Primary carers provide much of the day-to-day care for community-dwelling people living with dementia (PWD). Maintaining that contribution will require a more in-depth understanding of the primary carer role and the support needs that flow from that role. This study explored patterns of formal and informal support utilisation by people caring for a PWD in a rural-regional context. In-depth semi-structured interviews were conducted with 18 rural primary carers of a PWD and thematically analysed. Participant primary carers' almost total commitment to, and absorption in their role and their assumption of ultimate responsibility for the PWD's wellbeing meant that external social context, such as rurality, became less relevant. Carer networks effectively contracted to those key individuals who were central to supporting them in their caring task. External sources of support were tightly managed with strong boundaries around the provision of direct care to the PWD largely excluding all but professional providers. Primary carers are generally categorised along with other family and friends as informal care. However, in assuming primary responsible for the care and wellbeing for the PWD they effectively become the key care provider, suggesting that it would be productive in both research and practice to treat primary carers as key members of a care partnership alongside professional carers, rather than as adjuncts to formal care and/or another client.
BackgroundInternet interventions for improving health and well-being have the potential to reach many people and fill gaps in service provision. Serious gaming interfaces provide opportunities to optimize user adherence and impact. Health interventions based in theory and evidence and tailored to psychological constructs have been found to be more effective to promote behavior change. Defining the design elements which engage users and help them to meet their goals can contribute to better informed serious games.ObjectiveTo elucidate design elements important in SPARX, a serious game for adolescents with depression, from a user-centered perspective.MethodsWe proposed a model based on an established theory of health behavior change and practical features of serious game design to organize ideas and rationale. We analyzed data from 5 studies comprising a total of 22 focus groups and 66 semistructured interviews conducted with youth and families in New Zealand and Australia who had viewed or used SPARX. User perceptions of the game were applied to this framework.ResultsA coherent framework was established using the three constructs of self-determination theory (SDT), autonomy, competence, and relatedness, to organize user perceptions and design elements within four areas important in design: computer game, accessibility, working alliance, and learning in immersion. User perceptions mapped well to the framework, which may assist developers in understanding the context of user needs. By mapping these elements against the constructs of SDT, we were able to propose a sound theoretical base for the model.ConclusionsThis study’s method allowed for the articulation of design elements in a serious game from a user-centered perspective within a coherent overarching framework. The framework can be used to deliberately incorporate serious game design elements that support a user’s sense of autonomy, competence, and relatedness, key constructs which have been found to mediate motivation at all stages of the change process. The resulting model introduces promising avenues for future exploration. Involving users in program design remains an imperative if serious games are to be fit for purpose.
Creative activities have been used as a therapeutic tool since the inception of occupational therapy. The role of creative activities has varied over time due to the changing focus of treatment in favour of kinesiological, neurological and psychodynamic approaches (Perrin 2001). Although the literature reflects a resurgence of interest in creative activities and occupation (Harris 2008), few studies address their value in physical rehabilitation today.Rehabilitation is a process 'intended to enable people with disabilities to reach and maintain optimal physical, sensory, intellectual, psychological and /or social function' (World Health Organisation 2009). To locate studies on the use of art in rehabilitation, the Medline, Psychlit and CINAHL databases were searched using the following key terms: art as therapy, physical rehabilitation, chronic illness and creativity. Further terms were searched in relation to themes during the data analysis process, such as self-esteem and time use.Aims: The aims of this study were to understand the experience of participation in visual art from the perspective of adults undergoing outpatient physical rehabilitation and to determine whether art has a place in this context.Method: This qualitative study involved interviewing adults who attended a weekly art class run by a qualified art teacher and occupational therapists in an outpatient physical rehabilitation setting. Nine participants with neurological conditions discussed their experience of the programme and the goals they were working towards or had achieved through painting.Findings: The themes that emerged from the study show that art contributed to the participants meeting their individual rehabilitation goals. It also assisted the participants in using time, increasing enjoyment, regaining confidence and planning for engagement in future activities. All these achievements were seen by the participants to contribute to their rehabilitation or recovery. The identified themes align with the aims of rehabilitation and are similar to findings from many other studies investigating the use of art by people affected by illness or disability.Conclusion: The findings of this study inform clinical practice in the use of visual art with clients in rehabilitation and validate its place in a physical rehabilitation programme.
Staying socially engaged is known to improve health and longevity in older people. As the population ages, maintaining levels of social engagement among older people becomes increasingly important. Nevertheless, advancing age brings with it many challenges to social engagement, especially in rural areas. A three-year Australian Research Council Linkage Project sought to improve understandings of age-related triggers to social disengagement in six Tasmanian communities that are representative of rural Australian experience, and thus of wider salience. A collaboration between academics and health and social professionals, the project investigated design solutions for service frameworks that may be useful before ageing individuals become isolated and dependent, and that may support those individuals to actively contribute to and benefit from social life. The purpose of this paper is to report on perspectives about diminishing levels of social engagement held by older rural participants and service providers, and to advance a number of key insights on ways in which to nurture social engagement and improve the experience of ageing.
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