Addressing data deficiencies in assistive technology by using statistical matching methodology: a case study from Malawi.

PURPOSE: To address the data gap on efforts to assess use of assistive technology among children with disability in sub-Saharan Africa. Contribute towards efforts examining access to assistive technologies in sub-Saharan Africa. MATERIALS AND METHODS: The paper uses data from the 2017 survey on Living conditions among persons with disabilities in Malawi and the 2015-16 Malawi Demographic and Health survey to address the objective of the study. The two datasets were statistically matched through random hot deck technique, by integrating the two datasets using randomly selected units from a subset of all available data donors. RESULTS: Results indicate that statistical matching technique produces a composite dataset with an uncertainty value of 2.2%. An accuracy assessment test of the technique also indicates that the marginal distribution of use of assistive technology in the composite dataset is similar to that of the donor dataset with an Overlap index value of close to 1 (Overlap = 0.997). CONCLUSIONS: The statistical matching procedure does enable generation of good data in data constrained contexts. In the current study, this approach enabled measurement of access to assistive products among children with disabilities, in situations where the variables of interest have not been jointly observed. Such a technique can be valuable in mining secondary data, the collection of which may have been funded from different sources and for different purposes. This is of significance for the efficient use of current and future data sets, allowing new questions to be asked and addressed by locally based researchers in poor settings. Implications for RehabilitationIn resource-poor settings, the technique of statistical matching can be used to examine factors that predict the use of assistive technology among persons with disabilities.The statistical matching technique is of significance for the efficient use of current and future datasets, allowing new questions to be asked and addressed by locally based researchers.

Scoping review of economic evaluations of assistive technology globally.

The paper presents a scoping review of existing economic evaluations of assistive technology (AT). The study methodology utilized a PRISMA flow approach with final included studies that met an adapted PICOS framework. Types of economic evaluations employed, study type and rigor and domains of AT impact were considered and analyzed. The economic evaluations in this study included 13 CBA, 9 CMA, 18 CEAs and 10 CUA. The majority of studies (32 studies in total) mentioned or recorded that AT investment, access and/or usage had impacts on the domain of both informal and formal health care. Specifically, care costs, time, and resources were affected. Our study has found that current AT economic evaluations are limited. This study advocates for a wider use of robust alternative evaluation and appraisal methodologies that can highlight AT value and which would subsequently provide further evidence that may make governments more willing to invest in and shape AT markets.

Using locational data in a novel mixed-methods sequence design: Identifying critical health care barriers for people with disabilities in Malawi.

The primary aim of this study was to determine which health care barriers were most important for people with disabilities in Malawi. To accomplish this, we devised a sequential mixed-methods research design that integrated locational survey data and qualitative data from field studies. Our secondary aim was to evaluate this research design not only as a design-solution to our particular research objective, but as a tool with more general applicability within social sciences. Malawi has one of the most underserved health service populations in the world with chronic resource shortages and long travel distances where people with disabilities are at a particular disadvantage. Nevertheless, our results show that even in a resource scarce society such as Malawi it is the interpersonal relationships between patients and health service providers that has the largest impact on the perception of access among patients. Our results also suggest that the sequential mixed-methods design is effective in guiding researchers towards models with strong specifications.

Factors associated with staff-to-resident abuse in Norwegian nursing homes: a cross-sectional exploratory study.

BACKGROUND: Elder abuse is a public health problem that is gaining attention due to its serious impacts on people's health and well-being, and it is predicted to increase along with the world's rapidly ageing population. Staff-to-resident abuse in nursing homes is a complex and multifaceted phenomenon associated with multiple factors on different levels of the ecological model. This study aimed to explore individual, relational, and institutional characteristics associated with perpetrated staff-to-resident abuse in nursing homes, using a multilevel hierarchical approach. METHODS: This was a cross-sectional exploratory study of 3693 nursing staff (response rate 60.1%) in 100 randomly selected nursing homes in Norway. We explored the characteristics of nursing staff, their relationship with residents, and institutional features associated with three types of abuse: psychological abuse, physical abuse, and neglect. These were modelled using multilevel mixed-effects logistic regression analyses. RESULTS: Individual staff factors found to be associated with all three types of abuse were 1) being a registered nurse/social educator (OR 1.77-2.49) or licensed practical nurse (OR 1.64-1.92), 2) reporting symptoms of psychological distress (OR 1.44-1.46), 3) intention to leave the job (OR 1.35-1.40), and 4) reporting poor attitudes towards people with dementia (OR 1.02-1.15). Also, staff who reported poorer quality of childhood were more likely to perpetrate neglect (OR 1.14). Relational factors such as care-related conflicts (OR 1.97-2.33) and resident aggression (OR 1.36-2.09) were associated with all three types of abuse. Of institutional factors, lack of support from a manager was associated with perpetrating psychological abuse (OR 1.56). CONCLUSIONS: We found several predictors of staff-to-resident abuse on different levels of the ecological model, which underlines the importance of using a multifaceted approach to identify risk factors of elder abuse in nursing homes. However, future studies should explore the underlying mechanism and causes with a prospective or qualitative design and target the multifaceted nature of risk factors when designing preventive interventions.

