Miriam Stewart

“Who Do They Think We Are, Anyway?”: Perceptions of and Responses to Poverty Stigma

In this article, we report on qualitative findings pertaining to low-income peoples perceptions of and responses to “poverty stigma,” a key component of social exclusion with important implications for health and well-being. Our findings are drawn from a multimethod study designed to investigate experiences of social exclusion and social isolation among people living on low incomes. We conducted semistructured individual interviews (n = 59) and group interviews (total n = 34) with low-income residents of two large Canadian cities. Data were analyzed using thematic content analysis techniques. Participants overwhelmingly thought that other members of society tend to view them as a burden to society—as lazy, disregarding of opportunities, irresponsible, and opting for an easy life. Low-income people responded to perceived stigma with a variety of cognitive and behavioral strategies that reflected their efforts to reconcile their perceived “social” and “personal” identities. These strategies included confronting discrimination directly, disregarding responses from others, helping other low-income people, withdrawing and isolating themselves from others, engaging in processes of cognitive distancing, and concealing their financial situation.

Fostering children's resilience

Resilience is relevant to nurses because of its implications for health. Research on the resilience of children and adolescents has proliferated over the past five years. However, the specific processes underlying resilience and outcome variables require further study. Furthermore, few intervention studies have been conducted. This article describes resilience and factors that influence resilience of children, examines the relationship between resilience and health, identifies interventions that foster childrens resilience and health, reviews research focusing on childrens resilience, and suggests the relevance of resilience to nursing of children.

Expanding theoretical conceptualizations of self-help groups

Self-help groups, a prevalent and significant source of social support, manifest the public-participation premise of primary health care. Yet, self-help studies have typically lacked theoretical grounding. Psychoneuroimmunological and social-learning theories could contribute to the theoretical understanding of self-help groups. As self-help groups can mitigate the impact of natural social-network losses, they could help prevent health disorders via an immunocompetence-maintenance function. Health professionals could consider this possibility in assessment, planning, intervention and evaluation. Furthermore, health professionals could take steps to enhance self-efficacy and collective efficacy, derivative concepts of social-learning theory germane to self-help groups. Therefore, pertinent concepts and creative linkages are proposed in a preliminary attempt to initiate a self-help group theoretical framework for health professionals.

Parents’ Perceptions of the Impact of a Telephone Support Group Intervention

Parents living with a child or adolescent with a chronic condition experience wide-ranging demands and an increased risk of health problems. Their social support resources serve as a protective factor and can help to moderate the health effects of stressful situations associated with caregiving. This intervention study tested the impact of a 12-week telephone peer support group intervention for parents in a randomized trial. The support group parents described their experiences and perceptions of the impact of the intervention in weekly diaries and in interviews at three points over the 6 months following the intervention. Parents described increased social support, enhanced coping, increased sense of confidence, and changed outlook, family activities and relationships, and health care encounters. The vast majority were satisfied with the support groups. The telephone support groups tested in this study may improve the day-to-day quality of life for parents and diminish the risk of long-term negative health effects of caregiving.

Social support intervention studies: a review and prospectus of nursing contributions

Nurse researchers have contributed some conceptual clarity, measurement devices and empirical studies of support resources and target populations to the social support literature. One apparent deficit, surprising when one considers nursings practice-orientation, is the virtual absence of empirical intervention studies. Accordingly, potential foci for nursing investigations at five levels of social-support interventions (individual, dyadic, group, social system and community levels) are proposed here. Nurses can not only propose but can also validate concepts of social support in real-life situations with real-world populations. They are qualified to bring a unique perspective to the study of social support. Empirical intervention research conducted by appropriately educated nurses should enhance future theoretical and practical development of the social support field.

A Support Intervention to Promote Health and Coping Among Homeless Youths

Homeless youths are often vulnerable to limited support resources and loneliness. Peers are a potent source of social support. A support intervention for homeless youths was designed to optimize peer influence and was pilot tested. The intervention was based on an initial assessment of support needs and intervention preferences from the perspective of 36 homeless youths and 27 service providers. Based on the results, a 20-week pilot intervention program was designed, consisting of 4 support groups, optional one-on-one support, group recreational activities, and meals. Support was provided by professional and peer mentors, including formerly homeless youths. A total of 56 homeless youths aged 16 to 24 took part. Participants completed pre-, mid-, and post-test quantitative measures and qualitative interviews. In spite of challenges due primarily to attrition, the youths reported enhanced health behaviours, improved mental well-being, decreased loneliness, expanded social network, increased coping skills, enhanced self-efficacy, and diminished use of drugs and alcohol. Further research could focus on replication at other sites with a larger sample.

