An initiative to develop capability-adjusted life years in Sweden (CALY-SWE): Selecting capabilities with a Delphi panel and developing the questionnaire.

INTRODUCTION: Capability-adjusted life years Sweden (CALY-SWE) are a new Swedish questionnaire-based measure for quality of life based on the capability approach. CALY-SWE are targeted towards use in cost-effectiveness evaluations of social welfare consequences. Here, we first motivate the measure both from a theoretical and from a Swedish policy-making perspective. Then, we outline the core principles of the measure, namely the relation to the capability approach, embedded equity considerations inspired by the fair-innings approach, and the bases for which capabilities should be considered. The aims were to 1) the most vital capabilities for individuals in Sweden, 2) to define a sufficient level of each identified capability to lead a flourishing life, and to 3) develop a complete questionnaire for the measurement of the identified capabilities. MATERIAL AND METHODS: For the selection of capabilities, we used a Delphi process with Swedish civil society representants. To inform the questionnaire development, we conducted a web survey in three versions, with each Swedish 500 participants, to assess the distribution of capabilities that resulted from the Delphi process in the Swedish population. Each version was formulated with different strictness so that less strict wordings of a capability level would apply to a larger share of participants. All versions also included questions on inequality aversion regarding financial, educational, and health capabilities. RESULTS: The Delphi process resulted in the following six capabilities: Financial situation & housing, health, social relations, occupations, security, and political & civil rights. We formulated the final phrasing for the questionnaire based on normative reasons and the distribution of capabilities in the population while taking into account inequality aversion. CONCLUSION: We developed a capability-based model for cost effectiveness economic evaluations of broader social consequences, specific to the Swedish context.

Healthy Aging-Relevant Goals: The Role of Person-Context Co-construction.

OBJECTIVES: This article considers how individuals' motivation for healthy aging manifests within the myriad of different contexts that older adults are embedded in as they move through later life. METHODS: Drawing on the concept of co-construction, we argue that persons and contexts both contribute to the emergence, maintenance, and disengagement from healthy aging relevant goals in adulthood and old age. RESULTS: To promote the understanding of such co-constructive dynamics, we propose four conceptual refinements of previous healthy aging models. First, we outline various different, often multidirectional, ways in which persons and contexts conjointly contribute to how people set, pursue, and disengage from health goals. Second, we promote consideration of context as involving unique, shared, and interactive effects of socio-economic, social, physical, care/service, and technology dimensions. Third, we highlight how the relevance, utility, and nature of these context dimensions and their role in co-constructing health goals change as individuals move through the Third Age, the Fourth Age, and a terminal stages of life. Finally, we suggest that these conceptual refinements be linked to established (motivational) theories of lifespan development and aging. DISCUSSIONS: In closing, we outline a set of research questions that promise to advance our understanding of the mechanisms by which contexts and aging persons co-construct healthy aging relevant goals and elaborate on the applied significance of this approach for common public health practices.

The real-world cost-effectiveness of bariatric surgery for the treatment of severe obesity: a cost-utility analysis.

BACKGROUND: Severe obesity is associated with adverse health outcomes and increased risk of death. This study evaluates the real-world cost-utility of therapy for severe obesity, from the publicly funded health care system and societal perspectives. METHODS: We conducted a cost-utility analysis using primary data from a prospective observational cohort of adults living with severe obesity (BMI ≥ 35 kg/m2 and a major medical comorbidity or BMI ≥ 40 kg/m2) who were enrolled in a regional obesity program over 2 years. We extrapolated 10-year and lifetime Markov models, validated and supplemented with literature sources, to compare medical, surgical and standard care therapies. We performed deterministic and probabilistic sensitivity analyses. RESULTS: The cohort included 500 adults living with severe obesity, 150 of whom received laparoscopic surgical therapy. From a publicly funded health system perspective, at 2 years, surgical therapy had an incremental cost-effectiveness ratio (ICER) of $54 456 per quality-adjusted life-year (QALY) compared with standard care therapy. Over a lifetime, it had an ICER of $14 056 per QALY. From the societal perspective, at 2 years, surgical therapy had an ICER of $340 per QALY; over a lifetime, it was the dominant option. The results were robust to sensitivity analysis. INTERPRETATION: From a public health care perspective, surgery for severe obesity is cost effective, and when approached from a societal perspective, it becomes cost saving. Real-world data support using surgical therapy for severe obesity, and our results contribute to the health economic and clinical literature with regard to a robust analysis from a societal perspective.

