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Background: To sufficiently house and support persons experiencing homelessness (PEH), deeper understandings of the cultural appropriateness and responsiveness of community resources and the service delivery system is essential. In the case of Metro Vancouver, Canada, the cultural appropriateness and responsiveness of Housing First as a service model for supporting PEH was explored. Methods: Local service providers and stakeholders (n = 52) participated in three full day service-mapping workshops to identify Housing First supports for older adults, youth, and women experiencing homelessness, as part of a municipal-wide participatory and action-oriented study. Data were analyzed using a structured framework thematic analysis approach and cultural safety and humility lenses. Results: We generated three key themes: (i) insufficient built environments create challenges across gender and age, (ii) cultural safety and humility concerns at the intersection of gender and age, and (iii) implications for a culturally-responsive Housing First implementation. Conclusions: Findings informed the development of a Culturally-Responsive Planning resource to support housing, health, and social service providers who are implementing Housing First initiatives. [ABSTRACT FROM AUTHOR]

Background and Objectives The digital revolution has resulted in innovative solutions and technologies that can support the well-being, independence, and health of seniors. Yet, the notion of the "digital divide" presents significant inequities in terms of who accesses and benefits from the digital landscape. To better understand the social and structural inequities of the digital divide, a realist synthesis was conducted to inform theoretical understandings of information and communication technologies (ICTs); to understand the practicalities of access and use inequities; to uncover practices that facilitate digital literacy and participation; and to recommend policies to mitigate the digital divide. Research Design and Methods A systematic search yielded 55 articles published between 2006 and 2016. Synthesis of existing knowledge, combined with user-experience elicited through a deliberative dialogue session with community stakeholders (n = 35), made visible a pattern of privilege that determined individual agency in ICT access and use. Results Though age is consistently centralized as the key determinant of the digital divide, our analyses, which encompassed both van Dijk's resources and appropriation theory and intersectionality, appraised this notion and revealed that age is not the sole determinant. Findings highlight the role of other factors that contribute to digital inequity among community-dwelling middle-aged (45–64) and older (65+) adults, including education, income, gender, and generational status. Discussion and Implications Informed by results of a realist synthesis that was guided by intersectional perspectives, a conceptual framework was developed outlining implications for theory, policy, and practice to address the wicked problem that is the digital divide. [ABSTRACT FROM AUTHOR]

Principles of aging-in-place emphasize the importance of creating sustainable environments that enable older people to maintain a sense of belonging, autonomy, independence, safety and security. Simply altering the built environment is insufficient for creating more inclusive environments for older persons, as creating ‘meaningful’ places for aging involves consideration of psychosocial and cultural issues that go beyond issues of physical space. This paper illustrates how applications of community-based participatory research methods, in particular, participatory community mapping workshops (PCMWs), can be used to access experiences of place, identify facilitators and barriers to accessing the built environment and co-create place-based solutions among older people and service providers in a new affordable housing development in Western Canada. Founded on tenets of empowerment and relationship building, four PCMWs were undertaken with 54 participants (N = 38 older people; N = 16 local service providers). PCMWs comprised (i) experiential group walks around the community to access understandings of place and community and (ii) mapping exercises, whereby participants articulated their place-based needs within the context of the new affordable housing development and surrounding neighbourhood. Dialogues were digitally recorded, transcribed and thematically analysed. Visual data, including photographs taken during experiential group walks were categorized and integrated into the narrative to illustrate place meanings. PCMWs enabled senior housing and social care professionals and decision-makers to co-construct knowledge with older tenants that facilitated place action and change. Key themes identified by participants included: identifying services and needs for health and wellbeing, having opportunities for social participation and overcoming cross-cultural challenges. PCMWs were found to be a nuanced method of identifying needs and resources and generating knowledge. [ABSTRACT FROM AUTHOR]

This review examined the breadth of gender-sensitive tobacco and alcohol interventions that target girls and women. A comprehensive review of databases and websites was conducted in 2011/2012 for interventions that focused on girls and women health, incorporated an understanding of sex and/or gender, engaged with the determinants of women's health, and sought to reduce gender-related social and health inequities. Results of the review suggest that interventions designed with an understanding of the effect of gender roles, norms, and behaviors on women's health are limited and that much work remains to encourage practitioners to use a gender-sensitive approach when designing interventions. [ABSTRACT FROM AUTHOR]

