Health-related nudging: : A critical multimodal approach using Foucault and Habermas

The aim of this paper is to present a methodological approach that provides analytical, critical and normative purchase on nudges’ bypassing of reflection, using a combination of multimodal analysis, Foucauldian theory, and Habermas’s (1996) concept of deliberative democracy. The approach is demonstrated using an example of a health-related nudge from the Danish context: healthy product placement in a supermaket. Multimodal analysis highlights how various modes (colour, symbol, front and back, positioning and discourse) contribute meanings to the nudge. A Foucauldian perspective provides critical perspectives on nudges as shaping practices, as short of epistemic content and thus potentially difficult to resist, and as representing a politicisation of public space. Nudges’ lack of transparency is discussed in relation to Habermas’s normative framework of deliberative democracy where recognising public perspectives and ensuring consensus are key. Limitations of the article include a smaller data set; however, the data are used to illustrate the methodological approach. On the basis of the findings, I argue for the importance of furthering critical public discourse on nudging. That way, nudgees may be better positioned to spot nudges, and the implications of policymakers using this technique of governance can be more effectively scrutinised

Hub of medical expertise or medicalised conveyor-belt? Sharing meanings online on the hospital birth setting

In 2014, the official risk advice in the UK regarding birth setting was altered given scientific evidence that for low-risk groups, home births are safer than hospital births. As hospital births were previously the de facto recommendation, and pregnant women in the UK now need to consider their birth setting options carefully, many go online, seeking advice about birth setting options from their peers. In this paper, I investigate how the hospital birth setting is constructed on an online forum where women seek advice on the relative merits of various birth settings, analysing posters’ constructions of the hospital birth setting using Foucauldian discourse analysis. Findings reveal that the hospital birth setting is characterised either as the best and safest place to ensure safe delivery due to on-site biomedical experts and technology, or it is constructed as dehumanising, involving unnecessary intervention-related risks to mother and baby. The majority of the threads are critical of the hospital birth setting. Besides these findings, this paper contributes methodologically to the study of birth settings as it adopts a cultural approach supported by discourse analysis, illustrating the metapragmatic context within which birth setting decisions are made. As women’s perspectives on the birth setting issue are in focus, findings regarding women’s satisfaction with the various options are valuable for healthcare professionals who support women with birth setting decisions, as well as obstetric and maternity practitioners in the hospital setting. The extent of posters’ critique of the hospital birth setting suggests the need for further research

Investigating Interdiscursivity in Hospital Strategic Plans Using Foucauldian Discourse Analysis

Critical genre analysis (CGA) investigates the impact of context on genres by analyzing interdiscursivity (the integration of discourses in genres), but there has been a shortage of discussion of specific methods. This paper demonstrates that Foucauldian discourse analysis (FDA) – specifically, statement function analysis – constitutes a very useful approach with which to analyze interdiscursivity in CGA. Analysis of the move of “priorities/goals” (Cornut et al. 2012)  in three strategic plans produced by British hospitals using FDA reveals three main discourses: strategic management, public service accountability, and patient centeredness. As interdiscursive analysis reveals the discursive foundations of organizational practices, CGA is well-positioned to make many valuable contributions to organizational research

The Discursive Construction of Risk and Trust in Patient Information Leaflets

There is wide recognition that the communication of risk in Patient Information Leaflets (PILs) – the instructions that accompany medications in Europe – problematises the reception of these texts. There is at the same time growing understanding of the mediating role of trust in risk communication. This paper aims to analyse how risk is discursively constructed in PILs, and to identify and analyse discourses that are associated with trust-generation. The corpus (nine PILs chosen from the British online PIL bank, www.medicines.org.uk) is analysed using Foucauldian (1972) discourse analysis: specifically, this involves identifying the functions of the statements that constitute the discourses. A discourse analysis of the corpus of PILs reveals that the discourse of risk revolves around statements of the potential harm that may be caused by taking the medication, whilst trust is constructed through three discourses: the discourses that relate to competence and care, in accordance with the trust theories of Poortinga/Pidgeon (2003) and Earle (2010), and a third discourse, corporate accountability, which functions to construct an ethical (trustworthy) identity for the company. This paper contributes to PIL literature in the following ways: it introduces a methodology that has not been used before in relation to these texts, namely, Foucauldian discourse analysis; it helps to identify the presence of trust-generating discourses in PILs; and analysing the discourses of risk and trust at statement-level facilitates a better understanding of how these discourses function in texts that are generally not well-received by the patients for whom they are intended

