When Do Misunderstandings Matter? Evidence From Survey Interviews About Smoking

This paper examines when conceptual misalignments in dialog lead to consequential miscommunication. Two studies explore misunderstanding in survey interviews of the sort conducted by governments and social scientists, where mismeasurement can have real social costs. In 131 interviews about tobacco use, misalignment between respondents’ and researchers’ conceptions of ordinary expressions like “smoking” and “every day” was quantified by probing respondents’ interpretations of survey terms and re‐administering the survey questionnaire with standard definitions after the interview. Respondents’ interpretations were surprisingly variable, and in many cases they did not match the conceptions that researchers intended them to use. More often than one might expect, this conceptual variability was consequential, leading to answers (and, in principle, to estimates of the prevalence of smoking and related attributes in the population) that would have been different had conceptualizations been aligned; for example, fully 12% of respondents gave a different answer about having smoked 100 cigarettes in their entire life when later given a standard definition. In other cases misaligned interpretations did not lead to miscommunication, in that the differences would not have led to different survey responses. Although clarification of survey terms during the interview sometimes improved conceptual alignment, this was not guaranteed; in this corpus some needed attempts at clarification were never made, some attempts did not succeed, and some seemed to make understanding worse. The findings suggest that conceptual misalignments may be more frequent in ordinary conversation than interlocutors know, and that attempts to detect and clarify them may not always work. They also suggest that at least some unresolved misunderstandings do not matter in the sense that they do not change the outcome of the communication—in this case, the survey estimates.Schober et al. describe two studies on how survey interview respondents misunderstand interview questions. After answering a survey, participants are given standardized definitions of the questions they have just answered. Even apparently simple questions such as “Have you smoked more than 100 cigarettes?” are interpreted very differently by participants. Moreover, clarifying the meaning of the definitions with the interviewer does not always help resolve the miscommunication.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/143616/1/tops12330_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/143616/2/tops12330.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/143616/3/tops12330-sup-0003-AppendixS3.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/143616/4/tops12330-sup-0002-AppendixS2.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/143616/5/tops12330-sup-0005-TableS2.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/143616/6/tops12330-sup-0001-AppendixS1.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/143616/7/tops12330-sup-0004-TableS1.pd

A systematic review of lesbian, gay, bisexual and transgender health in the West Midlands region of the UK compared to published UK research

It is estimated that approximately 3-8% of the UK population identify as lesbian, gay, bisexual or trans (LGBT). Until now, most health research on gay and bisexual men has been around HIV, AIDS and sexually transmitted diseases and for trans people has been on the transitioning process only. However, it has been apparent to the LGBT community that that there are a wide variety of other physical and mental health issues that are also important and that the proportion of gay and bisexual men who have HIV/AIDS is relatively small. Very little general LGBT health research has been published so far and there are very few health services that specifically address the general health concerns of the LGBT community. This systematic review presents all available research conducted in the West Midlands on LGBT health since 2000. Local health research is compared to UK national, peer reviewed and published LGBT health research in order to determine whether the local results are unusual compared to national LGBT data, and to routinely collected data on the UK population, where appropriate, in order to determine whether and where the LGBT population differ from the general population. Only UK research has been included because there was no previous UK specific systematic review so it was unclear how generalisable foreign research would be to the UK

The attendance of e-cigarette users at stop smoking services: a mixed methods study

Background: Stop smoking services (SSSs), combined with pharmacotherapy, are more effective for quitting smoking than other aids used alone, including e-cigarettes. SSS uptake has nonetheless declined for six years. Amidst pressure on council budgets, this declining footfall has led to many areas reducing or discontinuing services. When making cuts, councils often cite widespread vaping and suggest this indicates smokers nowadays need SSSs less. This PhD aimed to investigate whether vaping amongst smokers can influence SSS use and, if so, how this occurs. Methods: A systematic review synthesised evidence on sociodemographic differences in e-cigarette use from 58 studies identified across seven databases. Repeat crosssectional survey data was collected from 2,139 current smokers through questions added into the ‘Smoking Toolkit’ survey. Multivariable logistic regression assessed associations between SSS uptake and: a) e-cigarette use; b) knowledge/belief statements about e-cigarettes or SSSs. Finally, 46 semi-structured interviews were undertaken with smokers and SSS professionals at three sites. Principles of framework analysis were applied to examine factors influencing smokers’ decisions to use ecigarettes or SSSs, including potential impacts of differences in perspectives between smokers and SSS professionals. Findings: Systematic review results suggested higher e-cigarette use among younger adults, males and people of white ethnicity. Survey data showed smokers who vaped were more likely than others to report both past and planned SSS uptake. Further analyses showed beliefs about e-cigarettes’ effectiveness and familiarity with vaping were associated with decisions to use SSSs. Semi-structured interviews indicated a range of views on potential risks from vaping. These appeared to be key factors influencing – for smokers – their e-cigarette use, and – for services – the support provided in relation to e-cigarettes. Conclusion: Smokers using e-cigarettes remain keen to use SSSs. Given social gradients in smoking rates, removing opportunities to access such services may have retrograde health impacts for society’s most vulnerable people

