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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]

Entrustable professional activities (EPAs) is a recent concept that helps operationalise competency‐based education. In this paper, we report on the development of EPAs and incorporation into an e‐portfolio for work‐based assessment of final year dietetics students in a community and public health professional placement. We aimed to determine the utility of the EPAs for work‐based assessment in this context. We used action research methodology to conduct broad consultation with students and supervisors using anonymous surveys and focus groups to understand their beliefs and attitudes towards work‐based assessment. Consequently, 40 EPAs with an accompanying four‐point entrustment scale were developed and mapped to the National Competency Standards for Dietitians in Australia. The EPAs and assessment tool were piloted and evaluated via an anonymous online user survey across three cohorts of students (n = 133) and supervisors (n = 67). Following mediocre pilot year evaluation results, EPAs were revised and reduced in number. While students positively evaluated the e‐portfolio, their appraisal of the EPAs and entrustment scale was less positive compared to supervisors. Supervisor evaluation of the EPA‐based e‐portfolio supported the validity, feasibility and acceptability of this novel assessment method in a community and public health setting. Assessment using EPAs, and the resulting educational data collected by the tool, offers potential for individual learners to identify areas needing development during placement, as well as potential to inform curriculum improvements and increase understanding of learning opportunities and outcomes for dietetic students in community and public health settings. [ABSTRACT FROM AUTHOR]

This paper presents findings from the evaluation of an Australian trial of self‐managed home aged care. The self‐management model was codesigned by advocacy organisation COTA Australia, consumers and service providers. The primary aim of the evaluation was to examine whether self‐management improved consumers' perceptions of their choice, control, and wellbeing. The secondary aim was to examine whether provider prior experience with self‐managed packages significantly influenced consumers' perceptions of choice, control and wellbeing, thereby confounded trial effects. A pre‐test post‐test quasi‐experimental design and mixed‐methods design were used to collect data over nine months in 2018–2019. The pre‐trial methods and findings have been published. The post‐trial evaluation replicated the pre‐trial data collection method of an online survey (n = 60) and semi‐structured telephone interviews with consumers (n = 9), family carers (n = 13), and consumers and carers jointly (n = 2), totalling 24 interviews. Semi‐structured telephone interviews were also conducted with CEOs and senior managers from each of the seven providers (n = 14). Three providers had prior experience supporting self‐management. Parametric and non‐parametric tests examined the statistical data. Qualitative data were analysed thematically and framed according to self‐determination principles and ecological systems theory. Both datasets demonstrated that consumers reported greater choice and control at post‐trial than pre‐trial. This finding was not affected by providers' prior experience with self‐management; therefore, it was not a confounding factor. Participants reported improved wellbeing in interviews, however this was not reinforced statistically. Key desirable features of self‐management included greater autonomy and control over spending, recruiting support staff and paying lower administration fees. There was no evidence of increased risks or fraud. The research limitations included a small sample size, convenience sampling with providers recruiting interview participants, no control group and differences in trial implementation. The findings support the expansion of self‐management opportunities and more comprehensive evaluations that use mixed methods. [ABSTRACT FROM AUTHOR]

Primary care mental health services need to expand to assist the increased number of people reporting mild to moderate mental health difficulties. In Ireland, the primary care mental health service has been recently enhanced through the employment of Assistant Psychologists (AP) in primary care psychology. This paper provides an early and brief evaluation of the impact of the AP‐enhanced model through a tripartite approach to evaluation which utilises measures of throughput, output and stakeholder satisfaction. We use data from two sources; Health service key performance indicators, and a routinely gathered minimal dataset of client measures. Results indicate that the numbers of clients seen in the period rose by 16%, that AP‐delivered treatments are beneficial for clients with mild to moderate mental health difficulties, and more than 80% of clients reported being 'totally satisfied' with the care received. The data provide early evidence that the AP model is beneficial in meeting clients' needs across a range of presentations within the service admission criteria, and that the AP‐enhanced model may offer a satisfactory solution to primary care needs. However, further data collection is required, and additional stakeholder input is necessary for a complete evaluation of the assistant psychologist model in primary care. [ABSTRACT FROM AUTHOR]

This paper reports on data collected in 2011 from a national study about the operation of the best interests principle, a key feature of the Mental Capacity Act ( MCA) 2005 for England and Wales. The objective was to provide a picture of current professional practices in best interests decision-making. Four contrasting sample sites were selected, in which National Health Service trusts, social care and other organisations were recruited to participate. A multimethod design was followed, including an online survey with 385 participants, followed by qualitative research through a telephone survey of 68 participants, and face-to-face semi-structured interviews following up 25 best interests cases, with different perspectives on the process in 12 of those cases. The current paper reports only on the qualitative findings. The findings indicate that the MCA was successful in providing a structure for these practitioners, and that the five principles of the MCA were in general adhered to. A variety of perceived risks led to best interests processes being undertaken, and a typical scenario was for a period of hospitalisation or ill health to trigger a best interests decision process about a social care and or a life decision. The study supported previous research in finding the notion of capacity the most difficult aspect of the MCA, and it provides evidence of some specific capacity assessment practices, including problematic ones relating to 'insight'. Best interests decisions were often made by consensus, with practitioners taking on different roles within the process. Meetings played a key part, but other ways of involving people lacking capacity and significant others were also important. It was recommended that the issues highlighted in this research could be clarified further in the Code of Practice, or within risk guidance. [ABSTRACT FROM AUTHOR]

This paper explores older people's views, experiences and sources of bereavement support following the death of a spouse, family member or other significant individual. Telephone interviews were conducted with 28 bereaved older adults recruited from the Brief Risk Identification Geriatric Health Tool trial participants in three geographically diverse District Health Boards in New Zealand. Analysis adhered to the principles of grounded theory and followed the National Centre for Social Research 'Framework' approach. Findings indicate that family and friends play a fundamental role supporting older bereaved adults, both emotionally and practically. Existing community-based organisations were identified as an important source of support following bereavement. Despite the emotional, financial and practical challenges associated with bereavement, the majority of participants questioned the role of, need for and value of formal bereavement support services. Instead, study participants cited a combination of being older and previous life experiences as factors that had enabled them to cope with these largely 'expected' events. Moreover, they demonstrated considerable resilience in managing the emotional and practical changes associated with loss and bereavement. This study poses a challenge to the argument that the growing secularisation of society has led to an increase in the use of professional bereavement services over more 'traditional' forms of support, such as family, friends and community and religious organisations. The paper highlights the value of adopting a public health-based approach as a way of optimising bereavement support via the use of existing community organisations previously known to older people. This is particularly important in those countries where the provision of bereavement support is limited due to resource constraints. [ABSTRACT FROM AUTHOR]

The Adult Social Care Outcomes Toolkit four response‐level interview schedule (ASCOT INT4) for service users was translated into Finnish. The aim of this paper was to investigate the construct validity and structural characteristics of the Finnish ASCOT. We used data from a face‐to‐face interview survey of older people receiving publicly funded home care services, which was conducted in 2016–2017 (n = 493), excluding missing values and proxy respondents (n = 334). Chi‐square tests, adjusted residuals and analyses of variance were used to examine hypothesised associations between each attribute and a number of relevant variables regarding health and well‐being, disabilities, living arrangements, social contact and support, experience of service use, and the nature of the locality and environment. Structural characteristics were explored using exploratory factor analysis and Cronbach's alpha test. The EQ‐5D‐3L and ASCOT were moderately correlated (r = 0.429; p < 0.001). The ASCOT attributes were statistically positively related to the overall quality of life. For other tested variables, we found a high number of significant associations with the control over daily life, occupation, social participation, and personal cleanliness attributes, but fewer significant associations with the other attributes. Cronbach's alpha was 0.697 and a single factor was extracted. This assessment provides evidence to support the construct validity of the Finnish ASCOT. The results support the introduction of the Finnish ASCOT into Finland for use in practical applications. Future research on its reliability would be useful. [ABSTRACT FROM AUTHOR]

