- freely available
Dent. J. 2019, 7(1), 11; https://doi.org/10.3390/dj7010011
2. Materials and Methods
2.1. Theoretical Underpinning of the Pedagogical Workshop Program
2.3.1. Research Context
2.3.2. Gathering the Participants: The Sample
2.3.3. Pedagogical Workshop Program: Phases of Development
2.4. Pedagogical Workshop Program Structure and Timing
2.5. Workshop Structure
2.6. Qualitative Data and Analysis
2.7. Ethical Considerations
Demographic Profile of the Participants
Conflicts of Interest
- BBC. Sofa Surfers: The Young Hidden Homeless. Available online: http://www.bbc.co.uk/news/uk42427398?intlink_from_url=http://www.bbc.co.uk/news/topics/c48yr9322xrt/homelessness&link_location=live-reporting-story (accessed on 22 December 2017).
- Scottish Government. Homelessness in Scotland: 2015–2016; Scottish Government: Edinburgh, UK, 2016.
- Scottish Government. Homelessness: Minister’s Statement. Available online: https://beta.gov.scot/publications/ministerial-statement-on-homelessness-september-2017/ (accessed on 20 September 2017).
- Scottish Government. A Nation with Ambition: The Government’s Programme for Scotland 2017–2018. Available online: https://beta.gov.scot/publications/nation-ambition-governments-programme-scotland-2017-18/ (accessed on 20 September 2017).
- Scottish Government. Policy: Homelessness. Available online: https://beta.gov.scot/policies/homelessness/ (accessed on 20 September 2017).
- Scottish Government. Public Bodies (Joint Working) (Scotland) Act 2014. Available online: http://www.legislation.gov.uk/asp/2014/9/pdfs/asp_20140009_en.pdf (accessed on 10 May 2017).
- Fitzpatrick, S.; Pawson, H.; Bramley, G.; Wilcox, S.; Watts, B. The Homelessness Monitor: England 2017; Crisis: London, UK, 2017. [Google Scholar]
- Harleigh-Bell, N. Youth Homelessness in Scotland 2015; Homeless Action Scotland: Edinburgh, UK, 2016. [Google Scholar]
- MacInnes, T.; Tinson, A.; Hughes, C.; Born, T.B.; Aldridge, H. Monitoring Poverty and Social Exclusion 2015. Available online: https://www.jrf.org.uk/mpse-2015 (accessed on 17 April 2017).
- Homelessness Task Force. Helping Homeless People: Legislative Proposals on Homelessness; Scottish Executive: Edinburgh, UK, 2000.
- Homelessness Task Force. Helping Homeless People: An Action Plan for Prevention and Effective Response; Scottish Executive: Edinburgh, UK, 2002.
- Scottish Executive. Health and Homelessness Guidance. Available online: www.scotland.gov.uk/library3/health/hahg-00.asp (accessed on 17 April 2017).
- Health Scotland. Delivering Health Care to Homeless People: An Effectiveness Review (Research in Brief, 13); NHS Health Scotland: Edinburgh, UK, 2004. [Google Scholar]
- Scottish Executive. Health and Homelessness Standards; Scottish Executive: Edinburgh, UK, 2005.
- Sheiham, A.; Watt, R.G. The Common Risk Factor Approach: A rational basis for promoting oral health. Community Dent. Oral Epidemiol. 2000, 28, 399–406. [Google Scholar] [CrossRef] [PubMed]
- Coles, E.; Themessl-Huber, M.; Freeman, R. Investigating community-based health and health promotion for homeless people: A mixed methods review. Health Educ. Res. 2012, 27, 624–644. [Google Scholar] [CrossRef] [PubMed]
- Coles, E.; Freeman, R. Exploring the oral health experiences of homeless people: A deconstruction–reconstruction formulation. Community Dent Oral Epidemiol. 2016, 44, 53–63. [Google Scholar] [CrossRef] [PubMed]
- Hudson, B.F.; Flemming, K.; Shulman, C.; Candy, B. Challenges to access and provision of palliative care for people who are homeless: A systematic review of qualitative research. BMC Palliat. Care 2016, 15, 96. [Google Scholar] [CrossRef] [PubMed]
- Galea, N.K.; Kenyonb, S.; MacArthur, C.; Jolly, K.; Hope, L. Synthetic social support: Theorizing lay health worker interventions. Soc. Sci. Med. 2018, 196, 96–105. [Google Scholar] [CrossRef] [PubMed]
- Wolf, M.S.; Wilson, E.A.; Rapp, D.N.; Waite, K.R.; Bocchini, M.V.; Davis, T.C.; Rudd, R.E. Literacy and learning in health care. Pediatrics 2009, 124 (Suppl. 3), S275–S281. [Google Scholar] [CrossRef] [PubMed]
- Freeman, R. Storytelling, sugar snacking, and toothbrushing rules: A proposed theoretical and developmental perspective on children’s health and oral health literacy. Int. J. Pediatr. Dent. 2015, 25, 339–348. [Google Scholar] [CrossRef] [PubMed]
- Freire, P. Education for Critical Consciousness; Bloomsbury Revelation Series: London, UK, 1974. [Google Scholar]
- Freire, P. Pedagogia do Oprimido, 19th ed.; Paz e Terra: Rio de Janeiro, Brazil, 1991. [Google Scholar]
- Candau, V.; Sacavino, S. Educar em Direitos Humanos: Construir Democracia; DP&A: Rio de Janeiro, Brazil, 2000. [Google Scholar]
- Rodriguez, A. Labyrinth of Trafficking: Lives, Practices and Interventions; 7 Letras Publisher: Rio de Janeiro, Brazil, 2013. [Google Scholar]
- Fernandes, F.L.; Rodriguez, A. The “lost generation” and the challenges in working with marginalized groups. Learnt lessons from Brazilian Favelas. Radic. Community Work J. 2015. Available online: http://www.rcwjournal.org/ojs/index.php/radcw/article/view/5 (accessed on 22 May 2018).
