Claire Hooker

Evidence, Ethics, and Values: A Framework for Health Promotion

We propose a new approach to guide health promotion practice. Health promotion should draw on 2 related systems of reasoning: an evidential system and an ethical system. Further, there are concepts, values, and procedures inherent in both health promotion evidence and ethics, and these should be made explicit. We illustrate our approach with the exemplar of intervention in weight, and use a specific mass-media campaign to show the real-world dangers of intervening with insufficient attention to ethics and evidence. Both researchers and health promotion practitioners should work to build the capacities required for evidential and ethical deliberation in the health promotion profession.

Beliefs and beyond: what can we learn from qualitative studies of lay people’s understandings of cancer risk?

Background  Clinicians and public health professionals are centrally concerned with mediating risk. However, people often resist the risk‐related information that is communicated to them by experts, or have their own models of risk that conflict with expert views. Quantitative studies have clearly demonstrated the importance of health beliefs and various cognitive and emotional processes in shaping risk perception. More recently, a growing body of qualitative research has emerged, exploring lay conceptualizations, experiences and constructions of cancer risk. To date, this literature has not been synthesized.

Balance, Balancing, and Health:

In this article we explore the concept of balance in the context of health. We became interested in balance during a grounded theory study of lay conceptualizations of cancer risk in which participants were concerned with having a good life, which relied heavily on balancing processes. This led us to the qualitative literature about balance in the context of health, which was large and in need of synthesis. We identified 170 relevant studies and used Thomas and Harden’s technique of thematic synthesis to identify key balance-related themes and develop these into more abstract analytic categories. We found that balance and balancing were salient to people in three health-related contexts: health maintenance, disease or disability management, and lay or professional caregiving. In each of these contexts, balance or imbalance could be a state or a process. In addition, those using the word balance had either an internally or externally focused orientation to the world around them. Clinicians and public health practitioners might benefit from using these insights in their research and communication.

Zoonotic disease risk perceptions and infection control practices of Australian veterinarians: call for change in work culture.

Abstract This study was conducted to determine the perceptions of zoonotic disease risk among Australian veterinarians, the infection control practices they use to protect themselves from zoonotic diseases, and the factors influencing their use of these protective practices. A questionnaire was designed and piloted prior to its administration to veterinarians at the annual Australian Veterinary Association Conference in May 2011. The questionnaire comprised 21 closed, semi-closed and open questions. Data from the questionnaire were analyzed using ordinal logistic regression analyses to determine significant factors for veterinarians’ use of personal protective equipment (PPE). A total of 344 veterinarians completed the questionnaire of which 63.7% were women, 63.2% worked in small/companion animal practice, and 79.9% worked in private veterinary practice. Of the respondents, 44.9% reported contracting a zoonosis during their careers with 19.7% reporting a suspected case and 25.2% reporting a confirmed incidence. Around 40–60% of veterinarians perceived exposure to zoonosis likely or very likely in a variety of situations. With reference to current national industry guidelines, the reported use of PPE was less than “adequate” for most scenarios except for performing postmortems, surgery or dental procedures. No PPE was used by 60–70% of veterinarians for treating respiratory and neurological cases and by 40–50% when treating gastrointestinal and dermatological cases. Workplace conditions need improvement as 34.8% of workplaces did not have isolation units for infected animals, 21.1% did not have separate eating areas for staff, and 57.1% did not have complete PPE kits for use. Veterinarians were more likely to use PPE if they had undertaken postgraduate education, perceived that zoonosis exposure from animals and procedures was likely, consciously considered PPE use for every case they dealt with and believed that liability issues and risks encouraged use of PPE. In contrast, those working in private practices, those who tended to ‘just hope for the best’ when trying to avoid zoonotic diseases, and those who were not aware of industry guidelines were less likely to use PPE. The results suggest that veterinarians’ perceptions and workplace policies and culture substantially influence their use of PPE. Efforts should be made to encourage veterinarians and their workplaces to use infection control practices to protect themselves and their staff from zoonotic diseases.

An innovative approach to strengthening health professionals' infection control and limiting hospital-acquired infection: video-reflexive ethnography

Objective To strengthen clinicians’ infection control awareness and risk realisation by engaging them in scrutinising footage of their own infection control practices and enabling them to articulate challenges and design improvements. Design and participants Clinicians and patients from selected wards of 2 hospitals in western Sydney. Main outcome measures Evidence of risk realisation and new insights into infection control as articulated during video-reflexive feedback meetings. Results Frontline clinicians identified previously unrecognised infection risks in their own practices and in their teams practices. They also formulated safer ways of dealing with, for example, charts and patient transfers. Conclusions Video-reflexive ethnography enables frontline clinicians to identify infection risks and to design locally tailored solutions for existing risks and emerging ones.

