Alice Malpass

Globalizing Responsibility: The Political Rationalities of Ethical Consumption

Globalizing Responsibility: The Political Rationalities of Ethical Consumption presents an innovative reinterpretation of the forces that have shaped the remarkable growth of ethical consumption. Develops a theoretically informed new approach to shape our understanding of the pragmatic nature of ethical action in consumption processes. Provides empirical research on everyday consumers, social networks, and campaigns. Fills a gap in research on the topic with its distinctive focus on fair trade consumption. Locates ethical consumption within a range of social theoretical debates –on neoliberalism, governmentality, and globalisation. Challenges the moralism of much of the analysis of ethical consumption, which sees it as a retreat from proper citizenly politics and an expression of individualised consumerism.

THE ELUSIVE SUBJECTS OF NEO-LIBERALISM

This paper assesses the degree to which conceptualizations of neo-liberal governance and advanced liberal governmentality can throw light on contemporary transformations in the practices and politics of consumption. It detours through theories of governmentality, stories about consumption and shopping, and different variations on what we can learn from Foucault. We explore the degree to which aspects of Foucaults discussions of government and ethics can be put to work methodologically without necessarily buying into fully systematized theories of governmentality that have been built around them. The idea that organizations and networks might share rationalities through which they problematize and seek to intervene in specified areas of social life seems worth pursuing. So too does the notion of various modes of ethical problematization through which people come to take their own activities as requiring moral reflection. In neither case, however, can the analytics of governmentality provide a coherent theoretical account of how political processes of rule and administration work, or indeed of how they connect up with cultural processes of self-formation and subjectivity.

Patients with Type 2 diabetes experiences of making multiple lifestyle changes: a qualitative study

OBJECTIVES To explore patients newly diagnosed with Type 2 Diabetes Mellitus (T2DM) experiences of making single (diet) or multiple (diet and physical activity) changes in order to (1) assess whether patients experienced increases in physical activity as supporting or hindering dietary changes and vice versa, and (2) whether patients found making multiple lifestyle changes counterproductive or beneficial. METHODS In-depth interviews with 30 individuals taking part in a randomised controlled trial that aimed to determine the effect of diet and physical activity on T2DM. Interviewees had been randomised to receive usual care, intensive dietary advice, or intensive dietary advice plus information on physical activity. Respondents were interviewed 6 and 9 months post-randomisation. They were asked about their experiences of making lifestyle changes. Data were analysed thematically. RESULTS Findings suggest providing diet and physical activity information together encourages patients to use physical activity in strategic ways to aid disease management and that most patients find undertaking multiple lifestyle changes helpful. CONCLUSION Increasing physical activity can act as a gateway behaviour, i.e. behaviour that produces positive effects in other behaviours. PRACTICE IMPLICATIONS Practitioners should provide diet and physical activity information together to encourage patients to use physical activity strategically to maintain dietary changes.

The Effect of Complex Interventions on Depression and Anxiety in Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-Analysis

Background Depression and anxiety are very common in people with chronic obstructive pulmonary disease (COPD) and are associated with excess morbidity and mortality. Patients prefer non-drug treatments and clinical guidelines promote non-pharmacological interventions as first line therapy for depression and anxiety in people with long term conditions. However the comparative effectiveness of psychological and lifestyle interventions among COPD patients is not known. We assessed whether complex psychological and/or lifestyle interventions are effective in reducing symptoms of anxiety and depression in patients with COPD. We then determined what types of psychological and lifestyle interventions are most effective. Methods and Findings Systematic review of randomised controlled trials of psychological and/or lifestyle interventions for adults with COPD that measured symptoms of depression and/or anxiety. CENTRAL, Medline, Embase, PsychINFO, CINAHL, ISI Web of Science and Scopus were searched up to April 2012. Meta-analyses using random effects models were undertaken to estimate the average effect of interventions on depression and anxiety. Thirty independent comparisons from 29 randomised controlled trials (n = 2063) were included in the meta-analysis. Overall, psychological and/or lifestyle interventions were associated with small reductions in symptoms of depression (standardised mean difference −0.28, 95% confidence interval −0.41 to −0.14) and anxiety (standardised mean difference −0.23, 95% confidence interval −0.38 to −0.09). Multi-component exercise training was the only intervention subgroup associated with significant treatment effects for depression (standardised mean difference −0.47, 95% confidence interval −0.66 to −0.28), and for anxiety (standardised mean difference −0.45, 95% confidence interval −0.71 to −0.18). Conclusions Complex psychological and/or lifestyle interventions that include an exercise component significantly improve symptoms of depression and anxiety in people with COPD. Furthermore, multi-component exercise training effectively reduces symptoms of anxiety and depression in all people with COPD regardless of severity of depression or anxiety, highlighting the importance of promoting physical activity in this population.

