Gaps In Services Research Articles

Harnessing food system equity from the ground up: shifting co-governance practices in the funding of food security responses during the pandemic crisis in Toronto, Canada

ABSTRACT The COVID-19 pandemic was a disrupting force that magnified social inequities and service gaps in underserved urban communities. It was also a “window of opportunity” for the Black Lives Matter movement and Indigenous reconciliation synergies to spur calls to action for more open and inclusive dialog regarding community food security. Increasingly, community-based organizations (CBOs) that have not been traditionally food-focused are becoming more involved in food security responses. These factors have offered space to revisit antiquated and exclusionary practices within resource allocation and decision-making processes that reinforce systems of oppression within the food system. We explore the interconnection between CBOs, municipal actors, and funders in Toronto and draw upon the concept of co-governance to unpack their evolving relationships and influence on equity-focused change in policies and practices. Based on an analysis of interviews (n = 48), this paper articulates that a number of realized progressive, yet incremental, changes have been made, including changes to policies and internal practices and targeted support for Black and Indigenous communities. However, ultimately, a transfer of resources and influence is required in order to achieve the broader goal of harnessing food system equity.

Developing a transit desert interactive dashboard: Supervised modeling for forecasting transit deserts.

Transit deserts refer to regions with a gap in transit services, with the demand for transit exceeding the supply. This study goes beyond merely identifying transit deserts to suggest actionable solutions. Using a multi-class supervised machine learning framework, we analyzed factors leading to transit deserts, distinguishing demand by gender. Our focus was on peak-time periods. After assessing the Support Vector Machine, Decision Tree, Random Forest, and K-nearest Neighbor, we settled on the Random Forest method, supported by Diverse Counterfactual Explanation and SHapley Additive Explanation in our analysis. The ranking of feature importance in the trained Random Forest model revealed that factors such as density, design, distance to transit, diversity in the built environment, and sociodemographic characteristics significantly contribute to the classification of transit deserts. Diverse Counterfactual Explanation suggested that a reduction in population density and an increase in the proportion of green open spaces would likely facilitate the transformation of transit deserts into transit oases. SHapley Additive Explanation highlighted the differential impact of various features on each identified transit desert. Our analysis results indicate that identifying transit deserts can vary depending on whether the data is aggregated or separated by demographics. We found areas that have unique transit needs based on gender. The disparity in transit services was particularly pronounced for women. Our model pinpointed the core elements that define a transit desert. Broadly, to address transit deserts, strategies should prioritize the needs of disadvantaged groups and enhance the design and accessibility of transit in the built environment. Our research extends existing analyses of transit deserts by leveraging machine learning to develop a predictive model. We developed a machine learning-powered interactive dashboard. Integrating participatory planning approaches with the development of an interactive interface could enhance ongoing community engagement. Planning practices can evolve with AI in the loop.

A qualitative study to understand the barriers and facilitators in smoking cessation practices among oncology health care practitioners in one health system.

Despite the benefits of quitting smoking for those who have cancer, including improved health outcomes and reduced therapeutic toxicities, it is unclear how many people are supported in quit attempts during this time. Variations in the availability and provision of smoking cessation (SC) services are reported, with little understanding of the challenges and solutions. This co-designed study aimed to understand the perspectives of health care professionals (HCPs) working in oncology settings to engage in SC practices and identify recommendations for developing an SC pathway. This was a qualitative study. Eighteen HCPs participated in semi-structured interviews from July 2021 to May 2022. We used thematic analysis approaches to code data and present four emergent themes and SC strategies at micro, meso and organizational levels. Four themes emerged specifically: 1) timing and knowledge, 2) building a relationship, 3) frequent asking with infrequent action, and 4) removing the barriers and tailoring the system. While HCPs discuss SC, there are variations in documentation and when conversations occur. Primarily, HCPs value the time to build therapeutic relationships with patients and thus may limit SC discussions in preference to treatment in clinical interactions. The role of structural barriers, including prescriptive authority for nurses, hinders active SC processes, as it is the lack of continuity and embedding of services supported by a clinical champion for SC. The study suggests re-evaluating the status quo in SC service, highlighting service gaps and suggesting opportunities at organizational levels to reduce structural barriers. Variations in smoking cessation services exist in designated cancer centres. The data from this study can be used to inform a real time health systems approach for SC services in oncology settings. Developing tailored smoking cessation services and interventions that are patient-centred and informed by their experiences are required. The data in this study suggests developing specialist education and training to upskill HCPs for equitable engagement if we are to meet EU and Moonshot goals for cancer reduction.

