Health Sociologists Research Articles

How physiotherapists attend to the human aspects of care when working with people with low back pain: a thematic analysis

ABSTRACT Pain is a multidimensional experience. Physiotherapy has attempted to enhance earlier biomedical approaches to patient care through approaches like the ‘biopsychosocial’ model. Nevertheless, physiotherapy continues to focus on biomedical and/or behavioural aspects of care. We critically investigated how physiotherapists attend to human (psychosocial, emotional, existential, and moral) aspects of low back pain care. We co-analysed ethnographic data with researchers, patients, and physiotherapists using concepts of conforming, tinkering and abandoning ‘scripts’. Data included observations of 28 physiotherapy interactions between 26 patients and 10 physiotherapists and 7 researcher-clinician dialogues. Analysis suggests when conforming to scripts, clinicians have difficulty recognising and responding to emotions; time pressure limited clinicians focus, and a biological focus often distracted from psychosocial aspects of people’s back pain experiences. In contrast, tinkering with or abandoning scripts allowed space to broaden the focus. Drawing from theorists such as Butler (1999) and Gibson et al. (2020) our analysis contributes to health sociology, arguing that ‘tinkering’ with or ‘abandoning’ scripts can foster more humanistic, flexible and reflexive approaches to care. Although health sociologists have explored tinkering, abandoning is new; within physiotherapy, it encapsulates being able to respond with agility to non-physical elements of care without constraint from traditional ways of thinking and doing.

Women’s views on moderate and low alcohol consumption: stages of the subjective transition from pregnancy to postpartum

BackgroundAlcohol consumption during pregnancy and breastfeeding is associated with a risk for the child’s healthy development. Nevertheless, about 16 to 25% of all women in the European region, including Switzerland, consume alcohol during pregnancy and probably even more during breastfeeding. Little is known about how women perceive this risk and how risk perception changes during the transition to motherhood. The present study aims to explore the subjective transition from the woman’s perspective, focusing on perceptions of alcohol as a risk, changes in alcohol consumption in daily life and experienced support from health professionals in this period.MethodsThe longitudinal qualitative, semi-structured interview study was jointly designed and conducted by health sociologists and midwifery researchers. Using the theoretical framework of sociocultural risk and life course transition, we interviewed 46 women from the French and German speaking part of Switzerland during pregnancy and until six months after birth.ResultsIn our study, we found that pregnant and breastfeeding women perceive alcohol consumption as a risk to the health of the child. Abstinence is sought especially during pregnancy, but this does not preclude occasional and low-level consumption according to some women. Alcohol consumption and risk perception change during the transition to motherhood. We identified five stages that characterise this transition in terms of alcohol consumption and risk perception. From the women’s perspective, there was a lack of counselling from health professionals, and the women expressed a desire for respectful and more individualised counselling.ConclusionMany women express a need for guidance and counselling by health care professionals at some stages of the transition to motherhood. The stages identified can be used as pointers to address the subject of alcohol consumption in professional practice. The stage around conception and early pregnancy should be taken more into account, as women experience themselves as particularly vulnerable during this time. Low-threshold counselling services should be therefore offered to women before or in the stage around conception and be continued until the end of the breastfeeding period.

The challenge of institutionalised complicity: Researching the pharmaceutical industry in the era of impact and engagement.

The pharmaceutical industry plays a central role in the production of the drugs we use to treat most illnesses. It is immensely powerful and has received sustained attention from sociologists of health and illness, who have provided a critique of its influence and sometimes unethical behaviour. However, in recent years, funders are increasingly expecting researchers to engage and collaborate with stakeholders, including industry. This raises important questions about the institutionalisation of complicity and the different forms this might take. This article asks: How can sociologists engage with the pharmaceutical industry in a positive and constructive manner, whilst remaining independent, principled and critical? It will draw on my experience of establishing a major project on high-priced drugs for rare diseases and the literature on collaboration, stakeholder engagement and responsible research to propose a methodological framework to address this challenge. This is based on six PRIMES: (normative) Principles, Reflection and Independence, (field) Mapping, (careful) Engagement and Strategic intervention that have broad applications to many other areas of contemporary social science research.

