The political economy of co-ordination challenges in the National Health Service: a postpositivist evaluation of diabetes policy and governance

The present PhD thesis develops and applies an evaluative methodology suited to the evaluation of policy and governance in complex policy areas. While extensive literatures exist on the topic of policy evaluation, governance evaluation has received less attention. At the level of governance, policymakers confront choices between different policy tools and governance arrangements in their attempts to solve policy problems, including variants of hierarchy, networks and markets. There is a need for theoretically-informed empirical research to inform decision-making at this level. To that end, the PhD develops an approach to evaluation by combining postpositivist policy analysis with heterodox political economy. Postpositivist policy analysis recognises that policy problems are often contested, that choices between policy options can involve significant trade-offs and that knowledge of policy options is itself dispersed and fragmented. Similarly, heterodox economics combines a concept of incommensurable values with an appreciation of the strengths and weaknesses of different institutional arrangements to realise them. A central concept of the field is coordination, which orientates policy analysis to the interactions of stakeholders in policy processes. The challenge of governance is to select the appropriate policy tools and arrangements which facilitate coordination. Via a postpositivist exploration of stakeholder ‘frames’, it is possible to ascertain whether coordination is occurring and to identify problems if it is not. Evaluative claims of governance can be made where arrangements can be shown to frustrate the realisation of shared values and objectives. The research makes a contribution to knowledge in a number of ways a) a distinctive evaluative approach that could be applied to other areas of health and public policy b) greater appreciation of the strengths and weaknesses of different forms of evidence in public policy and in particular health policy and c) concrete policy proposals for the governance and organisation of diabetes services, with implications for the NHS more broadly.

National Level Stakeholders’ Perceptions of Facilitators and Barriers in Utilization of World Health Organizations’ Preventing Early Pregnancy Guidelines in National Level Health Policy Creation

Thesis (Master's)--University of Washington, 2016-07

Relational and reproductive trajectories leading to adolescent pregnancy in Portugal: a national and regional characterization

INTRODUCTION: The current study aimed to describe the relational and reproductive trajectories leading to adolescent pregnancy in Portugal, and to explore whether there were differences in this process according to adolescents' place of residence. MATERIAL AND METHODS: Data were collected between 2008 and 2013 in 42 public health services using a self-report questionnaire developed by the researchers. The sample consisted of a nationally representative group of pregnant adolescents (n = 459). RESULTS: Regardless of having had one (59.91%) or multiple sexual partners (40.09%), the majority of adolescents became pregnant in a romantic relationship, using contraception at the time of the conception and knowing the contraceptive failure which led to pregnancy (39.22%). In some regions other trajectories were highly prevalent, reflecting options such as planning the pregnancy (Alentejo Region/ Azores Islands), not using contraception (Centro Region/Madeira Islands) or using it incorrectly, without identifying the contraceptive failure (Madeira Islands). On average, romantic relationships were longer than 19 months and adolescents' partners were older than themselves (> 4 years) and no longer in school (75.16%); these results were particularly significant when the pregnancy was planned. DISCUSSION: The knowledge gained in this study shows that prevention efforts must be targeted according to the adolescents' needs in each region and should include high-risk male groups. CONCLUSION: Our results may enable more efficient health policies to prevent adolescent pregnancy in different country regions and support educators and health care providers on sexual education and family planning efforts.

The Impact of Global English in Xinjiang, China: Linguistic Capital and Identity Negotiation among the Ethnic Minority and Han Chinese Students

Thesis (Ph.D.)--University of Washington, 2016-08

Pathways to emotional closeness in neonatal units - a cross-national qualitative study.

BACKGROUND: Research shows evidence for the importance of physical and emotional closeness for the infant, the parent and the infant-parent dyad. Less is known about how, when and why parents experience emotional closeness to their infants in a neonatal unit (NU), which was the aim of this study. METHODS: A qualitative study using a salutogenic approach to focus on positive health and wellbeing was undertaken in three NUs: one in Sweden, England and Finland. An 'emotional closeness' form was devised, which asked parents to describe moments/situations when, how and why they had felt emotionally close to their infant. Data for 23 parents of preterm infants were analyzed using thematic networks analysis. RESULTS: A global theme of 'pathways for emotional closeness' emerged from the data set. This concept related to how emotional, physical, cognitive and social influences led to feelings of emotional closeness between parents and their infants. The five underpinning organising themes relate to the: Embodied recognition through the power of physical closeness; Reassurance of, and contributing to, infant wellness; Understanding the present and the past; Feeling engaged in the day to day and Spending time and bonding as a family. CONCLUSION: These findings generate important insights into why, how and when parents feel emotionally close. This knowledge contributes to an increased awareness of how to support parents of premature infants to form positive and loving relationships with their infants. Health care staff should create a climate where parents' emotions and their emotional journey are individually supported.