Challenges towards an AIDS-free generation in Africa and Asia.

To review the latest data on prevention of HIV vertical transmission in Asia and Africa and discuss strategic directions to achieve an AIDS free generation by 2030. Progress in vertical transmission elimination efforts in Africa and Asia have stalled in the last decade, with 130 000 new infections in 2022. Main causes of vertical transmissions vary; in Asia-Pacific due to its low-burden, thus low testing coverage, but high overall vertical transmission rates, in South and East Africa due to new HIV infections during pregnancy and breast/chestfeeding, whereas in Western and Central Africa due to low antiretroviral therapy (ART) coverage. Long-acting injectable ART and neutralizing antibodies for treatment and prevention show promise in supporting efforts to further reduce vertical transmissions. Integrated and more accessible pre- and postnatal care is needed to achieve an AIDS-free generation. Much can be implemented to address existing HIV service gaps; including strengthening of HIV prevention services for youth and women of childbearing age and pregnant people, early detection and treatment, and the delivery of integrated services that can reach and retain pregnant and postpartum people living with HIV in care.

Street Medicine as Service Learning: Lessons from a Needs Assessment Conducted by Medical Students

Background The homeless population is growing across the United States, particularly in urban areas. Oftentimes, there is a disconnect between existing community services and actual needs of individuals experiencing homelessness. These services gaps are frequently identified by needs assessments and utilized by community agencies to inform outreach efforts and program development. Community outreach by medical students through participation in community-based service learning projects is critically important for the preparation of future physicians to care for underserved and vulnerable populations. This study describes the stepwise approach taken by medical students to design and administer a needs assessment for the purpose of informing the development of a new street medicine program. This study is intended to serve as a guide to students who aspire to launch a new street medicine program but is generalizable to other student-led service learning outreaches. Methods We conducted a needs assessment from April-June 2018 of 144 unsheltered homeless individuals in metro Phoenix, Arizona. The 16-question survey investigated perceptions of priority needs, sources of medical care, health literacy, and health status. Survey results were analyzed using Wilcoxon Rank Sum Test, chi-squared analysis, and multivariable logistic regression. Results Most respondents (91.6%) identified food as a top need. The majority (64.1%) utilized Emergency Departments as their primary source of care, and 40.1% reported suboptimal health. Suboptimal health was more likely to be reported in those who expressed transportation (OR 3.03, 95% CI: 1.30-7.07) as a top priority need. Health illiteracy (OR 3.68, 95% CI: 0.76-17.9) was associated with suboptimal health, as was obtaining care at an Emergency Department (OR 2.05, 95% CI: 0.81-5.25). Conclusions Pairing health care with meals and other primary needs may be an effective strategy to increase service utilization by this population. Needs assessments provide an opportunity for health professional students to learn about social needs and more effectively connect patients with services from community agencies and health care organizations.

“I’ve Got No Skills to Maintain – to Keep That Going”: A Qualitative Study of People with Chronic Aphasia and Their Partners About Factors Contributing to the Maintenance of Aphasia Therapy Gains

