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Bishop GM, Llewellyn G, Kavanagh AM, Badland H, Bailie J, Stancliffe R, Emerson E, Fortune N, Aitken Z. Disability-related inequalities in the prevalence of loneliness across the lifespan: trends from Australia, 2003 to 2020. BMC Public Health 2024; 24:621. [PMID: 38413942 PMCID: PMC10898179 DOI: 10.1186/s12889-024-17936-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 01/30/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Experiencing loneliness can be distressing and increasing evidence indicates that being lonely is associated with poor physical and mental health outcomes. Cross-sectional studies have demonstrated that people with disability have increased risk of experiencing loneliness compared to people without disability. However, we do not know if these inequalities have changed over time. This study investigated the prevalence of loneliness for people with disability in Australia annually from 2003 to 2020 to examine whether disability-related inequalities in loneliness have changed over time, and disaggregated results for subgroups of people with disability by age group, sex, and disability group. METHODS We used annual data (2003-2020) from the Household, Income and Labour Dynamics in Australia Survey. Loneliness was measured by a single question assessing the subjective experience of loneliness. For each wave, we calculated population-weighted age-standardised estimates of the proportion of people experiencing loneliness for people with and without disability. We then calculated the absolute and relative inequalities in loneliness between people with and without disability for each wave. Analyses were stratified by 10-year age groups, sex, and disability group (sensory or speech, physical, intellectual or learning, psychological, brain injury or stroke, other). RESULTS From 2003 to 2020, the prevalence of loneliness was greater for people with disability, such that people with disability were 1.5 to 1.9 times more likely to experience loneliness than people without disability. While the prevalence of loneliness decreased for people without disability between 2003 and 2020, the prevalence of loneliness did not decrease for people with disability during this period. Inequalities in loneliness were more substantial for people with intellectual or learning disabilities, psychological disability, and brain injury or stroke. CONCLUSION This study confirms that people with disability have increased risk of loneliness compared to people without disability. We add to the existing evidence by demonstrating that disability-related inequalities in loneliness have persisted for two decades in Australia without improvement. Our findings indicate that addressing inequalities in loneliness for people with disability is a critical public health concern given that loneliness is associated with a wide range of poor health outcomes.
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Affiliation(s)
- Glenda M Bishop
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, 3010, Australia.
| | - Gwynnyth Llewellyn
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, 3010, Australia
- Centre for Disability Research and Policy, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Anne M Kavanagh
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Hannah Badland
- Social and Global Studies Centre, RMIT University, Melbourne, VIC, 3000, Australia
| | - Jodie Bailie
- Centre for Disability Research and Policy, The University of Sydney, Camperdown, NSW, 2006, Australia
- University Centre for Rural Health, The University of Sydney, Lismore, NSW, 2480, Australia
| | - Roger Stancliffe
- Centre for Disability Research and Policy, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Eric Emerson
- Centre for Disability Research and Policy, The University of Sydney, Camperdown, NSW, 2006, Australia
- Centre for Disability Research, Faculty of Health & Medicine, Lancaster University, Lancaster, LA1 4YW, UK
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, 5042, Australia
| | - Nicola Fortune
- Centre for Disability Research and Policy, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Zoe Aitken
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, 3010, Australia
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Fortune N, Bailie J, Gordon J, Plunkett K, Hargrave J, Madden R, Llewellyn G. Developing self-report disability questions for a voluntary patient registration form for general practice in Australia. Aust N Z J Public Health 2023; 47:100032. [PMID: 37001218 DOI: 10.1016/j.anzjph.2023.100032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 10/25/2022] [Accepted: 11/03/2022] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVE This article reports on research undertaken to develop self-report disability questions for a patient registration form that may be implemented in general practices across Australia as part of a voluntary patient registration program. METHODS There were four research components: rapid review of approaches for capturing disability information; expert informant interviews (n=19); stakeholder consultation via virtual focus groups (n=65); and online survey (n=35). Findings from each component informed development of materials for subsequent components in an iterative research process. RESULTS Three disability questions were developed: two alternative questions for identifying disability, conceptually aligned with the operational definition of disability in Australia's national disability survey; one question to determine the patient's disability group/s. CONCLUSIONS Knowledge and perspectives from a variety of sources informed the development of self-report questions to identify patients with disability. Implementing these questions represents an opportunity to test new ways of capturing disability information suited to mainstream service provision contexts. It will be essential to evaluate the quality of the data produced during the initial period of implementation. IMPLICATIONS FOR PUBLIC HEALTH The collection of self-report patient disability information within general practice, using standard and conceptually-sound questions, has the potential to support improved provision of health care to patients with disability.
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Bailie J, Fortune N, Plunkett K, Gordon J, Llewellyn G. A call to action for more disability-inclusive health policy and systems research. BMJ Glob Health 2023; 8:bmjgh-2022-011561. [PMID: 36958749 PMCID: PMC10040021 DOI: 10.1136/bmjgh-2022-011561] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/27/2023] [Indexed: 03/25/2023] Open
Abstract
To date, the exclusion of people with disability participating in research has limited the evidence base informing health system strengthening policy and practice more generally, and addressing disability-related inequalities in access to health services and better health outcomes more particularly. Given that more than 1 billion people, or 16% of the world's population, have a disability, we may fail to respond to the needs of a large proportion of the population unless we are purposeful with inclusion. Our research in this area indicates that online qualitative methods can be effective in engaging under-represented groups and are essential to ensure their input into health policy and systems research. This has important implications for researchers whose responsibility it is to make all health research disability inclusive, for ethical and methodological reasons, so they do not perpetuate the under-representation of people with disability in health policy and systems research. Our paper puts forward several recommendations to facilitate more people with disability participating in health policy and systems research. By critically reflecting on a health system strengthening research project, in which we purposefully aimed to support the participation of people with disability, we identify lessons learnt and issues to consider when planning and conducting accessible research. We also propose a set of actions for moving the agenda forward.
