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Contents -- List of Figures -- Acknowledgements -- 1 Trust, Risk and Framing Contemporary Childhood -- News media and panics about threatened childhood and youth disorder -- From periodic panics to 'permanent' panicking: lessons from the literature -- Questions of trust and security -- Gaps in the literature -- 2 'Worthy' vs 'Unworthy' Children: Images of Childhood through Time -- The ambiguous child -- Worthy versus unworthy children: positioning the young today -- 3 Our Children and Other People's: Childhood in the Age of Distrust

Background: Rigorous evaluation of community based interventions is necessary to build the evidence base for maternal and child survival in developing countries. Randomised controlled trials may be the most reliable method of determining effectiveness of interventions, but they are unable to evaluate the impact of context and implementation, and explain how an outcome occurred. This thesis explores the outcome of a cluster randomised controlled trial using women's groups in Nepal. Intervention areas experienced a 30% reduction in neonatal mortality, and increases in good care behaviours. I describe how communities experienced the intervention and explore how the implementation process and community context affected the community response. Methods: I used qualitative research methods, purposefully sampling stakeholders from two intervention areas, and one control area. Photoelicitation was used, and research assistants conducted semi-structured interviews, group interviews, focus group discussions, and observations. Data were tape recorded, transcribed and translated into English. Data were analysed using framework and NVIVO qualitative analysis software. Data were also fed back to respondents to increase validity. Results: Themes emerging from the data revealed a lack of trust in local health facilities, plurality in care seeking during illness, and a positive attitude towards working with non governmental organisations. Women's groups created a learning forum for group members, and this knowledge was disseminated in communities. Strategies to address problems were of particular significance in enabling dissemination of information and enabling community participation. The intervention increased social networks and built community capacity. Discussion: The effect of context on the intervention is considered in order to assess the generalisability of the intervention. Potential mechanisms of effect are also discussed which help to explain the trial outcome. This thesis supports calls for the integration of concurrent process evaluations within randomised controlled trials, and contributes to the evidence for community-based interventions for maternal and newborn survival.

AbstractThis paper considers the problem of managing process improvement when resources are constrained. The paper develops a system dynamics model that formalizes the critical interaction between first‐ and second‐order improvements as options for governing production. Both first‐ and second‐order improvement are effective in boosting short‐term organizational performance, whereas only second‐order improvement builds sustainable capability. Analytical results characterize the optimal trade‐off between these options (working harder and working smarter). Simulation results show how pressuring the workforce to work harder can set off a vicious cycle of deteriorating process capability that squeezes out improvement activity. Results also highlight the key role of process capability as a form of organizational slack and demonstrate tipping points in the dynamics of process improvement. By moving from causal loops to a simulating model, this paper provides an example of how formal quantitative modeling can lead to important insights not discovered with causal loop diagramming alone. Copyright © 2012 System Dynamics Society.