Biopedagogy digitalized: ‘educational’ relations among participants on an online weight loss surgery forum

Foucault uses the term ‘biopower’ to describe the totalizing effects of regulation of life through the manipulation of political messages, such as those in the obesity debate. This paper attempts to uncover ways in which these flows are made manifest among members of a public online weight loss surgery (WLS) discussion forum. Drawing from Foucauldian scholarship, we spent two-and-a-half years conducting a critical discourse analysis of over 2000 conversational threads on one US-based public discussion forum devoted to providing a support community to those who were considering WLS. Our intent is to analyze how ‘truths’ about the surgery are constructed among and between the community participants at different stages of the surgery to identify how they engage with ideologies associated with contemporary obesity and healthism.     

‘I am not a man’: Trans-specific barriers and facilitators to PrEP acceptability among transgender women

ABSTRACT

The frequent conflation of transgender (‘trans’) women with ‘men who have sex with men (MSM)’ in HIV prevention obscures trans women's unique gender identities, social and behavioural vulnerabilities, and their disproportionately high rates of HIV infection. Pre-exposure prophylaxis (PrEP) is an efficacious biomedical HIV prevention approach. However, trans women are underrepresented in PrEP research, and are often aggregated with MSM without consideration for their unique positions within sociocultural contexts. This study examined PrEP acceptability among trans women via three focus groups and nine individual interviews (total N?=?30) in San Francisco. While knowledge of PrEP was low, interest was relatively high once participants were informed. Due to past negative healthcare experiences, ability to obtain PrEP from a trans-competent provider was cited as essential to PrEP uptake and adherence. Participants noted that PrEP could address situations in which trans women experience reduced power to negotiate safer sex, including sex work. Trans-specific barriers included lack of trans-inclusive marketing of PrEP, prioritisation of hormone use, and medical mistrust due to transphobia. Findings underscore the importance of disaggregating trans women from MSM in HIV prevention strategies to mitigate disparate risk among this highly vulnerable population.     

‘Yarning up with Koori kids’ – hearing the voices of Australian urban Indigenous children about their health and well-being

Objective: Australian Indigenous children experience some of the most substantial health inequalities globally. In this context, research regarding their health and well-being has overemphasised physical illnesses with limited exploration of a diverse range of dimensions and determinants, particularly those based on Indigenous holistic understandings of health and well-being. This deficit-based approach has thus missed many strengths and assets of Indigenous children. This research aimed to gain insight into the perspectives of Indigenous children about their health and well-being in an urban setting in Australia. It joins a limited international literature examining views and experiences of non-majority children.

Design: Participatory and qualitative child-friendly research methods were utilised. The project was developed in partnership with Indigenous community organisations and members. Photo-elicitation activities and focus groups were conducted with 31 Indigenous children aged 8–12 years. Qualitative data were analysed thematically, combining focus group and interview data.

Results: It was evident an urban Indigenous child perspective of health and well-being includes rich understandings of the interconnectedness of physical, social-emotional and cultural dimensions of holism, as well as the integral importance of family and community relationships. The study also found that specific worries regarding loss of loved ones and racism were highly salient in Indigenous children’s lives.

Conclusion: The overwhelming conclusion to be drawn from this research is that Indigenous children in urban areas need ongoing recognition of both their agency and resilience in the face of adversity, within a wider context of historical and contemporary racialisation and racism.     

‘If I am not doing my own playing then I am not able to truly share the gift of play with children’: using poststructuralism and care ethics to examine future early childhood educators' relationships with play in adulthood

The current sociopolitical context of schooling is positioning play as incongruous with children's academic learning. As a result, teacher educators must increasingly guide future early childhood professionals to develop the skills and knowledge necessary to become effective play advocates. This includes articulating the value of play across the lifespan to a variety of stakeholders. Yet, ironically, many adult women entering the early childhood profession report that a wide range of barriers prevent them from including play in their adult lives. Two case studies highlight how early childhood graduate students use their experiences with play across the lifespan as a foundation for becoming play advocates. Nel Noddings's care ethics and feminist poststructural critiques of the construct of care inform the analysis and discussion of the findings. Implications suggest the importance of guiding early childhood professionals to acknowledge self-care as a component of care and play as an essential expression of self-care.     

