Individual Responsibility For Health Research Articles

A qualitative analysis of post-hoc interviews with multilevel participants of a randomized controlled trial of a community-based intervention.

Community-based health interventions often demonstrate efficacy in clinical trial settings but fail to be implemented in the real-world. We sought to identify the key operational and contextual elements of the Los Angeles Barbershop Blood Pressure Study (LABBPS), an objectively successful community-based health intervention primed for real-world implementation. LABBPS was a cluster randomized control trial that paired the barbers of Black-owned barbershops with clinical pharmacists to manage uncontrolled hypertension in Black male patrons, demonstrating a substantial 21.6 mmHg reduction in systolic blood pressure. Despite this success, the LABBPS intervention has not expanded beyond the original clinical trial setting. The aim of this study was to determine the facilitating and limiting factors to expansion of the LABBPS intervention. We undertook a qualitative assessment of semi-structured interviews with study participants performed after trial completion. Interviews included a total of 31 participants including 20 (6%) of the 319 LABBPS program participants ("patrons"), 10 (19%) barbers, and one (50%) clinical pharmacist. The semi-structured interviews were focused on perceptions of the medical system, study intervention, and influence of social factors on health. Several common themes emerged from thematic analysis of interview responses including: importance of care provided in a convenient and safe environment, individual responsibility for health and health-related behaviors, and engagement of trusted community members. In particular, patrons reported that receiving the intervention from their barber in a familiar environment positively influenced the formation of relationships with clinical pharmacists around shared efforts to improve medication adherence and healthy habits. All interviewee groups identified the trust diad, comprising the familiar environment and respected community member, as instrumental in increasing health-related behaviors to a degree not usually achieved by traditional healthcare providers. In conclusion, participants of an objectively successful community-based intervention trial consistently identified key features that could facilitate wider implementation and efficacy: social trust relationships, soliciting insights of trust bearers, and consistent engagement in a familiar community setting. These findings can help to inform the design and operations of future community-based studies and programs aiming to achieve a broad and sustainable impact.

Managing the new wave of weight loss medication in general practice: A qualitative study.

In early 2023, a new type of weight loss medication, Wegovy (semaglutide), was made available in Denmark. Both subsequent media coverage and public demand were huge. Wegovy is only available by prescription, primarily via general practitioners. However, there is very little knowledge about how healthcare professionals (HCPs) in general practice might deal with the great demand for and attention surrounding a new weight loss drug. The aim of this qualitative study was, therefore, to explore how Wegovy is managed and negotiated in general practice, particularly in terms of prescribing and follow-up. We conducted a focused ethnography study based on direct observation of consultations and both formal and informal interviews with seven doctors and four nurses from three general practices in Denmark. Using discourse analysis, we identified four central discourses revolving around trust in medicine, individual responsibility for health, the cost of weight loss medication, and the importance of shared decision-making. This study shows that the availability of a new, sought-after weight loss medication presents both opportunities and challenges for HCPs in general practice. The management of Wegovy involves numerous factors, including medical, economic, organizational, interpersonal and moral concerns.

Survey of patients’ awareness of the actual cost of visits in relation to their individual responsibility for health

Survey of patients’ awareness of the actual cost of visits in relation to their individual responsibility for health

The path to good health: Shifting the dialogue and promoting social ecological thinking

The purpose of our research was to assess whether an intervention could produce changes in critical consciousness (CC) relative to participants' understanding of social influences on health and individual health behaviors. The intervention was a 4-min animation, entitled The Path to Good Health , that described how factors in our social environment influence individuals in a variety of ways and thereby our health. We used the same sampling and intervention strategies with two discrete cohorts of participants (Initial study: June 2018, n = 249; Retest study: October 2019, n = 315), who were recruited and incentivized through Amazon's Mechanical Turk platform. We measured direction and extent of change from pre-to post-intervention in four key constructs of CC (Passive Adaptation, Emotional Engagement, Cognitive Awakening, and Intentions to Act) using the 4-Factor Critical Consciousness Scale (4-FCCS), and we investigated differential effects of the intervention related to demographics of participants, including political typology. We also assessed concurrent and predictive validity of the (4-FCCS). Changes of CC subscale scores from pretest to posttest moved in the expected direction in both the Initial and Retest studies; Cohen's d effect sizes were medium to very large in both studies. Overall, findings suggest the video intervention was effective at improving CC among participants drawn from the general population. We demonstrated that it is possible to influence people's cognitive-emotional interpretations in as little as 4 min, regardless of one's political ideology, and that the (4-FCCS) is sufficiently sensitive to measure changes in CC. This study provides preliminary evidence that a brief intervention can broaden cognitive-emotional interpretations from an over-emphasis on personal responsibility for individual health to an appreciation of the impact of social ecological factors on population health.

