8,155 research outputs found

    Navigating the system vs. changing the system: a comparative analysis of the influence of asset-based and rights-based approaches on the well-being of socio-economic disadvantaged communities in Scotland

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    Asset-based and rights-based approaches have become leading strategies in Scottish community development. The asset-based approach seeks to help communities develop skills to provide self-help solutions. The rights-based approach seeks to help communities claim rights and make governments more accountable. These two approaches are based on contrasting conceptions of empowerment, employ opposing methods and lead to different outcomes. However, there is no empirical research that has comparatively assessed the two. This thesis represents the first in-depth exploration of the comparative effects of asset-based and rights-based approaches on the well-being of communities experiencing socio-economic disadvantage in Scotland. The study follows a qualitative design that includes a comparative case study of two projects: the AB project (representing the asset-based approach), and the RB project (representing the rights-based approach). The study also includes the perspectives of a wider pool of practitioners working in a range of community development organisations in Scotland. In total, forty-five participants across seventeen organisations have participated in this study. To assess the influence of asset-based and rights-based approaches upon well-being, this thesis employs a pluralistic account that combines objective and subjective indicators across three dimensions: material, social and personal. The specific well-being framework employed is the result of combining White’s (2010) well-being framework for the development practice and Oxfam Scotland’s (2013) Humankind Index. The results of this study indicate that asset-based and rights-based approaches have important contrasting effects on well-being. The asset-based approach seems to have a more positive effect on project participants and across a higher number of well-being indicators. The rights-based approach has more observable effects on material well-being and a higher impact on the wider community, but across fewer indicators. My findings also suggest that employing these approaches in community development settings brings different advantages and disadvantages. The asset-based approach seems easier to apply and to prove the positive outcomes on those involved. This approach, however, risks sustaining the status quo and, by doing so, misses out the opportunity to achieve more transformational outcomes. The right-based approach seems able to address structural disadvantages more effectively. Yet, it is more difficult to apply and to prove a positive impact. Organisations, practitioners, and communities applying it also face higher costs. These findings have significant implications at the practice level. Asset-based and rights-based approaches are rarely combined in UK community development settings. As a result, practitioners are often left in the position of having to make a trade-off between helping improve the well-being of project participants and helping improve the well-being of the wider community. In theory, practitioners could avoid this trade- off by combining these approaches. In practice, this is not always possible. Asset-based and rights-based approaches represent opposing theories of change. There are also legal and funding requirements that prevent organisations from following a combination of both. Given this, understanding the comparative impact of applying asset-based and rights-based approaches in community development is critical

    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

    Management strategies and contributory factors for resistance exercise-induced muscle damage: an exploration of dietary protein, exercise load, and sex

