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Hensikten med studien er å analysere faktorer som forklarer omsorgsbelastning blant pårørende til hjemmeboende personer med demens. Studien bidrar med ny kunnskap ved å analysere en rekke forklaringsfaktorer samlet – i motsetning til tidligere studier som har analysert et begrenset antall faktorer. Dermed gir studien også grunnlag for å sammenligne betydningen av de ulike forklaringsfaktorene. Studien er en tverrsnittspørreundersøkelse basert på medlemsregisteret til Nasjonalforeningen for folkehelsen i Norge. Utvalget består av 231 pårørende til hjemmeboende personer med demens. Variablene er fortrinnsvis hentet fra etablerte og validerte instrumenter. Analysene i denne artikkelen inkluderer mange av de kjente forklaringsfaktorene i en samlet regresjonsmodell. Resultatene viser at variablene som inngår i analysen, forklarer 70 % av omsorgsbelastningen hos pårørende til hjemmeboende personer med demens. Omsorgsbelastningen øker med redusert mestringsevne hos pårørende, økt bruk av kommunale omsorgstjenester, økt omsorgstid og redusert omsorgskompetanse. Omsorgsbelastningen er videre større om pårørende bor sammen med den demenssyke, er kvinner, er yngre og har dårligere helsetilstand. Bruk av kommunale omsorgstjenester, omfanget av pårørendes omsorg og pårørendes mestringsevne bidrar sterkest til å forklare omsorgsbelastningen. Egenskaper både ved personer med demens og deres pårørende må sees i sammenheng for å forebygge omsorgsbelastning. Det er helt sentralt at den kommunale helse- og omsorgstjenesten innleder samarbeid med pårørende tidlig i demensforløpet. Det kan bidra til å forebygge alvorlig slitasje hos pårørende og kritiske situasjoner i hjemmet gjennom støtte til både omsorgspersonen og den som har demenssykdom.

The primary aim of this study was to determine which health care barriers were most important for people with disabilities in Malawi. To accomplish this, we devised a sequential mixed-methods research design that integrated locational survey data and qualitative data from field studies. Our secondary aim was to evaluate this research design not only as a design-solution to our particular research objective, but as a tool with more general applicability within social sciences. Malawi has one of the most underserved health service populations in the world with chronic resource shortages and long travel distances where people with disabilities are at a particular disadvantage. Nevertheless, our results show that even in a resource scarce society such as Malawi it is the interpersonal relationships between patients and health service providers that has the largest impact on the perception of access among patients. Our results also suggest that the sequential mixed-methods design is effective in guiding researchers towards models with strong specifications.

AIM Many children with disabilities in low- and middle-income countries do not attend school and one-third are out of school. In order to ensure that education is for all including children with disabilities, research is needed on barriers to schooling to identify targets for intervention. The study will examine the determinants of school achievement among persons with and without disabilities as well as among each type of impairment. METHODS The study will utilize data from a recent national, representative household survey on living conditions among persons with and without disabilities. The individual level data used in this article comprise 2123 persons with and 2000 persons without disabilities. RESULTS The results show that an alarmingly high proportion of persons in Nepal have not accessed formal education, with access being significantly lower among persons with disabilities. While the results may be influenced by the assumed relationship between disability and poverty, results from analyzing the cross-sectional data cannot be conclusive on the influence of disability vs. poverty in determining differences in access and school attainments. Increased environmental barriers, higher age, rural location, and increased levels of disability were found to be associated with lower educational achievement. Pronounced differences in access to education were found between impairment types, with individuals with physical impairments achieving the highest level and individuals with multiple impairments, hearing and mental impairments achieving lowest. CONCLUSIONS It is necessary both to strengthen the entire educational sector and at the same time allocate resources that will ensure that all children are on board and that particular efforts are implemented to cater for those who are easily side-lined.Implications for rehabilitationAn alarmingly high proportion of persons in Nepal have not attended school.Substantially more individuals with than without disabilities have never attended school.Increased environmental barriers, higher age, rural location, and increased levels of disability were found to be associated with lower educational achievement.Pronounced differences in access to education were found between impairment types, with individuals with physical impairments achieving the highest level and individuals with multiple impairments, hearing and mental impairments achieving lowest.It is necessary both to strengthen the entire educational sector in Nepal and at the same time ensure that particular efforts are implemented to cater for those who are easily sidelined.

It is estimated that only 5-15% of people in low and middle income countries (LMICs) who need assistive technologies (AT) have access to them. This scoping review was conducted to provide a comprehensive picture of the current evidence base on AT within LMICs and other resource limited environments.The scoping review involved locating evidence, extracting data, and summarizing characteristics of all included research publications.Of the 252 publications included, over 80% focused on types of AT that address mobility (45.2%) and vision (35.5%) needs, with AT types of spectacles and prosthetics comprising over 50% of all publications. Evidence on AT that addresses hearing, communication, and cognition is the most underrepresented within the existing evidence base. The vast majority of study designs are observational (63%).Evidence on AT in resource-limited environments is limited in quantity and quality, and not evenly distributed across types of AT. To advance this field, we recommend using appropriate evidence review approaches that allow for heterogeneous study designs, and developing a common language by creating a typology of AT research focus areas. Funders and researchers must commit much greater resources to the AT field to ameliorate the paucity of evidence available. Implications for Rehabilitation An increase in the quality and quantity of research is required in resource limited environments, where 80% of the global population of people with disabilities reside. Improved and increased evidence is needed to identify and understand needs, inform policy and practice, and assess progress made in increasing access to and availability of appropriate AT. Over 80% of the existing research publications on assistive technologies in resource limited environments address mobility and vision. More research is needed on AT that address hearing, communication and cognition. The use of a common language would facilitate the advancement of the global AT research field. Specifically there is a need for researchers to use a common definition of AT (i.e., ISO 9999) and typology of AT research focus areas.

