Vulnerable Users Research Articles

Risks of the Metaverse: A VRChat Study Case

This paper examines the potential social risks of the metaverse. Previous research has found that video games, including Virtual Reality (VR) ones, can be associated with violence normalization and objectification of women. Moreover, some studies have suggested that gaming platforms even serve as tools for extremist groups to recruit and radicalize vulnerable people. Nonetheless, these risks have not been further studied in the context of the metaverse. This research analyzed relevant cases from different gaming platforms including Meta Horizon Worlds. Moreover, the game VRChat was studied due to the similarities it has with the metaverse in terms of design and features. An evaluation of VRChat's user experience was carried out through an analysis of its most popular reviews. Though no signs of radicalization were found, an important number of these reviews expressed sentiments such as loneliness and depression, which make people more vulnerable to be radicalized. Additionally, a tendency for online harassment and sexual deviance was found in the game since 2018 and remained persistent to date. For further insight into the sexual misconduct findings, an interview was conducted with psychiatrist and sexuality expert, Dr. Zenteno. This research found that the game developers of VRChat have not done enough to address sexual misconduct effectively and protect its most vulnerable users. This research concluded that due to the lack of incentives that game developers have to regulate their platforms themselves for social good, further intervention of all the stakeholders involved is needed. This includes policymakers, parents, legal guardians, and educators.

The Effect of Food Vouchers and an Educational Intervention on Promoting Healthy Eating in Vulnerable Families: A Pilot Study

Cost has been reported as the main barrier to healthy eating in vulnerable groups. We aimed to evaluate the effect of a nutrition education intervention on adherence to Mediterranean Diet and health when providing food vouchers. This pilot study has a randomized control trial design. We included 66 vulnerable users from the Red Cross of Zaragoza (Spain). Intervention and control group individuals received 120 euros/month of food vouchers over 3 months to be spent in supermarkets (60 euros/month if under 12 y) plus a 10-week nutrition education program for the intervention group. Family food purchases were assessed using electronically recorded supermarket-obtained transactions. During and at the end of the intervention the percentage of healthy food was higher in the intervention than in the control group. Once the nutrition education was over, differences between groups dissipated. In the intervention group, health parameters improved, particularly weight-status, lipids, and liver enzymes. Control participants gained weight, although lipid and liver enzymes improved. Blood pressure and HbA1c did not improve in either the intervention or the control group. In conclusion, providing unrestricted food vouchers to vulnerable groups to increase healthy food consumption appears to be insufficient and should be accompanied by medium-long term nutrition education.

Implementation of a patient-reported experience measure in a Dutch disability care organization: A process evaluation of cocreated tailored strategies.

In 24/7 disability care facilities, patient-reported experience measures (PREMs) are important to help healthcare professionals understand what matters to care users and to improve the quality of care. However, the successful implementation of a PREM is complex. In a Dutch disability care organization, stakeholders cocreated tailored implementation strategies aimed at improving the use and integration of a qualitative PREM. This study gives insights into the uptake and experiences with these cocreated implementation strategies and the perceived impact of the set of strategies. We performed a prospective process evaluation between February 2020 and February 2021. We collected data in three disability care facilities from 35 care users, 11 professionals, 3 facility managersand 4 organization representatives. Data collection included observations during kick-offs and learning goal meetings and several attendance checklists. We collected 133 questionnaires (Time 0 and Time 1). We conducted 35 individual semistructured interviews and an online focus group interview. Quantitative data were analysed using descriptive statistics and qualitative data using directed content analysis. The exposure to and adoption of strategies was between 76% and 100%. Participants were positive about tailoring the strategies to each facility. Implementation was hindered by challenges in care users' communication and COVID-19. The perceived impact referred to an improved understanding of the goal and added value of the PREM and better preparation and execution of the PREM. The impact of the set of strategies was mainly experienced on the micro level. The uptake of the cocreated implementation strategies was acceptable. The participants valued the tailored approach, which enabled them to focus on facility-specific learning goals. Stakeholder engagement and co-created strategies may have strengthened the adoption of and experiences with the implementation. In this article, we present the process evaluation of implementation strategies for the integrated use of a PREM in disability care. A development group consisting of communication vulnerable care users, trainersand professionals developed the implementation strategies. The disability care organization was responsible for the planning and organization of the implementation process. During the process evaluation the end users, trainers, professionalsand managers tailored the implementation strategies to their own settings and needs. Researchers observed this implementation process and interviewed the stakeholders about their experiences and the perceived impact.