Intergenerational communities can be understood as communities where multiple age groups interact, feel valued, and contribute to community life in an inclusive way. However, older adults in many communities in the UK can be excluded from intergenerational mixing. The PlaceAge project undertook interviews, photo-diaries, community mapping workshops, and knowledge cafés to explore older adult experiences of and participation in their cities and communities. Three key themes were generated, showcasing intergenerationality: (1) Connectedness in place and space; (2) Feeling old in siloed communities; and (3) Play in everyday life. This research emphasizes the importance of inclusive and accessible intergenerational places and activities that foster sustainable social connections and combat ageism. It highlights the value of playfulness, skill-sharing and co-mentoring, and advocates for the importance of incorporating intergenerational opportunities into the planning and development of age-friendly cities and communities. [ABSTRACT FROM AUTHOR]

Housing First is a model and philosophy for housing homeless people in immediate and permanent housing. In order to implement and deliver Housing First, research is essential to understand the system of support services as they currently exist. Guided by principles of community-based participatory research, this paper presents the findings from a senior-focused deliberative dialogue workshop in Metro Vancouver, Canada. Participants (16 service providers and 1 service recipient) identified services and resources available to support seniors in maintaining housing and barriers and facilitators for accessing services. Broadly, data were organized into seven themes: (1) Housing; (2) Home support; (3) Transportation; (4) Information availability, accessibility, and navigation; (5) Cultural diversity; (6) Discrimination; and (7) Funding and financial support. Results found that affordable housing that adapts to changing health conditions, income supports, health services, homecare, transportation, and culturally appropriate and nondiscriminatory informational resources are among the supports most needed for persons as young as 50 years old to succeed under the Housing First model in Metro Vancouver. Barriers to Housing First service provision, including rigid eligibility criteria for chronically and episodically homeless, should be revised to better support the growing number of older adults who are newly entering homelessness in Metro Vancouver. [ABSTRACT FROM AUTHOR]

Background and Objectives The age-friendly cities and communities (AFCC) agenda has led to a range of policy initiatives aimed at supporting aging in place for older people. While there is case study evidence of how people age across urban contexts, there has been little research exploring cross-national understandings of age-friendly places among older people. The objective of this article is to identify the place experiences of older people living across cities and communities in India, Brazil, and the United Kingdom and to discuss implications for the AFCC agenda. Research Design and Methods A total of 300 semistructured interviews were undertaken with older people across 9 cities and 27 communities in India, Brazil, and the United Kingdom. The data were analyzed using thematic analysis undertaken by each national team and then discussed and revised at collaborative workshops with researchers from each of the 3 country teams. Results The data capture the ways in which place is constructed from the perspective of older people drawing upon social, community, and cultural dimensions of aging across diverse urban environments. We explore how older people negotiate place in the context of their everyday life and identify the relational and interconnected ways in which place attachment, belonging, and identity are constructed. Discussion and Implications Age-friendly interventions need to attend to the changing physical, social and cultural dimensions of aging and place. Integrated place-making practices are required to support older people to age in the right place across rapidly transforming urban contexts globally. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims This study provides a systematic review of existing research that has empirically evaluated interventions designed to reduce stigma related to substance use disorders. Methods A comprehensive review of electronic databases was conducted to identify evaluations of substance use disorder related stigma interventions. Studies that met inclusion criteria were synthesized and assessed using systematic review methods. Results Thirteen studies met the inclusion criteria. The methodological quality of the studies was moderately strong. Interventions of three studies (23%) focused on people with substance use disorders (self-stigma), three studies (23%) targeted the general public (social stigma) and seven studies (54%) focused on medical students and other professional groups (structural stigma). Nine interventions (69%) used approaches that included education and/or direct contact with people who have substance use disorders. All but one study indicated their interventions produced positive effects on at least one stigma outcome measure. None of the interventions have been evaluated across different settings or populations. Conclusions A range of interventions demonstrate promise for achieving meaningful improvements in stigma related to substance use disorders. The limited evidence indicates that self-stigma can be reduced through therapeutic interventions such as group-based acceptance and commitment therapy. Effective strategies for addressing social stigma include motivational interviewing and communicating positive stories of people with substance use disorders. For changing stigma at a structural level, contact-based training and education programs targeting medical students and professionals (e.g. police, counsellors) are effective. [ABSTRACT FROM AUTHOR]

