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Recently, the institutional performance model has been used to explain the increased distrust of health care system by arguing that distrust is a function of individuals’ perceptions on the quality of life in neighborhood and social institutions. We examined (1) whether individuals assess two dimensions of distrust consistently, (2) if the multilevel institutional performance model explains the variation of distrust across neighborhoods, and (3) how distrust patterns affect preventive health care behaviors.

Using data from 9,497 respondents in 914 census tracts (neighborhoods) in Philadelphia, we examined the patterns of how individuals evaluate the competence and values distrust using the Multilevel Latent Class Analysis (MLCA), and then investigated how neighborhood environment factors are associated with distrust patterns. Finally, we used regression to examine the relationships between distrust patterns and preventive health care.

The MLCA identified four distrust patterns: Believers, Doubters, Competence Skeptics, and Values Skeptics. We found that 55 percent of the individuals evaluated competence and values distrust coherently, with Believers reporting low levels and Doubters having high levels of distrust. Competence and Values Skeptics assessed distrust inconsistently. Believers were the least likely to reside in socioeconomically disadvantaged and racially segregated neighborhoods among these patterns. In contrast to Doubters, Believers were more likely to use preventive health care, even after controlling for other socioeconomic factors including insurance coverage.

Our findings suggest that distrust patterns are a function of neighborhood conditions and distrust patterns are associated with preventive health care. This study provides important policy implications for health care and future interventions.

The purpose of this paper is to report on the initial validation of a new method, called the “Meaning of the Child Interview” (MotC), to assess the psychological meaning all children have for their parents, but which in cases of risk, submerge or distort the child’s identity. The MotC analyses parental discourse using a method developed from the discourse analysis used to classify the Adult Attachment Interview together with patterns derived from the infant CARE-Index, a procedure that evaluates face-to-face parent-child interaction. This allows the MotC to illuminate how the parent’s thinking influences the developing relationship between parent and child.

Parents are interviewed using the Parent Development Interview (PDI), or an equivalent, and then the interview transcript is classified using the MotC system. The coding method was developed from interviews drawn from the first author’s work with children and families in the family court system, and then tested with a sample of 85 mothers and fathers, 62 of whom were parents drawn from an “at risk” context. The parents were also videoed in a short free play interaction, using the CARE-Index.

The study found a strong correspondence between the levels of risk as assessed by the MotC patterns of parental representation of care giving, the risk to the parent-child relationship observed using the CARE-Index. There was also corroboration of the patterns of interaction identified by the MotC.

The results of the study provide good evidence for the Meaning of the Child as an identifiable construct, and as an assessment tool to identify and assess the nature of “at risk” parent-child relationships. MotC was developed in a clinical setting within the Family Court justice system, and is designed to offer assistance to child protection and mental health practitioners deciding how to intervene in particular parent-child relationships.

Spain is typically considered a familialistic country where the family is the main responsible for individuals’ well-being. Recent demographic, socioeconomic and policy changes raise the question to what extent familialism is regarded as the preferred care arrangement in society or whether more state support is considered legitimate. The purpose of this paper is to analyse individual preferences among Spanish residents regarding care responsibility for pre-school children and the frail elderly, and the factors that influence such preferences.

Representative data from the 2012 International Social Survey Programme are used (n=1419). Six patterns of care responsibility that capture preferences regarding who, between the family or the state, should provide and pay for the care of pre-school children and the frail elderly are identified. Logistic regressions are performed on each care responsibility pattern to analyse the factors influencing individuals’ preferences.

Multiple preferences coexist and state responsibility is often preferred over family responsibility, especially for elderly-care. It suggests that the tendency to rely on the family in Spain is due to insufficient support rather than to familialistic values. Individuals who usually bear most care work responsibilities, such as women and individuals in caring ages, or those with a poor health, high care load or low income consider there should be extra-family support. Individuals’ values also matter: the least religious, the most supportive of maternal employment and left-wing voters are most likely to reject traditional care arrangements.

This is the first study to analyse both elderly- and childcare policy preferences in one single study. It shows that childcare is more often seen as a family responsibility than elderly care.

