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Domains of quality of life in children with autism spectrum disorder have not previously been explored and there has been no quality of life measure developed for this population. Our study investigated parent observations to identify the domains important to children with autism spectrum disorder who also had an intellectual disability. In all, 21 parents (19 mothers, 2 fathers) of children with autism spectrum disorder (aged 6-17 years) participated in a qualitative study to discuss their child's quality of life. Thematic analysis using a grounded theory framework was conducted and 10 domains emerged in relation to health and well-being, capacity to perform and develop skills in daily life, and connections with the community and environment. Unique aspects of quality of life included varying levels of social desire, consistency of routines, and time spent in nature and the outdoors, which are not comprehensively captured in existing measures. Parent observations provide an initial framework for understanding quality of life in autism spectrum disorder and support the development of a new measure for this population.

Purpose: This paper aims to present a literature review of the health workforce, hospital and clinic systems, infrastructure, primary care, regulatory climate, the pharmaceutical industry and community health behavior of the Kenyan health-care system with the purpose of providing a thorough background on the health-care environment in Kenya. Design/methodology/approach: A systematic literature review was conducted using Pub Med, searching for "Kenya" in the title of articles published from January 1, 2015 to February 24, 2016; this provided a broad overview of the type of research being conducted in Kenya. Other data provided by governmental agencies and non-governmental agencies was also reviewed to describe the current state of population health in Kenya. Findings: An initial review of 615 Pubmed articles included 455 relevant articles. A complete review of these studies was conducted, resulting in a final sample of 389 articles. These articles were categorized into three main subject areas with 14 secondary subject areas (Figure 1). Research limitations/implications: The narrow scope of the search parameters set for the systematic review was a necessary limitation to focus on the most relevant literature. The findings of this study provide a thorough background on health care in Kenya to researchers and practitioners. Originality/value: This compilation of data specific to Kenya provides a detailed summary of both the country's health-care services and health status, focusing on potential means of realizing increased quality and length of life.

The importance of English language acquisition for resettlement of refugees is well established, particularly as a pathway to education, employment, health and social connections. A qualitative study was conducted in 2011 in Melbourne, Australia utilising focus groups with 87 refugee background women from Karen, Iraqi, Assyrian Chaldean, Lebanese, South Sudanese and Bhutanese refugee backgrounds. Focus groups and interviews were also conducted with 18 service providers and five bicultural and community workers. Several barriers were identified that prevented refugee mothers from learning English; however, some innovative and flexible models appear promising. The development, implementation and evaluation of innovative models and settings for refugee background women with young children to learn English in a culturally appropriate way are essential.

Background: Raising a child with a disability can place significant strain on the mental wellbeing of parents and carers. This study developed a mental wellbeing resource specifically for parents and carers of children and adolescents with a disability. Methods: Interviews with 20 parents and carers and 13 health and disability service professionals were conducted to determine resource content and format. Results: Key information areas for the resource were information about parent/carer wellbeing; understanding the barriers to wellbeing, including lack of support, being unable to ask for help, being isolated from the community, and having insufficient time or income to spend on self; suggestions on how to organise respite; and opportunities for increasing wellbeing. Conclusions: Given parental mental health is key to the quality of life of the child and family, it is recommended that the resource is distributed to parents and professionals, and adapted for different cultural and linguistic backgrounds.

Purpose: The purpose of this article is to provide a general review of the health-care needs in Kenya which focuses on the role of community engagement in facilitating access and diminishing barriers to quality care services. Health-care concerns throughout Kenya and the culture of Kenyan's health-care practices care are considered. Design/methodology/approach: A comprehensive review covered studies of community engagement from 2000 till present. Studies are collected using Google Scholar, PubMed, EBSCOhost and JSTOR and from government and nongovernment agency websites. The approach focuses on why various populations seek health care and how they seek health care, and on some current health-care delivery models. Findings: Suggestions for community engagement, including defining the community, are proposed. A model for improved health-care delivery introduces community health workers (CHWs), mHealth technologies and the use of mobile clinics to engage the community and improve health and quality of care in low-income settings. Practical implications: The results emphasize the importance of community engagement in building a sustainable health-care delivery model. This model highlights the importance of defining the community, setting goals for the community and integrating CHWs and mobile clinics to improve health status and decrease long-term health-care costs. The implementation of these strategies contributes to an environment that promotes health and wellness for all. Originality/value: This paper evaluates health-care quality and access issues in Kenya and provides sustainable solutions that are linked to effective community engagement. In addition, this paper adds to the limited number of studies that explore health-care quality and access alongside community engagement in low-income settings.

