A Comparison of Audio Recordings and Therapist's Process Notes in Child and Adolescent Psychoanalytic Psychotherapy

Therapistsʼ process notes - written descriptions of a session produced shortly afterwards from memory - hold a significant role in child and adolescent psychoanalytic psychotherapy. They are central in training, in supervision, and in developing oneʼs understanding through selfsupervision and forms of psychotherapy research. This thesis examines such process notes through a comparison with audio recordings of the same sessions. In so doing, it aims to generate theory that might illuminate the causes of significantly patterned discrepancies between the notes and recordings, in order to understand more about the processes at work in psychoanalytic psychotherapy and to explore the nature of process notes, their values and limitations. The literature searches conducted revealed limited relevant studies. All identified studies that compare process notes with recordings of sessions seek to quantify the differences between the two forms of recording. Unlike these, this thesis explores the meaning of the differences between process notes and recordings through qualitative data analysis. Using psychoanalytically informed grounded theory, in total nine sets of process notes and recordings from three different psychoanalytic psychotherapists are analysed. The analysis identifies eight core categories of findings. Initial theories are developed from these categories, most significantly concerning the role and influence of a ʻcore transference dynamicʼ between therapist and patient. Further theory is developed on the nature and function of process notes as a means for the therapistʼs conscious and unconscious processing of the session, as well as on the nature of the influence of the relationships – both internal and external – within which they are written. In the light of the findings, a proposal is made for a new approach for learning about the patient and clinical work, ʻthe comparison methodʼ (supervision involving a comparison of process notes and recordings), and, in particular, for its inclusion within the training of psychoanalytic psychotherapists. Further recommendations for research are also made.

Investigating Links Between Intimacy and Violence in Intensive Psychotherapy

This research examines links between intimacy and violence within the transference relationship of a three year old boy during intensive psychotherapy. Psychoanalytic clinical findings are used to examine triggers to violence that initially appeared to link with moments of emotional warmth. The research uses a retrospective single case study design. The clinical data cover a period of transition in the child's life from being a 'looked after child' in foster care to being adopted. There was a history of early trauma from neglect and domestic abuse. Clinical process notes from supervised sessions were coded using an adapted grounded theory approach to reveal complex interlinking themes of intimacy, violence, Oedipal issues, control and difficulties regulating affect. Data in this study show how intimacy and violence are linked when there is evidence of a separation between the self and the object of intimacy. Explosive violence is triggered by the threat of loss of the object and the rage is, at times directed towards the object of intimacy. The findings of this study support concepts identified by earlier research in the field about the impact of a lack of maternal containment on innate violence, associated struggles with the Oedipal complex and the impact upon the capacity for symbol formation and thinking. However, the research findings challenge Glasser's (1979) theory of the 'core complex' that suggests that intimacy triggers violence. The results of this research indicate that it is the threat to the loss of intimacy as a result of separation from the object that is the trigger to violence. I believe this study may, in a modest way, further understanding about links between violence and intimacy in human relationships. This may help other child psychotherapists be alert to certain dangers when dealing with violence in the therapy room.

Unlinked Embedded Graphs

This paper is a self-contained development of an invariant of graphs embedded in three-dimensional Euclidean space using the Jones polynomial and skein theory. Some examples of the invariant are computed. An unlinked embedded graph is one that contains only trivial knots or links. Examples show that the invariant is sufficiently powerful to distinguish some different unlinked embeddings of the same graph.

Artificial Skin - Culturing of Different Skin Cell Lines for Generating an Artificial Skin Substitute on Cross-Weaved Spider Silk Fibres

Background: In the field of Plastic Reconstructive Surgery the development of new innovative matrices for skin repair is in urgent need. The ideal biomaterial should promote attachment, proliferation and growth of cells. Additionally, it should degrade in an appropriate time period without releasing harmful substances, but not exert a pathological immune response. Spider dragline silk from Nephila spp meets these demands to a large extent. Methodology/Principal Findings: Native spider dragline silk, harvested directly out of Nephila spp spiders, was woven on steel frames. Constructs were sterilized and seeded with fibroblasts. After two weeks of cultivating single fibroblasts, keratinocytes were added to generate a bilayered skin model, consisting of dermis and epidermis equivalents. For the next three weeks, constructs in co-culture were lifted on an originally designed setup for air/liquid interface cultivation. After the culturing period, constructs were embedded in paraffin with an especially developed program for spidersilk to avoid supercontraction. Paraffin cross-sections were stained in Haematoxylin & Eosin (H&E) for microscopic analyses. Conclusion/Significance: Native spider dragline silk woven on steel frames provides a suitable matrix for 3 dimensional skin cell culturing. Both fibroblasts and keratinocytes cell lines adhere to the spider silk fibres and proliferate. Guided by the spider silk fibres, they sprout into the meshes and reach confluence in at most one week. A well-balanced, bilayered cocultivation in two continuously separated strata can be achieved by serum reduction, changing the medium conditions and the cultivation period at the air/liquid interphase. Therefore spider silk appears to be a promising biomaterial for the enhancement of skin regeneration.

