Why men experiencing deep poverty in Montréal avoid using health and social services in times of crisis

Adaptation and qualitative evaluation of the BETTER intervention for chronic disease prevention and screening by public health nurses in low income neighbourhoods: views of community residents

BACKGROUND

The BETTER intervention is an effective comprehensive evidence-based program for chronic disease prevention and screening (CDPS) delivered by trained prevention practitioners (PPs), a new role in primary care. An adapted program, BETTER HEALTH, delivered by public health nurses as PPs for community residents in low income neighbourhoods, was recently shown to be effective in improving CDPS actions. To obtain a nuanced understanding about the CDPS needs of community residents and how the BETTER HEALTH intervention was perceived by residents, we studied how the intervention was adapted to a public health setting then conducted a post-visit qualitative evaluation by community residents through focus groups and interviews.

METHODS

We first used the ADAPT-ITT model to adapt BETTER for a public health setting in Ontario, Canada. For the post-PP visit qualitative evaluation, we asked community residents who had received a PP visit, about steps they had taken to improve their physical and mental health and the BETTER HEALTH intervention. For both phases, we conducted focus groups and interviews; transcripts were analyzed using the constant comparative method.

RESULTS

Thirty-eight community residents participated in either adaptation (n = 14, 64% female; average age 54 y) or evaluation (n = 24, 83% female; average age 60 y) phases. In both adaptation and evaluation, residents described significant challenges including poverty, social isolation, and daily stress, making chronic disease prevention a lower priority. Adaptation results indicated that residents valued learning about CDPS and would attend a confidential visit with a public health nurse who was viewed as trustworthy. Despite challenges, many recipients of BETTER HEALTH perceived they had achieved at least one personal CDPS goal post PP visit. Residents described key relational aspects of the visit including feeling valued, listened to and being understood by the PP. The PPs also provided practical suggestions to overcome barriers to meeting prevention goals.

CONCLUSIONS

Residents living in low income neighbourhoods faced daily stress that reduced their capacity to make preventive lifestyle changes. Key adapted features of BETTER HEALTH such as public health nurses as PPs were highly supported by residents. The intervention was perceived valuable for the community by providing access to disease prevention.

TRIAL REGISTRATION

#NCT03052959, 10/02/2017.

The Administrative Burden Framework: A New Horizon for Research and Practice in Social Work?

Social work is widely recognized as a human rights profession. The commitment to protect and advocate for social and economic rights has been incorporated into official definitions and codes of ethics of the profession globally, undergirding social work models and services. However, despite the overwhelming recognition of the importance of social work advocacy, a unified framework for research and practice has not been agreed upon, and new challenges to welfare states have somewhat contested the existing, primarily European advocacy framework built on the literature on take-up of social and economic rights. The purpose of this integrative context review is to introduce the administrative burden (AB) literature as a potential framework for meeting social work advocacy challenges by emphasizing a subjective viewpoint, a multifaceted understanding of the bureaucratic encounter, and the secondary effects of burden. The article concludes by identifying directions for future research and practice concerning the nexus between AB and social work.

The impact of novel and traditional food bank approaches on food insecurity: a longitudinal study in Ottawa, Canada

Background

Food insecurity is strongly associated with poor mental and physical health, especially with chronic diseases. Food banks have become the primary long-term solution to addressing food insecurity. Traditionally, food banks provide assistance in the form of pre-packed hampers based on the food supplies on hand, such that the food items often do not meet the recipients’ cultural, religious or medical requirements. Recently, new approaches have been implemented by food banks, including choice models of food selection, additional onsite programming, and integrating food banks within Community Resource Centres.

Methods

This study examined changes in food security and physical and mental health, at four time points over 18 months at eleven food banks in Ottawa, Ontario, Canada. The participants – people who accessed these food banks – were surveyed using the Household Food Security Survey Module (HFSSM) and the Short-Form Health Survey Version 2 (SF-12). Statistical analyses included: pairwise paired t-tests between the mean perceived physical and mental health scores across the four waves of data collection, and longitudinal mixed effects regression models to understand how food security changed over time.

Results

The majority of people who were food insecure at baseline remained food insecure at the 18-month follow-up, although there was a small downward trend in the proportion of people in the severely food insecure category. Conversely, there was a small but significant increase in the mean perceived mental health score at the 18-month follow-up compared to baseline. We found significant reductions in food insecurity for people who accessed food banks that offered a Choice model of food distribution and food banks that were integrated within Community Resource Centres.

Conclusions

Food banks offer some relief of food insecurity but they don’t eliminate the problem. In this study, reductions in food insecurity were associated with food banks that offered a Choice model and those that were integrated within a Community Resource Centre. There was a slight improvement in perceived mental health at the 18-month time point; however, moderately and severely food insecure participants still had much lower perceived mental health than the general population.

