4,462 research outputs found

    A Multi-level Analysis on Implementation of Low-Cost IVF in Sub-Saharan Africa: A Case Study of Uganda.

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    Introduction: Globally, infertility is a major reproductive disease that affects an estimated 186 million people worldwide. In Sub-Saharan Africa, the burden of infertility is considerably high, affecting one in every four couples of reproductive age. Furthermore, infertility in this context has severe psychosocial, emotional, economic and health consequences. Absence of affordable fertility services in Sub-Saharan Africa has been justified by overpopulation and limited resources, resulting in inequitable access to infertility treatment compared to developed countries. Therefore, low-cost IVF (LCIVF) initiatives have been developed to simplify IVF-related treatment, reduce costs, and improve access to treatment for individuals in low-resource contexts. However, there is a gap between the development of LCIVF initiatives and their implementation in Sub-Saharan Africa. Uganda is the first country in East and Central Africa to undergo implementation of LCIVF initiatives within its public health system at Mulago Women’s Hospital. Methods: This was an exploratory, qualitative, single, case study conducted at Mulago Women’s Hospital in Kampala, Uganda. The objective of this study was to explore how LCIVF initiatives have been implemented within the public health system of Uganda at the macro-, meso- and micro-level. Primary qualitative data was collected using semi-structured interviews, hospital observations informal conversations, and document review. Using purposive and snowball sampling, a total of twenty-three key informants were interviewed including government officials, clinicians (doctors, nurses, technicians), hospital management, implementers, patient advocacy representatives, private sector practitioners, international organizational representatives, educational institution, and professional medical associations. Sources of secondary data included government and non-government reports, hospital records, organizational briefs, and press outputs. Using a multi-level data analysis approach, this study undertook a hybrid inductive/deductive thematic analysis, with the deductive analysis guided by the Consolidated Framework for Implementation Research (CFIR). Findings: Factors facilitating implementation included international recognition of infertility as a reproductive disease, strong political advocacy and oversight, patient needs & advocacy, government funding, inter-organizational collaboration, tension to change, competition in the private sector, intervention adaptability & trialability, relative priority, motivation &advocacy of fertility providers and specialist training. While barriers included scarcity of embryologists, intervention complexity, insufficient knowledge, evidence strength & quality of intervention, inadequate leadership engagement & hospital autonomy, poor public knowledge, limited engagement with traditional, cultural, and religious leaders, lack of salary incentives and concerns of revenue loss associated with low-cost options. Research contributions: This study contributes to knowledge of factors salient to implementation of LCIVF initiatives in a Sub-Saharan context. Effective implementation of these initiatives requires (1) sustained political support and favourable policy & legislation, (2) public sensitization and engagement of traditional, cultural, and religious leaders (3) strengthening local innovation and capacity building of fertility health workers, in particular embryologists (4) sustained implementor leadership engagement and inter-organizational collaboration and (5) proven clinical evidence and utilization of LCIVF initiatives in innovator countries. It also adds to the literature on the applicability of the CFIR framework in explaining factors that influence successful implementation in developing countries and offer opportunities for comparisons across studies

    Resilience and food security in a food systems context

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    This open access book compiles a series of chapters written by internationally recognized experts known for their in-depth but critical views on questions of resilience and food security. The book assesses rigorously and critically the contribution of the concept of resilience in advancing our understanding and ability to design and implement development interventions in relation to food security and humanitarian crises. For this, the book departs from the narrow beaten tracks of agriculture and trade, which have influenced the mainstream debate on food security for nearly 60 years, and adopts instead a wider, more holistic perspective, framed around food systems. The foundation for this new approach is the recognition that in the current post-globalization era, the food and nutritional security of the world’s population no longer depends just on the performance of agriculture and policies on trade, but rather on the capacity of the entire (food) system to produce, process, transport and distribute safe, affordable and nutritious food for all, in ways that remain environmentally sustainable. In that context, adopting a food system perspective provides a more appropriate frame as it incites to broaden the conventional thinking and to acknowledge the systemic nature of the different processes and actors involved. This book is written for a large audience, from academics to policymakers, students to practitioners

    Facilitating prosociality through technology: Design to promote digital volunteerism

