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Objective:Physical activity (PA) is a known benefit to older adults with diabetes; however, the determinants of PA are less well studied in this population. Applying the World Health Organization’s International Classification of Functioning, Disability and Health (ICF), a well-established biopsychosocial framework, we explored PA participation among older adult with type 2 diabetes.Method:Using data from the Health and Retirement Study and the RAND Center for the Study of Aging (N = 2,016; mean age = 73.19; SD = 6.16), we conducted hierarchical stepwise regression analysis to evaluate the relative contribution of different biopsychosocial predictors to PA – namely, body functions and structure, activity and participation, personal, and environmental factors.Results:Altogether, biopsychosocial factors accounted for 20% of the variance in PA participation. Of the personal factors, high extraversion and low neuroticism explained approximately 54% of the variance in PA among the older adults – beyond sociodemographics. Low body mass index, reduced pain, reduced depression, and higher cognitive functioning also had good explanatory power (25% of explained variance), whereas activity participation and environment did not (10% each).Conclusion:Aligning care with components of the ICF will help to ensure a focus on person-centric practices and, in turn, optimize participation outcomes such as PA.

Religiosity is widespread in Africa and permeates the life of the continent’s young adults in ways yet to be fully understood. It is unclear what meanings young Africans perceive with their religiosity or the pathways to experiencing meaning. Therefore, we investigated the role of religious commitment in the search for and experience of meaning among young people in Ghana. In a cross-sectional design study, 342 Ghanaian students (female = 67%; mean age = 21 years, SD = 3.25) completed the Religious Commitment Inventory and the Meaning in Life Questionnaire. Structural equation modelling (SEM) in Mplus was used to test direct and interaction effects to demonstrate the dynamic relationships among religious commitment, and the search for and the presence of meaning. While results indicated a positive association between religious commitment and presence of meaning, the search for meaning was unrelated to religious commitment or presence of meaning. The interaction between search for meaning and religious commitment did not result in a significant effect on presence of meaning. These findings suggest that in this Ghanaian sample, religious commitment played a role in determining meaningful life experience, but the search for meaning did not play a role in the experience of meaning.

Older adults are at high risk for mental health distress due to COVID-19 pandemic restrictions. This scoping review aimed to map emerging evidence on the types of leisure and recreation activities (LRA) adults, 60 years and older, are engaged in for their mental health during the COVID-19 pandemic. We identified 10 studies on LRA for mental health by older adults with COVID-19 mitigation from a search of the following databases: Medline/PubMed, Excerpta Medica database (EMBASE), Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane Database of Systematic Reviews, JBI Evidence Synthesis, and Epistemonicos. A narrative synthesis of the data revealed age cohorts of young-old (60–69 years) and middle-old (70–79 years) engaging mainly in online LRA for mental health compared to the older-old adults (80 years and older). The middle-old (70–79 years) and older-old adults (80–89 years) engaged in more physical LRA for mental health compared to the younger-old adults. Across age cohorts, the older adults engaged in social connectedness LRA for mental health wellbeing. COVID-19–safe LRA mental health support interventions for older adults should be tailored to their age cohort predispositions for optimal benefit.

Background and Objectives Cognitive training delivered in conjunction with physical activity, may help to optimize aging and delay or prevent dementia in individuals with mild cognitive impairment (MCI). However, their efficacy is less well studied compared to pharmaceutical treatments. This systematic review synthesizes the emerging evidence on combined cognitive-physical interventions for enhancing functioning in older adults with MCI, with implications for practice and research. Research Design and Methods We searched the PubMed, PsycINFO, Ageline, Medline, Web of Science and ProQuest databases, and hand-searched articles published between July 2013 and November 2018. Only randomized controlled trials which incorporated cognitive and physical components targeted to individuals with MCI over the age of 50 were eligible. Our search yielded 10 eligible, independent articles. Results Intervention participants with MCI self-reported, or demonstrated, improved functioning across a range of cognitive (global cognitive function, executive function, processing speed, memory, attention, mood, emotion, motivation, brain cortex, orientation), and physical (gait, balance, mobility) outcomes. Interventions which combined cognitive-physical training were comparable to those which isolated these same elements, in terms of their effects on executive function, processing speed, attention, mood, and cardiorespiratory fitness. Discussion and Implications There is preliminary evidence to support the positive effects of multicomponent interventions to improve cognitive-motor abilities in older adults at risk of developing dementia. The strength of this research evidence is, however, limited. Longitudinal studies are needed to determine whether these effects are maintained over time. The optimal intervention intensity and length also need to be established.

