Julian Randall | University of Aberdeen (original) (raw)
Papers by Julian Randall
Action Learning: Research and Practice, 2016
PLOS ONE, May 1, 2012
Background: Antiretroviral therapy (ART) is a lifesaver for individual patients treated for Human... more Background: Antiretroviral therapy (ART) is a lifesaver for individual patients treated for Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS). Maintaining optimal adherence to antiretroviral drugs is essential for HIV infection management. This study aimed to understand the factors influencing adherence amongst ART-prescribed patients and care providers in Nepal. Methods: A cross-sectional mixed-methods study surveying 330 ART-prescribed patients and 34 in-depth interviews with three different types of stakeholders: patients, care providers, and key people at policy level. Adherence was assessed through survey self-reporting and during the interviews. A multivariate logistic regression model was used to identify factors associated with adherence, supplemented with a thematic analysis of the interview transcripts. Results: A total of 282 (85.5%) respondents reported complete adherence, i.e. no missed doses in the four-weeks prior to interview. Major factors influencing adherence were: non-disclosure of HIV status (OR = 17.99, p = 0.014); alcohol use (OR = 12.89, p = ,0.001), being female (OR = 6.91, p = 0.001), being illiterate (OR = 4.58, p = 0.015), side-effects (OR = 6.04, p = 0.025), ART started #24 months (OR = 3.18, p = 0.009), travel time to hospital .1 hour (OR = 2.84, p = 0.035). Similarly, lack of knowledge and negative perception towards ART medications also significantly affected non-adherence. Transport costs (for repeat prescription), followed by pills running out, not wanting others to notice, side-effects, and being busy were the most common reasons for non-adherence. The interviews also revealed religious or ritual obstacles, stigma and discrimination, ART-associated costs, transport problems, lack of support, and side-effects as contributing to non-adherence. Conclusion: Improving adherence requires a supportive environment; accessible treatment; clear instructions about regimens; and regimens tailored to individual patients' lifestyles. Healthcare workers should address some of the practical and cultural issues around ART medicine whilst policy-makers should develop appropriate social policy to promote adherence among ART-prescribed patients.
Tropical Medicine & International Health, Oct 3, 2011
Prairie Schooner, 2017
My father told me two things, a religion of sorts. Don’t eat these white folks’ food when there’s... more My father told me two things, a religion of sorts. Don’t eat these white folks’ food when there’s food in the house and Stop starving yourself, you making it look like I don’t feed you. And he did. For years I did not dream of empty, but chose it in the name of purity. I learned hunger and whiteness in the same place. I know how to refuse and not mean it, the only evidence a fist beneath the table, four half-moons sitting in my empty palm. Everything my mouth does is a sin, a windowless church swallowing the breeze. I drip No thank you by instinct, then flood back into myself. If I’m hungry, I’m nobody’s child. If I never kissed the fingers of a foreign hand, I would have made for an exceedingly small casket. I still might.
D ate 9^ sig n atu re of c an d id a te / DEDICATION This dissertation is dedicated to Hyacinth I... more D ate 9^ sig n atu re of c an d id a te / DEDICATION This dissertation is dedicated to Hyacinth Irene Randall, my mother, who worked persistently to ensure that I had the best education possible and encouraged me even in the face of defeat and failure. Without that firm foundation much that I have achieved since would not have been possible. My thanks are due to Drs Robin Fincham and Jerry Hallier who supervised my early efforts at the University of Stirling and initiated me in the adversarial nature of academic debate; to Professor Alan McKinlay who took over at the University of St Andrews and who had a marvellous knack of getting me to achieve with his non-directive and encouraging way; to Pauline, my wife, without whose technical expertise on the PC and patience at my many absences researching, this work would not have been possible; to Ray Griffiths, my fatherin-law, who accompanied me to the University library and acted as my scribe and supporter; to Jiorgis Kritsotakis, who shared the MBA course with me, going on to St Andrews to pursue his own PhD yet still had time to read through the final draft of this work and suggest improvements in important and significant detail; to my colleagues and many students at Stirling and St Andrews whose Ideas and discussions I have always enjoyed and frequently benefited from.
Handbook of Research Methods for Organisational Culture, 2022
Managing Change/Changing Managers The topic of change management presents students with many chal... more Managing Change/Changing Managers The topic of change management presents students with many challenges. One of the most challenging is making sense of guru and hero-manager literature, of which there is a plethora. Managing Change/Changing Managers is an ...
