Agency-based Approach Research Articles

Navigating the disclosure landscape: Parents' perspectives on healthcare professionals' role in supporting intersex children and families.

Intersex, an umbrella term, describes individuals with sex characteristics that cannot be exclusively categorized into binary definitions of male or female. The intersex community faces a lack of social visibility perpetuated by a history of medical discrimination and pathologization shaped by "normalizing" genital surgeries without the child's consent. Despite efforts to reform clinical practice, there remains a paucity of research centering the needs of the intersex community and their families. This study explored parents' perspectives on how healthcare professionals (HCPs), such as genetics professionals, can provide patient-centered education and support when parents first learn of their child's intersex variation, with the aim of offering recommendations to HCPs to promote parental adjustment and protect intersex children's right to autonomy. Thirteen qualitative semi-structured interviews were conducted with 14 parents of intersex children. Through reflexive thematic analysis, under the framework of an agency-based approach to intersex health, thematic categories were inductively conceptualized, including barriers and facilitators to HCPs' sensitivity and to parental adjustment in the early disclosure environment. Barriers to HCPs' sensitivity were imposed by educational, religious, or medical institutions, along with sociocultural prejudices and pathologizing language. Barriers to parental adaptation included uncertainty regarding their child's future, sociocultural gender norms, and unsuitable information provision. Incorporating parental needs in the disclosure environment can facilitate familial acceptance, including normalization of variations of sex characteristics (VSCs), enhanced medical education, facilitation of patients' navigation, and prioritization of parents' social support needs.

Going Local: An Agency-Based Approach to Collapse, Resistance, and Resilience in Hittite Anatolia

Abstract Crisis and collapse have long been prominent themes in Hittite studies (much more so than the related topics of resistance and resilience) and most of the extant body of scholarship on these themes have concentrated on the disintegration of the Hittite Empire around 1200 BCE. Though the events, conditions and processes that culminated in the disintegration of the Hittite Empire elude historical reconstruction, recent studies have unanimously rejected monocausal explanations of collapse in favor of the view that it was brought about by a combination of factors – internal, external, acute or chronic. In Hittite scholarship, the study of collapse and its aftermath have typically operated within a markedly state-centered and progressivist framework, focusing primarily on figuring out “what went wrong.” Meanwhile, especially in text-based studies, the agency and resilience of local, small(er)-scale, peripheral, and non-state individuals and communities, as well as their role in the construction, maintenance, and collapse of the Hittite empire, remain largely overlooked. The aim of the present paper is to shift the focus and scale of analysis away from the state, and to draw out from the textual record, the long-term agency, resistance, and resilience of local, small-scale, and often non-state individuals, communities, or socio-political institutions, which have typically been left out of text-based modern narratives. This paper will reassess the prominent view of the Hittite king (and state) as the absolute political, military, judicial, and religious authority, and argue that certain local and non-state communities and socio-political institutions exercised diverse kinds of agency, were remarkably resilient in the long term, and survived the final collapse of the Hittite state. In order to situate the inquiry in its broader scholarly and intellectual context, it will begin with an overview of where things stand in the study of the Hittite collapse. The next step will be to identify individual or collective local actors in the textual record. It will lastly focus on the interactions of diverse local agents with the Hittite state.

Entrepreneurial ecosystems, agency and regional development: Emergence and new path creation in the Cardiff city region

This paper addresses the process of entrepreneurial ecosystem emergence in regions and the mechanisms through which new industrial paths are created. It focuses on the context of a relatively weak economic region and develops a mode of analysis that considers the role of human agency within the emergence of entrepreneurial ecosystems. This analysis addresses the case study of the Cardiff city region in the United Kingdom. It indicates that the revitalisation of lagging regions through an entrepreneurial ecosystem approach is likely to be contingent upon a number of important components: (1) access to potential entrepreneurial agency, (2) the engagement of ‘enlightened’ local political agency and (3) the formation of a collective agency across entrepreneurial and political agents as well as other relevant stakeholders. The emergence of collective agency in the city region is found to have led to new policies, networks and entrepreneurial support within the high-tech industry, coupled with the development of new industrial paths and improved economic conditions. The paper argues that adopting an agency-based approach to analysing entrepreneurial emergence highlights the importance of key human actors in such emergence. It is concluded that lagging regions can trigger a process of development through new path creation stemming from the emergence of an entrepreneurial ecosystem.

