Personal Factors Research Articles

Keep it CooL! Results of a two-year CooL-intervention: a descriptive case series study

BackgroundCoaching on Lifestyle (CooL) is a two-year healthcare intervention for people with overweight or obesity, stimulating weight reduction by promoting sustained healthier behavior. The objective of this study is to investigate the effects of CooL on participants’ anthropometrics, personal factors and behavioral factors over the two-year timeframe of CooL.MethodsA descriptive case series study, using a broad set of routinely collected data on anthropometrics, personal factors and behavioral factors of adults living across the Netherlands. The data were collected between November 2018 and December 2021 among participants of CooL (N = 746) at three moments during the intervention: at baseline (T0), at 8 months (T1) after completion of phase 1 and at 24 months (T2) after ending CooL. Changes over time were analyzed using paired t-tests comparing baseline to T1 and baseline to T2. In addition, potential differences on outcomes in subgroups based on education level, weight status and group size were examined using paired t-tests and ANOVA-tests.ResultsThe results showed positive changes on all outcomes at 24 months compared to baseline. The largest effects were on perceived health, attentiveness towards meal size and meal composition (large effect size). Mean weight loss was 4.13 kg (SD 7.54), and mean waist circumference decreased with 4.37 centimeters (SD 8.59), indicating a medium to large effect size. Changes were consistent across subgroups varying in educational level, BMI at baseline and group size.ConclusionThe study demonstrated sustained weight-related effects of CooL over 24 months supporting its two-year duration. The results indicate that CooL, though not for every individual, is in general appropriate and effective for different group sizes and for a wide variety of participants regardless of level of education, or BMI at baseline.Trial registrationDutch Trial Register NTRNL6061 (13-01-2017). Registered at Overview of Medical Research in the Netherlands (OMON), via https://www.onderzoekmetmensen.nl/.

Comparison of psychopathology, purpose in life and moral courage between nursing home and hospital healthcare workers during the COVID-19 pandemic

The COVID-19 pandemic deeply affected healthcare workers, although the impact may have differed according to different workplace contexts. The aim of this current research was to compare the psychopathology presented by hospital versus nursing home healthcare workers during the COVID-19 pandemic and to analyse the predictive role of purpose in life and moral courage in the appearance of psychopathology. This was an observational, cross-sectional study carried out on a sample of 108 healthcare workers, 54 each from a hospital or nursing homes, who were recruited during the 5 and 6th waves of the COVID-19 pandemic in Spain. Various self-reported scales were used to assess anxiety, depression, acute/post-traumatic stress disorder, drug and alcohol abuse, burnout, purpose in life, and moral courage. Compared to the hospital healthcare workers, nursing home healthcare workers had higher scores and a higher prevalence of anxiety (74.1% vs. 42%), depression (40.7% vs. 14.8%), and post-traumatic stress disorder (55.6% vs. 25.9). In the overall sample, purpose in life was a protective factor against psychopathology (OR = 0.54) and burnout (OR = 0.48); moral courage was a protective factor against depression (OR = 0.47) and acute stress (OR = 0.45); and exposure of family/friends to SARS-CoV-2 was a risk factor for acute stress (OR = 2.24), post-traumatic stress disorder (OR = 1.33), and higher burnout depersonalisation subscale scores (OR = 1.84). In conclusion, the increased presence of psychopathology in nursing home healthcare workers may be influenced by workplace and occupational contexts, personal factors such as exposure of family/friends to SARS-CoV-2, or internal dimensions such as purpose in life and moral courage. This knowledge could be useful for understanding how a future epidemic or pandemic might affect the mental health of healthcare workers in different labour contexts.

Developing an Educational Resource Aimed at Improving Adolescent Digital Health Literacy: Using Co-Design as Research Methodology.

