Exploring social barriers to adaptation: insights from Western Nepal

As the challenges and opportunities posed by climate change become increasingly apparent, the need for facilitating successful adaptation and enhancing adaptive capacity within the context of sustainable development is clear. With adaptation high on the agenda, the notion of limits and barriers to adaptation has recently received much attention within both academic and policymaking spheres. While emerging literature has been quick to depict limits and barriers in terms of natural, financial, or technologic processes, there is a clear shortfall in acknowledging social barriers to adaptation. It is against such a backdrop that this paper sets out to expose and explore some of the underlying features of social barriers to adaptation, drawing on insights from two case studies in the Western Nepal. This paper exposes the significant role of cognitive, normative and institutional factors in both influencing and prescribing adaptation. It explores how restrictive social environments can limit adaptation actions and influence adaptive capacity at the local level, particularly for the marginalised and socially excluded. The findings suggest a need for greater recognition of the diversity and complexity of social barriers, strategic planning and incorporation at national and local levels, as well as an emphasis on tackling the underlying drivers of vulnerability and social exclusion.

Social implications of radical technology adoption within the livestock industry - a design investigation: Innovating disruptive technologies in traditional marketplaces

This thesis presents a design investigation into how traditional technology-orientated markets can use design led innovation (DLI) strategies in order to achieve better market penetration of disruptive products. In a review of the Australian livestock industry, considering historical information and present-day trends, a lack of socio-cultural consideration was identified in the design and implementation of products and systems, previously been taken to market. Hence the adoption of these novel products has been documented as extremely slow. Classical diffusion models have typically been used in order to implement these products. However, this thesis poses that it is through the strategic intent of design led innovation, where heavily technology-orientated markets (such as the Australian livestock industry), can achieve better final adoption rates. By considering a range of external factors (business models, technology and user needs), rather than focusing design efforts solely on the technology, it is argued that using DLI approach will lead to disruptive innovations being made easier to adopt in the Australian livestock industry. This thesis therefore explored two research questions: 1. What are the social inhibitors to the adoption of a new technology in the Australian livestock industry? 2. Can design be used to gain a significant feedback response to the proposed innovation? In order to answer these questions, this thesis used a design led innovation approach to investigate the livestock industry, centring on how design can be used early on in the development of disruptive products being taken to market. This thesis used a three stage data collection programme, combining methods of design thinking, co-design and participatory design. The first study found four key themes to the social barriers of technology adoption; Social attitudes to innovation, Market monitoring, Attitude to 3D imaging and Online processes. These themes were built upon through a design thinking/co-design approach to create three ‘future scenarios’ to be tested in participant workshops. The analysis of the data collection found four key socio-cultural barriers that inhibited the adoption of a disruptive innovation in the Australian livestock industry. These were found to be a lack of Education, a Culture of Innovation, a Lack of Engagement and Communication barriers. This thesis recommends five key areas to be focused upon in the subsequent design of a new product in the Australian livestock industry. These recommendations are made to business and design managers looking to introduce disruptive innovations in this industry. Moreover, the thesis presents three design implications relating to stakeholder attitudes, practical constraints and technological restrictions of innovations within the industry.

Envejecimiento, caserío y atención social: la familia asume el cuidado del mayor

[ES] La desestructuración familiar que en España ha supuesto un éxodo rural intensivo queda en evidencia varias décadas después, una vez que la población que decidió continuar residiendo en el medio rural ha envejecido. El anciano que habita en el medio rural carece a menudo del apoyo familiar necesario para hacer frente a las barreras físicas y sociales que la edad y el aislamiento le imponen mientras los servicios públicos no se adecúan a los caracteres propios de este medio. El habitante del caserío vasco, dada la proximidad del medio urbano, ha sufrido en menor medida las consecuencias del éxodo rural, manteniéndose más íntegra la red de apoyo familiar o, en todo caso, viéndose completada con la presencia del que acudió al medio urbano. Como consecuencia, es la familia la que asume el cuidado del mayor, cumpliendo éste su deseo de residir en casa hasta el final de su vida.

