Quality of Life Versus Quality of Care: Implications for People and Programs

Potential impact of autism services on the quality of life of individuals with autism spectrum disorder and their families

Autism spectrum disorder (ASD) is a lifelong condition that requires autism-specific services. However, the quality of autism services in Saudi Arabia has rarely been examined. Therefore, exploring issues from the parents' perspective is crucial to improve the quality of life (QOL) outcomes for such a population. Semi-structured interviews were administered to nine parents of individuals with ASD, and thematic analysis was used for data analysis. Results showed that parents' experiences regarding the quality of autism services varied. In addition, the quality of autism services must be further developed to meet the diverse needs of individuals with ASD and their families, in line with the 2030 vision of Saudi Arabia, which prioritises the QOL of individuals with a disability and their families. This study highlighted some influencing factors of the quality of autism services and QOL of individuals with ASD and their families from the parents' perspective. This study concluded that further research is necessary to gain in-depth understanding of the influencing factors of the quality of national autism services. Overall, the reasons behind the diversity in experiences amongst parents of individuals with ASD regarding the quality of autism services must be further explored.

Comparing the quality of life of adults with and without intellectual disability

BACKGROUND

Quality of life (QOL) is an important issue for all citizens, comprising equity, equality, inclusion and participation of each person in society. The research purposes driving this investigation were (1) to compare QOL among people with and without intellectual disability (ID) and (2) to examine the predictors of QOL in both groups of participants.

METHODS

Data were collected from 1929 adults, including 1264 individuals with an ID and the remainder (n = 665) were participants without a disability. QOL was assessed by the Portuguese version of the Personal Outcomes Scale.

RESULTS

The findings supported significantly higher QOL for adults without ID. Furthermore, QOL is influenced by individual and environmental variables, stressing that the health status was the highest mutual predictor of QOL among those with and without ID.

CONCLUSION

The gaps among both groups of participants should be addressed in service provision and policies. Taking into account the research findings, the personalised supports should enable the full inclusion and participation of adults with ID in community-based settings.

Moving Us Toward a Theory of Individual Quality of Life

This article discusses three steps involved in moving us toward a theory of individual quality of life: developing a conceptual model, integrating theory components, and applying and evaluating the theory. Each of the proposed steps is guided by established standards regarding theory development and use. The article concludes with a discussion of criteria that can be used to evaluate the theory and the contribution that a theory of individual quality of life would make to the field of disability.

Does performance management affect nurses' well-being?

AIM

This article focuses on employee performance-management practices in the healthcare sector. We specifically aim to contribute to a better understanding of the impact of employee performance-management practices on affective well-being of nurses in hospitals. Theory suggests that the features of employee-performance management (planning and evaluation of individual performances) predict affective well-being (in this study: job satisfaction and affective commitment).

METHODS

Performance-management planning and evaluation and affective well-being were drawn from a survey of nurses at a Flemish hospital. Separate estimations were performed for different aspects of affective well-being.

RESULTS

Performance planning has a negative effect on job satisfaction of nurses. Both vertical alignment and satisfaction with the employee performance-management system increase the affective well-being of nurses; however, the impact of vertical alignment differs for different aspects of affective well-being (i.e. job satisfaction and affective commitment).

CONCLUSION

Performance-management planning and evaluation of nurses are associated with attitudinal outcomes. The results indicate that employee performance-management features have different impacts on different aspects of well-being.

Identifying good group homes: qualitative indicators using a quality of life framework

Abstract Despite change toward more individualized support, group homes are likely to remain for people with severe intellectual disability. As such, the search continues for ways to determine and maintain the quality of these settings. This article draws on in-depth qualitative analysis of participant observations conducted over 9-12 months in seven group homes for 21 people with a severe and profound level of intellectual disability. It explores the conceptualization of good outcomes and support for this group in terms of their quality of life and staff practices. The qualitative indicators of good outcomes for this group using quality of life domains can be used by auditors, community visitors, funders, advocates, or family members to guide observation and judgements about group homes.

The training needs of staff supporting individuals ageing with intellectual disability

BACKGROUND

The issue of ageing within the cohort of people with intellectual disabilities has been an increasing focus for research. However, the training needs of the staff who support them has not been subject of extensive examination.

MATERIALS AND METHODS

A multiround Delphi project was conducted focusing upon the impact ageing issues have on the support provided by disability workers, and what training is required to address the identified areas.

RESULTS

Three rounds of the Delphi identified twenty-six separate important issues. A thematic analysis identified five main themes including Generic Training Issues; Medical Issues; Emerging Ageing Issues Requiring Changing Support; Mental Health Issues; and Quality of Life.

CONCLUSIONS

The study identified a series of training priorities for staff assisting people ageing with an intellectual disability. It would appear possible for many training programmes to be developed and delivered with minimal cost impacts even within rural localities.

