Antoinette Fage-Butler - Academia.edu (original) (raw)

Papers by Antoinette Fage-Butler

Public Understanding of Science

Social Science & Medicine

Analysing Health Communication

Poststructuralist discourse analysis (PDA) that draws on Foucauldian discourse theory enables res... more Poststructuralist discourse analysis (PDA) that draws on Foucauldian discourse theory enables researchers to analyse cultural aspects of health communication, as it makes it possible to identify the discourses and subject positions available to and used by those who communicate about health-related topics. This chapter presents and illustrates the methods of statement function analysis to analyse discourses, and subject position analysis to analyse the identities associated with discursive statements, using data from an online forum where HPV vaccination was debated. The findings show that constructing the basis for knowing is central in the posts, with the diverging perspectives legitimized in various ways. The chapter ends with a discussion of the usefulness of employing poststructuralist discourse analysis to map out broader cultural meanings in health communication texts when values are at the heart of the matter.

BMJ Open

ObjectiveEmail consultations have become part of everyday doctor–patient communication in many co... more ObjectiveEmail consultations have become part of everyday doctor–patient communication in many countries. The objective of this study is to investigate how patients and general practitioners (GPs) perceive the communicative advantages and disadvantages of access via email consultation drawing on a media-theoretical perspective.DesignWe analysed qualitative interview data from general practices in Denmark to identify salient themes.ParticipantsOur data set consists of semi-structured interviews with 30 patients and 23 GPs. The data were collected from February 2016 to September 2019.ResultsThe following themes emerged: (1) lower contact threshold, (2) accessing a new interaction space and (3) access to access. From the patients’ perspective, email consultations provided more convenient contact with their GP. From the GPs’ perspective, email consultations facilitated contact with patients whom they otherwise rarely saw, but also resulted in overuse and inappropriate use. Patients and ...

Health Education & Behavior

Nudging is increasingly used in public health interventions in Western societies to produced heal... more Nudging is increasingly used in public health interventions in Western societies to produced health-promoting behavior changes; however, there is lack of clarity as to what constitutes a nudge, scant knowledge of the effectiveness of nudging techniques in public health lifestyle interventions and a number of ethical and value-based concerns. The aim of this review is to address these research lacunae and identify the characteristics of nudges in empirical research on public health interventions intended to induce healthy lifestyle changes, including whether they are effective. We conducted systematic searches for relevant articles published between January 2008 and April 2019 in three databases, PubMed, CINAHL and PsycINFO, and combined this with a metasynthesis to construct interpretative explanations. A total of 66 original studies met the inclusion criteria. The findings of the systematic review showed that most nudging interventions involved diet/nutrition, most were carried out...

Health Promotion International

Summary Nudging has been discussed in the context of public health, and ethical issues raised by ... more Summary Nudging has been discussed in the context of public health, and ethical issues raised by nudging in public health contexts have been highlighted. In this article, we first identify types of nudging approaches and techniques that have been used in screening programmes, and ethical issues that have been associated with nudging: paternalism, limited autonomy and manipulation. We then identify nudging techniques used in a pamphlet developed for the Danish National Screening Program for Colorectal Cancer. These include framing, default nudge, use of hassle bias, authority nudge and priming. The pamphlet and the very offering of a screening programme can in themselves be considered nudges. Whether nudging strategies are ethically problematic depend on whether they are categorized as educative- or non-educative nudges. Educative nudges seek to affect people’s choice making by engaging their reflective capabilities. Non-educative nudges work by circumventing people’s reflective capa...

Conjunctions. Transdisciplinary Journal of Cultural Participation

New technologies have facilitated doctor–patient email consultations (e-consultations). Guideline... more New technologies have facilitated doctor–patient email consultations (e-consultations). Guidelines for e-consultation use in Denmark state that they should be used for simple, concrete and non-urgent queries; however, a small-scale Danish study suggested that doctors encounter e-consultations that do not match the guidelines. The purpose of this article is to explore whether e-consultations in Denmark reflect recommendations that they should be simple, short, concrete and well defined, and if not, what forms of complexity are evident. We inductively analysed 1,671 e-consultations from 38 patients aged 21–91 years communicating with 28 doctors, 6 nurses, 1 medical student and 8 secretaries. Results showed both quantitative complexity in terms of number of interaction turns, communicative participants, and questions asked, and qualitative complexity relating to patients’ psychosocial contexts and GPs’ biomedical disease perspective. Thus, despite existing guidelines and the leanness a...

