Learning from fall-related interventions for older people at home: A scoping review.

This scoping review aims to provide a better understanding about the fall-related interventions, and the conditions which stand out as effective in decreasing fall risks of older people at home. A total of 28 peer-reviewed papers were included when they reported interventions with an incidence of falls or fall-risk as a primary outcome for older people, focusing on the home environment, from 8 databases. Qualitative examination was complemented by quantitative risk ratio analysis where it was feasible. The interventions regarding incidence of falls had a mean risk rate of 0.75; moreover, interventions using multiple strategies were found relatively successful. The interventions regarding fall risk had a mean hazard rate of 0.66. A considerable number of no-effect ratios were evident. Combining education, home assessment or improvement, and use of technology with implementation by health service experts appears to be the most promising intervention strategy to reduce falls.

Working-age first-time hearing aid users' self-reported outcomes.

OBJECTIVE: To study patient-reported hearing aid (HA) rehabilitation outcomes, social-communicative functioning, and expectations/experiences during eight months of HA use. DESIGN: Three self-reporting instruments, the International Outcome Inventory for Hearing Aids (IOI-HA), the Quantified Denver Scale of Communicative Function (QDS), and questionnaires tapping pre-rehabilitation expectations (HA-EXP-Q1) and post-rehabilitation experiences (HA-EXP-Q2) were administered. STUDY SAMPLE: 144 patients ages 23-66 with gradually acquired, adult-onset, mild-to-moderate sensorineural hearing loss affecting both ears who acquired their first HAs. RESULTS: According to self-reports, HA rehabilitation outcomes were good, and everyday social-communicative functioning improved after one month and after eight months of HA use. When the effects from demographic and audiological variables were analysed, younger age and positive expectations of HAs were associated with better outcomes and social-communicative functioning. The form or hearing loss severity, and the type or number of HAs did not affect outcomes. CONCLUSION: Working-age HA users reported better HA outcomes than older adults in previous studies. Coping in work life may be a strong motivator for active HA use. Considering that younger age and positive expectations resulted in better outcomes, early rehabilitation that supports positive and realistic expectations of HA performance is essential.

Preserving client autonomy when guiding medicine taking in telehomecare: A conversation analytic case study.

Background: Enhancing client autonomy requires close coordination of interactional practices between nurse and client, which can cause challenges when interaction takes place in video-mediated settings. While video-mediated services have become more common, it remains unclear how they shape client autonomy in telehomecare. Research aim: To analyse how video mediation shapes client autonomy when nurses guide medicine taking remotely through video-mediated home care. Research design: This is a conversation analytic case study using video recordings of telehomecare encounters. The theoretical approach draws on ethnomethodology and empirical ethics. Participants and research context: Four home-dwelling older adults and three nurses participated in the data collection; data extracts include one client and two nurses. The study was conducted in Finland. Ethical considerations: Special attention was given to protect the rights of home care clients. An ethical statement for the study was given by the Ethics Committee of the Tampere Region Findings: Video mediation complicates interacting remotely with care-relevant artefacts because of nurses' limited visual access to the medicine and client's need to simultaneously engage in vocal interaction and medicine taking. This can be overcome by dividing the guidance into manageable steps which invite the client to explicate their readiness to take the medicine and situating the video-mediation equipment and medicine close together. Different interactional practices and ways of situating video-mediation equipment and medicine have consequences for client autonomy. Discussion: Understanding client autonomy in digitalised settings demands empirical examination that recognises the importance of different human and non-human aspects of care that shape client autonomy. Conclusions: To harness the benefits of video-mediated home care, communication technologies' reliance on home space and interactional practices should be recognised. Empirical ethics research is needed in order to make normative suggestions that fit a wide variety of care situation.

Effects of Transmission Delay on Client Participation in Video-Mediated Group Health Counseling.

In face-to-face group counseling, active client participation contributes to the counseling agenda by a variety of social processes, but little is known about how video mediation shapes client participation. In this article, we use conversation analysis to investigate how transmission delay affects client participation in video-mediated group counseling through shaping the resolution of overlapping talk. Data are video recordings from three video-mediated group health counseling sessions recorded simultaneously in the two participating locations. The delay changes the timing of the overlapping turns and pauses at each end of the mediated counseling, making it difficult to interpret who should take the turn after the overlap. This may pose obstacles to client participation. While mediated counseling services can increase access to services and thus improve client participation at a macro level, transmission delay can pose threats to active client participation at the micro level of interaction.

