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Critical bioethics: beyond the social science critique of applied ethics.

This article attempts to show a way in which social science research can contribute in a meaningful and equitable way to philosophical bioethics. It builds on the social science critique of bioethics present in the work of authors such as Renee Fox, Barry Hoffmaster and Charles Bosk, proposing the characteristics of a critical bioethics that would take social science seriously. The social science critique claims that traditional philosophical bioethics gives a dominant role to idealised, rational thought, and tends to exclude social and cultural factors, relegating them to the status of irrelevancies. Another problem is they way in which bioethics assumes social reality divides down the same lines/categories as philosophical theories. Critical bioethics requires bioethicists to root their enquiries in empirical research, to challenge theories using evidence, to be reflexive and to be sceptical about the claims of other bioethicists, scientists and clinicians. The aim is to produce a rigorous normative analysis of lived moral experience.

Bioethics↗

Mental and social health in disasters: relating qualitative social science research and the Sphere standard.

Increasingly, social scientists interested in mental and social health conduct qualitative research to chronicle the experiences of and humanitarian responses to disaster We reviewed the qualitative social science research literature in relation to a significant policy document, the Sphere Handbook, which includes a minimum standard in disaster response addressing "mental and social aspects of health", involving 12 interventions indicators. The reviewed literature in general supports the relevance of the Sphere social health intervention indicators. However, social scientists' chronicles of the diversity and complexity of communities and responses to disaster illustrate that these social interventions cannot be assumed helpful in all settings and times. With respect to Sphere mental health intervention indicators, the research largely ignores the existence and well-being of persons with pre-existing, severe mental disorders in disasters, whose well-being is addressed by the relevant Sphere standard. Instead, many social scientists focus on and question the relevance of posttraumatic stress disorder-focused interventions, which are common after some disasters and which are not specifically covered by the Sphere standard. Overall, social scientists appear to call for a social response that more actively engages the political, social, and economic causes of suffering, and that recognizes the social complexities and flux that accompany disaster. By relating social science research to the Sphere standard for mental and social health, this review informs and illustrates the standard and identifies areas of needed research.

Altruism↗

[The stress-coping paradigm, a complimentary contribution from social science and nursing sciences in the development of knowledge].

This article provides an illustration of the combined contributions of social sciences and nursing in the development and application of knowledge. More specifically, the article presents a discussion of the respect ive contributions of the social sciences and nursing in the development of knowledge about the stress-coping paradigm. First, the significant role of the social sciences in initially developing the concepts of stress and coping if revealed through a review of different research perspectives considered to date, most notably in sociology and social psychology . After presenting some key markers in the development of nursing as a professional discipline, this paper illustrates how work developed through multidisciplinary efforts in the area of social sciences is pertinent to the development of theory, empirical research and the practice of nursing. The singular contribution of nursing to the development of knowledge in stress-coping is emphasized. The author concludes by noting that the discipline of nursing is somewhat similar to social sciences and sha res some common interests, notably with regard to phenomena such as reac tion to stress.

Adaptation, Psychological↗

Community medicine: its contribution to the social science of medicine.

The Division of Behavioral Sciences operates today in a social climate different from that in its formative years. The federal agencies created specifically to stimulate and support social research have been cut back severely over the past two decades, and in some instances have been eliminated. The official policy of the National Institute of Mental Health, once the main source of support for both training and research in social science in medicine, has changed to a much narrower biomedical focus. On the other hand, there are more social scientists engaged in integral roles both locally at Mount Sinai, at medical institutions nationally, and internationally (25-26). Further, reassertion of the importance for medical education of social science specifically, and of behavioral sciences more broadly defined, has been endorsed in the strongest terms by both the Association of American Medical Colleges and the National Board of Medical Examiners (27). Also, the published literature now incorporates what we in the Division of Behavioral Sciences judge to be a richer intellectual contribution to the field than ever before (28). Perhaps most important, funding for health services research and epidemiological studies has been increased in recent federal budgets. Therefore, the division is planning for expansion of both its research and education, perceiving the future as a challenge continuous with challenges of the past: finding new ways to understand the relation between social factors and the problems of health and illness.

