Key Tensions Research Articles

The moral perils of conditional cash transfer programmes and their significance for policy: a meta-ethnography of the ethical debate.

Conditional cash transfer (CCT) is a compelling policy alternative for reducing poverty and improving health, and its effectiveness is promising. CCT programmes have been widely deployed across geographical, economic and political contexts, but not without contestation. Critics argue that CCTs may result in infringements on freedom and dignity, gender discrimination and disempowerment and power imbalances between programme providers and beneficiaries. In this analysis, we aim to identify the ethical concepts applicable to CCTs and to contextualize these by mapping the tensions of the debate, allowing us to understand the separate contributions as parts of a larger whole. We searched a range of databases for records on public health CCT. Strategies were last run in January 2017. We included 31 dialectical articles deliberating the ethics of CCTs and applied a meta-ethnographic approach. We identified 22 distinct ethical concepts. By analysing and mapping the tensions in the discourse, the following four strands of debate emerged: (1) responsibility for poverty and health: personal vs public duty, (2) power balance: autonomy vs paternalism, (3) social justice: empowerment vs oppression and (4) marketization of human behaviour and health: 'fair trade' vs moral corruption. The debate shed light on the ethical ideals, principles and doctrines underpinning CCT. These were consistent with a market-oriented liberal welfare regime ideal: privatization of public responsibilities; a selective rather than a universal approach; empowerment by individual entrepreneurship; marketization of health with a conception of human beings as utility maximizing creatures; and limited acknowledgement of the role of structural injustices in poverty and health. Identification of key tensions in the public health ethics debate may expose underpinning ideological logics of health and social programmes that may be at odds with public values and contemporary political priorities. Decisions about CCTs should therefore not be considered a technical exercise, but a context-dependent process requiring transparent, informed and deliberative decision-making.

“You Feel Like You Belong Nowhere”: Conflict-Related Sexual Violence and Social Identity in Post-Genocide Rwanda

Globally, the systematic use of sexual violence in modern warfare has resulted in the birth of thousands of children. Research has begun to focus on this often invisible group and the obstacles they face, including stigma, discrimination and exclusion based on their birth origins. Although sexual violence during the Rwandan genocide has been documented on a massive scale, little research has focused on the relational dynamics between mothers who experienced genocide rape and the children they bore. This paper explores the post-genocide realities of these two under-explored populations, revealing two key tensions in relation to identity-building and belonging. Drawing upon in-depth interviews conducted with 44 mothers and 60 youth, we examine how youth participants’ quest for the truth in forming their own identities is often in conflict with mothers’ efforts to disassociate their identities from sexual violence and genocide. Furthermore, both mothers’ and children’s identities remain ‘caught’ in the rigid ethnic politics of the genocide at the national level. Ultimately, this article highlights that the distinction between the self and the larger politics of post-genocide Rwanda are not easily disentangled, as challenges faced by these families exist at the nexus of the personal and the national, the individual and structural.

Atonement and Martyrdom in the Gospel of John

Abstract Does the Gospel of John portray Jesus’ death as an atoning sacrifice? This paper offers a new approach to the revelation vs. sacrifice impasse in scholarship, arguing that Jesus’ atoning death in John should be understood with reference to the non-cultic atoning deaths of the Jewish martyrdom traditions. After critically engaging scholarship, I contextualize John within post-biblical debates regarding sacrificial martyrdom, focusing on the competing reconfigurations of non-cultic atonement in the Maccabean literature. I subsequently show how Jesus’ atoning martyrdom reveals his anti-violent way of the cross as the true martyrdom and atoning sacrifice accepted by God, thereby resolving key tensions within Johannine scholarship. I then demonstrate how this vision of atonement addresses John’s understanding of sin as ignorance and addresses an audience itself facing threats of martyrdom (John 16:2). I conclude with some reflections on how John’s vision of atonement critically differs from later theological theories, particularly penal substitution.