Psychometric testing of perceived implicit rationing of nursing care (PIRNCA).

AIMS: To evaluate the psychometric properties of the Perceived Implicit Rationing of Nursing Care (PIRNCA) instrument and to report the prevalence of rationed care at university and faculty hospitals. DESIGN: A cross-sectional study. METHODS: The study was carried out at two university and five faculty hospitals in the Slovak Republic. Participants were 895 Registered Nurses recruited by the purposive sampling method between December 2017-July 2018. Data were collected using the PIRNCA instrument. Construct validity and reliability of the instrument were tested. RESULTS: The prevalence of rationed care at university and faculty hospitals was identified as being 42.1%. Furthermore, 87.6% of nurses reported rationing one or more nursing care activities. Using both statistical methods when evaluating the PIRNCA resulted in the confirmation that the tool is valid and reliable. CONCLUSION: Rationed care is a common phenomenon at university and faculty hospitals. The PIRNCA is a suitable instrument to measure the phenomenon in adult acute care units because of its high reliability and validity. We recommend using the instrument in different contexts, not only for specific conditions that were presented for this study. IMPACT: Rationed care at university and faculty hospitals has never been reported. Psychometric properties of the instrument that measures nurses´ perception of rationed care have never been evaluated by using different approaches. The most frequently rationed nursing care activities are those that nurses are competent to initiate on the basis of their knowledge and skills - the independent ones. The PIRNCA is a valid and reliable instrument. Hospital management can use the instrument to explore the prevalence of rationed care, followed by the application of prevention strategies. Our findings represent the base for further exploration of rationed care using the PIRNCA.

Communities as 'renewable energy' for healthcare services? a multimethods study into the form, scale and role of voluntary support for community hospitals in England.

OBJECTIVE: To examine the forms, scale and role of community and voluntary support for community hospitals in England. DESIGN: A multimethods study. Quantitative analysis of Charity Commission data on levels of volunteering and voluntary income for charities supporting community hospitals. Nine qualitative case studies of community hospitals and their surrounding communities, including interviews and focus groups. SETTING: Community hospitals in England and their surrounding communities. PARTICIPANTS: Charity Commission data for 245 community hospital Leagues of Friends. Interviews with staff (89), patients (60), carers (28), volunteers (35), community representatives (20), managers and commissioners (9). Focus groups with multidisciplinary teams (8 groups across nine sites, involving 43 respondents), volunteers (6 groups, 33 respondents) and community stakeholders (8 groups, 54 respondents). RESULTS: Communities support community hospitals through: human resources (average=24 volunteers a year per hospital); financial resources (median voluntary income = £15 632); practical resources through services and activities provided by voluntary and community groups; and intellectual resources (eg, consultation and coproduction). Communities provide valuable supplementary resources to the National Health Service, enhancing community hospital services, patient experience, staff morale and volunteer well-being. Such resources, however, vary in level and form from hospital to hospital and over time: voluntary income is on the decline, as is membership of League of Friends, and it can be hard to recruit regular, active volunteers. CONCLUSIONS: Communities can be a significant resource for healthcare services, in ways which can enhance patient experience and service quality. Harnessing that resource, however, is not straight forward and there is a perception that it might be becoming more difficult questioning the extent to which it can be considered sustainable or 'renewable'.

Reconceptualising precision public health.

