Academic literature on the topic 'Contradiction between discourse and practice in health promotion'

Despite the majority of needle–syringe sharing occurring between sexual partners, the intimate partnerships of people who inject drugs have been largely overlooked as key sites of both hepatitis C virus prevention and transmission, and risk management more generally. Drawing on interviews with 34 couples living in inner-city Australia, this article focuses on participants’ accounts of ‘sharing’. While health promotion discourses and conventional epidemiology have tended to interpret the practice of sharing (like the absence of condom use) in terms of ‘noncompliance’, we are interested in participants’ socially and relationally situated ‘rationalities’. Focussing on participants’ lived experiences of partnership, we endeavour to make sense of risk and safety as the participants themselves do.How did these couples engage with biomedical knowledge around hepatitis C virus and incorporate it into their everyday lives and practices? Revisiting and refashioning the concept of ‘negotiated safety’ from its origins in gay men’s HIV prevention practice, we explore participants’ risk and safety practices in relation to multiple and alternative framings, including those which resist or challenge mainstream epidemiological or health promotion positions. Participant accounts revealed the extent to which negotiating safety was a complex and at times contradictory process, involving the balancing or prioritising of multifarious, often competing, risks. We argue that our positioning of participants’ partnerships as the primary unit of analysis represents a novel and instructive way of thinking about not only hepatitis C virus transmission and prevention, but the complexities and contradictions of risk production and its negotiation more broadly.

The role of community development for health promotion has been problematic, not least because of a lack of trust between government and civil society and the use of top-down pro-grams that have contributed to low community involvement. This paper discusses the much needed reinterpretation of community development for health promotion in the 21st Century. It is grounded in an understanding of its origins, in the role of community-based organisations and in its relationship with capacity building and community empowerment. Health promotion is political and a reinterpretation of community development has to reflect the extent to which communities can be politicized to take more control-over the determinants of their lives and health. In the 21st Century we can substitute the use of the term ‘community development' with the use of ‘community empowerment' in both discourse and practice in health promotion.

The seminal Consensus Study by the National Academies of Science, Engineering, and Medicine released in September 2019 describes the benefits of integrating health and social care service delivery, underscoring the central role of social determinants of health (SDOH) in health outcomes. Although the report’s focus on the integration of health and social care contributes a much needed perspective to the national discourse on SDOH and offers a useful framework for organizing service delivery activities, the omission of prevention and health promotion throughout the report is a substantial limitation. We call for increased attention to and investment in prevention and health promotion in the proposed 5As framework. We contend that effectively addressing SDOH and improving alignment between health and social systems require reconceptualization of the traditional health care workforce and renewed state and national advocacy efforts. A paradigm shift encompassing a broader “workforce for health” that is well trained in prevention, health promotion, and advocacy is critical to addressing SDOH, improving population health outcomes, and achieving health equity. Given their professional mission, training, expertise, and scope of practice, social workers are well positioned to lead this effort.

ABSTRACT Objective This study aimed to understand the role of health professionals in educational groups that have food and nutrition as their theme. Methods Qualitative research was conducted in the city of São Paulo, with professionals from the Family Health Strategy. Interviews were conducted to understand the professionals’ perceptions of the roles played in groups. These were analyzed using the Discourse of the Collective Subject technique. The groups’ observations on the performance of the professionals in their mediations were analyzed, based on the following items: meeting organization, communication, support, participation, confirmation of messages, and encouragement to ask questions. Results Twenty-two professionals from different backgrounds were interviewed, and 23 groups of different configurations were observed. The speeches showed that the professionals recognize themselves as organizers, mediators, and evaluators of the groups. Under the topic of organization, teamwork was highlighted. In mediation, there was an assumption of different types of performance that are inserted in conceptions of banking education and dialogical education. In the theme of evaluation, conflict and contradiction arose, pointing out the complexity of approaching a group theme when professionals seek a more horizontal posture with users. Observation of the groups revealed a duality between discourse and professional practice, which is surrounded by contradictions inserted into academic formation and the work process of the teams. Conclusion It was possible to understand the complexity of the practice of professionals when approaching the theme in groups, evidencing the need for spaces of care and for permanent education, especially when regarding professionals who use problematic and active approaches.

This qualitative study analyzed, from the teacher’s perspective, if the principle of comprehensiveness is included in child healthcare teaching in nursing education. The participants were 16 teachers involved in teaching child healthcare in eight undergraduate nursing programs. Data collection was performed through interviews that were submitted to thematic content analysis. The theory in teaching incorporates comprehensive care, as it is based on children’s epidemiological profile, child healthcare policies and programs, and included interventions for the promotion/prevention/rehabilitation in primary health care, hospitals, daycare centers and preschools. The comprehensive conception of health-disease process allows for understanding the child within his/her family and community. However, a contradiction exists between what is proposed and what is practiced, because the teaching is fragmented, without any integration among disciplines, with theory dissociated from practice, and isolated practical teaching that compromises the incorporation of the principle of comprehensiveness in child healthcare teaching.

