Distrusting doctors’ evidence: a qualitative study of disability income support policy makers

2018 ◽  
Vol 42 (4) ◽  
pp. 475 ◽  
Author(s):  
Ashley McAllister ◽  
Stephen R. Leeder
Keyword(s):  
Diagnostic Tests ◽  
Mental Illnesses ◽  
Income Support ◽  
Snowball Sampling ◽  
Structured Interviews ◽  
Policy Makers ◽  
Data Collection And Analysis ◽  
Diagnostic Certainty ◽  
Support Policy ◽  
Disability Income

Objective The aim of the present study was to describe how policy makers (bureaucrats and politicians) in Australia and Ontario (Canada) perceive evidence provided by doctors to substantiate applications for disability income support (DIS) by their patients with mental illnesses. Because many mental illnesses (e.g. depression) lack diagnostic tests, their existence and effects are more difficult to demonstrate than most somatic illnesses. Methods Semi-structured interviews were conducted with 45 informants, all influential in the design of the assessment of DIS programs. The informants were subcategorised into advocates, legal representatives, doctors (general practitioners (GPs) and specialists (e.g. psychiatrists)), policy insiders and researchers. Informants were found through snowball sampling. Following the principles of grounded theory, data collection and analysis occurred in tandem. Results Informants expressed some scepticism about doctors’ evidence. Informants perceived that doctors could, due to lack of diagnostic certainty, ‘write these things [evidence] however [they] want to’. Psychiatrists, perceived as having more time and skills, were considered as providing more trustworthy evidence than GPs. Conclusion Doctors, providing evidence to support applications, play an important role in determining disability. However, policy makers perceive doctors’ evidence about mental illnesses as less trustworthy than evidence about somatic illnesses. This affects decisions by government adjudicators. What is known about the topic? Doctors (GPs and psychiatrists) are often asked to provide evidence to substantiate a DIS application for those with mental illnesses. We know little about the perception of this evidence by the policy makers who consider these applications. What does this paper add? Policy makers distrust doctors’ evidence in relation to mental illnesses. This is partly because many mental illnesses lack diagnostic proof, in contrast with evidence for somatic conditions, where the disability is often visible and proven through diagnostic tests. Furthermore, GPs’ evidence is considered less trustworthy than that of psychiatrists. What are the implications for practitioners? Although doctors’ evidence is often required, the utility of their evidence is limited by policy makers’ perceptions.

Mental illnesses are not an ‘ideal type’ of disability for disability income support: Perceptions of policymakers in Australia and Canada

2019 ◽  
Vol 48 (4) ◽  
pp. 452-459 ◽  
Author(s):  
Ashley Mcallister
Keyword(s):  
Grounded Theory ◽  
Ideal Type ◽  
Mental Illnesses ◽  
Constructivist Grounded Theory ◽  
Medical Illness ◽  
Theory Approach ◽  
Income Support ◽  
The Disabled ◽  
Disability Income ◽  
Grounded Theory Approach

Aim: This article aims to explore how policymakers conceptualise a person suitable for disability income support (DIS) and how this compares across two settings – Australia and Canada. Methods: A constructivist grounded theory approach was used; 45 policymakers in Australia and Canada were interviewed between March 2012 and September 2013. All policymakers are or were influential in the design or assessment of DIS. Results: Results found that the policymakers in both jurisdictions define a suitable person as having as an ‘ideal type’ of disability with five features – visibility, diagnostic proof, permanency, recognition as a medical illness and perceived as externally caused. Many of the policymakers described how mental illnesses are not an ‘ideal type’ of disability for DIS by juxtaposing the features of mental illnesses against physical illnesses. As such, mental illnesses were labelled imperfect disabilities and physical illnesses as ‘ideal type’ for DIS. Conclusions: The rise of DIS recipients has divided the once protected ‘deserving’ category of the disabled into more (‘ideal type’ of disability) and less deserving (imperfect disability). Such conceptualisations are important because these categories can influence the allocation of welfare resources.

scholarly journals Uncertain Subjects: Shaping Disabled Women’s Lives Through Income Support Policy