- Labonte, R.; Laverack, G. Capacity building in health promotion, part 1: For whom? and for what purpose? Crit. Public Health 2001, 11, 111–127. [Google Scholar] [CrossRef]
- Kidd, S.; Kral, M. Practicing participatory action research. J. Couns. Psychol. 2005, 52, 187–195. [Google Scholar] [CrossRef]
- Rock Trust. Available online: http://www.rocktrust.org/about/ (accessed on 17 April 2016).
- Marconi, M.A.; Lakatos, E.M. Research Techniques: Planning and Execution of Research, Sampling and Research Techniques, Elaboration, Analysis and Interpretation of Data; Atlas: São Paulo, Brazil, 2006. (In Portuguese) [Google Scholar]
- Miles, M.B.; Huberman, I.; Saldana, J. Qualitative Data Analysis: A Methods Sourcebook, 3rd ed.; Sage Publications Ltd.: London, UK, 2014. [Google Scholar]
- Islam, M.K.; Merlo, J.; Kawachi, I.; Lindström, M.; Gerdtham, U.G. Social capital and health: Does egalitarianism matter? A literature review. Int. J. Equity Health 2006, 5, 3. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Giroux, H. Paulo Freire and the courage to be political. In Reinventing Paulo Freire: A Pedagogy of Love; Darder, A., Ed.; Routledge: New York, NY, USA, 2017. [Google Scholar]
- Coles, E.; Chan, K.; Collins, J.; Humphris, G.M.; Richards, D.; Williams, B.; Freeman, R. Decayed and missing teeth and oral-health-related factors: Predicting depression in homeless people. J. Psychosom. Res. 2011, 71, 108–112. [Google Scholar] [CrossRef] [PubMed]
- Bell, S.L.; Foley, R.; Houghton, F.; Maddrell, A.; Williams, A.M. From therapeutic landscapes to healthy spaces, places and practices: A scoping review. Soc. Sci. Med. 2018, 196, 123–130. [Google Scholar] [CrossRef] [PubMed][Green Version]
|Phase 1||The selection of a key NGO supporting youth homeless in Scotland through a preliminary mapping of homelessness services and organizations.|
A series of meetings between the PI with staff members of the NGO and with youth homeless living in temporary accommodations.
Identification of the main topics to be covered through the workshops as agreed by all participants.
Co-design and delivery of the workshops.
|An initial package of four workshops planned as requested by staff members and the young people, delivered and evaluated. Topics: [i] Oral health, [ii] Mental health, [iii] Education & the future, [iv] Stigma|
Planning of the workshops involved a multidisciplinary collaboration between the PI with one NHS Board and one NGO to provide expert knowledge on the evidence-base and current guidance on oral health and mental health.
Evaluation by direct observation on participants’ feedback and group discussion during the workshops, and post-workshop questionnaires.
|Phase 2||Following the same participative approach, the feedback received following Phase 1 was positive, and the young people requested further workshops. |
Meetings with young people were convened to discuss openly and using critical consciousness, to identify the additional workshop topics regarding the workshop package 2.
