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Air pollution is a hybrid phenomenon, understood and produced through social practices and material environmental processes. This hybridity leads us to engage critically with how air quality science is carried out. In dialogue with the critical physical geography subdiscipline, we propose a critical air quality science (CAQS) framework to study air pollution’s sociomateriality. We use CAQS to illuminate four tensions in the dynamics of knowledge production during a citizen science air quality monitoring project: making undone science matter, blurring “insiderness”/“outsiderness”, traffic as both life and death, and changing behaviours versus changing systems. Drawing on interviews with citizen scientists, we outline the implications of these tensions for air quality research design and reporting. The CAQS framework provokes critical thought about the consequences of how air quality science understands, creates and communicates knowledge, and how we can reconfigure our relations with the air to minimise air inequalities.

Objective: There is strong evidence that individuals’ feminist orientation is a significant predictor of gender-based violence awareness and capability to intervene. The objective of this study is to validate the Spanish version of the Feminism and the Women's Movement Scale (FWMS) that assesses the feminist orientation. Method: A cross-sectional descriptive study was carried out, administering the FWMS to 407 university students of Health Sciences and Social Work. A confirmatory factor analysis was carried out and the adjustment of the model was examined through confirmatory factor analysis, analyzing structural equations. Results: The results revealed Cronbach's alpha = 0.869 and KMO = 0.923; Bartlett

Background: Gender and sexuality are recognised as social determinants of health. While gender and sexuality are becoming important frameworks guiding many disciplines and studies, discussions about quality of healthcare (QHC) lack a sufficient focus on these. When QHC studies have considered gender and sexuality the primary focus tends to be on the practice of individual professionals, patients’ differential health seeking behaviors or outcomes. Methods: This is an amalgamation of published literature that examines the relationship between gender, sexuality and quality of healthcare. It applies a gender and sexuality lens to Donabedian’s framework to further understand the influence of gender and sexuality in shaping QHC. Results: The framework illustrates how the very foundations of QHC, namely institutional structures, processes and outcomes, play a determinant role in increasing or reducing inequalities in QHC linked to gender, sexuality (as well as other factors). The commentary suggests practices that would reduce these inequalities. Conclusion: In the context of present debates over inequality in medicine, science and global health, exposed and magnified by COVID-19, this commentary is a reminder that health systems have a critical role to play in ensuring that QHC does not perpetuate them. This has implications for clinicians, healthcare management and policy.

Active learning methodologies, such as flipped classroom (FC), generate a higher level of student engagement, greater dynamism in learning and more significant interactions with course content. Some other active methodologies used in the academic environment are problem-based learning (PBL) and case study (CS). There are few studies that analyse FC combined with PBL class activities or with course-based learning (CBL) activities, however, in fact, there are no studies that analyse which combination of activities would lead to better academic performance and student satisfaction. The main aim of this study is to comparate FC methodology, combined with PBL activities or with CBL activities, in improving the academic performance of undergraduate social work students. This work also intends to analyse the level of satisfaction with the course and the methodology used. A class level randomisation study was performed. Both groups in the study used an FC active methodology, but group 1 applied this methodology with PBL, whereas group 2 applied it in conjunction with a CBL methodology. The students also had to do activities at home that were related to the PBL or CS methodology. There were significant differences in both categorical and quantitative exam scores, with the group that had applied the FC + PBL methodology achieving a higher grade in the exam and containing a higher percentage of students who passed or received merit and outstanding grades. In general, there was a good level of satisfaction in both groups and there were no significant differences across all items asked, except for ‘It helps critical thinking’ and ‘It helps to apply theory to assessment’, which were evaluated more favourably by the FC + CBL students.

Background Despite insistent calls for more and better evidence to inform action to reduce health inequities, applied health research sensitive to these inequalities is rare. Recognising this problem, the Collaboration for Leadership in Applied Research and Care in the North West Coast (England) developed the Health Inequalities Assessment Toolkit (HIAT) to support those involved in health research to integrate equity into their work. Objective This paper reports on an evaluation of the extent to which HIAT enhances the equity focus of the work of users. Methods The evaluation used semi-structured interviews, focus groups and workshops (n = 131 respondents including Public Advisers, university, NHS and local government partners). Routine data included HIAT feedback forms. Findings HIAT can help to strengthen the equity focus of applied health research by: increasing understanding of how socioeconomic inequities impact on health; building capacity for integrating equity into all aspects of research, implementation and capacity building; stimulating thinking on action to address local structural drivers of health inequalities; and increasing understanding of the positive contribution public involvement can make to research. Conclusion If we are to advance health equity goals delivering research and training needs to be combined with political commitment to create more equal societies.

