Mathehu's Weblog

mulling over (research) ideas

Tackling health inequality and mental wellbeing in the community: Reflection on a project evaluation

The first impression I had when starting an evaluation of a project tackling health inequalities and mental wellbeing in a defined community was that the key terms are vague and – at least on first impression- not well defined. Hence, first challenge for the evaluation.

The project builds on changes to existing service delivery within the area, particularly on improved partnership working. Here is the second (and related) challenge, what does partnership working mean?

A look through the baseline data and relevant community surveys showed another interesting picture. 80% of the project area was classified as very deprived in Council and Government reports. However, survey findings indicate high satisfaction with most features of the area. The main problems appear to be drug use and prostitution but these were mentioned as problems by less than a third of the surveyed people. Also, some wellbeing scores (using WemWbs) were higher in this area than in one of the regions most affluent areas. Serendipitously, just this week a paper was published looking income and happiness in a global survey.

The authors write that  the level of income was a predictor of life evaluation but not so much of positive and negative feelings. These feelings were strongly related to the fulfillment of psychological needs, including learning, autonomy, using one’s skills, respect, and the ability to count on others in an emergency. They conclude that a person’s economic status and psycho-social evaluation predict different types of well-being. Interesting.

July 27, 2010 Posted by | Uncategorized | Leave a comment

Partnership working in health care – Ontological and epistemological perspectives

Partnership working: What is it and how do we know it when we see it?

The following is a summary and reflection on Janette Pow’s PhD Thesis entitled “Assessing partnership working: Evidence from the National Sexual Health Demonstration Project“.  I had the honour of being one of her supervisors and I am now able to reap the harvest from her excellent work. All the substantial information provided is taken out of her thesis, which is an excellent read!! My only contributions are the odd comments and bridges.

Reference: Pow, J. (2010). Assessing partnership working: Evidence from the National Sexual Health Demonstration Project. Unpublished thesis: Napier University.

Partnership working has been a buzz word within health care and beyond for quite a while. Yet, defining partnership working is a “terminological quagmire” (Lloyd, et al 2001). Terms such as collaboration, cooperation, coordination, coalition, network, alliance and partnership are often used interchangeably within the same literature (Huxham 1996, Percy-Smith 2005 and Sloper 2004).  Indeed, the Audit Commission (2004) argued that “the term partnership is increasingly losing credibility, as it has become a catch all for a wide range of concepts, and a panacea for a multitude of ills”.

Thankfully, various systems to identify and evaluate partnership working have been developed. Overall, partnership working is likely also to involve a combination of social, political, environmental and health care factors (Baron-Epel et al 2003).  Various ways to characterise partnerships in more detail have also been suggested. For example, the Audit Commission (1998) differentiates between formal and informal partnerships, whereas Lasker et al (2003) distinguish between strategic and operational partnerships.

Wildridge (2004)  is one of many authors who provided  assistance in navigating this quagmire by identifying several commonalities between the different conceptualisations of partnerships.

Commonalities between the different conceptualisations of partnerships (Wildridge, 2004)

  • Between organizations, groups, agencies, individuals, disciplines

  • Common aim or aims, vision, goals, mission or interests

  • Joint rights, resources and responsibilities

  • New structure(s) and processes

  • Autonomous, independent

  • Improve and enhance access to services for users and carer’s

  • Equality

  • Trust

Ling (2002), on the other hand, provided an  illuminating perspective on variations in partnership characteristica.

Varying characteristics in partnership working (Ling, 2002)

Partnership Members

Links between partners

Scale and Boundaries

Organizational context of partnership

Individuals

High or low trust

National/local/global

‘Fit’ with existing institutional architecture

Parts of organizations

Equal or hierarchical

Numbers of partners

Maturity of relationships

Whole organizations

Focused or broad sweep

Boundaries (where they are drawn)

Legitimate or illegitimate

Public

Co-evolution, coupling and convergence

Boundaries (tight or loose)

Resource dependency

Private

Formal/Informal/
Contractual

Boundaries (own or mandate)

Impact/steerage capacity

Voluntary

Continue reading

July 20, 2010 Posted by | Uncategorized | 1 Comment

Protected: Is the hegemony of medicine a burden for health care provision?