ABSTRACT Background The maintenance of therapy gains is critical for successful aphasia rehabilitation, a topic often overlooked in both research and clinical practice. For some people with chronic aphasia, maintaining therapeutic gains can be challenging, potentially resulting in diminished communicative function over time. Furthermore, maintaining therapy gains may necessitate consistent, deliberate effort; however, little is known about the factors supporting this process. People living with chronic aphasia and their family members may provide critical insights into the behavioural factors that impact the maintenance of therapy gains. Understanding these factors will be crucial for developing long-lasting, effective aphasia interventions. Aim In this study, we explored the perspectives and practices of people with chronic aphasia and their partners concerning the maintenance of gains from therapy for post-stroke chronic aphasia. Methods & Procedures Eight in-depth, semi-structured interviews were conducted, involving four people with chronic aphasia and four partners. We employed inductive thematic data analysis to identify emergent themes. Outcomes & Results Five themes were identified that were perceived to influence the maintenance of gains made during aphasia rehabilitation. These were: 1) Beliefs about change: improvement, decline, and maintenance; 2) Personal abilities impact improvement and maintenance; 3) External support impacts improvement and maintenance; 4) Engaging in ongoing real-life communication impacts improvement and maintenance; and 5) Knowledge and services gaps in maintenance. The findings demonstrate the complexity and interaction of factors that potentially facilitate or hinder the maintenance of therapy gains in chronic aphasia. Conclusions People with chronic aphasia and their partners report having a limited understanding of the necessity and methods for maintaining therapy gains. They also describe a lack of services to support this. A lack of knowledge and services could hinder the ability to maintain therapeutic benefits. Our study also suggests various behavioural factors are involved in maintaining gains. Forming meaningful real-life communication routines may potentially optimise such gains. These findings highlight the necessity of placing maintenance at the heart of aphasia rehabilitation, informing future interventions and service development.

Cancer Survivorship Care in the United States at Facilities Accredited by the Commission on Cancer

Since 2021, American College of Surgeons Commission on Cancer (CoC) accreditation standards require providing a survivorship program for patients with adult-onset cancer treated with curative intent. Since more than 70% of all patients with cancer in the US are treated at CoC-accredited facilities, this presents an opportunity for a landscape analysis of survivorship care availability. To determine the prevalence, types, and outcomes of cancer survivorship services at CoC-accredited facilities. This survey study used an anonymous, online, cross-sectional survey conducted from May 4 to 25, 2023. Participants were CoC-accredited facilities in the US representing diverse CoC program categories, institutional characteristics, geographic regions, and practice types. Department of Veterans Affairs cancer programs were excluded due to data usage restrictions. Data were analyzed from July to October 2023. CoC Survivorship Standard 4.8 was released in October 2019 and programs were expected to adhere to the Standard beginning January 1, 2021. Questions included self-reported survivorship program characteristics, availability of services aligned to CoC Survivorship Standard 4.8, and perceived program impacts. Response frequencies and proportions were determined in aggregate and by CoC program category. There were 1400 eligible programs, and 384 programs participated (27.4% response rate). All regions and eligible program categories were represented, and most had analytic caseloads of 500 to 4999 patients in 2021. Most survivorship program personnel included nurses (334 programs [87.0%]) and social workers (278 programs [72.4%]), while physical (180 programs [46.9%]) and occupational (87 programs [22.7%]) therapists were less common. Services most endorsed as available for all survivors were screening for new cancers (330 programs [87.5%]), nutritional counseling (325 programs [85.3%]), and referrals to specialists (320 programs [84.7%]), while treatment summaries (242 programs [64.7%]), and survivorship care plans (173 programs [43.0%]), sexual health (217 programs [57.3%]), and fertility (214 programs [56.9%]) were less common. Survivorship services were usually delivered by cancer treatment teams (243 programs [63.3%]) rather than specialized survivorship clinics (120 programs [31.3%]). For resources needed, additional advanced practice clinicians with dedicated survivorship effort (205 programs [53.4%]) and electronic health record enhancements (185 programs [48.2%]) were most endorsed. Lack of referrals and low patient awareness were endorsed as the primary barriers. A total of 335 programs (87.2%) agreed that Survivorship Standard 4.8 helped advance their programs. These findings of this survey study of CoC-accredited programs establish a benchmark for survivorship care delivery in the US, identify gaps in specific services and opportunities for intervention, contribute to longitudinal reevaluation for tracking progress nationally, and suggest the value of survivorship care standards.

