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van Swieten M, de Looff P, VanDerNagel J, Didden R. The association between aggressive behaviour and non-suicidal self-injury and shared risk factors in adults with mild intellectual disability. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13288. [PMID: 39192714 DOI: 10.1111/jar.13288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 07/09/2024] [Accepted: 07/22/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND Aggressive behaviour (AB) and non-suicidal self-injury (NSSI) are common in people with mild intellectual disability or borderline intellectual functioning, leading to adverse consequences for themselves and those around them. METHOD We investigated the relationship between AB (both total and physical in particular) and NSSI and risk factors in 125 residents in a treatment clinic using incident reports and standard clinical measurements. RESULTS There was a weak correlation between AB and NSSI, as well as between impulsivity and total AB, and between coping and AB and NSSI. However, NSSI, impulsivity and coping skills did not predict AB. CONCLUSION Results do not corroborate those of other studies in this area. In future studies impulsivity, coping, aggression and NSSI may be measured using other instruments, and differences between people with and without intellectual disability regarding these variables may be explored.
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Affiliation(s)
- Marlieke van Swieten
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Research and Development, Trajectum, Zwolle, The Netherlands
| | - Peter de Looff
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- National Expert Centre Intellectual Disabilities and Severe Behavioral Problems, De Borg, Den Dolder, The Netherlands
- Science and Treatment Innovation, Fivoor, Rotterdam, The Netherlands
- Department of Developmental Psychology, Tilburg University, Tilburg, The Netherlands
| | - Joanneke VanDerNagel
- Research Department, Tactus, Deventer, The Netherlands
- ZOB, Aveleijn, Borne, The Netherlands
- Department Human Media Interactions, University of Twente, Enschede, The Netherlands
- Nijmegen Institute for Scientist-Practitioners in Addiction, Radboud University, Nijmegen, The Netherlands
| | - Robert Didden
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Research and Development, Trajectum, Zwolle, The Netherlands
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2
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Reyes-Martín J, Simó-Pinatella D, Andrés A. Emotional Reactions of Professionals to Challenging Behaviors in People with Intellectual and Developmental Disability. Behav Sci (Basel) 2024; 14:707. [PMID: 39199103 PMCID: PMC11351142 DOI: 10.3390/bs14080707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 08/09/2024] [Accepted: 08/10/2024] [Indexed: 09/01/2024] Open
Abstract
Professionals working with people with intellectual and developmental disability (IDD) can be exposed to challenging behaviors (CBs), which may result in professionals exhibiting emotional reactions that can impact their practices. This study examined these reactions and analyzed how they are influenced by the individual characteristics of people with IDD (gender, age, and level of IDD) and the variables related to CB (type of behavior and its frequency and behavioral function). A total of 125 professionals assessed 293 people with IDD who exhibited CBs. The professionals were asked to complete the Behavior Problems Inventory-Short Form, the Emotional Reactions to Challenging Behavior Scale, and the Questions About Behavior Function measure. It was revealed that positive emotional reactions predominated over negative ones. Significant results were found regarding the level of disability and the age of people with IDD. Emotional reactions were related to the severity of CBs, especially self-injurious and aggressive/destructive behavior, as well as certain behavioral functions. The severity of CBs and the age of people with IDD emerge as key predictors of the emotional reactions of professionals. In short, these reactions vary according to different variables, highlighting the importance of interventions that address professionals' emotional needs.
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Affiliation(s)
- Juliana Reyes-Martín
- Facultat de Psicologia, Ciències de l’Educació i de l’Esport, Blanquerna, Ramon Llull University, 08022 Barcelona, Spain; (D.S.-P.); (A.A.)
- Fundació Vallparadís, Mutua Terrassa, 08221 Barcelona, Spain
| | - David Simó-Pinatella
- Facultat de Psicologia, Ciències de l’Educació i de l’Esport, Blanquerna, Ramon Llull University, 08022 Barcelona, Spain; (D.S.-P.); (A.A.)
| | - Ana Andrés
- Facultat de Psicologia, Ciències de l’Educació i de l’Esport, Blanquerna, Ramon Llull University, 08022 Barcelona, Spain; (D.S.-P.); (A.A.)
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Adam E, Meiland F, Frielink N, Meinders E, Smits R, Embregts P, Smaling H. User Requirements and Perceptions of a Sensor System for Early Stress Detection in People With Dementia and People With Intellectual Disability: Qualitative Study. JMIR Form Res 2024; 8:e52248. [PMID: 38905626 PMCID: PMC11245304 DOI: 10.2196/52248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 04/09/2024] [Accepted: 04/24/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Timely detection of stress in people with dementia and people with an intellectual disability (ID) may reduce the occurrence of challenging behavior. However, detecting stress is often challenging as many long-term care (LTC) residents with dementia and residents with ID have communication impairments, limiting their ability to express themselves. Wearables can help detect stress but are not always accepted by users and are uncomfortable to wear for longer periods. Integrating sensors into clothing may be a more acceptable approach for users in LTC. To develop a sensor system for early stress detection that is accepted by LTC residents with dementia and residents with ID, understanding their perceptions and requirements is essential. OBJECTIVE This study aimed to (1) identify user requirements for a garment-integrated sensor system (wearable) for early stress detection in people with dementia and people with ID, (2) explore the perceptions of the users toward the sensor system, and (3) investigate the implementation requirements in LTC settings. METHODS A qualitative design with 18 focus groups and 29 interviews was used. Focus groups and interviews were conducted per setting (dementia, ID) and target group (people with dementia, people with ID, family caregivers, health care professionals). The focus groups were conducted at 3 time points within a 6-month period, where each new focus group built on the findings of previous rounds. The data from each round were used to (further) develop the sensor system. A thematic analysis with an inductive approach was used to analyze the data. RESULTS The study included 44 participants who expressed a positive attitude toward the idea of a garment-integrated sensor system but also identified some potential concerns. In addition to early stress detection, participants recognized other potential purposes or benefits of the sensor system, such as identifying triggers for challenging behavior, evaluating intervention effects, and diagnostic purposes. Participants emphasized the importance of meeting specific system requirements, such as washability and safety, and user requirements, such as customizability and usability, to increase user acceptance. Moreover, some participants were concerned the sensor system could contribute to the replacement of human contact by technology. Important factors for implementation included the cost of the sensor system, added value to resident and health care professionals, and education for all users. CONCLUSIONS The idea of a garment-integrated sensor system for early stress detection in LTC for people with dementia and people with ID is perceived as positive and promising by stakeholders. To increase acceptability and implementation success, it is important to develop an easy-to-use, customizable wearable that has a clear and demonstrable added value for health care professionals and LTC residents. The next step involves pilot-testing the developed wearable with LTC residents with dementia and residents with ID in clinical practice.