Measuring Reading Motivation: A Cautionary Tale

AbstractMeasuring students’ reading motivation is a common practice in literacy classrooms, and results often inform instruction. This mixed‐methods study problematizes this practice, raising tensions between how reading motivation is measured and its enactment in a reading class. Key tensions include reading motivation as competition versus a collective endeavor, reading motivation emphasizing teacher‐directed learning versus student‐led learning, and reading motivation valuing texts as windows versus mirrors. The author suggests that teachers should take a critical lens to reading motivation measurement tools before using them.

Ambiguity and Conflict in Policy Implementation: The Case of the New Care Models (Vanguard) Programme in England

AbstractPolicy driven change is challenging, with a significant gap between theory and practice. A key tension in enacting such change is achieving a balance between bottom-up development of local, context-specific approaches, and top-down, centrally determined policy solutions and their mutual sequencing. Ideal type models of the policy-making process envisage a rational ordered approach, driven by evidence and accompanied by ongoing evaluation of outcomes (Parsons, 1995, p77); however, the reality is far more complex. We examine the implementation and early operation of the New Care Models (NCM) Vanguard programme in England, using Matland’s (1995) ambiguity-conflict model, to explore the aims and expectations of the programme. We consider the relationship between top-down and bottom-up approaches to policy development and draw attention to the pressures coming from what was initially perceived as a permissive policy approach of encouraging experimentation, whilst also requiring rapid learning, scale and spread. We suggest that future programmes for large-scale policy implementation initiatives could be crafted differently to take account of the environment of implementation and render ambitions more realistic. Rather than aiming to create a set of definite products and templates, it may be that a set of principles for design and implementation should be developed and spread.

Realising local food policies: a comparison between Toronto and the Brussels-Capital Region’s stories through the lenses of reflexivity and co-learning

ABSTRACTThis paper revisits the development of Toronto and Brussels’ local food policies by analysing reflexivity and co-learning as important dimensions within a Hybrid Governance Approach (HGA); it approaches the interaction between four forms of governance (bottom-up, networked, state, market-led) and the tensions between them as hybrid dynamics. Within this approach, reflexivity refers to the positionality of agents, i.e. to the ways local food actors embody as well as reflect on and reconsider their principles and practices through time. Closely related to reflexivity, co-learning involves agential interactions to co-construct enabling food policy delivery systems. The HGA is mobilised to understand the ways in which reflexive capacities, as well as co-learning, take place in the two cases and how they lay the basis of particular modes of (de)institutionalisation. Learning from the two cases’ trajectories, this paper highlights: (a) the role of key governance tensions as triggers as well as breeding grounds for reflexivity and co-learning outcomes; (b) the challenges of food movement actors to surmount or valorise key tensions in order to build accountable modes of food policy delivery through time; (c) the struggles to build legitimacy and accountability in local food movements through the development of bottom-linked organisations and governance modes.

Standardization in the MSPE: Key Tensions for Learners, Schools, and Residency Programs.

The Medical Student Performance Evaluation (MSPE), which summarizes a medical student's academic and professional undergraduate medical education performance and provides salient information during the residency selection process, faces persistent criticisms regarding heterogeneity and obscurity. Specifically, MSPEs do not always provide the same type or amount of information about students, especially from diverse schools, and important information is not always easy to find or interpret. To address these concerns, a key guiding principle from the Recommendations for Revising the MSPE Task Force of the Association of American Medical Colleges (AAMC) was to achieve "a level of standardization and transparency that facilitates the residency selection process." Benefits of standardizing the MSPE format include clarification of performance benchmarks or metrics, consistency across schools to enhance readability, and improved quality. In medical education, standardization may be an important mechanism to ensure accountability of the system for all learners, including those with varied backgrounds and socioeconomic resources. In this article, members of the aforementioned AAMC MSPE task force explore 5 tensions inherent in the pursuit of standardizing the MSPE: (1) presenting each student's individual characteristics and strengths in a way that is relevant, while also working with a standard format and providing standard content; (2) showcasing school-specific curricular strengths while also demonstrating standard evidence of readiness for internship; (3) defining and achieving the right amount of standardization so that the MSPE provides useful information, adds value to the residency selection process, and is efficient to read and understand; (4) balancing reporting with advocacy; and (5) maintaining standardization over time, especially given the tendency for the MSPE format and content to drift. Ongoing efforts to promote collaboration and trust across the undergraduate to graduate medical education continuum offer promise to reconcile these tensions and promote successful educational outcomes.

