Effectiveness of Web Accessibility Policy Implementation in Online Healthcare Information.

UN have recommended the adoption of Web Content Accessibility Guidelines (WCAG) version 2.0 from W3C to guarantee that web content is more accessible to everyone. This study aims to evaluate the effectiveness of WCAG 2.0 implementation by comparing the country with and without WCAG2.0 policy adoption. The objective is to compare the impact of adopting the WCAG 2.0 standard in health information provision by analyzing the differences between countries that adopted the WCAG 2.0 standard and those that did not, specifically for health information related to the elderly. To this end, searches were performed on the Google search engine for online health websites with the keyword "Alzheimer" and the specific country settings for Indonesia and UK, in the local language of each country. Website evaluations were performed for ten websites found with this search by using the WCAG 2.0 measurement tool Axe. Statistical analysis using descriptive and Mann-Whitney analysis to measure the impact of the WCAG 2.0 showed a predominance of low violation occurrences in the UK with 40% from selected websites compared to 80% medium violation occurrences and no low violation occurrences in Indonesia. Although the country with WCAG 2.0 implementation had a lower frequency of violation, no significant differences were found between countries and the media type in WCAG 2.0 evaluation, implying the need to improve the effectiveness of policy implementation.

Effects of 'participatory group-based care management' on wellbeing of older people living alone: a randomized controlled trial.

BACKGROUND AND OBJECTIVES: More knowledge is needed of the effectiveness of complex interventions that aim to promote the wellbeing of older people. This study examines the effects of 'participatory group-based care management' conducted among community-dwelling older adults living alone in Central and Eastern Finland. The intervention aimed to promote wellbeing and quality of life (QoL) using a needs-based and participatory approach. METHODS: The study was carried out as a randomized control trial (intervention group n = 185, control group n = 207). In this article, baseline and 6-month follow-up surveys were used. QoL (WHOQOL-Bref instrument), loneliness (Revised UCLA Loneliness Scale; single-item question), and trust (two items of generalized trust and six items of institutional trust) were used as outcome measurements, and generalized estimating equations (GEE) modeling as the analysis method. Both per-protocol and intention-to-treat analyses were applied. RESULTS: According to the per-protocol analysis, the intervention had no effects on QoL. Loneliness decreased among older people with poor QoL at the baseline. Additionally, the intervention enhanced trust in other people and some dimensions of institutional trust. The intention-to-treat analysis did not result in any significant effects on QoL or loneliness, but some small positive changes in institutional trust were found. CONCLUSIONS: Based on some evidence of small positive effects, the intervention may be beneficial in alleviating loneliness and enhancing trust among older people living alone. Because of the contradictory results, more research is needed to examine the complexity of 'participatory group-based care management´ from the perspective of process evaluation.

"They're always in a hurry" - Older people´s perceptions of access and recognition in health and social care services.

The article examines older people's perceptions of quality of life from the perspective of access and use of health and social care services. The data include focus group discussions with older people living alone. The data were analysed using thematic analysis focusing on the older people's collective views on health and social care services as supportive or restrictive factors for their quality of life. Two central themes were present in all the focus group discussions: the importance of accessing services and information regarding the services, and need for recognition within the services/by the professionals. Both themes were connected to the older people's desire to maintain autonomy in their everyday life despite increasing functional disabilities, which was seen as an important factor of quality of life. The older people felt that accessing and finding information about the services was difficult, and dependent on the professional's good will and the older person's own financial resources. Within the services, older people experienced a lack of recognition of their own personhood and individual needs. The participants felt that they were easily bypassed and left out of negotiations regarding their own care. The article highlights the importance of developing health and social care services and practices towards a more holistic approach recognising older people's individual needs.

Influence of previous work experience and education on Internet use of people in their 60s and 70s.

BACKGROUND: Internet use among the elderly is influenced by various demographic backgrounds, social life and health factors. OBJECTIVE: This study aims to identify the impact of several demographic features on 60- to 79-year-old individuals' intention to use the Internet. METHOD: Finland population data (N = 2508) from the 2012 IKIPOSA project was used with two cohorts: 60s group (n = 1515) and 70s group (n = 990). Descriptive statistic and two binomial logistic regressions have been used with the unadjusted effect and Forward LR method to measure each predictor's contribution to the model. In addition, a preliminary analysis to measure the multicollinearity was performed. RESULT: Of the 18 independent variables, only nine predictors, namely, age, education, financial situation, having children, entrepreneurship, a leadership position, a higher level white-collar worker and a lower level white-collar worker, were significant factors in predicting the Internet use. Meanwhile, gender, having grandchildren, living alone, marital status, house location and type, stay-at-home mother or father, blue-collar worker, agricultural entrepreneur and social relations satisfaction were not significant predictors. The most significant predictors were education and age, which contributed 19% and 10%, respectively, to the model. Other significant predictors, lower level white-collar worker, higher level white-collar worker and financial situation, had less impact with only around 6%. CONCLUSION: Education and age were influential factors among elderly to use the Internet in their later life. Certain work experiences affect elderly people's engagement with the Internet after retirement.

