Search

With the aging population, the financial burdens associated with chronic diseases continue to escalate. Among various management strategies, family physician contracting stands out as a significant initiative aimed at addressing this challenge, officially introduced in China in 2016. However, current research has given relatively little attention to the economic benefits of family physician contracting in developing countries. This paper evaluates the economic effect of family physician contracting by employing microdata of patients with chronic diseases at the Yuyuantan Community Health Service Center, Haidian District, Beijing, from January 2019 to May 2021. This research contributes to the theoretical discourse in healthcare services by introducing a modified Anderson model. The empirical findings demonstrated that family physician contracting effectively reduced healthcare costs for patients with chronic diseases. Notably, the effect of family physician contracting on healthcare costs was more pronounced among patients with chronic diseases aged less than 65 years. At the same time, it is inferred that expediting the reform of the health insurance payment system, coupled with the promotion of family physician contracting services, would enhance the wellbeing of patients with chronic diseases. This research offers valuable insights into the ongoing and future development of family physician contracting in developing countries. [ABSTRACT FROM AUTHOR]

Purpose. This study aims to elucidate the gender gaps in the strategies for maintaining the social participation and interaction of older adults with people in a local community. Methods. The subjects were 130 older adults aged 65 years or older and independently living in their homes in Saitama, Saitama Prefecture, Japan. The authors conducted an anonymous questionnaire survey on paper and performed multiple regression analysis for men and women separately using the Lubben Social Network Scale-6 (LSNS-6) as the dependent variable. Results. Among the independent variables used for the analysis, those that significantly influenced LSNS-6 in men were social activities related to the daily life satisfaction of the elderly (SARDS). The independent variables that significantly influenced LSNS-6 in women were SARDS, sense of coherence-13 (SOC-13), and the number of family members living with the subjects. Discussion. Health promotion is not associated with interaction with people in men compared with women. [ABSTRACT FROM AUTHOR]

The last three census data highlighted that UK Bangladeshi communities have the worst health outcomes. This includes a higher risk of type two diabetes and heart diseases; both are risk factors for developing vascular dementia. However, little is known about Bangladeshi community members' understandings of dementia, including cultural myths. This paper focuses on the cultural myths, superstitions, and stigma surrounding dementia in an English Bangladeshi community from the direct experiences of people living with dementia, their caregivers, and the views of dementia service providers/stakeholders. This qualitative research was undertaken with three distinct participant groups using semistructured interviews (n = 25), who were recruited from community settings. The first and second participant groups explored the experiences of people with dementia (n = 10) and their family caregivers (n = 10). The third group examined stakeholders'/service providers' views (n = 5). Interviews were recorded digitally and transcribed verbatim. Findings were reached using an interpretive approach, emphasising the sense people make in their own lives and experiences and how they frame and understand dementia. The study revealed that participants with dementia and their caregivers have "alternative" knowledge about dementia and do not necessarily understand dementia in a Westernised scientific/biomedical context. Misconceptions about dementia and belief in various myths and superstitions can lead people to go to spiritual healers or practice traditional remedies rather than to their GPs, delaying their dementia diagnosis. This paper concludes that there is a lack of awareness among the Bangladeshi participants and a need for targeted awareness about dementia to help dispel cultural myths and combat the stigma surrounding dementia within the Bangladeshi community. [ABSTRACT FROM AUTHOR]

Domestic abuse is a worldwide public health and social issue which impacts the health and wellbeing of those experiencing abuse and their families. People living with a life-limiting illness are at increased risk of domestic abuse because they are often frail, isolated, and dependent on others. Little is known about domestic abuse and the coexistence of life-limiting illness and existing support for those experiencing or at risk of abuse. A scoping review was conducted to identify factors that shape and characterise experiences of adults with a life-limiting illness affected by domestic abuse and the health and social care practitioners and other organisations that support them. The Joanna Briggs Institute (JBI) methodology and checklist for Preferred Reporting Items for Systematic Reviews and Meta Analyses-Extension for Scoping Reviews (PRISMA-ScR) were applied. Five databases were systematically searched from 2000 to 2021: MEDLINE; CINAHL; PsycINFO; Social Sciences Citation Index (Web of Science); and ProQuest Dissertations and Global. Twenty-one papers met the inclusion criteria. Most studies were conducted in North America, with female participants living with cancer, and conducted in health and community settings. There were no studies involving third sector organisations. A range of abusive behaviours was reported resulting in missed medical appointments, delays in screening leading to late diagnosis, and palliative rather than curable treatment. Abuse also impacted on the physical, emotional, and psychological wellbeing of the person experiencing the abuse, which increased stress levels and could have a detrimental effect on their health. Identifying domestic abuse within the context of life-limiting illness was reported to be challenging for health and social care professionals, as was responding to and managing a disclosure. Further research is needed to address existing knowledge in order to inform policy and practice to identify and manage domestic abuse where it coexists with life-limiting illness. [ABSTRACT FROM AUTHOR]

Anemia is a global public health problem, especially common among children in developing countries, which affects their physical and mental health development. However, there is currently a lack of research on the relationship between anemia and academic performance. The objective of this study was to explore the association between anemia and academic performance, and the possible factors mediating this association among Chinese children. The data for this study came from the baseline survey of the Chinese Education Panel Survey Elementary School Cohort. The cohort was conducted from September 2018 to June 2019 in 160 elementary schools, covering 20 provinces and 40 counties/districts throughout China. Paper-based questionnaires were used, completed by 4th grade students, parents, head teachers, main teachers, and principals. The data used included questionnaire responses, physical measurements, and academic performance of 17,695 students. Based on students' hemoglobin levels and school altitude data, we grouped them into anemia and nonanemia categories using WHO criteria. The anemia group had 1,154 individuals, while the nonanemia group had 16,541 individuals. An ordinary least squares regression and mediation effect analysis were conducted. Our findings found the prevalence of anemia was 6.52% among Chinese Grade 4 students. Students without anemia had a higher average test score for three academic subjects than students with anemia (P < 0.001); their test scores for Chinese, Mathematics, and English were also higher (P < 0.05). Multivariate regression analysis showed a negative association between anemia and average test scores as well as individual test scores for the three subjects. Mediation analysis found that anemia affected academic performance directly (P < 0.05), and indirectly by decreasing the cognition score (P < 0.05). The indirect effect was 19.9% of the total effect. Findings highlighted anemia affected academic performance both directly and indirectly. Nutrition-related interventions should be implemented to prevent a decrease in academic performance among students with anemia. [ABSTRACT FROM AUTHOR]

Objective. The health benefits of medical care services for older adults have been well known. This study aims to identify trajectories of medical care accessibility and their impacts on Chinese older adults' psychological well-being to enrich findings on health outcomes of medical care accessibility. Methods. This study included 2660 participants aged 65 years and older from the 2005–2018 Chinese Longitudinal Healthy Longevity Survey, and this paper used the latent class growth model to analyze the heterogeneous trajectories of medical care accessibility among Chinese older adults. Ordinary least squares (OLS) regression was also used to explore whether the trajectories of medical care accessibility impact the psychological well-being of Chinese older adults and its heterogeneity among different subgroups of older adults. Results. Three distinct trajectories of medical care accessibility "maintaining high accessibility" (n = 2230, 84.1%), "medium to high accessibility" (n = 222, 8.10%), and "high to low accessibility" (n = 208, 7.80%) were identified, respectively. Regression results show that older adults maintaining high accessibility to medical care reported well psychological well-being. This result was particularly evident among older adults in urban and eastern areas. Discussion. Our findings highlight the importance of maintaining high accessibility to medical care and reducing inequalities in the accessibility to medical care for increasing psychological well-being of Chinese older adults. [ABSTRACT FROM AUTHOR]