Dissonant Belonging and the Making of Community: Native Hawaiian Claims to Selfhood and Home

In 1898 the United States illegally annexed the Hawaiian Islands over the protests of Queen Liliʽuokalani and the Hawaiian people. American hegemony has been deepened in the intervening years through a range of colonizing practices that alienate Kanaka Maoli, the indigenous people of Hawaiʽi, from their land and culture. Dissonant Belonging and the Making of Community is an exploration of contemporary Hawaiian peoplehood that reclaims indigenous conceptions of multiethnicity from colonizing narratives of nation and race. Drawing from archival holdings at the University of Hawaiʽi, Mānoa and in-depth interviews, this project offers an analysis of public and everyday discourses of nation, race, and peoplehood to trace the discursive struggle over Local identity and politics. A context-specific social formation in Hawaiʽi, “Local” is commonly understood as a multiethnic identity that has its roots in working-class, ethnic minority culture of the mid-twentieth century. However, American discourses of race and, later, multiethnicity have functioned to render invisible the indigenous roots of this social formation. Dissonant Belonging and the Making of Community reclaims these roots as an important site of indigenous resistance to American colonialism. It traces, on the one hand, the ways in which Native Hawaiian resistance has been alternately erased and appropriated. On the other hand, it explores the meanings of Local identity to Native Hawaiians and the ways in which indigenous conceptions of multiethnicity enabled a thriving community under conditions of colonialism.

Extensão universitária e associativismo popular : um estudo a partir da educação ambiental crítica

Partimos do pressuposto que a universidade pública é um bem do povo e deve servir aos interesses da sociedade, sobretudo aos interesses daqueles cuja vida é ameaçada mediante as condições desiguais sob as quais a sociedade capitalista se funda. Entendemos que a extensão universitária é uma atividade da universidade e deve, como ensino e pesquisa, ser reconhecida como produtora de conhecimentos e não por trabalhos assistenciais, como se caracteriza, na realidade concreta, a extensão universitária analisada nesta dissertação. Com base nisso, o trabalho que se segue discorre sobre a relação de dependência das associações populares, ligadas ao movimento da economia popular solidária à extensão da Universidade Federal do Rio Grande – FURG, especificamente aquela realizada pelo Núcleo de Desenvolvimento Social e Econômico – NUDESE-FURG, da região de Rio GrandeRS. O objetivo do trabalho foi conhecer a relação entre o núcleo e as associações, problematizando-a com base em alguns princípios da Educação Ambiental Crítica (diálogo, totalidade, relação teoria/prática e participação social). O referencial que sustenta o trabalho articula autores da sociologia do trabalho, economia da educação, ecologia política, geografia crítica, todos, de alguma forma, ligados ao materialismo histórico como perspectiva de análise. O trabalho se caracteriza como um estudo de caso, onde os principais recursos perpassaram pela análise de documentos e, fundamentalmente, as entrevistas gravadas e transcritas na íntegra, pelas quais nosso estudo se baseia. A análise do material foi feita a partir dos pressupostos da análise crítica do discurso, a qual busca entrelaçar os pronunciamentos dos sujeitos com a totalidade social na qual o discurso está inscrito, possibilitando o alcance do significado concreto. O estudo demonstra que a extensão universitária desenvolvida pelo NUDESE-FURG tem características assistencialistas, cuja consequência prática é a realização de atividades para os trabalhadores associados (principalmente elaboração e gestão de projetos), impedindo que as associações desenvolvam suas ações sem depender do núcleo. Além disso, ao assumir recursos financeiros oriundos de projetos (via editais), as associações apenas transferem para o Estado a condição de dependência do intermediário, o que não extingue o problema, mas reafirma-o. Por isso, entendemos que a Educação Ambiental Crítica oferece, por meio dos princípios que utilizamos, um instrumento crítico importante ao estudo de processos e políticas que buscam a emancipação dos sujeitos. Isso porque, também, ao reconhecer a crise socioambiental que vivemos, fruto do modo de produção capitalista, dos conflitos existentes na sociedade (portanto dos diferentes interesses, concepções e valores em disputa), pela apropriação da riqueza produzida, podem-se possibilitar conhecimentos úteis dos trabalhadores das associações. Para que isso aconteça, defendemos o encontro da extensão universitária do NUDESE-FURG com a Educação Ambiental Crítica, caso a emancipação, de fato, esteja no horizonte das práticas deste núcleo, já que pelo estudo, nesta pesquisa, predomina dependência de tais grupos do NUDESE-FURG.

