An Exploratory Study on the Impacts of Individual Skills and Health Information Exposure on Perceptions of Cancer Control and Expert Competence.

People's perceptions of control over their risk of cancer, and their perceptions of health experts' abilities to manage cancer risks, shape their beliefs about the effectiveness of expert-recommended cancer-preventive behaviors and actions. The aims of this exploratory study were to investigate the impact of individual skills and sources of health information on (i) internal locus of cancer control (ILOC) and (ii) perceived expert competence. Using a cross-sectional survey (n = 172), we collected data on individual health expertise, numeracy, health literacy, amounts of health information received from various sources, ILOC for cancer prevention and perceived expert competence (i.e., believing that health experts have the knowledge to correctly estimate cancer risks). Significant associations between health expertise and ILOC, and between health literacy and ILOC, were not observed in this study (OR = 2.15, 95%CI = 0.96-5.98; OR = 1.78, 95%CI = 0.97-3.63, respectively). Participants who received more health information from the news were more likely to perceive experts as competent (OR = 1.86, 95%CI = 1.06-3.57). Logistic regression analyses suggested that higher levels of health literacy among individuals with lower numeracy may promote ILOC but discourage expert competence beliefs. Analyses by gender suggested females with low educational attainment and lower numeracy may especially benefit from educational interventions to improve health literacy and promote ILOC. Our findings build off existing literature that point to a possible interaction between numeracy and health literacy. This research, with follow up work, may have practical implications for health educators aiming to promote specific cancer beliefs that lead to the uptake of expert-recommended cancer-preventive behaviors.

Application of the child community health inclusion index for measuring health inclusion of children with disabilities in the community: a feasibility study.

BACKGROUND: Participation in the community is a fundamental human right for children with disabilities and is a key component of their health and development. Inclusive communities can enable children with disabilities to participate fully and effectively. The Child Community Health Inclusion Index (CHILD-CHII) is a comprehensive assessment tool developed to examine the extent to which community environments foster healthy, active living for children with disabilities. OBJECTIVES: To assess the feasibility of applying the CHILD-CHII measurement tool across different community settings. METHODS: Participants recruited through maximal representation, and purposeful sampling from four community sectors (Health, Education, Public Spaces, Community Organizations) applied the tool on their affiliated community facility. Feasibility was examined by assessing length, difficulty, clarity, and value for measuring inclusion; each rated on a 5-point Likert scale. Participants provided comments for each indicator through the questionnaire and a follow-up interview. RESULTS: Of the 12 participants, 92% indicated that the tool was 'long' or 'much too long'; 66% indicated that the tool was clear; 58% indicated that the tool was 'valuable' or 'very valuable'. No clear consensus was obtained for the level of difficulty. Participants provided comments for each indicator. CONCLUSION: Although the length of the tool was regarded as long, it was seen to be comprehensive and valuable for stakeholders in addressing the inclusion of children with disabilities in the community. The perceived value and the evaluators' knowledge, familiarity, and access to information can facilitate use of the CHILD-CHII. Further refinement and psychometric testing will be conducted.

Content development of the Child Community Health Inclusion Index: An evaluation tool for measuring inclusion of children with disabilities in the community.

BACKGROUND: Addressing barriers in the environment can contribute to health and quality of life for children with disabilities and their families. The Community Health Inclusion Index (CHII) is a measurement tool developed in the United States to identify environmental barriers and facilitators to community health inclusion. The CHII adopts an adult viewpoint and aspects crucial for children may have been omitted. AIMS: This study aimed to develop a comprehensive list of items that are relevant for the community inclusion of children with disabilities in the Canadian context. METHODS: The relevance and priority of items generated from a review of existing guidelines and best practice recommendations for community inclusion were rated as a dichotomous response and discussed by an expert panel in relevant fields related to children with disabilities. RESULTS: A total of 189 items from 12 instruments and best practice guidelines were identified. Expert consensus contributed to a relevant and comprehensive list of items. Expert suggestions were considered to refine and reduce the item list. CONCLUSION: This study highlights the importance of a child version of a community inclusion tool, as the needs of children with disabilities differ from those of adults. It can help communities improve inclusion of children with disabilities and inform health promotion initiatives for this population.

An ambivalent atmosphere: Employment training programs and mental health recovery.

This article critically examines the role of employment training programs in the personal recovery of adults living with mental illness in community settings. Using Cameron Duff's (2014) notion of 'assemblages of recovery,' we explore how, and to what extent, employment training programs provide the supportive resources linked to personal recovery. Using an ethnographic case study, we describe the ambivalent atmospheres associated with one program. This ambivalence expresses the fundamental tension between the genuine aspirations of personal recovery and the realities of the capitalist labor process.