International capital and new frontiers of biofuel production in brazilian midwest

v. 18, n.1, jan./mar. 2016.

Developing leadership in managers to facilitate the implementation of national guideline recommendations : a process evaluation of feasibility and usefulness

Background: Previous research supports the claim that managers are vital players in the implementation of clinical practice guidelines (CPGs), yet little is known about interventions aiming to develop managers’ leadership in facilitating implementation. In this pilot study, process evaluation was employed to study the feasibility and usefulness of a leadership intervention by exploring the intervention’s potential to support managers in the implementation of national guideline recommendations for stroke care in outpatient rehabilitation. Methods: Eleven senior and frontline managers from five outpatient stroke rehabilitation centers participated in a four-month leadership intervention that included workshops, seminars, and teleconferences. The focus was on developing knowledge and skills to enhance the implementation of CPG recommendations, with a particular focus on leadership behaviors. Each dyad of managers was assigned to develop a leadership plan with specific goals and leadership behaviors for implementing three rehabilitation recommendations. Feasibility and usefulness were explored through observations and interviews with the managers and staff members prior to the intervention, and then one month and one year after the intervention. Results: Managers considered the intervention beneficial, particularly the participation of both senior and frontline managers and the focus on leadership knowledge and skills for implementing CPG recommendations. All the managers developed a leadership plan, but only two units identified goals specific to implementing the three stroke rehabilitation recommendations. Of these, only one identified leadership behaviors that support implementation. Conclusion: Managers found that the intervention was delivered in a feasible way and appreciated the focus on leadership to facilitate implementation. However, the intervention appeared to have limited impact on managers’ behaviors or clinical practice at the units. Future interventions directed towards managers should have a stronger focus on developing leadership skills and behaviors to tailor implementation plans and support implementation of CPG recommendations.

Social Capital in Jordan: Wasta in Employment Selection

Social capital has emerged as a concept of great interest and potential to help understand and explain how social structures and networks impact political, social and business practices at the collective and individual levels. The basic premise is: investment in social relations will yield expected returns. Extant research has largely focused on the West; our knowledge of how social capital plays out in the Middle East is limited. We marry social capital with ‘wasta’, the strong family and tribal based connections secured in networks in the Arab world, and investigate HR managers’ perceptions of wasta in employment selection in Jordan. Often use of wasta in employment selection is related to favouritism and nepotism and the many negative outcomes of not adhering to merit-based selection. Through in-depth interview data we reveal a more nuanced and multifaceted view of wasta in employment selection. When examined through the social capital lens six distinct themes emerge: (i) wasta as an enabler to get jobs, (ii) wasta as social ties/ solidarity, (iii) wasta as a method to transfer/ attain information, (iv) wasta as a guide in decision-making, (v) wasta as an exchange, and (vi) wasta as pressure. Our findings confirm that at times wasta grants individuals unfair access to employment that is beyond their qualifications, skills, knowledge and/ or abilities. However, organisational context is relevant. In banking, not all roles are open to wasta. Where the possible negative impact on the organisation poses too great a risk HR managers feel able to resist even strong wasta. Context also emerges as being of key importance with regards to the background and business model of an organisation. Family businesses tend to operate wasta more frequently and extensively using tribal connections, religious networks and geographical area based networks as a key source in hiring. Despite globalisation and international nature of banking, wasta and tribalism feature strongly in daily business conduct in Jordan. Our paper illuminates the positive effects of wasta, e.g.as a method to transfer information, together with discussion on the dangers of ‘cloning’, a (lack of diversity), and the dangers of an incompetent workforce .

Financialisation, Capital Accumulation and Economic Development : A Theoretical and Empirical Investigation of the Nigerian Economy

