'You Just Struggle on Your Own': Exploring Older People and Their Caregivers' Perspectives About Falls Prevention Education in Hospitals.

BACKGROUND: Providing older patients with an opportunity to participate in individualised falls preventive education, has been shown to reduce hospital falls. However, few studies have explored older peoples' perspectives of hospital falls prevention education. This study aimed to explore older people and their caregivers' knowledge and awareness about hospital falls prevention, including their reflections on the education they received when hospitalised. METHODS: A qualitative, exploratory study with focus groups and semistructured interviews was conducted. Participants were a purposively selected sample of community-dwelling older people (65+ years) admitted to a hospital in the past 5 years and caregivers of older people. Data were thematically analysed using deductive and inductive approaches, and a capability-opportunity-motivation-behaviour model was applied to understand key determinants of implementing falls education for hospitalised older people. RESULTS: Participants' [n = 46 (older people n = 37, age range 60-89 years), caregivers n = 9] feedback identified five themes: distress and disempowerment if the participant did have a hospital fall or nearly fell, anxiety and uncertainty about what behaviour was required while in hospital, insufficient and inconsistent falls prevention education, inadequate communication and underlying attitudes of ageism. Applying a behaviour change model suggested that older people and their caregivers did not develop falls prevention knowledge, awareness or motivation to engage in falls prevention behaviour. Older people were also provided with limited opportunities to engage in falls preventive behaviour while in hospital. CONCLUSION: Older people in our study received sporadic education about falls prevention during their hospital admissions which did not raise their awareness and knowledge about the risk of falls or their capability to engage in safe falls preventive behaviour. Conflicting messages may result in older people feeling confused and anxious about staying safe in hospital.

CONNECT 60+: A Wellness Program for Older Adults Delivered From a Community Hub.

BACKGROUND: Community hubs offer a pragmatic approach to address the wellness needs for older adults at risk of social isolation and declining physical activity. OBJECTIVE: The current study evaluated the effectiveness of a wellness program delivered from a community hub (either in person or online) on exercise and social connections of community-dwelling older adults living in Australia during a time of social isolation imposed by COVID-19. METHODS: A single group pre-post quasi-experimental study was conducted online and in person from a community hub. The 9-week program (CONNECT60+) was designed using a community-based participatory approach. It consisted of weekly group exercises led by a health professional and a wellness activity that aligned with active ageing guidelines, such as education, book club, and nature walks. Participants were encouraged to complete daily wellness activities and record these in a workbook. Data were gathered at pretest and 10-week post-test using questionnaires. RESULTS: A total of 47 participants completed the program. Most participants were aged between 64 and 74 years (61.7%), and 82.9% were female. Thirty-five participants (74.5%) attended the program in person, and 12 (25.5%) attended online from home. Preliminary findings showed participants prioritized social connections during the week and increased the duration (median [interquartile range] minutes) of exercise completed per week (pretest: 285 minutes (inter-quartile range, 246-567 minutes); post-test: 346 minutes (interquartile range, 150-415 minutes); P < .01). CONCLUSIONS: The study endorsed the wellness program delivered in person and online from a community hub to enable older adults to complete wellness activities, including exercise and socially connecting during a time of self-isolation due to the COVID-19 pandemic.

Older adults' experiences of a community wellness program (Connect 60+) that focused on physical activity and social connections: a qualitative exploratory study.

BACKGROUND: Being physically active and socially connected is positively associated with healthy aging. Older adults living in the community may be at risk of social isolation and reduced physical activity, especially in recent times due to COVID-19. There are many programs that offer opportunities for evidence-based physical activity or social connection; however, there is a lack of programs that include both. The objective of this study was to explore the lived experience of older adults who participated in Connect 60+ - a program that promoted exercise and social activities - delivered from a community hub that could be attended either in person or online. METHODS: A qualitative study that used descriptive phenomenology was conducted. A purposive sample of 13 older adults (age ≥65years) was recruited to take part in semistructured telephone interviews to discuss barriers and enablers to program engagement. Data were analysed using thematic analysis. RESULTS: The overarching theme was that participating in Connect 60+ was an enjoyable and encouraging experience for participants. The program enabled them to increase their physical activity and build social connections within their community. The main themes that enabled engagement were: (1) an enabling program design, (2) developing new connections in the community, and (3) experiencing motivation to engage. A few barriers were identified, including difficulties connecting online and lack of male attendance. CONCLUSIONS: Wellness programs delivered in community hubs may facilitate older adults to increase their engagement in both physical and social activity. The program appeared to impact positively on participants' motivation, with some participants reporting that they had sustained their behaviour changes since program completion. To address identified barriers, easy to use online technology is recommended, and strategies to promote male attendance.

