Exploring the role-based challenges of providing culturally inclusive health care for maternal and child health nurses: Qualitative findings

Aims

To explore how maternal and child health nurses (MCHNs) working in a specific regionally located service perceive and experience delivering health care to a diverse population.

Design

Qualitative exploratory study.

Methods

Qualitative interviews were conducted with MCHNs (N = 6) working in a particular regionally located service. Data were selectively coded, categorized and interpreted through a process of argument writing influenced by poststructuralist thought and Foucauldian conceptualizations of power.

Results

The data analysed were interpreted into the following categories: (a) system-level expectations of the maternal and child health role; (b) what these system-level expectations mean for the role and practice of MCHNs; and (c) what MCHNs themselves report prioritizing in their work. The analysis suggests that a substantial hindrance to the development and support of culturally safe, inclusive and quality maternal and child health care lies in the very ways contemporary health institutions seek to discipline the routine practices of MCHNs.

Using a historical genealogical approach to examine Ireland's health care system

The health of a nation tells much about the nature of a social contract between citizen and state. The way that health care is organised, and the degree to which it is equitably accessible, constitutes a manifestation of the effects of moments and events in that country's history. Research around health inequalities often focuses on demonstrating current conditions, with little attention paid to how the conditions of inequality have been achieved and sustained. This article presents a novel approach to inequalities research that focuses on examining powerful historical discourses as legitimising processes that serve to sustain unequal conditions. The use of this Foucauldian historical genealogical approach in a study of the Irish health care system is explored and proposed as a novel approach to the research of health inequities.

An exploratory study into social and healthcare variables of maternal mortality: a case-control study

Background Regarding the important role the mothers' health plays in shaping nations' well-being, this study endeavored to explore the main social and healthcare factors related to maternal mortality. Methods In this case-control study, data (viz., all maternal mortalities) were gathered from the national maternal mortality surveillance system. Likewise, control data (viz., alive mothers) were obtained from mother health records in 22 health centers located in 21 cities of Isfahan, Iran. The data were related to the years 2001-2016. Case and control groups were matched according to year of delivery, mother's age at delivery time and city of residence. Results Analysis of the gathered data revealed that during the years 2001-2016, 171 maternal mortalities occurred in Isfahan. In view of that, 523 mothers were selected as the control group. Most of the mothers attended high school (36%), were housewives (64%), delivered by cesarean section (59%) and suffered from different kinds of proximate medical causes (55%). The logistic regression results showed that being an immigrant, having a history of proximate medical cause, vaginal delivery and illiteracy raised the odds ratios (ORs) of maternal mortality up to 5.87, 4.41, 2.28 and 1.84 times, respectively. In contrast, using public antenatal care and planned pregnancy have had a protective, significant effect on maternal mortality (ORs <1). Conclusion The results suggested that in addition to social factors including immigrant status and low level of education which led to the increase of maternal mortality, healthcare factors including proximate medical causes, delivery method and antenatal care seem to be essential in tackling the issue of maternal mortality.

Recruiting African American Children for Research: An Ecological Systems Theory Approach

With health disparities still pervasive and persistent in the United States, medical researchers and social scientists continue to develop recruitment strategies to increase the inclusion of racial/ethnic minority groups in research and interventions. Effective methods for recruiting samples of African American participants for pediatric research may be best understood when situated within an overarching conceptual model-one that serves to organize and explain effective recruitment strategies. A theoretical framework well suited for this purpose is Bronfenbrenner's ecological systems theory, which views individuals as influencing and being influenced by (both directly and indirectly) a series of interconnected social systems. Based on the ecological systems theory and on previous research from multiple domains (e.g., medicine, psychology, public health, social work), in the current article, we review strategies for effective recruitment of African American children and adolescents for research.

Health inequalities as a foundation for embodying knowledge within public health teaching: a qualitative study

INTRODUCTION

Recent U.K. health policies identified nurses as key contributors to the social justice agenda of reducing health inequalities, on the assumption that all nurses understand and wish to contribute to public health. Following this policy shift, public health content within pre-registration nursing curricula increased. However, public health nurse educators (PHNEs) had various backgrounds, and some had limited formal public health training, or involvement in or understanding of policy required to contribute effectively to it. Their knowledge of this subject, their understanding and interpretation of how it could be taught, was not fully understood.

