Perspective Of Service Providers Research Articles

2014 The experience of frailty in the Tanzanian hospital system: A qualitative exploration service user and provider perspectives

Abstract Background Frailty is becoming increasingly prevalent in Low- and Middle-Income Countries (LMICs). However, little is known about the lived experience of older people with frailty in their interactions with the healthcare systems in LMICs. This study aimed to explore the experiences, attitudes and needs of hospitalised older people with frailty in a low-income setting, from the perspective of service users and providers. Methods A purposive sample of older people with frailty recently admitted to hospital, their carers and healthcare providers, were recruited from four hospitals in the Kilimanjaro Region of Tanzania. One-to-one and dyad interviews were conducted in Swahili, based around a structured topic guide. Recordings were transcribed and translated into English in an iterative process aimed at preserving the original meaning through “transliteration”. Transcripts were analysed using a reflexive thematic paradigm. Results Interviews with 43 service users and 15 service providers highlighted the cultural norm of respect and value placed on older people; as such it is considered the role of everyone in society to provide care. However, many working age adults struggle with the competing responsibilities of supporting their parents and their children. Maintaining strong relationships with family and financial preparation were therefore considered critical to healthy ageing. The complex health problems and significant care needs of older people with frailty pose a considerable challenge during hospital admission. On the ward, family often take responsibility for personal care and feeding to reduce the work of healthcare providers. Economic worries and resource scarcity impact every part of the patient journey from struggles in accessing hospital services, to quality of care during admission and after discharge. Conclusion Frailty is understood as a communitywide issue in Tanzania, and family are expected to take a much larger role in care during acute hospital admission, partly mitigating the impact of resource scarcity.

An Exploratory Study of State-Level Policies to Address Domestic Violence-Related Needs of Asian Indian Marriage Migrants: Perspectives of Service Providers Across Five States

ABSTRACT Domestic violence experiences of Asian Indian marriage migrants are unique due to an interplay of distinct aspects of their life contexts in the United States, such as immigration status, language barriers, and social support. What gaps exist in state-level policies to address the needs and concerns of abused Asian Indian marriage migrants? This research examines the question with interviews of 11 nonprofit sector professionals working closely with Asian Indian women across five states – California, Texas, New York, New Jersey, and North Carolina. The findings indicate that five critical areas of policy interventions profoundly impact the experiences of abused Asian Indian marriage migrants as they begin their journey to live independently of the abuser. Examining the strengths and weaknesses of these policies highlights that future holistic interventions should be strengthened to support the creation of a safe and protective environment for abused Asian Indian marriage migrants to navigate their lives.

Health equity and gendered border blindness: an exploration of healthcare services at the international border in Rajasthan

ObjectivesCitizens' access to health care and the delivery of the healthcare services is significantly affected by the spatiality of the regions and the connectedness of the elements of the healthcare system. This network of healthcare system, region and delivery of services faces myriad challenges in the borderland geography, which is characterised by accentuated military presence, poor physical infrastructure, disinterest of habitation near the border, lack of adequate, necessary and allied services such as schools and industry, social seclusion, migration etc. All these factors amalgamate to create an effect of gender-blind phenomenon as well as border-blind phenomenon. This is particularly acute for women and children. Study designA phenomenology research design has been used for the study. It encapsulates qualitative aspects of the views of those who experience marginalisation inclusive of gender-blind experiences. Marginalised women and frontline healthcare workers at the borderland were considered for the inquiry in this study. The study is a composite description of the phenomenon. MethodsThe border districts of Rajasthan from the Radcliffe line of Rajasthan have been identified for the purpose of the study. Using narrative ethnography along with interviews, an examination was executed from health professionals and marginalised women to comprehend health care access and equity from the service provider's perspective as well as the beneficiary's perspective. ResultsThe study provides a range of attributions based on which it could be established that health inequities exist in bordering rural areas. ConclusionsThe study realises the geopolitical influence of the Radcliffe line, where borderlands are commonly vital to the continuum struggle between the centre and state. Yet, there remains a gap towards implementing various schemes and services due to varied reasons for access from main to far-off border areas, making the situation vulnerable from a resource deficiency point of view. The Health Equity Framework cannot meet Social Determinants of Health in borderland areas of Rajasthan.

