Digital atmospheres: affective practices of care in Elefriends

This article develops the concept of digital atmosphere to analyse the affective power of social media to shape practices of care and support for people living with mental distress. Using contemporary accounts of affective atmospheres, the article focuses on feelings of distress, support and care that unfold through digital atmospheres. The power of social media intersects with people's support and care‐seeking practices in multiple ways and not in a straightforward model of ‘accessing or providing support’. Indeed, we find that the caring relations developed through social media often need to be cared for themselves. The article draws on online and interview data from a larger project investigating how practices of care and support are (re)configured in the mental health‐related social media site Elefriends. Users have to negotiate the disruption of moving support online, as well as the possibility of becoming subject to a fragility in care, in which caring for oneself becomes bound up in the ambiguities of caring for others. We argue that understanding how experiences of distress are shaped by social media is essential for understanding the implications of the increased digitisation of mental healthcare.     

Computerized decision support and the quality of care

The notion of quality of care in medicine is not new, but it is becoming increasingly important as the competitive health care market demands objective measures to compare physicians, hospitals, and managed care organizations. Informatics researchers and health care vendors have responded with computer systems that promise to improve health care delivery. How well do these systems fulfill the promise? The answer requires an understanding of systems and the standards of quality used to assess them. This review paper will focus on the computerized methods designed to improve some components of quality of health care. The first section will provide a broad definition for quality of care and discuss the ways it is measured. The second portion of this article is a hypothetical case discussion of the implementation of strategies of quality improvement. We provide expectations of the effectiveness of these strategies with different degrees of computerized support. Finally, we review the literature in computer-based decision-support systems, and draw conclusions about their effects on aspects of quality.     

Bringing a family practice model of health to the People's Republic of China

The health care system in the People's Republic of China (PRC) is undergoing a major transition that has made the government revise its approach to how medicine is taught and practiced. Family medicine, which provides a generalist approach to medical care, is at the forefront of this transition. This article reviews the recent history of medical education in the PRC, including the establishment of the discipline of family medicine in the mid 1980s, and factors promoting development of family medicine. These include the movement away from government-subsidized health care in hospital settings, the aging population, increased urbanization, increasing incidence of infectious diseases, and rising health care costs. We conclude from observations made in the PRC and from a review of secondary sources that family medicine in China is in its infancy. The value of understanding the role that family medicine plays within China's changing health care system is that we gain a broader perspective of the variety and growing international importance of family practice as a profession.     

Advancing nursing practice for improved health outcomes using the principles of perceptual control theory

This article describes how an empirically supported theory of human behaviour, perceptual control theory, can be used to advance nursing practice and improve health outcomes for people who are accessing nursing care. Nursing often takes a pragmatic approach to the delivery of care, with an emphasis on doing what appears to work. This focus on pragmatism can sometimes take precedence over any consideration of the underlying theoretical assumptions that inform decisions to take one particular approach over another or the mechanisms through which nursing interventions have their effects. For nursing to develop as a profession, there needs to be an increased focus on the core principles that underpin the delivery of care. In addition to understanding what works, nurses must develop their understanding of how and why particular approaches work or do not work. Understanding the fundamental principles that underpin nurses’ actions will lead to more efficient and effective approaches to the delivery of nursing care. It will also enable nurses to maximize those elements of their practice that are most beneficial for people and minimize other activities that either have little effect or actually lead to worse outcomes. In this article, we will propose that the phenomenon of control is fundamental to human health. Perceptual control theory provides a coherent theoretical framework that enables us to understand the phenomenon of control through a functional model of human behaviour. People are healthy when their neurochemical, physiological, biological, psychological and social states are all controlled satisfactorily. We will explain the implications of understanding health as control throughout the paper. From this perspective, we will argue that the aim of nurses and nursing should be to support people to maintain or recover control over those aspects of their lives that are important and meaningful to them.     