Service users' perspectives of social treatment in social service departments in Israel: Differences between standard and poverty-aware treatments

This article uses mixed methods to examine service user satisfaction with social work treatment in social services departments (SSDs) in Israel-its level, the factors that influence it and its experiential dimensions. A total of 235 service users (SUs) from 11 SSDs were interviewed for this study. They were divided into three groups: (a) SUs receiving standard treatment; (b) SUs participating in poverty-aware programs and (c) SUs receiving a poverty-aware standard treatment. The quantitative findings indicated a significant higher level of satisfaction among the SUs who had been included on poverty-aware programs or received a poverty-aware standard care compared to SUs who had received standard treatment. Additionally, high reported levels of satisfaction were influenced by the frequency of meetings between the service user and the social worker, while the history of care in the SSD had no apparent impact on satisfaction levels. The qualitative analysis indicated that high levels of satisfaction were linked to the service user perceiving the social worker as active, supportive and respectful, and as responsive to the user's emotional and material needs. These findings are discussed in the context of the Poverty-Aware Paradigm and relationship-based social work.

Transformative medical education: must community-based traineeship experiences be part of the curriculum? A qualitative study

BACKGROUND

There are shortcomings in medical practitioners' capacity to adapt to the particular needs of people experiencing circumstances of social vulnerability. Clinical traineeships create opportunities for the acquisition of knowledge, competencies, attitudes, and behaviors. However, some authors question the learnings to be made through classical clinical training pathways. This article explores the learnings gained from a traineeship experience within a community-based clinical setting intended for patients experiencing social vulnerability and operating under an alternative paradigm of care. To our knowledge, there is little research intended to identify and understand what medical trainees gain from their experience in such contexts.

METHODS

This exploratory qualitative study is based on twelve interviews with practicing physicians who completed a traineeship at La Maison Bleue (Montreal, Canada) and three interviews conducted with key informants involved in traineeship management. Based on Mezirow's theory of transformational learning, data were analyzed according to L'Écuyer's principles of qualitative content analysis. NVivo software was used.

RESULTS

The main learnings gained through the traineeship are related to (1) greater awareness of beliefs, assumptions and biases through prejudice deconstruction, cultural humility and critical reflection on own limitations, power and privileges; (2) the development of critical perspectives regarding the health care system; (3) a renewed vision of medical practice involving a less stigmatizing approach, advocacy, empowerment, interdisciplinarity and intersectorality; and (4) strengthened professional identity and future practice orientation including confirmation of interest for community-based practice, the identification of criteria for choosing a future practice setting, and commitment to becoming an actor of social change. Certain characteristics of the setting, the patients and the learner's individual profile are shown to be factors that promote these learnings.

CONCLUSIONS

This article highlights how a traineeship experience within a clinical setting intended for a clientele experiencing circumstances of social vulnerability and operating under an alternative paradigm presents an opportunity for transformative learning and health practice transformation toward renewed values of health equity and social justice. Our findings suggest medical traineeships in community-based clinical settings are a promising lead to foster the development of fundamental learnings that are conducive to acceptable and equitable care for people experiencing social vulnerability.

Unconnected and out-of-sight: identifying health care non-users with unmet needs

Background

While current debates on how to deliver sustainable health care recognise socio-economic dimensions to health service use, attention has focussed on how to reduce demand for services. However, the measures of demand may not account for a subgroup of the population who to date have remained out of sight because they do not access health services. This study aimed to describe the characteristics of individuals who self-reported having fair or poor health but did not use health services.

Methods

Data from the 2010 LINKIN health census survey (n = 7895) and the 2013 HILDA National Panel Survey (n = 13,609) were analysed focussing on the population who self-reported their overall health status as fair or poor. Simple and multivariable logistic regression modelling examined characteristics associated with a lack of health services use. The outcome measure of interest was no health service use in the previous 12 months and co-variables included demographic and socioeconomic indicators, health-related quality of life, having no health condition and health risk factors.

Results

Overall 21% of LINKIN respondents reported their overall health as fair or poor compared to 18% in the HILDA dataset. In LINKIN, 4.4% of those reporting fair or poor health, reported not using any health service provider in the past 12 months. Similarly, 4.5% of HILDA respondents were non-users. When adjusted for multiple co-variables, unemployment (aOR 3.24, 95% CI 1.28-8.17), educational level at Year 10 or below (aOR 1.94, 95% CI 1.02-3.70) and smoking (aOR 2.67, 95% CI 1.38-5.17) were significantly associated with non-use for the LINKIN data, as did lack of health conditions (aOR 0.18, 95% CI 0.08-0.41). The HILDA regression analyses indicated the same directions of association between equivalent variables and lack of health service use, with the exception of educational level.

