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

Succeeding at university can be a complex matter, and the barriers are manifold for students with disabilities (SwDs). Accommodations are available for those with needs, but these alone do not meet the political goals of inclusive educations. Student ambassadors act as experienced representatives on campuses, supporting others and gaining individual benefits themselves. Approaches building on SwDs’ experiences and capacities can be a means to overcome the complex barriers often faced throughout education. This scoping review aimed to map research on student ambassador interventions for SwDs in higher education and identify the interventions’ key concepts. The result will inform an ambassador intervention in higher education. Six electronic databases were searched for peer-reviewed articles of any design published between 2010 and December 2020. Six studies met the inclusion criteria. A thematic synthesis resulted in three key concepts: peer guidance and supportive relationships; building strategies and transferable skills; and advocating for change. However, no program utilises exclusively students with disabilities in ambassador roles. The results indicate a lack of research as well as awareness on the unexplored potential of actively involving SwDs in ambassador roles.

Central to this article is the issue of choosing sites for where a fieldwork could provide a better understanding of divergences in health care accessibility. Access to health care is critical to good health, but inhabitants may experience barriers to health care limiting their ability to obtain the care they need. Most inhabitants of low-income countries need to walk long distances along meandering paths to get to health care services. Individuals in Malawi responded to a survey with a battery of questions on perceived difficulties in accessing health care services. Using both vertical and horizontal impedance, we modelled walking time between household locations for the individuals in our sample and the health care centres they were using. The digital elevation model and Tobler’s hiking function were used to represent vertical impedance, while OpenStreetMap integrated with land cover map were used to represent horizontal impedance. Combining measures of walking time and perceived accessibility in Malawi, we used spatial statistics and found spatial clusters with substantial discrepancies in health care accessibility, which represented fieldwork locations favourable for providing a better understanding of barriers to health access.

Background Elder abuse is a public health problem that is gaining attention due to its serious impacts on people’s health and well-being, and it is predicted to increase along with the world’s rapidly ageing population. Staff-to-resident abuse in nursing homes is a complex and multifaceted phenomenon associated with multiple factors on different levels of the ecological model. This study aimed to explore individual, relational, and institutional characteristics associated with perpetrated staff-to-resident abuse in nursing homes, using a multilevel hierarchical approach. Methods This was a cross-sectional exploratory study of 3693 nursing staff (response rate 60.1%) in 100 randomly selected nursing homes in Norway. We explored the characteristics of nursing staff, their relationship with residents, and institutional features associated with three types of abuse: psychological abuse, physical abuse, and neglect. These were modelled using multilevel mixed-effects logistic regression analyses. Results Individual staff factors found to be associated with all three types of abuse were 1) being a registered nurse/social educator (OR 1.77–2.49) or licensed practical nurse (OR 1.64–1.92), 2) reporting symptoms of psychological distress (OR 1.44–1.46), 3) intention to leave the job (OR 1.35–1.40), and 4) reporting poor attitudes towards people with dementia (OR 1.02–1.15). Also, staff who reported poorer quality of childhood were more likely to perpetrate neglect (OR 1.14). Relational factors such as care-related conflicts (OR 1.97–2.33) and resident aggression (OR 1.36–2.09) were associated with all three types of abuse. Of institutional factors, lack of support from a manager was associated with perpetrating psychological abuse (OR 1.56). Conclusions We found several predictors of staff-to-resident abuse on different levels of the ecological model, which underlines the importance of using a multifaceted approach to identify risk factors of elder abuse in nursing homes. However, future studies should explore the underlying mechanism and causes with a prospective or qualitative design and target the multifaceted nature of risk factors when designing preventive interventions. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

The paper presents a scoping review of existing economic evaluations of assistive technology (AT). The study methodology utilized a PRISMA flow approach with final included studies that met an adapted PICOS framework. Types of economic evaluations employed, study type and rigor and domains of AT impact were considered and analyzed. The economic evaluations in this study included 13 CBA, 9 CMA, 18 CEAs and 10 CUA. The majority of studies (32 studies in total) mentioned or recorded that AT investment, access and/or usage had impacts on the domain of both informal and formal health care. Specifically, care costs, time, and resources were affected. Our study has found that current AT economic evaluations are limited. This study advocates for a wider use of robust alternative evaluation and appraisal methodologies that can highlight AT value and which would subsequently provide further evidence that may make governments more willing to invest in and shape AT markets.

