Social Care Systems Research Articles

Is the EU steering national social and health policy making? A case-study on Finland's national reform

As part of the European Semester, Finland received country-specific recommendations (CSRs) in 2013–2020 that encouraged the reform of national social and health services. These recommendations were part of efforts to balance public finances and implement public-sector structural reforms. Finland has been struggling to reform the national social and health care system since 2005. Only on 1 January 2023 did the new wellbeing services counties become liable for organizing social, health, and rescue services. Studying the CSRs for Finland enables us to understand better what genuinely occurs at the EU member state level. This data-driven case study aims to disclose the relevance of the European Semester for Finland in the pursuit of a national social and health system reform. The mixed-method approach is based on the research tradition of governance, and the study contains features of data sourcing and methodological triangulation. Empirically, the research material consists of Finland's official policy documents and anonymous semi-structured elite interviews. The study highlights that although the received CSRs on the need to restructure social and health services corresponded to Finland's views, their influence to national reform efforts was limited. The CSRs were administered according to the established formal routines, but separately from the national reform preparations. The CSRs, however, delivered implicit steering, which were considered to affect social and health policy making in various ways.

Racial (In)Equity in South Los Angeles-Community Centered Experiences with COVID-19 Syndemics.

To analyze community experiences involving COVID-19 vaccination access and equity in Black and Latina/o/x communities within South Los Angeles, using a socioecological framework. We conducted four virtual focus groups (n = 33 total participants) in 2021, with Black and Latina/o/x community members, community leaders, and community-based providers in South Los Angeles, a region highly impacted by the COVID-19 pandemic. We used a grounded theory approach to guide the analysis and generate data shaped by participant perspectives. Participants across groups consistently emphasized medical mistrust, fear/skepticism, misinformation, accessibility, and feelings of pressure and blame as factors influencing COVID-19 vaccination decisions. The need to address pandemic-related socioeconomic hardships in underresourced communities was equally highlighted. Findings show that building trust, providing tailored information, and continued investment into diversity and equity initiatives can support Black and Latino/a/x communities in making informed health decisions. Community-centered support services should address the economic, social, and structural impact of the pandemic on vulnerable communities. Furthermore, public health and policy efforts must prioritize funding to equip social and health care systems with infrastructure investment in racial and ethnic minority communities.

Barriers to and facilitators of deprescribing for older people in secondary care in Saudi Arabia: a qualitative study using a theory-based approach

Abstract Introduction In Saudi Arabia, more than 55% of older patients are subjected to potentially inappropriate prescribing.[1] Despite this, deprescribing by healthcare professionals (HCPs; e.g. physicians and pharmacists) is limited. Therefore, identifying barriers to and facilitators of deprescribing from HCPs’ perspective is crucial to establish the evidence base to inform future development of a deprescribing intervention in the hospital setting in Saudi Arabia. Aim To explore HCPs’ experiences and perspectives of deprescribing in older patients in order to identify barriers to and facilitators of deprescribing, using a theory-based approach. Methods A qualitative study using semi-structured interviews conducted with physicians and pharmacists who worked in hospitals in a southern region of Saudi Arabia. A purposive sampling approach was employed to recruit participants from various hospitals with different levels of experience. Physicians who worked with older inpatients and pharmacists with a ward-based role who had input into prescribing decisions were eligible to be included. Theoretical Domains Framework (TDF2)-based interviews were conducted with participants until theoretical data saturation was achieved.[2] Interviews were audio recorded, transcribed verbatim and data analysed inductively using reflexive thematic analysis. Themes were mapped to the TDF2, enabling prioritisation of domains and identification of behaviour change techniques (BCTs) for inclusion in future intervention development. Results Forty HCPs were interviewed (20 physicians and 20 pharmacists). Four themes associated with facilitators and barriers to deprescribing were identified: (i) perceptions and consequences of deprescribing; (ii) roles of HCPs and communication; (iii) factors influencing deprescribing decisions and (iv) culture, environment, and resources. All determinants from these themes were mapped to TDF domains. Six TDF domains were prioritised to represent key barriers and facilitators. These were: the limited role of pharmacists in deprescribing (‘Social/professional role and identity’); lack of formal documentation of deprescribing outcomes (‘Behavioural regulation’); perceived risks versus benefits of deprescribing (‘Beliefs about consequences’); lack of tailored guidelines for deprescribing (‘Knowledge’); lack of a connected system between different hospital settings (‘Environmental context/resources’) and the importance of inter-professional social support and collaboration between HCPs (‘Social influences’). These domains were mapped to 40 BCTs for consideration for inclusion in a deprescribing intervention. Conclusion This study served as a starting point for the design of a theory-based intervention in Saudi Arabia to implement deprescribing in hospital settings. The findings have revealed influences on deprescribing that have not previously been described in this context. These encompassed the need to enhance the interface between primary and secondary care and the potential impact of improving health and social care systems in Saudi Arabia to enable deprescribing. Participants were sampled across a southern region of Saudi Arabia, which enhanced the transferability of the findings to other similar hospital settings. However, only physicians and pharmacists were recruited, which may limit the international transferability of the findings to countries where other professionals have a role in deprescribing. Future work will determine the prioritised BCTs to be operationalised in the intervention using the APEASE (Affordability, Practicability, Effectiveness/cost-effectiveness, Acceptability, Side-effects/safety, Equity) criteria.

