An appreciative inquiry into leadership sense-making and possibilities: a story of values in action

A thesis submitted to the University of Bedfordshire, in partial fulfilment of the requirements for the degree of Professional Doctorate in Systemic PracticeThe first question you might ask yourself when you start reading this thesis could possibly be: what is it that makes this research important, interesting, and worth reading? The answer could only be found in the eyes of the beholder and when you join in on the journey you will discover your own meaning. My wish is to contribute with views and a space for reflection that can inspire leaders to look at and act on possibilities within leadership. In many ways this research might challenge traditional ways of thinking and doing research with its aim to contribute with the uniqueness of how sense-making can be developed through the perspective of systemic practice research. In systemic practice research my own practice and development becomes very important. This includes how I understand and interpret issues related to the research question and how my understanding emerges during the research process. Ways to develop systemic practice in general for the future also becomes important. The thesis explores stories leaders tell about how they make sense of leadership and possibilities they see. This also includes me and how I have made sense. Systemic practice could be described as a reflexive and reflecting practice. This means that I will share my own reflections through the whole thesis. My learnings from this research journey could also be seen as emerging through the reflections I have made during the process. The method is inspired by systemic and social constructionist perspectives related to practice research and also grounded theory. The sense I have made and express in this thesis is inevitably intertwined with experiences from past and present but also with hopes for the future, issues I would like to address for the future. The learning is partly influenced by interviews with leaders from different fields. Their sense-making has been summarised in themes that are explored and connected with and complemented with theoretical perspectives. The thesis highlights leaders’ personal and professional development as intertwined in an infinite process. The research also casts light on exploring aspects connected to values and ethics. From this journey a conceptualising of a leadership relational ethical compass and an organisational relational ethical compass has been developed. It shows that if we are grounded in values we also can be guided by these values in our leadership. But our values also need to be transformed in a meaningful and useful way to our employees and in relation to the mission we have. Leadership possibilities that arise could be seen as the aesthetics of leadership and how leadership is noticed and experienced. Often, small actions make a huge difference; how we think, communicate, and the words we use all create worlds and invite people into different patterns and meaning making conversations that are more or less helpful. The thesis highlights the importance of being comfortable with oneself and the mission as a leader. The thesis pays interest to how leaders’ self-development is intertwined with the potential of the organisation. Leaders can always increase their ability to interact with others in a meaningful and constructive way. This also shows that the mind-set we have as leaders plays an important role in how we experience our mission and the possibilities we see. The thesis is built on the idea of different domains. The introduction and methodology part represents what we can call the production domain. After this you will be invited to my personal domain and stories from my life that has influenced my sense-making. The next part will show some of the results and reflections that have arisen from interviews and will from this view take part of the production domain combined with reflections. The last chapter could be seen as my reflexive domain; how I have interwoven learning from the whole and come to certain hypotheses. The aesthetical domain could be seen as the overall how; how I have put it all together, the language and approach I have used, and how I have lived my values. This thesis and the research could also be seen as built on four parts: My professional development which is my systemic leadership practice. Developing systemic leadership practice in general. Focus on conducting systemic practice research which could be seen as in its birth. Interviews with leaders and connection to their understanding to increase aspects of leadership, sense-making and possibilities

Agents of change: Comparing HIV-related risk behavior of people attending ART clinics in Dar es Salaam with members of their social networks.

The aim of the study is to compare sociodemographic characteristics, psychosocial factors, HIV knowledge and risk behaviors of people living with HIV (PLH) and their social network members (NMs) to inform HIV prevention programs that engage PLH as prevention educators in their communities. We compared baseline characteristics of PLH enrolled in an intervention to become HIV prevention Change Agents (CAs) (n = 458) and 602 NMs they recruited. CAs and NMs responded to questionnaires through a computer-driven interface with Audio Computer-Assisted Self Interview (ACASI) software. Although NMs scored higher on socio-economic status, self-esteem and general self-efficacy, they had lower HIV knowledge (AOR 1.5; 95% CI: 1.1-2.1), greater inconsistent condom use (AOR 3.2; 95% CI: 2.4-4.9), and recent experience as perpetrators of physical (AOR 2.5; 95% CI: 1.2-5.1) or sexual (AOR 4.1; 95% CI: 1.4-12.7) intimate partner violence; and as victims of physical (AOR 1.5; 95% CI: 1.0-2.3) or sexual (AOR 2.2; 95% CI: 1.3-3.8) forms of violence than CAs. Higher HIV knowledge and lower sexual risk behaviors among CAs suggest PLH's potential as communicators of HIV prevention information to NMs. CAs' training should also focus on improving self-esteem, general self-efficacy and social support to increase their potential effectiveness as HIV prevention educators and enhance their own overall health and well-being

Agents of change among people living with HIV and their social networks: stepped-wedge randomised controlled trial of the NAMWEZA intervention in Dar es Salaam, Tanzania.

INTRODUCTION: NAMWEZA is a novel intervention that focuses on preventing HIV and promoting sexual and reproductive health and rights by addressing underlying factors related to vulnerability of acquiring HIV, such as depression, intimate partner violence (IPV) and stigma. The goal of the study was to evaluate the effect of the NAMWEZA intervention on risk behaviour as well as factors potentially contributing to this vulnerability for people living with HIV and their network members. METHODS: A stepped-wedge randomised controlled trial was conducted from November 2010 to January 2014 among people living with HIV and their network members in Dar es Salaam, Tanzania. 458 people living with HIV were randomised within age/sex-specific strata to participate in the NAMWEZA intervention at three points in time. In addition, 602 members of their social networks completed the baseline interview. Intention-to-treat analysis was performed, including primary outcomes of uptake of HIV services, self-efficacy, self-esteem, HIV risk behaviour and IPV. RESULTS: For people living with HIV, a number of outcomes improved with the NAMWEZA intervention, including higher self-efficacy and related factors, as well as lower levels of depression and stigma. IPV reduced by 40% among women. Although reductions in HIV risk behaviour were not observed, an increase in access to HIV treatment was reported for network members (72% vs 94%, p=0.002). CONCLUSION: These results demonstrate the complexity of behavioural interventions in reducing the vulnerability of acquiring HIV, since it is possible to observe a broad range of different outcomes. This study indicates the importance of formally evaluating interventions so that policymakers can build on evidence-based approaches to advance the effectiveness of HIV prevention interventions. TRIAL REGISTRATION NUMBER: NCT01693458