Journal of Change Management, 2010
Institutional logics and professional change has challenged researchers to identify in micro term... more Institutional logics and professional change has challenged researchers to identify in micro terms the empirical evidence for change in day-to-day working practices and professional practices. This lack of evidence is not made any easier by the professional boundaries which can bedevil openness between professionals, even where they may be working in the same teams. Nowhere is this clearer than among medical teams where it is accepted that professional knowledge is to be defended from outsiders and where treatment of patients ...
Organization Studies, 2010
This research concerns mental health workers who treat the victims of sexual abuse. The health wo... more This research concerns mental health workers who treat the victims of sexual abuse. The health workers were all part of a forum composed of doctors, counsellors and a community psychiatric nurse, who met to discuss issues of best practice in their everyday work. The research examined how these workers make sense of their work, particularly in terms of how they understand the concept of care and the kinds of knowledge that they use in their work, professional and otherwise. A great deal of scepticism was expressed concerning the traditional medical approaches to caring for the victims of abuse, and as a consequence these practitioners developed pragmatic and exploratory approaches to caring in order to help their clients. Many important similarities exist between the accounts given by the medical and voluntary practitioners of this forum and the insights of Michel Foucault’s genealogical studies of medicine, particularly his analysis of processes of normalization and his later work o...
Organization, 2007
This research is based on interviews conducted with a voluntary group of health practitioners who... more This research is based on interviews conducted with a voluntary group of health practitioners who care for the adult survivors of childhood sexual abuse in one area of Scotland. This project takes a broadly interpretive approach to the interviews, and examines the processes of sense-making apparent in the scripts of the doctors, community nurse and counsellors who comprise this voluntary Forum. Those interviewed were highly sceptical of traditional medical approaches to dealing with survivors of such abuse, and they all questioned the effectiveness of expert professional knowledge. The research highlights the role of patient disclosure as a key mechanism in the process of their treatment, which is akin to the confessional technology discussed in detail in the work of Michel Foucault. Combined with other medical technologies patient disclosure is revealed as a technique of normalization. In this particular case the experts themselves were engaged in unravelling this process in search...
AIDS Care, 2009
The aim of the study was to gain a deeper understanding of the factors that influence adherence t... more The aim of the study was to gain a deeper understanding of the factors that influence adherence to ART in a paediatric population in South India. Semi-structured interviews, guided by a questionnaire based on literature review, were undertaken with fourteen primary caregivers of children with HIV on ART focusing on the factors influencing adherence and non-adherence. Adherence to ART was assessed by caregiver reported adherence for the last three days. The framework approach was used for analysis of the transcribed interviews. Adherence behaviour in children taking ART was influenced by medication, child, caregiver, family and healthcare service related factors. Medication related factors such as palatability, formulation, and difficult regime were among the common reasons for non-adherence. While a supportive family appears to contribute to adherence, some caregivers are reluctant to inform their family for fear of isolation. All participants were strongly appreciative of the study centre's model of care and this had a positive effect on adherence behaviour. From the public health point of view, the respondents' reluctance to access publicly funded HIV care services is a cause for concern. Almost all caregivers were sceptical of the quality of free ART medications provided by public services, indicating an urgent need for appropriate education to
Trop Med Int Health, Oct 3, 2011
Objective To systematically review the literature of factors affecting adherence to Antiretrovir... more Objective To systematically review the literature of factors affecting adherence to Antiretroviral treatment (ART) in Asian developing countries. Methods Database searches in Medline/Ovid, Cochrane library, CINAHL, Scopus and PsychINFO for studies published between 1996 and December 2010. The reference lists of included papers were also checked, with citation searching on key papers. Results A total of 437 studies were identified, and 18 articles met the inclusion criteria and were extracted and critically appraised, representing in 12 quantitative, four qualitative and two mixed-method studies. Twenty-two individual themes, including financial difficulties, side effects, access, stigma and discrimination, simply forgetting and being too busy, impeded adherence to ART, and 11 themes, including family support, self-efficacy and desire to live longer, facilitated adherence. Conclusion Adherence to ART varies between individuals and over time. We need to redress impeding factors wh...
