Social Care Organisations Research Articles

Plan for the crisis!

Abstract Background The COVID-19-crisis has posed major challenges for organisations providing care in terms of fulfilling their contracts as well as maintaining their quality standards. This project aimed to analyse the implementation of gender and diversity sensitive crisis preparedness in health and social care organisations in Austria. The innovation of this project lies in the organisational crisis preparation including the interfaces of all organisations and actors involved in the care of a vulnerable person. Methods A comprehensive survey and analysis of existing structures and processes was carried out. A participatory approach was used to develop modular guidelines tailored to different crisis scenarios. This was followed by a detailed process analysis, integration of good practices and the creation of assessment tools for practical evaluation. Staff training and technology needs were identified, followed by an assessment of the applicability of the findings to other social sector organisations. Results This project created guidelines with modular structures that enable preparation for crises and their consequences. Thereby strategies for risk mitigation and good practice examples, e.g. from the COVID-19 pandemic, were developed. A self-assessment of the status of crisis preparation as well as the continuous monitoring with special consideration of the intersectional diversity of the target groups and their vulnerability was developed and made available on the web. Conclusions The project results in guidelines as well as a self-assessment and monitoring tool directly benefiting the participating organisations. Through its transferability to other organisations the project promotes overall crisis resilience and sustainably strengthens the care for vulnerable groups in times of crisis. In addition, solidarity-based help in crisis situations is promoted. The project promotes not only organisational, but also individual as well as macro-social and economic benefits. Key messages • The project developed guidelines for gender and diversity sensitive crisis preparedness for health and social care organisations, including risk mitigation strategies and self-assessment/monitoring. • Crisis preparation must be systematically implemented in health and social care organisations involved in care of vulnerable persons.

Analysis of the national structure of care provided to older people in Slovenia

Ageing in place has for many years been at the forefront of political goals for care provision for older people in Europe. The organization of care in terms of the national governing structure must therefore be continually observed to better understand the care actually offered and then used by older people. In this study, we examined the organization of social home care and institutional care across municipalities and administrative units in terms of what is offered to older people as formal care. Variation across municipalities and administrative units is observed with explorative cluster analysis and analysis of means of key dependent variables across clusters to better understand the variability in the care offered to older people in those municipalities and administrative units. The results show that while social home care is temporally available across several clusters of municipalities, and the affordability of social home care is also stable across clusters of municipalities, there are still municipalities where social home care has a limited time availability and municipalities where the out-of-pocket contribution to social home care delivery is nearly the twice the average of such contributions. In terms of institutional care, one can find administrative units with either a deficit or a surplus of placements of such care available.

Employer support for health and social care registered professionals, their patients and service users involved in regulatory fitness to practise regulatory proceedings.

Health and social care employees may be involved in professional regulatory proceedings because their alleged behaviour raises health or conduct concerns. Employees, patients or service users may also be involved in a regulatory tribunal as witnesses. This study is about the role of employers in supporting them in this process. Taking an organisational support perspective, we interviewed 25 senior employees in health and social care organisations in the UK who are responsible for managing the employer's role in the proceedings. Template analysis was used to analyse the transcripts. Support for patients was limited to that offered during an employer's complaints process, and only one employer gave some support during the regulatory process if the patient or service user initiated regulatory proceedings. Support for employees in tribunals was little different to that offered during an initial investigation by the employer. However, where additional support for being involved in a regulatory tribunal was offered to employees, it most often came from the senior employees' own experience of the stressfulness of being a witness in these proceedings. Employers were not aware of training resources that would better support their employees to engage with professional regulatory proceedings. Employers offer limited support to employees who are involved in professional regulatory proceedings, and the support offered may depend more on senior employee's individual experience of involvement in regulatory proceedings to exercise this discretion. Patients, service users and other public witnesses receive almost no support from health and social care employers during professional regulatory proceedings.

