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BACKGROUND Neonatal mortality (death within 0-28 d of life) in Kenya is high despite strong evidence that newborn care recommendations save lives. In public healthcare facilities, nurses counsel caregivers on term newborn care, but knowledge about the content and quality of nurses' recommendations is limited. PURPOSE To describe the term newborn care recommendations provided at a tertiary-level, public referral hospital in Western Kenya, how they were provided, and related content taught at a university nursing school. METHODS A rapid, focused ethnographic assessment, guided by the culture care theory, using stratified purposive sampling yielded 240 hours of participant observation, 24 interviews, 34 relevant documents, and 268 pages of field notes. Data were organized using NVivo software and key findings identified using applied thematic analysis. RESULTS Themes reflect recommendations for exclusive breastfeeding, warmth, cord care, follow-up examinations, and immunizations, which were provided orally in Kiswahili and some on a written English discharge summary. Select danger sign recommendations were also provided orally, if needed. Some recommendations conflicted with other providers' guidance. More recommendations for maternal care were provided than for newborn care. IMPLICATIONS FOR PRACTICE There is need for improved consistency in content and provision of recommendations before discharge. Findings should be used to inform teaching, clinical, and administrative processes to address practice competency and improve nursing care quality. IMPLICATIONS FOR RESEARCH Larger studies are needed to determine whether evidence-based recommendations are provided consistently across facilities and other populations, such as community-born and premature newborns, who also experience high rates of neonatal mortality in Kenya.

This article is set in a gated enclave of the new elite in Mysuru (formerly Mysore) city in the state of Karnataka in South India. Mysuru is a growing information technology centre that it is also undergoing urban transformation which includes international style fortified neighbourhood developments suitable for this class of highly qualified, globally mobile wealthy professionals predominantly engaged in the information technology sector. Residents in the neighbourhood seem to live in a world of their own, where they set their own rules and enforce their own sanctions. They have chosen to stay there to segregate themselves from the world outside. Ensconced in their comfortable high walled enclosures, they nevertheless allow the entry of a much polarized lower class into their homes as workers for various services, for sheer need of sustaining the grandeur of their daily lives. The neighbourhood association has become a powerful corporate and a potent tool for expression of everyday power. Using participant observation, interviews, narrative lore and other qualitative measures, the article probes the psyche of the new elite, their interaction with service classes, and the dynamics of power in the enclave. Narrating one incident as the prism that deflects several strands in the complex web of relationships, I have demonstrated the power of the residents’ welfare association as experienced, expressed and enacted in the everyday in that domain. I have argued that this power gets augmented through the fortification and essentially draws from ownership and control over spatial arrangements.

In complex watershed management systems, learning from mistakes and adapting the rules accordingly is important. Our study investigates the interaction between two groups of stakeholders in a government-led Integrated Water Resources Management (IWRM) program in Peru’s Colca Valley: 1) local water users at the community level and 2) regional water agency officials. We examined how learning and adaptation happened or did not happen for both stakeholder groups. We collected data through 90 semi-structured interviews with local water users in three Colca Valley communities and water agency officials, as well as participant observation during meetings between the two groups. We found that both stakeholder groups learned and adapted to each other’s responses in a dynamic way. Nevertheless, the type of adaptation that occurred was maladaptive because it sustained the program flaws that reinforced the gap between the IWRM policies of regional water agencies and the water management priorities and incentives of local water users. We found that while there was an initial top-down and bottom-up sharing of information, water agency officials generally did not have the capacity to implement lessons learned and often dismissed negative feedback voiced by local water users. At the community level, water users had limited incentives to comply with IWRM requirements because the rules disadvantaged them economically. As a result, they learned to withhold information from water agency officials. We label this phenomenon maladaptive learning and argue that it leads to outcomes that are mutually non-beneficial for both stakeholder groups.

Studying the social aspects of pharmaceuticals is an inherent part of the field of social pharmacy. Ethnography as a methodology provides a lens to guide researchers on this endeavor by offering richer insights into “real world practices” of professionals, patients and relatives compared to other methods. With a focus on meaning making, ethnography goes beyond descriptions and promotes theory-informed interpretations. Therefore, this methodology can lead to new understandings of medicine use in practice and in policy making. This article provides a brief introduction to ethnography, especially in relation to doing participant observation and fieldwork. An example from an ethnographic fieldwork on Danish home care for frail elderly is used to illustrate how ethnography can be applied, while focusing on three key features of ethnographic analysis: Thick descriptions, analytical generalizability and reflexivity.

Food-energy-water (FEW) nexus governance includes the communication and collaboration among multi-level stakeholders across sectoral boundaries of the resources for decision-making. It can increase resource security and decrease unintended consequences, as compared to single-sector governance approaches. Despite these benefits, in practice, many decisions continue to be made separately from one another without cross-sector collaboration. This research integrates the theory of collaborative governance with the concept of the FEW nexus to identify and understand the barriers to this collaboration and to provide recommendations for increased collaborative FEW nexus governance. Focusing on the Phoenix, Arizona metropolitan area, a water-scarce region with a growing population, we conduct a comprehensive case study with social network analysis, participant observation, and interviews. We present the results of our analysis in three sections. First, we identify the key barriers to collaborative FEW nexus governance within four identified themes: structural asymmetries, process asymmetries, communication and coordination, and external influences. Second, we unpack how stakeholders in our study case experience these barriers. Finally, from our case study, we provide recommendations for overcoming barriers and implementing collaborative FEW nexus governance in practice, such as building trust and finding mutual benefit. We conclude that “sector mismatch,” similar to scale mismatch, is the main cause of the identified barriers and that approaches to collaborative FEW nexus governance must address this mismatch for successful engagement.

On the basis of participant observation and questionnaire data, we consider the cultural shaping of video gaming pleasure and distress in face-to-face gaming centers in Udaipur, Rajasthan, India. W...

