Evidence Based Practice Symposium - McMaster University

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workers with mental health concerns. RESULTS Interview and questionnaire data were combined and revealed a range of responses to workers with mental health issues, including silence, inaction, and a lack of support. Qualitative analysis revealed that these actions were shaped by four key themes: Theme 1. Negative attitudes and stigma towards workers with mental illness Participants discussed the effect negative attitudes have on action or inaction in the workplace. “Thinking back, the shame I felt at having a problem was a barrier to me seeking out help for it.” [OR] Theme 2. Lack of knowledge of mental illness Participants spoke to a lack of understanding of mental illness and supports within the organization and shared perspectives on what education was needed to help support individuals. “The affected people need more information about where help is available.” [OR] Theme 3. Limited communication skills Participant responses reflected barriers of not knowing what to say, or how to address issues. “... You do know but you don’t know what to say.” [S8] Theme 4. An organizational context lacking in support Participants described a stressful workplace that did not promote the mental health of its employees. “…Organizational culture is a huge influencer and that that probably plays the largest role in determining workplace health.” [S1] DISCUSSION Study results suggest that the absence of knowledge and skills, combined with stigmatizing attitudes in an unsupportive workplace, results in silence and inaction. The future direction of this project is to implement and evaluate an education strategy that will promote early intervention for workers with mental illness. The themes identified emphasize the need to target all of these areas to effectively facilitate provision of support. The following strategies are recommended for implementing an education-based early intervention initiative: 1. Build a workplace culture of support. Attitudes, skills and knowledge do not function in isolation, therefore a supportive workplace context is necessary. It is recommended that stakeholders and champions be engaged at all levels of the organization, from frontline workers to union reps and high level managers, to facilitate change. 2. Change negative attitudes in the workplace. One educational approach in addressing stigmatizing attitudes is through contact-based education whereby a peer, someone with lived experience of mental illness, would provide the education. This evidence-based format of delivery has been reported to increase positive perceptions and decrease stigmatizing attitudes towards individuals with mental illness 6 . 3. Increase mental health literacy. Education should focus on providing an understanding of the signs and symptoms of mental illness and what resources and supports are available, both within and outside of the workplace. 4. Foster communication skills to overcome silence. Education is needed on concrete communication strategies for speaking with an employee who is ill, or communicating challenges. The workplace would benefit from protocols and procedures outlining who, when, and how to voice any concerns. Strengths and Limitations Participants were predominantly female, welleducated, clinical employees who volunteered for the study, which may indicate a bias in perspectives. Additionally, member checking is planned but not yet completed. A strength of this study was the triangulation of methods through in-depth interviews, an online questionnaire, and involvement of the advisory group. This allowed for increased participant involvement and higher credibility and validity of results. Another strength was in conducting purposeful sampling to obtain multiple perspectives. CONCLUSION Many individual, social and institutional forces shape how people respond to employees with mental health issues, therefore a multi-pronged, multi-layered education strategy is needed to create positive change. ACKNOWLEDGEMENTS Thank you to Sandra Moll, Erika Pond Clements, and our HHS partners Andrew Doppler and Lisa Gilmour. REFERENCES 1. Mental Health Commission of Canada. (2012). Changing directions, changing lives: The mental health strategy for Canada. Retrieved from http://strategy.mentalhealthcommission.ca/pdf/strategy -text-en.pdf 2. Sroujian, C. (2003). Mental health is the number one cause of disability in Canada. Insurance Journal, 8. 3. Health Canada (2009). Environmental Scan on Workplace Health in Canada. Ottawa: Author. 4. Stuart, H. (2006). Mental illness and employment discrimination. Current Opinion in Psychiatry, 19, 522-526. 5. Graham et al. (2006). Lost in knowledge translation: Time for a map? The Journal of Continuing Education in the Health Professions, 26, 13-36 6. Corrigan, P.W., River, L., Lundin, R.K., Penn, D.L., Uphoff-Wasowski, K. & Campion, J. (2001). Three strategies for changing attributions about severe mental illness. Schizophrenia Bulletin, 27(2), 187-195
Exploring Social Participation in Women Aging with HIV Lisa Blenkhorn and Jennifer Siemon, M.Sc. O.T. (2012) Candidates Project Supervisors: Patty Solomon (Ph.D., P.T.) & Seanne Wilkins (Ph.D.) School of Rehabilitation Science, <strong>McMaster</strong> <strong>University</strong>, Hamilton, Ontario Abstract Objective: The present study aims to explore the social participation experiences of women aging with HIV to create a conceptual model illuminating both their experiences, and how rehabilitation professionals may better support this client population. Methods: Using a grounded theory approach, 20 women over the age of 50 with HIV-positive status participated in semi-structured interviews exploring various aspects of social participation. Interviews were audio-recorded, transcribed, and coded. The codes were analyzed and compiled to elicit themes. The themes informed a conceptual model that outlined the factors related