Disadvantaged Urban Area Research Articles

Cross-cultural art therapy in the virtual realm: reimagining cultural proficiency in Kenya

ABSTRACT Background This article describes a remote psychosocial art therapy group for educators in Kenya, led by a Barbadian and an American art therapist, and explores cross-cultural considerations. Context Intervention took place in Kibera, Kenya, an economically disadvantaged urban area, in 2020–2021. Group participants explored experiences of trauma and loss, as illustrated in art therapy case examples, and psychoeducation was provided on arts-based, trauma-informed interventions for children. Approach Group goals were developed in conjunction with the hosting Kenyan NGOs. Outcomes Ongoing adaptations and flexibility were needed due to cross-cultural challenges and the group’s remote status. The art therapists strove to ground themselves in a reflexive, self-aware stance. Conclusions Despite the group’s remote status and varied cultural dilemmas, flexibility and the centring of participant voices promoted group cohesion. Art-making and the group container enabled the expression of shared trauma, loss, faith, and resilience. Group members introduced their own arts traditions into the group, building resilience and taking leadership. Implications for research Cross-cultural art therapy interventions hold promise if group participants are given the space to lead and set their own goals. Future studies should continue to identify challenges that arise in cross-cultural art therapy settings while also examining the long-term effects and efficacy of these interventions. Plain-language summary This article describes a remote art therapy project led in Kenya by a Barbadian and an American art therapist. It was hosted by two Kenyan NGOs, and was implemented by the Red Pencil, an international humanitarian organisation. Through the lens of this experience, the authors explore cross-cultural, remote art therapy practice, and its essential grounding in cultural competence, cultural humility, and the consideration of cross-cultural power dynamics. They share their experiences of implementing a remote art therapy group in Kibera, Kenya, a disadvantaged urban area, with Kenyan educators during the COVID-19 pandemic, and describe their aims to provide psychosocial support while maintaining an ethically informed, collaborative stance that centred participant voices. Flexibility and creativity were paramount to combat technical difficulties and limitations of the virtual space. Group cohesion and safety were fostered as participants adaptively initiated practices of healing and socialisation that were rooted in their own cultural traditions. Art therapy assisted in promoting expression and solidarity, as illustrated in case examples, for group members facing trauma, loss, and strains of the pandemic. Recommended future research includes the ongoing identification of challenges that arise in cross-cultural art therapy settings, and the examination of the long-term effects and efficacy of these interventions.

Supporting disengaged children and young people living with diabetes to self-care: a qualitative study in a socially disadvantaged and ethnically diverse urban area

ObjectiveTo explore how to enhance services to support the self-care of children and young people (CYP) clinically considered ‘disengaged’ by diabetes services.DesignQualitative study.SettingTwo diabetes clinics in an ethnically diverse and...

Urban social regeneration through local sports clubs: a case study of Ballymun, Dublin and Setanta GAA

Urban deprivation has led to governments implementing urban regeneration initiatives to combat the decay of disadvantaged urban areas. However, such initiatives often fail to tackle the social problems which affect these places and as a result they fail to benefit the residents of these neighbourhoods. This article will explore how local sports clubs can positively influence the social regeneration of disadvantaged areas by looking at how sports clubs can strengthen social capital, along with mitigating stigma attached to these areas. Ballymun in Dublin, Ireland will be used as an example of a disadvantaged urban area, while Setanta GAA will be used as an example of how local sports clubs can facilitate high levels of social capital and mitigate self-stigmatisation. Based on the findings, we recommend that the role of local sports clubs, along with integration from other local community groups, should be introduced into urban regeneration policy.

