Personal Responsibility For Health Research Articles

Personal responsibility for health in Bulgarian public health law and social legislation

BackgroundIn the last decades all health systems have experienced a lack of resources. Against this background, the idea of ​​applying personal responsibility of the patient as a criterion for allocation of resources (PRCAR) is gaining increasing attention. Bulgarian healthcare reform has been marked by the implementation of many new strategies, that grounded our scientific interest towards investigating PRCAR in Bulgarian public health law and social legislation.MethodsThrough a search of national legal databases 7 documents were selected and subjected to content analysis.ResultsProspective responsibility was found in two and retrospective responsibility - in three documents, two of which imposed explicit penalties on the patient. Two documents did not distinguish between the types of patient responsibility. PRCAR was found to be controversial through the prism of the social justice principle. The discussion was conducted through the perspectives of evidence translation of research to law, particularities of social cohesion in Bulgaria, and the interpretation of principles of public health ethics.ConclusionAlthough PRCAR was traceable in Bulgarian legislation, no supporting arguments for its introduction were deduced. The applicability of PRCAR should be further studied and wider public debate should be initiated.

Promoting Individual Health Responsibility in the Welfare State.

The public health insurance in Germany will face huge economic challenges in the upcoming years. New diagnostic and therapeutic methods as well as the demographic change contribute to constantly rising expenditure. Although incentives for health-promoting behaviour or financial sanctions for an unhealthy lifestyle have been already discussed in the past, there has been a general reluctance to legally establish corresponding mechanisms for fear of eroding solidarity and increasing state control. In the course of the Coronavirus pandemic however, a stronger awareness rose to the fact that personal health-related life choices can have a huge impact on the stability of the healthcare system including public health insurance. Not only in Germany but throughout much of Europe, the pandemic led to a new and more fundamental debate about the relationship between individual responsibility for personal health and the wider responsibility for public health assumed by the community of solidarity.

“I *know* all the things I should be doing …”: accounting for mental health and illness in an online mental health discussion forum during the COVID-19 pandemic

BackgroundMental health is highly correlated with a person’s social and economic circumstances, and the recent COVID-19 pandemic made this connection uniquely visible. Yet a discourse of personal responsibility for mental health often dominates in mental health promotion campaigns, media coverage and lay understandings, contributing to the stigmatisation of mental ill-health.MethodsIn this study, we analysed how the concept of ‘mental health’ was discursively constructed in an online mental health peer-support forum in Australia during 2020, the period of the first two waves of the COVID-19 pandemic. An approach informed by Critical Discursive Psychology was employed to analyse all posts made to a discussion thread entitled “Coping during the coronavirus outbreak” in 2020, a total of 1,687 posts.ResultsTwo main interpretative repertoires concerning mental health were identified. Under the first repertoire, mental health was understood as resulting largely from the regular performance of a suite of self-care behaviours. Under the second repertoire, mental health was understood as resulting largely from external circumstances outside of the individual’s control. The existence of two different repertoires of mental health created an ideological dilemma which posters negotiated when reporting mental ill-health. A recurring pattern of accounting for mental ill-health was noted in which posters employed a three-part concessive structure to concede Repertoire 1 amid assertions of Repertoire 2; and used disclaimers, justifications, and excuses to avoid negative typification of their identity as ignorant or irresponsible.ConclusionsMental ill-health was commonly oriented to by forum posters as an accountable or morally untoward state, indicating the societal pervasiveness of a discourse of personal responsibility for mental health. Such discourses are likely to contribute to the stigmatisation of those suffering from mental ill-health. There is a need therefore for future communications about mental health to be framed in a way that increases awareness of social determinants, as well as for policy responses to effect material change to social determinants of mental health.

Health Information Seeking Behavior Among Perinatal Women: A Systematic Review

The health of perinatal women is critical to maternal well-being and infant development. Understanding how perinatal women seek health information is essential for providing effective antenatal and postnatal care. However, there is a lack of systematic reviews on this topic. This study aimed to conduct a comprehensive literature review of existing research following the PRISMA-SCR guidelines. The results showed that perinatal women commonly seek pregnancy-related health information. Interpersonal sources were identified as the primary and most trusted sources of information. The study also identified various factors and barriers that influence health information seeking, including individual, socio-cultural, structural, and information-related factors, with personal responsibility for health being an influential factor that has not been emphasized previously. It provides valuable insights into the health information seeking behavior of perinatal women. The influence of personal health responsibility, social power dynamics and socio-cultural norms on health information seeking needs to be further investigated.

