Dialogue Meetings Research Articles

PHR in health and social care for older people – regional development through learning within and across organisations

The study draws on findings from a series of seven participatory action research projects in community care for older people carried out over a period of eight years in 20 municipalities in southern Sweden. The analysis here looks at social impact across administrative levels and geographical scales. Different professional groups and care workers in community care participated, crossing divides between social work and health care. The participatory methods all involved a phase of individual reflection, a phase of reflection in practice with colleagues and mixed groups at the regional level, including unit managers and directors in some stages. Impacts concerned interprofessional learning and improved conditions for collaboration in care for older people across institutional boundaries as well as organisational learning across the municipalities. The action research approach was characterised by intensive work with values, empowering low-status professional groups. Social impacts were achieved beyond each project by benefitting from the multi-stakeholder design, using the structure of the organisations and the regional R&D department of the Association of Local Authorities. Over time, the different projects thus contributed to regional development ‘from below’. Nevertheless, employer perspectives tended to determine which conclusions from the projects were eventually implemented and prioritised. Continued reflective dialogue meetings between professional groups are therefore, needed as part of regular work processes. Local and regional structures need forms of autonomy that allow them to implement recommendations from participatory projects. Finally, employee perspectives need to be reflected in decision-making at all levels, particularly including low-status groups of care staff.

Participatory approach to design social accountability interventions to improve maternal health services: a case study from the Democratic Republic of the Congo

BackgroundSocial accountability (SA) comprises a set of mechanisms aiming to, on the one hand, enable users to raise their concerns about the health services provided to them (voice), and to hold health providers (HPs) accountable for actions and decisions related to the health service provision. On the other hand, they aim to facilitate HPs to take into account users’ needs and expectations in providing care. This article describes the development of a SA intervention that aims to improve health services responsiveness in two health zones in the Democratic Republic of the Congo.MethodsBeneficiaries including men, women, community health workers (CHWs), representatives of the health sector and local authorities were purposively selected and involved in an advisory process using the Dialogue Model in the two health zones: (1) Eight focus group discussions (FGDs) were organized separately during consultation aimed at sharing and discussing results from the situation analysis, and collecting suggestions for improvement, (2) Representatives of participants in previous FGDs were involved in dialogue meetings for prioritizing and integrating suggestions from FGDs, and (3) the integrated suggestions were discussed by research partners and set as intervention components. All the processes were audio-taped, transcribed and analysed using inductive content analysis.ResultsOverall there were 121 participants involved in the process, 51 were female. They provided 48 suggestions. Their suggestions were integrated into six intervention components during dialogue meetings: (1) use CHWs and a health committee for collecting and transmitting community concerns about health services, (2) build the capacity of the community in terms of knowledge and information, (3) involve community leaders through dialogue meetings, (4) improve the attitude of HPs towards voice and the management of voice at health facility level, (5) involve the health service supervisors in community participation and; (6) use other existing interventions. These components were then articulated into three intervention components during programming to: create a formal voice system, introduce dialogue meetings improving enforceability and answerability, and enhance the health providers’ responsiveness.ConclusionsThe use of the Dialogue Model, a participatory process, allowed beneficiaries to be involved with other community stakeholders having different perspectives and types of knowledge in an advisory process and to articulate their suggestions on a combination of SA intervention components, specific for the two health zones contexts.

The recommendations of ICRP Publication 111 in the light of the ICRP dialogue initiative in Fukushima.

Publication 111, published by the International Commission on Radiological Protection (ICRP) in 2009, provided the first recommendations for dealing with the long-term recovery phase after a nuclear accident. Its focus is on the protection of people living in long-term contaminated areas after a nuclear accident, drawing on the experience of the Belarus population, Cumbrian sheep farmers in the UK, and Sami reindeer herders in Norway affected by the fallout from Chernobyl. The ICRP dialogue initiative in Fukushima confirmed what had been identified after Chernobyl, namely the very strong concern for health, particularly that of children, loss of control over everyday life, apprehension about the future, disintegration of family life and of the social and economic fabric, and the threat to the autonomy and dignity of affected people. Through their testimonies and reflections, the participants of the 12 dialogue meetings shed light on this complex situation. The ICRP dialogue initiative also confirmed that the wellbeing of the affected people is at stake, and radiological protection must focus on rehabilitation of their living conditions. The challenge is to incorporate the important clarifications resulting from the ICRP dialogue initiative into the updated version of Publication 111 that is currently in development. This paper does not necessarily reflect the views of the International Commission on Radiological Protection.

