Integrating social justice advocacy into a family health team: Successes and lessons learned.

PROBLEM ADDRESSED: Health is largely determined by socioeconomic factors. Health care providers can potentially address these factors through social justice advocacy. However, many individual providers and teams have not taken on this role in Canada. OBJECTIVE OF PROGRAM: To address identified barriers in integrating social justice advocacy into the practice of individual health care providers and interdisciplinary teams. PROGRAM DESCRIPTION: An Advocacy Tool Kit was created in 2017 to build individual capacity for social justice advocacy. An advocacy framework was adopted in 2018 that reiterated the commitment of the Department of Family and Community Medicine at St Michael's Hospital in Toronto, Ont, to social justice advocacy and outlined 2 new processes: to adopt and implement specific departmentwide campaigns to advocate for social justice; and to respond to inquiries about social justice issues and external advocacy campaigns. CONCLUSION: The initiatives have helped integrate social justice advocacy into the core activities of the interdisciplinary primary care team and can likely be replicated by other interested groups across the country.

Addressing financial strain through a peer-to-peer intervention in primary care.

BACKGROUND: Financial strain is a key social determinant of health. As primary care organizations begin to explore ways to address social determinants, peer-to-peer interventions hold promise. OBJECTIVE: Our objective was to evaluate a peer-to-peer intervention focussed on financial empowerment delivered in primary care, in partnership with a social enterprise. METHODS: This intervention was hosted by a large primary care organization in Toronto, Canada. Participants were recruited within the organization and from local services. We organized three separate groups who met over 10 weekly in-person, facilitated sessions: millennials (age 19-29) no longer in school, precariously employed adults (age 30-55) and older adults near retirement (age 55-64). We applied principles of adult education and peer-to-peer learning. We administered surveys at intake, at exit and at 3 months after the intervention, and conducted three focus groups. RESULTS: Fifty-nine people took part. At 3 months, participants had sustained higher rates of optimism about their financial situation (54% improved from baseline), their degree of control (55% improved) and stress around finances (50% improved). In focus groups, participants reported greater understanding of their finances, that they were not alone in struggling with finances, and that it was useful to meet with others. One group continued to meet for several months after the intervention. CONCLUSIONS: In this study, a peer-to-peer intervention helped address a key social determinant of health, likely through reducing stigma, providing group support and creating a space to discuss solutions. Primary care can host these interventions and help engage potential participants.