Search Results (386)

CareCoach seeks to enhance self-efficacy in family caregivers of people living with dementia and has been feasibility tested in a multicentre randomised controlled trial. The intervention offers two face-to-face sessions with a trained coach and access to an online platform with nine modules. This paper reports findings from an embedded qualitative process evaluation assessing implementation from the implementer’s (‘coach’s’) (n = 8) perspective using individual interviews and implementer group discussions. Qualitative data were transcribed verbatim, inductively coded and analysed using Normalisation Process Theory. Implementers demonstrated (1) ‘Coherence’ by seeking to understand how CareCoach compared to current practice, highlighting the importance of supporting coaches to differentiate and identify boundaries between their new ‘coach role’ and usual practice; (2) ‘Cognitive Participation’ by reviewing training and resources to understand their role own responsibilities and facilitate delivery of coaching sessions; group supervision and peer support were also emphasised; (3) ‘Collective Action’ through interactions with carers to deliver key behavioural aspects such as goal setting, problem solving, and providing feedback; and (4) ‘Reflexive Monitoring’ by appraising the intervention to gain useful insights that could facilitate refinement of CareCoach training and delivery. This study provides a theoretically informed understanding of the implementation of CareCoach for caregivers of people living with dementia and provides recommendations to enhance training for coaches, intervention delivery and carer engagement. Full article

Background: Social and financial services are essential for the inclusion and well-being of people with disabilities (PWDs), who often rely on family caregivers to access these systems. In Saudi Arabia, where disability inclusion is a strategic goal under Vision 2030, understanding caregiver experiences is crucial to identifying service gaps and improving accessibility. Objectives: This study aimed to explore caregivers’ perspectives on awareness, perceived barriers, and accessibility of social and financial services for PWDs in Saudi Arabia. The analysis is grounded in Andersen’s Behavioural Model of Health Service Use and the WHO’s International Classification of Functioning, Disability and Health (ICF) framework. Methods: A cross-sectional survey was conducted with 3353 caregivers of PWDs attending specialised day schools. The survey collected data on demographic characteristics, service awareness, utilisation, and perceived obstacles. Exploratory Factor Analysis (EFA) identified latent constructs, and Structural Equation Modelling (SEM) was used to test relationships between awareness, barriers, and accessibility. Results: Findings reveal that over 70% of caregivers lacked awareness of available services, and only about 3% had accessed them. Key challenges included technological barriers, complex procedures, and non-functional or unclear service provider platforms. Both User Barriers and Service Barriers were negatively associated with Awareness and Accessibility. Awareness, in turn, significantly predicted perceived Accessibility. Caregiver demographics, such as age, education, gender, and geographic location, also influenced awareness and service use. Conclusions: There is a pressing need for targeted awareness campaigns, accessible digital service platforms, and simplified service processes tailored to diverse caregiver profiles. Inclusive communication, decentralised outreach, and policy reforms are necessary to enhance service access and promote the societal inclusion of PWDs in alignment with Saudi Arabia’s Vision 2030. Full article

Wheelchair-mounted assistive robotic manipulators can provide reach and grasp functions for power wheelchair users. This in-lab study evaluated a vision-guided shared control (VGS) system with twelve users completing two multi-step kitchen tasks: a drinking task and a popcorn making task. Using a mixed methods approach participants compared VGS and manual joystick control, providing performance metrics, qualitative insights, and lessons learned. Data collection included demographic questionnaires, the System Usability Scale (SUS), NASA Task Load Index (NASA-TLX), and exit interviews. No significant SUS differences were found between control modes, but NASA-TLX scores revealed VGS control significantly reduced workload during the drinking task and the popcorn task. VGS control reduced operation time and improved task success but was not universally preferred. Six participants preferred VGS, five preferred manual, and one had no preference. In addition, participants expressed interest in robotic arms for daily tasks and described two main operation challenges: distinguishing wrist orientation from rotation modes and managing depth perception. They also shared perspectives on how a personal robotic arm could complement caregiver support in their home. Full article

