Christopher Dowrick
Biographic Data
| ID | 89654 |
|---|---|
| NAME | Christopher Dowrick |
| GIVEN NAMES | Christopher |
| FAMILY NAME | Dowrick |
| SIGNATURE | DOWRICK C |
| AFFILIATIONS | University of Liverpool |
| ORCID | 0000-0002-4245-2203 |
| VERIFIED | Yes |
| TOTAL WORKS | 51 |
| TOTAL CITATIONS | 213 |
| AUTHOR COUNT | 51 |
| EDITOR COUNT | 0 |
| FIRST PUBLICATION YEAR | 1992 |
| LATEST PUBLICATION YEAR | 2024 |
| H-INDEX | 9 |
‘My cousin said to me . . .’ Patients’ use of third-party references to facilitate shared decision-making during naturally occurring primary care consultations
In this paper, we explore the ways in which patients invoke third parties to gain decision-making influence in clinical consultations. The patients’ role in decision-making processes is often overlooked, and this interactional practice has rarely been systematically studied. Through a contextual narrative exploration of 42 naturally occurring consultations between patients (aged 22–84) and general practitioners (GPs) in England, we seek to fill t…
‘I’d best take out life insurance, then.’ Conceptualisations of risk and uncertainty in primary care consultations, and implications for shared decision-making
The main objective of this study is to gain knowledge about interactional factors that support and obstruct mutual risk-assessments and shared decision-making (SDM) in clinical consultations. Through a narrative analysis of verbatim transcripts of 28 naturally occurring consultations performed in English National Health Service practices, we explore the ways in which patients and general practitioners conceptualise, construct and negotiate risks …
‘It feels like my metabolism has shut down’. Negotiating interactional roles and epistemic positions in a primary care consultation
INTRODUCTION: Our aim is to explore the ways in which a patient and a general practitioner (GP) negotiate knowledge claims stemming from different epistemic domains while dealing with a mismatch between experiential and biomedical knowledge during the clinical consultation. We interpret their interaction in relation to the sociocultural context in which their negotiation is embedded and identify factors facilitating their successful negotiation (…
Time for united action on depression
Feasibility of Patient Reported Outcome Measures in Psychosocial Palliative Care
Palliative care patients can be at risk of social isolation or loneliness. Interventions that can provide effective social support, and particularly emotional support, could facilitate healthy coping that bolsters quality of life and reduces depression in palliative care patients. This is an observational cohort study which recruited thirty patients ( n = 30) from the day services of four independent hospices in England. Participants completed pa…
Good life is first of all security, not to live in fear
There is growing interest in using Sen’s Capability Approach (CA) as a framework to assess the quality of life and well-being. The aim of the current paper was to use an interpretative phenomenological analysis (IPA) approach using the CA framework to explore what constitutes a ‘good life’ for female refugees post-resettlement in the UK. Four focus groups with 16 women were conducted in Liverpool. Data was analysed using an IPA. The women’s exper…
What is the impact of day care on older people with long‐term conditions
Involving migrants in the adaptation of primary care services in a ‘newly’ diverse urban area in Ireland
Modes of Interaction in Naturally Occurring Medical Encounters With General Practitioners
In this article, we qualitatively explore the manner and style in which medical encounters between patients and general practitioners (GPs) are mutually conducted, as exhibited in situ in 10 consultations sourced from the One in a Million: Primary Care Consultations Archive in England. Our main objectives are to identify interactional modes, to develop a classification of these modes, and to uncover how modes emerge and shift both within and betw…
Negotiating uncertainty in clinical encounters
Based on a narrative analysis of 20 naturally occurring clinical consultations between general practitioners and patients in England, sourced from the One in a million data archive, we explore how they conceptualize and negotiate medical and existential uncertainty. To capture the interactional element, which is often overlooked, three consultations receive special attention. While exploring the ongoing dynamics of the moment-to-moment realizatio…
Participatory implementation research in the field of migrant health
OBJECTIVE: This study aimed to explore whether positive impacts were sustained and unanticipated ripple effects had occurred four years after the implementation of interventions to improve cross-cultural communication in primary care. BACKGROUND: Sustaining the implementation of change using complex interventions is challenging. The EU-funded "RESTORE" study implemented guidelines and training on cross-cultural communication in five Primary Care …
Assessing refugee healthcare needs in Europe and implementing educational interventions in primary care
