Health & Social Care in the Community最新文献

This paper investigates rural–urban disparities in the experiences of in-home care services for older adults in a sparsely populated municipality (Storuman) in Northern Sweden. Such municipalities are characterised by long-term population loss and ageing, an increasing concentration of residents and services in municipal centres and resultant rural ‘resource deserts’. Disparities are measured through four ‘endpoint’ measures—exits to residential care, resource use, longevity and survival in the in-home care system. Data were drawn from the municipality’s care service contract database (2014–2020). Users living in the municipal centre had lower resource use and used direct care less frequently than those in smaller and more distant settlements. Those living near a grocery store were more likely than others to survive long term in the in-home care system. The research reveals a potential to reduce exits to residential care, to make more effective use of direct care and shopping services and to limit disruptive transfers of care, particularly between municipal and regional health services. Overall, there was limited evidence of rural–urban disparities in in-home care outcomes, but particular attention should be paid to transactional proximity of different parts of the care system and proactive rather than reactive care planning. The paper contributes to debates about quality measures for in-home care and the impacts of micro-urbanisation on the lives of people living in sparsely populated areas.

Noncommunicable diseases (NCDs) are shaped by modifiable and nonmodifiable factors. Addressing them requires multisectoral strategies that complement clinical care. Social prescribing (SP) enables health professionals to identify health needs that might benefit from community supports and refer patients to services that promote well-being. This study examined the characteristics of patients referred to an SP programme in Lisbon, Portugal, and factors associated with uptake. We conducted a cross-sectional study including all referrals to two Family Health Units from September 2018 to December 2022, using referral forms and electronic health records. Logistic regression was applied to identify factors linked to uptake, defined as attending at least one SP appointment. Of 1022 referrals, 55.1% resulted in uptake. Compared with patients aged 0–25 years, uptake was more likely among those aged 51–75 years (OR 1.65; 95% CI 0.99–2.75) and those aged > 75 years (OR 2.21; 95% CI 1.42–3.46). Referrals for social or financial reasons (vs. no referred for this reason) (OR 1.47; 95% CI 1.12–1.92), having one chronic disease (OR 1.67; 95% CI 1.13–2.48) or two to three chronic diseases (OR 1.55; 95% CI 1.05–2.29) (vs. no chronic condition), and referrals during the COVID-19 period (vs. prepandemic) (OR 1.47; 95% CI 1.12–1.93) were also associated with uptake. Identifying which patients are more likely to engage can inform targeted outreach to improve participation and ensure the sustainability of SP initiatives.

Background: Research priority setting projects provide a method to engage stakeholders in the prioritisation of research activities. We conducted a priority setting project to identify priorities for research into the primary and secondary prevention of stroke.

Methods: A modified James Lind Alliance method was used for this project undertaken in Australia and New Zealand with two online surveys (September–November 2021 and May-June 2022) and an online workshop (August 2022). The main question addressed was ‘What question about preventing stroke would you like to see answered by researchers?’ Responses to Survey 1 were refined and reviewed to identify evidence uncertainties. Questions with uncertain evidence were presented in Survey 2 where participants rated the importance of questions. Quantitative analysis of the importance ratings identified highly rated questions. These questions were taken to the online workshop with two rounds of facilitated discussion to create a final list of priorities. A postworkshop evaluation questionnaire explored user’s perceptions of the process.

Results: In Survey 1, 375 people proposed > 700 research questions. These were refined to 134 questions that were checked against evidence with 47 determined to be unanswered and distributed for consideration in Survey 2. Respondents to Survey 2 (n = 97) rated 24 of the 47 questions highly that were then discussed in the online workshop (n = 16 participants). There was agreement on the most highly rated question ‘How can we improve early detection and measurement of stroke risk?’ but limited agreement on the remaining questions. Participants favoured keeping all questions but presenting them thematically. The final list includes 22 questions under behavioural; pharmacological/clinical; structural; policy; individual; population and secondary prevention themes. Participants rated the workshop experience as acceptable.

Conclusion: A suite of research priorities for the primary and secondary prevention of stroke were identified by a broad range of stakeholders including people with lived experience of stroke, the public and health professionals.

Background: The increasing adoption of mobile technologies among older adults presents new opportunities for cognitive health interventions. This study explores the acceptability and feasibility of a Cantonese-language gamified mobile application, Challenges in Town, designed to support cognitive training through real-life simulations. Grounded in the Technology Acceptance Model (TAM), the research investigates how gender, age, education and socioeconomic status influence older adults’ engagement with the app.

