Family Provision Research Articles

Influence of male targeted short message service on uptake of family planning among spouses in Marsabit County, Kenya

Background: Family planning helps in regulating the number of children and determine healthy spacing and timing of births between pregnancies. The global contraceptive prevalence stands at 49.0%, Sub-Saharan Africa at 29.0%, Kenya at 56.9% while in Marsabit County at 5.6%. Male spouse involvement on matters of family planning deserves attention. This study aimed at establishing the influence of male targeted short message service on uptake of family planning among female spouses in Marsabit County, Kenya. Methods: A pre-test and post-test quasi experimental study design was adopted involving randomly selected 220 couples from Laisamis and Moyale sub-counties. Intervention of male targeted short message service was offered to male spouses from Moyale sub-county for a period of 4 months. A questionnaire was used to collect data. Quantitative data analysis was done using SPSS. All the required ethical and logistical considerations followed. Results: At baseline level of uptake was overall 14.3%, control 13.2% and intervention 15.4% while at endline overall 30.2%, control 20.4% and intervention 39.5%. Further results revealed that uptake of family planning was increased by use of short message service. Conclusions: The study concluded that the level of uptake was low but with SMS intervention uptake significantly increased. The Ministry of Health should consider integrating male targeted short message service intervention in provision of family planning services to increase uptake.

Association between pregnancy intention and completion of newborn and infant continuum of care in Sub-Saharan Africa: systematic review and meta-analysis

BackgroundThe newborn and infant continuum of care such as essential newborn care, early initiation and exclusive breastfeeding, and immunisation are highly recommended for improving the quality of life and survival of infants. However, newborn and infant mortality remains high across Sub-Saharan African countries. While unintended pregnancies are associated with adverse newborn and infant health outcomes, there is inconclusive evidence on whether pregnancy intention influences newborn and infant continuum of care completion. Therefore, this review aimed to pool findings reported in the literature on the association between pregnancy intention and newborn and infant health care across the continuum of care in Sub-Saharan Africa.MethodsWe searched MEDLINE Complete, EMBASE, CINAHL Complete, and Global Health databases for studies potentially eligible for this systematic review and meta-analysis. Two researchers independently screened the identified articles by abstract and title, and then full-text using Covidence. We used the Newcastle–Ottawa Scale to assess the quality of the included studies. The Cochran’s Q test and I2 were executed to detect and quantify the presence of statistical heterogeneity in the studies. Meta-analysis was done for each outcome when more than one original study reported relevant data, using Stata statistical software version 18.ResultsEleven studies were included from a total of 235 articles identified by the search. The odds of completing essential newborn care (pooled odds ratio: 3.04, 95% CI: 1.56, 5.90), early initiation of breastfeeding (pooled odds ratio: 1.30, 95% CI: 1.13, 1.52), exclusive breastfeeding (pooled odds ratio: 2.21, 95% CI: 1.68, 2.89), and being fully immunised (pooled odds ratio: 2.73, 95% CI: 1.16, 6.40) were higher among infants born to women with intended pregnancies as compared to women with unintended pregnancies.ConclusionIntended pregnancy was positively associated with essential newborn care completion, early initiation and exclusive breastfeeding, and full immunisation of infants in SSA countries. Thus, policy-makers and stakeholders should strengthen the provision of quality family planning services to prevent unintended pregnancy. Furthermore, follow-up of women with unintended pregnancies is needed to increase women’s opportunity to access essential newborn health care services that further reduce the risk of newborn and infant morbidity and mortality.Systematic review registrationPROSPERO registration number CRD42023409148.

Knowledge and practice of health workers on sexual and reproductive health and rights and gender-based violence: Evidence from three municipalities in Senegal.

