True Partnership Research Articles

Limits of India–US Relations: Balancing Through Strategic Autonomy and Multi-alignment

The India–US relationship has often been described as a defining partnership. But the nature of the friendship in actuality is yet to assume depth. Despite convergences at multiple levels, it falls short of a true strategic partnership or deep friendship. The India–US relationship is neither a trusted nor an assured economic or security partnership. It is often tested by the vagaries of real-time issues, especially involving other great powers. That is why, despite signing the civilian nuclear deal, foundational agreements, being members of the QUAD and Indo-Pacific Economic Forum, and with the common objective of containing the rise of China, they are unable to work closely together on myriad bilateral, international and regional issues. There are differences over matters of primary interests and the type of partnership that each wants to establish. The United States was insensitive to Indian concerns in its abrupt drawdown from Afghanistan in 2021, sub-continental security threats emanating from the China–Pakistan axis and its continued military support to Pakistan. India’s neutral stand (read in the United States as being pro-Russian) in the Ukraine crisis marked by its abstention from voting against Russia in the UN and purchase of Russian oil despite strong objections from the US-led Western camp are cases in point. We argue that India’s US policy is a case of limited balancing dictated by compulsions and lacks depth. For rising India, a continued desire for strategic autonomy and multi-alignment—the post-non-alignment foreign policy principles—guides its foreign policy orientation. For Washington, a deeper relationship would imply India abandoning its visions of strategic autonomy and joining more formally in Washington’s orbit. These core national objectives of the two countries limit the level of partnership they can forge.

Implantable cardioverter defibrillator explantation upon patient request: Clinical and ethical considerations.

Implantable Cardioverter Defibrillator (ICD) implantation has significantly modified the natural history of patients at high risk of sudden cardiac death (SCD) in various types of heart diseases. However there is a high rate of psychological distress and reduced quality of life in patients with an ICD, more evident in younger individuals. The ICD removal upon patient request is a very rare event and causes many clinical and ethical issues. The article discusses the case of a young patient affected by hypertrophic obstructive cardiomyopathy, who underwent implantable cardioverter defibrillator (ICD) implantation as a primary prevention of sudden cardiac death (SCD). Two years after the implantation, the patient repeatedly requested removal of the ICD due to of a significant and untreatable psychological device intolerance. Intervention became possible only after extensive psychological evaluation, which excluded specific pathology, and the ratification of Italian law 219/2017 on informed consent and advance directives, which guarantees the patient's independent decisions on current and future medical treatment. The explantation was performed 7 years after the implant. The patient is alive and in good health. The paper debates the issues related to establishing a patient-physician relationship based on respect for the patient's autonomy and experience of illness, in reference to principles such as beneficence and non-maleficence, and the conflicts that sometimes arise between them. If a paternalistic approach in the patient-physician relationship evolves into a patient-centered model, it is more certain that the patient's choice is realistically known and shared, and that it is consistent with the patient's values and life goals. The shared decision making (SDM) process and the use of pathology-specific decision aids are able to transform the informed consent tool, usually related to medical-legal issues, into an aid for true partnership between the patient and the medical care team.

Reflecting on the Spectrum of Involvement: How do we involve patients as partners in education?

The Spectrum of Involvement describes six levels of active patient involvement in healthcare education. Only at the highest levels are patients described as 'equal partners'. Although this framework was never intended to be hierarchical, healthcare educators continue to strive towards aspirations for involving patients as 'equal partners' in education. However, we do not know what these partnerships mean for all stakeholders and how they can be achieved in practice. This study explores key stakeholders' understandings and experiences of patient partnerships in healthcare education. A qualitative case study design was adopted, underpinned by a social constructivist philosophical stance. Semi-structured interviews were conducted with patients (n = 10) and educators (n = 10) from across a Medical School and a Healthcare School. Five focus groups were held with penultimate year students (n = 20) from across the two Schools. Data were analysed using reflexive thematic analysis. Three themes were generated: (i) equal partnerships are neither feasible nor desirable; (ii) partnership is about being and feeling valued; and (iii) valuing patients as partners. Patients did not always desire the highest levels of involvement, as 'equal partners' in education. All stakeholders agreed that partnership need not be synonymous with equality. Instead, they contended that true partnerships were about valuing patients for their contributions at any level of involvement. Remuneration, student feedback, training and providing institutional access were viewed as important methods of valuing patients as partners. Patients, educators and students questioned the notion that patient partnerships are only achievable at the highest levels of involvement. Critical application of the Spectrum of Involvement in future research and education is encouraged. This study addresses a gap in the literature, providing tangible approaches to valuing patients as partners that are endorsed by all stakeholders. We propose a model for achieving valued patient partnerships in educational practice.

