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BackgroundCitizens living in disadvantaged neighborhoods experience poorer health than the majority, and this inequality is a public health problem even in a welfare state such as Sweden. Numerous initiatives aimed at improving health and quality of life in these populations are being implemented and evaluated. Given that these populations are predominantly multicultural and multilingual, an instrument such as the WHOQOL-BREF, which is cross-culturally validated and available in multiple languages, may be appropriate. However, this cannot be ascertained since the psychometric properties of WHOQOL-BREF have never been assessed in the Swedish context. Thus, the current study aimed at assessing the psychometric properties of the WHOQOL-BREF questionnaire in citizens from a disadvantaged neighborhood in Southern Sweden.MethodsThe respondents in this study were 103 citizens who participated in the health promotional activities of a Health promotional program and also responded to the 26-item, WHOQOL-BREF questionnaire as a part of an evaluation to assess the impact of the activities on the health-related quality of life of citizens. A Rasch model using WINSTEP 4.5.1 was used to assess the psychometric properties in this study.ResultsFive of the 26 items, including pain and discomfort, dependence on medical substances, physical environment, social support, and negative feelings did not display acceptable goodness-of-fit to the Rasch model. On removing these items, the 21-item WHOQOL-BREF scale had an improved internal scale validity and person-separation reliability than the original 26-item version for this group of citizens from the neighborhood. When assessing the individual domains, three of the five items that were misfits on analyzing the full model also showed misfits in relation to two respective domains. When these items were removed, the internal scale validity of the domains also improved.ConclusionWHOQOL-BREF seemed to be psychometrically inadequate when used in the original form due to internal scale validity problems, while the modified 21-item scale seemed better at measuring the health-related quality of life of citizens living in socially disadvantaged neighborhoods in Sweden. Omission of items shall be done but with caution. Alternatively, future studies may also consider rephrasing the items with misfits and further testing the instrument with larger samples exploring the associations between subsamples and specific item misfit responses.

There is limited empirical knowledge about how older adults living with dementia enact their social citizenship through out-of-home participation. This study aimed: (a) to investigate out-of-home participation among older adults with and without dementia in four countries and (b) to compare aspects of stability or change in out-of-home participation. Using a cross-sectional design, older adults with mild-to-moderate dementia and without dementia, aged 55 years and over, were interviewed using the Participation in ACTivities and Places OUTside the Home questionnaire in Canada ( n = 58), Sweden ( n = 69), Switzerland ( n = 70), and the United Kingdom ( n = 128). Data were analyzed using descriptive statistics and a two-way analysis of variance. After adjustment for age, diagnosis of dementia and country of residence had significant effects on total out-of-home participation ( p < .01). The results contribute to policies and development of programs to facilitate social citizenship by targeting specific activities and places.

Introduction: This study pertains to the design of a decision aid (DA) to shed light on information and support needs in colorectal cancer screening, with the aim to explore the calling patterns to the Screening of Swedish Colons (SCREESCO) study's helpline. Methods: A cross-sectional study was conducted with data from documented telephone calls to the SCREESCO study, including individuals, 59-60 years, randomized to colonoscopy or high sensitive faecal immunochemical test (FIT). Results: More than 2000 calls (women 58.5%; colonoscopy 59%) were analysed. Calling patterns: unsubscribing from screening, confirmation of participation, logistical concerns about the screening procedure, counselling, and FIT screening difficulties or in need of a new FIT test. Comorbidity was the most frequent reason for unsubscribing and most of the counselling calls included questions about the FIT test or the colonoscopy. Conclusion: Most of the calls to the helpline seemed to be related to individuals' lack of understanding about the organization of the screening programme and the screening procedure. Therefore, we find it important to further stress the tailoring part in our DA developing process, that is, provide limited information initially, with the possibility of access to more, if desired by the individual, still with respect to the individual's needs, health and digital literacy. Patient and public contribution: Individuals representing the public and invited to SCREESCO participated since we analysed their calls to the helpline. The findings will contribute to our continued work with the DA where the public will contribute and participate.

Background Citizens with low levels of social capital and social status, and relative poverty, seem to have been disproportionally exposed to COVID-19 and are at greater risk of experiencing poor health. Notably, the incidence of COVID-19 was nearly three times higher among citizens living in socially vulnerable areas. Experiences from the African Ebola epidemic show that in an environment based on trust, community partners can help to improve understanding of disease control without compromising safety. Such an approach is often driven by the civil society and local lay health promoters. However, little is known about the role of lay health promoters during a pandemic with communicable diseases in the European Union. This study had its point of departure in an already established Community Based Participatory Research health promotion programme in a socially disadvantaged area in southern Sweden. The aim of this study was to explore how citizens and local lay health promoters living in vulnerable neighbourhoods responded to the COVID-19 pandemic a year from the start of the pandemic. Method In-depth interviews with the 5 lay health promoters and focus group discussions with 34 citizens from the neighbourhood who were involved in the activities within the programme were conducted in autumn 2020. The interviews and focus group discussions were transcribed verbatim and analysed using qualitative content analysis following an inductive approach. Results Four themes emerged including, ‘balancing between different kinds of information’, ‘balancing between place-based activities and activities on social media’, ‘bridging between local authorities and the communities and community members’, and ‘balancing ambivalence through participatory dialogues’. Conclusion The study highlights that a Community Based Participatory Research programme with lay health promoters as community trust builders had a potential to work with communicable diseases during the pandemic. The lay health promoters played a key role in promoting health during the pandemic by deepening the knowledge and understanding of the role that marginalised citizens have in building resilience and sustainability in their community in preparation for future crises. Public health authorities need to take the local context into consideration within their pandemic strategies to reach out to vulnerable groups.