Researching the health and social inequalities experienced by European Roma populations: Complicity, oppression and resistance.

This paper draws on the experience of two Romani and three non-Romani scholars in knowledge production on the health and social inequalities experienced by European Roma populations. Together, we explore how we might better account for, and work against, the complex web of dynamic oppressions embedded within processes of academic knowledge production. Our aim is to encourage careful scrutiny through which sociologists of health and illness might better recognise our own complicity with oppression and identify concrete actions towards transforming our research practices. Drawing on a well-known domains of racism typology (Annual Review of Public Health, 40, 2019, 105), we use examples from our own work to illustrate three interconnected domains of oppression in which we have found ourselves entangled (structural, cultural and interpersonal). A new conceptual framework is proposed as an aid to understanding the spectrum of different "types" of complicity (voluntary-involuntary, conscious-unconscious) that one might reproduce across all three domains. We conclude by exploring how sociologists of health and illness might promote a more actively anti-racist research agenda, identifying and challenging subtle, hidden and embedded negative ideologies and practices as well as more obviously oppressive ones. We hope these reflections will help revitalise important conversations.

The impossibility of engaged research: Complicity and accountability between researchers, 'publics' and institutions.

Over the past decade, U.K. universities have increasingly sought to involve publics in research as active participants in the construction of academic knowledge. Sociologists of health have largely welcomed this enthusiasm for engaged and participatory ways of working, including methodologies long in use in the field such as patient-led research and co-creation. Despite the strong interest in engaged research, however, we argue that funding patterns, bureaucratic structures and an overreliance on people employed on casual contracts make it extremely difficult, often impossible, to do engaged research in British universities. Drawing on our own experiences, we show how our attempts to practise and deepen accountability to variously situated publics were constrained by the way our institution imagined and materially supported engagement. We argue that it falls to individual researchers to mitigate or work around structural barriers to engagement, and that this process creates dilemmas of complicity. If engaged research is to fulfil its remit for inclusion and its radical potential, researchers need to think carefully about how the U.K. engagement agenda entwines with processes of casualisation, acceleration and projectification, and how institutional recuperations of engagement can undermine its political and epistemic objectives.

Coronavirus (COVID-19), pandemic psychology and the fractured society: a sociological case for critique, foresight and action.

In the wake of the COVID-19 pandemic and mass lockdowns that continue to shake the world, sociologists of health and illness have been advised to undertake research only when the time feels right and to avoid premature evaluation. Such advice makes sense, especially amidst an epidemic of interpretation that has resulted in substandard work. However, this contribution argues that when trying to understand and perhaps analyse early societal responses to COVID-19, medical sociology comprises a toolbox of ideas that are 'good to think with' and should not be ignored. Indeed, our community is well placed to make its presence felt sooner rather than later as we collectively live through a deepening critical situation. Divided into two sections, this piece first offers a critical appreciation of Philip Strong's classic essay on 'epidemic psychology', noting some insights and posing research questions for pandemic times. Second, going from micro- to macro-sociological concerns, it builds on Graham Scambler's calls for not only critique but also foresight and action within a 'fractured society' comprising class-generated fissures and tensions. Early interventions from other leading medical sociologists and publicly engaged intellectuals are also cited when asking 'what sort of society are we heading towards and what sort of world do we want to share?'