Involving stakeholders in radiological protection decision making: recovery history and lessons from the people of Fukushima

Between September 2011 and August 2015, the International Commission on Radiological Protection (ICRP) organised a series of 12 stakeholder dialogue workshops with residents of Fukushima Prefecture. Discussions focused on recovery, addressing topics such as protection of children, management of contaminated food, monitoring, and self-help measures. The OECD Nuclear Energy Agency (NEA) supported, and the Committee on Radiation Protection and Public Health (CRPPH) Secretariat attended, all 12 meetings to listen directly to the concerns of affected individuals and draw lessons for CRPPH. To summarise the dialogue results, ICRP organised a final meeting in Date, Japan with the support of NEA and other organisations. The lessons from and utility of the dialogue meetings were praised by dialogue participants and sponsors, and ICRP agreed that some form of dialogue would continue, although with ICRP participation and support rather than leadership. This paper summarises the internationally relevant lessons learned by CRPPH from this important process.

Potential positive impact of group-based diabetes dialogue meetings on diabetes distress and glucose control in people with type 1 diabetes

ObjectiveTo evaluate the effect of group-based diabetes dialogue meetings (DDMs) on diabetes distress, perceived competence and glycaemic control. MethodsPatients with type 1 diabetes (T1D) were invited to DDMs with peers and healthcare professionals. The impact of participation was evaluated by change in diabetes distress measured by Problem Areas in Diabetes (PAID), diabetes competence measured by Perceived Competence in Diabetes (PCD), change in HbA1c before and one year after the DDMs. Results120 patients with T1D participated in at least one DDM: 75% female, mean age 50 years (range 21–76), mean diabetes duration 23 years (range 0–64); 39% of all participants had a baseline PAID score≥33, indicating high levels of distress. After one year, both PAID (from 30.4±16.6 to 27.4±17.1; n=81, p=0.03), and mean HbA1c (61.6±10.2 to 58.8±9.9; n=120, p<0.0001) had improved significantly. PCD showed no change. Meanwhile, the benefit from participating was rated high with a median of four out of five and the major gain being the possibility to share experiences with peers. ConclusionGroup-based DDMs were highly appreciated by participants and associated with significant improvements in diabetes distress and HbA1c. Practice implicationsDDMs target a large group of patients using few staff resources.

The Role of Independent Human Rights Institutions for Children (IHRICs) in Africa in Raising Awareness about Children's Rights among Children

This article discusses implementation of the UNCRC 1989, by African Countries. It explores ways of using Independent Human Rights Institutions for Children (IHRIC) in Africa, to increase awareness of children's rights among children so that they (children) can participate and even lead in realizing their own rights. It is based on a qualitative design in two phases. Phase 1 was a documentary review of periodic reports from 25 African signatory states. Content analysis revealed that IHRICs by African Countries are not independent according to the recommendations of the General Comment No. 2 2002 which reverberates with the Paris Principles 1993. Phase 2 Field work was conducted in two districts and two communities in Uganda. Action Research approaches were employed to 72 participants including 21 children aged 10-15 years. Focus Group Discussions were conducted with children, Dialogue Meetings for the community facilitated by children and Key Informant Interviews. It was found that children can articulate their rights and contribute to decisions that affect them. This article suggests that States Parties in Africa should support implementation of UNCRC by availing funds to the HRIC to fulfill their functions. Emphasis should be on raising awareness about children's rights and involving children in decisions making, planning and policy development activities.

