Amidst a winter snow storm we drove slowly and carefully to our research site. Leaving much earlier than usual we wanted to be there to greet the indigenous youth who we had come to know in the ...process of inquiring into their ongoing identity making. We came to know them over several months in a junior high school arts club and had developed relationships with them that were marked by care. In attending to care, Noddings (1984) offered us a way to think about ethics. Yet Noddings did not explicitly turn her attention to an ethics for research, rather her focus was on an ethics of care in moral education. Drawing on our work alongside indigenous youth we show how these four components of an ethics of care shaped our narrative inquiry and show how a relational ethics builds on, and extends, an ethics of care in narrative inquiry.
In this article, we develop, through drawing forward fragments of our experiences, a concept of reciprocity as always situated within the relational ontology of narrative inquiry. Reciprocity is most ...commonly understood within a transactional sense, an exchange of goods. We show important aspects of reciprocity in narrative inquiry, including the importance of intentionally creating and responding to spaces where reciprocity occurs and can be sustained over time and place, and the potential reciprocity holds to change who we, and those with whom we work, are. As we reconsider the ways in which reciprocity is not understood as a transaction in a relational methodology, new questions about the entanglement of reciprocity and recognition emerge. We understand that recognition does not necessarily have to be reciprocal, but recognition is necessary to compose a space where reciprocity can live in our ordinary interactions with others.
Drawing on several studies we take up question about fictionalization in this article. In particular, we are interested in the intentions and purposes of fictionalization and discus these within the ...context of narrative inquiry. We draw attention to how fictionalizing has become a common and often unquestioned part of responding to concerns about anonymity raised by research ethics boards. We see three purposes for fictionalization: (a) protection of the identities of participants, (b) creation of distance between ourselves and our experiences, and (c) a way to engage in imagination that enriches inquiry spaces and research understandings.
During the coronavirus disease 2019 pandemic, public health has issued three interrelated dominant narratives through social media and news outlets: First, to care for others, we must keep physically ...distant; second, we live in the same world and experience the same pandemic; and third, we will return to normal at some point. These narratives create complexities as they collide with the authors' everyday lives as nurses, educators, and women. This collision creates three paradoxes for us: (a) learning to care by creating physical distance, (b) a sense of togetherness erases inequities, and (c) returning to normal is possible. To inquire into these three paradoxes, we draw on our experiences with Ingrid, an older adult who requires in‐home physical care, and Matthew, a man with multiple disabilities including severe oral dyspraxia and developmental delays. We outline how narrative care is a counterstory to the dominant narratives and enables us to find ways to live our lives within the paradoxes. Narrative care allows us, through attention to embodiment, liminality, and imagination, to create forward looking stories. Understanding narrative care within these paradoxes allows us to offer more complex understandings of the ways narrative care can be embodied in our, and others', lives.
As a teacher researcher, I used a narrative format to present and further develop an understanding of voice in the research process. Through reflection on my own research story, the teacher's story, ...and the children's research story, several themes were found which strengthened an emerging interpretation of voice in the research process. These themes came to be expressed as stages of the research process. They were exploration, commitment, embodiment and celebration. As well, relationship, time and trust became threads which wove through many of the stories. Children must be given sufficient time and a variety of experiences during the exploration stage in order for them to form a relationship with the topic. Once this relationship is established, a high degree of commitment to a chosen focus is observed. As children present their own unique interpretation of their topic, they identify very strongly with their work. It appears as embodiment. Celebration and a sense of growth occurs throughout the process as children become a part of what they learn and their voices are heard. (Abstract shortened by UMI.)
To evaluate the secondary impact of a multilevel, child-focused, obesity intervention on food-related behaviours (acquisition, preparation, fruit and vegetable (FV) consumption) on youths' primary ...caregivers.
B'More Healthy Communities for Kids (BHCK) group-randomized controlled trial promoted access to healthy foods and food-related behaviours through wholesaler and small store strategies, peer mentor-led nutrition education aimed at youths, and social media and text messaging targeting their adult caregivers. Measures included caregivers' (n 516) self-reported household food acquisition frequency for FV, snacks and grocery items over 30 d, and usual FV consumption in a sub-sample of 226 caregivers via the NCI FV Screener. Hierarchical models assessed average treatment effects (ATE). Treatment-on-the-treated-effect (TTE) analyses evaluated correlation between behavioural change and exposure to BHCK. Exposure scores at post-assessment were based on self-reported viewing of BHCK materials and participating in activities.
Thirty Baltimore City low-income neighbourhoods, USA.ParticipantsAdult caregivers of youths aged 9-15 years.
Of caregivers, 90·89 % were female; mean age 39·31 (sd 9·31) years. Baseline mean (sd) intake (servings/d) was 1·30 (1·69) fruits and 1·35 (1·05) vegetables. In ATE, no significant intervention effect was found on caregivers' food-related behaviours. In TTE, each point increase in BHCK exposure score (range: 0-6·9) increased caregivers' daily fruit consumption by 0·2 servings (0·24 (se 0·11); 95 % CI 0·04, 0·47). Caregivers reporting greater social media exposure tripled their daily fruit intake (3·16 (se 0·92); 95 % CI 1·33, 4·99) and increased their frequency of unhealthy food purchasing v. baseline.
