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Collaboration among health care providers is intended to dissolve boundaries between the sectors of health care systems. The implementation of adequate augmentative and alternative communication (AAC) care of people without natural speech depends highly on collaboration among multiple stakeholders such as speech and language pathologists, teachers, or physicians. This paper examines existing barriers to and facilitators of collaboration from a stakeholder perspective. Five heterogeneous focus group interviews were conducted with N= 32 stakeholders including speech and language pathologists, AAC consultants, teachers, employees of sheltered workshops, parents, and relatives of AAC users, and other educational professionals (e.g., employees of homes for persons with disabilities) at three AAC counseling centers in Germany. Interview data were analyzed by structured qualitative content analysis. The results show very different experiences of collaboration in AAC care. Factors were identified that can have both positive and negative effects on the collaboration between all stakeholders (e.g., openness toward AAC, knowledge about AAC, communication between stakeholders). In addition, stakeholder-specific influencing factors, such as working conditions or commitment to AAC implementation, were identified. The results also reveal that these factors may have an impact on the quality of AAC care. Overall, the results indicate that good collaboration can contribute to better AAC care and that adequate conditions such as personnel, and time-related resources, or financial conditions need to be established to facilitate collaboration. [ABSTRACT FROM AUTHOR]

Objectives: There is a growing consensus worldwide that palliative care needs to be both more inclusive of conditions other than cancer and to improve. This paper explores some common challenges currently faced by professionals providing palliative care for patients with either cancer or dementia across five countries. Method: One focus group (n = 7) and 67 interviews were conducted in 2012 across five countries: England, Germany, Italy, the Netherlands and Norway, with professionals from dementia, cancer and palliative care settings. Results: The interviews revealed five common challenges faced across the five countries: communication difficulties (between services; and between professionals, and patients and their families); the variable extent of structural/functional integration of services; the difficulties in funding of palliative care services; problematic processes of care (boundaries, definitions, knowledge, skills and inclusiveness) and, finally, time constraints. Conclusion: These are not problems distinct to palliative care, but they may have different origins and explanations compared to other areas of health care. This paper explored deeper themes hidden behind a discourse about barriers and facilitators to improving care. [ABSTRACT FROM AUTHOR]

As social and health inequalities deepen around the world, scholarship in occupational therapy and occupational science has increasingly emphasised the role of occupation as a powerful tool in transformative processes. To explore how opportunities for everyday doing together may contribute to processes of social transformation by identifying ways occupation is being taken up in socially-transformative practice. A generic descriptive qualitative case study design was utilised in order to describe current practice examples and identify ways occupation was being taken up in five initiatives working towards social transformation located in Canada, Germany, South Africa and the United Kingdom. Focussing on the positioning of occupation within the initiatives, three themes were developed: The intentionality of the process, the nature of occupation within the initiatives, and the role of occupation within the processes of social transformation. Providing examples of agency on the micro level and of engagement with socioeconomic, political and cultural power structures at the societal level, this analysis raises important considerations in addressing how occupational therapy practice can move in socially responsive and transformative directions. [ABSTRACT FROM AUTHOR]

This paper examines the methodological issues encountered in a comparative case study, which investigated how discourses shaped and legitimated policy maintenance and policy change in Germany before and after unification. The research strategy involved discourse analysis of party political and parliamentary documents, integrating detailed textual and contextual analysis of the institutional framework within which discourses were articulated. The paper examines the possibility of using comparative case studies to develop concepts, and reviews the relationship between concepts and context in qualitative comparative research. A critique is then offered of the process of analysis, ranging from the initial data analysis using NUD*iST, to the re-contextualisation of the textual analysis, and the reintegration of context, theory and textual analysis in writing up the research. [ABSTRACT FROM AUTHOR]

Role expectations of physicians providing health care for hunger strikers have been discussed in the context of prisons and detention centres. Ethical guidance for physicians in these situations is codified in the Declaration of Malta. In the last years, new forms of collective, public hunger strikes of asylum seekers have occurred. We have aimed at reconstructing the experiences of health-care personnel involved in one of such cases. Semi-structured interviews with nine participants (physicians and paramedics) that had been involved in a public collective hunger strike of asylum seekers in Germany were conducted. We identified three health-care provider groups: voluntary physicians, emergency service providers and medical consultants for the authorities. Role conflicts arising from multiple loyalty situations with obligations towards different stakeholders (e.g., strikers, employers, authorities) were perceived as the greatest challenge especially for voluntary doctor and emergency service provider participants. Such conflicts culminated in feeling instrumentalized for political goals. The results illustrate that professional challenges in the health care during a public collective hunger strike differ in various aspects from those described in the literature on custodial settings. We recommend expanding and adapting the medico-ethical guidance. [ABSTRACT FROM AUTHOR]

