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Kúld PB, Frielink N, Schuengel C, Embregts PJCM. Supporting self-determination of individuals with severe or profound intellectual and multiple disabilities according to relatives and healthcare professionals: A concept mapping study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13267. [PMID: 38863165 DOI: 10.1111/jar.13267] [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: 10/02/2023] [Revised: 05/16/2024] [Accepted: 06/03/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND This study aimed to identify perspectives of relatives and healthcare professionals regarding self-determination support for people with severe or profound intellectual and multiple disabilities, highlighting agreements and differences in their viewpoints. METHOD Following a concept mapping study, online focus group meetings yielded statements on self-determination support from relatives (residential facilities: n = 6, family homes: n = 7) and healthcare professionals (residential facilities: n = 9, family home: n = 5). Participants clustered and rated statements, resulting in four concept maps interpreted by experts (N = 6). RESULTS The 285 statements were categorised into 5-7 clusters per map, revealing key strategies for self-determination support: communication and choice making (facilitated by aids), sensitivity, familiarity, and collaboration among involved parties. CONCLUSION Each group placed different emphasis on these strategies, highlighting importance of continuous support in their implementation. Future research should prioritise practical implementations of these strategies to enhance self-determination.
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Affiliation(s)
- P B Kúld
- Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - N Frielink
- Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - C Schuengel
- Department of Clinical Child and Family Studies, Vrije Universiteit, Amsterdam, The Netherlands
| | - P J C M Embregts
- Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
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van den Bemd M, Koks-Leensen M, Cuypers M, Leusink GL, Schalk B, Bischoff EWMA. Care needs of chronically ill patients with intellectual disabilities in Dutch general practice: patients' and providers' perspectives. BMC Health Serv Res 2024; 24:732. [PMID: 38877510 PMCID: PMC11177393 DOI: 10.1186/s12913-024-11155-0] [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: 10/25/2023] [Accepted: 05/31/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND To reduce the impact of chronic diseases (cardiovascular disease, diabetes mellitus type 2, and chronic lung disease (asthma or chronic obstructive pulmonary disease (COPD)), it is imperative that care is of high quality and suitable to patients' needs. Patients with intellectual disabilities (ID) differ from the average patient population in general practice because of their limitations in adaptive behaviour and intellectual functioning, and concomitant difficulties recognising and reacting to disease symptoms, proactively searching health information, and independently managing diseases effectively. Because of these differences, information on their care needs is essential for suitable chronic disease management (CDM). Inadequate recognition of the care needs of this vulnerable population may hamper the harmonisation of evidence-based and person-centred care, compounded by issues such as stigma, misconceptions, and diagnostic overshadowing. This study therefore aimed to explore the needs of patients with ID from perspectives of both patients and of healthcare providers (HCPs) in the context of CDM in general practice. METHODS This qualitative study recruited patients with ID for face-to-face individual interviews and HCPs for focus groups. With the Chronic Care Model as the underlying framework, semi-structured interviews and focus-group guides were defined to explore patients' care needs and HCPs' perspectives. All interviews and focus groups were audio-recorded and transcribed verbatim. Using Atlas.ti software, data were analysed using reflexive thematic analysis. RESULTS Between June and September 2022, 14 patients with ID and cardiovascular disease, diabetes mellitus type 2, and/or asthma/COPD were interviewed; and 32 general practitioners and practice nurses participated in seven focus groups. We identified six care needs underpinning suitable CDM: trusting relationship between patient and HCP; clear expectations about the CDM process; support in disease management; directive decision-making; support in healthy lifestyle; accessible medical information. CONCLUSIONS This vulnerable patient population has complex care needs that must be acknowledged for suitable CDM. Although HCPs largely recognise these needs, organisational factors and lack of training or experience with patients with ID hamper HCPs' ability to fully adjust care provision to these needs. Access to, and knowledge of, easy-language information on chronic diseases and communication guidelines could aid HCPs to facilitate patients in managing their diseases more adequately.
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Affiliation(s)
- Milou van den Bemd
- Department of Primary and Community Care, Radboud University Medical Centre, Geert Grooteplein Zuid 10, Nijmegen, 6525 GA, The Netherlands.
