Health & Social Care in the Community最新文献

Family doctors serve as the initial contact for individuals seeking regular medical service like routine physical exam, diagnosis, and treatment of illness. Nonetheless, immigrant population who do not speak the official language usually prefers receiving healthcare in their own mother tongues. Past studies have focused on exploring accessibility to family doctors speaking Mandarin Chinese, which is not mutually intelligible with another major Chinese language called Cantonese. Despite the significant number of Cantonese-speaking population in the Greater Toronto Area (GTA) and a recent wave of immigration from Hong Kong, China (hereafter “Hong Kong”) to Canada, little knowledge has been obtained regarding the geographic accessibility to Cantonese-speaking family doctors. This study seeks to fill the knowledge gap of spatial accessibility to Cantonese-speaking family doctors in the GTA by using the two-step floating catchment area (2SFCA) method. By considering the vulnerability in terms of spatial accessibility and attractiveness to the new immigrants from Hong Kong, we have unveiled that more than 90% of neighbourhoods, with below-median accessibility scores across all five thresholds yet high likelihood of attracting new Hong Kong immigrants, are clustered within four lower-tier municipalities of Markham, Toronto, Richmond Hill, and Vaughan. This study not only sheds lights on the knowledge gap but also provides timely guidance in formulating public health policies in light of the incoming Cantonese-speaking immigrants from Hong Kong.

Postwar migrants from the Caribbean and Indian subcontinent (Bangladesh, India, and Pakistan) to the UK are now experiencing the onset of age-related diseases such as dementia. Our evidence base, both quantitative and qualitative, documenting the experiences of family caregivers of people with dementia is largely drawn from studies undertaken with white European, North American, and Australasian populations. Consequently, there is a need for research in the field of dementia caregiving to reflect the increasing diversity in ethnic identities of the older adult population of the UK. Using semistructured interviews, we investigated the experiences of 18 caregivers of people with dementia in Black Caribbean, Black African, and South Asian (Indian, Pakistani, and Bangladeshi) communities in England. Participants were recruited from the Join Dementia Research platform and were predominantly female intergenerational carers. We identified the following three themes: motivation to care (spending time with the care recipient and reciprocity), positive and negative consequences of caregiving (rewards and consequences), and the cultural context of caregiving (cultural norms and values supporting caregiving and negative attitudes towards dementia). Our findings develop existing literature by identifying (a) the importance of spending time with the person they care for, (b) the absence of faith as a caregiving driver, and (c) the challenge of watching the declining health of a parent. We highlight how the different motivations to care are intertwined and dynamic. This is illustrated by the linking of obligation and reciprocity in our dataset and positive and negative experiences of caregiving.

Despite increased incidence of stroke in young adulthood across the world, young adults report significant difficulties finding services with the expertise and experience to meet their needs. This service mapping study sought to identify and characterise the availability, accessibility, and accommodation of services to meet the needs of young adults (aged 18–44 years) with stroke in two Australian states. Methods. Relevant clinical, rehabilitation, and allied health services were systematically identified from previous publications; the National Health Service Directory; professional association “find a provider” listings; and Stroke Foundation service lists. Desktop audit (n = 465 services) and key informant interviews (n = 321 services) were used to collect service design and delivery characteristics; level of experience, confidence, and willingness to work with young adults with stroke; and accommodation of communication impairments. Results. Most services (85%) were in major cities or inner regional areas. No services worked solely with young adults with stroke; however, several reported having relevant expertise, training, experience, and programmes to provide neurological rehabilitation to meet the needs of young adults with stroke. Reported willingness (91.0%) to work with young adults with stroke was high, but only 57.0% were very confident to do so. Most services with neurorehabilitation expertise addressed psychosocial recovery needs (e.g., emotional adjustment and relationships) as well as functional recovery, but few supported return-to-driving, peer support, and sensory processing disturbances. Further gaps were the use of accessible communication materials in only 50.2% of services, and staff had completed communication training at only 60.4% of services. Conclusion. Findings highlight that while expert neurorehabilitation services exist, they are not sufficiently available, accessible, or accommodating of the needs of young adults with stroke. There remains a need to improve access to services where clinicians have the skills to meet the rehabilitation needs of young adults with stroke in Australia.