Purpose: Prior research provides limited information on the roles that leisure can play among Western international students studying in Eastern countries. Exploring this directional difference can provide its implications for Western international student support. Therefore, the purpose of this study is to explore leisure behaviours and leisure benefits associated with acculturation among Western international students residing in South Korea.Method: Using a purposeful criterion sampling strategy, a total of 18 participants (7 males and 11 females) were recruited. This study employed semi-structured in-depth interviews and a content mapping and content mining question strategy was incorporated.Results: The following core themes were associated with the health benefits of leisure activities experienced by international students living in South Korea: (a) promoting mental health, (b) experiencing dynamics of inter-and intra-group friendships, and (c) facilitating acculturation.Conclusions: The findings showed that participants developed friendships with the host individuals and other international students, became well acculturated into a new culture and experienced benefits to their mental health, indicating that leisure participation can be instrumental in improving social and psychological wellbeing. [ABSTRACT FROM AUTHOR]

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To examine the possible contributions of capability, opportunity, and motivation for explaining long-term physical activity among people with multiple sclerosis and to report the results of a German survey study. The questionnaire, which was based on an expert interview study and behavior change theory, was structured and detailed applying the Theoretical Domains Framework. A total of 1027 people with multiple sclerosis provided data on sociodemographics, disease-related characteristics, and a set of constructs possibly related to long-term adherence. Participants were assigned to three groups: not regularly active, currently regularly active, and long-term regularly active. Eta squared was calculated to assess the magnitude of differences between groups using ANOVA. Moderate or large differences between groups were identified for many domains within capability, opportunity, and motivation. For the following theoretical domains, large differences (η2 ≥0.140) were observed: Intention, Behavioural Regulation, Beliefs about Capabilities and Goals. Our results suggest that capability, opportunity, and motivation should be targeted simultaneously when designing future interventions. Inactive people with multiple sclerosis might benefit most from interventions increasing action self-efficacy and intention. Boosting autonomous motivation, goal setting, action planning as well as maintenance and recovery self-efficacy could have a positive effect on long-term adherence. This study applied the COM-B model and Theoretical Domains Framework to identify a set of constructs for explaining long-term physical activity among people with MS. Behaviour change and maintenance interventions for people with MS should include techniques that foster intention, perceived self-efficacy and self-regulatory skills, and promote goal setting and autonomy of motivation for regular physical activity. Although barriers of the physical and social environmental context did not seem to be that important in our sample, scientists should consider addressing them in interventions for inactive and more disabled people with MS. Information about the benefits of physical activity should be regularly provided in MS rehabilitation, while further research should explore the relevance of information provision and knowledge for behaviour change in different groups of people with MS. [ABSTRACT FROM AUTHOR]

This study was conducted in a home-based context where trained occupational therapists delivered progressive physical exercise training and home modification intervention for preventing falls, namely the FIT-at-Home intervention. We assessed the feasibility of the intervention's content and mode of delivery from the occupational therapists' perspective as well as the feasibility of study procedures. We used a mixed-methods approach, which generated qualitative data from 14 OTs' after delivering the intervention via interviews and quantitative data of the study procedures via questionnaires and documentation sheets. In total, 16 of the 17 older people completed the intervention. Of 9 recorded falls, no serious physical problems occurred. Qualitative data suggested that the intervention content and mode was feasible. Only minor adaptations to the program are needed based on the users' feedback. The main benefit was seen in the fact that simple exercises can be integrated into everyday life for older people with restricted mobility. The FIT-at-Home intervention comprising lifestyle-integrated balance and strength exercises and home safety is feasible for occupational therapists to deliver. The findings will help to further refine the intervention and study procedures. Falling is a frequent and serious health problem for many community-living older people, and the incidence of injurious falls increases with advancing age. Home visiting programs comprising physical exercise training and home modification appear to be beneficial for older people with poor health, functional limitations, and limited mobility. This study indicates that it is feasible to introduce lifestyle-integrated balance and strength exercises, performed as part of daily routine for older people at risk of falling. Behavioural self-management strategies have the potential to improve the implementation of exercises during the course of rehabilitation treatment and afterward. [ABSTRACT FROM AUTHOR]

