Publications by category
Books
Thomas F (2016).
Handbook of Migration and Health., Edward Elgar Publishing.
Abstract:
Handbook of Migration and Health
Abstract.
Aggleton P, Parker R, Thomas F (eds)(2015). Culture, health and sexuality: an introduction. Abingdon, Routledge.
Thomas F, Gideon J (eds)(2013).
Migration, Health and Inequality. London, Zed Books.
Abstract:
Migration, Health and Inequality
Abstract.
Thomas F, Haour-Knipe M, Aggleton P (eds)(2010).
Mobility, Sexuality and AIDS. Abingdon, Routledge.
Abstract:
Mobility, Sexuality and AIDS
Abstract.
Author URL.
Journal articles
Thomas F, Aggleton P (In Press). A confluence of evidence: What lies behind a whole-school approach to health education in schools?. Health Education, 116(2).
Thomas F (In Press). Asking about self-harm and suicide in primary care: Moral and practical dimensions. Patient Education and Counseling
Thomas F (In Press). How is the Patient Health Questionnaire (PHQ-9) used in practice?. Qualitative Health Research
Hansford L, Thomas F, Wyatt K (In Press). The impact of the Work Capability Assessment on mental health: Claimants’ lived experiences and GP perspectives in low-income communities.
Journal of Poverty and Social Justice,
27(3), 351-368.
Abstract:
The impact of the Work Capability Assessment on mental health: Claimants’ lived experiences and GP perspectives in low-income communities
© Policy Press 2019 This paper examines the impact of increased welfare conditionality on people with mental health issues claiming benefits in the UK. Drawing on data from the DeStress study, this paper explores the lived experience of welfare claimants in low-income communities, and the perspectives of GPs seeking to support them. Particular focus is placed on people’s experience of the Work Capability Assessment, the tool used to determine welfare claimants’ entitlement to sickness benefit, and how the narratives and culture surrounding welfare reform and the actual assessment itself can have a negative impact on mental health and wellbeing.
Abstract.
Thomas F, Wyatt K, Hansford L (In Press). The violence of narrative: embodying responsibility for poverty-related distress. Sociology of Health and Illness: a journal of medical sociology
Higgins S, Thomas F (In Press). Urban freshwaters, biodiversity and human health and wellbeing: setting an interdisciplinary research agenda. WIREs Water
Hansford L, Thomas F, Wyatt K (2022). How does housing affect end-of-life care and bereavement in low-income communities? a qualitative study of the experiences of bereaved individuals and service providers in the United Kingdom.
Palliative Care and Social Practice,
16Abstract:
How does housing affect end-of-life care and bereavement in low-income communities? a qualitative study of the experiences of bereaved individuals and service providers in the United Kingdom
Background: Access to affordable, appropriate housing is one of the key social determinants of health, affecting well-being across the lifecourse. However, beyond a recognition that housing quality is linked to place of death, little is known about the ways in which housing status impacts social, emotional, and practical aspects of dying and bereavement. Method: the Checking Out project is a qualitative study aiming to explore the ways in which socio-economic status impacts people’s experiences of, and attitudes towards, death, dying, and bereavement in the United Kingdom. Qualitative interviews were carried out with 14 bereaved individuals with experience of poverty at end of life or in bereavement, and 15 professionals supporting individuals in low-income communities. Interviews were conducted via phone/video call, and data include experiences of end of life and bereavement both before and during the pandemic. Transcripts were examined using thematic analysis. Results: Housing emerged as an important factor affecting people’s experiences, with 7 of the 14 bereaved individuals and all except 1 of the professionals discussing housing-related issues. Participants described ways in which unsuitable housing and housing insecurity impacted practical aspects of dying but also emotional and social well-being at end of life. Housing-related issues affected both patients and their families, though families found it difficult to air these concerns when their relative was dying. Conclusion: the paper demonstrates how trusted professionals are able to advocate or address the issues faced by bereaved individuals and suggests implications for policy and practice. A greater awareness of the potential impact of housing status across public services, including healthcare practitioners, welfare support, and housing providers, could better support patients and practitioners to address these issues proactively. Housing providers and policy-makers should be included as key partners in collaborative public health approaches to palliative care.
Abstract.
Hansford L, Thomas F, Wyatt K (2022). Poverty, choice and dying in the UK: a call to examine whether public health approaches to palliative care address the needs of low-income communities. Mortality, 1-17.
Green J, Fischer EF, Fitzgerald D, Harvey TS, Thomas F (2022). The publics of public health: learning from COVID-19. Critical Public Health, 32(5), 592-599.
Thomas F, Hansford L, Wyatt K, Byng R, Coombes K, Finch J, Finnerty K, Ford J, Guppy K, Guppy R, et al (2020). An engaged approach to exploring issues around poverty and mental health: a reflective evaluation of the research process from researchers and community partners involved in the DeStress study. Health Expectations, 24(S1), 113-121.
Ford J, Thomas F, Byng R, McCabe R (2019). Exploring how patients respond to GP recommendations for mental health treatment: an analysis of communication in primary care consultations.
BJGP OpenAbstract:
Exploring how patients respond to GP recommendations for mental health treatment: an analysis of communication in primary care consultations.
BACKGROUND: Patient take-up and adherence to antidepressants and talking therapy is low. However, little is known about how GPs recommend these treatments and whether patients accept them. AIM: to examine how GPs recommend antidepressants and talking therapy, and how patients respond. DESIGN & SETTING: a total of 52 recorded primary care consultations for depression, anxiety, and stress were analysed. METHOD: Using a standardised coding scheme, five ways doctors recommend treatment were coded, conveying varying authority and endorsement. The treatment recommendation types were as follows: more directive pronouncements (I'll start you on X); proposals (How about we start X?); less directive suggestions (Would you like to try X?); offers (Do you want me to give you X?); and assertions (There are medications that might help). It was also coded whether patients accepted, passively resisted (for example, withholding response), or actively resisted (for example, I've tried that before). RESULTS: a total of 33 recommendations occurred in 23 consultations. In two-thirds of cases, GPs treated the patient as primary decision-maker by using suggestions, offers, or assertions. In one-third of cases, they used more directive pronouncements or proposals. GPs endorsed treatment moderately (67%), weakly (18%), or strongly (15%). Only one-quarter of recommendations were accepted immediately. Patients cited fears about medication side effects and/or dependency, group therapy, and doubts about treatment efficacy. Despite three-quarters of patients resisting, 76% got prescriptions or self-referral information for talking therapy. CONCLUSION: Initially, GPs treat patients as the decision-maker. However, although patients resist, most end up with treatment. This may impact negatively on treatment uptake and success. Social prescribing may fill a treatment gap for some patients.
Abstract.
Thomas F, Hansford L, Ford J, Wyatt K, McCabe R, Byng R (2019). How accessible and acceptable are current GP referral mechanisms for IAPT for low-income patients? Lay and primary care perspectives. Journal of Mental Health, 29(6), 706-711.
Hughes G, Mehtta M, Bresciani C, Strange S (2019). Introduction.
The Cambridge Journal of Anthropology,
37(2), 1-20.