The propose of this paper is to generate a research agenda on exploring the possible prospects of cultural exchanges in the context of trade routes along the Belt and Road Initiative by using cha chaan teng (茶餐厅), or Hong Kong style cafe, which has been a “by-product” of inter-cultural experiences in the 1950s in Hong Kong. Thus, the theoretical framework used for researching cha chaan teng, and constructing the research agenda are informed with the concepts of food, culture, and mobilities. Ethnographic in-depth interviews, systematic participant observation of cafes, content analysis of selected cha chaan teng websites were used to gain understanding of this cultural practice. Drawn on the past development of cha cha cheng, this paper suggests that Belt and Road Initiative can be seen as one of the many trade initiatives at the current time, and food consumption, adaptation, and invention along the routes are businesses which go along well with the movements of people and projects. It is reasonable to expect intriguing business opportunities and products through cultural exchanges, something similar to the development of cha chaan teng started in the past in Hong Kong. The research agenda advocate inter- and multidisciplinary theoretical approach and mixed methodologies to explore what new developments will be brought along the routes either something that will emerge as new, or something that will continue to synergize from the past practices. Hopefully, empirical findings will direct toward a culturally sensitive interaction, in which understanding, compassion, tolerance, and respect can be nurtured and developed.

This paper analyses the networks, experiences and aspirations of Nepalese workers in Southern Portugal's farms and greenhouses. The main research objective is to analyse how recruitment networks, which supported the move of Nepalese to Portugal, were established and have rapidly consolidated. These networks impacted not only the increase of irregular migration flows but also the migration experience and vulnerability in the country of destination, including the passive acceptance of a certain degree of exploitation. By highlighting the perspective of the migrants themselves, we examine the impact on their lives, both of the migration experience and of paying large sums to smugglers, usually obtained through indebtment, to enter Portugal. We relate this impact to a context of immigration where the existence of a large informal labour market facilitates these workers being hired as irregular migrants. The study employed secondary data, in-depth interviews and participant observation. As well as migrants, greenhouse owners and recruiters were also interviewed for the study. The main finding is that the disposition of Nepalese to migrate, in which the pressure of the family plays a key role, tends to be reinforced by the action of the networks of recruiting agents. Secondly, the costs of migration and labour exploitation tend to be accepted by the migrants as a way to fulfil their social aspirations and economic necessities. info:eu-repo/semantics/acceptedVersion

Brazil stands out at the global level for having implemented several policies intending to promote agroecology as a productive paradigm for small-holder farmers. However, the impacts of this process of institutionalization of agroecology still lack research and debates that evaluate the effectiveness of these policies. In this paper, we assess and discuss the impacts of a policy specifically focused on education in agroecology, the support to the establishment of Centers for the Study of Agroecology and Organic Production (NEAs) in higher education institutions throughout Brazil. NEAs bring together teachers, researchers, and students who engage in teaching, research, and extension activities in partnerships with peasant farmers, their organizations, and rural extension workers. The hypothesis that guides our analysis is that this support to establish NEAs allowed redistribution of symbolic power in the universities where they were established, supporting agroecology to gain greater legitimacy inside and outside the university field. Based on an in-depth study of four NEAs, the NEAs are evaluated from the perspective of social fields in dispute. Our findings suggest that the State support to university groups dedicated to the promotion of agroecology has allowed the construction of what we have named agroecological spaces, which symbolically dispute the dominant paradigms in educational institutions, supporting the constitution of agroecological territories., RESUMEN. El Brasil se destaca a nivel mundial por haber implementado varias políticas destinadas a promover la agroecología como paradigma productivo para los pequeños agricultores. Sin embargo, los impactos de este proceso de institucionalización de la agroecología aún carecen de investigaciones y debates que evalúen la efectividad de estas políticas. En este trabajo, evaluamos y discutimos los impactos de una política específicamente centrada en la educación en agroecología, el apoyo al establecimiento de Centros para el Estudio de la Agroecología (NEAs) en educación superior en todo Brasil. Los NEAs reúnen a maestros, investigadores y estudiantes que participan en actividades de enseñanza, investigación y extensión en asociación con campesinos, sus organizaciones y trabajadores de extensión rural. La hipótesis que guía nuestro análisis es que este apoyo para establecer NEAs permitió la redistribución del poder simbólico en las universidades donde se establecieron, apoyando a la agroecología para ganar mayor legitimidad dentro y fuera del ámbito universitario. Sobre la base de un estudio en profundidad de cuatro NEAs, los NEAs se evalúan desde la perspectiva de los campos sociales en disputa. Nuestros hallazgos sugieren que el apoyo del Estado a los grupos universitarios dedicados a la promoción de la agroecología ha permitido la construcción de lo que hemos denominado espacios agroecológicos, que simbólicamente disputan los paradigmas dominantes en las instituciones educativas, apoyando la constitución de territorios agroecológicos., O Brasil se destaca em nível global por ter implementado políticas com a intenção de promover a agroecologia como paradigma produtivo para a agricultura familiar. No entanto, a eficácia dessas políticas ainda carece de pesquisas e debates que permitam a sua avaliação e a compreensão dos impactos desse processo de institucionalização da agroecologia. Neste artigo, avaliamos e discutimos o apoio à criação de Núcleos de Estudo em Agroecologia (NEAs) em instituições de ensino superior em todo o Brasil. Os NEAs reúnem professores, pesquisadores e estudantes que se engajam em atividades de ensino, pesquisa e extensão em parcerias com camponeses, suas organizações e extensionistas rurais. A hipótese que norteia nossa análise é que o apoio ao estabelecimento dos NEAs permitiu uma redistribuição do poder simbólico dentro das universidades onde eles foram estabelecidos, permitindo que a agroecologia ganhasse maior legitimidade. Com base em um estudo aprofundado de quatro NEAs, os avaliamos na perspectiva de campos sociais em disputa. Nossos achados sugerem que o apoio do Estado aos grupos universitários dedicados à promoção da agroecologia permitiu a construção do que chamamos de espaços agroecológicos, que simbolicamente contestam os paradigmas dominantes nas instituições de ensino, apoiando a constituição dos territórios agroecológicos. Palavras-chave: poder simbólico, agroecologia, transdisciplinaridade, educação superior, Brasil. Winning Hearts and Minds Through a Policy Promoting the Agroecological Paradigm in Universities ABSTRACT. Brazil stands out at the global level for having implemented several policies intending to promote agroecology as a productive paradigm for small-holder farmers. However, the impacts of this process of institutionalization of agroecology still lack research and debates that evaluate the effectiveness of these policies. In this paper, we assess and discuss the impacts of a policy specifically focused on education in agroecology, the support to the establishment of Centers for the Study of Agroecology and Organic Production (NEAs) in higher education institutions throughout Brazil. NEAs bring together teachers, researchers, and students who engage in teaching, research, and extension activities in partnerships with peasant farmers, their organizations, and rural extension workers. The hypothesis that guides our analysis is that this support to establish NEAs allowed redistribution of symbolic power in the universities where they were established, supporting agroecology to gain greater legitimacy inside and outside the university field. Based on an in-depth study of four NEAs, the NEAs are evaluated from the perspective of social fields in dispute. Our findings suggest that the State support to university groups dedicated to the promotion of agroecology has allowed the construction of what we have named agroecological spaces, which symbolically dispute the dominant paradigms in educational institutions, supporting the constitution of agroecological territories. Keywords: symbolic power, agroecology, transdisciplinary, higher education, Brazil. Ganar corazones y mentes a través de una política que promueva el paradigma agroecológico en las universidades RESUMEN. El Brasil se destaca a nivel mundial por haber implementado varias políticas destinadas a promover la agroecología como paradigma productivo para los pequeños agricultores. Sin embargo, los impactos de este proceso de institucionalización de la agroecología aún carecen de investigaciones y debates que evalúen la efectividad de estas políticas. En este trabajo, evaluamos y discutimos los impactos de una política específicamente centrada en la educación en agroecología, el apoyo al establecimiento de Centros para el Estudio de la Agroecología (NEAs) en educación superior en todo Brasil. Los NEAs reúnen a maestros, investigadores y estudiantes que participan en actividades de enseñanza, investigación y extensión en asociación con campesinos, sus organizaciones y trabajadores de extensión rural. La hipótesis que guía nuestro análisis es que este apoyo para establecer NEAs permitió la redistribución del poder simbólico en las universidades donde se establecieron, apoyando a la agroecología para ganar mayor legitimidad dentro y fuera del ámbito universitario. Sobre la base de un estudio en profundidad de cuatro NEAs, los NEAs se evalúan desde la perspectiva de los campos sociales en disputa. Nuestros hallazgos sugieren que el apoyo del Estado a los grupos universitarios dedicados a la promoción de la agroecología ha permitido la construcción de lo que hemos denominado espacios agroecológicos, que simbólicamente disputan los paradigmas dominantes en las instituciones educativas, apoyando la constitución de territorios agroecológicos. Palabras clave: poder simbólico, agroecología, transdisciplinar, educación superior, Brasil.

