•Sense of belongingness and usefulness with their family and outside impacts older adults’ well-being•Traditional familial values of elderly care is central to joint and nuclear families.•Young ...relatives’ visible efforts to stay in contact and practical support offer a sense of belongingness to older adults.•Care and support provision, and participation in family decision-making process helped older adults feel a renewed meaning.•Social networks with non-kin offer emotional support for older adults who lost the sense of belonging with their family
Drawing from Science and Technology Studies we investigate the consequences for social differentiation of physicians’ practices in Dutch illness certification. Using participant observation methods, ...we followed six ‘Arbodienst’ physicians for two weeks each. Our analysis explores whether and how the work of Dutch physicians contributes to the appearance of a category of ‘problematic migrant patients’. We present how physicians, in using instruments to distinguish plausible from implausible claims for sick leave, impose order upon reality. In particular situations this ordering involves a distinction between Dutch and migrant clients. Here ethnicity appears in physicians’ practice as a separate instrument to constitute order, which in the case of migrants overrules the productive instruments that are used for ‘Dutch’ clients. By interpreting clients’ behaviour in cultural terms and making them into strangers, physicians lose their ability to fine-tune their coaching activities to the needs of these clients. As a result migrants remain work incapacitated for a longer period, which leads to a higher risk of their ending up in the disability pension program. As a consequence migrants become visible as a problematic group in the data on work incapacity and disability. The practice to categorise migrant clients with separate instruments thus results in a ‘hard’ category of problematic migrant clients and leads to social differentiation.
► In distinguishing between plausible and implausible claims, arbo physicians' practices contributes to social differentiation. ► Culturalising their behaviour causes that professionals loose the ability to fine-tune coaching activities to migrants' needs. ► Cultural explanations of migrants' behaviour contribute to problems in professional practices instead of decreasing them.
The rise of the social determinants of health (SDH) discourse on the basis of statistical evidence that correlates ill health to SDH and pictures causal pathways in comprehensive theoretical ...frameworks led to widespread awareness that health and health disparities are the outcome of complex pathways of interconnecting SDH. In this paper we explore whether and how SDH frameworks can be translated to effectively inform particular national health policies. To this end we identified major challenges for this translation followed by reflections on ways to overcome them. Most important challenges affecting adequate translation of these frameworks into concrete policy and intervention are 1) overcoming the inclination to conceptualize SDH as mere barriers to health behavior to be modified by lifestyle interventions by addressing them as structural factors instead; 2) obtaining sufficient in-depth insight in and evidence for the exact nature of the relationship between SDs and health; 3) to adequately translate the general determinants and pathways into explanations for ill health and limited access to health care in local settings; 4) to develop and implement policies and other interventions that are adjusted to those local circumstances. We conclude that to transform generic SDH models into useful policy tools and to prevent them to transform in SDH themselves, in depth understanding of the unique interplay between local, national and global SDH in a local setting, gathered by ethnographic research, is needed to be able to address structural SD in the local setting and decrease health inequity.
Abstract
The notion of patient rights encompasses the obligations of the state and healthcare providers to respect the dignity, autonomy and equality of care-seeking individuals in healthcare ...processes. Functional patient grievance redressal systems are key to ensuring that the rights of individuals seeking healthcare are protected. We critically examined the published literature from high-income and upper-middle-income countries to establish an analytical framework on grievance redressal for patient rights violations in health facilities. We then used lawsuits on patient rights violations from the Supreme Court of India to analyse the relevance of the developed framework to the Indian context. With market perspectives pervading the health sector, there is an increasing trend of adopting a consumerist approach to protecting patient rights. In this line, avenues for grievance redressal for patient rights violations are gaining traction. Some of the methods and instruments for patient rights implementation include charters, ombudsmen, tribunals, health professional councils, separating rules for redressal and professional liability in patient rights violations, blame-free reporting systems, direct community monitoring and the court system. The grievance redressal mechanisms for patient rights violations in health facilities showcase multilevel governance arrangements with overlapping decision-making units at the national and subnational levels. The privileged position of medical professionals in multilevel governance arrangements for grievance redressal puts care-seeking individuals at a disadvantaged position during dispute resolution processes. Inclusion of external structures in health services and the healthcare profession and laypersons in the grievance redressal processes is heavily contested. Normatively speaking, a patient grievance redressal system should be accessible, impartial and independent in its function, possess the required competence, have adequate authority, seek continuous quality improvement, offer feedback to the health system and be comprehensive and integrated within the larger healthcare regulatory architecture.
Abstract
Many internally displaced persons (IDPs) in Colombia are teenage mothers, who experience unique gendered identity struggles in the rural areas where they were born and during processes of ...displacement and resettlement. We chose an ethnographic approach both to collect the life stories of 20 displaced adolescent mothers who had resettled in Bogotá and to conduct eight workshops. The analysis shows that the participants struggled with their identities as ‘women’ in the rural areas in the context of violence and armed conflict when they faced motherhood while still being adolescent and becoming displaced and when they embraced the formal ‘displaced person’ identity while enduring difficulties with the receptor communities during resettlement. The new identity status as ‘displaced’ that they wished for as a basis for benefits does not imply that the identity struggles are over. Our analysis shows that the gendered struggles of adolescent IDP mothers with multiple identities that are not easily aligned are accumulating, resulting in a complex challenge during resettling.