Background Millions of people in Southern Africa are deprived of basic human rights such as the right to education and work because of the large and growing unmet demand for assistive technologies (AT). Evidence is needed to better characterize the lack of AT access. Methods This study serves to identify the sociodemographic factors that are associated with access to AT in two countries in Southern Africa, Botswana and Swaziland. To achieve this aim, logistics regression was applied to a subset of variables from two Living Conditions Studies, nationally representative surveys that were conducted in Southern Africa (2014 and 2010). Results In Botswana, 44% of people who needed AT did not receive it, while in Swaziland the unmet need was 67%. Among the sociodemographic variables tested, the type of disability was the most important factor in determining AT access in both countries. The likelihood of AT access was highest in both countries for those who had mobility limitations (i.e., difficulty walking/climbing stairs) [Botswana: 6.4 odds ratio (OR) = 6.4., 95% confidence internal (CI) (3.6–11.3); Swaziland: OR = 3.2, CI (1.4–7.3)], in comparison to those with non-mobility types of disabilities. Conclusions These findings provide support for governments and other stakeholders in the AT sector to prioritize AT to address the large unmet demand, and expand the range of AT products provided so that people with hearing, seeing, self-care, communication and cognition difficulties have equal access to AT as those with mobility impairments. A step toward achieving these aims is to inventory AT product types that are commonly covered through the public sector in each country, and identify common gaps (e.g., daily living aids). Advancing the AT sector as a whole within Southern Africa will require large scale qualitative studies that achieve a comprehensive understanding of the bottlenecks in regional AT supply, procurement, and delivery systems.

Purpose: Health should be a universal phenomenon. However, little is known about the relationship between disability status and health issues – particularly in rural areas. This study looks at health issues of persons with disabilities in Madwaleni, a rural impoverished area in South Africa in 2011, and compares them to persons with no disabilities. Materials and Methods: Standardized questionnaires were used in the survey to assess disability and health status. The sample comprised of 773 individuals – 322 persons with disability and 451 comparisons (without disability) – covering 527 households. Children under the age of five were excluded from the sample. We used purposive sampling. Results and Conclusion: This study found that persons with disabilities have poorer reported health outcomes than persons with no disabilities. There is also an association between disability severity and mental health issues as assessed by the GHQ-12. A significantly higher percentage of persons with disability did not get health care when needed. Persons with disabilities also have less favorable attitudes toward competence of health care workers. This study has shown greater health needs and less satisfaction with services, which strongly indicates insufficient access for persons with disabilities in a rural impoverished are within South Africa. •Implications for rehabilitation •Persons with disabilities in rural South Africa have poorer reported health outcomes. •Persons with disabilities have less favorable attitudes towards competence of health care workers in rural South Africa. •Better access to health care for persons with disabilities is needed in rural South Africa. The perceived needs-access gap for health services among persons with disabilities in a rural area within South Africa

This study looks at the equality challenges and opportunities for women with disabilities in low and middle income countries (LMICs) to participate and succeed in education, employment and motherhood. It is based on a systematic review of the literature from academic and non-governmental organization databases. The search of these databases yielded 24 articles, which were subsequently passed through open, axial, and selective coding. The resulting review found that women with disabilities in LMICs have severe difficulty participating and succeeding in education, employment and motherhood due to a number of interrelated factors: (i) hampered access to education, employment, intimacy and marriage, (ii) stigma and cultural practices resulting in discrimination and prejudice, and (iii) lack of support from family, teachers and institutions—all of which are exacerbated by poverty. Support from families, communities, the government, and non-governmental organizations improves women’s ability to fulfil their social roles (as students, employees and mothers), resulting in a better quality of life. Strategies that create awareness, minimize poverty and facilitate justice may improve the opportunities for women with disabilities in LMICs to participate in education, employment and motherhood, as well as their ability to succeed in these domains.

Introduction: The aim of this article was to study aspects of the evaluation of participation in occupations of older adults with beginning functional decline who receive home-based services. The aspects of evaluation studied were importance of, satisfaction with, and choice in participation. Method: A cross-sectional interview-based survey of 155 older adults receiving home-based services, administered through the Participation Survey/Mobility. The data were analysed with descriptive statistics. Findings: Moving around in the house, being in charge of personal care, and participating in leisure activities were perceived as the most important occupations for participation. Respondents were most satisfied with their participation in managing money, and least satisfied with their participation in leisure and social activities. Participation in leisure activities afforded them more choice than participation in physical activities. Few significant differences were found between gender, age, and level of functioning. Conclusion: In general, participation in both personal care and leisure activities was perceived as important, and the respondents felt they had choice when performing these occupations. They were less satisfied with their participation in social occupations, supporting the need for occupational therapists to enhance participation in this area.

Purpose statement: The article explores assistive technology sources, services and outcomes in South Africa, Namibia, Malawi and Sudan. Methods: A survey was done in purposively selected sites of the study countries. Cluster sampling followed by random sampling served to identify 400–500 households (HHs) with members with disabilities per country. A HH questionnaire and individual questionnaire was completed. Country level analysis was limited to descriptive statistics. Results: Walking mobility aids was most commonly bought/provided (46.3%), followed by visual aids (42.6%). The most common sources for assistive technology were government health services (37.8%), “other” (29.8%), and private health services (22.9%). Out of the participants, 59.3% received full information in how to use the device. Maintenance was mostly done by users and their families (37.3%). Devices helped a lot in 73.3% of cases and improved quality of life for 67.9% of participants, while 39.1% experienced functional difficulties despite the devices. Conclusion: Although there is variation between the study settings, the main impression is that of fragmented or absent systems of provision of assistive technology. * Implications for rehabilitation * Provision of assistive technology and services varied between countries, but the overall impression was of poor provision and fragmented services. * The limited provision of assistive technology for personal care and handling products is of concern as many of these devices requires little training and ongoing support while they can make big functional differences. * Rural respondents experienced more difficulties when using the device and received less information on use and maintenance of the device than their urban counterparts. * A lack of government responsibility for assistive device services correlated with a lack of information and/or training of participants and maintenance of devices.

