When risk becomes illness: The personal and social consequences of cervical intraepithelial neoplasia medical surveillance

[Abstract] Background, After the early detection of cervical intraepithelial neoplasia (CIN), medical surveillance of the precancerous lesions is carried out to control risk factors to avoid the development of cervical cancer. Objective. To explore the effects of medical surveillance on the personal and social lives of women undergoing CIN follow-up and treatment. Methodology. A generic qualitative study using a poststructuralist perspective of risk management was carried out in a gynecology clinic in a public hospital of the Galician Health Care System (Spain). Participants were selected through purposive sampling. The sample consisted of 21 women with a confirmed diagnosis of CIN. Semistructured interviews were recorded and transcribed, and a thematic analysis was carried out, including researcher triangulation to verify the results of the analysis. Findings. Two main themes emerged from the participants’ experiences: CIN medical surveillance encounters and risk management strategies are shaped by the biomedical discourse, and the effects of “risk treatment” for patients include (a) profound changes expected of patients, (b) increased patient risk management, and (c) resistance to risk management. While doctors’ surveillance aimed to prevent the development of cervical cancer, women felt they were sick because they had to follow strict recommendations over an unspecified period of time and live with the possibility of a life-threatening disease. Clinical risk management resulted in the medicalization of women’s personal and social lives and produced great uncertainty. Conclusions. This study is the first to conceptualize CIN medical surveillance as an illness experience for patients. It also problematizes the effects of preventative practices in women’s lives. Patients deal with great uncertainty, as CIN medical surveillance performed by gynecologists simultaneously trivializes the changes expected of patients and underestimates the effects of medical recommendations on patients’ personal wellbeing and social relations

Is health education good for you?: the social construction of health education in the Brazilian national health system.

This study is about the social construction of health education in the\ud Brazilian national health system. Health education is examined as a social policy and\ud as a health practice. The theoretical framework is based on the work of Michel\ud Foucault, with special attention to the concepts of bio-power, bio-politics of the\ud population and anatomo-politics of the human body. The thesis pursued is that health\ud education represents a singular contribution to the exercise of bio-power through the\ud health system. Its involvement with prevention and promotion of health, as well as its\ud educational character, enhance the set of power techniques employed in the\ud management of the individual and social body. The data presented are created by\ud analysis of documents and surveys covering federal, state, and municipal levels of\ud government in Brazil and also health centres. Interviews with policy-makers, health\ud professionals, and users of the health system and the observation of two health centres\ud as case studies are also sources of information. Health education policy contributes\ud to expand the surveillance that the work of health professionals represents over any\ud aspect of individual and community life. As a practice, health education can make use\ud of prescriptive or participatory approaches to promote healthy life-styles. However,\ud both of them discipline and normalize individuals and communities. This study also\ud suggests in its conclusion that Foucault's concept of bio-power as power over life\ud centred on the control of sex should be re-thought, focusing on health as the key\ud element in the exercise of bio-power

Relaciones de poder en enfermería y salud mental: críticas y retos para el futuro

XX Congreso Nacional de Enfermería en Salud Mental, Alicante, 10-12 abril de 200

É a Educação em Saúde saudável? Repensando a Educação em Saúde através do coceito de bio-poder

This artic1e employs Foucault's concept of biopower to analyse health education. Bio-power refers to the management of biological life as a political event. The central argument is that health education represents a singular contribution to the exerci se of bio-power. Its involvement with prevention and health promotion, as well as its educational nature, enhance the set of power techniques that come into play in the management of individual and social bodies. Data from a study on health education policy and practices in the Brazilian national health system are presented to illustrate the analysis.Este artigo emprega o conceito de bio-poder desenvolvido por Foucault para analisar a Educação em Saúde. O bio-poder refere-se à administração da vida biológica como um evento político. O argumento central é o de que a Educação em Saúde representa uma contribuição singular para o exercício de bio-poder. Seu envolvimento com a prevenção e a Promoção da Saúde, bem como a suanatureza educacional, contribuem para o conjunto de técnicas de poder que entram em jogo na administração do corpo individual e social. Informações de um estudo sobre as políticas e práticas de Educação em Saúde no sistema público de saúde do Brasil são apresentadas para ilustrar a análise

Body-map storytelling as a health research methodology: blurred lines creating clear pictures