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Affiliation(s)
- Jodie Bailie
- Centre for Disability Research and Policy, The University of Sydney, Sydney, New South Wales, Australia
- University Centre for Rural Health, The University of Sydney, Lismore, New South Wales, Australia
| | - Nicola Fortune
- Centre for Disability Research and Policy, The University of Sydney, Sydney, New South Wales, Australia
- Centre of Research Excellence in Disability and Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Karleen Plunkett
- Centre for Disability Research and Policy, The University of Sydney, Sydney, New South Wales, Australia
| | - Julie Gordon
- Centre for Disability Research and Policy, The University of Sydney, Sydney, New South Wales, Australia
| | - Gwynnyth Llewellyn
- Centre for Disability Research and Policy, The University of Sydney, Sydney, New South Wales, Australia
- Centre of Research Excellence in Disability and Health, The University of Melbourne, Melbourne, Victoria, Australia
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Shea B, Bailie J, Dykgraaf SH, Fortune N, Lennox N, Bailie R. Access to general practice for people with intellectual disability in Australia: a systematic scoping review. BMC Prim Care 2022; 23:306. [PMID: 36447186 PMCID: PMC9707181 DOI: 10.1186/s12875-022-01917-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 11/17/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND People with intellectual disability experience inadequate access to general practice and poorer health outcomes than the general population. While some access barriers have been identified for this population, these studies have often used narrow definitions of access, which may not encompass the multiple dimensions that influence access to general practice. To address this gap, we conducted a scoping review to identify factors impacting access to general practice for people with intellectual disability in Australia, using a holistic framework of access conceptualised by Levesque and colleagues. METHODS This scoping review followed Joanna Briggs Institute methodology and was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Medline (Ovid), Scopus, CINAHL, Informit and PsycINFO databases were searched. Screening, full-text review and data extraction were completed by two independent reviewers, with consensus reached at each stage of the study. Data were extracted, coded and synthesised through deductive qualitative analysis - using the five corresponding conceptual dimensions within Levesque and colleagues' theoretical framework of access, which incorporate both supply-side features of health systems and services, and demand-side characteristics of consumers and populations. RESULTS The search identified 1364 publications. After duplicate removal, title and abstract screening and full-text review, 44 publications were included. Supply-side factors were more commonly reported than demand-side factors, with the following issues frequently identified as impacting access to general practice: limited general practitioner education about, and/or experience of, people with intellectual disability; communication difficulties; and inadequate continuity of care. Less frequently included were factors such as the health literacy levels, promotion of general practice services and availability of complete medical records. CONCLUSIONS This is the first scoping review to assess access barriers for people with intellectual disability using a comprehensive conceptualisation of access. The findings highlight the need for increased efforts to address demand-side dimensions of access to general practice and offer a basis for a balanced portfolio of strategies that can support recent policy initiatives to enhance access to care for people with intellectual disability.
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Affiliation(s)
- Bradley Shea
- grid.1013.30000 0004 1936 834XSydney Medical School, The University of Sydney, Sydney, NSW Australia
| | - Jodie Bailie
- grid.1013.30000 0004 1936 834XUniversity Centre for Rural Health, The University of Sydney, Lismore, NSW Australia ,grid.1013.30000 0004 1936 834XCentre for Disability Research and Policy, The University of Sydney, Sydney, NSW Australia
| | - Sally Hall Dykgraaf
- grid.1001.00000 0001 2180 7477Rural Clinical School, Australian National University, Canberra, ACT Australia
| | - Nicola Fortune
- grid.1013.30000 0004 1936 834XCentre for Disability Research and Policy, The University of Sydney, Sydney, NSW Australia ,grid.1008.90000 0001 2179 088XCentre of Research Excellence in Disability and Health, University of Melbourne, Carlton, VIC Australia
| | - Nicholas Lennox
- grid.1003.20000 0000 9320 7537Queensland Centre for Intellectual and Developmental Disability, University of Queensland, Brisbane, QLD Australia
| | - Ross Bailie
- grid.1013.30000 0004 1936 834XSydney Medical School, The University of Sydney, Sydney, NSW Australia
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Fortune N, Bailie J, Llewellyn G. The need for improved Australian data on social determinants of health inequities. Med J Aust 2022; 217:325. [DOI: 10.5694/mja2.51698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/29/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Nicola Fortune
- Centre for Disability Research and Policy University of Sydney Sydney NSW
- Centre of Research Excellence in Disability and Health University of Melbourne Melbourne VIC
| | - Jodie Bailie
- Centre of Research Excellence in Disability and Health University of Melbourne Melbourne VIC
- University Centre for Rural Health University of Sydney Lismore NSW
- Centre for Disability Research and Policy University of Sydney Sydney NSW
| | - Gwynnyth Llewellyn
- Centre for Disability Research and Policy University of Sydney Sydney NSW
- Centre of Research Excellence in Disability and Health University of Melbourne Melbourne VIC
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Bailie J, Fortune N, Gordon J, Madden RC, Llewellyn G. Making everyone count: it is time to improve the visibility of people with disability in primary care. Med J Aust 2022; 217:173-175. [PMID: 35908261 PMCID: PMC9543419 DOI: 10.5694/mja2.51650] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/22/2022] [Accepted: 03/22/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Jodie Bailie
- University Centre for Rural Health University of Sydney Lismore NSW
- Centre for Disability Research and Policy University of Sydney Sydney NSW
| | - Nicola Fortune
- Centre for Disability Research and Policy University of Sydney Sydney NSW
- Centre of Research Excellence in Disability and Health University of Melbourne Melbourne VIC
| | - Julie Gordon
- WHO Collaborating Centre for Strengthening Rehabilitation Capacity in Health Systems University of Sydney Sydney NSW
| | - Richard C Madden
- Centre for Disability Research and Policy University of Sydney Sydney NSW
| | - Gwynnyth Llewellyn
- Centre for Disability Research and Policy University of Sydney Sydney NSW
- Centre of Research Excellence in Disability and Health University of Melbourne Melbourne VIC
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Fortune N, Curryer B, Badland H, Smith-Merry J, Devine A, Stancliffe RJ, Emerson E, Llewellyn G. Do Area-Level Environmental Factors Influence Employment for People with Disability? A Scoping Review. Int J Environ Res Public Health 2022; 19:ijerph19159082. [PMID: 35897452 PMCID: PMC9330484 DOI: 10.3390/ijerph19159082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/19/2022] [Accepted: 07/19/2022] [Indexed: 11/17/2022]
Abstract
Employment is an important social determinant of health and wellbeing. People with disability experience labour market disadvantage and have low labour force participation rates, high unemployment rates, and poor work conditions. Environmental factors are crucial as facilitators of or barriers to participation for people with disability. Understanding how the physical, social, and economic characteristics of local areas influence employment for people with disability can potentially inform interventions to reduce employment inequalities. We conducted a scoping review of research investigating associations between area-level environmental factors and employment for people with disability. Eighteen articles published between 2000 and 2020 met the inclusion criteria, and data were extracted to map the current evidence. Area-level factors were categorised into six domains relating to different aspects of environmental context: socioeconomic environment, services, physical environment, social environment, governance, and urbanicity. The urbanicity and socioeconomic environment domains were the most frequently represented (15 and 8 studies, respectively). The studies were heterogeneous in terms of methods and data sources, scale and type of geographic units used for analysis, disability study population, and examined employment outcomes. We conclude that the current evidence base is insufficient to inform the design of interventions. Priorities for future research are identified, which include further theorising the mechanisms by which area-level factors may influence employment outcomes, quantifying the contribution of specific factors, and interrogating specific factors underlying the association between urbanicity and employment outcomes for people with disability.
