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Lucassen L, Rinaldi R, Batsele E. Interplay between representations, practices, and stigma variables towards people with intellectual disabilities among healthcare professionals: A cross-sectional study. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2024:17446295241259913. [PMID: 38841896 DOI: 10.1177/17446295241259913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
Disparities in healthcare are observed among people with intellectual disabilities. They generally face stigmatisation and negative attitudes from healthcare professionals. The aim of this study is to investigate the link of diagnostic label and social distance on inclusive health representations and practices towards people with intellectual disabilities among healthcare professionals. We conducted an online survey of 163 healthcare professionals living in French-speaking Belgium. The results highlighted that the diagnostic label and a lower social distance predict better representations and practices in inclusive health. In addition, an analysis of mediation showed the mediating effect of social distance on the link between being in contact with people with intellectual disabilities (through employment) and better representations and practices in inclusive health. This study enabled us to assess the interplay between stigma variables and healthcare professionals' representations and practices towards people with intellectual disabilities and to identify potential facilitators for promoting health equity.
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Kildahl AN. Bias in assessment of co-occurring mental disorder in individuals with intellectual disabilities: Theoretical perspectives and implications for clinical practice. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2024; 28:393-414. [PMID: 36708367 PMCID: PMC11059834 DOI: 10.1177/17446295231154119] [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: 06/18/2023]
Abstract
Influence from bias is unavoidable in clinical decision-making, and mental health assessment seems particularly vulnerable. Individuals with intellectual disabilities have increased risk of developing co-occurring mental disorder. Due to the inherent difficulties associated with intellectual disabilities, assessment of mental health in this population often relies on a different set of strategies, and it is unclear how these may affect risk of bias. In this theoretical paper, we apply recent conceptualisations of bias in clinical decision-making to the specific challenges and strategies in mental health assessment in intellectual disabilities. We suggest that clinical decision-making in these assessments is particularly vulnerable to bias, including sources of bias present in mental health assessment in the general population, as well as potential sources of bias which may be specific to assessments in this population. It follows that to manage potential bias, triangulating information from multi-informant, multi-method, interdisciplinary assessment strategies is likely to be necessary.
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Affiliation(s)
- Arvid Nikolai Kildahl
- Arvid Nikolai Kildahl, Regional Section Mental Health, Intellectual Disabilities/Autism, Oslo University Hospital, Verkensveien 19, Oslo, Asker 1385, Norway.
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Sanders JS, Williams K, Thompson D, Shapiro HF. Enhancing comfort of resident physicians treating adults with intellectual and developmental disabilities by facilitating meaningful interactions. Front Med (Lausanne) 2024; 11:1264958. [PMID: 38835795 PMCID: PMC11148428 DOI: 10.3389/fmed.2024.1264958] [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: 08/18/2023] [Accepted: 03/25/2024] [Indexed: 06/06/2024] Open
Abstract
Background Many physicians feel uncomfortable caring for patients with intellectual and developmental disabilities (IDD). While some residency training programs include lecture content on IDD, few provide structured experiences with individuals with IDD. One strategy for improving comfort is "contact theory:" increasing interactions with "dissimilar" people can lead to decreased negative attitudes toward that population. Objective Evaluate the impact of an interactive session on resident physicians' comfort with adults with IDD. Methods Small groups of resident physicians and artists with IDD collaborated on art projects during the noon conference. A prospective pre-post-intervention survey, including the validated Interaction with Disabled Persons Scale (IDP), evaluated residents' comfort with patients with IDD before and after the session. Results 53 residents completed both pre- and post-conference surveys. Mean IDP scores decreased from 78.7 (10.9) to 75.8 (9.5; p < 0.01), indicating decreasing discomfort. The mean level of comfort interacting with individuals with IDD increased from uncomfortable 3.6 (1.2), before the intervention, to comfortable 4.4 (1.2) after the intervention (p = <0.01). The mean level of comfort treating individuals with IDD increased from uncomfortable 3.5 (1.1) to comfortable 4.1 (1.3) after the intervention (p < 0.01). Discussion Providing resident physicians with real-life connections with people with IDD was associated with increased comfort. If statistically significant improvements occurred after one session, future studies should evaluate if additional experiences with people with IDD could have more substantial, lasting impacts on future doctors' comfort with and willingness to care for patients with IDD.
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Affiliation(s)
- Jessica Solomon Sanders
- School of Medicine, Department of Pediatrics, Section of Developmental Pediatrics, University of Colorado, Denver, CO, United States
| | - Kathryn Williams
- Boston Children's Hospital, Institutional Centers for Clinical and Translational Research, Biostatistics and Research Design Center, Boston, MA, United States
| | - Darcy Thompson
- School of Medicine, Department of Pediatrics, Section of Nutrition, University of Colorado, Denver, CO, United States
| | - Hannah F Shapiro
- Department of Neurology, UCSF Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA, United States
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Hotez E, Pan M, Jackson N, Rava J, Wisk LE, Lei Y, Schickedanz A, Kuo AA. Health and Well-Being at the Transition to Adulthood Among Individuals With Disabilities: An Analysis of the Panel Study of Income Dynamics. J Adolesc Health 2024; 74:964-970. [PMID: 38340121 DOI: 10.1016/j.jadohealth.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 02/12/2024]
Abstract
PURPOSE To describe positive mental health, or "flourishing," and self-reported health trajectories among transition-aged young adults (TAYA) with developmental/learning and physical disabilities over a 12-year period, utilizing a population-based sample. METHODS This study features a secondary analysis of national data from the Panel Study of Income Dynamics Transition to Adulthood Supplement. The analytic sample included all TAYA with (n = 487) and without (n = 810) disabilities, including developmental/learning disabilities (DD/LD), attention deficit hyperactivity disorder (ADHD), and speech, hearing, and vision impairments who participated in 2017 Transition to Adulthood Supplement data collection (n = 1,297; M age = 24.5, standard deviation = 2.40). We utilized linear mixed modeling to retrospectively describe flourishing and self-reported health trajectories across 12 years among TAYA with and without disabilities between ages 18 to 28, adjusting for demographic and developmental characteristics. RESULTS Relative to TAYA without disabilities, TAYA with speech [0.10, 0.85] and vision impairments [0.10, 0.92], DD/LD [0.38, 1.11], and ADHD [0.27, 0.97] demonstrated lower flourishing. TAYA with speech [0.07, 0.36] and vision impairments [0.08, 0.38], DD/LD [0.15, 0.411], and ADHD [0.14, 0.93] reported lower health. Relative to TAYA with other disabilities, TAYA with ADHD [0.14, 0.93] and DD/LD [0.01, 0.29] reported lower flourishing and health, respectively. Interaction effects and descriptive analyses revealed distinct patterns of change for TAYA with ADHD. DISCUSSION TAYA with disabilities report lower flourishing and health, relative to TAYA without disabilities. TAYA with specific disabilities differ in their flourishing and health trajectories. Findings can inform the development of interventions for TAYA with disabilities.
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Affiliation(s)
- Emily Hotez
- Department of General Internal Medicine & Health Services Research, University of California, Los Angeles (UCLA), David Geffen School of Medicine, Los Angeles, California.
| | - Mengtong Pan
- Department of General Internal Medicine & Health Services Research, University of California, Los Angeles (UCLA), David Geffen School of Medicine, Los Angeles, California
| | - Nicholas Jackson
- Department of General Internal Medicine & Health Services Research, University of California, Los Angeles (UCLA), David Geffen School of Medicine, Los Angeles, California
| | - Julianna Rava
- Department of General Internal Medicine & Health Services Research, University of California, Los Angeles (UCLA), David Geffen School of Medicine, Los Angeles, California
| | - Lauren E Wisk
- Department of General Internal Medicine & Health Services Research, University of California, Los Angeles (UCLA), David Geffen School of Medicine, Los Angeles, California
| | - Yvonne Lei
- Department of General Internal Medicine & Health Services Research, University of California, Los Angeles (UCLA), David Geffen School of Medicine, Los Angeles, California
| | - Adam Schickedanz
- Department of General Internal Medicine & Health Services Research, University of California, Los Angeles (UCLA), David Geffen School of Medicine, Los Angeles, California
| | - Alice A Kuo
- Department of General Internal Medicine & Health Services Research, University of California, Los Angeles (UCLA), David Geffen School of Medicine, Los Angeles, California
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Stone EM, Wise E, Stuart EA, McGinty EE. Experiences of health care services among people with cognitive disabilities and mental health conditions. Disabil Health J 2024; 17:101547. [PMID: 37949697 PMCID: PMC11210385 DOI: 10.1016/j.dhjo.2023.101547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/23/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND People with cognitive disabilities such as intellectual and developmental disabilities face significant barriers to accessing high-quality health care services. Barriers may be exacerbated for those with co-occurring mental health conditions. OBJECTIVE This study compares patient experiences of health care services between adults with and without cognitive disabilities and, among people with a cognitive disability, those with and without co-occurring mental health conditions. METHODS Cross-sectional analyses were conducted using 2021 Medical Expenditure Panel Survey data, a national U.S. survey, to examine differences in Consumer Assessment of Healthcare Providers and Systems measures. RESULTS Adults with cognitive disabilities reported lower satisfaction with health care services compared to the general population (7.62 (95% confidence interval (CI): 7.41-7.83) vs. 8.33 (95% CI: 8.29-8.38) on scale from 0 to 10). Adults with cognitive disabilities were less likely to report that providers listened carefully to them (odds ratio (OR): 0.55, 95% CI: 0.42-0.71), explained things in a way that was easy to understand (OR: 0.48, 95% CI: 0.35-0.66), showed respect for what they had to say (OR: 0.38, 95% CI: 0.29-0.51), spent enough time with them (OR: 0.52, 95% CI: 0.40-0.69), or gave advice that was easy to understand (OR: 0.40, 95% CI: 0.28-0.58) compared to the general population. Among adults with cognitive disabilities, there were no differences based on co-occurring mental health conditions. CONCLUSIONS Adults with cognitive disabilities report lower satisfaction with health care services driven by worse experiences with the health care system. Policies to increase provider capacity to support this population should be prioritized.
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Affiliation(s)
- Elizabeth M Stone
- Center for Health Services Research, Rutgers Institute for Health, Health Care Policy, and Aging Research, 112 Paterson St., New Brunswick, NJ 08901, USA; Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, 671 Hoes Lane, Piscataway, NJ, 08854, USA.
| | - Elizabeth Wise
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 600 N. Wolfe St., Baltimore, MD, 21287, USA
| | - Elizabeth A Stuart
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
| | - Emma E McGinty
- Division of Health Policy and Economics, Department of Population Health Sciences, Weill Cornell Medicine, 402 E. 67th St., New York, NY, 10065, USA
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Wallace RA. A system for developing reasonable adjustments to the application of the National Safety and Quality Health Service Standards for adult patients with intellectual disability in Australian hospital settings. Intern Med J 2024; 54:503-510. [PMID: 38251817 DOI: 10.1111/imj.16321] [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: 02/16/2023] [Accepted: 12/14/2023] [Indexed: 01/23/2024]
Abstract
The Australian Commission of Safety and Quality in Health Care mandates the application of the eight National Safety and Quality Health Service Standards to minimise high-risk adverse events in hospital settings for all Australian patients. It acknowledges that adults with intellectual disability require reasonable adjustments to the application of the standards to optimise the impact of the quality and safety measures for this group. The paper proposes a system whereby reasonable adjustments can be developed for this population. First, particular criteria, items or actions of a standard are selected for the formulation of reasonable adjustments. Second, the adjustments are broken down into categories of alterations to usual knowledge, process, content and organisation involved in compliance with the chosen aspect of the standard. Third, the categories of reasonable adjustments are simultaneously influenced and shaped by aspects of living with intellectual disability, disability supports and a health-disability sectoral interface.