As currently conceived, precision public health is at risk of becoming precision medicine at a population level. This paper outlines a framework for precision public health that, in contrast to its current operationalisation, is consistent with public health principles because it integrates factors at all levels, while illuminating social position as a fundamental determinant of health and health inequities. We review conceptual foundations of public health, outline a proposed framework for precision public health and describe its operationalisation within research and practice. Social position shapes individuals' unequal experiences of the social determinants of health. Thus, in our formulation, precision public health investigates how multiple dimensions of social position interact to confer health risk differently for precisely defined population subgroups according to the social contexts in which they are embedded, while considering relevant biological and behavioural factors. It leverages this information to uncover the precise and intersecting social structures that pattern health outcomes, and to identify actionable interventions within the social contexts of affected groups. We contend that studies informed by this framework offer greater potential to improve health than current conceptualisations of precision public health that do not address root causes. Moreover, expanding beyond master categories of social position and operationalising these categories in more precise ways across time and place can enrich public health research through greater attention to the heterogeneity of social positions, their causes and health effects, leading to the identification of points of intervention that are specific enough to be useful in reducing health inequities. Failure to attend to this level of particularity may mask the true nature of health risk, the causal mechanisms at play and appropriate interventions. Conceptualised thus, precision public health is a research endeavour with much to offer by way of understanding and intervening on the causes of poor health and health inequities.As currently conceived, precision public health is at risk of becoming precision medicine at a population level. This paper outlines a framework for precision public health that, in contrast to its current operationalization, is consistent with public health principles because it integrates factors at all levels, while illuminating social position as a fundamental determinant of health and health inequities. We review conceptual foundations of public health, outline a proposed framework for precision public health and describe its operationalization within research and practice. Social position shapes individuals' unequal experiences of the social determinants of health. Thus, in our formulation, precision public health investigates how multiple dimensions of social position interact to confer health risk differently for precisely defined population subgroups according to the social contexts in which they are embedded, while considering relevant biological and behavioural factors. It leverages this information to uncover the precise and intersecting social structures that pattern health outcomes, and to identify actionable interventions within the social contexts of affected groups. We contend that studies informed by this framework offer greater potential to improve health than current conceptualizations of precision public health that do not address root causes. Moreover, expanding beyond master categories of social position and operationalizing these categories in more precise ways across time and place can enrich public health research through greater attention to the heterogeneity of social positions, their causes and health effects, leading to identification of points of intervention that are specific enough to be useful in reducing health inequities. Failure to attend to this level of particularity may mask the true nature of health risk, the causal mechanisms at play and appropriate interventions. Conceptualized thus, precision public health is a research endeavour with much to offer by way of understanding and intervening on the causes of poor health and health inequities.

In-depth examination of issues surrounding the reasons for child marriage in Kelantan, Malaysia: a qualitative study.

OBJECTIVE: To examine individual, familial, community and societal issues surrounding the reasons for child marriage in Kelantan, Malaysia. DESIGN: Qualitative study by means of semistructured interviews with women and key informants, using social-ecological model as a conceptual framework. SETTING: Interviews were conducted in Kota Bharu district, Kelantan, a northeast state in Peninsular Malaysia. PARTICIPANTS: Eighteen women of reproductive age (18 to 44 years old) that experienced their first marriage below the age of 18, as well as five key informants, consisting of a government officer, a community leader, an officer from religious department and two mothers. The women were recruited from a reproductive health clinic. The key informants who had specialised knowledge related to child marriage were selectively chosen. RESULTS: Three themes emerged that aligned with the social-ecological model: immaturity in decision-making, family poverty and religious and cultural norms. CONCLUSIONS: The findings imply that sex education and awareness-building activities regarding the consequences of child marriage must be implemented to eradicate child marriage in Malaysia. Such implementation must be coordinated as a team-based approach involving experts in such fields as law, religion, psychology, social-welfare and public health. In order to increase the awareness of child marriage consequences, the target for awareness must extend not only to the adolescent girls and their families, but also to the community and society at large by clearly communicating the negative consequences of and addressing the drivers for child marriage.

The Role of Inclusion Benefits in Ethics Committee Assessment of Research Studies.

The relationship between risks and benefits is central to the ethics of research involving human participants. Traditionally, to be ethically justifiable, risks should be reasonable in relation to anticipated benefits (if any) to subjects and to the potential social benefits resulting from research. This calculus is being further complicated by findings from an increasing number of social science studies that reveal that prospective and actual research participants frequently describe various types of inclusion benefits (for example, personal benefits such as access to or improved health care, increased knowledge about their disease or condition, and greater solidarity with the local community) as important to them. What is the ethical significance of such inclusion benefits, particularly those nonmedical in nature, for research ethics committees' risk-benefit assessment of research studies? We argue that, unless participants are clearly mistaken in their perceptions, ethics committees should take these types of inclusion benefits into account, and we suggest a few ways this might look in practice.

Fair or square? Experiences of introducing a new method for assessing general work ability in a sickness insurance context.