Older adults with schizophrenia have some of the highest rates of both medical and psychiatric comorbidities. Despite this, little is known about comorbid pain and depressive symptoms in schizophrenia research. This study aimed to examine the associations between levels of pain intensity and depressive symptoms among community-dwelling adults aged 50 years and older with schizophrenia spectrum disorders. Recruited from U.S. community mental health centers, participants reported on pain and depressive symptoms at the onset of the Helping Older People Experience Success (HOPES) study. Unadjusted and adjusted regression analyses were conducted. Higher pain intensity was associated with elevated depressive symptoms in all analyses, which is consistent with other studies in the general population. Given the widespread efforts to manage pain and related mental health complications in older adults without serious mental illnesses, it is likewise important that community-based mental health professionals monitor and address intense pain and related depressive symptoms among older adults with schizophrenia.

Background The ways church youth make sexual decisions are incompletely understood and yet important for public health interventions. This study aimed to examine personal religiosity influences on the sexual decisions by church youth from the country of Botswana, taking into account their sense of personal agency. Method Participants were 235 Botswana Pentecostal faith church youth (females = 67.2%, male = 32.8%; age range 12–23 years). They completed measures of personal religiosity, personal agency, sexual abstinence, and contraception use predisposition. We analysed the data applying Structural Equation Modelling to test five paths - personal religiosity to personal agency, personal agency to abstinence, personal religiosity to abstinence, personal agency to contraceptive use, and personal religiosity to contraceptive use. Results Results suggest that personal religiosity influences the youth in their sexual abstinence and contraception decisions through personal agency. High personal agency, but not personal religiosity, was associated with pro-sexual abstinence, and contraception use was associated with religiosity. Personal agency augmented the likelihood of both abstinence and contraception use decisions among the older church youth and with church youth with higher levels of formal education. Conclusion Church youth likely adopt discretionary sexual behaviours over the developmental period from early to older adolescents, which would make them more receptive to public sexual health messages. Personal agency appears to be an important resource for public health interventions aimed at influencing church youth’s sexual decisions.

Increasingly, people with autism spectrum disorder (ASD) participate in mainstream employment like typical others, with varied outcomes influenced primarily by the workplace supports they receive. Autism spectrum disorder is characterized by three distinct features: persistent impairments in verbal and/or nonverbal communication, difficulties in forming and maintaining social interactions, and restricted, repetitive behaviors and interests. Autism spectrum disorder (ASD) is categorized based on the severity level and need for supports: Level 3 (requiring very substantial support), Level 2 (requiring substantial support), and Level 1 (requiring support). These support needs bear on the technologies that they would require for successful work participation. This chapter makes the case that to the extent that people with ASD receive appropriate work participation tools, they would flourish in their work roles, which will be to the mutual benefit of their employer organization. In the fourth industrial age, the tools would be predominantly digital and for greater job content or process accessibility. Job content is about the essential functions of a job. Job processes are the activities involved in implementing a work task. Moreover, the chapter considers occupational health and safety for those with ASD supported by digital technology tools in the context of inclusive human resource management policies and practices. Digital technologies increasingly are utilized for addressing occupational health and safety vulnerabilities from job content or process factors, adding to the wellness of employer organizations. The chapter also indicates present research needs on the work wellness effects of digital technology for use by people with ASD in diverse employment settings that present. This chapter contributes insights on digital technologies for work wellness in people with autism spectrum disorder.

Diversity in human attributes provides for richness in how we engage and flourish as people and communities. This fact may not be apparent or as well appreciated for people with neurodiverse conditions such as those with attention-deficit/hyperactivity disorder (ADHD), autism, and dyslexia. In this chapter, we define and characterize neurodiversity in human populations, and the associated community health-related implications. We follow this up by providing a brief history of the research and practice with people with neurodivergent conditions, addressing their health and wellbeing. Next, we discuss current and prospective inclusive approaches to the sustainable health of people with neurodivergent conditions. In doing so, we also consider the cultural, professional, and legal issues relevant to the sustainable health of people with neurodivergent conditions as well as the roles of interdisciplinary services. We conclude our chapter by discussing issues for research and practice to inform the sustainable health of neurodivergent individuals.

Chinese women are known to have both a high prevalence of metabolic syndrome (MetS) and vitamin D deficiency (serum 25-hydroxyvitamin D (25OHD) 55 years) Macanese, anthropometry, blood samples and validated questionnaires, including sleep duration and cardiovascular risk factors, were simultaneously collected. On multivariable categorical analyses, those women, not men, who had short sleep duration (≤6 hours (h)) were at a 2-fold risk for vitamin D deficiency (both 8 h) were 3-fold more likely to have vitamin D deficiency (OR = 3.07, 95%CI 1.47–6.39; OR = 2.75, 95%CI 1.08–7.00, respectively) compared to those with normal sleep duration (6–8 h). Both women and men with MetS were 2-fold more likely to have vitamin D deficiency (women: OR = 2.04, 95%CI 1.31–3.17; OR = 2.15, 95%CI 1.11–4.17, respectively; men: OR = 2.01, 95%CI 1.23–3.28; OR = 2.04, 95%CI 1.00–4.29, respectively). Moreover, women with both short sleep duration and MetS had an increased risk of vitamin D deficiency (OR = 3.26, 95%CI 1.10–9.64). These associations were not found in those with longer sleep. Men with longer sleep and MetS had a 5-fold risk of vitamin D deficiency (OR = 5.22; 95%CI 2.70–10.12). This association was non-significant for men with shorter sleep. We conclude that both short and long sleep duration were associated with vitamin D deficiency in older Chinese women. Further research is needed in larger cohorts or with intervention studies to further examine the associations between reduced sleep, metabolic syndrome and vitamin D deficiency.

