Health & Social Care in the Community最新文献

Background. In 2020, figures estimated that 39 million preschool children worldwide, experienced overweight or obesity. Global prevalence has almost tripled in the last 40–50 years. The number of preschool children impacted makes it severe enough to be one of the most serious public health challenges for the 21st century, which could be addressed during infancy, for improved short- and long-term health outcomes. Objective. Research in a local Trust providing health visiting services in the northeast of England aimed to describe and interpret the interaction between UK parents and health visitors around infant weight (0–2) in delivering the UK Healthy Child Programme. Methods. The research paradigm was social construction, and interpretative phenomenology enabled the interpretation of experiences of self and everyday situational encounters or participants lived experiences. The research applied theoretical perspectives of hermeneutic phenomenology and symbolic interactionism. Purposive sampling recruited 14 parents and 20 health visitors, and 4 focus groups and 8 semistructured interviews were completed. Data analysis was thematic. Findings. Interaction between health visitors and parents around infant weight was complex. Assumptions were made, and the interaction was open to misinterpretation. This impacted the integrity of the conversation. Managing infant weight was superseded by other public health needs of parents. There was no obvious approach to assessment of infant weight that might be exceeding normal growth centiles, whole family approaches, or risk assessment. Infant weight remained an emotive subject for parents and health visitors, and this governed how it was addressed. Conclusion. While existing research has emphasised that infant weight is a sensitive issue to raise with parents, this research is unique, providing detailed implications for UK health visitors and recommendations for future management of infant weight within the UK Healthy Child Programme. Findings are transferrable to other public health professionals communicating with infants and parents in the management of infant weight.

Pressure on healthcare systems to address growing population needs is forcing services to adapt, which includes supporting acute patients in the community. One emerging service in the United Kingdom that offers this level of treatment is “Hospital at Home” (HaH). Self-management support is an area of particular importance in this context considering that acute treatment is provided in a community setting with limited input and monitoring by healthcare professionals. There is currently limited understanding about the range of formal and informal support and resources needed and accessed by patients in such circumstances, and whether and how HaH professionals engage with the everyday contexts and the network members of patients. Semistructured interviews were conducted with nurses (n = 9) from a single Hospital at Home site to further understand their experiences of providing acute treatments in the context of patients’ homes; and how self-management and social network support roles are perceived. Thematic analysis was used and four themes were identified: The value of prioritising illness work at home within a discourse of person-centered care; the work involved in the “naturally” therapeutic environment of the home; partners as key members of the informal care team; limited awareness and engagement with (in)formal networks. Findings demonstrate tensions between discourses where nurses idealise the value of the home and a holistic service provision, while in practice prioritising illness (over relational, emotional, and practical) work and delivering a service that is routinised, and time- and cost-efficient. Nurses recognise the positive role of network members for illness management in the context of people’s everyday life, but awareness and engagement are limited to partners and the formal services that HaH staffs are familiar with. Developing a better understanding of the role of social networks (SNs) in supporting people with acute needs at home can help improve patient experiences and care and HaH services, especially for people who are vulnerable, with complex needs, living alone, and with limited access to resources.

Introduction. Social prescribing (SP) is an integrated care program aimed to improve individuals’ health and wellbeing. Understanding the influence of SP and determining best practices and processes are challenging due to variability in its delivery, implementation, and intervention characteristics between different studies and countries. This study aimed to identify the intervention characteristics, mechanisms, and outcomes associated with SP research and explore how these factors relate to the influence of SP on health and wellbeing, healthcare utilization, and care experiences. Method. A comprehensive search was conducted in twelve databases, Google Scholar, and reference lists of relevant studies published from January 2010 up to April 2023. Searches were limited to literature written in English or Dutch. We utilized ASReview, an open-source machine learning tool, to conduct title and abstract screening. The methodological quality of the included studies was assessed using the Mixed Methods Appraisal Tool, and the risk of bias was evaluated using the Cochrane RoB2 and the ROBINS-I. We coded all intervention characteristics, mechanisms, and relevant outcomes. Quantitative data were visually presented using Harvest Plots, and qualitative data were narratively summarized. Results and Discussion. In total, 49 papers were included, of which seven qualitative, seventeen quantitative, and 25 mixed method studies. The findings highlight the importance of social-related mechanisms, including loneliness and social connectedness, in contributing to the observed positive influence of SP on mental health and wellbeing. The observed outcomes seem to be influenced by various characteristics, including gender, age, the presence of a link worker, and the use of behavior change techniques. However, we should be cautious when interpreting these results due to limitations in study designs, such as the lack of controlled trials and statistical considerations. Further rigorous research is needed to comprehensively understand the impact and potential benefits of SP.

