Human Flourishing and Population Health: Meaning, Measurement, and Implications

Human flourishing has recently emerged as a construct of interest in clinical and population-health studies. Its origins as a focus of research are rooted in philosophical writing dating to Aristotle's concept of eudaimonia, in the work of contemporary psychologists, and in studies by epidemiologists, physicians, and social and behavioral scientists who have investigated religious influences on physical and mental health since the 1980s. Inasmuch as human flourishing has been characterized as multidimensional or multifaceted, with hypothetically broad antecedents and significant outcomes, it may be an especially valuable construct for researchers. For one, it would seem to tap something deeper and more meaningful than the superficial single-item measures that often characterize such studies. This article surveys the rich history of the concept of human flourishing in its multiple meanings and contexts across disciplines, proposes a conceptual model for assessing the construct, and lays out an agenda for clinical and population-health research.

Understanding digital health: Productive tensions at the intersection of sociology of health and science and technology studies

In this editorial introduction, we explore how digital health is being explored at the intersection of sociology of health and science and technology studies (STS). We suggest that socio-material approaches and practice theories provide a shared space within which productive tensions between sociology of health and STS can continue. These tensions emerge around the long-standing challenges of avoiding technological determinism while maintaining a clear focus on the materiality and agency of technologies and recognising enduring sets of relations that emerge in new digital health practices while avoiding social determinism. The papers in this Special Issue explore diverse fields of healthcare (e.g. reproductive health, primary care, diabetes management, mental health) within which heterogenous technologies (e.g. health apps, mobile platforms, smart textiles, time-lapse imaging) are becoming increasingly embedded. By synthesising the main arguments and contributions in each paper, we elaborate on four key dimensions within which digital technologies create ambivalence and (re)configure health practices. First, promissory digital health highlights contradictory virtues within discourses that configure digital health. Second, (re)configuring knowledge outlines ambivalences of navigating new information environments and handling quantified data. Third, (re)configuring connectivity explores the relationships that evolve through digital networks. Fourth, (re)configuring control explores how new forms of power are inscribed and handled within algorithmic decision-making in health. We argue that these dimensions offer fruitful perspectives along which digital health can be explored across a range of technologies and health practices. We conclude by highlighting applications, methods and dimensions of digital health that require further research.

Towards a sociology of healthcare safety and quality

The contributions to this collection address technologies, practices, experiences and the organisation of quality and safety across a wide range of healthcare contexts. Spanning three continents, from hospital to community, maternity to mental health, they shine a light into the boardrooms, back offices and front-lines of healthcare, offering sociological insights from the perspectives of managers, clinicians and patients. We review these articles and consider how they contribute to some of the dilemmas that confront mainstream approaches to quality and safety and then look ahead to outline future lines of sociological inquiry to progress the theory and practice of quality and safety.

Healthcare quality and safety: a review of policy, practice and research

Over the last two decades healthcare quality and safety have risen to the fore of health policy and research. This has largely been informed by theoretical and empirical ideas found in the fields of ergonomics and human factors. These have enabled significant advances in our understanding and management of quality and safety. However, a parallel and at time neglected sociological literature on clinical quality and safety is presented as offering additional, complementary, and at times critical insights on the problems of quality and safety. This review explores the development and contributions of both the mainstream and more sociological approaches to safety. It shows that where mainstream approaches often focus on the influence of human and local environment factors in shaping quality, a sociological perspective can deepen knowledge of the wider social, cultural and political factors that contextualise the clinical micro-system. It suggests these different perspectives can easily complement one another, offering a more developed and layered understanding of quality and safety. It also suggests that the sociological literature can bring to light important questions about the limits of the more mainstream approaches and ask critical questions about the role of social inequality, power and control in the framing of quality and safety.

What is the role of individual accountability in patient safety? A multi-site ethnographic study

An enduring debate concerns how responsibility for patient safety should be distributed between organisational systems and individual professionals. Though rule-based, calculus-like approaches intended to support a 'just culture' have become popular, they perpetuate an asocial and atomised account. In this article, we use insights from practice theory--which sees organisational phenomena as accomplished in everyday actions, with individual agency and structural conditions as a mutually constitutive, dynamic duality--along with contributions from the political science and ethics literature as a starting point for analysis. Presenting ethnographic data from five hospitals, three in one high-income country and two in low-income countries, we offer an empirically informed, normative rethinking of the role of personal accountability, identifying the collective nature of the healthcare enterprise and the extent to which patient safety depends on contributions from many hands. We show that moral responsibility for actions and behaviours is an irreducible element of professional practice, but that individuals are not somehow 'outside' and separate from 'systems': they create, modify and are subject to the social forces that are an inescapable feature of any organisational system; each element acts on the other. Our work illustrates starkly the structuring effects of the broader institutional and socioeconomic context on opportunities to 'be good'. These findings imply that one of the key responsibilities of organisations and wider institutions in relation to patient safety is the fostering of the conditions of moral community.