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Affiliation(s)
- Robyn A Wallace
- Calvary Lenah Valley Hospital, Hobart, Tasmania, Australia
- College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
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Molnar C, Strnadová I, Dunn M, Loblinzk J, Sarfaraz S, Cathcart-King Y, Tso M, Danker J, Hayes S, Willow SA, Hansen J, Lim TQ, Boyle J, Terrill B, Scully JL, Palmer EE. The need for co-educators to drive a new model of inclusive, person-centred and respectful co-healthcare with people with intellectual disability. Front Psychiatry 2024; 15:1346423. [PMID: 38414506 PMCID: PMC10896908 DOI: 10.3389/fpsyt.2024.1346423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/29/2024] [Indexed: 02/29/2024] Open
Affiliation(s)
- Chloe Molnar
- Discipline of Paediatrics and Child Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Iva Strnadová
- School of Education, University of New South Wales, Sydney, NSW, Australia
- Disability Innovation Institute, University of New South Wales, Sydney, NSW, Australia
- Self-Advocacy Sydney Inc., Sydney, NSW, Australia
| | - Manjekah Dunn
- Discipline of Paediatrics and Child Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Centre for Clinical Genetics, Sydney Children's Hospitals Network, Sydney, NSW, Australia
| | - Julie Loblinzk
- School of Education, University of New South Wales, Sydney, NSW, Australia
- Self-Advocacy Sydney Inc., Sydney, NSW, Australia
| | | | | | - Michelle Tso
- School of Education, University of New South Wales, Sydney, NSW, Australia
| | - Joanne Danker
- School of Education, University of New South Wales, Sydney, NSW, Australia
| | - Sarah Hayes
- School of Education, University of New South Wales, Sydney, NSW, Australia
| | | | - Jennifer Hansen
- School of Education, University of New South Wales, Sydney, NSW, Australia
| | - Tiffany Qing Lim
- School of Education, University of New South Wales, Sydney, NSW, Australia
| | - Jackie Boyle
- The New South Wales Genetics of Learning Disability (GOLD) Service, Waratah, NSW, Australia
| | - Bronwyn Terrill
- Australian Genomics, Melbourne, VIC, Australia
- Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Jackie Leach Scully
- Disability Innovation Institute, University of New South Wales, Sydney, NSW, Australia
| | - Elizabeth Emma Palmer
- Discipline of Paediatrics and Child Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Centre for Clinical Genetics, Sydney Children's Hospitals Network, Sydney, NSW, Australia
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McMahon M, Lynch L, Wormald A, Eustace-Cook J, McCarron M, McCallion P, Smith V. Prevalence and incidence of cancer amongst adults with intellectual disability - a systematic review and meta-analysis protocol. HRB Open Res 2024; 6:51. [PMID: 38332848 PMCID: PMC10850849 DOI: 10.12688/hrbopenres.13740.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 02/10/2024] Open
Abstract
Background People with intellectual disabilities have poorer health and die earlier than their peers without identified disabilities. This difference represents a significant inequality. Until recently, it was considered that cancer was less common in this population, mainly because they did not live long enough to develop age-related cancers. However, recent evidence has identified that people with intellectual disabilities may be at an increased risk of developing cancer but more likely to present for medical treatment at a later stage when cancer has spread. Nonetheless, the evidence is lacking and there is a need to understand the prevalence and incidence of cancer and subtypes of cancer in adults with intellectual disabilities. Methods A systematic review and meta-analysis will be undertaken to investigate the prevalence and incidence of cancer and subtypes of cancer in adults with an intellectual disability. The JBI Systematic reviews of prevalence and incidence and the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to develop this protocol. Electronic databases will be searched using predefined search terms to identify relevant studies using the Condition Context Population (CoCoPop) framework. Eligible studies should be observational and have published baseline data that have estimated or presented data on the prevalence or incidence of cancer in adults with intellectual disabilities. To assess the methodological quality of studies included in this review a modified version of the JBI Critical Appraisal Checklist for Studies Reporting Prevalence Data will be used. Prevalence and incidence proportions will be analysed separately with individual study data being pooled using the DerSimonian-Laird proportion method and a random effects meta-analysis will be undertaken. Discussion This review will advance the epidemiological evidence to identify where targeted cancer care interventions are needed to help reduce the inequalities that this population experiences. Systematic review registration PROSPERO registration number: CRD42023423584.
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Affiliation(s)
- Martin McMahon
- School of Nursing & Midwifery, The University of Dublin Trinity College, Dublin, D02 PN40, Ireland
- Trinity Centre for Ageing with Intellectual Disability (TCAID), The University of Dublin Trinity College, School of Nursing & Midwifery, Dublin, Ireland
| | - Louise Lynch
- School of Nursing & Midwifery, The University of Dublin Trinity College, Dublin, D02 PN40, Ireland
- Trinity Centre for Ageing with Intellectual Disability (TCAID), The University of Dublin Trinity College, School of Nursing & Midwifery, Dublin, Ireland
| | - Andrew Wormald
- Trinity Centre for Ageing with Intellectual Disability (TCAID), The University of Dublin Trinity College, School of Nursing & Midwifery, Dublin, Ireland
| | - Jessica Eustace-Cook
- School of Nursing & Midwifery, The University of Dublin Trinity College, Dublin, D02 PN40, Ireland
| | - Mary McCarron
- School of Nursing & Midwifery, The University of Dublin Trinity College, Dublin, D02 PN40, Ireland
- Trinity Centre for Ageing with Intellectual Disability (TCAID), The University of Dublin Trinity College, School of Nursing & Midwifery, Dublin, Ireland
| | - Philip McCallion
- Trinity Centre for Ageing with Intellectual Disability (TCAID), The University of Dublin Trinity College, School of Nursing & Midwifery, Dublin, Ireland
- School of Social Work (College of Public Health), Temple University, Philadelphia, Pennsylvania, USA
| | - Valerie Smith
- School of Nursing & Midwifery, The University of Dublin Trinity College, Dublin, D02 PN40, Ireland
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Gómez-Vilcapoma N, Briceño-Vergel G, Córdova-Limaylla N, Ladera-Castañeda M, Cervantes-Ganoza L, Allen-Revoredo C, Castro-Rojas M, Cayo-Rojas C. Factors associated with dental interns and professors perception of the management of disabled patients: A cross-sectional study under multivariable analysis. Heliyon 2024; 10:e24213. [PMID: 38756203 PMCID: PMC11096086 DOI: 10.1016/j.heliyon.2024.e24213] [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: 09/07/2023] [Revised: 12/27/2023] [Accepted: 01/04/2024] [Indexed: 05/18/2024] Open
Abstract
Background Patients with disabilities experience oral health inequalities, including increased disease prevalence and unmet healthcare needs. The aim of this study was to assess factors associated to the perceived management of patients with physical disabilities among dental interns and professors at a university located in the capital city and a branch in a province in Peru. Methods This cross-sectional, observational, and analytical study included 100 dental interns and 75 Peruvian dental professors and was conducted from January to April 2022. A validated perception scale was used to evaluate the management of disabled patients. For the statistical analysis, the study employed Pearson's chi-square test and Fisher's exact test, along with a Poisson regression model that used robust variance. The adjusted prevalence ratio (APR) was utilized to evaluate perception while taking into account factors such as gender, age, marital status, origin, professional experience, previous treatment of a patient with physical disability, and previous cohabitation with a disabled patient. The significance level was set at p < 0.05. Results The 86 % of dental interns and 88 % of dental professors had a poor perception of managing disabled patients, with no significant association between them (p = 0.698). Male and female dental interns displayed significant differences in perception (p = 0.004), while no other variables showed significant differences (p < 0.05). Conversely, dental professors displayed significant differences in all variables analyzed (p < 0.05). In dental interns, gender was found to be the only influential variable, with females having a 41 % higher likelihood of perceiving disabled patient management poorly compared to males (APR = 1.41; 95 % CI: 1.04-1.91) (p = 0.028). However, gender was not found to be a significant factor for dental professors (p = 0.449). Conclusion The majority of dental interns and professors had a poor perception of managing disabled patients, with no significant differences observed between them. Moreover, gender significantly influenced the perception of managing patients with physical disabilities among dental interns specifically. On the other hand, neither age, marital status, origin, professional experience, previous treatment of a patient with physical disability, nor previous cohabitation with a disabled patient were found to be associated factors among dental interns and professors.
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Affiliation(s)
| | | | | | - Marysela Ladera-Castañeda
- Universidad Nacional Federico Villarreal, Postgraduate School, Research Team “Salud Pública – Salud Integral”, Lima, Peru
| | | | | | - Miriam Castro-Rojas
- Universidad Nacional Federico Villarreal, Postgraduate School, Research Team “Salud Pública – Salud Integral”, Lima, Peru
| | - César Cayo-Rojas
- Universidad Privada San Juan Bautista, School of Stomatology, Lima, Peru
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Schuengel C, Cuypers M, Bakkum L, Leusink GL. Reproductive health of women with intellectual disability: antenatal care, pregnancies and outcomes in the Dutch population. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:1306-1316. [PMID: 36167410 DOI: 10.1111/jir.12982] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/29/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Research in a handful of countries found that women with intellectual disability (ID) faced barriers and risks regarding antenatal care and reproductive health. This study tested disparities between women in the Netherlands with and without ID in antenatal care, pregnancy rates and pregnancy outcomes. METHODS Secondary analyses on the large representative panel of primary health patients in the Netherlands by the Netherlands Institute for Health Services Research (NIVEL) compared women in their reproductive age (18-49 years) with (n = 2397) and without (n = 228 608) indicators of ID. Bias due to underreporting and under-identification was reduced by linkage with an index of ID for the total Dutch population from Statistical Netherlands. RESULTS Women with ID were more likely to receive contraceptive care [95% confidence interval (CI) for odds ratio (OR) = 1.37-1.61] and became somewhat more often pregnant (95% CI OR = 1.06-2.30) than women from the general population, adjusting for age difference and follow-up time. No statistical differences were found in medical complications during pregnancy, delivery and immediately after birth, but women with indicators of ID had a higher risk of losing their pregnancy, including through induced abortion (95% CI OR = 1.26-1.99). CONCLUSIONS Women with ID have specific needs around contraceptive care and risks around their pregnancy that may require more awareness among practitioners and better understanding of the processes of care and decision-making.
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Affiliation(s)
- C Schuengel
- Department of Educational and Family Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M Cuypers
- Radboud University Medical Center (Radboudumc), Radboud University Nijmegen, Nijmegen, The Netherlands
| | - L Bakkum
- Department of Educational and Family Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - G L Leusink
- Radboud University Medical Center (Radboudumc), Radboud University Nijmegen, Nijmegen, The Netherlands
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Mohd FN, Said AH, Ahmad MS, Ridzwan AN, Muhammad AI, Mat Naji AS. Exploring the Barriers and Expectations Towards Health Care Services Among Parents/Caretakers of People with Intellectual Disability in Kuantan, Malaysia: A Qualitative Study. J Int Soc Prev Community Dent 2023; 13:477-484. [PMID: 38304533 PMCID: PMC10829287 DOI: 10.4103/jispcd.jispcd_89_23] [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: 06/13/2023] [Revised: 11/03/2023] [Accepted: 11/09/2023] [Indexed: 02/03/2024] Open
Abstract
Backgrounds People with intellectual disabilities (PWID) are often characterized by challenges in learning and difficulties in performing daily activities. These difficulties can have an impact not only on the individuals themselves but also on the people around them, especially their parents, caregivers, and healthcare workers. Therefore, establishing a positive relationship between parents or caregivers and individuals with disabilities is crucial as a key factor in promoting positive healthcare experiences and outcomes. Aim This study aims to explore the barriers and perceptions toward healthcare services among parents or caretakers of people with intellectual disability, including the challenges and their expectations toward healthcare services. Materials and Methods This was a qualitative study using purposive sampling. Thirty participants were contacted at the initial stage and invited to participate in the study. Semi-structured in-depth interviews were done among parents and caretakers of PWID who attended Special Care Dentistry and Paediatric Dentistry clinics in Sultan Ahmad Shah Medical Centre, Kuantan, Pahang. Topic guides were generated from literature review and expert opinions, followed by pilot interviews to refine them. However, after the interviews were done for the first 13 participants, we have reached data saturation, and no new themes emerged. The interviews were recorded, verbatim transcribed, and analyzed using Braun and Clarke's guidelines for thematic analysis. Results The satisfaction of parents or caretakers toward healthcare services for PWID and positive experiences in receiving healthcare services were noted. However, the results revealed several barrier themes in seeking healthcare services: lack of availability of parking, longer waiting time, appointment time, crowded environment, limited information on the availability of the services, and longer travel duration. Furthermore, expectation themes emerged from this study: continuous follow-up, accessibility to healthcare services, and staff attitude.