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    The World Health Organisation recommends that resistance exercise be performed at least twice per week to benefit general health and wellbeing. However, resistance exercise is associated with acute muscle damage that potentially can dampen muscle adaptations promoted by chronic resistance training. The extent to which muscle is damaged by exercise is influenced by various factors, including age, training status, exercise type, and – notable to this thesis – sex. To this end, establishing sex-specific management strategies for exercise-induced muscle damage (EIMD) is important to optimise the benefits of exercise. Two EIMD management strategies were focussed on in this thesis: dietary protein supplementation and exercise load manipulation. It was identified in this thesis that research into the impact both of protein supplementation and exercise load on EIMD heavily underrepresent female populations (chapters 3 and 5), despite well-documented sex differences in EIMD responses. Therefore, future research priority should be placed on bridging the sex data gap by conducting high-quality studies centralising around female-focussed and sex-comparative methodological designs. Both peri-exercise protein supplementation and exercise load manipulation in favour of lighter loads were revealed to be effective management strategies for resistance EIMD in males through systematic and scoping review of the current literature (chapters 3 and 5, respectively). Due to a lack of data from females, it is only appropriate for these strategies to be recommended for males at present. To decipher whether protein supplementation and lower exercise loads are beneficial for managing EIMD in females, a randomised controlled trial (RCT) (chapter 4) and a protocol for an RCT (chapter 6) involving male and female participants are presented in this thesis. The incorporation of ecologically-valid resistance exercise in the RCT in chapter 4 highlighted that even mild muscle damage is attenuated in females, reflected in diminished increases in post-exercise creatine kinase concentration and muscle soreness compared with males; however, the reason for this difference requires further investigation. This study, while supporting sex differences, contrasted previous studies, as neither males nor females experienced an attenuation of EIMD during milk protein supplementation. This difference likely owed to the lower severity of muscle damage induced in the current study relative to previous studies, and accordingly, future research should seek to discover alternative management strategies for mild EIMD. A protocol for an RCT examining the impact of exercise load on EIMD in untrained males and females is described in Chapter 6 of this thesis and may be used as guidance for researchers developing similar, sex-comparative studies. It was hypothesised that females will experience attenuated muscle damage relative to males and low-load exercise will induce less muscle damage than high-load exercise in both sexes. A lack of methodological consistency among EIMD studies was a recurring finding throughout this thesis, which posed an issue when attempting to compare between-study outcomes and reach a consensus. Achieving greater uniformity in study designs by adopting comparable methods relating to EIMD markers and time-points of assessment would help improve understanding of the factors influencing the magnitude of EIMD and effective management strategies. While there are limitations with several EIMD markers – for example the variability of biomarkers and subjectivity of perceptual assessments – once the optimal markers are determined, these should be consistently used moving forward. Overall, this thesis has contributed to the current body of knowledge by demonstrating that milk protein ingestion is not an effective management strategy for muscle damage following ecologically-valid resistance exercise; therefore, alternative strategies to mitigate mild muscle damage should be investigated. Further, this work supported previous reports of sex differences in EIMD and indicated that the attenuation of EIMD in females relative to males was not attributed to sex differences in body composition; thus, the aetiology of such differences necessitates further exploration by means of high-quality sex comparative research. Finally, this thesis reached the consensus recommendation that lower exercise loads can be utilised to reduce muscle damage in males; nonetheless, supporting evidence for the application of this recommendation to females is required

    a systematic review

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    Funding Information: This study is part of an interdisciplinary research project, funded by the Special Research Fund (Bijzonder Onderzoeksfonds) of Ghent University.Introduction: Ontologies are a formal way to represent knowledge in a particular field and have the potential to transform the field of health promotion and digital interventions. However, few researchers in physical activity (PA) are familiar with ontologies, and the field can be difficult to navigate. This systematic review aims to (1) identify ontologies in the field of PA, (2) assess their content and (3) assess their quality. Methods: Databases were searched for ontologies on PA. Ontologies were included if they described PA or sedentary behavior, and were available in English language. We coded whether ontologies covered the user profile, activity, or context domain. For the assessment of quality, we used 12 criteria informed by the Open Biological and Biomedical Ontology (OBO) Foundry principles of good ontology practice. Results: Twenty-eight ontologies met the inclusion criteria. All ontologies covered PA, and 19 included information on the user profile. Context was covered by 17 ontologies (physical context, n = 12; temporal context, n = 14; social context: n = 5). Ontologies met an average of 4.3 out of 12 quality criteria. No ontology met all quality criteria. Discussion: This review did not identify a single comprehensive ontology of PA that allowed reuse. Nonetheless, several ontologies may serve as a good starting point for the promotion of PA. We provide several recommendations about the identification, evaluation, and adaptation of ontologies for their further development and use.publishersversionpublishe

    Comparing the Performance of Initial Coin Offerings to Crowdfunded Equity Ventures

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    Uncertainty in markets increases the likelihood of market failure due to volatility and suboptimal functioning. While initial coin offerings (ICOs) and crowdfunded equity (CFE) offerings may improve functioning in growing markets, there is a lack of knowledge and understanding pertaining to the relative efficiency and behavior of ICO markets compared to CFE markets, potentially perpetuating and thwarting the various communities they are intended to serve. The purpose of this correlational study was to compare a group of ICOs with a group of CFE offerings to identify predictive factors of funding outcomes related to both capital offering types. Efficient market hypothesis was the study’s theoretical foundation, and analysis of variance was used to answer the research question, which examined whether capital offering type predicted the amount of funds raised while controlling for access to the offering companies’ secondary control factors: historical financial data, pro forma financial projections, detailed product descriptions, video of product demonstrations, company website, company history, company leadership, and company investors. Relying on a random sample of 115 campaigns (84 ICOs and 31 CFE) from websites ICOdrops.com, localstake.com, fundable.com, and mainvest.com, results showed differences in mean funds raised between CFEs and ICOs (346,075comparedto346,075 compared to 4,756,464, respectively). ANOVA results showed no single secondary control factors and only one two-factor interaction (company leadership and company investors) influenced mean funds raised. This study may contribute to positive social change by informing best practices among market participants including entrepreneurs, regulators, scholars, and investors