Co-design and delivery of the workshops.
|A second package of workshops was planned, delivered and evaluated following the same procedure as in Phase 1.|
Topics requested by the young people:
[i] Homeless trajectory, [ii] Substance misuse, [iii] Resilience, [iv] Healthy eating
Planning of the workshops again involved a multidisciplinary collaboration between the PI with one NHS Board and one NGO to provide expert knowledge on the evidence-base and current guidance on substance use, resilience, and healthy eating.
|Phase 3||Semi-structured interviews with all participants to explore key issues raised during the workshops including perceptions of the efficacy and appropriateness of using pedagogical workshops to explore the life experiences, views and opinions of the young people||Identification of key issues and perceptions of efficacy and appropriateness of workshops.|
|Workshop 1. Oral health||Exploration of group perceptions of oral health, fears and barriers to accessing dental treatment emerged. A spontaneous discussion of the psychosocial effects of poor oral health on self-esteem, social interaction, and employability occurred. Common and divergent experiences were then identified and built into collective strategies to achieve good oral health as a way to improve other aspects of life.|
|Workshop 2. Mental health||[Part 1] Exploration of group perceptions of wellbeing and mental health; health information on different mental health problems and their causes; treatments available; role of practitioners, friends and family to tackle mental health problem. |
[Part 2] Sensitive discussions of relationship breakdown as a cause of mental health problems among young people; sharing of life experiences with family members and/or partners; the group discussed how to improve communication; how to manage conflicts, differing beliefs and world views; consensus of how these factors can affected their well-being and mental health.
|Workshop 3. Education & the future||[Part 1] The participants were asked to identify and discuss different levels of knowledge in their lives built from both formal education (e.g., courses, college or university) and life experience; the recognition that both types of learning are important and serve the context required. [Part 2] Discussion of aspirations for the future. To visualise this future the participants built a collage to express a life project involving and promoting their health and wellbeing. [Part 3] Identification of feelings coming with the life planning exercise and an exploration of how they would make healthier choices for a better future.|
|Workshop 4. Stigma||The aim of this workshop was to continue to humanise the gaze and to enable participants to discuss the meaning and process of the construction of stigma against groups in society and especially youth homelessness. Using favelas in Brazil and their youth residents as an example of a stigmatized group, the participants felt comfortable to bring their own experiences of bias and stigma and the agreed strategies they would use to deal with discrimination. The participants were invited to create a campaign against prejudice, stigma and discrimination towards homelessness.|
|Workshop 5. Homeless trajectory||Discussions around participants’ definitions of being young and their homelessness journey; exploration of the positive/negative aspects of this period of their lives; identifying routes that lead to their homelessness. The group was invited to engage individually and/or as a group in activities to produce a consensus outcome using diverse and creative ways of expression to translate this knowledge into an action plan for their lives.|
|Workshop 6. Substance misuse||Increased participants’ awareness and knowledge of substance misuse; focussing on the increased use of New Psychoactive Substances (NPS), by young people; exploration of their reasons for becoming involved in drug use; participants’ consensus of how to deal with drug use and how to overcome involvement.|
|Workshop 7. Resilience||Discussion of the meaning of resilience as the capacity to adapt and overcome risk and adversity; exploration of how they may become more resilient; learning of life skills and strategies to build their strength when going through a difficult time. Through the identification of positive thoughts that lead to their social change and negative thoughts that hold them back, the participants worked on the construction of their resilience, their life goals for future planning and the different steps necessary to achieve these goals (an action plan).|
|Workshop 8. Health eating||Discussion of the role of food in people’s daily lives beyond the survival aspect; raising awareness and understanding of food as a way to  encourage social interaction,  break cultural and social barriers,  engage with people,  increase health literacy and  promote wellbeing. The participants reflected upon health eating and the effect of their position and social inequalities as the main reason why people living in poverty do not eat healthy food. This provided the basis for a co-construction of knowledge and an action plan for healthy eating.|
|Quotes Related with the Workshop on Oral Health|
|||(I am) brushing my teeth differently (as a result of the workshop on how to brush teeth with fluoride toothpaste);|
|||(I am) using mouthwash at different times [as a result of information about not using a mouthwash immediately after brushing teeth;|
|||(I will) not use water when brushing my teeth as it’ll wash away the concentrated fluoride in the remaining toothpaste’ (as a result of the knowledge gained at the workshop);|
|||‘I now use a pea size of my toothpaste’ (following the information given at the OH workshop when the facilitator asked a participant to show the right amount of toothpaste that should be used to brush the teeth and the amount showed was far away more than the recommended by NHS boards);|
|||I am using a straw to drink any juice’ (as result of the workshop on OH and diet that revealed the high amount of sugar present in the carbonated drinks consumed by the young people. The information caused a lot of surprise among the participants. The workshop provided advice on how to minimize the effects of these drinks with simple tips such as using a straw;|
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