'I thought we would be cherished and safe here': understanding the multi-faceted nature of mental health among Arab immigrants/refugees in Ontario, Canada- the CAN-HEAL study.

Mental health (MH) is a critical public health issue. Arab immigrants/refugees (AIR) may be at high risk for MH problems owing to various unique stressors, such as post-September/11 demonization. Despite the growing AIR population in Western countries, there is a lack of AIR-MH research in these nations. The CAN-HEAL study examined MH experiences and needs among AIR in Ontario, Canada. This study employed a cooperative community-based participatory research and integrated knowledge translation approach. The study used photovoice, qualitative interviews and a questionnaire survey. Sixty socio-demographically diverse AIR adults partook in this study. The research was informed by the "social determinants of health" framework and the "years since immigration effect" (YSIE) theory. The term "mental health" was deemed offensive for participants aged > 30years. Participants proposed other culturally-appropriate words including "well-being" and "emotional state". The prevalence of poor mental well-being in the sample was alarming (55%). Of first-generation immigrant participants, 86.8% reported negative changes in MH since migration. The negative changes are not straightforward; they are complex and dynamic, and mainly related to micro/macro-aggression, cross-cultural pressures, dissatisfaction with the health and social care system, and poor living conditions. Intersections between different socio-demographic factors (e.g., gender, length of residency, income, parenthood, religion) amplified the negative changes in MH and exacerbated inequities. MH needs among AIR are distinct and intersectionality aggravated inequities. Culturally and structurally competent healthcare and structural/policy reformation are required to tackle MH inequities. This can be fulfilled through intersectoral cooperation and including AIR in decision-making.

Developing the Principles of Falls Management in Care Homes: An expert Consensus Process

Context: Managing falls in care homes requires an individualised approach for each resident with involvement of staff from care homes and the wider health and social care system. A large randomised controlled trial evaluating an individualised falls management programme (Action FALLS) demonstrated positive findings. However, the delivery of the key components of such programmes is still unclear. Greater understanding of the core components of falls management programmes is needed to support future implementation research. Objective: To establish expert consensus on the core components of falls management for older care home residents. Methods: A modified Nominal Group Technique included the development of a draft set of principles through a scoping review of the grey literature (published elsewhere) and a one-off online nominal group with care home staff and clinicians. Following the group, a single online survey was circulated to gain agreement on the final principles. Findings: 10 participants (including healthcare professionals, care home managers, and care home staff) took part in the online nominal group. Thirty-five core principles of falls management were developed within the domains of theoretical approach, assessments, interventions, training, time points, wider systems, and governance and reporting. Limitations: Since a small number of experts took part in this consensus process from a large and diverse care home sector, it is important to consider the principles as providing support for future implementation work. Implications: These core principles provide a foundation to guide care homes in managing falls in care home residents. Further research is needed to develop implementation strategies and test the feasibility of embedding the principles in routine practice.