This paper investigates the impact of community home‐based care (CHBC) on self‐management outcomes for chronically ill patients in rural Malawi. A pre‐ and post‐evaluation survey was administered among 140 chronically ill patients with HIV and non‐communicable diseases, newly enrolled in four CHBC programmes. We translated, adapted and administered scales from the Stanford Chronic Disease Self‐Management Programme to evaluate patient's self‐management outcomes (health status and self‐efficacy), at four time points over a 12‐month period, between April 2016 and May 2017. The patient's drop‐out rate was approximately 8%. Data analysis included descriptive statistics, tests of associations, correlations and pairwise comparison of outcome variables between time points, and multivariate regression analysis to explore factors associated with changes in self‐efficacy following CHBC interventions. The results indicate a reduction in patient‐reported pain, fatigue and illness intrusiveness, while improvements in general health status and quality of life were not statistically significant. At baseline, the self‐efficacy mean was 5.91, which dropped to 5.1 after 12 months. Factors associated with this change included marital status, education, employment and were condition‐related; whereby self‐efficacy for non‐HIV and multimorbid patients was much lower. The odds for self‐efficacy improvement were lower for patients with diagnosed conditions of longer duration. CHBC programme support, regularity of contact and proximal location to other services influenced self‐efficacy. Programmes maintaining regular home visits had higher patient satisfaction levels. Our findings suggest that there were differential changes in self‐management outcomes following CHBC interventions. While self‐management support through CHBC programmes was evident, CHBC providers require continuous training, supervision and sustainable funding to strengthen their contribution. Furthermore, sociodemographic and condition‐related factors should inform the design of future interventions to optimise outcomes. This study provides a systematic evaluation of self‐management outcomes for a heterogeneous chronically ill patient population and highlights the potential and relevant contribution of CHBC programmes in improving chronic care within sub‐Saharan Africa. [ABSTRACT FROM AUTHOR]

Loneliness is a global public health concern linked to a range of negative health outcomes (Cacioppo & Cacioppo, 2018. The Lancet. 391(10119), 426). Internationally, this has led to the development of a number of interventions, but these are rarely implemented or evaluated on a large scale. This paper is one of the first of its kind to describe elements of an evaluation of a large‐scale national social prescribing scheme to reduce loneliness, deploying individual link workers to signpost people to community activities. Reporting on findings from interviews with staff (n = 25 of which 6 were repeat interviews) and volunteers (n = 9) between October 2017 and December 2018 in localities across the United Kingdom. We reflect on the complexities of the link worker role, the challenges of service delivery and the importance of community infrastructure. There was evidence that highly skilled link workers who had developed positive relationships with providers and service‐users were key to the success of the intervention. As well as providing an effective liaison and signposting function, successful link workers tailored the national programme to local need to proactively address specific gaps in existing service provision. For social prescribing services to be successful and sustainable, commissioners must consider additional funding of community infrastructure. [ABSTRACT FROM AUTHOR]

Community environments have the potential to alleviate loneliness and social isolation as they offer opportunity for sociality and to expand personal social network connections. Implementing a social network intervention in community environments to connect people to who are at risk of loneliness or social isolation could help alleviate these concerns. However, implementing interventions in community environments is made difficult by the interplay between the community context and intervention. Thus, to support implementation a detailed understanding of the types of community contexts is required. To examine the optimal factors that promote the implementation of a social network designed to alleviate loneliness and social isolation intervention in the community observations, interviews and documentary analysis were conducted. The Consolidated Framework for Implementation Research and a typology of community contexts were used to inform the data analysis and interpret the findings. Key factors were found to affect the implementation of the intervention in the different community contexts. These inter‐related factors operated across three domains. Service User Needs affected intervention take up as its suitability varied. The stability of the workforce and nature of everyday work also impacted on implementation. Finally, the fluctuating capacity of organisations and the organisational culture were also influential. No single community environment was found to have all of the optimal factors required for implementation and sustainably. The UK policy agenda of austerity had negatively affected community environments' capacity to deliver such intervention through increasing service user needs and reducing available resources. Trial registration: ISRCTN19193075. [ABSTRACT FROM AUTHOR]

A brief intervention using Zero‐time Exercise (ZTEx), a foot‐in‐the‐door approach, was developed to reduce sedentary behaviour and increase physical activity. ZTEx refers to the integration of simple strength‐ and stamina‐enhancing physical activity into daily life, which can be done anytime, anywhere and by anyone. This paper presents the development, feasibility, and preliminary evidence for the effectiveness of this intervention under the Hong Kong Jockey Club FAMILY Project. Needs assessments were conducted with social workers from the Christian Family Services Center(CFSC) and the Social Welfare Department (SWD). This single group prospective ZTEx intervention trial, guided by the Health Action Process Approach, included a 3‐hr core session at baseline and a 1‐hr booster session at 1‐month follow‐up. Fifty‐six participants (social and service‐related workers) from CFSC (n = 28) and SWD (n = 28) received the intervention and completed the self‐administered questionnaires at baseline. Forty‐nine and 43 participants completed the 1‐month and 3‐month self‐administered questionnaires, respectively. Fifteen participants attended the focus group interviews to share their feedback on ZTEx intervention after implementing their community‐based ZTEx activities. Intention‐to‐treat analysis was conducted with missing data replaced by baseline values. Participants reported significant decreases in sitting time by 27 (2, 52) minutes (mean [95% confidence interval]) and 36 (0.2, 71) minutes on a weekday, increases in physical activity while seated by 0.7 (0.2, 1.4) days and 1.1 (0.6, 1.7) days in a week, and improvements in perceived knowledge, outcome expectancies and plan on doing ZTEx at the 1‐month and 3‐month follow‐up, respectively. Balance and muscle strength significantly improved at the 1‐month follow‐up. The effect ranged from small to large (Cohen's d: 0.27–1.05, all p < 0.05). The qualitative feedbacks support the quantitative findings. Our findings show early evidence that ZTEx effectively reduced sedentary behaviour and enhanced physical activity and fitness. Further trials on this simple and low‐cost intervention as the first step to promote higher intensity exercise are warranted. [ABSTRACT FROM AUTHOR]

This paper reports on a study exploring the experiences and meaning of social participation for family carers of people living with dementia. Participants were 33 family carers (17 spouses and 16 adult children) of older adults diagnosed with dementia (any stage or type) who responded to advertisements by the national Alzheimer's association, Alzheimer's Australia. Data were collected through semi-structured face-to-face and/or telephone interviews using an interview guide, which included prompts such as 'Tell me about what social participation means to you', and 'How did this change...'. The methods of grounded theory were drawn upon to guide sampling and analysis of data, which continued until theoretical saturation was achieved and occurred over the period September 2011 to March 2012. Data arising from the interviews were analysed line-by-line and coded and categorised using the constant comparative method, with codes clustered into themes and with abstraction from the themes to arrive at the core process. The core category arising from the data was adaptation, which encompassed four main themes: autonomy to choose; the impact of care-giving; employing strategies; and establishing meaningful connections. Carers went through a process whereby the ways in which they had previously participated socially were compromised, which often prompted an exploration of new ways in which to remain socially engaged. [ABSTRACT FROM AUTHOR]

Restorative home-care services, or re-ablement home-care services as they are now known in the UK, aim to assist older individuals who are experiencing difficulties in everyday living to optimise their functioning and reduce their need for ongoing home care. Until recently, the effectiveness of restorative home-care services had only been investigated in terms of singular outcomes such as length of home-care episode, admission to hospital and quality of life. This paper reports on a more complex and perhaps more significant measure - the use and cost of the home-care and healthcare services received over the 2-year period following service commencement. Seven hundred and fifty older individuals referred for government-funded home care were randomly assigned to a restorative or standard service between June 2005 and August 2007. Health and aged care service data were sourced and linked via the Western Australian Data Linkage System. Restorative clients used fewer home-care hours (mean [ SD], 117.3 [129.4] vs. 191.2 [230.4]), had lower total home-care costs ( AU$5570 vs. AU$8541) and were less likely to be approved for a higher level of aged care ( N [%], 171 [55.2] vs. 249 [63.0]) during follow-up. They were also less likely to have presented at an emergency department ( OR = 0.69, 95% CI = 0.50-0.94) or have had an unplanned hospital admission [ OR (95% CI), 0.69 (0.50-0.95)]. Additionally, the aggregated health and home-care costs of the restorative clients were lower by a factor of 0.83 (95% CI 0.72-0.96) over the 2-year follow-up ( AU$19,090 vs. AU$23,428). These results indicate that at a time when Australia is facing the challenges of population ageing and an expected increase in demand for health and aged care services, the provision of a restorative service when an older person is referred for home care is potentially a more cost-effective option than providing conventional home care. [ABSTRACT FROM AUTHOR]

