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Sarmiento I, Cockcroft A, Dion A, Belaid L, Silver H, Pizarro K, Pimentel J, Tratt E, Skerritt L, Ghadirian MZ, Gagnon-Dufresne MC, Andersson N. Fuzzy cognitive mapping in participatory research and decision making: a practice review. Arch Public Health 2024; 82:76. [PMID: 38769567 PMCID: PMC11103993 DOI: 10.1186/s13690-024-01303-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 04/30/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Fuzzy cognitive mapping (FCM) is a graphic technique to describe causal understanding in a wide range of applications. This practice review summarises the experience of a group of participatory research specialists and trainees who used FCM to include stakeholder views in addressing health challenges. From a meeting of the research group, this practice review reports 25 experiences with FCM in nine countries between 2016 and 2023. RESULTS The methods, challenges and adjustments focus on participatory research practice. FCM portrayed multiple sources of knowledge: stakeholder knowledge, systematic reviews of literature, and survey data. Methodological advances included techniques to contrast and combine maps from different sources using Bayesian procedures, protocols to enhance the quality of data collection, and tools to facilitate analysis. Summary graphs communicating FCM findings sacrificed detail but facilitated stakeholder discussion of the most important relationships. We used maps not as predictive models but to surface and share perspectives of how change could happen and to inform dialogue. Analysis included simple manual techniques and sophisticated computer-based solutions. A wide range of experience in initiating, drawing, analysing, and communicating the maps illustrates FCM flexibility for different contexts and skill bases. CONCLUSIONS A strong core procedure can contribute to more robust applications of the technique while adapting FCM for different research settings. Decision-making often involves choices between plausible interventions in a context of uncertainty and multiple possible answers to the same question. FCM offers systematic and traceable ways to document, contrast and sometimes to combine perspectives, incorporating stakeholder experience and causal models to inform decision-making. Different depths of FCM analysis open opportunities for applying the technique in skill-limited settings.
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Affiliation(s)
- Iván Sarmiento
- Department of Family Medicine, McGill University, 5858 Ch. de la Côte-des-Neiges, Montreal, QC, H3S 1Z1, Canada.
- Universidad del Rosario, Grupo de Estudios en Sistemas Tradicionales de Salud, Bogota, Colombia.
| | - Anne Cockcroft
- Department of Family Medicine, McGill University, 5858 Ch. de la Côte-des-Neiges, Montreal, QC, H3S 1Z1, Canada
| | - Anna Dion
- Department of Family Medicine, McGill University, 5858 Ch. de la Côte-des-Neiges, Montreal, QC, H3S 1Z1, Canada
| | - Loubna Belaid
- Department of Family Medicine, McGill University, 5858 Ch. de la Côte-des-Neiges, Montreal, QC, H3S 1Z1, Canada
| | - Hilah Silver
- Department of Family Medicine, McGill University, 5858 Ch. de la Côte-des-Neiges, Montreal, QC, H3S 1Z1, Canada
| | - Katherine Pizarro
- Department of Family Medicine, McGill University, 5858 Ch. de la Côte-des-Neiges, Montreal, QC, H3S 1Z1, Canada
| | - Juan Pimentel
- Department of Family Medicine, McGill University, 5858 Ch. de la Côte-des-Neiges, Montreal, QC, H3S 1Z1, Canada
- Facultad de Medicina, Universidad de La Sabana, Chía, Colombia
| | - Elyse Tratt
- Institut Lady Davis pour la Recherche Médicale, Montreal, Canada
| | - Lashanda Skerritt
- Department of Family Medicine, McGill University, 5858 Ch. de la Côte-des-Neiges, Montreal, QC, H3S 1Z1, Canada
| | - Mona Z Ghadirian
- Department of Family Medicine, McGill University, 5858 Ch. de la Côte-des-Neiges, Montreal, QC, H3S 1Z1, Canada
| | - Marie-Catherine Gagnon-Dufresne
- Department of Family Medicine, McGill University, 5858 Ch. de la Côte-des-Neiges, Montreal, QC, H3S 1Z1, Canada
- École de santé publique, Département de médecine sociale et préventive, Université de Montréal, Montreal, Canada
| | - Neil Andersson
- Department of Family Medicine, McGill University, 5858 Ch. de la Côte-des-Neiges, Montreal, QC, H3S 1Z1, Canada
