Empirical Evidence for Professional Practice and Public Policies: An Exploratory Study on Social Exclusion in Users of Primary Care Social Services in Spain
Abstract
:1. Introduction
1.1. Social Exclusion
- Structural origin: The causes are structural, derived from inequalities generated by the socioeconomic, political and cultural model.
- Multidimensional character: Social exclusion affects multiple dimensions or facets of people’s lives over time.
- The dynamic nature of the process: Social exclusion is not static, rather the intensity and scope vary with the life cycle of people over time.
1.2. Social Services and Social Exclusion
2. Materials and Methods
2.1. Participants
- People served by professionals (with direct interaction and not through a third party) in the first care services during the data collection period.
- People between 18 and 65 years old and emancipated minors (16 years or older).
- If data from all cases could be collected in a single day, they followed the order of appointment.
- If the above could not be done, they collected select cases cited on different days and in different time slots.
2.2. Instrument
2.3. Procedure
2.4. Ethical Issues
2.5. Data Analysis
3. Results
3.1. Sociodemographic Profile
- Women made up 15% more of the sample than the general inhabitant population (50.1%).
- The study population was over-represented in terms of those aged 25 to 29 (with differences between 0.5% and 6%), while for the rest of the intervals (minors under age 25 and those over age 59) it was under-represented (with differences of 2.4% and 5.8%).
- The family units with five or more members were over-represented in the study population with respect to the Census (with differences between 0.1% and 8.4%), and especially units with five and six members. The family units with one to four people were under-represented (with differences between 0.6% and 10.9%).
- In the sample, there was 29% greater foreign population than the resident population.
3.2. Scope and Intensity of Social Exclusion
- 1.
- Dimensions with greatest levels of exclusion are:
- D3—Work. Severe exclusion affects 67%, and moderate exclusion affects 10%. Both are present in 77% of the total.
- D2—In terms of the economic situation/income level, severe exclusion affects 58% of people and moderate exclusion affects 24%. Together they make up 81% of the total.
- D4—In terms of education and training, severe exclusion affects 44% and moderate exclusion affects 33%. Both are present in 77% of the total.
- 2.
- The dimensions in which the majority of people do not present social exclusion or present slight exclusion are, in the following order:
- D1—Housing. About 56% of people do not present social exclusion in this dimension. Moderate exclusion affects 20% and severe exclusion affects 10%. Together they represent 30% of the total. Fourteen percent find themselves with slight exclusion. Those affected by some level of social exclusion make up 44% of the total.
- D6—Isolation. Although 32% of people do not present exclusion in this dimension, one in four presents moderate exclusion (25%), and severe exclusion affects 13%. Together they make up 38% of the total. Slight exclusion is around 30%. Thus, people affected by some level of exclusion represent 68% of the total.
- 3.
- The dimensions with the least level of exclusion, or those in which the majority of the population does not present exclusion (with percentages over 65% of the total are (from lower to higher levels)):
- D8—Social acceptance. Severe and moderate exclusion affected 28% of the population. There were no situations of slight exclusion.
- D7—Family and social conflict: Severe and moderate exclusion affected 29% of the population, and slight exclusion affected 2%.
- D5—Health. Severe exclusion and moderate exclusion affected 35% of the population. There were no observed situations of slight exclusion.
3.3. Classification of the Population: Trajectories
- No cluster coincides in terms of the intensity and exclusion in a single dimension.
- Dimensions D2—Economy and D4—Education present similar behavior in all of the clusters and range between a moderate and severe intensity.
- In the majority of the clusters, there is an absence of exclusion or a slight exclusion for the dimensions D1—Housing, D6—Isolation and D8—Social acceptance.
- The principal differences among the groups are situated in dimensions D3—Work (in which severe exclusion is predominant), D5—Health (with observed absence of exclusion or moderate exclusion, by cluster), D7—Conflict (in which there is severe exclusion or absence of exclusion, by group).
