Anne Westhues

Developing Theory From Complexity: Reflections on a Collaborative Mixed Method Participatory Action Research Study

Research studies are increasingly complex: They draw on multiple methods to gather data, generate both qualitative and quantitative data, and frequently represent the perspectives of more than one stakeholder. The teams that generate them are increasingly multidisciplinary. A commitment to engaging community members in the research process often adds a further layer of complexity. How to approach a synthesizing analysis of these multiple and varied data sources with a large research team requires considerable reflection and dialogue. In this article, we outline the strategies used by one multidisciplinary team committed to a participatory action research (PAR) approach and engaged in a mixed method program of research to synthesize the findings from four subprojects into a conceptual framework that could guide practice in community mental health organizations. We also summarize factors that hold promise for increasing productivity when managing complex research projects.

A Comparison of the Adjustment of Adolescent and Young Adult Inter-country Adoptees and their Siblings

Results of studies to determine how well children, who have been adopted internationally, have adjusted are inconclusive. Little is known about the adjustment of adolescents (12-17 years of age) in relation to young adults (18-25 years of age). This study compares the adjustment by age and by gender for 86 adolescent inter-country adoptees with that of 33 of their adolescent siblings raised in the same family. Also examined is the adjustment of 49 young adult adoptees (18-25 years of age) in comparison with 65 of their young adult siblings.

From Death Notification Through the Funeral: Bereaved Parents' Experiences and Their Advice to Professionals

Parents who experience the sudden death of a child will interact with many professionals in the period immediately following the death notification through to the funeral. The way these professionals respond to the parents during this critical period may be perceived as helpful, and thus support them in beginning the process of managing the trauma and starting a healthy grieving process. It may also be perceived as unhelpful, though, and contribute to more prolonged and complicated grieving. This article identifies the interventions that a sample of 20 parents who had experienced the sudden death of a child found helpful with different aspects of grieving. Specific advice is given to police, nurses, doctors, coroners, social workers, crisis counselors, funeral directors, and chaplains or clergy.

A Developmental Stage Approach To Program Planning and Evaluation

Human service programs can be seen as proceeding through a number of stages in the course of their development. Each stage can be characterized by a major issue or question to be answered. Evaluation research, if appropriately matched to a programs stage of development, can help inform the decision making that goes on at each step and resolve the questions that need to be answered before proceeding to subsequent stages. This article presents a brief overview of what these stages are, the questions to be answered at each stage, and the kinds of research activity that can assist in answering those questions.

A Socially Excluded Space: Restrictions on Access to Health Care for Older Women in Rural Bangladesh:

This study was an exploration of the experiences of 17 women, age 60 or more years, from Bangladesh. The women were asked about decision-making processes with respect to their access to health care and whether they perceived that there were differences based on age and sex in the way a household responds to an illness episode. The overall theme that characterized their experiences was “being in a socially excluded space.” The themes that explained this perception of social exclusion included gender- and age-based social practices, gender- and class-based economic practices, religious beliefs that restricted the mobility of women, and social constructions of health and illness that led the women to avoid seeking health care. We conclude that the Bangladesh constitutional guarantee that disparities will be eliminated in access to health care between rich and poor, men and women, rural and urban residents, and younger and older citizens has not yet been realized.

The adjustment of intercountry adoptees in Canada

Abstract Intercountry adoption has become an important social policy issue in Canada Almost unheard of until the post-World War II period, the numbers have grown from fewer than ten a year when records were first kept in 1970 (Gravel & Roberge, 1984; National Adoption Desk Statistics) to an estimate of more than 2400 a year in 1991 (Daly & Sobol, 1993). At the same time that the number of intercountry adoptions has increased, the number of children available for adoption in Canada has declined steadily. This means that nonrelative adoptions in Canada are now as likely to involve children who were born outside of Canada as those born within Canada. Most of the children from out-of-country have a different racial background from their adoptive parents, as well as a different cultural background. The question for policymakers, service providers, prospective adoptive parents and biological parents deciding whether to relinquish their child is whether these crosscultural and transracial adoptions work.

Risk Factors for Abuse and Neglect among Older Adults

This research presents risk factors for abuse and neglect among older adults who accessed health and social service organizations in London, Ontario, 1991. The paper reviews four theoretical perspectives on elder abuse and neglect: the situational model, social exchange theory, symbolic interactionism and a feminist model. Risk factors for physical abuse, chronic verbal abuse, material abuse and neglect were identified for each theoretical model. Each set of risk factors was regressed on each type of abuse in order to determine the efficacy of the theoretical models. The data suggest that the risk factors associated with the situational and feminist model(s) provide the best fit in terms of physical abuse; the symbolic interaction model explains the most variance in chronic verbal abuse; both the symbolic interaction and feminist models explain about the same amount of variance in neglect; and none of the theoretical models adequately explains the variance in material abuse.

Building Positive Relationships: An Evaluation of Process and Outcomes in a Big Sister Program

Research has shown that one-to-one mentoring has beneficial effects on the development of children who experience some form of disadvantage in childhood. What is not known is whether a nonintensive group program, in conjunction with one-to-one mentoring, will have even greater benefits for children. This study assesses the effects of a group program called Building Positive Relationships which was offered to 31 Little Sisters in grades three to final year of high school. A wait list comparison group of 21 Little Sisters who were in a one-to-one mentoring relationship and expressed interest in the program was part of the design. Outcomes measured included levels of self-esteem, empathy, family and peer relationships, problem-solving skills, and self-advocacy skills. The findings showed that significant changes occurred in level of self-esteem which were maintained at followup.

Rural Women's Access to Health Care in Bangladesh: Swimming Against the Tide?

Large segments of the population in developing countries are deprived of a fundamental right: access to basic health care. The problem of access to health care is particularly acute in Bangladesh. One crucial determinant of health seeking among rural women is the accessibility of medical care and barriers to care that may develop because of location, financial requirements, bureaucratic responses to the patient, social distance between client and provider, and the sex of providers. This article argues that to increase accessibility fundamental changes are required not only in resource allocation but also in the very structure of health services delivery.

The Medicine That Might Kill the Patient: Structural Adjustment and Its Impacts on Health Care in Bangladesh

Over the past decade, reforms of the health sector have evolved as a global phenomenon. There is, by now, a fair literature on the relationship between globalization and health. Within this literature, however, there is relatively little attention given to the Structural Adjustment Program (SAP), one aspect of globalization, and its impact on health. It can be observed that the SAP has had a dramatic impact on the status of education, health, the environment, and women and children in many developing countries. The restructuring of the health sector has led to the collapse of preventive and curative care due to the lack of medical equipment, supplies, poor working conditions, low pay of medical personnel, and the resulting low morale in Ghana, Philippines, and Zimbabwe. User fees in primary health care have led to the exclusion of a large section of the population from accessing health services as they are unable to pay. This article discusses the health specific impact of the SAP and the economic reforms initiated under it in Bangladesh. In particular, it will analyze how these policies affect the health care delivery system in Bangladesh in relation to geographic accessibility, affordability, quality of services, administrative efficiency, the rural urban service gap, public provision of health care, and donor influence on health policy.