Social Psychology of and for World-Making.

ACADEMIC ABSTRACT: Social psychology's disconnect from the vital and urgent questions of people's lived experiences reveals limitations in the current paradigm. We draw on a related perspective in social psychology1-the sociocultural approach-and argue how this perspective can be elaborated to consider not only social psychology as a historical science but also social psychology of and for world-making. This conceptualization can make sense of key theoretical and methodological challenges faced by contemporary social psychology. As such, we describe the ontology, epistemology, ethics, and methods of social psychology of and for world-making. We illustrate our framework with concrete examples from social psychology. We argue that reconceptualizing social psychology in terms of world-making can make it more humble yet also more relevant, reconnecting it with the pressing issues of our time. PUBLIC ABSTRACT: We propose that social psychology should focus on "world-making" in two senses. First, people are future-oriented and often are guided more by what could be than what is. Second, social psychology can contribute to this future orientation by supporting people's world-making and also critically reflecting on the role of social psychological research in world-making. We unpack the philosophical assumptions, methodological procedures, and ethical considerations that underpin a social psychology of and for world-making. Social psychological research, whether it is intended or not, contributes to the societies and cultures in which we live, and thus it cannot be a passive bystander of world-making. By embracing social psychology of and for world-making and facing up to the contemporary societal challenges upon which our collective future depends will make social psychology more humble but also more relevant.

Beyond performance and protocols: early responders' experiences of multiple accountability demands in the response to the 2015 Nepal earthquake.

Critics have long questioned the push for professionalised and performance-driven accountability in the humanitarian sector, yet the matter is largely treated as a 'back office' issue of standards, guidelines, and processes. Scant attention is paid to the accountability demands experienced by early responders to disasters. Set in the contested climate of the emergency response to the earthquake in Nepal on 25 April 2015, and drawing on interviews with 15 early responders, this paper reveals three forms of accountability demands: (i) accountability as compliance; (ii) accountability as the object of government regulation; and (iii) accountability as public opposition and interrogation. Beyond the performance-centric, non-governmental organisation-driven understanding of accountability, early responders to the earthquake experienced multidirectional accountability demands, not only from donors and beneficiaries, but also from the national government and wider public. Engaging with public criticism is a significant feature of early responders' responsibility that warrants further consideration by the humanitarian community.

Beyond the binaries: reshaping pain communication through arts workshops.

Pain is difficult to communicate and translate into language, yet most social research on pain experience uses questionnaires and semi-structured interviews that rely on words. In addition to the mind/body dualism prevalent in pain medicine in these studies pain communication is characterised by further value-laden binaries such as real/unreal, visible/invisible, and psychological/physical. Starting from the position that research methods play a role in constituting their object, this article examines the potential of participatory arts workshops for developing different versions of pain communication. Twenty-two participants were involved in workshops using drawing, digital photography, sound and physical theatre to explore pain communication. The use of arts materials made pain tangible. By manipulating pain-related objects, participants could consider alternative relationships to their pain. Pain's sociality was also explored, with relations with clinicians and others emerging as potentially cooperative rather than adversarial. Discussions considered whether pain felt internal or external, and whether it was possible to conceive of a self without pain. We argue that the socio-material context of participatory arts workshops enabled these alternative versions of pain. Such methods are a useful addition to medical sociology's heavy reliance on qualitative interviewing.

Transition to parenthood during the transition to modernity in Jordan: New parents' views on family and healthcare support systems.

AIMS AND OBJECTIVES: This study aims to explore new parents' experiences of family support during their transition to parenthood. BACKGROUND: Family support is widely considered a crucial factor in contributing toward positive outcomes for parents during transition to parenthood. However, inter-generational and socio-cultural differences among family members in understandings and practices of childcare can be a source of tension between new parents and family members. Few studies have examined the role of family support in the context of rapid social change taking place in Middle Eastern countries. This study aims to address this gap by examining the parenting experiences of young Jordanian couples within the family context they are embedded in. RESEARCH DESIGN AND METHODS: A qualitative study was conducted in Jordan involving sixty semi-structured, in-depth interviews. Twenty mothers, twenty fathers, and twenty family members identified as support providers were interviewed. RESULTS: The key theme, "it's too much" emerged from interviews to describe the nature of family support experienced by new parents from marriage to pregnancy and until after the arrival of their first child. The study found varied interpretations of traditional child-care practices among older and younger generation of family members, leading to family conflict. This study also found that the lack of credible information from the health system about child-care compelled them to accept the only available information for them from their parents, often times with much resistance and reluctance. This created a situation of stress and anxiety among young parents and undermined the potential for healthy parenting experience. This study also found that not all social support during early days of parenthood led to beneficial health outcomes to mother and child."Social visiting" by family members to hospital and home, was particularly found to interfere with new parents' pursuit toward privacy and family bonding, immediately following the birth of child. CONCLUSION: This study has produced a new understanding of the experience of Jordanian new parents' transition to parenthood. This study particularly sheds light on the current dilemma in which these Jordanian new parents find themselves in, which reflect a clash between traditional and modern values. Although the findings aim to contribute to the body of literature that deals with cultural influences on new parents' experiences in Jordon, the learning could be relevant to the other contexts in the Middle Eastern societies.

