How a 'good parent' decides on childhood vaccination. Demonstrating independence and deliberation during Dutch healthcare visits.

Childhood vaccination consultations are considered an important phase in parents' decision-making process. To date, only a few empirical studies conducted in the United States have investigated real-life consultations. To address this gap, we recorded Dutch vaccination conversations between healthcare providers and parents during routine health consultations for their newborns. The data were analysed using Conversation Analysis and Discursive Psychology. We found that the topic of vaccination was often initiated with 'Have you already thought about vaccination?' (HYATAV), and that this formulation was consequential for parental identity work. Exploring the interactional trajectories engendered by this initiation format we show that: (1) interlocutors treat the question as consisting of two types of queries, (2) conversational trajectories differ according to which of the queries is attended to and that (3) parents work up a 'good parent' identity in response to HYATAV, by demonstrating that they think about their child's vaccination beforehand and make their decisions independently. Our findings shed new light on the interactional unfolding of parental vaccination decisions.

Health Promotion Values Underlying Healthy Eating Strategies in The Netherlands.

Healthy eating strategies are a large focus of research, practice, and policy in the Netherlands to improve the diets of socioeconomically disadvantaged populations (SDPs) and reduce health inequalities. However, the fundamental values of the health professionals that develop, implement, and evaluate healthy eating strategies are not explicit. Understanding and challenging these values may be an important step in aligning and improving efforts to support healthy diets in SDPs. The purpose of this qualitative study was to critically examine the values influencing strategies to promote healthy eating in SDPs in the Netherlands. In-depth interviews guided by a critical health promotion model were conducted with a diverse group of health professionals (n = 29) between October 2020 and January 2021 and analyzed using reflective thematic analysis. Results indicated that health professionals' values overlapped in many ways, including their shared values concerning beneficence, responsibility, and collaboration. However, value conflicts were also uncovered surrounding assumptions about SDPs and ethical change processes. The co-existence of conventional and holistic health promotion values also reflected an enduring emphasis on individual-level healthy eating strategies. It is concluded that ongoing attention to the values of health professionals is needed to advance healthy eating strategies and reduce diet-related health inequalities.

To like or not to like: Negotiating food assessments of children from families with a low socioeconomic position.

The present study explored how primary school-aged children from families with a low socioeconomic position produce 'likes' and 'dislikes' of foods during everyday family meals, and how these (dis)likes are understood and treated by their parents. It is crucial to understand how food preferences develop in the course of everyday life, as it is known that there are socioeconomic disparities in food preference and consumption, and that children from families with a low socioeconomic position have relatively poorer diets. Deploying an interactional approach to food preference, video recordings of 79 evening meals in families with a low socioeconomic position were analyzed using discursive psychology and conversation analysis. The analysis highlighted that children's food likes and dislikes were treated differently by their parents. While likes were routinely not responded to, agreed with or further elaborated, dislikes were predominantly oriented to as food refusals or treated as inappropriate, or non-genuine claims. Children's food assessments, i.e., likes and dislikes, were often disattended by parents when they appeared to be food preference displays. By contrast, assessments that accomplished social actions like refusals and complaints were more often responded to. The analysis also revealed the importance of distinguishing between assessments about food items in general, that were not currently being eaten, and assessments of food eaten here-and-now. All in all, the study evidences that and how assessment sequences open up interactional spaces where children and parents orient to and negotiate relative rights and responsibilities to know, to assess and to accomplish specific actions. Implications for food preference research are discussed.

Healthy eating strategies for socioeconomically disadvantaged populations: a meta-ethnography.

