Links across disabilities: unveiling associations between functional domains.

BACKGROUND: Persons with disabilities experience higher risks of mortality as well as poorer health as compared to the general population. The aim of this study is to estimate the correlations between functional difficulties across several domains in six countries. METHODS: National census data with questions on disability from six countries (Mauritius, Morocco, Senegal, Myanmar, Vietnam, and Uruguay) was used in this study. We performed logistic regressions to assess the extent to which having a functional difficulty in one domain is correlated with having a functional difficulty in each of the other domains and report weighted odds ratios (ORs) overall and within age-groups ('18-44' years and '45+' years). Models adjust for age, sex, and location (rural or urban). Sensitivity analyses around different choices of predictors and response variables were conducted. FINDINGS: For all countries, reporting a functional difficulty in one domain was consistently and significantly positively correlated with reporting a functional difficulty in other domains (overall) and for each of the two age-groups considered - '18-44' years and '45+' years. All ORs were greater than one. Cognition, mobility, and hearing were the domains that were the most correlated ones with other domains. The highest pairwise correlations were for i/ hearing and cognition; ii/ mobility and cognition. Results were robust to changing the severity thresholds for functional difficulties. Across countries, Uruguay, the only high-income country among the six countries under study, had the lowest correlations between functional domains. CONCLUSIONS: There are consistent positive associations in the experience of functional difficulties in various domains in the six countries under study. Such correlations may reflect barriers to social services including healthcare services and resources (e.g. assistive devices) that may lead to an avoidable deterioration of functioning across domains. Further research is needed on the trajectories of functional difficulties and on structural barriers that people with functional difficulties may experience in their communities and in healthcare settings in particular. This is important as some functional difficulties may be preventable.

A parametric 3D printed assistive device for people with cerebral palsy - assessment of outcomes and comparison with a commercial counterpart.

This paper presents the use of a parametric design platform and 3D printing to create personalized assistive devices (ADs) for individuals with cerebral palsy, specifically a fork/spoon holder. Five subjects participated in the study, each receiving a customized device to fit their dominant hand, and they tested both the 3D printed device and a commercially available one. The devices were evaluated based on functionality and satisfaction using two standard clinical questionnaires (IPPA and QUEST 2.0). The results showed that neither the 3D printed nor the commercial device provided substantial benefits, but the questionnaires provided valuable feedback on areas for improvement. The study highlights the need for highly personalized solutions in ADs, which could be addressed by 3D printing. A configurator for generating production files from a parametric model could facilitate personalization, but a large number of model versions should be available to meet individual needs. Future research could explore clinical evaluations and guide the development of efficient and effective frameworks for digital fabrication in terms of clinically feasible AD model sourcing.

* 3D printing can be a method of creating assistive devices with dimensions fitting the user.* Standard questionnaires for measuring the effectiveness and satisfaction may efficiently identify shortcomings and suggest improvements.* Each person may have individual requirements, which calls for a large database of solutions in order to meet the person's needs.

Digital Enabling Assistive Technology Through the Provision Lens - A Global Perspective in a Nordic Context.

The Nordic healthcare system is well-established, taxation-based, and locally administered, featuring person-centered care as a social welfare pillar. Public provision of assistive technology and welfare technology within healthcare systems means every citizen has equal access to services. But how well are policies and procedures keeping pace with demographic changes and technology developments?. This study critically analyses qualitative data from 24 stakeholders involved in municipal-level procurement and allocation of assistive and welfare technology in Sweden with a specific focus on emerging digital technology. An extant analysis framework was used: the World Health Organization-GATE 5P framework for strengthening access to AT. Recommendations are made for agile procurement and an outcome-based decision frame. The voice of the AT user may be a valuable addition to inform policy.

Harmonising Assistive Technology Assessment Data: A Case Study in Nepal.

