Experiences of injecting drugs, alcohol use and hepatitis C in Merseyside: Barriers to hepatitis C support

Hepatitis C is a blood borne virus affecting the liver. In the UK, approximately 214,000 people are infected with the hepatitis C virus. Hepatitis C disproportionally affects marginalised populations and in the UK sharing equipment used to inject drugs is the main risk factor for hepatitis C infection. Despite there being treatments for hepatitis C, many do not access it or indeed get tested, leading to deaths from complications of hepatitis C such as end stage liver disease or hepatocarcinoma. The World Health Organization’s target to eliminate viral hepatitis as a major public health threat by 2030, has led to calls for action to increase access to hepatitis C testing and treatment. To increase uptake of testing and treatment, an understanding of the current barriers to access is required. Historically, alcohol and injecting drug use have been barriers to receiving treatment. Alcohol is also regarded as problematic as it expedites the progression of hepatitis C. There is however a paucity of research on experiences of alcohol use in People Who Inject Drugs (PWID) who have hepatitis C. The aim of this research was to gain an understanding of the experiences, practices and meanings of alcohol for people living with hepatitis C and to understand their needs and support requirements. Being qualitative in nature, this research took an explorative, inductive approach, allowing emerging themes to lead the direction of the research. The starting point was observation of hepatitis C support groups and interviews with people who have/had hepatitis C (services users, n=21), leading onto interviews with professionals (n=12) working in drug, alcohol and hepatitis C services. A multi-methods approach was used. Service user interviews were life history interviews, using a calendar method, and for the interviews with professionals, vignettes about hypothetical services users and semi structured interviews were used. Data were analysed using a combination of approaches. For the interviews using the calendar method, the individual calendars were studied to ascertain the sequence of events in a participant’s life. More generally, an ongoing constant comparative approach occurred throughout the various stages of the research and interview transcripts were analysed using thematic analysis. This research has explored alcohol use in PWID who have hepatitis C, however the methods employed have afforded wider findings, giving an insight into barriers and challenges to hepatitis C support. Barriers/challenges were found at service user, service and strategic levels. For service users, barriers were to accessing support (incorporating, testing, treatment, advice, information and peer support) and for service providers and commissioners, challenges were to providing support services for people with the hepatitis C virus. Alcohol fits in to this picture as a barrier to support from the PWID community, due to the stigma of becoming ‘a drinker’ and as an exclusion to receiving hepatitis C treatment. There is a paucity of qualitative research on alcohol use and hepatitis C in PWID. To our knowledge this research is the first study exploring the lived experience of alcohol use for PWID who have hepatitis C in England. The findings from this study therefore contribute to the current limited body of knowledge on this topic. Although on completing this thesis some of the findings are out dated as hepatitis C treatment is now being provided out of the hospital setting, other barriers to providing and accessing hepatitis C support are still relevant. These findings will be of interest to those working both in practice and public health policy who are working towards the elimination of hepatitis C by 2030

Work Package Report 6: Shared, plural and cultural values of ecosystems – Summary