Examining the feasibility of advanced practice radiation therapy roles within the Singaporean healthcare arena: a joint UK-Singapore study

Background: Advanced clinical practice in UK healthcare has matured over recent years. The field now promotes multi-professional working and flexibility in patient care, which are significant factors of the modern healthcare workforce, due to the ongoing shortage of clinicians nationwide. In radiation oncology, the advanced practitioner radiographer role has been pivotal. Observing a rising necessity for similar roles in Singapore, officials from the National University Health System, Singapore, conducted a scientific visit to the UK to explore the implementation of UK advanced practice radiation therapist roles. Aims: The objective of the trip was to explore and learn about the infrastructure of the advanced practitioner radiographer role in the UK, with a view to establish similar positions in Singapore and improve service delivery within its healthcare system. Methods: During the scientific visit, Singaporean experts engaged in collaborative discussions with UK expert practitioners. These interactions centred on legislative frameworks, their applications and the educational aspects associated with the advanced practitioner radiographer role. The specialists visited various hospitals and a university to gain deeper insights. Following the visit, a survey was conducted among the Singaporean experts to gather comprehensive feedback regarding the visit. Findings: Active participation in the visit led to the researchers gaining a nuanced understanding of the UK's advanced practitioner radiographer role, and whether an equivalent advanced practice radiation therapist framework could be feasibly implemented in Singapore. The insights garnered will be instrumental for strategic planning, addressing service gaps and fostering advancements in Singapore's healthcare system. Conclusion: Adaptive governance of advanced practice is essential. Learning from the UK's intricate models can guide robust policy formulation and professional role development in Singapore. This can help to facilitate the national establishment of advanced practice radiation therapist roles, supported by suitable education and accreditation structures.

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.

The role of the Latin American Professional Society of Genetic Counseling (SPLAGen): Advancing genetic counseling in Latin America

The increasing importance of genomics and its expanding clinical application underscore the significance of genetic counseling in disseminating this vital information. In many countries, including regions of Latin America and the Caribbean, there is a shortage of adequately trained genetics providers thus limiting access to these essential services. Moreover, providers practicing genetic counseling are scarce and experience a lack of professional support. To address these challenges, the Latin American Professional Society of Genetic Counseling (SPLAGen, for its Spanish and Portuguese abbreviation) was established with the objective to increase awareness of and access to genetic counseling services in the region. Through this commentary, we aim to provide insights into the formation and organizational structure of SPLAGen, outlining our impactful work, as well as the current and future obstacles we foresee in our endeavor. SPLAGen’s efforts aim to serve as a critical step toward bridging the gap in genetic counseling services and promoting better health care outcomes for patients living in Latin America and the Caribbean.

Ayres Sensory Integration® Intervention for Autistic Children: A Telehealth Adaptation.

Ayres Sensory Integration® is an evidence-based, manualized occupational therapy intervention for autism that is delivered in person. A telehealth adaptation could bridge service gaps for families who may have challenges accessing services. To create a telehealth adaptation of the evidence-based manualized protocol of Ayres Sensory Integration using best practice for telehealth guidelines and to obtain input on the adaptation from experts. Online survey of U.S. telehealth experts and occupational therapy clinicians in fall and winter 2022. Two telehealth experts and six occupational therapy clinicians. Two Qualtrics surveys focused on perceived feasibility and acceptability, resources included, and clarity of instructions. Telehealth experts and occupational therapy clinicians rated the Ayres Sensory Integration telehealth adapted manual as easy to follow, aligned with telehealth best practices, and feasible for remote delivery. Suggestions for additional adaptations included adding resources for technology troubleshooting, intervention planning, rapport building, and continuing education. Suggested adaptations were made; the manual is ready for feasibility testing. Plain-Language Summary: This report is the first to describe a telehealth adaptation of Ayres Sensory Integration®. The manual provides comprehensive training and resources to support clinicians in delivering sensory integration, telehealth-based interventions to autistic children. Two telehealth experts and six occupational therapy clinicians rated the Ayres Sensory Integration telehealth adapted manual as easy to follow, aligned with telehealth best practices, and feasible for remote delivery. The manual will be available to clinicians after feasibility and pilot testing.

