Measuring social exclusion in healthcare settings: a scoping review

Patrick O’Donnell,Khalifa Elmusharaf,Diarmuid O’Donovan

doi:10.1186/s12939-018-0732-1

Patrick O’Donnell, Khalifa Elmusharaf + Show 1 more

Open Access

https://doi.org/10.1186/s12939-018-0732-1

Copy DOI

Abstract

BackgroundSocial exclusion is a concept that has been widely debated in recent years; a particular focus of the discussion has been its significance in relation to health. The meanings of the phrase “social exclusion”, and the closely associated term “social inclusion”, are contested in the literature. Both of these concepts are important in relation to health and the area of primary healthcare in particular. Thus, several tools for the measurement of social exclusion or social inclusion status in health care settings have been developed.MethodsA scoping review of the peer-reviewed and grey literature was conducted to examine tools developed since 2000 that measure social exclusion or social inclusion. We focused on those measurement tools developed for use with individual patients in healthcare settings. Efforts were made to obtain a copy of each of the original tools, and all relevant background literature. All tools retrieved were compared in tables, and the specific domains that were included in each measure were tabulated.ResultsTwenty-two measurement tools were included in the final scoping review. The majority of these had been specifically developed for the measurement of social inclusion or social exclusion, but a small number were created for the measurement of other closely aligned concepts. The majority of the tools included were constructed for engaging with patients in mental health settings. The tools varied greatly in their design, the scoring systems and the ways they were administered. The domains covered by these tools varied widely and some of the tools were quite narrow in the areas of focus. A review of the definitions of both social inclusion and social exclusion also revealed the variations among the explanations of these complex concepts.ConclusionsThere are several definitions of both social inclusion and social exclusion in use and they differ greatly in scope. While there are many tools that have been developed for measuring these concepts in healthcare settings, these do not have a primary healthcare focus. There is a need for the development of a tool for measuring social inclusion or social exclusion in primary healthcare settings.

Highlights

Social exclusion is a concept that has been widely debated in recent years; a particular focus of the discussion has been its significance in relation to health
The searches carried out were limited to papers in English, and those published since the year 2000. This scoping review offers a comprehensive description of existing work on the measurement at the individual level in healthcare settings of social exclusion and social inclusion
We have firstly shown that there is a wide range of definitions of both terms in use, and they tend to focus on quite different aspects of social exclusion and social inclusion

Summary

Introduction

Social exclusion is a concept that has been widely debated in recent years; a particular focus of the discussion has been its significance in relation to health. The government of the United Kingdom (UK) had championed the idea of focusing on exclusion, establishing a specific Social Exclusion Unit (SEU) in 1997, which became part of the Office of the Deputy Prime Minister to drive this agenda across government departments and policymaking activity [3, 8, 9] Many international bodies, such as the World Bank and the International Labour Organization, have adopted the concept of social exclusion for use in their spheres of influence [10–12]. Commentators have discussed the apparent rise in popularity of this relatively new term social exclusion; one wrote that “conventional measures of poverty and deprivation were considered inadequate to capture the alienation, isolation or ‘exclusion’ from socially normative functioning” [13] Others felt that this ‘new’ concept could be seen as more acceptable politically and less stigmatising for those people who are affected by it [10, 14]. Network, based on APQ 6 tool based on HOS below, but academic literature and published mental health h service user accounts influence tool developed meant to 4 facilitate discussion in clinical setting, based on theory of Pinfold [77]

Methods

Results

Discussion

Conclusion