Querying Everyday Scarcity: A Feminist Political Economy Analysis of Kidney Dialysis and Transplantation in Rural British Columbia

This thesis uses a feminist political economy perspective to analyze the findings from a qualitative case study regarding kidney dialysis and transplantation in rural and remote British Columbia. This case study was conducted in order to investigate the concept of "scarcity," which is very common in organ transfer discourse. Critical ethnography and document analysis were used to examine the ways in which scarcity manifests in policy, practice, and everyday life. The main areas of focus include: the systemic context for the practices; the intersection of social location and geographic isolation; the intersection of gender, work and health; the implications of work in the local resource industry for renal health and renal replacement options; the role of unpaid care work provided by family members; and the implications of shifting care from institutions to families and individuals – particularly in a rural and remote context. Broadly, I argue that the scarcity of transplantable organs remains the dominant public discourse, that this discourse informs policies and practices, and that, despite these trends, lived experiences of scarcity at this site of study have more to do with the scarcity of human and health care resources, particular services, and health and life-sustaining resources for patients

Sexual expression in Alberta's continuing care homes: perspectives from residents and family members

In this report, we outline the findings from Phase 2 of a multi-phase, Alberta-wide study on sexual expression in supportive living and long-term care homes. By “sexual expression,” we mean handholding, hugging, fantasizing, bed sharing, kissing, masturbation, grooming and self-presentation, forming intimate relationships, and engaging in physical sex acts. In what follows, we outline some of the key themes from the academic literature; briefly describe our methods for data collection and analysis; share key findings; and make recommendations for policy and practice. We conclude with a list of resources for family members and residents who are navigating sexual expression in continuing care homes.Alberta Innovate

Sexual expression in Alberta's continuing care homes: perspectives from managers and leaders

In this report, we outline the findings from Phase 1 of a multi-phase, Alberta-wide study on sexual expression in supportive living and long-term care homes. In what follows, we outline some of the key themes from the academic literature; briefly describe our methods for data collection and analysis; share key findings; and make recommendations for practice, policy, research, and education. We conclude with a list of resources for those navigating sexual expression in continuing care

Long-term care in rural Alberta: exploring autonomy and capacity for action

Context: Since the 1990s, Alberta, Canada has seen considerable restructuring to health and long-term care (LTC) services. Most LTC research is conducted in urban centres. As a result, little is known about the effects that restructuring has had on rural LTC homes. Objective(s): In this article, we outline our findings related to autonomy and capacity for action in rural LTC homes. Method(s): We conducted a multi-site comparative case study. Using rapid ethnography, we conducted weeklong site visits at three rural LTC homes. This involved two types of data collection: semi-structured qualitative interviews and field observations. We used a feminist political economy lens to analyze the data. Findings: Our findings offer insights into how rural LTC staff are empowered to create change and/or constrained from doing so. We outline these findings at macro, meso, and micro levels of analysis and conclude that a combination of site-level and systemic factors contribute to a LTC home’s level of autonomy and capacity for action. Limitations: Our findings reflect experiences and observations at three LTC homes at three distinct points in time. Though the data provide rich descriptions, they do not provide an exhaustive account of the strengths and challenges of rural LTC. Implications: Community resources, local industries, and other socioeconomic and organizational factors contribute to a community’s response to LTC restructuring and their ability to make change and ruralize their LTC provision. These factors, and the heterogeneity of rural communities, should be taken into consideration during decision-making about rural health policy and service provision

Intersections in rural long-term care: a comparative case study in Alberta

In this report, we outline the results of a comparative case study of long-term care (LTC) in rural Alberta.Ye

Continuing care in rural Alberta: a scoping review

This is an open-access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modification or adaptations are made.Across Canada the demand for continuing care services is increasing. However, little is known about the implications this has for rural communities. This scoping review identifies several key themes in the literature related to continuing care in Alberta. These include contextual factors, quality assurance and improvement, and workforce issues. We identify the ways in which rural dynamics are included in, or omitted from, this literature and recommend areas for future research on rural continuing care provision. Further research on residential care services in rural communities should work towards bridging the rural health, academic, and organizational literature on continuing care. This synthesis will help to position rurality as a determinant of health and to situate continuing care services in specific rural settings.Ye

