Anette Lykke Hindhede

Negotiating hearing disability and hearing disabled identities

Using disability theory as a framework and social science theories of identity to strengthen the arguments, this article explores empirically how working-age adults confront the medical diagnosis of hearing impairment. For most participants hearing impairment threatens the stability of social interaction and the construction of hearing disabled identities is seen as shaped in the interaction with the hearing impaired person’s surroundings. In order to overcome the potential stigmatization the ‘passing’ as normal becomes predominant. For many the diagnosis provokes radical redefinitions of the self. The discursively produced categorization and subjectivity of senescence mean that rehabilitation technologies such as hearing aids identify a particular life-style (disabled) which determines their social significance. Thus wearing a hearing aid works against the contemporary attempt to create socially ideal bodily presentations of the self, as the hearing aid is a symbolic extension of the body’s lack of function.

School Nurses’ Experiences With Motivational Interviewing for Preventing Childhood Obesity

Motivational interviewing is a counseling method used to bring about behavior change; its application by school nurses for preventing obesity in children is still new. This study, based on in-depth interviews with 12 school nurses, shows how school nurses adapted motivational interviewing and integrated it into their daily practice along with other methods they knew from the past. Three dilemmas for school nurses were revealed: when the child was severely overweight and the parents did not perceive this as a problem, when the child and the parents were at different stages of motivation to change, and when applying an individualized approach such as motivational interviewing for preventing a complex societal problem, in this instance obesity. The study raises an important issue to consider, with implications for school nursing and obesity prevention: motivational interviewing as either a counseling method or a prevention strategy.

Everyday Trajectories of Hearing Correction

Abstract This paper reports on a qualitative study of the onset of acquired hearing impairment. The focus of attention is why a person seeks treatment. The Danish welfare state serves the population ‘in need’ such as those with an audiological need and gives them guidance on becoming hearing aid wearers in order to rehabilitate them back to ‘normalcy’. However, within audiological research, noncompliance has attracted much attention as investigations have shown that more than 20 percent of hearing aids are very seldom, if ever, in use and 19 percent are used only occasionally. As shown in the paper the form a problem takes is in large part a product of micro-political struggles. Hence, at the onset ‘need’ is often embedded in social pressure from significant others. The paper examines these two discursive frameworks and their constitution of (hearing) problems and concludes that norms of disease are complex and epistemologically contested and can help explain why noncompliance is dominant when it comes to hearing rehabilitation for hearing impaired adults.

Risk, the prediabetes diagnosis and preventive strategies: critical insights from a qualitative study

Diagnosis constitutes a major categorisation tool in medicine. This paper adds to the paucity of knowledge about part of the work such a tool performs. It examines the ways in which diabetes epidemiology translates into attempts to prevent diabetes from occurring through screening and diagnosing, and then managing those categorised as ‘at high risk’. Using a qualitative design in the context of a small-scale Danish intervention study, the findings suggest that health professionals overinterpreted relative risk reductions and exaggerated treatment effects; simultaneously, prediabetics called into question the scientifically set thresholds. Nonetheless, arguments concerning changed behaviour’s benefits were sought to be incorporated into self-care routines. The data highlight how, by identifying a normatively set threshold, a diagnosis can determine health promotion messages’ impact in ‘high-risk’ prevention strategies.

Prediabetic categorisation: the making of a new person

The increasing global prevalence of type 2 diabetes has given rise to numerous trials designed to preventing diabetes. Most of these trials focus on encouraging individuals, especially ‘high-risk’ individuals to make lifestyle changes to reduce their chance of developing diabetes. Based on group interviews with health care professionals and qualitative in-depth interviews with participants in a diabetes preventive intervention with a biomedical aim to reduce risk of diabetes, in this article I critically explore the transformative potential of the medical classification prediabetes. My analysis of these data was informed by Bourdieu’s theory of practice and his concept of habitus which he defined as ‘systems of durable, transposable dispositions, structured structures predisposed to function as structuring structures, that is, as principles which generate and organise practices and representations’. Health professionals especially doctors saw the categorisation of patients as prediabetic in biomedical terms as a technical exercise that made visible information that already existed. In contrast, I found that patients saw the categorisation as creating a more fundamental change, the making of a new ‘high-risk’ person who had to take action based on a dialectical interplay between freedom and constraint in their everyday life, to manage these risk factors. They defined themselves as having a medical condition, a ‘lifestyle disease’. For these individuals, the precise meaning of and potential course of action depended on context, for example being diagnosed with prediabetes, could lead to personal benefits for those who were able to lower their blood glucose level. However, for some, there were circumstances, such as genetics, age or race, which could be neither influenced nor controlled. In this article, I note that screening-based preventive interventions that fail to consider embodied social knowledge and lived experiences will not achieve their desired outcomes.

