Fear, family and the placing of emotion: Black women's responses to a breast cancer awareness intervention.

This paper is based upon findings from the qualitative element of a mixed-methods study on the response of Black women aged 25-50 to a public health intervention related to breast cancer. The focus groups were conducted in the London Borough of Hackney, UK between 2013 and 2016, and were part of an evaluation of the effectiveness of a breast awareness DVD. While the content of the DVD was generally well-received by the participants, the focus group discussions revealed a complex and, at times, contradictory response to the women's construction as an 'at risk' community. As the paper highlights, for many of the women, breast cancer remains a disease of whiteness and the information provided in the DVD prompted a range of emotional responses; from anxiety and fear to a desire to become more knowledgeable and active in the promotion of self-care. As the paper argues, of particular importance to the women was the need to feel a much stronger emotional connection to the information presented in the DVD. The paper concludes by arguing that placing greater emphasis on feeling and emotion is an important dimension of future research in this area.

Evaluating a DVD promoting breast cancer awareness among black women aged 25-50†years in East London.

BACKGROUND: The mean age of presentation for breast cancer among black women is substantially earlier than their white counterparts. Black women also present with adverse prognostic factors that have major clinical implications, including lower survival. To pilot the use of a 6 min DVD on breast cancer in young (under 50 years) black women, to raise awareness and examine the impact of the DVD on increased consultation and referral rates among these women. METHODS: Two general practices (intervention practices) in the Hackney area were randomised to have the DVD mailed to all black women aged 25-50 years registered with the practices, and two practices to no intervention (control practices). EMIS data was used to compare consultation rates preintervention and postintervention, in the intervention as well as control practices. Interviews with practice staff and focus groups with patients in participating practices provided qualitative data on the study context and DVD effectiveness. RESULTS: A trend of declining consultations for breast symptoms was observed (-22% and -31% among non-black women in the control and intervention practices, and -23% among black women in the control practice) except among the target population of black women aged 25-50 years for the DVD in the intervention practices, which saw an increase of 28% in consultations. The qualitative data indicated that the DVD was well received in the target population, and suggested further ways of disseminating awareness messages and overcoming barriers to help-seeking. CONCLUSIONS: Pilot results suggest that the strategy of distributing the DVD may increase consultations for breast problems.

Managing the body work of home care.

Body work is a key element of home healthcare. Recent restructuring of health and social care services means the home is increasingly a key site of long-term care. While there is a growing literature on the social dynamics between care recipients and their family caregivers, less is known about the formal work dynamic between paid care workers and care recipients and family caregivers. Drawing on interview data from an Ontario-based study of long-term home care, we explore how body work is negotiated through the embodied practices of care in the home and through care relationships associated with home care. In particular we focus on how the practices of intimate body care (such as bathing, toileting, and catheter management) show the diverse dynamics of care work through which caregivers, care recipients and homespace are constituted. We argue that the practices of care are shaped by a complex interweaving of regulatory mechanisms associated with home care along with the physical and affective dimensions of intimate body work. In turn this suggests the need for new ways of understanding body work in contemporary landscapes of care.

Place, health and home: gender and migration in the constitution of healthy space.

This paper contributes to recent literature that considers the role of everyday activity in constructing 'healthy space', specifically exploring the tension between agency and structural processes in explanation. The focus is a comparison of two groups of migrant women in British Columbia, Canada: South Asian Sikhs from Punjab, India, and Afghan-Muslim refugees. It explores the routine practices whereby they work to create 'healthy space' as they orchestrate their families' health. Through food preparation and consumption practices, traditional healing and religious observance, the women delineate the physical, social and symbolic dimensions of healthy space. The women's narratives demonstrate the productive capacity of everyday routines in forging healthy space within the particularities of migrant settlement.

Power and client-centred practice: an insider exploration of occupational therapists' experiences.

BACKGROUND: Although problems with power sharing are frequently described in discussions about client-centred practice, little research has explored occupational therapists' experiences with this model of service delivery. To critically examine this aspect of occupational therapy, an insider study was conducted. PURPOSE: The objectives of the study were to explore therapists' experiences with client-centred practice and to reveal how power works within this practice and in the health service environment. METHOD: Semi-structured interviews with 9 therapists were conducted, and a thematic analysis of these transcripts was completed. A variety of institutional documents were reviewed and analysed. RESULTS: Three main themes were identified: the different interpretations of occupational therapy discourse, the power of context, and the continuum of client-therapist interactions. CLINICAL IMPLICATIONS: It is important to consider the various competing discourses and institutional practices that frame the therapeutic relationship when evaluating methods to improve client-centred practice.