A qualitative method for analysing multivoicedness.

'Multivoicedness' and the 'multivoiced Self' have become important theoretical concepts guiding research. Drawing on the tradition of dialogism, the Self is conceptualised as being constituted by a multiplicity of dynamic, interacting voices. Despite the growth in literature and empirical research, there remains a paucity of established methodological tools for analysing the multivoiced Self using qualitative data. In this article, we set out a systematic, practical 'how-to' guide for analysing multivoicedness. Using theoretically derived tools, our three-step method comprises: identifying the voices of I-positions within the Self's talk (or text), identifying the voices of 'inner-Others', and examining the dialogue and relationships between the different voices. We elaborate each step and illustrate our method using examples from a published paper in which data were analysed using this method. We conclude by offering more general principles for the use of the method and discussing potential applications.

Evidence synthesis in international development: a critique of systematic reviews and a pragmatist alternative.

Systematic reviews are an instrument of Evidence-Based Policy designed to produce comprehensive, unbiased, transparent and clear assessments of interventions' effectiveness. From their origins in medical fields, systematic reviews have recently been promoted as offering important advances in a range of applied social science fields, including international development. Drawing on a case study of a systematic review of the effectiveness of community mobilisation as an intervention to tackle HIV/AIDS, this article problematises the use of systematic reviews to summarise complex and context-specific bodies of evidence. Social development interventions, such as 'community mobilisation' often take different forms in different interventions; are made successful by their situation in particular contexts, rather than being successful or unsuccessful universally; and have a rhetorical value that leads to the over-application of positively valued terms (e.g. 'community mobilisation'), invalidating the keyword search process of a systematic review. The article suggests that the policy interest in definitive summary statements of 'the evidence' is at odds with academic assessments that evidence takes multiple, contradictory and complex forms, and with practitioner experience of the variability of practice in context. A pragmatist philosophy of evidence is explored as an alternative. Taking this approach implies expanding the definition of forms of research considered to be 'useful evidence' for evidence-based policy-making; decentralising decisions about 'what works' to allow for the use of local practical wisdom; and prioritising the establishment of good processes for the critical use of evidence, rather than producing context-insensitive summaries of 'the evidence'.

The impact of community mobilisation on HIV prevention in middle and low income countries: a systematic review and critique.

While community mobilisation (CM) is increasingly advocated for HIV prevention, its impact on measurable outcomes has not been established. We performed a systematic review of the impact of CM within HIV prevention interventions (N = 20), on biomedical, behavioural and social outcomes. Among most at risk groups (particularly sex workers), the evidence is somewhat consistent, indicating a tendency for positive impact, with stronger results for behavioural and social outcomes than for biomedical ones. Among youth and general communities, the evidence remains inconclusive. Success appears to be enhanced by engaging groups with a strong collective identity and by simultaneously addressing the socio-political context. We suggest that the inconclusiveness of the findings reflects problems with the evidence, rather than indicating that CM is ineffective. We discuss weaknesses in the operationalization of CM, neglect of social context, and incompatibility between context-specific CM processes and the aspiration of review methodologies to provide simple, context-transcending answers.

Promoting Equity, Diversity, and Inclusion in Surveys: Insights from a Patient-engaged Study to Assess Long COVID Healthcare Needs in Brazil.