‘You are labelled by your children’s disability’ – A community-based,participatory study of stigma among Somali parents of children with autism living in the United Kingdom

Objectives: Social stigma is commonly experienced by parents of children with autism. Our aim was to understand the nature of stigma experienced by Somali parents of children with autism in the United Kingdom (UK), and to consider how they coped with or resisted such stigma.

Design: We used a community-based participatory research approach, collaborating with a community organisation of Somali parents. In-depth interviews with simultaneous translation were conducted with 15 Somali parents of children with autism living in Bristol, UK, in 2015. Parents were sampled purposively to capture diversity in children’s age, severity of autism and time since diagnosis. Directed thematic analysis used Link and Phelan’s model of stigma.

Results: Of the 15 participants, 12 were mothers (mean age 36). The 17 children with autism they cared for were 4–13 years’ old, and five were girls. Two main themes with sub-themes were identified: the nature of stigma (labelling and stereotyping; separation; emotional reactions, discrimination and power), and coping and resistance (the power of language; faith as a resource; learning, peer support and community relationships). Children with autism were labelled and stereotyped (e.g. as ‘sick’, ‘naughty’, ‘different’) and parents blamed for not controlling them, leading to social rejection and isolation. Stigma was associated with a poor understanding of autism, a lack of vocabulary related to autism in the Somali community, and prejudice against mental illness and disability. There was evidence of enacted and felt stigma and examples of discrimination. Finding their own language to describe their child’s condition and drawing on faith, learning and peer support were important resources in resisting stigma.

Conclusions: Findings inform support for this community, highlighting the need to raise awareness of autism, enable parents to speak openly, and ensure appropriate professional services and interventions are available.     

‘I’m searching for solutions’: why are obese individuals turning to the Internet for help and support with ‘being fat’?

Introduction This study explores what types of information obese individuals search for on the Internet, their motivations for seeking information and how they apply it in their daily lives. Method In‐depth telephone interviews with an Australian community sample of 142 individuals with a BMI ≥ 30 were conducted. Theoretical, purposive and strategic samplings were employed. Data were analysed using a constant comparative method. Results Of the 142 individuals who participated in the study, 111 (78%) searched for information about weight loss or obesity. Of these, about three quarters searched for weight loss solutions. The higher the individual’s weight, the more they appeared to search for weight loss solutions. Participants also searched for information about health risks associated with obesity (n = 28), how to prevent poor health outcomes (n = 30) and for peer support forums with other obese individuals (n = 25). Whilst participants visited a range of websites, including government‐sponsored sites, community groups and weight loss companies, they overwhelmingly acted upon the advice given on commercial diet websites. However, safe, non‐judgemental spaces such as the Fatosphere (online fat acceptance community) provided much needed solidarity and support. Conclusions The Internet provides a convenient source of support and information for obese individuals. However, many turn to the same unsuccessful solutions online (e.g. fad dieting) they turn to in the community. Government and community organisations could draw upon some lessons learned in other consumer‐driven online spaces (e.g. the Fatosphere) to provide supportive environments for obese individuals that resonate with their health and social experiences, and address their needs.     

On the unraveling of ‘revitalization of local health traditions’ in India: an ethnographic inquiry

Background

India has recently renewed emphasis on non-allopathic systems of medicine as a means to address the health needs of its populace. Earlier in 2002, its national health policy had sought to ‘revitalize’ community-based health knowledge and practices – jointly christened ‘local health traditions’. Yet policy texts remain silent on the actual means by which ‘revitalization of local health traditions’ should take place. Our research sought to understand the policy lessons of and for revitalization of local health traditions in the three Southern Indian states through an ethnographic inquiry in 2014–2016.