Access can be understood as the spatial dimension of social inclusion and exclusion. It is from this understanding that the authors incorporate the gender perspective when analysing the possibilities of mobility in the city. This research focusses on a specific moment in the life cycle of men and women: childbirth and the presence of children in the household. The aim is to elucidate how much the presence of children in the household impacts the urban mobility of the people responsible for the household, comparing data of men and women responsible for households with or without cohabiting children. The authors used descriptive statistics and correlation analysis based on data from the Origin–Destination Survey 2012 of Belo Horizonte, Brazil. The authors analysed the travel motivations, the ratio of journeys by trips and the means of transportation used, in addition to some indicators of immobility. The results of the research show the impact of the presence of children in an unequal way considering the gender of those responsible for the household, with women in all scenarios carrying out a greater frequency of trips associated with care, but in a specific way according to their degree of schooling and their children’s ages.

To determine gendered patterns of preventive medical care (physical and dental/optical) use among pan-ethnic U.S. Asian and Latino adults.

Using National Latino and Asian American Study (2004) data, we apply Andersen’s (1995) Behavioral Model of Health Services Use to assess how preventive care use among Asian and Latino men and women varies as a function of predisposing, enabling, and need-based characteristics. We explore whether adjustment for these factors mediates gender disparities in both physical and dental/optical check-ups, and test whether certain factors operate differently among men versus women.

A higher proportion of women reported a routine care visit last year, especially among Latinos. Adjusting for predisposing, enabling, and need-based factors explained the gender difference in reporting a dental/optician check-up, but not a physical check-up, among both Asian and Latino adults.

Our findings illustrate how gender patterns in routine care use differ by race/ethnicity, and highlight the fundamental importance of enabling characteristics (especially health insurance and having a regular doctor) for shaping routine care use between men and women, both Asian and Latino. Limitations of this chapter are that the data are cross-sectional and were collected before the implementation of the Affordable Care Act, and measures are self-reported.

This chapter focuses on Asian and Latinos because they represent the fastest growing minority populations in the United States, yet few studies have evaluated gender differences in preventative health care use among these groups.

While there is considerable evidence supporting the relationship between job satisfaction and organizational commitment, the relationship between the antecedents of job satisfaction, organizational commitment and career commitment are not clearly understood. This study seeks to clarify whether these antecedents have an effect independent of job satisfaction on career commitment or whether these antecedents are mediated by job satisfaction.

In total, 2,799 questionnaires were mailed out to members of the American College of Healthcare Executives (ACHE). The responses received were 643 (22.9 percent) and after eliminating retirees or students, a sample of 456 respondents currently employed in the health care industry was obtained. Path analysis was conducted to test the hypothetical relationships between work situation, career experiences and career commitment.

It was found that job satisfaction mediated the influences of job tenure and career pattern on career commitment. Job satisfaction partially mediated the influences of perceived job security and one's satisfaction with career on career commitment. Both of these measures had a direct influence on career commitment. Career experience such as sector change was also positively associated with career commitment.

While the research offers some insights into the factors affecting the career commitment of health care executives, the sample was limited to respondents who were members of the American College of Healthcare Executives, and thus may not represent the views of all managers in the health care sector.

To retain high‐valued health care workers it is important that an organization has a work environment that enhances their commitment to their occupation as well as their careers.

This study clarifies the influence of job satisfaction on the career commitment of health care managers during a very dynamic period.

The purpose of this paper is to explore the potential value of applying spatial science and technology to the issue of care integration across what are the often fragmented domains of health and social care provision. The issue of focus for this purpose is population ageing because it challenges existing information and practice silos. Better integration, the author proposes, needs to adopt a geographic approach to deal with the challenges that population ageing present to health and social care as they currently function in many countries.

The approach utilised here explores the role that could be played by enhancing spatial perspectives in care integration. Spatial and temporal strategies need to be coordinated to produce systems of integrated care that are needed to meet the needs of growing numbers of older people.

The author’s premise is that, with some rare exceptions, geographies of care are needed to address important shifts in demography such as population ageing and their epidemiological consequences. The rising intersection between the ageing and disability concepts illustrates how the fluid nature of health and social care client groups will challenge existing systems and their presuppositions. Health and medical geography offer a theoretical and practical response to some of these emerging problems.

