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PubMed2002

Facilitating large-scale transitions to quality of care: an idea whose time has come.

In the field of reproductive health, investigation of the transfer of knowledge gained from demonstration and pilot projects to large public-sector programs typically has not been considered a relevant domain for research or other investigation. This article draws on a range of research in the social sciences and presents two frameworks for understanding the critical attributes of successful expansion of small-scale innovations. Seven key lessons are developed using examples from family planning where scaling up was an explicit objective, including the early Taichung Study of Taiwan, the Chinese Experiment in Quality of Care, the Bangladesh MCH-FP Extension Project, the Navrongo Project in Ghana, and the Reprolatina Project in Brazil. Unless small, innovative projects concern themselves from the outset with determining how their innovations can be put to use on a larger scale, they risk remaining irrelevant for policy and program development.

Diffusion of Innovation↗
PubMed2005

The birth of the empirical turn in bioethics.

Since its origin, bioethics has attracted the collaboration of few social scientists, and social scientific methods of gathering empirical data have remained unfamiliar to ethicists. Recently, however, the clouded relations between the empirical and normative perspectives on bioethics appear to be changing. Three reasons explain why there was no easy and consistent input of empirical evidence in bioethics. Firstly, interdisciplinary dialogue runs the risk of communication problems and divergent objectives. Secondly, the social sciences were absent partners since the beginning of bioethics. Thirdly, the meta-ethical distinction between 'is' and 'ought' created a 'natural' border between the disciplines. Now, bioethics tends to accommodate more empirical research. Three hypotheses explain this emergence. Firstly, dissatisfaction with a foundationalist interpretation of applied ethics created a stimulus to incorporate empirical research in bioethics. Secondly, clinical ethicists became engaged in empirical research due to their strong integration in the medical setting. Thirdly, the rise of the evidence-based paradigm had an influence on the practice of bioethics. However, a problematic relationship cannot simply and easily evolve into a perfect interaction. A new and positive climate for empirical approaches has arisen, but the original difficulties have not disappeared.

Bioethics↗
PubMed1992

The uses of theory in health advocacy: policies and programs.

This paper illustrates the utility of theory for health educators who advocate for health promotion policies and programs. It describes how diffusion of innovation and other social science theories were employed by a statewide coalition called the Health Promotion and Education Council of Virginia in its effort to reduce premature and preventable death and disability in the state. To this end the Council sought legislative action to accelerate the diffusion of health promotion throughout the state. Discussing elements of diffusion theory such as working through opinion leaders, creating information-exchange relationships, and tailoring the attributes of the innovation to achieve its objectives, the paper reviews the process through which the Council became an effective advocate, and the strategies it devised to communicate the innovation of health promotion to legislators. The legislation that was generated by the work of the legislative study committee and future uses of theory are also discussed.

Diffusion of Innovation↗
PubMed1995

Playing at research: methodological pluralism and the creative researcher.

In its quest for acceptance by the scientific community, mental health nursing research has developed an unhealthy obsession with methodological rigour. This paper draws on the work of several writers from the philosophy of social science to argue that this focus on methodology stifles individual creativity and acts as a gatekeeper to the profession which excludes many of our brightest and most creative researchers. The author proposes a new approach to doing research that facilitates the creative process by encouraging a playful approach that temporarily abandons the accepted rules and methods of the research process in favour of an 'anarchistic epistemology' and a variety of unusual and not necessarily externally validated methods. It is only at the end of the research process that valid and generalizable methods are introduced, and the author calls for journals to open a creative dialogue by being more willing to publish papers describing the early, exploratory stages of research, based on a judgement of their creativity and innovation.

Creativity↗
PubMed2005

Omnibus hypothesis testing in dominance-based ordinal multiple regression.

Often quantitative data in the social sciences have only ordinal justification. Problems of interpretation can arise when least squares multiple regression (LSMR) is used with ordinal data. Two ordinal alternatives are discussed, dominance-based ordinal multiple regression (DOMR) and proportional odds multiple regression. The Q2 statistic is introduced for testing the omnibus null hypothesis in DOMR. A simulation study is discussed that examines the actual Type I error rate and power of Q2 in comparison to the LSMR omnibus F test under normality and non-normality. Results suggest that Q2 has favorable sampling properties as long as the sample size-to-predictors ratio is not too small, and Q2 can be a good alternative to the omnibus F test when the response variable is non-normal.

Data Collection↗
PubMed2006

Interpretive pedagogy in action: design and delivery of a violence and health workshop for baccalaureate nursing students.