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Affiliation(s)
- Farah Natashah Mohd
- Special Care Dentistry Unit, Department of Oral Diagnosis and Oral Maxillofacial Surgery, Kulliyyah of Dentistry, International Islamic University Malaysia, Kuantan, Malaysia
| | - Abdul Hadi Said
- Department of Family Medicine, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, Malaysia
| | - Mas Suryalis Ahmad
- Special Care Dentistry Unit, Universiti Teknologi Malaysia, Kuantan, Malaysia
| | - Ain Nuha Ridzwan
- Kulliyyah of Dentistry, International Islamic University Malaysia, Kuantan, Malaysia
| | - Amira Izwani Muhammad
- Kulliyyah of Dentistry, International Islamic University Malaysia, Kuantan, Malaysia
| | - Ahmad Syahir Mat Naji
- Dental Clinic Pekan Tajau, Maran District, Dental Health Unit, Oral Health Department, Ministry of Health, Pahang, Malaysia
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Moloney M, Hennessy T, Doody O. Parents' perspectives on reasonable adjustments in acute healthcare for people with intellectual disability: A qualitative descriptive study. J Adv Nurs 2023; 79:4268-4279. [PMID: 37391905 DOI: 10.1111/jan.15772] [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: 03/03/2023] [Revised: 06/11/2023] [Accepted: 06/21/2023] [Indexed: 07/02/2023]
Abstract
AIM To describe parents' perspectives on reasonable adjustments in acute healthcare for people with intellectual disability (ID). BACKGROUND People with ID are vulnerable in terms of their health needs and marginalized when accessing and utilizing acute healthcare services. Reasonable adjustments are positive measures that can help alleviate health disparities. However, despite significant research advocating their use, evidence of implementation of reasonable adjustments in acute healthcare practice is limited. DESIGN A qualitative descriptive study. METHODS Qualitative semi-structured interviews were conducted with six parents of children with ID, who had accessed and used acute healthcare services. The interviews were conducted between January and May 2022, audio-recordings were transcribed and thematically analysed. RESULTS Parents described limited or no experiences of reasonable adjustments when accessing or utilizing acute healthcare services for their children. The findings are captured in three themes; describing the reality, understanding the impact and signposting the future. The findings highlight a lack of implementation of reasonable adjustments in acute healthcare which negatively impacts the experience of all stakeholders. CONCLUSION There is a pressing need for reasonable adjustments to be implemented at a strategic level across acute healthcare services, so that people with ID and their families can access person-centred acute healthcare when needed. IMPACT The research findings will inform researchers interested in reasonable adjustments and implementation research, and those interested in advocating for the rights of people with ID. REPORTING METHOD This study adhered to the Equator research reporting checklist: Consolidated criteria for reporting qualitative research: a 32-item checklist for interviews and focus groups. PATIENT OR PUBLIC CONTRIBUTION A parent of a child with an ID was part of the research team informing the design, data collection, data analysis and write-up of this article.
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Affiliation(s)
- Mairead Moloney
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
- Health Implementation Science and Technology, Limerick, Ireland
| | - Therese Hennessy
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
- Health Implementation Science and Technology, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Owen Doody
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
- Health Implementation Science and Technology, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
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13
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Seymour R, Scher C, Frasso R, Truong S, Ziring D, Ankam N. Exposing the disability-related hidden curriculum in case-based learning: A qualitative study. Disabil Health J 2023; 16:101483. [PMID: 37344272 DOI: 10.1016/j.dhjo.2023.101483] [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: 03/15/2023] [Revised: 05/15/2023] [Accepted: 05/21/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND People with disabilities face significant health disparities. Studies show that healthcare professionals harbor negative attitudes towards disability, compromising the quality of care. These attitudes, in unwritten, unofficial, and even unintended ways can be passed from providers to learners in the medical education setting. OBJECTIVE Using a Critical Disability Studies (CDS) paradigm, the authors uncovered the disability-related hidden curriculum within Case-Based Learning (CBL) and proposed guidelines for promoting a disability-conscious medical education that resists ableism. METHODS The study team conducted a qualitative analysis of all CBL cases from the pre-clerkship curriculum (n = 53) at Sidney Kimmel Medical College. The authors employed a directed content analysis approach to develop a codebook based on case examination, literature review, and CDS concepts. Two researchers coded all cases and assessed intercoder reliability. The results informed the development of an explanatory model. RESULTS Only four of 53 cases overtly mentioned disability, none of which defined disability according to CDS. Coding did not identify content challenging stereotypical views of disability. Additionally, two cases included content fueling negative attitudes of disability. CONCLUSION By inadequately addressing disability from a CDS perspective, harmful assumptions of disability may go unchallenged, driving a hidden curriculum within CBL. This phenomenon leaves medical students ill-prepared to care for people with disabilities and creates physicians ill-equipped to teach the next generation. Since many health professions utilize CBL to educate students, these cases provide an untapped opportunity to resist ableism and better prepare students to address the negative attitudes driving health disparities experienced by people with disabilities.
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Affiliation(s)
- Rory Seymour
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Carly Scher
- University College Dublin School of Medicine, Dublin, Ireland
| | - Rosemary Frasso
- College of Population Health at Thomas Jefferson University, Philadelphia, PA, USA; Asano-Gonnella Center for Research in Medical Education and Health Care, Sidney Kimmel Medical College, Thomas Jefferson University, USA
| | - Susan Truong
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Deborah Ziring
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Nethra Ankam
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
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Bobbette NJ, Lysaght R, Ouellette-Kuntz H, Tranmer J, Donnelly C. Stakeholder Perspectives on Interprofessional Primary Care for Adults With Intellectual and Developmental Disabilities in Ontario, Canada. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2023; 61:349-367. [PMID: 37770051 DOI: 10.1352/1934-9556-61.5.349] [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: 09/15/2020] [Accepted: 02/13/2023] [Indexed: 10/03/2023]
Abstract
Access to high-quality primary care has been identified as a pressing need for adults with intellectual and developmental disabilities (IDD). Interprofessional primary care teams offer comprehensive and coordinated approaches to primary care delivery and are well-positioned to address the needs of adults with IDD. The overall aim of this article is to describe the current provision of interprofessional primary care for adults with IDD from the perspectives of patients, caregivers, and health providers. Results provide important insights into the current state of practice and highlight a critical need for further work in the field to develop processes to engage in team-based care and demonstrate the value of the approach for this population.
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Affiliation(s)
- Nicole J Bobbette
- Nicole J. Bobbette, Rosemary Lysaght, Hélène Ouellette-Kuntz, Joan Tranmer, and Catherine Donnelly, Queen's University, Ontario, Canada
| | - Rosemary Lysaght
- Nicole J. Bobbette, Rosemary Lysaght, Hélène Ouellette-Kuntz, Joan Tranmer, and Catherine Donnelly, Queen's University, Ontario, Canada
| | - Hélène Ouellette-Kuntz
- Nicole J. Bobbette, Rosemary Lysaght, Hélène Ouellette-Kuntz, Joan Tranmer, and Catherine Donnelly, Queen's University, Ontario, Canada
| | - Joan Tranmer
- Nicole J. Bobbette, Rosemary Lysaght, Hélène Ouellette-Kuntz, Joan Tranmer, and Catherine Donnelly, Queen's University, Ontario, Canada
| | - Catherine Donnelly
- Nicole J. Bobbette, Rosemary Lysaght, Hélène Ouellette-Kuntz, Joan Tranmer, and Catherine Donnelly, Queen's University, Ontario, Canada
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15
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Strnadová I, Loblinzk J, Scully JL, Danker J, Tso M, Jackaman KM, Dunn M, Willow SA, Sarfaraz S, Fitzgerald V, Boyle J, Palmer EE. "I am not a number!" Opinions and preferences of people with intellectual disability about genetic healthcare. Eur J Hum Genet 2023; 31:1057-1065. [PMID: 36670247 PMCID: PMC10474088 DOI: 10.1038/s41431-023-01282-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/13/2022] [Accepted: 12/19/2022] [Indexed: 01/21/2023] Open
Abstract
There is limited research exploring the knowledge and experiences of genetic healthcare from the perspective of people with intellectual disability. This study, conducted in New South Wales (Australia), addresses this gap. Eighteen adults with intellectual disability and eight support people were interviewed in this inclusive research study. The transcribed interviews were analysed using inductive content analysis. The findings were discussed in a focus group with ten adults with intellectual disability and in three multi-stakeholder advisory workshops, contributing to the validity and trustworthiness of the findings. Five main themes emerged: (i) access to genetic healthcare services is inequitable, with several barriers to the informed consent process; (ii) the experiences and opinions of people with intellectual disability are variable, including frustration, exclusion and fear; (iii) genetic counselling and diagnoses can be profoundly impactful, but translating a genetic diagnosis into tailored healthcare, appropriate support, peer connections and reproductive planning faces barriers; (iv) people with intellectual disability have a high incidence of exposure to trauma and some reported that their genetic healthcare experiences were associated with further trauma; (v) recommendations for a more respectful and inclusive model of genetic healthcare. Co-designed point-of-care educational and consent resources, accompanied by tailored professional education for healthcare providers, are required to improve the equity and appropriateness of genetic healthcare for people with intellectual disability.
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Affiliation(s)
- Iva Strnadová
- School of Education, UNSW Sydney, Sydney, NSW, Australia
- Disability Innovation Institute, UNSW Sydney, Sydney, NSW, Australia
- Self-Advocacy Sydney, Sydney, NSW, Australia
- Gonski Institute for Education, UNSW Sydney, Sydney, Australia
| | - Julie Loblinzk
- School of Education, UNSW Sydney, Sydney, NSW, Australia
- Self-Advocacy Sydney, Sydney, NSW, Australia
| | | | - Joanne Danker
- School of Education, UNSW Sydney, Sydney, NSW, Australia
| | - Michelle Tso
- School of Education, UNSW Sydney, Sydney, NSW, Australia
| | | | - Manjekah Dunn
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Medicine and Health, Sydney, NSW, Australia
| | | | | | | | - Jackie Boyle
- NSW Genetics of Learning Disability Service, NSW Health, Waratah, NSW, Australia
| | - Elizabeth Emma Palmer
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Medicine and Health, Sydney, NSW, Australia.
- Sydney Children's Hospitals Network, NSW Health, St Leonards, NSW, Australia.
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16
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Gilliand M, Bernier Emch A, Perrenoud B. Adults with intellectual disabilities' satisfaction regarding their hospitalization: A correlational descriptive study. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023:17446295231193461. [PMID: 37565271 DOI: 10.1177/17446295231193461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
When hospitalized, adults with intellectual disabilities are more anxious and have more unmet needs than the general population. Despite these problems, studies report contradictory results about their satisfaction with hospitalization. The aim of this study was to determine the level of satisfaction of adults with intellectual disabilities regarding their hospital care and the factors associated with satisfaction. An analysis of the Patient Satisfaction Scale (PSS) and Cognitive Appraisal of Health Scale (CAHS) instruments completed by adults with intellectual disabilities, or their caregivers, after hospitalization was done. The 32 participants' mean PSS score was 3.6/5, with means of 13.3/25 and 8.7/25 on the CAHS' 'harm/loss' dimension and 'challenge' dimension, respectively. None of the factors studied was associated with the total PSS score. Adults with intellectual disabilities were not fully satisfied with their hospital care, experiencing challenges and losses. These findings call for a rethink of the care provided to this population.
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Affiliation(s)
- Morgane Gilliand
- HESAV School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland; Institute of Higher Education and Research in Healthcare-IUFRS, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | | | - Béatrice Perrenoud
- Lausanne University Hospital (CHUV), Lausanne, Switzerland; La Source School of Nursing Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland
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17
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Seidu AA, Malau-Aduli BS, McBain-Rigg K, Malau-Aduli AEO, Emeto TI. "God is my only health insurance": a mixed-methods study on the experiences of persons with disability in accessing sexual and reproductive health services in Ghana. Front Public Health 2023; 11:1232046. [PMID: 37546318 PMCID: PMC10398390 DOI: 10.3389/fpubh.2023.1232046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/29/2023] [Indexed: 08/08/2023] Open
Abstract
Background Access to sexual and reproductive health (SRH) services is a fundamental human right, but people with disabilities (PwDs) in low-and middle-income countries often face multiple barriers to utilisation. This study aimed to assess the level of SRH services utilisation and the enabling and inhibiting factors among PwDs in Ghana's Ashanti region. Methods A sequential explanatory mixed-methods study design was employed, involving quantitative (n = 402) and qualitative (n = 37) data collection from PwDs. Quantitative data were analysed using descriptive and inferential statistics, while qualitative data were analysed using inductive thematic analysis. Results The study found that only 33.8% of the PwDs had ever used SRH services. Utilisation was associated with sex, marital status and travel duration to health facility. The qualitative data revealed that factors at the individual, family/community and health facility levels influenced utilisation of SRH services, acting as both enablers and barriers. Conclusion PwDs had relatively low utilisation of SRH services in Ghana's Ashanti region. To increase utilisation, it is recommended to address the stigma and discrimination towards PwDs, provide more training for healthcare providers, improve the accessibility of healthcare facilities, and strengthen the national health insurance scheme. Further research could explore PwDs' SRH outcomes and strategies to improve these outcomes in Ghana.