Processus d’adaptation des personnes vivant avec la schizophrénie et ayant un soutien social limité

Résumé : La schizophrénie est un trouble mental grave qui affecte toutes les facettes de la vie de la personne. En outre, le manque de soutien social est un problème important qui contribue à l’aggravation de la maladie, notamment en influençant négativement la capacité d’adaptation. Chez les personnes atteintes de schizophrénie, la capacité à utiliser des stratégies d’adaptation adéquates et efficaces est essentielle afin d’améliorer la santé, le bien-être et la prévention des rechutes. Cette recherche utilise la conception de l’adaptation de Roy (2009). De nombreuses études confirment la présence de difficultés d’adaptation chez ces personnes. De plus, le processus d’adaptation lui-même reste mal connu. La question de recherche était : Quel est le processus d’adaptation des personnes vivant avec la schizophrénie lorsque leur soutien social est limité ? Cette question sous-tendait deux objectifs : 1) décrire le processus d’adaptation des personnes atteintes de schizophrénie dans un contexte de soutien social limité et 2) contribuer au développement du modèle de Roy dans le contexte des troubles mentaux graves. Le devis de recherche était la théorisation ancrée constructiviste, auprès de 30 personnes vivant avec la schizophrénie. Les données étaient composées d’entrevues et de résultats de trois questionnaires qui ont contribué à décrire de façon plus détaillée le profil des participants. Les résultats sont une modélisation du processus d’adaptation nommée « les filtres dans le processus d’adaptation des personnes vivant avec la schizophrénie ». Cette modélisation met en lumière le fait que le potentiel d’adaptation des personnes vivant avec la schizophrénie est affecté à la fois par des éléments de l’environnement social et des éléments inhérents à la maladie elle-même. Ces éléments altèrent la possibilité et la capacité à utiliser des stratégies d’adaptation adéquates et efficaces. Ces résultats de recherche pourraient permettre d’améliorer l’évaluation des personnes atteintes de schizophrénie et de diminuer les « inconnues » dans l’effet des interventions, tout comme de favoriser les actions visant à lutter contre les conditions sociales qui nuisent à l’adaptation.

Research into crown rot and wilt diseases of strawberries in Queensland

Plant losses due to fungal diseases in strawberry (Fragaria × ananassa Duch.) can potentially cause total loss of production. Three fungal pathogens, Fusarium oxysporum f. sp. fragariae, Colletotrichum gloeosporioides and Macrophomina phaseolina, cause similar crown rot and wilt symptoms in strawberries in Queensland. Since the withdrawal of methyl bromide in 2005, no effective chemical control of any of the three pathogens has been available. This study aims at identifying sources of plant genetic resistance that can be used in the breeding program to develop resistant cultivars for use as part of an integrated disease management plan in commercial strawberry production. Results from glasshouse pathogenicity and screening trials on the three pathogens showed that when breeding for resistance against a pathogen, resistance to other pathogens also needs to be considered, e.g., cultivar 'Festival' is resistant to F. oxysporum f. sp. fragariae, but is highly susceptible to C. gloeosporioides. The cultivars 'Earlisweet', 'Kabarla' and 'Phenomenal', two seedling clones and four DAFF breeding lines were resistant to C. gloeosporioides. Cultivar 'Suncoast Delight' showed the most promising level of resistance to M. phaseolina. These cultivars, breeding lines and seedling selections have been made available for incorporation into the crossing program to support the Queensland strawberry breeding program.