The 2030 Agenda for Sustainable Development highlighted the growing attention to the adequacy of health planning models to sustainable development. A re-reading of the results of a round table debate on "sustainable planning", which took place at the 5th National Congress of Tropical Medicine (Portugal, 2019) under a participant observation strategy, framed by the findings of a “synthesis of better evidence” literature review and cross-referenced with the reflections of different authors and experts about the momentum created by the COVID-19 pandemic, underlined the challenges to sustainable health planning that have emerged and are projected beyond the current pandemic context. Variable perceptions of the term “sustainable health development”, leading to the potential loss of their relevance in guiding the elaboration of policies and strategic plans, and the potential higher effectiveness of the participatory approaches of health planning in achieving sustainable health were highlighted in the debate and literature, in general and in public health emergency contexts. Those results gained new relevance during the current COVID-19 pandemic, bringing back to the forefront a reflection of the inadequate planning framework that has usually been used to understand and respond to global health challenges, despite the already existing experience, evidence and support instruments. Highlights: - The path to sustainable development needs appropriate health planning models; - COVID-19 pandemic exposed the fragilities of the strategic planning frameworks; - Sustainable health planning approaches demand social and community mobilisation; - Equity in health must integrate the planning models for sustainable development. info:eu-repo/semantics/publishedVersion

Religious cyberization is a new way of dissemination and development of traditional offline religions. In the process of cyberization, all aspects of religions are likely to be affected by the new Internet environment. Taking a Chinese online religious group as Internet field, this article analyzes the influence of cyberization on belief system, religious authority and religious experience of folk religion, and makes a preliminary exploration of its causes in combination with the characteristics of Internet and folk religion. This study mainly adopted the method of participant observation, and conducted online and offline interviews with participants when necessary. In addition, the researcher also analyzed documents, audio and other files uploaded in the online group. In the case discussed in this article, compared with officially recognized religions in China, folk religion seems to be more adapted to the opportunities and challenges brought by the new territory of the Internet due to its unique diffuseness and inclusiveness.

Purpose It is predicted that increasing numbers of citizens of the Pacific Island nation of Tuvalu will migrate to New Zealand in the coming decades due to the threat of climate change. Tuvaluans currently living in New Zealand face disparities in income, education and health. This study aims to understand the views of recent Tuvaluan immigrants to Auckland, New Zealand on health behaviors, health care and immigration. Design/methodology/approach The authors conducted semi-structured interviews, key informant interviews and participant observation using a focused ethnography methodology. Findings Participants explained that Tuvaluans in New Zealand do not fully use primary care services, have a poorer diet and physical activity compared to those living in Tuvalu, and struggle to maintain well-paying, full-time employment. Practical implications As Tuvaluan immigration to New Zealand continues, it will be important to educate the Tuvaluan community about the role of primary health-care services and healthy behaviors, facilitate the current process of immigration and provide job training to recent immigrants to improve their opportunities for full-time employment and ensure cultural survival in the face of the threat of climate change. Originality/value This paper contributes to a greater understanding of the challenges to be faced by Tuvaluan environmental migrants in the future and features a high proportion of study participants who migrated due to climate change.

Practice change is essential if environmental agencies are to incorporate diverse values in decision making, but little is currently known about what constrains or enables such change. Over a 19-month period, we observed how environmental professionals responded to an agency request that they consider a wider range of values in strategic bushfire management planning than had been considered in past practice. Through participant observation, interviews and document analysis, we examined how practices did and did not change and what contributed to these outcomes. Practices for assessing well understood values (e.g. towns and houses, ecological resilience) were refined, while practices for handling less familiar values (e.g. animal welfare, economic values and Indigenous cultural heritage) were either maintained, adapted or transformed, with outcomes varying across values and regions. The findings partly confirm expected biases toward values that can be spatially located and quantified, and point to other conditions supporting change to incorporate new types of values: alignment between policy and planning guidance, alignment between a value and priorities of professionals and agencies involved in planning, collaboration that supported input from cross-agency actors, and scope for experimentation. We discuss the practical implications of these findings for agencies seeking to incorporate values in environmental planning.