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June 2, 2010 Posted by | Uncategorized | Enter your password to view comments.

A selection of psychological theories on motivation

Below is a quick overview of the main motivation theories used in psychology, education, economics, and public health. I took most of the information off the net and provided links to informative, yet brief, sites.

Content theories of motivation

Content theories explore the forces or building blocks driving peoples actions.

The main content theories of motivation are:

–     Maslow’s Hierarchy of Needs

–     ERG

–     Herzberg’s Two Factor theory

Maslow’s Hierarchy of Needs

Maslow’s Hierarchy of Needs model has definitely become part of common knowledge. A short but educational summary of the main tenets of this theory can be found at http://www.abraham-maslow.com/m_motivation/Hierarchy_of_Needs.asp

ERG Theory

Clayten Alderfer modified Maslow’s Hierarchy of Need by summarizing the levels of need into three basic categories: existence needs, relatedness needs, growth needs (ERG). More about ERG and the differences to Maslow’s model can be found in a short and concise overview at http://www.netmba.com/mgmt/ob/motivation/erg/ .

Herzberg’s Two-factor Theory

Herzberg’s theory takes a different perspective on what motivates (satisfies) or de-motivates (dissatisfies) us. In a nutshell, Herzberg’s theory did not define satisfaction and dissatisfaction as being at opposite ends of the same continuum. The opposite of satisfaction is not dissatisfaction, but no satisfaction. The opposite of dissatisfaction is not satisfaction, but no dissatisfaction.

The following figures provide schematic overviews of the traditional view of viewing satisfaction and dissatisfaction on two ends of the same scale. Herzberg, as discussed above, saw different factors leading to satisfaction and dissatisfaction.

For more information, including critical views of the theory’s validity, see one of the links below:

http://psychology.wikia.com/wiki/Herzberg%E2%80%99s_Two_Factor_Theory_of_motivation

http://www.netmba.com/mgmt/ob/motivation/herzberg/

Here is a link to Herzberg’s book in which he outlines his two-factor theory: Motivation to Work

Process theories of motivation

Process theories explore the cognitive processes determining people’s actions.

The major process theories are

–     Equity theory

–     Expectancy theory

–     Goal-setting theory

Equity theory

According to equity theory the perception of unfairness in a social or organisational setting leads to tension, which in turn motivates the individual to act to resolve that unfairness.
For more information, see http://www.businessballs.com/adamsequitytheory.htm

Expectancy theory

F = ∑(V x I x E)

Expectancy theory argues that the strengths or ‘force’ of an individual’s motivation for behaviour change is expressed as the product of the valence of the outcome from that behaviour, the expectancy that effort will lead to good performance, and the instrumentality of good performance in leading to valued outcomes.

For more information, see http://www.arrod.co.uk/archive/concept_vroom.php

Goal-setting theory

Goal setting is both a process theory of motivation and a motivational technique, based on the argument that work performance can be explained with reference to characteristics of the objectives being pursued, such as goal difficulty, goal specificity and knowledge of results.

For more information, see http://www.mindtools.com/pages/article/newHTE_87.htm

April 15, 2010 Posted by | Uncategorized | 1 Comment

Evaluability assessment

Here is a manuscript I started to write a couple of years back. I never finished it to a standard that made me consider submitting it to a journal. However, it should contain enough information to provide an overview of the nature and benefits of evaluability assessments.

Evaluability assessment

April 15, 2010 Posted by | Uncategorized | Leave a comment

Salutogenesis

As a first and quick response to David’s blog, I uploaded a Powerpoint presentation on Salutogenesis. This should provide a rough overview of this inspiring perspective on health promotion

April 15, 2010 Posted by | Uncategorized | 1 Comment

Framing a research proposal idea

A year or so ago, I came across this simple but exeedingly helpful set of questions to help kick start a research proposal idea.