Disrupting the Pathway from Truancy to Delinquency: A Randomized Field Trial Test of the Longitudinal Impact of a School Engagement Program

ObjectiveTruancy in adolescence is related to detrimental developmental outcomes over the life-course, including a greater risk for delinquency during adolescence and offending in adulthood. This paper presents results from the Ability School Engagement Program (ASEP): a Third Party Policing partnership between schools and police that sought to disrupt the relationship between truancy and delinquency by communicating, in a procedurally fair dialogue, the legal responsibilities of parents to ensure their children attend school. This paper examines the impact of ASEP on antisocial behavior and the modifying effects of ASEP on the relationship between willingness to go to school and antisocial behavior.MethodsASEP was evaluated under randomized field trial conditions, where 102 truanting young people from a highly disadvantaged urban area in Brisbane, Australia, were randomly assigned to either the ASEP intervention or the business-as-usual condition.ResultsUtilizing four waves of survey data collected over a 2-year time period, we found evidence that ASEP was related to decreases in self-reported antisocial behavior throughout the 2 years study. We also find that ASEP lessened the negative relationship between willingness to go to school and self-reported antisocial behavior for those in the experimental condition up to 1 year post random allocation.ConclusionsPartnerships between schools and police that communicate, in a procedurally fair way, parental legal responsibilities for their children to attend school holds promise for increasing a truanting young person’s willingness to go to school and reducing their self-reported antisocial behaviour, at least in the short run.

Strengthening stakeholder buy-in and engagement for successful exploration and installation: A case study of the development of an area-wide, evidence-based prevention and early intervention strategy

BackgroundThe implementation of evidence-based programmes (EBPs) designed to improve outcomes for children and young people and prevent disadvantage is an increasingly important international policy imperative. However, the integration of EBPs into existing service settings and systems is a complex and multifaceted undertaking. MethodsA process evaluation was conducted to appraise the design and development of a large-scale, area-based, prevention and early intervention initiative. This initiative, called Youngballymun, consisted of five service strategies comprising a range of EBPs (e.g. the Incredible Years Programme, Highscope) targeted at children and young people and their families (from birth to 20 years). The initiative was designed to promote the development, adoption and implementation of EBPs within routine children and youth services in a disadvantaged urban area in the Republic of Ireland. The analytical approach involved the systematic analysis and triangulation of data obtained from relevant documentation (e.g. programme manuals, meeting minutes), as well as a series of one-to-one interviews (n = 27) and six group discussions with key stakeholders (n = 29). ResultsAdopting aspects of an implementation stages framework (Fixsen, Naoom, Blase, & Friedman, 2005), we examined the key implementation stages of exploration and installation. Data gathering and needs assessment and strategic organisational development played an important role in implementation. However, resistance to innovation amongst local service providers emerged as a major challenge to implementation. Factors identified as crucial to overcoming this challenge and promoting stakeholder buy-in for innovation included: encouraging and supporting stakeholder engagement; and adopting a flexible approach to implementation planning. ConclusionGenerating buy-in amongst stakeholders is central to ensuring a fit between innovative programmes and practices and the systems in which they are to be embedded. Some key lessons, such as the need for the active involvement of community-based service providers in the planning process at the earliest stages of implementation, are identified. The kinds of implementation strategies that may be used to address challenges to practice change and innovation, particularly stakeholder responsiveness to, and perceived compatibility of, EBPs, are discussed.

EEPIC - Enhancing Employability through Positive Interventions for improving Career potential: the impact of a high support career guidance intervention on the wellbeing, hopefulness, self-efficacy and employability of the long-term unemployed - a study protocol for a randomised controlled trial

