Intersectionality in Clinical Medicine: The Need for a Conceptual Framework

Intersectionality has become a significant intellectual approach for those thinking about the ways that race, gender, and other social identities converge in order to create unique forms of oppression. Although the initial work on intersectionality addressed the unique position of black women relative to both black men and white women, the concept has since been expanded to address a range of social identities. Here we consider how to apply some of the theoretical tools provided by intersectionality to the clinical context. We begin with a brief discussion of intersectionality and how it might be useful in a clinical context. We then discuss two clinical scenarios that highlight how we think considering intersectionality could lead to more successful patient–clinician interactions. Finally, we extrapolate general strategies for applying intersectionality to the clinical context before considering objections and replies.     

Protected or Unprotected Sex: The Conceptions and Attitudes of the Youth in Bolgatanga Municipality,Ghana

The youth in Bolgatanga municipality in Ghana have relatively less knowledge of sexual and reproductive health (SRH) compared to the youth in other parts of Ghana. More fundamental knowledge is needed of the factors that influence young people to have protected and unprotected sex in specific social and cultural contexts, in order to protect them from adverse consequences, such as sexually transmitted diseases (STIs), HIV/AIDS and unintended pregnancies. This study therefore analyzed the conceptions and attitudes of the youth toward protected and unprotected sex, and particularly condom use, in Bolgatanga municipality. Semi-structured and focus group interviews were held with 71 young males and females and 17 adults. The results indicated that many of them lack a comprehensive knowledge of STIs, contraceptives and pregnancy, while a group of them had a negative attitude towards contraceptives. Not all parents, schools and organisations provide young people with a comprehensive education about SRH, and some even discourage such education because they believe it would encourage young people to have sex before marriage. In addition, young people also inform each other about SRH issues, sharing stories and personal experiences with their peers. The information they exchange is not always correct, however; sometimes it merely reflects their own personal preferences. The unequal power in the sexual relationships of young people—related to the traditional value system that gives men, but not women, “sexual freedom, both in and outside marriage”—is another determining factor for unprotected sex.     

Preparing the Field for Feasibility Testing of a Parenting Intervention for War‐Affected Mothers in Northern Uganda

In this article, we discuss the successful implementation of an adapted evidence‐based parenting intervention for families affected by two decades of war in Northern Uganda. The adaptation and adoption of such interventions to support mental health and family functioning is widely endorsed by prevention scientists and considered a priority in global mental health. The preparation and early adoption phases of engaging with a highly vulnerable community affected by war trauma are documented in this paper along with a discussion of the steps taken to adapt a parenting intervention for cultural and contextual fit. This study is a component of an overall program of research aimed at reducing the long‐term negative effects of war on parenting practices and childhood outcomes, which have considerable implications for preventing mental, neurological, and substance‐use disorders. The processes described here cover a 4‐year period culminating in the implementation of the nine‐session Enhancing Family Connection intervention piloted with a group of 14 mothers. The lessons in cultural adaptation have been valuable and the feasibility results promising for further testing the intervention.     

Strategy and Misdirection in Forced Choice Memory Performance Testing in Deception Detection

We examined forced choice memory performance testing in deception detection from a theoretical perspective. Evidence suggests that participants form different strategies to defeat this test. We attempted to describe these strategies within the framework of Cognitive Hierarchy Theory, a theory that distinguishes strategies based on their degree of anticipation of opponents' strategies. Additionally, we explored whether the strategy selection process is malleable. Truth tellers and liars were subjected to a forced choice memory test about a mock crime. Additionally, half of the sample was subjected to a misdirection changing the appearance of the test to that of a polygraph examination. We found detection accuracies and strategies similar to previous experiments and our misdirection manipulation elicited new strategies and behaviour. Theoretical and practical applications are discussed.Copyright © 2017 John Wiley & Sons, Ltd.     

