1
|
Waters EA, Pachur T, Pogge G, Hunleth J, Webster GD, Fedele DA, Shepperd JA. How are mental representations of asthma triggers and symptoms related to interpersonal risk perceptions? A psychometric investigation of caregivers of children with asthma. Psychol Health 2023:1-23. [PMID: 37545105 PMCID: PMC11073392 DOI: 10.1080/08870446.2023.2244522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 07/25/2023] [Accepted: 07/29/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE Parents and guardians (hereafter caregivers) make decisions for their children's medical care. However, many caregivers of children with asthma struggle to understand their child's illness. We used the psychometric paradigm to investigate how caregivers conceptualize, or mentally represent, asthma triggers and symptoms and how these representations are linked to perceived asthma exacerbation risk. METHODS We asked 377 caregivers of children with asthma across the U.S. to rate 20 triggers or 20 symptoms along 15 characteristics. Caregivers also indicated their perceived risk of their child having an asthma exacerbation (hereafter interpersonal risk perceptions). Using principal components analysis, we extracted key dimensions underlying caregivers' ratings on the characteristics. Then we related the triggers' and symptoms' scores on the dimensions to caregivers' interpersonal risk perceptions. RESULTS Interpersonal risk perceptions were higher for triggers with high ratings for the dimensions severe and relevant, and negative affect-yet manageable, but not chronic-yet unpredictable. Risk perceptions were also higher for symptoms with high ratings for the dimensions severe and unpredictable, and relevant and common, but not self-blame or manageable despite unknown cause. CONCLUSION By identifying key dimensions underlying caregivers' mental representations of asthma triggers and symptoms, these findings can inform a new approach to asthma education.
Collapse
Affiliation(s)
- Erika A. Waters
- Washington University in St. Louis, Saint Louis, Missouri, USA
| | | | | | - Jean Hunleth
- Washington University in St. Louis, Saint Louis, Missouri, USA
| | | | | | | |
Collapse
|
2
|
Eli K, Ochieng C, Hawkes C, Perkins GD, Couper K, Griffiths F, Slowther AM. Secondary care consultant clinicians' experiences of conducting emergency care and treatment planning conversations in England: an interview-based analysis. BMJ Open 2020; 10:e031633. [PMID: 31964663 PMCID: PMC7044868 DOI: 10.1136/bmjopen-2019-031633] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To examine secondary care consultant clinicians' experiences of conducting conversations about treatment escalation with patients and their relatives, using the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) process. DESIGN Semi-structured interviews following ward round observations. SETTING Two National Health Service hospitals in England. PARTICIPANTS Fifteen medical and surgical consultants from 10 specialties, observed in 14 wards. ANALYSIS Interview transcripts were analysed using thematic analysis. RESULTS Three themes were developed: (1) determining when and with whom to conduct a ReSPECT conversation; (2) framing the ReSPECT conversation to manage emotions and relationships and (3) reaching ReSPECT decisions. The results showed that when timing ReSPECT conversations, consultant clinicians rely on their predictions of a patient's short-term prognosis; when framing ReSPECT conversations, consultant clinicians seek to minimise distress and maximise rapport and when involving a patient or a patient's relatives in decision-making discussions, consultant clinicians are guided by their level of certainty about the patient's illness trajectory. CONCLUSIONS The management of uncertainty about prognoses and about patients' emotional reactions is central to secondary care consultant clinicians' experiences of timing and conducting ReSPECT conversations.