Sustainable health for people with intellectual and developmental disabilities (IDD) depends significantly on the service infrastructure they can access and the appropriateness, sufficiency, dependability, coordination, responsiveness, and inclusiveness of that infrastructure. Yet, there is little documentation on the health system supports for people with IDD important for their long-term wellbeing and inclusive living in their communities. In this chapter, we briefly discuss professional and legal definitions of IDD and provide an overview of the historical research and practices that have shaped community health issues for people with IDD. More importantly, we discuss the current and prospective wellness-oriented approaches for the sustainable health of people with IDD. We also consider cultural, professional, and legislative influences on the sustainable health of the community of people with IDD and the role of related disciplines services. Finally, we consider research and practice matters important to the community wellness and sustainable health of people with IDD.

Obesity is a medical term that describes a condition in which adipose tissue, a body fat storage depot, increases beyond a healthy level. The risk of developing a chronic disease persists as body fat increases. Some examples of obesity-related chronic diseases are cardiovascular disease, nonalcoholic fatty liver disease, and diabetes mellitus. As the incidence of obesity spreads across a population so does disease burden, health care costs, losses in productivity, and early mortality. The sustainable health of populations requires managing obesity, a known cause of costly chronic conditions. In this chapter, we discuss sustainable ways to mitigate the adverse impact of obesity on community wellbeing, prioritizing a whole systems approach. A whole systems approach considers the multifaceted drivers of obesity and its disease outcomes. We discuss the critical importance of communities and neighborhoods in promoting effective health care systems, providing socially supported obesity control, and mitigation interventions. We open the chapter with a review of obesity and metabolic syndrome, a collection of obesity-related chronic diseases. Next we consider pertinent historical landmarks in obesity and related disease research with an emphasis on current practices and evolving community-level interventions. We then propose community-level strategies that promote physical activity, healthy food environments, and robust community health systems to reduce the prevalence of obesity in a given population. In discussing these community-oriented interventions, we consider the cultural, professional, and/or legislative issues relevant to those practices across locations and disciplines. Lastly, we discuss the future research and practice evidence needed to strengthen sustainable community-level interventions to reduce the incidence of obesity and related chronic diseases.

Objectives: Fall preventive programs aim to reduce risks for mortality from fall-related injuries among older adults. However, the covariation between personal perceptions of falls and factors and confidence of self-management in falls (CSMoF) is still under-studied despite its importance to fall prevention. We aimed to investigate the relative contribution of CSMoF in relation to fall risk self-perceptions while controlling for demographics and self-reported health and functioning. Method: Participants were 691 older adults recruited from Area Agency on Aging at Arlington, Texas (females = 76.1%, mean age = 76.23, SD = 6.44, with chronic condition = 79.5%). They completed measures of physical functioning, CSMoF, fall risk perceptions and fear of falls. Results: Regression analyses indicated that fear of fall was the most predictive factor of CSMoF among older persons, accounting for about 25% of the variance. Physical function measures of age, chronic illnesses of metabolism, sensory impairment, and health status were also significant predictors of the CSMoF, but to a lesser extent than fear of falls and fall perceptions. The interaction of perception of falls and fall experience attenuated CSMoF, with physical functioning limitations. Conclusion: The joint effects of perception of falls and fear of falls likely explain CSMoF among older adults more than physical functional indicators. Fall prevention programs for older adults should prioritize to address modifiable subjective factors of fall perceptions, fear of falls, and CSMoF across health and functioning statuses.

Obesity takes a substantial toll on society as a whole. Obesity and its health-related complications contribute significantly to healthcare costs and negatively affects almost every aspect of human life. It is therefore reasonable for the government to be involved in finding solutions to control the epidemic. This article examined factors that influence support for government intervention in the obesity epidemic in the United States. We used data from Obesity in the United States: Public Perceptions, a survey of a nationally representative sample of American adults. We conducted OLS regression analysis, to understand how three main covariates that described beliefs about causes of obesity and a series of controls impact support for government intervention in obesity control. There was a significant negative relationship between support for government intervention and beliefs about causes of obesity. Also, political ideology and party affiliation significantly influenced support for government intervention. For instance, while Democrats were more supportive of government interventions to control obesity, Republicans were not supportive of such intervention. Additionally, race and environmental characteristics of place of residence significantly influenced support for government intervention. Further, there were significant joint effects of political affiliation, race, and weight status on support for government intervention. Unlike previous studies, we find that one of the important factors that drive people to either support or abhor government intervention is the perception of what causes obesity. It is important that public health officials and other stakeholders understand the intricacies of public support for obesity control.

