Kamppailu sananvapaudesta : sosiaalialan ammattilaisen toiminta ja valtasuhteet mediavaikuttamisen kentällä

Tässä tutkimuksessa tarkastelen sosiaalialan ammattilaisten toteuttamaa mediavaikuttamista ja siihen liittyviä valtakamppailuja. Tarkasteluni keskipisteenä on sosiaalialan ammattilainen, jonka mediavaikuttamista tarkastelen suhteessa hänen työnantajanaan toimivaan sosiaalialan organisaatioon. Sosiaalialan ammattilaiset toteuttavat mediavaikuttamista toimintakentällä, joka muodostuu sosiaalialan julkisen viestinnän ja rakenteellisen sosiaalityön kohtausalueelle. Tutkimuksessa käsittelen seuraavia kysymyksiä: 1) Millainen on sosiaalialan julkisen viestinnän ja rakenteellisen sosiaalityön muodostama sosiaalisen toiminnan kenttä? 2) Millaista on sosiaalialan ammattilaisen toiminta mediavaikuttamisen kentällä? 3) Millaisia valtakamppailuja sosiaalialan ammattilaiset kohtaavat mediavaikuttamisen kentällä? Sosiaalialan professionaalisena toimintana mediavaikuttaminen asemoituu rakenteellisen sosiaalityön työskentelyorientaatioon, jonka tavoitteena on yhteiskunnallisen oikeudenmukaisuuden edistäminen. Tutkimukseni tehtävänä on lisätä tietoa sosiaalialan mediavaikuttamisesta rakenteellisen sosiaalityön välineenä sekä käsitteellistää sosiaalialan työntekijöiden subjektiivisia sananvapauden kokemuksia. Tutkimukseni koostuu neljästä tieteellisestä artikkelista ja yhteenveto-osiosta. Yhteenveto-osion teoreettinen tulkintakehys rakentuu Pierre Bourdieun sosiaalisen kentän teoriasta. Sosiaalitieteellisistä tutkimustraditioista tutkimukseni paikantuu rakenteellisen sosiaalityön tutkimusten joukkoon sekä tutkimuskeskusteluihin sosiaalityön asiantuntijuuden yhteiskunnallisesta paikasta, sosiaalialan mediavaikuttamisesta ja epäkohtien paljastamisesta. Tutkimusaineisto koostuu 19 mediavaikuttamista käyttäneen sosiaalialan ammattilaisen haastatteluista. Lisäksi yhdessä osatutkimuksessa olen käyttänyt aineistona kirjallisia keskusteluja mediavaikuttamista toteuttaneiden sosiaalialan ammattilaisten kanssa. Toteutin aineiston analyysin teoriaohjaavaa sisällönanalyysia käyttäen. Neljästä osajulkaisusta ensimmäinen käsittelee mediavaikuttamisen tavoitteita sekä sosiaalialan julkisuuden kenttää. Se vastaa kysymyksiin, millaista julkisen viestinnän avulla toteutettava rakenteellinen sosiaalityö on ja mitä sillä tavoitellaan. Toinen osajulkaisu kuvailee tekijöitä, jotka ohjaavat sosiaalialan ammattilaisia vetäytymään julkisesta keskustelusta ja jatkamaan hiljaisuuden kulttuuria. Osajulkaisu vastaa kysymykseen, millaisina mediavaikuttamisen esteet ilmenevät sosiaalialan työntekijöiden kertomina. Kolmas osajulkaisu tarkastelee sosiaalialan työntekijöiden sananvapauden kokemuksia heidän pyrkiessään mediavaikuttamaan. Se vastaa kysymyksiin, millä tavoilla sosiaalialan työntekijöiden julkiseen keskusteluun osallistumista rajoitetaan sekä millaisena vallankäyttönä sananvapauden rajoittaminen ja julkisen keskustelun vaientaminen näyttäytyvät. Neljännessä osajulkaisussa pureudun epäkohtien paljastamisen estämiseen analysoimalla, millaista on vaientaminen. Vastaan siinä kysymykseen, kuinka vaientaminen toteutetaan institutionaalisissa prosesseissa. Kaikki neljä osajulkaisua luovat omalta osaltaan pohjaa yhteenvedon synteesille ja johtopäätöksille. Tutkimustuloksissa kuvailen mediavaikuttamisen prosessia, johon vaikuttavat mediavaikuttaja itse, toiset mediavaikuttamisen kentän toimijat ja kentän luonne. Mediavaikuttamisen prosessi muodostuu työntekijän oman toimivallan tunnistamisesta, kentän toimintalogiikan tunnustelusta, kentälle pääsyn kamppailusta, kentällä toiminnasta sekä muiden reagoinnista kentällä toimimiseen. Organisaatioissa on erilaisia viestinnän puhujaoikeuksia, joista käydään kamppailuja. Kamppailuja käydään organisaatioiden virallisten ja epävirallisten ohjeiden välityksellä, jotka ovat kirjoitettuja, ääneen lausuttuja tai vaiettuja. Mediavaikuttamisen luonne vaikuttaa muiden reagointiin. Kriittinen, erityisesti epäkohtia paljastava, vaikuttaminen kohtaa enemmän vaientamista kuin neutraali tai positiivinen viestintä. Mediavaikuttamisen kentän toimijat pyrkivät saavuttamaan pääomia, mutta voivat myös menettää niitä kentän kamppailuissa. Sosiaalialan työntekijät tavoittelevat mediavaikuttamisen kentällä valta-aseman muutosta itselleen, professiolleen, edustamalleen palvelulle, organisaatiolle tai palveluiden käyttäjille.In this thesis, I examine social work professionals’ engagement in media advocacy and the related power struggles. The study focuses on the social work professional whose engagement in media advocacy is examined in relation to his/her employer organisation in the field of social work. Social work professionals engage in media advocacy in a field located in the intersection of public communication in social work and structural social work. This study addresses the following questions: 1) What kind of field of social action is formed by social work public communication and structural social work? 2) What kinds of actions do social work professionals take in the field of media advocacy? 3) What kinds of power struggles do social work professionals experience in the field of media advocacy? As a form of professional action within the field of social work, media advocacy is located within the orientation of structural social work, the purpose of which is to promote social justice. The aim of the present study is to contribute to our understanding of media advocacy as a tool for structural social work and to conceptualise social work professionals’ experiences of freedom of speech. The thesis consists of four peer-reviewed articles and a concluding chapter. The theoretical framework employed in the concluding chapter is Pierre Bourdieu’s theory of social fields. Among the research traditions of social sciences, the present study is located within structural social work research, as well as in the domain of scientific discussions of the societal role of social work expertise, media advocacy and whistleblowing in the context of social work. The research is based on qualitative data. The primary data consist of interviews with 19 social workers who have actively engaged in media advocacy. The secondary data comprise online and email conversations with social work professionals about media advocacy. The data were analysed by theory-driven content analysis. The first of the four articles deals with the objectives of media advocacy and social work as a field of publicity. It sets out to answer the question: “What is structural social work implemented through public communication like and what are its objectives?” The second article explores the reasons for non-engagement in media advocacy in social work. It addresses the factors contributing to social work professionals’ withdrawal from public discussions and their decision to adopt – or continue to maintain – a culture of silence. The article answers the question: “How do barriers of media advocacy manifest themselves as experienced by social work professionals?” The third article analyses different ways of silencing social workers. It examines social workers’ experiences of freedom of speech in the context of their attempts to engage in media advocacy. It answers the question: “How is social workers’ participation in public discussion controlled?” It also analyses freedom of speech violations and restrictions imposed on participation in public communication as forms of power. The fourth article focuses on preventing whistleblowing – disclosure of wrongdoings observed within an organization to the public – by analysing the phenomenon of silencing. The article answers the question: “How is silencing produced in and through an institutional process?” All four articles create a basis for the synthesis and conclusions presented in the final chapter chapter of this thesis. The results indicate that media advocacy in the context of social work is a process influenced by the individual social worker engaging in an act of media advocacy, the other actors in the field of media advocacy, as well as the nature of the field itself. The process of media advocacy is initiated as the social worker becomes aware of his/her power to act, which is followed by exploring the field as an operational environment, struggling in order to be able to enter the field, taking action in the field, and other actors’ reactions to the actions taken. In organizations, people have different degrees of freedom regarding public communication that are subject to constant struggle. The struggles take place through unofficial and official rules that can be written, spoken or unspoken. The nature of engagement in media advocacy has an effect on how others react to the action taken. An individual engaging in critical media advocacy, in particular whistleblowing, experiences more silencing than those who engage in forms of media advocacy that are perceived as more neutral or positive forms of media advocacy. The agents in the field of social work media advocacy aim to accumulate different forms of capital, but they can also lose capital in a struggle. In the field of media advocacy, employees in the field of social work seek to subvert the existing power relations to improve their own professional position, the position of the service or organization they represent, or the position of the service user

