Understanding the use of digital technologies to provide disability services remotely during the COVID-19 pandemic; a multiple case study design.

BACKGROUND: Using digital technologies to provide services and supports remotely may improve efficiency and accessibility of healthcare, and support people with disabilities to live independently. This study aimed to explore the experience of using digital technologies to access and provide disability services and supports during the Covid-19 pandemic, from the perspective of people with disabilities, families and service providers. METHODS: Using a multiple case study design, we purposively sampled three cases based on service user characteristics and geographical reach of the service. We conducted semi-structured interviews with 40 service users and service providers. Topic guides and analysis were informed by the Consolidated Framework for Implementation Research (CFIR). Analysis followed a largely deductive approach, using the CFIR constructs as a coding framework. A summary memo was developed for each case. Influence and strength of each construct was rated to identify constructs that influenced implementation of digital technologies. Ratings were compared across services to identify facilitators and barriers to implementation. RESULTS: Service users and providers were positive about using digital technologies to access and provide disability services and supports remotely. Advantages over in-person delivery included reduced travel time, increased opportunity for peer support and peer learning, more choice and opportunity to participate in activities, and an enhanced sense of self while accessing services from the secure environment of their home. The urgency to identify new modes of service delivery to meet the needs of service users during Covid-19 was a strong facilitator but did not necessarily result in successful implementation. Other factors that were strong facilitators were the use of adaptations to enable service users to access the online service, service users' willingness to try the online service, service users' persistence when they encountered challenges, and the significant time and effort that service providers made to support service users to participate in the online service. Barriers to implementation included the complexity of accessing online platforms, poor design quality of online platforms, and organisations prioritising in-person delivery over online services. CONCLUSIONS: These findings may allow service providers to leverage facilitators that support implementation of online disability services and supports.

Death anxiety, self-worth, and exposure to human donor remains: A longitudinal study of Irish medical students.

This study aimed to investigate the relationship between death anxiety levels at pre-exposure to human donor remains, post-exposure self-worth, and post-exposure death anxiety levels, among a sample of Irish medical students. A multi-wave prospective study was conducted, using questionnaires administered at six time-points. Path analysis was used to investigate the effect of pre-exposure death anxiety levels and post-exposure self-worth on post-exposure death anxiety levels. Baseline death anxiety was found to predict post-exposure death anxiety. Furthermore, self-worth at one month of exposure was found to mediate the relationship between pre-exposure death anxiety levels and death anxiety levels at six months.

Commentary: Challenges and opportunities in autism assessment - a commentary on Kanne and Bishop (2020).

Kanne and Bishop's (2020) Editorial Perspective 'The Autism waitlist crisis and remembering what families need' offers a strong argument to provide greater access to high-quality assessments for Autism Spectrum Disorder (ASD). They note, correctly, that due to increasing numbers of referrals practitioners are under increasing pressure to provide quicker or abbreviated evaluations, that some cases are extremely complex and require considerable expertise to assess, and that a good assessment is a good investment in effective intervention. I agree with these points but also want to highlight some difficulties and dilemmas associated with the assessment of ASD; and to argue that improving access to assessments and interventions through the use of nonspecialists and new technologies may be a promising direction.

Exploring equity and inclusion in Malawi's National Disability Mainstreaming Strategy and Implementation Plan.

BACKGROUND: Equity and inclusion are important principles in policy development and implementation. The aim of this study is to explore the extent to which equity and inclusion were considered in the development of Malawi's National Disability Mainstreaming Strategy and Implementation Plan. METHODS: We applied an analytical methodology to review the Malawi's National Disability Mainstreaming Strategy and Implementation Plan using the EquIPP (Equity and Inclusion in Policy Processes) tool. The EquIPP tool assesses 17 Key Actions to explore the extent of equity and inclusion. RESULTS: The development of the Malawi National Disability Mainstreaming Strategy and Implementation Plan was informed by a desire to promote the rights, opportunities and wellbeing of persons with disability in Malawi. The majority (58%) of the Key Actions received a rating of three, indicating evidence of clear, but incomplete or only partial engagement of persons with disabilities in the policy process. Three (18%) of the Key Actions received a rating of four indicating that all reasonable steps to engage in the policy development process were observed. Four (23%) of the Key Actions received a score five indicating a reference to Key Action in the core documents in the policy development process. CONCLUSIONS: The development of disability policies and associated implementation strategies requires equitable and inclusive processes that consider input from all stakeholders especially those whose wellbeing depend on such policies. It is pivotal for government and organisations in the process of policy or strategy development and implementation, to involve stakeholders in a virtuous process of co-production - co-implementation - co-evaluation, which may strengthen both the sense of inclusion and the effectiveness of the policy life-cycle.