PURPOSE: To study social validity and perceived fairness of a new method for assessing general work ability in a sickness insurance context. Assessments are based on self-reports, combined with examinations by physicians, and, if needed, occupational therapists, physiotherapists and/or psychologists. MATERIALS AND METHODS: Interviews with 36 insurance officials, 10 physicians, and 36 sick-listed persons, which were analysed through a qualitative content analysis. RESULTS: Insurance officials and physicians considered the method useful and that it facilitated benefit decisions. The experiences of persons who had undergone the assessment differed, where the dialog with insurance officials seemed to have had an influence on experiences of the assessment and the decisions it led to. CONCLUSIONS: The perceived fairness and social validity of the assessment depended on how it was carried out; organisational conditions and priorities; communication skills; and decision outcomes. Professionals have an important pedagogical task in explaining the purpose and procedure of the assessment in order for the sick-listed to perceive it as fair rather than square, i.e., too standardised and not considering individual conditions. If the assessment could be used also for rehabilitative purposes, it could possibly be perceived as more acceptable also in cases where it leads to denied benefits. Implications for rehabilitation The perceived fairness of work ability assessments is dependent on procedures for the assessment, communication with the person, and the outcome. What is considered fair differs between assessing professionals and persons being assessed. Professionals may influence the perceptions of fairness through their way of communication. Assessments need to be coupled with rehabilitation measures in order to perceived as relevant and acceptable.

Qualidade da assistência em saúde mental: desenvolvimento de um instrumento de avaliação / Calidad de la atención en salud mental: desarrollo de un instrumento de evaluación / Care quality in mental health: development of an assessment instrument

Objetivo: desenvolver um instrumento para avaliar a estrutura e o processo da assistência em saúde mental nos centros de atenção psicossocial e buscar evidências de validade de conteúdo. Método: estudo transversal, metodológico, com abordagem quantitativa, em duas etapas. Considerou-se a avaliação normativa, a partir de um instrumento de pesquisa (check-list). Na verificação dos níveis de concordância e de consistência entre os juízes (n=50), foram aplicados o Coeficiente Kappa e o Índice de Validade de Conteúdo. Resultados: a maioria dos juízes era da região Sudeste: enfermeiros, doutores, atuantes na docência e pesquisa. Na rodada 1, dos 40 itens propostos para o instrumento, 13 foram excluídos e 08 sugeridos. Na segunda rodada, dois novos sugeridos. Conclusão: a composição do instrumento foi aceita pelos juízes e os índices aplicados mostraram evidências de validade de conteúdo do mesmo.

Objective: this study aimed to develop an instrument to evaluate the structure and process of mental health care in Psychosocial Care Centers and to seek evidence of content validity. Method: cross-sectional methodological study with quantitative approach intwo stages. The normative evaluation of a research instrument (checklist) was carried out. The Kappa coefficient and the ContentValidity Index were applied to check the levels of agreement and consistency among judges (n=50). Results: most of the judgeswere from the southeast region: nurses, doctors, active in teaching and research. In phase 1, 13 of the 40 proposed items of the instrument were excluded and 08 suggested. In phase 2, two new items were suggested. Conclusion: the composition of theinstrument was accepted by judges and the applied indexes indicated evidence of validity of their content.

Objetivo: este estudio tuvo como objetivo desarrollar una herramienta para evaluar la estructura y el proceso de la atención sanitaria prestada en los centros de atención psicosocial y buscar evidencias de validez de contenido. Método: Estudio transversal, metodológico con enfoque cuantitativo en dos etapas. Se consideró la evaluación normativa, a partir de un instrumento de investigación (lista de comprobación). En la verificación de los niveles de concordancia y de consistencia entre los jueces (n = 50) seaplicaron el Coeficiente Kappa y el Índice Validez de Contenido. Resultados: La mayoría de los jueces eran del Sudeste: los enfermeros, doctores, activos en la docencia y en la investigación. En la fase 1, entre los 40 artículos propuestos, se excluyeron 13 y08 sugeridos. En la fase 2, dos nuevos fueron sugeridos. Conclusión: La composición del instrumento fue aceptado por los jueces y los índices aplicados indican evidencias de la validez de su contenido.

Impact of Performance Feedback in Family-Centered and Culturally Responsive Interview Instruction.

PURPOSE: Conducting culturally responsive and family-centered diagnostic interviews is an important part of speech and language services. However, there is limited information on the effective ways to teach speech-language pathology graduate students to acquire these skills. The purpose of this study was to examine the effect of performance feedback on graduate students' use of ethnographic principles, open-ended questions, and restating and summarizing comments in caregiver interviews. METHOD: A randomized controlled crossover design (n = 26) was used to examine the differential effects of students receiving performance feedback or general feedback on role-play interviews. Ethnographic principles, open-ended questions, and restating and summarizing comments were measured at 3 time points: after class instruction (Groups 1 and 2), after the first feedback type allocation (Group 1: performance feedback; Group 2: general feedback), and after the second feedback type allocation (Group 1: general feedback; Group 2: performance feedback). RESULTS: Statistically significant increases, with large effect sizes, were found in students' use of ethnographic principles, open-ended questions, and restating and summarizing comments following the performance feedback conditions. CONCLUSION: These findings suggest that performance feedback is an effective and efficient instructional procedure to increase culturally responsive and family-centered interview skills through an ethnographic interview approach in preservice speech-language pathology students.