Towards digitally mediated social work – the impact of the COVID-19 pandemic on encountering clients in social work

In the spring of 2020, the COVID-19 pandemic spread around the globe. The viral outbreak was followed by rapid changes in people’s everyday and working lives. Because of the wide-scale societal restrictions that took place to prevent the pandemic, social work was forced to take a digital leap. In this article, we examine Finnish social workers’ experiences of extending the use of digitally mediated social work (DMSW) in working with clients during the first wave of the pandemic, the spring of 2020. The data consist of 33 social workers’ personal diaries, which are analysed using a qualitative theory-based content analysis. Henri Lefebvre’s theory of spatial triad will be utilised in theorising how social workers represent DMSW through three dimensions of space, that is, how they perceive, conceive and live digital spaces when encountering their clients and how physical, mental and social spaces are embodied in the representations. The results suggest that the three dimensions of space 1) basis of, 2) conceived and 3) lived DMSW intertwine closely together. The results reveal how the physical space, including IT infrastructure, its functionality and applicability, along with the organisational contexts, form a bedrock for the social workers’ DMSW practice and had a decisive impact on their experiences. Second, the conceived space consists of workers’ cognitive and emotional elements, such as competencies, preconceptions and attitudes towards ICT. Finally, the third dimension of spatiality concludes with the social and relational aspects of the user experiences and encounters between clients and social workers

