To Örebro University

BACKGROUND: Achieving equitable global health frameworks requires the intentional integration of diverse voices-both professional and lived-from across the high-resourced Global North (GN) and low-resourced South (GS). It is, however, rare that Core Set development using the International Classification of Functioning, Disability and Health (ICF) has equal data representation from both regions. Using the data from the development of Core Sets on deafblindness, we explored a unique opportunity, given the geographic distribution of data sources. We compared ICF category frequencies from the GN and GS across body structure, body function, activities and participation, and environmental factors. METHODS: We divided the data from an expert survey (n = 105) and from interviews with deafblind individuals (n = 72) by country of origin into GN and GS using the Brandt Line, representing all six regions of the WHO (28 countries). Using the ICF coding system to identify perceived categories of functioning, aggregated frequencies of unique ICF categories were compared across ICF components and chapters using chi-square statistics. RESULTS: Survey data showed no significant geographic differences across activities and participation or environmental factors; however, qualitative interviews revealed significant deviations. For activities and participation, GN emphasized d9205 (socializing) and d940 (human rights), while GS highlighted d760 (family relationships). For environmental factors, GN focused on e5800 (health services) and e298 (environmental adaptations), whereas GS emphasized e5550 (associations), e310 (family), and e325 (community supports). Within the GN, survey and interview data also differed. Surveys emphasized e310, e315 and e320 (supports), while interviews highlighted e410, e425, e450, and e455 (attitudes). For activities and participation, d660 (assisting others) was more frequent in interviews. The GS showed significant within-region differences for e4 (attitudes), d9 (community, social and civic life) and d2 (general tasks and demands). CONCLUSIONS: Findings highlight the regional variations in activities and participation among individuals with deafblindness as they reflect differences in environmental factors. Rooted in cultural and resource differences, geographic region itself constitutes a key environmental factor. Expert perspectives may underrepresent differences in lived environmental realities of individuals with deafblindness. Future Core Set development will benefit from including more diverse sources.

BACKGROUND: Increasing global migration creates new challenges for multicultural societies in providing equitable care. Culturally and linguistically diverse (CALD) people who move into care homes find themselves in an environment where health professionals do not speak their language and the access to cultural activities is limited. This may increase loneliness and social isolation. When designing care home environments for CALD residents with dementia, culture is a key consideration. The aim of this integrative review is to highlight what elements of the care home environment are reported to meet culture-specific needs of CALD residents with dementia, and how.

METHODS: A search strategy which included terms for care homes, forms of dementia and CALD people was developed, and a systematic search was carried out in six databases. Eligible articles were original peer-reviewed studies published between 2013 and 2024 and contained examples of how care home environments have been used to meet culture-specific needs of CALD residents. All screenings and extractions were carried out by two independent researchers.

RESULTS: The search resulted in 4311 records. After the screening process, 27 articles met the eligibility criteria. The review findings are categorized according to components of the WHO's International classification of functioning, disability and health (ICF). Results linked to the ICF component Activities and participation stress the importance of communication in the resident's preferred language, social and supportive relationships and culturally relevant activities, while the component Environmental factors highlights the significance of ethnic food and support from culturally competent care professionals and family members.

CONCLUSIONS: This integrative review underlines the complexity of using environments to meet culture-specific needs of CALD residents with dementia. The findings highlight the importance of bilingual staff, culturally relevant activities and inclusive environments in enhancing communication, building interpersonal relationships and reducing frustration among CALD residents. Collaborations between culturally competent staff, family members and members of cultural communities also facilitate meeting social and cultural needs of these residents. This review offers suggestions on how environments in care homes can be adapted for CALD residents and encourages further research to find practical solutions for equitable care. REGISTRATION: A study protocol is registered on Prospero (CRD42023492906).

Background People with hearing loss (HL) report several challenging situations in working life (WL). HL can negatively affect, e.g., the ability to communicate, creating barriers and difficulties in WL. However, there is a lack of studies that investigates salutary aspects in relation to working conditions for the target group. Sense of Coherence (SOC) is a salutary concept widely used when investigating aspects in WL but is less explored in relation to HL.

Objective To explore the concept of Sense of Coherence (SOC) in relation to working conditions for employees with HL.

Methods An observational study with a cross-sectional design including people with HL in working age using hearing aids (HAs) or cochlear implants (CIs). Comparisons were made between participants "in work" and participants on "HL-related sick leave".

Results The "in work" group reported a higher SOC compared to the "HL-related sick leave" group. The analysis showed significant differences between the two groups in all three dimensions of SOC with the "in work" group being better off in almost all investigated variables.

Conclusion SOC is a valuable concept for investigating working conditions for employees with HL. The results indicate that to increase the possibility of salutary working conditions, it is necessary to focus on consequences of HL, such as the need for recovery, autonomy and support. Addressing these aspects increases employees' comprehension of and ability to manage the work situation and their sense of meaningfulness, which may act as a buffer against work-related stress and reduce the risk of sick leave.