2020 ◽  
Vol 9 (3) ◽  
pp. 78-103
Author(s):  
Sally A. Kimpson
Keyword(s):  
Chronic Conditions ◽  
Support Program ◽  
Income Support ◽  
Disabled People ◽  
Doctoral Research ◽  
The Everyday ◽  
Disabled Women ◽  
Women's Lives ◽  
Support Policy ◽  
Disability Income

This article provides a critical reading of one aspect of the “third mobilization of transinstitutionalization” (Haley & Jones, 2018), focused on how power is exercised through the B.C. government income support program (or the ambiguously-named B.C. Benefits), shaping the embodied lives of women living with chronic physical and mental impairments. I research and write as a woman living with a disabling chronic illness whose explicit focus is power: how it is enacted and what it produces in the everyday lives of women with disabling chronic conditions living on income support. I too have been the recipient of disability income support. Thus, my accounts are ‘interested.’ My writing seeks to create a disruptive reading that destabilizes common-sense notions about disabled women securing provincial income support benefits, in particular in British Columbia (B.C.), interviewed as part of my doctoral research. Despite public claims by the B.C. government to foster the independence, community participation, and citizenship of disabled people in B.C., the intersection of government policy and practices and how they are read and taken up by disabled women discipline them in ways that produce profound uncertainty in their lives, such that these women become uncertain subjects (Kimpson, 2015).

Issues in the financing and provision of Orthotics and Prosthetics services in Iran: Protocol for a Qualitative Research Study (Preprint)

2019 ◽  
Author(s):  
Saeed Shahabi ◽  
Ahmad Ahmadi ◽  
Hosein Shabaninejad
Keyword(s):  
Qualitative Content Analysis ◽  
Health Coverage ◽  
Snowball Sampling ◽  
Structured Interviews ◽  
Policy Makers ◽  
Face To Face ◽  
Purposeful Sampling ◽  
Content Analysis Method ◽  
The Individual ◽  
Policy Solutions

BACKGROUND The demand for rehabilitation services, including Orthotics and prosthetics services, is increasing. Traffic injuries, Eight-years imposed war, natural disasters, aging, and chronic diseases are the main causes of disability in Iran that lead to the great need for receiving these services. This study will attempt to identify the challenges in the financing and provision of Orthotics and Prosthetics services in Iran and declare the policy solutions to improve the financing and delivery of these services in line with the universal health coverage. OBJECTIVE This study aims to explore the challenges in the financing and provision of the Orthotics and Prosthetics services in Iran and propose policy solutions to strengthen this sector. METHODS This study will use the qualitative content analysis method for understanding the challenges. The study population of this study will be all clinicians, academics, and policy-makers who involved in the financing and provision of the Orthotics and Prosthetics services. The purposeful sampling, as well as the snowball sampling, will be used to select the informants. The individual face-to-face semi-structured interviews will be conducted in Tehran, Isfahan, and Shiraz. Furthermore, telephone and Skype interviews will be applied to participants who lived in other regions. This project will be performed from 2019 to 2020. RESULTS We believe the results will lead to identifying challenges and also policy solutions to strengthen the Orthotics and Prosthetics services in the healthcare system and improve the utilization in Iran. CONCLUSIONS The findings will inform the policy-makers to better planning in Iran and internationally.

scholarly journals Experiences and Perspectives of Traditional Bullying and Cyberbullying Among Adolescents in Mainland China-Implications for Policy

2021 ◽  
Vol 12 ◽  
Author(s):  
Jiameng Li ◽  
Therese Hesketh
Keyword(s):  
Quantitative Research ◽  
Mainland China ◽  
Well Being ◽  
Theory Approach ◽  
Snowball Sampling ◽  
Traditional Bullying ◽  
Structured Interviews ◽  
Data Collection And Analysis ◽  
Teachers And Parents ◽  
And Coping