The current political crisis, conflicts and riots in many Middle Eastern and African countries have led to massive migration waves towards Europe. European countries, receiving these migratory waves as first port of entry (POE) over the past few years, were confronted with several challenges as a result of the sheer volume of newly arriving refugees. This humanitarian refugee crisis represents the biggest displacement crisis of a generation. Alth…
Material practices for meaningful engagement
BACKGROUND: The material practices which researchers use in research partnerships may enable or constrain the nature of engagement with stakeholder groups. Participatory learning and action (PLA) research approaches show promise, but there has been no detailed analysis of stakeholders' and researchers' experiences of PLA techniques for data generation and co-analysis. OBJECTIVES: To explore stakeholders' and researchers' experiences of PLA techni…
Implementing guidelines and training initiatives to improve cross-cultural communication in primary care consultations
Migrants, primary care providers and other key stakeholders can work effectively together to adapt and implement G/TIs to improve communication in cross-cultural consultations, and enhance understanding and trust between GPs and migrant patients
Anxious and depressed women's experiences of emotional suffering and help seeking in a Rio de Janeiro favela
Taking into consideration issues such as stigma and the mental health gap, this study explores narratives of anxious and depressed women treated in a community-based primary care service in a Rio de Janeiro favela about their suffering and care. We analysed 13 in-depth interviews using questions from Kadam's study. Framework analysis studied Access, Gateway, Trust, Psychosocial Issues, and Primary Mental Health Care, as key-concepts. Vulnerabilit…
A critical analysis of the implementation of service user involvement in primary care research and health service development using normalization process theory
Older men and social activity
Finding ways of improving the health and wellbeing of older men is an important challenge for public health. This review aimed to assess evidence for the effects of Men's Sheds and other gendered social activities on the health and wellbeing of older men, and to consider their effective components and theoretical frameworks. A scoping review using standardised search criteria and terms identified 31 relevant papers of sufficient quality for inclu…
Social support network, mental health and quality of life
The objective of this study was to identify the association between emotional distress and social support networks with quality of life in primary care patients. This was a cross-sectional study involving 1,466 patients in the cities of São Paulo and Rio de Janeiro, Brazil, in 2009/2010. The General Health Questionnaire, the Hospital Anxiety and Depression Scale and the brief version of the World Health Organization Quality of Life Instrument wer…
Community Engagement in a complex intervention to improve access to primary mental health care for hard‐to‐reach groups
BACKGROUND: Despite the availability of effective evidence-based treatments for depression and anxiety, many 'harder-to-reach' social and patient groups experience difficulties accessing treatment. We developed a complex intervention, the AMP (Improving Access to Mental Health in Primary Care) programme, which combined community engagement (CE), tailored (individual and group) psychosocial interventions and primary care involvement. OBJECTIVES: T…
The effect of strategies of personal resilience on depression recovery in an Australian cohort
Strategies of personal resilience enable successful adaptation in adversity. Among patients experiencing depression symptoms, we explored which personal resilience strategies they find most helpful and tested the hypothesis that use of these strategies improves depression recovery. We used interview and survey data from the Diagnosis, Management and Outcomes of Depression in Primary Care 2005 cohort of patients experiencing depression symptoms in…
Brazilian multicentre study of common mental disorders in primary care
Mental health problems are common in primary health care, particularly anxiety and depression. This study aims to estimate the prevalence of common mental disorders and their associations with socio-demographic characteristics in primary care in Brazil (Family Health Strategy). It involved a multicenter cross-sectional study with patients from Rio de Janeiro, São Paulo, Fortaleza (Ceará State) and Porto Alegre (Rio Grande do Sul State), assessed …
Mandalas as a visual research method for understanding primary care for depression
Depression is a complex problem, commonly but not always successfully managed in primary care. We know relatively little about the system of primary care for depression particularly at the level of organisations. In this paper, we describe the use of mandalas as a visual data collection method within an in-depth programme of participatory action research undertaken in six primary care organisations in Victoria, Australia. We draw on mandala image…
Maps, Models, and Narratives