Studies on stigma regarding hearing impairment and hearing aid use among adults of working age: a scoping review.

PURPOSE: Research on stigma has been criticized for centering on the perceptions of individuals and their effect on social interactions rather than studying stigma as a dynamic and relational phenomenon as originally defined by Goffman. This review investigates whether and how stigma has been evaluated as a social process in the context of hearing impairment and hearing aid use. MATERIALS AND METHODS: Systematic literature searches were conducted within four major databases for peer-reviewed journal articles on hearing impairment and hearing aid rehabilitation. In these, 18 studies with stigma, shame or mental wellbeing as the primary research interest were identified. The reports were examined for their methodology, focus and results. RESULTS: The reviewed studies used both quantitative and qualitative methodologies, questionnaires and interviews being the most common methods. All studies concentrated on the participants' experiences or views concerning stigma. Studies examining the social process of stigmatization were lacking. Most studies pointed out the negative effect of stigma on the use of hearing aids. CONCLUSIONS: In order to understand the process of stigmatization, more studies using observational methods are needed. Moreover, additional research should also focus on how stigma as a social and relational phenomenon can be alleviated. IMPLICATIONS FOR REHABILITATION Low adherence in hearing aid use is connected to fear of stigma related to hearing impairment and hearing aids. Hearing health services should include counseling to deal with individual's experiences and fear of stigma. Stigmatization is a social process that concerns individuals with hearing impairment in contact with their social environment. Hearing health professionals should consider including close relatives and/or partners of hearing impaired individuals in discussions of starting hearing aid rehabilitation. In consulting patients with hearing impairment professionals should give advice about how to deal with questions of hearing aid, hearing impairment and fear of stigma at work.

Discussing Hearing Aid Rehabilitation at the Hearing Clinic: Patient Involvement in Deciding upon the Need for a Hearing Aid.

The quality of interaction between hearing health professionals and patients is one prominent, yet under-studied explanation for the low adherence in acquiring and using a hearing aid. This study describes two different ways of introducing hearing aid to the patients at their first visits at the hearing clinic: an inquiry asking patients opinion followed by offer, and an expert evaluation of the necessity of a hearing aid; and shows two different trajectories ensuing from these introductions. The trajectories represent two extreme ends of a continuum of practices of starting a discussion about hearing aid rehabilitation, in terms of how these practices affect patient participation in decision-making. The analysis shows how granting different degrees of deontic and epistemic rights to professionals and patients has different consequences with regard to the activity of reaching shared understanding on the treatment. The data consist of 17 video-recorded encounters at the hearing clinic. The method used is conversation analysis.

Developing theory- and evidence-based counseling for a health promotion intervention: A discussion paper.

Although the use of theories and evidence is often stressed in the development of health promotion interventions, this does not guarantee the success of an intervention. Thus, we need to reflect on intervention development processes that use different types of theories and evidence. In this paper, we provide a reflective discussion on how we identified evidence-based behavior change techniques and counseling themes for a health promotion intervention. In addition, we discuss the challenges that we encountered and what we learned during the process: a) a lack of previous research and meta-analyses, b) inconsistencies in evidence, c) integrating evidence and theories that have different starting points, and d) collaborating with researchers who represent different evidence and theories. During the process, we benefitted from having the clear goal of conducting evidence- and theory-based work. We solved the challenges by, for example, utilizing different types of evidence and being reflective about the reasons behind any inconsistencies in the evidence. In retrospect, we would have benefitted from closer collaboration between the teams that worked separately with different evidence. These kinds of reflective descriptions of development processes and the challenges encountered during them may help other researchers and professionals avoid encountering the same challenges.

Stories of Change: Comparative Time-Framed Experience Telling in Health Promotion Group Discussions.

In this article, we examine comparative time-framed experience telling: episodes of interaction in health promotion group discussions in which one of the participants tells their experience and, in response, another participant tells their own experiences from separate moments or periods of their life and compares them. In so doing, group members reinforce and encourage the previous speaker's positive stance or challenge the negative stance toward contextually relevant objects: behavior change and suggested solutions. This practice allows group members to demonstrate their independent access to experiences that are similar to those of the other, present evidence of similarities and differences between the experiences, and show their epistemic independence regarding their claims. By recontextualizing the experience of the other in this way, it becomes possible for the group members to interpret and even oppose it while maintaining a level of understanding of the differences between the experiences in question and respecting them.

Open-class repair initiations in conversations involving middle-aged hearing aid users with mild to moderate loss.

