Rachel Phillips

Community-Academic Research on Hard-to-Reach Populations: Benefits and Challenges

In this article, the authors examine some of the benefits and challenges associated with conducting research on hard-to-reach/hidden populations: in this instance, sex workers. The population studied was female and male sex workers working in different sectors of the sex industry in a medium-size Canadian metropolitan area. The authors describe the need for close community-academic cooperation, given the hidden and highly stigmatized nature of the target population that was investigated and the local context in which the research project was embedded. The authors discuss the main benefits and challenges of the research collaboration for the various parties involved, including the community partner organization, indigenous research assistants, and academic research team. They conclude with a discussion of strategies to help overcome the main challenges faced during the research endeavor.

In for the Long Haul: Knowledge Translation Between Academic and Nonprofit Organizations

Although scientists are continually refining existing knowledge and producing new evidence to improve health care and health care delivery, far too little scientific output finds its way into the tool kits of practitioners. Likewise, the questions that clinicians would like to be answered all too rarely get taken up by researchers. In this article we focus on knowledge translation challenges accompanying a longitudinal research program with nonprofit organizations providing direct and indirect health and social services to disadvantaged groups in one region of Canada. Three essential factors influencing authentic and reciprocal knowledge transfer and utilization between nonprofit service providers and researchers are discussed: strong institutional partnerships, the use of skilled knowledge brokers, and the meaningful involvement of frontline personnel.

Sporting Girls, Streetwalkers, and Inmates of Houses of Ill Repute: Media Narratives and the Historical Mutability of Prostitution Stigmas

This article examines the mutability of symbolic sanctions— or stigmas—applied to sex industry work by examining newspaper narratives in one medium-sized Canadian city over two time periods: 1870–1910 and 1980–2004. The articles purpose is first to get a sense of what the authors call the ecology of stigmas—their relation to the temporal and spatial contexts in which they are produced—and second to give needed historical context to them and the representational tropes that currently dominate media, policy, and academic discussions about prostitution. This article finds significant continuities and discontinuities between media representations during the two study periods. In particular, prostitution stigmas are constituted out of cross-articulations of narratives around containment, culpability, and contagion across the twentieth century, but the ideational contents and empirical referents of these narratives reflect the intersection of sex industry contexts with historically specific concerns around gender, sexuality, race, and social status. Stigmas of the sex industry, rather than being constant, reveal themselves to be both deeply ecological and accommodating to a range of concerns about female sexuality and normative behavior that are sensitive to historical time.

Social factors linked to postpartum depression: A mixed-methods longitudinal study

Background: There is a large body of research on the mental well-being of childbearing women focusing on the prevalence rates of antenatal and postpartum depression, and associated risk factors. However, there is a paucity of research on postpartum depression in its social context and in relation to the lived experience of the mother. Aims: To investigate the association between social factors, the organization of maternity care services, and the prevalence of depression among a purposive sample of new mothers at 3 – 4 weeks and 4 – 6 months post-partum. Method: Longitudinal, mixed-methods research design. Results: Our quantitative analyses demonstrate that income and postpartum depression were linked and there was also an association between satisfaction with the birth experience and depression at 3 – 4 weeks postpartum. Thematic analysis of the qualitative interview data revealed two main sources of dissatisfaction: disruption of birth plans and inadequate support from maternity providers. Discussion & limitations: We discuss some of the benefits and limitations of our mixed-methods longitudinal study and directions for further research. Declaration of interests: None.

Social Determinants of Health Care Access Among Sex Industry Workers in Canada

Drawing on closed and open-ended interview data (n=79), this paper explores the health care experiences of a purposive sample of sex industry workers in a medium-sized metropolitan area of British Columbia, Canada. The respondents reported high average health care utilization and many reported satisfactory access to health care, including a positive relationship with a regular health provider. However, several respondents reported feeling intimidated and shamed in health care settings (felt stigma) and many choose to withhold information relevant to their health care due to fear of discrimination (enacted stigma) by health professionals.

Disability stigmatization as a barrier to employment equity for legally-blind Canadians

Canada has expressed a strong commitment to the rights of its citizens against discrimination, including those with disabilities. A question remains whether Canadians with disabilities are able to practice these rights. Our mixed-methods study sheds light on the situation of one important sub-group of people with disabilities – those who are legally blind. Our survey results show that the labour-force participation rate for this population is very low compared with those without disabilities, and also lower than the rate for persons with other disabilities. Legally-blind working-age Canadians have significantly higher rates of unemployment and underemployment, and perceive major barriers to employment. In-person interviews reveal the negative impact of one major barrier – disability stigmatization – on accessing meaningful employment and other societal assets. We discuss the implications of these findings and suggest policy directions.