The Expository Times, 2008
7. Bibliography t. Baarda, Essays on the Diatessaron (CBet 11; Kampen, Kok pharos, 1994). W. Baue... more 7. Bibliography t. Baarda, Essays on the Diatessaron (CBet 11; Kampen, Kok pharos, 1994). W. Bauer, Orthodoxy and Heresy in Earliest Christianity (eng. trans., london: sCm, 1972). e. J. hunt, Christianity in the Second Century: The case of Tatian (london: routledge, 2003). ...
Journal of Health, Population and Nutrition, 2012
Patient's adherence is crucial to get the best out of antiretroviral therapy (ART). This stud... more Patient's adherence is crucial to get the best out of antiretroviral therapy (ART). This study explores in-depth the barriers to and facilitators of ART adherence among Nepalese patients and service providers prescribing ART. Face-to-face semi-structured interviews were conducted with 34 participants. Interviews were audiotaped, transcribed, and translated into English before being analyzed thematically. ART-prescribed patients described a range of barriers for failing to adhere to ART. Financial difficulties, access to healthcare services, frequent transport blockades, religious/ritual obstacles, stigma and discrimination, and side-effects were the most-frequently discussed barriers whereas trustworthy health workers, perceived health benefits, and family support were the most-reported facilitators. Understanding barriers and facilitators can help in the design of an appropriate and targeted intervention. Healthcare providers should address some of the practical and cultural is...
Abstract. This research is based on interviews conducted with a voluntary group of health practit... more Abstract. This research is based on interviews conducted with a voluntary group of health practitioners who care for the adult survivors of childhood sexual abuse in one area of Scotland. This project takes a broadly interpretive approach to the interviews, and examines the processes of sense-making apparent in the scripts of the doctors, community nurse and counsellors who comprise this voluntary Forum. Those interviewed were highly sceptical of traditional medical approaches to dealing with survivors of such abuse, and they all questioned the effectiveness of expert professional knowledge. The research highlights the role of patient disclosure as a key mechanism in the process of their treatment, which is akin to the confessional technology discussed in detail in the work of Michel Foucault. Combined with other medical technologies patient disclosure is revealed as a technique of normalization. In this particular case the experts themselves were engaged in unravelling this process...
Action Learning: Research and Practice, 2016
PLOS ONE, May 1, 2012
Background: Antiretroviral therapy (ART) is a lifesaver for individual patients treated for Human... more Background: Antiretroviral therapy (ART) is a lifesaver for individual patients treated for Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS). Maintaining optimal adherence to antiretroviral drugs is essential for HIV infection management. This study aimed to understand the factors influencing adherence amongst ART-prescribed patients and care providers in Nepal. Methods: A cross-sectional mixed-methods study surveying 330 ART-prescribed patients and 34 in-depth interviews with three different types of stakeholders: patients, care providers, and key people at policy level. Adherence was assessed through survey self-reporting and during the interviews. A multivariate logistic regression model was used to identify factors associated with adherence, supplemented with a thematic analysis of the interview transcripts. Results: A total of 282 (85.5%) respondents reported complete adherence, i.e. no missed doses in the four-weeks prior to interview. Major factors influencing adherence were: non-disclosure of HIV status (OR = 17.99, p = 0.014); alcohol use (OR = 12.89, p = ,0.001), being female (OR = 6.91, p = 0.001), being illiterate (OR = 4.58, p = 0.015), side-effects (OR = 6.04, p = 0.025), ART started #24 months (OR = 3.18, p = 0.009), travel time to hospital .1 hour (OR = 2.84, p = 0.035). Similarly, lack of knowledge and negative perception towards ART medications also significantly affected non-adherence. Transport costs (for repeat prescription), followed by pills running out, not wanting others to notice, side-effects, and being busy were the most common reasons for non-adherence. The interviews also revealed religious or ritual obstacles, stigma and discrimination, ART-associated costs, transport problems, lack of support, and side-effects as contributing to non-adherence. Conclusion: Improving adherence requires a supportive environment; accessible treatment; clear instructions about regimens; and regimens tailored to individual patients' lifestyles. Healthcare workers should address some of the practical and cultural issues around ART medicine whilst policy-makers should develop appropriate social policy to promote adherence among ART-prescribed patients.