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Affiliation(s)
- Esmee Adam
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- University Network for Care sector Zuid-Holland, Leiden University Medical Center, Leiden, Netherlands
| | - Franka Meiland
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- Department of Medicine for Older people, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Noud Frielink
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | | | - Reon Smits
- Mentech Innovation B.V., Eindhoven, Netherlands
| | - Petri Embregts
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Hanneke Smaling
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- University Network for Care sector Zuid-Holland, Leiden University Medical Center, Leiden, Netherlands
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4
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Lokman S, Bal R, Didden R, Embregts PJ. Factors affecting the feelings of safety among individuals with mild intellectual disabilities and severe challenging behaviour in residential care: A qualitative study of professional and service users' perspectives. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2024:17446295241246569. [PMID: 38889201 DOI: 10.1177/17446295241246569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
Background: This study focuses on what feeling safe means for people with mild intellectual disabilities and severe challenging behaviour, and which factors affect their sense of safety. Method: Thematic analysis was used to analyse data collected during (1) ethnographic longitudinal research and (2) interviews and focus groups among professionals and service users. Results: Feelings of safety can relate to three main themes: (1) a physical environment that reduces risks and temptations; (2) a reliable, predictable, and supportive environment; and (3) an accepting environment that enables service users to establish a normal life. An analysis of which factors affect service users' sense of safety identified 20 themes (e.g. team climate) and 34 subthemes (e.g. interactions with other service users). Conclusions: A range of interconnected factors can affect service users' feelings of safety. Future research should explore what organisations and external actors (e.g. the police) can do to promote those feelings.
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Affiliation(s)
- Suzanne Lokman
- Tranzo, Tilburg School of Social and Behavorial Sciences, Tilburg University, The Netherlands
| | - Roland Bal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, The Netherlands
| | - Robert Didden
- Radboud University, Behavioural Science Institute, The Netherlands
- Trajectum, The Netherlands
| | - Petri Jcm Embregts
- Tranzo, Tilburg School of Social and Behavorial Sciences, Tilburg University, The Netherlands
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Hermsen M, Simons R, van Veen H, Prudon A, Rooijackers L, Otten R, Koordeman R. Building high-quality interpersonal staff-client relationships with people with severe to profound intellectual disabilities and challenging behavior: Insights of professionals and relatives. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2024; 28:17-34. [PMID: 36198498 DOI: 10.1177/17446295221131443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background: Staff-client relationships impact the quality of support and life of people with severe to profound intellectual disabilities and challenging behavior, but are challenging to build due to clients' intense, complex and varying support needs. The present study explores the perspectives of professionals and relatives on what affects these interpersonal relationships. Method: 17 professionals and 11 relatives participated in focus groups and interviews. Data collection and analysis was performed in collaboration with a co-researcher. Data were synthesized thematically. Results: Interpersonal relationships constituted equivalence, striving for mutual understanding, trust and exploring clients' potential. The combination of staff characteristics (enthusiasm/passion, patience, resilience, creativity/humor, flexibility) and expertise (knowledge, vulnerability/sincerity, self-reflection) enabled staff to build these relationships. The importance of involving relatives was addressed. Contextual influences included the team (cooperation, flexibility, culture), organization (cooperation, boundary conditions) and setting (predictability, interior/atmosphere). Conclusions: The findings make practical knowledge explicit and scientifically underpinned for this specific population.
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Affiliation(s)
| | - Rianne Simons
- Pluryn, Netherlands
- Radboud University Nijmegen, Netherlands
| | | | | | | | - Roy Otten
- Pluryn, Netherlands
- Radboud University Nijmegen, Netherlands
- Arizona State University, Tempe, AZ, USA
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Tournier T. "Connectedness" between people with intellectual disabilities and challenging behaviour and support staff: Perceptions of psychologists and support staff. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023; 27:121-137. [PMID: 35086364 PMCID: PMC9941799 DOI: 10.1177/17446295211056820] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/11/2021] [Indexed: 06/14/2023]
Abstract
The tacit practical knowledge of psychologists and support staff to foster a real connection between support staff and people with intellectual disabilities and challenging behaviour was explored. Therefore, six dyads comprising individuals with intellectual disabilities and challenging behaviour and their support staff were video recorded during joint engagement in an activity. To tap into the implicit knowledge of professionals about when staff have 'a real connection' with a person with an intellectual disability, 10 psychologists and 10 support staff were asked to pinpoint these moments in the pre-recorded video compilation. They also shared their interpretations about what they considered to be a real connection. The results displayed that participants designated real connections as occurring when they noticed concrete interactions taking place. Based on thematic analysis of the data, four themes were identified that encapsulated what professionals deemed to be a real connection. In conclusion: joint engagement in an activity appears to be a context that fosters opportunities for real connection. Furthermore, support staff should adopt a sensitive attitude and create a safe atmosphere, to establish real connections.
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Affiliation(s)
- T Tournier
- T Tournier, Tranzo, Tilburg School of
Social and Behavioral Sciences, Tilburg University, P.O. Box 90153, Tilburg 5000
LE, The Netherlands.
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7
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Samways B. Professionals' attitudes towards people with intellectual disabilities who self-harm: A literature review. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2022; 26:954-971. [PMID: 34338080 PMCID: PMC9608005 DOI: 10.1177/17446295211025959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND National Institute for Health and Care Excellence (NICE, 2013) Guidance on Self-Harm states that professionals supporting people who self-harm should demonstrate compassion, respect and dignity. This literature review examines the evidence for professionals' attitudes towards people with intellectual disabilities who self-harm. METHOD Four databases (PsychInfo, IBSS, CINAHL and Medline) were systematically searched to find relevant research since 2000. RESULTS Four studies met the criteria. Attitudes of professionals supporting people with intellectual disabilities are contrasted with those of professionals in settings focused on supporting people without intellectual disabilities. Professionals supporting people with intellectual disabilities tended to display attitudes and attributions reflective of biobehavioural and psychosocial theories of self-harm, with a greater emphasis on relationships. CONCLUSION Much more research is needed which examines the attitudes of professionals supporting people with intellectual disabilities who self-harm.
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Affiliation(s)
- Beverley Samways
- Beverley Samways, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol BS8 1TZ, UK.