| | - Monique Koks-Leensen
- Department of Primary and Community Care, Radboud University Medical Centre, Geert Grooteplein Zuid 10, Nijmegen, 6525 GA, The Netherlands
| | - Maarten Cuypers
- Department of Primary and Community Care, Radboud University Medical Centre, Geert Grooteplein Zuid 10, Nijmegen, 6525 GA, The Netherlands
| | - Geraline L Leusink
- Department of Primary and Community Care, Radboud University Medical Centre, Geert Grooteplein Zuid 10, Nijmegen, 6525 GA, The Netherlands
| | - Bianca Schalk
- Department of Primary and Community Care, Radboud University Medical Centre, Geert Grooteplein Zuid 10, Nijmegen, 6525 GA, The Netherlands
| | - Erik W M A Bischoff
- Department of Primary and Community Care, Radboud University Medical Centre, Geert Grooteplein Zuid 10, Nijmegen, 6525 GA, The Netherlands
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Granberg A, Lundqvist LO, Duberg A, Matérne M. The influence of contextual factors on an intervention for people with disabilities from support persons' and health personnel's perspectives: a focus group study. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1294990. [PMID: 38751820 PMCID: PMC11094220 DOI: 10.3389/fresc.2024.1294990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 04/22/2024] [Indexed: 05/18/2024]
Abstract
Introduction Contextual factors influence interventions in healthcare and pose a particular challenge in interventions designed for people with profound intellectual and multiple disabilities (PIMD). Exploring support persons' and health personnel's experience of an intervention may improve our understanding of the influence of contextual factors. Such exploration is important for revealing areas and focus points for future implementations. Therefore, the aim of this study is to explore support persons' and health personnel's experience of contextual factors during involvement in an intervention for people with PIMD. Methods This focus group study includes eight groups, comprising a total of 34 support persons and health personnel, at habilitation centres at four regions in central Sweden. Data were analysed inductively using a content analysis approach. Results Three themes emerged from the analysis of the informants' perspectives on the contextual factors: (1) structure and support enhances intervention feasibility; (2) an intervention's benefit for people with PIMD increases its acceptability; and (3) being engaged and involved increases support persons' and health personnel's motivation. Our findings show that the implementation of an intervention for people with PIMD should focus on the recipients of the intervention in its context, forming a clear communication plan. A training programme should be provided for the recipients and providers of the intervention. Discussion Finally, the implementation process can be facilitated by creating space for staff to contribute and by encouraging participation and ownership for everyone involved. Using a co-design strategy can enable a shared responsibility to solve the identified challenges, while contributing to the development and design of future interventions for people with disabilities.
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Affiliation(s)
- Anette Granberg
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - Lars-Olov Lundqvist
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - Anna Duberg
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - Marie Matérne
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
- School of Behavioural, Social and Legal Sciences, Örebro University, Örebro, Sweden
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Ware J, Buell S, Chadwick DD, Bradshaw J, Goldbart J. A systematic review of research on staff training as an intervention to develop communication in children and adults with profound intellectual and multiple disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13201. [PMID: 38332474 DOI: 10.1111/jar.13201] [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: 12/20/2022] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 02/10/2024]
Abstract
INTRODUCTION This paper aims to identify to what extent staff training interventions are successful in enhancing the development of communication skills in people with profound intellectual and multiple disabilities. METHODS A systematic review was undertaken, conforming to PRISMA guidelines. English language, peer reviewed, empirical studies of staff training interventions to enhance the communication of people with profound intellectual and multiple disabilities were included. Databases Scopus, Web of Science, Proquest, Linguistics and Language Behaviour Abstracts (LLBA) and Medline were searched in July 2015 and updated in December 2022. Quality appraisal was conducted on 13 studies using Crowe's Critical Appraisal Tool (CCAT). RESULTS Few good quality evaluations of interventions were found. Challenges to research rigour included the diversity of people with profound intellectual and multiple disabilities, small sample sizes, intervention intensity and the management of fidelity. CONCLUSIONS Manualised and bespoke interventions showed promise in improving staff communication and responsiveness.
