Financial inclusion for people with disability: a scoping review.

BACKGROUND: Financial exclusion is a human rights issue affecting health equity. Evidence demonstrates that financial exclusion is exacerbated for people with disability and those in low- to middle-income countries (LMIC). Barriers to financial access include limited demand for services, banking inadequacies in catering to people with disability, and insufficiently accessible information technologies (ICT) and infrastructure. OBJECTIVES: This scoping review sought to identify barriers to and facilitators of financial inclusion for people with disability in LMIC. As a secondary objective, the study explored the potential of financial education and ICT utilisation as viable strategies for enhancing financial inclusion. METHODS: This review utilised the Arksey and O'Malley framework and PRISMA Checklist for systematic literature examination and data extraction. The WHO's Environmental Factors guided the analysis to propose potential interventions and to generate recommendations. RESULTS: The review analysed 26 publications from various global regions and fields including finance, business, technology, health and disability policy. It identified consistent financial inclusion barriers for people with disability, resulting in a set of global recommendations across attitudes, environment, technology, services, and policy. CONCLUSIONS: Recommendations include using ICT, digital innovation and multi-stakeholder collaboration to address the financial barriers experienced by people with disability. These efforts, rooted in social justice, aim to include people with disability in LMIC as valued financial sector participants, promoting health and equity.

Main findings: There are global access barriers and enablers to financial inclusion for people living with disability. Recommendations to improve access include countering stigma and attitudinal barriers, engaging in user centred design of financial services,providing financial education and ensuring accessibility of assistive technology and ICT, along with the physical environment of the bank.Added knowledge: This study reviews the literature and offers a global overview of financial inclusion for people with disabilities, along with recommendations for universally applicable actions to enhance access.Global health impact for policy and action: Identifying barriers to financial inclusion and suggesting strategies to overcome them provides valuable guidance for policymakers and advocates working to improve access to financial services for people with disability.

Guidelines for assistive technology service provision - A scoping review.

PURPOSE: Despite the high unmet need for effective AT provision, multiple service delivery models across different countries, and a shortage of personnel trained in this field, no widely useable and accepted Assistive Technology (AT) service provision guidelines currently exist. This review aims to provide an overview of the literature regarding AT service provision guidelines to inform the development of globally useable AT provision guidance, aligned with contemporary global initiatives to improve access to AT. MATERIALS AND METHODS: The rapid scoping review method used a two-tiered approach to identifying relevant publications: (1) systematic search of academic databases (Medline, CINAHL, SCOPUS, and Google Scholar); (2) consultation with international AT organisations and experts. The search was conducted in March 2023 with no date limitations. Analysis was guided by the TIDE-funded HEART research on quality AT provision and service delivery processes in Europe, as well as the WHO-GATE 5 P framework for strengthening access to AT. RESULTS: 35 publications were identified from various countries, and directed at differing assistive products, personnel, and provision contexts. No established guidelines for AT service provision currently exist. However, despite the variety in contexts, the range of assistive products and the range of stakeholders to whom guidelines are directed, several key service delivery steps were identified that may form part of such guidelines. CONCLUSIONS: This review offers a strong starting point for developing guidance for AT provision to meet global needs. Careful consideration of vocabulary, process, and application to the diversity of assistive products is recommended in systematizing globally applicable guidance.

Guidelines offer accepted benchmarks for clinical practice.Evidence-based guidelines ensure consistent and appropriate interventions, including assistive technology provision.The evidence suggests global guidance is required, and a substantial evidence base can be drawn upon to formulate such guidelines.

Symptoms of depression and risk of emergency department visits among people aged 70 years and over.

BACKGROUND: Older people experiencing depression and anxiety have higher rates of health service utilisation than others, but little is known about whether these influence their seeking of emergency care. The aim was to examine the associations between symptoms of depression and the use of emergency health care, in an Australian context, among a population of people aged 70 years and over initially free of cardiovascular disease, dementia or major physical disability. METHODS: We undertook secondary analyses of data from a large cohort of community-dwelling Australians aged [Formula: see text]70 years. Multivariable logistic regression was used to compare the association of symptoms of depression (measured using the Center for Epidemiological Studies Depression Scale 10 question version, CESD at baseline) with subsequent episodes of emergency care, adjusting for physical and social factors of clinical interest. Marginal adjusted odds ratios were calculated from the logistic regression. RESULTS: Data were available for 10,837 Australian participants aged at least 70 years. In a follow-up assessment three years after the baseline assessment, 17.6% of people self-reported an episode of emergency care (attended an ED of called an emergency ambulance) in the last 12 months. Use of emergency healthcare was similar for men and women (17.8% vs. 17.4% p = 0.61). A score above the cut-off on the CESD at baseline was associated with greater use of emergency health care (OR = 1.35, 95% CI 1.11,1.64). When modelled separately, there was a greater association between a score above the cut-off on the CESD and emergency healthcare for women compared with men. CONCLUSIONS: This study is unique in demonstrating how depressive symptoms among healthy older persons are associated with subsequent increased use of emergency healthcare. Improved understanding and monitoring of mental health in primary care is essential to undertake effective healthcare planning including prevention of needing emergency care.

