Cathy Chabot

Risk, resistance and the neoliberal agenda: young people, health and well-being in the UK, Canada and Australia

In this article we describe how concepts of risk are both generated by and used to reinforce a neoliberal agenda in relation to the health and well-being of young people. We examine how risk may be used as a tool to advance ideals such as rational choice and individual responsibility, and how this can further disadvantage young people living within the contexts of structural disadvantage (such as geographic areas of long-term unemployment; communities that experience racial discrimination). We also identify the ways in which risk is applied in uneven ways within structurally disadvantaged contexts. To suggest a way forward, we articulate a set of principles and strategies that offer up a means of resisting neoliberal imperatives and suggest how these might play out at the micro-, meso- and macro-levels. To do this, we discuss examples from the UK, Canadian and Australian contexts to illustrate how young people resist being labelled as risky, and how it is possible to engage in health equity-enhancing actions, despite seemingly deterministic forces. The cases we describe reveal some of the vulnerabilities (and hence opportunities) within the seemingly impenetrable world view and powers of neoliberals, and point towards the potential to formulate an agenda of resistance and new directions for young peoples health promotion.

Ethical and Epistemological Insights: A Case Study of Participatory Action Research with Young People

Debates over how to determine age of consent for youth to participate in research feature prominently in the practice of researchers, research ethics boards (REBs), and community decision makers working with youth. In particular, tensions can arise over how the ethical principles of beneficence, autonomy, and justice are interpreted and applied in research involving young people. We discuss our experiences obtaining ethical approval to conduct a participatory action research project involving youth and the differences of opinion we encountered regarding underage youths capability to make informed consent. We suggest that researchers, REBs, and community decision makers all share a responsibility to conduct proactive outreach to youth participants, so that they are adequately informed of their rights related to research.

Get Checked… Where? The Development of a Comprehensive, Integrated Internet-Based Testing Program for Sexually Transmitted and Blood-Borne Infections in British Columbia, Canada.

Background Testing for sexually transmitted and blood-borne infections (STBBI) is an effective public health strategy that can promote personal control of one’s health and prevent the spread of these infections. Multiple barriers deter access to testing including fear of stigmatization, inaccurate health care provider perceptions of risk, and reduced availability of clinic services and infrastructure. Concurrent increases in sexually transmitted infection (STI) rates and demands on existing clinical services make this an even more pressing concern. Web-based testing offers several advantages that may alleviate existing clinical pressures and facilitate appropriate testing access. Objective This paper describes the planning, development, and usability testing of a novel Web-based testing service, GetCheckedOnline (GCO), as a complementary testing option integrated within existing sexual health services within British Columbia (BC). Methods From 2009 to 2014, we engaged a multidisciplinary team in the design and development of GCO. We conducted 3 initial research studies to ascertain the opinions of youth, men who have sex with men (MSM), and STI clinic clients regarding Web-based testing and elicited perspectives of sexual health care providers through focus groups. We developed an informed consent process, risk assessment questions, and test recommendations based on provincial and national guidelines and evaluated these through consultations with clinical and community stakeholders. We also conducted a preliminary health equity impact assessment whose findings also informed the GCO program mode. Finally, from April 2011 to December 2012 we gathered qualitative data from 25 participants on the functionality and usability of a GCO prototype and incorporated their recommendations into a final model. Results GCO launched in the fall of 2014 across 6 pilot sites in Vancouver, BC. The service involves 3 main steps: (1) create an account, complete an assessment, and print a laboratory requisition, (2) provide blood and urine specimens at participating laboratory locations, and (3) receive test results on the Internet or by phone. During this pilot phase, we promoted GCO to existing STI clinic clients and MSM in the Greater Vancouver region. A rigorous mixed-method evaluation of GCO’s uptake, acceptability, and health system impacts is currently underway. Conclusions GCO is the first comprehensive Web-based STBBI testing program in Canada that is integrated with existing sexual health services, with the potential to reduce pressures on existing clinical services and reach populations facing the greatest barriers to testing. Our experience highlights the facilitators and challenges of developing and implementing novel complex eHealth interventions within the health care system, and underscores the importance of considering broader implementation contexts.

STI service delivery in British Columbia, Canada; providers' views of their services to youth

BackgroundLittle is known about service providers’ knowledge, attitudes, and experiences in relation to the assessment, diagnosis, and treatment of individuals seeking care for sexually transmitted infections (STIs), and how they influence the delivery of services. The purpose of this study was to explore the perceptions of STI care providers and the ways they approached their practice.MethodsWe used a qualitative approach drawing on methods used in thematic analysis. Individual semi-structured in-depth interviews were conducted with 21 service providers delivering STI services in youth clinics, STI clinics, reproductive health clinics, and community public health units in British Columbia (BC), Canada.ResultsService providers’ descriptions of their activities and roles were shaped by a number of themes including specialization, scarcity, and maintaining the status quo. The analysis suggests that service providers perceive, at times, the delivery of STI care to be inefficient and inadequate.ConclusionFindings from this study identify deficits in the delivery of STI services in BC. To understand these deficits, more research is needed to examine the larger health care structure within which service providers work, and how this structure not only informs and influences the delivery of services, but also how particular structural barriers impinge on and/or restrict practice.

