User perspective on palliative care services: experiences of middle-aged partners bereaved through cancer known to social work services in Northern Ireland

This qualitative research study explores experiences of partners bereaved through cancer, who were resident in an urban area of Northern Ireland and who had been service users of the social work services. Data were collected in 2004 from 10 individuals who participated in semi-structured interviews. Emergent themes were identified using thematic content analysis and findings analysed under four categories: cancer journey; impact of bereavement; process of adjustment and change; and experience of support services. Opportunities to facilitate communication were not always maximised, often resulting in poor bereavement outcomes. Although hospices undertook bereavement risk assessment, participants were unaware of its use and queried its accuracy without service user involvement. The most cited informal support was family and friends, although such help was time-limited. Service user feedback regarding social workers was generally positive; however, there was a lack of knowledge about their role in palliative care. Post-bereavement adjustment was influenced by the quality of social networks, the responsibilities of lone parenthood, and challenges to life values and core beliefs. A framework for palliative care social work has been recommended based on research findings.

Recovering Social Networks from Individual Attributes

One of the most important challenges of network analysis remains the scarcity of reliable information on existing connection structures. This work explores theoretical and empirical methods of inferring directed networks from nodes attributes and from functions of these attributes that are computed for connected nodes. We discuss the conditions, under which an underlying connection structure can be (probabilistically) recovered, and propose a Bayesian recovery algorithm. In an empirical application, we test the algorithm on the data from the European School Survey Project on Alcohol and Other Drugs.

The social consequences of broken urban structures: a case study of Belfast

This article explores how the design and layout of the urban environment can have significant social impacts on working class communities whose access to employment and other necessary services depends largely on public transport and safe walk-able streets. It does so by considering a case study of Belfast. Although Belfast has a distinctive recent history as the site of political violence and territorial division, it also has a spatial configuration that emerged out of a modernising roads and redevelopment programme in the 1960s and 1970s. However, an understanding of contemporary Belfast, particularly its urban structure and form, requires n analysis of how the social impacts of such ubiquitous regional and urban planning practices were not addressed. The article argues that a culture of ‘politically safe’ bureaucratic inaction developed during the ‘war years’ has been sustained in the ‘new democracy’. In turn, this has had significant consequences for the functioning of the city. Major areas of derelict land around the city core together with the impediments created by regional road infrastructure have combined to create a doughnut city that, on the one hand, facilitates a commuting middle class, while on the other, discriminates against the poorest inner city communities. The article goes on to examine how an activist urban design group, known as the Forum for Alternative Belfast, has responded to these challenges. It focuses particularly on action-research undertaken during its 2010 Summer School which aimed to address issues of disconnection in inner North Belfast that affect some of the most territorialised and deprived communities in the city.

Narratives of Spatial Division: The Role of Social Memory in Shaping Urban Space in Belfast

The paper examines the role of shared spaces in divided cities in promoting future sustainable communities and spaces described as inclusive to all. It addresses the current challenges that prevent such inclusiveness and suggests future trends of its development to be of benefit to the wider city community. It explains how spaces in divided cities are carved up into perceived ownerships and territorialized areas, which increases tension on the shared space between territories; the control of which can often lead to inter-community disputes. The paper reports that common shared space in-between conflicting communities takes on increased importance since the nature of the conflict places emphasis on communities’ confidence, politically and socially, while also highlighting the necessity for confidence in inclusion and feeling secure in the public domain. In order to achieve sustainable environments, strategies to promote shared spaces require further focus on the significance of everyday dynamics as essential aspects for future integration and conflict resolution.

Identity and Link Reliability in Social Networks

This paper considers a non-cooperative network formation game where identity is introduced as a single dimension to capture the characteristics of a player in the network. Players access to the benefits from the link through direct and indirect connections. We consider cases where cost of link formation paid by the initiator. Each player is allowed to choose their commitment level to their identities. The cost of link formation decreases as the players forming the link share the same identity and higher commitment levels. We then introduce link imperfections to the model. We characterize the Nash networks and we find that the set of Nash networks are either singletons with no links formed or separated blocks or components with mixed blocks or connected.

Comparing the experiences of rural and urban family caregivers of the terminally ill

Introduction: There are many challenges in delivering rural health services; this is particularly true for the delivery of palliative care. Previous work has identified consistent themes around end-of-life care, including caregiver burden in providing care, the importance of informal care networks and barriers imposed by geography. Despite these well-known barriers, few studies have explored the experience of palliative care in rural settings. The purpose of the present study was to compare the experiences of rural family caregivers actively providing end-of-life care to the experiences of their urban counterparts. Methods: Caregivers' perceived health status, the experience of burden in caregiving, assessment of social supports and the pattern of formal care used by the terminally ill were explored using a consistent and standardized measurement approach. A cross-sectional survey study was conducted with 100 informal caregivers (44 rural, 56 urban) actively providing care to a terminally ill patient recruited from a publicly funded community agency located in northeastern Ontario, Canada. The telephone-based survey included questions assessing: (i) caregiver perceived burden (14-item instrument based on the Caregiver's Burden Scale in End-of-Life Care [CBS-EOLC]); (ii) perceived social support (modified version of the Multidimensional Scale of Perceived Social Support [MSPSS] consisting of 12 items); and (iii) functional status of the care recipient (assessed using the Eastern Collaborative Oncology Group performance scale). Results: Rural and urban caregivers were providing care to recipients with similar functional status; the majority of care recipients were either capable of all self-care or experiencing some limitation in self-care. No group differences were observed for caregiver perceived burden: both rural and urban caregivers reported low levels of burden (CBS-EOLC score of 26.5 [SD=8.1] and 25.0 [SD=9.2], respectively; p=0.41). Urban and rural caregivers also reported similarly high levels of social support (mean MSPSS total score of 4.3 [SD=0.7] and 4.1 [SD=0.8], respectively; p=0.40). Although caregivers across both settings reported using a comparable number of services (rural 4.8 [SD=1.9] vs urban 4.5 [SD=1.8]; p=0.39), the types of services used differed. Rural caregivers reported greater use of family physicians (65.1% vs 40.7%; p=0.02), emergency room visits (31.8% vs 13.0%; p=0.02) and pharmacy services (95.3% vs 70.4%; p=0.002), while urban caregivers reported greater use of caregiver respite services (29.6% vs 11.6%; p=0.03). Conclusion: Through the use of standardized tools, this study explored the experiences of rural informal family caregivers providing palliative care in contrast to the experiences of their urban counterparts. The results of the present study suggest that while there are commonalities to the caregiving experience regardless of setting, key differences also exist. Thus, location is a factor to be considered when implementing palliative care programs and services. © K Brazil, S Kaasalainen, A Williams, C Rodriguez, 2013.

"Hidden" Social Networks in Behavior Change Interventions

We investigated whether “hidden” (or unobserved) social networks were evident in a 2011 physical activity behavior change intervention in Belfast, Northern Ireland. Results showed evidence of unobserved social networks in the intervention and illustrated how the network evolved over short periods and affected behavior. Behavior change interventions should account for the interaction among participants (i.e., social networks) and how such interactions affect intervention outcome.