BACKGROUND: To manage conversational breakdowns, individuals with hearing loss (HL) often have to request their interlocutors to repeat or clarify. AIMS: To examine how middle-aged hearing aid (HA) users manage conversational breakdowns by using open-class repair initiations (e.g., questions such as sorry, what and huh), and whether their use of repair initiations differs from their normally hearing interlocutors. METHODS & PROCEDURES: Eighteen 45-64-year-old adults with acquired mild to moderate HL participated in the study. The participants were videotaped in everyday interactions at their homes and workplaces and in clinical encounters with hearing health professionals. Interactions were transcribed and open-class repair initiations of participants with HL and their interlocutors were identified using conversation analysis. The frequencies of initiations were analyzed statistically between the groups, and the contexts and structure of repair sequences dealing with communication breakdown were analyzed. OUTCOMES & RESULTS: Before acquiring HA the participants with HL reported intense use of open-class repair initiation. After HAs were acquired, there was no statistically significant difference in the frequency of open-class repair initiations between HA users and their interlocutors. The most common means for open-class repair initiation in the data was interrogative word mitä ('what'). Vocalization hä ('huh'), apologetic expression anteeksi ('sorry') and clausal initiations (e.g., 'what did you say'/'I didn't hear') occurred less often. Open-class repair initiations emerged in contexts where they typically occur in conversation, such as topical shifts, overlapping talk and action, background noise, and disagreements. When used, open-class repair initiations most often led to repetition by the interlocutor, which immediately repaired the conversational breakdown. Long clarification sequences with multiple repair initiations did not occur. CONCLUSIONS & IMPLICATIONS: Participants with mild to moderate HL using hearing amplification initiate open-class repair similarly to their normally hearing conversational partners when the frequency, types, contexts and structure of repair are considered. The findings diminish the stigma related to HL, HAs and the use of open-class repair. The findings suggest that HA amplifies hearing successfully in everyday conversation when the level of HL is mild to moderate. However, the evidence for the benefit of HAs remains indirect.

National policies for the promotion of physical activity and healthy nutrition in the workplace context: a behaviour change wheel guided content analysis of policy papers in Finland.

BACKGROUND: Health policy papers disseminate recommendations and guidelines for the development and implementation of health promotion interventions. Such documents have rarely been investigated with regard to their assumed mechanisms of action for changing behaviour. The Theoretical Domains Framework (TDF) and Behaviour Change Techniques (BCT) Taxonomy have been used to code behaviour change intervention descriptions, but to our knowledge such "retrofitting" of policy papers has not previously been reported. This study aims first to identify targets, mediators, and change strategies for physical activity (PA) and nutrition behaviour change in Finnish policy papers on workplace health promotion, and second to assess the suitability of the Behaviour Change Wheel (BCW) approach for this purpose. METHOD: We searched all national-level health policy papers effectual in Finland in August 2016 focusing on the promotion of PA and/or healthy nutrition in the workplace context (n = 6). Policy recommendations targeting employees' nutrition and PA including sedentary behaviour (SB) were coded using BCW, TDF, and BCT Taxonomy. RESULTS: A total of 125 recommendations were coded in the six policy papers, and in two additional documents referenced by them. Psychological capability, physical opportunity, and social opportunity were frequently identified (22%, 31%, and 24%, respectively), whereas physical capability was almost completely absent (1%). Three TDF domains (knowledge, skills, and social influence) were observed in all papers. Multiple intervention functions and BCTs were identified in all papers but several recommendations were too vague to be coded reliably. Influencing individuals (46%) and changing the physical environment (44%) were recommended more frequently than influencing the social environment (10%). CONCLUSIONS: The BCW approach appeared to be useful for analysing the content of health policy papers. Paying more attention to underlying assumptions regarding behavioural change processes may help to identify neglected aspects in current policy, and to develop interventions based on recommendations, thus helping to increase the impact of policy papers.

Group members' questions shape participation in health counselling and health education.

OBJECTIVE: This study examines how group members' questions shape member participation in health counselling and health education groups. METHODS: The study applies conversation analytic principles as a method. The data consist of video-recorded health education lessons in secondary school and health counselling sessions for adults with a high risk of Type 2 diabetes. RESULTS: Group members' questions accomplish a temporary change in participatory roles. They are used to 1) request counselling, 2) do counselling or 3) challenge previous talk. They are usually treated as relevant and legitimate actions by the participants, but are occasionally interpreted as transitions outside the current action or topic. CONCLUSION: Group members' questions result in a shift from leader-driven to member-driven discussion. Thus they constitute a pivot point for detecting changes in participation in group interventions. PRACTICE IMPLICATIONS: Observing the occurrence of group members' questions helps group leaders to adjust their own actions accordingly and thus facilitate or guide group participation. Comparison of the type and frequency of members' questions is a way to detect different trajectories for delivering group interventions and can thus be used to develop methods for process evaluation of interventions.