Social competence following mild head injury and moderate traumatic brain injury: Investigating the neuropsychological relationships between arousal, social decision-making and depression

Client-directed long-term rehabilitative goals and life satisfaction following head injury emphasize the importance of social inclusion, rather than cognitive or physical, outcomes. However, very little research has explored the socio-emotional factors that pose as barriers to social reintegration following injury. This study investigates social barriers following head injury (i.e., decision-making - Iowa Gambling Task [IGT] and mood – depression) and possible amelioration of those challenges (through treatment) in both highly functioning university students with and without mild head injury (MHI) and in individuals with moderate traumatic brain injury (TBI). An arousal manipulation using emotionally evocative stimuli was introduced to manipulate the subject’s physiological arousal state. Seventy-five university students (37.6% reporting a MHI) and 11 patients with documented moderate TBI were recruited to participate in this quasi-experimental study. Those with head injury were found to be physiologically underaroused (on measures of electrodermal activation [EDA] and pulse) and were less sensitive to the negative effects of punishment (i.e., losses) in the gambling task than those without head injury, with greater impairment being observed for the moderate TBI group. The arousal manipulation, while effective, was not able to maintain a higher state of arousal in the injury groups across trials (i.e., their arousal state returned to pre-manipulation levels more quickly than their non-injured cohort), and, subsequently, a performance improvement was not observed on the IGT. Lastly, head injury was found to contribute to the relationship between IGT performance and depressive symptom acknowledgment and mood status in persons with head injury. This study indicates the possible important role of physiological arousal on socio- emotional behaviours (decision-making, mood) in persons with even mild, non-complicated head injuries and across the injury severity continuum.

Life Raft Australia?

In the helter skelter of people legally and illegally seeking refuge in Australia, often overlooked are the realities of how to obtain that hoped for better life. One of the avenues chosen to achieve their dream is higher education; however, once enrolled in higher education many such students [termed Culturally and Linguistically Diverse (CALD)] find they are ill equipped to achieve academic success; they become overwhelmed by the pressures of study/family/work; and ultimately lose heart and their place at university. Life raft Australia has just become another disillusioning vehicle to a depressing future. This paper discusses how universities across Australia are now putting processes in place that will enable CALD students to confront and overcome academic and social barriers, and thus realise their dream of a better life. Exemplars from the University of Tasmania provide practical models of how higher education institutions, not only in Australia but globally can assist immigrant students to self actualize; to be empowered to become integral and successful members of the Australian community.

Life Raft Australia?

In the helter skelter of people legally and illegally seeking refuge in Australia, often overlooked are the realities of how to obtain that hoped for better life. One of the avenues chosen to achieve their dream is higher education; however, once enrolled in higher education many such students [termed Culturally and Linguistically Diverse (CALD)] find they are ill equipped to achieve academic success; they become overwhelmed by the pressures of study/family/work; and ultimately lose heart and their place at university. Life raft Australia has just become another disillusioning vehicle to a depressing future. This paper discusses how universities across Australia are now putting processes in place that will enable CALD students to confront and overcome academic and social barriers, and thus realise their dream of a better life. Exemplars from the University of Tasmania provide practical models of how higher education institutions, not only in Australia but globally can assist immigrant students to self actualize; to be empowered to become integral and successful members of the Australian community.

