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Background. Mobile health (mHealth) interventions hold promise in assisting older adults to meet physical activity (PA) guidelines. Yet, little is known about how older adults perceive using smartphones to enhance their PA. This study explored older adults' experiences with the "My Health Plan" mHealth intervention and examined which person‐level factors were associated with adherence. Methods. Forty older adults (52.5% female, mean age: 72.6 years) were instructed to use the My Health Plan application, which provided up to six stretch‐ and strengthening exercises per day and to wear a Fitbit Charge activity monitor for seven consecutive days. Person‐level factors (e.g., gender and age) and psychosocial factors (e.g., intention and motivation) were assessed using a questionnaire. Afterwards, semistructured interviews were conducted to gather participants' experiences with the application and Fitbit. Deductive thematic analysis (qualitative data) and regression analyses (quantitative data) were conducted. Results. Key themes emerging from the interviews were (1) smartphone notifications (including timing and number) and carrying the smartphone throughout the day, (2) suggested stretch‐ and strengthening exercises, (3) providing feedback, (4) experiences with Fitbit, and (5) overall suggestions for improving the application and mHealth interventions. Overall, participants reported positive experiences with the application and Fitbit. Being male, having higher baseline PA, lower anxiety, and greater ability to participate in social roles and activities were related to increased engagement with the proposed exercises. Conclusions. This study provides valuable insights to optimize future mHealth interventions tailored to older adults' specific needs, aligning with their perceptions of the digital transformation in health promotion. [ABSTRACT FROM AUTHOR]

Consumer-directed care (CDC) is increasingly widespread among aged care service options in Organisation for Economic Co-operation and Development (OECD) countries. However, the evidence base regarding the programmatic and contextual factors that affect the outcome of CDC interventions is surprisingly small. This paper reports on a self-directed care approach for older Australians with complex care needs. A multimethods longitudinal comparative cohort study was employed comprising 4 survey tools and 56 semi-structured interviews. Participation rates were around 20%. A total of 185 (98 in the intervention and 87 in the control group) older people and carers were recruited at baseline. Eleven months later, 109 participants (59 in the intervention and 50 in the control group) completed the repeat measure. Attrition rates were around 40%. Data collection occurred between July 2010 and April 2012. The data suggest that intervention group participants were likely to be more satisfied with the way they were treated (P = 0.013), their care options (P = 0.014), the 'say' they had in their care (P < 0.001), the information they received regarding their care (P = 0.012), what they were achieving in life (P = 0.031), that the services changed their view on what could be achieved in life (P = 0.020) and with their standard of living (P = 0.008). The evaluation suggests that while only a very small segment of older people is interested in a voucher or cash option, a substantially larger group would like to have greater say over and more direct access to their care, without, however, assuming administrative and financial responsibilities. The paper concludes that a stepped capacity-building approach to CDC may improve the acceptability of CDC to older people and generate synergies that improve older people's care outcomes. [ABSTRACT FROM AUTHOR]

Following changes in the structure and funding of the Australian medical system, patients have become 'consumers' or 'clients'. Family and friends have become 'carers' or 'caregivers', signifying their increased responsibilities as patients move from hospitals to communities. While policy makers embrace the term 'carer', some argue that the title is not widely recognised and has disempowering connotations. This paper examines spouses' reflections on the term 'carer' based on qualitative interviews with 32 Australians caring for a spouse with cancer from a study conducted between 2006 and 2009. Recruitment involved survey and snowball sampling. Following a grounded theory approach, data collection and analysis were performed simultaneously. Using Holland and colleagues' sociocultural 'identity as practice' theory and a thematic approach to analysis, findings depict identification with the 'spouse' and 'carer' label as relationally situated and dependent on meaningful interaction. Although others argue that the term 'carer' is a 'failure', these findings depict identification with the label as contextual, positional and enacted, not fixed. Furthermore, and of most significance to practitioners and policy makers, the title has value, providing carers with an opportunity to position themselves as entitled to inclusion and support, and providing health professionals with a potential indicator of a spouse's increased burden. [ABSTRACT FROM AUTHOR]

