Theorising disability: a practical and representative ontology of learning disability

This article contributes to the ongoing development of the theorisation of learning disability, focusing on the value of the ontological turn. We argue that while social theory has influenced understandings of disability within academia, particularly within disability studies, it has had a limited impact on the discursive and practical use of the term ‘learning disability’. How ‘learning disability’ is constructed is of direct consequence to the lives of people with learning disabilities. Owing to this, we present a practical and representative ontology of learning disability in order to progress the ontological turn into everyday understandings of disability. To do this, disability theory is discussed, critically appraised and progressed. We then outline how this new theorisation could be re-contextualised within policy, with a view to further re-contextualisation into practice and the everyday. It is hoped that this article will spark discussion regarding how the ontological turn can be used for change

'It's just a likelihood': Uncertainty as topic and resource in conveying 'positive' results in an antenatal screening clinic

The recognition of uncertainty as a pivotal issue for the sociology of medicine is longstanding. More recently, the widespread integration of new medical technologies into healthcare has led to a renewed analytic focus on uncertainty. However, there remains little work on the interactional manifestations of uncertainty. This article uses conversation analysis to examine how uncertainty is introduced and used in one specific setting: an antenatal screening clinic in Hong Kong. We focus on women who have received “screen positive” or higher risk results, and reflect on the ways in which uncertainty is an “essential tension” (Mazeland and ten Have 1996) in the activity of conveying these results to them. We conclude that as well as posing potential difficulties for interaction, the uncertainty of test results is also used here as an interactional resource in managing the institutionally defined category of “high risk.

Operations analysis of Fleet battle experiments using the Battlespace Information War methodology: preliminary report

This report outlines an approach for quantitative operations analysis of aspects of Fleet Battle Experiments (FBEs) using the methodology underlying the Battlespace Information War (BAT/IW) analytical tool. The general approach of this analysis methodology is to focus on a specific experimental initiative from one or more FBEs, such as Time Critical Targeting (TCT). BAT/IW models are then tailored to the experimental situation using actual data obtained from one or more experiments and the experiment systems architecture. After the models and actual data are reconciled, further analysis tasks are undertaken, such as predictions of the effects of attack intensity, and/or of C4ISR response time reduction. BAT/IW modeling helps analyze and understand the system-level impact of sensor data quality, including timeliness, as one contributor to total operation/campaign success. BAT/IW modeling also accounts for the latency involved in processing information, including communications delays, decision time, waiting, etc. An example is developed to show how operational data obtained during FBE Foxtrot can be quantitatively analyzed to indicate important sensitivities.--Report documentation page.Approved for public release; distribution is unlimited

Avoiding repair, maintaining face: Responding to hard-to-interpret talk from people living with dementia in the acute hospital

People living with dementia (PLWD) are almost always admitted to the acute hospital for reasons unrelated to their dementia, finding themselves in the unfamiliar environment of a Health Care of Older Persons acute ward. The effect of this environment creates a challenge not just for a PLWD themselves, but also for the staff who care for them. Concerns have been raised by both policy makers and staff about the quality of communication between hospital staff and PLWD. Using conversation analysis, we examined 41 video recordings of healthcare professional (HCP)/PLWD interactions collected across three acute inpatient wards in a large teaching hospital in the UK. In this paper, we focus our analysis on hard-to-interpret talk (talk where there are problems in hearing, speaking and/or understanding), and the ways in which healthcare professionals respond to this. Repair of hard- to- interpret talk is common in ordinary interaction, but we find that HCPs in this setting use a range of approaches to avoid direct repair. These approaches are: the use of non-committal responses and continuers such as ‘yeah’ or nods; the use of repetitions or partial repetitions; responding to the emotional tone displayed in the PLWD's utterance; closing the current topic and shifting to the next; and treating the PLWD's talk as related to the task at hand. We suggest that the use of these approaches may be one way in which HCPs manage respecting the personhood of the PLWD, by preserving face and enabling a continuation of an interaction in which the PLWD can take an active part. Our paper provides an empirical demonstration of the high level of interactional skill involved in dementia care work. It also illustrates how these skills can be described and specified, and hence incorporated into the recommendations and tips that are produced for communication with PLWD

