How does the UK public think and feel about people with visual impairment: a review of existing evidence.

Despite legislation to protect people with visual impairment (V.I.) from discrimination in the United Kingdom (UK), the latter continue to experience overt and covert negative behaviours. Perceived discrimination has been associated with an adverse impact on identity, health and well-being, while negative attitudes have been identified as the biggest barrier to participation in everyday life. This article provides a narrative review of existing evidence of how the UK public treats (behaviours), thinks (perceptions) and feels (attitudes) about people with V.I. Despite limitations, the findings suggest that there is a gap between the behaviours reported by people with V.I. and the attitudes expressed by members of the UK public. Social psychological theories are used to explore possible reasons for this gap, and ways in which it may be addressed. As such, the article provides an example of how social psychological theories can be used to address problems in an applied context.

Social functioning in adults with visual impairment from minority ethnic communities in the United Kingdom.

Background: Visual impairment (V.I.) has been associated with a negative impact on social functioning, while social support can impact on well-being in those with V.I. Adults from minority ethnic communities (MEC) are projected to make up an increasing proportion of adults living with V.I. in the UK, but limited research has explored their social functioning. This article provides a preliminary insight into social functioning among MEC adults living with V.I. in the UK. Methods: The article reports findings from a secondary analysis of V.I. Lives survey data. V.I. Lives was a UK telephone survey, which explored the life experiences of people with V.I. across a wide range of topics including social functioning. This secondary analysis explored social participation, support, isolation, and relationships among a matched control sample of 77 MEC and 77 adults aged 18 and over from White communities (WC). Participants were matched on age, gender, UK region and urban/rural setting. Subgroup analyses were also conducted for the two largest subgroups within the MEC group, Asian (n = 46) and Black participants (n = 22). Results: Contact with like-minded people (U = 2174.50, p = 0.003, r = -0.24) and opportunities to take part in more social activities (U = 2253.50, p = 0.007, r = -0.22) was significantly more important to MEC than WC participants. Moreover, MEC participants were significantly less likely to feel supported by friends/family (U = 3522.50, p = 0.017, r = 0.19) and had fewer people they could ask for help (U = 3775.50, p = 0.001, r = 0.26), but there were no significant differences in the perceived impact of V.I. on their friendships/social life and marriage/relationship, their ability to take part in a range of activities, nor their marital status. Asian participants were significantly more likely than Black participants to feel cut off from the people and places around them (U = 655.50, p = 0.042, r = 0.25). Effect sizes were overall small. Although there were no further statistically significant differences between the two groups, Asian participants were also less likely to be able to take part in activities, and more likely to report a negative impact on their social life/friendships and on their marriage/relationship, as well as a smaller social network. Conclusion: The findings suggest that V.I. may have had a greater impact on social functioning among Asian participants in this sample, including on experiences of social isolation and participation in social activities. Future research will need to confirm these findings and explore the possible reasons.

Exploring mental well-being, the emotional impact of visual impairment and experiences of prejudice and discrimination among adults from minority ethnic communities in the UK.

Background: Visual impairment (V.I.) has been associated with a negative impact on mental health outcomes, including a process of grief among those who lose their sight. Older adults with V.I. who had experienced discrimination have been found to be at increased risk of depression, loneliness, poorer life satisfaction and poorer quality of life. Adults from minority ethnic communities (MEC) may be at increased risk of V.I. and yet, research on the experiences of MEC adults with V.I. remains limited. This article forms part of a series which explores issues and status among MEC adults living with V.I. in the UK. Methods: A secondary analysis of V.I. Lives survey data was performed to explore mental well-being assessed by the short Warwick-Edinburgh Mental Well-being scale (SWEMWBS), the emotional impact of V.I., and prejudice and discrimination among a matched control sample of 77 MEC and 77 adults from white communities (WC). Participants were matched by age, gender, UK region and urban/rural setting. Subgroup analyses were also conducted for the two largest MEC subgroups, Asian (n = 46) and black participants (n = 22). Results: There were few statistically significant differences between the groups. MEC participants were significantly more likely than WC participants to rate emotional support to come to terms with their V.I. as important and to feel optimistic about their V.I. but they were significantly less likely to agree that they were receiving the level of emotional support they needed to get on with their life. Within the MEC group, participants from Asian communities had significantly poorer mental well-being, and they were also significantly more likely to agree that the general public were often prejudiced against people with V.I. and less likely to feel optimistic about their V.I. than black participants. Conclusion: Although there were few statistically significant differences, participants from Asian communities were more likely to report poor mental and emotional well-being, and experiences of discrimination, than black and white participants. In contrast, participants from black communities fared the same as, or in some cases better than, white participants. Future research will need to confirm these findings and explore reasons for these.