Purpose: In developed countries, diet-related health inequalities between people with different levels of socioeconomic advantage persist. However, there is limited qualitative evidence to inform the design of effective healthy eating (HE) strategies in socioeconomically disadvantaged populations (SDPs). The purpose of this review was to explore the characteristics influencing HE strategies for SDPs and develop a new understanding of how and why they influence their success.Methods: A qualitative evidence synthesis using a systematic meta-ethnographic approach. The twelve studies included were conducted in the USA, Canada, Australia, and UK.Results: The studies described a range of HE strategies, including nutrition education programs, food vouchers, and community gardens. Personal values and sense of pride and autonomy were found to have an influence on participants' attitudes towards HE strategies. Similarly, social characteristics such as level of social support and opportunities for shared benefits influenced participants' engagement. Structural characteristics such as the affordability and accessibility of healthy foods determined strategy acceptability and success. Finally, organizational characteristics such as flexibility influenced how well strategies supported the circumstances of participants.Conclusions: These overlapping characteristics may be used to inform the development, implementation, and evaluation of strategies to improve healthy eating in SDPs.

Healthy eating beliefs and the meaning of food in populations with a low socioeconomic position: A scoping review.

Profound understanding of healthy eating beliefs in populations with a low socioeconomic position (SEP) can benefit attempts to improve diet quality in this population, but literature on this subject is fragmented. The purpose of this scoping review was to systematically map healthy eating beliefs and the meaning of food and eating in populations with a low SEP. Systematic search of electronic databases yielded 35 relevant publications that were included in a qualitative synthesis. Populations with a low SEP perceived healthy eating as important, although they expressed various meanings of 'healthy' and 'good' eating. Lack of time and money posed perceived barriers to healthy eating, as well as social influences, and desired identities that can be expressed by specific foods. Traditions were important influences on food and eating practices. Eating behavior was perceived as one's own responsibility and desirably within one's own control. Parents expressed the role of food to regulate children's (eating) behavior. In conclusion, perceived limited control over what is eaten due to various barriers as described by populations with a low SEP, may also be viewed as competing values. Deeper understanding of reasons and thoughts underlying healthy eating beliefs and what it means to eat 'well' is largely lacking in this domain. The findings call for an in-depth exploration of the origin and construction of beliefs regarding 'healthy' and 'good' eating in populations with a low SEP.

Understanding science-in-the-making by letting scientific instruments speak: From semiotics to postphenomenology.

Latour encourages us to use science-in-the-making as an entry point to understanding science, because it allows us to see how scientific knowledge is constituted and through which processes the 'absolute certainties' of ready-made science appear. He approaches science-in-the-making from the perspective of semiotics because it enables him (1) to attribute equal importance to humans and nonhumans, and (2) to let the actors in scientific practices speak for themselves. We argue that Latour's semiotic approach to science-in-the-making and his understanding of scientific instruments as inscription devices do not fulfill these desiderata. This, in turn, prevents him from understanding the crucial role that scientific instruments play in science-in-the-making. As an alternative to Latour's semiotic approach, we present a postphenomenological approach to studying science-in-the-making. Using the notion of technological mediation, we argue that scientific instruments actively mediate how reality becomes present to - and is treated by - scientists. Focusing on how intentional relations between scientists and the world are mediated by scientific instruments makes it possible to turn them into genuine actors that speak for themselves, thereby recognizing their constitutive role in the development of the interpretational frameworks of scientists. We then show how a postphenomenological approach can be understood as an ethnomethodology of human-technology relations that meets both of Latour's requirements when studying science-in-the-making.

Making expertise fit: On the use of certified versus experiential knowledge in becoming an informed patient.

This article reports a discursive psychological study of online conversations among patients with ADHD, diabetes, or ALS on what constitutes an "informed patient." Being informed means different things for different patient groups. Whether patients prioritize experiential or certified expert knowledge is not indicative of patients' preferences per se but depends on how they give meaning to the responsibilities particular to their disease. ADHD patients hold each other accountable for demonstrating the seriousness of their disease. ALS patients use expert information to orient to a norm of thinking positive. Diabetes patients challenge experts to carve out independence from the diabetes regimen.

Empathically designed responses as a gateway to advice in Dutch counseling calls.