Abstract:
Introduction
Ugly emotions like envy and greed tend to emerge ethnographically through accusations (as opposed to self-attribution), de-centring the individual psyche and drawing attention to how emotions are deployed in broader projects of moral policing. Tracking the moral, social dimension of emotions through accusations helps to account concretely for the political, economic and ideological factors that shape people’s ethical worldviews – their defences, judgements and anxieties. Developing an anthropological understanding of these politics of accusation leads us to connect classical anthropological themes of witchcraft, scapegoating, and inter- and intra-communal conflict with ethnographic interventions into contemporary debates around speculative bubbles, inequality, migration, climate change and gender. We argue that a focus on the politics of accusation that surrounds envy and greed has the potential to allow for a more analytically subtle and grounded understanding of both ethics and emotions.
Abstract.
Thomas F (2018). Health education and migration. Health Education Journal
Hinchliffe S, Jackson M, Wyatt K, Barlow A, Barreto M, Clare L, Deplege M, Durie R, Fleming L, Groom N, et al (2018). Healthy publics: Enabling cultures and environments for health. Palgrave Communications, 4, n/a-n/a.
Thomas F, Hansford L, Ford J, Wyatt K, McCabe R, Byng R (2018). Moral narratives and mental health: rethinking understandings of distress and healthcare support in contexts of austerity and welfare reform.
Palgrave Communications,
4Abstract:
Moral narratives and mental health: rethinking understandings of distress and healthcare support in contexts of austerity and welfare reform
Associations between mental health and poverty are increasingly well established. Yet in neoliberally oriented contexts in which distress engendered through the everyday hardships of poverty is increasingly pathologised and medicalised, important questions are raised over the assumptions inherent within mental health policy and its implementation. Using the UK as a focus, this paper reviews and maps out key questions that require investigation in order to better understand the complex inter-relations between poverty and distress; explores how current paradigms might influence notions of individual responsibility and agency as well as health seeking behaviours; and examines the role of, and cultural and systemic expectations and constraints placed upon GPs as they respond to distress amongst patients from low-income communities. In so doing, we argue for recognition of the moral narratives that underpin both mental health care and processes of welfare reform, and call for an expansion of conventional notions of evidence-based healthcare to incorporate the understandings, experiences and priorities of people from low-income groups. We call for more detailed questioning and analysis of the interactions that lead to mental health diagnosis and treatment and better understanding of the relevance and effectiveness of current treatment options. As a central tenet of this, we argue for more flexible and nuanced healthcare responses that better reflect the dynamic and multi-faceted nature of poverty-related distress.
Abstract.
Thomas F (2017). Pharmaceutical waste in the environment: a cultural perspective. Public Health Panorama
Thomas F (2016). Climate change and health. Reference Module in Earth Systems and Environmental Science
Thomas F (2016). Young people's use of medicines: pharmaceuticalised governance and illness management within household and school settings. Social Science and Medicine, 165, 150-158.
Thomas F, Depledge M (2015). Medicine ‘misuse’: Implications for health and environmental sustainability. Social Science & Medicine, 143, 81-87.
Thomas F (2015). The role of natural environments within women's everyday health and wellbeing in Copenhagen, Denmark.
Health Place,
35, 187-195.
Abstract:
The role of natural environments within women's everyday health and wellbeing in Copenhagen, Denmark.
Urbanisation has been linked with sedentary lifestyles and poor mental health outcomes amongst women. The potential for natural environments to enhance physical activity and mental wellbeing in urban areas is now well recognised. However, little is known about the ways that women use natural spaces for health and wellbeing within the context of their everyday lives. This paper draws on ideas developed in the therapeutic landscapes literature to examine how experiences in different types of green and blue space provide important health and wellbeing benefits for women in Copenhagen, Denmark. As well as facilitating physical exercise, such spaces were found to enable a range of more subtle benefits that helped to restore mental wellbeing through stress and anxiety alleviation, the facilitation of emotional perspective, clarity and reassurance, and through the maintenance of positive family dynamics. However, amongst some women who were overweight, the socio-political associations they made with natural environments deterred use of such spaces. Such findings challenge dominant planning and policy assumptions that equate open public access to natural spaces with universal benefit.
Abstract.
Author URL.
Thomas F, Sabel CE, Morton K, Hiscock R, Depledge MH (2014). Extended impacts of climate change on health and wellbeing.
ENVIRONMENTAL SCIENCE & POLICY,
44, 271-278.
Author URL.
Bennett C, Thomas F (2013). Seeking asylum in the UK: lesbian perspectives. Forced Migration Review, 42, 25-28.
Drew R, Aggleton P, Boyce P, Chalmers H, Maxwell C, Pachauri S, Thomas F, Warwick I, Wood K (2011). Social Network Analysis to evaluate organisational networks on sexual health and rights.
Development in Practice,
21(8), 1062-1079.
Abstract:
Social Network Analysis to evaluate organisational networks on sexual health and rights
There are many challenges in evaluating international networks. The use of conventional tools can be difficult and often provides less than useful information. Social Network Analysis offers benefits for network evaluators by allowing for documentation and analysis of inter-relationships between individuals and organisations. This paper describes the use of this approach in the evaluation of a major international project entitled the Global Dialogues on Sexual Health and Well-being. It highlights the value of maps in enabling clear visual representations of networks, the identification of areas needing greater focus and the basis on which networks are constructed. © 2011 Copyright Taylor and Francis Group, LLC.
Abstract.
Thomas F, Aggleton P, Anderson J (2010). 'Experts', 'partners' and 'fools': exploring agency in HIV treatment seeking among African migrants in London.
Social Science and Medicine,
70, 736-743.
Abstract:
'Experts', 'partners' and 'fools': exploring agency in HIV treatment seeking among African migrants in London
In an attempt to promote patient agency and foster more egalitarian relationships between patients and doctors, discourse concerning health and wellbeing in the UK has increasingly centred around the notion of informed and ‘expert’ patients who are able to effectively input into the direction and management of their own health care and treatment. While the relationship between a patient and their doctor can play a vital role in influencing the treatment decisions and health-related outcomes of people living with long term illness, little is known about the ways in which people living with HIV actually perceive their relationship with their doctors, nor the implications this may have for the types of treatment they may seek to use and the related information that they share. Drawing on 11 focus group discussions and 20 repeat interviews undertaken in 2008–2009 with HIV-positive adult migrants from Zambia, Zimbabwe and South Africa living in the UK, this paper argues that patient-doctor relationships can be heavily influenced by the perceived legitimacy of different forms of medical knowledge and treatments and by culturally influenced ideas regarding health, wellbeing and agency. Despite a desire amongst some migrants to use ‘traditional’ medicines from southern Africa as well as other non-biomedical treatments and therapies, the research found that the perceived lack of legitimacy associated with these treatments in the UK rendered their use a largely clandestine activity. At the same time, many patients made clear distinctions concerning issues affecting their immediate health and factors influencing their more general wellbeing, which in turn, impacted upon the information that they chose to share with, or conceal from, their doctors. Such findings challenge assumptions underpinning policy promoting patient agency and have significant and, in cases, potentially adverse implications for the safety and effective administration and management of HIV treatments in African migrant populations and possibly more generally.
Abstract.
Author URL.
Thomas F, Aggleton P, Anderson J (2010). If I cannot access services then there is no need for me to test." the impacts of health service charges on HIV testing and treatment amongst migrants in England.
