Participatory Health Research With Mothers Living in Poverty in the Netherlands: Pathways and Challenges to Strengthen Empowerment

Empowerment von Menschen, die unter prekären Bedingungen leben, ist eine zentrale Prämisse partizipativer Gesundheitsforschung (PGF). Empowerment, die Selbstermächtigung einer Person innerhalb ihrer sozialen Umgebung, hat eine persönliche, eine relationale und eine politische Komponente. Die hier berichtete Studie wurde mit Müttern durchgeführt, die unter prekären Bedingungen in den Niederlanden leben. Wir beschreiben in diesem Beitrag, wie Empowerment im Projekt gefördert werden konnte 1. im Rahmen der Agenda (Eigentumsrechte) und 2. durch die Anerkennung sowohl der Selbstartikulation als auch der geteilten Darstellung der Teilnehmerinnen über ihre eigenen Belange (epistemische Gerechtigkeit). Ein Ergebnis unsere Studie ist, dass insbesondere die Bemühung um relationales und politisches Empowerment sehr herausfordernd sein können: Relationale Spannungen in der Gruppe beeinträchtigten unsere Arbeit, und die Reflexion struktureller Ursachen für die missliche Lage der Mütter benötigte Zeit und relationale Sensitivität. Hier konzentrierten wir uns als Forschende insbesondere auf ethische Fragen und versuchten, mit kreativen Außenstehenden zusammenzuarbeiten, um der Disharmonie in der Gruppe entgegenzuwirken. Relationales und politisches Empowerment ist im Rahmen von PGF ein langfristiges Unterfangen und birgt einige Stolpersteine im Forschungsprozess.Empowerment of people in challenging circumstances is a central premise of participatory health research (PHR). Empowerment, a process of strengthening vis-à-vis one's social environment, has three components: personal, relational, and political. The current PHR study was conducted with mothers living in unfortunate situations in the Netherlands. In this article, we describe how PHR fostered personal empowerment to a certain degree by 1. setting an agenda for the project (ownership), and 2. listening to and acknowledging the articulation of the participants' own story and a collective story about their issues (epistemic justice). One result of the study is that achieving relational and political empowerment can be challenging. Relational tensions in the group distracted us. Conducting critical reflection on more structural causes of the unfortunate situations of the mothers is a process that needs time and calls for relational sensitivity and inclusion. The participatory researcher as facilitator focused on ethics and tried to collaborate with creative outsiders to change the disharmony in the group. Reaching relational and political empowerment is a long-term process in PHR, but not without stumbling blocks on the journey

“We are all so different that it is just … normal.”:Normalization practices in an academic hospital in the Netherlands

Internationally, academic hospitals are giving increasing attention to diversity management. This paper sheds light on the actual praxis of cultural diversity management by professionals in workplace interactions. An ethnographic study in a Dutch academic hospital showed that normalization practices were obscuring diversity issues and obstructing inclusion of cultural minority professionals. The normalization of professionalism-as-neutral and equality-as-sameness informed the unequal distribution of privilege and disadvantage among professionals and left no room to question this distribution. Majority and minority professionals disciplined themselves and each other in (re)producing an ideal worker norm, essentialized difference and sameness, and explained away the structural hierarchy involved. To create space for cultural diversity in healthcare organizations in the Netherlands and beyond, we need to challenge normalization practices

The quality of caring relationships

In health care, relationships between patients or disabled persons and professionals are at least co-constitutive for the quality of care. Many patients complain about the contacts and communication with caregivers and other professionals. From a care-ethical perspective a good patient-professional relationship requires a process of negotiation and shared understanding about mutual normative expectations. Mismatches between these expectations will lead to misunderstandings or conflicts. If caregivers listen to the narratives of identity of patients, and engage in a deliberative dialogue, they will better be able to attune their care to the needs of patients. We will illustrate this with the stories of three women with multiple sclerosis. Their narratives of identity differ from the narratives that caregivers and others use to understand and identify them. Since identities give rise to normative expectations in all three cases there is a conflict between what the women expect of their caregivers and vice-versa. These stories show that the quality of care, defined as doing the right thing, at the right time, in the right way, for the right person, is dependent on the quality of caring relationships

Experiential Knowledge of Mental Health Professionals. Service Users’ Perceptions

Introduction: Nowadays the Western mental health system is in transformation to recovery-oriented and trauma informed care in which experiential knowledge becomes incorporated. An important development in this context is that traditional mental health professionals came to the fore with their lived experiences. From 2017 to 2021, a research project was conducted in the Netherlands in three mental health organizations, focussing on how service users perceive the professional use of experiential knowledge. Aims: This paper aims to explore service users’ perspectives regarding their healthcare professionals’ use of experiential knowledge and the users’ perceptions of how this contributes to their personal recovery. Methods: As part of the qualitative research, 22 service users were interviewed. A thematic analysis was employed to derive themes and patterns from the interview transcripts. Results: The use of experiential knowledge manifests in the quality of a compassionate user-professional relationship in which personal disclosures of the professional’s distress and resilience are embedded. This often stimulates users’ recovery process. Conclusions: Findings suggest that the use of experiential knowledge by mental health professionals like social workers, nurses and humanistic counselors, demonstrates an overall positive value as an additional (re)source

Responsive evaluation: an innovative evaluation methodology for workplace health promotion interventions

Background: Workplace health promotion (WHP) interventions have limited effects on the health of employees with low socioeconomic position (SEP). This paper argues that this limited effectiveness can be partly explained by the methodology applied to evaluate the intervention, often a randomised controlled trial (RCT). Frequently, the desired outcomes of traditional evaluations may not match employees'-and in particular employees with low SEP-needs and lifeworld. Furthermore, traditional evaluation methodologies do not function well in work settings characterised by change resulting from internal and external developments. Objective: In this communication, responsive evaluation is proposed as an alternative approach to evaluating WHP interventions. Responsive evaluation's potential added value for WHP interventions for employees with low SEP in particular is described, as well as how the methodology differs from RCTs. The paper also elaborates on the different scientific philosophies underpinning the two methodologies as this allows researchers to judge the suitability and quality of responsive evaluation in light of the corresponding criteria for good science

THE ROLE OF A PARTICIPATORY SPACE IN THE DEVELOPMENT OF CITIZENSHIP

Research and policymaking are paying increasing attention to the development of citizenship, stimulated by the transition towards a participatory society. In this paper we focus specifically on citizens in mental health and homeless care, whose citizenship is often underdeveloped. Pols (2016) endorses the need for a participatory space outside home or work where people in a vulnerable position can develop relational citizenship. We reflect on the influence a participatory space can have on the development of individual and democratic citizenship besides the more commonly described relational citizenship. We specifically focus on characteristics of a participatory space that can influence the development of citizenship. To this end we use both theoretical insights and empirical data from a longitudinal participatory study into Je Eigen Stek (JES, Your own place), a self-managed transitional programme in homeless care. JES as a participatory space contributes to the development of individual, relational and democratic citizenship, even though not all participants benefit equally. The different forms of citizenship both hinder and stimulate each other. Our paper brings to light aspects of a participatory space that can influence the development of individual, relational and democratic citizenship. We also found indications for the importance of looking at physical aspects of a participatory space in relation to the development of citizenship. Citizens in homeless care are able to develop citizenship, supported by a participatory space if adequately facilitated. It is therefore important to assess the quality of the participatory space