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Whitelaw S. Fostering resilience in young people with intellectual disabilities using a 'settings' approach. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2024; 28:549-566. [PMID: 36977495 PMCID: PMC11059839 DOI: 10.1177/17446295231168186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
The need to foster resilience amongst young people with intellectual disabilities is increasingly recognised within policy. Critically, understanding of the actual means by which this aspiration might be most sensitively and effectively met is considered weak. This paper reports on an exploratory case-study of a social enterprise community café - The Usual Place - that through the promotion of employability, seeks to promote resilience amongst its young 'trainees' with intellectual disabilities. Two research questions were set: "how is 'resilience' conceptualized within the organisation" and "what features within the organisation are significant in fostering resilience"? We identify a range of significant features associated with being able to successfully foster resilience - the need for a foundational 'whole organisation'(settings) approach based on high levels of participation and choice; the negotiation of a constructive dynamic tension between 'support' and 'exposure'; and the embedding of these actions in embodied actions and day-to-day organisational activities.
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Affiliation(s)
- Sandy Whitelaw
- School of Interdisciplinary Studies, University of Glasgow, Dumfries, UK
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Shields N, Bhowon Y, Prendergast L, Cleary S, Taylor NF. Fostering positive attitudes towards interacting with young people with disability among health students: a stepped-wedge trial. Disabil Rehabil 2024; 46:1212-1219. [PMID: 37101339 DOI: 10.1080/09638288.2023.2193429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 03/16/2023] [Indexed: 04/28/2023]
Abstract
PURPOSE To investigate if a 12-week community-based exercise program (FitSkills) fostered positive attitudes towards disability among university student mentors. METHODS A stepped-wedge cluster randomised trial was completed with 4 clusters. Students were eligible to be a mentor if enrolled in an entry-level health degree (any discipline, any year) at one of three universities. Each mentor was matched with a young person with a disability and the pair exercised together at the gym twice a week for an hour (24 sessions total). At 7 times over 18 months, mentors completed the Disability Discomfort Scale to indicate their level of discomfort when interacting with people with disability. Data were analysed according to the intention to treat principles using linear mixed-effects models to estimate changes in scores over time. RESULTS A total of 207 mentors completed the Disability Discomfort Scale at least once, of whom 123 participated in FitSkills. Analysis found an estimated reduction of 32.8% (95% confidence interval (CI) -36.8 to -28.4) in discomfort scores immediately after exposure to FitSkills across all four clusters. These decreases were sustained throughout the remainder of the trial. CONCLUSIONS Mentors reported more positive attitudes towards interacting with people with disability after completing FitSkills with changes retained for up to 15 months.
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Affiliation(s)
- Nora Shields
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Yeshna Bhowon
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, Victoria, Australia
- Department of Mathematical and Physical Sciences, La Trobe University, Melbourne, Victoria, Australia
| | - Luke Prendergast
- Department of Mathematical and Physical Sciences, La Trobe University, Melbourne, Victoria, Australia
| | - Stacey Cleary
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
| | - Nicholas F Taylor
- Allied Health Clinical Research Office, Victoria, Australia
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Melbourne, Victoria, Australia
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Wang H, Chen Z, Li Z, He X, Subramanian S. How economic development affects healthcare access for people with disabilities: A multilevel study in China. SSM Popul Health 2024; 25:101594. [PMID: 38283543 PMCID: PMC10820636 DOI: 10.1016/j.ssmph.2023.101594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 12/26/2023] [Accepted: 12/28/2023] [Indexed: 01/30/2024] Open
Abstract
Meeting the healthcare needs of people with disabilities is an important challenge in achieving the central promise of "leave no one behind" during the Sustainable Development Goals era. In this study, we describe the accessibility of healthcare for people living with disabilities, as well as the potential influences of individuals' socioeconomic status and regional economic development. Our data covered 324 prefectural cities in China in 2019 and captured the access to healthcare services for people with disabilities. First, we used linear probability regression models to investigate the association between individual socioeconomic status, including residence, poverty status, education, and healthcare access. Second, we conducted an ecological analysis to test the association between prefectural economic indicators, including GDP (gross domestic product) per capita, urbanization ratio, average years of education, Engel's coefficient, and the overall prevalence of access to healthcare for people with disabilities within prefectures. Third, we used multilevel regression models to explore the association between the individual's socio-economic status, prefectural economic indicators, and access to healthcare at the individual level for people with disabilities. The results showed, first, that higher individual socioeconomic status (urban residence or higher educational level) was associated with better access to healthcare for people with disabilities. Second, regional economic indicators were positively associated with access to healthcare at the aggregate and individual levels. This study suggests that local governments, particularly in low- and middle-income countries, should promote economic development and conduct poverty alleviation policies to improve healthcare access for disadvantaged groups.
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Affiliation(s)
- Hongchuan Wang
- School of Public Policy & Management, Tsinghua University, 100084, Beijing, China
- Institute for Contemporary China Studies, Tsinghua University, 100084, Beijing, China
| | - Zhe Chen
- Institute for Contemporary China Studies, Tsinghua University, 100084, Beijing, China
| | - Zhihui Li
- Vanke School of Public Health, Tsinghua University, 100084, Beijing, China
| | - Xiaofeng He
- Shenzhen Health Development Research and Data Management Center, 518000, Shenzhen, Guangdong, China
| | - S.V. Subramanian
- Harvard Center for Population and Development Studies, Cambridge, MA, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Majeed-Ariss R, Mattison M, Rodriguez PM, White C. Exploring the similarities and differences amongst service users with and without learning disabilities attending Saint Marys Sexual Assault Referral Centre. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:1288-1296. [PMID: 37503887 DOI: 10.1111/jar.13147] [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: 12/11/2021] [Revised: 02/23/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND People with learning disabilities are over-represented amongst Sexual Assault Referral Centre service users. This work aims to explore the similarities and differences between service users with and without learning disabilities. METHOD Medical notes of 52 service users likely to have a learning disability were compared with 52 service users not likely to have a learning disability (according to the Learning Disability Screening Questionnaire); all of whom attended Saint Marys SARC for a forensic medical examination during a 12-month period. RESULTS Significant associations were found between the likelihood of learning disability and relationship to perpetrator; location of assault; alcohol use; time taken to present to SARC; domestic violence; self-harm; suicide attempts and mental health service involvement. CONCLUSIONS People with learning disabilities in the sexually assaulted population are more likely to present with intersecting vulnerabilities emphasising the need for timely, accessible and appropriate patient-centred care for this group.
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Affiliation(s)
- Rabiya Majeed-Ariss
- Saint Mary's Sexual Assault Referral Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | | | - Pablo M Rodriguez
- Saint Mary's Sexual Assault Referral Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Catherine White
- Saint Mary's Sexual Assault Referral Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
- Institute for Addressing Strangulation Sexual Offences, Manchester, UK
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Al-Bataineh RT, Al-Hammouri MM, Al-Jaraideh WK. Perspective of healthcare providers on assessing the quality and accessibility of health services for chronic diseases in Jordan during Covid-19: a mixed method study. BMC Health Serv Res 2023; 23:895. [PMID: 37612605 PMCID: PMC10464245 DOI: 10.1186/s12913-023-09919-1] [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: 01/11/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Hospital services in all parts of the world were severely affected by the crisis caused by the Coronavirus pandemic. This was particularly concerning for patients who suffer from chronic diseases. AIM This study aimed to: assess the level of quality and accessibility of chronic disease services from the perspectives of healthcare providers, assess the association between healthcare providers' socio-demographic factors and their perspectives on accessibility and quality level, and explore the providers' perspectives on the barriers and facilitators of quality and accessibility to chronic disease health services during the COVID -19 pandemic. METHOD Design: An explanatory mixed method design was employed in this study using a questionnaire and focus group discussion approach. The questionnaire consisted of three sections including, demographic, accessibility, and quality. SAMPLE A convenience sampling approach was used to collect the quantitative from 412 healthcare providers working at public, private, and teaching hospitals. A purposive sample of 12 healthcare providers were interviewed to collect the qualitative data. ANALYSIS The quantitative data were analyzed using SPSS Statistics Version 25. The qualitative data was analyzed using the thematic analysis approach. RESULTS This study found that the quality and accessibility of chronic disease services in northern Jordan were affected during COVID-19. Quantitative: The majority of the participants reported moderate level of accessibility and quality. Qualitative: Four main and six subthemes were identified: 1) Accessibility barriers including transportation and fear of infection; 2) Accessibility facilitators including availability of Personal Protective Equipment (PPE) and Covid-19 vaccination; 3) Quality barriers including staff shortage; 4) Quality facilitators including safety protocol. CONCLUSION The quality and accessibility of chronic disease services were affected due to the healthcare system restating to address the Covid-19 pandemic. Different barriers and facilitators for chronic disease healthcare services accessibility and quality were identified. The findings of this study lay the ground for healthcare decision and policymakers to develop strategies and formulate polices to ensure these patients receive the needed healthcare services, and hence improve their health outcomes.
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Affiliation(s)
- Raya T Al-Bataineh
- Department of Health Management and Policy, College of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
| | - Mohammed M Al-Hammouri
- Department of Community and Mental Health, College of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Wafa'a K Al-Jaraideh
- Department of Health Management and Policy, College of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Gabrielsson A, Tromans S, Newman H, Triantafyllopoulou P, Hassiotis A, Bassett P, Watkins L, Sawhney I, Cooper M, Griffiths L, Pullen A, Roy A, Angus-Leppan H, Rh T, Kinney M, Tittensor P, Shankar R. Awareness of social care needs in people with epilepsy and intellectual disability. Epilepsy Behav 2023; 145:109296. [PMID: 37336133 DOI: 10.1016/j.yebeh.2023.109296] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Nearly a quarter of people with intellectual disability (ID) have epilepsy with large numbers experiencing drug-resistant epilepsy, and premature mortality. To mitigate epilepsy risks the environment and social care needs, particularly in professional care settings, need to be met. PURPOSE To compare professional care groups as regards their subjective confidence and perceived responsibility when managing the need of people with ID and epilepsy. METHOD A multi-agency expert panel developed a questionnaire with embedded case vignettes with quantitative and qualitative elements to understand training and confidence in the health and social determinants of people with ID and epilepsy. The cross-sectional survey was disseminated amongst health and social care professionals working with people with ID in the UK using an exponential non-discriminative snow-balling methodology. Group comparisons were undertaken using suitable statistical tests including Fisher's exact, Kruskal-Wallis, and Mann-Whitney. Bonferroni correction was applied to significant (p < 0.05) results. Content analysis was conducted and relevant categories and themes were identified. RESULTS Social and health professionals (n = 54) rated their confidence to manage the needs of people with ID and epilepsy equally. Health professionals showed better awareness (p < 0.001) of the findings/recommendations of the latest evidence on premature deaths and identifying and managing epilepsy-related risks, including the relevance of nocturnal monitoring. The content analysis highlighted the need for clearer roles, improved care pathways, better epilepsy-specific knowledge, increased resources, and better multi-disciplinary work. CONCLUSIONS A gap exists between health and social care professionals in awareness of epilepsy needs for people with ID, requiring essential training and national pathways.
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Affiliation(s)
- A Gabrielsson
- Hertfordshire Partnership University NHS Trust, Hatfield, UK
| | - S Tromans
- University of Leicester, Leicester, UK; Leicestershire Partnership NHS Trust, Leicester, UK
| | - H Newman
- University of Plymouth Peninsula School of Medicine, Plymouth, UK
| | | | | | | | - L Watkins
- University of South Wales, Pontypridd, UK; Swansea Bay University Health Board, Port Talbot, UK
| | - I Sawhney
- Hertfordshire Partnership University NHS Trust, Hatfield, UK
| | - M Cooper
- National Development Team for Inclusion Bath, UK
| | - L Griffiths
- National Development Team for Inclusion Bath, UK
| | | | - A Roy
- Coventry and Warwickshire Partnership Trust, Birmingham, UK
| | | | | | - M Kinney
- Belfast Health and Social Trust, Belfast, UK
| | - P Tittensor
- Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - R Shankar
- University of Plymouth Peninsula School of Medicine, Plymouth, UK; Cornwall Partnership NHS Foundation Trust, Truro, UK.