Self-reported health and the social body

Since the strong predictive power of self-reported health (SRH) for prospective health and social outcomes has been established, researchers have been in a quest to build a theoretical understanding of this widely used health measure. Current literature based predominantly in a biomedical perspective asserts a linear relationship between physical conditions and perception of health. Discrepancies from this expected relationship are considered an important weakness of SRH. Systematic discrepancies between physical conditions and reporting of SRH have been documented across different socio-economic groups. Evidence identified for educational groups shows that for the same level of health status, lower-educated groups report poorer levels of perceived health. This raised doubts whether it is useful to use SRH to measure social inequalities in health within and between countries. To date, sociologists of health have not engaged in the discussion of reporting heterogeneity in SRH. After reviewing existing evidence, we contend that the discrepancy in SRH reporting across social groups argued to be a weakness of SRH as a health measure is a strength from a sociological perspective. SRH as a social measure of health is a better predictor than objective measures of health precisely because it captures the lived experience of the embodied agent.

Beyond the anti-racist reason: a postcolonial perspective on pandemic politics

ABSTRACT This article interrogates the politics of the COVID-19 pandemic from a postcolonial perspective. One alarming concern during the pandemic is the rise of racism against Asians all over the world. However, little explored behind media reports are the legacies, tensions and challenges left by imperial domination inherited from the past, especially within the postcolonial regimes in Asia, such as Hong Kong and China. Drawing upon postcolonialism as a critical lens, this article makes perceptible the intractable issues of health politics. Postcolonial challenges shown by COVID-19 include immigration, changing politico-juridical definitions of identity, the legacy left by the Soviet era which poses an obstacle to modernising China's healthcare system, and the boom of birth tourism welcomed by the marketised turn of health and tourism policy in Hong Kong in the post-SARS era. A postcolonial perspective invites health sociologists to scratch beneath the surface of political problems such as racism, and attend to the complex heterogeneity of health politics in the pandemic.

Peace, Health, and Sustainable Development in the Middle East.

As two essential human rights, as well as pillars of sustainable development, health and peace are closely interrelated. Further, health and well-being are the focus of Sustainable Development Goal (SDG) 3, while peace lies at the heart of SDG 16. This paper investigates the relationship between the three concepts of health, peace and sustainable development in the relevant literature. This is a qualitative study. Following the establishment of the construct of peace and health through consultation with three key informants (one health sociologists, one high-ranking diplomat, and one health policy maker), we conducted a scoping review of the literature, followed by purposefully obtained grey literature, i.e. UN and country reports. As a result, 30 documents, including journal articles, were identified. We used content analysis to extract themes and categorize them in line with the relevant SDGs. Lack of peace has direct and indirect impact on health, as well as health workers, the civil society, and the whole community who have in turn a critical role in creating peace. Strong and resilient health systems are essential in reaching out to citizens during war, while achieving SDGs would be impossible if SDG 16 is compromised. Health and peace are interchangeable, and achieving either is impossible without the other. Physicians and other human resources for health are the key actors in peaceful environment to attain health for all. In the absence of peace, the resilience of health system will be threatened and the hope for sustainable development may fade.

Corrigendum to: Promoting interdisciplinary research through transversality-an aid to communicating more effectively with health sociologists.

Corrigendum to: Promoting interdisciplinary research through transversality-an aid to communicating more effectively with health sociologists.

Promoting interdisciplinary research through transversality—an aid to communicating more effectively with health sociologists

This work was funded by a Research School of Social Sciences Grant from the Australian National University (2017, GS).

Doing care work on the fly - exploring the unnoticed socio-emotional skills of male ambulance staff.

Prehospital ambulance work is a healthcare arena hitherto neglected by sociologists of health and illness. This is unfortunate because it is an interesting and dynamic area, and in contrast to most healthcare sectors, it is male dominated. Via ethnographic fieldwork, this article examines the particular caring practices and socio-emotional skills that ambulance staff use in practising prehospital care work. The empirical analysis outlines six recurring prehospital practices: medicine work, machine work, scene management, becalming work, communication work and bodywork. Each practice represents a different element of prehospital care practice and is best understood as a repertoire, as many different assemblages of these care practices can work effectively in prehospital situations. The article concludes that despite institutionalised blue-collar masculinity, numeric dominance and scarce formal education in ambulance psychology, male ambulance staff are generally proud and reflexive care practitioners.

