Anthropology and history: Audrey Richards and the representation of gender relations in northern Rhodesia

African Studies Seminar series. Paper presented 23 March 1992In June 1930, Audrey Richards, a young British anthropologist who had trained with Malinowski, arrived in her research area - the Bemba plateau in the northeastern corner of what was then Northern Rhodesia. She was to stay until July 1931, returning for a second piece of field work between January 1933 and July 1934. As a result of this research Richards published, in 1939,a book entitled Land, Labour and Diet in Northern Rhodesia: an Economic Study of the Bemba Tribe [LLD]. [In the first part of this paper I will describe what I feel to have been the major contribution of this work. Then I will go on to talk about the context in which it was produced, and finally to say something about the difficulties of following it up]. The concerns of LLD are familiar ones to the Africanist anthropologist and historian sixty years later. In LLD Richards documented the material circumstances of the lives of a rural African people. She described in detail their agricultural system, paying particular attention to the gender division of labour within this. She described the way in which her Bemba informants used the land, and what meanings they attached to the land and its uses. She described what is now fashionably called 'indigenous knowledge1, and particularly local ecological management. She paid close attention to the seasonally of agricultural production, her discussion of which provided the link bewteen her analysis of production and that of consumption, for LLD is not only about how and what an African agricultural people produced, but is also about how the product was distributed and consumed. LLD is one of the very first studies of what Richards called the 'primitive diet', and there were two aspects to Richards' approach to this issue. On the one hand (and following logically from her earlier work on hunger which I will discuss in more detail later), she was concerned with the social meaning of food, with the emotions which food engendered in a people who were familiar with hunger. She was, in particular, concerned to test out the hypothesis that some 'primitive peoples' might hold beliefs about food, and especially food taboos, which were directly detrimental to their nutritional status. The other aspect of her study of diet, however, was quantitative and positivistic in orientation. This was a direct and pioneering study of consumption, involving not only daily records of what she observed different groups and individuals eating, but also, on a smaller scale, the weighing of food consumed and a calculation of its nutritional value. Since the Bemba diet included centrally, at certain times of year,a significant proportion of wild and gathered foods (including caterpillars and mushrooms), this calculation of nutritional values was no mean task

Social and Economic Change in Southern Malawi: A Study of Rural Communities in the Shire Highlands and Upper Shire Valley From the Mid-Nineteenth Century to 1915.

This study of rural economic and social change in a small area of Southern Malawi begins by examining the nature of society and production there in the early nineteenth century and the changes wrought by immigration into the area and by increasing involvement in long-distance trading. It then goes on to examine the nature of the early colonial economy, the structural ambiguities of which affected the lives of Africans in different parts of the country in diverse ways. Two separate geographical areas are then dealt with in detail. The study traces the effects on societies in the Shire Highlands of the dislocations of the late nineteenth century, and the development of an estate economy in the early twentieth century. The demands of the latter for land and labour gave rise to a number of changes in the structure of African production in the area, including the adoption of new food crops and the intensification of female labour. In the Upper Shire Valley and on the Chilwa plain a wide variety of economic structures emerged in the early twentieth century, some showing more continuity with the the nineteenth century than others. The effects of colonial economic policies were less clear-cut here, ranging from the establishment of a peasant cotton industry, to the development of a labour tenancy system similar to that found on the Highlands. The final chapter deals with these diverse changes thematically by examining changes in agricultural production within the African societies here, changes in kinship, family and 'tribal' structures, and finally the changing nature of economic and social stratification

An evaluation of how digitised periodicals serve academic research in a New Zealand Context

Research problem This research investigates how researchers from humanities backgrounds research print periodicals that have been digitised. It investigates how New Zealand digitised periodical resources facilitate that research. How do these resources represent the periodical as an object, not just textual content? Methodology This research project is mixed methods in design combining two qualitative approaches of content analysis and a self-reporting survey comprised of mainly open-ended questions. These approaches facilitated exploration of rich data interspersed with some quantitative data to help interpret some of the findings. Both methods were undertaken simultaneously after an initial pilot study of one online source. The content analysis focused on four New Zealand digitised periodicals sources and there were nineteen responses to the survey. Results The findings indicated humanities researchers are using content and paratexts in their research. They require context from the digitised periodicals they use and they want good quality images and readable text. Researchers call for refinement of search results into component categories and want good browsing functionality. New Zealand digitised resources are inconsistent, fulfilling only some of these requirements and not delivering on others. Implications A better understanding of paratexts in periodicals and how they are used in research will address some of the assumptions in library practice that lead to incomplete digitisation and/or limited accessibility. The importance of consultation with targeted research communities during the planning of digitisation projects is highlighted