Farming is often considered one of the most stressful occupations. At the same time, farming men symbolically represent a strong, traditional, or hegemonic form of masculinity based on stoicism, resourcefulness, and resilience to adversity. A contrast is observed between this social representation and their health status, marked by higher levels of stress, social isolation, psychological distress, and suicide than many other subgroups of men. A salutogenic approach was taken in this study to enable the investigation of the social contexts in which farming men positively engage in health-promoting behaviors that may prevent or ameliorate mental health problems. A focus was placed on how farming men cope with stress on their own, and the relationship of this to their popular image of being resourceful and resilient. Thirty-two individual in-depth interviews with farming men and a focus group with five key informants working in rural areas within the Province of Quebec, Canada, were carried out. Self-distraction and cognitive strategies emerged as the most relevant for participants. Notably, taking work breaks conflicted with the discourse of the “relentless worker” that farmers are expected to be. Pathways to positive coping and recovery implied an ambivalence between contemplation of strategies aligned with negative aspects of traditional masculinity norms in North America and strategies aligned with more positive, progressive aspects of these norms based on the importance of family and work life balance. Health promotion and future research should investigate how various positive masculine practices can be aligned with farmers’ health and well-being and that of their family.

Since the key to effective health communication lies in its ability to communicate well, some of its core problems are those that relate to the sharing of meaning between communicators. In elaborating on these problems, this paper offers two key propositions: one, health communication has to pass through the filter of a particular world view that creates a discrepancy between expected and actual message reception and response. Two, the assumption of a rational human actor made implicitly by most health psychological models is a contestable issue, as many times message recipients do not follow a cognitive judgment process. The phenomenon of resisting health messages by reasonable people asks the question whether we ought to rethink our adherence to a particular vision of human health as many times the adverse reaction to behaviour modification occurs as the result of a particular dialogical or discursive situation. At the same time, most motivational decisions in people’s daily routines are automatic and use a concept known as self-identity to give stability to their behaviour patterns. Finally, health communication as part of organised government practices adheres to predominant value perspectives within health promotion practice that affect the manner in which health issues become problematised. This paper proposes a humanistic model that aims to pay attention to the intricacies of human communication by addressing all of the above problems in turn. It interprets the sharing of meaning element in human communication and addresses the question of how the idea of health is created through discourse. As such, it offers a complementary and constructive paradigm and set of approaches to understand health, its meanings and communication.

AimTo develop and evaluate an individually tailored age-appropriate diabetes diary and information pack for children and young people aged 6–18 years with type 1 diabetes to support decision-making and self-care with a specific focus on insulin management and blood glucose monitoring, compared with available resources in routine clinical practice.DesignFour-stage study following the Medical Research Council framework for designing and evaluating complex interventions. Stage 1: context – brief review of reviews and mixed-method systematic review; updating of database of children’s diabetes information; children’s diabetes information quality assessment and diabetes guideline analysis; and critical discourse analysis. Stage 2: intervention development – working with expert clinical advisory group; contextual qualitative interviews and focus groups with children and young people to ascertain their information preferences and self-care practices; ongoing consultation with children; development of intervention programme theory. Stage 3: randomised controlled trial (RCT) to evaluate the diabetes diaries and information packs in routine practice. Stage 4: process evaluation.FindingsThe RCT achieved 100% recruitment, was adequately powered and showed that the Evidence into Practice Information Counts (EPIC) packs and diabetes diaries were no more effective than receiving diabetes information in an ad hoc way. The cost per unit of producing the EPIC packs and diabetes diaries was low. Compared with treatment as usual information, the EPIC packs fulfilled all NHS policy imperatives that children and young people should receive high-quality, accurate and age-appropriate information about their condition, self-management and wider lifestyle and well-being issues. Diabetes guidelines recommend the use of a daily diabetes diary and EPIC diaries fill a gap in current provision. Irrespective of allocation, children and young people had a range of recorded glycated haemoglobin (HbA1c) levels, which showed that as a group their diabetes self-management would generally need to improve to achieve the HbA1clevels recommended in National Institute for Health and Care Excellence guidance. The process evaluation showed that promotion of the EPIC packs and diaries by diabetes professionals at randomisation did not happen as intended; the dominant ‘normalisation’ theory underpinning children’s diabetes information may be counterproductive; risk and long-term complications did not feature highly in children’s diabetes information; and children and young people engaged in risky behaviour and appeared not to care, and most did not use a diabetes diary or did not use the information to titrate their insulin as intended.LimitationsRecruitment of ‘hard to reach’ children and young people living away from their families was not successful. The findings are therefore more relevant to diabetes management within a family context.ConclusionsThe findings indicate a need to rethink context and the hierarchical relationships between children, young people, parents and diabetes professionals with regard to ‘partnership and participation’ in diabetes decision-making, self-care and self-management. Additional research, implementation strategies and service redesign are needed to translate available information into optimal self-management knowledge and subsequent optimal diabetes self-management action, including to better understand the disconnection between children’s diabetes texts and context; develop age-appropriate Apps/e-records for recording blood glucose measurements and insulin management; develop interventions to reduce risk-taking behaviour by children and young people in relation to their diabetes management; reconsider what could work to optimise children’s self-management of diabetes; understand how best to reorganise current diabetes services for children to optimise child-centred delivery of children’s diabetes information.Study registrationCurrent Controlled Trials ISRCTN17551624.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