Barriers to HIV testing and possible interventions to improve access to HIV healthcare among migrants, with a focus on migrant women: Results from a European survey.

According to European Centre for Disease Prevention and Control (ECDC) reports, women and migrants are more likely to have delayed HIV diagnosis (CD4 <350 cells/mm3). As a follow-up to a previously published systematic review revealing a range of barriers to HIV testing among migrant women, the aim of the present study was to identify barriers to HIV testing from the perspective of service providers and to formulate possible interventions to improve access to HIV healthcare among migrants in Europe, with an emphasis on migrant women. Between November 2021 and February 2022 an online survey, consisting of 20 questions, was forwarded to 178 stakeholders and non-governmental organizations (NGOs) working with migrant populations in 33 countries from the World Health Organization (WHO) European region. Forty-three responses from 14 countries were analysed. Most respondents (70%) judged migrants' access to healthcare as worse than that for the resident native population. Only 2/11 prevention interventions were available to all in at least 50% of participating countries. The three main barriers to accessing healthcare for migrant women and reasons for late HIV diagnosis among migrant women were stigma and discrimination, language barriers, and cultural barriers. Many HIV prevention interventions are not free of charge for all within Europe. The results of this survey show that migrant women face many barriers to accessing healthcare and that these might contribute to late HIV diagnosis. Simplification of access to free healthcare for all, more awareness raising about HIV screening and prevention among migrant women, and more migrant-focused outreach programmes are suggested to improve migrant women's access to HIV healthcare in Europe.

Food provision to support improved nutrition and well-being of people experiencing disadvantage - perspectives of service providers.

Diet quality is significantly impacted by social and environmental factors. People experiencing socio-economic disadvantage face inequitable barriers to accessing nutritious foods and health services, resulting in significant health disparities. This study aimed to explore the barriers faced by organisations that provide food support to people experiencing disadvantage as well as to identify potential strategies to enhance this support for improved well-being of clients. Semi-structured interviews using an exploratory approach and inductive thematic analysis. Australia. Individuals from organisations involved in the provision of food support for people experiencing disadvantage aged ≥16 years. Two major themes were identified from thirteen interviews. 'Dignity and respect for clients' serves as a guiding principle for food-related services across all organisations, while 'food' was a point of connection and a potential gateway to additional support pathways. Five additional subthemes included 'food as a platform to reduce social isolation, foster connection and promote participation', challenges with 'servicing clients with diverse experiences and needs', 'dependence on staff and volunteers with varying knowledge and skillsets', ensuring 'adequate access to services, resources and facilities' and 'necessity of community collaboration'. This study highlights the unique position of organisations involved in food support to identify client-specific needs and implement broader holistic health support. Future interventions should prioritise dignity, respect and social connection in design. Organisations require an adequately trained, sustainable workforce, with shared or enhanced services, resources and facilities, and greater community coordination with other services to maximise effectiveness.

Factors Related to Client Satisfaction with Community Based Health Insurance Services During COVID-19 Pandemic in Central Uganda: A Mixed Methods Healthcare Facility Based Study.