Previous conversation analytic studies of institutional interaction included analyses of empathy in interaction. These studies revealed that professionals may use empathy displays not only to validate the client's worry, but also to perform actions oriented to other institutional goals and tasks such as closing off a troubles-telling sequence. In this article, we present an analysis of empathically designed responses in Dutch telephone counseling. The data consist of 36 calls from the Alcohol and Drugs Info Line. In some of the calls, clients' troubles-telling includes 'emotion discourse', that is, descriptions of their feelings/emotions. Counselors may respond to these descriptions using conventional empathy displays like 'I can imagine that' and 'I understand that' in a range of verbal and prosodic variations. The analysis reveals that these responses open up advice sequences that vary in the extent to which they treat the client's articulated feelings as valid. Most are affiliating, treating the client's feelings as the basis for advice, while some are less affiliative, putting the client's feelings into perspective or implicitly questioning their legitimacy. Hence, empathically designed responses are pivots to advice-giving.

'You must know what you mean when you say that': the morality of knowledge claims about ADHD in radio phone-ins.

Drawing on a corpus of radio phone-ins, we present a discursive psychological analysis of how mothers carefully tailor their knowledge claims regarding their children with Attention Deficit Hyperactivity Disorder (ADHD). Mothers typically claim knowledge about their children's good intentions, but not about the 'ADHD-ness' of their conduct. Whereas the former is seen as appropriate knowledge for a concerned parent, the latter is treated as a matter of expert knowledge. We show that as soon as problematic behaviour is treated as observable from the outside and describable by mothers and other lay persons, it becomes vulnerable to being formulated as 'normal disobedience', rather than symptomatic of a professionally administered, doctorable condition. We argue that it is important to be aware of the moralities hidden in knowledge claims, as they help sustain an unproductive perspective in which either the child's brain or his mother is blamed for behaviour perceived as problematic.

"Listen to your body": Participants' alternative to science in online health discussions.

We present a discursive psychological analysis of how the idiomatic expression "Listen to Your Body" is deployed in online forum discussions about ADHD medication and aspartame. The Listen to Your Body device allows participants to demonstrate to others that they take their health seriously and for that reason avoid scientific knowledge. They contrast Listen to Your Body with "blindly following science," presenting Listen to Your Body as the more critical and, therefore, more rational behavior. Instead of treating the idiomatic expression as "anyone's knowledge," speakers and recipients compete for the right to own it. It is discussed what these results mean for the role of and relation between experiential knowledge ("lay expertise") and scientific expertise in online discussions about health issues.

The role of genes in talking about overweight: An analysis of discourse on genetics, overweight and health risks in relation to nutrigenomics.

This study examines whether the assumptions embedded in nutrigenomics, especially the alleged relation between information about personal health risks and healthy behaviour, match how people account for the relation between food, health and genes in everyday life. We draw on discourse analysis to study accounts of overweight in six group interviews with people who are and who are not overweight. The results show potentially contradictory normative orientations towards behavioural explanations of (over)weight. Overt gene accounts are interactionally problematic (in contrast to more indirect accounts such as 'build'), indicating that participants treat 'behaviour' as the normatively appropriate explanation for overweight. At the same time, however, healthy behaviour is an accountable matter, i.e. it is dealt with in interaction as behaviour that is not self-evidently right but requires an explanation. It is discussed how bringing these interactional concerns to the surface is essential for understanding future users' response to nutrigenomics and emergent technologies more in general.

If you can't eat what you like, like what you can: how children with coeliac disease and their families construct dietary restrictions as a matter of choice.

Although it is recognised that a gluten-free diet has many social implications for coeliac disease patients, not much is known about how such patients actually manage these implications in their everyday interactions. This article examines how dietary restrictions are treated by patients and their families. Data from recorded mealtime conversations of seven Dutch families with children suffering from coeliac disease were analysed using discursive psychology. We found two main discursive strategies by which patients and their families manage the diet during mealtime interactions. A reference to pleasure is used to manage the tension between the child's agency and parental responsibility in the face of health requirements and, by softening the denial of food, the diet is normalised and treated as a shared family practice. The analysis shows that the gluten-free diet is demedicalised and treated as a matter of choice rather than prescription. We conclude with the practical implications of these findings.

