Rural homelessness: how the structural and social context of small-town living influences the experience of homelessness.

OBJECTIVES: Homelessness is increasingly recognized as a crisis beyond Canada's largest cities where it is most visible, yet little is known about the experience and outcomes associated with rural homelessness. The aims of this study were to explore the experience of housing insecurity and its impact on the health of rural residents, identify the various factors contributing to homelessness in a rural Ontario context, and give voice to people with lived experience about their needs, challenges, and potential solutions to the housing crisis. METHODS: This exploratory qualitative study used interpretive description and a critical theory lens. Interviews were conducted with people who were currently experiencing homelessness and key informants in a rural community experiencing a housing crisis. Data collection took place between August 2020 and May 2021. Analysis was inductive and concurrent. RESULTS: Findings from interviews with 27 participants (16 with lived experience and 11 key informants) revealed how the structural and social context contributed to rural homelessness. Barriers to securing rental housing in a tight market were influenced by small-town dynamics and discrimination. These experiences led to feelings of hopelessness, which combined with daily stressors of managing unsuitable living conditions to contribute to deteriorating physical and mental health. Opportunities for tailoring interventions to the rural context include increasing awareness, expanding transportation, improving access to local services, and applying Housing First principles. CONCLUSION: Interventions to prevent and manage homelessness must be tailored to the unique rural context.

RéSUMé: OBJECTIFS: Le sans-abrisme est de plus en plus reconnu comme une crise qui sévit aussi hors des plus grandes villes du Canada, où il est le plus visible, mais on en sait peu sur l'expérience et les résultats cliniques associés au sans-abrisme rural. Notre étude visait à explorer l'expérience de l'insécurité du logement et ses effets sur la santé des résidents ruraux, à cerner les divers facteurs contribuant au sans-abrisme en milieu rural en Ontario et à permettre à des personnes ayant une expérience vécue d'exprimer leurs besoins, leurs difficultés et des solutions possibles à la crise du logement. MéTHODE: Cette étude qualitative exploratoire a fait appel à la description interprétative et au prisme de la théorie critique. Des entretiens ont été menés avec des gens actuellement sans abri et avec des informateurs et des informatrices dans une communauté rurale aux prises avec une crise du logement. La collecte des données s'est déroulée entre août 2020 et mai 2021. Leur analyse a été inductive et concurrente. RéSULTATS: Les constatations des entretiens avec 27 participants (16 ayant une expérience vécue et 11 informateurs et informatrices) ont révélé que le contexte structurel et social contribue au sans-abrisme rural. Les obstacles à l'obtention de logements locatifs dans un marché étroit étaient influencés par la dynamique d'une petite ville et par la discrimination. Ces expériences ont mené à des sentiments de désespoir qui, combinées au stress quotidien de conditions de vie inadaptées, ont contribué à la détérioration de la santé physique et mentale. Pour adapter les interventions au contexte rural, on peut faire de la sensibilisation, développer les transports, améliorer l'accès aux services locaux et appliquer les principes de Logement d'abord. CONCLUSION: Les interventions pour prévenir et gérer le sans-abrisme doivent être adaptées aux particularités du contexte rural.

Competing perspectives on rural homelessness: Findings from a qualitative study in Ontario, Canada.

Rural homelessness in Canada has only recently been acknowledged, and several gaps remain in our understanding of the phenomenon and how it is influenced by the rural context. This qualitative exploratory study aimed to help understand the experience of housing insecurity, factors that lead to rural homelessness, and potential solutions to the housing crisis in a rural Ontario community. Interviews were conducted with 27 participants: 16 individuals who were housing insecure and 11 key informants who had knowledge of the local homelessness situation. Data collection took place between August 2020 and May 2021 and inductive analysis was concurrent. Findings revealed competing perspectives on the magnitude of the crisis, its root causes, and potential solutions to rural homelessness. The invisible nature of rural homelessness and values of individualism that assign responsibility for homelessness to poor choices rather than structural factors may account for these different perspectives. Stigma also played an important role in how homelessness was understood, particularly for individuals who were homeless and perceived to be using substances. The lack of privacy, limited services, and low housing stock in the rural environment contributed to challenges with overcoming homelessness. Strategies to help improve supports for individuals facing homelessness include anti-stigma education, capacity building, and inclusion of people with lived experience of homelessness in decision and policymaking. Prevention should also be incorporated into the response to rural homelessness through intersectoral collaboration and upstream policies that target the structural drivers of homelessness.

Pilot program integrating outpatient opioid treatment within a rural primary care setting.

