To examine patients' experiences of fairness and commitment in the health care context with an emphasis on primary care providers.
Qualitative, semistructured, individual interviews were used to gather evidence for the justice and commitment frameworks across a variety of settings with an emphasis on primary care relationships.
Rural, urban, and semiurban communities in Nova Scotia.
Patients (ages ranged from 19 to 80 years) with varying health care needs and views on their health care providers.
Participants were recruited through a variety of means, including posters in practice settings and communication with administrative staff in clinics. Individual interviews were conducted and were audiotaped and transcribed verbatim. A modified grounded theory approach was used to interpret the data.
Current conceptualizations of justice (distributive, procedural, interpersonal, informational) and commitment (affective, normative, continuance) capture important elements of patient-health care provider interactions and relationships.
Justice and commitment frameworks developed in other contexts encompass important dimensions of the patient-health care provider relationship with some exceptions. For example, commonly understood subcomponents of justice (eg, procedural consistency) might require modification to apply fully to patient-health care provider relationships. Moreover, the results suggest that factors outside the patient-health care provider dyad (eg, familial connections) might also influence the patient's commitment to his or her health care provider.
This article reviews evolution of the recovery paradigm in Canadian mental health. We first trace the origins and development of the recovery concept through the literature, followed by an examination of how the recovery concept has been implemented in national and provincial mental health policy since publication of the 2006 Kirby Commission Report. Based on consultations with Canadian policymakers, and an examination of available policy documents, we explore how the dual theme of 'recovery' and 'well-being', adopted by the Mental Health Commission of Canada in its 2009 strategy: Toward Recovery and Well-being - A Framework For a Mental Health Strategy has subsequently played out in mental health policymaking at the provincial level. Findings reveal mixed support for recovery as a guiding principle for mental health reform in Canada. While policies in some provinces reflect widespread support for recovery, and strong identification with the aspirations of the consumer movement; other provinces have shifted to population-based, wellness paradigms that privilege evidence-based services and professional expertise. The recognition of social equality for people who experience mental illness emerges as an important value in Canadian mental health policy, cutting across the conceptual divide between recovery and well-being.
Drawing on self-prediction theory and the positive benefits of increasing health service user participation in risk assessments, the Transition Inventory (TI) was developed. It is an aid to the assessment of areas that people anticipate will be of difficulty in the next stage of transition, for example from open hospital to the community.
The aim of this paper is to determine reliability and convergent/discriminant validity data for the TI and its subscales, including behavioral impulsivity, social pressure, substance misuse, financial/employment, leisure, negative affect, interpersonal and family concerns and social alienation.
Eighty-eight male offenders coming towards the end of a period of imprisonment were asked to complete the TI. Their results were compared with the staff-rated Measures of Criminal Attitudes and Associates (MCAA) scale, alcohol blame and causation of crime items. Comparisons with the MCAA's antisocial intent scale, which is a future-orientated scale, and the associates scale allowed for convergent/discriminant validity to be examined with TI scales. With a community offender sample, TI results were used to predict researcher ratings.
The TI scales demonstrated adequate internal consistency. Overall, the MCAA's antisocial intent scale had higher correlations with the TI than with a nonfuture-orientated scale. TI scales also demonstrated convergent validity with other measures and preliminary predictive validity with researcher ratings.
The TI provides a way to increase service user involvement in the assessments that determine when and how they transfer to settings where they will have more independence.
Agency and communion are fundamental human motives, often conceptualized as being in tension. This study examines the notion that moral exemplars overcome this tension and adaptively integrate these 2 motives within their personality. Participants were 25 moral exemplars-recipients of a national award for extraordinary volunteerism-and 25 demographically matched comparison participants. Each participant responded to a life review interview and provided a list of personal strivings, which were coded for themes of agency and communion; interviews were also coded for the relationship between agency and communion. Results consistently indicated that exemplars not only had both more agency and communion than did comparison participants but were also more likely to integrate these themes within their personality. Consistent with our claim that enlightened self-interest is driving this phenomenon, this effect was evident only when agency and communion were conceptualized in terms of promoting interests (of the self and others, respectively) and not in terms of psychological distance (from others) and only when the interaction was observed with a person approach and not with the traditional variable approach. After providing a conceptual replication of these results using different measures elicited in different contexts and relying on different coding procedures, we addressed and dismissed various alternative explanations, including chance co-occurrence and generalized complexity. These results provide the first reliable evidence of the integration of motives of agency and communion in moral personality.
