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Weise J, Cvejic R, Trollor J. Strategies for Accessible Breast Screening for People With Intellectual Disability. J Prim Care Community Health 2024; 15:21501319241251938. [PMID: 38708679 DOI: 10.1177/21501319241251938] [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] [Indexed: 05/07/2024] Open
Abstract
INTRODUCTION People with intellectual disability are less likely to participate in breast screening than people without intellectual disability. They experience a range of barriers to accessing breast screening, however, there is no consensus on strategies to overcome these barriers. Our objective was to reach consensus on the strategies required for accessible breast screening for people with intellectual disability. METHODS Fourteen experts participated in a modified on-line Delphi that used Levesque's model of health care access as the theoretical framework. At the end of each round descriptive and thematic analyses were completed. Data was then triangulated to determine if consensus was reached. RESULTS After 3 rounds, 9 strategies were modified, 24 strategies were added and consensus was reached for 52 strategies across the 5 dimensions of access. Key areas of action related to (i) decision making and consent, (ii) accessible information, (iii) engagement of peer mentors, (iv) service navigators, and (v) equipping key stakeholders. CONCLUSIONS The resulting strategies are the first to articulate how to make breast screening accessible and can be used to inform health policy and quality improvement practices.
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Clements KM, Mitra M, Zhang J, Parish SL. Postpartum Health Care Among Women With Intellectual and Developmental Disabilities. Am J Prev Med 2020; 59:437-444. [PMID: 32605865 PMCID: PMC8204383 DOI: 10.1016/j.amepre.2020.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 03/05/2020] [Accepted: 03/10/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Postpartum health care among women with intellectual and developmental disabilities has not been well studied. This study uses administrative claims to compare postpartum outpatient visits among women with and without intellectual and developmental disabilities. METHODS Massachusetts All Payers Claims Database 2012-2015 was used to identify women with intellectual and developmental disabilities and a live birth during 2012-2014, matched by infant birth year to 3 women without intellectual and developmental disabilities. Women were followed up for 1 year after delivery. Analyses were conducted in 2019. Poisson regression compared guideline-concordant postpartum and other outpatient visits during the early (21-56 days after delivery) and late (57-365 days after delivery) periods. Types of nonpostpartum care visits were examined. RESULTS Overall, 962 and 2,886 women with and without intellectual and developmental disabilities, respectively, comprised the sample. Among women with intellectual and developmental disabilities, 23.9% had a postpartum visit in the early and 33.3% in the late postpartum periods, compared with 25.2% and 32.1% of women without intellectual and developmental disabilities who had visits in the early and late postpartum periods, respectively (p=0.49, 0.59). Women with intellectual and developmental disabilities were more likely to have other outpatient visits than those without intellectual and developmental disabilities, both in the early (63.1% vs 40.3%, adjusted RR=1.42, 95% CI=1.28, 1.58, p<0.001) and late (94.2% vs 82.3%, RR=1.11, 95% CI=1.08, 1.14, p=0.008) postpartum periods. Ancillary services, home health services, and alcohol/drug-related visits were much more common among women with intellectual and developmental disabilities. CONCLUSIONS Women with intellectual and developmental disabilities are equally likely to receive guideline-concordant postpartum visits and more likely to have other outpatient visits than other women. Further research is needed to evaluate visit quality and identify best practices to support mothers with intellectual and developmental disabilities during the postpartum period.
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Affiliation(s)
- Karen M Clements
- Commonwealth Medicine Division, University of Massachusetts Medical School, Shrewsbury, Massachusetts.