Mothers' part-time employment: associations with mother and family well-being

The associations between mothers' part-time employment and mother well-being, parenting, and family functioning were examined using seven waves of the NICHD Study of Early Child Care and Youth Development data (N = 1,364), infancy through middle childhood. Concurrent comparisons were made between families in which mothers were employed part time and both those in which mothers were not employed and those in which mothers were employed full time. Using multivariate analysis of covariance with extensive controls, results indicated that mothers employed part time had fewer depressive symptoms during the infancy and preschool years and better self-reported health at most time points than did nonemployed mothers. Across the time span studied, mothers working part time tended to report less conflict between work and family than those working full time. During their children's preschool years, mothers employed part time exhibited more sensitive parenting than did other mothers, and at school age were more involved in school and provided more learning opportunities than mothers employed full time. Mothers employed part time reported doing a higher proportion of child care and housework than mothers employed full time. Part-time employment appears to have some benefits for mothers and families throughout the child rearing years.     

Helping military families through the deployment process: Strategies to support parenting

Recent studies have highlighted the impact of deployment on military families and children and the corresponding need for interventions to support them. Historically, however, little emphasis has been placed on family-based interventions in general, and parenting interventions in particular, with returning service members. This paper provides an overview of research on the associations between combat deployment, parental adjustment of service members and spouses, parenting impairments, and children's adjustment problems, and provides a social interaction learning framework for research and practice to support parenting among military families affected by a parent's deployment. We then describe the Parent Management Training-Oregon model (PMTO(?)), a family of interventions that improves parenting practices and child adjustment in highly stressed families, and briefly present work on an adaptation of PMTO for use in military families (After Deployment: Adaptive Parenting Tools, or ADAPT). The article concludes with PMTO-based recommendations for clinicians providing parenting support to military families.     

Coronary Intervention Improves Disease Specific Health-Related Quality of Life but Not Individualised Quality of Life: A Potential Response Shift Effect?

To explore potential response shift effects with different quality of life (QoL) instruments in cardiac patients undergoing coronary intervention. Study Design and Setting: Recalibration was assessed with the disease specific health-related quality of life (HRQL) instrument MacNew in combination with a then-test approach. Reconceptualisation and reprioritisation were assessed with the individualised QoL instrument SEIQoL-DW. Significant treatment effects were seen on the MacNew (global Δ: 0.6 ± 1.1, p = 0.004) but not on the SEIQoL-DW (Δ: 3.3 ± 16, p = 0.37) 6 months after coronary intervention. No recalibration effect was found on the MacNew then-test, while with the SEIQOL-DW potential response shift effects of reconceptualisation and reprioritisation were seen. For the first time response shift effects were explored in cardiac patients undergoing coronary intervention. This study confirmed that there is a clinically significant improvement in disease specific HRQL over time following successful coronary interventions. However, no treatment effect was seen for individualised QoL with the SEIQoL-DW. This might be due to reconceptualisation and reprioritisation response effects. Future studies need to focus on exploring response shift effects, and the interrelationship between its different components, captured by different patient reported outcome instruments in larger patient groups undergoing coronary interventions.     

"I feel fat": an experimental induction of body displacement in disordered eating

Body displacement, the theory that predicts that individuals with eating disorders will displace negative feelings about themselves onto their body, was tested experimentally in this study. Unrestrained eaters (n = 61), restrained eaters (n = 33), and individuals with eating disorders (n = 26) were randomly assigned to a control condition or an ineffectiveness induction. In the ineffectiveness condition participants were asked to recall and reflect on a past experience when they felt useless or incapable (i.e., ineffective). Results showed that individuals with eating disorders who were made to feel ineffective reported more implicit appearance/body concern than those in the control condition. Unrestrained and restrained eaters did not show this effect. This is the first experimental study to support body displacement theory. These data can be used clinically to educate and encourage patients with eating disorders to address thoughts and feelings related to ineffectiveness directly, instead of displacing this distress onto their body and potentially perpetuating their eating disorder.