Abstract: Many patients find using medicines burdensome. This paper reports the types of issues people experience with medicines, using a validated measure of medicines burden, and the factors associated with high burden. The cross‐sectional study involved patients presenting prescriptions at pharmacies or awaiting appointments at GP practices or outpatient clinics, during October 2015 to December 2016. Adults using at least one regular medicine were asked to complete the Living with Medicines Questionnaire V3 (LMQ‐3). The LMQ‐3 contains 41 statements rated on a 5‐point scale (strongly agree to strongly disagree), with higher scores indicating greater burden, plus a visual analogue scale for self‐reporting of overall perceived burden (VAS‐burden). For a subsample, access to their medication record was requested, facilitating calculation of the complexity of their medicine regimen using the Medicine Regimen Complexity Index (MRCI). Of 1,888 questionnaires distributed, 684 were returned (36.2%) and medication records obtained for 163. The median number of medicines respondents reported using was 4 (range 1 to 26). Two‐thirds (418; 67.0%) used medicines more than once daily, 67 (10.1%) required assistance with medicines and 189 (28.3%) paid a prescription charge. LMQ‐3 scores showed a strong positive relationship with VAS‐burden scores (r = .547; p < 0.001). LMQ‐3 and VAS‐burden scores were lower in older age groups, but both increased with increasing number of medicines and dosing frequency. LMQ‐3 score was positively related to MRCI score (n = 163; r = .217; p = 0.005), whereas VAS‐burden was not. Older respondents reported lower burden in most domains. Higher numbers and frequency of medicines, paying prescription charges, needing support and deprivation increased burden across multiple domains. Factors strongly associated with high LMQ‐3 scores were: needing support, high dosing frequency and unemployment. Interventions seeking to reduce medicines burden should consider targeting individuals who need support with using medicines, use at least four medicines, more than twice daily and/or pay prescription charges. [ABSTRACT FROM AUTHOR]

As a part of the national carers' strategy, the Department of Health commissioned six pilot workshops spread across England for General Practitioners (GPs) and other primary healthcare workers. The six workshops were held during September and October 2009, arranged by the Royal College of General Practitioners and planned in consultation with the Princess Royal Trust for Carers. The workshops were delivered by one of two GPs and by a carer. The Department of Health commissioned an evaluation of the workshop programme. This paper reports on the attitudes towards and knowledge of carers by GPs and other primary care workers, such as community matrons, practice nurses, healthcare assistants, practice managers and receptionists. It also tracks changes over time from the questionnaire responses pre- and post-workshop and 3 months later in the GPs' and other primary care workers' response to carers. Prior to the workshops, GPs and other primary care workers saw primary care as having a significant role in directly assisting carers, especially with emotional support and in signposting to other services. However, there was a lack of knowledge about issues facing carers, limited confidence in assisting carers and few services within the primary care teams directly focussed on carers. The workshops were regarded positively by those who attended, and the evaluation found that there was a positive impact with GPs and other primary care workers reporting specific actions they had taken post-workshop to assist carers, greater confidence and awareness in working with carers, and increased knowledge about carers. The paper concludes by recommending how the pilot programme might be rolled out more widely. [ABSTRACT FROM AUTHOR]

This paper explores the effects of kin, social network and the neighbourhood on an individual's well-being. The material is drawn from a community-based qualitative study that explored the attitudes and experiences of African-Caribbean adolescents and their families in the north of England towards healthy lifestyles. A convenience sample of 10 African-Caribbean households units comprising 24 adolescents (12-18 years of age) and 18 adults (22-60 years of age) participated in the study with interviews conducted in their homes. The paper focuses on the adult participants' perception of the role of social support networks and neighbourhood effects on well-being. An in-depth interview schedule was used to explore participants' perceptions on barriers to health and healthy lifestyles; and factors facilitating and inhibiting good health and healthy lifestyles. Data were subjected to thematic analysis with the aid of a Qualitative Data Analysis software package. Emerging categories were discussed with participants by conducting post interview visits and at community events. Findings indicated that participants believed that being a member of a kin network enhanced one's well-being, with such networks described as capable of providing protective support for one's health and well-being. In addition, they preferred to live in neighbourhoods with a high concentration of people of the same ethnicity, despite the effects of neighbourhood deprivation such as poor housing and lack of services. However, participants believed that ethnic segregation leads to marginalisation and further deprivation. These findings suggest that there is a need to explore further the influence of social networks and neighbourhoods on the full spectrum of an individual's well-being. The study concludes by suggesting that in considering new paradigms for the promotion of well-being, health and social care practitioners need to incorporate ways to promote social support and consider relevant psychosocial and neighbourhood factors in designing models of community well-being. [ABSTRACT FROM AUTHOR]

Humour research in healthcare has tended to focus on rehearsed as opposed to spontaneous humour. This paper reports an empirical example of spontaneous humour in healthcare interactions: a negative case analysis from a constructivist grounded theory study. Twenty Clinical Nurse Specialist (CNS)-patient interactions and CNS pre- and postinteraction audio diaries provided the baseline data corpus. Follow-up interviews, field notes, focus groups and observations serviced theory generation with a constant comparison approach to data collection and analyses. Interpretative and illustrative frameworks incorporating humour theories, non-laughter humour support, discursive features and prosodical features of speech were applied to all data. This paper is based upon the negative case comprising a 90-minute follow-up interview and 10 hours of field note observations. The negative case - a CNS working with female drug users' sexual and reproductive health needs - contradicted emerging findings from the baseline data corpus. First, the negative case had greater awareness of humour, deliberately initiated humour and recognised parameters and exclusion zones. Second, a good patient persona was evident in the baseline data corpus but the negative case worked with 'bad' patients. Accordingly, a specific type of humour - harsh humour - was evident in the negative case. Harsh humour used areas of potential discord (e.g. drug use) as a focus of humour creation and maintenance. The deliberate initiation of harsh humour enabled the negative case and her colleagues to achieve their aims by engaging effectively with unpredictable, reluctant and recalcitrant patients. The negative case demonstrates how humour can be used to therapeutically enhance healthcare interactions with disenfranchised individuals. Humour is not superficial but integral to the accomplishment of key aspects of interactions. Health and social care workers should consider the potential for therapeutic humour to engage and maintain all patients - disenfranchised or otherwise - in healthcare interactions. [ABSTRACT FROM AUTHOR]

Within the UK, there is growing recognition that individuals will need to take increased responsibility for managing their own health for there to be improvements in population health. The current evidence base on self care interventions reflects an interest in enhancing self care knowledge, skills and behaviour in relation to the management of long-term conditions. In contrast, this paper reports on a community-based self care initiative that was designed to promote self care approaches in the general population. The principal component was a self care skills training course delivered to groups of lay people in community and workplace settings. Self Care for People was piloted in three primary care trusts and a process evaluation was undertaken. The aim of this paper is to examine the feasibility, relevance and acceptability of the initiative. Qualitative interviews were conducted with a sample of stakeholders involved in implementation including coordinators, trainers and key informants from organisations hosting the course. In total 40 interviews and two focus groups were conducted from 2006 to 2008 and the data were analysed thematically. The evaluation found that implementation was relatively straightforward with few major barriers reported. Recruitment to the self care skills training course took place in both workplace and community group settings, including in organisations supporting socially excluded groups. The course was seen to provide a valuable space for contemplation on personal health, however, participation could raise sensitive issues that needed to be dealt with by skilled facilitators. Motivations for involvement differed markedly in host organisations and different strategies for marketing were adopted. The paper concludes by suggesting that while Self Care for People was both feasible and relevant to different stakeholder groups, there needs to be flexibility in responding to the needs of participants in different settings. [ABSTRACT FROM AUTHOR]