| | - Monika Mitra
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Jianying Zhang
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Susan L Parish
- College of Health Professions, Virginia Commonwealth University, Richmond, Virginia
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McCarron M, Cleary E, McCallion P. Health and Health-Care Utilization of the Older Population of Ireland: Comparing the Intellectual Disability Population and the General Population. Res Aging 2017; 39:693-718. [DOI: 10.1177/0164027516684172] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background/Objectives: Largely unresearched are the similarities and differences compared to the general population in the aging of people with an intellectual disability (ID). Data reported here compare the health and health-care utilization of the general aging population in Ireland with those who are aging with ID. Design: Data for comparisons were drawn from the 2010 The Irish Longitudinal Study on Ageing (TILDA) and the Intellectual Disability Supplement (IDS)-TILDA Wave 1 data sets. Setting: TILDA participants were community dwelling only while IDS-TILDA participants were drawn from community and institutional settings. Participants: TILDA consists of a sample of 8,178 individuals aged 50 years and older who were representative of the Irish population. The IDS-TILDA consists of a random sample of 753 persons aged 40 and older. Using age 50 as the initial criterion, 478 persons with ID were matched with TILDA participants on age, sex, and geographic location to create the sample for this comparison. Measurements: Both studies gathered self-reported data on physical and mental health, behavioral health, functional limitations, and health-care utilization. Results: Rates of chronic disease appeared higher overall for people with ID as compared to the general population. There were also age-related differences in the prevalence of diabetes and cancer and different rates of engagement between the two groups in relevant behavioral health activities such as smoking. There were higher utilization levels among IDS-TILDA participants for allied health and general practitioner visits. Conclusion: Different disease trajectories found among IDS-TILDA participants raise concerns. The longitudinal comparison of data for people with ID and for the general population offered a better opportunity for the unique experiences of people with ID to be included in data that inform health planning.
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Affiliation(s)
- Mary McCarron
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Eimear Cleary
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Philip McCallion
- Center for Excellence in Aging and Community Wellness, University at Albany, Albany, NY, USA
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Trétarre B, Bourgarel S, Stoebner-Delbarre A, Jacot W, Bessaoud F, Satge D. Breast cancer and screening in persons with an intellectual disability living in institutions in France. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2017; 61:266-278. [PMID: 27624823 DOI: 10.1111/jir.12336] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 07/29/2016] [Accepted: 08/10/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND We aimed to describe, among a population of women with intellectual disabilities (ID) living in institutions in France, the characteristics in whom breast cancer (BC) was diagnosed and of those who participated in BC screening. METHODS Study was performed in 2009 among a random, representative sample of women with ID living in institutions in France. Participants answered a questionnaire either directly by themselves, or with the help of an intermediary. RESULTS In total, 978 women with ID aged over 18 years were included, and 14 were diagnosed with BC. The incidence observed in this sample of women with ID is similar to that of the general population (standardised incidence ratio, SIR 0.857, 95% confidence interval (CI) 0.42-1.53). Average age at diagnosis was 47.8 years, and the risk of developing BC before the age of 50 was 2.03% (0.4-3.66). This risk was not significantly different from that of the general population (2.4%, 1.0-3.78). Obesity was almost twice as frequent in women who had BC as compared to those without BC (43% vs. 22.5%, P = 0.0196). Among the 310 women aged >50 years and eligible for the national BC screening programme, 238 (77%) had already had at least one mammogram, and 199 had had it within the previous 2 years. Adherence to the screening programme was 64.2% (199/310) in the participating institutions. This rate was slightly higher than the national average of 62% for the same period. CONCLUSIONS The results of this study show that BC is equally as frequent among women with ID living in institutions as in the general population, and occurs at around the same age. Obesity was significantly more frequent among women in whom BC was diagnosed in our study. Participation in BC screening is slightly higher among women with ID living in institutions than among the general population.
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Affiliation(s)
- B Trétarre
- Registre des tumeurs de l'Hérault, 298 rue des Apothicaires, Montpellier Cedex 5, France
| | - S Bourgarel
- Centre régional d'études, d'actions et d'information sur le handicap (CREAI) PACA et Corse, Marseille, France
| | - A Stoebner-Delbarre
- Institut regional du Cancer de Montpellier, Department of Supportive Care, Montpellier, Languedoc-Roussillon, France
| | - W Jacot
- Institut regional du Cancer de Montpellier, Department of Medical Oncology, Montpellier, Languedoc-Roussillon, France