Medical humanities as expressive of Western culture

In this paper we articulate a growing awareness within the field of the ways in which medical humanities could be deemed expressive of Western cultural values. The authors suggest that medical humanities is culturally limited by a pedagogical and scholarly emphasis on Western cultural artefacts, as well as a tendency to enact an uncritical reliance upon foundational concepts (such as ‘patient’ and ‘experience’) within Western medicine. Both these tendencies within the field, we suggest, are underpinned by a humanistic emphasis on appreciative or receptive encounters with ‘difference’ among patients that may unwittingly contribute to the marginalisation of some patients and healthcare workers. While cultural difference should be acknowledged as a central preoccupation of medical humanities, we argue that the discipline must continue to expand its scholarly and critical engagements with processes of Othering in biomedicine. We suggest that such improvements are necessary in order to reflect the cultural diversification of medical humanities students, and the geographical expansion of the discipline within non-Western and/or non-Anglophone locations.

Health scares: Professional priorities

Currently, many health scholars are concerned about health scares. But what do they mean by the term ‘health scare’ — are health scares an identifiable phenomenon and how do we currently understand their causation and consequences? By collecting and analysing published articles about events considered to be health scares, this article maps the current views of scholars on their characteristics and causes. Results show that health scares are generally understood as events characterized by fears of catastrophic consequences but little actual mortality. However, the social and economic impacts of these events have often been severe. This survey shows that health scares can be usefully sorted into six categories, each with identifiable internal dynamics, suggesting different communications strategies to achieve resolution in each category. Using the social amplification of risk framework, the conditions under which risk signals were amplified were traced in general terms among major stakeholders. Simple causes for health scare events could not be identified, though some triggers did emerge. Importantly, public ignorance of real risk, media scaremongering and political inaction could be dismissed as primary explanations, though they were sometimes factors in scare events. Implications for risk communication and for future research on risk and public health are discussed.

Writing the risk of cancer: Cancer risk in public policy

In this paper we examine how cancer risk is written in cancer policy documents from the English speaking OECD nations. We offer an audit of the multiple ways in which cancer risk is conceptualised and presented in health policy and professional contexts with the long term aim of comparing this with lay conceptualisations. Our study sampled cancer policy documents produced by six nations, the World Health Organization and the International Union for Cancer Control since 2000 and analysed them iteratively through questions and codes. Whilst the documents contained a comprehensive range of concepts and locations for cancer risk, our analysis found two predominant representations: firstly, well established metaphors that depict cancer as uniformly dreadful and life threatening; and secondly, through a concentration on five behavioural risk factors (tobacco smoking, drinking alcohol, inadequate nutrition, sun exposure and physical inactivity) and one bodily state (overweight). We discuss the implications of this dual focus and of other tensions within ideas about cancer risk that we identified for risk communication.

Suicidology as a Social Practice

Suicide has long been the subject of philosophical, literary, theological and cultural–historical inquiry. But despite the diversity of disciplinary and methodological approaches that have been brought to bear in the study of suicide, we argue that the formal study of suicide, that is, suicidology, is characterized by intellectual, organizational and professional values that distinguish it from other ways of thinking and knowing. Further, we suggest that considering suicidology as a “social practice” offers ways to usefully conceptualize its epistemological, philosophical and practical norms. This study develops the idea of suicidology as a social practice and considers the implications for research, practice and public discourse.

Understanding empathy: why phenomenology and hermeneutics can help medical education and practice

This article offers a critique and reformulation of the concept of empathy as it is currently used in the context of medicine and medical care. My argument is three pronged. First, that the instrumentalised notion of empathy that has been common within medicine erases the term’s rich epistemological history as a special form of understanding, even a vehicle of social inquiry, and has instead substituted an account unsustainably structured according to the polarisations of modernity (subject/object, active/passive, knower/known, mind/body, doctor/patient). I suggest that understanding empathy by examining its origins within the phenomenological tradition, as a mode of intersubjective understanding, offers a different and profitable approach. Secondly, I argue that the appropriation of empathy in medicine means that, ironically, empathy can function as a technique of pastoral power, in which virtue, knowledge and authority remain with the doctor (Mayes in Bioeth Inq 6:483–493, doi:10.1007/s11673-009-9195-9, 2009). And thirdly, empathy is in danger of being resourced as a substitute for equity and funding within health systems. I conclude however with hope for the productive possibilities for empathy.