Adolescents in low- and middle-income countries face numerous developmental, sexual and reproductive health (SRHR) challenges, including exposure to multidimensional violence. Dealing with gender-based violence (GBV) is of great importance and health personnel are key players. The objective of this work was to study the knowledge and practices of health personnel on SRHR and gender-based violence in Guédiawaye, Kaolack and Kolda communities in Senegal. A descriptive and analytical cross-sectional study was conducted, which consisted of health professionals (general practitioners and specialists, nurses, and midwives) and community health workers (community relays, bajenu gox, matrons). All health facilities in the three communities were included. Data analysis consisted of univariate analysis and logistic regression modeling to investigate the factors associated with the knowledge and practice of health personnels. An alpha risk of 5% was taken. A total of 78 health professionals and 128 community actors were included in the study. More than half of the health personnel (56.3%) had good knowledge of policies, standards and protocols relating to sexual and reproductive health services for women (adolescents) and about 60% on conventions and laws. The level of knowledge was good among 51% of respondents and good practices among 54.9%. The factors associated with good knowledge were the municipality in which the profession was practiced, and the effects of training received in the social construction of gender. The factors associated with the practices were knowledge of policies, standards and protocols through training, training received in the provision of family planning services, and in medico-psychosocial management of cases of sexual violence. We conclude that the knowledge of stakeholders (health professionals and community health workers) about sexual and reproductive health and gender-based violence is important for better service provision and good management of cases of gender based violence.

Family Provision across Borders

It takes little for family provision claims to cross borders, whether state or national. The property may be located in different places — other states or countries; the personal representatives, claimants or beneficiaries under the will may be from different places; or the deceased may have had a strong personal connection with another place. Any one of those cross-border considerations raises questions of a court’s jurisdiction to deal with a family provision application, or of the law that will apply to it. In this article, we give an account of the principles of private international law — which in this area also apply in interstate matters — that affect family provision claims in Australia. In doing so, we explore recurrent complications with these cross-border family provision claims, including those arising under the cross-vesting scheme and in the federal jurisdiction. While we consider that the current equitable principles of choice of law remain best placed to address how provision should be made from different forms of property, reforms must be made to the equitable principles of jurisdiction if complications raised by the cross-vesting scheme and the possible exercise of federal jurisdiction in family provision claims are to be overcome.

Family model and family-gender roles in the assessments of modern youth

Modern trends in changing the marriage and family attitudes of modern youth are characterized by the transformation of gender roles. Based on a questionnaire survey of modern youth, social attitudes of young people were obtained regarding the gender distribution of roles in the sphere of decision-making, financial security of the family, parenthood, organization of everyday life and a favorable climate in the family, as well as the assessment of these areas in the parental family. Data indicate an egalitarianization of the family model, but in relation to the sphere of family provision, this trend is less pronounced. Young people more often name love as the reasons for starting a family, followed by socio-psychological comfort and having children.

Piloting Eyes on the Baby: A Multiagency Training and Implementation Intervention Linking Sudden Unexpected Infant Death Prevention and Safeguarding

We describe the coproduction, pilot implementation, and user evaluation of an evidence-based training intervention addressing prevention of Sudden Unexpected Deaths in Infancy (SUDI) for the multiagency workforce supporting vulnerable families with babies in a northern English county. We aimed in this pilot study to improve knowledge, skills, and engagement of professionals and support staff providing services for vulnerable families with increased risk of SUDI. The training intervention was co-produced by the academic team and the project Steering Committee which comprised senior leaders from the local authority, health and care sectors, and third-sector organisations, and rolled out to multiagency teams between November 2022 and March 2023. Evaluation data were collected using a post-training questionnaire, followed up by the Normalisation Process Theory (NPT) NoMAD survey issued at two time-points post-training, and interviews with stakeholders. The evaluation, conducted from January to May 2023, aimed to assess how well the multiagency workforce accepted SUDI prevention as part of their remit and incorporated SUDI prevention activities into their everyday work. Most multiagency professionals and support staff were enthusiastic about the training and their role in SUDI prevention. Fewer health professionals completed the training than expected. Forty percent (397/993) of invited staff completed the training. Our results revealed initial lack of knowledge and confidence around SUDI prevention and targeted provision for vulnerable families which improved following the Eyes on the Baby training. The proportion of nonhealth professionals rating their knowledge of SUDI prevention as good or excellent increased significantly from 28% before training to 57% afterwards. Self-rated confidence in discussing SUDI prevention with families increased significantly from 71% to 97%. Health professionals’ ratings increased significantly for knowledge from 62% to 96%, and confidence from 85% to 100%. Use of NPT allowed us to identify that by the time of evaluation, the earliest adopters were cognitively involved with the programme and engaged in collective action, while later adopters had not yet reached this stage. We conclude that effective implementation of multiagency working for SUDI prevention can be accomplished by providing clear training and guidance for all staff who have regular or opportunistic contact with vulnerable families. Our next step is to evaluate the sustainability of MAW SUDI prevention over the medium to long term and assess the responses of recipient families to this approach.

