Unmasking quality: exploring meanings of health by doing art.

BACKGROUND: Quality in healthcare has many potential meanings and interpretations. The case has been made for conceptualisations of quality that place more emphasis on describing quality and less on measuring it through structured, vertically oriented metrics. Through discussion of an interdisciplinary community arts project we explore and challenge the dominant reductionist meanings of quality in healthcare. DISCUSSION: The model for structured participatory arts workshops such as ours is 'art as conversation'. In creating textile art works, women involved in the sewing workshops engaged at a personal level, developing confidence through sharing ideas, experiences and humour. Group discussions built on the self-assurance gained from doing craft work together and talking in a relaxed way with a common purpose, exploring the health themes which were the focus of the art. For example, working on a textile about vitamin D created a framework which stimulated the emergence of a common discourse about different cultural practices around 'going out in the sun'. These conversations have value as 'bridging work', between the culture of medicine, with its current emphasis on lifestyle change to prevent illness, and patients' life worlds. Such bridges allow for innovation and flexibility to reflect local public health needs and community concerns. They also enable us to view care from a horizontally oriented perspective, so that the interface in which social worlds and the biomedical model meet and interpenetrate is made visible. Through this interdisciplinary art project involving academics, health professionals and the local community we have become more sensitised to conceptualising one aspect of health care quality as ensuring a 'space for the story' in health care encounters. This space gives precedence to the patient narratives, but acknowledges the importance of enabling clinicians to have time to share stories about care.

A model for translating ethnography and theory into culturally constructed clinical practices.

This article describes the development of a dynamic culturally constructed clinical practice model for HIV/STI prevention, the Narrative Intervention Model (NIM), and illustrates its application in practice, within the context of a 6-year transdisciplinary research program in Mumbai, India. Theory and research from anthropology, psychology, and public health, and mixed-method ethnographic research with practitioners, patients, and community members, contributed to the articulation of the NIM for HIV/STI risk reduction and prevention among married men living in low-income communities. The NIM involves a process of negotiation of patient narratives regarding their sexual health problems and related risk factors to facilitate risk reduction. The goal of the NIM is to facilitate cognitive-behavioral change through a three-stage process of co-construction (eliciting patient narrative), deconstruction (articulating discrepancies between current and desired narrative), and reconstruction (proposing alternative narratives that facilitate risk reduction). The NIM process extends the traditional clinical approach through the integration of biological, psychological, interpersonal, and cultural factors as depicted in the patient narrative. Our work demonstrates the use of a recursive integration of research and practice to address limitations of current evidence-based intervention approaches that fail to address the diversity of cultural constructions across populations and contexts.

La intervención en habilidades narrativas en alumnado con dificultades del lenguaje. Una oportunidad para el trabajo colaborativo entre logopedas, profesorado y familias / The intervention in narrative skills in students with language difficulties. An opportunity for collaborative work between speech therapists, teachers and families

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La medición por criterio de la narrativa en niños con trastorno específico del lenguaje / Criterion-referenced assessment of narrative in children with specific language impairment

Diversos autores han señalado las principales dificultades que al narrar suelen presentar los niños con trastorno específico del lenguaje. Para evaluar las narraciones infantiles existen test basados en la norma, que determinan la presencia o ausencia de elementos en la narración, y test basados en criterio, que evalúan de acuerdo a diversos aspectos que se asumen como centrales en dicha modalidad, indicando distintos niveles de logro. Dentro de este marco, el objetivo del presente trabajo es describir la narración de niños con y sin trastorno específico del lenguaje a través de una versión adaptada del Índice de Complejidad Narrativa, una evaluación basada en criterio. Se trabajó con 38 niños con trastorno específico del lenguaje y 41 con desarrollo típico que asistían a preescolar. Todos ellos vieron un cuento en formato audiovisual y luego lo recontaron con apoyo gráfico. Sus narraciones fueron transcritas y analizadas con el Índice de Complejidad Narrativa adaptado. Los resultaron no solo permitieron observar una diferencia a favor a los niños con desarrollo típico, sino también demostraron que, independiente de la población a la que pertenezca el niño, el dominio incremental de la narrativa se concentra inicialmente en los criterios relacionados con la cadena causal de las acciones y luego se extiende a otros. Además, el Índice de Complejidad Narrativa adaptado demostró ser una forma de evaluación válida y confiable para monitorizar los avances de los niños en la producción narrativa (AU)

Several authors have described the problems that children with specific language impairment present in their narratives. There are 2 ways of assessing the narrative performance of children: through norm-referenced test, that determine the presence or absence of narrative elements; and through the criterion-reference test, which allows to describe the narratives of children on the basis of the level of development of certain elements or skills. In this context, the purpose of this study is to describe the narrative performance of children with and without specific language impairment using an adapted version of the Index of Narrative Complexity, which is a criterion-referenced test. We worked with 38 children with specific language impairment and 41 children with typical development, all attending kindergarten. Each children watched a story in audiovisual format and then retold it with a graphic support. Their narratives were transcribed and analyzed with the adapted version of the Index of Narrative Complexity. The results not only allowed observing a difference in favor of children with typical development, but it also showed that, with independence to the population to which the child belonged, the incremental development of the narrative is initially devoted to the elements associated to the causal chain of the actions an then it extended to other elements. Moreover, the adapted version of the Index of Narrative Complexity proved to be a valid and useful form of assessment that enables the speech therapist to monitor the progress of individuals in the narrative production (AU)

Análisis de las dificultades en el discurso narrativo en alumnado con Trastorno Específico del Lenguaje / Analysis of difficulties in narrative discourse in pupils with Specific Language Impairment

El objetivo de nuestro estudio ha sido comparar la producción y la comprensión de narraciones en 2 grupos de niños hispanohablantes, uno con desarrollo típico y otro con Trastorno Específico del Lenguaje (TEL). La muestra estuvo compuesta por 35 alumnos diagnosticados con TEL y 21 niños sin problemas de lenguaje. Para la evaluación narrativa se ha diseñado un protocolo de naturaleza cualitativa a partir de la revisión y adaptación de algunas propuestas, entre las que cabe destacar el Test of Narrative Language (TNL) de Gillam y Pearson (2004). Los resultados indican un peor desempeño en el grupo de niños con TEL en el manejo del cuento sin ayuda, en la macroestructura narrativa, en la complejidad sintáctica y en la comprensión global de la historia (AU)