Structural Facilitators and Barriers to Access to and Continuity of French-Language Healthcare and Social Services in Ontario's Champlain Region.

Purpose: The purpose of this article is to examine access to and continuity of French-language healthcare and social services in Ontario's Champlain region through an analytical framework that incorporates people seeking care, their caregivers and the linguistic component of care into a health and social service system bounded by community, organizational, political and symbolic structures. Methods: Experiences of French-speaking seniors seeking care and those of health and social service providers and managers from two qualitative exploratory studies are used to describe trajectories through the system. Results: Participants exposed how, together with community vitality, issues within each of the system's symbolic, political or regulatory and organizational structures influence these trajectories. Conclusions: To meet the needs of francophone seniors, additional work is needed to increase French-language services coordination within the organizational, regulatory and policy structures of the health and social service system.

Management strategies to improve French language service coordination and continuity for official language Francophone seniors in Canada.

Evidence suggests that language barriers present obstacles to healthcare access and quality for Francophone seniors in official language minority communities across Canada. Addressing language barriers and providing continuity is challenging, as French language services (FLSs) rely heavily on bilingual providers and the practice of active offer by all staff. This qualitative research used semi-structured group and individual interviews to explore mechanisms supporting FLS coordination and continuity in two Canadian provinces. Identification of the language variable in health records, virtual healthcare, and FLS directories are conducive to FLS continuity, but financial and resource limitations present major obstacles. Management strategies to facilitate continuity of FLS across health organizations are discussed.

Very low neighbourhood income limits participation post stroke: preliminary evidence from a cohort study.

BACKGROUND: Neighbourhood income level is associated with the incidence of stroke and stroke-related mortality. It has also been linked to receipt of appropriate services, post discharge motor recovery and functional status following a stroke. We examined the impact of neighbourhood income on participation among community-dwelling stroke survivors during the two years following the stroke. METHODS: Secondary analysis of data from a prospective cohort study. Participants were 67 individuals who were treated in acute care or rehabilitation following a first ever stroke, and were discharged to the community with FIM™ scores of at least 3 for comprehension, memory and problem solving. On this functional independence measure, these scores indicate that assistance is needed with related tasks up to 50 % of the time. Participation at 6, 9, 12, 18 and 24-months post stroke was measured using the Reintegration to Normal Living Index (RNLI). Income was measured by median neighbourhood annual family income according to postal code. The impact of very low neighbourhood income (median family income $20,000 Cdn or less) on participation at each follow-up period was determined controlling for potential confounders. RESULTS: Six (9.0 %) of the participants lived in very low-income neighbourhoods. These participants had average RNLI scores approximately 25 % lower at each follow-up period. While there was a trend for increasing participation with time among those in higher income neighbourhoods, this was not seen among very low-income neighbourhood participants. Very low me neighbourhood income had an independent effect on participation after controlling for discharge FIM™, 2-min walk test, gender, self-rated health, age, and emotional well-being at all follow-up periods. CONCLUSIONS: Our results indicate that very low neighbourhood income is linked with decreased participation during the first two years following stroke. Our findings indicate the need for further investigation of this relationship, and the importance of close follow-up of stroke survivors living in very low-income contexts.

Peer support for stroke survivors: a case study.

BACKGROUND: Innovative and sustainable programs are required to support the well-being of stroke survivors. Peer support is a potentially low cost way to enhance well-being of recent stroke survivors and the well-being and community reintegration of their peer supporters. This article describes the perceptions of stroke survivors, care partners, peer supporters, and professionals of an individual peer support program. METHODS: An instrumental case study design was used to examine a volunteer peer support program that provides acute care visits and telephone follow-up post-discharge. In particular, a) type of support provided, b) benefits for the stroke survivor and care partner, c) potential harms to the stroke survivor, d) impact of providing support on the peer supporter, and e) required processes were considered. Semi-structured interviews were carried out with 16 new stroke survivors and 8 care partners immediately following hospital discharge and then 6 months later, and with 7 peer supporters, 3 program co-ordinators and 4 health professionals to gather feedback from multiple stakeholders. RESULTS: Emotional, affirmational and informational support were perceived as being offered by the peer supporters. Peer visits were perceived as providing encouragement, motivation, validation, and decreased feelings of being alone. However, the visits were not perceived as beneficial to all stroke survivors. The impact on the peer supporters included increased social connections, personal growth, enjoyment, and feelings of making a difference in the lives of others. Involvement of the healthcare team, peer supporter training and a skilled coordinator were crucial to the success this program. CONCLUSIONS: Peer support can potentially enhance service to stroke survivors and promote community reintegration for peer volunteers. Further research is needed to determine the preferred format and timing of peer support, and the characteristics of stroke survivors most likely to benefit.