Nature-Based Offsets in Russia: Key Challenges and Conditions for Success

The article discusses the key problems and conditions for the successful development of the nature-based offset projects (NBOPs) in Russia. The conditions for the successful entry of verified carbon units from Russian nature-based offset projects into the global market were determined considering the state and prospects for development of global carbon markets. The key limitations for the national carbon market for offsets are presented: the lack of internal economic incentives for companies to buy carbon units and to invest in Russian NBOPs; the lack of national methodologies for the NBOPs; legal restrictions for land-use; lack of available tools for assessing costs and profitability of NBOPs on given land plots; failures of carbon market regulation under the Sakhalin experiment. The limitations of the narrow agency-based approach to the development of NBOPs are shown. These limitations result in inconsistent decisions that do not fit real conditions in the global market. It is necessary to create a competence center to solve the issues of the NBOPs from specific methodologies of individual projects to science-based assessments of their total potential in Russia. Two scenarios of the use of NBOPs for decarbonization of the Russian economy are analyzed. Scenario 1 assumes large-scale sale of carbon units generated in Russian in foreign markets in order to maximize mid-term profit. Scenario 2 assumes the use of carbon units generated in Russian NBOPs mainly by Russian companies to achieve net zero by 2060. A realistic and balanced strategy assumes that the key buyers of carbon credits from Russian NBOPs in the first stage should be export-oriented Russian companies that can use these credits to reduce the carbon footprint of their products and implement corporate climate strategies.

The Academic Turn of Child and Youth Care Practicum Coordination at MacEwan University

The established agency-based approach to child and youth care (CYC) practicum coordination in post-secondary education is no longer sustainable. It has been impacted by the persistent expansion of professional programs requiring practicum placements for increasing student populations and must be rethought to address the changing needs of stakeholder service providers. This article discusses the creation of a non-administrative, academic CYC practicum coordination position at MacEwan University. The primary focus of this newly created position is to lead the transition from an all-inclusive agency-based placement model of field education to a multifaceted approach to coordination, which will include both research-focused and project-based practicum opportunities.

Complex, Varied and Evolving Manifestations of Food Agency in Daily Life Among Diabetes Prevention Program Participants in Baltimore, Maryland

ObjectiveTo characterize food agency (one's capacity to procure and prepare food in particular contexts) among Diabetes Prevention Program (DPP) participants and gather perspectives about experiences with DPP. DesignPhotograph-elicitation in-depth interviews and survey measures. SettingBaltimore, Maryland (June–August 2021). ParticipantsBlack women (n = 13) who participated in DPP. Phenomenon of InterestFood agency and strategies used to procure and prepare food and the influence of DPP on daily food behaviors. Surveys measured food agency using the Cooking and Food Provisioning Action Scale and cooking behaviors. AnalysisThematic analysis of qualitative in-depth interviews and descriptive statistics for quantitative measures. ResultsAs quantitative and qualitative data revealed, participants were frequent and confident cooks with high food agency. Participants viewed cooking as a key strategy for healthy eating and desired more hands-on cooking instruction within DPP to develop new healthy cooking skills. The primary barriers identified were related to lack of time or energy. Food procurement and preparation practices shifted over time, and DPP was a key influence on current behaviors. Conclusions and ImplicationsFood agency is complex and manifests heterogeneously in daily life. A life course, contextual, and food agency-based approach could be considered for future diabetes prevention interventions.

Epistemic Agency and the Value of Knowledge and Belief

“Credit-worthiness” accounts of the value of knowledge focus on the exercise of agency as the source of value in question. This focus is shared by an approach suggested by Sally Haslanger to the value of belief (and thus true belief). The standard examples and counterexamples from the “value of knowledge” literature treat the relevant sort of agency in fundamentally individualistic terms. But recent work on relational autonomy recommends that we think of agency as fundamentally socially embedded. This reorientation not only disarms a standard objection to the “credit-worthiness” approach, but suggests that the putative counterexample is actually a paradigm-case of the exercise of epistemic agency for creatures like us. In so doing, it also exhibits the agency-based account of the value of knowledge and its main competitor, which focuses on the status of potential informants, as two sides of the same coin. Meanwhile, epistemic agency is an essential component of agency tout court. Effective action requires information. But perhaps the possession of information can take other forms than the having of true beliefs. Paul Churchland characterizes what’s peculiar to belief in terms of the sentential form in “that”-clauses in belief attributions. The alternatives that he envisages divorce informational content from sentence content. But for creatures like us, sentences are the basic units of communication of information. If our agency is paradigmatically exercised in socially embedded contexts, an essential part of the picture is that our information be in substantial measure communicable in sentences, i.e., that it take the form of beliefs. So the socially-oriented version of the agency-based approach to the value of knowledge also confirms Haslanger’s hunch that the value of belief can be vindicated and developed in terms of the role of belief in the exercise of agency for creatures like us.