Background Sudan has one of the largest numbers of internally displaced persons (IDPs) in the world, estimated at five million. The main cause of displacement was the civil war. Attention to the health and in particular the mental health of IDPs has been lacking. That includes limited population longitudinal data describing the “natural” fluctuations of mental morbidity among these groups. The aim of this study is to investigate the level and stability of mental disorders among IDPs over a 1-year period. Method In this 1-year follow-up of IDPs in two settlement areas in central Sudan, 1549 persons 18 years or older were interviewed twice using the MINI International Neuropsychiatric Interview. Trained psychologists collected the data in a random household survey in the selected IDP areas. Results We found overall high stability among those having and those free of mental disorders in this 1-year follow-up study. There were, however, discernible and statistically significant increases in overall new cases of mental disorders from T1 to T2 as major depression increased by 1.4%, generalized anxiety by 2.8% and social phobia by 1.4%. Conclusion The study revealed continued high levels and increases of mental disorders over time, although with a pattern of substantial persistence among those initially ill and limited recovery. This might be due to a complex set of factors such as unavailability of mental health services, poverty, low educational level and social exclusion.

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

Background Elder abuse is a global public health and human rights problem that is predicted to increase as many countries experience a rapid growth in their population of older adults. Elder abuse undermines an older person’s well-being and is associated with a range of serious health consequences. In institutional care settings, older residents are particularly vulnerable and hence at higher risk of being abused, but few countries have explored the extent and nature of this phenomenon in national studies. The aim of this study is to estimate the prevalence of observed and perpetrated staff-to-resident abuse in Norwegian nursing homes. Methods We conducted a cross-sectional exploratory study of nursing staff in 100 randomly drawn Norwegian nursing homes. Nursing staff completed a pen and paper survey measuring how often during the past year they had observed staff commit acts of neglect and psychological, physical, financial/material, and sexual abuse towards residents. They also reported how often they had perpetrated acts of abuse themselves, and these rates were disaggregated by nursing staff’s gender, age and education. Results Of 3693 nursing staff (response rate 60.1%), 76% had observed one or more incidents of elder abuse during the past year, and 60.3% reported they had perpetrated one or more incidents of abuse in the same period. Psychological abuse and neglect were most commonly reported. Male staff reported more acts of physical abuse, while female staff reported more acts of neglect. Higher education of staff was associated with higher rates of self-reported psychological abuse, physical abuse and neglect. Conclusions This first national survey of staff in Norwegian nursing homes is one of the largest studies globally estimating the prevalence of elder abuse in institutional settings. Overall, we found staff-to-resident abuse to be relatively common, and our findings propose a need for preventive strategies to improve the quality of life and safety of residents in Norwegian nursing homes.