BACKGROUND AND OBJECTIVE: Long COVID (LC) refers to persistent symptoms after acute COVID-19 infection, which may endure for months or years. LC affects millions of people globally, with substantial impacts on quality of life, employment, and social participation. Ensuring access to effective, patient-centered care for LC demands evidence, grounded in inclusive representation of those affected by the condition. Yet survey studies frequently under-represent people with the most disabling disease presentations and racially and socio-economically marginalized groups. We aimed to describe a patient-engaged approach to developing a survey to inform public LC healthcare, and to assess its implementation in terms of enabling participation by diverse LC patients in Brazil. METHODS: Survey development was iterative, achieved through an interdisciplinary collaboration among researchers including people living with LC, and grounded in three guiding principles: (1) evidence-based; (2) inclusive, intersectional, and patient-centered understanding of chronic illness and research participation; and (3) sensitivity to the context of healthcare access. RESULTS: The product of our collaboration was a longitudinal survey using a questionnaire assessing: LC symptoms; their clinical and functional evolution; and impacts on quality of life, household income, health service access, utilization, and out-of-pocket expenses. We illustrate how we operationalized our three principles through survey content, instrument design, and administration. 651 participants with diverse LC symptoms, demography, and socio-economic status completed the survey. We successfully included participants experiencing disabling symptoms, Black and mixed race participants, and those with lower education and income. CONCLUSION: By centering patient experience, our novel, principles-based approach succeeded in promoting equity, diversity, and inclusion in LC survey research. These principles guiding patient-engaged collaboration have broad transferability. We encourage survey researchers working on chronic illness and in other contexts of marginalization and inequality to adopt them.

Systematic review of reviews of behavioural HIV prevention interventions among men who have sex with men.

Men who have sex with men (MSM) remain one of the groups most at risk of HIV. The growing evidence-base on behavioural HIV prevention interventions includes systematic review-level evidence, including reviews specific to MSM populations. Here, we provide an up-to-date review of these systematic reviews in which we examined the effectiveness of behavioural HIV prevention interventions among MSM. A systematic search of electronic databases, including MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, PsycInfo, from January 2000 to October 2010, along with hand searches of the reference lists of retrieved documents were conducted. Inclusion criteria included: study design limited to systematic reviews and meta-analyses; methodological quality; and review to focus on MSM and behavioural interventions. A narrative synthesis was conducted. Across the four included meta-analyses (102 studies; 52 independent studies), there was strong and consistent evidence for group- and community-level interventions being associated with reductions in UAI (27-30% and 30%, respectively) and increases in condom use amongst MSM, but inconsistent evidence for the effectiveness of individual-level interventions. Skills-building, trained professionals delivering the training and theory-based interventions were also consistently effective. The inherent limitations of the review of review method within a changing health domain meant it was difficult to develop contemporary and directly transferable guidance to HIV prevention policy development. However, the analysis does demonstrate a need for a step change in the kinds of data that are collated in the development of future systematic reviews of HIV prevention interventions among MSM.

How can community health programmes build enabling environments for transformative communication? Experiences from India and South Africa.

Much research has examined how to empower the poor to articulate demands for health-enabling living conditions. Less is known about creating receptive social environments where the powerful heed the voices of the poor. We explore the potential for 'transformative communication' between the poor and the powerful, through comparing two well-documented case studies of HIV/AIDS management. The Entabeni Project in South Africa sought to empower impoverished women to deliver home-based nursing to people with AIDS. It successfully provided short-term welfare, but did not achieve local leadership or sustainability. The Sonagachi Project in India, an HIV-prevention programme targeting female sex workers, became locally led and sustainable. We highlight the strategies through which Sonagachi, but not Entabeni, altered the material, symbolic and relational contexts of participants' lives, enabling transformative communication and opportunities for sexual health-enabling social change.

Towards a "fourth generation" of approaches to HIV/AIDS management: creating contexts for effective community mobilisation.

Many biomedical and behavioural HIV/AIDS programmes aimed at prevention, care and treatment have disappointing outcomes because of a lack of effective community mobilisation. But community mobilisation is notoriously difficult to bring about. We present a conceptual framework that maps out those dimensions of social context that are likely to support or undermine community mobilisation efforts, proposing that attention should be given to three dimensions of social context: the material, symbolic and relational. This paper has four parts. We begin by outlining why community mobilisation is regarded as a core dimension of effective HIV/AIDS management: it increases the "reach" and sustainability of programmes; it is a vital component of the wider "task shifting" agenda given the scarcity of health professionals in many HIV/AIDS-vulnerable contexts. Most importantly it facilitates those social psychological processes that we argue are vital preconditions for effective prevention, care and treatment. Secondly we map out three generations of approaches to behaviour change within the HIV/AIDS field: HIV-awareness, peer education and community mobilisation. We critically evaluate each approach's underlying assumptions about the drivers of behaviour change, to frame our understandings of the pathways between mobilisation and health, drawing on the concepts of social capital, dialogue and empowerment. Thirdly we refer to two well-documented case studies of community mobilisation in India and South Africa to illustrate our claim that community mobilisation is unlikely to succeed in the absence of supportive material, symbolic and relational contexts. Fourthly we provide a brief overview of how the papers in this special issue help us flesh out our conceptualisation of the "health enabling social environment". We conclude by arguing for the urgent need for a 'fourth generation' of approaches in the theory and practice of HIV/AIDS management, one which pays far greater attention to the wider contextual influences on programme success.