,
22(4), 526-531.
Abstract:
If I cannot access services then there is no need for me to test." the impacts of health service charges on HIV testing and treatment amongst migrants in England
Policy governing entitlement to access government health care for foreign nationals in England is a subject of debate, controversy and confusion. of particular concern to health providers has been the impact of National Health Service charges on delaying HIV testing and anti-retroviral treatment uptake and adherence amongst certain migrant groups. Data obtained through focus groups with 70 migrants from southern Africa, suggest that confusion over health care entitlements exists amongst those seeking health care and is reported amongst health service providers. This confusion, as well as financial difficulties and fears over deportation facing some migrants, can in turn be a factor influencing their decisions to avoid formal health services, resort to alternative and often ineffective or potentially adverse forms of therapy, and delay HIV testing and treatment uptake
Abstract.
Author URL.
Chase E, Chalmers H, Thomas F, Hollingworth K, Aggleton P (2010). Shifting Policies and Enduring Themes in. School Nursing. British Journal of School Nursing, 5, 492-500.
Thomas F (2010). Transnational health and treatment networks: meaning, value and place in health seeking amongst southern African migrants in London.
Health and Place,
16(3), 606-612.
Abstract:
Transnational health and treatment networks: meaning, value and place in health seeking amongst southern African migrants in London
Drawing upon research undertaken with migrants from southern Africa living in London, this paper examines the important role played by transnational health networks in influencing individual’s treatment seeking decisions. As well as exploring the ways in which these networks provide important sources of help and support for people in times of ill health, the paper examines the ways in which treatments from particular places and contexts carry certain associations, meanings and values, which are in turn, considered vital in influencing health care outcomes.
Abstract.
Author URL.
Evans R, Thomas F (2009). Emotional interactions and an ethic of care: caring relations in families affected by HIV and AIDS'.
Emotions, Space and Society,
2(2), 111-119.
Abstract:
Emotional interactions and an ethic of care: caring relations in families affected by HIV and AIDS'
In the context of global processes of economic restructuring, the HIV and AIDS epidemic and socio-cultural constructions of care, many women and young people in low-income households have been drawn into caring roles within the family. Drawing on the literature on an ethics of care, emotional geographies and embodiment, this paper examines the emotional dynamics of the caring process in families affected by HIV and AIDS. Based on the perspectives of both ‘caregivers’ and ‘care-receivers’ from research undertaken in Namibia, Tanzania and the UK, we examine the everyday practices of care that women and young people are engaged in and explore how emotions are performed and managed in caring relationships. Our research suggests caregivers play a crucial role in providing emotional support and reassurance to people with HIV, which in turn often affects caregivers' emotional and physical wellbeing. Within environments where emotional expression is restricted and HIV is heavily stigmatised, caregivers and care-receivers seek to regulate their emotions in order to protect family members from the emotional impacts of a chronic, life-limiting illness. However, whilst caregiving and receiving may lead to close emotional connections and a high level of responsiveness, the intensity of intimate caring relationships, isolation and lack of access to adequate resources can cause tensions and contradictory feelings that may be difficult to manage. These conflicts can severely constrain carers' ability to provide the ‘good care’ that integrates the key ethical phases in Tronto's (1993) ideal of the caring process.
Abstract.
Author URL.
Thomas F (2008). Indigenous narratives of HIV/AIDS: morality and blame in a time of change.
Medical Anthropology,
27(3), 227-256.
Abstract:
Indigenous narratives of HIV/AIDS: morality and blame in a time of change
While it is increasingly recognized that contextually relevant HIV prevention and AIDS mitigation interventions are more likely to succeed than enforced generic strategies, relatively little attention has been given to understanding the manner in which affected individuals and communities themselves perceive and subsequently experience the epidemic. Drawing on research undertaken in the Caprivi region of Namibia, this article challenges dominant biomedical HIV/AIDS discourse and demonstrates the important role of alternative illness narratives in shaping local understandings of and responses to HIV/AIDS. Four interlinked illness narratives are examined: the relationship between illness and resource use, gender and pollution, religious ideas about morality, and witchcraft accusations. Links are made between these narratives and threats to the social and moral order brought about by socioeconomic change. While treatment sought can initially be influenced by the illness narrative employed, an overriding concern to cure the ill person combined with a range of coexisting social pressures to be seen to be doing the "right thing" ultimately play a more significant role in determining treatment.
Abstract.
Thomas F (2008). Remarriage after spousal death: options facing widows and implications for livelihood security. Gender & Development, 16(1), 73-83.
Thomas F (2008). Remarriage after spousal death: options facing widows and implications for livelihood security.
Gender and Development,
16(1), 75-85.
Abstract:
Remarriage after spousal death: options facing widows and implications for livelihood security
Remarriage following the death of a spouse has important implications for individual and household livelihoods in rural areas. Research in the Caprivi Region of Namibia found that while widowers commonly remarry, the 'traditional' option open to women through widow inheritance has been outlawed. While forcing widows off the land is now prohibited, socio-cultural pressures, the status of the woman's children, and a lack of basic support from the late husband's relatives can result in a more subtle form of property disinheritance. In addition to upheaval caused by relocation, many widows are limited in undertaking livelihood activities, constrained in their capacity to engage in profitable income-earning opportunities, and heavily reliant on the support of others
Abstract.
Thomas F (2007). Eliciting emotions in HIV/AIDS research: a diary‐based approach. Area, 39(1), 74-82.
Thomas F (2007). Eliciting emotions: using solicited text and photo diary methods in HIV/AIDS research.
Area,
39(1), 74-82.
Abstract:
Eliciting emotions: using solicited text and photo diary methods in HIV/AIDS research
Little attention has been given to understanding the emotional well-being of people
living with HIV/AIDS in developing countries despite the fact that emotions may
impact on people’s sense of purpose and value, and ultimately their ability and resolve
to hold livelihood and familial responsibilities together. Drawing upon research
undertaken in the Caprivi Region of Namibia, this paper examines the use of solicited
text and photo diaries in enabling insight into the emotional impacts of HIV/AIDS.
The advantages and constraints of diary methods are examined, focusing on
informant-directed research and the ethical considerations surrounding their use.
Abstract.
Author URL.
Thomas F (2007). Global rights, local realities: negotiating gender equality and sexual rights in the Caprivi Region, Namibia.
Culture, Health and Sexuality,
9(6), 599-614.
Abstract:
Global rights, local realities: negotiating gender equality and sexual rights in the Caprivi Region, Namibia
Gender inequalities are frequently cited as a major reason for high HIV-prevalence rates in southern Africa. While steps have been taken to promote and pass legislation that upholds equal rights for women, this paper examines the ways in which discourses of gender equality and ensuing sexual rights can have complex, contradictory and even adverse implications when they are mobilised, resisted and reinterpreted at local level. Drawing upon research undertaken in the Caprivi Region of Namibia, this paper examines this ways in which men and women respond to ideas about gender equality, and seeks to place these responses within the wider context of socioeconomic change and understandings of morality prevalent within the region. The tendency of many young women to seek out relationships with older men and the increasing costs of bride-wealth payments play a key role in reinforcing patriarchal attitudes and fuelling disrespect for women's rights both before and within marriage. In addition, a failure to adhere to customary norms, which uphold men's dominant role, continues to threaten the support networks and assets available to women. The consequences of this situation are examined with particular focus on implications for the future transmission of HIV.