This study aimed to understand the coping strategies used by men with Adult Onset Epileptic Seizures (AOES) following elective neurosurgery, and in particular, how those adaptive skills relate to their subjective wellbeing (SWB). Open-ended qualitative interviews were conducted with five men with a history of neurosurgery for AOES (aged 34–59). The interview data was thematically analysed utilising interpretive phenomenological analysis. The findings indicated that the men experienced significant role marginalisation by family and co-workers, and also poor communication provided by health care professionals. They reported a higher sense of SWB with the use of ego-buffering strategies, such as positive reframing, threat minimisation, emotional self-acceptance and engaging in wish-fulfilling fantasies. Self-blame led to lower SWB. Findings imply that agentic behaviour is important to successful living with AOES following neurosurgery.

The aim of this study was to investigate trends of body mass index (BMI) with age in westernizing Macau and to make comparisons with Australian data. A representative random sample (n = 1406, 18-93 years, 55% female) from Macau was recruited in 2012. The Australian sample was extracted from the Australian Health Survey 2011-2012 (n = 7958, 18 to ≥85 years, 52% female). BMI in Australians was greater than Macanese, mean difference 4.4 kg/m2 ( P < .001). While BMI increases steadily with ageing in each population, the plateau for Macau subjects appears 5 to 10 years earlier than Australians. Prevalence of overweight/obesity in young Macanese adults (18-40 years) was 25% (men) and 22% (women), with the greatest increase in BMI from age 25 to 39 years and 24 to 45 years in men and women, respectively. BMI shifts in younger Macanese men and women, which may reflect emerging lifestyle and nutrition transitions, are a future population health concern in Macau.

Autism Spectrum Disorders (ASD) is a high-incidence condition affecting approximately one out of 68 of people. Adults with ASD are three to four times less likely to be employed than peers who do not have a disability. The high rate of unemployment of adults with ASD suggests a gap in employment development theory and practice knowledge addressing the specific needs of this population. This chapter provides new insights on theoretical framing of employment support interventions for people with ASD, including the interface between behavioral-gradient, structural-infrastructure, and psychosocial factors in vocational development with individuals with ASD. Practical implications of this chapter include taking into account level of functioning with ASD, structural-infrastructural supports, and the use of digital technologies in career counseling of people with neurodiversity.

Background American Indian/Alaskan Native (AI/AN) communities are second only to White Americans in mortality from opioid use disorder (OUD), while the smallest racial/ethnic minority population group in the USA. Those in rural communities experience significant health care disparities, including poorer treatment access for substance use disorder. This systematic scoping review aimed to trend the emerging evidence on opioid use disorder (OUD) management among rural AI/AN communities as well as workforce training needs. Method We searched the Medline, Embase, PsycInfo, SSCI, and Digital theses databases for empirical study publications on OUD management among AI/AN rural communities across the continuum of prevention, treatment and care. Eight studies met the following criteria: (a) focused on OUD; (b) sampled rural AI/AN members; (c) investigated prevention, treatment and/or care perspectives and/or practices or health provider preparation; and (d) published during the period 2009–2020. Included studies met the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) quality control standards. Findings Six of eight of the studies (75%) were surveys with community members and other stakeholders on OUD management within rural AI/AN communities rather than active interventions within this population. Moreover, five of eight of the studies (63%) reported a preference for culturally grounded health and wellness interventions with rural AI/AN, involving families, and community interventionists, utilizing community reinforcement approaches. Three of eight studies (37.5%) reported need for the cultural adaption of medication-assisted treatments (MAT) and use of culturally informed recovery care approaches. One of eight studies (12.5%) proposed to use culturally adapted contingency management behavioral approaches for OUD treatment and recovery care. Conclusion The evidence is trending to endorse culturally adapted OUD management with rural AI/AN communities, prioritizing prevention education, and use of MAT with cultural adaptation and whole person approaches to sustainable recovery care. Mental health care should be a part OUD prevention, treatment and recovery care in rural AI/AN rural communities.

This literature scoping review compared recidivism rates of moderate- and high-risk sexual offenders who received cognitive-behavioral therapy (CBT) oriented treatments. Ten empirical studies from 2001 to 2014 were selected for review that met the following criteria: (a) Treatment program included a CBT-based intervention with a comparative intervention; (b) participants included adult, male, moderate- and high-risk sexual offenders only; and (c) follow-up data for up to 12 months. Data were analyzed using a summative metric for recidivism rate comparisons ( N = 3,073 for CBT and N = 3,588, for comparison approaches). Sexual offense recidivism rates varied from 0.6% to 21.8% (with CBT) and from 4.5% to 32.3% (with comparison intervention). The within-sample median rate of violent recidivism with a history of sexual offense was 21.1% (with CBT) versus 32.6% (comparison). Sexual offenders had a general felonies (within-sample) median recidivism rate of 27.05% (with CBT) versus 51.05% (comparison). The evidence supports the conclusion that CBT in its various forms is an efficacious treatment modality to prevent offense recidivism by sexual offenders. Suggestions for future research are considered.