- Cluster 5 is that which shows greatest global intensity of social exclusion, followed by cluster 2 and cluster 3. The cluster that presents less intensity of exclusion is cluster 1.
- Cluster 1. Moderate exclusion in terms of economy-education/training, with slight intensity in social relationships (isolation).
- Cluster 2. Severe exclusion in terms of work with moderate intensity in economy-education/training-health and slight exclusion in terms of housing–social relationships (isolation).
- Cluster 3: Severe exclusion in economy-work with moderate intensity in training and slight intensity in housing and in the social relationships area (isolation/social acceptance).
- Cluster 4: Severe exclusion in the area of social relationships (family and social conflict) with moderate intensity in economy-work–education/training and with slight intensity in social relationships (isolation).
- Cluster 5: Severe exclusion in economy-work-training with severe intensity or moderate in terms of housing and in the social relationships area (isolation/family or social conflict/social acceptance).
4. Discussion
- Trajectory 1 “From integration to vulnerability”. This corresponds to cluster 1, characterized by moderate social exclusion in economy-education/training, with slight intensity in terms of social relationships (isolation). From the perspective of sociodemographics, the primary difference observed with respect to the rest of the clusters is that it is the group with the lowest percentage of people with Roma ethnicity (0.6%) and with the greatest percentage of people who finished their mandatory schooling (56%).
- Trajectory 2 “In permanent vulnerability”. This corresponds to cluster 4, with the following characteristics: severe exclusion in the area of social relationships (family and social conflict) with moderate intensity in terms of economy-work-education/training and with slight intensity in terms of social relationships (isolation). In comparison with the rest of the clusters, it is the second group with the lowest percentage of members of the Roma ethnicity (0.7%) and of people in an irregular legal situation or in the process of regularization (1%).
- Trajectory 3 “From integration to exclusion”. This corresponds to group 2, which is characterized by severe exclusion in terms of work with moderate intensity in economy-education/training-health and slight intensity in housing and in the social relationship area (isolation). In terms of sociodemographics, the most relevant characteristics compared to the other clusters are the following: it is the group of families with the lowest number of minors age 0 to 16 and the group that presents the greatest relative percentage of people with illness and disability (75%), with ability limitations (62%) and with the need for health care and health follow-up (81%).
- Trajectory 4 “From vulnerability to exclusion”. This corresponds to group 3, characterized by severe exclusion in economy-work with moderate intensity in education/training and slight intensity in housing and in the social relationship area (isolation/social acceptance). The primary sociodemographic difference with respect to all of the clusters is that it is the group with the greatest percentage of foreigners (50%).
- Trajectory 5 “In permanent exclusion”. This corresponds to cluster 5, characterized by severe exclusion in economy-work-education/training with severe intensity or moderate intensity in housing and in the area of social relationships (isolation, family or social conflict, social acceptance. It should be noted in terms of sociodemograhics that this group includes the greatest percentage of people with Roma ethnicity (8%), of people with an irregular legal status in the country (12%) and without completion of mandatory schooling (75%). Also, there is a relatively high percentage of people with illness and/or disability (57%) and with needs for health care and health follow-up (63%).
5. Conclusions
- In terms of professional practice, it supports the design of intervention protocols based on evidence that can help to lay out objectives, priority action area, the typology and intensity of actions, their duration and the needed resources, etc.
- In terms of uses for organizations and policy makers, this evidence allows for the design of public policies tailored to the needs of people and the places they reside, considering the priority area of public policy, the typologies and intensity and needed resources, etc.
- The scope of the interventions, when orienting on the areas that are the competence of the social services in which it is necessary to act (material support, autonomy, family and social relations, etc.), and on the areas in which is necessary to connect people with other social protection systems (housing, work, education-training, health, etc.) and establish coordination systems between their professionals and organizations.
- The intensity of the necessary interventions with each group, in terms of urgency, number and periodicity of actions, considering the intensity of the exclusion according to the vital area/dimension affected.