Birmingham Black Sisters: Struggles to end injustice

This article provides a critical reflection on Birmingham Black Sisters’ (BBS) experiences of fighting racism and sexism during the 1980s, having lain dormant for three decades and now attempting to regalvanise, the article explores some of the key tensions they faced and reflects on the possibilities for future activism. The article is based on both individual contributions from BBS members, who loosely maintain contact today, as well as BBS archives (minutes and reflection) and material from a publication of one of the male dominated organisations with which BBS was involved. The views expressed here, however, are the sole responsibility of the authors. We first outline the political context in which BBS was formed in the 1980s, why we came together and what we achieved. We then highlight some of the contradictions this presented, and how these unfolded then, and their impact on us today.

Healthcare provider and service user perspectives on STI risk reduction interventions for young people and MSM in the UK

ObjectiveBehavioural interventions have been shown to reduce sexual behaviours associated with increased risk of sexually transmitted infections in young people (<25 years) and men who have sex with men (MSM)...

Democratic Socialists on Social Media: Cohesion, Fragmentation, and Normative Strategies

This essay focuses on members of the Democratic Socialists of America (DSA) political organisation in the US and the ambivalence of using social media as a primary means of communication for socialist information and culture. Relying on in-depth interviews with fifteen active members and leaders in DSA, this essay asks: How does socialist communication on social media encourage both cohesion and fragmentation for activists within the DSA? Locating and analysing key tensions felt by DSA members in response to their use of Facebook and Twitter, this project sheds light on the ways in which socialism is presently communicated to publics and counterpublics and identifies important challenges for the expansion of the socialist movement.

Ethnography in health professions education: Slowing down and thinking deeply.

Ethnography has been gaining appreciation in the field of health professions education (HPE) research, yet it remains misunderstood. Our article contributes to this growing literature by describing some of the key tensions with which both aspiring and seasoned ethnographers should productively struggle. We respond to the injunction made by Varpio etal (2017) that HPE researchers should ground their methodological ventures in their historical and philosophical tenets. To do so, we first review core ethnographic texts that provide a background for ethnographic research in HPE, then provide an orienting definition to bind the specificities of ethnographic research. Finally, we review core theoretical and practical considerations for ethnographic research. Ethnography is a slow and deep approach to knowledge production, and as such it requires careful engagement with theory and deliberate choice of methods. Core theoretical tensions include the ontological, epistemological and axiological dimensions of ethnography, and concerns with quality and rigour. Practical tensions include the scope and remit of ethnography, the importance of observing naturally occurring behaviour and the crafting of rich field notes. We encourage ethnographers to pursue scholarship that challenges the status quo. Ethnographers should favour deep encounters with research participants, dig deep into the cultural and structural aspects of HPE and be reflexive about knowledge outputs. At a time in HPE when the pressures to publish are high, using ethnography as a research methodology offers an opportunity to slow down and think deeply.

Departmentalization in Elementary Schools: Contradictions Teachers Confront

This paper presents analyses of observational and interview data gathered in a study of exemplary fourth-grade teachers from five states. The central issue explored is the relative merits of self-contained and departmentalized models of instruction. We found no achievement differences in the classrooms by organizational pattern, but differences in the instruction offered in these two models were identified, and mixed views of the relative advantages of either organization plan were expressed by the participants. A key tension was whether these organizational plans are intended to primarily benefit teachers or students. However, the complexities of the cost/benefit concerns are the findings that this study highlights.

Hanging in the balance: Conceptualising doctoral researcher mental health as a dynamic balance across key tensions characterising the PhD experience

Doctoral researchers (DRs) appear at elevated risk of mental health problems and poor wellbeing during the PhD process, yet there is limited high quality research in this area. We aimed to derive a conceptual model of DR mental health risk and protective factors using thematic analysis of focus group data. The model positions mental health as reflecting dynamic balance across key tensions characterising the doctoral experience (chaos-cosmos, product-person, agency-acceptance, social-individual, safety-authenticity) within core experiential domains; the doctoral researcher, the supervisory relationship, and the system. Individual factors, including historical and personal characteristics, impact on mental health and the expression and balance of key tensions. Key practice recommendations include supporting DR mental health with a whole university approach rather than intervention silos.