During the COVID-19 lockdowns, healthcare services were disrupted and community-based health insurance (CBHI) schemes could not operate efficiently. This study assessed the level of client satisfaction with CBHI schemes, associated factors, and service provider perspectives in central Uganda. This was an explanatory sequential mixed-methods (quantitative - qualitative) study that was conducted between March and September 2021. In the first phase, a cross-sectional study among the 365 clients of the CBHI schemes who were aged ≥18 years old. The participants were recruited consecutively as they reported to the healthcare facility. Quantitative data were collected at patient exit using a piloted semi-structured interviewer-administered questionnaire. In the second phase, qualitative data were collected through 11 key informant interviews. These data were analyzed using a deductive thematic analysis approach. Modified Poisson regression was used to assess factors associated with client satisfaction and a p-value ≤0.05 at a 95% confidence interval was considered to be statistically significant. Of the total number of participants, 38.9% (142/365) were "satisfied" with the CBHI services. Less satisfaction was associated with secondary level of education or above (adjPR = 0.55, 95% CI: 0.36-0.85, P=.007); residing beyond 16 kilometers from the healthcare facility (adjPR = 0.68, 95% CI: 0.41-0.95, P=.014); staying on the scheme for over 3 years (adjPR = 0.71, 95% CI: 0.51-0.99, P=.046); and good knowledge about the CBHI (adjPR = 0.76, 95% CI: 0.58-0.99, P=.040). Irregular availability of healthcare workers and long waiting time affected client satisfaction. Satisfaction was considerably low during the lockdown. Lockdowns due to pandemics interrupt healthcare services and subsequently affect the satisfaction of CBHI clients with scheme services. Scheme managers need to identify facilities that are closer to enrolees and invest in technologies that reduce waiting time in the healthcare facility.

Developing a spectrum model of engagement in services for first episode psychosis: beyond attendance.

Early intervention services (EIS) for psychosis have proven highly effective in treating first episode psychosis. Yet, retention or "engagement" in EIS remains highly variable. Dis/engagement as a contested concept and fluid process involving relationships between service providers and service users remains poorly understood. This study aimed to critically evaluate and explain the dynamic interplay of service provider-user relationships in effecting dis/engagement from an early intervention program for psychosis. Forty study participants, 16 service providers and 24 service users (19 current and 5 disengaged) from a Canadian EIS program, were administered semi-structured interviews. Qualitative analysis was conducted using grounded theory methods, with findings captured and reconceptualized in a novel explanatory model. A model of engagement with eight major domains of engagement in EIS positioned along a control-autonomy spectrum was developed from the findings, with Clinical engagement (attendance) and Life engagement (life activities) at opposite ends of the spectrum, interspersed by six intermediate domains: Medication/treatment, Symptoms/illness, Mental health, Physical health/wellness, Communication, and Relationships, each domain bearing uniquely on engagement. An examination of service user and service provider perspectives on the various domains identified in the spectrum model, and their dynamic interplay, reveals the complexity of choices faced by service users in engaging and not engaging with services.

Service Provider Perspectives on the Differences between Place‐Based and Scattered‐Site Permanent Supportive Housing in Los Angeles County after the Onset of the COVID‐19 Pandemic

Background. Permanent supportive housing (PSH) is an evidence‐based solution to chronic homelessness. There are two common PSH models: place‐based (PB) programs where clients live in one building with services provided onsite and scattered‐site (SS) programs, which use community apartments coupled with mobile case management and support. Understanding the relative strengths and weaknesses of PB and SS is important for PSH planning and service delivery. This paper explores homeless service provider perspectives on these two models after the onset of the COVID‐19 pandemic. Methods. Service providers (N = 37) from across 5 PSH agencies in Los Angeles that provided either PB or SS services during the pandemic participated in focus groups. Discussions were recorded, transcribed, and analyzed using template analysis, grounded theory, and inductive techniques. Results. Providers identified four major differences between PB and SS services: (1) challenges in finding placements; (2) managing relationships with landlords/property managers; (3) frequency of contact; and (4) community integration. Advantages of PB included ease of finding units, ease of managing relationships with landlords/property managers, greater ability to serve clients efficiently, more frequent client contact, and more community among residents. SS was seen to provide tenants with more opportunities to grow, live in healthier environments, and develop independence. During the pandemic, finding units for SS clients became more difficult, while differences between PB and SS related to frequency of contact and community integration became more attenuated. Conclusions. PB can be advantageous for clients with higher levels of acuity, whereas SS could be more appropriate for clients who are more stable and independent. PB programs are seen to have practical and logistical advantages, but some providers prefer SS services. Clients and providers should be matched to PSH configurations that best match their needs and preferences, and providers should be aware that public health emergencies may impact PB and SS settings differently.