Background and purpose The impact of COVID-19 and its control measures have exacerbated existing mental health conditions. Although the deleterious effects of mental health problems are well known, fewer studies have examined the links between the Social Determinants of Health (SDHs) and depression. This study provides insights into the relationship between SDHs and depression during the first strict lockdown in Spain, which lasted for a period of 7 weeks. Methods Fifty-two structured interviews were conducted with people diagnosed with depression during June 2020 in the province of Zaragoza (Spain). Interviews were conducted by telephone due to lockdown constraints. Inductive thematic content analysis was used to explore, develop, and define emergent categories of analysis, which were mapped against the SDH framework. Results Listening to people’s experiences of living with depression during lockdown provided insights into their concerns and coping strategies, which are greatly influenced by the conditions in which they live, their job and their age. Examples of these factors include access to and quality of physical spaces, including housing conditions and public spaces for socialising, social support, adverse working conditions which include caring responsibilities, and access to digital technologies and healthcare services. Conclusion SDHs have played a fundamental role in shaping people’s health and well-being during the COVID-19 pandemic, and this study has shown that they have a considerable effect on depression outcomes. Governments should consider implementing social welfare programs to tackle both psychosocial problems and material need during crisis situations.

Purpose: Strengthening research capacity (RC) amongst health professionals has both organisational and individual benefits. It can increase the quality of research and support the transfer of evidence into practice and policy. However there is little evidence on what works to develop and strengthen RC. This paper contributes to the evidence base by reporting findings from an evaluation of a programme that aimed to build capacity to use and do research amongst NHS and local authority organisations and their staff in a large english research partnership organisation. Methods: The evaluation used multiple qualitative methods including semi-structured interviews, focus groups and workshops (n=131 respondents including public advisers, university, NHS, and local government partners). Results: The RC building programme provided a range of development opportunities for NHS and local authority staff resulting in increased confidence and skills to undertake, participate in, and use research. Additionally, positive influences on organisational practice and collaborative working were reported. Conversely, challenges to developing research capacity were also identified as were the importance of resources, senior level buy-in, and the relevance of research topic to practice in facilitating participation in the programme. Conclusion: Collaboration for Leadership in Applied Health Research and Care North West Coast’s (CLAHRC-NWC) RC building programme differed from convential approaches giving less emphasis to formal teaching and more to experiental learning and focusing on both individual capacities and supporting organisations to integrate RC building into staff development programmes. The findings demonstrate that providing opportunities for staff in NHS and local authority organisations to develop research knowledge and skills alongside an infrastructure that supports and encourages their participation in research can have positive impacts on research capacity and organisational research culture. The potential for generalising this approach to other organisational contexts is discussed

There is strong evidence that individuals' feminist orientation is a significant predictor of gender-based violence awareness and capability to intervene. The objective of this study is to validate the Spanish version of the Feminism and the Women's Movement Scale (FWMS) that assesses the feminist orientation.A cross-sectional descriptive study was carried out, administering the FWMS to 407 university students of Health Sciences and Social Work. A confirmatory factor analysis was carried out and the adjustment of the model was examined through confirmatory factor analysis, analyzing structural equations.The results revealed Cronbach's alpha=0.869 and KMO=0.923; Bartlett0.001. The factorial model found a sole factor that merged the 10 items into a latent variable called feminist movement and explained 99.15% of the total variance. The factorial model yielded one factor that explained 99.15% of the variance. The factorial loads of the items exceeded 0.837.These results confirm the validity of the Spanish version of FWMS questionnaire.