What are the Factors Influencing Service Provider Response to Working with Families Affected by Intimate Partner Violence and Abuse? A Qualitative Systematic Review of the Literature

Abstract Purpose Intimate partner violence and abuse (IPVA) is a major public health issue with long-term negative impacts on abused adults and affected children. Addressing this complex problem requires a multi-agency response, but barriers to effective joint working remain. This review aimed to understand the factors that influence multi-agency response to families who experience IPVA and to their children. Method We undertook a qualitative systematic review of international literature via five electronic databases and supplemented the review by citation searches, online searches of grey literature, and hand searches of relevant journals. We analyzed data thematically. Results The 31 identified papers reported findings from 29 unique studies undertaken in six countries and drew on data from 1049 professionals across health care, social care, the police, courts, schools and voluntary organisations. The main factors influencing service provider response to IPVA were siloed approaches to IPVA, particularly the separation between adult and childrens services. This influenced assessment and response to risk. Risk was also a consideration when child-protection staff were expected to work with perpetrators in ‘family settings’, even in lower-risk cases. Multi-agency working facilitated information sharing between agencies, an understanding of each other’s remit, and building trust. Conclusion Multi-agency collaboration needs to be supported by clear policies of interaction between agencies. Providers of child protection services, health, mental health, housing police and probation need to be supported by specialist training in IPVA, not only in high-risk cases, but also to relieve pressure on an already overstretched workforce.

Lessons Learned from the Experiences of Domestic Violence Service Providers in Times of Crisis: Insights from a Central Asian Country.

Domestic violence is a widespread problem in both stable and crisis contexts. During crisis-driven periods, such as environmental, economic, political, and health emergencies, existing gender inequalities are exacerbated, and the risks of violence against women (VAW) are amplified. This qualitative study explores the experiences of professionals working in VAW organisations in a Central Asian country during the COVID-19 pandemic. By interviewing 45 professionals from social care organisations in Kazakhstan, this study aims to understand the impact of COVID-19 on the ability of VAW organisations to assist victims of domestic violence and comprehend the adjustments they made to support victims. The findings shed light on the challenges faced by VAW organisations, including reduced capacity, increased service demand, the shift to remote services, and funding cuts. The study highlights the critical role of these organisations in crises and urges the consideration of lessons learned to prevent VAW in emergency and non-emergency situations. In the Central Asian region, where domestic violence is persistent, this research offers valuable insights for interventions during and after crises. The study offers effective strategies for achieving Sustainable Development Goal 5.2, which aims to eliminate violence against women, and SDG 3.8, ensuring access to healthcare, psychological support, and safe environments.

Cross-sector collaboration to reduce health inequalities: a qualitative study of local collaboration between health care, social services, and other sectors under health system reforms in England

BackgroundPolicymakers across countries promote cross-sector collaboration as a route to improving health and health equity. In England, major health system reforms in 2022 established 42 integrated care systems (ICSs)—area-based partnerships between health care, social care, public health, and other sectors—to plan and coordinate local services. ICSs cover the whole of England and have been given explicit policy objectives to reduce health inequalities, alongside other national priorities.MethodsWe used qualitative methods to understand how local health care and social services organizations are collaborating to reduce health inequalities under England’s reforms. We conducted in-depth interviews between August and December 2022—soon after the reforms were implemented—with 32 senior leaders from NHS, social care, public health, and community-based organizations in three ICSs experiencing high levels of socioeconomic deprivation. We used a framework based on international evidence on cross-sector collaboration to help analyse the data.ResultsLeaders described strong commitment to working together to reduce health inequalities, but faced a combination of conceptual, cultural, capacity, and other challenges in doing so. A mix of factors shaped local collaboration—from how national policy aims are defined and understood, to the resources and relationships among local organizations to deliver them. These factors interact and have varying influence. The national policy context played a dominant role in shaping local collaboration experiences—frequently making it harder not easier. Organizational restructuring to establish ICSs also caused major disruption, with unintended effects on the partnership working it aimed to promote.ConclusionsThe major influences on cross-sector collaboration in England mirror key areas identified in international research, offering opportunities for learning between countries. But our data highlight the pervasive—frequently perverse—influence of national policy on local collaboration in England. National policymakers risked undermining their own reforms. Closer alignment between policy, process, and resources to reduce health inequalities is likely needed to avoid policy failure as ICSs evolve.

Mistreated but Still Resilient! Unraveling the Role of Servant Leadership in Mitigating the Adverse Consequences of Care Recipients' Incivility

ABSTRACTIn many countries, social care workers suffer from mistreatment from social care recipients. Such mistreatment poses a significant challenge from the human resource management (HRM) perspective as finding and retaining competent social care workers is a global challenge. However, only a few studies focus on the relationship between such mistreatment and social care workers' job and psychological resources. Drawing on the conservation of resources (COR) theory, our study sheds light on the relationship between social care recipients' incivility and the resilience of social care workers. Specifically, our study examines the mediating role of work meaningfulness on the care recipient incivility–care worker resilience link, and the moderating role of servant leadership on this mediated relationship. To test the proposed moderated mediation model, two studies were conducted in social care organizations in England (n = 248) and Romania (n = 296). Our results revealed that perceived care recipient incivility is indirectly and negatively related to care workers' resilience by undermining their perceptions of work meaningfulness. Moreover, when social care workers work under a servant leader, this indirect relationship becomes weaker. The discussion elaborates on the findings of our model as well as the theoretical and practical implications for the management of human resources in social care organizations.