Collapse
Affiliation(s)
- Karin Eli
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Claire Hawkes
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry, UK
- Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Keith Couper
- Warwick Medical School, University of Warwick, Coventry, UK
- Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | | |
Collapse
|
3
|
Tarrant C, Krockow EM, Nakkawita WMID, Bolscher M, Colman AM, Chattoe-Brown E, Perera N, Mehtar S, Jenkins DR. Moral and Contextual Dimensions of "Inappropriate" Antibiotic Prescribing in Secondary Care: A Three-Country Interview Study. FRONTIERS IN SOCIOLOGY 2020; 5:7. [PMID: 33869416 PMCID: PMC8022648 DOI: 10.3389/fsoc.2020.00007] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/04/2020] [Indexed: 05/08/2023]
Abstract
Overuse of broad-spectrum antibiotics in secondary care is a key contributor to the emergence and spread of antimicrobial resistance (AMR); efforts are focused on minimizing antibiotic overuse as a crucial step toward containing the global threat of AMR. The concept of overtreatment has, however, been difficult to define. Efforts to address the overuse of medicine need to be informed by an understanding of how prescribers themselves understand the problem. We report findings from a qualitative interview study of 46 acute care hospital prescribers differing in seniority from three countries: United Kingdom, Sri Lanka and South Africa. Prescribers were asked about their understanding of inappropriate use of antibiotics. Prescriber definitions of inappropriate use included relatively clear-cut and unambiguous cases of antibiotics being used "incorrectly" (e.g., in the case of viral infections). In many cases, however, antibiotic prescribing decisions were seen as involving uncertainty, with prescribers having to make decisions about the threshold for appropriate use. Decisions about thresholds were commonly framed in moral terms. Some prescribers drew on arguments about their duty to protect public health through having a high threshold for prescribing, while others made strong arguments for prioritizing risk avoidance for the patients in front of them, even at a cost of increased resistance. Notions of whether prescribing was inappropriate were also contextually dependent: high levels of antibiotic prescribing could be seen as a rational response when prescribers were working in challenging contexts, and could be justified in relation to financial and social considerations. Inappropriate antibiotic use is framed by prescribers not just in clinical, but also in moral and contextual terms; this has implications for the design and implementation of antibiotic stewardship interventions aiming to reduce inappropriate use of antibiotics globally.
Collapse
Affiliation(s)
- Carolyn Tarrant
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
- *Correspondence: Carolyn Tarrant
| | - Eva M. Krockow
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, United Kingdom
| | | | - Michele Bolscher
- Tygerberg Academic Hospital and Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Andrew M. Colman
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, United Kingdom
| | - Edmund Chattoe-Brown
- School of Media, Communication and Sociology, University of Leicester, Leicester, United Kingdom
| | - Nelun Perera
- Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Shaheen Mehtar
- Tygerberg Academic Hospital and Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - David R. Jenkins
- Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| |
Collapse
|
4
|
Gaspar M, Rosenes R, Burchell AN, Grennan T, Salit I, Grace D. Diagnosing uncertainty: The challenges of implementing medical screening programs for minority sub-populations in Canada. Soc Sci Med 2019; 244:112643. [PMID: 31698281 DOI: 10.1016/j.socscimed.2019.112643] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/22/2019] [Accepted: 10/25/2019] [Indexed: 12/29/2022]
Abstract
The social science literature on medical screening has documented a notable disjuncture between the promises of population-based screening programs and the complex realities of their rollout in everyday practice. We contribute to this scholarship by examining how healthcare providers confront numerous uncertainties associated with the implementation of anal cancer screening programs in Canada given the absence of standardized national evidence-based guidelines. The data was derived from in-depth interviews conducted with 13 physicians and 2 clinical researchers about anal cancer screening for gay, bisexual and other men who have sex with men living with HIV, the minority sub-population at the highest risk for HPV-associated anal cancer. Despite having unknown utility and low specificity, an initial anal Pap test was used to triage patients into anal dysplasia clinics for high-resolution anoscopy. This process led to technological scepticism toward the Pap's accuracy, diagnostic ambiguity related to the interpretation of the cytology results and increased patient anxiety regarding abnormal results. Physicians navigated a tension between wanting to avoid exposing their patients to additional uncertainties caused by screening and pre-cancer treatment and wanting to ensure that their patients did not develop anal cancer under their care. A high number of abnormal anal Pap results paradoxically reintroduced some of the capacity issues that the Pap was meant to resolve, as the existing dysplasia clinics were incapable of seeing all patients with abnormal results. We define this sequence as the epistemic-capacity paradox, a dynamic whereby seeking evidence to improve healthcare capacity simultaneously produces evidence that introduces capacity challenges and generates additional uncertainty. The epistemic-capacity paradox demonstrates the limitations of evidence-based medicine frameworks at determining best practices in the context of rarer health conditions affecting minority sub-populations, where smaller population numbers and limited institutional support pose systemic challenges to the acquisition of sufficient evidence.