A potential HIV epidemic among male street laborers in urban Vietnam

Background: Mass migration to Asian cities is a defining phenomenon of the present age, as hundreds of millions of people move from rural areas or between cities in search of economic prosperity. Although many do prosper, large numbers of people experience significant social disadvantage. This is especially the case among poorly educated, migrant unskilled unregistered male laborers who do much of the manual work throughout the cities. These men are at significant risk for many health problems, including HIV infection. However, to date there has been little research in developing countries to explain the determinants of this risk, and thereby to suggest feasible preventive strategies. Objectives and Methodology: Using combined qualitative and quantitative methods, the aim of this study was to explore the social contexts that affect health vulnerabilities and to develop conceptual models to predict risk behaviors for HIV [illicit drug use, unsafe sex, and non-testing for HIV] among male street laborers in Hanoi, Vietnam. Qualitative Research: Sixteen qualitative interviews revealed a complex variety of life experiences, beliefs and knowledge deficits that render these mostly poor and minimally educated men vulnerable to health problems including HIV infection. This study formed a conceptual model of numerous stressors related to migrants’ life experiences in urban space, including physical, financial and social factors. A wide range of coping strategies were adopted to deal with stressors – including problem-focused coping (PFC) and emotion-focused coping (EFC), pro-social and anti-social, active and passive. These men reported difficulty in coping with stressors because they had weak social networks and lacked support from formal systems. A second conceptual model emerged that highlighted equivalent influences of individual psychological factors, social integration, social barriers, and accessibility regarding drug use and sexual risk behavior. Psychological dimensions such as tedium, distress, fatalism and revenge, were important. There were strong effects of collective decision-making and fear of social isolation on shaping risk behaviors. These exploratory qualitative interviews helped to develop a culturally appropriate instrument for the quantitative survey and informed theoretical models of the factors that affect risk behaviors for HIV infection. Quantitative Research: The Information-Motivation-Behavioral Skills (IMB) model was adopted as the theoretical framework for a large-scale survey. It was modified to suit the contexts of these Vietnamese men. By doing a social mapping technique, 450 male street laborers were interviewed in Hanoi, Vietnam. The survey revealed that the risk of acquiring and transmitting HIV was high among these men. One in every 12 men reported homosexual or bisexual behavior. These men on average had 3 partners within the preceding year, and condom use was inconsistent. One third had had sex with commercial sex workers (CSW) and only 30% of them reported condom use; 17% used illicit drugs sometimes, with 66.7% of them frequently sharing injecting equipment with peers. Despite the risks, only 19.8% of men had been tested for HIV during the previous 12 months. These men have limited HIV knowledge and only moderate motivation and perceived behavioral skills for protective behavior. Although rural-to-urban migration was not associated with sexual risk behavior, three elements of the IMB model and depression associated with the process of mobility were significant determinants of sexual behavior. A modified model that incorporated IMB elements and psychosocial stress was found to be a better fit than the original IMB model alone in predicting protected sex behavior among the men. Men who were less psychologically and socially stressed, better informed and motivated for HIV prevention were more likely to demonstrate behavioral skills, and in turn were more likely to engage in safer sexual behavior. With regard to drug use, although the conventional model accounted for slightly less variance than the modified IMB model, data were of better fit for the conventional model. Multivariate analyses revealed that men who originated from urban areas, those who were homo- or bi-sexually identified and had better knowledge and skills for HIV prevention were more likely to access HIV testing, while men who had more sexual partners and those who did not use a condom for sex with CSW were least likely to take a test. The modified IMB model provided a better fit than the conventional model, as it explained a greater variance in HIV testing. Conclusions and Implications: This research helps to highlight a potential hidden HIV epidemic among street male, unskilled, unregistered laborers. This group has multiple vulnerabilities to HIV infection through both their partners and peers. However, most do not know their HIV status and have limited knowledge about preventing infection. This is the first application of a modified IMB model of risk behaviors for HIV such as drug use, condom use, and uptake of HIV testing to research with male street laborers in urban settings. The study demonstrated that while the extended IMB model had better fit than the conventional version in explaining the behaviors of safe sex and HIV testing, it was not so for drug use. The results provide interesting directions for future research and suggest ways to effectively design intervention strategies. The findings should shed light on culturally appropriate HIV preventive education and support programs for these men. As Vietnam has much in common with other developing countries in Southeast Asia, this research provides evidence for policy and practice that may be useful for public health systems in similar countries.

Accessing Education: Legal Perspectives

Access to education becomes an issue of equity with diverse claims from stakeholders justifying their rights based on perceptions of equity — both social and individual. In-spite of the phenomenal increase since independence in the number of institutions imparting education and the number of beneficiaries, India being the second largest nation in terms of population of the young finds its resources spread thin in meeting the demand for education. Quality education comes at a premium in India whether it is provided in the private or in the public sector. Education seemingly enables the individuals, singly and collectively. to overcome the social barriers perpetuated by the caste system. Taken together, these unleash grave demands on formulating equitable standards. It is in this context that identifying the deserving for favourable consideration becomes all the more important. In this sea of claims and counter-claims, this thesis tries to identify the issues involved on the question of equitable access to education on the basis of the factual position in the field of education. Identifying the issues correctly provides the necessary impetus for framing the questions that provide meaningful answers. The objective of this research is to help formulate the policy guidelines governing the principles of equity that is needed to ensure universal access to education in India.

Agricultural adaptation to climate change: insights from a farming community in Sri Lanka

The vulnerability of smallholder farmers to climate change and variability is increasingly rising. As agriculture is the only source of income for most of them, agricultural adaptation with respect to climate change is vital for their sustenance and to ensure food security. In order to develop appropriate strategies and institutional responses, it is necessary to have a clear understanding of the farmers’ perception of climate change, actual adaptations at farm-level and what factors drive and constrain their decision to adapt. Thus, this study investigates the farm-level adaptation to climate change based on the case of a farming community in Sri Lanka. The findings revealed that farmers’ perceived the ongoing climate change based on their experiences. Majority of them adopted measures to address climate change and variability. These adaptation measures can be categorised into five groups, such as crop management, land management, irrigation management, income diversification, and rituals. The results showed that management of non-climatic factors was an important strategy to enhance farmers’ adaptation, particularly in a resource-constrained smallholder farming context. The results of regression analysis indicated that human cognition was an important determinant of climate change adaptation. Social networks were also found to significantly influence adaptation. The study also revealed that social barriers, such as cognitive and normative factors, are equally important as other economic barriers to adaptation. While formulating and implementing the adaptation strategies, this study underscored the importance of understanding socio-economic, cognitive and normative aspects of the local communities.

