'Keeping It Real': women's Enactments of Lay Health Knowledges and Expertise on Facebook

"Can Anyone Tell Me…". Online Health Communities in Diabetes Self-Management in Poland and Italy

This paper contributes to the debate about the role of Online Health Communities (OHCs) in the healthcare system by concentrating on the kind of information sought and shared by their members. The paper focuses on OHCs for diabetes and discusses the main findings of a qualitative study conducted in Italy and Poland. The Uses and Gratifications approach informed the study, while content analysis was used to perform the analysis. The findings show that OHCs' role goes beyond information and emotional support, which relies on expertise by experience. Indeed, the lack of basic knowledge constituting the essential diabetes literacy for self-management was partially compensated by peer exchange in the OHCs. This raises at least two problems: quality and reliability of the information shared online, and consequences in terms of the equity that a healthcare system provides.

On the verge between the scientific and the alternative: Swedish women's claims about systemic side effects of the copper intrauterine device

The article intervenes in discussions on lay knowledge production about health in the Internet era, through the case of a group of women claiming that their use of copper intrauterine devices has led to systemic side effects. Based on online group interviews and written essays, we examine how women embracing these knowledge claims navigate various sources of information, focusing on the role of scientificity in these epistemic negotiations. The women were found to be involved in an active, scientifically oriented process of knowledge formation, which we refer to as a collective labour of scientific patchworking. Meanwhile, due to a perceived lack of scientifically based expertise on their condition, the women reported having little choice but turn to resources with weaker scientific foothold. We argue that the tendency to portray these women's claims as unscientific simplifies the nature of lay knowledge production, potentially deepening divides between medical authorities and the public.

Long covid and medical gaslighting: Dismissal, delayed diagnosis, and deferred treatment

While we know a lot more about Long Covid today, patients who were infected with Covid-19 early on in the pandemic and developed Long Covid had to contend with medical professionals who lacked awareness of the potential for extended complications from Covid-19. Long Covid patients have responded by labeling their contentious interactions with medical professionals, organizations, and the broader medical system as "gaslighting." We argue that the charge of medical gaslighting can be understood as a form of ontological politics. Not only do patients demand that their version of reality be recognized, but they also blame the experts who hold gatekeeping power over their medical care for producing a distorted version of said reality. By analyzing results from an online survey of Long Covid patients active on social media in the United States (n ​= ​334), we find that experiences of contention and their reframing as "gaslighting" were common amongst our respondents. In short answer responses about their experience obtaining medical care for Long Covid, our respondents described encountering medical professionals who dismissed their experience, leading to lengthy diagnostic odysseys and lack of treatment options for Long Covid. Even though we are limited by characteristics of our sample, there is good reason to believe that these experiences and their contentious reframing as medical gaslighting are exacerbated by gender, class, and racial inequalities.

Support amid uncertainty: Long COVID illness experiences and the role of online communities

Long COVID is characterized by persistent and debilitating long-term symptoms from COVID-19. Many persons with Long COVID began gathering in online communities during the early phases of the pandemic to share their illness experiences. This qualitative interview study explored the subjective experiences of 20 persons with Long COVID recruited from five online communities. Their understandings of illness and associated implications for social relationships with family and friends, healthcare professionals, and online community members were explored. Three themes were identified from our analysis, including (1) complex and unpredictable illness experienced amid an evolving understanding of the pandemic; (2) frustration, dismissal, and gaslighting in healthcare interactions; and (3) validation and support from online communities. These findings highlight the significant uncertainty that persons with Long COVID navigated, the features of their often dismaying healthcare experiences, and the ways in which online communities aided them in understanding their illness.

Negotiating mental illness across the lay-professional divide: Role play in peer work consultations

Patient involvement is a prominent policy aim in modern health care. Today, mental health services employ peer workers (PWs) who have personal experiences with mental illness. Based on 22 interviews with PWs and 26 audio recordings of real-life consultations, we show how PWs talk about their personal experiences as professional qualifications. Furthermore, we demonstrate how in real-life encounters, PWs and patients convert personal experiences into a professional approach through an interactionist role play that balance PWs role as former patients and current professionals. Our analysis shows that PWs combine the personal pronoun 'I' (stressing that it is personal) with the indefinite pronoun 'one' (referring to generalised patient experiences) when they recount illness experiences. This convey that PWs engage with mental illness as both a personal and professional topic. In addition, the analysis shows that PWs (and patients) use professional clues to manifest PWs' positions as professionals. Overall, the article demonstrates that instead of focussing on authentic patient relationships, as previous research has done, it is beneficial to investigate peer work from a symbolic interactionist approach revealing how PWs and patients skilfully manoeuvre the contradictions embedded in the PWs' dual role as former patients and current professionals.