Who cares for the carer? Codesigning a carer health and wellbeing clinic for older care partners of older people in Australia.

INTRODUCTION: Older carers or 'care partners' of older people experiencing care needs often provide essential support, at times while neglecting their own health and well-being. This is an increasingly frequent scenario due to both demographic changes and policy shifts towards ageing in place. Multiple community stakeholders within the care and support ecosystem hold valuable expertise about the needs of older care partners, and the programme and policy responses that may better support their health and well-being. The aim of this study was to identify the perspectives of stakeholders obtained through the codesign phase of a multicomponent research project investigating new models of care and support for older care partners suitable for the Australian context. METHODS: Principles of codesign were used to engage a purposeful sample of older care partners, health professionals, researchers, policy makers and health service administrators. Participants took part in a series of three codesign workshops conducted remotely via video conferencing. The workshops were supported with briefing material and generated consensus-based summaries, arriving at a preferred service model. FINDINGS: This paper reports the research design and structure of the codesign panels, the range of findings identified as important to support the health and well-being of older carers of older people, and the resulting service model principles. The codesigned and preferred model of care is currently being prepared for implementation and evaluation in Australia. PUBLIC CONTRIBUTION: This study was conducted using codesign methodology, whereby stakeholders including older care partners and others involved in supporting older carers, were integrally involved with design, development, results and conclusions.

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.

Unpacking 'What Works': A Commentary of the Key Learnings for ICT from the AT2030 Program.

The AT2030 programme was launched in 2018 to test 'what works' in getting assistive technology (AT) to people globally, specifically in low- and middle-income countries (LMIC), where there is often a systematic lack of provision. After four years, this paper reviews the project outcomes, focussing on published material. It provides the backdrop to the AT2030 program, contextualises current developments in global AT global and funding, and unpacks the key learnings of what works to get AT to the people that need it around the world, with a focus on ICT. The paper does this by applying Global Disability Innovation Hub's mission-led and transformative approach, concluding with contemporary actions to improve access to AT to illustrate the value of embracing complexity for AT ecosystem stakeholders, including researchers, practitioners, AT users and policymakers.

Digital Capabilities of Older People and Uptake of Online Healthy Ageing Interventions: An Australian Study.

The promise of digital health interventions is tempered by the realities of digital capabilities and infrastructure, especially for older persons. This paper critically examines learnings from a rapid evidence review of digital information tools along with a study evaluating the uptake of a digitally-based healthy ageing intervention by 53 older Australians. Findings suggest that digital literacy is an important precursor to engagement with digital information tools, and that digital information tools must be designed with digital literacy in mind. To achieve digital health equity and realise the potential outcomes that digital tools offer, it may well be necessary to support consumers with the basics of mastering digital platforms.

My assistive technology outcomes framework: rights-based outcome tools for consumers to 'measure what matters'.

AT outcomes research is the systematic investigation of changes produced by AT in the lives of AT users and their environments. In contrast to focal outcome measures, My Assistive Technology Outcomes Framework (MyATOF) envisions an alternative starting point, co-designing a holistic and evidence-based set of outcome dimensions enabling AT users to quantify their own outcomes. International classification systems, research evidence, regulatory and service delivery frameworks underpin six optional tools: supports, outcomes, costs, rights, service delivery pathway and customer experience. Designed to empower the consumer-as-researcher and self-advocate, MyATOF has the potential to fill an identified gap in policy-relevant, consumer-focussed and consumer-directed outcome measurement in Australia and internationally. This paper presents the need for consumer-focussed measurement and articulates the conceptual foundations of MyATOF. The iterative development and results of MyATOF use-cases collected to date are presented. The paper concludes with next steps in using the Framework internationally, as well as its future development.