Focused Acceptance and Commitment Therapy Skills Training (FACT-ST) program for paraprofessionals serving families of children with special health care needs: A service evaluation study

Addressing mental health needs among parents of children with Special Health Care Needs (SHCN) requires improved access to effective interventions. This study assessed the satisfaction, skills implementation intention, and psychological flexibility of frontline paraprofessionals providing family and child rehabilitation services for families of children with SHCN in Hong Kong following participation in a Focused Acceptance and Commitment Therapy Skills Training (FACT-ST) program. The training program comprised two phases: an initial foundation training stage (i.e., the FT group), which provided theoretical instruction on ACT, and a subsequent supervised practice stage (i.e., the FT + SP group), during which participants were required to conduct at least three video-conferencing FACT sessions with parents of children with SHCN under supervision. A diverse sample of 317 paraprofessionals participated, with 246 completing the foundation training and an additional 71 completing both training phases. The FACT-ST program was positively received, as indicated by high average client satisfaction questionnaire scores. In the FT + SP group, paired sample t-test indicated that the mean total skills implementation intention score remained consistent at the 3-month follow-up (M = 36.65, SD = 7.56) when compared to the 2-week follow-up (M = 36.00, SD = 8.28, P = 0.063). Repeated measures analysis of covariance showed significant improvements in psychological flexibility from baseline to the 3-month follow-up in both the FT (F = 57.57, P = < 0.001, ηp2 = 0.20) and the FT + SP groups (F = 19.06, P = < 0.001, ηp2 = 0.24). Qualitative feedback highlighted the utility of live demonstrations, experiential exercises, and collaborative interactions during training. Our findings are one of the first affirming both the feasibility and acceptability of the FACT-ST program for paraprofessionals working with parents of children with SHCN. The findings underscore the potential of paraprofessionals to become crucial contributors to the mental health care system, addressing service gaps within the community.

'There was nothing, just absolute darkness': Understanding the needs of those caring for children and young people with complex neurodisability in a diverse UK context: A qualitative exploration in the ENCOMPASS study.

Children and young people (CYP) with complex neurodisability experience multiple physical, communication, educational and social challenges, which require complex packages of multidisciplinary care. Part of the holistic care required includes supporting the families and parents/caregivers. The aim of the wider study was to introduce a new programme ('Ubuntu') to parents/caregivers and healthcare professionals (HCPs) in order to test the feasibility and acceptability of the concept and content, with the goal of potential adaptation for the UK in mind. Data collection and analysis uncovered rich data on caregiving journeys, navigation of health services, and perceived service gaps. This paper focuses solely on these topics. Further papers will report on the feasibility and adaptation data. Two rounds of semi-structured interviews were conducted with 12 caregivers of CYP with complex neurodisability and six HCPs from a variety of disciplines, recruited from a community child health service in London Borough of Newham, UK in 2020. The interviews included open-ended questions to explore caregiving journeys, experiences of navigating health services and perceived service gaps. Transcripts were analysed using a data-driven inductive thematic analysis. Three themes were identified that related to the aim of understanding caregivers' experiences and unmet needs relating to current service provision. These were (1) Caregiver Mental Health, (2) The Information Gap and (3) The Need for Holistic Support. Mental health difficulties were reported, particularly around the period of diagnosis. Priority needs included the provision of clear information about the diagnosis and services offered, opportunities to forge peer support networks and for services across the community to collaborate. The delivery of health services for CYP with neurodisability should encompass the broad needs of the family as well as meeting the clinical needs of the CYP.

