Postdoctoral Research Fellow, RECOVER Injury Research Centre, The University of Queensland, Brisbane, QLD, Australia.
Associate Professor, School of Social Science, The University of Queensland, Brisbane, QLD, Australia.
J Health Serv Res Policy. 2024 Jan;29(1):12-21. doi: 10.1177/13558196231193862. Epub 2023 Aug 8.
Justice and equity-focused practices in health services play a critical but overlooked role in low back pain (LBP) care. Critical reflexivity - the ability to examine and challenge power relations, and broader social issues embedded in everyday life - can be a useful tool to foster practices that are more socially just. No research has yet explored this approach in back pain health services. This study sought to understand how clinicians construct LBP in relation to broader socio-cultural-political aspects of care and explore if those constructions changed when clinicians engaged with critically reflexive dialogues with researchers.
Using critical discourse analysis methods, this qualitative study explored institutionalised patterns of knowledge in the construction of LBP care. We conducted 22 critically reflexive dialogues with 29 clinicians from two health services in Australia - a private physiotherapy clinic and a public multidisciplinary pain clinic.
Our analyses suggested that clinicians and services often constructed LBP care at an individual level. This dominant individualistic discourse constrained consideration of justice-oriented practices in the care of people with LBP. Through dialogues, discursive constructions of LBP care expanded to incorporate systems and health service workplace practices. This expansion fostered more equitable clinical and service practices - such as assisting patients to navigate health care systems, considering patients' socioeconomic circumstances when developing treatment plans, encouraging staff discussion of possible systemic changes to enhance justice, and fostering a more inclusive workplace culture. Although such expansions faced challenges, incorporating broader discourses enabled recommendations to address LBP care inequities.
Critical reflexivity can be a tool to foster greater social justice within health services. By expanding constructions of LBP care beyond individuals, critical reflexive dialogues can foster discussion and actions towards more equitable workplace cultures, services and systems.
卫生服务中以公正和公平为重点的实践在腰痛（LBP）护理中发挥着至关重要但却被忽视的作用。批判性反思——即审视和挑战权力关系以及日常生活中嵌入的更广泛社会问题的能力——可以成为促进更具社会公正性实践的有用工具。目前还没有研究探讨这种方法在腰痛保健服务中的应用。本研究旨在了解临床医生如何构建与护理更广泛的社会文化政治方面相关的 LBP，并探讨当临床医生与研究人员进行批判性反思对话时，这些构建是否会发生变化。
本定性研究采用批判话语分析方法，探讨了构建腰痛护理中制度化知识模式。我们在澳大利亚的两个卫生服务机构（私人物理治疗诊所和公共多学科疼痛诊所）与 29 名临床医生进行了 22 次批判性反思对话。
我们的分析表明，临床医生和服务机构经常在个人层面上构建 LBP 护理。这种占主导地位的个人主义话语限制了对腰痛患者护理中面向正义的实践的考虑。通过对话，LBP 护理的话语构建扩展到包含系统和卫生服务工作场所实践。这种扩展促进了更公平的临床和服务实践，例如帮助患者在医疗保健系统中导航，在制定治疗计划时考虑患者的社会经济情况，鼓励工作人员讨论可能的系统性变革以增强正义，以及培养更具包容性的工作场所文化。尽管这种扩展面临挑战，但纳入更广泛的话语可以提出解决 LBP 护理不平等的建议。
批判性反思可以成为在卫生服务中促进更大社会公正的工具。通过将 LBP 护理的构建扩展到个人之外，批判性反思对话可以促进更公平的工作场所文化、服务和系统的讨论和行动。