Persuading, protesting and exchanging favours: strategies used by Indian sex workers to win local support for their HIV prevention programmes.

Given that the communities which are most vulnerable to HIV often have little control over their own lives and their health-related behaviour, HIV prevention policies increasingly recommend that HIV prevention projects work to build relationships with powerful external groups (i.e., build "bridging social capital"). To aid conceptualisation of how community organisations may build such social capital, this paper outlines a typology of strategies for influencing local stakeholders. We present a study of two successful Indian sex workers' organisations, VAMP and DMSC, focusing on how the organisations have influenced three groups of stakeholders, namely police, politicians and local social organisations. Interviews with project employees (45), with representatives of the three groups of stakeholders (12) and fieldwork diaries recording 6 months of observation in each site provide the data. Three approaches emerged. "Persuading" refers to the practice of holding information-giving meetings with stakeholders and requesting their support. It appears to build "weak social ties". "Protesting" entails a collective confrontation with stakeholders, and appears to be useful when the stakeholder has a public image to protect that would be tarnished by protest, and when the protestors can stake a legitimate claim that their rights are being denied. In "exchanging favours", the sex workers' organisations find creative ways to position themselves as offering valued resources to their stakeholders (such as useful information on criminal activities for the police, a stage and audience for politicians or a celebration for local social organisations) as incentives for their support. In conclusion, we discuss the strengths and weaknesses of each approach, the implications for social capital theorising and implications for community HIV prevention.

The social underpinnings of mental distress in the time of COVID-19 - time for urgent action.

We argue that predictions of a 'tsunami' of mental health problems as a consequence of the pandemic of coronavirus disease 2019 (COVID-19) and the lockdown are overstated; feelings of anxiety and sadness are entirely normal reactions to difficult circumstances, not symptoms of poor mental health.  Some people will need specialised mental health support, especially those already leading tough lives; we need immediate reversal of years of underfunding of community mental health services.  However, the disproportionate effects of COVID-19 on the most disadvantaged, especially BAME people placed at risk by their social and economic conditions, were entirely predictable. Mental health is best ensured by urgently rebuilding the social and economic supports stripped away over the last decade. Governments must pump funds into local authorities to rebuild community services, peer support, mutual aid and local community and voluntary sector organisations.  Health care organisations must tackle racism and discrimination to ensure genuine equal access to universal health care.  Government must replace highly conditional benefit systems by something like a universal basic income. All economic and social policies must be subjected to a legally binding mental health audit. This may sound unfeasibly expensive, but the social and economic costs, not to mention the costs in personal and community suffering, though often invisible, are far greater.

Let's get real (with a small 'r'): for a health psychology that prioritizes the concrete.

Depending on which kind of philosophy of science we espouse, health psychology can be a relatively concrete or relatively abstract activity. Estacio, I suggest, prioritizes the concrete, by foregrounding real social phenomena. I argue that prioritizing the concrete has two particular benefits: it increases the social relevance of health psychology, and it increases the validity of our analyses, by ensuring that they are close to reality. To further the pursuit of the concrete, I suggest that critical health psychology is in particular need of exemplars of critical health psychology in action, rather than reflexive commentary on critical health psychology itself.

A pragmatist approach to the problem of knowledge in health psychology.

The multiplicity of forms of health-related knowledge, including biomedical knowledge, lay knowledge and critical constructionist knowledge, raises challenges for health researchers. On one hand, there is a demand for a pluralist acceptance of the variety of health-related knowledge. On the other, the need to improve health calls for action, and thus for choices between opposing forms of knowledge. The present article proposes a pragmatist approach to this epistemological problem. According to pragmatism, knowledge is a tool for action and as such it should be evaluated according to whether it serves our desired interests. We identify implications for research methodology and the choice of research goals.

The social conditions for successful peer education: a comparison of two HIV prevention programs run by sex workers in India and South Africa.

Peer education is a community-based intervention being implemented worldwide as an approach to HIV prevention. However, its results are inconsistent, with little consensus on why some projects succeed while others fail. Considering peer education as an 'intervention-in-context', we systematically compare the context and the implementation of two peer education interventions run by sex workers, one in India and one in South Africa, which produced contrasting outcomes. In so doing, we aim to identify key factors in the projects' successes or failures that may inform future peer education efforts. The Indian project's relative success was facilitated (1) by a more stable and supportive social, material and political context, and (2) by a community development ethos which devoted significant resources to sex workers' involvement, ownership and empowerment, as opposed to a biomedical approach which marginalised sex workers' concerns. We conclude with lessons learned and implications for current trends in peer education.