Abstract.
Author URL.
Thomas F (2007). Our families are killing us": witchcraft narratives and social tensions in the Caprivi Region, Namibia.
Anthropology and Medicine,
14(3), 279-291.
Abstract:
Our families are killing us": witchcraft narratives and social tensions in the Caprivi Region, Namibia
The importance of exploring ‘indigenous’ constructions of illness is vital when
explanatory models of ill health differ markedly from dominant biomedical
paradigms. In the Caprivi Region of Namibia, an upsurge of witchcraft accusations
can be seen as a direct reaction to increasing AIDS-related illness and deaths, and to
changes in socio-economic attitudes and expectations. The mobilisation of witchcraft
narratives provides a socially acceptable explanation for illness, and can positively
influence decisions regarding the care and identity of the ill person. However,
drawing upon data collected at kin and village level, this paper demonstrates that
while witchcraft accusations can avert stigma and blame away from the ill person,
they can also result in significant disruption to livelihoods, and place considerable
tension upon key social capital networks at a time when the household is particularly
vulnerable. Such findings have significant implications for the effectiveness of HIV
prevention and AIDS mitigation initiatives, and for livelihood security.
Abstract.
Author URL.
Thomas F (2007). ‘Our Families are Killing Us’: HIV/AIDS, Witchcraft and Social Tensions in the Caprivi Region, Namibia. Anthropology and Medicine, 14(3), 279-291.
Thomas F (2006). Stigma, fatigue and social breakdown: exploring the impacts of HIV/AIDS on patient and carer well-being in the Caprivi Region, Namibia.
Social Science and Medicine,
63, 3174-3187.
Abstract:
Stigma, fatigue and social breakdown: exploring the impacts of HIV/AIDS on patient and carer well-being in the Caprivi Region, Namibia
It is generally assumed that caring is a substantial burden upon households afflicted by HIV/AIDS. However, as a ‘private’ household responsibility, little is known about the experiences of either those who provide the care, or those receiving care, despite the fact that the process may extend over several years and may have a greater impact upon the livelihood security and well-being of the household than the actual death of the ill person. Drawing upon data collected through solicited diaries, this paper explores how illness and the daily and long-term duties of caring amongst a sample of households in the Caprivi Region of Namibia impacts upon the physical and psychological well-being of ill people and their carers. While optimism and enhanced well-being were recorded during periods of illness remission, AIDS-related illnesses invariably result in periods of sickness and dependency. This results in disempowerment and lowered self-esteem, and decreased well-being amongst ill people. This paper argues that the increasing dependency of the ill person, widespread pressure to maintain household integrity through ‘seeing for yourself’, i.e. being self-sufficient, or at least contributing to reciprocal support networks, and the stigma attached to HIV/AIDS can result in considerable intra-household tension and breakdown of key social support networks
Abstract.
Author URL.
Chapters
Thomas F (2021). Medicalisation. In (Ed) Routledge International Handbook of Critical Issues in Health and Illness, 23-33.
Thomas F, Fietje N (2020). Capturing the cultural narratives of well-being. In (Ed)
Well-Being: Expanding the Definition of Progress Insights from Practitioners, Researchers, and Innovators from Around the Globe, 67-82.
Abstract:
Capturing the cultural narratives of well-being
Abstract.
Thomas F, Hansford L (2019). Supporting mental health in low-income communities: Implications for justice and equity. In (Ed) Practical Justice: Principles, Practice and Social Change, 54-68.
Wyatt K, Durie R, Thomas F (2016). Asset Based Approaches for Community Engagement. In (Ed) Oxford Research Encyclopedia of Environmental Science.
Thomas F (2016). Climate change and health. In (Ed) Encyclopedia of the Anthropocene, UK: Elsevier.
Thomas F (2016). Cultural competence in migrant healthcare. In Thomas F (Ed) Handbook of Migration and Health, Edward Elgar, 459-476.
Thomas F (2016). Migration and health: an introduction. In Thomas F (Ed)
Handbook of Migration and Health, Edward Elgar Publishing, 3-18.
Abstract:
Migration and health: an introduction
Abstract.
Thomas F, Aggleton P (2016). School-Based Sex and Relationships Education: Current Knowledge and Emerging Themes. In (Ed) Global Perspectives and Key Debates in Sex and Relationships Education: Addressing Issues of Gender, Sexuality, Plurality and Power, 13-29.
Thomas F, Hoyez A (2016). Socio-spatial dimensions of healthcare for newly arrived migrants. In Thomas F (Ed) Handbook of Migration and Health, Edward Elgar, 158-172.
Aggleton P, Parker R, Thomas F (2015). From Sex to Sexuality: Sexual Cultures and Sexual Selves. In Aggleton P, Parker R, Thomas F (Eds.) Culture, Health and Sexuality: an introduction, Abingdon: Routledge.
Aggleton P, Parker R, Thomas F (2015). From sex to sexuality. In (Ed) Culture, Health and Sexuality, 1-6.
Thomas F, Aggleton P (2015). School-based sex and relationships education: current knowledge and emerging themes. In Sundaram V, Saunston H (Eds.) Global Perspectives and Key Debates in SRE: Addressing Issues of Gender, Sexuality, Plurality and Power, Palgrave.
Thomas F (2013). Multiple medicaments: looking beyond structural inequalities in migrant healthcare. In Thomas F, Gideon J (Eds.) Migration, Health and Inequality, London: Zed Books, 137-149.
Schifter J, Thomas F (2010). Fantasies, dependency and denial: HIV and the sex industry in Costa Rica. In Thomas F, Haour-Knipe M, Aggleton P (Eds.) Mobility, Sexuality and AIDS, London: Routledge.
Conferences
Kazakova O, Thomas F, Suvalo O (2021). Building resilience to early life trauma in belarus and Ukraine.
Author URL.
Kazakova O, Thomas F, Zrazikova V (2021). Impact of relative mental illness on caregivers.
Author URL.
Kazakova O, Thomas F, Zrazikova V, Gvazdzeuskaya M (2020). Factors influencing family decisions to institutionalize or care for a relative with mental illness at home.
Author URL.
Thomas F (2020). Mental health disorders: an anthropological perspective.
Author URL.
Kazakova O, Thomas F, Suvalo O, Krupchanka D, Fietje N (2020). Understanding and building resilience to early life trauma in belarus and ukraine.
Author URL.
Reports
Napier D, Depledge MH, Knipper M, Lovell R, Ponarin E, Sanabria E, Thomas F (2017).
Culture matters: using a cultural contexts of health approach to enhance policy-making. World Health Organisation, Copenhagen, World Health Organisation.
Abstract:
Culture matters: using a cultural contexts of health approach to enhance policy-making
Abstract.
Aggleton P, Thomas F (2012). Diversity in School. Brazil, Latin American Center in Sexuality and Human Rights.
Wood K, Aggleton P, Thomas F (2010).
Developing sexual health programmes: a framework for action. World Health Organisation, Geneva, WHO.
Author URL.