Conclusions

In line with recent assertions on real denominators in health need, this study describes those people rarely included in the population at risk and the potential for systematic bias towards the overestimation of the effectiveness of interventions. This study informs current policy debates and planning, including how we connect with hard-to-reach populations and how this sub-group might be more appropriately included when measuring effectiveness of health policies and programs.

Multiple obstacles to psychological care from the viewpoint of addiction service users

Purpose

– The purpose of this paper is to explore addiction service users’ experiences of psychological interventions for depression symptoms, with an emphasis on understanding obstacles to engage with treatment.

Design/methodology/approach

– This was a thematic analysis of semi-structured interviews with ten people who took part in a randomised controlled trial of cognitive and behavioural interventions; four of whom never engaged with treatment.

Findings

– Five prominent obstacles to access therapy were: memory deficits, becoming overwhelmed by multiple demands and appointments, being housebound due to fluctuations in mental health problems, tendency to avoid the unfamiliar, and contextual life problems related to deprivation and social conflict.

Research limitations/implications

– The authors note some possible limitations related to overreliance on telephone interviews and interviewers’ field notes. The authors discuss the findings in light of epidemiological research, cognitive, behavioural and motivational enhancement theories.

Practical implications

– The authors propose it is important to recognise and address multiple obstacles to therapy. Offering therapy appointments that are co-located within addiction services and time-contingent to other social/medical interventions may help to address some of these obstacles.

Originality/value

– The present qualitative results complement the prior experimental research and enrich the understanding of how to maximise engagement with psychological interventions.

[The involvement of vulnerable people in participatory research in primary care: a literature review]

Malgré un vif intérêt pour la participation des patients à la gestion et à la prestation des soins de santé primaires, il n’existe aucune revue de la littérature sur le rôle des personnes vulnérables dans les projets de recherche participative menés dans le domaine des soins primaires. Une revue de la littérature de type narrative a été menée afin de combler cette lacune. L’objectif principal de cette revue a été d’évaluer le rôle des personnes vulnérables au sein de projets de recherche participative. Notre revue a recensé 26 articles et analysé 33 projets de recherche ou d’intervention en soins primaires. Elle révèle de nombreux écueils concernant l’implication des personnes vulnérables. Ces personnes ont joué un rôle varié, mais surtout modeste ou limité au sein des différents projets. Leur implication a surtout eu lieu à l’étape de la collecte des données. Peu de projets ont permis aux personnes vulnérables de prendre part à l’analyse des données ou à la diffusion des connaissances. Les tensions entre les chercheurs et les personnes vulnérables et la tendance à intégrer des acteurs organisés au sein des projets ont contribué à affaiblir le degré de participation des personnes vulnérables, et ce, à diverses étapes du processus de recherche et du développement d’intervention. Malgré tout, plusieurs retombées positives ont été identifiées, tant pour la communauté et les personnes vulnérables que pour les chercheurs. Entre autres, les projets ont permis aux chercheurs non universitaires d’acquérir de nouvelles compétences. De plus, certains projets ont favorisé la mise en place de nouveaux modèles de prestations de soins. Enfin, différents mécanismes permettant de rehausser la réciprocité entre les chercheurs et les personnes vulnérables sont proposés comme solutions pour réduire les inégalités et les tensions et, ultimement, favoriser l’implication des personnes vulnérables.

A systematic review of the factors associated with delays in medical and psychological help-seeking among men

Despite a growing literature on the factors associated with men's low rates of medical and psychological help-seeking, a systematic review of these is missing. Such an overview can help to inform health psychologists of the barriers to the performance of adaptive health behaviours, such as prompt help-seeking, and could inform theoretical advancements and the development of targeted interventions to facilitate prompt help-seeking among men. We systematically reviewed quantitative and qualitative empirical papers on factors associated with delays in men's medical and psychological help-seeking. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and we used the databases PsycINFO, Medline, Embase and PsycARTICLES (with keywords: men/male*/gender*, help*/seek* and health*/service*/utili*[sation]) for papers in English. 41 citations (amounting to 21,787 participants aged 15-80 + ) met the inclusion criteria. Approximately half of these used qualitative methodologies (i.e., semi-structured interviews and focus groups), while half used quantitative methodologies (i.e., questionnaires). We identify a number of recurring cognitive, emotional, health-service related and socio-demographic help-seeking factors/predictors from the 41 papers. Of these, the most prominent barriers to help-seeking were disinclination to express emotions/concerns about health, embarrassment, anxiety and fear, and poor communication with health-care professionals.