"Money Doesn't Buy You Happiness": Negative Consequences of Using the Freemium Model for Mental Health Apps

As global rates of anxiety and depression increase, we observe millions of downloads of mobile apps addressing mental health that adopt 'freemium' charging models offering complex combinations of free and paid features. We explore potentially negative outcomes of deploying such freemium designs to vulnerable MH populations. We assess outcomes for 41 frequently downloaded mental health apps, by combining thematic analysis of 41K user reviews with audits to validate app descriptions and reviews. We propose a new analytic framework identifying three types of negative outcomes for freemium deployments: first vulnerable users currently experiencing crises may feel pressure to download unhelpful or costly apps. Second unintuitive descriptions of complex apps can lead to inappropriate treatments and expensive subscriptions. Third, limited duration offers may result in incomplete treatments or unexpected charges. We discuss ethical considerations and broader HCI consequences. We describe implications for mental health app design, including the need for greater transparency around free versus paid features, and propose new approaches to provide vulnerable users with validated information about these commonly downloaded apps.

Outsourcing and children's social care services: an observational longitudinal analysis of inspection outcomes among English children's homes and local authorities

BackgroundMost children's social care services in England are operated by for-profit companies, but the implications of this development are not well understood. We aimed to evaluate the associations between for-profit outsourcing and quality of service provision among local authorities and children's home providers in England, UK. MethodsWe did an observational longitudinal analysis of inspection outcomes among English children's homes and local authorities. We created and analysed a novel, longitudinal dataset of inspections from Ofsted (ie, the independent regulator of children's social care in England) over a period of 7 years (2014–21; n=13 452). We also analysed the association between Ofsted local authority ratings (n=147) and the use of for-profit outsourcing. FindingsWe found that for-profit children's home providers are significantly more likely to be rated of lower quality than both public and third sector services across all provider level Ofsted inspection domains. For example, for-profit providers have 33·7% lower odds (odds ratio [OR] 0·663; 95% CI 0·522–0·842) than local authority providers of being rated “Outstanding”, “Good”, or “Requires Improvement”, as opposed to “Inadequate” in the main “Overall Experiences” Ofsted category. For-profit services also violate more legal requirements (OR 0·380 [95% CI 0·186–0·575]) and receive more recommendations (0·391 [0·242–0·540]) than local authority providers. These findings are robust to model specification and consistent over the full analysed period. Further, we found provisional evidence that local authority Ofsted ratings are negatively correlated with the percentage of for-profit outsourcing, suggesting that poorly performing local authorities tend to outsource a greater amount of their services than well performing local authorities. InterpretationOur findings are of considerable concern given the focus of these services on society's most vulnerable service users. However, caution is needed in terms of regulating the sector going forward, as the role of for-profit providers cannot be replaced without substantial coordination and long-term planning. FundingThe John Fell Fund and the Carlsberg Foundation.

“A Lot Takes Place Digitally Now, So It Can Be Good to Train on It’’: A Large-Scale Repeated Cross-Sectional Study on Recording Live-Streamed Educational Activities among Health, Social, and Education Students

Audio recording is used in language and music education as an active learning resource to help students reflect on their performance and improve their accuracy. Recordings may be used to provide feedback on both verbal and nonverbal skills and to prepare professional candidates for talking to vulnerable users or other professionals. Despite its potential, recording among health, social, and education candidates to help them improve their digital relations skills is usually not part of pre-service training. Therefore, the objective was to assess the extent to which professional students were affected by recordings in live-stream settings and to explore their perspectives through qualitative elaboration. The design was a repeated cross-sectional mixed-methods study conducted in 2020–2021 (n = 1040 and n = 2238, response rate: 46% and 45%, respectively). Although participation was reduced, active online participation was low, regardless of recording practice. Educational background and age were determinants of active participation, regardless of the recording practice. Active students were the least affected by recording. Students wanted more recordings. Their perspectives revolved around different practices, privacy issues, and the recording used for traditional knowledge transfer instead of active learning. Although the General Data Protection Regulation must be met, we suggest that recording is an underused learning resource.