From ‘if-then’ to ‘what if?’ Rethinking healthcare algorithmics with posthuman speculative ethics

This article discusses the role that algorithmic thinking and management play in health care and the kind of exclusions this might create. We argue that evidence-based medicine relies on research and data to create pathways for patient journeys. Coupled with data-based algorithmic prediction tools in health care, they establish what could be called health care algorithmics—a mode of management of healthcare that produces forms of algorithmic governmentality. Relying on a critical posthumanist perspective, we show how healthcare algorithmics is contingent on the way authority over bodies is produced and how predictive health care algorithms can reproduce inequalities of the worlds from which they are made, centreing possible futures on existing normativities regulated through algorithmic biopower. In contrast to that, we explore posthuman speculative ethics as a way to challenge understanding of ‘ethics’ and ‘care’ in healthcare algorithmics. We suggest some possible avenues towards working speculative ethics into health care while still being critically attentive to algorithmic modes of management and prediction in health care.     

Access to evidence-based care for eating disorders during the COVID-19 crisis

The COVID-19 pandemic has forced an abrupt change in the delivery of clinical services, including for individuals with an eating disorder. We present this Virtual Issue as a resource for the eating disorder community to showcase research published in the International Journal of Eating Disorders that provides information on effective strategies to help address the challenges arising from COVID-19-related disruptions. Articles included describe original research or systematic reviews on obstacles to health services use and strategies to improve access to care; technological tools to provide or enhance interventions; patients' and clinicians' attitudes or perspectives on using digital tools for clinical care; factors influencing therapeutic alliance; and ideas for improving reach and uptake of digital interventions. We hope that readers will find ways to observe and record their own experiences during this global crisis; the experiences of people at risk for developing or exhibiting an eating disorder; and the experiences of those who care for people with an eating disorder. These lived experiences will be invaluable in formulating hypotheses for future studies in service of advancing the understanding of eating disorders and improving interventions and policies for reducing the burden of suffering attributable to eating disorders.     

Health promotion in palliative care: the case for conceptual congruence

This article provides a critical review of the literature relevant to the conceptual foundations of health promoting palliative care. It explores the separate emergence and evolution of palliative care and health promotion as distinct concerns in health care, and reviews the early considerations given to their potential convergence. Finally, this article examines the proposal of health promoting palliative care as a specific approach to providing end of life care through a social model of palliative care. Research is needed to explore the impact for communities, health care services and policy when such an approach is implemented within palliative care organisations.     

Is digital health care more equitable? The framing of health inequalities within England's digital health policy 2010–2017

Informed by a discourse analysis, this article examines the framing of equity within the UK's digital health policies between 2010 and 2017, focusing on England's development of NHS Digital and its situation within the UK Government's wider digital strategy. Analysis of significant policy documents reveals three interrelated discourses that are engaged within England's digital health policies: equity as a neoliberal imaginary of digital efficiency and empowerment; digital health as a pathway towards democratising health care through data‐sharing, co‐creation and collaboration; and finally, digital health as a route towards extending citizen autonomy through their access to data systems. It advances knowledge of the relationship between digital health policy and health inequalities. Revealing that while inclusion remains a priority area for policymakers, equity is being constituted in ways that reflect broader discourses of neoliberalism, empowerment and the turn to the market for technological solutionism, which may potentially exacerbate health inequalities.     

COMMUNICATION PATTERNS BETWEEN HEALTH CARE PROVIDERS AND THEIR CLIENTS AT AN ANTENATAL CLINIC IN ZIMBABWE

We conducted this study to explore communication between pregnant women and health care providers at an antenatal clinic in Zimbabwe. We adopted a field research approach using qualitative strategies for data collection and analysis. Using content analysis, we identified impersonal communication, nonprivate communication, rigid communication, uninformed communication, and authoritative communication as characteristic components of the interaction between the pregnant women and the health care providers. The attitudes reflected by the communication styles at the antenatal clinic must be viewed in relationship to the culture and tradition of Zimbabwe. With further research, we may identify obstacles to communication that are not related to culture. This knowledge may lead to a better understanding of appropriate communication strategies to promote healthy pregnancy.     

