Digital adaptation of the Standing up for Myself intervention in young people and adults with intellectual disabilities: the STORM feasibility study

Background

Stigma contributes to the negative social conditions persons with intellectual disabilities are exposed to, and it needs tackling at multiple levels. Standing Up for Myself is a psychosocial group intervention designed to enable individuals with intellectual disabilities to discuss stigmatising encounters in a safe and supportive setting and to increase their self-efficacy in managing and resisting stigma.

Objectives

To adapt Standing Up for Myself to make it suitable as a digital intervention; to evaluate the feasibility and acceptability of Digital Standing Up for Myself and online administration of outcome measures in a pilot; to describe usual practice in the context of the coronavirus disease 2019 pandemic to inform future evaluation.

Design

Adaptation work followed by a single-arm pilot of intervention delivery.

Setting and participants

Four third and education sector organisations. Individuals with mild-to-moderate intellectual disabilities, aged 16+, members of existing groups, with access to digital platforms.

Intervention

Digital Standing Up for Myself intervention. Adapted from face-to-face Standing Up for Myself intervention, delivered over four weekly sessions, plus a 1-month follow-up session.

Outcomes

Acceptability and feasibility of delivering Digital Standing Up for Myself and of collecting outcome and health economic measures at baseline and 3 months post baseline. Outcomes are mental well-being, self-esteem, self-efficacy in rejecting prejudice, reactions to discrimination and sense of social power.

Results

Adaptation to the intervention required changes to session duration, group size and number of videos; otherwise, the content remained largely the same. Guidance was aligned with digital delivery methods and a new group member booklet was produced. Twenty-two participants provided baseline data. The intervention was started by 21 participants (four groups), all of whom were retained at 3 months. Group facilitators reported delivering the intervention as feasible and suggested some refinements. Fidelity of the intervention was good, with over 90% of key components observed as implemented by facilitators. Both facilitators and group members reported the intervention to be acceptable. Group members reported subjective benefits, including increased confidence, pride and knowing how to deal with difficult situations. Digital collection of all outcome measures was feasible and acceptable, with data completeness ≥ 95% for all measures at both time points. Finally, a picture of usual practice has been developed as an intervention comparator for a future trial.

Limitations

The pilot sample was small. It remains unclear whether participants would be willing to be randomised to a treatment as usual arm or whether they could be retained for 12 months follow-up.

Conclusions

The target number of groups and participants were recruited, and retention was good. It is feasible and acceptable for group facilitators with some training and supervision to deliver Digital Standing Up for Myself. Further optimisation of the intervention is warranted.

Future work

To maximise the acceptability and reach of the intervention, a future trial could offer the adapted Digital Standing Up for Myself, potentially alongside the original face-to-face version of the intervention.

Study registration

This study was registered as ISRCTN16056848.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 17/149/03) and is published in full in Public Health Research; Vol. 12, No. 1. See the NIHR Funding and Awards website for further award information.

Health of people with selected citizenships: results of the study GEDA Fokus

Background

The health situation of people with a history of migration is influenced by a variety of factors. This article provides an overview of the health of people with selected citizenships using various indicators.

Methods

The analyses are based on the survey 'German Health Update: Fokus (GEDA Fokus)', which was conducted from November 2021 to May 2022 among people with Croatian, Italian, Polish, Syrian and Turkish citizenship. The prevalence for each health outcome is presented and differentiated by sociodemographic and migration-related characteristics. Poisson regressions were performed to identify relevant factors influencing health situation.

Results

Self-assessed general health, the presence of depressive symptoms, prevalence of current smoking and the utilisation of general and specialist healthcare differed according to various factors considered here. In addition to sociodemographic determinants, the sense of belonging to society in Germany and self-reported experiences of discrimination were particularly associated with health outcomes.

Conclusions

This article highlights the heterogeneity of the health situation of people with a history of migration and points to the need for further analyses to identify the reasons for health inequalities.

Recommendations for collecting and analysing migration-related determinants in public health research

Background

According to the definition of the German Federal Statistical Office, about every fourth person living in Germany has a so-called migration background (MB), i.e., the person or at least one of their parents was born without German citizenship. However, MB has been defined differently in many studies. Also, the MB summarises people in different living situations, making differentiated analysis in health science more difficult. This article formulates recommendations for the collection and analysis of migration-related, as well as social and structural, determinants of health.

