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Obesity, stigma, and responsibility in health care: A synthesis of qualitative studies  [cached]
Kirsti Malterud,Kjersti Ulriksen
International Journal of Qualitative Studies on Health & Well-Being , 2011, DOI: 10.3402/qhw.v6i4.8404
Abstract: Objective: To synthesize research findings on experiences and attitudes about obesity and stigma in health care. Methods: We compiled qualitative studies and applied Noblitt & Hare's meta ethnography to identify, translate, and summarize across studies. Thirteen qualitative studies on experiences and attitudes about obesity and stigma in health care settings were identified and included. Results: The study reveals how stigmatizing attitudes are enacted by health care providers and perceived by patients with obesity. Second-order analysis demonstrated that apparently appropriate advice can be perceived as patronizing by patients with obesity. Furthermore, health care providers indicate that abnormal bodies cannot be incorporated in the medical systems—exclusion of patients with obesity consequently happens. Finally, customary standards for interpersonal respect are legitimately surpassed, and patients with obesity experience contempt as if deserved. Third-order analysis revealed conflicting views between providers and patients with obesity on responsibility, whereas internalized stigma made patients vulnerable for accepting a negative attribution. A theoretical elaboration relates the issues of stigma with those of responsibility. Conclusion: Contradictory views on patients’ responsibility, efforts, knowledge, and motivation merge to internalization of stigma, thereby obstructing healthy coping and collaboration and creating negative contexts for empowerment, self-efficacy, and weight management. Professionals need to develop their awareness for potentially stigmatizing attitudes towards vulnerable patient populations.
Should I stay or should I go? Understanding families’ decisions regarding initiating, continuing, and terminating health services for managing pediatric obesity: the protocol for a multi-center, qualitative study  [cached]
Ball Geoff DC,Garcia Arnaldo Perez,Chanoine Jean-Pierre,Morrison Katherine M
BMC Health Services Research , 2012, DOI: 10.1186/1472-6963-12-486
Abstract: Background At least two million Canadian children meet established criteria for weight management. Due to the adverse health consequences of obesity, most pediatric weight management research has examined the efficacy and effectiveness of interventions to improve lifestyle behaviors, reduce co-morbidities, and enable weight management. However, little information is available on families’ decisions to initiate, continue, and terminate weight management care. This is an important knowledge gap since a substantial number of families fail to initiate care after being referred for weight management while many families who initiate care discontinue it after a brief period of time. This research aims to understand the interplay between individual, family, environmental, and systemic factors that influence families’ decisions regarding the management of pediatric obesity. Methods/Design Individual interviews will be conducted with children and youth with obesity (n = 100) and their parents (n = 100) for a total number of 200 interviews with 100 families. Families will be recruited from four Canadian multi-disciplinary pediatric weight management centers in Vancouver, Edmonton, Hamilton, and Montreal. Participants will be purposefully-sampled into the following groups: (i) Non-Initiators (5 families/site): referred for weight management within the past 6 months and did not follow-up the referral; (ii) Initiators (10 families/site): referred for weight management within the past 6 months and did follow-up the referral with at least one clinic appointment; and (iii) Continuers (10 families/site): participated in a formal weight management intervention within the past 12 months and did continue with follow-up care for at least 6 months. Interviews will be digitally recorded and analyzed using an ecological framework, which will enable a multi-level evaluation of proximal and distal factors that underlie families’ decisions regarding initiation, continuation, and termination of care. Demographic and anthropometric/clinical data will also be collected. Discussion A better understanding of family involvement in pediatric weight management care will help to improve existing health services in this area. Study data will be used in future research to develop a validated survey that clinicians working in pediatric obesity management can use to understand and enhance their own health services delivery.