Social participation is positively related to mental health recovery and wellbeing, yet people with mental health problems are often socially isolated. This article investigates how social participation was incorporated into an Australian-integrated program that aimed to improve the wellbeing of people with chronic mental health needs. The data are from a longitudinal evaluation of the integrated program, including data linkage (5533 participants) and interviews (111). The paper uses concepts from the network perspective of social capital (bonding, bridging, linking, horizontal, and vertical) as lenses to re-examine the evaluation's findings about the consumers' social participation in life areas (social, leisure, and productive) facilitated by the program. This social capital perspective offers a lens to examine the breadth and intensity of participation experienced by the consumers taking part in the support program. The article adds to the literature about how service providers can improve social participation and therefore consumers' opportunities for recovery and wellbeing. The analyses found that the support increased people's social interaction and their capacity in the community. Their social interaction was mostly with other people in the service. Often their interactions in the community were only transactional. Few consumers participated in activities in productive life areas, and few of the activities promoted vertical social capital in social networks outside the service. The implications are that service providers need greater attention on facilitating a variety of social participation activities that can extend mental health consumers' horizontal and vertical social capital and so further contribute to their current and future recovery and wellbeing. [ABSTRACT FROM AUTHOR]

Introduction: Recent research has identified social capital as an essential element of social context that influences the healthy aging experience. Since social capital is a resource that is context and culture relative, this study builds on and extends the existing literature on social capital among older adults by investigating different dimensions of social capital in later life and related individual and environmental characteristics in the Chinese context. Materials & Methods: Using the China Family Panel Study (CFPS) 2016 wave, 8097 individuals aged 60 years and older were included in the sample. Factor analysis was used to explore the dimensions that comprise the social capital of Chinese older adults. Multiple indicators, multiple cause (MIMIC) structural equation models were used to identify influential individual and environmental characteristics. Results: The findings of this study showed that as an interaction between the actor and the multiple levels of the social environment, the social capital of Chinese older adults derived from three levels of social environment—family, community, and macro society. Rural older adults had higher levels of social capital across all three levels. While demographic factors and functioning, including female, age, marital status, education, and functional limitations, had a significant relationship with family‐based social capital, having higher income and better self‐rated health were related to higher level of community‐ and society‐based social capital. Additionally, the physical community environment was a key determinant across all three levels of social capital. Discussion and Conclusion: Findings from this study demonstrate the important roles of neighborhood environment in shaping older adults' all levels of social capital. The findings also identified the unique role of family social capital and the need for policies and practices to reduce the vulnerability associated with a limited ability to adapt to the broader environment. [ABSTRACT FROM AUTHOR]

Caregiving is a process affected by both caregiver and care recipients and contains both positive and negative experiences. However, there is a lack of theories that capture the impact of the progression of dementia on family caregiving. This study proposed and examined a dementia caregiver process two‐factor (DCPT) model. Specifically, we explored (a) the relationship between the severity of caregiving stressors and caregiver psychological well‐being, along with the mediating role of positive aspects of caregiving (PAC) and caregiving burden, and (b) the moderating role of stages of dementia. Data were obtained from a two‐wave longitudinal data collected from 328 adult–child dementia caregivers in Hong Kong. Multiple group analysis was used to examine the proposed hypotheses. Results show that PAC and burden both significantly mediated the relationship between care recipients' neuropsychiatric symptoms (NPS) and caregiver depressive symptoms and life satisfaction. Stages of dementia significantly moderated the relationship between PAC and caregiver depressive symptoms, with PAC associated with lesser depressive symptoms only among caregivers of those with middle‐ or late‐stage dementia. In sum, the dementia caregiver process two‐factor model proposed in this study was supported by our empirical data. This theory and the study results underscore the importance of both PAC and burden and capture the specificity of the caregiving process in different dementia stages. Findings in this study suggest the need to develop tailored interventions that can better accommodate caregivers with diverse characteristics and adapt to the entire disease trajectory. [ABSTRACT FROM AUTHOR]

Pressure on healthcare systems to address growing population needs is forcing services to adapt, which includes supporting acute patients in the community. One emerging service in the United Kingdom that offers this level of treatment is "Hospital at Home" (HaH). Self‐management support is an area of particular importance in this context considering that acute treatment is provided in a community setting with limited input and monitoring by healthcare professionals. There is currently limited understanding about the range of formal and informal support and resources needed and accessed by patients in such circumstances, and whether and how HaH professionals engage with the everyday contexts and the network members of patients. Semistructured interviews were conducted with nurses (n = 9) from a single Hospital at Home site to further understand their experiences of providing acute treatments in the context of patients' homes; and how self‐management and social network support roles are perceived. Thematic analysis was used and four themes were identified: The value of prioritising illness work at home within a discourse of person-centered care; the work involved in the "naturally" therapeutic environment of the home; partners as key members of the informal care team; limited awareness and engagement with (in)formal networks. Findings demonstrate tensions between discourses where nurses idealise the value of the home and a holistic service provision, while in practice prioritising illness (over relational, emotional, and practical) work and delivering a service that is routinised, and time‐ and cost‐efficient. Nurses recognise the positive role of network members for illness management in the context of people's everyday life, but awareness and engagement are limited to partners and the formal services that HaH staffs are familiar with. Developing a better understanding of the role of social networks (SNs) in supporting people with acute needs at home can help improve patient experiences and care and HaH services, especially for people who are vulnerable, with complex needs, living alone, and with limited access to resources. [ABSTRACT FROM AUTHOR]

Family‐focussed practice is an important component of mental health care. In Australia, service users' views about their experience of service are collected using instruments such as the Your Experience of Service (YES) survey. This study examined 10,579 Queensland (Australia) service users' experiences of mental health services during 2019–2021, with a particular focus on their perspectives of how family and carers are involved in their care. The study examined if family‐focussed practice is welcomed by service users and if it is important in terms of predicting recovery‐related outcomes (e.g., hopefulness, managing day‐to‐day life, well‐being, and experience of care) and which demographics (e.g., age, gender, and Indigenous status) and service characteristics (e.g., time in service, duration, year of service, and setting type) are associated with these outcomes and with family member involvement. A substantial majority of service users reported a positive experience of care (very good or excellent), feeling they had opportunities for family involvement and that their opinions about family involvement were respected (usually or always). Chi‐square tests and nonlinear regression models showed that family involvement predicts care outcomes. Specifically, where individuals felt that their perspectives were recognised, their outcomes were consistently rated as more positive. The results also revealed that setting, age group, time in service, and admission status were significantly correlated with all user experience outcome variables and family‐oriented variables. Future research has the potential to further strengthen this understanding of service users' preferred opportunities and opinions about family involvement and how to improve family engagement and better meet the needs of service users and their families. [ABSTRACT FROM AUTHOR]

Objective. This research aimed to validate the Informal Supporter Readiness Inventory (ISRI) for evaluating the preparedness of informal supporters, in an Australian sample, to provide assistance in the context of intimate partner violence (IPV). Method. The ISRI's four distinct factors were each assessed with separate confirmatory factor analyses (CFA). Reliability was calculated using Cronbach's alpha values, and test‐retest reliability was evaluated using intraclass correlation coefficients. Additionally, the ISRI's validity was assessed through Pearson's correlations with both convergent and divergent measures. Results. The CFAs supported the four distinct factors of the ISRI: normative, individual, situational‐emotion, and situational‐assessment. The measure exhibited good‐to‐excellent internal consistency across these factors and good test‐retest reliability at four weeks. Convergent validity was supported by a strong positive correlation with the Intent to Help Friends Scale, while its weak association with the Generic Job Satisfaction Scale supported divergent validity. Discussion. The ISRI has emerged as a practical instrument with relevance to certain Australian sociocultural dynamics, offering utility in both research and clinical settings. The ISRI supports a network‐oriented approach to IPV survivor support, assisting the alliance between formal and informal support mechanisms. Future research should focus on broadening the ISRI's applicability by assessing its effectiveness across diverse Australian populations. [ABSTRACT FROM AUTHOR]