In the last two decades, metabolic and bariatric surgery (MBS) has become the mainstay of treatment for severe and complex obesity. The majority of patients undergoing MBS are women of childbearing age. Coupled with the dramatic increase in the utilization of MBS, caregivers are likely to encounter patients who have undergone MBS in routine practice. From this perspective, we highlight the different reproductive health challenges and issues encountered throughout the pre-operative, peri-operative, and postoperative phases. Full article

Background/Objectives: The study aims to identify key cognitive and non-cognitive variables (e.g., clinical, neuroimaging, and genetic data) predicting cognitive decline in Parkinson’s disease (PD) patients using machine learning applied to a sample (N = 618) from the Parkinson’s Progression Markers Initiative database. Traditional research has mainly employed explanatory approaches to explore variable relationships, rather than maximizing predictive accuracy for future cognitive decline. In the present study, we implemented a predictive framework that integrates a broad range of baseline cognitive, clinical, genetic, and imaging data to accurately forecast changes in cognitive functioning in PD patients. Methods: An artificial neural network was trained on baseline data to predict general cognitive status three years later. Model performance was evaluated using 5-fold stratified cross-validation. We investigated model interpretability using explainable artificial intelligence techniques, including Shapley Additive Explanations (SHAP) values, Group-Wise Feature Masking, and Brute-Force Combinatorial Masking, to identify the most influential predictors of cognitive decline. Results: The model achieved a recall of 0.91 for identifying patients who developed cognitive decline, with an overall classification accuracy of 0.79. All applied explainability techniques consistently highlighted baseline MoCA scores, memory performance, the motor examination score (MDS-UPDRS Part III), and anxiety as the most predictive features. Conclusions: From a clinical perspective, the findings can support the early detection of PD patients who are more prone to developing cognitive decline, thereby helping to prevent cognitive impairments by designing specific treatments. This can improve the quality of life for patients and caregivers, supporting patient autonomy. Full article

The “Baby Ubuntu” programme is a well-established, low-cost, community-based intervention to support caregivers of children with complex neurodisability, like cerebral palsy, in low- and middle-income country (LMIC) contexts. This process-focused paper describes our utilisation of the ADAPT guidance to adapt “Baby Ubuntu” for use in ethnically and linguistically diverse, and economically deprived urban boroughs in the United Kingdom (UK). The process was guided by an adaptation team, including parents with lived experience, who explored the rationale for the intervention from local perspectives and its fit for this UK community. Through qualitative interviews and co-creation strategies, the perspectives of caregivers and healthcare professionals substantially contributed to the “Encompass” programme theory, drafting the content, and planning the delivery. Ten modules were co-produced with various topics, based on the “Baby Ubuntu” modules, to be co-facilitated by a parent with lived experience and a healthcare professional. The programme is participatory, allowing caregivers to share information, problem solve, and form supportive peer networks. The “Encompass” programme is an example of a “decolonised healthcare innovation”, as it aims to transfer knowledge and solutions developed in low- and middle-income countries to a high-income context like the UK. Piloting of the new programme is underway. Full article

Background/Objectives: Sexual health research involving young adolescents remains scarce despite rising rates of early sexual debut, pregnancies, and sexually transmitted infections (STIs) in this population. We explored community stakeholders’ perspectives on engaging young adolescents in sexual health research in Western New York to inform strategies for engaging young adolescents in sexual health research. Methods: This qualitative descriptive study was conducted from April 2022 to June 2023. Seventeen community stakeholders, including health education teachers, youth counselors, and adolescent health providers, participated in semi-structured in-depth interviews. Data were analyzed using conventional content analysis, managed by MAXQDA 2020. The rigor and trustworthiness of the data were ensured through triangulation with observations, peer debriefing, team analysis, and respondent validation. Results: Participants were predominantly female (94.1%), 52.9% Black/African American, 41.2% White, and 5.9% Caucasian–Indian American, and aged 23–59 years. Four themes emerged: perspectives on conducting sexual health research with young adolescents, recruitment strategies, sexual health questions appropriate for young adolescents, and building readiness for participation in sexual health research. Participants reported the need for sexual health research with young adolescents and recommended building a trusting relationship and involving schools, parents, and trusted community organizations in the research process. Suggested research questions included those related to awareness of sex, STIs, available resources, experiences with sexual education, and desired support. The findings also revealed the need to initiate sexual health conversations early when children start asking questions, as a foundation for meaningful participation in sexual health research. Conclusions: The findings suggest that sexual health research with young adolescents is feasible and necessary, with implications for the design of developmentally appropriate sexual health research and interventions grounded in trust and community collaboration. Future research should explore the perspectives of caregivers and young adolescents to inform studies and programs that are attuned to young adolescents’ developmental needs. Full article

