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Internet interventions have gained popularity and the idea is to use them to increase the availability of psychological treatment. Research suggests that internet interventions are effective for a number of psychological disorders with effect sizes comparable to those found in face-to-face treatment. However, when provided as an add-on to treatment as usual, internet interventions do not seem to provide additional benefit. Furthermore, adherence and dropout rates vary greatly between studies, limiting the generalizability of the findings. This underlines the need to further investigate differences between internet interventions, participating patients, and their usage of interventions. A stronger focus on the processes of change seems necessary to better understand the varying findings regarding outcome, adherence and dropout in internet interventions. Thus, the aim of this dissertation was to investigate change processes in internet interventions and the factors that impact treatment response. This could help to identify important variables that should be considered in research on internet interventions as well as in clinical settings that make use of internet interventions.
Study I (Chapter 5) investigated early change patterns in participants of an internet intervention targeting depression. Data from 409 participants were analyzed using Growth Mixture Modeling. Specifically a piecewise model was applied to model change from screening to registration (pretreatment) and early change (registration to week four of treatment). Three early change patterns were identified; two were characterized by improvement and one by deterioration. The patterns were predictive of treatment outcome. The results therefore indicated that early change should be closely monitored in internet interventions, as early change may be an important indicator of treatment outcome.
Study II (Chapter 6) picked up on the idea of analyzing change patterns in internet interventions and extended it by using the Muthen-Roy model to identify change-dropout patterns. A sligthly bigger sample of the dataset from Study I was analyzed (N = 483). Four change-dropout patterns emerged; high risk of dropout was associated with rapid improvement and deterioration. These findings indicate that clinicians should consider how dropout may depend on patient characteristics as well as symptom change, as dropout is associated with both deterioration and a good enough dosage of treatment.
Study III (Chapter 7) compared adherence and outcome in different participant groups and investigated the impact of adherence to treatment components on treatment outcome in an internet intervention targeting anxiety symptoms. 50 outpatient participants waiting for face- to-face treatment and 37 self-referred participants were compared regarding adherence to treatment components and outcome. In addition, outpatient participants were compared to a matched sample of outpatients, who had no access to the internet intervention during the waiting period. Adherence to treatment components was investigated as a predictor of treatment outcome. Results suggested that especially adherence may vary depending on participant group. Also using specific measures of adherence such as adherence to treatment components may be crucial to detect change mechanisms in internet interventions. Fostering adherence to treatment components in participants may increase the effectiveness of internet interventions.
Results of the three studies are discussed and general conclusions are drawn.
Implications for future research as well as their utility for clinical practice and decision- making are presented.
This working paper examines the concept of metabolism and its potential as a critical analytical lens to study the contemporary city from a political perspective. The paper illustrates how the metabolism concept has been used historically, both as a metaphor to describe the technological, social, political and economic dimensions of human-environment relations, and as a concrete analytical tool to quantify and better understand how flows of matter and energy shape the territorial and spatial configurations of cityscapes. Drawing on the example of the urban water metabolism of the Greater Accra Metropolitan Area (GAMA), it is argued that contemporary approaches to metabolic analysis should be extended in two ways to increase the integrative potential of the urban water metabolism concept. On the one hand, the paper demonstrates that a political ecology approach is particularly well-suited to illuminate the contested production of urban environments and move beyond a narrow technical, managerial and state- centric focus in research on urban metabolic relations. On the other hand, the paper advocates for an approach to metabolic analysis that views the urban environment not simply as a relatively static exteriority that is produced by dynamic flows of matter, energy and information, but rather as a dynamic, nested and co-evolutionary network of complex biosocial and material relations, which in itself shapes how various metabolisms interact across scales. The paper then concludes by briefly discussing how a combination of metabolic analysis and political ecology research can inform urban water governance. In sum, the paper emphasizes the need for metabolic analysis to remain open to a plurality of different knowledge forms and perspectives, and to remain attentive to the inherently political nature of material and technological phenomena in order to allow for mutually beneficial exchanges between various scholarly communities.
The impacts of intense urbanization and associated urban land-use change along coastlines is vast and unprecedented. Several coasts of the world have been be subjected to human-induced coastal changes and it is imperative to monitor, assess and quantify them. This paper provides the state-of-the-art discourses on the changing dynamics of urban land-use driven by the forces of urbanization. Drawing on extant literature mainly from Web of Science and Google scholar, the status quo of the spatio-temporal dynamics of urbanization and urban change processes were explored with specific focus on global, Africa, Ghana and an actual case of Accra coast. Findings show whilst urbanization continues to increase exponentially, urban land also continue to change markedly. Current trends and patterns shows that changing urban dynamics exhibit are distinctly different from that of the past. Particularly, the rate, magnitude, geographic location, urban forms and functions are changing. In the specific case of Accra coast, there is general trend of urbanization moving outwards, i.e. from the core city centre towards the peripheral areas. Additionally, spatial urban pattern is dominated by urban sprawl, characterized by the cyclical process of diffusion and coalescence. The processes of urbanization are further exacerbated within coastal areas with a new and unique spatial urban form, “tourism urbanization” emerging. This new urban form is largely driven by rapid expansion of tourist infrastructure, developing at the instance of government policy to develop coastal tourism. In addition, the coastal conurbation of Accra-Tema is a powerful hub for industrial and commercial activities, which is drawing huge “humanline” to- wards the coastline. The literature illustrates that contemporary approaches and conceptualizations for urbanization and urban land-use change analysis be extended particularly from the mere focus on statistical classifications of cities in different size categories. With the urban fringe spreading outwardly, it should be kept in mind that new forms of urban settlements are emerging along with varying sizes. Considering the multiple scales, magnitude and rates involved as well as the geospatial patterns of urban change processes, experimental case studies that include coastal cities, Peri-urban fringes and interconnections with rural areas across a range of urbanization processes is essential and very urgent.