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8
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Bailey A, Mullins LE. Scoping Review of the Factors Influencing Compatibility of Autistic Roommates. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2022. [DOI: 10.1007/s40474-022-00264-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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9
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Patterson CW, Golightly M. Adults with intellectual disabilities and third‐wave therapies: A systematic review and
meta‐ethnography. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2022; 36:13-27. [DOI: 10.1111/jar.13045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 06/20/2022] [Accepted: 10/20/2022] [Indexed: 11/09/2022]
Affiliation(s)
| | - Mark Golightly
- Peterborough Adult locality Team Adult Mental Health Peterborough UK
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10
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Lokman S, van Oorsouw WMWJ, Didden R, Embregts PJCM. Setting up a new team of support staff for people with mild intellectual disability or borderline intellectual functioning and severe challenging behaviour: A concept mapping study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2022; 35:1348-1359. [PMID: 35789034 PMCID: PMC9795899 DOI: 10.1111/jar.13023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 06/05/2022] [Accepted: 06/09/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Studies about teams of staff supporting people with intellectual disability have focused on team performance of existing teams. This study aimed to examine important factors in the process of setting up a new team of support staff. Specifically, we considered the process for a team that supports service users with mild intellectual disability or borderline intellectual functioning who display severe challenging behaviour from the orthopedagogical perspective (i.e., with a focus on contextual factors). METHOD Three participant groups (service users, support staff, and professionals supporting a team) participated in a concept mapping procedure, including generating statements in interviews and focus groups, sorting, and rating. An expert group interpreted the results. RESULTS Important factors to one or more groups were: service users and support staff getting acquainted early, team safety, social support, a shared vision, and a positive reputation of the new home. CONCLUSIONS Four core outcomes were addressed that may help service organisations to provide an environment matching the needs of service users who show severe challenging behaviour from the start.
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Affiliation(s)
- Suzanne Lokman
- Tranzo, Tilburg School of Social and Behavorial SciencesTilburg UniversityTilburgThe Netherlands
| | | | - Robert Didden
- Radboud UniversityBehavioural Science InstituteNijmegenThe Netherlands,TrajectumZwolleThe Netherlands
| | - Petri J. C. M. Embregts
- Tranzo, Tilburg School of Social and Behavorial SciencesTilburg UniversityTilburgThe Netherlands
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11
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Penninga W, Nijs SLP, van Bakel HJA, Embregts PJCM. Meaningful moments of interaction with people with profound intellectual disabilities: Reflections from direct support staff. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2022; 35:1307-1316. [PMID: 35726014 PMCID: PMC9796127 DOI: 10.1111/jar.13019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 04/28/2022] [Accepted: 05/29/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND High-quality, affective relationships are built on meaningful moments of interaction, which are challenging for support staff to establish with people with profound intellectual disabilities. Therefore, we explored what makes a moment of interaction meaningful to support staff and what circumstances facilitate meaningful moments of interaction taking place. METHOD Five direct support staff took part in unstructured, in-depth interviews. The interviews were analysed using interpretative phenomenological analysis (IPA). Member checks were also conducted. RESULTS Support staff experienced moments of interaction as meaningful because they felt a connection with a person with profound intellectual disabilities and/or they had the feeling of being meaningful for this person. Staff-related and contextual circumstances facilitating meaningful moments of interaction to take place were described. CONCLUSIONS Meaningful moments of interaction are highly valued by support staff, who believe these moments are valued by persons with profound intellectual disabilities as well. Implications for daily practice are described.
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Affiliation(s)
- Wieneke Penninga
- Tranzo, Tilburg School of Social and Behavioral SciencesTilburg UniversityTilburgThe Netherlands,AmerpoortBaarnThe Netherlands
| | - Sara L. P. Nijs
- Tranzo, Tilburg School of Social and Behavioral SciencesTilburg UniversityTilburgThe Netherlands
| | - Hedwig J. A. van Bakel
- Tranzo, Tilburg School of Social and Behavioral SciencesTilburg UniversityTilburgThe Netherlands
| | - Petri J. C. M. Embregts
- Tranzo, Tilburg School of Social and Behavioral SciencesTilburg UniversityTilburgThe Netherlands
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12
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Samways B, Heslop P, Dowling S. Self-reported explanations for self-injury by people with intellectual disabilities: a systematic review of qualitative studies. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2022; 70:382-396. [PMID: 38699488 PMCID: PMC11062260 DOI: 10.1080/20473869.2022.2098665] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 07/01/2022] [Indexed: 05/05/2024]
Abstract
Background Emotional distress has received less attention as an explanatory factor for self-injury in people with intellectual disabilities, with research and practice primarily focusing on biobehavioural factors. This systematic review examines the self-reported explanations for self-injury by people with mild or moderate intellectual disabilities, and discusses how the findings contrast with those from self-reported studies of people within the general population who self-harm. Methods Five databases (PsychINFO, IBSS, CINAHL, Web of Science and Medline) were systematically searched to find qualitative, empirical research since 2000 about self-reported reasons for self-injury. Results Four studies were found which conducted research with people with intellectual disabilities. Three primary themes are discussed: relief from overwhelming emotions; trauma and loss; and difficulty in articulating emotions. Conclusion This review found a paucity of research asking people with intellectual disabilities about their own self-injury. However, the research available suggests that explanatory factors for self-injury typically reported in the general population should be considered for those with mild or moderate intellectual disabilities.
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Affiliation(s)
| | - Pauline Heslop
- Professor of Intellectual Disabilities Studies, University of Bristol, Bristol, UK
| | - Sandra Dowling
- Senior Lecturer, School, for Policy Studies, University of Bristol, Bristol, UK
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13
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Bruinsma E, van den Hoofdakker BJ, Hoekstra PJ, de Kuijper GM, de Bildt AA. Exploring the association of staff characteristics with staff perceptions of quality of life of individuals with intellectual disabilities and challenging behaviours. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2022; 35:1231-1243. [PMID: 35689398 PMCID: PMC9546376 DOI: 10.1111/jar.13017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 04/21/2022] [Accepted: 04/28/2022] [Indexed: 11/29/2022]
Abstract
Background This study aimed to examine the associations between individual staff and staff team characteristics and quality of life of individuals with intellectual disabilities and challenging behaviours. Method With multilevel analyses, we examined educational level, experience, attitudes and behaviours of 240 staff members, in relation to their perception of quality of life of 152 individuals with intellectual disabilities and challenging behaviours they cared for. Results Two individual staff characteristics were related to better quality of life: higher educational and self‐reflection levels. Of the team characteristics, higher educational level, higher self‐efficacy and more friendly behaviour were associated with better quality of life. Unexpectedly, higher staff‐individual ratio was related to lower quality of life. Conclusions Both individual staff and staff team characteristics are associated with quality of life, indicating the need to take staff team characteristics into account when examining quality of life.
