Policy Decisions and Community Participation in Health: Understanding the public’s view of the National Health Insurance Scheme (NHIS)

Gina Teddy

gt501@york.ac.uk, Department of Social Policy and Social Work, University of York

Background and Aims: Government response to public concerns has been to develop policies to deal with them. Policy makers are increasingly designing strategies to address public needs and problems. With regard to health policies, governments play significant roles in developing them and executing them. Meanwhile, policy recipients tend to have little or no role in the development and measurement of these policies. The public’s understanding of a policy affect how they respond to it and the outcome. Yet little has been done to involve them. This study explored the views and perceptions of community residents on their understanding and experience of the National Health Insurance Policy (NHIP) in Ghana. It tests how much the public knew about the policy, how that affect the response to healthcare use under the scheme, what additional information they require on NHIP and the significance of that knowledge to them, their decisions and reactions to it.

Data and Methods: A qualitative research was employed to explore participants’ views, using nine focus group discussions based on a purposive sampling of three districts with previous experience of community health financing. These discussions were set to include residents of: Dangme West; Kwahu West; and Nkoranza districts. Participants included both scheme and non-scheme members who are 18 years and above from various socio-demographic backgrounds. Each FGD consisted between 8-16 participants.

Results and Conclusion: Findings from the study showed that the public want to be adequately informed of health policies and decisions made at both the national and local levels. They noted that even though the NHIP require their participation at the community level and affect their decision on healthcare, they have very vague information on it. Policies tend to be imposed on them with little or no reference to their individual circumstances. As a result, membership to the scheme is challenged, despite the policy’s aim to improve healthcare access. And this is because the level of information and education about the scheme is very limited. The general public lack information on the NHIP and their place as members, so they tend to rely on uninformed sources. They, therefore, expressed interest in being informed of health policies undertaken locally and nationally. The study concluded that policy recipients must be included more in policy processes, especially, when it has direct impact on them. Policy makers and implementers must employ various means to communicate policy decisions to the best of their ability and beyond the general provision of advertisements.

Personal Narratives of Environmental Behaviour

Sarah Hards

skh500@york.ac.uk. Department of Social Policy and Social Work, University of York

Background: While individual environmental behaviour is currently high on the agenda, both in academia and in policy circles, our understanding of the topic remains patchy. Key issues, such as the factors that drive behavioural change, remain only partially understood. To understand these issues, an interdisciplinary approach is needed. This study draws on literature from psychology and behavioural studies, sociology, social policy and political studies. While studies in the past have provided descriptions of behaviour across the population, in-depth, individual-scale approaches are also needed, to explain the underlying psychological and emotional processes.

Aim: This study aims to address this need, taking account of the dynamic nature of environmental behaviour throughout the life-course, and recognising that environmental behaviour may be entwined with other aspects of an individual’s life, and needs to be studied within this social and personal context. The central question to be answered by this study is: How and why does participation in action on climate change develop over time?

Methods: The study adopts a Narrative Life-Course approach. This combines elements of Narrative Inquiry (Riessman, 2008) with elements of Life Course or Biographical methods. In-depth interviews are being conducted with environmentally-active individuals in York. By inviting participants to “tell the story” of their environmental behaviour over time, this study takes a holistic approach to an individual’s life, focusing on processes of change, and the factors driving and obstructing them.

Results/Findings, Discussion, Conclusion: This paper presents some preliminary results from the first phase of data-collection, including life graphs drawn by participants. It also offers reflections on the challenges and benefits of this unconventional methodology, with particular reference to its potential applications within other disciplines.

References:

Riessman, C. K. (2008) “Narrative Methods for the Human Sciences”, Sage: London.

Mental Health Policy and Service Delivery in Taiwan and England

Jin-Yong Wang

jw536@york.ac.uk. Department of Social Policy and Social Work, University of York

Background: Over the last one hundred years, the way people with mental illness are treated and cared has hugely changed due to various reasons. It is argued that contextual factors such as culture apparently play a pivotal role in shaping societal perceptions and reactions to mental health problems.

Aim: In my study, I try to discover the historic development of mental health policy in Taiwan and England, and accordingly propose the possible future development of mental health policy in Taiwan. Also, I am interested to know the various stakeholders’ perspectives on mental health policy and how they have shaped the formation of mental health policy.

Methods: I conducted 41 qualitative semi-structured interviews with service users, family carers, professionals, staff of voluntary organisations and governmental policy officers. In addition to interview transcripts, I also used official statistics and policy documents to answer my research questions.