[The basic principles of the implementation of sociological monitoring programs in public health]

The implementation of sociological research is an important part of information provision of health management. The effectiveness of the sociological studies increases in case of their transfer into monitoring category. The organization of sociological monitoring requires the adherence to the particular technical approaches to provide data validity and data correctness. The possibility to implement the data dynamics analysis can testify the ongoing alterations in the functioning of health care system and the effectiveness of implemented managerial decisions based on the provided sociological information.

Research, policy and funding - academic treadmills and the squeeze on intellectual spaces

In recent years, there has been a great deal of collective rumination about social scientists' role in society. In the post-1997 UK context, public policy commitments to 'evidence-based policy' and 'knowledge transfer' have further stimulated such reflections. More recently, Michael Burawoy's 2004 address to the American Sociological Association, which called for greater engagement with 'public sociology' has reverberated throughout the discipline, motivating a series of debates about the purpose of sociological research. To date, most such contributions have been based on personal experience and anecdotal evidence. In contrast, this paper responds directly to Burawoy's suggestion that we should 'apply sociology to ourselves,' in order that we 'become more conscious of the global forces' driving our research (Burawoy 2005: 285). Drawing on an empirical research project designed to explore of the relationship between health inequalities research and policy in Scotland and England, in the period from 1997 until 2007, this paper discusses data from interviews with academic researchers. The findings suggest that the growing pressure to produce 'policy relevant' research is diminishing the capacity of academia to provide a space in which innovative and transformative ideas can be developed, and is instead promoting the construction of institutionalized and vehicular (chameleon-like) ideas. Such a claim supports Edward Said's (1994) insistence that creative, intellectual spaces within the social sciences are increasingly being squeezed. More specifically, the paper argues we ought to pay far greater attention to how the process of seeking research funding shapes academic research and mediates the interplay between research and policy.

Eugenic utopias/dystopias, reprogenetics, and community genetics

The impetus for this review is the intriguing realisation that eugenics, viewed as dystopian and authoritarian in most of the 20th century, is in the process of being reinterpreted today--in the context of reproductive genetics--as utopian and liberal. This review offers an analytical framework for mapping the growing literature on this subject in order to provide a summary for both teaching and research in medical sociology. Recent works are subsumed and explored in three areas: historical criticism of the 'old eugenics'; the continuation of this stream in the form of criticism of reprogenetics as a new, 'backdoor' eugenic regime of bio-governmentality--an area which also includes the application of Foucauldian and feminist perspectives; and the recent enthusiasm regarding 'liberal eugenics,' claiming that reprogenetic decisions should be left to individual consumers thus enhancing their options in the health market. The review concludes by discussing and illustrating potential research directions in this field, with a focus on the social and ethical aspects of 'community genetics' and its emerging networks of individuals genetically at risk.

Types of centredness in health care: themes and concepts

BACKGROUND

For a variety of sociological reasons, different types of centredness have become important in health and social care. In trying to characterize one type of centredness, we were led to consider, at a conceptual level, the importance of the notion of centredness in general and the reasons for there being different types of centeredness.

METHOD

We searched the literature for papers on client-, family-, patient-, person- and relationship- centred care. We identified reviews or papers that defined or discussed the notions at a conceptual level. The reviews and papers were analyzed as text transcripts.

RESULTS

We identified 10 themes that were common to all the types of centredness. At a conceptual level we could not identify thematic differences between the types of centredness. These findings were subjected to a philosophical critique using ideas derived from Wittgenstein.

CONCLUSION

Different types of centredness are required in different contexts. The differences are justified by their practical utility. The unifying themes of centredness, however, reflect a movement in favour of increasing the social, psychological, cultural and ethical sensitivity of our human encounters.

Developing public sociology through health impact assessment

The renewed interest in 'public sociology' has sparked debate and discussion about forms of sociological work and their relationship to the State and civil society. Medical sociologists are accustomed to engaging with a range of publics and audiences inside and outside universities and are in a position to make an informed contribution to this debate. This paper describes how some of the debates about sociological work are played out through a 'health impact assessment' of a proposed housing renewal in a former coal mining community. We explore the dynamics of the health impact assessment process and relate it to wider debates, current in the social sciences, on the 'new knowledge spaces' within which contentious public issues are now being discussed, and the nature of different forms of expertise. The role of the 'public sociologist' in mediating the relationships between the accounts and interpretations of lay participants and the published 'evidence' is described as a process of mutual learning between publics, professionals and social scientists. It is argued that the continued existence and development of any meaningful 'professional sociology' requires an openness to a 'public sociology' which recognises and responds to new spaces of knowledge production.