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    Volunteerism covers many activities involving no financial rewards for volunteers but which contribute to the common good. There is existing work in designing technology for volunteerism in HumanComputer Interaction (HCI) and related disciplines that focuses on motivation to improve performance, but it does not account for volunteer wellbeing. Here, I investigate digital volunteerism in three case studies with a focus on volunteer motivation, engagement, and wellbeing. My research involved volunteers and others in the volunteering context to generate recommendations for a volunteer-centric design for digital volunteerism. The thesis has three aims: 1. To investigate motivational aspects critical for enhancing digital volunteers’ experiences 2. To identify digital platform attributes linked to volunteer wellbeing 3. To create guidelines for effectively supporting volunteer engagement in digital volunteering platforms In the first case study I investigate the design of a chat widget for volunteers working in an organisation with a view to develop a design that improves their workflow and wellbeing. The second case study investigates the needs, motivations, and wellbeing of volunteers who help medical students improve their medical communication skills. An initial mixed-methods study was followed by an experiment comparing two design strategies to improve volunteer relatedness; an important indicator of wellbeing. The third case study looks into volunteer needs, experiences, motivations, and wellbeing with a focus on volunteer identity and meaning-making on a science-based research platform. I then analyse my findings from these case studies using the lens of care ethics to derive critical insights for design. The key contributions of this thesis are design strategies and critical insights, and a volunteer-centric design framework to enhance the motivation, wellbeing and engagement of digital volunteers

    Identity, Power, and Prestige in Switzerland's Multilingual Education

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    Switzerland is known for its multilingualism, yet not all languages are represented equally in society. The situation is exacerbated by the influx of heritage languages and English through migration and globalization processes which challenge the traditional education system. This study is the first to investigate how schools in Grisons, Fribourg, and Zurich negotiate neoliberal forces leading to a growing necessity of English, a romanticized view on national languages, and the social justice perspective of institutionalizing heritage languages. It uncovers power and legitimacy issues and showcases students' and teachers' complex identities to advocate equitable multilingual education

    Sport team leadership coaching and captaincy in elite level rugby union football

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    A wide range of literature exists on coaching but it is concerned predominantly with the high school and college levels, is based upon athlete or coach perceptions, or is confined to observations of training or competition. As leaders of sports teams, coaches and captains have rarely been studied at the highest level of national or international sports competition. In the present study, the team leadership roles of the coach and captain in elite rugby union football in New Zealand were examined using participant observation and other qualitative research methods. Elite was defined as New Zealand rugby’s highest internal level of competition: (a) the national provincial championships and (b) international test matches of the national team, the All Blacks. The study explored the roles of the elite rugby coach and captain in vivo in a wide variety of team situations. It was felt that this could provide first-hand information on particular team leader behaviours, on what a coach and captain actually do, and how they are perceived by those around them. The main objective, however, was to use grounded theory techniques to create a model of elite rugby team leadership that might guide developmental programmes on such leadership. The research phases undertaken were those of participant observation with a Provincial Team for five matches, a survey of provincial teams’ coaches and captains on their leadership associated with actual matches, three years’ participant observation with the All Blacks (including observation in eight test match weeks), multiple perspectives on elite team leadership from past rugby test players in New Zealand and overseas, and interviews with national team leaders in sports other than rugby. Participant observation, interviews, questionnaires and document analysis generated data from the research settings. These data were considered in terms of symbolic interactionism and subjected to a grounded theory process. This led to a set of elite rugby team leadership categories and properties which, in turn, generated a comprehensive set of theoretical propositions. The propositions became the basis for a model of elite rugby team leadership. This model was then considered as the basis for a programme to develop elite rugby team leaders. Significant aspects of the research findings which have not featured in previous research literature included the coach’s vision, team culture, centrality of the game plan, match week build-up, the importance of the captain’s playing example, the coach's ability to utilise teaching precepts, the coach’s personal qualities, and the need to develop and evaluate team leaders. The model, and the developmental programme principles emanating from it, are seen as relevant for developing elite level leaders in team sports other than rugby

    Interdisciplinarity as a political instrument of governance and its consequences for doctoral training

