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Focusing on Swedish home care for older people, this article explores the discursive (re)production of home care as an institution. Equality and universal service provision have been described as defining features of the Nordic care regime. At the same time, Nordic research has highlighted a shift in social care policy, from a focus on universalism and egalitarian ideals towards a focus on freedom of choice, diversity and individualised services. This article takes as a starting point that home care for older people is formed by different and potentially conflicting ideas. We understand home care as a contested formation and define institutional change in terms of ongoing discursive struggles. The analysis draws on qualitative semi-structured interviews with key informants, including politicians, local authority officials and representatives of interest organisations. Informants were engaged in policy making, implementation or advocacy related to care for older people. We examine the meanings attached to home care for older people and the analysis reveals three different discourses – on choice, needs and equality. By comparing and contrasting discourses, we reveal silences, conflicts and tensions, and highlight the politics involved in (re)creating home care as an institution. [ABSTRACT FROM AUTHOR]

During the last few years, there has been a growing concern for environmental justice within international social work. This article connects to such concerns and aims to present and discuss environmental injustices faced by local communities in Mauritius, Peru and Sweden. Primary data were collected through face-to-face semi-structured interviews with a total of 25 key representatives of local communities in the three countries. Secondary materials were combined with the primary data in ATLAS-ti v.8.3 for a deductive critical discourse analysis. The findings describe the substantive, distributive and procedural environmental injustices faced by local communities in the three case studies. The article then considers the implications of the findings for international social work interventions in promoting environmental justice. The article concludes on the need for international social workers to continue their efforts and practices towards achieving environmental justice for all, in promoting global sustainable development. [ABSTRACT FROM AUTHOR]

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This study aimed to explore how diabetes specialist nurses (DSNs) discursively construct and reconstruct their professional position in their working relationships with physicians and thereby the relation with patients in primary healthcare in Sweden. Twenty-nine DSNs working in diabetes care from 21 primary healthcare centres were included in focus-group interviews. The interviews were analysed using discourse analysis. From a social constructionist perspective, findings showed that the working relationship between the DSNs, physicians and thereby the relation with patients was discursively constructed as a relationship within a gendered discourse. The DSNs constructed their subject position metaphorically as 'mothers' in this relationship. The construction of doing gender implies that the DSNs became visible as biological women, but invisible in being perceived as competent, well-educated professionals, because skills such as multitasking and versatility are often associated with female abilities. [ABSTRACT FROM AUTHOR]

The psychoactive plant khat has been "made ethnic" in Sweden, as dominant discourses have constructed its use as being exclusive to the Somali ethnic minority. The aim of this article is to analyse how representatives of Swedish-Somali civil society organisations talked through and talked back to dominant discourses about khat use. Sixteen semi-structured interviews were conducted with organisation representatives, and the material was analysed within a multi-perspectival discourse analysis framework. The interviewees described khat use as a social problem, but also acknowledged that it can offer users social support. They viewed khat use to be more common among people of Somali background living in Sweden, but tended to view associations between khat use and the Somali ethnic minority as stigmatising. Khat was commonly compared to alcohol, and those who use khat in problematic ways were described as comparable to "alcoholics" or "junkies". Interventions based on cultural competence were not suggested, as khat use was seen as related to socio-economic marginalisation. The interviewees' resistance to making khat use an ethnic problem is notable, and suggests a more complex and nuanced view of dominant discourses about khat use in the West. It also suggests problematic and stigmatising effects of one-dimensionally associating certain drugs to specific ethnic categories. [ABSTRACT FROM AUTHOR]

Objective:The aim of the study was to describe and explore patient agency through resistance in decision-making about cardiovascular preventive drugs in primary care. Design:Six general practitioners from the southeast of Sweden audiorecorded 80 consultations. From these, 28 consultations with proposals from GPs for cardiovascular preventive drug treatments were chosen for theme-oriented discourse analysis. Results:The study shows how patients participate in decision-making about cardiovascular preventive drug treatments through resistance in response to treatment proposals. Passive modes of resistance were withheld responses and minimal unmarked acknowledgements. Active modes were to ask questions, contest the address of an inclusive we, present an identity as a non-drugtaker, disclose non-adherence to drug treatments, and to present counterproposals. The active forms were also found in anticipation to treatment proposals from the GPs. Patients and GPs sometimes displayed mutual renouncement of responsibility for decision-making. The decision-making process appeared to expand both beyond a particular phase in the consultations and beyond the single consultation. Conclusions:The recognition of active and passive resistance from patients as one way of exerting agency may prove valuable when working for patient participation in clinical practice, education and research about patient–doctor communication about cardiovascular preventive medication. We propose particular attentiveness to patient agency through anticipatory resistance, patients’ disclosures of non-adherence and presentations of themselves as non-drugtakers. The expansion of the decision-making process beyond single encounters points to the importance of continuity of care.KEY POINTSGuidelines recommend shared decision-making about cardiovascular preventive treatment. We need an understanding of how this is accomplished in actual consultations.This paper describes how patient agency in decision-making is displayed through different forms of resistance to treatment proposals.•The decision-making process expands beyond particular phases in consultations and beyond single encounters, implying the importance of continuity of care.•Attentiveness to patient participation through resistance in treatment negotiations is warranted in clinical practice, research and education about prescribing communication. [ABSTRACT FROM PUBLISHER]