Publications by year
In Press
Thomas F, Aggleton P (In Press). A confluence of evidence: What lies behind a whole-school approach to health education in schools?. Health Education, 116(2).
Thomas F (In Press). Asking about self-harm and suicide in primary care: Moral and practical dimensions. Patient Education and Counseling
Thomas F (In Press). How is the Patient Health Questionnaire (PHQ-9) used in practice?. Qualitative Health Research
Hansford L, Thomas F, Wyatt K (In Press). The impact of the Work Capability Assessment on mental health: Claimants’ lived experiences and GP perspectives in low-income communities.
Journal of Poverty and Social Justice,
27(3), 351-368.
Abstract:
The impact of the Work Capability Assessment on mental health: Claimants’ lived experiences and GP perspectives in low-income communities
© Policy Press 2019 This paper examines the impact of increased welfare conditionality on people with mental health issues claiming benefits in the UK. Drawing on data from the DeStress study, this paper explores the lived experience of welfare claimants in low-income communities, and the perspectives of GPs seeking to support them. Particular focus is placed on people’s experience of the Work Capability Assessment, the tool used to determine welfare claimants’ entitlement to sickness benefit, and how the narratives and culture surrounding welfare reform and the actual assessment itself can have a negative impact on mental health and wellbeing.
Abstract.
Thomas F, Wyatt K, Hansford L (In Press). The violence of narrative: embodying responsibility for poverty-related distress. Sociology of Health and Illness: a journal of medical sociology
Higgins S, Thomas F (In Press). Urban freshwaters, biodiversity and human health and wellbeing: setting an interdisciplinary research agenda. WIREs Water
2022
Hansford L, Thomas F, Wyatt K (2022). How does housing affect end-of-life care and bereavement in low-income communities? a qualitative study of the experiences of bereaved individuals and service providers in the United Kingdom.
Palliative Care and Social Practice,
16Abstract:
How does housing affect end-of-life care and bereavement in low-income communities? a qualitative study of the experiences of bereaved individuals and service providers in the United Kingdom
Background: Access to affordable, appropriate housing is one of the key social determinants of health, affecting well-being across the lifecourse. However, beyond a recognition that housing quality is linked to place of death, little is known about the ways in which housing status impacts social, emotional, and practical aspects of dying and bereavement. Method: the Checking Out project is a qualitative study aiming to explore the ways in which socio-economic status impacts people’s experiences of, and attitudes towards, death, dying, and bereavement in the United Kingdom. Qualitative interviews were carried out with 14 bereaved individuals with experience of poverty at end of life or in bereavement, and 15 professionals supporting individuals in low-income communities. Interviews were conducted via phone/video call, and data include experiences of end of life and bereavement both before and during the pandemic. Transcripts were examined using thematic analysis. Results: Housing emerged as an important factor affecting people’s experiences, with 7 of the 14 bereaved individuals and all except 1 of the professionals discussing housing-related issues. Participants described ways in which unsuitable housing and housing insecurity impacted practical aspects of dying but also emotional and social well-being at end of life. Housing-related issues affected both patients and their families, though families found it difficult to air these concerns when their relative was dying. Conclusion: the paper demonstrates how trusted professionals are able to advocate or address the issues faced by bereaved individuals and suggests implications for policy and practice. A greater awareness of the potential impact of housing status across public services, including healthcare practitioners, welfare support, and housing providers, could better support patients and practitioners to address these issues proactively. Housing providers and policy-makers should be included as key partners in collaborative public health approaches to palliative care.
Abstract.
Hansford L, Thomas F, Wyatt K (2022). Poverty, choice and dying in the UK: a call to examine whether public health approaches to palliative care address the needs of low-income communities. Mortality, 1-17.
Green J, Fischer EF, Fitzgerald D, Harvey TS, Thomas F (2022). The publics of public health: learning from COVID-19. Critical Public Health, 32(5), 592-599.
2021
Kazakova O, Thomas F, Suvalo O (2021). Building resilience to early life trauma in belarus and Ukraine.
Author URL.
Kazakova O, Thomas F, Zrazikova V (2021). Impact of relative mental illness on caregivers.
Author URL.
Thomas F (2021). Medicalisation. In (Ed) Routledge International Handbook of Critical Issues in Health and Illness, 23-33.
2020
Thomas F, Hansford L, Wyatt K, Byng R, Coombes K, Finch J, Finnerty K, Ford J, Guppy K, Guppy R, et al (2020). An engaged approach to exploring issues around poverty and mental health: a reflective evaluation of the research process from researchers and community partners involved in the DeStress study. Health Expectations, 24(S1), 113-121.
Thomas F, Fietje N (2020). Capturing the cultural narratives of well-being. In (Ed)
Well-Being: Expanding the Definition of Progress Insights from Practitioners, Researchers, and Innovators from Around the Globe, 67-82.
Abstract:
Capturing the cultural narratives of well-being
Abstract.
Kazakova O, Thomas F, Zrazikova V, Gvazdzeuskaya M (2020). Factors influencing family decisions to institutionalize or care for a relative with mental illness at home.
Author URL.
Thomas F (2020). Mental health disorders: an anthropological perspective.
Author URL.
Kazakova O, Thomas F, Suvalo O, Krupchanka D, Fietje N (2020). Understanding and building resilience to early life trauma in belarus and ukraine.
Author URL.
2019
Ford J, Thomas F, Byng R, McCabe R (2019). Exploring how patients respond to GP recommendations for mental health treatment: an analysis of communication in primary care consultations.
BJGP OpenAbstract:
Exploring how patients respond to GP recommendations for mental health treatment: an analysis of communication in primary care consultations.
BACKGROUND: Patient take-up and adherence to antidepressants and talking therapy is low. However, little is known about how GPs recommend these treatments and whether patients accept them. AIM: to examine how GPs recommend antidepressants and talking therapy, and how patients respond. DESIGN & SETTING: a total of 52 recorded primary care consultations for depression, anxiety, and stress were analysed. METHOD: Using a standardised coding scheme, five ways doctors recommend treatment were coded, conveying varying authority and endorsement. The treatment recommendation types were as follows: more directive pronouncements (I'll start you on X); proposals (How about we start X?); less directive suggestions (Would you like to try X?); offers (Do you want me to give you X?); and assertions (There are medications that might help). It was also coded whether patients accepted, passively resisted (for example, withholding response), or actively resisted (for example, I've tried that before). RESULTS: a total of 33 recommendations occurred in 23 consultations. In two-thirds of cases, GPs treated the patient as primary decision-maker by using suggestions, offers, or assertions. In one-third of cases, they used more directive pronouncements or proposals. GPs endorsed treatment moderately (67%), weakly (18%), or strongly (15%). Only one-quarter of recommendations were accepted immediately. Patients cited fears about medication side effects and/or dependency, group therapy, and doubts about treatment efficacy. Despite three-quarters of patients resisting, 76% got prescriptions or self-referral information for talking therapy. CONCLUSION: Initially, GPs treat patients as the decision-maker. However, although patients resist, most end up with treatment. This may impact negatively on treatment uptake and success. Social prescribing may fill a treatment gap for some patients.
Abstract.