Objective: A growing body of work is examining the role health research itself plays in the construction of 'ethnicity.' We discuss the results of our investigation as to how the political, social, ...and institutional dynamics of the context in which health research takes place affect the manner in which knowledge about ethnicity and health is produced.
Design: Qualitative content analysis of academic publications, interviews with biomedical and health researchers, and participant observation at various conferences and scientific events.
Results: We identified four aspects related to the context in which Dutch research takes place that we have found relevant to biomedical and health-research practices. Firstly, the 'diversity' and 'inclusion' policies of the major funding institution; secondly, the official Dutch national ethnic registration system; a third factor was the size of the Netherlands and the problem of small sample sizes; and lastly, the need for researchers to use meaningful ethnic categories when publishing in English-language journals.
Conclusions: Our analysis facilitates the understanding of how specific ethnicities are constructed in this field and provides fruitful insight into the socio-scientific co-production of ethnicity, and specifically into the manner in which common-sense ethnic categories and hierarchies are granted scientific validity through academic publication and, are subsequently, used in clinical guidelines and policy.
Biomedical and public health researchers and practitioners routinely record and comment on ethnicity: however, the use of this category is often vague and without explicit statement on what ethnicity ...is or how it correlates to health disparities. Presented here is an inquiry into the case of ethnicity in HIV/STI research in the Netherlands. This paper considers the construction and operationalization of the concept ethnicity in HIV/STI epidemiological research in the Netherlands. The concept ethnicity is followed as it is defined, measured, categorized, communicated and constructed in the annual national HIV/STI surveillance report of the Dutch National Institute for Public Health and the Environment (RIVM) and as this construction co-evolves in society through the Dutch media, politics and prevention practice. The epidemiological work of the RIVM on HIV/STI in The Netherlands has resulted in the materialization of a distinct ethnic construction, the high risk sexual ethnic other, presumed, not only to be at heightened risk for HIV, but also to spread HIV in the Netherlands through promiscuity and absent safe sex practices. This construct is shown to be perpetually self-validating as it informs methodological choices, such that, behavioural studies almost always establish ethnic behavioural differences. The construct and related ethnic rhetoric also allow for the extrapolation of "findings" within a specific ethnic group regarding a specific STI to all groups considered ethnic minorities and so a categorical ethnic minority problem group is constructed within Dutch society. This imagery is disseminated through newspaper articles and dialogue in the Dutch House of Representative and HIV/STI prevention practice, through which the construct is reaffirmed and ascribed scientific and social validity. Knowledge of ethnic minorities’ high-risk status and their sexual practices that lead to this become common, and so the construct is further operationalized in government budget planning and subsequent research programmes.
► The epidemiological work on HIV/STI in the Netherlands resulted in the materialization of a distinct ethnic construction, the high-risk sexual ethnic other. ► In co-evolution between scientific and professional HIV and STI practice and society socially constructed notions of ethnicity are enacted. ► These scientifically proven facts about ethnic minorities and HIV re-enter society where they further evolve and solidify.
Pregnancy in adolescence is higher among internally displaced women in Colombia than non-displaced women. It is defined as a problem with significant negative outcomes by both biomedical and ...epidemiological approaches. However, little is known about pregnancy during adolescence from the perspective of women who experienced this in the specific context of armed conflict and displacement.
This article focuses on how internally displaced women understand their experiences of pregnancy in adolescence in the context of armed conflict through an ethnographic approach in a receptor community of internally displaced women in Bogotá, Colombia.
Based on 10 years of experience in the community, we conducted 1 year of fieldwork, using an ethnographic approach. We collected life stories of 20 internally displaced women through in-depth interviews and ran 8 workshops with them and other women from the community. We used thematic analysis to analyse the responses of internally-displaced women and understand how they made meaning around their experiences of adolescent pregnancy in the context of displacement.
The main themes that emerged from participants' experiences include rural violence, early family life (characterized by violence and mistreatment at home), meanings of pregnancy at an early age (including being challenged and feelings of love), and reactions to their pregnancies during adolescence (such as stigmatization) from their families and partners.
Our analysis of the in-depth interviews and the workshops suggests that adolescent pregnancy among women who are internally displaced has complex dynamics, characterized by the violent context of the rural areas, but primarily by the violence experienced during their childhood. The experience of pregnancy during adolescence brings feelings of ownership and also challenges, together with the forced displacement. This understanding will provide insights for policy makers and healthcare providers on how to work with this specific population who have experienced pregnancy in adolescence.
Previous research has problematised the diversity of conceptualisations and operationalisations of ethnicity within health research and the field of Ethnicity and Health. In this article, we explore ...how practices in health research and the field of Ethnicity and Health themselves contribute to the enactment of different versions of ethnicity. Using a qualitative content analysis of contemporary peer-reviewed Dutch biomedical and health research, we identified various dynamics in research practices and the research situation, which are relevant to understanding the enactment of multiple versions of ethnicity and specific ethnic and racial categories in health research in the Netherlands. Specifically, we discuss the production of academic publications and the manner in which researchers must establish the premises for ethnicity-specific health research; the organisation and ethnic and racial labelling of the data; and the discussion of new research findings in comparison with previous ethnicity-specific research. Ultimately, our analysis illustrates that, in health research and publications, ethnicity and its relation to health are not simply discovered or found; rather we discuss how the manner in which ethnicity and specific categories of ethnicity are enacted is contingent upon these everyday dynamics of research practices and the specific research situation in which research takes place.
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