Collapse
Affiliation(s)
- Mark Gaspar
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Ron Rosenes
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - Ann N Burchell
- Department of Family and Community Medicine and MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Troy Grennan
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Irving Salit
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| |
Collapse
|
5
|
Toft EL, Kaae SE, Malmqvist J, Brodersen J. Psychosocial consequences of receiving false-positive colorectal cancer screening results: a qualitative study. Scand J Prim Health Care 2019; 37:145-154. [PMID: 31079520 PMCID: PMC6566584 DOI: 10.1080/02813432.2019.1608040] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objective: The objective of this study was to investigate the psychosocial consequences of receiving false-positive colorectal cancer (CRC) screening results, following a positive immunochemical faecal occult blood test. Design, setting, and subjects: We conducted a qualitative study with four semi-structured focus group interviews with 16 participants aged 50-74, all of whom had received a false-positive result in the national Danish CRC screening programme. We selected, recruited, and grouped participants to ensure maximum variation, and to enable a level of confidence to speak openly about experiences of screening. We subjected interview data, audio-recordings, and transcripts to a strategy of qualitative analysis called systematic text condensation. Results: We identified four main themes which described the psychosocial consequences of false-positive CRC screening results: anxiety; discomfort; changed self-perception and behaviour; and considerations on participation in screening. Each of these themes covered a wide range of experiences which were relevant to the informants and broadly shared by them in many aspects. Conclusions: Receiving false-positive results from CRC screening can lead to negative psychosocial consequences such as changes in self-perception and anxiety: some participants may experience subsequent relief, others not. These negative psychosocial consequences might persist over time. Implications: Negative psychosocial consequences from false-positive CRC screening results may result in a greater use of general practitioner services by healthy people who need reassurance or further tests. More research using condition-specific measures is required to further understand the degree and potential persistence of psychosocial consequences of false-positive results from CRC screening. Key Points Participants who receive false-positive colorectal cancer (CRC) screening results may experience negative psychosocial consequences e.g. anxiety and subsequent relief. Participants who receive false-positive CRC screening results may experience discomfort during the screening process. Participants who receive false-positive CRC screening results may experience longer term changes of self-perception. Participants who receive false-positive CRC screening results may experience ambivalence about the offered diagnostic down-stream procedures including colonoscopy.
Collapse
Affiliation(s)
- Eva Lykke Toft
- Center for Research & Education in General Practice, Copenhagen, Denmark;
| | - Sara Enggaard Kaae
- CONTACT Kaae S. Center for Research & Education in General Practice, Copenhagen, Denmark
| | - Jessica Malmqvist
- Center for Research & Education in General Practice, Copenhagen, Denmark;
- Primary Health Care Research Unit, Region Zealand, Denmark
| | - John Brodersen
- Center for Research & Education in General Practice, Copenhagen, Denmark;
- Primary Health Care Research Unit, Region Zealand, Denmark
| |
Collapse
|
6
|
|
7
|
Restivo L, Julian-Reynier C, Peyla L, Apostolidis T. What makes decision-making difficult for oncologists faced with critical situations? The socio-affective side of the physician-patient relationship. J Health Psychol 2018; 25:1396-1409. [PMID: 29417840 DOI: 10.1177/1359105318755431] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The aim of this qualitative study based on a Social Representations approach was to explore experienced oncologists' representations of difficult decision-making situations. In total, 22 semi-structured interviews with oncologists were conducted and analysed by performing a thematic content analysis. The thematic content analysis brought to light the main medical problem involved such as uncertainty, the lethal nature of cancer and physicians' specialties, as well as the psychosocial ones, such as patients' non-medical characteristics and the patient-physician relationships. This analysis also showed the painful tensions experienced by specialists in the context of decision-making situations when the medical arguments conflict with the psychosocial ones. These findings suggest that in order to understand more clearly the complex processes involved in difficult medical decision-making situations, studies on physicians' expertise should include the socio-affective climate involved in each patient-physician relationship.