This article presents the planning and implementation of a Violence and Health Immersion Workshop for undergraduate nursing students. Given the enormous personal and economic costs of violence, the central importance of addressing violence issues in nursing curricula is emphasized. The application of three key interpretive pedagogical strategies is described: choosing critical social science as a conceptual framework for the workshop; placing specific emphasis on the decentering of content; and creating space for learners to explore this difficult issue. Formative and summative evaluations of the workshop indicated that the majority of students found the workshop to be helpful in providing the opportunity to examine and shift their own values, attitudes, and beliefs regarding violence and health. Recommendations for future research include the need for increased knowledge regarding barriers to the implementation of interpretive pedagogies, and for greater insight regarding the process of attending to differences in the participants and the facilitators.

Attitude of Health Personnel↗
PubMedDate not supplied

Factors that determine prevalence of use of contraceptive methods for men.

Globally, men have not shared equally with women the responsibility for fertility regulation. While family planning efforts have been directed almost exclusively toward women, the lack of male involvement may also reflect the limited options available to men. Current methods for men are either coitus-dependent, such as the condom or withdrawal, or permanent, such as vasectomy. The 20-year history of social science research on male contraceptive methods is examined here in terms of the human and method factors related to the acceptability of hypothetical methods and the prevalence of use of existing methods. New male methods, particularly if reversible, may alter men's willingness to accept or share responsibility for the control of fertility. Research opportunities in the areas of gender, decision-making, communication, health education, and service delivery will be enhanced when methods for women and men are comparable.

Contraception↗
PubMedDate not supplied

Quality-of-life measurements: origin and pathogenesis.

Despite extensive growth in recent years, the field of "quality-of-life" appraisal still evokes debate about basic perception of the concept and is accompanied by a plethora of indexes for measurement. One prime reason for the problems is that the measurements have been transferred from two separate sources - medical health status indexes and social-science population indexes - neither of which was designed for appraising the particular personal distinctions of the way people feel about their own quality of life. When regulatory and commercial incentives were offered for measuring patients' quality of life, it became appraised with the indexes available from the medical and psychosocial sources, even though neither set of indexes was specifically intended for that purpose. They are not developed from the basic principle that a person's "quality of life" is a state of mind, not a state of health, which is uniquely perceived by that person, and which will not be appropriately appraised unless the most cogent personal components are allowed suitable expressions. An approach that lets patients state their own opinions directly can offer the "face validity" or "common sense" that now seems absent from the generally applied measurements.

Humans↗
PubMed2006

Polemic: five proposals for a medical school admission policy.

Five proposals for admitting better applicants into medical school are discussed in this article: (1) An A level in a humanity or social science would be required, to supplement--not replace--the stringent science requirement. This would ensure that successful candidates would be better "primed" for the medical curriculum. (2) Extra points in the applicant's initial screening would be awarded for an A level in English literature. (3) There would be a minimum age of 23 for applicants, although a prior degree would not be required. This is to ensure that the applicants are mature enough to know themselves and the world better, to make a more informed and motivated choice of career, and to get more out of the humanities components of the curriculum. (4) A year's full-time experience in a healthcare or charity environment would be desirable. (5) Applicants would be given two lists of interview discussion topics to prepare: works of literature and topics in healthcare politics.

Age Factors↗
PubMed1993

A critique of Fawcett's 'Conceptual models and nursing practice: the reciprocal relationship'.

This paper offers a critique of Fawcett's paper 'Conceptual models and nursing practice: the reciprocal relationship' published in 1992, in which it is argued that 'conceptual models inform and transform nursing practice by informing and transforming the way in which nursing is experienced and understood, and that nursing practice informs and transforms conceptual models by informing and transforming the content of the conceptual model'. The critique begins by locating Fawcett's view of the relationship of nursing models to nursing practice within the intellectual tradition of positivism. For the purposes of the critique, Fawcett's positivism is not taken as being problematic in itself; however, it is argued that the standards of evidence upon which some of her arguments are based are not compatible with the practice of positivist social science, with the result that the paper is internally inconsistent. In particular, Fawcett's suggestion that nursing models are validated as evidence accumulates in their favour is contrasted with Popper's view that the validity of theoretical statements is established as they withstand attempts to demonstrate their falsity; and Fawcett's belief that nursing models are models in the scientific sense, which can be inferred from her adoption of the terminology of Kuhnian epistemology, is not found to be justified. If, for the positivist, the validity of practice is directly proportional to the validity of the theory upon which it is based, then nursing models which lack 'scientific' validity cannot be regarded as a proper basis for nursing practice. Finally, Fawcett has been criticized for failing to produce evidence of any kind to demonstrate that nursing models have a beneficial effect upon nursing outcomes.

Models, Nursing↗
PubMed2005

Remarks on the analysis of causal relationships in population research.