La irrupción del marketing digital en el sector turístico ha sido esencial en la evolución y mejora de su actividad simplificando muchos de los procesos propios de la mercadotecnia tradicional. Desde la declaración del Estado de Alarma en España a mediados de marzo del año 2020 y la consecuente imposibilidad de viajar, parte de los agentes turísticos han comprendido y valorado la utilidad de estas nuevas herramientas para promocionar y comercializar sus productos y servicios turísticos. El propósito de este trabajo es conocer y proponer las aplicaciones del marketing digital en la etapa de restablecimiento del turismo en Galicia, que puedan aplicarse a las oficinas de turismo de la comunidad gallega. Para ello, se ha recabado información mediante dos técnicas de investigación cualitativa, la observación participante y las entrevistas con expertos, al mismo tiempo que se ha realizado una amplia revisión de la literatura. La recuperación del sector residirá en la cooperación público-privada para la planificación de estrategias que permitan una supervivencia sostenible del turismo en Galicia. De manera específica, las oficinas de turismo tendrán que aplicarse en la mejora de sus servicios. Para ello, el marketing y la comunicación digital tendrán un papel importante en la recuperación de la demanda con el uso consciente de herramientas como las redes sociales.

Whereas the emergence of pyramid schemes exerted considerable impacts on people’s lives, up to now, far too little attention has been paid to the experiences of members from the sociological perspective, particularly in non-Western contexts. Therefore, this study illuminates social processes underlying participation in such schemes in a less studied social setting, Iran. This article also critically traces the social and psychological consequences of membership in pyramid schemes. We adapted a critical ethnographic approach, including participant observation of local branch offices, followed by 16 in-depth interviews with the former members of schemes. Our findings suggest that the practices deployed by the schemes lead to the building of social identity, namely, “superhuman,” mainly based on the misinterpretation of the real world. Finding the reality surrounded deliberately contrasted with the firms’ promises, the constructed identity fails, and members lose their social capital.

Education is strategic to increasing human resources quality which is a determinant factor of national development. To achieve education goals, we need human resources. Human resources are a keys factor in an institution. Human resources will support organizations with their creation, talent, creativity, and support. Education plays an important role in increasing human resources. Human resources in education include principle, teachers, staff, and committees. Teacher plays an important role to decided education success to produce quality output. A teacher is the main key to learning success. The teacher is expecting to create learning education interaction and make innovation to learning quality improvement. The purpose of study is to analysis and finding increasing teacher performance through human resources in Islamic education Institution. The research method used descriptive qualitative. The data collecting method uses in-depth interviews, participant observation, and documentation. The result of the study the human resources at Pondok Pesantren Banyumas Jawa Tengah managed is well. The study has proven with planning, recruitment, teacher selection, placement process or orientation, teacher performance assessment, training, carrier development, compensation and allowance, teacher dismissal. Teacher performance is optimal yet, cause many teachers cannot finish their tasks on time, although discipline is a priority. While the implementation of human resources management did well and given an effect on increasing teacher performance. Many resistances increasing teacher performance is prepared lesson plan and learning media maximal yet

Most criminal justice research pertaining to social climate in U.S. prisons has focused on the experiences of incarcerated people and correctional officers, with no studies to our knowledge that explore correctional educators’ significant contributions to prison social climate. Utilizing results from semi-structured interviews and participant observation with correctional educators in institutions managed by eight different state prison administrations, the present study fills this knowledge gap by examining two questions. First, how do correctional educators characterize the life experiences and motivations of incarcerated people who are pursuing an education? Second, how do correctional educators variously regard their respective professional roles as influencing and/or intervening in incarcerated individuals’ lives? Taken together, these findings offer insights into the nuanced ways that correctional educators interpret and understand compound disadvantage among incarcerated people, prison social climate, and motivations for engaging in correctional education. Our recommendations indicate the utility of fostering a collaborative, peer-driven learning environment by including current and former prisoners in education and programming initiatives, and prioritizing sustainable education in a humane institutional environment through recruitment of skilled professional staff willing to engage in cross-professional dialogue.

Educational inclusion of foreign pupils has become a priority objective in recent years in many countries worldwide. Attending to the cultural diversity of pupils and providing an inclusive educational response is now a main goal of education systems. In this context, educational leadership is a key factor for school improvement. Management teams face the difficult mission of responding to the diversity of people that make up the educational community in a scenario marked by the expansive increase in migrant families and the scarcity of inclusive and intercultural government programmes. This article explores good management practices for cultural diversity management in six early childhood and primary education centres in Spain and Chile from an inclusive leadership approach. Factors that influence the development of inclusive leadership and the process deployed to carry out diversity management are examined. Through a qualitative methodology, six case studies were carried out using the interview, participant observation, and document analysis as instruments. The main outcomes show the importance of leaders in promoting an inclusive collaborative culture, in classroom practices focused on the knowledge and cultural capital of foreign pupils, the development of organisational and didactic strategies based on the recognition and participation of the educational community, its commitment to social justice, a management of diversity based on collaboration, and a shared concept of educational inclusion. The conclusions show four common dimensions in the good practices of each country: professional development of the community, school participation, inclusive school culture, and positive management of diversity., We are deeply grateful to the editors and unknown reviewers of this article for the valuable comments we received for writing this article. We would also like to thank the Spanish Ministry of Economy and Competit‐ iveness (project CSO2013–43266‐R “Construyendo difer‐ encias en la escuela. Estudios de las trayectorias de las ATAL en Andalucía, de su profesorado y de su alum‐ nado”) who supported the research and the National Research and Development Agency (ANID) through the National Scientific and Technological Research Commission (CONICYT; Fondecyt projects 1190349 and 3200192). This article was translated by Neil Macowan Language Services.

This is a qualitative study examining the utilisation pattern of traditional medicine among young Malay women breast cancer patients. The study has shown that there is an increasing number of breast cancer patients to opt for traditional medicine in searching for a cure. To address the issue, an ethnographic fieldwork was carried out in Klang Valley and several selected areas of Selangor. Thirteen (13) young Malay breast cancer patients were selected as informants for this study by employing purposive snowballing technique. Guided by semi-structured interview schedule, a series of in-depth interviews, phone and online interviews and participant observation were conducted at various settings to capture informants’ health seeking behaviour. It is evident that traditional medicine is still prevalent as one of the treatment options among breast cancer patients. They strongly believed that relying on a single treatment for chronic illness like breast cancer is insufficient. In relation to this, traditional healers and health practitioners such as bomoh and ustaz were consulted by Malay informants either as an alternative or complementary for a cure. Several treatment methods such as herbal remedies for oral consumption, air penawar (healing water) for drinking and bathing and specific item such as an egg for surgery-like procedure were prescribed to treat the cancer-related symptoms suffered. In most instances, majority of the patients were guided by family and friends’ suggestions towards the utilisation of traditional medicine.