An exploration of parent ivolvement in Response to Intervention (RTI) in Title I schools

Research demonstrates that parental involvement positively impacts student achievement and enhances targeted instruction. Notably, however, little research currently exists on how schools involve parents in Response to Intervention (RTI), a framework for implementing targeted, tiered, research-based instruction. The purpose of this study was to interview selected parents, teachers, RTI specialists, and principals in three Title I elementary schools in one school district, plus one district-level administrator, in order to examine how elementary schools currently involve parents in RTI prereferral interventions, and to understand the factors that might facilitate or challenge such parent involvement. I employed a comparative case study qualitative design with each elementary school as the main unit of analysis. I conducted individual, in-depth interviews that lasted approximately 45-60 minutes with a total of 33 participants across the three school sites, including 11 parents, 12 teachers, and six RTI specialists, three principals, and one district-level administrator. I also analyzed documents related to RTI processes that are available through websites and participants. I used Strauss and Corbin’s (1998) three-step scheme for thematic/grounded theory analysis, and Atlas.ti as the electronic tool for management and analysis. Analyses of the data revealed that personnel across the sites largely agreed on how they explain RTI to parents and notify parents of student progress. Parents mostly disagreed with these accounts, stating instead that they learn about RTI and their child’s progress by approaching teachers or their own children with questions, or by examining report cards and student work that comes home. Personnel and parents cited various challenges for involving parents in RTI. However, they all also agreed that teachers are accessible and willing to reach out to parents, and that teachers already face considerable workloads. It appears that no district- or school-wide plan guides parent involvement practices in RTI at any of the three schools. Finally, I present a discussion of findings; implications for teachers, RTI implementation leaders, and Title school leaders; study limitations; and possibilities for future research.

An explanation of consumer trust recovery in a food retailer

An organization trusted by consumers enjoys a number of benefits. Unfortunately, instances of trust-damaging events involving organizations happen often. Damaged consumer trust in an organization has numerous negative consequences for the organization and for consumers. Currently, there is a paucity of theory about consumer trust recovery. So, understanding why and how consumer trust recovery occurs is timely, and theoretically and practically relevant. However, the findings from this study suggest that we need to distinguish between two kinds of consumer trust recovery. The first (I call it unconscious consumer trust recovery) refers to trust recovery that occurs without the consumer being fully conscious of it. In other words, a consumer is aware of their damaged trust during the scandal, but is not aware that their trust in the organization has improved. The consumer does not think about his or her recovered trust, just as they did not think about their level of trust before the scandal. The consumer trust is habitual. The second (I call it conscious consumer trust recovery) refers to an improvement in damaged trust where the consumer is fully conscious of their trust recovery. In other words, in conscious trust recovery the consumer is aware that the scandal damaged their trust in the organization. Also, after the scandal, in contrast to unconscious trust recovery, in conscious trust recovery the consumer is also fully aware that he trusts the organization as much or more than during the scandal. My aim is to inductively develop a theory explaining each type of consumer trust recovery. To do so, I use Charmazian grounded theory methodology, because this methodology is developed for theory-building from data and is aligned with the philosophical underpinnings of this study. The empirical context for this study is the meat adulteration scandal (“the horse meat scandal”) in 2013 in the UK. I collect and analyse empirical data about both types of trust recovery in an organization from 31 consumers that experienced both types. My analysis shows that when consumers perceive the scandal as less important, they experience unconscious trust recovery. This happens because the reduced importance of the scandal leads to a shift in consumers’ attention, which in turn leads to their inattentiveness to the scandal. Consumer inattentiveness is an immediate antecedent of unconscious trust recovery. Conscious consumer trust recovery occurs because consumers see cues indicating to them that the food retailer has improved product control systems, which in turn leads to consumer perceptions of the organization’s renewed ability. Consumer perception of renewed ability is an immediate antecedent of their conscious trust recovery. My findings lead me to make three main theoretical contributions to the theory of trust recovery in general and to consumer trust recovery in particular. The first contribution lies in showing that there are two types of consumer trust recovery in an organization, not one, as previously conceptualised, and that the same consumers can experience both types. The second contribution is a theory of unconscious consumer trust recovery in an organization that involves three concepts: consumers’ perceived importance of the scandal, consumers’ shift of attention, and consumer inattentiveness. The third contribution is the finding that conscious recovery of consumer trust occurs even when existing theory of trust recovery would predict that it would not. This study can help managers aiming to repair consumer trust in an organization by identifying a set of antecedents and underlying mechanisms that can guide such trust repair.

El cuerpo como artefacto: tecnologías médicas, anatomopolítica y resistencia

En este artículo se defiende la tesis de que hay un giro importante en el biopoder anatomo-político de finales del siglo XX y comienzos del XXI. Este giro consiste en la aparición de diferentes tendencias culturales que comprenden el cuerpo humano como un artefacto que puede usarse para manifestar resistencia al poder. Para ello, estas tendencias se sirven de las tecnologías médicas como un medio para diseñar el cuerpo de acuerdo con una intención particular que permita cumplir cierta función elegida de antemano por quien identifica ese cuerpo como propio.