    “Have patients with chronic skin diseases needs been met?”:A thesis on psoriasis and eczema patient care in dermatology service

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    Background: Common chronic skin diseases such as eczema and psoriasis usually require long term medical care. They are often associated with psychological and metabolic comorbidities, which can impact on patient quality of life (QOL) and on the self-management of these diseases. Regular assessment of patient needs, comorbidities and feedback is a critical step in the development of decision-analytic models. Currently, no intervention is available to regularly assess such patients’ needs and comorbidities and support their involvement in the decision-making and self-management of their morbidity and comorbidities. The aim of this research is to involve the patients in decision making of their care and to support their self-management by the use of a paper questionnaire (study tool) at each consultation. Objective: To explore the acceptability and potential of a self-developed paper questionnaire that constituted a study tool for addressing the needs, comorbidities, and feedback of patients with psoriasis and eczema and supporting their involvement in decision making and self-management of their chronic conditions. Method: A mixed method study was conducted and included a postal survey on adult male and female patients with psoriasis and eczema, using the study tool, which is a paper questionnaire and contains the Dermatology Life Quality Index (DLQI) and seven supplementary open-ended questions to capture patients’ views, feedback, comorbidities, coping status and needs. The survey was followed by semi-structured face-to-face interviews with a sample of the patients who had participated in the survey. The aims of the interviews were two-fold: 1. to gain a deeper understanding of their experience of living with and managing their skin disease; and 2. to gather patient feedback on the service they received as well as their views on using the new study tool or any alternative intervention to address and support their self-management. The final study was a pilot which involved presenting a proposal of an online version of the study tool to a group of healthcare experts asking them to critically review the extent to which the online model responded to patients expressed needs. Results: Of the 114 patients who participated in the postal survey 108 (94.7%) of them expressed physical, metabolic and psychological comorbidities. Stress was identified as the dominant disease-triggering factor in 72 (63%) participants. Thirty-three (28.9%) of participants reported that they could not cope with their chronic illness. Eighteen (15.7%) participants suffered from anxiety, and 12 (10.5%) had depression and suicidal thoughts. Twenty-nine (25%) participants addressed their needs for support at home, and 16 (14%) of them asked for support at work. In the patient feedback section, 21 (18.4%) and 9 (7.8%) participants rated the service they received from their general practitioner (GP) and dermatologist as poor, respectively. In the interviews, all the participants 22 (100%) welcomed the use of the study tool on a regular basis to address their needs, comorbidities and feedback. Nineteen (86.3%) of them suggested that they would prefer using an online version of the tool or patient portal system as a convenient way of remote and interactive communication with the healthcare provider, particularly during the worsening of their skin condition. In the final pilot study, the healthcare experts agreed that the proposed online version of the study tool could be a convenient platform for such patients to support their self-management. They discussed the potential importance of such a tool if it provided them with access to supportive services such as patient information on skin diseases and self-management, access to local mental health service and other relevant psoriasis and eczema patients’ support groups and charities. Conclusion: This novel mixed method research identified knowledge gaps in managing patients with psoriasis and eczema. It provided a new tool that has the potential to regularly engage and assess patients’ unmet needs, comorbidities and feedback. The tool can involve patients in decision-making and offers them the autonomy to disclose heterogeneous needs that may support their self-management. All the interviewees welcomed regular use of the study tool and the majority of them suggested that they would prefer using an online version of the tool if it was available. Future research is needed to assess the impact of the study tool in filling important gaps in patient self-management and in health service improvement

    Cognitive Behavioural Therapists’ Experiences of Working Remotely With Language Interpreters