Barriers and facilitators to retention in care and treatment adherence among racially/ethnically diverse women with HIV in South Florida: a qualitative study

ABSTRACT Women, particularly those from racial/ethnic minority groups, experience disparities in HIV care and treatment, and in achieving viral suppression. This study identified barriers and facilitators influencing retention in HIV care and treatment adherence among women belonging to racial/ethnic minority groups. We conducted semi-structured interviews with 74 African American, Hispanic/Latina and Haitian cisgender women receiving care from the Ryan White HIV/AIDS Program in Miami-Dade County, Florida in 2019. Data were analyzed using a thematic analysis approach. The most salient barriers faced by women were competing life priorities, mental health and substance use issues, medication-related concerns and treatment burden, negative experiences with HIV care services, transportation and parking issues and stigma and discrimination. Important facilitators identified by women included taking personal responsibility for health, social support, and patient-friendly and supportive HIV care services. Our findings suggest that HIV care could be enhanced for this population by understanding the non-HIV needs of the women in care, provide more flexible and relevant services in response to the totality of these needs, and simplify and expand access to care and supportive services.

On the Anatomy of Health-related Actions for Which People Could Reasonably be Held Responsible: A Framework.

Should we let personal responsibility for health-related behavior influence the allocation of healthcare resources? In this paper, we clarify what it means to be responsible for an action. We rely on a crucial conceptual distinction between being responsible and holding someone responsible, and show that even though we might be considered responsible and blameworthy for our health-related actions, there could still be well-justified reasons for not considering it reasonable to hold us responsible by giving us lower priority. We transform these philosophical considerations into analytical use first by assessing the general features of health-related actions and the corresponding healthcare needs. Then, we identify clusters of structural features that even adversely affected people cannot reasonably deny constitute actions for which they should be held responsible. We summarize the results in an analytical framework that can be used by decision-makers when considering personal responsibility for health as a criterion for setting priorities.

Implementation and impact of a social prescribing intervention: an ethnographic exploration.

Social prescribing involves referral of patients from primary care to link workers, who work with them to access appropriate local voluntary and community sector services. To explore how a social prescribing intervention was delivered by link workers and the experiences of those referred to the intervention. The study used ethnographic methods to conduct a process evaluation of a social prescribing intervention delivered to support those living with long-term conditions in an economically deprived urban area of the North of England. Participant observation, shadowing, interviews, and focus groups were used to examine the experiences and practices of 20 link workers and 19 clients over a period of 19 months. Social prescribing provided significant help for some people living with long-term health conditions. However, link workers experienced challenges in embedding social prescribing in an established primary care and voluntary sector landscape. The organisations providing social prescribing drew on broader social discourses emphasising personal responsibility for health, which encouraged a drift towards an approach that emphasised empowerment for lifestyle change more than intensive support. Pressures to complete assessments, required for funding, also encouraged a drift to this lighter-touch approach. A focus on individual responsibility was helpful for some clients but had limited capacity to improve the circumstances or health of those living in the most disadvantaged circumstances. Careful consideration of how social prescribing is implemented within primary care is required if it is to provide the support needed by those living in disadvantaged circumstances.

The Impact of Socioeconomic Status, Perceived Threat and Healthism on Vaccine Hesitancy