Risk factors for preterm delivery among early onset cancer survivors: A Finnish register-based study

Previous studies have shown an elevated risk for preterm delivery among early onset cancer survivors. Whether the preterm delivery starts spontaneously, due to possible uterine damage because of cancer treatment, or is induced due to maternal conditions is unclear. Our aim was to assess pregnancy related conditions in female cancer survivors possibly underlying the elevated risk for preterm labor. Nationwide cancer and birth registries were merged to identify 1,753 first deliveries of cancer survivors (diagnosed below 40 years of age) and 5,123 first deliveries of matched female comparison subjects between January 1991 and December 2013. Conditional logistic regression models were used to estimate the risk for pregnancy related conditions adjusting for maternal age, gestational age and smoking. We found an overall increased risk for hospitalization during pregnancy (OR 1.45, 95% CI 1.25-1.68), intrahepatic cholestasis (OR 2.86, 95% CI 1.09-7.49), fear of childbirth (OR 2.25, 95% CI 1.31-3.85) and mental disorders and diseases of the nervous system complicating pregnancy and labor (OR 5.89, 95% CI 2.31-15.00). Among survivors, 129 (7.4%) delivered preterm compared to 268 (5.2%) comparisons subjects (p = 0.004). We found a statistically significant increased risk for preterm delivery among cancer survivors with vaginal bleeding (OR 1.35, 95% CI 1.07-1.71) and pre-eclampsia (1.35, 95% CI 1.06-1.72) compared to comparison subjects with the same condition. Health professionals treating these women should be aware of these risks. In general, however, our results are reassuring when it comes to pregnancies among cancer survivors.Peer reviewe

Lapsuusiän syöpää sairastaneiden naisten lisääntymisterveys

Vertaisarvioitu.Viime vuosikymmenien aikana tapahtuneen kehityksen myötä yli 80 % lapsena syövän sairastaneista on elossa viiden vuoden kuluttua syövän toteamisesta. Syöpähoidot saattavat kuitenkin vaurioittaa tytön munasarjoja pysyvästi. Tutkimusten mukaan lapsuusiän syövästä toipuneet saavatkin lapsia harvemmin kuin terveet väestöverrokit. Vaikka taustalla on usein tahaton lapsettomuus, myös tiedonpuute hoitojen riskeistä ja vaikutuksesta hedelmällisyyteen, seksuaalisuuteen ja raskauksiin voi olla osatekijä. Asiantunteva neuvonta syöpähoitojen vaikutuksesta lisääntymisterveyteen on ensiarvoisen tärkeää. Lapsuusiän syövästä toipuneiden naisten koeputkihedelmöityshoitojen määrä on viime vuosina selvästi lisääntynyt. Jos hoidot johtavat raskauteen, siihen liittyvät riskit ovat yleensä pieniä, ja lapsuudessa syöpää sairastaneet naiset voivat yleensä synnyttää lapsensa turvallisesti. .Peer reviewe

Use of fertility drugs in early onset female cancer survivors –A Finnish register-based study on 8,929 survivors

Advances in multimodality cancer treatments have increased the risk of long-term complications in early onset cancer survivors. For female cancer survivors these include diminished reproductive function, often resulting in a narrowed fertile window. The aim of this study was to evaluate the use of fertility treatments in cancer survivors (aged 0-39 years at diagnosis) compared to siblings. Data from Finnish registers on cancer, birth and prescribed medications were merged to identify 8,929 survivors and 9,495 siblings without previous deliveries. Fertility drug purchases from 1993 to 2012 at the age of 16-41 years were included. A Poisson regression model was used to estimate incidence rate ratios (IRR) for the use of fertility drugs, adjusting for age and calendar time at fertility drug purchase. Fertility treatments were more common in survivors compared to siblings, as 6.1% of survivors compared to 3.8% of siblings had bought fertility drugs (IRR 1.43, 95% confidence interval [CI] 1.25-1.65). A sub-classification of fertility treatments into ovulation inductions and assisted reproductive technology (ART), showed increased use of ART (IRR 2.41, 95 % CI 1.97-2.96), whereas the use of ovulation induction was similar in survivors and siblings. Analyses by calendar time periods showed the use of ART to be significantly higher in the most recent decade, from 2003 onwards. We conclude that cancer survivors have an increased risk for subfertility, which is why fertility counselling is important. However, our results mirror a more active approach among clinicians towards fertility treatments in cancer survivors during the most recent years. This article is protected by copyright. All rights reserved.Peer reviewe

Periodontal disease-associated micro-organisms in peri-menopausal and post-menopausal women using or not using hormone replacement therapy : A two-year follow-up study

Peer reviewe