Purpose: This paper aims to critically analyze the empirical literature on health and human development in high-, middle- and low-income countries to develop a sustainable model for investing in human health. The model is critical in building a comprehensive health-care system that fosters the stakeholders' financial stability, economic growth and high-quality education for the local community. Design/methodology/approach: A comprehensive literature review was carried out on health, human development and sustainable health investment. After thoroughly examining theoretical frameworks underlying the strategies of successful human health systems, a summary of empirical articles is created. Summaries provided in this paper represent relevant health-care strategies for Kenya. Findings: Based on the empirical review of literature, a Nexus Health Care model focusing on human development, social and cultural development, economic development and environmental development in high-, middle- and low-income countries is proposed. The goal of this model is to enhance sustainable development where wealth creation is accompanied with environmental uplifting and protection of social and material well-being. Research limitations/implications: This paper is limited to a comprehensive literature review presenting empirical evidence of human development and sustainability. Originality/value: Kenya like other developing nations aspires to contribute significantly in improving health through development of health products but the approaches used have been limiting. In most cases, the use of Western theories, lack of empowering the community and dependence on donor support have hindered the country from achieving comprehensive health and human development. This papers seeks to develop a model for health-care investment and provide strategies, operations and structure of successful health systems and human development for a developing country, such as Kenya.

Purpose: The purpose of this paper is to present proposed solutions and interventions to some of the major barriers to providing adequate access to healthcare in Kenya. Specific business models are proposed to improve access to quality healthcare in low- and middle-income countries. Finally, strategies are developed for the retail clinic concept (RCC). Design/methodology/approach: Google Scholar, PubMed and EBSCOhost were among the databases used to collect articles relevant to the purpose in Kenya. Various governmental and news articles were collected from Google searches. Relevant business models from other sectors were considered for potential application to healthcare and the retail clinic concept. Findings: After a review of current methodologies and approaches to business and franchising models in various settings, the most relevant models are proposed as solutions to improving quality healthcare in Kenya through the RCC. For example, authors reviewed physician recruitment strategies, insurance plans and community engagement. The paper is informed by existing literature and reports as well as key informants. Research limitations/implications: This paper lacks primary data collection within Kenya and is limited to a brief scoping review of literature. The findings provide effective strategies for various business and franchising models in healthcare. Originality/value: The assembling of relevant information specific to Kenya and potential business models provides effective means of improving health delivery through business and franchising, focusing on innovative approaches and models that have proven effective in other settings.

This paper presents baseline data from Thrive, a capacity-building program for family day care educators. Educators completed a self-report survey assessing knowledge and confidence in promoting children's social and emotional wellbeing. An in-home observation was used to assess care quality. Twenty-four educators responded to the survey (40 per cent response rate). They had an average of nine years' experience and 82 per cent held childcare qualifications. Educators reported knowledge of, on average, three early signs of social and emotional problems in children, three risk factors and two protective factors. Using a scale from 0-10, mean educator confidence levels ranged from an average of 6.69 to 7.25. Quality of care ratings were moderate. Although educators had a good understanding of children's social and emotional wellbeing, the study identified opportunities for significant changes in the quality of the educators' interactions with children in their care and their professional development

Background: Functional abilities and social outcomes of young adults with cerebral palsy (CP) are relatively underresearched. Improvements in paediatric care have extended the expectation of achieving adulthood to 90%. Method: Young adults aged 20-30 years with CP (n = 335) were compared to a population-based control group (n = 2,152) of the same age. Motor function, self-care abilities, educational level, and social outcomes were determined by questionnaire. Results: Half the study group walked independently, but only 35.5% were independent in self-care. In comparison to their peers without disability, the study group's highest educational level was lower (p < 0.0001), as were rates of employment (36.3% compared with 80%), they were more likely to be living with parents (80% compared with 21%), to be single, and to have limited financial resources. Conclusion: Young adults with CP are functionally and socially disadvantaged in contrast with their peers without disability. Self-care dependence, intellectual disability, and communication impairments contribute to these outcomes but are not solely responsible.