BackgroundAction to address the structural determinants of health inequalities is prioritized in high-level initiatives such as the United Nations Sustainable Development Goals and many national health strategies. Yet, the focus of much local policy and practice is on behaviour change. Research shows that whilst lifestyle approaches can improve population health, at best they fail to reduce health inequalities because they fail to address upstream structural determinants of behaviour and health outcomes. In health research, most efforts have been directed at three streams of work: understanding causal pathways; evaluating the equity impact of national policy; and developing and evaluating lifestyle/behavioural approaches to health improvement. As a result, there is a dearth of research on effective interventions to reduce health inequalities that can be developed and implemented at a local level.ObjectiveTo describe an initiative that aimed to mainstream a focus on health equity in a large-scale research collaboration in the United Kingdom and to assess the impact on organizational culture, research processes and individual research practice.MethodsThe study used multiple qualitative methods including semi-structured interviews, focus groups and workshops (n = 131 respondents including Public Advisers, university, National Health Service (NHS), and local and document review.Resultsutilizing Extended Normalization Process Theory (ENPT) and gender mainstreaming theory, the evaluation illuminated (i) the processes developed by Collaboration for Leadership in Applied Health Research and Care North West Coast to integrate ways of thinking and acting to tackle the upstream social determinants of health inequities (i.e. to mainstream a health equity focus) and (ii) the factors that promoted or frustrated these efforts.ConclusionsFindings highlight the role of contextual factors and processes aimed at developing and implementing a robust strategy for mainstreaming health equity as building blocks for transformative change in applied health research.

Introduction There is an extensive literature on public involvement (PI) in research, but this has focused primarily on experiences for researchers and public contributors and factors enabling or restricting successful involvement in specific projects. There has been less consideration of a ‘whole system’ approach to embedding PI across an organization from governance structures through to research projects. Objective To investigate how a combination of two theoretical frameworks, one focused on mainstreaming and the other conceptualizing quality, can illuminate the embedding of positive and influential PI throughout a research organization. Methods The study used data from the evaluation of a large UK research collaboration. Primary data were collected from 131 respondents (including Public Advisers, university, NHS and local government staff) via individual and group interviews/workshops. Secondary sources included monitoring data and internal documents. Findings CLAHRC‐NWC made real progress in mainstreaming PI. An organizational vision and infrastructure to embed PI at all levels were created, and the number and range of opportunities increased; PI roles became more clearly defined and increasingly public contributors felt able to influence decisions. However, the aspiration to mainstream PI throughout the collaboration was not fully achieved: a lack of staff ‘buy‐in’ meant that in some areas, it was not experienced as positively or was absent. Conclusion The two theoretical frameworks brought a novel perspective, facilitating the investigation of the quality of PI in structures and processes across the whole organization. We propose that combining these frameworks can assist the evaluation of PI research.

[Resumen] El cáncer de mama ha cobrado una visibilidad sin precedentes en el Estado español. Tras unos orígenes preocupados por el carácter opresivo del rol de la paciente y los determinantes sociales de la incidencia del cáncer, las últimas tres décadas se han caracterizado por una preocupación con el diagnóstico temprano de la enfermedad a través de programas de cribado y de campañas solidarias de concienciación. A priori parece que habría que festejar esta politización progresiva del cáncer de mama que lo ha puesto en la agenda nacional. En este articulo argumento que lo político ha entrado en crisis, despolitizando la enfermedad sin tan apenas levantar sospechas entre los sectores más críticos del país, incluido el feminista. Retomo la crítica de la ‘sobreinvisibilización’ del cáncer de mama de la antropóloga vasca Mari Luz Esteban (2017) para demostrar cómo nos encontramos en una situación en la que la premisa ‘el fin justifica los medios’ ha colonizado el pensamiento colectivo. Esta colonización limita la capacidad de las instituciones, personas, organizaciones, profesionales y corporaciones de hacer autocrítica. No planteamos cuestiones entorno a qué temas se abordan, cómo se habla de la enfermedad, cómo se representa a las mujeres y qué temas permanecen silenciados o tabú. Para ilustrar la despolitización presentaré ejemplos de los dos elementos que componen la sobreinvisibilización: los discursos y prácticas sobre el cáncer de mama hipervisibles y aquellos que son invisibilizados. Los primeros son dominantes, monotemáticos y perpetúan mensajes androcéntricos. Los invisibilizados raramente llegan al ámbito público, principalmente porque cuestionan el estatus quo de la industria del cáncer. [Abstract] Breast cancer has acquired unprecedented visibility in Spain. Although the origins of the breast cancer movement were concerned with the oppressive patient role and the increasing incidence of the disease, the last three decades have been marked by a focus on diagnosis through screening and awareness campaigns. Some would say that we need to celebrate this progressive politization of breast cancer that has placed the disease on the national agenda. However, I argue that its political purpose is in crisis and has depolitised the disease without raising any suspicions among the most critical sectors, including feminist circles. Building on my work on breast cancer from the past 14 years, in this article I take a cue from Mari Luz Esteban’s (2017) critique of the ‘overinvisibilization’ of breast cancer to demonstrate how it has been depoliticized. I will reinterrogate how breast cancer is spoken about, how women are represented, what topics make headlines and which ones are silenced or remain taboo. In particular, I will illustrate how the ‘overinvisibilization’ of breast cancer results in various forms of discourses and practices. These include the hypervisibility of hegemonic and monothematic messages that are compounded with sexism; and the invisibilization of those differential experiences and discourses about the disease that questions the status quo of the industry of cancer.