| | - F Bessaoud
- Registre des tumeurs de l'Hérault, 298 rue des Apothicaires, Montpellier Cedex 5, France
| | - D Satge
- Oncodefi, Montpellier, France, and Institut Universitaire de Recherche Clinique de Montpellier (IURC), Montpellier, France
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Lin JD, Lin LP, Hsu SW. Aging People with Intellectual Disabilities: Current Challenges and Effective Interventions. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2016. [DOI: 10.1007/s40489-016-0082-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Shooshtari S, Temple B, Waldman C, Abraham S, Ouellette-Kuntz H, Lennox N. Stakeholders’ Perspectives towards the Use of the Comprehensive Health Assessment Program (CHAP) for Adults with Intellectual Disabilities in Manitoba. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2016; 30:672-683. [DOI: 10.1111/jar.12261] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Shahin Shooshtari
- Faculty of Health Sciences; Department of Community Health Sciences; St. Amant Research Centre; University of Manitoba; Winnipeg MB Canada
| | - Beverley Temple
- Faculty of Health Sciences; College of Nursing; St. Amant Research Centre; University of Manitoba; Winnipeg MB Canada
| | - Celeste Waldman
- Faculty of Health Sciences; College of Nursing; St. Amant Research Centre; University of Manitoba; Winnipeg MB Canada
| | - Sneha Abraham
- Faculty of Health Sciences; Department of Community Health Sciences; University of Manitoba; Winnipeg MB Canada
| | | | - Nicholas Lennox
- The Queensland Centre for Intellectual and Developmental Disability; School of Medicine; South Brisbane QLD Australia
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Bishop KM, Hogan M, Janicki MP, Keller SM, Lucchino R, Mughal DT, Perkins EA, Singh BK, Service K, Wolfson S. Guidelines for dementia-related health advocacy for adults with intellectual disability and dementia: National Task Group on Intellectual Disabilities and Dementia Practices. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2015; 53:2-29. [PMID: 25633379 DOI: 10.1352/1934-9556-53.1.2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Increasing numbers of adults with intellectual disabilities (ID) are living into old age. Though this indicates the positive effects of improved health care and quality of life, the end result is that more adults with ID are and will be experiencing age-related health problems and also exhibiting symptoms of cognitive impairment and decline, some attributable to dementia. Early symptoms of dementia can be subtle and in adults with ID are often masked by their lifelong cognitive impairment, combined with the benign effects of aging. A challenge for caregivers is to recognize and communicate symptoms, as well as find appropriate practitioners familiar with the medical issues presented by aging adults with lifelong disabilities. Noting changes in behavior and function and raising suspicions with a healthcare practitioner, during routine or ad hoc visits, can help focus the examination and potentially validate that the decline is the result of the onset or progression of dementia. It can also help in ruling out reversible conditions that may have similar presentation of symptoms typical for Alzheimer's disease and related dementias. To enable caregivers, whether family members or staff, to prepare for and advocate during health visits, the National Task Group on Intellectual Disabilities and Dementia Practices has developed guidelines and recommendations for dementia-related health advocacy preparation and assistance that can be undertaken by provider and advocacy organizations.
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Greenwood NW, Dreyfus D, Wilkinson J. More than just a mammogram: breast cancer screening perspectives of relatives of women with intellectual disability. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2014; 52:444-455. [PMID: 25409131 DOI: 10.1352/1934-9556-52.6.444] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Women with intellectual disability (ID) have similar rates of breast cancer as the general public, but higher breast cancer mortality and lower rates of regular screening mammography. Screening rates are lowest among women who live with their families. Though women with ID often make decisions in partnership with their relatives, we lack research related to family member perspectives on mammography. We conducted a qualitative study of family members of women with ID, with an interview guide focused on health care decision making and experiences, and breast cancer screening barriers, facilitators, and beliefs as related to their loved ones. Sixteen family members underwent semistructured interviews. Important themes included mammography as a reference point for other social and cultural concerns, such as their loved one's sexuality or what it means to be an adult woman; fear of having to make hard decisions were cancer to be diagnosed acting as a barrier to screening; a focus on quality of life; and desire for quality health care for their loved one, though quality care did not always equate to regular cancer screening. Adults with ID are valued members of their families, and their relatives are invested in their well-being. However, families fear the potentially complicated decisions associated with a cancer diagnosis and may choose to forgo screening due to misinformation and a focus on quality of life. Effective interventions to address disparities in mammography should focus on adults with ID and their families together, and incorporate the family context.