Dilemmatic group memberships of hard-of-hearing employees during the process of acquiring and adapting to the use of hearing aids.

We describe how hard-of-hearing (HOH) employees renegotiate both their existing and new group memberships when they acquire and begin to use hearing aids (HAs). Our research setting was longitudinal and we carried out a theory-informed qualitative analysis of multiple qualitative data. When an individual discovers that they have a hearing problem and acquire a HA, their group memberships undergo change. First, HOH employees need to start negotiating their relationship with the HOH group. Second, they need to consider whether they see themselves as members of the disabled or the nondisabled employee group. This negotiation tends to be context-bound, situational, and nonlinear as a process, involving a back-and-forth movement in the way in which HOH employees value different group memberships. The dilemmatic negotiation of new group memberships and the other social aspects involved in HA rehabilitation tend to remain invisible to rehabilitation professionals, occupational healthcare, and employers.

Approaches used in investigating family support in transition to parenthood.

Early support has been acknowledged to be needed in the phase of transition to parenthood, and increasing knowledge is available on the factors enhancing this transition. The issue is to translate the knowledge into practices of preventive care. In this article, our aim is to map out recent research on supporting parents in maternity and child health care and to analyse how the subject of family support has been studied. The data consist of 98 scientific articles published in peer-reviewed journals during 2000-09. Most of the reported research was Anglo-American, and fell within the academic fields of nursing studies, medicine and public health. The studies were categorized into three groups according to the epistemic perspective that was taken on the subject of family support, the studies focusing on (i) views and perceptions on family support of both clients and professionals (63 studies), (ii) the effectiveness of interventions (27 studies) and (iii) activities in the practices and processes of MCH (8 studies). First, the groups were described with regard to the study participants and the data and methods used. A bias towards the perspectives of risk groups and mothers was detected. Second, we examined the potential of different epistemic perspectives to describe care practices. The article contributes to the discussion about how to examine the practices and processes of health promotion and preventive care in such a way that the 'good practices' identified could be implemented in other contexts than the one studied.

Influence of turn-taking in a two-person conversation on the gaze of a viewer.

In natural conversation, the minimal gaps and overlaps of the turns at talk indicate an accurate regulation of the timings of the turn-taking system. Here we studied how the turn-taking affects the gaze of a non-involved viewer of a two-person conversation. The subjects were presented with a video of a conversation while their eye gaze was tracked with an infrared camera. As a control, the video was presented without sound and the sound with still image of the speakers. Turns at talk directed the gaze behaviour of the viewers; the gaze followed, rather than predicted, the speakership change around the turn transition. Both visual and auditory cues presented alone also induced gaze shifts towards the speaking person, although significantly less and later than when the cues of both modalities were available. These results show that the organization of turn-taking has a strong influence on the gaze patterns of even non-involved viewers of the conversation, and that visual and auditory cues are in part redundant in guiding the viewers' gaze.

["The patient's role"--is there one?]. / Potilaan rooli--onko sitä?

Instead of patient compliance, reference is currently made to the patient's and the doctor's mutual opinion of the treatment. The relationship between the doctor and the patient appears most concretely in the interaction at a consultation visit. Investigation of the relationship by using conversation analysis on video-recorded medical consultations reveals how the parties bring forward their own role in their mutual conversation. Drawing upon recent studies, both parties continue to maintain the doctor's role as medical expert and the patient's role as the person in need of the doctor's expertise. Equalization of the interaction has, however, already taken place and is expected to continue.

Engaging parents through gaze: speaker selection in three-party interactions in maternity clinics.