Although moving from institutional to home-like long-term care (LTC) settings can promote and sustain the health and wellbeing of older adults, there has been little research examining how home is perceived by older adults when moving between care settings. A qualitative study was conducted over a two-year period during the relocation of residents and staff from an institutional LTC home to a purpose-built LTC home in Western Canada. The study explored perceptions of home amongst residents, family members and staff. Accordingly, 210 semi-structured interviews were conducted at five time-points with 35 residents, 23 family members and 81 staff. Thematic analyses generated four superordinate themes that are suggestive of how to create and enhance a sense of home in LTC settings: (a) physical environment features; (b) privacy and personalisation; (c) autonomy, choice and flexibility; and (d) connectedness and togetherness. The findings reveal that the physical environment features are foundational for the emergence of social and personal meanings associated with a sense of home, and highlight the impact of care practices on the sense of home when the workplace becomes a home. In addition, tension that arises between providing care and creating a home-like environment in LTC settings is discussed. [ABSTRACT FROM AUTHOR]

Background: Asylum seekers, refugees and persons without legal status have been reported to experience a range of difficulties when accessing public services and supports in the UK. While research has identified health care barriers to equitable access such as language difficulties, it has not considered the broader social contexts of marginalization experienced through the dynamics of 'othering'. The current study explores health and health care experiences of Somali and Iraqi asylum seekers, refugees and persons without legal status, highlighting 'minoritization' processes and the 'pathologization' of difference as analytical lenses to understand the multiple layers of oppression that contribute to health inequities.Methods: For the study, qualitative methods were used to document the lived experiences of asylum seekers, refugees and persons without legal status. Thirty-five in-depth interviews and five focus groups were used to explore personal accounts, reveal shared understandings and enable social, cognitive and emotional understandings of on-going health problems and challenges when seeking treatment and care. A participatory framework was undertaken which inspired collaborative workings with local organizations that worked directly with asylum seekers, refugees and persons without legal status.Results: The analysis revealed four key themes: 1) pre-departure histories and post-arrival challenges; 2) legal status; 3) health knowledges and procedural barriers as well as 4) language and cultural competence. Confidentiality, trust, wait times and short doctor-patient consultations were emphasized as being insufficient for culturally specific communications and often translating into inadequate treatment and care. Barriers to accessing health care was associated with social disadvantage and restrictions of the broader welfare system suggesting that a re-evaluation of the asylum seeking process is required to improve the situation.Discussions: Macro- and micro-level intersections of accustomed societal beliefs, practices and norms, broad-level legislation and policy decisions, and health care and social services delivery methods have affected the health and health care experiences of forced migrants that reside in the UK. Research highlights how 'minoritization processes,' influencing the intersections between social identities, can hinder access to and delivery of health and social services to vulnerable groups. Similar findings were reported here; and the most influential mechanism directly impacting health and access to health and social services was legal status.Conclusions: Equitable health care provision requires systemic change that incorporate understandings of marginalization, 'othering' processes and the intersections between the past histories and everyday realities of asylum seekers, refugees and persons without legal status. [ABSTRACT FROM AUTHOR]

Objective: To obtain improved quality information regarding psychiatrist waiting times by use of a novel methodological approach in which accessibility and wait times are determined by a real-time patient referral procedure.Method: An adult male patient with depression was referred for psychiatric assessment by a family physician. Consecutive calls were made to all registered psychiatrists (n = 297) in Vancouver. A semistructured call procedure was used to collect information about the psychiatrists' availability for receipt of this and similar referrals, identify factors that affect psychiatrist accessibility, and determine the availability of cognitive-behavioural therapy (CBT).Results: Efforts were made to contact 297 psychiatrists and 230 (77%) were reached successfully. Among the 230 psychiatrists contacted, 160 (70%) indicated that they were unable to accept the referral. Although 70 (30%) indicated that they might be able to consider accepting a referral, 64 (91% of those who would consider accepting the referral) indicated that they would need to review detailed, written referral information and could not provide estimates of the length of wait times if the patient was to be accepted. Only 6 (3% of the 230 psychiatrists contacted) offered immediate appointment times and their wait times ranged from 4 to 55 days. When asked whether they could provide CBT, most (56%) psychiatrists in clinical practice answered maybe.Conclusions: Substantial barriers exist for family physicians attempting to refer patients for psychiatric referral. Consolidated efforts to improve access to psychiatric assessment are needed. [ABSTRACT FROM AUTHOR]