Danish job advertisements: Increasing in complexity

Although job advertisements have developed to incorporate an important array of functions, they are not well understood and there has been little documentation of evolution in the genre (Rafaeli & Oliver; 1998, 342). The purpose of this article is to address this gap by analysing changes in the genre over time, in this way revealing the background for current practice. Examples of Danish job advertisements for communication positions from 1961, 1991 and 2011 are analysed using Critical Discourse Analysis, and a rich format for job advertisements is developed on the basis of the findings of the analysis and existing theory. The results are likely to be of interest to producers of job advertisements who want a broader knowledge of how this genre with its increasingly complex functionality has evolved and for whom genre features of contemporary job advertising practice is relevant.

Antenatal group consultations: Promoting wellbeing

Background: Most healthcare encounters take place in a dyadic encounter between a patient and healthcare practitioner, and improving dyadic communication has been the object of much health communication research. However, it seems that an alternative to the dyadic encounter – group consultations – may have distinct advantages for the promotion of patients’ wellbeing. Aim: This article focuses on antenatal group consultations (AGCs), where groups of pregnant women meet with one or more healthcare practitioners instead of meeting their midwife individually, and explores how the presence of other pregnant women in AGCs may promote wellbeing. Methods: Adopting a post-intentional phenomenological approach, we analysed the transcripts of 16 semi-structured interviews undertaken with pregnant women who attended AGCs in Denmark, focusing on their accounts of being with each other. Results: The presence of other pregnant women helped to generate trust, with the participants’ pregnant bodies symbolising their common situation. The presence of peers prompted feelings of identification and solidarity, generally decreased the women’s concerns, and normalised their experiences of pregnancy. Discussion and conclusion: This article develops understandings of how patients experience interpersonal healthcare encounters, and suggests the value of alternatives to the clinical dyad, such as group consultations, for promoting the wellbeing of other patient groups

Introduction to Thematic Section: Critical Genre Analysis

No abstract

The Interpersonal Dimension of Online Patient Forums: How Patients Manage Informational and Relational Aspects in Response to Posted Questions

The internet has revolutionised the ways in which patients acquire medical information, a development which has clearly been welcomed by patients: seeking out health information online is now the third most popular activity after internet searches and e-mail (Timimi 2012). However, it has led to concerns about the quality of the information, the ability of lay people to understand it (Gerber/Eiser 2001) as well as potential cyberchondria (Starcevic/Berle 2013). In light of these conflicting perspectives, this paper examines one such source of online information, namely, the patient forum where patients communicate with other patients about a particular medical condition. Although doctor-patient communication in the clinical situation has been extensively researched, little is known about how patient-patient communication is managed in online situations such as patient forums. The purpose of this paper is to contribute to research in that relatively un-researched area by examining how patients manage relational and informational aspects of communication in online patient forums. Whilst a typical interactional structure of the patient forum exchange is question and answer, we focus on responses to questions on patient forums.This paper reports on the findings of a thematic analysis (Braun/Clarke 2006) of an online thyroid disease patient forum, investigating how interpersonal aspects are negotiated where patients share condition-related knowledge. We identify themes that relate both to informational and relational aspects as well as themes that fit under a new category which we call ‘info-relational’ as it subsumes informational and relational elements. We discuss a number of theoretical implications, which are valuable as existing health communication models and understandings of patient expertise have yet to catch up with the effects of new media such as online patient forums

Interdisciplinary: To Be or Not to Be? Working Across Disciplinary Boundaries in the Humanities (and Beyond)

This article introduces student readers to the realm of the interdisciplinary, with a primary focus on the humanities. We first introduce interdisciplinarity and other related terms as concepts. We then present eight specific examples, on which we illustrate interdisciplinary research. Finally, we address the question of when one should be interdisciplinary