Introduction In the following self-reflexive (examining my own experiences) piece I discuss the methodology of my PhD thesis which, completed in 2014 (Johnson On a Tightrope), focused on how women negotiate, reject and embody the expectations associated with contemporary pregnancy and mothering. In this qualitative research project I examined the types of pregnancy and parenting practices (defined as those practices undertaken to manage and maximise the success of women’s pregnancies and parenting) women engage in with reference to contemporary sources of information. Central to this, I studied the changing nature of pregnancy and mothering practices in the context of increasing digitalisation, with a particular focus on whether and how technologies enable new spaces for experiential learning and health responsibilisation. This also allowed me to query how various discourses work to inform particular ideas of ‘good’ or ‘appropriate’ mothering behaviours and mothering ideologies, and the expert patient ideal (Johnson Maternal Devices). An examination of the different resources and technologies women draw on during their transition to first-time motherhood reveals how dominant discourses are resisted, negotiated or differentially embodied by women facing first-time pregnancy and motherhood. Since the time I began my research, there has been an explosion of applications (apps) into the market. Pregnancy and mothering have been ‘appified’. Apps offer a unique way to order, engage with and reshape our bodies and biology today. They reflect wider cultural and social changes in the understanding of our identity, our ‘lifestyle’ and our body. In my study I drew on characterisations from participants in attempting to understand the affordances of apps and the role they may play during both pregnancy and new motherhood. I found that apps format motherhood and pregnancy in new ways, instituting new rules into new devices and offering templates which actively shape meanings and practices. They provide new ways to imagine or create foetal/child identity, to monitor child activity from a distance, to gather and interpret data and the enactment of “digital” helicopter parenting (Johnson Maternal Devices). Apps also represent a ‘tidbitisation’ of information which is delivered directly into the user’s intimate sphere, sometimes ‘pushed’ into this intimate sphere, no matter where they are. This ‘device-ification’ of mothering purports to turn it into an administrative and calculable activity, valuing data over subjective experiences and changing the meaning of what it is to mother and be a mother. Apps also represent the contemporary intersection between social media, medical advice, expectations of self-management and notions of convenience. They also creates new social relations and valuing practices, such as ‘likeability’ on Facebook, which have the potential to alter our understandings of health and identity. Increasing numbers of health initiatives are adopting apps in their promotional marketing campaigns and the appification of health means that medical knowledge is being increasingly incorporated into new sorts of social interactions. Ongoing research must consider the multiplicity of women’s engagement with these apps across the transition to first-time motherhood and for parents who are trying to manage child health. It would be productive to direct focus onto the lived experiences associated with apps rather than lauding or criticising the content of apps. Background The initial question that motivated my research was: ‘How do women draw on, weave together, and reject aspects of the dominant advice which configures contemporary perceptions of maternal subjectivity, encompassing specifically the transition to first-time motherhood?’ I was interested in what women in the transition to first-time motherhood experienced and how they reflected on and interpreted these experiences. The subjective accounts of women tell a particular story, so, rather than administering a survey to a large group of women I focused on in-depth, semi-structured but flexible interviews as a way of discovering participant experiences as expressed in their own words. Having only a small number of interview participants meant that I was able to analyse my data closely in a way that would be difficult with a larger sample. In total, I conducted twenty-two interviews with twelve women during January and September, 2012. This included two interviews with ten participants and one interview with the remaining two participants. The first interview was conducted during the third trimester of pregnancy, ranging from 32 to 38 weeks. The second interview was undertaken postnatally when the babies ranged from 3 to 7 months of age. For participant demographic information, please refer to earlier publications (Johnson Maternal Devices; Intimate Mothering Publics). Interviewing late in pregnancy and early in new motherhood provided a realistic sense of the changes, both positive and negative, which occur during this transition as well as the – at times – deep rift between experience and expectation. The time between interviews was important as it allowed women time to adjust somewhat to life as a new mum, allowed time for reflection on both the pregnancy and the early months of mothering. The interviews were conversational and relaxed in nature and allowed to flow in the direction the participant chose to take. The women were generous in sharing intimate details of their experiences from conception through to motherhood. Their responses revealed different ways of being pregnant, being supported and responsibilised during pregnancy, and the different ways women cope with stress, anxiety and more. The stories also demonstrate the amount of work, thought and often deliberate self-transformation which occurs throughout pregnancy, and as a new mother. I believe my personal biography influenced the data that I collected during the interviews. My age and sex advantaged my position as an interviewer. Being a relatively young female researcher it was easy to develop rapport with the participants. In addition, being a woman likely increased my access, as a researcher, to the intimate experiences women shared throughout the interviews, especially considering the gendered and personal nature of the research. It was also apparent that my absence of first-hand experience of pregnancy and mothering enhanced the depth of interview data, encouraging participants to provide access to details and feelings that they may have believed were unnecessary to discuss had I also been a mother. Rebecca Horn discusses a similar experience in her research with prison inmates and police staff, which she describes as being due to her projected image as an “innocent abroad” (96). It also meant that participants were more likely to share details because my lack of experience