THEORETICAL FRAMEWORKS

To make sense of primary and secondary data, I have used various theories and analytical frameworks that illuminate the ways in which we can engage in person-centered and relational care. I have both applied and advanced understanding in intersectional approaches (e.g., the intersectional life course), and the Candidacy Framework for understanding access to care.

Person-centered/relational care

Person-centered care is often reduced to the idea of individuality. More deeply, however, it can push medical practitioners to look beyond the disease they are treating and consider the different elements that constitute personhood. This notion varies cross-culturally but it directs our attention to the relationship between body and mind, the individual and society, and demands that we move beyond these dualisms to consider the variations between each extreme. We also know that a sense of self is often co-constructed through interaction with others and that care must be taken to protect a sense of selfhood in those for whom this taken-for-granted concept has become fragile, most especially those with dementia. Thus relational care, which involves the connection of care providers with care recipients as whole persons, becomes important.

I explore personhood in an Indian context as it relates to health in A Fine Balance. With colleagues Drance and Kozak, I adopted a ‘Needs-Driven Dementia-Compromised’ approach to reframe ‘Leonard’s’ FTD-compromised behaviours in relation to his unmet needs on a special care unit. Quality of life for diverse older adults in Assisted Living is best promoted when autonomy is encouraged but understood as a relational concept rather than an individual one. Our research with Chinese-Canadian older adults in long-term care also found that the relational care necessary to ensure their quality of care and promote the quality of life of residents and their families alike was compromised by language and cultural incongruities with care staff.

Intersectionality

In Ageing at the Intersections, in which I analyse the literature on ageism through an intersectional lens, I described intersectionality as follows:

“Intersectionality maintains that the compounding effects of different sources of identity influence either positive or negative outcomes for people in ways that are distinct from the effects that each identity exerts individually (e.g., the experience of black women in the workforce are distinct from those of either white women or black men). In contexts in which negative societal stereotypes are attached to these identities, the effects of interlocking oppressions marginalize people and deprive them of their rights in society.”

I have advanced scholarship on intersectionality in

I have also applied this lens to better understand research findings in

I also use intersectionality in my teaching which I have described in a conference poster, Embracing intersectionality: Engaging diverse students and reducing essentialism in gerontological teaching.

Candidacy Framework

In a Pathways project book chapter, I describe the Candidacy Framework as follows:

“Accessing medical care and social supports … is a complex undertaking that requires the alignment of a diverse array of resources at the individual, social and organizational levels. The Candidacy Framework developed by Dixon-Woods and colleagues [1] provides a valuable lens through which the constituent processes of this undertaking become more apparent. This in turn facilitates identification of potential solutions to inhibitors of access at each level…. The complex construct of access is partitioned into seven dimensions: the first six of these are transition points at which a person’s candidacy for care must be negotiated; the seventh captures the broader environmental context of negotiations.”


[1] Dixon-Woods M, Cavers D, Agarwal MS, Annandale E, Arthur T, Harvey J, et al. Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups. BMC Med Res Methodol [Internet]. 2006;6(35). Available from: http://www.biomedcentral.com/1471-2288/6/35

The Framework was extremely valuable to our goal of generating policy recommendations out of the rich four-site data set generated by our Pathways to a Diagnosis of Dementia team. As one of the first researchers to apply the framework to enhance understanding of primary research findings in Negotiating Candidacy: Access to Care for Ethnic Minority Seniors (BACEMS project), my work is often cited by others who have utilized and expanded on this valuable lens. Our national Health Care Equity team used the framework to assess how access was compromised relative to its seven dimensions in relation to different health care domains. This provided a basis for comparison and synthesis. We also used the Framework to structure the Building Trust research, the main goal of which was to understand and remedy access barriers to dementia care for different immigrant populations. The Framework also proved useful in our analysis of access to health promotion programs (the S4AC Case study).