Beyond the hype: 'acceptable futures' for AI and robotic technologies in healthcare.

AI and robotic technologies attract much hype, including utopian and dystopian future visions of technologically driven provision in the health and care sectors. Based on 30 interviews with scientists, clinicians and other stakeholders in the UK, Europe, USA, Australia, and New Zealand, this paper interrogates how those engaged in developing and using AI and robotic applications in health and care characterize their future promise, potential and challenges. We explore the ways in which these professionals articulate and navigate a range of high and low expectations, and promissory and cautionary future visions, around AI and robotic technologies. We argue that, through these articulations and navigations, they construct their own perceptions of socially and ethically 'acceptable futures' framed by an 'ethics of expectations.' This imbues the envisioned futures with a normative character, articulated in relation to the present context. We build on existing work in the sociology of expectations, aiming to contribute towards better understanding of how technoscientific expectations are navigated and managed by professionals. This is particularly timely since the COVID-19 pandemic gave further momentum to these technologies.

Setting the research agenda for living with and beyond cancer with comorbid illness: reflections on a research prioritisation exercise.

BACKGROUND: People living with and beyond cancer are more likely to have comorbid conditions and poorer mental and physical health, but there is a dearth of in-depth research exploring the psychosocial needs of people experiencing cancer and comorbid chronic conditions. A patient partnership approach to research prioritisation and planning can ensure outcomes meaningful to those affected and can inform policy and practice accordingly, but can be challenging. METHODS: We aimed to inform priorities for qualitative inquiry into the experiences and support needs of people living with and beyond cancer with comorbid illness using a partnership approach. A three-step process including a patient workshop to develop a consultation document, online consultation with patients, and academic expert consultation was carried out. The research prioritisation process was also appraised and reflected upon. RESULTS: Six people attended the workshop, ten responded online and eight academic experts commented on the consultation document. Five key priorities were identified for exploration in subsequent qualitative studies, including the diagnostic journey, the burden of symptoms, managing medications, addressing the needs of informal carers, and service provision. Limitations of patient involvement and reflections on procedural ethics, and the challenge of making measurable differences to patient outcomes were discussed. CONCLUSIONS: Findings from this research prioritisation exercise will inform planned qualitative work to explore patients' experiences of living with and beyond cancer with comorbid illness. Including patient partners in the research prioritisation process adds focus and relevance, and feeds into future work and recommendations to improve health and social care for this group of patients. Reflections on the consultation process contribute to a broadening of understanding the field of patient involvement.

Epinephrine auto-injector use in adolescents at risk of anaphylaxis: a qualitative study in Scotland, UK.

BACKGROUND: Adolescents with severe allergies are at particular risk of severe and fatal anaphylactic reactions. Epinephrine (adrenaline) is known to be under-utilized by teenagers. OBJECTIVE: We sought to gain knowledge of adolescents' attitudes towards and experience of epinephrine auto-injectors in order to inform improvements in patient education. METHODS: A qualitative study of adolescents in Scotland, UK with a history of anaphylaxis and their parents. In-depth interviews explored adolescents' accounts of anaphylactic reactions, including issues related to using epinephrine auto-injectors. Focus groups with adolescents and parents were used to discuss interventions to improve adolescent self-management of anaphylaxis. RESULTS: Twenty-six adolescents and 28 parents were interviewed. Eight adolescents and 10 parents participated in separate focus groups. Most adolescents had not used the auto-injector in an anaphylactic emergency. We identified multi-faceted barriers to use, including: failure to recognize anaphylaxis; uncertainty about auto-injector technique and when to administer it; fear of using the auto-injector. Most adolescents reported carrying auto-injectors some of the time, though several found this inconvenient due to the size; only one reported non-use of an auto-injector because it had not been carried. CONCLUSION AND CLINICAL RELEVANCE: Adolescents and parents reported under-use of epinephrine auto-injectors. Carriage is insufficient to ensure that auto-injectors are used. Barriers to use are multiple and complex, and unlikely to be overcome using simple educational interventions. Auto-injector training currently offered is often inadequate preparation for an emergency. A more comprehensive approach is needed, addressing the psychosocial dimensions of anaphylactic emergencies as well as treatment. Training should ideally be provided by specialist allergists or nurses, but can also be provided and reinforced in primary care.

Practising what we preach? A practical approach to bringing research, policy and practice together in relation to children and health inequalities.