It isn't just Mom: Gendered provision of family and home responsibilities among emerging adults during COVID-19.

Media and research reports have highlighted the disproportionate burden of home and family responsibilities shouldered by women and mothers due to COVID-19-related school/childcare shutdowns. This cross-sectional study extends this line of inquiry to emerging adults. Our study of 329 diverse emerging adults suggests that young women took on more home/family responsibilities than young men amidst the pandemic, and that these duties were associated with symptoms of depression. However, results also indicate that emerging adults who reported greater home/family responsibilities amidst the pandemic also experienced more quality family time, suggesting that pandemic-related challenges may have also been accompanied by opportunities for family connection. Contrary to previous research that has shown home/family responsibilities to be concentrated by SES and race/ethnicity, we found that participants uniformly endorsed COVID-19-related impacts on home/family responsibilities across these demographic distinctions. This could reflect the ubiquity of COVID-19's impact; across race/ethnicity and class-but differentially by gender-young adults faced significant challenges in taking on new home/family roles.

Spatial distribution and determinants of unmet need for family planning among all reproductive‑age women in Uganda: a multi‑level logistic regression modeling approach and spatial analysis

IntroductionUnmet need for family planning is defined as the percentage of sexually active and fecund women who want to delay the next birth (birth spacing) or who want to stop childbirth (birth limiting) beyond two years but who are not using any modern or traditional method of contraception. Despite the provision of family planning services, the unmet need of family planning remains a challenge in low- and middle-income countries (LMICs). Thus, this study aimed to assess the spatial distribution and determinant factors of unmet need for family planning among all reproductive‑age women in Uganda.MethodsA secondary data analysis was done based on 2016 Ugandan Demographic and Health Surveys (UDHS). Total weighted samples of 18,506 women were included. Data processing and analysis were performed using SPSS Version 26, STATA 14.2, ArcGIS 10.8, and SaTScan 10.1.2 software. Spatial autocorrelation and hotspot analysis was made using Global Moran’s index (Moran’s I) and Gettis-OrdGi*statistics, respectively. Determinants of unmet needs for family planning were identified by multi-level logistic regression analysis. Variables with a p-value < 0.05 were declared statistically significant predictors.ResultsThe spatial distribution of unmet need for family planning among women of reproductive age in Uganda was found to be clustered (Global Moran’s I = 0.27, Z-score of 12.71, and p-value < 0.0001). In the multivariable multilevel logistic regression analysis; women in West Nile (AOR = 1.86, 95% CI: 1.39, 2.47), aged 25–49 years old (AOR = .84; 95% CI .72, .99), highly educated (AOR = .69; 95% CI .54, .88), Muslim (AOR = 1.20, 95% CI: 1.03, 1.39), high wealth status (AOR = .73, 95% CI: .64, .82), and had five or more living child (AOR = 1.69, 95% CI: 1.51, 1.88) were significant predictors of unmet need for family planning. Significant hotspot areas were identified in West Nile, Acholi, Teso, and Busoga regions.ConclusionA significant clustering of unmet need for family planning were found in Uganda. Moreover, age, educational status, religion, wealth status, number of alive children, and region were significant predictors of unmet need for family planning. Therefore, in order to minimize the burdens associated with unmet need, an interventions focusing on promotion of sexual and reproductive health service should be addressed to the identified hotspot areas.