Experiential knowledge in mental health services: Analysing the enactment of expertise in peer support

The shift towards recovery-oriented mental health care has led to the extensive growth of peer support in contemporary service delivery. When enacting peer support, peer workers (PWs) use their lived experiences of mental illness to provide support to individuals experiencing mental health difficulties. While PWs are increasingly an integrated part of mental health services, the way in which peer support unfolds in everyday practices remains understudied. Drawing on ethnographic fieldwork from Danish mental health centres, this paper investigates how peer workers and users enact experiential knowledge and expertise to support one another. Theoretically, this paper draws on a micro-sociological approach that comprehends expertise as an interactional accomplishment enacted within institutional arrangements. First, the analysis shows how PWs and users develop affective relations based on shared illness experiences that enable the enactment of expertise. Second, it demonstrates how PWs and users engage in these relations by exchanging sympathy and knowledge according to different situational demands. Third, it shows how experiences of relational limitations make service users contest the value of experiential knowledge and PWs' position as valid experts. Centrally, this paper contributes to a general discussion of expertise and the implications of bringing lived experiences into mental health services.

Digital mediation of candidacy in maternity care: Managing boundaries between physiology and pathology

This paper brings together scholarship across sociology, media and communication, and human computer interaction to explore the intersection of digital health and the maternity care system. We draw on data (including interviews, focus groups, observations, and analyses of digital media content) from 19 studies involving over 400 women to explore women's experiences of using different forms of digital support such as the Internet, mobile technologies (apps and text messaging), social media, and remote monitoring devices in their reproductive journeys. We use a best fit approach to analysis, mapping our findings to the candidacy framework and notions of trajectory work to understand how women engage in digital health practices to negotiate boundaries between physiology and pathology and to enter dialogue with maternity services during conception, pregnancy and the postnatal period. We propose an integrated revised conceptual framework which explicates intersections between digital and care practices, and micro-level negotiations between women and professionals in the maternal health context. Our revised framework retains the dimensions of candidacy, but it introduces a precursor to the identification of candidacy in the form of 'understanding normality'. It identifies distinct forms of digital work (e.g. information work, navigation work, machine work) which operate across the candidacy dimensions that women (and partners at times) engage in to negotiate legitimacy when entering into encounters with the maternity care system. Operating conditions (norms around expert motherhood; neoliberal discourses around health optimisation, risk and responsibilisation) provide a broader macro-level context, influencing the micro-level dialogic processes between women and healthcare professionals. Our synthesis highlights digital mediation as a useful filter to understand care systems, distribution of lay/professional responsibilities, relational practices and the (dis)enablement of candidacy.

From loyalty to resignation: Patient-doctor figurations in type 1 diabetes

This paper contributes to the debate on the patient-doctor relationship by focussing on a specific chronic disease: type 1 diabetes. This field is characterised by an increasing use of technology, specifically therapeutic devices and a significant requirement of patient self-management. This paper presents the main findings of research conducted in Italy in 2018. It is argued that this relationship is more properly described as an interdependent figuration of actors characterised by a dynamic process of power balances, which recalls Elias' (What is sociology? Columbia University Press, 1978) figurational-processual and relational sociology. In this theoretical context, patients may manage their (dis)satisfaction with their diabetologists by choosing different behaviours that stem from Hirschman's archetype (Exit, voice, and loyalty. Responses to decline firms, organizations, and states. Harvard University Press, 1970): voice, exit, loyalty and, we would add, resignation. These categories are fluid, and all of them can be experienced by patients over time, depending on the quality of the figurations built among these transactors.

"Sharing Is Caring:" Australian Self-Trackers' Concepts and Practices of Personal Data Sharing and Privacy

Self-tracking technologies and practices offer ways of generating vast reams of personal details, raising questions about how these data are revealed or exposed to others. In this article, I report on findings from an interview-based study of long-term Australian self-trackers who were collecting and reviewing personal information about their bodies and other aspects of their everyday lives. The discussion focuses on the participants' understandings and practices related to sharing their personal data and to data privacy. The contextual elements of self-tracked sharing and privacy concerns were evident in the participants' accounts and were strongly related to ideas about why and how these details should be accessed by others. Sharing personal information from self-tracking was largely viewed as an intimate social experience. The value of self-tracked data to contribute to close face-to-face relationships was recognized and related aspects of social privacy were identified. However, most participants did not consider the possibilities that their personal information could be distributed well-beyond these relationships by third parties for commercial purposes (or what has been termed "institutional privacy"). These findings contribute to a more-than-digital approach to personal data sharing and privacy practices that recognizes the interplay between digital and non-digital practices and contexts. They also highlight the relational and social dimensions of self-tracking and concepts of data privacy.