Quality of services and quality of life from service providers' perspectives: analysis with focus groups

BACKGROUND

Concepts such as support, quality of life and quality of services are customary in services for people with intellectual disabilities. The identification of the different ways of conceiving, prioritising and implementing these concepts by service providers can help to drive changes to achieve better personal outcomes for this population. The current study aims to identify service providers' perceptions regarding the quality of life of their clients and the quality of services they provide. It also aims to identify similarities and differences of appraisals among professionals, and to identify associations between supports, quality of life and quality of services.

METHOD

Data were collected from 22 service providers who attended three focus groups (professionals, direct support staff, and managers) from whom 424 comments were analysed. Service providers were asked about the required support for users, the meaning of quality of life for those users, and about features that should characterise quality services. Thematic analysis was employed and transcripts of the sessions were coded according to the dimensions of models on supports, quality of life and quality of services. Chi-squared tests were utilised to test for potential differences among groups.

RESULTS

Each professional group has its own priorities concerning required supports. Among the organisation different and potentially conflicting perceptions regarding the meaning of experiencing quality of life coexist. Concerning quality of services, only managers mentioned personal outcomes. Finally, institutionalisation has a negative impact on supports, quality of life and quality of services.

CONCLUSIONS

It is necessary to move beyond a shared awareness of the negative impact of institutionalisation towards the transformation of services in search of personal quality outcomes.

The use of evidence-based outcomes in systems and organizations providing services and supports to persons with intellectual disability

This article describes how evidence-based outcomes (EBOs) can be used to improve clinical, managerial, and policy decisions. As a component of evidence-based practices, EBOs are defined as measures obtained from the assessment of quality of life-related indicators that are based on a cross-culturally validated quality of life conceptual and measurement model, have utility in that they can be used for multiple purposes, and have robustness in reference to reliability and validity of the assessment strategy employed. A 5-component EBO model is described that provides a framework for the activities involved in selecting, developing, and implementing evidence-based outcomes. Three international examples based on the reliable, valid, and standardized assessment of individual quality of life outcomes are presented that demonstrate how EBOs can be used to improve clinical, managerial, and policy decision making. The article concludes with a discussion of guidelines for developing and using EBOs, and the challenges involved in their use.

Persons with multiple disabilities accessing stimulation and requesting social contact via microswitch and VOCA devices: new research evaluation and social validation

The first of these two studies assessed whether 11 participants with multiple disabilities of 5.3-18.2 (M=10.7) years of age would succeed in combining a microswitch for accessing preferred environmental stimuli and a Voice Output Communication Aid (VOCA) for requesting social contact. The second study conducted a social validation assessment of the aforementioned microswitch-VOCA combination. Data showed that all participants learned to use the microswitch and the VOCA. Moreover, the 10 participants, who received a 1-month post-intervention check, largely maintained their responding. The social validation assessment indicated that the raters (i.e., 110 university psychology students) favored the combination of microswitch and VOCA over the microswitch or the VOCA alone, and hypothetical combinations of microswitches or VOCAs.

The conceptualization and measurement of quality of life: implications for program planning and evaluation in the field of intellectual disabilities

The concept of quality of life (QOL) is increasingly being used in the field of intellectual disabilities as a conceptual and measurement framework for program planning and evaluation. This article describes the development of a QOL conceptual and measurement framework, and summarizes how this framework is currently being used both nationally and internationally to assess and report personal QOL-related outcomes, to guide quality improvement strategies, and to evaluate the effectiveness of those strategies. Implications of such use are discussed, including those related to understanding mental models, developing internal data systems, supporting organization change, and building on current public policies. The article concludes with reference to the evolving nature of the QOL concept and the impact of this on model development and transdisciplinary research.

Three persons with multiple disabilities accessing environmental stimuli and asking for social contact through microswitch and VOCA technology

BACKGROUND

Direct access to environmental stimuli and opportunity to ask for social contact/attention may be considered highly relevant objectives for persons with multiple disabilities. We assessed the possibility of enabling three of these persons (two children and one adolescent) to combine two microswitches (for accessing environmental stimuli) and a Voice Output Communication Aid (VOCA), which allowed them to ask for caregiver's attention.

METHODS

Initially, the participants were required to use each of the two microswitches individually and then together. Thereafter, they were taught to use the VOCA. Eventually, the VOCA was available together with the microswitches, and the participants could use any of the three.

RESULTS

The results, which support preliminary data on this topic, showed that all participants (1) were able to operate the two microswitches as well as the VOCA; and (2) used all three of them consistently when they were simultaneously available.

CONCLUSIONS

Teaching persons with multiple disabilities to combine a VOCA with conventional microswitches may enrich their general input, emphasize their active social role and eventually enhance their social image.