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    UK educational policies exploit interdisciplinarity as a marketing tool in a competitive educational world by building images of prosperous futures for society, the economy, and universities. Following this narrative, interdisciplinary science is promoted as superior to disciplinary forms of research and requires the training of future researchers accordingly, with interdisciplinary doctoral education becoming more established in universities. This emphasis on the growth of interdisciplinary science polarises scholars’ views on the role of academic research between the production of knowledge on the one hand and knowledge as an economic resource at the other end of the spectrum. This research asks: what is the rationale behind the perceived value of interdisciplinary research and training, and how does it affect graduate students’ experiences of their PhD? Based on a practice theory perspective for its suitability in generating insights into how university’s social life is organised, reproduced and transformed, the doctorate is conceptualised as sets of interconnected practices that are observable as they happen. This current study, therefore, comprised two stages of data collection and analysis; the examination of documents to elucidate educational policy practices and an educational ethnography of an interdisciplinary doctoral programme. This study found interdisciplinary doctoral training is hindered by the lack of role models and positive social relationships, which are crucial to the way interdisciplinary students learn. Furthermore, it is argued that interdisciplinarity is sometimes applied to research as a label to fit with funders’ requirements. Specifically, in this case, medical optical imaging is best seen as an interdiscipline as it does not exhibit true interdisciplinary integration. Further insights show that while interdisciplinarity is promoted in policy around promises and expectations for a better future, it is in tension with how it is organisationally embedded in higher education. These insights form the basis for a list of practical recommendations for institutions. Overall, interdisciplinary doctoral training was observed to present students with difficulties and to leave policy concerns unaddressed

    FIRST NATIONS LED MENTAL HEALTH RECOVERY IN THE FACE OF ENVIRONMENTAL AND FLOODING JEOPARDY

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    Understanding the factors influencing mental and social health after extreme weather events or incremental climate change is crucial to addressing these issues on First Nation reserves in the Canadian prairies. Previous research on an international level has linked climate change to effects on mental health for general populations but, within a First Nations context, the literature base is severely lacking. What little the literature does indicate, however, is that policy in Canada is failing to prevent physical and mental harm to First Nations people from anthropogenically-driven environmental and climate change when compared with general populations. Using interdisciplinary and mixed methodologies, this thesis explores the academic literature linking climate change, disasters, and weather events, and mental health effects, defines and explores environmental mismanagement affecting reserve land, and critically assesses the colonial policies and circumstances that affect First Nations mental health outcomes. The objectives of the present research are executed through systematic review, and qualitative analysis of first-hand experience with flood recovery. The direction of this research is informed by partnerships with Yellow Quill First Nation and James Smith Cree Nation in Saskatchewan. This thesis forms a better understanding of the circumstances of mental health issues in an environmental context and ultimately places itself to inform policy that can reduce environment-related mental health issues in First Nations reserve communities based on an interdisciplinary and community-driven exploration of First Nations led disaster planning, mental health recovery, and environmental management

    Responsibilities related to adolescents’ use of alcohol – Perspectives of adolescents and parents