- The type of actions required with each group: information, advice-support, educational-training, material or institutional support, advocacy, supervision-monitoring, evaluation, organizational and professional networking, internal and external coordination, etc.
- The typology of resources needed, both human and benefits, programs and services, and its priority.
Author Contributions
Funding
Conflicts of Interest
References
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Level of Exclusion (Intensity) | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|
Dimensions (Scope) | Without Exclusion | Slight Exclusion | Moderate Exclusion | Severe Exclusion | Total | |||||
n | % | N | % | n | % | n | % | n | % | |
D1—Housing | 569 | 56.4 | 136 | 13.5 | 201 | 19.9 | 103 | 10.2 | 1009 | 100.0 |
D2—Economy | 35 | 3.5 | 155 | 15.4 | 239 | 23.7 | 580 | 57.5 | 1009 | 100.0 |
D3—Work | 130 | 12.9 | 104 | 10.3 | 104 | 10.3 | 671 | 66.5 | 1009 | 100.0 |
D4—Education | 40 | 4.0 | 195 | 19.3 | 329 | 32.6 | 445 | 44.1 | 1009 | 100.0 |
D5—Health | 658 | 65.2 | 0 | 0.0 | 190 | 18.8 | 161 | 16.0 | 1009 | 100.0 |
D6—Isolation | 327 | 32.4 | 305 | 30.2 | 250 | 24.8 | 127 | 12.6 | 1009 | 100.0 |
D7—Conflict | 697 | 69.1 | 19 | 1.9 | 64 | 6.3 | 229 | 22.7 | 1009 | 100.0 |
D8—Acceptance | 730 | 72.3 | 0 | 0.0 | 239 | 23.7 | 40 | 4.0 | 1009 | 100.0 |
Dimensions | Cluster | Error | F | Sig. | ||
---|---|---|---|---|---|---|
Quadratic Mean | df | Quadratic Mean | df | |||
D1—Housing | 49.340 | 4 | 0.955 | 1004 | 51.675 | 0.000 |
D2—Economy | 22.430 | 4 | 0.658 | 1004 | 34.101 | 0.000 |
D3—Work | 202.295 | 4 | 0.391 | 1004 | 517.576 | 0.000 |
D4—Education | 11.113 | 4 | 0.724 | 1004 | 15.350 | 0.000 |
D5—Health | 238.165 | 4 | 0.516 | 1004 | 461.429 | 0.000 |
D6—Isolation | 37.867 | 4 | 0.899 | 1004 | 42.126 | 0.000 |
D7—Conflict | 378.470 | 4 | 0.132 | 1004 | 2861.990 | 0.000 |
D8—Acceptance | 39.148 | 4 | 0.802 | 1004 | 48.826 | 0.000 |
Cluster Number | N | % |
---|---|---|
1 | 178 | 17.6 |
2 | 198 | 19.6 |
3 | 344 | 34.1 |
4 | 141 | 14.0 |
5 | 148 | 14.7 |
Total | 1009 | 100.0 |
Dimensions | Cluster | ||||
---|---|---|---|---|---|
1 | 2 | 3 | 4 | 5 | |
D1—Housing | S | S | S | ∅ | M |
D2—Economy | M | M | SE | M | SE |
D3—Work | ∅ | SE | SE | M | SE |
D4—Education | M | M | M | M | SE |
D5—Health | ∅ | M | ∅ | ∅ | M |
D6—Isolation | S | S | S | S | M |
D7—Conflict | ∅ | ∅ | ∅ | SE | SE |
D8—Acceptance | ∅ | ∅ | S | ∅ | M |
Sociodemographic Variables | Cluster 1 | Cluster 2 | Cluster 3 | Cluster 4 | Cluster 5 | Total |
---|---|---|---|---|---|---|
Gender | ||||||
Woman | 63.5 | 62.1 | 65.4 | 73.0 | 64.2 | 65.3 |
Man | 36.5 | 37.9 | 34.6 | 27.0 | 35.8 | 34.7 |
Total | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 |
Age | ||||||
Mean (SD) | 40.8 (9.4) | 47.1 (11.1) | 40.7 (11.0) | 39.8 (10.3) | 40.0 (9.0) | 41.7 (10.8) |
Number of members in family unit | ||||||
