Professional identity construction in the healthcare sector
Narratives around facilitating migrants’ access to healthcare
DOI:
https://doi.org/10.1558/jalpp.20369Keywords:
professional identity, narrative, positioning, migration, healthcare system, tellabilityAbstract
Professionals who engage with migrants in the healthcare sector may take on the role of mediator of information or advisor. Research has shown how these roles might either facilitate or obstruct migrants’ access to healthcare, but little is known about how professionals navigate the potentially conflicting interests of migrants and representatives of the healthcare system, despite their central role in realizing migrants’ rights to healthcare. This article explores the perspectives of professionals in the Swedish healthcare sector who engage in mediating healthcare information to migrants across linguistic and cultural boundaries and advising them on how to access services. Narrative interviews with five stakeholder groups were conducted. The narrative analysis of two focal excerpts from different professional groups demonstrates how these professionals construct mediating as multidirectional, providing information to the migrants and also keeping the state authority informed. The findings reveal the importance of the knowledge positions that different professionals construct in their narratives and to what extent these support their perceived potential to change the healthcare system. In contrast to findings from other studies, the participants are adamant as regards the importance of treating migrants within the framework of the legal provisions, rather than by finding ways around legal constraints. Nevertheless, the use of rhetorical means to create an effective story can bear the danger of perpetuating one-sided accounts of the migrants and other stakeholders.
References
Bamberg, Michael and Alexandra Georgakopoulou (2008) Small stories as a new perspective in narrative and identity analysis. Text & Talk 28 (3): 377–396. https://doi.org/10.1515/TEXT.2008.018
Baraldi, Claudio (2018) Interpreting as mediation of migrants’ agency and institutional support: A case analysis. Journal of Pragmatics 125: 13–27. https://doi.org/10.1016/j.pragma.2017.11.012
Baraldi, Claudio and Laura Gavioli (2016) On professional and non-professional interpreting in healthcare services: The case of intercultural mediators. European Journal of Applied Linguistics 4 (1): 33–55. https://doi.org/10.1515/eujal-2015-0026
Baynham, Mike (2011) Stance, positioning, and alignment in narratives of professional experience. Language in Society 40 (1): 63–74. https://doi.org/10.1017/S0047404510000898
Baynham, Mike and Anna De Fina (2017) Narrative analysis in migrant and transnational contexts. In Marilyn Martin-Jones and Deirdre Martin (eds) Researching Multilingualism: Critical and Ethnographic Perspectives, 31–45. London: Routledge.
Chouliaraki, Lilie and Rafal Zaborowski (2017) Voice and community in the 2015 refugee crisis: A content analysis of news coverage in eight European countries. International Communication Gazette 79 (6–7): 613–635. https://doi.org/10.1177/1748048517727173
Cioc?nel, Alexandra, Florin Laz?r, Shari Munch, Cara Harmon, Georgiana-Cristina Rentea, Daniela Gaba and Anca Mihai (2018) Helping, mediating, and gaining recognition: The everyday identity work of Romanian health social workers. Social Work in Health Care 57 (3): 206–219. https://doi.org/10.1080/00981389.2018.1426674
Codó, Eva (2013) Trade unions and NGOs under neoliberalism: Between regimenting migrants and subverting the state. In Alexandre Duchêne, Melissa Moyer and Celia Roberts (eds) Language, Migration and Social Inequalities: A Critical Sociolinguistic Perspective on Institutions and Work, 24–54. Berlin: De Gruyter. https://doi.org/10.21832/9781783091010-003
Collins, James and Stef Slembrouck (2015) Classifying migrants in the field of health: Sociolinguistic scale and neoliberal statecraft. In Christopher Stroud and Mastin Prinsloo (eds) Language, Literacy and Diversity: Moving Words, 16–33. London: Routledge.