Locked down-locked in: experiences of families of young children with autism spectrum disorders in Delhi, India.

The onset of the COVID-19 pandemic and subsequent lockdowns in March 2020 disrupted the lives of families across India. The lockdown related restrictions brought forth a multitude of challenges including loss of employment, social isolation, school closures and financial burdens. Specifically, it also resulted in the restriction of health-care services for children with neurodevelopmental disabilities. This qualitative study was conducted as a part of a larger trial in India to understand the experiences of families of young children with autism during the pandemic. In-depth interviews were carried out with 14 caregivers residing in New Delhi, India. Our findings identified pandemic and lockdown's universal impacts on family life and financial stability stemming from job loss, business closure, and salary deductions, affecting quality of life of families. Furthermore, COVID-19 pandemic's impact on autistic children was evident through limited access to essential services and financial challenges related service interruptions even after resumption of services. The lockdown's novelty also affected children's behavior, with both challenging behavioral changes and positive impacts. Primary caregivers, predominantly mothers, assumed additional responsibilities in household tasks, schooling, and therapy administration. While some these experiences were universally experienced, a few of these improved outcomes for autistic children. Despite challenges, parents expressed gratitude for their family's safety and well-being during the difficult time. These findings inform service provision for vulnerable families and offer implications for designing interventions such as credit schemes for families, guidance and resources for establishing and maintaining routines of children with autism, adopting flexible and adaptable approaches to service delivery, and special provisions for children with autism to be able to maintain their routines outside of home. Furthermore, the study highlights the need for comprehensive support, including educational resources and stress management counselling to empower parents in supporting essential care and routines for their children during such unprecedented times.

Digitalization of Family Planning Services: A Reality or Fantasy?

This position paper examines the changing environment of digitalizing family planning services, investigating how established healthcare paradigms might be transformed via the incorporation of new technology. The increasing use of digital technologies in the healthcare sector has brought attention to the provision of family planning services, leading to an examination of the practicality and achievability of this technological advancement. The study explores several aspects of this discussion, such as the present condition of family planning services, technical advancements, obstacles to digitalization, user viewpoints, and policy deliberations. The story begins by analysing the wider digitalization patterns in healthcare, setting the stage for the convergence of technology and reproductive health. The study critically examines the significance of digital technologies in family planning, including both the potential advantages and difficulties they may provide. It tackles the obstacles related to privacy, access, and cultural factors, in contrast to the optimistic potential of developing technology. The article showcases case studies and success stories that demonstrate the effectiveness of digital family planning, offering significant insights for future implementation. The report finishes by endorsing a series of policy proposals designed to navigate the complex interaction between technology, ethics, and healthcare infrastructure. These proposals prioritise the need of explicit rules, purposeful investments in digital literacy and accessibility, and smooth integration into current healthcare systems. This study examines the digitization of family planning services, highlighting its role as both a technical innovation and a potential driver of social change. It emphasises the importance of individual empowerment and well-being in discussions about reproductive health.

Improving access to family planning for women with disabilities in Kaduna city, Nigeria: study protocol for a pragmatic cluster-randomized controlled trial with integrated process evaluation