Key findings: Finding 1: Shared values resulting from deliberative, group-based valuation are different from individual values. Case study evidence suggests that they are more informed, considered, confident and reflective of participants’ deeper-held, transcendental values. Deliberated, group-based monetary values may be a better reflection of real welfare impacts than non-deliberated individual values, if derived through a carefully designed and managed process. Although more research is needed to expand the currently small evidence base on deliberative monetary methods, group deliberation has the potential to significantly enhance elicitation of values. Finding 2: The ethical, moral and justice dimensions of many environmental issues necessitate approaches that allow for the elicitation of shared and plural values. Key ethical concerns include: 1) providing a space and opportunity for people to identify values that they may find difficult to articulate (e.g. spiritual, identity); 2) recognising that some values cannot be traded without discussion and negotiation (e.g. the legal or felt rights of local people, intrinsic values of other species); and 3) understanding that it is often difficult to isolate valuation from decision-making processes because people feel there are strong ethical or moral issues at stake that need to be debated (e.g. the justice of the process, fairness in the distribution of benefits or disbenefits, responsibility, and issues of sustainability and future generations). Finding 3: Catalyst and/or conflict points can play a key role in the emergence and articulation of values at a societal or community level that have not previously been outwardly or explicitly articulated. Catalyst and conflict points can be symbolic and are often linked to wider contested issues and meanings about who is involved in decision-making, whose voice counts and who receives the benefits or disbenefits of environmental change. These catalyst points can potentially be connected to feelings of powerlessness that give rise to concern and protest. By recognising transcendental societal and communal values (the deeper-held and overarching values held by society and communities), it becomes possible to make these values explicit and incorporate them in decision-making to better anticipate and manage conflicts. Finding 4: There is a diversity of ways in which shared, plural, cultural and social values are used, but they are rarely conceptualised. The UK NEAFO provides a clear theoretical framework that distinguishes and categorises different dimensions and types of shared values. The proposed range of value types was both identifiable and distinguishable within case study results. This suggests that the framework provides a useful basis for operationalizing shared values for decision-making. Finding 5: Shared and social values in the sense of value to society is conceptualised very differently by conventional economics and other disciplines. Neoclassical economists have generally undertaken valuation by equating social value with the aggregate of individual values. They consider values as fundamentally commensurable. In contrast, literature from other disciplines consistently considers values as plural, not just in the sense that multiple things have value, but also that there are multiple dimensions to value that cannot necessarily be captured in a single metric. Within mainstream economics, the difficulties associated with commensurability and aggregating values have long been recognised, but have also been neglected. An interesting area for future debate between economic and non-economic views on values may be the normative nature of value-aggregation. Finding 6: A mixed method approach is required to elicit the multiple dimensions of shared values and to translate deeper-held, transcendental values into contextual values and preferences. Monetary valuation is limited to quantifying values. Other methods are needed to understand their meaning or content, and the communal, societal and transcendental values that underpin them. Psychometric, non-analytical and interpretive methods (e.g. storytelling) can reveal those shared values. They can be combined with deliberative-analytical methods (e.g. deliberative monetary valuation and multi-criteria analysis) to provide a comprehensive valuation that can quantify values, understand their individual and shared meanings and significance, and better include ethical dimensions. Finding 7: Deliberative and social learning processes help people to understand the values held by others; they can lead to increased sharing of values and/or to greater acceptance of the decisions emerging from such processes. Deliberation clearly affects what values participants express compared to non-deliberated processes. There is also a growing body of theoretical and empirical research suggesting that deliberation has the potential to affect how people understand and shape the values of others. Although rarely considered in the economic literature, the concept of social learning helps to explain some of the processes involved in deliberation. The extent to which deliberation or social learning helps participants express and shape values will depend upon the frequency and depth of interactions and the timescale over which interactions occur. Only a shift in cultural values (e.g. less emphasis on material wealth), reflected in other societal institutions (e.g. changes in the indicators used to measure national progress) is likely to achieve sustainable outcomes in the long-term. Finding 8: Media analysis is a promising avenue for characterising different types of shared values at a large scale, as well as assessing the conflicts between the communal values of different sectors of society. There has been a marked increase in public interest in environmental issues over the last decade, which is reflected in their increased media coverage. Media content and discourse analysis is able to distinguish and characterise the plurality of cultural, societal and transcendental values and their interrelationships, and can offer a picture of the self- and other-regarding values that underpin environmental issues and conflicts. Social media can provide a further forum for understanding societal and communal values surrounding environmental issues. Finding 9: Aesthetic and spiritual values of ecosystems have a strong non-instrumental component. While they benefit human well-being, they should not simply be classified as just ‘services’ or ‘benefits’. Many spiritual discourses about nature resist talk of consequentialist benefits and economic analysis. These discourses counter assertions of the disenchantment of the world, which is associated with an instrumental environmental ethic and the commodification of nature. Allowing the possibility of enchantment can be a richer way of understanding our experience of nature and alerts us to the limitations of using economic models for valuation and informing decisions about these profound cultural ecosystem ‘services’. Faith communities have experience of using these non-utilitarian values in their own decision-making and provide models that could be adapted for use in environmental decision-making. Finding 10: Subjective well-being measures provide a useful means of assessing ‘intangible’ cultural ecosystem services and their benefits. Different user groups associate common elements of subjective well-being with environmental settings, providing opportunities for development of standardised measures. In the UK NEAFO, key facets of well-being associated with places in nature across different user groups included: engagement with nature (incorporating elements of connectedness, getting to know nature and the beauty of nature, and taking care of a place); therapeutic benefits (including physical and mental aspects of health); place identity (including a sense of place and belonging); spiritual value (in the sense of feeling connected or responsible to something larger than oneself); social bonding with others; and transformative and memorable experiences. Further empirical work with different user groups and environmental settings would allow for the continued development of a standardised tool for large-scale non-monetary assessment of cultural ecosystem services