Place-based industrial strategy and economic trajectory: advancing agency-based approaches

ABSTRACT Agency-based approaches represent a fundamental advance in how researchers and policymakers can address questions of place-based industrial strategy, including issues of governance, leadership, new technology and regional assets. However, these approaches can be advanced further by recognizing the centrality of discourse in regional change. This paper does this by synthesizing two conceptual frameworks: Grillitsch and Sotarauta’s trinity of change agency and Moulaert et al.’s framework of Agency Structure Institutions Discourse (ASID). Deploying two Australian case studies to shed light on drivers of change at the local scale, this paper demonstrates that discourse is a necessary component of transformative regional processes. Furthermore, it contends that successful transformation is presupposed by the extent to which local discourse overlaps with local opportunity spaces and forms of agency. Successful place-based industrial strategies need to mobilize these multiple elements of regional change in order to maximize their potential for success.

Towards an agency-based model of intersex, variations of sex characteristics (VSC) and DSD/dsd health

Agency-based approaches to the health of intersex people and those with DSD focus on bodily autonomy and the cessation of normalising medical interventions until an under-age person can exercise fully informed choice regarding treatment. Discussions regarding intersex agency and health care can be inspired by the social model of health that emerged from disability theory. However, a purely social model is insufficient to address the harms that has been caused by DSD medical interventions, and the healthcare needs that some intersex people have. Drawing on original empirical research conducted in Italy, Switzerland and the UK, this article explores agency-based approaches to intersex and DSD, incorporating the social model’s critique of the pathologisation of bodily diversities, whilst supporting the provision of effective healthcare where needed. The article addresses healthcare deficits and their cultural underpinnings. It identifies key impediments to intersex agency, including body normativity and sex and gender binarism. While there has been slight movement towards an agency-based approach to intersex in some national medical settings in the last ten years, there is still a need for change to the conceptualisation of intersex/DSD and subsequent revisions to healthcare provision.

Agency and Performance of Reach-to-Grasp With Modified Control of a Virtual Hand: Implications for Rehabilitation.

This study investigated how modified control of a virtual hand executing reach-to-grasp affects functional performance and agency (perception of control). The objective of this work was to demonstrate positive relationships between reaching performance and grasping agency and motivate greater consideration of agency in movement rehabilitation. We hypothesized that agency and performance have positive correlation across varying control modes of the virtual hand. In this study, each participant controlled motion of a virtual hand through motion of his or her own hand. Control of the virtual hand was modified according to a specific control mode. Each mode involved the virtual hand moving at a modified speed, having noise, or including a level of automation. These specific modes represent potential control features to adapt for a rehabilitation device such as a prosthetic arm and hand. In this study, significant changes in agency and performance were observed across the control modes. Overall, a significant positive relationship (p < 0.001) was observed between the primary performance metric of reach (tracking a minimum path length trajectory) and an implicit measurement of agency (intentional binding). Intentional binding was assessed through participant perceptions of time-intervals between grasp contact and a sound event. Other notable findings include improved movement efficiency (increased smoothness, reduced acceleration) during expression of higher agency and shift toward greater implicit versus explicit agency with higher control speed. Positively relating performance and agency incentivizes control adaptation of powered movement devices, such as prostheses or exoskeletons, to maximize both user engagement and functional performance. Agency-based approaches may foster user-device integration at a cognitive level and facilitate greater clinical retention of the device. Future work should identify robust and automated methods to adapt device control for increased agency. Objectives include how virtual reality (VR) may identify optimal control of real-world devices and assessing real-time agency from neurophysiological signals.

Mental Health Care in Pediatric Rehabilitation Hospitals: A Biopsychosocial, Collaborative, and Agency-based Service Integration Approach

ABSTRACT Background: Canadian hospitals are not currently prepared to meet the psychosocial needs of children with disabilities as services are rooted in a biomedical care model. Objective: To describe a practical and holistic framework for pediatric rehabilitation hospitals to meet the health care needs of children and their families. Method: An environmental scan was conducted of best practice guidelines, policy documents, and models of integrated mental health care. Recommendations from clinical guidelines and national strategy documents were incorporated to develop a service integration approach. Results: An agency-based approach was used to develop a two-phase biopsychosocial framework. In framework Phase I, reactive care is provided to mental health concerns. In Phase II, there is a shift to proactive care and mental health wellbeing. Conclusions: Emphasis is placed on capacity building of clinical staff into best practices for mental health care. Implementation needs and consideration for uptake of the framework are also discussed.