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Affiliation(s)
- Eke Bruinsma
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Barbara J van den Hoofdakker
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.,Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Pieter J Hoekstra
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Gerda M de Kuijper
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.,Centre for Intellectual Disability and Mental Health, Assen, The Netherlands
| | - Annelies A de Bildt
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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14
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Mukuria C, Connell J, Carlton J, Peasgood T, Scope A, Clowes M, Rand S, Jones K, Brazier J. Qualitative Review on Domains of Quality of Life Important for Patients, Social Care Users, and Informal Carers to Inform the Development of the EQ-HWB. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:492-511. [PMID: 35365298 DOI: 10.1016/j.jval.2021.11.1371] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/25/2021] [Accepted: 11/23/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To identify the themes to inform the content of a new generic measure, the EQ-HWB (EQ Health and Wellbeing), that can be used in economic evaluation across health, social care, and public health, based on the views of users and beneficiaries of these services including informal carers. METHODS A qualitative review was undertaken. Systematic and citation searches were undertaken focusing on qualitative evidence of the impact on quality of life from reviews for selected health conditions, informal carers, social care users, and primary qualitative work used in the development of selected measures. A subset of studies was included in the review. Framework analysis and synthesis were undertaken based on a conceptual model. RESULTS A total of 42 reviews and 24 primary studies were selected for inclusion in the review. Extraction and synthesis resulted in 7 high-level themes (with subthemes): (1) feelings and emotions (sadness, anxiety, hope, frustration, safety, guilt/shame); (2) cognition (concentration, memory, confusion, thinking clearly); (3) self-identity (dignity/respect, self-esteem); (4) "coping, autonomy, and control" relationships; (5) social connections (loneliness, social engagement, stigma, support, friendship, belonging, burden); (6) physical sensations (pain, discomfort, sleep, fatigue); and (7) activity (self-care, meaningful activities, mobility, communication, hearing, vision). Apart from physical sensations, most of the other themes and subthemes were relevant across both health and social care, including for informal carers. CONCLUSIONS The findings from this broad review identified themes that go beyond health and that are relevant to patients, informal carers, and social care users. The themes and subthemes informed the domains for the EQ-HWB.
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Affiliation(s)
- Clara Mukuria
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, England, UK.
| | - Janice Connell
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, England, UK
| | - Jill Carlton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, England, UK
| | - Tessa Peasgood
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, England, UK
| | - Alison Scope
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, England, UK
| | - Mark Clowes
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, England, UK
| | - Stacey Rand
- Personal Social Services Research Unit (PSSRU), University of Kent, Canterbury, England, UK
| | - Karen Jones
- Personal Social Services Research Unit (PSSRU), University of Kent, Canterbury, England, UK
| | - John Brazier
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, England, UK
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Vseteckova J, Jordan J, Tilley E, Larkin M, Ryan S, Wallace LM. Transitions for older people with learning disabilities and behaviours that challenge others, and their family carers: a merged protocol for two rapid scoping reviews of evidence. Syst Rev 2022; 11:14. [PMID: 35042546 PMCID: PMC8767693 DOI: 10.1186/s13643-021-01883-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 12/27/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND There are over 1 million adults with a learning disability in the UK, of whom approximately 20% displaying behaviours that challenge others. Two thirds of people with learning disabilities live in the family home. As they and their family carers age, both are likely to face particular difficulties and stresses, but there is little understanding of their experiences and needs. To address this evidence gap, our main objective is to undertake two rapid scoping reviews that will collectively focus on the health and social care needs, experiences, service interventions and resources of older people with learning disabilities and behaviours that challenge others, and their family carers. Both reviews will focus on issues relating to forward planning and transitions to different care contexts. The study is part of a research project funded by the National Institute for Health Research No.129491. METHODS We propose to address the need for evidence via two rapid scoping reviews. We will include published and unpublished (grey) literature, encompassing empirical research, policy and practice guidance and lay resources to support decision-making. We will search multiple electronic databases, hand search references lists, and use expert guidance to identify potential evidence. The following databases were used for research and grey literature: CINAHL; Healthcare Management Information Consortium (HMIC); NHS Evidence; Scopus; Turning Evidence Into Practice (TRIP); Web of Science (WoS); Google (first 5 pages); and Google Scholar (first 5 pages). For RR2, additional intended databases are the Carer Research Knowledge Exchange Network (CAREN) and Social Care Institute for Excellence (SCIE). Two reviewers will independently screen all citations and full-text articles for inclusion. One reviewer will extract data, with an independent review undertaken by the research team. Critical appraisal will depend on the nature of included evidence. Narrative synthesis will be collaboratively developed, with descriptive information presented in tables summarising study characteristics and thematic analysis of findings presented in the main text. Dissemination will be through journal publication, conference presentations and written short-form, easy-read versions of articles and audio-video clips for lay audiences. DISCUSSION We will consider the strengths and limitations of our reviews, considering their impact on findings. We will summarise the main findings and provide an interpretation linked to the review questions and objectives. We will consider the implications of our findings for policy and practice, as well as future research addressing the support of older people with learning difficulties and behaviours that challenge others, and their family carers, in the context of transition to different care contexts in the UK. The protocol has been registered as Vseteckova, J., Jordan, J., Tilley, E., Larkin, M., Ryan, S., and Wallace, L. (2021, December 4). Transitions for older people with learning disabilities and behaviours that challenge others, and their family carers: a merged protocol for two rapid scoping reviews of evidence. Retrieved from osf.io/jzrn9.
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Affiliation(s)
- J. Vseteckova
- School of Health, Wellbeing and Social Care, Faculty of Wellbeing, Education and Language Studies, The Open University, Walton Hall, Milton Keynes, MK7 6AA UK
| | - J. Jordan
- School of Health, Wellbeing and Social Care, Faculty of Wellbeing, Education and Language Studies, The Open University, Walton Hall, Milton Keynes, MK7 6AA UK
| | - E. Tilley
- School of Health, Wellbeing and Social Care, Faculty of Wellbeing, Education and Language Studies, The Open University, Walton Hall, Milton Keynes, MK7 6AA UK
| | - M. Larkin
- School of Health, Wellbeing and Social Care, Faculty of Wellbeing, Education and Language Studies, The Open University, Walton Hall, Milton Keynes, MK7 6AA UK
| | - S. Ryan
- Department of Social Care and Social Work, Manchester Metropolitan University, Manchester, UK
| | - L. M. Wallace
- School of Health, Wellbeing and Social Care, Faculty of Wellbeing, Education and Language Studies, The Open University, Walton Hall, Milton Keynes, MK7 6AA UK
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Bennett A, Hanna P. Exploring the Experiences of Male Forensic Inpatients' Relationships with Staff within Low, Medium and High Security Mental Health Settings. Issues Ment Health Nurs 2021; 42:929-941. [PMID: 33914668 DOI: 10.1080/01612840.2021.1913683] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Therapeutic relationships within psychiatric settings are highlighted as important throughout the literature. However, research from the forensic inpatient perspective is limited. We address this gap by exploring the patient-staff relationships within forensic mental health inpatient services, from the patient's perspective. Thirty adult male forensic inpatients were interviewed about their experiences on the ward and their interactions with staff. Our analysis examines inpatients experiences of respectful and reciprocal relationships, relationships that empower, a disinterest in their patients' and authoritarian relationships. This study concludes by highlighting the need to prioritise the development of reciprocal relationships within forensic services.