Methods

Our inquiry included a narrative synthesis of policy texts tracing the history of governance processes and mechanisms pertaining to traditional medicine, including local health traditions, linking this to the activities of non-governmental organizations (NGOs) and networks involved in “revitalization”. Through in-depth interviews, observations and case studies, we sought to understand the life worlds of local health tradition practitioners and what revitalization meant to them. Our method revealed that beyond a purely academic inquiry, we needed an (inter)action that would give greater voice to these perspectives and views leading to hosting an interactive dialogue among practitioners, NGO representatives, academics, and government officials.

Results

Our ethnographic inquiry unraveled the problematic of a litotic approach to local health traditions as those which are non- institutionalized, non-certified, non-documented; assuming the state to be the only source of power and legitimacy. Revitalization discussions were restricted (and often misled) by such an approach. Local health practitioners and others directed us to interesting possibilities of revitalization either through participatory modes of documentation of traditional health knowledge, strengthening existing collective forums for formal social recognition, and building pedagogical institutions that promote experiential learning.

Conclusion

Were we not enabled by ethnography as a method that changes its shape apace with emerging findings, we would have not been able to comprehensively answer our questions. This is critical because not only was this already a marginalized area of inquiry, but with any other method we risked reinforcing inequities by imposing epistemological and other hierarchies on our participants– whom we would argue were partners - in arriving at our conclusions.

     

‘Therapeutic landscape’ experiences – redefining their relationship with the everyday

Feelings of removal from, and connection to, everyday life, are central to much of the ‘therapeutic landscapes’ literature, and to understanding of what makes ‘therapeutic landscapes’ ‘therapeutic’. This paper develops understanding of the relationship between the everyday and ‘therapeutic landscape’ experiences, by exploring the origins of feelings of removal and connection. Data collected through a phenomenological approach (fieldwork sites: Buddhist meditation retreats, and non-Buddhist walking groups and conservation volunteering groups), targeted at capturing highly detailed information, demonstrates that both feelings of removal from, and connection to, the everyday, are bound-up with the everyday itself, with who we are and where we come from, and moreover, that these feelings exist alongside one another.     

‘I’m not clear on what the risk is’: women’s reflexive negotiations of uncertainty about alcohol during pregnancy

Health guidelines in many countries advise women that not drinking alcohol during pregnancy is the safest option for their babies. This advice is based on a lack of evidence about what is a safe amount of alcohol and increasing concern about Foetal Alcohol Spectrum Disorders. While there is some knowledge of factors informing women’s views and practices in relation to alcohol consumption during pregnancy, there is little knowledge or understanding of the ways women interpret and respond to the abstinence public health advice in Australia and its bearing, if any, on their own practices. In this article, we examine women’s experiences of alcohol consumption during pregnancy and their views of the abstinence advice. We locate our analysis within the body of thinking that views pronouncements about risks during pregnancy as bound up with social and cultural values and ideas about what it means to be a ‘good’ or ‘bad’ mother, as much as they are about science. We draw on a study that we undertook in 2014 of 20 women, who were either pregnant, had recently had a child or who had young children, or who were planning for pregnancy, who took part in one-to-one qualitative interviews or participated in focus group discussions in Canberra, Australia. We found that the women in our study variously described receiving reassurance after drinking in early pregnancy; opting to abstain as the safest option in the face of uncertainty; and having an occasional drink if they felt like it. In response to the abstinence advice, we found that some women understood it as a responsible message, even if they had not necessarily adhered to it, while others criticised it as an example of policing pregnant women. Overall, the women in our study accepted that it was possible to drink responsibly during pregnancy and defended this view through strategies of normalising the occasional drink, emphasising a woman’s right to make her own decisions, and associating low-level consumption with low risk.     

