Ann V. Bell

“I Think About Oprah” Social Class Differences in Sources of Health Information

Health information influences an individual’s health outcomes. Indeed, researchers have found that communication inequalities contribute to health inequalities. We do not have a clear understanding of why and how the communication disparities exist, however, particularly the social forces behind such differences. The qualitative nature of this article reveals the nuances of health information seeking using the case of infertility. Through 58 in-depth interviews, I demonstrate how differences in social and cultural capital between women of low and high socioeconomic status (SES) result in different ways of learning about health. Women of high SES have access to support groups, physicians, and the Internet, whereas women of low SES do not discuss their health problems with their peers, and lack access to and distrust physicians. I explore how these differences in health information shape the illness experience. I conclude with policy implications.

The (stalled) progress of interprofessional collaboration: the role of gender

Abstract Researchers have demonstrated that team-based, collaborative care improves patient outcomes and fosters safer, more effective health care. Despite such positive findings, interprofessional collaboration (IPC) has been somewhat stunted in its adoption. Utilizing a socio-historical lens and employing expectation states theory, we explore potential reasons behind IPC’s slow integration. More specifically, we argue that a primary mechanism hindering the achievement of the full promise of IPC stems not only from the rigid occupational status hierarchy nested within health care delivery, but also from the broader status differences between men and women – and how these societal-level disparities are exercised and perpetuated within health care delivery. For instance, we examine not only the historical differences in occupational status of the more “gendered” professions within health care delivery teams (e.g. medicine and nursing), but also the persistent under-representation of women in the physician workforce, especially in leadership positions. Doing so reveals how gender representation, or lack thereof, could potentially lead to ineffective, mismanaged and segmented interprofessional care. Implications and potential solutions are discussed.

The margins of medicalization: Diversity and context through the case of infertility

There is a prolific literature on medicalization. While that research highlights numerous effects of the process, it is just beginning to explore medicalizations complexity. In an effort to understand medicalization as a diverse, contextual process, I utilize the case of infertility in the U.S., a highly stratified, medicalized condition. I interviewed 95 individuals among those at the margins of mainstream understandings of reproduction-women of low socioeconomic status, men who were part of an infertile couple, and women in same-sex relationships who were accessing medical treatment to assist in conception-and compared their experiences to 17 straight women of high socioeconomic status who are at the center of reproductive care. Through such comparison, I examine the gender, class, and sexuality dimensions of inequality in medicalization. Ultimately, medicalization excludes, but it does so differentially and with different effects depending on an individuals social location. Such findings demonstrate that medicalization is not a fixed, universal process. It is fluid and relational and shifts depending on context.

There's a higher power, but He gave us a free will: socioeconomic status and the intersection of agency and fatalism in infertility.

Existing literature characterizes fatalism as a passive reaction to health in the face of powerlessness and constructs agency as a more activist perspective based in self-efficacy and control. Frequently studied together, researchers extol agency as the appropriate approach to decision-making around health, while discouraging fatalistic outlooks. Despite associating such beliefs with social classes-agency with high socioeconomic status (SES) groups and fatalism with low SES groups-there is little research that compares health beliefs across class groups. By examining the medicalized condition of infertility among women of both high and low SES, this study examines how social class shapes reactions to health and illness. Through 58 in-depth interviews with infertile women in the U.S., we reveal the complexity of fatalism and agency and the reasons behind that complexity. We first examine the commonalities among SES groups and their mutual use of fatalism. We then demonstrate the nuance and continuity between the health beliefs themselves-fatalism can be agentic and agency can be achieved through fatalism. In other words, we disrupt the binary construction of health beliefs, their conflation with social class, and the static application of health beliefs as psychological attributes, ultimately exposing the classist basis of the concepts. Doing so can result in improved patient care and reduced health inequalities.

Diagnostic diversity: The role of social class in diagnostic experiences of infertility

Research in the area of the sociology of diagnosis has recently expanded. Despite this development, the foundations of the social aspects of diagnoses, including race, class and gender, are relatively unexplored. Understanding such diversity is important, however, as researchers have shown that diagnoses have significant repercussions on the illness experience. This article is an effort to overcome this gap in the literature by examining class diversity in interpretations and understandings of diagnoses. Using the medicalised condition of infertility as a case example of class differences around diagnoses, I conducted 58 in-depth interviews with infertile women of various class backgrounds in the USA. By comparing the lived experiences of infertility between higher and lower class women, I explore differences in the understanding, interpretation and outcomes of diagnoses, specifically. Furthermore, among lower class women, I examine how they understand infertility outside the medical diagnostic framework. The findings reveal how interpretations and experiences of diagnoses vary depending on an individuals social location. In other words, the study demonstrates that class matters in terms of diagnoses and their understanding.