The main socio-ecological pressures in five wetlands in the Greater Accra Region were first identified and then summarized by reviewing the relevant literature. As a second step, fieldwork in the region was carried out in 2016 to further examine the pressures identified in the literature. Most research on the wetlands in Ghana was published around the year 2000. Yet, similar socio-ecological pressures persist today. Based on both, fieldwork observations and the literature review, these pressures were ranked using the IUCN pressures system analysis framework. It is suggested that further research needs to proceed with uncovering how trade-offs between ecosystem and quality of life can be defined.
In a first step, this paper analyses the emergence of the UN Sustainable Development Goals (SDGs) as new global development framework with regard to key actors, social learning cycles, innovation platforms, fundamental policy changes and transition dynamics towards sustainability. In a second step, it traces the convolution of social, political and environmental dimensions, social power relations and governance paradigms embedded in the drafting process and final framework of the water related SDG 6. This research concludes that the SDGs induced important paradigm and policy changes in addition to rearranging existing power relations.
Stakeholder Mapping
(2016)
This report presents the results of a stakeholder mapping exercise carried out in the WaterPower project. The mapping was conducted for the following main research areas of the project: water supply, land use planning and management, wetland management and climate change adaptation/disaster risk reduction. The report gives an overview of the stakeholders that play a role in these respective areas and identifies those who have concomitant responsibilities in different sectors. It represents the first step towards further involvement of stakeholders in the WaterPower project.
In the first overview lecture, we take a look at conceptualizations of water – from the hydrological cycle to socio-political perspectives on water. During the 20th century, water management developed from traditional uses and local industrial schemes to the “hydraulic paradigm” and finally, to the concept of modern water governance at the turn of the millennium. We will raise the question of whether there has truly been a paradigm shift from the natural, science based hydraulic paradigm to water governance and how dual- isms of culture/society and nature are still being reproduced. With this in mind, we will also take an introductory look at the much talked about global water crisis.
GIS – what can and what can’t it say about social relations in adaptation to urban flood risk?
(2017)
Urban flooding cannot be avoided entirely and in all areas, particularly in coastal cities. Therefore adaptation to the growing risk is necessary. Geographical Information Systems (GIS) based knowledge on risk informs location-based approach to adaptation to climate risk. It allows managing city- wide coordination of adaptation measures, reducing adverse impacts of local strategies on neighbouring areas to the minimum. Quantitative assessments dominate GIS applications in flood risk management, for instance to demonstrate the distribution of people and assets in a flood prone area. Qualitative, participatory approaches to GIS are on the rise but have not been applied in the context of flooding yet. The overarching research question of this working paper is: what can GIS, and what can it not say about relationships / social relations in adaptation to urban flood risk? The use of GIS in risk mapping has exposed environmental injustices. Applications of GIS further allow model- ling future flood risk in function of demographic and land use changes, and combining it with decision support systems (DSS). While such GIS applications provide invaluable information for urban planners steering adaptation they however fall short on revealing the social relations that shape individual and household adaptation decisions. The relevance of networked social relations in adaptation to flood risk has been demonstrated in case studies, and extensively in the literature on organizational learning and adaptation to change. The purpose of this literature review is to identify the type of social relations that shape adaptive capacities towards urban flood risk which can- not be identified in a conventional GIS application.
Understanding the mechanisms that shape access to the fisheries ecosystem service in Tsokomey, Accra
(2019)
Questions of access to ecosystem services remain largely unaddressed. Yet, in the coming decades, addressing access to services and securing them for livelihoods and well-being of people will likely gain importance, especially to guide according policies at the local scale. Through a qualitative approach, this paper addresses the mechanisms that shape access to the fisheries eco- system service in Accra, Ghana. The analysis uses a framework that focuses on access to land, tools and technology, knowledge and information, capital and credit, as well as labor. This research reveals how access is organized across the different categories of this framework and how people’s well-being is shaped. Moreover, it helps to further our understanding of what regulates the access to ecosystem services and how to address future shocks and capacity in terms of production of ecosystem services.
The rate and range of ongoing changes in social and ecological systems and particularly the global environmental degradation illustrates the need of holistic and sustainable approaches for the governance of natural resources to ensure their well-functioning for future generations (Rockström et al. 2009). The narrative of common pool resources system such as SES of small-scale fisheries, reports world-wide of stock collapse, environmental degradation and overexploitation (Cinner et al. 2013). In order to understand the complexity of system interactions in those resource systems, the consideration of local scale specific phenomena is of great relevance (Ostrom 2007b). The focus of this thesis consequently is the social-ecological system of a small scale fishery in a heavily urbanised coastal wetland on the fringes of Ghana ́s capital Accra. With the theoretical foundation of the social-ecological system (SES) theory (Folke et al. 2004; Berkes et al. 2003; G. S. Cumming 2011) and the social-ecological system framework (SESF) by Ostrom (2007a) and McGinnis & Ostrom (2014) as analytical tool, the study ex- amines the role of the fishers as focal actor group and the governance system based on traditional ecological knowledge (TEK) (Berkes et al. 2003). While the common narrative of system collapse is partly confirmed for the focal system, also contradicting findings about the diversity of the actor group, their sustainable and responsible exploitation of the deltas resources have been found, that rather illustrate the fishers as potential cooperation partners for the development of sustainable governance strategies (see Hollup 2000) than simply as bur- den to the system. However, the results also show that in order to achieve sustainable outcomes in the focal SES, so far unsuccessful top-down governance efforts have to work cooperatively with the fishers to challenge the multiple threats to the system from external perturbation and internal changes, in the long run.