Tropical Medicine & International Health, Oct 3, 2011
Prairie Schooner, 2017
My father told me two things, a religion of sorts. Don’t eat these white folks’ food when there’s... more My father told me two things, a religion of sorts. Don’t eat these white folks’ food when there’s food in the house and Stop starving yourself, you making it look like I don’t feed you. And he did. For years I did not dream of empty, but chose it in the name of purity. I learned hunger and whiteness in the same place. I know how to refuse and not mean it, the only evidence a fist beneath the table, four half-moons sitting in my empty palm. Everything my mouth does is a sin, a windowless church swallowing the breeze. I drip No thank you by instinct, then flood back into myself. If I’m hungry, I’m nobody’s child. If I never kissed the fingers of a foreign hand, I would have made for an exceedingly small casket. I still might.
D ate 9^ sig n atu re of c an d id a te / DEDICATION This dissertation is dedicated to Hyacinth I... more D ate 9^ sig n atu re of c an d id a te / DEDICATION This dissertation is dedicated to Hyacinth Irene Randall, my mother, who worked persistently to ensure that I had the best education possible and encouraged me even in the face of defeat and failure. Without that firm foundation much that I have achieved since would not have been possible. My thanks are due to Drs Robin Fincham and Jerry Hallier who supervised my early efforts at the University of Stirling and initiated me in the adversarial nature of academic debate; to Professor Alan McKinlay who took over at the University of St Andrews and who had a marvellous knack of getting me to achieve with his non-directive and encouraging way; to Pauline, my wife, without whose technical expertise on the PC and patience at my many absences researching, this work would not have been possible; to Ray Griffiths, my fatherin-law, who accompanied me to the University library and acted as my scribe and supporter; to Jiorgis Kritsotakis, who shared the MBA course with me, going on to St Andrews to pursue his own PhD yet still had time to read through the final draft of this work and suggest improvements in important and significant detail; to my colleagues and many students at Stirling and St Andrews whose Ideas and discussions I have always enjoyed and frequently benefited from.
Handbook of Research Methods for Organisational Culture, 2022
Managing Change/Changing Managers The topic of change management presents students with many chal... more Managing Change/Changing Managers The topic of change management presents students with many challenges. One of the most challenging is making sense of guru and hero-manager literature, of which there is a plethora. Managing Change/Changing Managers is an ...
Journal of Change Management, 2010
Institutional logics and professional change has challenged researchers to identify in micro term... more Institutional logics and professional change has challenged researchers to identify in micro terms the empirical evidence for change in day-to-day working practices and professional practices. This lack of evidence is not made any easier by the professional boundaries which can bedevil openness between professionals, even where they may be working in the same teams. Nowhere is this clearer than among medical teams where it is accepted that professional knowledge is to be defended from outsiders and where treatment of patients ...
Organization Studies, 2010
This research concerns mental health workers who treat the victims of sexual abuse. The health wo... more This research concerns mental health workers who treat the victims of sexual abuse. The health workers were all part of a forum composed of doctors, counsellors and a community psychiatric nurse, who met to discuss issues of best practice in their everyday work. The research examined how these workers make sense of their work, particularly in terms of how they understand the concept of care and the kinds of knowledge that they use in their work, professional and otherwise. A great deal of scepticism was expressed concerning the traditional medical approaches to caring for the victims of abuse, and as a consequence these practitioners developed pragmatic and exploratory approaches to caring in order to help their clients. Many important similarities exist between the accounts given by the medical and voluntary practitioners of this forum and the insights of Michel Foucault’s genealogical studies of medicine, particularly his analysis of processes of normalization and his later work o...
Organization, 2007
This research is based on interviews conducted with a voluntary group of health practitioners who... more This research is based on interviews conducted with a voluntary group of health practitioners who care for the adult survivors of childhood sexual abuse in one area of Scotland. This project takes a broadly interpretive approach to the interviews, and examines the processes of sense-making apparent in the scripts of the doctors, community nurse and counsellors who comprise this voluntary Forum. Those interviewed were highly sceptical of traditional medical approaches to dealing with survivors of such abuse, and they all questioned the effectiveness of expert professional knowledge. The research highlights the role of patient disclosure as a key mechanism in the process of their treatment, which is akin to the confessional technology discussed in detail in the work of Michel Foucault. Combined with other medical technologies patient disclosure is revealed as a technique of normalization. In this particular case the experts themselves were engaged in unravelling this process in search...