Mean (SD) | 3.3 (1.5) | 2.7 (1.4) | 3.4 (1.7) | 3.3 (1.5) | 2.7 (1.316) | 3.1 (1.6) |
Number of minors age 0–16 in the family unit | ||||||
Mean (SD) | 1.3 (1.2) | 0.70 (1.1) | 1.4 (1.2) | 1.5 (1.1) | 1.1 (1.4) | 1.9 (1.0) |
Nationality | ||||||
Spanish | 63.5 | 73.7 | 49.7 | 65.2 | 62.8 | 61.0 |
Foreign | 36.5 | 26.3 | 50.3 | 34.8 | 37.2 | 39.0 |
Total | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 |
Roma ethnicity | ||||||
Yes | 0.6 | 1.5 | 1.8 | 0.7 | 8.1 | 2.3 |
No | 99.4 | 98.5 | 98.2 | 99.3 | 91.9 | 97.7 |
Total | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 |
Legal status situation in the country | ||||||
Irregular or in the process of regularization | 2.8 | 3.0 | 3.8 | 1.4 | 12.2 | 4.4 |
Regular | 97.2 | 97.0 | 96.2 | 98.6 | 87.8 | 95.6 |
Total | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 |
Education level | ||||||
Has not completed mandatory schooling | 43.7 | 57.5 | 59.6 | 59.0 | 75.0 | 58.7 |
Completed mandatory schooling | 56.3 | 42.5 | 40.4 | 41.0 | 25.0 | 41.3 |
Total | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 |
Illness/disability | ||||||
Without illness/disability | 82.1 | 24.7 | 87.1 | 77.1 | 43.2 | 66.2 |
With illness /disability | 17.9 | 75.3 | 12.9 | 22.9 | 56.8 | 33.8 |
Total | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 |
Ability limitations | ||||||
Does not present | 86.8 | 38.0 | 91.9 | 84.4 | 61.4 | 75.2 |
Presents (diagnosed or not) | 13.2 | 62.0 | 8.1 | 15.6 | 38.6 | 24.8 |
Total | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 |
Attention and/or health follow-up | ||||||
Does not need | 78.4 | 19.0 | 79.8 | 75.0 | 37.4 | 60.8 |
Needs (punctual or continuous) | 21.6 | 81.0 | 20.2 | 25.0 | 62.6 | 39.2 |
Total | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 |
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Giménez-Bertomeu, V.M.; Domenech-López, Y.; Mateo-Pérez, M.A.; de-Alfonseti-Hartmann, N. Empirical Evidence for Professional Practice and Public Policies: An Exploratory Study on Social Exclusion in Users of Primary Care Social Services in Spain. Int. J. Environ. Res. Public Health 2019, 16, 4600. https://doi.org/10.3390/ijerph16234600
Giménez-Bertomeu VM, Domenech-López Y, Mateo-Pérez MA, de-Alfonseti-Hartmann N. Empirical Evidence for Professional Practice and Public Policies: An Exploratory Study on Social Exclusion in Users of Primary Care Social Services in Spain. International Journal of Environmental Research and Public Health. 2019; 16(23):4600. https://doi.org/10.3390/ijerph16234600
Chicago/Turabian StyleGiménez-Bertomeu, Víctor M., Yolanda Domenech-López, Miguel A. Mateo-Pérez, and Nicolás de-Alfonseti-Hartmann. 2019. "Empirical Evidence for Professional Practice and Public Policies: An Exploratory Study on Social Exclusion in Users of Primary Care Social Services in Spain" International Journal of Environmental Research and Public Health 16, no. 23: 4600. https://doi.org/10.3390/ijerph16234600