Health & Social Care in the Community最新文献

Women experiencing homelessness may face heightened vulnerabilities and encounter barriers to accessing social services, which could perpetuate their situation and exacerbate the impact on their physical and mental health. This research aims to identify barriers and opportunities for women experiencing homelessness to access social care services based on a systematic integrative literature review. The inclusion criteria encompassed scientific articles and gray literature, focusing on studies of the access to social care services for women experiencing homelessness. English and Spanish documents from the past 20 years were considered, excluding publications lacking full-text access. The search was conducted until April 30, 2024, across 6 databases including Web of Science, Scopus, PsycINFO, Social Services Abstracts, Sociology, and Cochrane. Article quality was assessed before inclusion to mitigate bias. Data analysis employed a narrative approach using categories and subcategories. Thirty-eight publications were included, consisting of 36 articles and 2 theses. These publications predominantly relied on qualitative methods. Two main areas and eight categories emerged, covering structural, institutional, social, and personal barriers and opportunities, with 36 subcategories identified. Study limitations include a predominance of women in the study sample who had access to social care services, making it hard to include those experiencing hidden homelessness. Nonetheless, the research underscores the significance of gender-specific barriers and opportunities in access to social care. The need for gender-sensitive and intersectional policies is emphasized, as well as professional practices and training, to enhance the well-being of women experiencing homelessness and improve their access to services.

Introduction: Recent research has identified social capital as an essential element of social context that influences the healthy aging experience. Since social capital is a resource that is context and culture relative, this study builds on and extends the existing literature on social capital among older adults by investigating different dimensions of social capital in later life and related individual and environmental characteristics in the Chinese context.

Materials & Methods: Using the China Family Panel Study (CFPS) 2016 wave, 8097 individuals aged 60 years and older were included in the sample. Factor analysis was used to explore the dimensions that comprise the social capital of Chinese older adults. Multiple indicators, multiple cause (MIMIC) structural equation models were used to identify influential individual and environmental characteristics.

Results: The findings of this study showed that as an interaction between the actor and the multiple levels of the social environment, the social capital of Chinese older adults derived from three levels of social environment—family, community, and macro society. Rural older adults had higher levels of social capital across all three levels. While demographic factors and functioning, including female, age, marital status, education, and functional limitations, had a significant relationship with family-based social capital, having higher income and better self-rated health were related to higher level of community- and society-based social capital. Additionally, the physical community environment was a key determinant across all three levels of social capital.

Discussion and Conclusion: Findings from this study demonstrate the important roles of neighborhood environment in shaping older adults’ all levels of social capital. The findings also identified the unique role of family social capital and the need for policies and practices to reduce the vulnerability associated with a limited ability to adapt to the broader environment.

Background: Under a housing affordability crisis, Montreal, Canada, is host to a growing homeless population. While people who use drugs or alcohol make up a large part of this group, homeless resources in the city continue to exclude them through sobriety rules or by not adapting programming to their specific needs. This systematic exclusion, and the conditions of these resources, can often be retraumatizing for individuals seeking help. Applying a trauma-informed spaces of care framework, this research asks what are the needs of homeless individuals who use substances to exit homelessness? What are the current limits within homeless resources in Montreal to actualize these needs? How can they change to meet these needs?

Methods: In 2023, 30 semistructured interviews were conducted, with follow-up at 3 months, with individuals who use drugs or alcohol currently experiencing homelessness. Transcribed interviews were analyzed in Nvivo.

Results: Findings called for serious reforms to homeless service provision, with an emphasis on more forms of harm reduction-based programming, integrated occupational activities, improved psychosocial accompaniment, better division of service users, and alternative and adapted housing interventions for substance users. Most participants disclosed potentially traumatic life experiences, highlighting the need for trauma-informed programming.

Conclusion: Allowing individuals to articulate their needs and desires for programming demonstrates that this group recognizes the inadequacy of services and identifies the homeless resource as a site of potential traumatization. While the recommendations of people with living experience of homelessness and substance use articulate promising practices in substance use recovery, as well as homelessness service provision, homeless service providers are slow to adapt their programming accordingly.