Non-Western cleaners have been shown to have poorer health than their Danish colleagues. One reason could be a poorer psychosocial work environment. However, it is unknown if differences in self-reported psychosocial work environment exist between non-Western and Danish workers within the same social class. The aim of this study was to investigate such differences among cleaners with the hypothesis that the non-Western compared with Danish cleaners would report a generally poorer psychosocial work environment.
Two hundred and eighty-five cleaners (148 Danes and 137 non-Western immigrants) from 9 workplaces in Denmark participated in this cross-sectional study. The cleaners' immigrant status was tested for association with psychosocial work environment scales from the short version of the Copenhagen Psychosocial Questionnaire (COPSOQ) using ordinal logistic regression.
Models adjusted for age, sex, BMI, smoking, workplace, and perceived physical work exertion showed that non-Western cleaners compared with Danish cleaners reported significantly higher scores with regard to Predictability (OR = 3.97), Recognition (OR = 1.92), Quality of Leadership (OR = 1.81), Trust Regarding Management (OR = 1.72), and Justice (OR = 2.14).
This study showed that non-Western immigrant cleaners reported a statistically significantly better psychosocial work environment than Danish cleaners on a number of scales. Therefore, the hypothesis of non-Western immigrants reporting worse psychosocial work environment than their Danish colleagues was not supported.
The three issues of gender equality, human rights and cultural diversity have dominated my organizational commitments, research, and clinical practice in transcultural psychiatry. These issues are intertwined in many ways and have broad implications for transcultural psychiatry. With increasing globalization, psychiatrists in many countries are likely to be treating patients who have migrated from different cultures and who may have been exposed to a variety of traumatic experiences that have a profound impact on their mental health. Of particular concern is the group of torture survivors and the elucidation of their symptom manifestations, as well as effective therapeutic interventions, which clearly show how human rights issues are linked to research and clinical psychiatry. The analyses of how different ethnic groups use psychiatric services, epitomize how important it is to pay attention to gender aspects in the interpretation of the findings and their therapeutic, as well as policy, implications.
Disparities in dental health care that characterize poor populations are well known. Children suffer disproportionately and most severely from dental diseases. Many countries have school-based dental therapist programs to meet children's primary oral health care needs. Although dental therapists in the United States face opposition from national and state dental associations, many state governments are considering funding the training and deployment of dental therapists to care for underserved populations. Dental therapists care for American Indians/Alaska Natives in Alaska, and Minnesota became the first state to legislate dental therapist training. Children should receive priority preference; therefore, the most effective and economical utilization of dental therapists will be as salaried employees in school-based programs, beginning in underserved rural areas and inner cities.
In early welfare states, social rights predominantly derived from formal employment relations. Within the past two decades, however, some European countries have opened these social institutions to care work also. Cash-for-care and social entitlements for periods of at-home family caregiving have changed the characteristics of informal care work that family members traditionally provide to older relatives. Formerly based on unpaid kinship relations, it has changed towards new paid and more formalized forms of care work by family members. But it can be assumed that long-term care work by family members is constructed differently across welfare states. The paper is guided by the following research question: How do welfare-state policies differ in the degree to which their policies towards family care for senior citizens create social risks for the caring family members? We use the conceptual framework of "family care regimes" as our analytical framework for the comparative research. To do this, we compare care policies towards older care-needy people in the welfare states of the Netherlands, Germany and Denmark. The findings show that a common feature in all three countries is that the situation of family carers is to some degree being formalized: in all three countries a frail senior citizen can chose a family member as the care provider, and the welfare states support the family care providers. Still, the legal situation as well as the quality and level of social rights for family caregivers differ considerably among the three countries. It is shown that the institutional framework for senior care by family members in Germany and the Netherlands represents a family care regime that supports semi-formal family care, and that in Denmark it can be classified as a family care regime that supports formal family care. We show that these different types of family care regimes differ considerably in the social risks they pose to family carers.
