Ethics in the everyday: exploring discursive care practices within households that include children with obesity

In my doctoral project I explored medicine taking amongst patients with atrial fibrillation (AF), focusing on the blood-thinning medications known as direct oral anticoagulants (DOACs) and vitamin K antagonists such as warfarin. I reviewed the available research on how people take their DOACs and found that one third of patients do not possess enough medication to follow their prescription more than 80% of the time, and 1 in 4 patients discontinue within one year.

I interviewed 17 patients and analysed patterns in how they described their illness journeys, the types of illness metaphors they used, and the themes that they talked about. I characterised the illness journeys that patients experienced in four ways: the 'big event', the 'long road', the 'chance find', and the 'juggling act'. I went on to show that the decisions people make about medicines emerge from the interaction and negotiation of a collection of actors, bodily sensations, sources of information and objects over time. Finally, I demonstrated how patients undertake work and strategies to create a 'good patient' self when talking about medicines. This effort reflects circulating moral beliefs and understandings about risk, healthy and unhealthy bodies, blame for illness, deservingness for care, and responsible use of scarce healthcare resources.

The aims of this one year fellowship include communicating these findings with researchers, clinicians and patients with AF and their carers, through publication in peer reviewed journals, presentations at conferences, and a blog. I will also create an animation aimed at clinicians and patients with AF, and their carers and families.

My narrative doctoral work attended to cross cutting themes around the enactment of health practices and decision making, and how beliefs about risk, responsibility and morality are negotiated in cardiovascular illness. With this strong foundation, I will continue my focus on the 'moral', or 'ethical' in everyday health practices. I will extend my methodological expertise to include ethnography, continue my interest in language and metaphor, and bring these together in a linguistic ethnographic approach.

Obesity - a complex, stigmatising and contentious condition - is a rich case for continuing my research focus on the negotiation of health practices and decision making. Shifting from the clinic to the household, my planned study will contribute to understanding how ethics and morality play out in everyday conversations and routines in households with childhood obesity, through interviews and observations with families in East London.

Focusing on social practices and interaction in these household collectives will illuminate whether, how, and to what extent circulating moral beliefs and social structures shape everyday decision making and actions. It will open up opportunity to consider alternative ways of 'doing' health and happiness that may not focus on weight, but on other ways of doing and being 'good'.

My development of two fellowship proposals will include preparatory work such as holding co-production workshops with parents and children from East London, and skills training. I will also undertake a meta-ethnography to inform the proposal and build networks with academics and practitioners from local communities.