Remote consultations for diabetes care in a post COVID-19 world.

Remote consultations for diabetes care in a post COVID-19 world.

Contextualising co-production and complex needs: Understanding the engagement of service users with severe and multiple disadvantages

Much has been written about co-production in mainstream services but less is known about its applicability to service users with severe and multiple disadvantages (SMD). Given the sometimes-precarious relationship between providers and users with SMD, the paper argues that co-production should not be approached in the same way as conventional user engagement because of the degree of marginalisation, stigma and exclusion users with SMD face. Through a thematic analysis of evidence systematically collated via a rapid evidence assessment, the author proposes a co-production framework comprising a series of organisational principles to create an enabling environment for co-production with vulnerable service users. The application of the model is encouraged across a range of sectors and settings so that all service users can become empowered participants in the design and delivery of services that affect their lives.

Oral health ambassador scheme: training needs analysis in the community setting.

Introduction Successful oral health promotion relies on resource availability, adequate training and stakeholder engagement. Community nursing teams are in a unique position to promote oral health due to their vulnerable service users who have increased oral health concerns. This article will share results from a training needs analysis.Aims To understand the previous oral health promotion experience of staff within community nursing teams, including identification of previous training and barriers to oral health promotion.Materials and methods An electronic training needs analysis was distributed to non-dental, patient-facing staff within Birmingham Community NHS Foundation Trust.Results In total, 91% (n = 120) of staff members had seen a patient who displayed oral health concerns, 68% (n = 90) of responders had never received training for assessing a patient's mouth and providing mouth care and 9% (n = 12) of staff had received internal trust training regarding oral health. Lack of training impeded 56% (n = 74) of participants from providing oral care and 92% (n = 121) of participants expressed they would benefit from further oral health training.Conclusion Community nursing teams should be supported to engage with oral health promotion to encourage reduced knowledge and confidence deficits, which will support holistic patient management to encourage improvement of oral and general health.

How is the learning disability nurse shortage affecting inpatients on mental health wards?

A lack of specialist staff are ill-equipped to meet the care needs of the most vulnerable service users

Socio-behavioral correlates of pre-exposure prophylaxis use and correct adherence in men who have sex with men in West Africa

BackgroundMultiple barriers compromise pre-exposure prophylaxis (PrEP) engagement (i.e., use and adherence) in men who have sex with men (MSM). In low/middle-income countries, little is known about PrEP engagement in this population. In West Africa, the CohMSM-PrEP study was one of the rare interventions providing PrEP to MSM. We estimated PrEP use and correct adherence rates in CohMSM-PrEP, together with associated factors over time. MethodsCohMSM-PrEP recruited MSM in four community-based clinics in Mali, Côte d’Ivoire, Burkina Faso, and Togo. Quarterly follow-up included collecting socio-behavioral data, and providing a comprehensive HIV prevention package, PrEP (daily or event-driven), and peer educator (PE)-led counselling. Using repeated measures, multivariate generalized estimating equations models were used to identify factors associated with self-reported i) PrEP use and ii) correct PrEP adherence during participants’ most recent anal intercourse (defined as four pills/week for daily users and 2 + 1 + 1 for event-driven users).ResultsFive hundred twenty participants were included with a median follow-up time of 12 months (IQR 6–21). Of the 2839 intercourses declared over the follow-up period, PrEP use was self-reported for 1996 (70%), and correct PrEP adherence for 1461 (73%) of the latter. PrEP use was higher in participants who also attended participating clinics outside of scheduled visits (adjusted odds ratio (aOR) [95% Confidence Interval, CI], p-value; 1.32[1.01–1.71], 0.040), and in those who practiced condomless anal sex (1.86[1.54–2.24], < 0.001). Correct adherence was higher in those who often contacted PE outside of scheduled visits (2.16[1.01–4.64], 0.047) and in participants who adopted receptive/versatile sexual positions with stable partners (1.36[1.03–1.81], 0.030). Instead, after an interaction effect between financial situation and regimen was tested, it was lower in event-driven users with a difficult/very difficult financial situation (comfortable/just making ends meet & daily, 4.19[2.56–6.86], < 0.001; difficult/very difficult & daily, 6.47[4.05–10.30], < 0.001; comfortable/just making ends meet & event-driven, 1.63[1.22–2.17], 0.001), and in participants who felt alone (0.76[0.58–0.99], 0.042).ConclusionsCommunity-based clinic attendance and PE contact outside of scheduled visits were both associated with higher PrEP engagement, but some socially and economically marginalized participants struggled with adherence. As scale-up continues in West Africa, we recommend implementing community-based interventions and providing extra support for vulnerable users to ensure adequate PrEP engagement.