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Affiliation(s)
- Abdul-Aziz Seidu
- Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Bunmi S. Malau-Aduli
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Kristin McBain-Rigg
- Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Aduli E. O. Malau-Aduli
- School of Environmental and Life Sciences, University of Newcastle, Newcastle, NSW, Australia
| | - Theophilus I. Emeto
- Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
- World Health Organization Collaborating Center for Vector-Borne and Neglected Tropical Diseases, James Cook University, Townsville, QLD, Australia
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18
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Rinaldi R, Batselé E. "Is it my job?" An exploratory qualitative analysis of medical specialists' adaptation strategies when addressing the health needs of people with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023; 27:388-403. [PMID: 35503871 DOI: 10.1177/17446295221095706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Access to equal healthcare is a priority for people with intellectual disabilities. Most studies have focused on primary care providers; however, the administration of inclusive healthcare also relies on medical specialists, who should be considered a specific group because their practice varies significantly in this regard. Semi-directive interviews were conducted with 12 medical specialists to explore their representations regarding the care of people with intellectual disabilities. An inductive thematic analysis was applied to the data. The results highlighted a significant heterogeneity between practitioners' representations of people with intellectual disabilities in healthcare, current practices, and their perceptions and expectations in the process of ensuring quality care. This study highlights the importance of considering medical specialists' awareness raising and training to handle consultations with people with intellectual disabilities. From a broader perspective, a clear political framework to guide healthcare practices at the national level should be developed.
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Affiliation(s)
- Romina Rinaldi
- Université de Mons, Service d'Orthopédagogie Clinique, Mons, Belgium
| | - Elise Batselé
- Université de Mons, Service d'Orthopédagogie Clinique, Mons, Belgium
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19
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Hotez E, Rava JA, Shea L, Kuo A. Developing "Adulting for Health": Investigating the Health Needs of Neurodivergent Emerging Adults. Cureus 2023; 15:e41102. [PMID: 37519609 PMCID: PMC10375927 DOI: 10.7759/cureus.41102] [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: 05/26/2023] [Accepted: 06/24/2023] [Indexed: 08/01/2023] Open
Abstract
INTRODUCTION Neurodivergent emerging adults - defined as individuals between the ages of 18 and 30 with intellectual and/or developmental disabilities (e.g., attention-deficit hyperactivity disorder (ADHD), autism, cerebral palsy, learning disabilities, seizures, developmental delays, with or without intellectual impairment) and physical and/or sensory disabilities (e.g., blindness or hearing impairment) - experience poor mental and physical health outcomes. Existing interventions are insufficient because they are not based on the self-reported and developmental needs of this population. METHODS The current study is an exploratory pilot study that features a multidimensional health-based needs assessment of self-identified neurodivergent emerging adults with ADHD, learning disabilities, autism, and other conditions, mean (M) age = 22.8; standard deviation (SD) = 3.4; n = 26). This research used validated measures. The assessment - administered via Qualtrics to the participants in two sites - included the Mental Health Continuum-Short Form, Kessler-6 Psychological Distress Scale, Project EAT (Eating and Activity over Time)-IV (with the intuitive eating, weight-related control, emotional eating, and physical activity subscales), and an original health-focused needs assessment developed by interdisciplinary healthcare professionals and neurodivergent individuals. RESULTS The sample reported low positive mental health, with only 3% reportedly "flourishing." The sample also reported high psychological distress according to clinical and psychometric cut-off scores; varied intuitive eating and weight-control behaviors and attitudes; and distinct needs related to integrating the principles of health promotion into daily life, navigating the healthcare system, and learning from healthcare professionals. Based on these findings, we present an initial conceptualization of "Adulting for Health," a potential virtual education program to promote health-related knowledge and capacities for this population. CONCLUSIONS The results from this exploratory pilot study can be incorporated into existing programs and spur efforts to develop and test new interventions that can ameliorate health disparities for neurodivergent emerging adults.
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Affiliation(s)
- Emily Hotez
- General Internal Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, USA
| | - Julianna A Rava
- Public Health, University of California Los Angeles Fielding School of Public Health, Los Angeles, USA
| | - Lindsay Shea
- Health Policy, Drexel University AJ Drexel Autism Institute, Philadelphia, USA
| | - Alice Kuo
- Division of Medicine-Pediatrics, University of California Los Angeles David Geffen School of Medicine, Los Angeles, USA
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20
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Kersten M, Wilson NJ, Pracilio A, Howie V, Trollor J, Buckley T, Morphet J, Bryce J, Griffin K, Cashin A. A scoping review to inform an auditing framework evaluating healthcare environments for inclusion of people with intellectual disability and/or autism. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023:17446295231174282. [PMID: 37217215 DOI: 10.1177/17446295231174282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
People with intellectual disability and/or autism are likely to be in hospital more often, for longer, and have poorer health outcomes. Few audit tools exist to identify their barriers in mainstream healthcare environments. This study aimed to identify evidence of audit characteristics of healthcare contexts specifically for people with intellectual disability and/or autism, for conceptual development of an auditing framework. A scoping review of evaluations of healthcare environments was completed in January 2023. Findings were presented using the PAGER framework. Of the sixteen studies identified, most originated in the UK, nine focused on intellectual disability, four on autism, and three were concerned with mixed diagnosis. Six domains for auditing healthcare environments were identified: care imperatives, communication to individuals, understanding communication from individuals, providing supportive environments of care, supporting positive behaviour, and actions to make things go well. Further research is recommended to refine an audit framework.
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Affiliation(s)
- Michelle Kersten
- Faculty of Health and Human Sciences, Southern Cross University, Lismore, NSW, Australia
| | - Nathan John Wilson
- School of Nursing and Midwifery, Western Sydney University, Penrith South, NSW, Australia
| | - Amy Pracilio
- Faculty of Health and Human Sciences, Southern Cross University, Lismore, NSW, Australia
| | - Virginia Howie
- Faculty of Health and Human Sciences, Southern Cross University, Lismore, NSW, Australia
| | - Julian Trollor
- Department of Developmental Disability Neuropsychiatry, UNSW Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
| | - Thomas Buckley
- Susan Wakil Building, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Julia Morphet
- Nursing & Midwifery, Monash University, Peninsula Campus, Frankston, VIC, 3199, Australia
| | - Julianne Bryce
- Australian Nursing and Midwifery Federation, Federal Office, Melbourne, VIC, 3000, Australia
| | - Ken Griffin
- Australian Primary Health Care Nurses Association, Melbourne, VIC, 3000, Australia
| | - Andrew Cashin
- Faculty of Health and Human Sciences, Southern Cross University, Lismore, NSW, Australia
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21
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Arboleya-Faedo T, González-Menéndez A, González-Pando D, Paino M, Alonso-Pérez F. Experiences of Self-Stigma in People with Chronic Psychosis: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095688. [PMID: 37174206 PMCID: PMC10178090 DOI: 10.3390/ijerph20095688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023]
Abstract
We present the results of a phenomenological study understanding the personal meaning of self-stigma in people with chronic psychosis. Self-stigma is a frequent phenomenon in the lives of people with psychosis and their families and it functions as a barrier to recovery. Semi-structured in-depth interviews were conducted with fourteen outpatients that suffer from chronic psychosis during January 2020. Data analysis was carried out using an inductive approach as described by Graneheim and Lundman through the MAXQDA 2022 program. The themes observed were: "Contextual Stigma", "Components of Self-Stigma", "Skills Loss" and "Coping with Self-Stigma". The main categories and subcategories were avoidance and escape behaviours from their social environment, labelling, loss of social relationships, negative impact and self-concealment of the diagnosis. Our results revealed influence on each other, forming a looping effect that explains and amplifies the lived experience of self-stigma. These findings highlight the need to implement strategies in nursing practice aimed at training the acceptance and distancing necessary to minimize the impact of self-stigma on people with chronic psychosis. This study adheres to the EQUATOR guidelines for the Consolidated Criteria for Reporting Qualitative Research (COREQ).
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Affiliation(s)
| | | | - David González-Pando
- ISPA-Health Research Institute of the Principality of Asturias, 33011 Oviedo, Spain
- Faculty of Nursing, University of Oviedo, 33394 Gijón, Spain
| | - Mercedes Paino
- Department of Psychology, University of Oviedo, 33003 Oviedo, Spain
| | - Fernando Alonso-Pérez
- ISPA-Health Research Institute of the Principality of Asturias, 33011 Oviedo, Spain
- Faculty of Nursing, University of Oviedo, 33394 Gijón, Spain
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22
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Bourne MJ, Smeltzer SC, Kelly MM, Mariani B. ADAPTATION AND TESTING OF THE DEVELOPMENTAL DISABILITY ATTITUDES IN NURSING CARE INSTRUMENT. J Nurs Meas 2023; 31:96-108. [PMID: 36941040 DOI: 10.1891/jnm-2021-0015] [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: 11/25/2022]
Abstract
Background and Purpose: Individuals with developmental disability (DD) often experience poor health outcomes, potentiated by healthcare inequities. Nurses have the potential to reduce these inequities through the quality of care provided. The quality of care provided by nursing students, the future generation of nurses, is affected by the attitudes of their clinical nursing faculty. The purpose of this study was to adapt and test an instrument to specifically measure the attitudes of clinical nursing faculty toward providing care to people with DD. Methods: The Disability Attitudes in Health Care (DAHC) instrument was adapted to create the new Developmental Disability Attitudes in Nursing Care (DDANC) instrument. Results: Content experts reviewed the DDANC for content validity (CVI = 0.88), followed by testing for internal consistency reliability (Cronbach's alpha = 0.7). The study respondents had overall positive attitudes toward the care of people with DD. Conclusions: The DDANC is an acceptably valid and reliable instrument to assess attitudes of clinical nursing faculty toward providing care to people with DD.
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Affiliation(s)
- Melissa J Bourne
- PhD Student, M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA, United States
- Visiting Assistant Professor, Wegmans School of Nursing, St. John Fisher College, Rochester, NY, United States
| | - Suzanne C Smeltzer
- The Richard and Marianne Kreider Endowed Professor in Nursing for Vulnerable Populations, M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA, United States
| | - Michelle M Kelly
- Associate Professor, M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA, United States
| | - Bette Mariani
- Vice Dean for Academic Affairs, Associate Professor of Nursing, M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA, United States
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23
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Windsor C, Zhang T, Wilson NJ, Blyth K, Ballentine N, Speyer R. Psychosocial-behavioural interventions for school-aged children with intellectual disabilities: A systematic review of randomised control trials. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:458-485. [PMID: 36814060 DOI: 10.1111/jar.13086] [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: 07/30/2022] [Revised: 12/09/2022] [Accepted: 02/06/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Evidence-based interventions are essential for school-aged children with intellectual disabilities to facilitate development and promote future independence. METHODS Using a PRISMA approach, systematic screening of five databases was undertaken. Original randomised controlled studies with psychosocial-behavioural interventions were included where participants were school aged (5-18 yrs) with documented intellectual disability. Study methodology was assessed using the Cochrane RoB 2 tool. RESULTS Two thousand three hundred and three records were screened with 27 studies included. Studies mainly included primary school participants with mild intellectual disabilities. Most interventions focused on intellectual skills (e.g., memory, attention, literacy and mathematics) followed by adaptive skills (e.g., daily living, communication, social and education/vocation) and some focused on a combination of these. CONCLUSION This review highlights the gap in evidence-base for social, communication and education/vocation interventions with school-aged children with moderate and severe intellectual disability. Future RCTs that bridge this knowledge gap across ages and ability are required for best practice.
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Affiliation(s)
- Catriona Windsor
- Department Special Needs Education, University of Oslo, Oslo, Norway
| | - Tingwei Zhang
- Department Special Needs Education, University of Oslo, Oslo, Norway
| | - Nathan J Wilson
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
| | - Katrina Blyth
- Faculty of Medicine and Health, Discipline of Speech Pathology, University of Sydney, Sydney, New South Wales, Australia
| | - Natalie Ballentine
- Rehabilitation and Physical Medicine (Medicina Física y Rehabilitación), Clinica Alemana Santiago, Vitacura, Chile
| | - Renée Speyer
- Department Special Needs Education, University of Oslo, Oslo, Norway.,Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, Leiden, The Netherlands.,Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
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24
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Nash-Patel T, Anderson E, O'Donoghue B, Paliokosta P, Morrow E. StoryAid: Nursing Students' Relational Learning for Adolescents With Intellectual Learning Disabilities. J Nurs Educ 2023; 62:51-57. [PMID: 36279549 DOI: 10.3928/01484834-20220912-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Nursing students express fears and anxieties about caring for people with intellectual learning disabilities (ILDs). Educational storytelling interventions may help overcome these concerns and improve nursing care. METHOD StoryAid was used and developed in the Heritage-2Health (H2H) Virtual Art and Drama Project. Eight online sessions followed a story about differences and connections. Two trained facilitators and three academic educators supported nursing students (n = 15), adolescents with ILDs (n = 7), their parents (n = 7), and a specialist teacher to deconstruct, reconnect, and rediscover understandings using rights-based ethnographic evaluation and thematic analysis. RESULTS Themes included relating to the story and characters, participating in the storytelling process, relating to other participants in the storytelling, and relating learning to clinical contexts and professionalism. CONCLUSION The partnership of StoryAid and H2H created safe spaces for nursing students to engage, challenge assumptions, and develop relational skills. [J Nurs Educ. 2023;62(1):51-57.].
