The Disability and Wellbeing Monitoring Framework: data, data gaps, and policy implications

Diverse perspectives on supporting the health and wellness of people with intellectual and developmental disabilities

BACKGROUND

Persons with intellectual and/or developmental disabilities (IDD) are a growing population, frequently living with complex health conditions and unmet healthcare needs. Traditional clinical practice and research methods and measures may require adaptation to reflect their preferences.

OBJECTIVE

The perspectives of people with IDD, caregivers/partners, and clinicians were obtained to provide insight into factors contributing to the health and wellness of people with IDD. These, in turn, suggest opportunities for improvements in clinical training and care, and considerations for enhancing research methods and measures.

METHODS

An exploratory design, participatory methods, abductive qualitative approach and thematic analysis were employed. Interview data were obtained in twelve focus groups with people with IDD (n = 25), caregivers/partners (n = 21), and clinicians (n = 27). Particular attention was paid to supporting attendees in focus group participation, with adaptations and accommodations made for communication preferences, and graphic illustrations were provided.

RESULTS

Themes emerging across attendee categories that reflect factors contributing to health and wellness for people with IDD include: (1) making healthy choices; (2) participating in everyday activities; (3) benefitting from natural supports (e.g., family, friends, peers); and (4) accessing skilled professional supports (e.g., healthcare provision and payment).

CONCLUSIONS

Study findings underscore factors related to supporting health and wellness for people with IDD and suggest the importance of autonomy, accessibility, healthy relationships, self-advocacy, and tailored clinical care. People with IDD can be actively engaged throughout the research enterprise to ensure the relevance, acceptability, and accessibility of research methods and measures; promote inclusiveness; and address health disparities.

Social interventions to support people with disability: A systematic review of economic evaluation studies

Social interventions are essential in supporting the health and well-being of people with disability, but there is a critical need to prioritise resources for those that provide the best value for money. Economic evaluation is a widely used tool to assist priority setting when resources are scarce. However, the scope and consistency of economic evaluation evidence for disability social services are unclear, making it hard to compare across interventions to guide funding decisions. This systematic review aims to summarise the current evidence in the economic evaluation of social services for people with disability and to critically compare the methodologies used in conducting the economic evaluations with a focus on the outcomes and costs. We searched seven databases for relevant studies published from January 2005 to October 2021. Data were extracted on study characteristics such as costs, outcomes, perspectives, time horizons and intervention types. Overall, economic evaluation evidence of social services for people with disability was scarce. Twenty-four economic evaluations were included, with the majority conducting a cost-effectiveness analysis (n = 16). Most interventions focused on employment (n = 10), followed by community support and independent living (n = 6). Around 40% of the studies addressed people with mental illnesses (n = 10). The evidence was mixed on whether the interventions were cost-effective but the methods used were highly variable, which made comparisons across studies very difficult. More economic evidence on the value of interventions is needed as well as a more standardised and transparent approach for future research.

Auditing the impact of artificial intelligence on the ability to have a good life: using well-being measures as a tool to investigate the views of undergraduate STEM students

AI/ML increasingly impacts the ability of humans to have a good life. Various sets of indicators exist to measure well-being/the ability to have a good life. Students play an important role in AI/ML discussions. The purpose of our study using an online survey was to learn about the perspectives of undergraduate STEM students on the impact of AI/ML on well-being/the ability to have a good life. Our study revealed that many of the abilities participants perceive to be needed for having a good life were part of the well-being/ability to have a good life indicator lists we gave to participants. Participants perceived AI/ML to have and continue to have the most positive impact on the ability to have a good life for disabled people, elderly people, and individuals with a high income and the least positive impact for people of low income and countries from the global south. Regarding indicators of well-being and the ability to have a good life given to participants, we found a significant techno-positive sentiment. 30% of respondents selected the purely positive box for 28 of the indicators and none did so for the purely negative box. For 52 indicators, the purely negative was below 10% (not counting the 0%) and for 10 indicators, none selected purely negative. Our findings suggest that our questions might be valuable tools to develop an inventory of STEM and other students' perspectives on the implications of AI/ML on the ability to have a good life.

A Scoping Review of Approaches to Improving Quality of Data Relating to Health Inequalities

Identifying and monitoring of health inequalities requires good-quality data. The aim of this work is to systematically review the evidence base on approaches taken within the healthcare context to improve the quality of data for the identification and monitoring of health inequalities and describe the evidence base on the effectiveness of such approaches or recommendations. Peer-reviewed scientific journal publications, as well as grey literature, were included in this review if they described approaches and/or made recommendations to improve data quality relating to the identification and monitoring of health inequalities. A thematic analysis was undertaken of included papers to identify themes, and a narrative synthesis approach was used to summarise findings. Fifty-seven papers were included describing a variety of approaches. These approaches were grouped under four themes: policy and legislation, wider actions that enable implementation of policies, data collection instruments and systems, and methodological approaches. Our findings indicate that a variety of mechanisms can be used to improve the quality of data on health inequalities at different stages (prior to, during, and after data collection). These findings can inform us of actions that can be taken by those working in local health and care services on approaches to improving the quality of data on health inequalities.

