title: Trust and gender in patient-practitioner relationships

authors: FitzPatrick, Mary

abstract: This research investigates the phenomenon of patient trust in primary health care providers. Using the qualitative methodology of Memory Work, this research draws largely on social constructionism to understand gendered 'lived' experiences of trust within the patient-practitioner relationship. The central question of this research, then, was: How do male and female patients describe and perceive their experience, both positive and negative, of trust in primary health care practitioners (PHCPs)? Following the Memory Work method, two groups of participants, one comprising four men, the other five women, independently wrote detailed narratives of their lived experiences of trust. These experiences were evoked by agreed 'trigger' topics that each group felt explored and represented trust within the patient-practitioner relationship. The participants then came together as a group to discuss and analyse the individual narratives for the 'common' sense or the social aspects of the experiences common to the group, and the processes used to make sense of them. Both the women's research group and the men's research group met for five sessions, each session lasting at least three hours. Between them the research participants wrote 43 individual narratives (two absences) and generated more than 30 hours of recorded group work. From their written descriptions and verbal discussions of their individual narratives, this research describes and explains the trust that these participants experienced, and explores the meaning that these men and women themselves ascribe to trust in various health care service contexts. Specifically, Memory Work facilitated the participants' own understanding of how their individual experiences of trust have been constructed by the self, and the social processes of gender on self. 
This research worked at two levels of analysis and interpretation (textual and crosssectional), examining the experiences both within and between the men and women in the study. A number of common themes were found to be critical to patient trust for these women and men showing important gender differences in how trust is lived and understood within the patient-practitioner relationship. The themes that the women use to make sense of their trust in PHCPs are: Vulnerability, Knowledge, Affirmation, Voice, Clinical Skills, Responsiveness, Professional Confidence, Thoroughness, Acceptance, Personal Connection, Honesty, Empathy, Reciprocity, Safety, and Empowerment. Collectively the men develop the following themes: Risk, Evidence, Autonomy, Personal Connection, Clinical Skills, Professionalism, Empathy, Friendliness, 'Reading' Skills, Honesty, Reciprocity, and Alliance. Finally, the discussion elaborates the participants' theorising by connecting it to existing marketing literature. The research finds that there are both profound relational and social dimensions to trust in this service context. Trust is understood as a relational phenomenon through the heuristic device of the 'She' /'He', 'Other', and 'They'. 
This research extends the relationship marketing literature by developing a deep understanding of the phenomenon of trust from the patients' perspective, and the interconnections between this trust and gender as it is lived in health care service contexts. These insights provide a sound base for implementing improvements to current health care practice that are valued by the patient, and therefore have immediate practical relevance for health care practitioners, health care policy makers, and patients. This research also contributes academically by establishing a new way of analysing and interpreting relational phenomena such as trust.

text: Trust and gender in patient-practitioner relationships This research investigates the phenomenon of patient trust in primary health care providers. Using the qualitative methodology of Memory Work, this research draws largely on social constructionism to understand gendered 'lived' experiences of trust within the patient-practitioner relationship. The central question of this research, then, was: How do male and female patients describe and perceive their experience, both positive and negative, of trust in primary health care practitioners (PHCPs)? Following the Memory Work method, two groups of participants, one comprising four men, the other five women, independently wrote detailed narratives of their lived experiences of trust. These experiences were evoked by agreed 'trigger' topics that each group felt explored and represented trust within the patient-practitioner relationship. The participants then came together as a group to discuss and analyse the individual narratives for the 'common' sense or the social aspects of the experiences common to the group, and the processes used to make sense of them. Both the women's research group and the men's research group met for five sessions, each session lasting at least three hours. Between them the research participants wrote 43 individual narratives (two absences) and generated more than 30 hours of recorded group work. From their written descriptions and verbal discussions of their individual narratives, this research describes and explains the trust that these participants experienced, and explores the meaning that these men and women themselves ascribe to trust in various health care service contexts. Specifically, Memory Work facilitated the participants' own understanding of how their individual experiences of trust have been constructed by the self, and the social processes of gender on self. 
This research worked at two levels of analysis and interpretation (textual and crosssectional), examining the experiences both within and between the men and women in the study. A number of common themes were found to be critical to patient trust for these women and men showing important gender differences in how trust is lived and understood within the patient-practitioner relationship. The themes that the women use to make sense of their trust in PHCPs are: Vulnerability, Knowledge, Affirmation, Voice, Clinical Skills, Responsiveness, Professional Confidence, Thoroughness, Acceptance, Personal Connection, Honesty, Empathy, Reciprocity, Safety, and Empowerment. Collectively the men develop the following themes: Risk, Evidence, Autonomy, Personal Connection, Clinical Skills, Professionalism, Empathy, Friendliness, 'Reading' Skills, Honesty, Reciprocity, and Alliance. Finally, the discussion elaborates the participants' theorising by connecting it to existing marketing literature. The research finds that there are both profound relational and social dimensions to trust in this service context. Trust is understood as a relational phenomenon through the heuristic device of the 'She' /'He', 'Other', and 'They'. 
This research extends the relationship marketing literature by developing a deep understanding of the phenomenon of trust from the patients' perspective, and the interconnections between this trust and gender as it is lived in health care service contexts. These insights provide a sound base for implementing improvements to current health care practice that are valued by the patient, and therefore have immediate practical relevance for health care practitioners, health care policy makers, and patients. This research also contributes academically by establishing a new way of analysing and interpreting relational phenomena such as trust.

year: 2004

title: Estimating the numbers of aquatic birds affected by oil spills: pre-planning, response, and post-incident considerations

authors: Fraser, G.S.