In this article, we explore how reproductive health care providers in Sweden, a country often described as one of the most gender-equal countries in the world, incorporate gender equality ideals in multicultural contraceptive counseling. In the tension between gender equality promotion on one hand and respect for cultural diversity and individualized care on the other, we will demonstrate that values of gender equality were often given priority. This is not necessarily undesirable. Nevertheless, our proposal is that the gender equality ideology may inhibit providers’ ability to think differently about issues at stake in contraceptive counseling, which may negatively influence women’s possibilities to obtain adequate support. At the end of the article, we suggest how health care providers’ reflexivity might be used as a working tool for increased awareness about the taken-for-granted cultural norms that exist in their clinical milieu. [ABSTRACT FROM AUTHOR]

The Swedish welfare debate increasingly focuses on market liberal notions and its healthcare perspective aims for more patient-centered care. This article examines the new Swedish Patient Act describing and analyzing how the patient is constructed in government documents. This study takes a Foucauldian discourse analysis approach following Willig's analysis guide. The act contains an entitlement discourse for patients and a requirement discourse for healthcare personnel. These two discourses are governed by a values-based healthcare discourse. Neo-liberal ideology, in the form of New Public Management discourse, focusing on the value of efficiency and competition, is given a hegemonic position as laws and regulations are used to strengthen it. The new Swedish Patient Act seems to further strengthen this development. The Act underlines the increased entitlement for patients, but it is not legally binding as it offers patients only indirect entitlement to influence and control their care. To safeguard the patient's entitlement under the Patient Act, healthcare personnel should be made aware of the contents of the Act, so that they can contribute to the creation of systems and working methods that facilitate respect of the Act's provisions in daily healthcare work. [ABSTRACT FROM AUTHOR]

When a lesbian couple conceives through donor insemination, the partners transform their relations to each other. In this article, I explore how women in lesbian relations depict their parental roles in relation to the notion of equality. Drawing on critical discursive psychology, I conducted and analyzed interviews with 96 Swedish lesbian parents. Findings show how the interviewees draw on three different interpretative repertoires when they talk about their parental roles. In one repertoire, parents describe themselves as being spontaneously equal in relation to the child. In a second repertoire, equality is depicted as a potential result of struggling, where some parents claim to have achieved equality, whereas others describe being frustrated about their unequal situation. Finally, in a third repertoire, inequality is depicted as a given starting point, drawing on a biologistic rhetoric. Although most parents present equality as idealized, most also refer to biology as a reality that sets the benchmark. Findings in the present study could be useful for clinicians working with lesbian couples; rather than assuming that a lesbian couple is more or less equal, it is important to consider the specific couple and their descriptions. [ABSTRACT FROM PUBLISHER]

In this article the authors present a follow-up study of women's interview narratives about life 5 to 7 years after a breast cancer operation. The women had taken part in a study during the 6-month postoperation period. Art therapy contributed to well-being, including strengthening personal boundaries. In the new study, interview analysis informed by critical discursive psychology indicated three problematic discourses that the women still struggled with several years after the operation: the female survivor, the “good woman,” and individual responsibility. We concluded that many women with a history of breast cancer need support several years after their medical treatment is finished. [ABSTRACT FROM AUTHOR]

The spouses of people suffering from dementia are commonly first-in-line caregivers. This can have a considerable effect on their own lives, health and marriages. Several studies have focused on spouses' experiences, but very few have focused in any depth on their descriptions of themselves as subjects. Therefore, the aim of this study is to describe how spouse caregivers can express themselves when living with and caring for their partners with dementia. The study has a qualitative approach with a discourse analysis design and uses analytical tools such as rhetoric, subject positions and categorization. The results reveal three subject positions: as an actor, as a parent and as a survivor. The results show that as spouses struggle with external and internal clashes as subjects, they therefore need to develop coping strategies. They also experience pronounced loneliness and a risk to their own health. There is thus a need to support these spouses as individuals in their differing and changing needs. [ABSTRACT FROM AUTHOR]