Wages or Legitimacy? A Qualitative Analysis of Home Care Worker Perspectives in Choosing Work Settings.

Directly-Funded (DF) home care allows users to organize and purchase their own care services and is expanding globally. Little is known about the career pathways of home care workers. Our study asks, what experiences and factors do home care workers consider when choosing a work setting? And, specifically, what influences their decisions to work directly for their clients? Framed with Cranford's (2020) flexibility-security matrix for analyzing home care dynamics, we remotely interviewed 20 home care workers in two Canadian provinces. Three team members conducted axial coding and thematic analysis using Dedoose software. We identified personal and material factors at the intimate and labor market level that workers weigh when choosing whether to work for an agency or directly for a client. At the intimate level, workers value the flexibility, autonomy, and respect facilitated in care relations when working directly for a client. At the labor market level, agencies provide better job security and the benefit of supervisory support but lower wages. Additionally, as care work often serves as a stepping stone for immigration and citizenship agency positions are considered a more "legitimate" option than working directly for a client. Our study shows that workers directly employed by their clients enjoy more flexibility but lack security, whereas agency employed workers risk immediate reductions in working conditions in exchange for limited improvements in safety and supervision and, like other frontline care work, DF home care represents a key career pathway for immigrants with previous experience in health and social care settings.

Medical invalidation in the clinical encounter: a qualitative study of the health care experiences of young women and nonbinary people living with chronic illnesses.

BACKGROUND: Medical invalidation is a well-documented phenomenon in the literature on chronic illnesses, yet there is a paucity of research capturing the perspectives of young adults living with chronic illnesses, and especially of those who are gender diverse or from groups that face broader societal marginalization. Our study sought to answer the following question: How do young women and nonbinary adults living with chronic illnesses characterize their experiences of medical invalidation and its impact on their health and well-being? METHODS: This was a patient-oriented qualitative study informed by feminist disability theory. Eligibility requirements included self-identifying as having a chronic illness, self-identifying as a woman or nonbinary person receiving health care in Manitoba, and being between the ages of 18 and 35 years. Participants took part in online arts-based workshops and subsequent focus group discussion in November 2021. RESULTS: Eight women and 2 nonbinary individuals participated. Medical invalidation was experienced by all of the participants at different points in their illness journeys and took a variety of forms depending on their social location and their particular illness, positioning invalidation as an issue of in/visibility. We identified several consequences of medical invalidation, including internalizing invalidation, overcompensating for their illness, avoiding care and, ultimately, symptom intensification. We also present participants' recommendations to avoid medical invalidation. INTERPRETATION: This study provides insight into the phenomenon of medical invalidation, understood as the act of dismissing, minimizing or otherwise not taking patient concerns seriously. We suggest person-centred care may not be enough, and critical reflexivity may help avoid unintentionally invalidating patient experiences.

"None of it was especially easy": improving COVID-19 vaccine equity for people with disabilities.

OBJECTIVES: Our study aimed to (1) identify barriers to equitable access to COVID-19 vaccines for Canadians with disabilities and (2) present recommendations made by study participants to improve immunization programs in terms of inclusivity and equitable access. METHODS: We invited Manitobans living with disabilities to participate in online focus groups. Focus groups were conducted across multiple disability experiences, although one focus group was advertised explicitly as offering simultaneous American Sign Language interpretation to encourage people who are d/Deaf or hard of hearing to participate. Participants were asked about their perspectives on the management of COVID-19 public health measures and vaccination program rollout. Participants were also asked about barriers and facilitators of their vaccination experiences and if they had recommendations for improvement. RESULTS: The participants identified three areas where they encountered routine barriers in accessing the COVID-19 vaccines: (1) vaccine information and appointment booking, (2) physical access to vaccination clinics, and (3) vaccination experience. While participants identified specific recommendations to improve vaccine accessibility for people with disabilities, the single most crucial advice consistently identified was to involve people with disabilities in developing accessible immunization programs. CONCLUSION: Meaningful engagement with people living with disabilities in immunization program planning would help ensure that people with disabilities, who already face significant challenges due to COVID-19, are offered the same protections as the rest of the population. These recommendations could be easily transferred to the administration of other large-scale immunization campaigns (e.g., influenza vaccines).

RéSUMé: OBJECTIFS: Notre étude visait à (1) identifier les obstacles à un accès équitable aux vaccins contre la COVID-19 pour les Canadiens vivant avec un handicap; et (2) présenter les recommandations faites par les participants à l'étude pour améliorer les programmes de vaccination en termes d'inclusivité et d'accès équitable. MéTHODES: Nous avons invité les Manitobains vivant avec un handicap à participer à des groupes de discussion en ligne. Les groupes de discussion ont été organisés pour divers types de handicap, bien qu'un groupe de discussion ait été explicitement annoncé comme offrant une interprétation simultanée en langue des signes américaine pour encourager les personnes sourdes ou malentendantes à participer. Les participants ont été interrogés sur leurs points de vue sur la gestion des mesures de santé publique contre la COVID-19 et le déploiement du programme d'immunisation. Les participants ont également été interrogés sur les obstacles et les facilitateurs de leurs expériences de vaccination et s'ils avaient des recommandations d'amélioration. RéSULTATS: Les participants ont identifié trois domaines dans lesquels ils ont rencontré des obstacles récurrents pour accéder aux vaccins contre la COVID-19 : 1) l'information sur les vaccins et la prise de rendez-vous, 2) l'accès physique aux cliniques de vaccination, et 3) l'expérience de la vaccination. Bien que les participants aient formulé des recommandations spécifiques pour améliorer l'accessibilité des vaccins pour les personnes handicapées, le conseil le plus crucial systématiquement identifié a été d'impliquer les personnes vivant avec un handicap dans l'élaboration de programmes d'immunisation accessibles. CONCLUSION: Un engagement significatif envers les personnes handicapées dans la planification du programme d'immunisation aiderait à garantir que les personnes vivant avec un handicap, qui sont déjà confrontées à des défis importants en raison de la COVID-19, bénéficient des mêmes protections que le reste de la population. Ces recommandations pourraient être facilement transférées à l'administration d'autres campagnes de vaccination à grande échelle (par exemple, le vaccin contre la grippe).

Towards a sociological understanding of medical gaslighting in western health care.

In recent years, the term 'medical gaslighting' and accompanying accounts of self-identified women experiencing invalidation, dismissal and inadequate care have proliferated in the media. Gaslighting has primarily been conceptualized in the field of psychology as a phenomenon within interpersonal relationships. Following the work of Paige Sweet (American Sociological Review, 84, 2019, 851), I argue that a sociological explanation is necessary. Such an explanation illustrates how medical gaslighting is not simply an interpersonal exchange, but the result of deeply embedded and largely unchallenged ideologies underpinning health-care services. Through an intersectional feminist and Foucauldian analysis, I illuminate the ideological structures of western medicine that allow for medical gaslighting to be commonplace in the lives of women, transgender, intersex, queer and racialized individuals seeking health care. Importantly, these are not mutually exclusive groups, and I use the term bio-Others to highlight and connect how those with embodied differences are treated in medicine. This article indicates the importance of opening a robust discussion about the sociology of medical gaslighting, so that we might better understand what structural barriers people of marginalized social locations face in accessing quality health care and develop creative solutions to challenge health-care inequities.