Resident-to-resident aggression in Norwegian nursing homes: a cross-sectional exploratory study.

BACKGROUND: Resident-to-resident aggression in nursing homes is a public health problem of growing concern, impacting the safety, health and well-being of all residents involved. Despite this, little research has been conducted on its occurrence particularly in large-scale national studies. The aim of this study was to explore the extent and nature of resident-to-resident aggression in Norwegian nursing homes, as reported by nursing staff. METHODS: We conducted a cross-sectional exploratory study, where nursing staff in 100 randomly selected Norwegian nursing homes completed a pen and paper survey measuring how often they had observed incidents of resident-to-resident aggression during the past year. These rates were separated according to nursing home size, location and units of workplace. RESULTS: Of the 3693 nursing staff who participated (response rate 60.1%), 88.8% had observed one or more incidents of resident-to-resident aggression during the past year, with acts of verbal and physical aggression being the most commonly reported. Nursing staff working in dementia special care units, larger nursing homes and nursing homes located in suburban/urban municipalities, reported more incidents of resident-to-resident aggression than staff in short-term and long-term units, small institutions, and nursing homes located in rural municipalities. CONCLUSIONS: This is the first national study of resident-to-resident aggression in Norwegian nursing homes and is one of the largest surveys worldwide exploring the extent and nature of resident-to-resident aggression in long-term care settings. Overall, we found a high occurrence of all types of aggression, suggesting a need for strategies to improve residents' safety and quality of life in nursing homes.

Elder abuse in Norwegian nursing homes: a cross-sectional exploratory study.

BACKGROUND: Elder abuse is a global public health and human rights problem that is predicted to increase as many countries experience a rapid growth in their population of older adults. Elder abuse undermines an older person's well-being and is associated with a range of serious health consequences. In institutional care settings, older residents are particularly vulnerable and hence at higher risk of being abused, but few countries have explored the extent and nature of this phenomenon in national studies. The aim of this study is to estimate the prevalence of observed and perpetrated staff-to-resident abuse in Norwegian nursing homes. METHODS: We conducted a cross-sectional exploratory study of nursing staff in 100 randomly drawn Norwegian nursing homes. Nursing staff completed a pen and paper survey measuring how often during the past year they had observed staff commit acts of neglect and psychological, physical, financial/material, and sexual abuse towards residents. They also reported how often they had perpetrated acts of abuse themselves, and these rates were disaggregated by nursing staff's gender, age and education. RESULTS: Of 3693 nursing staff (response rate 60.1%), 76% had observed one or more incidents of elder abuse during the past year, and 60.3% reported they had perpetrated one or more incidents of abuse in the same period. Psychological abuse and neglect were most commonly reported. Male staff reported more acts of physical abuse, while female staff reported more acts of neglect. Higher education of staff was associated with higher rates of self-reported psychological abuse, physical abuse and neglect. CONCLUSIONS: This first national survey of staff in Norwegian nursing homes is one of the largest studies globally estimating the prevalence of elder abuse in institutional settings. Overall, we found staff-to-resident abuse to be relatively common, and our findings propose a need for preventive strategies to improve the quality of life and safety of residents in Norwegian nursing homes.

The perceived needs-access gap for health services among persons with disabilities in a rural area within South Africa.