Land consolidation of dryland-to-paddy conversion in China: Analysis of spatial patterns, impacts on cropland ecosystem services, and adaptive management strategies

Irrigation agriculture has become integral to global food production because it drastically improves productivity. Land use pattern conversion significantly influences cropland water use, the soil environment, management practices, and ecosystem services (ESs). Studies on adaptive management strategies of land consolidation of dryland-to-paddy conversion (LC-DtPC) and their effects on ESs are scarce. Therefore, this study analyzed the evolutionary spatial pattern characteristics of LC-DtPC in China over the past 20 years, assessed the overall ESs gains or losses in the LC-DtPC areas, simulated the spatial patterns of LC-DtPC under different scenarios, and explored the adaptive management strategies of LC-DtPC. The results revealed that in the past 20 years, the LC-DtPC area reached 129,700 km2, accounting for 7.31% of the cultivated land area in 2020, was concentrated in China's southern and eastern regions, especially the Northeast Plain, Sichuan Basin, and surrounding areas. In the LC-DtPC zones, there were significant tradeoffs and synergistic relationships between the ESs. The food supply, water yield, and soil conservation services were promoted, while the carbon sequestration services were inhibited. Specifically, the former increased by 3787.55 × 104 t, 1329.55 × 104 m3, and 141.69 × 104 t respectively, while the latter decreased by 814.39 × 104 t. While the simulated spatial patterns of LC-DtPC varied under different scenarios, they were always concentrated in China's northeastern and southern regions. The balanced development scenario of agricultural production and ecological protection has the best long-term ecological effect, with differentiated adaptive management strategies for LC-DtPC (planning, implementing, monitoring, and evaluating). This study will fill a gap in ecosystem services of LC-DtPC, the results are instrumental in the sustainable utilization of cropland resources and regional sustainable development.

How Can Transitional Housing Be Improved? Insights from Residents' Experiences and Perceptions in New York City.

Homelessness, affecting over half a million Americans, significantly elevates the risks of mental and physical health issues, consequently diminishing life expectancy when compared with the general population. Homelessness is a critical public health issue, and efforts are needed to address lack of housing as a social determinant of health. Transitional housing (TH) programs emerge as vital interventions, offering a place to stay with various support services to facilitate the transition to permanent residency. Nearly half of the unhoused population in the country and over 90% in New York live in TH or shelters. Despite the high utilization rates of TH, engagement with support services and opportunities for improvement remain poorly understood. This study aimed to fill this gap by examining the factors influencing support service usage and opportunities for enhancement through semi-structured interviews with TH residents in New York City to capture their lived experiences and perspectives. Analysis of the interviews (n = 20) revealed five main factors affecting service engagement that aligned with constructs of the socioecological model: intrapersonal (self-efficacy, chronic health conditions, mental health), interpersonal (parenthood and well-being of children with special needs, individual staff interactions, and communication), institutional (bureaucratic challenges, administrative burden, and living facilities), community (social isolation and educational opportunity), and policy (challenge meeting basic needs and undocumented status). Recommendations for bridging service gaps primarily arose at the institutional and community levels, offering critical insights for administrators to tailor services more effectively to TH residents' needs, thus contributing to the broader goal of advancing health equity among the unhoused.

Analisis Perbaikan Kualitas Pelayanan Jasa Penyewaan Gudang Menggunakan Metode Service Quality dan Importance Performance Analysis

Service quality is crucial for companies in the service sector, directly impacting customer satisfaction. PT BLI, a company offering TPS warehouse rental services, is facing issues with a low influx of containers and customer complaints. This research aims to analyze the service quality at PT BLI's warehouse storage section using the Servqual method, which encompasses five quality dimensions and 24 attributes, followed by Importance Performance Analysis (IPA) to identify attributes that require immediate improvement. The Servqual analysis revealed that 10 attributes of PT BLI's service quality do not meet customer expectations. Through IPA, five attributes were identified as high-priority for improvement: the safety of goods in the warehouse (gap of -0.07), the informativeness of employee service regarding activity updates (gap of -0.14), the speed of employees in processing goods in and out of the LCL warehouse (gap of -0.34), the ability of employees to understand consumer needs (gap of -0.01), and the communication skills of employees in providing excellent service (gap of -0.32). Addressing these critical service quality gaps will help PT BLI enhance customer satisfaction, reduce complaints, and potentially increase the number of incoming containers, positively impacting the company's standing in the warehouse rental industry.

