Hegemony, transformism and anti-politics: community-driven development programmes at the World Bank

This thesis scrutinises the emergence, expansion, operations and effects of community-driven development (CDD) programmes, referring to the most popular and ambitious form of local, participatory development promoted by the World Bank. On the one hand, this thesis draws on the writings of Antonio Gramsci to explore new ways of contextualising and understanding CDD programmes along the lines of hegemony and transformism, as promoting social stability and demobilising counter-hegemonic challenges under conditions of democratisation and decentralisation, in support of economic liberalisation. On the other hand, it scrutinises the performative operations of CDD discourse in producing, legitimising and reproducing interventions, along the lines of "anti-politics," inspired by the Foucauldian approaches of James Ferguson and Tania Li. It also examines the performances elicited by CDD discourse, which "hails" politicians as "progressive" leaders, and "interpellates" the population as an "empowered" and "civil" society. Focusing on "Kalahi," the "flagship" CDD programme of the World Bank in the Philippines, in the "showcase" Province of Bohol, this research also reveals that CDD interventions, ostensibly designed to promote popular participation in local governance, have in practice worked to shore up the position of entrenched local machine politicians, and to undermine local peasant and fishermen's organisations mobilised to demand implementation of agrarian reform and legislation restricting large-scale fishing. Kalahi, the thesis further shows, was from the outset also intertwined with the expansion of agro-business and tourism ventures in the province, and with counterinsurgency operations. In parallel, Kalahi discourse has promoted new discursive styles of leadership, which have enabled local politicians to enhance their political clout and to reinforce their popular support base, whilst practices and institutions have remained essentially unchanged. Overall, this thesis thus shows that CDD programmes have worked to shore up hegemony in rural localities throughout the Philippines, and elsewhere across the developing world

Giving and receiving thanks: a mixed methods pilot study of a gratitude intervention for palliative patients and their carers

Abstract Background Psychological research examining the nature and workings of gratitude has burgeoned over the past two decades. However, few studies have considered gratitude in the palliative care context. Based on an exploratory study which found that gratitude was correlated with better quality of life and less psychological distress in palliative patients, we designed and piloted a gratitude intervention where palliative patients and a carer of their choice wrote and shared a gratitude letter with each other. The aims of this study are to establish the feasibility and acceptability of our gratitude intervention and provide a preliminary assessment of its effects. Methods This pilot intervention study adopted a mixed-methods, concurrent nested, pre-post evaluation design. To assess the intervention’s effects, we employed quantitative questionnaires on quality of life, quality of relationship, psychological distress, and subjective burden, as well as semi-structured interviews. To assess feasibility, we considered patients and carers’ eligibility, participation and attrition rates, reasons for refusal to participate, appropriateness of intervention timeframe, modalities of participation, and barriers and facilitators. Acceptability was assessed through post-intervention satisfaction questionnaires. Results Thirty-nine participants completed the intervention and twenty-nine participated in interviews. We did not find any statistically significant pre/post intervention changes for patients, but found significant decrease in psychological distress for carers in terms of depression (median = 3 at T0, 1.5 at T1, p = .034) and total score (median = 13 at T0, 7.5 at T1, p = .041). Thematic analysis of interviews indicates that overall, the intervention had: (1) multiple positive outcomes for over a third of interviewees, in the form of positive emotional, cognitive, and relational effects; (2) single positive outcomes for nearly half of interviewees, who experienced emotional or cognitive effects; (3) no effect on two patients; and (4) negative emotional effects on two patients. Feasibility and acceptability indicators suggest that the intervention was well received by participants, and that it should adopt flexible modalities (e.g. writing or dictating a gratitude message) to ensure that it is feasible and adapted to individual needs and preferences. Conclusions Larger scale deployment and evaluation of the gratitude intervention, including a control group, is warranted in order to have a more reliable evaluation of its effectiveness in palliative care

Interventions to improve care quality in long-term care facilities for older adults ::An umbrella review protocol

Background: As part of sustained efforts to improve the quality of care and meet the challenges associated with ageing, Swiss long-term care facilities for older people are under a legal obligation to report quality indicators to the federal authorities. Whilst a vast amount of literature focuses on individual quality indicator areas, knowledge is scattered and not readily actionable, which makes it difficult for policymakers and practitioners in long-term care facilities to improve current practices based on the best available evidence. Against this backdrop, this umbrella review will identify and describe effective interventions to: improve monitoring, assessment, care, raise awareness, and/or reduce the prevalence of malnutrition, pain, or pressure ulcers in older adults residing in long-term care facilities; improve care practices by reducing polypharmacy or the use of physical restraints or by improving the coverage and effects of advance care planning or medication reviews in long-term care facilities for older adults. Methods: We will follow the Joanna Briggs Institute (JBI) guidelines for umbrella reviews. We will include systematic reviews and meta-analyses based on empirical evidence published between 2013 and 2023. We will search the following databases: Medline (Ovid), CINHAL (EBSCO), PsycINFO (Ovid), Emcare (Ovid), Embase (Elsevier), Cochrane Library, JBI EBP Database (Ovid), Web of Science, Epistemonikos, and Google scholar as a supplementary resource; and Dissertations and Theses (Proquest) and MedNar for grey literature. Two independent reviewers will screen titles and abstracts then full texts of selected reviews, using inclusion criteria based on a Population–Interventions–Context–Outcomes (PICO) framework. We will assess methodological quality to include only high-quality reviews and use the standardised JBI tool to extract relevant data. A descriptive narrative summary will present main findings in relation to effective interventions in the areas of malnutrition, pain, pressure ulcers, polypharmacy, physical restraints, advance care planning, and medication reviews in long-term care facilities for older adults. Discussion: Our findings will present a synthesis of the literature on key quality indicators areas, which will be helpful in guiding policymakers and practitioners in the development, implementation, and sustainment of evidence-based care quality improvement initiatives.This work is conducted and funded as part of the National Implementation Programme – Strengthening quality of care in partnership with residential long-term care facilities for older people 2022–2026 (NIP-Q-UPGRADE), commissioned by the Swiss Federal Quality Commission (FQC) to ARTISET with the industry association CURAVIVA and senesuisse. It is implemented in collaboration with the Institut für Pflegewissenschaft (INS), Universität Basel, Institut et Haute Ecole de la Santé La Source (La Source), Lausanne, and Scuola universitaria professionale della Svizzera italiana (SUPSI), Manno