Purpose: Health should be a universal phenomenon. However, little is known about the relationship between disability status and health issues - particularly in rural areas. This study looks at health issues of persons with disabilities in Madwaleni, a rural impoverished area in South Africa in 2011, and compares them to persons with no disabilities. Materials and Methods: Standardized questionnaires were used in the survey to assess disability and health status. The sample comprised of 773 individuals - 322 persons with disability and 451 comparisons (without disability) - covering 527 households. Children under the age of five were excluded from the sample. We used purposive sampling. Results and Conclusion: This study found that persons with disabilities have poorer reported health outcomes than persons with no disabilities. There is also an association between disability severity and mental health issues as assessed by the GHQ-12. A significantly higher percentage of persons with disability did not get health care when needed. Persons with disabilities also have less favorable attitudes toward competence of health care workers. This study has shown greater health needs and less satisfaction with services, which strongly indicates insufficient access for persons with disabilities in a rural impoverished are within South Africa. Implications for rehabilitation Persons with disabilities in rural South Africa have poorer reported health outcomes. Persons with disabilities have less favorable attitudes towards competence of health care workers in rural South Africa. Better access to health care for persons with disabilities is needed in rural South Africa.

Prevalence of HIV infection among people with disabilities: a population-based observational study in Yaoundé, Cameroon (HandiVIH).

BACKGROUND: In resource-limited settings, people with disabilities have been left behind in the response to HIV. In the HandiVIH study, we estimate and compare HIV prevalence and associated risk factors between people with and without disabilities. METHODS: In this cross-sectional, population-based, observational study, we used two-phase random sampling to recruit adults with disabilities and a control group matched for age, sex, and residential location from households of the general population. We used the Washington Group Short Set of Questions on Disability to identify people with disabilities. We administered an HIV test and a life-course history interview to participants. The primary outcome was the prevalence of HIV among participants with and without disabilities. FINDINGS: Between Oct 2, 2014, and Nov 30, 2015, we recruited 807 people with disabilities and 807 participants without disabilities from Yaoundé, Cameroon. 28 of 716 people in the control population had a positive HIV test result (crude prevalence 3·9%, 95% CI 2·9-5·3) compared with 50 of 739 people with disabilities (6·8%, 5·0-8·6; conditional odds ratio [OR] 1·7; p=0·04). Women with disabilities were more often involved in paid sexual relationships than were women without disabilities (2·5% vs 0·5%, p=0·05). People with disabilities were also at increased risk of sexual violence than were women without disabilities (11·0% vs 7·5%, OR 1·5; p=0·01). Sexual violence and sex work were strongly associated with increased risk of HIV infection among participants with disabilities but not among controls (OR 3·0, 95% CI 1·6-5·6 for sexual violence and 12·3, 4·4-34·6 for sex work). Analyses were done in men and women. INTERPRETATION: The higher prevalence of HIV infection in people with disabilities than people without disabilities reflects a higher exposure to HIV infection as well as the presence of disability-associated HIV infection. The susceptibility of people with disabilities to HIV infection seems to be shaped by social and environmental factors. Research is needed to inform firm recommendations on how to protect this vulnerable population. FUNDING: Agence nationale de recherches sur le sida et les hépatites virales (ANRS-Inserm) and the 5% Initiative.

A household perspective on access to health care in the context of HIV and disability: a qualitative case study from Malawi.

BACKGROUND: Equitable access to health care is a challenge in many low-income countries. The most vulnerable segments of any population face increased challenges, as their vulnerability amplifies problems of the general population. This implies a heavy burden on informal care-givers in their immediate and extended households. However, research falls short of explaining the particular challenges experienced by these individuals and households. To build an evidence base from the ground, we present a single case study to explore and understand the individual experience, to honour what is distinctive about the story, but also to use the individual story to raise questions about the larger context. METHODS: We use a single qualitative case study approach to provide an in-depth, contextual and household perspective on barriers, facilitators, and consequences of care provided to persons with disability and HIV. RESULTS: The results from this study emphasise the burden that caring for an HIV positive and disabled family member places on an already impoverished household, and the need for support, not just for the HIV positive and disabled person, but for the entire household. CONCLUSIONS: Disability and HIV do not only affect the individual, but the whole household, immediate and extended. It is crucial to consider the interconnectedness of the challenges faced by an individual and a household. Issues of health (physical and mental), disability, employment, education, infrastructure (transport/terrain) and poverty are all related and interconnected, and should be addressed as a whole in order to secure equity in health.

HandiVIH--A population-based survey to understand the vulnerability of people with disabilities to HIV and other sexual and reproductive health problems in Cameroon: protocol and methodological considerations.

