insights can be used to develop meaningful health promotion strategies.

Experiences and implications of smartphone apps for depression and anxiety

Apps on smartphones are increasingly used for self-care for depression and anxiety, yet how and why they are accessed, and their social effects, remain under-investigated. Sociologists have begun to theorise how these technologies affect and relate; crucial questions for a contemporary sociology of health. This study seeks to contribute to our conceptualisation of how digital health technologies are implicated in health by investigating the motivations, experiences and relations of people using mobile apps for depression or anxiety. We interviewed 14 individuals living in England with a diagnosis of depression or an anxiety disorder, who used smartphone apps as part of self-care. Analysis followed a thematic approach. Three themes were identified. Apps exist within relational contexts - alongside smartphones, beliefs about mental health and other support - which shape app use and lead to an imprecise, casual approach. People engage with apps in a straightforward and uncomplicated manner, leading to immediate symptomatic alleviation, but to limited longer term benefit. The contradiction between the apps' promise as tools of individual empowerment, with their ability to promote responsibilising frameworks that restrain users' reflexivity, is central to their implications. Apps can thus contribute to isolation from interpersonal support and promote reductionist biomedical conceptualisations of mental ill health.

Re-Thinking Ethics and Politics in Suicide Prevention: Bringing Narrative Ideas into Dialogue with Critical Suicide Studies

The purpose of this paper is to explore the conviviality between practices of narrative therapy and the emerging field of critical suicide studies. Bringing together ideas from narrative therapy and critical suicide studies allows us to analyze current suicide prevention practices from a new vantage point and offers us the chance to consider how narrative therapy might be applied in new and different contexts, thus extending narrative therapy’s potential and possibilities. We expose some of the thin, singular, biomedical descriptions of the problem of suicide that are currently in circulation and attend to the potential effects on distressed persons, communities, and therapists/practitioners who are all operating under the influence of these dominant understandings. We identify some cracks in the dominant storyline to enable alternative descriptions and subjugated knowledges to emerge in order to bring our suicide prevention practices more into alignment with a de-colonizing, social justice orientation.

Young People’s Perspectives on and Experiences of Health-Related Social Media, Apps, and Wearable Health Devices

: It has been reported from numerous international and socio-economic contexts that young people are becoming increasingly interested in and/or using social media, apps, and wearable devices for their health. Yet, there are few robust empirical accounts on the types of health-related information young people find, select, and use, the reasons for their choices, and how young people use these technologies in a way that influences their health-related knowledge and behaviors. This paper synthesizes findings from three separate projects that investigated over 1600 young people’s (age 13–19) perspectives on and experiences of health-related social media, apps, and wearable health devices. The findings show that young people are both critical and vulnerable users and generators of digital health technologies. Many young people experience a range of positive benefits for their physical activity, diet/nutritional, and body image related behaviors. Yet there are a number of risks, and young people report on the power of digital health technologies to shape, influence, and change their health-related behaviors. The paper concludes by providing new and evidence-based direction and guidance on how relevant adults (including teachers, parents/guardians, health professionals/practitioners, policy-makers, and researchers) can better understand and support young people’s engagement with digital health technologies.