More-than-Human Wellbeing: Materialising the Relations, Affects, and Agencies of Health, Kinship, and Care

Introduction The concept of ‘wellbeing’ is typically thought of in human-centric ways, referring to the affective feelings and bodily sensations that people may have which inform their sense of health, safety, and connection. However, as our everyday lives, identities, relationships, and embodiments become digitised and datafied, ‘wellbeing’ has taken on new practices and meanings. The use of digital technologies such as mobile and wearable devices, social media platforms, and networks of information mediate our interactions with others, as well as the ways we conceptualise what it means to be human, including where the body begins and ends. In turn, digital health technologies and ‘wellness’ cultures such as those promoted on social media sites such as Instagram, Pinterest, YouTube, TikTok, and Facebook have also shaped our understanding of ‘wellness’ and ‘wellbeing’, their parameters, and how they ought to be practiced and felt (Baker; Lupton Digital Health; Lupton et al.). For millennia, aspects of human bodies have been documented and materialised in a variety of ways to help people understand states of health and illness: including relationships to the environments in which they lived. Indigenous and other non-Western cosmologies have long emphasised the kinds of vibrancies and distributed agencies that are part of reciprocal more-than-human ‘manifestings’ of kinships, and have called for all people to adopt the role of stewards of the ecosystem (Bawaka Country et al.; Hernández et al.; Kimmerer; Rots; Todd; Tynan). In Western cultures, ideas of the human body that reach back to ancient times adopt a perspective that viewed the continuous flows of forces (the four humours) in conjunction with the elements of air, wind, earth, and fire inside and outside the body as contributing to states of health or ill health. It was believed that good health was maintained by ensuring a balance between these factors, including acknowledgement of the role played by climactic, ecological, and celestial conditions (Hartnell; Lagay). A more-than-human approach is beginning to be re-introduced into Western cultures through political activism and academic thinking about the harms to the planet caused by human actions, including global warming and climate crises, loss of habitats and ecological biodiversity, increased incidence of extreme weather events such as bushfires, floods, and cyclones, and emerging novel pathogens affecting the health not only of humans but of other living things (Lewis; Lupton Covid Societies; Lupton Internet of Animals; Neimanis et al.). Contemporary Western more-than-human philosophers argue for the importance of acknowledging our kinship with other living and non-living things as a way of repositioning ourselves within the cosmos and working towards better health and wellbeing for the planet (Abram; Braidotti; Plumwood). As these approaches emphasise, health, wellbeing, and kinship are always imbricated within material-social assemblages of humans and non-digital things which are constantly changing, and thereby generating emergent rather than fixed capacities (Lupton "Human-Centric"; Lupton et al.). In this article, we describe our More-than-Human Wellbeing exhibition. To date, new media, Internet, and communication studies have not devoted as much attention to more-than-human theory. It is this more-than-digital and more-than-human approach to health information and wellbeing that marks out our research program as particularly distinctive. Our research focusses on the many and varied digital and non-digital forms that information about health and bodies takes. We are interested in health data as they are made and form part of the objects and activities of people’s everyday lives and aim to expand the human-centric approach offered in digital health by positioning human health and embodiment as always imbricated within more-than-human ecosystems. We acknowledge that all environments (natural and human-built) are intertwined with humans, and that to a greater or lesser extent, all are configured with and through the often exploitative and extractive practices and ideologies of those living in late modern societies in which people are positioned as superior to and autonomous from other living things. Together with more-than-human scholarship, we take inspiration from work in which arts-based, multisensory, and museum curation methods are employed to draw attention to the intertwining of people and ecologies (Endt-Jones; Howes). Our exhibition was planned as a research translation and engagement project, communicating several of our studies’ findings in arts-based media (Lupton "Embodying"). In what follows, we outline the concepts leading to the creation of our exhibits and describe how these pieces materialise and extend more-than-human concepts of wellbeing and care. Five of the exhibits we created for this exhibition are discussed. They all draw on our research findings across a range of studies, together with more-than-human theory and medical history (Lupton "More-Than-Human"). We describe how we used these pieces to materialise more-than-human concepts of health, wellbeing, and kinship in ways that we hoped would provoke critical thought, affective responses, and open capacities for action for contributing to both human and nonhuman flourishing. The background, thinking, and modes of making leading to the creation of ‘Cabinet of Human/Digital/Data Curiosities’, ‘Smartphone Fungi’, ‘Hand of Signs’, ‘Silken Anatomies’, and ‘Talking/Flowers’ are explained below. Bodily Curios Vaughan Wozniak-O’Connor and Deborah Lupton. Cabinet of Human/Digital/Data Curiosities. Reclaimed timber, found objects, resin 3D prints. 