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Affiliation(s)
- Nicola Fortune
- Centre for Disability Research and Policy, The University of Sydney, Camperdown, NSW 2006, Australia; (B.C.); (J.S.-M.); (R.J.S.); (G.L.)
- NHMRC Centre of Research Excellence in Disability and Health, Parkville, VIC 3010, Australia; (H.B.); (A.D.); (E.E.)
- Correspondence:
| | - Bernadette Curryer
- Centre for Disability Research and Policy, The University of Sydney, Camperdown, NSW 2006, Australia; (B.C.); (J.S.-M.); (R.J.S.); (G.L.)
| | - Hannah Badland
- NHMRC Centre of Research Excellence in Disability and Health, Parkville, VIC 3010, Australia; (H.B.); (A.D.); (E.E.)
- Centre for Urban Research, RMIT University, Melbourne, VIC 3000, Australia
| | - Jennifer Smith-Merry
- Centre for Disability Research and Policy, The University of Sydney, Camperdown, NSW 2006, Australia; (B.C.); (J.S.-M.); (R.J.S.); (G.L.)
- NHMRC Centre of Research Excellence in Disability and Health, Parkville, VIC 3010, Australia; (H.B.); (A.D.); (E.E.)
| | - Alexandra Devine
- NHMRC Centre of Research Excellence in Disability and Health, Parkville, VIC 3010, Australia; (H.B.); (A.D.); (E.E.)
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Roger J. Stancliffe
- Centre for Disability Research and Policy, The University of Sydney, Camperdown, NSW 2006, Australia; (B.C.); (J.S.-M.); (R.J.S.); (G.L.)
- NHMRC Centre of Research Excellence in Disability and Health, Parkville, VIC 3010, Australia; (H.B.); (A.D.); (E.E.)
| | - Eric Emerson
- NHMRC Centre of Research Excellence in Disability and Health, Parkville, VIC 3010, Australia; (H.B.); (A.D.); (E.E.)
- Centre for Disability Research, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YW, UK
| | - Gwynnyth Llewellyn
- Centre for Disability Research and Policy, The University of Sydney, Camperdown, NSW 2006, Australia; (B.C.); (J.S.-M.); (R.J.S.); (G.L.)
- NHMRC Centre of Research Excellence in Disability and Health, Parkville, VIC 3010, Australia; (H.B.); (A.D.); (E.E.)
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Madden R, Fortune N, Gordon J. Health Statistics in Australia: What We Know and Do Not Know. Int J Environ Res Public Health 2022; 19:ijerph19094959. [PMID: 35564353 PMCID: PMC9099714 DOI: 10.3390/ijerph19094959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/21/2022] [Accepted: 02/02/2022] [Indexed: 01/18/2023]
Abstract
Australia is a federation of six states and two territories (the States). These eight governmental entities share responsibility for health and health services with the Australian Government. Mortality statistics, including causes of death, have been collected since the late 19th century, with national data produced by the (now) Australian Bureau of Statistics (ABS) from 1907. Each State introduced hospital in-patient statistics, assisted by State offices of the ABS. Beginning in the 1970s, the ABS conducts regular health surveys, including specific collections on Aboriginal and Torres Strait Islander peoples. Overall, Australia now has a comprehensive array of health statistics, published regularly without political or commercial interference. Privacy and confidentiality are guaranteed by legislation. Data linkage has grown and become widespread. However, there are gaps, as papers in this issue demonstrate. Most notably, data on primary care patients and encounters reveal stark gaps. This paper accompanies a range of papers from expert authors across the health statistics spectrum in Australia. It is hoped that the collection of papers will inform interested readers and stand as a comprehensive review of the strengths and weaknesses of Australian health statistics in the early 2020s.
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Affiliation(s)
- Richard Madden
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
- Correspondence:
| | - Nicola Fortune
- Centre for Disability Research and Policy, University of Sydney, Sydney, NSW 2006, Australia;
- Centre of Research Excellence in Disability and Health, University of Melbourne, Carlton, VIC 3053, Australia
| | - Julie Gordon
- WHO Collaborating Centre for Strengthening Rehabilitation Capacity in Health Systems, University of Sydney, Sydney, NSW 2006, Australia;
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Fortune N, Madden RH, Clifton S. Health and Access to Health Services for People with Disability in Australia: Data and Data Gaps. Int J Environ Res Public Health 2021; 18:11705. [PMID: 34770219 PMCID: PMC8583158 DOI: 10.3390/ijerph182111705] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/05/2021] [Accepted: 11/06/2021] [Indexed: 11/17/2022]
Abstract
The right of people with disability to enjoyment of the highest attainable standard of health without discrimination on the basis of disability is enshrined in the United Nations Convention on the Rights of Persons with Disabilities (CRPD). Among its obligations as a signatory to the CRPD, Australia is required to collect appropriate information, including statistical and research data, to inform development and implementation of policies to give effect to the Convention. In this commentary, we first describe how the International Classification of Functioning, Disability and Health (ICF) conceptual model of disability can be operationalised in statistical data collections, with a focus on how this is achieved in key Australian data sources such that people with disability can be identified as a population group. We then review existing statistical data on health and health service use for people with disability in Australia, highlighting data gaps and limitations. Finally, we outline priorities and considerations for improving data on health and access to health services for people with disability. As well as conceptual, practical, and ethical considerations, a key principle that must guide future disability data development is that people with disability and their representative organisations must be involved and participate fully in the development of disability data and statistics, and in their use.
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Affiliation(s)
- Nicola Fortune
- Centre for Disability Research and Policy, The University of Sydney, Susan Wakil Health Building, Western Ave., Camperdown, NSW 2050, Australia; (R.H.M.); (S.C.)
- Centre of Research Excellence in Disability and Health, University of Melbourne, 207 Bouverie Str., Carlton, VIC 3053, Australia
| | - Rosamond H. Madden
- Centre for Disability Research and Policy, The University of Sydney, Susan Wakil Health Building, Western Ave., Camperdown, NSW 2050, Australia; (R.H.M.); (S.C.)
| | - Shane Clifton
- Centre for Disability Research and Policy, The University of Sydney, Susan Wakil Health Building, Western Ave., Camperdown, NSW 2050, Australia; (R.H.M.); (S.C.)
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Kavanagh A, Fortune N, Disney G, Aitken Z, Badji S. 1074The role of epidemiology in improving the health of people with disability. Int J Epidemiol 2021. [DOI: 10.1093/ije/dyab168.337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Focus and outcomes for participants
The symposium will focus on the role of epidemiologists in building an evidence base to improve the health of the 15% of the world’s population with disability who currently experience vast health inequalities. Participants will be introduced to new ways of conceptualising disability in epidemiology; state of the art approaches to monitoring disability-related socio-economic and health inequalities; methodological challenges and solutions to address the biases due to misclassification, confounding and reverse causation; and the application of causal mediation analysis and natural experiments in identifying potential policy solutions. Participants will gain a greater understanding of how epidemiological methods can be applied to improve the health of people with disability, as well as insights and ideas for their research. A network of epidemiologists interested in this topic will be generated to foster ongoing communication and collaborative opportunities.
