Chair, Indigenous & Northern Health; Senior Scientist, Health Sciences North Research Institute; Scientific Director, Institute of Indigenous Peoples' Health, Canadian Institutes of Health Research, Sudbury, ON.
This commentary examines the inequitable access to healthcare services that Indigenous peoples in Canada face on a daily basis. It considers not only geographical or physical access but also culturally safe access to healthcare. Racism is cited as a major deterrent in not accessing mainstream health services. Three recent studies are cited that reveal that racism, discrimination, stigma, sexism and bias prevent Indigenous peoples from accessing mainstream health services. Cultural safety training is recommended, as well as recruitment and retention of Indigenous health professionals. Several recommendations to address physical and geographical access are also recommended, including self-governance and capacity building; enhanced partnerships and collaboration to address jurisdictional issues, particularly for First Nations communities, and a national strategy for access to healthy and affordable food in northern, remote and rural communities.
The study aims were to examine (i) adolescents' attitudes towards family members who use a wheelchair in relation to other health problems and conditions, and (ii) the association between perceived wheelchair stigma and socio-demographic factors. Data were based on surveys from 2790 seventh to 12th grade students derived from the 2007 cycle of the Ontario Student Drug Use and Health Survey. Stigmatized attitudes towards a family member who required the use of a wheelchair (5.5%) were lower than those attitudes towards a family member who was addicted to drugs (68.3%), alcohol (54.9%), or gambling (53.7%), or who had mental illness (25.9%), and similar to those attitudes for a family member with asthma (2.2%). Grade level was the only significant negative correlate of the perceived wheelchair stigma. The perceived wheelchair stigma among the adolescents may not be a significant barrier towards community integration for wheelchair users.
This theoretical article proposes a framework of understanding a user perspective of assistive devices utilisation in everyday life.
Utilising the MPT model (Matching Person and Technology) and the ValMO model (Values and Meaning in Human Occupations), a framework of understanding is proposed.
Main components are person, assistive device, and activity, connected by the person's expectations and experiences concerning the doability/doworthiness (possible to do/worth doing) of an activity, and the usability/useworthiness (possible to use/worth using) of an assistive device. Expectations may differ based on not only earlier experiences (habitus), but also situational and environmental variations, and result in differing experiences. In general, the purpose of an assistive device is to increase a person's repertoire of doable activities. For a person, this can be a function of the evaluation of possible gains, in terms of correlation between investments (in terms of time and energy), and the (expected) result of the activity.
The only person able to estimate the useworthiness/usability of a device and the doworthiness/doability of an activity is the user her/himself, assessing the degree at which a specific assistive device enhances the value of an activity, in turn affecting the habitus of the (presumptive) user. [Box: see text].
Associations between HIV-related stigma, racial discrimination, gender discrimination, and depression among HIV-positive African, Caribbean, and Black women in Ontario, Canada.
Abstract African, Caribbean, and Black (ACB) women are greatly overrepresented in new HIV infections in comparison with Canada's general population. Social and structural factors such as HIV-related stigma, gender discrimination, and racial discrimination converge to increase vulnerability to HIV infection among ACB women by reducing access to HIV prevention services. Stigma and discrimination also present barriers to treatment, care, and support and may contribute to mental health problems. We administered a cross-sectional survey to HIV-positive ACB women (n=173) across Ontario in order to examine the relationships between HIV-related stigma, gender discrimination, racial discrimination, and depression. One-third of participants reported moderate/severe depression scores using the Beck Depression Inventory Fast-Screen guidelines. Hierarchical block regression, moderation, and mediation analyses were conducted to measure associations between independent (HIV-related stigma, gender discrimination, racial discrimination), moderator/mediator (social support, resilient coping), and dependent (depression) variables. Findings included: (1) HIV-related stigma was associated with increased depression; (2) resilient coping was associated with reduced depression but did not moderate the influence of HIV-related stigma on depression; and (3) the effects of HIV-related stigma on depression were partially mediated through resilient coping. HIV-related stigma, gender discrimination, and racial discrimination were significantly correlated with one another and with depression, highlighting the salience of examining multiple intersecting forms of stigma. Generalizability of findings may be limited due to nonrandom sampling. Findings emphasize the importance of multi-component interventions, including building resilient coping skills, mental health promotion and assessment, and stigma reduction programs.