The purpose of this paper was to describe occupational hazards for nurses working in home care ( HC) and explore how they differ across the rural-to-urban gradient. Responses ( n = 823) from a cross-sectional survey conducted in 2012 of HC nurses registered to practise nursing in the Province of Ontario, Canada were used. Using chi-square analysis and posthoc pairwise tests with a Bonferroni correction, 14 occupational hazards were individually tested for differences between four geographical settings (rural, town, suburban or urban areas). Our study reports that in addition to common occupational hazards that all HC nurses experience, the frequency of experiencing some hazards varies based on geographic setting. These specific hazards include exposure to: aggressive pets, environmental tobacco smoke, oxygen equipment, unsafe neighbourhoods and pests. Findings from this study suggest that a relationship exists between where a patient's home is located and the types of occupational hazards that may be experienced by HC staff. This research is useful for HC organisations in developing staff training programmes to recognise and manage occupational hazards that workers are likely to encounter. Home healthcare and policy leaders may use these findings to develop and implement educational and other strategies to reduce risk and manage exposures across the rural-to-urban gradient. [ABSTRACT FROM AUTHOR]

The recent economic crisis along with changing demographic trends has stimulated an increased interest in the value obtained from social care expenditure so as to ensure the sustainability of systems in the future. In Ireland, the Department of Health, further to a recent review of its disability services, commited to a new approach that will reshape and redesign its service provision. It specifically outlined a reorganisation of financing services, from a model of prospective block grant funding to a system of individualised budgeting based on an assessment of need. This paper examines the relationship between need, service utilisation and cost for high-cost users of adult intellectual disability residential services in an Irish county under the current model of block grant financing. The analysis reported is based on primary data collected from 68 high-cost users of adult intellectual disability residential services in an Irish county in 2013. Statistical analysis was performed to identify the relationship between need and cost, and also to examine the variations in the cost of support between the service provider organisations. Our analysis determined an association between need and cost, with poorer levels of psychological well-being related to higher costs. However, the study found no evident relationship between staff/client ratios, the numbers of staff engaged at the residential units and need. An examination of cost variations between the service provider organisations revealed that agency status; service unit size; client and staff characteristics all contributed to variations in the cost of care. This study supports the development of a national resource allocation framework as being fundamental to the equitable and transparent distribution of scarce resources, as recommended by the Department of Health in Ireland. [ABSTRACT FROM AUTHOR]

With an ageing population, there are increasing numbers of experienced family carers (FCs) who could provide peer support to newer carers in a similar care situation. The aims of this paper are to: (i) use a cross-sectional study design to compare characteristics of volunteers and recipients of a peer support programme for FCs of people with dementia, in terms of demographic background, social networks and psychological well-being; and (ii) use a longitudinal study design to explore the overall impact of the programme on the volunteers in terms of psychological well-being. Data were collected from programmes run in Norfolk, Northamptonshire, Berkshire and four London boroughs between October 2009 and March 2013. The volunteer role entailed empathic listening and encouragement over a 10-month period. Both carer support volunteers ( N = 87) and recipient FCs ( N = 109) provided baseline demographic information. Data on social networks, personal growth, self-efficacy, service use and well-being ( SF-12; EuroQol Visual Analogue Scale; Hospital Anxiety and Depression Scale; Control, Autonomy, Self-Realisation, Pleasure-19) were collected prior to the start of the intervention ( N = 43) and at either 3- to 5 month or 10 month follow-up ( N = 21). Volunteers were more likely than recipients of support to be female and to have cared for a parent/grandparent rather than spouse. Volunteers were also more psychologically well than support recipients in terms of personal growth, depression and perceived well-being. The longitudinal analysis identified small but significant declines in personal growth and autonomy and a positive correlation between the volunteers' duration of involvement and perceived well-being. These findings suggest that carers who volunteer for emotional support roles are resilient and are at little psychological risk from volunteering. [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]

The incidence of diabetes in people with an intellectual disability, although unknown, is indicated to be higher than the general population. Given the challenges individuals with intellectual disability may face, this population is often dependent upon key workers to manage their health and well-being. One aim of a wider study on the self-management of diabetes by people with intellectual disability was to explore how key workers supported their self-management. That aim was the focus of this paper. Between 2009 and 2010, 17 staff from five residential intellectual disability services and two supported independent living services within New Zealand, consented to a semi-structured interview. Transcripts of the interviews were analysed using Thomas' General Inductive Approach. Three overarching themes emerged; having knowledge and understanding, being lifestyle police and ensuring future well-being. While knowledge, skills and perspectives varied, all participants were committed to ensuring that the lifestyle of the person concerned was compatible with the management of their diabetes. A range of perspectives existed between the expectations they had of themselves, colleagues and the individual with diabetes. There was an identified need for initial and ongoing education of permanent and casual staff and the people themselves with diabetes in collaboration with health and disability services to build confidence and promote self-management practices. In so doing, the impacts of this long-term condition may be reduced and the health outcomes improved for people with intellectual disability. [ABSTRACT FROM AUTHOR]

The prevalence of perinatal common mental disorders in South Africa is high, yet little is known about mental health service use among pregnant and postnatal women. This paper reports on pregnant women's patterns of use of a counselling service at a primary level obstetric facility in Cape Town, South Africa, between January 2010 and December 2011. It investigates whether these are associated with demographics, severity and risk of depressive symptoms. Participants ( N = 3311) were screened for psychological distress using the Edinburgh Postnatal Depression Scale ( EPDS) at their first antenatal visit. Risk factors for antenatal depression were assessed using a 11-item checklist. Questionnaires were self-administered, but some participants required assistance. Participants scoring positive (≥13) on the EPDS were offered referral to on-site, individual counselling, and assigned to one of three groups according to their service use: declined referral; accepted referral and attended counselling sessions; and accepted referral but defaulted all appointments. Consent to participate was received by 3437 (96.4%) participants who were offered screening, of which 627 (18.9%) screened positive on the EPDS. Of these, 363 (57.9%) attended counselling. Both bivariate analyses and regression analyses revealed that age and risk factor assessment score were associated with screening positive on the EPDS. Odds ratios ( OR) for accepting counselling were OR = 0.94 (95% CI = 0.92-0.97) for gestation, OR = 1.27 (95% CI = 1.15-1.39) for EPDS score and OR = 0.48 (95% CI = 0.23-0.99) for reporting three or more risk factors. OR for attending counselling were, for age: OR = 1.06 (95% CI = 1.00-1.12) and for reporting three or more risk factors: OR = 0.60 (95% CI = 0.37-0.97). While the majority of women with psychological distress accessed the counselling service provided, strategies to increase service use of younger pregnant women specifically are required. [ABSTRACT FROM AUTHOR]

This paper describes the participation of informal caregivers in the discharge process when patients aged 80 and over who were admitted from home to different hospitals in Norway were discharged to long-term community care. Data for this cross-sectional survey were collected through telephone interviews with a consecutive sample of 262 caregivers recruited between October 2007 and May 2009. The Discharge of Elderly Questionnaire was developed by the research team and was designed to elicit data concerning informal caregivers' self-reported perceptions on participation in the discharge process. A descriptive and comparative analysis of Thompson's levels of participation reported by the older generation (spouses and siblings) and the younger generation (adult children and children-in-law, nieces and grandchildren) was undertaken using bivariate cross-tabulations and chi-square tests for association and trend. Analyses showed that the younger generation of caregivers received and provided information to hospital staff to a greater degree than the older generation. Overall, 52% of the informal caregivers reported co-operating with the staff to a high or to some degree. A multivariate logistic regression analysis was used to analyse factors predicting the likelihood of informal caregivers reporting co-operation with hospital staff. The odds of younger generation caregivers reporting co-operation were more than twice as high ( OR = 2.121, P = 0.045) as the odds of the older generation. Caregivers of patients with a hearing impairment had higher odds of reporting co-operation ( OR = 1.722, P = 0.049) than caregivers of patients with no such impairment. The length of hospital stay, the caregiver's and patient's gender and education level were not significantly associated with caregiver's co-operation. The informal caregivers' experiences with information practices and user participation in hospitals highlight important challenges that must be taken seriously to ensure co-operation between families and hospitals when elderly patients are discharged back to the community. [ABSTRACT FROM AUTHOR]