The Intriguing Diagnosis of Lung Cancer in a Psychiatry Inpatient Unit: A Reflection Through a Case Report

People with intellectual developmental disorders are vulnerable to somatic and mental illnesses, often presenting with behavioural changes. Through an intriguing and uncommon case report, we aim to provide an overview of behavioural changes in patients with an intellectual developmental disorder, emphasizing the need for screening for non-psychiatric conditions. We present a clinical case of a 57-year-old man with a personal history of intellectual developmental disorder, epilepsy, and alcohol and tobacco abuse. He had a previous acute psychiatric admission in 2017 due to behaviour disorganization and irritability. In April 2019, he was readmitted with disorganized behaviour and caregiver exhaustion. On the 58th day of hospitalization, he fell off his bed and suffered a mild traumatic brain injury. A cerebral CT scan revealed two metastatic lesions in the brain. Further investigations discovered a primary neoplastic lung lesion with metastasis to pulmonary lymph nodes. This case emphasizes that despite a long follow-up with psychiatry services, physical illness should be considered when patients with intellectual developmental disorders present with behavioural changes as they can precede image and laboratory findings. Additionally, further studies are needed in order to provide guidelines and proper medical and psychosocial care for this particular population and the caregivers.

Exposure to risk and experiences of river flooding for people with disability and carers in rural Australia: a cross-sectional survey

OBJECTIVES

In this paper, we explore the exposure to risk and experiences of people with disability and carers during a flooding event and the subsequent mental health impacts.

DESIGN

A cross-sectional survey between September and November 2017. Binary logistic regression models were used to investigate associations between the mental health of people with disability and carers and their exposure to the flood. Inductive content analysis was used to analyse qualitative data.

SETTING

Flood-affected communities in the rural area of Northern Rivers, New South Wales, Australia, 6 months after river flooding in 2017.

PARTICIPANTS

People over 16 years and a resident in the Northern Rivers at the time of the flood were invited to participate. Using a purposive, snowballing sampling technique participants were drawn from a wide range of socioeconomic backgrounds and had experienced different degrees of flood exposure.

RESULTS

Of 2252 respondents, there were 164 people with disability and 91 carers. Both groups had increased odds of having their home flooded (people with a disability: OR 2.41 95% CI 1.71 to 3.39; carers: OR 1.76 95% CI 1.10 to 2.84). On evacuation, respondents reported inaccessible, conflicting and confusing information regarding flood warnings. Essential services such as healthcare and social services were disrupted (people with a disability: OR 3.98 95% CI 2.82 to 5.60; carers 2.17 95% CI 1.33 to 3.54) and access to safe and mould free housing post flood event was limited. After taking sociodemographic factors into account, respondents with a disability and carers had greater odds of probable post-traumatic stress disorder compared with other respondents (people with a disability: 3.32 95% CI 2.22 to 4.96; carers: 1.87 95% CI 1.10 to 3.19).

CONCLUSION

Our findings show the profound impact and systemic neglect experienced by people with disability and carers during and after the 2017 flood event in the Northern Rivers. As people with disability will take longer to recover, they will require longer-term tailored supports and purposeful inclusion in flood preparedness and recovery efforts.