Opportunities for human resources for health and rehabilitation: a response to Jesus et al.

We welcome Jesus et al.'s paper, which makes an important contribution to the under-researched area of the physical rehabilitation workforce. The authors present recommendations to "advance a policy and research agenda for ensuring that an adequate rehabilitation workforce can meet the current and future rehabilitation health needs" (p. 1). We argue that their perspective could however be strengthened by adopting a stronger global perspective, including consideration of the needs of low-resource settings. In particular, we highlight the integral role of more effective sector and inter-sectoral governance, the opportunity to support the development of community-based rehabilitation (CBR), the lessons that can be learnt from human resources for health (HRH) research and practice more generally, and the recent developments in the global provision of assistive technologies. Each of these issues has important implications and contributions to make to advance the policy and research agenda for the global rehabilitation workforce.

A study of human resource competencies required to implement community rehabilitation in less resourced settings.

BACKGROUND: It is estimated that over one billion persons worldwide have some form of disability. However, there is lack of knowledge and prioritisation of how to serve the needs and provide opportunities for people with disabilities. The community-based rehabilitation (CBR) guidelines, with sufficient and sustained support, can assist in providing access to rehabilitation services, especially in less resourced settings with low resources for rehabilitation. In line with strengthening the implementation of the health-related CBR guidelines, this study aimed to determine what workforce characteristics at the community level enable quality rehabilitation services, with a focus primarily on less resourced settings. METHODOLOGY: This was a two-phase review study using (1) a relevant literature review informed by realist synthesis methodology and (2) Delphi survey of the opinions of relevant stakeholders regarding the findings of the review. It focused on individuals (health professionals, lay health workers, community rehabilitation workers) providing services for persons with disabilities in less resourced settings. RESULTS: Thirty-three articles were included in this review. Three Delphi iterations with 19 participants were completed. Taken together, these produced 33 recommendations for developing health-related rehabilitation services. Several general principles for configuring the community rehabilitation workforce emerged: community-based initiatives can allow services to reach more vulnerable populations; the need for supportive and structured supervision at the facility level; core skills likely include case management, social protection, monitoring and record keeping, counselling skills and mechanisms for referral; community ownership; training in CBR matrix and advocacy; a tiered/teamwork system of service delivery; and training should take a rights-based approach, include practical components, and involve persons with disabilities in the delivery and planning. CONCLUSION: This research can contribute to implementing the WHO guidelines on the interaction between the health sector and CBR, particularly in the context of the Framework for Action for Strengthening Health Systems, in which human resources is one of six components. Realist syntheses can provide policy makers with detailed and practical information regarding complex health interventions, which may be valuable when planning and implementing programmes.

Globalization and Health: developing the journal to advance the field.

Founded in 2005, Globalization and Health was the first open access global health journal. The journal has since expanded the field, and its influence, with the number of downloaded papers rising 17-fold, to over 4 million. Its ground-breaking papers, leading authors -including a Nobel Prize winner- and an impact factor of 2.25 place it among the top global health journals in the world. To mark the ten years since the journal's founding, we, members of the current editorial board, undertook a review of the journal's progress over the last decade. Through the application of an inductive thematic analysis, we systematically identified themes of research published in the journal from 2005 to 2014. We identify key areas the journal has promoted and consider these in the context of an existing framework, identify current gaps in global health research and highlight areas we, as a journal, would like to see strengthened.

Assistive products and the Sustainable Development Goals (SDGs).

The Sustainable Development Goals (SDGs) have placed great emphasis on the need for much greater social inclusion, and on making deliberate efforts to reach marginalized groups. People with disabilities are often marginalized through their lack of access to a range of services and opportunities. Assistive products can help people overcome impairments and barriers enabling them to be active, participating and productive members of society. Assistive products are vital for people with disabilities, frailty and chronic illnesses; and for those with mental health problems, and gradual cognitive and physical decline characteristic of aging populations. This paper illustrates how the achievement of each of the 17 SDGs can be facilitated by the use of assistive products. Without promoting the availability of assistive products the SDGs cannot be achieved equitably. We highlight how assistive products can be considered as both a mediator and a moderator of SDG achievement. We also briefly describe how the Global Cooperation on Assistive Technology (GATE) is working to promote greater access to assistive products on a global scale.

Promoting good policy for leadership and governance of health related rehabilitation: a realist synthesis.