PURPOSE: The aim of the current study was to translate the English original version of the Hearing and Functioning in Everyday Life Questionnaire (HFEQ) to Swedish, evaluate the translation in terms of comprehensibility and relevance from a patient perspective, and culturally adapt the Swedish version (HFEQ-SWE).

METHOD: A six-step methodology including translation into Swedish according to best practice methodology, evaluation, and cultural adaptation of the HFEQ-SWE using qualitative focus group interviews was used in this study. Thirteen adults with hearing loss were recruited from the audiological clinic in Örebro, Sweden. Their mean age was 57 years, and the four-frequency pure-tone average for the best ear ranged from 5 to 115 dB HL.

RESULTS: The results demonstrated that most of the items in the HFEQ-SWE were viewed as relevant by the informants. Not all items were considered relevant for all people, which also reflect the individual variability of everyday functioning. Most items were recognized as comprehensible without any changes needed.

CONCLUSIONS: Overall, the results indicate that the translation is semantically and culturally valid from the patient's perspective. Some revisions were suggested that need to be addressed in the further validation process of the HFEQ, and one item was removed.

Background: Increasing global migration creates new challenges for multicultural societies in providing equitable care. Culturally and linguistically diverse (CALD) people with dementia who move into care homes find themselves in an environment where health professionals do not speak their language and the access to cultural activities is limited. When designing care home environments for CALD dementia residents, culture is a key consideration. This integrative review aims to highlight what elements of care home environments are reported to meet culture-specific needs of CALD residents with dementia.

Methods: The search strategy included search terms for care homes, various forms of dementia and the CALD population. A systematic search was carried out in six databases. Eligible articles were original peer-reviewed studies published in 2013-2024 that contained examples of how care home environments had been used. All screenings and extractions were carried out by two independent researchers.

Results: The database search resulted in 4311 records. After the screening process, 27 articles were found to meet the eligibility criteria. The review findings are categorized according to components of the WHO’s International classification of functioning, disability and health (ICF). Results linked to the ICF component Activities and participation, stress the importance of communication in the resident’s preferred language, social and supportive relationships and culturally relevant activities, while the component Environmental factors highlight the significance of ethnic food and support from culturally competent care professionals and family members.

Conclusions: This integrative review underlines the complexity of using environments to meet culture-specific needs of CALD residents with dementia. The findings highlight the importance of bilingual staff, culturally relevant activities and inclusive environments in enhancing communication, building interpersonal relationships and reducing frustration. This review gives suggestions on how care home environments may be adapted for CALD residents and encourages further research to find practical solutions for equitable care.

PURPOSE: There is an increasing concern regarding hazardous recreational noise exposure among adolescents and young adults. Daily exposure to loud sound levels over a long period of time can increase the risk of noise-induced hearing loss. The full extent of the impact of recreational noise on hearing is not yet fully understood. The purpose of this review was to synthesize research that investigated hearing function in relation to recreational noise exposure in adolescents and young adults.

METHOD: A systematic literature search of five databases covering the years 2000-2023 was performed. The articles included investigated audiological measurements of hearing function in relation to recreational noise exposure.

RESULTS: Four hundred sixty records were identified, of which 20 met the inclusion criteria and were included in the results. This review showed that although some recreational noise activities can be potentially harmful, there is an unclear relationship between exposure and outcome. Some findings indicated hearing threshold shifts or reduced otoacoustic emission amplitudes after recreational noise exposure, but most changes were short term and in the extended high-frequency range.

CONCLUSIONS: There seemed to be inconsistencies regarding the utilization of methods of measuring exposure and outcome between studies. This might be one reason for the differing results in studies on the reported impact on hearing function from recreational noise exposure. To draw more certain conclusions about long-term effects, there is a need for longitudinal research that utilizes sound level measurements to assess low and high degrees of recreational noise exposure in relation to hearing function.

SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25114193.

BACKGROUND: The development of International Classification of Functioning, Disability, and Health (ICF) Core Sets greatly enhances the global recognition of health conditions, thereby advancing research, education, and care provision. Aside from the work of researchers, and the viewpoint of persons with lived experience, the development of Core Sets for deafblindness needs to include the viewpoints of professionals with expertise unique to this condition.

AIM: To represent the perspective of health and social service expert professionals in the development of ICF Core Sets for deafblindness.

DESIGN: Cross-sectional cohort study.

SETTING: Global online survey representing all six regions of the World Health Organization.

POPULATION: One hundred and five professionals providing and health or social service to individuals living with deafblindness with a minimum of 2 years of work experience with this population.

METHODS: An online survey was distributed through professional networks and social media for individuals working with persons living with deafblindness. Demographic items were summarized using descriptive statistics. Six open-ended questions explored the perceptions of body functions and structures that influence activities and participation, as well as environmental and personal factors that facilitate functioning. Data were linked to the ICF codes using established linking rules and procedures.