This paper aims to identify the inter-relationships between the social factors that influence epidemiological patterns in the city neighbourhood of Casablanca, Zaragoza (Spain). Data for a cross-sectional survey were collected between January 2008 and April 2008 from a representative random sample of 1032 residents aged more than 15 years. The study interview contained information scales on healthcare behaviours, treatment evaluation, the number of medical consultations in the weeks pervious to the interview and the perceived health status of the respondents, using The Health Perception Questionnaire. The global index (continuous variable) allowed inferences to be made on the individual's perception of his/her own health. The assessment of social vulnerability was based on the occupational, educational and economic conditions of the interviewees. An individual was considered to belong to a vulnerable subeconomic group if he/she had a personal income of 6000 euros or less; or had no formal education or had been educated up to primary school level only; or was not in paid employment at the time of the interview. A descriptive and comparative analysis of the vulnerable and non-vulnerable population groups for perceived and diagnosed health variables was undertaken using parametric and non-parametric tests. A total of 550 interviewees (53.3%) were considered vulnerable people. Low level of instruction (primary or no education) was the main characteristic of this group (356 subjects, 64.7% of those identified as vulnerable). Binary logistic regression was used to analyse the association between belonging to the vulnerable group and a number of health variables adjusted for gender, age and area of residence. The vulnerable group had worse levels of perceived health even when controlled for gender and area of residence. In Casablanca, the place of residence is an important social stratification indicator reflected in the characteristics of the vulnerable population group and its perceived health. [ABSTRACT FROM AUTHOR]

After more than a decade of concerted effort by policy-makers in Canada and elsewhere to encourage older adults to age at home, there is recognition that the ageing-in-place movement has had unintended negative consequences for family members who care for seniors. This paper outlines findings of a qualitative descriptive study to investigate the health and wellness and support needs of family caregivers to persons with dementia in the Canadian policy environment. Focus groups were conducted in 2010 with 23 caregivers and the health professionals who support them in three communities in the Southern Interior of British Columbia. Thematic analysis guided by the constant comparison technique revealed two overarching themes: (1) forgotten: abandoned to care alone and indefinitely captures the perceived consequences of caregivers' failed efforts to receive recognition and adequate services to support their care-giving and (2) unrealistic expectations for caregiver self-care relates to the burden of expectations for caregivers to look after themselves. Although understanding about the concepts of caregiver burden and burnout is now quite developed, the broader sociopolitical context giving rise to these negative consequences for caregivers to individuals with dementia has not improved. If anything, the Canadian homecare policy environment has placed caregivers in more desperate circumstances. A fundamental re-orientation towards caregivers and caregiver supports is necessary, beginning with viewing caregivers as a critical health human resource in a system that depends on their contributions in order to function. This re-orientation can create a space for providing caregivers with preventive supports, rather than resorting to costly patient care for caregivers who have reached the point of burnout and care recipients who have been institutionalised. [ABSTRACT FROM AUTHOR]

This paper explores how disabled adults and older people find and use information to help make choices about services. It presents findings from a qualitative longitudinal study in England. Thirty participants had support needs that fluctuated, meaning that additional services might be needed on a temporary basis; and 20 had the sudden onset of support needs resulting from an accident or rapid deterioration in health. Each disabled adult or older person was interviewed three times between 2007 and 2009, using a semi-structured topic guide. They were asked to discuss a recent choice about services, focussing, amongst other things, on their use of information. Interviews were transcribed and coded, then charted according to emergent themes. A wide range of choices and sources of information were discussed. These were dominated by health and to some extent by social care. Key findings are that information was valuable not just in weighing up different service options, but as a precondition for such choices, and that disabled adults and older people with the gradual onset of support needs and no prior knowledge about services can be disadvantaged by their lack of access to relevant information at this pre-choice stage. Timely access to information was also important, especially for people without the support of emergency or crisis management teams. Healthcare professionals were trusted sources of information but direct payment advisers appeared less so. Ensuring that practitioners are confident in their knowledge of direct payments, and have the communication skills to impart that knowledge, is essential. There may be a role also for specialist information advocates or expert lay-advisers in enabling disabled adults and older people to access and consider information about choices at relevant times. [ABSTRACT FROM AUTHOR]

Psychiatric morbidity has been shown to be associated with the increased reporting of a range of social problems involving legal rights ('rights problems'). Using a validated measure of psychiatric morbidity, this paper explores the relationship between psychiatric morbidity and rights problems and discusses the implications for the delivery of health and legal services. New representative national survey data from the English and Welsh Civil and Social Justice Survey (CSJS) surveyed 3040 adults in 2007 to explore the relationship between GHQ-12 scores and the self reported incidence of and behaviour surrounding, rights problems. It was found that the prevalence of rights problems increased with psychiatric morbidity, as did the experience of multiple problems. It was also found the likelihood of inaction in the face of problems increased with psychiatric morbidity, while the likelihood of choosing to resolve problems without help decreased. Where advice was obtained, psychiatric morbidity was associated with a greater tendency to obtain a combination of 'legal' and 'general' support, rather than 'legal' advice alone. The results suggest that integrated and 'outreach' services are of particular importance to the effective support of those facing mental illness. [ABSTRACT FROM AUTHOR]

Despite the love that exists between children with disabilities and their parents and the positive contribution that children with a disability make to families and communities, caring for a child with a disability can be difficult and demanding for parents, carers and the family. Their interaction with the many and varied health professionals they encounter can serve to either ameliorate or exacerbate these difficulties. In this paper we report on a qualitative needs analysis undertaken as part of a project to develop disability awareness resources for generic health professionals (GHP). Data were collected through focus groups ( n = 5) and individual interviews ( n = 7) with 34 parents/carers and was analysed using a process of thematic analysis. 'Partnership' was identified as the overarching theme that answers the question 'What do parents/carers want from a GHP?' Three further themes were identified that together tell the partnership 'story'. These are: 'The GHP-parent partnership', 'Qualities of a GHP', and 'The role of advocacy in the GHP-parent partnership'. Implications are presented that highlight the importance of advocacy in GHP-parent partnerships and suggest improvements in GHP education and preparation. [ABSTRACT FROM AUTHOR]

This article reports on findings from a qualitative study, undertaken in England that explored the experiences of 21 gay men and lesbian women who care, or cared, for a person with dementia. The aim of the study was to explore how a person’s gay or lesbian sexuality might impact upon their experience of providing care in this context. This paper reports on one theme that emerged from the wider study – carers’ experiences of ‘coming out’ to service providers. Respondents were recruited using ‘snowballing’ methods and the study employed semi-structured interviewing techniques. Data collection occurred over a protracted period (2003–2007), the time scale being determined by (the well documented) difficulties in recruiting respondents from this group of people. Data analysis was undertaken with the intent of developing common and contrary themes using a constant thematic comparative method. The results reported here demonstrate the ways in which carers mediated disclosures of their sexualities to health and social care service providers and, for some, their wider support network. For many carers, responses to these disclosures proved to be a critical issue and one that coloured their experience of providing care. Service providers’ reactions are demonstrated as being characterised by, at best, a broad acceptance of gay and lesbian people’s circumstances, through to a pervasive disregard of their needs. [ABSTRACT FROM AUTHOR]

The objective of this study was to estimate the joint effects of cognitive impairment and depressive symptoms on health‐related quality of life (HRQoL) and to explore the mediating role of disability among Chinese community‐dwelling older adults. A cross‐sectional study was conducted with 2525 community‐dwelling older adults aged ≥60 years and living in Shanghai, China in 2019. Participants were divided into four groups: (1) non‐depressed without dementia, (2) non‐depressed with probable MCI, (3) depressed without dementia and (4) depressed with probable mild cognitive impairment (MCI). HRQoL was assessed using the 36‐Item Short‐Form Health Survey. Cognitive impairment and depressive symptoms were evaluated with the AD8 and the Geriatric Depression Scale respectively. Activities of daily living (ADL) and instrumental activities of daily living (IADL) disability and other sociodemographic variables were also assessed. The results of this study showed that controlling for sociodemographic characteristics, significant differences in a physical component score (PCS) and a mental component score (MCS) of HRQoL were found across the four groups. Compared to those who were non‐depressed without dementia, older adults who were depressed with probable MCI reported the lowest level of PCS and MCS, followed by older adults who were depressed without dementia. Both ADL and IADL disabilities played mediating roles in the relationship between cognitive impairment and depressive symptoms and PCS. Based on this study, we suggest that the early detection and adequate management of depressive symptoms and cognitive status—as well as efforts to improve individuals' ability to manage their ADLs and IADLs—may help to maintain or improve their HRQoL. [ABSTRACT FROM AUTHOR]