Objective. To elicit the barriers and facilitators experienced by social prescribing service providers when designing and delivering social prescribing services to support adult mental health. Design. Semistructured interviews were conducted with social prescribing service providers across England and Wales in the third sector. Data were analysed in accordance with the Theoretical Domains Framework (TDF) and Thematic Framework Analysis (TFA). Results. Twenty-one providers (15 females and 6 males) from 17 social prescribing services agreed to participate. Nine analytical themes were identified across seven TDF domains associated with the design of services (e.g., skills and environmental context and resources). Thirteen analytical themes across nine TDF domains were associated with the delivery of services (e.g., beliefs about consequences and optimism). Key recommendations for future social prescribing services were increasing public knowledge of social prescribing; clearly communicating the role of a social prescriber to the public and professionals; providing training to providers on how to safely and effectively lived experiences; adopting a person-centred approach, including use of person-centred measures of mental health and well-being; and strategies to address sustainability of social prescribing services. Conclusions. Service providers are an essential part of the design and delivery of social prescribing services. Person-centred care, sustainable funding, and improved knowledge of social prescribing all warrant further research. Sustainable funding for social prescribing remains a salient policy-level barrier.

This study employs a qualitative methodology to investigate the implications of Romanian women’s migration to Italy for employment in the domestic care sector. The research is based on in-depth interviews conducted face to face with 20 Romanian women who have resided in Italy for over a decade, with the aim of capturing the details of their long-term integration processes. These interviews, conducted in 2022, specifically focus on the participants’ lived experiences of migration and adaptation within the Italian context. Findings reveal that economic motivations are a primary driver intertwined with aspirations for personal and familial advancement. However, the research also highlights the challenges faced by these women, including precarious employment conditions, emotional strain due to family separation, and complexities of integration within the host society. Social networks and transnational ties emerge as crucial factors influencing both the decision to migrate and the subsequent adaptation process. The analysis underscores the duality inherent in care work migration: While it bolsters the Italian care economy and offers economic opportunities for the migrants, it simultaneously exposes them to vulnerabilities such as job insecurity and potential exploitation. By investigating this migration of care workers, the research contributes to the field of welfare economics by clarifying the economic ramifications of gendered occupational segregation and migration status. Furthermore, it advocates for implementing inclusive labour market practices and policies that prioritize the well-being of migrant care workers and facilitate their successful integration into host societies.

Health and social needs exist along a dynamic continuum. Recognising that health status is inextricably impacted by social determinants of health, community paramedicine has opportunities and a responsibility to reduce inequities. The objective of this scoping review was to investigate the peer-reviewed and grey literature to explore how community paramedicine supports community needs along a health and social continuum. We conducted a scoping review of the English language literature using the JBI Scoping Review methodology. We searched CINAHL, EMBASE, MEDLINE, Google Scholar, and organisational websites. 30 peer-reviewed and 13 grey literature articles met the inclusion criteria. The findings describe the ways community paramedicine models evolved from minimising system pressures on emergency health services to addressing health and social needs. A key recommendation across the literature was the need to meaningfully engage communities early in the program development to understand how best to implement and codesign integrated service models addressing specific community needs although there was a lack of evidence to guide this approach. There is a notable lack of evidence pertaining to optimising technologies in the program design and implementation. The results highlight opportunities to determine the best practices for conducting holistic community needs assessments that include equitable stakeholder engagement and enhancing education to prepare paramedics for expanded roles. Community paramedicine provides opportunities to better meet the needs of structurally marginalised communities. There is a social responsibility and opportunity to engage communities to codesign service delivery, advance paramedic education, and enhance interprofessional collaboration to better support community needs and generate upstream solutions for individuals and communities.

There is widespread and growing support and requirement for researchers and larger organisations to collaborate with communities. This ensures that social, educational, or health programmes are relevant and acceptable and address the needs of groups that experience inequity. There is limited research about the processes and approaches that impact successful collaboration. The aim of this study was to identify the best-practice processes used to develop and sustain collaborative partnerships between community members and formal organisations in Aotearoa New Zealand. Using a qualitative case study methodology and guidance from our community advisory group, we selected three effective collaborations with groups that experienced inequity in Aotearoa New Zealand. We examined these by reviewing their publicly available documents and conducting focus group discussions and interviews with key stakeholders. We coded and analysed transcriptions thematically to develop case study summaries of findings and then conducted cross-case analysis to identify themes inherent in the data. Seven themes emerged from the data: (1) work together under Te Tiriti to ensure that collaborations are built on the articles of this founding document of Aotearoa New Zealand; (2) start before the beginning by forming strong relationships with diverse and representative community members; (3) walk the talk by using critically reflexive processes built on shared values and equal power relations; (4) use pencils not pens to implement ensuring an iterative project process; (5) recognise all contributions and especially the value of lived experience and local knowledge; (6) journey at a pace that allows all to participate; and (7) listen twice, talk once to give priority to hearing quieter voices. These seven practices can be utilised by other collaborative initiatives to increase genuine and power-shared participation. These participatory processes can make sure that collaborative projects respect local knowledge, indigenous culture, and respond iteratively to community needs.