The ideology of healthism and low perceptions of the threat of vaccine-preventable diseases may explain the positive link between socioeconomic status (SES) and vaccine hesitancy in high-income countries. The present study aimed to examine the effect of three measures of SES (education, income and family economic status), the perceived threat of infectious diseases and two dimensions of healthism (personal responsibility for own health and distrust in healthcare institutions) on vaccine hesitancy, adjusting for sociodemographic variables. A cross-sectional quantitative study was performed in 2019. Non-probability sampling was employed by sending invitations to respondents over the age of 18 to participate in the study. The snowball technique was used, employing e-mails and digital social networks (Facebook, Twitter and Instagram). Data from 661 respondents were collected via 1 ka.si, an online survey tool. Multivariate regression analysis indicated that vaccine hesitancy was significantly more likely to be expressed by women (β = 0.09; p < 0.001), high-income respondents (β = 0.09; p < 0.01), those who have lower perceptions of the threat of vaccine-preventable diseases (β = 0.39; p < 0.001) and those scoring high on two healthism measures (expressing high perceived control of their own health (β = 0.18; p < 0.001) and high distrust in the Slovenian healthcare system and institutions (β = 0.37; p < 0.001)). The findings indicate that among the examined predictors, low perceived threat of vaccine-preventable diseases and low trust in the healthcare system are among the strongest predictors of vaccine hesitancy among the Slovenian public. Policymakers, physicians and other healthcare workers should be especially attentive to the public’s and patients’ perceptions of the risk of infectious diseases and distrust in medical institutions, including during doctor–patient communication and through public health campaigns and policies.

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.

Citizen Science in News Media: Boundary Mediation of Public Participation in Health Expertise

In this article, I examine how scientific boundary work describes or represents citizen science as credible forms of expertise. Citizen science is an ambiguous concept, and I leverage that ambiguity to examine citizen science as a proxy for nonprofessional or noninstitutional scientific practices more generally. I argue that media representations of citizen science perform boundary work through different articulations of institutional “buy-in” to the legitimacy or credibility of citizen science. Using a discourse analysis of mainstream news media, I trace three framings of citizen science’s relationship to institutional networks, which I describe as subservient to, corrective to, and exceeding the norms of institutional expertise. I find that the perspectives of professional, credentialed scientists dominate public discourse concerning citizen science and perform different adjudications of how citizen science contributes to networks of expertise. By focusing on citizen science concerning human health and medicine, I additionally show how mainstream framings of citizen science engage with overlapping media representations of personal health responsibility and patient empowerment. I suggest that representations of citizen science as a form of “missing expertise” can conflict with portrayals of citizen science as “going too far” in the pursuit of treatments or interventions.

Model of visitors to the health center regarding commitment to a healthy lifestyle and the level of personal responsibility for health

Model of visitors to the health center regarding commitment to a healthy lifestyle and the level of personal responsibility for health

IMPLICATIONS OF HEALTH PROMOTION ON HOLISTIC HEALTH IN INDIA

Based on the responses of lay participants, this micro-level qualitative study explores the reasons for the rising health consciousness among the lay populace in urban India. Health promotive behaviour reflects the negotiations of the individuals in fortifying their bodies against health risks prevalent in the modern society. These goals were also compatible with the pursuit of healthy and fit bodies as fashion. Health promotive behaviour is both an end in itself and a means to an end. The paper examines the rationale of the lay persons in actively furthering and improving their health. Further, it investigates implications of such behaviour in creating a demand for holistic health systems. The study illustrates that lay conception of health impacts both the health behaviour and medical choices that guarantee fortification of health and attainment of wellness. The participants admitted that cultivation and preservation of health weighed heavily on their minds. A number of reasons were elicited to explain this phenomenon that included rising incidence of disease and the lack of familial support to the elderly. The lay reasoning provided a deep insights into the range of factors that impinge on health behaviour. The burgeoning definition of health along with commitment to personal responsibility for health, together create a surge for holistic health services for they are compatible with attainment of the goals of wellness. The sociological factors that trigger health promotive behaviour generate debates on medicalization and de-medicalization of everyday life.

Who is watching the World Health Organisation? ‘Post-truth’ moments beyond infodemic research

The World Health Organization (WHO) has established a public research agenda to address infodemics. In these, ‘an overflow of information of varying quality surges across digital and physical environments’. The WHO’s expert panel has raised concerns that this can result in negative health behaviours and erosion of trust in health authorities and public health responses. In sponsoring this agenda, the WHO positioned itself as a custodian that can flag illegitimate narratives (misinformation), the spread of which can potentially result in societal harm. Such ‘post-truth’ moments are rife with the coronavirus disease 2019 (COVID-19) public health emergency. It provides an opportunity for researchers to analyse divisions in knowledge labour, which can help explain when ‘post-truth’ moments arrive. The first COVID-19 example for this division foregrounds the development of knowledge in an academic context. Added to this is the infodemic or disinfodemic research agenda and personal health responsibility, whose academic contributors are similar. In contrast, the division of labour for messenger ribonucleic acid (mRNA) vaccine research foregrounds the role of vaccine manufacturing pharmaceutical companies in driving and promoting related knowledge production.Transdiciplinary Contribution: This analysis focuses on intergroup contradictions between the interests of agencies and their contrasting goals and across different types of knowledge division. Many intergroup contradictions exist, and a few intergroup examples are also described. An overarching contradiction was identified where rushed guidance based on weak evidence from international health organisations may well perpetuate negative health and other societal outcomes rather than ameliorate them.

