Concerns have been raised regarding the extent to which the services provided through the Assertive Community Treatment (ACT) model are based on an understanding of recovery as primarily a clinical phenomenon rather than a journey that is fundamentally about self-determination, social inclusion, citizenship and civil rights. Until recently, the limited degree of social inclusion experienced by users of ACT has been assumed to result from individual functioning or inadequate practitioner training. These explanations negate the role of organizing conditions in shaping a systematic approach to everyday practice that diminishes opportunities for inclusion. The current study identifies key areas where practices consistent with the current recovery vision and theories of social inclusion are superseded by accepted and legitimized forms of practice that are aligned with a medical model approach. The study explicates both how and why this happens in the course of everyday practice.
PurposeThe purpose of the present study was to advance a theoretical understanding of the mechanisms by which WISEs can influence the stigma associated with mental illness. Many people with serious mental illnesses want to work, but despite much attention to work entry strategies, unemployment rates remain exceptionally high among this population. Stigma has been identified as a particularly pernicious barrier to the full community participation of people with mental illnesses. If work integration social enterprises (WISE) are to positively impact the full community participation of people with mental illnesses, then addressing stigma will be integral to their operation.Design/methodology/approachA comparative case study approach was used to address the following research questions: "How is the stigma of mental illness experienced in the everyday operations of WISE?" and "What influence do WISEs have on the stigma of mental illness within the workplace and beyond?" Five established WISEs that pay workers at minimum wage or better were selected for inclusion. The maximum variation sample included WISEs that varied in terms of geographical location, form of commerce, business size, revenues and degree of connection with mental health systems and local communities. Data analysis was conducted in four stages using qualitative methods.FindingsThe study findings suggest processes by which WISEs can positively impact the stigma of mental illness. Three social processes are associated with the potential of WISE to contribute to stigma reduction: perception of legitimacy, perception of value and perception of competence. Each of these social processes is fueled by underlying tensions in practice that arise in the context of negotiating the dual goals of the business.Research limitations/implicationsThis study advances theoretical understanding of the ways in which stigma may be perpetuated or reduced in WISE by revealing the social processes and practice tensions that may be associated with operation choices made by WISEs and their partners. Further research would be required to determine if the processes described actually lead to reduced stigma. Although efforts were made to select WISEs that demonstrate a variety of features, it is likely that some important features were absent. Additional research could further explore the findings identified here with WISEs from other sectors, including youth and workers with transient or less severe forms of illness. This work should be replicated internationally to explore how contextual factors may influence individual and public perceptions.Practical implicationsThe findings provide guidance for WISE developers in the mental health sector concerning strategies that may help mitigate the development of stigmatizing features within a social enterprise and by extension improve the work experience and workforce integration of employees. The identification of these processes and tensions can be used to advance the development of consensus principles and standards in the WISE field and contribute to ongoing evaluation and research.Social implicationsWISEs have the potential to reduce stigma, an important goal to support their efforts to improve employment and integration outcomes for people with mental illnesses. Through their business structures and operations they may be able to impact stigma by positively influencing perceptions of legitimacy, value and competence – all issues that have been associated with public assumptions about mental illness that sustain stigma.Originality/valueTo the best of the authors' knowledge, this study is one of the first to specifically focus on stigma in the WISE sector, particularly as it relates to the work integration of persons with mental illnesses. The findings provide a range of theoretical and practical implications for future development in the field and highlight factors that merit consideration more broadly in the sector.
Often, research projects are presented as final products with the methodologies cleanly outlined and little attention paid to the decision-making processes that led to the chosen approach. Limited attention paid to these decision-making processes perpetuates a sense of mystery about qualitative approaches, particularly for new researchers who will likely encounter dilemmas and uncertainties in their research. This paper presents a series of questions that assisted one Ph.D. student in making key methodological choices during her research journey. In this study, a collective case study design informed by constructivist grounded theory data analysis methods was used to develop a framework of community development from an occupational therapy perspective. Ten methodological questions are proposed regarding research question development, research paradigm, design and analysis, and trustworthiness. Drawing on examples from this research project, these questions are used to explicate the decisions made "behind the scenes", with the intention of providing both theoretical and practical guidance to others embarking on similar research journeys.
PurposeThis study explored how intermittent work capacity (IWC) presents in workplaces in order to advance conceptual understanding of this phenomenon and establish a set of initial principles to assist in its management.Design/methodology/approachThe study followed a grounded theory approach in a multi-stage data collection process. In total, 25 employers representing diverse employment sectors were recruited with a goal of exploring their experiences with IWC. The first phase of the study comprised individual interviews with all employers. A subset of these employers later participated in two focus groups organized by company size. Finally, in-depth case studies were conducted with two information rich organizations to understand their approaches to managing IWC. Analysis methods consistent with grounded theory were used.FindingsAlthough employers have a variety of positive motivations for supporting employees with IWC, they are challenged by the uncertainty arising from the unpredictable work patterns associated with IWC. Five distinct expressions of uncertainty were identified. Negotiation of this uncertainty involves attention to a range of factors, including intrapersonal factors, workplace relations and morale, specific job demands, communication processes, and structural and organizational factors.Research limitations/implicationsThe findings of this study advance understanding of the expression of IWC, and factors that influence its impact. This paper presents a series of workplace strategies that both enable the well-being and capabilities of employees who experience IWC, and ensure productive and diverse workplaces.Originality/valueThe findings of this study advance understanding of the expression of IWC, and factors that influence its impact. This paper presents a series of workplace strategies that both enable the well-being and capabilities of employees who experience IWC, and ensure productive and diverse workplaces.