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Özdemir A, Hall R, Lovell A, Ellahi B. Nutrition knowledge and influence on diet in the carer-client relationship in residential care settings for people with intellectual disabilities. NUTR BULL 2023; 48:74-90. [PMID: 36647738 DOI: 10.1111/nbu.12600] [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: 04/28/2022] [Revised: 12/11/2022] [Accepted: 12/13/2022] [Indexed: 01/18/2023]
Abstract
People with intellectual disabilities generally have poorer health outcomes compared with those who do not, including outcomes related to nutrition-related non-communicable diseases. Carers support people with intellectual disabilities in many aspects including habitual shopping and preparation of food, but their own nutrition knowledge and the influence this may have on dietary intakes of clients is unknown. We explored the nutrition knowledge of carers of people with intellectual disabilities in residential care settings, their dietary habits and their influence on clients' food shopping and preparation and therefore the diet consumed by their clients. Ninety-seven carers belonging to a large independent care sector organisation specialising in the care of people with an intellectual disability completed a validated general nutrition knowledge and behaviour questionnaire. Seventeen carers from the residential care settings were interviewed to contextualise practice. Knowledge about key dietary recommendations scored highly. Carers who had more work experience were found to have higher scores in 'making everyday food choices' (p = 0.034). Daily consumption of fruit and vegetables (at least one portion per day) was observed (for fruit by 46% of the carers and for vegetables by 60% of the carers), whilst most carers reported avoiding consuming full-fat dairy products, sugary foods and fried foods. The concept of a healthy diet; typical dietary habits of clients; role in food acquisition; and training in nutrition emerged as themes from the interviews. Carers discussed various topics including the importance of a balanced diet, cooking fresh foods and control of food portion sizes for clients relative to the care philosophy of a client-centred approach, which encapsulates client autonomy. Gaps in knowledge around specific nutrients, making healthy choices and cooking skills remain. Carers have an influence on clients' dietary choices; they are able to provide healthy meals and share good dietary habits with clients. Further training in nutrition is recommended for impact on clients' health.
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Affiliation(s)
- Aslıhan Özdemir
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Rebecca Hall
- Department of Mental Health and Learning Disabilities, Faculty of Health and Social Care, University of Chester, Chester, UK.,School of Nursing, Midwifery and Social Work, University of Salford, Salford, UK
| | - Andrew Lovell
- Department of Social Work and Interprofessional Studies, Faculty of Health and Social Care, University of Chester, Chester, UK
| | - Basma Ellahi
- Department of Social Work and Interprofessional Studies, Faculty of Health and Social Care, University of Chester, Chester, UK
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Odongo DA, Forkuor JB, Ofori-Dua K, Dapaah JM, Dwumah P. The nature and extent of healthcare provision for people with intellectual disabilities in Ghana: A qualitative study. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2022; 26:637-656. [PMID: 34219545 DOI: 10.1177/17446295211016171] [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: 06/13/2023]
Abstract
Ghana has designated special schools with the mandate of training and equipping persons with intellectual disabilities with social functioning and vocational skills needed to promote their social inclusion. This study investigates the nature and extent of healthcare provision for persons with intellectual disabilities in their respective special schools. This research adopted a qualitative, but participatory approach to collect data from respective stakeholders. The findings reveal that some of these special schools do not have professional health workers, and most healthcare providers have challenges diagnosing and prescribing medication for this population due to the health workers' limited understanding of their healthcare needs, coupled with communication barriers. The researchers have suggested setting up of a special health department with personnel who have received training on intellectual disabilities. This department must undertake training for the housemothers in special schools, parents in the communities, and teachers in special schools.
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Affiliation(s)
| | | | - Kwadwo Ofori-Dua
- Kwame Nkrumah University of Science and Technology (KNUST), Ghana
| | | | - Peter Dwumah
- Kwame Nkrumah University of Science and Technology (KNUST), Ghana
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Omrani O, Spiers J, Prior D, Haberland K, Kabir A, Sinclair C, Woods T, Hall I, Checkley L. Improving access to Hackney Integrated Learning Disability Service. BMJ Open Qual 2022. [PMCID: PMC9438083 DOI: 10.1136/bmjoq-2021-001728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Aims Improving access to Hackney Integrated Learning Disability Service (ILDS) using quality improvement (QI) methodology by reducing the time taken to complete eligibility assessment by 50% by April 2021, while improving service user and staff experience. Background Referrals to ILDS require assessment of eligibility. It was noted that there was significant waiting time between referral and eligibility assessment, exacerbated by the COVID-19 pandemic. Quality Network for Community Learning Disability Services guidelines suggest waiting times for those accessing adult learning disability (LD) community services be locally agreed, although there is limited literature on this topic. Methods All staff members across the multidisciplinary team were invited to participate in the QI project. We defined outcome measures as days from referral to allocation of eligibility assessment to staff member and to completion of eligibility assessment, comparing referrals received before and after start of the project. The key change ideas tested using Plan-Do-Study-Act cycles were: (1) eligibility screening checklist, (2) eligibility assessments drop-in sessions for staff, (3) formal training for ILDS staff, (4) eligibility screening allocation system, (5) template letters for eligibility decisions, (6) new ILDS referral form, (7) workshops for local general practitioners. Results Time taken to eligibility assessment allocation decreased from median of 184 (mean=183.5±109.8) to 13 days (mean=19.9±26.4) (93% reduction). Time to completion of eligibility assessment decreased from a median of 271 (mean=296.0±133.8) to 63 days (mean=75.7±34.8) (77% reduction). We received positive feedback from staff and service users regarding the new eligibility process. Conclusions We report waiting times for accessing our community adult LD services and effective strategies for reducing this. We recommend similar services use a QI methodology to reduce waiting times and improve the experience of staff and service users.
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Affiliation(s)
- Osama Omrani
- City and Hackney Integrated Learning Disability Service, East London NHS Foundation Trust, London, UK
| | - Jessica Spiers
- City and Hackney Integrated Learning Disability Service, East London NHS Foundation Trust, London, UK
| | - David Prior
- City and Hackney Integrated Learning Disability Service, East London NHS Foundation Trust, London, UK
| | - Kirsty Haberland
- City and Hackney Integrated Learning Disability Service, East London NHS Foundation Trust, London, UK
| | - Anwar Kabir
- City and Hackney Integrated Learning Disability Service, East London NHS Foundation Trust, London, UK
| | - Candace Sinclair
- City and Hackney Adult Mental Health Directorates, East London NHS Foundation Trust, London, UK
| | - Tom Woods
- City and Hackney Integrated Learning Disability Service, London Borough of Hackney, London, UK
| | - Ian Hall
- City and Hackney Integrated Learning Disability Service, East London NHS Foundation Trust, London, UK
| | - Laura Checkley
- City and Hackney Integrated Learning Disability Service, East London NHS Foundation Trust, London, UK
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Parey B, Sinanan L. Healthcare Barriers Among Working-Age Persons with Disabilities in Trinidad. QUALITATIVE HEALTH RESEARCH 2022; 32:479-490. [PMID: 34893008 DOI: 10.1177/10497323211059151] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Even though easily accessible and cost-effective healthcare is a fundamental human right, many persons with disabilities experience healthcare barriers and poor health outcomes. We explore the healthcare barriers among working-age persons with disabilities in Trinidad using a qualitative descriptive approach. Semi-structured interviews with 26 participants reveal barriers at the personal, healthcare facility, and societal levels. The findings indicate the need for a nation-wide integrated digitalized system and increased intersectoral collaborations to support adequate healthcare among persons with disabilities in Trinidad. Increased consultation with persons with disabilities and transformation of the disability discourses within the healthcare system and at the national level are also recommended as part of the humanisation of their care.
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Affiliation(s)
- Bephyer Parey
- Sir Arthur Lewis Institute of Social and Economic Studies, 37612The University of the West Indies, St. Augustine, Trinidad and Tobago
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Borthwick C, Inchley J, Jones J. Health promotion in adults with Down's syndrome: Experiences of caregivers. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2021; 25:312-330. [PMID: 31775568 DOI: 10.1177/1744629519890956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Individuals with Down's syndrome rely on caregivers to support lifestyle behaviour change. It is therefore important to understand how caregivers put health recommendations into practice. Through conducting semi-structured interviews, the present study sought to understand the facilitators and barriers that caregivers faced when implementing health promotion advice. Five interviews were conducted with paid support staff and four with family carers of individuals attending a specialist multidisciplinary Down's syndrome health promotion screening clinic. Three main themes emerged in their accounts, including active promotion of weight management by caregivers, benefits of working practices such as record keeping and communication channels and the importance of having access to social care services and recreational activities. These findings have important implications for professionals working in specialised healthcare settings who may be able to tailor communication and services to better meet the needs of individuals with Down's syndrome and their caregivers.
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Anderson R, Booth A, Eastwood A, Rodgers M, Shaw L, Thompson Coon J, Briscoe S, Cantrell A, Chambers D, Goyder E, Nunns M, Preston L, Raine G, Thomas S. Synthesis for health services and policy: case studies in the scoping of reviews. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
For systematic reviews to be rigorous, deliverable and useful, they need a well-defined review question. Scoping for a review also requires the specification of clear inclusion criteria and planned synthesis methods. Guidance is lacking on how to develop these, especially in the context of undertaking rapid and responsive systematic reviews to inform health services and health policy.
Objective
This report describes and discusses the experiences of review scoping of three commissioned research centres that conducted evidence syntheses to inform health and social care organisation, delivery and policy in the UK, between 2017 and 2020.
Data sources
Sources included researcher recollection, project meeting minutes, e-mail correspondence with stakeholders and scoping searches, from allocation of a review topic through to review protocol agreement.
Methods
We produced eight descriptive case studies of selected reviews from the three teams. From case studies, we identified key issues that shape the processes of scoping and question formulation for evidence synthesis. The issues were then discussed and lessons drawn.
Findings
Across the eight diverse case studies, we identified 14 recurrent issues that were important in shaping the scoping processes and formulating a review’s questions. There were ‘consultative issues’ that related to securing input from review commissioners, policy customers, experts, patients and other stakeholders. These included managing and deciding priorities, reconciling different priorities/perspectives, achieving buy-in and engagement, educating the end-user about synthesis processes and products, and managing stakeholder expectations. There were ‘interface issues’ that related to the interaction between the review team and potential review users. These included identifying the niche/gap and optimising value, assuring and balancing rigour/reliability/relevance, and assuring the transferability/applicability of study evidence to specific policy/service user contexts. There were also ‘technical issues’ that were associated with the methods and conduct of the review. These were choosing the method(s) of synthesis, balancing fixed and fluid review questions/components/definitions, taking stock of what research already exists, mapping versus scoping versus reviewing, scoping/relevance as a continuous process and not just an initial stage, and calibrating general compared with specific and broad compared with deep coverage of topics.
Limitations
As a retrospective joint reflection by review teams on their experiences of scoping processes, this report is not based on prospectively collected research data. In addition, our evaluations were not externally validated by, for example, policy and service evidence users or patients and the public.
Conclusions
We have summarised our reflections on scoping from this programme of reviews as 14 common issues and 28 practical ‘lessons learned’. Effective scoping of rapid, responsive reviews extends beyond information exchange and technical procedures for specifying a ‘gap’ in the evidence. These considerations work alongside social processes, in particular the building of relationships and shared understanding between reviewers, research commissioners and potential review users that may be reflective of consultancy, negotiation and co-production models of research and information use.