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Mexico
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Kadykalo AN, Findlay CS, Spencer M, Callaghan CL, Cooke SJ, Young N. Collaboration and engagement with decision-makers are needed to reduce evidence complacency in wildlife management. AMBIO 2024; 53:730-745. [PMID: 38360970 PMCID: PMC10991221 DOI: 10.1007/s13280-024-01979-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/07/2023] [Accepted: 01/02/2024] [Indexed: 02/17/2024]
Abstract
There exists an extensive, diverse, and robust evidence base to support complex decisions that address the planetary biodiversity crisis. However, it is generally not sought or used by environmental decision-makers, who instead draw on intuition, experience, or opinion to inform important decisions. Thus, there is a need to examine evidence exchange processes in wildlife management to understand the multiple inputs to decisions. Here, we adopt a novel approach, fuzzy cognitive mapping (FCM), to examine perceptions of individuals from Indigenous and Western governments on the reliability of evidence which may influence freshwater fisheries management decisions in British Columbia, Canada. We facilitated four FCM workshops participants representing Indigenous or Western regulatory/governance groups of fisheries managers. Our results show that flows of evidence to decision-makers occur within a relatively closed governance network, constrained to the few well-connected decision-making organizations (i.e., wildlife management agencies) and their close partners. This implies that increased collaboration (i.e., knowledge co-production) and engagement (i.e., knowledge brokerage) with wildlife managers and decision-makers are needed to produce actionable evidence and increase evidence exchange.
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Affiliation(s)
- Andrew N Kadykalo
- Fish Ecology and Conservation Physiology Laboratory, Department of Biology and Institute of Environmental and Interdisciplinary Sciences, Carleton University, Ottawa, ON, K1S 5B6, Canada.
- Department of Natural Resource Sciences, Faculty of Agricultural and Environmental Sciences, McGill University, Montreal, QC, H9X 3V9, Canada.
| | - C Scott Findlay
- Department of Biology and Institute of the Environment, University of Ottawa, Ottawa, ON, Canada
| | | | | | - Steven J Cooke
- Fish Ecology and Conservation Physiology Laboratory, Department of Biology and Institute of Environmental and Interdisciplinary Sciences, Carleton University, Ottawa, ON, K1S 5B6, Canada
| | - Nathan Young
- Department of Sociology and Anthropology, School of Sociological and Anthropological Studies, University of Ottawa, Ottawa, ON, K1N 6N5, Canada
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Dion A, Carini-Gutierrez A, Jimenez V, Ben Ameur A, Robert E, Joseph L, Andersson N. Weight of Evidence: Participatory Methods and Bayesian Updating to Contextualize Evidence Synthesis in Stakeholders' Knowledge. JOURNAL OF MIXED METHODS RESEARCH 2022; 16:281-306. [PMID: 35872747 PMCID: PMC9297342 DOI: 10.1177/15586898211037412] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Mixed methods research is well-suited to grapple with questions of what counts as valid knowledge across different contexts and perspectives. This article introduces Weight of Evidence as a transformative procedure for stakeholders to interpret, expand on and prioritize evidence from evidence syntheses, with a focus on engaging populations historically excluded from planning and decision making. This article presents the procedure's five steps using pilot data on perinatal care of immigrant women in Canada, engaging family physicians and birth companions. Fuzzy cognitive mapping offers an accessible and systematic way to generate priors to update published literature with stakeholder priorities. Weight of Evidence is a transparent procedure to broaden what counts as expertise, contributing to a more comprehensive, context-specific, and actionable understanding.
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Affiliation(s)
- Anna Dion
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
- Anna Dion, Department of Family Medicine, McGill University, 5858 chemin de la Cotes-des-Neiges, Montréal, Québec H3S 1Z1, Canada.