Quand la manifestation tourne à l'émeute : les affrontements violents entre forces de l'ordre et manifestants en Côte d'Ivoire

Les manifestations de crise, en Côte d'Ivoire, ont été extrêmement violentes. Au cours des quinze dernières années, plus de 400 personnes sont mortes, tuées dans des affrontements avec les forces de sécurités ou des contre-manifestants. Malgré la gravité du problème, peu d’études scientifiques y sont consacrées et les rares analyses et enquêtes existantes portent, de façon unilatérale, sur l’identité et la responsabilité pénale des auteurs et commanditaires putatifs de cette violence. La présente étude s’élève contre le moralisme inhérent à ces approches pour aborder la question sous l’angle de l’interaction : cette thèse a pour objectif de comprendre les processus et logiques qui sous-tendent l’usage de la violence au cours des manifestations. Le cadre théorique utilisé dans cette étude qualitative est l’interactionnisme symbolique. Le matériel d’analyse est composé d’entrevues et de divers documents. Trente-trois (33) entrevues semi-dirigées ont été réalisées avec des policiers et des manifestants, cooptés selon la technique de la boule de neige, entre le 3 janvier et le 15 mai 2013, à Abidjan. Les rapports d’enquête, de l’ONG Human Rights Watch, sur les manifestations de crise, les manuels de formation de la police et divers autres matériaux périphériques ont également été consultés. Les données ont été analysées suivant les principes et techniques de la théorisation ancrée (Paillée, 1994). Trois principaux résultats ont été obtenus. Premièrement, le système ivoirien de maintien de l'ordre est conçu selon le modèle d’une « police du prince ». Les forces de sécurité dans leur ensemble y occupent une fonction subalterne d’exécutant. Elles sont placées sous autorité politique avec pour mandat la défense inconditionnelle des institutions. Le style standard de gestion des foules, qui en découle, est légaliste et répressif, correspondant au style d’escalade de la force (McPhail, Schweingruber, & Carthy, 1998). Cette « police du prince » dispose toutefois de marges de manœuvre sur le terrain, qui lui permettent de moduler son style en fonction de la conception qu’elle se fait de l’attitude des manifestants : paternaliste avec les foules dites calmes, elle devient répressive ou déviante avec les foules qu’elle définit comme étant hostiles. Deuxièmement, à rebours d’une conception victimaire de la foule, la violence est une transaction situationnelle dynamique entre forces de sécurité et manifestants. La violence suit un processus ascendant dont les séquences et les règles d’enchainement sont décrites. Ainsi, le premier niveau auquel s’arrête la majorité des manifestations est celui d’une force non létale bilatérale dans lequel les deux acteurs, protestataires et policiers, ont recours à des armes non incapacitantes, où les cailloux des premiers répondent au gaz lacrymogène des seconds. Le deuxième niveau correspond à la létalité unilatérale : la police ouvre le feu lorsque les manifestants se rapprochent de trop près. Le troisième et dernier niveau est atteint lorsque les manifestants utilisent à leur tour des armes à feu, la létalité est alors bilatérale. Troisièmement, enfin, le concept de « l’indignité républicaine » rend compte de la logique de la violence dans les manifestations. La violence se déclenche et s’intensifie lorsqu’une des parties, manifestants ou policiers, interprète l’acte posé par l’adversaire comme étant en rupture avec le rôle attendu du statut qu’il revendique dans la manifestation. Cet acte jugé indigne a pour conséquence de le priver de la déférence rattachée à son statut et de justifier à son encontre l’usage de la force. Ces actes d’indignités, du point de vue des policiers, sont symbolisés par la figure du manifestant hostile. Pour les manifestants, l’indignité des forces de sécurité se reconnait par des actes qui les assimilent à une milice privée. Le degré d’indignité perçu de l’acte explique le niveau d’allocation de la violence.