“Ageing Out” When Policy and Social Orders Intrude on the “Disordered” Realities of Young Mothers

Despite a general decline, early-age motherhood continues to manifest disproportionately among young women living in rural/remote Canada. Although public health interventions exist to ameliorate the negative impacts, key determinants of young mothers’ well-being exist in sectors outside of health. Moreover, there is no clear understanding of how social context interacts with policy to enhance/detract from interventions. We undertook an ethnographic study in a northern Canadian city to investigate the impacts of sociocultural conditions and policy interventions on young mothers. “Ageing out” was identified as an important example of the intersection between social context and policy. “Ageing out” occurs when State-provided educational/income supports are removed because a young mother reaches the age of majority. Ageing out within unsupportive social contexts compounds negative consequences for young mothers, especially in relation to housing, parenting, and employment. The findings illustrate how some policy interventions have negative consequences that exacerbate health and social inequities.

Morally Problematic: Young Mothers' Lives as Parables about the Dangers of Sex.

Drawing on data from an ethnographic study examining the experiences of early-age mothers living in a remote city in northern British Columbia, Canada, we examine the perspectives of two study participants – one young mother and one service provider – who proposed that young mothers should visit high school classrooms to provide experiential narratives about the potential dangers of sex, particularly for young women. While many participants suggested that these peer-education presentations could be a positive experience for students as well as the young mothers/peer educators, the parables that their experiences represent reinforce social and physical distance between early-age mothers and mainstream society. Using a Foucauldian analysis, we demonstrate how these parables are more likely to demonize young womens sexualities and further alienate the young mothers from other teens.

A narrative analysis of the birth stories of early-age mothers

Abstract The telling of birth stories (i.e. stories that describe womens experiences of giving birth) is a common and important social practice. Whereas most research on birth narratives reflects the stories of middle‐class, ‘adult’ women, we examine how the birth stories told by early‐age mothers interconnect with broader narratives regarding social stigma and childbearing at ‘too early’ an age. Drawing on narrative theory, we analyse in‐depth interviews with 81 mothers (ages 15–24 years) conducted in Greater Vancouver and Prince George, Canada, in 2014–15. Their accounts of giving birth reveal the central importance of birth narratives in their identity formation as young mothers. Participants’ narratives illuminated the complex interactions among identity formation, social expectations, and negotiations of social and physical spaces as they narrated their experiences of labour and birth. Through the use of narrative inquiry, we examine the ways in which re‐telling the experience of giving birth serves to situate young mothers in relation to their past and future selves. These personal stories are also told in relation to a meta‐narrative regarding social stigma faced by ‘teenage’ mothers, as well as the publics ‘gaze’ on motherhood in general – even within the labour and delivery room.

Examining E-Loyalty in a Sexual Health Website: Cross-Sectional Study

Background Web-based sexual health resources are typically evaluated in terms of their efficacy. Information is lacking about how sexual health promotion websites are perceived and used. It is essential to understand website use to address challenges with adherence and attrition to Web-based health interventions. An existing theoretical framework for examining loyalty to electronic health (eHealth) interventions has been not yet been applied in the context of sexual health promotion nor has the association between e-loyalty and intended intervention efficacy outcomes been investigated. Objective The objectives of this study were to investigate users’ loyalty toward a sexual health website (ie, e-loyalty), measure user perceptions of the website, and measure the association between e-loyalty and perceived knowledge increase and intent to change behavior. Methods Over 4 months, website users (clients and health care providers) participated in an open, online, cross-sectional survey about their user experiences that measured e-loyalty, user perceptions, and intended website efficacy outcomes. Relationships between user perceptions and e-loyalty were investigated using structural equation modeling (SEM). Associations between e-loyalty and website efficacy outcomes were tested using Spearman rank correlation. Results A total of 173 participants completed user perception questions and were included in the analysis. E-loyalty was high for both clients and providers and was significantly correlated with clients’ perceived knowledge increase (ρ(171)=.30, P<.001), their intent to have safer sex (ρ(171)=.24, P=.01), and their intent to get tested for sexually transmitted infections (ρ(171)=.37, P<.001). The SEM showed that trustworthiness, overall experience, active trust, and effectiveness were directly related to e-loyalty. Finding the website “easy to understand” was significantly related to active trust (ie, participants’ willingness to act upon information presented on the website). Conclusions E-loyalty may be related to the efficacy of the selected website in improving one’s sexual health and was significantly associated with all three intended knowledge and behavioral outcomes. To increase e-loyalty, trustworthiness and active trust are important user perceptions to deliberately engender. Our findings indicate that understanding a website contributes to active trust, thereby highlighting the importance of considering eHealth literacy in designing health promotion websites. Our study confirms the relevance of e-loyalty as an outcome for evaluating the antecedents of the use and efficacy of online public health interventions across disciplines by adapting and validating an existing e-loyalty framework to the field of sexual health promotion. Our findings suggest that e-loyalty is positively associated with measures of website efficacy, including increased knowledge and intent to change behavior. Longitudinal research with larger samples could further investigate the relationships between e-loyalty, website understandability, and outcomes of online health interventions to determine how the manipulation of website characteristics may impact user perceptions and e-loyalty.