Background: Children with food allergies can present with paediatric feeding disorder (PFD). However, access to coordinated multidisciplinary services to support these children in Australia is inconsistent. To date, the availability of services or the perceived care needs of Australian health professionals working with this population have not been formally explored. Methods: A web-based survey was distributed to health professionals in Australia. Quantitative demographic data were summarised using descriptive statistics, and open-ended responses were analysed using content analysis. Results: The final sample comprised 98 responses, with speech pathologists representing the largest professional group (n = 39; 40%). A majority (59%) worked in hospital-based services. Open-ended responses were coded utilising content analysis. Three categories were developed including (1) service delivery, (2) intervention, and (3) resources. Services were commonly impacted by long wait times, limited staff training, and inconsistencies between hospital and community care. Additionally, mental health support was frequently reported as insufficient. Conclusions: The findings from this study underscore the need for integrated services for children with food allergies and paediatric feeding disorder. Recommended areas for future research include exploring caregiver perspectives and the impact of food allergies and paediatric feeding disorder, and consideration of co-designed studies to inform service improvement initiatives. Full article

Background: Indigenous peoples in Canada endure lasting effects of colonialism including racism, marginalization, and social, political, and geographic inequities resulting in disproportionate rates of disease and inequitable healthcare. Indigenous infants and children in Canada experience a high incidence of birth complications and illnesses, and families are often left to navigate the care of their child with limited resources. Accordingly, improved, culturally responsive and safe healthcare is needed to enhance child outcomes and optimize family well-being. Purpose and Methods: A qualitative study was conducted by our research team including family members of Indigenous children with serious illnesses, a Cultural Advisor, researchers, and pediatric clinicians. In one component of the study, we explored pediatric healthcare providers’ (HCPs) experiences of caring for Indigenous families of children with serious illness. A purposive sample of 19 pediatric healthcare providers took part in semi-structured qualitative interviews or one focus group. The data were analyzed thematically to identify common experiences and priorities for improved supportive healthcare. Findings: Five themes were identified representing insights from pediatric HCPs, with a focus on barriers to effective healthcare at the interpersonal, institutional, and system levels for seriously ill Indigenous children and their families. Ideas for enhancing the social and cultural responsiveness and safety of supportive healthcare were identified. Implications and Conclusions: The findings offer valuable insights and strategies for HCPs to support holistic, comprehensive, and culturally safe and responsive healthcare. Full article