Research knowledge transfer to improve the care and support of adolescents with sickle cell disease in Ghana

Introduction: Effective transfer of research findings to key knowledge users, particularly in low- and middle-income countries, is not always achieved, despite being a shared priority among researchers, funders, healthcare and community stakeholders and decision-makers. A constructivist grounded theory study conducted in 2015–2019 in Ghana that explored sickle cell-related fatigue in adolescence resulted in numerous implications for practice and policy. Peer-reviewed funding was obtained to support disseminating these findings to relevant stakeholders. Methods: Key steps in implementing this study dissemination project included: (1) identifying and attracting target stakeholders from healthcare and community organizations; (2) tailoring tools for communication of research findings for the stakeholder groupsand (3) designing interactive workshops to facilitate knowledge sharing and uptake. Finding: Despite the COVID-19 pandemic, 50 healthcare and community stakeholders participated in the dissemination workshops. The dissemination activities contributed new layers of understanding to the original research findings through discussions. Through the workshops, participants identified culturally valuable and actionable recommendations that they could take forward to improve care and support for young people with sickle cell disease in Ghana. A follow-up 6 months post the workshops indicated some positive knowledge usage and benefits. Conclusion: This dissemination project provided a unique opportunity for researchers and stakeholders to share in the interpretation of research findings and to strategically plan recommendations to improve SCD-focused care and support for young people in Ghana. Further research dissemination should continue to be grounded in locally generated knowledge, include systematic, long-term evaluation of dissemination outcomesand be adequately financed. Patient and Public Contribution: Public involvement in this study was critical to the research dissemination project. The Sickle Cell Association of Ghana (Kumasi chapter) actively supported the project's development, organizationand facilitation. Parent members of the Association, the Association's executive members and volunteers, and the health professionals involved in sickle cell care at the Komfo Anokye Teaching Hospital participated in the project workshops. They contributed to the knowledge transfer and uptake

Improving the inclusivity and credibility of visual research: interpretive engagement as a route to including the voices of people with learning disabilities in analysis

Visual methods are often used in social science because of the potential for inclusivity and accessibility. In disability studies in particular, inclusive research is widely viewed as best practice and visual methods are often considered more accessible than traditional research methods. However, visual methods can encounter challenges at the stage of analysis: it is at this stage that either rigour or inclusivity are most likely to be compromised. This paper focuses on the use of interpretive engagement to overcome such challenges in the analysis of photovoice findings. Drawing on experience of using this method of analysis with 16 people with learning disabilities in the England, we first briefly outline some of the tensions that can emerge when attempting to improve inclusion in research, before going on to describe the analytic process used as way of addressing some of these tensions. The inclusiveness of interpretive engagement contributed to the rigour and meaningfulness of the findings by revealing layers of meaning which gave access to a multi-dimensional understanding of the phenomenon in question

Characteristics and prevalence of hardcore smokers attending UK general practitioners

BACKGROUND: Smoking remains a public health problem and although unsolicited GPs' advice against smoking causes between one and three percent of smokers to stop, a significant proportion of smokers are particularly resistant to the notion of stopping smoking. These resistant smokers have been called "hardcore smokers" and although 16% of smokers in the community are hardcore, little is known about hardcore smokers presenting to primary care physicians. Consequently, this study reports the characteristics and prevalence of hardcore smokers attending UK GPs. METHODS: A cross-sectional survey using data from two different research projects was conducted. Data for this analysis had been collected from surgery consultation sessions with 73 GPs in Leicestershire, England, (42 GPs from one project). Research assistants distributed pre-consultation questionnaires to 4147 adults attending GPs' surgery sessions. Questionnaires identified regular smokers, the proportion of hardcore smokers and their characteristics. Non-hardcore and hardcore smokers' ages, gender and nicotine addiction levels were compared. RESULTS: 1170 regular smokers attended surgery sessions and, 16.1% (95% CI, 14.1 to 18.4) were hardcore smokers. Hardcore smokers had higher levels of nicotine addiction than others (p = 0.000), measured by the Heaviness of Smoking Index and were more likely to be male [50.5% hardcore versus 35.3% non-hardcore, (OR = 1.88, 95% CI = 1.4 to 2.6)] but no age differences were observed between groups. CONCLUSION: A significant minority of the smokers who present in general practice are resistant to the notion of smoking cessation and these smokers are more heavily nicotine addicted than others. Although clinical guidelines suggest that GPs should regularly advise all smokers against smoking, it is probable that hardcore smokers do not respond positively to this and help to make up the 97%–99% of smokers who do not quit after being advised to stop smoking by GPs. General practitioners need to find approaches for raising the issue of smoking during consultations in ways that do not reinforce the negative opinions of hardcore smokers concerning smoking cessation