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Iacono T, Bigby C, Unsworth C, Douglas J, Fitzpatrick P. A systematic review of hospital experiences of people with intellectual disability. BMC Health Serv Res 2014; 14:505. [PMID: 25344333 PMCID: PMC4210514 DOI: 10.1186/s12913-014-0505-5] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 10/09/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with intellectual disability are at risk of poor hospital experiences and outcomes. The aims were to conduct a content and quality review of research into the acute hospital experiences of both people with intellectual disabilities and their carers, and to identify research gaps. METHOD A systematic search was conducted of primary research between 2009 and 2013 that addressed the experiences of the target group in general acute care hospitals. Quality appraisal tools yielded scores for quantitative and qualitative studies, and overarching themes across studies were sought. RESULTS Sixteen studies met inclusion criteria. Quality scores were 6/8 for a survey, and 2/11-9/11 (mean =5.25) for qualitative studies/components. Content analysis revealed seven over-arching themes covering individuals' fear of hospital encounters, carer responsibilities, and problems with delivery of care in hospitals including staff knowledge, skills and attitudes. CONCLUSIONS Our review of eligible papers revealed that despite 20 years of research and government initiatives, people with intellectual disability continue to have poor hospital experiences. The need for research to identify and investigate care at specific points of encounter across a hospital journey (such as admission, diagnostic testing, placement on a ward, and discharge) as well as to include people with a diversity of disabilities is discussed in terms of potential to influence policy and practice across health and disability sectors.
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Affiliation(s)
- Teresa Iacono
- />La Trobe Rural Health School, La Trobe University, Bendigo, PO Box 199, Bendigo, Victoria 3552 Australia
| | - Christine Bigby
- />Department of Social Work and Social Policy, La Trobe University, Melbourne, Australia
| | - Carolyn Unsworth
- />Department of Occupational Therapy, La Trobe University, Melbourne, Australia
| | - Jacinta Douglas
- />Department of Human Communication Sciences, La Trobe University, Melbourne, Australia
| | - Petya Fitzpatrick
- />Department of Social Work and Social Policy, La Trobe University, Melbourne, Australia
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Wang CT, Greenwood N, White LF, Wilkinson J. Measuring preparedness for mammography in women with intellectual disabilities: a validation study of the Mammography Preparedness Measure. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2014; 28:212-22. [PMID: 25266546 DOI: 10.1111/jar.12123] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND Women with intellectual disabilities have similar breast cancer rates as the general population, but lower rates of regular mammography and higher breast cancer mortality rates. Although prior qualitative work demonstrates that women with intellectual disabilities face unique, disability-specific barriers to mammography, the present authors lack standardized, validated instruments for measuring knowledge of breast cancer screening in this population. In addition, much research related to adults with intellectual disabilities focuses on family or carer perspectives, rather than involving women with intellectual disabilities, themselves. METHODS The present authors first pilot tested a general population instrument measuring breast cancer knowledge, and found that it did not perform adequately in women with intellectual disabilities. In response, the present authors developed the Mammography Preparedness Measure (MPM), a direct short interview tool to measure knowledge and preparedness in women with intellectual disabilities, themselves, rather than relying on caregiver or other reports, and using inclusive methodology. The present authors validated the MPM by assessing test-retest reliability. RESULTS Average test-retest per cent agreement of 84%, ranging from 74 to 91% agreement per item, with an overall kappa of 0.59. CONCLUSION The MPM appears to be a valid instrument appropriate for measuring mammography preparedness in women with intellectual disabilities. The success of this innovative tool suggests that direct, rather than informant-directed tools can be developed to measure health knowledge and cancer screening readiness in adults with intellectual disabilities, an important measure in studying and reducing disparities.
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Affiliation(s)
- Claire Tienwey Wang
- Department of Family Medicine, Boston University School of Medicine, Boston, MA, USA
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Swaine JG, Parish SL, Luken K, Son E, Dickens P. Test of an intervention to improve knowledge of women with intellectual disabilities about cervical and breast cancer screening. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2014; 58:651-663. [PMID: 23796162 DOI: 10.1111/jir.12062] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/29/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND There is a critical need for evidence-based health education interventions for women with intellectual disabilities (IDs) to promote receipt of preventive health screenings. Previous research has established Women Be Healthy, an 8-week classroom-style intervention designed to teach women with IDs about breast and cervical cancer screenings, as a promising practice. However, additional research is needed to determine how to further improve screening-related knowledge gains. This study aimed to test a modified version of Women Be Healthy, Women Be Healthy 2, and compare its effectiveness in increasing knowledge gains to the original intervention. METHOD Women living in the community across one state in the United States were randomly assigned to a treatment (n = 98), delayed treatment, (n = 35), or no intervention group (n = 65). Women in the treatment group received Women Be Healthy, and women in the delayed treatment group received the modified Women Be Healthy 2. Baseline and post-intervention interviews were conducted to measure knowledge of cervical and breast cancer screening. Knowledge scores were compared across groups. RESULTS Among the nine knowledge items measured, one breast knowledge measure and one cervical knowledge measure showed statistically significant group differences; marginally significant differences were observed for two other knowledge measures. After adjusting for covariates, women who received Women Be Healthy 2 had increased knowledge overall compared with the women receiving no intervention. CONCLUSION Women Be Healthy 2 is promising, but additional efforts appear necessary to increase the knowledge women with IDs have about cervical and breast cancer screening.