To assess the measurement properties of a new QOL instrument, the Cerebral Palsy Quality of Life Questionnaire-Teen (CP QOL-Teen), in adolescents with cerebral palsy (CP) aged 13-18 years, examining domain structure, reliability, validity and adolescent-caregiver concordance. Based on age, 695 eligible families were invited to participate by mail. Questionnaires were returned by 112 primary caregivers (71.8% of questionnaires sent). 87 adolescents aged 12-18 years also completed the questionnaires. CP QOL-Teen, generic QOL instruments (KIDSCREEN, Pediatric Quality of Life Inventory), functioning (Gross Motor Function Classification System) and a condition-specific instrument (PedsQL-CP) were used. Principal components analysis produced seven scales: wellbeing and participation; communication and physical health; school wellbeing; social wellbeing; access to services; family health; feelings about functioning. Cronbach's alphas for the derived scales ranged from 0.81 to 0.96 (primary caregiver report) and 0.78 to 0.95 (adolescent report). Test-retest reliability (4 weeks) ranged from 0.57 to 0.88 for adolescent self-report and 0.29 to 0.83 for primary caregiver report. Moderate correlations were observed with other generic and condition specific measures of QOL, indicating adequate construct validity. Moderate correlations were observed between adolescent self-report and primary caregiver proxy report. This study demonstrates acceptable psychometric properties of both the adolescent self-report and the primary caregiver proxy report versions of the CP QOL-Teen. (Contains 4 tables.)

Family day care in Australia is currently undergoing rapid "professionalisation" within a national reform agenda that seeks to raise and standardise early childhood service quality. Included within this reform is a requirement that all family day care workers obtain formal qualifications and that workers are referred to as "educators" rather than "carers". This study drew on focus groups and interviews with family day care workers, management, government and industry representatives collected as part of a larger study into family day care workers' capacity to promote children's social and emotional wellbeing. Our analysis identified three discourses of professionalisation within family day care that provide important insights into the sector at a time of significant change. Management promoted workers as "educators" aligned with a neo-liberal, masculine understanding of professionalism and the objective measures used to assess service quality. This discourse excluded what "carers" felt were important, subjective and maternal aspects of their service delivery. To reconcile these discursive extremes, some workers took up a discourse that emphasised the requirements of their "job" and the standards of professionalism required by management. In conclusion, we contend that the take-up of educational discourses in family day care produce and reproduce tensions between "women's work" and "masculine professionalism" that undermine the sector's attempts to increase their status and recognition. (Contains 1 note.)

Despite emerging evidence of the contributors to high-quality family day care, a comprehensive comparison of international family day care systems has not been undertaken. The aim of this paper is to compare regulated family day care (FDC) in Australia, Canada, England and Wales, Germany, Ireland, Japan, Norway, New Zealand, Sweden, and the USA, using standard information about FDC usage and each country's structural characteristics, regulatory approach, quality assurance indicators, supervision and support, and sector challenges. A template was developed by representatives of the International Family Day Care Organisation, including academics, FDC providers, and FDC educators and management staff. The paper demonstrates that, although the existing body of published research is sufficient to provide clear guidance for developing and maintaining quality FDC, this knowledge is not always being applied in current practices. Three practices, each pertaining to several countries, are of concern: (a) minimal requirements for being a regulated FDC provider, (b) minimal quality assurance guidelines, and (c) minimal provider supports. There is great potential to learn from countries that have a high level of success in providing high-quality FDC and strong support for providers and families. (Contains 6 tables.)

This study aimed to explore family day care (FDC) educators' knowledge of child social and emotional wellbeing and mental health problems, the strategies used to promote children's wellbeing, and barriers and opportunities for promoting children's social and emotional wellbeing. Thirteen FDC educators participated in individual semi-structured interviews. FDC educators were more comfortable defining children's social and emotional wellbeing than they were in identifying causes and early signs of mental health problems. Strategies used to promote children's mental health were largely informal and dependent on educator skills and capacities rather than a systematic scheme-wide approach. Common barriers to mental health promotion were limited financial resources, a need for more training and hesitance raising child mental health issues with parents. There is a need to build FDC educators' knowledge of child social and emotional wellbeing and for tailored mental health promotion strategies in FDC.

