Skinner, Mark W

Aligning health services with aging populations is the fundamental issue of modern Canadian health policy, yet rural older populations still experience compromised patient safety and poor-quality care as they transfer between care settings. As such, contemporary scholars acknowledge that more contextually sensitive studies are needed to better understand the unique health and care experiences of this vulnerable population across the care continuum. Informed by inquiry in critical gerontology, health services and human geography, my dissertation attends to this gap in research by revealing the interplay between older adult health construction and the influence of multidimensional contexts on rural older adult transitions in care. Using a community-based approach, I conduct a case study on Haliburton County that encompasses three phases (e.g., a rural community inventory, go-alongs and semi-structured interviews) and focuses on two types of transitions in care (when an older adult is transferred from a hospital to a long-term care home and when an older adult is transferred from a hospital to a home in the community). In total, 19 patients, 24 informal supports, 51 front-line staff and five administrators/managers participated in my dissertation, resulting in 99 total participants being included in 19 go-alongs and 85 semi-structured interviews. My results indicate that multi-leveled facets of the rural care context continually attend to and hinder rural older adult health during transitions in care. In particular, sectored divisions, urban centrism, biomedicine and ageism inhibit rural care providers from leveraging their strengths to attend to the heterogeneity of rural older adult health and the nuances of rural care contexts. I then argue the need for macro health systems reform to embrace the relationality of rural older adult transitions in care and to capitalize on the strengths inherent in rural communities. To foster knowledge mobilization of my findings, I provide a foundation of information and recommendations for the community partners (Haliburton Highlands Health Services and Seniors Care Network) as well as questions to inform research, policy and practice. Establishing the first study of rural older adult transitions in care where a researcher accompanies older adults and their informal supports across care settings, my dissertation will help prepare Canada for the impact of the aging population and transform transitional care provision to meet the needs of all Canadians in the 21st century.

Author Keywords: Canada, Geriatric Care, Health Care, Older Adult Health, Rural Health Care, Transitions in care

This dissertation explored how rural communities enhance the capacity of youth to both navigate and negotiate healthy identities and well-being in the context of social ecological resilience. Resilience refers to the capacity for individuals to have good outcomes in spite of exposure to significant adversity. Rural communities are often identified as places of deficit both in scholarly literature and in general social discourse which can constitute adversity. Given the importance of place as a social determinant of health, rural communities can have a notable impact on the positive development of adolescent identity and well-being of the youth that reside within them.

Drawing on the concept of social ecological resilience which draws attention to the importance of environments and relationships to support development, this project engaged with high school aged adolescents (14 to 18 years old) from Haliburton County in Central Ontario. Leveraging mixed model methods, the project featured both quantitative and qualitative approaches. There were 63 participants (33 male, 28 female and 2 non-binary) for the quantitative phase of the research which made use of the Child and Youth Resilience Measure survey instrument. The second phase of the research was qualitative and featured 14 participants who engaged in six focus groups. The focus groups provided context specific awareness of place-based factors which participants found supportive in their development.

The results indicated that while the overall resilience scores for the community were lower than the national average (t(62) = 3.20, p <0.01), some study participants found the community to be resilience bolstering. Specifically, participants recognized the importance of supportive people, an awareness of an enriched sense of community, and a powerful sense of the value of nature and the outdoors to be the most significant aspects for the development of their resilience.

The results indicate that rural youth are not naïve to the complexity of their circumstances but are able to use their rural contexts to develop the capacity to negotiate and navigate towards healthy identities and well-being.

Author Keywords: Adolescent, Place-based, Resilience, Rural, Social Ecological, Youth