BackgroundGlobally, women with disabilities are less likely to have access to family planning services compared to their peers without disabilities. However, evidence of effective interventions for promoting their sexual and reproductive health and rights remains limited, particularly in low- and middle-income settings. To help address disparities, an inclusive sexual and reproductive health project was developed to increase access to modern contraceptive methods and reduce unmet need for family planning for women of reproductive age with disabilities in Kaduna city, Nigeria. The project uses demand-side, supply-side and contextual interventions, with an adaptive management approach. This protocol presents a study to evaluate the project’s impact.MethodsA pragmatic cluster-randomized controlled trial design with surveys at baseline and endline will be used to evaluate interventions delivered for at least 1 year at health facility and community levels in comparison to ‘standard’ state provision of family planning services, in the context of state-wide and national broadcast media and advocacy. Randomization will be conducted based on the health facility catchment area, with 19 clusters in the intervention arm and 18 in the control arm. The primary outcome measure will be access to family planning. It was calculated that at least 950 women aged 18 to 49 years with disabilities (475 in each arm) will be recruited to detect a 50% increase in access compared to the control arm. For each woman with disabilities enrolled, a neighbouring woman without disabilities in the same cluster and age group will be recruited to assess whether the intervention has a specific effect amongst women with disabilities. The trial will be complemented by an integrated process evaluation. Ethical approval for the study has been given by the National Health Research Ethics Committee of Nigeria and London School of Hygiene & Tropical Medicine.DiscussionDefining access to services is complex, as it is not a single variable that can be measured directly and need for family planning is subjectively defined. Consequently, we have conceptualized ‘access to family planning’ based on a composite of beliefs about using services if needed.Trial registrationISRCTN registry ISRCTN12671153. Retrospectively registered on 17/04/2023.

The Perspectives of Family Foster Care in the Czech Republic, Hungary, Poland and Slovakia

Reforms of the child protection systems, provision of family- and community-based alternative care has been developed to a certain level in all countries in Central and Eastern Europe and has increased the role of care provided by foster families replacing institutions to ensure that the best interests principle is taken into consideration when children are separated from their families. The research describes the foster care system in the so-called Visegrád countries: the Czech Republic, Hungary, Poland and Slovakia, and the results based on at least 50 interviews in each country conducted by local experts on subjective well-being of foster parents, their perceptions about their roles and place in their respective countries and their needs. The article includes the legal framework, recruitment, preparation and support to foster families, their subjective well-being and needs in the four countries, including the history of their child protection systems to better understand the current situation. The outcomes show differences in approach to foster care, the perception on the roles, responsibilities and needs based on the different traditions, earlier and current policies and practices. Understanding the attitude changes related to the rights of children, those in vulnerable situations, and to their families of origin would be essential to further develop and improve the child welfare and protection systems, and listening to children on their perceptions and the realisation of their rights.

A Delphi Study to identify strategies to mitigate the adverse impact of COVID-19 on children under the age of five in Wales

The COVID-19 global pandemic has caused widespread impact on education across all settings and contexts, including early childhood education and care (ECEC). In Wales, it is estimated that roughly three-quarters of children under the age of five (c.155,000 children) were impacted by the closure of ECEC settings. While literature is still emerging on the long-term impact of the pandemic on children under five, little research has explored the potential strategies to mitigate these adverse impacts. This research project used the Delphi method to investigate what experts and ECEC practitioners believe are the most effective strategies to mitigate the adverse impact of the pandemic on children under five, using Wales as a national-level case study. Between May and September 2021, three consecutive surveys were distributed to study participants, who were identified as ECEC experts (n=39). Furthermore, alongside the traditional Delphi study a one-off anonymous online survey was also sent to the wider ECEC practitioner community in Wales (n=378). The dominant theme within the strategies suggested by the study participants was the importance of high-quality play experiences. The importance of universal provision and quality support for practitioners and families was also highlighted. These themes were dominant in both expert and practitioner groups, despite consensus not being found between them. This paper presents and critically explores these identified themes, providing the foundation for replication and portability of this work and its outcomes to ECEC settings in other nations and jurisdictions.

