Direct Support Research Articles

Reconceptualising the role of direct support staff for adults with intellectual disabilities by introducing the holistic support model

ABSTRACT Background: This study aims to introduce direct support staff (DSS) working with adults with intellectual disabilities to the Holistic Support Model (HSM) and assess its influence on their perceptions of their professional role. The HSM, grounded in humanistic principles, guides the support process, prioritising autonomy and meaningful living. Method: Using participatory action research, this study used survey data, qualitative analysis of group meetings, and interviews, to assess changes in DSSs' role perceptions after undergoing in-service training on the HSM. Results: DSS exhibited a shift towards a humanistic perspective, gaining clarity on their roles, which reduced frustration. Doubts persist among DSS regarding the applicability of the HSM to all adults with intellectual disabilities. Conclusions: The studies underscore the positive impact of the HSM on DSS, highlighting its potential to enhance DSS practice. It recommends researching the experiences of adults with intellectual disabilities with the HSM.

The role of national nutrition programs on stunting reduction in Rwanda using machine learning classifiers: a retrospective study

BackgroundIn Rwanda, the prevalence of childhood stunting has slightly decreased over the past five years, from 38% in 2015 to about 33% in 2020. It is evident whether Rwanda's multi-sectorial approach to reducing child stunting is consistent with the available scientific knowledge. The study was to examine the benefits of national nutrition programs on stunting reduction under two years in Rwanda using machine learning classifiers.MethodsData from the Rwanda DHS 2015–2020, MEIS and LODA household survey were used. By evaluating the best method for predicting the stunting reduction status of children under two years old, the five machine learning algorithms were modelled: Support Vector Machine, Logistic Regression, K-Near Neighbor, Random Forest, and Decision Tree. The study estimated the hazard ratio for the Cox Proportional Hazard Model and drew the Kaplan–Meier curve to compare the survivor risk of being stunted between program beneficiaries and non-beneficiaries. Logistic regression was used to identify the nutrition programs related to stunting reduction. Precision, recall, F1 score, accuracy, and Area under the Curve (AUC) are the metrics that were used to evaluate each classifier's performance to find the best one.ResultsBased on the provided data, the study revealed that the early childhood development (ECD) program (p-value = 0.041), nutrition sensitive direct support (NSDS) program (p-value = 0.03), ubudehe category (p-value = 0.000), toilet facility (p-value = 0.000), antenatal care (ANC) 4 visits (p-value = 0.002), fortified blended food (FBF) program (p-value = 0.038) and vaccination (p-value = 0.04) were found to be significant predictors of stunting reduction among under two children in Rwanda. Additionally, beneficiaries of early childhood development (p < .0001), nutrition sensitive direct support (p = 0.0055), antenatal care (p = 0.0343), Fortified Blended Food (p = 0.0136) and vaccination (p = 0.0355) had a lower risk of stunting than non-beneficiaries. Finally, Random Forest performed better than other classifiers, with precision scores of 83.7%, recall scores of 90.7%, F1 scores of 87.1%, accuracy scores of 83.9%, and AUC scores of 82.4%.ConclusionThe early childhood development (ECD) program, receiving the nutrition sensitive direct support (NSDS) program, focusing on households with the lowest wealth quintile (ubudehe category), sanitation facilities, visiting health care providers four times, receiving fortified blended food (FBF), and receiving all necessary vaccines are what determine the stunting reduction under two among the 17 districts of Rwanda. Finally, when compared to other models, Random Forest was shown to be the best machine learning (ML) classifier. Random forest is the best classifier for predicting the stunting reduction status of children under two years old.

Digital Therapeutics in Hearing Healthcare: Evidence-Based Review.