The National Strategy defines the main directions and objectives of public policy in the interests of children and the key mechanisms for its implementation. The strategy is based on the universally recognized principles and norms of international law. Implementation of the National Strategy will be realized in the following areas: Family Child Welfare Policy, availability to quality education and training, cultural development, and information security of children, child-friendly health care, and healthy lifestyle; equal opportunities for children in need of special care of the State, the creation of protection and safeguarding the rights and interests of children and child-friendly justice, and children - members of the realization of National Strategy. School health care is intended to be actively involved in two directions: availability to quality education and training, cultural development, and information security of children, health care, child-friendly and healthy lifestyle. The main tasks in the part of hygiene and children's health are: state support for the construction of new preschool educational institutions and the development of all forms of safe preschool education, including non-state sector, providing for every upperclassman safe choice of training profile corresponding to his inclinations and life plans, as well as the functional possibilities and health state; providing quality psychological, correctional and pedagogical aid to children in educational institutions; renewal of forms and methods of control of child neglect, drug addiction, alcoholism, crime, prostitution; the development of effective mechanisms in prevention of deviant behavior in childhood; the creation and implementation of training programs for children and adolescents on rules of safety behavior in the World Wide Web, prevention of Internet addiction; the introduction of the system for monitoring of the educational environment; the creation of portals and sites accumulating the information about best resources for children and parents. Creation child-friendly health care is provided by: improvement of the regulatory and legal framework in the area of the healthcare of children, the development of technologies for complex diagnosis and early medical and social care for children with deviations in development and health, development of adolescent medicine, creation of the Youth Counselling Centres, centers for reproductive health care for adolescents and centers for medical and social care for adolescents; implementation of educational work on the prevention of early pregnancies and abortions in minors; support for successfully realized projects for creation friendly to children and young people clinics in the regions; restoring medical offices in educational institutions, the encouragement of responsibility of health staff in medical institutions in delivery of health care to children, available developed network of institutions, including telephone emergency services, counseling online, providing help to children and adolescents to will protect children in hardship. Availability of physical culture and sports, tourism infrastructure for all children with bearing in mind their individual needs, increasing the proportion of children and adolescents regularly engaged in physical culture and sport, will meet natural biological move requirements of children.
Assess the impact of heavy drinking on homicide and suicide mortality in Russia between 1956 and 2002. MEASURES AND DESIGN: Alcohol-related mortality was used as a proxy for heavy drinking. We used autoregressive integrated moving average techniques to model total and sex-specific alcohol-homicide and alcohol-suicide relationships at the population level.
We found a positive and significant contemporaneous association between alcohol and homicide and between alcohol and suicide. We found no evidence of lagged relationships. These results held for overall and sex-specific associations.
Our results lend convergent validity to the alcohol-suicide link in Russia found by Nemtsov and to the alcohol-homicide associations found in cross-sectional analyses of Russia. Levels of alcohol consumption, homicide and suicide in Russia are among the highest in the world, and the mounting evidence of the damaging effects of consumption on the social fabric of the country reveals the need for intervention at multiple levels.
Disparities in health status between American Indians and other groups in the United States have persisted throughout the 500 years since Europeans arrived in the Americas. Colonists, traders, missionaries, soldiers, physicians, and government officials have struggled to explain these disparities, invoking a wide range of possible causes. American Indians joined these debates, often suggesting different explanations. Europeans and Americans also struggled to respond to the disparities, sometimes working to relieve them, sometimes taking advantage of the ill health of American Indians. Economic and political interests have always affected both explanations of health disparities and responses to them, influencing which explanations were emphasized and which interventions were pursued. Tensions also appear in ongoing debates about the contributions of genetic and socioeconomic forces to the pervasive health disparities. Understanding how these economic and political forces have operated historically can explain both the persistence of the health disparities and the controversies that surround them.
Institute of Work, Health & Organisations, University of Nottingham, 8 William Lee Buildings, Nottingham Science and Technology Park, University Boulevard, Nottingham NG7 2RQ, UK. firstname.lastname@example.org
Prior studies on social capital and health have assessed social capital in residential neighbourhoods and communities, but the question whether the concept should also be applicable in workplaces has been raised. The present study reports on the psychometric properties of an 8-item measure of social capital at work.