Background Socio-cultural factors may influence the uptake of breast cancer treatments. This study aimed to explore these socio-cultural influences on treatment decision-making for women in Ghana. Method An ethnographic approach was adopted. Observation was conducted of women newly diagnosed with breast cancer, nominated relatives, nurses and doctors at a breast clinic in Ghana. Semi-structured interviews followed participant observation. Thematic analysis was employed. Findings Over 16 weeks (July 2017–November 2017), 31 participants were observed and 29 took part in semi-structured interviews. Three overarching themes were identified: (1) unequal power relationships; (2) Language barriers and (3) structural constraints. Following a breast cancer diagnosis, essential information necessary for treatment decision making is ‘hidden’ from women due to an unequal patient-provider relationship. Patients acknowledged cultural behaviours of deference to experts. Doctors deliberately misrepresented treatment information to women to encourage them to undergo surgical treatment. Structural issues such as the lack of privacy during consultations hindered quality patient engagement with decision-making. High treatment costs and the lack of resources to assist women with fertility after treatment impeded open discussions around these issues. Language barriers included a lack of terms in the local Twi language to explain cancer and its treatment. There was also an absence of appropriate information materials. Conclusion Findings highlight the need for health professionals to be aware of the socio-cultural factors that limit access to quality information which is needed for informed treatment decision making. Policies that aim to provide adequate logistics; increase staffing levels; improve staff cultural awareness training and remove financial barriers are recommended.

Objective The objective of this study is to elucidate the decision-making experiences of youth with brachial plexus birth injuries who face preference-sensitive decisions regarding treatment options for a persistent elbow contracture. Methods Transcripts, research-created drawings, and field notes from in-depth interviews with 5 young adults and 14 youth-parent dyads, and 15 participant observation sessions of families and clinicians in the clinic setting were deductively and inductively coded and thematically analyzed. Results Youth’s shared decision making was influenced by relational processes with their clinicians and parents. Youth’s trust in their clinicians’ recommendations for pursuing treatment and pressure from their parents to pursue or continue rehabilitation treatment affected how their voices were expressed and heard. Parental emotional adjustment to the birth injury played a role in parental perceptions of what was deemed their youth’s best interest in the shared decision. Conclusions The decision-making experiences of youth with brachial plexus birth injury illustrate the complexity of paediatric preference-sensitive decisions and the significance of social and emotional factors on these shared decisions. Practice implications Opportunity for youth to express their voice without external pressure during shared decision making is needed to make well-informed decisions based on their own values. Interventions such as decision coaching and decision support tools may help youth and parents to formally identify and discuss these relational processes.

The influence of private financing on ecological conservation has grown in recent years, but little is known about the actual links between large-scale development projects, public-private contractual arrangements, and community-based conservation. We analyze the political economy of such links by considering a conservation area under management by a rural community involved in wind energy projects receiving environmental compensation. Our study was carried out in the Isthmus of Tehuantepec, Mexico, the most significant wind corridor in Latin America, where the Voluntary Conservation Areas (VCA) strategy was originated. We investigated the role of public-private conservation financing in developing wind energy projects in the area, with a critical approach to the neo-institutional theory of natural resources management. Our mixed field research methods combined ethnography, in-depth structured interviews, surveys, participant observation, and social cartography. We found that: 1) The neoliberal Mexican government has actively oriented community conservation towards a market compensation mechanism; 2) since this mechanism can be easily corrupted, it results in a mix of formal and informal rules that allegedly provides “sustainable and socially responsible” cooperation, but exploits and deepens the market and state failures to which rural poor are exposed; 3) the mechanism provides malicious incentives that allow transnational energy companies to continue to profit from degrading the environment, by combining this degradation with low-cost low-effective conservation of mountain and forest areas owned by rural and indigenous peoples.

In cities of the Global South, including many African cities, large segments of the population are underserved by the city’s formal water regime. In these situations, informal or hybrid methods of water access emerge, often in the form of small water enterprises (SWEs). Spaces occupied, traveled through, and served by SWEs lead to new spaces of access in cities where they are present. We introduce the concept of hydrosocial routes, or pathways established by human processes involved in linking water sources to consumers. This article examines the routes created by one SWE in Niamey, Niger: that of house-to-house water delivery. It draws from the concept of hydrosocial territories, but extends the discussion to include the pathways that exist within, extend, or connect hydrosocial territories. Using participant observation and geographic information systems to map delivery routes of house-to-house water vendors, we show how cultural norms of the water delivery economy in Niamey create hydrosocial routes. We argue that while hydrosocial territories are often defined by conflict, the hydrosocial routes, in this case, help to prevent conflict and encourage equity among vendors in the hybrid system of water delivery. Understanding the context of how these routes are established and maintained helps us better understand urban water vending and water access challenges in Niamey and elsewhere.

Considering the epidemiological situation of the new coronavirus - COVID 19 in Portugal, the XXII Constitutional Government decided, in March 2020, to suspend all classroom teaching and non-teaching activities in all educational establishments in the national territory. Consequently, all Portuguese educational institutions had to adapt to the new educational reality, where technologies play a leading role in ensuring communication, interaction and collaboration between all stakeholders in the teaching-learning process. Naturally, this adaptation took time and was accompanied by several opinions and guidelines issued by the Ministry of Education and other responsible entities. In general, these guidelines aimed to ensure that all students continue to learn in a pandemic context, regardless of geographical and temporal barriers. One of the guidelines issued was the design, development and implementation of a Distance Learning Plan in each of the Portuguese schools. Thus, based on the case study methodology, we intend to demonstrate the process of designing and implementing a distance education plan in a school in Portugal. The plan was categorized into three main areas - technology, pedagogy, and content - and arise from the theoretical model Technological, Pedagogical and Content Knowledge (TPACK). This plan was developed based on the consultation of all educational agents in that school, but, in a special way, of the students and teachers who were the protagonists in the educational process. Participant observation, recorded in the researcher's diary, was also another instrument used that contributed to the design of the distance education plan. The results of the study suggest that the plan designed, despite the improvements that it naturally had to have during its implementation, was adequate for the realization of the process of teaching and learning at a distance in times of pandemic.