Researching Experiences of Cancer Risk Through Online Blogs: A Reflexive Account of Working Toward Ethical Practice.

By providing space to document personal narratives and hold virtual discussions, the Internet represents a fruitful resource for sociologists of health and illness. However, the use of social media content for research entails complex ethical considerations. Due to the fluidity of online material, existing ethical guidelines advise a deliberative approach. However, this has led to disparity in the use of social media resources within the social sciences. I share an account of "doing ethics" for qualitative research with blogs focused on hereditary cancer risk. Blogging emerged not only as cathartic for authors, but also a means of accessing support. Blogs may thus be construed as constitutive and not only representative of cancer (risk) experience. Ethical questions surround anonymity and the appropriation of authors' accounts beyond the context in which they are composed. By sharing reflections on working with hereditary cancer risk blogs, I contribute to the continued reflexivity of social media researchers.

Pearce, R.Understanding Trans Health: Discourse, Power and Possibility. Bristol: Policy Press, 2018. £26.99 pbk. ISBN: 978‐1447342359

Within the interdisciplinary field of Transgender Studies, a perennial problem is the differing understandings which scholars (and more broadly, social actors) have of the ontologies of sex, gender and transgender – correspondingly shaping their readings of texts. In this work, Pearce brings theoretically constructive discussion to bear on how trans people, their communities, and the healthcare services and practitioners which centre them inform and relate to each other discursively. The book results from a 7-year (2009-2016) ethnographic doctoral project in the UK, focused on online community spaces. The intersectional content creates motives for interest from many readers, including scholars of Transgender Studies, sociologists of health and illness, and gender studies with interest in service user/provider power dynamics. There is also great reflexive potential for medical practitioners – both the “gender experts” (p. 92) working within Gender Identity Clinics, and service providers working in general practice. The text opens with an autoethnographic passage to situate the origins of the research. Chapters 1, 3, 4, 5 and 7 open with a first-person vignette, drawing upon Pearce's personal experiences of community, healthcare and scholarship. The autoethnographic accounts benefit the work by interlacing a deeply relatable sincerity which complements the genealogical approach taken to contextualising the field. As Pearce puts it, the genealogical approach “acknowledges and examines how subjectivities are constructed through social processes” (p. 20, italics original) – the well-developed contexts for these processes provide a robust foundation for the sociological consideration of subjectivities in relation to (shifting and evolving) trans discourses. I argue (in a manner analogous to feminist standpoint theory) that the strength of Pearce's analytic clarity and dedicated reflection on community inter- (and intra-) actions would not have been possible without her positionality. Further, Pearce's insider status has not only equipped her to access the community forums which partially comprised her data set, but also the growing “sophistication of informal theorisation” (p. 39, italics original) in some digital trans spaces. Drawing upon ideas of value produced outside the academy adds to the originality and sophistication of the material reviewed in the first section of the book (chapters 1-3). The book aims to answer how different understandings and experiences of trans are “produced, reified and legitimised through health discourses and practices” (p.8). Further, it considers how such health discourses are negotiated, disseminated and contested between trans community groups, activists and professionals – while recognising that these groups are heterogeneous and overlapping. Exceptional attention is given to unfolding the language used to communicate central technical concepts – notably discourse, cultural and professional cisgenderism (Kennedy, 2013), and key theoretical contributions through the conceptual vehicles of ‘trans as movement’ and ‘trans as condition’. The social processes which both inform and constitute a person being diagnosed with gender dysphoria (or other diagnostic terms, dependent on what guidelines were followed, and when) simultaneously “make trans lives possible and limit the liveable scope of those possibilities” (p.29, italics original). The second section of the book (chapters 4 and 5) addresses research findings, while the third section (chapters 6 and 7) looks to the future and possible changes to address problems in trans healthcare. These problems are depressingly predictable and familiar to many insider group members in particular – at least in descriptive terms. The value of this work lies in the theoretical nuance displayed in answering the research questions it sets out. In arguing that trans identities undergo co-construction between health professionals and trans service users, Pearce shows that “condition-oriented definitions of trans… can also limit the scope of trans possibilities, thereby rendering trans conditional” (p. 90, italics original). This occurs through the impact of interactions within clinical space, and the indirect impact that clinical discourses have on how trans people reflexively engage with their genders. The limitation of trans possibilities is discursively richer than how options are navigated within gender clinics. The flattening of trans to transition is also addressed, with important discussion on both the lack of trans health research beyond transition (i.e, accessing hormone replacement therapy or gender-related surgeries), and the impact on trans people when their health needs are reduced to transition. The conditionality of trans undergoes further theoretical development in chapter 5, through the consideration of temporality. The ways in which trans embodiment, expression, and beliefs can be opened up or closed down based on how (and if) healthcare interactions are navigated are framed as “strategic futurities” (p. 133).The range of theoretical conversations which are developed across different chapters is impressive. Ultimately, this book offers sophisticated yet clear explanations of the terrain of trans health in the UK, with superb analytic purchase – made all the more impressive by its accessibility and candour.