Adolescence is a key developmental period that affects lifelong health and is impacted by adolescents regularly engaging with digital health information. Adolescents need digital health literacy (DHL) to effectively evaluate the quality and credibility of such information, and to navigate an increasingly complex digital health environment. Few educational resources exist to improve DHL, and few have involved adolescents during design. The co-design approach may hold utility through developing interventions with participants as design partners. This project aimed to explore the co-design approach in developing an educational resource to improve adolescents' DHL. Adolescents (12-17 years old) attended 4 interactive co-design workshops (June 2021-April 2022). Participant perspectives were gathered on DHL and the design of educational resources to improve it. Data generated were analyzed through content analysis to inform educational resource development. In total, 27 participants from diverse backgrounds attended the workshops. Insight was gained into participants' relationship with digital health information, including acceptance of its benefits and relevance, coupled with awareness of misinformation issues, revealing areas of DHL need. Participants provided suggestions for educational resource development that incorporated the most useful aspects of digital formats to develop skills across these domains. The following 4 themes were derived from participant perspectives: ease of access to digital health information, personal and social factors that impacted use, impacts of the plethora of digital information, and anonymity offered by digital sources. Initial participant evaluation of the developed educational resource was largely positive, including useful suggestions for improvement. Co-design elicited and translated authentic adolescent perspectives and design ideas into a functional educational resource. Insight into adolescents' DHL needs generated targeted educational resource content, with engaging formats, designs, and storylines. Co-design holds promise as an important and empowering tool for developing interventions to improve adolescents' DHL.

Addressing the links between and internal vs. external regulation factors, achievement emotions and gender in problematic use of ICT at university

ContextThe study of internal and external regulation in the use of Information and Communications Technology (ICT) and the analysis of academic emotions have become increasingly important due to their impact on academic life at university.ObjectivesThis research aims to investigate the links between internal vs. external regulation factors, achievement emotions, and gender in the problematic use of ICT among university students.MethodologyThe study recruited 317 university students, predominantly female (72.51%), using an ex-post facto design. The SRT-ERT scale was used to assess technology-related behaviors, and the AEQ Scales measured academic emotions before, during, and after class. Correlation analysis, multiple regression analysis, and ANOVA were employed to identify significant relationships.ResultsSignificant relationships were identified between regulatory behaviors, with male students exhibiting more dysregulated behavior and greater exposure to dysregulatory technology environments. Individual and contextual behavioral nonregulation and dysregulation in the use of ICT were significantly predictive of negative academic emotions.ConclusionThe findings suggest that both personal and contextual factors of regulation significantly influence the emotional experiences of students in academic settings. The study highlights the need for psycho-educational interventions to promote better regulatory behaviors among university students, particularly males.

School-Based Suicide Prevention Efforts: The Impact of School Nurse Exclusivity on Moral Distress.

School nurses are well-positioned to assess, identify, and refer children and adolescents who are at risk of suicide. This multiple-case study examined the personal, behavioral, and environmental factors that influence the role of the school nurse in youth suicide prevention and intervention. Purposive sampling was used to recruit two school nurses who were identified as unique cases. Data from interviews, surveys, and documents generated a cross-case analysis. Findings indicate that school-level exclusive practices, such as a lack of communication and collaboration, greatly influence the role and reach of school nurses. Further, dilemmas arising from environmental barriers hinder school nurse capacity to promote student safety and affect moral distress levels. Leveraging data to demonstrate the pivotal role of school nurses to support mental health equity and reduce disparities in youth suicide is crucial to developing inclusive and responsive suicide prevention programs.

Using polygenic risk modification to improve breast cancer prevention: study protocol for the PRiMo multicentre randomised controlled trial

IntroductionEstablished personal and familial risk factors contribute collectively to a woman’s risk of breast or ovarian cancer. Existing clinical services offer genetic testing for pathogenic variants in high-risk genes to...

Rethinking treatment failures. Research on a group of Italian psychotherapists

IntroductionPsychotherapeutic failures involve situational, relational, and personal factors. Dropout refers to a patient’s unilateral termination of treatment without the therapist’s knowledge or approval. Premature termination occurs when therapy is discontinued before achieving a sufficient reduction in initial problems.ObjectiveThis study explores the role of therapist’s emotional response (countertransference), gender, psychotherapeutic orientation, and patient diagnosis in the context of psychotherapeutic failures.MethodA mixed-method approach was used. Fifty-nine Italian psychotherapists, practicing mostly privately with at least 5 years of experience, were recruited through Italian professional internet websites. The Therapist Response Questionnaire and the Impasse Interview were administered to each psychotherapist. Each therapist was asked to reflect on their last dropout patient. Quantitative (MANOVA) and qualitative analyses (textual content analysis) were conducted with SPSS and T-LAB, respectively.ResultsThe quantitative analyses revealed that the most frequent countertransference response was Helpless/Inadequate, with female therapists experiencing this more frequently than male therapists. The qualitative analyses identified two main factors explaining most of the variance in countertransference responses: Parental/Protective versus Hostile/Angry, and Positive/Satisfying versus Helpless/Inadequate, with Helpless/Inadequate central. Additionally, the qualitative analysis of treatment interruption methods revealed two factors explaining over 50% of the variance. Lack of communication was linked to negative themes, while mediated and direct communication were associated with positive terms. Direct communication was characterized as useful, while mediated communication was linked to dropout and attachment figures.ConclusionUnder pressure, psychotherapists’ anxiety levels increase, often managed ambivalently or avoidantly. These results suggest that awareness of psychotherapist emotional responses is important to limit psychotherapeutic failures. These findings offer valuable insights for clinical practice.

