Using the photovoice method to understand experiences of people with physical disabilities working in social enterprises

BackgroundSocial enterprises can be an alternative option for people with disabilities to build confidence in the job market, where unemployment and difficulty securing a decent job is a social issue for this population. However, limited studies have examined these experiences from the participants’ perspectives.ObjectiveThis study explored the life experiences of people with disabilities working in social enterprises, using the photovoice method.MethodsFive employees with physical disabilities working in a social enterprise participated in five sessions of photovoice in South Korea. They took photos for each session on four themes and participated in group discussions.ResultsThis paper draws from narrations and photos shared during group discussions regarding four themes selected by participants: my current state, life changes after being employed in a social enterprise, feeling frustrated, and my future. The participants reported better quality of life both financially and socially, but also felt frustration facing interpersonal, health, or workload problems while working at a social enterprise. They expressed hope to continue working in their social enterprise, and thus ultimately experience better quality of life and a sense of contributing to society.ConclusionsEmployers can create more supportive and sustainable workplaces to secure decent job opportunities for persons with disabilities at a social enterprise and contribute social value. Social work professionals should provide professional support to employees with disabilities who are struggling with health and psychosocial problems that often occur in social enterprises.     

Knowledge and Social Work in Health Care—The Case of Finland

Abstract

Studies carried out in different countries have shown that there is a lack of a common and up-dated knowledge base in social work, and that social workers make use of research in their everyday practice only to a very limited extent. On the other hand it has been shown that social workers feel they need knowledge but not necessarily in the form it is produced by the researchers.

This paper explores issues of knowledge and competence in health social work based on the results of a survey and a focus group interview conducted among social workers in Finland. According to the results, social workers in health care do feel they need new knowledge. Some significant differences were found in the way health social workers view the acquisition and maintenance of professional competence and in the way they seek knowledge, when compared to social workers working in the municipal social services.     

Ethnicité et statut d’immigrant : quelle association avec le travail et les symptômes dépressifs ?

BackgroundThe purpose of this research is to determine whether, in the Canadian workforce, cultural identity traits, particularly ethnicity and immigrant status, might modify the association of work with depressive symptoms.MethodData were derived from the nine cycles of the National Population Health Survey (NPHS) conducted by Statistics Canada. Based on a sample of 6477 workers, multilevel regression models were brought into being. Analyses were adjusted for family-related factors, non-work social support, and personal characteristics.ResultsAfter accounting for potential confounders, ethnicity and work-related factors were distinctly and directly associated with depressive symptoms. Workers belonging to visible minorities had significantly fewer depressive symptoms than their Caucasian counterparts. Unlike Caucasians, they were more often overqualified, less in a position to use their skills, and largely without decision-making authority. On the other hand, all analyses having to do with immigrant status led to inconclusive results.ConclusionEthnicity seems to have some bearing on the association of work with depressive symptoms among members of the Canadian workforce. It might be beneficial to carry out targeted interventions aimed at improving working conditions according to ethnicity and situations involving professional overqualification.     

L’influence de l’identité professionnelle sur la détresse psychologique dans les métiers spécialisés des secteurs de la construction et manufacturier au Québec

ObjectiveThis study explores how the structure of professional identity and its undermining are associated with symptoms of psychological distress in the skilled trades, focusing on the construction and manufacturing sectors in Quebec. One limitation of the current research is its neglect of professional identity, even though this concept is important to explaining psychological distress symptoms.MethodsThe sample includes 282 workers from four manufacturing and seven construction sites in Quebec. Data were collected for the years 2016 and 2017. Multilevel regression analysis was carried out with the statistical software Stata 13. Five variables were controlled in this study: sex, gender, age, type of team and occupational sector.ResultsThe results of multilevel regression models, addressing variations across 54 participating teams, suggested that a low skilled trades self-esteem, a higher professional identification, a low integration of differences, heavy demands at work, and job insecurity are associated with psychological distress, as are the factors of being a woman or being a younger worker.ConclusionStudy results corroborate the importance of taking preventive actions on identity dimensions to reduce psychological distress symptoms. In particular, at the level of skilled trades culture, it would be beneficial to incorporate values based on a better inclusion of all workers and an open mind with regard to differences.     