INTRODUCTION: In resource-limited countries, people with disabilities seem to be particularly vulnerable to HIV infection due to barriers to accessing information and services, frequent exposure to sexual violence and social exclusion. However, they have often been left behind in the HIV response, probably because of the lack of reliable epidemiological data measuring this vulnerability. Multiple challenges in conducting good quality epidemiological surveys on people with disabilities require innovative methods to better understand the link between disability and HIV. This paper describes how the design and methods of the HandiVIH study were adapted to document the vulnerability of people with disabilities to HIV, and to compare their situation with that of people without disabilities. METHODS AND ANALYSIS: The HandiVIH project aims to combine quantitative and qualitative data. The quantitative component is a cross-sectional survey with a control group conducted in Yaoundé (Cameroon). A two-phase random sampling is used (1) to screen people with disabilities from the general population using the Washington Group questionnaire and, (2) to create a matched control group. An HIV test is proposed to each study participant. Additionally, a questionnaire including a life-event interview is used to collect data on respondents' life-course history of social isolation, employment, sexual partnership, HIV risk factors and fertility. Before the cross-sectional survey, a qualitative exploratory study was implemented to identify challenges in conducting the survey and possible solutions. Information on people with disabilities begging in the streets and members of disabled people's organisations is collected separately. ETHICS AND DISSEMINATION: This study has been approved by the two ethical committees. Special attention has been paid on how to adapt the consenting process to persons with intellectual disabilities. The methodological considerations discussed in this paper may contribute to the development of good practices for conducting quantitative health surveys on people with disabilities. TRIAL REGISTRATION NUMBER: NCT02192658.

Importance of participation in major life areas matters for return to work.

INTRODUCTION: The complexity of the process and outcome of vocational rehabilitation yearns for a multifaceted approach. This article investigates whether importance of participation in major life areas for men and women predicts the outcome of vocational rehabilitation. METHODS: This longitudinal study provides measure points at the start of the intervention (T1), at the end of the intervention (T2) and at a follow-up 6-12 months after completing the rehabilitation program (T3). Associations were assessed by nominal logistic regression. RESULTS: The importance of participation in work was positively associated to return to work (RTW), while the importance of participation in leisure activities and importance of participation in family was negatively associated with RTW after the rehabilitation. Gender and number of children also contributed significantly to the regression model. CONCLUSION: To identify individuals' subjective evaluation of the importance of participation may be of value in explaining return or not RTW and contribute to explain gender differences in outcomes. It may also inform rehabilitation counselors in collaboration with clients and facilitate tailoring interventions to the individual's needs.

Gender differences in the importance of participation associated with injured workers/persons perceived barriers to returning to work in the context of vocational rehabilitation.

PURPOSE: To investigate gender differences in the importance of participation in core domains of life, and the association to perceived hindrances for return to work (RTW) before (T1) and after (T2) vocational rehabilitation. METHODS: Two hundred-seventy (T1) and 149 (T2) respondents completed the questionnaire. Gender differences in the importance of participation were calculated using t-tests. A principal component analysis was conducted on 21 questions of hindrances for RTW. A four-component structure was chosen. The family care barrier component was kept as an outcome variable in the logistic regression. RESULTS: There were mean gender differences in importance of participation in family prior to chronic pain and at T1. Importance of work changed from prior to pain to rehabilitation. At T1 children, age and importance of participation in work and family contributed to the model for women. For men importance of participation in leisure contributed to the model. The variables which contributed to the model at T2 for women were age and importance of participation in work and for men; children and importance of participation in leisure. CONCLUSION: Understanding gender differences in participation, and the association to hindrances for RTW, can enhance the rehabilitation counsellor's ability to work collaboratively with the clients. Implications for Rehabilitation Participation is a value and context driven process which influences the process of vocational rehabilitation. Understanding the driving forces for participation in important domains of life can illuminate gender differences in the process and outcome of vocational rehabilitation. Understanding gender differences in importance of participation, and the association to perceived hindrances to return to work, facilitates a shared understanding of rehabilitation goals among clients and rehabilitation professionals.

Disability associated with exposure to traumatic events: results from a cross-sectional community survey in South Sudan.