Strategies for Scaling up HIV prevention among Adolescents: TASO Masaka Safe Male Circumcision Experience

Issue: Uganda has HIV prevelance of 7.3%; however HIV prevalence in Masaka is at 10%. TASO Masaka has 383 active adolescents in care. Men’s uptake of Safe Male Circumcision is at 34% in the central area of Uganda including Masaka. Safe male circumcision (SMC) is one intervention for HIV prevention that targets male adolescents directly. SMC was conducted at the facility with one mobilizer doing mobilization. There was also limited community leadership involvement in the program. To improve adolescents’ uptake of SMC services, TASO Masaka came up with strategies like training community linkage facilitators to mobilize adolescents for SMC, targeting schools, conducting dialogue meetings and setting up circumcision camps. Description: 6 dialogue meetings were conducted in 6 districts to allow community participation. 2 linkage facilitators were trained in SMC and community mobilization. Targeting schools for sensitization and encouraging adolescents seek consent from their parents. Offering free transport to facility and camping sites, Provided IEC through videos, flipcharts, fliers complemented by health talks and one to one counseling. Circumcised Peers were encouraged to do mobilization of their fellow peers. HCT and safe male circumcision services are provided to all eligible clients. Follow ups are done after 48 h, 7 days and 6 weeks. SMC telephone hotline was established for follow ups. Lessons learnt: Dialogue meetings help program implementers to work in a coordinated manner with meaningful involvement of community leadership. A total of 20786 adolescents received HCT and circumcision (6/1/2014 to 17/12/2015 contributing to 85% of the total men circumcised. Peer to peer mobilization has worked more with adolescents as compared to men. A school approach (221 schools) targeted many adolescents for mobilization and follow up services, 16628) adolescents were followed up in the review period. SMC camps bring services nearer to the community a, total of 1883 adolescents were circumcised in camps. 20786 Adolescents have tested for HIV, 100 treated sexually transmitted infections and receive risk reduction messages. The SMC hotline improved follow-ups, linkages and mobilization. Interventions that target a particular group for HIV prevention need a multidisciplinary approach.

‘If they'd written more…’ – On students’ perceptions of assessment and assessment practices

The focus of the current study is students’ perceptions of assessment and assessment practices. Assessment is understood as practices closely connected to the planning, enactment and evaluation of teaching and learning activities. The data derive from focus group interviews and dialogical meetings with students at a Swedish comprehensive school. Theories of assessment and validity are used as a framework to interpret and contextualise the data. An empirically developed interconnecting data analysis model is used as an analytical tool to connect students’ perceptions, assessment aspects and preconditions in a specific context. Our results indicate that students perceive assessment at different comprehension levels, categorised as performing, understanding and learning. Preconditions affect students’ possibilities of accessing assessment practices and using assessments to improve their performance. In this article we highlight the importance of taking student voice and preconditions into consideration when structuring accessible and meaning-making assessment practices that hold possibilities for enhanced learning.

Japanese experience in stakeholder involvement: ICRP Dialogue meetings

The International Commission on Radiological Protection initiated a forum for dialogue with the parties concerned (ICRP Dialogue) to support the rehabilitation of living conditions after the Fukushima nuclear accident. Ten meetings have been held as of the end of 2014, involving a wide variety of participants including the local residents, authorities, NPOs, experts, professionals, media and foreign representatives. Through sharing information and experiences among various parties, the Dialogues have fostered an awareness of the human dimension and the importance of self-help protective actions assisted by relevant experts. Such understanding will be essential for the development and implementation of a radiological protection strategy in the complex situations of the affected areas.

Maternal, newborn and child health needs, opportunities and preferred futures in Arusha and Ngorongoro: hearing women's voices.

