Health: current issue

Health: RSS feed -- current issue

Negotiated pleasures in health-seeking lifestyles of participants of a health promoting intervention

Using focus group discussion data the present article examines argumentation around pleasure from food and physical activity among participants of a health promoting intervention. The article analyses the conflicts produced by pleasure-seeking and health enhancement, and the pursuits to solve these conflicts. Due to the discrepancy between the pleasure-seeking and health enhancement, pleasure was constructed not simply as a spontaneous experience but often as a planned and disciplined event. In respect of food, it was considered as appropriate to negotiate with different sources of pleasure and discipline one’s inclination to simply follow one’s taste. However, the tastiness of food was seen to have a value of its own and the need for pleasurable tastes was often experienced as beyond the individual’s control. We term food related pleasures ‘negotiated pleasures’ stressing the diverse strategies used by individuals while negotiating between food related pleasures and their overall health-seeking lifestyle. In respect of physical activity, life resembled more a mosaic where passivity was occasionally interrupted with disciplined physical activity that seldom produced pleasure. The scarcity of pleasures from physical activity as well as from healthy foods is a challenge for health promoters. Instead of building more self-controlling and self-denying individuals, it could be fruitful to focus health promoters’ attention to the enhancement of the experiences of pleasure. No matter how self-disciplined individuals are, if the dilemma of pleasure and health is not disentangled, lifestyle change will not last long.

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Disrupted lives and threats to identity: The experiences of people with colorectal cancer within the first year following diagnosis

In this article we focus on the experiences of 18 people with colorectal cancer, involved in a large longitudinal qualitative study to explore people’s experiences of cancer within the first year following diagnosis. Three depth interviews over the course of the year were carried out. During analysis, we drew on biographically informed approaches of understanding chronic illness, particularly the work of Bury and Charmaz, to explore the extent to which people within the first year following diagnosis experience cancer as biographically disruptive. We explore the biographical work that individuals carry out in the context of an assault on their identity and discuss the relevance of the concept biographical disruption for people who experience cancer as an acute, chronic and/or life-threatening condition. We also discuss the concept’s relevance for people who have lived a hard life and, hence, may anticipate these types of disruptions in their lives and experience their impact differently. We conclude that universal application of the concept biographical disruption to the experience of cancer within the first year of diagnosis is not appropriate. This study has implications for cancer services, in particular, the findings call for the development of interventions to support those people who experience cancer as an assault on their identity.

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'Do you feel sorry for him?': Gift relations in an HIV/AIDS on-line support forum

Sociologists have debated whether meaningful emotional relationships can be formed on-line. Drawing on Mauss’ concept of the gift, I explore how caregivers who participate in Hope, an on-line support forum dedicated to HIV/AIDS, incorporate moral percepts and understandings about ethics into their caregiving experiences. Their intense discussions on the essence of familial loyalties give rise to emotionally vibrant, empathic communities in which a socio-emotional economy is formulated. Can the Internet act as a moral space? How are concepts such as reciprocity, obligation, and commitment talked about and practiced in an on-line forum that exists in the ever present?

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Medical technocracies in liver transplantation: Drawing boundaries in medical practices

This article explores the ways in which the mastery of particular medical technologies plays a crucial role in drawing the boundaries between medical specialities, to form what we refer to as medical technocracies. It sets out, above all, to demonstrate how the frontiers between the different medical specialities act, on the one hand, as articulating mechanisms to be found in the division of medical work and, on the other hand, as barriers to the interaction of the various skills. Through a more searching study of the division of labour between surgeons and liver specialists (hepatologists) and surgeons and anaesthetics, we highlight the contrast between those two sets of relations.This illustrates the boundaries and articulation that exist between medical technocracies. The key theoretical guidelines are drawn from medical sociology and sociology of professions. The research methodology includes participant observation in a liver transplantation hospital unit and on site interviews. By using data gathered from physicians actually working in such areas where boundaries have been drawn between surgeons and anaesthesiologists and surgeons and liver specialists, we propose to understand how different medical skills are negotiated between the different groups and where the social arrangements are the result of processes of interaction between the different specialities, which are constantly being reorganized and redefined.