Assistive technology for people with deafblindness in Southern Africa: a Delphi study exploring dimensions of impact.

PURPOSE: Assistive technology (AT) is a highly effective intervention to address the capability gap for people living with deafblindness. The My AT Outcomes Framework (MyATOF) is a novel Australian framework founded upon AT process principles and outcomes research. It guides stakeholders to articulate AT use according to 6 dimensions. MyATOF was developed as a data collection and knowledge translation tool. The use case of AT by people with deafblindness in Southern Africa was investigated in this study to determine the applicability of MyATOF dimensions to (a) people with deafblindness and (b) low- and middle-income countries. MATERIALS AND METHODS: Two online surveys, using the Delphi methodology, were undertaken with key stakeholders including people with deafblindness, family members, researchers, service providers, educators and advocates. An expert panel of 17 completed Phase 1, with 14 completing Phase 2. The WHO 5 Ps AT systems thinking model was used in data analysis. RESULTS: Respondents affirmed the validity of the dimensions of MyATOF for people with deafblindness in four Southern African countries. In-country barriers and constraints were identified as significantly impacting the capacity of AT users with deafblindness, to realize positive outcomes. CONCLUSIONS: The MyATOF dimensions show promise in their use with persons with deafblindness in Southern Africa, though further research is needed.IMPLICATIONS FOR REHABILITATIONThe impact of assistive technology and related supports can be evaluated across a number of dimensions including human rights, costs incurred and saved, consumer experience, and service delivery satisfaction.These dimensions of impact resonate across the two continents investigated to date, with contextual factors being considered.Variables influencing access to assistive technology across contexts can be understood through the WHO GATE five P's systems thinking model.Few tools place data capture and outcomes measurement in the hands of assistive technology users, but indications are that this is of value to consumers.

Co-creating an assistive technology peer-support community: learnings from AT Chat.

PURPOSE: Inclusion is a core philosophy for health practitioners and human service users, and co-production is a way to achieve inclusion. Australia's assistive technology (AT) community seeks to include and amplify the voices of service and product users at multiple levels. Implementation of genuine partnerships for inclusion is however challenging. This paper describes the iterative co-design process undertaken to structure and deliver a peer-led information and support program, enabling AT users and supporters to build their AT decision making capability and share their expertise with each other and the broader community. METHODS: A living labs approach was grounded in co-design principles and drew on the peer education, AT competency and capability-building knowledge base. Methods included embedding intersectional capabilities within the service, and the engagement of over 600 people in design thinking and program iterations through surveys, focus groups, journey mapping and think tanks. RESULTS: A national, peer-led, co-designed online community for AT users was established and has been running since 2017. The community of 5000 users contribute to a peer-led information and support initiative geared to share expertise and build AT decision making capability. CONCLUSIONS: Service delivery by the AT user community and for the AT user community requires a commitment to co-design, and an engagement with concepts of risk, competency, scope of practice and capability. The learnings from AT Chat have implications for AT services on this journey everywhere.Implications for rehabilitationActive co-design of AT services meets human rights and good practice benchmarks required by contemporary services.Foregrounding AT users within program design and delivery, brings a range of positive outcomes and possibilities for the way services are delivered.AT users have substantial untapped potential which brings tangible outcomes for other AT users, health professionals, service provider organizations and for society.Development of paid roles and pathways to recognize the skills of AT users, and indeed AT communities has potential to improve AT user self-efficacy as well as to contribute to the AT workforce.

Measuring what matters: a descriptive participatory case evaluation of a tool for measuring outcomes of assistive technology after acquired brain injury.

Acquired Brain Injury (ABI) can lead to the need to plan for housing, assistive technology and support to meet a person's goals. Recent Australian policy reforms have brought about opportunities for person-centred approaches to assistive technology (AT) product selection, and the opportunity for users of supports such as assistive technology and environmental adaptations to describe and measure their own outcomes. My AT Outcomes Framework (MyATOF) is an Australian tool designed for use by AT users and their support networks to articulate supports, outcomes, costs, and service delivery experiences. This article aims (i) report on use of MyATOF in a case study of ABI and AT-enabled housing and (ii) critically evaluate MyATOF tools and administration for this use case from the perspectives of the MyATOF author, an occupational therapist, and a lived experience expert with an ABI. An iterative development and test design was used to adapt the MyATOF administration procedures and conduct a case report evaluation. Results support the relevance of MyATOF conceptual domains, and detailed data about outcomes made possible by an AT-enabled home was captured. Recommendations are made to further refine the questions for ease of use by persons with ABI including simplifying the costing tool and enabling staggered administration. This case report suggests MyATOF can 'measure what matters' for ABI and AT-enabled housing and is worthy of further evaluation.

