Weighing up the risks and benefits of community gambling venues as recreational spaces for people with lifelong disability.

BACKGROUND: Community gambling venues (pubs and clubs) are commonly associated with leisure and recreational options in Australian communities. While these venues offer a range of activities and facilities, including social opportunities, sporting facilities, live entertainment, they also contain gambling products that are known to cause significant harm to individuals, their families and communities. Although researchers have explored how adults and children engage with these venues, there is limited understanding about the potential risks and benefits of these venues for people with lifelong disability. METHODS: Semi structured interviews were conducted with nineteen people aged 20-70 years with lifelong disability (includes in this context intellectual disability, autism spectrum disorder, ADHD, and learning disability), predominately intellectual disability. The interviews occurred in a large Australian city and explored interviewees' experiences and attitudes towards pubs and clubs. Using a range of visual prompts (if needed), participants were asked to describe their engagement in different activities offered within the venue. Interviews were audio-recorded and transcribed, with a thematic analysis used to identify themes across the group. RESULTS: Most participants attended venues with family, friends, and supporters, with a few attending on their own. Participants described socialising in the venue, going for reduced price meals, and attended for a range of activities including recreational activities, live entertainment and sport. Some participants also valued being a member of venues, and the interactions with staff members. While participants were cautious about the consumption of alcohol, most had gambled, particularly on electronic gambling machines (EGMs, pokies, or slots). Some participants stated that they had experienced problems with gambling. CONCLUSIONS: While many people with lifelong disability have positive experiences in pubs and clubs, some are vulnerable to the harms associated with risky products such as gambling within the venue. While it is important to acknowledge the positives associated with recreational facilities and encourage engagement in leisure activities for people with lifelong disability, further consideration is needed to ensure people are informed and protected from the harms associated with gambling and other products that are provided within these spaces.

How Do People With Intellectual Disability Engage With and Understand Gambling? A Qualitative Study of Adults in Victoria, Australia.

Objective: This study aimed to understand the factors that may influence how and why people with intellectual disability may engage in gambling. Method: Nineteen people with intellectual disability were recruited from a disability advocacy organization and participated in face to face, semi-structured qualitative interviews. Open ended questions were used to explore participants' gambling participation, recall of, and attitudes toward, different gambling products, understanding of gambling harm, and awareness of responsible gambling messages. Results: All participants could remember gambling in their lifetime and some participants had recently engaged in gambling. Many participants were aware of different gambling products, and a few participants could describe in detail the technical aspects of electronic gambling machines. Most participants did not specifically recall seeing gambling harm minimization messages, however some described engaging in individual responsibility measures, such as limits and control, as they perceived this reduced the risks of experiencing harm. Conclusions: People with intellectual disability are engaging with gambling products in a similar way to the general community. Therefore, it is important to understand the different pathways that may lead people with intellectual disability to initiate and continue gambling and to ensure that they are aware of and protected from the potential risk. Implications for Public Health: Policy makers and practitioners should seek to understand and implement a range of strategies to reduce and prevent the harms associated with particular gambling products and environments for this population sub-group.

Boy Interrupted - Biographical disruption during the transition to adulthood.

Most studies on the gendered aspects of biographical disruption are predicated on adult experiences of chronic illness, often based on heterogeneous samples. This paper goes beyond typologies by analysing the life-history case study of 'Sam', a 23-year-old Australian man raised in a refugee family, who developed a disabling chronic health condition at 15 years of age. The analysis illustrates how critical contextual factors like life-phase, combine with powerful social structures like ethnicity and gender to shape Sam's experiences of, and responses to, biographical disruption. Even before the onset of any symptoms, Sam was railing against the marginal position he occupied in the Australian gender order as a young Asian man. With little guidance on how to adapt his biography to integrate his new differently functioning body, Sam's transition to adulthood stalls, and he becomes in effect, a boy interrupted.

Erognomic education on housework for women with upper limb repetitive strain injury (RSI): a conceptual representation of therapists' clinical reasoning.

BACKGROUND: Ergonomic education in housework that aims to facilitate behavior change is important for women with upper limb repetitive strain injury. Therapists usually conduct such programs based on implicit reasoning. Making this reasoning explicit is important in contributing to the profession's knowledge. AIM: To construct a conceptual representation of how occupational therapists make clinical decisions for such program. METHOD: Based on a constructivist-grounded theory methodology, data were collected through in-depth interviewing with 14 occupational therapists from a major hospital in Singapore. Interviews were audiotaped and transcribed. Data was analyzed with line by line, focused and axial coding with constant data comparison throughout data collection. RESULTS: Therapists made clinical decisions based on their perceptions of their clients' behavior change in three stages: (i) listen; (ii) try; and (iii) persevere, bearing significant similarities to the transtheoretical theory of change. The study also showed that therapists may not have considered the full range of meanings that their clients attach to housework when interacting with them, a gap that needs to be addressed. CONCLUSIONS: The present study indicates the importance of therapists' understanding of the meanings that their clients attach to housework. Further research needs to address how to achieve this in a time-pressured clinical environment. Implications for Rehabilitation This study used qualitative research to demonstrate the process of translating therapists' tacit knowledge into an explicit form. It elucidates the following major implications for practice when therapists conduct ergonomic education to facilitate behavior change in housework for female homemakers with upper limb RSI:The conceptual framework of clinical reasoning constructed from the results can be used to increase therapists' awareness of how they make clinical decisions during an intervention. This framework can also be used for training new therapists. It is important for therapists to actively listen to their clients. Active listening will enable the therapists to understand and consider the personal meanings that these women attach to housework in order to facilitate a behavior change. Client-therapist interactions to facilitate clients' willingness to change should become a major focus in such a program. Similar research should be conducted in other clinical areas to develop explicit clinical reasoning frameworks to facilitate learning of novice therapists and reflection of experienced therapists to address any gap in their clinical reasoning.

