Using intervention mapping to develop 'Healthy HR' aimed at improving sustainable employability of low-educated employees

BACKGROUND

The perspectives of low-educated employees are often neglected when designing sustainable employability (SE) interventions. As a result, the interventions offered by the employer do often not align with the needs of low-educated employees. This particular group should therefore be actively involved in the process of developing and implementing SE interventions in their work organizations. The current paper describes the development process of a web-based intervention for HR managers and direct supervisors aimed at improving the SE of low-educated employees. This intervention is specifically designed to involve low-educated employees.

METHODS

The first four steps of the Intervention Mapping (IM) approach were used to systematically develop the intervention with the active involvement of stakeholders. Step 1 comprised a needs assessment including a literature review, empirical evidence, scoping search and several focus group interviews with employees and with representatives of employers. Step 2 formulated the intervention objective. During step 3, suitable theoretical methods were selected and translated to practical applications. Step 4 involved the development of a web-based intervention by integrating all information from the preceding steps.

RESULTS

The needs assessment indicated that the employees' active involvement and employees-employer genuine dialogue should be essential characteristics of an SE intervention for low-educated employees. The online toolkit 'Healthy HR' (HHR) was developed, which contains eight steps. Each step consists of one or more tasks helping the employer and employees with developing and implementing SE interventions themselves. One or more dialogue-based tools support each task. The leading principle providing structure within HHR was Adapted Intervention Mapping.

CONCLUSION

Principles of IM appeared to be useful to develop the intervention HHR systematically. This development process resulted in a practical online toolkit that supports employers in the development and implementation of local SE interventions tailored to the needs of low-educated employees. These employees should be actively involved in the process through a dialogue-based approach. By using IM principles, HHR is expected to increase the effectiveness in bettering the health and well-being of low-educated employees.

Repurposing Case-Based Learning to a Conversational Agent for Healthcare Cybersecurity

A crucial factor for successful cybersecurity education is how information is communicated to learners. Case-based learning of common cybersecurity issues has been shown to improve human behaviour for prevention. However, some delivery methods prevent realistic critical appraisal and reflection of awareness. Conversational agents can scaffold healthcare workers' understanding and promote deterrence strategies. The challenges of repurposing material to create a case-based agent were explored, and the ASPIRE process was modified. Heuristic evaluation from 10 experts in innovative educational technology resulted in the desired outcomes of usability, however Natural Language Understanding improvements were needed. Discussion of best practice when repurposing into conversational agents suggested modification of the ASPIRE process is feasible for future use.

On the Sociality and Immersiveness of the Introspective Encounter

Scientifically accessing and systematically approaching self-reports and a research subject's reflection is a central task of psychological research. However, psychological research often fails to account for the sociality of the individual's self-reports and reflection. In fact, addressing the complexity of the multi-faced reciprocal relations, how individuals get in touch with themselves through the encounter with the 'other' occupies psychology since its beginning up to the present day. A recently published volume edited by Gobodo-Madikizela (2021) delivers an in-depth analysis of the mutual encounters of second-generation descendants of perpetrators and survivors of the Holocaust and stresses the importance of "engaging with the past through second generation dialogue", showing that the introspective, dialogical encounter offers fruitful insight to processes that frequently remain 'invisible' and under the surface of intergenerationally travelling trauma, shame and guilt. Using the example of Gobodo-Madikizela's volume (2021), this article seeks to highlight contemporary applications of the introspectiv encounter and shows its value for locating psychology beyond a strict natural scientific discipline-understanding. By developing the notion of the introspective encounter 'of the first and the second degree', this article aims at showing how Gobodo-Madikizela's volume immerses readers, not only showing how psychology can produce a scientific outcome by crossing the border of the classic subject-object separation (first degree), but also facilitating the reader to enter an introspective dialogue with herself (second degree). By this analysis, this article challenges the way we currently converse in psychological research.