Information about the level of distrust in healthcare systems is very limited in Chinese populations, and no validated instrument has been developed to measure this distrust. Therefore, to begin addressing this research gap, this study evaluated the psychometric properties of a traditional Chinese version of the Revised Health Care System Distrust Scale and used it to assess the level of distrust in a healthcare system. The study involved a community‐based personal interview survey of individuals in Hong Kong. A total of 340 men were randomly recruited. In addition to the distrust instrument, the two‐item Trust in Physician Scale and the Patient Health Questionnaire‐9 were used. The two‐factor structure of the distrust scale was confirmed. The item‐total correlations corrected for overlap were >0.4 for both the Competence and Values Distrust subscales, confirming the internal construct validity of the scale. The Cronbach's alpha coefficient was 0.77 for both subscales. The scores of both the Competence and Values subscales were moderately negatively correlated with the total score of the Trust in Physician Scale, providing support for convergent validity. Regarding known‐group validity, the scale could differentiate people according to marital status, monthly personal income and severity of depressive symptoms. Moreover, we found that men who had previously undergone prostate cancer screening had higher Values Distrust scores than those who had not. The descriptive analysis showed that only about half of the participants reported that they received high‐quality medical care and that the healthcare system provided excellent medical care, suggesting that more effort is needed to improve the quality of care and people's satisfaction with healthcare in Hong Kong. In summary, the translated traditional Chinese version of the Revised Health Care System Distrust Scale used in this study is a valid and reliable scale for assessing the level of distrust in a healthcare system. [ABSTRACT FROM AUTHOR]

Utilising telepractice videoconferencing technology to offer home visitation services has the potential to provide access and parenting support through a high‐tech and high‐touch service delivery option. Families can receive evidence‐based, family support intervention from their home via videoconferencing technology, removing the need for the provider to be physically in the home. While the expansion of telehealth and telepractice services for families is essential for meeting the needs of both parents and their children, well‐documented engagement barriers to digital health/computer‐mediated interventions exist across treatment modalities and technology platforms. Semi‐structured interviews with 15 providers were conducted and analysed to identify engagement strategies utilised to sustain families in a home visitation model offered through live videoconferencing technology on a telehealth platform. Analysis revealed four themes that were deemed essential for successfully attracting and maintaining families in a telepractice‐based home visitation programme: (a) engagement strategies to encourage families to participate; (b) clinical skills used within sessions; (c) articulation of benefits to the family; and (d) exploration of rationale for ending services. This study was able to identify strategies for engagement and sustained involvement of families in telehealth‐based home visitation. Findings include evidence that providers should be able to move between telehealth and on‐ground service provision with relative ease. [ABSTRACT FROM AUTHOR]

Health providers often focus on secondary conditions and spend less time prioritising overweight/obesity care. Informal caregivers are well positioned to facilitate health‐promoting behaviours of healthy eating and physical activity among community‐dwelling care recipients with spinal cord injury (SCI) for prevention and management of overweight/obesity. Literature has typically focused on caregiver adjustment post‐injury and burden related to their roles in secondary condition care. The novel objective of this study was to describe informal caregivers' perspectives of their roles in facilitating health‐promoting weight management behaviours, healthy eating and physical activity, for care recipients with SCI. This was a qualitative study that used semi‐structured interviews with informal caregivers for data collection in 2019. Braun & Clarke's established thematic phases were used for analysis. Participants included informal caregivers of individuals with SCI living in the community (n = 24). Caregivers identified eight themes to describe their role in facilitating weight management for care recipients. Themes included: (1) meal planning/shopping, (2) meal preparation/cooking, (3) using portion control, (4) serving/feeding, (5) helping the care recipient with physical activity and/or leisure activities, (6) mutually participating in weight management activities, (7) providing motivation and encouragement and (8) being an information liaison. In summary, informal caregivers have an intimate understanding of care recipients' needs and have insights on obstacles and enablers to health‐promoting behaviours, making their involvement in facilitating weight management in individuals with SCI vital. Caregivers self‐identified several significant roles for promoting weight management. This is especially valuable for conditions such as overweight/obesity for which prevention and treatment involve health‐promoting behaviours that need consistent attention in the community setting. It is important to ensure that informal caregivers and care recipients have the information required in order to facilitate healthy eating and physical activity in persons with SCI and have opportunities for mutual dyadic participation when both partners are interested. [ABSTRACT FROM AUTHOR]