subjects: Science & Technology

abstract: Oil spills most visibly affect waterbirds and often the number of birds affected, a key measure of environmental damage from an incident, is required for public communication, population management, and legal reasons. We review and outline steps that can be taken to improve accuracy in the estimation of the number of birds affected in each of three phases: (1) pre-planning; (2) during a response; and (3) post-response. The more pre-planning undertaken, the more robust the estimates will be. Personnel involved in damage assessment efforts must have training in quantitative biology and need support during all three phases. The main approaches currently used to estimate the number of birds affected include probability exposure models and carcass sampling — both onshore and on the water. Probability exposure models can be used in the post-incident phase, particularly in offshore scenarios where beached bird surveys are not possible, and requires three datasets: (1) at-sea bird densities; (2) bird mortality; and (3) the spill trajectory. Carcass sampling using beached bird surveys is appropriate if trajectories indicate affected birds will reach shore. Carcass sampling can also occur via on-water transects and may overlap with risk assessment efforts. Damage assessment efforts should include a measure of sublethal effects following the post-acute phase of spills, yet this area has significant knowledge gaps. We urge jurisdictions worldwide to improve pre-incident planning. We provide guidance on how, in the absence of pre-incident data, quality data can be obtained during or after an incident. These recommendations are relevant for areas with aquatic-based industrial activities which can result in a spill of substances that could injure or kill waterbirds.

text: Estimating the numbers of aquatic birds affected by oil spills: pre-planning, response, and post-incident considerations Oil spills most visibly affect waterbirds and often the number of birds affected, a key measure of environmental damage from an incident, is required for public communication, population management, and legal reasons. We review and outline steps that can be taken to improve accuracy in the estimation of the number of birds affected in each of three phases: (1) pre-planning; (2) during a response; and (3) post-response. The more pre-planning undertaken, the more robust the estimates will be. Personnel involved in damage assessment efforts must have training in quantitative biology and need support during all three phases. The main approaches currently used to estimate the number of birds affected include probability exposure models and carcass sampling — both onshore and on the water. Probability exposure models can be used in the post-incident phase, particularly in offshore scenarios where beached bird surveys are not possible, and requires three datasets: (1) at-sea bird densities; (2) bird mortality; and (3) the spill trajectory. Carcass sampling using beached bird surveys is appropriate if trajectories indicate affected birds will reach shore. Carcass sampling can also occur via on-water transects and may overlap with risk assessment efforts. Damage assessment efforts should include a measure of sublethal effects following the post-acute phase of spills, yet this area has significant knowledge gaps. We urge jurisdictions worldwide to improve pre-incident planning. We provide guidance on how, in the absence of pre-incident data, quality data can be obtained during or after an incident. These recommendations are relevant for areas with aquatic-based industrial activities which can result in a spill of substances that could injure or kill waterbirds.

year: 2022

title: Viruses without vaccines, or valuing indigenous research? The tensions of introducing Western research assessment practices into an indigenous university

authors: Bruce Ferguson, Pip

abstract: Over my past twenty-five years of educational practice, I have striven to develop a better understanding of indigenous ways of being and doing (in New Zealand’s case, this involves the values and knowledge of Māori). I have done this by visiting and occasionally staying on marae (Māori gathering-places); by reading relevant literature; by engaging in conversations with knowledgeable scholars and by researching the impact of Western practices on indigenous peoples.

In 2003 I managed a research team for Te Wānanga o Aotearoa, a Māori tertiary institution with branches across the country. Our Tertiary Education Commission had just introduced a variation of the English RAE, called the Performance-Based Research Fund, through which government research funds would henceforth be distributed. In collaboration with Māori colleagues, we chose to enter this process, believing that Māori research would be recognised and funded by our participation.

While this proved to be the case, there were significant examples of values clashes, such as the requirement for people to ‘boast’ of their research achievements in a context where such boasting is anathema; to claim ownership of knowledge where tradition often indicates that knowledge is not the property of individuals; and worst, at one point I found myself accused by my Māori manager of introducing ‘viruses without vaccines’. By this he meant Westernised ideas and practices which appeared to be benevolent but in fact were toxic (the idea derives from white settlers who apparently gave native Americans blankets permeated with a virus, causing thousands to die).

In this paper I will explore tensions of operating cross-culturally, and whether/how we can protect people from unintended toxic consequences of intended benevolent actions.

text: Viruses without vaccines, or valuing indigenous research? The tensions of introducing Western research assessment practices into an indigenous university Over my past twenty-five years of educational practice, I have striven to develop a better understanding of indigenous ways of being and doing (in New Zealand’s case, this involves the values and knowledge of Māori). I have done this by visiting and occasionally staying on marae (Māori gathering-places); by reading relevant literature; by engaging in conversations with knowledgeable scholars and by researching the impact of Western practices on indigenous peoples.

In 2003 I managed a research team for Te Wānanga o Aotearoa, a Māori tertiary institution with branches across the country. Our Tertiary Education Commission had just introduced a variation of the English RAE, called the Performance-Based Research Fund, through which government research funds would henceforth be distributed. In collaboration with Māori colleagues, we chose to enter this process, believing that Māori research would be recognised and funded by our participation.

While this proved to be the case, there were significant examples of values clashes, such as the requirement for people to ‘boast’ of their research achievements in a context where such boasting is anathema; to claim ownership of knowledge where tradition often indicates that knowledge is not the property of individuals; and worst, at one point I found myself accused by my Māori manager of introducing ‘viruses without vaccines’. By this he meant Westernised ideas and practices which appeared to be benevolent but in fact were toxic (the idea derives from white settlers who apparently gave native Americans blankets permeated with a virus, causing thousands to die).

In this paper I will explore tensions of operating cross-culturally, and whether/how we can protect people from unintended toxic consequences of intended benevolent actions.

year: 2012