Health & Social Care in the Community最新文献

Fuel poverty was a significant problem during the cost-of-living crisis that started in 2021 as energy prices increased. Local authorities launched warm bank schemes around the United Kingdom to address this problem by providing warm spaces for residents to visit who could not heat their homes. This paper reports on an evaluation of the warm bank scheme launched by South Tyneside Council in winter 2022, locally known as Welcoming Places. Over 70 locations were opened around the borough. The evaluation consisted of two stages. In stage 1, we conducted semistructured interviews (n = 16) with residents who attended Welcoming Places and two focus groups with people running them (n = 9). In stage 2, we discussed the initial findings from stage 1 in a focus group with residents (n = 8). Three major themes are presented: “help and support with the cost-of-living crisis,” “it’s worth its weight in gold,” and “capability and strength of Welcoming Places.” This is one of the first evaluations of a warm bank scheme in England. We illustrate how the Welcoming Places in South Tyneside were used and experienced by residents. The scheme was valued by residents, provided significant support during the cost-of-living crisis, and had a positive impact on self-reported mental health among participants. Warm bank schemes offer a practical, rapid public health response to the cost-of-living crisis for local authorities as well as improving residents’ mental health and well-being; however, holistic approaches must be taken to address the underlying causes of fuel poverty.

Evidence indicates growing demand on community health and social care services by people with severe obesity (BMI ≥40 kg/m²), often due to functional limitations. The experiences of this population are largely unexplored. As part of a larger mixed-methods study, this qualitative study explored the lived experience of people with severe obesity using community health and social care services. Participants were recruited via community professionals and visited at home. They consented to individual, audio-recorded, semistructured interviews, which were transcribed and analysed using thematic analysis. Nine women and three men (n = 12) participated, aged 40–76 (mean 60) years, BMI ranged from 45 to 74 (mean 59) kg/m², and eight were housebound. Three overarching themes were identified. Firstly, the hidden struggles of living with a larger body affected all participants, including functional limitations affecting mobility and personal care. These contributed to a sense of being stuck physically, socially, and biographically. Secondly, most participants reported implicit weight bias by a system structurally unprepared to care for people with larger bodies. The majority of participants showed strong internalised weight bias, linked to shame and self-blame for their poor function and larger bodies. Thirdly, a day-to-day coping theme highlighted strategies regularly used by participants: resigned acceptance, avoidance and denial, exercising choice, and support from informal carers. These findings demonstrate that participants experienced unmet physical and psychological care needs associated with living with a larger body, leading to poor quality of care and life. Given rising prevalence, changes to care services are needed. Specific recommendations include staff training about the needs of people with severe obesity, ensuring that the physical infrastructure of care services can safely accommodate people with severe obesity, and improving access to effective, person-centred weight management treatments.

Throughout history, disability has been understood in different ways: as a curse, a biomedical condition, a societal/political problem, a minority identity, and a social and cultural construction. Disability understandings reflect society’s legislation and the character of social support for people with disability and vice versa. In this article, qualitative interviews with adults with cerebral palsy were analyzed with a focus on how care, as a fundamental need between people, might be mediated by implicit and explicit understandings of disability. The central focus lies in how historical paradigms of disability and caregiving are reflected in the lived experiences of adults with cerebral palsy. The findings were overall twofold. First, contemporary disability understandings do not substitute former understandings but coexist as superimposed practices of care. Second, new perspectives of disability and care emerged emphasizing equitable relationships, empowerment, and solidarity. It is discussed how premodern, modern, late modern, and postmodern understandings of disability shape the nature of care directed at people with disability in a Western welfare context and how practices of care can contribute to the advancement of social justice.