Addressing Ethical Issues in Contemporary International Education & Development

Abstract Empowered by global movements like Millennium Development Goals (mdg s), Sustainable Development Goals (sdg s), and Education for All (efa), the field of international education policy continues to help improve educational access and quality for millions of children and adult learners worldwide, including those affected by extreme poverty. However, often times the way that educational policy and programming is conducted in global South does not always reflect the positive ideals behind these goals. This piece examines ongoing trends of unethical partnerships, policies, and practices in contemporary international education. Reflecting legacies of neocolonialism and ethnocentricity, these problems can create a toxic development culture and minimize authentic collaboration at all levels. Yet, through engaging in a dialogue about these issues, we may begin to make valuable changes that help foster true partnerships and more effective, sustainable change for those most in need.

Building genomic capacity for precision health in Africa.

The African continent is poised to have a pivotal role in the global population landscape, with the United Nations projecting a population of 2.5 billion (more than 25% of the global population) by 2050. Amid this demographic shift, Africa faces a unique healthcare challenge-navigating a complex landscape of infectious and non-communicable diseases. This necessitates a departure from the conventional 'one-size-fits-all' medical model toward precision approaches that are efficient and sustainable. Genomic capacity is a pillar of precision health; however, access to up-to-date genetic testing in African countries is limited, compounded by a startling lack of representation of data from populations of African descent in gene discovery studies. In this Review, we delve into the challenges impeding the development of genomic capacity in Africa, such as the lack of electronic clinical and epidemiological records, infrastructural challenges, high supply chain costs and the 'dependency trap' that jeopardizes long-term sustainability. We emphasize the need for strategies hinged on true partnerships, robust infrastructure, workforce development and well-crafted policies. Finally, we outline recent progress and existing initiatives that should be considered as role models for future capacity-building initiatives.

Students as partners for effective change

My journey as a student partner began in the summer of 2020, amidst overwhelming COVID-19 hysteria and an opportunity to explore a new kind of online learning. I was doing research with a professor of mine and invited to a workshop about Pedagogical Partners with Alison Cook-Sather. When I learned how impactful my work could be as a student partner, I was hooked. For many years, I had felt as though students were not listened to, heard, or respected. I wanted students to be able to play an active role in their own learning. My freshman year, I became an undergraduate teaching assistant (UTA). The experience truly changed my college experience - I mended my troubled relationship with school and learning and came to love it. Now, in my final year of college, I’ve been a UTA every semester since my freshman year. I’ve done research on the number of UTAs across the country and on campus at Syracuse University (SU). At SU, UTAs were few and far between, just about 10% of classes had one. The most common answer as to why UTAs weren’t used was that there was no money to pay them, so I created my own class that gave students 3 credits to be a UTA and partnered up with two close faculty mentors of mine to teach it. We reflected, dished out advice, and made important bonds with faculty and each other. After one very successful semester, we combined with the Partnership for Inclusive Education (PIE) Program through the Center for Teaching and Learning Excellence to merge the UTA program with a student consultant program. This semester, I am enjoying the best of both worlds as a UTA as well as a lead student consultant. Over the course of my college career, I have learned what a true partnership means, experienced the two-way learning it provides, and worked to make courses more inclusive, understanding, and student-centered. I’ve fought hard to put students in decision-making roles and mentored countless students into fantastic student partners that have changed campus for the better.