Quitting is not an option: An analysis of online diet talk between celiac disease patients.

This is an empirical study of the way in which celiac disease patients manage the risk of gluten intake in their everyday life.The article examines naturally occurring conversational data in order to study how patients cope interactionally with constantly being at risk in their day-to-day living. They reject quitting the diet as a valid option, and instead construct a 'diet world' in which dietary transgression is presented as an integrated part of everyday life. In this way, patients can manage occasional diet lapses without putting the validity of the diet itself at stake. By examining how the gluten-free diet is treated in interaction, we find out more about the pre-existing everyday strategies that have to be taken into account when new therapies are being introduced.

I eat healthfully but I am not a freak. Consumers' everyday life perspective on healthful eating.

The gap between the awareness and understanding of healthful eating on the one hand and actual eating practices on the other has been addressed in several ways in the literature. In this paper, we consider it from an everyday life perspective. Using discourse analysis, we analyse how Dutch consumers account for their everyday food choices. We show how Dutch consumers use three interpretative repertoires to confirm the importance of health, while not portraying themselves as too self- and health-conscious eaters. The first repertoire associates healthful eating with common knowledge and 'scripted' actions, thereby suggesting that such eating is self-evident rather than difficult. The second repertoire constructs eating for health and pleasure as uncomplicated, by emphasizing consumers' relaxed way of dealing with both. The third repertoire constructs unhealthful eating practices as naturally requiring compensation in the form of certain products or pills. We discuss how the use of these repertoires may pose socio-interactional barriers to the pursuance of healthful eating behaviour. The depiction of one's eating habits as uncomplicated, self-evidently healthful and - when bad - easy to compensate for, does not seem to provide a basis for critical considerations about these eating habits. If structural change in eating practices is to be achieved, nutrition promotion must invest in creating a new social standard that both avoids 'overdoing' bio-medical health and challenges people's construction of their eating habits as naturally healthful.

Turning adolescents into analysts of their own discourse: raising reflexive awareness of everyday talk to develop peer-based health activities.

Adopting principles applied in discursive psychology and translated to suit the practice of participatory health education, we describe in this article the five steps of the discursive action method (DAM). With this method, adolescents are stimulated to explore their own everyday conversations to become consciously aware of how they talk about health issues with their peers. Using detailed accounts of adolescents' experiences with the method, we present some first indications of the kinds of results this method can achieve. We show that the strength of the method specifically lies in two closely related domains: (a) stimulating adolescents' attentiveness to interactional problems and strategies as they occur in their own everyday talk, and (b) operating as a catalyst for developing participatory health activities aimed at peers.

Normalizing ideological food choice and eating practices. Identity work in online discussions on veganism.

In this paper we use discursive psychology to explore the relation between ideologically based food choice and identity in an online forum on veganism. The discursive psychological perspective underlines the notion of identities being part of social actions performed in talk, and thus designed and deployed for different interactional purposes. It is demonstrated that participants draw on specific discursive devices to (1) define vegan meals as ordinary and easy to prepare and (2) construct methods of preventing vitamin deficiency, such as taking supplements, as routine procedures. In 'doing being ordinary', participants systematically resist the notion that being a vegan is complicated--in other words, that it is both difficult to compose a meal and to protect your health. In this way, 'ordinariness' helps to construct and protect veganism as an ideology. We point out similarities and differences with other studies on eating or healthy lifestyles and argue, more broadly, that identities and their category-bound features are part and parcel of participants' highly flexible negotiation package.

The good life: living for health and a life without risks? On a prominent script of nutrigenomics.