A cross-sectional study of sleep, mood, well-being, motivations, and perceived support in Ukrainian veterans and active-duty military personnel with disability, and their supporters, preparing for a sporting event.

Purpose: The benefits of sports and exercise to the lives and rehabilitative journeys of military veterans with disabilities is increasingly well-documented but veteran sporting events remain underexplored. Addressing this topic, the current article seeks to provide insight into the health and well-being of Team Ukraine during a 5-week preparatory camp in the UK before attendance at the 2022 Warrior Games. Materials and methods: Two surveys were run, one toward the beginning and one toward the end of the camp. Eighteen of the 55 veterans and serving personnel (with disability), support staff, and family members in attendance responded to both surveys. Data on sleep, mood, and competition-related emotions, motivations for participation and perceived support were gathered. Data were analysed descriptively, and sleep, mood, and competition-related emotion responses were categorised to explore improvements, maintenance, or worsening in these areas. Results and conclusion: Sleep, mood, and competition-related emotions were relatively stable, although sleep duration was low, and there were some increases in daytime dysfunction, anxiety, nervousness, and feeling tense. Family was the most important source of support and representation of one's country and raising awareness of Ukraine's circumstances were the most important motivational factors. Findings offer insight into not only the health and well-being experiences associated with participation in this disabled veteran sporting event, but also the important role played by this event in meeting collective goals relating to this unique time in Ukraine's history.

A rapid review of evidence relating to service use, experiences, and support needs of adults from minority ethnic communities along the eyecare pathway in the United Kingdom.

Background: There is growing awareness of the health inequalities experienced by minority ethnic communities, who make up an increasing proportion of the United Kingdom (UK) population and have been found to be at increased risk of visual impairment (V.I.). V.I. impacts on a wide range of life domains including employment, social functioning and activities of daily living. Considering existing health inequalities, the increased risk of V.I. and its wide-ranging impact, it is important to understand the experiences of adults from minority ethnic communities living with V.I. in the UK. Methods: A rapid evidence review of academic and gray literature published since 2005 and in English was performed. A search of AMED, CINAHL Plus and MEDLINE via EBSCOhost identified 969 articles. Articles were included in the review if they reported findings relating to the UK-context, to adults from minority ethnic communities living with V.I., and to experiences of V.I. and the eyecare pathway. Results: A total of 11 academic articles and 4 charity reports presented findings relating to perceptions of V.I. and eye disease (n = 3), access to services and service use (n = 5), impact of interventions (n = 7), the wider impact of V.I. (n = 2), and registration status (n = 1). Much of the literature focused on primary eyecare resulting in a comprehensive list of barriers and recommendations to increase eye tests. Less research addressed experiences and use of services further along the eyecare pathway although use of services may be low. Overall, the research on the experiences of adults with V.I. from minority ethnic communities in the UK remains anecdotal, outdated or unavailable. There are substantial gaps in the evidence relating to the wider impact of V.I., the impact of perceptions of V.I., and the use of services beyond primary eyecare. Conclusions: This review summarizes our current knowledge of the experiences of adults from minority ethnic communities living with V.I. in the UK and highlights substantial gaps in the evidence. The findings provide practical implications for practitioners and researchers committed to addressing health inequalities in the field of eyecare in the UK.

Access to eye care and support services among adults from minority ethnic communities living with visual impairment in the United Kingdom.

Background: Despite an increased risk of certain eye conditions which can lead to visual impairment (V.I.), there is evidence of a greater delay to treatment-seeking among adults from minority ethnic communities (MEC). MEC adults may also be underrepresented on V.I. registers, within early intervention services, and among the beneficiaries of national V.I. charities. However, much of this evidence is outdated or anecdotal. Methods: This secondary analysis of V.I. Lives survey data explored use of eye health and support services and mobility aids among a matched control sample of 77 MEC and 77 adults aged 18 and over from white communities (WC). Participants were matched on age, gender, UK region and urban/rural setting. Additional subgroup analysis was conducted for Asian (n = 46) and black participants (n = 22). Results: There were no significant group differences in areas such as eye health service use, registration status, contact with charities, and level of practical support received. But MEC participants were significantly more likely than WC participants to have received direct payments from social services to cover their care needs, Χ2 (1, 154) = 8.27, p = 0.004, and to use apps on their mobile for mobility, Χ2 (1, 154) = 5.75, p = 0.017. In contrast, WC participants were significantly more likely to agree that they were getting the level of emotional support to get on with their life, U = 3,638, p = 0.010, to feel confident to ask their friends for support, U = 2,416, p = 0.040, and to have a guide dog for mobility, Χ2 (1, 154) = 3.62, p = 0.057, although the latter did not reach statistical significance. Within the MEC group, Asian participants were significantly more likely than black participants to use a long cane, Χ2 (1, 68) = 7.24, p = 0.007, but they were significantly less likely to agree that they had received the right level of support when they started to experience V.I., U = 236.5, p = 0.040. Conclusion: The preliminary findings suggests that there is scope to increase support provided by V.I. charities and the V.I. register, although, contrary to existing evidence, there were no statistically significant differences in eye health service use, registration status and use of wider support services. Further research is required to confirm these findings and explore reasons for differences.