Soothing dementia carers: A pilot evaluation of an imagery-based wellbeing app feature to support family carers of people with dementia during the COVID-19 pandemic

Background The COVID-19 pandemic has presented unprecedented risks to the health of people living with dementia. Confinement to their homes and extra pressure on the health and social care system, left people with dementia and their carers with reduced access to care services. Accordingly, family carers assumed more caring responsibilities and faced a greater risk of social isolation and loneliness, negatively affecting their mental wellbeing. In response, we developed a new imagery-based feature called Project Soothe within an existing app, CogniCare, which aimed to support the wellbeing of family carers looking after someone with dementia at home. Methods This new feature aimed to test the utility of our previous research which has shown that viewing soothing images has positive mood benefits on users. In this pilot, we examined the usage of the Project Soothe feature over a one-year period. Results Our results indicate the feasibility of the imagery-based app feature as we found that most users found viewing the soothing images to have a positive influence on their mood. Conclusions This finding illustrates feasibility of this imagery-based wellbeing app in this population of interest, and suggests that, upon further replication and research, the Project Soothe feature within the CogniCare app has potential to be developed as a digital wellbeing tool for family carers of people with dementia.

Pension reforms in Hungary: have they gone too far?

Abstract As a result of unfavorable demographic processes, the pension systems in the Central and Eastern European (CEE) EU countries face significant challenges, which has made the implementation of reforms inevitable in the last decade. Relying on economic theory, this paper analyses the effects of the Hungarian pension reforms in comparison with those of other CEE countries, and discusses the consequences from the point of view of social policy and the sustainability of the pension schemes. We explore the reasons why the reforms in Hungary ultimately did not improve sustainability but rather contributed to dismantling the social care system. Therefore, the Hungarian case provides useful lessons for other countries, and at the same time underlines the importance of automatic adjustment mechanisms. The study pays particular attention to the theoretical analysis of pension indexation because its accurate quantitative effects are far from being sufficiently clarified in the literature, although it is vital for a thoughtful evaluation of pension reforms.

Navigating multiple and complex systems of care and support with ageing family carers from multicultural backgrounds in Australia

Ageing family caregivers of family members with disability must navigate complex social care systems within a single household for long-term and end-of-life transitions. This is particularly challenging for migrants from culturally and racially marginalised (CaRM) backgrounds, given their historical exclusion from developing disability and aged care support systems. Limited research exists on the lived experiences of new and second-generation CaRM communities providing informal care to family members with disabilities, globally and in Australia. This paper highlights the challenges faced by CaRM families navigating racial, ethnic, and immigration politics while seeking access to appropriate disability and ageing social care supports. The findings reveal that Many CaRM families face isolation and difficulty accessing needed support due to misconceptions about their strong local networks. Moreover, the significance of place, especially in low-resource urban areas, poses challenges for ageing family primary caregivers managing a dual long-term care arrangement, leading to uncertainties about their future.

(Data-) Cooperatives in health and social care: a scoping review

Abstract Aim To gather information about the structure of cooperatives in health and social care, in general, and data cooperatives, in particular, to derive implications for their future implementation. Subject and methods Health and social care systems are currently under pressure due to rising costs and demands. Many hopes lie on digitization, digitalization, and the potentials of health data. A scoping review was conducted searching nine databases and grey literature. Data on information about aim, type, and structure of the cooperatives, member structure, founding process, and their way of financing were extracted. Results All searches resulted in 9080 articles and websites. Overall, we included 26 cooperatives and categorized them as follows: (1) worker cooperatives with focus on workers’ rights and service provision to clients, (2) consumer cooperatives, (3) consumer and worker cooperatives, (4) cooperatives of institutions, (5) general practitioner (GP) cooperatives, (6) cooperatives as health insurance models, and (7) health data cooperatives. Conclusions Information provided on (data) cooperatives differed greatly in detail. Their common goal is to tackle and overcome existing barriers in their field such as working conditions or unequal health care. We identified five challenges: (1) salary structures; (2) cooperating with other providers and surrounding institutions; (3) building an identity and recruiting potential members; (4) motivation of members to participate actively; and (5) distinction from other types. Benefits are: (1) improvement of conditions; (2) being stronger together; (3) support of research; and (4) data governance. When successful and competent, (data) cooperatives can be powerful tools on public, scientific, and political levels.