Creating a consumer-driven global community of practice to support action within environmental design with people living with dementia: assistive technology challenges and opportunities.

The environment, and assistive technologies as part of this, can play an important role in supporting the participation and wellbeing of people living with dementia. If not considered, environments can be overwhelming and disempowering. Disability approaches including environmental considerations and assistive technology were often not offered routinely with people living with dementia. Concerned by this, dementia advocates aimed to create change in this area. The Environmental Design-Special Interest Group (ED-SiG) of Dementia Alliance International was developed as an international consumer-driven community of practice bringing together people with different relevant expertise including living experience (people living with dementia, care partners), architecture and design, occupational therapy, rehabilitation and care provision. This practice opinion piece provides an overview of dementia, the need for collaborative practices within practice with people living with dementia, and the considerations of assistive technology, environmental design and the global context. The reflection provides insights into this international community of practice, with personal reflections of members with living experience of dementia, and benefits and opportunities in considering environmental design and assistive technology from the perspectives of members. This work demonstrates and advocates collaborations that centre the perspectives and expertise of people living with dementia.

Towards Co-Design in Delivering Assistive Technology Interventions: Reconsidering Roles for Consumers, Allied Health Practitioners, and the Support Workforce.

A complexity of factors, from health and technology innovations to policy redesign to achieve consumer-directed care, are impacting traditional roles for Australian allied health practitioners (AHPs). This pilot study considers roles for AHPs in relation to assistive technology (AT) interventions. Articulating 'who does what' may serve a number of purposes including de-professionalization of the discourse; better utilization of support networks and workforces; and alignment with contemporary policy. Yet, a suitable framework to assist with collaborative AT implementation between relevant stakeholders was not identified within the existing literature. This research aimed to develop and pilot an AT collaboration tool which enables AHPs, consumers, their support networks and the support workforce, to navigate policy redesign toward ethical consumer-directed implementation of AT interventions. An AT collaboration tool was developed based upon practice-based knowledge, relevant regulatory and practice evidence and identifies relevant stakeholders, AT service steps and roles, and quality indicators to support competent practice. The tool was piloted in four separate and diverse practice analyses of AT interventions (custom prosthetics, home enteral nutrition, communication devices, and vehicle modifications) considering four allied health professions (prosthetics and orthotics, dietetics, speech pathology, occupational therapy). Pilot testing of the tool supports the feasibility of re-framing AT provision using competency-based and risk-informed approaches and enabling more inclusive roles for consumers and the support workforce. Further testing of the tool is indicated, followed by strategic actions for uptake by individuals, professions and policymakers. The AT collaboration tool has potential to enable AHPs to fulfil ethical obligations for consumer-centered practice, and to facilitate consumer choice, both in Australia and internationally.

Understanding the Role, Quality of Life and Strategies Used by Older Carers of Older People to Maintain Their Own Health and Well-Being: A National Australian Survey.

Introduction: Carers play a critical role in supporting older people with health problems to remain living at home. This study aimed to understand the role and quality of life of older carers of older people and identify strategies used to manage their own health and well-being. Methods: Older carers (aged ≥50 years) of older people (aged ≥65 years) in Australia participated in a cross-sectional survey focused on carer roles, self-rated health, information and activities used to maintain their carer role and health, barriers to accessing health care, and assessment of quality of life (QoL) using the Dementia Quality of Life Scale for Older Family Carers. Multiple regression analysis examined relationships between variables and the QoL outcome. Results: The survey was completed by 189 older carers (mean age: 68 years; SD = 9.3). Most were female (83.5%), 80.2% providing care daily and 47.8% provided ≥six hours care daily. Almost half (45.1%) self-reported their health as average or below. Despite rating ensuring personal health as very important (mean importance 8/10), only 46.3% reported receiving support from their general practitioner for their carer role. The most common barrier to accessing care for themselves was "not having enough time". Factors independently associated with poorer carer QoL were living with the care-recipient, caring for someone with depression/anxiety and poor care-recipient health. Factors independently associated with higher carer QoL were placing high importance on personal health, receiving assistance from a specialist clinic as a carer, and older age. Conclusion: Older carers of older people provide high levels of care and experience reduced quality of life. Innovative approaches that provide integrated care and support for older carers to promote their QoL are urgently needed.