Background With the approaching sunset on the Millennium Development Goals (MDGs), Tanzania continues with its final national push towards achievement of MDG #4 and MDG #5. The Mama Kwanza Socio-economic Health Initiative (MKSHI) was introduced in the hope of contributing to improving maternal, newborn, and child health in Arusha and Ngorongoro. The MKSHI project is a holistic, inter-sectoral approach to maternal, newborn, and child health which aligns with the Government of Tanzania’s Vision 2025. At the project onset, a baseline assessment was conducted to launch ongoing benchmarking, monitoring, and evaluation of the project’s impacts and implications. The aim of this baseline assessment was twofold. First it was to determine the state of maternal, newborn, and child health in the two project sites. Second it was to ensure that a baseline of key indicators was established as well as identification of unique indicators relevant to the populations of interest.ResultsThe baseline study was a mixed methods approach to identify maternal, newborn, and child risk factors and indicators in the two target sites. This paper focuses on the qualitative methods and findings. The qualitative component included a series of five community dialogue meetings and thirty-seven individual/dyad interviews with women, providers, and stakeholders. Initially, community meetings were held as open dialogues on maternal, newborn, and child health issues, opportunities, and preferred futures. Individual/dyad interviews were held with women, providers, and stakeholders who held unique information or experiences. Both community dialogue and interview data was analysed for themes and guiding or critical comments. Three over-arching findings emerged: What took you so long to come? How do we know what you know? and How will it change for our daughters?ConclusionsParticipant voices are vital in ensuring the achievement of local and global efforts and preferred futures for maternal, newborn, and child health services. This study contributes to the inclusion of women in all aspects of the planning, implementation, and delivery of maternal, newborn, and child health services in the target areas and beyond.

Children’s perceptions of their right to quality healthcare in Uganda: Critical gaps in programme and policy development

In 1989, Article 24 of the Convention on the Rights of the Child (UNCRC) stipulated good quality healthcare, the best healthcare possible, as a human right for every child. This qualitative study in Uganda examined children’s awareness of and access to timely, quality healthcare as part of a broader study examining whether institutions established for children in Africa are raising awareness about children’s rights amongst children and engaging with children in decision-making and planning. To establish whether children possessed knowledge of their rights and could inform decisions at a community level. Using action research approaches, the team conducted focus group discussions (FGD), drawing, key informant interviews(KII), dialogue meetings (DM), and observations in one village in a rural and another in aperi-urban district, with 72 participants (21 children aged 10–15 and 51 adult stakeholders at community, district and national levels). Children were aware of their right to quality health services. In FGDs and drawing, children described their dissatisfaction with and difficulties in accessing healthcare services. These were confirmed with the adult stakeholders in the KIIs and DMs, the DMs also including children who presented their FGD results to community stakeholders. The findings suggested a lack of clear guidelines in schools or health facilities to support children needing medical attention. There was limited stakeholder capacity to involve children meaningfully in programme plans and decisions directly affecting them. Recommendations included the development of explicit policies with specific strong linkages between educational, health and other service institutions to promote, protect and respect children’s rights and also training to elicit children’s perspectives in decisions that affect them.

Trust, structures and Track-2 Dialogue in the EU-China relationship: resetting and resettling a ‘strategic partnership’?

This article looks at matters of trust, of structures and of dialogue in the European Union (EU)-China relations. It argues that EU-China relations need resetting given the increasingly negative perceptions of China in Europe and given Chinese dissatisfaction with what it considers to be a degree of EU incoherence, incompetence and inconsistencies. Their ‘strategic partnership’ proclaimed in 2003 in many ways is rather empty and lacks much coordination of diplomacy. Their economic relationship while substantial is problematic and asymmetric in nature. However, restructuring the relationship through new dialogue mechanisms and agreements may resettle their relationship along more pragmatic functional grounds. In particular, the creation in 2012 of a third High Level Dialogue, at Track-2 rather than Track-1 level, that of People-to-People (PPD), may reduce the ‘trust deficit’ in the still longer term. Consequently, the article seeks to contextualize and evaluate the rhetoric and substance surrounding the various dialogue meetings and structures emerging in 2012. It also considers the progress, or perhaps lack of progress, on concluding a Partnership and Cooperation Agreement (PCA). It concludes that one way forward is to de-politicize the partnership.