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Affiliation(s)
- J G Swaine
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
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Wilkinson J, Lauer E, Greenwood NW, Freund KM, Rosen AK. Evaluating representativeness and cancer screening outcomes in a state department of developmental services database. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2014; 52:136-146. [PMID: 24725112 DOI: 10.1352/1934-9556-52.2.136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Though it is widely recognized that people with intellectual and developmental disabilities (IDD) face significant health disparities, the comprehensive data sets needed for population-level health surveillance of people with IDD are lacking. This paucity of data makes it difficult to track and accurately describe health differences, improvements, and changes in access. Many states maintain administrative health databases that, to date, have not been widely used for research purposes. In order to evaluate the feasibility of using administrative databases for research purposes, the authors attempted to validate Massachusetts' administrative health database by comparing it to a large safety net hospital system's patient data regarding cancer screening, and to the state's service enrollment tables. The authors found variable representativeness overall; the sub-population of adults who live in 24-hr supported residences were better represented than adults who live independently or with family members. They also found a fairly low false negative rate for cancer screening data as compared with the "gold standard" of hospital records. Despite some limitations, these results suggest that state-level administrative databases may represent an exciting new avenue for health research. These results should lend context to efforts to study cancer and health screening variables using administrative databases. The present study methods may also have utility to researchers in other states for critically evaluating other state IDD service databases. This type of evaluation can assist researchers in contextualizing their data, and in tailoring their research questions to the abilities and limitations of this kind of database.
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Wilkinson J, Greenwood NW, Wang CT, White LF, Culpepper L. Measuring staff empowerment regarding health care for clients with intellectual disabilities. INTERNATIONAL JOURNAL OF FAMILY MEDICINE 2014; 2014:678127. [PMID: 24719760 PMCID: PMC3955629 DOI: 10.1155/2014/678127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 01/09/2014] [Accepted: 01/12/2014] [Indexed: 06/03/2023]
Abstract
Background. Women with intellectual disabilities (ID) contract breast cancer at the same rate as the general population but have higher breast cancer mortality and lower rates of breast cancer screening. Many women with ID live in group homes or supported residences where they are cared for by direct support workers. While direct support workers are thought to influence client health, this effect is underresearched, and we lack tools for measuring staff empowerment and perceptions regarding client health. Methods. We developed and validated an instrument, the staff empowerment tool (SET), to measure staff empowerment as related to supporting clients in preventive health. Results. The SET was found to be a reliable instrument for measuring staff activation and empowerment in helping clients access mammography screening. Discussion. Quantifying staff empowerment and perspectives is important in studying and reducing disparities among adults with ID, a vulnerable population. Further research to determine the impact of staff empowerment levels on their clients' health and health care access is suggested. The SET is a valuable tool for measuring the construct of staff empowerment, evaluating interventions, and collecting data regarding variation in staff empowerment.
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Affiliation(s)
- Joanne Wilkinson
- Department of Family Medicine, Boston University School of Medicine, Dowling 5, 771 Albany Street, Boston, MA 02118, USA
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | - Nechama W. Greenwood
- Department of Family Medicine, Boston University School of Medicine, Dowling 5, 771 Albany Street, Boston, MA 02118, USA
| | - Claire Tienwey Wang
- Department of Family Medicine, Boston University School of Medicine, Dowling 5, 771 Albany Street, Boston, MA 02118, USA
| | - Laura F. White
- Department of Biostatistics, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
| | - Larry Culpepper
- Department of Family Medicine, Boston University School of Medicine, Dowling 5, 771 Albany Street, Boston, MA 02118, USA
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Wilkinson J, Dreyfus D, Bowen D, Bokhour B. Patient and provider views on the use of medical services by women with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2013; 57:1058-1067. [PMID: 22974084 DOI: 10.1111/j.1365-2788.2012.01606.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND People with intellectual disabilities (ID) receive primary care in community-based practices and are encouraged to participate in the physician-patient relationship. However, the nature of this participation is not known. METHODS Qualitative data were analysed to obtain perspectives from patients and providers regarding clinic visits. Patient participants were recruited from community organisations, while physician participants were recruited from emails and phone calls to local and regional practices and a national and regional list serve. Analysis methods derived from grounded theory were used. RESULTS Twenty-seven women with ID and 22 family physicians were interviewed. Themes important to both groups included time, how the support worker should be used in the encounter and the nature of the physician-patient relationship. Patients expressed frustration at how little time they spent with their physician, and wished that physicians would speak directly to them instead of to their support worker. Physicians felt that patients with ID took too much time, and said that they preferred communicating with the support worker. The interviews also revealed unconscious biases about people with ID. CONCLUSIONS Patient participation is encouraged for people with ID, but is limited because of both physician and patient factors. Greater awareness of these factors may improve care for patients with ID.
