BackgroundConventional systematic review techniques have limitations when the aim of a review is to construct a critical analysis of a complex body of literature. This article offers a reflexive account of an attempt to conduct an interpretive review of the literature on access to healthcare by vulnerable groups in the UKMethodsThis project involved the development and use of the method of Critical Interpretive Synthesis (CIS). This approach is sensitised to the processes of conventional systematic review methodology and draws on recent advances in methods for interpretive synthesis.ResultsMany analyses of equity of access have rested on measures of utilisation of health services, but these are problematic both methodologically and conceptually. A more useful means of understanding access is offered by the synthetic construct of candidacy. Candidacy describes how people's eligibility for healthcare is determined between themselves and health services. It is a continually negotiated property of individuals, subject to multiple influences arising both from people and their social contexts and from macro-level influences on allocation of resources and configuration of services. Health services are continually constituting and seeking to define the appropriate objects of medical attention and intervention, while at the same time people are engaged in constituting and defining what they understand to be the appropriate objects of medical attention and intervention. Access represents a dynamic interplay between these simultaneous, iterative and mutually reinforcing processes. By attending to how vulnerabilities arise in relation to candidacy, the phenomenon of access can be better understood, and more appropriate recommendations made for policy, practice and future research.DiscussionBy innovating with existing methods for interpretive synthesis, it was possible to produce not only new methods for conducting what we have termed critical interpretive synthesis, but also a new theoretical conceptualisation of access to healthcare. This theoretical account of access is distinct from models already extant in the literature, and is the result of combining diverse constructs and evidence into a coherent whole. Both the method and the model should be evaluated in other contexts.
Despite increasing awareness of the importance of gender perspectives in health science, there is conceptual confusion regarding the meaning and the use of central gender theoretical concepts. We argue that it is essential to clarify how central concepts are used within gender theory and how to apply them to health research. We identify six gender theoretical concepts as central and interlinked-but problematic and ambiguous in health science: sex, gender, intersectionality, embodiment, gender equity and gender equality. Our recommendations are that: the concepts sex and gender can benefit from a gender relational theoretical approach (i.e., a focus on social processes and structures) but with additional attention to the interrelations between sex and gender; intersectionality should go beyond additive analyses to study complex intersections between the major factors which potentially influence health and ensure that gendered power relations and social context are included; we need to be aware of the various meanings given to embodiment, which achieve an integration of gender and health and attend to different levels of analyses to varying degrees; and appreciate that gender equality concerns absence of discrimination between women and men while gender equity focuses on women's and men's health needs, whether similar or different. We conclude that there is a constant need to justify and clarify our use of these concepts in order to advance gender theoretical development. Our analysis is an invitation for dialogue but also a call to make more effective use of the knowledge base which has already developed among gender theorists in health sciences in the manner proposed in this paper.
Seventy six senior academics from 11 countries invite The BMJ’s editors to reconsider their policy of rejecting qualitative research on the grounds of low priority. They challenge the journal to develop a proactive, scholarly, and pluralist approach to research that aligns with its stated mission
The emergence of gender as a major area of interest in medical sociology in the 1970s set an exciting agenda for future research. However, despite a growing literature, our understanding of the mechanisms linking gender and health has advanced little in recent years. This may, in part, be due to problems in conceptualising gender. In particular, despite theoretical advances, biological sex and sociological gender continue to be conflated in empirical research. In this paper we argue that sex and gender are not necessarily coincidental and that gender roles and gender role orientations may cross-cut sex. We draw upon a recent tradition of research on gender role orientation in psychology which assesses the level of 'masculinity' and 'femininity' in an individual's self-concept through identification with traditionally 'masculine' and 'feminine'characteristics. Considering a range of health measures we conclude that the sex (male-female) differences that are traditionally found in research on gender and health may mask an association of 'femininity' with relatively poor health and 'masculinity' with relatively good health in both men and women.
Feminist theory and research on the sociology of human reproduction have historically been bound together as each has developed. Yet recently sociologists of reproduction and 'women's health' have lost sight of core debates in feminist theory. They still tend to work with the assumption that feminism is an internally coherent body of thought, despite the emergence of significant intemal divisions since the mid-1980s. In this paper we evaluate the challenge that feminist poststructuralism poses to prior conceptualisations of gender in the context of reproductive health through a critique of sociological work in this area from the 1970s and 1980s. We conclude with a critical exploration of the new insights that might emerge from a post-structuralist 'deconstruction' of gender in the context of human reproduction.
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