| Popis: |
This critical reading aims to evaluate the extent to which evidence-based practice meets the intervention and care provision needs of minority patient groups. Among problem drug and alcohol users, certain sub-populations such as ethnic minorities, women, extreme age groups and those with complex problems present particular challenges for identification of needs and appropriate service provision. People from ethnic minorities are under-represented among substance use treatment populations, and young males are identified as presenting high suicide risk and either experiencing, or at risk of experiencing, social exclusion and criminality, but at the same time have greater difficulties accessing treatment pathways. There is also an increasing clinical concern about young, aged and female substance misusers, and recognition that there is limited knowledge about their particular service access and intervention needs. Current practices and policies for substance misuse services, however, may often be based on medically dominated evidence established from the majority patient population, leading to provision targeted at the needs of, often, white, middle-aged men who have the easiest access to services. The methodological approach of this thesis is a critical reading of existing research underpinning current evidence-based practice, with an analysis of how, and in what ways, quantitative methodological approaches favoured in medicine fail to recognise and accommodate the needs and presentations of minority sub-groups. In this way, the analysis focuses on the manifest and latent limitations of each quantitative approach, identifying and exploring evidence regarding sub-populations for whom the findings, and therefore the evidence-based practice, may not apply. The investigator's own studies will be included in the critical reading and alternative methodologies will also be examined. It is argued that, in addition to acute and chronic illness, lifestyle health problems such as substance misuse represent a third category of health concern by being subject to contextual influence and behaviour change. It is therefore less suited to a disease model approach to evidence for practice and demands evidence based on behavioural and psychological change processes rather than treatment outcomes. |