Leviathan: Interdisciplinary Journal in English

This article introduces student readers to the realm of the interdisciplinary, with a primary foc... more This article introduces student readers to the realm of the interdisciplinary, with a primary focus on the humanities. We first introduce interdisciplinarity and other related terms as concepts. We then present eight specific examples, on which we illustrate interdisciplinary research. Finally, we address the question of when one should be interdisciplinary.

Health Promotion International

Violence against women constitutes a significant public health problem affecting an estimated 35%... more Violence against women constitutes a significant public health problem affecting an estimated 35% of women worldwide (WHO, 2013); the scale of the problem and its ongoing intransigence indicate the need for critical and transformative approaches that confront the cultures that support gender violence and lead to change. The present paper analyses a program run in Scottish primary schools for 10–12 year olds called RESPECT that was successful in making pupils alert to and critical of gendering norms and practices. Analysis reveals that the teaching plans and activities of RESPECT are highly consistent with a critical pedagogical approach (Freire, 2005; Matthews, 2014), and indicates the value of combining the theoretical approaches of critical pedagogy, feminism and critical health literacy in public health campaign materials aimed at challenging the cultural bases of gender violence in ways that promote health in an educational setting.

International Journal of Cultural Policy

Abstract The EU’s cultural policy of creating a recognisable, common European identity is exempli... more Abstract The EU’s cultural policy of creating a recognisable, common European identity is exemplified by the EU’s cultural programme, European Capitals of Culture (ECOCs), whose official purpose is to highlight similarities and differences across European cultures to generate a greater sense of European identity among the citizens of Europe. To date, there has been little qualitative investigation of how ECOC attenders perceive the representation of European culture in the events and what they think about using ECOC events to promote Europeanisation. In this article, I use the methodology of intercept interviews at four Aarhus 2017 events to explore these two aspects. Findings indicate that the inclusion of European culture in Aarhus 2017 events often went unnoticed by the event attenders, and there was uncertainty about what European culture might actually comprise. Instead of perceiving ECOC events as promoting Europe, event attenders tended to interpret Aarhus 2017 events within a local, national or international framework, with ECOC events perceived as promoting tolerance and intercultural understanding. The findings are discussed in relation to the value of ECOC as a political-cultural initiative for generating European citizens’ identification with the EU.

HERMES - Journal of Language and Communication in Business

The internet has revolutionised the ways in which patients acquire medical information, a develop... more The internet has revolutionised the ways in which patients acquire medical information, a development which has clearly been welcomed by patients: seeking out health information online is now the third most popular activity after internet searches and e-mail (Timimi 2012). However, it has led to concerns about the quality of the information, the ability of lay people to understand it (Gerber/Eiser 2001) as well as potential cyberchondria (Starcevic/Berle 2013). In light of these conflicting perspectives, this paper examines one such source of online information, namely, the patient forum where patients communicate with other patients about a particular medical condition. Although doctor-patient communication in the clinical situation has been extensively researched, little is known about how patient-patient communication is managed in online situations such as patient forums. The purpose of this paper is to contribute to research in that relatively un-researched area by examining ho...

DIGITAL HEALTH

Objective This article explores how a diabetes app called Diapplo affected adolescents’ participa... more Objective This article explores how a diabetes app called Diapplo affected adolescents’ participation in their healthcare by investigating adolescents’ meaning-making in relation to their use of the app. Methods Using a qualitative single case-study design, we adopted a multimethod responsive approach to data generation that included written data from the app development process, individual and group interviews and observations of the adolescents in the clinical situation. This article presents the results from a qualitative content analysis of group and individual semi-structured interviews conducted with five adolescents diagnosed with type 1 diabetes during and after the four-week test phase of a prototype of the app. Results The adolescents appreciated the diabetes app’s design and interface and having an overview of their blood glucose values. However, they stated that the app’s content only partly met their needs and they considered several of its features unnecessary. They wo...

Health, Risk & Society

In hegemonic risk discourses, hospital obstetric units are represented as the safest and best bir... more In hegemonic risk discourses, hospital obstetric units are represented as the safest and best birth settings; however, a minority of women in England and Wales (2.3% in 2014) still opt for home birth. In this article, I analyse pro-home birth discourses on a UK-based online discussion group for pregnant women covering the period 2010–2015 and collected in March 2016, to identify how individuals making pro-home birth posts on the site represented home birth as a morally responsible choice. Using Foucauldian discourse analysis, I identify three main themes: home births as a normal process, representing an intimate, existential life moment which meets women’s needs for care and personal autonomy, and is convenient and relatively safe, in contrast to hospital births which are characterised as risky; home births as morally legitimate and justified by discourses of evidence-based risk assessment, woman centredness and empowerment; and home birth as not risky and the mothers who opt for it were not taking unnecessary risks but were acting responsibly. In this article, I examine the ways in which the online setting can be used to resist dominant risk discourses. I show how the participants in the online discussion group in my study used available discursive resources to challenge hegemonic risk discourses regarding birth setting, making resistance to dominant risk discourses possible, as pro-home birth discourses legitimised ‘nonconformist’ decisions regarding birth setting. The focus on the ‘risk-takers’ in this article is valuable for healthcare practitioners seeking to improve their communication about birth setting choices with pregnant women.