To reach equity, health policies need to incorporate particular strategies to reach the most vulnerable groups (VGs). International policies and strategies for health are important to frame and facilitate reaching this goal in low-income countries. In order to gain a better understanding of how current international policies address equity in health services for VGs, EquiFrame was developed as an analytical framework. Based on a comprehensive development and validation process, EquiFrame comprises 21 core concepts (CCs), 12 VGs, and a qualitative scoring system. Ten international health policies were selected for analyses. The analyses showed that the international health policies included did mention many of the VGs, with the more general and systems oriented terms being the most frequent. The link between CCs and the VGs was low across the policy documents, and the overall quality of the documents, using the EquiFrame scoring system, was low. Lack of specificity regarding CCs of human rights and limited inclusion of VGs in international health policy documents is problematic and may reduce possibilities for up-scaling and implementing health services in low-income countries that can promote health for all, and particularly the most VGs. EquiFrame offers a tool for evaluating health policies, benchmarking and identifying best practice, and for revising and developing more inclusive policies that can address the challenge of achieving the health-related MDGs and health for all.

Background Good governance may result in strengthened performance of a health system. Coherent policies are essential for good health system governance. The overall aim of this research is to provide the best available scientific evidence on principles of good policy related leadership and governance of health related rehabilitation services in less resourced settings. This research was also conducted to support development of the World Health Organization’s (WHO) Guidelines on health related rehabilitation. Methods An innovative study design was used, comprising two methods: a systematic search and realist synthesis of literature, and a Delphi survey of expert stakeholders to refine and triangulate findings from the realist synthesis. In accordance with Pawson and Tilley’s approach to realist synthesis, we identified context mechanism outcome pattern configurations (CMOCs) from the literature. Subsequently, these CMOCs were developed into statements for the Delphi survey, whereby 18 expert stakeholders refined these statements to achieve consensus on recommendations for policy related governance of health related rehabilitation. Results Several broad principles emerged throughout formulation of recommendations: participation of persons with disabilities in policy processes to improve programme responsiveness, efficiency, effectiveness, and sustainability, and to strengthen service-user self-determination and satisfaction; collection of disaggregated disability statistics to support political momentum, decision-making of policymakers, evaluation, accountability, and equitable allocation of resources; explicit promotion in policies of access to services for all subgroups of persons with disabilities and service-users to support equitable and accessible services; robust inter-sectoral coordination to cultivate coherent mandates across governmental departments regarding service provision; and ‘institutionalizing’ programmes by aligning them with preexisting Ministerial models of healthcare to support programme sustainability. Conclusions Alongside national policymakers, our policy recommendations are relevant for several stakeholders, including service providers and service-users. This research aims to provide broad policy recommendations, rather than a strict formula, in acknowledgement of contextual diversity and complexity. Accordingly, our study proposes general principles regarding optimal policy related governance of health related rehabilitation in less resourced settings, which may be valuable across diverse health systems and contexts. © 2016 The Author(s).Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

This study investigates the prevalence of psychotic-like experiences (PLEs) and examines exposure to potentially traumatic events and other relevant risk factors for PLEs in the general population of a conflict-affected, low-income country. We conducted a cross-sectional community based study of four Greater Bahr el Ghazal States, South Sudan (n = 1200). The Harvard Trauma Questionnaire was applied to investigate exposure to potentially traumatic events. The Mini-International Neuropsychiatric Interview was used to detect PLEs. The estimated prevalence of lifetime PLEs was 23.3 % and the rate of PLEs which were evaluated as bizarre was 9.5 %. Exposure to higher number of potentially traumatic events, younger age, rural residency, being unemployed, not having a regular income and having traditional religion were significantly associated with having PLEs. PLEs were significantly associated with reporting of psychological distress when controlling for other covariates. The finding of association between traumatic exposure and PLEs calls for greater attention to the diversity of negative mental health outcomes in conflict-affected populations.

Over more than three decades, the need for refining and improving disability definition and measurement, and using those tools to analyse the life experiences of individuals with disability, has been advanced through international initiatives and policy documents. With respect to the former, the work of the World Health Organization in the development of the International Classification of Functioning, Disability and Health (ICF) (WHO 2001) and the formation, in 2002, of the United Nations Washington Group on Disability Statistics have been paramount. In terms of policy, the focus of the international community has been directed to issues of disability in recent decades, highlighted with the World Program of Action Concerning Disabled Persons (UN 1982; 1993), The Standard Rules on the Equalization of Opportunities for Persons with Disabilities (UN 1994) and more recently in the UN Convention on the Rights of Persons with Disabilities (Article 31) (UN 2006) and the Report by the High-Level Panel on the Post-2015 Development Agenda (Chap. 4, page 23) (UN 2013a). Estimation of disability prevalence in a population, statistics on access to basic services and descriptions of the status of living conditions are regarded as important for policy development, for planning purposes, for resource allocation, for monitoring, impact assessments and comparisons across groups, for awareness building and as a foundation for advocacy work and improved dialogue between stakeholders, including disabled people’s organisations (DPOs) and relevant national authorities (Madans et al. 2004). Reliable and valid disability statistics are seen as instrumental for monitoring the implementation of the UN Conventions, and to ensure the human rights of people with disability. This understanding has also been adopted by the international disability movement, as exemplified by the recent resolution of the International Disability Alliance supporting an inclusive post-2015 development agenda for persons with disability in Africa (point 6) (IDA 2014). This chapter draws some historical lines to illustrate the development of the discourse on disability and uses this as a background for a critical examination of current possibilities and challenges in disability statistics.

Older Homecare Service Recipients' Satisfaction with Participation in daily Life Activities

Increased user participation and community integration are central aims for contemporary mental health policy in many countries. User participation in community mental health services is developed through practice; from interaction between service-users and professionals working on the ground level. Despite this, there is a lack of research exploring users' and professionals' experiences and views based on the practice of user participation. The objective of this study was to illuminate user participation in a community mental health context based on the experiences of users and professionals within the same services. A qualitative study with an explorative design was applied. Preliminary data analyses based on a field study within three community mental health centres in a Norwegian city lead to our specific focus on experiences of user participation. This theme was explored in individual interviews with 10 users and two group interviews with six professionals. This article is based on the data from these interviews. All informants valued user participation in the service and highlighted the importance of the environment. Users and professionals did, however, highlight interesting issues of user participation from different perspectives. We developed the findings into three main themes: (i) user participation--experiences and preferences, (ii) an environment that promotes user participation and (iii) professional help, responsibility and user participation. Developing service-users' influence through participation is important, not only on the political and organisational level, but also in the contexts where users and professionals meet and collaborate. Self-determination in how to use services means that there are opportunities for receiving support without being subjected to control. Community mental health services which provide flexible, accepting environments with possibilities for both support and challenges may enhance participation and give all users possibilities to have an influence.

