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To describe a sequential mixed methods review method that prioritized synthesized qualitative evidence from primary studies to explain the complexities of older persons with multiple chronic conditions’ unplanned readmission experiences.
Background
Segregated mixed methods review studies frequently prioritize quantitative evidence synthesis to examine the effectiveness of interventions; utilizing qualitative evidence to explain quantitative data. There is a lack of guidance about how to prioritize qualitative evidence.
Results
Five procedural steps were developed to prioritize qualitative evidence synthesis. In Step 1, research questions were developed. In Step 2, databases were searched, studies were mapped to their method (qualitative or quantitative) and appraised. In Step 3, meta-synthesis and applied thematic analysis were used to synthesize extracted qualitative evidence about the psychosocial processes and factors that influenced unplanned readmission. In Step 4, quantitative evidence was synthesized using vote counting to determine the factors influencing unplanned readmission. In Step 5, a matrix was used to compare, determine the agreement between the qualitative and quantitative evidence, juxtapose findings, and uphold validity. Factors were mapped to the model of psychosocial processes and analytic themes.
Conclusion
Prioritizing qualitative evidence synthesis in a mixed methods review study prioritizes participants’ experiences, perspectives, and voices to understand complex clinical problems from participants who experienced the event. Synthesizing and integrating evidence facilitates the construction of holistic new understandings about phenomenon and expands mixed methods systematic review methods.
Implications
Prioritizing patients’ perspectives is useful for developing new client-centered interventions, establishing best practices for future reviews, generating theories, and expanding research methods.
The Dominican Republic retroactively stripped thousands of Dominico-Haitians of their Dominican citizenship yet managed to defuse international opprobrium over time. After a direct assault on people’s citizenship status in 2013 provoked the human rights community’s ire, the DR employed administrative obstructionism to maneuver around human rights activism and institutions. Policies instituted in 2014 appeared to offer a pathway for Dominico-Haitians to reinstate their citizenship yet were so administratively onerous that most of the affected population remains effectively stateless. Administrative obstructionism makes for an elusive target of attack because it unfolds across a series of decisions over time, transfers responsibility from a highly visible leader to dispersed and faceless bureaucrats, and is exceedingly difficult to monitor. Administrative obstructionism drags out proceedings, causing media attention to wither. Because international forces face special challenges in countering this strategy, a strong domestic opposition movement is necessary to sustain pressure on a rights-violating government.
In the last two decades governments across Latin America have adopted and implemented conditional cash transfer (CCT) programs, lifting large numbers of poor families out of economic destitution and inducing child beneficiaries to attend school and receive preventive health care on a regular basis. First emerging in Mexico and Brazil, this social policy innovation was quickly adopted in a wide range of other countries in the region. This chapter employs the analytical framework of diffusion to examine and analyze the spatial and temporal clustering that characterized the spread of CCTs in Latin America. Distinguishing between the adoption of the new policy innovation and its implementation, the chapter argues that diffusion dynamics were crucial in the adoption phase. It leverages a diffusion framework to explain why so many countries adopted CCTs at all. At the same time, the chapter grants that many other factors influenced how CCTs unfolded during the implementation phase, shaping the varied forms they have taken across the region.
Conditional cash transfer programs (CCTs) have emerged as an important social welfare innovation across the Global South in the last two decades. That poor mothers are typically the primary recipients of the grants renders easy, but not necessarily correct, the notion that CCTs empower women. This article assesses the relationship between the world’s largest CCT, Brazil’s Bolsa Família, and women’s empowerment. To systematize and interpret existing research, including our own, it puts forth a three-part framework that examines the program’s effects on economic independence, physical health, and psychosocial well-being. Findings suggest that women experience some improved status along all three dimensions, but that improvements are far from universal. A core conclusion is that the broader institutional context in which the Bolsa Família is embedded—that is, ancillary services in health and social assistance—is crucial for conditioning the degree of empowerment obtained.