Digital nomadism and cities: exploring the production of mobility infrastructures in Barcelona

This study explores digital nomadism (DN) from the perspective of local service providers. Anchored in the new mobilities paradigm, it aims to explore the territorial impacts of DN in Barcelona, focusing on coworking and coliving businesses. How do service providers perceive digital nomads? How do they adapt their businesses to digital nomads? Three main findings emerge. Firstly, this article pinpoints the importance of shifting the focus from identity of digital nomads to the practice of working remotely while travelling in order to have a more nuanced discussion over the local impacts of DN. Secondly, it presents six adaptation strategies of local businesses and their broader implications for the city, including the emergence of new services, the reconfiguration of the built environment, and ongoing gentrification processes. Thirdly, the study sheds light on the complex interactions between public and private sectors in adapting urban services to digital nomads, often at the expense of the local communities.

Challenges and adaptations of mental health services during the COVID-19 Pandemic in Uganda.

Coronavirus disease (COVID-19) significantly impacted mental health and mental health services worldwide. We sought to explore the challenges faced by mental health services from the perspectives of service users, providers, and policymakers during the COVID-19 pandemic in Uganda and the strategies put in place to ensure the continuity of these services. qualitative data were collected using semi-structured interviews with eight mental health service users, four mental health workers, four hospital administrators, four district mental health focal persons, and two policymakers. The data were analyzed using thematic analysis. the challenges reported by participants included human resource shortages, loss of space for service provision, low funding, drug shortages, changes in patient load, and lack of access to services due to restrictive measures. The adaptations included the use of innovative means like mobile phone technology, reorientation of health facility functioning to COVID-19 restrictions, using different methods to deliver medications, integration of mental health in general health services, and alternative financing for mental health services. the COVID-19 pandemic posed significant challenges to mental health service provision. Nevertheless, the health system responded by implementing various measures to ensure continuity of care. Further research is needed to evaluate the effectiveness and scalability of these innovations in the long term.

Deep CNN and LSTM Approaches for Efficient Workload Prediction in Cloud Environment

In the dynamic landscape of cloud computing, efficient resource allocation and workload prediction are paramount for optimizing infrastructure utilization, cost management, and overall service quality. As a result, an efficient resource management approach involves pooling available resources among many customers in a manner that considers their energy usage, SLAs, and forecasting accuracy all at once. Based on the performance analysis results, it is determined that integrating these techniques would result in the most efficient and adaptable cloud data centre. We proposed a Model based on Deep Convolutional Neural Networks (DCNN) and Long Short-Term Memory (LSTM) for handling SLAs in the cloud from both the perspective of consumers and service providers. Subsequently, we delve into the methodology of applying deep CNN and LSTM models to the problem of workload prediction in cloud environments. This methodology encompasses data preprocessing, model architecture, training parameters, and the choice of performance metrics. To anticipate CPU consumption from time series data and detect SLA violations, we suggested a DCNN-LSTM model. The accuracy prediction, energy usage, CPU use, and Service Level Agreement monitoring are all a part of this model. The proposed method is effective in helping cloud providers cut down on service violations and associated fines. Regarding the composite metric of Energy SLA Violation, which assesses the combined aspects of energy use and adherence to Service Level Agreements (SLAs), DCNN-LSTM surpasses ARIMA-LSTM, CNN, LSTM, and ARIMA 6.8%, 10.88%, 16.6%, and 22.4%, respectively.

"A whole ball of all-togetherness": The interwoven experiences of intimate partner violence, brain injury, and mental health.