Method: A qualitative methodology was employed, involving 18 semistructured interviews and two focus groups with 20 participants aged 66–85 years in Hong Kong. Thematic analysis was conducted using TAM constructs: perceived usefulness (PU), perceived ease of use (PEU), attitude towards use (ATU) and behavioural intention to use (BIU). Stratified analysis provided insights into demographic-specific experiences.

Results: Findings revealed high acceptability, with participants reporting cognitive benefits, emotional satisfaction and motivation to continue use. Younger and more tech-savvy users adapted quickly, while older participants required initial support but expressed satisfaction postadaptation. Gendered differences emerged, with men valuing cognitive challenge and women emphasising practical memory support. Educational and socioeconomic backgrounds influenced expectations and perceived utility.

Discussion and Conclusion: The study highlights the importance of user-centred design, including intuitive navigation, customizable features and family-assisted onboarding. While TAM provided a useful framework, emergent themes such as family support and intergenerational support, and emotional engagement and social dimensions suggest the need for broader models. These findings inform the development of inclusive digital tools that promote cognitive well-being in ageing populations.

The objective of this scoping review is to map the extent, range and nature of literature pertaining to women caregivers and their engagement with healthcare for their personal healthcare needs. It is estimated that 3 out of 5 people will become caregivers at some stage throughout their life, with a large percentage of women (75%) being primary carers. Family or informal care has been the subject of extensive research in the past, demonstrating the physical and emotional health risks placed on caregivers. However, little is known about how women caregivers engage with healthcare services for their own health needs, a factor that could mediate or prevent these health outcomes. Arksey and O’Malley’s scoping review methodology was applied to identify relevant empirical, peer-reviewed studies across six databases: MEDLINE, PsycINFO, SocIndex, CINAHL, Web of Science and Sociological Abstracts. Searches were limited from January 2013 to May 2025. A total of 11,228 papers were screened, with 41 papers meeting the inclusion criteria for the review. Studies were primarily quantitative, with a focus on physical and mental health, and the comparison of caregiver to noncaregiver experiences. Three key categories/issues were identified in these studies: (1) a varying frequency of service use (higher, lower and no difference when compared with noncaregivers), (2) key engagement factors (with a focus on individual versus contextual factors), and (3) encounters with health professionals. Findings demonstrate that specific caregiving roles and healthcare system factors influence the way in which carers engage with healthcare services for themselves and have the potential to inform overall health outcomes through a lack of timely treatment or an increased likelihood of requiring healthcare. With women comprising the majority of caregivers, they face a heightened risk of exposure to these challenges, yet existing research overlooks their specific needs and experiences. Opportunities for new and innovative directions in research exist to address ongoing gaps and for the development of meaningful policy and intervention to support women caregivers more effectively.

Child and adolescent mental health difficulties are increasing in the UK and internationally. Social prescribing (SP), a nonmedical, community-linked approach, has shown promise for improving adult wellbeing, but its use and acceptability among young people (YP) remain under-researched. There is limited evidence regarding YP’s own views on whether SP is a valuable option for supporting youth mental health. This study aimed to explore YP’s views on SP in England. Participants included YP both with and without experience of SP in England, recruited via youth organisations, social media and community contacts. Overall, 10 YP between the ages of 11 and 25 (mean = 19.6) were interviewed. This included five YP who had engaged in SP and five who had not. Data from semistructured interviews were analysed using thematic analysis (TA), identifying 10 themes organised within three main categories. These reflected positive views (e.g., a new social sphere, self-transformation and valuing a nonmedical alternative), negative views (including concerns about SP replacing therapy and experiences of feeling invalidated or dismissed) and moderating factors (such as the influence of social support, shared decision-making, resource availability and differing expectations). Findings from this study have highlighted what YP themselves think of and may want from SP services, including what would make them more or less likely to engage with SP. This study has also highlighted some limits of SP as an approach to tackle mental health inequalities in YP.