Carers of people living with a disability, mental health problems, alcohol or drug dependency, chronic condition, terminal illness or who are frail due to age may experience negative caregiving impacts. Although carers' social isolation has been reported in many qualitative studies, it has largely been neglected in quantitative studies. Using data collected in the Carers NSW 2020 National Carer Survey, this large‐scale quantitative study aimed to identify the extent of Australian carers' social connectedness and what factors may be related to their social well‐being. The validated Friendship Scale was used to measure social connectedness of 5585 carers. More than half (56.2%) of these carers were socially isolated. Analysis found that a longer duration of caring, more time spent weekly caring, living with the care recipient, caring for a greater number of people, receiving no help from others, higher reported psychological distress and reporting perceived needs were all associated with greater social isolation. Identifying as female or nonbinary/gender diverse, identifying with a culturally and linguistically diverse background, and caring as a parent, former partner or young carer were also related to poorer social connectedness. Health and social services need to consider the needs of carers, identify carers who are socially isolated and provide resources to promote social connectedness. Greater attention in practice and research to focus on carers' social connectedness to address this crucial caregiving experience is required. [ABSTRACT FROM AUTHOR]

They are participating as a volunteer implies active personal positioning accompanying others. Evidence supports that experiences of those who experience an illness, who are hospitalised or feel lonely, impact the volunteers: positive emotions like engagement and Compassion Satisfaction (CS) or, the reverse, Compassion Fatigue (CF). Motivations help us understand why volunteers spend their time on these activities. And self‐care practices will be a challenge to counteract the exhausting emotions of volunteering. This research presents a mixed, exploratory and sequential design study on the island of Majorca (Spain). The first phase (n = 216) was quantitative, gathering data from November 2018 to April 2019. Then, the second phase (two focus groups) started with qualitative data collection (July 2019). Firstly, the study determines CS and work engagement levels and examines the relationship between self‐care, CF and motivations. Secondly, the study finds out how they recognise their positive and negative emotions, their relationship with self‐care and what motivates them to be volunteers. The results show that the volunteers report highly positive feelings associated with their volunteering (CS and engagement) and are backed up by a good level of personal Self‐Care. The Understanding and Enhancement motivational functions generate even more positive feelings for the volunteers themselves, who attach a positive value to their experience of caring for others. Despite the positive results collected, we must not ignore the phenomenon of CF in relational volunteering and pain support because it occurs. After all, that could lead to abandonment by volunteers. [ABSTRACT FROM AUTHOR]

The social determinants of health affect an individual's capacity to cope during a crisis such as the COVID‐19 pandemic which could potentially impact their well‐being. The aim of this study was to examine the relationship between well‐being and the social determinants of health among Australian adults during the COVID‐19 pandemic. A cross‐sectional study of adults residing in Australia was conducted using SurveyMonkey between 20 August and 14 October 2020. Participants were recruited via social media. Well‐being was measured using the 10‐item Multicultural Quality of Life Index and social determinants of health were measured using validated tools and investigator developed questions. Data were analysed using SPSS version 25. Inferential statistics, including independent t‐test and one‐way ANOVA, were undertaken. Multiple regression analysis was used to investigate the predictors of well‐being. In total, 1211 responses were received. Females accounted for 80.7% of the responses, men 16.7% and transgender/non‐binary 2.6%. The mean age of the respondents was 43 years (SD 14.2). The mean score for total well‐being was 62.58 (SD 21.22). The significant predictors of higher well‐being were housing security (p = 0.000), food security (p = 0.000), social support (p = 0.000) and access to healthcare (p = 0.000). This study demonstrates that those with poor social support, difficulty accessing healthcare, insecure housing and food insecurity had significantly poorer well‐being during the COVID‐19 pandemic. It shows that the COVID‐19 pandemic has exacerbated social vulnerabilities and highlights the need for action to address the social determinants of health and inequalities. [ABSTRACT FROM AUTHOR]

In Ontario, new home care clients are screened with the interRAI Contact Assessment and only those expected to require longer‐term services receive the comprehensive RAI‐Home Care assessment. Although Ontario adopted this two‐step approach in 2010, it is unknown whether the assessment guidelines were implemented as intended. To evaluate implementation fidelity, the purpose of this study is to compare expected to actual client profiles and care co‐ordinator practice patterns. We linked interRAI CA and RAI‐HC assessments and home care referrals and services data for a retrospective cohort of adult home care clients admitted in FY 2016/17. All assessments were done by trained health professionals as part of routine practice. Descriptive analyses were used to evaluate congruency between recommended and actual practice. Adjusted cause‐specific hazards and logistic approaches were used to examine time to RAI‐HC assessment and being a high‐priority client. Of 225,989 unique home care clients admitted to the publicly funded home care program, about three‐quarters of clients were assessed with the interRAI CA only (27.9% completed the Preliminary Screener only and 46.6% completed both the Preliminary Screener and Clinical Evaluation). There was substantial agreement between the skip logic and completion of the Clinical Evaluation section (Cohen's kappa = 0.67 [95% CI: 0.66–0.67]). One‐quarter of clients were assessed with both the interRAI CA and RAI‐HC. As expected, RAI‐HC assessed clients were older, reported more health needs, and often received home care services for >6 months. Clients in higher Assessment Urgency Algorithm (AUA) levels were significantly more likely to receive a RAI‐HC assessment and be assigned to a higher home care priority level; however, 28.3% of clients in the highest AUA level did not receive a RAI‐HC assessment. We conclude that the use of the interRAI CA and RAI‐HC balances the investment of time and resources with the information and tools to deliver high‐quality, holistic, and client‐centred care. The interRAI CA guides the care co‐ordinator to screen every client for a broad range of possible needs and tailor further assessment to each client's unique needs. We recommend integrating the AUA into provincial assessment guidelines as well as developing a new quality indicator focused on measuring access to the home care system. [ABSTRACT FROM AUTHOR]

Care‐giving burden and internalised stigma are prevalent among family caregivers of people diagnosed with schizophrenia. Internalised stigma has been regarded as a source of care‐giving burden. But it remains unclear if high levels of internalised stigma directly contribute to an increased risk of care‐giving burden or if the effects could be buffered by psychological factors. This cross‐sectional study was to investigate the relationship between internalised stigma and care‐giving burden, and to determine the mediating effects of coping styles and social support. Data were collected from 344 Chinese family caregivers of adults diagnosed with schizophrenia in a psychiatric outpatient department of a tertiary hospital in Changsha, Hunan between April and August 2018. A self‐reported questionnaire was used to collect data anonymously. Instruments included the Simplified Coping Style Questionnaire, the Multidimensional Scale of Perceived Social Support, the Internalized Stigma of Mental Illness Scale and the Caregiver Burden Inventory. Data analysis was conducted using descriptive statistics, the Spearman correlation and regression analysis to estimate direct and indirect effects using bootstrap analysis. Results showed that internalised stigma, social support and passive coping were significant correlates of care‐giving burden; social support partially mediated the relationship between internalised stigma and care‐giving burden; active coping did not show impacts on internalised stigma and care‐giving burden. This study provided social workers and healthcare providers with a better understanding of the development of care‐giving burden. Comprehensive interventions should be designed to provide supportive resources and reduce the possibilities of internalisation of stigma and passive coping, to alleviate care‐giving burden. [ABSTRACT FROM AUTHOR]

Introduction: Helping professionals are at high risk of being affected by the negative aspects of helping such as compassion fatigue. To date, no study has provided a comprehensive overview of compassion fatigue and compared the prevalence among different helping professions. Objectives: The aim of this study was to explore the prevalence and differences in compassion fatigue among different helping professions. We also wanted to explore the relationship between compassion, self‐compassion, self‐criticism and compassion fatigue. Methods: Six hundred and seven participants working in the helping professions were recruited. The sample consisted of 102 nurses, 44 doctors, 57 paramedics, 39 home nurses, 66 teachers, 103 psychologists, 40 psychotherapists and coaches, 76 social workers, 39 priests and pastors and 41 police officers. The data were collected using an online questionnaire battery measuring levels of compassion, self‐compassion, self‐criticism, compassion fatigue and compassion satisfaction. Results: We found significant differences in compassion fatigue levels among various helping professions. No large differences were found in the compassion and self‐compassion levels exhibited by professionals with medium versus low compassion fatigue scores. However, participants with higher levels of compassion fatigue scored higher in self‐criticism. Self‐criticism was found to be the best predictor of compassion fatigue. The effect of profession on compassion fatigue as mediated by self‐criticism and self‐compassion was significant. Conclusions: Based on the results, we recommend designing programs to combat compassion fatigue that teach helping professionals to better manage their work time and workload (hours per week with clients/patients) and learn healthier inner talk (less self‐critical and more self‐compassionate). [ABSTRACT FROM AUTHOR]