This paper explores the need for better links between research and practice in relation to work with children and health inequalities. Despite continuing discussion about the need to improve dissemination of research activity in general, study of this area remains largely neglected. As a result, despite the rhetoric, the research and practice gap continues to exist. An attempt to remedy this was undertaken through the support of a user fellowship as part of the UK Economic and Social Research Council Health Variations Programme. The paper describes a number of activities that were undertaken during the fellowship, and discusses the implications of these for improving connections and minimizing the research and practice 'gap'. It argues that a need exists for researchers to develop innovative dissemination strategies and suggests that potential exists for an interactive model of dissemination. Such a model implies a more active role for users of research in the shaping of research agendas.

Continuities and changes: teenage smoking and occupational transition.

Rates of cigarette smoking among young people in the U.K. remain high and may be increasing. However, few studies have explored smoking behaviour during the mid- to late teens. This paper reports the third wave of a longitudinal study that followed 106 15-year-olds from their last compulsory year at school for 22 months. Using a mixture of qualitative and quantitative methods, the study shows that this is a period of considerable flux in smoking behaviour. Becoming a regular smoker is not a straightforward progressive process. The role of friendship groups and social context is highlighted. Smoking prevention programmes should be developed to meet the needs of young people in this transitional period.

Male youth street culture: understanding the context of health-related behaviours.

In the UK growing concerns have been expressed about young people, and particularly young men, who spend large amounts of their leisure time on the streets. Problems such as vandalism, under-age drinking and drug use have all been heavily reported in local and national media. This paper reports on ethnographic (primarily participant observation-based) research which sought to explore the motivations, meanings and behaviours of young people hanging around on the streets during the evening in a Scottish town. The aim is to move beyond previous research which has largely focused on the 'risk' factors associated with health-relevant behaviours, and to provide an understanding of the roles of alcohol, illicit drugs and tobacco within the young people's street culture. The paper therefore provides contextualized accounts of health-relevant behaviours. In conclusion it is argued that, to be effective, health promotion programmes need to locate lifestyle risk behaviours within broader life circumstances and that without a reduction in 'risk conditions' it is unlikely that youth street culture will disappear or that 'risk behaviours' will reduce.

Health related behavioural change in context: young people in transition.

Post-modern theorists have highlighted the impacts of rapid social and economic change in lessening structural constraints, arguing that the concepts of "gender" and "social class" are now less useful in understanding people's life chances and choices. While the epochal nature of such changes has been questioned, increasing levels of individualisation and reflexivity have been widely recognised. Agency is prioritised and structural disembeddedness increasingly assumed: people are held to construct their identities and biographies reflexively from a diverse range of experiences and opportunities. When used in relation to understanding health related behaviours this theorising has led to an increasing focus upon the symbolic significance of consumption (and indeed risk) in defining lifestyles and identities. Here we report on the health related behaviours of 106 young people (15/16 yr) during their transition from school to employment, training or further education. This period is arguably central in the process of creating adult identities and accordingly should involve considerable lifestyle choice, reflexivity and symbolic consumption as identities are formed. By drawing on two rounds of data (semi-structured interviews and structured questionnaires) we consider how smoking and drinking behaviours related to the wider social transitions towards adulthood. We provide a situated account of health related behaviours which acknowledges both subjective experience and social location. We argue that the current challenge is to integrate the different levels of structural constraint and individual agency within the context of current rapid social and economic change and suggest that it is only through empirical investigation which embraces an analysis both at the level of structure and individual experience that the conditions of late modernity can be more thoroughly understood.

Mental health: what do we know, how did we find it out and what does it mean for nurses?

In recent years service providers, practitioners and academics have all moved away from the term mental illness in favour of mental health. At the same time nurses have been increasingly asked to go beyond work aimed at the alleviation or reduction of mental illness and to actively promote mental health. Such a perspective acknowledges that those who experience mental illness can equally experience and have the potential for mental health. In this paper we review key works from within psychology and health promotion (including medical sociology) that have shed light on the factors that influence mental health in its positive sense. Throughout the review we are careful to reflect on the role that research methods have played in constructing our current understanding of mental health. The aim of the review is to provide nurses with the knowledge that is necessary to undertake the challenge of promoting mental health in a practical but also reflective way.

Medical students' perceptions of medical malpractice.

Despite increasing interest in medical malpractice in the UK, there is very little empirical research on doctors' own concerns. This paper explores first and fifth year medical students' knowledge about malpractice, their attitudes toward litigation and its perceived significance for their future practice.