The Assessment of Motor and Process Skills (AMPS) is a standardized occupation-based measure; however, barriers often limit use in practice. The Knowledge to Action Framework (KTA) is one of the most widely used implementation approaches to induce practice change. The objective of the study is to examine the feasibility and acceptability of a KTA-informed intervention to increase the use of the AMPS. AMPS-trained occupational therapists were recruited through convenience sampling. Interventions included workshops, action planning, goal setting, peer support, and organizational resources. Recruitment and retention were tracked. Pre- and post-survey results of interventions’ helpfulness, AMPS behaviors, and motivational changes informed acceptability. Participants ( n = 5) rated 7/7 (100%) intervention strategies as helpful, reported decreased barriers and increased frequency of AMPS administration, increased resources for AMPS implementation, and improved compatibility with practice. Implementation of a KTA-informed intervention to increase AMPS practice was feasible and supported by environmental changes and peer support in a physical rehabilitation setting.

Background Unmet community mobility needs of older adults, published since the announcement of the UN sustainable development goals was synthesised to describe the health equity characteristics of research identifying unmet community mobility needs of older adults. Methods Searches were conducted in March and April 2020, 2275 articles were screened and 100 identified for data extraction. Results Findings showed underrepresentation of articles considering rural settings [9%] and originating in the global South [14%]. Gender, disability, education, and transport / driving were identified as key health equity characteristics and only 10 articles provided detail on all four of these. External factors inhibiting community mobility included built environments, service availability, and societal attitudes. Internal factors included finances, fear and apprehension, and functional limitations. Conclusions The need for standardised reporting of participant characteristics in the community mobility of older adults was highlighted. These characteristics are required by research consumers to judge equity dimensions, and the extent to which findings represent minority or marginalised groups. Fifteen years after the UN pledge to reduce inequalities, peer reviewed primary research does not reflect a global drive to end discrimination, exclusion and reduce the inequalities and vulnerabilities that leave people behind.

Public health practitioners have been striving to reduce the social gradient and promote physical activity among citizens living in disadvantaged neighborhoods. The emergence of the COVID-19 pandemic, which has affected these citizens extensively, has posed a significant challenge to efforts to maintain a physically active lifestyle. Thus, the aim of this study was to explore the impact of a CBPR-informed physical activity intervention before and during the COVID-19 pandemic from the perspective of women from a socially disadvantaged neighborhood.A total of 34 women participated in a CBPR-informed physical activity intervention previously developed in collaboration with lay health promoters and other citizens from the same neighborhood. Focus group discussions were conducted at four time points, namely, at baseline prior to the intervention, post-intervention, 6 months after the intervention ended, and during the COVID-19 pandemic. The data were analyzed using qualitative content analysis following an inductive approach.In total, four themes emerged from the discussions: "Wavering between frustration and action," "Shifting from prioritizing family needs to taking control of self," "Between isolation and social support," and "Restricted access to health-related knowledge vs. utilizing internalized knowledge".The results of this study reveal that building on CBPR-informed health promotion initiatives has the potential to foster individual empowerment and assist during acute situations like the COVID-19 pandemic through mobilizing communities and their resources, which leads to increased community resilience and health. This study is regarded as unique in that it involves evaluation of a CBPR intervention that was initiated ahead of the pandemic and followed even during the pandemic.

The role of Everyday Technology (ET) use is presented as subsidiary or neutral in policy for age- and dementia-friendly communities; and yet, research suggests that older people, especially those with dementia, experience increased challenges using ET in their everyday lives. Through the lens of micro-citizenship, the study aims to deepen the knowledge about how use of ET outside the home, including portable ETs, relates to participation in places visited within public space among people with dementia over time. Using a longitudinal study design, 35 people with dementia were recruited at baseline and followed over three years. Data were collected through semi-structured interviews using standardised questionnaires: the Participation in ACTivities and Places OUTside Home Questionnaire (ACT-OUT) and the Everyday Technology Use Questionnaire (ETUQ). Random intercept modelling and descriptive statistics were used to analyse the data. Throughout the three-year study, decreasing use of ET outside the home, including portable ETs, was associated with decreasing participation in places visited within public space, in a statistically significant way when controlling for age (F = 7.59, p = 0.01). The findings indicate that facilitating access and use of ET outside the home, among people with dementia, should be integral to promoting and maintaining participation in age- and dementia-friendly communities.

Measuring and assessing the different aspects of gambling behavior and its consequences is crucial for planning prevention, treatment, and understanding the development of at-risk and problem gambling. Studies indicate that instruments measuring problem gambling produce different results based on the characteristics of the population assessed. To accurately measure at-risk and problem gambling behavior, especially in a low-risk population, measures must cover a wider set of dimensions than the negative consequences already manifest. The Jonsson-Abbott Scale (JAS) includes items that cover overconsumption, actions that reinforce gambling behavior, and belief in gambling fallacies, based on a three-factor structure and has previously demonstrated good psychometric properties. However, there is a need to investigate how the instrument also functions in low-risk populations. This study aims to do so using both confirmatory factor and Rasch analysis; this research included 1,413 Swedish participants who endorsed at least one JAS item. The results replicated the previous three-factor solution and indicated that the instrument had good reliability. In addition, the results demonstrated that the three factors are independent, and the overall score per factor needs to be analyzed. In summary, the JAS appears suitable for use in low-risk populations to measure various aspects of gambling behavior.

Introduction Older persons with cognitive impairment have often been disregarded in providing information on their own perceptions. This study explored the number of relevant everyday technologies and the ability to use everyday technologies as perceived by persons with cognitive impairment in comparison with their proxies’ estimates using the Short Everyday Technology Use Questionnaire. Method In this cross-sectional study, persons with cognitive impairment ( n = 21) and their proxies ( n = 21) were interviewed on separate occasions with the Short Everyday Technology Use Questionnaire, which measures the number of relevant everyday technologies and the ability to use everyday technologies. The data were analysed with t-tests, z-comparisons, and Fisher’s exact test. The level of significance was set at p Results At the group level, no significant differences were found between persons with cognitive impairments’ perceptions and their proxies’ estimates regarding the number of relevant everyday technologies or the ability to use everyday technologies. On the individual level, significant differences were found in the ability measures within four out of the 21 dyads. Conclusion The persons with cognitive impairment and their proxies verified each other’s responses, providing evidence that persons with cognitive impairment should be the primary source for information about their own everyday technology use.