Like all scientific innovations, nutrigenomics develops through a constant interplay with society. Normative assumptions, embedded in the way researchers formulate strands of nutrigenomics research, affect this interplay. These assumptions may influence norms and values on food and health in our society. To discuss the possible pros and cons of a society with nutrigenomics, we need to reflect ethically on assumptions rooted in nutrigenomics research. To begin with, we analysed a set of scientific journal articles and explicated three normative assumptions embedded in the present nutrigenomics research. First, values regarding food are exclusively explained in terms of disease prevention. Health is therefore a state preceding a sum of possible diseases. Second, it is assumed that health should be explained as an interaction between food and genes. Health is minimised to quantifiable health risks and disease prevention through food-gene interactions. The third assumption is that disease prevention by minimisation of risks is in the hands of the individual and that personal risks, revealed either through tests or belonging to a risk group, will play a large role in disease prevention. Together, these assumptions suggest that the good life (a life worth living, with the means to flourish and thrive) is equated with a healthy life. Our thesis is that these three normative assumptions of nutrigenomics may strengthen the concerns related to healthism, health anxiety, time frames and individual responsibilities for health. We reflect on these ethical issues by confronting them in a thought experiment with alternative, philosophical, views of the good life.

About evidence based and beyond: a discourse-analytic study of stakeholders' talk on involvement in the early development of personalized nutrition.

This paper draws on discourse analysis to examine how Dutch stakeholders in health education, health care, health insurance, social science, the food industry and the media make sense of innovations in the field of 'personalized nutrition' and their own role and significance in an early stage of technology development. Previous research has focused on factors that help or hinder collaboration between stakeholders, and on the development, management and implementation of joint programs. However, no attention has been paid to how stakeholders themselves handle issues of responsibility and initiative in relation to early technology development and collaborative interactions. The present study shows how such stakeholders establish themselves as gatekeepers of innovation by displaying authority on what consumers 'want' and 'cannot do', while avoiding a proactive role. Uncertainty in scientific knowledge, fixed roles and responsibilities and dependency on incompetent or biased others are drawn upon to account for a wait-and-see policy.

Patients, evidence and genes: an exploration of GPs' perspectives on gene-based personalized nutrition advice.

BACKGROUND: Nutrigenomics science examines the response of individuals to food compounds using post-genomics technology. It is expected that in the future, personalized nutrition advice can be provided based on information about genetic make-up. OBJECTIVES: Gene-based personalized nutrition advice emerges at the junction of different disciplines and technologies and may directly influence people's lives. Therefore, public concern is to be expected. Because GPs are gatekeepers of health care, their involvement in early stages of the development process is desirable. METHOD: In 2006, 15 GPs were interviewed to collect their perceived barriers and opportunities towards involvement in gene-based nutrition advice. The interviews were qualitatively analysed with use of Atlas.ti, a qualitative analysis programme. RESULTS: The participants held a mostly critical view towards such personalized nutrition advice. They argued that findings of nutritional studies lacked robustness, were not based on patients' needs and were often equivocal. And that a patient central perspective urges them to question consequences for patients. Participants argued that GPs should be involved in selecting and monitoring patients in nutrigenomics studies. CONCLUSIONS: Early involvement of GPs in the development process is needed to allow for the integration of their practical, social and ethical considerations in the technical and scientific agendas. However, the background of their critical attitude towards nutrigenomics-based personalized nutrition, and nutrition advice more generally, has to be explored further. To facilitate a joint learning process and to improve socio-technical decision making with respect to this innovation, initiatives that allow different stakeholders to exchange their perspectives should be organized.

Disputing taste: food pleasure as an achievement in interaction.

While identity has been a dominant topic in research on food choice, literature on identity in consumers' everyday life is scarce. In this article we draw on insights from discursive psychology to demonstrate how members of an online forum on food pleasure handle the hedonic appreciation of food in everyday interaction. We examined 40 discussions consisting of 1715 e-mails related to culinary topics. The analysis focuses on the way in which the participants of this forum work up and establish their identities as "gourmets". A dominant tool in performing this identity work is the discursive construction of independent access to knowledge of and experience with food items, so as to compete with or resist the epistemic superiority of a preceding evaluation. Data are presented with nine examples of the 73 manifestations of the construction of independent access. Contrary to sensory approaches to food choice, this study depicts the enjoyment of food as an interactional achievement rather than a pure physiological sensation. Wider implications of this study for the relation between food, identity and taste are discussed.