BACKGROUND: There is a general lack of knowledge regarding disability and especially factors that are associated with disability in low-income countries. We aimed to study the overall and gender-specific prevalence of disability, and the association between exposure to traumatic events and disability in a post-conflict setting. METHODS: We conducted a cross-sectional community based study of four Greater Bahr el Ghazal States, South Sudan (n = 1200). The Harvard Trauma Questionnaire (HTQ) was applied to investigate exposure to trauma events. Disability was measured using the Washington Group Short Measurement Set on Disability, which is an activity-based scale derived from the WHO's International Classification of Disability, Functioning and Health. RESULTS: The estimated prevalence of disability (with severe difficulty) was 3.6% and 13.4% for disability with moderate difficulties. No gender differences were found in disability prevalence. Almost all participants reported exposure to at least one war-related traumatic event. The result of a hierarchical regression analysis showed that, for both men and women, exposure to traumatic events, older age and living in a polygamous marriage increased the likelihood of having a disability. CONCLUSIONS: The finding of association between traumatic experience and disability underlines the precariousness of the human rights situation for individuals with disability in low-income countries. It also has possible implications for the construction of disability services and for the provision of health services to individuals exposed to traumatic events.

The mental health of internally displaced persons: an epidemiological study of adults in two settlements in Central Sudan.

AIMS: There is a scarcity of data on mental health problems among Sudanese internally displaced persons (IDPs). This study aims to assess the prevalence of mental disorders of IDPs in Sudan, and to determine and compare the association between mental disorders and socio-demographic variables between the rural and urban long-term IDP populations. METHODS: This cross-sectional study was implemented in two IDP areas in Central Sudan. Data were collected during face-to-face interviews using structured questionnaires to assess socio-demographic factors and the Mini International Neuropsychiatric Interview (MINI) to determine psychiatric diagnoses. A total of 1,876 adults were enrolled from both study areas. RESULTS: The overall prevalence of having any mental health disorder in the IDP population was 52.9%. The most common disorders were major depressive disorder (24.3%), generalized anxiety disorder (23.6%), social phobia (14.2%) and post-traumatic stress disorder (12.3%). Years of displacement and education were associated with different mental disorders between the two areas, and there were no gender differences in prevalence of mental disorders in either area. CONCLUSION: This study shows high prevalence rates of mental disorders in both urban and rural IDP populations in Sudan, indicating a need to explore the circumstances for these high rates and to develop appropriate responses.

Understanding experiences of participation among men and women with chronic musculoskeletal pain in vocational rehabilitation.

OBJECTIVE: The objective of this study was to provide knowledge about participation and change in participation among men and women experiencing chronic musculoskeletal pain and undergoing multidisciplinary vocational rehabilitation. PARTICIPANTS: Six women and four men participating in a vocational rehabilitation intervention. METHOD: Data were collected through semi-structured in-depth interviews. The participants were encouraged to talk about their experiences and thoughts regarding participation in different life areas using previous, present, and future expectations. The analysis performed was constant comparative and inspired by grounded theory. RESULTS: The core category was identified as "goal-oriented participation" which represented participation as intentional and situated. Three categories, "participating as before," "participation constantly changing," and "participating in work on hold," were used, taking into account gender-influenced trajectories and understandings of participation before, during, and after sick leave and rehabilitation. CONCLUSION: The different trajectories of participation seemed to be gender specific and were connected to broader societal and environmental factors. These combined aspects seemed to affect values, motivation, and understanding of important goals while experiencing chronic pain. Examining goal-oriented participation may add to the understanding of gender differences in the rehabilitation process and thereby have implications for rehabilitation interventions.

HIV issues and people with disabilities: a review and agenda for research.

The recent AIDS and Disability Partners Forum at the UN General Assembly High Level Meetings on AIDS in New York in June 2011 and the International AIDS Conference in Washington, DC in July 2012 underscores the growing attention to the impact of HIV and AIDS on persons with disabilities. However, research on AIDS and disability, particularly a solid evidence base upon which to build policy and programming remains thin, scattered and difficult to access. In this review paper, we summarise what is currently known about the intersection between HIV and AIDS and disability, paying particular attention to the small but emerging body of epidemiology data on the prevalence of HIV for people with disabilities, as well as the increasing understanding of HIV risk factors for people with disabilities. We find that the number of papers in the peer-reviewed literature remains distressingly small. Over the past 20 years an average of 5 articles on some aspect of disability and HIV and AIDS were published annually in the peer-reviewed literature from 1990 to 2000, increasing slightly to an average of 6 per year from 2000 to 2010. Given the vast amount of research around HIV and AIDS and the thousands of articles on the subject published in the peer-reviewed literature annually, the continuing lack of attention to HIV and AIDS among this at risk population, now estimated to make up 15% of the world's population, is striking. However, the statistics, while too limited at this point to make definitive conclusions, increasingly suggest at least an equal HIV prevalence rate for people with disabilities as for their non-disabled peers.