Introduction: Although the family day care workforce has changed over the past decade in response to evolving childcare regulations and accreditation requirements, there is little research on family day care educators in Australia. The aim of this study was to describe characteristics of Australian family day care educators, including their qualifications, professional training, characteristics of the children they care for, and connections to their family day care scheme and community organisations. Methods: Secondary data analysis was conducted using cross-sectional data from Wave Two of the Longitudinal Study of Australian Children (LSAC) Birth Cohort. Data from family day care (FDC) educators were extracted from the mail-out Home-Based Carer (HBC) survey completed by 207 FDC educators (56% response rate). Descriptive statistics were used to profile demographics and qualifications of FDC educators, their scheme and community connections, and the characteristics of children in their care. Results: More than half of the FDC educators did not have qualifications specific to early childhood; 28 per cent of educators were currently studying in the area; and a quarter were qualified. One-third of educators were caring for at least one child with a disability or developmental delay, 27 per cent were looking after children from non-English speaking backgrounds, and 16 per cent were looking after children from Aboriginal or Torres Strait Islander backgrounds. Most FDC educators reported a high level of connection with their coordinating scheme (89%) but that assistance from other organisations such as schools, preschools or childcare centres was rare. Discussion: The results from this study reflect the movement in FDC towards gaining formal qualifications. Given that many educators were caring for children from culturally and linguistically diverse backgrounds and had special needs, tailored support is needed to build their knowledge, skills and confidence to ensure inclusive care provision. Isolation of FDC educators from the wider community and other child-centred organisations highlights potential to develop connections outside of FDC to facilitate professional development and support. (Contains 4 tables.)

Quality of life (QOL) has emerged over the past 20 years as an outcome for measuring the effectiveness of health-improvement interventions. The Cerebral Palsy Quality of Life Questionnaire for Children (CPQOL-Child) is well regarded and now integrated into research internationally. We describe the results of qualitative research, using grounded research in which we aimed to identify domains of QOL for adolescents with cerebral palsy (CP) from adolescent and parent perspectives to guide the development of an adolescent version. Seventeen adolescents (nine males, eight females) aged 13 to 18 years (mean = 15.53 SD = 1.74), with varying levels of impairment (Gross Motor Function Classification System levels I n = 5, II n = 2, III n = 6, IV n = 4, and V n = 6) and their parents (n = 23) participated in semi-structured interviews. Questions included: "What do you think is important to your (child's) QOL?" and "How does CP impact on your (child's) life?" Fifteen themes were identified, including domains related to health issues in adolescence, participation, education, specific CP-related issues (pain and discomfort, communication), family issues, practical issues (financial resources), and changes associated with adolescence (sexuality, independence). The composition of these QOL domains reflects the developmental concerns of adolescents with CP, adding to the views of children, and strongly supports adolescent participation in the development of self-reported well-being and QOL measures. Many of the domains are consistent with child reports of QOL and thus it appears feasible and valid to develop a measure that will be transferable across childhood and adolescence.

People with mobility impairment have the right to live in accessible housing that meets their needs. Although the Australian National Construction Code for residential housing will be amended to include minimum accessibility standards in September 2022, some states have chosen not to adopt these standards (New South Wales, Western Australia and South Australia). The inclusion of people with lived experience in decisions surrounding accessible housing design is lacking. This study sought the perspective of people with mobility impairment on the most important modifications they would make to the design of their own homes, and the homes of their friends and family, to make them more accessible. An online survey was completed from February to March 2021 by 145 people living in Australia including 112 people with mobility impairment, and 33 family members. Results indicated that 71 per cent of the participants were living in housing that did not fully meet their accessibility needs. Descriptive qualitative analyses demonstrated that commonly reported modifications included a step‐free entrance, wider internal doors and corridors, and level access throughout the home. These modifications would promote social inclusion, functioning, independence and overall quality of life. These results have policy implications for the implementation of accessibility standards in the National Construction Code. [ABSTRACT FROM AUTHOR]

