How does policy alienation develop? Exploring street-level bureaucrats’ agency in policy context shift in UK telehealthcare

Policies can fail when frontline staff feel they have limited influence on policy implementation (powerlessness) or that policy has little or no personal meaning (meaninglessness) – they become alienated from the policy – but how does this alienation develop? In this article we ask whether policy alienation might be viewed as a process that develops over time: a process that ebbs and flows, interacting with the policy landscape as it shifts, rather than a psychological state. Feelings of alienation can be shared across groups of actors, as they collectively shift and initiate change. This study uses participant observation and interviews with front-line employees as they navigate a UK government policy introducing telehealthcare to improve health management of patients with chronic conditions. We find that: (i) cumulative misalignment between different policy implementation contexts allows policy alienation to develop over time; (ii) the shared experience of alienation in co-worker groups contributes to further misalignment; and (iii) front-line staff use their discretion to respond to policy alienation, which has the power to enhance or destroy policy implementation. We offer an alternative perspective for understanding how policy alienation can be prevented and policy implementation can be enhanced.

“It takes a village to get through cancer,” A photo-elicitation study exploring lived experiences of community cancer survivors

Introduction Cancer survivors continue to experience complications that last months to years following diagnosis and treatment, which can impact daily life. The purpose of this study was to explore the lived experiences of adult community cancer survivors related to daily activities and occupational performance. Method Phenomenology study design and photo-elicitation were utilized to blend photos and words. Thirteen adult survivors were recruited from a community-based cancer support organization. Open coding, axial and in vivo coding, and constant comparative analysis were utilized to analyze data and achieve conceptual saturation. Results Participants experienced a shift in cultural context, wherein they took on a new context defined by their cancer survivorship. This context shift is dynamic and interconnected to the sub-themes of distress, changes in perspectives, and side effects that all ultimately influence occupational performance and engagement. The cultural context shift supported participants’ ability to engage in new, meaningful occupations, supported their new identity, and ultimately created a sense of support and belonging. Conclusion Occupational therapists have a unique position to assist with the adjustment process during this cultural context shift and provide interventions in cancer support communities to assure cancer survivors’ continued performance and engagement in meaningful activities.

A CIDADE SUBMARINA: UM EXERCÍCIO PROJETUAL INTERDISCIPLINAR

This paper presents a pedagogical experiment of context shift applied to undergraduate Design classes, with students from the second period of the course. The proposal consisted of a project exercise that transported students to the bottom of the sea to participate in an interdisciplinary learning experience in the fictional context of a Submarine City, enabling the displacement of their creative references and enabling conditions that enhanced meaningful learning. The article describes the exploration of a way of teaching related to the search for innovative solutions to problems that can be extended to disciplines of any area of knowledge.

Touch and the Fluctuation of Agency and Motor Control in Pediatric Dentistry

This study investigates a variety of ways in which dental clinicians and adult guardians touch child patients to get them to participate in dental procedures in China’s mainland. Children at the dentist’s office often experience pain and show fear, and dental care practitioners as well as adult guardians (in our case, parents and grandparents) perform tactile and haptic actions of comfort and control in response. Our analysis shows the dual roles that the children’s bodies play when touching and being touched in the dentist’s office: At times, they are agents or animators in control of their own movements; at other times, they are objects of manipulation by others. Moreover, sometimes their movements are collaboratively controlled by multiple participants, including the patient him/herself. During intercorporeal engagements in Chinese pediatric dentistry, as in many other contexts of interpersonal touch, the center of control and the source of animation of movements and actions are often distributed among multiple bodies. What is more, tactile and haptic actions in this context shift back and forth between direct forms, where the act of one body causes a change in the other, and actions that can be properly called semiotic or communicative in Grice’s (1968) sense, which aim to make the other person recognize the actor’s intent and act on it of his or her own volition.

3. Defending knowledge

‘Defending knowledge’ considers some of the different philosophical responses to the problem of radical scepticism. It begins with the natural response to a philosophical puzzle: to insist on our commonsense principles and work back from there, focusing on the work of G.E. Moore. It then looks at a different kind of response to the sceptical problem, which involves the idea that perhaps there is some sort of context-shift in play in the sceptical reasoning. Finally, it discusses a more radical approach to the problem of radical scepticism outlined by Ludwig Wittgenstein. There is no one particular solution to radical scepticism, but numerous philosophical responses to the problem.

Effect of a context shift on the inverse base rate effect

The Inverse Base Rate Effect (IBRE; Medin and Edelson (1988)) is a non-rational behavioural phenomenon in predictive learning. In the IBRE, participants learn that a stimulus compound AB leads to one outcome and that another compound AC leads to a different outcome. Importantly, AB and its outcome are presented three times as often as AC (and its outcome). On test, when asked which outcome to expect on presentation of the novel compound BC, participants preferentially select the rarer outcome, previously associated with AC. This is irrational because, objectively, the common outcome is more likely. Usually, the IBRE is attributed to greater attention paid to cue C than to cue B, and so is an excellent test for attentional learning models. The current experiment tested a simple model of attentional learning proposed by Le Pelley, Mitchell, Beesley, George, and Wills (2016) where attention paid to a stimulus is determined by its associative strength. This model struggles to capture the IBRE, but a potential solution suggested by the authors appeals to the role of experimental context. In the present paper, we derive three predictions from their account concerning the effect of changing to a novel experimental context at test, and examine these predictions empirically. Only one of the predictions was supported, concerning the effect of a context shift on responding to a novel cue, was supported. In contrast, Kruschke (2001b)’s EXIT model, in which attention and associative strength can vary independently, captured the data with a high degree of quantitative accuracy.

Does alcohol cue Inhibitory Control Training survive a context shift?

Rationale: Inhibitory control training (ICT) is a novel psychological intervention that aims to improve inhibitory control in response to alcohol-related cues through associative learning. Laboratory studies have demonstrated reductions in alcohol consumption following ICT compared to control / sham training, but it is unclear if these effects are robust to a change of context. Objectives: In a pre-registered study we examined whether the effects of ICT would survive a context shift from a neutral context to a semi-naturalistic bar setting. Methods: Using a mixed design, sixty heavy drinkers (40 female) were randomly allocated to receive either ICT or control / sham training in a neutral laboratory over two sessions. We developed a novel variation of ICT that used multiple stop signals in order to establish direct stimulus-stop associations. The effects of ICT / control were measured once in the same context and once following a shift to a novel (alcohol-related) context. Our dependent variables were ad-libitum alcohol consumption following training, change in inhibitory control processes and change in alcohol value (the proposed mechanisms of action of ICT). Results: ICT did not reduce alcohol consumption in either context compared to the control group. Furthermore, we demonstrated no effects of ICT on inhibitory control processes or alcohol value. Bayesian analyses demonstrated overall support for the null hypotheses. Conclusion: This study failed to find any effects of ICT on alcohol consumption or candidate psychological mechanisms either in the same context, or in a novel context. These findings illustrate the difficulty in training alcohol-inhibition associations, and they add to a growing body of literature which suggest ICT holds little evidential value as a psychological intervention for alcohol use disorders.