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    This study describes responsibilities related to adolescents’ use of alcohol from adolescents’ and parents’ perspectives. The aim was to produce knowledge to support adolescents in growing up and taking responsibility, and to strengthen parents’ capabilities related to the questions of adolescents’ use of alcohol. Knowledge of the responsibilities can help adolescents to make more responsible health choices at home and in preventive healthcare. The study consisted of two parts and used a multi-methods approach. In the first part, an integrative review of the previous literature (n = 22) was conducted to explore the forms of parental involvement in preventing adolescents’ use of alcohol. The data was analysed using inductive content analysis method. In the second part, adolescents’ and parents’ perceptions and experiences of responsibilities related to adolescents’ use of alcohol were described. The two datasets used were group interviews among 14–16-year-old adolescents (n = 87), and semi-structured individual and couple interviews with parents (n = 20). The first sub-study focused on adolescents’ and the second sub-study on parents’ perspectives. Inductive content analysis was used. The third sub-study was a deductive secondary analysis, based on Hart’s taxonomy of moral responsibility. The analysis utilized NVivo software. Based on the integrative review findings, parental involvement in adolescents’ use of alcohol was described in three forms: parental monitoring, suitable family rules, and mutual parent-child communication. The second part of the study displayed adolescents’ multifaceted and developing responsibilities, with a particular focus on taking care of one’s own and peers’ health. Parents’ responsibilities referred to conscious and unquestionable duties to prevent the negative impact of alcohol. According to adolescents’ and parents’ concurrent descriptions, moral responsibilities were based on reasonable knowledge and reflected actions and their consequences in accordance with their role and the prevailing legislation. A need for peer support and collaboration supporting both adolescents and their parents was detected. In conclusion, it is noted that the responsibilities related to adolescents’ use of alcohol can be perceived as a topic shared by adolescents and their parents. In essence, shared responsibilities seem to protect adolescents against the use of alcohol and can prevent their use of alcohol as adolescents prepare for the transition towards taking full responsibility. There is a need for further research from the perspectives of school nurses, teachers and different family types.Nuorten alkoholin kĂ€yttöön liittyvĂ€t vastuut – nuorten ja vanhempien nĂ€kökulma TĂ€mĂ€ tutkimus kuvaa nuorten alkoholin kĂ€yttöön liittyviĂ€ vastuita nuorten ja vanhempien nĂ€kökulmista. Tavoitteena oli tuottaa tietoa nuoren oman kasvun ja vastuunoton tukemiseksi sekĂ€ vanhempien valmiuksien vahvistamiseksi nuorten alkoholin kĂ€ytön kysymyksissĂ€. Vastuiden tunteminen voi auttaa nuoria kohti vastuullisia terveysvalintoja kotona, ja olla hyödyksi ennaltaehkĂ€isevĂ€ssĂ€ terveydenhuollossa. Tutkimus oli monimenetelmĂ€tutkimus, joka toteutettiin kahdessa osassa. EnsimmĂ€inen osa muodostui integratiivisesta kirjallisuuskatsauksesta, jossa kuvattiin vanhempien puuttumista nuorten alkoholin kĂ€ytön ennaltaehkĂ€isyssĂ€. KansainvĂ€liset tutkimusartikkelit (n = 22) analysoitiin sisĂ€llönanalyysimenetelmĂ€llĂ€. Toisessa osassa kuvattiin nuorten ja vanhempien kĂ€sityksiĂ€ ja kokemuksia nuorten alkoholin kĂ€yttöön liittyvistĂ€ vastuista. KĂ€ytetyt kaksi aineistoa olivat puolistrukturoidut 14–16-vuotiaiden nuorten (n = 87) ryhmĂ€haastattelut sekĂ€ vanhempien (n = 20) yksilö- ja parihaastattelut. EnsimmĂ€inen osatutkimus kohdistui nuorten, ja toinen vanhempien nĂ€kemyksiin. Haastattelut analysoitiin aineistolĂ€htöisellĂ€ sisĂ€llönanalyysimenetelmĂ€llĂ€. Kolmas osatutkimus oli deduktiivinen sekundaarianalyysi, jossa hyödynnettiin NVivo-analyysiohjelmaa. Kirjallisuuskatsauksen tulosten mukaan vanhemman puuttuminen nuorten alkoholin kĂ€yttöön tarkoitti nuorten valvontaa, perheen sÀÀntöjĂ€ sekĂ€ kunnioittavaa ja molemminpuolista vuorovaikutusta vanhemman ja nuoren vĂ€lillĂ€. Empiirinen osio osoitti, ettĂ€ nuorten monitahoiset, kehittymĂ€ssĂ€ olevat vastuut kohdistuivat erityisesti omaan ja vertaisten terveydestĂ€ huolehtimiseen. Vanhemmilla oli tiedostettu ja itsestÀÀn selvĂ€ vastuu alkoholin kĂ€ytön haitallisten seurausten ehkĂ€isystĂ€. Nuorten ja vanhempien samansuuntaisten kuvausten mukaan moraaliset vastuut pohjautuivat perusteltuun tietoon, ja kohdistuivat roolin ja lainsÀÀdĂ€nnön mukaisiin toimiin ja niiden seurauksiin. Nuorten ja vanhempien vastuunoton tueksi tarvittiin vertaistukea ja yhteistyötĂ€ eri tahojen kanssa. JohtopÀÀtöksenĂ€ todetaan, ettĂ€ nuorten alkoholin kĂ€yttöön liittyvĂ€t vastuut voidaan kĂ€sittÀÀ nuorten ja vanhempien yhteisenĂ€ aihealueena. Nuorten terveysvalinnoissa jaetuilla vastuilla nĂ€yttÀÀ olevan nuorten alkoholin kĂ€yttöÀ suojaava ja ennaltaehkĂ€isevĂ€ olemus, kun nuoret valmistautuvat siirtymÀÀn kohti tĂ€yttĂ€ vastuutaan. LisĂ€tutkimus vastuista kouluterveydenhoitajien, opettajien ja erilaisten perhemuotojen nĂ€kökulmasta on alkoholin kĂ€ytön kysymyksissĂ€ tarpeen
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