This article explores the experiences of Black newly qualified social workers and student social workers in England. Drawing on related studies that have begun to outline the challenges faced by Global Ethnic Majority social workers in the UK, the article highlights that this is both an important and under-researched area. The article provides a much-needed contribution to understanding the unique experiences of Black social workers through a thematic analysis of interviews with Black social workers, providing an opportunity for social work colleagues, managers, educators, and academics to understand the challenges and obstacles that these social workers face. The research reveals a dire situation in which Black social workers are hindered by racial stereotyping, discrimination, and invisibility. Black social worker voices also highlight suggestions for best practice and guidance for the social work sector about how to improve. By centering these underrepresented voices, this article provides an opportunity to acknowledge and begin to rectify the barriers and challenges that Black social workers face.

This study examined the associations between community social capital and self-reported oral health among older adults in urban China, as well as the moderating effect of household income and the mediating role of depressive symptoms in these associations. Data were obtained from a community survey conducted in 2020 in Tianjin and Shijiazhuang City, China; the final analytical sample comprised 776 adults aged 60 years and above. To test the proposed moderation and mediation models, the data were analysed using binary logistic regression models and a path analysis, respectively. The findings showed that cognitive social capital and social participation (i.e., an indicator of structural social capital) were significantly associated with self-reported oral health. Additionally, the results revealed that while income significantly moderated the association between cognitive social capital and self-reported oral health, depressive symptoms significantly mediated it. The findings not only highlight the crucial role of community social capital in promoting oral health in later life among low-income older adults but also provide important evidence for a psychosocial pathway between social capital and oral health. Given the impacts of income and depressive symptoms on the relationship between community social capital and oral health among older adults, future social policies and interventions to support oral health should target financially vulnerable older adults with poor psychological well-being.

Background. Permanent supportive housing (PSH) is an evidence-based solution to chronic homelessness. There are two common PSH models: place-based (PB) programs where clients live in one building with services provided onsite and scattered-site (SS) programs, which use community apartments coupled with mobile case management and support. Understanding the relative strengths and weaknesses of PB and SS is important for PSH planning and service delivery. This paper explores homeless service provider perspectives on these two models after the onset of the COVID-19 pandemic. Methods. Service providers (N = 37) from across 5 PSH agencies in Los Angeles that provided either PB or SS services during the pandemic participated in focus groups. Discussions were recorded, transcribed, and analyzed using template analysis, grounded theory, and inductive techniques. Results. Providers identified four major differences between PB and SS services: (1) challenges in finding placements; (2) managing relationships with landlords/property managers; (3) frequency of contact; and (4) community integration. Advantages of PB included ease of finding units, ease of managing relationships with landlords/property managers, greater ability to serve clients efficiently, more frequent client contact, and more community among residents. SS was seen to provide tenants with more opportunities to grow, live in healthier environments, and develop independence. During the pandemic, finding units for SS clients became more difficult, while differences between PB and SS related to frequency of contact and community integration became more attenuated. Conclusions. PB can be advantageous for clients with higher levels of acuity, whereas SS could be more appropriate for clients who are more stable and independent. PB programs are seen to have practical and logistical advantages, but some providers prefer SS services. Clients and providers should be matched to PSH configurations that best match their needs and preferences, and providers should be aware that public health emergencies may impact PB and SS settings differently.