To address the data gap on efforts to assess use of assistive technology among children with disability in sub-Saharan Africa. Contribute towards efforts examining access to assistive technologies in sub-Saharan Africa.The paper uses data from the 2017 survey on Living conditions among persons with disabilities in Malawi and the 2015-16 Malawi Demographic and Health survey to address the objective of the study. The two datasets were statistically matched through random hot deck technique, by integrating the two datasets using randomly selected units from a subset of all available data donors.Results indicate that statistical matching technique produces a composite dataset with an uncertainty value of 2.2%. An accuracy assessment test of the technique also indicates that the marginal distribution of use of assistive technology in the composite dataset is similar to that of the donor dataset with an Overlap index value of close to 1 (Overlap = 0.997).The statistical matching procedure does enable generation of good data in data constrained contexts. In the current study, this approach enabled measurement of access to assistive products among children with disabilities, in situations where the variables of interest have not been jointly observed. Such a technique can be valuable in mining secondary data, the collection of which may have been funded from different sources and for different purposes. This is of significance for the efficient use of current and future data sets, allowing new questions to be asked and addressed by locally based researchers in poor settings.Implications for RehabilitationIn resource-poor settings, the technique of statistical matching can be used to examine factors that predict the use of assistive technology among persons with disabilities.The statistical matching technique is of significance for the efficient use of current and future datasets, allowing new questions to be asked and addressed by locally based researchers.

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

Background Equitable access to health services is a key ingredient in reaching health for persons with disabilities and other vulnerable groups. So far, research on access to health services in low- and middle-income countries has largely relied on self-reported survey data. Realizing that there may be substantial discrepancies between perceived and actual access, other methods are needed for more precise knowledge to guide health policy and planning. The objective of this article is to describe and discuss an innovative methodological triangulation where statistical and spatial analysis of perceived distance and objective measures of access is combined with qualitative evidence. Methods The data for the study was drawn from a large household and individual questionnaire based survey carried out in Namibia and Malawi. The survey data was combined with spatial data of respondents and health facilities, key informant interviews and focus group discussions. To analyse access and barriers to access, a model is developed that takes into account both measured and perceived access. The geo-referenced survey data is used to establish four outcome categories of perceived and measured access as either good or poor. Combined with analyses of the terrain and the actual distance from where the respondents live to the health facility they go to, the data allows for categorising areas and respondents according to the four outcome categories. The four groups are subsequently analysed with respect to variation in individual characteristics and vulnerability factors. The qualitative component includes participatory map drawing and is used to gain further insight into the mechanisms behind the different combinations of perceived and actual access. Results Preliminary results show that there are substantial discrepancies between perceived and actual access to health services and the qualitative study provides insight into mechanisms behind such divergences. Conclusion The novel combination of survey data, geographical data and qualitative data will generate a model on access to health services in poor contexts that will feed into efforts to improve access for the most vulnerable people in underserved areas. © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/)

Background: Exposure to war and conflict increases the risk of mental health problems. Poor living conditions are known to negatively impact mental health. Hypothesis: It is hypothesized that exposure to negative events after armed conflict interacts with past negative experiences, socioeconomic factors and current mental health problems. Methods: A cross-sectional survey was carried out in three contexts of previous internal armed conflict: Nepal, Guatemala and Northern Ireland. Three nationally representative samples were drawn, comprising a net sample of 3,229 respondents. Results: Both recent negative events and past negative events linked to the previous conflicts were found to be associated with elevated risk of post-traumatic stress syndrome (PTSD). Economic marginalization and urban residency also contributed to current risk of PTSD. Conclusions: The results support the study hypothesis that both past and recent negative events in combination with economic marginalization contribute to explain current risk of PTSD. It is necessary both to improve living conditions more broadly and to establish and develop health services that have the capacity to screen, prevent and treat mental health problems also in poor contexts, in particular against a background of previous armed conflict.

Postprint-versjonen av artikkelen er fagfellevurdert, men inneholder ikke nødvendigvis tidsskriftets endelige layout, sidetall og rettelser. Den publiserte versjonen av artikkelen finner du her: Sanhori, Z., Eide, A. H., Ayazi, T., Mdala, I., & Lien, L. (2019). Change in Mental Health Stigma After a Brief Intervention Among Internally Displaced Persons in Central Sudan. Community Mental Health Journal, 55(3), 534-541. doi:http://dx.doi.org/10.1007/s10597-019-00375-y Stigmatizing attitudes towards people with mental illness is a worldwide phenomenon, This Longitudinal study aimed to determine the level of stigma, among the internal displaced persons in central Sudan and explore possible changes in stigma associated with an intervention. 1549 persons were interviewed using standardized stigma attitude tools. The study reveled high level of stigma among our respondents and there was no significant difference in attitudes towards mental illness observed after the intervention. The intervention was not associated with change in stigma. However, the findings can inform policy to create sustainable national mental health strategies to address the stigma.