Bonding Goes Back to the Dawn of Cosmos

Bonding is more than a lifelong process. It is a process that begins long before conception. In a broader context, this process begins with the dawn of the cosmos itself. Bonding is the linking process that bridges the prenatal and postnatal stages and prepares the child to connect securely and meaningfully with the world and life on earth. This article highlights aspects of bonding in the pre-conception and conception periods, as well as in pregnancy and birth, so that connections can be made to pre-, gestational, then peri-, and postnatal growth. A list of bonding support issues accompanies the consideration of parent and child development within the psychocultural, spatial, and temporal environments so that taking responsibility for personal health and growth at different stages becomes possible. In summary, bonding is about strengthening the life-enhancing polarity over the life-diminishing polarity.

Effectiveness of a self-management mobile app on the quality of life of women with breast cancer: a study in a developing country

BackgroundSelf-management involves taking responsibility for personal health and taking the initiative to do so. This can be accomplished by learning information and skills that will help consider the difficulties may encounter during and after cancer treatment. With this perspective, we have aimed to develop a self-management mobile app for women with breast cancer in Iran and evaluate its impact on the quality of life of patients.MethodThis study is a methodological study in 2021. We developed the app during three phases. The first phase aimed at identifying educational content and designing user experience, the second phase aimed at developing and implementing the app, and the third phase aimed at evaluating pre-and post-implementation.ResultIn this study, an Android app for self-management women with breast cancer was developed. According to the results of the pre-and post-implementations among the most significant changes were in the quality of life level, highest respectively: social avoidance (Pre: 6.41–Post: 3.56), negative feelings (Pre: 5.93 - Post: 3.40), sexual function (Pre: 6.80 - Post: 5.04), sexual interest (Pre: 6.41 - Post: 4.75) and pain (Pre: 6.37 - Post: 4.97). And least the changes respectively: distress-family (Pre: 7 - Post: 7), distress-recurrence (Pre: 4.49 - Post: 4.38), benefits (Pre: 2.47 - Post: 3.12), appearance (Pre: 4.10 - Post: 3.32). Also, we calculated the usability evaluation of this app with the system usability scale (SUS); the overall rating score was 83/100, an excellent level (> 80.3), and a grade A.ConclusionThe study shows that a breast cancer self-management app can support and improve the quality of life of women with breast cancer. We conducted this study to show that by developing a self-management app, women with breast cancer can improve their quality of life, − by increasing their self-management skills.

Personal Responsibility for Health: Exploring Together with Lay Persons.

Emerging parallel to long-standing, academic and policy inquiries on personal responsibility for health is the empirical assessment of lay persons' views. Yet, previous studies rarely explored personal responsibility for health among lay persons as dynamic societal values. We sought to explore lay persons' views on personal responsibility for health using the Fairness Dialogues, a method for lay persons to deliberate equity issues in health and health care through a small group dialogue using a hypothetical scenario. We conducted two 2-h Fairness Dialogues sessions (n = 15 in total) in Nova Scotia, Canada. We analyzed data using thematic analysis. Our analysis showed that personal choice played an important role in participants' thinking about health. Underlying the concept of personal choice was considerations of freedom and societal debt. In participants' minds, personal and social responsibilities co-existed and they were unwilling to determine health care priority based on personal responsibility. The Fairness Dialogues is a promising deliberative method to explore lay persons' views as dynamic values to be developed through group dialogues as opposed to static, already-formed values waiting to be elicited.