AIDS Care, 2009
The aim of the study was to gain a deeper understanding of the factors that influence adherence t... more The aim of the study was to gain a deeper understanding of the factors that influence adherence to ART in a paediatric population in South India. Semi-structured interviews, guided by a questionnaire based on literature review, were undertaken with fourteen primary caregivers of children with HIV on ART focusing on the factors influencing adherence and non-adherence. Adherence to ART was assessed by caregiver reported adherence for the last three days. The framework approach was used for analysis of the transcribed interviews. Adherence behaviour in children taking ART was influenced by medication, child, caregiver, family and healthcare service related factors. Medication related factors such as palatability, formulation, and difficult regime were among the common reasons for non-adherence. While a supportive family appears to contribute to adherence, some caregivers are reluctant to inform their family for fear of isolation. All participants were strongly appreciative of the study centre's model of care and this had a positive effect on adherence behaviour. From the public health point of view, the respondents' reluctance to access publicly funded HIV care services is a cause for concern. Almost all caregivers were sceptical of the quality of free ART medications provided by public services, indicating an urgent need for appropriate education to
Trop Med Int Health, Oct 3, 2011
Objective To systematically review the literature of factors affecting adherence to Antiretrovir... more Objective To systematically review the literature of factors affecting adherence to Antiretroviral treatment (ART) in Asian developing countries. Methods Database searches in Medline/Ovid, Cochrane library, CINAHL, Scopus and PsychINFO for studies published between 1996 and December 2010. The reference lists of included papers were also checked, with citation searching on key papers. Results A total of 437 studies were identified, and 18 articles met the inclusion criteria and were extracted and critically appraised, representing in 12 quantitative, four qualitative and two mixed-method studies. Twenty-two individual themes, including financial difficulties, side effects, access, stigma and discrimination, simply forgetting and being too busy, impeded adherence to ART, and 11 themes, including family support, self-efficacy and desire to live longer, facilitated adherence. Conclusion Adherence to ART varies between individuals and over time. We need to redress impeding factors wh...
The Expository Times, 2008
7. Bibliography t. Baarda, Essays on the Diatessaron (CBet 11; Kampen, Kok pharos, 1994). W. Baue... more 7. Bibliography t. Baarda, Essays on the Diatessaron (CBet 11; Kampen, Kok pharos, 1994). W. Bauer, Orthodoxy and Heresy in Earliest Christianity (eng. trans., london: sCm, 1972). e. J. hunt, Christianity in the Second Century: The case of Tatian (london: routledge, 2003). ...
Journal of Health, Population and Nutrition, 2012
Patient's adherence is crucial to get the best out of antiretroviral therapy (ART). This stud... more Patient's adherence is crucial to get the best out of antiretroviral therapy (ART). This study explores in-depth the barriers to and facilitators of ART adherence among Nepalese patients and service providers prescribing ART. Face-to-face semi-structured interviews were conducted with 34 participants. Interviews were audiotaped, transcribed, and translated into English before being analyzed thematically. ART-prescribed patients described a range of barriers for failing to adhere to ART. Financial difficulties, access to healthcare services, frequent transport blockades, religious/ritual obstacles, stigma and discrimination, and side-effects were the most-frequently discussed barriers whereas trustworthy health workers, perceived health benefits, and family support were the most-reported facilitators. Understanding barriers and facilitators can help in the design of an appropriate and targeted intervention. Healthcare providers should address some of the practical and cultural is...
Abstract. This research is based on interviews conducted with a voluntary group of health practit... more Abstract. This research is based on interviews conducted with a voluntary group of health practitioners who care for the adult survivors of childhood sexual abuse in one area of Scotland. This project takes a broadly interpretive approach to the interviews, and examines the processes of sense-making apparent in the scripts of the doctors, community nurse and counsellors who comprise this voluntary Forum. Those interviewed were highly sceptical of traditional medical approaches to dealing with survivors of such abuse, and they all questioned the effectiveness of expert professional knowledge. The research highlights the role of patient disclosure as a key mechanism in the process of their treatment, which is akin to the confessional technology discussed in detail in the work of Michel Foucault. Combined with other medical technologies patient disclosure is revealed as a technique of normalization. In this particular case the experts themselves were engaged in unravelling this process...