True partnerships in SEND. Working together to give children, families and professionals a voice By H.Green and B.Edwards, London: Routledge. 2023. ISBN: 978‐0‐367‐54494‐2

True partnerships in <scp>SEND</scp>. Working together to give children, families and professionals a voice By H.Green and B.Edwards, London: Routledge. 2023. ISBN: 978‐0‐367‐54494‐2

Lessons learned in measuring patient engagement in a Canada-wide childhood disability network

BackgroundThe CHILD-BRIGHT Network, a pan-Canadian childhood disability research Network, is dedicated to patient-oriented research, where numerous stakeholders, including patient-partners, researchers, and clinicians are involved at different levels. The Network is committed to continuously improving the level of engagement and partnerships’ impact. Measuring patient engagement is therefore important in reflecting on our practices and enhancing our approaches. We aimed to measure patient engagement longitudinally and explore in greater depth the perceived benefits, barriers and facilitators, and overall satisfaction with patient engagement, from the perspectives of the different stakeholders.MethodsPatient engagement was measured using online surveys. In a longitudinal study design over a 3-years period (2018–2020) the Community-Based Participatory Research (CBPR) questionnaire was used. To enrich our understanding of patient engagement in Year 3, we employed the Public and Patient Engagement Evaluation Tool (PPEET) in a cross-sectional, convergent parallel mixed-method study design. Descriptive statistics and a thematic-based approach were used for data analysis.ResultsThe CBPR questionnaire was completed by n = 167 (61.4% response rate), n = 92 (30.2% response rate), and n = 62 (14.2% response rate) Network members in Years 1, 2, and 3, respectively. Ninety-five (n = 95, 21.8% response rate) members completed the PPEET in Year 3. CBPR findings demonstrate a stable and high satisfaction level with patient engagement over time, where 94%, 86%, and 94% of stakeholders indicated that the project is a “true partnership” in Years 1, 2, and 3, respectively. In Years 2 and 3, we noted an improvement in patient-partners’ comfort level in sharing their views and perspectives (92% and 91% vs. 74%). An increase in critical reflective trust (i.e., allowing for discussing and resolving mistakes) from Year 1 to 3 was found, both from the perspectives of patient-partners (51–65%) and researchers (48–75%). Using the PPEET, patient engagement factors (i.e., communications and supports for participation, ability to share views and perspectives) and impact were highly rated by most (80–100%) respondents. PPEET’s qualitative responses revealed several patient engagement advantages (e.g., increased projects’ relevance, enhanced knowledge translation), barriers (e.g., group homogeneity), facilitators (e.g., optimal communication strategies), and solutions to further improve patient engagement (e.g., provide clarity on goals).ConclusionOur 3-years patient engagement evaluation journey demonstrated a consistent and high level of satisfaction with patient engagement within the Network and identified advantages, barriers, facilitators, and potential solutions. Improvements were observed in members’ comfort in sharing their views and perspectives, along with an increase in critical reflective trust. These findings underscore the Network's commitment to enhancing patient engagement and provide valuable insights for continued improvement and optimization of collaborative efforts.

Building a Community Partnership for the Development of Health Ministries Within the African American Community: The Triad Pastors Network

African Americans continue to have worse health outcomes despite attempts to reduce health disparities. This is due, in part, to inadequate access to healthcare, but also to the health care and medical mistrust experienced by communities of color. Churches and worship centers have historically served as cultural centers of trusted resources for educational, financial, and health information within African American communities and a growing number of collaborations have developed between academic institutions and community/faith entities. Herein, we describe the infrastructure of a true and sustainable partnership developed with > 100 prominent faith leaders within the Piedmont Triad region of North Carolina for the purpose of developing or expanding existing health ministries within houses of worship, to improve health literacy and overall health long-term. The Triad Pastors Network is an asset-based partnership between the Maya Angelou Center for Health Equity at Wake Forest University School of Medicine and faith leaders in the Piedmont Triad region of North Carolina that was created under the guiding principles of community engagement to improve health equity and decrease health disparities experienced by African American communities. A partnership in which co-equality and shared governance are the core of the framework provides an effective means of achieving health-related goals in a productive and efficient manner. Faith-based partnerships are reliable approaches for improving the health literacy needed to address health disparities and inequities in communities of color.

The Be REAL Framework: Enhancing Relationship-Building Skills for Community Health Workers.