BACKGROUND: Good governance may result in strengthened performance of a health system. Coherent policies are essential for good health system governance. The overall aim of this research is to provide the best available scientific evidence on principles of good policy related leadership and governance of health related rehabilitation services in less resourced settings. This research was also conducted to support development of the World Health Organization's (WHO) Guidelines on health related rehabilitation. METHODS: An innovative study design was used, comprising two methods: a systematic search and realist synthesis of literature, and a Delphi survey of expert stakeholders to refine and triangulate findings from the realist synthesis. In accordance with Pawson and Tilley's approach to realist synthesis, we identified context mechanism outcome pattern configurations (CMOCs) from the literature. Subsequently, these CMOCs were developed into statements for the Delphi survey, whereby 18 expert stakeholders refined these statements to achieve consensus on recommendations for policy related governance of health related rehabilitation. RESULTS: Several broad principles emerged throughout formulation of recommendations: participation of persons with disabilities in policy processes to improve programme responsiveness, efficiency, effectiveness, and sustainability, and to strengthen service-user self-determination and satisfaction; collection of disaggregated disability statistics to support political momentum, decision-making of policymakers, evaluation, accountability, and equitable allocation of resources; explicit promotion in policies of access to services for all subgroups of persons with disabilities and service-users to support equitable and accessible services; robust inter-sectoral coordination to cultivate coherent mandates across governmental departments regarding service provision; and 'institutionalizing' programmes by aligning them with preexisting Ministerial models of healthcare to support programme sustainability. CONCLUSIONS: Alongside national policymakers, our policy recommendations are relevant for several stakeholders, including service providers and service-users. This research aims to provide broad policy recommendations, rather than a strict formula, in acknowledgement of contextual diversity and complexity. Accordingly, our study proposes general principles regarding optimal policy related governance of health related rehabilitation in less resourced settings, which may be valuable across diverse health systems and contexts.

Resilience and well-being amongst seafarers: cross-sectional study of crew across 51 ships.

OBJECTIVES: Duration at sea was investigated as a potential chronic stressor amongst seafarers in addition to the mediating roles of previous seafaring experience and hardiness between duration and stress. METHODS: In a cross-sectional design, questionnaires were emailed to 53 tanker vessels in an international shipping company with questions relating to duration at sea, perceived stress, personality hardiness and work characteristics. The sample comprised 387 seafarers (98% male) including ratings, crew, officers, engineers, and catering staff that had been on board their ship between 0 and 24 weeks. RESULTS: Duration at sea was unrelated to self-reported perceived stress, even after controlling for previous seafaring experience and hardiness. Additional regression analyses demonstrated that self-reported higher levels of resilience, longer seafaring experience and greater instrumental work support were significantly associated with lower levels of self-reported stress at sea. CONCLUSIONS: These results imply that at least for the first 24 weeks at sea, exposure to the seafaring environment did not act as a chronic stressor. The confined environment of a ship presents particular opportunities to introduce resilience and work support programmes to help seafarers manage and reduce stress, and to enhance their well-being at sea.

Optimal evidence in difficult settings: improving health interventions and decision making in disasters.

Martin Gerdin and colleagues argue that disaster health interventions and decision-making can benefit from an evidence-based approach Please see later in the article for the Editors' Summary.

The Kenyan assistive technology ecosystem: a network analysis.

BACKGROUND: Assistive technology is central to the realization of the rights of persons with disabilities. However, there remains limited access to assistive technology throughout much of the world, with particularly poor access in lower- and middle-income countries. Evaluating stakeholder engagement in assistive technology networks has been used as a successful strategy to understand and address gaps in the assistive technology ecosystem. OBJECTIVE: The objective of this research was to provide an overview of the Kenyan Assistive Technology Ecosystem, including available assistive products and related services, and an understanding of the nature and strength of relationships between stakeholders. METHODS: In this study, we employed an online qualitative stakeholder survey (2021) with representatives of organizations involved in assistive technology in Kenya. RESULTS: The assistive technology network in Kenya is distributed, with Government Ministries and Agencies and Organizations of persons with disabilities central to the network. The strength of relationships is concentrated on awareness and communication, with fewer organizations actively collaborating. Innovation training organizations are not yet well integrated into the network. CONCLUSIONS: Improving access to assistive technology in Kenya will benefit from greater collaboration amongst all assistive technology stakeholders.

Psychotropic medicines' prevalence, patterns and effects on cognitive and physical function in older adults with intellectual disability in Ireland: longitudinal cohort study, 2009-2020.