The potential impact of bereavement grief on workers,work, careers,and the workplace

ABSTRACT

Bereavement grief is typically very painful and often highly consequential. People who are working could be significantly impacted by the death of someone they care about. A qualitative study sought an understanding of the lived experience of bereavement on the mourner’s ability to work and their work-related experiences following the death of a loved one. Three themes emerged: (a) grief is universal but individually impactful, (b) accommodation is needed to assist the return to work and to regain work abilities, and (c) there are many impediments to working again. These themes highlight the potential for bereavement grief to substantially effect mourners and thus their work, careers, and the workplace. Older workers could be particularly disadvantaged because of workplace ageism. Societal and other changes appear to be needed for the health and wellbeing of mourning workers, and to address related work and bereavement issues. Bereavement grief is highly relevant to the social work profession, given its involvement in providing information, developing supportive services, and making referrals.     

From context to contexting: professional identity un/doing in a medical leadership development programme

Physicians are known for safeguarding their professional identities against organisational influences. However, this study shows how a medical leadership programme enables the reconstruction of professional identities that work with rather than against organisational and institutional contexts to improve quality and efficiency of care. Based on an ethnographic study, the results illustrate how physicians initially construct conflicting leadership narratives – heroic (pioneer), clinical (patient's guardian) and collaborative (linking pin) leader – in reaction to changing organisational and clinical demands. Each narrative contains a particular relational-agentic view of physicians regarding the contexts of hospitals: respectively as individually shapeable; disconnected or collectively adjustable. Interactions between teachers, participants, group discussions and in-hospital experiences led to the gradual deconstruction of the heroic –and clinical leader narrative. Collaborative leadership emerged as the desirable new professional identity. We contribute to the professional identity literature by illustrating how physicians make a gradual transition from viewing organisational and institutional contexts as pre-given to contexting, that is, continuously adjusting the context with others. When engaged in contexting, physicians increasingly consider managers and directors as necessary partners and colleague-physicians who do not wish to change as the new ‘anti-identity’.     

Changing Practice

Abstract

Changes to professional work now ensure that social care and health care workers should be accountable to service users, and not only to their professional colleagues. This paper seeks to explore how this may eventually be realised in new working relationships that will profoundly affect mental health social work.

These changes are driven by factors that are external to the social work profession-in policy initiatives that introduce measures of performance that incorporate the service user in both evaluating and planning services, in efforts to build new relationships, and in a breakdown of barriers between social work practitioners and service managers. While these changes are sometimes likely to be resisted by practitioners and service users alike, the demands of policy makers for a new professional accountability to service users can be used to pave the way for effective dialogue. The paper outlines the steps necessary to build confidence among both service users and service providers. This requires sensitive management and leadership. It also requires that action demonstrably follows from such dialogue. The paper uses evidence from Community Mental Health Teams in Swansea, over a three-year period, to demonstrate how the policy and management imperatives faced by service providers can be reconciled with the expressed desires of mental health service users.     

Profils et représentations professionnelles des agents en centre de santé au Burundi : des groupes socio-professionnels aux savoirs cloisonnés

BackgroundThe professional identities, profiles and representations of Burundian health workers remain insufficiently explored. Our twofold objective is to identify the different socio-professional profiles of first-line caregivers and to explore their respective representations of health workers and work.MethodsThe first study describes the overall population of the 1047 staff members employed in 2014–2015 in 62 health centers. The second is a cross-sectional survey conducted in April 2014. Using IRAMUTEQ© software, we conducted textology analysis of the structure and contents of 911 respondents’ representations via 3 free associations with regard to 6 questions on the “good worker” and the “what renders one capable of doing good work”.ResultsAt the normative level, among all categories of staff, a relational role is a foundation of professional identity, while technical or administrative functions remain marginal. At the positional level, responses differed according to initial qualification level but not as a function of their role with patients or their professional experience. Three socio-professional categories emerged. The most qualified category (one-quarter of the population) consists primarily of male caregivers, with a high turnover rate (4 years) associated with prospects for further training and career development. These persons present the most professionalized representations of the worker and work. The second quarter has an average level of qualification and turnover (10 years), and is mainly composed of female caregivers with limited professional perspectives. This group's representations are less technical and more patient-centered. Finally, the remaining half consists of relatively low-skilled staff members in charge of technical and logistical support, who are likely to spend their entire career in the same center (> 20 years). Largely disregarded by the health care system and its funders, they have few opportunities for training or advancement and despite their long experience, maintain profane representations of workers and work.ConclusionOur results shed light on the predicament of unskilled staff members whose expectations are rarely taken into consideration, even though they represent a significant proportion of the workforce, perform tasks essential to quality of care, and serve as bearers of the memory of their hospital center. These results also highlight the compartmentalization of practices and knowledge between categories of workers and underscore the failure of continuous training strategies targeting the unskilled.     