Stepwise Design and Evaluation of a Values-Oriented Ambient Intelligence Healthcare Monitoring Platform

ObjectivesThe majority of all developed digital health technologies do not reach successful implementation. A discrepancy among technology design, the context of use, and user needs and values is identified as the main reason for this failure. Value-sensitive design (VSD) is a design method enabling to align design with user values by embedding values in technology, yet the method is lacking clear heuristics for practical application. To improve the successful design and implementation of digital health, we propose and evaluate a stepwise approach to VSD.MethodsThe approach consists of the phases: experiment, demonstrate, and validate. Experiment takes place in an office to create makeshift solutions. Demonstrate takes place in a mock-up environment and aims to optimize design requirements through user feedback. The validate phase takes place in an authentic care situation and studies how the novel technology affects current workflows.ResultsWe applied the stepwise VSD approach to the design of a hospital-based ambient intelligence solution for remotely and continuously monitoring quality and safety of patient care. We particularly focused on embodiment of the values of safety, privacy, and inclusiveness in the design. Design activities of the experiment and demonstrate phase are discussed.ConclusionsA stepwise approach to VSD enables a design to optimally meet the values of all users involved, while aligning the design process with the practical limitations of healthcare institutions. We discuss some benefits and challenges related to VSD and the potential for transfer of this approach to other digital health solutions.     

The Use of Traditional and Western Medicine Among Korean American Elderly

With the current wave of Asian immigration to the United States, awareness of their use of traditional medicine, often in combination with Western medicine, is an increasingly salient issue for health care professionals. This paper describes the use of traditional and Western medicine by Korean American elderly and factors that are associated with their health-seeking behaviors and health service utilization. Data were obtained from a convenience sample of 205 Korean elderly immigrants through interview. The findings revealed that health service utilization among Korean American elderly covered a broad spectrum of health resources, including the use of Western medicine, the traditional Korean medicine (hanbang), or both Western and traditional clinics. In addition, health insurance status and the source of health care were found to relate to the types of health service that Korean American elderly chose to utilize. Better understanding of patterns of health service utilization may improve the quality of health care by increasing health providers' cultural sensitivity and facilitating adequate communication between Asian immigrant clients and their care providers. Implications for research and practice are discussed.     

Strategies to read and learn: overcoming learning by consumption

Medical Education 2010: 44 : 340–346 Objectives This article discusses the need for, and value of, providing students with instruction in how to use comprehension strategies as well as the effectiveness of inducing strategy use through cognitive disequilibrium. The leading assumption that guides this article is that learning facts and figures is not enough. Students need to build deep knowledge that is interconnected, coherent and includes understanding of potential causal mechanisms. Doing so requires going beyond the printed page by generating inferences and developing coherent explanations. Inferences and explanations allow the student to make links between concepts in the material and, importantly, to make connections to prior knowledge. These connections render students’ understanding of new material more coherent and, in consequence, deeper and more stable. Discussion This article describes two means of inducing students to construct a deeper understanding of new material. One means of challenging students is through cohesion gaps in a text (or a lecture) that require the student to generate inferences to understand the relationships between concepts. Although low‐knowledge readers are not able to generate these inferences, relatively high‐knowledge readers (e.g. medical students) are more likely to successfully generate inferences to bridge conceptual gaps, and doing so results in a deeper understanding of the material. A second means of inducing active processing is to provide students with instruction and practice in how to use comprehension strategies. This article describes methods of providing such instruction, including the intelligent tutoring system, iSTART. Conclusions The overarching goal of the research described in this article is to scaffold students towards ideal learning strategies. This cannot happen simply by telling students about good strategies. It is ineffective to inform a student that the content will be better understood if it is explained or evaluated. Such an approach is a victim of learning by consumption attitudes towards education.     