“Keep Portland Weird”?

The Portland Book Festival, originally known as “Wordstock,” is the main annual literary event in Portland, Oregon. It is also an increasingly prominent literary festival in the United States. The branding shift from “Wordstock” to “Portland Book Festival” in 2018 unearths key tensions, hierarchies, subversions, and cultural changes in the communicative and social functions of the Festival. The essay identifiestransactionalandtransformativeaspects of the Festival. Bank of America’s festival-naming “title” sponsorship, the partnership of cultural heritage organizations, and Portland place branding offertransactionalstability for the Festival, where parties give and get in kind. The Festival’s temporary affective bonds and their social media documentation facilitatetransformationalexperiences that reinscribe hierarchies of centre/periphery. The name change fosters a more democratic and accessible festival experience. This article takes a multimethod approach, triangulating sentiment analysis of tweets from the 2017 and 2018 Festivals, a survey of 2018 Portland Book Festival attendees, and interviews with prominent stakeholders in the Festival rebranding.

Struggles with autonomy: Exploring the dual identities of surgeons and learners in the operating room

BackgroundDeveloping autonomy is a critical component of becoming an attending surgeon. General surgery training has evolved in recent decades, however, leaving residents less time to work with attendings to establish entrustment. Limited entrustment can impact resident learning and engagement. MethodsA constructivist grounded theory approach was used to guide interviews of 12 general surgery residents and 10 attendings. ResultsEngagement in the OR is perceived by both residents and attendings as fundamental to achieving autonomy. Our study uncovered three key tensions: 1. Residents and attendings both occupy dual roles in the OR; 2. System demands put those roles in tension and opposition constantly; 3. Residents and attendings do deploy strategies to seek balance in those tensions. ConclusionsIn an academic OR setting, competing priorities can negatively impact resident engagement. Participants described some strategies for helping residents and attendings prioritize learning and teaching to better prepare residents for future practice.

Gender norms and social norms: differences, similarities and why they matter in prevention science.

Two streams of theory and practice on gender equity have begun to elide. The first is work conducted to change social norms, particularly using theory that emerged from studies in social psychology. The second is work done on gender norms, emerging historically from feminist scholars working to counter gender inequality. As these two streams of work intersect, conceptual clarity is needed to understand differences and similarities between these two traditions. Increased clarity will improve efforts to address harmful norms and practices. In this article, we review similarities and differences between social and gender norms, reviewing the history of the concepts and identifying key tension points of contrast. We identified six areas of comparison that might be helpful for practitioners working for the promotion of global health as they make sense of social and gender norms. We then offer a definition of gender norms for practitioners and researchers working at the intersection between these two theories. Our definition draws from the two different streams of thought of how norms influence people's actions, acknowledging the double nature of gender norms: beliefs nested in people's minds and embedded in institutions that profoundly affect health‐related behaviours and shape differential access to health services.

Young People's Online Help-Seeking and Mental Health Difficulties: Systematic Narrative Review.