Barriers to addressing the social determinants of health: Insights from the Canadian experience. Health Policy 88(2-3):

To date, Ontario public health units (PHUs) have generally neglected the social determinants of health (SDH) concept in favor of risk aversion and behaviorally oriented health promotion approaches. Addressing SDH and responding to the presence of health inequities is required under the Ontario Public Health Standards and is a component of provincial public health documents and reports. Nevertheless, units vary in their understanding and application of the SDH concept in their activities. The authors conducted 18 interviews with Medical Officers of Health and lead staff persons from nine Ontario PHUs, in order to better understand how these differences in addressing the SDH among health units come about. The findings suggest that differences in practice largely result from epistemological variations: conceptions of the SDH; the perceived role of public health in addressing them; and understandings concerning the validity of differing forms of evidence and expected outcomes. Drawing from Bachelard's concept of epistemological barriers and Raphael's seven discourses on the SDH, we examine the ways in which the participating units discuss and apply the SDH concepts. We argue that a substantial barrier to further action on the SDH is the internalization of discourses and traditions that treat health as individualized and depoliticized. Keywords: social determinants of health; public health; epistemological barriers; Canada Introduction Despite Canada's reputation for developing concepts related to the social determinants of health (SDH), government agencies, professional health organizations, and local public health units (PHUs) have struggled with how to apply the concept to improve the health of the Canadian public The French philosopher and historian Gaston Bachelard introduced the concept of 'epistemological obstacles' or 'epistemological barriers' to explain the intellectual hurdles that scientists may face when they approach new scientific problems. He claimed that in order to develop new approaches to a problem, scientists must overcome the barriers posed by their prior views Raphael We apply the notion of epistemological barriers in our discussion of OntarioCanada's most populous province -PHUs and their efforts to address the SDH. In this case, the barriers may stem from particular discourses about health and society and the appropriate role for the public health community in addressing these issues. To date, Ontario PHUs have generally neglected the SDH in favor of risk aversion and behaviorally oriented health promotion approaches (NCCDH 2010). Addressing SDH and responding to the presence of health inequalities is required under the Ontario Public Health Standards Downloaded by [109.174.179.68] at 09:21 22 July 2013 how these differences came about. Our findings suggest that these differences in practice result largely from varying conceptions of: the nature of SDH, the perceived role of public health in addressing them, and understandings concerning the validity of differing forms of evidence and expected outcomes. Based on Raphael's (2011) model of SDH discourses and the ways in which the participating units discussed the SDH, we categorized them into three clusters, those that take functional, analytical, and structural approaches. These approaches are defined in the results section. Background and specific goals of this researc

Long-Term Care in Rural Alberta: Exploring Autonomy and Capacity for Action

Context: Since the 1990s, Alberta, Canada has seen considerable restructuring to health and long-term care (LTC) services. Most LTC research is conducted in urban centres. As a result, little is known about the effects that restructuring has had on rural LTC homes. Objective(s): In this article, we outline our findings related to autonomy and capacity for action in rural LTC homes. Method(s): We conducted a multi-site comparative case study. Using rapid ethnography, we conducted weeklong site visits at three rural LTC homes. This involved two types of data collection: semi-structured qualitative interviews and field observations. We used a feminist political economy lens to analyze the data. Findings: Our findings offer insights into how rural LTC staff are empowered to create change and/or constrained from doing so. We outline these findings at macro, meso, and micro levels of analysis and conclude that a combination of site-level and systemic factors contribute to a LTC home’s level of autonomy and capacity for action. Limitations: Our findings reflect experiences and observations at three LTC homes at three distinct points in time. Though the data provide rich descriptions, they do not provide an exhaustive account of the strengths and challenges of rural LTC. Implications: Community resources, local industries, and other socioeconomic and organizational factors contribute to a community’s response to LTC restructuring and their ability to make change and ruralize their LTC provision. These factors, and the heterogeneity of rural communities, should be taken into consideration during decision-making about rural health policy and service provision