Background: Patients with Down syndrome (DS) commonly experience psychological and mental problems. Studying the quality of life (QoL) of children with DS is important because it increases knowledge related to understanding the challenges that this group may face. This study aims to examine the QoL of children with DS from a parental perspective in terms of physical, emotional, social, and school domains, depending on several factors, and identify demographic characteristics of their parents that may affect their QoL. Methods: This online survey study was conducted in Saudi Arabia between November 2024 and March 2025. The inclusion criteria targeted parents of children with confirmed DS diagnoses aged between 8 and 18 years. Results: The findings of this study showed that children with DS aged between 0 and 2 years had significantly lower QoL scores (10.18 ± 3.83) compared to other age groups (p = 0.02). In addition, gender differences were significant in the emotional (p = 0.03), social (p = 0.01), and school (p = 0.01) domains, with females scoring lower QoL scores in all areas compared to males. Moreover, educational level showed significant results across all domains, particularly for children with no education, who had the lowest QoL scores in the physical domain (22.34 ± 7.53, p = 0.004), emotional domain (10.41 ± 3.79, p = 0.003), social domain (11.22 ± 4.06, p = 0.001), and school domain (8.75 ± 5.09, p = 0.001). The findings of this study showed that children with DS who are in primary school (odds ratio (OR) = 5.90, 95% confidence interval (CI): 1.85–18.78, p = 0.003) and middle school (OR = 5.27, 95% CI: 1.44–19.31, p = 0.012) had significantly higher odds of better QoL compared to children with no formal education. Additionally, children cared for by their fathers had significantly lower odds compared to those cared for by their mothers (OR = 0.07, 95% CI: 0.01–0.90, p = 0.041). None of the demographic characteristics of caregivers reached a statistical significance level to have influence on caregivers QoL (p > 0.05). Conclusions: The findings of this study demonstrated a low level of QoL, affecting the emotional, social, and school domains, especially among female children with DS aged between 0 and 2 years with no formal education and cared for by their fathers. Governments should develop a comprehensive plan to care for these children and families in order to enhance their rights and quality of life, thereby placing emphasis on those who exhibit parameters related to a lower QoL. Full article

Background/Objectives: Rates of receiving opioid use disorder (OUD) treatment among adolescents and young adults (AYA) aged 16–25 are low. The current study qualitatively analyzed informants’ perspectives regarding the availability of, developmental considerations relevant to, and barriers associated with OUD treatment for AYA. Methods: Thirty key informants involved with OUD treatment in the northeastern United States completed individual, semi-structured interviews, including treatment providers (N = 11) and clinic leaders in programs that provide medication and psychosocial treatments for AYA with OUD (N = 10), as well as opioid-related policymakers (N = 6) and patient advocates (N = 3). Interviews were transcribed and independently double coded. Template-style thematic analysis methods were used and revealed seven themes. Results: The first theme highlighted limited treatment program availability for adolescents (aged < 18 years) with OUD. Four themes related to developmentally optimizing OUD treatment for AYA, describing the importance of caregiver involvement, AYA peer connections, wraparound services, and early intervention. Two themes described barriers to AYA OUD treatment, including stigma and knowledge gaps about medications for OUD as well as deficits in AYA’s access to basic resources (e.g., housing, food security) that prohibit effective participation in treatment. Conclusions: Results highlight concerns from systems-level key informants regarding gaps in OUD treatment options for youth under the age of 18 and a high need for OUD treatment that is developmentally tailored to AYA. Findings point toward potential modifications and additions to existing adult treatment programs to make OUD treatment more accessible, relevant, and engaging for AYA. Full article

In the context of rapid urbanization, urban streets have become critical spatial environments for children’s daily activities, directly influencing their mobility safety, behavioral development, and the spatial equity of cities. However, conventional assessment methods largely rely on subjective surveys and qualitative analyses, lacking objectivity and scalability. To address these limitations, this study takes urban streets in Shanghai as a case study and integrates deep learning technologies to propose a generalizable methodology for developing a child-friendliness evaluation and enhancement system that incorporates multi-source data and perceptual indicators for urban streets. The system extracts spatial features of streets based on urban street environmental information, and incorporates evaluation inputs from intergenerational user groups, including children and their caregivers. A neural network model is trained to enable automated, multidimensional assessment of child-friendliness and to generate context-sensitive and adaptable strategies. The findings reveal significant perceptual differences between user groups: children place greater emphasis on playfulness and interactivity, while caregivers prioritize safety and comfort. This validates the necessity and effectiveness of adopting an intergenerational collaborative perspective for comprehensive child-friendliness evaluation. By overcoming the limitations of traditional approaches in terms of accuracy and efficiency, this research expands the methodological repertoire of child-friendly urban studies and provides data-driven support for the intelligent design and inclusive governance of urban streets. Full article