I came across it in a workshop at CQUniversity (Australia). I think it was produced by Janelle Kidd (DVC at CQUniversity) and/or Stewart Lockie (now Prof in Sociology, ANU, Australia).

It has helped me a couple of times to move from research idea to implementable strategy.

Framing a proposal idea

  1. Write a research question
  2. What is the important theoretical or conceptual setting?
  3. Write 2-3 key points about why it is important (Significance? Innovation?)
  4. Write 1-2 brief objective points (formulate full aims later)
  5. Write a couple of points about the approach you might take
  6. Will I have all the expertise/resources? Should I be talking to collaborators? Might the proposal be strengthened by having a team?
  7. Do I or will I need some ‘proof of concept’, preliminary data or demonstration of competency to undertake the project?
  8. Will the team/partners be competitive in this field?
  9. What would the outcome(s) be and who benefits?
  10. What is the ‘WOW’, ‘HOOK’, or ‘EXCITEMENT’ factor?

April 14, 2010 Posted by | Uncategorized | 2 Comments

Improving learning, teaching and engagement: What can we learn from behaviour change research?

This blog is based on discussions with a colleague on a range of topics surrounding behaviour change, (psycho)education and engaging clients.

One branch of our discussions has explored the utility of behaviour change models and techniques for learning, teaching, and client engagement with online mental health and (psycho)education tools.

It was hardly surprising that there is a wealth of literature surrounding the idea of changing people’s behaviour. I was particularly impressed with the work of Susan Michie and colleagues.

I particularly like their attempt at creating a taxonomy of behaviour change techniques inclusive of links to underlying theoretical frameworks. The following table provides an overview of their findings (Michie & Abraham, 2008, p. 382):

Another team of leading UK psychologists, including Michie and Abraham, summarised  and commented on the content of a national guidance document (published by NICE at) on behaviour change. Again, I provide a verbatim quote from their text but here is also a link to the recommendations section in the actual NICE document.

A framework for good practice in BCI design and evaluation
Following an introduction, the guidance discusses various considerations that were taken into account in drawing up the recommendations and particularly the integration of individual and social approaches to behaviour change.

The recommendations, themselves, are organised into eight principles of good practice which correspond closely to the principles of intervention mapping …

First, ‘planning of interventions’ should take account of socioeconomic and cultural contexts and strengths and skills of target groups. Planning should also anticipate barriers to change, ensure that BCI content is evidence-based and that ineffective interventions are discontinued.

The second, related principle concerns ‘assessing the social context’ in which interventions are situated including identifying and attempting to remove social, financial and environmental barriers that prevent people from making positive changes in their lives by, for example, tackling local poverty, limited employment and education opportunities.

The third principle concerns the ‘education and training’ of those responsible for BCI planning, implementation and evaluation.

The fourth, focussing on ‘individual-level interventions’, concerns application of psychological concepts to optimise motivation and support behaviour change.

Principle five, focusses on ‘community level interventions’ and concerns investment in
the strengths of individuals and communities. This principle underlines the importance of social relationships in facilitating behaviour change.

Principle six advocates that ‘population-level interventions’, including policy and legislative interventions are based on good information about the context, needs and behaviours of the target population(s) and are consistent with interventions delivered to individuals and communities.

Principle seven proposes that all interventions (and therefore funding for interventions) make provision for ‘rigorous monitoring and evaluation’ including use of appropriate process and outcome measures.

Finally, principle eight emphasises the need to ‘assess cost effectiveness’ and to ensure that this is central to intervention planning, evaluation and adoption” (Abraham, Kelly, West & Michie, 2009, p.3).