meant that I was not in a position to judge these experiences against my own. Throughout the interviews, the participants often wanted to know more about me, asking me questions like: How old are you? Have you ever been pregnant? Do you have a partner? Does doing this research turn you off having children? Does doing this research make you want to have children? What do you plan to do after you’ve finished your thesis? Similar to other researchers who discuss their interview experiences in self-reflexive pieces Edwards, Finch and Oakley, I found that by sharing some of my own personal experiences I was able to establish trust and develop rapport with the participants. Like Kasper I worked with the assumption that each interview is a collaborative and consensual enterprise among women. I focused on earning trust, displaying sensitivity and fairness, and showing support. The participants expressed genuine interest in my research and the findings it was generating, with most women keen to read any published findings from the research. Many participants asked to have a copy of their interview transcripts for posterity or to reflect on with friends or in future pregnancies. ‘Getting Personal’ Now that I am contemplating the extension of my research into the future I must think about how my position as a researcher has changed. As one of my key interests is the ways in which digital technologies impact on parenting I have to ask myself whether I will use this broad range of technologies myself, as a parent. If I do use these technologies, will I insert myself into my research asking questions about my own user experiences and considering whether my partner uses these technologies in a different way to myself? If so, how, and what are the implications of this? I also need to consider my child amongst this, as both a parent and a researcher. Am I comfortable with my child having a digital life from a young age? I have already contemplated this question and made the conscious decision not to discuss or mention my pregnancy on social media, Facebook in particular. This question will again be important when my partner and I make decisions around the different ways we choose to announce the birth of our first child. These questions will continue to be important to me as a parent in an increasingly digitalised world. Until I become a mother, (some time in the next five weeks) I believe I cannot answer these questions. Rather, this article functions as a sounding board, allowing me to begin contemplating these questions in my future dual role as a mother and a researcher. Becoming a mother will change my position as a researcher in other important ways. I will no longer be the inexperienced, childless researcher. I will continue to treat my participants as partners in my research but being a mother myself, intersubjectivity, “the acknowledgment of the reciprocal sharing of knowledge and experience between the researcher and the researched” (Shields and Dervin 67), will become all the more essential to my approach. In this way I would hope to continue to de-emphasise the conventional hierarchies and dichotomies of research by focusing on the dialectical relationship between myself and my research ‘partners’. It will be imperative that I not only listen to these women without judgement but that I also share the intricacies of my research project and my own experiences as a maternal subject. These women are the experts of their own lives (Kasper) and I am sure this research would benefit from their involvement from an early phase where they would be invited to share in the design of research questions and the collection and interpretation of results. This is particularly important when designing research on new technologies where the only experiences I can currently draw from are my own and perhaps those of friends, family and colleagues. Digital research methodologies are still in their infancy, as this special issue attests, and although research into the use of apps is growing, there continues to be little research into the user experiences of apps. Apps as Tools of Convenience? As noted above, apps create a “tidbitisation” of information (Johnson Maternal Devices), where information is convenient and accessible in small ‘tidbits’ that anyone can access anywhere, anytime on their smartphone. This is something I have already utilised during my pregnancy (checking symptoms, reading about baby’s development) and I am sure this will be useful for me as a new mum. I have also been using my smartphone for other baby-related resources such as gathering lists of lullabies and nursery rhymes. These few examples indicate that smartphones do offer a great number of conveniences to new parents. But, they could also appear worrisome – raising questions around smartphones as distractions from parenting or relying on smartphones to track health conditions or baby habits, and perhaps even the deferral of responsibility, for example, busy parents using apps to entertain children. At this stage we actually know very little about the user experience of apps for mothers and new parents and new research in this area needs to ask questions such as: Who uses apps and why? What are users paying attention to and what is ignored or ‘switched off’? Do push notifications actually work? Do they create a new form of responsibilisation and if so, what are the repercussions of this, particularly if these apps are directed towards women as new parents, rather than men? This last question is particularly important for a scholar such as myself in the field of Gender and Cultural Studies where questions of gender and gendering are often central to our research. I have found that, as apps continue to be developed at an alarming rate, those specific to parenting are, more often than not targeted to women rather than men. Those that are targeted to men are often patronising and poorly executed, lacking detailed information and emphasising gendered stereotypes (for examples, see Johnson Maternal Devices). This is important to note because I found in my study that app use constitutes part of the intimate relationship of parents-to-be and new parents. Male partners rarely read guidebooks or significant detail from other information sources and so apps played a role in their day-to-day gathering of knowledge, usually via their partner. Rather than reading a chapter of a book or googling a pregnancy symptom, quiet time chatting on the couch after work often included the sharing of information from apps or regular email updates on a variety of topics. Men used the same apps as women but this was usually on their partner’s phone, rather than their own. This raises another important question. How do we research indirect use of apps? Is this even possible? The obvious way to answer this question would be through the use of qualitative interviews. This is made difficult through the mere fact that we first must know who uses these apps indirectly before we recruit them into our research. Researching Digital Technologies through Discourse Analysis In my PhD the use of smartphones and apps only emerged as a theme of interest late into the research project. The