Davidson, Brad (2000) The interpreter as institutional gatekeeper: The social-linguistic role of interpreters in Spanish-English medical discourse. Journal of Sociolinguistics 4 (3): 379–405. https://doi.org/10.1111/1467-9481.00121
De Fina, Anna (2009) Narratives in interview. The case of accounts: For an interactional approach to narrative genres. Narrative Inquiry 19 (2): 233–258. https://doi.org/10.1075/ni.19.2.03def
De Fina, Anna (2013) Positioning Level 3: Connecting local identity displays to macro social processes. Narrative Inquiry 23 (1): 40–61. https://doi.org/10.1075/ni.23.1.03de
De Fina, Anna (2015) Narrative and identities. In Anna De Fina and Alexandra Georgakopoulou (eds) The Handbook of Narrative Analysis, 351–368. Oxford: WileyBlackwell. https://doi.org/10.1002/9781118458204.ch18
De Fina, Anna and Alexandra Georgakopoulou (2012) Analyzing Narratives: Discourse and Sociolinguistic Perspectives. Cambridge: Cambridge University Press. https://doi.org/10.1017/CBO9781139051255
De Fina, Anna and Kendall A. King (2011) Language problem or language conflict? Narratives of immigrant women’s experiences in the US. Discourse Studies 13 (2): 163–188. https://doi.org/10.1177/1461445610392135
Duchêne, Alexandre, Melissa Moyer and Celia Roberts. (2013). Introduction: Recasting institutions and work in multilingual and transnational spaces. In Alexandre Duchêne, Melissa Moyer and Celia Roberts (eds) Language, Migration and Social Inequalities: A Critical Sociolinguistic Perspective on Institutions and Work, 24–54. Berlin: De Gruyter. https://doi.org/10.21832/9781783091010-002
Erickson, Frederick (2001) Co-membership and wiggle room: Some implications of the study of talk for the development of social theory. In Nikolas Coupland, Srikant Sarangi and Christopher N. Candlin (eds) Sociolinguistics and Social Theory, 152–181. Harlow, UK: Longman.
EXPH [Expert Panel on Effective Ways of Investing in Health] (2016) Access to Health Services in the European Union. Brussels: European Commission. Available online: https://ec.europa.eu/health/sites/health/files/expert_panel/docs/015_access_healthservices_en.pdf
Georgakopoulou, Alexandra (2006) The other side of the story: Towards a narrative analysis of narratives-in-interaction. Discourse Studies 8 (2): 235–257. https://doi.org/10.1177/1461445606061795
Georgakopoulou, Alexandra (2013) Building iterativity into positioning analysis: A practice-based approach to small stories and self. Narrative Inquiry 23 (1): 89–110. https://doi.org/10.1075/ni.23.1.05geo
Hall, Christopher, Srikant Sarangi and Stef Slembrouck (1999) The legitimation of the client and the profession: Identities and roles in social work discourse. In Srikant Sarangi and Celia Roberts (eds) Talk, Work and Institutional Order: Discourse in Medical, Mediation and Management Settings, 323–350. Berlin: De Gruyter Mouton. https://doi.org/10.1515/9783110208375.3.293
Hasselbladh, Hans and Eva Bejerot (2017) Performative policy: The case of Swedish healthcare reforms. Critical Policy Studies 11 (3): 291–310. https://doi.org/10.1080/19460171.2016.1166973
Kaufhold, Kathrin and Karolina Wirdenäs (2018) Att mediera information om vårdmöjligheter för nyanlända: Evaluering av SLL:s kommunikation 2015/16. Slutrapport. [Mediating access to healthcare for newly arrived migrants: Evaluating Stockholm County Council’s communication campaign 2015/16. Final report] Available online: http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-155535
Labov, William (1972) Language in the Inner City. Philadelphia: University of Pennsylvania Press.
Larsson, Bengt, Martin Letell and Håkan Thörn (2012) Transformations of the Swedish welfare state: Social engineering, governance and governmentality. In Bengt Larsson, Martin Letell and Håkan Thörn (eds) Transformations of the Swedish Welfare State, 3–22. London: Palgrave Macmillan. https://doi.org/10.1057/9780230363953_1
Mangrio, Elisabeth and Katarina Sjögren Forss (2017) Refugees’ experiences of healthcare in the host country: A scoping review. BMC Health Services Research 17(1): 814. https://doi.org/10.1186/s12913-017-2731-0
Marra, Meredith and Jo Angouri (2011) Investigating the negotiation of identity: A view from the field of workplace discourse. In Jo Angouri and Meredith Marra (eds) Constructing Identities at Work, 1–14. London: Palgrave Macmillan. https://doi.org/10.1057/9780230360051_1
Monrouxe, Lynn V. (2009) Negotiating professional identities: Dominant and contesting narratives in medical students’ longitudinal audio diaries. Current Narratives 1 (1): 41–59.