Physical disability and sexual esteem

The current study investigated the impact of physical disability on sexual feelings, sexual experiences, and sexual esteem. Thirty-five respondents (18 males and 17 females), with physical disabilities between 19 to 60 years (SD = 10, mean = 38) participated in focus groups where they discussed how their physical disability impacted on their sexuality. They also responded to a series of questions that were designed to examine disability-specific issues in sexual esteem using a four-point Likert-type scale. The data demonstrated that the participants struggled with many social and sexual barriers that were associated with having a physical impairment. This appeared to lead to increased feelings of negativity in many participants, including a belief that they were less sexually desirable than an able-bodied person and that having a disability seriously limited their sexual expression. The implications of these findings for practitioners and suggestions for future research are discussed.

Inclusion and accountability: communications research with consumers with disabilities

Over the past two decades there has been an increasing focus on doing research with and for consumers rather than on consumers. Research that is collaborative and inclusive has been called for by people with disabilities. People with disabilities are a group of telecommunications consumers who are disadvantaged because of social barriers and access issues with equipment, services and information. In this paper, the benefits and challenges of collaborative (e.g. participatory, participatory action, emancipatory) research with these consumers and the processes that can facilitate inclusive and accountable research outcomes are addressed. Throughout the paper, four questions will be explored: Who determines which research issues are explored and the methods that are used? What is the level of consumer involvement in the research process? How can academics and government ensure that consumer-focused research is inclusive and participatory? How, and to whom, should research results be made available?

In the first part of the paper, the perspectives on consumer research by people with disabilities are presented. Respect for and appreciation of consumers' views underpins the philosophical stance needed by researchers and funding bodies before serious engagement in empowering, person-centred research can be successful.

In the second part of the paper, there is a focus on defining the features of collaborative research approaches. Participatory research, participatory action research, and emancipatory research are variations that incorporate differing levels of consumer involvement. Each of these, however, embrace shifts in philosophy and methods away from more traditional 'scientific' research. Such changes result in a greater sense of inclusion and project ownership by consumers.

The third part of the paper addresses some of the issues associated with collaborative research for consumers with disabilities, for academic researchers, and for government funding bodies. Differing understandings of the social nature of disablement influence attitudes toward consumer involvement and are demonstrated in the choice of research questions, project aims, and the methodologies used. Differing agendas are reflected in reactions to the traditional project requirements and processes of government, the preferred research methodologies of researchers, and the perceived accountability of researchers or government for the dissemination and sharing of research results. The challenges to successful engagement with consumers in collaborative research have been identified in the literature and a number of strategies recommended (Barnes, 2003; Clear, 1999; Mercer, 2002; Oliver, 1992, 1997; Zarb, 1997). Application of inclusive strategies by researchers and funding bodies is essential for positive change and inclusive, empowering outcomes.

The paper concludes with a case study of a DCITA-funded research project. The project is evaluated using participatory/emancipatory research criteria modified from Zarb (1992) and addresses consumer, researcher, and funding body participation. The four questions used in the discussion of the paper are applied to this particular project. In addition, the benefits and learnings from the project will be compared with the outcomes desired by consumers who espouse collaborative research approaches.

Tuberculose: conhecimentos, representações sociais e experiências da doença na visão do portador