In diesem Artikel sichten wir die vorliegende Literatur zur Nutzung von Body-Maps (BM) in den Gesundheitswissenschaften, um zum einen den aktuellen Wissensstand zu systematisieren und zum anderen zu dessen Weiterentwicklung beizutragen. Unsere kritische Recherche wurde durch zwei Fragen geleitet: 1. Wie sind BM in den Gesundheitswissenschaften eingesetzt worden? 2. In welcher Weise können BM zu einer antikolonialen Agenda verhelfen? Insgesamt wurden 27 englische, spanische und portugiesische Studien in die Untersuchung einbezogen. Die meisten wurden zwischen 2011 und 2016 veröffentlicht und waren in Südafrika, Kanada, Australien, Brasilien, Chile und den USA durchgeführt worden. Thematisch geht es zumeist um marginalisierte Gruppen und soziale Determinanten von Gesundheit, wobei Methoden der Datenerhebung und -analyse erheblich variieren. Auch werden BM unter teilweise unterschiedlichen Bezeichnungen und in verschiedener Weise zunehmend im Rahmen visueller, narrativer und partizipativer Methodologien eingesetzt. Doch trotz dieser Diversität sind einige Kernelemente erkennbar, dass nämlich Forschungspartner/innen als vernunftfähige und reflexive Individuen erachtet werden, die bei der Artikulation ihrer teilweise sehr komplexen Lebensgeschichten durch das Zeichnen (z.B. ihrer Körper und sozialen Umstände) unterstützt werden können. Eine Dekolonialisierung der Gesundheitswissenschaften finden dann statt, wenn auf diesem Weg Gegennarrative zu exklusiven kapitalistischen, patriarchalen und kolonialistischen Rationalitäten entstehen, eine Methodologie, die wir als "Body-Map-Erzählung" bezeichnen.In this article we review the literature on body-mapping (BM) as an approach to health research in order to systematize recent advancements and to contribute to its development. We conducted a critical narrative synthesis of the literature published until September 2016 guided by two questions: 1. How has BM been utilized in health research? 2. How does BM advance a decolonization agenda? Twenty-seven studies in English, Spanish, and Portuguese were analyzed. Most of them were published between 2011 and 2016 and were conducted in South Africa, Canada, Australia, Brazil, Chile, and USA. They narrate stories of marginalized groups and commonly focus on the social determinants of health. Data generation, analysis, and knowledge mobilization strategies differ considerably. Recent developments show that body-mapping is a visual, narrative, and participatory methodology that has several names and is used unevenly by health researchers. Despite its diversity, core methodological elements reveal that participants are considered knowledgeable, reflexive individuals who can better articulate their complex life journeys when painting and drawing their bodies and social circumstances. The decolonization of health research occurs when these unlikely protagonists tell their stories producing counter-hegemonic discourses to exclusionary capitalist, patriarchal and colonialist rationalities. We call this methodology body-map storytelling

Sex as Boys\u27 Fame, but Girls\u27 Shame: Adversarial Gender Roles and Gender-based Violence in Guyana

Gender-based violence (GBV) is a significant issue for youth in Guyana, particularly among young women. Yet, discussions about sex, dating, and violence rarely occur at the community level. To understand the heightened risk for GBV with youth in Guyana, we utilized a critical qualitative design to explore adolescent dating violence with adolescents (14–16 years old), parents, and school officials in a public secondary school in Guyana. In total, 36 racially and religiously diverse participants from low to middle-income households participated in focus groups (n = 30) and interviews (n = 6). Discussions centered on dating in adolescence; community awareness of dating violence; gender, racialization, and class in relation to dating violence; and dating violence prevention in schools and family settings. Our results revealed that heteronormative, adversarial gender roles in Guyana are enacted in adolescent relationships in ways that contribute to violence. Two important factors emerged in relation to femininity: female respectability related to sexuality; and the relationship between clothing, sexuality, and social class. Masculinity for adolescent boys was centered on reproducing normative assumptions about femininity and explaining the use of violence through pathologizing race. Participants were also asked to identify gender roles that adolescent boys and girls should embody in relationships, which revealed possibilities for overcoming adversarial roles in relationships. We propose that adolescent GBV prevention initiatives consider long-standing and deeply embedded ideas within gender norms that are connected to sexuality, class, and race. Without accounting for these systemic factors, GBV prevention initiatives and programs may inadvertently perpetuate traditional definitions of masculinity and femininity that contribute to violence

Health promotion and empowerment: a reflection based on critical-social and post-structuralist perspectives

In this paper we describe the theoretical framework and the core strategies of health promotion followed by a critical intra- and extra-paradigmatic analysis of the key ideas of this movement. From an intra-paradigmatic perspective we privilege a critical social theory perspective for analyzing one of the key concepts of health promotion - empowerment - exploring its potential to transform community and professional practices in the field of health. Next, we reflect about health promotion from an extra-paradigmatic perspective, seeking in the post-structuralist theories new analytical possibilities for understanding the power relations that establish themselves on the basis of practices and policies of health promotion. Throughout this article, we articulate the explored theoretical principles to contextual questions and current debates in the field of health in Brazil.Neste trabalho, descrevemos o arcabouço teórico e as estratégias centrais da Promoção à Saúde, seguidos de uma análise crítica tanto intra como extra-paradigmática ao ideário do referido movimento. A partir de uma perspectiva intra-paradigmática, privilegiamos o enfoque ao qual se filia a Promoção à Saúde, as teorias crítico-sociais, para analisar um dos seus conceitos estruturantes - o conceito de empoderamento -, explorando seu potencial para a transformação das práticas comunitárias e profissionais em saúde. A seguir, refletimos sobre a Promoção à Saúde a partir de uma perspectiva extra-paradigmática, buscando nas teorias pós-estruturalistas novas possibilidades analíticas para entender as relações de poder que se estabelecem a partir das práticas e políticas de Promoção à Saúde. Ao longo deste artigo, articulamos os princípios teóricos explorados a questões contextuais e a debates atuais na área da saúde no Brasil.20292040Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Asymmetric power relations in gynaecological consultations for cervical cancer prevention: biomedical and gender issues