Improving safety in small enterprises through an integrated safety management intervention

This study tests the applicability of a participatory behavior-based injury prevention approach integrated with safety culture initiatives. Sixteen small metal industry enterprises (10–19 employees) are randomly assigned to receive the intervention or not. Safety coaching of owners/managers result in the identification of 48 safety tasks, 85% of which are solved at follow-up. Owner/manager led constructive dialogue meetings with workers result in the prioritization of 29 tasks, 79% of which are accomplished at follow-up. Intervention enterprises have significant increases on six of eight safety-perception-survey factors, while comparisons increase on only one factor. Both intervention and comparison enterprises demonstrate significant increases in their safety observation scores. Interview data validate and supplement these results, providing some evidence for behavior change and the initiation of safety culture change. Given that over 95% of enterprises in most countries have less than 20 employees, there is great potential for adapting this integrated approach to other industries.

The encounter between two research disciplines – innovation through rethinking values and mealtime in nursing homes

More than 44,000 Norwegian citizens live in nursing homes. Many health problems are related to malnutrition and under-nourishment. Registered nurses are responsible for the care quality in nursing homes. Due to limitations with respect to workforce and budget, it is of importance that staff discovers new mealtime solutions. In the field of industrial design, the profession is continuously proliferating in specialized directions concerning both design tasks to solve, design approaches, as well as the span of technological and human-oriented means as part of solutions. The aim has been to explore how to improve the quality of mealtime in nursing homes. We have included: 1) observations 2) dialogue meetings and 3) workshops. The final result of the study is seen as two-fold: the value platform and five design concept ideas. Within the field of clinical nursing research, the hunt for new solutions is a challenge. In this work, crossing disciplinary frontiers is of great importance. In the present study, we have tried to implement this approach and experience. Through rethinking values, we have discovered innovative solutions and strategies that might have been difficult to discover within a traditional, single disciplinary method.

Exploring ART Intake Scenes in a Human Rights-Based Intervention to Improve Adherence: A Randomized Controlled Trial

To assess the effectiveness of a psychosocial individual intervention to improve adherence to ART in a Brazilian reference-center, consenting PLHIV with viral load >50 copies/ml were selected. After 4 weeks of MEMS cap use, participants were randomized into an intervention group (IG) (n = 64) or control group (CG) (n = 57). CG received usual care only. The IG participated in a human rights-based intervention approach entailing four dialogical meetings focused on medication intake scenes. Comparison between IG and CG revealed no statistically significant difference in adherence measured at weeks 8, 12, 16, 20 and 24. Viral load (VL) decreased in both groups (p < 0.0001) with no significant difference between study groups. The lower number of eligible patients than expected underpowered the study. Ongoing qualitative analysis should provide deeper understanding of the trial results. NIH Clinical Trials: NCTOO716040.

Dialogue as nuclear waste management policy: can a Swedish transparency programme legitimise a final decision on spent nuclear fuel?

The purpose of this article is to discuss Swedish nuclear waste management policy and assess whether a transparency programme has affected the policy discourse and contributed to legitimatising the forthcoming government decision on a final solution for spent nuclear fuel. The transparency programme implemented by the National Council for Nuclear Waste (NW Council) consisted of two main activities: dialogue meetings and public hearings for deliberating on different aspects of the waste issue. Lessons are drawn from an evaluation of the programme. The article concludes that the NW Council has implemented the government's legitimatisation policy by its existence and through the transparency programme, but achieving long lasting legitimacy is a complicated matter. Dialogue meetings and public hearings are reasonable measures; whether these measures are sufficient to legitimatise the final decision also depends on how the appropriate state agencies and the government justify their assessments and decisions regarding the long-term safety, security and sustainability of the Swedish Nuclear Fuel and Waste Management Company's proposed final repository. The dialogue policy and transparency programme, however, has failed to influence the key decisions which remain in the control of the powerful interests, most notable Swedish Nuclear Fuel and Waste Management Company (SKB) and the government.