A pervasive barrier to preventing, reducing, and ending homelessness is the stigmatization of and discrimination towards persons experiencing homelessness (PEH), termed “homeism.” To date, there has been no systematic review of the experiences and outcomes of stigmatization and discrimination among PEH or interventions to reduce this discrimination. To fill this gap in the literature, we conducted a scoping review to identify the ways in which PEH have been stigmatized and discriminated against, the results of these experiences, and interventions that have been used to reduce stigma and discrimination. We reviewed results from 12 databases with no date restrictions; 205 studies met our inclusion criteria. Thematic data analyses resulted in the identification of 12 categories. Using community consultation, the scoping review themes were reviewed and validated with 25 PEH or service providers in the homelessness sector and their feedback integrated into our results. Thematic categories included discrimination and stigmatization in healthcare, social services, workplaces and employment, and public spaces by the general public; discrimination and stigmatization from landlords, police and security guards, informal social networks, and by PEH toward PEH; discrimination and stigmatization linked to intersectional domains; PEH feelings about discrimination and stigmatization; outcomes of discrimination and stigmatization for PEH; and interventions to reduce stigma, discrimination, and prejudice towards PEH. Based on findings from this review, we argue that homeism serves as a social determinant of health as PEH confront multiple barriers to housing, income security, and healthcare due to interpersonal, institutional, structural, and intrapersonal stigmatization and discrimination.

Background. Clinical reasoning is a crucial process for healthcare professionals, involving both intuitive and analytical components. Intuition, which can be defined as immediate and context-sensitive thoughts, would play an important role in the clinical reasoning of occupational therapists (OTs). However, understanding of how OTs use their intuition remains limited. Thus, this study aimed to better understand the place of intuition in the clinical decision-making of OTs in a real-life context. Methods. Adopting a constructivist epistemological stance, this qualitative multiple-case study involved four OTs. For each OT, data were collected through a video-recorded clinical session and a subsequent explicitation interview. Conversational analysis of the video data and inductive thematic analysis of the interviews were conducted. Results. The OTs, with 2 to 34 years of experience, demonstrated a nuanced use of intuition in their clinical reasoning. Experienced OTs relied more heavily on intuitive reasoning, seamlessly integrating it into their analytical approach, while novice therapists alternated between the two modes, giving equal importance to both. Key themes highlighted the central role of practice context, professional experience, the therapeutic relationship, and emotional management in the expression of intuition. Conclusion. The study highlights the decisive influence of the practice context whether routine or unusual, on the expression of OTs’ intuition. Additionally, the findings underscore the regulatory role of the clinicians’ emotions and the importance of empathic management of the clients’ emotional aspects, which shape the intuitive reasoning processes.

Family-focussed practice is an important component of mental health care. In Australia, service users’ views about their experience of service are collected using instruments such as the Your Experience of Service (YES) survey. This study examined 10,579 Queensland (Australia) service users’ experiences of mental health services during 2019–2021, with a particular focus on their perspectives of how family and carers are involved in their care. The study examined if family-focussed practice is welcomed by service users and if it is important in terms of predicting recovery-related outcomes (e.g., hopefulness, managing day-to-day life, well-being, and experience of care) and which demographics (e.g., age, gender, and Indigenous status) and service characteristics (e.g., time in service, duration, year of service, and setting type) are associated with these outcomes and with family member involvement. A substantial majority of service users reported a positive experience of care (very good or excellent), feeling they had opportunities for family involvement and that their opinions about family involvement were respected (usually or always). Chi-square tests and nonlinear regression models showed that family involvement predicts care outcomes. Specifically, where individuals felt that their perspectives were recognised, their outcomes were consistently rated as more positive. The results also revealed that setting, age group, time in service, and admission status were significantly correlated with all user experience outcome variables and family-oriented variables. Future research has the potential to further strengthen this understanding of service users’ preferred opportunities and opinions about family involvement and how to improve family engagement and better meet the needs of service users and their families.