How does the school built environment impact students' bullying behaviour? A scoping review.

RATIONALE: School bullying is a public health concern affecting the physical and mental health of children and young people. While school-based interventions to prevent bullying have been developed internationally, the effectiveness of many interventions has been mixed and modest. Despite a growing recognition that the school built environment may impact bullying behaviour, few anti-bullying interventions have addressed the built environment. OBJECTIVE: This systematic scoping review explored existing literature for evidence that the school built environment influences bullying behaviour in school students. METHODS: The review was guided by Arksey and O'Malley's methodological framework for scoping reviews. A search of six databases (Medline, PsycINFO, ERIC, EMBASE, CINAHL Plus and The Cochrane Library) identified studies addressing primary, middle and secondary school students, bullying, school bullying locations, and school built environments. Peer-reviewed journal articles published in English prior to July 19, 2021, were included. RESULTS: In total, 7568 documents were screened by title and abstract. Following a full-text review, 61 studies (63 articles) were selected; 43 studies identified school bullying locations, and 19 studies linked features of the school built environment to bullying behaviour. Classrooms, playgrounds, and corridors were identified as common bullying locations. Features of the school built environment linked to bullying behaviour included security cameras, architectural design, aesthetics, seating, and vandalism. CONCLUSIONS: This review identified key school settings for anti-bullying interventions and identified gaps in existing built environment and bullying literature. Further analyses of published studies will inform anti-bullying policy and practice.

Prescribing tailored home exercise program to older adults in the community using a tailored self-modeled video: A pre-post study.

Background: Community rehabilitation for older people after hospital discharge is necessary to regain functional ability and independence. However, poor adherence to exercise programs continues to hinder achieving positive health outcomes in older people. This study aimed to evaluate the effectiveness of prescribing a tailored video self-modeled DVD-HEP for 6 weeks, on functional mobility, physical activity, exercise self-efficacy, and health-related quality of life, in a sample of frail older adults. Materials and methods: A pre- and post-test intervention study design was conducted, with each participant acting as their own control. A convergent, parallel, mixed-methods approach involving quantitative, and qualitative data collection was used. Participants received an individualized assessment at baseline and subsequently were provided with a 30-min tailored 6-week self-modeled DVD-HEP that showed the physiotherapist instructing the participant. The physiotherapist phoned participants fortnightly to encourage engagement in the program and explore responses to it. Outcomes evaluated included functional mobility, balance, gait speed, and exercise self-efficacy. Results: Participants (n = 15) showed clinically meaningful improvements at follow-up compared to baseline in functional mobility (TUGMCID = 3.4-3.5 s, 3-MWTMCID = 0.1-0.2 m/s) and gait speed (3-MWTMCID = 0.1-0.2 m/s). There were also significant improvements in balance and self-efficacy for exercise and a 2.5- and a 1.3-fold increase in moderate and light physical activity participation at follow-up compared to baseline. The deductive themes were: (i) Enjoyment, self-efficacy, and wellbeing; (ii) Achieving life goals; (iii) Background music as a motivator to adherence; and (iv) Enhanced motor performance and learning: Task goal mastery, multimodal feedback, autonomy to self-regulate learning. The new inductive theme was (v) Preference for in-person support for exercise. Conclusion: Future studies are warranted to compare a tailored self-modeled video HEP to face-to-face programs and other digital health modalities to evaluate older adults' adherence levels and functional improvement.

In-the-moment experiences of mothers of children with autism spectrum disorder: a comparison by household status and region of residence.

