Rural Embedded Assistants for Community Health (REACH) Network: First-Person Accounts in a Community–University Partnership

Community research and action projects undertaken by community–university partnerships can lead to contextually appropriate and sustainable community improvements in rural and urban localities. However, effective implementation is challenging and prone to failure when poorly executed. The current paper seeks to inform rural community–university partnership practice through consideration of first-person accounts from five stakeholders in the Rural Embedded Assistants for Community Health (REACH) Network. The REACH Network is a unique community–university partnership aimed at improving rural health services by identifying, implementing, and evaluating innovative health interventions delivered by local caregivers. The first-person accounts provide an insider’s perspective on the nature of collaboration. The unique perspectives identify three critical challenges facing the REACH Network: trust, coordination, and sustainability. Through consideration of the challenges, we identified several strategies for success. We hope readers can learn their own lessons when considering the details of our partnership’s efforts to improve the delivery infrastructure for rural healthcare.     

Causalité juridique et imputabilité médicale : l’incidence de l’approche juridique du lien de causalité sur la pratique expertale en droit de la réparation du dommage corporel

Traditionally, a “direct and certain” causal link was required between fault and harm in order to engage an individual's compensatory liability. However, upon reading case law, it is possible to note that causality no longer necessarily has to be either direct or certain. Indeed, although the presence of a previous condition long enabled the exclusion of a direct link between a harmful event and its aftereffects, the French Court of Appeal (Cour de Cassation) now considers that pathological predispositions must no longer be taken into account (in respect of an exclusion or a reduction in the right to compensation) if these were latent, and only revealed by the harmful event. Similarly, on occasion the plaintiffs support their claims with bundles of evidence and arguments that can but force magistrates to set aside the absence of absolute certainty on a scientific level. Presumptions of accountability have even been put forward in some areas of personal injury compensation (traffic accidents and workplace accidents). The conduct and content of forensic expertises are then disrupted, both for the expert and for the victim's lawyer.     

Children's event reports: Factors affecting responses to repeated questions in vignette scenarios and event recall interviews

When adults repeat questions, children often give inconsistent answers. This study aimed to test the claim that these inconsistencies occur because children infer that their first answer was unsatisfactory, and that the adult expects them to change their answer. Children aged 4, 6, and 8 years (N= 134) were asked about vignettes in which an adult repeated a question, with manipulation of the adult's overt dissatisfaction (high vs. low pressure) and knowledge about the information sought. On a separate occasion, the children were given an unrelated event recall interview containing repeated questions. All age groups showed sensitivity to adult dissatisfaction, interpreting question repetition as an implicit request for answer change more frequently in the high than in the low‐pressure vignettes. Overall, however, these ‘change‐expected’ interpretations were least frequent in the younger children, who were the most prone to shifting. Also there was no evidence that these interpretations were associated with more frequent shifting in the recall interview. The results do not provide clear support for a simple conversational inference account of shifting, especially in younger children.     

Method of Suicide in the Mentally Ill: A National Clinical Survey

Comparisons of psychiatric patients who die by suicide using different methods are scarce. We aimed to establish the methods of suicide used by those who are currently or have recently been in contact with mental health services in England and Wales (N = 6,203), and describe the social and clinical characteristics of suicides by different methods. We found that hanging, self‐poisoning, and jumping (from a height or in front of a moving vehicle) were the most common methods of suicide, accounting for 79% of all deaths. The implications of these and other findings are discussed.     

Individual Differences in Decision Making Depend on Cognitive Abilities,Monitoring and Control

Decision making is the process by which actions are constructed and initiated. Across many research streams, this can be explained in terms of three broad cognitive processes: cognitive abilities that construct judgements and potential courses of action, and interacting monitoring and control processes that determine when to initiate them as behaviour. The aim of this research was to investigate the generality of individual differences in these processes, and their power to predict patterns of decision behaviour identified in our previous research. Undergraduate participants (N = 364) completed nine tests assessing cognitive abilities, monitoring confidence, control thresholds and various patterns of decision behaviour. The tests differed in their cognitive ability requirements and the nature of the payoffs associated with decisions. Cognitive abilities were a strong predictor of individuals' decision competence and optimality, while monitoring confidence and control thresholds were strong and unique predictors of their overall decisiveness, and reckless and hesitant errors. These results were strongest when the measures of cognitive abilities and monitoring confidence were derived from tests with the same cognitive requirements as the tests used to derive the decision behaviours and when the control threshold measure was derived from tests with the same decision payoffs as the test used to derive the decision behaviours. This effect was particularly pronounced for control thresholds, highlighting the domain‐specific nature of cognitive control processes. These findings demonstrate how cognitive abilities, monitoring output and control thresholds interact with cognitive requirements and context‐specific payoffs to drive individual differences in decision‐making behaviour. Copyright © 2016 John Wiley & Sons, Ltd.     

‘Undesirable’ and ‘desirable’ shifts in children's responses to repeated questions: age differences in the effect of providing a rationale for repetition

This study examined factors influencing children's tendency to shift responses when questions are repeated within an interview. Forty nine 4–5‐year‐olds and 40 7–8‐year‐olds were questioned about a video they had seen, with questions repeated by the same or a different interviewer. Half the children were given a rationale for question repetition, and half were not. Overall, the older children shifted less than the younger children, and, unlike the younger children, more to misleading than unbiased questions. The rationale did not affect overall shifting, but reduced the probability of ‘undesirable’ shifts (towards inaccuracy) in the younger children, and increased ‘desirable’ shifts (towards accuracy) at both ages. In the younger children, the rationale reduced total number of shifts, but only with the same interviewer, while in the older children the reverse applied. The results suggest developmental progression in the relative contributions of memorial and social/motivational factors to shifting. Implications for investigative interviewing with children are discussed. Copyright © 2004 John Wiley & Sons, Ltd.     

‘They’ve invited me into their world’: a focus group with clinicians delivering a behaviour change intervention in a UK contraceptive service

Although teenage conceptions rates in the United Kingdom (UK) have seen a downward trend recently, it remains imperative that contraceptive services for young people continue to improve. To ensure that evidence-based interventions are sustained in clinical practice, it is useful to assess the experiences of those delivering them. This study explores the experiences of sexual health clinicians who were trained to deliver a one-to-one behaviour change intervention aiming to improve contraceptive use in young women. The intervention was set in a UK NHS contraceptive and sexual health service and involved clinicians’ facilitating (within one-to-one consultations) the formation of implementation intentions (or ‘if-then’ plans) that specified when, where and how young women would use contraception. A focus group was conducted with seven clinicians who had delivered the intervention. A thematic analysis of the focus group revealed three overall themes: (1) How the intervention worked in practice; (2) barriers and benefits to delivering the intervention; and (3) positive changes to individual consultation style and wider ‘best practice’ within the clinic. Our findings show that, with support, clinical staff would be in favour of incorporating if-then planning as a strategy to help promote contraceptive adherence in young women.