Participation by doing: Social interaction in everyday activities among persons with schizophrenia

Schizophrenia impacts on social functioning and participation in everyday life. However, there is limited research describing how persons with schizophrenia interact with others when performing daily activities. The aim of this study is to describe how persons with schizophrenia interact with others while performing everyday activities in different contexts in terms of facilitating and hindering factors. Repeated participant observations of four persons with schizophrenia were conducted in their environment. The observed activities and social interactions were chosen from the participant's daily routines. Field notes were taken during the observations. Qualitative content analysis was used to analyse the data. Two themes constitute the main result: Facilitating social interaction in activity performance and Hindering social interaction in activity performance. These two themes serve as headings for sub-themes representing factors influencing social interaction in activity performance. Through a further analysis of the themes the following dichotomous contexts were identified as influential: meaningful/not meaningful activity being performed; attitudes were trusting/lacking trust; and location, at home/outside the home. Conclusion: If the facilitating contextual factors are considered for each individual when planning and performing everyday activities together with others there is a possibility to improve social interaction skills and thereby participation.     

Residential neighborhood,geographic work environment,and work economic sector: associations with body fat measured by bioelectrical impedance in the RECORD Study

PurposeStudies of associations between geographic environment and obesity have mostly examined body mass index and focused on residential neighborhoods. We investigated associations between residential neighborhoods, geographic work environments, and work economic sectors and the fat mass index (FMI) and percentage of fat mass (%FM).MethodsData on 4331 participants from the French RECORD Study geolocated at their residence and workplace were analyzed. Body composition was assessed by bioelectrical impedance analyzers. Multilevel linear regression was used to investigate the determinants of FMI and %FM.ResultsAfter adjustment, among men, the FMI and %FM increased independently with decreasing density of population and educational level in the residential neighborhood. Among women, the residential educational level was related to the FMI and %FM. Among men, a higher FMI and %FM were observed among participants working in the construction and transportation/communication sectors than in the education sector. For women, the FMI was higher among participants working in the public administration and health/social work sectors than in the transport/communication sector. A long home-work distance was associated with a higher FMI among women. There was evidence that body mass index cannot fully capture work economic sector effects on fat mass.ConclusionsPublic health interventions to reduce social/territorial disparities in obesity should also consider the different contexts to which the participants belong, such as residential environments and work economic sectors.     

Epistemology, evidence and experience: evidence based health care in the work of Accident Alliances

Evidence based health care has attracted considerable interest from NHS commissioners, public health specialists and sociologists as both a rational approach to decision making and as representing an ideological shift in health care. This paper explores the social construction of 'evidence' in one arena, that of the work of Accident Alliances. Interviews with key participants and observations of meetings suggest a high level of consensus that evidence was important for their work in terms of strategic decision making, operational planning and evaluation. However, evidence was framed differently across the professions and organisations involved in the alliances. Rather than being a neutral tool used to inform decision making, evidence was both constructed through professional practice and contributed to the construction of professional identity. The formal advocacy of evidence based interventions makes explicit a number of potential conflicts in inter-agency working, and Accident Alliances provide an illuminating case study of how these are managed in day-to-day working in health care.     

