Promoting Health Equity Research: Insights from a Canadian Initiative.

In 2002 the Canadian Institutes of Health Research launched a national initiative to promote health equity research reflecting the World Health Organization imperative of investment in health equity research. Funded researchers and teams have investigated health disparities faced by vulnerable populations, analyzed interactions of health determinants, and tested innovative interventions. Strategies for building research capacity have supported students, postdoctoral fellows, new investigators, and interdisciplinary research teams. Partnerships have been created with 10 national and 7 international organizations. Strategies used to secure and sustain this research initiative could be adapted to other contexts. Nurse scholars led the launch and have sustained the legacy of this national research initiative. Moreover, nurse researchers and research trainees, supported by the initiative, have contributed to the expansion and translation of the health equity knowledge base.

En 2002, les Instituts de recherche en santé du Canada ont lancé une initiative pancanadienne visant à promouvoir la recherche sur l'équité en matière de santé, conformément à une recommandation émise par l'Organisation mondiale de la Santé soulignant l'importance d'investir dans ce domaine. Les chercheurs et les équipes bénéficiant d'un financement se sont penchés sur les disparités touchant les populations vulnérables en matière de santé. Ils ont également analysé les interactions entre les déterminants de la santé et ont mis à l'épreuve des interventions novatrices. Des stratégies destinées à accroître la capacité de recherche ont appuyé les efforts des étudiants, des boursiers de recherches post-doctorales, des nouveaux chercheurs et des équipes de recherche interdisciplinaire. Des partenariats ont été créés avec dix organisations nationales et sept organisations internationales. Les stratégies utilisées pour consolider et soutenir cette initiative de recherche pourraient être adaptées à d'autres contextes. Les chercheurs en sciences infirmières ont assuré le lancement et maintenu l'héritage qu'a laissé cette initiative de recherche pancanadienne. De plus, les chercheurs et les stagiaires de recherche en sciences infirmières qui ont bénéficié de l'initiative ont contribué à l'expansion et à l'application de la base de connaissances sur l'équité en matière de santé.

Where there is smoke, there is stress: low-income women identify support needs and preferences for smoking reduction.

Efforts to assist low-income women with tobacco reduction and cessation have typically not been informed by assessment of their needs and wishes. This multi-site qualitative study focused on assessing 64 low-income women's support needs and intervention preferences. These women were interested in smoking cessation, but identified many barriers and needed appropriate supports. However, available smoking cessation programs did not address underlying conditions, such as income instability and stress. The support recommended was psychosocial (e.g., buddy and group support), included self-care (e.g., nutrition, activity, and personal time), and reflected their social-economic circumstances (e.g., free cessation aids and child care).

Impacts of a support intervention for low-income women who smoke.

The objective of this pilot study was to implement and evaluate the impact of a support intervention tailored to the assessed support needs, resources and preferences of low-income women who smoke in three Canadian cities. The support intervention, informed by theoretical foundations, provided holistic one-to-one and group support over 14 weeks. The support intervention was facilitated by trained professional and peer facilitators. The impact was evaluated through analysis of qualitative and quantitative data collected at pre-, post-, and delayed post-test contacts. This analysis revealed that the intervention exerted positive impacts on smoking reduction/cessation, social networks, coping, and health behaviors. Participants reported satisfaction with the intervention.

"Who do they think we are, anyway?": perceptions of and responses to poverty stigma.

In this article, we report on qualitative findings pertaining to low-income people's perceptions of and responses to "poverty stigma," a key component of social exclusion with important implications for health and well-being. Our findings are drawn from a multimethod study designed to investigate experiences of social exclusion and social isolation among people living on low incomes. We conducted semistructured individual interviews (n = 59) and group interviews (total n = 34) with low-income residents of two large Canadian cities. Data were analyzed using thematic content analysis techniques. Participants overwhelmingly thought that other members of society tend to view them as a burden to society-as lazy, disregarding of opportunities, irresponsible, and opting for an easy life. Low-income people responded to perceived stigma with a variety of cognitive and behavioral strategies that reflected their efforts to reconcile their perceived "social" and "personal" identities. These strategies included confronting discrimination directly, disregarding responses from others, helping other low-income people, withdrawing and isolating themselves from others, engaging in processes of cognitive distancing, and concealing their financial situation.

