The Aphasia Communication Outcome Measure: Motivation, Development, Validity Evidence, and Interpretation of Change Scores

The Aphasia Communication Outcome Measure (ACOM) is a patient-reported measure of communicative functioning developed for persons with stroke-induced aphasia. It was motivated by the desire to include the perspective of persons with aphasia in the measurement of treatment outcomes and to apply newly accessible psychometric tools to improve the quality and usefulness of available outcome measures for aphasia. The ACOM was developed within an item response theory framework, and the validity of the score estimates it provides is supported by evidence based on its content, internal structure, relationships with other variables, stability over time, and responsiveness to treatment. This article summarizes the background and motivation for the ACOM, the steps in its initial development, evidence supporting its validity as a measure of patient-reported communication functioning, and current recommendations for interpreting change scores.

A Preliminary Degradation Pathology of Rangeland Declines Near Opuwo in the Kunene, Namibia: The Tragedy of Disrupting Traditional Commons Management

The Kunene in far north-western Namibia is widely recognised as having amongst the most widely and severely degraded rangelands (de Klerk, 2004; Joubert et al., 2008), yet this was not always the case. In many communal areas, major episodes of degradation have only occurred for the first time in recent decades. The degradation is not many decades old and yet it is seen as obvious support for the concept of the tragedy of the commons (Hardin, 1968). This simplistic, convenient interpretation of change is strongly dissonant with what I have observed first hand. What has gone wrong and can this inform us about rangeland rehydration and repair? I draw on experiences from a small number of communities with whom I worked and learnt to piece together what has gone wrong. I also suggest cause for optimism of rangeland revival in the Kunene when the fundamental, root causes are addressed with clear community ownership and leadership based on local, people-centred problem solving. The major challenges are cultural, social, administrative and perhaps economic. They are not lack of knowledge regarding scientific rangeland management although the latter needs adaptive attention in a new, socially engineered human context.

Using structural equation modeling to investigate change and response shift in patient-reported outcomes: practical considerations and recommendations

Background Patient-reported outcomes (PROs) are of increasing importance for health-care evaluations. However, the interpretation of change in PROs may be obfuscated due to changes in the meaning of the self-evaluation, i.e., response shift. Structural equation modeling (SEM) is the most widely used statistical approach for the investigation of response shift. Yet, non-technical descriptions of SEM for response shift investigation are lacking. Moreover, application of SEM is not straightforward and requires sequential decision-making practices that have not received much attention in the literature. Aims To stimulate appropriate applications and interpretations of SEM for the investigation of response shift, the current paper aims to (1) provide an accessible description of the SEM operationalizations of change that are relevant for response shift investigation; (2) discuss practical considerations in applying SEM; and (3) provide guidelines and recommendations for researchers who want to use SEM for the investigation and interpretation of change and response shift in PROs. Conclusion Appropriate applications and interpretations of SEM for the detection of response shift will help to improve our understanding of response shift phenomena and thus change in PROs. Better understanding of patients’ perceived health trajectories will ultimately help to adopt more effective treatments and thus enhance patients’ wellbeing.

A reply to Fairness, generosity and conditionality in the welfare system: the case of UK disability benefits by Johnson and Nettle: Inequality and existential threat.

Johnson and Nettle initially focus upon the detail of policy changes and argue that these changes may seem sensible to a social primate reflexively applying tribal scale psychology. This is a commentary upon policy makers. But later they shift their attention to a broader constituency, those to whom policy makers are appealing and those campaigning to change policy. In concluding comments, the authors state that their thesis could be coupled with a broader account of societal change, that might offer a richer interpretation of change, and it is to this idea that the current commentary is addressed.

Constituency, Imbrication, and the Interpretation of Change-of-State Verbs in isiNdebele

This paper describes the interplay of lexical and grammatical aspect with other grammatical phenomena in the interpretation of the aspectual suffix ‑ile (which we analyse as Perfective) in isiNdebele, a Nguni Bantu language spoken in South Africa. Crucial other phenomena include constituency-related factors such as the conjoint-disjoint distinction and (related) penultimate lengthening, along with morphophonological conditions that trigger different forms of ‑ile. These factors appear to interact differently in isiNdebele than they do in closely related Zulu, suggesting two different paths of grammaticalization, which we argue can change the interpretation of markers of grammatical aspect as they interact with lexical aspectual classes.

Methodological and interpretive concerns about Beemster et al.’s article ‘The interpretation of change score of the pain disability index after vocational rehabilitation is baseline dependent’: a letter to the editor

This is a critique of Beemster et al.’s article ‘The interpretation of change score of the pain disability index after vocational rehabilitation is baseline dependent’ (2018). The methodological issues in question include the choices of anchor to determine the minimal important change, and the intraclass correlation coefficient on which the calculation of the standard error of measurement was based. We believe these undermine the authors’ interpretation.

The mechanisms and processes of connection: developing a causal chain model capturing impacts of receiving recorded mental health recovery narratives

Background Mental health recovery narratives are a core component of recovery-oriented interventions such as peer support and anti-stigma campaigns. A substantial number of recorded recovery narratives are now publicly available online in different modalities and in published books. Whilst the benefits of telling one’s story have been investigated, much less is known about how recorded narratives of differing modalities impact on recipients. A previous qualitative study identified connection to the narrator and/or to events in the narrative to be a core mechanism of change. The factors that influence how individuals connect with a recorded narrative are unknown. The aim of the current study was to characterise the immediate effects of receiving recovery narratives presented in a range of modalities (text, video and audio), by establishing the mechanisms of connection and the processes by which connection leads to outcomes. Method A study involving 40 mental health service users in England was conducted. Participants were presented with up to 10 randomly-selected recovery narratives and were interviewed on the immediate impact of each narrative. Thematic analysis was used to identify the mechanisms of connection and how connection leads to outcome. Results Receiving a recovery narrative led participants to reflect upon their own experiences or those of others, which then led to connection through three mechanisms: comparing oneself with the narrative and narrator; learning about other’s experiences; and experiencing empathy. These mechanisms led to outcomes through three processes: the identification of change (through attending to narrative structure); the interpretation of change (through attending to narrative content); and the internalisation of interpretations. Conclusions This is the first study to identify mechanisms and processes of connection with recorded recovery narratives. The empirically-based causal chain model developed in this study describes the immediate effects on recipients. This model can inform selection of narratives for use in interventions, and be used to support peer support workers in recounting their own recovery narratives in ways which are maximally beneficial to others.

The Social Division of Welfare

This chapter looks at how some students of social policy see the development of ‘The Welfare State’ in historical perspective as part of a broad, ascending road of social betterment provided for the working classes since the nineteenth century and achieving its goal in the present time. This interpretation of change as a process of unilinear progression in collective benevolence for these classes led to the belief that in the year 1948 ‘The Welfare State’ was established. Since then, successive governments, Conservative and Labour, have busied themselves with the more effective operation of the various services. Both parties have also claimed the maintenance of ‘The Welfare State’ as an article of faith.