From Clinical Practice to System Change: A Critical Realist Qualitative Study of Social Workers' Perspectives on Borderline Personality Disorder Care Delivery in Ontario
Notice bibliographique
Résumé
This manuscript-based dissertation examines how social workers in Ontario experience and understand providing care to people living with Borderline Personality Disorder (PLBPD), with particular attention to structural barriers and systemic challenges in care delivery. Through 41 in-depth interviews with social workers across diverse practice settings, this research illuminates the complex intersections between individual care experiences, professional practice, and broader systemic factors that shape BPD care provision. The dissertation consists of four manuscripts that progressively build upon each other: The first manuscript details innovative methodological approaches to conducting qualitative research during the COVID-19 pandemic, highlighting the opportunities and challenges of remote data collection. The second manuscript demonstrates the application of Critical Realism (CR) methodology in social work research, providing a detailed framework for examining complex social phenomena. The third manuscript analyzes how provider-based stigma and interprofessional dynamics impact care delivery for PLBPD, revealing both individual and structural barriers to effective care. The fourth manuscript examines structural barriers within Ontario's healthcare system, identifying how system fragmentation, resource constraints, and social determinants of health create compounding challenges in BPD care delivery. Key findings reveal that while social workers recognize BPD as a complex diagnosis requiring comprehensive support, they face significant challenges in providing effective care due to limited resources, inadequate training, and systemic barriers. The research identifies four interconnected themes across the manuscripts: (1) the impact of healthcare system fragmentation on care coordination; (2) the persistence of provider-based stigma despite increasing awareness; (3) the intersection of social determinants of health with care access; and (4) the need for collaborative, integrated approaches to care delivery. This dissertation makes several significant contributions to the field. Methodologically, it provides a detailed example of applying critical realist analysis to complex healthcare phenomena. Empirically, it offers new insights into how structural mechanisms shape both individual care experiences and systemic outcomes in BPD care delivery. Practically, it identifies specific opportunities for healthcare system reform while highlighting the crucial role of social workers in addressing both immediate care needs and broader systemic barriers. Findings indicate that addressing BPD care requires moving beyond individual clinical interventions toward coordinated system-level responses, including integrated care pathways, anti-stigma initiatives at institutional levels, and enhanced workforce development. Keywords: Borderline Personality Disorder, healthcare systems, structural stigma, social work, critical realism, qualitative research
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,007 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,001 |
| Méta-épidémiologie (sens large) | 0,002 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,000 | 0,001 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; les deux têtes enseignantes s’accordent sur ce qui est montré ici.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».