On the person in personal health responsibility

In this paper, we start by comparing the two agents, Ann and Bob, who are involved in two car crashes. Whereas Ann crashes her car through no fault of her own, Bob crashes as a result of reckless driving. Unlike Ann, Bob is held criminally responsible, and the insurance company refuses to cover the car’s damages. Nonetheless, Ann and Bob both receive emergency hospital treatment that a third party covers, regardless of any assessment of personal responsibility. What warrants such apparent exceptionalism with respect to personal responsibility in the healthcare context? We turn our attention to an understudied aspect of the debate on personal health responsibility, namely, the conceptualisation of the person in need of emergency hospital treatment. Drawing on the research of Joshua Knobe and Shaun Nichols, we propose that a context-dependent conceptualisation of the person may help explain a reluctance to ascribe responsibility to the individual for negative health outcomes.

Obesity: Policy and Practice Recommendations for High-Risk Populations Influenced by the COVID-19 Pandemic.

ABSTRACTObesity has been linked to higher morbidity and mortality in those that contract novel viruses, such as H1N1 and SARS-CoV-2. Loss of life and the high cost of obesity highlight the need to focus on preventative measures. The state of Maine (United States) is profiled as a rural state with high rates of obesity and low health literacy that benefits from programs to improve health. However, more multidirectional efforts are needed. Four recommendations for building a healthier, more resilient patient population are discussed here: (i) state incentives and subsidies, (ii) employers to incentivize healthy living, (iii) federal incentives and initiatives, and (iv) personal responsibility for health and wellness.

Are individual risky behaviours relevant to healthcare allocation decisions? An exploratory study

PurposeThe problematic surrounding patients' prioritization decisions are currently at the centre of political leaders' concerns. How to define whom to treat when there are not enough resources to treat everybody is the key question. This exploratory study aims to investigate the views of Bulgarian citizens regarding the relevance of the information concerning eight individual health-related behaviours in priority setting decisions: smoking, excess of alcohol, illegal drug use, overweight/obesity, speed driving, extreme sports practice, unsafe sex and overuse of internet and/or mobile devices.Design/methodology/approachData were collected through a questionnaire where 322 respondents faced hypothetical rationing dilemmas comprising option pairs of the eight risky behaviours. Descriptive statistics and non-parametric tests were performed to define the penalization of each of the risky behaviours and to test for the association between this penalization and the respondent's health habits and sociodemographic characteristics.FindingsMost respondents would refuse to grant access to healthcare based on patients' personal responsibility for the disease. Nevertheless, respondents were more willing to consider illegal drug use, excessive alcohol consumption, engagement in unsafe sex behaviours and smoking. Respondent's own interest or advantage seems to be somehow relevant in explaining the penalization of risk behaviours in priority setting.Practical implicationsThis study shows that most respondents support the lottery criterion and thus do not want to see lifestyle prioritization in action.Originality/valueThis study is the first attempt to awaken attention to the impact that personal responsibility for health may have on intergenerational access to healthcare in Bulgaria.

Obrazovanjem do zdravlja. Zdravstveno prosvjećivanje mladih u Hrvatskoj od kraja Drugoga svjetskog rata do početka 1970-ih.

This paper shall examine the role and development of health education in the Socialist Republic of Croatia from the end of the Second World War to the beginning of the 1970s. Consideration shall be accorded to the public health priorities and measures that clarify the role of schooling in the health education of young people both within and outside of the school system, particularly in the 1960s within the context of political, economic and social change in the Socialist Republic of Croatia, when socialism was being systematically implemented at all levels and structural changes in society were under way. In this sense, it is noteworthy that the educational system was considered a vital area for anticipating changes in the spirit of the socialist self-management transformation. Improvement of the overall culture of health in society was accomplished by educating children about health through the school system. In this vein, instruction about preserving health and a healthy lifestyle and the prevention of infectious diseases was promoted through mandatory basic education from the earliest age. At the end of the 1960s, topics pertaining to health and sexuality were introduced into educational curricula with the aim of protecting the health of pupils. The Educational Advisory Board of the Socialist Republic of Croatia adopted the General Educational Curriculum and Programme for Primary Schools which contained components aimed at fostering personal responsibility for health. An analysis of the General Educational Curriculum and Programme will be employed to examine contemporary themes and demonstrate how the introduction of new educational content in the school system led to significant changes in the modes for the systematic health education of young people.