Background: Everyday life outside home and accessing a variety of places are central to occupation. Technology is ever more taken for granted, even outside home, and for some may culminate in occup...

Everyday information and communication technologies (EICTs) are increasingly being used in our society, for both general and health-related purposes. This study aims to compare how older adults with cognitive impairment perceive relevance and level of EICT challenge between eHealth use and general use.This cross-sectional study includes 32 participants (65-85 years of age) with cognitive impairment of different origins (due to e.g., stroke or dementia). The Short Everyday Technology Use Questionnaire+ (S-ETUQ+) was used, providing information about the relevance of EICTs and measuring the EICT level of challenge. Data were analysed with descriptive statistics, standardizedThe result shows that the perceived amount of relevant EICTs for eHealth use was lower in all 16 EICTs compared to those of general use. About the perceived level of challenge, a significant difference was detected in one of the seven included EICTs between eHealth use and general use.In this sample, all EICTs were perceived as having lower relevance for eHealth use compared to general use, suggesting that the purpose of using an EICT affects the perceived relevance of it. Also, once an EICT is perceived as relevant and used for eHealth purposes, there seem to be little to no differences in perceived challenge compared to the same EICT used for general purposes.Implications for rehabilitationAll stakeholders, including health care providers, need to be aware of the hindrances that come with digitalization, making it challenging to many citizens to make use of digital solutions.It is of great importance that social services including eHealth services be tailored to suit the individual/target group.Older adults may need support and an introduction to EICTs to discover the potential relevance of the specific device and/or service.

RATIONAL Life satisfaction is strongly associated with participation in everyday life activities. Yet, older adults with cognitive impairments have been found to experience difficulties in accessing and engaging in more complex everyday activities, especially, if these involve everyday technology. Considering the rapidly advancing technological landscape, this may substantially affect individuals' life satisfaction and their participation in meaningful community-based and home-based activities. OBJECTIVES This study aimed to explore the associations between life satisfaction, ability to use everyday technology and number of relevant everyday technologies used in older adults (n = 117) with and without mild cognitive impairment (MCI) and Alzheimer's disease (AD). It also aimed to understand the role of depression, activity involvement and diagnosis regarding life satisfaction in this sample. METHOD Descriptive statistics, Mann-Whitney U tests and t-tests were applied to compare those satisfied and those dissatisfied with life regarding ability to use everyday technology and number of relevant everyday technologies used. FINDINGS The number of relevant community-based everyday technologies currently not used was significantly associated with being dissatisfied with life (p

Interprofessional Education (IPE) is essential to prepare future health-care professionals for collaborative practice, but IPE requires evaluation. One psychometrically sound instrument is the Interprofessional Education Collaborative Competence Self-Efficacy Tool consisting of nine items (IPECC-SET 9). This tool does not, to date, exist in a Swedish version. Therefore, the aim of this study was to translate and validate the Swedish version of the IPECC-SET 9. The English version was translated into Swedish and tested among 159 students in the 3-year Bachelor Programs in Nursing and in Biomedical Laboratory Science. The psychometric analysis was guided by a Rasch model, which showed that the items functioned well together, confirming unidimensionality, and that the person misfit was also lower than the set criterion. The separation index was 2.98, and the Rasch-equivalent Cronbach-alpha measure was estimated to .92, supporting internal consistency. No systematic differences on item level in IPECC-SET 9 further supported fairness in testing. The Swedish IPECC-SET 9 demonstrates sound psychometric properties and has the potential to be used as a measure of self-efficacy for competence in interprofessional collaborative practice among health profession students. However, the IPECC-SET 9 is recommended to be further tested in larger samples representing the entirety of health-care teams.

Background Rasch analysis is widely used in the life sciences. Rasch analysis is a mathematical and probabilistic model based on the assumption that the probability of passing a single item is governed by a person's ability and the difficulty of the item. However, its use in nursing science remains unclear.AimTo (i) describe the use of Rasch analysis in nursing research and (ii) determine the quality of reporting in nursing studies using Rasch models.MethodsA methodological scoping review of literature was conducted. The systematic electronic literature search was initially conducted on 1 February 2020 and updated on 16 April 2021 from PubMed/Medline and CINAHL databases. The search was limited to covering the timeframe from the earliest literature available until 31 December 2020. The search terms used were Rasch, IRT, item response theory, and nursing. The search was limited to the English language and title/abstract level. The analysis included quantification and content analysis. Results In total, 388 hits were identified. Following a two-phase retrieval process, 88 articles were included in the final analysis. Rasch analysis was used to test the psychometric properties of the newly developed instrument, and validate or test a short version of the existing instrument. The reporting of Rasch analysis demonstrated large variability in quality. Rating scale functioning, internal scale validity using goodness-of-fit statistics, and unidimensionality were the most frequently reported outcomes. Conclusion The use of Rasch analysis in nursing science was found to be unsystematic. Rasch analysis could provide new possibilities for investigating measurement properties. However, robust, comprehensive, and precise reporting of the methodological choices and results of Rasch analysis is needed. Furthermore, the use of Rasch analysis in nursing science is encouraged. What is already known Rasch analysis is a mathematical and probabilistic model based on the assumption that the probability of passing a single item is related to a person's ability and the difficulty of the item. Rasch analysis is widely used in the life sciences. However, its use and quality of reporting in nursing science have yet to be explored. What this paper adds Rasch analysis is rarely used in nursing science, although its use is increasing. This review has identified deficiencies in the reporting of nursing validation studies using Rasch analysis. Minimum standards for the reporting of Rasch analysis in nursing research are proposed.