There is a practical demand to maximise existing data to understand and meet the assistive technology (AT) needs in dynamic populations. Harmonisation can generate new insight by integrating multiple datasets that were not previously comparable into a single longitudinal dataset. We harmonised AT assessment data from three population-based surveys collected several years apart in Nepal: the Living Conditions of Persons with Disabilities (2014-2015), the Multiple Indicator Cluster Survey (2019), and the rapid Assistive Technology Assessment (2022). The harmonised dataset demonstrates a method that can be used for unifying AT surveys in other settings and conducting trend analyses that are necessary for monitoring a population's dynamic AT needs. We set out to explore AT data's potential for harmonisation, and learned there is indeed value in this approach for situating disparate datasets, though the methodology proposed will need further validation.

Barriers for Accessing Assistive Products in Low- and Middle-Income Countries (LMICs).

WHO implemented the Rapid Assistive Technology Assessment in 2021. This is a household survey on self-reported use, need and barriers for accessing AT in 35 countries globally. In order to obtain comparable data, all surveys followed guidelines developed by WHO, including national two-stage random sampling of households. The 2021 rATA survey included 32 of a total of 140 LMICs globally. Around 40 % of the total respondents (all countries) estimated travel distance to be <5 km, varying from less than 10 % to almost 60 % among the countries. Around 15 % had to travel more than 50 km, varying from 1.3 % to 37.5 %. More individuals living in rural as compared to urban areas had to travel more than 25 km to get their main assistive product. Gender differences were marginal. By far the most prevalent barrier to access assistive products was "Cannot afford", amounting to 39.9% and varying from 6.7 % to 79.1 % among countries. This was followed by "No support" with 14.3 %, varying from 2.3 % to 36.9 %, and "Not available" with 8.1 %, varying from 1 % to 21.5 %. More barriers were reported in rural than urban areas and women report more barriers than men. Variation between countries in both travel time and barriers is substantial and country-specific service development is needed to guide service development.

Cocreation of Assistive Technologies for Patients With Long COVID: Qualitative Analysis of a Literature Review on the Challenges of Patient Involvement in Health and Nursing Sciences.

BACKGROUND: Digital assistive technologies have the potential to address the pressing need for adequate therapy options for patients with long COVID (also known as post-COVID-19 condition) by enabling the implementation of individual and independent rehabilitation programs. However, the involvement of the target patient group is necessary to develop digital devices that are closely aligned to the needs of this particular patient group. OBJECTIVE: Participatory design approaches, such as cocreation, may be a solution for achieving usability and user acceptance. However, there are currently no set methods for implementing cocreative development processes incorporating patients. This study addresses the following research questions: what are the tasks and challenges associated with the involvement of patient groups? What lessons can be learned regarding the adequate involvement of patients with long COVID? METHODS: First, a literature review based on a 3-stage snowball process was conducted to identify the tasks and challenges emerging in the context of the cocreation of digital assistive devices and services with patient groups. Second, a qualitative analysis was conducted in an attempt to extract relevant findings and criteria from the identified studies. Third, using the method of theory adaptation, this paper presents recommendations for the further development of the existing concepts of cocreation in relation to patients with long COVID. RESULTS: The challenges of an active involvement of patients in cocreative development in health care include hierarchical barriers and differences in the levels of specific knowledge between professionals and patients. In the case of long COVID, patients themselves are still inexperienced in dealing with their symptoms and are hardly organized into established groups. This amplifies general hurdles and leads to questions of group identity, power structure, and knowledge creation, which are not sufficiently addressed by the current methods of cocreation. CONCLUSIONS: The adaptation of transdisciplinary methods to cocreative development approaches focusing on collaborative and inclusive communication can address the recurring challenges of actively integrating patients with long COVID into development processes.

Participatory Action Design and Engineering of Powered Personal Transfer System for Wheelchair Users: Initial Design and Assessment.