Conceptualizations of well-being in adults with visual impairment: A scoping review.

Background: Despite its ubiquity, it is often not clear what organizations and services mean by well-being. Visual impairment (VI) has been associated with poorer well-being and well-being has become a key outcome for support and services for adults living with VI. A shared understanding of what well-being means is therefore essential to enable assessment of well-being and cross-service provision of well-being support. Objectives: To provide an overview of the ways in which well-being has been conceptualized in research relating to adults living with VI. Eligibility criteria: Articles were included in the review if the article discussed well-being in the context of adults living with VI, was available in English and as a full text. Data sources: A systematic search using search terms relating to VI and well-being was conducted in EBSCOHost (Medline, CINHL) and Ovid (Embase Classic, Embase, Emcare 1995, Health + Psychosocial, HMIC Health Management Info, APA, PsycArticles, PsycInfo, PsycTests). Charting: A team of three reviewers screened titles, abstracts and full-texts articles and extracted data. Ambiguous articles were referred to the research group and discussed. Results: Of 10,662 articles identified in the search, 249 were included in the review. These referred to 38 types of well-being. The most common types were general well-being (n = 101; 40.6%) emotional well-being (n = 86, 34.5%) and psychological well-being (n = 66, 26.5%). Most articles (n = 150; 60.2%) referred to one type only, with a maximum of 9 listed in one article. A large number of articles did not clearly define well-being. A wide range of indicators of well-being related to the domains of hedonia, mood, positive and negative affect, quality of life, mental health, eudaimonia, self/identity, health, psychological reactions to disability and health problems, functioning, social functioning and environment, were extracted, many of which were used just once. Conclusions: There remains a lack of consensus on how well-being is conceptualized and assessed in the context of adult VI. A standardized multi-domain approach derived with input from adults with VI and practitioners working with them is required to enable comparison of findings and cross-organizational provision of support.

Scoping review of remote rehabilitation (telerehabilitation) services to support people with vision impairment.

OBJECTIVE: Telerehabilitation for individuals with vision impairment aims to maintain maximum physical and/or psychological functioning through remote service delivery. This review aims to describe the type of telerehabilitation services available to people with vision impairment and summarise evidence on health-related outcomes, well-being and cost-effectiveness. DESIGN: Scoping review. DATA SOURCES: CINAHL Plus, MEDLINE, PsycARTICLES, PsychINFO, Embase, PubMed, HMIC and Ovid Emcare were searched, without date restrictions up to 24 May 2021. Charity and government websites, conference proceedings and clinical trial databases were also examined. ELIGIBILITY CRITERIA: Eligible studies evaluated benefits of telerehabilitation services for adults with vision impairment. Studies were excluded if they were not available in English, or focused on distance learning of visually impaired students. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers screened articles and extracted data. A risk of bias analysis was performed. OUTCOME MEASURES: Measures of benefit included performance-based assessment, patient-reported outcomes and cost-effectiveness. RESULTS: Of 4472 articles, 10 eligible studies were included. Outcomes addressed patient satisfaction (n=4;33.3%), quality-of-life, activities of daily living and well-being (n=4;33.3%), objective visual function (n=2;16.6%) and knowledge relating to ocular symptoms (n=1;8.3%). Two studies addressed multiple outcomes. Cost-effectiveness was addressed in one article (8.3%). Patients were generally satisfied with their experiences, which had a range of positive benefits on functional and quality-of-life outcomes in areas relating to daily activities (eg, reading, making phone calls). Telerehabilitation allowed patients to undertake vision optimisation training to prevent vision deterioration. Grey literature indicated that there are no completed clinical trials relating to low vision telerehabilitation. Charity services had implemented digital skills training to help beneficiaries communicate remotely. CONCLUSION: While acceptability of telerehabilitation was mostly high, limited real-world data are available which raises questions around the long-term desirability of this approach. Further trials are needed to evaluate telerehabilitation using a robust set of outcome measures. PROSPERO REGISTRATION NUMBER: CRD42021254825.