Tuberculosis is considered one of the most ancient human diseases, cases were registered 3900 years before Christ, and it is currently regarded as a serious public health problem in the world due to several factors such as income mismanagement, precarious standard of life and some sort of prejudice comprised by the word tuberculosis. Taking this into consideration, it was developed a descriptive and exploratory study aiming at analyzing the social representations of tuberculosis made by its patient from the Unidades de Saúde da Família (Family Health Units a public health program) in Campina Grande City PB, in relation to the decentralization of the policies that administrate the disease. It was interviewed 34 tuberculosis patient that were being treated from 2007 to 2008. The age group of the interviewees varied from 10 to 60 years old, but most of them were between 36 and 60 years old (58,8%, n=20), some were young adult and adult (21 35 years old), with 11 (32,3%) respondents, and, less frequent, children and teenagers (11 20 years old), with 03 (8,8%) participants. Data was collected through semi-structured interview. The questions that guided the research were elaborated based on the operational recommendations of DOTS strategy; that is: access to laboratory examinations; medication guarantee; directly observed treatment. Besides that, the experiences of the patient were considered in their relation with the family and the different social groups. The analysis of the discursive material was submitted to the Analyse Lexicale par Context d un Ensemble de Segments de Texte software - ALCESTE 4.7. Data interpretation showed five categories for the social representations of the tuberculosis patient that participated in DOTS strategy: 1) the accessibility of the health assistance service; 2) the patient perspective of the disease; 3) the change in the operation of the productive life; 4) the signals and symptoms of the tuberculosis disease; 5) the rearrangement and mechanisms used to face the disease. The Central Nucleus reveals that tuberculosis is a transmissible disease that can be prevented by people through educational practices, health promotion, active search for symptomatic respiratory and control of the carriers communication; these mechanisms should be incorporated to the routine of all participants of the family health groups. The Intermediate Elements, based on quotidian life, as well as the individual experiences of the tuberculosis patient, reveals prejudiced attitude and beliefs that lead to isolation and restriction of interpersonal relationship. Peripheral Elements were constituted by themes that showed the patient feelings of indignation because of the social barriers they had to face in the Family Health Units during the treatment. These elements demonstrate a negative perspective of the representation concerning the accessibility, i.e. inadequate structure of the health service; long distance to the Health Centre, this factormakes it difficult for the patient to continue the treatment; scheduling delay; and limited service regarding other requests (doctor, dentist etc). One expects to contribute for the construction of a new perspective of the health question between the different agents who make the assistencial institutions and formation of professionals, either in central or local scope

Cuidados paliativos e ser-para-morte: reflexões sobre um atendimento psicológico

Death is a theme that fascinates, though at the same time, frightens and uneasy the human being, despite the finitude being present at our daily lives. In each historical time, death has been represented in a peculiar way, from familiar death (at Middle Ages), to interdicted death (at contemporary times). Through this path it‟s possible to recognize several attitudes and stages front of death and the process of dying as possibilities of coping and the understanding of these occurrences. In other hand, the palliative care proposal came as a humanized attention, front of the human finitude, recognizing death as a part of the vital cycle. The Brazilian reality, in this context, still faces a lot of political, economic and social barriers that makes difficult the consolidation of palliative care at the death process in the Brazilian Health Care policies. Currently, according to the Brazilian Palliative Care Association, Brazil presents an average of 40 services with this proposal. Such data portray our inexpressive condition in relation to these cares when considering the territorial extension and population of our country. Considering this scenario is relevant think about death and the process of dying at contemporary times, at a health context in which palliative care, when trying to humanize the process of dying, bring to light the issue of human finitude and the beingtowards- death, as thought by the philosopher Martin Heidegger. According to him, the human being (Dasein) is constituted as a being-towards-death, once death is its most own potentiality-for-bein and its last possibility to be lived. In view of the ideas presented, the proposed study appears as a qualitative research of existential-phenomenological inspiration and aims to understand the experience of being-toward-death from the psychological care to a person out of possibilities of cure living on palliative cares. The psychological care happened at the patient‟s home, understanding the clinical process of being-with-the-other from the written reports of the psychology/researcher, by the accompanying sessions, configured as an experience report. These reports are focused on the experiences lived by the patient, as well as apprehended by the psychologist at the intersubjectivity relation and its own experience with Dasein and, therefore, being-toward-death. The reports were hermeneutically interpreted, from the senses that emerged in this process, considering the notion of being-toward-death proposed by Heidegger. Furthermore, it was important to dialogue with other authors that approached the studied theme. It is perceived, through brief and meaningful reflections about the clinical treatments started, that the experience of illness with no possibilities of cure makes the Dasein revises feelings and experiences that were marked at the temporality and historicity of existence. It is a stage of life in which the cultural dimension and the common sense of finitude, often gains ground in the human condition, taken in its ordinary sense, unlike the way it has been thought from an ontological and existential perspective of death. Thus, there are singulars and revealing paths in the palliative care scenery as possible ways for authenticity of being-toward-death

„Abgeschoben in die Marginalität“ - Eine empirische Untersuchung zur problematischen Eingliederung der wegen Straffälligkeit aus Deutschland abgeschobenen türkischen Staatsangehörigen in der türkischen Gesellschaft

