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南亚社区痴呆症患者服务中合作的障碍。

Barriers to partnership working within dementia services for people from south Asian communities.

作者信息

Cheston R, Dodd E, Smith P, Woodstoke N S, Jutlla K, Fry G, Truswell D, Butt J, Parveen S

机构信息

School of Social Sciences, University of the West of England, UK.

School of Health and Social Wellbeing, University of the West of England, UK.

出版信息

Dementia (London). 2025 May;24(4):611-630. doi: 10.1177/14713012241283189. Epub 2024 Sep 14.

Abstract

People from South Asian communities are under-represented at all levels of dementia services. Consequently, there is pressure for the statutory sector to deliver services in partnership with Voluntary, Community, Faith and Social Enterprises (VCFSEs). This study set out to explore the constraints to effective partnership working which prevent dementia care from being delivered in an equitable way. Data collection consisted of two phases. First, we interviewed seven people with experience of partnership working and developed three fictional vignettes that were representative of the challenges they faced. We then used these vignettes to stimulate discussion in focus groups and interviews with 13 VCFSE and 16 statutory sector participants. Data was analysed using deductive thematic analysis. Three themes were developed during the analysis. First, White British-centric services focused on the challenges for statutory services in meeting the needs of South Asians, developing flexible, responsive services and making inclusive partnership working truly meaningful. Second, VCFSE participants (but not statutory service participants) associated a failure to deliver effective partnership working with unconscious bias operating within systems, leading to the devaluing of their expertise and to their views being ignored. Finally, participants emphasised the need to prioritise relationships if they were to meet the challenges of developing partnership working. We identified three constraints acting to prevent effective partnership working. First, the different meanings that statutory and VCFSE participants attach to challenges threatens their ability to develop a shared understanding of the needs of communities. Second, a reluctance to explicitly address service deficiencies can mean that stereotypes remain unaddressed. Finally, while both parties lacked power to change the fundamentals of service delivery, power and resources were also unbalanced with VCSFE services being more reliant on the statutory sector.

摘要

在痴呆症服务的各个层面,南亚社区的人群代表性不足。因此,法定部门面临着与志愿、社区、宗教和社会企业(VCFSEs)合作提供服务的压力。本研究旨在探讨阻碍有效合作的制约因素,这些因素妨碍了以公平的方式提供痴呆症护理。数据收集包括两个阶段。首先,我们采访了七位有合作经验的人,并编写了三个虚构的案例,这些案例代表了他们所面临的挑战。然后,我们利用这些案例在焦点小组以及对13名VCFSE和16名法定部门参与者的访谈中激发讨论。使用演绎主题分析法对数据进行了分析。分析过程中形成了三个主题。首先,以英国白人为主的服务关注法定服务在满足南亚人需求、发展灵活且响应迅速的服务以及使包容性合作真正有意义方面所面临的挑战。其次,VCFSE参与者(而非法定服务参与者)将未能实现有效的合作与系统中存在的无意识偏见联系起来,这导致他们的专业知识被贬低,观点被忽视。最后,参与者强调,如果要应对发展合作所面临的挑战,就需要优先考虑关系。我们确定了阻碍有效合作的三个制约因素。首先,法定和VCFSE参与者对挑战的不同理解威胁到他们对社区需求形成共同理解的能力。其次,不愿明确解决服务缺陷可能意味着刻板印象得不到解决。最后,虽然双方都没有权力改变服务提供的基本状况,但权力和资源也不均衡,VCFSE服务更依赖法定部门。

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