Caregivers that assist with wheelchair transfers are susceptible to back pain and occupational injuries. The study describes a prototype of the powered personal transfer system (PPTS) consisting of a novel powered hospital bed and a customized Medicare Group 2 electric powered wheelchair (EPW) working together to provide a no-lift solution for transfers. The study follows a participatory action design and engineering (PADE) process and describes the design, kinematics, and control system of the PPTS and end-users' perception to provide qualitative guidance and feedback about the PPTS. Thirty-six participants (wheelchair users (n = 18) and caregivers (n = 18)) included in the focus groups reported an overall positive impression of the system. Caregivers reported that the PPTS would reduce the risk of injuries and make transfers easier. Feedback revealed limitations and unmet needs of mobility device users, including a lack of power seat functions in the Group-2 wheelchair, a need for no-caregiver assistance/capability for independent transfers, and a need for a more ergonomic touchscreen. These limitations may be mitigated with design modifications in future prototypes. The PPTS is a promising robotic transfer system that may aid in the higher independence of powered wheelchair users and provide a safer solution for transfers.

Assistive technologies and strategies to support the medication management of individuals with hearing and/or visual impairment: A scoping review.

BACKGROUND: Individuals with sensory impairment (visual and/or hearing) experience health inequalities and increased the risk of medication-related iatrogenic disease compared with the general population. Assistive technologies and tailored strategies could support medication management for individuals with sensory impairment to reduce harm and increase the likelihood of therapeutic benefit. OBJECTIVE: This scoping review identified assistive technologies and strategies to support medication management of/for people with hearing and/or visual impairment. METHODS: Standard scoping review methodology was used to identify studies that evaluated technologies or strategies designed to support people with sensory impairment with independent medicine management. Electronic databases were searched (MEDLINE, Embase, CINAHL, ACM, Cochrane) from inception to 18/07/22. Independent duplicate screening, selection, and data extraction were undertaken. RESULTS: Of 1231 publications identified, 18 were included, reporting 17 studies, 16 of which evaluated technologies to assist people with visual impairment and one study to assist people with hearing impairment. The range of technologies and devices included: applications for android phones (n = 6); eyedrop-assistance devices (n = 5); audio-prescription labelling/reading systems (n = 2); touch-to-speech devices (n = 2); continuous glucose monitoring system (n = 1); magnifying technology (n = 1). Ten studies tested early-stage prototypes. Most participants could operate the technologies effectively and deemed them to be useful. CONCLUSIONS: Despite the increasing number of medicine-related assistive technologies, there has been limited empirical evaluation of their effectiveness for supporting individuals with sensory impairment. Prototypes appear to be useful for people with visual or hearing impairment, however wider 'real-life' testing is needed to confirm the benefits of these technologies.

A structural analysis of the rail unit of an indoor assistive mobility system.

BACKGROUND: Individuals with gait disturbances, such as that post-stroke, are discharged home to undergo outpatient rehabilitation. Rehabilitation in the community is not as effective as that in hospital, due to long travel times and short program duration. OBJECTIVE: This study analyzed rail unit structure, with the aim of assisting home indoor assistive mobility system (HIAMS) development, allowing patients to undergo gait-related rehabilitation training at home. METHODS: The HIAMS consists of a mobile rail running around the whole room, a turn-table for movement between rails, and a weight-supporting component. Structural analysis was performed using the Abaqus/CAE solution (Version 6.14, Dassault systems, Inc.) to verify device safety, according to the load applied to the rail and turn-table units. The load was applied vertically at 150 kg to reflect the weight of potential users. RESULTS: Structural analysis was performed on the weight-supporting components, which was consist of turn-table case, bearing components (center, left), connective bracket and rail rollers. The safety factors of each components were estimated as 1.31, 5.39 (bearing, center), 8.45 (bearing, left), 1.43 and 3.61 in sequence. CONCLUSION: We demonstrated a safety factor of ⩾ 1.3 for the key system units, suggesting this technology is safe for use in the home rehabilitation training of individuals with gait impairment post-ICU stay.

Experimental Evaluation of EMKEY: An Assistive Technology for People with Upper Limb Disabilities.