Many researchers within the social sciences, medicine, and humanities have examined the ways people talk and think about depression. In their research and published literature they have attempted to determine the theoretical frameworks and appropriate language for categorizing such concepts and understandings. Drawing from mental health and broader social science scholarship, in this article we examine three approaches to developing an inclusive …
Get into Reading as an intervention for common mental health problems
There is increasing evidence for the efficacy of non-medical strategies to improve mental health and well-being. Get into Reading is a shared reading intervention which has demonstrable acceptability and feasibility. This paper explores potential catalysts for change resulting from Get into Reading. Two weekly reading groups ran for 12 months, in a GP surgery and a mental health drop-in centre, for people with a GP diagnosis of depression and a v…
The space of access to primary mental health care
Access to primary mental health care for hard-to-reach groups
Lay accounts of depression amongst Anglo-Australian residents and East African refugees
Brazilian multicentre study of common mental disorders in primary care
Mental health problems are common in primary health care, particularly anxiety and depression. This study aims to estimate the prevalence of common mental disorders and their associations with socio-demographic characteristics in primary care in Brazil (Family Health Strategy). It involved a multicenter cross-sectional study with patients from Rio de Janeiro, São Paulo, Fortaleza (Ceará State) and Porto Alegre (Rio Grande do Sul State), assessed …
Revisiting biographical disruption
Biographical accounts of illness offer useful insights into the social and adaptive processes of living with chronic illness. Yet there are concerns that the underlying theoretical assumptions of a reflexive self seeking to maintain meaning may not reflect the lived experience of individuals. A narrative emphasis may neglect the importance of emotional/felt experiences; while an analytical focus on disruptive processes may not adequately reflect …
Get into Reading as an intervention for common mental health problems
There is increasing evidence for the efficacy of non-medical strategies to improve mental health and well-being. Get into Reading is a shared reading intervention which has demonstrable acceptability and feasibility. This paper explores potential catalysts for change resulting from Get into Reading. Two weekly reading groups ran for 12 months, in a GP surgery and a mental health drop-in centre, for people with a GP diagnosis of depression and a v…
How healers manage the pluralistic healing context
The somatising effect of clinical consultation
Negotiations of distress between East Timorese and Vietnamese refugees and their family doctors in Melbourne
Recent critiques of depression have contested its coherence as a concept and highlighted its performance in medicalising distress. Studies of depression in a cross-cultural context have focused on language and belief systems as technical barriers to practice that need to be overcome in enacting depression work. This paper seeks to locate culture within the broader socio-structural context of depression care in general practice. The paper draws on…
The Politics of Conducting Research on Depression in a Cross-Cultural Context
Successful community engagement is often a crucial component of effective qualitative research. In this article we reflect on our experience of engaging with ethnic minority communities in a qualitative study of help seeking for depression. Community engagement emerges as a complex process that provides important insights into the way mental illness is constructed in various cultural contexts and from diverse perspectives. Contested notions of et…
Resilience and depression
Resilience refers to the capacity for successful adaptation or change in the face of adversity. This concept has rarely been applied to the study of distress and depression. We propose two key elements of resilience - ordinary magic and personal medicine - which enable people to survive and flourish despite current experience of emotional distress. We investigate the extent to which these elements are considered important by a sample of 100 peopl…
Why may older people with depression not present to primary care? Messages from secondary analysis of qualitative data
Depression in older people is common, under-recognised and often undertreated. This study aimed to explore the reasons why older people with depression may not present to primary care. Secondary analysis was carried out, of qualitative data collected in two previous studies in North-West England. Older people are reluctant to recognise and name 'depression' as a set of symptoms that legitimises attending their general practitioner (GP). They do n…
Developing Evidence for How to Tailor Medical Interventions for the Individual Patient