Auditing the ‘Social’ of Quantum Technologies: A Scoping Review

Various phrases such as “social implications”, social impact” and “ethical, legal and social implications” are used to indicate the impact of a given scientific or technological advancements on the ‘social’. The impact on the ‘social’ is one focus of science and technology governance discussions. Many terms and phrases can be used to audit the engagement of a given technology (such as quantum technologies) with the ‘social’. Marginalized groups are particularly impacted by the ‘social’. Equity, Diversity, and, Inclusion (EDI) and similar phrases are part of discussing the ‘social’. EDI frameworks and phrases are employed as policy concepts to decrease the research, education, and general workplace problems members of marginalized groups such as women, Indigenous peoples, visible/racialized minorities, disabled people, and LGBTQ2S+ encounter at universities and other workplaces. How quantum technologies-focused discussions engage with the ‘social’ can impact EDI activities, and quantum technologies-focused discussions can be impacted in turn by EDI activities. The objective of this study was to map the engagement with the ‘social’ in the quantum technologies-focused academic literature. A scoping review coupled with a manifest coding approach was used to answer three research questions: (1) Which terms, phrases, and measures that can be seen to cover aspects of the ‘social’ are present in the quantum technologies-focused academic literature? (2) To what extent are EDI frameworks and phrases present in the quantum technologies-focused academic literature? (3) Which marginalized groups visible in EDI discourses are covered in the quantum technologies-focused academic literature? Using the academic databases SCOPUS, EBSCO-HOST, Web of Science, Compendex, Inspec Archive, and Knovel, 362,728 English language abstracts were obtained for the manifest coding using 62 Quantum-related technical phrases and 1062 English language abstracts were obtained using 17 non-technical Quantum-related phrases. Within the 362,728 abstracts of the 200 terms and phrases (which did not have to contain the term “social”) used to answer the research questions, 87 were not mentioned in any abstracts, 47 were mentioned in less than 10, 30 were mentioned in between 10 and 100, and 29 were mentioned in over 100 abstracts. Within the 1062 abstracts, 164 terms and phrases were not mentioned at all, 19 were mentioned in over 10, 8 were mentioned in between 10 and 100 (all false positive), and one was mentioned in over 100 abstracts (false positive). The term “social” or phrases containing “social” appeared in only 867 of the 362,728 abstracts and only 10 of the 1062 abstracts. EDI frameworks and phrases were not present in the 362,728 abstracts and 1062 abstracts, and many marginalized groups engaged with in EDI discussions were not present in the 362,728 and 1062 abstracts either. The results reveal vast opportunities to engage with the ‘social’ of quantum technologies in many different ways, including through EDI frameworks and concepts and by engaging with marginalized groups covered under EDI.

Health and Access to Health Services for People with Disability in Australia: Data and Data Gaps

The right of people with disability to enjoyment of the highest attainable standard of health without discrimination on the basis of disability is enshrined in the United Nations Convention on the Rights of Persons with Disabilities (CRPD). Among its obligations as a signatory to the CRPD, Australia is required to collect appropriate information, including statistical and research data, to inform development and implementation of policies to give effect to the Convention. In this commentary, we first describe how the International Classification of Functioning, Disability and Health (ICF) conceptual model of disability can be operationalised in statistical data collections, with a focus on how this is achieved in key Australian data sources such that people with disability can be identified as a population group. We then review existing statistical data on health and health service use for people with disability in Australia, highlighting data gaps and limitations. Finally, we outline priorities and considerations for improving data on health and access to health services for people with disability. As well as conceptual, practical, and ethical considerations, a key principle that must guide future disability data development is that people with disability and their representative organisations must be involved and participate fully in the development of disability data and statistics, and in their use.

An exploration of the sociodemographic and health conditions associated with self-rated wellbeing for Aboriginal and Torres Strait Islander adults

OBJECTIVE

To identify sociodemographic factors and health conditions associated with self-rated wellbeing for Aboriginal and Torres Strait Islander adults. Participants were recruited via investigator networks and an online panel provider with an established nationwide panel of Aboriginal and Torres Strait Islander adults. Those interested were invited to complete a survey that included an assessment of wellbeing using a visual analogue scale. Data was collected from October-November 2019 and August-September 2020. Exploratory analyses were conducted to ascertain factors associated with self-rated wellbeing for Aboriginal and Torres Strait Islander adults.

RESULTS

Having more than enough money to last until next pay day, full-time employment, completion of grade 12, having a partner, and living with others were significantly associated with higher wellbeing among Aboriginal and Torres Strait Islander adults. A self-reported history of depression, anxiety, other mental health conditions, heart disease, or disability were associated with lower self-rated wellbeing scores. Our findings indicate a need for further investigation among these socioeconomic and patient groups to identify how to improve and support the wellbeing of Aboriginal and Torres Strait Islander adults.

Area-Level Associations between Built Environment Characteristics and Disability Prevalence in Australia: An Ecological Analysis

The importance of health-promoting neighborhoods has long been recognized, and characteristics of local built environments are among the social determinants of health. People with disability are more likely than other population groups to experience geographic mobility and cost restrictions, and to be reliant on 'opportunity structures' available locally. We conducted an ecological analysis to explore associations between area-level disability prevalence for people aged 15-64 years and area-level built environment characteristics in Australia's 21 largest cities. Overall, disability was more prevalent in areas with lower walkability and lower local availability of various neighborhood amenities such as public transport, healthier food options, public open space, physical activity and recreation destinations and health and mental health services. These patterns of lower liveability in areas of higher disability prevalence were observed in major cities but not in regional cities. Our findings suggest that geographically targeted interventions to improve access to health-enhancing neighborhood infrastructure could reduce disability-related inequalities in the social determinants of health.