The Political Rationalities of Fair-Trade Consumption in the United Kingdom

This article situates the analysis of fair-trade consumption in the context of debates about civic activism and political participation. It argues that fair-trade consumption should be understood as a political phenomenon, which, through the mediating action of organizations and campaigns, makes claims on states, corporations, and institutions. This argument is made by way of a case study of Traidcraft, a key player in the fair-trade movement in the United Kingdom. The study focuses on how Traidcraft approaches and enrolls its supporters.

Problematizing Choice: Responsible consumers and sceptical citizens

‘Choice’ has become a keyword in public policy debate in the United Kingdom, perhaps even ‘the mantra of health, education and pension provision’.2This coincides with the emergence of ‘the consumer’ as the privileged figure of policy discourse. The assumption underlying this proliferation of choice in policy discourse is that consumerism has transformed people’s expectations, so that public services must now be restructured in line with the demands of citizen-consumers who demand efficiency, responsiveness, choice and flexibility. The ubiquity of the choice paradigm can be interpreted as the outcome of a determined effort to recast the balance of responsibility between the state and citizens. What has been dubbed the ‘personalisation agenda’ now ‘stretches right across government’, encompassing health initiatives and pensions policy.3The stated aim of this agenda is to reframe the role of state-led initiatives in terms of empowering individuals to make informed choices, based on information provided by government. Choice is in turn presented as a means of making service-providers more responsive to the variegated needs of citizens. One can see this individualization of responsibility in a number of fields, extending beyond the realm of the state as such. For example, the individualization of health risks has also

Women's experiences of referral to a domestic violence advocate in UK primary care settings: a service-user collaborative study.

BACKGROUND Women experiencing domestic violence and abuse (DVA) are more likely to be in touch with health services than any other agency, yet doctors and nurses rarely ask about abuse, often failing to identify signs of DVA in their patients. AIM To understand womens experience of disclosure of DVA in primary care settings and subsequent referral to a DVA advocate in the context of a DVA training and support programme for primary care clinicians: Identification and Referral to Improve Safety (IRIS). DESIGN AND SETTING A service-user collaborative study using a qualitative study design. Recruitment was from across IRIS trial settings in Bristol and Hackney, London. METHOD Twelve women who had been referred to one of two specialist DVA advocates (based at specialist DVA agencies) were recruited by a GP taking part in IRIS. Women were interviewed by a survivor of DVA and interviews were recorded and transcribed verbatim. Analysis was thematic using constant comparison. RESULTS GPs and nurses can play an important role in identifying women experiencing DVA and referring them to DVA specialist agencies. GPs may also have an important role to play in helping women maintain any changes they make as a result of referral to an advocate, by asking about DVA in subsequent consultations. CONCLUSION A short time interval between a primary care referral and initial contact with an advocate was valued by some women. For the initial contact with an advocate to happen as soon as possible after a primary care referral has been made, a close working relationship between primary care and the third sector needs to be cultivated.