Particularly relevant to this blog is their expansion on the fourth recommendation, which follows below:

“(K)ey psychological targets worthy of consideration include:

  • Knowledge and outcome expectancies (helping people to develop accurate knowledge about the health consequences of their behaviours)
  • Personal relevance (emphasising the personal salience of health behaviours, that is, what the consequences mean for individuals)
  • Positive affective attitudes (promoting positive feelings towards the outcomes of behaviour change)
  • Descriptive norms (promoting the visibility of positive health behaviours in people’s reference groups – that is, the groups they compare themselves with, or aspire to)
  • Subjective norms (enhancing social approval for positive health behaviours in significant others and reference groups)
  • Personal and moral norms (promoting personal and moral commitments to behaviour change)
  • Self-efficacy (enhancing people’s belief in their ability to change) .
  • Intention/goal setting and the formation of concrete plans (helping people to form
    Behavioural contracts (inviting people to commit to their plans with others).
  • Social relationships (helping people recognise how their social contexts and relationships may affect their behaviour) plans and goals in graded steps, over time and in specific contexts, including making if-then plans and developing appropriate coping strategies)
  • Relapse prevention (helping people to develop skills to cope with difficult situations and conflicting goals once they have initiated change)” (Abraham, Kelly, West & Michie, 2009, p. 4-5).

What I particularly like about this last list of psychological targets is that they do not exclusively focus on the components of, for example, a functional analysis. They do not stop at considering antecedents, beliefs/behaviours, and consequences. They allude to the importance of working with people’s aspirations, the meaning they find in their actions as well as the social and physical context affecting them. If anything, these drivers of behaviour would deserve more attention in lists like the above.

Now, I maneuvered myself to a place where I can start talking about Salutogenesis and its focus on “comprehensibility—the cognitive component; (ii) manageability—the instrumental or behavioural component; and (iii) meaningfulness—the motivational component” (Lindstroem & Eriksson, 2006, p. 31).

But that’s for another blog…

References:

Abraham C, Kelly MP, West R, & Michie S. (2009). The UK national institute for health and clinical excellence public health guidance on behaviour change: a brief introduction. Psychology, Health & Medicine, 14(9), 1-8.

Lindström, B., & Eriksson, M. (2006). Contextualizing salutogenesis and Antonovsky in public health development. Health promotion international, 21(3), 238-44. doi: 10.1093/heapro/dal016.

Michie S, Abraham C. (2008). A taxonomy of behavior change techniques used in interventions. Health Psychology, 27(3), 379-87.

NICE. (2007). Behaviour change. Retrieved from http://www.nice.org.uk/Guidance/PH6.

April 14, 2010 Posted by | Uncategorized | 1 Comment

How do we explain human actions and experiences?

I am currently reading Brian Green’s The Fabric of the Cosmos. He starts out by outlining different perspectives on reality as taken by historical or contemporary (physical) scientists. It struck me that I am not readily able to come up with similar perspectives aiming to explain people’s actions and experiences. It might be time for me to go  back to basics and I am trying to start this process below.

In psychology, we take a variety of perspectives to try and explain human actions and experiences. A basic systematisation of this perspective is difficult. For example, I could start with the following points of view:

  • behavioural
  • cognitive
  • social
  • evolutionary
  • spiritual
  • genetic
  • eco-systemic
  • cultural
  • linguistic
  • neuro-sequential
  • physical
  • ecological
  • economic

 

These perspective can be taken on their own or combined in various ways. Some of them may already be combinations of perspectives. Is this important or does it not really matter?

I think it is important as each of these can be associated with underlying methaphors. The behaviour perspective, for example, may utilise mechanistic metaphors or the cognitive perspective information-processing metaphors.

I’ll try to keep working on this over the next little while…

March 31, 2010 Posted by | Uncategorized | Leave a comment

CBT and CFS/ME

Ever wondered whether CBT works for patients with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis?

Well, wonder no more 😉

See: Cognitive behaviour therapy for chronic fatigue syndrome in adults

March 1, 2010 Posted by | Uncategorized | | Leave a comment