Anti oppressive practice: a route to the empowerment of people with dementia through communication and choice

This short study looks at the issue of anti oppressive practice and the way that it relates to the care of people with dementia. In particular it considers ways in which people can be empowered and given choices around aspects of day-to-day living in a care setting. The study took place over a period of 6 months and utilized the Dementia Care Mapping (DCM) observation process to assess the level of well being of residents in the setting studied. The results can only be seen as a first stage in the process of understanding ways in which people with dementia may be empowered. It is demonstrated that a change of practice developed over the 6 months between the two observation periods. Areas such as communications and day-to-day activities are examined to identify both problems and strategies for such change. The conclusion highlights the need to continue the mapping exercise as a way of ensuring that change is not only maintained but also advanced.     

Health-related lifestyle advice: critical insights

This article situates itself within contemporary public health workforce development issues and provides critical insights into the newly developed roles of health trainers and the wider practice of health-related lifestyle advice. It highlights a number of contradictions and paradoxes in relation to health-related lifestyle advice, in terms of the organisation of the public body in intervention targets, in terms of choice and risk, of the power relation it involves and in terms of the dichotomy between professionalisation and personalisation of public health messages. The analysis highlights the competing discourses of expertise on the one side, and empowerment, autonomy and independence on the other. It is likely that, rather than enforcing only one kind of narrative, health trainer roles would realise a greater liberating potential by facilitating the navigation between different sets of realities at different times and different geographical, cultural and conceptual places.     

Evaluating the effectiveness of advocacy training for breast cancer advocates in Australia

There is growing trend in health care for patients and consumers to have an active voice in all decisions related to their care. The purpose of the current study was to assess the effectiveness of an advocacy training programme for breast cancer consumers in Australia. The participants included 51 women who attended a 3-day advocacy training programme in three different states across Australia. Participants completed a pre- and post-questionnaire at 6 months follow-up to assess their involvement in breast cancer advocacy activities and organizations. Findings revealed a significant increase in participants' involvement in serving as a member of a board or committee, working on clinical trials recruitment issues, working on patient resources, and involvement in breast cancer advocacy groups after completing the training programme. However, no change was found in other key advocacy areas, such as, lobbying for change or reviewing research protocols. Implications for future advocacy training programmes and research were discussed.     

The challenge of low literacy in health promotion: Using empowerment methods with out-of-school adolescents in North India

This article reports on a series of three-month projects undertaken among out-of-school adolescents in North India that used photographs and charts to elicit critical analysis of health in small groups led by peer educators. This method of “problematization” is a component of the empowerment model. The study found that the methodology of problematization through pictures was very effective in identifying the local knowledge level of semi-literate adolescents and bringing out relevant barriers to health. Knowledge of health topics improved and many participants began to attend school after the project; however, behaviour changes were limited by obstacles and challenges beyond the control of the adolescents. The methodology allowed for flexibility in order that the social and cultural contexts of this project, namely caste divisions, gender divisions, poor literacy and parental desire to “listen in”, could be incorporated into the design. It also allowed the unique social and cultural problems of the area regarding relationships, crime and alcohol to emerge as part of the discussions. Recommendations are that health promotion projects using empowering methods need to be long term and involve the entire community in order to be sustainable.     

The culture of midwifery in the National Health Service in England

The culture of midwifery in the National Health Service was examined in order to foster understanding of the context of midwifery practice. In-depth interviews were conducted with midwives in five, very different, sites across England. The culture which emerged was one of service and sacrifice where midwives lacked the rights as women which they were required to offer to their clients. There was a lack of mutual support and of positive role models of support with considerable pressure to conform. Guilt and self-blame were common as was learned helplessness and muting. The dilemmas of this culture are considered and the resistance which it offered to change in relationships. Change was either resisted, brought about by stealth or strategically planned to equip midwives to change their culture.     

Assessing the factors influencing continuous quality improvement implementation: experience in Korean hospitals.

OBJECTIVE: To assess the extent of continuous quality improvement (CQI) implementation in Korean hospitals and to identify its influencing factors. DESIGN: Cross-sectional study by mailed questionnaire survey. STUDY PARTICIPANTS: One hundred and seventeen staff members with responsibility for CQI at 67 hospitals with > or = 400 beds. MAIN OUTCOME MEASURES: The degree of CQI implementation was measured using the Malcolm Baldrige National Quality Award Criteria (MBNQAC). Factors related to the degree of CQI implementation were the four components of the CQI pyramid, namely the cultural, technical, strategic, and structural attributes of individual hospitals. RESULTS: The average CQI implementation score across the seven dimensions by MBNQAC was 3.34 on a 5-point scale. The highest score was achieved in the dimension of 'customer satisfaction' (3.88), followed by 'information/analysis' (3.59), and 'quality management' (3.35). Regression analysis showed that hospitals which better fulfilled technical requirements, such as improving information systems (P< 0.05), using more scientific CQI tools, and adopting systematic problem-solving approaches (P<0.01), tended to achieve higher degrees of CQI implementation. Although statistically insignificant, positive trends were observed for group/developmental culture and the degree of employee empowerment, and the use of prospective strategy. CONCLUSION: It appears that the most important contributing factors to active CQI implementation in Korean hospitals were the use of scientific skills in decision-making and the adoption of a quality information system capable of producing precise and valid information.     

Experiences of disability consumer-directed care users in Australia: results from a longitudinal qualitative study

The rapidly growing body of literature suggests that Consumer-directed Care (CDC) has the potential to empower consumers and improve the flexibility and quality of care. However, reports highlighting quality and risk concerns associated with CDC focusing on a longer time frame have been few. This paper presents the findings from a qualitative longitudinal evaluation of an Australian CDC programme. Focusing on the period between 2003 and 2008, it reports on the experiences of 12 families caring for a dependent family member. It is based on two external evaluations completed 6 and 36 months after enrolment, and one internal evaluation completed 48 months after enrolment. The findings were triangulated with internal memos, reports and minutes of meetings, as well as with the theoretical literature. The study demonstrates that CDC harbours considerable benefits for people with disabilities and their carers. However, the study also suggests that, over time, carers may experience an increased sense of isolation and lack of support as a result of their involvement in the CDC programme. The paper argues that the development of safeguards addressing these weaknesses is crucial for the sustainability of CDC programmes in contexts where risk cannot be simply transferred onto consumers.