Data were derived from the Finnish Public Sector Study (N = 48,592) collected in 2000-2002. Based on face validity, an expert unfamiliar with the data selected 8 questionnaire items from the available items for a scale of social capital. Reliability analysis included tests of internal consistency, item-total correlations, and within-unit (interrater) agreement by rwg index. The associations with theoretically related and unrelated constructs were examined to assess convergent and divergent validity (construct validity). Criterion-related validity was explored with respect to self-rated health using multilevel logistic regression models. The effects of individual level and work unit level social capital were modelled on self-rated health.
The internal consistency of the scale was good (Cronbach's alpha = 0.88). The rwg index was 0.88, which indicates a significant within-unit agreement. The scale was associated with, but not redundant to, conceptually close constructs such as procedural justice, job control, and effort-reward imbalance. Its associations with conceptually more distant concepts, such as trait anxiety and magnitude of change in work, were weaker. In multilevel models, significantly elevated age adjusted odds ratios (ORs) of poor self-rated health (OR = 2.42, 95% confidence interval (CI): 2.24-2.61 for the women and OR = 2.99, 95% CI: 2.56-3.50 for the men) were observed for the employees in the lowest vs. highest quartile of individual level social capital. In addition, low social capital at the work unit level was associated with a higher likelihood of poor self-rated health.
Psychometric techniques show our 8-item measure of social capital to be a valid tool reflecting the construct and displaying the postulated links with other variables.
Cites: J Epidemiol Community Health. 2003 Feb;57(2):114-912540686
Cites: Philos Trans R Soc Lond B Biol Sci. 2004 Sep 29;359(1449):1435-4615347534
Cites: Health Policy Plan. 2002 Mar;17(1):106-1111861592
Cites: Int J Epidemiol. 2004 Aug;33(4):667-71; discussion 700-415282226
Cites: Int J Epidemiol. 2004 Aug;33(4):682-90; discussion 700-415282222
Cites: Int J Epidemiol. 2004 Aug;33(4):650-6715282219
Cites: Health Policy. 2004 Oct;70(1):11-2215312706
Most pharmaceutical research carried out today is focused on the treatment and management of the lifestyle diseases of the developed world. Diseases that affect mainly poor people are neglected in research advancements in treatment because they cannot generate large financial returns on research and development costs. Benefit sharing arrangements for the use of indigenous resources and genetic research could only marginally address this gap in research and development in diseases that affect the poor. Benefit sharing as a strategy is conceptually problematic, even if one, as we do, agrees that impoverished indigenous communities should not be exploited and that they should be assisted in improving their living conditions. The accepted concept of intellectual property protection envisages clearly defined originators and owners of knowledge, whereas the concept of community membership is fluid and indigenous knowledge is, by its very nature, open, with the originator(s) lost in the mists of time. The delineation of 'community' presents serious conceptual and practical difficulties as few communities form discrete, easily discernable groups, and most have problematic leadership structures. Benefit sharing is no substitute for governments' responsibility to uplift impoverished communities. Benefit sharing arrangements may be fraught with difficulties but considerations of respect and equity demand that prior informed consent and consultation around commercialisation of knowledge take place with the source community and their government.
Despite injustice at the workplace being a potential source of sleep problems, longitudinal evidence remains scarce. We examined whether changes in perceived organizational justice predicted changes in insomnia symptoms.
Data on 24 287 Finnish public sector employees (82% women), from three consecutive survey waves between 2000 and 2012, were treated as 'pseudo-trials'. Thus, the analysis of unfavourable changes in organizational justice included participants without insomnia symptoms in Waves 1 and 2, with high organizational justice in Wave 1 and high or low justice in Wave 2 (N = 6307). In the analyses of favourable changes in justice, participants had insomnia symptoms in Waves 1 and 2, low justice in Wave 1 and high or low justice in Wave 2 (N = 2903). In both analyses, the outcome was insomnia symptoms in Wave 3. We used generalized estimating equation models to analyse the data.
After adjusting for social and health-related covariates in Wave 1, unfavourable changes in relational organizational justice (i.e. fairness of managerial behaviours) were associated with increased odds of developing insomnia symptoms [odds ratio = 1.15; 95% confidence interval (CI) 1.02-1.30]. A favourable change in relational organizational justice was associated with lower odds of persistent insomnia symptoms (odds ratio = 0.83; 95% CI 0.71-0.96). Changes in procedural justice (i.e. the fairness of decision-making procedures) were not associated with insomnia symptoms.