Challenges Experienced by Health Professionals in Implementing the Family Integrated Service Post in Public Health Center; A qualitative study

The Family Integrated service post is a program that aiming to provide accessible health services to all over the villages and/or sub-villages in the province. The family integrated service post (FISP) targeting pregnant women, breastfeeding mothers, babies, adolescent, productive age, and elderly. Healthcare workers faced some challenges during the provision of integrated service post, either from their co-workers or from the communities. The challenges perceived have significant impact on the quality of services as well as the provision of integrated service post program. Hence, this study was aimed to investigate the challenges perceived by health professionals during the implementation of the FISP in PHC of Sembalun. This study used a qualitative interview design and adopted constructivists paradigm. The study used purposive stratified sampling technique to determine the sample. Three midwives, three nurses, a health promotion practitioner, and two nutritionists were participated in the study. This study identified four main challenges experienced by health professionals in public health center of Sembalun. The challenges are communities’ schedule, lack of awareness, unsupported of essential tools, and staff shortage. Participants verbally conveyed that these challenges have significant effects on the provision of family integrated service post. Further study is needed to explore more challenges that could impede health services as well as study regarding the impact of these challenges

최근 혼인과 가족생활의 변화에 대한 헌법적 대응과 보장

Our Constitution stipulates that marriage and family life should be established and maintained on the basis of individual dignity and equality of sexes, and the state has an obligation to guarantee this.&#x0D; However, recent changes in marriage and family life are occurring due to various factors of society. In Korea, too, family forms are diversifying due to the collapse of the traditional family system and various choices for freedom of marriage due to late marriage, non-marriage, graduating from marriage, and reduced fertility. Our Constitution stipulates marriage, family life and the obligation of the state to guarantee it in Article 36, but the current legal concept and constitutional response to marriage and family seems insufficient.&#x0D; In order to effectively respond to this, I think it is necessary to appropriately revise marriage and family provisions when revising the constitution. The content and form of the discipline of Article 36, Paragraph 1 of the current Constitution has a limit to constitutionally embrace and guarantee the deinstitutionalization of the family in modern society because the traditional family system has a strong guarantee character.&#x0D; Problem solving through the existing constitutional interpretation may be the next best thing, but in order to protect and support a new type of community that does not correspond to traditional marriage and family forms as marriage and family, it is necessary to fully consider the possibility of acceptance into our society and accept it based on constitutional possibility and grounds through consensus of the public sphere.&#x0D; Furthermore, in recognizing a new type of marriage and family form, it is time to change the sense of solidarity of being a companion to live together in this age, avoiding discriminatory judgment based on preconception and prejudice on the constitutional basis.

Syrian refugee women’s access to family planning services and modern contraception during overlapping crises in Bekaa, Lebanon

BackgroundPolitical, financial, and pandemic crises in Lebanon have affected both provision of reproductive health services including family planning and modern contraception methods as well as women’s interest and ability to seek those services. This study aims to explore the impact of the compounding crises on the provision and use of family planning services including modern contraception methods for Syrian refugees in Lebanon focusing on the perspectives of Syrian refugee women.MethodsWe carried out 12 Focus Group Discussions (FGDs) with 119 Syrian refugee women recruited from two cities in West Bekaa, Lebanon from inside and outside the informal tented settlements. We used Skype video calls to moderate the FGDs due to the limited mobility at the time of the study because of Covid-19. We used thematic analyses to analyse the data.ResultsThe crises seemed to exacerbate supply side barriers, which influenced provision of family planning services and women’s demand for them. These included Covid-19 regulations and maltreatment by staff at public health facilities, disruption of outreach reproductive health services that provide family planning and modern contraception, and reduced supply of modern contraception methods. On the demand side, women reported financial limitations in accessing and paying for services, concern over being infected with Covid-19, and concerns about insecurity.ConclusionsWe suggest possible interventions to address these challenges and better reach these populations. These include using mobile health technology (mHealth) that may provide contraceptive counselling and/or can inform refugee women about where they may receive family planning and modern contraception. These services may also support Syrian refugees to access care they are entitled to receive and may also address disruptions in service provision due to overlapping crises, including availability and rising costs of contraceptives. These can be coupled with mobile outreach reproductive health services that provide family planning. We also suggest considering the provision of Long Acting Reversible Contraception (LARC) for Syrian refugee women, which would reduce a barrier of needing to revisit health facilities to obtain an additional supply of contraception pills.

