Can inequality be tamed through boundary work? A qualitative study of health promotion aimed at reducing health inequalities

Pedersen, Pia Vivian; Hjelmar, Ulf; Høybye, Mette Terp; Rod, Morten Hulvej

doi:10.1016/j.socscimed.2017.05.025

Cited by 26 publications

(26 citation statements)

References 21 publications

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“…Within medical sociology the concept has been used to examine the production, adjustment and management of boundaries among and within groups of professionals. As illustrated by the work of Pedersen et al (2017) and Cramer et al (2018), the concept can help us understand how professionals in practice set and negotiate the boundaries for their work tasks in relation to other professionals, and what is at stake in such negotiations.…”

Section: Theoretical Frameworkmentioning

confidence: 99%

Challenging care work: General practitioners’ perspectives on caring for young adults with complex psychosocial problems

Andersen

Tjørnhøj‐Thomsen

Reventlow³

et al. 2019

Health (London)

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The international literature shows that primary care is well placed to address mental health problems in young people, but that primary care professionals experience a range of challenges in this regard. In Denmark, young adults who have complex psychosocial problems, and who are not in education or work, cause political and academic concern. They are also in regular contact with their general practitioners, the Danish municipalities and psychiatric services. However, little is known about general practitioners’ perspectives on caring for this vulnerable group of patients. In this article, we investigate how general practitioners’ care work is shaped by the bureaucratic management of care in a complex infrastructure network comprising the general practitioners, psychiatry, the municipalities and the young adults. The analysis is based on interviews and focus groups with general practitioners, psychiatric nurses and social workers. We employ Tronto’s concept of care and the concept of boundary work as a theoretical framework. We argue that general practitioners strive to provide care, but they are challenged by the following: contested diagnostic interpretations and the bureaucratic significance of diagnoses for the provision of care from psychiatry and the municipalities, systemic issues with handling intertwined social and mental health problems, and the young adults’ difficulties with accessing and receiving available care.

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Section: Theoretical Frameworkmentioning

confidence: 99%

Challenging care work: General practitioners’ perspectives on caring for young adults with complex psychosocial problems

Andersen

Tjørnhøj‐Thomsen

Reventlow³

et al. 2019

Health (London)

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“…Symbolic and social boundaries also exist between social groups at a societal and community level [ 6 ]. They can confine people to marginalised groups—sometimes over generations, impacting on participation in community life [ 7 ] and access to services [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…Boundary spanning describes the way some people bridge these organisational, symbolic and social boundaries. Considering organisations, boundary spanning occurs for several purposes, depending on context, including for accessing information [ 9 ], innovation and knowledge transfer [ 10 ], collaboration [ 8 , 11 ] and for improving business performance [ 12 ]. Considering communities, boundary spanning occurs often as a form of social leadership [ 13 – 15 ].…”

Section: Introductionmentioning

confidence: 99%

“…With recent increased policy emphasis in developed country contexts on health services working more closely with their communities for collective benefit, (including on, for example, service integration, primary healthcare and co-design), an emergent challenge is identifying effective and cost-effective ways for staff and diverse community members to cross boundaries between institutions and community, to work together. The institutionalised nature of health—with health professionals set up as technical experts [ 8 , 31 ]—presents a barrier for marginalised citizens who could receive positive health benefits from accessing services. Efforts to enhance access need to account for the symbolic and social boundaries that marginalised citizens’ experience, in addition to more obvious physical and institutional boundaries to accessing health services.…”

Section: Introductionmentioning

confidence: 99%

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Community boundary spanners as an addition to the health workforce to reach marginalised people: a scoping review of the literature

2018

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BackgroundHealth services in high-income countries increasingly recognise the challenge of effectively serving and engaging with marginalised people. Effective engagement with marginalised people is essential to reduce health disparities these populations face. One solution is by tapping into the phenomenon of boundary-spanning people in the community—those who facilitate the flow of ideas, information, activities and relationships across organisation and socio-cultural boundaries.MethodsA scoping review methodology was applied to peer-reviewed articles to answer the question: “How do health services identify, recruit and use boundary spanners and what are the outcomes?” The review was conducted in seven databases with search terms based on community-based boundary spanning, marginalised people and health services.FindingsWe identified 422 articles with the screening process resulting in a final set of 30 articles. We identified five types of community-based boundary spanning: navigators, community health workers, lay workers, peer supporters and community entities. These range from strong alignment to the organisation through to those embedded in the community. We found success in four domains for the organisation, the boundary spanner, the marginalised individuals and the broader community. Quantifiable outcomes related to cost-savings, improved disease management and high levels of clinical care. Outcomes for marginalised individuals related to improved health knowledge and behaviours, improved health, social benefits, reduced barriers to accessing services and increased participation in services. We identified potential organisational barriers to using boundary spanners based on organisational culture and staff beliefs.ConclusionsCommunity boundary spanners are a valuable adjunct to the health workforce. They enable access to hard to reach populations with beneficial health outcomes.Maintaining the balance of organisational and community alignment is key to ongoing success and diffusion of this approach.

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“…We conceptualised connectors as "boundary spanners", a term originating in business and management literature [45] and since more widely adopted in social science [46] and organisational studies of health and education [47,48], to describe people who act as the links between a unit and its environment for purposes of information exchange, access to resources, innovation and group representation [45]. We used the term "community connectors" (connectors) which we found citizens liked more than the term "boundary spanners".…”

Section: Introductionmentioning

confidence: 99%

Collaboration with community connectors to improve primary care access for hardly reached people: a case comparison of rural Ireland and Australia

Wallace

Farmer

White

et al. 2020

Preprint

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Background: This study presents a way for health services to improve service access for hardly reached people through an exploration of how staff can find and collaborate with citizens (referred to as connectors) who span socio-cultural boundaries in their community. The study explored the local socio-cultural contexts of connectors’ boundary spanning activities and if they are health related; boundary spanning occurring between connectors and health professionals at the interface of health systems and community; and the opportunities and barriers to actively seeking out and collaborating with community connectors to access marginalised and hardly reached people. Methods: We conducted a qualitative case comparison from rural Ireland and Australia. Following purposive snow-ball sampling techniques to recruit participants, semi-structured interviews were conducted with 34 community informants, 21 healthcare staff and 32 connectors. Transcripts were coded and analysed using an inductive approach to ascertain categories and overall themes. Results: We found a diverse sample of connectors relating to heterogenous, small and locally distinct groups of hardly reached people. Overall 26 connectors were active at the interface between health services and the community, with variation in how this occurred between cases. The majority (21) described one or more health related activities with hardly reached people. All connectors expressed a willingness to develop a relationship with local health services on issues they identified as relevant. Barriers to collaborations between connectors and health services related to bureaucracy, workload, and burnout. Conclusions: Collaborating with connectors has potential as one strategy to improve access to health services for hardly reached people. To enact this, health staff need to identify local socio-cultural boundaries and associated connectors, facilitate two-way connections at the boundary between health services and community and enable collaboration by attending to activities in the community, at the interface between health services and community, and within the health system.

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Can inequality be tamed through boundary work? A qualitative study of health promotion aimed at reducing health inequalities

Cited by 26 publications

References 21 publications

Challenging care work: General practitioners’ perspectives on caring for young adults with complex psychosocial problems

Challenging care work: General practitioners’ perspectives on caring for young adults with complex psychosocial problems

Community boundary spanners as an addition to the health workforce to reach marginalised people: a scoping review of the literature

Collaboration with community connectors to improve primary care access for hardly reached people: a case comparison of rural Ireland and Australia

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