This scoping review sought to map the emerging evidence on use of harm minimization drug treatment programs in criminal justice settings. A search of various data bases including Cochrane Database of Systematic Reviews Medline, ProQuest, SAGE Premier, Scopus, Taylor & Francis Online, and Web of Science yielded eight studies that met inclusion criteria. The available evidence suggests increasing adoption of harm minimization policy oriented programs by countries around the world. Specific programs adopted include needle and syringe exchange, methadone maintenance, buprenorphine maintenance and treatment in lieu of incarceration. Each of these programs has evidence to support their effectiveness in relation to individual harm reduction, disease reduction, increase treatment retention and reduced criminality. This article considers implications of the adoption of harm minimization policies by criminal justice systems.

By drawing lessons from several southern African countries, this chapter argues for CBR to be a preferred development strategy in promoting disability-inclusive social development. They believe that a socially inclusive community-based rehabilitation implements development strategies that promote full participation of people with disabilities. Such disability-inclusive community development strategies seek to create and sustain structures that optimise the participation of people with disabilities in their diversity, rather than expecting them to fit in within existing sub-optimal arrangements. Also, the authors argue that full collaboration of governmental and civic community in the design and delivery of community development initiatives in which persons with disabilities actively contribute, are key elements of a successful community-based rehabilitation programme.

Health-related quality of life (HRQoL) is an important outcome in coronary heart disease (CHD). However, variability in HRQoL indicators suggests a need to consider domain coverage. This review applies a globally accepted framework, the International Classification of Functioning, Disability and Health (ICF), to map HRQoL measures that are reliable and valid among people with CHD.The Embase, Pubmed and PsycInfo databases were searched, with 10 observational studies comparing HRQOL among 4786 adults with CHD to 50949 controls identified. Study reporting quality was examined (QualSyst). Hedges' g statistic (with 95% CIs and p values) was used to measure the effect size for the difference between group means (≤ 0.2 small, ≤ 0.5 medium, ≤ 0.80 large difference), and between-study heterogeneity (tau, IAdults with CHD reported lowered HRQoL (gThe ICF provides a framework for evaluating and understanding the impact of CHD on HRQoL. The results demonstrate that HRQoL goes beyond physical symptoms, with activity limitations, social support and participation, and personal perceptions identified as key ICF domains in CHD assessment. Further investigations are needed to unravel the dynamic and inter-relationships between these domains, including longitudinal trends in HRQoL indicators.

Religious communities influence health-related behaviors of adherents in important ways for public health promotion. Questions remain about the processes involved and resultant health promotion actions of the religious adherents. This study applied a structural theory analysis to understand the ways by which religious adherents adopt and enact health norms. Structural theory proposes systemic influences on behavioral predispositions at the latent, interpretive, and elective levels. Latent influences on health norms occur through a process of social mediation, predisposing the religious adherents to impute faith-aligned meanings to their health norms. Religious adherents also might adopt interpretation to guide their health norms in those grey areas in which faith-based guidelines are not apparent or open to contestation. Moreover, religious adherents may elect to construct health norms combining faith-aligned and prevailing secular community standards. Public health promotion with religious adherents should address their faith-aligned health beliefs while also addressing their evolving personal health norms.

Parent carers of children with Autism Spectrum Disorder (ASD) often report increased levels of stress, depression, and anxiety. Unmet parent carer mental health needs pose a significant risk to the psychological, physical, and social well-being of the parents of the child affected by ASD and jeopardize the adaptive functioning of the family as well as the potential of the child affected by ASD. This systematic review identifies key qualities of interventions supporting the mental health of parent carers and proposes practitioner-parent carer support guidelines. A search of four databases (Medline, PubMed, PsycINFO, and Social Science Data) was conducted to identify studies that met the following criteria: (1) an intervention was delivered to parent carers of a child with ASD under the age of 18 years; (2) the research design allowed for a comparison on outcomes across groups; and (3) outcome measures of the parent carers’ mental health were used. A total of 23 studies met the inclusion criteria. A critical interpretive synthesis approach was used to produce an integrated conceptualization of the evidence. Findings suggest practitioner guidelines to support the mental health and wellbeing of parent carers should include addressing the parent’s self-perspective taking and skill for real time problem-solving.

Post-injury return to work (RTW) is an important rehabilitation outcome regardless of injury type. With Spinal Cord Injury (SCI), the odds of successful RTW are lower than for the general population of work-injured. Australians living with a SCI have a higher RTW rate than many other developed countries, including the United States. Important influences on relatively higher post-injury RTW rates in the Australian context include its universal disability care policy, Australia's suite of no-fault accident insurance systems that allow for multi-faceted rehabilitation services to be provided to eligible individuals in addition to appropriate rewards for rehabilitation service providers. A combination of these systemic factors is important when delivering comprehensive rehabilitation services to those with catastrophic injuries, such as SCI. The empirical evidence on drivers of successful RTW post SCI is, however, limited in comparison to the evidence on interventions for enhanced coping following SCI. Future studies could consider the relative merits of specific RTW interventions with SCI contrasting policy and capitation systems as well as utilising study designs that take into account pre-morbid work participation and secondary health conditions.