Speakers extrapolate community-level knowledge from individual linguistic encounters

Speakers' lexical choices are affected by interpersonal-level influences, like a tendency to reuse an interlocutor's words. Here, we examined how those choices are additionally affected by community-level factors, like whether the interlocutor is from their own or another speech community (in-community vs. out-community partner), and how such interpersonal experiences contribute to the acquisition of community-level linguistic knowledge. Our three experiments tested (i) how speakers' lexical choices varied depending on their partner's choices and speech community, and (ii) how speakers' extrapolation of these choices to a subsequent partner was influenced by their partners' speech communities. In Experiment 1, Spanish participants played two sessions of an online picture-matching-and-naming task, encountering the same pictures but different confederates in each session. The first confederate was either an in-community partner (Spanish) or an out-community partner (Latin American); the second confederate was either from the same community as the first confederate or not. Participants' referential choices in Session 1 were influenced by their partner's choices, but not by their community. However, participants' likelihood to subsequently maintain these choices was affected by their partners' communities. Experiment 2 replicated this pattern in Mexicans, and Experiment 3 confirmed that these results were driven by confederates' communities, rather than perceived linguistic status. Our results suggest that speakers encode speech community information during dialogue and store it to inform future contexts of language use, even when it has not affected their choices during that particular encounter. Thus, speakers learn community-level knowledge by extrapolating linguistic information from interpersonal-level experiences.

Many lenses for planetary health: seeding citizen engagement for sustainable futures visioning with new ways of seeing

OBJECTIVES

This pilot project sought to seed citizen engagement processes for sustainable futures visioning with ideas, perspectives, and processes informed by Indigenous ways of knowing.

METHODS

Five circle dialogues were convened with students, faculty, and members of the public, in the spring of 2019, using Indigenous talking circle methodology and intentionally seeded with "disruptive" ideas to encourage reflexivity and open space for "out-of-the-box" thinking. These were complemented by a series of one-on-one dialogues with members of the pan-Canadian research team. Pre- and post-dialogue surveys, notes taken by participants, team members, and co-facilitators, as well as notes from one-on-one interviews, constituted the data drawn upon for this paper.

RESULTS

Participants were overwhelmingly positive about their experience, noting they were able to go further and deeper in their thinking and listening, and that they valued the Indigenous talking circle methodology, even if they stopped short of claiming the experience had transformed their way of seeing the world. Key points raised in the dialogues included the need for a more relational worldview, the need to repair severed relations with the land and nature, the importance of Indigenous ways of knowing, the importance of community building, and the need to question the fundamental assumptions undergirding contemporary Western societies.

CONCLUSIONS

While caution must be exercised in drawing conclusions and extrapolating from this modest pilot project, our experience underscores the value of processes that intentionally catalyze critical reflexivity and openness to other ways of seeing, informed by Indigenous ways of knowing and talking circle methodology.

Open dialogue about complementary and alternative medicine (CAM) integrated in conventional oncology care, characteristics and impact. A systematic review

OBJECTIVE

To systematically review evidence on the characteristics, experiences and impact of an open dialogue about complementary and alternative medicine (CAM) integrated in oncology care.

METHODS

We searched MEDLINE, EMBASE, AMED, Scopus, ProQuest Dissertations and Thesis, Cochrane Central Register, clinicaltrials.gov, forskningsdatabase.dk and PROSPERO. Two reviewers screened title, abstract and full-text articles. Each study was appraised using the Critical Appraisal Skills Programme (CASP) and synthesized narratively. PROSPERO registration CRD42019112242.

RESULTS

We retrieved 4736 articles and included 5; 3 received 9 ½, 1 received 9, and 1 received 5 points on the CASP score. Predominately, the open dialogue was one or two individual, patient-centered, face-to-face consultations led by oncology physicians. In one study, it was a tele-phone consultation and in another it was structured counseling led by pharmacists. Integrated information and recommendations about CAM contributed to high level of satisfaction and improvement in concerns, quality of life and well-being.