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    In the United Kingdom, approximately one million people cannot speak English well enough to access therapy in English. If there is no shared language used by both the client and therapist, then individuals require access to an interpreter so that they receive an equitable service. Research highlights the anxiety and pressures that working with an interpreter can bring for professionals. In light of the Coronavirus pandemic and increased remote working, this research aimed to explore the experience and perspectives of cognitive behavioural therapists working with language interpreters remotely. Semi-structured interviews were conducted with eighteen participants who were asked about their experience of working with interpreters remotely. Data was analysed using Braun and Clarke’s six phases of reflexive thematic analysis (Braun & Clarke, 2019; Braun & Clarke, 2006). The analysis resulted in five main themes being constructed: the system doesn’t make it easier; therapist values of inclusive and self-reflective practice; working in a culturally sensitive way; the powerful role of the interpreter and remote therapy – different landscape, different journey. In total, 17 subthemes were created. Findings offer an understanding of how working with an interpreter impacts CBT ways of working. The findings draw attention to the impact of the organisational context where therapists work. The results also offer an insight into the relationship dynamics when introducing a third person in a remote setting as opposed to the traditional client-therapist dyad. Findings are considered in relation to competencies and therapeutic skills. Training and learning needs are highlighted, along with service level implications

    “A sticking plaster over a burst artery” An explanatory theory of moral distress: Frontline workers experience of supporting rough sleepers with a mental illness through austerity, welfare reform and the COVID-19 pandemic.

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    For a decade, prior to the COVID-19 pandemic, frontline homelessness workers in England have worked within national and local policies of welfare reform and austerity, within which there was a major cut to public spending. After the COVID-19 outbreak frontline workers began working within policies relating to the pandemic and homelessness. There is little empirical research on how these policies have impacted frontline workers who support rough sleepers with a mental illness as previous research focuses on people experiencing homelessness and/or mental illness during austerity and welfare reform, rather than the experience of the frontline homelessness worker. The purpose of this empirical research was to explore the experiences of homelessness frontline workers supporting rough sleepers with a mental illness post austerity, welfare reform and during the COVID-19 pandemic in the Midlands geographical area. Using a constructivist grounded theory approach, ten frontline workers, who worked within a variety of statutory and third sector organisations, took part in sixteen semi-structured interviews. The study offers an explanation of how working within welfare reform, austerity and COVID-19 has affected frontline workers who support rough sleepers with a mental illness. An explanatory theory of moral distress was co-constructed with the research participants. The frontline workers worked within disconnected systems across, housing, health, social care and the department of work and pensions, with the COVID-19 pandemic exacerbating this. They were frequently restricted in supporting their service users as they saw fit. This caused them to experience moral distress. The findings have significance going forward as due to the cost-of-living crisis, homelessness may increase, and planned cuts to public services will put additional pressure across housing, health, and social care services, which in turn will impact on homelessness organisations and frontline workers in the sector. If this does occur without any increase to funding to homelessness and mental health services, along with changes to policy and legislation, frontline workers will be under even higher risk of experiencing moral distress

    ‘Inner qualities versus inequalities’: A case study of student change learning about Aboriginal health using sequential, explanatory mixed methods

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    Racism and lack of self-determination in health care perpetuate injury and injustice to Aboriginal people. To instil cultural safety at individual, organisational, community and systems levels, a key site of action has been health professional education that seeks to elicit reflexivity, cultural humility and a working understanding of Aboriginal health concepts. Studies in Aboriginal community settings show Family Well Being (FWB) empowerment education is effective in supporting personal and collective reflexivity and transformation through empowering life skills development. Implementation of FWB within educational settings shows early signs of effectiveness among students. Yet knowledge of the steps and processes of student change is lacking. This mixed methods explanatory case study sought to measure and understand change in postgraduate students of a leading Australian university learning about Aboriginal health and wellbeing through blended delivery, including through face-to-face immersion in FWB in an urban classroom. Three interrelated studies investigated fidelity and acceptability of the program, measured and analysed growth and empowerment in students, and explained processes of change observed, through thematic analysis of asynchronous online discussions using lenses based on transformative learning and empowerment. Researcher reflexivity was promoted by Aboriginal supervision. Over six years, 194 students enrolled in two different Aboriginal public health courses, 85 of them in the FWB course. As well as achieving program fidelity and acceptability, pre/post-course change in students across a range of emotional empowerment, personal growth and life-long learning processes was measured in the FWB group. Thematic analysis revealed students’ fluid and recursive processes of transformative learning in their professional selves and capacities to act in domains important to Aboriginal health. This case study contributes new knowledge critical to strengthening health professional capabilities for ever more complex, uncertain and emotionally demanding sites of practice, and to work in empowering ways—with, not for, Aboriginal people and communities
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