Qualitative studies of obesity: A review of methodology  [PDF]
Ian Brown, Jill Gould
Health (Health) , 2013, DOI: 10.4236/health.2013.58A3010
Abstract:

BACKGROUND: There is a developing interest in qualitative research to understand the perspectives and experiences of people living with obesity. However, obesity is a stigmatised condition associated with negative stereotypes. Social contexts emphasizing large body size as a problem, including research interviews, may amplify obesity stigma. This study reviews the methodology employed by qualitative studies in which study participants were obese and data collection involved face-to-face interviews. METHODS: Database searches identified qualitative studies meeting inclusion criteria from 1995 to 2012. Following screening and appraisal data were systematically extracted and analyzed from 31 studies. RESULTS: The studies included 1206 participants with a mean age of 44 years and mean BMI of37 kg/m2. Women (78.8%) outnumbered men (21.2%) by four to one. Socio-economic background was not consistently reported. The studies employed similar, typically pragmatic, qualitative methodologies, providing rich textual data on the experience of obesity derived from face-to-face interviews. The majority considered quality issues in data collection, analyses and generalizability of findings. However, the studies were weak as regards researcher reflexivity in relation to interviewer characteristics and obesity stigma. CONCLUSIONS: The impact of obesity stigma has not been attended to in the qualitative research. Clear information about study

Arguing for Decisions: A Qualitative Model of Decision Making  [PDF]
Blai Bonet,Hector Geffner
Computer Science , 2013,
Abstract: We develop a qualitative model of decision making with two aims: to describe how people make simple decisions and to enable computer programs to do the same. Current approaches based on Planning or Decisions Theory either ignore uncertainty and tradeoffs, or provide languages and algorithms that are too complex for this task. The proposed model provides a language based on rules, a semantics based on high probabilities and lexicographical preferences, and a transparent decision procedure where reasons for and against decisions interact. The model is no substitude for Decision Theory, yet for decisions that people find easy to explain it may provide an appealing alternative.
Charting a Moral Life: The Influence of Stigma and Filial Duties on Marital Decisions among Chinese Men who Have Sex with Men  [PDF]
Wayne T. Steward, Pierre Miège, Kyung-Hee Choi
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0071778
Abstract: Introduction Stigma constitutes a critical challenge to the rising rates of HIV among Chinese men who have sex with men (MSM). It reduces willingness to disclose one’s sexual orientation and can lead to concurrent sexual partnerships. Disclosure decisions are also affected by cultural norms that place pressures on sons to marry. In this manuscript, we characterize how stigma and cultural factors influenced Chinese MSM’s decisions around disclosure and marriage. We seek to show that MSM’s actions were motivated by moral considerations, even when those choices posed HIV transmission risks. Methods We conducted qualitative interviews with 30 MSM in Beijing, China. Interviews were audio-recorded, transcribed, and translated into English for analysis. Transcripts were coded using a procedure that allowed for themes to emerge organically. Results Participants struggled with feelings of shame and believed that others possessed stigmatizing attitudes about homosexuality. They had experienced relatively little discrimination because they infrequently disclosed their MSM status. In response to marital pressures, participant had to reconcile same-sex attractions with filial expectations. Their choices included: not being involved with women; putting on the appearance of a heterosexual relationship by marrying a lesbian; or fulfilling family expectations by marrying a heterosexual woman. Regardless of the decision, many rooted the justifications for their choices in the considerations they had given to others’ needs. Conclusion The growing epidemic among MSM in China requires action from the public health community. As programs are scaled up to serve these men, it is critical to remember that MSM, who often fear social sanction if they were to reveal their sexual orientation, continue to face the same pressures from culturally normative social duties as heterosexual men. Interventions must find ways to help men navigate a balance between their own needs and the responsibilities they feel toward their parents and others.