METHODOLOGY

This research aimed to understand how public health nurse educators' professional knowledge could be conceptualised and to develop a substantive theory of their knowledge of teaching public health, using a qualitative data analysis approach. Qualitative in-depth semi-structured interviews (n=26) were conducted with eleven university-based PHNEs.

RESULTS

Integrating public health into all aspects of life was seen as central to the knowing and teaching of public health; this was conceptualised as 'embodying knowledge'. Participants identified the meaning of embodying knowledge for teaching public health as: (a) possessing a wider vision of health; (b) reflecting and learning from experience; and (c) engaging in appropriate pedagogical practices.

CONCLUSION

The concept of public health can mean different things to different people. The variations of meaning ascribed to public health reflect the various backgrounds from which the public health workforce is drawn. The analysis indicates that PHNEs are embodying knowledge for teaching through critical pedagogy, which involves them engaging in transformative, interpretive and integrative processes to refashion public health concepts; this requires PHNEs who possess a vision of what to teach, know how to teach, and are able to learn from experience. Their vision of public health is influenced by social justice principles in that health inequalities, socioeconomic determinants of health, epidemiology, and policy and politics are seen as essential areas of the public health curriculum. They believe in forms of teaching that achieve social transformation at individual, behavioural and societal levels, while also enabling learners to recognise their capacity to effect change.

The social paediatrics initiative: a RICHER model of primary health care for at risk children and their families

BACKGROUND

The Responsive Interdisciplinary Child-Community Health Education and Research (RICHER) initiative is an intersectoral and interdisciplinary community outreach primary health care (PHC) model. It is being undertaken in partnership with community based organizations in order to address identified gaps in the continuum of health services delivery for 'at risk' children and their families. As part of a larger study, this paper reports on whether the RICHER initiative is associated with increased: 1) access to health care for children and families with multiple forms of disadvantage and 2) patient-reported empowerment. This study provides the first examination of a model of delivering PHC, using a Social Paediatrics approach.

METHODS

This was a mixed-methods study, using quantitative and qualitative approaches; it was undertaken in partnership with the community, both organizations and individual providers. Descriptive statistics, including logistic regression of patient survey data (n=86) and thematic analyses of patient interview data (n=7) were analyzed to examine the association between patient experiences with the RICHER initiative and parent-reported empowerment.

RESULTS

Respondents found communication with the provider clear, that the provider explained any test results in a way they could understand, and that the provider was compassionate and respectful. Analysis of the survey and in-depth interview data provide evidence that interpersonal communication, particularly the provider's interpersonal style (e.g., being treated as an equal), was very important. Even after controlling for parents' education and ethnicity, the provider's interpersonal style remained positively associated with parent-reported empowerment (p<0.01).

CONCLUSIONS

This model of PHC delivery is unique in its purposeful and required partnerships between health care providers and community members. This study provides beginning evidence that RICHER can better meet the health and health care needs of people, especially those who are vulnerable due to multiple intersecting social determinants of health. Positive interpersonal communication from providers can play a key role in facilitating situations where individuals have an opportunity to experience success in managing their and their family's health.

Applying Bourdieu's theory to accounts of living with multimorbidity

OBJECTIVES

Chronic illness is well researched. Broadly, empirical enquiry has focused on either determinants of behaviors or exploring lived experiences. This paper attempts to advance understandings of the lived experience of multimorbidity in broader cultural and structural settings.

METHODS

Twenty-three people in their early 50s were recruited from a community health survey in Scotland. The participants had 4 or more chronic illnesses and were interviewed twice. Key concepts of Bourdieu were applied to the data set

RESULTS

The analysis presented here is organized around 4 sections: 1) Habitus, capitals and the ill body; 2) Relational positioning; 3) Illness and symbolic violence; 4) The GP as dispenser of capitals. Applying Bourdieu's theory to the accounts highlighted how broader cultural structures worked their way into personal illness narratives and illustrated how living with multimorbidity is a dialectic of structure and agency.

DISCUSSION

Interventions and support for those with multimorbidity need to take into account the tensions of opposing habitus underpinning medical encounters and the ongoing negotiation of structure and agency which is integral to living with chronic illness and underpins illness actions such as help-seeking and self-managing.