Community Medicine↗

Social science and health research: growth at the National Institutes of Health.

Programs within the National Institutes of Health (NIH) have recently taken steps to enhance social science contributions to health research. A June 2000 conference convened by the NIH Office of Behavioral and Social Sciences Research highlighted the role of the social sciences in health research and developed an agenda for advancing such research. The conference and agenda underscored the importance of research on basic social scientific concepts and constructs, basic social science research on the etiology of health and illness, and the application of basic social science constructs in health services, treatment, and prevention research. Recent activities at NIH suggest a growing commitment to social science research and its integration into interdisciplinary multilevel studies of health.

Culture↗

What can the social sciences contribute to the study of ethics? Theoretical, empirical and substantive considerations.

This article seeks to establish that the social sciences have an important contribution to make to the study of ethics. The discussion is framed around three questions: (i) what theoretical work can the social sciences contribute to the understanding of ethics? (ii) what empirical work can the social sciences contribute to the understanding of ethics? And (iii) how does this theoretical and empirical work combine, to enhance the understanding of ethics, as a field of analysis and debate, is socially constituted and situated? Through these questions the argument goes beyond the now commonly cited objection to the over-simplistic division between normative and descriptive ethics (that assigns the social sciences the 'handmaiden' role of simply providing the 'facts'). In extending this argument, this article seeks to establish, more firmly and in more detail, that: (a) the social sciences have a longstanding theoretical interest analysing the role that a concern with ethics plays in explanations of social change, social organisation and social action; (b) the explanations that are based on the empirical investigations conducted by social scientists exemplify the interplay of epistemological and methodological analyses so that our understanding of particular substantive issues is extended beyond the conventional questions raised by ethicists, and (c) through this combination of theoretical and empirical work, social scientists go beyond the specific ethical questions of particular practices to enquire further into the social processes that lie behind the very designation of certain matters as being 'ethical issues.'

Behavioral Research↗

Social science research in malaria prevention, management and control in the last two decades: an overview.

In the recent past, considerable progress has been made in understanding how human behavior and social organization, macro- and micro-level economic processes, and health and political systems affect responses to malaria at global, national, community, household, and individual levels. Advances in malaria-related social, behavioral, economic, evaluation, health systems, and policy (social science) research have resulted in improvements in the design and implementation of malaria prevention, management and control (PMC) strategies. Indeed, the past two decades chronicle dramatic advances in the implementation of evidence-based interventions, drawn not only from biomedical but also from social science research. Malaria awareness-raising, advocacy, case management, and prevention efforts have reaped the benefits of social science research and as a result, many programs are implemented and evaluated in a more effective manner than in the past. However, the pace at which findings from social science research are integrated into program and policy implementation is unsatisfactory. Additionally, examples remain of programs that fail to utilize findings from social science research and as a result, achieve minimal results. Furthermore, there is a sizeable body of knowledge that is underutilized and which, if assimilated into programs and policies, could accelerate progress in malaria PMC. Examples include information on meaningful community participation, gender, socio-economic status, and health systems. Regrettably, although social science input is necessary for almost all interventions for malaria management and control, the numbers of scientists working in this area are dismal in most of the key disciplines-medical anthropology; demography; geography and sociology; health economics and health policy; social psychology; social epidemiology; and behavior-change communication. Further, skills of program workers charged with implementation of interventions and strategies at country level are most often inadequate. The Special Program for Research and training in tropical diseases (TDR) and the multi-lateral initiative on malaria (MIM) have remained in the forefront of capacity building for this area of research, but additional efforts are needed to bring more applied social scientists into the fold. Their skills are necessary to ensure that social science findings get to program planners and implementers in a useful form that allows for more rapid and appropriate integration of the results into malaria PMC programs and policies. A re-thinking of the current focus within capacity building efforts is proposed.

Communication↗

Exploring diagnostic processes: social science perspectives.

This review explores social science analyses of diagnosis of childhood neurological disabilities. The paper moves through three sections, which capture the historical and conceptual trends within the literature. The first focuses on work identifying the need to communicate effectively with parents when giving a diagnosis, the second explores the role parents can play as "partners" or contributors to diagnosis, and the final section goes further in exploring the social complexity of diagnoses in order to examine the embedded nature of social practices, power relations and hierarchies, and institutions in the diagnosis encounter.

