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How Does Organisational Literacy Impact Access to Health Care for Homeless Individuals?

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Abstract

This article describes a study that examined the experiences of 27 individuals who frequented an Open Access homeless shelter in Toronto, Canada. The overarching aim of this study was to map the social organisation of health care in Toronto, with particular regards to the ways in which literacy, or the lack of literacy, mediates the experiences of homeless individuals attempting to gain access to health care. While terms such as “literate” or “illiterate” might be seen to reflect an individual’s level of acquired education or competence, critical social theorists argue that such terms instead more accurately reflect an individual’s relative class or position within the social hierarchy. Individuals who possess literacy are able to read into texts for their implicit understandings, directives, and power structures. Furthermore, they are able to translate and decode texts as potential pretexts for coordination or control. This study draws on a Freirean critical standpoint, which acknowledges that knowledge and power are inextricably interconnected. This study asked: How does literacy, or the lack of literacy, facilitate or impede access to health care for homeless individuals? What are the social consequences of illiteracy?

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Notes

  1. Pseudonyms are employed throughout this article.

  2. Nominalisation is an effective semantic device that occurs frequently in institutional literature. For example: “He decided to change the system for individuals” employs the verb “decided” and references the perpetrator “he.” In nominalised format, the verb “decided” is reframed as a noun: “A decision was made yesterday to change the system for individuals.” Nominalisation removes human actors or “doers” from the intent of the text, thereby enabling institutions to remove active perpetrators or potentially culpable individuals from any perceived responsibility for institutional policies or outcomes proposed in the text. Smith [27] explains that while tasks and duties appear to be both planned and accomplished, the agent (or person responsible) has been purposefully deleted (p. 111). Textual analysis and mapping involves unpacking and dissecting textually based, semantic mechanisms employed by institutions.

  3. The Canadian health care system is delivered through a universal or publically funded health care system, which is available to all legal residents of Canada (including non-citizen, permanent residents). In Canada, health care that is administered by a physician is fully covered and necessitates no co-payment fees.

  4. Ontario Works is a province-wide social assistance program, which was previously referred to as “welfare”.

References

  1. Hughes, N. R. (2014). Are institutional health policies exclusionary? Journal of Qualitative Health Research, 24(3), 366–374.

  2. Bostock, S., & Steptoe, A. (2012). Association between low functional health literacy and mortality in older adults: Longitudinal cohort study. BMJ, 344, e1602.

  3. Campbell, M., & Gregor, F. (2002). Mapping social relations: A primer in doing institutional ethnography. Aurora, Ontario: Garamond Press.

    Google Scholar 

  4. Canadian Council on Learning (2007). Health literacy in Canada report. Ontario: Canadian Council on Learning. Retrieved from http://www.ccl-cca.ca/ccl/Reports/HealthLiteracy.htm.

  5. Darville, R. (1995). Literacy, experience, power. In M. Campbell & A. Manicom (Eds.), Knowledge, experience, and ruling relations: Studies in the social organization of knowledge. Toronto, Ontario: University of Toronto Press.

    Google Scholar 

  6. Denzin, N. (1978). The research act. Chicago: Aldine.

    Google Scholar 

  7. DeVault, M., & McCoy, L. (2006). Institutional ethnography: Using interviews to investigate ruling relations. In D. Smith (Ed.), Institutional ethnography as practice. Lanham: AltaMira Press, Rowman & Littlefield.

    Google Scholar 

  8. Foucault, M. (1972). The archaeology of knowledge and the discourse on language. New York, NY: Pantheon.

    Google Scholar 

  9. Foucault, M. (1991). Discipline and punish: The birth of a prison. London, England: Penguin.

    Google Scholar 

  10. Foucault, M. (1998). The history of sexuality: The will to knowledge. London, England: Penguin.

    Google Scholar 

  11. Freebody, P., & Luke, A. (2003). Literacy as engaging with new forms of life: The four roles model. In G. Bull & M. Anstey (Eds.), The literacy lexicon. Pearson Education: Australia.

