Constructing prevention programmes with a Māori health service provider view

Mainstream approaches to chronic condition management and prevention inadequately address the needs of Māori, the Indigenous people of New Zealand. Māori health service providers (MHSPs) are uniquely placed to address the critical gap in the prevention of chronic conditions. In this paper, we report qualitative research findings investigating how prevention was being modelled, practiced and measured in selected MHSP settings. Results indicate barriers to achieving wellbeing through health service delivery. The dominant individualistic, medical conditions-focused discourse, along with responding to acute need, is a driver of service delivery norms.There are examples of shifts in organisational structure and delivery configurations that demonstrate that these norms are being challenged and reframed, in some form, by MHSPs. Consolidation of these approaches requires significant work and increased resources as well as a broader systems-level response that prioritises prevention.     

Seat belt laws: why we should keep them

In the June 2007 issue of Significance , John Adams argued for the repeal of seat belt laws. They have never been demonstrated to save lives, he said; and they increase the number of pedestrians and cyclists killed on the roads. Richard Allsop, Oliver Carsten, Andrew Evans and Robert Gifford argue that Parliament should keep the seat belt laws on the statute book and that we should all keep wearing belts whenever we travel in a car, van or coach—and they contest John's statistics.     

A test among models of nonverbal immediacy reactions: Arousal-labeling,discrepancy-arousal,and social cognition

Individuals may respond to an increase in nonverbal immediacy by either increasing or decreasing the immediacy of their own behavior. To account for this, a number of models have been proposed, including arousal-labeling (Patterson, 1976), discrepancy-arousal (Cappella & Greene, 1982), and social cognition (e.g., Ellsworth, 1978). An experiment was designed to test the social cognition approach and, when combined with findings of previous studies, to serve as a test among three models. Individual male subjects discussed a moral dilemma with a male confederate at a seating distance of either 1.1 m (control group) or 0.3 m in two experimental groups (confederate intentional-close and confederate forced-close). Subjects in both experimental conditions showed less immediate nonverbal behavior, but only subjects in the intentional-close condition evaluated the confederate more negatively than subjects in the control group. These results, when combined with past research findings, suggest that social cognition alone may determine whether nonverbal compensation or reciprocation will occur, and that arousal-based explanations may be unnecessary. Other self-report findings of the study, however, create difficulties for all three models of nonverbal exchange.We thank Paul Baker, Larry Coutts, David Gartrell, Leslie Hayduk, Ron Hoppe, Eric Knowles, G. Alexander Milton, and an anonymous reviewer for their comments on earlier drafts.     

Implementing a case management initiative in high-need schools

States continue to experiment with ways of improving health and human service use by people with complex needs. Such efforts have often sought to increase individual and family control over services as well as to enhance coordination among providers. Paths to achieving these goals are not well understood. This study draws on two previously distinct conceptual frameworks to examine how 71 public schools implemented a team approach to increasing family and agency engagement for children at risk. Results from the longitudinal data fit the core components expected to affect implementation and also indicated sustainability, but in ways distinctive to the initiative's public school settings. Accountability to the state appeared to be a major catalyst, yet in some respects also constrained local agencies from participating as intended. School inertia may have both undermined the program through some evaluation practices and gaps in administrative support, and supported integration into organizational routines and successful experimentation over time in increasing caregiver involvement. Family hesitation about sharing information with multiple agencies may also help explain why the goal of seamless coordination remains elusive.     

Home Ownership, Social Insurance, and the Welfare State

Home ownership has potentially significant consequences for welfare state policy. High owner-occupancy rates may function as private insurance where social spending is low (a substitution effect). Alternatively, state income redistribution policies could raise the number of home owners (an income effect). Cross-national time-series data show that social spending is negatively related to home ownership, and mediates the positive relationship between income inequality and owner-occupancy rates. This suggests that owner-occupancy acts as a form of social insurance over the life course. Future welfare state researchers should consider the issue of home ownership in analyses of inequality and the social safety net.

Through their eyes: seeing experiences of settlement in photographs taken by refugee background youth in Melbourne,Australia

Although ‘refugees’ are frequently represented in visual media, it is predominantly as the central subject matter and rarely are they positioned as the photographers of their own journeys. In this article, we present photographic images that have been taken by refugee background youth portraying their experiences of the first years of settlement in Australia. We consider how, in our longitudinal research conducted with 120 refugee background youth, visual materials can provide equally important yet different insights in comparison to written or spoken narratives on the experiences of refugee settlement. Through an examination of the photograph’s visual content, we explore the ways in which they portrayed their early experiences of external suburban settlement environments and their depictions of interior spaces and home-making practices. We discuss how these visual insights capture an alternative way of seeing the experiences of becoming at home as the youth become emplaced post-resettlement in Australia. We argue that the photographs taken by these refugee background youth illustrate how visual methods and materials can provide equally important but often overlooked insights into early settlement experiences. Importantly, the photographic images offer a way of portraying the people, places and sentiments that are central to the everyday lives of refugee background youths in ways that oral and written narratives cannot.     

Physician perspectives on the structure and function of group practice HMOs

This article explores physicians' perspectives regarding how their HMOs function and their satisfaction with and loyalty to HMOs. Three HMOs were studied: a mature (28-year-old) staff model, a 16-year-old staff model, and a 13-year-old group model with both HMO and fee-for-service patients. While these HMOs were found to vary somewhat in terms of emphasis on patient care versus costs, methods used to control costs and degrees of centralization of decision making, they all received high overall satisfaction and loyalty scores. The staff model HMO with a more decentralized decision making structure received the highest satisfaction/loyalty score from its physicians. The degree to which physicians perceive the HMO to be effective and supportive and the use of educational programs and peer review to influence resource use were also found to be significantly related to physician satisfaction and loyalty.     

The experience of personal space: Perception of interpersonal distance

The experience of personal space was studied by comparing objective interpersonal distance with subjects' perception of interpersonal distance. Regardless of sex, several personality traits, and objective size of personal space, perceived personal space is larger than objective personal space. Yet in non-personal space situations, subjects did not overestimate distance. In personal space situations, individuals apparently believe they are farther from other people than they actually are.     

The Camouflaged Safety Net: The U.S. Armed Forces as Welfare State Institution

Observers of the U.S. welfare state often contrast its low levelsof social spending with its lavish defense spending. This articledemonstrates that U.S. military institutions in fact providea segment of the population with benefits that have characteristicsof formal welfare state programs and have similar social welfarepurposes. It thus conceives of social assistance benefits formilitary families as comprising a distinct welfare state institution,one that challenges assumptions that the U.S. strategy for achievingsocial welfare goals fundamentally depends on rewarding marketparticipation and financially supporting families only underconditions of extreme poverty.