Perceptions of urinary symptoms and health-care-seeking behaviour amongst men aged 40-79 years.

BACKGROUND: Little is known about why men fail to seek medical help for urological symptoms. AIM: This study was designed to document men's perceptions of urinary symptoms and to increase understanding of health-care-seeking behaviour. METHOD: A stratified random sample of men aged 40-79 years was drawn from the age-sex register of a health centre in Central Scotland. Two hundred men were interviewed using semi-structured qualitative techniques and asked to complete a symptom questionnaire. The response rate was 65%. RESULTS: Urinary symptoms reported to be most bothersome were dribbling, hesitancy and straining. All but the youngest age group (40-49 years) associated developing urinary symptoms with ageing. This was considered to be a reason not to consult a doctor. Most symptoms were not thought to be serious. Pain, haematuria and acute retention gave cause for concern, and were perceived as reasons for seeking medical help. Although urinary symptoms interfered with selected activities in daily life, this was not a worry to the men and was not seen to be a sufficient reason alone to consult their general practitioner. CONCLUSION: The insidious development of urinary problems over time reinforces the belief that it is part of getting older and accounts for the accommodation of symptoms within men's everyday living experiences. Bothersomeness associated with urinary symptoms was not synonymous with worry or problems. Doctors must be prepared to initiate discussion about urinary function in order to assess the impact of symptoms on an individual's daily life.

Mothers' concepts of normality, behavioural change and illness in their children.

Several sociological models have been put forward to explain illness behaviour. However, little research has examined general practitioners' understanding of mothers' perceptions of their children's health and illness. The aim of this study was to attempt to understand the cultural context of children's illness. Mothers' concerns about their children's health and illnesses were examined by describing the mothers' own perceptions of alterations in their children's behaviour. The mothers' perceptions of normality appeared to underpin their negotiation of illness. The concept of normality was found to change over time, to be uniquely based on individual experience, to be related to health, and to a process of normalization. The mothers' perceived importance of children's behavioural changes are discussed: they may be precursors or results of illness, causes for concern in their own right, or a management problem for the household. Identifying and acknowledging the unique way in which mothers perceive health and illness in their children may lead to enhanced understanding and satisfaction for both the general practitioner and mother in the consultation process.

Pharmacists and primary care: some research findings and recommendations.

To achieve effective primary care we need to take into account lay perspectives on services. This study investigated a sample of 54 mothers with at least one child under five years old to elucidate their approaches to minor illnesses in their children and their use of pharmacists. The use of the pharmacist and of proprietary medicines were found to be important elements in self-care, sometimes replacing general practitioner consultations. However, the mothers held differing opinions about how to deal with children's symptoms and who to contact for help. This variety needs to be taken into account when recommending changes in the provision of primary care for this group, especially concerning the role of the pharmacist.

"And have you done anything so far?" An examination of lay treatment of children's symptoms.

Interview data and health diary material were collected for an investigation of mothers' perceptions of their children's illnesses and of how they routinely coped with minor ailments in their children. The descriptions offered by the mothers of how they treated their children's symptoms and their actual use of various remedies as reported in the health diaries helped clarify the issues and processes concerned in their use of proprietary medicines and home remedies and their attitudes towards prescriptions. There was extensive use of proprietary medicines, yet mothers also used some home remedies or took no action at all. They were found to treat their children's symptoms themselves, contacting their general practitioner only if symptoms did not clear up or became more serious. Generally mothers should be treated as competent in caring for a child whose health and behaviour are causing concern, and in these cases the skills of the general practitioner should be viewed as complementing those of the mother. Mothers do not invariably expect a prescription from the doctor.

The role of the chemist in primary health care for children with minor complaints.

There has been considerable debate about the professional status of pharmacy and the relationship between pharmacists and the medical profession. There has been less emphasis on the consumers' view of chemists and on the use made of over-the-counter remedies. This paper examines the actual and potential role of the chemist in dealing with minor complaints in young children. A sample of 54 mothers of young children were interviewed in a study examining the cultural context of childhood illness. The use which the mothers made of chemists for advice and for the purchase of proprietary medicines was examined. The findings of this aspect of the study are outlined, and the implications which these have for the role of the chemist within the primary health care team and lay health care network are discussed. In the light of this analysis tentative recommendations are made for an expansion of the role of the chemist in dealing with minor complaints in children.