Positive emotions in caring for a spouse: a literature review.

This article aimed at identifying the positive emotions connected to spouse caregiving and the advantages for spouse carers. Theoretically, the article is based on the concept of emotion and the assumptions of positive psychology. Data search is conducted via electronic literature databases and the analysis method is partly theory-driven and partly inductive content classification. Our analyses discover and clarify the concepts associated with positive emotions in caring, such as the gains of caregiving, benefit-finding, finding meaning, personal growth, post-traumatic growth and resilience. We also utilise a conceptual framework to describe positive emotions in caregiving, and the identified advantages of positive emotions in spouse caregiving include distress buffering, mediation in coping with stress, increased quality of life and well-being, and finding a sense of purpose. Finally, spouse care is seen in this article as a challenging life situation which at best can support personal growth, if the processing of both positive and negative emotions is included in daily life. Hence, the service and support system should be developed further by utilising the findings of positive psychology as well as studies of personal growth.

Multiculturalism in social agencies for the aged.

This study uses content analysis and visual representation methods to explore how multiculturalism is displayed on the websites of agencies providing social care for the aged. These agencies use strategically planned texts to portray multicultural categories of inclusion, diversity and individuality; and emphasize the text referents through ethno-related pictures as universal equivalence symbols for ethno-cultural diversity. With the few cases of non-text referents, which are open to cultural and sociological relativities, the study posited that the patterns and modes of portraying multiculturalism are similar. It concluded with the need for further studies to establish whether state policies or agencies' market strategies are behind the liberal multicultural references.

Elderly people's interaction with advanced technology.

Aging of population is an inevitable process by which the number of elderly people is increasing. Rapid development of information and communication technology (ICT) is changing basic needs of elderly people; therefore society should ensure opportunities for elderly to learn and use ICT in a way to manage their daily life activities and in this way enable them participation in the information and knowledge society. The purpose of the study was to find out whether elderly are acquainted with the advanced technology and to what extent they use it or they desire to use it. Within the single point study we interviewed 100 randomly selected elderly people from different geographical regions in Slovenia. Results showed the differences in the use of advanced technology by Slovenian regions; therefore in the future activities should be focused on organizing promotional and demonstrational activities including ICT courses to increase elderly's motivation for ICT interaction.

People with multimorbidity: forgotten outsiders or dynamic self-managers?

PURPOSE: The purpose of this paper is to draw attention to the discursive construction of multimorbidity. The study illustrates how the social reality of multimorbidity and the agency of patients are discursively constructed in scientific articles addressing care for people with multiple chronic conditions. DESIGN/METHODOLOGY/APPROACH: The study is based on the postmodern assumptions about the power of talk and language in the construction of reality. Totally 20, scientific articles were analysed by critically oriented discourse analysis. The interpretations of the findings draw on the agency theories and principals of critical management studies. FINDINGS: Four discourses were identified: medical, technical, collaborative and individual. The individual discourse challenges patients to become self-managers of their health. It may, however, go too far in the pursuit of patients' active agency. The potential restrictions and consequences of a "business-like" orientation must be paid careful attention when dealing with patients with multimorbidity. RESEARCH LIMITATIONS/IMPLICATIONS: The data consisted solely of scientific texts and findings therefore serve as limited illustrations of the discursive construction of multimorbidity. In future, research focusing for example on political documents and practice talk of professionals and patients is needed. Social implications - The findings highlight the power of talk and importance of ethical considerations in the development of care for challenging patient groups. ORIGINALITY/VALUE: By identifying the prevailing discourses the study attempts to cast doubt on the taken-for-granted understandings about the agency of patients with multimorbidity.

The match between institutional elderly care management research and management challenges - a systematic literature review.

BACKGROUND: Elderly care practice and its management together with policy and research play a crucial role in responding to increasing challenges in institutional care for elderly people. Successful dialogue between these is necessary. The purpose of this systematic literature review is to compare how institutional elderly care management research meets the care challenges currently emphasized in international long-term care policy documents. METHODS: This paper was based on a systematic literature review. After screening 1971 abstracts using inclusion/exclusion criteria, 58 refereed articles published between 2000 and 2010 remained for analysis. The articles were analyzed using theory-based content analysis by comparing the results to the framework based on analysis of international long-term care management policy documents. RESULTS: The current challenges of long-term care management identified from policy documents were Integrated Care Management, Productivity Management, Quality Management, Workforce Management and ICT Management. The research on institutional elderly care management responded somewhat to the challenges mentioned in policy documents. However, some of the challenges were studied broadly and some were paid only minor attention. Further, only few studies focused on the core items of challenges addressed in policy documents. CONCLUSIONS: Institutional care management research needs to focus more on challenges in integrated care, productivity, ICT and division of labor. Managers, researchers and policy-makers should assume more active collaborative roles in processes of research, policymaking and policy implementation. In addition managers' and policymakers' scientific literacy needs to be enhanced.

Discursive construction of polyphony in healthcare management.