Making It Work: The Experiences of Delivering a Community Mental Health Service during the COVID-19 Pandemic.

The COVID-19 pandemic forced rapid innovative change to healthcare delivery. Understanding the unique challenges faced by staff may contribute to different approaches when managing future pandemics. Qualitative interviews were conducted with 21 staff from a Community Mental Health Team in the North West of England, UK, three months after the first wave of the pandemic. Thematic analysis was used to examine data reporting the challenges arising when working to deliver a service during the pandemic. Data is discussed under four headings; “senior trust managers trying to make it work”, “individuals making it work”, “making it work as a team”, and “making it work through working at home”. Clear communication was essential to ensure adherence to guidelines while providing safe care delivery. The initial response to the pandemic involved the imposition of boundaries on staff by senior leadership to ensure that vulnerable service users received a service while maintaining staff safety. The data raises questions about how boundaries were determined, the communication methods employed, and whether the same outcome could have been achieved through involving staff more in decision-making processes. Findings could be used to design interventions to support mental health staff working to deliver community services during future crises.

Effects of exposure to noise, PM2.5 and NO2 on emotional well-being during daily travel

BACKGROUND AND AIM: Urban residents are exposed to the environment during everyday travel. While previous studies have shown the potential impacts of environmental exposure on mental health and subjective well-being, few studies have examined this relationship in the dynamic transportation context. We aim to address this gap by using smartphone-survey data to quantify the impacts of exposure to PM2.5, NO2, traffic noise, and green/blue space on monetary mood and energy level during daily travel. METHODS: We conducted a smartphone-app survey in the Columbus metropolitan area in Ohio, USA in 2019 (n=465 people). We used the ecological momentary assessment approach and GPS tracking to track travelers’ movement and subjective well-being over the course of 14 days. Using a buffer of 300m along the travel routes, we tabulated the area of green space, traffic noise level, PM2.5 and NO2 concentrations, and travel time by each mode every day. We calculated the dose inhaled based on exposure duration during transportation by each travel mode. We then quantified the impacts of exposure to these environmental factors on positive mood, energy level, calmness, and stress. RESULTS: Our multilevel models show that PM2.5 and noise level were associated with a decrease in positive feeling. On the other hand, NO2 and noise were associated with an increase in stress level, while PM2.5 shows the opposite effect. Noise was found to reduce energy level while green space and water show the opposite effect. CONCLUSIONS: Our study adds further evidence to the relationship between environmental exposure and momentary subjective well-being during daily transportation. The findings imply the need for cities to provide open space and reduce noise and air pollution to promote well-being, especially for vulnerable mode users such as pedestrians and cyclists. Who are more exposed to these factors at a higher level. KEYWORDS: GPS, mental health, exposure

A Circular and Bio-based Renovation Strategy for Low-income Neighbourhoods

The impact of climate change is expected to increase in the following decade. Possible effects on the built environment are identified as urban heat stress, air pollution, extreme weather conditions, etc. As a result, there is an increase in disease and mortality specifically in the cities among the vulnerable citizens such as elderly people and children. Moreover, many cities worldwide are in the evolution of urbanization which leads to increased carbon emissions as well as a demand for more material production and waste. Consequently, the construction industry embodies great potential for reaching the energy and carbon mitigation goals. For regeneration of the built environment, the European directives requires for the renovation of existing building stock as quick as possible. In Flemish context, cities stimulate renovation projects on a systematic and planned basis, by defining ‘urban renovation districts’ which received special financial facilities and subsidizing. Consequently, there is a growing demand for affordable housing in combination with a shortage of qualitative and energy efficient housing opportunities. In the last decades, there has been an intensive effort to develop different retrofit strategies, but there is a lack of comprehensive approach that delivers innovative technical solutions such as circular and bio-based construction methods as a solution to the increased housing demand of vulnerable people. For this purpose, this study combines the efforts of two initiatives, (1) Interreg Circular Bio-Based Construction Industry (CBCI) and (2) the innovative financial policy instrument of subsidy retention for low-income groups (refers to citizens living in poor quality houses with insufficient economic means & social skills to renovate). The study has the ambition to explore the coherence between technical, economical, legal, social aspects for circular urban retrofit strategies. Circular building materials and methods were developed and tested in real-life setting with construction of a prototype living lab (LL) in Technology Campus, Ghent. Depending on the results from the LL, an urban renewal strategy for Flemish districts is proposed by using subsidy retention on macro-economic and social level. The scenario is envisaged as a collective approach with the local community in which the vulnerable users also benefit as direct participants to the research.