Thomas F, Hansford L, Ford J, Wyatt K, McCabe R, Byng R (2019). How accessible and acceptable are current GP referral mechanisms for IAPT for low-income patients? Lay and primary care perspectives. Journal of Mental Health, 29(6), 706-711.
Hughes G, Mehtta M, Bresciani C, Strange S (2019). Introduction.
The Cambridge Journal of Anthropology,
37(2), 1-20.
Abstract:
Introduction
Ugly emotions like envy and greed tend to emerge ethnographically through accusations (as opposed to self-attribution), de-centring the individual psyche and drawing attention to how emotions are deployed in broader projects of moral policing. Tracking the moral, social dimension of emotions through accusations helps to account concretely for the political, economic and ideological factors that shape people’s ethical worldviews – their defences, judgements and anxieties. Developing an anthropological understanding of these politics of accusation leads us to connect classical anthropological themes of witchcraft, scapegoating, and inter- and intra-communal conflict with ethnographic interventions into contemporary debates around speculative bubbles, inequality, migration, climate change and gender. We argue that a focus on the politics of accusation that surrounds envy and greed has the potential to allow for a more analytically subtle and grounded understanding of both ethics and emotions.
Abstract.
Thomas F, Hansford L (2019). Supporting mental health in low-income communities: Implications for justice and equity. In (Ed) Practical Justice: Principles, Practice and Social Change, 54-68.
2018
Thomas F (2018). Health education and migration. Health Education Journal
Hinchliffe S, Jackson M, Wyatt K, Barlow A, Barreto M, Clare L, Deplege M, Durie R, Fleming L, Groom N, et al (2018). Healthy publics: Enabling cultures and environments for health. Palgrave Communications, 4, n/a-n/a.
Thomas F, Hansford L, Ford J, Wyatt K, McCabe R, Byng R (2018). Moral narratives and mental health: rethinking understandings of distress and healthcare support in contexts of austerity and welfare reform.
Palgrave Communications,
4Abstract:
Moral narratives and mental health: rethinking understandings of distress and healthcare support in contexts of austerity and welfare reform
Associations between mental health and poverty are increasingly well established. Yet in neoliberally oriented contexts in which distress engendered through the everyday hardships of poverty is increasingly pathologised and medicalised, important questions are raised over the assumptions inherent within mental health policy and its implementation. Using the UK as a focus, this paper reviews and maps out key questions that require investigation in order to better understand the complex inter-relations between poverty and distress; explores how current paradigms might influence notions of individual responsibility and agency as well as health seeking behaviours; and examines the role of, and cultural and systemic expectations and constraints placed upon GPs as they respond to distress amongst patients from low-income communities. In so doing, we argue for recognition of the moral narratives that underpin both mental health care and processes of welfare reform, and call for an expansion of conventional notions of evidence-based healthcare to incorporate the understandings, experiences and priorities of people from low-income groups. We call for more detailed questioning and analysis of the interactions that lead to mental health diagnosis and treatment and better understanding of the relevance and effectiveness of current treatment options. As a central tenet of this, we argue for more flexible and nuanced healthcare responses that better reflect the dynamic and multi-faceted nature of poverty-related distress.
Abstract.
2017
Napier D, Depledge MH, Knipper M, Lovell R, Ponarin E, Sanabria E, Thomas F (2017).
Culture matters: using a cultural contexts of health approach to enhance policy-making. World Health Organisation, Copenhagen, World Health Organisation.
Abstract:
Culture matters: using a cultural contexts of health approach to enhance policy-making
Abstract.
Thomas F (2017). Pharmaceutical waste in the environment: a cultural perspective. Public Health Panorama
2016
Wyatt K, Durie R, Thomas F (2016). Asset Based Approaches for Community Engagement. In (Ed) Oxford Research Encyclopedia of Environmental Science.
Thomas F (2016). Climate change and health. Reference Module in Earth Systems and Environmental Science
Thomas F (2016). Climate change and health. In (Ed) Encyclopedia of the Anthropocene, UK: Elsevier.
Thomas F (2016). Cultural competence in migrant healthcare. In Thomas F (Ed) Handbook of Migration and Health, Edward Elgar, 459-476.
Thomas F (2016).
Handbook of Migration and Health., Edward Elgar Publishing.
Abstract:
Handbook of Migration and Health
Abstract.
Thomas F (2016). Migration and health: an introduction. In Thomas F (Ed)
Handbook of Migration and Health, Edward Elgar Publishing, 3-18.
Abstract:
Migration and health: an introduction
Abstract.
Thomas F, Aggleton P (2016). School-Based Sex and Relationships Education: Current Knowledge and Emerging Themes. In (Ed) Global Perspectives and Key Debates in Sex and Relationships Education: Addressing Issues of Gender, Sexuality, Plurality and Power, 13-29.
Thomas F, Hoyez A (2016). Socio-spatial dimensions of healthcare for newly arrived migrants. In Thomas F (Ed) Handbook of Migration and Health, Edward Elgar, 158-172.
Thomas F (2016). Young people's use of medicines: pharmaceuticalised governance and illness management within household and school settings. Social Science and Medicine, 165, 150-158.
2015
Aggleton P, Parker R, Thomas F (eds)(2015). Culture, health and sexuality: an introduction. Abingdon, Routledge.
Aggleton P, Parker R, Thomas F (2015). From Sex to Sexuality: Sexual Cultures and Sexual Selves. In Aggleton P, Parker R, Thomas F (Eds.) Culture, Health and Sexuality: an introduction, Abingdon: Routledge.
Aggleton P, Parker R, Thomas F (2015). From sex to sexuality. In (Ed) Culture, Health and Sexuality, 1-6.
Thomas F, Depledge M (2015). Medicine ‘misuse’: Implications for health and environmental sustainability. Social Science & Medicine, 143, 81-87.
Thomas F, Aggleton P (2015). School-based sex and relationships education: current knowledge and emerging themes. In Sundaram V, Saunston H (Eds.) Global Perspectives and Key Debates in SRE: Addressing Issues of Gender, Sexuality, Plurality and Power, Palgrave.
Thomas F (2015). The role of natural environments within women's everyday health and wellbeing in Copenhagen, Denmark.
Health Place,
35, 187-195.
Abstract:
The role of natural environments within women's everyday health and wellbeing in Copenhagen, Denmark.
Urbanisation has been linked with sedentary lifestyles and poor mental health outcomes amongst women. The potential for natural environments to enhance physical activity and mental wellbeing in urban areas is now well recognised. However, little is known about the ways that women use natural spaces for health and wellbeing within the context of their everyday lives. This paper draws on ideas developed in the therapeutic landscapes literature to examine how experiences in different types of green and blue space provide important health and wellbeing benefits for women in Copenhagen, Denmark. As well as facilitating physical exercise, such spaces were found to enable a range of more subtle benefits that helped to restore mental wellbeing through stress and anxiety alleviation, the facilitation of emotional perspective, clarity and reassurance, and through the maintenance of positive family dynamics. However, amongst some women who were overweight, the socio-political associations they made with natural environments deterred use of such spaces. Such findings challenge dominant planning and policy assumptions that equate open public access to natural spaces with universal benefit.
Abstract.
Author URL.
2014
Thomas F, Sabel CE, Morton K, Hiscock R, Depledge MH (2014). Extended impacts of climate change on health and wellbeing.
