Seeing the invisible: extracurricular learning processes and learning outcome as experienced by student volunteers accompanying persons in a socially vulnerable situation to healthcare appointments-an ethnographic study.

Becoming a healthcare professional is a complex process, where learning occurs in various ways. This study explores an extracurricular learning approach, called the Social Health Bridge-Building Programme, designed to address health inequities. Student volunteers accompany persons in a socially vulnerable situation to healthcare appointments. Operating outside the realms of health education, the programme intends to provide an alternative road to training healthcare students to become capable of engaging with diverse populations, and reducing barriers to healthcare access. Based on an ethnographic fieldwork, using interviews and participant observation ("walking along") as methods, the aim of the study was to explore the learning processes and learning outcomes associated with bridge-building, as experienced by students. Our findings show that this extracurricular learning complemented the formal curriculum, and bridged the gap from theoretical knowledge to practice and to real persons, preparing students for their future roles. The particular positioning of walking alongside or sitting beside persons made the invisible visible, enabling student volunteers to see the variety of persons in need of bridge-building, ways of living in a socially vulnerable situation, inequity in health, and see the persons, beyond initial impression, fostering a deeper understanding and empathy among the students. Learning outcomes included communicational, relational, and observations skills, and a more comprehensive grasp of the healthcare system's complexity. We conclude that a non-governmental organization, independent of the healthcare system, may have found a novel way of providing extracurricular learning about health inequity to students. Demonstrating how the Social Health Bridge-Building Programme complements formal curricula, the concept could be applicable in other settings.

Navigating (un)certainty in 'downhill' trajectories: An ethnographic study about rehabilitees' and professionals' experiences of goal-setting in Parkinson's disease rehabilitation.

OBJECTIVE: To explore rehabilitees' and professionals' experiences of goal-setting in a context of (un)certainty with a progressive neurodegenerative disease and how they navigate this (un)certainty in Parkinson's disease rehabilitation. DESIGN: A long-term multi-sited ethnographic fieldwork (2019-2020) following 20 rehabilitees and their goals over time and settings. Observation at 30 goal-setting meetings. PARTICIPANTS: Rehabilitees and professionals in Danish Parkinson's disease rehabilitation. Two randomly chosen groups of rehabilitees attending a Parkinson's disease course at a rehabilitation centre participated. METHODS: Semi-structured interviews and participant observation. RESULTS: Living with Parkinson's disease holds a certainty that the condition will progress yet an uncertainty regarding the pace and severity, as indicated by the notion (un)certainty. The (un)certainty challenges goal-setting. Reflecting on goal-setting, rehabilitees brought forth existential, economical, and societal considerations. Some expressed an ambivalent view, questioning the value of goal-setting with a progressive condition, yet finding own rehabilitation goals relevant. Others expressed a pragmatic view, attuning goals to fit the situation. Professionals found that the visible and invisible symptoms and the uncertain pace of Parkinson's made goal-setting challenging. They had to strike a balance between mentioning symptoms to come, yet not rendering the future too bleak. CONCLUSIONS: Rehabilitees and professionals found that setting goals in a condition that progresses is no easy task. They made use of strategies such as observation, repetition, future-proofing strategies, and attuning goals to navigate the (un)certainty. In goal-setting, to maintain functioning with progressive Parkinson's disease was a viable goal. Participants found they just do the best they can to navigate (un)certainty.

Bridging gaps in health? A qualitative study about bridge-building and social inequity in Danish healthcare.

Attendance to health appointments may pose challenges to patients, especially when living in socially disadvantaged situations, with a fragile network. Inequality in health is increasingly highlighted in Denmark. To enhance social equity in health, a non-governmental organization introduced bridge-building, where healthcare students volunteer to accompany persons in socially vulnerable situations to health appointments.The purpose of the study was to explore what bridge-building entails and which gaps bridge-building attempts to span, in a welfare state, based on equal rights to healthcare.The study is based on an ethnographic fieldwork among the stakeholders in bridge-building, using interviews and participant observation in the form of "walking fieldwork".Informants emphasized safe-making and wayfinding as important components in bridge-building, with bridge-builders acting as as-if-relatives. Bridge-building navigates in borderlands, the in-between spaces with fluid and contested borders, encompassing public, civic society, and family spheres. All informants emphasized that bridge-building covers a need in contemporary Danish healthcare.Bridge-building entails a double temporality, a here-and-now intervention where persons in vulnerable situations get social support to make it to health appointments, and a future investment in future health professionals' understanding of vulnerability in lives and barriers to health access; insights that may be valuable in their future job positions.

Bridging Inequity Gaps in Healthcare Systems While Educating Future Healthcare Professionals-The Social Health Bridge-Building Programme.