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Revisiting biographical disruption: Exploring individual embodied illness experience in people with terminal cancer

Biographical accounts of illness offer useful insights into the social and adaptive processes of living with chronic illness. Yet there are concerns that the underlying theoretical assumptions of a reflexive self seeking to maintain meaning may not reflect the lived experience of individuals. A narrative emphasis may neglect the importance of emotional/felt experiences; while an analytical focus on disruptive processes may not adequately reflect the totality of actual events. In this study, we explored how well biographical theory supports understanding of individual lived experience. Narratives from 19 individuals identified from General Practice lists with a terminal diagnosis of cancer were analysed using the holistic-form approach described by Lieblich. Participants described an ongoing process of living their life, ‘managing’ disruptive events and maintaining an overall sense of well-being (narrative form = biographical flow). For a minority, continuity was lost when people’s capacity to continue living their everyday lives was overwhelmed (narrative form = fracture). The identified emphasis was on individual creative capacity in the face of terminal illness, highlighting the importance of embodied experience in understanding outcome and need. Maintaining continuity was draining: exhaustion precipitated fracture and thus need for external help to restore continuity. By focusing on feelings associated with overall narrative form, rather than individual disruptive events, we highlight the context in which disruptive events are experienced, and individual perceptions of their relative importance. We conclude that combining narrative and emotion offers new insights into the value of understanding of biographical accounts of illness in the context of individual creative capacity. We discuss the possibilities for new approaches to clinical assessment and management of need.

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Reaching the parts that other theories and methods can't reach: How and why a policy-as-discourse approach can inform health-related policy

This article illustrates how conceptualizing policy-as-discourse offers opportunities for those with a vested interest in policy to ‘reach the parts that other theories and methods can’t reach’. First, it explores the dialogical relationship between theory and method in the context of policy analysis, summarizing contemporary writing on conceptualizing and analysing policy and drawing on the work of Bacchi to describe the theoretical underpinnings of three different policy representations along with methodological corollaries, research practices and disclosures about the world that flow from each. This involves reflecting on three different answers to the question ‘what is policy?’: considering how policy might be conceptualized and analysed under each and narrating the kind of research stories that emerge. Second, the article focuses on one of Bacchi’s representations — policy-as-discourse — to provide readers with a case study of this dialogical relationship and drawing on published research exploring the development of primary care research policy to illustrate what elements of discursive policy analysis might look like. Last, the article concludes by reflecting on the ways in which such an approach may (and may not) prove valuable in analysing health-related policy.

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Review: Taking care of yourself in later life: A qualitative study into the use of non-prescription medicines by people aged 60+

The last 40 years have witnessed substantial changes to the experience of later life. Health and life expectancy have improved and the emergence of a putative third age has allowed post-working life to move beyond being a residual social category to become an arena in which later life lifestyles can be constructed. Greater emphasis is now placed on expectations of self-agency and choice. Allied to this is the growing role of consumerism as a way of organizing key aspects of social life. Not only do these changes place increased emphasis on individual responsibility for health, but they also engage individuals in various forms of health consumerism.This study draws on these aspects of contemporary society to provide an explanatory framework for understanding older people’s engagement with, and consumption of non-prescription medicines. We present a qualitative study in which we interviewed 22 men and women aged 60 plus who were purchasing or interested in purchasing non-prescription medicines, including complementary and alternative medicines. Our findings suggest that the use of non-prescription medicines is both pluralistic and makeshift. Moreover, while this pluralism led to tensions with conventional bio-medicine, conventional bio-medicine still maintained the legitimacy of its knowledge base. Self-care using non-prescription medicines appeared more governed by hope than by evidence or knowledge of the treatments concerned.We conclude that such pluralism of approach reflects the growing consumerism in health and self-care and that older people may in fact be similar to other age groups in terms of their approach to such commodification.

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