A BEME systematic review of UK undergraduate medical education in the general practice setting: BEME Guide No. 32

Abstract Background: General practice is increasingly used as a learning environment in undergraduate medical education in the UK. Aim: The aim of this project was to identify, summarise and synthesise research about undergraduate medical education in general practice in the UK. Methods: We systematically identified studies of undergraduate medical education within a general practice setting in the UK from 1990 onwards. All papers were summarised in a descriptive report and categorised into two in-depth syntheses: a quantitative and a qualitative in-depth review. Results: 169 papers were identified, representing research from 26 UK medical schools. The in-depth review of quantitative papers (n = 7) showed that medical students learned clinical skills as well or better in general practice settings. Students receive more teaching, and clerk and examine more patients in the general practice setting than in hospital. Patient satisfaction and enablement are similar whether a student is present or not in a consultation, however, patients experience lower relational empathy. Two main thematic groups emerged from the qualitative in-depth review (n = 10): the interpersonal interactions within the teaching consultation and the socio-cultural spaces of learning which shape these interactions. The GP has a role as a broker of the interactions between patients and students. General practice is a socio-cultural and developmental learning space for students, who need to negotiate the competing cultures between hospital and general practice. Lastly, patients are transient members of the learning community, and their role requires careful facilitation. Conclusions: General practice is as good, if not better, than hospital delivery of teaching of clinical skills. Our meta-ethnography has produced rich understandings of the complex relationships shaping possibilities for student and patient active participation in learning.

Psychological advocacy toward healing (PATH): study protocol for a randomized controlled trial

BackgroundDomestic violence and abuse (DVA), defined as threatening behavior or abuse by adults who are intimate partners or family members, is a key public health and clinical priority. The prevalence of DVA in the United Kingdom and worldwide is high, and its impact on physical and mental health is detrimental and persistent. There is currently little support within healthcare settings for women experiencing DVA. Psychological problems in particular may be difficult to manage outside specialist services, as conventional forms of therapy such as counseling that do not address the violence may be ineffective or even harmful. The aim of this study is to assess the overall effectiveness and cost-effectiveness of a novel psychological intervention tailored specifically for survivors of DVA and delivered by domestic violence advocates based in third-sector organizations.Methods and study designThis study is an open, pragmatic, parallel group, individually randomized controlled trial. Women ages 16 years and older experiencing domestic violence are being enrolled and randomly allocated to receive usual DVA agency advocacy support (control) or usual DVA agency support plus psychological intervention (intervention). Those in the intervention group will receive eight specialist psychological advocacy (SPA) sessions weekly or fortnightly, with two follow-up sessions, 1 month and then 3 months later. This will be in addition to any advocacy support sessions each woman receives. Women in the control group will receive usual DVA agency support but no additional SPA sessions. The aim is to recruit 250 women to reach the target sample size. The primary outcomes are psychological well-being and depression severity at 1 yr from baseline, as measured by the Clinical Outcomes in Routine Evaluation–Outcome Measure (CORE-OM) and the Patient Health Questionnaire (PHQ-9), respectively. Secondary outcome measures include anxiety, posttraumatic stress, severity and frequency of abuse, quality of life and cost-effectiveness of the intervention. Data from a subsample of women in both groups will contribute to a nested qualitative study with repeat interviews during the year of follow-up.DiscussionThis study will contribute to the evidence base for management of the psychological needs of women experiencing DVA. The findings will have important implications for healthcare commissioners and providers, as well as third sector specialist DVA agencies providing services to this client group.Trial registrationISRCTN58561170

Faith in Ethical Consumption

This chapter traces significant interconnections between faith-motivated activists and the widening participation in fair-trade activities in and around the city of Bristol in the UK. Despite the attempts of institutionalised religion to demonstrate the contrary (see, for example, the Archbishop of Canterbury’s Commission on Urban Priority Areas, 1985) ‘faith and ‘the city’ have often been awkward bedfellows within social science narratives. Disciplines such as human geography, for example, have developed rather uncontroversial geographies of religion, marking out both geographies of difference, in which religion poses as an aspect of ethnicity or political factionalism (Guelke 2006), and geographies of landscape and place involving both formal and informal spaces of the sacred (Kong 2001). Beyond safe havens such as these, however, human geography’s account of the groups and individuals identified with faith and/or religion has often been characterised by embarrassment, suspicion or hostility. ‘Faith’ has become easily essentialised as fundamentalist, proselytising, politically conformist and integrally immersed in the workings of the capitalist state and, as such, it has been framed as an object of critique rather than a legitimate source of explanation and understanding (Cloke 2002).