This is a brief conceptual piece in favour of integrating geographic concepts and methods in the context of changing demography and the social, economic and service implications of such changes. It is limited in scope and a more detailed explanation would be required for a proof of concept.

Practically we know that all human services vary across space as do both healthcare and related social services and supports. Issues of quality and safety are numerous in these policy domains generally, with aged care evidencing a growing number of problems and challenges. Being able to inquire on significant challenges in health and social care through a spatial lens has the potential to provide another, highly practical, kind of evidence in this field of work. This lens is, the author contends, very poorly integrated into either health or social care at present. However, doing so would have a variety of useful outcomes for monitoring and intervening on real problems in care integration. An example could be “frequent flyers” in emergency departments as has been done in Camden, New Jersey through patient mapping.

The author’s position in this paper is that the challenges we face in providing integrated care to ageing and increasingly disabled (including both physical and cognitive impairments) populations will only grow in the face of variable governmental responses and increasingly complex funding and service provider arrangements. Without a geographical perspective and the concepts and tools of spatial science the author does not see an adequate response emerging. The shift to community-based care for many groups, including the aged, means that location will become more important rather than less so. This is a societal concern of major proportions and the very concept of integrated care requires of us a geographical perspective.

This is a short but, the author believes, conceptually rich piece with a variety of potential practical implications for health and social care service provision. Issues of equity, quality, safety and even basic access can only grow as population ageing progresses and various forms of chronic disease and disability continue to grow. Knowing where the most affected people and their social and service connections are located will support better integration. And better integration may resolve some of the financial and related resource problems that are already evident but which can only continue to increase. In this context, the author suggests that the integrated care of the future needs to be geographically informed to be effective.

Since the 1960s, the health system has seen the professionalisation of a new occupation, carer of the elderly. The form and result of this process differs between countries according to their welfare systems. In this paper, the differences will be analysed in a comparison between two countries, Germany and Sweden, the representatives of two prototypical welfare systems. Sweden is renowned for its state‐oriented universal welfare system, whereas Germany is considered to be an example of a conservative, family‐oriented system. The process of professionalisation and its consequences for the carer and the care receivers will be looked at from the perspective of gender and social inequality. On a theoretical basis, this paper includes gendered and mainstream welfare state approaches and thus combines issues of gender and social inequality, as well as theories in the area of professionalisation. Empirically, the development of the new occupation is examined in two phases. In the first step, it looks at the time‐period between the 60s and 80s, when the stateoriented vs. family‐oriented principles of care for the elderly were established. The 90s brought about change in both countries. In Germany, with the introduction of the Long‐term Care Insurance, a new mode of care has developed, shared between informal family care, and public or private providers. In Sweden, budget restrictions in the 90s in this area led to a reorganisation, restructuring and reduction of the role of the welfare state. The consequences of the different processes in both countries will be discussed from the perspective of the predominantly female employees and the receivers of care. The results reveal a complex interaction between patterns of gender and social inequality and welfare state policies for the carers and care receivers.

The purpose of this paper is to consider some notions that are currently in use in integrated care, with the aim of exploring whether these notions improve the quality and integration of care.

Notions like “continuity of care”, “coordination of care”, “team‐working” and “partnerships” are some of the wide variety of terms increasingly employed within the range of initiatives and efforts that aim to enhance the quality of health and social care environments for patients and users. While each of these notions seems to represent a worthy cause in the quest for better care, and is accompanied by varying extents of evidence of its effectiveness, conceptual clarity of each notion remains a challenge. This paper undertook a detailed examination of what each of these notions comprises, how it is measured objectively and subjectively, whilst highlighting any apparent overlap between the notions.

From the analysis of the four notions, two main patterns of dysfunctional features emerged: the first pattern involved issues of multiple, imprecise and constricted definitions; the second pattern had to do with imprecise or conflicting assessments of how the different notions or dimensions thereof are related to one another.

A review of the literature suggests that the meanings, and consequently the measurement, of these notions could benefit from less ambiguity in order to prevent confusion about what precisely is being implemented and measured.

In order that calls for quality improvement do not become slogan statements, there is an urgent need for integrated framework(s) that add clarity to an already compound web of notions. This could contribute to improving the quality of research and evidence base of this complex field.