Paul Russell Ward

Critical perspectives on 'consumer involvement' in health research: Epistemological dissonance and the know-do gap

Researchers in the area of health and social care (both in Australia and internationally) are encouraged to involve consumers throughout the research process, often on ethical, political and methodological grounds, or simply as ‘good practice’. This article presents findings from a qualitative study in the UK of researchers’ experiences and views of consumer involvement in health research. Two main themes are presented. First, we explore the ‘know—do gap’ which relates to the tensions between researchers’ perceptions of the potential benefits of, and their actual practices in relation to, consumer involvement. Second, we focus on one of the reasons for this ‘know—do gap’, namely epistemological dissonance. Findings are linked to issues around consumerism in research, lay/professional knowledges, the (re)production of professional and consumer identities and the maintenance of boundaries between consumers and researchers.

Health researchers' attitudes towards public involvement in health research

Objective  To investigate health researchers’ attitudes to involving the public in research.

Consumerism and professional work in the community pharmacy

In this paper we consider the professional role and status of the community pharmacist (chemist) in the context of consumerist health care. The sociological perspective of pharmacy as an incomplete or marginal profession has been challenged in more recent work, which describes how pharmacists act to ‘transform’natural objects (drugs) into more valued social objects (medicines). We consider this process as it applies to the everyday and ‘taken-for-granted’ act of buying medicines in the pharmacy. We draw on focus group and interview data from a study involving consumers and pharmacy staff in the North West of England. The consumers had purchased one of a group of ‘deregulated’ medicines, which were previously available only with a doctor’s prescription. One way in which pharmacists have sought to develop their professional role is by trying to formalise their involvement in the surveillance of medicine sales. We show how this professionalising strategy is challenged by the consumer’s power in the commercial transaction and perceived expertise in the management of minor illness. This challenge forms a boundary to the pharmacists’‘transformatory’ work, and forms part of an ongoing negotiation of the meaning and relevance of their expertise. We present the strategies adopted by consumers and pharmacy staff to (respectively) obtain the desired medicines and fulfil professional responsibilities against a background of differing and contested assessments of the risks associated with medicines use.

An ecological analysis of factors associated with food insecurity in South Australia, 2002-7

OBJECTIVE To estimate the extent of food insecurity in South Australia and its relationship with a variety of socio-economic variables. DESIGN Data collected routinely from 2002 to 2007 by SA Health were analysed to explore food security in the States population. An ecological analysis of data collected by the South Australian Monitoring and Surveillance System (SAMSS) that collects data on key health indicators. Questions on food security are asked periodically from July 2002 to December 2007. SETTING South Australia. SUBJECTS Over 37,000 interviewees took part in SAMSS surveys. Questions about food security were asked of 19,037 subjects. The sample was weighted by area, age and gender so that the results were representative of the South Australian population. RESULTS Seven per cent (1342/19,037) of subjects reported running out of food during the previous year and not having enough money to buy food (food insecurity). Logistic regression analysis found food insecurity to be highest in households with low levels of education, limited capacity to save money, Aboriginal households, and households with three or more children. CONCLUSIONS The study confirms that food insecurity is strongly linked to economic disadvantage. Increasing cost of food is likely to exacerbate food insecurity. This is of concern given that food insecurity is associated with poor health, especially obesity and chronic disease. Comprehensive action at all levels is required to address root causes of food insecurity. Regular surveillance is required to continue to monitor levels of food security, but more in-depth understandings, via qualitative research, would be useful.

Trust in the health system: An analysis and extension of the social theories of Giddens and Luhmann

Abstract Social theory provides a lens through which we can analyse the role of trust in health systems. However, the majority of theoretically informed trust literature addresses ‘institutional’ or ‘interpersonal’ trust individually, failing to investigate trust as determined by a ‘web’ of mutually interacting relationships between individuals and social systems. Current theoretical assumptions are also problematic as they fail to recognise the role that social factors (such as socio-economic status, class and age) play in an individual’s willingness to trust. Through the analysis and critique of existing social theories of trust, this paper demonstrates a need for further empirical research into the multidimensionality of trusting relationships, while suggesting new directions for research in public health.

How equitable are colorectal cancer screening programs which include FOBTs? A review of qualitative and quantitative studies.

OBJECTIVE To review published literature on the equity of participation in colorectal cancer screening amongst different population subgroups, in addition to identifying factors identified as barriers and facilitators to equitable screening. Studies were included in the review if they included FOBT as at least one of the screening tests. METHOD Relevant published articles were identified through systematic electronic searches of selected databases and the examination of the bibliographies of retrieved articles. Studies of the association with colorectal cancer screening test participation, barriers to equitable participation in screening, and studies examining interventional actions to facilitate screening test participation were included. Data extraction and analysis was undertaken using an approach to the synthesis of qualitative and quantitative studies called Realist Review. RESULTS Sixty-three articles were identified that met the inclusion criteria. SES status, ethnicity, age and gender have been found as predictors of colorectal cancer screening test participation. This review also found that the potential for equitable cancer screening test participation may be hindered by access barriers which vary amongst population sub-groups. CONCLUSION This review provides evidence of horizontal inequity in colorectal cancer screening test participation, but limited understanding of the mechanism by which it is sustained, and few evidence-based solutions.

