title: Pierre Bourdieu and transformative agency: a study of how patients in Benin negotiate blame and accountability in the context of severe obstetric events.
abstract: This paper explores the social and institutional processes that constrain and enable obstetric patients in Benin to critically evaluate quality of healthcare and to stimulate positive changes in the health system. Based on qualitative data collected as part of a hospital auditing system, the paper analyses semi-structured patient feedback interviews and their function as a primary mechanism through which critical patient evaluation can develop constructively. Using a Bourdieuan framework, we explore the dynamic social conditions that give rise to transformative agency and institutional change. Our results show that hospitals are often permeated with the habitus of employment, kinship and reproductive social fields, through which a number of social, economic and healthcare conflicts, power struggles and blame-inducing interactions emerge. These conflicts generally serve to keep patients quiescent and passive when it comes to developing critical statements of quality of care. In a subset of cases, however, these conflicts are transformed by patients and their family members into opportunities for modifying the values and practices of each habitus in new and creative ways. The active negotiation of social conflict and blame enabled a minority of patients actively to divert blame from themselves and to develop and maintain critical healthcare evaluations.
authors.affiliation: Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK. dominique.behague@lshtm.ac.uk
authors.forename: Dominique P
authors.initials: DP
authors.lastname: Béhague
authors.forename: Lydie G
authors.initials: LG
authors.lastname: Kanhonou
authors.forename: Véronique
authors.initials: V
authors.lastname: Filippi
authors.forename: Solange
authors.initials: S
authors.lastname: Lègonou
authors.forename: Carine
authors.initials: C
authors.lastname: Ronsmans
mesh_terms: D001541:Benin; D007407:Interviews as Topic; D008485:Medical Audit; D009775:Obstetrics and Gynecology Department, Hospital / Q000592:standards*; D017060:Patient Satisfaction; D011787:Quality of Health Care; D012539:Scapegoating