The use of information and communication technologies (ICTs) has gained relevance since they are a tool for socialization around substance use and sex through the formation of social networks of gay men (GM). This study investigated how and why substance use is related to the use of ICT in GM. Moreover, what social and cultural dynamics characterize the use of ICTs concerning sexualized drug use in Mexican GM? In May 2022, focus groups were held in which 19 GM from Mexico participated. Different types of ICTs used by GM were identified as playing a role in online interactions around substance use and chemsex. It was found that specific platforms, such as mobile geolocation applications, favored access to sexual practices and drugs. In addition, online sexual subcultures destigmatized substance use and non-normative sexual practices and reinforced social ties, offering caring information about sexualized drug use practices among GM. The findings contribute to understanding the health of GM from a contemporary digital context.

Caregiving is a process affected by both caregiver and care recipients and contains both positive and negative experiences. However, there is a lack of theories that capture the impact of the progression of dementia on family caregiving. This study proposed and examined a dementia caregiver process two-factor (DCPT) model. Specifically, we explored (a) the relationship between the severity of caregiving stressors and caregiver psychological well-being, along with the mediating role of positive aspects of caregiving (PAC) and caregiving burden, and (b) the moderating role of stages of dementia. Data were obtained from a two-wave longitudinal data collected from 328 adult–child dementia caregivers in Hong Kong. Multiple group analysis was used to examine the proposed hypotheses. Results show that PAC and burden both significantly mediated the relationship between care recipients’ neuropsychiatric symptoms (NPS) and caregiver depressive symptoms and life satisfaction. Stages of dementia significantly moderated the relationship between PAC and caregiver depressive symptoms, with PAC associated with lesser depressive symptoms only among caregivers of those with middle- or late-stage dementia. In sum, the dementia caregiver process two-factor model proposed in this study was supported by our empirical data. This theory and the study results underscore the importance of both PAC and burden and capture the specificity of the caregiving process in different dementia stages. Findings in this study suggest the need to develop tailored interventions that can better accommodate caregivers with diverse characteristics and adapt to the entire disease trajectory.

With the aging population, the financial burdens associated with chronic diseases continue to escalate. Among various management strategies, family physician contracting stands out as a significant initiative aimed at addressing this challenge, officially introduced in China in 2016. However, current research has given relatively little attention to the economic benefits of family physician contracting in developing countries. This paper evaluates the economic effect of family physician contracting by employing microdata of patients with chronic diseases at the Yuyuantan Community Health Service Center, Haidian District, Beijing, from January 2019 to May 2021. This research contributes to the theoretical discourse in healthcare services by introducing a modified Anderson model. The empirical findings demonstrated that family physician contracting effectively reduced healthcare costs for patients with chronic diseases. Notably, the effect of family physician contracting on healthcare costs was more pronounced among patients with chronic diseases aged less than 65 years. At the same time, it is inferred that expediting the reform of the health insurance payment system, coupled with the promotion of family physician contracting services, would enhance the wellbeing of patients with chronic diseases. This research offers valuable insights into the ongoing and future development of family physician contracting in developing countries.

Background: There are 14,228 care homes in England with a population of approximately 372,035 residents, many of whom are living with frailty or multiple and complex comorbidities. Policy and international literature advocate that care homes provide high-quality person-centred care that meets each person’s specific needs. This study aims to provide an exploration of person-centred care in care homes in the South West of England from the perspective of all those involved.

Methods: A qualitative multiple case study design was used across seven care homes in a region of South West England. Semistructured interviews were conducted with 61 participants (residents, family and health and care professionals). Nonparticipant observations were undertaken in communal areas to understand the practices and cultures of the care homes. All data were analysed using reflexive thematic analysis.

Findings: The findings are presented as six themes, they are adjusting to the transition into a care home; people at the centre of care; the place we call home with the people we call family; working across the boundaries of care; supporting, valuing and empowering care home teams; and managing complex and challenging moments of care.