CONCLUSION

Integration of open dialogue about CAM in oncology care including acknowledging patients' preferences, values, wishes and knowledge, and providing information about CAM expands the opportunities for improving patients' health, quality of life and well-being.

PRACTICE IMPLICATIONS

Open dialogue about CAM has potentials, but research on how it specifically helps patients, is needed.

Making oneself predictable in linguistic interactions

While language production is a highly demanding task, conversational partners are known to coordinate their turns with striking precision. Among the mechanisms that allow them to do so is listeners' ability to predict what the speaker will say, and thus to prepare their response in advance. But do speakers also play a role in facilitating coordination? We hypothesized that speakers contribute by using coordination smoothers - in particular by making their turns easier to predict. To test this, we asked participants to type definitions for common English words, either on their own (n = 26 individuals) or interacting with a partner (n = 18 pairs), and we measured the timing with which they produced the definitions. In a post-test, additional participants (n = 55) attempted to predict the final word of these definitions and rated them for quality. We found that interacting speakers initiated their turns with less variable delays than solo individuals. In contrast, our post-test measures suggested that jointly produced definitions were in fact of lower predictability and quality than those produced by individuals, but the analysis revealed these findings were likely confounded by task difficulty. We propose that the reduction in temporal variability observed for interacting speakers may facilitate prediction and thus act as a coordination smoother in linguistic interactions.

The "things themselves": challenging heuristics and inciting empathy via Husserlian phenomenology

I propose that the phenomenology of Edmund Husserl provides a meaningful mode of access to the patient experience. By reflecting on a real-life encounter with grief, my own medical training, and two works of literature, Nausea and Love in the Time of Cholera, I illustrate the application of philosophy and specifically phenomenology to clinical education. Phenomenology allows clinicians to strip away assumptions, habits of thinking, and normative ideas within the clinical encounter in order to enter the descriptive world of the patient. In suspending presuppositions and heuristics, the clinician can better empathize with the vivid, embodied stories that the patient is describing. Finally, the practice of phenomenology makes tangible the complexities of medical illnesses, emotions, and lived experiences.

Patient-Initiated Follow-Up (PIFU) as reorganized support for increased patient involvement - focus group discussions among patients' with inflammatory arthritis

Background

Inflammatory Arthritis is characterized by lifelong medical treatment and an unpredictable trajectory because of the fluctuating nature of the diseases. Proactive disease management is recommended, which includes close monitoring of disease activity that traditionally has been ensured by outpatient visits to rheumatologists at various fixed intervals. Internationally, there is a growing interest in how healthcare systems can be more flexible, individual-oriented and increasingly involve patients with lifelong diseases in their own treatment and care. We aimed to explore how patients with Inflammatory Arthritis with low disease activity or remission (DAS-CRP < 2.9) experience patient involvement in a reorganized follow-up care based on flexibility and patient-initiated contact.

Methods

We conducted a qualitative study based on four mixed group discussions focused on patients with inflammatory arthritis (rheumatoid arthritis [n = 21], axial spondyloarthritis [n = 3] and psoriatic arthritis [n = 1]) participating in a reorganized follow-up care. Changes in follow-up included access to a nurse and patient-initiated follow-up (PIFU). The analysis was based on content analysis. The reporting adheres to the Consolidated Criteria for Reporting Qualitative Research (COREQ).

Results

In total, 25 patients (20 females (80%), mean age 61.8 [range 28–79]) participated. We identified three categories. 1) Patient-Initiated Follow-Up do not affect patients’ perceived support in disease control; this refers to patients’ experience of more time available through better resource utilization, as well as trust that access to professional support would be available whenever needed. The category 2) Information is valued by patients to delineate responsibilities in a new patient role reflects patients’ uncertainty in the transition to PIFU, combined with confusion about the distribution of responsibilities. 3) Patients need both extended perspectives of their arthritis and focused dialogue is about expanding patients’ understanding of their arthritis by interaction over time with both a rheumatologist and a rheumatology nurse in a focused dialogue to involve the patient.

