OBJECTIVE: The present study aimed to identify the prevalence and predisposing factors of frailty and social inclusion among community-dwelling older adults.
METHODS: The study was conducted using a cross-sectional design.
METHODS: The target population consisted of older adults registered in five family health centers in a city in Turkey. The study was completed with 600 older adults.
METHODS: The Tilburg frailty indicator (TFI) and the social inclusion scale were used to collect data.
RESULTS: The prevalence of frailty in older adults was 60.5%. Multiple logistic regression analysis indicated that the risk of frailty was found to be higher in older adults aged 75 and over (2.5 times), those with low education level (5.8 times), those who were single (2 times), those with chronic diseases (1.8 times), those with unhealthy lifestyle (2.8 times), and those who were dissatisfied with their home living environment (5.9 times). It was found that age, education level, marital status, income, presence of chronic disease, lifestyle, satisfaction with their home living environment, and frailty explained 50% of the variance in social inclusion.
CONCLUSIONS: The study concluded that most community-dwelling older adults were frail, and social inclusion was lower in those frail. Age, education level, marital status, lifestyle, presence of chronic disease, and satisfaction with their home living environment were found to be predisposing factors for both frailty and social inclusion. Public health nurses could develop strategies to prevent frailty in older adults and increase activities that encourage participation in social life.

BACKGROUND: Most individuals with severe mental illness (SMI) strongly prefer independent living over living in an institution. Independent Supported Housing (ISH) provides housing rehabilitation for persons with SMI in their accommodations. However, most individuals who need housing rehabilitation live in institutional housing settings (housing rehabilitation as usual: HAU). We investigated which housing rehabilitation setting is effective on which variable in the long term to support service users to form an informed preference for either housing rehabilitation setting.
METHODS: We conducted a two-year longitudinal observational non-inferiority study to test the effectiveness of ISH in improving participants\' social inclusion, quality of life, emotional social support, capabilities, symptom severity, functioning, service utilisation and costs. Participants were assessed at baseline and after six, twelve, and 24 months. Mixed effects models were computed to test between-group and within-group effects.
RESULTS: The study included 83 participants in ISH (n = 31) and HAU (n = 52) housing rehabilitation settings with a mean age of 36.2 years. Most participants were male (64%) and had a primary psychotic or schizophrenic (35%) or an affective diagnosis (24%). During the study, ISH participants significantly improved their quality of life (β = 0.54; 95% CI: 0.26 to 0.82), symptoms (β = -0.32; 95% CI: -0.60 to -0.03), and capabilities (β = 4.46; 95% CI: 0.14 to 8.77) and decreased psychiatric hospitalisations (p = 0.04). HAU participants improved their quality of life (β = 0.40; 95% CI: 0.12 to 0.69). Housing and rehabilitation support costs were almost half with ISH than with HAU.
CONCLUSIONS: ISH has been shown to be much less expensive than HAU and was associated with several improvements like reduced psychiatric hospitalisations and improved quality of life. Therefore, our findings strongly argue for a preference-driven provision of housing rehabilitation services and to end the institutionalisation of persons with SMI.
BACKGROUND: The study was registered on December 04, 2018, at ClinicalTrials.gov (NCT03815604).

Participation in group activities such as choirs has been shown to have positive effects on emotional health and overall well-being. Inclusive choirs, which integrate individuals of various abilities and diverse backgrounds, provide a unique space for social interaction, emotional expression, and inclusion. This study aims to explore the impact of participation in an inclusive choir on the emotional health of its members, identifying both positive and negative emotional impacts as well as personal experiences derived from their participation. This longitudinal exploratory study combines participant observation, field notes, focus groups, and questionnaires to gain a deep understanding of the participant\'s emotional experiences through their narratives. The study was conducted in an inclusive choir located in a medium-sized city in Spain, which brings together people of various ages, genders, abilities, and cultural backgrounds. The results indicated that most participants experienced significant improvements in their emotional well-being, including increased self-esteem, a greater sense of belonging, and reduced symptoms of anxiety and depression. Participants also reported that the choir provided a safe space for emotional expression and the building of meaningful relationships. Participation in an inclusive choir can have a considerable positive impact on the emotional health of its members.

UNASSIGNED: Participation in sports represents a potent means of empowerment and social inclusion. Nevertheless, women with physical impairments encounter specific challenges in accessing Para sports. The main aim of this study is to present the experiential participation and achievements in sports of women with physical impairments in Saudi Arabia.
UNASSIGNED: Twenty women athletes with physical impairments who engaged in competitive Para sports in Saudi Arabia were interviewed. Interpretive phenomenological analysis was employed to extract themes elucidating the experiences of women athletes with physical impairments in Para sports.
UNASSIGNED: Four dimensions were identified: (i) Exploring participation in sports; (ii) The positive impact of participation in sports; (iii) obstacles in participation in sport; and (iv) hopes and aspirations to improve participation in Para sports.
UNASSIGNED: In Saudi Arabia, participation in Para sports functions as a powerful tool for empowering and socially integrating women with physical impairments. However, these women encounter challenges in accessing sports. Achieving empowerment in Para sports necessitates the establishment of an inclusive ecosystem that celebrates diversity and equality. Collaborative efforts from governments, sports organizations, communities, and individuals are indispensable in creating an environment where women with impairments can flourish in sports.

