Analysis of the accessibility of perinatal and early childhood services for parents with physical disabilities: A modelled reading of access barriers

Perinatal and early childhood services are valuable resources for all new parents, particularly in supporting them as they transition to their new role. However, parents with physical disabilities report several barriers to accessing these services, including difficulty physically accessing services, lack of knowledge or negative attitudes of professionals, and lack of adaptation of services. The objective of this article is to analyse, through the Dixon-Woods et al. accessibility model, the barriers to accessing perinatal and early childhood services from the perspective of parents with physical disabilities. Thirteen semi-structured individual interviews, using the life story approach, were conducted. The results highlight barriers to access to services in all dimensions of the accessibility model. Principal barriers reported include non-inclusive criteria for accessing services (taking account both parenthood and disability), lack of knowledge about the services offered and the inadequacy of services in addressing parents’ needs. The sixth dimension (“offers and resistance”) presents a dynamic element, as it relates to the parents’ decision to use – or not – a service to which they are entitled. Using this model allowed for a pragmatic and systematic description of the obstacles encountered by parents, as well as the identification of needs and potential directions for action

The geometrical headache of French policies: Can vertical cultures be tilted horizontally?

French governmental policymaking operates by top-down processes of decision-making, jeopardizing all forms of power transfer and social transformation. The technocratic structure of public health promotes cost-effective, evidence-based curative and preventive strategies, focusing on individuals rather than on contexts. On the other hand, field workers, whose theoretical orientation is based mainly on psychoanalysis and individual clinical practices, are as reluctant as policymakers to move towards community practices and power sharing processes. This paper is based on our work as a community psychologist, working in a French governmental agency, and as a sociologist of mental health studying the processes of political decision-making in regard to preventive public health policies. The objective is first to reflect on the distinctive aspects of governmental policymaking in our country, and second, to underline the obstacles to and facilitators of success in our social policy-related work. In our context, we propose that community psychologists act in order to (1) apply social science knowledge and contextualize actions, with the intention to help political decision-making by including environmental, social and community variables in the definition of human processes and behaviors; 2) criticize the top-down decision-making process and the focus on the individual, by developing an interactionist model of knowledge evaluation, which would allow vertical understanding and decision-making to tilt horizontally, and 3) support people to create legitimate knowledge from their contexts rather than empowering them through psychological interventions

The geometrical headache of French policies: Can vertical cultures be tilted horizontally?

French governmental policymaking operates by top-down processes of decision-making, jeopardizing all forms of power transfer and social transformation. The technocratic structure of public health promotes cost-effective, evidence-based curative and preventive strategies, focusing on individuals rather than on contexts. On the other hand, field workers, whose theoretical orientation is based mainly on psychoanalysis and individual clinical practices, are as reluctant as policymakers to move towards community practices and power sharing processes. This paper is based on our work as a community psychologist, working in a French governmental agency, and as a sociologist of mental health studying the processes of political decision-making in regard to preventive public health policies. The objective is first to reflect on the distinctive aspects of governmental policymaking in our country, and second, to underline the obstacles to and facilitators of success in our social policy-related work. In our context, we propose that community psychologists act in order to (1) apply social science knowledge and contextualize actions, with the intention to help political decision-making by including environmental, social and community variables in the definition of human processes and behaviors; 2) criticize the top-down decision-making process and the focus on the individual, by developing an interactionist model of knowledge evaluation, which would allow vertical understanding and decision-making to tilt horizontally, and 3) support people to create legitimate knowledge from their contexts rather than empowering them through psychological interventions

Analysis of the accessibility of perinatal and early childhood services for parents with physical disabilities: A modelled reading of access barriers

Perinatal and early childhood services are valuable resources for all new parents, particularly in supporting them as they transition to their new role. However, parents with physical disabilities report several barriers to accessing these services, including difficulty physically accessing services, lack of knowledge or negative attitudes of professionals, and lack of adaptation of services. The objective of this article is to analyse, through the Dixon-Woods et al. accessibility model, the barriers to accessing perinatal and early childhood services from the perspective of parents with physical disabilities. Thirteen semi-structured individual interviews, using the life story approach, were conducted. The results highlight barriers to access to services in all dimensions of the accessibility model. Principal barriers reported include non-inclusive criteria for accessing services (taking account both parenthood and disability), lack of knowledge about the services offered and the inadequacy of services in addressing parents’ needs. The sixth dimension (“offers and resistance”) presents a dynamic element, as it relates to the parents’ decision to use – or not – a service to which they are entitled. Using this model allowed for a pragmatic and systematic description of the obstacles encountered by parents, as well as the identification of needs and potential directions for action

Access to Indigenous and allopathic medicines: A systematic review of barriers and facilitators