Who Care for our Caregivers? Building the Evidence For Change

Unpaid caregivers are in distress. Almost two thirds (63%) of caregivers are at the breaking point – but feel they have no choice but to continue on (Spotlight Report: 2022). While caregivers find their role meaningful and know that they play a crucial role in sustaining our health, social and long-term care systems, they also feel invisible and unvalued, struggling with only ad hoc support. The Ontario Caregiver Coalition, a grassroots non-profit coalition of caregivers and the organizations that support them, is advocating for recognition and support for the family, friends and neighbours whose unpaid care is the hidden backbone of Ontario’s health system.

It's about living a normal life: parents' quality of life when their child has a life-threatening or life-limiting condition - a qualitative study.

Pediatric palliative care (PPC) seeks to enhance the quality of life (QoL) for both children and their families. While most studies within PPC have focused on the ill child's QoL, less is known about parents' experiences of their own QoL. The aim of this study was to explore parents' QoL when their child has a life-threatening or life-limiting condition. The study has a qualitative, hermeneutic phenomenological design inspired by van Manen's phenomenology of practice. In-depth interviews were conducted with 12 fathers and 12 mothers of children living with cancer or a genetic condition. A deeper understanding of parents' lived experiences was obtained through an adapted photo elicitation method. Two rounds of thematic analysis were conducted, covering both the photo elicitation data, and interview data. The findings describe four themes related to parents' QoL: living a normal life, giving my child a good life, having time to fulfill siblings' needs, and feeling heard and respected in the health and social care system. The complexity of elements shaping parents' QoL is evident. The interconnectedness between parents, the ill child, siblings, and interactions with the health and social care system, highlights the need to understand and address diverse aspects in enhancing parents QoL.

Informal caregivers' experiences of support from a tailored primary healthcare unit for older adults - A focus group study.

Informal caregivers are an essential part of health and social care systems worldwide. As such, they may need professional support. The aim of this study was to describe informal caregivers' experiences and need for support from a tailored primary health care (PHC) unit. This is a qualitative descriptive study using data collected from five semi-structured focus group discussions with a purposeful sample of 16 informal caregivers of older relatives. Respondents were recruited from a tailored PHC unit for people aged 75 years or older in a region in central Sweden. The data were analysed by qualitative content analysis with an abductive approach, based on the principles of the patient- and family-centred care framework. The overarching theme was 'Striving for partnership'. The findings indicate that informal caregivers to some extent felt supported by the healthcare professionals. However, the caregivers expressed a need to be further acknowledged by the professionals in order to participate in the care of their older relatives in the way they wanted. Moreover, insufficient information regarding the older adult's health condition and care provided by the professionals had a negative impact on the caregiver's participation in care. Informal caregivers have unmet needs for support and strive for a partnership with the PHC professionals. PHC professionals should be more attentive and invite informal caregivers to participate in the care of the older adult in order to meet their support needs and build an equal partnership. The patient- and family-centred care framework may be of guidance when providing care for older adults in a PHC context.

Does the Design of Welfare Programs Stipulate Nursing Home Utilization? A Comparative Analysis of Long-Term Care Systems in Japan and Germany

Abstract Japan and Germany are both facing a rapidly aging population and have similar social insurance-based long-term care systems. However, there are significant differences in utilization and costs. This paper presents a microeconomic decision model validated by regression analysis, Blinder-Oaxaca decomposition, and Data Envelopment Analysis to contrast the utilization patterns in the Japanese and German long-term care sectors. The design of the welfare programs for low-income families has been identified as one of the main reasons. In Germany, the welfare system leads to a demand curve for nursing home care that is comparable to that of an inferior good which makes external long-term care in nursing homes the more attractive, the poorer the respective households are. In addition, the resulting inelastic demand of the population groups in need of social benefits seem to reduces competition among Germany’s long-term care providers, which is associated with a loss of efficiency in how they use production factors. In Japan, this negative outcome is avoided by a comfort segmentation in the nursing home market.