The body politic: the relationship between stigma and obesity-associated disease
Peter Muennig
BMC Public Health , 2008, DOI: 10.1186/1471-2458-8-128
Abstract: In this study, I pursue novel lines of evidence to explore the possibility that obesity-associated stigma produces obesity-associated medical conditions. I also entertain alternative hypotheses that might explain the observed relationships.I forward four lines of evidence supporting the hypothesis that psychological stress plays a role in the adiposity-health association. First, body mass index (BMI) is a strong predictor of serological biomarkers of stress. Second, obesity and stress are linked to the same diseases. Third, body norms appear to be strong determinants of morbidity and mortality among obese persons; obese whites and women – the two groups most affected by weight-related stigma in surveys – disproportionately suffer from excess mortality. Finally, statistical models suggest that the desire to lose weight is an important driver of weight-related morbidity when BMI is held constant.Obese persons experience a high degree of stress, and this stress plausibly explains a portion of the BMI-health association. Thus, the obesity epidemic may, in part, be driven by social constructs surrounding body image norms.Over the past two decades, body mass has increased rapidly, especially among persons who are already overweight or obese.[1] This increase in body mass presents public health challenges both because thin bodies are seen as physically attractive, and because obesity is associated with poor health outcomes.[2,3] Obese persons' health is worse throughout the lifecourse than normal weight persons, and their lifespan is nearly two years shorter on average.[2]The conventional wisdom is that this obesity-related excess mortality arises from a series of biochemical changes associated with adiposity. [4-14] These changes include higher serum levels of pro-inflammatory, pro-thrombotic cytokines, such as C-reactive protein (CRP), tumor necrosis factor alpha (TNF-alpha), and interleukin-6 (IL-6).[15] Cytokines serve as messenger molecules that mobilize the immune sy
Moving Beyond the Stigma: Systematic Review of Video Games and Their Potential to Combat Obesity  [PDF]
Stacey Guy,Alexandria Ratzki-Leewing,Femida Gwadry-Sridhar
International Journal of Hypertension , 2011, DOI: 10.4061/2011/179124
Abstract: Increasing epidemic proportions of overweight children in the United States presents formidable challenges for education and healthcare. Given the popularity and pervasiveness of video gaming culture in North American children, the perfect opportunity arises to investigate the potential of video games to promote healthful behaviour. Our objective was to systematically review the literature for possible benefits of active and educational video games targeting diet and physical activity in children. A review of English-language journal articles from 1998 to 2011 using EMBASE and PubMed was conducted. Thirty-four studies concerned with children, video games, physical, and/or nutritional outcomes were included. Results of these studies that showed some benefit (increased physical activity and nutritional knowledge as a result of gaming) demonstrate the possibility of video games to combat childhood obesity—looking beyond the stigma attached to gaming. 1. Introduction Overweight or obesity among American children has reached epidemic proportions [1]. Over the past 25 years, childhood overweight or obesity has nearly quadrupled in the United States, affecting almost 17% of children and adolescents aged 2–19 in 2007-2008 [2, 3]. Childhood overweight or obesity is defined as having a body mass index (BMI) greater or equal to the age- and sex-specific 95th percentile of the 2000 Centre for Disease Control growth charts [3]. Overweight-obese youth are increasingly suffering from comorbid conditions once considered limited to adults [4]. Despite considerable efforts to halt or reverse the growing rates of childhood overweight or obesity, the incidence continues to escalate. Paediatric overweight or obesity has been implicated in a myriad of serious health concerns. Short-term consequences of overweight-obese status include chronic orthopedic and psychological disorders, nonalcoholic fatty liver diseases, metabolic syndrome, as well as a host of cardiovascular diseases such as hypertension and Type II diabetes mellitus [5, 6]. Long-term consequences have proven the persistence of childhood obesity into adulthood, with an estimated 50% of obese adolescents becoming obese adults [6]. This persistence into adulthood incites a cascade of cardiovascular risk factors and other chronic morbidities, dramatically increasing the risk for premature mortality [5]. The economic burden of overweight and obesity on the American healthcare system is expected to intensify with persevering rates of childhood overweight and obesity [7]. Physical activity and diet are important in the
Moving Beyond the Stigma: Systematic Review of Video Games and Their Potential to Combat Obesity  [PDF]
Stacey Guy,Alexandria Ratzki-Leewing,Femida Gwadry-Sridhar
International Journal of Hypertension , 2011, DOI: 10.4061/2011/179124
Abstract: Increasing epidemic proportions of overweight children in the United States presents formidable challenges for education and healthcare. Given the popularity and pervasiveness of video gaming culture in North American children, the perfect opportunity arises to investigate the potential of video games to promote healthful behaviour. Our objective was to systematically review the literature for possible benefits of active and educational video games targeting diet and physical activity in children. A review of English-language journal articles from 1998 to 2011 using EMBASE and PubMed was conducted. Thirty-four studies concerned with children, video games, physical, and/or nutritional outcomes were included. Results of these studies that showed some benefit (increased physical activity and nutritional knowledge as a result of gaming) demonstrate the possibility of video games to combat childhood obesity—looking beyond the stigma attached to gaming.