Intimate partner violence (IPV) is a global public health crisis, with physical violence leaving IPV survivors at high risk of brain injury (BI). Both BI and IPV have significant physical, psychological, cognitive, and social impacts, including a high risk of mental health concerns, yet there is limited exploration of IPV survivors' experiences with BI and mental health. This study aimed to explore the BI- and mental health-related needs and experiences of IPV survivors from the perspectives of survivors and service providers with the objective of developing knowledge translation materials to raise awareness and support survivors and service providers in addressing these concerns. This qualitative interpretive description study involved 19 semi-structured interviews and two focus group discussions (2-3 participants each) with 24 participants including IPV survivors experiencing BI and mental health concerns as well as IPV, mental health, and BI service providers between October 2020 and February 2021. Three screening questions were used to identify probable BI among survivors. Participants across groups were an average of 48.5±12.7 years old and were predominantly cisgender women (96%), of European origin (75%), with a university degree (71%). Interviews were recorded, transcribed, and thematically analyzed. Across interviews, participants spoke about IPV, BI, and mental health as being complex and interrelated experiences that have impacts across the survivor's life and extend well beyond the abusive relationship. Because of the underrecognized nature of BI in IPV, finding and accessing care requires persistence that survivors spoke of as being like "a full-time job." The benefit of making meaningful connections, particularly with other survivors, was highlighted. Recognition of BI as a contributing factor shaping the lived experience of IPV survivors; acknowledgement that the impacts of IPV, BI, and mental health are far reaching and long lasting; and reducing barriers to finding and accessing appropriate care are critical to better supporting IPV survivors with BI and mental health concerns. Clinicians should consider BI and its lingering impacts among the IPV survivors with whom they work. Health and social policy that supports integration of care and the reduction of unnecessary barriers should be a priority.

Exploring the perceptions of health service providers and adolescents on the utilization of adolescent sexual and reproductive health services in Tikur, 2023: A qualitative study.

Globally, twenty-three million adolescents aged 15-19 years have an unmet need for sexual and reproductive health services and are at risk of unintended pregnancy. In Sub-Saharan Africa, including Ethiopia, it might be difficult for adolescents to get access to sexual and reproductive health services that are acceptable to use. Privacy, a fear of sharing health concerns, a sociocultural environment, the unfriendliness of current services, and traditional taboos are some of the key reasons. This study aimed to explore the perspectives of service providers and adolescents on the use of sexual and reproductive health services. A qualitative phenomenological study was conducted from January to February 2023 in the Tikur Anbessa specialized hospital. Purposive sampling was applied to select the study participants. A total of 17 in-depth interviews (with 7 adolescents and 10 health providers) were held. Instead of relying on the number of participants, data saturation was used. Thematic analysis was employed in analyzing the data. The findings indicate that obstacles to the use of sexual and reproductive health services include challenges related to the availability of resources and accessibility; resistance from religious beliefs, cultural beliefs, and customs; quality and institutional-related challenges; and stigma and discrimination in sexual and reproductive health services, which pose the biggest barrier to health professionals providing standardized sexual and reproductive health services. A multi-pronged approach should be created to overcome these challenges, including community outreach for sexual and reproductive health and increasing awareness of the importance of early access to sexual and reproductive health through appropriate community forums. Existing sexual and reproductive health services are not promoted to adolescents and youth, and a lack of and difficulty getting resources for sexual and reproductive health services should be resolved.

PENGEMBANGAN SUMBER DAYA MANUSIA UNTUK PENINGKATAN KUALITAS PEGAWAI DI PT KERETA API INDONESIA (PERSERO)

PT Kereta Api Indonesia (Persero) has established an HR development program. The company's main goal is to transform the employee perspective into a service provider perspective by fostering high-level expertise, increasing individual productivity, and enabling them to better contribute to initiatives aimed at increasing business success. The purpose of the research is to find out the HR development programs carried out by PT Kereta Api Indonesia (Persero) to improve the quality of employees. The method used is descriptive qualitative with data collection through literature study. The results showed that PT Kereta Api Indonesia (Persero) has a human resource development strategy, including a quality recruitment process by finding qualified candidates through job fairs at various prestigious universities and competency-based education and training (Diklat) programs held in stages, starting from the professional growth stage to the development of fundamental competencies through six available training venues.