| | | | - Vania Jimenez
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | | | - Emilie Robert
- SHERPA University Institute, Montreal, Quebec, Canada
- ICARES Montreal, Quebec, Canada
| | - Lawrence Joseph
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Neil Andersson
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
- Autonomous University of Guerrero, Acapulco, Mexico
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Cockcroft A, Omer K, Gidado Y, Mohammed R, Belaid L, Ansari U, Mitchell C, Andersson N. Impact-Oriented Dialogue for Culturally Safe Adolescent Sexual and Reproductive Health in Bauchi State, Nigeria: Protocol for a Codesigned Pragmatic Cluster Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e36060. [PMID: 35289762 PMCID: PMC8965671 DOI: 10.2196/36060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 01/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background Adolescents (10-19 years) are a big segment of the Nigerian population, and they face serious risks to their health and well-being. Maternal mortality is very high in Nigeria, and rates of pregnancy and maternal deaths are high among female adolescents. Rates of HIV infection are rising among adolescents, gender violence and sexual abuse are common, and knowledge about sexual and reproductive health risks is low. Adolescent sexual and reproductive health (ASRH) indicators are worse in the north of the country. Objective In Bauchi State, northern Nigeria, the project will document the nature and extent of ASRH outcomes and risks, discuss the findings and codesign solutions with local stakeholders, and measure the short-term impact of the discussions and proposed solutions. Methods The participatory research project is a sequential mixed-methods codesign of a pragmatic cluster randomized controlled trial. Focus groups of local stakeholders (female and male adolescents, parents, traditional and religious leaders, service providers, and planners) will identify local priority ASRH concerns. The same stakeholder groups will map their knowledge of factors causing these concerns using the fuzzy cognitive mapping (FCM) technique. Findings from the maps and a scoping review will inform the contextualization of survey instruments to collect information about ASRH from female and male adolescents and parents in households and from local service providers. The survey will take place in 60 Bauchi communities. Adolescents will cocreate materials to share the findings from the maps and survey. In 30 communities, randomly allocated, the project will engage adolescents and other stakeholders in households, communities, and services to discuss the evidence and to design and implement culturally acceptable actions to improve ASRH. A follow-up survey in communities with and without the intervention will measure the short-term impact of these discussions and actions. We will also evaluate the intervention process and use narrative techniques to assess its impact qualitatively. Results Focus groups to explore ASRH concerns of stakeholders began in October 2021. Baseline data collection in the household survey is expected to take place in mid-2022. The study was approved by the Bauchi State Health Research Ethics Committee, approval number NREC/03/11/19B/2021/03 (March 1, 2021), and by the Faculty of Medicine and Health Sciences Institutional Review Board McGill University (September 13, 2021). Conclusions Evidence about factors related to ASRH outcomes in Nigeria and implementation and testing of a dialogic intervention to improve these outcomes will fill a gap in the literature. The project will document and test the effectiveness of a participatory approach to ASRH intervention research. Trial Registration ISRCTN Registry ISRCTN18295275; https://www.isrctn.com/ISRCTN18295275 International Registered Report Identifier (IRRID) DERR1-10.2196/36060
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Affiliation(s)
- Anne Cockcroft
- Community Information for Empowerment and Transparency-Participatory Research at McGill, Department of Family Medicine, McGill University, Montreal, QC, Canada.,Centro de Investigacion de Enfermedades Tropicales, Universidad Autonoma de Guerrero, Acapulco, Mexico
| | - Khalid Omer
- Centro de Investigacion de Enfermedades Tropicales, Universidad Autonoma de Guerrero, Acapulco, Mexico
| | - Yagana Gidado
- Federation of Muslim Women's Associations of Nigeria, Bauchi, Nigeria
| | - Rilwanu Mohammed
- Bauchi State Primary Health Care Development Agency, Bauchi, Nigeria
| | - Loubna Belaid
- Community Information for Empowerment and Transparency-Participatory Research at McGill, Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Umaira Ansari
- Centro de Investigacion de Enfermedades Tropicales, Universidad Autonoma de Guerrero, Acapulco, Mexico
| | - Claudia Mitchell
- Department of Integrated Studies in Education, McGill University, Montreal, QC, Canada
| | - Neil Andersson
- Community Information for Empowerment and Transparency-Participatory Research at McGill, Department of Family Medicine, McGill University, Montreal, QC, Canada.,Centro de Investigacion de Enfermedades Tropicales, Universidad Autonoma de Guerrero, Acapulco, Mexico