The effects of a facilitator-enabled online multicomponent iSupport for dementia programme: A multicentre randomised controlled trial

BackgroundMulticomponent interventions with carers of people with dementia demonstrate positive effects on the health and quality of life for carers and care recipients. The World Health Organization's iSupport for Dementia is an evidence-based online psychoeducation programme for carers. However, the programme was mainly implemented as a self-learning tool which might have limited its positive effects on carers and care recipients. Evidence for online multicomponent interventions with carers that incorporates the iSupport programme remains unknown. ObjectivesThis study aimed to partner with health and social care organisations to evaluate the effects of a facilitator-enabled online multicomponent Chinese iSupport programme, which included psychoeducation using the iSupport programme, facilitator-enabled carer support groups and access to care services. DesignA multicentre randomised controlled trial. Settings and participantsParticipants were family carers in Australia and greater China. We recruited participants to the study from 1st November 2021 to 30th June 2022. MethodsThe intervention group received the Chinese iSupport programme delivered online. The intervention lasted for 6 months. Our primary outcome was carers' quality of life. Our secondary outcomes were carers' self-efficacy, social support, distress reactions to changed behaviours, care recipients' frequency of changed behaviours, quality of life, unplanned hospital admissions, emergency department presentations and permanent admissions to nursing homes. The outcomes were measured at baseline (T0), 6 months (T1) and 9 months (T2). We applied a multivariate mixed effect linear regression model to capture the group effect, time effect and their interaction. ResultsIn total, 266 eligible family carers agreed to participate and were randomly assigned to an intervention group (n = 131) or a usual care group (n = 135). Most carers were women with a mean age of 53 years. The intervention group showed a statistically significant higher score of mental-health-related quality of life (mean difference = 4.1, 95 % CI: 1.5, 6.8, p = 0.002), self-efficacy in controlling upsetting thoughts (mean difference = 7.1, 95 % CI: 2.2, 12.0, p = 0.005) and lower score of distress reactions to changed behaviours (mean difference = −0.1, 95 % CI: −0.3, −0.03, p = 0.012) than the usual care group at T1. ConclusionThe facilitator-enabled online multicomponent Chinese iSupport programme demonstrated positive effects for carers on mental health-related quality of life, controlling upsetting thoughts and distress reactions to changed behaviours of people with dementia. Trial registrationThis study is registered in the Australia New Zealand Clinical Trials Registry on 12th March 2021 (ACTRN12621000276853). Tweetable abstractThe facilitator-enabled online multicomponent Chinese iSupport programme improved family carers' mental health-related quality of life, control of upsetting thoughts and distress reactions to changed behaviours of people with dementia.

“We can’t allow ourselves to fall ill”: Health and (self-)discipline in female family caregivers from a gender perspective

Research has shown significant differences and inequalities in the health of women and men who care for older dependent family members, with women having poorer health and suffering more from overload. Women internalize a cultural model of caregiving involving social norms whereby caring becomes a central dimension of gender-female identity, cutting across other aspects of life. This study takes a biopsychosocial approach, understanding gender as a determinant of health, in order to investigate the processes of subjectivation (and “technologies of the self”) that mediate between the social organization of care and the health of women. A reflexive thematic analysis was undertaken in this qualitative study, following in-depth interviews with nineteen women caring for family members. The results show that women’s biopsychosocial health is affected by the subjective positions they adopt in order to submit to or resist gender-based social norms about caring in three dimensions: their relationship to their own health problems, their experience of vulnerability, and the place of love and morality in relation to being a caregiver. Those (inter)subjective processes reflect the neoliberal update of the gendered social organization of care and the way its social discourses, such as free choice and unstinting performance, relate to female caregivers’ biopsychosocial health. It is necessary to deconstruct this traditional model and the self-regulated processes as recast by the neoliberal order for the sake of women’s health, to relieve them of this burden. It is essential to commit to sociopolitical articulations aimed at shared responsibility in care.

