"We are fierce, independent thinkers and intelligent": Social capital and stigma management among mothers who refuse vaccines.

Despite measurable benefits of childhood vaccines, mothers with high levels of social privilege are increasingly refusing some or all vaccines for their children. These mothers are often clustered geographically or networked socially, providing information, emotional support, and validation for each other. Mothers who reject vaccines may face disapproval from others, criticism in popular culture, negative interactions with healthcare providers, and conflicts with people they know, which serve to stigmatize them. This article uses qualitative data from in-depth interviews with parents who reject vaccines, ethnographic observations, and analyses of online discussions to examine the role of social capital in networks of vaccine-refusing mothers. Specifically, this article explores how mothers provide each other information critical of vaccines, encourage a sense of one's self as empowered to question social expectations around vaccination, provide strategies for managing stigma that results from refusing vaccines, and define a sense of obligation to extend social capital to other mothers. In examining these strategies and tensions, we see how social capital can powerfully support subcultural norms that contradict broader social norms and provide sources of social support. Even as these forces are experienced as positive, they work in ways that actively undermine community health, particularly for those who are the most socially vulnerable to negative health outcomes from infection.

A Qualitative Study of Hospitalists' Perceptions of Patient Satisfaction Metrics on Pain Management.

Hospital initiatives to promote pain management may unintentionally contribute to excessive opioid prescribing. To better understand hospitalists' perceptions of satisfaction metrics on pain management, the authors conducted 25 interviews with hospitalists. Transcribed interviews were systematically analyzed to identify emergent themes. Hospitalists felt institutional pressure to earn high satisfaction scores for pain, which they perceived influenced practices toward opioid prescribing. They felt tying compensation to satisfaction scores commoditized pain. Hospitalists believed satisfaction would improve with increased time spent at the bedside. Focusing on methods to improve patient-physician communication, while maintaining efficiency in clinical practice, may promote both patient-centered pain management and satisfaction.

The hospitalist perspective on opioid prescribing: A qualitative analysis.

BACKGROUND: Pain is a frequent symptom among patients in the hospital. Pain management is a key quality indicator for hospitals, and hospitalists are encouraged to frequently assess and treat pain. Optimal opioid prescribing, described as safe, patient-centered, and informed opioid prescribing, may be at odds with the priorities of current hospital care, which focuses on patient-reported pain control rather than the potential long-term consequences of opioid use. OBJECTIVE: We aimed to understand physicians' attitudes, beliefs, and practices toward opioid prescribing during hospitalization and discharge. DESIGN: In-depth, semistructured interviews. SETTING: Two university hospitals, a safety-net hospital, a Veterans Affairs hospital, and a private hospital located in Denver, Colorado or Charleston, South Carolina. PARTICIPANTS: Hospitalists (N = 25). MEASUREMENTS: We systematically analyzed transcribed interviews and identified emerging themes using a team-based mixed inductive and deductive approach. RESULTS: Although hospitalists felt confident in their ability to control acute pain using opioid medications, they perceived limited success and satisfaction when managing acute exacerbations of chronic pain with opioids. Hospitalists recounted negative sentinel events that altered opioid prescribing practices in both the hospital setting and at the time of hospital discharge. Hospitalists described prescribing opioids as a pragmatic tool to facilitate hospital discharges or prevent readmissions. At times, this left them feeling conflicted about how this practice could impact the patient over the long term. CONCLUSIONS: Strategies to provide adequate pain relief to hospitalized patients, which allow hospitalists to safely and optimally prescribe opioids while maintaining current standards of efficiency, are urgently needed. Journal of Hospital Medicine 2016;11:536-542. © 2016 Society of Hospital Medicine.

Of natural bodies and antibodies: Parents' vaccine refusal and the dichotomies of natural and artificial.

Despite eliminating incidences of many diseases in the United States, parents are increasingly rejecting vaccines for their children. This article examines the reasons parents offer for doing so. It argues that parents construct a dichotomy between the natural and the artificial, in which vaccines come to be seen as unnecessary, ineffective, and potentially dangerous. Using qualitative data from interviews and observations, this article shows first, how parents view their children's bodies, particularly from experiences of birth and with infants, as naturally perfect and in need of protection. Second, parents see vaccines as an artificial intervention that enters the body unnaturally, through injection. Third, parents perceive immunity occurring from illness to be natural and superior and immunity derived from vaccines as inferior and potentially dangerous. Finally, parents highlight the ways their own natural living serves to enhance their children's immunity rendering vaccines unnecessary. Taken together, this dichotomy allows parents to justify rejection of vaccines as a form of protecting children's health. These findings expose perceptions of science, technology, health, and the meanings of the body in ways that can inform public health efforts.

Cultural competence in interdisciplinary collaborations: a method for respecting diversity in research partnerships.

There is growing recognition of the need by funding agencies, universities, and research units for interdisciplinary research to tackle complex societal problems that cannot be adequately addressed by single disciplines alone. Interdisciplinary collaboration capitalizes on a diversity of perspectives and practices that each discipline offers in hopes of providing innovative solutions to multifaceted problems. However, for interdisciplinary work to be effective, members of the collaboration must recognize that cultural differences exist between and within disciplines. This paper conceptualizes disciplines as cultural groups and advocates for culturally competent practices to facilitate interdisciplinary research and practice. Specifically, each participant in interdisciplinary collaborations must value diversity, develop the capacity for self-assessment, work towards understanding one's own disciplinary culture, and be sensitive to the dynamics inherent when cultures interact. Additionally, members of any interdisciplinary endeavor must be cognizant of power dynamics at play and avoid such things as tokenism, informal hierarchies, and disciplinary policing. Through awareness of one's own disciplinary culture and sensitivity to others, interdisciplinary research and practice may provide creative solutions to important problems.