Explaining the Health Gap Experienced by Girls and Women in Canada: A Social Determinants of Health Perspective

In the last few decades there has been a resurgence of interest in the social causes of health inequities among and between individuals and populations. This ‘social determinants’ perspective focuses on the myriad demographic and societal factors that shape health and well-being. Heeding calls for the mainstreaming of two very specific health determinants - sex and gender - we incorporate both into our analysis of the health gap experienced by girls and women in Canada. However, we take an intersectional approach in that we argue that a comprehensive picture of health inequities must, in addition to considering sex and gender, include a context sensitive analysis of all the major dimensions of social stratification. In the case of the current worldwide economic downturn, and the uniquely diverse Canadian population spread over a vast territory, this means thinking carefully about how socioeconomic status, race, ethnicity, immigrant status, employment status and geography uniquely shape the health of all Canadians, but especially girls and women. We argue that while a social determinants of health perspective is important in its own right, it needs to be understood against the backdrop of broader structural processes that shape Canadian health policy and practice. By doing so we can observe how the social safety net of all Canadians has been eroding, especially for those occupying vulnerable social locations.

Reenvisioning Success for Programs Supporting Pregnant Women With Problematic Substance Use

Community-based, integrated, primary care maternity programs for pregnant women affected by problematic substance use are emerging as effective models for engaging women affected by multiple health and social issues. Although addictions services have historically been evaluated by individual achievement of abstinence, new definitions of program success are required as addiction comes to be viewed as a chronic illness. We conducted a mixed-methods study to follow the formative development stages of a community-based program, identifying key evaluation indicators and processes related to this program, program team members, and women and families served. As this program model develops, it is critical that providers, community partners, and health system leaders collaborate to frame definitions of success in ways helpful for guiding program development.

Complicating the dominant morality discourse: mothers and fathers’ constructions of substance use during pregnancy and early parenthood

IntroductionConsumption of substances is a highly controversial behaviour, with those who do so commonly viewed as deviants, even criminals, or else as out of control addicts. In other work we showed that the use of substances by women who are pregnant or have recently become parents was mainly viewed by health and social care providers as morally wrong. Problematic substance use was framed through the narrow lens of gendered responsibilisation, resulting in women being seen primarily as foetal incubators and primary caregivers of infants.MethodsIn this follow-up paper we examine descriptive and qualitative data from a convenience sample of biological mothers and fathers (N = 34) recruited as part of a larger mixed methods study of the development and early implementation of an integrated primary maternity care program. We present a description of the participants’ backgrounds, family circumstances, health status, and perception of drug-related stigma. This is succeeded by a thematic analysis of their personal views on substance use during both pregnancy and the transition to parenthood.ResultsOur results show that while many mothers and fathers hold abstinence as the ideal during pregnancy and early parenting, they simultaneously recognize the autonomy of women to judge substance use risk for themselves. Participants also call attention to social structural factors that increase/decrease harms associated with such substance use, and present an embodied knowledge of substance use based on their tacit knowledge of wellness and what causes harm.ConclusionsWhile these two main discourses brought forward by parents concerning the ideal of abstinence and the autonomy of women are not always reconcilable and are partially a reflection of the dissonance between dominant moral codes regarding motherhood and the lived experiences of people who use substances, service providers who are attuned to these competing discourses are likely to be more effective in their delivery of health and social services for vulnerable families. More holistic and nuanced perspectives of health, substance use, and parenting may generate ethical decision-making practice frameworks that guide providers in meeting and supporting the efforts of mothers and fathers to achieve well-being within their own definitions of problematic substance use.

Sex workers as peer health advocates: community empowerment and transformative learning through a Canadian pilot program

BackgroundSocial marginalization and criminalization create health and safety risks for sex workers and reduce their access to health promotion and prevention services compared to the general population. Community empowerment-based interventions that prioritize the engagement of sex workers show promising results. Peer-to-peer interventions, wherein sex workers act as educators of their colleagues, managers, clients and romantic partners, foster community mobilization and critical consciousness among sex workers and equip them to exercise agency in their work and personal lives.MethodsA pilot peer health education program was developed and implemented, with and for sex workers in one urban centre in Canada. To explore how the training program contributed to community empowerment and transformative learning among participants, the authors conducted qualitative interviews, asked participants to keep personal journals and to fill out feedback forms after each session. Thematic analysis was conducted on these three data sources, with emerging themes identified, organized and presented in the findings.ResultsFive themes emerged from the analysis. Our findings show that the pilot program led to reduced internalized stigma and increased self-esteem in participants. Participants’ critical consciousness increased concerning issues of diversity in cultural background, sexual orientation, work experiences and gender identity. Participants gained knowledge about how sex work stigma is enacted and perpetuated. They also became increasingly comfortable challenging negative judgments from others, including frontline service providers. Participants were encouraged to actively shape the training program, which fostered positive relationships and solidarity among them, as well as with colleagues in their social network and with the local sex worker organization housing the program. Resources were also mobilized within the sex worker community through skills building and knowledge acquisition.ConclusionThe peer education program proved successful in enhancing sex workers’ community empowerment in one urban setting by increasing their knowledge about health issues, sharing information about and building confidence in accessing services, and expanding capacity to disseminate this knowledge to others. This ‘proof of concept’ built the foundation for a long-term initiative in this setting and has promise for other jurisdictions wishing to adapt similar programs.