International trends towards people-centred, integrative care and support require any measurement of functioning and disability to meet multiple aims. The information requirements of two major Australian programs for disability and rehabilitation are outlined, and the findings of two searches for suitable measures of functioning and disability are analysed. Over 30 current measures of functioning were evaluated in each search. Neither search found a generic measure of functioning suitable for these multibillion dollar programs, relevant to a wide range of people with a variety of health conditions and functioning experiences, and capable of indicating support needs, associated costs, progress and outcomes. This unsuccessful outcome has implications internationally for policy-relevant information for disability, rehabilitation and related programs. The paper outlines the features of an Integrative Measure of Functioning (IMF) based on the concepts of functioning and environmental factors in the International Classification of Functioning, Disability and Health (ICF). An IMF would be applicable across a variety of health conditions, settings and purposes, ranging from individual assessment to public health. An IMF could deliver person-centred, policy-relevant information for a range of programs, promoting harmonised language and measurement and supporting international trends in human services and public health. Centre for Disability Research and Policy

This chapter provides an overview on vocational rehabilitation services in rural Australia and New Zealand (Australasia), a region with significant geo-cultural diversity – ranging from extremely remote regions to highly urbanised areas. It surveys the work opportunity settings for residents of rural and remote Australasia and the types of vocational rehabilitation service needs in that setting. Both Australia and New Zealand’s indigenous have state-supported vocational rehabilitation services, which also allow private for-profit operators or providers. Indigenous people tend to be habitants of rural and remote Australia and less for New Zealand. They have significant disability prevalence compared to the general population and are likely to be unemployed − if with employment their vocational rehabilitation needs are less likely to be met due to scarcity of services in their rural and remote habitats. Vocational rehabilitation services in rural and remote Australasia are likely to be successful if designed for typical rural economy industry and with providers grounded in local cultures.

© 2017 American Psychological Association. Purpose: Acceptance of the International Classification of Functioning, Disability and Health (ICF) in research and clinical practice has been delayed, despite its multiperspective approach to health measurement. This review utilized the ICF to examine evidence on the associations between depressive symptoms and psychosocial functioning in a patient cohort: multiple sclerosis (MS). Research Method: Forty-nine studies, involving 7,548 adults with relapsing or progressive forms of MS, were quantitatively evaluated. Data were categorized according to ICF domains: activities of individuals along with their participation in life areas and influential environmental and personal factors. Effect size estimates, in the form of Pearson's r, 95% confidence intervals and Fail-safe Ns were calculated. Results: Depression severity was linked to reduced social activities and participation levels (29%, n = 14 studies). Limited quality and/or frequency of informal support from family and friends was also identified as an environmental barrier to participation (29%, n = 14 studies). Intrapersonal markers of depressive symptomatology (e.g., low self-efficacy, anxiety, poor coping, illness attitudes and beliefs) were routinely reported (53%, n = 29 studies). Conclusions: The ICF can help guide the selection of clinical measures to assess psychosocial functioning in adults with MS and highlight areas necessitating further research and/or intervention. For those reporting depressed mood, this might include interventions premised on supporting activity and participation in addition to reinforcing interpersonal strengths. To enhance the utility of the ICF in MS care, further research is needed to operationalize its domains and to map this framework onto existing measurement tools.

In this study the authors explore the impact of protective factors on the health and well-being of grandmothers who are primary caregivers. Although researchers in Africa have studied grandparents who assume primary caregiving responsibilities, it is rare that they do so from a strength perspective, hence the need to examine the utility of personal, social, and environmental assets on caregiving. Grandmothers are the primary caregivers of orphaned children due to HIV and AIDS deaths; thus it becomes pertinent to establish how they are coping without the provision of social security. The results of this study will be beneficial to all stakeholders interested in the welfare of elders with similar responsibilities. Knowledge about the health and well-being of grandmothers who are caregivers will assist public service and private sectors to formulate viable policies concerning elderly carers who foster orphans, particularly in countries with high HIV prevalence.

The authors have conducted a thematic review of the literature on the evidence of, and enquiry into, individualized placement and support (IPS) efficacy as an intervention for people with schizophrenia or schizoaffective disorders. Eight studies were identified that met all inclusion criteria. Explicit themes in the research included (a) investigation of the impact of schizophrenia sequelae on IPS efficacy and the differential impact of neurocognitive enhancement therapy in minimizing psychiatric symptoms and improving IPS outcomes and (b) IPS as an alternative to treatment-as-usual in different age demographics (older and younger clients). Implicit themes coalesced around a general theme of dealing with change, in practice and research, that implementing IPS implies. Each theme represents a challenge or confound to the research corpus and included (a) vaguely defined rationale for the issue of return on investment, (b) practical burden of overstressed and unprepared service structures, (c) diffuse outcom...