We aim to answer the question: How can we develop an evidence base that will assist tailoring health interventions to individual patients? Using social theory and interview data from people living with chronic illness, we developed a new approach to analysis. Individuals were considered as emergent complex systems, adjusting and adapting within their environment and sometimes transforming. The notion of illness trajectory brought our attention to…
Good life is first of all security, not to live in fear
There is growing interest in using Sen’s Capability Approach (CA) as a framework to assess the quality of life and well-being. The aim of the current paper was to use an interpretative phenomenological analysis (IPA) approach using the CA framework to explore what constitutes a ‘good life’ for female refugees post-resettlement in the UK. Four focus groups with 16 women were conducted in Liverpool. Data was analysed using an IPA. The women’s exper…
Conceptualizing Psychosis in Uganda
A qualitative study, investigating the representations and explanatory models of `madness' held by indigenous and religious healers, was undertaken in urban Uganda. Case vignettes of individuals with a diagnosis of a psychotic disorder were discussed by the healers in terms of phenomenology, causality, intervention and outcome. Indigenous healers primarily understood `madness' as spiritual or physiological, whereas religious healers also held psy…
The Confidential Patient
The interpersonal relationship between doctor and patient is fundamental to general medical practice. In this paper we explore the ways in which general practitioners make sense of the changing political economy of this relationship, as it is restructured by ideas about the patient as consumer, and as it increasingly constitutes the consultation as a point of interaction that may be intrinsically therapeutic. In particular, we explore the ways in…
Negotiating uncertainty in clinical encounters
Based on a narrative analysis of 20 naturally occurring clinical consultations between general practitioners and patients in England, sourced from the One in a million data archive, we explore how they conceptualize and negotiate medical and existential uncertainty. To capture the interactional element, which is often overlooked, three consultations receive special attention. While exploring the ongoing dynamics of the moment-to-moment realizatio…
Access to mental health in primary care
Knowledge about depression, access and help-seeking has increasingly been influenced from a range of disciplines including clinical and applied social science. A range of interventions can improve outcomes of depression and anxiety. However, many in need do not seek help, or their interaction with care-givers does not address their needs. We carried out a systematic search for qualitative articles focusing on the experiences of eight exemplar gro…
Rethinking the doctor-patient relationship in general practice
The doctor-patient relationship in general practice can best be characterized by its use. Perceptions of it will vary depending on the context within which it is situated, and on the perspective of the observer. The context of British general practice has changed over the past three decades, particularly with the development of large primary care teams and expansion in the content of consultations. From the perspective of general practitioners, t…
A Care-Full Diagnosis
It is often argued that Western medical responses to illness take illness out of the intimate social contexts within which illness becomes meaningful for people and that, as a result, Western medicine can often constitute an ineffective or, at worst, a disempowering response to illness. While not wishing to challenge such arguments, we seek in this article to present material that might serve as a useful caveat to them. Drawn from interviews cond…
Modes of Interaction in Naturally Occurring Medical Encounters With General Practitioners
In this article, we qualitatively explore the manner and style in which medical encounters between patients and general practitioners (GPs) are mutually conducted, as exhibited in situ in 10 consultations sourced from the One in a Million: Primary Care Consultations Archive in England. Our main objectives are to identify interactional modes, to develop a classification of these modes, and to uncover how modes emerge and shift both within and betw…
Mandalas as a visual research method for understanding primary care for depression
Depression is a complex problem, commonly but not always successfully managed in primary care. We know relatively little about the system of primary care for depression particularly at the level of organisations. In this paper, we describe the use of mandalas as a visual data collection method within an in-depth programme of participatory action research undertaken in six primary care organisations in Victoria, Australia. We draw on mandala image…
Maps, Models, and Narratives
Many researchers within the social sciences, medicine, and humanities have examined the ways people talk and think about depression. In their research and published literature they have attempted to determine the theoretical frameworks and appropriate language for categorizing such concepts and understandings. Drawing from mental health and broader social science scholarship, in this article we examine three approaches to developing an inclusive …