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Affiliation(s)
- Alice Bennett
- Department of Psychological Interventions, University of Surrey, Guildford, UK
| | - Paul Hanna
- Department of Psychological Interventions, University of Surrey, Guildford, UK
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17
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Truong A, Alverbratt C, Ekström-Bergström A, Antonsson H. Caring for Persons With Intellectual Disabilities and Challenging Behavior: Staff Experiences With a Web-Based Training Program. Front Psychiatry 2021; 12:580923. [PMID: 33584380 PMCID: PMC7876340 DOI: 10.3389/fpsyt.2021.580923] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 01/05/2021] [Indexed: 01/10/2023] Open
Abstract
Background: Clear and effective communication is a prerequisite to provide help and support in healthcare situations, especially in health, and social care services for persons with intellectual disabilities, as these clients commonly experience communication difficulties. Knowledge about how to communicate effectively is integral to ensuring the quality of care. Currently, however, there is a lack of such knowledge among staff working in the disabilities sector, which is exacerbated by challenges in the competence provision in municipal health and social care services. Therefore, the aim of the study was to explore staffs' experience of web-based training in relation to their professional caring for persons with intellectual disabilities and challenging behavior. The intention is to move toward well-evaluated and proven web-based training in order to contribute to competence provision in this specific context. Methods: Fourteen semi-structured interviews were carried out with individual staff members to gather data regarding their experiences with web-based training in relation to their profession. The collected data were analyzed using qualitative content analysis with a focus on both manifest and latent content. Results: The staff's experiences with the web-based training program were presented as a single main theme: "Web-based training for staff initiates a workplace learning process by promoting reflections on and awareness of how to better care for persons with intellectual disabilities and challenging behavior." This theme contained three categories which are based on eight sub-categories. Conclusion and clinical implications: The benefits of web-based training for workplace learning could clearly be observed in the strengthening of professional care for persons with intellectual disabilities and challenging behavior. Staff members claimed to have gained novel insights about how to better care for clients as well as about the importance of interactions in their encounters with clients. Professional teamwork is crucial to providing effective care for persons with intellectual disabilities and challenging behavior. Hence, future research aimed at investigating the views of other healthcare professionals, such as registered nurses, is recommended to improve the competence provision within municipal health and social care services and thereby enhance the quality of care.
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Affiliation(s)
- Anh Truong
- Department of Health Sciences, University West, Trollhättan, Sweden
| | | | - Anette Ekström-Bergström
- Department of Health Sciences, University West, Trollhättan, Sweden
- Department of Nursing and Reproductive, Perinatal and Sexual Health, School of Health Sciences, University of Skövde, Skövde, Sweden
| | - Helena Antonsson
- Department of Health Sciences, University West, Trollhättan, Sweden
- Department of Nursing, Umeå University, Umeå, Sweden
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18
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Organisational interventions for decreasing the use of restrictive practices with children or adults who have an intellectual or developmental disability. Hippokratia 2021. [DOI: 10.1002/14651858.cd013840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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19
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Olivier‐Pijpers VC, Cramm JM, Landman W, Nieboer AP. A multiple case study investigating changes in organizations serving residents with intellectual disabilities and challenging behaviours. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 34:190-199. [PMID: 32939925 PMCID: PMC7821192 DOI: 10.1111/jar.12797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 08/06/2020] [Accepted: 08/12/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND the present authors examined changes made in disability service organizations supporting residents with intellectual disabilities and challenging behaviours, because these changes may influence residents' support and subsequently their challenging behaviours. METHOD In this multiple case study, the present authors collected and qualitatively analysed data (organizational documents, meetings records and focus group reports) on organizational changes made in two specialized Dutch disability service organizations, using ecological theory as a sensitizing framework and the constant comparative method. RESULTS Themes describing organizational changes in this context were as follows: a messy start to the transition; staff, professionals and managers remain at a distance; staff members' ability to change; clear boundaries between formal and informal caregivers; and staff's feelings of being unheard. CONCLUSIONS Organizational changes can enhance, but also limit, the quality of residential support services provided to people with intellectual disabilities and challenging behaviours. The change process and impact of organizational changes on residents must be examined closely.
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Affiliation(s)
- Vanessa Charissa Olivier‐Pijpers
- Centre for Consultation and ExpertiseUtrechtThe Netherlands
- Erasmus School of Health Policy and ManagementErasmus University RotterdamThe Netherlands
| | - Jane Murray Cramm
- Erasmus School of Health Policy and ManagementErasmus University RotterdamThe Netherlands
| | | | - Anna Petra Nieboer
- Erasmus School of Health Policy and ManagementErasmus University RotterdamThe Netherlands
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20
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Gleeson G, Spies M, McDermott G. Living with others with behaviours that challenge: experiences and perceptions of adults with intellectual disabilities. Disabil Rehabil 2020; 44:3493-3500. [PMID: 33377795 DOI: 10.1080/09638288.2020.1867655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND This study explored the experiences of people with intellectual disabilities who live with others who display behaviours that challenge. Previous research has focused on the impact of behaviours that challenge on staff and families but less is known about the effect it has on service-users. METHOD Semi-structured interviews were conducted with six participants who were recruited from a service specialising in the management of behaviours that challenge. Data were transcribed verbatim and analysed using Interpretative Phenomenological Analysis. RESULTS Four superordinate themes were identified: the emotional impact of others' behaviours that challenge; participants' perceptions of behaviours that challenge; participants' own experiences engaging in behaviours that challenge; and things that help. Sub-themes were also identified under each superordinate theme. CONCLUSIONS People with an intellectual disability are knowledgeable about behaviours that challenge, have insight into potential causes, and can offer suggestions as to what might help. Results were discussed in relation to clinical implications and methodological strengths.IMPLICATIONS FOR REHABILITATIONLiving with others who engage in behaviours that challenge has a significant impact on the well-being of people with an intellectual disability.People with an intellectual disability need to be empowered through inclusion in the decisions that concern them, especially in relation to their living circumstances.This is vital in order to improve the quality of life and mental well-being, enhance opportunities for skill development and promote independence.