Conclusions

Patients participating in PIFU welcome the flexibility and involvement. However, patients need relevant information to act adequately within a new patient role. Interaction with both rheumatologists and nurses, combined with sufficient time for dialogue, broaden patients’ perspective, make opportunities for action visible, and contribute to patients’ ability to participate in follow-up care.

Discursive and Non-discursive Symbolization during couple's Conflict

The purpose of this article was exploring the role of discursive and non-discursive symbolization - specifically gestures - in the negotiation of differences in couples´ interactions. Five married heterosexual couples were invited to hold a conversation about an unsolved problem in their relationship. A videographic analysis was carried out to explore gestures in dialogical sequences and Microgenetic Semiotic Analysis (ASM) was conducted. The results showed that gestures complemented verbal signs as semiotic devices in the regulation of meaning construction and differences in negotiation, displaying strategies for facing and avoiding conflict, as well as resources for undergoing tension dealing with personal objectives and emotional difficulties; Its role is discussed as preparation of the verbal communicative expression, as devices for self-regulation and access to tension relief. Further, the discussion addresses their function as paths for encounter, mutuality and closeness.

Improving dialogue among researchers, local and indigenous peoples and decision-makers to address issues of climate change in the North

The Circumpolar North has been changing rapidly within the last decades, and the socioeconomic systems of the Eurasian Arctic and Siberia in particular have displayed the most dramatic changes. Here, anthropogenic drivers of environmental change such as migration and industrialization are added to climate-induced changes in the natural environment such as permafrost thawing and increased frequency of extreme events. Understanding and adapting to both types of changes are important to local and indigenous peoples in the Arctic and for the wider global community due to transboundary connectivity. As local and indigenous peoples, decision-makers and scientists perceive changes and impacts differently and often fail to communicate efficiently to respond to changes adequately, we convened a meeting of the three groups in Salekhard in 2017. The outcomes of the meeting include perceptions of how the three groups each perceive the main issues affecting health and well-being and recommendations for working together better.

Gifts of wise women: A reflection on enduring ideas in nursing that transcend time

In this essay, I propose there are enduring ideas in the works of nurse theorists from the 1960s and 1970s that were valuable not only in the past, but in nursing today as well as in possibly shaping the future of nursing knowledge development. I identify these as gift ideas and draw on the work of Wiedenbach for the gift of dignity in nursing philosophy, and the gifts of dialogue from Orlando, behavioral systems from Johnson, context from Roy, self-care from Orem, and finally the gift of nursing science as emergent in understanding life processes from Rogers. Although the core of nursing knowledge may be elusive, the gift ideas mentioned in this essay provide some guideposts in articulating and developing that core in the present as well as in the future.

Linguistic Convergence to Observed Versus Expected Behavior in an Alien-Language Map Task

Individuals shift their language to converge with interlocutors. Recent work has suggested that convergence can target not only observed but also expected linguistic behavior, cued by social information. However, it remains uncertain how expectations and observed behavior interact, particularly when they contradict each other. We investigated this using a cooperative map task experiment, in which pairs of participants communicated online by typing messages to each other in a miniature "alien" language that exhibited variation between alien species. The overall task comprised three phases, in each of which participants were told that they would be paired with a different partner. One member of the pair was given explicit linguistic expectations in each phase, while the software controlled whether or not observed behavior from their partner would be consistent or inconsistent with these expectations. The other participant was given no such expectations, allowing us to control for the role of expectation. Participants converged to both observed and expected linguistic behavior, and convergence was boosted when observation and expectation were aligned. When expected and observed behavior were misaligned, participants updated their expectations, though convergence levels did not drop. Furthermore, participants generalized what they learned about one partner to apparent novel partners of the same alien species. We also discuss individual variation in convergence patterns and the lack of a relationship between linguistic convergence and success at the map task. Findings are consistent with observations outside the laboratory that language users converge toward expected linguistic behavior. They also have broader implications for understanding linguistic accommodation and the influence of social information on linguistic processing and production.

