Laura Hurd

Many larger patients experience weight-based discrimination in healthcare settings, and are judged by practitioners as irresponsible and non-compliant (Phelan et al., 2014). Though there has been increased attention on how weight-based discrimination jeopardizes patient health outcomes (Sutin et al., 2015), empirical research is lacking on 1) practitioners who adopt a social justice approach to caring for larger patients or 2) larger patients’ experiences of receiving social justice-informed care. Social justice in practice refers to addressing intersecting macro-level inequities such as racism, sexism, and sizeism through micro-level practitioner-patient interactions (Mishler, 2005). The present study fills a research gap by examining how social justice is understood, enacted, and experienced in weight-related clinical interventions. Drawing on one-on-one interviews with 22 diverse healthcare practitioners who identify as social justice advocates and 20 larger patients served by such practitioners, four main questions were addressed: 1) How do participants understand social justice? 2) How do practitioners translate social justice principles into practice? 3) What challenges do practitioners encounter when practicing social justice? 4) How does social justice-informed care shape larger patients’ experience? The findings reveal that participants rejected the notion of obesity as an individual problem, and demonstrated a deep awareness of the broader social factors shaping weight and overall wellbeing. Nonetheless, participants’ approaches to care differed depending on whether they regarded obesity as either primarily a social construct or a biomedical fact. Furthermore, despite the prevailing paradigm of obesity as a disease, participants conveyed that non weight-related factors such as financial strain and racism more profoundly impacted patients’ health, which casts doubt on whether medicalizing obesity truly benefits larger patients. A social justice informed-approach to care was found to enhance patients’ experience, with patients expressing appreciation for having their trauma histories and social challenges handled with compassion and curiosity. The study highlights the need to integrate micro-level strategies for individual healing with a macro-level framework of systemic change, as well as cultivate in patients, clinicians, and the public at large a more nuanced understanding of weight and health. The findings provide practice-oriented insights for care informed by frameworks of weight-inclusivity, structural competency, and person-centredness.

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Despite the high prevalence of walking difficulties and widespread use of walking aids in later life, to date, there has been minimal scholarly interest in the study of canes and walkers. Building on the existing literatures in rehabilitation, social gerontology, and geographies of disability, the present study aimed to gain a fuller understanding of older men’s and women’s perceptions and embodied experiences of having walking difficulties and using a cane or a walker. The study was informed by an interpretive approach grounded in feminist disability theory, and was guided by the following research questions:1. How do older men and women perceive and experience having walking restrictions in later life? 2. How do older men and women perceive and experience the use of a cane or a walker in their everyday lives? 3. How does the social and environmental context of mobility shape individuals’ use of canes and walkers in later life? Using a qualitative descriptive method, I conducted a combination of sit-down and walk-along interviews with six male and 18 female cane and walker users aged 67 to 98. The men and women each took part in two sit-down interviews, during which I asked them to discuss what it was like to have walking limitations and to regularly use a walking aid. In addition, participants completed one walk-along interview, during which I accompanied them on an outing to a location of their choosing. In the findings, I discuss the men’s and women’s embodied experiences of having walking limitations and utilizing canes and walkers in the context of the ableist, ageist, and gendered organization of everyday life. In particular, the findings examine the social and spatial practices that organize older adults’ use of their canes and walkers; the cultural meanings attributed to canes and walkers in later life; how these meanings are shaped by the embodied experience of aging and impairment; and how in turn, the use of walking aids may inform older adults’ views of their bodies and identities.

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Women’s body image may be influenced by the changes to body functioning, health, and appearance they face as they age. Body image has been associated with physical activity engagement, life satisfaction, and eating behaviours. To advance understanding of older women’s body image, three studies were conducted using interviews with physically active women aged 65 to 94, adopting interpretive and narrative constructionist approaches. Study one explored how women perceived, experienced, and coped with their aging bodies, and examined their perceptions of the utility of self-compassion for the management of aging body-related changes. Participants were accepting yet critical of the physical changes accompanying aging. They engaged in activity and healthy eating to maintain their body’s functioning and health, and used exercise, diet, and aesthetic strategies to maintain their appearances. Self-compassion for the aging body was viewed as idealistic and contextual. Study two explored the emotions in women’s aging body and physical activity stories. The cultural narrative of decline associating later life with deteriorating health and dependence influenced the women’s experiences in the physical domain. The participants were anxious about body decline. Body-related shame and guilt permeated their stories; they were frustrated with body changes and with their inabilities to engage in certain activities. The women concurrently told stories of body and physical activity-related pride to reassure themselves and others that they were taking responsibility for their health. Study three explored the stories of aging recounted by a 75-year-old woman, which were permeated by narratives of acceptance and resistance. Annabelle accepted yet attempted to slow body decline while facing breast cancer, widowhood, retirement, and ageism. These experiences elicited body shame, sadness, self-pity, anger, anxiety, and pride, and were coped with using cognitive reframing, community engagement, appearance management strategies, and end of life preparations. Overall, these dissertation findings contribute to our understanding of the multidimensionality of body image by drawing attention to the cognitions, emotions, and behaviours involved in how older women perceive and cope with changes to body functioning, health, and appearance. The findings also highlight the role of cultural age and body norms in shaping later life experiences in the physical domain.

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When the Paralympic Movement is discussed, it is predominantly described as both an extension of the Olympic Movement and an uncorrupted version of Olympism. Yet to define the Paralympics only in reference to the Olympic Movement is to ignore its rich history and the unique factors that continue to inform the practice of disability sport. In this research, I collaborated with five Paralympians to create a blog that discussed disability sport and the Paralympic Movement. Collectively, the team published posts on disability sport-related topics and recruited readers to the site. Over a period of 14 months, the blog was visited 9,700 times by individuals in more than 90 countries, resulting in 339 posted comments.I conducted interviews with blog team members and with 20 individuals who were reading and commenting on the blog. Transcripts of the interviews as well as the posts and comments were thematically coded to address the following questions:•How and why do individuals choose to interact with the blog and what are the perceived outcomes of their participation?•How do blog users (readers and writers) understand the relation between the discussions occurring on the blog and their individual online and offline actions to promote, advocate for, and/or transform para-sport?•How do participants (readers and writers) define their involvement in the Paralympic Movement and what do participants perceive to be the ‘key’ issues that the social movement must address?Drawing on new social movement theory and literature into the use of online communication by social movements, I address how blogs are being employed within the Paralympic Movement and the value they have in promoting and advocating for disability sport. The findings discuss blogging as an opportunity for: (1) athletes as authors to share resources, discuss ideas, and provide support to other athletes, (2) members of the Paralympic movement to connect with various audiences and provide outsiders with a ‘window onto para-sport’, and (3) disability sport advocates to call out or challenge individuals, organizations, practices, and policies that are perceived to be discriminatory and as contributing to the marginalization of athletes with disabilities.

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