BACKGROUND: Tuberculosis (TB) remains a major public health problem in Nepal, high in settings marked by prevalent gender and social inequities. Various social stratifiers intersect, either privileging or oppressing individuals based on their characteristics and contexts, thereby increasing risks, vulnerabilities and marganilisation associated with TB. This study aimed to assess the inclusiveness of gender and other social stratifiers in key health related national policies and the Health Management Information System (HMIS) of National Tuberculosis Programme (NTP) by conducting an intersectional analysis of TB cases recorded via HMIS.
METHODS: A desk review of key policies and the NTP\'s HMIS was conducted. Retrospective intersectional analysis utilized two secondary data sources: annual NTP report (2017-2021) and records of 628 TB cases via HMIS 6.5 from two TB centres (2017/18-2018/19). Chi-square test and multi-variate analysis was used to assess the association between social stratifers and types of TB, registration category and treatment outcome.
RESULTS: Gender, social inclusion and concept of intersectionality are incorporated into various health policies and strategies but lack effective implementation. NTP has initiated the collection of age, sex, ethnicity and location data since 2014/15 through the HMIS. However, only age and sex disaggregated data are routinely reported, leaving recorded social stratifiers of TB patients static without analysis and dissemination. Furthermore, findings from the intersectional analysis using TB secondary data, showed that male more than 25 years exhibited higher odds [adjusted odds ratio (aOR) = 4.95, 95% confidence interval (CI): 1.60-19.06, P = 0.01)] of successful outcome compared to male TB patients less than 25 years. Similarly, sex was significantly associated with types of TB (P < 0.05) whereas both age (P < 0.05) and sex (P < 0.05) were significantly associated with patient registration category (old/new cases).
CONCLUSIONS: The results highlight inadequacy in the availability of social stratifiers in the routine HMIS. This limitation hampers the NTP\'s ability to conduct intersectional analyses, crucial for unveiling the roles of other social determinants of TB. Such limitation underscores the need for more disaggregated data in routine NTP to better inform policies and plans contributing to the development of a more responsive and equitable TB programme and effectively addressing disparities.

BACKGROUND: In the United States, autistic people face high rates of co-occurring mental illnesses and premature death due to self-harm, which are indicators of threats to mental well-being. Social inclusion may enhance mental well-being and resilience among autistic people. According to Simplican and colleague\'s (2015) model of social inclusion for people with intellectual and developmental disabilities, social inclusion is an interaction between community participation and interpersonal relationships. There is limited research on social inclusion that includes the integration of interpersonal relationships and community participation among autistic people or the impact of social inclusion on the well-being of autistic people. Additionally, little evidence exists regarding how autistic people prefer to be included in the community or form interpersonal relationships.
OBJECTIVE: The long-term objective of this project is to improve social inclusion factors to support the mental well-being of autistic people. This protocol describes a community-based, mixed methods pilot study to develop a definition of meaningful social inclusion for autistic people and to understand the relationship between meaningful social inclusion and mental well-being among autistic adolescents and emerging adults.
METHODS: The project uses a community-based, sequential mixed methods design with a formative phase (Phase 1) that informs a survey phase (Phase 2) and concludes with a process evaluation of the community engagement process (Phase 3). During Phase 1, we will recruit 10 community partners (autistic adults and stakeholders) and conduct sharing sessions to cocreate a definition of meaningful social inclusion and a survey of meaningful social inclusion and well-being. During Phase 2, we will recruit 200 participants (100 autistic adolescents and emerging adults and 100 caregivers) to complete the survey. We will examine whether meaningful social inclusion predicts well-being given sociodemographic factors using ordered logistic regression, with well-being categorized as low, medium, and high. During Phase 3, the community partners from Phase 1 will complete a survey on their experiences with the project.
RESULTS: Ethics approval was obtained for this project in March 2023. We have recruited community partners and started the Phase 1 focus groups as of September 2023. Phase 2 and Phase 3 have not yet started. We expect to complete this study by March 2025.
CONCLUSIONS: Using a community-based, mixed methods approach, we intended to develop a definition of meaningful social inclusion for autistic people and understand the role meaningful social inclusion plays in the well-being of autistic people.
UNASSIGNED: PRR1-10.2196/52658.