“My child is my job now” – Care, work and careers of mothers with disabled children in the Norwegian welfare state

In this article, we investigate how mothers of disabled children in Norway experience the work–family conflict and its impact on their careers, highlighting the role of provision of health and welfare services. We use a qualitative multiple case study of 11 mothers with disabled children. Although Norway is characterized by high labor market participation for women and an emphasis on care policies that support working mothers, we show that mothers of disabled children still experience considerable work–family conflict, creating ill-health and income-related struggles. This conflict is heavily influenced by inadequate support from health and welfare services. However, some of the mothers also highlighted how caring for their disabled children led to growth and new career paths, using their care experiences to craft new careers. Drawing on Fraser's (2022) concept of the care crunch and a relational perspective on disability, we demonstrate how the social organization of care for disabled children undervalues the care work mothers do and puts disabled children at risk of receiving insufficient and unequal services.

Health and social care leaders’ and employees’ perceptions of remote leadership and the associated factors

PurposeThe purpose of this study was to describe health and social care leaders’ and employees’ perceptions of remote leadership and the associated factors.Design/methodology/approachA total of 45 leaders and 177 employees from one Finnish health and social care organization completed an electronic questionnaire between October and November 2020. The questionnaire included questions related to background information, along with structured and open-ended questions addressing remote leadership and the associated factors. The collected quantitative data was analyzed with statistical methods, while inductive content analysis was used to analyze the qualitative data.FindingsRemote leadership emerged as a developing form of leadership that was part of everyday life at a regional health and social care organization. However, it was also considered by some as a distanced and authoritarian form of leadership that reduced communication to a one-way flow of information. Remote leadership and digitalization in health and social care were generally perceived positively, especially among higher educated participants and those working mainly in a remote context. However, digitalization was also perceived as a burden and remote leadership as a source of uncertainty at work, especially among lower educated participants and those who worked mainly in traditional contexts.Originality/valueThis study expands the little-researched area and provides insights that can be used to further develop remote leadership and the related education.

How Do Curricula for Medical Students and Physician Learners Address the Social Determinants of Health? A Scoping Review.

Curricula about social determinants (drivers) of health (SDOH) are becoming more common in medical education, reflecting increasing expectations from payers and accreditors that health care systems do more to address health-related social needs and close pervasive health equity gaps. Few previous reviews have addressed the content of SDOH-related curricula. This review examines the scope and focus of medical education on SDOH and adjacent concepts. The authors screened 2,442 articles describing curricula delivered in undergraduate, graduate, and continuing medical education settings between 2010 and 2023 using PubMed and 2 field-specific databases, yielding 289 articles. Data on course duration, pedagogic approach, assessment methods, and curricular content were extracted and analyzed. Curricular content was categorized using the National Academies of Science, Engineering, and Medicine's (NASEM's) 5As framework, which recommends 5 key activities health care can undertake to mitigate social risk (awareness, adjustment, assistance, alignment, and advocacy). A total of 289 articles were included in this review. Curricula covering SDOH-related concepts have increased over time. Of the included articles, 190 (65.7%) referenced at least 1 of NASEM's 5 key activities. Training on social risk screening and other awareness activities were noted most frequently (123 [42.6%]), followed by curricula on helping patients get social care (assistance; 86 [29.8%]) and providing social risk-adjusted health care (adjustment; 81 [28.0%]). Curricula on system- and policy-level activities, including alignment of health care and social care organizations (alignment), and advocacy (advocacy) were described less frequently (43 [14.9%] and 49 [17.0%], respectively). Ninety-four articles (32.5%) referenced only general information about SDOH without describing specific actions to adjust care or reduce social adversity. NASEM's 5As framework provides a useful construct for characterizing SDOH-related curricula. Medical educators should teach not only the prevalence and pathophysiology of SDOH but also what physicians can do to address these factors.

Connected lives: Care, money management, and gender inequality in low-income households in times of crisis in Argentina.

Inspired by the sociology of Zelizer, this article lays out a framework of analysis that sheds light on money management as a cornerstone of the social organization of care. First, it lays out the features of the money management of care and caretaking practices to reveal a cyclical process in which the money side of care is rendered invisible and naturalized. It then turns to the question of debt, a key aspect of money management, and its reinforcement of gender inequalities during the care crisis associated with COVID-19. The findings are drawn from a qualitative survey of low-income households conducted in Argentina in 2021.