Understanding decision-making towards housework among women with upper limb repetitive strain injury.

BACKGROUND: Among women with upper limb repetitive strain injury (RSI), occupational therapy interventions include education to facilitate ergonomic practices in housework. From a client-centred perspective, an understanding of women's decision-making about housework is needed to design effective occupational therapy programmes. This study addresses a gap in research in this area by exploring women's views about changing housework habits. AIM: The aim was to construct a conceptual representation to explain decision-making in housework by drawing on experiences of a sample of Singapore Chinese women with upper limb RSI from one hand therapy clinic. METHODS: Based on a constructivist grounded theory methodology, data were collected through in-depth interviewing with 15 women. Interviews were audiotaped and transcribed. Data were analysed with line by line coding, focussed coding and axial coding with constant comparison throughout data collection. RESULTS: Decision-making in housework among these women involved three main themes: (i) emotional attachment to housework; (ii) cognitively informed decision; and (iii) emotionally influenced decision. Women with upper limb RSI had to make cognitive decisions for or against a change in housework to manage their condition. However, the women's cognitively informed decisions were shaped by their emotional attachment to housework. As such, they experienced strong emotional barriers to changing their housework practices even when they had cognitively accepted the necessity and possibility of making a change. CONCLUSIONS: Therapists need to be aware that counselling to address the emotional barriers experienced by women is important during ergonomic education.

From diminished men to conditionally masculine: sexuality and Australian men and adolescent boys with intellectual disability.

Men and boys with intellectual disability represent a unique group who have hitherto been overlooked by researchers and theorists exploring men and masculinities. Qualitative data from an Australian ethnographic study focused on the sexual health needs of men and adolescent boys with moderate to profound intellectual disability. Findings suggest that masculinity for this group of men is more a biopsychosocial phenomenon than a social construct organised around heteronormative ideals. The conditional masculinity of the men participating in the study was based instead on a number of intrinsic and external factors, which are described in detail.

Masculinity theory in applied research with men and boys with intellectual disability.

Researchers in intellectual disability have had limited theoretical engagement with mainstream theories of masculinity. In this article, the authors consider what mainstream theories of masculinity may offer to applied research on, and hence to therapeutic interventions with, men and boys with intellectual disability. An example from one research project that explored male sexual health illustrates how using masculinity theory provided greater insight into gendered data. Finally, we discuss the following five topics to illustrate how researchers might use theories of masculinity: (a) fathering, (b) male physical expression, (c) sexual expression, (d) men's health, and (e) underweight and obesity. Theories of masculinity offer an additional framework to analyze and conceptualize gendered data; we challenge researchers to engage with this body of work.

Gendered service delivery: a masculine and feminine perspective on staff gender.

Despite acknowledgement that paid caregivers have a significant impact on the lives of people with intellectual disability, the subjective experience of staff gender is rarely considered in research. Qualitative data from a study on the sexual health needs of men and boys with intellectual disability is presented. We designed this study to determine what impact staff gender has on the sexual health needs of men and boys with intellectual disability. Findings suggest that although staff traverse the same geographies of care, they do it in uniquely gendered ways. Staff gender is an important consideration when dealing with sexual health matters and can enhance the type and quality of relationships between people with intellectual disability.

A masculine perspective of gendered topics in the research literature on males and females with intellectual disability.

BACKGROUND: A focus on male social pathologies may have evolved within parts of the intellectual disability research literature. This article explores this notion and makes some connections between mainstream gender theory about hegemonic masculinity and the current gendered discourse in intellectual disability research. METHOD: We conducted a thematic analysis of all journal article titles from four prominent intellectual disability journals where "man," "woman," "men," "women," "male," "female," "girl," and "boy" were mentioned in the title. RESULTS: Thematic differences were identified between articles that focused on males or females, with less research attention on male health compared with female health. A strong focus was evident on problematised male sexual behaviour. CONCLUSIONS: There is a distinct difference evident between articles that problematise males and articles for females encouraging health promotion that suggests a disparate focus on male social pathologies. A deeper contextual analysis of unique sex differences in research is proposed.

Stigma, community, ethnography: Joan Ablon's contribution to the anthropology of impairment-disability.

Joan Ablon has helped establish the anthropology of impairment-disability and significantly contributed to the role of anthropology in disability studies. In this article, we review the development of and situate Ablon's ethnographic research in the anthropology of impairment-disability. We then address various methodological issues in her work including her ethnographic approach, her grounding in action anthropology and her support for the development of the academic study of disability in anthropology and the careers of disabled anthropologists. The next section of the article examines Ablon's use of the notion of stigma, her understanding of community, and her engagement with disability rights. As examples of themes important to disability studies, we present her discussion of the implications of the ideal of the body beautiful, and gender differences in negotiating intimacy for people with physical differences. We close with a discussion of the future of an anthropology of impairment-disability.