Low-income Canadians' experiences with health-related services: implications for health care reform.

This study investigated the use of health-related services by low-income Canadians living in two large cities, Edmonton and Toronto. Interview data collected from low-income people, service providers and managers, advocacy group representatives, and senior-level public servants were analyzed using thematic content analysis. Findings indicate that, in addition to health care policies and programs, a broad range of policies, programs, and services relating to income security, recreation, and housing influence the ability of low-income Canadians to attain, maintain, and enhance their health. Furthermore, the manner in which health-related services are delivered plays a key role in low-income people's service-use decisions. We conclude the paper with a discussion of the health and social policy implications of the findings, which are particularly relevant within the context of recent health care reform discussions in Canada.

Lay understandings of the effects of poverty: a Canadian perspective.

Although there is a large body of research dedicated to exploring public attributions for poverty, considerably less attention has been directed to public understandings about the effects of poverty. In this paper, we describe lay understandings of the effects of poverty and the factors that potentially influence these perceptions, using data from a telephone survey conducted in 2002 on a random sample (n=1671) of adults from eight neighbourhoods in two large Canadian cities (Edmonton and Toronto). These data were supplemented with interview data obtained from 153 people living in these same neighbourhoods. Multivariate linear and logistic regressions were used to determine the effects of basic demographic variables, exposure to poverty and attribution for poverty on three dependent variables relating to the effects of poverty: participation in community life, the relationship between poverty and health and challenges facing low-income people. Ninety-one per cent of survey respondents agreed that poverty is linked to health, while 68% agreed that low-income people are less likely to participate in community life. Affordable housing was deemed especially difficult to obtain by 96%, but other resources (obtaining healthy food, giving children a good start in life, and engaging in healthy behaviours) were also viewed as challenging by at least 70% of respondents. The regression models revealed that when controlling for demographics, exposure to poverty explained some of the variance in recognising the effects of poverty. Media exposure positively influenced recognition of the poverty-health link, and attending formal talks was strongly related to understanding challenges of poverty. Attributions for poverty accounted for slightly more of the variance in the dependent variables. Specifically, structural and sociocultural attributions predicted greater recognition of the effects of poverty, in particular the challenges of poverty, while individualistic attributions predicted less recognition. Older and female respondents were more likely to acknowledge the effects of poverty. Income was positively associated with recognition of the poverty-health link, negatively associated with understanding the challenges of low-income people, and unrelated to perceptions of the negative effect of poverty on participation in community life.

Adolescent mothers: support needs, resources, and support-education interventions.

Adolescent mothers are prone to live in poor conditions, lack adequate financial resources, suffer high stress, encounter family instability, and have limited educational opportunities. These factors contribute to inadequate parent-child interactions and diminished infant development. Social support can promote successful adaptation for adolescent mothers and their children. This review article describes the support needs and challenges faced by adolescent parents and their children, the support resources available to and accessed by adolescent parents, and existing support-education intervention studies, to provide directions for future research. Relevant research published between January 1982 and February 2003 was obtained from online database indices and retrieved article bibliographies. Frequently encountered problems included small sample sizes and attrition, lack of suitable comparison groups, and measurement inconsistencies. When planning support-education interventions, content, duration, intensity, mode, level, intervention agents, and targets should be considered. Future research can address these challenges.

Immigrant women: making connections to community resources for support in family caregiving.

The purpose of this ethnographic study was to understand how immigrant women caregivers accessed support from community resources and identify the barriers to this support. The study included 29 Chinese and South Asian women caring for an ill or disabled child or adult relative. All experienced barriers to accessing community services. Some possessed personal resources and strategies to overcome them; others remained isolated and unconnected. Family and friends facilitated connections, and a connection with one community service was often linked to several resources. Caregivers who failed to establish essential ties could not initiate access to resources, and community services lacked outreach mechanisms to identify them. These findings contribute new understanding of how immigrant women caregivers connect with community resources and confirm the impact of immigration on social networks and access to support.