The civil service\u2019s gender diversity agenda under the coalition: where have the critical feminist actors gone?

This article examines the patterns of gender representation in the UK Civil Service to interrogate the claim that there was a regressive change in the proportion of women in the most senior grades of Whitehall under the UK Coalition Government (2010–2015). It does so by analysing both quantitative data covering civil service employment patterns during the Coalition years, complemented by new, primary qualitative data drawn from interviews conducted by the authors. The article presents an original explanation of these shifting patterns, emphasising the crucial role of ‘critical feminist actors’ in driving forward gender equality and diversity agendas in Whitehall. It concludes by highlighting dilemmas and risks involved in this agency-based approach to equality and diversity, which relies on the personal drive and commitment of key, senior actors; and at the same time is subject to the vicissitudes of change in personnel and political environment.

What It Takes to Lead Sustainability Transitions from the Bottom-Up: Strategic Interactions of Grassroots Ecopreneurs

This paper studies features of grassroots ecopreneurs’ leadership in their attempt to ignite transformations in production-consumption systems from the bottom up. It builds on a comprehensive approach of change agency based on institutional work, innovation, and learning intermediation literature. The paper describes grassroots ecopreneurs’ interaction strategies to resource business models for sustainability. Empirical data comes from an action research project that consisted of implementing a sustainability experiment in Sur de Bolívar (Colombia). The experiment shows grassroots ecopreneurs’ arrays of activities around making sense, shaping, securing support, nurturing, expanding, and scaling the value proposition, the business infrastructure, the customer interface and the financial model of their ventures. Our findings suggest that leading businesses transition into a more sustainable field requires grassroots ecopreneurs acting as change agents by performing a diverse array of boundary, practice, and knowledge circulation strategies, aiming at securing the societal and environmental impact of their ventures. Change agency manifests in the ways ecopreneurs maneuver to bring about transformations and strive to sustain it. The study contributes to a better understanding of processes of socio-technical change for sustainability in highly diverse institutional contexts, such as (but not exclusively) the developing world. An agency-based approach is proposed as an alternative to a managerial approach.

Development in the context of care migration from rural Hungary: An agency-based approach

This paper aims to create a better understanding of the interplay between structural constraints and individual agency in the process of international labor migration based on empirical evidence collected in Hungarian small towns and villages. Drawing on Amartya Sen’s capability-based concept of development, and a theory of agency elaborated by Emirbayer and Mische, the paper focuses on live-in care migration as a specific form of female circular migration from Hungary to Western European countries, and highlights the varying and dynamic nature of migrant women’s agency within the complexity of structural constraints. The object of this paper is twofold: first, it compares and systematically analyzes Hungarian migrant elderly care workers’ coping strategies in the face of constraints set in the global context of care work. Second, it aims to provide a comprehensive theoretical framework based on the concepts of agency in which diverse empirical findings – human games within a host household and narratives problematizing these specific social roles – can be interpreted. Our empirical evidence shows that human games and tactics are triggered precisely by structural constraints; they are directly inspired by limitations. Although these tactics are potential tools for enlarging individual room for maneuver situationally, they evidently cannot alter structures. The asymmetry of structure and agency is clearly demonstrated in the fact that the overwhelming majority of Hungarian care workers describe individual gains from their jobs as fragments of development. These fragments reflect not only structural constraints, but also highlight potential gains from this specific type of circular migration, pointing out that the concept of “remittances” is more complex than a mere increase in financial stability.

Implementing pay-for-performance in primary health care: the role of institutional entrepreneurs

Institutional entrepreneurs are vital for facilitating non-incremental health policy change in complex institutional settings where established traditions and practices carry considerable weight. This paper describes a comparative case study of health policy-making which shows that Kingdon’s Multiple Streams Framework for non-incremental policy change requires enhancement to explain results in policy-making in two Westminster unitary majoritarian jurisdictions. The most similar systems comparative study found that historical, rational choice, organisational and discursive institutionalist approaches explained the policy change and variation observed better than agency-based approaches did. However, institutional entrepreneurs were important in both cases. Differences in coordinative discourse help to explain the differences in degree of change achieved in each case study and highlight the importance of discursive institutionalist approaches in bridging institutional and agency-based approaches.