PURPOSE: This study compared the in-the-moment experiences among mothers of children with Autism Spectrum Disorders (ASD) by their household status (i.e., single versus coupled) and region of residence (i.e., regional versus major city area). METHODS: An experience sampling method was employed to collect data, and a total of 40 mothers used an iOS device to record activity types and in-the-moment experiences for one week during school term. Mann-Whitney U test and multilevel analysis were conducted to compare the experiences of these mothers. RESULTS: The analyses found the following results: 1) mothers spent most time in childcare and least time in self-care activities; 2) coupled mothers were more likely to feel supported; 3) coupled mothers were less likely to feel supported in domestic tasks; 4) mothers from major city were more likely to feel challenged in self-care activities; and 5) mothers from major city were more likely to feel supported in productivity tasks. CONCLUSION: Limited but significant differences between single and coupled mothers, as well as mothers from regional and major city areas, were found. Future research direction and service provisions were suggested.Implications for rehabilitationThis study shows that all mothers spent the most time on childcare and the least amount of time on self-care activities.In-the-moment experiences between single and coupled mothers, as well as mothers from major cities and mothers from regional areas, differ somewhat; however, this study builds evidence to support that these mothers' experiences are similar.The result of the study indicates that single mothers require extra support as they carry similar levels of responsibilities as coupled mothers, but without the support of a partner.Promoting a sense of control may assist all mothers to fully engage in parenting activities.

Scoping review on noticing concerns in child development: a missing piece in the early intervention puzzle.

BACKGROUND: Between 13 and 32% of children in developed nations are at-risk for developmental delays. In order to identify concerns, there is a need to understand the mechanisms that facilitate becoming aware of it. AIM: A scoping review was conducted to understand this process of "noticing", through existing literature on parent experiences. METHODS: Records from major academic databases and grey literature sources were searched using key terms. Thematic analysis was then conducted to synthesise findings. RESULTS: Twenty papers meeting inclusion were identified. Noticing a delay was found to be an interplay between who notices - parents or other - and how they do so. How concerns are noticed was through two mechanisms: knowledge of child development, and comparison with other children. CONCLUSIONS: This review highlights the nuanced complexity of noticing concerns with a child's development. Understanding how this process occurs and the key ingredients that enable it is vital to supporting early detection of developmental delays.Implications for rehabilitationNoticing developmental delays is a complex process that evolves over time, derived of 'who' notices and 'how' this occurs.When asking parents about child development, professionals need to listen for both bolder "aha moments" as well as more subtle "niggling" comments as indicators of parental concerns.Building baseline parental knowledge of developmental milestones may facilitate noticing of atypical development.Encouraging parents to engage in social opportunities with other children promotes both positive child development and enables developmental monitoring through use of comparison.

A twelve-month follow-up of an information communication technology delivered intervention for children with autism spectrum disorder living in regional Australia.

This study investigated the long-term follow-up of an information communication techonology based intervention, the Therapeutic Outcomes By You application, for children with autism spectrum disorder living in regional Australia. Fifteen participants who completed a three-month randomised controlled trial of the Therapeutic Outcomes By You were assessed at least 12 months post-intervention to determine the maintenance or continued improvement of their language and social communication skills. Findings demonstrate the receptive language, social skills, pragmatic language and playfulness of children with autism spectrum disorder improved during the three-month intervention period and were maintained at least 12 months after ceasing the Therapeutic Outcomes By You app intervention.

Road vehicle transportation of children with physical and behavioral disabilities: A literature review.

Background: A literature review in 2001 found that children with disabilities were frequently transported in unsafe conditions and further research was required to investigate the gap between regulations, standards and actual transportation practices.Objectives: To synthesize available evidence on the transportation of children with disabilities in road vehicles.Methods: Four databases were systematically searched: CINAHL; Medline; National Transport Library Catalogue (Sweden); and Transport Research International Documentation.Results: Nineteen studies ranging in methodological quality from poor to excellent were included in the review. The findings are presented under the following six major themes: child safety restraints, wheelchairs, vehicles, travel habits, parental and professional knowledge. The results are mapped onto two groups of children, those with behavioral problems and those with physical disabilities.Conclusion: The literature reflected little change across the six major themes since the previous review. Children with disabilities continue to be inappropriately restrained in vehicles, constituting an ongoing road safety problem. There is a strong need to increase parent knowledge, upskill health professionals and provide families with financial assistance to enable them to ensure the safe transportation of children with disabilities to minimize the risk of injury and fatalities on the road, and enhance their participation in the community.

Appropriateness of the TOBY Application, an iPad Intervention for Children with Autism Spectrum Disorder: A Thematic Approach.