Brief health and wellbeing conversations within the Third and Social Economy (TSE) sector (groups or organisations operating independently to family and government with social justice as the primary aim) could help to reduce health inequalities through increased access to disadvantaged populations. This study aimed to explore the acceptability of health and wellbeing conversations such as within the TSE, including their existence without specific training. A qualitative design was adopted, utilising semistructured, one-to-one interviews. Service providers (n = 15) and users (n = 5) across a variety of TSE settings including charities and religious settings were interviewed, most of whom had not received no specific training in initiating and engaging in health and wellbeing conversations. Reflexive thematic analysis was applied using Nvivo. Five themes were identified; TSE as an ecosystem of empowerment, an existing community-initiated style of health and wellbeing conversations, readiness to engage in brief health and wellbeing conversations, capabilities of TSE as determined by external factors, and apprehension towards health and wellbeing conversations. Generally, the safe and empowering TSE environment naturally fostered health and wellbeing conversations, mostly initiated by service users. The TSE shows a readiness to conduct health and wellbeing conversations through existing infrastructure, partnerships, expertise, and an ambition for social justice. Barriers include fear of worsening the situation such as damaging strong and trusting relationships with service users, safeguarding concerns, and the instability and uncertainty of funding within the TSE. Relevant recommendations in light of these findings are made, including that the TSE is appropriate for the conduct of health and wellbeing conversations, and funding would provide cost efficiencies for its delivery at scale. Specific training within the TSE should focus on actively initiating health and wellbeing conversations and addressing fears of adverse consequences.

Social prescribing link workers are recently introduced roles in English primary care. One of their intended functions is to support patients with conditions influenced by the wider, social determinants of health. Their main purpose is to connect people to community resources to meet their nonmedical needs. However, our research reveals that link workers provide not only connections but also what we have described as “holding” for individuals with complex needs, who lack informal networks of support or who are waiting to access services. We explore the concept of holding, its meaning and significance in this context, and consider its consequences. As part of a realist evaluation, we observed seven link workers in GP practices in England during focussed ethnographies over a 3-week period. We took field notes and interviewed 61 patients and 93 healthcare and voluntary sector professionals. Nine to twelve months later, we carried out follow-up interviews with forty-one patients, seven link workers, and a link worker manager. We identified four functions of holding: supporting patients waiting for services, sustaining patients as they prepare for change, reducing the emotional burden of primary healthcare professionals, and bearing witness to patients’ distress. Holding appears to be a vital but often overlooked aspect of social prescribing. Patients benefit from having a reliable and consistent person to support their emotional needs. However, similar to the impact of holding on other primary care professionals, there are unintended consequences: some link workers exceed their capacity, become overburdened, experience burnout, and leave their job. Recognizing the importance of holding and understanding its role in link workers’ primary care responsibilities are critical. If holding work is accepted as a role for link workers, providing training and support to them should be prioritised to ensure successful implementation and positive outcomes for patients, link workers, and primary healthcare staff.

Caring for an autistic child is fraught with various difficulties and may present unmet needs that could affect the overall well-being of caregivers and children themselves. Consequently, gaining insight into the unmet needs of these caregivers is imperative for the development of targeted and effective interventions to enhance their quality of life and improve their ability to care for their children. Using a descriptive qualitative research design, this study engaged 10 primary caregivers of autistic children in Ghana to understand their unmet needs. Data were collected through in-depth interviews and thematically analyzed. The analysis revealed the urgent need for financial support for primary caregivers, the availability of more special schools, and the services of trained professionals in the field of autism. Caregivers also called for the intensification of public education to help reorient the perspectives of the general population on the autism condition. Based on the findings, some recommendations for policy and practice were made. The implications of the findings for social work are also discussed.

Objectives. How geriatric care models impact the health-related behaviors of the elderly and the function of social support within this context. Methods. We conducted binary logistic regression and PSM-DID analyses using data from the China Tracking Survey of Factors Influencing Elderly Health (CLHLS) and the China Health and Aging Tracking Survey (CHARLS). Results. Compared to living alone, other aging models negatively affected health behaviors. In the living with family model, parental intergenerational support attenuated these effects, while children’s financial support reduced negative impacts on health-protective behaviors. In the institutional model, negative effects on health-hazardous behaviors were exacerbated by emotional and social support. Loneliness and a lack of self-worth were crucial pathways. Discussion. Governments should offer public services to alleviate the intergenerational support burden on older individuals and strengthen social support for them.