constant mention of various apps during the interviews prompted me to examine a number of key pregnancy and parenting apps in terms of the discourses they mobilise and their functionality (Johnson Maternal Devices). As Dorothy Smith attests, we live in a textually mediated world. Pregnancy and parenting books, magazines, technologies such as apps and other forms of popular advice represent a mediated version of motherhood, parenthood and fatherhood. If these texts can influence and be influenced by patterns of parenting discourse then critical discourse analysis can contribute to an understanding of the ways in which mothering can be influenced or constructed by popular media and discourse. Thus, in my PhD research I applied discourse analysis to the study of apps. Discourse analysis examines how language constructs social phenomena and investigates the ways in which it produces certain social realities and expectations (Sunderland). Discourse analysis is valuable because of the questions it enables us to ask about the constructed nature of our experiences and the texts that we are exposed to. Smartphone apps, social media and the Internet are growing resources for women in the transition to first-time motherhood. These technologies require further research as they represent a particular way for women to engage with the neoliberal project of responsibilisation. Targeting first-time mothers and parents research allows access to users of digital technologies who most likely have a vested interest (i.e. the health and development of their children) in understanding the way new technologies are increasingly intervening in our everyday lives. Maternal subjects are likely to view such technologies as a means to monitor her pregnancies and her children’s health and development. A central aim of my research is to render visible the enduring nature of ideologies and expectations of motherhood – which include the ways in which women as mothers are responsibilised – and the ways in which different variants of mothering are inserted in new ways into tools of self-help, social media and new ‘pushy’ technologies (apps). This will reveal how discourse is constituted by mothers and how mothering discourse can work to constitute particular maternal practices and beliefs or expectations. Thus I argue that discourse analysis is central to the research of pregnancy/parenting apps. My research demonstrates how women draw on new technologies in rebellious, ironic or affirmative ways to enact different technologies of the self (Foucault). The texts can be viewed as disciplinary in a Foucauldian sense, and by analysing these different forms of advice it is possible to provide an ongoing demonstration of the difficulty of complying with the various demands of motherhood. Women’s interactions with a range of parenting discourses and attempts to create their own version of motherhood can be seen to constitute one component of the work of motherhood and the ways women practice and enact motherhood (this is discussed in detail in an article currently under review). Although researching the potential affordances of apps is important this research must be connected to user experience. In other words, are apps used in the ways we think they are? In order to move forward and ask questions such as: “Are women responsibilised and their conduct shaped in a new way via their smartphones in what I have characterised ‘push responsibilisation’?” we must move beyond discourse analysis and ask questions that focus on the user experience of apps. It would be useful to draw on existing research in other fields, which have started to develop a range of ethnographic methods and tools for research into computer-user interactions, applications and social media including Tinder, Grindr and Instagram. Other questions I wish to include in a future empirical study include: Who adopts these apps and why? Are there variations in the ways different generational users adopt apps? Who rejects these apps and why? Are push notifications ignored, considered obtrusive or do they prompt specific practices or actions? How are apps used? How do apps maintain already existing gender inequalities in parenting? In asking these questions I believe we could also begin to interrogate a much broader question, that is: “What can the use of devices during this particular ‘life stage’ tell us more broadly about mapping, tracking and quantifying the self?” This brings me again to the central question in this piece: How do we do this research? In this article I have not attempted to answer this question but rather to provoke discussion and encourage debate. In particular, I would like to consider new research methodologies which have the potential to extend our research capabilities and those whom we are able to involve in our research. An example would be conducting research online through pre-existing discussion forums. I have attended numerous academic events in the past two years where academics have started to ponder these questions more generally but my hope is that this article can act as encouragement for further debate. References Edwards, Rosalind. “Connecting Method and Epistimology: A White Woman Interviewing Black Women.” Women's Studies International Forum 13 (1990): 477-490. Finch, Janet. “It’s great to have someone to talk to”: The Ethics and Politics of Interviewing Women. Social Researching: Politics, Problems, Practice. Eds. Colin Bell and Helen Roberts. London: Routledge, 1984. Foucault, Michel. "Technologies of the Self: A Seminar with Michel Foucault." Technologies of the Self: A Seminar with Michel Foucault. Eds. Luther Martin, Huck Gutman, and Patrick Hutton. Amherst: University of Massachusetts Press, 1998. Horn, Rebecca. “Reflexivity in Placement: Women Interviewing Women.” Feminism & Psychology 5 (1995): 94-98. Johnson, Sophia. “On a Tightrope? Technologies of Motherhood in Neoliberal Society.” PhD Thesis. Sydney: Department of Gender and Cultural Studies, University of Sydney, 2014. Johnson, Sophia. “‘Maternal Devices’, Social Media and the Self-Management of Pregnancy, Mothering and Child Health”. Societies 4.2 (2014): 330-350. Johnson, Sophia. “‘Intimate Mothering Publics’: Comparing Face-To-Face Support Groups and Internet Use for Women Seeking Information and Advice in the Transition to First-Time Motherhood.” Culture, Health and Sexuality: An International Journal for Research, Intervention and Care 17.2 (2015): 237-251. Kasper, Anne. “A Feminist, Qualitative Methodology: A Study of Women with Breast Cancer.” Qualitative Sociology 17.3 (1994): 263-281. Oakley, Ann. “Interviewing Women: A Contradiction in Terms.” Doing Feminist Research. Ed. Helen Roberts. London: Routledge and Kegan Paul, 1981. Shields, Vickie Rutledge, and Brenda Dervin. “Sense-Making in Feminist Social Science Research: A Call to Enlarge the Methodological Options of Feminist Studies.” Women's Studies International Forum 16.1 (1993): 65-81. Smith, Dorothy. The Everyday World as Problematic: A Feminist Sociology. Boston: Northern University Press, 1987. Sunderland, J. “'Parenting' or 'Mothering'? The Case of Modern Childcare Magazines.” Discourse & Society 17.4 (2006): 503-528.