Developing professional habitus: a Bernsteinian analysis of the modern nurse apprenticeship

This paper discusses the development of professional habitus in nursing students from a sociological, and specifically, a Bernsteinian perspective. It outlines the theoretical basis for the development of this trait, regarded as one of the defining characteristics of professional practice, and discusses how its development has shaped the modern nurse apprenticeship with its current emphasis on situated learning. The paper considers some of the pitfalls to this approach and raises some caveats about the assumptions which underpin nursing education at the current time. It discusses how students' legitimate peripheral participation in the workplace may be jeopardised, and outlines how they may be faced with untenable choices in respect of 'fitting in' to the ward team or challenging poor practice where this occurs. Moreover, the paper considers how the increasing abrogation of 'caring' activities to non-registered staff threatens the very notion of professional habitus in nursing and posits some possible explanations for this. The paper concludes by arguing that a better understanding of professional habitus is required by all within the profession, and suggests that this concept provides the means by which two seemingly disparate concepts, 'professionalism' and 'vocationalism' can be brought together to the benefit of the nursing profession.

The development of medical sociology in the post-Soviet society: the case of Lithuania

This article explores the historical development of medical sociology and analyses the social problems that have had impacted the changes of health care institutionalization particularly in Lithuania during the Soviet and post-soviet period. Approaching the interaction between sociology and public health sciences, it is intended to apply the concept of medical sociology and its determinants in the context of health care and education systems. By analyzing the case past of medical sociology in Lithuania, we claim that its prospects should be associated with the study of new challenges in the biomedical sciences. In order to improve the importance of medical sociology in developing democracies we should focus on the questions, for instance, to what extent modern biotechnologies should be applied, how to improve the situation with patients' rights, and how to combine the knowledge of social sciences and biomedicine in order to improve the quality of healthcare services and to ensure better functioning of the healthcare system in particular district.

Spirituality and secularization: nursing and the sociology of religion

AIM

The concept of spirituality is much discussed in the UK nursing literature, despite the fact that Britain is one of the most secular countries in the world, and steadily becoming more so. Here, I pose the following question: given this increasing secularization, what accounts for the current interest in spirituality among UK nurses?

BACKGROUND

The literature on spirituality in nursing has blossomed in the last 10 years, and various attempts have been made to define 'spirituality', 'spiritual need' and 'spiritual care'. Most definitions distinguish between 'spirituality' and 'religion', acknowledging that the latter is more institutional, and theologically more restrictive, than the former; and they suggest that spirituality is universal, something which (unlike religion) all human beings share.

METHOD

I draw on the sociology of religion - neglected, for the most part, in the nursing literature - to establish two main points. Firstly, that the UK and the USA are at opposite ends of the religion/secularity spectrum, implying that it is a mistake to assimilate USA and UK sources. Secondly, that the concept of spirituality, as currently understood, is of very recent origin, and is still 'under construction', having become separated from its associations with Christian piety and mysticism only since the 1980s.

CONCLUSIONS

The extension of spirituality into secular domains is part of a professionalization project in nursing, a claim to jurisdiction over a newly invented sphere of work. For the time being, it remains an academic project (in the UK) as it is not one with which many clinicians identify. Relevance to clinical practice. What counts as 'spiritual need' or 'spiritual care' may not be the same in both countries, and UK clinicians are unlikely to welcome the role of surrogate chaplain, which their USA colleagues are apparently willing to embrace.

Perspectives on the prevalence and treatment of personality disorder

Personality disorder (PD) is the most prevalent psychiatric disorder. A methodical literature search identified that PD is under researched compared with other mental health problems such as depression or schizophrenia. Social and psychotherapeutic approaches emerge as dominant treatment approaches with PD where there is good evidence of efficacy. Collaborative group-based therapeutic approaches appear to offer a therapeutic counterpoise to the anti-social traits often prevalent in PD. A retrospective analysis of formal group therapy on acute inpatient units (treating PD patients among other mental health disorders) reveals only one violent incident in over 40,000 treatment hours of formal group therapy. It is argued that group-based and social therapy should be the recommended treatment approach because these approaches have been shown to create a safe and contained milieu, establishing a good base for therapeutic gain with PD patients. The case for widening the scope of collaborative group and community-based therapies is considered and the merits and shortcomings of a key worker system with PD patients are critiqued.