This study sought to predict posttraumatic stress disorder (PTSD) from women's reproductive health events after an earthquake experience. Data on antenatal care, pregnancy outcomes, family planning, socioeconomic status, earthquake experiences, and mental health were collected from a random sample of 425 women of reproductive age using the Centers for Disease Control and Prevention Reproductive Health Assessment Toolkit and the Harvard Trauma Questionnaire. Data were analyzed using multivariate regression analysis to predict PTSD symptoms from posttrauma care variables and reproductive health events. Restricted social participation, use of temporary accommodation, pregnancy complications, and use of injectable contraceptives were significant risk factors of PTSD. These factors may be exacerbated by the social context of conservative societies, traditions about health care-seeking behavior, and access to health care. Antecedent reproductive health events influence women's reaction to major trauma including events such as an earthquake.

Sexual and reproductive health (SRH) addresses sexual rights, reproductive processes, and sexual functions at all stages of life. It is about the right to participate in sexuality, including seeking, receiving, and passing on information about sexuality. It also encompasses personal choices about sexual activity, including fertility control. Yet, SRH is a taboo subject in many tradition-led communities, and its practice is constrained by social mores and conventions that restrict access to SRH information by women and minors. This is most apparent in four key areas of SRH practice: fertility control, sexually transmitted infections, maternal health, and sex education. Keywords: health; sexuality; indigenous healing systems; sexually transmitted disease

This study utilized participatory action research approaches to construct a follower-centric framework for measuring influences on sexual decision making by youth members of a church organization. Participants were Batswana Pentecostal church members self-reporting on their engagement in pre-marital sex (n = 68, females = 62%; age range 15–23 years; median age = 20.3 years) from eight of 26 randomly selected congregations. They completed a multi-stage concept mapping process that included free listing of statements of potential influences on their sexual decisions. They then sorted the statements into groupings similar in meaning to them, and rated the same statements for relative importance to their sexual decisions. Multidimensional scaling and hierarchical cluster analysis of the data yielded a five cluster solution in which church teachings emerged as most salient to the teenagers’ sexual decision making followed by future orientation, community norms, knowledge about HIV/AIDS and prevention education. While the youth believed to be influenced by religion teachings on primary sexual abstinence, they self-reported with pre-marital sex. This suggests a need for secondary abstinence education with them to reduce their risk for STIs/HIV and unwanted pregnancies. Concept mapping is serviceable to construct frameworks and to identify content of follower-centric influences on sexual decision making by church youth members.

Rehabilitation assessment data influence decisions for the design of preferred lifestyles with a chronic illness or disability (CID). As a result, careful consideration of the source, type and scope of these data is needed in selecting appropriate procedures for their collection and use. This article proposes three essential qualities of data to assess in life design counselling with CID.A narrative analytical review approach is applied to synthesize findings from the research on person-oriented approaches to rehabilitation assessments. In addition, illustrative life design data on preferred community living solutions with CID for rehabilitation clients (n = 68) are presented. The concept of life design foregrounds the narrative analytical review on essential qualities of rehabilitation assessments to support life choices with disability.The evidence from a narrative synthesis of the person-oriented assessment literature and community living study suggests that effective life design with CID is enhanced with person-centric, resource enabling and participation focused data. Data that prioritizes personal values for participation enable persons with a disability jurisdiction in their life design choices.Life design is a robust concept to understand the purposes for which rehabilitation assessment data are gathered, and the essential qualities for those data. When life design measures have person-centric qualities, people with CID are empowered to construct their own lives.

The authors used state-of-the-art concept mapping approaches to examine structural institutional effects of church and secular high schools on the types of sexual and HIV-prevention education messages transmitted to learners in Zimbabwe. Participants were school teachers (n = 26), school counselors (n = 28), and pastors involved in student pastoral care (n = 14; males = 27, females = 41). They reported on messages perceived to influence sexual decisions of learners in their school setting. The self-report data were clustered into message types using concept mapping and contrasted for consistency of content and structure both between and within type of school. The authors also engaged in curriculum document study with member checks in the participant schools to determine convergence of the evidence on school-type effects of the messages transmitted to students. Church schools prioritized faith-informed sexual and HIV-prevention messages, whereas both types of schools prioritized Life skills education and a future focus. Secular schools prioritized sex and HIV messages in the context of community norms. Facts about HIV and AIDS were relatively underemphasized by church schools. The implicit knowledge values that differentiate types of schools influence learner access to information important for their sexual decisions.