Why do the O'Sheas consult so often? An exploration of complex family illness behaviour
Involving migrants in the adaptation of primary care services in a ‘newly’ diverse urban area in Ireland
The effect of strategies of personal resilience on depression recovery in an Australian cohort
Strategies of personal resilience enable successful adaptation in adversity. Among patients experiencing depression symptoms, we explored which personal resilience strategies they find most helpful and tested the hypothesis that use of these strategies improves depression recovery. We used interview and survey data from the Diagnosis, Management and Outcomes of Depression in Primary Care 2005 cohort of patients experiencing depression symptoms in…
Why do the O'Sheas consult so often? An exploration of complex family illness behaviour
The Confidential Patient
The interpersonal relationship between doctor and patient is fundamental to general medical practice. In this paper we explore the ways in which general practitioners make sense of the changing political economy of this relationship, as it is restructured by ideas about the patient as consumer, and as it increasingly constitutes the consultation as a point of interaction that may be intrinsically therapeutic. In particular, we explore the ways in…
Leaky Bodies and Boundaries. Feminism, Postmodernism and (Bio)ethics
Margrit Shildrick, Routledge, £45, pp 272 ISBN 0 415 14616 X The medical model—derived, according to Shildrick, from Cartesian dualism—involves a fundamental split between the mind and the body. The knowing mind (the doctor, the male) is detached from the corporeal raw material (the patient, the female). The mind observes and dispenses wisdom at a distance without being involved with or affected by the body. Starting with the female body as her c…
Developing Mental Health Services in a Primary Care Setting
The Liverpool Primary Care Mental Health Project (PCMHP) was set up in 1996 to provide mental health services in a primary care setting. This study describes and evaluates an impact of a working model of a multi-disciplinary team in close association with five Liverpool practices. The data were collected on all patients who came in contact with the PCMHP team during a three-year period and compared with the data available for the five neighboring…
The somatising effect of clinical consultation
Negative life events, social support and gender difference in depression
Why Do Primary Care Physicians Propose Medical Care to Patients With Medically Unexplained Symptoms? A New Method of Sequence Analysis to Test Theories of Patient Pressure
OBJECTIVE: We test predictions from contrasting theories that primary care physicians offer medical care to patients with medically unexplained symptoms in response to a) patients' attribution of symptoms to disease and demand for treatment or b) their progressive elaboration of their symptoms in the attempt to engage their physicians. METHODS: Primary care physicians identified consecutive patients who consulted with symptoms that the physician …
Primary Care Consultations About Medically Unexplained Symptoms
OBJECTIVE: In primary care, many consultations about physical symptoms that the doctor thinks are not explained by physical disease nevertheless lead to somatic interventions. Our objective was to test the predictions that somatic intervention becomes more likely a) when doctors provide simple reassurance rather than detailed symptom explanations and do not help patients discuss psychosocial problems and b) when patients try to engage doctors by …
Assessing community care needs within general practice
Rethinking the doctor-patient relationship in general practice
The doctor-patient relationship in general practice can best be characterized by its use. Perceptions of it will vary depending on the context within which it is situated, and on the perspective of the observer. The context of British general practice has changed over the past three decades, particularly with the development of large primary care teams and expansion in the content of consultations. From the perspective of general practitioners, t…
Self-assessment by elderly people-a means of identifying unmet need in primary care
The objective of this research was to assess the value of a self-completed questionnaire in identifying unmet needs amongst elderly patients in primary care. The setting was one general practice in Liverpool. A questionnaire was sent to all patients aged 75 and over on the practice age-sex register (n=498). Responses were compared with existing practice records. Measures were: self-reports of need with 18 questions covering social support, disabi…
How healers manage the pluralistic healing context
Conceptualizing Psychosis in Uganda
A qualitative study, investigating the representations and explanatory models of `madness' held by indigenous and religious healers, was undertaken in urban Uganda. Case vignettes of individuals with a diagnosis of a psychotic disorder were discussed by the healers in terms of phenomenology, causality, intervention and outcome. Indigenous healers primarily understood `madness' as spiritual or physiological, whereas religious healers also held psy…