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Muacevic A, Adler JR, Tanios V, Chelko S, Nowakowski A. A Novel Disability Advocacy and Awareness Program for Training Future Healthcare Professionals on Care for Patients with Disabilities. Cureus 2023; 15:e33881. [PMID: 36819399 PMCID: PMC9934934 DOI: 10.7759/cureus.33881] [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: 09/13/2022] [Accepted: 01/17/2023] [Indexed: 01/19/2023] Open
Abstract
In a poll of 714 US physicians, it was revealed that only 40.7% felt very confident in their ability to provide the same quality of care, overall, to patients with disabilities (PWDs) compared with patients without disabilities. It was also found that only 56.5% strongly agreed that they welcomed PWDs into their practice as healthcare providers. This suggests a systemic issue of inequity in medicine, which affects both physicians and patients. If this problem is not corrected, our healthcare system will continue to lack in providing adequate care to PWDs. A key component of this issue is that the lack of confident care for PWDs appears to be a result of insufficient exposure to PWDs during the formative years in medical schools. Although medical students are taught extensive clinical skills and bedside manners, there appears to be little mention of how to make adaptations to basic patient encounters to accommodate PWDs. Further, the lack of representation of PWDs in the medical community results in minimal experience among trainees and the perpetuation of unjust biases in the healthcare system. Changes to the medical field must start with shaping future physicians and filling the void in medical education. As a solution, we at Florida State University (FSU) College of Medicine (COM) propose a program called the Disability Advocacy and Awareness Program (DAAP). Two interactive sessions were designed, and students were offered an immersive experience in which they were not only provided with information through well-crafted presentations but also encouraged to engage in direct interactions with PWDs and a myriad of assistive devices. We believe a great deal of the program's success stemmed from the two-phase interactive model that allowed students to undergo a truly immersive experience that a textbook cannot endow. Although we cannot expect every provider to be an expert on all disabilities, all physicians should have an understanding of how a disability may impact a patient's life and medical care. Improved knowledge and awareness surrounding disability and the barriers faced by the PWD population will provide insights that will allow for the most equitable, patient-centered care for the disabled community.
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Nash-Patel T, Morrow E, Paliokosta P, Dundas J, O'Donoghue B, Anderson E. Co-design and delivery of a relational learning programme for nursing students and young people with severe and complex learning disabilities. NURSE EDUCATION TODAY 2022; 119:105548. [PMID: 36116386 DOI: 10.1016/j.nedt.2022.105548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 08/12/2022] [Accepted: 09/08/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND National Health Service (NHS) staff in the UK are required to undergo training about learning disabilities at the appropriate level for their role. However, this requirement does not apply to nurses in training and student nurses report fear and anxiety about caring for people with intellectual learning disabilities (ILDs). Young people with intellectual disabilities report feeling scared of nurses and parents feel staff do not listen to them or involve them in care. OBJECTIVES (i) For a university and special school for young people with server and complex ILDs to work in partnership to co-design a programme for nursing students, young people, their teachers, and parents. (ii) To deliver the programme online as part of the university's existing nursing courses. DESIGN The partnership between the university and the special school focused on co-design of an interactive programme, parent involvement, safeguarding, and the design of accessible learning resources to support young people with severe and complex ILDs' engagement. The programme was informed by relational inquiry, service user and transformative pedagogies, and parents and teacher's knowledge and views about the young people. Delivery of the programme was designed to fit into existing nursing courses and enable students on placement and young people at home or in hospital to participate. A rights-based ethnographic evaluation was designed to support participant feedback and programme development. SETTING The Heritage2Health Virtual Arts and Drama Programme was piloted with nursing students at one UK university and young people with severe and complex ILDs from one special school, their parents and teachers. PARTICIPANTS 15 nursing students (BSc Year 2 = 10, Year 3 = 3, MSc = 2) and 7 young people with severe and complex learning disabilities (age 11-14 yrs). Other participants were parents/guardians of young people (7), arts/drama facilitators (2), academic lecturers (2), special needs teachers (2), registered nurse (1). METHODS An 8-week dynamic programme of arts and drama. Sessions included 30-min start-up/presencing, 45-min storytelling/drama with young people and parents, 30-min reflection/close. Sessions were facilitated by 2 arts and drama specialists. The story of 'Ubuntu the Lion with the Long, Long, Mane' (by TNP) was used to explore difference and ways of being. The evaluation methods were participant observation, semi-structured interviews (2-6 weeks post) and thematic analysis. RESULTS Participation in the programme was a challenging, creative, and reflective experience that was transformative for all. Nurses and young people's fears and anxieties about each other were revealed and addressed by participating in arts and drama activities together. Nursing students learnt how to adopt a relational orientation to young people and their parents and teachers. CONCLUSIONS A co-designed programme for nursing students and young people with severe and complex ILDs can benefit student knowledge and skills and reduce fears and anxieties between nurses and young people with ILDs. With adequate planning and resources, the programme could be adopted by multidisciplinary partnerships between other universities and special schools.
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Affiliation(s)
- Theresa Nash-Patel
- Kingston University & St George's University of London, Heritage2Health, United Kingdom.
| | | | - Paty Paliokosta
- Inclusive Education and Special Educational Needs, Inclusion and Social Justice Special Interest Group, Kingston University & St George's University of London, United Kingdom.
| | - Jane Dundas
- Kingston University & St George's University of London, Heritage2Health, United Kingdom.
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Children’s Self-Esteem and Attitudes toward Disability, Perceived Competence and Morality: The Indirect Effect of Cognitive Empathy. CHILDREN 2022; 9:children9111705. [DOI: 10.3390/children9111705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022]
Abstract
The present study explored children’s attitudes toward disability and the links with demographic factors (i.e., gender) and personal factors (i.e., empathy, sympathy, self-esteem). Our sample comprised 405 children aged 9 to 11 (M = 9.88, SD = 0.65, 47.4% males). First, we explored the links between self-esteem, empathy (cognitive and affective), and attitudes toward disability. Then, by using three scenarios involving a child in a wheelchair (Group 1), a child with an intellectual disability (Group 2), and a child with visual impairment (Group 3), we investigated the perceived competence and morality of these characters. The results suggested that cognitive empathy mediated the link between self-esteem and attitudes toward disability. Moreover, our data suggested that the character in a wheelchair (Group 1) received the highest scores regarding morality and competence, whereas the character with an intellectual disability (Group 2) received the lowest scores. We discuss the present findings regarding their practical implications for inclusive education strategies.
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Martínez-Medina A, Morales-Calvo S, Rodríguez-Martín V, Meseguer-Sánchez V, Molina-Moreno V. Sixteen Years since the Convention on the Rights of Persons with Disabilities: What Have We Learned since Then? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11646. [PMID: 36141926 PMCID: PMC9517366 DOI: 10.3390/ijerph191811646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
Persons with disabilities have historically been subjected to discrimination and exclusion, placing them in dangerous situations of social vulnerability. The Convention on the Rights of Persons with Disabilities, passed on the 13th of December 2006, was an important legislative landmark for valuing the rights of this population group. This study involved a bibliometric analysis of 1024 research articles published in Scopus on the social, workplace, educational, and financial inclusion of persons with disabilities since the Convention. The results show an increase in scientific production, and there is also a great deal of multi-disciplinarity, which has led to important breakthroughs for the all-encompassing inclusion of this section of the population. The most productive journals, authors, institutions, and countries, as well as the international cooperation networks, are presented here. The review concludes by setting out the main themes and trends in the research.
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Affiliation(s)
- Andrés Martínez-Medina
- Health Sciences PhD Program, Catholic University of Murcia, Campus de los Jerónimos nº135, Guadalupe, 30107 Murcia, Spain
| | - Sonia Morales-Calvo
- Department of Research and Diagnostic Methods in Education, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain
| | - Vicenta Rodríguez-Martín
- Department of Social Work and Social Services, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain
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Ee J, Stenfert Kroese B, Rose J. Experiences of mental health professionals providing services to adults with intellectual disabilities and mental health problems: A systematic review and meta-synthesis of qualitative research studies. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2022; 26:758-781. [PMID: 34165022 PMCID: PMC9442780 DOI: 10.1177/17446295211016182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Mental health professionals play an important role in providing care and treatment for adults with intellectual disabilities. A number of studies use qualitative methods to explore the experiences of these professionals and their perspectives regarding the mental health services for this population. A systematic review using meta-ethnographic approach was undertaken to summarise this research. METHOD A systematic search found 14 relevant studies which were critically appraised. Key themes from these studies were extracted and synthesised. RESULTS Three main themes were identified: 1) Understanding the person, 2) Relational interaction and 3) Organisational factors. CONCLUSIONS The findings of this review identified the issues mental health professionals raised in relation to their work. They described the complex presenting problems as intense yet fulfilling therapeutic relationships with their clients and their wish to improve their knowledge and skills. They identified organisational issues that need to be addressed to improve staff morale and efficiency.
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Affiliation(s)
| | | | - John Rose
- John Rose, Centre for Applied Psychology,
School of Psychology, The University of Birmingham, Edgbaston, Birmingham B15
2TT, UK.
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Franklin MS, Bush C, Jones KA, Davis NO, French A, Howard J, Greiner MA, Maslow GR. Inequities in Receipt of the North Carolina Medicaid Waiver Among Individuals with Intellectual Disability or Autism Spectrum Disorder. J Dev Behav Pediatr 2022; 43:393-401. [PMID: 35353786 PMCID: PMC9462136 DOI: 10.1097/dbp.0000000000001075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 01/07/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We examined characteristics associated with receiving the North Carolina Home and Community-Based Services Waiver for intellectual and developmental disabilities (I/DDs) and its association with emergency department (ED) utilization. METHOD Through analysis of the North Carolina 2017 to 2018 Medicaid claims and enrollment data, we examined characteristics (age, sex, race and ethnicity, geography, diagnosis (intellectual disability [ID] with or without autism spectrum disorders or autism spectrum disorder without ID) associated with receiving the NC I/DD Waiver and the association of this Wavier with ED utilization. We identified patients with at least 1 International Classification of Diseases-10-CM diagnosis code for an ID or autism spectrum disorder. We excluded patients with missing county information and whose enrollment in the NC I/DD Waiver program began after October 1, 2017. RESULTS Only 22% of 53,531 individuals with I/DD in North Carolina received the Waiver. Non-Hispanic Blacks and Hispanic individuals were less likely to receive the Waiver than non-Hispanic White individuals. Adults (>21 years old), men, and urban residents were more likely to receive the Waiver. Individuals who received the Waiver were 31% less likely to use the ED. CONCLUSION Innovative strategies are needed to provide equitable access to the NC I/DD Waiver and provide services to the 14,000 people with I/DD currently waiting to receive the Waiver. Through the Waiver, those with I/DD can access preventative and therapeutic outpatient services and decrease their need for ED care. These findings highlight the need for policy reform to address inequities in access to the Waiver for individuals with I/DD.
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Affiliation(s)
| | - Christopher Bush
- Department of Population Health Sciences, Duke University, Durham, NC
| | - Kelley A. Jones
- Department of Population Health Sciences, Duke University, Durham, NC
| | - Naomi Ornstein Davis
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Alexis French
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Jill Howard
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | | | - Gary R. Maslow
- Department of Pediatrics, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
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Kazembe A, Simwaka A, Dougherty K, Petross C, Kafulafula U, Chakhame B, Chodzaza E, Chisuse I, Kamanga M, Sun C, George M. Experiences of women with physical disabilities accessing prenatal care in low- and middle-income countries. Public Health Nurs 2022; 39:1156-1166. [PMID: 35512242 DOI: 10.1111/phn.13087] [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: 02/23/2022] [Revised: 04/15/2022] [Accepted: 04/16/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Women with physical disabilities experience barriers to accessing patient-centered and accommodative care during the prenatal and childbirth periods. While there is a growing body of work in high-income countries to address these needs, there is little research detailing specific challenges in low- and middle-income countries (LMICs) where a woman's' burden- and need-is greatest. METHODS We conducted an integrative review to synthesize the experiences of women with physical disabilities accessing prenatal care and childbirth services in LMICs. Five databases were searched for systematic reviews, retrospective cohort studies, cross-sectional studies, narrative literature reviews, as well as other evidence types. We used Ediom's EvidenceEngine™, a machine-assisted search engine that uses artificial intelligence to conduct this search using pertinent keywords to identify original research published between January 2009 - September 2018. These results were augmented by hand searching of reference lists. Forty articles were identified using this method and 11 retained after duplicates were removed and inclusion and exclusion criteria applied. RESULTS Four types of experiences are described in these 11 studies: (1) limited physical and material resources; (2) health care worker knowledge, attitudes, and skills; (3) pregnant people's knowledge; and (4) public stigma and ignorance. DISCUSSION People with physical disabilities face specific challenges during pregnancy and childbirth. Importantly, these findings offer targets for enhanced clinical training for nurses, midwives, traditional birth attendants and public health workers, as well as opportunities for the improved delivery of prenatal care and childbirth services to these vulnerable women.