Background: Chronic postsurgical pain (CPSP) occurs in approximately one in five children who undergo surgery. Youth with anxiety and depressive symptoms are at greater risk of developing CPSP. Psychological interventions hold promise to prevent CPSP; however, existing psychological interventions are often brief and offered exclusively pre-surgically. Objective: The Perioperative Pain Program (PPP) was designed to address psychological risk factors for CPSP. This study aimed to explore acceptability and satisfaction with the PPP, from the perspective of youth and caregivers. Method: In this mixed-methods study, 24 youth and caregivers completed a satisfaction questionnaire, and six dyads participated in semi-structured interviews. Quantitative data was analyzed using descriptive statistics. Qualitative data was analyzed using inductive content analysis. Results: The qualitative analysis generated four categories: (1) developing support and a sense of preparedness for surgery; (2) connection matters between families and the team; (3) personal characteristics may impact intervention use; (4) the need for adaptable content and delivery. Quantitative data indicated overall satisfaction and acceptability of the intervention. Conclusions: Psychological interventions that facilitate interpersonal connections in a timely manner may be key to facilitating more meaningful engagement and help prevent CPSP in youth. Full article

Background/Objectives: Gastrostomy tube (GT) placement plays a vital role in managing children with chronic illnesses who are unable to meet their nutritional needs orally. While its clinical benefits are well established, limited data exist on caregivers’ satisfaction with GT use in Jordan. This study aimed to assess caregivers’ satisfaction and identify factors that influence their experiences by using a validated satisfaction scoring system in which a score greater than 20 indicates a high level of satisfaction. Methods: A cross-sectional study was conducted at Jordan University Hospital, including children under 18 years of age who underwent endoscopic GT insertion between July 2017 and December 2024. Caregivers completed the Structured Satisfaction Questionnaire with Gastrostomy Feeding (SAGA-8), and demographic and clinical data were collected. Statistical analyses explored associations between satisfaction levels and patient-, caregiver-, and healthcare-related factors. Results: A total of 46 caregivers participated. The median satisfaction score was 26.1, surpassing the high satisfaction threshold of 20. Overall, 63% of caregivers expressed satisfaction or high satisfaction with GT feeding, and 82.6% were satisfied with the support provided by the healthcare team. Additionally, 69.5% and 65.2% of caregivers reported improvements in their child’s nutritional status and overall family well-being, respectively. Notably, 89.1% observed a reduction in feeding time, and 84.8% reported fewer respiratory infections following GT placement. Over half of the caregivers (58.7%) indicated that they would have agreed to earlier GT placement if they had been more aware of its benefits. Conclusions: Caregivers reported high satisfaction with GT use, with scores well above the validated threshold indicating high satisfaction. These findings highlight the positive impact of GT placement on children’s health outcomes and family quality of life. Enhancing caregiver education and providing robust healthcare support are crucial to improving the management of children who require GT feeding. Full article

The rapid growth of China’s aging population has made elderly care a pressing social issue. Due to an imperfect pension system, limited uptake of institutional care, and uneven regional economic development, most elderly people in China still rely on home-based care. Elderly people living at home are usually cared for by their family, partners, caregivers, or themselves. However, this often fails to meet their complex health, safety, and emotional needs. Artificial intelligence may provide promising solutions to improve home care experiences and address the multifaceted health and lifestyle challenges faced by homebound elderly people. This review explores the applications of artificial intelligence in home-based care from four main perspectives: home health care, home safety and security, smart life assistants, and psychological care and emotional support. We systematically searched PubMed, IEEE Xplore, CNKI, and Scopus databases, integrated the latest research published between 2015 and 2024, focused on peer-reviewed, practice-oriented research, and reviewed relevant technology development paths and the current status of the field. Unlike previous studies that focused on physiological monitoring, this study is the first to systematically and comprehensively evaluate the role of artificial intelligence in improving the convenience of daily life and mental health support for elderly people at home. By comprehensively reviewing and analyzing the basic principles and application background of artificial intelligence technology in this field, we summarize the current technical and ethical challenges and propose future research directions. This study aims to help readers gain a deeper understanding of the current status and emerging trends of artificial intelligence-enabled home-based elderly care, thereby providing valuable insights for continued innovation and application in this rapidly developing field. Full article