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Traditional faith healers (TFHs) are often consulted for serious mental illness (SMIs) in low- and middle-income countries (LMICs). Involvement of TFHs in mental healthcare could provide an opportunity for early identification and intervention to reduce the mental health treatment gap in LMICs. The aim of this study was to identify models of collaboration between TFHs and biomedical professionals, determine the outcomes of these collaborative models and identify any mechanisms (i.e., explanatory processes) or contextual moderators (i.e., barriers and facilitators) of these outcomes. A systematic scoping review of five electronic databases was performed from inception to March 2023 guided by consultation with local experts in Nigeria and Bangladesh. Data were extracted using a predefined data charting form and synthesised narratively. Six independent studies (eight articles) satisfied the inclusion criteria. Study locations included Ghana (n = 1), Nigeria (n = 1), Nigeria and Ghana (n = 1), India (n = 1), Hong Kong (n = 1) and South Africa (n = 1). We identified two main intervention typologies: (1) Western-based educational interventions for TFHs and (2) shared collaborative models between TFHs and biomedical professionals. Converging evidence from both typologies indicated that education for TFHs can help reduce harmful practices. Shared collaborative models led to significant improvements in psychiatric symptoms (in comparison to care as usual) and increases in referrals to biomedical care from TFHs. Proposed mechanisms underpinning outcomes included trust building and empowering TFHs by increasing awareness and knowledge of mental illness and human rights. Barriers to implementation were observed at the individual (e.g., suspicions of TFHs), relationship (e.g., reluctance of biomedical practitioners to equalise their status with TFHs) and service (e.g., lack of formal referral systems) levels. Research on collaborative models for mental healthcare is in its infancy. Preliminary findings are encouraging. To ensure effective collaboration, future programmes should incorporate active participation from community stakeholders (e.g., patients, caregivers, faith healers) and target barriers to implementation on multiple levels.
This chapter studies the voting behavior of members of the House of Representatives. If the presence of Fox News in a district shapes potential candidates’ perceptions about district party composition and the constituency’s electoral preferences, there are good chances that the same can be said of sitting House members. Here, of course, the expectation is not about how these perceptions affect the decision to run for office; instead, they affect decisions about how to perform so as to stay in office. Much like potential candidates, sitting members of Congress have to make inferences about what their constituents want. Typically, they make these inferences based on their perceptions of the partisan composition of their district, among other considerations. If sitting members are influenced like potential candidates, Fox News might shift their perceptions in the direction of thinking their district is more right-leaning. Alternatively, based on our evidence from Chapter 3, they might feel more vulnerable to challenges from potential candidates to their (ideological) right. In either case, a reasonable expectation, which we find evidence for, is that member roll call votes will move in a rightward direction, especially among Democrats representing more competitive districts.
In this chapter, we investigate whether Fox News’ presence in districts shaped the competitive electoral landscape by influencing potential candidates’ perceptions about the partisan make-up of the constituency in the district and shaping their perceived chances of winning or losing. Specifically, in this chapter, we test whether the entry of Fox News created the perception of a rightward shift in district party composition among potential Republican candidates considering a run in the district. We find that in districts with more Fox News availability, high-quality potential Republican candidates were more likely to challenge Democratic incumbents, especially if the districts were closely competitive.
In this concluding chapter, we review our findings in the context of our initial pre-analysis plan and discuss the limitations of our studies. We then analyze the implications of our study and findings for their scholarly contributions and discuss next steps for future research. We conclude with a discussion of the normative implications of our findings. Despite the hubbub about Fox News being a bull-in-the-china shop, its effects on politicians were contingent on the context of the district they represented. Even if its effects were circumscribed, our evidence shows that the consequences were real. The implications of our findings are twofold. On the one hand, it throws some cold water on the popular notion that Fox News was a right-wing bulldozer that pulled American politics uniformly in a conservative direction. On the other hand, it makes clear that standard theoretical models of congressional behavior are founded on an assumption that, while useful, is most certainly flawed. Namely, politicians are not fully informed rational calculators. Politicians are people.
This chapter focuses on collective representation, examining whether Fox News affects how the American public is represented. Chapter 5 revealed Fox News effects on dyadic representation; we cannot assume similar effects on collective representation. Yet, in some ways, the path by which Fox News would affect collective representation is clearer than at the district-level. Because Fox News is a national outlet with a wide following, it could affect collective representation through agenda-setting. If many people across many districts regularly watch Fox News, it may draw the attention of both legislators and constituents to the same set of issues. To test for Fox News effects on collective representation, we examine whether the presence of Fox produced different policy outcomes than would have occurred in its absence. We simulate a world where Fox News does not exist in any member’s district and then compare it to the actual behavior of members of Congress given the observed levels of Fox News. The results suggest a boost for Republican policies in four of the six Congresses we examined. However, the effects are only statistically significant for one Congress, the 108th (2003–2004).