The increased funding provided for Community Health Worker (CHW) hiring and training as part of the COVID‐19 pandemic response was to increase their impact in alleviating the effects of negative social determinants of health in the lives of the most vulnerable individuals and communities. This enhanced use of CHW in vulnerable populations can also be used to improve access to such populations for applied research to study ways to improve health outcomes for low‐income minority populations. We carried out a feasibility study using the State CHW association as partners to reach CHWs working with low‐income minority population. Three hundred and three (303) clients of CHWs were interviewed on various demographic, health access, and employment information and both univariate and multivariate analyses was used to determine factors associated with being unvaccinated against COVID‐19 and chi‐squared used to determine if employment was associated with having health insurance. About half of the clients self‐identified as Black/African American and half as Hispanic. Two‐thirds were women and 52.1% were unemployed and 55.1% had no health insurance. There was no association between employment status and having health insurance. Majority (71.6%) had received one dose of a type of COVID‐19 vaccine and being younger and being African American were associated with not getting a dose of COVID‐19 vaccine, as well as being unemployed and not having health insurance. Most of the clients came to see the CHW about a Health/Healthcare issue of the five social determinants of health (SDOH). There were 38 different job titles provided by the clients and the job titles were mainly blue collar jobs and jobs in health and personal care. Our results indicate that CHWs reach the most vulnerable population who have limited health access and high unemployment and that CHWs can effectively be used for linkage to low‐income minority population for applied research. Our analyses found that in this low‐income population, being younger, being African American, being unemployed, and not having health insurance are each associated with not getting vaccinated against COVID‐19, and employment is not associated with having health insurance. We have shown that partnership with CHWs to access their clients as research subjects leads to elucidating new information on the population that can be used in addressing public health programming. [ABSTRACT FROM AUTHOR]

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]

Background. High numbers of young people are living with obesity in England, with associated negative impacts on their mental and physical health. Social prescribing involves professionals referring individuals to community‐based services to provide additional health and well‐being support. Social prescribing may be a helpful way to provide holistic support to young people living with obesity alongside weight management services. However, there is a need to better understand the availability of community‐based services that could provide this support. Aims. This study aimed to explore the process for mapping community‐based services to be part of a social prescribing offer within children's specialist weight management services in one region of England and to provide an understanding of the availability of community‐based services in this region that are accessible for this population. Method. Community‐based services providing physical activity opportunities to young people in an area local to a specialist weight management service (South Yorkshire) were mapped using a mixed methods approach, including scoping of online resources and meetings with relevant contacts. Services were identified and reviewed against criteria developed through stakeholder engagement to assess suitability for young people living with obesity. Results. A total of 933 community‐based services were identified across South Yorkshire between January and June 2023. Scoping and suitability assessment of these services took 6 months. There was often limited information provided about services, particularly relating to costs. Nineteen services met all suitability criteria. Conclusion. It requires time and capacity to identify relevant community‐based services as part of a social prescribing offering. Although a high number of services were identified, few of these were suitable for young people living with obesity. Consideration should be given to how young people can be supported to access services, as well as how services can be supported to meet the needs of young people living with severe obesity. [ABSTRACT FROM AUTHOR]

This paper aims to establish strategies of coping with COVID-19 pandemic adopted by the clients of social assistance from the perspective of social workers. The qualitative research among Polish social workers and family assistants was conducted from September to November 2021. Based on 30 in-depth interviews with social work professionals, groups of social assistance clients' behaviours were identified and classified into the theoretical models of reactions to social change by Merton and Giddens. The following types of behaviour have been selected and categorized into four groups of reactions when dealing with social workers in a pandemic situation: coolheaded calculation, defiance, confusion, and adaptation. At the same time, reactions to the situation of social change were categorized into one of the strategies of active or passive behaviour: innovation, contestation, retreat, and acceptance. In addition, we discussed the impact of clients' coping strategies on social workers and established three attitudes of the surveyed social workers: adapting to the pandemic situation and customer behaviour, assuming the role of an emotional buffer and informant, and expecting support from superiors and coworkers. Knowing the behaviour of social assistance clients in a challenging situation makes it possible to adopt tailor-made measures. [ABSTRACT FROM AUTHOR]

Vulnerable communities (including people from refugee, Indigenous, culturally and linguistically diverse, and low socioeconomic backgrounds) represent the most at-risk populations facing inequities and negative health, economic, and social outcomes. The recent COVID-19 pandemic both highlighted and fuelled these disparities. Community gardening has emerged as a community-based solution to address these inequities, yet the research literature has largely considered outcomes for the general population rather than those with the most need. This paper represents the first systematic review to summarise the evidence on the broad impact of community gardening on outcomes for vulnerable populations. A systematic search of 13 databases (PubMed, Medline, Scopus, ScienceDirect, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Web of Science, Academic Search Complete, Education Source, Education Resources Information Center, Psychology and Behavioral Science Collection, SocINDEX, and Allied Health and Complementary Medicine Database) for English language articles from 1985 to 2022 was conducted. There were 33 studies identified where females were substantially overrepresented in the studies compared to males, and the main criteria for vulnerability included low socioeconomic-status and culturally diverse populations. Findings revealed that community gardening provides a wide range of benefits for vulnerable populations, with social connection, health, education, and nutrition being the more commonly cited. A relative emphasis on benefits of social connections, education, and nutrition is apparent for vulnerable populations in comparison to reviews considering the general population. The quality of studies was evaluated as moderate with little information provided about program characteristics. These shortcomings reduce the understanding of what characteristics are most likely to result in improvements and limit the capacity of practitioners to translate research into policy and practice for vulnerable communities. [ABSTRACT FROM AUTHOR]

Objectives. To review the prevalence of loneliness (during/after COVID-19) in older people. Design. Scoping review using Medline and PsycInfo for worldwide prevalence estimates (white published literature search) and Google for prevalence data inside the Euregio Meuse-Rhine (grey literature). Setting. Worldwide prevalence estimates and a focus on the Euregio Meuse-Rhine. Participants. Papers published between 2016 and 2022 and a mean age of minimum of 65 years. Measurements. Prevalence estimates for older people. Results. The white literature search yielded 37 articles. Before the onset of the COVID-19 pandemic, loneliness estimates were the highest in Nigeria (46%) and the lowest in Australia (5%) (mean prevalence was 25.6%). Loneliness was reported to be higher in specific populations, for example, people living in specific communities such as senior housing communities or with impairments, than in the general population, with a mean prevalence estimate of 47.8%. During COVID-19, the prevalence of loneliness was higher than that before the pandemic: we observed a mean prevalence of 39.4%, in comparison to 25.6 before COVID-19. The grey literature search showed that, compared to Belgium and the Netherlands (13.5% and 36.5%, respectively), loneliness estimates were the lowest in Germany, with a mean prevalence of 7.7%. Conclusion. Large international differences in the prevalence of loneliness were observed between countries and populations studied. Several hypotheses could explain such differences, including sociocultural or historical-political characteristics. Without surprise, the pandemic and associated measures were linked to a higher level of loneliness. Furthermore, recommendations for addressing loneliness, including interventions, are discussed. [ABSTRACT FROM AUTHOR]

People with dementia and their care partners report a lack of support, treatment, and information, fragmented services, and a lack of inclusion in decisions about their care. Care planning may address these issues; however, there is scarce literature on the process or benefits of care planning for people with dementia. This review describes the literature on care planning for community-dwelling people with dementia and their care partners. A systematic scoping methodology was followed to identify the research questions, identify relevant documents, select relevant documents, chart the data, and collate, summarise, and report the results. 31 full-text documents published between 2010 and May 2020 were identified and reviewed. Seven were guidelines, seven were expert opinion pieces, 11 were intervention studies, and six were descriptive studies. The topics and process of care planning varied depending on the service context (e.g., memory clinic, home care, and primary care). Care planning was presented as a component of case management in 15 papers. Six of the 11 intervention studies reported positive outcomes, one showed no improvement, and one did not evaluate outcomes for people with dementia or their care partners. Of the six with positive outcomes, four evaluated care planning in the context of care management. There is limited evidence that care planning alone improves outcomes for people with dementia and their care partners. It is unclear whether it may have benefits when combined with care management. [ABSTRACT FROM AUTHOR]