BACKGROUND More than 200,000 people in Norway have chronic obstructive pulmonary disease (COPD), but knowledge about their living conditions is insufficient. MATERIAL AND METHODS The Living Conditions Survey of 2002 (Statistics Norway) included specific questions about COPD. We have compared living conditions of people with self-reported chronic bronchitis, pulmonary emphysema or COPD with that of other groups with or without chronic disease. RESULTS People with chronic bronchitis, pulmonary emphysema or COPD have considerably worse living conditions than comparable groups. This is especially true in areas such as health, education, employment and income. Similar patterns are also seen in their social relationships. In a global index, where 1 indicates good living conditions and 0 bad living conditions, the COPD group scored 0.46, while people with other chronic diseases scored 0.60. Smokers with difficulty breathing have equally bad living conditions as those with self-reported COPD. The number of people stating they have COPD is considerably lower than shown in other recent studies of prevalence. INTERPRETATION Patients with COPD have larger problems within several areas of life than other groups with chronic diseases. In addition, the results indicate that many people have this disease without knowing it.

The impact of disability on the living conditions of people living in specifically resource‐poor areas in South Africa has not previously been addressed. This paper presents a comparison of people with a disability and their non‐disabled peers with respect to some key poverty indicators among a sample of Xhosa speaking individuals in resource‐poor areas of Eastern and Western Cape Provinces. A questionnaire on the level of living conditions (household composition and socio‐economic characteristics) and a detailed disability questionnaire that captured more specific details of the disability experience of the individual with a disability were adapted to the South African context and utilised. Despite the improved situation of households with a disabled family member in terms of financial resources (due primarily to the allocation of disability grants), other measures of poverty (education and employment) remain divisive for those with disabilities.

There exists no single definition of disability. The multidimensionality of disability demands that more complex, flexible measures that will capture disability in all its manifestations be developed and adapted. The measurement of disability prevalence must be seen in light of the purpose that these data are collected for example, provision of services, assessment of the level of functioning in the population or equalisation of opportunities and inclusion of people with disabilities in society. Any reported disability prevalence rate is dependent both on the definition or aspect of disability that is being targeted and on the intended purpose for collecting disability statistics. Results from a national, representative survey of living conditions among people with disabilities in Zambia based, in part, on the work of the Washington Group on Disability Statistics (WG) that operationalises a functional approach to disability are presented and contrasted with historical census data to illustrate how a flexible approach to the measurement of disability is better suited to the multiple purposes of collecting disability statistics and to the diversity of disability in a population.

To contribute to the testing and development of the ICF model by exploring the relationship between activity limitations, participation restrictions and environmental barriers.Structured questionnaire-based interviews were carried out among a convenience sample of 950 households counting 4917 individuals in Eastern and Western Cape, South Africa. Approximately half of the households had at least one individual with disability, while the other half represented controls in the study. Activity limitations, participation restrictions and environmental barriers were operationalized by means of questions drawn directly from the ICF checklist.Principal component analyses supported a four-component solution for the activity and participation variables, and a two-component solution for the barrier variables. Scales for each sub-component were produced by adding the individual items under each sub-component. Male respondents are more restricted than females when it comes to social activities, individual care, education and mobility barriers. While respondents in Western Cape scored higher (more limitations and restrictions) on the activity and participation sub-scales individual care, daily activities and education, Eastern Cape respondents scored higher on both the environmental barrier sub-scales.A viable structure of sub-components under the broader ICF concepts has been demonstrated. The study has provided some support to viewing activity limitations and participation restrictions as two independent dimensions, but also invites further studies and refinement of the model.

Impairments pose a certain degree of difficulty to disabled people, however the impact of the environment is the major cause of disability. Despite the fact that the disabling effect of environmental factors is acknowledged, little research has been done to explore the impact of the environment on varying degrees of disability and different impairments. The aim of this study was to investigate the experience of disabled people with regard to environmental barriers in an urban as opposed to a rural setting. The specific objectives were to identify which items within the International Classification of Functioning, Disability and Health (ICF) checklist of environmental factors presented people with disability with the most barriers and to see whether the barriers were different for those living in a rural as opposed to an urban setting. The study was conducted amongst Xhosa speaking people in the Eastern and Western Cape aresa of South Africa which have, respectively, 5.8% and 4.1% disability prevalences. A...

Objectives To examine the current perceived needs of the general population in a war-affected setting, and to study the influence of perceived needs on the participants’ mental health status and functional impairment across genders. Methods A cross-sectional community survey (n=464) was conducted in war-affected South Sudan. Three regression models were analysed. Perceived needs were assessed with the Humanitarian Emergency Settings Perceived Needs Scale. Psychological distress was measured with the General Health Questionnaire and level of functioning by the Short Form Health Survey (SF-12). Results The most frequently expressed needs were related to drinking water, alcohol and drug use in the community and access to sanitation facilities. No gender differences were found regarding the level of perceived needs or the number of traumatic events. Higher level of perceived needs significantly predicted psychological distress and lower level of functioning even when numbers of experienced trauma events were taken into account. Conclusions The associations of higher level of needs and trauma experiences, on the one hand, and negative health outcomes on the other, necessitate a greater integration of interventions directed towards the population's perceived needs and mental health, particularly for those who have been exposed to trauma.

Background: Despite the high worldwide prevalence and association with other mental disorders and disability, only few studies are available on social phobia in low-income countries. Aims: This study aims to assess the prevalence, socio-demographic correlates and comorbidity of social phobia and its association with disability among long-term internally displaced persons (IDPs) in one urban and one rural area in Central Sudan. Methods: This cross-sectional study was implemented in two IDP areas in Central Sudan. Data were collected during face-to-face interviews using structured questionnaires to assess socio-demographic factors and the Mini International Neuropsychiatric Interview (MINI) to determine psychiatric diagnoses. A total of 1,876 adults were enrolled from both study areas. Results: The overall lifetime prevalence of social phobia was 14.2%, with higher rates among IDPs in the rural area and among those who were less educated. Social phobia was associated with other mental disorders in both study areas. Disability and prolonged displacement increased the risk of having social phobia in the rural area. Conclusion: Further work needs to be done to improve our understanding and to establish proper interventions in dealing with social phobia, other common mental disorders and disability among long-term IDPs in these impoverished areas.