The necessary contradictions of 'community-led' health promotion: a case study of HIV prevention in an Indian red light district.

Health promotion interventions with marginalised groups are increasingly expected to demonstrate genuine community participation in their design and delivery. However, ideals of egalitarian democratic participation are far removed from the starting point of the hierarchical and exploitative social relations that typically characterise marginalised communities. What scope is there for health promotion projects to implement ideals of community leadership within the realities of marginalisation and inequality? We examine how the Sonagachi Project, a successful sex-worker-led HIV prevention project in India, has engaged with the unequal social relations in which it is embedded. Our ethnographic study is based on observation of the Project's participatory activities and 39 interviews with a range of its stakeholders (including sex worker employees of the Project, non-sex-worker development professionals, brothel managers, sex workers' clients). The analysis shows that the project is deeply shaped by its relationships with non-sex-worker interest groups. In order to be permitted access to the red light district, it has had to accommodate the interests of local men's clubs and brothel managers. The economic and organisational capacity to run such a project has depended upon the direct input of development professionals and funding agencies. Thus, the 'community' that leads this project is much wider than a local grouping of marginalised sex workers. We argue that, given existing power relations, the engagement with other interest groups was necessary to the project's success. Moreover, as the project has developed, sex workers' interests and leadership have gained increasing prominence. We suggest that existing optimistic expectations of participation inhibit acknowledgement of the troubling work of balancing power relations. Rather than denying such power relations, projects should be expected to plan for them.

Implementing Family Health Nursing in Tajikistan: from policy to practice in primary health care reform.

The health systems of former Soviet Union countries are undergoing reform away from the highly centralised, resource-intensive, specialised and hierarchical Soviet system, towards a more generalist, efficient health service with greater focus on primary health care. Family Health Nursing is a new model designed by WHO Europe in which skilled generalist community nurses deliver primary health care to local communities. This paper presents a qualitative evaluation of the implementation of Family Health Nursing in Tajikistan. Using Stufflebeam's 'Context, Input, Process, and Product' model, the paper aims to evaluate the progress of this reform, and to understand the factors that help or hinder its implementation. A four-phase research design investigates the development of the Family Health Nurse role over time. In 5 rural areas, 6 focus groups and 18 interviews with Family Health Nurses, 4 observations of their practice, 7 interviews with families and 9 interviews with physicians were carried out. Data were analysed according to the components of Stufflebeam's model. Although the legacy of the Soviet health system did not set a precedent for a nurse who is capable of decision-making and who works in partnership with the physician, Family Health Nurses were successfully implementing new practices. Crucial to their ability to do so were the co-operation of physicians and families. Physicians were impressed by the nurses' development of knowledge, and families were impressed that the nurses could offer real solutions to their problems. However, failure to pay the nurses regular salaries had led to serious attrition of the workforce. We conclude that the success of the Family Health Nurse role in other countries will depend upon its position in relation to the historical health care system.

Front-line perspectives on 'joined-up' working relationships: a qualitative study of social prescribing in the west of Scotland.

Cross-sector collaboration has been promoted by government policies in the United Kingdom and many western welfare states for decades. Literature on joint working has focused predominantly on the strategic level, neglecting the role of individual practitioners in putting 'joined-up working' into practice. This paper takes the case of 'social prescribing' in the west of Scotland as an instance of joined-up working, in which primary healthcare professionals are encouraged to refer patients to non-medical sources of support in the third sector. This study draws on social capital theory to analyse the quality of the relationships between primary healthcare professionals and third sector practitioners. Eighteen health professionals and 15 representatives of third sector organisations participated in a qualitative interview study. Significant barriers to collaborative working were evident. The two stakeholder groups expressed different understandings of health, with few primary healthcare professionals considering non-medical sources of support to be useful or relevant. Health professionals were mistrustful of unknown third sector organisations, and concerned about their accountability for referrals that were not successful or positive for the patient. Third sector practitioners sought to build trust through face-to-face interactions with health professionals. However, primary healthcare professionals and third sector practitioners were not connected in effective networks. We highlight the ongoing imbalance of power between primary healthcare professionals and third sector organisations. Strategic collaborations should be complemented by efforts to build shared understandings, trust and connections between the diverse front-line workers whose mutual co-operation is necessary to achieve effective joined-up working.