Rationale for the symposium, including for its inclusion in the Congress
The health of disabled people has largely been ignored by epidemiologists. This is despite emerging evidence that people with disability experience poorer health because of factors unrelated to their impairment, including socio-economic disadvantage, discrimination, and violence. However, turning epidemiologists’ efforts to the health of people with disability presents conceptual and methodological challenges, some of which are unique to the content area. Participants will be shown a suite of approaches that can be deployed to address these problems. Participatory methods and innovative graphical and statistical methods for analysing disability-related health inequalities, approaches rarely used in epidemiology, will be covered. The symposium will also concentrate on the application of methods to optimise causal inference in the presence of multiple potential biases, and methods that simulate randomised controlled trial conditions to model policy interventions.
Presentation program
The presentations are from researchers from the CRE-DH, funded through Australia’s National Health and Medical Research Council organised four themes.
Theme 1: Conceptualisation of disability
We will present findings from a scoping review of original articles in epidemiology journals and will argue that, while, disability is usually conceptualised in epidemiology as an outcome, reconceiving of disability as an exposure, mediator and/or effect modifier can provide important insights on the determinants of health of people with disability.
Theme 2: Monitoring disability-related inequalities
We will demonstrate how the CRE-DH has used participatory methods, where people with disability are ‘experts through lived experience’, to develop indicators to monitor disability-related inequalities and design a National Community Attitudes survey. We will demonstrate innovative ways to graphically illustrate prevalence, absolute and relative inequalities simultaneously, and discuss how hierarchical Bayesian methods can be used to overcome inadequate power due to disaggregation and assess inequalities under uncertainty.
Theme 3: Approaches to minimising bias
We will talk about how biases can affect estimates of disability prevalence and disability-outcome associations, including reverse causation, confounding and misclassification. We will discuss a range of approaches we have used to address these challenges including modelling incident (rather than prevalent) disability, using fixed effects models and propensity score approaches, and approaches to addressing misclassification bias drawing on examples from our program of research.
Theme 4: Identification of policy interventions
We will discuss methods that can be used to model the impact of policies on the health of people with disability using examples from our research. We will present the results of a causal mediation analysis modelling the impact of different employment policy interventions on mental health outcomes. We will illustrate the value of natural policy experiments for estimating effects of policy changes on employment and health of people with disability using two examples – the 2014 reassessment of Disability Support Pensioners under stricter impairment tables and the introduction of Australia’s National Disability Insurance Scheme.
The symposium will conclude with a facilitated discussion focussed on how epidemiologists can come together internationally to grasp the opportunities and address the challenges in research focussed on the health of people with disabilities.
Names of presenters
Professor Anne Kavanagh, PhD
Dr Nicola Fortune, PhD
Dr George Disney, PhD
Dr Zoe Aitken
Dr Samia Badji, PhD
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Affiliation(s)
| | | | | | - Zoe Aitken
- University of Melbourne, Melbourne, Australia
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Fortune N, Badland H, Clifton S, Emerson EE, Stancliffe ER, Llewellyn G. 263Disability and inequality on the social determinants of health: data, data gaps, and policy implications. Int J Epidemiol 2021. [DOI: 10.1093/ije/dyab168.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Focus of Presentation
People with disability experience inequality in relation to social determinants of health such as employment, education and housing. Under the UN Convention on the Rights of Persons with Disabilities, Australia must collect data to assess fulfilment of its Convention obligations and to identify and address barriers faced by people with disability in exercising their rights. The objective of our research was to determine the extent to which such data are currently available.
Findings
With input from people with disability, we developed a monitoring framework and indicators to measure inequalities between Australians with and without disability in relation to social determinants of health. National data sources that included a disability identifier were available to report on 73% of the 128 indicators. For example, in the domain ‘Employment’, national data were available for indicators of labour force status, long-term unemployment, leave entitlements, and employment in high-skill jobs. Data were not available for the following indicators: under-employment, access to job design modifications, and disability-related discrimination in the workplace.
Conclusions/Implications
It is currently not possible to quantify inequalities between Australians with and without disability, track change over time, or identify factors that can inform effective policy responses for indicators where we lack national data that include a disability identifier.
Key messages
Addressing data gaps, including by facilitating disability identification in existing data collections, is essential for tackling disability-related inequalities on social determinants of health and meeting our obligations under the UN Convention on the Rights of Persons with Disabilities.
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Affiliation(s)
- Nicola Fortune
- Centre for Disability Research and Policy, The University of Sydney, Camperdown, Australia
| | - Hannah Badland
- Centre for Urban Research, RMIT University, Melbourne, Australia
| | - Shane Clifton
- Centre for Disability Research and Policy, The University of Sydney, Camperdown, Australia
| | - Emeritus Eric Emerson
- Centre for Disability Research, Faculty of Health & Medicine, Lancaster University, Lancaster, United Kingdom
| | | | - Gwynnyth Llewellyn
- Centre for Disability Research and Policy, The University of Sydney, Camperdown, Australia
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Abstract
BACKGROUND Research has suggested that exposure to loneliness can have a powerful detrimental impact on health, including mental health. Addressing socially determined health inequity requires understanding of the situation of marginalized or vulnerable groups. People with disability are increasingly being recognized as one such group. Little population-based research has addressed the association between loneliness and health among working age adults with and without disability. METHODS Secondary analysis of data collected in waves 8 and 9 of Understanding Society, the UK's main annual household panel study. RESULTS Rates of exposure to substantial loneliness were 25.4% (95%CI 23.5-27.3%) among adults with persistent disability (disability at W8 and W9), 15.4% (13.3-17.5%) among adults with disability onset (disability at W9 only), 12.3% (10.1-14.5%) among adults with disability offset (disability at W8 only), and 6.9% (6.5-7.3%) among adults with no disability. Exposure to loneliness was positively associated with the incidence (GHQ-12) and prevalence (SF-12 Mental) of mental health problems, but not the prevalence of physical health problems (SF-12 Physical). Disability status appeared to moderate the association between loneliness and health, with the difference between the persistent disability and no disability group increasing with exposure to greater levels of loneliness. CONCLUSION Loneliness may be an important determinant of the poorer mental health of working age adults with disability in the UK. Exposure rates are significantly higher than among the non-disabled population. The strength of association between exposure to loneliness and poorer mental health is greater for people with persistent disability than people with no disability.