'Nesef Doctora'-When mothers are considered to be 'half-doctors': Self-medication with antibiotics and gender roles in the Arab society in Israel

This qualitative study focuses on self-medication with antibiotics as it relates to gender roles and traditions in the Arab society in Israel, a collectivist minority with defined traditional gender norms. Its findings draw on the analysis of 116 face-to-face interviews with 60 pharmacists, 27 primary care physicians and 29 community members, mainly mothers and unmarried women, from different geographical localities. The findings describe how mothers are assigned the role of the family health caretakers, expected to abide to a hierarchical power structure, and listen to the advice of 'senior mothers'. These expectations can lead to mothers self-medicating their children and themselves with antibiotics. Traditional constraints associated with sexuality were also found to compel unmarried women to self-medicate. The findings point to a duality of power in family relations: women submit to having limited power in traditional gender roles but are accorded power as medical experts in health-care decision-making. The study concludes with recommendations for considering sociocultural factors of hierarchy, traditions and collectivist orientation when researching self-care patterns and developing interventions to curtail antibiotics overuse. It also points to the importance of recognising pressures exerted on unmarried women and enabling them to use health-care resources in their community for managing sexual health.

'That thing in his head': Aboriginal and non-Aboriginal Australian caregiver responses to neurodevelopmental disability diagnoses

Little is known about the significance of cultural differences to how caregivers receive a diagnosis of neurodevelopmental disability. As part of a Fetal Alcohol Spectrum Disorder prevalence study among sentenced, detained youth, our qualitative study explored the experiences of diagnostic assessment among detained young people and their caregivers. We present findings from the perspectives of caregivers. In conversation with the sociology of diagnosis literature, we present vignettes of three Aboriginal and two non-Aboriginal caregivers' experiences of the diagnostic assessment process. We found that Aboriginal caregivers conceptualised their children's diagnosis and ongoing management in the context of their family networks and community. In contrast, non-Aboriginal caregivers focused on how the diagnosis would affect their child and interactions with various institutions including healthcare systems and schools. Caregivers' engagement with diagnostic reports and resources also followed cultural lines. Reflections on intergenerational drinking were voiced by Aboriginal caregivers, who expressed shame at receiving diagnosis. These findings advance our appreciation of cultural difference in receiving a diagnosis, the examination of which is in its nascent stages. We also suggest ways to mitigate harm from a stigmatising diagnosis and soften the well-established effects of medical dominance over the process of defining a person's capacity and status.

Online resources and apps to aid self-diagnosis and help seeking in the perinatal period: A descriptive survey of women's experiences

OBJECTIVE

Assess the role of online resources and apps for women's help seeking and staff's response to concerns in the perinatal period.

DESIGN

Online survey. Descriptive analysis of women's use and experiences of digital resources for self-diagnosis and help seeking, drawing on numerical and free-text responses.

SETTING

Two tertiary referral centres and one district general hospital in two UK geographic locations.

PARTICIPANTS

632 postnatal women, surveyed over a 4 month period.

MEASUREMENTS

Women's access to digital devices; frequency and type of health concerns experienced after 22 weeks' gestation; variability in use and experiences of websites/apps; perceptions of staff's response to concerns after help-seeking.

FINDINGS

1254 women were approached over a 4-month period; 632 participated (response rate: 50%). Women reported a 'mix and match' blended use of digital resources to both learn about, and self-diagnose/self-triage for potential complications in pregnancy as an adjunct to care provided by maternity staff. Over half the participants experienced concerns about themselves or their baby after 22 weeks. The top concern was fetal movements, reported by 62%. Women used 91 different digital resources to help with understanding and decision-making, in addition to seeking support from family, friends and healthcare professionals. Enabling features of staff responses were identified from free-text responses (n = 292) by women who sought professional help regarding their health concerns, and influencing factors at clinical, organisational and digital level.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Online information retrieval and digital self-monitoring is increasingly integral to women's self-care during pregnancy and offers opportunities to support escalation of care and shared decision-making. Further work should assess optimal inclusion of this 'digital work' into clinical consultations.

Feeling less alone online: patients' ambivalent engagements with digital media

Digital media offer the chronically ill, especially those who experience related isolation, unparalleled opportunities to connect with others. This article asks, how do these individuals ascribe meaning to and use these media to manage their condition and related isolation? Using the concepts of affordance and emotional community, and drawing on the findings from an Australian study on patients' use of digital media, we examine individuals' ambivalent ascriptions of media, which are both feared and distrusted for the risks they present and embraced as invaluable tools of social connection. We argue that this ambivalence is explicable in terms of the communities to which the chronically ill belong which are founded on strong emotional bonds. In a context in which individuals tend to feel isolated through pain and/or stigmatisation, digital media may offer powerful means for sharing and affirming their experiences, the subjective benefits of which may outweigh the perceived risks. The article discusses the functions and features of digital media that the chronically ill value and distrust and concludes by considering the implications of our analysis for strategies to address the needs of people who feel isolated as a consequence of their condition.