Fundamentación conceptual

Only two articles made specific reference to the importance of relationships in providing care and support (1,4), this is interesting given the recent policy and practice focus on providing person centred care within social work and social care. Larkin et al. (2018) describe the positive impact that good quality personalised relationships can have for minority ethnic individuals with learning disabilities. The researchers identify that service users evaluated the quality of their care primarily on the relationships they had with specific workers, with continuity and reliability seen as crucial to being classified as a good carer. Additionally, it was considered that when good relationships were built, service users were able to make complex context dependent decisions about their ethnic identity.

Similarly, Pound and Greenwood (2016) found that relationships, including communication and rapport were important in supporting stroke patients and their carers, with one participant describing the importance of being able to ‘connect with someone’ (2016:1992). This was seen as a universal requirement for successful care provision, however forming this relationship was described as more complex and time-consuming where there was a language barrier, particularly where the patient had high levels of need.

The researchers use the term ‘humanly sensitive’ care to describe ideal care provision. Based on a framework for humanising care (Todres et al. 2009). Pound and Greenwood suggest that applying the eight-point framework which includes attributes such as togetherness and personal journey to practice can help to ensure high quality care provision even where there are communication difficulties.

3.8 Conclusion

Despite the Department of Health report being published 20 years ago, evidence from the literature review suggests that although efforts have been made to address inequality, there is still substantial evidence of differential experiences based on ethnicity. The steps that have been taken, for example introducing cultural competence training, appear to have focussed on ‘learning about differences’ which has, in turn, created new challenges. Evidence from practitioners, service users and carers all indicate that even when difficulties are shared with the white population, these are exacerbated by issues that are specific to the minority ethnic population, for example language barriers and interpreter requirements. In addition, these specific issues are not felt equally across the whole minority ethnic population, for example second language acquisition is related to both age and gender.

4. Theoretical Perspectives

4.1 Introduction

This chapter describes the theoretical perspectives that underpin this research project. They are presented here in relation to the project to explain why specific methods, explored in the following chapter, are used, and why they are appropriate to the aims of the study.

4.2 Social Construction

I understand identity as a social activity, which can be situated within the theoretical framework of social construction. This is an umbrella term which encompasses explanations of society that come from the perspective that our world is not a fixed, external entity that we as individuals passively experience, but a world where reality is generated and perpetuated by our interactions. Burr (2003:3-5) describes social constructionism as without a single definition but as underpinned by four central tenets;

1. ‘A critical stance towards taken for granted knowledge’; here Burr is calling for readers to think about the divisions and categories we use to make sense of our surroundings. She urges us to challenge the rigidity of these categories to better understand how they have come to exist. For this thesis, the decision to recruit older Pakistani women from a specific geographical area of England uses many socially constructed divisions; age, ethnicity, gender, and class.

2. ‘Historical and cultural specificity’; by recognising that the categories and divisions within and between societies are fluid and unfixed between time, space, and place, we are able to consider what purpose they serve. In relation to this research project, how an older Pakistani woman experiences her life depends greatly on where she lives, her income, the political context alongside many other variables.

3. ‘knowledge is sustained by social processes’; the categorisations that exist are perpetuated by the passing on of constructed ideas between people through their interactions.

4. ‘Knowledge and social action go together’; the way we, as societies understand the world and the categorisations we create within it has an impact on our responses to those who fall within such categories.

It is clear from Burr’s four tenets that social construction is heavily influenced by both interpretivist and critical theorist perspectives on the nature of reality. For the latter, this is underpinned by the acknowledgment of the impact of power. By understanding reality as socially constructed by our own interactions rather than an objective world awaiting discovery, we must also understand the influence that power can have on which divisions and categories are created, and how they are maintained. Burr (2002) refers to such constructed bodies of thought as ‘discourses’, which are created and maintained by those in positions of power, to ensure their position is upheld within a hierarchical society. Goffman (1963) on the other hand focussed more specifically on the creation and maintenance of specific groups as ‘stigmatised’ and explored the impact of such labelling on the behaviours of the group and the individuals within it. Both Burr’s and Goffman’s work is grounded in social constructionist epistemology.

4.3 Social Identity

Once we understand our reality as socially constructed, we can then consider the impact this has on the formation of identity. If the world as we know it, including the divisions and categories we use to group people together is created by our interactions, then this also has consequences for how we understand ourselves, and the behaviours that we, and the people around us, display.

In his 2014 work, Richard Jenkins presents a holistic approach to understanding social identity. Jenkins believes this concept is a more complex and interactional entity than the oppositional binary understandings often presented (internal v’s external, similarity v’s difference, individual v’s group). His analysis starts with the premise that all identity is social, this is a belief shared by Goffman and myself. This understanding opens the wider debate around ‘nature v’s nurture’ however here is not the place to expand on that

argument. The following section will focus on specific elements of social identity, discussing how they relate to the research project, participants, and their situation (more specific analysis of the impact of social identity on the participants can be found in the discussion chapter).