Digital therapeutics (DTx) in hearing research have emerged as a new category of therapies providing evidence-based intervention via digital means, such as software, smartphone apps, or websites. However, although relatively new, they are not well-established. In this article, we review DTx technologies in hearing research fields, focusing on three categories: prevention and diagnosis, aid (assistance), and cure (digital medicine). We observe that most DTx systems require interactions with users (or patients) without the direct support of clinical professionals to obtain or collect medical evidence; this makes training (or education) features crucial to the therapy's success. In this view, this article discusses the education or training functions of the current DTx and their contribution and purposes. The impact of emerging artificial intelligence (AI) on DTx in hearing research is being explored, and the future of DTx concerning AI integration is being discussed. We believe that this work will contribute to a better understanding of the current and future DTx technological advancements and, in particular, shed light on the field of hearing research.

Share pledge and accounting conservatism in share-pledging firms: Evidence from a natural experiment in China.

This paper focuses on firms in which insiders pledge their shares as collateral for loans. By investigating a natural experiment-China's enactment of provisions on share reductions that restrict pledge creditors' cashing-out behavior-we find that pledging firms exhibited more conservative financial reporting after the implementation than non-pledging firms. This effect was pronounced in firms with a higher ratio of pledged shares, a longer maturation period of the pledged shares, and more concentrated pledge creditors. Additionally, we show that pledging firms increased their accounting conservatism after the shock, leading to a lower risk of margin calls and stock price crashes. The effect on accounting conservatism was stronger in firms with controlling pledgers or when the pledge creditors were banks. Our results remained consistent after we performed several robustness tests. These behaviors are economically logical because the provisions heighten creditors' liquidity risk and the potential losses of loan default. Pledging shareholders embrace more accounting conservatism to mitigate creditors' concerns about agency costs and avoid triggering margin calls. Our findings provide direct support that creditors have a real demand for accounting conservatism and highlight the impact of shareholder-creditor conflicts on the financial reporting policies of pledging firms.

Open government and US development co‐operation in Colombia: Lessons for locally led development

AbstractMotivation“Localization”—direct donor support for national organizations in aid recipient countries—has become a top priority for international development. The United States Agency for International Development (USAID) pledged to raise the proportion of direct funding to national organizations to 25% and for 50% of funding to involve “locally led” input. Independently, USAID commits to proactive disclosure of project information. This study analyses sectoral priorities, access to project data, and localization trends to inform policy discussion about how USAID can reach its twin localization goals, with a focus on Colombia, the largest US aid recipient in Latin America.PurposeAn open government perspective can shed light on whether and how development agencies are making progress towards localization. Moreover, user‐centred information disclosure by donors is necessary to inform locally led development. The goals of this study are to document USAID's sectoral funding priorities, gaps in data disclosure, implementation actions, and direct local funding percentages to make patterns more visible to stakeholders. We ask: What are the strengths and limitations of public disclosure of data concerning US aid in Colombia?Approach and methodsThis analysis uses open‐source data review methods to bring together different sources of publicly available data. These methods include triangulating government data disbursed across multiple sites, recoding government data to make trends visible, and identifying barriers to data access.FindingsPublic data indicate that US funding for peace‐related projects increased in the years following Colombia's 2016 Peace Accord, though the security share of total US aid remains high. Funding trends demonstrate that USAID is far behind its localization goals in Colombia, though absolute funding totals to local organizations are increasing. Finally, publicly available project data are not user‐centred, require technical acumen to access, and are fragmented across multiple sites.Policy implicationsUser‐centred disclosures are key to locally led development to ensure informed participation and accountability to stakeholders.

Impact of government support policies on entrepreneurial orientation and SME performance

Small and medium enterprises (SMEs) are often resource-constrained and motivated by necessity or opportunity. They play an essential role in national economies due to their contributions to employment, human capital development, knowledge spillovers, and social mobility in maintaining diverse entrepreneurial ecosystems. Government support policies (GSP), both financial and nonfinancial, can directly impact SME performance or indirectly by developing an entrepreneurial orientation (EO). Few studies have investigated the important question of how GSP simultaneously may impact both the EO and the performance of an SME. Thus, this paper aims to identify the current understanding of how different forms of GSPs relate to and impact the EO and the performance of SMEs. A systematic literature review was conducted using the PRISMA methodology to synthesize this understanding, resulting in 65 relevant articles from the ABI/INFORM, ScienceDirect, Scopus and Web of Science databases. The relationships between the constructs were analyzed using thematic and semantic analyses, employing computer-assisted data analysis software (NVivo 12 and Leximancer 4.5). This resulted in the categorization of GSPs as direct and indirect support policies, with financial and nonfinancial-subcategories, and depicted their pathways of influence on SMEs’ EO and performance. The study found that GSPs have four different pathways by which they can impact performance. Both direct and indirect policies have moderating effects that can magnify the impact of EO on performance. The review established that the direct effect of GSP on EO varies by sector, SME growth-intention, and type of GSP. Based on the findings, we recommend policymakers develop support policies tailored to SMEs’ specific sector and its intentions to enhance performance.

