Doing Relationships and Sexuality Education with Young People in State Care

Background: Existing literature indicates that young people in state carehave particular sexual health needs that include addressing their social andemotional well-being, yet little has been published as to how thesecomponents of sex education are actually delivered by service-providers.Objective: To analyse the processes involved in delivering relationship andsexuality education to young people in state care from the perspectives ofa sample of service-providers with a role in sexual health care delivery.Design: Qualitative methodological strategy.Setting: Service-delivery sites at urban and rural locations in Ireland.Method: Twenty-two service-providers were interviewed in depth, and datawere analysed using a qualitative analytical strategy resembling modifiedanalytical induction.Findings: Participants proffered their perceptions and examples of theirpractices of sex education in relation to the following themes: (1)acknowledging the multi-dimensional nature of sexual health in the case ofyoung people in care; (2) personal and emotional development educationto address poor self-esteem, emotional disconnectedness and an inabilityto recognise and express emotions; (3) social skills’ education as part of arepertoire of competencies needed to negotiate relationships and safer sex;(4) the application of positive social skills embedded in everyday socialsituations; and (5) factual sexuality education.Conclusion: Insights into service providers’ perceptions of the multidimensionalnature of the sexual health needs of young people in statecare, and the ways in which these service-providers justified their practicemake visible the complex character of sex education and the degree of skillrequired to deliver it to those in state care.

‘New’ migrant identities: unravelling opportunities and restrictions

Labour and capital mobility from globalisation has given rise to significant increases in the reliance of migrant labour in established gateways, but also in new migration destinations. Many aspects of migrant incorporation in new migration destinations have received some attention, not least regarding employer and employee relations. Less attention has been focused on the construction of migrant as a marker of identification, although identities, particularly regarding gender and ethnicity, in the workplace have received considerable attention. This article aims to illuminate knowledge on how migration produces social change thereby responding to a call from Batnitzky et al. (2009, p. 1290) for additional attention on what ‘the practical and symbolic effects of migration are as people move across different structures and institutions of social control….’ Mindful of Goffman’s (1969, 1983) emphasis on individual interactions and experiences, it examines what it means to be a migrant in terms of everyday encounters and experiences. It investigates the array and interplay of internal and external processes that create migrant identities and the implications of this for social integration.

The paper argues that one of the paradoxes of globalisation, and of the associated increased levels of migrant labour, is the construction of the migrant identity that ultimately impedes social integration. It shows how the application of migrant identity (internally and externally) bestows a particular status that affects (options for) individual behaviour and subsequent actions and outcomes. The paper argues that while migrants value the migrant identity status because of the benefits that it brings, this status can also cause high levels of dissatisfaction among migrants and it can exclude migrants from wider benefits of full citizenship. Migrants have individual identification processes, but external forces, including social structures and institutions, also affect migrant identity. These forces help to shape individual expectations and standards, contributing to identity interruption and dissonance.

The paper is structured as follows: it uses social identity theory as a means of understanding what it is to be a ‘migrant’ in a new destination, while simultaneously recognising the inevitability of this generic label - migrants are an extremely heterogeneous group, made up of individuals with different experiences, values and so forth. The analysis considers the significance of context and of social interactions, thus paying attention to how identity is constructed and performed by the individual and also assigned by others. Empirical evidence is used to examine how having a migrant status affects individual prospects. The paper evaluates the extent to which patterns and processes of migration present an opportunity for social change, positive or negative.

A realist synthesis of educational interventions to improve nutrition care competencies and delivery by doctors and other healthcare professionals

Objective: To determine what, how, for whom, why, and in what circumstances educational interventions to improve the delivery of nutrition care by doctors and other healthcare professionals work?

Design: Realist synthesis following a published protocol and reported following Realist and Meta-narrative Evidence Synthesis: Evolving Standards (RAMESES) guidelines. A multidisciplinary team searched Medline, CINAHL, ERIC, EMBASE, PsyINFO, Sociological Abstracts, Web of Science, Google Scholar, and Science Direct for published and unpublished (grey) literature. The team identified studies with varied designs; appraised their ability to answer the review question; identified relationships between contexts, mechanisms, and outcomes (CMOs); and entered them into a spreadsheet configured for the purpose. The final synthesis identified commonalities across CMO configurations.

Results: Over half of the 46 studies from which we extracted data originated from the US. Interventions that improved the delivery of nutrition care improved skills and attitudes rather than just knowledge; provided opportunities for superiors to model nutrition care; removed barriers to nutrition care in health systems; provided participants with local, practically relevant tools and messages; and incorporated non-traditional, innovative teaching strategies. Operating in contexts where student and qualified healthcare professionals provided nutrition care in both developed and developing countries, these interventions yielded health outcomes by triggering a range of mechanisms, which included: feeling competent; feeling confident and comfortable; having greater self-efficacy; being less inhibited by barriers in healthcare systems; and feeling that nutrition care was accepted and recognised.

Conclusion: These findings show how important it is to move education for nutrition care beyond the simple acquisition of knowledge. They show how educational interventions embedded within systems of healthcare can improve patients’ health by helping health students and professionals to appreciate the importance of delivering nutrition care and feel competent to deliver it.

Phonic skills mediate improved literacy outcomes in at-risk primary school children: results from the Ready-to-Learn Programme

Background
Learning to read is a key goal during primary school: reading difficulties may curtail children’s learning trajectories. Controversy remains regarding what types of interventions are effective for children at risk for academic failure, such as children in disadvantaged areas. We present data from a complex intervention to test the hypothesis that phonic skills and word recognition abilities are a pivotal and specific causal mechanism for the development of reading skills in children at risk for poorer literacy outcomes.
Method
Over 500 pupils across 16 primary schools took part in a Cluster Randomised Controlled Trial from school year 1 to year 3. Schools were randomly allocated to the intervention or the control arm. The intervention involved a literacy-rich after-school programme. Children attending schools in the control arm of the study received the curriculum normally provided. Children in both arms completed batteries of language, phonic skills, and reading tests every year. We used multilevel mediation models to investigate mediating processes between intervention and outcomes.
Findings
Children who took part in the intervention displayed improvements in reading skills compared to those in the control arm. Results indicated a significant indirect effect of the intervention via phonics encoding.
Discussion
The results suggest that the intervention was effective in improving reading abilities of children at risk, and this effect was mediated by improving children’s phonic skills. This has relevance for designing interventions aimed at improving literacy skills of children exposed to socio-economic disadvantage. Results also highlight the importance of methods to investigate causal pathways from intervention to outcomes.