The problem of determining cause and effect is one of the oldest in the social sciences, where laboratory experimentation is generally not possible. This article provides a perspective on the analysis of causal relationships in population research that draws upon recent discussions of this issue in the field of economics. Within economics, thinking about causal estimation has shifted dramatically in the past decade toward a more pessimistic reading of what is possible and a retreat in the ambitiousness of claims of causal determination. In this article, the framework that underlies this conclusion is presented, the central identification problem is discussed in detail, and examples from the field of population research are given. Some of the more important aspects of this framework are related to the problem of the variability of causal effects for different individuals; the relationships among structural forms, reduced forms, and knowledge of mechanisms; the problem of internal versus external validity and the related issue of extrapolation; and the importance of theory and outside evidence.

Causality↗
PubMed2003

The effect of missing data on estimating a respondent's location using ratings data.

In social science research there are a number of instruments that utilize a rating scale such as a Likert response scale. For a number of reasons a respondent's response vector may not contain responses to each item. This study investigated the effect on a respondent's location estimate when a respondent is presented an item, has ample time to answer the item, but decides to not respond to the item. For these situations different strategies have been developed for handling missing data. In this study, four different approaches for handling missing data were investigated for their capability to mitigate against the effect of omitted responses on person location estimation. These methods included ignoring the omitted response, selecting the "midpoint" response category, hot-decking, and a Likelihood-based approach. A Monte Carlo study was performed and the effect of different levels of omissions on the simulees' location estimates was determined. Results showed that the hot-decking procedure performed the best of methods examined. Implications for practitioners were discussed.

Humans↗
PubMed1994

Reproductive health research in China: the Ford Foundation initiatives.

Increasing demographic and epidemiological evidence shows that maternal health problems are widespread and are linked to social, cultural, and economic factors, in particular, to women's status in society. Thus, there is an urgent need to expand existing knowledge about these influences on reproductive health and to empower women to gain control over them. To this end, there is a need for a comprehensive, interdisciplinary approach with an emphasis on social science research and training. The Ford Foundation, after an extensive review of its work in population and development, embarked on a new, ten-year, comprehensive reproductive health program for the 1990s. This paper describes one component of that program, a partnership with the All China Women's Federation to sponsor a series of reproductive health research activities. It examines the development and evaluates the positive and negative outcomes of the project, which commenced in 1991, from the perspective of a consultant involved in the process. So far, the project has generated interest in reproductive health in at least twenty-one Chinese provinces and has fostered a real partnership between the sponsoring and the collaborating agency. Based on the immediate outcomes of a research competition designed to identify research projects and investigators, of participant evaluation of the methodology training course, and of the strategies aimed at building capabilities and strengthening institutions in order to ensure future success, I conclude that the Ford Foundation's reproductive health initiative in China is a worthwhile and sustainable project.

China↗
PubMed2006

Fitness extraction and the conceptual foundations of political biology.

In well known formulations, political science, classical and neoclassical economics, and political economy have recognized as foundational a human impulse toward self-preservation. To employ this concept, modern social-sciences theorists have made simplifying assumptions about human nature and have then built elaborately upon their more incisive simplifications. Advances in biology, including advances in evolutionary theory, notably inclusive-fitness theory, have for decades now encouraged the reconsideration of such assumptions and, more ambitiously, the reconciliation of the social and life sciences. I ask if this reconciliation is feasible and test a path to the unification of politics and biology, called here "political biology." Two new notions, "fitness extraction" and "fitness exchange," are defined, then differentiated from each other, and lastly contrasted to cooperative gaming, the putative essential element of economics.

Journal Article↗
PubMed2002

Rituals and nursing: a critical commentary.

AIM OF THE PAPER: This critical commentary explores the concept of ritual in the nursing and social science literature in terms of investigating different understandings of its meaning and purpose. RATIONALE: The term 'ritual' is often used in a pejorative sense in nursing literature to refer to unthinking, routinized action by nurses, which lacks any empirical foundation. The purpose of this paper is to explore alternative understandings of the meaning of ritual, suggesting that the negative usage described above misses out on the wider symbolic meaning of the word. METHOD: The literature search used a combination of electronic databases (CINAHL, ASSIA, MEDLINE and RCN) from 1960 to 2000 and serendipitous references in texts. FINDINGS: The commentary is presented under the following two broad emerging themes: first, the complex issues surrounding the definition of ritual, including the relationship between rational and rational action and second, the purposes served by ritual. CONCLUSION: The paper concludes with the recommendation that the rituals nurses use in the performance of their care are worthy of research as a rich source of insight into the meaning and purpose of nursing actions.

Anthropology, Cultural↗
PubMed1999

How will we know "good" qualitative research when we see it? Beginning the dialogue in health services research.