2023. Fig. 1: Cabinet of Human/Digital/Data Curiosities. Fig. 2: Detail from Cabinet of Human/Digital/Data Curiosities. The objects we have placed in Cabinet of Human/Digital/Data Curiosities (figs. 1 and 2) mix together such things from the past as prosthetic human eyeballs and teeth used in medicine and dentistry in earlier eras. This collection of found and manufactured objects, both old and new, draws on the concept of the ‘cabinet of curiosities’, also known as cabinets of wonder, which first became popular in the sixteenth century. Artefacts were assembled together for viewing in a room or a display case. The items were chosen for being notable in some way by the curator, including objects from natural history, antiquities, and religious relics, as well as works of art. These collections, purchased, curated, and assembled by members of the nobility or the wealthy as a marker of refinement, knowledge, or social status, were the precursor of museums (Endt-Jones). We see digital devices such as mobile phones as one of a multitude of ways that operate to document and preserve elements of human embodiment – indeed, as contemporary ‘cabinets of curiosities’. Our cabinet also refers to the tradition of medical museums, which display preserved human organs, body parts, and tissue in glass bottles for pedagogical purposes. Under this model of health, specimens of both ‘ideal’ health and also ‘ill’ health – abnormalities in the flesh – were documented as a means of categorising wellbeing. Museums such as these would often treat diseased and disabled bodies as oddities and artefacts of ‘curiosity’. In this work, we reimagine and wind back this way of thinking, through displaying and drawing attention and curiosity towards signs of the body and the everyday. We are showing that wellbeing is more than a process of categorisation, comparison, or measurement of ‘ideal’ or ‘abnormal’; it is in the traces we leave behind us when we return to the earth. Our information data are human remains, moving as endless constellations of the interior and exterior of the body (Lupton Data Selves). In this artwork, both reclaimed wood and 3D-printed resin were used as a synergy between the natural and synthetic. Taking our cue from the manner of display of these items in medical museums, we have added our own curios, including 3D-printed body organs sprouting fungi (fig. 2), as a way of demonstrating the entanglements between humans and the fungal kingdom. Interspersed among these relics of human bodies is a discarded mobile phone with its screen badly shattered. It is displayed as a more recent antiquated object for making images and collecting, storing, and displaying information and images about human bodies, which itself is subject to disastrous events despite its original high-tech veneer of glossy impermeability. Technologies are more-than-flesh as human-made simulacra of body parts. Our wellbeing is sensed and made sense of through bodies’ entanglements of human and nonhuman. These curios both materialise traces of our bodies and wellbeing and extend our bodies into the physical spaces we inhabit and through which we move. Reading the Traces and Signs Vaughan Wozniak-O’Connor and Deborah Lupton. Smartphone Fungi. Recycled European oak, 3D printed resin, CNC carved plywood. 2023 Vaughan Wozniak-O’Connor and Deborah Lupton. Hand of Signs. Laser-etched walnut and plywood. 2023. Fig. 3: Smartphone Fungi. / Fig. 4: Detail from Smartphone Fungi. Wellbeing is also a process of mark-making, realised through the reciprocal impressions we leave on each other and the world around us. In Smart Phone Fungi (figs. 3 and 4) we capture the idea of ‘recording’ that takes place between people, technologies, and the natural world. It was inspired by a huge tree which members of our team noticed on a bush walk in the Blue Mountains, near Sydney, Australia. Growing from this tree were fungi of similar size and shape to the smartphone that was used to capture the image. In our interpretation, a piece of reclaimed timber was used to represent the tree, itself marked by its human use, and fungal shapes replicating those on the tree were produced using computer numerical controlled (CNC) carving. The central timber post is covered with human and more-than-human traces, such as old tool marks, weather damage, and wood borer holes. Alongside these traces, the CNC-carved fungi forms add a conspicuously digital layer of human intervention. Fig. 5: Hand of Signs. In Hand of Signs (fig. 5), we extend this idea of both organic and digital data traces as something that can be ‘read’ or interpreted. Inspired by the practice of palmistry, this work re-interprets line reading, the historical wooden anatomical model, and human body scanning as ways of reading for signs of wellbeing in past and future. Palm readers interpret people’s character, health, longevity, and other aspects of their lives through the creases and traces of development, wear, and deteriorations in the skin of our hands (Chinn). Life leaves its traces on our palms. The piece also refers to the newer tradition of