Organisations spanning social services, public health and healthcare have increasingly experimented with collaboration as a tool for improving population health and reducing health disparities. While there has been progress, the results have fallen short of expectations. Reflecting on these shortcomings, the Robert Wood Johnson Foundation (RWJF) recently proposed a new framework for cross‐sector alignment intended to move the field towards improved outcomes. A central idea in this framework is that collaboratives will be more effective and sustainable if they develop collaborative systems in four core areas: shared purpose, governance, finance and shared data. The goal of this paper is to provide a foundation for research on the four core areas of the cross‐sector alignment framework. Accordingly, this study is based on two guiding questions: (1) how are collaboratives currently implementing systems in the four core areas identified in the framework, and (2) what strategies does the literature offer for creating sustainable systems in these four areas? Given the emergent nature of research on health‐oriented cross‐sector collaboration and the broad research questions, we conducted a systematic scoping review including 179 relevant research papers and reports published internationally from the years 2010–2020. We identified the main contributions and coded each based on its relevance to the cross‐sector alignment framework. We found that most papers focused on programme evaluations rather than theory testing, and while many strategies were offered, they tended to reflect a focus on short‐term collaboration. The results also demonstrate that starting points and resource levels vary widely across individuals and organisations involved in collaborations. Accordingly, identifying and comparing distinct pathways by which different parties might pursue cross‐sector alignment is an imperative for future work. More broadly, the literature is ripe with observations that could be assessed systematically to produce a firm foundation for research and practice. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate how legal professionals in Australia responded to the mental distress experienced by clients with insecure visa status in the Fast Track Assessment (FTA) process. This article reports on survey findings obtained from 38 legal professionals followed up by focus groups and interviews with 16 participants. The participants were all involved in providing legal assistance to refugees and asylum seekers with insecure visa status, the majority delivering that assistance via pro bono or community law centre settings. An inductive thematic analysis was used to analyse the data. The study uncovered a complex interplay of practical challenges, emotions, and ethical dilemmas that legal professionals encounter while assisting asylum seekers in the FTA process. The study participants' experiences highlight that a migration law practice frequently becomes the initial setting where asylum seekers disclose mental distress. Legal professionals found themselves simultaneously witnessing human suffering and endeavouring to prevent re‐traumatisation of their clients. Responding to distress was difficult to achieve as the operational setting in which they provided legal assistance and the prevailing hardline political messaging by the Australian government toward asylum seekers who arrived by boat was hostile and (re)traumatising. There is a pressing need for more trauma‐informed education and training for both current and future legal professionals. Findings are discussed alongside practical suggestions for trauma‐informed interviewing for legal professionals who interview asylum seekers. [ABSTRACT FROM AUTHOR]

Aim. To explore how Black African international students adjust to their new university environment and gain insight into how they feel supported to engage in physical activity (PA). Background. People from ethnic minority backgrounds have poor physical activity levels compared with white populations in the UK. The Black population is known to have the lowest PA levels among the ethnic minority groups in the UK. This trend is suggested to be the case among university students, but no research has examined this. Ethnic minority students, including international students, encounter adaptation difficulties such as cultural barriers and social isolation which affect their university experiences and health behaviours such as physical activity. Methodology. This was a qualitative method, with in‐depth semistructured interviews conducted with five African students (two males and three females) aged between 21 and 40 years from a university in the West Midlands. The transcribed interviews were analysed using Braun and Clarke's thematic analysis. Results/Findings. Culture and lifestyle of physical activity; knowledge, experience, and self‐motivation; the effect of various social groups, activities, and services at the university; and weather variations and physical settings were the identified themes. The key finding of the study is that respondents engaged in PA to a greater extent at the British university than they did in their home countries. This was due to a combination of factors, including low‐cost gym memberships and events and a general lack of racial or gender‐based discrimination. Conclusions/Recommendations. Participants expressed satisfaction with the cultural and social support systems at their university, such as sports clubs and societies, and mental health support services that encouraged them to learn about and engage more in physical activity. Although some barriers, such as weather variations, were mentioned, various indoor options coupled with cheaper gymnasiums motivated students to remain or become active. Understanding the experiences of minority student groups in physical activity could help in reviewing current provisions and extending them to a wider population. [ABSTRACT FROM AUTHOR]

Increasing frailty or a medical crisis threatens older people's autonomy. Further threats may arise from adult children if such changes or events are perceived as permitting or signalling a need to assume greater control over their parent's life. In the context of reablement—a time‐limited intervention seeking to help older people regain their confidence and ability to live as independently as possible—this is observed in cases where adult children resist, or seek to sabotage, reablement. This runs counter to the notion of family being a valuable resource and partner to reablement services in achieving the desired outcomes. Notions of autonomy and legitimate authority, which often co‐occur in care relationships, provide a useful lens to understand this phenomenon. The aims of this study were to explore reablement staff's accounts of the ways adult children seek to assume control over their parents' reablement, and how they manage such situations. We undertook a secondary analysis of a qualitative dataset comprising transcripts of 11 focus groups with staff (n = 78) in five reablement services in England and Wales conducted for the purposes of a study investigating the factors affecting older people's engagement with reablement. Staff's accounts included descriptions of the different ways adult children can seek to exert control over the reablement process. Staff believed that, when aware this was happening, older people ceded control to their child(ren) because preserving the relationship with their child(ren) was a greater priority than maximising their independence. Staff's descriptions of the different strategies they used to protect family relationships whilst supporting the older person's autonomy shed light on the skills reablement staff require. Findings support person‐centred approaches to reablement which understand and respond to the wider family context. They also point to possible limitations or gaps in workforce training and supervision. [ABSTRACT FROM AUTHOR]

Background. Local government is important for health equity because local policies often affect place‐based health, health equity, and their wider social determinants of health. In England, local governments must produce Joint Health and Wellbeing (JH&W) Strategies, outlining local strategies for health improvement. These strategies have been produced concurrently with budget cuts to local governments that are associated with adverse health and mortality outcomes. Using a novel approach, we assessed whether English local governments' strategies for place‐based health and equity help explain why some disadvantaged areas have better mortality trends than others. Methods. We sampled "Joint Health and Wellbeing" (JH&W) Strategies for 20 disadvantaged localities covering the years 2013–2017. We sampled areas to include some with larger and some with smaller budget cuts. We developed a qualitative appraisal process for scoring the extent to which JH&W strategies focused on (i) place‐based social determinants of health and (ii) health equity. Using qualitative comparative analysis, we assessed whether mortality trends might be explained by JH&W scores or wider contextual factors such as budget cuts, population age, and disadvantage. Results. JH&W strategies on place‐based social determinants of health and equity were often underdeveloped. Only a minority of strategies were highly rated (i.e., scoring >2 out of 3) for addressing social inequalities of health (n = 6), and even fewer scored highly for place‐based social determinants of health (n = 3). Our qualitative comparative analysis found that external and contextual factors (e.g., budget cuts and disadvantages) offer more plausible explanations than JH&W strategies for place variations in life expectancy trends. Conclusion. Budget cuts and other contextual factors better explain mortality trends than JH&W strategies. This raises concerns about what such strategies can realistically achieve in the face of structural disadvantage and national policies that restrict local spending. [ABSTRACT FROM AUTHOR]

Background. Changing demographics has led to healthcare systems reorientating healthcare delivery towards the community setting and implementing integrated models of care worldwide. This systematic review examines the effectiveness of community‐based multidisciplinary integrated care strategies with general practitioner (GP) participation for community‐dwelling older adults and describes the level of care integration in each study. Methods. PubMed, Embase, CINAHL, Central Register of Controlled Trials in the Cochrane Library, and MEDLINE were systematically searched in February 2024. Randomised controlled trials (RCTs) or cluster RCTs that focused on interventions for community‐dwelling older adults delivered by health and social care professionals with GPs were included. Two reviewers independently conducted the risk of bias assessment, applied the GRADE tool to quantify the certainty of evidence, and used the rainbow model of integrated care taxonomy to describe the elements of integrated care. Outcomes included functional status, healthcare utilisation, participant satisfaction with care, health‐related quality of life, mortality, nursing home admission, and adverse outcomes. Meta‐analyses were performed using Review Manager 5.4. Results. Twelve trials recruiting 8069 participants across 8 countries were included. Community‐based multidisciplinary team (MDT) integrated care demonstrated significant improvements in functional status (standardised mean difference (SMD): 0.21; 95% confidence interval (CI): 0.05–0.37; low certainty evidence), hospitalisation (risk ratio (RR): 0.77; 95% CI: 0.63–0.95; very low certainty evidence), and participant satisfaction with care (SMD: 0.46; 95% CI: 0.15–0.76; low certainty evidence) from 12 to 36 months. No statistically significant effects favouring community‐based MDT interventions for functional status at 6‐month follow‐up, emergency department presentation, mortality, health‐related quality of life, or nursing home admission were established. Conclusion. Community‐based MDT integrated care with GP participation improves functional status, reduces hospitalisations, and increases patient satisfaction among community‐dwelling older adults in the long term. Future research should focus on models of integrated care that respond to the needs and preferences of older adults. This trial is registered with CRD42022309744. [ABSTRACT FROM AUTHOR]