Child↗

Integrating behavioral and social sciences research at the National Institutes of Health, U.S.A.

Readers of Social Science & Medicine may find it interesting to know that in 1993 the United States Congress established the Office of Behavioral and Social Sciences Research (OBSSR) at the National Institutes of Health (NIH) in the belief that scientific research on behavioral and social factors in order to facilitate a growth in this important area of research. As is discussed in this paper, the philosophy of the OBSSR is that, although discoveries in the behavioral and social sciences are as critical for health as those from the biomedical sciences, knowledge from both areas must ultimately be integrated. Such integration will accelerate our understanding and treatment of physical and mental illnesses in both the developed and the developing world. This paper briefly presents the scientific evidence supporting this philosophy, outlines the mandated responsibilities of the OBSSR, and discusses some of its current and planned activities.

Behavioral Sciences↗

Fractional designs: a simulation study of usefulness in the social sciences.

Fractional designs can be extremely useful in social science research, especially when a large number of factors is involved. Reluctance for the use of fractional designs seems to be warranted for two reasons: (1) In the social sciences, the amount of measurement error is often large, which may decrease the power, and (2) higher order interactions are assumed to be nonsignificant, which is difficult to guarantee without sufficient research. This simulation study shows the effects of measurement error and assumption violations under various conditions. It is concluded that fractional designs handle measurement error gracefully and that they are as powerful as a full design when equal degrees of freedom are available. Significant interaction effects can cause serious problems, especially in situations with low or intermediate measurement error, and can lead to erroneous conclusions. Only when estimated confounded effects are clearly not significant, the chance of a wrong decision is reasonably small. Therefore, fractional designs are especially warranted for the exclusion of irrelevant factors. However, we note pitfalls in the use of Version 1.0 of the program Trail Run from SPSS, Inc., to implement the procedures.

Bias↗

Reflections on the disciplinary gulf between the natural and social sciences.

The general purpose of this essay is to explore key features of the disciplinary gulf between the natural and social sciences, and, in particular, differences in fundamental assumptions concerning the nature and purpose of knowledge. The essay contrasts the claims of the natural sciences to objectivity and universality with those of the social sciences, especially the qualitative social sciences, to the historical and cultural contingency of knowledge. It examines the ways in which the use of two 'key words' - 'expertise' and 'responsibility'--serves to maintain the disciplinary gulf by reinforcing assumptions concerning the neutrality and technical nature of scientific knowledge and how those concepts marginalize social and ethical dimensions to create a politically influential hierarchy of knowledge claims.

Humans↗

Improving the fit between social science and health care practice: suggested next steps for the researcher.

The aim of this paper is to assess social science research on health and illness in order to enhance its utility for the practical world of health care. The premise is that both social scientists and health care professionals share complementary intellectual interests in fostering empirical research on health and illness. Barriers built into the orientation and reward structure of both professions impede collaborative efforts. In our view, however, the advantages of working on these problems outweigh the disadvantages. Toward this end, we suggest several substantive and methodological directions to be encouraged and then discuss prospects for collaboration from the perspectives of social science, medicine and the wider society. We see opportunity for comparative work, synthesis and the systematic nesting of findings into a knowledge base that will permit generalizations. Our goal is to improve the fit between social science and health practice by increasing the relevance of social science findings for the delivery of care and the training of health care professionals. In addition, hopefully, our suggestions will advance social research independent of its impact on the health field.

Chronic Disease↗

Relevant behavioural and social science for medical undergraduates: a comparison of specialist and non-specialist educators.