COVID‐19 is an unexpected and brutal pandemic that requires new innovation models to overcome the constraints of this crisis and address its multiple challenges. Open innovation does not replace a traditional closed R&D model; but in the current crisis situation, it can support an ecosystem stakeholders’ effort by leveraging several collaborations. Based on the Tunisian experience, this study illustrates how a crisis can spontaneously create these collaborations between the maker’s community, the users (public healthcare professionals) and key stakeholders (universities, civil society and the private sector among others). To investigate this research question, we adopted a qualitative approach based on a single embedded case study and collected data through participant observation technique. The case study describes a process of crisis‐driven innovation based on 3D printing technologies in order to provide personal protective equipment (PPE) to healthcare professionals. It highlights two distinct phases describing the evolution from a local collaborative model to the creation of a national ecosystem able to design, manufacture and address the growing need of the public healthcare system. Our findings show with empirical evidence the crucial roles played by the makers’ community, FabLabs and engineers in the fight against the COVID‐19 pandemic. This study draws lessons on how a large health crisis can trigger national crisis‐driven innovation (CDI) initiatives, which helped structure the makers’ network and promote collaboration towards a common national goal. A collaborative framework for CDI initiated by the Tunisian makers’ community is proposed in this study and could be adopted in similar crisis contexts, in Global South and North settings.

Research Question What lessons can be learned from counter-terrorism policing in a recent 3-year time period in which the UK suffered the loss of 41 lives by 12 terrorist attacks, with the concurrent successful disruption of 29 other attacks? Data A 2017 internal review into the 2017 attacks was undertaken by police and MI5, yielding 104 recommendations for improved practices. This list was later complemented by multiple reviews in 2018–2020 that led to more than 400 further recommendations for multiple counter terrorism partners. Methods Thematic analysis of these 500 + recommendations led to the author’s distillation, as a participant observer, of 8 key focal points for future efforts to prevent terrorist attacks. Findings Eight themes uniting the recommendations for developing future CT practice emerged from the internal reviews, raising complex issues of (1) data, (2) partnerships, (3) right-wing terrorism, (4) the 625,000 crowded public spaces in the UK, (5) online harm, (6) management of convicted terrorists, (7) domestic growth of terrorism replacing overseas direction and (8) earlier onset of terrorist commitments, from age 13. Conclusions These thematic findings led to four conclusions: (a) the Protect Duty will provide an improved framework for countering terrorism, (b) we must adapt to the changing nature of terrorists, (c) we must increase our efforts against online harm and (d) we must renew and sustain our commitment to the Prevent pillar of the CONTEST strategy, which is now and shall be fit for purpose.

The marked increase in transnational higher education third party arrangements in recent years represents globalizing forms of education. Third party arrangements involve a partner institution being approved to deliver the primary institution’s government-accredited courses. The primary institute is accountable for monitoring and documenting quality assurance and the third party is responsible to the primary institute for meeting the required higher education standards. This arrangement is particularly attractive for students who want to undertake an accredited degree from overseas, while retaining close relational, industry and cultural links in the home country. There has been some recent examination of higher education third parties focused on equity, transcultural pedagogy, and quality assurance. However, little research has been done regarding the Australian context. Alphacrucis College is one of the largest non-university, faith-based independent higher education institutes in Australia with three onshore third party arrangements in Sydney and Melbourne, as well as two offshore in Finland and the Philippines. Based on a case study including participant observation and a staff survey, this research argues that the success of faith-based third parties is largely a result of shared values and collaborative relationships. These are outworked in professional development and mentoring in learning and teaching, joint research and scholarship projects, equity of student experience through resourcing, and effective governance and quality assurance built on trust. While other higher education institutes may not have faith-based approaches, these findings can serve to produce successful onshore and offshore third parties in a broad range of contexts. Supplementary Information The online version contains supplementary material available at 10.1007/s11233-021-09077-1.

Gardening is an activity that involves a number of dimensions of increasing interest to HCI and CSCW researchers, including recreation, sustainability, and engagement with nature. This paper considers the garden setting in order to understand the role that collaborative and social computing technologies might play for practitioners engaging in outdoor skilled activities. We conducted participant observations with nine experienced gardeners aged 22-71 years. Through this process, we find that gardeners continuously configure their environments to accommodate their preferences for sociality. They share embodied skills and help others attune to sensory information in person, but also influence learning through the features in their garden that are observed by others. This paper provides an understanding of sociality in the garden, highlights skill sharing as a key domain for design in this space, and contributes design considerations for collaborative technologies in outdoor settings., 13 pages

As one of the countries with the largest Muslim population in the world (87.18%), Indonesia has the potential to become the center of the world's halal industry. Halal certification can increase the competitiveness of MSME products, especially related to product guarantees to provide comfort, security, safety, and certainty of the availability of halal products for the public in consuming and using the product. The purpose of this study is to analyze the problems and solutions for food and beverage SMEs (Ekraf) related to the Halal Certification Process and Perceptions of Halal Certification Costs with the Actor's Intention to obtain a halal certificate. The research method uses qualitative and quantitative approaches by using primary and secondary data. The qualitative approach was carried out through FGD, webinars and participant observation with key informants and supporting informants. The quantitative approach is carried out by distributing questionnaires to 100 business actors and then processing the Pearson Product Moment correlation data. The results of the study show (i) the halal certification process (by assisting) has a very strong correlation with the perpetrator's intention and is significant, (ii) the perception of the cost of halal certification (with the cost of halal certification that gets subsidized) has a strong correlation with the perpetrator's intention and is significant, ( iii) The Halal Certification Process has a strong correlation with the perpetrators' perceived Halal Certification Costs and is significant, (iv) The Halal certification process and the perceived cost of Halal certification with the perpetrator's intention are very strong and significant. The halal certification process and the perception of the cost of halal certification, both individually and jointly, are correlated with the intentions of food and beverage creative economy actors (MSMEs). In order to achieve this goal, the synergy between central and regional stakeholders and related parties is needed.