Inclusion of vulnerable groups in health policies: Regional policies on health priorities in Africa.

BACKGROUND: If access to equitable health care is to be achieved for all, policy documents must mention and address in some detail different needs of groups vulnerable to not accessing such health care. If these needs are not addressed in the policy documents, there is little chance that they will be addressed at the stage of implementation. OBJECTIVES: This paper reports on an analysis of 11 African Union (AU) policy documents to ascertain the frequency and the extent of mention of 13 core concepts in relation to 12 vulnerable groups, with a specific focus on people with disabilities. METHOD: The paper applied the EquiFrame analytical framework to the 11 AU policy documents. The 11 documents were analysed in terms of how many times a core concept was mentioned and the extent of information on how the core concept should be addressed at the implementation level. Each core concept mention was further analysed in terms of the vulnerable group in referred to. RESULTS: The analysis of regional AU policies highlighted the broad nature of the reference made to vulnerable groups, with a lack of detailed specifications of different needs of different groups. This is confirmed in the highest vulnerable group mention being for 'universal'. The reading of the documents suggests that vulnerable groups are homogeneous in their needs, which is not the case. There is a lack of recognition of different needs of different vulnerable groups in accessing health care. CONCLUSION: The need for more information and knowledge on the needs of all vulnerable groups is evident. The current lack of mention and of any detail on how to address needs of vulnerable groups will significantly impair the access to equitable health care for all.

Challenges to providing HIV prevention education to youth with disabilities in South Africa.

PURPOSE: In South Africa, little is known how HIV prevention education is implemented in schools for learners with disabilities. This article reports on findings from a study exploring the extent to which HIV education is reached to people with disabilities in South Africa, and the challenges faced by educators providing HIV prevention education to learners with disabilities. METHOD: A survey questionnaire completed by 34 schools for learners with special education needs in the Western Cape province of South Africa. Additional complimentary data were collected through interviews with a total of 21 members of staff at schools for learners with disabilities. RESULTS: Respondents recognise the importance of providing HIV prevention education for people with disabilities. Staff reports some challenges in providing HIV prevention education: barriers to communication; discomfort about issues of sexuality and disability; disagreements among staff about what is appropriate content for sexual health education; and fears of promoting sexual activity. CONCLUSIONS: There is a need for HIV prevention education to be specifically customized to the needs of the specific population. A general programme, which is included as part of a general curriculum and generally tailored to "mainstream" schools, would need to be adapted according to specific needs and disabling barriers faced.

Disabled persons' knowledge of HIV prevention and access to health care prevention services in South Africa.

The main research question in this article is how access to information about HIV/AIDS and level of HIV/AIDS prevention related knowledge are distributed among disabled people, and whether level of knowledge predicts access to HIV/AIDS related services. A survey was carried out among a sample of 285 disabled people from three provinces in South Africa. Analyses of the data revealed that gender and level of education, together with geographical differences, are key predictors for access to information and knowledge about HIV/AIDS among disabled people. For male respondents number of information sources predicts access to voluntary counselling and testing services and HIV testing, while knowledge about prevention predicts access to Voluntary Counselling and Testing centres. Significant gender differences with regards to information, knowledge and access to services highlight the need for gender specific prevention strategies among disabled people.

Professional carers' perspectives on participation for older adults living in place.

PURPOSE: The purpose of this study was to provide knowledge about professional carers' subjective descriptions and understanding of older adults' participation in everyday life, when living in place and depending on home-based service delivery. METHOD: Thirty professionals from different organisational levels were selected, allowing for differences in ages, gender, length of working experience, and profession or education. Six focus group discussions were held. A grounded theory approach was used to analyse the data. RESULTS: The core category was identified as 'participation in one's own life'. Two categories included the care providers' descriptions and understanding of participation in the life of older adults; 'carrying out tasks in everyday-life' and 'interaction during service delivery'. Participation as carrying out tasks was related to the contexts inside and outside the house. The professional carers' understandings of older adults' participation in interaction during service delivery included three categories; 'Being included and taking part in decision-making', 'socialising during service delivery' and 'collaboration in keeping up or regaining functions'. CONCLUSIONS: To promote participation for older adults living in place and in the context of service delivery, the findings suggest that the professional carers must extend their focus on participation as socialising and its significance for older adults. At a system level there is a need to focus on how the professional role in home-based service delivery can be adjusted and developed to promote collaboration about participation in older adults.