AIM: To compare what medical educators who are specialists in the behavioural and social sciences and their non-specialist counterparts consider to be core concepts that medical graduates should understand. BACKGROUND: Previously perceived as 'nice to know' rather than 'need to know', the General Medical Council (GMC) now places behavioural and social sciences on the same need-to-know basis as clinical and basic sciences. Attempts have been made to identify what components of these topics medical students need to know; however, it remains unknown if decisions over programme content differ depending on whether or not educationalists have specialist knowledge of the behavioural and social sciences. METHODS: In a survey of medical educationalists within all UK medical schools, respondents were asked to indicate from a comprehensive list of psychological, sociological and anthropological concepts what they considered a minimally competent graduate should understand. Comparisons were made between the concepts identified by specialist behavioural and social science (BSS) educators and those without such training. RESULTS: Despite different disciplinary backgrounds, non-specialist educators largely concurred with BSS specialist educators in the concepts they considered tomorrow's doctors should know about. However, among BSS specialists there remained disagreement on what BSS content was relevant for graduates. Differences reflect specialist knowledge and recognition of the role of theoretical underpinning of BSS and reveal gaps in non-specialists knowledge. CONCLUSIONS: Educationalists with formal training in the full range of behavioural and social sciences should be involved in the development of BSS curriculum content at both national and school levels.

Attitude of Health Personnel↗

The imagework method in health and social science research.

Existing alongside the traditional forms of qualitative social science research, there is a set of potential research methods that derive from experiential groupwork and the humanistic human potential movement and are only slightly used by researchers. Social science research has barely begun to use these powerful strategies that were developed originally for personal and group change but that are potentially applicable to the research domain. This article will locate these methods within the qualitative research domain and propose a novel view of their value. The study of the actual and potential use of one of these methods, imagework, will be the particular focus of this article. References to the use of artwork, sculpting, psychodrama, gestalt, and dreamwork will also be made. The hypothesis underpinning the author's approach is that experiential research methods such as imagework can elicit implicit knowledge and self-identifies of respondents in a way that other methods cannot.

Art↗

The importance of social science research in protecting adolescents' sexual and reproductive choice.

This paper reviews the ways in which social science research findings can influence action in the areas of reproductive health and rights. Essentially, social science research: (a) establishes the levels and patterns of behaviours, attitudes or perceptions; (b) explores factors underlying these behaviours, attitudes and perceptions; (c) explains programme and organisational impediments constraining, in practice, the exercise of informed choices or the acquisition of preventive and curative services; (d) monitors the extent to which interventions have been successful in modifying behaviours, attitudes or perceptions, and (e) facilitates an understanding of the policy, social and legal arenas that impinge on the determinants and consequences of reproductive choice. Findings highlight possible courses for legal, policy or programmatic interventions. Such research has enormous relevance for our understanding of reproductive and sexual health, and the health-seeking choices that women and men--from adolescent to adult--make in various settings, the constraints they face in making these choices, and the kinds of interventions that might enhance choices given the prevailing sociocultural context. Focusing on adolescent sexual and reproductive health and choice, the paper concludes that social science research findings are fundamental for informing efforts to protect reproductive rights.

Adolescent↗

Social science research in tropical disease.

Awareness of the importance of social science research in health education and the control of tropical diseases is increasing. This article outlines the current status of social science research, highlighting ways in which an understanding of indigenous beliefs and perceptions about illnesses can facilitate their treatment in tropical regions.

Diagnosis↗

Some frontiers in social science.

The fundamental challenge in the social sciences is moving from complicated correlations to useful prediction. Progress usually reflects an interplay between theory, data, and tools. Six areas of innovation, principally data and tools, are now pushing at the frontiers of these sciences: longitudinal data, laboratory experimentation, improved statistical methods, geographic information tools, biosocial science, and international replication. These innovations are gaining power as they cross disciplinary boundaries, helping to attribute causality to observed relationships, to understand their nature, and thereby to improve the accuracy and usefulness of predictions.

Animals↗

Teaching the social sciences to undergraduate medical students.

An increasing number of medical schools have introduced undergraduate programs in the social sciences in an attempt to improve the ability of their graduates to communicate with patients and to meet their needs. However, teaching programs in the social sciences have often encountered varying degrees of student resistance, possibly because of their uncertain relevance for clinical practice, incongruity with the biomedical model, teachers' attitudes, and poorly defined educational goals. The objective of this essay is to analyze the causes of students' resistance to the social sciences and to identify the features of a teaching program responsive to their needs.

Attitude of Health Personnel↗