'It's just the nature of the work': Barriers and enablers to the health and well-being of preconception, pregnant and postpartum working women in a community service organisation.

Poor lifestyle practices, combined with excess weight gain and weight retention during the preconception, pregnancy and postpartum periods can increase health risks for mothers and their children. Little is known about how workplaces impact the health and well-being of women of child-bearing age, particularly across work roles and settings. This qualitative descriptive study explored the enablers and barriers to the healthy lifestyle practices and well-being of women of reproductive age within an Australian community services organisation by capturing the perspectives of both the women and workplace executives. Eleven interviews were conducted with executives (n=12), and three focus groups and three interviews were conducted with women (n=16). Data were thematically analysed, and six main themes were identified: blurring of the role and work environment, clarity and equity in policy and entitlements, the nature of community services work, individual responsibility for health, tiered levels of support and a management-driven culture of awareness and support. Barriers included high-stress roles, work targets, sedentary work behaviours, lack of clarity around policies, funding and the emotional labour associated with community services work. Hands-on leadership, open communication, work relationships, resourcing and manager training were identified as facilitators. While findings indicate agreement between executives and the women, many executives focused on the challenges associated with pregnancy in the high-risk workplace environment and did not perceive specific barriers for those in non-frontline roles. Management education to generate an understanding of women's needs during this life stage and increased resourcing to facilitate workplace well-being would be beneficial.

“I feel like the worst mother in the world”: Neoliberal subjectivity in Indigenous Australian oral health

Neoliberalism gained popularity during the post-Cold War period as a set of dominating ideologies, practices and policies that underpinned the movement towards globalisation. Neoliberalism champions competitive private markets, deregulation that facilitates economic activity, personal responsibility, and reduced public expenditure on infrastructure. A decade after the initial rise of neoliberalism, health inequities became concerns on the global stage. Oral health inequities aptly reflect social injustices due to the unique relation between material circumstances, access to health services and structural inequities. In Australia, Indigenous children experience early childhood caries at alarmingly higher rates than non-Indigenous children. Recently, neoliberalism has been suggested as an overwhelming contributor to Indigenous oral health disparities. This qualitative research is an extension of a single-blind parallel-arm randomised control trial that aimed to identify factors related to the increased occurrence of dental caries in Indigenous children. The objective of this constructivist grounded theory study was to generate an understanding of how neoliberal subjectivity exists for Indigenous peoples in the context of oral health in Australia. Experiences of ownership, guilt, failure, embarrassment, shame, and judgment were key in participants’ experiences of neoliberal subjectivity; these feelings were exacerbated by experiences of bullying, financial limitations, and institutional racism. We argue that individual responsibility for health, as a tenet of neoliberal ideologies, furthers Indigenous oral health inequities and that neoliberalism as a societal discourse perpetuates colonial values by benefitting the privileged and further oppressing the disadvantaged. Trial registrationAustralian New Zealand Clinical Trial Registry ACTRN12611000111976; registered February 01, 2011.

Effectiveness of Narrative Messaging Styles about the Social Determinants of Health and Health Inequities in Ontario, Canada.

Health inequities are systemic, avoidable, and unjust differences in health between populations. These differences are often determined by social and structural factors, such as income and social status, employment and working conditions, or race/racism, which are referred to as the social determinants of health (SDOH). According to public opinion, health is considered to be largely determined by the choices and behaviours of individuals. However, evidence suggests that social and structural factors are the key determinants of health. There is likely a lack of public understanding of the role that social and structural factors play in determining health and producing health inequities. Public opinion and priorities can drive governmental action, so the aim of this work was to determine the most impactful way to increase knowledge and awareness about the social determinants of health (SDOH) and health inequities in the province of Ontario, Canada. A study to test the effectiveness of four different messaging styles about health inequities and the SDOH was conducted with a sample of 805 adult residents of Ontario. Findings show that messages highlighting the challenges faced by those experiencing the negative effects of the SDOH, while still acknowledging individual responsibility for health, were the most effective for eliciting an empathetic response from Ontarians. These findings can be used to inform public awareness campaigns focused on changing the current public narrative about the SDOH toward a more empathetic response, with the goal of increasing political will to enact policies to address health inequities in Ontario.