Assistive technology can help people with disabilities to use computers more effectively and can enable them to access the same information and resources as people without disabilities. To obtain more insight into the factors that can bring about the design of an Emulator of Mouse and Keyboard (EMKEY) to higher levels of user satisfaction, an experimental study was conducted in order to analyse its effectiveness and efficiency. The experimental study involved 27 participants (Mage = 20.81, SD = 1.14) who performed three experimental games under different conditions (using the mouse and using EMKEY with head movements and voice commands). According to the results, the use of EMKEY allowed for the successful performance of tasks such as matching stimuli (F(2,78) = 2.39, p = 0.10, η2 = 0.06). However, the execution times of a task were found to be higher when using the emulator to drag an object on the screen (t(52,1) = -18.45, p ≤ 0.001, d = 9.60). These results indicate the effectiveness of technological development for people with upper limb disabilities; however, there is room for improvement in terms of efficiency. The findings are discussed in relation to previous research and are based on future studies aimed at improving the operation of the EMKEY emulator.

Change in care hours, cost, and functional independence following continence and assistive technology intervention in an acquired brain injury population.

PURPOSE: After acquired brain injury (ABI) dependence on intervention for continence management is common. This preliminary investigation aimed to (i) quantify toileting care hours and costs in a community-based ABI rehabilitation and disability setting, and (ii) measure change in care needs, costs, and functional independence after intervention with assistive technologies (ATs). METHOD: Pragmatic pre-post intervention pilot study of 14 adults with ABI and toileting disability accessing community-based neurorehabilitation or disability support in Western Australia. Toileting and functional independence were assessed monthly from baseline (T0) to 3-month follow-up (T3). Basic and nursing care hours (Northwick Park Dependency Score), cost of care estimates (Northwick Park Care Needs Assessment), functional independence (Functional Independence and Assessment Measure), and cost of consumables were examined pre- and post-intervention with ATs. Multilevel mixed-effects models with bootstrap estimation were conducted. RESULTS: Cost of consumables significantly declined (AU$69/week), and functional independence significantly improved following intervention (+23.5 points). There was a non-significant reduction in care needs for toileting (4 h/week) and in the cost of toileting care (AU$633/week). CONCLUSION: Toileting disability substantially impacts care hours and costs. This study provides preliminary evidence that comprehensive continence management is beneficial in reducing costs and supporting people with an ABI to increase their independence.IMPLICATIONS FOR REHABILITATIONA comprehensive continence assessment and management plan reduces the number of care hours, cost of care, and cost of continence products in a neurorehabilitation and disability support sample for people with acquired brain injury (ABI).Assistive technologies for continence management are beneficial in supporting people with ABI to increase independence, and reduce costs.Providing comprehensive continence assessment and management plan reduces reliance on staff for continence care, and improves functional independence.

Design of a low-cost, reconfigurable, standing wheelchair with easy and stable sit-stand-sit transition capability.

PURPOSE: Assistive devices like Standing Wheelchairs (SWC) have remained out of reach of the economically underprivileged even before the pandemic-induced financial downturn, and more so now. This paper describes the mechanical design of a manual user-actuated SWC that is cost-effective (equivalent of USD 210 in India, ex-factory) and has special features that minimise user effort and accommodates varying body weights (50-110 kg) and dimensions (1.52-1.83 m height). METHODS: The design includes a six-bar mechanism and spring balancing to optimise user effort during operation. The optimised gas spring incorporates adjustability to minimise each user's force for sit-stand-sit transitions. The handle shape is ergonomically designed using kinematic analysis to provide convenient gripping positions for actuation. The design has been customised based on parametric studies to suit varying body weights. RESULTS: Overall, the SWC design provides standing functionality with ease of operation, safety locks, customisability, affordability, outdoor mobility and is aesthetically pleasing. CONCLUSIONS: Customisability and the low cost of the device would enhance the accessibility of the SWC to a larger group of eligible users.Implications for rehabilitationManual user-operated standing wheelchair design using a six-bar mechanismSpring balancing used to reduce user effort to self-lift to the standing positionKinematic analysis used to determine convenient handle location for user easeCustomisability for wide range of users to ensure correct posture, optimal effortDesign refined through multiple iterations using inputs from users and cliniciansDesign commercialised at an affordable cost, making it accessible to a larger population.

The informal economy as a provider of assistive technology: lessons from Indonesia and Sierra Leone.

