Monitoring the Normal Body: Ideals and Practices among Normal-Weight and Moderately Overweight People.

INTRODUCTION: An extensive body of literature is concerned with obese people, risk, and weight management. However, little is known about weight management among people not belonging to the extreme BMI categories. Management of weight among normal-weight and moderately overweight individuals provides us with knowledge about how to prevent future overweight or obesity. This paper investigates body size ideals and monitoring practices among normal-weight and moderately overweight people. METHODS: The study is based on in-depth interviews combined with observations. 24 participants were recruited by strategic sampling based on self-reported BMI 18.5-29.9 kg/m2 and socio-demographic factors. Inductive analysis was conducted. RESULTS: Normal-weight and moderately overweight people have clear ideals for their body size. Despite being normal weight or close to this, they construct a variety of practices for monitoring their bodies based on different kinds of calculations of weight and body size, observations of body shape, and measurements of bodily firmness. Biometric measurements are familiar to them as are health authorities' recommendations. Despite not belonging to an extreme BMI category, they translate such measurements and recommendations in meaningful ways to fit their everyday life. CONCLUSIONS: Normal-weight and moderately overweight people are concerned with their body size and continuously monitor it. Future health promotion work should consider the kind of practices already established in daily life when recommending ways of conducting body management.

Smoking cessation advice in consultations with health problems not related to smoking? Relevance criteria in Danish general practice consultations.

OBJECTIVE: To identify frames of interaction that allow smoking cessation advice in general practice consultations. DESIGN: Qualitative study based on individual in-depth interviews with GPs and their patients. Each of the GPs' consultations were observed during a three-day period. Interviews primarily addressed the consultations that had been observed. The concept of "frames" described by Goffman was deployed as an analytic tool. SETTING: Danish general practice. SUBJECTS: Six GPs and 11 of their patients. RESULTS: Both GPs and patients evaluated potential issues to be included during consultations by relevance criteria. Relevance criteria served the purpose of limiting the number of issues in individual consultations. Issues could be included if they connected to something already communicated in a consultation. Smoking cessation advice was subject to these relevance criteria and was primarily discussed if it posed a particular risk to a particular patient. Smoking cessation advice also occurred in conversations addressing the patient's well-being. If occurring without any other readable frame, smoking cessation advice was apt to be perceived by patients as part of a public campaign. CONCLUSIONS: Relevance criteria in the shape of communication of particular risks to particular patients and small-talk about well-being reflect the concept of "frames" by Goffman. Criteria of relevance limit the number of issues in individual consultations. Relevance criteria may explain why smoking cessation advice has not yet been implemented in many more consultations.

'Fantastic hands' - But no evidence: The construction of expertise by users of CAM.

Both in the Scandinavian welfare states and elsewhere the private CAM market acts as a health provider alongside the state. There is very limited established scientific evidence for the effects of treatments and often they are non-authorised. How, then, do users construct and attribute expertise to CAM practitioners? Drawing on 90 in-depth interviews with 30 Danish CAM users of reflexology or acupuncture, three aspects of expertise emerged from the empirical analysis of how the CAM users ascribe legitimacy to the therapies involved. Thus, expertise is: (i) embodied and produced by means other than those used in evidence-based knowledge or abstract expert systems; (ii) constructed by making a clear-cut division between the roles and responsibilities of the practitioner and the user; and (iii) constructed on the basis of specific training or education that practitioners have achieved. The expertise that the users seek and construct is not necessarily available, and users therefore consult many different kinds of experts. In doing so, they may themselves become the 'experts' in heterogeneous, context-specific dimensions of knowledge. In conclusion we propose further studies of what lay people can offer to a democratised and customer-sensitive system of health care as an area of inquiry that holds promise for providing a sociological approach to the domain of expertise.

Evaluating complex health interventions: a critical analysis of the 'outcomes' concept.

BACKGROUND: The extent to which a health care intervention causes or facilitates health-related change is a key question in research. The need to quantify such change has led to the development of an increasing number of change indicators, to measure what have come to be known as 'outcomes'. In the context of medical research into the efficacy or effectiveness of an intervention the term 'outcomes' has often been interpreted to mean single endpoints with a linear cause and effect link to an external intervention. DISCUSSION: In this paper we present a critical analysis of the nature and interpretation of the 'outcomes' concept and of the assumptions that underpin it. Drawing on our own work and that of others, we analyse the problems that arise when the concept is applied to complex interventions and discuss the use of other models, such as programme theory, as a basis for alternative conceptualisations for indicators of change.Our analysis demonstrates that the interpretation of 'outcomes' that may be appropriate for clinical trials of pharmaceutical products, is problematic when used in evaluations of complex interventions in areas such as complementary medicine, palliative care, rehabilitation, and health promotion. The 'outcomes' concept may impose inappropriate patterns of thought and meaning. We present alternative models, such as those based on programme theory, which conceptualise health-related change as resulting from the interaction between intervention, process and context over time. In this framework both the intervention and the patient are defined as causal factors, because the result of the treatment is dependent on the resources of the patient - such as the body's ability to heal itself--and the impact of the patient's situation. SUMMARY: Evaluations based on a model such as programme theory will encompass a wide range of health-related changes that include aspects of process, such as new meanings and understanding, as well as longer term changes in health, wellbeing and health-related competences and behaviours.

Derivative benefits: exploring the body through complementary and alternative medicine.

Since the 1960s, in Western societies, there has been a striking growth of consumer interest in complementary or alternative medicine (CAM). In order to make this increased popularity intelligible this paper challenges stereotypical images of users' motives and the results of clinical studies of CAM by exploring bodily experiences of acupuncture, reflexology treatments, and mindfulness training. The study draws on 138 in-depth interviews with 46 clients, client diaries and observations of 92 clinical treatments in order to identify bodily experiences of health and care: experiences that are contested between forces of mastery, control and resistance. We discuss why clients continue to use CAM even when the treatments do not help or even after they have been relieved of their physiological or mental problems. The encounter between the client and CAM produces derivative benefits such as a fresh and sustained sense of bodily responsibility that induces new health practices.