This article deals with the political context of social work practice with refugees. Specifically, it addresses the ways politics and policies that derive from them, interplay with social workers' perceptions and constructions regarding their daily practice. It is based on findings from a qualitative study that included 22 in-depth interviews with Israeli and German social workers who work with refugees. Working in a 'highly political' field meant that practitioners encountered xenophobia and racism, reinforced by the negative public discourse surrounding refugees, and faced the outcomes of exclusionary state policies towards service users and social services. The article demonstrates that working under challenging political circumstances, enhanced social workers' political awareness, termed politicisation, in that they became more attuned to their identities in relation to practice, to user-worker power imbalances, and to the ways politics and policies influence service users' well-being. Politicisation included social workers highly emotional involvement, which motivated them to take action towards social justice, as well as enhanced the risk of being overwhelmed and experiencing 'political fatigue'. The article discusses implications for the 're-politicisation' of social work research, practice and education. [ABSTRACT FROM AUTHOR]

Introduction: This article describes the main results of an empirical impact analysis of a music therapy model project for the prevention of violence in schools, developed and investigated by the author. Methods: Based on the investigation of research hypotheses, the assumed effects of the program were explored in a quasi-experimental evaluation study. The study was carried out in two regular secondary schools (middle schools) in the 5th year level. Results: The experiment showed significant but heterogeneous effects. Of 42 time-by-group interaction effects tested, 21 were significant. In one of the two project classes (treatment groups), the positive effect of violence prevention through the project model was confirmed by the research results throughout. In the other project class, the research hypotheses were predominantly rejected with the exception of a highly significant decrease in the category of aggressive acts. Discussion: The results are analyzed and evaluated in terms of class and project variables. For this purpose, interviews with experts are methodically evaluated in a qualitative analysis, which was carried out after completion of the project work. On the basis of the summaries of these research steps, knowledge is obtained indicating which conditions promote preventative effects, such as relations between the students or common interest in the project work, and under which conditions steps for modification of the program are required, such as little willingness to show consideration for others or a sudden decrease in motivation due to a lack of immediate success and a lack of common interests and goals. [ABSTRACT FROM AUTHOR]

Background: This study describes the psychometric testing of the Achondroplasia Personal Life Experience Scale (APLES): a new disease- and functioning-specific health-related quality of life instrument for young people with achondroplasia, which was developed based on the International Classification of Functioning–Children and Youth Version. Method: The qualitative analysis of focus group statements from German patients and parents using the International Classification of Functioning–Children and Youth Version yielded 59 items, which after cognitive debriefing were included in a pilot-test. Psychometric performance was cross-culturally examined in a field- and re-test in Germany and Spain. Results: Cognitive debriefing and pilot-test results suggested to reduce the 59-APLES version to a 35-items version. Field-test data showed acceptable reliability and validity, which further improved after the APLES was shortened to 21 items. Conclusion: Developing a disease-specific instrument within the framework of the International Classification of Functioning allows the universal assessment and comparison of perceived health. Psychometric analysis showed that the APLES fulfills psychometric quality standards and provides a way to assess health-related quality of life from self- and observer report in young persons with achondroplasia. Further studies may use the instrument in clinical research and practice to understand perceived burden and to optimize care. Health-related quality of life instruments are useful tools to include in clinical research and/or practice to evaluate treatment effects directly from the patient's perspective. Cross-culturally developed health-related quality of life measures that are based on the International Classification of Functioning Disability and Health provide the opportunity to assess the health status in a standardized language and to compare it across countries and health professions. All four components of the International Classification of Functioning Disability and Health – Child and Youth Version ("Body Functions & Structures", "Activities and Participation", "Environmental Factors", and "Personal Factors") have been shown to be relevant in assessing health-related quality of life and functioning in young achondroplasia patients. Results underline the important aspects associated with disproportionate short stature, emphasizing the benefits of a disease-specific instrument. [ABSTRACT FROM AUTHOR]

