The present paper reports results from a larger study of 500 heavy drinkers (men drinking more than 50units of alcohol per week, women more than 35 units), untreated for their drinking within the last ten years, recruited by advertising and snowballing in the English West Midlands. Data on participants' perceived benefits and drawbacks of their own drinking were obtained by I) a computer-administered set of ratings of benefits and drawbacks in thirteen life domains, and 2) open-ended interviewing with a subsample of 50 participants leading to qualitative analysis of post-interview reports and transcripts. The main fmdings were: perceived benefits outweighed drawbacks in both forced-choice ratings and open-ended interview; there was a small but significant correlation between drinking large quantities in a day and perceived drawbacks; social benefits and drawbacks were dominant in open-ended interview; enhancement and coping benefits were linked by the concept of "relaxation" and were difficult to distinguish; becoming argumentative and aggressive with friends and family was the dominant drawback in open-ended interview; in the health domain, toxic and short-term drawbacks were more salient than longer-term illness effects. These findings suggest a model of the perceived benefits and drawbacks of heavy drinking which challenges both conventional health promotion efforts and motivational balance models of alcohol consumption.
Background People who use substances experience high levels of substance-related stigma, both within and outside of health care settings, which can prevent people from help-seeking and contribute further to health inequities. Recognizing and respecting how political, social, economic, and historical conditions influence health and health care, cultural safety, with origins in addressing Indigenous racism, is a potential strategy for mitigating stigma and marginalization in health care. Using a participatory research approach, we applied the concept of cultural safety to develop a model of safe primary care from the perspective of people who use substances. Methods People who use or used substances were involved in all phases of the research and led data collection. Study participants (n = 75) were 42.5 years old on average; half identified as female and one quarter as Indigenous. All were currently using or had previous experience with substances (alcohol and/or other drugs) and were recruited through two local peer-run support agencies. Concept mapping with hierarchical cluster analysis was used to develop the model of safe primary care, with data collected over three rounds of focus groups. Results Participants identified 73 unique statements to complete the focus prompt: “I would feel safe going to the doctor if …” The final model consisted of 8 clusters that cover a wide range of topics, from being treated with respect and not being red-flagged for substance use, to preserving confidentiality, advocacy for good care and systems change, and appropriate accommodations for anxiety and the effects of poverty and criminalization. Conclusions Developing a definition of safe care (from the patient perspective) is the necessary first step in creating space for positive interactions and, in turn, improve care processes. This model provides numerous concrete suggestions for providers, as well as serving as starting point for the development of interventions designed to foster system change.
Patient-oriented research (POR) aims to increase patient engagement in health research to improve health research and health services. In Canada, the Strategies for Patient-Oriented Research (SPOR) framework provides guidance for conducting POR. We critically review the SPOR framework through the lens of public health systems and services research. The SPOR framework is primarily focused on engaging individual patients in health research without attention to broader structural forces that shape health and participation in healthcare systems. Shifting from patient to public involvement and from patient to community engagement and being explicit about the range of health research that SPOR encompasses would enhance the framework and strengthen the potential of SPOR to improve health systems through health protection, promotion and prevention of disease and injury.
Aims. To describe the positions adopted by close family members of a community sample of untreated heavy drinkers. Design. Detailed interview and questionnaire study of a sample of close family members and the heavy drinkers to whom they were related. Sample. 50 close relatives of 50 heavy drinkers drawn from a community cohort of 500 in the English West Midlands. Data. Perceived benefits and drawbacks of drinking checklist (family members and heavy drinkers); readiness to change questionnaire (family members and heavy drinkers); coping questionnaire (family members only); semi-structured interview (family members only). Findings. A wide range of positions towards their relatives' heavy drinking was evident in this sample of family members. Most recognised at least some drawbacks to their relatives' drinking, and some were engaged in efforts to change it. A number of impediments to taking a stand about their relatives' drinking were apparent, including recognising the benefits of drinking, mitigating factors, the wish not to be intolerant, others' support for their relatives' drinking, and sometimes the family member's own heavy drinking. Conclusions. Some light has been thrown on the experiences of a hitherto neglected population of family members, who may face a number of difficulties and dilemmas in deciding how to respond in the face of heavy drinking.
Introduction People who use substances often mistrust the primary care system, impeding access. Objectives To build on research clarifying how to improve patients’ feelings of safety, through co-creating best practice guidelines with physicians and patient representatives. Methods After obtaining Research Ethics Board approval, this qualitative study engaged 22 participants including patients, physicians, and health system partners. We held a series of workshops, co-facilitated by patients and researchers, corresponding to 3 phases of the research: (1) establishment of cultural safety processes for participants during the workshops; (2) a facilitated, collaborative world café to develop guideline content; (3) validation of best practice guidelines. An implementation plan was developed and implemented. Finally, an external peer review was conducted by McGill University. Results Best practices guidelines were developed giving the patient perspective on how to enhance primary care, as follows: (1) become trauma informed; (2) consider your clinical environment; (3) build a network; (4) supply an array of resources; (5) co-create a long-term treatment plan; (6) help me to stay healthy; (7) ensure timely access to specialized medical and surgical care; (8) be an advocate; (9) ask for feedback; (10) follow up. Resources were developed and disseminated. Conclusion The best practice guidelines reflect the patients’ perspectives on common challenges patients have encountered, which impede their access to primary care. They support primary care physicians in providing more effective services to this challenging population of patients.
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