BackgroundThe United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) establishes a right to legal capacity for all people, including those with support needs. People with disabilities have a legal right to be given the appropriate supports to make informed decisions in all aspects of their lives, including health. In Ireland, the Assisted Decision-Making (Capacity) Act (2015) ratifies the Convention and has established a legal framework for Assisted Decision Making (ADM). The main provisions of the Act are not yet implemented. Codes of Practice to guide health and social care professionals are currently being developed. Internationally, concerns are expressed that ADM implementation is poorly understood. Using realist synthesis, this study aims to identify Programme Theory (PT) that will inform ADM implementation in healthcare.MethodsA Rapid Realist Review using collaborative methods was chosen to appraise relevant literature and engage knowledge users from Irish health and social care. The review was led by an expert panel of relevant stakeholders that developed the research question which asks, ‘what mechanisms enable healthcare professionals to adopt ADM into practice?’To ensure the PT was inclusive of local contextual influences, five reference panels were conducted with healthcare professionals, family carers and people with dementia. PT was refined and tested iteratively through knowledge synthesis informed by forty-seven primary studies, reference panel discussions and expert panel refinement and consensus.ResultsThe review has developed an explanatory PT on ADM implementation in healthcare practice. The review identified four implementation domains as significant. These are Personalisation of Health & ADM Service Provision, Culture & Leadership, Environmental & Social Re-structuring and Education, Training & Enablement. Each domain is presented as an explanatory PT statement using realist convention that identifies context, mechanism and outcome configurations.ConclusionsThis realist review makes a unique contribution to this field. The PT can be applied by policymakers to inform intervention development and implementation strategy. It informs the imminent policy and practice developments in Ireland and has relevance for other worldwide healthcare systems dealing with similar legislative changes in line with UNCRPD.
The processes of globalization that have characterized recent decades have prompted social psychology to rethink some everyday life concerns and local problems at a global level. This article presents an explanatory model of collective action aimed at fighting poverty with a proposal to integrate the Encapsulated Model of Social Identity in Collective Action (EMSICA) with some antecedents from both the psychology of volunteerism and authority relationship literature. A self‐report questionnaire was administered to 783 Italian participants, and through structural equation modeling, we demonstrated that moral reasoning, engagement values, and prosocial disobedience function as antecedents of the EMSICA model and, thus, are elements in the global fight against poverty.
The present research aims to investigate the psychosocial phenomena of obedience and disobedience in young adults residing in the United States, as a replication of a previous study by Pozzi, Fattori, Bocchiaro, and Alfieri (2014). We utilize social representation theory as a means to better understand and define (dis)obedience, a behavioral dimension of the concept of authority. The analysis was conducted using a concurrent mixed methods design. One hundred and fifty-one participants completed a self-report online questionnaire. The results indicate that participants see both obedience and disobedience as related to an authority. Obedience was mostly perceived as an ability to be responsive to laws, social norms, or physical authorities, as well as a positive social object. Disobedience, instead, was defined as a failure of a negative line of conduct. These results differ from previous research, contributing meaningfully and pragmatically to the theoretical debate on (dis)obedience. Theoretical and practical implications of these findings are discussed.
The aim was to explore shared representations of alcohol use in students who were to travel abroad to study. Focus group data from Italian students ( N = 69) were collected. Analyses used Grounded Theory Methodology and were informed by the four key components of Social Representation Theory (cognition, emotion, attitude and behavioural intentions). The study abroad experience was described as one that would involve an increase in alcohol consumption compared to pre-departure levels. Reasons given included greater social and leisure opportunities involving alcohol, reduced social control and features of the host country environment. Opportunities to intervene and address risky alcohol use in this group are discussed.
Obedience and disobedience have always been salient issues for both civil society and social psychologists. Since Milgram’s first studies on destructive obedience there has not been a bottom-up definition of what obedience and disobedience mean. The current study aimed at investigating the social representations young adults use to define and to co-construct knowledge about obedience and disobedience in Austria. One hundred fifty four (106 females, 68.8%) Austrian young adults (Mean age = 22.9; SD = 3.5) completed a mixed-method questionnaire comprising open-ended questions and free word associations. Overall obedience and disobedience are respectively defined as conformity and non-conformity to regulations, ranging from implicit social norms to explicit formal laws. Authority is multi-faceted and has a central role in orienting obedience and disobedience. Further fundamental determinants of the authority relationship and relevant application of the results are discussed in this paper.
The concept of citizenship is used both as a synonym of social action when referencing to an active form of citizenship as well as to indicate a form of civic obligation (formal citizenship). According to these premises, citizenship can be formalized in a large number of activities that contribute to building it in different ways. The aim of the present work is to explore how the concepts of citizenship and being a citizen are co-built by Italian young adults. Two groups of young adults are considered (engaged vs. not engaged). Eighty-nine young adults participants aged 18–36 completed a self-administered mixed-method questionnaire. A content and thematic analysis was conducted and a composite representation of citizenship emerged. Results of the present work can clarify the concept of citizenship by exploring how it is cognitively and socially represented in young adults and how this representation changes in engaged and not engaged young adults
Objective: The Assisted Decision-Making (ADM) (Capacity) Act was enacted in 2015 in Ireland and will be commenced in 2021. This paper is focused on this pre-implementation stage within the acute setting and uses a health systems responsiveness framework. Methods: We conducted face-to-face interviews using a critical incident technique. We interviewed older people including those with a diagnosis of dementia (n = 8), family carers (n = 5) and health and social care professionals (HSCPs) working in the acute setting (n = 26). Results: The interviewees reflected upon a healthcare system that is currently under significant pressures. HSCPs are doing their best, but they are often halted from delivering on the will and preference of their patients. Many older people and family carers feel that they must be very assertive to have their preferences considered. All expressed concern about the strain on the healthcare system. There are significant environmental barriers that are hindering ADM practice. Conclusions: The commencement of ADM provides an opportunity to redefine the provision, practices, and priorities of healthcare in Ireland to enable improved patient-centred care. To facilitate implementation of ADM, it is therefore critical to identify and provide adequate resources and work towards solutions to ensure a seamless commencement of the legislation.
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