Many people are reluctant to access voluntary counselling and testing services for fear of stigma and the implications of death often associated with a positive HIV diagnosis. This study however noted how Tonga females residing in Binga, one of Zimbabwe’s poorest and most food insecure districts, were eager for an HIV positive result in order to secure food handouts from Non-Governmental Organisations. Using a conceptual framework developed by Weiser and colleagues for understanding the bidirectional links between food insecurity and HIV/AIDS linkages, this paper explored the relationship between food insecurity, gender roles and HIV/AIDS. Qualitative in-depth interviews, participant observation and focus group discussions were conducted with 53 caregivers and four healthcare personnel. Data were analysed using content analysis. The findings show the interrelationship between food insecurity, gender roles and HIV/AIDS entwined in a vicious cycle that heightens vulnerability to and worsens the severity of each condition. The findings from this study can help in informing policy interventions geared towards HIV/AIDS, gender inequality and food insecurity.

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

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

Background: Understanding caregivers’ views on rehabilitation services is important as it may assist in informing healthcare services and patient management. Objectives: The aim of this study was to explore caregivers’ perceptions and satisfaction regarding rehabilitation services in the Western Cape, South Africa, and to inform clinical practice and policy in this emerging field. Method: This study used a descriptive, qualitative design using in-depth interviews with conveniently selected participants. Interviews were conducted with 13 caregivers of patients with: amputations (3), cerebrovascular accidents (5) and neuromuscular disorders (5). Thematic content analysis was conducted with the transcripts. Results: Four key themes emerged, which were (1) financial difficulties, (2) caregiver and therapist relationships, (3) facility management and (4) caregiver experience with service delivery. Conclusion: Based on the participants’ feedback, the rehabilitation services seem to be meeting the basic rehabilitation needs of the patients; however, the needs of the caregivers require attention.

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

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

This paper explores differences in experienced environmental barriers between individuals with and without disabilities and the impact of additional factors on experienced environmental barriers. Data was collected in 2011-2012 by means of a two-stage cluster sampling and comprised 400-500 households in different sites in South Africa, Sudan Malawi and Namibia. Data were collected through self-report survey questionnaires. In addition to descriptive statistics and simple statistical tests a structural equation model was developed and tested. The combined file comprised 9,307 participants. The Craig Hospital Inventory of Environmental Factors was used to assess the level of environmental barriers. Transportation, the natural environment and access to health care services created the biggest barriers. An exploratory factor analysis yielded support for a one component solution for environmental barriers. A scale was constructed by adding the items together and dividing by number of items, yielding a range from one to five with five representing the highest level of environmental barriers and one the lowest. An overall mean value of 1.51 was found. Persons with disabilities scored 1.66 and persons without disabilities 1.36 (F = 466.89, p < .001). Bivariate regression analyses revealed environmental barriers to be higher among rural respondents, increasing with age and severity of disability, and lower for those with a higher level of education and with better physical and mental health. Gender had an impact only among persons without disabilities, where women report more barriers than men. Structural equation model analysis showed that socioeconomic status was significantly and negatively associated with environmental barriers. Activity limitation is significantly associated with environmental barriers when controlling for a number of other individual characteristics. Reducing barriers for the general population would go some way to reduce the impact of these for persons with activity limitations, but additional and specific adaptations will be required to ensure an inclusive society.

