Acerca de las instituciones para niños y adolescentes

In th is research we intended to lis te n to the comments which c lie n ts may have to make, acknowledging the importance of the meaning of encounters fo r them. There is a tendency in s o c ia l psychological research to deny the so cial context and see human problems as in te r n a lly caused.

Seeing problem s, as in te r n a lly caused assumes personal consistency, whereby p rio r s ta te s of the person (c h a ra c te ris tic s or a ttr ib u te s ) could p re d ic t the s itu a tio n a l outcome; or how the c lie n t w i ll behave in . a given, s itu a tio n . Thus explanations are a rriv e d a t by going back to p rio r s ta te s or the c h a ra c te ris tic given and the outcomes p re d ic te d , An a n a ly tic a l a lte r n a tiv e can be found in Thomas' s itu a tio n a l, a n a ly s is whereby behaviour is described in s itu a tio n a l-d e fin itio n a l term s as

CHAPTER 2a .. S tu d ie s o f .underusage

responses to s itu a tio n s as defined by actors w ith in them , (Ashworth

1979). . .The claim is-.made th a t in order to understand s o cia l .conduct,

we must look to th e meanings o f s itu a tio n s as they are: experienced, by -the. a cto rs Located w ith in them. Such an an alysis re s ts on the common sense notion th a t persons behave in accordance w ith th e ir, d e fin itio n of th e s itu a tio n , ie on-the b asis of what they see. is to be/done, can be done and w ill be done by .o th e rs. I t embodies, th e .h o tio n th a t people act on th e basis of th e ir constructio ns of th e w orld; they are a c tiv e in te rp re te rs ; and, s itu a tio n s , which may be co n sisten t o b je c tiv e ly . s p e a k in g ,. are . always problem atic when the s u b je c tiv e

experience of the actor, is considered.

The p ro b lem atic,, v a ria b le n ature of s itu a tio n a l d e fin itio n s .has le d to a p re fe re n c e .fo r more extern al 'o b je c tiv e ' research. The way th a t. constant s itu a tio n s may be v a rio u s ly defined by acto rs s e le c tiv e ly constructin g t h e ir own in te rp re ta tio n s of bo& minimised e m p iric a l in v e s tig a tio n . Also the complete d e s c rip tio n of .a s itu a tio n remains im possible because of the i n f i n i t e number of relevances in r e a l world s itu a tio n s , acto rs b ringing many in te r p r e ta tiv e schemes to b ear. So w h ils t recognising the importance of s u b je c tiv e (q u a lita tiv e ) -approaches .to the. understanding of behaviour, the p ro p e rtie s of such

s itu a tio n s have seemed unamenable to system atic in v e s tig a tio n .

The most .o b je c tiv e methods of research can also be th e le a s t in fo rm a tiv e ; s itu a tio n s are assumed to be e s s e n tia lly s im ila r fo r a l l respondents and they are scored on vario u s dimensions thought to be of relevance.. The ric h e s t and most in fo rm a tiv e methods are th e most s u b je c tiv e and in d iv id u a l, re q u irin g c a re fu l in te rp re ta tio n by the research er. Where one wants to describe and understand relevances fo r

CHAPTER 2: S tu d ie s o f underusage

the under-user, th e re i s a need fo r higher q u a lity r ic h d a ta r e q u irin g .

a p r i m a r ily . qual i t a t i ve, o ri e n ta tio n towards ch o ice. of method-. To . th is

end, i t was necessary, to .adopt a / q u a lita tiv e m e th D d . which.would f a c i l i ta te th e discovery, o f the m eaning.of use of medical f a c i 1i t i e s w ith in th e underusers.own frame of re fe re n c e ,, w ith o u t.p re fig u rin g th e areas of re le v a n c e .to them. S u b jective data was to be the -means of d isco verin g , th e meaning of . use of medical f a c i l i t i e s w ith in th e life w o rl.d o f in d iv id u a ls w ith o u t.b ein g regarded as 's u b je c tiv e ' in the derogatory sense of being closed to s c ie n tific , s c ru tin y or u s ele s sly id io s y n c h ra tic .

In th is research , then, we attem pted to use an open ended approach on a sm all sample of under-users seeking to map out more f u l l y how they make sense, of th e ir experiences.

Ong (1983), in her study of new mothers in Oldham, concludes th a t i f we want to provide services fo r women which respond to th e ir needs and wants instead of c o n tra d ic tin g them, we must s ta r t lis te n in g to and

learn in g from th e ir own accounts. (p a g e .2 7 ff).