This study examined the quality of life of single mothers making the mandatory transition from welfare to work. The Australian government purported that the benefits of making this transition would include higher incomes, better social participation, and improved wellbeing. It is currently unknown, however, how single mothers currently engaged in welfare to work programs evaluate their quality of life. Quality of life scores for 334 single mothers engaged in welfare to work in Australia were compared with normative data. Participants reported significantly lower quality of life scores than the general population for all quality of life domains, highlighting the need to carefully examine welfare to work policies to ensure they promote participants' quality of life. KEYWORDS quality of life, welfare, single mothers, Australia DOI 10.1080/03630240903423980

Objectives: To conduct a critical and systematic analysis of descriptive studies regarding the health, development and wellbeing status of Indigenous children in Australia and to map them according to 1) Reported Indigenous involvement in the research process; 2) Domains of the life-course model of health; and 3) Geographical location of the Indigenous child population sample. Methods: A search of electronic databases, targeted websites and reference lists of relevant papers. Studies from 1958 to 2005 with clear methods and results were included. Data were extracted, mapped and analysed according to domains of the life-course model of health and development, study location, and reported level of Indigenous involvement. Results: 217 studies were eligible. Research predominantly addressed physical health (75.1%) with few studies addressing mental health and wellbeing (2.8%) or health determinants (27.6%). Indigenous involvement in the research process was not apparent in 71.4% of studies, although it appears to be increasing. Compared with 10.6% in metropolitan locations, 67.2% of the studies were conducted in very remote areas. Remaining studies were conducted in remote or regional areas or were national. Conclusions: More work is needed to establish an evidence base of Australian Indigenous child health and wellbeing that is founded on Indigenous values, knowledge and participation. Not withstanding the significant need to address issues of core morbidity and physical health for Indigenous children, more research addressing emotional and social health and wellbeing is required, as are research questions of importance to Indigenous children living in urban settings. Key words: child health, Indigenous population, systematic review

Health literacy is a broad and multidimensional construct, making its measurement and conclusions inconsistent. This study aims to compare the patterning of health literacy using different assessment tools and examine their impact on children's developmental outcomes. A cross-sectional study was conducted with 650 students in Years 7–9 from four secondary schools in Beijing. Health literacy was measured by the eight-item health literacy assessment tool (HLAT, score range 0–37), the six-item Newest Vital Sign (NVS, score range 0–6), and the 16-item Health Literacy Survey (HLS, score range 0–16). Based on Manganello's health literacy framework, information on upstream factors (e.g., gender, ethnicity, socioeconomic status) and developmental outcomes (e.g., health-promoting behaviours, health service use, global health status) was collected. Overall, the average scores for health literacy were 26.34 ± 5.89, 3.64 ± 1.64, and 13.72 ± 2.94, respectively, for HLAT, NVS, and HLS. The distribution of health literacy varied by socio-demographics and individual characteristics except for gender, no matter which health literacy assessment tool was used. The magnitude of associations between health literacy, its upstream factors and developmental outcomes was greater when using three-domain instruments (HLAT and HLS) than using single-domain instruments (NVS). The approach to health literacy measurement will influence the conclusion. Using multidimensional assessment tools may better capture a child's health literacy and contribute to the maximum efficiency and effectiveness of school-based health literacy interventions. [ABSTRACT FROM AUTHOR]

Over 4500 people under 65 years of age live in residential aged care (RAC) in Australia, and they experience poorer quality of life than people with similar disabilities in other settings. Governments have long aimed to reduce admissions of young people to RAC, but in 2019, for the first time, the Australian Government adopted target dates for resolving the issue. The targets include reducing admissions of young people to near zero by 2022 and ensuring almost no one remains in RAC beyond 2025. The national strategy focuses mostly on housing and support needs being met via the National Disability Insurance Scheme. The present study drew on quarterly data from the National Aged Care Data Clearinghouse to examine progress toward these targets. Significant progress was evident in terms of young people entering RAC: admissions reduced each quarter between September 2018 and July 2020, halving over two years. No progress was evident in terms of young people leaving RAC for better arrangements; the trend neither increased nor decreased. Prospects for achieving the targets are discussed. [ABSTRACT FROM AUTHOR]