Background It is estimated that over one billion persons worldwide have some form of disability. However, there is lack of knowledge and prioritisation of how to serve the needs and provide opportunities for people with disabilities. The community-based rehabilitation (CBR) guidelines, with sufficient and sustained support, can assist in providing access to rehabilitation services, especially in less resourced settings with low resources for rehabilitation. In line with strengthening the implementation of the health-related CBR guidelines, this study aimed to determine what workforce characteristics at the community level enable quality rehabilitation services, with a focus primarily on less resourced settings. Methodology This was a two-phase review study using (1) a relevant literature review informed by realist synthesis methodology and (2) Delphi survey of the opinions of relevant stakeholders regarding the findings of the review. It focused on individuals (health professionals, lay health workers, community rehabilitation workers) providing services for persons with disabilities in less resourced settings. Results Thirty-three articles were included in this review. Three Delphi iterations with 19 participants were completed. Taken together, these produced 33 recommendations for developing health-related rehabilitation services. Several general principles for configuring the community rehabilitation workforce emerged: community-based initiatives can allow services to reach more vulnerable populations; the need for supportive and structured supervision at the facility level; core skills likely include case management, social protection, monitoring and record keeping, counselling skills and mechanisms for referral; community ownership; training in CBR matrix and advocacy; a tiered/teamwork system of service delivery; and training should take a rights-based approach, include practical components, and involve persons with disabilities in the delivery and planning. Conclusion This research can contribute to implementing the WHO guidelines on the interaction between the health sector and CBR, particularly in the context of the Framework for Action for Strengthening Health Systems, in which human resources is one of six components. Realist syntheses can provide policy makers with detailed and practical information regarding complex health interventions, which may be valuable when planning and implementing programmes. © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/)

Summary Background In resource-limited settings, people with disabilities have been left behind in the response to HIV. In the HandiVIH study, we estimate and compare HIV prevalence and associated risk factors between people with and without disabilities. Methods In this cross-sectional, population-based, observational study, we used two-phase random sampling to recruit adults with disabilities and a control group matched for age, sex, and residential location from households of the general population. We used the Washington Group Short Set of Questions on Disability to identify people with disabilities. We administered an HIV test and a life-course history interview to participants. The primary outcome was the prevalence of HIV among participants with and without disabilities. Findings Between Oct 2, 2014, and Nov 30, 2015, we recruited 807 people with disabilities and 807 participants without disabilities from Yaounde, Cameroon. 28 of 716 people in the control population had a positive HIV test result (crude prevalence 3·9%, 95% CI 2·9–5·3) compared with 50 of 739 people with disabilities (6·8%, 5·0–8·6; conditional odds ratio [OR] 1·7; p=0·04). Women with disabilities were more often involved in paid sexual relationships than were women without disabilities (2·5% vs 0·5%, p=0·05). People with disabilities were also at increased risk of sexual violence than were women without disabilities (11·0% vs 7·5%, OR 1·5; p=0·01). Sexual violence and sex work were strongly associated with increased risk of HIV infection among participants with disabilities but not among controls (OR 3·0, 95% CI 1·6–5·6 for sexual violence and 12·3, 4·4–34·6 for sex work). Analyses were done in men and women. Interpretation The higher prevalence of HIV infection in people with disabilities than people without disabilities reflects a higher exposure to HIV infection as well as the presence of disability-associated HIV infection. The susceptibility of people with disabilities to HIV infection seems to be shaped by social and environmental factors. Research is needed to inform firm recommendations on how to protect this vulnerable population. Funding Agence nationale de recherches sur le sida et les hepatites virales (ANRS-Inserm) and the 5% Initiative.