Baby‐led weaning or self‐regulated small chunk feeding by the baby has emerged as an alternative to the traditional method of complementary feeding. Parents and healthcare professionals often differ in the benefits and drawbacks about it. The research aims were to describe the knowledge of health professionals about complementary feeding and baby‐led weaning (BLW) method and the attitudes towards its recommendation, and to explore the knowledge, experiences and attitudes of parents who have used this method to feed their children. A mixed methods research was carried out. A questionnaire was completed by 38 health professionals and 10 interviews were conducted with participating mothers. A total of 52.6% of health professionals recommended initiating complementary feeding at 6 months of age, a guideline followed by the mothers who used BLW. Some 86.8% of the professionals knew the BLW method and 76.3% knew its benefits, but the mothers consulted mainly informal sources of information sources to learn about and implement it. The health professionals stated that it facilitated family transition, enabled the infant to adapt better to flavours and textures, promoted chewing and the development of fine motor skills, improved growth and might also be a protective factor against obesity. The mothers noted that the method was natural, encouraged infant autonomy and promoted healthy eating habits. The health professionals expressed varied opinions concerning the risks entailed in the method. The main conclusions are that the majority of health professionals participating in the study know the BLW method, its benefits; however, they do not recommend it in all cases. Mothers listen to the advice of professionals but continue to rely on other informal sources of information. [ABSTRACT FROM AUTHOR]

The efficacy of crisis planning in mental health services is contested. As recovery and self‐management are core to Early Intervention in Psychosis (EIP) services and the Care Programme Approach (CPA), the views of EIP practitioners of the most useful aspects of crisis planning can inform this vital aspect of practice. We conducted a mixed methods study using a national cross‐sectional survey (n = 70) and semi‐structured interviews (n = 12) with EIP practitioners in England in 2019. Data were analysed using non‐parametric tests and thematic analysis. A Joint Crisis Plan (JCP) template was used as a benchmark to judge current practice by (Sutherby et al., 1999; Henderson et al., 2004; Thornicroft et al., 2013). The most useful crisis plan themes identified by practitioners included early warning signs, triggers and helpful treatments, although not all elements were considered useful. Additionally, the interviews identified that collaboration with clients, carers and other services; personalisation; and self‐management were all considered important in effective crisis planning. The practitioners also identified barriers to effective crisis planning, such as the electronic records system, lack of time and lack of available service provision. The research highlighted the important aspects of EIP and was significant in impacting the service and wider EIP network further. While crisis planning is a significant part of EIP, it does not appear to be consistently applied in practice. Fully implementing collaborative crisis planning in EIP services may require changes to policy, practice and local systems to ensure that crisis planning is as effective as possible. [ABSTRACT FROM AUTHOR]

Death doulas (DD) are working with people at the end of life in varied roles with more clarity needed around their role and place within the health and social care systems. The aim of this work is to explore the DD role in end‐of‐life care from the perspective of DDs. A sub‐group of 20 DDs from a larger quantitative survey participated in semi‐structured telephone Skype or Zoom interviews. Interview data were analysed using thematic analysis. Seven themes emerged from the qualitative analysis: what a DD offers, what a DD does, challenges and barriers, occupational preferences, family support, contract of service/fee and regulation. There is a general perception that healthcare professionals (HCP) do not understand what it is that DDs do; thus, the current study has helped to demystify the DD role and potentially reduce suspicion. The lack of a DD business model sees inconsistencies in what services each DD offers and what patients and families can expect. End of life is complex and confusing for patients and families and there is a need to further explore the DD role and how it can work when there are many inconsistencies in working practice. More research is required to look at the interplay among DDs, HCPs and palliative care volunteers in addressing the gaps in care provision and how these relationships might be more seamlessly managed. [ABSTRACT FROM AUTHOR]