Anticipating and Managing Future Trade-offs and Complementarities between Ecosystem Services

This paper shows how, with the aid of computer models developed in close collaboration with decision makers and other stakeholders, it is possible to quantify and map how policy decisions are likely to affect multiple ecosystem services in future. In this way, potential trade-offs and complementarities between different ecosystem services can be identified, so that policies can be designed to avoid the worst trade-offs, and where possible, enhance multiple services. The paper brings together evidence from across the Rural Economy and Land Use Programme’s Sustainable Uplands project for the first time, with previously unpublished model outputs relating to runoff, agricultural suitability, biomass, heather cover, age, and utility for Red Grouse (Lagopus scotica), grass cover, and accompanying scenario narratives and video. Two contrasting scenarios, based on policies to extensify or intensify land management up to 2030, were developed through a combination of interviews and discussions during site visits with stakeholders, literature review, conceptual modeling, and process-based computer models, using the Dark Peak of the Peak District National Park in the UK as a case study. Where extensification leads to a significant reduction in managed burning and grazing or land abandonment, changes in vegetation type and structure could compromise a range of species that are important for conservation, while compromising provisioning services, amenity value, and increasing wildfire risk. However, where extensification leads to the restoration of peatlands damaged by former intensive management, there would be an increase in carbon sequestration and storage, with a number of cobenefits, which could counter the loss of habitats and species elsewhere in the landscape. In the second scenario, land use and management was significantly intensified to boost UK self-sufficiency in food. This would benefit certain provisioning services but would have negative consequences for carbon storage and water quality and would lead to a reduction in the abundance of certain species of conservation concern. The paper emphasizes the need for spatially explicit models that can track how ecosystem services might change over time, in response to policy or environmental drivers, and in response to the changing demands and preferences of society, which are far harder to anticipate. By developing such models in close collaboration with decision makers and other stakeholders, it is possible to depict scenarios of real concern to those who need to use the research findings. By engaging these collaborators with the research findings through film, it was possible to discuss adaptive options to minimize trade-offs and enhance the provision of multiple ecosystem services under the very different future conditions depicted by each scenario. By preparing for as wide a range of futures as possible in this way, it may be possible for decision makers to act rapidly and effectively to protect and enhance the provision of ecosystem services in the face of unpredictable future change.Additional co-authors: Nanlin Jin, Brian J Irvine, Mike J Kirkby, William E Kunin, Christina Prell, Claire H Quinn, Bill Slee, Sigrid Stagl, Mette Termansen, Simon Thorp, and Fred Worral

What are shared and social values of ecosystems?

The theoretical framework outlined in this paper was developed initially through a series of expert workshops as part of the Valuing Nature Network — BRIDGE: From Values to Decisions project, funded by the UK Natural Environment Research Council (NERC). It was developed further through the follow-on phase of the UK National Ecosystem Assessment (Work Package 6: Shared, Plural and Cultural Values) funded by the UK Department of the Environment, Food and Rural Affairs (Defra), the Welsh Government, NERC, the Economic and Social Research Council (ESRC), and the Arts and Humanities Research Council (AHRC).Peer reviewedPublisher PD

Disrupting the Ethical Imperatives of “Junior” Critical Qualitative Scholars in the Era of Conservative Modernization

In this article, we wrestle with the core issue of how early career researchers translate central tenets and core concepts of critical theory and critical methodology into their research practice. By way of creative representation, we draw from bell hooks and Cornel West’s (1991) written rendition of their verbal dialogue in Breaking Bread: Insurgent Black Intellectual Life. Their hope was to offer the book in a dialogic format in such a way that mirrored the synergy in their verbal discussions as friends and intellectual colleagues. In a similar vein, we hope to share with readers the synergy and depth of the narratives that have transpired during our ongoing discussions on the important topic of critical praxis as part of a collaborative research group called the Disruptive Dialogue Project (Gildersleeve, Kuntz, Pasque & Carducci, 2010; Kuntz, Pasque, Carducci, & Gildersleeve, 2009).Yeshttps://us.sagepub.com/en-us/nam/manuscript-submission-guideline

Atribuciones causales y nivel educativo familiar en la comprensión del desempeño escolar en alumnos portugueses