[Budget impact analysis of antiplatelet therapy with ticagrelor and clopidogrel in patients with acute coronary syndrome after coronary artery bypass surgery]. / Analiz «vliyaniya na byudzhet¼ primeneniya antitrombotsitarnoi terapii tikagrelorom i klopidogrelom u patsientov s ostrym koronarnym sindromom, perenesshikh operatsiyu koronarnogo shuntirovaniya.

AIM: Clinical and economic examinations were made to study whether it is appropriate to use antiplatelet therapy (APT) with ticagrelor in combination with acetylsalicylic acid (ASA) versus a combination of clopidogrel and ASA in patients with acute coronary syndrome (ACS) following coronary artery bypass surgery (CABS). MATERIAL AND METHODS: A budget impact analysis was used. Data on the efficiency and safety of APT were taken from a relevant analysis in the subgroups of the randomized controlled trial PLATO. Direct medical cost due to APT and expenses on therapy for acute myocardial infarction, stroke, and massive bleeding, and those on medical care for patients dying from cardiovascular events and other causes, as well as indirect cost - gross domestic product (GDP) losses due to untimely death, were taken into account. The findings were assessed from the perspectives of society. RESULTS: The analysis indicated that direct medical costs per patient following CABS, both in case of calculation based on the recorded price for ticagrelor and on the median registered prices for clopidogrel generics, and based on the auction prices for comparison agents proved to be lower when clopidogrel was administered because of the higher cost of ticagrelor-based APT. At the same time GDP losses due to untimely death, as calculated per patient with ACS during post-CABS therapy with clopidogrel + ASA, were more than twice above average losses per patient taking ticagrelor in combination with ACA (107,122 and 221,645 rubles, respectively). From the registered price for ticagrelor and the median registered prices for clopidogrel generics, the total costs per patient with ACS following CABS were lower if Brilinta was used in combination with ASA versus therapy with clopidogrel in combination with ASA (210,092 and 273,257 rubles per year, respectively; the cost savings were 63,165 rubles per patient per year when ticagrelor was administered). On the basis of the auction prices for comparison drugs, the total costs per patient with ACS after CABS proved to be lower if Brilinta was used in combination with ASA versus therapy with brand name clopidogrel in combination with ASA (201,018 and 293,982 rubles per patients year, respectively; the cost savings were 92,963 rubles per patient per year when ticagrelor was used). CONCLUSION: The use of ticagrelor in combination with ASA ensures resource savings to treat ACS patients undergoing CABS as compared with a regiment including a combination of clopidogrel and ASA.

Inadequate physical activity and health care expenditures in the United States.

This study estimates the percentage of health care expenditures in the non-institutionalized United States (U.S.) adult population associated with levels of physical activity inadequate to meet current guidelines. Leisure-time physical activity data from the National Health Interview Survey (2004-2010) were merged with health care expenditure data from the Medical Expenditure Panel Survey (2006-2011). Health care expenditures for inactive (i.e., no physical activity) and insufficiently active adults (i.e., some physical activity but not enough to meet guidelines) were compared with active adults (i.e., ≥150minutes/week moderate-intensity equivalent activity) using an econometric model. Overall, 11.1% (95% CI: 7.3, 14.9) of aggregate health care expenditures were associated with inadequate physical activity (i.e., inactive and insufficiently active levels). When adults with any reported difficulty walking due to a health problem were excluded, 8.7% (95% CI: 5.2, 12.3) of aggregate health care expenditures were associated with inadequate physical activity. Increasing adults' physical activity to meet guidelines may reduce U.S. health care expenditures.

[Modern directions of scientific and practical research of the policy of active and healthy longevity: experience and perspectives].