Understood simply, people are either citizens of a country or stateless. Yet reality belies this dichotomy. Between absolute statelessness and full citizenship exist millions of people who are nationals of a country in principle but lack the identity documents to prove it, beginning with a birth certificate. Languishing in a gray zone, undocumented nationals have difficulty accessing the full services and rights that their documented counterparts enjoy. Drawing on a range of country examples, Undocumented Nationals: Between Statelessness and Citizenship calls attention to and analyzes the plight of people who cannot exercise full citizenship owing to evidentiary deficiencies. The existing literature has not adequately conceptualized and examined this in-between status, which results sometimes from state neglect and other times from intentional state discrimination. By highlighting its causes and consequences, and exploring ways to address the problem, this Cambridge Element addresses an important gap in the literature.
The purpose of this study was to analyse the consistency and extent of palliative content across high-level guiding documents related to the care of persons residing in Canadian long-term care homes. A systematic search was conducted examining documents at the national level and across five provinces (Alberta, Ontario, Saskatchewan, Manitoba, and Quebec). Twenty-five documents were selected based on inclusion criteria from 273 documents identified in the systematic search. The majority of these documents were created nationally (48%) or in Ontario (28%). Documents varied in palliative topics discussed, and long-term care was discussed minimally. A minimal number of palliative care guiding documents were found. Long-term care specific documents were absent, and all documents lacked consistency on palliative topics. It is imperative that palliative principles are present and consistent in high-level documents in order to improve the quality of life and care for long-term care residents across Canada.
Has democracy promoted poverty alleviation and equity-enhancing reforms in Brazil, a country of striking inequality and destitution? The effects of an open, competitive political system have not been straightforward. Factors that would seem to work toward this goal include the voting power of poor people, the progressive 1988 Constitution, the activism of social movements, and governance since 1995 by presidents affiliated with center-left and left parties. Yet these factors have been counterbalanced by the strong political influence and lobbying power of organized interests with a stake in preexisting arrangements of social protection and human capital formation. An analysis of four key federal sectors, social security, education, health care, and public assistance, illustrates the challenges for social sector reforms that go beyond raising basic living standards to enhancing socioeconomic inequality.
This article analyzes Luiz Inácio da Silva's resounding reelection victory in the wake of corruption scandals implicating his party and government. Voters with lower levels of economic security and schooling played a critical role in returning Lula to the presidency. Least prone to punish the president for corruption, poorer Brazilians were also the most readily persuaded by the provision of material benefits. Minimum wage increases and the income transfer program Bolsa Família expanded the purchasing power of the poor. Thus, executive power and central state resources allowed Lula to consolidate a social base that had responded only weakly to his earlier, party-based strategy of grassroots mobilization for progressive macrosocietal change. Although Lula won handily, the PT's delegation to Congress shrank for the first time, and the voting bases of president and party diverged. The PT benefited far less than the president himself from government investment in social policy.
A birth certificate is essential to exercising citizenship, yet vast numbers of poor people in developing countries have no official record of their existence. Few academic studies analyze the conditions under which governments come to document and certify births routinely, and those that do leave much to be explained, including why nontotalitarian governments at low to middle levels of economic development come to prioritize birth registration. This article draws attention to the impetus that welfare-building initiatives give to identity documentation. The empirical focus is on contemporary Latin America, where extensions in institutionalized social protection since the 1990s have increased the demand for and supply of birth registration, raising the life chances of the poor and building state infrastructure in the process. The authors' argument promises to have broader applicability as welfare states form in other developing regions.