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Affiliation(s)
- Gwen Gleeson
- School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Marelise Spies
- School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Garret McDermott
- Department of Psychology, Tallaght University Hospital, Dublin, Ireland
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21
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Flynn S, Hastings RP, Gillespie D, McNamara R, Randell E. Trainer and support staff's experiences of engaging with the Who's Challenging Who? challenging behaviour training course. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2020; 24:367-380. [PMID: 30606072 DOI: 10.1177/1744629518821789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND The Who's Challenging Who? (WCW) training is coproduced and delivered by people with intellectual disabilities (IDs), and it aims to improve staff empathy for people with challenging behaviour (CB). This study qualitatively describes trainees' and trainers' experiences of the WCW. METHODS Semi-structured interviews were undertaken with managers (n = 7), support staff (n = 6) and the WCW trainers (n = 4; three had IDs). Interviews were transcribed verbatim and analysed using thematic analysis. RESULTS Two cross-cutting themes were drawn from the data: (1) valued roles of the trainers, whereby trainers and trainees benefited from the training being coproduced and delivered by people with IDs, and (2) beyond the training, within which trainees reported that they were engaging in increased reflection about their past and current practice. CONCLUSIONS Being trained by people with IDs and CB appears to be a useful method, which can lead to perspective taking and reflection about supporting people with IDs and CB.
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22
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Olivier-Pijpers VC, Cramm JM, Nieboer AP. Residents' and resident representatives' perspectives on the influence of the organisational environment on challenging behaviour. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 100:103629. [PMID: 32142969 DOI: 10.1016/j.ridd.2020.103629] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 01/28/2020] [Accepted: 02/28/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND This study explored the perspectives of residents of residential disability service organisations and resident representatives on the influence of the organisational environment on challenging behaviour in people with intellectual disabilities (ID). METHOD Sixteen residents and representatives from four specialised Dutch disability service organisations were interviewed. Data were analysed using a grounded theory approach, with a sensitising frame based on Bronfenbrenner's ecological theory. RESULTS Some organisational factors (e.g. staff turnover, insufficient finances) can have negative effects on interactions among residents and staff and family members, resulting in more challenging behaviour, but other organisational factors (e.g. shared vision, values and expectations, competent staff) can positively influence staffs' attitudes and actions, which in turn helps to manage challenging behaviour in people with ID. CONCLUSIONS Residents' and representatives' perspectives provide a better understanding of the positive and negative influences of the organisational environment on challenging behaviour in people with ID.
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Affiliation(s)
- V C Olivier-Pijpers
- Centre for Consultation and Expertise, Australielaan 14, 3526AB, Utrecht, The Netherlands.
| | - J M Cramm
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, The Netherlands
| | - A P Nieboer
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, The Netherlands
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23
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Neijmeijer L, Kuiper C, Kroon H, Didden R. Experiences of service users with a mild intellectual disability or borderline intellectual functioning with Flexible Assertive Community Treatment: A qualitative study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 33:1005-1015. [PMID: 32141154 PMCID: PMC7496458 DOI: 10.1111/jar.12723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 02/14/2020] [Accepted: 02/17/2020] [Indexed: 11/27/2022]
Abstract
Background In the Netherlands, Flexible Assertive Community Treatment (FACT) teams have been established for people with mild intellectual disability (MID) or borderline intellectual functioning (BIF) and mental health problems or challenging behaviour. Little is known yet about service users’ experiences with FACT. Method An inductive grounded theory approach was used to explore how service users valued the treatment and their own functioning, and which factors were perceived as supportive. Semi‐structured interviews were held with 15 service users. Results Most service users highly appreciated the contact with the staff and the practical and emotional support. Persistent involvement, availability and humanity, and respect for autonomy were distinguished as core values in the relationship with the staff. Most service users experienced improvement in time and attributed this to intrapersonal changes and/or less stress in life. Conclusions From the perspective of service users with MID/BIF, FACT appears to have an added value.
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Affiliation(s)
- Laura Neijmeijer
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands.,Trajectum, Zwolle, The Netherlands
| | - Chris Kuiper
- University of Applied Sciences Leiden, Leiden, The Netherlands
| | - Hans Kroon
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.,Tranzo, School of Social and Behavioural Sciences, Tilburg University, Tilburg, The Netherlands
| | - Robert Didden
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands.,Trajectum, Zwolle, The Netherlands
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24
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Tournier T, Hendriks AH, Jahoda A, Hastings RP, Embregts PJCM. Developing a Logic Model for the Triple‐C Intervention: A Practice‐Derived Intervention to Support People with Intellectual Disability and Challenging Behavior. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2020. [DOI: 10.1111/jppi.12333] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Tess Tournier
- Tilburg University Tilburg The Netherlands
- ASVZ Sliedrecht The Netherlands
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25
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Nijs S, Taminiau EF, Frielink N, Embregts PJCM. Stakeholders' perspectives on how to improve the support for persons with an intellectual disability and challenging behaviors: a concept mapping study. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2019; 68:25-34. [PMID: 35173961 PMCID: PMC8843164 DOI: 10.1080/20473869.2019.1690859] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 11/05/2019] [Accepted: 11/05/2019] [Indexed: 06/14/2023]
Abstract
INTRODUCTION People with an intellectual disability (ID) are at risk of developing challenging behavior. Although previous research provided important insights into how to support people with an ID and challenging behavior, it remains unclear what various stakeholders consider to be the most essential aspects to further improve their support. METHOD Statements regarding aspects perceived necessary to improve the support to people with an ID and challenging behavior were collected in focus groups. Afterwards participants individually prioritized and clustered these statements, resulting in concept maps for people with an ID, direct support workers, and psychologists. Since only three relatives participated in the entire concept mapping procedure, no concept map could be composed based on their input. RESULTS Participants generated 200 statements. In the concept map of clients, statements were mentioned regarding relational aspects, providing clarity and structure, characteristics of support staff, and professional attitude of direct support workers. Direct support workers provided statements related to their own personal competencies, the necessity of feeling supported and appreciated, and a physical safe environment. Psychologists provided statements regarding their support for direct support workers, the support for the clients, the perspective on the client, and their role as psychologists. CONCLUSION The results of this study may be a starting point to foster increased evidence based practice for the support for persons with an ID and challenging behavior. Moreover, it provides opportunities to create care founded on mutual attunement, based on listening to each other's ideas and insight into perspectives and needs of various stakeholders.