Promoting the use of assistive technology (AT) is crucial for the health and well-being of users, but there is a huge global problem of unmet need for AT. In this context informal (unregulated) providers of AT play a significant role of meeting AT user need, particularly in less-resourced settings. This study draws on research into formal and informal AT provision in low-income urban communities in Indonesia and Sierra Leone to explore the potential of informal providers in addressing unmet need. Specifically, it looks at the different performance of formal and informal providers regarding the availability and the adequacy of AT that they provide. The study concludes by proposing further research into the scope for coproduction of AT between formal and informal providers.

Assistive technology (AT) (e.g. wheelchairs, hearing aids, or products for people with visual impairments) are crucial for the wellbeing of users, but there is huge and growing unmet need for AT globally. In low-income settings many users access AT from the informal (unregulated) economy, which tends to provide AT in under-served communities, and at lower cost, helping to address this gap. However, AT from informal providers often fails to meet minimum product standards and/or lacks associated services such as assessment, fitting, user training, maintenance and repairs. On the other hand, many users of AT from informal sources value, in addition to low cost, some other features, such as their ability to customize assistive products and innovate in product development. This study therefore proposes exploring ways in which formal and informal providers of AT could work together to improve access at the same time as ensuring the safety and quality of AT for low-income users.

Improving access to prosthetic services in Western Nepal: a local stakeholder perspective.

PURPOSE: Evidence of effective strategies to improve access to assistive technology (AT) like prostheses is limited, especially in rural and remote areas of low- and middle-income countries where unmet needs are the greatest. This study aimed to identify barriers and facilitators to accessing prosthetic services in rural areas of western Nepal and explore strategies to improve access from the perspective of local stakeholders. METHOD: Semi-structured interviews were conducted with 13 service providers and consumers. Barriers and facilitators of access were highlighted and potential solutions to overcome access barriers were explored using thematic analysis of transcripts. RESULTS: Six themes concerning barriers and facilitators arose: awareness and literacy of prosthetic services, attitudes and belief systems, financial supports, geographical access, health system and referral processes, as well as service provider capacity and regulation. Six themes regarding potential solutions were also identified: awareness campaigns, procurement pathways, referral pathways, subsidised and shared costs of AT, professional support networks and development opportunities, as well as task shifting and sharing. CONCLUSIONS: While facilitating interventions support access to prosthetic services, they remain insufficient to overcome several barriers that continue to inhibit this access. Nevertheless, real opportunities to alleviate barriers and address the unmet need exist and must be explored.Implications For RehabilitationIt is advised that rehabilitation professionals, particularly those delivering prosthetic services in rural and remote settings of Nepal, consider piloting alternative service delivery strategies which utilise resources accessible to them in order to overcome several existing barriers to AT access e.g., task shifting.Rehabilitation professionals in Nepal have the opportunity to support others working in low-resources settings to expand professional development opportunities through online and digital platforms.Gathering and sharing data on the current state of prosthetic and AT service delivery within Nepal is highly valuable to the development of the prosthetic rehabilitation profession and ultimately equity in access to appropriate AT.Proposed interventions identified within this study can potentially serve to guide stakeholders in rural and remote settings of other LMICs in developing strategies to overcome barriers to AT access suitable to their context.

Coordination of health and rehabilitation services for person with disabilities in Sierra Leone - a stakeholders' perspective.

