1. Informal End-of-Life Care- Giving and Barriers to Rural Womens Health Michele McIntosh RN PhD Allison Williams PhD Wendy Duggleby PhD Beverley Liepert PhD

2. Background Care-giving makes women sick Care-giving affects physical, emotional, spiritual health Care-giving is influenced by and influences the social determinants of health e.g. sex, gender, income and place The World Health Organization (1984) defines health as a resource for living, not just the absence of disease. Women who provide informal end-of-life care at home in rural Canada lack or lose this resource Descriptive studies document the health sequelae of care-giving Gap in theorizing the processes involved in this erosion of health

3. Good Public Policy What is best evidence? RCTs have been considered gold standard Evidence from these are not easily translated into different contexts Complex human phenomenon require multiple methodologies to capture context, meaning as well as measurement Ethical public policy ought be informed by best knowledge

4. Purpose: To better understand the impact of EOL care-giving on rurual womens health 1) To construct processes, sensitizing concepts, situational analytics and theorize about caregivers' loss of health. 2) To identify the elements involved and the relationships among these that undermine womens health 3) To utilize an innovative research designSituational Analysis in order to accomplish the above

5. Data Collection Interviews with women who have provided informal end-of-life care to someone who has died though not necessarily at home Two telephone interviews: in-depth and semi-structured Sample size 15 Discourse

6. Recruitment Rural communities within Ontario RIO <60 Rural Index of Ontario i.e. proximity to general and specialist medical referral centres and population under 10,000 Direct recruitment and snowball recruitment from Family Health Teams and agencies e.g. CCACs

7. Situational Analysis Situational Maps: human, non-human, discursive, and material elements in the research situation of concern and provoke analysis of relations among them Social worlds/arenas maps lay out the collective actors and their arenas of commitment, framing meso-level interpretations of the situation Positional maps examine the major positions taken (and not taken) in the discourse

8. Messy Map: All elements (Clarke, 2005, p. 271)

9. Ordered Map (Clarke, p. 272)

10. Social Worlds Map (Clarke, p 278)

11. Position Map (Clarke, p. 285)

12. Individual human actors Collective human actors Discursive Constructions Political & Economic Elements Nonhuman Actants Socio-cultural/Symbolic Spatial & Temporal Elements Situational Analysis: Informal EOL Care-giving & Barriers to Health

13. Timeline May 2010: Recruitment, Initial Interviews, Analysis JuneSeptember 2010: Ongoing recruitment, Initial and Follow-up Interviews and Analysis October 2010: Results Policy Implications: 1) To implement strategies to target those processes that undermine womens health 2) ethical policy based on best knowledge of this complex human phenomenon

15. References Clarke, Adele E. (2005). Situational analysis: Grounded theory after the postmodern turn. Thousand Oaks: Sage.