Observations on the Scientific Base of Health Social Work

This article examines aspects of social work in health care from a philosophy of science perspective, which suggests different ways of conceptualizing and defining variables ranging from service recipients to principles undergirding social work intervention. Focus is given to the relationships among theory, practice, and research in social work by considering the nature of clinical theory; health social work theory; and theory grounded research.     

A Critical Interdisciplinary Analysis of Culturally Appropriate Research Approach and Practices in Health Care and Social Work

This paper presents a critique of research approaches used in health and social care research with vulnerable and socially disadvantaged groups, and children and young people from minority ethnic backgrounds in Britain. The paper aims to critically examine research processes in health and social care from a psychological perspective and a social work perspective. This paper argues that a conceptual framework that incorporates a cross-cultural perspective for understanding the development of minority ethnic children is critical in order to address omissions in existing theoretical formulations and research in social work and health care theory and research. In the United Kingdom there is a lack of social work research from a cross-cultural perspective. Research knowledge and information from a cross-cultural perspective on minority ethnic family life, minority ethnic children and young people are vital to the health care and social work profession.     

ILLUMINATING SOCIAL DETERMINANTS OF WOMEN'S HEALTH USING GROUNDED THEORY

Emphasis in health policy has shifted from curative intervention to prevention and health promotion through personal responsibility for lifestyle choices and, most recently, to the social determination of health. These shifts draw attention to and legitimize women's health research that moves beyond biomedical, epidemiological, and subjective knowledge to question previously unquestioned societal norms and structures that influence women's health. The challenge is to avoid relying solely on population-based studies that support relationships between social determinants and indicators of women's health and to find ways to illuminate the processes by which social determinants interact with the health of specific groups of women. Without such research, our knowledge of how social factors that underpin women's health interact will be faceless and will not address the interplay of health and social policy within women's lives. One research method that may be useful for exploring the interplay between such policies and women's health is grounded theory. Grounded theory is a widely used approach in women's health research. The goal of grounded theory is the discovery of dominant social and structural processes that account for most of the variation in behavior in a particular situation. Despite the usefulness of this method for capturing the interaction between social conditions and women's health experiences, many grounded theory researchers restrict themselves to women's subjective experiences as a source of data for theory development. Consequently, the resultant theory's capacity to illuminate the effects of the social determinants of health is limited. The purpose of this article is to discuss how the grounded theory method can be used in a participatory way to theoretically sample structural conditions at many levels. Using examples from completed and ongoing women's health research where data have and have not been collected primarily from women themselves, we outline the benefits and process for using grounded theory to influence health and public policy in women's health.     

Understanding India, globalisation and health care systems: a mapping of research in the social sciences

ABSTRACT: National and transnational health care systems are rapidly evolving with current processes of globalisation. What is the contribution of the social sciences to an understanding of this field? A structured scoping exercise was conducted to identify relevant literature using the lens of India - a 'rising power' with a rapidly expanding healthcare economy. A five step search and analysis method was employed in order to capture as wide a range of material as possible. Documents published in English that met criteria for a social science contribution were included for review. Via electronic bibliographic databases, websites and hand searches conducted in India, 113 relevant articles, books and reports were identified. These were classified according to topic area, publication date, disciplinary perspective, genre, and theoretical and methodological approaches. Topic areas were identified initially through an inductive approach, then rationalised into seven broad themes. Transnational consumption of health services; the transnational healthcare workforce; the production, consumption and trade in specific health-related commodities, and transnational diffusion of ideas and knowledge have all received attention from social scientists in work related to India. Other themes with smaller volumes of work include new global health governance issues and structures; transnational delivery of health services and the transnational movement of capital. Thirteen disciplines were found represented in our review, with social policy being a clear leader, followed by economics and management studies. Overall this survey of India-related work suggests a young and expanding literature, although hampered by inadequacies in global comparative data, and by difficulties in accessing commercially sensitive information. The field would benefit from further cross-fertilisation between disciplines and greater application of explanatory theory. Literatures around stem cell research and health related commodities provide some excellent examples of illuminating social science. Future research agendas on health systems issues need to include innovative empirical work that captures the dynamics of transnational processes and that links macro-level change to fine-grained observations of social life.National and transnational health care systems are rapidly evolving with current processes of globalisation. What is the contribution of the social sciences to an understanding of this field? A structured scoping exercise was conducted to identify relevant literature using the lens of India - a 'rising power' with a rapidly expanding healthcare economy. A five step search and analysis method was employed in order to capture as wide a range of material as possible. Documents published in English that met criteria for a social science contribution were included for review. Via electronic bibliographic databases, websites and hand searches conducted in India, 113 relevant articles, books and reports were identified. These were classified according to topic area, publication date, disciplinary perspective, genre, and theoretical and methodological approaches. Topic areas were identified initially through an inductive approach, then rationalised into seven broad themes. Transnational consumption of health services; the transnational healthcare workforce; the production, consumption and trade in specific health-related commodities, and transnational diffusion of ideas and knowledge have all received attention from social scientists in work related to India. Other themes with smaller volumes of work include new global health governance issues and structures; transnational delivery of health services and the transnational movement of capital. Thirteen disciplines were found represented in our review, with social policy being a clear leader, followed by economics and management studies. Overall this survey of India-related work suggests a young and expanding literature, although hampered by inadequacies in global comparative data, and by difficulties in accessing commercially sensitive information. The field would benefit from further cross-fertilisation between disciplines and greater application of explanatory theory. Literatures around stem cell research and health related commodities provide some excellent examples of illuminating social science. Future research agendas on health systems issues need to include innovative empirical work that captures the dynamics of transnational processes and that links macro-level change to fine-grained observations of social life.     