Indicators for capturing relevant determinants of health

As part of the Improving Health Monitoring in Migrant Populations project (IMIRA), the previous approaches to operationalise and measure migration-related determinants were revised based on literature research and exchange formats, such as workshops, meetings, congress contributions, etc. Instead of MB, the country of birth of the respondents and their parents, duration of residence, citizenship(s), residence status, and German language proficiency should be recorded as minimum indicators and analysed as individual variables. Further social and structural determinants, such as socioeconomic position, working and housing conditions, or self-reported discrimination, should be included.

Conclusions

In order to describe health inequalities and to specifically identify the needs of people with a history of migration, a mutual and differentiated consideration of migration-related and social determinants of health is essential.

Independent External Validation of FRAX and Garvan Fracture Risk Calculators: A Sub-Study of the FRISBEE Cohort

Probabilistic models including clinical risk factors with or without bone mineral density (BMD) have been developed to estimate the 5‐ or 10‐year absolute fracture risk. We investigated the performance of the FRAX and Garvan tools in a well‐characterized population‐based cohort of 3560 postmenopausal, volunteer women, aged 60 to 85 years at baseline, included in the Fracture Risk Brussels Epidemiological Enquiry (FRISBEE) cohort, during 5 years of follow‐up. Baseline data were used to calculate the estimated 10‐year risk of hip and major osteoporotic fractures (MOFs) for each participant using FRAX (Belgium). We computed the 5‐year risk according to the Garvan model with BMD. For calibration, the predicted risk of fracture was compared with fracture incidence across a large range of estimated fracture risks. The accuracy of the calculators to predict fractures was assessed using the area under the receiver operating characteristic curves (AUC). The FRAX tool was well calibrated for hip fractures (slope 1.09, p < 0.001; intercept −0.001, p = 0.46), but it consistently underestimated the incidence of major osteoporotic fractures (MOFs) (slope 2.12, p < 0.001; intercept −0.02, p = 0.06). The Garvan tool was well calibrated for “any Garvan” fractures (slope 1.05, p < 0.001; intercept 0.01, p = 0.37) but largely overestimated the observed hip fracture rate (slope 0.32, p < 0.001; intercept 0.006, p = 0.05). The predictive value for hip fractures was better for FRAX (AUC: 0.841, 95% confidence interval [CI] 0.795–0.887) than for Garvan (AUC: 0.769, 95% CI 0.702–0.836, p = 0.01). The Garvan AUC for “any Garvan” fractures was 0.721 (95% CI 0.693–0.749) and FRAX AUC for MOFs was 0.708 (95% CI 0.675–0.741). In conclusion, in our Belgian cohort, FRAX estimated quite well hip fractures but underestimated MOFs, while Garvan overestimated hip fracture risk but showed a good estimation of “any Garvan” fractures. Both models had a good discriminatory value for hip fractures but only a moderate discriminatory ability for MOFs or “any Garvan” fractures. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Concepts for migration-sensitive health monitoring

According to microcensus data, nearly one quarter of the German population has a migration background. This means that either themselves or at least one parent was born without German citizenship. Based on the currently available data and due to the underrepresentation of specific population groups, representative findings on the health of the total population residing in Germany are only possible to a limited degree. Against this backdrop, the Robert Koch Institute initiated the Improving Health Monitoring in Migrant Populations (IMIRA) project. The project aims to establish a migration-sensitive health monitoring system and to better represent people with a migration background in health surveys conducted by the Robert Koch Institute. In this context it is crucial to review and further develop relevant migration-sensitive concepts and appropriate surveying instruments. To achieve this, the concepts of acculturation, discrimination, religion and subjective social status were selected. This article theoretically embeds these concepts. Furthermore, we describe their application in epidemiology as well as provide a proposal on how to measure and operationalise these concepts. Moreover, recommendations for action are provided regarding the potential application of these concepts in health monitoring at the Robert Koch Institute.