Social support from the physiotherapist and the therapeutic relationship in physiotherapy: bridging theory to practice

ABSTRACT Background/Purpose Therapeutic relationship and social support are critical components in physiotherapy that shape patient outcomes. However, defining these constructs, discerning their similarities and differences, and measuring them pose challenges. This article aims to facilitate scientific and clinical advancement on social support and the therapeutic relationship in physiotherapy by (a) providing conceptual clarity, (b) discussing measurement tools, and (c) offering practical recommendations for the deliberate incorporation of these constructs in clinical practice. Methods This is a perspective paper drawing on examples from existing research. Key Results Assessing the nature and strength of social support and promoting naturally occurring social support networks are practical ways for physiotherapists to foster social support in physiotherapy clinical practice. Physiotherapists can offer direct support, facilitate the development of an individual’s social skills, and promote participation in group activities. To strengthen the therapeutic relationship, it is important to maintain good communication, foster connectedness with the patient, demonstrate professional skills, and adopt a reflective practice. Physiotherapists are encouraged to establish clear roles and responsibilities, prioritize individualized patient-centered care, and involve patients in shared decision-making, ensuring congruence in goals and expectations. Willingness to dedicate time and energy within and beyond direct patient-therapist interactions can foster connections. Moreover, using the body – which is the main point of contact with patients – and physical touch can help physiotherapists to connect with patients. Finally, physiotherapists must be prepared to address and mend any conflicts which can impact the relationship’s trajectory. Conclusion Social support and therapeutic relationships are complementary aspects of one’s health care, and it is crucial to purposefully account for both in physiotherapy practice to optimize person-centered care and rehabilitation outcomes.

EMPOWERING ADOLESCENTS: THE CRUCIAL ROLE OF SCHOOL GUIDANCE AND COUNSELLING SERVICES IN ADDRESSING EDUCATIONAL CHALLENGES IN SRI LANKA

School Guidance and Counselling services are universally implemented to facilitate students in realizing their full potential and shaping their future lives (Smith, 2020)1. While these services play a crucial role in meeting the diverse needs of students in Sri Lanka, research indicates operational challenges (Buddhiprabha, 2016)2. This article presents findings from a survey study conducted to explore how school guidance and counselling units in Sri Lanka can contribute to resolving educational problems faced by adolescents. The main research study employed a mixed-methods design, incorporating 275 students, 24 class teachers, 5 principals and 5 counselling teachers in the Walasmulla Educational zone in Sri Lanka. The data collection involved the use of questionnaires and interviews. Quantitative analysis was conducted using percentages and charts, while qualitative analysis relied on summaries descriptive essays and structured compositions. Results highlights prevalent educational problems among adolescents, predominantly cognitive issues. Challenges related to studying, exams, the learning process, and external factors were also identified. Despite efforts by school guidance and counselling units to address these challenges, they have not been entirely successful. Notably, students who received direct counselling support reported significant assistance in overcoming their educational hurdles. This underscores the importance of formalized support structures within school guidance and counselling units in providing practical solutions to adolescents' educational challenges, ultimately better preparing them for the future.