ENVIRONMENTAL SCIENCE & POLICY,
44, 271-278.
Author URL.
2013
Thomas F, Gideon J (eds)(2013).
Migration, Health and Inequality. London, Zed Books.
Abstract:
Migration, Health and Inequality
Abstract.
Thomas F (2013). Multiple medicaments: looking beyond structural inequalities in migrant healthcare. In Thomas F, Gideon J (Eds.) Migration, Health and Inequality, London: Zed Books, 137-149.
Bennett C, Thomas F (2013). Seeking asylum in the UK: lesbian perspectives. Forced Migration Review, 42, 25-28.
2012
Aggleton P, Thomas F (2012). Diversity in School. Brazil, Latin American Center in Sexuality and Human Rights.
2011
Drew R, Aggleton P, Boyce P, Chalmers H, Maxwell C, Pachauri S, Thomas F, Warwick I, Wood K (2011). Social Network Analysis to evaluate organisational networks on sexual health and rights.
Development in Practice,
21(8), 1062-1079.
Abstract:
Social Network Analysis to evaluate organisational networks on sexual health and rights
There are many challenges in evaluating international networks. The use of conventional tools can be difficult and often provides less than useful information. Social Network Analysis offers benefits for network evaluators by allowing for documentation and analysis of inter-relationships between individuals and organisations. This paper describes the use of this approach in the evaluation of a major international project entitled the Global Dialogues on Sexual Health and Well-being. It highlights the value of maps in enabling clear visual representations of networks, the identification of areas needing greater focus and the basis on which networks are constructed. © 2011 Copyright Taylor and Francis Group, LLC.
Abstract.
2010
Thomas F, Aggleton P, Anderson J (2010). 'Experts', 'partners' and 'fools': exploring agency in HIV treatment seeking among African migrants in London.
Social Science and Medicine,
70, 736-743.
Abstract:
'Experts', 'partners' and 'fools': exploring agency in HIV treatment seeking among African migrants in London
In an attempt to promote patient agency and foster more egalitarian relationships between patients and doctors, discourse concerning health and wellbeing in the UK has increasingly centred around the notion of informed and ‘expert’ patients who are able to effectively input into the direction and management of their own health care and treatment. While the relationship between a patient and their doctor can play a vital role in influencing the treatment decisions and health-related outcomes of people living with long term illness, little is known about the ways in which people living with HIV actually perceive their relationship with their doctors, nor the implications this may have for the types of treatment they may seek to use and the related information that they share. Drawing on 11 focus group discussions and 20 repeat interviews undertaken in 2008–2009 with HIV-positive adult migrants from Zambia, Zimbabwe and South Africa living in the UK, this paper argues that patient-doctor relationships can be heavily influenced by the perceived legitimacy of different forms of medical knowledge and treatments and by culturally influenced ideas regarding health, wellbeing and agency. Despite a desire amongst some migrants to use ‘traditional’ medicines from southern Africa as well as other non-biomedical treatments and therapies, the research found that the perceived lack of legitimacy associated with these treatments in the UK rendered their use a largely clandestine activity. At the same time, many patients made clear distinctions concerning issues affecting their immediate health and factors influencing their more general wellbeing, which in turn, impacted upon the information that they chose to share with, or conceal from, their doctors. Such findings challenge assumptions underpinning policy promoting patient agency and have significant and, in cases, potentially adverse implications for the safety and effective administration and management of HIV treatments in African migrant populations and possibly more generally.
Abstract.
Author URL.
Wood K, Aggleton P, Thomas F (2010).
Developing sexual health programmes: a framework for action. World Health Organisation, Geneva, WHO.
Author URL.
Schifter J, Thomas F (2010). Fantasies, dependency and denial: HIV and the sex industry in Costa Rica. In Thomas F, Haour-Knipe M, Aggleton P (Eds.) Mobility, Sexuality and AIDS, London: Routledge.
Thomas F, Aggleton P, Anderson J (2010). If I cannot access services then there is no need for me to test." the impacts of health service charges on HIV testing and treatment amongst migrants in England.
,
22(4), 526-531.
Abstract:
If I cannot access services then there is no need for me to test." the impacts of health service charges on HIV testing and treatment amongst migrants in England
Policy governing entitlement to access government health care for foreign nationals in England is a subject of debate, controversy and confusion. of particular concern to health providers has been the impact of National Health Service charges on delaying HIV testing and anti-retroviral treatment uptake and adherence amongst certain migrant groups. Data obtained through focus groups with 70 migrants from southern Africa, suggest that confusion over health care entitlements exists amongst those seeking health care and is reported amongst health service providers. This confusion, as well as financial difficulties and fears over deportation facing some migrants, can in turn be a factor influencing their decisions to avoid formal health services, resort to alternative and often ineffective or potentially adverse forms of therapy, and delay HIV testing and treatment uptake
Abstract.
Author URL.
Thomas F, Haour-Knipe M, Aggleton P (eds)(2010).
Mobility, Sexuality and AIDS. Abingdon, Routledge.
Abstract:
Mobility, Sexuality and AIDS
Abstract.
Author URL.
Chase E, Chalmers H, Thomas F, Hollingworth K, Aggleton P (2010). Shifting Policies and Enduring Themes in. School Nursing. British Journal of School Nursing, 5, 492-500.
Thomas F (2010). Transnational health and treatment networks: meaning, value and place in health seeking amongst southern African migrants in London.
Health and Place,
16(3), 606-612.
Abstract:
Transnational health and treatment networks: meaning, value and place in health seeking amongst southern African migrants in London
Drawing upon research undertaken with migrants from southern Africa living in London, this paper examines the important role played by transnational health networks in influencing individual’s treatment seeking decisions. As well as exploring the ways in which these networks provide important sources of help and support for people in times of ill health, the paper examines the ways in which treatments from particular places and contexts carry certain associations, meanings and values, which are in turn, considered vital in influencing health care outcomes.
Abstract.
Author URL.
2009
Evans R, Thomas F (2009). Emotional interactions and an ethic of care: caring relations in families affected by HIV and AIDS'.
Emotions, Space and Society,
2(2), 111-119.
Abstract:
Emotional interactions and an ethic of care: caring relations in families affected by HIV and AIDS'
In the context of global processes of economic restructuring, the HIV and AIDS epidemic and socio-cultural constructions of care, many women and young people in low-income households have been drawn into caring roles within the family. Drawing on the literature on an ethics of care, emotional geographies and embodiment, this paper examines the emotional dynamics of the caring process in families affected by HIV and AIDS. Based on the perspectives of both ‘caregivers’ and ‘care-receivers’ from research undertaken in Namibia, Tanzania and the UK, we examine the everyday practices of care that women and young people are engaged in and explore how emotions are performed and managed in caring relationships. Our research suggests caregivers play a crucial role in providing emotional support and reassurance to people with HIV, which in turn often affects caregivers' emotional and physical wellbeing. Within environments where emotional expression is restricted and HIV is heavily stigmatised, caregivers and care-receivers seek to regulate their emotions in order to protect family members from the emotional impacts of a chronic, life-limiting illness. However, whilst caregiving and receiving may lead to close emotional connections and a high level of responsiveness, the intensity of intimate caring relationships, isolation and lack of access to adequate resources can cause tensions and contradictory feelings that may be difficult to manage. These conflicts can severely constrain carers' ability to provide the ‘good care’ that integrates the key ethical phases in Tronto's (1993) ideal of the caring process.