Informal carers' support needs, facilitators and barriers in the transitional care of older adults: A qualitative study.

INTRODUCTION: Inclusion of informal carers in transitional care is challenging because of fast throughput and service fragmentation. This study aimed to understand informal carers' needs during the care transitions of older adults from inpatient care to the community. METHODS: A qualitative exploratory design was used with mixed-methods data collection. Seventeen semi-structured telephone interviews were conducted with family carers; one focus group was conducted by videoconference with two family carers and three community-based advocacy and aged care providers; and eight semi-structured telephone interviews were undertaken with healthcare practitioners from rehabilitation services. Data were thematically analysed. FINDINGS: All carers described the main social challenge that they needed to address in transitional care as 'Needing to sustain family'. Carers reported their social needs across five solutions: 'Partnering with carers', 'Advocating for discharge', 'Accessing streamlined multidisciplinary care', 'Knowing how to care' and 'Accessing follow-up care in the community'. Focus group participants endorsed the findings from the carer interviews and added the theme 'Putting responsibility back onto carers'. All healthcare practitioners described the main social challenge that they needed to address as 'Needing to engage carers'. They reported their social solutions in three themes: 'Communicating with carers', 'Planning with carers' and 'Educating carers'. DISCUSSION: Findings highlight the importance of reconstructing the meaning of transitional care and relevant outcomes to be inclusive of carers' experiences and their focus on sustaining family. Transitional care that includes carers should commence at the time of hospital admission of the older adult. CONCLUSIONS: Future sustainable and high-quality health services for older adults will require transitional care that includes carers and older adults and efficient use of inpatient and community care resources. Healthcare professionals will require education and skills in the provision of transitional care that includes carers. To meet carers' support needs, models of transitional care inclusive of carers and older adults should be developed, implemented and evaluated. PUBLIC CONTRIBUTION: This study was conducted with the guidance of a Carer Advisory Group comprising informal carers with experience of care transitions of older adults they support and community-based organizations providing care and advocacy support to informal carers.

Housing and Support for People with Disability: Perspectives of Motor Accident, Disability and Injury Insurers across Australia and New Zealand.

Housing is a critical enabler of a dignified life, civic participation and the achievement of human rights. Providing appropriate housing for people who experience neurotrauma as a result of road or workplace injury, with both the assistive technology and human support required, continues however to be a policy and practice challenge. Australian and New Zealand motor accident, disability and injury insurers have high and enduring liability in this area, and their under-researched perspectives are needed to strengthen the evidence base for policy and practice development. This qualitative study utilised focus group methodology with representatives from government injury and disability insurers across Australia and New Zealand (n = 8). The study aimed to identify (a) issues and trends; (b) factors for decision making; and (c) service impacts relating to housing and support for people with disability and high daily support needs. Thematic analysis generated results across four key areas: influences on the decision to fund housing and/or support; identifying 'good' housing solutions; evaluating cost-benefit of housing and support investments; and developing future investment in housing and support. Findings such as those regarding decision-making, and investment, attest to the value of capturing the perspectives of this key group of stakeholders to assist to envision better housing and support for people with disability.

Standard terminology is critical to advancing rehabilitation and assistive technology: a call to action.

This perspective piece discusses inconsistencies in assistive technology (AT) language as a barrier to communication in AT provision, research, development, trade, and policy. The imperative to improve communication is explored in relation to AT stakeholder endeavours. This commentary is a call for action to develop a terminology standard through the aggregation of evidence-based concepts and terms to inform and optimize stakeholder outcomes. IMPLICATIONS FOR REHABILITATIONStandardized terminology supports the gathering, aggregation, analysis, and interpretation of valid data and the development of tools used for needs and outcomes assessment.Standardized terminology also supports effective and efficient documentation, practice, collaboration, and capacity building by stakeholders in both national and international contexts.

Assistive Technology during the COVID-19 Global Pandemic: The Roles of Government and Civil Society in Fulfilling the Social Contract.

The COVID-19 pandemic imposed significant challenges to users of assistive technology (AT). Three key issues emerged from a series of structured qualitative interviews with 35 AT users in six low- and middle-income countries. These were (1) access to information about COVID-19 and available supports and policies, (2) insufficiency of the government response to meet the needs of AT users, and (3) the response of civil society which partially offset the gap in government response. AT users noted the need for better communication, improved planning for the delivery and maintenance of AT during times of crisis, and higher-quality standards to ensure the availability of appropriate technology.