Provision of family planning services by community health workers in urban slums of Cameroon.

Over 50% of pregnancies in slums are unintended, signifying unmet family planning (FP) needs. In Cameroon, about 60% of city dwellers live in slums where basic health services including FP is lacking. With an acute shortage of health personnel in Africa, community health workers (CHWs) can play a vital role in administering basic FP services. The Cameroon Baptist Convention Health Services implemented a pilot project to reduce the unmet FP needs in urban slums through utilization of CHWs. We found that with adequate training and support, CHWs can successfully provide basic FP services in urban slums.

Family Leave Policies and Employee Attitudinal Outcomes in Korea: The Moderating and Joint Moderating Effects of Gender and Marital Status

Demographic changes that many contemporary societies experience - e.g., the increase of dual-career couples and non-traditional families, the Millennials reshaping the workplace, and so on - and subsequent needs of individuals pose challenges for organizations. As a way to better motivate and retain employees, organizations provide employees with new types of support such as family leave policies that can help them with better work-family balance. This study examines the impact of organizational provision of family leaves on attitudinal outcomes of Korean employees as moderated by employee demographic characteristics. The findings suggest that the impact of family leave provisions vary depending on employee characteristics. Their impact on employee job satisfaction and organizational commitment are stronger for married female employees than for any other gender-marital status groups.

Functional Decline Over Time and Change in Family and Other Unpaid Care Provided to Community-Dwelling Older Adults Living With and Without Dementia.

To provide a longitudinal analysis of how functional decline over time among older adults affects provision of family and unpaid care, overall and stratified by dementia status. Longitudinal cohorts of community-dwelling adults ≥65 years between 2015 and 2017 from the National Health and Aging Trends Study (NHATS; n = 5,103) and their caregivers from the National Study of Caregiving (n = 862 caregivers for 595 NHATS care recipients). A panel data fixed-effects model was used to examine how increases in mobility, self-care, and household activity-related impairment between 2015 and 2017 affected family and unpaid care (care recipient reported: total number of family and unpaid caregivers, total hours of care received; caregiver reported: hours of care provided, caregiving-related emotional, and physical difficulties). Among community-dwelling older adults overall, impairment in 1 additional self-care activity led to 0.12 more caregivers and 19 additional total monthly hours of care. Among those with dementia, impairment in 1 additional self-care activity led to 0.14 more caregivers and 28 additional total monthly hours of care; among those without dementia, this was 0.11 caregivers and 15 total monthly hours of care. For dementia caregivers, impairment in 1 additional self-care activity among their care recipients led to 8% higher probability of caregiving-related emotional difficulty. There is a mismatch between the large additional hours of care received by older adults who experience functional decline (particularly self-care activities) and the relatively small accompanying increase in family and unpaid caregivers. Targeted functional supports, particularly for self-care activities, may benefit both older adults and their caregivers.

Mapping the service system that supports children and families in the context of place-based-disadvantage: Potential leverage points for intervention

There is strong evidence to suggest that children are negatively impacted by growing up in places where there are high levels of disadvantage present. However, these children can reap substantial developmental benefits (even more so than those who do not experience disadvantage) from access to and engagement with community and social services supporting health, education, and wellbeing. Yet, due to the complexity of service provision, access, and outcomes for children and families living in disadvantaged places, the service system in these contexts often is found to be ineffective in meeting the needs of the community. This study utilises a participatory approach, engaging service providers working with children and families in a disadvantaged place to identify key leverage points that have the potential to promote systems reform. Using participatory systems mapping, the findings illustrate aspirations (or the ideal state) of the service system that are characterised by early intervention, high levels of service coverage, and interconnected services, all of which enable wellbeing for children and families. User orientated and service orientated factors that act as barriers or enablers are also identified and key levers of service reform are discussed, particularly increasing accessibility of services and reducing vulnerability of service users.