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Affiliation(s)
- J Wilkinson
- Family Medicine, Boston University School of Medicine, Boston, MA, USA Community Health Sciences, Boston University School of Public Health, Boston, MA, USA Health Policy and Management, Boston University School of Public Health, Boston, MA, USA
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Parish SL, Swaine JG, Son E, Luken K. Determinants of cervical cancer screening among women with intellectual disabilities: evidence from medical records. Public Health Rep 2013; 128:519-26. [PMID: 24179263 PMCID: PMC3804095 DOI: 10.1177/003335491312800611] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We examined receipt of cervical cancer screening and determinants of screening for women with intellectual disabilities in one Southeastern state. METHODS Using medical records data from 2006 through 2010 for community-dwelling women with intellectual disabilities who were 18-65 years of age (n=163), we employed descriptive and bivariate statistics and a multivariate regression model to examine receipt of cervical cancer screening and the determinants of cervical cancer screening across women's sociodemographic and health-care provider characteristics. RESULTS Of women 18-65 years of age with intellectual disabilities, 55% received a Papanicolaou (Pap) test during 2008-2010, markedly below the Healthy People 2020 targets or rates of Pap test receipt of women without intellectual disabilities. Women with intellectual disabilities who lived in residential facilities, those who lived in rural communities, and those who had an obstetrician/gynecologist had higher rates of receipt of care than other women with intellectual disabilities. CONCLUSIONS Assertive measures are required to improve the receipt of cervical cancer screening among women with intellectual disabilities. Such measures could include education of women with intellectual disabilities, as well as their paid and family caregivers, and incentives for health-care providers who achieve screening targets.
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Affiliation(s)
- Susan L. Parish
- Brandeis University, Heller School for Social Policy and Management, Lurie Institute for Disability Policy, Waltham, MA
| | - Jamie G. Swaine
- University of North Carolina at Chapel Hill, School of Social Work, Chapel Hill, NC
| | - Esther Son
- Brandeis University, Heller School for Social Policy and Management, Lurie Institute for Disability Policy, Waltham, MA
| | - Karen Luken
- University of North Carolina at Chapel Hill, FPG Child Development Institute, North Carolina Office on Disability and Health, Chapel Hill, NC
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Swaine JG, Parish SL, Luken K. Breast and cervical cancer screening for women with intellectual disabilities. HEALTH & SOCIAL WORK 2013; 38:183-186. [PMID: 24437024 DOI: 10.1093/hsw/hlt012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Jamie G Swaine
- School of Social Work, University of North Carolina at Chapel Hill, USA
| | - Susan L Parish
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02454, USA
| | - Karen Luken
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, USA
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Son E, Parish SL, Swaine JG, Luken K. Accuracy of self-reported cervical and breast cancer screening by women with intellectual disability. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2013; 118:327-336. [PMID: 23937373 DOI: 10.1352/1944-7558-188.4.327] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This study examines the accuracy of self-report of cervical and breast cancer screening by women with intellectual disability (n = 155). Data from face-to-face interviews and medical records were analyzed. Total agreement, sensitivity, specificity, positive predictive value and negative predictive value were calculated. Total agreement between self-report and medical record on receipt of both procedures was 75% for Pap test and 87% for mammography. Self-reported Pap tests and mammography showed >90% sensitivity, but specificity was low for both procedures (41% for Pap test, 30% for mammogram), indicating overreporting of receipt of Pap tests and mammography similar to women without disabilities. Clinicians and researchers are cautioned to corroborate self-reported data with other sources for patients and research participants with intellectual disability.