Animals,veterinarians and the sociology of diagnosis

While sociologists of medicine have focused their efforts on understanding human health, illness, and medicine, veterinary medical practice has not yet caught their attention in any sustained way. In this critical review article, we use insights from the sociology of diagnosis literature to explore veterinary practice, and aim to demonstrate the importance of animals to sociological understandings of health, illness and disease. As in human medicine, our analysis shows the importance of diagnosis in creating and maintaining the power and authority of the veterinary professional. However, we then explore how diagnosis operates as a kind of dance, where professional authority can be challenged, particularly in light of the complex ethical responsibilities and clinical interactions that result from the triad of professional/owner/animal patient. Finally, we consider diagnosis via the precept of entanglement, and raise the intriguing possibility of interspecies health relations, whereby decision-making in human health care may be influenced by experiences in animal health care and vice-versa. In our conclusion, we argue that this analysis provides opportunities to scholars researching diagnosis in human health care, particularly around the impact of commercial drivers; has implications for veterinary and public health practitioners; and should help animate the emerging sociology of veterinary medicine.     

Networks and social capital: a relational approach to primary healthcare reform

Collaboration among health care providers and across systems is proposed as a strategy to improve health care delivery the world over. Over the past two decades, health care providers have been encouraged to work in partnership and build interdisciplinary teams. More recently, the notion of networks has entered this discourse but the lack of consensus and understanding about what is meant by adopting a network approach in health services limits its use. Also crucial to this discussion is the work of distinguishing the nature and extent of the impact of social relationships – generally referred to as social capital. In this paper, we review the rationale for collaboration in health care systems; provide an overview and synthesis of key concepts; dispel some common misconceptions of networks; and apply the theory to an example of primary healthcare network reform in Alberta (Canada). Our central thesis is that a relational approach to systems change, one based on a synthesis of network theory and social capital can provide the fodation for a multi-focal approach to primary healthcare reform. Action strategies are recommended to move from an awareness of 'networks' to fully translating knowledge from existing theory to guide planning and practice innovations. Decision-makers are encouraged to consider a multi-focal approach that effectively incorporates a network and social capital approach in planning and evaluating primary healthcare reform.     

Existing Roles of Traditional Healers (<Emphasis Type="Italic">mor baan</Emphasis>) in Southern Thailand

Traditional healers ( mor baan ) played an important role in Thai health long before the introduction of Western medicine. Although modern health professional play a key role of health care provider of Thai health care system, traditional healers and their practice still exist in most rural areas of Thailand. In this article, we address the roles and practices of traditional healers in southern Thailand. An ethnographic method was employed. This approach is the hallmark method used to describe the role and the practice of traditional healers and to grasp in-depth understanding of their everyday life. Participation observation and unstructured interview with 18 traditional healers were conducted. Thematic analysis method was used to analyse the data. Most of the traditional healers chose their role because they were influenced by their ancestors, although a few others chose it because of individual interests and a desire to help ill people. All are trained in multiple skills, using supernatural spirits, ceremonies and natural plant products as resources for counteracting various health problems. They refer patients to modern hospitals or other healers if they cannot adequately manage illness themselves. Their service provision is flexible and based on a holistic approach that suits people’s lifestyles and needs. The role of traditional healer tends not to attract the interest of younger generations, although traditional healers have contributed greatly to people’s health. Their presence improves people’s access to healthcare and offers an alternative to modern medicine, which often has a limited role. We conclude that the services of traditional healers should be incorporated into contemporary healthcare provision of Thai health care system.     

Beyond base pairs to bedside: a population perspective on how genomics can improve health

A decade after the sequencing of the human genome, the National Human Genome Research Institute announced a strategic plan for genomic medicine. It calls for evaluating the structure and biology of genomes, understanding the biology of disease, advancing the science of medicine, and improving the effectiveness of health care. Fulfilling the promise of genomics urgently requires a population perspective to complement the bench-to-bedside model of translation. A population approach should assess the contribution of genomics to health in the context of social and environmental determinants of disease; evaluate genomic applications that may improve health care; design strategies for integrating genomics into practice; address ethical, legal, and social issues; and measure the population health impact of new technologies.     