This study aimed to explore the appropriateness of an ICT intervention, the Therapeutic Outcomes by You application (TOBY app), from the perspectives of the parents. Parental experiences of twenty-four parents of a child with ASD who had participated in a three-month trial using the TOBY app were collected using semi-structured interviews. Thematic analysis was conducted and themes were mapped against an appropriateness framework. Collectively, parents felt the TOBY app was relevant and important to them and their children's needs, while expressing partial support of the TOBY app as: a positive experience for them and their children, beneficial for them and their children, a socially and ecological valid intervention, and an intervention that supported change and continuation in the skills learnt.

Preparing Children with Autism for Transition to Mainstream School and Perspectives on Supporting Positive School Experiences.

School readiness is important to a positive start and success in school but children with Autism Spectrum Disorder (ASD) are at risk of not being school-ready. This study aimed to explore parent and therapist perspectives on school readiness skills of children with ASD and factors impacting on a positive mainstream school experience. A mixed methods design was used. Key findings were that school readiness depends on child and school factors, with social skills the most important child factor. The child's experience was largely reliant on teacher and education assistant attitudes and highlighted a need for further training and support. This study identified areas of focus for early intervention as well as school-aged intervention and the need for collaborative practice.

Parental experiences using the Therapy Outcomes by You (TOBY) application to deliver early intervention to their child with autism.

PURPOSE: As computer-based interventions become commonplace for parents of children with neurodevelopmental disorders, this study sought to understand the experience of using a parent-delivered supplementary early intervention therapy for children with autism spectrum disorder grounded in a variety of behavioral, sensory, developmental, and relationship-based approaches and delivered via a tablet device. METHODS: Parental experiences using the 'Therapy Outcomes by You' (TOBY) application were collected through semi-structured interviews with 17 parents. RESULTS: Parents reported TOBY facilitated parent-child engagement, provided ideas for therapeutic activities, created feelings of empowerment, and positively impacted their child's development. Barriers to use included preparation time, execution of the intervention, and individual strengths and weaknesses of their child. CONCLUSION: The overall parental experience of TOBY was positive when use of the application aligned with parental proficiency, opportunities for use, and importantly, the needs of the child.

A Randomised Controlled Trial of an Information Communication Technology Delivered Intervention for Children with Autism Spectrum Disorder Living in Regional Australia.

This exploratory randomised controlled trial tested the effectiveness of a tablet-based information communication technology early intervention application to augment existing therapy with the aim of improving visual motor, imitation, language and social skills in young children with ASD who reside in regional areas. Fifty-nine participants were recruited and randomised to either a therapy-as-usual group or intervention group. With the exception of the expressive language subscale on the Mullen Scales of Early Learning, no significant between-group differences were recorded for visual motor, imitation, receptive language and social skills of participants between baseline and post-intervention. When all participants were pooled and measured over time, improvements were shown in receptive and pragmatic language and social skills; these gains were maintained, thus suggesting skill acquisition.

An examination of health promotion and social inclusion activities: A cross-sectional survey of Australian community Men's Sheds.

ISSUE ADDRESSED: The activities and well-being outcomes from participating at Men's Sheds are the focus of a growing body of research. Although many Men's Sheds have a clear health or social philosophy, this does not always translate into health and social activities. METHOD: This cross-sectional survey explored the health promotion and social inclusion activities of Men's Sheds and features of Sheds that predict greater levels of these activities. All Australian Men's Sheds were invited to participate. Based on survey responses, Sheds were classified as "active" or "not active" in health promotion and social inclusion, which formed the main survey outcomes. Profiles of the responding Sheds were summarised and compared against the main survey outcomes. Multivariate logistic regression analyses explored the profile variables associated with "active" Sheds. RESULTS: Responses from 300 Sheds indicated 37% and 70% of Sheds were "active" in health promotion and social inclusivity respectively. Number of members, members with mental illness or of Indigenous descent, providing meals and targeting war veterans were associated with health promotion. Having five or more members with a disability, members with English as a second language, targeting of war veterans were associated with social inclusiveness. CONCLUSIONS: Men's Sheds may serve as a unique community resource to reduce barriers of access to preventative health care, education and social connectedness, especially for marginalised members and those living in rural communities. SO WHAT?: A proportion of Men's Sheds reflects the health and well-being exemplars mentioned in the National Male Health Policy that can help to counter the social determinants of poor health, particularly for marginalised males.