The prevalence of traditional bullying and cyberbullying is high among Chinese adolescents. The aims of this study are to explore: (1) characteristics of children who are targets or perpetrators of traditional bullying or cyberbullying; (2) causes of bullying in middle school; (3) reactions and coping strategies of bullying victims; and (4) impacts of bullying on victims' psychosocial well-being. Students were selected based on the findings of previous quantitative research at schools in Zhejiang, Henan, and Chongqing. Snowball sampling led to identification of more informants. Semi-structured interviews were conducted with students involved in traditional bullying and cyberbullying as perpetrators, victims, and bystanders. Forty-one students aged 12–16 years (21 boys and 20 girls) from 16 schools in three provinces participated. Data collection and analysis followed a grounded theory approach. Among these students traditional bullying was much more common than cyberbullying, but there was a large overlap between the two types. The results informed a conceptual framework which identified the main causes of bullying in these settings: these included lack of education about bullying, inadequate classroom and dormitory management, and teachers' failure to recognize and punish bullying. Children with specific characteristics (such as being unattractive or low-achieving), were more likely to be bullied. Most victims lacked support of parents and teachers even when requested, leading to poor psychosocial well-being, difficulties with socialization, and poor academic performance. Our findings suggest that schools need to address bullying culture, through multi-faceted locally-appropriate approaches, based on zero tolerance. It is crucial to ensure that students, teachers and parents recognize the importance of such interventions.

scholarly journals Five Challenges of Designing Disability Income Support for People with Mental Illnesses: A Qualitative Case Study of Australia and Ontario

2017 ◽  
Vol 36 (4) ◽  
pp. 109-126
Author(s):  
Ashley McAllister
Keyword(s):  
Grounded Theory ◽  
Policy Design ◽  
Qualitative Case Study ◽  
Mental Illnesses ◽  
Theory Approach ◽  
Income Support ◽  
Vulnerable Group ◽  
Disability Income ◽  
Grounded Theory Approach

In most disability income support (DIS) programs, mental illnesses is the fastest growing category of illness, but it is unknown how policy designers consider this vulnerable group. Forty-five DIS policy designers in Australia and Ontario explained how they consider mental illnesses when designing policy. Using a grounded theory approach, five challenges emerged: validating duration, proving an illness, (un)differentiating mental illnesses, managing mental illnesses, and separating the person from the illness. Each challenge is described and compared across Australia and Ontario. These challenges provide a framework for other settings to determine how well their DIS policies have considered mental illnesses in policy design.

The Ontario Disability Support Program Work Exit Process: Parallels to a Hostage Negotiation

2020 ◽  
pp. 104420732094460
Author(s):  
Pamela Lahey ◽  
Bonnie Kirsh ◽  
Emile Tompa ◽  
Joy MacDermid ◽  
Rebecca E. Gewurtz
Keyword(s):  
Mental Illness ◽  
Service Providers ◽  
Support Program ◽  
Theory Approach ◽  
Income Support ◽  
Welfare To Work ◽  
Structured Interviews ◽  
People With Mental Illness ◽  
Disability Support ◽  
Disability Income

There is a lack of empirical data on the experiences of people with mental illness (PMI) who transition from welfare to work, or how policy programs are designed to facilitate this outcome. We explore the factors that facilitate or hinder PMI from exiting disability income support programs in Ontario, Canada. Drawing on a grounded theory approach, we examine the process of exiting the Ontario Disability Support Program (ODSP). Data were collected from semi-structured interviews with current and former recipients with mental illness, service providers who support current and former recipients, and ministry staff. A metaphor for the work exit process emerged with four embedded themes: (a) picking yourself back up, (b) breaking the rules to get ahead, (c) stabilizing illness for employment success, and (d) displaying resiliency and resourcefulness for successful exits. The main finding is that system supports are not the determining factors in a successful transition. Rather, participants describe how recipients exit for employment by leveraging personal resources to successfully transition off income support benefits. A system redesign is needed to address the inherent tension between social and health programs if the policy intent is to promote successful welfare-to-work transitions for PMI.

scholarly journals Physical rehabilitation financing in Iran: a policy analysis using Kingdon’s multiple streams

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Saeed Shahabi ◽  
Parviz Mojgani ◽  
Hosein Shabaninejad ◽  
Ahmad Ahmadi Teymourlouy ◽  
Masoud Behzadifar ◽  
...  
Keyword(s):  
Insurance Coverage ◽  
Physical Rehabilitation ◽  
Financial Resources ◽  
Political Agenda ◽  
Rehabilitation Services ◽  
Snowball Sampling ◽  
Multiple Streams ◽  
Structured Interviews ◽  
Policy Makers ◽  
Factors Affecting