Lay accounts of depression amongst Anglo-Australian residents and East African refugees
Resilience and depression
Resilience refers to the capacity for successful adaptation or change in the face of adversity. This concept has rarely been applied to the study of distress and depression. We propose two key elements of resilience - ordinary magic and personal medicine - which enable people to survive and flourish despite current experience of emotional distress. We investigate the extent to which these elements are considered important by a sample of 100 peopl…
Development of a theory of implementation and integration
BACKGROUND: Theories are important tools in the social and natural sciences. The methods by which they are derived are rarely described and discussed. Normalization Process Theory explains how new technologies, ways of acting, and ways of working become routinely embedded in everyday practice, and has applications in the study of implementation processes. This paper describes the process by which it was built. METHODS: Between 1998 and 2008, we d…
When diagnosis fails
The Politics of Conducting Research on Depression in a Cross-Cultural Context
Successful community engagement is often a crucial component of effective qualitative research. In this article we reflect on our experience of engaging with ethnic minority communities in a qualitative study of help seeking for depression. Community engagement emerges as a complex process that provides important insights into the way mental illness is constructed in various cultural contexts and from diverse perspectives. Contested notions of et…
Normalisation process theory
BACKGROUND: The past decade has seen considerable interest in the development and evaluation of complex interventions to improve health. Such interventions can only have a significant impact on health and health care if they are shown to be effective when tested, are capable of being widely implemented and can be normalised into routine practice. To date, there is still a problematic gap between research and implementation. The Normalisation Proc…
Developing Evidence for How to Tailor Medical Interventions for the Individual Patient
We aim to answer the question: How can we develop an evidence base that will assist tailoring health interventions to individual patients? Using social theory and interview data from people living with chronic illness, we developed a new approach to analysis. Individuals were considered as emergent complex systems, adjusting and adapting within their environment and sometimes transforming. The notion of illness trajectory brought our attention to…
Revisiting biographical disruption
Biographical accounts of illness offer useful insights into the social and adaptive processes of living with chronic illness. Yet there are concerns that the underlying theoretical assumptions of a reflexive self seeking to maintain meaning may not reflect the lived experience of individuals. A narrative emphasis may neglect the importance of emotional/felt experiences; while an analytical focus on disruptive processes may not adequately reflect …
A Care-Full Diagnosis
It is often argued that Western medical responses to illness take illness out of the intimate social contexts within which illness becomes meaningful for people and that, as a result, Western medicine can often constitute an ineffective or, at worst, a disempowering response to illness. While not wishing to challenge such arguments, we seek in this article to present material that might serve as a useful caveat to them. Drawn from interviews cond…
Negotiations of distress between East Timorese and Vietnamese refugees and their family doctors in Melbourne
Recent critiques of depression have contested its coherence as a concept and highlighted its performance in medicalising distress. Studies of depression in a cross-cultural context have focused on language and belief systems as technical barriers to practice that need to be overcome in enacting depression work. This paper seeks to locate culture within the broader socio-structural context of depression care in general practice. The paper draws on…
Why may older people with depression not present to primary care? Messages from secondary analysis of qualitative data
Depression in older people is common, under-recognised and often undertreated. This study aimed to explore the reasons why older people with depression may not present to primary care. Secondary analysis was carried out, of qualitative data collected in two previous studies in North-West England. Older people are reluctant to recognise and name 'depression' as a set of symptoms that legitimises attending their general practitioner (GP). They do n…
Access to primary mental health care for hard-to-reach groups
Psychology (40 works) · Medicine (38 works) · Psychiatry (24 works) · Sociology (24 works) · Social Psychology (19 works) · Political science (17 works) · Family medicine (16 works) · Mental health (15 works) · Nursing (15 works) · Computer Science (14 works)