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Affiliation(s)
- Jean Ware
- School of Educational Sciences, Bangor University, Bangor, Wales
| | - Susan Buell
- School of Health Sciences, University of Dundee, Dundee, Scotland
| | - Darren D Chadwick
- School of Psychology, Liverpool John Moores University, Liverpool, England
| | - Jill Bradshaw
- Tizard Centre, University of Kent, Canterbury, England
| | - Juliet Goldbart
- Department of Psychology, Manchester Metropolitan University, Manchester, England
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Baumstarck K, Hamouda I, Aim MA, Anzola AB, Khaldi-Cherif S, Felce A, Maincent K, Lind K, Auquier P, Billette de Villemeur T, Rousseau MC. Health care management adequacy among French persons with severe profound intellectual and multiple disabilities: a longitudinal study. BMC Health Serv Res 2024; 24:99. [PMID: 38238747 PMCID: PMC10795329 DOI: 10.1186/s12913-024-10552-9] [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: 04/03/2023] [Accepted: 01/03/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND The care organization of persons with profound intellectual and multiple disabilities (PIMD) varies by country according to the health care system. This study used a large sample of French individuals with severe PIMD/polyhandicap to assess: 1) the adequacy of care setting over a 5-year period and 2) health care consumption. METHODS The longitudinal study used data from the French EVALuation PoLyHandicap (EVAL-PLH) cohort of persons with severe PIMD/polyhandicap who were receiving managed in specialized care centres and residential facilities. Two assessments were performed: wave 1 (T1) in 2015-2016 and wave 2 (T2) in 2020-2021. The inclusion criteria were as follows: age > 3 years at the time of inclusion; age at onset of cerebral lesion younger than 3 years old; and severe PIMD. The adequacy of the care setting was based on the following: i) objective indicators, i.e., adequacy for age and adequacy for health status severity; ii) subjective indicators, i.e., self-perception of the referring physician about medical care adequacy and educational care adequacy. Health care consumption was assessed based on medical and paramedical care. RESULTS Among the 492 persons assessed at the 2 times, 50% of individuals at T1 and 46% of individuals at T2 were in an inadequate care setting based on age and severity. Regarding global subjective inadequacy, the combination of medical adequacy and educational adequacy, 7% of individuals at T1 and 13% of individuals at T2 were in an inadequate care setting. At T2, a majority of individuals were undermonitored by medical care providers (general practitioners, physical medicine rehabilitation physicians, neurologists, orthopaedists, etc.). Important gaps were found between performed and prescribed sessions of various paramedical care (physiotherapy, occupational therapy, psychomotor therapy, etc.). CONCLUSIONS This study revealed key elements of inadequate care management for persons with severe PIMD/polyhandicap in France. Based on these important findings, healthcare workers, familial caregivers, patients experts, and health decision-makers should develop appropriate care organizations to optimize the global care management of these individuals. TRIAL REGISTRATION NCT02400528, registered 27/03/2015.
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Affiliation(s)
- Karine Baumstarck
- EA 3279, CEReSS - Research Centre On Health Services and Quality of Life, Aix Marseille University, 27 Boulevard Jean-Moulin, 13385, Marseille, France.
- Epidemiology and Health Economy Department, Assistance Publique Hôpitaux de Marseille, 27, Boulevard Jean-Moulin, 13385, Marseille, France.
| | - Ilyes Hamouda
- EA 3279, CEReSS - Research Centre On Health Services and Quality of Life, Aix Marseille University, 27 Boulevard Jean-Moulin, 13385, Marseille, France
- Epidemiology and Health Economy Department, Assistance Publique Hôpitaux de Marseille, 27, Boulevard Jean-Moulin, 13385, Marseille, France
| | - Marie-Anastasie Aim
- UR 849, LPS - Social Psychology Laboratory, Aix-Marseille University, 29 Av. Robert Schuman, 13621, Aix-en-Provence, France
| | - Any Beltran Anzola
- EA 3279, CEReSS - Research Centre On Health Services and Quality of Life, Aix Marseille University, 27 Boulevard Jean-Moulin, 13385, Marseille, France
| | - Sherezad Khaldi-Cherif
- General Union Health Insurance Fund (Union Générale Caisse Assurance Maladie, UGECAM), 26-50 Avenue du Professeur-André-Lemierre, 75986, Paris, Ile de France, France
| | - Agnès Felce
- Hendaye Hospital, Route Corniche, 64700, Hendaye, Assistance Publique-Hôpitaux de Paris, France
| | - Kim Maincent
- Committee for Studies, Education and Care for People With Multiple Disabilities (Comité d'Études, d'Éducation Et de Soins Auprès Des Personnes Polyhandicapées, CESAP), 62 Rue de La Glacière, 75013, Paris, France
| | - Katia Lind
- General Union Health Insurance Fund (Union Générale Caisse Assurance Maladie, UGECAM), 26-50 Avenue du Professeur-André-Lemierre, 75986, Paris, Ile de France, France
| | - Pascal Auquier
- EA 3279, CEReSS - Research Centre On Health Services and Quality of Life, Aix Marseille University, 27 Boulevard Jean-Moulin, 13385, Marseille, France
- Epidemiology and Health Economy Department, Assistance Publique Hôpitaux de Marseille, 27, Boulevard Jean-Moulin, 13385, Marseille, France
| | - Thierry Billette de Villemeur
- Service de Polyhandicap Pédiatrique, Roche Guyon Hospital, Assistance Publique Hôpitaux de Paris, 1 Rue Justinien Blazy 95780, La Roche-Guyon, France
- Hospital Fédération Des Hôpitaux de Polyhandicap Et Multihandicap, San Salvadour Hospital, Assistance Publique Hôpitaux de Paris, 4312 Rte de L'Almanarre, 83400, Hyères, France