Urban and rural differences in HIV/AIDS stigma in five African countries

Stigma and discrimination have been widely researched, especially within the context of health. In the context of HIV/AIDS, studies have shown that stigma variously impacts on prevention, on accessing treatment, and on care programmes. Decreasing stigma is therefore an important goal in HIV/AIDS programmes. This paper explores whether urban and rural differences existed in reported incidents of HIV stigma from five African countries. A descriptive, qualitative research design was used to explore the experience of HIV stigma of people living with HIV (PLHIV) and nurses. Focus group discussions were held with respondents to capture an emic and etic view of stigma and discrimination. The frequency of reported incidents shows that although comparable numbers of nurses and PLHIV were sampled, the PLHIV from both the urban and rural settings in all five countries conveyed more incidents of received stigma than did the nurses. The results suggest that treatment programmes and support structures need to be designed appropriately for the different settings.

The effectiveness of a national communication campaign using religious leaders to reduce HIV-related stigma in Ghana

This article describes the effects of a national mass media and community-level stigma-reduction programme in Ghana, in which national and local religious leaders urged their congregations and the general public to have greater compassion for people living with HIV or AIDS (PLHA). Data were collected from men and women living in three regions, first in 2001 (n = 2 746) and again in 2003 (n = 2 926). Attitudes related to a punitive response to PLHA both improved over time and were positively associated with exposure to the programme's campaign, controlling for potential confounding variables. Respondents in the 2003 survey were 20% more likely than respondents in the 2001 survey to be willing to care for an HIV-infected relative in their own household and 40% more likely to believe that an HIV-infected female teacher should be allowed to continue teaching. Overall, respondents exposed to the campaign were 45% more likely than those not exposed to it to be willing to care for a HIV-infected relative, and 43% more likely to believe that an HIV-infected female teacher should be allowed to continue teaching. Respondents exposed to the campaign also had significantly more favourable scores on an attitude scale measuring the belief that HIV-infected individuals should be isolated from others. The results of this evaluation suggest that mass media channels and religious leaders can effectively address HIV-related stigma on a national scale.

Updating the OMERACT filter: discrimination and feasibility

The "Discrimination" part of the OMERACT Filter asks whether a measure discriminates between situations that are of interest. "Feasibility" in the OMERACT Filter encompasses the practical considerations of using an instrument, including its ease of use, time to complete, monetary costs, and interpretability of the question(s) included in the instrument. Both the Discrimination and Reliability parts of the filter have been helpful but were agreed on primarily by consensus of OMERACT participants rather than through explicit evidence-based guidelines. In Filter 2.0 we wanted to improve this definition and provide specific guidance and advice to participants.

Dominican Immigrants and Discrimination in a New Destination: The Case of Reading, Pennsylvania*

The last decade has witnessed the diversification of immigrant destinations in the United States. Although the literature on this phenomenon is burgeoning, research on the experiences of smaller immigrant groups in new destinations is underdeveloped. This is especially the case for those from the Dominican Republic, a group that is expanding beyond the traditional gateway cities of the Northeast. Using a survey of Dominican immigrants in Reading, Pennsylvania, this study has two objectives. The first objective is to describe the prevalence of experiences with institutional and interpersonal discrimination. The second objective is to determine the extent to which these experiences are structured around racial markers (i.e. skin tone), forms of capital, forms of incorporation, and exposure to the U.S. Our results show that a substantial minority of Dominican immigrants claims to have been treated unfairly, primarily because of their "race and ethnicity." In addition, experiences with some types of discrimination are positively associated with skin tone (i.e., darkness) and several factors that are identified in models of assimilation.

Influence of gender, self-consciousness and stigmatisation on perceived acceptance among people living with HIV in Nigeria

This study investigates the influence of perceived acceptance of people living with HIV in Nigeria. The results reveal that gender and public self-consciousness jointly and significantly influenced an individual's perception of acceptance. Also, males with a high level of private self-consciousness scored higher on a scale measuring perceived acceptance than females with a high level of private self-consciousness. In addition, private self-consciousness and perceived stigmatisation jointly and significantly influenced an individual's perception of acceptance. The findings emphasise that the society is far from having an accepting attitude towards individuals living with HIV.