BackgroundLabour market policy (LMP) and its implementation have undergone rapid change internationally in the last three decades with a continued trend towards active LMP. In Ireland however, this shift has been more recent with ongoing reforms since 2012 and a concomitant move toward active labour market ‘work-first’ policy design (i.e. whereby unemployed people are compulsorily required to work in return for their social welfare benefits). Labour market policies vary from those that require this compulsory approach to those which enable the unemployed to move towards sustainable quality work in the labour market through upskilling (human capital approach). Despite this, however, long-term unemployment—a major cause of poverty and social exclusion—remains high, while current employment support approaches aimed at sustainable re-employment are, arguably, unevaluated and under examined. This study examines the effectiveness of a new high support career guidance intervention in terms of its impact on aspects of wellbeing, perceived employability and enhancing career sustainability.MethodThe study involves a single-centre randomised, controlled, partially blinded trial. A total of 140 long-term unemployed job-seekers from a disadvantaged urban area will be randomly assigned to two groups: (1) an intervention group; and (2) a ‘service as usual’ group. Each group will be followed up immediately post intervention and six months later. The primary outcome is wellbeing at post intervention and at six-month follow-up. The secondary outcome is perceived employability, which includes a number of different facets including self-esteem, hopefulness, resilience and career self-efficacy.DiscussionThe study aims to assess the changes in, for example, psychological wellbeing, career efficacy and hopefulness, that occur as a result of participation in a high support intervention vs routinely available support. The results will help to inform policy and practice by indicating whether a therapeutic approach to job-seeking support is more effective for long-term unemployed job-seekers than routinely available (and less therapeutic) support. The findings will also be important in understanding what works and for whom with regard to potentially undoing the negative psychological impacts of unemployment, building psychological capital and employability within the individual, and developing career trajectories leading to more sustainable employment.Trial registrationISRCTN registry, ISRCTN16801028. Registered on 9 February 2016.

Causes of stillbirth in a socioeconomically disadvantaged urban Australian population – a comprehensive analysis

Introduction: The aim of this paper was to provide an in-depth analysis of all stillbirth causation over a period of 10 years in a busy maternity unit located in a socioeconomically disadvantaged urban area, with an emphasis on overlapping pathology.Materials and methods: A retrospective analysis of all structurally normal stillbirths in singleton pregnancies born during 2002–2012. The PSANZ stillbirth classification was used; per stillbirth subgroup main risk factors were evaluated.Results: Out of 130 cases, 43% showed overlapping pathologies. In the remaining 74 (56%) cases, the following single pathologies were found: IUGR 20 (15%), infection 12 (9%), abruption 8 (6%), placental thrombotic pathology 8 (6%), miscellaneous 6 stillbirths (5%), and 20 cases (15%) unexplained. Smoking was a risk factor for stillbirth associated with abruption (OR 3.639), infection (OR 2.271), and thrombotic pathology (OR 2.168). Drug use had an association with (placental) infection (OR 3.598). Obesity showed a significant association with IUGR (OR 3.782) and abruption (OR 9.040). Thrombophilia risk analysis for the overall group of stillbirths showed significant results for Protein S (OR 8.889) and homocysteine >90th centile (OR 2.087).Conclusions: Overlapping pathology was identified in 43% of stillbirths. Infection, IUGR, and abruption were the most important single cause of stillbirth.

Low parental support in late adolescence predicts obesity in young adulthood; Gender differences in a 12-year cohort of African Americans.

BackgroundMost studies that have investigated the link between parenting behaviors and risk of obesity among offsprings have mostly used a cross-sectional design, enrolled Caucasian samples, focused on childhood obesity, and covered aspects of parenting behaviors that directly influence energy balance and food intake of the children. Thus, more longitudinal research is needed on how more general aspects of parenting influence obesity in young ethnic minority adults. The current longitudinal study aimed to test if baseline parental support predicts change in body mass index (BMI) of African Americans, and if this prediction varies based on gender of offspring.MethodsThe current study followed 227 young African American adults (109 male and 118 female) for 12 years from year 2000 (mean age 20) to year 2012 (mean age 32). All participants were enrolled from a disadvantaged urban area in the Midwest of the United States. Baseline demographics (age, gender), socio-economics (family structure, and parental employment), psychological symptoms (anxiety and depression), general parental support (maternal support, and paternal support) were measured. BMI was measured at baseline and at follow up. We used gender-specific linear regressions to test the predictive role of baseline paternal and maternal support (year 2000) on change in BMI (from 2000 to 2012).ResultsRegression analysis showed that among female African American young adults, high baseline maternal support was predictive of a lower increase in BMI from 2000 to 2012. The association remained significant while all covariates were in the model. We could not find such an association for male African American young adults.ConclusionHigh maternal support appears to be protective against increases in BMI among African American female young adults. As parental support is a modifiable factor within available evidence-based interventions that enhance parenting, it should be included in obesity prevention programs for African American women. Policies and programs should support African American mothers in disadvantaged neighborhoods to enable them to provide high levels of parental support for their young adult daughters. Future research should test the efficacy of such programs and policies for reducing obesity among African American women.