Objective: To test a theoretical model on the relationship between level of disability, psychological problems, social activity, and social networks. Study Design: A repeated cross-sectional study included in 2 representative studies in the general population in Norway. Structural equation modeling was applied to test different models. Results: Activity limitations contribute to the prediction of psychological problems and level of social activity over time, whereas the reverse effects were not demonstrated. However, cross-sectional associations between psychosocial variables and activity limitations were found. Conclusions: The study confirms that activity limitations predict level of psychosocial problems. Although the reverse longitudinal effect from psychosocial problems on activity limitations was not demonstrated, short-term effects cannot be ruled out with the current study design.

Background: While disability is universal, there is a marked variation in caregivers’ experiences of caring for children with disabilities. Therefore the diversity of disability experiences across the world needs to be acknowledged in order to understand care practices relative to disability. Aim: The paper explores the link between disability perceptions and treatment among the Tonga of Binga through their disabled children. Method: A total of 53 participants were enrolled in a longitudinal, qualitative and ethnographic study. Data was collected through in-depth interviews, participant observation and focus group discussions. The primary researcher returned to the field over time to explore changes and the processes associated with these changes from 2005 to 2013. Data analysis: Thematic analysis was conducted to discern recurring patterns within the data. Results: The results showed both positive and negative attitudes and behaviour towards children with disabilities; and the complexities of these influenced by their historical background, life experiences, social, cultural and economic factors. Policy consideration: Local cultural knowledge for policy designing and implementation.

Accessible and flexible “low threshold” community services have been recommended in order to assist people’s social participation and recovery from mental health problems. In this ethnographic study from a Norwegian city, we studied activities and social interaction within three community mental health centres with a low threshold organisation and recovery approach. These centres were part of the same community mental health service, and aimed to function both as social meeting-places and as steps towards rehabilitation. Through participant observation and qualitative interviews, we explored in what way this service could contribute to service users’ recovery. Central features of social interaction were support from both professionals and peers, along with sharing of practical advice and experiences. This encouraged social participation and seemed to enhance mutual experiences of recognition. In the article we highlight how these centres could assist recovery from mental health problems by functioning as available “resource-bases” in the community. © 2017 The Author(s). This open access article is distributed under a Creative Commons Attribution (CC-BY) 4.0 license.

Introduction The complexity of the process and outcome of vocational rehabilitation yearns for a multifaceted approach. This article investigates whether importance of participation in major life areas for men and women predicts the outcome of vocational rehabilitation. Methods This longitudinal study provides measure points at the start of the intervention (T1), at the end of the intervention (T2) and at a follow-up 6–12 months after completing the rehabilitation program (T3). Associations were assessed by nominal logistic regression. Results The importance of participation in work was positively associated to return to work (RTW), while the importance of participation in leisure activities and importance of participation in family was negatively associated with RTW after the rehabilitation. Gender and number of children also contributed significantly to the regression model. Conclusion To identify individuals’ subjective evaluation of the importance of participation may be of value in explaining return or not RTW and contribute to explain gender differences in outcomes. It may also inform rehabilitation counselors in collaboration with clients and facilitate tailoring interventions to the individual’s needs.

To investigate gender differences in the importance of participation in core domains of life, and the association to perceived hindrances for return to work (RTW) before (T1) and after (T2) vocational rehabilitation.Two hundred-seventy (T1) and 149 (T2) respondents completed the questionnaire. Gender differences in the importance of participation were calculated using t-tests. A principal component analysis was conducted on 21 questions of hindrances for RTW. A four-component structure was chosen. The family care barrier component was kept as an outcome variable in the logistic regression.There were mean gender differences in importance of participation in family prior to chronic pain and at T1. Importance of work changed from prior to pain to rehabilitation. At T1 children, age and importance of participation in work and family contributed to the model for women. For men importance of participation in leisure contributed to the model. The variables which contributed to the model at T2 for women were age and importance of participation in work and for men; children and importance of participation in leisure.Understanding gender differences in participation, and the association to hindrances for RTW, can enhance the rehabilitation counsellor's ability to work collaboratively with the clients. Implications for Rehabilitation Participation is a value and context driven process which influences the process of vocational rehabilitation. Understanding the driving forces for participation in important domains of life can illuminate gender differences in the process and outcome of vocational rehabilitation. Understanding gender differences in importance of participation, and the association to perceived hindrances to return to work, facilitates a shared understanding of rehabilitation goals among clients and rehabilitation professionals.

Background: As health care practitioners, it is important to have an understanding of the common barriers to and facilitators of the rehabilitation services we provide.Objectives: This article aimed to review the relevant literature regarding barriers to and facilitators of rehabilitation services for people with disabilities.Method: Articles for the period 1990–2010 using descriptors related to rehabilitation services, barriers, facilitators and the physically disabled population were retrieved for this review.Results: A total of 19 article titles were identified from references of other articles but following application of the inclusion criteria selected for this review, only six articles were chosen. Five of these articles were qualitative studies and one was a quantitative study. Barriers and facilitators regarding rehabilitation services highlighted by participants in the studies included a perception that health professionals have a lack of understanding of rehabilitation for people with disabilities and there was a lack of information sharing from health professionals about the rehabilitation process. On the other hand some participants reported that health professionals demonstrated confidence in the disability and rehabilitation process during consultation and highlighted that their needs were met by the rehabilitation professionals.Conclusion: Even though there were few studies highlighting the barriers to and facilitators of rehabilitation services, they highlighted that there are gaps in the process of rehabilitation services provided. It would be advisable for health professionals to take cognisance of the issues highlighted in this study in order to make rehabilitation services more effective.