Providers’ Perceptions of Medical Interpreter Services and Limited English Proficiency (LEP) Patients Understanding the “Bigger Picture”

Patient’s ability to understand and effectively communicate health information facilitates disease prevention, self-management of illness, the adoption of healthy behaviors, and their ability to act on important public health information. However, patients who have limited English proficiency (LEP) are significantly disadvantaged. Previous studies have shown the benefit of medical interpreter services in bridging the health communication gap between patients and providers. This qualitative study, focusing on medical interpreter utilization within obstetrical and neonatal services, provides perspectives from multiple types of providers to further explore the role of medical interpreter services and specific barriers to the use of such services. Five separate focus groups were conducted with postpartum nurses, labor and delivery/triage nurses, obstetrics and gynecology (OBGYN) resident physicians, neonatal intensive-care unit (NICU) nurses, and faculty physicians, nurse practitioners, and midwives. The data show that barriers to the utilization of professional medical interpreters can be categorized by distinct but related institutional- and individual-level factors. Further interpretation of the barriers, however, suggests that providers’ use/non-use of interpreter services is merely one piece of a much “bigger picture” regarding difficulties and challenges in delivering care to a growing culturally diverse patient population, and that these cultural challenges, not just the availability of interpreter services, may affect providers’ ability to deliver effective and efficient care. It is argued that simply adding additional communication-based resources may not be sufficient to impact providers’ attitudes and behaviors or the overarching organizational culture regarding LEP patients.

“Bubble wrapping vs. helping him learn his way”: gender and definitions of parenting through the case of infertility

ABSTRACT Researchers deem gender a fundamental organizing principle of parenting. Men and women not only have distinct roles of fathers and mothers, but also perform those roles according to norms of masculinity and femininity. Recently, however, such distinctions are converging. Fathers are no longer the distant male breadwinner of the past; they are now aligned with stereotypically feminine traits of caring, gentleness, and involvement in the “new, nurturant” fatherhood. While cultural images abound, there is little understanding of how individuals themselves make sense of parenting. I explore such understanding using the case of infertility. To do so, I compare men’s definitions of fatherhood to women’s conceptions of motherhood, revealing the significance of gender to their meaning-making. Indeed, even with shifting social ideologies, important gender differences in parenting remain. Through interviews with white, high-income individuals in the US who are struggling with their reproduction (n = 43), I find that nurturing is at the center of women’s understandings of motherhood in which self-sacrifice is prominent. In contrast, men distance themselves from this caretaker role by constructing their time spent with children in masculine ways. In other words, men leave the “nurturing” to women and have redefined the nurturant father to maintain parenting as gendered.

Biological Relatives: IVF, Stem Cells, and the Future of Kinship

members. Each of these teams had been combined from separate units following challenging experiences—an explicitly racist incident for Team East and a corruption issue for Team Southwest. Both had very troubled relationships between the managers and team members. Understandably, given the context, neither of these teams actively engaged in discussions of race and ethnicity, even those individuals personally committed to a color cognizant perspective. Those identified as black, Hispanic, or Asian, are portrayed as thinking differently and having different and valuable experiences or knowledge bases to bring to bear. Yet most of the people of color on these teams either are U.S.-born or have lived in the United States since childhood, so one might question whether their cultural backgrounds are all that different. What is clearly more likely to influence both the social workers on these teams and their clients is the set of attributions likely to be made to them because of their place in the societal racial and ethnic hierarchy. Citizenship or immigrant status is likely to have strong influences as well. None of these issues is given much attention by Foldy and Buckley. Finally, although the model outlined by the authors on team process and performance is supported by a wide body of research on teams and diversity, this book does not provide guidance on how to create the conditions for psychological or identity safety, mutual learning among team members, or engaged and knowledgeable leaders. Further, the setting here is primarily about how teams in social service can do a better job working with clients, with much less attention to how team members might work better with each other. Most of the literature on psychological safety, team learning, and leadership has addressed making teams more effective in their own interactions. It seems far more challenging to openly raise issues of race and ethnicity in conversations to address conflict or misunderstanding with coworkers than with regard to working better with clients or customers. Foldy and Buckley claim that their analyses are generalizable, but talking through differences may not be enough to transform the structures of inequality without more explicit attention to changes in those structures. The same may be said with regard to a national conversation about race.