Evaluating a Health Care Partnership in Australia

Introduction: Local Health Districts in Australia are responsible for providing publicly-funded community and hospital health services. Medicare Locals support primary health care doctors (general practitioners) and provide other primary health care services. Historically this care has not been systematically integrated. In 2012, Western Sydney Local Health District (WSLHD) and Western Sydney Medicare Local (WSML) signed a Partnership Memorandum committing to integrating health services in this relatively disadvantaged urban area. Theory/ Model: We undertook an evaluation of the consequences of the Partnership using a Program Logic Model (PLM).We met with key stakeholders to define inputs, activities, outputs, outcomes and early impacts and to assign measurable indicators of progress in each component. We collected quantitative and qualitative data from a review of local health and health services data, documents related to the partnership and semi-structured interviews with a range of informants and organisational representatives. We analysed these data descriptively using the PLM as a framework. Interview transcripts were further analysed using an inductive approach to identify areas of achievement and facilitators of the Partnership, challenges and barriers to the Partnership and to make recommendations for its future development of integrated health services. Results: The common geography and therefore population health needs faced by WSLHD and WSML have been key factors in building a shared vision and agreeing on common priorities. 15th International Conference on Integrated Care, Edinburgh, UK, March 25-27, 2015 1 International Journal of Integrated Care – Volume 15, 27 May – URN:NBN:NL:UI:10-1-116964 – http://www.ijic.org/ Operationalization of the Partnership has been facilitated by strong governance arrangements. Previous relationships and joint activities contributed to mutual respect, trust, and collegiality. In common with many partnerships at this early stage, the strong leadership provided by senior management, was not always evident at operational levels of the organisations, where resourcing of partnership activities may have been an issue. In addition to new shared oversight arrangements for pre-existing health programs, a number of new services have been established under the Partnership. Focussing on a limited number of agreed health priority areas has driven the implementation of key activities and achievement of early outcomes, although the need for adequate resourcing limited the number and range of these areas that could be actively engaged at any one time. Several initiatives focussed on integration of health information are likely to facilitate integration of health care across primary and secondary/ tertiary settings in the future, however service connectivity including sharing of patient records remains a challenge at present. Discussion: The enormous complexity of this undertaking, noted in evaluations of similar initiatives, has been compounded by policy changes and uncertainty surrounding primary health care organisations in Australia. Despite these challenges the Partnership has clearly articulated its vision of coordination and integration of healthcare across western Sydney, as summarized by the WentWest Chair: “Think as one system and act as if there are no barriers.” Organizational leadership, strong governance and mutual trust and respect have been essential to its early achievements. Differences in organisational size, governance and structure don’t preclude partnership, though integration of services takes longer to achieve and the consequent health outcomes, even longer. Conclusions: Although the Partnership is just one element of a very complex system, after two years the groundwork has been largely established for the Partnership to produce outputs that will benefit health outcomes in region. The findings of this evaluation have been considered by the WSLHD-WSML Partnership Advisory Council and used to inform ongoing Partnership activities. Lessons learned: Establishment and maintenance of organizational partnerships, whilst challenging, provide a basis for health care integration. Time invested early in the course of the Partnership in developing a structured evaluation framework, for example using a PLM approach, enables evaluation of all components of the Partnership, though outcomes and impacts require longer term measurement. The PLM approach provides a useful framework for mapping the Partnership and a valuable tool for evaluation. Evaluation of the inputs, activities and outputs of the Partnership at this early stage has informed review and re-direction of resources and activities. Collection of baseline data related to longer term outcomes and impacts of the Partnership will facilitate future evaluations. Limitations: This evaluation is limited to the first 18 months of a single partnership in a relatively disadvantaged area of urban Australia at a time of considerable policy upheaval. Nevertheless, the study has informed the Partnership’s ongoing development and demonstrates a methodology for evaluation of similar partnerships. Suggestions for future research: The PLM approach provides a framework for longer term evaluation of health service partnerships. Future studies should explore in more depth how the policy environment both constrains and enables effective organizational partnerships.