Collapse
Affiliation(s)
- Léa Restivo
- Aix Marseille Univ, LPS, Aix en Provence, France.,Aix Marseille Univ, INSERM, IRD, SESSTIM, Marseille, France
| | - Claire Julian-Reynier
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Marseille, France.,Institut Paoli-Calmettes, Equipe Cancer, Biomédecine, Société, Marseille, France
| | - Laura Peyla
- APHM, Hôpital de la Timone, Service Dermatologie, Vénérologie, Cancérologie cutanée, Marseille, France
| | | |
Collapse
|
8
|
Manca T. Health professionals and the vaccine narrative: ‘the power of the personal story’ and the management of medical uncertainty. HEALTH RISK & SOCIETY 2016. [DOI: 10.1080/13698575.2016.1190319] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
9
|
Pickles K, Carter SM, Rychetnik L, McCaffery K, Entwistle VA. General Practitioners' Experiences of, and Responses to, Uncertainty in Prostate Cancer Screening: Insights from a Qualitative Study. PLoS One 2016; 11:e0153299. [PMID: 27100402 PMCID: PMC4839572 DOI: 10.1371/journal.pone.0153299] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 03/10/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Prostate-specific antigen (PSA) testing for prostate cancer is controversial. There are unresolved tensions and disagreements amongst experts, and clinical guidelines conflict. This both reflects and generates significant uncertainty about the appropriateness of screening. Little is known about general practitioners' (GPs') perspectives and experiences in relation to PSA testing of asymptomatic men. In this paper we asked the following questions: (1) What are the primary sources of uncertainty as described by GPs in the context of PSA testing? (2) How do GPs experience and respond to different sources of uncertainty? METHODS This was a qualitative study that explored general practitioners' current approaches to, and reasoning about, PSA testing of asymptomatic men. We draw on accounts generated from interviews with 69 general practitioners located in Australia (n = 40) and the United Kingdom (n = 29). The interviews were conducted in 2013-2014. Data were analysed using grounded theory methods. Uncertainty in PSA testing was identified as a core issue. FINDINGS Australian GPs reported experiencing substantially more uncertainty than UK GPs. This seemed partly explainable by notable differences in conditions of practice between the two countries. Using Han et al's taxonomy of uncertainty as an initial framework, we first outline the different sources of uncertainty GPs (mostly Australian) described encountering in relation to prostate cancer screening and what the uncertainty was about. We then suggest an extension to Han et al's taxonomy based on our analysis of data relating to the varied ways that GPs manage uncertainties in the context of PSA testing. We outline three broad strategies: (1) taking charge of uncertainty; (2) engaging others in managing uncertainty; and (3) transferring the responsibility for reducing or managing some uncertainties to other parties. CONCLUSION Our analysis suggests some GPs experienced uncertainties associated with ambiguous guidance and the complexities of their situation as professionals with responsibilities to patients as considerably burdensome. This raises important questions about responsibility for uncertainty. In Australia in particular they feel insufficiently supported by the health care system to practice in ways that are recognisably consistent with 'evidence based' professional standards and appropriate for patients. More work is needed to clarify under what circumstances and how uncertainty should be communicated. Closer attention to different types and aspects of the uncertainty construct could be useful.
Collapse
Affiliation(s)
- Kristen Pickles
- Centre for Values, Ethics & the Law in Medicine, University of Sydney, Australia
| | - Stacy M. Carter
- Centre for Values, Ethics & the Law in Medicine, University of Sydney, Australia
| | - Lucie Rychetnik
- School of Medicine, University of Notre Dame, Sydney, Australia
| | | | | |
Collapse
|
10
|
Hunleth JM, Steinmetz EK, McQueen A, James AS. Beyond Adherence: Health Care Disparities and the Struggle to Get Screened for Colon Cancer. QUALITATIVE HEALTH RESEARCH 2016; 26:17-31. [PMID: 26160775 PMCID: PMC4684740 DOI: 10.1177/1049732315593549] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Dominant health care professional discourses on cancer take for granted high levels of individual responsibility in cancer prevention, especially in expectations about preventive screening. At the same time, adhering to screening guidelines can be difficult for lower income and under-insured individuals. Colorectal cancer (CRC) is a prime example. Since the advent of CRC screening, disparities in CRC mortality have widened along lines of income, insurance, and race in the United States. We used a community-engaged research method, Photovoice, to examine how people from medically under-served areas experienced and gave meaning to CRC screening. In our analysis, we first discuss ways in which participants recounted screening as a struggle. Second, we highlight a category that participants suggested was key to successful screening: social connections. Finally, we identify screening as an emotionally laden process that is underpinned by feelings of uncertainty, guilt, fear, and relief. We discuss the importance of these findings to research and practice.