Exploring ‘Successful’ Outcomes of Entrepreneurship Education

During 2005–2006 entrepreneurship students in several UK universities completed a survey about their background and career intentions. This paper reports, eight years on, on a follow-up study with ten of these participants, with the aim of exploring the students' intentions and subsequent actions since graduating. Using a qualitative methodology, the authors examined whether those who were measured as likely to be entrepreneurial are entrepreneurs; and whether the participants consider that their entrepreneurship education experience was valuable. The study finds that career experiences and outcomes are highly idiosyncratic and do not seem to correspond closely to original intentions, regardless of original ambitions. The authors suggest that career destinations are complex in a dynamic graduate employment context, and that entrepreneurship education has a contribution to make for graduates, irrespective of whether or not they become entrepreneurs. The paper identifies a weakness in entrepreneurship education research in its over-reliance on agency-based approaches and its assumption that outcomes are measured in the binary terms of ‘entrepreneur’ or ‘not entrepreneur’. The authors recommend methodological development in the field to capture more appropriately the rich and nuanced relationship between entrepreneurship education and graduate careers. This should lead to a more robust understanding on which to base information for delivery and practice.

Diffusion, contestation and localisation in post-war states: 20 years of Western Balkans reconstruction

This special issue explores norm diffusion, contestation and localisation in the contexts of political transition in general and post-war peacebuilding specifically. It engages with critical moments in which international diffusion endeavours meet local politics of norm contestation in societies undergoing post-war and/or post-authoritarian transitions. The ‘third wave’ of norm research offers an agency-based approach to the negotiation and contestation of the meaning of norms that is consistent with work in peacebuilding studies on the meeting between international norms and local realities in post-war contexts. By honing in on the ‘normative powers’ of local agents, their perspectives and capacities, and how these contribute to norm construction, the special issue provides theoretical and conceptual advances to capture these transition processes in the context of the Western Balkans.

Older rehabilitees’ life-course agency in Finnish gerontological rehabilitation

Aims: This study investigates gerontological rehabilitation sessions of Finnish rehabilitees in the framework of life-course agency from the perspectives of temporal orientation and agency. Methods: The research data were obtained by non-participatory observation in 11 individual goal-setting sessions between 11 rehabilitees and their personal counsellors. The data were analysed in accordance with data-driven, qualitative content and narrative analysis, with an emphasis on the life-course agency approach. Results: Four temporal orientations of older rehabilitees were identified in the rehabilitation sessions: (i) timeless, (ii) past, (iii) present, and (iv) life course. For each temporal orientation, the rehabilitees displayed different kinds of agency. Fractured agency was intertwined with the timeless orientation, frozen agency was related to the past orientation, practical agency to the present orientation, and transitional agency emerged in relation to the life-course orientation. Conclusions: The article contributes to the discussion of how older adults’ rehabilitation should be reformed within the Finnish context. The study suggests that a person-centred gerontological rehabilitation process should be conceptualized in terms of an agency-based approach with a personally constructed and temporally embedded life-course perspective. This kind of conceptualizing could promote empowered cooperation and innovative interventions with flexible schedules in the rehabilitation processes of older adults.

Feedback loops in a world of complexity: a cybernetic approach at the interface of foreign policy analysis and international relations theory

Feedback in foreign policy occurs when a state's foreign policy affects the international context of that state and those changes in context subsequently impact on the state's future foreign policy decisions. In this way, feedback loops can develop, which may become self-reinforcing and in which foreign policy and international context continuously affect each other. Even though such processes are ubiquitous especially in a globalized world, they have hitherto received little systematic attention. We introduce cybernetics as a perspective that puts such feedback effects at the centre of attention and provides an accessible sequential framework for analysing them. Such a cybernetic analysis not only demonstrates the significance of feedback processes in foreign policies but also speaks to several recent debates in international relations theory and foreign policy analysis. In particular, it highlights processes of learning and change, of non-linearity and indeterminacy, and enables the researcher to integrate insights from structure- and agency-based approaches. We outline the merits of a cybernetic analysis by discussing the effects of feedback in the United States' War on Terror.

Tracing discursive space: Agency and change in sustainability transitions

Abstract This article argues that a lack of a consistent agency-based approach in theory on sustainability transitions makes it difficult to describe processes of change. To overcome this problem, elements from transition theory will be rearticulated in terms of ‘discursive fields’, which are the bodies of meanings with which actors engage in social action. With that an agency-based conceptual framework is developed with which processes of change related to sustainability transitions can be researched. Discursive fields are subjected to a different degree of ‘fixation’—some discursive fields are more susceptible to change than others. The notion of discursive fixation helps us to develop new insights about the some of the elementary elements of sustainability transitions, such as the establishment of a so-called socio-technological niche, as well as the scaling up of the outcomes of such a niche. Moreover, the approach developed will be used to explore how individual agents can contribute to change processes. These insights give rise to an array of new empirical research in relation to sustainability transitions.