Describing providers’ perspectives on the needs and challenges of family caregivers of African American people living with dementia

ABSTRACT The primary purpose of this study was to explore the needs and challenges of African American family caregivers of People living with dementia (PLWD) from the perspective of service providers including healthcare and social service providers. The study conducted three online semi-structured focus group interviews with service providers (n = 15). Data were analyzed using Braun & Clarke’s guide to thematic analysis approach. Five themes emerged from the analysis of the focus group data: (i) Inadequate information about resources; (ii) Dementia education; (iii) Burden of dementia on families; (iv) Limited financial support and funding; and (v) Suggestions for needed resources. Service providers expressed the lack of community-based dementia service and support programs in African American communities. Findings from the study indicated the need to provide culturally appropriate information on dementia caregiving. This study adds to the scope of knowledge by exploring the processes of seeking help and using services.

Voices from the field: exploring service providers’ insights into service delivery and AAC use in Canada

Use of augmentative and alternative communication (AAC) often relies on the involvement of AAC service providers; however little is known about how AAC services are delivered across Canada. This study aimed to explore AAC service provision and factors influencing use of AAC from the perspectives of service providers across Canada who are involved in providing and/or supporting use of AAC systems. The 22 participants from nine (of the 10) provinces participated in online focus groups. Participants were speech-language pathologists, occupational therapists, communicative disorders assistants, and a teacher. Transcripts of the audio recordings were analyzed using reflexive thematic analysis. Four themes were generated that reflect service-related factors contributing to the use of AAC in Canada: Support of Organizational Structures, Concordant Relationships and Goals, Making the Right Decisions, and Influence of Knowledge and Attitudes. These themes highlight how government systems, key stakeholders, assessment practices, and knowledge of AAC influence service provision and use of AAC. Voices from across Canada highlighted shared experiences of services providers as well as revealed variability in service delivery processes. The findings bring to attention a need for further research and development of service provision guidelines to support consistency, quality in practice, and equity in AAC services.

SERVICE PROVIDER PERSPECTIVES ON ADVANCE CARE PLANNING USE IN RURAL DEMENTIA PATIENTS AND CAREGIVERS

Abstract Compared to urban areas, advance care planning (ACP) utilization remains very limited in rural communities. ACP earlier in the disease trajectory is particularly important for people with dementia (PWD) due to its progressive nature affecting their decision-making ability. Considering well-documented benefits of ACP in improving quality of end-of-life (EOL) care, the rural vs. urban disparity may indicate poorer EOL quality for rural PWD. Moreover, research on factors affecting ACP use among PWD has been primarily based in metropolitan/urban areas. To address the knowledge gap, this study aimed to explore barriers and current resources for ACP of PWD from perspectives of health and social service providers in rural Alabama. Using a qualitative approach, semi-structured face-to-face interviews were conducted with 10 health and social service professionals serving older adults and their caregivers in rural communities of Alabama. Thematic analysis was used to find recurrent themes and patterns from transcribed interview data. Our analysis revealed four areas of barriers to rural PWD’s ACP: (1) PWD’s and caregivers’ lack of knowledge about ACP, dementia, EOL care options, and available resources, (2) misconceptions of completing formal documentations, (3) emotional barriers, and (4) limited access to existing resources. Elder law clinic and local Area Agencies on Aging were the most prominent, existing resources for ACP in rural Alabama. Participants also showed a type of misconception that a lawyer and/or a notary is required for ACP. The study highlighted an urgent need for social policy in ACP education for both caregivers and service providers in rural settings.