Concepts of social epidemiology in health services research

Background

Social epidemiologists aim to identify social characteristics that affect the pattern of disease and health distribution in a society and to understand its mechanisms. Some important concepts of social epidemiology are: social inequalities, social relationships, social capital, and work stress.

Discussion

Concepts used in social epidemiology can make a useful contribution to health services research because the underlying social factors do not only influence health but are also related to health care. Social inequality indicators like education or income have an impact on access to health care as well as on utilization and quality of health care. Social relationships influence adherence to medical treatment, help-seeking behavior, utilization of health services, and outcomes. Social capital in health care organizations is an important factor for the delivery of high-quality coordinated care. Job stress is highly prevalent among health care providers and can not only affect their health but also their performance.

Summary

The theoretical considerations behind factors like social inequalities, social relationships, social capital and work stress can enrich health services research because theory helps to specify the research question, to clarify methodological issues, to understand how social factors are related to health care, and to develop and implement interventions.

     

Toward a neighborhood resource-based theory of social capital for health: can Bourdieu and sociology help?

Within the past several years, a considerable body of research on social capital has emerged in public health. Although offering the potential for new insights into how community factors impact health and well being, this research has received criticism for being undertheorized and methodologically flawed. In an effort to address some of these limitations, this paper applies Pierre Bourdieu's (1986) [Bourdieu, P. (1986). Handbook of theory and research for the sociology of education (pp. 241-258). New York: Greenwood] social capital theory to create a conceptual model of neighborhood socioeconomic processes, social capital (resources inhered within social networks), and health. After briefly reviewing the social capital conceptualizations of Bourdieu and Putnam, I attempt to integrate these authors' theories to better understand how social capital might operate within neighborhoods or local areas. Next, I describe a conceptual model that incorporates this theoretical integration of social capital into a framework of neighborhood social processes as health determinants. Discussion focuses on the utility of this Bourdieu-based neighborhood social capital theory and model for examining several under-addressed issues of social capital in the neighborhood effects literature and generating specific, empirically testable hypotheses for future research.     

社会资本与医院发展理论研究

社会资本理论的提出,为人们研究社会各行业的发展提供了一个崭新的视角。社会资本对经济增长乃至整个社会发展的重要性给予了充分肯定,同时,社会资本的概念或理论为人们提供了一条探讨社会因素作用于医院发展机理的线索。重视对社会资本理论的研究,充分认识和利用社会资本的卫生保健功能,有利于对医院实行有效的管理,发挥最大的协同作用,有利于医院的长远建设,有利于实现医院的可持续发展,有利于开创卫生工作的新局面。     

Illuminating social determinants of women's health using grounded theory

Emphasis in health policy has shifted from curative intervention to prevention and health promotion through personal responsibility for lifestyle choices and, most recently, to the social determination of health. These shifts draw attention to and legitimize women's health research that moves beyond biomedical, epidemiological, and subjective knowledge to question previously unquestioned societal norms and structures that influence women's health. The challenge is to avoid relying solely on population-based studies that support relationships between social determinants and indicators of women's health and to find ways to illuminate the processes by which social determinants interact with the health of specific groups of women. Without such research, our knowledge of how social factors that underpin women's health interact will be faceless and will not address the interplay of health and social policy within women's lives. One research method that may be useful for exploring the interplay between such policies and women's health is grounded theory. Grounded theory is a widely used approach in women's health research. The goal of grounded theory is the discovery of dominant social and structural processes that account for most of the variation in behavior in a particular situation. Despite the usefulness of this method for capturing the interaction between social conditions and women's health experiences, many grounded theory researchers restrict themselves to women's subjective experiences as a source of data for theory development. Consequently, the resultant theory's capacity to illuminate the effects of the social determinants of health is limited. The purpose of this article is to discuss how the grounded theory method can be used in a participatory way to theoretically sample structural conditions at many levels. Using examples from completed and ongoing women's health research where data have and have not been collected primarily from women themselves, we outline the benefits and process for using grounded theory to influence health and public policy in women's health.     