Gender matters in career exploration and job-seeking among adults with autism spectrum disorder: evidence from an online community.

Purpose: The purpose of this study was to explore the role of gender in career exploration and job-seeking experiences among adults with autism.Methods: The study drew on qualitative content analysis of 714 randomly sampled posts (357 by women and 357 by men) from an online autism forum. The stages of considering work: contemplation, preparation, and action informed the analysis.Results: The analysis showed several similarities and some differences. In the initial stage of deciding whether or not to seek employment, low self-esteem, rejecting paid employment as a life goal, fear of losing disability benefits and parental overprotection influenced both genders. Gender role and family responsibilities further constrained women. In the stage of defining career goals, common issues included the need for autism-tailored career-matching tools and sector-specific guidance, and lack of self-employment support. Women were further limited by assumptions about stereotypical jobs to which they should aspire. In the job search stage, overly specific job descriptions, a lack of social networks, and transportation barriers influenced both genders. While women talked more frequently about unfavorable experiences in employment support services, men recounted more difficulties with job applications and interviews.Conclusion: Gender-sensitive vocational approaches are needed to assist adults with autism throughout the career decision-making process.Implications for rehabilitationVocational psychologists, clinicians, and policymakers should help to overcome the psychological, social, and financial reasons that may lead adults with autism to decide not to pursue paid work.To assist in setting career goals, vocational specialists need to be aware of the challenges facing adults with autism across various employment sectors and provide them with tailored career-matching tests and tools.Vocational rehabilitation specialists and educators should encourage women with autism into non-traditional areas of employment.Vocational rehabilitation services should empower both males and females with autism by encouraging negotiation and self-advocacy, promoting autism-focused programs, and reducing paperwork and processing time.Vocational rehabilitation specialists should tailor their practice to the gender-specific needs of adults with autism throughout their career decision-making process.

Accounting for context: Social enterprises and meaningful employment for people with mental illness.

BACKGROUND: Many people living with mental illness want paid work, but finding and maintaining mainstream employment remains challenging. In recent decades, social enterprises have emerged as one alternative site for paid employment. Existing research has examined the experiences of people with mental illness working in social enterprises, but less is known about the organizational character of these workplaces. OBJECTIVE: The objective of this paper is to develop a better understanding of social enterprises as organizational contexts for workers with mental illness. METHODS: The research employed a qualitative methodology, conducting semi-structured interviews with executive directors and managers at 42 organizations operating 67 social enterprises across CanadaRESULTS:While there are strong similarities in organizational mandate to create meaningful employment there are also important variations between social enterprises. These include variations in size, economic activity and organizational structure, as well as differences in hours of work, rates of pay and the nature and extent of workplace accommodation. These variations reflect both immediate organizational contexts as well as broader economic constraints that enterprises confront. CONCLUSIONS: Understanding the varied nature of social enterprises is important for thinking about future enterprise development, and the capacity of such organizations to create meaningful employment for people living with mental illness.

Representations of disability in the Canadian news media: a decade of change?

PURPOSE: To assess stability and change in representations of disability and persons with disability in the Canadian news media between 1998 and 2008. METHOD: The study replicated research conducted in 1998 that assessed the representation of disability in the Canadian news media. Following the earlier study, three newspapers were selected (Globe and Mail, Toronto Star and Toronto Sun) and all articles from a three-month period in 1998 and 2008 were assessed for disability content. In total, 362 articles were found in the two time periods. These were coded for structure and content using a schema developed in the earlier research. RESULTS: Between 1998 and 2008, there was a significant increase in the proportion of stories using "person first" language, and a significant increase in the proportion of "progressively" themed articles (e.g. dealing with barriers to participation, or disability awareness and inclusion). At the same time, there were significant differences between newspapers, with the Toronto Sun (a tabloid) maintaining a strong focus on "traditional" themes (e.g. special education, charitable provision). CONCLUSIONS: The differences in news media representations between 1998 and 2008 suggest a positive change in the way people with disabilities are represented, with greater attention to the complexity of their identity and their multiple social roles. IMPLICATIONS FOR REHABILITATION: The participation of persons with disabilities in society continues to be limited by negative attitudes. Media reporting has a significant influence on public attitudes toward disability. In a content analysis of three Canadian newspapers, this study found several significant changes in the language and content of disability-related articles. Together, these changes provide some evidence of more favorable media representations of disability. Further research in rehabilitation is needed to understand how such changes may both reflect and facilitate ongoing efforts to enhance people with disabilties' participation in social life.