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Marks B, Sisirak J, Chang YC. Efficacy of the HealthMatters Program
Train-the-Trainer Model. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2013; 26:319-34. [DOI: 10.1111/jar.12045] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Beth Marks
- Rehabilitation Research and Training Center on Aging with Developmental Disabilities; Department of Disability and Human Development; College of Applied Health Sciences; University of Illinois at Chicago; Chicago IL USA
| | - Jasmina Sisirak
- Rehabilitation Research and Training Center on Aging with Developmental Disabilities; Department of Disability and Human Development; College of Applied Health Sciences; University of Illinois at Chicago; Chicago IL USA
| | - Yen-Ching Chang
- Department of Healthcare Administration; I-Shou University; Kaohsiung Taiwan
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Swaine JG, Parish SL, Ghosh S, Luken K, Wright GA. Obtaining Medical Records for Women With Intellectual Disabilities in a Community-Based Health Promotion Intervention. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2013. [DOI: 10.1111/jppi.12022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Jamie G. Swaine
- School of Social Work; University of North Carolina at Chapel Hill; Chapel Hill NC USA
- Lurie Institute for Disability Policy; Heller School for Social Policy and Management; Brandeis University; Waltham MA USA
| | - Susan L. Parish
- Lurie Institute for Disability Policy; Heller School for Social Policy and Management; Brandeis University; Waltham MA USA
| | - Subharati Ghosh
- Lurie Institute for Disability Policy; Heller School for Social Policy and Management; Brandeis University; Waltham MA USA
| | - Karen Luken
- North Carolina Office on Disability and Health; FPG Child Development Institute; University of North Carolina at Chapel Hill; Chapel Hill NC USA
| | - Grace A. Wright
- North Carolina Office on Disability and Health; FPG Child Development Institute; University of North Carolina at Chapel Hill; Chapel Hill NC USA
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Swaine JG, Dababnah S, Parish SL, Luken K. Family caregivers' perspectives on barriers and facilitators of cervical and breast cancer screening for women with intellectual disability. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2013; 51:62-73. [PMID: 23360409 DOI: 10.1352/1934-9556-51.01.062] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Women with intellectual disability do not receive cervical and breast cancer screening at the same number as women without disabilities. Numerous barriers to receipt of screening have been reported by individuals with intellectual disability, paid caregivers, nurses, and other medical professionals. This study utilized semi-structured qualitative interviews to assess barriers to care from the perspective of female familial caregivers (n = 32). Caregivers reported a number of barriers to care including not knowing or not believing the exam was needed for their family member and discomfort during exams. Caregivers also described enablers to screening. The most common response to what enabled the woman with an intellectual disability to receive the exam was preparation prior to the exam. A significant portion of the sample of family caregivers lacked knowledge about the need for cervical and breast cancer screening by women with intellectual disability. Policy recommendations are discussed.
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Greenwood NW, Wilkinson J. Sexual and reproductive health care for women with intellectual disabilities: a primary care perspective. INTERNATIONAL JOURNAL OF FAMILY MEDICINE 2013; 2013:642472. [PMID: 24455249 PMCID: PMC3876698 DOI: 10.1155/2013/642472] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 09/19/2013] [Accepted: 10/03/2013] [Indexed: 05/22/2023]
Abstract
Adults with intellectual disabilities (ID) face multiple health disparities and challenges to accessing health care. Little is known about sexual health care of this population and about how to optimize women's reproductive health care for women with intellectual disabilities. Women with ID face important barriers to care, including lack of provider training and experience, hesitancy to broach the topic of sexual health, a lack of sexual knowledge and limited opportunities for sex education, disability-related barriers, higher prevalence of sexual abuse and assault, often underreported, lack of dialogue around this population's human right to consensual sexual expression, undertreatment of menstrual disorders, and legal and systemic barriers. We conducted a limited literature review related to six aspects of sexual health care of women with ID, including barriers to sexual health care, sex education, sexual abuse and consensual sexuality, contraception, screening for sexually transmitted infections and cervical cancer, and pregnancy and parenting. After providing background information about each topic, we suggest practice recommendations for primary care clinicians, using a rights-based framework.