Permanent supportive housing (PSH) is the main approach advocated in Western countries for eradicating homelessness. Considering that PSH residents are not a homogeneous group and that their quality of life (QoL) and community integration (CI) might differ in this setting, improving our understanding of these residents’ profiles may help stakeholders formulate informed recommendations to improve PSH. This study identified PSH resident profiles based on their QoL, CI, and sociodemographic and clinical characteristics and associated these profiles with housing features and service use. A total of 308 PSH residents were recruited in Montreal (Canada) in 2020–2022. Structured interviews were conducted. PSH resident profiles were produced with cluster analysis and subsequently compared using chi-square, Fisher’s, and t-tests, taking into account housing features and service use. Three PSH resident profiles were found. Profile 1 residents (22% of the sample) had low QoL and CI, were younger, and had major social and health issues and unmet needs. Showing moderate QoL and CI, Profile 2 residents (27%) were more educated, had little foster care history, were older on their first homelessness episode, and had few co-occurring MD-SUD. Profile 3 residents (51%) had the best QoL and CI and mostly included men with little education, affected by co-occurring MD-SUD and satisfied with services. More intensive housing support and care coordination may be recommended for Profile 1 PSH residents in response to their diverse needs. Work integration may be beneficial to Profile 2 residents, with programs such as Individual Placement and Support, along with increased rehabilitation activities. A better integration of MD-SUD treatments may be promoted for Profile 3 residents. Considering most PSH residents had multiple health issues and unmet needs, satisfaction with care could be monitored better, as it was found to be a key variable in measuring care adequation.

Social participation in older age has been positively associated with enhanced health and wellbeing. This project examined key aspects of social participation for older people living in the community to identify what was most important for maintaining social participation in the event they transitioned to living in a nursing home. We conducted interviews and focus groups with 36 older people, aged 65 years or older living in the community in Victoria, Australia, between 2020 and 2022. Interview transcripts were analysed thematically. Participants discussed their understanding of the importance of social participation and what helped maintain it. Findings demonstrated the key importance of relationships, both old and new, in maintaining social participation, and to the preservation of a sense of identity. An important facilitator to maintaining relationships was having a physical place to go to interact. Barriers to social participation included diminishing social networks and life transitions. The impacts of the COVID-19 pandemic were commonly referred to by all participants, outlining the obvious impediments to maintaining relationships (e.g., social isolation associated with lockdowns) and how that affected social participation. Conversely, some participants outlined the positive impact the restrictions had on their connection with friends and family. These perspectives outline the importance of being able to maintain relationships through life transitions, like a pandemic or moving into a nursing home, to optimise opportunities for social participation. Findings from this study will be relevant for aged care providers as they implement services to optimise social participation for older people who transition to living in nursing homes.

Objective. Improving access to and utilization of healthcare services are necessary factors for improving the overall health of the ageing population. Accordingly, strategies to improve the access to health services should be considered. The aim of this review study was to identify, categorize, and synthesize the interventions suggested to improve access and utilization of health services by the ageing population. Methods. This scoping review was conducted based on the framework established by Arksey and O’Malley. To find relevant studies, searches were conducted in various databases such as Medline (PubMed), Scopus, Science Direct, and ProQuest, using appropriate keywords ranging from 2000 to 2022. The authors independently screened search results, extracted the data, and synthesized the data from the included studies. A framework analysis identified key interventions based on the framework established by the World Health Organization (WHO) in 2000. Results. Of the 8286 initially retrieved studies, only 79 were eligible for the final inclusion as they met the selection criteria. Results showed out of the 22 countries who have utilized some strategies the United States have implemented the most interventions (27 studies) , with service delivery enhancement being the most commonly area of action(23 items), followed by improvement in financing, stewardship, and creating recourse (12, 11, and 11 items, respectively) functions of health services. Conclusion. This scoping review compiled a range of interventions aimed at enhancing older adults’ access to and utilization of health services. While most of these interventions have been implemented in high-income countries, other nations can adapt their effective approaches to their unique contexts.