Background: Older adults manage increasing numbers of everyday technologies to participate in home and community activities. Purpose: We investigated how assessing use of everyday technologies enhanced predictions of overall needed assistance among urban older adults. Method: We used a cross-sectional design to analyze responses from 114 participants completing the Everyday Technology Use Questionnaire, the Montreal Cognitive Assessment, and a sociodemographic questionnaire. We estimated overall needed assistance based on definitions in the Assessment of Motor and Process Skills. We created logistic regression models and receiver operator characteristic curves to analyze variables predicting overall needed assistance. Findings: With high specificity and sensitivity, the Everyday Technology Use Questionnaire and the Montreal Cognitive Assessment were the strongest predictors of overall needed assistance. Implications: Assessing everyday technology use enhanced predictions of overall needed assistance among urban older adults.

Background:Psychological treatments provide many benefits for patients with psychiatric disorders, but research also suggests that negative effects might occur from the interventions involved. The Negative Effects Questionnaire (NEQ) has previously been developed as a way of determining the occurrence and characteristics of such incidents, consisting of 32 items and six factors. However, the NEQ has yet to be examined using modern test theory, which could help to improve the understanding of how well the instrument works psychometrically.Aims:The current study investigated the reliability and validity of the NEQ from both a person and item perspective, establishing goodness-of-fit, item bias, and scale precision.Method:The NEQ was distributed to 564 patients in five clinical trials at post-treatment. Data were analysed using Rasch analysis, i.e. a modern test theory application.Results:(1) the NEQ exhibits fairness in testing across sociodemographics, (2) shows comparable validity for a final and condensed scale of 20 instead of 32 items, (3) uses a rating scale that advances monotonically in steps of 0 to 4, and (4) is suitable for monitoring negative effects on an item-level.Conclusions:The NEQ is proposed as a useful instrument for investigating negative effects in psychological treatments, and its newer shorter format could facilitate its use in clinical and research settings. However, further research is needed to explore the relationship between negative effects and treatment outcome, as well as to test it in more diverse patient populations.

Background: In the light of the existence of social inequalities in health, a CBPR (Community Based Participatory Research) programme for health promotion started in Malmö, Sweden, in 2017. The programme was based on a penta-helix structure and involved a strategic steering group with representatives from academia, voluntary organisations, the business sector, the public sector, and citizens from the geographical community where the programme took place. The aim of this study was to explore how the penta-helix collaboration worked out from the perspectives of all partners, including the citizens.Methods: Individual interviews, that were based on a guide for self-reflection and evaluation of CBPR partnerships, were conducted with the representatives (N= 13) on three occasions, during the period 2017-2019. A qualitative content analysis was used to analyse the interviews. Results: Six themes emerged from the analysis including Challenges for the partners in the penta-helix collaboration; Challenges for the professionals at the local level; Citizens driving processes important for penta-helix collaboration; Health promoters building trust over different sectors in the society; System changes takes time and Shift of power. The analysis shows that the penta- helix collaboration worked well at the local level in a governance related model for penta- helix cooperation. In the overall cooperation it was the citizen-driven processes that make the program work. However, the findings also indicated an inflexibility in organisations with hierarchical structures that created barriers for citizens involvement in the penta-helix collaboration.Conclusion: The main issue uncovered in this study is the problem of vertically organized institutions where discovery and innovation processes flow down from the top, thereby eliminating the essential input of the people and community that they are supposed to serve. The success of the programme was based on an interprofessional cooperation at a local level, where local professions worked together with voluntary organisations, social workers, CBPR researchers from the university, citizens and local health promoters.

BackgroundIn the light of the existence of social inequalities in health, a CBPR (Community Based Participatory Research) programme for health promotion started in Malmö, Sweden, in 2017. The programme was based on a penta-helix structure and involved a strategic steering group with representatives from academia, voluntary organisations, the business sector, the public sector, and citizens from the community where the programme took place. The aim of this study was to explore how the penta-helix collaboration worked from the perspectives of all partners, including the citizens.MethodsIndividual interviews, that were based on a guide for self-reflection and evaluation of CBPR partnerships, were conducted with the representatives (N = 13) on three occasions, during the period 2017–2019. A qualitative content analysis was used to analyse the interviews.ResultsSix themes emerged from the analysis, including Challenges for the partners in the penta-helix collaboration; Challenges for the professionals at the local level; Citizen-driven processes are important for the penta-helix collaboration; Health promoters are essential to build trust between different sectors of society; Shift of power; and System changes take time. The analysis shows that the penta-helix collaboration worked well at the local level in a governance-related model for penta-helix cooperation. In the overall cooperation it was the citizen-driven processes that made the programme work. However, the findings also indicated an inflexibility in organisations with hierarchical structures that created barriers for citizen involvement in the penta-helix collaboration.ConclusionThe main issue uncovered in this study is the problem of vertically organised institutions where discovery and innovation processes flow down from the top, thereby eliminating the essential input of the people and community that they are supposed to serve. The success of the programme was based on an interprofessional cooperation at a local level, where local professions worked together with voluntary organisations, social workers, CBPR researchers from the university, citizens and local health promoters.