Collapse
Affiliation(s)
- Jean M Hunleth
- Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Amy McQueen
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Aimee S James
- Washington University School of Medicine, St. Louis, Missouri, USA
| |
Collapse
|
11
|
de Groot E, Endedijk M, Jaarsma D, van Beukelen P, Simons RJ. Development of critically reflective dialogues in communities of health professionals. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2013; 18:627-643. [PMID: 22976456 DOI: 10.1007/s10459-012-9403-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 09/04/2012] [Indexed: 06/01/2023]
Abstract
Critically reflective dialogues (CRD) are important for knowledge sharing and creating meaning in communities. CRD includes different aspects: being open about mistakes, critical opinion sharing, asking for and giving feedback, experimentation, challenging groupthink and research utilisation. In this article we explore whether CRD aspects change over time, through a study of two dialogues each from six different communities of veterinary health professionals. Change was studied from the perspective of observations, through analysing transcripts of dialogues, and from the perspective of community members' perceptions, through an evaluative discussion with members. The results showed that some communities became more open about mistakes, a finding that is related to an increase in trust. Other observed aspects of CRD seemed to be fairly stable over time. Community members perceived research utilisation and asking for and giving feedback to have been increased. From an analysis of perceptions of the community members it emerged that limited interaction could be associated with the epistemological conceptions of community members.
Collapse
Affiliation(s)
- Esther de Groot
- Faculty of Veterinary Medicine, Utrecht University, PO Box 80163, 3508 TD, Utrecht, The Netherlands,
| | | | | | | | | |
Collapse
|
12
|
Hutchison KJ, Rogers WA. Challenging the epistemological foundations of EBM: what kind of knowledge does clinical practice require? J Eval Clin Pract 2012; 18:984-91. [PMID: 22994996 DOI: 10.1111/j.1365-2753.2012.01905.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This paper raises questions about the epistemological foundations of evidence-based medicine (EBM). We argue that EBM is based upon reliabilist epistemological assumptions, and that this is appropriate - we should focus on identifying the most reliable processes for generating and collecting medical knowledge. However, we note that this should not be reduced to narrow questions about which research methodologies are the best for gathering evidence. Reliable processes for generating medical evidence might lie outside of formal research methods. We also question the notion of the knower that is assumed by EBM. We argue that EBM assumes an enlightenment conception of knowers as autonomous, substitutable individuals. This conception is troubled by the way that clinicians learn the role of anecdote in health care and the role of patient choice, all of which bring into play features of clinicians and patients as situated individuals with particular backgrounds and experiences. EBM's enlightenment conception of the knower is also troubled by aspects of the way evidence is produced. Given these limitations, we argue that EBM should retain its reliabilist bent, but should look beyond formal research methodologies in identifying processes that yield reliable evidence for clinical practice. We suggest looking to feminist epistemology, with its focus on the standpoints of individual situated knowers, and the role of social context in determining what counts as knowledge.
Collapse
|
13
|
Lindenmeyer A, Jamie K, Griffiths F, Légaré F. "They're made in factories and not by witches on the allotment": a qualitative study of midlife women in the united kingdom, exploring their approaches to complementary and alternative medicines. Health Care Women Int 2012; 32:1046-67. [PMID: 22087594 DOI: 10.1080/07399332.2011.603864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
This article explores midlife women's experiences and approaches related to complementary and alternative therapies (CAMS). Ninety-six midlife women were asked about their use of CAMs as part of their overall approach to midlife health. Qualitative thematic analysis was combined with a case-based approach. Women set their experience of CAMs in the context of conventional medicine taking and discussed their safety and different uses. For treatments requiring direct contact with a practitioner, accessibility and quality of the relationship were crucial. Four overall approaches could be discerned (political-critical, pragmatic, careful and wellbeing-oriented) that dynamically interacted with women's experiences.
Collapse
|
14
|
Armstrong N, Eborall H. The sociology of medical screening: past, present and future. SOCIOLOGY OF HEALTH & ILLNESS 2012; 34:161-176. [PMID: 22369578 DOI: 10.1111/j.1467-9566.2011.01441.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Medical screening raises fundamental issues for sociological inquiry, but at present a well-developed sociology of medical screening is lacking. This special issue on the sociology of screening brings together an exciting collection of new work that tackles medical screening from a variety of theoretical and methodological approaches. In this opening paper, we begin by explaining what we mean by screening, and why we believe screening merits sociological attention. Secondly, we reflect on the sociology of screening to date and provide an introduction for those new to this area. We then provide an overview of the papers in this collection, highlighting links and contrasts between papers. We conclude by reflecting on sociology's potential contribution to wider debates about screening, and propose future research directions.