Despite the importance of carers supporting the lives of people with mental illness, there are limited studies investigating the well‐being and needs of Malay carers in multicultural Singapore. The Malays consist of 13.4% of Singapore's population. A mixed methods qualitative dominant research approach was used to explore the well‐being and needs of Malay carers in a voluntary welfare organisation. The Kessler‐10, Friendship Scale and Carers' and Users' Expectations of Services—Carer version were used to assess the needs and well‐being of 17 Malay carers. Findings show that Malay carers experienced poor well‐being and had numerous unmet needs. Four main themes were found: (a) Concerns related to relatives with mental illness, (b) Mental health practices related to carers, (c) Holistic support for carers and (d) Preference for greater spiritual support in mental health. Recovery‐oriented mental health practice implications are discussed. Spirituality of Malay carers needs to be given greater consideration in recovery‐oriented mental health services. [ABSTRACT FROM AUTHOR]

High costs of living and low wage growth in Australia have resulted in an increase in the number of people experiencing food insecurity, and a corresponding increase in the number of people accessing food aid. This research employs qualitative methods alongside standard methods to explore food security to investigate these issues in food aid settings in Victoria, Australia. The two aims of this study were, 1) to explore the profile of people who access food aid and 2) to explore the experiences of people accessing food aid. A convenience sample of people was recruited from organisations that distribute food aid from across the state. People in need of food aid typically self‐refer to charities, who then apply varied and localised criteria to manage access to the charitable service. Interviews were conducted with 78 participants between June 2018 and January 2019. Participants had been accessing food aid for 4 years on average (SD 5.7, range 1 month—40 years), most participants were female (n = 57, 73.1%), with an average age of 52.6 years (SD 15.9), and over half were born in Australia (n = 44, 56.4%). Most participants were in receipt of a government welfare payment (n = 75, 96.2%), and over 40% were living in private rental accommodation. Around two thirds of participants reported low or very low food security (n = 54, 67.5%). Participants reported a range of both positive and negative experiences accessing food aid. This study adds to the body of literature exploring food insecurity in high‐income settings and its persistence despite significant national economic prosperity. Current economic and political conditions in Australia mean that the reliance on food aid by welfare recipients is unlikely to decrease. [ABSTRACT FROM AUTHOR]

Family support is an important protective factor for pregnant women with a foetal abnormality and can prevent adverse psychological outcomes in this population. This study aimed to explore the importance and influencing factors of family support for pregnant women with foetal abnormalities requiring pregnancy termination and then determine the correlation between family support and women's post‐traumatic stress symptoms. A mixed methods study was conducted from March 2016 to September 2017. In all, 214 participants were surveyed using self‐reported questionnaires including the demographic, family and obstetric information questionnaire, the Family Adaptation Partnership Growth Affection and Resolve Index and the Impact of Event Scale‐Revised to collect quantitative data. Semi‐structured in‐depth interviews with 28 participants were conducted to collect qualitative data. Of the pregnant women with foetal abnormalities, 35% had obstacles in family function such that family support was low. The Impact of Event Scale‐Revised score was negatively associated with total score on the Family Adaptation Partnership Growth Affection and Resolve Index as well as the score for each item on this index. In terms of family support, the demographic, family and obstetric variables hierarchically entered into the regression models significantly explained 20.0%, 26.5% and 2.6% of variation, respectively. In addition, three key themes were identified based on qualitative analyses: intensified instrumental support, inadequate emotional support and insufficient informational support. The findings showed that family support plays a protective role in preventing post‐traumatic stress symptoms following termination of pregnancy. At present, family support still needs to be improved, especially in emotional support and informational support. The factors influencing family support may be important to consider for improving family support. [ABSTRACT FROM AUTHOR]