This study examined the associations between community social capital and self‐reported oral health among older adults in urban China, as well as the moderating effect of household income and the mediating role of depressive symptoms in these associations. Data were obtained from a community survey conducted in 2020 in Tianjin and Shijiazhuang City, China; the final analytical sample comprised 776 adults aged 60 years and above. To test the proposed moderation and mediation models, the data were analysed using binary logistic regression models and a path analysis, respectively. The findings showed that cognitive social capital and social participation (i.e., an indicator of structural social capital) were significantly associated with self‐reported oral health. Additionally, the results revealed that while income significantly moderated the association between cognitive social capital and self‐reported oral health, depressive symptoms significantly mediated it. The findings not only highlight the crucial role of community social capital in promoting oral health in later life among low‐income older adults but also provide important evidence for a psychosocial pathway between social capital and oral health. Given the impacts of income and depressive symptoms on the relationship between community social capital and oral health among older adults, future social policies and interventions to support oral health should target financially vulnerable older adults with poor psychological well‐being. [ABSTRACT FROM AUTHOR]

Objectives. How geriatric care models impact the health‐related behaviors of the elderly and the function of social support within this context. Methods. We conducted binary logistic regression and PSM‐DID analyses using data from the China Tracking Survey of Factors Influencing Elderly Health (CLHLS) and the China Health and Aging Tracking Survey (CHARLS). Results. Compared to living alone, other aging models negatively affected health behaviors. In the living with family model, parental intergenerational support attenuated these effects, while children's financial support reduced negative impacts on health‐protective behaviors. In the institutional model, negative effects on health‐hazardous behaviors were exacerbated by emotional and social support. Loneliness and a lack of self‐worth were crucial pathways. Discussion. Governments should offer public services to alleviate the intergenerational support burden on older individuals and strengthen social support for them. [ABSTRACT FROM AUTHOR]

Permanent supportive housing (PSH) is the main approach advocated in Western countries for eradicating homelessness. Considering that PSH residents are not a homogeneous group and that their quality of life (QoL) and community integration (CI) might differ in this setting, improving our understanding of these residents' profiles may help stakeholders formulate informed recommendations to improve PSH. This study identified PSH resident profiles based on their QoL, CI, and sociodemographic and clinical characteristics and associated these profiles with housing features and service use. A total of 308 PSH residents were recruited in Montreal (Canada) in 2020–2022. Structured interviews were conducted. PSH resident profiles were produced with cluster analysis and subsequently compared using chi‐square, Fisher's, and t‐tests, taking into account housing features and service use. Three PSH resident profiles were found. Profile 1 residents (22% of the sample) had low QoL and CI, were younger, and had major social and health issues and unmet needs. Showing moderate QoL and CI, Profile 2 residents (27%) were more educated, had little foster care history, were older on their first homelessness episode, and had few co‐occurring MD‐SUD. Profile 3 residents (51%) had the best QoL and CI and mostly included men with little education, affected by co‐occurring MD‐SUD and satisfied with services. More intensive housing support and care coordination may be recommended for Profile 1 PSH residents in response to their diverse needs. Work integration may be beneficial to Profile 2 residents, with programs such as Individual Placement and Support, along with increased rehabilitation activities. A better integration of MD‐SUD treatments may be promoted for Profile 3 residents. Considering most PSH residents had multiple health issues and unmet needs, satisfaction with care could be monitored better, as it was found to be a key variable in measuring care adequation. [ABSTRACT FROM AUTHOR]

Social participation in older age has been positively associated with enhanced health and wellbeing. This project examined key aspects of social participation for older people living in the community to identify what was most important for maintaining social participation in the event they transitioned to living in a nursing home. We conducted interviews and focus groups with 36 older people, aged 65 years or older living in the community in Victoria, Australia, between 2020 and 2022. Interview transcripts were analysed thematically. Participants discussed their understanding of the importance of social participation and what helped maintain it. Findings demonstrated the key importance of relationships, both old and new, in maintaining social participation, and to the preservation of a sense of identity. An important facilitator to maintaining relationships was having a physical place to go to interact. Barriers to social participation included diminishing social networks and life transitions. The impacts of the COVID‐19 pandemic were commonly referred to by all participants, outlining the obvious impediments to maintaining relationships (e.g., social isolation associated with lockdowns) and how that affected social participation. Conversely, some participants outlined the positive impact the restrictions had on their connection with friends and family. These perspectives outline the importance of being able to maintain relationships through life transitions, like a pandemic or moving into a nursing home, to optimise opportunities for social participation. Findings from this study will be relevant for aged care providers as they implement services to optimise social participation for older people who transition to living in nursing homes. [ABSTRACT FROM AUTHOR]

Background. Despite the growing prevalence of Parkinson's disease (PD) and the need to plan for future health service provision, little is known in the Irish context about PD patients' experiences of service access/use. Methods. A cross-sectional survey, with multiple formats, i.e., online, pen-and-paper, and telephone. Data were collected from May 2020 to July 2021 using a multipronged recruitment strategy. The survey was completed by people with PD alone or with the support of a carer/support person. Results. A total of 1402 responses were included. Over half (53%) were male. Approx. 10% were diagnosed with young-onset PD. A minority (6%) reported attending only their GP to manage their PD, with the rest attending a generic or specialist outpatient clinic. Almost 1-in-5 reported it took more than 12 months to obtain the diagnosis. Most were diagnosed by neurologists (84%), followed by GPs (8%) and geriatricians (7%); 1% indicated "other." Of those diagnosed privately, 37% of these patients subsequently switched to the public system for ongoing management. The majority (97%) reported currently taking PD medications, but just 52% believed these were working effectively. Access to the range of health and social care professionals, including PD nurse specialists and clinical therapies is universally poor. Conclusions. A number of significant gaps in PD care are discussed, which require urgent attention. A reconfigured model of PD care is necessary to accommodate the growing need for specialist, integrated care at the population level. Specifically, more PD nurse specialists are needed within the public health system. [ABSTRACT FROM AUTHOR]

A strong First Nations health workforce is necessary to meet community needs, health rights, and health equity. This paper reports the findings from a national survey of Australia's First Nations people employed in health services to identify enablers and barriers to career development, including variations by geographic location and organisation type. A cross-sectional online survey was undertaken across professions, roles, and jurisdictions. The survey was developed collaboratively by Aboriginal and non-Aboriginal academics and Aboriginal leaders. To recruit participants, the survey was promoted by key professional organisations, First Nations peak bodies and affiliates, and national forums. In addition to descriptive statistics, logistic regression was used to identify predictors of satisfaction with career development and whether this varied by geographic location or organisation type. Of the 332 participants currently employed in health services, 50% worked in regional and remote areas and 15% in Aboriginal Community-Controlled Health Organisations (ACCHOs) with the remainder in government and private health services. All enablers identified were associated with satisfaction with career development and did not vary by location or organisation type. "Racism from colleagues" and "lack of cultural awareness," "not feeling supported by their manager," "not having role models or mentors," and "inflexible human resource policies" predicted lower satisfaction with career development only for those employed in government/other services. First Nations people leading career development were strongly supported. The implications for all workplaces are that offering even a few career development opportunities, together with supporting leadership by Aboriginal and Torres Strait Islander staff, can make a major difference to satisfaction and retention. Concurrently, attention should be given to building managerial cultural capabilities and skills in supporting First Nations' staff career development, building cultural safety, providing formal mentors and addressing discriminatory and inflexible human resources policies. [ABSTRACT FROM AUTHOR]