In classical anthropology, biological motherhood is given, and the genetic tie between parents and child is unbreakable. Heterosexual intercourse is thought to develop close bonds based on love. Feminist scholars have long debunked descent and alliance theory, traceable to the nineteenth-century Victorian period. But these continue to influence practices, social norms, law, policy and healthcare. How “old” kinship ideologies emerge are explored through: (1) the enforcement of heteronormative marriage, (2) the violence implicit in “amorous thought” and (3) how the quest for biological motherhood underlies an obsession to use new reproductive technologies. Those who do not fit confined models of kinship are excluded from social and legal benefits granted by marriage and motherhood. Their sexualities and alternative kin arrangements are marginalised and criminalised.

‘Health, Culture and Society’ has been explored in classic texts by a diverse range of scholars. We want to demonstrate that enduring concepts have consistently been complex and contested. We pose questions about the ways they have been defined, used and applied to health. Our tone is recharging arguments through enduring concepts, and we want to demonstrate the relevance of these concepts to practice and apply them in an overtly political way to the ‘here and now’. While these enduring concepts are commonly used, they are at times used inappropriately. We take a unique approach to the configuration of ‘Health, Culture and Society’. Despite the wealth of material in medical sociology and medical anthropology, no existing texts attempt to take on the approach we offer.

Breast cancer awareness campaigns are the major strategy used by public institutions and private organizations to empower women about breast cancer. Yet, drawing on my own research and observations as an academic and activist over the past 9 years in Spain, I argue that these mainstream campaigns are often unaware of, or oversimplify, conceptualisations of empowerment. I illustrate my argument with examples from Spain and North America. I show how the specific goal of empowerment aims to persuade women to comply with biomedical recommendations which include behaviour change and treatment-seeking. Towards this end, their main approach focuses on the use of coercive fear-mongering tactics, including misleading information and exaggeration of data on incidence, mortality, survival and treatment efficacy. A further problem is that they allude to assumptions about the reasons for women's compliance: stereotypical moral and gendered responsibilities for one's health and family as well as fear of a horrible death. Some justify this particular use of fear by appealing to the need to target women with a simplified, high-impact message. However, there is evidence that fear creates unnecessary social psychosis and further distorts the decision-making process, conflicting with empowerment intent. I argue that there is an urgent need to stimulate debate about how to improve breast cancer awareness campaigns and propose an alternative approach, grounded in a critical pedagogy paradigm- a model of critical health literacy based on a patient-centred approach that aims to develop critical consciousness and reflection of the social factors that affect breast cancer.