Hitting the books: textbooks as cultural artifacts of a splintered field

ABSTRACT Therapeutic recreation (TR) presents two conceptualizations of recreation: as rehabilitation or as part of overall wellness. Textbooks are cultural artifacts used for passing disciplinary knowledge to students. The study purpose was to understand how TR practice is constructed and reproduced in textbooks, with attentiveness to hidden discourses. Selected chapters from two highly subscribed TR textbooks in Canada and the USA underwent a discourse analysis. Using a critical disability studies framework, respective thematic distinctions arose: individual responsibility for health, professionalization of TR, and medicalization of recreation; and being in relationship, disability as diversity, and solution and strength-based focus. The respective authors’ TR assumptions of either ameliorating deficits or building on existing strengths led to differing TR goals, varied practice contexts, and distinctive positions on relationship building – creating divergent discourses and discord at a cost to the field and those utilizing its services.

Learning From Practice and Politics: The Rise and Fall of Social Marketing in Aotearoa New Zealand (1984–2017)

Background: This article is the first to explore the emergence and evolution of social marketing as a professional practice in Aotearoa New Zealand [1] (NZ). Focus of the Article: The article identifies key political factors enabling the emergence, and causing the decline, of social marketing in NZ. Research Question: What are the factors that practitioners of social marketing identify as most influential on its development in NZ? Importance to the Social Marketing Field: The article makes a unique contribution to the growing literature on the history of social marketing in different jurisdictions by providing the first account of how social marketing evolved in NZ and by identifying the crucial role of political factors. Methods: The research is based on appreciative inquiry-based interviews with 20 experienced social marketers and a review of key documents. Because the field in NZ is small, it was possible to interview almost all of the leading figures. Results: This study constructs a timeline of significant political impacts on social marketing in NZ and identifies neoliberal approaches as key. Initially, neoliberalism enabled the growth of social marketing due to its emphasis on individual responsibility for health. Later, a neoliberal agenda helped disestablish the discipline due to social marketing shifting focus from downstream to upstream economic, political and social factors. Recommendations for Research or Practice: This research concludes that to sustain the legitimacy of their field, social marketers need to produce ongoing evidence-based communication of their effectiveness and responsibility and be less dependent on government funding. It also suggests the continuing enlargement of specifically situated studies of the different evolutions of social marketing in different places to better map commonalities and contrasts. Limitations: The study is limited to social marketing in NZ and would be strengthened by comparative studies of social marketing within other cultures and political systems during particular historical periods. While mainly exploring NZ social marketers’ experience from their own point of view, it could be broadened to include other perspectives.

Ethics of sharing medical knowledge with the community: is the physician responsible for medical outreach during a pandemic?

A recent update to the Geneva Declaration’s ‘Physician Pledge’ involves the ethical requirement of physicians to share medical knowledge for the benefit of patients and healthcare. With the spread of...

An exploration of the portrayal of the UK soft drinks industry levy in UK national newspapers.

News media play a role in politics through the portrayal of policies, influencing public and policymaker perceptions of appropriate solutions. This study explored the portrayal of sugar and sugar-sweetened beverage (SSB) taxes in UK national newspapers. Findings aid understanding of the role newspapers play in shaping understanding and acceptance of policies such as the UK Soft Drink Industry Levy (SDIL). Articles discussing sugar or SSB taxes published in six UK national newspapers between 1 April 2016 and 1 May 2019 were retrieved from the LexisNexis database. Articles were thematically analysed to reveal policy portrayal. Analysis of UK newspaper articles. Two hundred and eighty-six articles were assessed. Sugar and SSB taxes were discussed across the sample period but publication peaked at SDIL announcement and introduction. Themes were split according to support for or opposition to taxation. Supportive messaging consistently highlighted the negative impacts of sugar on health and the need for complex actions to reduce sugar consumption. Opposing messages emphasised individual responsibility for health and the unfairness of taxation both for organisations and the public. Sugar and SSB taxes received considerable media attention between 2016 and 2019. All newspapers covered arguments in support of and opposition to taxation. Health impacts of excess sugar and the role of the soft drink industry in reducing sugar consumption were prevalent themes, suggesting a joined-up health advocacy approach. Industry arguments were more varied, suggesting a less collaborative argument. Further research should investigate how other media channels portray taxes such as the SDIL.

Patients’ perspectives of facilitators and barriers to patient-centred care: insights from qualitative patient interviews

ObjectivesPrevious studies on patient-centred care (PCC) and its facilitators and barriers usually considered specific patient groups, healthcare settings and aspects of PCC or focused on expert perspectives. The objective of...