Patient organizations (POs) represent patient collectives in health care policy. The inclusion of people with a ‘neuro-psychiatric’ condition poses a particular challenge for the organizational processes and political representation of such collectives. In recent years, new POs (POs of) have been established in the field of autism spectrum disorder and dementia that advocate a different agenda and have a different organizational structure than traditional POs (POs for). The divide between these two types of POs indicates a different standpoint with regard to who should be included on an organizational level, which voices are accepted and who should represent these voices on the political level. The inclusion and exclusion of voices needs to be normatively justified in order to be regarded legitimate representation of such a collective. With the help of Miranda Fricker's theory of epistemic injustice, we scrutinize whether and, if so, which types of epistemic injustices (wrongdoings to a person as a knower) can be found within POs' practices and the political field in which they operate, by analyzing 37 interviews with PO representatives, their members and policy makers. Our in-depth analysis indicates that persistent stereotypes hamper the inclusion of affected members both within POs and on the health political level. Being affected causes distrust in having the ‘capacity to know' in a two-fold way; it is assumed that those who can represent themselves are “not affected enough” to present valuable insights into the condition and those who have difficulties to express themselves due to their condition are excluded because of their affectedness. We conclude that our analysis of the epistemic practices of POs serves as a good starting point to address these shortcomings from a theoretical and practical perspective and offers a valuable starting point for bioethics to understand unjust structures in the health political context. [ABSTRACT FROM PUBLISHER]

Objective:This study aimed to explore medication adherence among adherent and non-adherent persons suffering from rheumatoid arthritis (RA). A special focus was put on the reasons accounting for successful medication adherence and on potential barriers or facilitating factors. Design:A qualitative study with semi-structured interviews was conducted. Eighteen participants were recruited through stratified purposive sampling according to their medication adherence level. Interviews were analysed by interpretative phenomenological analysis. Results:Medication adherence behaviour was described on a continuum ranging from non-adherent to adherent. Participants’ current adherence level was represented as a result of inner negotiations between a variety of influential factors and the successful application of a range of strategies. The influential factors were: experiences with medication, outcome expectations, knowledge of therapeutic options, the traits ‘openness’ and ‘conscientiousness’, belief in medical progress, characteristics of the medication, level of trust in one’s physician, and perceived autonomy. Facilitating strategies were: establishing routines, using social support and the deliberate suppression of information about potential adverse events. Conclusion:The experience of and the reasons for medication (non-)adherence from the perspective of people with RA were explored comprehensively. Participants’ ongoing negotiations between adherence and non-adherence emerged as a key finding with implications for health service providers. [ABSTRACT FROM PUBLISHER]

In a qualitative elicitation study with 61 cancer patients, a broad range of attitudes toward physical activity could be obtained, especially negative attitudes among insufficiently active patients. Based on these results, a second quantitative study was conducted; 64 patients [40 men; 42% insufficiently active (<150 minutes/week)] completed a Theory of Planned Behavior (TPB) questionnaire. Regression analyses revealed that different variables of the TPB are relevant for explaining the intention to exercise for physically active (subjective norm) and insufficiently active (attitudes) cancer patients. Health professionals should adapt their support to the special needs of insufficiently active and active cancer patients. [ABSTRACT FROM PUBLISHER]

Cardiovascular diseases (CVDs) constitute one of the fastest-growing categories of disease in Germany, including among people with a background of migration. Although a growing number of epidemiological studies attempt to explain the course of migrants’ health, the extent to which cultural factors affect individual patients’ perception of and strategies for prevention of CVD (as a primary deterrent) remains clearly understudied. This pilot study describes the results of a qualitative research project based on content analysis that explores Turkish migrants’ understanding and perception of health and disease prevention and the degree to which they take advantage of health-related social services as they pertain to CVD. An important objective of the study was to explore the relationship between interviewees’ cultural background and their perceptions of health and prevention. Findings are first that despite an awareness of healthy living and disease prevention, formal healthcare is avoided unless acute illness/pain is experienced, and second that cultural factors are complex when it comes to perceptions and acceptance of disease prevention strategies. Avenues for much needed further qualitative research are outlined. [ABSTRACT FROM PUBLISHER]