The primary focus of this study is to highlight those unobtrusive, yet fundamental, factors undermining economic development in Nigeria. To begin with, it posits that the decelerating pace of capital accumulation in Nigeria, which naturally occasions rising unemployment and poverty levels, and widening inequality gap, is the result of the ‘low possibility’ of capitalist enterprises in the country of earning an adequate rate of profit from their productive processes. In turn, the ‘low possibility’ is argued to be the result of the uneven development inherent in the modern capitalist structure, the high cost of capital and of production peculiar to Nigeria, and the ineffective demand for goods made in Nigeria: these elements are viewed as been precipitated by the contradictions of the contemporary political-economic arrangement that organises the Social Structures of Accumulation. For Nigeria to ‘develop’, it is contended that the unobtrusive elements inherent in the contradiction of the political-economic economic that undermine the capitalists’ ability to earn a commensurate rate of profit in the country needs to be fully addressed first. Furthermore, this study suggests that it is crucial the country embraces knowledge-based industrialisation if it is to achieve some form of ‘competitive advantage’ in the global market, which could enable its productive processes extract a commensurate level of profit from the market. To facilitate the knowledge-based industrialisation, the state should, not only create a conducive environment for industrial development but also play the lead role in transforming the peripheral and oil dependent economy to a knowledge-based economy by coordinating business organisations and investing in high-risk innovations.

What happens at the gap between knowledge and practice? Spaces of encounter and misencounter between environmental scientists and local people

Researchers studying processes of global environmental change are increasingly interested in their work having impacts that go beyond academia to influence policy and management. Recent scholarship in the conservation sciences has pointed to the existence of a research-action gap and has proposed various solutions for overcoming it. However, most of these studies have been limited to the spaces of dissemination, where the science has already been done and is then to be passed over to users of the information. Much less attention has been paid to encounters that occur between scientists and nonscientists during the practice of doing scientific research, especially in situations that include everyday roles of labor and styles of communication (i.e., fieldwork). This paper builds on theories of contact that have examined encounters and relations between different groups and cultures in diverse settings. I use quantitative and qualitative evidence from Madidi National Park, Bolivia, including an analysis of past research in the protected area, as well as interviews (N = 137) and workshops and focus groups (N = 12) with local inhabitants, scientists, and park guards. The study demonstrates the significance of currently unacknowledged or undervalued components of the research-action gap, such as power, respect, and recognition, to develop a relational and reciprocal notion of impact. I explain why, within such spaces of encounter or misencounter between scientists and local people, knowledge can be exchanged or hidden away, worldviews can be expanded or further entrenched, and scientific research can be welcomed or rejected.

Learning from one another: evaluating the impact of horizontal knowledge exchange for environmental management and governance

There is increasing advocacy for inclusive community-based approaches to environmental management, and growing evidence that involving communities improves the sustainability of social-ecological systems. Most community-based approaches rely on partnerships and knowledge exchange between communities, civil society organizations, and professionals such as practitioners and/or scientists. However, few models have actively integrated more horizontal knowledge exchange from community to community. We reflect on the transferability of community owned solutions between indigenous communities by exploring challenges and achievements of community peer-to-peer knowledge exchange as a way of empowering communities to face up to local environmental and social challenges. Using participatory visual methods, indigenous communities of the North Rupununi (Guyana) identified and documented their community owned solutions through films and photostories. Indigenous researchers from this community then shared their solutions with six other communities that faced similar challenges within Guyana, Suriname, Venezuela, Colombia, French Guiana, and Brazil. They were supported by in-country civil society organizations and academics. We analyzed the impact of the knowledge exchange through interviews, field reports, and observations. Our results show that indigenous community members were significantly more receptive to solutions emerging from, and communicated by, other indigenous peoples, and that this approach was a significant motivating force for galvanizing communities to make changes in their community. We identified a range of enabling factors, such as building capacity for a shared conceptual and technical understanding, that strengthens the exchange between communities and contributes to a lasting impact. With national and international policy-makers mobilizing significant financial resources for biodiversity conservation and climate change mitigation, we argue that the promotion of community owned solutions through community peer-to-peer exchange may deliver more long-lasting, socially and ecologically integrated, and investment-effective strategies compared to top-down, expert led, and/or foreign-led initiatives.

Searching for Masculine Capital: Experiences Leading to High Drive for Muscularity in Men

Studies on the drive for muscularity (DFM) have primarily been quantitative, focused on identifying correlates. Currently little is known about men’s experiences leading them to desire high levels of muscle and engage in behaviours to increase their masculine capital. Our purpose was to explore the stories of men with high DFM revealing the socio-cultural and personal factors leading to DFM and their search for masculine capital. In-depth life-history interviews and multiple in-the-field conversations were undertaken with twenty men (Mean age=28.45, SD=6.96, years) scoring ≥ 3 on the Drive for Muscularity Scale (Mean=4.30, SD=0.70). Men’s stories focused on a set of dysfunctional childhood and adolescent socio-cultural interactions, including forms of symbolic violence, between them and significant others. In these interactions men were exposed to dominant social narratives of masculinity, and through comparisons and reinforcement they identified discrepancies between themselves and these narratives. In late adolescence and early adulthood men came to believe that they lacked masculine capital. Men struggled to increase their masculine capital through engagement with other traditional masculine activities (e.g., sport) and driven by activating events, they compensated through DFM desires and behaviours. This study advances knowledge by revealing the socio-cultural and personal processes participants believed led to their high DFM. Findings disclose that men’s search for masculine capital may have led them to develop and maintain high levels of DFM.