Prior to its introduction in Australia, many people opposed euthanasia—or voluntary assisted dying as it is known—because of its potentially detrimental impact on grief and bereavement outcomes for family members and carers. We examine the novel experiences of grief and bereavement of VAD for family members and carers who were going through, had gone through, or were contemplating VAD, juxtaposing the international literature on grief and bereavement. As such, 42 semistructured interviews with family members and carers were undertaken in the state of Victoria, which was the first jurisdiction to legislate in favour of VAD. Interviews explored many themes around end-of-life decision-making in order to ascertain the ways in which VAD helped or hindered grief and bereavement processes. A thematic analysis of the interview data was undertaken using QSR NVivo software. Four key themes were identified: values and meaning-making, expression of a continuing bond, anticipatory grief, and the burden of care associated with supporting loved ones going through VAD. These themes were juxtaposed with the key literature on grief and bereavement to demonstrate how VAD presents novel challenges for carers. We argue that while VAD deaths share similar characteristics to other deaths; in some respects, grief and bereavement outcomes for family members and carers are unique. For family members and carers helping a loved one go through VAD, they were able to derive a sense of meaning from fulfilling their wishes and striving for them to have a “good death”; they were able to maintain a bond with them through advocacy of VAD and unique rituals; and they were able to plan and prepare effectively by knowing the exact time of death. Family members and carers also noted that VAD presents some significant challenges for grief and bereavement, especially in terms of the impact of VAD on familial relationships and burdens associated with moral predicaments. Nonetheless, VAD was generally viewed positively by family members and carers, who expressed gratitude for mitigating their loved one’s suffering.

Alcohol is widely used in many cultures as part of everyday life and for special occasions. It is a leading cause of preventable death in the UK, with higher rates among socioeconomically disadvantaged people. Gypsies and Travellers are ethnic and cultural minorities who experience extreme social disadvantage but there is a lack of knowledge about their alcohol use. The study aim was to explore experiences of alcohol use and harm in these distinct groups. Taking a participatory research approach, peer researchers conducted semistructured interviews (n = 26) to explore experiences of alcohol use and harm within the following four Gypsy/Traveller communities: Irish Travellers, Boaters, Gypsies, and Slovakian Roma. Vignettes were used as a basis for interview questions. Data were analysed thematically following the framework model. Alcohol consumption was found to be fundamental to celebration in all groups and integrated within social norms. Among Gypsies, Irish Travellers and Roma, drinking was associated with masculinity and despite an increase in alcohol use among women, female drinking remains highly socially regulated. Gypsies and Irish Travellers reported being illegally excluded from public drinking venues, while Slovakian Roma experienced less discrimination towards their ethnic group in the UK. Knowledge of the risks of alcohol dependence was high in all groups, but there was little awareness of the health impact of regular heavy drinking. Shame was a barrier to help-seeking for Gypsy, Roma, and Irish Traveller men and women, while Boaters’ nomadism reduced access to both primary care and alcohol treatment services. These distinct ethnic and cultural groups are aware of the health and social risks of alcohol use but experience barriers to accessing healthcare. Each community has different needs in relation to prevention of alcohol dependence, highlighting the need for targeted health promotion to accompany national strategies to reduce alcohol harm.

Recently, baby healthcare monitoring systems have emerged as a key research area. However, numerous research studies have been conducted on babies and their state of either awakening or sleeping. But there is a lack of comprehensive and systematic review in this area of research. The existing research considers mostly the children’s monitoring vital health parameters, in turn, giving relaxation to the parents in caring of their babies. Still, the fundamental practical issues related to daily life are missing. As a result, the safety of babies against suffocation and falling hazards for employed parents or mothers involved in the workforce has been overlooked. Only a few studies exist that cover the age range of 0 months to 4 years, with further focus on the age range of 6 months to 4 years. In response to these gaps in previous research and existing technologies, this review work proposes a vision for a baby safety system that utilizes various sensors and technologies like machine learning and image processing to ensure a safer environment for babies.

Children with disabilities in out-of-home care (OOHC) are an overrepresented group in Australia, yet little is known about their circumstances, needs, and experiences within OOHC. Utilising a systematic scoping review methodology, we explored the state of knowledge about the experiences of children and young people with a disability in out-of-home care in Australia. Findings in this review speak to the unmet needs and challanges that children with disabilities face in child welfare systems and how systemic failures can lead to institutional pipelines of further maltreatment, adversity, and marginalisation. The review discusses the key themes in the literature, including (i) compounding trauma and placement failures, (ii) concerns of safety, stability, and neglect, (iii) limited control and choice, and (iv) disability and multisystem involvement.