Using Social Network Analysis as a Method to Assess and Strengthen Participation in Health Promotion Programs in Vulnerable Areas

This article provides an example of the application of social network analysis method to assess community participation thereby strengthening planning and implementation of health promotion programming. Community health promotion often takes the form of services that reach out to or are located within communities. The concept of community reflects the idea that people’s behavior and well-being are influenced by interaction with others, and here, health promotion requires participation and local leadership to facilitate transmission and uptake of interventions for the overall community to achieve social change. However, considerable uncertainty exists over exact levels of participation in these interventions. The article draws on a mixed methods research within a community development project in a vulnerable neighborhood of a town in Denmark. It presents a detailed analysis of the way in which social network analysis can be used as a tool to display participation and nonparticipation in community development and health promotion activities, to help identify capacities and assets, mobilize resources, and finally to evaluate the achievements. The article concludes that identification of interpersonal ties among people who know one another well as well as more tenuous relationships in networks can be used by community development workers to foster greater cohesion and cooperation within an area.

The field of Danish audiology: A historical perspective

This contribution briefly describes the history of Danish audiology during the last 50–60 years from the establishment of the National Hearing Health Services (NHHS). Progress within the field is framed according to the theory of Bourdieu which challenges the present concept of evidence based medicine and health technology assessment (HTA). The humanistic field has recently been re-introduced due to the international impact of the WHO-ICF, in contrast to the former exclusion of this field from the NHHS. The major impact from the political field, resulting in a partial privatization, is regarded as potentially leading to a reduction of future research and training within audiology. In contrast, the political field considers it as an improvement despite the substantial increase in costs for the state.

Inadequate Description of Educational and Behavior Change Theories in Lifestyle Interventions for Type 2 Diabetes Prevention

The aim of this article is to explore the extent to which educational and behavior change theories were adequately described in studies aiming at postponing or preventing type 2 diabetes among individuals with prediabetes using lifestyle interventions. This is essential in order to design effective interventions for ‘real life’ settings. A number of databases were searched: Web of Science, PubMed, SCOPUS, Cochrane Library, Cross (MEDLINE, EMBASE, CUCO, BIOSIS), EPPI-Centre: Database of promoting health effectiveness reviews (DoPHER) and EPPI-Centre: The Trials Register of Promoting Health Interventions (TRoPHI). Sixteen randomized controlled trials were selected based on the criteria of prediabetes, defined as impaired glucose tolerance and/or impaired fasting glucose and efficacious lifestyle interventions (diet and/or physical activity). Only four trials made explicit reference to use of educational and behavior change theories in the development of the lifestyle interventions. Another five trials provided partial information, whereas the remaining seven did not refer to theories directly or indirectly. In order to allow replicability and comparison, future studies should explicitly describe and/or consider use of educational and behavior change theories in the development of lifestyle interventions.

Disciplining the audiological encounter

Abstract This article addresses the social power variations in the context of audiological rehabilitation. The empirically based study examines the everyday interaction between professional medicine and the patient when hearing aids are being provided. By the use of video recordings an analysis is conducted of the structural level of rehabilitation practice for hard-of-hearing working age people in two outpatient clinics in two different public hospitals in Denmark. It is shown that the hearing aid fitting consultations are conducted in a ritualised manner which makes it possible to control what kind of experiences patients are allowed to bring to the audiological encounter. Bureaucratic time imperatives preclude patients’ subjective experiences and standardised, normative accountabilities based on scientific knowledge work as an effective structuring principle to get the work done in the appropriate time.

Neighbourhood renewal, participation, and social capital in deprived areas: unintended consequences in a Nordic context

ABSTRACT This paper addresses the use of the concept of social capital in neighbourhood renewal programmes which aim to influence social and health-related processes. Based on a social network analysis of 17 groups comprising 133 members, qualitative interviews were conducted with 22 participants to consider the kinds of patterns and connections that build up in a neighbourhood renewal project in a small, deprived neighbourhood of a provincial town in Denmark. Results show that outcomes of community participation depend on the kind of social capital generated and on who is excluded from these resources or capital. Problems hindering inclusive participatory processes include self-exclusion and exclusionary dynamics in the neighbourhood. These dynamics centre on power struggles that lead the least powerful to opt out. Thus, the Danish ‘Ghetto Strategy’, which aims to increase local community participation and volunteering, could have the unintended consequence of increasing social and health inequalities rather than reducing them.