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BackgroundeHealth can help reduce social health inequalities (SHIs) as much as it can exacerbate them. Taking a co-design approach to the development of eHealth tools has the potential to ensure that these tools are inclusive. Although the importance of involving future users in the development of eHealth tools to reduce SHIs is highlighted in the scientific literature, the challenges associated with their participation question the benefits of this involvement as co-designers in a real-world context. ObjectiveOn the basis of Amartya Sen’s theoretical framework of social justice, the aim of this study is to explore how co-design can support the development of an inclusive eHealth tool for caregivers of functionally dependent older persons. MethodsThis study is based on a social justice design and participant observation as part of a large-scale research project funded by the Ministry of Families as part of the Age-Friendly Quebec Program (Québec Ami des Aînés). The analysis was based on the method developed by Miles and Huberman and on Paillé’s analytical questioning method. ResultsA total of 78 people participated in 11 co-design sessions in 11 Quebec regions. A total of 24 preparatory meetings and 11 debriefing sessions were required to complete this process. Co-designers participated in the creation of a prototype to support the search for formal services for caregivers. The majority of participants (except for 2) significantly contributed to the tool’s designing. They also incorporated conversion factors to ensure the inclusiveness of the eHealth tool, such as an adequate level of digital literacy and respect for the caregiver’s help-seeking process. In the course of the experiment, the research team’s position regarding its role in co-design evolved from a neutral posture and promoting co-designer participation to one that was more pragmatic. ConclusionsThe use of co-design involving participants at risk of SHIs does not guarantee innovation, but it does guarantee that the tool developed will comply with their process of help-seeking and their literacy level. Time issues interfere with efforts to carry out a democratic process in its ideal form. It would be useful to single out some key issues to guide researchers on what should be addressed in co-design discussions and what can be left out to make optimal use of this approach in a real-world context.

BackgroundA clinical algorithm (Algo) in paper form is used in Quebec, Canada, to allow health care workers other than occupational therapists (OTs) to make bathroom adaptation recommendations for older adults. An integrated knowledge transfer process around Algo suggested an electronic version of this decision support system (electronic decision support system [e-DSS]) to be used by older adults and their caregivers in search of information and solutions for their autonomy and safety in the bathroom. ObjectiveThis study aims to (1) create an e-DSS for the self-selection of bathroom-assistive technology by community-dwelling older adults and their caregivers and (2) assess usability with lay users and experts to improve the design accordingly. MethodsOn the basis of a user-centered design approach, the process started with content identification for the prototype through 7 semistructured interviews with key informants of various backgrounds (health care providers, assistive technology providers, and community services) and 4 focus groups (2 with older adults and 2 with caregivers). A thematic content transcript analysis was carried out and used during the creation of the prototype. The prototype was refined iteratively using think-aloud and observation methods with a clinical expert (n=1), researchers (n=3), OTs (n=3), older adults (n=3), and caregivers (n=3), who provided information on the usability of the e-DSS. ResultsOverall, 4 themes served as the criteria for the prototype of the electronic Algo (Hygiene 2.0 [H2.0]): focus (safety, confidentiality, well-being, and autonomy), engage, facilitate (simplify, clarify, and illustrate), and access. For example, users first pay attention to the images (engage and illustrate) that can be used to depict safe postures (safety), illustrate questions embedded in the decision support tool (clarify and illustrate), and demonstrate the context of the use of assistive technology (safety and clarify). ConclusionsThe user-centered design of H2.0 allowed the cocreation of an e-DSS in the form of a website, in line with the needs of community-dwelling older adults and their caregivers seeking bathroom-assistive technology that enables personal hygiene. Each iteration improved usability and brought more insight into the users’ realities, tailoring the e-DSS to the implementation context.

BackgroundeHealth can help reduce social health inequalities (SHIs); at the same time, it also has the potential to increase them. Several conversion factors can be integrated into the development of an eHealth tool to make it inclusive: (1) providing physical, technical, and financial access to eHealth; (2) enabling the integration of people at risk of SHIs into the research and development of digital projects targeting such populations (co-design or participatory research); (3) promoting consistency between the digital health literacy level of future users (FUs) and the eHealth tool; (4) developing an eHealth tool that is consistent with the technological skills of FUs; (5) ensuring that the eHealth tool is consistent with the help-seeking process of FUs; (6) respecting the learning capacities of FUs; and (7) being sensitive to FUs’ cultural context. However, only little empirical evidence pointing out how these conversion factors can be integrated into an effective eHealth tool is available. ObjectiveOn the basis of Amartya Sen’s theoretical framework of social justice, the objective of this study was to explore how these 7 conversion factors can be integrated into an eHealth tool for caregivers of functionally dependent older persons. MethodsThis study was based on a social justice design and participant observation as part of a large-scale research project funded by the Ministère de la Famille through the Quebec Ami des Aînés Program. Data were collected by recording the preparation sessions, the co-design and advisory committee sessions, as well as the debriefing sessions. The results were analyzed using Miles and Huberman’s method. ResultsA total of 78 co-designers participated in 11 co-design sessions, 24 preparation sessions, and 11 debriefing sessions. Of the 7 conversion factors, 5 could be explored in this experiment. The integration of conversion factors has been uneven. The participation of FUs in the development of the tool supports other conversion factors. Respecting the eHealth literacy level of FUs means that their learning abilities and technological skills are also respected because they are closely related to one another and are therefore practically difficult to be distinguished. ConclusionsConversion factors can be integrated into the development of eHealth tools that are intended to be inclusive and contribute to curbing SHIs by integrating FU participation into the tool design process.