Mapping the information-coping trajectory of young people coping with long term illness: An evidence based approach

Purpose - Purpose: We explore the relationship between information and coping information from the experiences of young people coping with long term illness. Design/methodology/approach - Methodology: Situational Analysis was used as a methodological approach. It has roots in the Chicago Symbolic Interactionism School. Cartographic approaches enabled the analysis, mapping the complexities emerging from the data. Findings - Findings: As the young people became more informed about their health conditions, and gained knowledge and understanding both about their illnesses, their own bodies and boundaries, their confidence and capacity to cope increased. Gaining confidence, the young people often wanted to share their knowledge becoming information providers themselves. From the data we identified five positions on an information-coping trajectory (1) Information deficiency (2) Feeling ill-informed (3) Needing an injection of information (4) Having information health and (5) Becoming an information donor. Research limitations/implications - Research limitations/implications: The research was limited to an analysis of thirty narratives. The research contributes to information theory by mapping clearly the relationship between information and coping. Originality/value - Originality/value: The information theories in this study have originality and multi-disciplinary value in the management of health and illness, and information studies

Restaurant and Bar Owners’ Exposure to Secondhand Smoke and Attitudes Regarding Smoking Bans in Five Chinese Cities

Despite the great progress made towards smoke-free environments, only 9% of countries worldwide mandate smoke-free restaurants and bars. Smoking was generally not regulated in restaurants and bars in China before 2008. This study was designed to examine the public attitudes towards banning smoking in these places in China. A convenience sample of 814 restaurants and bars was selected in five Chinese cities and all owners of these venues were interviewed in person by questionnaire in 2007. Eighty six percent of current nonsmoking subjects had at least one-day exposure to secondhand smoke (SHS) at work in the past week. Only 51% of subjects knew SHS could cause heart disease. Only 17% and 11% of subjects supported prohibiting smoking completely in restaurants and in bars, respectively, while their support for restricting smoking to designated areas was much higher. Fifty three percent of subjects were willing to prohibit or restrict smoking in their own venues. Of those unwilling to do so, 82% thought smoking bans would reduce revenue, and 63% thought indoor air quality depended on ventilation rather than smoking bans. These results showed that there was support for smoking bans among restaurant or bar owners in China despite some knowledge gaps. To facilitate smoking bans in restaurants and bars, it is important to promote health education on specific hazards of SHS, provide country-specific evidence on smoking bans and hospitality revenues, and disseminate information that restricting smoking and ventilation alone cannot eliminate SHS hazards

Health knowledge and expected outcomes of risky behaviour: a comparative study of non-disabled adolescents and young people with intellectual and physical disabilities

Research exploring the physical health needs of people with intellectual disabilities is increasing. Unfortunately, first hand accounts from young people with intellectual disabilities remain largely absent. This is despite the fact that many of these individuals, albeit to a lesser extent than their non-disabled peers, are engaging in behaviours that can have a potentially negative impact on their health status (poor dietary habits, excessive alcohol consumption, and risky sexual behaviour). While knowledge alone does not always result in the adoption of healthier behavioural choices, it is an important prerequisite if young people are too keep themselves safe. In addition, understanding what young people know about health is pivotal to the formulation and development of appropriate education programmes and services. The limited research that does exist suggests that young people with intellectual disabilities have low levels of health knowledge, particularly in relation to sexual health and sexuality. Whereas public health messages are widely available concerning topics such as healthy eating and alcohol, information regarding sexual health is less accessible, owing to it being a private area of people’s lives. Much of our social/sexual development is largely experiential and gained through informal routes, such as interacting with peers. Yet the social networks of young people with intellectual disabilities may be compromised, which could partly account for the low levels of sexual knowledge reported. In support of this, sexual knowledge is also limited in young people with physical disabilities, another socially excluded group. Thus, the aim of this thesis is to further our understanding of how key features of social exclusion - impoverished social networks and access to sources of health information and experience - may impact upon young people with disabilities’ knowledge, attitudes and behaviour in relation to healthy eating, alcohol, pregnancy/contraception and HIV/AIDS. A substantial part of the research process was concerned with the development and piloting of appropriate methods with which to address these aims. Through structured and semi-structured questionnaires and vignette-based methodology, data from over 100 young people, aged 16-25, has been analysed and interpreted. Three groups of young people took part in the study, those with i) Intellectual disabilities (ID), ii) Physical disabilities (PD), and iii) typically developing, non-disabled (ND). With regards to health knowledge, the ID group had the poorest scores on the healthy eating and alcohol scales. However, the largest differences between the groups were related to health issues considered to be more personal and private, such as pregnancy and contraception, with both groups of young people with disabilities having lower levels of sexual health knowledge than their non-disabled peers. Thus, deficits in sexual knowledge did not just appear to be the result of the ID group’s cognitive deficits. Moreover, content analyses of open-ended questions on the questionnaire showed that all three groups held a surprising number of misconceptions about sexuality. It was also notable that young people with ID reported discussing sexual issues with friends and family less frequently than their non-disabled peers and reported being more reliant upon formal sources of sex education, such as that received through school or college. In addition, when participants with intellectual and physical disabilities were asked about how others would react to them drinking excessive amounts of alcohol and being open to a possible sexual encounter, using vignettes, they anticipated more negative attitudes from their friends for engaging in these potentially risky behaviours then their non-disabled peers. Although the majority of young people with disabilities also reported that their parents would disapprove of their actions, in contrast to their non-disabled peers, most of the young people with disabilities said that their parents’ views would matter to them. This research has highlighted the importance of people’s unique learning and socialisation experiences in shaping not only their health knowledge, but also their attitudes and beliefs. A number of implications for health education and for professionals working with both individuals with disabilities and their families are outlined. New avenues for research are also suggested