Ochs, Elinor and Lisa Capps (2001) Living Narrative: Creating Lives in Everyday Storytelling. Cambridge, MA: Harvard University Press.
Papen, Uta (2010) Literacy mediators, scribes or brokers? The central role of others in accomplishing reading and writing. Langage et société 3 (133): 63–82. https://doi.org/10.3917/ls.133.0063
Patterson, Wendy (2013) Narratives of events: Labovian narrative analysis and its limitations. In Molly Andrews, Corinne Squire and Maria Taboukou (eds) Doing Narrative Research (2nd edition), 23–40. London: Sage. https://doi.org/10.4135/9780857024992.d3
Petersson, Jesper (2012) From medicine by wire to governing wireless: Changing geographies of healthcare. In Bengt Larsson, Martin Letell and Håkan Thörn (eds) Transformations of the Swedish Welfare State, 153–167. London: Palgrave Macmillan. https://doi.org/10.1057/9780230363953_10
Pomerantz, Anita (1986) Extreme case formulations: A way of legitimating claims Human Studies 9: 219–229. https://doi.org/10.1007/BF00148128
Slembrouck, Stef (2015) The role of the researcher in interview narratives. In Anna De Fina and Alexandra Georgakopoulou (eds) The Handbook of Narrative Analysis, 239–254. Oxford: WileyBlackwell. https://doi.org/10.1002/9781118458204.ch12
SFS [Svensk författningssamling, Swedish Codes of Statutes] (2008) Lag om hälso- och sjukvård åt asylsökande m.fl. [Healthcare for Asylum Seekers Act]. Lag 2008:334. Available online: http://www.notisum.se/rnp/sls/lag/20080344.HTM
SFS [Svensk författningssamling, Swedish Codes of Statutes] (2013) Lag om hälso- sjukvård till och vissa utlänningar som vistas i Sverige utan nödvändiga tillstånd [Healthcare for foreigners without residence permit]. Lag 2013:407. Available online: http://www.notisum.se/rnp/sls/lag/20130407.htm
SFS [Svensk författningssamling, Swedish Codes of Statutes] (2017) Lag Hälso- och sjukvårdslag [Healthcare Act]. Lag 2017:30. Available online: http://www.notisum.se/rnp/sls/lag/20170030.htm
Strömbäck, Jesper, Felicia Andersson and Eveliina Nedlund (2017) Invandring i medierna: Hur rapporterade svenska tidningar åren 2010-2015? [Immigration in the Nedia: How Did Swedish Newspapers Report in 2010-2015?] Rapport 2017, 6. Stockholm: Delmi. Available online: https://web.archive.org/web/20201018104649/https://www.delmi.se/nyheter/ny-rapport-invandring-i-medierna
Wirdenäs, Karolina and Kathrin Kaufhold (2019) ‘Det funkar men det är på annorlunda sätt’: Om att positionera sig som förmedlare av vårdinformation. [‘It works but in different way’: Positioning as mediator of healthcare information]. Svenskans beskrivning 36: 345–358. Available online: http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-378180
Wortham, Stanton (2001) Narratives in Action. New York: Teachers College Press.
Wortham, Stanton, Katherine Mortimer, Kathy Lee and Elaine Allard (2011) Interviews as interactional data. Language in Society 40 (1): 39–50. https://doi.org/10.1017/S0047404510000874
Wroe, Lauren Elizabeth (2017) ‘It really is about telling people who asylum seekers really are, because we are human like anybody else’: Negotiating victimhood in refugee advocacy work. Discourse & Society 29 (3): 324–343. https://doi.org/10.1177/0957926517734664
Published
Issue
Section
License
Equinox Publishing Ltd.