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Affiliation(s)
- Eric Emerson
- Centre for Disability Research and Policy, Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia.,Centre of Research Excellence in Disability and Health, University of Sydney, Sydney, NSW, Australia.,Centre for Disability Research, Faculty of Health & Medicine, Lancaster University, Lancaster, UK
| | - Roger Stancliffe
- Centre for Disability Research and Policy, Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia.,Centre of Research Excellence in Disability and Health, University of Sydney, Sydney, NSW, Australia
| | - Nicola Fortune
- Centre of Research Excellence in Disability and Health, University of Sydney, Sydney, NSW, Australia
| | - Gwynnyth Llewellyn
- Centre for Disability Research and Policy, Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia.,Centre of Research Excellence in Disability and Health, University of Sydney, Sydney, NSW, Australia
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Fortune N, Madden R, Riley T, Short S. The International Classification of Health Interventions: an 'epistemic hub' for use in public health. Health Promot Int 2021; 36:1753-1764. [PMID: 33585880 DOI: 10.1093/heapro/daab011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The current lack of a common basis for collecting data on population-level prevention and health promotion interventions causes public health to be relatively invisible within broader health systems, making it vulnerable to funding cuts when there is pressure to reduce spending. Further, the inconsistent use of terms for describing interventions hinders knowledge translation and building an evidence base for public health practice and policy. The International Classification of Health Interventions (ICHI), being developed by the World Health Organization, is a standard statistical classification for interventions across the full scope of health systems. ICHI has potential to meet the need for a common language and structure for describing and capturing information about prevention and health promotion interventions. We report on a developmental appraisal conducted to examine the strengths and limitations of ICHI for coding interventions delivered for public health purposes. Our findings highlight classification challenges in relation to: consistently identifying separate components within multi-component interventions; operationalizing the ICHI concept of intervention target when there are intermediary targets as well as an ultimate target; coding an intervention component that involves more than one ICHI target or action; and standardising what is being counted. We propose that, alongside its purpose as a statistical classification, ICHI can play a valuable role as an 'epistemic hub', to be used flexibly by public health actors to meet a range of information needs, and as a basis for improved communication and exchange.
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Affiliation(s)
- Nicola Fortune
- Faculty of Medicine and Health, The University of Sydney, NSW, 2006, Australia
| | - Richard Madden
- Faculty of Medicine and Health, The University of Sydney, NSW, 2006, Australia
| | - Therese Riley
- Therese Riley Consulting, Sandringham, VIC, 3191, Australia
| | - Stephanie Short
- Faculty of Medicine and Health, The University of Sydney, NSW, 2006, Australia
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Fortune N, Short S, Madden R. Building a statistical classification: A new tool for classification development and testing. ACTA ACUST UNITED AC 2020. [DOI: 10.3233/sji-200633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Statistical classifications are essential for collecting consistent data that can be compared over space and time. However, a publicly-documented body of practice concerning how to undertake the development and testing of a statistical classification is currently lacking. What aspects of the classification should be tested during the development process? How do we judge whether the classification is fit-for-purpose? How should problems and shortcomings be identified so that they can be remedied? To fill this gap, we drew on existing, authoritative sources to develop an analytic structure for use in the development and testing of statistical classifications. It consists of two components: (1) a statistical classification development and testing framework reflecting the required features of a statistical classification; and (2) a 4-tier model representing the main elements that make up a statistical classification, to use as a heuristic structure within which to locate issues identified and consider how they can be addressed. In this paper, we outline the development of the framework and model, and reflect on their application in testing a draft classification of health interventions. We propose this analytic structure as a new tool to support those engaged in the development of statistical classifications.
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15
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Fortune N, Singh A, Badland H, Stancliffe RJ, Llewellyn G. Area-Level Associations between Built Environment Characteristics and Disability Prevalence in Australia: An Ecological Analysis. Int J Environ Res Public Health 2020; 17:E7844. [PMID: 33114716 PMCID: PMC7662552 DOI: 10.3390/ijerph17217844] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/15/2020] [Accepted: 10/21/2020] [Indexed: 12/05/2022]
Abstract
The importance of health-promoting neighborhoods has long been recognized, and characteristics of local built environments are among the social determinants of health. People with disability are more likely than other population groups to experience geographic mobility and cost restrictions, and to be reliant on 'opportunity structures' available locally. We conducted an ecological analysis to explore associations between area-level disability prevalence for people aged 15-64 years and area-level built environment characteristics in Australia's 21 largest cities. Overall, disability was more prevalent in areas with lower walkability and lower local availability of various neighborhood amenities such as public transport, healthier food options, public open space, physical activity and recreation destinations and health and mental health services. These patterns of lower liveability in areas of higher disability prevalence were observed in major cities but not in regional cities. Our findings suggest that geographically targeted interventions to improve access to health-enhancing neighborhood infrastructure could reduce disability-related inequalities in the social determinants of health.
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Affiliation(s)
- Nicola Fortune
- Centre of Research Excellence in Disability and Health, University of Melbourne, Parkville, VIC 3010, Australia; (A.S.); (H.B.); (R.J.S.); (G.L.)
- Centre for Disability Research and Policy, University of Sydney, Lidcombe, NSW 2141, Australia
| | - Ankur Singh
- Centre of Research Excellence in Disability and Health, University of Melbourne, Parkville, VIC 3010, Australia; (A.S.); (H.B.); (R.J.S.); (G.L.)
- Centre for Health Equity & Centre for Epidemiology & Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC 3053, Australia
| | - Hannah Badland
- Centre of Research Excellence in Disability and Health, University of Melbourne, Parkville, VIC 3010, Australia; (A.S.); (H.B.); (R.J.S.); (G.L.)
- Centre for Urban Research, RMIT University, Melbourne, VIC 3000, Australia
| | - Roger J. Stancliffe
- Centre of Research Excellence in Disability and Health, University of Melbourne, Parkville, VIC 3010, Australia; (A.S.); (H.B.); (R.J.S.); (G.L.)
- Centre for Disability Research and Policy, University of Sydney, Lidcombe, NSW 2141, Australia
| | - Gwynnyth Llewellyn
- Centre of Research Excellence in Disability and Health, University of Melbourne, Parkville, VIC 3010, Australia; (A.S.); (H.B.); (R.J.S.); (G.L.)