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Affiliation(s)
- S. Nijs
- Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - E. F. Taminiau
- Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - N. Frielink
- Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - P. J. C. M. Embregts
- Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
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van den Bogaard KJHM, Nijman HLI, Embregts PJCM. Attributional styles of support staff working with people with intellectual disabilities exhibiting challenging behaviour. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 33:465-474. [PMID: 31746107 PMCID: PMC7187445 DOI: 10.1111/jar.12688] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 10/18/2019] [Accepted: 10/31/2019] [Indexed: 11/30/2022]
Abstract
Background Attributions are cognitive variables that influence a person's behaviour. Although a large volume of research has been conducted on the attributions of support staff with regard to challenging behaviour (CB) exhibited by people with intellectual disabilities (ID), studies on patterns of attributional dimensions (i.e. attributional styles) are scarce. Method Using semi‐structured interviews, 19 support staff members were asked to describe incidents of aggressive, self‐injurious and sexualized challenging behaviour. Data on attributions were analysed using the Leeds Attributional Coding System. Results Four attributional styles differed significantly for aggressive, self‐injurious and sexualized challenging behaviour. In addition, support staff members largely attributed these three types of CB to characteristics and behaviour of clients with ID. Conclusions The results indicate that it is important to train support staff to recognize and understand the ways in which their attributions and behaviour influence the existence and maintenance of CB.
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Affiliation(s)
- Kim J H M van den Bogaard
- Department Tranzo, Tilburg University, Tilburg, The Netherlands.,Dichterbij Science and Innovation, Gennep, The Netherlands
| | - Henk L I Nijman
- Behavioural Science Institute (BSI), Radboud University Nijmegen, Nijmegen, The Netherlands.,Aventurijn - Fivoor forensic psychiatric institute, Den Dolder, The Netherlands
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27
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Wolkorte R, van Houwelingen I, Kroezen M. Challenging behaviours: Views and preferences of people with intellectual disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 32:1421-1427. [PMID: 31183971 PMCID: PMC6851968 DOI: 10.1111/jar.12631] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 04/18/2019] [Accepted: 05/15/2019] [Indexed: 12/03/2022]
Abstract
Background Challenging behaviour is a common problem among people with ID and in services for people with ID. This paper aims to provide an overview of the views and preferences of people with ID on challenging behaviour. Method Semi‐structured interviews were conducted with thirteen adults with mild to moderate ID and seven proxies (family or close associates of adults with ID who were unable to communicate and/or with severe or profound ID) in the Netherlands. The interviews were audio‐recorded, transcribed and analysed thematically. Results People with ID and (a history of) challenging behaviour have clear views and preferences on factors related to challenging behaviour, assessments, non‐pharmacological and pharmacological interventions and health professionals’ approach. Conclusions The identified views and preferences of people with ID are not always in accordance with current procedures and treatments for challenging behaviour and should be included in future care processes and research.
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Affiliation(s)
- Ria Wolkorte
- Intellectual Disability Medicine, Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Ingrid van Houwelingen
- Research group Knowledge analysis societal security, HU University of Applied Sciences, Utrecht, The Netherlands
| | - Marieke Kroezen
- Intellectual Disability Medicine, Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Browne C, Brown G, Smith IC. Adapting dialectical behaviour therapy in forensic learning disability services: A grounded theory informed study of "what works". JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 32:792-805. [PMID: 30687987 DOI: 10.1111/jar.12569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 12/18/2018] [Accepted: 01/06/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Emerging evidence indicates effectiveness of dialectical behaviour therapy (DBT) for people with intellectual disabilities (PWID) in forensic settings; however, little is known about "what works" facilitating engagement and change. METHODS Eleven interviews were conducted with nine service users across two secure inpatient services. Grounded theory was used to develop a model of perceived engagement and change. RESULTS The model provides insights into how change occurs during DBT delivered in forensic settings. DBT constitutes a challenging journey, yet provides the motivation and means to address individual's intra-/interpersonal aggression and progress towards release. Participants experienced engaging with DBT as difficult and coercive, moving from compliance and avoidance to acceptance and change. Key factors included participants' motivation, beliefs about safety and ability to change, and interactions with staff. CONCLUSION Recommendations are made for increasing intrinsic motivation, reducing perceived coercion and distress, and for future research to address potential aversive elements and enhance effectiveness.
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Affiliation(s)
- Claire Browne
- Clinical Psychology Programme, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Gill Brown
- Clinical Psychology Programme, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Ian C Smith
- Clinical Psychology Programme, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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29
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Embregts PJCM, Negenman A, Habraken JM, de Boer ME, Frederiks BJM, Hertogh CMPM. Restraint interventions in people with moderate to profound intellectual disabilities: Perspectives of support staff and family members. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 32:172-183. [PMID: 30191671 PMCID: PMC7379273 DOI: 10.1111/jar.12519] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 06/18/2018] [Accepted: 06/22/2018] [Indexed: 12/04/2022]
Abstract
BACKGROUND Due to incompatibilities in communication, it is key that family members and support staff can take the perspective of people with moderate to profound intellectual disabilities (ID) whilst putting aside their own perspectives. METHOD Ten vignettes describing types of restraint interventions (RIs) were presented to 20 unique pairs of support staff and family members related to individuals with moderate to profound ID. RESULTS In taking their own perspective, more than half of the support staff and family members perceived all RIs as involuntary and severe. In contrast, when asked to put themselves in the position of the client/family member, only three RIs were considered involuntary by a majority of support staff and family members. CONCLUSIONS These results indicate that support staff and family members can take into account the perspective of people with moderate to profound ID in the evaluation and consideration of involuntary care.