Child-focused community-based nutrition interventions may also benefit family members' fruit intake. Child-focused interventions should involve adult caregivers and intervention effects on family members should be assessed. Future multilevel studies should consider using social media to improve reach and engage caregiver participants.
Frail older adults are commonly prescribed antidepressants. Yet, there is little evidence to determine the efficacy and safety of antidepressants to treat depression with concomitant frailty. To ...better understand this issue, we examined the efficacy and safety of second-generation antidepressants for the treatment of older adults with depression and then considered implications for frailty.
Due to the absence of therapeutic studies of frail older adults with depression, we conducted a systematic review and meta-analysis of double-blind, randomized controlled trials that compared antidepressants versus placebo for adults with depression, age 65 years or older. We searched PubMed/MEDLINE, Cochrane Library, reference lists from meta-analyses/studies, hand searches of publication lists, and related articles on PubMed. Outcomes included rates of response, remission, and adverse events. After evaluating the data, we applied a frailty-informed framework to consider how the evidence could be applied to frailty.
Nine trials were included in the meta-analysis (n = 2704). Subjects had moderate to severe depression. For older adults with depression, there was no statistically significant difference in response or remission to second-generation antidepressants compared to placebo. Response occurred in 45.3% of subjects receiving an antidepressant compared to 40.5% receiving placebo (RR 1.15, 95% CI: 0.96 - 1.37, p = 0.12, I2 = 71%). Remission occurred in 33.1% with antidepressant versus 31.3% with placebo (RR 1.10, 95% CI: 0.92 - 1.31, p = 0.30, I2 = 56%) (Figure 2 and 3). There were more withdrawals due to adverse events with antidepressants, 13% versus 5.8% (RR 2.30, 95% CI: 1.45-3.63; p < 0.001; I
= 61%; NNH 14, 95% CI:10-28).
Subjects in the meta-analysis did not have obvious characteristics of frailty. Using framework questions to consider the implications of frailty, we hypothesize that, like older adults, frail individuals with depression may not respond to antidepressants. Further, observational studies suggest that those who are frail may be less responsive to antidepressants compared to the non-frail. Given the vulnerability of frailty, adverse events may be more burdensome.
Second-generation antidepressants have uncertain benefit for older adults with depression and cause more adverse events compared to placebo. Until further research clarifies benefit, careful consideration of antidepressant prescribing with frailty is warranted.
Background. Psychosocial factors are important determinants of health behaviors and diet-related outcomes, yet relatively little work has explored their relation to food-purchasing and preparation ...behaviors in low-income populations. Aim. To evaluate the psychosocial factors associated with food-related behaviors. Methods. Cross-sectional data collected from 465 low-income African American adult caregivers in the baseline evaluation of the B’more Healthy Communities for Kids obesity prevention trial. Questionnaires were used to assess household sociodemographic characteristics, food sources frequently used, and food preparation and food acquisition behaviors. Multiple linear regression models explored the associations between caregiver psychosocial variables and food-related behaviors, controlling for caregivers’ age, sex, household income, household size, and food assistance participation. Results. Caregivers purchased prepared food at carry-outs on average 3.8 times (standard deviation SD = 4.6) within 30 days. Less healthy foods were acquired 2 times more frequently than healthier foods (p < .001). Higher food-related behavioral intention and self-efficacy scores were positively associated with healthier food acquisition (β = 0.7; 95% confidence interval CI 0.09, 1.4; β = 0.04; 95% CI 0.02, 0.06) and negatively associated with frequency of purchasing at prepared food sources (β = −0.4; 95% CI −0.6, −0.2; β = −0.5; 95% CI −0.7, −0.3), respectively. Higher nutrition knowledge was associated with lower frequency of purchasing food at prepared food venues (β = −0.7; 95% CI: −1.2, −0.2). Discussion. Our findings indicate a positive association between psychosocial determinants and healthier food acquisition and food preparation behaviors. Conclusion. Interventions that affect psychosocial factors (i.e., food-related behavioral intentions and self-efficacy) may have the potential to increase healthier food preparation and food-purchasing practices among low-income African American families.
Development and Implementation Schwendler, Teresa; Shipley, Cara; Budd, Nadine ...
Health promotion practice,
11/2017, Volume:
18, Issue:
6
Journal Article
Peer reviewed
Open access
Higher rates of obesity and obesity-related chronic disease are prevalent in communities where there is limited access to affordable, healthy food. The B’More Healthy Communities for Kids (BHCK) ...trial worked at multiple levels of the food environment including food wholesalers and corner stores to improve the surrounding community’s access to healthy food. The objective of this article is to describe the development and implementation of BHCK’s corner store and wholesaler interventions through formal process evaluation. Researchers evaluated each level of the intervention to assess reach, dose delivered, and fidelity. Corner store and wholesaler reach, dose delivered, and fidelity were measured by number of interactions, promotional materials distributed, and maintenance of study materials, respectively. Overall, the corner store implementation showed moderate reach, dose delivered, and high fidelity. The wholesaler intervention was implemented with high reach, dose, and fidelity. The program held 355 corner store interactive sessions and had 9,347 community member interactions, 21% of which were with children between the ages of 10 and 14 years. There was a 15% increase in corner store promoted food stocking during Wave 1 and a 17% increase during Wave 2. These findings demonstrate a successfully implemented food retailer intervention in a low-income urban setting.
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