Dialogue with ACE Fellows and Interns

Mushin- the beginner’s mind

Types of questions Single system Values system Multi-minded system Evidence and reasoning within system Subjective preference Evidence and reasoning within multiple systems Correct or wrong answer Subjective opinion Better or worse answers Knowledge Hard to assess Judgment

Elements of Thought Point of view Purpose Question at issue Information Interpretation and inference Concepts Assumptions Implications and Consequences

Intellectual Traits Humility Integrity Autonomy Courage Perseverance Confidence in Reason Empathy Fairmindedness

Standards Clarity Accuracy Relevance Logic Breadth Precision Significance Completeness Fairness Depth

Egocentric and socio-centric thinking “It’s true because I believe it” – Innate egocentrism “It’s true because we believe it” – innate socio- centrism “It’s true because I want to believe it”-innate wish fulfillment “It’s true because I have always believed it”- Innate self-validation “It’s true because it is in my selfish interest to believe it –Innate selfishness

Ends drive means Through the lens of your shared vision, find the key constraint and the “tipping point” in a system. Ends Means

Evidence-based thinking and science of the day Science Problems Solutions X Y

What happens when the problem lies outside of the science of the day? Science Problems Solutions ? YY X

What happens when the problem lies outside of the science of the day? Science Problems Solutions ? YY X That’s difficult! That’s impossible! That’s beyond imagination!

Our best thinking got us here. The problems that we face cannot be solved by the same level of thinking that created them. Albert Einstein

We need to find solutions outside of the science of the day! Science Problems Solutions Y X

Science values intuition and imagination too! “Imagination is more important than knowledge.” Albert Einstein

Where do leaders operate? Science ten years from now Tomorrow’s science Today’s science Yesterday’s Science Problems Solutions XY

Evolution in “evidence-based thinking” Evidence-based Evidence informed Evidence nurturing

Our learning can have the following results Maintain your present levels of uncertainty Lower your present levels of uncertainty Increase your present levels of uncertainty Generate information space

Karl Popper We cannot “prove” a theory to be true. We can only show that it is false.

All swans are white. There are no black swans!

There are black swans in Australia and Tasmania!

Underlying Conditions Domains of Communication Initial Outcomes Environment Service Systems Community Individual Behavioral Outcomes Sustainable Health Outcomes Context Disease Burden Social Cultural Economic Communication Technology Political Legal Reduction in: Unintended/ mistimed pregnancies Morbidity/mortality from pregnancy/ childbirth Infant/child morbidity/mortality HIV transmission Threat of infectious diseases Resources Human and Financial Resources Strategic Plan/Health Priorities Other Development Programs Policies Supportive Environment Multi-sectoral partnerships Public opinion Institutional performance Resource access Media support Activity level Service Performance Access Quality Client volume Client satisfaction Client Behaviors Community Sanitation Hospice/PLWA Other actions Individual Timely service use Contraception Abstinence/partner reduction Condom use Safe delivery BF/nutrition Child care/immuniz. Bednet use Hand washing Political will Resource allocation Policy changes Institutional capacity building National coalition National comm strategy Availability Technical competence Information to client Interpersonal communication Follow-up of clients Integration of services Leadership Participation equity Information equity Priority consensus Network cohesion Ownership Social norms Collective efficacy Social capital Message recall Perceived social support/stigma Emotion and values Beliefs and attitudes Perceived risk Self-efficacy Health literacy Pathways Conceptual Framework -- Full version Social Political Environment Community action groups Media advocacy Opinion leader advocacy Organizational development Coalition building Service Delivery System Norms & standards Rewards & incentives Job/peer feedback Job aides Training in CPI Supportive settings Community outreach Internet portals Distance learning Community & Individual Participation in social change efforts Strengthening social networks Peer support groups Multimedia programs Enter-education Social marketing Household care Interactive media & internet