Trust plays an integral part in the effective functioning of public health systems. During the COVID-19 pandemic, distrust of public health fueled vaccine hesitancy and created additional barriers to immunization. Although most Americans have received at least one COVID-19 vaccine, the percentage of fully immunized adults remains suboptimal. To reach vaccine-hesitant communities, it is vital that public health be worthy of trust. As trusted members of their communities, community health workers (CHWs) can serve as ideal messengers and conversation partners for vaccination decision-making. We developed the Be REAL framework and training materials to prepare CHWs to work with vaccine-hesitant communities nationwide. Through the four steps of "Relate," "Explore," "Assist," and "Leave (the door open)," CHWs were taught to prioritize relationship building as a primary goal. In this shift from focusing on adherence to public health recommendations (e.g., get vaccinated) to building relationships, the value of vaccine uptake is secondary to the quality of the relationship being formed. The Be REAL framework facilitates CHWs harnessing the power they already possess. The goal of the Be REAL framework is to foster true partnership between CHWs and community members, which in turn can help increase trust in the broader public health system beyond adherence to a specific recommendation.

Riders' Effects on Horses-Biomechanical Principles with Examples from the Literature.

Movements of the horse and rider in equestrian sports are governed by the laws of physics. An understanding of these physical principles is a prerequisite to designing and interpreting biomechanical studies of equestrian sports. This article explains and explores the biomechanical effects between riders and horses, including gravitational and inertial forces, turning effects, and characteristics of rider technique that foster synchronous movement with the horse. Rider symmetry, posture, and balance are discussed in the context of their relationship to rider skill level and their effects on the horse. Evidence is presented to support the feasibility of improving equestrian performance by off-horse testing followed by unmounted therapy and exercises to target the identified deficiencies. The elusive quality of harmony, which is key to a true partnership between riders and horses, is explored and described in biomechanical terms.

Gender Equality as a Necessary Approach for the Country’s Development Process and for Gender Integration

The key word in the concept of gender integration is the word perspective. To implement this concept, a major change in the way we think and act is necessary. (Gender Integration in Practice, 2007:11) When gender equality is discussed as a policy in its own right, the focus is on gender structures, not just women as underrepresented gender groups. Gender mainstreaming is the inclusion of a gender perspective at every stage of the process, approval, implementation, planning, evaluation and delivery of legislation, policies or programmes. In all political, economic and social spheres, taking into account the promotion and advancement of equal opportunities between men and women. Defined as equality between men and women in all spheres, both public and private, gender equality means equal access to and control over resources and benefits, equal participation in political decision-making, and equality before the law for women and men. (Shkurti 2009:19). Gender is not just a socially constructed definition of women and men, it is a socially constructed definition of the relationship between the sexes. Policies and structures play a very important role in living conditions and often institutionalize the maintenance of the social construction of gender (Anastasi, Mandro-Balili, Shkurti, Bozo, 2012:8). This social construction contains an unequal power relationship with male dominance and female subordination in most spheres of life. This means a true partnership between men and women and their sharing of responsibility for correcting imbalances in their public and real lives. The issue remains in the use of the skills, values and talents of every citizen, as well as in the inclusion of women and men in the construction of society. Gender inequality must be fought, protected and promoted as a human right. Gender equality means participation, empowerment and visibility of both sexes in all spheres of public and private life. An important goal is the full recognition and implementation of women's rights as human rights. This means respecting, protecting and promoting the human rights of both women and men, ensuring that both parties fully respect these rights. It also means fighting interference with women's freedom and dignity.

The Medicine Wheel: informing the management of tuberculosis outbreaks in Indigenous communities

ABSTRACT Many Indigenous communities in Canada experience endemic tuberculosis with superimposed periodic epidemic outbreaks. Failures in outbreak management have resulted in the “seeding” of future infection and disease. In this paper we present a model that may be used in planning, implementation and review of tuberculosis outbreak management in Cree Indigenous communities in Canada, based on the Medicine Wheel, a paradigm for holistic living. In the context of tuberculosis management, the Medicine Wheel provides a path for the establishment of respectful cross-cultural relationships, the expression of values through action, true community engagement and partnership, and the establishment of culture-based processes of transparency, accountability and change.

