"Whatever I said didn't register with her": medical fatphobia and interactional and relational disconnect in healthcare encounters.

Introduction: This article focuses on medical fatphobia as a specific phenomenon structuring interactions between patients and healthcare practitioners. Throughout the article, we use 'fat' and 'fatphobia' as the preferred terms in the body positivity and fat acceptance communities. It is well documented that 'fat' people frequently experience negative and highly stigmatising healthcare encounters where weight is disproportionately centred and over-attributed as a cause of ill-health. This can compound and worsen disordered eating, trigger mental health problems, and lead to healthcare avoidance. Although the regularity and risks of these weight-focused encounters are well established, there does not yet exist a coherent theoretical framework for understanding such discriminatory practises. Methods: In this article, we draw on the experiences of 15 fat women who are members of the Health at Every Size (HAES) online community to explore how they perceive their fatness impacting medical encounters. Results and discussion: Through these data and specifically drawing on the framework of 'cultural health capital,' we suggest that given the deep purchase of cultural tropes surrounding it, fatness is perceived to embody and therefore confer on patients' assumptions of low cultural health capital. We argue that ubiquitously characteristic of medical fatphobia is what we call an 'interactional and relational disconnect' between fat patients and healthcare practitioners. We suggest that this disconnect structures fatphobic interactions by over-attributing fatness as the underlying cause of medical problems, which entrenches patient and practitioner ambivalence because of a lack of joint decision-making. We argue that interactional and relational disconnect is produced by, sustained by, and reproduces asymmetric power relations between patients and practitioners. While we demonstrate that patients develop tactics to mitigate and manage fatphobia in healthcare encounters, the persistent interactional asymmetry between doctors and patients means these attempts often fail. We conclude with a plea for sociology to take medical fatphobia seriously as a form of intersectional systemic discrimination. While movements like HAES, fat positivity, and body acceptance create kinship and support fat patients with self-advocacy in healthcare interactions, we suggest that systemic rather than individual change is necessary for effective healthcare inclusion and interaction.

A qualitative study exploring the lived experience of medication use in different disease states: Linking experiences of disease symptoms to medication adherence.

WHAT IS KNOWN: Medication non-adherence leads to negative health outcomes. Medication adherence is predicted if patients understand the necessity of medication use to control disease symptoms and progression. It could be expected then, that patients with diseases with symptoms which are managed with medications, such as chronic obstructive pulmonary disorder or gout, or diseases with high-mortality rates, such as cancer, would have higher adherence rates than asymptomatic diseases, such as hypertension. However, poor medication adherence remains problematic in both symptomatic and asymptomatic diseases. Further work is needed to explore patient experiences of medication adherence to understand the link between adherence and symptom control. OBJECTIVE: To explore patients' lived experiences of medication adherence. METHODS: Participants were recruited from community pharmacies and general practices. Forty-one semi-structured interviews and three focus groups were used to collect data from patients with disease states that had different symptomatic and asymptomatic profiles. Inductive thematic analysis was used to identify key parts of the experience of using medications. RESULTS: Participants reported similar experiences of medication adherence despite having different disease symptoms. Participants said that they used medications because it was an expected part of everyday life and that medications 'must be needed' because they had been supplied, rather than being used for a particular symptom. Participants reported short-term episodes of non-adherence were unlikely to lead to negative health outcomes but may result in negative social consequences. DISCUSSION: The findings broaden our understanding of patient experiences of medication use by indicating patients with symptomatic and asymptomatic diseases share similar experiences of medication use. The necessity to use medications appeared to come from 'the system' of healthcare professionals, family and friends that supply and recommend medications. WHAT IS NEW: There were key similarities in experiences of medication adherence in patients with different disease states. The negative consequences of short-term episodes of non-adherence were normalized by healthcare professionals. CONCLUSION: Patients with symptomatic and asymptomatic diseases share similar experiences of medication adherence.

'I just don't think it's that natural': adolescent mothers' constructions of breastfeeding as deviant.