Background: Citizens living in disadvantaged neighborhoods are susceptible to chronic diseases associated with factors such as physical inactivity and poor nutrition. Women are considered more vulnerable in these situations owing to lack of access to health promotional activities catering their needs. This study aimed at evaluating the effects of a participatory research informed physical activity intervention on the health and related behavior of women living in disadvantaged neighborhoods in Southern Sweden. Methods: Forty women were invited to participate in a participatory research informed physical activity intervention delivered by health promoters and health ambassadors over a 3-month period. Quality of life was assessed using the WHOQOL-BREF questionnaire and questions regarding behavioral factors including frequency of leisure time physical activity, everyday activities, intake of fruit, vegetable, fish and soda were assessed at three time points including t1, prior to intervention start, t2 immediately post-intervention and t3, 6-month post-intervention. Furthermore, biomedical outcomes such as hemoglobin, blood pressure, resting heart rate, blood flow rate, body mass index, fat mass index and muscle mass index were also assessed at the same three time points. Wilcoxon’s Sign Rank Test was used to compare pre- and post-test scores. Results: There was an increase in the scores of the different domains of health related quality of life at t2 immediately post-intervention (p

Importance: Occupational therapy can play a role in primary care management of chronic diseases among older adults. Objective: To assess the feasibility of delivering a primary care occupation-focused intervention (Integrated PRimary care and Occupational therapy for Aging and Chronic disease Treatment to preserve Independence and Functioning, or i-PROACTIF) for older adults with chronic disease. Design: Feasibility study comparing i-PROACTIF with complex care management using a two-group randomized controlled trial design with data gathered at baseline and during and after the 8-wk intervention. Setting: Family medicine clinic serving an urban, low-income, working-class community. Outcomes and Measures: Feasibility indicators were recruitment, retention, utility of clinical assessments, and acceptability of interventions assessed through feedback surveys completed by patients and primary care providers (PCPs). Patient outcomes, including perspectives on chronic illness care, occupational performance, and overall well-being, were collected using standardized, validated measures and analyzed descriptively. Participants: Eighteen adult volunteers, ages ≥50 yr, with heart disease, arthritis, and uncontrolled diabetes completed the study. Ten PCPs completed feedback surveys. Intervention: i-PROACTIF focuses on preserving functional independence, is based on the Person–Environment–Occupation framework, and consists of two assessment sessions and six weekly treatment sessions. Results: Recruitment goals were achieved, with an 86% retention rate. Clinical measures unearthed deficits in areas that were unreported or underreported by patients. Participants reported being extremely satisfied with the intervention. Physicians and nurses also supported the intervention. Both groups showed improved scores on most outcomes. Conclusion and Relevance: Delivering and evaluating i-PROACTIF was feasible and acceptable. Future efficacy trials are needed before it can be used in clinical settings. What This Article Adds: The results of this study can inform future occupational therapy interventions and clinical trials in primary care for older adults with chronic conditions.

Understanding the dynamics and aspects of how activity choices impact health and well-being in people living with chronic obstructive pulmonary disease (COPD) is important to inform rehabilitation.To describe, firstly, how much time people living with COPD spend on work, daily living tasks, recreation and rest; secondly, how this population perceived competence, importance and enjoyment related to these activities; thirdly, if differences in such perceptions and time use were associated with the living situation and COPD severity.This cross-sectional study involved 76 participants (+45 years, COPD, living in ordinary homes), who completed the Occupational Questionnaire (OQ). Descriptive statistics and group comparisons were performed.Most of the participants' time were spent on daily living activities and recreational activities. Participants spent approx. 80% of their recorded time in OQ on activities they valued, enjoyed and in which they felt competent. Participants living alone scored significantly lower on enjoyment in restful activities than those living in couples (Findings underscore the importance of targeting overall daily activity repertoires including compositions of activity types, time use and perceived competence, importance and enjoyment.

ObjectivesInequalities in oral health have been on the rise globally. In Sweden, these differences exist not between regions, but among subgroups living in vulnerable situations. This study aims at understanding behavioural change after taking part in participatory oral health promotional activity among families living in socially disadvantaged neighbourhoods in Southern Sweden.SettingThe current study involved citizens from a socially disadvantaged neighbourhood in Malmö, together with actors from the academic, public and private sectors. These neighbourhoods were characterised by high rates of unemployment, crime, low education levels and, most importantly, poor health.ParticipantsFamilies with children aged 7–14 years from the neighbourhood were invited to participate in the health promotional activities by a community representative, known as a health promoter, using snowball sampling. Between 8 and 12 families participated in the multistage focus groups over 6 months. Data were analysed using qualitative content analysis.ResultsThree main themes emerged from the analysis, providing an understanding of the determinants for behavioural change, including meaningful social interactions, family dynamics and health trajectories. The mothers in the study valued the social aspects of their participation; however, they believed that gaining knowledge in combination with social interaction made their presence also meaningful. Further, the participants recognised the role of family dynamics primarily the interactions within the family, family structure and traditional practices as influencing oral health-related behaviour among children. Participants reported having experienced a change in general health owing to changed behaviour. They started to understand the association between general health and oral health that further motivated them to follow healthier behavioural routines.ConclusionsThe results from this study show that oral health promotion through reflection and dialogue with the communities, together with other stakeholders, may have the potential to influence behavioural change and empower participants to be future ambassadors for change.

Additional file 4. Item conceptualisation and I-CVI 1st and 2nd round. Operationalisation of items intended to present PCC in line with GPCC’s concept and I-CVI calculations for first and second Delphi round.

Additional file 6. Content analysis cognitive interviews, free-text comments and field notes. Subcategories and codes generated using an unconstrained matrix with four pre-defined main categories.

Additional file 3. Content analysis key informants. Subcategories and codes generated using an unconstrained matrix with three pre-defined main categories.

Background: The changing technological environment is reflected in regular updates made to the everyday technology (ET) use questionnaire (ETUQ). Newly added ETs may not present comparable challenges across countries and diagnoses. Aims: To identify whether country context, or dementia diagnosis, impact ETs’ challenge level. Material and methods: 315 older adults from three countries were included; Sweden (n = 73), United States (n = 114), England (n = 128), and had a confirmed diagnosis of mild dementia (n = 99) or no known cognitive impairment (n = 216). Differential Items Functioning (DIF) analysis was performed on 88 ETs included in the ETUQ by country and diagnosis. The impact of DIF was evaluated in a Differential Test Functioning (DTF) analysis. Results: Nine items (10.2%) in the ETUQ showed statistically significant DIF between countries; five of which were public space ETs and none of which were information and communication technologies (ICTs). Three ICT items, and no others, showed significant DIF by diagnosis. The items’ DIF was shown to have no impact upon person measures of ability to use ET in the DTF. Conclusions and significance: The utility of the ETUQ in occupational therapy practice and research internationally is highlighted through the stability of the challenge hierarchy and lack of impact on person measures.