RESULTS: The 2934 survey response units were linked using IFC categories. Of the 421 unique categories, 133 were used by 5% or more of respondents. Most categories within the Activities and Participation component were equally emphasized. The most frequent Environmental factors were support and relationships, services, systems, and policies, as well as and the physical environment (e.g., hearing aids or noise). Mental functions, including higher level cognitive functions, temperament and personality were frequently emphasized.

CONCLUSIONS: Almost three quarters (73.3%) of the entire ICF classification categories were included in the expert survey results. This proportion emphasizes the importance of a multidimensional tool, such as the ICF, for assessing functioning and health for persons with deafblindness.

CLINICAL REHABILITATION IMPACT: The representation of this professional perspective in Core Set development will improve standardized assessment and documentation, intervention planning, and facilitate interprofessional communication with the goal of improving person-centered care for persons living with deafblindness.

BACKGROUND: The needs of people with deafblindness remain poorly understood and addressed globally. This study is part of a larger body of work to develop Core Sets for deafblindness using the International Classification of Functioning, Disability, and Health (ICF).

AIM: To determine the perspectives on functioning of individuals with lived experience of deafblindness as they relate to the ICF. DESIGN: Cross-sectional interview study.

SETTING: Global, representing all six regions of the World Health Organization.

POPULATION: A diverse cohort of 72 individuals living with deafblindness or as close family members, ranging across the spectrum of severity.

METHODS: Qualitative interviews and focus groups were used to explore six open-ended questions about perceived barriers and facilitators to functioning of body functions and structures, activities and participation, and environmental and personal factors. Data were synthesized using content analysis, and the resulting topics were linked to the ICF codes using established linking methodology prescribed by the World Health Organization's ICF Research Branch. Descriptive statistics summarized all demographic data.

RESULTS: The analyses of the transcripts uncovered 2534 meaning units, leading to the identification of 492 corresponding distinct codes from the ICF framework, and spanning across 93.33% of coding categories available. Sensory (b2) and Mental Functions (b1) emerged as the most frequent Body Functions (b) codes. Most categories referred to Activities & Participation, with Mobility (d4) being the most frequently mentioned topic. Services, Systems and Policies (e5) was the most frequently used Environmental factor.

CONCLUSIONS: Over 93% of the ICF classification categories were accessed to code the data provided by participants, demonstrating the complexity of functioning with deafblindness. This study provides valuable information to shape policy and research by providing representation of lived experience towards the consensus conference for the comprehensive and abbreviated Core Sets for deafblindness.

CLINICAL REHABILITATION IMPACT: The inclusion of lived experience provides a holistic understanding of the daily challenges faced by individuals living with deafblindness. By being part of this process, they have a voice in shaping the classification system that will be used to describe their experiences, fostering a sense of ownership and empowerment.

PURPOSE: The aim of the current study was to explore the construct validity and internal consistency reliability of the International Classification of Functioning, Disability and Health (ICF)-based original English version of the Hearing and Functioning in Everyday Life Questionnaire (HFEQ) and to revise the HFEQ based on the results.

METHOD: This study used a cross-sectional survey design. The data were collected using an online survey. Adults with self-reported hearing disability (n = 513) from the United States were included. The ICF components of body functions, activity and participation, and environmental factors were tested as the underlying structure of the HFEQ using confirmatory factor analysis and then adjusted by triangulation with previous content validation.

RESULTS: The results of the current study confirmed the ICF components of body functions, activity and participation, and environmental factors as underlying constructs of the HFEQ. However, after triangulation with previous content validation, fine adjustments were made. The revised version of the HFEQ includes two removed items and a fine-tuned factor structure.

CONCLUSION: The results confirm that the structure of the HFEQ aligns with the ICF, and the overall results indicate that HFEQ has acceptable construct validity and internal consistency.

BACKGROUND: Persons with hearing loss (HL) are a vulnerable group in working life. Studies have shown that they are more likely than the general population to be in part-time work, to be unemployed, receive disability pension, and to be on sick leave. Many workers with HL also experience unhealthy work conditions, such as jobs where they experience high demands combined with low control as well as safety concerns and social isolation. There is a lack of studies that focus on factors that promote a healthy, sustainable work situation for the target group.

OBJECTIVE: To investigate health factors that contribute to a sustainable work situation for employees with HL.

METHODS: The current study was a comparative, observational study with a cross-sectional design including a clinical population of adults with HL. Comparisons were made between workers with HL "in work" and workers with HL on "HL-related sick leave".

RESULTS: Seven health factors were identified. Those "in work" experienced a healthier work environment as well as lower levels of mental strain, hearing-related work characteristics and content, cognitively demanding work content, hearing-related symptoms, energy-demanding activities, and bodily aches and pain than those on "HL-related sick leave".

CONCLUSION: The results demonstrate a clear pattern regarding health factors for a sustainable working life. The type of job was not related to whether an individual was on sick leave or working. Rather, the work climate and the content of the work mattered.