The social-mediated crisis communication research: Revisiting dialogue between organizations and publics in crises of China

The rapid diffusion of social media is ushering in a new era of crisis communication. To enhance our understanding of the social-mediated dialogue between organizations and their publics in crises of China, this study conducts a content analysis of 61 relevant journal articles published in 2006-2018. Results of this research present an overview of ongoing research trends such as theoretical frameworks and methodological preferences. This research also explores how the unique Chinese social media characteristics affect the dialogue between types of organizations and their publics. Contextual factors such as face and favor, relationship (Guanxi) and sentiment (Renqing), and the centralized political system that may facilitate/inhibit dialogue in crises of China are identified as well. Finally, this study suggests promising new directions such as a scholarly assessment tool for the social-mediated crisis communication research in China.

Are People Sensitive to Problems in Communication?

Recent research indicates that interpersonal communication is noisy, and that people exhibit considerable insensitivity to problems in communication. Using a dyadic referential communication task, the goal of which is accurate information transfer, this study examined the extent to which interlocutors are sensitive to problems in communication and use other-initiated repairs (OIRs) to address them. Participants were randomly assigned to dyads (N = 88 participants, or 44 dyads) and tried to communicate a series of recurring abstract geometric shapes to a partner across a text-chat interface. Participants alternated between directing (describing shapes) and matching (interpreting shape descriptions) roles across 72 trials of the task. Replicating prior research, over repeated social interactions communication success improved and the shape descriptions became increasingly efficient. In addition, confidence in having successfully communicated the different shapes increased over trials. Importantly, matchers were less confident on trials in which communication was unsuccessful, communication success was lower on trials that contained an OIR compared to those that did not contain an OIR, and OIR trials were associated with lower Director Confidence. This pattern of results demonstrates that (a) interlocutors exhibit (a degree of) sensitivity to problems in communication, (b) they appropriately use OIRs to address problems in communication, and (c) OIRs signal problems in communication.

Understanding beneficial self-management support and the meaning of user involvement in lifestyle interventions: a qualitative study from the perspective of healthcare professionals

BACKGROUND

In light of the high prevalence of overweight and obesity among adults and the subsequent stigmatization and health consequences, there is a need to develop effective interventions to support lifestyle change. The literature supports the key role of healthcare professionals (HPs) in facilitating self-management through lifestyle interventions for those with chronic conditions. However, there is a lack of knowledge about how HPs practice self-management support (SMS) and user involvement for persons afflicted by overweight or obesity in lifestyle interventions in primary care Healthy Life Centres (HLC). The aim of this study was to explore how HPs provide SMS and what user involvement implies for HPs in HLCs.

METHODS

An interpretative exploratory design, using qualitative thematic analysis of data from two focus group interviews with ten HPs from eight different HLCs, was conducted.

RESULTS

The analysis resulted in one overall theme; A partnership based on ethical awareness, non-judgemental attitude, dialogue and shared responsibility, comprising four interrelated themes: 1) Supporting self-efficacy, self-worth and dignity through an attitude of respect, acknowledgement and generosity, 2) Promoting self-belief and self-perceived health, 3) Collaborating and sharing responsibility, and 4) Being flexible, adjusting and sharing time.

CONCLUSION

HPs in HLCs see service users as equal partners in a collaboration based on shared responsibility, acknowledgement and generosity. In order to help, their practice involves a heightened level of ethical awareness, including a non-judgemental attitude and dialogue. HPs in HLCs have something to teach us about ethical acting and helping persons who are struggling with overweight or obesity to change their lifestyle and regain dignity. They seem to see the service users' existential needs and have learned the art of meeting the other in her/his most vulnerable situation i.e., seeking help for a "wrong lifestyle". It may be time to highlight the need for SMS and user involvement to focus on shared responsibility in partnership rather than personal responsibility. More research is required to explore the conditions for such practice.