Do financial incentives for delivering health promotion counselling work? Analysis of smoking cessation activities stimulated by the quality and outcomes framework

<p>Abstract</p> <p>Background</p> <p>A substantial fraction of UK general practitioners' salaries is now intended to reflect the quality of care provided. This performance-related pay system has probably improved aspects of primary health care but, using the observational data available, disentangling the impacts of different types of targets set within this unique payment system is challenging.</p> <p>Discussion</p> <p>Financial incentives undoubtedly influence GPs' activities, however, those aimed at encouraging GPs' delivery of health promotion counselling may not always have the effects intended. There is strong, observational evidence that targets and incentives intended to increase smoking cessation counselling by GPs have merely increased their propensity to record this activity in patients' medical records. The limitations of using financial incentives to stimulate the delivery of counselling in primary care are discussed and a re-appraisal of their use within UK GPs' performance-related pay system is argued for.</p> <p>Summary</p> <p>The utility of targets employed by the system for UK General Practitioners' performance related pay may be inappropriate for encouraging the delivery of health promotion counselling interventions. An evaluation of these targets is essential before they are further developed or added to.</p

Exploring Difference or Just Watching the Experts at Work? Interrogating Patient and Public Involvement (PPI) in a Cancer Research Setting Using the Work of Jurgen Habermas

Patient and public involvement (PPI) has emerged as a key consideration for organisations delivering health research and has spawned a burgeoning literature in the health and social sciences. The literature makes clear that PPI in health research encompasses a heterogeneous set of practices with levels of participation and involvement ranging from relatively minimal contributions to research processes to actively driving the research agenda. In this paper, we draw on the work of Jurgen Habermas to explore the ways in which PPI was accomplished in a cancer research setting in England. Drawing on ethnographic data with PPI participants and professional researchers, we describe the ways in which the life-world experiences of PPI participants were shaped by the health research system. We argue that PPI in this setting is less about exploring differences with regard to a plurality of expertise and more about simply watching or supporting the professional researchers at work

Developing an online learning community for mental health professionals and service users: a discursive analysis

<p>Abstract</p> <p>Background</p> <p>There is increasing interest in online collaborative learning tools in health education, to reduce costs, and to offer alternative communication opportunities. Patients and students often have extensive experience of using the Internet for health information and support, and many health organisations are increasingly trying out online tools, while many healthcare professionals are unused to, and have reservations about, online interaction.</p> <p>Methods</p> <p>We ran three week-long collaborative learning courses, in which 19 mental health professionals (MHPs) and 12 mental health service users (MHSUs) participated. Data were analysed using a discursive approach to consider the ways in which participants interacted, and how this contributed to the goal of online learning about using Internet technologies for mental health practice.</p> <p>Results</p> <p>MHSUs and MHPs were able to discuss issues together, listening to the views of the other stakeholders. Discussions on synchronous format encouraged participation by service users while the MHPs showed a preference for an asynchronous format with longer, reasoned postings. Although participants regularly drew on their MHP or MHSU status in discussions, and participants typically drew on either a medical expert discourse or a "lived experience" discourse, there was a blurred boundary as participants shifted between these positions.</p> <p>Conclusions</p> <p>The anonymous format was successful in that it produced a "co-constructed asymmetry" which permitted the MHPs and MHSUs to discuss issues online, listening to the views of other stakeholders. Although anonymity was essential for this course to 'work' at all, the recourse to expert or lay discourses demonstrates that it did not eliminate the hierarchies between teacher and learner, or MHP and MHSU. The mix of synchronous and asynchronous formats helped MHSUs to contribute. Moderators might best facilitate service user experience by responding within an experiential discourse rather than an academic one.</p