Khat Use, PTSD and Psychotic Symptoms among Somali Refugees in Nairobi - A Pilot Study.

In East-African and Arab countries, khat leaves are traditionally chewed in social settings. They contain the amphetamine-like alkaloid cathinone. Especially among Somali refugees, khat use has been associated with psychiatric symptoms. We assessed khat-use patterns and psychiatric symptoms among male Somali refugees living in a disadvantaged urban settlement area in Kenya, a large group that has not yet received scientific attention. We wanted to explore consume patterns and study the associations between khat use, traumatic experiences, and psychotic symptoms. Using privileged access sampling, we recruited 33 healthy male khat chewers and 15 comparable non-chewers. Based on extensive preparatory work, we assessed khat use, khat dependence according to DSM-IV, traumatic experiences, posttraumatic stress disorder (PTSD), and psychotic symptoms using standardized diagnostic instruments that had been adapted to the Somali language and culture. Hazardous use patterns like chewing for more than 24 h without interruption were frequently reported. All khat users fulfilled the DSM-IV-criteria for dependence and 85% reported functional khat use, i.e., that khat helps them to forget painful experiences. We found that the studied group was heavily burdened by traumatic events and posttraumatic symptoms. Khat users had experienced more traumatic events and had more often PTSD than non-users. Most khat users experience khat-related psychotic symptoms and in a quarter of them we found true psychotic symptoms. In contrast, among control group members no psychotic symptoms could be detected. We found first evidence for the existence and high prevalence of severely hazardous use patterns, comorbid psychiatric symptoms, and khat use as a self-medication of trauma-consequences among male Somali refugees in urban Kenyan refugee settlements. There is a high burden by psychopathology and adequate community-based interventions urgently need to be developed.

Inhabitants’ and professionals’ social representations of health determinants in a disadvantaged urban area in France: A qualitative analysis

Background and objectiveAccess to care in French disadvantaged urban areas remains an issue despite the implementation of local healthcare structures. To understand this contradiction, we investigated social representations held by inhabitants of such areas, as well as those of social and healthcare professionals, regarding events or behaviours that can impact low-income individuals’ health. MethodIn the context of a health diagnosis, 288 inhabitants living in five disadvantaged districts of Aix-les-Bains, as well as 28 professionals working in these districts, completed an open-ended questionnaire. The two groups of respondents were asked to describe what could have an impact on health status from the inhabitants’ point of view. The textual responses were analyzed using the Alceste method. ResultsWe observed a number of differences in the way the inhabitants and professionals represented determinants of health in disadvantaged urban areas: the former proposed a representation mixing personal responsibility with physiological, social, familial, and professional aspects, whereas the latter associated health issues with marginalization (financial, drug, or alcohol problems) and personal responsibility. Both inhabitants and professionals mentioned control over events and lifestyle as determinants of health. DiscussionThe results are discussed regarding the consequences of these different representations on the beneficiary – healthcare-provider relationship in terms of communication and trust.

