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Complementary and alternative medicine legitimation efforts in a hostile environment
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Resumo(s)
This article explores complementary and alternative medicine (CAM) organisations’ legitimation efforts that face extra obstacles as they are subject to more than one institutional logics (hybrids) and operate in a contested organisational space (hostile environment). CAM organisations espouse the health and market logics and their practices are questioned at an institutional level. The study is conducted in Portugal, where the legalisation of CAM therapies was a contested process over 10 years. Taking an abductive approach and drawing on qualitative interviews, the authors analyse CAM managers’ efforts to legitimise their practices and build viable organisations despite hostile conditions. Contrary to prior studies of hybrid healthcare organisations, CAM organisations derive moral legitimacy from the market logic rather than the health logic. The findings show that relationships, trust-building and consumer education appear to be the primary vehicles for establishing pragmatic legitimacy. Thus, pragmatic legitimacy relies on the health logic. The market logic dominates the pursuit of moral legitimacy through financial sustainability, human capital, marketing communications and partnerships, and advocating complementarity with biomedicine. We propose a model through which organisations use pragmatic legitimacy to enhance moral legitimacy and to create recursive feedback between moral and pragmatic legitimacy on the path to cognitive legitimacy.
Descrição
Funding Information: The authors express their gratitude to the participants for their availability to be a part of this study. Also, we thank the participants in a workshop organised by the Accounting, Governance and Organisations Group at the University of St Andrews for the extremely helpful and constructive comments in the revision of the paper. Thanks also to the two anonymous reviewers of this article. This work was funded by National Funds through FCT—Fundação para a Ciência e Tecnologia under the projects: UID/ECO/00124/2013, UID/ECO/00124/2019, UIDB/00315/2020; by Social Sciences DataLab under the project: LISBOA‐01‐0145‐FEDER‐022209; by POR Lisboa under the projects LISBOA‐01‐0145‐FEDER‐007722 and LISBOA‐01‐0145‐FEDER‐022209; and by POR Norte under the project: LISBOA‐01‐0145‐FEDER‐022209. Publisher Copyright: © 2023 The Authors. Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for the Sociology of Health & Illness.
Palavras-chave
complementary and alternative medicine hostile environment hybrid organisations legitimacy Health(social science) Health Policy Public Health, Environmental and Occupational Health SDG 3 - Good Health and Well-being