장애인 교통수단 효율성에 대한 핵심 결정요인 분석

The demand for demand-responsive transit (DRT) services has continuously increased for vulnerable transport users such as the elderly and disabled. DRT operators must maximize efficiency because their fares are regulated by law despite their high operating costs. Although a comprehensive evaluation of the efficiency of DRT services is imperative, little work has been done in this area. The main objective of this research is to identify the variables that significantly affect the operational efficiency of DRT service providers and propose ways to improve the competitiveness of DRT services. This study presents a new approach to analyzing the efficiency of DRT operators and investigating the determinants of their efficiency. The results indicate the significant impacts of minimum reservation time, maximum reservation time, and operational experience on efficiency. Unlike previous studies, however, ownership type does not significantly affect efficiency. This study presents guidance for policy makers and managers who want to develop transparent management strategies.

Outsourcing and children's social care: A longitudinal analysis of inspection outcomes among English children's homes and local authorities

Most residential children's social care services in England, including children's homes, are operated by for-profit companies, but the implications of this development are not well understood. This paper aims to address this gap by undertaking the first longitudinal and comprehensive evaluation of the associations between for-profit outsourcing and quality of service provision among English local authorities and children's homes. To enable investigation of the implications of outsourcing children's residential social care services, we create and analyse a novel and longitudinal dataset covering more than 13,000 children's home inspections by Ofsted (the independent regulator of children's social care in England) over a period of 7 years (2014–2021). We also investigate the association between Ofsted local authority (LA) ratings and the reliance of LAs on for-profit and third sector outsourcing of children in care placements. Our analysis shows that for-profit providers are statistically significantly more likely to be rated of lower quality than both public and third sector services. For-profit children's homes also violate a greater number of requirements and receive more recommendations compared to other ownership types. These findings are robust to model specification and consistent over the full analysed period. At LA level, we find provisional evidence that LA Ofsted ratings are negatively correlated with the percentage of for-profit outsourcing, suggesting that LAs which outsource a greater amount of their children in care placements perform less well than those which do not. These findings are of significant concern given the focus of these services on society's most vulnerable service users. However, caution is needed in terms of regulating the sector going forward, as the role of for-profit provision cannot be replaced without substantial coordination and long-term planning.

Recovery-Oriented Practices in a Mental Health Centre for Citizens Experiencing Serious Mental Issues and Substance Use: As Perceived by Healthcare Professionals

Introduction: Recovery-oriented practices have become a means of promoting user recovery during hospitalisation, but we do not know much about the concrete means of practicing recovery-orientation for the most vulnerable users with serious mental difficulty and substance use. Aims: We investigated the concrete means of practicing recovery-orientation in care work and the elements, dimensions, outcomes, or steps of it in a special department of mental health centres. Method: Focus group interviews were conducted with 16 health professionals with experience with users with serious mental difficulty and substance use. Qualitative content analysis was undertaken. Results: The main theme was “holistic recovery on structural terms” based on two themes and four subthemes. The first theme was “recovery based on an individual approach” with subthemes “detective—find hope” and “how to do recovery-oriented practice”. The next theme was “recovery subject to structural framework” with subthemes “tension between different interests” and “symptoms as a barrier”. Conclusions: recovery-oriented practice is understood as an approach where health professionals emphasise forming relationships based on trust, being hopeful for the users’ future, spending time with users, and respecting users’ experiences and knowledge from their own life. There are cross-pressures between different interests. The desire to meet the users’ perspectives and respect these perspectives but at the same time live up to mental health centre purposes to stabilise the users’ health and achieve self-care.