Background: Persons with disability run the danger of not profiting from the development process due to exclusion from basic services and opportunities. Still, the knowledge base on exclusion mechanisms is relatively weak and there is a danger that important aspects are not addressed as they are hidden behind established understandings that are not critically scrutinised.Objectives: The main purpose of this article was to highlight critical thoughts on prevailing knowledge of the relationship between disability and poverty, the policy base for addressing the rights of persons with disability, and culture as a key component in continued discrimination.Method: This article aimed at integrating three papers on the above topics presented at the 2011 African Network for Evidence-to-Action on Disability (AfriNEAD) Symposium. The researchers have therefore thoroughly examined and questioned the relationship between disability and poverty, the influence of policy on action, and the role of culture in reproducing injustice.Results: The article firstly claims that there are limitations in current data collection practice with regards to analysing the relationship between poverty and disability. Secondly, ambitions regarding inclusion of persons with disability in policy processes as well as in implementation of policies are not necessarily implemented in an optimal way. Thirdly, negative aspects of culture in discrimination and bad treatment of disabled need to be highlighted to balance the discussion on disability and culture.Conclusion: A critical view of prevailing understandings of disability and development is key to producing the knowledge necessary to eradicate poverty amongst persons with disability and other vulnerable groups. Not only do we need research that is actually designed to reveal the mechanisms behind the disability–poverty relationship, we need research that is less tied up with broad political agreements that is not necessarily reflecting the realities at ground level.

Background There is a general lack of knowledge regarding disability and especially factors that are associated with disability in low-income countries. We aimed to study the overall and gender-specific prevalence of disability, and the association between exposure to traumatic events and disability in a post-conflict setting. Methods We conducted a cross-sectional community based study of four Greater Bahr el Ghazal States, South Sudan (n = 1200). The Harvard Trauma Questionnaire (HTQ) was applied to investigate exposure to trauma events. Disability was measured using the Washington Group Short Measurement Set on Disability, which is an activity-based scale derived from the WHO’s International Classification of Disability, Functioning and Health. Results The estimated prevalence of disability (with severe difficulty) was 3.6% and 13.4% for disability with moderate difficulties. No gender differences were found in disability prevalence. Almost all participants reported exposure to at least one war-related traumatic event. The result of a hierarchical regression analysis showed that, for both men and women, exposure to traumatic events, older age and living in a polygamous marriage increased the likelihood of having a disability. Conclusions The finding of association between traumatic experience and disability underlines the precariousness of the human rights situation for individuals with disability in low-income countries. It also has possible implications for the construction of disability services and for the provision of health services to individuals exposed to traumatic events.

This study investigates attitudes and social distance towards the mentally ill in a post-conflict, low-income country. A cross-sectional community survey (n = 1,200) was conducted in South Sudan. Associations between various sociodemographic variables and attitudes toward/social distance from the mentally ill were investigated. The regression analysis showed that lower levels of education were positively associated with social distance, and Christian or Muslim beliefs, compared with traditional beliefs, were negatively associated with social distance. Familiarity with mental illness or psychological distress was not significantly associated with social distance. Participants who endorsed community-oriented attitudes (rather than hospital/drug-oriented attitudes) about health care for the mentally ill were more likely show a decreased social distance. Participants who believed that the mentally ill were dangerous had higher scores on the social distance scale. A high level of stigma towards the mentally ill exists in South Sudan, especially in the rural areas. Alongside efforts to build up mental health services in South Sudan, the existing stigma needs to be addressed. Information regarding the role of the community both in preventing mental illnesses and in service delivery should be prioritised.

OBJECTIVE: The objective of this study was to provide knowledge about participation and change in participation among men and women experiencing chronic musculoskeletal pain and undergoing multidisciplinary vocational rehabilitation. PARTICIPANTS: Six women and four men participating in a vocational rehabilitation intervention. METHOD: Data were collected through semi-structured in-depth interviews. The participants were encouraged to talk about their experiences and thoughts regarding participation in different life areas using previous, present, and future expectations. The analysis performed was constant comparative and inspired by grounded theory. RESULTS: The core category was identified as "goal-oriented participation" which represented participation as intentional and situated. Three categories, "participating as before," "participation constantly changing," and "participating in work on hold," were used, taking into account gender-influenced trajectories and understandings of participation before, during, and after sick leave and rehabilitation. CONCLUSION: The different trajectories of participation seemed to be gender specific and were connected to broader societal and environmental factors. These combined aspects seemed to affect values, motivation, and understanding of important goals while experiencing chronic pain. Examining goal-oriented participation may add to the understanding of gender differences in the rehabilitation process and thereby have implications for rehabilitation interventions.

Aims: There is a scarcity of data on mental health problems among Sudanese internally displaced persons (IDPs). This study aims to assess the prevalence of mental disorders of IDPs in Sudan, and to determine and compare the association between mental disorders and socio-demographic variables between the rural and urban long-term IDP populations. Methods: This cross-sectional study was implemented in two IDP areas in Central Sudan. Data were collected during face-to-face interviews using structured questionnaires to assess socio-demographic factors and the Mini International Neuropsychiatric Interview (MINI) to determine psychiatric diagnoses. A total of 1,876 adults were enrolled from both study areas. Results: The overall prevalence of having any mental health disorder in the IDP population was 52.9%. The most common disorders were major depressive disorder (24.3%), generalized anxiety disorder (23.6%), social phobia (14.2%) and post-traumatic stress disorder (12.3%). Years of displacement and education were associated with different mental disorders between the two areas, and there were no gender differences in prevalence of mental disorders in either area. Conclusion: This study shows high prevalence rates of mental disorders in both urban and rural IDP populations in Sudan, indicating a need to explore the circumstances for these high rates and to develop appropriate responses.