Key issues in intervention research: A program evaluation perspective

Over the last two decades, theory and practice in the field of program evaluation have generated a rich array of concepts and methods for research on the effectiveness of social programs. This paper attempts to summarize the lessons from program evaluation research that might usefully inform intervention research in occupational health and safety. (This article is a US Government work and, as such, is in the public domain in the United States of America.) © 1996 Wiley-Liss, Inc.     

Environmental health research: setting an agenda by spinning our wheels or climbing the mountain?

This paper examines the nature and characteristics of research in environmental health, viewed as the effects of the environment on human health. It is argued that most of this work has been predicated on an epidemiological approach which has yielded significant (if sometimes equivocal) findings about exposure-outcome relationships. This discussion, however, concentrates on the limited and somewhat partial view of theory implied in this perspective. It advocates instead a broad-based approach to theory as the basis for understanding significant portions of the social world. It posits, as illustrations, several social theories and with examples tries to show how environmental health research might be different.     

The Use of Theoretical Constructs and Research Data to Establish a Base for Clinical Social Work in Health Settings

This article suggests a means for organizing a base for clinical social work practice in health settings. Membership, as a theoretical construct, is used to explore the essentials of social work, to explicate its key practice concepts, and to review characteristics of the health field. Selected findings from a secondary analysis of data from the New England Regional Survey of Social Work Practice are considered with reference to theory and essential concepts of health social work practice. Questions are raised and implications drawn for the practice of clinical social work in health settings and for education for that practice.     

Research on organizational issues in health care social work

A rich body of knowledge spans organizational topics relevant to the practice, conceptual development and planning of social work health care services. At a time when health care organizations are experiencing major changes in their structure and financing; organizational research informs both the system adjustments and leadership which social work can offer the health care field. Organizational research on health care social work is grouped into three categories: management and administrative issues; interprofessional and interorganizational relations; and service delivery topics. Within each category, the major issues are presented with single site and multi-site research reviewed. Recommendations to improve the contributions of this body of research include greater attention to methodological rigor in designing and implementing research projects.     

Are qualitative methods misunderstood?

Qualitative research methods are increasingly utilised by health researchers. Along with this the criteria for assessing the quality of qualitative research are changing from a natural science model to an interpretative social science model. This is a product of the realisation by health researchers that qualitative methods utilise a different epistemology to statistical methods. I demonstrate that a recent article in the Australian and New Zealand Journal of Public Health draws on a now outdated natural science methodology of assessing bias in focus groups. Drawing on interpretativist social science theory and recent work in the British Medical Joumal I argue for the importance of examining the social contexts through which qualitative data is produced.     

Job satisfaction and turnover intent among hospital social workers in the United States

Feelings of job satisfaction and turnover intentions among social workers affect work quality for both social workers and the people for whom they provide services. Existing literature on job satisfaction among hospital social workers is limited, and is overly focused on issues of compensation. There is job satisfaction research with hospital nurses available for comparison. Other informative social work research on job satisfaction and turnover exists in mental health and generally, across settings. Research on turnover intent in social work is primarily from child welfare settings and may not generalize. The literature notes gaps and contradictions about predictors of job satisfaction and turnover intent. Using a large national dataset of hospital social workers, this research clarifies and fills gaps regarding hospital social workers, and explores how Herzberg’s theory of work can clarify the difference between sources of job dissatisfaction and job satisfaction. Findings include hospital social workers reporting high job satisfaction and that demographics do not contribute to the predictive models. The findings do support centralized social work departments and variety in the job functions of hospital social workers, and are consistent with the theoretical framework.     

Integrating fundamental cause theory and Bourdieu to explain pathways between socioeconomic status and health: the case of health insurance denials for genetic testing

Fundamental cause theory (FCT) is among the most widely recognised and accepted social science frameworks used to examine the processes driving health inequalities. Despite the wide influence of the theory, it remains largely underutilised in practical and applied research on health disparities. This paper proposes that Pierre Bourdieu’s theories of capital and symbolic power can be integrated with FCT to address limitations in the latter theory, making it more useful in health disparities research. Using a case study of U.S. health insurance claim denials for genetic testing among women with a breast cancer diagnosis, this work illustrates how the theoretical constructs of FCT and Bourdieu’s work articulate, and consequently deepens our appreciation for the durable relationship between socioeconomic status and health. Study results reveal the multiple and complex mechanisms that play a role in access to healthcare services, which has significant implications for how we think about the role of health policy in addressing health disparities.     