The experiences of mothers of children with autism spectrum disorder: Managing family routines and mothers' health and wellbeing.

BACKGROUND/AIM: Families of children with autism spectrum disorder (ASD) use family routines to provide predictability and structure to support occupational engagement of their family members. Mothers assume the major role to orchestrate occupations in constructing family routines, which may impact their health and wellbeing. However, the experiences of mothers in managing family routines and their health and wellbeing have not been the main focus in previous research. Thus, this study explored the experiences of mothers of children with ASD in managing family routines and their perceptions of the impact of family routines on their health and wellbeing. METHODS: An interpretive phenomenological approach was used. Twenty mothers of children with ASD, aged between 28 and 56 years, participated in semi-structured interviews. Data were transcribed verbatim and each transcript was analysed. RESULTS: Five themes that summarise mothers' perceptions towards health and wellbeing when managing family routines emerged: (i) Keeping on track keeping healthy; (ii) My life is busy, because I do everything for everyone else; (iii) Keeping on track all the time is tiring or frustrating; (iv) Looking after my family by looking after myself; and (v) I am not perfect and it is OK. CONCLUSION: This study highlighted the substantial efforts required in constructing family routines that may be at the cost of mothers' health and wellbeing. However, mothers may be able to cope with everyday demands in managing family routines by changing their perspectives. By integrating 'me-time' activities in family routines, mothers may be able to support their own health and wellbeing. Mothers' values and needs are reflected in family routines; hence, thorough understanding of family routines may be a key to support mothers' occupational engagement.

Scoping Review of the Driving Behaviour of and Driver Training Programs for People on the Autism Spectrum.

Gaining a driver's licence represents increased independence and can lead to improved quality of life for individuals and their families. Learning to drive a motor vehicle and maintaining safe on-road skills are often more difficult for people on the autism spectrum. Many countries currently have no autism-specific licencing requirements for learner drivers, and there is a general lack of ASD-specific support and training packages for individuals, their families, and driving instructors. This review synthesises the peer-reviewed literature about the driving characteristics of drivers on the spectrum and driver training available for the cohort. The evidence in this review showed that individuals on the autism spectrum drive differently from their neurotypical counterparts. There are shortcomings in tactical skills of drivers on the autism spectrum, but the extent to which this affects their own safety or the safety of other road users is unclear. Tactical skills can be improved through training programs. There are few autism spectrum-specific learner training programs available. Development of an effective training program will benefit individuals on the spectrum to learn to drive, be independent, and be safe on the road.

Intergenerational mentoring at Men's Sheds: A feasibility study.

BACKGROUND: This study reports on the feasibility of an intergenerational mentoring programme for youth with intellectual disability (ID) aimed at developing skills and building networks. METHODS: Youth with ID were paired with older male mentors who were trained to support the mentees participate in activities and social interactions during weekly sessions. We interviewed the mentees and mentors, and assessed them on a range of outcomes using standardized measures. RESULTS: Interviews highlighted that the programme presented a great "opportunity" for the mentees and mentors. The participants described facilitators and challenges to the acquisition of practical skills by mentees and the development of relationships between mentors and mentees, including communication, transportation and mentor training. The youth with ID had difficulty completing the self-report measures. CONCLUSIONS: Mentoring programmes are viable to support youth with ID during the transition to adulthood; however, refinement is required in the rollout out of a pilot intervention.

Factors associated with stress in families of children with autism spectrum disorder.

PURPOSE: The purpose of this study was to identify key factors associated with severe stress in families raising a child with autism spectrum disorder (ASD). METHODS: Questionnaires were mailed to families with one or more children with a diagnosis of ASD. Data from 543 surveys were analyzed using univariate and multivariate logistic regression. RESULTS: Forty-four percent (n = 241) of the caregivers reported severe family stress related to raising a child with ASD. Severe family stress was associated with (1) reduced ability to socialize; (2) not having accessed individual therapy; (3) negative co-parent relationships; and (4) high out of pockets costs due to the child's ASD. The specific ASD diagnosis, comorbid conditions, socio-demographic variables, and social support were not associated with severe family stress. CONCLUSION: The findings of the current study highlight the importance of a systemic approach to family stress, whereby individual, family, and ecological factors are investigated.