Begrepet deltagelse er ikke nytt i helse- og omsorgslitteraturen, men det erkjennes at involvering av pasienter og brukere har vært begrenset, og at kompleksiteten knyttet til økt deltagelse for brukere og pasienter til dels har blitt oversett. Denne artikkelen formidler innsikter fra åtte artikler fra et forskningsprosjekt med målsetting å utvikle kunnskap om hvordan eldre som mottar kommunale hjemmetjenester, handler og deltar i dagliglivet, og hvordan personalet arbeider for å støtte den enkeltes deltagelse. Studien ble gjennomført i en bykommune og en landkommune i Midt-Norge og omfattet intervjuer med 10 eldre tjenestemottakere, en spørreundersøkelse blant 155 eldre tjenestemottakere, og i alt fem fokusgrupper med 30 helsearbeidere. Studien viste at deltagelse forstås ulikt blant tjenestemottakere og tjenesteytere, at tjenestene til hjemmeboende eldre kan bidra til passivisering, og at fleksibilitet og individuell tilpasning er nødvendig for at tjenestene i større grad skal bidra til økt deltagelse blant de som mottar tjenester i hjemmet. Å bygge en felles forståelse av deltagelse blant eldre, pårørende og helsearbeidere er dermed en viktig oppgave. © Universitetsforlaget 2017. This is the authors' manuscript to the article. The final publication is available at https://doi.org/10.18261/issn.2387-5984-2017-01-08

Background Global research suggests that persons with disabilities face barriers when accessing health care services. Yet, information regarding the nature of these barriers, especially in low-income and middle-income countries is sparse. Rural contexts in these countries may present greater barriers than urban contexts, but little is known about access issues in such contexts. There is a paucity of research in South Africa looking at “triple vulnerability” – poverty, disability and rurality. This study explored issues of access to health care for persons with disabilities in an impoverished rural area in South Africa. Methods The study includes a quantitative survey with interviews with 773 participants in 527 households. Comparisons in terms of access to health care between persons with disabilities and persons with no disabilities were explored. The approach to data analysis included quantitative data analysis using descriptive and inferential statistics. Frequency and cross tabulation, comparing and contrasting the frequency of different phenomena between persons with disabilities and persons with no disabilities, were used. Chi-square tests and Analysis of Variance tests were then incorporated into the analysis. Results Persons with disabilities have a higher rate of unmet health needs as compared to non-disabled. In rural Madwaleni in South Africa, persons with disabilities faced significantly more barriers to accessing health care compared to persons without disabilities. Barriers increased with disability severity and was reduced with increasing level of education, living in a household without disabled members and with age. Conclusions This study has shown that access to health care in a rural area in South Africa for persons with disabilities is more of an issue than for persons without disabilities in that they face more barriers. Implications are that we need to look beyond the medical issues of disability and address social and inclusion issues as well.

The 2010 South Africa health plan has highlighted the need to ensure a qualified workforce in order to improve access to quality health care.

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

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

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

Background: Health policies have the potential to be important instruments in achieving equity in health. A framework – EquiFrame - for assessing the extent to which health policies promote equity was used to perform an equity audit of the health policies of three international aid organizations. Objective: To assess the extent to which social inclusion and human rights feature in the health policies of DFID (UK), Irish Aid, and NORAD (Norway). Method: EquiFrame provides a tool for analyzing equity and quality of health policies with regards to social inclusion and human rights. Each health policy was analyzed with regards to the frequency and content of a predefined set of Vulnerable Groups and Core Concepts. Results: The three policies vary but are all relatively weak with regards to social inclusion and human rights issues as defined in EquiFrame. The needs and rights of vulnerable groups for adequate health services are largely not addressed. Conclusion: In order to enhance a social inclusion and human rights perspective that will promote equity in health through more equitable health policies, it is suggested that EquiFrame can be used to guide the revision and development of the health policies of international organizations, aid agencies and bilateral donors in the future. Limitations: Analyses are limited to “policy on the books” and does not measure how effectively vulnerable groups are included in mainstream health policy work.