Funding
This report has been based on work commissioned by the National Institute for Health Research (NIHR) Health Services and Delivery Research (HSDR) programme as three university-based evidence synthesis centres to inform the organisation, delivery and commissioning of health and social care; at the University of Exeter (NIHR 16/47/22), the University of Sheffield (NIHR 16/47/17) and the University of York (NIHR 16/47/11). This report was commissioned by the NIHR HSDR programme as a review project (NIHR132708) within the NIHR HSDR programme. This project was funded by the NIHR HSDR programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 15. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Rob Anderson
- Exeter Health Services and Delivery Research Evidence Synthesis Centre, Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Andrew Booth
- Sheffield Health Services and Delivery Research Evidence Synthesis Centre, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Alison Eastwood
- York Health Service and Delivery Research Evidence Synthesis Centre, Centre for Reviews and Dissemination, University of York, York, UK
| | - Mark Rodgers
- York Health Service and Delivery Research Evidence Synthesis Centre, Centre for Reviews and Dissemination, University of York, York, UK
| | - Liz Shaw
- Exeter Health Services and Delivery Research Evidence Synthesis Centre, Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Jo Thompson Coon
- Exeter Health Services and Delivery Research Evidence Synthesis Centre, Institute of Health Research, University of Exeter Medical School, Exeter, UK
- National Institute for Health Research Applied Research Collaboration South West Peninsula, Devon, Cornwall and Somerset, UK
| | - Simon Briscoe
- Exeter Health Services and Delivery Research Evidence Synthesis Centre, Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Anna Cantrell
- Sheffield Health Services and Delivery Research Evidence Synthesis Centre, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Duncan Chambers
- Sheffield Health Services and Delivery Research Evidence Synthesis Centre, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Elizabeth Goyder
- Sheffield Health Services and Delivery Research Evidence Synthesis Centre, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Michael Nunns
- Exeter Health Services and Delivery Research Evidence Synthesis Centre, Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Louise Preston
- Sheffield Health Services and Delivery Research Evidence Synthesis Centre, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Gary Raine
- York Health Service and Delivery Research Evidence Synthesis Centre, Centre for Reviews and Dissemination, University of York, York, UK
| | - Sian Thomas
- York Health Service and Delivery Research Evidence Synthesis Centre, Centre for Reviews and Dissemination, University of York, York, UK
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Milne-Ives M, Shankar R, Goodley D, Lamb K, Laugharne R, Harding T, Meinert E. Humanising health and social care support for people with intellectual and developmental disabilities: Protocol for a scoping review (Preprint). JMIR Res Protoc 2021; 11:e31720. [PMID: 35507388 PMCID: PMC9118084 DOI: 10.2196/31720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 03/01/2022] [Accepted: 03/16/2022] [Indexed: 11/13/2022] Open
Abstract
Background Health care is shifting toward a more person-centered model; however, people with intellectual and developmental disabilities can still experience difficulties in accessing equitable health care. Given these difficulties, it is important to consider how humanizing principles, such as empathy and respect, can be best incorporated into health and social care practices for people with intellectual and developmental disabilities to ensure that they are receiving equitable treatment and support. Objective The purpose of our scoping review is to provide an overview of the current research landscape and knowledge gaps regarding the development and implementation of interventions based on humanizing principles that aim to improve health and social care practices for people with intellectual and developmental disabilities. Methods The PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) and PICOS (Population, Intervention, Comparator, Outcome, and Study) frameworks will be used to structure the review. A total of 6 databases (PubMed, MEDLINE, Embase, CINAHL, PsycINFO, and Web of Science) will be searched for English articles published in the previous 10 years that describe or evaluate health and social care practice interventions underpinned by the humanizing principles of empathy, compassion, dignity, and respect. Two reviewers will screen and select references based on the eligibility criteria and extract the data into a predetermined form. A descriptive analysis will be conducted to summarize the results and provide an overview of interventions in the following three main care areas: health care, social care, and informal social support. Results The results will be included in the scoping review, which is expected to begin in October 2022 and be completed and submitted for publication by January 2023. Conclusions Our scoping review will summarize the state of the field of interventions that are using humanizing principles to improve health and social care for adults with intellectual and developmental disabilities. International Registered Report Identifier (IRRID) PRR1-10.2196/31720
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Affiliation(s)
- Madison Milne-Ives
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
| | - Rohit Shankar
- Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Dan Goodley
- School of Education, University of Sheffield, Sheffield, United Kingdom
| | - Kirsten Lamb
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Richard Laugharne
- Cornwall Partnership National Health Service Foundation Trust, Bodmin, United Kingdom
| | - Tracey Harding
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Edward Meinert
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, United States
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
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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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Feasibility of a community-based cancer awareness initiative: views of those delivering and managing the intervention. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-021-01581-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Abstract
Aim
Many people delay presenting to health services with cancer symptoms due to lack of awareness, particularly in areas of high socio-economic deprivation. A three-year community-based intervention was launched in Northwest England to improve public awareness of cancer symptoms. In this study, we aimed to evaluate this intervention by exploring the views of those involved in its management and delivery.
Methods
Ten semi-structured interviews were conducted with volunteers as well as members of the project management and steering group. Interviews were analysed qualitatively using thematic analysis.
Results
Participants felt they succeeded in raising awareness, influencing behaviour, connecting with local communities and engaging with vulnerable people. Participants perceived some weaknesses in the delivery of the intervention, including limited engagement of stakeholders, particularly general practitioners (GPs), and socially excluded groups.
Conclusions
Future public health interventions should pay particular attention to engagement of socially excluded individuals who do not interact with community events or groups, and to the engagement of stakeholders in early planning stages of the intervention. This should involve a specific GP engagement plan.
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Shields N, Stukas AA, Buhlert-Smith K, Prendergast LA, Taylor NF. Changing Student Health Professionals' Attitudes toward Disability: A Longitudinal Study. Physiother Can 2021; 73:180-187. [PMID: 34456430 PMCID: PMC8370727 DOI: 10.3138/ptc-2019-0069] [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: 11/20/2022]
Abstract
Purpose: The purpose of this study was to determine whether positive changes in self-reported attitudes toward disability were retained after students had participated in a 12-week voluntary community-based exercise programme for young people with disability. Method: Sixty-eight physiotherapy and exercise physiology students (45 women, 23 men; mean age 21 y) volunteered. Each student was matched with a young person with disability, and the pair exercised together twice a week for 12 weeks at their local gymnasium. The primary outcome measure was self-reported attitude toward disability. Secondary outcomes were self-reported professional skills competency, confidence, future work intentions, and motivations for volunteering. The outcomes were measured at Weeks 0, 13, and 24. The data were analyzed using generalized linear mixed-effects models, ordinal regression, and linear regression. Results: The students' attitudes toward disability were more positive at Weeks 13 and 24 than at baseline, but positive changes were not fully retained by Week 24. Small statistically significant reductions occurred after Week 13. Self-reported skills competencies, confidence, and future intentions of working in disability were higher at Weeks 13 and 24. Students' motivation for volunteering was wanting to support others, wanting to learn, and perceived positive career effects. Conclusions: Positive changes in students' attitudes toward disability were generally retained 3 months after volunteering in a community-based exercise programme.
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Affiliation(s)
- Nora Shields
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics
| | | | | | | | - Nicholas F. Taylor
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics
- Allied Health Clinical Research Office, Eastern Health, Melbourne, Vict., Australia
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Barriers and facilitators to primary health care for people with intellectual disabilities and/or autism: an integrative review. BJGP Open 2020; 4:bjgpopen20X101030. [PMID: 32605913 PMCID: PMC7465578 DOI: 10.3399/bjgpopen20x101030] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 10/23/2019] [Indexed: 01/14/2023] Open
Abstract
Background Globally, people with intellectual disabilities and/or autism experience health inequalities. Death occurs at a younger age and the prevalence of long-term morbidities is higher than in the general population. Despite this, their primary healthcare access rates are lower than the general population, their health needs are often unmet, and their views and experiences are frequently overlooked in research, policy, and practice. Aim To investigate the barriers and facilitators reported by individuals with intellectual disabilities, autism, or both, and/or their carers, to accessing and utilising primary health care for their physical and mental health needs. Design & setting An integrative review was undertaken, which used systematic review methodology. Method Electronic databases MEDLINE, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Cochrane were searched for relevant studies (all languages) using a search strategy. Two researchers independently screened the results and assessed the quality of the studies. Results Sixty-three international studies were identified. Six main themes relating to barriers and facilitators emerged from an analysis of these studies. The main themes were: training; knowledge and awareness; communication; fear and embarrassment; involvement in healthcare decision-making; and time. All the themes were underpinned by the need for greater care, dignity, respect, collaborative relationships, and reasonable adjustments. Opposing barriers and facilitators were identified within each of the main themes. Conclusion Adolescents and adults with intellectual disabilities and/or autism experience several barriers to accessing and utilising primary health care. The findings highlight the reasonable adjustments and facilitators that can be implemented to ensure that these individuals are not excluded from primary health care.
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Abodey E, Vanderpuye I, Mensah I, Badu E. In search of universal health coverage - highlighting the accessibility of health care to students with disabilities in Ghana: a qualitative study. BMC Health Serv Res 2020; 20:270. [PMID: 32234049 PMCID: PMC7106671 DOI: 10.1186/s12913-020-05138-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 03/20/2020] [Indexed: 11/10/2022] Open
Abstract
Background Accessibility of health care to students with disabilities is a global concern. This is no less important in Ghana, however, to date, no study has been undertaken regarding access to health care to students with disabilities. This study, therefore, aims to explore the accessibility of health care to students with disabilities, in the quest of achieving universal health coverage in Ghana. Methods Qualitative methods, involving in-depth interviews were employed to collect data from 54 participants (29 students with disabilities, 17 health workers and 8 school mothers), selected through purposive sampling. Thematic analysis was used to analyze the data. Results The study identified three themes – accessibility, adequacy, and affordability. The study findings highlighted that universal health coverage for students with disabilities has not been achieved due to barriers in accessing health care. The barriers faced by students with disabilities were unfriendly physical environments, structures, equipment, limited support services and poor health insurance policy to finance health care. Conclusion The study concludes that the government should prioritize disability-related issues in health policy formulation, implementation and monitoring. The current provisions and requirements in the disability act should be prioritized, enforced and monitored to ensure adequate inclusion of disability issues in health services. Further, the current exemption policy under the National Health Insurance Scheme should be revised to adequately address the needs of people with disabilities.
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Affiliation(s)
- Eric Abodey
- Department of Education and Psychology Studies, University of Cape Coast, Cape Coast, Ghana
| | - Irene Vanderpuye
- Department of Education and Psychology Studies, University of Cape Coast, Cape Coast, Ghana
| | - Isaac Mensah
- Department of Special Education, University of Education, Winneba, Ghana
| | - Eric Badu
- Department of Health Promotion and Disability Studies; School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
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19
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Williams G, Mueller J, Mbeledogu C, Spencer A, Parry-Harries E, Harrison A, Clough G, Greenhalgh C, Verma A. The impact of a volunteer-led community cancer awareness programme on knowledge of cancer risk factors and symptoms, screening, and barriers to seeking help. PATIENT EDUCATION AND COUNSELING 2020; 103:563-570. [PMID: 31611129 DOI: 10.1016/j.pec.2019.09.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 08/20/2019] [Accepted: 09/24/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To analyse the impact of a community cancer awareness programme on knowledge of cancer risk factors and symptoms, screening, and barriers to seeking help. METHODS Personalised information through peer-led champions was delivered to 5500 people in a range of settings and Cancer Awareness Measures questionnaires were completed by 119 participants at pre-arranged sessions (convenience sampling) before and after the intervention. Data were analysed using McNemar tests, Mann-Whitney U test and a Wilcoxon Signed Rank test. RESULTS Data showed increase in knowledge after the intervention for cancer screening programmes (p < 0.05), recognition of warning signs for cancer (p < 0.05), and recognition of risk factors for cancer in seven of the eleven options (p < 0.001). Results suggest a decrease in perception of barriers to seeking help (p < 0.05). The intervention had a stronger impact on recognition of cancer symptoms for people who have been affected by cancer (p = 0.02). CONCLUSION The Cancer Awareness Measures questionnaire proved an effective tool for evaluation and awareness improved after the intervention amongst those who completed it. PRACTICE IMPLICATIONS Enhancing the perceived personal relevance of information to those with experience of cancer may improve information processing and retention. The study highlights cancer awareness gaps among the public for future intervention development.
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Affiliation(s)
- Greg Williams
- University of Manchester, Division of Population Health, Health Services Research and Primary Care, Room 2.525 Stopford Building, Oxford Road, Manchester, M13 9PT, United Kingdom.
| | - Julia Mueller
- University of Manchester, Division of Population Health, Health Services Research and Primary Care, Room 2.525 Stopford Building, Oxford Road, Manchester, M13 9PT, United Kingdom.
| | - Cordelle Mbeledogu
- Manchester City Council & North Manchester CCG, Manchester City Council, Directorate of Children and Families, Public Health Team, Level 4, PO Box 532, Town Hall Extension, Manchester, M60 2LA, United Kingdom.
| | - Angela Spencer
- University of Manchester, Division of Population Health, Health Services Research and Primary Care, Room 2.525 Stopford Building, Oxford Road, Manchester, M13 9PT, United Kingdom.
| | - Emily Parry-Harries
- Kirklees Council, Civic Centre, 4(th) Floor North, High Street, Huddersfield, HD1 2NF, United Kingdom.
| | - Annie Harrison
- University of Manchester, Division of Population Health, Health Services Research and Primary Care, Room 2.525 Stopford Building, Oxford Road, Manchester, M13 9PT, United Kingdom.
| | - Gary Clough
- University of Manchester, Division of Population Health, Health Services Research and Primary Care, Room 2.525 Stopford Building, Oxford Road, Manchester, M13 9PT, United Kingdom.
| | - Christine Greenhalgh
- University of Manchester, Division of Population Health, Health Services Research and Primary Care, Room 2.525 Stopford Building, Oxford Road, Manchester, M13 9PT, United Kingdom.
| | - Arpana Verma
- University of Manchester, Division of Population Health, Health Services Research and Primary Care, Room 2.525 Stopford Building, Oxford Road, Manchester, M13 9PT, United Kingdom.