The personal significance of home: habitus and the experience of receiving long-term home care.

The physical, symbolic and experiential aspects of receiving long-term care are examined in this paper using Bourdieu's concepts of habitus and field. We draw on data from an ethnographic study of home care in 16 homes in urban, rural and remote locations in Ontario, Canada. Across all cases, data about domestic and caregiving routines were gathered through observation, interviews with clients and/or the primary family caregiver, interviews with service providers and videotaped tours of the home. Based on the analysis of these data, we argue that a transposition of logics and practices occurred when the domestic and health care fields were superimposed within the spaces of the home. Although all of the care recipients and their family caregivers indicated a strong preference for home care over institutional care, their experiences and practices within their homes were disrupted and reconfigured by the insertion of logics emanating from the healthcare field. These changes were manifested in three main themes: the politics of aesthetics; the maintenance of order and cleanliness; and transcending the limitations of the home. In each of these dimensions, it became apparent that care recipients engaged in improvisatory social practices that reflected their ambiguous and changing habitus or social location. The material spaces of their homes signified, or prompted, altered or changing social placement.

The home as a site for long-term care: meanings and management of bodies and spaces.

This paper is concerned with the constitution of the home as a landscape of care in a climate of extensive cost-cutting measures to community provided health care. It draws on data from a multi-disciplinary investigation of various dimensions of the home as a site of long-term care; this paper is concerned specifically with long-term health and associated home-care services provided by paid workers. Through analysis of interviews with adult care recipients and field observations, it examines the micro-scale processes through which the home is reconstructed as caregiving space, highlighting the negotiation of meanings of bodies and homes as fields of knowledge. It argues that the possibilities for the effective negotiation of body knowledge and homespace boundaries that are integral to the production of 'caring' space are embedded in and constrained by policies and practices constructed at a scale beyond home.

Individual and societal influences on participation in physical activity following spinal cord injury: a qualitative study.

BACKGROUND AND PURPOSE: Despite evidence that physical activity, a tool of rehabilitation, affects health and improves functional ability in people following spinal cord injury (SCI), such people are often physically inactive. We used a qualitative method to explore the experiences of individuals with SCI during participation in physical activity. SUBJECTS: The participants were 8 adults (5 male, 3 female), ranging from active to inactive, who were 2 to 27 years post-rehabilitation following SCI (paraplegic). METHODS: We used semistructured ethnographic interviews to explore barriers and enablers to participation in physical activity following SCI. Emerging themes were derived from the participants' experiences. RESULTS: Two themes were identified: (1) individual influences, defined as a period of loss of "able identity" and subsequent redefinition of self in which participation in physical activity may be a vehicle or an outcome, and (2) societal influences, which included environmental and attitudinal barriers. DISCUSSION AND CONCLUSION: The participants' experiences offer insight for therapists regarding physical activity following SCI.

Environmental analysis: insights from sociological and geographical perspectives.

Recent conceptual models, such as the Canadian Model of Occupational Performance, emphasize the transactional relationships between individuals, their occupations, and the environments in which they live. Nevertheless, further theoretical development is necessary in order to gain a comprehensive understanding of the nature of interconnections between the environment, occupation, and disability. This paper draws on concepts from sociology and geography that can broaden our understanding of the environment and the manner in which its different dimensions may influence individuals' experiences of disability. The paper demonstrates how theoretical ideas from these disciplines can be used to inform our understanding of the daily lives of three different individuals: a senior with Bipolar Affective Disorder, a man with HIV/AIDS, and a parent of a child with a severe disability. The paper concludes with a discussion of the implications of the analysis for occupational therapy theory and practice.

Rethinking cultural safety while waiting to do fieldwork: methodological implications for nursing research.

The concept of culture has been widely applied as an explanatory concept within health care, often within a framework representing culture as a fixed, reified entity, with cultural groups existing in a binary sense vis-;-vis mainstream culture. However, if our scholarship is to generate knowledge that addresses longstanding patterns of inclusion and exclusion along lines such as race, ethnicity, class, and gender, interpretive frames are needed that account for culture as embedded in fields of power relations; as mediated by social forces such as economics, politics, and historical patterns of oppression and colonization; and as being constantly renegotiated. In this article we trace a series of theoretical explorations, centered on the concept of cultural safety, with corresponding methodological implications, engaged in during preparation for an intensive period of fieldwork to study the hospitalization and help-seeking experiences of diverse ethnocultural populations.