Nowhere to go: exploring the social and economic influences on discharging people experiencing homelessness to appropriate destinations in Toronto,Canada

ObjectivesA main component of discharging patients from hospital is identifying an appropriate destination to meet their post-hospitalization needs. In Canada, meeting this goal is challenged when discharging people experiencing homelessness, who are frequently discharged to the streets or shelters. This study aimed to understand why and how the ability of hospital workers to find appropriate discharge destinations for homeless patients is influenced by dynamic social and economic contexts.MethodsGuided by critical realism, we conducted semi-structured, in-depth interviews with 33 participants: hospital workers on general medicine wards at three urban hospitals; shelter workers; and researchers, policy advisors, and advocates working at the intersection of homelessness and healthcare.ResultsHistorical and contemporary social and economic contexts (e.g., shrinking financial resources) have triggered the adoption of efficiency and accountability measures in hospitals, and exclusion criteria and rules in shelters, both conceptualized as mechanisms in this article. Hospitals are pressured to move patients out as soon as they are medically stable, but they struggle to discharge patients to shelters: to prevent inappropriate discharges, shelters have adopted exclusion and eligibility rules and criteria. These mechanisms contribute to an explanation of why identifying an appropriate discharge destination for people experiencing homelessness is challenging.ConclusionOur results point to a systems gap in this discharge pathway where there is nowhere for people experiencing homelessness to go who no longer need acute care, but whose needs are too complex for shelters. Systemic changes are needed to better support hospital and shelter frontline workers to improve discharge processes.     

Ecologies of security: On the everyday security tactics of female sex workers in Nairobi,Kenya

ABSTRACT

This paper highlights important environmental dimensions of HIV vulnerability by describing how the sex trade operates in Nairobi, Kenya. Although sex workers there encounter various forms of violence and harassment, as do sex workers globally, we highlight how they do not merely fall victim to a set of environmental risks but also act upon their social environment, thereby remaking it, as they strive to protect their health and financial interests. In so doing, we illustrate the mutual constitution of ‘agency’ and ‘structure’ in social network formations that take shape in everyday lived spaces. Our findings point to the need to expand the focus of interventions to consider local ecologies of security in order to place the local knowledges, tactics, and capacities that communities might already possess on centre stage in interventions. Planning, implementing, and monitoring interventions with a consideration of these ecologies would tie interventions not only to the risk reduction goals of global public health policy, but also to the very real and grounded financial priorities of what it means to try to safely earn a living through sex work.     

Developing professional values: perceptions of francophone occupational therapists in Quebec,Canada

Objective Recent literature shows growing interest in the values displayed by occupational therapists. Yet, none of these writings has so far examined the factors that contribute to the development of occupational therapists’ professional values. These factors are important, since values play a pivotal role in forging professional identity, which in the case of some occupational therapists remains somewhat ambiguous. This article proposes possible answers to the following question: What do Quebec Francophone occupational therapists perceive as the building blocks of their professional values? Methods Using a phenomenological qualitative method, the subjective experience of occupational therapists in Quebec, Canada was examined. Twenty-six occupational therapists took part in the study. Results As intended, their professional experience was varied. According to the participants, four factors contributed significantly to their professional values: professional experience, university training, personal experience, and professional development. However, fewer than 50% of the participants cited six other factors (workplace, family upbringing, personal development, personality and abilities, professional normative framework, and sociocultural background). Conclusions Most of these results are consistent with those documented in existing works. They point to the relevance of discussing professional values during university training and continuing professional development, as well as encouraging occupational therapists to become exemplars for their colleagues and interns. This study constitutes an initial step in understanding how occupational therapists’ axiological identity is formed.     

Conflicting identities between sex workers and motherhood: A systematic review

Being a mother is a traditional and central role for women. However, due to criminalization, social stigma and marginalized lifestyles, female sex workers (FSWs) may encounter disadvantages and social inequality. The aim of this review was to synthesize the results of studies focused on the challenges that FSWs face in negotiating their maternal identity with their stigmatized identity as sex workers. A total of 21 studies published from 2002 to 2016 were included in this review. Textual narrative and a thematic synthesis approach were adopted to synthesize key themes. Two common themes across countries were identified: conflicting identities between the jobs as sex workers and motherhood and responses to social expectations of ideal motherhood. Given the challenges that FSWs face with motherhood, comprehensive services, including health, family, social, and legal services, are needed to support FSWs as individuals and as mothers. A more holistic approach is recommended to address their physical, emotional, financial, and social problems faced by FSWs. Services should be offered in a friendly and non-judgmental manner. Further, to advance the health and safety of FSWs and their children, prostitution law may need to move toward decriminalization of sex work and educate the general public about respecting FSWs.     