digitising human bodies (Lupton Quantified Self; Lupton et al.), employing scanning and data visualising technologies, which uses spatial GPS data to deduce patterns of human activity. For both palmistry and in more contemporary monitoring technologies, one’s wellbeing can be deduced through the map: the lines of the palm and the errant traces collected by satellites and sensors. To reflect this relation between mapping and palmistry, our updated anatomical model references both the contours of 3D geospatial data and of the human palm. However, this piece looks to represent more layers of data beyond those captured by GPS data. By using reclaimed wood to construct this human hand model, we are again making an analogy between the marks of growth and life that timber displays and those that the human body bears and develops as people move through more-than-worlds throughout their lifespans. The piece also seeks to draw attention to the various ‘signs’ that have been used across centuries to interpret the current and future health and wellbeing of humans (once markings on or morphologies of the body, now often the digitised visualisations of the internal operations and physical movements of the body that are generated by digital health technologies), superimposing older and newer modes of corporeal knowledge. Layers of Mediation Megan Rose. Silken Anatomies. Digital print on satin and yoryu silk chiffon. 2023. Ash Watson. Talking/Flowers. Collage and digital inkjet on paper. 2023. Fig. 6: Detail from Silken Anatomies. The ways that we come to sense and understand wellbeing are also mediated through the reproductive interplay of natural and technological elements. Silken Anatomies (fig. 6) was inspired by anatomical prints from the Renaissance showing details of the interiors of human bodies and organs together with living things and objects from the natural world. These webs of interconnectivity were thought to be key to wellbeing and health. Produced at scale through metal engraving and woodblock printing, these natural history and compendia took on major importance as part of these educational resources (Kemp; Swan). In an effort to extend the reach of artefacts beyond their tangible presence, libraries globally have sought to create open access digital scans of historic medical and botanical illustrations. The images reconfigured in Silken Anatomies were downloaded from the Wellcome Trust’s online archive and have been reimagined through digital enhancement and sublimation dye techniques. Referencing shrouds, the yoryu silk panels enfold exhibition visitors, who were able to touch and pass through the silks, causing them to billow in response to human movement. We bring together an animal-made material (crafted by silkworms) with more-than-human images featuring both humans and other living creatures. The vibrancies of these beautifully engraved and coloured anatomical images are given a new life and a new feel, both affectively and sensuously, through this piece. We can both see and touch these more-than-human illustrations that speak to us of the early modern natural science visualisations that underpin contemporary digital images of the human body and the more-than-human world. The vibrancies of these beautifully engraved and coloured anatomical plates are given a new life and a new feel, both affectively and sensuously. The digital is returned to the tangible. Fig. 7: Detail from Talking/Flowers. Even in increasingly digitised healthcare environments, paper and other printed materials remain central documents in the landscape of health and wellbeing. Zines are small-scale, DIY, and typically handcrafted publications, which are often made to express creators’ thoughts and feelings about health and wellbeing (Lupton "Health Zines"; Watson and Bennett). Talking/Flowers (fig. 7), a zine of visual and textual work, explores the materialities of health information and healthcare encounters by creatively layering a diverse range of materials: clippings from MRI scans, digitally warped and recoloured images from medical infographics, and found poetry made from research publications. In this way, the zine remixes and reconstitutes key documents of authority in health institutions which continue to take primacy as evidence. While vital in the pipeline of diagnosis and treatment, such documents can become black boxes of meaning, and serve to distance health professionals from consumers and consumers from agentic understandings of their own health. These evidentiary materials are brought together here with other imagery, textures, and recollections of personal experience; the pages also feature leaves, flowers, fungi, and oceanic tones. Oceans, pools, rivers, lakes, and other coastal forms or waterways offer all-consuming sensory spaces in which people can find calm, balance, buoyancy, and connection with the wider world. Aqua tides, purple eddies, and misshapen pearls flow through the pages as the golden thread of the zine’s aesthetic theme. Also featured are three original poems. The first and third poems, ‘talking to a doctor’ and ‘talking to other people’, explore moments of relational vulnerability. The second poem, ‘untitled’, is a found poem made from the conclusions of sociologist Talcott Parsons’s 1975 article on the sick role reconsidered. In each of these poems, information and communication jar the encounters and more-than-human metaphors hold space for complex feelings. The