PURPOSE: To explore stakeholders' perceptions of the coordination of health and rehabilitation services for persons with disabilities in Sierra Leone. MATERIALS AND METHODS: A qualitative study including seven focus group discussions with health, rehabilitation, and disability organisations stakeholders in Sierra Leone. Content analysis was used for data analysis. RESULTS: One theme emerged; poor governance in implementing disability policies, healthcare, and rehabilitation services, which included seven subthemes: insufficient implementation of healthcare policies for persons with disabilities; changes, lack of coordination and communication between ministries governing disability policies and rehabilitation services; need for accurate disability data and clinical record keeping; absence of funds and poor political priority to healthcare and rehabilitation services; continuous support for non-governmental organisations (NGOs) to provide healthcare and rehabilitation service delivery; lack of coordination between different healthcare and rehabilitation service providers and calling for increasing persons with disabilities capacity for greater inclusion in society. CONCLUSIONS: Increasing governmental prioritisation, and ensuring coordination and trust between donors, NGOs, and governmental programmes were keys for sustainable health and rehabilitation services. Stakeholders need to ensure national coverage and equally distributed health and rehabilitation services. Including rehabilitation services and assistive technology in the Free Healthcare Initiative would contribute to implementing the Disability Act. Implications for rehabilitationPolitical prioritisation of persons with disability (PWD) need to increase to provide national coverage and equally distributed health and rehabilitation services for PWD.To ensure access to rehabilitation services and access to basic assistive technology for PWD, the government of Sierra Leone could agree on basic rehabilitation services and a priority list of assistive devices to be distributed through rehabilitation centres and funded by the Free Health Care Initiative programme or the Sierra Leone health insurance scheme.To increase access to health services for PWD, the government of Sierra Leone could ensure inclusion of PWD in the Free Health Care Initiative programme.The government, donors, and organisations providing or funding health and rehabilitation services for PWD need to mobilise and coordinate resources better and be mutually held accountable to maximise the benefits of PWD resources.

Effects of Assistive Technology Application in Dementia Intervention for People with Mild Cognitive Impairment & Mild Alzheimer Type Dementia and Caregiver.

Background: Dementia, a degenerative disease, requires alternative treatment to maintain function, but previous studies suggest only the therapeutic effect of a temporary program. Primary Study Objective: The current study aimed to examine the effects of assistive technologies on cognitive function, daily living ability, and psychosocial symptoms in elderlies with mild cognitive impairment, elderlies with mild dementia and their caregivers. Design: The research team designed an experimental study that used application as the intervention. Setting: To recruit participants living in the local community, research participation was supported through local public health centers, welfare centers, and social welfare organizations. Evaluation and intervention were conducted by visiting the participant's home. Participant: The study participants were 29 Mild Cognitive Impairment (MCI) and 16 mild Alzheimer type dementia (AD) patients over the age of 75 with a total of 45 patients, 10 MCI caregivers and 11 AD caregivers with a total of 21 caregivers. Intervention: The assistive technologies used for intervention are 3 area (8 daily living assistive devices, 7 safety assistive technologies, and 7 cognitive assistive technologies). Up to 5 assistive technologies were provided to one subject, and they were instructed to use them every day for 8 weeks. Outcome measure: Participants were evaluated at baseline and postintervention using specific scales appropriate to an area: cognitive function, activities of daily living, depression, anxiety, quality of life, satisfaction. Results: Cognitive function showed statistically significant changes in the MCI group. Basic activities of daily living, depression, anxiety, quality of life, satisfaction showed statistically significant positive effects in both MCI and AD groups. Instrumental activities of daily living did not show any statistically significant differences. Conclusion: As an alternative to dementia care in the future, the application and management of assistive technologies for each area should be provided at the government level.

Development of a metric to evaluate the ergonomic principles of assistive systems, based on the DIN 92419.