- Centre for Disability Research and Policy, University of Sydney, Lidcombe, NSW 2141, Australia
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16
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Emerson E, Fortune N, Llewellyn G, Stancliffe R. Loneliness, social support, social isolation and wellbeing among working age adults with and without disability: Cross-sectional study. Disabil Health J 2020; 14:100965. [PMID: 32843311 PMCID: PMC7403030 DOI: 10.1016/j.dhjo.2020.100965] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/02/2020] [Accepted: 06/14/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Loneliness is significantly related to health and wellbeing. However, there is little information on the prevalence of loneliness among people with disability or the association between disability, loneliness and wellbeing. OBJECTIVE/HYPOTHESIS For a nationally representative sample of adults (age 16-64) with/without disability, to examine exposure to three indicators of low social connectedness (loneliness, low perceived social support, social isolation), and to evaluate the association between low social connectedness and wellbeing. To test whether disability status moderated the relationship between low social connectedness and wellbeing. METHODS Secondary analysis of data from three annual rounds of the cross-sectional English Community Life Survey (CLS) 2016-19. RESULTS People with disability experienced loneliness, low perceived social support and social isolation at significantly higher rates than people without disability. Effect sizes were significantly greater for loneliness. Disability was associated with lower wellbeing. With one exception, low social connectedness was associated with lower wellbeing. Again, effect sizes were significantly greater for loneliness. The prevalence of loneliness was highest among adults with disability who were younger, economically inactive, living in rented or other accommodation, living alone and with low levels of access to environmental assets. There was no evidence that disability status moderated the association between exposure to low social connectedness and low wellbeing. CONCLUSIONS Loneliness was a particularly significant driver of poor wellbeing among people with disability. The relative independence between different indicators of social connectedness suggests that interventions to reduce loneliness will need to do more than simply increase rates of social contact or social support.
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Affiliation(s)
- Eric Emerson
- Centre for Disability Research and Policy, Faculty of Health Sciences, University of Sydney, Sydney, NSW, 2141, Australia; Centre of Research Excellence in Disability and Health, University of Sydney, Sydney, NSW, 2141, Australia; Centre for Disability Research, Faculty of Health & Medicine, Lancaster University, Lancaster, LA1 4YW, UK.
| | - Nicola Fortune
- Centre of Research Excellence in Disability and Health, University of Sydney, Sydney, NSW, 2141, Australia
| | - Gwynnyth Llewellyn
- Centre for Disability Research and Policy, Faculty of Health Sciences, University of Sydney, Sydney, NSW, 2141, Australia; Centre of Research Excellence in Disability and Health, University of Sydney, Sydney, NSW, 2141, Australia
| | - Roger Stancliffe
- Centre for Disability Research and Policy, Faculty of Health Sciences, University of Sydney, Sydney, NSW, 2141, Australia; Centre of Research Excellence in Disability and Health, University of Sydney, Sydney, NSW, 2141, Australia
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17
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Ohannessian R, Fortune N, Moulin T, Madden R. Telemedicine, Telestroke, and Artificial Intelligence Can Be Coded with the International Classification of Health Interventions. Telemed J E Health 2020; 26:574-575. [DOI: 10.1089/tmj.2019.0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Robin Ohannessian
- Télémédecine 360, Paris, France
- French Society of Télémédecine, Paris, France
- Department of Neurology, CHU Besançon, Bescanon, France
- Laboratory of Neuroscience, University of France Comté, Besançon, France
| | - Nicola Fortune
- National Center for Classification in Health, University of Sydney, Sydney, Australia
| | - Thierry Moulin
- Télémédecine 360, Paris, France
- French Society of Télémédecine, Paris, France
- Department of Neurology, CHU Besançon, Bescanon, France
- Laboratory of Neuroscience, University of France Comté, Besançon, France
| | - Richard Madden
- National Center for Classification in Health, University of Sydney, Sydney, Australia
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18
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Fortune N, Badland H, Clifton S, Emerson E, Rachele J, Stancliffe RJ, Zhou Q, Llewellyn G. The Disability and Wellbeing Monitoring Framework: data, data gaps, and policy implications. Aust N Z J Public Health 2020; 44:227-232. [PMID: 32311191 DOI: 10.1111/1753-6405.12983] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/01/2020] [Accepted: 02/01/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To develop a framework and indicators to monitor inequalities in health and the social determinants of health for Australians with disability. METHODS The development drew on existing frameworks and input from people with lived experience of disability. RESULTS The Disability and Wellbeing Monitoring Framework has 19 domains. Australian national data are available for 73% of the 128 indicators in these domains. Data gaps and limitations include the absence of national data and the absence of disability identifiers in some data sources. CONCLUSIONS The framework will be used to report baseline data for people with and without disability and to monitor inequalities over time in Australia. It will also be used to locate policy priorities and focus efforts to address data gaps. Implications for public health: Inequality between people with and without disability in relation to health and the social determinants of health is a public health issue that warrants greater attention than it has received to date. The framework provides a robust, evidence-informed tool to address the health inequalities of people with disability, inform the development of effective policy and practice responses, and monitor change over time.
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Affiliation(s)
- Nicola Fortune
- Centre for Disability Research and Policy, University of Sydney, New South Wales
| | | | - Shane Clifton
- Centre for Disability Research and Policy, University of Sydney, New South Wales
| | - Eric Emerson
- Centre for Disability Research, Faculty of Health & Medicine, Lancaster University, UK
| | - Jerome Rachele
- Melbourne School of Population and Global Health, University of Melbourne, Victoria
| | - Roger J Stancliffe
- Centre for Disability Research and Policy, University of Sydney, New South Wales
| | - Qingsheng Zhou
- Centre for Disability Research and Policy, University of Sydney, New South Wales
| | - Gwynnyth Llewellyn
- Centre for Disability Research and Policy, University of Sydney, New South Wales
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19
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Manchaiah V, Swanepoel DW, Fortune N. The International Classification of Health Interventions (ICHI) - a new tool for describing and reporting interventions in audiology. Int J Audiol 2020; 59:403-405. [PMID: 32151174 DOI: 10.1080/14992027.2020.1736344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Vinaya Manchaiah
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA.,Department of Speech and Hearing, School of Allied Health Sciences, Manipal University, Manipal, India
| | - De Wet Swanepoel
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Gauteng, South Africa.,Ear Science Institute Australia, Subiaco, Australia.,Ear Sciences Centre, School of Surgery, The University of Western Australia, Nedlands, Australia
| | - Nicola Fortune
- Centre for Disability Research and Policy, University of Sydney, Lidcombe, Australia
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20
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Emerson E, Fortune N, Aitken Z, Hatton C, Stancliffe R, Llewellyn G. The wellbeing of working-age adults with and without disability in the UK: Associations with age, gender, ethnicity, partnership status, educational attainment and employment status. Disabil Health J 2020; 13:100889. [PMID: 32046927 DOI: 10.1016/j.dhjo.2020.100889] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/21/2019] [Accepted: 01/24/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Few population-based studies have examined the association between disability and personal wellbeing (PWB) among working-age adults. OBJECTIVE/HYPOTHESIS To determine: (1) the magnitude of differences in wellbeing between working-age adults with and without disability in contemporary samples representative of the UK population; and (2) whether the size of any observed differences between people with and without disability is moderated by age, gender, ethnicity, partnership status, educational attainment or employment status. METHODS Secondary analysis of data from three national cross-sectional surveys. RESULTS In each survey, people with disability scored lower than people without disability on all four indicators of PWB. Adjusting for the main effects of potentially moderating variables reduced the effect size of disability on PWB by an average of 24%. Subsequently adjusting for the two-way interaction terms between disability and potentially moderating variables reduced the effect size of disability (main effect) on PWB by an additional average of 73%. PWB among people with disability was significantly lower for: (1) men; (2) younger people; (3) those who belong to the majority ethnic group (white British); (4) those without a partner; and (5) people with lower socio-economic position. CONCLUSIONS Our findings indicate that demographic characteristics and exposure to specific social determinants of poor health play a major role in the negative association between disability and personal wellbeing. A more sophisticated understanding of how social determinants interact to produce inequities associated with identities such as disability, gender, race, sexuality, and class (intersectionality) can inform effective policy interventions.