Localised refugee education: understanding nationally accredited refugee-led schools in Kenya’s Dadaab camps

ABSTRACT Research from displacement contexts globally has shown that refugees actively collaborate to establish learning centres in order to address educational service gaps facing their communities, such as lack of access or low-quality education. However, much of the existing research focuses on refugee-led educational initiatives that lack national accreditation. Less is known about nationally accredited refugee-led education initiatives – independently established, funded, and managed solely by refugees, especially in refugee camps. With this study, I contribute to the understanding of this lesser-known phenomenon. I examine the conditions underlying the emergence of nationally accredited refugee-led schools in Kenya’s Dadaab camps and what these schools do to improve education quality and their students’ performance in national exams. I draw on six months of ethnographic research and virtual follow-ups between 2020 and 2022. In the context of the evolving localisation of humanitarian aid discourse, this study broadens insights into governance practices that yield effective service delivery, good quality education, and better results in national examinations. The case of the nationally accredited refugee-led schools in Dadaab camps teaches us that direct support to the state and refugees, rather than intermediary INGOs, can improve students’ results in national exams and the quality of education overall.

Teaching strategies to facilitate social and cognitive processes in online learning environments

ABSTRACT This study used the Community of Inquiry framework to examine how university instructors designed, facilitated, and supported social and cognitive processes in online courses, and how instructors and students experienced these processes. In early 2021, 25 online focus groups were organized with instructors (n = 52) and students (n = 44) from all faculties of a large Dutch university to discuss this. In terms of design, instructors restructured their courses (e.g. reduced group sizes to intensify interaction and implemented a flipped classroom approach) and communicated more explicitly about the course structure and expectations to better enable students to self-regulate their learning process. During the course, instructors orchestrated cognitive and social processes by facilitating discourse (e.g. breakout room activities and collaboration activities) and offering direct support (e.g. online progress monitoring and “being there” for students). The analysis illustrated how teaching presence plays a crucial role in fostering cognitive and social processes in online courses. This study contributes to a better understanding of the role of teaching presence in a community of inquiry, while providing insights that can inform the development of effective online teaching strategies.

INTERNATIONAL NON-GOVERNMENTAL ORGANIZATIONS STRATEGIES AND WEALTH CREATION IN RWANDA A CASE OF RWANDA RED CROSS

This research was about the International non-governmental organizations (INGOs) strategies and wealth creation. The main objective of this research was to examine the influence of International Non-Governmental Organizations (INGOs) strategies on wealth creation in Rwanda taking a case of Rwanda Red Cross in Nyabihama Village in Gisagara district. The specific objectives of this research were: To investigate the influence of direct support, Income generating projects and model village (Agasozi ndatwa) on wealth creation in Nyabihama village. The study adopted mixed research design where both qualitative and quantitative methods were used. The target population was 114 people of Nyabihama village who are ones of the beneficiaries of Rwanda Red Cross. In selecting sample, the researcher used census sampling and purposive sampling techniques. Primary data was collected using questionnaires and interview. Data collected was analyzed using thematic analysis and SPSS version 26. The results presented that there was a statistically significant relationship between direct support and wealth creation, a significance influence of income generating projects on wealth creation, and a statistically significant relationship between the model village and wealth creation in Nyabihama Village as they were explained in the Research Findings and Discussions section. It was concluded that there was a statistically significant relationship between International Non-Governmental Organizations (INGOs) strategies and wealth creation in Rwanda where to some extent those strategies promoted wealth creation however to another extent wealth creation was not achieved.

Novice Teacher Recruitment and Retention in a Midwestern State: An Exploration of Contextual Factors

Teacher recruitment and retention consistently emerged as problematic in research and practice. This was particularly true in difficult-to-staff areas, such as rural school districts in the United States. As the teacher pipeline continued to decrease and various challenges plagued the field, this problem quickly became a crisis. The present study aimed to lift novice teachers' voices in rural and remote rural areas of a Midwestern State better to understand individuals' experiences in a rural setting and contribute to the current knowledge base of rural teacher recruitment and retention. Eleven participants in this qualitative phenomenological study aimed to uncover the specific contextual factors that influenced their experiences as novice teachers in a rural Midwestern State. Interviews revealed the need for direct support from administrators and colleagues to create a sense of belonging, which was imperative to positive novice teacher experiences. The need for appropriate preparedness within their preservice experiences and coursework, as well as solid induction and mentoring programs once hired, surfaced during the interviews. Rural-specific field experiences paired with comprehensive induction and mentoring programs focused on specific feedback prepare preservice teachers and novice teachers for successful rural teaching and living. Intentional recruitment efforts, including grow-your-own programs for future teachers and partnerships between rural school districts and teacher preparation programs, boosted the pipeline of novice teachers for rural areas.

