Conventional systematic review techniques have limitations when the aim of a review is to construct a critical analysis of a complex body of literature This article offers a reflexive account of an attempt to conduct an interpretive review of the literature on access to healthcare by vulnerable groups in the UK This project involved the development and use of the method of Critical Interpretive Synthesis (CIS) This approach is sensitised to the processes of conventional systematic review methodology and draws on recent advances in methods for interpretive synthesis Many analyses of equity of access have rested on measures of utilisation of health services, but these are problematic both methodologically and conceptually A more useful means of understanding access is offered by the synthetic construct of candidacy Candidacy describes how people's eligibility for healthcare is determined between themselves and health services It is a continually negotiated property of individuals, subject to multiple influences arising both from people and their social contexts and from macro-level influences on allocation of resources and configuration of services Health services are continually constituting and seeking to define the appropriate objects of medical attention and intervention, while at the same time people are engaged in constituting and defining what they understand to be the appropriate objects of medical attention and intervention Access represents a dynamic interplay between these simultaneous, iterative and mutually reinforcing processes By attending to how vulnerabilities arise in relation to candidacy, the phenomenon of access can be better understood, and more appropriate recommendations made for policy, practice and future research By innovating with existing methods for interpretive synthesis, it was possible to produce not only new methods for conducting what we have termed critical interpretive synthesis, but also a new theoretical conceptualisation of access to healthcare This theoretical account of access is distinct from models already extant in the literature, and is the result of combining diverse constructs and evidence into a coherent whole Both the method and the model should be evaluated in other contexts

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Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups

An integrative model of shared decision making in medical encounters

Politeness: some universals in language usage

Reversing Language Shift: Theoretical and Empirical Foundations of Assistance to Threatened Languages. Joshua A. Fishman. Multilingual Matters, 76. Clevedon: Multilingual Matters, 1991. 431 pp.

Reversing Language Shift: Theoretical and Empirical Foundations of Assistance to Threatened Languages

Garfinkel and Ethnomethodology

In his landmark contribution to the field of language shift/maintenance, Fishman maintains that, for language shift to be reversed, “face-to-face, small-scale social life must be pursued in their own right and focused upon directly.” This article responds to this call to examine language shift at the level of face-to-face interaction. It describes a specific interactional practice, referred to as “medium request,” observed in the Rwandan community in Belgium, where language shift is taking place from Kinyarwanda-French bilingualism to French monolingualism. The practice consists in the fact that younger members of the community, when in interaction with adult members, constantly (albeit indirectly) request the latter to “medium-switch” from Kinyarwanda to French. The article therefore describes the practice as a specific type of language/medium negotiation, examines its various strategies, and shows how, through this interactional practice, members of the community actually talk language shift into being. (Medium request, language shift, language maintenance, language/medium negotiation, other-initiated medium repair, embedded medium repair, generalized content repair, targeted content repair, understanding check)

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Medium request: Talking language shift into being

The concept of codeswitching has traditionally been understood, from an external observer's perspective, to mean any occurrence of two languages within the same conversation. Our position is that language alternation should be observed from participants' own perspective. From this perspective, many distinct types of language alternation can be identified, namely “language alternation itself as the medium,” “medium repair” (Gafaranga, 1999,2000) and functional deviance from the medium. In turn, in this last possibility, two situations can be found: "medium-switching" and “medium suspension.” However, for practical reasons of research continuity, we suggest to keep the term “codeswitching” to refer to both cases for both are instances of interactional otherness. Thus, our “respecification” is that codeswitching is, not any occurrence of two languages within the same conversation, but rather any instance of deviance from current medium which is not oriented to(by participants themselves) as requiring any rep...

Interactional otherness: Towards a redefinition of codeswitching

One of the issues studies of language alternation among bilingual speaker still have to resolve is that of the base language (Auer, 1997; Deprez de Heredia, 1991), of a scheme of interpretation (Garfinkel, 1967), with respect to which categories of language alternation are identified. Starting from the fact that the need for a scheme of interpretation is not felt by analysts only, but also by speakers themselves, this paper argues that, in order to “discover” the relevant scheme, a speakers' own perspective must be adopted. Therefore, the paper illustrates this perspective by examining two activities bilingual speakers accomplish while talking, namely medium repair and other-language repair. Both activities are accomplished when, missing the mot juste in one language, speakers draw on their other languages to overcome that difficulty. As the discussion shows, through their own orientation to their language choice acts while accomplishing these activities, speakers themselves reveal, to one another and to analysts as well, the scheme they are attending to here and now. As that scheme speakers themselves orient to need not consist of the use of one language, in the paper, I refer to it, not as the base language, but as the medium of a bilingual conversation.

Joseph Gafaranga

Papers

Medium request: Talking language shift into being

Interactional otherness: Towards a redefinition of codeswitching

Medium repair vs. other-language repair: Telling the medium of a bilingual conversation:

Demythologising language alternation studies: conversational structure vs. social structure in bilingual interaction

Linguistic identities in talk-in-interaction: Order in bilingual conversation