Understanding, embracing, rejecting: Women's negotiations of disability constructions and categorizations after becoming chronically ill.

The purpose of this article is to elucidate the various responses women have to being, or not being, categorized as disabled within specific spheres (e.g., medical, state) or places (e.g., doctor's office, work) after developing a contested chronic illness. Drawing on interviews conducted with 55 women living with fibromyalgia syndrome in Ontario, Canada, we examine how they come to understand various constructions of disability and whether or not they reflect their sense of self, and how and why they either embrace or reject external categorizations of themselves as disabled by the state or medical professionals. In doing so we contribute to the limited geographic literature which stresses the importance of spatiality and ways of being in place to ill and impaired persons' negotiations of the self and relationships with others. We find that negotiating disability was, for many, an emotionally charged and complex process, drawing on one or more strategies: reluctantly employing some meanings associated with 'being disabled' to achieve material ends, creating an understanding of disability that is most in keeping with one's sense of self, embracing other meanings to the extent that they offer a legitimate basis for identity, and/or rejecting disability in the interests of sustaining an existing identity. For those women in need of forms of state assistance such as income support and health care, state institutions exert powerful pressures to come to terms with what disability means in one's life - particularly as medical and state authorities classify people as 'disabled enough' or 'not disabled enough' for entitlement to state resources.

Emerging scholarship in the geographies of disability.

A recent symposium on the geographies of disability at the 2007 Association of American Geographers meeting attracted papers and panel contributions from 46 researchers. In this commentary, we draw on the content of the symposium to discuss recent developments in disability geography scholarship. We focus on three broad themes that ran through many of the contributions. These are: the evolving parameters of disability and chronic illness; the complex relationship between disabilities and technologies; and the struggle for citizenship.

Spaces of sobriety/sites of power: examining social model alcohol recovery programs as therapeutic landscapes.

While there has been interest in geographical variations in alcohol use and their implications for health, similar attention has not been given to geographies of alcohol treatment and recovery. This paper is concerned with exploring these geographies of alcohol recovery and treatment. Specifically, the paper uses the therapeutic landscape concept coupled with Foucault's concept of governmentality to frame a qualitative case study of a 'social model' recovery community in San Pedro, California. Analysis of the programs operating in San Pedro consisting of observation and interviews, demonstrates the complexity and contradictory character of such recovery landscapes. In particular, the governmentality perspective suggests that spaces created for alcohol recovery and support can be simultaneously understood as sites designed to govern the health-related conduct of individuals. Within programs, clients were provided with support and encouragement from staff and peers, but these same relations also made possible surveillance and the governing of daily routines. In the neighbourhood, program staff intervened to create 'healthy' spaces but these interventions also shaped the conduct of local residents and contributed to the spatial regulation of problem groups. While a focus on governmentality does not preclude recognition of the positive effects associated with therapeutic landscapes, it does provide an opportunity for further consideration of the complexities underlying such environments.

Putting policy into practice? Poverty and people with serious mental illness.

This paper addresses the effects of chronic poverty on people with serious mental illness. More specifically, we are concerned with the extent to which welfare restructuring, by deepening the poverty facing people with serious mental illness, undermines the expressed intent of mental health policy to improve the quality of life (QOL) of this population. The province of Ontario in Canada forms the setting for the study. The paper first examines recent trends in mental health care and social assistance policy in Ontario. While income support is consistently recognized as a core element of mental health care, welfare restructuring has led to a significant decline in the real value of income supports received by people with serious mental illness. The paper then examines the implications of this trend for the QOL of residential care facility tenants in Hamilton, Ontario. Here, the case study is explicitly connected to QOL scholarship. In addition, the study is grounded in an analysis of the broader transformation of the welfare state in Ontario. Interview data suggest that tenants experience chronic poverty that has a deleterious impact on multiple life domains including basic needs, family, social relations, leisure and self-esteem. Implications for research and policy are discussed.

Poverty and mental health: a qualitative study of residential care facility tenants.

The impact of poverty on daily living was assessed for twenty-two mental health consumers using qualitative in-depth interviews. Consumers reported considerable difficulty meeting basic needs, such as clothing, shoes and personal care items. A majority reported running out of money before the end of each month. Respondents used strategies including careful budgeting, borrowing and employment to cope with poverty. Analysis indicated that the poverty experienced by respondents worked directly against participation in meaningful activities and their ability to build and sustain social relationships. Moreover, poverty directly contributed to stigma experienced by respondents. Findings suggest that a failure to recognize poverty as a key mental health policy issue will continue to constrain efforts to facilitate consumer empowerment and social integration.