cover similarly merges imagery from botanical and historical medical illustrations with a silver shell, evoking the morphological dimensions that connect the more-than-human. Exhibition visitors were able to turn the pages of the original copy of the zine, and were invited to take a printed copy away with them. Conclusion More-than-Human Wellbeing is an exhibition which aims to expand the horizons of how we understand wellbeing and our entanglements with the world. Our exhibition was designed to draw on our research into the more-than-human dimensions of health and wellbeing in the context of an increasingly digitised and datafied world. We wanted to attune visitors to the relational connections and multisensory ways of knowing that develop with and through people’s encounters and entanglements with creatures, things, and spaces. We sought to demonstrate that in this digital age, in which digital devices and software are often considered the most accurate and insightful ways to monitor and measure health and wellbeing, multisensory and affective engagements with elements of the natural environment remain crucial to understanding our bodies and health. Through engagements with our artworks, we hoped that new capacities for visitors’ learning and thinking about the relational and distributed dimensions of more-than-human wellbeing would be opened. While traditionally thought of as human-centered, we explore human health and wellbeing as interconnected with both the natural and technological. We used materials from the natural world – timber, paper materials, and silk fabric – in our artworks to capture both the multigenerational traces and entanglements between humans and plant matter. Recent works of natural and cultural history have drawn attention to the mysterious and important worlds of the fungi kingdom and its role in supporting and living symbiotically with other life on earth, including humans as well as plants (Sheldrake; Tsing). We also made sure to acknowledge this third kingdom of living things in our artworks. We combined these images and materials from nature with digitised modes of printing and fabrication to highlight the intersections of the digital with the non-digital in representations and sensory feelings of health and wellbeing. We disrupt and make strange signs of traditional human-centric medicine through reconfigurations, bricolage, and re-imaginations of more-than-human wellbeing. As humans we are interconnected with the natural world, and the signs of these meetings can be traced and read. Through our artistic creations, we hope to re-orient people towards this more open way of thinking about wellbeing. Working with arts practices and creative data visualisations, both digital and analogue, we bring to the fore the role that more-than-human agents play in mediating and making these convivial more-than-digital connections. Acknowledgments This research was funded by the ARC Centre of Excellence for Automated Decision-Making and Society (CE200100005) and a Faculty of Arts, Design & Architecture collaboration grant. UNSW Library provided financial and curatorial support for the mounting of the exhibition. References Abram, David. "Wild Ethics and Participatory Science: Thinking between the Body and the Breathing Earth." Planet. Volume 1. Kinship: Belonging in a World of Relations. Eds. Gavin van Horn et al. Center for Humans & Nature Press, 2021. 50-62. Baker, Stephanie Alice. Wellness Culture: How the Wellness Movement Has Been Used to Empower, Profit and Misinform. Emerald Group, 2022. Bawaka Country, et al. "Working with and Learning from Country: Decentring Human Author-Ity." cultural geographies 22.2 (2015): 269-283. DOI: 10.1177/1474474014539248. Braidotti, Rosi. "'We' Are in This Together, But We Are Not One and the Same." Journal of Bioethical Inquiry 17 (2020): 465-469. DOI: 10.1007/s11673-020-10017-8. Chinn, Sarah E. Technology and the Logic of American Racism: A Cultural History of the Body as Evidence. Continuum, 2000. Endt-Jones, Marion. "Cultivating ‘Response-Ability’: Curating Coral in Recent Exhibitions." Journal of Curatorial Studies 9 (2020): 182-205. DOI: 10.1386/jcs_00020_1. Hartnell, Jack. Medieval Bodies: Life, Death and Art in the Middle Ages. Profile Books, 2018. Hernández, K.J., et al. "The Creatures Collective: Manifestings." Environment and Planning E: Nature and Space 4.3 (2020): 838-863. DOI: 10.1177/2514848620938316. Howes, David. "Introduction to Sensory Museology." The Senses and Society 9.3 (2014): 259-267. DOI: 10.2752/174589314X14023847039917. Kemp, Martin. "Style and Non-Style in Anatomical Illustration: From Renaissance Humanism to Henry Gray." Journal of Anatomy 216.2 (2010): 192-208. DOI: 10.1111/j.1469-7580.2009.01181.x. Kimmerer, Robin. "Restoration and Reciprocity: The Contributions of Traditional Ecological Knowledge." Human Dimensions of Ecological Restoration: Integrating Science, Nature, and Culture. Eds. Dave Egan et al. Springer, 2011. 257-276. Lagay, Faith. "The Legacy of Humoral Medicine." AMA Journal of Ethics 4.7 (2002): 206-208. Lewis, Bradley. "Planetary Health Humanities—Responding to Covid Times." Journal of Medical Humanities 42.1 (2021): 3-16. DOI: 10.1007/s10912-020-09670-2. Lupton, Deborah. Covid Societies: Theorising the Coronavirus Crisis. Routledge, 2022. ———. Data Selves: More-than-Human Perspectives. Polity Press, 2019. ———. Digital Health: Critical and Cross-Disciplinary Perspectives. Routledge,