This patient-centered outcome research (PCOR) engagement project, Mind Over Matter (M.O.M.), was driven by veterans and key stakeholders, employing a successful design methodology from prior projects using think tank meetings (TTMs). Focusing on mild traumatic brain injury (mTBI), the project aimed to enhance PCOR by engaging veterans and caregivers, building capacity, and fostering collaboration with researchers to advance PCOR and comparative effectiveness research (CER). The project’s structure involved creating M.O.M. units in four states, training members as PCOR and CER partners, building competencies of veterans with mTBI and caregiver stakeholders, understanding healthcare information preferences, and promoting collaborative relationships. Key steps included creating state units, training members, building competencies, understanding communication preferences, and promoting collaboration. The project also aimed to develop a Roadmap for Research on TBI, including future CER questions. The project utilized virtual TTMs organized around TBI domains, involving 210 participants, including veterans and various stakeholders. The M.O.M. team used field note templates to guide the discussion of the veterans and community stakeholders during the virtual TTMs. The field note templates were organized by domains: attention, memory sequencing, problem solving, and executive functioning. Each domain addressed TBI symptom areas that include thinking/remembering, physical, emotional/mood, and sleep. The project successfully fostered collaboration, skill-building, and engagement among veterans and stakeholders in the context of PCOR and CER, contributing to a comprehensive understanding and research roadmap to better address mTBI and its impact on veterans.

Background and Aims: This scoping review explored the role of activity providers (APs), also known as activity coordinators, in care homes for older people, and focuses on workforce issues, resources and professional development of APs in the UK. An AP is a staff member of a care home who is typically responsible for implementing activities that meet the needs of residents. Engagement in meaningful activities in care homes for older adults plays an important role in promoting older adults’ physical and mental well-being; however, despite this, evidence about AP roles is limited, and it is not known if the challenges faced in the social care workforce more generally are also a feature of activity provision roles.

Methods: The review used established scoping review methods to map concepts around AP roles, identify resources that are or are not available for activity provision in care homes and identify challenges relevant to AP roles in care homes.

Results: We identified 699 records across 11 databases, including grey literature. Sixty-eight publications were selected for screening, and 28 publications were included in the final data extraction. Thirteen publications were academic journal articles. Data extraction showed variation in the terms that are used to describe APs, with ‘activity coordinator’ being the most common. Resource issues were identified in funding, time and training for APs. The review identified recruitment and retention challenges specific to APs, such as inadequate support from frontline care staff and care home management. Most publications highlighted learning and development initiatives, which often included training in meaningful activities, dementia care and communication. These programmes produced positive outcomes: increased confidence and skills development for APs, and better community engagement.

Conclusion: The review underlines the importance of addressing workforce challenges, improving resource development and recognising the value of APs in care homes. It addresses a clear gap in the academic and grey literature by focussing specifically on APs in older people’s care homes in the UK. The review highlights the diverse terminology used to describe the staff who provide activities in care homes and points to resource limitations and limited training and development for APs. The involvement of non-AP staff in activity provision suggests collaboration with other care home staff members but also reveals a lack of protected time and staffing for dedicated activity provision roles. Improving support and role clarity for APs and recognising the value of APs in care environments may help support staff recruitment and retention.

Effective care preparation requires families to work as teams. This study employed a mixed-methods design and a dyadic approach to examine the levels, processes, person-centered profiles, and characteristics of intergenerational care preparation among families in Hong Kong. Quantitative data were collected from 213 pairs of older parents (aged ≥ 50 years) and their adult children. In addition, individual interviews were conducted with 60 pairs of older parents and their adult children to understand the role of adult children in their older parents’ care preparation. A latent profile analysis of the quantitative data identified three care planning profiles: child-active intergenerational planners, dyadic thinkers, and filial-uninvolved intergenerational avoiders. An integrative analysis of both quantitative and qualitative data revealed a child-centered approach across all three profiles, influenced by the life stage and circumstances of the dyad members. The study also uncovered intergenerational discrepancies in preparation and care expectations, highlighting the need to strengthen family dynamics and intergenerational engagement for effective later-life planning and wellbeing.

The global incidence of intracranial aneurysms is increasing annually, and their rupture is associated with a high mortality rate. Many community residents often unknowingly develop intracranial aneurysms and are at risk of rupturing. To solve this problem, we conduct an innovative approach using machine learning to predict both the occurrence and rupture of intracranial aneurysms in patients with brain diseases and analyze the essential features derived from residents’ health data at various stages of clinical admission. Specifically, we design an ensemble classifier candidate pool model for the initial two stages of admission diagnosis and a deep fusion network model that integrates textual and structured data for the detailed screening stage. Also, the feature importance is explored by the Shapley value and word frequency. The proposed deep fusion neural network achieves the highest predictive performance, with a precision of 0.787, sensitivity of 0.785, specificity of 0.870, F1 score of 0.785, and AUC of 0.871. In addition, text features contribute most significantly to model output, and word frequency varies across different disease types in patient medical records.