Additional file 2. Interview protocol cognitive interviews. Interview guide for cognitive interviews with patients in phase three.

Additional file 1. Interview guide key informants. Interview guide for key informants in phase one.

Supplemental material, sj-pdf-1-bjo-10.1177_0308022620954117 for The use of everyday technology; a comparison of older persons with cognitive impairments’ self-reports and their proxies’ reports by Elin Jakobsson, Louise Nygård, Anders Kottorp, Cecilia Bråkenhielm Olsson and Camilla Malinowsky in British Journal of Occupational Therapy

Additional file 5. Examples of the Delphi process. Examples from the Delphi process, including I-CVI values and comments from experts and resulting revisions.

Background: As the use of everyday technology is increasingly important for participation in daily activities, more in-depth knowledge of everyday technology use in relation to diagnosis and gender is needed. The purpose of this study was to investigate the stability of the perceived challenge of a variety of everyday technologies across different samples of varying diagnoses including both males and females. Methods: This cross-sectional study used 643 data records from clinical and research samples, including persons with dementia or related disorders, acquired brain injury, intellectual disability, various mental or medical disorders, and adults without known diagnoses. The Everyday Technology Use Questionnaire, comprising 93 everyday technology artifacts and services (items) measuring the level of everyday technology challenge and relevance of and perceived ability to use these was used for data gathering. A two-faceted Rasch model in combination with differential item functioning (DIF) analyses were used for comparing item hierarchies across samples. Results: Only three items (3.2%) demonstrated a clinically relevant DIF by gender, and nine items (9.7%) by diagnosis. Discussion: The findings support a stable hierarchy of everyday technology challenge in home and community that can facilitate planning of an accessible and inclusive society from a technological departure point. Implications for Rehabilitation The ability to manage everyday technology is increasingly important for participation in everyday activities at home and in the community for people with and without disabilities. This study demonstrates that differences in perceived challenges in using various everyday technologies across gender and diagnosis are minimal. The findings provide evidence of no or minor systematic bias in testing when using the Everyday Technology Use Questionnaire in clinical practice and research. Empirical knowledge about the perceived challenge of specific everyday technologies of people with variations in gender or diagnosis is still sparse, hence this study can inspire practice and future research.

Background: Everyday technologies are naturally integrated in people’s daily life. For older adults and adults living with a chronic disease like chronic obstructive pulmonary disease (COPD), the ability to use technologies for health management has become increasingly important. The aim of this study was to investigate inter-rater and test-retest reliability of the Danish version of the Everyday Technology Use Questionnaire (ETUQ) in a sample of older adults with (n = 23) and without (n = 24) COPD. Material and method: The ETUQ was initially translated in accordance with the dual panel approach and then administered to a sample of 47 participants. Svensson’s method for paired ordinal data was utilized to calculate and analyze reliability. Results: Overall, inter-rater and test-retest reliability of the Danish version of the ETUQ demonstrated excellent percentage agreement (PA) (>75%), although for test-retest reliability, nine items demonstrated fair (53%) to good (73%) agreement. Conclusion: This study supports the use of the Danish version of the ETUQ in a sample of older adults with or without COPD. Application to practice: The Danish version of the ETUQ is an evidence-based evaluation that can reliably contribute to clinical occupational therapy and research in Denmark focusing on everyday technology use.

As context may impact everyday technology (ET) use it is relevant to study this within different contexts.To examine the usefulness of the Everyday Technology Use Questionnaire (ETUQ) in different contexts by investigating and comparing (1) the level of challenge of ETs in the ETUQ and (2) the relevance of and perceived ability to use ET in samples of Swedish and Japanese older adults.The Swedish and the Japanese samples (n = 86/86) were interviewed using the ETUQ about relevance of and perceived ability to use ET. Data were analyzed using Rasch analysis, chi square and a general linear model. Moreover, Differential Item Functioning (DIF) was investigated.The hierarchy of ETs' level of challenge was generally stable in the two contexts. On group-level, the relevance was somewhat higher and the perceived ability to use ET significantly higher in the Swedish sample than in the Japanese.The similarities and differences between the technological landscapes of Sweden and Japan could be detected by ETUQ, demonstrating its usefulness in both countries. The potential causes to the differences in relevance of and perceived ability to use ET between older adults in Sweden and Japan need further exploration.

Background: Activities of daily living (ADL) are crucial for children because they enable them to participate in everyday life. For the evaluation of children`s ADL performance, health professionals such as occupational therapists use standardized ADL assessments. To implement assessments into practice it is important that the score generated from an assessment can be viewed as a unidimensional measure. Aim: To investigate the factor structure of the German Pediatric Evaluation of Disability Inventory (PEDI-G) in a sample of typically developing children and children with an impairment. Material and Methods: An exploratory factor analysis (EFA) with factor rotation was performed to assess the factor structure for the PEDI-G domains (self-care, mobility and social function) of the Functional Skills Scale and the Caregiver Assistance Scale. Results: 262 children (118 (45%) girls and 144 (55%) boys) participated in this study. Their mean age (SD) was 4 years (SD 1.91). Results suggest that the PEDI domains of the Functional Skills Scale and the Caregivers Assistance Scale can be used as unidimensional measures to evaluate child`s ability to perform activities of daily living. Conclusion: The results of this study support the use of the PEDI-G for research and practice in Austria, Germany and Switzerland.

Occupational therapists support everyday technology use; however, it is necessary to consider the challenges that people with dementia encounter with everyday technologies when participating in various places within public space.The purpose of the study was to explore stability and change in participation in places visited within public space in relation to the relevance of everyday technologies used within public space.People with dementia (Both samples participated in places within public space; however, participation and relevance of everyday technologies were significantly lower for the dementia group.To enable participation, occupational therapists need to be aware of challenges that technologies and places within public space present to people with dementia.

