Medical invalidation in the clinical encounter: a qualitative study of the health care experiences of young women and nonbinary people living with chronic illnesses.

BACKGROUND: Medical invalidation is a well-documented phenomenon in the literature on chronic illnesses, yet there is a paucity of research capturing the perspectives of young adults living with chronic illnesses, and especially of those who are gender diverse or from groups that face broader societal marginalization. Our study sought to answer the following question: How do young women and nonbinary adults living with chronic illnesses characterize their experiences of medical invalidation and its impact on their health and well-being? METHODS: This was a patient-oriented qualitative study informed by feminist disability theory. Eligibility requirements included self-identifying as having a chronic illness, self-identifying as a woman or nonbinary person receiving health care in Manitoba, and being between the ages of 18 and 35 years. Participants took part in online arts-based workshops and subsequent focus group discussion in November 2021. RESULTS: Eight women and 2 nonbinary individuals participated. Medical invalidation was experienced by all of the participants at different points in their illness journeys and took a variety of forms depending on their social location and their particular illness, positioning invalidation as an issue of in/visibility. We identified several consequences of medical invalidation, including internalizing invalidation, overcompensating for their illness, avoiding care and, ultimately, symptom intensification. We also present participants' recommendations to avoid medical invalidation. INTERPRETATION: This study provides insight into the phenomenon of medical invalidation, understood as the act of dismissing, minimizing or otherwise not taking patient concerns seriously. We suggest person-centred care may not be enough, and critical reflexivity may help avoid unintentionally invalidating patient experiences.

Exploring male adolescents' perceptions of gender relations in South India: A project ethnography of the Parivartan program.

In Northern Karnataka, South India, boys' behaviours and attitudes towards girls are regarded as one of the many important proximate structural barriers impeding girls' access to education and academic performance in rural communities. In response to these barriers, public health practitioners developed an intervention, known as the Parivartan program, to confront the wider social and structural influences that shape adolescent boys' perspectives on gender relationships and practices that subjugate adolescent girls. Drawing upon a project ethnography approach, this study presents the findings from two phases of research conducted between 2014 and 2016 among adolescent boys who participated in the Parivartan program. First, 20 baseline qualitative interviews were conducted among male participants (between the ages 14 and 18) enrolled in the program. Next, follow-up ethnographic research, which included participant observation and ethnographic field note composition, took place one year after commencement of the intervention to illuminate the effects of the program on participants' perspectives. Transcripts and field notes were coded for key themes and emergent categories focused on representing adolescent boys' views and experiences through their narrative accounts. Within the context of an intervention, our findings portray masculinity among participants as simultaneously socially contingent, shifting and still undergoing negotiation, thereby providing an entry point through which program implementers can further encourage boys to transcend patriarchal expectations. Our findings hold important lessons for the design of future HIV and gender-based interventions with adolescent boys in India.

Reproducing stigma: Interpreting "overweight" and "obese" women's experiences of weight-based discrimination in reproductive healthcare.

Amidst a barrage of policy documents, bio-medical research, and press items concerned with the "crisis" of obesity, a growing scholarship is concerned with what has come to be known as "obesity stigma." This scholarship hails from a range of sources including critical obesity scholars who problematize the idea of obesity as a health concern, as well as from "mainstream" organizations and researchers who, while maintaining obesity is a world-wide health problem, also argue that "obese" people are the targets of discrimination. In this paper, we analyze both interpretations of obesity stigma, particularly as that stigma applies to obese women's experiences of accessing and receiving reproductive care. We describe a qualitative study conducted with 24 overweight and obese women in 2 Canadian cities. Participants related overt and covert experiences of stigma when accessing reproductive care founded in healthcare practitioners' focus on fetal risk and "mother-blame" which, though partially evidence-based, was interpreted by participants as discriminatory. As such, we maintain that any true interruption of obesity stigma in the reproductive healthcare interaction requires a bridge between critical and mainstream scholarship, and careful attention to the risk-based foci in clinical settings which can be interpreted by clients as moralizing.

Addressing gaps in physician knowledge regarding transgender health and healthcare through medical education.

BACKGROUND: Transgender people (those people whose sex at birth does not "match" their felt gender identity) are a priority group for healthcare as they experience high rates of discrimination and related illnesses. Despite this, there is a trend of poor healthcare access for trans people due, in large part, to the denial of care on the part of physicians. A small body of literature is beginning to suggest that this denial of care may be due to a lack of physician knowledge as well as, in some cases, to transphobia. There is a dearth of research in Canada, however, exploring whether and/or how knowledge gaps create barriers to quality care, and whether medical education can attend to these gaps while and through addressing gender normativity. METHODS: To fill these gaps in the literature, we undertook a qualitative study with 30 trans identified people and 11 physicians (N=41) in Winnipeg, Manitoba. Methods included semi-structured individual interviews and focus groups. Data were transcribed and analyzed with NVivo qualitative data software using iterative methods. RESULTS: An overwhelming finding of this study was a lack of physician knowledge, as reported both by trans people and by physicians, that resulted in a denial of trans-specific care and also impacted general care. Transphobia was also identified as a barrier to quality care by both trans people and physicians. Physicians were open to learning more about trans health and healthcare. CONCLUSIONS: The findings suggest a pressing need for better medical education that exposes students to basic skills in trans health so that they can become competent in providing care to trans people. This learning must take place alongside anti-transphobia education. Based on these findings, we suggest key recommendations at the close of the paper for providing quality trans health curriculum in medical education.

The rural and the rotund? A critical interpretation of food deserts and rural adolescent obesity in the Canadian context.

Resting on the notion that rural spaces are "food deserts," rural adolescents are increasingly regarded as a "problem population" in Western obesity narratives. Using qualitative data gleaned from interviews with 51 teenage participants from rural areas across Canada, this paper focuses on the ways in which obesity is constructed as a rural disease in the Canadian context, demonstrating in particular how discourses of food deserts and related rural obesity rely on classist imaginings of obesity as a working-class embodiment. The paper will further question the understanding of the rural as a food desert, showing the ways in which rural teens acquire fresh, healthy foods in part through an informal economy of food growing and sharing.

"Too much of that stuff can't be good": Canadian teens, morality, and fast food consumption.

Recently, public health agents and the popular media have argued that rising levels of obesity are due, in part, to "obesogenic" environments, and in particular to the clustering of fast food establishments in Western urban centers that are poor and working class. Our findings from a multi-site, cross-national qualitative study of teenaged Canadians' eating practices in urban and rural areas offer another perspective on this topic, showing that fast food consumption is not simply a function of the location of fast food outlets, and that Canadian teens engage in complex ways with the varied dimensions of choosing (or rejecting) fast foods. Drawing on evidence gleaned from semi-structured interviews with 132 teenagers (77 girls and 55 boys, ages 13-19 years) carried out between 2007 and 2009, we maintain that no easy relationship exists between the geographical availability of fast food and teen eating behaviors. We use critical obesity literature that challenges widely accepted understandings about obesity prevalence and etiology, as well as Lamont's (1992, 2000) concept of "moral boundary work," to argue that teen fast food consumption and avoidance is multifaceted and does not stem exclusively nor directly from spatial proximity or social class. Through moral boundary work, in which teens negotiated with moralistic notions of healthy eating, participants made and re-made themselves as "good" and successful subjects by Othering those who were "bad" in references to socially derived discourses of healthy eating.