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Belaid L, Atim P, Ochola E, Omara B, Atim E, Ogwang M, Bayo P, Oola J, Okello IW, Sarmiento I, Rojas-Rozo L, Zinszer K, Zarowsky C, Andersson N. Community views on short birth interval in Northern Uganda: a participatory grounded theory. Reprod Health 2021; 18:88. [PMID: 33910570 PMCID: PMC8080315 DOI: 10.1186/s12978-021-01144-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 04/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Short birth interval is associated with adverse perinatal, maternal, and infant outcomes, although evidence on actionable factors underlying short birth interval remains limited. We explored women and community views on short birth intervals to inform potential solutions to promote a culturally safe child spacing in Northern Uganda. METHODS Gendered fuzzy cognitive mapping sessions (n = 21), focus group discussions (n = 12), and an administered survey questionnaire (n = 255) generated evidence on short birth intervals. Deliberative dialogues with women, their communities, and service providers suggested locally relevant actions promote culturally safe child spacing. RESULTS Women, men, and youth have clear understandings of the benefits of adequate child spacing. This knowledge is difficult to translate into practice as women are disempowered to exercise child spacing. Women who use contraceptives without their husbands' consent risk losing financial and social assets and are likely to be subject to intra-partner violence. Women were not comfortable with available contraceptive methods and reported experiencing well-recognized side effects. They reported anxiety about the impact of contraception on the health of their future children. This fear was fed by rumors in their communities about the effects of contraceptives on congenital diseases. The women and their communities suggested a home-based sensitization program focused on improving marital relationships (spousal communication, mutual understanding, male support, intra-partner violence) and knowledge and side-effects management of contraceptives. CONCLUSIONS The economic context, gender power dynamics, inequality, gender bias in land tenure and ownership regulations, and the limited contraceptive supply reduce women's capacity to practice child spacing.
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Affiliation(s)
- Loubna Belaid
- CIET (Community Information Epidemiological Technologies), Department of Family Medicine (PRAM), McGill University, 5858 Chemin de la Côte des Neiges, Montreal, QC H3S 1Z1 Canada
| | - Pamela Atim
- Department of Public Health, Gulu University, Laroo Division, Gulu Municipality 166, Gulu, Uganda
| | | | - Bruno Omara
- Gulu University, Gulu Municipality 166, Gulu, Uganda
| | | | - Martin Ogwang
- St Mary’s Lacor Hospital, Gulu/P.O. Box, 180, Gulu, Uganda
| | - Pontius Bayo
- St Mary’s Lacor Hospital, Gulu/P.O. Box, 180, Gulu, Uganda
| | | | | | - Ivan Sarmiento
- CIET (Community Information Epidemiological Technologies), Department of Family Medicine (PRAM), McGill University, 5858 Chemin de la Côte des Neiges, Montreal, QC H3S 1Z1 Canada
| | - Laura Rojas-Rozo
- Department of Family Medicine, McGill University, 5858 Chemin de la Côte des Neiges, Montreal, QC H3S 1Z1 Canada
| | - Kate Zinszer
- University of Montreal, 7101 Av du Parc, Montreal, QC H3N 1X9 Canada
| | | | - Neil Andersson
- CIET (Community Information Epidemiological Technologies), Department of Family Medicine (PRAM), McGill University, 5858 Chemin de la Côte des Neiges, Montreal, QC H3S 1Z1 Canada
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Mexico
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Andersson N, Silver H. Fuzzy cognitive mapping: An old tool with new uses in nursing research. J Adv Nurs 2019; 75:3823-3830. [PMID: 31486102 DOI: 10.1111/jan.14192] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/15/2019] [Accepted: 08/28/2019] [Indexed: 11/28/2022]
Abstract
AIMS Describe the implementation and uses of fuzzy cognitive mapping (FCM) as a constructive method for meeting the unique and rapidly evolving needs of nursing inquiry and practice. DESIGN Discussion paper. DATA SOURCES Drawing on published scholarship of cognitive mapping from the fields of ecological management, information technology, economics, organizational behaviour and health development, we consider how FCM can contribute to contemporary challenges and aspirations of nursing research. IMPLICATIONS FOR NURSING Fuzzy cognitive mapping can generate theory, describe knowledge systems in comparable terms and inform questionnaire design and dialogue. It can help build participant-researcher partnerships, elevate marginalized voices and facilitate intercultural dialogue. As a relatively culturally safe and foundational approach in participatory research, we suggest that FCM should be used in settings of transcultural nursing, patient engagement, person- and family-centred care and research with marginalized populations. FCM is amenable to rigorous analysis and simultaneously allows for greater participation of stakeholders. CONCLUSION In highly complex healthcare contexts, FCM can act as a common language for defining challenges and articulating solutions identified within the nursing discipline. IMPACT There is a need to reconcile diverse sources of knowledge to meeting the needs of nursing inquiry. FCM can generate theory, describe knowledge systems, facilitate dialogue and support questionnaire design. In its capacity to engage multiple perspectives in defining problems and identifying solutions, FCM can contribute to advancing nursing research and practice.
