Informal End-of-Life Care- Giving and Barriers to Rural Womens Health Michele McIntosh RN PhD...
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Transcript of Informal End-of-Life Care- Giving and Barriers to Rural Womens Health Michele McIntosh RN PhD...
Informal End-of-Life Care-Giving and Barriers to
Rural Womens’ Health Michele McIntosh RN PhD
Allison Williams PhD
Wendy Duggleby PhD
Beverley Liepert PhD
Background
Care-giving makes women sick
Care-giving affects physical, emotional, spiritual health
Care-giving is influenced by and influences the social determinants of health e.g. sex, gender, income and place
The World Health Organization (1984) defines health as a resource for living, not just the absence of disease.
Women who provide informal end-of-life care at home in rural Canada lack or lose this resource
Descriptive studies document the health sequelae of care-giving
Gap in theorizing the processes involved in this erosion of health
Good Public Policy
What is best evidence?
RCTs have been considered gold standard
Evidence from these are not easily translated into different contexts
Complex human phenomenon require multiple methodologies to capture context, meaning as well as measurement
Ethical public policy ought be informed by best knowledge
Purpose: To better understand the impact of EOL care-giving on rurual women’s health
1) To construct processes, sensitizing concepts, situational analytics and theorize about caregivers' loss of health.
2) To identify the elements involved and the relationships among these that undermine womens’ health
3) To utilize an innovative research design—Situational Analysis— in order to accomplish the above
Data Collection
Interviews with women who have provided informal end-of-life care to someone who has died though not necessarily at home
Two telephone interviews: in-depth and semi-structured
Sample size 15
Discourse
Recruitment
Rural communities within Ontario RIO <60
Rural Index of Ontario i.e. proximity to general and specialist medical referral centres and population under 10,000
Direct recruitment and snowball recruitment from Family Health Teams and agencies e.g. CCACs
Situational Analysis
Situational Maps: human, non-human, discursive, and material elements in the research situation of concern and provoke analysis of relations among them
Social worlds/arenas maps lay out the collective actors and their arenas of commitment, framing meso-level interpretations of the situation
Positional maps examine the major positions taken (and not taken) in the discourse
Messy Map: All elements (Clarke, 2005, p. 271)
Ordered Map (Clarke, p. 272)
Social Worlds Map (Clarke, p 278)
Position Map (Clarke, p. 285)
Individual human actors
Collective human actors
Discursive Constructions
Political & Economic Elements
Nonhuman Actants
Socio-cultural/Symbolic
Spatial & Temporal Elements
Situational Analysis: Informal EOL Care-giving & Barriers to Health
Timeline
May 2010: Recruitment, Initial Interviews, Analysis
June—September 2010: Ongoing recruitment, Initial and Follow-up Interviews and Analysis
October 2010: Results
Policy Implications:
1) To implement strategies to target those processes that undermine womens’ health
2) ethical policy based on best knowledge of this complex human phenomenon
References
Clarke, Adele E. (2005). Situational analysis: Grounded theory after the postmodern turn. Thousand Oaks: Sage.