This study sought to identify influences on rehabilitation counsellors' preference to work in rural areas, including their recruitment to, and retention in, rural work settings. Participants were 38 practicing rehabilitation counsellors (31% males) recruited through the Australian Society of Rehabilitation Counsellors and the Rehabilitation Counselling Association of Australasia. The mean age of participants was 38.67 years (SD= 12.9 years, age range, 25 to 65 years). Nineteen (50%) were working in rural areas at the time of the survey. A specifically designed survey, the Work Setting Preference Inventory (WSPI), which incorporated both quantitative and qualitative response options, was used to collect data. Analysis involved open coding of data into themes that emerged from the participants' responses. Descriptive statistical analysis was applied to quantify the prevalence or salience of particular themes. Results suggest that participants perceived preference to work in rural area to be influenced by the unique lifestyle of rural communities and family friendly employer policies. They perceived the availability of employment and training opportunities and supplemental financial compensations as incentives to attract rehabilitation counsellors to work in rural areas. Programs to recruit rehabilitation counsellors to rural areas should address employee lifestyle preferences in the context their overall career development.

HIV/AIDS poses grave risk to human development in sub-Saharan Africa. Evidence-based interventions that are rooted in local culture could help efforts to prevent threats to human development from HIV/AIDS. We used concept mapping (Concept System, 2006 ) to construct the components and content of a locally developed HIV/AIDS curriculum for use by secondary schools in Lusaka, Zambia. Participants were school counsellors (n = 14), youth health program officers (n = 7), and regular education teachers (n = 3) from the education, health, and youth development agencies in Lusaka, Zambia (males = 11; females = 13; mean age 38; SD = 15 years). Concept mapping yielded six statement clusters defining preliminary components of a locally grounded in-school HIV/AIDS prevention curriculum and the content items that define these components: (1) life skills education (18 items), (2) sexuality and reproductive health (10 items), (3) treatment, care and support (13 items), (4) counselling (12 items), (5) basic facts about HIV/AIDS (11 items), and (6) dissemination of information about HIV/AIDS (11 items). Zambian locally constructed constructs for an HIV/STD prevention curriculum overlap those promoted by public health programs in the country and internationally.

Constructions of sexuality and disability have been discussed widely by scholars across a number of fields. However, there has been relatively little research on how people with cerebral palsy construct their own sexuality and the salience of the socio-sexual schema which are involved in this process. One such sexual schema is that of sexual spontaneity. This research explored how people with cerebral palsy construct sexual participation particularly in relation to sexual spontaneity and the role it played in how they described their sexuality. This project utilized a hermeneutic phenomenological approach to explore these questions. Seven in-depth, semi-structured interviews were conducted with five men and two women with moderate to severe cerebral palsy. Sexual spontaneity was primarily a derivative of sexual exploration. Furthermore, participants defined sexual spontaneity as liberating and allowed them to experience their sexuality with others relatively independent of normative sexual scripts. Participants also described their sexuality primarily in terms of major transitions and experiences which involved others. The findings emphasize that people with cerebral palsy are cognizant and intelligent agents in the construction of their sexuality. Their articulations, understandings and descriptions of their sexuality demonstrate their interest and awareness in their sexuality and issues related to it.

Consider the case (Mpofu, 2003) in which an 8‐year‐old African child with early‐onset conduct disorder was believed by his family to be “acting out” because his departed mother’s spirit had not bee...

The study investigated sexual behaviors among 1573 rural South Africans in their early and late adolescents and young adults. The participants reported their number of sexual partners and behaviors related to sexual experience, including age of their first sexual experience, use of contraceptives, use of substances, and anal sex. The data from 630 adolescents with sexual experience (males: 362; females: 268) were analyzed to test three sequential models to predict the number of sexual partners from student characteristics (i.e., demographics, use of substances, sexual behaviors). Teenagers with early sexual experience and a history of substance-use tended to have multiple sexual partners, confirming the need for targeted HIV prevention interventions for young people in South Africa.

Minority is a term that has become particularly visible within the rehabilitation literature due to the increasing focus on the application of minority models to the understanding of the disability experience. At the same time, it is also one of the most ill-defined and misunderstood terms. In this article, the authors explore the meaning of minority status by discussing its core elements from a representational theory perspective. By doing so, they show that minority status is different from racial, ethnic, and cultural membership, although it partially overlaps with each of these constructs in some contexts. The authors argue that although race, culture, and ethnic minority status can attenuate or exacerbate minority status in some settings, these demographics are neither necessary nor sufficient conditions for minority status. Finally, the authors illustrate how many people with disabilities meet the essential criteria for minority status as outlined by representational theory and draw implications for rehabilitation practice, education, and research.

The purpose of this paper is to describe the development of an international collaborative effort that aims to reduce risky behavior (e.g., substance use, risky sexual behavior) that leads to outcomes such as HIV/AIDs, pregnancy, and addictions among a sample of South African youth. Because many of these risky behaviors occur in free time, a major part of the effort was leisure education to promote positive use of free time. The program described has been pilot tested and is currently underway as a larger-scale, randomized trial in the Province of the Western Cape in South Africa. This paper describes the conceptualization and revision of the HealthWise curriculum, working with the Western Cape Education Department, and the on-going randomized trial.