Background: If access to equitable health care is to be achieved for all, policy documents must mention and address in some detail different needs of groups vulnerable to not accessing such health care. If these needs are not addressed in the policy documents, there is little chance that they will be addressed at the stage of implementation. Objectives: This paper reports on an analysis of 11 African Union (AU) policy documents to ascertain the frequency and the extent of mention of 13 core concepts in relation to 12 vulnerable groups, with a specific focus on people with disabilities. Method: The paper applied the EquiFrame analytical framework to the 11 AU policy documents. The 11 documents were analysed in terms of how many times a core concept was mentioned and the extent of information on how the core concept should be addressed at the implementation level. Each core concept mention was further analysed in terms of the vulnerable group in referred to. Results: The analysis of regional AU policies highlighted the broad nature of the reference made to vulnerable groups, with a lack of detailed specifications of different needs of different groups. This is confirmed in the highest vulnerable group mention being for ‘universal’. The reading of the documents suggests that vulnerable groups are homogeneous in their needs, which is not the case. There is a lack of recognition of different needs of different vulnerable groups in accessing health care. Conclusion: The need for more information and knowledge on the needs of all vulnerable groups is evident. The current lack of mention and of any detail on how to address needs of vulnerable groups will significantly impair the access to equitable health care for all.

The recent AIDS and Disability Partners Forum at the UN General Assembly High Level Meetings on AIDS in New York in June 2011 and the International AIDS Conference in Washington, DC in July 2012 underscores the growing attention to the impact of HIV and AIDS on persons with disabilities. However, research on AIDS and disability, particularly a solid evidence base upon which to build policy and programming remains thin, scattered and difficult to access. In this review paper, we summarise what is currently known about the intersection between HIV and AIDS and disability, paying particular attention to the small but emerging body of epidemiology data on the prevalence of HIV for people with disabilities, as well as the increasing understanding of HIV risk factors for people with disabilities. We find that the number of papers in the peer-reviewed literature remains distressingly small. Over the past 20 years an average of 5 articles on some aspect of disability and HIV and AIDS were published annually in the peer-reviewed literature from 1990 to 2000, increasing slightly to an average of 6 per year from 2000 to 2010. Given the vast amount of research around HIV and AIDS and the thousands of articles on the subject published in the peer-reviewed literature annually, the continuing lack of attention to HIV and AIDS among this at risk population, now estimated to make up 15% of the world's population, is striking. However, the statistics, while too limited at this point to make definitive conclusions, increasingly suggest at least an equal HIV prevalence rate for people with disabilities as for their non-disabled peers.

The main research question in this article is how access to information about HIV/AIDS and level of HIV/AIDS prevention related knowledge are distributed among disabled people, and whether level of knowledge predicts access to HIV/AIDS related services. A survey was carried out among a sample of 285 disabled people from three provinces in South Africa. Analyses of the data revealed that gender and level of education, together with geographical differences, are key predictors for access to information and knowledge about HIV/AIDS among disabled people. For male respondents number of information sources predicts access to voluntary counselling and testing services and HIV testing, while knowledge about prevention predicts access to Voluntary Counselling and Testing centres. Significant gender differences with regards to information, knowledge and access to services highlight the need for gender specific prevention strategies among disabled people.

Introduction: Disability and Poverty a Global Challenge ~ Benedicte Ingstad and Arne Eide The Social Inclusion of Persons with Disabilities in Poverty Reduction Policies and Instruments: Initial Impressions from Malawi and Uganda ~Margaret Wazakili, Tsitsi Chataika, Gubela Mji, A.K. Dube, Malcolm MacLachlan Disability, poverty and health care: Changes in the canji ("disability") policies in the history of the People's Republic of China ~Gry Sagli and Heidi Fjeld Living conditions for people with disabilities in developing countries ~ Arne Eide and Mitch Loeb 'No disabled can go here - ' Disability and poverty in Malawi: Aspects of education ~ Stine Braaten and Mitch Loeb Disability and poverty in Uganda ~ Herbert Muyinda and Susan R. Whyte "We are also disabled". Disability grants and poverty politics in rural South Africa ~ Camilla Hansen and Washeila Sait Where culture really matters: Disability and well-being in Jemen ~ Benedicte Ingstad, Arwa Baider, Lisbet Grut Disability and barriers in Kenya ~ Lisbet Grut, Joyce Olenja, Benedicte Ingstad Disability and social suffering in Zimbabwe ~ Jenny Mudzeresi and Benedicte Ingstad "My story started from food shortage and hunger": Living with landmines in Cambodia ~ Merete Taksdal Poverty as trauma: Methodological problems when reality gets ugly ~ Hans Husum and Odd Edvardsen Some concluding thoughts - the way ahead ~Arne Eide and Benedicte Ingstad.

The purpose of this study was to provide knowledge about professional carers' subjective descriptions and understanding of older adults' participation in everyday life, when living in place and depending on home-based service delivery.Thirty professionals from different organisational levels were selected, allowing for differences in ages, gender, length of working experience, and profession or education. Six focus group discussions were held. A grounded theory approach was used to analyse the data.The core category was identified as 'participation in one's own life'. Two categories included the care providers' descriptions and understanding of participation in the life of older adults; 'carrying out tasks in everyday-life' and 'interaction during service delivery'. Participation as carrying out tasks was related to the contexts inside and outside the house. The professional carers' understandings of older adults' participation in interaction during service delivery included three categories; 'Being included and taking part in decision-making', 'socialising during service delivery' and 'collaboration in keeping up or regaining functions'.To promote participation for older adults living in place and in the context of service delivery, the findings suggest that the professional carers must extend their focus on participation as socialising and its significance for older adults. At a system level there is a need to focus on how the professional role in home-based service delivery can be adjusted and developed to promote collaboration about participation in older adults.

Despite the seriousness of the HIV epidemic globally, and in South Africa in particular, little is known about how HIV/AIDS affects disabled people. One important and little explored area is the role that organisations that represent disabled people or that work on behalf of disabled people, are playing in addressing the HIV/AIDS epidemic among the disabled people they represent or serve. This paper presents the findings of a nationwide survey of disability organisations in South Africa. The purpose of this study was to explore the role of disability organisations in addressing the HIV epidemic among disabled people in South Africa. The findings suggest that while organisations recognise the importance of providing HIV education, and many have taken steps to do so, disabled people are largely excluded from general HIV prevention messages. Disabled people also have significant difficulties in accessing general health care, relevant for HIV testing and treatment. In a country trying to manage serious social problems with limited resources, this paper highlights the need for increased cooperation and collaboration between relevant parties in order to facilitate the changes necessary for disabled people to access needed health information and care.