Este artigo analisa o contributo específico do nível educativo familiar e das atribuições causais para o bom e fraco rendimento escolar dos alunos na explicação do seu desempenho nas disciplinas de Língua Portuguesa e de Matemática numa amostra de 2.082 alunos do ensino público de 11 escolas de Portugal, incluindo as Regiões Autónomas dos Açores e da Madeira. As atribuições causais foram avaliadas por meio do Questionário das Atribuições Causais para os Resultados Escolares (QARE). O nível educativo familiar foi estimado levando em conta o nível escolar do progenitor com maior habilitação escolar. As classificações obtidas pelos alunos nas disciplinas de língua portuguesa e matemática foram também examinadas. Os resultados apontam para correlações estatisticamente significativas, destacando as atribuições na capacidade para a explicação do rendimento escolar, situação que contrasta com a atribuição dos níveis de rendimento a variáveis externas ao aluno. A análise de regressão permite associar 34,5% da variância no rendimento conjunto em Língua Portuguesa e em Matemática no ensino básico, assim como 21,3% no ensino secundário, às dimensões atribucionais e ao nível educativo familiar. Implicações educacionais são derivadas a partir dos achados.This paper analyzes the contribution of both family educational level and causal attributions in explaining students´ academic performance in Mathematics and Portuguese Language in a sample of 2.082 public school students from mainland Portugal and the Azores and Madeira regions. Causal attributions were assessed by the Causal Attributions Questionnaire for School Results (QARE). The family educational level was estimated taking into account the educational level of the parent with higher academic degree. The academic grades obtained by students in mathematics and portuguese language were also considered. The results show statistically significant correlations between variables. Internal causal attributions such as capacity and study methods were predominant to explain school performance in the sample and stood out in contrast to external attributions explanations. Regression analyses revealed that 34.5% of the variance in the combined achievement on Portuguese Language and Mathematics in primary education and 21.3% in secondary education could be explained by both the attributional dimensions and family education level. Some educational implications are present taking these data.Este artículo analiza la contribución específica del nivel educativo familiar y de las atribuciones causales para el buen y el flaco rendimiento escolar de los alumnos en la explicación de su desempeño en las disciplinas de Lengua Portuguesa y Matemáticas en una muestra de 2.082 alumnos de enseñanza pública de 11 escuelas de Portugal, incluyendo las Regiones Autónomas de Açores y Madeira. Las atribuciones causales fueron evaluadas por medio del “Questionário das Atribuições Causais para os Resultados Escolares” (QARE). El nivel educativo familiar fue estimado teniendo en cuenta el nivel escolar del progenitor con mayor habilitación escolar. Las clasificaciones obtenidas por los alumnos en las disciplinas de lengua portuguesa y matemáticas fueron también examinadas. Los resultados señalaron correlaciones estadísticamente significativas, destacando las atribuciones en la capacidad para la explicación del rendimiento escolar, situación que contrasta con la atribución de los niveles de rendimiento a variables externas al alumno. El análisis de regresión permite asociar 34.5% de la variancia en el rendimiento conjunto de la Lengua Portuguesa y las Matemáticas en la enseñanza básica, así como 21.3% en la enseñanza secundaria, a las dimensiones de atribución y al nivel educativo familiar. Implicaciones educacionales son derivadas a partir de los hallazgos.Editora Universitária São Francisc

Shallow waters: social science research in South Africa's marine environment

This paper provides an overview of social science research in the marine environment of South Africa for the period 1994–2012. A bibliography based on a review of relevant literature and social science projects funded under the SEAChange programme of the South African Network for Coastal and Oceanic Research (SANCOR) was used to identify nine main themes that capture the knowledge generated in the marine social science field. Within these themes, a wide diversity of topics has been explored, covering a wide geographic area. The review suggests that there has been a steady increase in social science research activities and outputs over the past 18 years, with a marked increase in postgraduate dissertations in this field. The SEAChange programme has contributed to enhancing understanding of certain issues and social interactions in the marine environment but this work is limited. Furthermore, there has been limited dissemination of these research results amongst the broader marine science community and incorporation of this information into policy and management decisions has also been limited. However, marine scientists are increasingly recognising the importance of taking a more holistic and integrated approach to management, and are encouraging further social science research, as well as interdisciplinary research across the natural and social sciences. Possible reasons for the lack of communication and coordination amongst natural and social scientists, as well as the limited uptake of research results in policy and management decisions, are discussed and recommendations are proposed.Web of Scienc