BACKGROUND: The frequent prescribing of psychotropics and high prevalence of polypharmacy among older adults with intellectual disabilities require close monitoring. AIMS: To describe change in prevalence, predictors and health outcomes of psychotropic use during the four waves (2009/2010, 2013/2014, 2016/2017, 2019/2020) of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA). METHOD: Eligible participants were adults (≥40 years) with intellectual disabilities who participated in all four waves of IDS-TILDA and who reported medication use for the entire period. Differences between groups were tested using Cochran's Q test for binary variables and the McNemar-Bowker test for variables with more than two categories. Generalised estimating equation models were used to assess associations between psychotropic use, participants' characteristics and health outcomes. RESULTS: Across waves (433 participants) there were no significant differences in prevalence of psychotropic use (61.2-64.2%) and psychotropic polypharmacy (42.7-38.3%). Antipsychotics were the most used subgroup, without significant change in prevalence between waves (47.6-44.6%). A significant decrease was observed for anxiolytics (26.8-17.6%; P < 0.001) and hypnotics/sedatives (14.1-9.0%; P < 0.05). A significant increase was recorded for antidepressants (28.6-35.8%; P < 0.001) and mood-stabilising agents (11.5-14.6%; P < 0.05). Psychotropic polypharmacy (≥2 psychotropics) was significantly associated with moderate to total dependence in performing activities of daily living over the 10-year period (OR = 1.80, 95% CI 1.21-2.69; P < 0.05). CONCLUSIONS: The study indicates an increase in usage of some classes of psychotropic, a reduction in others and no change in the relatively high rate of antipsychotic use over 10 years in a cohort of older adults with intellectual disabilities and consequent risk of psychotropic polypharmacy and medication-related harm.

Using a systems thinking approach to understand teachers perceptions and use of assistive technology in the republic of Ireland.

PURPOSE: Assistive technology (AT) enables and promotes inclusion and participation, especially for persons with a disability, ageing populations, and those with non-communicable diseases. AT is essential for generating collaborative learning environments, inclusive of students with a range of specific needs and required supports. However, many teachers lack the training, resources, and skills to use AT in the class. This study uses a systems thinking approach to consider teachers AT needs in the Irish classroom. METHODS: Three hundred and five teachers completed an online survey, and 10 took part in semi-structured focus groups. The survey examined teachers experiences with AT, their training needs, and the context within which they need support. RESULTS: Teachers reported low levels of AT knowledge, skills, and confidence. Many described limited access to training and support for AT use. Results also reveal non-systems thinking, whereby there is no meaningful linking across the main strategic drivers of AT - policy, products, provision, and personnel, to support the people at the centre of the AT system - between these and the contextual factors that influence their effectiveness. CONCLUSION: An AT system which is easy to navigate, which has policies and provision that supports educators, and has expert personnel on hand to support teachers, is crucial if AT is to become embedded in Irish classrooms. This research shows that a comprehensive AT system in education should include policies, practices, personnel, and products that interact to support people to engage easily and successfully with AT in the classroom.IMPLICATIONS FOR REHABILITATIONDescribes current trends in how teachers are engaging with Assistive Technology.Describes the current trends in disabilities in Irish classroom and teachers requirements for support.Understand the system challenges facing teachers attempting to use Assistive Technology.Support the development of Assistive Technology training for teachers which are informed by teachers needs.Inform the development and improving policies and processes for common situations.

Empirical research and available data on assistive technology for persons with disabilities in Malawi: A review.

Empirical research and data are necessary for policy, planning and provision of services for persons with disabilities. Research data may be available but still not used by researchers and policy makers. The aim of this study is to explore existing empirical research and sources of data on Assistive Technology (AT) in Malawi in order to facilitate the development of an AT policy and Assistive Product List (APL). A two-stage process using a scoping review methodology was adopted to identify (1) empirical research on AT in Malawi and (2) sources of existing data on AT in Malawi. Following a narrative synthesis, 12 heterogenous studies that reported on the use, availability, sources and knowledge about AT in Malawi were identified. Identified studies suggest that there is high unmet need for AT and services in Malawi. Five major sources of data on disability and AT were Identified. Only 2 out of the 12 studies had used existing sources of data. The high unmet need for AT and services in Malawi have substantial implications for persons with disabilities. Developing mechanisms that will improve the use of existing data on AT in all countries is pivotal for the efficient and effective development of AT ecosystems.

An overview of assistive technology products and services provided in Malawi.

