Paul Bernard

Using the life course perspective to study the entry into the illness trajectory: The perspective of caregivers of people with Alzheimer's disease

The research community is showing increasing interest in the analysis of the care trajectory of people with chronic health problems, especially dementias such as Alzheimers disease. However, despite this interest, there is little research on the initial phases of the care trajectory. The fact that the first symptoms of dementia are generally noticed by those surrounding the elderly person suggests that the recognition of the disease is intimately linked to interactions not only amongst family members but also amongst friends, neighbours and health professionals. This study focuses on the period beginning with the first manifestations of cognitive difficulties and ending with the diagnosis of Alzheimer-type dementia. Interviews with 60 caregivers in Montreal, Canada were used to reconstruct how older people with Alzheimer-type dementia enter into the care trajectory. Our methods consisted of the analysis of social networks, social dynamics and action sequences. Our findings are presented in the form of a typology comprised of 5 pathways of entries into the care trajectory that are structured around the following four principles of the Life Course Perspective: family history, linked lives, human agency and organisational effects. We believe that analyses of the initial phases of the care trajectory, such as this one, are essential for the application of effective early detection and intervention policies. They are also central to informing future studies that seek to understand the care experience in its entirety.

Life Course as a Policy Lens: Challenges and Opportunities

Ce groupe d’études traitant de l’approche des parcours de vie comme outil d’évaluation de certaines politiques publiques est le produit de plus de un an et demi de recherches et de discussions parmi des chercheurs universitaires et des analystes de politiques. Les six études empiriques de ce numéro spécial ont toutes pour objectif d’élargir la portée de l’approche des parcours de vie en l’appliquant à des domaines liés aux politiques publiques qui, jusqu’à maintenant, n’avaient pas été abordés de cette façon. Ces études portent sur la santé des Autochtones, la participation sociale, les conditions de logement précaires et les expulsions, les trajectoires de revenus et les changements qui marquent le cadre de vie des personnes âgées. Les conclusions majeures qui se dégagent de ce projet de recherche sont les suivantes : 1. Le Canada est à l’avant-garde en matière d’évaluation de politiques publiques grâce à l’approche des parcours de vie, et cet avantage devrait stimuler les chercheurs et les décideurs à aller plus loin encore dans cette voie ; 2. L’approche des parcours de vie est moins axée sur les itinéraires individuels que sur les interactions entre les individus et les institutions sociales, et particulièrement sur les situations (les «scénarios») où les structures sociales sont sources d’inégalités et où les inégalités sont imprimées dans les parcours de vie eux-mêmes ; 3. L’approche des parcours de vie, utilisée comme moyen de décrire des cheminements marqués par des dépendances et d’expliquer l’influence des forces de gravité sociale et des événements déstabilisants, met l’accent sur les conditions sociales plutôt que sur les choix individuels ; 4. Pour les décideurs politiques, l’approche des parcours de vie est un outil plus pragmatique, parce que plus sensible à la réalité que vivent les acteurs sociaux ; par conséquent, les acteurs sociaux se reconnaissent mieux dans les politiques élaborées grâce à cet outil ; et 5. L’approche des parcours de vie offre aux acteurs sociaux, aux chercheurs et aux responsables de politiques la possibilité de travailler en collaborant plus étroitement.

The Complexities of Help-Seeking: Exploring Challenges Through a Social Network Perspective

Over the past 40 years, scholars have developed a series of models designed to explain and predict the use of healthcare services. The models of the 1960s and 1970s generated copious research in the health departments of numerous universities, partly because of the fact that their standard, variable-centred methodology made it easy for researchers to create questionnaires patterned on the theoretical models. In later years, however, recognition of the growing complexity of modern society caused theorists to propose new models that took a greater number of social phenomena, especially help-seeking behaviour, into account and called for the application of not one but several methodologies. While these new complex models differ from each other on many points, they all attempt to address the following four dimensions: social structure, multilevel effects, culture, and temporality. In this chapter, we discuss these dimensions from the vantage point of social networks. Our approach analyzes the dimension of social structure through network terminology (network structure) and explores multilevel effects through the linkage processes between formal and informal networks (organizational networks). We interpret the notion of culture through the lens of social representations (network content) and we use sequential narrative analysis (network dynamics) to understand the dimension of temporality.

Introduction - Telling it with Numbers: Conceptual and Methodological Innovations in Social Statistics:

T Canadian journal Sociologie et sociétés is currently bringing out, in French, a special issue devoted to social statistics, under the title ‘Les nombres pour le dire’; this wordplay is meant to convey the idea that numbers can tell a good story, when used properly. At the instigation of its former Editor, Susan McDaniel, Current Sociology is publishing here, simultaneously and in English, four of these articles, those of most interest to its own audience because they address very broad methodological issues or because they offer comparative research. The use of statistics in social research has changed significantly over the last two decades. Users of quantitative methods were often suspected of not thinking things through theoretically, of basing their approaches on sociologically dubious assumptions, and of plunging headfirst into computations which made their undertakings obscure in the eyes of laypersons, or perhaps a good number of sociologists. But this era of alchemists is largely over. Social statistics are now responsive to new contexts of research, and they put to use methodological innovations whose significance connects to theory. One of the many driving forces of this renewal has been the rediscovery of the complexities of governance, and of the need to base these on solid evidence. To this end, new instruments for the observation of social life have been designed, in particular complex surveys, and even experiments, on a variety of public issues: poverty, labour market participation, child development, the social determinants of health, the situation of immigrants, the restructuring of metropolises, lifestyles, social networks, time use, values and political attitudes, etc. The theoretical schemes which necessitate the construction and analysis of such data increasingly borrow from a variety of