The DIN 92419 defines six principles for assistive systems' ergonomic design. There is, however, a lack of measurement tools to evaluate assistive systems considering these principles. Consequently, this study developed a measurement tool for the quantitative evaluation of the fulfilment of each principle for assistive systems. A systematic literature review was performed to identify dimensions belonging to the principles, identify how previous research evaluated these dimensions, and develop a measurement tool for assistive systems. Findings show that scales commonly used for evaluating assistive systems disregard several aspects highlighted as relevant by research, implying the need for considering the DIN 92419 principles. Based on established scales and theoretical findings, a questionnaire, and a checklist for evaluating assistive systems were developed. The work provides a grounding for measuring relevant aspects of assistive systems. Further development is needed to substantiate the reliability and validity of the proposed questionnaire scales and items. Practitioner Summary: Responding to the gap of a holistic measurement tool to evaluate assistive systems, a systematic literature review was performed considering the DIN 92419 principles. This resulted in a comprehensive summary of relevant aspects of assistive systems that were made numerically measurable, which proposes better criteria to assess assistive systems. Abbreviations: IoT: internet of things; RQ: research question; TAM: technology acceptance model; UTAUT: unified theory of acceptance and use of technology; AaaS: adaptivity as a service; SAR: socially assistive robots; SEEV: salience, effort, expectancy, and value; PRISMA: preferred reporting items for systematic reviews and meta-analyses; HMI: human-machine interaction; HRI: human-robot interaction; BCI: brain-computer interface; QUEST: Quebec user evaluation of satisfaction with assistive technology; SUS: system usability scale; NASA-TLX: NASA task load index; ATD PA: assistive technology device predisposition assessment; Wheel Con: wheelchair use confidence scale; CATOM: caregiver assistive technology outcome measure; CBI: caregiver burden inventory; RoSAS: robotic social attributes scale; WheelCon: wheelchair use confidence scale; IMI: intrinsic motivation inventory; ATD PA: assistive technology device predisposition assessment; UEQ: User experience questionnaire; USEUQ: usefulness satisfaction and ease of use questionnaire; USPW: usability scale for power wheelchairs; UES: user engagement scale; SUTAQ: service user technology acceptability questionnaire; QUEAD: questionnaire for the evaluation of physical assistive devices; FATCAT: functional assessment tool for cognitive assistive technology; SE-HRI: human-robot interaction scale; SART: situation awareness rating technique; TSQ;WT: tele-healthcare satisfaction questionnaire-wearable technology; PAIF: participants' assessment of the intervention's feasibility; SWAT: subjective workload assessment technique; MARS-HA: measure of audiologic rehabilitation self-efficacy for hearing aids; IOI-HA: International outcome inventory for hearing aids; FMA: functional mobility assessment; FBIS: familiarity and behavioural intention survey; CSQ: client satisfaction questionnaire; COPM: canadian occupational performance measure; ATCS: assistive technology confidence scale; ACC: acceptance; SSP: safety, security and privacy; OPT: optimisation of resultant internal load; CTRL: controllability; ADAPT: adaptability; P&I: perceptibility and identifiability; AAL: ambient assisted living; VR: virtual reality; AS: assistive system; WEIRD: Western, educated, industrialised, rich, and democratic; HEART: horizontal european activities of rehabilitation technology; AAATE: advancement of assistive technology in Europe's; GATE: global collaboration on assistive technology; ATA-C: assistive technology assessment toolkit.

Educação permanente no sistema único de saúde: concepções de profissionais da gestão e dos serviços / Continuing permanent education in the brazilian national health system: conceptions from management and care professionals / Educación continua en el sistema único de salud brasileño: concepciones de los profesionales de gestión y servicios

Este artigo pretende compreender as concepções de profissionais da gestão e dos serviços do Sistema Único de Saúde (SUS) sobre Educação Permanente em Saúde (EPS), bem como seus desafios e potencialidades. Utilizou-se de grupo focal para coleta, seguido de análise lexical do tipo classificação hierárquica descendente com auxílio do software Iramuteq. Os resultados delinearam quatro classes: a) EPS - entendimentos e expectativas; b) entraves à EPS; c) ETSUS e EPS por meio de cursos e capacitações; e d) dispositivos de EPS: potencialidades e desafios. Os participantes apontaram equívocos de entendimentos acerca da EPS ao equipará-la à Educação Continuada (EC) voltada à transferência de conteúdo, com repercussões negativas na prática de EPS. Discute-se o risco em centralizar o responsável pela concretização dessa proposta, que deveria ser coletiva e compartilhada entre diferentes atores. Reivindica-se, portanto, uma produção colaborativa, que possa circular entre os envolvidos, de modo que cada um experimente esse lugar e se aproprie da complexidade de interações propiciadas pela Educação Permanente em Saúde.(AU)