Experiences of parenting for autistic children in Australia and Italy: a qualitative cross-cultural comparison

IntroductionParents vary in their gradual adaptation to the demands of caring for an autistic child. Their experiences can be positive, negative, or a combination of both, depending on the severity of the cases and various personal and social factors. Cross-cultural comparisons can aid in understanding how contextual factors, such as the availability of social and health services, and cultural factors, such as family relationships and the distribution of care burden, may influence the caregiving experience. However, there is a limited amount of cross-cultural research on this topic, which is almost exclusively quantitative.Aims and methodsFrom an ecocultural perspective, our interview-based study aimed to explore the experiences of Australian (15) and Italian (11) parents of autistic children living in their respective countries.ResultsThe analysis identified three main themes. Life through autism, autism through life: coexisting with an unexpected life partner, Parenting autistic children: reorganization of parents’ subjectivity and familiar dynamics, and The unseen side of disability: autism communities between inclusion and segregation.DiscussionOur comparative approach reveals both commonalities and differences between the two groups of participants. The similarities support features previously identified in the literature: the emotional and physical burden on parents and the positive impact on parental identity. The differences relate to the diagnostic process, interactions with health professionals, the impact of autism on family dynamics and parental perspectives, and the role assigned to siblings. Despite facing similar challenges, these differences reveal how Italian and Australian parents articulate different understandings linked to social and cultural differences.

Differences in Dominance, Social Boldness and Privateness: A Comparative Study of Castes

The culture of any country is multi-dimensional in nature. The cultural differences exist everywhere. Caste differences is an intrinsic part of the Indian society. The personality differences may occur due to differences and discrimination among different castes. The present research is an attempt to measure the caste differences in the personality factors like dominance, social boldness and privateness. For this study the two broad categories of caste that is SC and Non-SC was studied. A sample of 600 college students from the age range between 18 and 25 was selected. The SC and Non-SC ratio was 1:1. The 16 PF Questionnaire developed by R. B. Cattell-5th Edition was used to measure dominance, social boldness and privateness. Independent t-test was carried out to analyze the data. The result of the study revealed that there were significant differences between SC and Non-SC on dominance, social boldness and privateness. Non-SC subjects were found to be higher on these three factors.

Why do Mandarin speakers code-switch? A case study of conversational code-switching in China

Multilingualism is becoming increasingly common worldwide, with multilingual studies becoming more popular and accelerating interpersonal language contacts; however, it remains controversial and ambiguous in China. The current study aims to explore code-switching (CS) patterns and factors among Mandarin-dominated mainland Chinese speakers and investigate multilingual development in China through CS, as it is a multilingual practice. Conversational analysis was conducted to analyse daily interactions in short videos posted online, categorise language varieties and frequencies, identify CS patterns, and examine the factors influencing CS patterns. The results revealed that foreign languages and dialects other than Mandarin were spoken by Mandarin-dominated speakers. Three of four CS patterns were also pinpointed regarding language practices in China. Insertion was the most predominant pattern, followed by backflagging and alternation. The CS patterns employed by Mandarin-dominated mainland Chinese speakers were influenced primarily by participant-related factors, followed by linguistic-related factors, sociopsychological factors, convenience, and situational factors. The prevalence of the insertional CS pattern and the influence of personal factors suggest that China’s Mandarin-speaking community is in an early phase of multilingual development.

Self-Service Hotel Check-In: Is There Still a Role for the In-Person Experience?