The influence of culture on the health beliefs and health behaviours of older Vietnam-born Australians living with chronic disease.

To explore the health beliefs and health behaviours of older Vietnam-born people living with chronic disease in Western Australia. This study was designed as a focused ethnography guided by the interpretative research paradigm and Leininger's Theory of Culture Care. Data were collected through participant observation and interviews undertaken at participants' homes in Western Australia over 7 months in 2019. Data were analysed using Wolcott's approach for transferring qualitative data, comprising three phases: description, thematic analysis and interpretation. This study included 12 participants. The health perspectives and practices of older Vietnam-born Australians significantly reflected the traditional Vietnamese values. These included the stigma towards chronic disease as an inevitable consequence of ageing; self-blame thoughts about chronic disease causations and maintained traditional dietary practices. However, some aspects of their health behaviours such as beliefs and practices in traditional medicine, Western medicine and physical exercise reflected a blended approach combining both Vietnamese-oriented and Westernized-orientated practices. Individual factors were also identified as contributing to chronic disease self-care among participants. This study emphasizes culture played a significant role in shaping the way that older Vietnam-born Australians believed and behaved while living with chronic conditions. However, it also indicates that culture is not a stationary concept, it evolves gradually and is socially constructed. A better understanding of the health beliefs and practices of older Vietnam-born Australians is expected to contribute to the delivery of culturally safe and effective support for this population. The achievement of culturally safe care requires a systemic approach and collaboration of strategies across sectors. This study encompassed the contribution of 12 older Vietnam-born Australians who offered the researcher the privilege to enter their world and the staff of social care organization who opened the gate for the researcher to approach participants.

How to manage being bullied as a nurse leader.

Bullying has existed in health and social care organisations for many years. Although researchers have examined the effects of bullying on nurses and nursing students, there has been too little focus on bullying behaviours inflicted directly or indirectly on nurse leaders and managers. This article provides concise and practical guidance for nurses in leadership or management roles on how to identify and manage bullying behaviours directed at themselves. •Overt or covert bullying in nursing can happen at every level of the organisation. •Bullying negatively affects practice, teamwork, staff morale and patient care. •Identifying bullying is the first step in addressing unacceptable behaviours. •Admitting that you may be being bullied and seeking support to manage bullying is a hallmark of an effective nurse leader. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: •How this article might improve your practice when managing being bullied as a nurse leader. •How you could use this information to educate your peers about managing being bullied as a nurse leader.

Critical reflexivities of women who cared for others during their childhood

This study examines the childhood care experiences of women between 20 and 30 years of age from low-income households in Santiago, Chile, by employing semi-structured interviews and qualitative analysis. At present, women understand their caregiving roles as older sisters, one which burdened them with agency practices, shaping critical reflections regarding the social organisation of care and influencing their present identity. They also articulate a desire for emotional resilience, a coping mechanism previously observed in low-income neighbourhoods in Chile. While downplaying their caregiving past, they subtly reveal the weight and regret associated with their responsibilities, influencing their reluctance to become mothers in the present. This study underscores the intricate interplay of past care experiences with present decisions, revealing the impacts of empowering discourses on women’s ideals and achievements, and the inherent fragility they carry.

A social network analysis approach to assess COVID19-related disruption to substance use treatment and informal social interactions among people who use drugs in Scotland.

To assess the extent of Coronavirus-related disruption to health and social care treatment and social interactions among people with lived or living experience of substance use in Scotland, and explore potential reasons for variations in disruption. Cross sectional mixed methods interview, incorporating a social network 'egonet interview' approach asking about whether participants had interactions with a range of substance use, health, social care or third sector organisations, or informal social interactions. Five Alcohol and Drug Partnership Areas in Scotland. 57 (42% women) participants were involved in the study, on average 42 years old. Five-point Likert scale reporting whether interactions with a range of services and people had gotten much better, better, no different (or no change), worse, or much worse since COVID19 and lockdown. Ratings were nested within participants (Individuals provided multiple ratings) and some ratings were also nested within treatment service (services received multiple ratings). The nested structure was accounted for using cross classified ordinal logistic multilevel models. While the overall average suggested only a slight negative change in interactions (mean rating 2.93), there were substantial variations according to type of interaction, and between individuals. Reported change was more often negative for mental health services (Adjusted OR = 0.93 95% CI 0.17,0.90), and positive for pharmacies (3.03 95% CI 1.36, 5.93). The models found between-participant variation of around 10%, and negligible between-service variation of around 1% in ratings. Ratings didn't vary by individual age or gender but there was variation between areas. Substance use treatment service adaptations due to COVID19 lockdown led to both positive and negative service user experiences. Social network methods provide an effective way to describe complex system-wide interaction patterns, and to measure variations at the individual, service, and area level.