Ethnomethodology: time for a revisit? A discussion paper

The aim of this paper is to provide a comprehensive overview of ethnomethodology and explore its usefulness as a methodology for nursing. Ethnomethodology was conceived through the writings of Harold Garfinkel, an American Sociologist in 1967. The influence of phenomenology, sociology and writings of the linguistic philosopher Wittengenstein is evident in this methodology. In the 1970s, it was both heralded by some as a threat to sociology and by others as a welcome development borne out of the dissatisfaction with positivist paradigm research. It is a methodology that has been utilised not only by sociologists but also by many health care disciplines. However, its utilisation by nurse researchers has not been widespread.

Public health asks of systems science: to advance our evidence-based practice, can you help us get more practice-based evidence?

Public health asks of systems science, as it did of sociology 40 years ago, that it help us unravel the complexity of causal forces in our varied populations and the ecologically layered community and societal circumstances of public health practice. We seek a more evidence-based public health practice, but too much of our evidence comes from artificially controlled research that does not fit the realities of practice. What can we learn from our experience with sociology in the past that might guide us in drawing effectively on systems science?

Health as a socially mediated process: theoretical and practice imperatives emerging from research on health inequalities

Population-based studies on health disparities provide compelling evidence that inequities in health status over the life course accrue from social conditions. Our knowledge of how such conditions exert their effect on health, however, is limited. An examination of explanations for health disparities shows that a theoretical perspective that enables the exploration of the links between broader social processes (macro) and experience (micro) would offer valuable insights for practice. This article introduces a theoretical perspective informed by Bourdieu and Smith that has been used to undertake such an analysis and that opens up possibilities for new practice forums and foci.

[Sociology and nursing science: reflections on an interdisciplinary approach]

The present text is not the result of a necessarily improved sociological theory. It acts rather like an exploratory questioning on the contribution of sociology to the formation and the practice of the nurses in the context of globalization. Our purpose is related more precisely to the "décloisonnement" of the disciplines and the contribution of the interdisciplinary studies. To do so, we put in perspective a new conceptual approach called the "socio-environmental approach for health" (Bouchard and his/her colleagues; 2002) which aloud to introduce and to question concepts like the governorship, globalization, the social capital, life quality and health care. This conceptual unit is not exhaustive nor even homogeneous. It only makes it possible to think of what is at stake in the development of nurses health care practice and shows the central contribution of an interdisciplinary approach.

Role of sociology within the nursing enterprise: some reflections on the unfinished debate

The present paper reviews literature on the relevance of sociology to nursing in the context of arguments presented by Cooke, Sharp and Porter. It explores some of the arguments presented for and against sociology in nursing education. On a broader perspective, sociology inter alia, is at best worthwhile for nurses and is not as positively harmful as Sharp asserts. The discussion draws attention to the relevance of social theory for nursing practice. It is argued that almost all social theories have been widely applied in nursing research. The case for sociology as applied to nursing or nursing sociology versus general sociology for nurses was examined. This paper concludes in favor of the inclusion of sociology as applied to nursing in the nursing curriculum.

Towards the social analysis of twinship

The article examines the proposition that twinship is an irreducibly social phenomenon. Gender, age, birth order, socio-economic status and other variables are considered, along with the role of different patterns of socialization as these affect twinship. It is argued that, to a very large extent, from conception. through gestation, childbirth and subsequently childhood and adolescence, the social processing and regulation of social members take place in unitary terms and that therefore twins (and higher multiples) are an anomaly in relation to such processes. Twins' reactions to stigma, stereotyping and labelling are explored as an integral aspect of the social structuring of twinship. The role of the twin, as distinct from the role of the non-twin, is examined in the context of cultural expectations of twinship regarding similarity of identity and similarity of behaviour. Subsequent or concurrent processes of differentiation between twins are also examined. The article concludes with suggestions for further analyses of twinship.

Bending a habit: critical social theory as a framework for humanistic nursing education

Nursing education is currently experiencing a transition away from a focus on behavioral outcomes and toward a focus which better reflects the humanistic, caring aspects of nursing. Nursing educational content and process must reflect this changing focus of healthcare, which itself is transgressing away from the inherent objectivism of acute care toward the more humanistic elements integral to community building. This paper studies this movement from behaviorism to humanism in nursing education and assumes its foundations in the tenets of critical social theory. The roots of critical social theory are examined, followed by an overview of the changes occurring within nursing education today.

Time for creative integration in medical sociology

The burgeoning of medical sociology has sometimes been accompanied by unfortunate parochialism and the presence of opposing intellectual camps that ignore and even impugn each other's work. We have lost opportunities to achieve creative discourse and integration of different perspectives, methods, and findings. At this stage we should consider how we can foster creative integration within our field.