| | - Marie-Christine Rousseau
- EA 3279, CEReSS - Research Centre On Health Services and Quality of Life, Aix Marseille University, 27 Boulevard Jean-Moulin, 13385, Marseille, France
- Hospital Fédération Des Hôpitaux de Polyhandicap Et Multihandicap, San Salvadour Hospital, Assistance Publique Hôpitaux de Paris, 4312 Rte de L'Almanarre, 83400, Hyères, France
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Verdugo MÁ, Schalock RL, Gómez LE, Navas P. A Systematic Approach to Implementing, Evaluating, and Sustaining the Shared Citizenship Paradigm in the Disability Field. Behav Sci (Basel) 2023; 13:970. [PMID: 38131825 PMCID: PMC10740522 DOI: 10.3390/bs13120970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/01/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
The disability field continues to face challenges in transforming and implementing meaningful and effective changes in person-centered services and supports aligned with the principles of the Convention on the Rights of Persons with Disabilities. To guide this transformative process effectively, a paradigm must be operationalized through a systematic approach. This article outlines such a systematic approach, consisting of two components: (a) aligning the paradigm's foundational pillars to the elements of an explanatory/implementation model (the Quality of Life and Supports Model) to facilitate the paradigm's operationalization, acceptance, and application and (b) aligning implementation, evaluation, and sustainability strategies with ecological systems, implementation targets, and the paradigm's foundational pillars to drive change across systems. The synergy and alignment between these components underscore the importance of linking public policies with professional and organizational practices to promote social inclusion and enhance the quality of life for people with disabilities. We provide practical examples highlighting the collaborative potential of this synergy and emphasize the significance of evidence-based and person-centered practices in promoting equal rights and social inclusion for people with disabilities.
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Affiliation(s)
| | | | - Laura E. Gómez
- Department of Psychology, Universidad de Oviedo, 33003 Oviedo, Spain
| | - Patricia Navas
- INICO, Universidad de Salamanca, 37005 Salamanca, Spain; (M.Á.V.); (P.N.)
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van Cooten VJC, Gielissen MFM, van Mastrigt GAPG, den Hollander W, Evers SMAA, Smeets O, Smit F, Boon B. Smart Continence Care for People With Profound Intellectual and Multiple Disabilities: Protocol for a Cluster Randomized Trial and Trial-Based Economic Evaluation. JMIR Res Protoc 2022; 11:e42555. [DOI: 10.2196/42555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 09/14/2022] [Accepted: 09/21/2022] [Indexed: 11/24/2022] Open
Abstract
Background
People with profound intellectual and multiple disabilities (PIMD) cannot communicate the need to change their incontinence products. The smart continence care (SCC) product Abena Nova signals caregivers when change is needed. This provides the opportunity for more person-centered care, increased quality of life, and a decreased number of leakages. However, there is a need for evidence of the effectiveness and cost-effectiveness of such technology compared with regular continence care (RCC) for people with PIMD.
Objective
This paper presents the research protocol for an effectiveness and cost-effectiveness study with people with PIMD living in long-term care facilities in the Netherlands.
Methods
A cluster randomized trial will be conducted in 3 consecutive waves across 6 long-term care providers for people with disabilities and 160 participants with PIMD. Long-term care providers are randomized at a 1:1 ratio, resulting in an intervention group and a group continuing RCC. The intervention group will receive implementation guidance and use SCC for 3 months; the other group will continue their RCC as usual and then switch to SCC. This study consists of three components: effectiveness study, economic evaluation, and process evaluation. The primary outcome will be a change in the number of leakages. The secondary outcomes are quality of life, the difference in the number of changes, the work perception of caregivers, cost-effectiveness, and cost utility. Data collection will occur at T0 (baseline), T1 (6 weeks), T2 (12 weeks), and T3 (9-month follow-up) for the first 2 intervention groups. An intention-to-treat analysis will be performed. The economic evaluation will be conducted alongside the trial from the societal and long-term care provider perspectives. Qualitative data collection through interviews and field notes will complement these quantitative results and provide input for the process evaluation.
Results
This research was funded in December 2019 by ZonMw, the Netherlands Organization for Health Research and Development. As of June 2022, we enrolled 118 of the 160 participants. The enrollment of participants will continue in the third and fourth quarters of 2022.
Conclusions
This study will provide insights into the effectiveness and cost-effectiveness of SCC for people with PIMD, allowing long-term care providers to make informed decisions about implementing such a technology. This is the first time that such a large-scale study is being conducted for people with PIMD.
Trial Registration
ClinicalTrials.gov NCT05481840; https://clinicaltrials.gov/ct2/show/NCT05481840
International Registered Report Identifier (IRRID)
DERR1-10.2196/42555
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