Overseas‐trained doctors in Indigenous rural health services: negotiating professional relationships across cultural domains

Objective: To examine how OTDs and staff in rural and remote Indigenous health contexts communicate and negotiate identity and relationships, and consider how this may influence OTDs’ transition, integration and retention. Method: Ten case studies were conducted in rural and remote settings across Australia, each of an OTD providing primary care in a substantially Indigenous practice population, his/her partner, co‐workers and Indigenous board members associated with the health service. Cases were purposefully sampled to ensure diversity in gender, location and country of origin. Results: Identity as ‘fluid’ emerged as a key theme in effective communication and building good relationships between OTDs and Indigenous staff. OTDs enter a social space where their own cultural and professional beliefs and practices intersect with the expectations of culturally safe practice shaped by the Australian Indigenous context. These are negotiated through differences in language, role expectation, practice, status and identification with locus with uncertain outcomes. Limited professional and cultural support often impeded this process. Conclusion: The reconstruction of OTDs’ identities and mediating beyond predictable barriers to cultural engagement contributes significantly not only to OTDs’ integration and, to a lesser extent, their retention, but also to maximising effective communication across cultural domains. Implications: Retention of OTDs working in Indigenous health contexts rests on a combination of OTDs’ capacity to adapt culturally and professionally to this complex environment, and of effective strategies to support them.     

Gender identity,healthcare access,and risk reduction among Malaysia's mak nyah community

ABSTRACT

Transgender women (TGW) face compounded levels of stigma and discrimination, resulting in multiple health risks and poor health outcomes. TGW identities are erased by forcing them into binary sex categories in society or treating them as men who have sex with men (MSM). In Malaysia, where both civil and religious law criminalise them for their identities, many TGW turn to sex work with inconsistent prevention methods, which increases their health risks. This qualitative study aims to understand how the identities of TGW sex workers shapes their healthcare utilisation patterns and harm reduction behaviours. In-depth, semi-structured interviews were conducted with 21 male-to-female transgender (mak nyah) sex workers in Malaysia. Interviews were transcribed, translated into English, and analysed using thematic coding. Results suggest that TGW identity is shaped at an early age followed by incorporation into the mak nyah community where TGW were assisted in gender transition and introduced to sex work. While healthcare was accessible, it failed to address the multiple healthcare needs of TGW. Pressure for gender-affirming health procedures and fear of HIV and sexually transmitted infection screening led to potentially hazardous health behaviours. These findings have implications for developing holistic, culturally sensitive prevention and healthcare services for TGW.     

Development of Professional Identity among Social Work Students: Contributing Factors

Based on the person-in-environment theory, this article presents empirical findings on the contribution of organizational resources (satisfaction with supervision), personal resources (empathic concern, self-differentiation, and sense of coherence), and environmental resources (values) to the professional identity of social work students. The sample consists of 160 social work students who were about to complete their Bachelor of Social Work (BSW) degrees. The participants filled out a set of questionnaires which examined these resources. Two variables contributed directly to the development of professional identity: satisfaction with supervision and personal values. Social values, self-differentiation, and empathic concern contributed to the development of a professional identity only when they interacted with satisfaction with supervision. Practical recommendations are discussed.     

Social Support,Medication Compliance and HIV/AIDS

ABSTRACT

Social work practitioners and researchers have greatly understudied the idea of how social support correlates with combination therapy medication compliance, in people living with HIV disease. Meanwhile, such data could help health social workers better assist HIV-infected people who want to cope well, live long, and avoid drug resistance. Therefore, this article presents findings from a three-stage empirical secondary data analysis that examined seven specific types of social support, psychological history and stage of illness variables, and sociodemographics and their connection to medication compliance ratings. A sub-sample of 179 HIV-infected clinical trial study participants enrolled in a federally funded combination therapy treatment study and a nested compliance study were analyzed. Analysis of 14 bivariate hypotheses and 20 predictor variables at the multivariate level revealed that having emotional support and being employed seemed to be predictive of being a “Good Complier.” Also, having higher levels of HIV symptoms appeared to be associated with being a “Poor Complier.”