ABSTRACT This study investigated the short service encounters of hotel guests’ in-person versus self-service technology (SST) check-in experiences based on their perceptions of the check-in significance and impact on service and relationship outcomes. Guests (n = 378) completed an intercept survey at four mega-resorts immediately after check-in. Based on social cognitive theory, a research model was developed and tested using PLS-SEM. Check-in significance was an important personal psychological factor in customer perceptions, influencing their service quality evaluation, satisfaction, intention to engage, and trust the service provider. Emotional engagement intention served as a partial mediator. Multi-group analysis showed a significantly higher effect of in-person check-in on customer satisfaction and intention to emotionally engage with employees compared to SST check-in. Theoretical and practical contributions to customer relationship management are presented.

Persevering through communication challenges: a qualitative descriptive exploration of communication experiences in aphasia

ABSTRACT Background People with aphasia often experience activity limitations and participation restrictions despite wanting to engage in communication activities that are satisfying and meaningful. Communication partner support, the complexity of the communication environment, and the thoughts and feelings of people with aphasia have important implications for both language processing and communicative participation. The perspectives of PWA about the role that environmental and personal factors (e.g. thoughts and feelings) play in their communication experiences could inform clinical practice. Aims To qualitatively explore the communication experiences of people with aphasia and how environmental demands and personal factors (especially emotional responses) affect these experiences. Methods & Procedures Fourteen participants with aphasia completed semi-structured interviews immediately following testing sessions for a larger mixed-methods project investigating the relationship between mood, attention, and language function. Interview questions related to their everyday communication experiences and how their communication environment affected their communication and concentration as well as how their emotions affected their communication. Interviews were recorded, transcribed orthographically, then analyzed using a generic qualitative descriptive approach. Coding was completed in two rounds, which included inductive and deductive coding. Codes were synthesized by reflexively analyzing code co-occurrence. Outcomes & Results Key antecedent variables included language deficits associated with aphasia and environmental demands, often leading to communication challenges. Participation was highlighted as the principal outcome, ranging from proactive engagement to withdrawal. Mental rehearsal, feelings, and attitudes mediated participation, but feelings and attitudes were also described as outcomes. Communication partners played a pivotal mediating role, often determining positive or negative outcomes. Supportive partners facilitated engagement, optimism, and contentment, while unsupportive partners led to frustration. Conclusions The results of this study highlight the role of various factors in influencing the communication experience of people with aphasia and indicate that, within the context of communication challenges, communication partners, attitudes, feelings, and participation play critical and interacting roles. Preparatory strategies such as mental rehearsal can also facilitate participation. These findings imply that targeting communication partner support, mental rehearsal focused on social scripts, or psychosocial adjustment could have important effects on participation.

Community Mobility in Persons Living With Dementia Significantly Predicts Caregiver Burden: Findings From a National Survey & Implications for OT

Abstract Date Presented 03/21/24 Caregivers of persons with dementia regularly report burden. Although research has identified protective factors for role management, this work highlights protective factors in persons with dementia as a focus for OT interventions. Primary Author and Speaker: Paul Arthur Additional Authors and Speakers: Chih-Ying Li

Systematic review of factors related to quality of life in patients with oral cancer: a systematic review.

This study aims to evaluate factors related to quality of life of patients with oral cancer. CNKI, Wanfang, VIP, CBM, Pubmed, Medline, Web of Science, Embase, and The Cochrane Library were searched up to May 2023 for studies that evaluated the quality of life of patients with oral cancer. All the included studies were independently selected, extracted, and rated by two researchers, and results are summarized by qualitative analysis. Twenty-four articles on 2 717 patients were included. Factors related to the quality of life of patients with oral cancer mainly included age, tumor TNM stage, radiochemotherapy, and gender, which could be summarized into three aspects: personal factors, disease-related factors, and surgical factors. More than five studies reported on the analysis of age, gender, tumor TNM stage, pathological stage, neck dissection method, marital status, recurrence, smoking, education level, etc. The results are relatively consistent. The incidence of oral cancer increases, and many factors affected the quality of life. The included literature is a cross-sectional study, and the sample size is limited. The causal relationship between relevant factors and quality of life should be verified using large sample sizes.

'A Meaningful Difference, but Not Ultimately the Difference I Would Want': A Mixed-Methods Approach to Explore and Benchmark Clinically Meaningful Changes in Aphasia Recovery.