The Impact of COVID-19 on Children, Young People, and Families in Sihanoukville, Cambodia: The Mitigating Work of M’Lop Tapang

ABSTRACT Globally, children have been adversely affected by the wide variety of impacts of SARS-CoV-2 (Coronavirus | COVID-19). Vulnerable children who depend on the support of education and health and social care systems were left unprotected as these systems were weakened by the pandemic. COVID-19 has exposed the already fragile situations in which many children and young people live and that thousands of children and young people would need ongoing support but remained invisible to statutory authorities. COVID-19 has also been a stark reminder of the vulnerability of individuals and societies and it has exposed deep divisions, inequalities, and injustices between different countries and groups of people. M’Lop Tapang is a local nonprofit organization registered with the Royal Government of Cambodia. This report discusses the efforts of M’Lop Tapang following the declaration of the COVID-19 global pandemic in early 2020, to address the local community needs; to ensure the voices of children remained heard; and to promote children’s rights remaining a priority throughout the remainder of the pandemic. What is already known on this topic Vulnerable children are dependent on remaining visible to education and health and social care systems to ensure they are safeguarded and protected. Poor safety, financial instability, unemployment, challenges to children’s rights and displacement all have the potential to increase vulnerabilities and intensify inequalities. The COVID-19 global pandemic has widened the global lens for the nursing profession and to effect change, children’s nurses need to think globally and act locally. What this study adds This study provides insights into the challenges faced by children and families in Sihanoukville, Cambodia, during the early part of the SARS-CoV-2 (COVID19) pandemic in 2020–2021. The economic impact of COVID-19 on children and families living in Sihanoukville, Cambodia, between 2020 and 2021 is reviewed. The learning from the pragmatic and rapid interventions of M’Lop Tapang, Sihanoukville during the early phase of the SARS-CoV-2 (COVID-19) pandemic, are of use in other countries around the world in future epidemic or pandemic situations.

Codesign principles for the effective development of digital heritage extended reality systems for health interventions in rural communities

ABSTRACT We present a methodological, theoretical, and technological outline of codesign principles for the effective development of digital heritage extended reality systems for health and care. The paper is based on two large-scale research projects involving ageing in rural and coastal communities, focused on the codesign of extended reality systems to stimulate new forms of access to local heritage sites with potential impact on health outcomes. Our approach stems from a multi-disciplinary collaboration between health, digital design, and heritage specialists, and suggests ways to reconcile diverging forms of knowledge production, such as our ‘researcher in residence’ methodology and the place-based complexities of codesigning such systems. Based on an analysis of fieldwork data and our own fieldwork experiences, the paper presents a roadmap for the codesign of digital heritage extended reality systems for health interventions that meet the needs of stakeholders and organisational implementation requirements, providing a useful tool in supporting the health and social care system for our ageing population.

Understanding responsibility for health inequalities in children’s hospitals in England: a qualitative study with hospital staff

ObjectivesThis study aimed to understand how staff in children’s hospitals view their responsibility to reduce health inequalities for the children and young people who access their services.DesignWe conducted an exploratory...

A protocol for stakeholder engagement in deliver-EE: A pragmatic randomized comparative effectiveness trial evaluating effects of meal delivery on the ability of homebound older adults to remain in the community

BackgroundFew clinical trials include a detailed protocol for stakeholder engagement in the design and execution of the clinical trial. Deliver-EE is a pragmatic clinical trial to assess how different types of home-delivered meals can affect older adults' health and well-being. We present the protocol for stakeholder engagement in this national, multi-site trial and initial findings from our efforts. MethodsTwenty-nine participants were recruited to two stakeholder advisory panels. The “Lived Experience Perspectives” panel is defined as the clients, caregivers, and meal delivery drivers with first-hand knowledge and lived experiences with meal delivery. The “System Perspectives” panel is defined as representatives from the larger financial, clinical, regulatory, and operational environments in which meal delivery to homebound older adults operate. Together, these two groups holistically represent interested parties that coordinate the interdependent elements of meal delivery to homebound older adults in order to: 1) inform our understanding of what matters most to older adults, their families, and the larger health and social care systems; 2) provide strategies to overcome challenges conducting the study; 3) enhance dissemination and uptake of study findings; and 4) identify opportunities for future research. ResultsAlthough stakeholder partners share a common goal of using home-delivered meals as a method to improve outcomes for homebound older adults, individuals have different goals for participating as advisors in this research. ConclusionsUnderstanding what individual stakeholders hope to gain from their participation is critical in designing an effective engagement protocol and critical for meaningful and rigorous stakeholder engagement in clinical trials.