Introduction There are increasing levels of concern around the health of citizens within Western neo-liberal democracies like Britain, the USA, and Australia. These governmental concerns are made manifest by discursive mechanisms that seek to both survey and regulate the lifestyles, eating habits and exercise regimes of citizens. Such governmental imperatives have historically targeted schools with school food ranking high in the priorities of public health policy, particularly in regards to the fears around childhood obesity and related health problems (Gard and Wright, Rich, Vander Schee and Gard). However, more recently such concerns have spilled into the wider public arena in Australia where fears of an “obesity epidemic”, the revision of the “food pyramid” and recent calls that make it mandatory for fast food companies to display calorie/kilojoule content on menu boards illustrate the increasing levels to which governments seek to intervene regarding the health of citizens. Not only does the attempt to produce a healthy citizen take place within policy imperatives but also within popular culture. Here, we see healthy eating and diet shows becoming international brands. For example The Biggest Loser, where obese contestants embark on a televised diet and exercise regime, competing to lose the most weight in the shortest time, and also Jamie Oliver’s attempt to change the eating habits of the British has crossed the Atlantic to the USA. There is a sense of urgency embedded in many such discursive practices and an implication that, as a society, we need a “lifestyle change” to make us healthier. Reflecting this urgency is an increase in cookbooks that not only provide recipe ideas but also seek to intervene into our day-to-day conduct. The content of such books moves beyond ways of putting a meal together and into the territory of self-surveillance and regulation. In this way, then, cookbooks can be read as pedagogical. This particular brand of pedagogy, moreover, feeds into wider socio-political discourses around the governance of the self within our late modern context. This chapter will argue that many contemporary cookbooks attempt to enact governmental imperatives around health and nutrition and that, by doing this, they become pedagogical devices that translate governmental devices into the homes of their readers. By using a post-Foucauldian analytical framework, we will illustrate the ways in which Jane Kennedy’s cookbook, Fabulous Food, Minus the Boombah mobilises discourses of health, gender, risk, and food in a rich (but 99 per cent fat free) mix. Analytical Framework This paper draws upon Foucauldian governmentality studies and the ways in which discursive practices are enacted in order to position and offer an analysis of cookbooks as pedagogical devices that translate the work of government into readers’ homes. Foucault defined government as “the conduct of conduct” arguing that government relates to the “way in which the conduct of individuals or groups might be directed: the government of children, of souls, of communities, of families, of the sick […] to govern in this sense, is to structure the possible field of action” (220–1). Foucault argued that attempts to shape conduct occur within socio-historical moments and contexts (Gordon) and they are, therefore, subject to change. Within this article, we seek to understand the ways in which governmental imperatives around food and lifestyle are taken up by cookbook authors and the implications of this in terms of public pedagogies within our late-modern context. Public health is located within a myriad of governmental sites that attempt to regulate people’s lives. In deciphering how government sites operate as mechanisms of regulation in modern times, Miller and Rose suggest that we require: An investigation not merely of grand political schemata, or economic ambitions, or even of general slogans such as ‘state control’, nationalization, the free market, and the like, but of apparently humble and mundane mechanisms which appear to make it possible to govern […] the list is heterogeneous and is, in principle unlimited (32). Such investigations can be grouped under the umbrella of “governmentality studies”. To grasp “governmentality” is complex and requires an analytics that can span history, and reach across macro and micro contours to trace various linkages and connections forged between governmental rationalities, techniques and practices (Leahy, Assembling). For the purposes of this paper we will be offering an analytic of the humble cookbook and its potential role in the governance of the self, a technique vital to contemporary neo-liberal modes of governance. Neo-liberalism produces particular versions of health, citizenship, and individualism. Within neo-liberal governmental assemblages, public health policy operates as a key site for enacting what Miller and Rose label “government at a distance” (32) by working to facilitate the shifting of responsibility for the health of citizens from the State to the individual. The individual, however, does not instinctively know how to incorporate governmental hopes for a healthy lifestyle into their lives—it is here that the cookbook, as pedagogical device, is vital because it translates macro governmental hopes to the micro level, that is, into the kitchens of citizens. Both risk and expertise also work alongside neo-liberalism in the assemblage to render the problems of government both thinkable and calculable, and in turn, practical. We will see in the next section how Jane Kennedy, the author of Fabulous Food, Minus the Boombah deploys both popular notions of risk alongside her own experience and expertise (her lifelong “battle” with weight) in order to fold the (female) reader in to Kennedy’s particular approach to healthy eating. Pedagogy could be described as part of the “doing” of education, the means through which ideas are transmitted through and between learners and teachers. Like contemporary neo-liberal government, contemporary pedagogies can be understood as assemblages; that is, they are made up of competing, intersecting, contradictory and multiple elements. Pedagogy is a technical device through which these elements are translated and transmitted to its audience, be that school pupils, students, adult learners or citizens. Elizabeth Ellsworth argues that pedagogy is a “social relationship [that] is very close in. It gets right in there in your brain, your body, your heart, your sense of self, of the world, of others, and of possibilities and impossibilities in all those realms” (6). In other words, effective pedagogical devices are necessary contact points between ideas and the self; they inform relationships between the macro and the micro, thus shaping both the individual and the collective. The remainder of this paper will demonstrate how Fabulous Food, Minus the Boombah deploys popular discursive trends regarding food, health, gender, and citizenship as pedagogic tools that aim to cultivate a healthier subject. Food That Makes Your Arse Huge? “Boombah: (adj). Word to describe food that makes your arse huge” (Kennedy 5). Lifestyle, diet, and health books can be seen to have saturated the market over recent years in an almost epidemic-like way. This phenomenon both mirrors and informs governmental imperatives around the health and lifestyle of citizens. A recent visit to our