Editorial: The case for more action and more research into healthcare provision and health inequalities for people with intellectual disabilities

Accessible SummariesAge, Sex, and Constitutional Factors Whittle et al. identify how sex impacts mental health service use for women with intellectual disability. Sheerin et al. highlight how age‐specific needs are unmet due to service gaps. Burke et al. identify how age‐related healthcare risks for bone health are different for people with intellectual disability.Living and Working Conditions van den Bemd et al. reported the recording of management of long‐term conditions for patients with intellectual disabilities in long‐term care appears suboptimal. Skoss et al. report on the infrastructure of group home settings in Australia and how after COVID‐19 people living in these settings receive fewer healthcare services.Individual Lifestyle Factors Lunsky et al. explored the use of a ‘check‐in tool’ to support people with intellectual disability proactively.Community and Social Networks Donaldson et al. and Karas et al. highlight systemic issues with eyecare and examine the impact of peer‐to‐peer support and community advocacy on improving access to eye care. Schormans et al. examine the lack of social and community support for homeless youth with intellectual disability. Sykes et al. highlight reasonable adjustments and influence of community and familial attitudes in influencing breast and cervical cancer screening access. Earle et al. detail how broader societal and cultural norms affect menstrual health support. Heslop and Lauer found limited evidence about preventing specific avoidable causes of death in people with intellectual disability and outline the need for ‘whole population’ policy changes. Iffland et al. found that lung infections, choking, flu and heart problems were much more likely to be a contributing cause of deaths for people with intellectual disability. Hatton et al. explore the impact of COVID‐19 on access to health services and highlight severe disruptions during the pandemic which persisted and worsened postpandemic. Beeken et al. detail how stakeholder engagement in research and policymaking can improve health and address health inequalities.

Risk factors and service gaps affecting a sustainable work: a qualitative multi-stakeholder analysis in the context of persons with acquired brain injury living in Switzerland

IntroductionAlong with the social and economic challenges posed by an aging society, creating work conditions that allow persons to stay healthy and work into old age has become a major task of Western societies. Retaining employment after returning to work is particularly difficult for individuals with a disability, as evidenced by the high rate of premature labor market dropout. Individuals with acquired brain injury (ABI) exemplify this challenge, as it often impairs cognitive, technical, and interpersonal abilities that are crucial in today’s labor market. To effectively support these individuals, vocational integration practitioners require comprehensive knowledge of risk factors for premature labor market dropout and effective strategies for sustainable work.ObjectiveThis study aimed to identify perceived risk factors and related service gaps regarding sustainable work for people with ABI, as reported by affected individuals, employers, vocational integration professionals, and health professionals.MethodsSecondary data analysis. Data that was originally collected through seven focus groups and two interviews with persons with ABI, 15 interviews with employers, and 13 interviews with vocational integration and health professionals in the context of the project ‘Sustainable employment’ was re-analysed thematically.ResultsTwo major themes of risk factors were identified: (1) person-related factors (including the subthemes: post-ABI impairments; lack of understanding of post-ABI impairments; poor health management) and (2) environment-related factors (including the subthemes: challenges related to the service structure; insufficient knowledge and education about ABI; challenges at the workplace; difficulties in private life). While stakeholders noted the variety of the currently available services, they particularly pointed to the missing long-term monitoring and counseling services for persons with ABI following the initial return-to-work, reflecting a major challenge for sustainable work. An overarching gap related to the fragmentation of the service structure and the lack of case coordination along the working life.ConclusionsMultiple stakeholders emphasized the importance of empowering individuals, ensuring easy access to professional support, and providing a suitable work environment to address key risk factors and facilitate sustainable work for individuals with ABI. Continuous coaching, long-term monitoring and counseling following return-to-work, were identified as potential strategies to achieve these goals.

