M. Judith Lynam

Support networks developed by immigrant women

Women with young children who were immigrants to Canada were interviewed to understand how they defined their needs and what resources they perceived to be available to meet their needs. All of the women described a need to feel as if they belonged in Canada and had people to turn to for personal support. The women identified general groups of people they perceived as able to provide them with differing forms of support. The three groups were labelled; kin, insider and outsider. The women also described how they used the sources of support and the feelings which resulted from their interactions with members of the support groups. The conceptualization which was developed from the data suggests women may follow a pathway in developing a support network. How this information might be used by health professionals in clinical practice is discussed.

Understanding marginalization as a social determinant of health

Population-based studies have drawn attention to the associations between social and material disadvantage and poor mental and physical health over the life course, thereby contributing to inequalities in health. More recently, research in Britain has demonstrated that the effects of such disadvantage are cumulative through childhood and has shown that ‘ethnic minorities’ are at particular risk. This study gathered data from persons at risk, specifically first-generation migrant teenaged girls and their mothers, in Britain and Canada, and identified marginalization as a central feature of their relationships with others. Bourdieus theoretical perspective is drawn on to examine the processes that contribute to marginalization and the conditions of broader society that sustain and reproduce them. It was the participants’ experience that their potential goes unrecognized, their opportunities to develop new relationships curtailed and possibilities to acquire new competences were eclipsed by others’ assumptions about them. The authors illustrate the social processes that contribute to the creation of tensions between seeking to belong and being assigned to the margins and consider their attendant influences on health. Taking direction from Bourdieu they illustrate ways in which discourses of marginalization and marginalizing practices associated with them can be interrupted, and in so doing work towards redressing processes that create a context for health inequalities.

Inequities in health and healthcare viewed through the ethical lens of critical social justice: contextual knowledge for the global priorities ahead.

The authors use the backdrop of the Healthy People 2010 initiative to contribute to a discussion encompassing social justice from local to national to global contexts. Drawing on findings from their programs of research, they explore the concept of critical social justice as a powerful ethical lens through which to view inequities in health and in healthcare access. They examine the kind of knowledge needed to move toward the ideal of social justice and point to strategies for engaging in dialogue about knowledge and actions to promote more equitable health and healthcare from local to global levels.

Parents' Perspectives on Decision Making After Antenatal Diagnosis of Congenital Heart Disease

OBJECTIVE To discover and describe how prospective parents make decisions when they learn of their babys congenital heart disease (CHD) during pregnancy, and to provide professionals with direction for their interactions with these families. DESIGN AND METHOD Qualitative analysis informed by symbolic interactionism. SETTING A tertiary care womens health center that provided referral services for a province with a population of 4 million. PARTICIPANTS Mothers and fathers of 19 babies with antenatally diagnosed CHD participated in interviews during pregnancy and after the birth of their baby. Thirty-four interviews were analyzed for common themes and distinguishing characteristics of antenatal decision making. RESULTS Parents approached their antenatal decisions regarding further testing and continuation of the pregnancy as their first parenting decisions. They made their decisions with differing degrees of apparent ease or deliberation, and some parents more readily sought the opinion of professionals. The offered opinions offended some parents, even though the professionals may have intended the information as descriptive of options, not suggestive of a particular decision. CONCLUSION Although advances in technology have enabled diagnosis of CHD antenatally, health care professionals, including nurses, must elicit each parents particular perspective, be cognizant of their professional influence, and actively support parents from the time of the antenatal diagnosis.