Mental health-related stigma is a major public health issue, and is an obstacle to the possibility for successful treatment, recovery, and reintegration.
To examine attitudes towards mental illness among employees in the social services.
The study design was part of a large randomized trial, and data presented in this study are baseline data from this trial. Respondents completed a baseline questionnaire to assess the respondents' attitudes.
A significant difference was found between employees' personal attitudes towards depression and schizophrenia. The same significant difference was found in the employees' perceived attitudes. Furthermore, a significant difference was found between the employees' personal and perceived attitudes. A significant difference was found between the respondents wish for social distance towards depression and schizophrenia in all cases, except regarding the willingness to provide a job at one's own workplace.
Employees in the social services are comparable to the general public concerning attitudes towards mental illness.
The results indicate that the employees in social services could have great use of gaining more knowledge about mental illness and ways in which to recognize a mental illness, in order to be able to offer the right kind of help and reduce the treatment gap concerning people suffering from mental illness.
To investigate attitudes towards schizophrenia and people with schizophrenia presented in YouTube videos.
We searched YouTube using the search terms "schizophrenia" and "psychosis" in Finnish and Greek language on April 3rd, 2013. The first 20 videos from each search (N = 80) were retrieved. Deductive content analysis was first applied for coding and data interpretation and it was followed by descriptive statistical analysis.
A total of 52 videos were analyzed (65%). The majority of the videos were in the "Music" category (50%, n = 26). Most of the videos (83%, n = 43) tended to present schizophrenia in a negative way, while less than a fifth (17%, n = 9) presented schizophrenia in a positive or neutral way. Specifically, the most common negative attitude towards schizophrenia was dangerousness (29%, n = 15), while the most often identified positive attitude was objective, medically appropriate beliefs (21%, n = 11). All attitudes identified were similarly present in the Finnish and Greek videos, without any statistically significant difference.
Negative presentations of schizophrenia are most likely to be accessed when searching YouTube for schizophrenia in Finnish and Greek language. More research is needed to investigate to what extent, if any, YouTube viewers' attitudes are affected by the videos they watch.
Balancing the use of language to enable care: a qualitative study of oral and written language used in assessments and allocations of community healthcare services for persons with dementia.
Although a large number of people are diagnosed with dementia each year, the syndrome is still perceived as a sensitive and tabooed topic. Communication about dementia to those living with the syndrome and their relatives is often experienced as challenging by health professionals. Failure to communicate clearly may threaten assessment and allocation of appropriate, effective healthcare services. Accordingly, the aim of this study was to explore how purchasers, assessing and allocating healthcare services to home-dwelling older people with dementia, described challenges in communicating about dementia with those with the syndrome and their relatives. Furthermore, the study aimed to explore the purchasers' justifications for their choice of words.
A qualitative study was conducted to investigate two data sources: focus group interviews with purchasers assessing need for healthcare services, and a review of administrative decisions written by those allocating services. Focus group data were explored using an interpretive approach and qualitative content analysis was carried out with the administrative decisions.
The purchasers found it challenging to talk and write about dementia to those with the syndrome and their relatives when assessing and allocating services. The purchasers were flexible in their communication and aimed to be open when talking and writing about dementia. However, euphemisms and omission were used extensively. Four justifications for the chosen verbal and written language were identified: avoiding disclosure; protecting the person with dementia; protecting the relatives/avoiding conflict; and last, taboo and stigma.
Despite purchasers experiencing difficulties in communicating about dementia to those with the syndrome and their relatives, they did manage to communicate in a conscious and flexible way. The purchasers had several justifications for their language choice. However, extensive use of euphemisms and omission might threaten appropriate identification of needs and provision of high quality healthcare services. The challenges experienced by the purchasers demonstrate the need to focus on appropriate and flexible strategies for individually-tailored communication about dementia with people living with the syndrome.
