{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T00:52:40Z","timestamp":1777683160281,"version":"3.51.4"},"reference-count":42,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2023,8,8]],"date-time":"2023-08-08T00:00:00Z","timestamp":1691452800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["JS: APP1157199"],"award-info":[{"award-number":["JS: APP1157199"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["PWH: APP1102905"],"award-info":[{"award-number":["PWH: APP1102905"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001794","name":"University of Queensland","doi-asserted-by":"publisher","award":["Early Career Research Grant"],"award-info":[{"award-number":["Early Career Research Grant"]}],"id":[{"id":"10.13039\/501100001794","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000940","name":"Arthritis Australia","doi-asserted-by":"publisher","award":["Project Grant"],"award-info":[{"award-number":["Project Grant"]}],"id":[{"id":"10.13039\/501100000940","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Health Serv Res Policy"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Justice and equity-focused practices in health services play a critical but overlooked role in low back pain (LBP) care. Critical reflexivity \u2013 the ability to examine and challenge power relations, and broader social issues embedded in everyday life \u2013 can be a useful tool to foster practices that are more socially just. No research has yet explored this approach in back pain health services. This study sought to understand how clinicians construct LBP in relation to broader socio-cultural-political aspects of care and explore if those constructions changed when clinicians engaged with critically reflexive dialogues with researchers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using critical discourse analysis methods, this qualitative study explored institutionalised patterns of knowledge in the construction of LBP care. We conducted 22 critically reflexive dialogues with 29 clinicians from two health services in Australia \u2013 a private physiotherapy clinic and a public multidisciplinary pain clinic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Our analyses suggested that clinicians and services often constructed LBP care at an individual level. This dominant individualistic discourse constrained consideration of justice-oriented practices in the care of people with LBP. Through dialogues, discursive constructions of LBP care expanded to incorporate systems and health service workplace practices. This expansion fostered more equitable clinical and service practices \u2013 such as assisting patients to navigate health care systems, considering patients\u2019 socioeconomic circumstances when developing treatment plans, encouraging staff discussion of possible systemic changes to enhance justice, and fostering a more inclusive workplace culture. Although such expansions faced challenges, incorporating broader discourses enabled recommendations to address LBP care inequities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Critical reflexivity can be a tool to foster greater social justice within health services. By expanding constructions of LBP care beyond individuals, critical reflexive dialogues can foster discussion and actions towards more equitable workplace cultures, services and systems.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/13558196231193862","type":"journal-article","created":{"date-parts":[[2023,8,9]],"date-time":"2023-08-09T01:53:47Z","timestamp":1691546027000},"page":"12-21","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Fostering equitable change in health services: Using critical reflexivity to challenge dominant discourses in low back pain care in Australia"],"prefix":"10.1177","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4107-6883","authenticated-orcid":false,"given":"Karime","family":"Mescouto","sequence":"first","affiliation":[{"name":"Postdoctoral Research Fellow, RECOVER Injury Research Centre, The University of Queensland, Brisbane, QLD, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecca E","family":"Olson","sequence":"additional","affiliation":[{"name":"Associate Professor, School of Social Science, The University of Queensland, Brisbane, QLD, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathalia","family":"Costa","sequence":"additional","affiliation":[{"name":"Lecturer in Physiotherapy, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, Australia"},{"name":"Adjunct Research Fellow, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7592-7850","authenticated-orcid":false,"given":"Kerrie","family":"Evans","sequence":"additional","affiliation":[{"name":"Group Chief Education and Research Officer, Healthia Limited, Brisbane, QLD, Australia"},{"name":"Senior Research Fellow, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miriam","family":"Dillon","sequence":"additional","affiliation":[{"name":"PhD Candidate, School of Social Science, The University of Queensland, Brisbane, QLD, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelly","family":"Walsh","sequence":"additional","affiliation":[{"name":"Senior Physiotherapist, Metro South Health Pain Rehabilitation Centre, Brisbane, QLD, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8574-847X","authenticated-orcid":false,"given":"Niamh","family":"Jensen","sequence":"additional","affiliation":[{"name":"Clinical Psychologist, Metro South Health Pain Rehabilitation Centre, Brisbane, QLD, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul W","family":"Hodges","sequence":"additional","affiliation":[{"name":"Professor & NHMRC Leadership Fellow, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathryn","family":"Lonergan","sequence":"additional","affiliation":[{"name":"Patient-Partner, Brisbane, QLD, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Megan","family":"Weier","sequence":"additional","affiliation":[{"name":"Senior Lecturer, Centre for Social Impact, University of New South Wales, Sydney, NSW, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jenny","family":"Setchell","sequence":"additional","affiliation":[{"name":"Senior Research Fellow, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2023,8,8]]},"reference":[{"key":"bibr1-13558196231193862","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)30489-6"},{"key":"bibr2-13558196231193862","doi-asserted-by":"publisher","DOI":"10.1016\/S0950-3579(05)80126-8"},{"key":"bibr3-13558196231193862","doi-asserted-by":"publisher","DOI":"10.1179\/1572513814Y.0000000007"},{"key":"bibr4-13558196231193862","doi-asserted-by":"publisher","DOI":"10.1080\/09638288.2020.1851783"},{"key":"bibr5-13558196231193862","doi-asserted-by":"publisher","DOI":"10.1177\/10497323221084358"},{"key":"bibr6-13558196231193862","doi-asserted-by":"publisher","DOI":"10.1111\/1467-9566.13598"},{"key":"bibr7-13558196231193862","unstructured":"World Health Organization. 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