Critical inquiry and knowledge translation: exploring compatibilities and tensions

Knowledge translation has been widely taken up as an innovative process to facilitate the uptake of research-derived knowledge into health care services. Drawing on a recent research project, we engage in a philosophic examination of how knowledge translation might serve as vehicle for the transfer of critically oriented knowledge regarding social justice, health inequities, and cultural safety into clinical practice. Through an explication of what might be considered disparate traditions (those of critical inquiry and knowledge translation), we identify compatibilities and discrepancies both within the critical tradition, and between critical inquiry and knowledge translation. The ontological and epistemological origins of the knowledge to be translated carry implications for the synthesis and translation phases of knowledge translation. In our case, the studies we synthesized were informed by various critical perspectives and hence we needed to reconcile differences that exist within the critical tradition. A review of the history of critical inquiry served to articulate the nature of these differences while identifying common purposes around which to strategically coalesce. Other challenges arise when knowledge translation and critical inquiry are brought together. Critique is one of the hallmark methods of critical inquiry and, yet, the engagement required for knowledge translation between researchers and health care administrators, practitioners, and other stakeholders makes an antagonistic stance of critique problematic. While knowledge translation offers expanded views of evidence and the complex processes of knowledge exchange, we have been alerted to the continual pull toward epistemologies and methods reminiscent of the positivist paradigm by their instrumental views of knowledge and assumptions of objectivity and political neutrality. These types of tensions have been productive for us as a research team in prompting a critical reconceptualization of knowledge translation.

Health as a socially mediated process: theoretical and practice imperatives emerging from research on health inequalities.

Population-based studies on health disparities provide compelling evidence that inequities in health status over the life course accrue from social conditions. Our knowledge of how such conditions exert their effect on health, however, is limited. An examination of explanations for health disparities shows that a theoretical perspective that enables the exploration of the links between broader social processes (macro) and experience (micro) would offer valuable insights for practice. This article introduces a theoretical perspective informed by Bourdieu and Smith that has been used to undertake such an analysis and that opens up possibilities for new practice forums and foci.

Joint Actions of Parents and Adolescents in Health Conversations

Based on an action theory approach, of 32 videotaped parent-adolescent conversations about health in two Canadian ethno-cultural groups were analyzed to identify and describe the joint action of parents and adolescents in the health domain. The data include manifest behavior (the conversation), internal processes (recalled thoughts and feelings on viewing the videotape of the conversation), and social meaning. These data were analyzed using the goals, functions, and elements of the conversations. Five categories of joint actions emerged from these data: sharing and exploring information, values, and beliefs about health; negotiating and struggling about aspects of the adolescent’s independence; providing and receiving guidance; adjusting to family and home issues; and fostering joint understanding by giving voice to the adolescent.

Family Health- promotion Proj ects An Action-theoretical Perspective

The concept of the family health-promotion project is introduced as a means of describing and analysing health-promoting processes in a family. We suggest that an action-theoretical conceptualization provides a language for dealing with socially embedded human behaviour. The levels of project organization are described and the issues discussed are: hierarchical organization, communication, goal structure, steering, control, regulation, energizing, perspectives and construction, group or joint action, three-dimensional structure of group action, dual enfolding of group actions, properties of group action and of family projects. The research design and methods of a current study on a family health-promotion project are presented and explained.

Culture, health, and inequalities: new paradigms, new practice imperatives

Abstract This paper builds upon insights from a programme of research on culture and health that is informed by critical theoretical perspectives. The evidence generated through this research programme is drawn upon to critically examine the assumptions about the prevailing understandings of the links between culture, health, and health inequalities and to illustrate the need for new paradigms of practice. Using the case of children at risk because of their social, cultural, and material circumstances, the tenets of an alternative model of health care practice, the RICH-ER (Responsive, Intersectoral-Interdisciplinary, Child Health – Education and Research) model was introduced and studied.

Towards the Creation of a Culturally Safe Research Environment

Creating a culturally safe research environment is a challenge for all researchers but particularly for researchers engaged in intercultural research. This article sets out to examine whether action theory and the research methods associated with it have the potential for creating a culturally safe environment for the conduct of research. The article will examine issues inherent in intercultural research, provide an overview of cultural safety and then draw upon data gathered from 32 parent–adolescent dyads of Indo-Canadian and Euro-Canadian background to illustrate how the research methods employed created a culturally safe environment.