Modern terminology on active and healthy aging used in scientific and project activities is discussed. There have been analyzed the WHO conception on active aging, which has no precise universally agreed definition, its main determinants. The directions of scientific expertise in the major European projects INNOVAGE - assessment of potentially profitable social innovations relating to the welfare and quality of life and health in old age; MOPACT - the interference between the demographic development and the main dimensions of economic and social contribution of older persons is defined. The approach to implement the policy of active and healthy longevity as a valuable asset of the modern society is underlined.

[The type of age-related cataract as available marker of socially significant diseases of the organism].

The aim of the research was to investigate the general somatic status and to investigate the influence of dominating part of vegetative nervous system, following the different types of senile cataract formation in human. Thus, the domination а sympathetic nervous system and correlated systemic dystrophic changes of the tissues in patients with cortical cataract have been found for the first time. Moreover, patients with nuclear cataract had the domination of parasympathetic nervous system and another character of dystrophic changes. Therefore, the type of a forming age-related cataract can be offered as an available clinical marker of character of neurodystrophic process occurring in an organism.

The social validity of a national assessment centre for selection into general practice training.

BACKGROUND: Internationally, recruiting the best candidates is central to the success of postgraduate training programs and the quality of the medical workforce. So far there has been little theoretically informed research considering selection systems from the perspective of the candidates. We explored candidates' perception of the fairness of a National Assessment Centre (NAC) approach for selection into Australian general practice training, where candidates were assessed by a Multiple Mini Interview (MMI) and a written Situational Judgment Test (SJT), for suitability to undertake general practice (GP) training. METHODS: In 2013, 1,930 medical practitioners, who were eligible to work in Australia attended one of 14 NACs in each of 5 states and 2 territories. A survey was distributed to each candidate at the conclusion of their assessment, which included open-ended questions aimed at eliciting candidates' perceived benefits and challenges of the selection process. A framework analysis was informed by the theoretical lens of Social Validity Theory. RESULTS: Qualitative data was available from 46% (n = 886/1,930) of candidates, who found the NAC experience fair and informative for their training and career goals, but wanted to be provided with more information in preparation. Candidates valued being able to communicate their skills during the MMI, but found some difficulty in interpreting the questions. A significant minority had concerns that a lack of relevant GP experience may inhibit their performance. Candidates also expressed concerns about the time limits within the written paper, particularly if English was not their first language. They also expressed a desire for formative feedback during the interview process. CONCLUSION: During any job selection process, not only is the organisation assessing the candidates, but the candidates are also assessing the organisation. However, a focus on the candidate experience throughout an organisation's selection process may provide benefits to both candidates and the organisation, regardless of whether or not candidates secured the job. Social Validity Theory is a useful addition to the methods for demonstrating the reasonableness of any selection system.

[PhD theses on gerontological topics in Russia 1995-2012: scientometric analysis].

The paper presents a scientometric analysis of PhD theses on gerontological topics in Russian humanities (excluding economics) for the period from 1995 to 2012. During this period, 253 PhD theses (238 of "candidate dissertations," and 15 of "doctoral dissertations") were defended in Russia. Almost half of them were defended during the boom years (2005-2006; 2009-2010). The number of theses defended in the 2000-s has increased significantly compared to the second half of 1990-s. However for gerontological PhD-s overall as a percentage of all theses defended in Russian humanities, the number hardly changed and remained small (less than 0.3%). The leading discipline in the study of aging (within the humanities) is sociology accounting for more than a third of all defended theses. Though the theses were defended in 48 cities, more than half of them were defended in 3 cities, which are Moscow, St. Petersburg and Saratov. Thematic analysis showed that the leading position was occupied by two topics: "the elderly and the state" (42%) and "(re)socialization/adaptation of the elderly" (25%). 14% of the works are devoted to intergenerational relations and social status of the elderly. Other topics (old man/woman's personality, self-perceptions of aging, violence and crime against the elderly, loneliness, discrimination, etc.) are presented by very few studies.

Community aging initiatives and social capital: developing theories of change in the context of NORC Supportive Service Programs.

This study aimed to develop theory on how Naturally Occurring Retirement Communities (NORC) Supportive Service Programs potentially transform social relationships within communities to promote aging in place. Data were analyzed from semi-structured in-depth interviews with 10 lead agencies representing 15 NORC programs in New Jersey. Results indicated that professionals seek to infuse capital within three domains of relationships: lead agency staff's relationships with older adults, formal service providers' relationships with each other, and older adults' relationships with each other. This social capital potentially enhances the amount of community-based services and supports within a residential area, as well as their accessibility, appropriateness, responsiveness, and coherence.