Mastering timely deliveries using dynamic capabilities: perspectives from logistics service providers and shippers

PurposeThe criticality of late deliveries in transportation lies in the threat of considerable multi-level supply chain costs. This study aims to reveal the dynamic capabilities playing a facilitating role in preventing delay, thus providing timely delivery, as well as developing an understanding of how and when those capabilities are activated within the supply chain network.Design/methodology/approachAn exploratory study was conducted involving 16 semi-structured expert interviews with the representatives of logistics service providers and shippers. Following an interpretive phenomenology framework, the prevention phenomenon was explained.FindingsFindings revealed two preventive capability categories in delay prevention: (1) proactive capabilities, referring to the enabling actions planned before departure, and (2) reactive capabilities, referring to actions planned after departure. Findings pinpoint that, in addition to the proactive capabilities, reactive capabilities enabled by innovative problem-solving actions are crucial for adapting to a dynamically changing environment in prevention. Moreover, this study shows that prevention capabilities are characterized by tangible and intangible resources and integration of resources with external links which constitute a delay prevention network within a wider service ecosystem.Originality/valueThis study stands out with its specific focus on delay prevention capabilities and enabling actions from the perspectives of logistics service providers and shippers. The premises of the resource-based view are combined with dynamic capabilities theory, leading to a proposed time-based taxonomy of proactive and reactive capabilities in supply chains, aimed at creating value and strengthening resilience.

Interventions Aimed at Alleviating Loneliness and Social Isolation among the Older Population: Perspectives of Service Providers

Background. Older people are one of the groups particularly vulnerable to loneliness due to factors such as deteriorating health, widowhood and death of friends/family, fewer confiding relationships, and being more likely to live alone. In the United Kingdom, services to alleviate and/or prevent loneliness can be classified as foundation services, direct interventions, gateway services, and structural enablers. Service managers and personnel involved in the delivery of interventions for older people are well-positioned to report on the mechanisms that contribute to the effectiveness of interventions. This study aimed to elicit from the perspective of a range of service providers, the barriers and facilitators of successful service provision, and the reduction of loneliness among older people. Methods. Semistructured interviews were conducted with 23 service managers of services providing an intervention to older people in Northern Ireland. Services were eligible for inclusion if they reported a goal of preventing or reducing loneliness and/or social isolation among older people. Transcripts were analysed using thematic analysis. Results. Eight themes were produced representing barriers or facilitators of successful service delivery, including characteristics of the service (person-centred approach, empowerment of service users and staff/volunteers, personal qualities of staff and volunteers, and funding for service provision) and characteristics of the wider community were services were located (hard to identify and/or reach lonely people; education and awareness of services; family and community structures; and accessible, affordable, and safe public transport). Conclusion. Developments in this area should prioritise integrated, systemic solutions that harness capacity and partnership working within communities, grounded in the principles of empowerment, inclusion, self-determination, and collective action.

Virtual Care and Social Support for Refugee Mothers during COVID-19: A Qualitative Analysis

Introduction: The intersection of gender, motherhood, and migration status creates distinct challenges for refugee mothers, but social support can facilitate their navigation of migration and motherhood. Taking a Salutogenic Theory approach (Antonovsky, 1979), we examined refugee mothers’ access to virtual social support during the COVID-19 pandemic. Our objective is to understand the provision of virtual social support for refugee mothers from the perspective of service providers and recently arrived refugee mothers to Canada. Methods: Virtual semi-structured interviews were conducted with three service providers and five refugee mothers in one settlement agency in Ontario, Canada. Data were subjected to thematic analysis. Six main themes emerged. Results: From interviews with service providers the themes include: virtual adaptation of services; unique barriers to virtual services emerging from the intersection of gender, culture, and migration status; and supporting women’s agency and independence. From interviews with mothers, we identified the following themes: gratitude for instrumental support; organization as a link between self and society; and usefulness of virtual support, but preference for in-person support. Discussion: Providers acknowledged clients’ diverse circumstances. They developed flexible strategies to identify client needs and help them build skills. Clients found virtual services essential to resettlement, if not ideal. Conclusion: With tailored programming, virtual services can be effective in providing support. Moreover, refugee mothers acquired digital skills to independently navigate virtual resources, despite limited digital literacy. This demonstrates the value of using of virtual services for vulnerable or hard to reach populations.