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20
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Sparby LE, Olsvold N, Obstfelder A. Mediating the interface between voluntariness and coercion: A qualitative study of learning disability nurses' work in medical examinations of people with intellectual disability. J Clin Nurs 2020; 29:1539-1551. [PMID: 32043689 DOI: 10.1111/jocn.15211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 12/13/2019] [Accepted: 02/03/2020] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To gain knowledge of prevention and use of restraints in provision of medical care to people with intellectual disability. To this end, we explore how learning disability nurses in community services support the individual through medical examinations when facing resistance. BACKGROUND Despite increased focus on limiting restraints, there is a lack of knowledge of how restraints are prevented and used in the delivery of physical health care to people with intellectual disability. DESIGN We used an ethnographic comparative case design (n = 6). METHODS The study was carried out in Norway. The analysis is based on data from semi-structured interviews, participant observation and document studies, in addition to health sociological perspectives on how to support individuals to make their body available for medical examination and intervention. The SRQR checklist was used. RESULTS Learning disability nurses strove to ensure that examinations were carried out on the individual's terms, supporting the individual in three phases: preparing for the examination, facilitating the examination and, when facing resistance, intervening to ensure safe and compassionate completion of the examination. CONCLUSIONS Supporting the person was a precarious process where professionals had to balance considerations of voluntariness and coercion, progress and breakdown, safety and risk of injury, and dignity and violation. Through their support, learning disability nurses helped to constitute the "resistant" individual as "a cooperative patient," whose body could be examined within the knowledge and methods of medicine, but who could also be safeguarded as a human being through the strain of undergoing examination. RELEVANCE TO CLINICAL PRACTICE The article sheds light on how restraints are used in the medical examination and treatment of people with intellectual disabilities and demonstrates the significance of professional support workers' contributions, both in facilitating safe and efficient medical care and in ensuring the least restrictive and most compassionate care possible.
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Affiliation(s)
- Linn Ebeltoft Sparby
- Centre for Care Research, North, University of Tromsø, The Arctic University of Norway, Tromsø, Norway.,Department of ReHabilitation, Finnmark Hospital Trust, Kirkenes Hospital, Kirkenes, Norway
| | - Nina Olsvold
- Faculty of Health, VID Specialized University, Oslo, Norway
| | - Aud Obstfelder
- Department of Health Sciences in Gjøvik, NTNU, Gjøvik, Norway
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21
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Cantrell A, Croot E, Johnson M, Wong R, Chambers D, Baxter SK, Booth A. Access to primary and community health-care services for people 16 years and over with intellectual disabilities: a mapping and targeted systematic review. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
In 2015, approximately 2.16% of adults were recorded as having intellectual disabilities. UK government policy is that adults with intellectual disabilities should access mainstream health services. However, people with intellectual disabilities experience challenges when accessing primary and community health services that can lead to inequalities and shorter life expectancy.
Objectives
To map and review the evidence on access to primary and community health-care services for adults with intellectual disabilities and their carers. To identify influencing factors for gaining access to primary and community health-care services. To determine which actions, interventions or models of service provision improve entry access to these services for people with intellectual disabilities and their carers. Finally, to identify the gaps in evidence and provide implications for health care and recommendations for research.
Data sources
MEDLINE, The Cochrane Library, Web of Science, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Applied Social Sciences Index and Abstracts (ASSIA) and Education Resources Information Center (ERIC) were searched from 2002 to 2018.
Review methods
The mapping review methodology included an extensive literature search, article selection and data extraction of relevant abstracts. Findings from the mapping review informed the scope of the targeted systematic review. Methodology for the targeted systematic review included an extensive literature search informed by the mapping review, article selection, data extraction, quality appraisal and narrative synthesis.
Results
The mapping review included 413 studies with data extraction completed on abstracts. The targeted systematic review synthesised the evidence from 80 studies reported in 82 publications. During the review process, the team identified three key points at which people with intellectual disabilities potentially interacted with primary and community health-care services: identifying needs, accessing services and interaction during a consultation. In addition, there were a number of papers about interventions or innovations to improve access. Evidence from the studies was synthesised within the four clusters. Influencing factors were identified: staff knowledge/skills, joint working with learning disability services, service delivery model, uptake, appointment making, carer/support role, relationship with staff, time, accessible information and communication. The influencing factors were cross-cutting through the literature, with certain factors having more importance in certain clusters.
Limitations
The main limitation was the weak evidence base. The studies generally had small samples, had study designs that were open to potential biases and measured only short-term outcomes.
Conclusions
Health checks were found to help identify health needs and improve the care of long-term conditions. Important factors for accessing health services for adults with intellectual disabilities were consistency of care and support, staff training, communication skills and time to communicate, and provision of accessible information. Health professionals need to ensure that there is joint working between different services, clear communication and accurate record-keeping. Future research questions centre on the need to develop and value creative study designs capable of addressing the complex issues identified in the findings of the review for this complex population.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 5. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Anna Cantrell
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Elizabeth Croot
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Maxine Johnson
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Ruth Wong
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Duncan Chambers
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Susan K Baxter
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Andrew Booth
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Byrnes K, Hamilton S, McGeechan GJ, O'Malley C, Mankelow J, Giles EL. Attitudes and perceptions of people with a learning disability, family carers, and paid care workers towards cancer screening programmes in the United Kingdom: A qualitative systematic review and meta-aggregation. Psychooncology 2019; 29:475-484. [PMID: 31834649 DOI: 10.1002/pon.5311] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 11/11/2019] [Accepted: 11/28/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Evidence suggests that people with a learning disability (PwLD) are less likely to attend cancer screening than the general population in the United Kingdom. The aim of this systematic review was to identify and synthesise qualitative studies reporting the attitudes and opinions of PwLD, family carers, and paid care workers towards national cancer screening programmes. METHODS Five electronic and two grey literature databases were searched. Fourteen thousand eight hundred forty-six papers were reviewed against predetermined inclusion criteria. Included papers were critically appraised. Findings were synthesised using meta-aggregation. RESULTS Eleven papers met the inclusion criteria, all related to cervical and breast screening. No papers were related to colorectal cancer screening. Findings were clustered into four synthesised findings: (1) supporting women with a learning disability (WwLD) to attend screening, (2) WwLD's awareness of screening and their psychophysical experiences, 3) professional practice barriers including the need for multidisciplinary working and an understanding of the needs of WwLD, and (4) approaches to improve the uptake of cervical and breast cancer screening. The synthesis highlights the significance of WwLD having support to understand the importance of screening to be able to make an informed choice about attending. CONCLUSIONS WwLD may not attend cancer screening due to fear, concerns over pain, and the potential influence of family carers and paid care workers. The review identified practical mechanisms which could help WwLD attend screening. Future research should focus on identifying potential barriers and facilitators as a proactive measure to promote colorectal cancer screening.
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Affiliation(s)
- Kate Byrnes
- School of Health & Life Science, Teesside University, Middlesbrough, UK
| | - Sharon Hamilton
- School of Health & Life Science, Teesside University, Middlesbrough, UK.,Teesside Centre for Evidence-Informed Practice: A JBI Affiliated Group, Teesside University, Middlesbrough, UK
| | - Grant J McGeechan
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, UK
| | - Claire O'Malley
- School of Health & Life Science, Teesside University, Middlesbrough, UK
| | - Jagjit Mankelow
- School of Health & Life Science, Teesside University, Middlesbrough, UK
| | - Emma L Giles
- School of Health & Life Science, Teesside University, Middlesbrough, UK
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23
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Maestri-Banks A. One size does not fit all: mental health services access for people with intellectual/learning disability requires individualised planning and education/training programmes for health and social care providers. Evid Based Nurs 2019; 23:107. [PMID: 31772063 DOI: 10.1136/ebnurs-2018-103035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Anita Maestri-Banks
- School of Nursing and Allied Health, Liverpool John Moores University, City Campus, Liverpool, UK
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24
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Nijs S, Maes B. Assistive technology for persons with profound intellectual disability: a european survey on attitudes and beliefs. Disabil Rehabil Assist Technol 2019; 16:497-504. [PMID: 31553275 DOI: 10.1080/17483107.2019.1668973] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Persons with profound intellectual disability (PID) are mostly not able to use assistive technology (AT) independently. Caregivers play an important mediating role in implementing AT in the daily life of persons with PID. Both first-order barriers, extrinsic to caregivers, and second-order barriers, intrinsic to caregivers, influence the attitudes and behaviors of caregivers with regard to AT-use. It could be asked if increased knowledge on and experience with AT may impact the effect of first- and second-order barriers. This study investigated how knowledge and experience influence the professional caregivers' beliefs about which factors may impact the AT use in persons with PID and their intentions to use AT for persons with PID. METHODS A questionnaire on the experienced limitations and successes in using AT was developed. The questionnaire was send to professionals working with or responsible for persons with PID in various countries in Europe. In total the answers of 195 respondents were included in this study. RESULTS AND CONCLUSIONS This study's results demonstrate that AT is used for various reasons in persons with PID, mostly to support communication and interaction or for fun or relaxation. Based on the answers of the respondents can be concluded that both experience and knowledge of caregivers seem to influence first- and second-order barriers. Besides, a possibility to overcome the second-order barriers is to provide professionals with possibilities to increase their knowledge and experience.IMPLICATIONS FOR REHABILITATIONAT for persons with PID is mostly used for communication and interaction or for fun and relaxation.Professional caregivers belief that AT-use may positively influence various aspects in the life of persons with PID, especially communication and interaction, active engagement and participation in activities, and self-esteem of the person.Caregivers need to have sufficient experience in order to rate the barriers of AT-use as less limited in the group of persons with PID.In order to overcome the barriers experienced in implementing AT in persons with PID, knowledge of caregivers is essential.
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Affiliation(s)
- Sara Nijs
- Parenting and Special Education Research Unit, KU Leuven, Leuven, Belgium
| | - Bea Maes
- Parenting and Special Education Research Unit, KU Leuven, Leuven, Belgium
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25
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Fasoulas A, Pavlidou E, Petridis D, Mantzorou M, Seroglou K, Giaginis C. Detection of dental plaque with disclosing agents in the context of preventive oral hygiene training programs. Heliyon 2019; 5:e02064. [PMID: 31334380 PMCID: PMC6624240 DOI: 10.1016/j.heliyon.2019.e02064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/03/2019] [Accepted: 07/05/2019] [Indexed: 02/03/2023] Open
Abstract
No studies have evaluated the relationship between the detection points for dental bacterial plaque (DBP or biofilm) and gender, age, socioeconomic status, body mass index (BMI), and oral health, hence the need to investigate and clarify their possible association. This study aimed to map out the occurrence of DBP, investigate and evaluate the factors affecting its localization, and design preventive interventions. The research was conducted on 588 public school children aged 4–18 years in a provincial area of Greece. The subjects’ oral health status and anthropometric characteristics were examined by a dentist (A.F.) and a dietitian (E.P.), respectively. To identify DBP, chewable double-staining disclosing tablets were used. The results of the present study indicate the following: (1) Age and socioeconomic status seem to be associated with DBP development, particularly in the oral cavity. (2) Overweight schoolchildren show more DBP on the upper posterior occlusal and upper posterior buccal surfaces compared to normal-weight children. (3) Moderate caries disease is associated with DBP detection on almost all tooth surfaces and especially on the tongue and lower anterior labial surface. (4) Severe caries disease is most strongly associated with DBP in the upper posterior palatal, lower posterior buccal, and lower posterior lingual spaces, as well as on the tongue. (5) Sex is the only variable without a significant impact on DBP detection surfaces. In conclusion, DBP identification in specific areas of the mouth seems to be influenced by age, socioeconomic level, BMI, and oral health. Gender has no influence on DBP detection points. Disclosing agents can be used in oral health prevention programs, both for more effective guidance on the use of oral hygiene tools and for their evaluation.
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Affiliation(s)
- Aristeidis Fasoulas
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, Myrina, Lemnos, Greece
| | - Eleni Pavlidou
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, Myrina, Lemnos, Greece
- Corresponding author.
| | - Dimitris Petridis
- Department of Food Science and Technology, International Hellenic University, Thessaloniki, Greece
| | - Maria Mantzorou
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, Myrina, Lemnos, Greece
| | - Kyriakos Seroglou
- Department of Statistics and Insurance Science of the University of Piraeus, Athens, Greece
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, Myrina, Lemnos, Greece
- Corresponding author.
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Navas P, Llorente S, García L, Tassé MJ, Havercamp SM. Improving healthcare access for older adults with intellectual disability: What are the needs? JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 32:1453-1464. [PMID: 31192529 DOI: 10.1111/jar.12639] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 04/29/2019] [Accepted: 05/28/2019] [Indexed: 02/02/2023]
Abstract
This qualitative study was carried out in Spain with the aim of identifying the changes that the health system should make to improve healthcare access for older adults with intellectual disability. Three hundred and sixty-nine family members and professionals expressed their opinion on how healthcare access could be improved. Participants responded to two open-ended questions included in a general survey about the health status of older individuals with intellectual disability. Most informants were women and professionals who had known the person with intellectual disability for more than 12 months. A system of categories, which showed good inter-rater agreement, was developed to analyse participants' written responses. Both family members and professionals emphasized the need to improve disability training for healthcare practitioners and highlighted the urgent need for flexibility in the structure of a healthcare system that currently overlooks the specific needs of this vulnerable population.