Usability engineering in practice: developing an intervention for post-stroke therapy during a global pandemic

This paper provides an overview of the usability engineering process and relevant standards informing the development of medical devices, together with adaptations to accommodate situations such as global pandemics where use of traditional face-to-face methods is restricted. To highlight some of those adaptations, a case study of a project developing a novel electronic rehabilitation device is referenced, which commenced in November 2020 amidst the COVID-19 pandemic. The Sheffield Adaptive Patterned Electrical Stimulation (SHAPES) project, led by Sheffield Teaching Hospitals NHS Foundation Trust (STH), aimed to design, manufacture and trial an intervention for use to treat upper arm spasticity after stroke. Presented is an outline and discussion of the challenges experienced in developing the SHAPES health technology intended for at-home use by stroke survivors and in implementing usability engineering approaches. Also highlighted, are the benefits that arose, which can offer easier involvement of vulnerable users and add flexibility in the ways that user feedback is sought. Challenges included: restricted travel; access to usual prototyping facilities; social distancing; infection prevention and control; availability of components; and changing work pressures and demands. Whereas benefits include: less travel; less time commitment; and greater scope for participants with restricted mobility to participate in the process. The paper advocates a more flexible approach to usability engineering and outlines the onward path for development and trialling of the SHAPES technology.

Communication at the margins: Online homophobia from the perspectives of LGBTQ + social media users

The Same-Sex Marriage Prohibition Act (SSMPA) is a Nigerian law that prohibits sexual relationships or marriages between persons of the same sex. Its enactment in 2013 is perceived as having exacerbated online homophobia against lesbian, gays, bisexual, transgender, and queer (LGBTQ+) communities on social media networks in Nigeria. This study investigates SSMPA’s contribution to homophobic online violence. Using online interviews with eight LGBTQ + participants and three members of a Nigerian nonprofit organization leadership for sexual minorities, I examine the perceptions, experiences, and communicative strategies of LGBTQ + persons toward online homophobia. Mark Orbe’s co-cultural theory on institutionalized “othering” of minorities across dominant heteronormative societies is used to foreground the lived experiences of Nigerian LGBTQ + persons online. Findings suggest, that although social media networks seemingly provide safe spaces for many vulnerable users, online homophobia has intensified for sexual minorities in Nigeria following the SSMPA legislation.

Proximity is not access: A capabilities approach to understanding non-motorized transport vulnerability in African cities

A paradigm shift regarding the fundamental premise of transport planning is underway. The objectives of shifting to accessibility-based planning includes changing the focus of transport planning practices from speed to access, from the system to the user, and from efficiency to equity. However, despite equity as a stated aim, many approaches to access planning fail to question an inequitable, often subconscious, belief at the core of transport planning: that proximity is access. But, for many groups of people in our society, proximity to public transport does not mean affordability, proximity to services does not mean disability-friendly, proximity to destinations does not mean personal safety; proximity is not the same as access. To explore this disjuncture between proximity and access for those vulnerable people groups, and what it means for transport planning, this study utilizes a less conventional conceptualization of access, one in terms of the capabilities approach. This framework, along with a series of semi-structured interviews, is used to better understand the nature and consequences of access deprivation on vulnerable young non-motorized transport users in three African cities, and its implications for transport planning practice. The research finds that, despite the theoretical access that the participants have, to amenities, services, employment opportunities and transport infrastructure, through proximity, their actual set of viable access options is constrained much further by factors outside of the remit of transport planning. The positivist nature of transport planning, and the reliance on quantitative data collection methods, hides the true cost burden of access deprivation for the most vulnerable transport users. The unseen cost burden being the trips that are not taken, the trips that cannot be taken despite the proximity of the destination, and the effect of those unrealized trips on a vulnerable person's freedom to access the opportunities that will improve their livelihood. Desire, intention, need, vulnerability, and capability are all vitally important characteristics of access that are largely invisible in current quantitative datasets, especially for those whose access is most fragile, vulnerable non-motorized transport users. A “just transition” from mobility-based to access-based transport planning needs to incorporate a combination of mixed-method transport practices.