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

Background Equitable access to health care is a challenge in many low-income countries. The most vulnerable segments of any population face increased challenges, as their vulnerability amplifies problems of the general population. This implies a heavy burden on informal care-givers in their immediate and extended households. However, research falls short of explaining the particular challenges experienced by these individuals and households. To build an evidence base from the ground, we present a single case study to explore and understand the individual experience, to honour what is distinctive about the story, but also to use the individual story to raise questions about the larger context. Methods We use a single qualitative case study approach to provide an in-depth, contextual and household perspective on barriers, facilitators, and consequences of care provided to persons with disability and HIV. Results The results from this study emphasise the burden that caring for an HIV positive and disabled family member places on an already impoverished household, and the need for support, not just for the HIV positive and disabled person, but for the entire household. Conclusions Disability and HIV do not only affect the individual, but the whole household, immediate and extended. It is crucial to consider the interconnectedness of the challenges faced by an individual and a household. Issues of health (physical and mental), disability, employment, education, infrastructure (transport/terrain) and poverty are all related and interconnected, and should be addressed as a whole in order to secure equity in health.

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

Introduction In resource-limited countries, people with disabilities seem to be particularly vulnerable to HIV infection due to barriers to accessing information and services, frequent exposure to sexual violence and social exclusion. However, they have often been left behind in the HIV response, probably because of the lack of reliable epidemiological data measuring this vulnerability. Multiple challenges in conducting good quality epidemiological surveys on people with disabilities require innovative methods to better understand the link between disability and HIV. This paper describes how the design and methods of the HandiVIH study were adapted to document the vulnerability of people with disabilities to HIV, and to compare their situation with that of people without disabilities. Methods and analysis The HandiVIH project aims to combine quantitative and qualitative data. The quantitative component is a cross-sectional survey with a control group conducted in Yaounde (Cameroon). A two-phase random sampling is used (1) to screen people with disabilities from the general population using the Washington Group questionnaire and, (2) to create a matched control group. An HIV test is proposed to each study participant. Additionally, a questionnaire including a life-event interview is used to collect data on respondents’ life-course history of social isolation, employment, sexual partnership, HIV risk factors and fertility. Before the cross-sectional survey, a qualitative exploratory study was implemented to identify challenges in conducting the survey and possible solutions. Information on people with disabilities begging in the streets and members of disabled people9s organisations is collected separately. Ethics and dissemination This study has been approved by the two ethical committees. Special attention has been paid on how to adapt the consenting process to persons with intellectual disabilities. The methodological considerations discussed in this paper may contribute to the development of good practices for conducting quantitative health surveys on people with disabilities. Trial registration number NCT02192658.

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

This is an Open Access article licensed under the Creative Commons Attribution License 3.0 (CC BY 3.0) and originally published in BMC Public Health. You can access the article by following this link: http://dx.doi.org/10.1186/s12889-016-3605-9 Dette er en vitenskapelig, fagfellevurdert artikkel som opprinnelig ble publisert i BMC Public Health. Artikkelen er publisert under lisensen Creative Commons Attribution License 3.0 (CC BY 3.0). Du kan også få tilgang til artikkelen ved å følge denne lenken: http://dx.doi.org/10.1186/s12889-016-3605-9 Background Alcohol use is a major public health problem with vast implications for poor, war-torn countries. The objective of this study was to describe prevalence of alcohol use and risky drinking across socio-demographic factors in South Sudan, and to determine the association between risky drinking, traumatic events and mental distress. Methods This is a randomized, population based, cross-sectional study from the north-western part of South Sudan with nearly 500 participants. We used the Alcohol Use Disorders Identification Test (AUDIT) as main outcome variable, the General Health Questionnaire (GHQ-28) for mental distress and five questions to assess traumatic events. Results The mean AUDIT score was 2.7 (SD 0.3) with 14,2 % in the high risk problem drinking category. Being male, lack of a regular income and psychological distress were significantly associated with higher AUDIT score. Traumatic events, however, was not associated with higher score on AUDIT. Conclusion Despite decades of civil war and great poverty the alcohol use in this population was at the same level as other countries in Southern Africa. Traumatic events were not related to risk of problem drinking.

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

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

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

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