When Health Care is Displaced by State Interests: Building Dialogue Through Shared Findings.

Health sociologists interested in how macro state influences affect micro health care practices have much to gain from meta-ethnography research. In this article, we bring together insights from two separate empirical studies on state health care services involving HIV/AIDS as a way to speak to larger issues about the organization and production of medical expertise and governance in health care systems. We use Noblit and Hare's meta-ethnography approach to bring these studies into conversation and identify six shared "organizers" of health care encounters. The organizers illustrate how state health interests operate across institutional contexts and impact the work of providers in seemingly unrelated health care settings. On the basis of this synthesis, we conclude that state interests both structure and create conflict in health care settings. We believe this perspective offers the potential to advance the goals of health sociology and the field of qualitative health research in general.

MEN’S HEALTH RESEARCH VERSUS ANDROLOGY—DEFINING THE DIVISION AND CLOSING THE DIVIDEMen’s Health Research from the Perspective of Andrology

Background and Objective
 We explore here men’s health research as practiced by health sociologists versus andrologists.
 Material and Methods
 We start by examining the occurrences of terms related to sex and gender in the literature of the two fields as a way to characterize and contrast their disciplinary differences. A sample of 30 terms that directly or indirectly related to sex and gender were searched in Google Scholar and the ratios of each term’s appearance within the literature for the two disciplines was recorded. Chi-squared tests assessed the statistical differences between the usage of each term in the two fields.
 Results
 Of the terms we sampled, only “penis”, “penile”, “testicles”, and “libido” did not differ significantly in their relative occurrence within either discipline’s publications. Words and phrases linked to gender, such as masculine, masculinity, and manhood, were significantly more common in “men’s health research” where gender is commonly construed as a social construct. We suggest, however, that the evidence for gender being purely a social construct is limited and neither necessary nor accepted as such within andrology. Andrology and men’s health research, we argue, are different disciplines in terms research methodologies and self-defined disciplinary borders. The presumption that gender is a social construct, though common within health sociology, is not implicit in andrology. Many problems in men’s health that have been assumed to be the products of enculturation have in fact a biological basis. However, solutions to those problems are often outside the domain of biomedicine and are more amenable to social solutions. We suggest that men’s health could be most effectively advanced if men’s health researchers and andrologists understood what divides their disciplines and made more effort to bridge that divide.