BackgroundYoung people frequently make use of the internet as part of their day-to-day activities, and this has extended to their help-seeking behavior. Offline help-seeking is known to be impeded by a number of barriers including stigma and a preference for self-reliance. Online help-seeking may offer an additional domain where young people can seek help for mental health difficulties without being encumbered by these same barriers.ObjectiveThe objective of this systematic literature review was to examine young peoples’ online help-seeking behaviors for mental health concerns. It aimed to summarize young peoples’ experiences and identify benefits and limitations of online help-seeking for this age group. It also examined the theoretical perspectives that have been applied to understand online help-seeking.MethodsA systematic review of peer-reviewed research papers from the following major electronic databases was conducted: PsycINFO, Cumulative Index of Nursing and Allied Health Literature, PubMed, Cochrane Library, Association for Computing Machinery Digital Library, and Institute of Electrical and Electronics Engineers Xplore. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. The search was conducted in August 2017. The narrative synthesis approach to reviews was used to analyze the existing evidence to answer the review questions.ResultsOverall, 28 studies were included. The most common method of data collection was through the use of surveys. Study quality was moderate to strong. Text-based query via an internet search engine was the most commonly identified help-seeking approach. Social media, government or charity websites, live chat, instant messaging, and online communities were also used. Key benefits included anonymity and privacy, immediacy, ease of access, inclusivity, the ability to connect with others and share experiences, and a greater sense of control over the help-seeking journey. Online help-seeking has the potential to meet the needs of those with a preference for self-reliance or act as a gateway to further help-seeking. Barriers to help-seeking included a lack of mental health literacy, concerns about privacy and confidentiality, and uncertainty about the trustworthiness of online resources. Until now, there has been limited development and use of theoretical models to guide research on online help-seeking.ConclusionsApproaches to improving help-seeking by young people should consider the role of the internet and online resources as an adjunct to offline help-seeking. This review identifies opportunities and challenges in this space. It highlights the limited use of theoretical frameworks to help conceptualize online help-seeking. Self-determination theory and the help-seeking model provide promising starting points for the development of online help-seeking theories. This review discusses the use of these theories to conceptualize online help-seeking and identify key motivations and tensions that may arise when young people seek help online.

Remodelling general practice training: Tension and innovation.

The transfer of general practice training in Australia to the two general practice colleges is an opportunity for change in the model of training. The dialectical theory of institutional change suggests that change occurs where organisational structures of training are in tension with the needs of those delivering training, and effective change arises from innovation within these tension points. These tensions have also been faced by general practice training organisations internationally, where solutions have also been crafted. By exploring training tensions and responses to these, the aim of this study was to inform the remodelling of general practice training in Australia. Senior educators and stakeholder representatives in Australia and internationally were interviewed to identify tensions in training delivery and innovative responses to these. An interpretative qualitative analysis was undertaken. Eight key tensions and associated innovative responses were identified. Drawing from the findings, this article provides recommendations for remodelling general practice training in Australia.

Question Asking and the Common Good: A Hermeneutic Investigation of Student Questioning in Moral Configurations of Classroom Practice

This qualitative study (based on a hermeneutic moral-realist interpretive frame (Yanchar &amp; Slife, 2017)) explored question asking as it unfolded in the everyday practice of being a student in a graduate course on design thinking (with an emphasis on design in education). Findings are presented as four key tensions that occurred within the complex classroom setting under investigation: “theory and overlapping practices,” “convergence and divergence,” “participation and reticence,” and “give and take.” Overall, these thematized tensions point to a dynamic interplay between student agency and the common good of the class. These findings have significant implications for understanding student questioning experiences and the study of classroom interactions.

How Civil Servants Frame Participation: Balancing Municipal Responsibility With Citizen Initiative in Ede’s Food Policy

Contemporary governance is marked by increased attention for participation of non-governmental actors (NGAs) in traditionally governmental activities, such as policy-making. This trend has been prevalent across food policy processes and reflects a key feature of food democracy. However, the role of governmental actors in facilitating and responding to this participation remains a gap in the literature. In this article, we ask how civil servants frame the participation of NGAs in policy processes. Drawing on ethnographic research, we introduce the case of civil servants working on an urban food policy for the municipality of Ede (the Netherlands). Our analysis uncovers two competing frames: 1) highlighting the responsibility of the municipality to take a leading role in food policy making, and 2) responding reflexively to NGAs. The analysis provides insights into how the framing of participation by civil servants serves to shape the conditions for participation of NGAs. It further sheds light on related practices and uncovers existing tensions and contradictions, with important implications for food democracy. We conclude by showing how, in the short term, a strong leadership role for civil servants, informed by the responsibility frame, may be effective for advancing policy objectives of the municipality. However, the reactive frame illustrates that civil servants worry this approach is not effective for maintaining meaningful participation of NGAs. This remains a key tension of participatory municipal-led urban food policy making, but balancing both municipal responsibility and an open and reactive attitude towards the participation of NGAs is useful for enhancing food democracy.