Psychosocial interventions for cardiac surgery patients: context of interdisciplinary interaction

IntroductionMulti-staged and personalized in nature, psychosocial interventions for cardiac surgery patients explain the necessity of relying on the potential of interdisciplinary interactionObjectivesTo present the review of the model of interdisciplinary interaction of experts and institutions in the course of psychosocial interventions for cardiac surgery patients, which is currently used in the Chuvash Republic.MethodsThis model involves the experts and institutions of the regional healthcare system, the regional system of social care, the regional and federal system of education, non-governmental medical and health resort institutions, and private practitioners.ResultsIn the center of this model is the Regional Cardiology Center, which interacts with the Psychotherapeutic Center and the Republican Mental Hospital’s Helpline. It also involves the town hospitals and the central district hospitals, non-governmental clinics and private practitioners. The process of rehabilitation and follow-up care continues in the regional health resorts. The social service centers provide additional support. The institute of chief experts of the regional Health Care Ministry, which includes a psychiatrist, cardiologist, psychotherapist, and psychologist, oversees the overall activity. The clinic faculty professors and associate professors are involved in the development of the programs.ConclusionsThe practical results of using the regional model of interdisciplinary interaction enhance the potential of psychosocial interventions for cardiac surgery patients.Disclosure of InterestNone Declared

What do child protection social workers consider to be the systemic factors driving workforce instability within the English child protection system, and what are the implications for the UK Government’s reform strategy?

ABSTRACT In 2023, the UK Government published its long-awaited reform strategy for England’s children’s social care system. Whilst the strategy set out planned reforms for several aspects of the wider system, an area requiring particular ‘priority’ was the purported workforce instability seen within child protection social work. However, the strategy has subsequently faced criticism on the basis that the suggested reforms were not satisfactorily informed by the testimonies of practicing social workers. This paper draws from a mixed-method study to report on the lived experiences of a sample of 201 child protection social workers practicing across England, in the context of better understanding the factors which they believed were impacting on workforce stability within England’s child protection system. Implications that emerge are the need for an increase in the monetary commitment offered by the UK Government (especially in the context of tackling high caseloads, and improving local authority pay scales to reduce the allure of agency work); a targeted emphasis on challenging local cultures preoccupied with evidencing compliance over time spent with children; and the Government taking a more assertive role in tackling the often-counterproductive commentary perpetuated by politicians and media.

중년 기혼 여성 근로자의 일생활균형에 관한 경험과 의미 탐색

This study aimed to explore how the experiences and meanings of work-life balance evolve across the life stages of middle-aged, married female workers. The study participants were 10 middle-aged, married female workers, aged 45 to 60, who had work experiences during both the parenting and middle-aged stages. The findings revealed that half of the participants experienced career interruptions due to pregnancy, childbirth, and childcare, influenced by social contexts such as family expectations of maternal roles, the passive involvement of husbands in childcare, and the absence of social care systems. Overall, satisfaction with work-life balance during this period was low, and it was a time when 'balance' itself was challenging to achieve. As these participants entered middle age, they reduced their family and parenting roles due to their children's independence, leading them to re-enter the workforce or focus more on their careers and showcase their abilities in the workplace. The key experiences of work-life balance during middle age included 'time for oneself, self-discovery, maintaining health and fitness, immersion and enjoyment in work, and changes in roles and relationships within the family.' The significance of this study lies in attempting to explore the experiences of middle-aged, married female workers, a group often overlooked as critical subjects of work-life balance discourse, and in considering the life context of middle age.