Establishing Best Practices in Telehealth Care for Adults with Developmental Disabilities in the United States: An e-Delphi Study.

Background: Telehealth care is now a key element of mainstream health care since the COVID-19 pandemic, with all types of health care providers joining the digital revolution. As a population experiencing health care disparities, adults with developmental disabilities and their supporters have described variable experiences with telehealth care that contribute to overall care quality and health outcomes. Methods: This e-Delphi study established consensus on best practices in telehealth care for adults with developmental disabilities in the United States. Online surveys and videoconferencing interviews were conducted with 44 expert panelists with experience with telehealth care and developmental disabilities, including adults with developmental disabilities, family members, direct support professionals, nurses, and health care providers. Results: Three rounds of surveys resulted in a set of 9 guidelines consisting of 42 items. The guidelines addressed 1) appropriate situations for telehealth care, 2) communication needs and preferences, 3) support person collaboration, 4) education and anticipatory guidance, 5) reminders, 6) coordination of care, 7) equitable and fair access, 8) privacy and safety, and 9) evidence-based practice. Conclusion: Health care providers can adopt these best practice guidelines to ensure telehealth care is provided equitably and safely to adults with developmental disabilities. Policy advocacy is needed for the uptake of these guidelines and for health care providers and adults with developmental disabilities to access the resources needed for safe and effective telehealth care use.

Skilled nursing facility staffing shortages: Sources, strategies, and impacts on staff who stayed.

To examine skilled nursing facility (SNF) staffing shortages across job roles during the COVID-19 pandemic. We aimed to capture the perspectives of leaders on the breadth of staffing shortages and their implications on staff that stayed throughout the pandemic in order to provide recommendations for policies and practices used to strengthen the SNF workforce moving forward. For this qualitative study, we engaged a purposive national sample of SNF leaders (n = 94) in one-on-one interviews between January 2021 and December 2022. Using purposive sampling (i.e., Centers for Medicare & Medicaid quality rating, region, ownership) to capture variation in SNF organizations, we conducted in-depth, semi-structured qualitative interviews, guided a priori by the Institute of Medicine's Model of Healthcare System Framework. Interviews were conducted via phone, audio-recorded, and transcribed. Rigorous rapid qualitative analysis was used to identify emergent themes, patterns, and relationships. SNF leaders consistently described staffing shortages spanning all job roles, including direct care (e.g., activities, nursing, social services), support services (e.g., laundry, food, environmental services), administrative staff, and leadership. Ascribed sources of shortages were multidimensional (e.g., competing salaries, family caregiving needs, burnout). The impact of shortages was felt by all staff that stayed. In addition to existing job duties, those remaining staff experienced re-distribution of essential day-to-day operational tasks (e.g., laundry) and allocation of new COVID-19 pandemic-related activities (e.g., screening). Cross-training was used to cover a wide range of job duties, including patient care. Policies are needed to support SNF staff across roles beyond direct care staff. These policies must address the system-wide drivers perpetuating staffing shortages (i.e., pay differentials, burnout) and leverage strategies (i.e., cross-training, job role flexibility) that emerged from the pandemic to ensure a sustainable SNF workforce that can meet patient needs.

Can Pilot Free Trade Zones Promote Sustainable Growth in Urban Innovation?