This article aims to understand the conceptions of professionals from the management and services of the Unified Health System (SUS) on Permanent Education in Health (EPS), as well as its challenges and potential. A focus group was used for data collection, followed by a lexical analysis of the descending hierarchical classification type using the Iramuteq software. The results delineated four classes: a) EPS - understandings and expectations; b) obstacles to EPS; c) ETSUS and EPS by courses and training; and d) EPS devices: potentialities and challenges. Participants pointed out misunderstandings about EPS, when equating it with Continuing Education (CE) focused on content transfer, with negative repercussions on EPS practice. The risk of centralizing the person responsible for implementing this proposal, which should be collective and shared among different actors, is discussed. Therefore, a collaborative production is claimed for, which can circulate among those involved, so that each one experiences this place and appropriates the complexity of interactions provided by Permanent Education in Health.(AU)

Este artículo tiene por objetivo comprender las concepciones de los profesionales de la gestión y servicios del Sistema Único de Salud (SUS) sobre Educación Continua en Salud (EPS), así como sus desafíos y potencialidades. Se utilizó un grupo focal para la recolección de datos, seguido por un análisis léxico del tipo clasificación jerárquica descendente con la ayuda del software Iramuteq. Los resultados delinearon cuatro clases: a) EPS: entendimientos y expectativas, b) Barreras para EPS, c) ETSUS y EPS a través de cursos y capacitación, y d) Dispositivos EPS: potencialidades y desafíos. Los participantes informaron que existen malentendidos sobre EPS al equipararla a Educación Continua, con repercusiones negativas en la práctica de EPS, orientada a la transferencia de contenidos. Se discute el riesgo de elegir a un solo organismo como responsable de implementar esta propuesta colectiva, que debería ser colectiva y compartida entre los diferentes actores. Se aboga por un liderazgo colaborativo, que pueda circular entre los involucrados, para que cada uno experimente este lugar y se apropie de la complejidad de interacciones que brinda la Educación Continua en Salud.(AU)

Relevance of assistive technology and the sustainable development goals to stakeholder organizations in Malawi.

Assistive technologies are critical to supporting the participation and engagement of persons with disabilities and others who experience functional difficulties in daily life. Assistive products have been demonstrated to be related to the achievement of the Sustainable Development Goals (SDGs); however, no previous research has explored the relationship between assistive technology (AT) and the SDGs from the perspective of stakeholder organisations working in the field of AT provision. In this study, we evaluated the relevance of AT and the SDGs to achieving the organisational missions of key stakeholders in AT ecosystem in Malawi. Key stakeholders (n = 36) in the AT field in Malawi were asked to rate the relevance of AT to achieving their organisational missions, and the relevance of AT to each of the 17 SDGs on a 5-point Likert scale. Stakeholders who participated were engaged in consultative meetings with the government and an action research team as part of a larger policy development project, and represented ministries and government agencies, organisations of persons with disabilities, and local and international non-governmental organisations. AT was rated as being relevant to all of the SDGs, albeit to varying degrees, and not surprisingly to achieving AT stakeholders' organisational missions. The cross-cutting nature of the relevance of AT underscores the importance of cross-ministerial cooperation and shared leadership in provision AT.

Equity in AgeTech for Ageing Well in Technology-Driven Places: The Role of Social Determinants in Designing AI-based Assistive Technologies.

AgeTech involves the use of emerging technologies to support the health, well-being and independent living of older adults. In this paper we focus on how AgeTech based on artificial intelligence (AI) may better support older adults to remain in their own living environment for longer, provide social connectedness, support wellbeing and mental health, and enable social participation. In order to assess and better understand the positive as well as negative outcomes of AI-based AgeTech, a critical analysis of ethical design, digital equity, and policy pathways is required. A crucial question is how AI-based AgeTech may drive practical, equitable, and inclusive multilevel solutions to support healthy, active ageing.In our paper, we aim to show that a focus on equity is key for AI-based AgeTech if it is to realize its full potential. We propose that equity should not just be an extra benefit or minimum requirement, but the explicit aim of designing AI-based health tech. This means that social determinants that affect the use of or access to these technologies have to be addressed. We will explore how complexity management as a crucial element of AI-based AgeTech may potentially create and exacerbate social inequities by marginalising or ignoring social determinants. We identify bias, standardization, and access as main ethical issues in this context and subsequently, make recommendations as to how inequities that stem form AI-based AgeTech can be addressed.