Social Characteristics of Psychological Distress in a Disadvantaged Urban Area of Kazakhstan

The present study aimed to systematically assess the association of socio-economic characteristics and psychological distress in a disadvantaged urban area of a post-Soviet Republic. Psychological distress was assessed in a random sample of 200 persons, aged 18-57, living in a disadvantaged urban area of Kazakhstan using the General Health Questionnaire with 28 items (GHQ-28). Bivariate and multivariate analyses were used to examine the association of social characteristics and psychological distress. Female gender (P<0.05), living without a partner (P<0.01), higher age (P<0.01), unemployment (P<0.01), and low perceived income (P<0.05) were associated with psychological distress in multivariate analyses. Non-Kazakh ethnicity (P<0.05) was linked with psychological distress in bivariate analyses. The educational level was not significantly associated with psychological distress. Women, aged 38-57, living without partner and with low access to financial resources, were at a very high risk of psychological distress. Possibly due to social drift or status inconsistency, higher educational levels were not associated with lower levels of psychological distress in the disadvantaged area.

Individuality and Contextual Influences on Drug Dependence: A 15-Year Prospective Longitudinal Study of Adolescents From Harlem

ABSTRACT In this 15-year longitudinal study the authors investigated individual and contextual factors that predispose adolescents from a disadvantaged urban area to drug dependence in adulthood. Adolescents were recruited from schools serving East Harlem in New York City. Of the 838 participants followed to adulthood, 59% were women, 55% were African American, and 45% were Puerto Rican. Self-report data were obtained on externalizing and internalizing problems, substance use, and contextual influences across adolescence and young adulthood. Drug dependence was assessed in adulthood. Multivariate logistic regressions of drug dependence were performed on the whole sample and separately by gender. Each of the domains was associated with adult drug dependence. Although mean gender differences were found, most associations of risk factors with drug dependence did not vary significantly by gender. Treating externalizing and internalizing problems, reducing substance use, and providing coping skills for adverse contextual influences in adolescence and young adulthood may reduce the likelihood of becoming drug dependent in adulthood.

Homeownership and Local Voting in Disadvantaged Urban Neighborhoods

Homeownership has long been considered the cornerstone of the American dream, and considerable research has pointed to the social benefits of homeownership for both families and communities. Yet research concerning this link between homeownership and social participation has recently undergone critique for failing to consider neighborhood context. Do homeowners in disadvantaged urban neighborhoods become active participants in neighborhood improvement, or do they feel stuck in undesirable neighborhoods where they perceive little potential for change? The research addresses endogeneity concerns and shows that, when compared with renters, homeowners are more likely to have voted in recent local elections. Neighborhood context does moderate this relationship, with homeowners in disadvantaged neighborhoods being more likely to vote than owners in other areas. These findings suggest that, despite potential household-level costs associated with owning a home in a disadvantaged urban area, responsible homeownership in such areas promotes local political involvement among lower income residents.

“You have to engage with life, or life will go away”: An intersectional life course analysis of older women’s social participation in a disadvantaged urban area

Social participation in later life has been studied as part of discourses around ‘active ageing’ but the promotion of participation in disadvantaged urban neighbourhoods meets with particular challenges. In this paper I argue that in order to effectively promote social participation in later life researchers and practitioners require an understanding of life-long relational practices which are embedded in social norms and places as they intersect with identities such as gender, class and age.The intersectional life course analysis traces complex relationalities between people and place across the life course of two women living in disadvantaged urban areas. It shows the effects of societal and structural changes on individuals’ opportunities for social participation as well as demonstrating how age-related relational practices may lead to spatial segregation of older people in society.

The Contribution of a Social Enterprise to the Building of Social Capital in a Disadvantaged Urban Area of London.

There has been much enthusiasm over the past 10 years for the potential contribution of social enterprises to the regeneration of disadvantaged urban areas. This enthusiasm has far outstripped the availability of empirical evidence. This paper reports a qualitative study of one social enterprise, a community café, and its contribution to building social capital in a disadvantaged urban area in London. The analysis reveals how the café builds 'bonding' and 'bridging' social capital whilst also addressing 'downside' social capital. Overall, the manager of the social enterprise played a considerable role in facilitating the development of social capital, thus emphasising the importance of individuals and their attitudes, skills, and background in urban regeneration. However, the role of the social enterprise in building 'linking' social capital was minor. In this instance, more effective mechanisms of community engagement need to be put in place in order to empower local residents and organisations.