Medical Writing

Package leaflets (PLs) have been legally required to accompany medicines in the EU since 1999. De... more Package leaflets (PLs) have been legally required to accompany medicines in the EU since 1999. Despite the best intentions and efforts, however, they are generally not well-received by the public for whom they are intended. This paper picks up on the challenges that medical regulatory writers face in producing quality PLs using the official PL template when research indicates that patients would prefer a more personalised genre that incorporated their experiences and knowledge. This paper advocates greater inclusion of patients' perspectives, as this is currently achievable given the current legislation. The paper also notes the tantalising prospect of replacing the template with a set of recommendations that draws on knowledge of what works best for patients.

European Journal of Public Health

Fachsprache Internationale Zeitschrift Fur Fachsprachenforschung Didaktik Und Terminologie, 2013

Existing research reveals that patients' perspectives are missing from mandatory patient info... more Existing research reveals that patients' perspectives are missing from mandatory patient information leaflets (PILs). At the same time, there is overwhelming consensus that they should be included in this genre, and a corresponding need for potential approaches to tackle this pro- blem. This paper examines the appropriateness of perspectivist theory as a means of conceptu- alising the underrepresentation of patients' perspectives in PILs. It also offers a framework for a possible solution that draws on polyocular theory, as polyocular approaches can support com- munication across perspectival asymmetries. The paper contributes theoretically in its innovative use of perspectivist theory in relation to text, and in identifying that the insights of polyocularity could valuably inform a new health communication paradigm, as current health communication paradigms do not fully recognize patients' perspectives. Apart from its theoretical contributions, the paper includes guidelines to support the production of PILs where patients' perspectives are included. The guidelines are informed by practices that have characterised previous polyocular communication events, as well as research into how to maximize patient participation in contexts where various forms of expertise are at play.

Public Understanding of Science

Social Science & Medicine

Analysing Health Communication

Poststructuralist discourse analysis (PDA) that draws on Foucauldian discourse theory enables res... more Poststructuralist discourse analysis (PDA) that draws on Foucauldian discourse theory enables researchers to analyse cultural aspects of health communication, as it makes it possible to identify the discourses and subject positions available to and used by those who communicate about health-related topics. This chapter presents and illustrates the methods of statement function analysis to analyse discourses, and subject position analysis to analyse the identities associated with discursive statements, using data from an online forum where HPV vaccination was debated. The findings show that constructing the basis for knowing is central in the posts, with the diverging perspectives legitimized in various ways. The chapter ends with a discussion of the usefulness of employing poststructuralist discourse analysis to map out broader cultural meanings in health communication texts when values are at the heart of the matter.

BMJ Open

ObjectiveEmail consultations have become part of everyday doctor–patient communication in many co... more ObjectiveEmail consultations have become part of everyday doctor–patient communication in many countries. The objective of this study is to investigate how patients and general practitioners (GPs) perceive the communicative advantages and disadvantages of access via email consultation drawing on a media-theoretical perspective.DesignWe analysed qualitative interview data from general practices in Denmark to identify salient themes.ParticipantsOur data set consists of semi-structured interviews with 30 patients and 23 GPs. The data were collected from February 2016 to September 2019.ResultsThe following themes emerged: (1) lower contact threshold, (2) accessing a new interaction space and (3) access to access. From the patients’ perspective, email consultations provided more convenient contact with their GP. From the GPs’ perspective, email consultations facilitated contact with patients whom they otherwise rarely saw, but also resulted in overuse and inappropriate use. Patients and ...

Health Education & Behavior

Nudging is increasingly used in public health interventions in Western societies to produced heal... more Nudging is increasingly used in public health interventions in Western societies to produced health-promoting behavior changes; however, there is lack of clarity as to what constitutes a nudge, scant knowledge of the effectiveness of nudging techniques in public health lifestyle interventions and a number of ethical and value-based concerns. The aim of this review is to address these research lacunae and identify the characteristics of nudges in empirical research on public health interventions intended to induce healthy lifestyle changes, including whether they are effective. We conducted systematic searches for relevant articles published between January 2008 and April 2019 in three databases, PubMed, CINAHL and PsycINFO, and combined this with a metasynthesis to construct interpretative explanations. A total of 66 original studies met the inclusion criteria. The findings of the systematic review showed that most nudging interventions involved diet/nutrition, most were carried out...