Active citizen participation in research is important to generate societal impact of outcomes. Even so, many times, the community input in these processes is limited or non-existent, and co-creation processes are often not documented. This paper describes a structured and systematised protocol to co-create a nature-based social prescribing intervention addressed to face loneliness in urban deprived neighbourhoods. As a result, a nature-based social prescription menu was co-developed with stakeholders from health, social prescription, nature, associative, and research sectors. The menu consists of open spaces and nature activities and will be offered to the participants of a randomised controlled trial to test actions for social prescribing in natural spaces. [ABSTRACT FROM AUTHOR]

Social enterprises, which are businesses with social objectives, have been championed by the UK government as an opportunity to deliver more innovative, socially oriented, and commercially sustainable public services. However, very little is known about them, especially in a social care context. This paper therefore aims to answer the following three questions: (1) What are care social enterprises?, (2) What are their distinctive qualities?, and (3) How can they contribute to the adult social care sector? It presents evidence from a "mapping" of care social enterprises in three English local authorities, and from interviews with 35 stakeholders from across the social care and social enterprise sectors. Drawing on an institutional logics framework, we explore the influence of different norms, goals, and practices on care social enterprises and the extent to which they are aligned with those of the public, private, and not-for-profit sectors. We found that their unique combination of business and social logics, along with an entrepreneurial mindset, may make them more flexible, innovative, and able to diversify their income than public and not-for-profit care organisations. They were also considered more trustworthy than private care services. However, their competing social and business logics can create internal tensions and bring uncertainty about what organisational model they are. These tensions can make it challenging for us to define what a care social enterprise is and in turn for social enterprises to promote themselves and attract funding. [ABSTRACT FROM AUTHOR]

Unnecessarily prolonged stays in hospitals can have negative impacts on patients and present avoidable costs to health and social care systems. This paper presents the qualitative findings of a multi‐methods study of the social care causes of delayed transfers of care (DTOC) for older people in England. The quantitative strand of this study found that DTOC are significantly affected by homecare supply. In this paper, we explore in depth how and why social care capacity factors lead to delays, from the perspectives of those working within the system. We examined the local transfer arrangements in six English local authority (LA) sites that were purposively sampled to include a range of DTOC performance and LA characteristics. Between March and December 2018, 52 professionals involved in arranging or facilitating discharge from hospitals in these sites provided qualitative data, primarily through semi‐structured interviews. Topics included discharge teams and processes, strategic issues and perceived causes of delays. The thematic analysis uncovered the nuances behind the causes of DTOC previously categorised broadly as 'provider capacity' and 'patient choice'. In particular, our analysis highlights the lack of fit between available provision and the needs of people leaving hospital (theme 1); workforce inconsistencies (theme 2) and a myth of patient choice (theme 3). We are now at a turning point in the development of policy to reduce DTOC in the English system, with the full implications of a new national discharge to assess programme yet to be seen. Our research shows the significance of the alignment of service capacity, including the type and location of provision, with the needs and preferences of those leaving hospital. As the new system becomes established, attendance to such nuances behind blockages in the system will be more important than ever. [ABSTRACT FROM AUTHOR]

Migrants face several unmet health needs due to the inability of the healthcare system to address their healthcare challenges. As a result, they adopt coping strategies to overcome their healthcare needs. Consequences can include infrequent but severe adverse reactions, dangerous drug interactions, incorrect dosage etc. Little is known in Ghana about the role played by cultural and linguistic barriers in shaping migrants' access to formal healthcare and the coping mechanisms adopted by these migrants to overcome their healthcare challenges. Surprisingly, most of the studies that have been conducted have focused on financial barriers to care accessibility. This presents a loss opportunity for any health programme aimed at addressing this inequity. Thus, the purpose of this paper is to fill this gap by exploring the challenges of healthcare accessibility and coping strategies adopted by migrants to overcome their healthcare needs in the informal urban settlement of Madina, in the Greater Accra Region. The author employed a narrative type of qualitative research design. A purposive and then snowball sampling technique were used to select 20 participants to participate in the study after saturation was reached. Twelve in‐depth interviews (IDIs) and six key informants' interviews (KIIs), as well as two focus group discussions (FGDs), were conducted. The study is consistent with the ecological model, which posits that health is determined by influences at multiple levels. The author found linguistic, cultural, stigmatisation and financial challenges as the main barriers to healthcare accessibility among the migrants. As a result, self‐medication and the use of lay health personnel for addressing healthcare needs were more pronounced. The study also found other means of survival that posed a health risk to the migrants. Based on this, it was recommended that healthcare systems take into account the healthcare needs of migrants who are people with culturally and linguistically diverse backgrounds. [ABSTRACT FROM AUTHOR]

Personal Assistants (PA) or client‐hired workers are directly employed by people needing care and support, often making use of government funding. In the context of Covid‐19, questions emerged about how this workforce is supported to practice safely. This paper reports PAs' understanding and views of infection control during the early months of the Covid‐19 pandemic in England. Telephone interviews were undertaken with 41 PAs between 16th April and 21st May 2020. PAs were recruited from a sample that had participated in a previous study in 2014–16. Interview questions focused on changes arising from the pandemic. Data were transcribed and analysed using Framework analysis. This paper focuses on PAs' perceptions of their role and responsibilities in preventing and managing infection. Arising themes were identified about barriers and facilitators affecting infection control in five areas: accessing information, social isolation, handwashing, hygiene, personal protective equipment and potential attitude to vaccines. Infection prevention and control are under‐researched in the home care sector generally and efforts are needed to develop knowledge of how to manage infection risks in home settings by non‐clinically trained staff such as PAs and how to engage home care users with these efforts, especially when they are the direct employers. [ABSTRACT FROM AUTHOR]

Young carers support family members affected by disability or a health condition. The Young Carer Bursary Program aims to support young carers' education. This paper analysed data from consenting bursary applicants (2017–2019) to investigate relationships between wellbeing, educational attendance, home study and other factors. Descriptive statistics, correlation and regression analysis determined significant issues, relationships and influential factors related to young carer (N = 1,443) wellbeing and education. Sixty‐eight percent were aged between 13 and 18 years and attended secondary school. One third of the sample reported that they were the main carer in their family and 29% reported receiving no support. Female applicants from single parent households who were the main carer attended educational settings less often. Eighteen percent (n = 267) rated their wellbeing as poor/very poor. Better wellbeing was associated with increased educational attendance (rs = 0.33, p < 0.001) and home study (rs = 0.34, p < 0.001). Wellbeing was associated with main carer status, caring for a parent, having a disability, being older and having few supports. Educational attendance was associated with main carer status, higher care load and fewer supports. Home study was associated with having a disability, caring for a sibling, caring for more than 11 hr per week and having fewer supports. Important factors about the age, life situation and challenges experienced by young carers identified in this paper indicate that further research into preferred supports and effectiveness of the bursary in improving educational engagement is warranted. [ABSTRACT FROM AUTHOR]