Understanding Risk, Choice and Amenity in an Urban Area at Risk of Flooding

This paper reports on a qualitative interview study of residents' perceptions of the probability and impact of flooding in a socially disadvantaged urban area identified and publicised as at risk of inundation. The people in this study engage with expert definitions of flood risk, but expert knowledge is not their most important reference point. While residents understand that the area is at risk of flooding, two key points emerge in their discussions of this risk. First, for most participants knowledge of this risk does not translate into personal worry; second, risk knowledge is balanced against their valuing of amenities in the area. While risk is of sociological and policy interest, for people living within, rather than analysing, areas prone to natural disasters risk is not the defining element of life; rather, it is contextualised within people's housing history, choices (or lack thereof) and experiences of an area.

Maternal Prenatal Stress and Later Child Behavioral Problems in an Urban South African Setting

Findings from a number of cohort studies suggest that children who are exposed to maternal stress during pregnancy have an increased risk of behavioral problems. All of the research assessing this association to date has been conducted in developed countries; yet the majority of the child population, and the majority of the burden of psychopathology, exist in developing nations, where different patterns and levels of stressors may exist. The present study set out to examine whether maternal prenatal stress is associated with an increased risk of subsequent child behavioral problems in a developing country. Participants (n = 953) were from Birth to Twenty, a longitudinal birth cohort study based in Soweto-Johannesburg, South Africa, a socioeconomically disadvantaged urban area. Pregnant women completed questionnaires assessing stressors, and children's behavioral functioning was subsequently assessed when they were aged 2 and 4 years. Children whose mothers had high levels of prenatal stressors did not have an increased risk of behavioral problems at age 2 years, but they did at 4 years (adjusted odds ratio 2.52 [CI = 1.04, 6.09]). Partner conflict and family adversity were the stressors most strongly associated with adverse child outcome. These findings highlight the importance of the psychological health of pregnant women in developing countries, both for the mother and her offspring, and the need for greater research in resource-poor settings.

'Knocking at St Peter's door'. A qualitative study of recovery after a heart attack and the experience of cardiac rehabilitation

This paper presents the findings of a study designed to explore myocardial infarction (MI) survivors' experiences of their heart attack, to obtain their views on existing services and to gather ideas for a new, community-based cardiac rehabilitation initiative. Despite the increasing emphasis on the consumer ‘voice’ in health service delivery, little research has been published exploring the experience of MI from the patient's perspective. This is of particular significance given the study's location in a disadvantaged urban area where the uptake of conventional hospital-based cardiac rehabilitation is poor. The study is based on qualitative, semi-structured interviews with 20 myocardial infarction survivors in southeast Nottingham. Participants were identified from the list of those invited to participate in a local hospital's cardiac rehabilitation programme. The interviews were carried out in patient's home between one and 12 months after the MI, were tape recorded and subsequently transcribed. Thematic analysis reflected both the issues identified in the interview schedule but also some unexpected findings elucidating the survivors' own perspectives. The paper is structured around four key themes: the story of the heart attack; the way survivors' lives have changed; experiences of existing services and ideas for service development. The paper concludes that MI should be understood as a long-term rather than an acute condition and discusses the implications for service delivery.

Children's experience of public space

Children and young people regard the external physical environment as important for their needs. Their use of space varies according to age and circumstance and includes designated play and leisure facilities as well as other informal areas within their neighbourhoods. However, children have little influence over the development of public space as they do not have the opportunity to contribute their views to local processes. This paper explores children's and young people's views and experience of public space in regeneration areas. It considers whether children's perspectives are accurately reflected in public policy. It draws on primary research with young people aged ten to 14 years and representatives from local organisations in a disadvantaged urban area in Scotland.