‘Do we hear what children want to say?’ Ethical praxis when choosing research tools with children under five

Over the recent years there has been a shift in the field of early childhood research to involving young children in the research process. A vast body of literature [Evans, P., & Fuller, M. (1996). Hello. Who am I speaking to? Communicating with pre-school children in educational research settings. Early Years, 17(1), 17–20; Clark, A. (2004). Listening as a way of life. London: National Children's Bureau; Clark, A., & Moss, P. (2001). Listening to young children: The mosaic approach. London: National Children's Bureau; Clark, A., & Moss, P. (2005). Spaces to play: More listening to young children using the Mosaic approach. London: National Children's Bureau; Thomson, P. (Ed.). (2008). Doing visual research with children and young people. Abingdon: Routledge; Farrell, A. (Ed.). (2005). Ethical research with children. Maidenhead: Open University Press] discusses methods to be used with young children in research by means of participatory methods and listening to children's voices. A number of researchers mentioned throughout the paper have offered creative and innovative research tools that enable young children to participate in research. While recognising the responsibility to keep the discourse around children's participation alive, there is a need to problematise it as well as the issue of participation of young children is a complex one which requires continuous critical refection. Thus the enquiry I conduct here employed grounded theory and aims to examine the paradigm of children's participation in research. It is suggested in this paper that although participation is a vitally important element in researching young children, the discourse of children's participation should be focused additionally on ethical praxis of the research which should revolve around six key layers: intersubjectivity, indivisibility, phronesis, parsimony, equilibrium and finally the power of relationships and interaction between children and adults. As a consequence of this enquiry I conclude that all methods become relevant to research with children when ethical praxis characterises the nature of the project.     

Notes on the concepts of ‘serodiscordance’ and ‘risk’ in couples with mixed HIV status

Abstract

Serodiscordant primary relationships, in which one partner is HIV-positive and the other is HIV-negative, are increasingly recognised as a key context for the transmission of HIV globally. Yet insights into the dynamics of serodiscordance remain relatively limited. I argue that to understand what makes serodiscordant couples engage in sexual practices that increase the chance of transmission, we need to examine what HIV ‘risk’ actually means in different cultures and contexts. A ‘socially situated’ approach to HIV risk moves beyond its scientific conceptualisation as an objective ‘fact’, revealing a diversity of perceptions and competing risks. It also reveals that couples do not necessarily perceive their mixed HIV status in terms of ‘difference’, a common assumption that predetermines serodiscordance and thereby obscures its many and complex enactments. I draw on examples from the social research literature to illustrate how serodiscordance is shaped in different ways by local practices, priorities, and meanings. I argue that it is within these lived contexts that perceptions and negotiations of ‘risk’ arise and, thus, where couples’ sexual practices need to be situated and understood. Such insights are timely as HIV research and prevention grapple with emerging scientific data that challenge traditional understandings about HIV transmission risk.     

‘I am like a woman’: constructions of sexuality among gay men in a low-income South African community

South African research on same-sex sexuality is sparse. Black men living in rural areas, and particularly coloured men, have often been neglected in same-sex sexuality research. This paper describes the findings from a study that explored the sexuality constructions of a group of young, coloured, self-identified gay men who live in a semi-rural, low-income, South African community. Social constructionist grounded theory was used to analyse interviews conducted with 12 men between the ages of 20 and 31. It was found that these men construct their sexuality as being ‘like a woman’. In our exploration of this core category, we show how men use notions of femininity to construct their sexuality. We conclude by considering how this group of gay men's performance of femininity could be viewed as reproducing mainstream ideas of gender within their community, while at the same time functioning as acts of subversion.     