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Affiliation(s)
- Eric Emerson
- Centre for Disability Research and Policy, Faculty of Health Sciences, University of Sydney, Sydney, NSW, 2141, Australia; Centre of Research Excellence in Disability and Health, University of Sydney, Sydney, NSW, 2141, Australia; Centre for Disability Research, Faculty of Health & Medicine, Lancaster University, Lancaster, LA1 4YW, UK.
| | - Nicola Fortune
- Centre of Research Excellence in Disability and Health, University of Sydney, Sydney, NSW, 2141, Australia
| | - Zoe Aitken
- Melbourne School Population and Global Health, The University of Melbourne, Victoria, 3010, Australia; Centre of Research Excellence in Disability and Health, University of Melbourne, Victoria, 3010, Australia
| | - Chris Hatton
- Centre of Research Excellence in Disability and Health, University of Sydney, Sydney, NSW, 2141, Australia
| | - Roger Stancliffe
- Centre for Disability Research and Policy, Faculty of Health Sciences, University of Sydney, Sydney, NSW, 2141, Australia; Centre of Research Excellence in Disability and Health, University of Sydney, Sydney, NSW, 2141, Australia
| | - Gwynnyth Llewellyn
- Centre for Disability Research and Policy, Faculty of Health Sciences, University of Sydney, Sydney, NSW, 2141, Australia; Centre of Research Excellence in Disability and Health, University of Sydney, Sydney, NSW, 2141, Australia
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21
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Fortune N, Rooney B, Kirwan GH. Supporting Law Enforcement Personnel Working with Distressing Material Online. Cyberpsychology, Behavior, and Social Networking 2018; 21:138-143. [DOI: 10.1089/cyber.2016.0715] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Nicola Fortune
- Career Development Centre, University College Dublin, Dublin, Republic of Ireland
| | - Brendan Rooney
- School of Psychology, University College Dublin, Dublin, Republic of Ireland
| | - Gráinne H. Kirwan
- Department of Technology and Psychology, Dun Laoghaire Institute of Art, Design, and Technology, Dublin, Republic of Ireland
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22
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Fortune N, Madden R, Almborg AH. Use of a New International Classification of Health Interventions for Capturing Information on Health Interventions Relevant to People with Disabilities. Int J Environ Res Public Health 2018; 15:ijerph15010145. [PMID: 29342077 PMCID: PMC5800244 DOI: 10.3390/ijerph15010145] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/12/2018] [Accepted: 01/13/2018] [Indexed: 12/03/2022]
Abstract
Development of the World Health Organization’s International Classification of Health Interventions (ICHI) is currently underway. Once finalised, ICHI will provide a standard basis for collecting, aggregating, analysing, and comparing data on health interventions across all sectors of the health system. In this paper, we introduce the classification, describing its underlying tri-axial structure, organisation and content. We then discuss the potential value of ICHI for capturing information on met and unmet need for health interventions relevant to people with a disability, with a particular focus on interventions to support functioning and health promotion interventions. Early experiences of use of the Swedish National Classification of Social Care Interventions and Activities, which is based closely on ICHI, illustrate the value of a standard classification to support practice and collect statistical data. Testing of the ICHI beta version in a wide range of countries and contexts is now needed so that improvements can be made before it is finalised. Input from those with an interest in the health of people with disabilities and health promotion more broadly is welcomed.
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Affiliation(s)
- Nicola Fortune
- National Centre for Classification in Health, University of Sydney, Camperdown, NSW 2006, Australia.
| | - Richard Madden
- National Centre for Classification in Health, University of Sydney, Camperdown, NSW 2006, Australia.
| | - Ann-Helene Almborg
- National Board of Health and Welfare, SE-10630 Stockholm, Sweden.
- Nordic WHO Family of International Classifications Collaborating Centre, Directorate for E-Health, NO-0130 Oslo, Norway.
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23
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Ohannessian R, Fortune N, Rodrigues JM, Moulin T, Derex L, Madden R, Schott AM. Coding acute stroke care and telestroke with the International Classification of Health Interventions (ICHI). Int J Med Inform 2017; 108:9-12. [PMID: 29132637 DOI: 10.1016/j.ijmedinf.2017.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/16/2017] [Accepted: 09/23/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND and purpose: Acute stroke care is to detect, diagnose, and treat patients in the shortest amount of time. Access to acute stroke care may however be limited in some areas and telemedicine has been thus used to increase its access. Coding acute stroke care as a health intervention had limited attention in the past. METHODS The International Classification of Health Interventions (ICHI) currently under development was used to identify existing codes relevant for coding acute stroke care interventions, including telestroke. A review of the ICHI was conducted to identify codes relevant for acute stroke care by two independent reviewers. RESULTS A matching ICHI code was found for each of the steps in the acute stroke care process but no ICHI codes were available to specifically capture telestroke. CONCLUSION As telemedicine intervention is likely to become more common in the future, it will be imperative that the ICHI is able to code such interventions.
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Affiliation(s)
- Robin Ohannessian
- Univ. Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425, F-69008 Lyon, France; Télémédecine 360, TLM360, France.
| | - Nicola Fortune
- National Center for Classification in Health, University of Sydney, Sydney, Australia
| | - Jean-Marie Rodrigues
- Department of Public Health and Medical Informatics, CHU Université Jean-Monnet, Saint Etienne, France
| | - Thierry Moulin
- Department of Neurology, University Hospital of Besançon, Besançon, France
| | - Laurent Derex
- Univ. Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425, F-69008 Lyon, France; Hospices Civils de Lyon, Hôpital Pierre Wertheimer, Unité neurovasculaire, F-69677 Bron cedex, France
| | - Richard Madden
- National Center for Classification in Health, University of Sydney, Sydney, Australia
| | - Anne-Marie Schott
- Univ. Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425, F-69008 Lyon, France; Hospices Civils de Lyon, Pôle IMER, Lyon, F-69003, France
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24
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Fortune N, Hardiker NR, Strudwick G. Embedding Nursing Interventions into the World Health Organization's International Classification of Health Interventions (ICHI). J Am Med Inform Assoc 2017; 24:722-728. [PMID: 28339684 PMCID: PMC7651898 DOI: 10.1093/jamia/ocw173] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/11/2016] [Accepted: 11/21/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The International Classification of Health Interventions, currently being developed, seeks to span all sectors of the health system. Our objective was to test the draft classification's coverage of interventions commonly delivered by nurses, and propose changes to improve the utility and reliability of the classification for aggregating and analyzing data on nursing interventions. MATERIALS AND METHODS A 2-phase content mapping method was used: (1) three coders independently applied the classification to a dataset comprising 100 high-frequency nursing interventions; (2) the coders reached consensus for each intervention and identified reasons for initial discrepancies. RESULTS A consensus code was found for 80 of the 100 source terms; for 34% of these, the code was semantically equivalent to the source term, and for 64% it was broader. Issues that contributed to discrepancies in Phase 1 coding results included concepts in source terms not captured by the classification, ambiguities in source terms, and uncertainty of semantic matching between "action" concepts in source terms and classification codes. DISCUSSION While the classification generally provides good coverage of nursing interventions, there remain a number of content gaps and granularity issues. Further development of definitions and coding guidance is needed to ensure consistency of application. CONCLUSION This study has produced a set of proposals concerning changes needed to improve the classification. The novel method described here will inform future health terminology and classification content coverage studies.