Health and social care managers' self-assessed competence in knowledge management: A descriptive cross-sectional study.

To describe health and social care managers' self-assessed competence in knowledge management and the factors associated with management competence. It has been shown that the performance of an organization is as good as the competence of its managers, so health and social care managers' competence in knowledge management should be assessed to improve organizational performance. A descriptive cross-sectional design. A total of 116 managers participated from six Finnish public health and social care organizations. The data were collected in February and August 2022 using the managers' competence in knowledge management (MCKM) instrument and analysed using descriptive statistical methods. Health and social care managers rated their self-reported total competence in knowledge management as good. Among the dimensions of knowledge management competence, managing a culture of competence received the highest rating, while planning competence development and cooperation was perceived as the weakest dimension. The results indicate that background factors such as the healthcare setting, the number of units managed and the number of direct staff had a statistically significant association with the health and social care managers' self-assessed competence in planning competence development and cooperation. Even though the health and social care managers' total self-assessed competence level in knowledge management was rated as good, the results underscore the significance of continuous competence development among these managers in all dimensions of knowledge management. By enhancing and clarifying managers' tasks and competence in knowledge management, managers can increase staff retention, attractiveness and work well-being. The results can be utilized to identify managers' strengths and weaknesses in knowledge management and, thus, effectively target their limited competence development resources. The STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist. There is no patient or public contribution.

"We all see things through a different lens based on our life experiences": co-production of a web-based implementation toolkit with stakeholders across the health and social care system.

Implementing new innovations across the health and social care system is complex, involving many factors that in recent years have been compounded by Covid-19. While a plethora of implementation tools and frameworks are available, there are limitations in terms of their design and accessibility. Co-production is a valuable mechanism for developing tools that have utility and accessibility for those tasked with using them in health and social care organisations and there is growing acknowledgement of increasing the role of co-production in implementation science. This paper provides novel insight into co-production practices and relevance to implementation science by reporting findings from a study to co-produce a web-based implementation toolkit (WIT) that is accessible, usable and designed to support adaptive implementation across health and social care systems. Key themes relating to the process of co-production are outlined and the value of using co-production in implementation processes are discussed. A web-based survey (n = 36) was conducted with a range of stakeholders across health and social care. Findings identified a need for WIT. Survey respondents were invited to express interest in becoming part of a co-production group and to take part in three online interactive workshops to co-produce WIT. Workshops took place with the group (n = 12) and focused on key developmental stages of WIT. Online co-production workshops were integral to the development and refinement of WIT. Benefits of using this process identified three interrelated themes: (i) Co-designing key features of the toolkit, (ii) Co-producing a toolkit with utility for users across health and social care settings, (iii) Co-producing a toolkit to support the implementation journey. Our approach of undertaking co-production as a dialogic process enabled generation of these themes. To illuminate discussion of these themes we draw upon iterative co-development of the "active ingredients" of key components (e.g., interactive Implementation Wheel) and functions (e.g., interactive "pop-up" definitions of keyword) and features (e.g., case studies) of WIT. Using a co-production approach with a range of end-users across health and social care systems, highlights the benefits of understanding implementation processes for users in these settings. User-centred design and processes for ensuring accessibility readily support the translation of implementation into rapidly changing health and social care systems to benefit outcomes for patients, their families, carers, service users and practitioners.

Community support for families affected by dementia.

This paper provides and overview of the community support services that may be available for people with dementia and their family carers. The authors introduce dementia, including the impact of the diagnosis on both the person with dementia and the wider family. Using a case study approach, the authors describe the support available, spanning health and social care and third sector organisations. They discuss how this support can enable people with dementia and their carers to maintain wellbeing and cope with the impact of dementia. This article will be of interest to community nurses, and health and social care professionals more generally, who may encounter families affected by dementia in community settings. Having a good knowledge of the support available and how to access it will allow community nurses to capitalise on the health promotion opportunities presented to them, when they come into contact with families affected by dementia in the course of their day-to-day practice.