Snapshot of health-related behaviours in adults living with disabilities 1 year into the COVID-19 pandemic: a cross-sectional survey study.

OBJECTIVES: This survey aimed to assess the status of a range of health-related behaviours 1 year after the coronavirus outbreak was declared a pandemic in adults living with disabilities comparative with those with no disabilities. DESIGN: This cross-sectional study reports findings from an online survey conducted in March 2021. Mann-Whitney U and Χ2 tests were used to compare a range of health behaviours including time spent self-isolating, smoking, alcohol consumption, exercise frequency and diet in adults with and without disabilities. SETTING: A convenience sample of UK adults was recruited through the researchers' personal and professional networks including UK-based sight loss sector charities, social media platforms and professional forums. PARTICIPANTS: A total of 123 UK participants completed the survey. OUTCOME MEASURES: COVID-19 diagnosis, time spent self-isolating, alcohol consumption frequency, exercise frequency, change in smoking habit and eating habits. RESULTS: No significant differences were found in alcohol consumption, smoking, water intake, breakfast, or fruit and vegetable intake. There were statistically significant differences in the time spent self-isolating (U=2061, p=0.001), exercise frequency (U=1171.5, p=0.005) and the amount of food eaten (χ2 (2)=9.60, p=0.008, Cramer's V=0.281). Although the majority in both groups reported exercising three to four times per week and eating what they should, those with disabilities were more likely to eat less than they should, not exercise at all and to have been self-isolating for over 6 months than participants with no disabilities. CONCLUSIONS: The data in this study present some key differences between the two groups, with those living with disabilities being more likely to report that they had been self-isolating for prolonged periods of time, not exercising at all, and not eating as much as they should . This raises concerns for the health and well-being of individuals with disabilities.

The Long-Term Impact of the COVID-19 Pandemic on Loneliness in People Living With Disability and Visual Impairment.

Background: There has been growing concern about the impact of restrictions put in place to contain the coronavirus pandemic on loneliness, particularly in individuals with disabilities. This study explored the longitudinal impact of the pandemic on loneliness in these individuals, with a focus on those living with visual impairment (VI). Methods: An online survey was conducted in April-2020 and repeated in March 2021 to explore current life circumstances, health-related behaviours, sleep (Pittsburgh Sleep Quality Index) and social well-being, including state anxiety (State-Trait Anxiety Index) and loneliness (UCLA Loneliness scale). A convenience sample of 602 participants completed the first survey. Participants who agreed to be re-contacted were invited to take part in the follow-up survey. Results: Data is presented for the 160 participants who completed both timepoints. At both timepoints, median loneliness was significantly higher in participants with disabilities and those with VI than in participants with no disabilities. While there was no significant change in loneliness in any of the three subgroups, participants with VI experienced the largest increase in median loneliness. Loneliness was associated with having a mental health condition and higher levels of state anxiety at both timepoints. Conclusions: Individuals with disabilities such as VI experienced consistently higher levels of loneliness than those with no disabilities throughout the pandemic. While loneliness remained relatively stable in individuals with no disabilities, it increased, albeit to a non-significant level, in those with disabilities and particularly those with VI. Interventions designed to alleviate loneliness may benefit from addressing state anxiety.

The Impact of COVID-19 on Sleep Quality in People Living With Disabilities.

Background: Research exploring the impact of the COVID-19 pandemic on sleep in people with disabilities has been scarce. This study provides a preliminary assessment of sleep in people with disabilities, across two timepoints during the pandemic, with a focus on those with visual impairment (VI). Methods: Two online surveys were conducted between April 2020 and March 2021 to explore sleep quality using the Pittsburgh Sleep Quality Index (PSQI). A convenience sample of 602 participants completed the first survey and 160 completed the follow-up survey. Results: Across both timepoints, participants with disabilities reported significantly poorer global sleep quality and higher levels of sleep disturbance, use of sleep medication and daytime dysfunction than those with no disabilities. Participants with VI reported significantly higher levels of sleep disturbance and use of sleep medication at both timepoints, poorer global sleep quality, sleep duration and latency at time 1, and daytime dysfunction at time 2, than those with no disabilities. Global sleep quality, sleep duration, sleep efficiency, and self-rated sleep quality deteriorated significantly in participants with no disabilities, but daytime dysfunction increased in all three groups. Disability and state anxiety were significant predictors of sleep quality across both surveys. Conclusion: While sleep was consistently poorer in people with disabilities such as VI, it appears that the COVID-19 pandemic has had a greater impact on sleep in people with no disabilities. State anxiety and, to a lesser extent, disability, were significant predictors of sleep across both surveys, suggesting the need to address anxiety in interventions targeted toward improving sleep.