Resisting privatization and marketization of health care: People’s Health Movement’s experiences from India, Philippines and Europe

ABSTRACT For the last three decades, healthcare systems have been under pressure to adapt to a neoliberal world and incorporate market principles. The introduction of market-based instruments, increasing competition among health care providers, introducing publicly -funded private sector provisioning of healthcare through health insurance financing systems to replace public provisioning of health care, promoting individual responsibility for health and finally, the introduction of market relations through privatization, deregulation and decentralization of health care have been some common elements seen globally. These reforms, undertaken under the guise of increasing efficiency and quality through competition and choice, have in fact harmed the physical, emotional and mental health of communities around the world and also contributed to a significant rise in inequities in health and healthcare access. They have weakened the public healthcare systems of countries and led to commercialization of healthcare. This article presents three case studies of resistance, to the commercialization of health care, by the People’s Health Movement (PHM) and associated networks. It aims to contribute to the understanding of the way neoliberal reforms, including those imposed under structural adjustment programmes and some promoted under the Universal Health Coverage (UHC) paradigm, have impacted country-level health systems and access of people to health care, and bring out lessons from the resistance against these reforms.

Peacework and mental health: from individual pathology to community responsibility

Using Canada and Ukraine as examples, this article asserts the importance of moving beyond addressing posttraumatic stress disorder as the major mental health focus in peacebuilding, to a more global whole health strategy as a way of building resilience in communities, preparing them better to deal with conflicts of different kinds, and generally providing habitus for people of all health and abilities to thrive. Authors who are academics, mental health service users and service providers examine current barriers to and movements toward mental health and wellness in their countries. Using a needs-based approach, authors assert the importance of using the social determinants of health, understanding engaged community membership requires good, supportive mental health. The social determinants of health provide the basis to move from a reactive medical model of health which seems prevelant globally to focus on proactive community, considering what it means to be a community member, including the importance of individual empowerment not only for their own community engagement but also for the actualization and development of their communities and the wider world. Key implications for practice It is important to move beyond treatment of posttraumatic stress disorder in response to trauma. Peacebuilding must include proactive mental health strategies. Global responsibility for individual health as described by the social determinants of health.

Men’s work-related self-care in the Finnish media

Individual responsibility for health at work has been a central point of interest in recent studies of working life. This article contributes to that discussion by considering the role of the media in gendering individual responsibility and the meanings of work-related health in Finnish society. It takes a critical look at media representations of men’s work-related self-care. The data comprises 30 texts collected from the Finnish media in spring 2016. The analysis reveals three discourses – Exemplariness, Expertise and Suspiciousness – and shows how they construct ideal ways of being a man in working life. They depict work as a necessary part of life for men. Self-care practices that aim to either maintain endurance or increase performance at work are presented in a favorable light. However, personal wellbeing is portrayed as secondary to productivity. The article concludes with a discussion on the broader implications of the persistent discursive interrelation of men and work for men’s social role.

Public health ethics: a flawed view of Kant's argument from autonomy.

This work explores the concept of morality as self-governing autonomy that has its origins in Immanuel Kant's ethics. It investigates how a mistaken view of Kant's ethics underpins a strand of debate in public health policy that is used to justify individual responsibility for health and well-being. Literature review. Applying a mistaken view of Kant's ethics to current day public health problems is inappropriate. The work discusses the social determinants of health and the call by some in the field to adopt a Kantian approach to tackle the problems of poor health resulting from lifestyle choices. The paper ends by arguing for a public health policy that is grounded in collaboration and for the adoption of Health in All Policies (HiAP).

Epigenetics: ethics, politics, biosociality.

Epigenetics is a burgeoning field of contemporary biosciences, which has attracted a lot of interest both in biomedical and in social sciences. Unsystematic literature analysis and retrospective mapping of highly cited work (source: Web of Science core collection) in the social sciences and humanities engaging with epigenetics. Epigenetics poses no new ethical issue over and above those discussed in relation to genetics. However, it encourages a different framing and reflexivity on some of the commonly held categories in the moral uptake of scientific discoveries. Epigenetics presents us with normative questions that touch upon privacy, responsibility for individual health and for the well-being of future generations, as well as matters of health justice and equality of opportunities. Epigenetic thinking could help us adjust and refine the problem frames and categories that inform our ethical and political questions with a complex biosocial description of situations, of persons or actions.