Objective: investigating whether the creation of the “Post-purchase” sector in a public University, in the south of Minas Gerais, can be understood as an entrepreneurial action. Method: qualitative and descriptive approach, supported by an observational study case. The data was obtained through participant observation, semi structured review and documentary research, and analyzed through the thematic analysis method, according to the proposed theoretical scheme. Originality/Relevance: displacing the focus of studies from highlighting the entrepreneurial individual to the entrepreneurial action itself, and exploring the “Post-purchase” theme in public organizations. This study is a way of providing the society with knowledge of the different innovative actions promoted by University which is being researched, as well as inspiring other public organizations to develop similar actions. Results: the creation of the sector enabled social results within the researched University, which manifested through the generation of qualitative benefits (changes in the perception had by providers, support to members of the university community, and positive impact in fulfilling material needs) and quantitative benefits (reduction of values included under Accrued Liabilities, improvement in budget execution and resource management, and improvement in the institution’s accounting ratios). Considering the characteristics being presented, it is concluded that this sector creation can be seen as an entrepreneurial action. Theoretical/Methodological contributions: beyond the contribution to the public entrepreneurship research field, this study proposes a theoretical scheme which can be applied to new empirical researches aiming to comprehend the occurrence of the entrepreneurial action in the public sector.

Este estudo teve como objetivo descrever as percepções dos discentes sobre as relações entre seu desempenho acadêmico e seu nível de identificação com o curso de graduação e com a instituição de ensino superior que estudam. O desempenho acadêmico do aluno é um dos fatores associados diretamente à evasão no ensino superior e pode estar associado a fatores sociais, demográficos e àqueles ligados à própria universidade, bem como a fatores psicológicos. Para tanto foi realizada uma pesquisa qualitativa descritiva, em que foram investigados os alunos do curso de graduação em administração da Universidade Federal de Viçosa (campus Florestal). Os dados foram coletados por observação participante, entrevistas semiestruturadas, técnica de escolha com 20 estudantes de diversos períodos. Foi realizada a análise de conteúdo e os dados organizados em três categorias: curso, universidade e desempenho acadêmico. Os resultados indicaram que a maioria dos discentes possui identificação ambivalente com o curso e se sentem superidentificados com a universidade, bem como se consideram com bom desempenho acadêmico. Concluiu-se que os alunos superidentificados tanto com o curso quanto com a universidade possuíam a tendência de ter um desempenho superior.

Introduction: studies on the evolution of the concept of stakeholders as well as on the impact of their claims on the strategic process of organizations are highlighted in the literature. A special feature is the understanding of the stakeholders of typically complex organizations, such as Higher Education Institutions (HEIs), and how their demands are prioritized by managers in the deliberative structures. That said, as an objective of this research, it was sought to elucidate how the influence and salience of the stakeholders are presented in the prioritization of demands by the managers of the Public Institutions of Higher Education, as well as the participation of the interested parties in the governance structures and in the decision-making process. decision-making bodies. This work has as theoretical anchor the Salience Model proposed by Mitchell et al. (1997) and the New university stakeholder model proposed by Mainardes et. al. (2012) and studies on governance in the university environment. Method: to observe the phenomenon, the case study was used as a methodological procedure, with the application of questionnaires, documentary research and participant observation in two public HEIs. Results and Conclusion: it was possible to verify that the demands of internal stakeholders prevail in the discussion agenda of the deliberative instances. In the case of IES A, there is still a preference for the demand of teachers. Finally, it is emphasized that the concept of prioritizing stakeholders, as well as the mechanisms for relating to them, need to be disseminated in the organizations surveyed, however it is clear that IES B managers are more familiar with the theme.

PurposeWhy are some lean workfloor teams able to improve their already high performance, over time, and others not? By studying teams' and leaders' behaviour-value patterns, this abductive field study uncovers a dynamic capability at the team level.Design/methodology/approachVarious methods were employed over three consecutive years to thoroughly examine five initially high-performing lean workfloor teams, including their leaders. These methods encompassed micro-behavioural coding of 59 h of film footage, surveys, individual and group interviews, participant observation and archival data, involving objective and perceptual team-performance indicators. Two of the five teams continued to improve and perform highly.FindingsContinuously improving high lean team performance is found to be associated with (1) team behaviours such as frequent performance monitoring, information sharing, peer support and process improvement; (2) team leaders who balance, over time, task- and relations-oriented behaviours; (3) higher-level leaders who keep offering the team face-to-face support, strategic clarity and tangible resources; (4) these three actors' endorsement of self-transcendence and openness-to-change work values and alignment, over time, with their behaviours; and (5) coactive vicarious learning-by-doing as a “stable collective activity pattern” among team, team leader, and higher-level leadership.Originality/valueSince lean has been undertheorised, the authors invoked insights from organisational behaviour and management theories, in combination with various fine- and coarse-grained data, over time. The authors uncovered actors' behaviour-value patterns and a collective learning-by-doing pattern that may explain continuous lean team performance improvement. Four theory-enriching propositions were developed and visualised in a refined model which may already benefit lean practitioners.

This paper aims to analyze education guarantees for children with special needs (ABK) in the Covid-19 era. The focus of the study is the phenomenon of crew members clowning on the streets of Medan City. The theory used in analyzing the data is the theory of implementation of Merilee S. Grindle's policies. This research uses a qualitative approach with a case study method. Data was collected using an open interview technique, participant observation, and documentation study. Furthermore, the data were analyzed through data reduction techniques, data display, and concluding. This study indicates that the North Sumatra government has been very responsive to inclusive education for children with special needs in the region.This is indicated by two things, namely (1) the declaration of North Sumatra as the Province of Inclusive Education since 2015 and (2) the issuance of the Governor of North Sumatra No. 29 of 2016 concerning the Implementation of Inclusive Education as a follow-up to Permendiknas Number 70 of 2009.

Introdução: Quando se fala em saúde pública é crucial considerar dados epidemiológicos e métodos de avaliação da assistência, com o intuito de promover melhoria. Uma maneira de propiciar isso são os modelos lógicos, associam atividades, entradas de recursos, saídas de produtos e resultados. Objetivo: Construir um modelo lógico ilustrativo do funcionamento de uma Unidade de Saúde da Família e validar o seu conteúdo. Metodologia: Foi realizada revisão de literatura, observação participante e conversa com informantes-chave. Ademais, houve validação do conteúdo por profissionais atuantes na Unidade de Saúde da Família (USF) em uma roda de conversa. Resultados: Elaborou-se cinco dimensões (Gestão do Trabalho, Atividades não assistenciais, Atividades assistenciais, Educação permanente continuada e Atividades docentes assistenciais) relacionadas à missão e aos elementos de recursos (físicos, informação, parcerias e financeiros), caracterizando, assim, o modelo. Conclusões: Os impactos alcançados com a aplicação do modelo remetem a critérios de qualidade (legitimidade, empoderamento e resolutividade); ao modelo assistencial instituído (vigilância à saúde); a características do próprio modelo (Clínica ampliada, intersetorialidade, ações multiprofissionais), além da motivação profissional. Todavia, embora validado por USF específica, o modelo orienta-se por uma Política Nacional, podendo contribuir com outras realidades pertinentes à saúde.