Rural induced abortion service has declined in Canada. Factors influencing abortion provision by rural physicians are unknown. This study assessed distribution, practice, and experiences among rural compared to urban abortion providers in the Canadian province of British Columbia (BC).
We used mixed methods to assess physicians on the BC registry of abortion providers. In 2011 we distributed a previously-published questionnaire and conducted semi-structured interviews.
Surveys were returned by 39/46 (85%) of BC abortion providers. Half were family physicians, within both rural and urban cohorts. One-quarter (17/67) of rural hospitals offer abortion service. Medical abortions comprised 14.7% of total reported abortions. The three largest urban areas reported 90% of all abortions, although only 57% of reproductive age women reside in the associated health authority regions. Each rural physician provided on average 76 (SD 52) abortions annually, including 35 (SD 30) medical abortions. Rural physicians provided surgical abortions in operating rooms, often using general anaesthesia, while urban physicians provided the same services primarily in ambulatory settings using local anaesthesia. Rural providers reported health system barriers, particularly relating to operating room logistics. Urban providers reported occasional anonymous harassment and violence.
Medical abortions represented 15% of all BC abortions, a larger proportion than previously reported (under 4%) for Canada. Rural physicians describe addressable barriers to service provision that may explain the declining accessibility of rural abortion services. Moving rural surgical abortions out of operating rooms and into local ambulatory care settings has the potential to improve care and costs, while reducing logistical challenges facing rural physicians.
Notes
Cites: Am J Med Qual. 2001 May-Jun;16(3):99-10611392176
This article's point of departure is recent claims that breast cancer survivorship displaying positivity and self-growth represents the gold standard for all forms of cancer survivorship in English-speaking Western cultures. An interview study of Norwegian women regarding gynaecological cancer followed by hysterectomy is used to explore whether this process is taking place beyond this setting. Results show that the women's experiences of having to display survivorship in this manner are not as notable as found in English-speaking Western countries, neither is their experience of social othering. Reasons for this may be strong norms of social egalitarianism marking Norwegian culture and breast cancer informational campaigns that have not yet totally defined Norwegian norms for how to survive cancer. At the clinic and in the public sphere, however, the women experience gynaecological cancer as clearly having lower status than breast cancer, leading to a strong sense that the bodily site of their disease is taboo. Hence, as found in English-speaking cultures, the complex embodied nature of having gynaecological cancer and life beyond treatment seems to be silenced by the media and medical institutions. Finally, implications for future research and health care related to cancer survivorship are also discussed.
Department of Community Health Sciences, Faculty of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary Alberta, Canada. tmcook@ucalgary.ca
The results of studies on perceived causes and stigma have been varied and inconsistent, with no studies examining this relationship in Canada. The objective of this study was to examine the associations between biological, psychosocial, and medical causal beliefs in depression and stigma against depression.
We randomly recruited participants in Alberta, aged 18-74 (n=3047, response rate 75.2%), for a cross-sectional telephone survey between February and June 2006, using random digit dialing. Participants were presented with a case vignette describing a depressed individual and responded to a personal stigma and depression causation questionnaire. Stigma scores were analyzed using Wald tests and multivariate logistic regression.
Nearly all respondents endorsed a psychosocial (99.1%) or genetic (96.4%) cause of depression. Participants who endorsed genetic cause of depression had a lower mean stigma scores than others. Logistic regression modeling showed that endorsing depression due to "being a nervous person" was associated with increased odds of having stigmatizing attitudes.
Recall and social desirability response biases were possible due to reliance on self report.
It is encouraging that 99% of participants endorsed a psychosocial cause of depression. There is no evidence that endorsing a biological cause of depression could increase stigma. To disseminate scientific knowledge in the process of mental health education and promotion, language shall be carefully crafted to avoid unnecessary stigma.