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Affiliation(s)
- Neil Andersson
- CIET-Participatory Research at McGill, Faculty of Medicine, McGill University, Montreal, QC, Canada.,Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, México
| | - Hilah Silver
- Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada
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Grounding evidence in experience to support people-centered health services. Int J Public Health 2018; 64:797-802. [PMID: 30542753 PMCID: PMC6565654 DOI: 10.1007/s00038-018-1180-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 11/08/2018] [Accepted: 11/23/2018] [Indexed: 11/25/2022] Open
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Cockcroft A, Marokoane N, Kgakole L, Kefas J, Andersson N. The Inter-ministerial National Structural Intervention trial (INSTRUCT): protocol for a parallel group cluster randomised controlled trial of a structural intervention to reduce HIV infection among young women in Botswana. BMC Health Serv Res 2018; 18:822. [PMID: 30376834 PMCID: PMC6208099 DOI: 10.1186/s12913-018-3638-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 10/19/2018] [Indexed: 11/10/2022] Open
Abstract
Background Wide recognition that structural factors are important in the HIV epidemic has not generated much evidence of impact of structural interventions. Few randomised controlled trials of structural interventions for HIV prevention have an HIV endpoint, and most of those did not show a significant impact. It has proved difficult to prevent new HIV infections in Botswana, especially among young women, many of whom are unable to act on HIV preventive choices. Proposed by a government think tank in Botswana, the Inter-ministerial National Structural Intervention trial (INSTRUCT) tests whether addressing social and economic factors, including gender inequality, gender violence, poverty, and poor access to education, can lower HIV infection rates among young women. Focussed on increasing access by marginalised young women to government support programs, the intervention seeks to change their structural position, reducing their vulnerability to transactional sex, and thus to HIV infection. Methods This parallel group cluster randomised controlled trial compares HIV rates among young women in districts with and without the structural interventions. The 30 administrative districts in the country, stratified by HIV prevalence and development status, will be randomly assigned to 5-district implementation waves. The intervention in the first-wave districts will include: (i) recruiting and preparing vulnerable young women to apply to government support programs, (ii) making the support programs more accessible to young women by engaging local program officers and young women in co-evaluation of programs and co-design of solutions; and (iii) generating an enabling environment for change in communities through an audio-drama edutainment program. In year five, an impact survey will measure HIV rates among vulnerable young women (15–29 years) in a random sample of communities in the five intervention districts and in the five second-wave (control) districts. Fieldworkers will undertake rapid HIV screening and interview young women and young men, collecting information on secondary outcomes of attitudes and behaviours. Discussion This is the first step in a planned stepped-wedge design that will roll out the intervention, modified as necessary, to all districts. Strong government commitment provides an important opportunity to reduce new HIV cases in Botswana, and guide prevention efforts in other countries. Trial registration Registration number: ISRCTN 54878784. Registry: ISRCTN. Date of registration: 11 June 2013.
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Affiliation(s)
- Anne Cockcroft
- Department of Family Medicine, McGill University, Montreal, Canada. .,CIET Trust Botswana, PO Box 1240, Gaborone, Botswana.
