Addressing the complexity of equitable care for larger patients: A critical realist framework

Kanagasingam, Deana

doi:10.1016/j.ssmqr.2022.100137

Cited by 4 publications

(5 citation statements)

References 83 publications

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“…This blame extends from the wider literature suggesting that preconception and pregnancy environments can influence the wellbeing and development of future generations, for example, through epigenetic changes [12], and biomedical discourse that legitimises controlling women's bodies [13]. This intersects with (predominantly Western) societal expectations for women to attain a thin and thus more 'attractive' body [14,15]. It is also possible that the extensive research into maternal obesity and the comparatively limited evidence for the contribution of paternal obesity to offspring outcomes [16] have led to an unbalanced perspective in the media that reinforces weight stigma and related messages for women [17].…”

Section: Introductionmentioning

confidence: 79%

The Challenge of Weight Stigma for Women in the Preconception Period: Workshop Recommendations for Action from the 5th European Conference on Preconception Health and Care

Hill,

Azzari Wynn-Jones,

Botting

et al. 2023

IJERPH

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Weight stigma is a well-recognised public health issue affecting many members of society including women during the preconception period. The impacts of preconception weight stigma on women are significant and may result in decreased access to and uptake of healthcare, and mental health concerns. The consequences of this weight stigma may translate to negative maternal outcomes and even intergenerational effects on the child. Eliminating weight stigma is therefore imperative. The aim of this paper is to report recommendations to reduce weight stigma for preconception women produced at a workshop with clinical and academic experts on preconception health and weight stigma at the 5th European Conference on Preconception Health and Care. The recommendations are related to two key areas: general societal recommendations prompting all people to acknowledge and adjust our attitudes towards larger-bodied people; and healthcare-specific recommendations imploring clinicians to upskill themselves to reduce weight stigma in practice. We therefore call for urgent approaches to address societal weight-stigmatising attitudes and norms related to both the general population and preconception women, while providing professional development opportunities for healthcare professionals relating to weight stigma. Eliminating weight stigma for preconception women may have positive impacts on the outcomes for mothers and children during pregnancy and beyond.

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Section: Introductionmentioning

confidence: 79%

The Challenge of Weight Stigma for Women in the Preconception Period: Workshop Recommendations for Action from the 5th European Conference on Preconception Health and Care

Hill,

Azzari Wynn-Jones,

Botting

et al. 2023

IJERPH

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“…A similar ‘value on mobility’ was recently reported for adults with osteoarthritis who perceived that the physical and psychological aspects of SB were interwoven with those of physical activity and who were trying to preserve mobility by keeping active. 58 This ‘value on mobility’ may be a particularly important maxim for adults with obesity during times of injury or when mobility has declined or is at risk of decline due to obesity related complications such as osteoarthritis.…”

Section: Discussionmentioning

confidence: 99%

A qualitative study of perceived barriers and facilitators to interrupting sedentary behavior among adults living with obesity

Curran,

Brennan,

Matthews

et al. 2023

Obesity Science & Practice

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IntroductionBoth obesity and sedentary behaviour (SB), are associated with negative health consequences including cardiovascular disease, diabetes, certain cancers and all‐cause mortality. To date, perceived barriers and facilitators to interrupting SB in adults living with obesity have not been identified.ObjectiveThis study aimed to identify these perceived barriers and facilitators by conducting a behavioural analysis underpinned by the theoretical domains framework (TDF) and the Capability, Opportunity, Motivation‐Behaviour (COM‐B) model, to enhance knowledge and inform future intervention development.MethodsA purposive and snowball sample (N=21) of adults living with obesity took part in semi‐structured interviews, guided by the TDF, to investigate perceived barriers or facilitators to interrupting SB. Transcribed interviews were inductively coded using reflexive thematic analysis. Key themes and subthemes were generated by grouping similar and recurring codes. Finally, subthemes were mapped to the TDF and COM‐B.ResultsFive key themes were identified, which influence SB across all domains of living. These relate to (i) physical and mental wellbeing; (ii) motivational readiness; (iii) roles, responsibilities and support; (iv) weight bias and stigma and (v) the environment. These themes were then deductively mapped to all 14 TDF domains and all six of the COM‐B constructs.ConclusionA complex interplay of individual, societal and policy factors contribute to the development and habituation of SB patterns for adults living with obesity. Factors identified in this study could assist in the development of interventions, strategies and policies designed to interrupt or reduce sedentary behaviour for this population.This article is protected by copyright. All rights reserved.