Background: Globally, Indigenous peoples are the victims of social inequalities in health. Their state of health is much lower than the health of the general population. Colonialism, living conditions and access to care are the main determinants of observed health conditions. The scientific objective of this systematic literature review is to study the facilitators and barriers to access healthcare for both, traditional and allopathic medicines. Methods: An inclusive search of electronic databases (e.g ProQuest, Ovid, Medline, CINAHL PLUS, Cochrane Library, ApaPsyNet, PsyINFO and Sociological Abstracts databases) of the past 20 years was performed. We retained studies discussing (1) traditional medicine (TM) or allopathic medicine (AM) or both and occurring (2) within Indigenous population worldwide. We made no distinction between research carried out in rural as opposed to urban areas. Results: A total of 45 studies published between 1996 and 2016 met our inclusion criteria and this speaks to the high interest and contemporary pertinence of accessing both systems of healthcare for Indigenous populations worldwide. Our thematic analysis enabled us to group barriers and facilitators into five categories, namely related to personal, relational, cultural, structural and policy components. As far as barriers and facilitators are concerned, the category that encompasses the most themes is the structural category. Conclusions: Mutual respect, trust and understanding of each other’s modalities is essential to offer the best healthcare options from both AM and TM to Indigenous peoples and hence pave the way to reducing health inequities. Wellness and strength-based approaches must also be favoured

Access to Indigenous and allopathic medicines: A systematic review of barriers and facilitators

Background: Globally, Indigenous peoples are the victims of social inequalities in health. Their state of health is much lower than the health of the general population. Colonialism, living conditions and access to care are the main determinants of observed health conditions. The scientific objective of this systematic literature review is to study the facilitators and barriers to access healthcare for both, traditional and allopathic medicines. Methods: An inclusive search of electronic databases (e.g ProQuest, Ovid, Medline, CINAHL PLUS, Cochrane Library, ApaPsyNet, PsyINFO and Sociological Abstracts databases) of the past 20 years was performed. We retained studies discussing (1) traditional medicine (TM) or allopathic medicine (AM) or both and occurring (2) within Indigenous population worldwide. We made no distinction between research carried out in rural as opposed to urban areas. Results: A total of 45 studies published between 1996 and 2016 met our inclusion criteria and this speaks to the high interest and contemporary pertinence of accessing both systems of healthcare for Indigenous populations worldwide. Our thematic analysis enabled us to group barriers and facilitators into five categories, namely related to personal, relational, cultural, structural and policy components. As far as barriers and facilitators are concerned, the category that encompasses the most themes is the structural category. Conclusions: Mutual respect, trust and understanding of each other’s modalities is essential to offer the best healthcare options from both AM and TM to Indigenous peoples and hence pave the way to reducing health inequities. Wellness and strength-based approaches must also be favoured

Déterminants relationnels de la santé mentale périnatale : approche psychosociale

During the second half of the twentieth century, the medical approach has taken the lead in the field of perinatality, over the interest for the community and social determinants of maternal mental health. According to the community model of mental health, social resources should be preferred to medical and professional interventions, as they promote the sustainability of mental health positive outcomes, by the autonomy offered to the community itself. This doctoral thesis aims at identifying the impact of the multiple dimensions of social support (emotional, practical, financial, guidance, socialization, positive feed-back) on mental health outcomes and more specifically on the prevention of postnatal depression. Using a social psychology of health methodology, 80 women have been recruited within a mental health promotion research. They have been evaluated on their social networks, received social support and perceived social support on each of the six dimensions of social support. The data analysis points out that common links reported between social support and mental health can't be found in this high-risk sample. The discussion focuses on research and intervention models for high psychosocial risk populations. Suggestions are made for improving community psychology actionsLa seconde moitié du XXe siècle a été marquée par un mouvement de médicalisation de la maternité et de la périnatalité, au détriment de l'intérêt porté aux déterminants relationnels de la santé mentale périnatale. L'approche communautaire de la santé mentale périnatale constitue le principe de subsidiarité applicable dans ce champ d'exercice : il est nécessaire de promouvoir les ressources sociales interpersonnelles si celles-ci peuvent se substituer à l'action médico-sociale. Ce travail de doctorat questionne l'impact du support social et de ses différentes formes (émotionnel, matériel, financier, informatif, socialisation, valorisation) sur les indicateurs de santé mentale et particulièrement sur la prévention de la dépression post-natale. A l'aide d'une méthodologie de psychologie sociale de la santé, 80 jeunes femmes en situation de grande vulnérabilité sociale et participant à une recherche-action de promotion de la santé mentale ont été questionnées sur leurs réseaux sociaux, sur le soutien social reçu et le soutien social perçu sur chacune des six dimensions du support social. L'analyse des données met en évidence qu'en contexte de grande précarité, on observe des liens différents entre support social et santé mentale que ceux habituellement reportés. La discussion porte sur les modèles de recherche et d'intervention spécifiques aux contextes de vulnérabilité psychosociale. Des perspectives sur les actions en psychologie communautaire sont proposée

Déterminants relationnels de la santé mentale périnatale (approche psychosociale)