Acceptability of financial incentives for maintenance of weight loss in mid-older adults: a mixed methods study

BackgroundHealth insurers worldwide implement financial incentive schemes to encourage health-related behaviours, including to facilitate weight loss. The maintenance of weight loss is a public health challenge, and as non-communicable diseases become more prevalent with increasing age, mid-older adults could benefit from programs which motivate weight loss maintenance. However, little is understood about their perceptions of using financial incentives to maintain weight loss.MethodsWe used mixed methods to explore the attitudes and views of participants who had completed an Australian weight loss and lifestyle modification program offered to overweight and obese health insurance members with weight-related chronic diseases, about the acceptability and usefulness of different types of financial incentives to support weight loss maintenance. An online survey was completed by 130 respondents (mean age = 64 years); and a further 28 participants (mean age = 65 years) attended six focus groups.ResultsBoth independent samples of participants supported a formalised maintenance program. Online survey respondents reported that non-cash (85.2%) and cash (77%) incentives would be potentially motivating; but only 40.5% reported that deposit contracts would motivate weight loss maintenance. Results of in-depth discussions found overall low support for any type of financial incentive, but particularly deposit contracts and lotteries. Some participants expressed that improved health was of more value than a monetary incentive and that they felt personally responsible for their own health, which was at odds with the idea of financial incentives. Others suggested ongoing program and peer support as potentially useful for weight loss maintenance.ConclusionsIf financial incentives are considered for mid-older Australian adults in the health insurance setting, program planners will need to balance the discordance between participant beliefs about the individual responsibility for health and their desire for external supports to motivate and sustain weight loss maintenance.

“Shameless” Sedentarism: Individual Responsibility for Health?

The text critically addresses the polarity between discourses on sedentary and healthy lifestyles, contextualized by new technological resources for searching and disseminating information about health. The argument is that contempora-neous technoscientific rationality has created an “economy of truths” that, with the perspective of leading to safe lifestyles, have been prescribing a normative set of self-discipline ideals which generates anxiety and distress. In the hegemonic production of these regimes, sedentary lifestyle presents itself as a health risk, equivalent to moral failure and an unacceptable lack of self care. We highlight that the abundance of discourses about lifestyles and risk, seen as biopolitical devices imbricated in the processes of communication in health matters, deserves attention for their ethical and political implications. The display of lifestyles associated with the consumption and the production of narratives that perversely influence our culture has taken us far away from a socially possible notion of health. Finally, the regulatory essence of such symbolic references in building knowledge systems that have been (re)defining what means to be healthy, normal, unhealthy is discussed.

The role of gender in the active attitude toward treatment and health among older patients in primary health care\u2014self-assessed health status and sociodemographic factors as moderators

BackgroundActive attitude toward treatment and health (ATH) leads to improved cooperation and better health outcomes in patients. Supporting it in the population of older adults is a growing need in primary care. Recognising the role of gender, health and other sociodemographic factors can help to distinguish patients who need the most assistance in activation from general practitioners (GPs). The objective of the study was to investigate gender differences in ATH as well as the moderating role of self-assessed health (SAH) and selected sociodemographic factors (age, education, financial status, marital status).MethodsA cross-sectional, multicentre study among 4936 primary care older patients (aged 50+) was conducted. The PRACTA-Attitude toward Treatment and Health questionnaire (PRACTA-ATH) was used to measure the cognitive, emotional (positive and negative affect), and motivational dimensions of ATH. Patients were approached before and after their visits in the primary health-care facilities randomly selected in Central Poland.ResultsGeneralised linear models (GENLIN) revealed the main effects of gender, SAH, and sociodemographic characteristics, such as financial status, marital status and education. Interaction effects of gender and age (Wald’s χ2 = 24.767, p < 0.001 for ATH Global), as well as gender and SAH (Wald’s χ2 = 16.712, p < 0.002 for ATH Global) on ATH were found. The most assistance in regard to ATH was required by men aged 50–74 and men declaring good self-assessed health. Generally, women declared a more active attitude than men, showing more knowledge (M = 5.40, SD = 0.07 and M = 5.21, SD = 0.07, for women and men, respectively, p = 0.046), positive emotion (M = 5.55, SD = 0.06 and M = 5.33, SD =0.06, for women and men, respectively, p = 0.015) and motivation to be involved in their health issues (M = 5.71, SD = 0.07 and M = 5.39, SD = 0.07, for women and men, respectively, p = 0.001). The level of negative emotions related to health was not significantly different between genders (p = 0.971).ConclusionsThe need to create health promoting programmes taking account of particular gender differences in older adults emerges. In regard to clinical practice, building a sense of efficacy and individual responsibility for health, providing information about the means of health promotion and prevention, and recognising health-related cognitions, is recommended especially for men who feel well and are less advanced in age (50–74).