Introduction

Epidemiological Change and Chronic Disease in Sub-Saharan Africa offers new and critical perspectives on the causes and consequences of recent epidemiological changes in sub-Saharan Africa, particularly on the increasing incidence of so-called ‘non-communicable’ and chronic conditions. Historians, social anthropologists, public health experts and social epidemiologists present important insights from a number of African perspectives and locations to present an incisive critique of ‘epidemiological transition’ theory and suggest alternative understandings of the epidemiological change on the continent. Arranged in three parts, ‘Temporalities: Beyond Transition’, ‘Numbers and Categories’ and ‘Local Biologies and Knowledge Systems’, the chapters cover a broad range of subjects and themes, including the trajectory of maternal mortality in East Africa, the African smoking epidemic, the history of sugar consumption in South Africa, causality between infectious and non-communicable diseases in Ghana and Belize, the complex relationships between adult hypertension and paediatric HIV in Botswana, and stories of cancer patients and their families as they pursue treatment and care in Kenya. In all, the volume provides insights drawn from historical perspectives and from the African social and clinical experience to offer new perspectives on the changing epidemiology of sub-Saharan Africa that go beyond theories of ‘transition’. It will be of value to students and researchers in Global Health, Medical Anthropology and Public Health, and to readers with an interest in African Studies

Motivational Interviewing Tailored Interventions for Heart Failure (MITI-HF): Study Design and Methods