La seconde moitié du XXe siècle a été marquée par un mouvement de médicalisation de la maternité et de la périnatalité, au détriment de l'intérêt porté aux déterminants relationnels de la santé mentale périnatale. L'approche communautaire de la santé mentale périnatale constitue le principe de subsidiarité applicable dans ce champ d'exercice : il est nécessaire de promouvoir les ressources sociales interpersonnelles si celles-ci peuvent se substituer à l'action médico-sociale. Ce travail de doctorat questionne l'impact du support social et de ses différentes formes (émotionnel, matériel, financier, informatif, socialisation, valorisation) sur les indicateurs de santé mentale et particulièrement sur la prévention de la dépression post-natale. A l'aide d'une méthodologie de psychologie sociale de la santé, 80 jeunes femmes en situation de grande vulnérabilité sociale et participant à une recherche-action de promotion de la santé mentale ont été questionnées sur leurs réseaux sociaux, sur le soutien social reçu et le soutien social perçu sur chacune des six dimensions du support social. L'analyse des données met en évidence qu'en contexte de grande précarité, on observe des liens différents entre support social et santé mentale que ceux habituellement reportés. La discussion porte sur les modèles de recherche et d'intervention spécifiques aux contextes de vulnérabilité psychosociale. Des perspectives sur les actions en psychologie communautaire sont proposéesDuring the second half of the twentieth century, the medical approach has taken the lead in the field of perinatality, over the interest for the community and social determinants of maternal mental health. According to the community model of mental health, social resources should be preferred to medical and professional interventions, as they promote the sustainability of mental health positive outcomes, by the autonomy offered to the community itself. This doctoral thesis aims at identifying the impact of the multiple dimensions of social support (emotional, practical, financial, guidance, socialization, positive feed-back) on mental health outcomes and more specifically on the prevention of postnatal depression. Using a social psychology of health methodology, 80 women have been recruited within a mental health promotion research. They have been evaluated on their social networks, received social support and perceived social support on each of the six dimensions of social support. The data analysis points out that common links reported between social support and mental health can't be found in this high-risk sample. The discussion focuses on research and intervention models for high psychosocial risk populations. Suggestions are made for improving community psychology actionsRENNES2-BU Centrale (352382101) / SudocSudocFranceF

Étude du phénomène d’isolement social chez des aînés vivant en milieu rural : d’une inscription sociale à une solitude individuelle

La population retraitée du monde agricole présente des caractéristiques uniques dans nos sociétés post-industrielles. Cette recherche qualitative donne la parole à des aînés issus du monde agricole après leur passage à la retraite et porte sur leur socialisation, interrogeant les concepts d’inclusion/isolement et de solitude. Les résultats mettent en évidence la fierté de s’affilier à une culture rurale séculaire. Les participants évoquent l’importance des contacts sociaux avec leurs pairs, qui ne sont plus nécessairement garantis par l’ancrage territorial, les lieux de vie traditionnels ayant été investis par de nouvelles populations. L’inclusion à travers des institutions formelles et informelles est abordée ainsi que la très complexe notion de pertes (du conjoint ou de la conjointe, des pairs et du mode de vie, des capacités physiques). Bien que les participants ne semblent pas se trouver dans une situation d’isolement social, les données font apparaître un ressenti de solitude, associé à de la détresse psychologique. La conclusion porte sur l’importance d’une prise en charge très spécifique de cette population, selon un ensemble de valeurs différent des interventions habituelles en santé publique

Être parent à l’intersection de différents contextes socioculturels : l’expérience de mères réfugiées originaires du Moyen-Orient au Québec, Canada

Research Framework: Refugee parents are particularly at risk of experiencing structural, social and mental health difficulties upon arrival in Quebec. Among the many challenges encountered, settling in a sociocultural context different from that of their country of origin can lead to significant difficulties, especially when these contexts include discordant elements. These challenges are likely to be heightened when children are between 0 and 5 years old. Objectives : This study explores the experience of parenthood among refugee mothers who find themselves at the intersection of different sociocultural contexts and who have a child between the age of 0 and 5. How do they experience parenthood in the face of different cultural elements?Methodology: Fifteen participants were interviewed via semi-structured interviews about their values, their parenting goals, and the challenges they have encountered as mothers since their arrival in the Quebec sociocultural context. Results: The results reveal sociocultural differences within three themes: 1) how they conceive the family and the ties within it, 2) how they conceive the ties with the neighbourhood, as a support network, and 3) how they conceive their child’s individual freedoms and rights. Conclusions: Analysis of the results highlights a difference underlying all three themes: the importance of the collective in the daily lives of the participants, as opposed to the individualism that they feel prevails in Quebec. The discussion underlines the multi-systemic dimension of this difference, and illustrates how it affects refugee mothers’ everyday experience. Contribution: The study provides a better understanding of the settlement experience of refugee mothers in Quebec. A number of recommendations and avenues of intervention are proposed to help support refugee families