Breastfeeding is recognised globally as the optimal method of infant feeding. For Murphy (1999) its nutritional superiority positions breastfeeding as a moral imperative where mothers who formula-feed are open to charges of maternal deviance and must account for their behaviour. We suggest that this moral superiority of breastfeeding is tenuous for mothers from marginalised contexts and competes with discourses which locate breastfeeding, rather than formula feeding, as maternal deviance. We draw on focus group and interview data from 27 adolescent mothers from socio-economically deprived neighbourhoods in three areas of the UK, and five early years professionals working at a Children's Centre in the Northeast of England. We argue that breastfeeding is constructed as deviance at three 'levels' as (i) a deviation from broad social norms about women's bodies, (ii) a deviation from local mothering behaviours and (iii) a transgression within micro-level interpersonal and familial relationships. Given this positioning of breastfeeding as deviant, breastfeeding mothers feel obliged to account for their deviance. In making this argument, we extend and rework Murphy's (1999) framework to encompass diverse experiences of infant feeding. We conclude with reflections on future research directions and potential implications for practice.

Exploring an extended role for pharmacy assistants on inpatient wards in UK hospitals: using mixed methods to develop the role of medicines assistants.

Objectives: This project explored the deployment of pharmacy assistants to inpatient wards in a new role as 'medicines assistants' (MA). Methods: Ward-based MAs were introduced to six wards across two UK hospitals to support medicines administration. Each 30-bed ward delivered acute inpatient services with MAs supporting typical nursing medication administration rounds to 15 patients. Data were collected using activity diaries, observations, clinical audit and semistructured interviews with pharmacy assistants, pharmacy technicians, clinical pharmacists, nurses, ward managers and pharmacy managers. Thematic analysis, descriptive statistics and the Mann-Whitney U test were used to analyse qualitative and quantitative data, respectively. Results: MAs were able to act as a point of contact between the ward and the pharmacy department and were perceived to save nursing time. A statistically significant reduction in the length of time to complete morning medication administration to 15 patients was observed (mean 74.5 vs 60.8 min per round, p<0.05). On average, 17.4 hours of medicines-related activity per ward per week was carried out by MAs rather than by nursing staff. Participants identified broader training and clarity was needed in relation to the accountability and governance of patient-facing roles. Conclusion: Pharmacy assistants deployed as MAs can contribute to saving nursing time and bridge the gap between nursing and pharmacy professionals.

The Social and Material Life of Antimicrobial Clay: Exploring Antimicrobial Resistance, Medicines' Materiality, and Medicines Optimization.

While sociologists have made significant theoretical contributions to the antimicrobial resistance (AMR) debate, little attention has been given to the antimicrobial products themselves. Here we advocate a significant new direction which centers on the social and material life of antimicrobials, specifically on what they are made from and how this affects their use. This focus is timely because, in the context of declining efficacy of biomedical antibiotics, diverse materials are increasingly taking center stage in research and drug discovery as potential agents for new antimicrobial treatments. Of particular significance are natural antimicrobials, such as plants, honey and clay, whose antimicrobial potential is well-documented and which are increasingly moving into mainstream antimicrobial research. Alongside this biomedical focus, we suggest that the social and material lives of these antimicrobial materials require attention to (i) highlight the ways they have been, and continue to be, used in diverse cultures globally, (ii) explore ways we might theorize these materials within wider AMR debates, and (iii) examine the impact of antimicrobials' materiality on their use by patients. This article takes the example of clay, whose antimicrobial properties are well-established and which has been used to treat wounds and gastrointestinal problems for millennia. We first locate clay as an exemplar of a wider shift toward natural products drug discovery in pharmaceutical science and antimicrobial research. We then offer a number of theoretical "ways in" for sociologists to begin making sense of clay as it comes under the western biomedical gaze. We map these conceptual lenses on to clay's physical and symbolic mobility from its use in the global south into western biomedical research and commercialization. We particularly concentrate on post-colonial theory as a means to understand clay's movement from global south to north; laboratory studies to examine its symbolic transformation to a black-boxed antimicrobial artifact; and valuation practices as a lens to capture its movement from the margins to the mainstream. We finish by reflecting on the importance of materiality in addressing optimal use of medicines and by advocating an interdisciplinary approach to AMR which positions sociology as a key contributor to AMR solutions.