Research has identified discrimination and a lack of knowledgeable providers as major barriers for transgender and gender diverse (TGD) individuals seeking care, which contributes to greater stress and significant health disparities affecting this population. However, research involving TGD youth is limited. The aim of this study, therefore, was to describe TGD adolescents' experiences, concerns and needs in healthcare settings, including their feedback on themes previously identified by healthcare providers (i.e. discomfort with gender‐related topics, reasons for not asking patients about gender and previous training regarding gender diversity). The authors conducted semi‐structured interviews with 12 TGD‐identified adolescents aged 14–17, living in Minnesota, USA in 2017–2018. Inductive thematic analysis was used to summarise participant comments into themes and subthemes. Two main themes were directly relevant to concerns and needs of TGD youth in healthcare settings and their views on healthcare providers' concerns: (a) asking about gender and pronouns and (b) training for healthcare providers. Findings suggest the need for revisions to clinic materials, infrastructure and protocols. Adding training to all general medical and nursing education to increase knowledge, comfort and competence around gender identity would further improve care and ultimately reduce healthcare disparities affecting TGD youth. [ABSTRACT FROM AUTHOR]

Cities without a prior established history of Latina/o migration are experiencing the fastest rate of growth in new immigrants in the United States (Wainer, A tale of two cities (and a town): Immigrants in the Rust Belt, 2013; Lichter & Johnson, Immigrant gateways and Hispanic migration to new destinations. International Migration Review, 43, 496, 2009). These new immigrant settlement cities experience the challenge of adapting their social care context to become more responsive to the needs of immigrants. Yet as cities and social care organisations struggle to keep up with the "lag" time in the availability of culturally and linguistically responsive resources and services, social care providers often work in conditions of scarcity in a social care context that is often lacking in its ability to fully respond to the needs of immigrants. Literature indicates that such conditions of scarcity can lead to work related stress, burn‐out, and can have a negative impact on the quality of services delivered by social care workers. Yet little is known regarding social care providers' motivations and responses to work stress; and how providers may positively respond and persist in their jobs despite such stressors. This study conducted in the new immigrant settlement city of Baltimore from 2014 to 2016, utilises semi‐structured interviews to qualitatively explore the personal motivational beliefs, workplace and demographic factors associated with buffering stress and frustration among social care workers in a new immigrant settlement city (N = 29). Findings highlight important motivational and work‐related factors that appear to minimise the impact of stress and frustration for social care providers and can be used in the development of burn‐out interventions as well as improving quality of services for vulnerable populations such as, immigrants, especially in low‐resource new immigrant settlement contexts. [ABSTRACT FROM AUTHOR]

Health and social sciences literature recognises the significance of psychological resilience in relation to stressful life events. Providing ongoing care for a friend or relative with dementia can be inherently stressful. The aims of this qualitative study were to: (a) explore discrepancies and congruency between definitions of resilience in the academic literature and carers own conceptualisations; (b) assess differences and similarities in conceptualisations of resilience between carers with high, medium and low resilience scores; (c) compare carers' perceived level of resilience with the level of resilience when measured on a standardised tool. Participants were recruited from an earlier study examining levels of resilience and well‐being in UK carers of people with dementia. A subset of carers were identified using theoretical sampling, to ensure a diversity of participant characteristics and caring experience. Thirteen carers took part in semi‐structured interviews between September and October 2017. Interpretative description was used to elicit findings relevant to clinical practice. We found carers' definitions were concordant with clinical and academic definitions described in the literature. However, they extended the concept and placed greater value on the role of self‐compassion. Carers recognised that the appearance of resilience may have negative consequences in terms of securing support from others. Scores on the Brief Resilient Coping Scale did not always match carers' own perceptions of their level of resilience. Additionally, service providers' offers of support did not always reflect carers' priorities. Aligning these two areas would better enable carers and providers to work together to identify resources to support resilience. [ABSTRACT FROM AUTHOR]