to the women’s social participation, and was grounded in the data. Findings: Participants identified several factors that were related to their social participation. These factors fell into four overarching themes: social engagement, social isolation, contrasting perceptions, and contextual factors. Factors related to social engagement included: feeling connected with people, with spirituality, and through volunteer work. Factors associated with social isolation included: lacking a desire to pursue relationships, perceiving physical appearance unfavourably, living with mental health issues, and experiencing barriers to employment. Contrasting perceptions that were experienced differently included: looking ahead to the future, disclosing HIV status, being mobile physically and in the community, coping with and managing HIV, and caring for others. Contextual factors also emerged that related to social participation, including: viewing instrumental supports as inadequate and experiencing stigma related to gender, age, culture, and HIV status. Conclusions: Women who are aging with HIV experience many factors that positively and negatively influence their social participation. Elements of the environment also influence social participation. Rehabilitation professionals are focused on enabling participation, acknowledging the environment, and facilitating client-centred change, and are thus well-equipped to support this client population. INTRODUCTION & LITERATURE REVIEW Adults older than 50 years comprise an increasing proportion of people infected with the human immunodeficiency virus (HIV) 1 . This reality is largely attributable to the development and introduction of highly active anti-retroviral therapies (HAART) – medications that have increased survival in people with HIV and transformed HIV from a terminal illness to a manageable and chronic disease. Individuals with HIV often face challenges related to their social participation 2 . Social participation is an indicator of wellbeing that refers to one’s involvement in social activities, such as volunteering, recreation, work, and cultural practices, all of which are influenced by a sense of belonging, the presence of social networks, and trust in others. Social participation challenges experienced by individuals with HIV stem from a variety of circumstances, including limited social networks, living in poverty, and stigma 3,4 . The added dimensions of aging and being female render older women with HIV particularly vulnerable to social participation challenges. METHODS Methodology: Charmaz’s grounded theory approach 5 was used to explore social participation among aging women with HIV. Participants: Participants were recruited through HIV clinics and AIDS Service Organizations (ASOs). Participants were women (19 born female, 1 MTF transgender) 50 years of age and over (mean age 55.30 years, range of 50-69) who had a diagnosis of HIV/AIDS (year of diagnosis range 1986-2010). Data collection: Participants were interviewed individually faceto-face or over the telephone by a trained and experienced research assistant. Interview questions explored various aspects of social participation, including self-care and household management, relationships with family, friends and romantic partners, work, and access to healthcare and social support services. The interviews were audio-recorded and transcribed. Data analysis: The authors read the transcribed interviews to obtain a sense of the overall content and meaning of the women’s experiences. Three transcripts were then coded independently. The authors met to establish a coding scheme, after which the remaining transcripts were coded independently. The codes were analyzed and compiled to elicit themes. The themes informed a conceptual model that outlined the factors related to the women’s social participation, and was grounded in the data. RESULTS The women identified several factors that were related to their social participation. These factors fell into four overarching themes. Those which were experienced positively by the women comprised the theme of social engagement and those experienced negatively represented the theme of social isolation. The theme of contrasting perceptions encompassed elements of social participation that were framed positively by some women, but unfavourably by others. The theme of contextual factors emerged as parts of the environment that also affected social participation. Social engagement Connecting with people Participants emphasized the benefits of having friends and family who provided emotional support and comfort as well as practical assistance: “I have this sort of little inner sanctum of good people that I trust” (136). Connecting with spirituality Having spiritual or faith-based connections enabled social engagement, and helped women to cope with their health challenges and with life in general: “I feel [church is] where I have gotten a lot of my emotional strength… to make peace with myself” (134). Connecting through volunteer work The women discussed how, through their volunteer work with ASOs, they related to others with similar experiences, and felt personally fulfilled: “it’s a passion to be able to share my experience especially if it’s helped someone else” (108). Social isolation Lacking a desire to pursue relationships Some women expressed that it was easier to be alone and that they did not have the desire to engage socially. Some attributed this feeling to being older and having less energy. Perceiving physical appearance unfavourably Many of the women expressed that they were unhappy with their physical appearance and described how this affected their selfconcept. Some described that their perception of their appearance was a barrier to their social participation; “I didn’t want to go out, I didn’t want to associate with anyone. I didn’t want to go to a family dinner because my face was so haggard” (144).
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