This research th en ,.aim s to analyse the i n t e l l i g i b i l i t y and relevance of c u rren t care, p ro visio n from the c lie n t! s point, of view . T h eir views are to be explored in a p o s itiv e re c e p tiv e lig h t as a v alu a b le and ric h source of re le v a n t and p e rtin e n t d ata, n o t. p rim a rily as a d evian t group in any m o ra lis tic judgemental way. This may lim it the g e n e r a lis a b ility of the fin d in g s , but appears to be an e s s e n tia l exp lo ra to ry step in th is f ie ld of research. There is l i t t l e d e s c rip tiv e research in to the h e alth needs of vu ln erab le groups .and a s c a rc ity of d ire c t surveys of c lie n ts ' own perceptions of need. W hilst

CHAPTER 2s S tu d ie s o f underusage

human behaviour c le a r ly can be studied a t a ll le v e ls of com plexity, depending p rim a rily on the aims of th e research, th e aims . of th is study are . co n sisten t w ith the adoption o f a p rim a rily q u a lita tiv e approach.

There are fo u r main aims of the study; the f i r s t being to a rriv e a t , a more d is c rim in a tin g and meaningful d e fin itio n of usage ap p ro p riate to a p a r tic u la r lo c a lit y and note which i f any aspects of provision are

The. second ouVn ia

m o st/least o ften used;A :to monitor the exten t and p a tte rn of uptake, document p re fe rre d sources o f-h e lp and attem pt to id e n tify c lie n t in it ia t e d uptake from p ro fe s s io n a lly in it ia t e d co n tact. (See Chapter 4, page 154). The second aim is to r e la te the c la r if ie d view of uptake to sociodemographic fe a tu re s of th e sample and some lif e s t y le fe a tu re s , to allo w fo r comparison w ith previous research. (See Chapter 4, page 191 ) . The th ird aim is to concentrate on the c lie n t p ersp ective: a) To fin d out what the consumers thought of the p ro visio n they had been o ffe re d , w ith such questions as: what use are c lin ic s and p ro fessio n als to f i r s t tim e mothers, when and fo r what reasons? Are the services regarded as re le v a n t, accessible and u seful? What was th e ir contact w ith the services lik e ? and b) To discover what s o rts of problems a mother has to deal w ith in her own term s, and to what exten t these are acknowledged by services on o ffe r : What do they see as th e ir needs a t th is tim e? The fo u rth aim is to look in d e ta il a t th e un d er-u sers' accounts, th is being th e most neglected area, w ith such questions asi how does h ealth care as provided fig u re in th e ir liv e s ? and how do they see services in

CHAPTER 3t PILOT WORK AND.RESULTANT.. METHODOLOGY...

This . . chapter .o u tlin e s th e major p a rts o f ..the..research*:study ..and .th e methods employed, a t each stage. These ..include th e s e le c tio n of an .ap propriate h e a lth .a u th o rity area in which th e study could, take p la ce ,

and th e procedure employed in id e n tify in g c lie n ts fo r in c lu s io n in the -study; .the com pilation of an ‘instrum ent to d is c rim in a te between users and underusers, of the s e rv ic e s , and an in te rv ie w protocol i or use in c lie n t .in te rvie w s .

In each section, th e .major considerations which were taken in to account in . determ ining choice of methods are o u tlin e d ; these are o ffe re d in

some d e ta il where s u b stan tial re v is io n s in th e lig h t of p ilo t work were, undertaken. This, a p p lie s to the two instrum ents designed fo r use in th e study; the . underusage index, and the in te rv ie w schedule. F in a lly , the procedures adopted fo r analysing in te rv ie w data are o u tlin e d in f u l l .

3.1 ETHICAL COMMENT

Before th e commencement of the study, a number of a d m in is tra tiv e and e th ic a l im p lic a tio n s had to be considered. Approval fo r the in v e s tig a tio n was sought and obtained from senior o ffic e r s of th e Area H ealth A u th o rity and the Chairman of the Local Medical Committee. C o n fid e n tia lity and p reservatio n of the rig h ts of th e in d iv id u a l c lie n t were a prime co n sideration in o b tain in g approval. This can re q u ire a g re a t deal of thought as Young (1979) suggests:

CHAPTER 3 i P ilo t .work and re s u lta n t methodology

" ...p e rs o n a l d e ta ils given in confidence to a

researcher .a n d -th e re a fte r beyond th e p a tie n t's .c o n tr o l, may be a necessary..prerequisite.Jto~conducting research* _ r,tin e .p o s s ib le , safeguard being th a t data should o n ly be

m a d e .a v a ila b le ;in such, a way th a t a p a tie n t cannot be i d e n t i f i e d , . which can.pose serio u s lim ita tio n s on the -re s e a rc h ." .

P rio r to perm ission being granted, the o ffic e r s concerned had to Ibe c e rta in .th at these aspects o f c o n fid e n tia lity were s a tis fa c to ry in the context, of the study. Mothers who were e lig ib le fo r in clu sio n in th e in te rv ie w sample were assigned a number, which was the only means of

id e n tific a tio n used th e re a fte r. H ealth, V is ito rs selected those

mothers who f u l f i l l e d the c r it e r ia fo r in clu sio n in the study, who had c h ild re n born in th e ap p ro p riate months fo r the study. Only then was

th e . researcher allowed access to the c lin ic and other records. The

Area Health. A u th o rity , s e ttin g s chosen and c lie n ts who took p a rt remain anonymous throughout the th e s is to ensure c o n fid e n tia lity and p rivacy are m aintained.