Conclusion: This study demonstrates a whole system understanding of person-centred care across seven care homes. The main components of person-centred care appear to be relational. These relationships take place in cultures and systems that are complex and challenging with care boundaries that need to be navigated. Navigating these care boundaries requires a people-centred care approach built on partnerships and mutual respect.

Background: Older adults under-report cybercrime, despite being more likely than younger people to experience repeat victimisation, financial loss and more severe emotional consequences. Considering vulnerabilities more common in old age, we sought to identify, and consider ways to address, barriers that older people experience when reporting cybercrime to statutory agencies with a role in reporting.

Methods: From community groups, police and victim support, and health and social care organisations, we purposively invited people aged 60+ who had experienced cybercrime (n = 16), their supporting family members (n = 2) and professional stakeholders (n = 15) to participate in semistructured in-person or virtual interviews and conducted a reflexive thematic analysis.

Results: Across 33 interviews, we identified four themes: (1) Shame and fear of repercussion; (2) Reporting unhelpful to emotional and financial recovery; (3) Lack of knowledge of scams and sources of support; and (4) Social support makes a difference.

Conclusions: Digital ageism, evidenced by structural barriers, stigma and disempowerment experienced by older adults deciding whether to report cybercrime, warrants attention from the FJN and authorities. Independent “advocates” such as health, social care and third sector professionals can support older victims of cybercrime to navigate such reporting challenges.

Communities of practice in health settings often serve to address contemporary public health issues by sharing knowledge and experiences about accelerating implementations and innovative solutions. Because there are gaps between the practical application of communities of practice and the scientific knowledge about their effectiveness, this realist synthesis aimed to identify how and why members of communities of practice translate the shared knowledge and apply it in their daily practice. In a six-step process, this realist synthesis included a scoping review that led to an initial theory map (Step 1), followed by searches (Step 2), appraisal (Step 3), extracts and organisation (Step 4), and analysis and synthesis (Step 5). These steps organised the literature into context–mechanism–outcome configurations that guided the development of a realist framework that can support research and practice (Step 6). We identified three key ways in which knowledge translation may occur: (1) Members bring (new) knowledge to their parent organisation; (2) members change the (daily) practice in their parent organisation; and (3) members improve health outcomes through systemic changes. We found that an initial outcome of knowledge sharing within the community of practice is conditional to achieving outcomes of knowledge translation outside the community of practice. This knowledge sharing within the community of practice is more likely to occur in a structured and trusted environment where members feel safe, as well as where members recognise individual and organisational benefits from participation. To achieve knowledge translation outside the community of practice, support from the parent organisation becomes important, alongside learning and developing confidence to implement the knowledge. The synthesis of the different contexts that potentially trigger mechanisms that lead to desired outcomes provides insight into how best to inform community of practice initiators and facilitators about supporting effective public health responses.

Safety net organizations in rural regions face structural barriers to providing services. Organizations that serve rural Latino communities may face additional barriers related to restrictive immigration policies and anti-immigrant climates. This study examines the impacts of restrictive immigration policies on safety net organizations that provide critical services to Latinos in rural areas to elucidate the mechanisms by which immigration policies influence Latino health. We conducted a qualitative analysis of 20 in-depth interviews with safety net organizations providing legal, nutritional, healthcare, labor, educational, and advocacy services to Latinos in rural California. Rural Latino-serving safety net organizations face immigration-related funding restrictions and anti-immigrant climates. Under restrictive immigration policies, rural safety net organizations are forced to extend beyond their organizational missions to circumvent immigration-related funding restrictions and address anti-immigrant climates to deliver their services. Staff working in these organizations are at the frontlines of anti-immigrant climates and experienced an emotional toll from their work. States should address anti-immigrant climates and increase funding to support organizations who serve Latinos in rural regions. To ensure that rural safety net organizations meet their mission, immigration-related eligibility requirements from safety net services should be removed. In addition, funders should allocate resources towards mental health services to address the impacts of anti-immigrant climates on staff who serve in rural Latino communities.