From local scenarios to national maps: a participatory framework for envisioning the future of Tanzania

Tackling societal and environmental challenges requires new approaches that connect top-down global oversight with bottom-up subnational knowledge. We present a novel framework for participatory development of spatially explicit scenarios at national scale that model socioeconomic and environmental dynamics by reconciling local stakeholder perspectives and national spatial data. We illustrate results generated by this approach and evaluate its potential to contribute to a greater understanding of the relationship between development pathways and sustainability. Using the lens of land use and land cover changes, and engaging 240 stakeholders representing subnational (seven forest management zones) and the national level, we applied the framework to assess alternative development strategies in the Tanzania mainland to the year 2025, under either a business as usual or a green development scenario. In the business as usual scenario, no productivity gain is expected, cultivated land expands by ~ 2% per year (up to 88,808 km²), with large impacts on woodlands and wetlands. Despite legal protection, encroachment of natural forest occurs along reserve borders. Additional wood demand leads to degradation, i.e., loss of tree cover and biomass, up to 80,426 km² of wooded land. The alternative green economy scenario envisages decreasing degradation and deforestation with increasing productivity (+10%) and implementation of payment for ecosystem service schemes. In this scenario, cropland expands by 44,132 km² and the additional degradation is limited to 35,778 km². This scenario development framework captures perspectives and knowledge across a diverse range of stakeholders and regions. Although further effort is required to extend its applicability, improve users’ equity, and reduce costs the resulting spatial outputs can be used to inform national level planning and policy implementation associated with sustainable development, especially the REDD+ climate mitigation strategy.

Effects of protected area downsizing on habitat fragmentation in Yosemite National Park (USA), 1864 – 2014

Protected area downgrading, downsizing, and degazettement (PADDD) has been documented worldwide, but its impacts on biodiversity are poorly understood. To fill this knowledge gap, we reviewed historical documents to identify legal changes that altered the boundaries of Yosemite National Park. We identified two downsizes and five additions between 1905 and 1937 that reduced the size of Yosemite National Park by 30%. To examine the effects of these downsizing events on habitat fragmentation by roads, we compared protected, never-protected, and downsized lands at three spatial scales using four habitat fragmentation metrics: road density, fragment (land surrounded by roads) area-to-perimeter ratio, fragment area, and fragment density. In general, lands that were removed from protection, e.g., downsized, were more highly fragmented than protected lands and indistinguishable from never-protected lands. Lands where downsizes were reversed were less fragmented than lands where downsizes were not reversed. These results suggest that protected area downsizing may exacerbate habitat fragmentation, a key contributor to biodiversity loss globally. Furthermore, the case study in Yosemite National Park demonstrates that iconic protected areas in developed countries are not immune to downsizing. These findings underscore the need to account for PADDD and governance histories in ecological research, monitoring, and evaluation. As we move toward more evidence-based conservation policy, a rigorous understanding of PADDD is essential to ensure that protected areas fulfill their promise as a strategy for conserving global biodiversity.

Measurement of the Ocean Economy From National Income Accounts to the Sustainable Blue Economy

The widespread efforts to incorporate the economic values of oceans into national income accounts have reached a stage where coordination of national efforts is desirable. A symposium held in 2015 began this process by bringing together representatives from ten countries. The symposium concluded that a definition of core ocean industries was possible but beyond that core the definition of ocean industries is in flux. Better coordination of ocean income accounts will require addressing issues of aggregation, geography, partial ocean industries, confidential, and imputation is also needed. Beyond the standard national income accounts, a need to incorporate environmental resource and ecosystem service values to gain a complete picture of the economic role of the oceans was identified. The U.N. System of Environmental and Economic Accounts and the Experimental Ecosystem Service Accounts provide frameworks for this expansion. This will require the development of physical accounts of environmental assets linked to the economic accounts as well as the adaptation of transaction and welfare based economic valuation methods to environmental resources and ecosystem services. The future development of ocean economic data is most likely to require cooperative efforts at development of metadata standards and the use of multiple platforms of opportunity created by policy analysis, economic development, and conservation projects to both collect new economic data and to sustain ocean economy data collection into the future by building capacity in economic data collection and use..