Abstract Background Adequate financing is a crucial function, securing that physical rehabilitation services (i.e., physiotherapy, occupational therapy, prosthetics and orthotics) are available with no financial hardship. Like many other countries, despite the adoption of various policies and strategies in recent decades, Iran enjoys no desirable physical rehabilitation financing (PRF). Accordingly, this qualitative study aimed to explore the PRF-related strategies and issues as well as their impacts on relevant policies in Iran. Methods An analysis of PRF-related policies was conducted in Iran using semi-structured interviews and policy documents review. Purposive and snowball sampling techniques were employed to select key informants, including health-policy makers, civil society, rehabilitation-policy makers, university professors, and practitioners. Thematic analysis was used to analyze the collected data. The analysis was framed within Kingdon’s multiple streams. Results The hindering factors for desirable financing were weak insurance coverage, lack of sustainable financial resources, fragmented financing, lack of split between provider and financer, high-cost of physical rehabilitation services, low engagement of relevant experts in policy-making processes, and corrupt activities. In the policy stream, the following factors were highlighted: involvement of sustainable financial resources, the use of external revenue sources, allocated resources’ earmarking, the integration of the current funds to have better pooling, the use of incentive and timely payment mechanisms, the implementation of strategic purchasing principals, and the employment of effective rationing strategies. Moreover, parliament support, changes in administrations, international effects, pressures from interest campaigns and NGOs, and international sanctions were found as factors affecting the politics stream. Conclusion The study findings revealed that a variety of national and international factors affect PRF-related issues in Iran. The recently enacted laws indicate that the PRF policies have already been on the national health political agenda. The study reflected the multifaceted nature of barriers to optimal PRF in Iran.

Cytisine as an alternative smoking cessation product for Pacific smokers in New Zealand

2018 ◽  
Vol 21 (2) ◽  
pp. 89-95
Author(s):  
Vili Nosa ◽  
Kotalo Leau ◽  
Natalie Walker
Keyword(s):  
Smoking Cessation ◽  
New Zealand ◽  
Nicotinic Acetylcholine Receptors ◽  
Cultural Practices ◽  
Partial Agonist ◽  
Snowball Sampling ◽  
Structured Interviews ◽  
Liquid Form ◽  
Pacific People ◽  
The Pacific

ABSTRACT Introduction: Pacific people in New Zealand have one of the highest rates of smoking.  Cytisine is a plant-based alkaloid that has proven efficacy, effectiveness and safety compared to a placebo and nicotine replacement therapy (NRT) for smoking cessation.  Cytisine, like varenicline, is a partial agonist of nicotinic acetylcholine receptors, and blocks the rewarding effects of nicotine. Cytisine is naturally found in some plants in the Pacific region, and so may appeal to Pacific smokers wanting to quit. This paper investigates the acceptability of cytisine as a smoking cessation product for Pacific smokers in New Zealand, using a qualitative study design. Methods: In December 2015, advertisements and snowball sampling was used to recruit four Pacific smokers and three Pacific smoking cessation specialists in Auckland, New Zealand. Semi-structured interviews where undertaken, whereby participants were asked about motivations to quit and their views on smoking cessation products, including cytisine (which is currently unavailable in New Zealand). Interviews were recorded and transcribed verbatim, with thematic analysis conducted manually. Findings: Pacific smokers reported wanting to quit for loved ones and family, but did not find currently available smoking cessation products effective. Almost all participants had not previously heard of cytisine, but many of the Pacific smokers were keen to try it. Participants identified with cytisine on a cultural basis (given its natural status), but noted that their use would be determined by the efficacy of the medicine, its cost, side-effects, and accessibility. They were particularly interested in cytisine being made available in liquid form, which could be added to a “smoothie” or drunk as a “traditional tea”.  Participants thought cytisine should be promoted in a culturally-appropriate way, with packaging and advertising designed to appeal to Pacific smokers. Conclusions: Cytisine is more acceptable to Pacific smokers than other smoking cessation products, because of their cultural practices of traditional medicine and the natural product status of cytisine.

Sign in / Sign up

Export Citation Format

Share Document