Understanding the gender aspects of tuberculosis: a narrative analysis of the lived experiences of women with TB in slums of Delhi, India

There have been few ethnographic studies on gender aspects of tuberculosis (TB). In this article, drawing on a qualitative study on TB in Delhi slums and through an intersectional analysis of group interviews and personal narratives of women living with TB, I bring forth the "genderization" of TB and the associated sufferings for women. With my findings I demonstrate how gender, in conjunction with other social forces, influences the disease outcomes and stigmatizes women, how lives in slums are uniquely organized by multiple discourses that contribute to the gender makings of TB, and, finally, how women strategize to reduce their burden of illness.

Cultural competence in occupational therapists working in early intervention therapy programs

BACKGROUND

Cultural competence promotes equity in health care outcomes and ensures that occupational therapists support clients in culturally relevant daily activities. However, it is unclear to what extent occupational therapists in early intervention therapy (EIT) settings practise cultural competence.

PURPOSE

To explore how occupational therapists working in EITsettings work towards cultural competence in practice.

METHODS

Qualitative methods in the ethnographic tradition were used to explore five occupational therapists' experiences of working with culturally diverse clients.

FINDINGS

Four major themes emerged from the data: (1) learning about culture; (2) applying cultural knowledge; (3) reflecting on culture; (4) family-centred partnerships. The first three themes occurred as a dynamic learning process within the context of family-centred partnerships. The findings corresponded with existing models; however, discussions lacked critical examination of power relationships. Implications. Occupational therapists could develop cultural competence further by engaging in reflexive practice and taking actions to promote equity in healthcare outcomes.

Conceptualising social exclusion and lesbian, gay, bisexual, and transgender people: the implications for promoting equity in nursing policy and practice

Since the early 1980s, there has been increasing recognition that the health of individuals and communities is affected by social disadvantage. Following the election of the New Labour Government in 1997, social exclusion became a key concept in UK policymaking. Social exclusion approaches consider health outcomes to be linked to living and working conditions rather than, primarily, to healthcare interventions. Social exclusion is thus an important concept for nursing scholarship for understanding how people’s life circumstances may have an impact on their health. This paper analyses some of the theoretical underpinnings which may lead to recognition of the concept of lesbian, gay, bisexual and trans (LGBT) social exclusion. The paper goes on to propose a model of the multidimensional aspects of lesbian, gay, bisexual and trans social exclusion drawing on research evidence of the social, political and global inequalities experienced by lesbian, gay, bisexual and trans people. In conclusion, it considers the implications for promoting health equity in nursing policy and practice.

Social paediatrics: creating organisational processes and practices to foster health care access for children ‘at risk’

In recent years understanding and addressing child health inequities has become a priority for research and practice. In this paper we share research insights on an approach that shows promise for engaging across the spectrum of health services to foster access to services and supports for child development to reduce child health inequities. As pathways of influence on children’s health and development extend beyond the biomedical domain new approaches to practice are needed to foster health care access and to mobilise needed supports. The Social Paediatrics Initiative has been introduced in one of Canada’s poorest inner city neighbourhoods where a disproportionate number of children experience adverse childhood events and enter school developmentally delayed. The research was undertaken in partnership with practitioners, community based organisations and the formal health services sector. The study gathered data from parents, community members and clinicians to understand the range of conditions that interfere with access to health care and to illustrate the ways the Social Paediatrics Initiative sought to foster access and provide care that was responsive to the health and developmental needs of children at risk because of their social and material circumstances. In particular we illustrate ways in which intersectoral and interdisciplinary partnerships enabled clinicians to provide needed supports to address the social determinants of health.

Inequities in health and healthcare viewed through the ethical lens of critical social justice: contextual knowledge for the global priorities ahead

The authors use the backdrop of the Healthy People 2010 initiative to contribute to a discussion encompassing social justice from local to national to global contexts. Drawing on findings from their programs of research, they explore the concept of critical social justice as a powerful ethical lens through which to view inequities in health and in healthcare access. They examine the kind of knowledge needed to move toward the ideal of social justice and point to strategies for engaging in dialogue about knowledge and actions to promote more equitable health and healthcare from local to global levels.