OBJECTIVE. We describe the development of a questionnaire, Participation in Activities and Places Outside Home (ACT–OUT), for older adults with cognitive impairment and align it to people with mild- to moderate-stage dementia. METHOD. ACT–OUT was developed in a cross-cultural collaboration in combination with three rounds of cognitive interviews in Switzerland with 26 older adults without cognitive impairment and five older adults with dementia. Qualitative data from the interviews were analyzed using a constant comparison approach. RESULTS. The final ACT–OUT Version 1.0 consists of three parts: (1) questions targeting places older adults visit; (2) questions on aspects influencing participation, such as transportation, familiarity, and risk perception; and (3) questions on perception of self. CONCLUSION. The development of an instrument such as ACT–OUT is more a cyclical than a linear process. This study is a first step toward a more systematic evaluation of out-of-home participation among older adults with and without dementia.

Item does not contain fulltext BACKGROUND: The Perceive, Recall, Plan & Perform (PRPP) system of task analysis might be feasible to evaluate occupational performance and information processing strategies for persons with Parkinson's disease (PD). AIM: To evaluate: (1) the random error between raters (inter-rater study), (2) the random error within raters (intra-rater study), and (3) the internal consistency of the PRPP. MATERIALS AND METHODS: (1) video-recorded performance of meaningful activities of 13 Dutch persons with PD, scored independently by 38 Dutch PRPP trained occupational therapists were included in the analysis. The random error between raters was analyzed with two-way random Intraclass Correlation Coefficients (ICC). (2) Four videos were scored twice by 30 raters (6 week time interval). The random error within raters was analyzed using one-way random ICC's. (3) Internal consistency study: data of 190 persons with PD were analyzed using Cronbach's alpha (alpha). RESULTS: Inter-rater reliability ranged from slight to moderate (ICC= 0.06-0.43). The mean intra-rater reliability ranged from moderate to almost perfect (ICC= 0.60-0.83). Internal consistency is good (alpha = 0.60-0.86). CONCLUSION: The limited inter-rater reliability but adequate intra-rater reliability and internal consistency show the feasibility of the PRPP when used for persons with PD. Implications for reliable clinical use are discussed.

AIM:The aim of this study was to evaluate the cross-cultural validity of the German version of the Pediatric Evaluation of Disability Inventory (PEDI-G) when used in Austria, Germany and Switzerlan ...

Little is known about health variables and if these variables could increase the risk of injuries among adolescent elite athletes. The primary aim was to present overall data on self-perceived stress, nutrition intake, self-esteem, and sleep, as well as gender and age differences, on two occasions among adolescent elite athletes. A secondary aim was to study these health variables as potential risk factors on injury incidence. A questionnaire was e-mailed to 340 adolescent elite athletes on two occasions during a single school year: autumn semester and spring semester. The results show that during autumn semester, the recommended intake of fruits, vegetables, and fish was not met for 20%, 39%, and 43% of the adolescent elite athletes, respectively. The recommended amount of sleep during weekdays was not obtained by 19%. Multiple logistic regression showed that athletes sleeping more than 8 h of sleep during weekdays reduced the odds of injury with 61% (OR, 0.39; 95% CI, 0.16-0.99) and athletes reaching the recommended nutrition intake reduced the odds with 64% (OR, 0.36; 95% CI, 0.14-0.91). Our findings suggest that nutrition intake and sleep volume are of importance in understanding injury incidence.

Introduction The number of older adults living with mild cognitive impairment (MCI) or mild-stage Alzheimer's disease (AD) is increasing and they are often expected to live in their own homes without support, despite limited ability to perform daily life activities. The Everyday Technology Use Questionnaire (ETUQ) has proven to be able to separate these groups and might also have potential to predict overall functional level (need of assistance in daily life activities) among them. Aim To investigate whether the ETUQ can predict overall functional level among older adults with MCI or mild-stage AD. Method Participants were older adults with a mean age of 76 years with MCI (n = 28) or mild-stage AD (n = 39). A three-step scale indicating (i) independence, (ii) need for minimal assistance or (iii) need for moderate to maximal assistance in daily life was dichotomised in two ways and used as outcome variables in two logistic regression models. Predictors in both models were perceived ability to use everyday technology (ET) and amount of relevant everyday technologies measured by the ETUQ. Ethical approval was obtained from the regional Ethical Committee. Result Perceived ability to use ET discriminated individuals who were independent or in need of minimal support from those in need of moderate to maximal assistance (OR = 1.82, p < 0.01, confidence interval = 95%; 1.76–2.82). The amount of relevant everyday technologies discriminated individuals who were independent from those in need of assistance at any level (OR = 1.39; p < 0.01; confidence interval = 95%; 1.11–1.75). Conclusion Both perceived ability to use ET and amount of relevant everyday technologies had potential to predict overall function but at different levels. The findings support the predictive validity of the ETUQ and suggest further research for the development of clinical cut-off criteria.

Importance: Occupational therapy education and practice has changed over time; however, items on the American Occupational Therapy Association’s (AOTA’s) Fieldwork Performance Evaluations (FWPEs) for the Occupational Therapy Student (OTS) and Occupational Therapy Assistant Student (OTAS) have not been updated in more than two decades. Objective: To explore evidence of validity in relation to test content of the revised FWPEs for the OTS and OTAS Design: A qualitative study using cognitive interviews was conducted to gather perspectives on the revised FWPEs, including updated items and a proposed rating scale. A content analysis approach was used to link patterns in responses to stable, meaningful constructs to further align and refine content of the tool before further validation. Setting: Fieldwork sites and academic settings. Participants: Eighteen fieldwork educators (FWEs) and academic fieldwork coordinators Results: Seven areas for refinement were identified: (1) relevance to a variety of practice settings, (2) overlapping and redundant items, (3) long item statements, (4) double- and triple-barreled item statements, (5) alignment between OTS and OTAS items, (6) further alignment with AOTA and Accreditation Council for Occupational Therapy Education documents and contemporary practice, and (7) wording and features of the proposed rating scale. The findings guided revisions of FWPE content. Conclusions and Relevance: Cognitive interviewing was a critical step in refining the FWPE items to support content validity. The issues identified may not have been detected using traditional approaches to survey development and therefore were critical in maximizing the validity and usefulness of the final items, which will ultimately benefit fieldwork educators and students. What This Article Adds: This study resulted in refinements to FWPE items before the next step in the validation process, ultimately improving the final FWPE items. In addition, this article outlines a process that other researchers can use to validate similar tools.