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Affiliation(s)
- Patricia Navas
- Department of Personality, Assessment and Psychological Treatment, University of Salamanca, Salamanca, Spain.,Institute on Community Integration (INICO), University of Salamanca, Salamanca, Spain
| | - Sandra Llorente
- Institute on Community Integration (INICO), University of Salamanca, Salamanca, Spain
| | - Laura García
- Institute on Community Integration (INICO), University of Salamanca, Salamanca, Spain
| | - Marc J Tassé
- Departments of Psychology and Psychiatry, The Ohio State University, Columbus, Ohio.,Nisonger Center - UCEDD, The Ohio State University, Columbus, Ohio
| | - Susan M Havercamp
- Departments of Psychology and Psychiatry, The Ohio State University, Columbus, Ohio.,Nisonger Center - UCEDD, The Ohio State University, Columbus, Ohio
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Bauer A, Taggart L, Rasmussen J, Hatton C, Owen L, Knapp M. Access to health care for older people with intellectual disability: a modelling study to explore the cost-effectiveness of health checks. BMC Public Health 2019; 19:706. [PMID: 31174506 PMCID: PMC6556058 DOI: 10.1186/s12889-019-6912-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 04/29/2019] [Indexed: 01/09/2023] Open
Abstract
Background Whilst people with intellectual disability grow older, evidence has emerged internationally about the largely unmet health needs of this specific ageing population. Health checks have been implemented in some countries to address those health inequalities. Evaluations have focused on measuring process outcomes due to challenges measuring quality of life outcomes. In addition, the cost-effectiveness is currently unknown. As part of a national guideline for this population we sought to explore the likely cost-effectiveness of annual health checks in England. Methods Decision-analytical Markov modelling was used to estimate the cost-effectiveness of a strategy, in which health checks were provided for older people with intellectual disability, when compared with standard care. The approach we took was explorative. Individual models were developed for a selected range of health conditions, which had an expected high economic impact and for which sufficient evidence was available for the modelling. In each of the models, hypothetical cohorts were followed from 40 yrs. of age until death. The outcome measure was cost per quality-adjusted life-year (QALY) gained. Incremental cost-effectiveness ratios (ICER) were calculated. Costs were assessed from a health provider perspective and expressed in 2016 GBP. Costs and QALYs were discounted at 3.5%. We carried out probabilistic sensitivity analysis. Data from published studies as well as expert opinion informed parameters. Results Health checks led to a mean QALY gain of 0.074 (95% CI 0.072 to 0.119); and mean incremental costs of £4787 (CI 95% 4773 to 5017). For a threshold of £30,000 per QALY, health checks were not cost-effective (mean ICER £85,632; 95% CI 82,762 to 131,944). Costs of intervention needed to reduce from £258 to under £100 per year in order for health checks to be cost-effective. Conclusion Whilst findings need to be considered with caution as the model was exploratory in that it was based on assumptions to overcome evidence gaps, they suggest that the way health systems deliver care for vulnerable populations might need to be re-examined. The work was carried out as part of a national guideline and informed recommendations about system changes to achieve more equal health care provisions. Electronic supplementary material The online version of this article (10.1186/s12889-019-6912-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Annette Bauer
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London, England, WC2A 2AE, UK.
| | - Laurence Taggart
- Institute of Nursing & Health Research, Ulster University, N Ireland, Newtownabbey, BT37 0QB, UK
| | - Jill Rasmussen
- Royal College of General Practitioners (RCGP), 30 Euston Square, London, England, NW1 2FB, UK
| | - Chris Hatton
- Centre for Disability Research, Division of Health Research, Lancaster University, Lancaster, England, LA1 4YG, UK
| | - Lesley Owen
- National Institute for Health and Care Excellence, 10 Spring Gardens, London, England, SW1A 2BU, UK
| | - Martin Knapp
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London, England, WC2A 2AE, UK
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Durbin J, Selick A, Casson I, Green L, Perry A, Chacra MA, Lunsky Y. Improving the quality of primary care for adults with intellectual and developmental disabilities: Value of the periodic health examination. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2019; 65:S66-S72. [PMID: 31023784 PMCID: PMC6501718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To implement a Health Check protocol for patients with intellectual and developmental disabilities (IDD) and assess outcomes. DESIGN Retrospective chart review and staff survey. SETTING Two Ontario family health teams. PARTICIPANTS Of 276 patients with IDD identified, 139 received the Health Check (Health Check group). A convenience sample (N = 147) of clinical staff participated in the survey. MAIN OUTCOME MEASURES The protocol included patient identification, invitation, and modified health examination. Chart review assessed completion of 8 preventive maneuvers, and clinical staff were surveyed on their comfort, knowledge, and skills in care of patients with IDD. Logistic regression analyses were used to compare outcomes for the Health Check and non-Health Check groups, adjusted for practice site. RESULTS Documentation of blood pressure, weight, body mass index, and influenza vaccination was significantly higher (P < .001) in the Health Check group, exceeding 70% of patients. Screening rates were higher for mammograms (63% vs 54%), fecal occult blood testing (39% vs 23%), and diabetes testing (80% vs 61%), but not significantly so, and they were similar to general population rates. Papanicolaou test rates were low for both groups (34% vs 32%). Staff comfort and skills were rated significantly higher (P < .05) for those who performed the Health Check. Still, fewer than half thought they had the necessary skills and resources to care for patients with IDD. CONCLUSION Performing the Health Check was associated with improved preventive care and staff experience. Wider implementation and evaluation is needed, along with protocol adjustments to provide more support to staff for this work.
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Affiliation(s)
- Janet Durbin
- Research Scientist for the Provincial System Support Program of the Centre for Addiction and Mental Health in Toronto, Ont, and Associate Professor in the Department of Psychiatry at the University of Toronto.
| | - Avra Selick
- Research Coordinator for the Provincial System Support Program of the Centre for Addiction and Mental Health
| | - Ian Casson
- Associate Professor in the Department of Family Medicine at Queen's University in Kingston, Ont
| | - Laurie Green
- Family physician practising at St Michael's Hospital in Toronto, Ont, and Lecturer at the University of Toronto
| | - Andrea Perry
- Transitions Facilitator for the Developmental Disabilities Primary Care Program, Surrey Place in Toronto
| | | | - Yona Lunsky
- Directs the Azrieli Adult Neurodevelopmental Centre at the Centre for Addiction and Mental Health and is Professor in the Department of Psychiatry at the University of Toronto
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O'Donovan MA, McCallion P, McCarron M, Lynch L, Mannan H, Byrne E. A narrative synthesis scoping review of life course domains within health service utilisation frameworks. HRB Open Res 2019; 2:6. [PMID: 32296746 PMCID: PMC7140772 DOI: 10.12688/hrbopenres.12900.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2019] [Indexed: 11/20/2022] Open
Abstract
Background: Current thinking in health recognises the influence of early life experiences (health and otherwise) on later life outcomes. The life course approach has been embedded in the work of the World Health Organisation since the Ageing and Health programme was established in 1995. Yet there has been limited debate on the relevancy of a life course lens to understanding health service utilisation. Aim: The aim of the review was twofold. Firstly, identify existing healthcare utilisation frameworks other than the dominant Andersen's behavioural model currently in use. Secondly, to identify if current frameworks incorporate the advocated life course perspective in understanding health service utilisation. Methods: A scoping review of PubMed, Cinahl Plus, Emerald, PsycINFO, Web of Knowledge and Scopus was conducted. Data extraction used a framework approach with meta-synthesis guided by the four domains of the life course proposed by Elder (1979): human agency, location, temporality and relationships, and interdependencies. Results: A total of 551 papers were identified, with 70 unique frameworks (other than Andersen's Behavioural Model) meeting the inclusion criteria and included in the review. Conclusion: To date there has been limited explicit discussion of health service utilisation from a life course perspective. The current review highlights a range of frameworks that draw on aspects of the life course, but have been used with this perspective in mind. The life course approach highlights important gaps in understanding and assessing health service utilisation (HSU), such as utilisation over time. HSU is a complex phenomenon and applying a structured framework from a life course perspective would be of benefit to researchers, practitioners and policy makers.
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Affiliation(s)
- Mary-Ann O'Donovan
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Phillip McCallion
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Mary McCarron
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Louise Lynch
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Hasheem Mannan
- School of Nursing and Midwifery, University College Dublin, Dublin, Ireland
| | - Elaine Byrne
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
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Gibson RC, Bouamrane MM, Dunlop M. Design Requirements for a Digital Aid to Support Adults With Mild Learning Disabilities During Clinical Consultations: Qualitative Study With Experts. JMIR Rehabil Assist Technol 2019; 6:e10449. [PMID: 30829575 PMCID: PMC6421513 DOI: 10.2196/10449] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 11/30/2018] [Accepted: 12/31/2018] [Indexed: 01/12/2023] Open
Abstract
Background Adults with mild learning disabilities (MLDs) face a plethora of obstacles when accessing effective health care. Central to many of these barriers is communication, with medical practitioners often remaining untrained on how to interact with patients who have learning disabilities (LDs). To date, research on how to promote this communication has largely centered on the development of low-tech aids. Objective The objective of this study was to assess the feasibility of utilizing tablet technologies to promote communication between general practitioners and patients with MLDs. We achieved this by identifying a set of design requirements from experts in LDs. Methods A set of design guidelines was formed during a 2-phase process. Phase 1 involved conducting a series of requirements-gathering interviews with 10 experts in LDs—the protocol of which emerged from the results of a separate scoping review. The interviews were subjected to a framework analysis to discern the key requirements discussed by the experts, and these were embedded within a technology probe. In phase 2, this probe was presented to a subset (n=4) of the experts during a round of usability studies, and the feedback received was used to update the requirements identified in phase 1. Results An initial set of design requirements has been produced that may assist in the development of clinical Alternative and Augmentative Communication technologies for adults with MLDs. Factors that must be considered range from the health, physical and cognitive needs of stakeholders, to the more individual needs of users. Conclusions The experts involved in the study were optimistic about the proposed app. They believe that such technologies can help to alleviate time constraints and promote communication by presenting information in a form understood by both practitioners and patients.
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Affiliation(s)
- Ryan Colin Gibson
- Digital Health and Well-Being Group, Department of Computer & Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Matt-Mouley Bouamrane
- Digital Health and Well-Being Group, Department of Computer & Information Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Mark Dunlop
- Digital Health and Well-Being Group, Department of Computer & Information Sciences, University of Strathclyde, Glasgow, United Kingdom
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Panca M, Buszewicz M, Strydom A, Hassiotis A, Welch CA, Hunter RM. Resource use and cost of annual health checks in primary care for people with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2019; 63:233-243. [PMID: 30461105 PMCID: PMC6451619 DOI: 10.1111/jir.12569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 10/10/2018] [Accepted: 10/14/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND The annual health check (AHC) programme, as part of a Directed Enhanced Service, offers an incentive to general practitioners in England to conduct health checks for people with intellectual disabilities (IDs). The aim of this analysis was to estimate the impact on health care costs of AHCs in primary care to the National Health Service in England by comparing adults with ID who did or did not have AHCs using data obtained from The Health Improvement Network. METHODS Two hundred eight records of people with ID from The Health Improvement Network database were analysed. Baseline health care resource use was captured at the time the first AHC was recorded (i.e. index date), or the earliest date after 1 April 2008 for those without an AHC. We examined the volume of resource use and associated costs that occurred at the time AHCs were performed, as well as before and after the index date. We then estimated the impact of AHCs on health care costs. RESULTS The average cost of AHC was estimated at £142.57 (95%CI £135.41 to £149.74). Primary, community and secondary health care costs increased significantly after the index date in the no AHC group owing to higher increase in resource utilisation. Regression analysis showed that the expected health care cost for those who have an AHC is 56% higher than for those who did not have an AHC. Age and gender were also associated with increase in expected health care cost. CONCLUSION The level of resource utilisation increased in both (AHC and no AHC) groups after the index date. Although the level of resource use before index date was lower in the no AHC group, it increased after the index date up to almost reaching the level of resource utilisation in the AHC group. Further research is needed to explore if the AHCs are effective in reducing health inequalities.