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Affiliation(s)
- Petri J. C. M. Embregts
- TranzoTilburg School of Social and Behavioral SciencesTilburg UniversityTilburgThe Netherlands
| | - Annemarieke Negenman
- TranzoTilburg School of Social and Behavioral SciencesTilburg UniversityTilburgThe Netherlands
- Dichterbij Innovation and ScienceGennepThe Netherlands
| | - Jolanda M. Habraken
- TranzoTilburg School of Social and Behavioral SciencesTilburg UniversityTilburgThe Netherlands
| | - Marike E. de Boer
- Department of General Practice & Elderly Care MedicineEMGO Institute for Health and Care ResearchVU University Medical CenterAmsterdamThe Netherlands
| | - Brenda J. M. Frederiks
- Department of Public and Occupational HealthEMGO Institute for Health and Care ResearchVU University Medical CenterAmsterdamThe Netherlands
| | - Cees M. P. M. Hertogh
- Department of General Practice & Elderly Care MedicineEMGO Institute for Health and Care ResearchVU University Medical CenterAmsterdamThe Netherlands
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30
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McGilloway C, Smith D, Galvin R. Barriers faced by adults with intellectual disabilities who experience sexual assault: A systematic review and meta‐synthesis. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2018. [DOI: 10.1111/jar.12445] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Connie McGilloway
- Donegal Sexual Assault Treatment Unit Letterkenny University Hospital Donegal Ireland
| | - David Smith
- Department of General Practice Royal College of Surgeons in Ireland Dublin Ireland
| | - Rose Galvin
- Faculty of Education and Health Sciences School of Allied Health Health Research Institute University of Limerick Limerick Ireland
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Randell E, Hastings RP, McNamara R, Knight R, Gillespie D, Taylor Z. Effectiveness of the 'Who's Challenging Who' support staff training intervention to improve attitudes and empathy towards adults with intellectual disability and challenging behaviours: study protocol for a cluster randomised controlled trial. Trials 2017; 18:460. [PMID: 28982380 PMCID: PMC5629774 DOI: 10.1186/s13063-017-2175-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 09/01/2017] [Indexed: 11/10/2022] Open
Abstract
Background Findings suggest approximately one in six people with intellectual disability engage in ‘challenging behaviours’, which include aggression towards others/property and self-injurious actions. In residential settings, actions of staff members can make challenging behaviours more likely to occur, or make these behaviours worse. In particular, negative attitudes from members of staff and lack of understanding about the reasons for challenging behaviour are contributory factors. ‘Who’s Challenging Who?’ (WCW) training is designed to emphasise the role of staff in residential settings as a challenge also to people with intellectual disability. The course is delivered jointly by a trainer with intellectual disability who has been labelled as having challenging behaviour, along with a trainer without intellectual disability. Methods This is a cluster randomised two-arm trial of WCW training versus a waiting list control. Overall, 118 residential settings will be recruited and randomised on a 1:1 ratio. Within each setting, two members of staff will be invited to take part in the trial. Participants will complete assessments at baseline and at 6 and 20 weeks. WCW is a half day initial training course with some follow-on coaching to ensure implementation. The primary outcome is changes in staff empathy towards people with challenging behaviour. Secondary outcomes at the staff level include confidence, attitudes and work-related well-being. Secondary outcomes at the residential setting level include recorded incidents of aggressive challenging behaviour, and use of any restrictive practices. Discussion If the results of the cluster randomised trial are positive, we will disseminate the findings widely and make all training manuals and materials freely available for anyone in intellectual disability services (and beyond) to use. Our training approach may have wider implications in other areas of social care. It may also provide a generally applicable model for how to train people with intellectual disability to act as co-trainers in intellectual disability social care settings. People with intellectual disability and challenging behaviour have already been involved centrally with the design, development and pilot evaluation of WCW and will also be fully involved throughout this trial. Trial registration Registered on the International Standard Randomised Controlled Trial Number registry on 8th December 2015: ISRCTN53763600. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2175-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Richard P Hastings
- Centre for Educational Development, Appraisal, and Research (CEDAR) University of Warwick, Coventry, UK
| | | | - Roseanna Knight
- Centre for Educational Development, Appraisal, and Research (CEDAR) University of Warwick, Coventry, UK
| | | | - Zachary Taylor
- Royal Mencap Society, Unit 7 Sundon Business Park, Dencora Way, Luton, UK
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O'Shea T. Civic republican medical ethics. JOURNAL OF MEDICAL ETHICS 2017; 43:56-59. [PMID: 27686996 DOI: 10.1136/medethics-2016-103697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 08/24/2016] [Accepted: 09/04/2016] [Indexed: 06/06/2023]
Abstract
This article develops a civic republican approach to medical ethics. It outlines civic republican concerns about the domination that arises from subjection to an arbitrary power of interference, while suggesting republican remedies to such domination in healthcare. These include proposals for greater review, challenge and pre-authorisation of medical power. It extends this analysis by providing a civic republican account of assistive arbitrary power, showing how it can create similar problems within both formal and informal relationships of care, and offering strategies for tackling it. Two important objections to civic republican medical ethics-that it overvalues independence and political participation in healthcare-are also considered and rebutted.
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Griffith GM, Jones R, Hastings RP, Crane RS, Roberts J, Williams J, Bryning L, Hoare Z, Edwards RT. Can a mindfulness-informed intervention reduce aggressive behaviour in people with intellectual disabilities? Protocol for a feasibility study. Pilot Feasibility Stud 2016; 2:58. [PMID: 27965874 PMCID: PMC5154058 DOI: 10.1186/s40814-016-0098-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 09/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Approximately 10-20 % of adults with intellectual disabilities engage in challenging behaviours such as aggression, destructiveness, and self-injury, which are often accompanied by feelings of anger. The inability to manage anger can reduce quality of life. For example, aggression is a strong predictor of out-of-area placements and is a risk variable for abuse. Recent research suggests that mindfulness-based therapies (specifically, Singh's Soles of the Feet meditation) can help people with intellectual disabilities manage angry emotions, with resultant reductions in challenging behaviour. However, previous research has been single-case design studies, and no group studies have been published with people with intellectual disabilities and aggressive behaviour. METHODS/DESIGN For this feasibility study, a UK protocol will be developed for use by health professionals within National Health Service (NHS) Intellectual Disability (ID) teams, based upon Singh's Soles of the Feet manual. Twenty adults with intellectual disabilities and identified problems with anger control will be recruited and six sessions will be delivered by a trained ID clinician. The study will monitor participant's aggressive behaviour, health-related quality of life, anxiety, depression, and use of support services (medication, hospital appointments etc.). These will be measured at three time points: (1) Baseline (within 2 weeks prior to the first session of the intervention), (2) 2 months post-baseline, and (3) 6 months post-baseline. Qualitative interviews will be conducted with participants, their carers, and the therapists who delivered the intervention. In order to help design an economic evaluation alongside a future full trial, we will cost the intervention and test the acceptability and validity of health economics measures to record resource use and health-related quality of life outcomes. DISCUSSION The data from this study will inform the feasibility of the project protocol and intervention, which will help develop future research and to determine whether a larger, randomised controlled trial with concurrent economic evaluation is feasible. TRIAL REGISTRATION UKCERN: 16743.
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Affiliation(s)
- Gemma Maria Griffith
- Centre for Mindfulness Research and Practice (CMRP), Bangor University, Bangor, UK
| | - Robert Jones
- School of Psychology, Bangor University, Brigantia Building, Penrhalt Road, Bangor, LL57 2AS UK
| | - Richard Patrick Hastings
- Centre for Educational Development, Appraisal and Research: (CEDAR) University of Warwick, Coventry, UK
| | - Rebecca S Crane
- Centre for Mindfulness Research and Practice (CMRP), Bangor University, Bangor, UK
| | - Judith Roberts
- School of Psychology, Bangor University, Brigantia Building, Penrhalt Road, Bangor, LL57 2AS UK
| | - Jonathan Williams
- Denbighshire Complex Disabilities Team, North Wales, North Wales, UK
| | - Lucy Bryning
- Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Bangor, UK
| | - Zoe Hoare
- North Wales Organisation for Randomised Trials in Health (NWORTH), Bangor University, Bangor, UK
| | - Rhiannon Tudor Edwards
- Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Bangor, UK
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