BACKGROUND: Assistive technology is the products and services used by individuals with functional limitations to enable participation in society and realisation of rights afforded by the United Nations Convention on the Rights of Persons with Disabilities. The Assistive Product List is a comprehensive list of products identified as essential for access through universal health coverage. Key stakeholders, including organisations of persons with disabilities, civil service organisations, academic organisations and government ministries are collaborating to integrate assistive technology into policy and develop a priority assistive products list for Malawi. OBJECTIVE: To understand the organisational characteristics of, and assistive products provided by, key stakeholders working in AT in Malawi. STUDY DESIGN: Online survey of representatives from key stakeholder organisations. METHODS: We surveyed representatives of key stakeholder organisations to gather information regarding assistive technology product and service provision in Malawi. Responses were analysed using counts for closed-ended questions, and conventional content analysis for open-ended questions. RESULTS: A total of 36 of the 50 APL products were provided by eight organisations. Related services were provided for 36 of the 50 APL products by twelve organisations. Five organisations reported providing both products and services. Products and services are largely funded by donation and provided free to those who require them. CONCLUSION: A range of organisations in Malawi play a role in assistive product delivery and related services. Coordinated AP delivery and service provision is required at a national level which is sustainable and inclusive, and is based on identified needs of the Malawian population.Implications for rehabilitationPolicies supporting assistive product and service provision must acknowledge the contextual needs of the communities where they are implemented.Coordination is required for assistive product and service provision at the national and subnational level.Existing and potential gaps in service provision must be addressed when implementing a national assistive products list.

The IDEAL PROCESS for developing Assistive Technology policy.

Policy development and implementation are key to improving access to Assistive Technology (AT). In this paper, we describe a strength-based framework for doing this at national level. We used an action research approach, with the United Nations Conventions on the Rights of Persons with Disability (UNCRPD) as the primary frame of reference. Primary data were collected using the World Health Organisation's rapid Assistive Technology Assessment (rATA). We describe the process of applying our emergent framework and how our findings support it. We identified seven guiding principles for effective policy process: Participatory, Resource aware, Outcomes focused, Collaborative, Evidence-informed, supporting good practices, and System strengthening - which can be summarized by the acronym PROCESS. Five crucial building blocks for effective AT policy development emerged: Identification of the assistive technology ecosystem, Demography of disability and AT use, Evaluation of inclusion and participation in existing policy, Alignment with UNCRPD and Sustainable Development Goals (SDGs), and Locality of implementation - which can be summarized with the acronym IDEAL. The IDEAL PROCESS incorporates key content building blocks and core process principles, constituting a systematic framework for guiding the development of context sensitive AT policy and a strength-based pathway to improving access AT.

SHAPES Marketplace: Transparency, Trust and Fair Competition in the Healthy Ageing Market.

Access to digital health and care solutions and services that promote healthy ageing, independent living, and ageing in place is limited due to significant market barriers and challenges. The SHAPES project addresses the challenge of ageing populations by developing a sociotechnical ecosystem comprising a variety of health and care digital solutions, tools and services to enable and facilitate active, independent, and healthy ageing at home. Within the SHAPES project, the SHAPES Marketplace serves as a one-stop-shop for digital solutions and services designed for the Silver Economy that target the smart and healthy ageing and independent living markets. Delivering a dynamic catalogue of health and care digital solutions and services, the Marketplace promotes a transparent expansion of a trusted market offer on digital solutions and services for healthy ageing and independent living on a pan-European scale, thereby preventing vendor lock-in and enhancing the agile and fair competitiveness of the health and care industry, particularly in Europe. This paper introduces the SHAPES Marketplace and considers its function as a market driver to raise awareness on the benefits and impact of health and care digital solutions and services, as well as to shape the healthy ageing market, upholding the Systems-Market for Assistive and Related Technologies (SMART) Thinking Matrix to stimulate transparency, trust and fair competition.

Assistive Technology to Promote Participation in Sport for People with Disabilities.

Participation in sports is identified in the UN Convention on the Rights of Persons with Disabilities as a fundamental right and is facilitated by the use of specialized Assistive Products (AP). However, little is known about the role everyday AP plays in promoting sport participation. PURPOSE: This study explores how the 50 priority APs on the World Health Organization's Assistive Products List can promote participation in sports. MATERIALS AND METHODS: We used an online survey with AP-users, caregivers, and coaches (n=96). Subsequently, we performed a thematic analysis for qualitative responses describing the use of APs in facilitating sport participation. RESULTS: Our results suggest everyday APs are required for sport participation for persons with disabilities. We present a conceptual model of AP use for sport participation. We found people with disability participate in a range of sports, contributing to community engagement. CONCLUSIONS: Access to everyday APs is integral to achieving the rights of persons with disabilities for participation in sport.