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Affiliation(s)
- Monica Panca
- UCL Institute of Epidemiology & Health Care, Research Department of Primary Care & Population Health, Royal Free Campus, Rowland Hill Street, London NW3 2PF
| | - Marta Buszewicz
- UCL Institute of Epidemiology & Health Care, Research Department of Primary Care & Population Health, Royal Free Campus, Rowland Hill Street, London NW3 2PF
| | - André Strydom
- Institute of Psychiatry Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF
| | - Angela Hassiotis
- UCL Division of Psychiatry, 149 Tottenham Court Road, London W1T 7NF
| | - Catherine A Welch
- Department of Cardiovascular Sciences, University of Leicester, Leicester, LE3 9QP
| | - Rachael M Hunter
- UCL Institute of Epidemiology & Health Care, Research Department of Primary Care & Population Health, Royal Free Campus, Rowland Hill Street, London NW3 2PF
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Appelgren M, Bahtsevani C, Persson K, Borglin G. Nurses' experiences of caring for patients with intellectual developmental disorders: a systematic review using a meta-ethnographic approach. BMC Nurs 2018; 17:51. [PMID: 30524202 PMCID: PMC6276187 DOI: 10.1186/s12912-018-0316-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 11/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research suggests that registered nurses (RNs) do not feel adequately prepared to support patients with intellectual disability disorder (IDD). This is unsurprising, as few European health sciences curricula include undergraduate and graduate training courses in IDD. As RNs are often in the front line of care, eliciting in-depth knowledge about how they experience nursing this group of patients is vital. Our aim in this study was to develop a conceptual understanding about RNs' experiences of nursing patients with IDD. METHOD We undertook a systematic review and meta-ethnography to synthesise qualitative research studies found in PubMed, CINAHL, PsycINFO, ERIC databases and by manual searching to identify additional studies. We condensed translatable second-order constructs, and developed an idiomatic translation. Finally, we formulated line of argument (LOA) syntheses to capture the core of the idiomatic translations. RESULTS We included eighteen published studies from eight countries involving 190 RNs. The RNs' experience of nursing patients with IDD were reflected in 14 LOAs. Six of these reflected a tentatively more distinctive and at times unique conceptualisation of RNs' experience of nursing this group of patients. The remaining eight LOAs represented a conceptualisation of nursing per se, a conceptualisation of nursing that was interpreted as a universal experience regardless of context and patient group. CONCLUSION Lack of awareness and knowledge are likely breeding grounds for the 'otherness' that still surrounds this group of patients. In encounters between patients and RNs, focusing on the person behind the disability label could be one way to secure relevant nursing care for patients with IDD. Undertaking appropriate under- and postgraduate education alongside the implementation of nursing models focusing on patient-centred care would help RNs in reducing the health and care inequalities this group of patients still face. TRIAL REGISTRATION PROSPERO 2017: CRD42017077703.
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Affiliation(s)
- Marie Appelgren
- 1Department of Care Science, Faculty of Health and Society, Malmö University, SE-205 06 Malmö, Sweden
- City of Malmö, Borough Administration Operation Support Management, SE-205 80 Malmö, Sweden
| | - Christel Bahtsevani
- 1Department of Care Science, Faculty of Health and Society, Malmö University, SE-205 06 Malmö, Sweden
| | - Karin Persson
- 1Department of Care Science, Faculty of Health and Society, Malmö University, SE-205 06 Malmö, Sweden
| | - Gunilla Borglin
- 1Department of Care Science, Faculty of Health and Society, Malmö University, SE-205 06 Malmö, Sweden
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Whittle EL, Fisher KR, Reppermund S, Trollor J. Access to mental health services: The experiences of people with intellectual disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2018; 32:368-379. [DOI: 10.1111/jar.12533] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 06/06/2018] [Accepted: 09/03/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Erin Louise Whittle
- 3DN; The Department of Developmental Disability Neuropsychiatry; UNSW; Sydney Australia
- Social Policy Research Centre; UNSW; Sydney Australia
| | | | - Simone Reppermund
- 3DN; The Department of Developmental Disability Neuropsychiatry; UNSW; Sydney Australia
| | - Julian Trollor
- 3DN; The Department of Developmental Disability Neuropsychiatry; UNSW; Sydney Australia
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Boot FH, Owuor J, Dinsmore J, MacLachlan M. Access to assistive technology for people with intellectual disabilities: a systematic review to identify barriers and facilitators. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2018; 62:900-921. [PMID: 29992653 DOI: 10.1111/jir.12532] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/25/2018] [Accepted: 06/14/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND The World Health Organisation has launched a programme to promote Global Cooperation on Assistive Technology. Its aim is to increase access to high-quality affordable assistive products (AP) for everybody in need. People with intellectual disabilities (ID) are a specific group that could benefit from AP, but use less AP compared to their non-intellectual disabled peers. METHOD A systematic literature search was carried out to identify barriers and potential facilitators for access to AP for people with ID globally. The search strategy terms were 'Intellectual Disability' and 'Assistive Technology' with the following electronic literature databases PubMed, Embase, ASSIA, Web of Science, Medline, CINAHL complete, PsycInfo, Scopus and ERIC. The quality and relevance of the studies were assessed. Factors associated with access were identified thematically, categorised into barriers and facilitators and mapped into themes. RESULTS In all, 22 key studies were retrieved, describing 77 barriers and 56 facilitators. The most frequently reported barriers were related to lack of funding and cost of AP, lack of awareness about AP and inadequate assessment. An increase of knowledge and awareness about AP and the need of AP for people with ID were most often extracted as factors that could potentially facilitate access. CONCLUSIONS This review proposes actions linked to the barriers and facilitators that have a particular importance for people with ID to access AP. Yet, only limited research is available describing factors that influence access to AP for people with ID in low and middle income countries and rural areas.
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Affiliation(s)
- F H Boot
- Assisting Living & Learning (ALL) Institute, Department of Psychology, Maynooth University, Maynooth, Ireland
- Centre for Global Health, School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - J Owuor
- Assisting Living & Learning (ALL) Institute, Department of Psychology, Maynooth University, Maynooth, Ireland
- Centre for Global Health, School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - J Dinsmore
- Centre for Practice and Healthcare Innovation, School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - M MacLachlan
- Assisting Living & Learning (ALL) Institute, Department of Psychology, Maynooth University, Maynooth, Ireland
- Centre for Rehabilitation Studies, Stellenbosch University, Cape Town, South Africa
- Olomouc University Social Health Institute (OUSHI), Palacky University, Olomouc, Czech Republic
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Bright T, Kuper H. A Systematic Review of Access to General Healthcare Services for People with Disabilities in Low and Middle Income Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15091879. [PMID: 30200250 PMCID: PMC6164773 DOI: 10.3390/ijerph15091879] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 08/17/2018] [Accepted: 08/29/2018] [Indexed: 12/30/2022]
Abstract
Background: A systematic review was undertaken to explore access to general healthcare services for people with disabilities in low and middle-income countries (LMICs). Methods: Six electronic databases were searched in February 2017. Studies comparing access to general healthcare services by people with disabilities to those without disabilities from LMICs were included. Eligible measures of healthcare access included: utilisation, coverage, adherence, expenditure, and quality. Studies measuring disability using self-reported or clinical assessments were eligible. Title, abstract and full-text screening and data extraction was undertaken by the two authors. Results: Searches returned 13,048 studies, of which 50 studies were eligible. Studies were predominantly conducted in sub-Saharan Africa (30%), Latin America (24%), and East Asia/Pacific (12%). 74% of studies used cross-sectional designs and the remaining used case-control designs. There was evidence that utilisation of healthcare services was higher for people with disabilities, and healthcare expenditure was higher. There were less consistent differences between people with and without disabilities in other access measures. However, the wide variation in type and measurement of disability, and access outcomes, made comparisons across studies difficult. Conclusions: Developing common metrics for measuring disability and healthcare access will improve the availability of high quality, comparable data, so that healthcare access for people with disabilities can be monitored and improved.
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Affiliation(s)
- Tess Bright
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
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Price HC, Ismail K. Royal College of Psychiatrists Liaison Faculty & Joint British Diabetes Societies (JBDS): guidelines for the management of diabetes in adults and children with psychiatric disorders in inpatient settings. Diabet Med 2018; 35:997-1004. [PMID: 30152583 DOI: 10.1111/dme.13673] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/11/2018] [Indexed: 11/30/2022]
Abstract
The Royal College of Psychiatrists Liaison Faculty & Joint British Diabetes Societies (JBDS) for Inpatient Care guidelines for the management of diabetes in adults and children with psychiatric disorders in inpatient settings are available in full at: www.diabetes.org.uk/joint-british-diabetes-society and https://abcd.care/joint-british-diabetes-societies-jbds-inpatient-care-group. This article summarizes the guidelines and recommendations. Commissioners are urged to ensure that the needs of people with diabetes and severe mental illness are specifically addressed in contracts with providers of inpatient care, and to avoid financial or other barriers to cross-organizational working and to ensure that patient-structured education is commissioned to meets the complex needs of people with diabetes and severe mental illness. Acute trusts are asked to develop joint pathways with mental health providers and facilitate multidisciplinary working and to screen for mental ill health in those admitted with acute complications of diabetes whose aetiology is unclear or not medically explained. Mental health trusts should create a diabetes register, screen for diabetes, particularly in those prescribed second-generation antipsychotics and ensure that staff are trained in managing and avoiding hypoglycaemia, and the safe use of insulin. Finally, clinical teams should ensure that all staff can access training in diabetes and mental health to support them to care for people with both diabetes and severe mental illness, develop local pathways for joint working and ensure best practice tariff criteria are met for diabetic ketoacidosis and hypoglycaemia, and for children and young people with diabetes.
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Affiliation(s)
- H C Price
- Southern Health NHS Foundation Trust, Southampton, UK
| | - K Ismail
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK
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Witham G, Haigh C. A narrative literature review examining cancer treatment issues for patients living with intellectual disabilities. Eur J Oncol Nurs 2018; 36:9-15. [PMID: 30322516 DOI: 10.1016/j.ejon.2018.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/10/2018] [Accepted: 07/11/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The experiences of cancer care can be mediated by many different factors and this narrative literature review aims to explore the experiences of cancer care in relation to people with intellectual disabilities receiving cancer treatment. METHOD We undertook a search for articles in English from (Jan) 2000-(Feb) 2018 using Medline, CINAHL, ScienceDirect, ASSIA and Wiley. The inclusion criteria are 2000-2018, English language and focussing on experiences of cancer journey. We used a narrative approach and thematically analysed the data. RESULTS There were 10 papers that met our inclusion/exclusion criteria. The themes generated included communication issues, information giving and decision-making. The literature suggests that communication and decision-making within cancer care are often mediated through support workers or family carers with minimal involvement of the person with intellectual disabilities. Information-giving by health professionals and support workers to people with intellectual disabilities was limited. This was often justified by the perceived distress this may cause. CONCLUSION Training for health professionals and support workers in supporting people with intellectual difficulties is required for more effective communication in cancer care.
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Affiliation(s)
- Gary Witham
- Manchester Metropolitan University, Department of Nursing, Brooks Building, Birley Campus, 53 Bonsall Street, Manchester, M15 6GX, United Kingdom.
| | - Carol Haigh
- Manchester Metropolitan University, Department of Nursing, Brooks Building, Birley Campus, 53 Bonsall Street, Manchester, M15 6GX, United Kingdom.
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Macdonald S, Morrison J, Melville CA, Baltzer M, MacArthur L, Cooper SA. Embedding routine health checks for adults with intellectual disabilities in primary care: practice nurse perceptions. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2018; 62:349-357. [PMID: 29423981 DOI: 10.1111/jir.12475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 11/10/2017] [Accepted: 12/21/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND Adults with intellectual disabilities (IDs) have consistently poorer health outcomes than the general population. There is evidence that routine health checks in primary care may improve outcomes. We conducted a randomised controlled trial of practice nurse led health checks. Here, we report findings from the nested qualitative study. AIM To explore practice nurse perceptions and experience of delivering an anticipatory health check for adults with IDs. DESIGN AND SETTING Qualitative study in General Practices located in NHS Greater Glasgow and Clyde, Scotland, UK. METHOD Eleven practice nurses from 11 intervention practices participated in a semi-structured interview. Analysis was guided by a framework approach. RESULTS Practice nurses reported initially feeling 'swamped' and 'baffled' by the prospect of the intervention, but early misgivings were not realised. Health checks were incorporated into daily routines with relative ease, but this was largely contingent on existing patient engagement. The intervention was thought most successful with patients already well known to the practice. Chronic disease management models are commonly used by practice nurses and participants tailored health checks to existing practice. It emerged that few of the nurses utilised the breadth of the check instead modifying the check to respond to individual patients' needs. As such, already recognised 'problems' or issues dominated the health check process. Engaging with the health checks in this way appeared to increase the acceptability and feasibility of the check for nurses. There was universal support for the health check ethos, although some questioned whether all adults with IDs would access the health checks, and as a consequence, the long-term benefits of checks. CONCLUSION While the trial found the intervention to be dominant over standard health care, the adjustments nurses made may not have maximised potential benefits to patients. Increasing training could further improve the benefits that health checks provide for people with IDs.