Abstract.
Author URL.
2008
Thomas F (2008). Indigenous narratives of HIV/AIDS: morality and blame in a time of change.
Medical Anthropology,
27(3), 227-256.
Abstract:
Indigenous narratives of HIV/AIDS: morality and blame in a time of change
While it is increasingly recognized that contextually relevant HIV prevention and AIDS mitigation interventions are more likely to succeed than enforced generic strategies, relatively little attention has been given to understanding the manner in which affected individuals and communities themselves perceive and subsequently experience the epidemic. Drawing on research undertaken in the Caprivi region of Namibia, this article challenges dominant biomedical HIV/AIDS discourse and demonstrates the important role of alternative illness narratives in shaping local understandings of and responses to HIV/AIDS. Four interlinked illness narratives are examined: the relationship between illness and resource use, gender and pollution, religious ideas about morality, and witchcraft accusations. Links are made between these narratives and threats to the social and moral order brought about by socioeconomic change. While treatment sought can initially be influenced by the illness narrative employed, an overriding concern to cure the ill person combined with a range of coexisting social pressures to be seen to be doing the "right thing" ultimately play a more significant role in determining treatment.
Abstract.
Thomas F (2008). Remarriage after spousal death: options facing widows and implications for livelihood security. Gender & Development, 16(1), 73-83.
Thomas F (2008). Remarriage after spousal death: options facing widows and implications for livelihood security.
Gender and Development,
16(1), 75-85.
Abstract:
Remarriage after spousal death: options facing widows and implications for livelihood security
Remarriage following the death of a spouse has important implications for individual and household livelihoods in rural areas. Research in the Caprivi Region of Namibia found that while widowers commonly remarry, the 'traditional' option open to women through widow inheritance has been outlawed. While forcing widows off the land is now prohibited, socio-cultural pressures, the status of the woman's children, and a lack of basic support from the late husband's relatives can result in a more subtle form of property disinheritance. In addition to upheaval caused by relocation, many widows are limited in undertaking livelihood activities, constrained in their capacity to engage in profitable income-earning opportunities, and heavily reliant on the support of others
Abstract.
2007
Thomas F (2007). Eliciting emotions in HIV/AIDS research: a diary‐based approach. Area, 39(1), 74-82.
Thomas F (2007). Eliciting emotions: using solicited text and photo diary methods in HIV/AIDS research.
Area,
39(1), 74-82.
Abstract:
Eliciting emotions: using solicited text and photo diary methods in HIV/AIDS research
Little attention has been given to understanding the emotional well-being of people
living with HIV/AIDS in developing countries despite the fact that emotions may
impact on people’s sense of purpose and value, and ultimately their ability and resolve
to hold livelihood and familial responsibilities together. Drawing upon research
undertaken in the Caprivi Region of Namibia, this paper examines the use of solicited
text and photo diaries in enabling insight into the emotional impacts of HIV/AIDS.
The advantages and constraints of diary methods are examined, focusing on
informant-directed research and the ethical considerations surrounding their use.
Abstract.
Author URL.
Thomas F (2007). Global rights, local realities: negotiating gender equality and sexual rights in the Caprivi Region, Namibia.
Culture, Health and Sexuality,
9(6), 599-614.
Abstract:
Global rights, local realities: negotiating gender equality and sexual rights in the Caprivi Region, Namibia
Gender inequalities are frequently cited as a major reason for high HIV-prevalence rates in southern Africa. While steps have been taken to promote and pass legislation that upholds equal rights for women, this paper examines the ways in which discourses of gender equality and ensuing sexual rights can have complex, contradictory and even adverse implications when they are mobilised, resisted and reinterpreted at local level. Drawing upon research undertaken in the Caprivi Region of Namibia, this paper examines this ways in which men and women respond to ideas about gender equality, and seeks to place these responses within the wider context of socioeconomic change and understandings of morality prevalent within the region. The tendency of many young women to seek out relationships with older men and the increasing costs of bride-wealth payments play a key role in reinforcing patriarchal attitudes and fuelling disrespect for women's rights both before and within marriage. In addition, a failure to adhere to customary norms, which uphold men's dominant role, continues to threaten the support networks and assets available to women. The consequences of this situation are examined with particular focus on implications for the future transmission of HIV.
Abstract.
Author URL.
Thomas F (2007). Our families are killing us": witchcraft narratives and social tensions in the Caprivi Region, Namibia.
Anthropology and Medicine,
14(3), 279-291.
Abstract:
Our families are killing us": witchcraft narratives and social tensions in the Caprivi Region, Namibia
The importance of exploring ‘indigenous’ constructions of illness is vital when
explanatory models of ill health differ markedly from dominant biomedical
paradigms. In the Caprivi Region of Namibia, an upsurge of witchcraft accusations
can be seen as a direct reaction to increasing AIDS-related illness and deaths, and to
changes in socio-economic attitudes and expectations. The mobilisation of witchcraft
narratives provides a socially acceptable explanation for illness, and can positively
influence decisions regarding the care and identity of the ill person. However,
drawing upon data collected at kin and village level, this paper demonstrates that
while witchcraft accusations can avert stigma and blame away from the ill person,
they can also result in significant disruption to livelihoods, and place considerable
tension upon key social capital networks at a time when the household is particularly
vulnerable. Such findings have significant implications for the effectiveness of HIV
prevention and AIDS mitigation initiatives, and for livelihood security.
Abstract.
Author URL.
Thomas F (2007). ‘Our Families are Killing Us’: HIV/AIDS, Witchcraft and Social Tensions in the Caprivi Region, Namibia. Anthropology and Medicine, 14(3), 279-291.
2006
Thomas F (2006). Stigma, fatigue and social breakdown: exploring the impacts of HIV/AIDS on patient and carer well-being in the Caprivi Region, Namibia.
Social Science and Medicine,
63, 3174-3187.
Abstract:
Stigma, fatigue and social breakdown: exploring the impacts of HIV/AIDS on patient and carer well-being in the Caprivi Region, Namibia
It is generally assumed that caring is a substantial burden upon households afflicted by HIV/AIDS. However, as a ‘private’ household responsibility, little is known about the experiences of either those who provide the care, or those receiving care, despite the fact that the process may extend over several years and may have a greater impact upon the livelihood security and well-being of the household than the actual death of the ill person. Drawing upon data collected through solicited diaries, this paper explores how illness and the daily and long-term duties of caring amongst a sample of households in the Caprivi Region of Namibia impacts upon the physical and psychological well-being of ill people and their carers. While optimism and enhanced well-being were recorded during periods of illness remission, AIDS-related illnesses invariably result in periods of sickness and dependency. This results in disempowerment and lowered self-esteem, and decreased well-being amongst ill people. This paper argues that the increasing dependency of the ill person, widespread pressure to maintain household integrity through ‘seeing for yourself’, i.e. being self-sufficient, or at least contributing to reciprocal support networks, and the stigma attached to HIV/AIDS can result in considerable intra-household tension and breakdown of key social support networks
Abstract.
Author URL.