OBJECTIVE: Lack of engagement in self-care is common among patients needing to follow a complex treatment regimen, especially patients with heart failure who are affected by comorbidity, disability and side effects of poly-pharmacy. The purpose of Motivational Interviewing Tailored Interventions for Heart Failure (MITI-HF) is to test the feasibility and comparative efficacy of an MI intervention on self-care, acute heart failure physical symptoms and quality of life. METHODS: We are conducting a brief, nurse-led motivational interviewing randomized controlled trial to address behavioral and motivational issues related to heart failure self-care. Participants in the intervention group receive home and phone-based motivational interviewing sessions over 90-days and those in the control group receive care as usual. Participants in both groups receive patient education materials. The primary study outcome is change in self-care maintenance from baseline to 90-days. CONCLUSION: This article presents the study design, methods, plans for statistical analysis and descriptive characteristics of the study sample for MITI-HF. Study findings will contribute to the literature on the efficacy of motivational interviewing to promote heart failure self-care. PRACTICAL IMPLICATIONS: We anticipate that using an MI approach can help patients with heart failure focus on their internal motivation to change in a non-confrontational, patient-centered and collaborative way. It also affirms their ability to practice competent self-care relevant to their personal health goals

Mechanisms of Change in Self-Care in Adults with Heart Failure Receiving a Tailored, Motivational Interviewing Intervention

Self-care is challenging but we previously demonstrated that motivational interviewing (MI) was effective in improving heart failure (HF) self-care. OBJECTIVE: To identify the mechanisms of intervention effectiveness by elucidating the MI techniques used and the relationship between the techniques and changes in self-care. METHODS: Audiotaped sessions (first and subsequent sessions) from 8 participants were transcribed verbatim and coded to evaluate changes in self-care. Using a sequential mixed method design, quantitative and qualitative self-care data were triangulated; congruence was 97%. The MI techniques used and mechanisms of intervention effectiveness were identified from the qualitative data. RESULTS: Three MI techniques used were related to improved self-care: 1) reflection and reframing, 2) genuine empathy, affirmation, and humor, and 2) individualized problem solving. These techniques stimulated openness to goal setting, positive self-talk, perceived ability to overcome barriers, and change talk. The mechanisms by which the techniques achieved the desired outcomes were the development of discrepancy and self-efficacy, which are consistent with the principles of MI. CONCLUSION: This study contributes to clarifying the mechanism by which MI facilitates behavioral change. PRACTICE IMPLICATIONS: Using MI to discuss self-care can help to overcome barriers and engage HF patients in goal setting for behavior change

Analysis of the impact of COVID-19 on Scotland’s care-homes from March 2020 to October 2021:national linked data cohort analysis

Background: The impact of the COVID-19 pandemic on long-term care residents remains of wide interest, but most analyses focus on the initial wave of infections. Objective: To examine change over time in: (1) The size, duration, classification and pattern of care-home outbreaks of COVID-19 and associated mortality; (2) Characteristics associated with an outbreak.Design: Retrospective observational cohort study using routinely-collected dataSetting: All adult care-homes in Scotland (1,092 homes, 41,299 places)Methods: Analysis was undertaken at care-home level, over three periods. Period (P)1 01/03/2020-31/08/2020; P2 01/09/2020-31/05/2021 &amp; P3 01/06/2021-31/10/2021. Outcomes were the presence and characteristics of outbreaks and mortality within the care-home. Cluster analysis was used to compare the pattern of outbreaks. Logistic regression examined care-home characteristics associated with outbreaks. Results: In total 296 (27.1%) care-homes had one outbreak, 220 (20.1%) had two, 91 (8.3%) had three, and 68 (6.2%) had four or more. There were 1,313 outbreaks involving residents: 431 outbreaks in P1, 559 in P2 and 323 in P3. The COVID-19 mortality rate per 1,000 beds fell from 45.8 in P1, to 29.3 in P2, and 3.5 in P3. Larger care-homes were much more likely to have an outbreak, but associations between size and outbreaks were weaker in later periods. Conclusions: COVID-19 mitigation measures appear to have been beneficial, although the impact on residents remained severe until early 2021. Care-home residents, staff, relatives and providers are critical groups for consideration and involvement in future pandemic planning.Keywords Long-term care, COVID-19, epidemiology, care-homes, data linkage<br/