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The purpose of this paper is to understand how digital interventions are mediating the identity work of community health workers (CHWs) in the context of two African countries.

This paper analyzes the everyday work of CHWs in two low- and middle-income country (LMIC) contexts (Uganda and Malawi) and seeks to understand changes in collective identity and the role of Information and Communication Technologies (ICTs) in mediating this “identity work”. As CHWs conduct their everyday tasks of care giving, data reporting and maintaining social interactions, they play two primary roles. One is the care giving role oriented towards the community, and two, is reporting and administrative work by virtue of them being affiliated with the Ministry of Health, either in formal or voluntary capacity. The ambivalence which they experience as they move back and forth between these two worlds of work is significantly now mediated through ICTs. The paper analyzes these dynamics and identifies three key sets of ambivalence in identity work: (1) role embracing-institutional distancing; (2) conformist-resistant and (3) dramaturgical-transformative. The paper makes unique contributions to information systems (IS) and ICT for development (ICT4D) studies in that it focuses on a nonprofessional group, which plays a fundamental role in providing care to underserved populations and also conducts data work which provides the foundation of the national health information system. This contrasts with dominant research in the field which focuses on professional groups, largely based in Western business organizations.

The paper identifies identity related tensions that emerge with the mediation of digital technologies in the work world of CHWs. These include tensions of conformist-resistant; and (3) dramaturgical-transformative. These findings are relevant and unique to the field of IS and ICT4D studies in that it focuses on a nonprofessional group, which plays a fundamental role in providing care to underserved populations and also conducts data work which provides the foundation of the national health information system.

While acknowledging identity construction and negotiation is a function of both work and social lives, in this paper we could only focus on the work lives.

As digital interventions in the health sector of low and middle income countries is becoming increasingly widespread, often the focus is more on the supply side (the supply of the technology) rather than on the demand side (users experiences and aspirations). Identity becomes a lens to understand these demand side dynamics, which helps provides practical guidance on implementation approaches to ensure that the technology adds value to user work processes and there is a seamless and not a disruptive transition.

CHWs are the most neglected cadre in the health system of low and middle income countries, even though they provide the cutting edge in care provision work to the most marginalized populations, living in rural and underserved areas. By focusing on how technologies can be more effectively implemented to support these care processes, the paper provides important social implications both for practice and research.

Analysis of identity construction and negotiation of informal groups in the unorganized sector of low and middle income countries has not received adequate attention in IS research. The paper seeks to fill this important gap.

This chapter seeks to quantify the effects of geographic access to community health centers on the likelihood of an individual having a regular source of health care.

Utilizing survey and center location data, the analysis employs bivariate cross-tabulation with chi-square and multinominal logistic regression to quantify the relationship between variables.

While individuals living in close spatial proximity to community health centers were more likely to identify a community health center as a regular source of care as compared with those without proximal access, the effect of community health center access on the identification of any source of regular health care was generally insignificant or negative, except for populations with a chronic medical condition.

While these findings support current literature suggesting that spatial proximity to care is insufficient to transform at-risk populations into regular primary care users, it is important to note that it is possible that individuals prefer to access primary care services outside of their immediate neighborhoods, potentially mediating the observed effect of proximity to care on the likelihood of having a regular source of care. Also, because this analysis is based on cross-sectional survey data, it is impossible to make a causal argument about the relationship between variables. Only the observed association can be asserted and used to inform future studies.

Existing research supports a positive association between community health center utilization and measures of health for social groups traditionally facing barriers to care, but few studies isolate the effect of center availability and health, particularly when considering those living in the catchment area but are not regular users. Due to the complexity and prevalence of barriers to health care for vulnerable and at-risk populations, these findings suggest that improving geographic access to primary health care does not guarantee positive outcomes for target groups. The magnitude of social disadvantage on vulnerable and at-risk populations can have a devastating effect on health care outcomes that is not easily overcome by social programs.

The aim of this study was to address the unmet information needs of Malawian informal carers. We report on a three-year project which we co-created with informal carers, medical doctors and NGOs with the view to disseminate health advisory messages.

This study was developed on the principles of co-production. The impact of our health advisory messaging approach was assessed through observations and questionnaire-based surveys for quality, clarity and usefulness.

The messages were disseminated beyond the local support groups and reached a much wider community via word of mouth. The messages also led to short and medium term benefits for informal carers and their loved ones.