Outcome measurement instruments (OMIs) are used to gauge the effects of treatment. In post-stroke aphasia rehabilitation, benchmarks for meaningful change are needed to support the interpretation of patient outcomes. This study is part of a research programme to establish minimal important change (MIC) values (the smallest change above which patients perceive themselves as importantly changed) for core OMIs. As a first step in this process, the views of people with aphasia and clinicians were explored, and consensus was sought on a threshold for clinically meaningful change. Sequential mixed-methods design was employed. Participants included people with post-stroke aphasia and speech pathologists. People with aphasia were purposively sampled based on time post-stroke, age and gender, whereas speech pathologists were sampled according to their work setting (hospital or community). Each participant attended a focus group followed by a consensus workshop with a survey component. Within the focus groups, experiences and methods for measuring meaningful change during aphasia recovery were explored. Qualitative data were transcribed and analysed using reflexive thematic analysis. In the consensus workshop, participants voted on thresholds for meaningful change in core outcome constructs of language, communication, emotional well-being and quality of life, using a six-point rating scale (much worse, slightly worse, no change, slightly improved, much improved and completely recovered). Consensus was defined a priori as 70% agreement. Voting results were reported using descriptive statistics. Five people with aphasia (n = 4, > 6 months after stroke; n = 5, < 65 years; n = 3, males) and eight speech pathologists (n = 4, hospital setting; n = 4, community setting) participated in one of four focus groups (duration: 92-112 min). Four themes were identified describing meaningful change as follows: (1) different for every single person; (2) small continuous improvements; (3) measured by progress towards personally relevant goals; and (4) influenced by personal factors. 'Slightly improved' was agreed as the threshold of MIC on the anchor-rating scale (75%-92%) within 6 months of stroke, whereas after 6 months there was a trend towards supporting 'much improved' (36%-66%). Our mixed-methods research with people with aphasia and speech pathologists provides novel evidence to inform the definition of MIC in aphasia rehabilitation. Future research will aim to establish MIC values for core OMIs. This work is the result of engagement between people with lived experience of post-stroke aphasia, including people with aphasia, family members, clinicians and researchers. Engagement across the research cycle was sought to ensure that the research tasks were acceptable and easily understood by participants and that the outcomes of the study were relevant to the aphasia community. This engagement included the co-development of a plain English summary of the results. Advisors were remunerated in accordance with Health Consumers Queensland guidelines. Interview guides for clinicians were piloted by speech pathologists working in aphasia rehabilitation.

Modeling passenger comfort in turboprop aircraft using objective measures.

A quantitative comfort model will aid in evaluating comfort levels of various target groups before the actual flight of an airplane. However, constructing the model is always a challenge due to the complexity of the phenomenon. In this paper, we present quantitative comfort models to predict the (dis)comfort of passengers flying with turboprops based on objective measures. Ninety-seven participants took part in two experiments conducted during real flights, during which forty of them had environmental and personal factors recorded using (self-developed) measurement tools. The collected data were analyzed to model the relations between objective measures and subjective feelings. Two preliminary models based on gradient boosting regression were developed. The models were able to predict the changes in comfort and discomfort of individual passengers with an accuracy of 0.12±0.01 and 0.21±0.01 regarding normalized comfort and discomfort scores, respectively. Additionally, contributions of different factors were highlighted. The outcomes of the models show that we took a step forward in modeling the human comfort experience using objective measurements. Anthropometry (including age), seat positions, time duration, and row (noise) emerged as leading factors influencing the feeling of (dis)comfort in turboprop planes.

Personality factors and pandemic-related behaviors

PurposeThe purpose of the current study was to determine whether there are personality differences (the HEXACO model, narcissism, sadism, compassion for others) in mask-wearing, social distancing, and hoarding.FindingsThose who always wore masks were significantly higher in compassion for others and significantly lower in sadism compared to those who did not always wear masks. Those who always socially distanced (compared to those who did not) were significantly higher in openness, compassion for others, and conscientiousness. Those who hoarded were significantly lower in agreeableness than those who did not hoard.ConclusionPerhaps physicians may use information to boost states of altruistic-type traits (agreeableness, compassion for others) while educating patients during visits in order to increase the likelihood of receiving vaccinations or booster shots.