On the Qualitative Comparison of Decisions Having Positive and Negative Features  [PDF]
Didier Dubois,Hélène Fargier,Jean-Fran?ois Bonnefon
Computer Science , 2014, DOI: 10.1613/jair.2520
Abstract: Making a decision is often a matter of listing and comparing positive and negative arguments. In such cases, the evaluation scale for decisions should be considered bipolar, that is, negative and positive values should be explicitly distinguished. That is what is done, for example, in Cumulative Prospect Theory. However, contraryto the latter framework that presupposes genuine numerical assessments, human agents often decide on the basis of an ordinal ranking of the pros and the cons, and by focusing on the most salient arguments. In other terms, the decision process is qualitative as well as bipolar. In this article, based on a bipolar extension of possibility theory, we define and axiomatically characterize several decision rules tailored for the joint handling of positive and negative arguments in an ordinal setting. The simplest rules can be viewed as extensions of the maximin and maximax criteria to the bipolar case, and consequently suffer from poor decisive power. More decisive rules that refine the former are also proposed. These refinements agree both with principles of efficiency and with the spirit of order-of-magnitude reasoning, that prevails in qualitative decision theory. The most refined decision rule uses leximin rankings of the pros and the cons, and the ideas of counting arguments of equal strength and cancelling pros by cons. It is shown to come down to a special case of Cumulative Prospect Theory, and to subsume the Take the Best heuristic studied by cognitive psychologists.
“Voices of Fear and Safety” Women’s ambivalence towards breast cancer and breast health: a qualitative study from Jordan
Hana Taha, Raeda Al-Qutob, Lennarth Nystr?m, Rolf Wahlstr?m, Vanja Berggren
BMC Women's Health , 2012, DOI: 10.1186/1472-6874-12-21
Abstract: We performed an explorative qualitative study with purposive sampling. Ten focus groups were conducted consisting of 64 women (aged 20 to 65?years) with no previous history and no symptoms of breast cancer from four governorates in Jordan. The transcribed data was analysed using latent content analysis.Three themes were constructed from the group discussions: a) Ambivalence in prioritizing own health; b) Feeling fear of breast cancer; and c) Feeling safe from breast cancer. The first theme was seen in women’s prioritizing children and family needs and in their experiencing family and social support towards seeking breast health care. The second theme was building on women’s perception of breast cancer as an incurable disease associated with suffering and death, their fear of the risk of diminished femininity, husband’s rejection and social stigmatization, adding to their apprehensions about breast health examinations. The third theme emerged from the women’s perceiving themselves as not being in the risk zone for breast cancer and in their accepting breast cancer as a test from God. In contrast, women also experienced comfort in acquiring breast health knowledge that soothed their fears and motivated them to seek early detection examinations.Women’s ambivalence in prioritizing their own health and feelings of fear and safety could be better addressed by designing breast health interventions that emphasize the good prognosis for breast cancer when detected early, involve breast cancer survivors in breast health awareness campaigns and catalyse family support to encourage women to seek breast health care.Breast cancer is the leading cause of cancer related mortality among women worldwide; it constitutes 23% of the total new cancer cases and 14% of the cancer deaths [1]. Early detection of breast cancer makes the treatment more effective which leads to better health outcomes and higher survival rates. The 5-year survival rate reaches 93 and 88% when breast cancer is de
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