OBJECTIVE: Describing and analyzing speaker selection in conversations between the health nurse and parents in maternity clinics. METHODS: The data consisted of ten video-recorded encounters in maternity clinics. Using conversation analysis, we investigated 89 sequences of interaction in which the health nurse asks a question that is verbally addressed to both parents. RESULTS: There was an observable pattern of selecting mothers as principal respondents by all participants of the encounters in maternity clinics. In a few deviant cases, fathers were selected as principal respondents. A typical practice of speaker selection was the gaze direction of the health nurse towards the recipient (usually the mother) at the closure of her question. Various situational elements also influenced which one of the parents answered the question. The deviant cases in which fathers were selected as principal respondents were mainly explainable by the use of the questionnaire designed to facilitate talking about psycho-social issues connected with the transition to parenthood. CONCLUSION: Particular interactional circumstances and practices can break the pattern of selecting mothers as respondents to questions addressed to both parents. PRACTICE IMPLICATIONS: Fathers could easily be engaged in conversations through gaze. Also the questionnaire seems promising in engaging fathers in conversations in clinics.

Therapeutic change in interaction: conversation analysis of a transforming sequence.

A process of change within a single case of cognitive-constructivist therapy is analyzed by means of conversation analysis (CA). The focus is on a process of change in the sequences of interaction, which consist of the therapist's conclusion and the patient's response to it. In the conclusions, the therapist investigates and challenges the patient's tendency to transform her feelings of disappointment and anger into self-blame. Over the course of the therapy, the patient's responses to these conclusions are recast: from the patient first rejecting the conclusion, to then being ambivalent, and finally to agreeing with the therapist. On the basis of this case study, we suggest that an analysis that focuses on sequences of talk that are interactionally similar offers a sensitive method to investigate the manifestation of therapeutic change. It is suggested that this line of research can complement assimilation analysis and other methods of analyzing changes in a client's talk.

'Unilateral' decision making and patient participation in primary care.

Using conversation analysis as a method, we examine patients' responses to doctors' treatment decision deliveries in Finnish primary care consultations for upper respiratory tract infection. We investigate decision-making sequences that are initiated by doctors' 'unilateral' decision delivery (Collins et al. 2005). In line with Collins et al., we see the doctors' decision deliveries as unilateral when they are offered as suggestions, recommendations or conclusions that make relevant patients' acceptance of the decision rather than their further contributions to the decision. In contrast, more 'bilateral' decision making encourages and is dependent in part on patient's contributions, too (Collins et al. 2005). We examine how patients respond to unilaterally made decisions and how they participate in and contribute to the outcome of the decision-making process. Within minimal responses patients approve the doctor's unilateral agency in decision making whereas within two types of extended responses patients voice their own perspectives. 1) In positive responses they appraise the doctor's decision as appropriate; 2) in other instances, patients may challenge the decision with an extended response that initiates a negotiation on the decision. We suggest that, firstly, unilateral decision making may be collaboratively maintained in consultations and that, secondly, patients have means for challenging it.

Patient resistance towards diagnosis in primary care: Implications for concordance.

This article reports a conversation analytic study of patients' resisting responses after doctors' diagnostic statements. In these responses, patients bring forward information that confronts the doctor's diagnostic information. We examine two turn formats - aligning and misaligning - with which patients initiate resistance displays, and describe conversational resources of resistance the patients resort to: their immediate symptoms, their past experiences with similar illness conditions, information received in past medical visits and their diagnostic expectations that have been established earlier in the consultation.Through the deployment of these resources, patients orient to the doctor's diagnostic information as negotiable and seek to further a shared understanding with the doctor on their condition. The results are discussed with regard to concordance as a process in which patients and doctors arrive at a shared understanding on the nature of the illness and its proper treatment. Our analysis illuminates the mechanisms in interaction in and through which concordance can be realized. Thus, we suggest that concordance can be seen to encompass not only treatment discussion but also the process where participants reach agreement about the diagnosis. The data of the study consist of 16 sequences of patients' resisting responses to diagnosis and is drawn from 86 Finnish primary care visits for upper respiratory tract infections.

Professional non-neutrality: criticising the third party in psychotherapy.

Using audio-recorded data from cognitive-constructivist psychotherapy, the article shows a particular institutional context in which successful professional action does not adhere to the pattern of affective neutrality which Parsons saw as an inherent component of medicine and psychotherapy. In our data, the professional's non-neutrality functions as a tool for achieving institutional goals. The analysis focuses on the psychotherapist's actions that convey a critical stance towards a third party with whom the patient has experienced problems. The data analysis revealed two practices of this kind of critique: (1) the therapist can confirm the critique that the patient has expressed or (2) return to the critique from which the patient has focused away. These actions are shown to build grounds for the therapist's further actions that challenge the patient's dysfunctional beliefs. The article suggests that in the case of psychotherapy, actions that as such might be seen as apparent lapses from the neutral professional role can in their specific context perform the task of the institution at hand.