Background: Public 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 methods: The 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.
Results: The 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.
Limitations: The scoping review provides a broad appraisal of a particular field. It generates ideas for future practice rather than a definite framework for action.
Conclusions: Our 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 work: Developing 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.

https://njl-admin.nihr.ac.uk/document/download/2004214

Implications for public health research of models and theories of disability: A scoping study and evidence synthesis

Informal caregivers are an essential pillar for ensuring and maintaining the outpatient care of the frail elderly. Due to demographic changes, including an increase in the number of people in need of care as well as changing social structures (full-time employment of women, increasing number of single households, etc.) these informal care structures are fraught by considerable challenges. To support and facilitate informal caregivers in their role of nursing, it is important to identify their preferences, needs, and thus create a preference-oriented system. A systematic review was conducted to identify preferences and needs regarding the organization of informal care. The database searches were performed by using EMBASE, Scopus and Dimdi. A total of 44 studies were included in the present review. Studies from 17 different countries provide broad international perspectives. Besides the preferences for long-term care structure, the following four principal topics were identified: (1) informational needs; (2) support needs; (3) organizational needs, and (4) needs for societal recognition. To meet the current challenges in the outpatient or home-based care of elders, it is essential to strengthen the role of informal caregivers. Therefore, it is necessary to adopt and further develop informal care structures according to the needs of informal caregivers. However, demographic, financial and cultural aspects of each country need to be considered as these may influence the preferences and needs of informal caregivers.

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Needs and preferences of informal caregivers regarding outpatient care for the elderly: a systematic literature review

Telepsychiatry: Effective, Evidence-Based, and at a Tipping Point in Health Care Delivery?

Rural Ageing: A good place to grow old?

Mobile health (mHealth), telemedicine and other technology-based services facilitate mental health service delivery and may be considered part of an e-mental health (eMH) spectrum of care. Web- and Internet-based resources provide a great opportunity for the public, patients, healthcare providers and others to improve wellness, practice prevention and reduce suffering from illnesses. Mobile apps offer portability for access anytime/anywhere, are inexpensive versus traditional desktop computers, and have additional features (e.g., context-aware interventions and sensors with real-time feedback. This paper discusses mobile mental health (mMH) options, as part of a broader framework of eMH options. The evidence-based literature shows that many people have an openness to technology as a way to help themselves, change behaviors and engage additional clinical services. Studies show that traditional video-based synchronous telepsychiatry (TP) is as good as in-person service, but mHealth outcomes have been rarely, directly compared to in-person and other eMH care options. Similarly, technology options added to in-person care or combined with others have not been evaluated nor linked with specific goals and desired outcomes. Skills and competencies for clinicians are needed for mHealth, social media and other new technologies in the eMH spectrum, in addition to research by randomized trials and study of health service delivery models with an emphasis on effectiveness.

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Advances in mobile mental health: opportunities and implications for the spectrum of e-mental health services.

SummaryWe conducted a pragmatic, mixed methods study comparing rural family caregivers receiving e-health caregiver support (n = 35) with a control group (n = 21) receiving conventional, non-e-health, caregiver support. After 18 months, the benefits of support were evaluated using the Care Effectiveness Scale (40-items exploring the domains of preparedness, enrichment and predictability). In all domains the e-health group scored significantly higher than the control group. The adjusted difference for overall benefits was 3.0 (P = 0.02) on the scale 0-10. In addition, semi structured interviews were conducted with a sub-sample of the caregivers. For the e-health group flexibility, availability and being able to individualise the support were essential factors. All caregivers in the control group found conventional support to be beneficial, but also stressed unmet needs related to the conventional support being standardised and non-flexible. The study suggests that providers of caregiver support should offe...

The benefits of e-health support for older family caregivers in rural areas.

This study focus on adolescents motivations about remaining in rural areas in the Mid Sweden Region, a part of Sweden with decreasing school performance scores and high out-migration. The study is based on 1,500 young people’s responses to a Web-based survey within the framework of a regional school development project. The research questions focused on: whether youths were going to stay there or move the future in urban or rural areas, influences, and the future choices and differences among genders, regions, and age groups. The empirical data are processed with statistical analysis. The study confirms previous research on young people’s relocations from rural areas; jobs and education are important motives, and the most prone to move are women. What is new knowledge is that lessons about the region’s importance have a positive, significant effect on individuals’ plans to remain in their home municipality. This can and should be highlighted in local, regional, and national politics, but more importantly in school discourses. Since school plays a role in students’ thinking and future choices, a larger formation effort could be of great value for norms and regional political standpoints. The study has relevance to the international terms of similar geographical areas.

/pdf/young-people-s-opinions-on-rural-sweden-27qcqw1tgw.pdf

Young People's Opinions on Rural Sweden.

Participation has emerged as a central concept in defining the goals of disability policy in Sweden as well as internationally. Yet it has rarely been operationalized as a foundation for planning services. As part of an attempt to survey the needs of individuals experiencing psychiatric disabilities, the authors have developed a scale for measuring participation in five areas of community life. The scale uses four distinct categories as levels, specific for each area of life, and a set of statistical descriptive techniques designed to illustrate and communicate information regarding levels, capacities, and wishes related to a participatory life in the community. Based on a pilot study, the article illustrates how the collective needs of a population of individuals experiencing psychiatric disability can be described and presented to practitioners as a support for system planning.

/pdf/an-approach-to-measurement-and-statistical-description-of-1mjgrb1plh.pdf

An approach to measurement and statistical description of participation in community life for people with psychiatric disabilities

ICT, information- and communication technologies, and e-health services are essential for meeting future care demands. Greater knowledge regarding the implementation of e-health services in long-te ...

Older People Using e-Health Services—Exploring Frequency of Use and Associations with Perceived Benefits for Spouse Caregivers

This research examined teachers’ attitudes in a school development project, The best regional educational system in the world which focuses on regional development and school improvement. The project was performed in counties in Mid Sweden, which have a lower educational level and school achievements and a competence escape compare with other parts of Sweden. Project schools were compared to references schools concerning staffs perception of the pedagogical platform. This study is based on a web-based survey. The quantitative results show that two of the factors in the survey distinguished themselves with statistical significance; namely, the pedagogical platform was 0.44 (p=0.036) and leadership factor, which was 0.25 (p=0.052) was lower for the project schools. The directed content analysis showed differences regarding awareness of the pedagogical platform concerning understanding vs. ambiguity and specifically targeting vs. general descriptions. The reference schools described an understanding of the school’s overall educational platform and described more clearly the school’s focus. The study points to the importance of teachers are aware of their own school platform to develop leadership and teams, which in turn influences student learning and achievement. If schools in the two counties are to be successful, in terms of students’ school performance and the competitiveness of the region, the pedagogical platform should be made clear to staff and be anchored in the teachers’ team work, probably even more than in other schools.

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Rolf Dalin

Papers

The benefits of e-health support for older family caregivers in rural areas.

Young People's Opinions on Rural Sweden.

An approach to measurement and statistical description of participation in community life for people with psychiatric disabilities

Older People Using e-Health Services—Exploring Frequency of Use and Associations with Perceived Benefits for Spouse Caregivers

Teachers' Perceptions of the Educational Platform-Is There a Connection between School Improvement and Regional Educational Development?