Collapse
Affiliation(s)
- Natalie Armstrong
- Department of Health Sciences, University of Leicester, Leicester, LE1 7RH, UK.
| | | |
Collapse
|
15
|
Eborall HC, Will CM. ‘Prevention is better than cure, but …’: Preventive medication as a risk to ordinariness? HEALTH RISK & SOCIETY 2011. [DOI: 10.1080/13698575.2011.624177] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
16
|
Griffiths F, Bendelow G, Green E, Palmer J. Screening for breast cancer: Medicalization, visualization and the embodied experience. Health (London) 2010; 14:653-68. [DOI: 10.1177/1363459310361599] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Women’s perspectives on breast screening (mammography and breast awareness) were explored in interviews with midlife women sampled for diversity of background and health experience. Attending mammography screening was considered a social obligation despite women’s fears and experiences of discomfort. Women gave considerable legitimacy to mammography visualizations of the breast, and the expert interpretation of these. In comparison, women lacked confidence in breast awareness practices, directly comparing their sensory capabilities with those of the mammogram, although mammography screening did not substitute breast awareness in a straightforward way. The authors argue that reliance on visualizing technology may create a fragmented sense of the body, separating the at risk breast from embodied experience.
Collapse
|
17
|
Groleau D, Pluye P, Nadeau L. A mix-method approach to the cultural understanding of distress and the non-use of mental health services. J Ment Health 2009. [DOI: 10.1080/09638230701496386] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
18
|
Kolip P, Hoefling-Engels N, Schmacke N. Attitudes toward postmenopausal long-term hormone therapy. QUALITATIVE HEALTH RESEARCH 2009; 19:207-215. [PMID: 19050178 DOI: 10.1177/1049732308328053] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
In this article we address the question of why postmenopausal women undergo hormone therapy. Thirty-five women aged 46 to 75 years living in Bremen (Germany) and taking postmenopausal hormones for at least 12 months were interviewed. Following Fritz Schütze, the interviews were analyzed according to a reconstructive analytical procedure. Five different types of users were identified. They differed from each other in terms of their reasons for using hormones, their expectations of this type of therapy, and their personal habits and circumstances, including an integrity-preserving attitude, a performance-oriented attitude, a searching attitude, a faith-in-medicine attitude, and a benefit-generalizing attitude. The interviews show that there is a need for target-oriented counseling, taking into account the individual attitudes toward menopause and postmenopausal hormone therapy.
Collapse
|
19
|
Mahadeen A, Halabi J, Callister L. Menopause: a qualitative study of Jordanian women's perceptions. Int Nurs Rev 2008; 55:427-33. [DOI: 10.1111/j.1466-7657.2008.00662.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
20
|
Whitmarsh I, Davis AM, Skinner D, Bailey DB. A place for genetic uncertainty: parents valuing an unknown in the meaning of disease. Soc Sci Med 2007; 65:1082-93. [PMID: 17561324 PMCID: PMC2267724 DOI: 10.1016/j.socscimed.2007.04.034] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2006] [Indexed: 10/23/2022]
Abstract
Klinefelter, Turner, and fragile X syndromes are conditions defined by a genetic or chromosomal variant. The timing of diagnosis, tests employed, specialists involved, symptoms evident, and prognoses available vary considerably within and across these syndromes, but all three share in common a diagnosis verified through a molecular or cytogenetic test. The genetic or chromosomal variant identified designates a syndrome, even when symptoms associated with the particular syndrome are absent. This article analyzes interviews conducted with parents and grandparents of children with these syndromes from across the USA to explore how they interpret a confirmed genetic diagnosis that is associated with a range of possible symptoms that may never be exhibited. Parents' responses indicate that they see the genetic aspects of the syndrome as stable, permanent, and authoritative. But they allow, and even embrace, uncertainty about the condition by focusing on variation between diagnosed siblings, the individuality of their diagnosed child, his or her accomplishments, and other positive aspects that go beyond the genetic diagnosis. Some families counter the genetic diagnosis by arguing that in the absence of symptoms, the syndrome does not exist. They use their own expertise to question the perceived certainty of the genetic diagnosis and to employ the diagnosis strategically. These multiple and often conflicting evaluations of the diagnostic label reveal the rich ways families make meaning of the authority attributed to genetic diagnosis.
Collapse
|