Cultivating Collaborative Relationships: A Case Study of Teacher Collaboration and Professional Development

Students often receive instruction from specialists, professionals other than their general educators, such as special educators, reading specialists, and ESOL (English Speakers of Other Languages) teachers. The purpose of this study was to examine how general educators and specialists develop collaborative relationships over time within the context of receiving professional development. While collaboration is considered essential to increasing student achievement, improving teachers’ practice, and creating comprehensive school reform, collaborative partnerships take time to develop and require multiple sources of support. Additionally, both practitioners and researchers often conflate collaboration with structural reforms such as co-teaching. This study used a retrospective single case study with a grounded theory approach to analysis. Data were collected through semi-structured interviews with thirteen teachers and an administrator after three workshops were conducted throughout the school year. The theory, Cultivating Interprofessional Collaboration, describes how interprofessional relationships grow as teachers engage in a cycle of learning, constructing partnership, and reflecting. As relationships deepen some partners experience a seamless dimension to their work. A variety of intrapersonal, interpersonal, and external factors work in concert to promote this growth, which is strengthened through professional development. In this theory, professional development provides a common ground for strengthening relationships, knowledge about the collaborative process, and a reflective space to create new collaborative practices. Effective collaborative practice can lead to aligned instruction and teachers’ own professional growth. This study has implications for school interventions, professional development, and future research on collaboration in schools.

"It's got to be more than that". Parents and speech-language pathologists discuss training content for families with a new speech generating device.

PURPOSE: Although parent-implemented interventions for children with a speech-generating device (SGD) have been well researched, little is known about parents' or speech-language pathologists' (SLPs) views around parent training content. In this project, we aimed to identify areas that parents and SLPs consider should be included in training for families with a new SGD.

METHODS: Seven parents of children with an SGD and three SLPs who were new to the SGD field, participated in individual semi-structured interviews. Ten SLPs experienced in SGD practice took part in two focus groups. Data were analysed using grounded theory methods.

RESULTS: Participants identified the following areas suitable for inclusion in a family SGD training package: (a) content aimed at improving acceptance and uptake of the SGD, including technical guidance, customisation and reassurance around SGD misconceptions; (b) content around aided language development and (c) home practice strategies, including responsivity, aided language stimulation and managing children's motivation.

CONCLUSIONS: Participants identified diverse training targets, many of which are unexplored in parent-training research to date. Their recounted experiences illustrate the diversity of family capacity, knowledge and training priorities, and highlight the need for collaborative planning between families and SLPs at all stages of SGD training. Implications for Rehabilitation Training needs for families with a new speech generating device (SGD) are diverse, ranging from technology-specific competencies to broader areas, such as advocacy, teamwork and goal-setting skills. Each family with a new SGD will have a unique profile of training needs, determined by individual learning capacity, priorities, prior knowledge and experience, as well as their child's current communication skills and future support needs. Parents and speech-language pathologists (SLPs) may hold different priorities concerning family SGD training, necessitating ongoing team discussion.

An exploration of how clinician attitudes and beliefs influence the implementation of lifestyle risk factor management in primary healthcare: a grounded theory study

Background

Despite the effectiveness of brief lifestyle intervention delivered in primary healthcare (PHC), implementation in routine practice remains suboptimal. Beliefs and attitudes have been shown to be associated with risk factor management practices, but little is known about the process by which clinicians' perceptions shape implementation. This study aims to describe a theoretical model to understand how clinicians' perceptions shape the implementation of lifestyle risk factor management in routine practice. The implications of the model for enhancing practices will also be discussed.

Methods

The study analysed data collected as part of a larger feasibility project of risk factor management in three community health teams in New South Wales (NSW), Australia. This included journal notes kept through the implementation of the project, and interviews with 48 participants comprising 23 clinicians (including community nurses, allied health practitioners and an Aboriginal health worker), five managers, and two project officers. Data were analysed using grounded theory principles of open, focused, and theoretical coding and constant comparative techniques to construct a model grounded in the data.

Results

The model suggests that implementation reflects both clinician beliefs about whether they should (commitment) and can (capacity) address lifestyle issues. Commitment represents the priority placed on risk factor management and reflects beliefs about role responsibility congruence, client receptiveness, and the likely impact of intervening. Clinician beliefs about their capacity for risk factor management reflect their views about self-efficacy, role support, and the fit between risk factor management ways of working. The model suggests that clinicians formulate different expectations and intentions about how they will intervene based on these beliefs about commitment and capacity and their philosophical views about appropriate ways to intervene. These expectations then provide a cognitive framework guiding their risk factor management practices. Finally, clinicians' appraisal of the overall benefits versus costs of addressing lifestyle issues acts to positively or negatively reinforce their commitment to implementing these practices.

Conclusion

The model extends previous research by outlining a process by which clinicians' perceptions shape implementation of lifestyle risk factor management in routine practice. This provides new insights to inform the development of effective strategies to improve such practices.