Background The concept of hope has been measured using the Herth Hope Index (HHI) in different samples, but varying factor structures comprising different items from the HHI have been reported. Therefore, further testing with regard to the dimensionality of the instrument is recommended. Rasch modeling can be used to evaluate validity evidence of an instrument’s underlying structure, to identify items with poor fit to the rest of the scale, and to identify items that perform inconsistently across groups. The aim of this study was to assess the HHI’s psychometric properties in a sample of cancer patients using a Rasch model. Adult oncology outpatients (n = 167) with pain from bone metastasis were included, and medical records were reviewed for disease and treatment information. Patients completed the 12-item HHI, which measures various dimensions of hope using a 4-point Likert scale that ranges from 1 (strongly disagree) to 4 (strongly agree). The internal scale validity, person response validity, unidimensionality, and uniform differential item functioning were evaluated by applying a Rasch rating scale model. Results Five (42%) of the twelve items (#3, #4, #5, #6 and #7) did not meet the criterion set for item goodness-of-fit. After removing these 5 items, the resulting 7-item scale demonstrated acceptable item fit to the model, acceptable unidimensionality (52.6% of the variance explained), acceptable person goodness-of-fit, adequate separation, and no differential item function. Conclusion A 7-item version of the HHI had better psychometric properties than the original 12-item version among patients with cancer-related pain. Trial registration The protocol ID is 158,707/V10 and it was registered on ClinicalTrials.gov as NCT00760305 . Registered September 25, 2008.

Assessing competence in interprofessional collaborative practice (ICP) among health professions students is a high priority. This cross-sectional study built on the authors' prior work that led to the development of the 38-item Interprofessional Education Collaborative Competency Self Efficacy Tool (IPECC-SET), an instrument to evaluate health professions students' self-efficacy in interprofessional collaborative competency, and addressed two primary questions. First, could a unidimensional scale based on the IPEC competencies and assessing perceived self-efficacy for competence in ICP and be constructed? Second, could a shorter version of that instrument still meet criteria for unidimensionality and retain the ability to separate students in distinct levels of perceived self-efficacy for competence in ICP? Study participants were two cohorts of students from 11 health professions programs participating in an institutional interprofessional immersion event in 2015 and 2016. Statistical stepwise analyses were conducted using a Rasch rating scale model. The original 38 IPECC-SET items did not meet the criteria to generate a valid unidimensional measure of self-efficacy for competence in ICP, but could be condensed into a 27-item scale that met all set criteria for unidimensionality, with an explained variance of 61.2% and a separation index of 3.02. A shorter, 9-item scale demonstrated a separation index of 2.21. The nine items included also demonstrated a relatively equivalent range (54.93-45.65) as compared to the 27-item scale (57.26-46.16). Findings confirm empirically the conceptual suggestion from our earlier work that the four dimensions in the original IPEC competencies contribute to a shared underlying construct: perceived competence in interprofessional collaboration. Given the emphasis on ICP, psychometrically sound instruments are needed to evaluate the effectiveness of educational efforts to promote competency for ICP. Based on the findings from this study, both the IPECC-SET 27 and IPECC-SET 9 can be used to measure perceived self-efficacy for competence in ICP.

Even though injury is common in elite sports, there is still a lack of knowledge of young athletes' injury perception both during and after injury. The aim of this mixed-method study was, therefore, to explore, in-depth, data on injury consequences and adolescent elite athletes' perceptions and experience of injury. Three hundred and forty adolescent elite athletes (age range 15-19), from 16 different sports, were bi-weekly monitored over 52 weeks using a valid questionnaire. Twenty athletes from the same cohort were interviewed in focus groups about injury experience and perceptions. The results show that the average bi-weekly prevalence of injury was 38.7% (95% CI 37.3-40.1), with 30.0% (n = 102) of the athletes injured for more than half of all reporting times. An overarching theme from the focus groups highlighted the risk among young athletes of a loss of identity while injured. The findings support several suggestions that may improve the rehabilitation process and enhance rehabilitation outcomes: (a) provide clear pathways to the medical team, (b) recognize the identity loss, (c) involve the injured athletes with the rest of the teammates and (d) educate athletes about how to interpret pain signals. Future research should explore and evaluate the effectiveness and generalization of such interventions.

Background: There is a need for in-depth understanding of how elderly persons resume their occupations while recovering from physical disabilities in their home and community. The aim of this study was to explore and understand how engaging in occupations unfolded over time for some older persons with physical disabilities in Japan. Materials and methods: In this narrative-in-action study four elderly participants were recruited following a mixed purposive and convenience sampling method. Data was gathered at two to three weeks’ intervals over six months, with a follow-up visit at nine months. Qualitative interviews and participant-observations were analyzed using narrative analysis. Results: This study identified the central meaning of resuming occupations as re-establishing former and establishing new familiarity. Familiarity was expressed in three features, namely as repertoires of occupations fulfilling needs and meanings, as performing occupations according to expectation, and as a resource for dealing with problems of engaging in occupation. What was experienced as familiar could be adjusted to accommodate ones changing needs or situation. Conclusion and significance: (Re-)establishing familiarity is a new concept representing transitions from an occupational perspective. Facilitating familiarity can assist older persons to experience health and well-being, even while transitioning after an illness or injury.