When Genetics Meets Religion: What Scientists and Religious Leaders Can Learn from Each Other

INTRODUCTION

To date scientists and religious leaders have not yet engaged in sustained face-to-face conversation concerning precision public health-related genetic technologies.

OBJECTIVES

To elucidate areas of commonality and divergence in scientists' and religious leaders' views of precision genetic technologies, and extract lessons conveyed by religious leaders to scientists, and scientists to religious leaders through participatory dialogue.

METHODS

Six 1.5-h dialogue sessions were held between 6 religious leaders, 8 University of Michigan scientists, and 3 additional public health/genetic counseling graduate students between October 2016 and September 2017, followed by an open conference at the Ann Arbor Public Library (n = 46). Statements were organized into thematically arranged duets comparing views of scientists and religious leaders. Duets were further ordered into interpretive levels. Comparative techniques were used to assure category agreement and face validity.

RESULTS

The analysis yielded 20 duets and 3 interpretive levels (expositional; implications and consequences; and integrative, bridging concepts). Scientists emphasized the value of epigenetic testing for health promotion, and cost saving for some forms of early genetic testing for adult-onset conditions. Religious leaders stressed care for an individual's willingness to change over technical fixes for behavioral conditions and, together with public participants, the importance of allocating money for societal needs. Both expressed caution on the use of nuclear transfer for mitochondrial DNA replacement and secondary uses of genetic data. Lay conference participants pointed towards a middle ground on the release of genetically edited mosquitoes for disease eradication.

DISCUSSION

Scientists stressed the value of professional guidance; religious leaders listened to family needs. Dialogues met four literature-based criteria for stakeholder involvement in deliberative processes.

CONCLUSION

While scientists and religious leaders differ in their points of emphasis and faith orientations (professional competency versus drawing on compassion), they can successfully collaborate in reaching mutual understanding and specific areas of agreement on precision genetic technologies relating to public health.

The potential of dialogues on social identity and diversity for immigrant civic integration

Local governments have become increasingly important in the governance of immigration. The present study evaluates a local government sponsored dialogue on social identity and diversity aimed at promoting the civic integration of immigrant participants. Based on models for community dialogues across cultural differences and on the literature on immigrant civic integration, the researcher designed, implemented and evaluated the dialogue. The evaluation was based on an exit questionnaire completed by participants, observation notes taken by the researcher, and a follow-up interview with the program coordinator. The evaluation suggests that dialogues among newcomers about social identity and diversity that match most of the ideal conditions for positive intergroup contact stated in the literature likely facilitate immigrant civic integration. Participants reported improved feelings of mutual understanding and inclination to collaborate across cultural differences. The findings also indicate that participants developed a capacity to balance appreciation for cultural differences and group identities with proclivity to collaboration across cultural groups.

Learning to interact and interacting to learn: a substantive theory of clinical workplace learning for diverse cohorts

Social interactions are integral to clinical workplace functioning and are recognised to play an important role in clinical workplace learning. How, why and to what end students, in the context of today's culturally and linguistically diverse cohorts, interact with members of clinical workplace communities during clinical workplace learning is not well understood. The aim of this research was to generate a theoretical understanding of students' interactive processes in clinical workplace learning that accounted for high levels of cultural/linguistic diversity. In accordance with constructivist grounded theory methods, data collection and analysis were premised on theoretical sampling and constant comparative analysis, and undertaken from an informed and reflexive stance. This involved iterations of survey, interview and diary data from two diverse cohorts of final year veterinary students who had undergone 11 months of clinical workplace learning. Clinical preceptors were also interviewed. As an aid to theory building, testing and refinement, and in order to test the theory's relevance, usefulness and transferability beyond veterinary clinical education, critical feedback was sought from medical and allied health educators. Our substantive level theory demonstrates that upon entering the clinical workplace community, students learn how to 'harness dialogue' in order to effectively coordinate three, inter-related interactive processes: (i) functioning in the workplace, (ii) impression management and (iii) learning-in-the-moment. We found both positive and negative consequences ensued, depending on how students harnessed dialogue. The theory responds to a perceived need in international student education to move away from a deficit discourse by developing educational theory which focuses on the nature of participation, rather than the nature of the student.