Our findings highlight the importance of understanding the contextual conditions of informal caring and that of co-producing interventions with the people these aim to benefit.

Transition from inpatient mental health care to community living can be very difficult, as people are at an increased risk of suicide, self-harm and ultimately readmission into hospital. There is little research conducted exploring peer support workers’ (PSWs) lived experiences that could provide insight into the key transitions of care, particularly the support required after discharge from inpatient mental health care. The purpose of this paper is thus to provide a particular insight into what it feels like being discharged from psychiatric care from a PSW’s perspective, how may support be improved post-discharge and what factors might impact the potential for readmission into inpatient care.

A qualitative, phenomenological approach was adopted to explore and describe PSWs’ lived experiences of transitioning from psychiatric care. Four PSWs who were employed by a UK secure mental health facility were recruited. PSW is a non-clinical role with their main duty to support patients, and they were considered for this type of the study for their experience in negotiating the discharge process to better carry out their job as a PSW.

After being discharged from psychiatric care, PSWs experienced issues that had either a negative impact on their mental wellbeing or even resulted in their readmission back into inpatient psychiatric care. This study identified three inter-related recurrent themes – continuity of support, having options and realisation, all concerning difficulties in adjusting to independent community life following discharge. The findings of the study highlighted the importance of ensuring that service users should be actively involved in their discharge planning, and the use of effective post-discharge planning processes should be used as a crucial step to avoid readmission.

A deeper insight into the factors that impact on readmission to secure care is needed. The active involvement of service users in effective pre- and post-discharge planning is crucial to avoid readmission.

Mental health professionals should consider developing more effective discharge interventions in collaboration with service users; inpatient services should consider creating more effective post-discharge information care and support packages. Their lived experience empowers PSWs to play a key role in guiding patients in the discharge process.

This is the first study, to the best of the authors’ knowledge, to explore what it feels like being discharged from inpatient mental health care by interviewing PSWs employed at a forensic mental health hospital by adopting a phenomenological approach. This paper offers a deeper insight into the transition process and explores in detail what support is needed post discharge to avoid potential readmission from PSWs’ perspectives.

This paper aims to provide new insights into and offer potential solutions to the challenges encountered by mental health services working with remote, rural or underserved communities in the UK.

In this paper, the authors reflect on the utility of integrating conventional clinical approaches, with preventive care and empowering work within the community, to provide culturally sensitive and accessible mental health services. The authors describe an example of community intervention from a mental health service in Ghana designed to enhance reach within remote and rural communities and identify potential lessons for practice in the UK.

The partnership between community mental health services and the rural communities, including families and existing social frameworks, applies collaborative care to overcome the lack of resources and facilitate the acceptability of mental health services to the local population. There are a series of important lessons from this experience including the importance of understanding the culture of a community to optimise reach and the importance of working IN the community and WITH the community.

This paper is novel because it provides learning from a model of care applied in the global south that has potential for implementation with underserved populations in the UK. The authors suggest a reframing of the notion of community care to encompass existing frameworks of community, not merely a biomedical conceptualisation.

The authors explore the outcomes of health-care professionals' participation in a vendor-hosted online community by combining qualitative and quantitative data collected in two separate studies. The authors aim to shed light on the potential value outcomes of community participation covering the reduction of service costs by professionals' community participation.

The authors explore the outcomes of health-care professionals' participation in a vendor-hosted online community by combining qualitative and quantitative data collected in two separate studies. The authors also introduce GABEK® as a unique method of qualitative empirical content analysis. In the quantitative study, the authors refer to customer survey data and transactional data.

The results show that participation in online communities by professionals emerges as a dual concept, consisting of both help-seeking and help-providing behaviors. These behaviors in turn facilitate the creation of economic and relational value, as well as influencing the perceived usefulness of the online community, resulting in higher satisfaction with the community among the participating professionals. Customer survey data and transactional data were gathered from a major medical equipment vendor hosting an online community, and those data confirm that participation also decreases service support costs to professionals by reducing the number of necessary service visits by the vendor's service technicians.

The resulting model of participation and corresponding benefits in an online community for health-care professionals reflects and informs current developments in the health care industry.

The combination of qualitative as well as quantitative studies relying on the data of a world leading medical equipment vendor hosting an online community provides unique and innovative insights into participation and value creation within B2B communities.

The purpose of this paper is twofold: to explore the existing evidence around dementia services and interrogate the overarching UK policy development relating to service inclusion of black and minoritised groups. The paper will go on to identify the implications for the dementia wellness pathway and make recommendations regarding how services can be more inclusive.