These data suggest that changes in perceived relational justice may affect employees' sleep quality. Decreases in the fairness of managerial behaviours were linked to increases in insomnia symptoms, whereas rises in fairness were associated with reduced insomnia symptoms.
This study examined the relationship between potential childhood risk factors and social phobia in an epidemiological sample. Identifying risk factors such as childhood adversities can often uncover important clues as to the aetiology of a disorder. This information also enables health care providers to predict which individuals are most likely to develop the disorder.
Data came from the Mental Health Supplement to the Ontario Health Survey of a survey of 8116 Canadian respondents, aged 15-64. Social phobia was diagnosed using the Composite International Diagnostic Interview (CIDI). Childhood risk factors were assessed by a series of standardized questions.
A positive relationship was observed between social phobia and lack of close relationship with an adult, not being first born (in males only), marital conflict in the family of origin, parental history of mental disorder, moving more than three times as a child, juvenile justice and child welfare involvement, running away from home, childhood physical and sexual abuse, failing a grade, requirement of special education before age 9 and dropping out of high school. Many of these variables remained significant after controlling for phobias, major depressive disorder and alcohol abuse. The data also suggest that some childhood risk factors may interact with gender to influence the development of social phobia.
Although an association was detected between social phobia and childhood risk factors, naturalistic prospective studies are needed to clarify the aetiological importance of these and other potential risk factors for the disorder.
During the past several years, budget cuts have forced hospitals in several countries to change the way they deliver care. Gilson (Gilson, L. (1998).
In defence and pursuit of equity. Social Science & Medicine, 47(12), 1891-1896) has argued that, while health reforms are designed to improve efficiency, they have considerable potential to harm equity in the delivery of health care services. It is essential to monitor the impact of health reforms, not only to ensure the balance between equity and efficiency, but also to determine the effect of reforms on such things as access to care and the quality of care delivered. This paper proposes a framework for monitoring these and other indicators that may be affected by health care reform. Application of this framework is illustrated with data from Winnipeg, Manitoba, Canada. Despite the closure of almost 24% of the hospital beds in Winnipeg between 1992 and 1996, access to care and quality of care remained generally unchanged. Improvements in efficiency occurred without harming the equitable delivery of health care services. Given our increasing understanding of the weak links between health care and health, improving efficiency within the health care system may actually be a prerequisite for addressing equity issues in health.
An overview of the role that social determinants of health play in influencing health is provided. Emphasis is on the impact of economic inequality in creating health inequities among Americans. Economic inequality is seen as impacting health in three ways: increasing economic inequality weakens population health by creating poverty; weakening communal social structures that support health such as social and health services; and decreasing social cohesion and civil commitment. Documentation is provided of the growing degree of economic inequality in the USA and complicating issues of racial segregation are considered. Specific recommendations for addressing economic inequality, from USA, British, and Canadian sources, are presented. These recommendations indicate the need to move from epidemiologic research to public health action, from demonstrating the major impact of economic inequality on community health to the development and implementation of specific policies and programs to reverse the continuing increase in economic inequality.
Swedish welfare has for decades served as a role model for universalistic welfare. When the economic recession hit Swedish economy in the beginning of the 1990s, a period of more than 50 years of continuous expansion and reforms in the welfare sector came to an end. Summing up the past decade, we can see that the economic downturn enforced rationing measures in most parts of the welfare state, although most of this took place in the beginning of the decade. Today, most of the retrenchment has stopped and in some areas we can see tendencies of restoration--but more so in financial benefits than in the caring sectors. In the article this process is discussed as a process of reallocation where general principles of solidarity become manifest. Various levels of decision making are discussed within the context of socio-political action. Current transitions in Swedish health care are described with respect to coverage rates, content, marketization and distribution. Basic principles of distribution are highlighted in order to analyse the meaning of social solidarity in a concrete allocative setting. The significance of popular opinion--it's shifts and determinants--is also considered. The article concludes with a discussion of how the (once salient) features of universalism in welfare and health care provision have been affected by the developments in the past decade in Sweden.