local bookshop revealed that there appears to be a polarisation of texts relating to food, health, and wellbeing. Books that explicitly relate to health and health issues can be found in one section, and cookbooks in another. However, there are an increasing number of texts that blend the two genres and offer diet, health, and lifestyle tips along with recipe ideas and cooking techniques. Within this blend there is also variation; there are texts that offer a scientific exposition of food, nutrition, and diet, such as Ricotti and Connelly’s The Healthy Family Cookbook, a text which offers a twelve-chapter overview of current theories and practices around health and nutrition before offering recipe ideas designed to help the reader achieve and maintain a “healthy weight” (page). In addition there are also texts that fold particular approaches to weight-loss, such as Jenny Craig or The Biggest Loser, together with cooking. The input of celebrity chef Jamie Oliver to the mix has been well documented (see Pike; Leahy, Disgusting; Rawlins; Zimmet and James) and the influence of Oliver’s approachable style of writing can be found within many contemporary cookbooks, including Fabulous Food, Minus the Boombah, a text within which Jane Kennedy blends together cooking, health, and lifestyle into a paste that is bound together with a Bridget Jones-style confessional commentary on her own, personal struggles with weight and dieting. For example: “I love food. Always have. Unfortunately I love it about one kilo per month more than I should. Perhaps I should put it another way: the food I love seems to have more calories than I need over a month and a year and a lifetime … it adds up! Yep, I get FAT” (xi). This style can be read as a way of “getting right in” (Ellsworth 6), to enfold the reader into Kennedy’s world. It also may provide readers, particularly, as we will discus below, middle-class Anglo-Australian females, with a sense of solidarity in a struggle against weight gain. Kennedy often deploys the spectre of designer jeans that no longer fit as a way to further entice the reader to embrace the healthy eating regime promoted by the book. Kennedy draws upon notions of horror and disgust at the fat body (her own but, implicitly, also the readers). Horror and disgust are potent pedagogical devices that are often put to work in educational and health promotion settings in an attempt to lure people and their bodies into action (Leahy, Disgusting; Lupton). In many ways Kennedy’s cookbook can be read as public pedagogy—its aim is to teach the reader how to cook food that is “packed full of flavour but minus the boombah” (xxvii), or minus that which causes bodily harm and/or disgusting transformation. In order to achieve this, Kennedy deploys “expert knowledge” as she takes the reader on a journey through her own struggles with weight, fad diets and failure to epiphany—which for Kennedy was a personal trainer and a new approach to cooking, eating and lifestyle and her book is peppered with self help-style narrative devices, for example: The key to successful weight loss with this style of eating is to be organised. Disorganisation is the open door though which every second excuse (and French fry) slips. “Oh no, the stores are closed. Oh well, better order takeaway”. Don’t do it. There. Is. No. Good. Takeaway. Food. (Kennedy xxii, emphasis original). Several mechanisms are being deployed here. Firstly, she is inadvertently constructing the perfect western neo-liberal subject: organised, self-contained, disciplined, and able to make informed rational decisions around food type and purchase. Secondly, by predicting and addressing the reader’s perceived resistance, Kennedy reveals her moralistic overtones. We see the judgment of a rational, ordered subject versus a messy, disorganised, immoral (and fat) subject in a piling up of connotations that lead to the same conclusion: this healthy way is the best healthy way. Kennedy’s personal narrative within the text follows a trajectory of “awareness, struggle and epiphany” (Plummer 131) that often characterise the confessional stories that we tell about ourselves: “I ended up […] back at square one: overweight, staring down a year of chicken consommé dinners […] I finally grew a brain and motivated myself to see a personal trainer” (Kennedy xiv). Kennedy’s narrative is a familiar one and a Foucauldian reading of confession enables us to take the position that confession is imperative to the contemporary construction of self. Modes of confession have become increasingly diverse and reified through the era of reality TV, social networking and the “personal trauma” sub-genre of autobiographical memoir (Brien). Kennedy’s book deploys confession as a narrative device that, like her moralising about the dangers of take away food, attempts to fold the reader into her world and, as a result, reifies her approach to healthy eating and lifestyle. We can do it because she has done it. Through the confessional she is not only able to tell of her love of food but also of her understanding of it as risky. This can be outlined by drawing upon an extract we looked at earlier: “the food I love seems to have more calories than I need and over a month and a year and lifetime it adds up! Yep, I get FAT” (xi). Risk and expertise work alongside neo-liberal individualism in the governmental assemblage to render the problems of government both thinkable and calculable, and in turn, practical. Kennedy deploys both risk and expert knowledge in order to successfully demonstrate her understanding of healthy eating as a battleground that see her appetite and tastes at war with her waistline. She guides us through the various fad diets she has tried, through gaining weight while being pregnant, and the anguish of seeing her image reflected back at her through her career in television, until her epiphany: the realisation that in order to achieve and maintain a healthy weight a balance of healthy eating and exercise is required. These are convincing pedagogical strategies that encourage the reader to apply modes of self-governance that reflect wider, macro hopes for the healthy neo-liberal citizen and Kennedy’s status as TV celebrity within Australia. Her use of the colloquial term “boombah” makes hers a uniquely Australian endeavour. It is worth noting here that Kennedy’s brand of Australian humour and use of colloquialism is deeply entrenched with raced and classed assumptions about desirable body size and the economic and cultural capital of its readers. It is middle class white Anglo-Australian women who are being targeted by this book and, arguably, by this brand of public pedagogy. As with many contemporary cultural texts about cooking, Kennedy’s book promotes an: “upper-middle-class lifestyle enhanced by the appropriation of goods and commodities. All the while, real issues surrounding the life-sustaining reality of food are ignored” (Wright and Sandlin 406). The lifestyle promoted by Kennedy is classed in this way. She writes of Bettina Liano jeans, of working on the popular Australian television show A Current Affair, of drinking wine, and using goats cheese and kaffir lime leaves in her cooking. Her levels of economic and cultural capital are obvious, and this sets the scene well for the type of reader she is attempting to educate. Although she does not explicitly mention gender, her “Bridget Jones”-style