Narratives of "dissonance" and "repositioning" through the lens of critical humanism: exploring the influences on immigrants' and refugees' health and well-being.

The focus of this article is on narratives of “starting over,” and the embedded processes, conceptualized as “dissonance”—between what people had expected to find in Canada and their actual experiences, and “repositioning”—how they subsequently restructured their lives and redefined their identities. This narrative analysis is one way of illuminating the complex ways in which social support networks influence dissonance and repositioning, and subsequently influence health and well-being.

Partnerships among Health Professionals and Self-Help Group Members

Occupational therapy practice in partnership with self-help groups is consistent with the principles of client-centred practice and health promotion. This qualitative research study examined the meanings and interactional mechanisms of effective partnerships with a theoretical sample of 47 health professionals, including seven occupational therapists, and 49 self-help group members. Inductive analysis of semi-structured interview transcripts resulted in a number of themes: roles of health professionals and self-help group members, relationships between them, characteristics of effective partnerships, tensions/barriers to effective partnerships, and strategies to promote partnerships. Themes with particular implications for occupational therapy practice include trust and trust building; knowledge, empathy and understanding; and the balance of power between health professionals and self-help group members. Effective partnership relationships require a continued commitment by occupational therapists, other health professionals and self-help group members to understand the experiences and perceptions of each other.

Early discharge and return to work following myocardial infarction

Individuals who have experienced a myocardial infarction (MI) account for the largest component of all hospitalization costs and foregone earnings due to cardiac disease. Early return to full employment and premorbid activity level should be the focus of cost-effective rehabilitative programs. Yet the economic benefits of vocational rehabilitation have not been directly researched. Therefore, issues of import regarding activity after MI include the timing of ambulation, discharge and return to work. Studies of early mobilization and discharge are contrasted in terms of methodology and outcome. These cite economic, social and psychological advantages, yet these factors are examined in isolation of other variables. A review of the literature reveals that there is a reluctance by many health professionals to institute such practices based in part on the dilemma surrounding selection of specific indicators and risk factors. Yet analysis reveals that the contention surrounding these exclusion criteria is perhaps unfounded, as the variance is less than is commonly assumed. Recurrent themes likewise emerge regarding the multiplicity of variables associated with the timing of resumption of employment, which is considered to be the most precise index of recovery following an MI. Of these, only early intense rehabilitation, directed at attitudinal and behavioural change, is amenable to modification by health professionals. Related research endeavours have examined employment following aortocoronary bypass surgery, risk factors in the work environment and work stressors which occur following MI. Controversy arises regarding the correlation of age and personality factors with return to work. Discrepancies in research findings are attributed to the diverse approaches to data collection, obstacles encountered in measuring psychological states, lack of operational definitions, differences in degree of rehabilitation and length of follow-up and the absence of controlled trials. Clearly, experimental research focusing on the job-related economic and human cost impact of specific rehabilitation programs must be conducted.(ABSTRACT TRUNCATED AT 400 WORDS)

Identifying gaps in asthma education, health promotion, and social support for Mi’kmaq families in Unama’ki (Cape Breton), Nova Scotia, Canada.

Introduction Asthma is the most common chronic condition affecting Aboriginal youth aged 8 to 12 years in Canada. Research investigating psychosocial challenges associated with asthma is limited. This study examines support resources, support-seeking strategies, support and education needs, and intervention preferences of Aboriginal youth with asthma and their caregivers in an effort to encourage community-wide, health-promoting behaviors. Methods We employed a community-based participatory research design to conduct interviews with 21 youths aged 8 to 12 years and 17 caregivers from 5 Mi’kmaq communities in Unama’ki (Cape Breton) Nova Scotia, Canada. After conducting interviews that explored existing and desired social, educational, and health support in participating communities, we held a 2-day asthma camp to engage participants in asthma education, social support networking, and cultural activities. At the camp, we collected data through participant observation, sharing circles, focus groups, and youth drawings of their experiences living with asthma. Results Our study yielded 4 key findings: 1) asthma triggers included household mold, indoor smoking, pets, season change, strenuous exercise, extreme cold, and humidity; 2) social and educational support is lacking in Mi’kmaq communities despite a strong desire for these services; 3) cultural, linguistic, and geographic barriers to accessing support exist; and 4) family members are primary support resources. Conclusion Improved support and educational resources are needed to foster effective Mi’kmaq asthma support networks. Future asthma interventions for marginalized populations must be culturally meaningful and linguistically accessible to those using and providing asthma support.