Discussing alcohol in medicines use reviews: experiences of patients in a community pharmacy context.

OBJECTIVES: Although pharmacist-led medicines use reviews (MURs) are effective for medicines management, little is understood about patients' experiences of alcohol-related advice delivered therein. Sampling a population at high risk for misuse (within an area of socio-economic deprivation), we explored patient experiences of alcohol-related MURs. METHODS: Two focus groups were conducted with patients who had discussed alcohol in an MUR in the preceding 3 months (n = 9). Data were analysed thematically. KEY FINDINGS AND CONCLUSION: Patients were open to discussing alcohol in the MUR context. The absence of practitioner-patient power asymmetry and pharmacists' sensitivity to cultural contexts were critical to patient engagement.

Health behaviours of young mothers: Implications for health promotion and cancer prevention.

OBJECTIVE: Evidence suggests that younger mothers engage in poorer health behaviours, resulting in increased cancer risk. We aimed to better understand the health behaviours of younger mothers and the factors that influence their lifestyle choices, in order to improve cancer prevention within this population. METHODS: A multiple focus group, photo-elicitation-aided approach was used, in which young mothers (n = 27; aged 16-24 years) were provided with cameras and asked to capture 'a week in your life'. Photographs were developed and participants invited to an initial focus group where photographs were used to elicit discussion, exploring participants' health behaviours. Data were thematically analysed particularly identifying themes relating to barriers and facilitators of positive health behaviours. Participants were later invited to participate in a second focus group, to explore and validate identified themes further. RESULTS: Themes emerged from the data relating to (1) the mothers' personal perceptions of health, (2) health-related behaviours and (3) beliefs about cancer and its causes. Barriers to positive health behaviours included a lack of money, childcare and cookery skills; facilitators included the social media, commercial weight loss programmes and local community organisations. CONCLUSION: Study findings provide insight into the health behaviours and life choices of young mothers. They help illustrate health perceptions in relation to cancer risk, providing an understanding of how their daily routine and circumstance influence young women's decisions and lifestyle behaviour choices and highlighting barriers to, and facilitators of, positive health behaviours. Data hold potential to inform future health-related research among young mothers, particularly relating to cancer prevention intervention.

The pharmacy gaze: bodies in pharmacy practice.

The body is a central feature of pharmacy practice. Despite this and the increased sociological focus on bodies in health and social care practice, the nature of the body and the work undertaken upon it in pharmacy have not been explored. Drawing on semi-structured interviews with hospital and community pharmacists, this article explores the ways in which bodies are constructed and managed in these two practice contexts. It is argued that pharmacists see patients' bodies in particular ways given their expertise in medicines, which is conceptualised here as the pharmacy gaze. The notion of complexity, as a way of constructing the body, and the generation of algorithmic bodies, as a way of managing this complexity, are shown to be central to the pharmacy gaze in both hospital and community contexts. In hospitals, complexity was located in a singular body, that is, increasingly rationalised to reduce costs and toxicity. In community practice, complexity arose from the multiplicity of bodies with which pharmacists interact in their multifaceted role as retailers, dispensers and public health practitioners. The article concludes by reflecting on the ways in which current UK health policy may broaden the body work that English pharmacists undertake.

"They're made in factories and not by witches on the allotment": a qualitative study of midlife women in the united kingdom, exploring their approaches to complementary and alternative medicines.

This article explores midlife women's experiences and approaches related to complementary and alternative therapies (CAMS). Ninety-six midlife women were asked about their use of CAMs as part of their overall approach to midlife health. Qualitative thematic analysis was combined with a case-based approach. Women set their experience of CAMs in the context of conventional medicine taking and discussed their safety and different uses. For treatments requiring direct contact with a practitioner, accessibility and quality of the relationship were crucial. Four overall approaches could be discerned (political-critical, pragmatic, careful and wellbeing-oriented) that dynamically interacted with women's experiences.