Assessing the Impact of Saudi Arabia's National Dialogue: The Controversial Case of the Cultural Discourse

This article attempts to advance our understanding of Saudi Arabia's National Dialogue institution and to appraise its significance, by examining a related but parallel development — the surprise decision by the King Abdulaziz Center for National Dialogue (KACND) to incorporate discussion of the issues of tribalism, regionalism and intellectual classification (Arabic: tasneef) and their impact on national unity, into the recently established KACND Cultural Discourse (Arabic: al-hiwar al-thaqafia). It also examines the rationale behind the decision to include controversial issues in the Cultural Discourse meetings. The establishment of the Cultural Discourse in 2009 and decision to hold two additional forums in relatively quick succession during the following year appears to suggest that KACND was willing to respond to criticism that it was no longer addressing issues deemed important to Saudi society and to counter increased apathy that had greeted its most recent service-related National Dialogue Meetings. This development could also be interpreted as an attempt to reinvigorate the dialogue process by including both individuals and constituencies absent from the dialogue process since the shift from ideology-related debate to service-related forums. In consequence, the establishment of the Cultural Discourse marked a return by KACND to ideologically orientated themes and discussions that appear to resonate with Saudi society. The article contextualises this decision through a general background of the Cultural Discourse in order to differentiate this forum from the ongoing series of National Dialogue Meetings. It examines the three Cultural Discourse meetings with emphasis on the third Cultural Discourse meeting in Jeddah on 28–9 December 2010.

Therapist attentiveness and negative capability in dialogical family meetings for psychosis

Jaakko Seikkula (2008) has pointed towards the importance of practitioners working in the present moment in dialogical therapy. Extrapolating from Seikkula's work, this article considers the significance of the qualities of therapist attentiveness, generosity and negative capability in dialogical family meetings for psychosis. It is proposed that these qualities are of particular importance when family meetings occur in crisis situations, as when under pressure practitioners can easily be drawn into prematurely interventionist stances that may unintentionally promote chronicity for the person experiencing psychosis. The value of co‐working arrangements in enabling practitioners to maintain attentiveness and negative capability in this work is also considered.

Bach in Edinburgh

Bach Network UK came into being in 2004, as the vision of Reinhard Strohm (Oxford), Ruth Tatlow (Stockholm) and John Butt (Glasgow). Positioned geographically and conceptually between the Bach Archive Leipzig and the American Bach Society, it has become an intellectual and collegial meeting place for Bach research and performance from around the globe. The biennial Dialogue Meetings—so-called explicitly in order to emphasize the practice of free exchange of ideas—has become a welcome opportunity to meet with colleagues and friends and share the most recent research about the composer. As an important by-product, the Dialogue Meetings provide the core material for BNUK's peer-reviewed online journal, Understanding Bach (www.bachnetwork.co.uk). Over the weekend of 12–14 August 2011, BNUK held its fifth Dialogue Meeting in Edinburgh. Seven sessions were organized over the three days, with papers given by musicologists, theorists, writers, students and performers. Interspersed between sessions were performances, exhibits, special speeches and panels, and plenty of breaks to get to know new colleagues and talk about Bach. The Meeting was held in the grounds of the spacious Loretto School outside Edinburgh, and the timing was intentionally planned to coincide with the Edinburgh Festival. The dialogue sessions were delivered in the beautiful 17th-century Pinkie House, with its famous 96-foot-long Painted Gallery, whose dramatic ceiling is sumptuously adorned with emblems and inscriptions.

Prevention of bullying and conflicts at work

PurposeThis paper aims tp prevent bullying and conflicts at work and to identify process factors associated with the implementation and effects of such interventions.Design/methodology/approachThe paper presents process evaluation data from an intervention study in two organizations. A quasi‐experimental, process‐oriented research design was used. The following interventions were implemented: lectures on bullying, courses in conflict prevention and management, dialogue meetings, the distribution of pamphlets, newsletters and posters as well as steering group meetings.FindingsResults indicate that participants benefited from the interventions, in particular the dialogue meetings and the courses in conflict prevention and management. Moreover, various factors stimulating or obstructing the implementation and effects of interventions were identified.Research limitations/implicationsThe use of process evaluation to document the phases of the study and relevant process factors is a major strength. However, the study only included two public sector workplaces and no control groups.Originality/valueThe use of qualitative process‐evaluation helped identify important process factors affecting the implementation of interventions and their perceived effects. The paper thus yields valuable knowledge to researchers and practitioners.