The Added Value of Studying Embodied Responses in Couple Therapy Research: A Case Study

This article reports on the added value of embodied responses identified through sympathetic nervous system (SNS) activity in couple therapy research. It focuses on moments of change and the timing of therapeutic interventions or therapeutic moves in a couple therapy session. The data for this single-case study comprise couple therapy process videotapes recorded in a multi-camera setting, and measurements of participants' SNS activity. The voluntary participants were a marital couple in their late thirties and two middle-aged male psychotherapists. The division into topic segments showed how the key issue of seeking help, which was found to comprise three separate components, was repeatedly dealt with in the session. SNS activity showed different degrees of synchronization between the couple, between the therapists, and between the couple and therapists during the dialogue pertaining to these three components. The issue of timing emerged as a complex, even ambivalent, phenomenon. Arousal in the therapists was in line with their therapeutic activity, whereas in the clients it was more anticipatory. The approach used here rendered visible some of the intensity that therapeutic dialogue can generate when dealing with issues of relationship change in the couple context and showed how this intensity can be dialogically regulated in the therapeutic system.

Empirically supported out-of-the-box strategies for science communication by environmental scientists

Scientists are expected to communicate their research to a wide audience, while often lacking appreciable training. Environmental science poses many value-laden and ethical questions. This necessitates the identification and use of specific strategies or guidelines, which encourage 2-way communication and enable trust in both the experts and the scientific results. The objective of this paper is to give environmental scientists tools for effective science communication based on sound scientific evidence that does not require further specialization in communication studies. Using common scientific search engines in Europe, scientific communication literature that met specific parameters was identified. The summarized data contextualize the importance of science communication in environmental sciences but also highlight the need of scientists for communication experts to aid in establishing objectives for particularly complex topics and audiences. Integr Environ Assess Manag 2019;15:499-504. © 2019 SETAC.

A Dialogue-Based Approach to Subjective Well-Being: Co-Interpreting the Meaning of Daily Experiences

Different from statistically analyzed self-reports of Subjective Well-Being (SWB), we explored how dialogue engenders the meaning of SWB as constituted through an individual's daily experiences. A revised Day Reconstruction Method (DRM; Kahneman et al. 2004) was used to describe the participants' previous day episodically, followed by a semi-structured life world interview (Kvale 1996) for the explication through dialogue of those episodes. The results of qualitative analyses on the structure and contents of the discourse of the DRM and interviews with three participants highlighted the following: 1) the participants construed the meaning of daily experiences by organizing and weighting them in individualized ways; 2) the meaning of daily episodes emerged and was clarified in the process of collaborative dialogue in the interview as well as in the analyses, and was vividly expressed in particular protocol sequences; and 3) Kelly's (1955) notion of Personal Construct is applicable to make sense of individualized narratives as a form of Well-Being. We concluded that the subjectivity of SWB does not merely imply the first-person authority in charge of the evaluation in the questionnaires, but rather is understood as a construct that reveals the personal meaning of one's daily experiences. The emergent quality of this process is crucial for understanding the nature of subjectivity in SWB.