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Affiliation(s)
- S Macdonald
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - J Morrison
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - C A Melville
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - M Baltzer
- College of Social Science, University of Glasgow, Glasgow, UK
| | - L MacArthur
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - S A Cooper
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
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Ummer-Christian R, Iacono T, Grills N, Pradhan A, Hughes N, Gussy M. Access to dental services for children with intellectual and developmental disabilities - A scoping review. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 74:1-13. [PMID: 29355670 DOI: 10.1016/j.ridd.2017.12.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 11/29/2017] [Accepted: 12/30/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Children with Intellectual and Developmental Disabilities (IDD) face considerable challenges in participating in dental services. These challenges include resource constraints and inadequate skills of health service providers to work with this population. AIM The aim was to scope published studies that addressed access to dental services for children with IDD in order to determine the extent to which various barriers have been researched, using an access framework derived from the literature. Access was defined to include the six dimensions of accessibility, availability, affordability, accommodation, acceptability, and appropriateness. METHOD Arksey and O'Malley's scoping review framework was used. Relevant databases (e.g., Medline) were searched for all empirical studies conducted from January 2000 to February 2017 that met inclusion criteria. Data were extracted along the six dimensions of the access framework. RESULTS Sixteen international studies were identified which indicated common key barriers to dental service use: the difficulties of physical inaccessibility, lack of access to information among carers, lack of knowledge of disability issues, and low experience and skills in caring for children with IDD among dental practitioners. CONCLUSIONS Key recommendations made were exploring dental practitioners' understanding of disability legislation and developing training for practitioners to expand on issues specific to IDD.
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Affiliation(s)
- Rahila Ummer-Christian
- La Trobe Rural Health School, La Trobe University, Edwards Road, Flora Hill, VIC 3550, Australia.
| | - Teresa Iacono
- La Trobe Rural Health School, La Trobe University, Edwards Road, Flora Hill, VIC 3550, Australia
| | - Nathan Grills
- Nossal Institute of Global Health, Melbourne School of Population and Global Health, The University of Melbourne, VIC 3010, Australia
| | - Archana Pradhan
- School of Dentistry, The University of Queensland, 288 Herston Road, Corner Bramston Terrace and Herston Rd, Herston, QLD 4006, Australia
| | - Nicole Hughes
- Nossal Institute of Global Health, Melbourne School of Population and Global Health, The University of Melbourne, VIC 3010, Australia
| | - Mark Gussy
- La Trobe Rural Health School, La Trobe University, Edwards Road, Flora Hill, VIC 3550, Australia
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Lee RLT, Leung C, Chen H, Louie LHT, Brown M, Chen JL, Cheung G, Lee PH. The Impact of a School-Based Weight Management Program Involving Parents via mHealth for Overweight and Obese Children and Adolescents with Intellectual Disability: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E1178. [PMID: 28981460 PMCID: PMC5664679 DOI: 10.3390/ijerph14101178] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/24/2017] [Accepted: 09/18/2017] [Indexed: 11/20/2022]
Abstract
There is a scarcity of resources and studies that utilize targeted weight management interventions to engage parents via mHealth tools targeting obese children and adolescents with mild intellectual disabilities (MIDs) extended from school to a home setting. To test the feasibility and acceptability of a school-based weight program (SBWMP) involving parents via mHealth tools designed to reduce weight, enhance knowledge and adopt healthy lifestyles, and thereby achieve better psychosocial well-being among children and adolescents with MIDs. Four special schools were randomly assigned as intervention or control schools. Students from the intervention group (n = 63) were compared to those in the control group (n = 52), which comprised those with usual school planned activities and no parental involvement. Demographics were considered as covariates in a general linear model, an ordinal regression model and a binary logistic regression model analyzing the relationships between the SBWMP and the outcome variables at baseline (T0) and six months later (T1). Body weight, body mass index, and triceps and subscapular skinfold thickness were lower in the intervention group compared to the control group, although the differences were not statistically significant. There was a positive and direct impact of the SBWMP on students' health knowledge and psychological impacts in the intervention group. The SBWMP extended to the home involving parents via mHealth tools is a feasible and acceptable program for this group with MIDs and their parents.
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Affiliation(s)
- Regina Lai-Tong Lee
- World Health Organization Collaborating Center for Community Health Services, School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Cynthia Leung
- Department of Applied & Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Hong Chen
- Infection Control Branch, Centre for Health Protection, Hong Kong, China.
| | - Lobo H T Louie
- Department of Physical Education, Hong Kong Baptist University, Hong Kong, China.
| | - Michael Brown
- School of Nursing and Midwifery, Queen's University, Belfast B79 7BL, Northern Ireland, UK.
| | - Jyu-Lin Chen
- Faculty of Nursing, University of California San Francisco, San Francisco, CA 94143, USA.
| | | | - Paul H Lee
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China.
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Collection of Patients' Disability Status by Healthcare Organizations: Patients' Perceptions and Attitudes. J Healthc Qual 2017; 39:219-229. [DOI: 10.1097/jhq.0000000000000036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Brown M, Taggart L, Karatzias T, Truesdale M, Walley R, Northway R, Macrae S, Carey M, Davies M. Improving diabetes care for people with intellectual disabilities: a qualitative study exploring the perceptions and experiences of professionals in diabetes and intellectual disability services. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2017; 61:435-449. [PMID: 28247543 DOI: 10.1111/jir.12369] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 02/04/2017] [Accepted: 02/08/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND Globally, diabetes is increasing with concerns about the impact on outcomes, including premature death and the costs associated with managing the condition. Research indicates that adults with intellectual disabilities (ID) are two to three times more likely to develop diabetes; however, there has been limited focus on diabetes service utilisation in this population. The aim of this study is to explore the perceptions and experiences of diabetes and ID practitioners. METHODS A series of 1:1 semi-structured interviews were undertaken in one Scottish health service area. In total, 29 qualitative interviews were conducted: 10 with diabetes practitioners from primary and secondary care, 14 from ID services and 5 from community care services regarding diabetes service provision for this population. Thematic content analysis was undertaken to identify the themes and subthemes. RESULTS Three main themes were identified: (1) enabling access to services to meet diabetes-related care needs of people with ID; (2) communication and service improvements between staff, patients and across services; and (3) providing person-centred diabetes care and developing adapted resources to increase patient self-care. CONCLUSIONS The findings of this study have important international implications in how diabetes practitioners plan and deliver services for people with ID and other vulnerable groups with limited cognitive ability and communication skills and difficulties in self-management. The findings highlight that access to diabetes education and adapted resources is needed, and if 'reasonable adjustments' are made to service provision and practice, people with ID can benefit from improved healthcare. Developing joint clinics to share knowledge and resources between diabetes and ID practitioners may improve service delivery and continuity of care, and thereby diminish the costs of not providing quality care.
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Affiliation(s)
- M Brown
- Department of Nursing and Midwifery, School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
- Department of Clinical Psychology, Specialist Learning Disability Services, NHS Lothian, Edinburgh, UK
| | - L Taggart
- Department of Nursing, Institute of Nursing and Health Research, University of Ulster, Coleraine, UK
| | - T Karatzias
- Department of Nursing and Midwifery, School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
- Department of Clinical Psychology, Rivers Centre for Traumatic Stress, NHS Lothian, Edinburgh, UK
| | - M Truesdale
- Department of Nursing and Midwifery, School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - R Walley
- Department of Nursing and Midwifery, School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - R Northway
- Department of Nursing and Midwifery, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - S Macrae
- Department of Nursing and Midwifery, School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - M Carey
- Leicester Diabetes Centre, Department of Health Sciences, University Hospitals of Leicester, Leicester
| | - M Davies
- Leicester Diabetes Centre, Department of Health Sciences, University Hospitals of Leicester, Leicester
- Diabetes Research Centre, Department of Health Sciences, University of Leicester, Leicester, UK
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Dunkley AJ, Tyrer F, Spong R, Gray LJ, Gillett M, Doherty Y, Martin-Stacey L, Patel N, Yates T, Bhaumik S, Chalk T, Chudasama Y, Thomas C, Sadler S, Cooper SA, Gangadharan SK, Davies MJ, Khunti K. Screening for glucose intolerance and development of a lifestyle education programme for prevention of type 2 diabetes in a population with intellectual disabilities: the STOP Diabetes research project. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05110] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BackgroundThe prevalence of type 2 diabetes mellitus (T2DM) and of cardiovascular disease (CVD) is believed to be higher among people with intellectual disability (ID) than in the general population. However, research on prevalence and prevention in this population is limited.ObjectivesThe objectives of this programme of work were to establish a programme of research that would significantly enhance the knowledge and understanding of impaired glucose regulation (IGR) and T2DM in people with ID; to test strategies for the early identification of IGR and T2DM in people with ID; and to develop a lifestyle education programme and educator training protocol to promote behaviour change in a population with ID and IGR (or at a high risk of T2DM/CVD).SettingLeicestershire, UK.ParticipantsAdults with ID were recruited from community settings, including residential homes and family homes. Adults with mild to moderate ID who had an elevated body mass index (BMI) of ≥ 25 kg/m2and/or IGR were invited to take part in the education programme.Main outcome measuresThe primary outcome of the screening programme was the prevalence of screen-detected T2DM and IGR. The uptake, feasibility and acceptability of the intervention were assessed.Data sourcesParticipants were recruited from general practices, specialist ID services and clinics, and through direct contact.ResultsA total of 930 people with ID were recruited to the screening programme: 58% were male, 80% were white and 68% were overweight or obese. The mean age of participants was 43.3 years (standard deviation 14.2 years). Bloods were obtained for 675 participants (73%). The prevalence of previously undiagnosed T2DM was 1.3% [95% confidence interval (CI) 0.5% to 2%] and of IGR was 5% (95% CI 4% to 7%). Abnormal IGR was more common in those of non-white ethnicity; those with a first-degree family history of diabetes; those with increasing weight, waist circumference, BMI, diastolic blood pressure or triglycerides; and those with lower high-density lipoprotein cholesterol. We developed a lifestyle educational programme for people with ID, informed by findings from qualitative stakeholder interviews (health-care professionals,n = 14; people with ID,n = 7) and evidence reviews. Subsequently, 11 people with ID (and carers) participated in pilot education sessions (two groups) and five people attended education for the feasibility stage (one group). We found that it was feasible to collect primary outcome measures on physical activity and sedentary behaviour using wrist-worn accelerometers. We found that the programme was relatively costly, meaning that large changes in activity or diet (or a reduction in programme costs) would be necessary for the programme to be cost-effective. We also developed a quality development process for assessing intervention fidelity.LimitationsWe were able to screen only around 30% of the population and involved only a small number in the piloting and feasibility work.ConclusionsThe results from this programme of work have significantly enhanced the existing knowledge and understanding of T2DM and IGR in people with ID. We have developed a lifestyle education programme and educator training protocol to promote behaviour change in this population.Future workFurther work is needed to evaluate the STOP Diabetes intervention to identify cost-effective strategies for its implementation.Trial registrationClinicalTrials.gov NCT02513277.FundingThe National Institute for Health Research Programme Grants for Applied Research programme and will be published in full inHealth Research Programme Grants for Applied Research; Vol. 5, No. 11. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Alison J Dunkley
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Freya Tyrer
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Rebecca Spong
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Laura J Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Mike Gillett
- School of Health & Related Research, University of Sheffield, Sheffield, UK
| | - Yvonne Doherty
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK
| | | | - Naina Patel
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Sabyasachi Bhaumik
- Learning Disabilities Service, Leicestershire Partnership NHS Trust, Leicester, UK
| | - Thomas Chalk
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Yogini Chudasama
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Chloe Thomas
- School of Health & Related Research, University of Sheffield, Sheffield, UK
| | - Susannah Sadler
- School of Health & Related Research, University of Sheffield, Sheffield, UK
| | - Sally-Ann Cooper
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
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Weise J, Pollack A, Britt H, Trollor JN. Primary health care for people with an intellectual disability: an exploration of demographic characteristics and reasons for encounters from the BEACH programme. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2016; 60:1119-1127. [PMID: 27278719 DOI: 10.1111/jir.12301] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 04/25/2016] [Accepted: 05/06/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND People with an intellectual disability (ID) have complex and different patterns of healthcare needs. Poor participation in primary health care contributes to the high levels of undetected and unmanaged health issues and premature deaths of people with an ID. Limited research is available on the characteristics of people with an ID, their reasons for consulting general practitioners (GPs), and if these differ to people without an ID. Gaining such insights may provide an avenue to better understand patterns of primary care use and potential gaps in usage by people with an ID given their complex health profile compared with people without an ID. METHOD A secondary analysis of data collected January 2003 to December 2012 from The Bettering the Evaluation and Care of Health programme was used. Participant characteristics and their reasons for encounter, pre- and post-age-sex standardisation, at all GP encounters with people identified in the encounter record as having an ID ('ID' encounters, n = 690) were compared with those at 'non-ID' encounters (n = 970 641). Statistical significance was tested with chi-squared statistics or 95% confidence intervals as appropriate. RESULTS This study identified significant differences in participant characteristics and their reasons for consulting GPs at ID encounters compared with non-ID encounters. Participants at ID encounters had a skewed demography, an over-representation of presentations for psychological, social and 'general and unspecified' reasons, and an under-representation of presentations for core physical health and preventive health measures. Administrative rather than medically related reasons dominated presentations to general practice at ID encounters. CONCLUSION There are significant differences in the characteristics of participants and their reasons for presentation to general practice in Australia for participants at ID encounters compared with non-ID encounters. This work suggests that there is a difference in service use patterns between these two groups. These findings may suggest that people with an ID experience barriers to participating in essential primary healthcare services.