China’s pilot free trade zones play an important role in promoting deep-level reform and high-standard opening up. Based on the panel data of 284 prefecture-level cities in China from 2009 to 2021, the article explores the impact of pilot free trade zones on urban innovation using the multi-period difference-in-differences model, mediation effect model, and spatial difference-in-differences model, treating the pilot free trade zone as a quasi-natural experiment. The study shows the following: the establishment of pilot free trade zones boosts sustained growth in urban innovation, and the results still hold after a series of robustness tests; the enabling effect of pilot free trade zones on urban innovation is most significant in eastern regions and large-scale cities; and the role of pilot free trade zones in promoting innovation varies by stage. The mediation impact study revealed that pilot free trade zones can influence urban innovation via talent concentration, foreign direct investment, market scale, and financial support. The pilot free trade zones enhance the innovation performance of its geographically adjacent cities with economic ties and the innovation level of the region. The analysis offers a policy basis for the sustainable growth of urban innovation.

Evaluating Double-Duty Actions in Rwanda's Secondary Cities.

The double burden of malnutrition (DBM) is escalating in low- and middle-income countries (LMICs), including in Rwanda, most notably in urbanizing areas. The 2019-2020 Rwanda Demographic Health Survey (DHS) revealed that 33% of children under 5 years old are stunted while 42% of women in urban areas are overweight or obese. This coexistence has contributed to a surge in non-communicable diseases (NCDs), particularly in secondary cities. Using the World Health Organization's (WHOs) "double-duty action" (DDA) concept, this study aims to identify and evaluate interventions with double-duty potential in Rwanda's Rusizi and Rubavu districts and generate key recommendations for their improvement. A desk review of national policies pinpointed four programs with the greatest DDA potential: early childhood development (ECD) centers, the school feeding program, farmer field schools (FFS), and the provision of nutrition-sensitive direct support. In-person interviews with key stakeholders assessed the implementation of each program and a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis was used to generate context-specific recommendations for their improvement. The main finding of this research is that Rwanda's potential to address the DBM can be improved across multiple sectors by implementing a few key changes: targeting beliefs surrounding nutrition, improving trainings for community educators, enhancing parent-particularly father-involvement, and engaging in close monitoring and follow-up. These findings offer actionable streps that governments and nutrition stakeholders can take to improve similar interventions in other rapidly urbanizing LMICs.

Dampak Pola Asuh Fatherless dalam Al-Qur'an: Study Kritis Parenting dalam Kisah Nabi Ya'kub

This research aims to investigate the impact of fatherless parenting as depicted in the Qur'an, especially through the story of the Prophet Ya'qub. The research method used is a critical analysis of parenting practices seen in the narrative of the Koran, with a focus on the role and influence of fathers in shaping the character of their children. This research describes fatherless parenting in the context of the life of the Prophet Ya'qub, who is the central figure in a complex and intriguing family story in the Qur'an. The results of the analysis highlight the various impacts that arise due to the absence of a father figure in the process of forming children's character. One of the main findings is the importance of the father's role as a family leader who provides moral direction and emotional support to children. Father absence can cause emotional instability and internal conflict in children and increase the risk of them falling into negative behavior. Apart from that, this research also explores the Prophet Ya'qub's efforts to overcome the challenges he faced as a single father. An in-depth analysis of the strategies used by the Prophet Ya'qub in raising his children provides valuable insight into the importance of a father's presence and influence in the family. The findings of this research provide an important contribution to our understanding of the importance of fathers' roles in the process of children's character formation, as well as their implications for contemporary parenting practices. The practical implications of this research include a better understanding of fatherless parenting and efforts that can be made to overcome its negative impacts in modern society.

Sustainability of an Educational Program on Oral Care/Hygiene Provision by Healthcare Providers to Older Residents in Long-Term Care Institutions: A Follow-Up Study.