Discharge communication is an important component of care transition between hospitals and community care, particularly for the complex needs of stroke survivors. Despite international research and regulation, ineffective information exchange during care transitions continues to compromise patient outcomes. Primary care practitioners are increasingly responsible for the provision of stroke care in the community, yet it is not known how their role is supported by discharge communication. The aim of this qualitative study was to describe the primary care practitioner perspective of discharge communication, identifying the barriers and enablers relative to continuity of care for stroke survivors. Semi‐structured telephone interviews were conducted with primary care practitioners across Australia, between April and September 2020. Data were analysed using thematic analysis with a constant‐comparison approach. The findings suggest that discharge communication is often inadequate for the complex care and recovery needs of stroke survivors. The challenges in accessing care plans were noted barriers to continuity of care, while shared understandings of stroke survivors' needs were identified as enablers. As discharge communication processes were perceived to be disconnected, primary care practitioners suggested a team approach across care settings. It is concluded that initiatives are required to increase primary care collaboration with hospital teams (which include stroke survivors and their caregivers) to improve continuity of care after stroke. [ABSTRACT FROM AUTHOR]

Arthritis is a long‐term musculoskeletal disease, requiring ongoing management. However, the financial burden of managing arthritis is under‐explored and is yet to be quantified from the perspective of individuals with the condition. Using an exploratory observational design, this study aimed to quantify arthritis‐related costs borne by a sample of working‐age adults aged 18–50 years who responded to the study advertisement. Participants completed a weekly cost diary for 6 weeks, detailing their personal non‐reimbursed (out‐of‐pocket) arthritis‐related costs. Financial distress was measured using the InCharge Financial Distress/Financial Well‐Being Scale. Costs data were analysed descriptively. Mann–Whitney U tests were used to examine relationships between residential location or employment status and out‐of‐pocket costs. Linear regression and Spearman's rho were used to estimate relationships between age or years since diagnosis and out‐of‐pocket costs, and between out‐of‐pocket costs and financial distress respectively. Sixteen adults (median age 40 years, 100% female) with a range of arthritis conditions (median (IQR): 8 (7.5) years since diagnosis) including rheumatoid arthritis, osteoarthritis, psoriatic arthritis, and ankylosing spondylitis completed the six‐week cost diary. All participants reported out‐of‐pocket expenditure related to arthritis. The median per‐person expenditure across the 6 weeks was AUD 1635. The highest reported costs per participant across the 6 weeks were for medical expenses (median AUD 197) and allied health appointments (median AUD 190). In total, the cohort spent AUD 15,272 across the study period. Perceived financial distress was high: median (IQR) financial distress 7 (2.25) on a 1 (lowest) to 10 (highest) scale. Positive relationships between age and costs, and between costs and financial distress were identified. These findings help us understand fiscal expenditure and related distress relevant to younger individuals with arthritis, and can be used to raise awareness of their financial concerns. [ABSTRACT FROM AUTHOR]

In Hong Kong, an increasing number of outdoor exercise facilities have been established in public open spaces to promote physical activity (PA) in older adults. However, no intervention is dedicated in educating the public on how to make use of these resources to fulfil the PA guidelines based on behavioural change theory. This study has two phases, phase one aims to describe the participatory development of the intervention, and phase two is the evaluation of a public outdoor exercise facilities‐based PA education intervention for community‐dwelling older adults. A mixed‐methods participatory design was used to evaluate the impact of the intervention. PA behaviour was assessed as the fulfilment of the PA recommendations by World Health Organization, and the Rapid Assessment of Physical Activity (RAPA) scale at baseline, immediately, and 3 and 6 months post‐intervention. Psychosocial constructs and physical assessments were carried out at both pre‐ and post‐intervention. Individual in‐depth interviews were conducted at post‐intervention. Forty‐seven participants were enrolled in the intervention. The average adherence rate was 90.87%. PA significantly increased after the intervention and remained elevated for the following 6 months. Post‐intervention, the qualitative findings supported the quantitative findings at both the individual and social levels. However, findings regarding the change in participants' usage of environmental resources were divergent. The intervention was well‐received by the participating older adults, as reflected by the high adherence rate. Both quantitative and qualitative data demonstrated the overall impacts of the intervention for creating sustainable changes in PA behaviour. [ABSTRACT FROM AUTHOR]

Family‐centred interventions addressing sociocultural and emotional stressors promise to prevent mental health problems among refugees in the United States. Peer‐led strategies are highly valued, as they engage communities and promote the sustainability of interventions. We assessed the effects of a peer‐led family‐centred Social and Emotional Well‐being (SEW) intervention on preventive (coping, social networking and conflict resolution) and mental health outcomes (stress, anxiety and depression) among resettled Bhutanese adults in Massachusetts. We conducted a SEW intervention with a pre‐intervention versus post‐intervention (7‐day) and follow‐up (3‐month) evaluation among 103 adults (50 families). The SEW is a culturally tailored 5‐weekly session program that included health education, problem‐solving and mind–body exercises to increase knowledge and skills regarding stress management and conflict resolution. We measured anxiety and depression using the Hopkins Symptom Checklist‐25 and stress using Cohen Perceived Stress scales. Health‐promoting behaviours were measured using validated scales. We used paired t‐tests for continuous and McNemar tests for categorical variables. Mean scores significantly decreased from pre‐intervention to post‐intervention and follow‐up for stress by 15% and 13.9%, anxiety by 20.9% and 25.1% and depression by 18.7% and 20.4% (all p's < 0.01). Mean scores increased from pre‐intervention to post‐intervention and follow‐up for coping by 10% and 17.2%, and for community networking by 28% and 36.8% (all p's < 0.01). Generalised estimating equations showed a significant reduction in stress, anxiety, depression and improved coping, self‐efficacy, family and community networking scored from baseline to follow‐ups (all p's < 0.01). Our peer‐led family‐centred SEW intervention was associated with improved preventive and mental health outcomes among Bhutanese adults. [ABSTRACT FROM AUTHOR]

The objective of this study was to identify the relationship of burden with depressive symptoms, mental disorders and older adults' functional dependence in paid and unpaid caregivers. This is a quantitative and cross‐sectional study, carried out in the inland of the state of São Paulo with 111 caregivers, 60 of whom were unpaid and 51 were paid. The caregivers answered a questionnaire for the assessment of sociodemographic and care characteristics, the Zarit Burden Inventory (ZBI), the Patient Health Questionnaire (PHQ‐9), the Self‐Report Questionnaire (SRQ‐20), and the Functional Assessment Questionnaire (FAQ). Unpaid caregivers were older, married, have been providing care for a longer period of time, and devoted more days and hours per week to care when compared to paid caregivers. Depressive symptoms and mental disorders (non‐psychotic) are related to the levels of burden in both paid and unpaid caregivers (p < 0.001). The care process causes harm such as burden, depressive symptoms, and mental disorders in paid and unpaid caregivers. Thus, it is important to think about coping strategies to minimize the psychological consequences of the care process. [ABSTRACT FROM AUTHOR]

Despite widespread hearing problems among older adults, only a minority of them use hearing aids. The decision to rely on hearing aids is influenced by several psychosocial factors, which may include attitudes influenced by significant others, particularly caregivers and health professionals. The language used by professionals when approaching this topic is particularly important. The purpose of this study was to deepen the role played by different communication styles in the area of hearing impairment by analysing the impact of language—medical versus everyday—used in the doctor–patient interaction on attitudes and behavioural intentions in a sample of potential caregivers of older adults. 209 Italian volunteers aged between 19 and 60 completed an online experimental study. The results suggested that, when interacting with doctors, exposure to a language that includes medical words promotes negative attitudes towards hearing loss. Nevertheless, medical language induces positive attitudes towards hearing aids and encourages people to adopt them when needed as well as recommending them to relatives and friends. Overall, the use of formal, medical language in doctor–patient communication, despite sounding less reassuring, is more effective in persuading people with hearing loss to rely on hearing aids. [ABSTRACT FROM AUTHOR]