Trends in maternal and child health care: implications for research and issues for social work practice

Trends are reviewed in four areas of maternal and child health care: (1) prenatal care; (2) infant mortality; (3) teenage pregnancy; and (4) HIV infected mothers and infants. The purpose of this review is to identify major trends in these programmatic areas, key indicators of physical-social health risk and survival, and central issues relevant to research and social work practice. Attention is directed to the status of research, and the usefulness of existing data sets available to researchers in the four programmatic areas of maternal and child health care under review. Emphasis is given to the importance of the integration of theory, research findings, and practice.     

BEHAVIOURALLY-BASED PRINCIPLES AS GUIDELINES FOR HEALTH PROMOTION

Programmes to promote health, which appear with increasing frequency, should be based on sound principles. This paper deals with an approach to health promotion based on behavioural theories to explain the change and maintenance of habitual patterns of activity. It derives from work to determine programme guidelines and policy recommendations in the promotion of exercising, and is presented so as to have more general application to health-related behaviours. It describes some relevant theoretical approaches to behaviour change and maintenance, and outlines a set of principles which may be used as guidelines. This involves an account of stages of behaviour change, operant conditioning and associative learning theories, cognitive-behavioural and self-management theories, and social learning theory, and suggests judicious integration of these theories and the use of attitudinal theories. Eleven principles derived from these theories and from research on health behaviour change are described. These perspectives may be useful in work to influence the health-related behaviours of individuals, and as suggestions for the modification of some environmental and social factors which constrain individuals' capacities to choose health promoting actions.     

Understanding health through social practices: performance and materiality in everyday life

The importance of recognising structure and agency in health research to move beyond methodological individualism is well documented. To progress incorporating social theory into health, researchers have used Giddens’ and Bourdieu's conceptualisations of social practice to understand relationships between agency, structure and health. However, social practice theories have more to offer than has currently been capitalised upon. This article delves into contemporary theories of social practice as used in consumption and sustainability research to provide an alternative, and more contextualised means, of understanding and explaining human action in relation to health and wellbeing. Two key observations are made. Firstly, the latest formulations of social practice theory distinguish moments of practice performance from practices as persistent entities across time and space, allowing empirical application to explain practice histories and future trajectories. Secondly, they emphasise the materiality of everyday life, foregrounding things, technologies and other non‐humans that cannot be ignored in a technologically dependent social world. In concluding, I argue the value of using contemporary social practice theories in health research is that they reframe the way in which health outcomes can be understood and could inform more effective interventions that move beyond attitudes, behaviour and choices.     

Networks and social capital: a relational approach to primary healthcare reform

Collaboration among health care providers and across systems is proposed as a strategy to improve health care delivery the world over. Over the past two decades, health care providers have been encouraged to work in partnership and build interdisciplinary teams. More recently, the notion of networks has entered this discourse but the lack of consensus and understanding about what is meant by adopting a network approach in health services limits its use. Also crucial to this discussion is the work of distinguishing the nature and extent of the impact of social relationships – generally referred to as social capital. In this paper, we review the rationale for collaboration in health care systems; provide an overview and synthesis of key concepts; dispel some common misconceptions of networks; and apply the theory to an example of primary healthcare network reform in Alberta (Canada). Our central thesis is that a relational approach to systems change, one based on a synthesis of network theory and social capital can provide the fodation for a multi-focal approach to primary healthcare reform. Action strategies are recommended to move from an awareness of 'networks' to fully translating knowledge from existing theory to guide planning and practice innovations. Decision-makers are encouraged to consider a multi-focal approach that effectively incorporates a network and social capital approach in planning and evaluating primary healthcare reform.     

Person/environment construct: positivist versus naturalist, dilemma or opportunity for health social work research and practice?

The purpose of this paper is to indicate that there is nothing fundamentally wrong with the social work purpose of simultaneous attention to persons in their contexts. In fact, the productive pull of both perspectives is what separates social work from other helping professions. Indeed, it is what separates health social work from other health professions. What has created difficulty, however, has been the predominant lens through which person and environment have been investigated, understood and manipulated. This paper compares two major models of knowledge building in an attempt to identify the consequences for research and practice in social work. Examples are provided from both research and practice that derive from these differing perspectives in an effort to clarify the choices social worker health professionals make when encountering a person-in situation.