Implementation of an HPV vaccination program in Eldoret, Kenya: results from a qualitative assessment by key stakeholders

Background: Cervical cancer strikes hard in low-resource regions yet primary prevention is still rare. Pilot projects have however showed that Human Papillomavirus (HPV) vaccination programs can attain high uptake. Nevertheless, a study accompanying a vaccination demonstration project in Eldoret, Kenya, revealed less encouraging outcomes: uptake during an initial phase targeting ten schools (i.e., 4000 eligible girls), was low and more schools had to be included to reach the proposed number of 3000 vaccinated girls. The previously conducted study also revealed that many mothers had not received promotional information which had to reach them through schools: teachers were sensitized by health staff and asked to invite students and parents for HPV vaccination in the referral hospital. In this qualitative study, we investigate factors that hampered promotion and vaccine uptake. Methods: Focus group discussions (FGD) with teachers (4) and fathers (3) were organized to assess awareness and attitudes towards the vaccination program, cervical cancer and the HPV vaccine, as well as a FGD with the vaccinators (1) to discuss the course of the program and potential improvements. Discussions were recorded, transcribed, translated, and analyzed using thematic analysis In addition, a meeting with the program coordinator was set up to reflect upon the program and the results of the FGD, and to formulate recommendations for future programs. Results: Cervical cancer was poorly understood by fathers and teachers and mainly linked with nonconforming sexual behavior and modern lifestyle. Few had heard about the vaccination opportunity: feeling uncomfortable to discuss cervical cancer and not considering it as important had hampered information flow. Teachers requested more support from health staff to address unexpected questions from parents. Non-uptake was also the result of distrust towards new vaccines. Schools entering the program in the second phase reacted faster: they were better organized, e.g., in terms of transport, while the community was already more familiarized with the vaccine. Conclusions: Close collaboration between teachers and health staff is crucial to obtain high HPV vaccine uptake among schoolgirls. Promotional messages should, besides providing correct information, tackle misbeliefs, address stigma and stress the priority to vaccinate all, regardless of lifestyle. Monitoring activities and continuous communication could allow for detection of rumors and unequal uptake in the community

Service learning in rural China

This paper discusses opportunities for and suitability of Service Learning as a teaching methodology in formal and non-formal settings in rural mainland China. It describes how Service Learning aligns with and fulfills goals of China’s national curriculum reforms and fosters values and skills useful to rural Chinese children and youth in improving their own lives and communities. Examples of Service Learning projects in rural Shanxi and Guangdong Provinces supported by the Rural China Education Foundation (RCEF) illustrate the potential of Service Learning as a powerful framework for curriculum development and teaching. The Rural China Education Foundation, founded in 2005, works with rural education workers in schools as well as community centers and summer camps to facilitate Service Learning with primary and secondary school-aged rural students. The models for, and challenges of, training and supporting teachers to facilitate Service Learning with quality and sustainability are key to its development in China. Ongoing efforts of the Rural China Education Foundation to partner with schools, local rural community organizations, and NGOs provide insight into the state of Service Learning promotion and implementation in mainland China. The goal of the paper is to share practical information for, and instigate mutual experience sharing with, Service Learning education practitioners working in disadvantaged education settings, such as NGOs and university-based volunteer groups that implement Service Learning projects serving similar populations of children and youth

Ethnicity, Older People and Palliative Care

This report brings together established and developing work on older people, ethnicity and palliative care from PRIAE (Policy Research Institute on Ageing and Ethnicity) and the National Council for Palliative Care (NCPC). It draws attention to the palliative care needs and experiences of elders from groups most commonly referred to in the UK as being 'minority ethnic'. The recognition of how multiple and simultaneous disadvantages can affect palliative care needs and experiences is an issue of broad relevance to palliative care - and one that is not restricted to the discussion of old age and ethnicity. In this sense, the report also aims to encourage more complex approaches to inequality in palliative care for all service users