Organizations play a fundamental role in mitigating social inequality, with emphasis on social enterprises. Thus, the objective is to analyze how a social enterprise acts as an intermediator to promote social innovations in companies. A case study was held in a local social enterprise located in the city of Porto Alegre, Brazil, and which develops projects of social impact for other organizations. The data stems from participant observation, interviews and access to secondary data. The results indicate that social innovation is generated from the interaction between client companies and the final benefited public, through the intermediation promoted by the analyzed company, when conducting the process of creating and implementing social projects. As organizações têm papel fundamental na mitigação da desigualdade social, com destaque para empresas sociais. Assim, o objetivo foi analisar de que maneira um empreendimento social pode atuar como um agente intermediário ao desenvolver projetos para empresas convencionais que desejam promover a inovação social. Foi realizado um estudo de caso em um empreendimento social localizado na cidade de Porto Alegre/RS, que desenvolve projetos de impacto social para outras organizações. Os dados foram provenientes de observação participante, entrevistas, sites e vídeos. Os resultados indicam que a inovação social é gerada a partir da interação entre as empresas clientes e o público beneficiado, por meio da intermediação promovida pela empresa analisada, ao conduzir o processo de criação e implementação dos projetos sociais. Las empresas sociales juegan un papel fundamental en la mitigación de la desigualdad social. Así, el objetivo fue analizar cómo una empresa social puede actuar como intermediaria en el desarrollo de proyectos para empresas convencionales que deseen impulsar la innovación social. Se realizó un estudio de caso en una empresa social ubicada en Porto Alegre/RS, Brasil, que desarrolla proyectos con impacto social para otras organizaciones. Los datos provienen de la observación participante, entrevistas, sitios web y videos. La innovación social se genera a partir de la interacción entre las empresas clientes y el público final beneficiado, a través de la intermediación promovida por la empresa analizada, a la hora de realizar el proceso de creación e implementación de proyectos sociales.

Purpose Considering the case study presented, the purpose of this paper is to analyse the impact of the pandemic in local services for homeless people. Drawing from the concept of ontological security, it will be discussed how different services’ levels of “housing adequacy” shaped remarkably different experiences of the pandemic for homeless people and social workers in terms of health protection and agency. Design/methodology/approach This paper focuses on a case study concerning homeless services for people during the COVID-19 pandemic in the metropolitan and suburban area of Turin, in Northern Italy. In-depth interviews with social workers and participant observation during online meetings of workers from the shelters constitute the empirical data that have been collected during the first wave of the pandemic in Italy. Findings According to the findings, the pandemic showed shelters as unsafe places that reduce homeless people’s decision power and separate them from the rest of the citizenship. Instead, Housing First projects emerged as imore inclusive and safermore inclusive and safer spaces, able to enhance people’s power over their own lives. The pandemic did not create emerging issues in the homeless services system or discontinuities: rather, it amplified pre-existing problematic aspects. Originality/value The case study presented provides empirical insights to recognise at the political and organisational level the importance of housing as a measure of individual and collective security, calling for an intervention to tackle homelessness in terms of housing policies rather than exclusively social and emergency treatment.

This article aims to understand the extent to which social entrepreneurship contributes to the construction of a collective dimension linked to social innovation. Since 2013, this work has been based on a participant observation of eight major events dedicated to social entrepreneurship or the Shared Economy. In-depth interviews with Tunisian social entrepreneurs were also conducted in order to enrich our corpus. The results show the necessary cooperation of social entrepreneurs for a sustainable and responsible social innovation. Indeed, the analysis emphasizes that the viability and sustainability of a social innovation is based essentially on a collective construction, beyond common social values.JEL CODES: O30, O35

Resumen Objetivo: Identificar los procesos de salud y enfermedad entre los pobladores de El Cajón (Catamarca, Argentina) y su vinculación con la biomedicina. Asimismo, estudiar las articulaciones entre la biomedicina y el sistema de salud tradicional. Materiales y métodos: Investigación cualitativa, mediante un abordaje etnográfico en el que la observación participante, la corresidencia y las entrevistas abiertas de sesiones múltiples cumplen un rol primordial. La pesquisa se ha centrado en los pobladores locales que regularmente asisten a la posta sanitaria, los enfermeros, los agentes sanitarios y los miembros del equipo de salud itinerante. La población total del lugar es aproximadamente 235 habitantes. Resultados: Se ha constatado que los procesos de salud y enfermedad no se limitan al cuerpo humano, sino que también en ellos intervienen el paisaje y los seres que lo pueblan. Se ha identificado que en la resolución de numerosas patologías resulta central la figura del especialista ritual. Se ha determinado que la gente valora y utiliza la biomedicina, aunque la asistencia a la institución hospitalaria suele ser rehuida. Conclusiones: Se ha identificado un uso combinado de ambos sistemas. En él influyen las valoraciones de las personas sobre la enfermedad de que se trate, pero también otros factores como la distancia hasta el centro asistencial y las relaciones interpersonales con los profesionales de la salud. Se resalta la relevancia del enfoque cualitativo para dar cuenta de las especificidades de las categorías locales, que resultan esquivas para un abordaje construido a partir de conceptos derivados del dualismo cartesiano. Abstract Objective: Identify the processes of health and disease among the people of San Antonio del El Cajón (Catamarca, Argentina), and the linkage of these dynamics to biomedicine. Additionally, study the articulations between the two systems. Materials and methods: Qualitative research, with an ethnographic approach in which participant observation, co-residence and multiple session open interviews play a primary role is privileged. The research has focused on local people who regularly attend the health center, nurses, health workers and members of the itinerant health team. The total population of the place is about 235 inhabitants. Results: It was found that the processes of health, disease and cure are not limited to the human body, but also the landscape and the creatures that inhabit it are involved. It has been identified that the figure of the ritual specialist is central in the resolution of many diseases. It has been determined that people value and use biomedicine, although attendance to the hospital institution is often shunned. Conclusion: A combined use of both systems has been identified. People’s valuations about the disease in question are influential, but other factors such as distance to the medical center and interpersonal relationships with health professionals are too. The relevance of a qualitative approach is emphasized in accounting for the specificities of local categories, which are elusive to an approach built from concepts derived from the Cartesian dualism.