Social inequity in healthcare persists even in countries with universal healthcare. The Social Health Bridge-Building Programme aims to reduce healthcare inequities. This paper provides a detailed description of the programme. The Template for Intervention Description and Replication (TIDieR) was used to structure the description. The programme theory was outlined using elements from the British Medical Research Council's framework, including identifying barriers to healthcare, synthesising evidence, describing the theoretical framework, creating a logic model, and engaging stakeholders. In the Social Health Bridge-Building Programme, student volunteers accompany individuals to healthcare appointments and provide social support before, during, and after the visit. The programme is rooted in a recovery-oriented approach, emphasising personal resources and hope. The programme finds support in constructs within the health literacy framework. Student volunteers serve as health literacy mediators, supporting individuals in navigating the healthcare system while gaining knowledge and skills. This equips students for their forthcoming roles as healthcare professionals, and potentially empowers them to develop and implement egalitarian initiatives within the healthcare system, including initiatives that promote organisational health literacy responsiveness. The Social Health Bridge-Building Programme is a promising initiative that aims to improve equity in healthcare by addressing individual, social, and systemic barriers to healthcare. The programme's description will guide forthcoming evaluations of its impact.

What Are Your Goals? Goal-Setting Logics in Danish Parkinson's Rehabilitation.

Across rehabilitation fields, rehabilitees and professionals meet to set rehabilitation goals. Portrayed as an ordinary, yet foundational practice in rehabilitation, participants often find goal-setting meetings challenging; ideal and real seem to clash. Based on a long-term fieldwork in Danish Parkinson's disease rehabilitation, we explore goal-setting and its rationale to gain insight into why goal-setting qualifies as challenging. We find that challenges relate to disease, organizational matters and an imbalance in institutional knowledge, but also that different logics, of choice, interdependence, and accountability, entangle and affect goal-setting. A competitive aspect between goal-setting logics appears pivotal to understand the challenges in goal-setting.

Moving goals. Goal-work in Parkinson's disease rehabilitation.

Chronic diseases often demand considerable work by patients: they must adhere to medical regimes and engage with social and embodied discontinuities. In Denmark, rehabilitees in Parkinson's disease rehabilitation talk about Parkinson's as their new job. In this article, we introduce goal-work as an optical lens to enlarge and explore the micro-social practices that concern a core practice in rehabilitation where professionals and rehabilitees set goals for the future and work toward the goals. To work with goals adds a new task to living with Parkinson's. Rehabilitation research tends to focus on the actual goal-setting meeting. Drawing on data from long-term ethnographic fieldwork on goals and their setting in Parkinson's disease rehabilitation, we show how participants in rehabilitation imagine, set, enact, review or share their rehabilitation goals, and how goals are worked with before and after the goal-setting meeting, across settings. We conceptualize these micro-social practices as goal-work, which we argue is a spatio-temporal process. The concept of goal-work emphasizes the fact that goal-setting is one event in a string of goal-related activities, and it turns our attention to the intersubjective dimensions inherent in goal-work, such as the role of relatives and how acts of imagination and acts of sharing form part of goal-work.

Usability of self-reported assessment of work functioning in municipal occupational rehabilitation teams: A qualitative study.

Aims: This study aimed to explore (1) whether self-reported assessment on work-related functioning, workability, return-to-work (RTW) self-efficacy, and expectation was useful in the professionals' assessment of sick-listed workers and could guide referral to interventions and (2) whether self-reporting in addition to "usual practice" could improve the RTW dialog and involvement in case management. Methods: The qualitative study took place in two municipal job centers in 2021. The assessment was based on the Work Rehabilitation Questionnaire, RTW-Self-efficacy Scale-19, and single items of self-rated health, workability, and RTW expectations. Sick-listed workers (n = 36) were interviewed by telephone. Three focus-group interviews were conducted with professionals who had used the questionnaire. Data were coded and analyzed thematically. Results: Three themes with seven subthemes emerged: (1) accessibility; (2) one tool in the RTW toolbox (subthemes: a supplementary tool, a tool for reflection, facilitating interdisciplinary communication, and enhancing active participation); and (3) the value of "ticking boxes" (subthemes: good days, bad days, the issue of power, and the cultural meaning of words). Conclusion: The professionals would not recommend the present questionnaire for use during their rehabilitation team meeting for assessment, interdisciplinary communication, or choice of interventions. However, using the parts assessing RTW self-efficacy and expectation combined with a dialog may be of value early in the RTW process. The self-reporting assessment tool was perceived to be meaningful to some sick-listed workers, as it provided reflections on important aspects of the RTW process. Some workers believed that it might contribute to the rehabilitation team, and thus, it could improve their involvement.