Health Promotion International

Summary Nudging has been discussed in the context of public health, and ethical issues raised by ... more Summary Nudging has been discussed in the context of public health, and ethical issues raised by nudging in public health contexts have been highlighted. In this article, we first identify types of nudging approaches and techniques that have been used in screening programmes, and ethical issues that have been associated with nudging: paternalism, limited autonomy and manipulation. We then identify nudging techniques used in a pamphlet developed for the Danish National Screening Program for Colorectal Cancer. These include framing, default nudge, use of hassle bias, authority nudge and priming. The pamphlet and the very offering of a screening programme can in themselves be considered nudges. Whether nudging strategies are ethically problematic depend on whether they are categorized as educative- or non-educative nudges. Educative nudges seek to affect people’s choice making by engaging their reflective capabilities. Non-educative nudges work by circumventing people’s reflective capa...

Conjunctions. Transdisciplinary Journal of Cultural Participation

New technologies have facilitated doctor–patient email consultations (e-consultations). Guideline... more New technologies have facilitated doctor–patient email consultations (e-consultations). Guidelines for e-consultation use in Denmark state that they should be used for simple, concrete and non-urgent queries; however, a small-scale Danish study suggested that doctors encounter e-consultations that do not match the guidelines. The purpose of this article is to explore whether e-consultations in Denmark reflect recommendations that they should be simple, short, concrete and well defined, and if not, what forms of complexity are evident. We inductively analysed 1,671 e-consultations from 38 patients aged 21–91 years communicating with 28 doctors, 6 nurses, 1 medical student and 8 secretaries. Results showed both quantitative complexity in terms of number of interaction turns, communicative participants, and questions asked, and qualitative complexity relating to patients’ psychosocial contexts and GPs’ biomedical disease perspective. Thus, despite existing guidelines and the leanness a...

Leviathan: Interdisciplinary Journal in English

This article introduces student readers to the realm of the interdisciplinary, with a primary foc... more This article introduces student readers to the realm of the interdisciplinary, with a primary focus on the humanities. We first introduce interdisciplinarity and other related terms as concepts. We then present eight specific examples, on which we illustrate interdisciplinary research. Finally, we address the question of when one should be interdisciplinary.

Health Promotion International

Violence against women constitutes a significant public health problem affecting an estimated 35%... more Violence against women constitutes a significant public health problem affecting an estimated 35% of women worldwide (WHO, 2013); the scale of the problem and its ongoing intransigence indicate the need for critical and transformative approaches that confront the cultures that support gender violence and lead to change. The present paper analyses a program run in Scottish primary schools for 10–12 year olds called RESPECT that was successful in making pupils alert to and critical of gendering norms and practices. Analysis reveals that the teaching plans and activities of RESPECT are highly consistent with a critical pedagogical approach (Freire, 2005; Matthews, 2014), and indicates the value of combining the theoretical approaches of critical pedagogy, feminism and critical health literacy in public health campaign materials aimed at challenging the cultural bases of gender violence in ways that promote health in an educational setting.

International Journal of Cultural Policy

Abstract The EU’s cultural policy of creating a recognisable, common European identity is exempli... more Abstract The EU’s cultural policy of creating a recognisable, common European identity is exemplified by the EU’s cultural programme, European Capitals of Culture (ECOCs), whose official purpose is to highlight similarities and differences across European cultures to generate a greater sense of European identity among the citizens of Europe. To date, there has been little qualitative investigation of how ECOC attenders perceive the representation of European culture in the events and what they think about using ECOC events to promote Europeanisation. In this article, I use the methodology of intercept interviews at four Aarhus 2017 events to explore these two aspects. Findings indicate that the inclusion of European culture in Aarhus 2017 events often went unnoticed by the event attenders, and there was uncertainty about what European culture might actually comprise. Instead of perceiving ECOC events as promoting Europe, event attenders tended to interpret Aarhus 2017 events within a local, national or international framework, with ECOC events perceived as promoting tolerance and intercultural understanding. The findings are discussed in relation to the value of ECOC as a political-cultural initiative for generating European citizens’ identification with the EU.