PURPOSE: The aim of the paper is to understand and define how the polyphony of management is constructed in interaction and to describe this through concrete management meeting cases. Polyphony refers to the diverse voices of various organization members, and how these voices are present, disclosed and utilized in management. DESIGN/METHODOLOGY/APPROACH: The study is based on the social constructionist and discursive perspectives of management, which question the traditional, individualistic approaches of management. The issue was examined through a qualitative case study by analysing the micro-level management discourse in three healthcare organizations. FINDINGS: Discursive practices that enhance or inhibit polyphony are often unnoticed and unconscious. Key moments of management discourse are an example of unconscious mundane practices through which members of organizations construct the reality of management. RESEARCH LIMITATIONS/IMPLICATIONS: The empirical results are locally contextual. In the future, research will be able to apply the approach to diverse contexts as well as link micro-level discourses to the construction of broader health and social management discourses. PRACTICAL IMPLICATIONS: The paper increases the understanding of how to enhance participation and staff contribution, and how to utilize the knowledge of all members of the organization. SOCIAL IMPLICATIONS: Both managers and other staff members are fully involved in the social construction of management. Micro-level discourse should be paid attention to in management work as well as in the education of managers and staff. ORIGINALITY/VALUE: The study increases the understanding of micro-level issues of management and challenges the conventional, taken-for-granted assumptions behind organization and management theories.

How is the New Public Management applied in the occupational health care system? - decision-makers' and OH personnel's views in Finland.

BACKGROUND: In many countries occupational health care system is in change. Occupational health studies are mainly focused on occupational health substance and content. This study offers new perspectives on municipal OHS and its operations from management perspective. AIM: The aim of this study is to analyse how New Public Management (NPM) doctrines are applied in the Finnish occupational health care system (OHS). The main focus is to describe and compare the views of decision-makers' and OH workers within the framework of NPM. METHODS: The data were collected by semi-structured interviews from 17 municipal decision-makers' and 26 municipal OH workers. Data was analyzed by examining coded data in a theory-driven way according to Hood's doctrine of NPM. RESULTS: The doctrines were not as compatible with the OH personnel view as with the decision-makers' view. Decision-makers and OH personnel highlighted the strict criteria required for operation evaluation. Moreover, decision-makers strongly accentuated professional management in the public sector and the reorganization of public sector units. These were not equally relevant in OH personnel views. In OH personnel views, other doctrines (more attention to performance and accomplishments, emphasizing and augmentation of the competition and better control of public expense and means test) were not similarly in evidence, only weak evidence was observed when their importance viewed as medium by decision-makers. Neither of the respondents group kept the doctrine of management models of the private sector relevant. CONCLUSIONS: The NPM and Hoods doctrine fitted well with OH research. The doctrine brought out view differences and similarities between decision-makers and OH personnel. For example, policymakers highlighted more strongly the structural change by emphasizing professional management compared to OH personnel. The need for reorganization of municipal OH, regardless of different operational preconditions, was obvious for both decision-makers and OH personnel. The adaptation of more clarify management to a municipal context is not trouble-free. The municipality systemic structure, complex operational environment, and reconciliation of political and officer authority set challenges to management of municipalities.

What happens to quality in integrated homecare? A 15-year follow-up study.

OBJECTIVES: To explore the impact of structural integration on homecare quality. METHODS: A case study in an organisation comprising a before-after comparison with baseline and four follow-up measurements during 1994-2009, using interviews with clients (n=66-84) and postal inquiries to relatives (n=73-78) and staff (n=68-136). RESULTS: Despite the organisational reform involving extensive mergers of health and social care organisations and cuts in staff and service provision, homecare quality remained at almost the same level throughout the 15-year follow-up. According to the clients, it even slightly improved in some homecare areas. CONCLUSIONS: The results show that despite the structural integration and cuts in staff and service provision, the quality of homecare remained at a good level. Assuming that the potential confounders did have inhibiting effects, the results suggest that structural integration had a positive impact on homecare quality. To obtain firmer evidence to support this tentative conclusion, further research with a randomised comparison design is needed.

Organization aesthetics in nursing homes.

AIM: The aim of this study was to make visible the material dimensions of nursing management. BACKGROUND: Management theories have mainly ignored the material dimensions, namely the physical spaces in which management actually takes place as well as the physical bodies of organization members. The perspective of organization aesthetics enhances our understanding of the role of materiality in nursing management. METHODS: The data were collected in 2009 using observation and interviews in eight nursing homes. Qualitative content analysis with critical interpretations was used. RESULTS: Three main issues of organizational aesthetics related to nursing management were identified: (1) the functionality of working spaces and equipment; (2) the relevance of 'organizational' space; and (3) the emotional-aesthetic dimension of daily work. CONCLUSIONS: Materiality is closely related to management topics, such as decision-making, values and identity formation of organizational members. Aesthetic dimensions of care are constructed by management practices which, in their turn, influence the nature of management. Implications for nursing management Nurse managers need to be aware of the unintended and unnoticed consequences of materiality and aesthetics. Space and body issues may have considerable effects, for example, on the identity of care workers and on the attractiveness of the care branch.