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Affiliation(s)
- J Weise
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, UNSW, Australia
| | - A Pollack
- Family Medicine Research Centre, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - H Britt
- Family Medicine Research Centre, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - J N Trollor
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, UNSW, Australia.
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McCann E, Lee R, Brown M. The experiences and support needs of people with intellectual disabilities who identify as LGBT: A review of the literature. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 57:39-53. [PMID: 27372882 DOI: 10.1016/j.ridd.2016.06.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 05/05/2016] [Accepted: 06/15/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND People who identify as lesbian, gay, bisexual and transgender (LGBT) can face many challenges in society including accessing education, care and support appropriate to individual needs. However, there is a growing and evolving evidence base about the specific needs of people with intellectual disabilities (ID) in this regard. AIMS The aim of this review was to explore the experiences of people with ID who identified as LGBT through an examination of studies that addressed their views and highlighted specific issues, concerns and service responses. METHODS AND PROCEDURES A comprehensive search of relevant databases from February 1995 to February 2015 was conducted. Studies were identified that met specific criteria that included: empirical peer reviewed studies, the use of recognised research methods and focused on people with ID whom identified as LGBT. The search yielded 161 papers in total. The search was narrowed and 37 papers were screened using rigorous inclusion and exclusion criteria. Finally, 14 papers were considered suitable for the review. OUTCOMES AND RESULTS The data were analysed and key themes identified that included accessing health services, gender and sexual identity, attitudes of people with ID regarding their LGBT status, and education, supports and therapeutic interventions. CONCLUSIONS AND IMPLICATIONS There is a need for service providers and carers to be more responsive to the concerns of people with ID who identify as LGBT to improve their health and well-being by reducing stigma and discrimination and by increasing awareness of their care and support needs. The implications are discussed in terms of policy, education, research and practice developments.
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Affiliation(s)
- Edward McCann
- School of Nursing and Midwifery, Trinity College Dublin, Ireland.
| | - Regina Lee
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong
| | - Michael Brown
- School of Nursing and Midwifery, Edinburgh Napier University, Scotland, UK
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Health information exchange for patients with intellectual disabilities: a general practice perspective. Br J Gen Pract 2016; 66:e720-8. [PMID: 27481859 DOI: 10.3399/bjgp16x686593] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 05/09/2016] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Inadequate health information exchange (HIE) between patients with intellectual disabilities (ID), their carers, and GPs may lead to ineffective treatment and poor treatment compliance. Factors influencing HIE are largely unexplored in previous research. AIM To provide insight into the perceived HIE facilitators of GPs and general practice assistants, and the barriers in GP consultations for patients with ID. DESIGN AND SETTING An interview-based study with GPs (n = 19) and general practice assistants (n = 11) in the Netherlands. METHOD Semi-structured interviews were conducted on topics relating to stages during and around GP consultation. Transcripts were coded and analysed using framework analysis. RESULTS The main themes were impaired medical history taking and clinical decision making, and fragile patient follow-up. Factors negatively influencing HIE related to patient communication skills and professional carers' actions in preparing the consultation and in collecting, recording, and sharing information. HIE barriers resulted in risk of delay in diagnosis and treatment, misdiagnosis, unnecessary tests, and ineffective treatment regimens. HIE facilitators were described in terms of GP adjustments in communication, planning of consultations, and efforts to compensate for fragile follow-up situations. CONCLUSION Inadequate HIE should be seen as a chain of events leading to less effective consultations, substandard treatment, and insufficient patient follow-up. The results indicate a mismatch between GPs' expectations about professional carers' competencies, responsibilities, and roles in HIE and the setting in which professional carers operate. Further research should focus on how daily GP practice can be attuned to the practicalities of HIE with patients with ID and their professional carers.
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Berghs M, Atkin K, Graham H, Hatton C, Thomas C. Implications for public health research of models and theories of disability: a scoping study and evidence synthesis. PUBLIC HEALTH RESEARCH 2016. [DOI: 10.3310/phr04080] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BackgroundPublic health interventions that are effective in the general population are often assumed to apply to people with impairments. However, the evidence to support this is limited and hence there is a need for public health research to take a more explicit account of disability and the perspectives of people with impairments.Objectives(1) To examine the literature on theories and models of disability; (2) to assess whether or not, and how, intervention studies of effectiveness could incorporate more inclusive approaches that are consistent with these theories and models; and (3) to use the findings to draw out implications for improving evaluative study designs and evidence-based practice.Review methodsThe project is a scoping review of the literature. The first stage examines theories and models of disability and reflects on possible connections between theories of disability and public health paradigms. This discussion is used to develop an ethical–empirical decision aid/checklist, informed by a human rights approach to disability and ecological approaches to public health. We apply this decision aid in the second stage of the review to evaluate the extent to which the 30 generic public health reviews of interventions and the 30 disability-specific public health interventions include the diverse experiences of disability. Five deliberation panels were also organised to further refine the decision aid: one with health-care professionals and four with politically and socially active disabled people.ResultsThe evidence from the review indicated that there has been limited public health engagement with theories and models of disability. Outcome measures were often insensitive to the experiences of disability. Even when disabled people were included, studies rarely engaged with their experiences in any meaningful way. More inclusive research should reflect how people live and ‘flourish’ with disability.LimitationsThe scoping review provides a broad appraisal of a particular field. It generates ideas for future practice rather than a definite framework for action.ConclusionsOur ethical–empirical decision aid offers a critical framework with which to evaluate current research practice. It also offers a resource for promoting more ethical and evidence-based public health research that is methodologically robust while being sensitive to the experiences of disability.Future workDeveloping more inclusive research and interventions that avoid conceptualising disability as either a ‘burden’ or ‘problem’ is an important starting point. This includes exploring ways of refining and validating current common outcome measures to ensure that they capture a diverse range of disabling experiences, as well as generating evidence on meaningful ways of engaging a broad range of disabled children and adults in the research process.FundingThe National Institute for Health Research Public Health Research programme.
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Affiliation(s)
- Maria Berghs
- Department of Health Sciences, University of York, York, UK
| | - Karl Atkin
- Department of Health Sciences, University of York, York, UK
| | - Hilary Graham
- Department of Health Sciences, University of York, York, UK
| | - Chris Hatton
- Faculty of Health and Medicine, Furness College, Lancaster University, Lancaster, UK
| | - Carol Thomas
- Faculty of Health and Medicine, Furness College, Lancaster University, Lancaster, UK
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Balogh R, McMorris CA, Lunsky Y, Ouellette‐Kuntz H, Bourne L, Colantonio A, Gonçalves‐Bradley DC. Organising healthcare services for persons with an intellectual disability. Cochrane Database Syst Rev 2016; 4:CD007492. [PMID: 27065018 PMCID: PMC8720486 DOI: 10.1002/14651858.cd007492.pub2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND When compared to the general population, persons with an intellectual disability have lower life expectancy, higher morbidity, and more difficulty finding and obtaining healthcare. Organisational interventions are used to reconfigure the structure or delivery of healthcare services. This is the first update of the original review. OBJECTIVES To assess the effects of organisational interventions of healthcare services for the mental and physical health problems of persons with an intellectual disability. SEARCH METHODS For this update we searched CENTRAL, MEDLINE, EMBASE, CINAHL and other databases, from April 2006 to 4 September 2015. We checked reference lists of included studies and consulted experts in the field. SELECTION CRITERIA Randomised controlled trials of organisational interventions of healthcare services aimed at improving care of mental and physical health problems of adult persons with an intellectual disability. DATA COLLECTION AND ANALYSIS We employed standard methodological procedures as outlined in the Cochrane Handbook of Systematic Reviews of Interventions, in addition to specific guidance from the Cochrane Effective Practice and Organisation of Care (EPOC) Group. MAIN RESULTS We identified one new trial from the updated searches.Seven trials (347 participants) met the selection criteria. The interventions varied but had common components: interventions that increased the intensity and frequency of service delivery (4 trials, 200 participants), community-based specialist behaviour therapy (1 trial, 63 participants), and outreach treatment (1 trial, 50 participants). Another trial compared two active arms (traditional counselling and integrated intervention for bereavement, 34 participants).The included studies investigated interventions dealing with the mental health problems of persons with an intellectual disability; none focused on physical health problems. Four studies assessed the effect of organisational interventions on behavioural problems for persons with an intellectual disability, three assessed care giver burden, and three assessed the costs associated with the interventions. None of the included studies reported data on the effect of organisational interventions on adverse events. Most studies were assessed as having low risk of bias.It is uncertain whether interventions that increase the frequency and intensity of delivery or outreach treatment decrease behavioural problems for persons with an intellectual disability (two and one trials respectively, very low certainty evidence). Behavioural problems were slightly decreased by community-based specialist behavioural therapy (one trial, low certainty evidence). Increasing the frequency and intensity of service delivery probably makes little or no difference to care giver burden (MD 0.03, 95% CI -3.48 to 3.54, two trials, moderate certainty evidence). It is uncertain whether outreach treatment makes any difference for care giver burden (one trial, very low certainty evidence). There was very limited evidence regarding costs, with low to very low certainty evidence for the different interventions. AUTHORS' CONCLUSIONS There is very limited evidence on the organisation of healthcare services for persons with an intellectual disability. There are currently no well-designed studies focusing on organising the health services of persons with an intellectual disability and concurrent physical problems. There are very few studies of organisational interventions targeting mental health needs and the results of those that were found need corroboration. There is an urgent need for high-quality health services research to identify optimal health services for persons with an intellectual disability and concurrent physical problem.
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Affiliation(s)
- Robert Balogh
- University of Ontario Institute of TechnologyFaculty of Health Sciences2000 Simcoe Street NorthOshawaONCanadaL1H 7K4
| | - Carly A McMorris
- Cumming School of Medicine, University of CalgaryDepartment of Pediatrics3820 24th AveCalgaryABCanadaT3B 2X9
| | - Yona Lunsky
- Centre for Addiction and Mental Health, University of TorontoDepartment of PsychiatryTorontoONCanada
| | | | | | - Angela Colantonio
- University of TorontoRehabilitation Sciences Institute500 University Avenue, Suite 160TorontoONCanadaM5G 1V7
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Bussière C, Sicsic J, Pelletier-Fleury N. Simultaneous effect of disabling conditions on primary health care use through a capability approach. Soc Sci Med 2016; 154:70-84. [DOI: 10.1016/j.socscimed.2016.02.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 02/05/2016] [Accepted: 02/14/2016] [Indexed: 01/16/2023]
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Chinn D. Review of Interventions to Enhance the Health Communication of People With Intellectual Disabilities: A Communicative Health Literacy Perspective. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2016; 30:345-359. [PMID: 26887631 DOI: 10.1111/jar.12246] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Communicative health literacy is a term relating to the range of competencies and capabilities patients bring to the task of seeking information about their health and sharing it with others. This exchange can be problematic for people with intellectual disabilities. The aim of this review was to synthesize findings from interventions designed to improve health communication for people with intellectual disabilities. MATERIALS AND METHOD Available evidence was systematically reviewed, and findings from 14 articles were synthesized in a narrative review. RESULTS AND CONCLUSIONS Interventions addressed communicative aspects of health consultations, taking into account emotional factors and social context. Questions remain about how such interventions might impact on real-life health consultations and how issues of power might be resolved.
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Affiliation(s)
- Deborah Chinn
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
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