Beyond ubiquity: Unravelling medicalisation within the frame of health insurance and health-policy making

Besides being extensively studied by health sociologists, medicalisation has also become a term that frequently appears in mainstream discourses on health and illness. Recently, scholars started to acknowledge a greater complexity within medicalisation. This article is situated within this research tradition and draws on three recurring critiques on the validity of medicalisation; critique on the construct validity, internal validity and external validity. By examining the interests and network of health-policy stakeholders, this article attempts to unravel different mechanisms of medicalisation and demedicalisation within a social health insurance system. The empirical data for this article derive from 30 elite interviews with key informants from 18 organisations in Belgium. Key representatives of these organisations provided us with in-depth information about their political intentions and interests. This study provides empirical evidence that both medicalisation and demedicalisation are different processes that can occur simultaneously. Furthermore, in order to facilitate studies on medicalisation in an institutional context, this article proposes some indicators for medicalisation and demedicalisation.

'Doing good by proxy': human-animal kinship and the 'donation' of canine blood.

This article demonstrates the relevance of animals to medical sociology by arguing that pet owners’ accounts of veterinary decision‐making can highlight key sociological themes which are important to both human and animal health. Based on semi‐structured interviews, the article argues that interspecies ‘kinship’ allows for the extension of sociological claims regarding altruism, self‐interest and mutuality from human blood donation to companion animal blood ‘donation’. Furthermore, this study extends sociological understanding of the human‐animal bond by showing how the dog's status as kin meant they were expected to donate blood, and that the act of donation itself represents an important opportunity for family ‘display’. However, owners who do not or cannot donate blood themselves describe pet blood donation as an opportunity to lessen associated feelings of guilt or obligation through ‘doing good by proxy’. These findings raise critical sociological and ethical questions concerning the risks and benefits of donation, and for how we understand third‐party decision making. Finally, the article argues for the close entanglement of human and animal health, and concludes that sociologists of health and medicine should explore the radical possibility that decision‐making in healthcare more generally might be influenced by experiences at the veterinary clinic, and vice versa. (A Virtual of this paper can be viewed at: https://www.youtube.com/channel/UC_979cmCmR9rLrKuD7z0ycA)

Professional Health Sociologists and the Crisis of the Italian Health System: A Pilot, Exploratory Study within Mental Health and Addiction Departments through an Electronic-DELPHI

This qualitative, pilot and exploratory study 1 is part of an ongoing research project conducted by Societa Italiana di Sociologia della Salute, (Italian Society of Health Sociology, hereinafter SISS) 2 including academic and professional Italian health sociologists. The Literature on interprofessionalism/managerialism and the various roles of these health professions as boundary spanners, gate-keepers and mediators, is still lacking in relation to the Italian Healthcare System (Servizio Sanitario Nazionale, hereinafter SSN) and its prolonged poli-crisis, from the point of view of Italian Health Sociologists employed within the SSN. In particular, in Italian Literature, empirical study does not exist on the representations and perceptions of interprofessionalism within this field. The aim of this qualitative essay is to present a counterpoint in the form of an explorative pilot study focused on a group of 17 Italian Professional Health Sociologists working in Mental Health and Addiction departments in the SSN. Here we consider the Professional Italian SSN Sociologist as an agent of change in the SSN transformation plan, and as a vehicle for interprofessionality.

Architecture and health care: a place for sociology.

Sociologists of health and illness have tended to overlook the architecture and buildings used in health care. This contrasts with medical geographers who have yielded a body of work on the significance of places and spaces in the experience of health and illness. A review of sociological studies of the role of the built environment in the performance of medical practice uncovers an important vein of work, worthy of further study. Through the historically situated example of hospital architecture, this article seeks to tease out substantive and methodological issues that can inform a distinctive sociology of healthcare architecture. Contemporary healthcare buildings manifest design models developed for hotels, shopping malls and homes. These design features are congruent with neoliberal forms of subjectivity in which patients are constituted as consumers and responsibilised citizens. We conclude that an adequate sociology of healthcare architecture necessitates an appreciation of both the construction and experience of buildings, exploring the briefs and plans of their designers, and observing their everyday uses. Combining approaches and methods from the sociology of health and illness and science and technology studies offers potential for a novel research agenda that takes healthcare buildings as its substantive focus.