Inspired by Marcia Inhorn's article "Defining Women´s Health. A Dozen Messages from More than 150 Ethnographies" (2006) a key dimension of my doctoral work was to focus on how Spanish women living with breast cancer define their own health priorities. Drawing on 38 fieldwork interviews with women living with breast cancer conducted in Spain between 2006 and 2008, I draw attention to the significance of what Ludica (2013) refers to as the "invisible scars of cancer" for a holistic understanding of women's experiences. I highlight two under acknowledged thematic concerns that emerged during our conversations: (1) the impact of treatments on women's ability to experience sexual pleasure; (2) the pain caused by axillary lymph node dissection (ALND) or armpit surgery. The aim of this paper is two-fold. First, to spark debate on some of the pressing problems affecting women living with breast cancer in Spain, which may be generalizable to other contexts. A second objective is to challenge the popular idea that a breast cancer survivorship is a wonderful journey through "cancerland". Dominant biomedical and mass-media tendencies in conceptualising survivorship have treated it in terms of a positive "transformative journey" that softens the disease. The most invoked image is that of the courageous, energetic, selfless and optimistic heroin. It is my premise that these invisible scars are often missing or simply obscured in the framings of medical and anthropological research as well as public discussions when they do not fit the "monovocal discourse" of breast cancer (Sandell, 2008). The present article is a timely reminder of the fact that for a shockingly high number of women diagnosed, the experience of breast cancer is emotionally and physically painful and quite often disabling. An understanding of women's experiences is essential to provide resources more sensitive to women's needs.

Este artículo es una reacción visceral a la cosificación y mercantilización de los pechos en los casos de cáncer de mama.

This commentary examines the problematic ways in which breast cancer campaigns have conceptualised the concept of empowerment in Spain. It uses discourses and content analysis of seven campaigns to demonstrate how the concept has become the ‘holy grail’ precisely because it has been depoliticised. Two problems are examined. Firstly, it problematizes the lack of debate over whether current measures to promote the empowerment of women living with breast cancer actually achieve the desired ends (i.e., are they ‘empowering’?). Secondly, it questions the implicit assumption that the ends necessarily justify the means is questioned –understood as content and format of these campaigns. It is argued that the current framework of cancer education is based on the traditional epidemiological model which is more concerned with coercing women to adopt changes in their lifestyle and comply, rather than promoting critical awareness.En el presente artículo se reflexiona sobre la conceptualización del término “empoderamiento” en las campañas de concienciación sobre cáncer de mama en España. Se analiza el discurso y el contenido de siete campañas de sensibilización y materiales divulgativos para ilustrar cómo este concepto se ha convertido en el Santo Grial, al despolitizarlo. Se examinan dos problemas fundamentales. El primero es la falta de cuestionamiento crítico de los fines. Raramente se debate si lo que se propone como empoderamiento es realmente empoderador. El segundo es que se acepta la premisa de que el fin justifica los medios –entendidos como el contenido y formato de las campañas. Concluye argumentando que el modelo actual está basado en el modelo tradicional epidemiológico de patrones de comportamiento, que es paternalista y está más centrado en coaccionar a las mujeres a que adopten estilos de vida “saludables”, que en potenciar la capacidad crítica y la autonomía.

Throughout the UK severe funding cuts are straining the capacity of local governments, National Health Service and voluntary organisations to improve public health and reduce health inequalities. At times like this, the word ‘resilience’ is invoked as a neoliberal mantra similar to “individual or community responsibility”. Decreased public funding for services increases pressure on individuals and communities to cope with socio-economic adversity without external support. We argue that resilience must be understood in relation to systems. Promoting individual or community resilience alone is not enough to reduce health inequalities locally. Resilience needs to be understood as a characteristic of people who live and work in areas and the organisations that employ them. Enhanced resilience at a systems levels, underpinning engagement between paid workers and communities, is essential to release collective capabilities to influence and respond to structural pressures. We argue that enhanced system resilience has the potential to improve the social drivers of health inequalities and leads to improvements in collective and individual health. In this presentation we describe the experience of the public health team within the NIHR Collaboration for Leadership in Applied Health Research and Care for the North West Coast (CLAHRC NWC). We introduce a system resilience framework and describe how we are testing this in 9 relatively disadvantaged neighbourhoods in the North West of England. We discuss a number of innovative features of this work. It seeks to nurture egalitarian collaboration between residents, Local Authorities, community and organisations to understand, and influence, action that can promote system resilience. Residents conduct local enquires to help plan for action to enhance system resilience and help evaluate the impact of changes put in place.