“<Emphasis Type="Italic">I’m not strong enough; I’m not good enough. I can’t do this,I’m failing</Emphasis>”: a qualitative study of low-socioeconomic status smokers’ experiences with accessing cessation support and the role for alternative technology-based support

Background

The social gradient in smoking rates persist with an overrepresentation of smoking and its associated harms concentrated within lower socioeconomic status (SES) populations. Low-SES smokers are motivated to quit but face multiple barriers when engaging a quit attempt. An understanding of the current treatment service model from the perspectives of treatment-seeking low-SES smokers is needed to inform the design of alternative smoking cessation support services tailored to the needs of low-SES populations. This qualitative study aimed to: i) explore low-SES smokers’ recent quitting experiences; ii) assess factors that impact treatment engagement; and iii) determine the acceptability and feasibility of alternative approaches to smoking cessation.

Method

Low-SES participants (n = 24) previously enrolled in a smoking cessation RCT participated in either a semi-structured focus group or in-depth telephone interview. Data was obtained and analysed using thematic analysis from October 2015 to June 2016. Analysis was deductive from the interview guide and supplemented inductively.

Results

Participants expressed feelings of guilt and shame around their smoking behaviour and experienced stigmatisation for their smoking. Guilt, shame, and stigmatisation negatively impacted treatment seeking behaviours with most avoiding current quit services. Costs of pharmacotherapy and treatment adherence were commonly cited barriers to treatment success. Electronic-cigarettes were perceived to be unsafe due to uncertainty on their legal status and regulatory restrictions. Technology-based text-messaging quit support was endorsed as a more favourable alternative compared to existing behavioural treatment services.

Conclusion

Stigmatisation was commonly endorsed and acted as an impediment to current treatment utilisation. Electronic-cigarettes may present a viable harm reduction alternative, but their likely uptake in socioeconomically disadvantaged groups in Australia is limited by smokers’ uncertainty about their regulation and legality. Mobile phone based cessation support may provide an alternative to telephone counselling and overcome the stigmatisation low-SES smokers face while trying to quit.

     

‘I’m not insane,my mother had me tested’: the risk and benefits of being labelled ‘at-risk’ for psychosis

In this article we examine the identification of young people deemed to be at an elevated risk of developing psychosis (often referred to as an At-Risk Mental State for psychosis). Although this is not a new concept within psychiatry, there has been a growing interest in this topic because of the proposed inclusion of an official ‘Psychosis Risk Syndrome’ in the 2013 Diagnostic and Statistical Manual. Although we discuss the risks and benefits associated with the categorisation of individuals based on the concept of risk itself, we also draw upon observations from one of our own research studies. We interviewed six adolescents with an identified At-Risk Mental State analysing the data using an Interpretative Phenomenological Analysis framework. We identified three key themes: ‘It is better to say it’, ‘How others would take me’ and ‘Just to have somebody to talk to’. Within these themes, participants endorsed risk identification as a means of personally justifying and explaining their current symptoms, as well as providing a sense of optimism that their condition was not yet fully formed. Concerns regarding stigmatisation were identified although rarely experienced. These findings indicate that there are indeed personal benefits for screening for psychosis risk in young people, despite the ‘undesirability’ of identification reported in other areas of health. The benefits observed may reflect genuine differences in adolescent mental health or the methodological constraints of this exploratory study. Nevertheless, the results contribute to the understanding and ongoing debate of screening for illness in potential ‘at-risk’ populations.     

‘I am a mother’: young women’s negotiation of femininity and risk in the transition to adulthood

In studies of sexual risk behaviour among youth, the role of dominant conceptions of masculinity and femininity has received increasing attention. However, where research has sought to explore femininity, it has predominantly focused on adolescent girls. This paper departs from previous research by offering insights into how young women negotiate their femininity as they transition from adolescence to adulthood and encounter changing social contexts. Drawing on data from ethnographic enquiry, it argues that as young women transition out of school and into emerging adulthood, their options for negotiating different types of femininity become constrained, with consequences for engagement in sexual risk behaviours. This may to some extent explain why in some South African contexts older young women are more vulnerable to HIV infection than adolescent girls. The paper offer insights into future prospects for youth development programming seeking to reduce young women’s vulnerability to risk.