OBJECTIVE: To lay the foundation for an explicit review and dialogue concerning the criteria that should be used to evaluate qualitative health services research. Clear criteria are critical for the discipline because they provide a benchmark against which research can be assessed. DATA SOURCES: Existing literature in the social sciences and health services research, particularly in primary care and medicine. PRINCIPAL FINDING: Traditional criteria for evaluating qualitative research are rooted in the philosophical perspective (positivism) most closely associated with quantitative research and methods. As a result, qualitative research and methods may not be used as frequently as they can be and research results generated from qualitative studies may not be disseminated as widely as possible. However, alternative criteria for evaluating qualitative research have been proposed that reflect a different philosophical perspective (post-positivism). Moreover, these criteria are tailored to the unique purposes for which qualitative research is used and the research designs traditionally employed. While criteria based on these two different philosophical perspectives have much in common, some important differences exist. CONCLUSION: The field of health services research must engage in a collective, "qualitative" process to determine which criteria to adopt (positivist or post-positivist), or whether some combination of the two is most appropriate. Greater clarity about the criteria used to evaluate qualitative research will strengthen the discipline by fostering a more appropriate and improved use of qualitative methods, a greater willingness to fund and publish "good" qualitative research, and the development of more informed consumers of qualitative research results.

Health Services Research↗
PubMedDate not supplied

[Socio-anthropological contributions to public nutrition: why, how and under which conditions?].

Socio-anthropological research is being increasingly recognised as important in public nutrition research. It helps to understand practices and behaviours the significance of which can partially escape the nutritionist. It also permits to increase knowledge about food systems and their underlying social dynamics and representations and therefore contributes to the understanding of often neglected aspects of nutritional problems. In this paper the authors highlight how their discipline and its main research techniques can be efficiently involved in public nutrition research, without however neglecting their own specific methodological requirements. The first objective of the paper is to draw methodological lessons from experiences. A second objective is to familiarise researchers, who are not specialised in social sciences, with the main techniques used in the discipline. After a brief presentation of the underlying principles and objectives of socio-anthropological research, the main data collection techniques used by socio-anthropologists (observation, interview, focus groups) are described and their use is illustrated by concrete research examples from Congo, Bolivia, Nepal and Tunisia. A special emphasis is put on the requirements of qualitative data analysis. The discussion focuses on the choice of techniques, the enhancement of quality in qualitative research and on the main constraints and difficulties encountered in involving socio-anthropology in public nutrition. The limits, constraints and conditions of this implication and contribution are discussed. For the authors the issue of involving socio-anthropology in public nutrition should not be viewed in terms of instrumentalisation of one discipline by the other. The main avenue to reach a fruitful and efficient collaboration is respect and recognition of the methodological approaches (and underlying epistemological assumptions) of socio-anthropology (qualification of researchers, quality criteria, etc.). These requirements are necessary for socio-anthropology to produce qualitatively sound data and analysis. More important, the set up of common conceptual frameworks on the basis of an interdisciplinary dialogue has to be established from conception of the research up to its conclusion.

Anthropology, Cultural↗
PubMed2006

A graduate education framework for tropical conservation and development.

Conventional graduate training related to tropical conservation and development has typically separated the two fields, with students focusing on either conservation from the perspective of the biophysical sciences or development as an extension of the social sciences. On entering the workforce, however graduates find they are required to work beyond disciplinary boundaries to address the complex interconnectivity between biological conservation and human well-being. We devised a framework for graduate education that broadens students' skill sets to learn outside their immediate disciplines and think in terms of linked socioecological systems, work in teams, communicate in nonacademic formats, and reflect critically on their own perspectives and actions. The University of Florida's Tropical Conservation and Development program has adopted a learning and action platform that blends theory, skills, and praxis to create an intellectual, social, and professionally safe space where students, faculty, and other participants can creatively address the complex challenges of tropical conservation and development. This platform operates within a nondegree-granting program and includes core courses that are taught by a team of biophysical and social scientists. It incorporates a range of alternative learning spaces such as student-led workshops, retreats, visiting professionals, practitioner experiences, and a weekly student-led seminar that collectively encourage students and faculty to enhance their skills and systematically and thoroughly reflect on program activities. Challenges to the described approach include increased service demands on faculty, a redefinition of research excellence to include effective and equitable collaboration with host-country partners, and the trade-offs and uncertainties inherent in more collaborative, interdisciplinary research. Despite these challenges, growing interdisciplinary programs, coupled with adaptive educational approaches that emphasize learning and action networks of students, faculty, and field partners, provide the best hope for responding to the emerging challenges of tropical conservation and development.

Conservation of Natural Resources↗