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Affiliation(s)
- Nicola Fortune
- National Centre for Classification in Health, Faculty of Health Sciences, University of Sydney, Lidcombe, Australia
| | - Nicholas R Hardiker
- School of Nursing, Midwifery, Social Work and Social Sciences, University of Salford, Salford, UK
| | - Gillian Strudwick
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
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25
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Madden RH, Glozier N, Fortune N, Dyson M, Gilroy J, Bundy A, Llewellyn G, Salvador-Carulla L, Lukersmith S, Mpofu E, Madden R. In search of an integrative measure of functioning. Int J Environ Res Public Health 2015; 12:5815-32. [PMID: 26016438 PMCID: PMC4483673 DOI: 10.3390/ijerph120605815] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 04/26/2015] [Accepted: 05/15/2015] [Indexed: 11/16/2022]
Abstract
International trends towards people-centred, integrative care and support require any measurement of functioning and disability to meet multiple aims. The information requirements of two major Australian programs for disability and rehabilitation are outlined, and the findings of two searches for suitable measures of functioning and disability are analysed. Over 30 current measures of functioning were evaluated in each search. Neither search found a generic measure of functioning suitable for these multibillion dollar programs, relevant to a wide range of people with a variety of health conditions and functioning experiences, and capable of indicating support needs, associated costs, progress and outcomes. This unsuccessful outcome has implications internationally for policy-relevant information for disability, rehabilitation and related programs. The paper outlines the features of an Integrative Measure of Functioning (IMF) based on the concepts of functioning and environmental factors in the International Classification of Functioning, Disability and Health (ICF). An IMF would be applicable across a variety of health conditions, settings and purposes, ranging from individual assessment to public health. An IMF could deliver person-centred, policy-relevant information for a range of programs, promoting harmonised language and measurement and supporting international trends in human services and public health.
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Affiliation(s)
- Rosamond H. Madden
- Centre for Disability Research and Policy, University of Sydney, P.O. Box 170, NSW 1826, Australia; E-Mails: (N.F.); (J.G.); (G.L.); (L.S.-C.); (R.M.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +61-293-519-115; Fax: +61-293-519-128
| | - Nick Glozier
- Brain & Mind Research Institute, Sydney Medical School, University of Sydney, 94 Mallett St., Camperdown, NSW 2050, Australia; E-Mail:
| | - Nicola Fortune
- Centre for Disability Research and Policy, University of Sydney, P.O. Box 170, NSW 1826, Australia; E-Mails: (N.F.); (J.G.); (G.L.); (L.S.-C.); (R.M.)
- National Centre for Classification in Health, University of Sydney, P.O. Box 170, NSW 1826, Australia
| | - Maree Dyson
- Dyson Consulting Group, 450 Chapel Street, South Yarra, VIC 3141, Australia; E-Mail:
| | - John Gilroy
- Centre for Disability Research and Policy, University of Sydney, P.O. Box 170, NSW 1826, Australia; E-Mails: (N.F.); (J.G.); (G.L.); (L.S.-C.); (R.M.)
| | - Anita Bundy
- Faculty of Health Sciences, University of Sydney, East Street, Lidcombe 2141, Australia; E-Mails: (A.B.); (E.M.)
| | - Gwynnyth Llewellyn
- Centre for Disability Research and Policy, University of Sydney, P.O. Box 170, NSW 1826, Australia; E-Mails: (N.F.); (J.G.); (G.L.); (L.S.-C.); (R.M.)
| | - Luis Salvador-Carulla
- Centre for Disability Research and Policy, University of Sydney, P.O. Box 170, NSW 1826, Australia; E-Mails: (N.F.); (J.G.); (G.L.); (L.S.-C.); (R.M.)
- Brain & Mind Research Institute, Sydney Medical School, University of Sydney, 94 Mallett St., Camperdown, NSW 2050, Australia; E-Mail:
| | - Sue Lukersmith
- Centre for Disability Research and Policy, University of Sydney, P.O. Box 170, NSW 1826, Australia; E-Mails: (N.F.); (J.G.); (G.L.); (L.S.-C.); (R.M.)
| | - Elias Mpofu
- Faculty of Health Sciences, University of Sydney, East Street, Lidcombe 2141, Australia; E-Mails: (A.B.); (E.M.)
| | - Richard Madden
- Centre for Disability Research and Policy, University of Sydney, P.O. Box 170, NSW 1826, Australia; E-Mails: (N.F.); (J.G.); (G.L.); (L.S.-C.); (R.M.)
- National Centre for Classification in Health, University of Sydney, P.O. Box 170, NSW 1826, Australia
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Madden R, Fortune N, Cheeseman D, Mpofu E, Bundy A. Fundamental questions before recording or measuring functioning and disability. Disabil Rehabil 2012; 35:1092-6. [DOI: 10.3109/09638288.2012.720350] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Smart G, Whatmore M, Crawley M, White J, Fortune N. Cardiac arrest scripts: Measuring the retention of the skills required to manage out-of-hospital cardiac arrest following a new training intervention. Resuscitation 2010. [DOI: 10.1016/j.resuscitation.2010.09.381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Fortune N. A framework for human functioning--the ICF in Australia. J AHIMA 2004; 75:66-8; quiz 71-2. [PMID: 15287337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- Nicola Fortune
- Functioning and Disability Unit, Australian Institute of Health and Welfare.
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Fortune N. A framework for human functioning-the ICF in Australia. HEALTH INF MANAG J 2004; 33:134-136. [PMID: 18257164 DOI: 10.1177/183335830403300406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Nicola Fortune
- Australian Institute of Health and Welfare, Canberra ACT.
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Thomas TR, Fortune N. An on line computer system for measuring sectional geometry. J Phys E 1975; 8:28-30. [PMID: 1110455 DOI: 10.1088/0022-3735/8/1/012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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