This paper examines the policy/practice landscape around dementia care provision and observes if lessons can be learnt to improve health outcomes for people living with dementia from black and minoritised communities.

A review of dementia policy demonstrates how opportunities to improve the awareness, diagnosis and post-diagnostic support for minoritised communities are being missed. The outcomes of this mean that individuals are denied vital treatment and support, which could enhance quality of life and delay the progression of dementia.

The authors’ premise is that not meeting the dementia support needs of less-heard communities has negative financial as well as social and health-related outcomes and has wider resonance and implications for all stages of the dementia wellness pathway. Moreover, there is a legal responsibility for public services to provide culturally sensitive, responsive, appropriate and available care, to all people, without discrimination.

This paper offers a valuable review of policy and practice around dementia care in the UK and makes recommendations to improve health outcomes for people living with dementia from black and minoritised communities.

At the beginning of the 21st century, multiple and diverse social entities, including the public (consumers), private and nonprofit healthcare institutions, government (public health) and other industry sectors, began to recognize the limitations of the current fragmented healthcare system paradigm. Primary stakeholders, including employers, insurance companies, and healthcare professional organizations, also voiced dissatisfaction with unacceptable health outcomes and rising costs. Grand challenges and wicked problems threatened the viability of the health sector. American health systems responded with innovations and advances in healthcare delivery frameworks that encouraged shifts from intra- and inter-sector arrangements to multi-sector, lasting relationships that emphasized patient centrality along with long-term commitments to sustainability and accountability. This pathway, leading to a population health approach, also generated the need for transformative business models. The coproduction of health framework, with its emphasis on cross-sector alignments, nontraditional partner relationships, sustainable missions, and accountability capable of yielding return on investments, has emerged as a unique strategy for facing disruptive threats and challenges from nonhealth sector corporations. This chapter presents a coproduction of health framework, goals and criteria, examples of boundary spanning network alliance models, and operational (integrator, convener, aggregator) strategies. A comparison of important organizational science theories, including institutional theory, network/network analysis theory, and resource dependency theory, provides suggestions for future research directions necessary to validate the utility of the coproduction of health framework as a precursor for paradigm change.

The Healthy at Home (H@H) is an older adult day program that is in Toronto in Ontario, Canada. This is an integrated health and social care (IHSC) program that seeks to address the social isolation and health needs of a highly vulnerable older adult population living in the north Toronto communities. These are Russian-speaking Jewish older adult immigrants. The case provides a detailed description of the factors that enabled a diverse group of health and social care organizations to integrate their respective services to address the health and social care needs of their clients using a culturally appropriate and trauma-informed lens.

A case description comprised of key informant interviews, and a focus group was undertaken of representatives from health and social care organizations serving clients in the north Toronto area.

This case description identified eleven integration factors that enabled organizations to provide integrated care using a culturally appropriate and trauma-informed lens, and they include developing an aligned vision and goals, communications, an inter-organization culture of inter-dependence, champions, pre-existing relationships, and champions. In addition, operating in the not-for-profit sector, sector differences, enabling public policies and a strong sense of community have influenced integration of services across the organizational partners to serve its high-risk client group.

This case description lends insights into how IHSC can be leveraged to provide culturally appropriate and trauma-informed care for highly vulnerable client/patient populations. A lesson learnt is that social care partners can engage in successful integration leadership in joint health and social care integration efforts.

This study aims to evaluate how a community psychiatry model, referred to as the Mental Health Action Trust (MHAT) in India, provides decentralized care and comprehensive services to people with severe mental illness living in poverty. Using the complex adaptive system (CAS) framework, the authors aim to understand the factors that contribute to the diverse outcomes of the MHAT community mental health programme as observed in four different locations.

Four MHAT clinics were purposively chosen from two districts in Kerala. A comparative case study methodology was used to document each clinic’s MHAT services and activities, as found during field visits and interviews with staff members and volunteers.

The study shows that all four clinics met the basic aim of providing free, quality mental health care to the poorest populations, although not all aspects of the comprehensive model could be equally provided. Alignment with the MHAT vision, appropriate leadership, the relationship with partners and their level of community engagement determined the varied success between clinics.

The current study evaluation stresses that community ownership is crucial. Careful attention must be paid to the characteristics of selected partners, including their leadership styles and ability to garner resources.