Unleashing the Personality Divide: Resilience in Dog Owners, Neuroticism in Cat Owners

ABSTRACT Personality differences have been reported in “dog people” and “cat people” across all Big Five personality traits. Dog ownership has also been associated with reduced loneliness in people living alone during periods of prolonged isolation, which may be suggestive of higher levels of resilience in this population of pet owners. This research extends these findings by investigating the predictive power of dog vs. cat ownership on Big Five personality traits and resilience in an Australian population, after controlling for age and gender. Three hundred and twenty-one participants completed an online survey consisting of questions on demographics, pet ownership, and personality, as well as providing free-hand responses for their choice in pet. As hypothesized, dog ownership was found to positively predict resilience, while cat ownership positively predicted neuroticism. In contrast to our expectations, no other personality differences were found between pet owners. Qualitative insights suggest pet choice is driven simply by “liking” that pet (i.e., being a “dog person” or “cat person”), pet personality factors, lifestyle habits, and living situations. Findings suggest that personality factors might explain why people who choose to own dogs fare better than people who choose not to own dogs during challenging times of social isolation, which may be unrelated to the animal itself.

Managers in the context of small business growth: a qualitative study of working conditions and wellbeing

PurposeIn view of the importance of managers’ wellbeing for their leadership behaviour, employee health, and business effectiveness and survival, a better understanding of managers’ wellbeing and working conditions is important for creating healthy and sustainable businesses. Previous research has mostly provided a static picture of managers’ wellbeing and work in the context of small businesses, missing the variability and dynamism that is characteristic of this context. Therefore, the purpose of this study is to explore how managers in small companies perceive their working conditions and wellbeing in the context of business growth.MethodsThe study is based on qualitative semi-structured interviews with 20 managers from twelve small companies. Content and thematic analysis were applied.ResultsThe findings indicate that a manager’s working environment evolves from its initial stages and through the company’s growth, leading to variations over time in the manager’s experiences of wellbeing and work–life balance as well as changes in job demands and resources. Managers’ working situation becomes less demanding and more manageable when workloads and working hours are reduced and a better work–life balance is achieved. The perceived improvement is related to changes in organizational factors (e.g. company resources), but also to individual factors (e.g. managers’ increased awareness of the importance of a sustainable work situation). However, there were differences in how the working conditions and wellbeing changed over time and how organizational and individual resources affected the studied managers’ wellbeing.ConclusionsThis study shows that, in the context of small business, managers’ working conditions and wellbeing are dynamic and are linked to growth-related changes that occur from the start of organizational activities and during periods of growth. In addition, the findings suggest that changes in managers’ working conditions and wellbeing follow different trajectories over time because of the interaction between organizational and personal factors.

When great responsibility comes with limited options: experiences and needs of older community-dwelling adults regarding accessing, understanding, appraising and using health-related information

BackgroundIn previous research, older adults have been associated with reduced levels of health literacy (HL) influenced by a range of contextual factors. To optimise HL, it is essential to better understand the interactions between the ageing process and both personal and environmental factors as perceived by older adults. This study aimed to explore the experiences and needs of older community-dwelling adults when accessing, understanding, appraising and using health-related information.MethodsAn explorative, qualitative design was used within the social constructivism framework. Semi-structured individual interviews were conducted with 20 adults aged 70–96 living at home in three areas in Northern Iceland. The transcribed interviews were constructed into categories and subcategories using qualitative content analysis.Findings.Four categories emerged. “Expectations for responsibility” describes the experience that individuals are responsible for taking care of their health, including accessing, understanding, appraising and using information and services, showing initiative and keeping needed communications active. “A gap between expectancy and ability/context” includes experiences while taking responsibility for expectations not aligning with skills/situations, creating information gaps. “Finding one’s own ways” comprises various adapted ways to access, understand, and use information and services. “Bridging the gap” describes experiences of needing shared responsibility and more manageable options to enable reasoned health-related decisions and navigation in the healthcare system.ConclusionsThe participants valued and took full responsibility for accessing, understanding, appraising and using information and services as part of a social norm; however, they experience information gaps. They request shared responsibility by being provided with fundamental health-related information as a vital step in making reasoned health-related decisions and navigating the healthcare system. They also request more inclusive and accessible service opportunities to bridge the gaps and facilitate HL. It is necessary to critically address, at a systematic level, the conflict between expected individual responsibility and the existence of options to act upon this responsibility. In matters of health, health services and HL, the need to analyse and confront structural disadvantages experienced by older adults is highlighted.