Introduction: Military family life is characterized by frequent relocations, regular periods of separation, and living with the persistent risk of injury or death of their military family member. The cumulative effects of these life events impact the health and wellness of military and Veteran families (MVFs) and may be exacerbated by challenges of accessing and navigating new health care systems when families relocate or when confronted with health care providers (HCPs) unaware of their experiences. Developing cultural competency in HCPs has been found to be beneficial to both the service provider and the service user. The purpose of this study is to identify cultural competencies for HCPs who work with MVFs. Methods: We completed a qualitative study using critical incident one-on-one interviews with HCPs. We used framework analysis for data analysis. Results: In total, we completed nine interviews with HCPs who have experience working with MVFs. Cultural competencies were identified in the domains of cultural awareness, cultural sensitivity, cultural knowledge, and cultural skills. Evidence also indicates the role of the ecological context on the ability of HCPs to be culturally competent. Discussion: Necessary competencies have been identified when providing culturally competent care to MVFs. The results highlight the need for MVF cultural competency training during pre-service health professional curricula and continuing education. We have acknowledged the need for policy and regulatory changes to facilitate the access and utilization of culturally informed health care. Finally, the cultural competencies identified will contribute to the development of an MVF cultural competency model for HCPs working in Canada.
Purpose The aim of this exploratory, mixed methods study was to develop and test a tool that identifies foundational dimensions of work integration social enterprises (WISEs) for use in empirical studies and enterprise self-assessment. Construction of the initial prototype was based upon a review of the literature and prior qualitative research by the authors.
Design/methodology/approach A 20-item question pool with a four-point response scale was constructed to explore WISE business and employment practices and strategies for worker growth and development. Three sequential field tests were conducted with the prototype – the first with 5 Canadian WISEs, the second with 14 WISEs in the UK and the third with 6 Canadian WISEs involved in an outcome study in the mental health sector. Each field test included completion of the questionnaire by persons with managerial responsibility within the WISE and evaluative feedback captured through questions on the applicability and interpretability of the items.
Findings Testing of the prototype instrument revealed the inherent diversity in the field and the difficulty in creating questions that both embrace that diversity and produce unidimensional variables definable along a spectrum. A number of challenges with question structure were identified and have been modified throughout the iterative testing process.
Research limitations/implications This study identified central domains for inclusion in a multi-dimensional WISE assessment tool. Further testing will help further refine scaling and establish psychometric properties.
Originality/value This measure will provide a descriptive profile of WISEs across sectors and identify WISE core dimensions for research and organizational development.
Introduction: Military family life is characterized by mobility, separation, and increased risk for injury or death of the military member, which impacts the health and well-being of all family members. Additional stress is experienced when accessing and navigating a new health care system. Unknown to most Canadians is the reality that military and Veteran families (MVFs) access the civilian health care system; this indicates a need for military family cultural competency among health care providers. This current research identifies aspects of military family cultural competency to inform health care provision to MVFs. Method: A qualitative study using one-on-one interviews was completed with MVFs. Critical Incident Technique (CIT) was used to develop interview questions. Framework analysis was used for data analysis. Results: In total 17 interviews were completed including:1 family (female military spouse, male military member and child); 1 male Veteran; and 15 female military spouses (1 Veteran; 1 active member). Military family cultural competency domains such as cultural knowledge (characteristics of military families; impacts of mobility, separation, and risk) and cultural skills (building relationships; use of effective and appropriate assessments and interventions) were identified. The ecological context was also described as impacting the health care experience. Discussion: The reported experiences of MVFs in this study have highlighted the gaps in the military family cultural knowledge and military family cultural skills Canadian health care providers have when providing care. Results of this study can be used to develop continuing education for health professionals and inform future research.
Background: Ethiopia, as a State Party to the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), has committed to upholding the rights of people with disabilities in Ethiopia. There is little evidence, however, reflecting the impact of this commitment on the lived experiences of people with disabilities in Ethiopia.Objectives: This study sought to uncover how the experiences of participation and activity shape the enactment of rights for Ethiopians with disabilities as enshrined in the UNCRPD.Method: Analysis of 25 qualitative interviews with people with disabilities and family members living in Ethiopia used a reflexive thematic analysis approach to arrive at central themes.Results: People with disabilities in Ethiopia experience marginalisation, distress and practical challenges in both routine daily activities and participation in broader social roles and opportunities. These experiences affect their ability to claim many of the rights afforded by the UNCRPD.Conclusion: Despite legislative efforts to bring about change in Ethiopia, people with disabilities continue to live on the social margins. A meaningful change will require substantial allocation of needed resources by the Ethiopian government to support national-level programmes and policy change. It is critical that people with disabilities and their families are engaged in receiving relevant support, and serve as change leaders.Contribution: This study illustrates how marginalisation, distress and practical challenges in daily activities and social participation arise and are sustained for people with disabilities in Ethiopia. The findings can help to inform the country's efforts to enact the rights of Ethiopians with disabilities as enshrined in the United Nations Convention on the Rights of Persons with Disabilities.