Keeping Safe Together: A Brief Report on Children’s Experiences of One ‘All of Family’ Domestic Violence Intervention Program in Melbourne, Australia

Abstract Purpose To develop a response to an identified service gap for domestic violence (DV) victim-survivors who are living with their abusive partner and have children in their care, Keeping Safe Together (KST) was designed as an ‘all of family’ program and piloted over 18-months in Victoria, Australia. The purpose of this brief report is to explore how children had experienced the KST program, and what, if any, changes to their safety and situations they experienced because of the program. Methods Interviews were conducted with eight children engaged in the program alongside their family members. Thematic analysis of the data was undertaken to draw out themes. Results The children were aware of the impact of the violence and conflict on their families. They demonstrated strong empathy for their family members’ wellbeing, and a desire for change. The children saw the KST program as having a positive impact on their own and their families’ safety and circumstances, particularly in terms of reducing their fathers’ abusive behaviors. The program supported them to increase their own sense of control, happiness, and development of coping strategies. Conclusions The findings indicate that the program met a significant support gap and improved the lives of children in this sample who were living with fathers using violence against their mothers. Further trial and evaluation of ‘all of family’ programs such as KST is needed to build the evidence base on their effectiveness for children.

Building a baby-friendly community: Development, strategy, implementation and evaluation of a BFCI program.

The aim of the study was to investigate the impact of the use of baby-friendly community initiative (BFCI) model on various stakeholders in the community. Quasi-experimental research design. The study was conducted in public premises and online workshops from April 2019 to September 2022. Participants were followed up for a period of 1 month, except for those employed at public premises. The program involved training based on an accredited BFCI framework to cultivate a breastfeeding-friendly attitude and knowledge. A paired sample t-test was used to examine breastfeeding attitude and knowledge scores before and after BFCI training among staff employed from public premises. An analysis of variance was conducted to examine the breastfeeding self-efficacy and attitude scores, measured repeatedly at different timepoints over 1-month timepoint (T0, T1 and T2) among pregnant and postpartum women. A total of 2340 perinatal women and 1339 staff from public premises were recruited. For staff, there was an increase in the mean score of breastfeeding knowledge and attitude by 5.8 and 6.1, respectively, at T1. Similarly, for perinatal women, there was an increase in the mean score of breastfeeding self-efficacy and attitude by 6.6 and 3.3, respectively, at T1. In summary, a BFCI model, with active community participation, accreditation and an award system, has been effective in promoting breastfeeding. Adapting the baby-friendly hospital initiative to local contexts and employing a social theory model can enhance breastfeeding promotion and improve infant health outcomes. Prioritizing culturally sensitive breastfeeding education is crucial for successful BFCI implementation. Healthcare professionals should consider clients' culture and socio-economic backgrounds when providing breastfeeding education to maximize effectiveness. The target audience for breastfeeding education should be expanded to include various community stakeholders beyond families. What problem did the study address? This study addressed the problem of knowledge gaps among stakeholders in building a breastfeeding-friendly community, particularly in implementing a baby-friendly community initiative (BFCI) as part of a baby-friendly hospital initiative (BFHI). The research filled a service gap by providing effective interventions targeting community stakeholders and assessing the impact of a BFCI program on their knowledge and attitudes towards breastfeeding. What were the main findings? The findings highlighted the effectiveness of a BFCI program in enhancing breastfeeding knowledge and attitudes among frontline staff and increasing breastfeeding confidence among mothers. These findings contribute to the understanding of the program's impact on different stakeholders in the community. Where and on whom will the research have an impact? It impacts on global policymakers by providing insights for developing comprehensive guidelines for future BFCI implementations. It also contributes to the creation of a more baby-friendly community, benefiting breastfeeding families and their infants by promoting and supporting breastfeeding families. This study has adhered to relevant EQUATOR guidelines using the TREND reporting guideline. No patient or public contribution. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: This study provides an overview of the establishment of a localized BFCI program. It also opens up a new direction for the community to investigate BFCI strategies for community stakeholders. It also provides evidence to support other countries in following a similar process, as each country approaches becoming breastfeeding-friendly in its own unique way. No protocol.