Assessing Community Health Among Indigenous Populations in Ecuador with a Participatory Approach: Implications for Health Reform

Health reform is an important movement in countries throughout the region of the Americas, which could profoundly influence how basic health services are provided and who receives them. Goals of health sector reform include to improve quality, correct inefficiencies, and reduce inequities in current systems. The latter may be especially important in countries with indigenous populations, which are thought to suffer from excess mortality and morbidity related to poverty. The purpose of this paper is to report the results of a community health assessment conducted in 26 indigenous communities in the Province of Cotopaxi in rural Ecuador. It is hoped that this information will inform the health reform movement by adding to the current understanding of the health and socioeconomic situation of indigenous populations in the region while emphasizing a participatory approach toward understanding the social forces impacting upon health. This approach may serve as a model for empowering people through collective action. Recommended health reform strategies include: 1) Develop a comprehensive plan for health improvement in conjunction with stakeholders in the general population, including representatives of minority groups; 2) Conduct research on the appropriate mix between traditional medicine, primary health care strategies, and high technology medical services in relation to the needs of the general population; 3) Train local health personnel and traditional healers in primary health care techniques; 4) Improve access to secondary and tertiary health services for indigenous populations in times of emergency; and 5) Advocate for intersectoral collaboration among government institutions as well as non-governmental organizations and the private sector.     

Explaining trends in the privatization of health services in South Africa

This paper analyses the two major factors that have affectedthe trend towards privatization in the health sector in SouthAfrica. The first is the shift in government policy in favourof greater private sector participation in hearth care. Thesecond is the increase in medical aid scheme membership. The shift in government policy towards privatization shouldbe seen in the context of a shift away from welfarism to monetaristmacro-economic policies, witnessed in several advanced industrializedcountries. The change in SA's health policy should also be seenin the light of the post-1977 reform strategies of the Apartheidstate. However, the most important factor in the policy shiftsis the state's inability or unwillingness to fund hearth servicesadequately. Yet for privatization to succeed there has to be an increasein demand for private health care, i.e., an increase in thenumber of people able and willing to afford private health care.In SA the market amongst whites for private care is more orless saturated. Thus the second major factor promoting the growthof private medicine in SA is the increase in the number of blackscovered by medical aid schemes (i.e. health insurance). Thereasons for this trend are outlined. Finally, the implicationsof this analysis for policy interventions are discussed.     

Health education: knowledge, social representation, and illness

This article discusses the theory and practice of health and education, beginning with the notion of the hegemony (in health education practice) of strategies linked to the notion that to grasp established knowledge always leads to the acquisition of new behaviors and practices. Five different axioms have oriented education and health practices, either juxtaposed or at different moments: (1) the notion of overcoming the determination of knowledge over practices; (2) the determination of representations over practices; (3) the analysis of representations within the traditional framework of right and wrong; (4) reciprocity between representations and practices; and (5) the importance of considering practices amenable to re-elaboration through representations, thus situating experience in understanding subjects' illness processes, as well as the way subjects culturally construct illness. The article highlights the need for a link between social representations and illness-as-experience in health education practices.     

"It depends on what you mean": a qualitative study of Swedish health professionals' views on health and health promotion

Background  

The role of health services must be re-oriented towards health promotion to more effectively contribute to population health. One of the objectives of the Swedish public health policy is that health promotion and disease prevention should be an integral part of the health care system and an important component of all care and treatment. However, the uncertainty about what the concepts of health and health promotion mean poses a challenge for implementation. Depending on how these concepts are interpreted, the attitudes of health professionals toward health promoting practices will differ. Thus, a more in-depth understanding of health professionals' views can be a starting point for a discussion about the values and attitudes that influence the current health care system and about the barriers and possibilities for future development of a health promoting health service.