Background: Stigma has been identified as an important barrier to the full community participation of people with mental illness. This study focuses on how stigma operates specifically within the domain of employment. Objectives: The purpose was to advance the development of theory related to the stigma of mental illness in employment to serve as a guiding framework for intervention approaches. Method: The study used a constructivist grounded theory methodology to analyze over 500 Canadian documents from a diverse range of sources and stakeholders, and interviews with 19 key informants. Findings: The paper develops several key components central to the processes of stigma in the work context. These include the consequences of stigma, the assumptions underlying the expressions of stigma, and the salience of these assumptions, both to the people holding them and to the specific employment situation. Assumptions are represented as varying in intensity. Finally specific influences that perpetuate these assumptions are presented. Implications: The model suggests specific areas of focus to be considered in developing intervention strategies to reduce the negative effects of stigma at work.
Minimal pain content has been documented in pre-licensure curricula and students lack important pain knowledge at graduation. To address this problem, we have implemented and evaluated a mandatory Interfaculty Pain Curriculum (IPC) yearly since 2002 for students (N=817 in 2007) from six Health Science Faculties/Departments. The 20-h pain curriculum continues to involve students from Dentistry, Medicine, Nursing, Pharmacy, Physical Therapy, and Occupational Therapy as part of their 2nd or 3rd year program. Evaluation methods based on Kirkpatrick's model now include evaluation of a Comprehensive Pain Management Plan along with the previously used Pain Knowledge and Beliefs Questionnaire (PKPQ) and Daily Content and Process Questionnaires (DCPQ). Important lessons have been learned and subsequent changes made in this iterative curriculum design based on extensive evaluation over the 6-year period. Modifications have included case development more relevant to the diverse student groups, learning contexts that are uni-, inter-, and multi-professional, and facilitator development in working with interprofessional student groups. PKBQ scores have improved in all years with a statistically significant average change on correct responses from 14% to 17%. The DCPQ responses have also indicated consistently that most students (85-95%) rated highly the patient panel, expert-lead clinically focused sessions, and small interprofessional groups. Relevancy and organization of the information presented have been generally rated highly from 80.3% to 91.2%. This curriculum continues to be a unique and valuable learning opportunity as we utilize lessons learned from extensive evaluation to move the pain agenda forward with pre-licensure health science students.
Women with disabilities need greater education on reproductive health and improved access to health care.
This article reports on a study conducted for the Canadian International Development Agency by The International Centre for Disability and Rehabilitation at the University of Toronto. We critically examined the broad literature in the area of disability and development and in this article we identify the key issues which emerged. Most of the data were collected from existing literature in the academic and practice settings and from the publications of key NGOs and governments. We first, examine disability in the context of low-income countries, and then discuss key critical issues: disability and poverty, disability and health, disability and education, disability and gender, disability and children/youth, disability and conflict/natural disasters and disability and human rights. In all these areas we find reports of discrimination, stigmatisation and marginalisation. We conclude that, as we address issues of multi-cultural disability services in developed countries, it is important to bear in mind the various issues that many people with disabilities and their families bring with them as the result of immigrating from a developing country. Although we address these issues within our own countries, we must bear in mind the changes that are occurring due to globalisation.
Participatory action research (PAR) is a form of collaborative research particularly concerned with power inequities of marginalized communities. With this approach, occupational therapists can work with clients and communities to address issues of access, inclusion, equity and collaboration in practice and research. This paper begins with a summary of key concepts and controversies related to participatory action research. Two examples from occupational therapy experience are used to demonstrate the initial steps and key principles of PAR projects and to highlight the conceptual links between PAR and community-based, client-centred occupational therapy. One project involved a group of mental health consumers, the other a community group of older adults. Several challenges and potential outcomes in PAR projects are highlighted in this examination of the complexity of PAR processes. The paper concludes by identifying possibilities and obstacles to the further use of PAR in occupational therapy.
Occupational therapy professionals and users of occupational therapy services are becoming increasingly aware of the issues of diversity encompassing their lived experiences, values and meaning systems. This paper situates a discussion of diversity and curriculum development in terms of inclusiveness of people's diverse lived experiences, which include complex combinations of ethnicity, religion, sexual orientation, gender, socioeconomic status and other factors. A pedagogical context is provided based on understandings of culture, inclusiveness and diversity in the healthcare literature. The experience of one occupational therapy department's efforts to create a learning environment that is inclusive of all its participants is used to illustrate effective educational and structural strategies. Despite noble aspirations, much remains to be accomplished regarding how the profession defines competencies in terms of transcultural evaluation standards, outcomes and indicators.
The authors suggest these characteristics can be incorporated across models and practice settings. The findings are discussed in terms of implications for best practice in occupational therapy.
Uncovering the varied discourses around work integration enables an understanding of the different ways in which the problem of work integration has come to be seen in today's context; how it is understood, spoken about, dealt with and internalised by individuals and groups. The framework sheds light on the rationale for the range of solutions that have been developed to address the problem of work integration, and it is useful in the analysis of how policy, practice and research initiatives are shaped and promoted.
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