    Google Scholar 

  12. Freire, P. (1970). Pedagogy of the oppressed. New York: Herder and Herder.

    Google Scholar 

  13. Garfinkel, H. (1976). Studies in ethnomethodology. Malden, MA: Polity Press/Blackwell.

    Google Scholar 

  14. Gee, J. P. (1992). The social mind: Language, ideology, and social practice. New York: Bergin & Garvey.

    Google Scholar 

  15. Geertz, C. (1977). The interpretation of cultures. New York, NY: Basic Books.

    Google Scholar 

  16. Giroux, H. (1987). Literacy and the pedagogy of political empowerment. In P. Freire & D. Macedo (Eds.), Literacy: Reading the word and the world. London, England: Routledge.

    Google Scholar 

  17. Giroux, H. (1989). Schooling for democracy: Critical pedagogy in the modern age. London, England: Routledge.

    Google Scholar 

  18. Lévi-Strauss, C. (1973). Tristes tropiques. New York, NY: Penguin.

    Google Scholar 

  19. Marx, K., & Engels, F. (1970). The German ideology. New York: International Publishers. (Original work published 1932).

  20. Ng, R., & Mirchandani, K. (2008). Linking global trends and local lives: Mapping the methodological dilemmas. In K. Gallagher (Ed.), The methodological dilemma: Creative, critical and collaborative approaches to qualitative research. Milton Park, UK.: Routledge.

    Google Scholar 

  21. Nielsen-Bohlman, L., Panzer, A., & Kindig, D. (2004). Committee on Health Literacy. Health literacy: A prescription to end confusion. The Institute of Medicine.

  22. Pamuk, E., Makuc, D., Heck, K., Reuben, C., & Lochner, K. (1998). Socioeconomic status and health chartbook. Hyattsville, ML: National Center for Health Statistics.

    Google Scholar 

  23. Perrin, B. (1989). Literacy and health project. Making the world healthier and safer for people who can”t read. Toronto, Ontario, Canada: Ontario Public Health Association. Retrieved from http://www.opha.on.ca/resources/docs/literacy1research.pdf.

  24. Pleasant, A. & Kuruvilla, S. (2008). A tale of two health literacies? Public health and clinical approaches to health literacy. Health Promotion International.

  25. Rudd, R. (2001). Canadian Public Health Association. National Literacy and Health Program. The captain”s log: First Canadian conference on literacy and health: Charting the course for literacy and health in the new millennium. Ottawa, Ontario, Canada: Canadian Public Health Association.

  26. Rudd, R., Colton, T., & Schacht, R. (2000, January). An overview of medical and public health literature addressing literacy issues: An annotated bibliography (NCSALL Report #14). Cambridge, MA: National Center for the Study of Adult Learning and Literacy.

  27. Smith, D. (2005). Institutional ethnography: A sociology for people. Lanham: AltaMira Press, Rowman & Littlefield.

    Google Scholar 

  28. Smith, D. (Ed.) (2006). Institutional ethnography as practice. Lanham: AltaMira Press, Rowman & Littlefield.

  29. Smith, G., Mykhalovskiy, E., & Weatherbee, D. (2006). Getting “Hooked Up”: An Organizational Study of the Problems People with HIV/AIDS Have Accessing Social Services. In D. Smith (Ed.), Institutional ethnography as practice. Lanham, MD: AltaMira Press, Rowman & Littlefield.

    Google Scholar 

  30. Snow, C. (1991). The theoretical basis for relationships between language and literacy in development. Journal of Research in Childhood Education, 6(1), 10.

    Article  Google Scholar 

  31. Street, B. (1984). Literacy in theory and practice. Cambridge, England: Cambridge University Press.

    Google Scholar 

  32. Turner, S. (2006). Mapping institutions as work and texts. In D. Smith (Ed.), Institutional ethnography as practice. Lanham: AltaMira Press, Rowman & Littlefield.

    Google Scholar 

  33. Weiss, B., Hart, G., McGee, D., & D'Estelle, S. (1992). Health status of illiterate adults: Relation between literacy and health status among persons with low literacy skills. Journal of the American Board of Family Practice, 5(2), 57–64.

    Google Scholar 

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  1. OISE, University of Toronto, 252 Bloor St. W., Toronto, ON, M5S 1V6, Canada

    Naomi Rebecca Hughes

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  1. Naomi Rebecca Hughes
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Correspondence to Naomi Rebecca Hughes.

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Hughes, N.R. How Does Organisational Literacy Impact Access to Health Care for Homeless Individuals?. Health Care Anal 25, 90–106 (2017). https://doi.org/10.1007/s10728-014-0283-6

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  • DOI: https://doi.org/10.1007/s10728-014-0283-6

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