Wellness 911

Wellness 911

Impact of COVID-19 Pandemic on Unemployment: Case Study - Jordan's Tourism Sector

This study aimed to investigate the impact of COVID -19 on unemployment in the tourism sector in Jordan. For the purpose of achieving the study objective, the researchers reviewed various previous articles that handled COVID -19 pandemic and its impact on unemployment in different countries in the world. The researchers reviewed all reports issued by the Ministry of Labor, Ministry of Tourism, Central Bank of Jordan and Statistics Department. All gathered data was reviewed to make a comparison of unemployment with the years prior to COVID -19. The study concluded that COVID -19 affected and increased unemployment in the tourism sector in Jordan, since more than 46% of tourism workers lost their jobs. The impact increased the unemployment rate from %19 in the year 2018 to 24% at the end of 2020. The study recommended that tourism parties in Jordan have to develop internal tourism programs to maximize the benefits of tourism in all governorates, in true partnership with the private sector, in addition to developing special plans to promote tourism, such as promoting domestic tourism, improving the quality of the tourism product periodically and conducting vaccination in the touristic areas for those who did not receive the preventive vaccination. The study results may help those who are concerned with the tourism sector as well as future researchers.

The Missed Fork in the “Forked-Road Situation”

The Missed Fork in the “Forked-Road Situation”

Global neurology: It's time to take notice.

Global neurology: It's time to take notice.

“Very Similar to Having a Pimp”: Community Advisory Board Members’ Experiences in Health-Related Community-Based Participatory Research

Despite the abundance of research on the experiences of researchers with community-based participatory research (CBPR), there has been comparatively little published on CAB members’ experiences. The goal of this research was to analyze the lived experiences of a small sample of CAB members in recent health-focused CBPR in Canada, with a particular focus on areas for improvement. We found that CAB members in CBPR experienced low perceived value from researchers due to communication patterns, education differences, and inadequate compensation. These issues may be mitigated through increased CAB member engagement throughout the research process, adequate compensation, and improved emotional support. This study demonstrates that if CBPR methodologies are to live up to their promise, it is crucial that CAB members are enabled to work in true partnership with researchers, receive adequate compensation that is meaningful to them, and are supported throughout the process.

Ethical Need for a Fertility Decision-Aid for Transgender Adults of Reproductive Age

Ethical Need for a Fertility Decision-Aid for Transgender Adults of Reproductive Age

Towards a deeper understanding of male involvement in the prevention of mother to child transmission of HIV in the Bogodogo District of the Central Region of Burkina Faso.

Men can play crucial roles at each stage of HIV mother-to-child-transmission (MTCT) prevention. Low male involvement in preventative MTCT (PMTCT) in Burkina Faso is partially associated with increased MTCT rates in the country. Male involvement is at the intersection of individual experiences, social locations, organizational and systemic forces. It is crucial that PMTCT interventions are co-designed with all stakeholders, using approaches which account for such interconnected elements. This study, aims to provide a deeper understanding of male involvement using an intersectionality framework. We used an intersectional theoretical approach as it positions male involvement at the intersection of social location, systemic forces, individual experiences, and dynamics within couples. We applied an interpretative qualitative description design. The study was performed at St-Camille's hospital in Ouagadougou, Burkina Faso. Our sample was theoretical to contrast for individual experiences and socioeconomic characteristics. Eligible women were identified via chart review and invited to participate with their male partners. We conducted individual semi-structured interviews with 12 couples. We performed a semantic thematic analysis using QDA Miner to identify themes and patterns among subjective perspectives, while accounting for variations between individuals. We interviewed 12 couples; 6 were serodiscordant. All women were HIV-positive. Participant ages ranged from 23 to 48 years. We found male involvement to be multidimensional and multifaceted, covering a large spectrum (from rejection to true partnership) and diverse involvement. Male involvement was limited by competing priorities, contradictory expectations, organizational opportunities and societal beliefs. We found interactions with caregivers impacted male involvement. This study contributed to enhancing our understanding of male involvement in PMTCT of HIV as a dynamic result of the interconnected individual, organizational and systemic experiences. Increasing male involvement will require implementation of coordinated interventions. Such interventions must strive to simultaneously integrate individual, organizational and systemic actions together.