Prior to its introduction in Australia, many people opposed euthanasia—or voluntary assisted dying as it is known—because of its potentially detrimental impact on grief and bereavement outcomes for family members and carers. We examine the novel experiences of grief and bereavement of VAD for family members and carers who were going through, had gone through, or were contemplating VAD, juxtaposing the international literature on grief and bereavement. As such, 42 semistructured interviews with family members and carers were undertaken in the state of Victoria, which was the first jurisdiction to legislate in favour of VAD. Interviews explored many themes around end‐of‐life decision‐making in order to ascertain the ways in which VAD helped or hindered grief and bereavement processes. A thematic analysis of the interview data was undertaken using QSR NVivo software. Four key themes were identified: values and meaning‐making, expression of a continuing bond, anticipatory grief, and the burden of care associated with supporting loved ones going through VAD. These themes were juxtaposed with the key literature on grief and bereavement to demonstrate how VAD presents novel challenges for carers. We argue that while VAD deaths share similar characteristics to other deaths; in some respects, grief and bereavement outcomes for family members and carers are unique. For family members and carers helping a loved one go through VAD, they were able to derive a sense of meaning from fulfilling their wishes and striving for them to have a "good death"; they were able to maintain a bond with them through advocacy of VAD and unique rituals; and they were able to plan and prepare effectively by knowing the exact time of death. Family members and carers also noted that VAD presents some significant challenges for grief and bereavement, especially in terms of the impact of VAD on familial relationships and burdens associated with moral predicaments. Nonetheless, VAD was generally viewed positively by family members and carers, who expressed gratitude for mitigating their loved one's suffering. [ABSTRACT FROM AUTHOR]

Internationally, community healthcare is provided by personal health budgets or personalised schemes as part of a consumer-directed care emphasis. Although the introduction of a personalised scheme in Australia has improved the lives of many, people with psychosocial disability (PSD) and their families have experienced many challenges with service integration. Six focus groups with 17 National Disability Insurance Scheme (NDIS) support workers were conducted between June and November 2022. Participants were asked semistructured questions about their engagement with emergency department (ED) clinicians when presenting with a person with PSD and NDIS plan. They were also asked how they contribute to service integration to improve communication practices between the two services. A qualitative, descriptive thematic analysis approach was used. Results indicate there is a need for improved service integration pathways between the ED and NDIS services. The thematic analyses identified five main themes: the ED is harmful and not safe, but nowhere else to go; make the ED safe; further training for ED staff; improving communication across services; and alternatives to the ED. This study reports NDIS support worker's experience when supporting a person they are caring for in the ED. NDIS support workers have an understanding of the needs of the people they care for;their wisdom can contribute greatly to ED clinical responses in crisis care. Recommendations are offered to assist with service integration between the two systems. [ABSTRACT FROM AUTHOR]

Rationale. Recent studies have highlighted organizational issues, work stressors, and moral distress as prevalent problems among staff working within care services for older people, but factors influencing regulatory compliance in care services for older people are currently uncharted. Aims and Objectives. The aim of this exploratory study was to investigate how organizational factors, the clinical characteristics of the clients, and perceived organizational factors are associated with staff regulation noncompliance within home care services and service housing facilities. Methods. A self-report survey was sent to practical and registered nurses working in home care services and service housing in Finland in October 2021. The sample consisted of 352 home care and 555 service housing staff members. Separate models were calculated for home care services and service housing facilities. The data were analyzed using logistic regression models. CROSS reporting guidelines were followed. Results. The results show that in service housing facilities, higher numbers of disruptions, lower team autonomy, and working for a private employer increased the odds of regulation noncompliance. In home care services, higher numbers of visits during a day, higher numbers of disruptions, and lower team autonomy increased the odds of regulation noncompliance, while attending to clients requiring less resources decreased the odds of regulation noncompliance. Perceived lack of time and resources were influential factors in both contexts. Conclusion. Allocating more time to attend to tasks, ensuring adequate staffing, as well as supporting team autonomy, may increase regulation compliance within care services for older people. [ABSTRACT FROM AUTHOR]

Community engagement (CE) has long been endorsed by policy makers and health practitioners. However, uncertainties remain about the workings and outcomes of CE. This study aims to provide in-depth insights into them. In a multiple case study, we investigated three participatory health promotion projects for families in vulnerable situations in the Netherlands. We adopted a realist approach combined with a theory of change (ToC) model. We then analysed the qualitative data for context–mechanism–outcome (CMO) configurations to refine this ToC. Results show that CE can strengthen social networks, empower families, and increase perceived health. However, specific contexts in combination with CE project approaches may or may not trigger positive responses. Participants may feel that they matter when asked to actively contribute to a project, which in turn can enhance their self-confidence. In another context, we found that families were overwhelmed by the responsibilities given to them in the project, leading to feelings of stress and withdrawal from the project. We present a list of CMO configurations and refine the ToC accordingly. Our main conclusion is that flexibility is key when CE is implemented in health promotion. Also, our findings question physical health outcomes as a realistic ambition for CE projects with groups in vulnerable situations. [ABSTRACT FROM AUTHOR]

Pediatric palliative care (PPC) programs are essential in encompassing not only the affected children but also their family system and the healthcare and educational professionals involved. Despite the field's significance, there is a notable scarcity in current literature, which underscores the pressing need for further research into the attributes of PPC programs that effectively enhance the quality of life (QoL) for pediatric patients. This study particularly emphasizes the pivotal role of schools as key community resources within this framework, highlighting the crucial aspect of educational integration in PPC. Through a systematic review of relevant literature and applying stringent inclusion and exclusion criteria, we identified pertinent studies across various databases. Of these, 30 articles met our criteria and were subject to a thorough qualitative analysis. Our findings indicate that while PPC programs may vary in their methodologies, they consistently share certain core elements that significantly boost the QoL for pediatric patients. These include a holistic approach that addresses the physical, emotional, psychosocial, and spiritual facets of care; encourages the active involvement of the patient in decision-making processes; and ensures timely access to PPC services. Importantly, our analysis identified the critical role of educational settings in enhancing QoL, shedding light on the vital need for educational inclusion and the integration of schools into the broader spectrum of PPC services. The distinct individual perceptions of QoL and the varied international practices in PPC underscore the imperative to tailor successful strategies to specific local contexts, thereby fostering the global well-being of pediatric palliative care patients. [ABSTRACT FROM AUTHOR]

There has been growing interest in exploring factors that influence the success or otherwise of welfare policies in democratic countries, such as the interrelationships between the proposed policy and the context it will be introduced into, such as the sociodemographic characteristics of the population and the population's previous experience with welfare policies. However, there has been little exploration of factors that could influence general population support for long-term care for older people. The aim of this study was to investigate the general population's attitudes for determinants of high-quality aged care and different mechanisms for funding and any impact of individual characteristics on these. A representative sample of the Australian general population aged 18 years and over (N = 10,315, 52% female, 22% aged 65 years and over) drawn via quota sampling participated in the survey online. Participants were asked to rate the importance of a list of 10 determinants of quality care and their support for four models of funding, both using a five-point Likert scale. We identified consistently high expectations for long-term care services across the general population, especially among older people, females, those with a family member in care, and those living in rural or regional areas. In terms of how governments practically fund a high-quality long-term care system, we also identified broad support among the general population for both payment of a co-contribution towards the cost of care by older people using services and increased government funding for the system. Over 40% of participants said they would be willing to pay additional tax to improve access and quality of aged care services. While often neglected by governments in the past who assumed voter apathy on the topic, by comparison, our findings indicate that there is currently a strong appetite among the general population for improvements to the quality of care provided and that they are willing to consider changes to the funding model. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic, the well-being of older adults has been highlighted as a significant public health concern. In this study, we investigated the role of psychological resilience in mediating the relationship between positive self-perceptions of aging (SPA) and the subjective well-being (SWB) of community-dwelling older adults in Taiwan during the pandemic. We collected data through face-to-face interviews conducted from October 2021 to February 2022, involving 1,095 participants aged 50 years or above residing in a southern city in Taiwan. More than half of the study participants were female, aged 65 or older, and had less than a high school education. More than two thirds were married and/or living with partners. More than a third had two or more noncommunicable diseases. We calculated scores for SWB, positive SPA, and psychological resilience and examined correlations among the outcome and predictor variables. Our findings indicated that higher positive SPA was significantly associated with better SWB among community-dwelling older adults in Taiwan and that this association was mediated by psychological resilience. Specifically, after controlling for covariates, structural equation modeling (SEM) analysis revealed a significant main effect of positive SPA on SWB (b = 0.412, β = 0187, and p < 0.001), while bootstrap mediation analysis showed a statistically significant indirect mediating effect from positive SPA on SWB via psychological resilience (0.597, 95% bootstrap CIs = [0.445, 0.749], and p < 0.001). These findings highlight the potential importance of cultivating positive self-perceptions of aging and implementing resilience-centered interventions to promote well-being among Chinese older adults in the community. [ABSTRACT FROM AUTHOR]