Welfare programs distribute benefits to citizens. Perhaps even more importantly, by conveying powerful messages about how the state views poor people, welfare programs shape people’s views about themselves as subjects or citizens. Theoretical debates on how public policies can enhance democratic citizenship inspire our study of Brazil’s Bolsa Família (Family Grant). Has this conditional cash transfer program, which forms a major point of contact between the state and millions of poor Brazilians, elevated feelings of social inclusion and agency? A prominent perspective in the welfare-state literature would not expect a positive outcome given the strict means testing and behavioral requirements entailed. Yet our focus group research with Bolsa Família recipients suggests that the program does foster a sense of belonging and efficacy. Policy design and government discourse matter. This innovative welfare program yields rich insights on alternative paths to citizenship development for middle- and low-income countries in the third wave of democracy.
Drawing on historical institutionalism and strategic frameworks, this book analyzes the evolution of the Workers' Party between 1989, the year of Lula's first presidential bid, and 2009, when his second presidential term entered its final stretch. The book's primary purpose is to understand why and how the once-radical Partido dos Trabalhadores (PT) moderated the programmatic positions it endorsed and adopted other aspects of a more catch-all electoral strategy, thereby increasing its electoral appeal. At the same time, the book seeks to shed light on why some of the PT's distinctive normative commitments and organizational practices have endured in the face of adaptations aimed at expanding the party's vote share. The conclusion asks whether, in the face of these changes and continuities, the PT can still be considered a mass organized party of the left.
Can Latin America's 'new left' stimulate economic development, enhance social equity, and deepen democracy in spite of the economic and political constraints it faces? This is the first book to systematically examine the policies and performance of the left-wing governments that have risen to power in Latin America during the last decade. Featuring thorough studies of Bolivia, Brazil, Chile, and Venezuela by renowned experts, the volume argues that moderate leftist governments have attained greater, more sustainable success than their more radical, contestatory counterparts. Moderate governments in Brazil and Chile have generated solid economic growth, reduced poverty and inequality, and created innovative and fiscally sound social programs, while respecting the fundamental principles of market economics and liberal democracy. By contrast, more radical governments, exemplified by Hugo Chávez in Venezuela, have expanded state intervention and popular participation and attained some short-term economic and social successes.
The purpose of the study was to determine patterns of diet use among middle-aged Australian men and women and the relationships between these different usage patterns and demographic characteristics, health status and health habits. A cross-sectional mail survey was conducted among a random sample of 2975 people aged 40–71 years in Victoria, Australia. A total of 1031 usable questionnaires were obtained which included information about the use of diets (e.g. low-fat and low-salt) during the past 3 months along with demographic information, health status and health habits. Based on the responses about the use of thirteen diets for both sexes, latent class analysis was employed to identify the optimal number of use of diets and the assignment of participants to particular groups. Three types of diet uses were identified and provisionally named: diet use, selected diet use and non-diet use. This classification was associated with demographics, health status and health habits, and these associations differed between men and women. The findings suggest that nutrition education programmes should be tailored to the different needs of the diet use groups.
The PT is a case of the successful and fairly gradual transformation of a radical institutionalized mass party into a more electorally competitive professional party. Given its start as exceptionally ideological and grassroots oriented, it was the kind of party we might least expect to have reoriented in a vote-maximizing way. Ultimately, the PT did adapt but its adaptation was fairly slow – arguably slower than, for example, the Argentine Peronists, the Chilean Socialists, or the Argentine FREPASO. After three failed presidential bids, the PT went on to win two consecutive presidential contests, an unprecedented feat for the left in Brazil. Although Lula had responded rationally to externally induced incentives (and persuaded significant elements in the party to go along with him), there was also internal resistance to change. The PT's origins and structure created lags and distortions in adaptation but also some real advantages, namely endowing the party with credibility as the voice of opposition in 2002, discipline in passing difficult reforms once Lula became president, and a reliable foundation that would help it weather a number of serious crises.
In this chapter I return to the analytical approaches that frame the book. I draw out the broader theoretical implications of the book's analysis after first revisiting the reasons for change within the PT and comparing anew the features of its adaptation that are explained by a strategic framework to those that historical institutionalism helps to understand.