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“…As this research is looking at the experiences of fat people within a specific condition, the COVID-19 pandemic, and a specific context, vaccination centres, using critical realism can help find the unseen mechanisms that affect these experiences. Critical realism has been used by Kanagasingam (2022) to investigate healthcare equity in relation to fatness, and Sims-Schouten and Riley (2019)as a tool to look at healthcare service users accounts (Sims-Schouten & Riley, 2019). Both of these show relevance to the current research which is looking to address a healthcare inequity for fat people through the accounts of their service use.…”

Section: Critical Realist Perspective and Body Privilege Frameworkmentioning

confidence: 99%

“…Both of these show relevance to the current research which is looking to address a healthcare inequity for fat people through the accounts of their service use. Kanagasingam (2022) uses critical realism to position fat as an emergent quality that has the potential to harm or do good but cannot be removed from its context nor can it be understood outside of its context. Within this study, fat is contextualised as being constituted of behavioural, socio-cultural, structural and economic factors (Kanagasingam, 2022).…”

Section: Critical Realist Perspective and Body Privilege Frameworkmentioning

confidence: 99%

“…Kanagasingam (2022) uses critical realism to position fat as an emergent quality that has the potential to harm or do good but cannot be removed from its context nor can it be understood outside of its context. Within this study, fat is contextualised as being constituted of behavioural, socio-cultural, structural and economic factors (Kanagasingam, 2022). Sims-Schouten and Riley (2019) employ critical realism to help understand the socially constructed nature of mental health and the impact that outside, structural and systemic factors can have on this construction.…”

Section: Critical Realist Perspective and Body Privilege Frameworkmentioning

confidence: 99%

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Self-Identified Fat Peoples Experiences of COVID-19 Vaccination Centre's in Aotearoa NZ

Stolte

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<p><strong>This study investigates self-identified fat people’s experiences of COVID-19 vaccination centres in Aotearoa NZ. This includes attention to multiple facets of the experience of COVID-19 vaccination centres including the physical environment, interaction with service providers, and knowledge of and access to a long needle in accordance with Ministry of Health vaccination guidelines. The thesis employs a critical realist/contextualist approach, underpinned by the theory of body privilege. Qualitative content analysis is used to analyse open-ended survey responses collected as part of a broader international study. Three main themes are identified from the data set. The first theme, ‘“Crammed in Like Sardines”: Navigating COVID-19 vaccination centre environments’ found mixed experiences and a number of challenges in fat people’s access to and movement through vaccination centres. The second theme, “Thank fuck for fat activists”: The need for COVID-19 vaccination advocacy’ captured the importance that fat people’s advocacy played, both at the individual and community level in ensuring access to COVID-19 vaccinations and in raising awareness about long needle guidelines. The third theme, ‘“I worry about the effectiveness of my vaccine now”: Trust and authority in the vaccination encounter’ identifies the power imbalance within vaccination centres that placed authority with the vaccinator and undermined fat people’s self-advocacy and self-determination for long needle use. I demonstrate the corrosive impact this had on fat people’s confidence that they were protected from COVID-19 and subsequently their trust in the governments COVID-19 responsiveness for fat people. Findings highlight the healthcare inequities experienced by fat people when accessing COVID-19 vaccination that can also be seen reflected in everyday healthcare systems and settings. Vaccination centers were found to privilege thinness at both a structural and interactional level which excluded fat people and disregarded the needs of the fat community as well as other marginalized communities. These inequities ultimately served to undermine public health policies that were meant to protect and provide equitable care to the entire population. The neglect of fat people’s needs led to the requirement of advocacy by fat people to seek accessible and equitable healthcare. Whilst effective in helping promote protection for fat people, public health programmes that rely on community and self-advocacy to ensure responsiveness to marginalized communities is neither a fair solution nor is it sustainable in the long term. Research findings point to important lessons to be learned to ensure the inclusion of and responsiveness to fat people in future pandemic responses and in healthcare systems more generally.</strong></p>

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Addressing the complexity of equitable care for larger patients: A critical realist framework

Cited by 4 publications

References 83 publications

The Challenge of Weight Stigma for Women in the Preconception Period: Workshop Recommendations for Action from the 5th European Conference on Preconception Health and Care

The Challenge of Weight Stigma for Women in the Preconception Period: Workshop Recommendations for Action from the 5th European Conference on Preconception Health and Care

A qualitative study of perceived barriers and facilitators to interrupting sedentary behavior among adults living with obesity

Self-Identified Fat Peoples Experiences of COVID-19 Vaccination Centre's in Aotearoa NZ

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