Date of Award
5-16-2025
Publication Type
Dissertation
Degree Name
Ph.D.
Department
Social Work
Keywords
Borderline Personality Disorder; critical realism; healthcare systems; qualitative research; social work; structural stigma
Supervisor
Adrian Guta
Supervisor
Robin Wright
Rights
info:eu-repo/semantics/embargoedAccess
Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
Abstract
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
Recommended Citation
Ahluwalia-Cameron, Aman, "From Clinical Practice to System Change: A Critical Realist Qualitative Study of Social Workers' Perspectives on Borderline Personality Disorder Care Delivery in Ontario" (2025). Electronic Theses and Dissertations. 9728.
https://scholar.uwindsor.ca/etd/9728