CONTEXT: Canada is experiencing an opioid crisis. In rural areas, limited access to specialty addictions services, public transportation, and many of the social determinants of health create a unique set of challenges for people who use substances. ISSUE: The Rural Outpatient Opioid Treatment (ROOT) program was created to bring some of the structure of an inpatient treatment program into a rural primary care setting in Ontario, Canada. The program uses a harm reduction approach to provide group recovery work, primary care, peer support, smoking cessation, opioid agonist therapy, screening and treatment for hepatitis C and HIV, and longitudinal follow-up. Sixteen participants have enrolled in three rounds of the ROOT program to date. LESSONS LEARNED: A program evaluation shows that opioid use decreased while use of other substances remained high, in particular methamphetamine use, which is increasing more broadly in the local area. Participants described feeling cared for and appreciated the 'seamless' nature of the multidisciplinary program, the peer support provided, and their new and expanded social networks. The rural context created both benefits and challenges for their substance use, recovery, and for community programming. In conclusion, the evaluation of this pilot program demonstrates that it is possible to successfully integrate an outpatient substance-use treatment program into rural primary care.

Social capital and self-rated health: A cross-sectional study of the general social survey data comparing rural and urban adults in Ontario.

The concept of social capital shows great promise for its potential to influence individual and population health. Yet challenges persist in defining and measuring social capital, and little is known about the mechanisms that link social capital and health. This paper reports on the quantitative phase of a sequential explanatory mixed methods study using data from Canada's 2013 General Social Survey (data collected 2013-14). An exploratory factor analysis revealed six underlying dimensions of social capital for 7,187 adults living in Ontario, Canada. These factors included trust in people, neighbourhood social capital, trust in institutions, sense of belonging, civic engagement, and social network size. A logistic regression indicated that having high Trust in People and Trust in Institutions were associated with better mental health while high Trust in Institutions, Sense of Belonging, and Civic Engagement were associated with better physical health. When comparing rural and urban residents, there were no differences in their self-reported health, nor did social capital influence their health any differently, despite rural residents having higher social capital scores. The study findings are important for understanding the nature of social capital and how it influences health, and provide direction for targeted health promotion strategies.

Contested Practice: Political Activism in Nursing and Implications for Nursing Education.

Canadian nurses have a social mandate to address health inequities for the populations they serve, as well as to speak out on professional and broader social issues. Although Canadian nursing education supports the role of nurses as advocates for social justice and leadership for health care reform, little is known about how nurse educators understand activism and how this translates in the classroom. A comparative life history study using purposeful sampling and a critical feminist lens was undertaken to explore political activism in nursing and how nurse educators foster political practice among their students. Findings from interviews and focus groups with 26 Ontario nurse educators and nursing students suggested that neoliberal dynamics in both the practice setting and in higher education have constrained nurses' activist practice and favour a technical rational approach to nursing education. Implications and strategies to inspire political action in nursing education are discussed.

How Activism Features in the Career Lives of Four Generations of Canadian Nurses.

Recent nursing research using a critical feminist lens challenges the prevailing view of political inertia in nursing. This comparative life history study using a critical feminist lens explores the relevance of activism with four generations of Canadian nurses. Purposeful sampling of Ontario nurses resulted in 40 participants who were diverse in terms of generation, practice setting, and activist practice. Interviews and focus groups were completed with the sample of Ontario registered nurses or undergraduate and graduate nursing students: 8 Generation X, 9 Generation Y (Millennials), 20 Boomers, and 3 Overboomers. Factors such as professional norms and personal and organizational supports shaped contradictory nursing activist identities, practices, and impacts. Gendered norms, organizational dynamics, and the political landscape influenced the meanings nurses attributed to critical incidents and influences that prompted activism inside and outside the workplace, shaping the transformative potential of nursing. Despite its limitations, the study has implications for creating professional and organizational supports for consideration of health politics and policy, and spaces for dialogue to support practice and research aligned with social justice goals.

Rural food insecurity: When cooking skills, homegrown food, and perseverance aren't enough to feed a family.

OBJECTIVE: More than 1 in 10 Canadians experience food insecurity, and a growing number of families rely on food banks each month. This ethnographic study aimed to give voice to rural families about their experiences with food insecurity while situating the findings within the broader social, political and economic context. METHODS: Semi-structured interviews were conducted with women who had children living at home, and interviewer observations within the food bank were recorded as field notes. Content analysis was combined with the constant comparison method of data analysis to identify common themes regarding the experience of living with food insecurity and the influence of public policy. RESULTS: Seven female participants described the emotional toll that food insecurity had on their well-being and relationships, with stress and depression common to many women. Strategies used to stretch resources included cooking from scratch, growing produce, stocking up on sale items, hunting and fishing, and paying half-bills. Many participants described going without food so that their children could eat first, and three participants went without prescription medications. Rurality and social programs were identified as both supports and barriers to overcoming food insecurity. CONCLUSION: Participants in this study were highly skilled in attempting to feed their families with limited resources, although this proved inadequate to overcome their food insecurity. This highlights the need for policy initiatives to address the root causes of food insecurity and health inequities, including access to rural employment and high-quality child care, drug benefits and guaranteed annual income programs.