Young parents’ personal and social information contexts for child feeding practices: An ethnographic study in British Columbia, Canada

Purpose The purpose of this paper is to utilize McKenzie’s two-dimensional model of information practices to situate child feeding practices as complex, socially situated information practices. Further, the authors examined a host of contextual factors (financial, physical, and social) that enabled and constrained information practices within the tightly controlled environment that defines the lives of young parents (YPs). Design/methodology/approach Methods of investigation were ethnographic in nature and data collection methods included naturalistic observation and interviews in two communities in British Columbia, Canada over a period of several years. Data collection and analysis was ongoing. During the initial stages of data analysis, a conventional approach to content analysis was used to identify key concepts, preliminary themes, and illustrative examples. Working within the broader category of child feeding practices, the authors used a constant comparative process of directed content analysis to identify sub-themes, namely, distinct physical, social, and financial influences on child feeding practices. Findings The YPs in this study described negotiating breastfeeding, formula feeding, and the introduction of solid foods within a heavily surveilled atmosphere with different and conflicting levels of support and information. The findings demonstrated that active seeking by YPs was often discouraged by authorities, and more passive practices of information encountering and receipt of information from proxies were accepted and expected. Research limitations/implications This study used McKenzie’s two-dimensional model to paint a richer picture of YPs’ information practices and their physical, geographical, financial, and social contexts. Practical implications These findings suggests that child feeding informational support should, rather than being prescriptive, take into account the complexities of YPs’ relationships and daily lives, as well as the social structures that shape their experiences as parents. Social implications Child feeding practices are influenced by a host of physical, financial, and social factors, and are situated within familial and education environments, as well as broader social and policy discourses. Originality/value This research utilized McKenzie’s two-dimensional model of information practices with a sample of YPs. Evidence suggested that child feeding practices were informed by active seeking, active scanning, non-directed monitoring, and by proxy, but these manifested differently for YPs than for the older expectant mothers upon whom McKenzie’s original model was derived. Using ethnographic methods, the authors situated child feeding practices as complex information practices that are informed by conflicting information, physical, social, and financial factors and intensive parenting ideologies. This reinforces the need for information science researchers to understand contextual factors that influence practices.

Anticipating the potential for positive uptake and adaptation in the implementation of a publicly funded online STBBI testing service: a qualitative analysis

BackgroundOnline health services are a rapidly growing aspect of public health provision, including testing for sexually transmitted and other blood-borne infections (STBBI). Generally, healthcare providers, policymakers, and clients imbue online approaches with great positive potential (e.g., encouraging clients’ agency; providing cost-effective services to more clients). However, the promise of online health services may vary across contexts and be perceived in negative or ambiguous ways (e.g., risks to ‘gold standard’ care provision; loss of provider control over an intervention; uncertainty related to budget implications). This study examines attitudes and perceptions regarding the development of a novel online STBBI testing service in Vancouver, Canada. We examine the perceptions about the intervention’s potential by interviewing practitioners and planners who were engaged in the development and initial implementation of this testing service.MethodsWe conducted in-depth interviews with 37 healthcare providers, administrators, policymakers, and community-based service providers engaged in the design and launch of the new online STBBI testing service. We also conducted observations during planning and implementation meetings for the new service. Thematic analysis techniques were employed to identify codes and broader discursive themes across the interview transcripts and observation notes.ResultsSome study participants expressed concern that the potential popularity of the new testing service might increase demand on existing sexual health services or become fiscally unsustainable. However, most participants regarded the new service as having the potential to improve STBBI testing in several ways, including reducing waiting times, enhancing privacy and confidentiality, appealing to more tech-savvy sub-populations, optimizing the redistribution of demands on face-to-face service provision, and providing patient-centred technology to empower clients to seek testing.ConclusionsParticipants perceived this online STBBI testing service to have the potential to improve sexual health care provision. But, they also anticipated actions-and-reactions, revealing a need to monitor ongoing implementation dynamics. They also identified the larger, potentially system-transforming dimension of the new technology, which enables new system drivers (consumers) and reduces the amount of control health care providers have over online STBBI testing compared to conventional in-person testing.