This chapter begins with a description of the arrival and proliferation of Fox News across the United States during its early years and concludes with a description and some analyses of Fox News’ content. Both demonstrations are critical to our case. The former is required because our identification strategy requires that we satisfy the assumption that the Fox News rollout was as-if random – or haphazard – in the sense that it is not related to political factors capable of shaping House members’ behavior. The latter is important for both our empirical evidence and theoretical arguments. First, if we expect the arrival and presence of Fox News to have a unique influence on elite political behavior, it is important to demonstrate whether and to what degree Fox News’ content is different from other networks. Second, examining Fox News’ content can tell us something about the mechanisms for its effects or the process by which it shapes the attitudes and behaviors of political elites.
This chapter sets up our main research question, which is what effect, if any, did the arrival and proliferation of Fox News have on US politicians? It summarizes the history of Fox News and describes the natural experiment created by the haphazard rollout of Fox News. It goes on to summarize the scholarly literature on media effects and, specifically, how little of it focuses on the behavior of politicians. In turn, it summarizes the scholarly literature on members of Congress and how little of it focuses on the media. It then explains our open science approach.
This chapter highlights the role media play in political accountability. If Fox News’ entry and presence can shape candidate and member perceptions about what districts want (as we saw in Chapters 3 and 4), can Fox News also shape how responsive representatives are to constituents’ policy preferences? This responsiveness to the district – also known as dyadic representation – is the subject of our examinations in Chapter 5. To test this question, we quantify the degree to which representatives’ voting behavior diverges from what it should be (if they were faithfully following district public opinion). Here we find, once again, that Fox News increases the tendency for Democratic members in marginal districts to “move rightward” in response to rising Fox News availability in the district. In this analysis, our measures reflect the tendency for Democrats in right leaning districts to err on the conservative side of the median voter in their district, and that tendency gets worse as district-level availability of Fox News increases.
The influence of partisan news is presumed to be powerful, but evidence for its effects on political elites is limited, often based more on anecdotes than science. Using a rigorous quasi-experimental research design, observational data, and open science practices, this book carefully demonstrates how the re-emergence and rise of partisan cable news in the US affected the behavior of political elites during the rise and proliferation of Fox News across media markets between 1996 and 2010. Despite widespread concerns over the ills of partisan news, evidence provides a nuanced, albeit cautionary tale. On one hand, findings suggest that the rise of Fox indeed changed elite political behavior in recent decades. At the same time, the limited conditions under which Fox News' influence occurred suggests that concerns about the network's power may be overstated.
Pharmacogenomic (PGx) testing identifies individual genetic variation that may inform medication treatment. Sentiment and barriers may limit PGx testing. Here we compare confidence in utilizing PGx testing and barriers to implementation by type of provider and treatment condition as identified in a survey.
Methods
Healthcare providers in the primary care setting were targeted between November 2022 and February 2023 via the Medscape Members paid market research program. The survey included 5 demographic, 5 multiple-choice, and 4 multi-component five-point Likert scale questions to assess PGx sentiments, use, and education in mental health (e.g., depression) and primary care (e.g., cardiovascular disease) conditions. Responses were descriptively compared.
Results
Of 305 U.S. provider respondents [40% nurse practitioners (NPs), 33% frontline MDs/DOs, 3% physician assistants (PAs), 24% other], 32% of NPs/PAs and 29% of MDs/DOs had used PGx testing for mental health conditions. The major barriers to adopt PGx testing were similar for mental health and primary care conditions yet differed by provider type. NPs/PAs (72-77%) were more concerned with patient cost than MDs/DOs (46-55%), whereas MDs/DOs were more concerned with evidence of clinical utility (54-59%) than NPs/PAs (40-42%). In respondents who use PGx testing, MDs/DOs reported slightly more confidence utilizing PGx than NPs/PAs. For both groups, confidence in using PGx for mental health conditions was somewhat greater than for non-mental health conditions.
Conclusions
These data illuminate the implementation barriers and confidence levels of clinicians utilizing PGx testing. Increasing awareness around patient cost and evidence of clinical utility for PGx testing may improve utilization.