[Abstract] A generic qualitative research, using a poststructuralist feminist perspective, was conducted in a Spanish gynaecology unit with the following aims: (a) to analyse how asymmetric power relations in relation to biomedical knowledge and gender shape the medical encounters between gynaecologists and women diagnosed with cervical intraepithelial neoplasia and (b) to explore the cognitive, moral, and emotional responses expressed by patients. A total of 21 women diagnosed with cervical intraepithelial neoplasia were recruited through purposive sampling. Semi-structured interviews were recorded and transcribed, and a thematic analysis was carried out. Two major themes were identified: (a) gendered relations in cervical intraepithelial neoplasia medical encounters are based on hidden, judgmental moral assumptions, making women feel irresponsible and blamed for contracting the human papillomavirus infection; (b) biomedical power is based on the positivist assumption of a single truth (scientific knowledge), creating asymmetric relations rendering women ignorant and infantilised. Women reacted vehemently during the interviews, revealing a nexus of cognitive, moral, and emotional reactions. In medical encounters for management of cervical intraepithelial neoplasia, patients feel they are being morally judged and given limited information, generating emotional distress. Healthcare professionals should question whether their practices are based on stereotypical gender assumptions which lead to power asymmetries during encounters

Le soutien social de l’intervenante tel que perçu par les participantes d’un programme de prévention en périnatalité en milieu d’extrême pauvreté

Un soutien global offert par une intervenante privilégiée à des femmes enceintes vivant en situation de pauvreté est un des éléments essentiels du Programme intégré de prévention en périnatalité Naître-égaux-Grandir en santé. Cette recherche constitue une analyse secondaire des verbatims recueillis lors d'entrevues effectuées pour l'étude de mise en oeuvre du programme. La perception du soutien reçu de l'intervenante par la cliente, le processus relationnel entre l'une et l'autre, ainsi que la perception des impacts du soutien sur le vécu de grossesse y sont étudiés au moyen d'une analyse thématique de contenu. Les catégories de soutien ressorties de cette analyse sont le soutien informatif, émotionnel, instrumental, le soutien à la modification des habitudes de vie, le soutien récréatif ainsi que la disponibilité du soutien. Les impacts perçus par les participantes sont les apprentissages, les modifications des habitudes de vie, le fait de garder un bon moral et l'utilisation des ressources communautaires. L'établissement d'une relation de confiance apparaît comme l'élément-clé dans la perception du soutien apporté par l'intervenante. Cette relation de confiance devient nécessaire au développement d'une intimité plus grande et à la perception d'un soutien plus intense. Ainsi le soutien social et la relation de confiance agissent en synergie et se renforcent mutuellement.One of the essential elements of the "Programme intégré de prévention en périnatalité-Naître-égaux-Grandir-en-santé" (Born Equal-Brought up Healthy) is to have a health professional offering general support to pregnant women living in poverty. This research is based on a secondary analysis of the transcriptions of interviews done in order to implement the program. The thematic content analysis was employed to analyze the women's perception of the support provided by the health professional, the relationship between client-professional, and the perceptions of these women about the impact that the social support had on their pregnancy experience. The categories of support that emerged from the analysis are: information support, emotional support, instrumental support, changing life style support, recreational support, and availability of support. The categories of impact perceived by the participants are: learning, changes in life style, to be in a good mood, and the use of community resources. A key element in the perception of support by the participants is the establishment of a relationship of trust between professional and client. This relationship of trust is important to the development of intimacy and to foster the perception of a more intense kind of support. Hence social support and the relationship of trust work in synergy and reinforce each other.Un apoyo global provilegiado ofrecido por un trabajador comunal a mujeres embarazadas viviendo en situaciôn de pobreza es uno de los elementos esenciales del Programa integrado de prevenciôn en prenatal, " Nacer iguales - crecer saludables ". Esta investigation constituye un anâlisis secundario de los propositus recogidos en el momento de las entrevistas efectuadas para el estudio de puesta en marcha del programa. La perception de la clientela del apoyo ofrecido por el trabajador comunal, el proceso de relation entre esta, asi que la perception de los impactos del apoyo sobre la vivencia del embarazo, son estudiados por medio de un anâlisis temâtico de contenido. Las categorîas del apoyo que sobresalen en este anâlisis son el sostén informativo,, el sostén emotional, el sostén instrumental, el sostén para la modification de los habitas de vida, el sostén recreativo asf que la disponibilidad de los mismos. Los impactos percibidos por las participantes son los aprendizajes, las modifications de los habitas de vida, el hecho de conservar el entusiasmo y la utilization de los recursos colectivos. El establecimiento de una relation de confianza aparece como el elemento clave en la perception del apoyo ofrecido por el trabajador comunal. Esta relation de confianza se impone necesaria al desarrollo de una intimidad mâs grande y a la perception de un apoyo mâs intenso. Asi apoyo social y la relation de confianza actûan en sinergia y se refuerzan mutuamente