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This chapter draws on findings from a comparative, qualitative research project investigating the decision-making of different groups of English higher education students in central England as they graduated from a Russell group university (46 interviewees) and a Post-92 university (28 interviewees). Half of the students graduated in 2014 (lower tuition fees regime) and the other half graduated in 2015 (higher tuition fees regime). The students interviewed were sampled by socio-economic background, gender, degree subject/discipline and secondary school type. Semi-structured interviews were used to explore students’ future plans and perceptions of their future job prospects. Despite higher debt levels, the 2015 sample of Russell Group graduates from lower socio-economic backgrounds had a positive view of their labour market prospects and a high proportion had achieved either a graduate job or a place on a postgraduate course prior to graduation. This group had saved money whilst studying. The 2015 sample of Post-1992 University graduates (from both lower and average socio-economic backgrounds) were worried about their level of debt, future finances and labour market prospects. This chapter raises questions about whether a fairer university finance system, involving lower levels of debt for graduates from less advantaged backgrounds, might avoid some graduates’ transitions to adulthood being so strongly influenced by financial anxieties.

This study frames the international disability movement – NGOs, foreign donors, and transnational networks focused on promoting the 2006 UN Convention on the Rights of Persons with Disabilities – as an organizational environment. As the movement expands into the Global South, it actively pressures local grassroots associations to adopt a new organizational model in order to become membership-based advocacy organizations. Many groups, however, are embedded in local civic environments that expect them to act as self-help and social support organizations. As such, grassroots associations are caught between two organizational environments, each promoting different models and practices.

This analysis draws upon 18 months of participant observation and 69 interviews gathered from a local coalition of seven grassroots disability associations in Nicaragua. This ethnographic approach is combined with sociological institutionalism, an analysis that emphasizes the way organizations conform to organizational models that spread across a field.

The local associations responded in a variety of ways to the advocacy model promoted by the international movement. Organizations either conformed, resisted, or developed hybrid organizational models on the basis of internal characteristics that determined how they straddled the two organizational environments.

This paper highlights the way international models may be ineffective in local environments that have civic traditions and lower levels of governmental capacity than found in the West. Some disability associations, however, will creatively combine local and international models to create new initiatives that make a positive impact in the lives of persons with disabilities at the grassroots.

Relational autonomy proposes that persons are socially embedded, with decisions being made within social relationships. Through this theoretical lens, this article explores how the healthcare professional–patient relationship can affect pregnant women’s decisions to accept pertussis and influenza vaccines.

Hackney was chosen as the study site as it has very low vaccine uptake rates. In-depth interviews were conducted with 40 pregnant and recently pregnant women, as well as 10 healthcare professionals. Interviews explored experiences of the UK's National Health Service (NHS) health care and views towards vaccination in pregnancy. An observation of a consultation between a pregnant patient and her General Practitioners (GPs) was also conducted in order to understand how the vaccination discussion takes place.

The findings of this study indicate that advice from friends and family can greatly influence a pregnant woman’s vaccination decisions. The patient’s social context, including influences on her decisions, must be understood by healthcare professionals, so that discussions about concerns can take place. If close relationships with patients are formed, healthcare professional advice is more likely to be trusted. With support from healthcare professionals, patients feel competent, empowered to make the right decision for them, and are more likely to vaccinate.

This research will help to inform contextualised policies aimed at increasing vaccination acceptance and reducing inequality in access to vaccination during pregnancy in Hackney.

To the author’s knowledge, this chapter is the first to apply the theory of relational autonomy to views towards maternal vaccination and decision making. It provides valuable insights into how healthcare professionals’ interactions with their pregnant patients can influence vaccination acceptance. The chapter contains advice on how both healthcare professionals and policy-makers can include mothers in vaccine decision-making processes in more personalised ways, by adopting a dialogue that appreciates and understands the social processes around vaccination concerns.

The efficacy of cognitive-behavioural therapy (CBT) for schizophrenia in community and general psychiatric settings has been widely investigated and its practice recommended in primary and secondary care. In secure forensic mental health services the evidence is less established. The purpose of this paper is to evaluate the effectiveness of group CBT for schizophrenia in a high secure hospital.

In all, 27 male forensic patients completed a manualised CBT group and were compared on primary and secondary outcomes to patients receiving treatment as usual (TAU). Primary outcomes were positive and negative symptoms as measured by the Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms (SANS) and the Psychotic Symptom Rating Scales (PSYRATS). A secondary outcome was interpersonal functioning as measured by the Inventory of Interpersonal Problems (IIP-64).

CBT participants showed improvement on negative symptoms; affective flattening, alogia, anhedonia and avolition; in comparison to participants in TAU. CBT participants also showed reductions in delusions and hallucinations on the SAPS but not the PSYRATS. TAU participants improved on positive symptoms as measured by the PSYRATS. CBT participants showed reductions in overall interpersonal problems, and most notably in being socially inhibited and self-sacrificing. No iatrogenic effects of treatment were found; improvements in depression anxiety and stress were reported by group completers, which contrasted to experiences of the TAU group.

Absence of random allocation to CBP or TAU groups retains the risk of recruitment bias. Findings are preliminary given the sample size. Multiple outcome assessments increase risk of a type I error.

CBT for schizophrenia can be effective with clients in secure forensic mental health settings. Improvements in negative symptoms and interpersonal functioning appear to be particular gains. Self-report measures might be subject to specific demand characteristics in such settings.

The evaluation includes a comparator group in a high secure setting, which is typically absent in reported evidence for this population (Blackburn, 2004). The study also investigated changes in interpersonal functioning, which has previously been noted as an important but absent outcome in CBT for psychosis (Haddock et al., 2009). Iatrogenic outcomes were also considered in the evaluation to ensure no adverse effects were experienced from treatment.