There is growing concern about alcohol problems in low- and middle-income countries. More research is required, particularly among the younger generation. The aim of this study was to investigate the prevalence of alcohol disorders and associated socioeconomic characteristics among young men and women living in the Eastern Cape Province, South Africa. This was a cross-sectional population-based study of 977 participants (52% male and 48% female) aged 18-40, the majority of whom lived in low-income areas. Data collection was carried out in 2012 by trained fieldworkers. The Mini International Neuropsychiatric Interview ( DSM- IV) was used to investigate the prevalence of alcohol dependence (increased tolerance to alcohol, failed attempt to cut down, risk of physical and mental effects) and alcohol abuse (harmful use, consistent intoxication, risk behaviour, physically hazardous, social problems). A high 12-month prevalence of alcohol dependence was found (26.5% in total; 39.0% among men and 19.1% among women) as well as of alcohol abuse (9% in total; 19.0% among men and 6.0% among women). Few socioeconomic differences emerged among the men, except older men ( OR 1.94, CI 1.11-3.42) and those supported by social grants ( OR 2.28, CI 1.06-4.93), who presented higher odd ratios for alcohol dependence than the reference groups. Among the women, more differences emerged: women who were widowed/single ( OR 2.35, CI 1.20-4.62), had no education ( OR 3.41, CI 1.04-11.21), had a low income ( OR 3.26, CI 1.55-6.80) and had no social support from friends when ill presented higher odd ratios ( OR 1.73, CI 1.07-2.80). In the adjusted model, marital status and low income remained statistically significant. With regard to alcohol abuse, fewer socioeconomic differences emerged. Interventions need to address the early onset of alcohol misuse in order to meet both current needs and long-standing mental and physical illness. [ABSTRACT FROM AUTHOR]

Frailty causes disability and restrictions on older people's ability to engage in leisure activities and for social participation. The objective of this study was to evaluate the effects of a 1-year case management intervention for frail older people living at home in Sweden in terms of social participation and leisure activities. The study was a randomised controlled trial with repeated follow-ups. The sample (n = 153) was consecutively and randomly assigned to intervention (n = 80) or control groups (n = 73). The intervention group received monthly home visits over the course of a year by nurses and physiotherapists working as case managers, using a multifactorial preventive approach. Data collections on social participation, leisure activities and rating of important leisure activities were performed at baseline, 3, 6, 9 and 12 months, with recruitment between October 2006 and April 2011. The results did not show any differences in favour of the intervention on social participation. However, the intervention group performed leisure activities in general, and important physical leisure activities, to a greater extent than the control group at the 3-month follow-up (median 13 vs. 11, P = 0.034 and median 3 vs. 3, P = 0.031 respectively). A statistically significantly greater proportion of participants from the intervention group had an increased or unchanged number of important social leisure activities that they performed for the periods from baseline to 3 months (93.2% vs. 75.4%, OR = 4.48, 95% CI: 1.37-14.58). Even though statistically significant findings in favour of the intervention were found, more research on activity-focused case management interventions is needed to achieve clear effects on social participation and leisure activities. [ABSTRACT FROM AUTHOR]

Anxiety is common among postpartum women and can have adverse effects on mother's and child's somatic and psychological health if left untreated. In the UK, nurses or midwifes with a specialisation in community public health nursing, also called health visitors ( HVs), work with families who have children younger than 5 years of age and are therefore in a key position to identify and support women with postpartum mental health issues. Until recently, postpartum mental health support provided by HVs mainly focused on identifying and managing depression, but the updated clinical guidance by the National Institute for Health and Care Excellence also includes guidance regarding screening and psychological interventions for perinatal anxiety. This study therefore aimed to explore HVs' experiences of supporting women with postpartum anxiety and their views on currently available care. Using a qualitative approach, in-depth semi-structured interviews were conducted with 13 HVs from the UK between May and October 2015. Participants were interviewed in person at their workplace or on the phone/Skype. Using thematic analysis, four main themes emerged: identification and screening issues; importance of training; service usage; and status of current service provision. Women with postpartum anxiety were commonly encountered by HVs in their clinical practice and described as often heavily using their or other related healthcare services, which puts additional strain on HVs' already heavy workload. Issues with identifying and screening for postpartum anxiety were raised and the current lack of perinatal mental health training for HVs was highlighted. In addition, HVs described a current lack of good perinatal mental health services in general and specifically for anxiety. The study highlights the need for HV perinatal mental health training in general and postpartum anxiety specifically, as well as better coverage of specialist mental health services and the need for development of interventions targeted at postpartum anxiety. [ABSTRACT FROM AUTHOR]