Findings: In Taiwan, psychiatric stigma and fear of mental illness have made the government to segregate people with mental illness from the community in long-term care hospitals. Psychiatric treatment has been sufficiently offered but rehabilitation and social care are relatively under-developed. Psychiatrists and policy makers have significantly influenced the direction of mental health policy.

Conclusion: There are possibilities that in the future community-based mental health care may be furthered in Taiwan, and the English experience may offer some lessons in this regard. Also, there are issues in developing culturally appropriate practice and helping service users reintegrate into the community.

Based on my social work and social policy training background, I stand on the ground of social science and am more concerned about the social issues and social care needs of people with mental illness and their families.

An exploration of the barriers to friendship formation for adults with learning disabilities who have low support needs.

Gillian Allan

gja500@york.ac.uk. Social Policy and Social Work

Background: Although often neglected in policy and practice, the question of the friendships and social networks of people with learning disabilities has received increasing interest amongst researchers over the past two decades (See e.g. Myers et.al 1998; McConkey 2007). Reasons for this include the fact that social networks, composed of a rich variety of relationships, have been found to be lacking in the lives of people with learning disabilities and therefore may be seen as a vital component of social inclusion strategies (Carnaby 1998; Leyin 2008).

Aim: The present study seeks (a) to explore the meaning of friendship to people with learning disabilities and the functions provided by their social networks (b) to discover the friendship aspirations of participants alongside a discussion of potential barriers and (c) to consider the role of social policy in helping people to overcome these barriers.

Method: An approach rooted in the principles of participatory research will be adopted.

Aim of Presentation: As the PhD is in the early stages (coming to the end of the first year), it is proposed to present the research topic and literature review. It is hoped that this presentation will not only be of interest to those working in social policy or social work but also to those interested in other areas as the question of friendship raises both sociological issues and has implications for health and wellbeing.

References:

Carnaby, S. (1998) Reflections on social integration for people with intellectual disability: Does interdependence have a role? Journal of Intellectual and developmental disability Vol 23; 3 pp219-228

Leyin (2008) Social Inclusion: Ten Years On Learning Disability Review Vol 13; 1 pp10- 17

Myers, F., Ager, K., Kerr, P. & Myles, S. (1998) Outside looking in? Studies of the community integration of people with learning disabilities. Disability and Society Vol 13 pp389-413

McConkey, R (2007) Variations in the social inclusion of people with intellectual disabilities in supported living schemes and residential settings Journal of Intellectual Disability Research, vol 51; 3, pp207-217

Critical Moments in and Case Histories of Marginalised Young People’s Lives

Aniela Wenham* and Hannah King§

*amw128@york.ac.uk, §hkk501@york.ac.uk. Social Policy and Social Work, University of York

Qualitative longitudinal research (QLR) has been described as an emerging and innovative methodology particularly adept to explore the complex multifaceted nature of young people’s lives. This approach has been found to be useful within the area of youth studies, with research focusing upon identity construction, youth transitions and critical moments. Exploring the potential of a holistic biographical approach, this paper draws upon the doctoral research of two students within the area of youth studies, which utilise its principles. Drawing on and further developing the Inventing Adulthoods study (Henderson et al 2006), the theses explore the role of ‘critical moments’ through time in defining and impacting upon young people and their life chances. Firstly, an example of research into the experiences of educationally excluded young people will highlight the use and value of this methodology. Secondly, a case history of a young mother from research into experiences of teenage pregnancy and motherhood will be drawn upon to demonstrate the complexity of this issue, especially with regard developments through time and how an individual narrative can unfold. The QLR approach allows diachronic and synchronic analysis, providing time and texture to the research. The value of focusing upon processes rather than simply outcomes can also help inform more receptive policy approaches. Being able to grasp the significance of events, and ascertain the causes and processes through time which lead to change and/or particular outcomes are integral if policy is to correspond to the needs of service users. Such depth and detail is often overlooked within the mainstream which potentially can result in a limited understanding of complex social issues. As the on-going doctoral research will highlight, QLR should be viewed as a distinctive methodological approach that can provide unique and valuable insights into the processes attached to complex social phenomena.

References:

Henderson, S., Holland, J., McGrellis, S., Sharpe, S. and Thomson, R., (2006) Inventing Adulthoods: A Biographical Approach to Youth Transitions, Sage: London