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Affiliation(s)
- Nechama W. Greenwood
- Department of Family Medicine, Boston University School of Medicine, Dowling 5, 771 Albany Street, Boston, MA 02118, USA
- *Nechama W. Greenwood:
| | - Joanne Wilkinson
- Department of Family Medicine, Boston University School of Medicine, Dowling 5, 771 Albany Street, Boston, MA 02118, USA
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, 4th floor, Boston, MA 02118, USA
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McCallion P, Burke E, Swinburne J, McGlinchey E, Carroll R, McCarron M. The influence of environment, predisposing, enabling and need variables on personal health choices of adults with intellectual disability. Health (London) 2013. [DOI: 10.4236/health.2013.54099] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Iacono T, Lewis B, Tracy J, Hicks S, Morgan P, Récoché K, McDonald R. DVD-based stories of people with developmental disabilities as resources for inter-professional education. Disabil Rehabil 2011; 33:1010-21. [DOI: 10.3109/09638288.2010.520802] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Marks B, Sisirak J, Hsieh K. Health services, health promotion, and health literacy: report from the State of the Science in Aging with Developmental Disabilities Conference. Disabil Health J 2011; 1:136-42. [PMID: 21122722 DOI: 10.1016/j.dhjo.2008.04.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Revised: 04/30/2008] [Accepted: 04/30/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND This article summarizes the proceedings of the Health Services, Health Promotion, and Health Literacy work group that was part of the "State of the Science in Aging with Developmental Disabilities: Charting Lifespan Trajectories and Supportive Environments for Healthy Living." Participants aimed to identify unmet needs related to health and health care and to determine training, research, and policy needs addressing the demands for increasing health care services and resources, end-of-life and palliative care, and health literacy. METHODS Key issues addressed included (1) major health-related disparities for adults with intellectual and developmental disabilities (I/DD); (2) the impact of internal and external factors on health care services and resources, end-of-life and palliative care, and health literacy for adults with I/DD; and (3) frameworks that can be used for understanding and promoting health care services and resources, end-of-life and palliative care, and health literacy. RESULTS Group participants identified research and practice needs related to primary care, health promotion, disease prevention, illness care, end-of-life issues, and palliative care. CONCLUSIONS Health care services for adults with I/DD may occur in a variety of settings including community-based programs, private practices, and community-based agencies supporting persons with disabilities. Major gaps relate to health disparities due to underdiagnosis, misdiagnosis, less chance of receiving prompt treatment, limited access to providers, lack of research information, transportation barriers, and lack of accessible medical equipment. Models of care including variables related to translation, sustainability, accessibility (e.g., affordability, availability), acceptability (e.g., culturally relevant, satisfaction), and equity need to be developed.
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Affiliation(s)
- Beth Marks
- Rehabilitation Research and Training Center on Aging with Developmental Disabilities and Department of Disability and Human Development, University of Illinois at Chicago, Chicago, IL 60608-6904, USA.
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Iacono T, West D, Bloomberg K, Johnson H. Reliability and validity of the revised Triple C: Checklist of Communicative Competencies for adults with severe and multiple disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2009; 53:44-53. [PMID: 18759959 DOI: 10.1111/j.1365-2788.2008.01121.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
AIMS Few tools are available to assess the communication skills of adults with severe and multiple disabilities functioning at unintentional to early symbolic levels. An exception is the Triple C: Checklist of Communicative Competencies. In this study, aspects of support worker and clinician agreement, internal consistency and construct validity of a revised version of the Triple C were explored. METHOD Triple C checklists were completed for 72 adults with severe intellectual disabilities (ID) by 118 support workers and stages were assigned by the researchers. Two support workers completed checklists for each of 68 adults with ID. Three researchers also conducted direct observations of 20 adults with ID. RESULTS The average support worker agreement for items across the five stages of the Triple C ranged from 81% to 87%; agreement for stage assignment based on first and second support worker checklists was moderate to high (k = 0.63). Internal consistency was high (KR20 = 0.97); the stages were found to tap one factor (accounting for approximately 74% of variance), interpreted to be unintentional to early symbolic communication. Agreements between stages based on researcher observations and support worker-completed checklists were 35% and 71% across first and second support workers. CONCLUSION The revised Triple C provides a reliable means of gathering data on which to determine the communication skills of adults with severe and multiple disabilities. The results support a collaborative use of the Triple C, such that a speech-language pathologist or other communication specialist works with a support worker to ensure understanding of the skills observed and development of appropriate intervention strategies.
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Affiliation(s)
- T Iacono
- Centre for Developmental Disability Health Victoria, Monash University, Melbourne, Victoria, Australia.
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