To develop a model of the dynamics of functioning, disability and contextual factors which harmonises with the International Classification of Functioning, Disability and Health (ICF).Model parts based on ICF were identified and a model drawing from engineering concepts was developed. The conceptual and practical applicability of the model was discussed.The so called Friction Model was created, which incorporates the ICF entities capacity, performance, environmental factors, health condition, body functions and structures, and personal factors. Friction describes the interaction between a person and his or her environment. The coefficient of friction is defined as the ratio between capacity and performance.Carrying conceptual strengths and limitations, the Friction Model appears to offer opportunities for practical applications, including ICF-based alternatives to health-economic analyses. Harmonising with the ICF model and terminology, the model uses friction to describe the interaction between a person and the environment. The coefficient of friction can be used as a simple measure of how facilitating an environment is. The applicability is not limited to functioning of people with impairments.

Experience in a number of situations of armed conflict and consequently post-conflict situations suggests that CBR has a constructive role to play in delivering services and promoting the rights of people with disabilities. Although not particularly designed for post-conflict and emergency situations, there are several good reasons for this. First, CBR has developed from a health-service delivery model for people in rural, poorly serviced areas into a model for community development, which also incorporates human rights, democracy, and a gender-based perspective within its ambitions. Such core values are under strong pressure in post-conflict situations, and CBR may be regarded as an important tool for ensuring a rights-based development with particular attention to those most at risk of poverty and abuse. Second, CBR is a flexible strategy operating at different levels and can easily adapt to different contexts and stages of conflict and post-conflict. Third, utilizing human resources within a community ensures a perspective that is based on local expertise and cultural understanding. Fourth, the central role of people with disabilities in CBR adds further to a needs-based approach and makes individuals with disabilities visible in their communities. Lastly, CBR will often be the only service focusing on individuals with disabilities, thus making sure that they are not forgotten and neglected. Although CBR may contribute positively in post-conflict and emergency situations, it is nevertheless important to develop particular responses to such situations in order to ensure that the needs and rights of people with disabilities are addressed and protected when times are difficult and extreme.

Purpose. HIV/AIDS has grown to become the biggest epidemic in modern history. Southern Africa is at the epicentre of the global epidemic, with just of a third of the world's HIV-positive population living here. It is known that HIV/AIDS affect vulnerable population groups. It is surprising then, that persons with disabilities, one of the world's most vulnerable population groups, particularly in southern Africa, have been largely overlooked with regards to HIV/AIDS. This review sought to establish the state of the knowledge at present. Method. This article reports on findings of a literature review conducted as an initial step in a research project currently underway in South Africa. This article focuses on HIV/AIDS as it affects persons with disabilities in southern Africa, as it is in this region that the majority of people living with HIV live. However, as fewer studies exist that have as its focus southern Africa (particularly looking at HIV/AIDS and persons with disabilities), relevant articles from the international literature were used as indications of what we may find through future research also in the southern African countries. Given the paucity of published literature dealing with HIV/AIDS and persons with disabilities, the review looked at various risk factors associated with HIV infection, and how it affects persons with disabilities. Results. Findings from the literature review suggest that persons with disabilities, particularly in southern Africa, are at significant risk for HIV infection. Conclusions. There is an urgent need for more research on HIV/AIDs and sexuality among persons with disabilities in Africa.

World Health Organization (WHO) has estimated that 10% of the global population has a disability, with social educational and/or economical consequences. Although such estimates have a weak basis (Metts, 2000; Eide and Loeb, 2006a) it might be about 600 million people around the world with special needs in terms of health care, education, rehabilitation, appropriate assistive devices and social support. Furthermore it is indicated that 80% of people with disabilities live in low-income countries and also in very poor life conditions with limited access to health care services, rehabilitation and assistive devices. Case studies in developing countries show that higher disability rates are associated with higher rates of illiteracy, poor nutritional status, lower immunization coverage, lower birth weight, higher rates of unemployment and underemployment, and lower occupational mobility (Elwan, 1999). Disability can cause poverty by preventing the full participation of persons with disabilities in the economic and social life of their communities, especially if the appropriate supports and accommodations are not available. This chapter draws on results from recent studies on living conditions among people with disabilities in southern Africa (Eide et al. 2003a, b; Loeb and Eide, 2004; Eide and Loeb, 2006b) and aims at describing the situation for disabled people in low-income contexts with regards to assistive technology.

Despite the severity of the HIV epidemic worldwide, and particularly in southern Africa, persons with disabilities have until recently been generally excluded from consideration in HIV prevention campaigns. This chapter outlines the situation with regard to HIV/AIDS as it affects persons with disabilities. The chapter will begin by first providing an outline of the experience and prevalence of disability in South Africa, highlighting how little is known about how HIV affects persons with disabilities in South Africa. An outline of some of the international literature, including a recent global survey on HIV/AIDS and disability, will be presented. With the background of findings from international studies, we shall then look at the issue of HIV/AIDS as it affects persons with disabilities in South Africa, with reference to recent research in this area. The chapter will also discuss and highlight some of the current contested issues involved with regard to HIV/AIDS as a disability and the disability grant.

This study was to establish whether there was a difference in the characteristics of people who received a disability grant and those who did not in rural and urban samples of isiXhosa-speaking people with disability in South Africa.The sample was a convenience sample and was identified through a 'snowballing' process.A demographic survey and isiXhosa versions of the International Classification of Functioning, Disability and Health (ICF) and EQ-5D, a health-related quality of life measure were utilized.The sample consisted of 244 rural and 61 urban respondents, demonstrating a preponderance of physical disabilities. The groups who received or did not receive grants were equivalent in terms of age, gender, marital status and employment status. A significantly higher proportion of rural dwellers accessed the grant. The grant holders displayed significantly more problems related to mobility and to technology and policies and services relating to mobility and transport. Those who did not receive grants reported more barriers with regard to the attitudes of health workers but not with regard to any other aspect of social support.The majority of men and women with disability identified in this study received the grant, whether or not they lived in remote rural or in urban areas. As there were few differences between the groups, it is likely that several non-grant holders might qualify if they were informed of the grant and applied. The role of medical doctors as 'gatekeepers' to the grant might need to be examined.