Qualitative Case Study: A Pilot Program to Improve the Integration of Care in a Vulnerable Inner-City Community

Abstract

Introduction:There is a strong correlation between vulnerable populations and poor health outcomes. Growing evidence suggests that person-centred interventions using 'link workers' can support communities to navigate and engage with health and community services, leading to improved health service access. We describe the initial phase and qualitative evaluation of a Healthy Living Program, supported by a link worker role. The Program aimed to improve health service access for residents of an Australian inner-city suburb. Methods:To inform future program development, semi-structured interviews were conducted with clients and stakeholders (n = 21). The interviews were analysed thematically to understand program impact, success factors, constraints and potential improvements.Results: Key themes relating to impacts were a new model of working with community, improved access to services, and responsiveness to community need. Key factors for success included being a trusted, consistent presence, having knowledge of the community and health system, and successful engagement with the community and stakeholders. The constraints included difficulty influencing health system change and lack of community input. Suggested improvements were expanding the service, enhancing health system change and increasing community involvement. Conclusion:Knowledge gained from this study will inform future integrated approaches in health districts to address health inequities in areas of need.

Supporting Women Exit Sex Work: A Contribution Analysis of the Exit Doors Here Integrated Care Program in Toronto, Canada

“…Indeed, building trust in others may be particularly challenging for marginalized groups such as sex workers who disproportionately report past experiences of betrayal from family, friends and service providers [ 15 ]. Ttrust has also been identified as central to successful integrated care programs involving marginalized populations as it facilitates clients’ acceptance of case managers or link workers, and a stronger connection to them [ 16 ].…”

“…Although focused on a population facing multiple systemic challenges, findings from this multi-method evaluation may be relevant to other populations and practices. Indeed the key program ingredients we identified have been documented in other integrated care practices characterized by complex change processes including some targeting youth [ 34 ], marginalized communities [ 16 ], and people living with chronic conditions [ 35 ].…”

“…For instance, trust has been found critical in providing integrated care services to marginalized populations [ 16 19 ], including sex workers [ 15 20 ]. Interestingly, Preble et al .…”

“…The third key ingredient we identified was connecting participants to community supports. Akin to patient navigation and linking schemes, it has been associated with improvements in community attitudes towards, and access to, health and social services [ 16 ], and increased care completion [ 36 ]. Two reviews also found linking and patient navigation schemes to promote patients’ well-being and reduce unmet care needs [ 29 35 ].…”

“…For instance, trust has been found critical in providing integrated care services to marginalized populations [16,19], including sex workers [15,20]. Interestingly, Preble et al (2016) found that sex workers may learn to trust others by modelling trust building practices from their case managers and other program staff [20], which reiterates the importance of building trust early on.…”