Integrating person-centred care and social justice: a model for practice with larger-bodied patients.

Person-centred care (PCC) has been touted as a promising paradigm for improving patients' experiences and outcomes, and the overall therapeutic environment for a range of health conditions, including obesity. While this approach represents an important shift away from a paternalistic and disease-focused paradigm, we argue that PCC must be explicitly informed by a social justice lens to achieve optimal conditions for health and well-being. We suggest that existing studies on PCC for obesity only go so far in achieving social justice goals as they operate within a biomedical model that by default pathologises excess weight and predetermines patients' goals as weight loss and/or management, regardless of patients' embodied experiences and desires. There remains a dearth of empirical research on what social justice-informed PCC looks like in practice with larger patients. This interview study fills a research gap by exploring the perspectives of 1) health practitioners (n=22) who take a critical, social justice-informed approach to weight and 2) larger patients (n=20) served by such practitioners. The research question that informed this paper was: What are the characteristics of social justice-informed PCC that play out in clinical interactions between healthcare practitioners and larger-bodied patients? We identified five themes, namely: 1) Integrating evidence-based practice with compassionate, narrative-based care; 2) Adopting a curious attitude about the patient's world; 3) Centring patients' own wisdom and expertise about their conditions; 4) Working within the constraints of the system to advocate for patients to receive equitable care; 5) Collaborating across professions and with community services to address the multifaceted nature of patient health. The findings illustrate that despite participants' diverse perspectives around weight and health, they shared a commitment to PCC by upholding patient self-determination and addressing weight stigma alongside other systemic factors that affect patient health outcomes.

'It's not just to treat everybody the same': A social justice framework for caring for larger patients in healthcare practice.

Drawing on semi-structured interviews with larger bodied patients (n = 20) and their healthcare practitioners (n = 22) in Canada, this paper combines micro and macro approaches in outlining a social justice approach to caring for larger patients in healthcare practice. Theoretically, we draw upon structural competency and critical consciousness to address the question of how social justice is enacted, experienced, and understood in interactions between clinicians and larger patients. Our findings highlight four key themes that provide a framework for integrating social justice into healthcare practice: (1) an awareness of one's simultaneous experience of marginalisation and privilege in the clinical interaction; (2) navigating between additive and interactive understandings of intersectionality; (3) micro and macro approaches to change; and (4) straddling the line between equity and equality. The synergies in participants' perspectives across social identities suggests that the cultivation of social justice awareness potentially mitigates some blinders of privilege. Furthermore, practitioners' social justice orientation positively impacted patient experience, with most patients expressing appreciation for having their various histories of trauma and social challenges handled compassionately during appointments.

From invisible to extraordinary: Representations of older LGBTQ persons in Canadian print and online news media.

The purpose of this study was to examine how older LGTBQ adults were portrayed in mainstream Canadian newspapers and popular magazines. Our sample included stories that were published in English between July 1, 2016 and June 30, 2017 in three national newspapers, 13 provincial newspapers, one national online news website, and the five most widely-read popular magazines whose readerships included or catered to the mature market. Our content and thematic analyses of our sample of 190 stories resulted in three overarching findings: a) older LGBTQ adults were largely invisible; b) older LGBTQ persons were often depicted as victims of historical and ongoing discrimination and social exclusion; and c) older LGBTQ individuals were frequently portrayed as extraordinary role models and icons who demonstrated resilience and had paved the way for the younger generations. We discuss our findings in light of the extant research and theorizing concerning the role of the media in reflecting, reproducing, and/or challenging dominant social norms and ideologies, including heterosexism, homophobia, and age-based prejudice.