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Affiliation(s)
- Abigail Kazembe
- Kamuzu College of Nursing, University of Malawi, Lilongwe, Malawi
| | - Andrew Simwaka
- Kamuzu College of Nursing, University of Malawi, Lilongwe, Malawi
| | - Kylie Dougherty
- Columbia University School of Nursing, New York, New York, USA
| | - Chisomo Petross
- Kamuzu College of Nursing, University of Malawi, Lilongwe, Malawi
| | | | - Bertha Chakhame
- Kamuzu College of Nursing, University of Malawi, Lilongwe, Malawi
| | | | - Isabella Chisuse
- Kamuzu College of Nursing, University of Malawi, Lilongwe, Malawi
| | - Martha Kamanga
- Kamuzu College of Nursing, University of Malawi, Lilongwe, Malawi
| | - Carolyn Sun
- Hunter College School of Nursing, New York, New York, USA
| | - Maureen George
- Columbia University School of Nursing, New York, New York, USA
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Mitchell RJ, Ryder T, Matar K, Lystad RP, Clay-Williams R, Braithwaite J. An overview of systematic reviews to determine the impact of socio-environmental factors on health outcomes of people with disabilities. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1254-1274. [PMID: 34850472 DOI: 10.1111/hsc.13665] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/05/2021] [Accepted: 11/18/2021] [Indexed: 06/13/2023]
Abstract
People with disabilities are often subject to intersecting layers of social and economic disadvantage and other barriers that drive health inequity. As a result, they frequently experience worse health than people without disabilities, beyond the direct effects of their health condition or impairment. The aim of this overview of systematic reviews was to summarise the evidence on the impact of socio-environmental factors (i.e. social, physical or attitudinal) on the health outcomes of disabled people. A systematic search of five databases (MEDLINE, PsycINFO, Embase, CINAHL and Scopus) for English-language articles from January 2000 to April 2021 was conducted. Abstracts were screened by two reviewers and reviews were critically appraised. Key data were extracted by topic, population, disability type, critical appraisal method, socio-environmental themes and health outcomes. There were 23 systematic reviews identified examining adult (60.9%) or child and young (8.7%) disabled people, with 30.4% not specifying an age range. Reviews examined people with neurological or physical (39.1%), intellectual (17.4%), sensory (8.7%) or a range of (34.8%) disabilities. Three key health outcomes (i.e. access to healthcare, health-promoting behaviour and care quality) and several recurring socio-environmental themes related to the health outcomes of disabled people were identified. Disabled people encounter common social, physical and attitudinal factors that hinder their health outcomes in terms of access to services and quality healthcare. Many preventive health services were identified as either inaccessible or not meeting the needs of disabled people. Greater involvement of disabled people in service design and awareness raising is essential.
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Affiliation(s)
- Rebecca J Mitchell
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Tayhla Ryder
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Katia Matar
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Reidar P Lystad
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Clemente KAP, da Silva SV, Vieira GI, de Bortoli MC, Toma TS, Ramos VD, de Brito CMM. Barriers to the access of people with disabilities to health services: a scoping review. Rev Saude Publica 2022; 56:64. [PMID: 35792776 PMCID: PMC9239543 DOI: 10.11606/s1518-8787.2022056003893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/22/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To analyze the scientific evidence regarding barriers to the access of people with disabilities to health services. METHODS A scoping review was carried out from the main question: "What are the main barriers that people with disabilities face in accessing health services?" The articles were surveyed in July 2019 in six scientific literature databases. Of the 1,155 documents identified in the searches, after selection by title and abstract, 170 publications were read in full and, thus, 96 articles were included and categorized according to the theoretical framework. RESULTS The main barriers indicated by the users of the service were: communication failure between professionals and patient/caregiver; financial limitations; attitudinal/behavioral issues; scarce service provision; organizational and transport barriers. The main barriers presented by service providers were: lack of training to professionals; failure of the health system; physical barriers; lack of resources/technology; and language barriers. CONCLUSIONS It was evident that people with disabilities face several barriers when trying to access the health services they need and that users and health professionals have distinct and complementary views on difficulties.
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Affiliation(s)
- Karina Aparecida Padilha Clemente
- Universidade de São PauloFaculdade de MedicinaDepartamento de Medicina Legal, Ética Médica, Medicina Social e do TrabalhoSão PauloSPBrasil Universidade de São Paulo. Faculdade de Medicina. Departamento de Medicina Legal, Ética Médica, Medicina Social e do Trabalho. São Paulo, SP, Brasil.
| | - Simone Vieira da Silva
- Universidade de São PauloFaculdade de MedicinaDepartamento de Medicina Legal, Ética Médica, Medicina Social e do TrabalhoSão PauloSPBrasil Universidade de São Paulo. Faculdade de Medicina. Departamento de Medicina Legal, Ética Médica, Medicina Social e do Trabalho. São Paulo, SP, Brasil.
| | - Gislene Inoue Vieira
- Universidade de São PauloFaculdade de MedicinaDepartamento de Medicina Legal, Ética Médica, Medicina Social e do TrabalhoSão PauloSPBrasil Universidade de São Paulo. Faculdade de Medicina. Departamento de Medicina Legal, Ética Médica, Medicina Social e do Trabalho. São Paulo, SP, Brasil.
| | - Maritsa Carla de Bortoli
- Secretaria de Estado da Saúde de São PauloInstituto de SaúdeDepartamento de Ciência e TecnologiaSão PauloSPBrasil Secretaria de Estado da Saúde de São Paulo. Instituto de Saúde. Departamento de Ciência e Tecnologia. São Paulo, SP, Brasil.
| | - Tereza Setsuko Toma
- Secretaria de Estado da Saúde de São PauloInstituto de SaúdeDepartamento de Ciência e TecnologiaSão PauloSPBrasil Secretaria de Estado da Saúde de São Paulo. Instituto de Saúde. Departamento de Ciência e Tecnologia. São Paulo, SP, Brasil.
| | - Vinícius Delgado Ramos
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Instituto de Medicina Física e Reabilitação. São Paulo, SP, Brasil.
| | - Christina May Moran de Brito
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Instituto do Câncer do Estado de São Paulo. São Paulo, SP, Brasil.
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Frawley P, Wilson N, David J, O’Shea A, Areskoug Josefsson K. Access to Sexual Health Services and Support for People with Intellectual and Developmental Disabilities: an Australian Cross-sector Survey. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 19:1935-1943. [PMID: 35669627 PMCID: PMC9159772 DOI: 10.1007/s13178-022-00734-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/13/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION People with intellectual and developmental disabilities under the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) have the right to access sexual health services including information, education, and support. Little is known about the capacity of sexual health professionals to provide these services. METHODS Using an observational research design, this study utilised a descriptive survey tool (PASH-Ext) that also encompassed a standardised measure, with a cross-sectional purposive sample of 52 Australian sexual health professionals. Data was collected in 2020. RESULTS Just over half of the participants reported having received training in their preservice education to work with people with intellectual and developmental disabilities, of these 60% held the view that people with intellectual and developmental disabilities would not feel embarrassed receiving sexual health information and support. CONCLUSION The study found that training is both important to the professionals' preparedness to work with people with intellectual and developmental disabilities, and that these professionals advocate for the continuation of this training in pre-service courses and additional training in post service education for sexual health workers. POLICY IMPLICATIONS To progressively realise Article 25 of the UNCRPD signatory, countries need to ensure sexual health services are accessible to people with intellectual and developmental disabilities. This study recommends that sexual health policy addresses equity of access for people with intellectual and developmental disability by ensuring all staff are prepared and supported to provide these services.
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Affiliation(s)
- Patsie Frawley
- Faculty of Education, Te Kura Toi Tangata, University of Waikato New Zealand, Gate 1 Knighton Road, Hamilton, New Zealand
| | - N.J. Wilson
- School of Nursing and Midwifery, Western Sydney University, Hawkesbury Campus, Locked Bag 3, Richmond, NSW 2753 Australia
| | - Jennifer David
- Disability & Inclusion, School of Health & Social Development, Deakin University, Gheringhap St, Geelong, 3220 Australia
| | - Amie O’Shea
- Disability & Inclusion, School of Health & Social Development, Deakin University, Gheringhap St, Geelong, 3220 Australia
| | - K. Areskoug Josefsson
- VID Specialized University, Vågsgaten 40, 4306 Sandnes, Norway
- Oslo Metropolitan University, St Olavs Plass, Postboks 4, 0130 Oslo, Norway
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Doody O, Hennessy T, Moloney M, Lyons R, Bright AM. The value and contribution of intellectual disability nurses/nurses caring for people with intellectual disability in intellectual disability settings: A scoping review. J Clin Nurs 2022; 32:1993-2040. [PMID: 35301775 DOI: 10.1111/jocn.16289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/22/2021] [Accepted: 02/09/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND People with intellectual disability experience poorer health and healthcare access issues. As a leading role in healthcare provision for people with intellectual disability nurses are key to supporting person-centred care and health outcomes. However, little is known about specialist intellectual disability nursing and their contribution to care provision for people with intellectual disability. METHODS A systematic scoping review. Searches of seven academic databases including MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Academic Search Complete, PsycINFO, Embase, Scopus and Web of Science were conducted to identify relevant literature. Literature addressing intellectual disability nursing or nursing care for people with intellectual disability in intellectual disability centres/units/care homes were reviewed and reported as per PRISMA-ScR checklist and PRISMA flow diagram. RESULTS The published literature (n = 68) is extensive and describes the value and contribution of intellectual disability nursing across all domains of professional practice and supports a biopsychosocial-educational approach to addressing the physical, mental and social needs of clients with intellectual disability across the care continuum of health management, health promotion and health education. CONCLUSIONS Despite the importance of the review question and the large volume of publication evidence detailing wide-ranging professional nursing roles and responsibilities, there remains limited literature on the assessment and intervention strategies employed by intellectual disability nurses that highlight their specialist knowledge and skill. Future research should focus on making the role of the nurse more visible and presenting their unique contributions to client care, service delivery, policy and ultimately to the art and science of nursing.
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Affiliation(s)
- Owen Doody
- Department of Nursing and Midwifery, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Therese Hennessy
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Mairead Moloney
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Rosemary Lyons
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Ann-Marie Bright
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
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Sexuality, Education and Support for People with Intellectual Disabilities: A Systematic Review of the Attitudes of Support Staff and Relatives. SEXUALITY AND DISABILITY 2022. [DOI: 10.1007/s11195-021-09724-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AbstractSupport staff and relatives are uncertain about multiple aspects of the sexuality of people with intellectual disabilities. Given that their attitudes embody positive and negative views, they can respectively support and restrict free sexual expression among people with intellectual disabilities and their potential for (intimate) relationships. A qualitative systematic literature review was conducted on the attitudes of support staff and relatives toward the sexuality of people with intellectual disabilities. A systematic search strategy was deployed across seven databases. The identified articles were screened on predetermined inclusion and exclusion criteria, and assessed on quality, which resulted in 31 included studies. A metasynthesis of these studies resulted in two major themes emerging, namely (a) attitudes toward the sexuality of people with intellectual disabilities, and (b) attitudes toward the sex education and support. Themes represented both positive and restrictive attitudes among support staff and relatives. The findings suggest that despite a general acceptance of the sexual rights of people with intellectual disabilities, certain forms of sexuality were approached more cautiously. Moreover, the sexual needs of some subgroups of people with intellectual disabilities received scarce attention. Those support staff and relatives holding rather restrictive attitudes appear to emphasize sexual risks. Finally, support staff and relatives stressed the importance of providing sex education and support for people with intellectual disabilities, while, simultaneously, expressing insecurity over the subject. The findings can help to improve the support provided to support staff and relatives to promote sexual health among people with intellectual disabilities.