| | | | | | - Joseph Kefas
- National AIDS Coordinating Agency, Gaborone, Botswana
| | - Neil Andersson
- Department of Family Medicine, McGill University, Montreal, Canada.,Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Mexico
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Chambers LA, Jackson R, Worthington C, Wilson CL, Tharao W, Greenspan NR, Masching R, Pierre-Pierre V, Mbulaheni T, Amirault M, Brownlee P. Decolonizing Scoping Review Methodologies for Literature With, for, and by Indigenous Peoples and the African Diaspora: Dialoguing With the Tensions. QUALITATIVE HEALTH RESEARCH 2018; 28:175-188. [PMID: 29182046 DOI: 10.1177/1049732317743237] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
This article summarizes our deepened understanding of decolonizing research with, for, and by Indigenous peoples and peoples of African descent that emerged from conducting a scoping review of the methodological literature and reflecting on our review process. Although our review identified decolonizing methodologies as a promising approach, we questioned if our scoping review process engaged in decolonizing knowing. To unpack the epistemological tensions between decolonizing knowing and Western ways of doing scoping reviews, we engaged in individual and collective reflective processes- dialoguing with the tensions-moving from individual immersion in the literature to transformative dialogues among the team. In reflecting upon our tensions with the scoping review process, themes that emerged included (a) ontological/epistemological disjunctures, (b) tensions with concepts and language, and (c) relationships with the literature and beyond. This reflexive process provides valuable insight into ways in which review methods might be made a decolonizing research experience.
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Affiliation(s)
| | | | | | | | - Wangari Tharao
- 4 Women's Health in Women's Hands, Toronto, Ontario, Canada
| | | | - Renee Masching
- 6 Canadian Aboriginal AIDS Network, Dartmouth, Nova Scotia, Canada
| | | | - Tola Mbulaheni
- 7 African and Caribbean Council on HIV/AIDS in Ontario, Toronto, Ontario, Canada
| | - Marni Amirault
- 6 Canadian Aboriginal AIDS Network, Dartmouth, Nova Scotia, Canada
| | - Patrick Brownlee
- 6 Canadian Aboriginal AIDS Network, Dartmouth, Nova Scotia, Canada
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Andersson N, Beauchamp M, Nava-Aguilera E, Paredes-Solís S, Šajna M. The women made it work: fuzzy transitive closure of the results chain in a dengue prevention trial in Mexico. BMC Public Health 2017; 17:408. [PMID: 28699563 PMCID: PMC5506572 DOI: 10.1186/s12889-017-4301-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A modified theory of planned behaviour (acronym CASCADA) proposes that Conscious knowledge precedes a change in Attitude, which in turn precedes positive deviations from negative Subjective norms, intention to Change, perception of Agency to change, Discussion of possible action, and Action itself. We used this as a results chain to investigate gender-specific behaviour dynamics in chemical-free dengue prevention. METHODS Secondary analysis of the Mexican arm of a cluster randomised controlled trial used household survey data on intermediate outcomes of dengue prevention behaviour. We used a matrix of odds ratios between outcomes, transformed to a symmetrical range (-1, 1), to compute fuzzy transitive closure of the results chain for control and intervention clusters, then for male and female respondents separately in each group. Transitive closure of a map computes the influence of each factor on each other factor, taking account of all influences in the system. Cumulative net influence was the sum of influences across the results chain. RESULTS Responses of 5042 women and 1143 men in 45 intervention clusters contrasted with those of 5025 women and 1179 men in 45 control clusters. Control clusters showed a distal block (negative influence) in the results chain with a cumulative net influence of 0.88; intervention clusters showed no such block and a cumulative net influence of 1.92. Female control respondents, like the overall control picture, showed a distal block, whereas female intervention responses showed no such blocks (cumulative net influence 0.78 and 1.73 respectively). Male control respondents showed weak distal blocks. Male intervention responses showed several new negative influences and a reduction of cumulative net influence (1.38 in control and 1.11 in intervention clusters). CONCLUSIONS The overall influence of the intervention across the results chain fits with the trial findings, but is different for women and men. Among women, the intervention overcame blocks and increased the cumulative net influence of knowledge on action. Among men, the intervention did not reinforce prevention behaviour. This might be related to emphasis, during the intervention, on women's participation and empowerment. The fuzzy transitive closure of the CASCADA map usefully highlights the differences between gender-specific results chains. TRIAL REGISTRATION ISRCTN27581154 .
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Affiliation(s)
- Neil Andersson
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Guerrero, Mexico. .,Department of Family Medicine, McGill University, Montreal, Canada.
| | | | - Elizabeth Nava-Aguilera
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Guerrero, Mexico
| | - Sergio Paredes-Solís
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Guerrero, Mexico
| | - Mateja Šajna
- Department of Mathematics and Statistics, University of Ottawa, Ottawa, Canada
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