Die vorliegende Arbeit zeigt anhand von Einzelfällen, welche Probleme und Folgen eine Ausweisung und/oder Abschiebung von kriminell gewordenen Angehörigen der sogenannten zweiten Generation türkischer Staatsangehöriger im Hinblick auf deren Eingliederung in die türkische Gesellschaft mit sich bringt.rnDem Bereich der Ausweisung und/oder Abschiebung – beides Formen von Zwangsmigration – ausländischer Staatsangehöriger in ihr Herkunftsland wurde bislang im weiten Feld der Integrationsforschung kaum Aufmerksamkeit geschenkt. Nicht anders verhält es sich in der politischen und öffentlichen Diskussion, wenn es um die „Entfernung“ kriminell gewordener Ausländer, die mitunter in Deutschland geboren und aufgewachsen sind oder sich bereits viele Jahre in der Bundesrepublik aufhalten, aus dem Bundesgebiet geht. Bei dieser Diskussion wird zwar die Bestrafung kriminell gewordener Ausländer mittels Ausweisung und/oder Abschiebung vorschnell befürwortet, besonders in solch spektakulären Fällen, wie in dem des Jugendlichen Muhlis Arı, genannt „Mehmet“ oder in dem des als „Münchner U-Bahn Schläger“ bekannt gewordenen Serkan. Die weitreichenden Folgen für den Einzelnen werden in der Regel jedoch nicht tiefergehend betrachtet.rnDeshalb steht im Zentrum dieser Arbeit die Frage, wie sich die Eingliederung von in Deutschland geborenen und hier aufgewachsenen Nachkommen der „Gastarbeiter“-Generation sowie später nachgeholter Kinder im Anschluss an eine Ausweisung und/oder Abschiebung in die türkische Gesellschaft gestaltet. Die theoretische Grundlage der Untersuchung bilden vier theoretische Konzepte zu Integration, Fremdheit und Marginalität. Dabei handelt es sich um die „Integrationstheorie“ von Hartmut Esser, das Konzept des „bleibenden Fremden“ von Georg Simmel, das des „einwandernden Fremden“ von Alfred Schütz sowie um das Konzept des „marginal man“ von Robert E. Park. Auf Basis dieser vier theoretischen Konzepte und der Auswertung des erhobenen empirischen Datenmaterials wird deutlich, dass hohe soziale Barrieren auf Seiten der Mitglieder der türkischen Aufnahmegesellschaft, mangelnde integrationsförderliche Opportunitäten, aber auch eine geringe Motivation auf Seiten der Betroffenen zur Aufnahme integrationsförderlicher Handlungen eine Integration verhindern. Die von Ausweisung und/oder Abschiebung Betroffenen sind letztlich dazu gezwungen, dauerhaft ein Leben am Rande der Gesellschaft in der Marginalität zu führen.rn

Health care professionals' views of paediatric outpatient non-attendance:implications for general practice

Background. Non-attendance at paediatric hospital outpatient appointments poses potential risks to children's health and welfare. Prevention and management of missed appointments depends on the perceptions of clinicians and decision makers from both primary and secondary care, including general practitioners (GPs) who are integral to non-attendance follow-up. Objectives. To examine the views of clinical, managerial and executive health care staff regarding occurrence and management of non-attendance at general paediatric outpatient clinics. Methods. A qualitative study using individual semi-structured interviews was carried out at three English Primary Care Trusts and a nearby children's hospital. Interviews were conducted with 37 staff, including GPs, hospital doctors, other health care professionals, managers, executives and commissioners. Participants were recruited through purposive and 'snowball' sampling methods. Data were analysed following a thematic framework approach. Results. GPs focused on situational difficulties for families, while hospital-based staff emphasized the influence of parents' beliefs on attendance. Managers, executives and commissioners presented a broad overview of both factors, but with less detailed views. All groups discussed sociodemographic factors, with non-attendance thought to be more likely in 'chaotic families'. Hospital interviewees emphasized child protection issues and the need for thorough follow-up of missed appointments. However, GPs were reluctant to interfere with parental responsibilities. Conclusion. Parental motivation and practical and social barriers should be considered. Responsibilities regarding missed appointments are not clear across health care sectors, but GPs are uniquely placed to address non-attendance issues and are central to child safeguarding. Primary care policies and strategies could be introduced to reduce non-attendance and ensure children receive the care they require. © The Author 2013.