Are GP practice prescribing rates for coronary heart disease drugs equitable? A cross sectional analysis in four primary care trusts in England

Study objective: To analyse the associations between proxies of healthcare need and GP practice prescribing rates for five major coronary heart disease (CHD) drug groups. Design: Cross sectional secondary analysis. Setting: Four primary care trusts (PCTs 1–4) in the north west of England, encompassing 132 GP practices. Results: Prescribing rates were generally positively associated with the percentage of patients aged 55–74 years and PASS-PUs (regionally specific prevalence, age, and sex standardised prescribing units). However, the percentage of patients aged over 75 years showed a lack of association with prescribing rates in all PCTs other than PCT2. Correlations with the proportion of South Asian patients were generally negative, particularly in PCT2, PCT4, and the combined dataset. There was a general lack of association with deprivation proxies and SMRs for CHD, although there were negative associations with both variables in PCT4 and the combined dataset. Scatter plots showed that GP practices with similar prescribing rates had widely differing levels of comparative healthcare need, and GP practices with similar levels of healthcare need had widely differing prescribing rates. Conclusion: GP prescribing rates in some PCTs were negatively associated with proxies of healthcare need based on patient age (patients aged over 75 years), ethnicity, levels of deprivation, and SMRs for CHD. As such, this study suggests that prescribing rates in these PCTs may be inequitable as they are not positively associated with healthcare need. This study may form the baseline for further studies to assess the effectiveness of the NSF for CHD in reducing the inequities in prescribing rates.

The dependent consumer: reflections on accounts of the risks of non-prescription medicines

Although academic writing about risk as a conceptual and theoretical category has burgeoned in recent years, debates about the characteristics of the risk society have tended to by-pass more mundane but ubiquitous dimensions of health and health-related behaviour. In this article, we argue that focusing on lay people’s understanding of the risks of a relatively commonplace example of modern medical technology (the use of non-prescription medicines for the self-medication of minor ailments) provides an insight and a challenge to what theorists of the risk society have described as the existential contours of life in late modernity. In the context of an empirical study detailing consumer responses to a naturally occurring risk, we explore some of the arguments proposed by Ulrich Beck and amplified by Anthony Giddens concerning the characteristics of the risk society. We provide evidence both for and against the propositions described by these authors and posit a more nuanced understanding of the risks of scientific medicine which acknowledges both lay expertise over medicines usage coupled with dependence on medicine and medical technology as forms of healing.

Stakeholders' views of UK nurse and pharmacist supplementary prescribing

Objectives: Supplementary prescribing (SP) by pharmacists and nurses in the UK represents a unique approach to improving patients’ access to medicines and better utilizing health care professionals’ skills. Study aims were to explore the views of stakeholders involved in SP policy, training and practice, focusing upon issues such as SP benefits, facilitators, challenges, safety and costs, thereby informing future practice and policy. Method: Qualitative, semi-structured interviews were conducted with 43 purposively sampled UK stakeholders, including pharmacist and nurse supplementary prescribers, doctors, patient groups representatives, academics and policy developers. Analysis of transcribed interviews was undertaken using a process of constant comparison and framework analysis, with coding of emergent themes. Results: Stakeholders generally viewed SP positively and perceived benefits in terms of improved access to medicines and fewer delays, along with a range of facilitators and barriers to the implementation of this form of non-medical prescribing. Stakeholders’ views on the economic impact of SP varied, but safety concerns were not considered significant. Future challenges and implications for policy included SP being potentially superseded by independent nurse and pharmacist prescribing, and the need to improve awareness of SP. Several potential tensions emerged including nurses’ versus pharmacists’ existing skills and training needs, supplementary versus independent prescribing, SP theory versus practice and prescribers versus non-prescribing peers. Conclusion: SP appeared to be broadly welcomed by stakeholders and was perceived to offer patient benefits. Several years after its introduction in the UK, stakeholders still perceived several implementation barriers and challenges and these, together with various tensions identified, might affect the success of supplementary and other forms of non-medical prescribing.

'We shed tears, but there is no one there to wipe them up for us': narratives of (mis)trust in a materially deprived community

This article reports on a qualitative study in a materially deprived locality in northern England, which originally aimed to explore local residents’ views of proposed changes to local health care provision. However, participants also quickly moved the research agenda onto widespread discussions of (mis)trust. Unlike much sociological literature that defines trust as operating on two levels (inter-personal and system-based), their narratives of trust were constructed on several inter-connected levels. We explore mistrust in local general practitioners (GPs) as a factor of mistrust of a number of local and national organizations and social systems, rather than solely related to the medical system. Widespread mistrust of ‘authority’ was narrated through a shared history of disinvestment and loss of services in the locality and ‘broken promises’ by a range of institutions, which precipitated feelings of social exclusion and disembeddedness