This article reports a study exploring what older people believe would enable them to adjust to and gain maximum benefit from wearing a hearing aid. A mixed methods approach was employed during 2006 involving interviews with key stakeholders, a survey across three Scottish health board areas and focus groups. Nine key stakeholders from six national and local organisations were interviewed about the needs of older people being fitted with hearing aids. In total, 240 older people belonging to three different types of hearing impaired older people were surveyed: long-term users of hearing aids, new hearing aid users, and those on a waiting list from urban and rural areas (response rate = 24%). A series of eight follow-up focus groups with 31 audiology patients was held. Health professionals appeared to neglect appropriate provision of information and overly rely on technological interventions. Of 154 older people already fitted with hearing aids, only 52% of hearing aid users reported receiving enough practical help post fitting and only 41% reported receiving enough support. Approximately 40% reported not feeling confident in the use of their aids or their controls. Older people wanted more information than they received both before and after hearing aid fitting. Information provision and attention to the psychosocial aspects of care are key to enabling older people to adjust and optimise hearing aid benefit. [ABSTRACT FROM AUTHOR]

Palliative care patients who live alone report greater psychological distress, and are less likely to die at home than those living with a family carer. However, there is a lack of research on the value of models of care that specifically address this disadvantage. This article describes the experiences of terminally ill 'home alone' people using one of two models of care aimed at maintaining participants' need for independent living, focusing on the effect of these two models of care on their physical, social and emotional needs. Twenty six palliative care patients of Silver Chain Hospice Care, in Western Australia, were randomly assigned to either having a personal alarm or additional care-aide hours in their home. An in-depth qualitative study was conducted in two phases in 2010 using face-to-face interviews. The care-aide model of care resulted in benefits such as easing the burden of everyday living; supporting well-being; enhancing quality of life and preserving a sense of dignity; and reducing loneliness and isolation. The personal alarm model of care imparted a sense of security; provided peace of mind; and helped to deal with feelings of isolation. Participants in both groups felt that they could remain at home longer. By providing a safer, more secure environment through the use of a personal alarm or additional care-aide hours, patients were able to continue their activities of daily living, could build a sense of 'normality' into their lives, and they could live independently through support and dignity. [ABSTRACT FROM AUTHOR]

The objective of this study was to examine patient- and parent-perceived factors that impact adherence to inflammatory bowel disease treatment using a qualitative descriptive individual interview approach. Sixteen adolescents and their parents were recruited from May through August 2007 and interviewed about medication adherence using an open-ended semi-structured interview format. Interviews were audio recorded, transcribed, and coded into themes. Parent-child dyads identified forgetting, interfering activities, parent-child conflict and oppositional behaviour and inadequate planning for treatment as challenges to adherence. Participants reported that family support and good parent-child relationships, routines, monitoring and reminding and organisational tools such as pill boxes facilitated treatment adherence. Other issues that emerged included immediacy of treatment effects and parent-adolescent responsibility for treatment. Patients and parents experience a number of challenges related to adherence within behavioural, educational, organisational and health belief domains. Behavioural interventions should focus on these issues, reduction of perceived barriers, and effective transition of responsibility for treatment adherence. Future research considerations are discussed. [ABSTRACT FROM AUTHOR]