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The role and key activities of Clinical Nurse Specialists and Advanced Nurse Practitioners in supporting healthcare provision for people with intellectual disability: An integrative review. Int J Nurs Stud 2022; 129:104207. [DOI: 10.1016/j.ijnurstu.2022.104207] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 11/26/2021] [Accepted: 02/10/2022] [Indexed: 12/29/2022]
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Heutmekers M, Naaldenberg J, Mastebroek M, Assendelft WJJ, van Schrojenstein Lantman-de Valk HMJ, Leusink GL. Out-of-hours primary care for people with intellectual disabilities: interviews in general practice. Fam Pract 2022; 39:106-111. [PMID: 34159369 DOI: 10.1093/fampra/cmab062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Out-of-hours primary care for people with intellectual disabilities (ID) involves different groups of health care professionals, who are often not familiar to one another nor to the specific health care needs of this vulnerable population. It is not known to what extend these specific health care needs or organizational factors influence the delivery of out-of-hours primary care for people with ID. OBJECTIVE The objective of this study is to explore the experiences of health care professionals regarding the medical content and the organizational context of out-of-hours primary care for people with ID. METHODS Semi-structured interviews were conducted with daily care professionals, triage nurses and general practitioners (GPs) involved in out-of-hours primary care for people with ID in the Netherlands. Interviews were thematically analysed for medical content and organizational context. RESULTS The analysis resulted in four interconnected themes: (i) uncertainties in the triage assessment of ID patients; (ii) confusion about inter-professional responsibilities; (iii) impact on routines and workflow concerning ID patients and (iv) constraints in the decision-making process. All issues raised were related to the organizational context. CONCLUSIONS Health care professionals involved in out-of-hours primary care for people with ID indicate that the quality of this care is more influenced by the organizational context than by the medical content. We recommend out-of-hours GP services and care provider services for people with ID to set standards for roles and responsibilities in order to facilitate health care professionals in delivering accessible and high-quality care to this vulnerable population.
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Affiliation(s)
- Marloes Heutmekers
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands
| | - Jenneken Naaldenberg
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands
| | - Mathilde Mastebroek
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands
| | - Willem J J Assendelft
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands
| | | | - Geraline L Leusink
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands
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Mimmo L, Woolfenden S, Travaglia J, Strnadová I, Phillips MTAK, van Hoek MAD, Harrison R. Codesigning patient experience measures for and with children and young people with intellectual disability: a study protocol. BMJ Open 2021; 11:e050973. [PMID: 34872999 PMCID: PMC8650477 DOI: 10.1136/bmjopen-2021-050973] [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] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Children and young people with intellectual disability represent one of the most vulnerable groups in healthcare, yet they remain under-represented in projects to design, develop and/or improve healthcare service delivery. Increasingly, healthcare services are using various codesign and coproduction methodologies to engage children and young people in service delivery improvements. METHODS AND ANALYSIS This study employs an inclusive approach to the study design and execution, including two co-researchers who are young people with intellectual disability on the project team. We will follow an adapted experience-based co-design methodology to enable children and young people with intellectual disability to participate fully in the co-design of a prototype tool for eliciting patient experience data from children and young people with intellectual disability in hospital. ETHICS AND DISSEMINATION This study was granted ethical approval on 1 February 2021 by the Sydney Children's Hospitals Network Human Research Ethics Committee, reference number 2020/ETH02898. Dissemination plan includes publications, doctoral thesis chapter, educational videos. A summary of findings will be shared with all participants and presented at the organisation quality and safety committee.
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Affiliation(s)
- Laurel Mimmo
- Clinical Governance Unit, Sydney Children's Hospitals Network, Randwick, New South Wales, Australia
- Population Child Health, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Susan Woolfenden
- Population Child Health, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Community Child Health, The Sydney Children's Hospitals Network, Randwick, New South Wales, Australia
| | - Joanne Travaglia
- Centre for Health Service Management, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Iva Strnadová
- Special Education and Disability Studies, School of Education, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, New South Wales, Australia
| | | | | | - Reema Harrison
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
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Smith SE, McCann HP, Urbano RC, Dykens EM, Hodapp RM. Training Healthcare Professionals to Work With People With Intellectual and Developmental Disabilities. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2021; 59:446-458. [PMID: 34814171 DOI: 10.1352/1934-9556-59.6.446] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 02/25/2021] [Indexed: 06/13/2023]
Abstract
This study assessed 155 healthcare providers, from nine disciplines, who work professionally with people with intellectual and developmental disabilities (IDD). Using a national, web-based survey, respondents rated their experience, comfort, and competence in treating individuals with different disability types and preferred methods of continuing education; respondents also provided suggestions for attracting others to work with the IDD population. Findings revealed that experiences, comfort, and competence were all higher concerning persons with autism spectrum disorder (ASD) and intellectual disability (ID), lower for those with deaf-blindness. Overall, levels of experience exceeded levels of comfort, which in turn exceeded levels of competence. The most helpful venues for continued training involved day-to-day contact with persons with IDD, which also characterized open-ended responses. Research and practical implications are discussed.
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Affiliation(s)
- Sydnie E Smith
- Sydnie E. Smith and Hannah P. McCann, Vanderbilt University, Peabody College, Department of Special Education and Vanderbilt Kennedy Center's University Center for Excellence in Developmental Disabilities
| | - Hannah P McCann
- Sydnie E. Smith and Hannah P. McCann, Vanderbilt University, Peabody College, Department of Special Education and Vanderbilt Kennedy Center's University Center for Excellence in Developmental Disabilities
| | - Richard C Urbano
- Richard C. Urbano, Vanderbilt Kennedy Center's University Center for Excellence in Developmental Disabilities and Vanderbilt University Medical Center, Department of Pediatrics
| | - Elisabeth M Dykens
- Elisabeth M. Dykens, Vanderbilt University, Peabody College, Department of Psychology and Human Development and Vanderbilt Kennedy Center's University Center for Excellence in Developmental Disabilities
| | - Robert M Hodapp
- Robert M. Hodapp, Vanderbilt University, Peabody College, Department of Special Education and Vanderbilt Kennedy Center's University Center for Excellence in Developmental Disabilities
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Rutherford M, Maciver D, Johnston L, Prior S, Forsyth K. Development of a Pathway for Multidisciplinary Neurodevelopmental Assessment and Diagnosis in Children and Young People. CHILDREN (BASEL, SWITZERLAND) 2021; 8:1033. [PMID: 34828746 PMCID: PMC8617836 DOI: 10.3390/children8111033] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/03/2021] [Accepted: 11/08/2021] [Indexed: 11/25/2022]
Abstract
There is a variable standard of access to quality neurodevelopmental assessment and diagnosis. People may have negative experiences, encountering lengthy waiting times, and inconsistent practices. Practitioners need guidance on standards and practices for assessment and diagnosis matched to new ways of working. In this paper, we present a new pathway and recommendations for multidisciplinary neurodevelopmental assessment and diagnosis for children and young people (<19 years), developed by the Scottish Government funded National Autism Implementation Team (NAIT). Our research used the Medical Research Council guidance for the development of complex interventions and included several iterative stages. Stage 1: n = 44 stakeholders attended an event on developing new practices for diagnosis and assessment. Stage 2: a literature synthesis was completed by the research team of clinical guidelines and diagnosis and assessment tools. Stage 3: an event with n = 127 stakeholders included discussion and debate of the data from stages 1 and 2. Recommendations and a draft pathway were written. Stage 4: successive drafts of recommendations and the pathway documentation were circulated among an advisory group, including multidisciplinary clinical experts and people with lived experience, until the final pathway was agreed upon. The finalised pathway includes guidance on terminology, assessment, diagnosis, triage, time standards and engagement of people with lived experience. The new pathway has been adopted by the Scottish Government. The pathway and associated documentation are freely available online for use by others.
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Affiliation(s)
- Marion Rutherford
- School of Health Sciences, Queen Margaret University, Edinburgh EH21 6UU, UK; (M.R.); (L.J.); (S.P.); (K.F.)
| | - Donald Maciver
- School of Health Sciences, Queen Margaret University, Edinburgh EH21 6UU, UK; (M.R.); (L.J.); (S.P.); (K.F.)
| | - Lorna Johnston
- School of Health Sciences, Queen Margaret University, Edinburgh EH21 6UU, UK; (M.R.); (L.J.); (S.P.); (K.F.)
- Additional Support for Learning Service, Communities and Families, City of Edinburgh Council, Edinburgh EH8 8BG, UK
| | - Susan Prior
- School of Health Sciences, Queen Margaret University, Edinburgh EH21 6UU, UK; (M.R.); (L.J.); (S.P.); (K.F.)
| | - Kirsty Forsyth
- School of Health Sciences, Queen Margaret University, Edinburgh EH21 6UU, UK; (M.R.); (L.J.); (S.P.); (K.F.)
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Desroches ML, Howie VA, Wilson NJ, Lewis P. Nurses' attitudes and emotions toward caring for adults with intellectual disability: An international replication study. J Nurs Scholarsh 2021; 54:117-124. [PMID: 34741386 DOI: 10.1111/jnu.12713] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 08/23/2021] [Accepted: 09/01/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Negative nurse attitudes and emotions toward caring for adults with intellectual disability have been implicated as a contributing factor to the cascade of health disparities faced by this population. The purpose of this study was to identify influencing factors of nurses' attitudes and emotions toward caring for adults with intellectual disability that transcend national borders and differing systems of care. METHODS This cross-sectional correlational predictive replication study used an online electronic survey with a snowball sample of 115 Australian nurses, from March to August 2020. RESULTS Nurses' attitudes toward adults with intellectual disability were significantly less positive compared to adults without intellectual disability, and nurses' beliefs about the quality of life of adults with intellectual disability predicted nurses' attitudes, replicating findings of the USA study. The frequency of both the professional and personal contact was associated with positive and negative emotions in both countries, however no consistent predictive pattern was evident. CONCLUSIONS Our findings suggest that worldwide, there is room for improvement in nurses' attitudes and emotions toward this underserved group. Future research should investigate the role of nurses' beliefs about quality of life of adults with intellectual disability for potential interventions to improve nurses' attitudes toward care. CLINICAL RELEVANCE Assisting nurses to identify misconceptions about the quality of life of adults with intellectual disability is suggested as an intervention to improve nurses' attitudes toward caring for adults with intellectual disability.
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Affiliation(s)
- Melissa L Desroches
- College of Nursing and Health Sciences, University of Massachusetts Dartmouth, North Dartmouth, Massachusetts, USA
| | - Virginia A Howie
- School of Nursing, Midwifery, and Social Sciences, CQUniversity, Nth Rockhampton, Queensland, Australia
| | - Nathan J Wilson
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
| | - Peter Lewis
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
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Evlyn D, Cayami FK, Ediati A, Utari A, Winarni TI. Attitudes of Indonesian health science undergraduates toward sexuality in individuals with intellectual disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 118:104082. [PMID: 34507052 DOI: 10.1016/j.ridd.2021.104082] [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: 03/09/2021] [Revised: 08/06/2021] [Accepted: 08/28/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Sexuality is a fundamental part of the lives of human beings. However, a significant inequality exists regarding the right of an individual with intellectual disabilities. AIMS This study aimed to explore the attitudes of undergraduate health science students toward sexuality in individuals with intellectual disability (ID) in Indonesia. METHODS A cross-sectional study was performed using the Indonesian version of Attitudes toward Sexuality Questionnaires in Intellectual Disability (ASQ-ID). This study involved 617 students in medical, psychology, and public health undergraduate programs. RESULTS Among all participants (n = 617, male = 137, female = 480), the attitude towards self-control was found a significant difference among all three health science undergraduates (p = .01). The psychology students had the most favorable attitudes toward self-control compared to other students. The difference was found between medical and public health students and between public health and psychology students with p = .009 and p = .011, respectively. Religion was significantly affected for the non-reproductive sexual behavior subscale (p = .038). The religion was found to have significant effect on the attitude towards nonreproductive sexual behavior subscale (p = .038). CONCLUSIONS Results show that Indonesian undergraduate students majoring in the health sciences have varying attitudes toward sexuality in individuals with ID. Medical and psychology students have more favorable attitudes toward self-control, whereas public health students have less favorable attitudes. Their religion influencing the attitudes toward nonreproductive sexual behavior.
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Affiliation(s)
- Desiyana Evlyn
- Faculty of Medicine, Diponegoro University, Jl. Prof. H. Soedarto, SH, Tembalang, Semarang, 50275, Central Java, Indonesia.
| | - Ferdy Kurniawan Cayami
- Department of Anatomy, Faculty of Medicine, Diponegoro University, Jl. Prof. H. Soedarto, SH, Tembalang, Semarang, 50275, Central Java, Indonesia; Center for Biomedical Research (CEBIOR), Faculty of Medicine, Diponegoro University, Jl. Prof. H. Soedarto, SH, Tembalang, Semarang, 50275, Central Java, Indonesia.
| | - Annastasia Ediati
- Faculty of Psychology, Diponegoro University, Jl. Prof. H. Soedarto, SH, Tembalang, Semarang, 50275, Central Java, Indonesia.
| | - Agustini Utari
- Center for Biomedical Research (CEBIOR), Faculty of Medicine, Diponegoro University, Jl. Prof. H. Soedarto, SH, Tembalang, Semarang, 50275, Central Java, Indonesia; Department of Pediatrics, Faculty of Medicine, Diponegoro University, Jl Dr. Sutomo no 16, Semarang, 50244, Central Java, Indonesia.
| | - Tri Indah Winarni
- Department of Anatomy, Faculty of Medicine, Diponegoro University, Jl. Prof. H. Soedarto, SH, Tembalang, Semarang, 50275, Central Java, Indonesia; Center for Biomedical Research (CEBIOR), Faculty of Medicine, Diponegoro University, Jl. Prof. H. Soedarto, SH, Tembalang, Semarang, 50275, Central Java, Indonesia.