Although the social work profession has focused on becoming an anti-racist profession, social work students report being insufficiently prepared to challenge and dismantle racism. Current recommendations for educating social workers on racism use findings from White students and omit the voices of individuals who experience racism. However, this phenomenological qualitative study described graduate students from historically excluded racial and ethnic groups in research along with White students' experiences learning about the influence of historical and contemporary racism upon Black adolescents. Twelve Black, Latinx, multiracial, and White students participated in either individual interviews or a focus group. Data were analyzed using thematic analysis. Key themes included: feeling uncomfortable as an important aspect of learning about racism, the reason for feeling validated in the course differed for Black and White students; and Black students had concerns about participating in a course on racism. Further, as students discussed how learning influenced their behaviors and perceptions of racism, the following themes emerged: a deeper understanding of racism, enhanced understanding of historical and contemporary racial trauma, greater reflection on policies and procedures, a better understanding of barriers to care, and the importance of trust and genuineness when providing care. Implications for social work education then are presented.

At-home respite services seem too rigid to meet the needs of older adults and their caregivers. It is critical to develop service flexibility, as it allows for personalized care, adapted to health conditions, preferences, and evolving needs. While no prior studies used coconstruction methods to increase flexibility, this study could offer a better understanding of flexible respite for stakeholders. Using a living lab approach, this article aimed to (1) empirically determine the characteristics of this type of respite model and (2) document the levers and obstacles to consider for its implementation. Starting from a pre-existing flexible respite model named ANAAIS, the research team led workshops and interviews. First, the team carried out 2 workshops (TRIAGE and persona-scenario) with a total of 3 caregivers and 8 homecare professionals or managers. Second, a team member conducted interviews with 3 caregivers and 6 homecare professionals or managers. Content analysis was used on the data. The stakeholders coconstructed a Québec version of ANAAIS, a web application allowing caregivers to request an affordable respite, at the time wanted, and offered by a qualified care worker, through a simple application. Levers and barriers to its deployment are linked to the model's characteristics as well as its internal and external context. For example, relations and connexions were perceived as a lever to deployment, while the lack of resources was considered an obstacle. This living lab project showed the feasibility and pragmatism of coconstructing a flexible and applicable respite service model. [ABSTRACT FROM AUTHOR]

Community organizations play a key role in reaching out to diverse populations of older adults to address their unmet social participation needs, including in times of crisis (e.g., pandemic) and beyond. It is important to learn from their experiences (challenges, strategies used) to improve preparedness for future crises and strengthen the post-pandemic adaptation of these organizations. This study documented the experiences of community organizations providing social participation services for older adults during the first eighteen months of the pandemic. A descriptive qualitative study was conducted, with data collected at two time points, August 2020 (T1) and August 2021 (T2). Fifteen of the twenty-three participants completed interviews at both time points. From T1 to T2, community organizations faced challenges in adapting services to meet the evolving needs of a heterogeneous population while managing the challenges posed by the digital divide, managing organizational challenges, and adapting to changing public health measures and their social implications. Their strategies evolved from an urgent response to basic needs (T1) to diversifying the solutions used (both technological and non-technological) to promote older adults’ active engagement in services (T2). From T1 to T2, they also strengthened communication bridges and partnerships. Having advocated for older adults’ rights during the pandemic, they emphasized, particularly at T2, the importance of empowering them (e.g., through intergenerational initiatives). These findings underscore the need to use effective mechanisms to support cross-sectoral collaboration in order to identify, implement, and sustain the promising initiatives that emerged during the pandemic, particularly in sectors at risk of experiencing inequities in accessing services [ABSTRACT FROM AUTHOR]

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Background: The choice of activities responding to the needs of people with moderate to severe dementia is a growing concern for care providers trying to target the need for a feeling of self-accomplishment by adapting activities to the abilities of elderly patients. The activities created by Maria Montessori seem to be adaptable to this clientele. This study evaluates the short-term effects, as compared to regular activities offered in the milieu. Methods: This is a quasi-experimental study where each of the 14 participants was observed and filmed in two conditions: during Montessori activities, during regular activities, and one control condition (no activity). Results: The results show that Montessori activities have a significant effect on affect and on participation in the activity. They support the hypothesis that when activities correspond to the needs and abilities of a person with dementia, these positive effects are also observed on behaviours. Conclusions: This study enabled its authors to corroborate the findings presented in the literature and to contribute additional elements on the positive effects of the use of Montessori activities and philosophy. Used with people with moderate to severe dementia these allow the satisfaction of their basic psychological needs, their well being, and hence, on their quality of life. (Contains 2 tables.)

Les previsions demographiques indiquent que le nombre de personnes agees doublera en moins de 30 ans au Quebec (Curateur public du Quebec, 2010a). Cette evolution de la population peut s'averer [...]