Lumbar surgery is a commonly prescribed intervention for low back pain but poses higher risks and worse outcomes for older adults. Identifying clinical phenotypes based on biopsychosocial factors may help identify older adults who are at greatest risk for poor postoperative recovery. This study aimed to (a) classify older adults who underwent lumbar surgery based on preoperative biopsychosocial factors, and (b) quantify the association between preoperative biopsychosocial classifications and 3 and 12 months postoperative improvement outcomes. Latent class analysis was used to identify biopsychosocial classifications in 10,283 individuals aged ≥60 from the Quality Outcomes Database (the United States, 2021–2018). Logistic regression models measured the association between biopsychosocial classifications and 3 and 12 months postoperative outcomes (back/leg pain intensity, disability and quality of life), adjusting for covariates. Three classes were identified based on 19 a priori biopsychosocial factors and were characterised as 'high‐risk' (15%), 'physical‐/social health‐risk' (44%) and 'low‐risk' (41%). The high‐risk class demonstrated increased odds of failing to recover post‐operatively compared to the other classes. Similarly, the physical‐/social‐risk class demonstrated increased odds of failing to recover in all outcomes and time points compared to the low‐risk class. Biopsychosocial factors with higher prevalence in the high versus low‐risk class were depression (92.5% vs. 10.6%), multiple morbidities (55.3% vs. 25.7%) and obesity (59.5% vs. 37.2%). This study introduces novel non‐recovery phenotypes for older adults undergoing lumbar surgery and may lead to the development of tailored interventions to improve clinical care and outcomes for this population. [ABSTRACT FROM AUTHOR]

We aimed to explore consumer experiences of ambulatory telehealth services and whether consumer experiences differed according to whether they received their consultation using telephone or video technology. We conducted structured telephone interviews with patient consumers who had received a recent remote consultation by telephone or video call, at local ambulatory allied health or multidisciplinary services within a large public metropolitan public health network. Respondents were asked about their recent experience and future choices in relation to telehealth. Responses from consumers who received telephone and video consultations were compared. Consumers from community rehabilitation, community health, allied health outpatients, multidisciplinary specialist clinics and mental health services participated (n = 379), of whom 245 received a telephone consultation (65%) and 134 a video consultation (35%). Almost half of respondents (49%) expressed preference for future face‐to‐face care and 29% reported they would choose to use telehealth over face‐to‐face consultation for a similar appointment again. Many commented that they would be influenced by the type of consultation required and expressed a desire to have a choice. Approximately 80% of both groups reported they had achieved the desired outcome from their telehealth consultation. Consumers using video were more likely to experience technical issues. Telehealth met the needs of most consumers, and responses were similar for telephone and video consultations. [ABSTRACT FROM AUTHOR]

Income and employment are recognised as social determinants of health. Occupationally related exposures and working conditions impact health behaviours. Taxi drivers have been recognised as an occupationally COVID‐19 at‐risk group. COVID‐19 threatens their lives and livelihoods. This study describes self‐reported income changes attributed to the COVID‐19 pandemic among taxi drivers. Associations between percentage change in income and reported prevention practices were ascertained. In May 2020, a cross‐sectional study was done among 282 taxi drivers in the Kingston and St. Andrew Metropolitan Area in Jamaica. Multi‐stage sampling was used to select taxi driver from seven hubs. Data collection utilised a 28‐item questionnaire. Self‐reported income before and during the COVID‐19 pandemic was ascertained and correlations between relative changes in income and COVID‐19 prevention practices were assessed. The median pre‐COVID‐19 monthly income was USD 1,428.57 (IQR = 1,467.26), about USD 51/day. Median monthly income since the COVID‐19 outbreak was USD 500 (IQR = 472.37), about USD 18/day, representing a 65% reduction in income. There was a statistically significant association between the relative change in income and the practice of wearing mask while transporting passengers. Generally, as the relative change (decline) in income increased, reported compliance with mask wearing decreased (Spearman's rho = −0.15, p = 0.02). Taxi drivers have experienced marked decline in income due to the COVID‐19 pandemic, with implications for health practices and the maintenance of desired health behaviours. Authorities should be cognisant of the economic impact and COVID‐related consequences in the taxi industry, as they seek to develop COVID‐19 occupationally related prevention and control programmes. [ABSTRACT FROM AUTHOR]

Although aquatic‐based interventions are increasingly used in the psychiatric rehabilitation services, the effects of this type of community program as an adjuvant therapy for psychosocial problems of people with serious mental illness (SMI) have been under‐explored. This research evaluated the feasibility and outcomes of an occupational therapy program consisting of aquatic‐based activities (AA‐OT program) in the community in Spain. This study is the first randomized controlled trial (RCT) on this topic. This pilot trial was conducted with a sample of 16 adults with SMI who were randomly allocated to the AA‐OT program plus treatment as usual or treatment as usual alone (eight in each group). The AA‐OT program included activation of daily living skills, warm‐up, group activities/tasks, and relaxation. It consisted of two sessions per week over 12 weeks. Outcomes were evaluated at week 0 and 12. A total of 14 participants (87.5%) completed the trial. No adverse events or side‐effects were noted. Comparisons between the two groups on change scores showed that participants in the intervention group showed significant improvements in several outcome measures: psychosocial problems (HoNOS), two health‐related quality of life scales (SF‐36: Physical Functioning and Mental Health), and performance of social activities (Activity and Social Relations scale). Satisfaction with the program was high. In conclusion, the results support the feasibility and potential benefits of this occupational therapy program. 12 weeks of aquatic‐based activities in a group intervention may enhance the outcomes of psychiatric rehabilitation improving the severity of psychosocial problems, patient‐reported health status, and social relations. This community‐based program may be beneficial as a non‐pharmacologic method in the illness management and recovery of people with SMI. The findings from this pilot trial need to be confirmed in a large, fully‐powered RCT. [ABSTRACT FROM AUTHOR]

Considering the small number of studies aimed at evaluating outcomes related to dizziness and falls in the older adults who live in long‐term care facilities, especially in north‐eastern Brazil, and considering the negative impact of these events on the quality of life of these individuals, this study purpose was to evaluate dizziness as a predictor of risk of falls in institutionalised older adults. This cross‐sectional analysis of data on falls and dizziness of 187 institutionalised older adults carried out between the years 2014 and 2016. The data collection instruments used were a socioeconomic and demographic questionnaire and questionnaires for assessing variables related to falls. The different diagnostic methods were compared using the Spearman correlation, and the Dizziness variable was evaluated by means of logistic regression. Inferential statistical analysis showed a significant association between dizziness and number of morbidities (p =.03) and dizziness and a history of falls (p =.04). Spearman's correlation analysis revealed statistically significant results only for FES‐I (Falls Efficacy Scale–International) (p <.01). Dizziness was a predictor of risk of falls and that it was associated with a greater number of morbidities and previous history of falls. Implementing rehabilitation practices to reduce dizziness symptoms can significantly reduce the risk of falls for institutionalised older adults. [ABSTRACT FROM AUTHOR]

Smoking is one of the most unhealthy behaviours and responsible for a variety of respiratory diseases. Although spirometric lung age (SLA) is regarded as an effective way to augment the smoking quit rate in other countries, it has not been calculated in Chinese smokers. Thus, the aim of this study was to determine the association of SLA with smoking status, and further explore whether smoking duration, dependence and other factors such as obesity and physical exercise affect SLA in Chinese current smokers. A total of 431 healthy men aged 20 years and older took part in the study from September 2018 to August 2019. Spirometric test was measured through a portable spirometry, and smoking status including smoking duration and dependence was investigated by using a questionnaire. SLA was calculated from an established equation which is based on the inverse calculation of the forced expiratory volume in one second in the Chinese population. Lung age difference (∆LA) could be obtained by counting the difference between SLA and chronological age. Results indicated that ∆LA is remarkably higher in current smokers than that in ex‐smokers and non‐smokers (p < 0.01). The study also revealed that smoking duration and dependence are related to ∆LA. Smokers with long smoking duration (smoked ≥10 years) and high dependence (consumed ≥20 cigarettes per day) had a significantly higher ∆LA than their counterparties (p < 0.01). Multiple regression analysis showed that body mass index, smoking duration and cigarettes per day were independently correlated with ∆LA in the current smokers (p < 0.01). The findings suggest that not only smoking or not, but smoking duration, dependence and obesity are strongly associated with SLA. [ABSTRACT FROM AUTHOR]