Three visions of doctoring: a Gadamerian dialogue

Medicine in the twenty-first century faces an 'identity crisis,' as it grapples with the emergence of various 'ways of knowing,' from evidence-based and translational medicine, to narrative-based and personalized medicine. While each of these approaches has uniquely contributed to the advancement of patient care, this pluralism is not without tension. Evidence-based medicine is not necessary individualized; personalized medicine may be individualized but is not necessarily person-centered. As novel technologies and big data continue to proliferate today, the focus of medical practice is shifting away from the dialogic encounter between doctor and patient, threatening the loss of humanism that many view as integral to medicine's identity. As medical trainees, we struggle to synthesize medicine's diverse and evolving 'ways of knowing' and to create a vision of doctoring that integrates new forms of medical knowledge into the provision of person-centered care. In search of answers, we turned to twentieth-century philosopher Hans-Georg Gadamer, whose unique outlook on "health" and "healing," we believe, offers a way forward in navigating medicine's 'messy pluralism.' Drawing inspiration from Gadamer's emphasis on dialogue and 'practical wisdom' (phronesis), we initiated a dialogue with the dean of our medical school to address the question of how medical trainees and practicing clinicians alike can work to create a more harmonious pluralism in medicine today. We propose that implementing a pluralistic approach ultimately entails 'bridging' the current divide between scientific theory and the practical art of healing, and involves an iterative and dialogic process of asking questions and seeking answers.

[Cardiovascular protection of diabetic patient with chronic renal disease and particular case of end-stage renal disease in elderly patients]

Type 2 diabetes has an increasing prevalence. Life expectancy is dominated by cardiovascular risk, which is the leading cause of death in these patients. Up to one third of diabetic patients will develop diabetic nephropathy related to micro-angiopathy. Renal impairment further increases cardiovascular risk. Reducing cardiovascular morbidity and mortality is a major public health issue, as well as early preventing and managing chronic kidney disease (CKD). Good glycemic control prevents the micro-vascular complications of the disease (retinopathy, nephropathy, etc.) and, more recently recognized through prolonged monitoring of the VADT cohort, prevents cardiovascular complications. Control of blood pressure and dyslipidemia are essential in primary or secondary cardiovascular prevention. In addition, the blockers of the renin-angiotensin system slow down the progression of the MRC. Elderly patients with chronic kidney disease (CKD) form another growing group of the nephrologist daily patient pool. Especially for very elderly patients with comorbidities, the question of favoring conservative treatment rather than starting or pursuing dialysis may arise. Survival and quality of life are indeed not necessarily better in elderly patients undergoing dialysis, complications can occur eventually leading to discontinuation, and are occasionally associated with a feeling of stubbornness. Creation of prognostic score is a useful tool to help the decision-making process. However, dialogue with the patient and his/her family, as well as multidisciplinary collaboration remain fundamentals to determine the most suitable care.

Analysis of environmental communication and its implication for sustainable development in Ethiopia

BACKGROUND

Environmental issues have been causing debates around the globe. These issues have also got much attention in Ethiopia. Ethiopia has been adversely affected by the environmental crisis. Developing countries and the poor were depicted as unfortunate victims of climate change. The causes of climate change include deforestation, industries, mismanagement of the environment, and utilization of natural resources. One of the effects of climate change brought natural disaster what we call a drought. Drought affected many people, even recently, in Ethiopia. Concerning the environmental problems and issues in Ethiopia, there are beginnings at the policy level. However, the practical aspects of communicating and addressing these issues could not get much attention from the authority.

OBJECTIVE

The aim of the research is to analyze environmental communication of Amhara National Regional State-Environmental Protection Authority.

METHOD

Case study as a qualitative research method is used. The case design type is descriptive. The researcher selected two techniques of collecting data: in-depth interview and documents.

RESULTS

The results show that the authority is unable to communicate environmental issues which were stated in the different conventions and policies.

CONCLUSION

There are gaps that could be considered from the outcome of the research. The major gaps and challenges in addressing practical issues of environment are identified namely poor environmental information systems, lack of awareness creation through communications, and weak public dialogue and genuine participation consideration.