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Doody O, Bailey ME, Hennessy T. Nature and extent of intellectual disability nursing research in Ireland: a scoping review to inform health and health service research. BMJ Open 2021; 11:e051858. [PMID: 34615681 PMCID: PMC8496393 DOI: 10.1136/bmjopen-2021-051858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To capture the extent and nature of intellectual disability nursing publications in Ireland. DESIGN Scoping review using Arksey and O'Malley approach. DATA SOURCES Six databases (PsycINFO, CINAHL, Medline, Academic Search Complete, Scopus, Embase) were searched along with a web-based search of the eight academic institutions delivering intellectual disability nurse education in Ireland for publications indexed from the earliest available date to the 31 December 2020. ELIGIBILITY CRITERIA Publications by an academic, practitioner or student working in intellectual disability practice or education in Ireland relating to intellectual disability nursing, care or education. DATA EXTRACTION AND SYNTHESIS Data pertaining to type of paper/design, authors (academic/professional/student), year, collaboration (national/international), topic/content area and title were extracted from each paper. Data were analysed by two authors using Colorafi and Evans content analysis steps where data was tabulated, and a narrative synthesis undertaken. RESULTS The reporting of the review is in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) and PRISMA extension for Scoping Reviews Checklist. Database and web-based searching resulting 245 articles meeting the criteria for this review. Through content analysis the 245 articles were mapped onto six themes: supporting inclusion, future planning, aspects of health, interventions, education, professional development and research, and personal and professional accounts of caring. CONCLUSIONS This review highlights the extent and nature of intellectual disability publications by academic, practitioner or student working in intellectual disability nursing in Ireland together with opportunities for future growth and development. From the findings it is apparent that there is an ongoing need for intellectual disability nurses to define their role across the full trajectory of health provision and to make visible their role in person-family centred support, inclusion, and contributions in health education, health promotion and health management.
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Affiliation(s)
- Owen Doody
- Nursing and Midwifery, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Maria E Bailey
- Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Therese Hennessy
- Nursing and Midwifery, University of Limerick, Limerick, Ireland
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Opoku MP, Elhoweris H, Jiya AN, Ngoh NAP, Nketsia W, Kumi EO, Torgbenu EL. Cross-national study of communal attitudes toward individuals with intellectual disabilities in sub-Saharan Africa: Cameroon vs. Ghana. PLoS One 2021; 16:e0257482. [PMID: 34582489 PMCID: PMC8478177 DOI: 10.1371/journal.pone.0257482] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/03/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND An intellectual disability (ID) is characterized by a deficit in the functional, cognitive, and adaptive skills required for independent living. Due to the low cognitive capabilities of individuals with IDs, they have become victims of marginalization, exclusion, and denial of their fundamental rights to basic necessities in societies around the world. While efforts are being made to improve service provision to and acceptance of individuals with disabilities, the extent of communal acceptance and recognition of these individuals as equal members of society remains underexplored in sub-Saharan African countries such as Cameroon and Ghana. OBJECTIVE As attitudes toward individuals with IDs are pivotal in shaping national policies, this cross-national study examined communal attitudes toward persons with IDs in Cameroon and Ghana. METHOD The Community Living Attitude Scale for Intellectual Disabilities (CLAS-ID) was used to collect data from a total of 741 university students in the two countries. The validity of the scale was assessed using confirmatory factor analysis and principal component analysis. The association between the background variables and attitudes was examined using t-tests, analysis of variance, linear regression, and two-way factor analysis. RESULTS The results showed the validity of the CLAS-ID as a valid tool for measuring communal attitudes toward individuals with IDs in sub-Saharan Africa. The participants appeared ambivalent about attitude towards individuals with ID and other findings showed no association between attitudes and variables such as gender, relation, and contact with individuals with IDs. CONCLUSION We discuss the need for innovative approaches aimed at changing attitudes toward individuals with IDs in sub-Saharan Africa as well as other study implications.
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Affiliation(s)
- Maxwell Peprah Opoku
- Special Education Department, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Hala Elhoweris
- Special Education Department, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Alex Nester Jiya
- Institute of Governance, Humanities and Social Sciences, Pan African University, Yaoundé, Cameroon
| | - Nlem Anne-Paule Ngoh
- Institute of Governance, Humanities and Social Sciences, Pan African University, Yaoundé, Cameroon
| | - William Nketsia
- School of Education, Western Sydney University, Sydney, Australia
| | | | - Eric Lawer Torgbenu
- Department of Physiotherapy and Rehabilitation Sciences, University of Health and Allied Sciences, Ho, Ghana
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Ee J, Lim JM, Stenfert Kroese B, Rose J. Services for people with intellectual disabilities and mental health problems in Singapore: perspectives from mainstream mental health professionals. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2021; 67:371-380. [PMID: 34570836 PMCID: PMC8451686 DOI: 10.1080/20473869.2021.1932394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/15/2021] [Accepted: 05/15/2021] [Indexed: 06/13/2023]
Abstract
Background: Generic mental health staff often have contact with people with intellectual disabilities when they access mainstream mental health services. To date, there has not been any research conducted in non-western countries to explore their views. This paper investigates the views and experiences of mainstream mental health professionals regarding the mental health services for people with intellectual disabilities in Singapore. Methods: Eight staff members from generic mental health services were interviewed. Thematic analysis was used to identify main themes. Findings: The main themes are related to their work experiences, perceptions of people with intellectual disabilities, ideal staff characteristics and service recommendations. Conclusions: Participants identified a lack of experience and knowledge when working with this population. They highlighted the challenges they face promoting choice and autonomy for people with intellectual disabilities. The discussion includes recommendations for improving staff knowledge through training opportunities, consideration of non-pharmacological approaches and early collaboration with caregivers during the treatment process.
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Affiliation(s)
- Jonathan Ee
- Centre for Applied Psychology, The University of Birmingham, Edgbaston, Birmingham, UK
| | - Jan Mei Lim
- Department of Psychology, Institute of Mental Health, Singapore, Singapore
| | - Biza Stenfert Kroese
- Centre for Applied Psychology, The University of Birmingham, Edgbaston, Birmingham, UK
| | - John Rose
- Centre for Applied Psychology, The University of Birmingham, Edgbaston, Birmingham, UK
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Gibson RC, Bouamrane MM, Dunlop MD. Alternative and Augmentative Communication Technologies for Supporting Adults With Mild Intellectual Disabilities During Clinical Consultations: Scoping Review. JMIR Rehabil Assist Technol 2021; 8:e19925. [PMID: 34106087 PMCID: PMC8235287 DOI: 10.2196/19925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/31/2020] [Accepted: 04/02/2021] [Indexed: 12/25/2022] Open
Abstract
Background People with intellectual disabilities (IDs) face significant communication barriers when accessing health care services; they find it difficult to identify and describe conditions clearly enough to support practitioners in making an accurate diagnosis. In addition, medical professionals generally have little knowledge and understanding of the needs of people with ID, which may result in the use of consultation techniques that do not cater to their patients’ skills. Objective This review aims to identify and synthesize the literature on alternative and augmentative communication technologies that are used to support adults with mild ID during the exchange of information with medical practitioners. Methods We performed a scoping review of studies published in English that describe the technologies that are used to promote communication with patients with mild ID during medical consultations. The databases searched were PubMed, ACM Digital Library, and Google Scholar. A qualitative framework-based approach was used to synthesize the data and discern key recurring themes across the identified literature. Results Of the 1557 articles screened, 15 (0.96%) met our inclusion criteria. The bulk of the communication aids used focused on low-tech solutions, including patient passports, note-based prompts, Talking Mats, health diaries, and easy-read information sheets. Their influence on current practice ranged from advancing medical professionals’ knowledge of the health and communication needs of people with ID to increasing interagency collaboration, patient advocacy skills, and health promotion activities. The major barriers to the implementation of low-tech aids were a lack of portability and increased maintenance efforts. Only 3 studies explored the use of mobile apps to promote communication. Their findings indicated that high-tech solutions offer greater customization with regard to the accessibility and health care needs of people with ID. Conclusions Alternative and augmentative communication technologies have the potential to increase the quality of care provided to patients with mild ID; however, little work has been carried out in this area. Greater emphasis must be placed on (high-tech) two-way communication aids that empower patients to become involved in decisions regarding their care. Quantitative evaluation methods should be used to discern the true benefits of such aids, and researchers should describe their study protocols in depth to promote replication and generalizability.
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Affiliation(s)
- Ryan Colin Gibson
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Matt-Mouley Bouamrane
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Mark D Dunlop
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, United Kingdom
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Garrels V. Considering the boundaries of intellectual disability: Using philosophy of science to make sense of borderline cases. PHILOSOPHICAL PSYCHOLOGY 2021. [DOI: 10.1080/09515089.2021.1914832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Veerle Garrels
- Department of Vocational Teacher Education, Oslo Metropolitan University, Oslo, Norway
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Foo B, Wiese M, Curryer B, Stancliffe RJ, Wilson NJ, Clayton JM. Specialist palliative care staff's varying experiences of talking with people with intellectual disability about their dying and death: A thematic analysis of in-depth interviews. Palliat Med 2021; 35:738-749. [PMID: 33730929 DOI: 10.1177/0269216321998207] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The cognitive and communication challenges experienced by people with intellectual disability present difficulties for health professionals, particularly in the face of illness and dying. AIM To explore the experiences of specialist palliative care staff in talking with people with intellectual disability about their dying and death, and factors that influence these conversations. DESIGN An inductive thematic analysis was conducted on data from a larger qualitative semi-structured interview study. SETTING/PARTICIPANTS Twenty palliative care staff from health services across Australia were interviewed. Participants were employed in multidisciplinary specialist palliative care teams and had provided palliative care to dying persons with intellectual disability. RESULTS Specialist palliative care staff did not consistently talk with people with intellectual disability about their dying and death. Conversations were influenced by (a) the perceived capacity of the person with intellectual disability, (b) experience and expertise of palliative care staff, (c) the relationship between palliative care staff and dying person and (d) values of palliative care staff and other caregivers (namely family members and paid carers). CONCLUSIONS Specialist palliative care staff experience difficulties in talking with people with intellectual disability about their dying. Development of communication guidelines, resources and training for palliative care teams are urgently required to improve palliative care for this patient group. A more comprehensive research agenda on the needs of people with intellectual disability and their caregivers in palliative care is needed, with a particular focus on strategies to effectively communicate about dying and death.
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Affiliation(s)
- Baby Foo
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Michele Wiese
- School of Psychology, Western Sydney University, Penrith, NSW, Australia
| | - Bernadette Curryer
- Centre for Disability Research and Policy, The University of Sydney, Sydney, NSW, Australia
| | - Roger J Stancliffe
- Centre for Disability Research and Policy, The University of Sydney, Sydney, NSW, Australia
| | - Nathan J Wilson
- School of Nursing and Midwifery, Western Sydney University, Hawkesbury, NSW, Australia
| | - Josephine M Clayton
- Centre for Learning & Research in Palliative Care, HammondCare, Greenwich Hospital, Sydney, Australia; Northern Clinical School, The University of Sydney, Sydney, NSW, Australia
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Moloney M, Hennessy T, Doody O. Reasonable adjustments for people with intellectual disability in acute care: a scoping review of the evidence. BMJ Open 2021; 11:e039647. [PMID: 33619184 PMCID: PMC7903074 DOI: 10.1136/bmjopen-2020-039647] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 01/14/2021] [Accepted: 01/23/2021] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES People with intellectual disability are vulnerable in terms of health service provision due to increased comorbidity, higher dependency and cognitive impairment. This review explored the literature to ascertain what reasonable adjustments are evident in acute care to support people with intellectual disability, ensuring they have fair access and utilisation of health services. DESIGN Scoping review. SETTING Acute care settings. METHODS Five databases were systematically searched to identify studies that reported on the implementation of reasonable adjustments. Authors worked in pairs to screen studies for inclusion, data were extracted and charted and findings were synthesised according to content and themes. RESULTS Of the 7770 records identified, six studies were included in the review. The volume of evidence was influenced by specific inclusion criteria, and only papers that reported on the actual implementation of a reasonable adjustment within an acute care setting were included. Many papers reported on the concept of reasonable adjustment; however, few identified its applications in practice. CONCLUSIONS The scoping review highlights a lack of research on the practice and implementation of reasonable adjustments within acute care settings. There is a need for increased support, education and the provision of intellectual disability specialists across acute care settings.
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Affiliation(s)
- Mairead Moloney
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Therese Hennessy
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Owen Doody
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, Health Research Institute, Health Implementation Science and Technology, University of Limerick, Limerick, Ireland
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