Participation and well-being poststroke: evidence of reciprocal effects.

OBJECTIVE: To explore reciprocal effects between participation and emotional and physical well-being during the first 2 years poststroke. DESIGN: Prospective cohort study. SETTING: Community. PARTICIPANTS: An inception cohort of adults (N=67) who had been discharged from an acute stroke unit or stroke rehabilitation unit after a first stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Participation (Reintegration to Normal Living Index), emotional well-being (General Well-being Schedule), and physical well-being (General Self-rating of Health Question) were measured at 6, 9, 12, 18, and 24 months poststroke. Hierarchical linear modeling was used to examine the association between participation and change in well-being, controlling for sex, age, impairment (discharge FIM), and median neighborhood income. RESULTS: Greater engagement in valued activities was significantly associated with subsequent improvement in emotional well-being. The effect of participation on change in physical well-being was marginal. Higher levels of well-being also predicted subsequent increases in participation, with emotional well-being effects moderated by income, and physical well-being effects moderated by level of impairment. CONCLUSIONS: Our results support a 2-pronged approach to addressing well-being poststroke where efforts to improve affect and boost participation are simultaneously applied.

Adaptation following stroke: a personal projects analysis.

OBJECTIVES: Assessment of adaptation following stroke has tended to focus either on acceptance of disability or global indicators of well-being. People with stroke, however, tend to view adaptation in terms of reengagement with personally valued activities. We model the adaptation process by assessing change in importance, control, stress, challenge, pleasure, support and self-identification of personal projects (i.e., one's current activities such as work, leisure, and recreational activities) from prestroke to 24 months poststroke. METHOD: Personal projects, general health, and general well-being were assessed via interviews with a sample of 67 community-residing stroke survivors (39 male; mean age = 64.7 years, SD = 13.2) on five occasions over the first 24 months poststroke. RESULTS: Multilevel (hierarchical) modeling of the longitudinal data indicates that project dimensions of Control, Stress, Challenge, Pleasure, and Support predict well-being in expected ways. Although projects at 6 months poststroke were rated as more important, stressful, challenging, and supported by others and less controllable and pleasurable than prestroke projects, by 12 to 18 months all project ratings had returned to prestroke levels, thereby suggesting successful adaptation. CONCLUSIONS/IMPLICATIONS: Longitudinal analysis of survivors' participation in valued activities poststroke revealed a pattern of adaptation that relates to but goes beyond that suggested by global measures of health, functioning, and well-being. The focus on adaptation of personal projects or valued activities may provide a helpful way of examining and improving well-being poststroke and offer new insights to inform the development of effective interventions for improving well-being following stroke. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

The process of re-engagement in personally valued activities during the two years following stroke.

PURPOSE: Engagement in valued activities is often difficult for people who have experienced stroke. A deeper understanding of the process of re-engagement in personally valued activities would be helpful to those designing interventions to address participation post-stroke. METHOD: Six community-dwelling individuals recovering from a first stroke were interviewed at 6, 9, 12, 18 and 24 months post-stroke. A grounded theory approach was used to construct a substantive theory of re-engagement in valued activities during this period. RESULTS: Two core concepts, social connection and being in charge were identified. Both led to activity engagement and risk taking to test abilities. These led to lowering of current expectations and activity adaptation which supported hope for recovery and further testing. Alternatively, difficulties perceived to be related to ageing led to disengagement. CONCLUSIONS: Rehabilitation practice that addresses and supports autonomy, social connection, risk taking, adaptation and hope among stroke survivors may help individuals regain personally valued activities post-stroke.

A critical reflection on occupational therapy within one Assertive Community Treatment team.

BACKGROUND: The generic process of occupational therapy is often described but is rarely the topic of critical analysis. PURPOSE: To critically reflect on the occupational therapy process within one Assertive Community Treatment team. METHODS: Using an instrumental case study approach, we interviewed one occupational therapist-client dyad from an Assertive Community Treatment team monthly over the course of nine months and reviewed occupational therapy chart notes. Data were analyzed for topical concerns and foreshadowed problems related to the process of occupational therapy. FINDINGS: Five topical concerns were identified. These related to the impact of the use of a medical model lens, unarticulated occupational therapy theory, acceptable occupational therapy goals, the complexity of occupational goals, and invisible emotions and unexamined relationships. IMPLICATIONS: Our research method allowed us to critically reflect on the occupational therapy process within one setting. This reflection may have implications for occupation-based, client-centred services in other areas.