Background. The goal of qualitative research is to learn more about the opinions and experiences of the subjects being studied in relation to a particular question. There is a paucity of information on opportunities and challenges encountered to conduct qualitative research among the academic staffs in the health sciences. The purpose of this study was to examine the opportunities and challenges of conducting qualitative research among academic staff of health sciences in Ethiopia. Methods. A descriptive qualitative study design was conducted among health sciences academic staffs of selected public universities in Ethiopia. The study was conducted at three universities' health sciences colleges, namely, Addis Ababa University, Dilla University, and Wolaita Sodo University. Data were collected using focus group discussions, in-depth interviews, and key informant interviews. MAXQDA 2020 software was used for coding and data management. A thematic analysis approach was followed to present the results. Both inductive and deductive coding approaches were used. Results. Three main themes have been identified as follows: general research practice, opportunities for qualitative research, and challenges to conduct qualitative research. Participants indicated that the availability of research opportunities will have a good impact on qualitative research engagement. Availability of grants, funding, and other incentives and demand for qualitative research in healthcare were described as opportunities for qualitative research practice. Despite the available opportunities, study participants uncovered different challenges that encountered by health academic staffs in conducting qualitative research. Resource limitations, lack of knowledge, negative attitudes or beliefs, publication, and language issues were raised as main challenges. Conclusion. Qualitative research practices were found to be low among health sciences academics. Lack of resources, training, and expertise, problems associated with publication, a lack of funding, and a shortage of experts were the main challenges in conducting qualitative research in health sciences academic settings in Ethiopia. [ABSTRACT FROM AUTHOR]

Iran is a developing country with low levels of economic development and globalization and is ruled by a theocratic government. To address the lack of national research on well-being in Iran, this retrospective observational study aims to examine life satisfaction and its main determinants among Iranian adults. Using World Gallup Poll data collected between 2006 and 2017, we examined life satisfaction as a cognitive aspect of subjective well-being in relation to various factors. Our results show that income is the strongest predictor of life satisfaction, followed by standard of living, gender, social support, age, negative affect, and education. In developing countries such as Iran, which face significant economic, political, and social challenges, individuals prioritize the satisfaction of basic needs by emphasizing factors such as the socioeconomic status. In contrast, developed countries with established welfare systems may emphasize other values such as social connections and healthy lifestyle behaviors as key factors in life satisfaction. This study contributes to a deeper understanding of the determinants of life satisfaction in Iran and provides insights for future research and policy making. [ABSTRACT FROM AUTHOR]

The urban blue-green space landscape ecology is an important component that supports the urban landscape ecosystem. In this study, a combination model of the grey system theory (GST), analytic hierarchy process (AHP), and technique for order of preference by similarity to ideal solution (TOPSIS) was used to construct criteria layers from the following four aspects: green space vegetation coverage, ecosystem diversity, air and water quality, social participation, and health. The GST method was employed to screen evaluation indicators, the AHP method was used to calculate the weight of each indicator, and finally, TOPSIS was applied for weighted ranking to verify the scientific and rationality of the evaluation system. The results indicated the following: (1) out of 36 indicator factors, 10 were not selected through the GST method; (2) the weight ranking of the criteria layer was as follows, from highest to lowest: D 2 ecosystem diversity 0.4816 > D 1 green space vegetation coverage 0.2608 > D 3 air and water quality 0.1864 > D 4 social participation and health 0.0713; and (3) the relative closeness and ranking of different regions in Jinan city were as follows: Da Ming Hu area > Shan Da Lu area > Gu Cheng area > Shang Bu area. This study can help avoid decision-making errors caused by subjective factors and provide new approaches for the assessment of the ecological health of urban blue-green space landscapes. [ABSTRACT FROM AUTHOR]

We describe the coproduction, pilot implementation, and user evaluation of an evidence-based training intervention addressing prevention of Sudden Unexpected Deaths in Infancy (SUDI) for the multiagency workforce supporting vulnerable families with babies in a northern English county. We aimed in this pilot study to improve knowledge, skills, and engagement of professionals and support staff providing services for vulnerable families with increased risk of SUDI. The training intervention was co-produced by the academic team and the project Steering Committee which comprised senior leaders from the local authority, health and care sectors, and third-sector organisations, and rolled out to multiagency teams between November 2022 and March 2023. Evaluation data were collected using a post-training questionnaire, followed up by the Normalisation Process Theory (NPT) NoMAD survey issued at two time-points post-training, and interviews with stakeholders. The evaluation, conducted from January to May 2023, aimed to assess how well the multiagency workforce accepted SUDI prevention as part of their remit and incorporated SUDI prevention activities into their everyday work. Most multiagency professionals and support staff were enthusiastic about the training and their role in SUDI prevention. Fewer health professionals completed the training than expected. Forty percent (397/993) of invited staff completed the training. Our results revealed initial lack of knowledge and confidence around SUDI prevention and targeted provision for vulnerable families which improved following the Eyes on the Baby training. The proportion of nonhealth professionals rating their knowledge of SUDI prevention as good or excellent increased significantly from 28% before training to 57% afterwards. Self-rated confidence in discussing SUDI prevention with families increased significantly from 71% to 97%. Health professionals' ratings increased significantly for knowledge from 62% to 96%, and confidence from 85% to 100%. Use of NPT allowed us to identify that by the time of evaluation, the earliest adopters were cognitively involved with the programme and engaged in collective action, while later adopters had not yet reached this stage. We conclude that effective implementation of multiagency working for SUDI prevention can be accomplished by providing clear training and guidance for all staff who have regular or opportunistic contact with vulnerable families. Our next step is to evaluate the sustainability of MAW SUDI prevention over the medium to long term and assess the responses of recipient families to this approach. [ABSTRACT FROM AUTHOR]

Maternal mental health plays a vital role in the overall wellbeing of mothers, children, families, whānau (core support network) and communities. However, many mothers face mental health challenges during the transition to parenthood. In this study, we used an online story-sharing platform to collect the experiences of mothers who have faced unmet needs while using the Well Child Tamariki Ora (WCTO) service in Aotearoa New Zealand. From the 420 submitted stories, 125 stories related to mental health need while using the WCTO service. Using thematic analysis, we identified three main themes that highlighted the experiences of mothers with the service. This includes (1) making it seem that I'm coping: Mothers' fear of being judged; (2) i wish I had connected with my WCTO nurse: Fostering meaningful relationships to facilitate personal information sharing; and (3) beyond the baby: Mothers desire for recognition and support during WCTO visits. These findings point to several missed opportunities for WCTO providers to inquire about mental health and offer support needed by mothers. To address this, a relational approach to care would prioritise families and whānau as the focus of care rather than just monitoring the development of babies. [ABSTRACT FROM AUTHOR]

Background. One in 5 people in the United States live with disability; however, the public health needs of this community have been largely overlooked. Although U.S. law mandates the availability of accessible medical exam equipment, people with mobility disabilities (PWMD) frequently encounter barriers that require self-advocacy to receive basic primary care. Objective. The purpose of this study was to qualitatively explore the impact of healthcare access barriers—specifically, the experiences of the need to self-advocate and factors that inform decisions to make accommodation requests—for PWMD. Methods. Qualitative semistructured interviews were performed across two phases of data collection with each of the 6 participants. Interpretative phenomenological analysis was used to highlight the essence of participants' experiences in making decisions to request healthcare accommodation. Results. Participants included a purposive sample of self-advocates with physical disabilities (3 men and 3 women). While individual approaches to self-advocacy varied, participants identified a process of "recognizing the normalization of disability discrimination and disability stigma" which necessitates the development of "agency in self-advocacy." This process has a lasting impact on people that includes a shared embodied experience of disability, as well as a sense of empowerment based on their collective and individual identities. Conclusions. Findings have implications for supporting individual disability consumer advocacy efforts as well as the need to address the normalization of disability discrimination within healthcare systems levels. [ABSTRACT FROM AUTHOR]