The importance of oral health in older adults, especially those in long-term care institutions (LTCIs), has been widely recognized. This study aimed to evaluate the sustainability of an oral health educational program (OHEP) for healthcare providers by measuring changes in their knowledge, attitudes, and practice (KAP) towards oral care provision 3 and 6 months after completing the OHEP. A pragmatic direct care nursing education trial with a control group was conducted to evaluate the sustainability of an OHEP by examining changes in KAP 3 and 6 months after the OHEP. The OHEP comprised both knowledge and skills related to oral care, whereas the control group received standard support in accordance with usual oral care practice. The study included 20 healthcare providers in the intervention group and 20 in the control group. At 6 months post-OHEP, a significant difference in knowledge was observed between the two groups, with the intervention group maintaining a positive effect (mean 13.90). Conversely, the control group showed a significant decline in knowledge (from mean 14.25 to 12.10). Both groups showed an improvement in attitudes regarding oral health, with the intervention group exhibiting better results 3 months post-OHEP. Intervention group participants rated oral care as a higher priority. An OHEP program for LTCI direct care staff provides enhanced knowledge and attitudes toward oral health care. Regular training in direct care and additional support may be needed to sustain optimal effects on oral care practice.

Optimising a clinical decision support tool to improve chronic kidney disease management in general practice

BackgroundEarly identification and treatment of chronic disease is associated with better clinical outcomes, lower costs, and reduced hospitalisation. Primary care is ideally placed to identify patients at risk of, or in the early stages of, chronic disease and to implement prevention and early intervention measures. This paper evaluates the implementation of a technological intervention called Future Health Today that integrates with general practice EMRs to (1) identify patients at-risk of, or with undiagnosed or untreated, chronic kidney disease (CKD), and (2) provide guideline concordant recommendations for patient care. The evaluation aimed to identify the barriers and facilitators to successful implementation.MethodsFuture Health Today was implemented in 12 general practices in Victoria, Australia. Fifty-two interviews with 30 practice staff were undertaken between July 2020 and April 2021. Practice characteristics were collected directly from practices via survey. Data were analysed using inductive and deductive qualitative analysis strategies, using Clinical Performance - Feedback Intervention Theory (CP-FIT) for theoretical guidance.ResultsFuture Health Today was acceptable, user friendly and useful to general practice staff, and supported clinical performance improvement in the identification and management of chronic kidney disease. CP-FIT variables supporting use of FHT included the simplicity of design and delivery of actionable feedback via FHT, good fit within existing workflow, strong engagement with practices and positive attitudes toward FHT. Context variables provided the main barriers to use and were largely situated in the external context of practices (including pressures arising from the COVID-19 pandemic) and technical glitches impacting installation and early use. Participants primarily utilised the point of care prompt rather than the patient management dashboard due to its continued presence, and immediacy and relevance of the recommendations on the prompt, suggesting mechanisms of compatibility, complexity, actionability and credibility influenced use. Most practices continued using FHT after the evaluation phase was complete.ConclusionsThis study demonstrates that FHT is a useful and acceptable software platform that provides direct support to general practice in identifying and managing patients with CKD. Further research is underway to explore the effectiveness of FHT, and to expand the conditions on the platform.

The prospective associations between autonomy support, basic psychological needs, motivation and well-being among people with a mild to borderline intellectual disability: a two-wave study.

This study, grounded in self-determination theory, examined how satisfaction of the needs for autonomy, relatedness and competence in people with mild to borderline intellectual disability (MBID) changed over a 4.5-year period. Additionally, it explored the association between life events across various domains (i.e. health, support and living situation, crime, relationships and freedom and finance) and these changes and explored the prospective associations between these needs, perceptions of support from direct support staff and the well-being and ill-being of people with MBID. Based on a sample of 117 adults with MBID, multiple regression analyses were conducted to determine correlations between constructs at both time points and the impact of autonomy support on need satisfaction and motivation, taking into account life events. The analyses showed that, at both time points, most constructs were statistically significantly correlated and remained so despite a time lag of 4.5 years. Autonomy support emerged as a significant positive predictor, of medium size, for satisfying autonomy and relatedness needs. Its association with competence need satisfaction was not statistically significant after Bonferroni correction. For type of motivation, autonomy support statistically predicted increased autonomous motivation, irrespective of life events. Findings underline the potential of autonomy supportive direct support in the lives of individuals with MBID. Some unexpected null findings underscore the need for further study into the interplay between autonomy support, life events and the well-being of people with MBID.