BACKGROUND: Individuals with severe mental illness living in supported accommodation are often socially excluded. Social inclusion is an important aspect of recovery-based practice and quality of life. The Social Inclusion Questionnaire User Experience (SInQUE) is a measure of social inclusion that has been validated for use with people with mental health problems. Previous research has suggested that the SInQUE could also help support care planning focused on enabling social inclusion in routine mental health practice.
OBJECTIVE: This study aims to develop a web-based version of the SInQUE for use in mental health supported accommodation services, examine its acceptability and perceived usefulness as a tool to support care planning with service users, determine the extent of uptake of the tool in supported accommodation settings, and develop a program theory and logic model for the online SInQUE.
METHODS: This study involved a laboratory-testing stage to assess the acceptability of the SInQUE tool through \"think-aloud\" testing with 6 supported accommodation staff members and a field-testing stage to assess the acceptability, utility, and use of the SInQUE tool over a 5-month period. An implementation strategy was used in 1 London borough to encourage the use of the SInQUE. Qualitative interviews with 12 service users and 12 staff members who used the tool were conducted and analyzed using thematic analysis. The use of the SInQUE was compared with that in 2 other local authority areas, 1 urban and 1 rural, where the tool was made available for use but no implementation strategy was used.
RESULTS: Overall, 17 staff members used the SInQUE with 28 different service users during the implementation period (approximately 10% of all service users living in supported accommodation in the study area). The staff and service users interviewed felt that the SInQUE was collaborative, comprehensive, user-friendly, and relevant. Although some staff were concerned that particular questions might be too personal, service users did not echo this view. Participants generally felt that the SInQUE could help identify individuals\' priorities regarding different aspects of social inclusion by prompting in-depth conversations and tailoring specific support to address service users\' inclusion goals. Some interviewees also suggested that the tool could highlight areas of unmet or unmeetable needs across the borough that could feed into service planning. The SInQUE was not used in the comparison areas that had no implementation strategy.
CONCLUSIONS: The online SInQUE is an acceptable and potentially useful tool that can be recommended to assess and support care planning to enable social inclusion of people living in mental health supported accommodation services. Despite this, uptake rates were modest during the study period. A concerted implementation strategy is key to embedding its use in usual care, including proactive endorsement by senior leaders and service managers.

BACKGROUND: Previous studies show that the personal support networks of people with intellectual disability are smaller and less diverse than those of people without intellectual disability. This article aims to compare the characteristics of the personal networks of young people with and without intellectual disability.
METHODS: The Personal Network Analysis (McCarty, Revista Hispana Para El Análisis de Redes Sociales, 2010, 19, 242-271) was applied. The participants comprised 51 young people aged between 13 and 19, of whom 27 had an intellectual disability. The Egonet programme was used to compile information, and SPSS v.27 for the statistical analysis.
RESULTS: Young people with intellectual disabilities have smaller personal networks than people without disability, while they also comprise more people with disability and fewer \'friends\' and support people.
CONCLUSIONS: The full social inclusion of people with intellectual disability requires schools, families, the community and the individual to work together to develop activities that help them initiate and maintain relationships, prioritising mainstream contexts.

To identify the contextual factors related to financial capability and financial well-being for adults living with acquired brain injury (ABI).
We conducted a qualitative descriptive study using photovoice and included 17 adults who live with ABI in Manitoba, Canada. Over 3-to-5 weeks, participants took photos of their financial capability (i.e. knowledge, skills, and behaviors related to managing finances) or their financial well-being (i.e. subjective and objective financial outcomes). Participants were interviewed about their photos. Five researchers iteratively and thematically analyzed interview transcripts.
Analysis identified the importance of the economic, social, technology, and physical or sensory context. Subthemes related to: (i) hard times finding financial resources; (ii) processes not making sense; (iii) getting help from the right person; and (iv) invisible disability bias and stigma.
There is decreased literature about financial capability or financial well-being after ABI. The results of this study highlight the salience of finance to living with ABI and the importance of the context to addressing financial-related life participation for people living with ABI. Information about contextual factors related to finance can improve rehabilitation assessment and intervention practice as well as emphasize needed accessibility changes to financial environments.

This study explores the experience of promoting inclusion and anti-racism work as either performance or deep work in the couple and family therapy (CFT) field through narrative qualitative analysis. While performance-based approaches focus on meeting external expectations and diversity quotas, deep work involves critical self-reflection, ongoing learning, and a commitment to addressing systemic inequalities. The paper prioritizes how deep inclusion assists with developing new approaches to creating meaningful and lasting change in teaching, research, and clinical work in the CFT field. Some professionals in the field include educators, researchers, and therapists who are engaged in anti-racism work, a recognition of the impact of systemic racism on family dynamics and therapeutic interventions, and a commitment to centering the voices and experiences of marginalized individuals and communities. Implications present a need for ongoing education, training, and support for professionals in the CFT field and other family science and family mental health-related professions. This study also identifies limitations and future directions for research in promoting inclusion and anti-racism work in family science and family mental health-related fields. It is essential to promote inclusion and anti-racism as deep work to create more inclusive and equitable teaching, research, and therapeutic environments that value the experiences of all individuals and communities. Challenges include resistance from shaking systems and making ourselves and others vulnerable with uncomfortable and continuous conversations. Our primary goal is to contribute to and inspire dialogue about the perspectives CFTs and other mental health-related professionals are taking in the relationship to inclusion and anti-racism work.