HERMES - Journal of Language and Communication in Business

The internet has revolutionised the ways in which patients acquire medical information, a develop... more The internet has revolutionised the ways in which patients acquire medical information, a development which has clearly been welcomed by patients: seeking out health information online is now the third most popular activity after internet searches and e-mail (Timimi 2012). However, it has led to concerns about the quality of the information, the ability of lay people to understand it (Gerber/Eiser 2001) as well as potential cyberchondria (Starcevic/Berle 2013). In light of these conflicting perspectives, this paper examines one such source of online information, namely, the patient forum where patients communicate with other patients about a particular medical condition. Although doctor-patient communication in the clinical situation has been extensively researched, little is known about how patient-patient communication is managed in online situations such as patient forums. The purpose of this paper is to contribute to research in that relatively un-researched area by examining ho...

DIGITAL HEALTH

Objective This article explores how a diabetes app called Diapplo affected adolescents’ participa... more Objective This article explores how a diabetes app called Diapplo affected adolescents’ participation in their healthcare by investigating adolescents’ meaning-making in relation to their use of the app. Methods Using a qualitative single case-study design, we adopted a multimethod responsive approach to data generation that included written data from the app development process, individual and group interviews and observations of the adolescents in the clinical situation. This article presents the results from a qualitative content analysis of group and individual semi-structured interviews conducted with five adolescents diagnosed with type 1 diabetes during and after the four-week test phase of a prototype of the app. Results The adolescents appreciated the diabetes app’s design and interface and having an overview of their blood glucose values. However, they stated that the app’s content only partly met their needs and they considered several of its features unnecessary. They wo...

Health, Risk & Society

In hegemonic risk discourses, hospital obstetric units are represented as the safest and best bir... more In hegemonic risk discourses, hospital obstetric units are represented as the safest and best birth settings; however, a minority of women in England and Wales (2.3% in 2014) still opt for home birth. In this article, I analyse pro-home birth discourses on a UK-based online discussion group for pregnant women covering the period 2010–2015 and collected in March 2016, to identify how individuals making pro-home birth posts on the site represented home birth as a morally responsible choice. Using Foucauldian discourse analysis, I identify three main themes: home births as a normal process, representing an intimate, existential life moment which meets women’s needs for care and personal autonomy, and is convenient and relatively safe, in contrast to hospital births which are characterised as risky; home births as morally legitimate and justified by discourses of evidence-based risk assessment, woman centredness and empowerment; and home birth as not risky and the mothers who opt for it were not taking unnecessary risks but were acting responsibly. In this article, I examine the ways in which the online setting can be used to resist dominant risk discourses. I show how the participants in the online discussion group in my study used available discursive resources to challenge hegemonic risk discourses regarding birth setting, making resistance to dominant risk discourses possible, as pro-home birth discourses legitimised ‘nonconformist’ decisions regarding birth setting. The focus on the ‘risk-takers’ in this article is valuable for healthcare practitioners seeking to improve their communication about birth setting choices with pregnant women.

Medical Writing

Package leaflets (PLs) have been legally required to accompany medicines in the EU since 1999. De... more Package leaflets (PLs) have been legally required to accompany medicines in the EU since 1999. Despite the best intentions and efforts, however, they are generally not well-received by the public for whom they are intended. This paper picks up on the challenges that medical regulatory writers face in producing quality PLs using the official PL template when research indicates that patients would prefer a more personalised genre that incorporated their experiences and knowledge. This paper advocates greater inclusion of patients' perspectives, as this is currently achievable given the current legislation. The paper also notes the tantalising prospect of replacing the template with a set of recommendations that draws on knowledge of what works best for patients.

European Journal of Public Health

Fachsprache Internationale Zeitschrift Fur Fachsprachenforschung Didaktik Und Terminologie, 2013

Existing research reveals that patients' perspectives are missing from mandatory patient info... more Existing research reveals that patients' perspectives are missing from mandatory patient information leaflets (PILs). At the same time, there is overwhelming consensus that they should be included in this genre, and a corresponding need for potential approaches to tackle this pro- blem. This paper examines the appropriateness of perspectivist theory as a means of conceptu- alising the underrepresentation of patients' perspectives in PILs. It also offers a framework for a possible solution that draws on polyocular theory, as polyocular approaches can support com- munication across perspectival asymmetries. The paper contributes theoretically in its innovative use of perspectivist theory in relation to text, and in identifying that the insights of polyocularity could valuably inform a new health communication paradigm, as current health communication paradigms do not fully recognize patients' perspectives. Apart from its theoretical contributions, the paper includes guidelines to support the production of PILs where patients' perspectives are included. The guidelines are informed by practices that have characterised previous polyocular communication events, as well as research into how to maximize patient participation in contexts where various forms of expertise are at play.