confessions of dietary failure (though Kennedy succeeds where Bridget would inevitably continue to fail), the mention of cooking both children’s and adult’s dinners, and the illustrations throughout the book that feature children’s toys implicitly position her as a “typical modern woman” with a career and a family to boot. In terms of pedagogy, Kennedy’s book reflects contemporary governmental discourse around health, food and wellbeing. It is designed “to shape with some degree of deliberation aspects of our behaviour according to particular sets of norms and for a variety of ends” (Dean 18). It reflects government fears around obesity, portion size, calorific content, and body shape. Pike and Leahy argue that food pedagogies provide government, and in this case the individual, with opportunities to shape, sculpt, mobilise, and work through the food choices, desires and aspirations, needs, wants, and lifestyles of parents, families, and children. The explicit intention of food pedagogies is to enlist the public into a process of “governmental self formation”: that is, “the ways in which various authorities and agencies seek to shape the conduct, aspirations, needs, desires and capacities of specified political and social categories, to enlist them in particular strategies and to seek definite goals” (Dean 563). Fabulous Food, Minus the Boombah then uses confession as a springboard to enlisting its readers into a healthier lifestyle and, more importantly, a healthier, risk aversive relationship with food. It individualises this struggle, and, like all good neo-liberal subjects, presents a healthy diet as an individual struggle: This way of cooking and eating works for me […] I feel much healthier and happier and I’ve got a lot more energy […] These recipes have to be better for you than chowing down a creepy bowl of 2 minute noodles and an entire pack of Tim Tams (yes, it’s time to let go). Be disciplined, even if you’ve struggled before. And if you really can’t live without your nightly routine of creamy pasta […] then bung this book back on the shelf. But stop whingeing about your huge arse (xix). This passage illustrates Kennedy’s pedagogy well, particularly the way in which her pedagogy is infused with neo-liberal discursive techniques. She positions herself as expert by stating that her way of cooking “works for me” as well as by deploying phrases like “I feel” and “I’ve got”. She then expertly shifts the reader’s focus from herself to the governance of the self by stating that it is up to the individual to be self-disciplined. Her pedagogy is littered with risk discourse as she informs us that you can continue to eat as you wish, but that there are consequences (a “huge arse”). This particular brand of risk discourse is gendered, as it is arguably mostly women who worry about the size of this part of their anatomy. One of the greatest contradictions of a neo-liberal approach to governance is that at the same time as promoting individual responsibility, there is also a strong emphasis on the collective. Kennedy reflects this throughout the book, as the above passage suggests. Her introductory section acts as a guide for the reader, who—once enfolded into Kennedy’s approach—she lets make their own way with encouragement. This is manifest in her final statements, “So let’s say goodbye to boombah. Go for it! And enjoy!” (xxvii). As pedagogy, then, Fabulous Food, Minus the Boombah attempts to cultivate and shape the reader’s choices around food by providing a practical means for transforming not only the reader’s food practices but also her image and self-esteem. This is achieved by the author’s supplement of supplying expert information, cooking skills, guidance, and incitement. Let’s Say Goodbye to Boombah? This paper has demonstrated how the contemporary cookbook can be read as pedagogy. In some ways the humble cookbook has always been pedagogical; seeking to teach the reader to make something that they previously did not, presumably, know how to, as well as providing cooking techniques and advice on the most suitable produce to use in particular recipes. However, in the contemporary moment, the cookbook arguably increasingly acts as a translation mechanism for governmental imperatives around food, health, and wellbeing. We have taken one cookbook amongst many as an illustration of our thesis. Jane Kennedy’s Fabulous Food Minus the Boombah is an Australian example of the neo-liberal project that lies at the heart of contemporary modes of governance of the population, but also, and more importantly, governance of the self. At the very heart of neo-liberalism is an imagined subject. That is, neo-liberalism needs and wants citizens to be autonomous, health seeking, enterprising, rational, choice-making individuals. The contemporary cookbook, it has been argued, can assist the individual in the production of a healthier-eating self. However, the more complex and intersecting aspects of selfhood—aspects such as socio-economic status, gender, location and ethnicity—are often absent from the construction of the healthy individual promoted by the contemporary cookbook. Above all, this paper has sought to problematise some of the dominant discourse around food, health, and wellbeing that can be found on the pages of the modern-day cookbook. 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The main theme of this thesis is the contradiction between discourse and practice in health promotion. Many health promoters continue to exert power-over the community through top-down programming whilst at the same time using an emancipatory discourse. The thesis has addressed this contradiction in three parts. The first part determines how the emancipatroty discourse has evolved and eplores the role of social movements in the development of contemporary health discourses and their influence on the legitimisation of empowerment. Central to this discourse is the empowerment of communities. To understand the role of this concept the thesis provides an interpretation of the different meanings of power and community, and the different levels of analysis of empowerment in the context of health promotion programming. The second part identifies the nature of health programming and the dominance of top-down, and to a much lesser extent, bottom-up approaches. The thesis argues that these two approaches are not, and do not have to be, mutually exclusive. To address this issue the thesis presents a new methodology is situated within a framework developed for the accomodation of empowerment goals within health promotion programmes. The study also identifies the organisational areas of influence on the processs of community empowerment and it is these which are used for the assessment of this concept. Both the framework and the methodology address the contradiction in health promotion by making community empowerment operational within a programme context. The third part of the thesis supports the rationale for the design of the methodology with field work in rural Fijian communities. The findings are presented as a composite case study to highlight the experiences of implementing the methodolgy and the main themes that emerged during the field work. the final chapter of the thesis brings together the central themes of the study and draws from these and 'emergent agenda' as a way forward for health promotion research and practice.