Ann-Helen Patomella

Background and Rationale. Persons with disabilities face inequalities in their everyday life due to the inability to participate in community activities and access places of importance. Many of these inequalities are based on environmental restrictions. Mobility is an important prerequisite of community participation and health of persons with and without disabilities However, there are no studies that examine the community participation of persons with disabilities in relation to mobility and health, their satisfaction with community participation, and how this compares to the situation of persons without disabilities. Furthermore, mobility services are often not available and/or accessible for all and are a barrier to community participation. The political goals to adapt public transport services, structures, and vehicles until the end of the year 2023, to provide access for all persons will not be reached, in Switzerland. Thus, there is a societal need and interest to develop policy recommendations to increase the elimination of discrimination of persons with disabilities.The overall objective of this project is to provide evidence and recommendations about mobility, community participation, and health of persons with and without disabilities, in Switzerland. Specifically, we aim to: a) identify if persons with disabilities have a lower frequency of visiting important places and a lower variety of transportation modes used than persons without disabilities

b) identify if persons with disabilities have a lower degree of self-rated community participation, of self-rated satisfaction with community participation, and self-rated quality of life than persons without disabilities

c) examine if self-rated degree of and satisfaction with community participation of persons with and without disabilities is associated with frequencies of visiting important places and modes of transportation

d) explore and describe the meaning community participation and visiting important places has for persons with disabilities

e) explain affordances/facilitators and barriers that hinder or support visiting important places for community participation

f) give a voice to persons with disabilities regarding their transportation/mobility needs

g) inform the development and validation of policy recommendations and tailor them to the Swiss federal context to increase persons with disabilities community participation in relation to their needs.Methods. We use a mixed method-design in this project, implementing qualitative and quantitative studies. Participants for the studies will be persons 1) 18 years of age and above, 2) with disabilities and/or chronic conditions

3) who need, want and/or are expected to participate in the community by being mobile and using transportation, and 4) who agree to participate in the study. The study will take place in the German, French, and Italian speaking parts of Switzerland. We will collect the data using qualitative and quantitative methods, such as narrative interviews, photo voice, and nationwide surveys using the Participation in Activities Outside Home (ACT-OUT) questionnaire, the European Quality of Life and Health measure (EuroQoL-5D), and other questionnaires focusing on mobility of persons with disabilities. Data analysis is implemented according to the various qualitative and quantitative study designs and depending on the type and distribution of data.Expected Results and Impact. We expect multiple impacts from the project, such as more knowledge on the needs of persons with disabilities regarding mobility, community participation, and health. In addition, the identified barriers and facilitators will provide a better insight into the modifications that need to be implemented in the environment. Lastly, the policy recommendations will be the basis to reduce environmental barriers and to increase accessibility for all.

Hjärt- och kärlsjukdomar som stroke orsakar flest dödsfall och funktionsnedsättningar i befolkningen och speciellt bland äldre. Stroke går att förebygga med livsstilsförändring och preventiva insatser är effektiva för de med hög risk. De som bor i områden med socioekonomiska utmaningar har mer än dubbel så stor risk att drabbas. Strokepreventiva insatser för personer som bor i dessa områden behöver i högre grad anpassas till individens erfarenheter och behov. Syftet med projektet är att a) ta fram ny kunskap om betydelsen av individens kontext, erfarenhet och behov för att delta i hälsofrämjande engagerande aktiviteter, b) genom samskapande metod utveckla en modell för en mer relevant och jämlik prevention av stroke i primärvården (PV), samt c) utvärdera genomförbarheten och möjlig effekt av en ny modell i PV för förebyggandet av stroke bland personer med ökad risk i områden med socioekonomiska utmaningar. I de olika delprojekten används olika vetenskapliga metoder: a) Betydelsen av individens kontext, erfarenhet och behov kommer att samlas in genom intervjuer som analyseras kvalitativt, b) en ny modell för strokeprevention samskapas med personer med strokerisk som bor i områden med socioekonomiska utmaningar samt c) genomförbarheten och möjlig effekt av programmet utvärderas med kvantitativ och kvalitativ datainsamling och analys. Projektet förväntas leda till ny kunskap för att förbättra strokeprevention för personer som lever i områden med socioekonomiska utmaningar.

Research problem and specific questions The overall aim is to develop models that support older adults´ participation in everyday activities that engage and lead to well-being where welfare technology is used to reduce the need for primary- and homecare.The needs of older adults at risk/ with frailty and significant others participating in interventions using digital technologies and what is needed for successful implementation will be studied together with the older adults, significant others, informal carer and staff.Research questions Can a prevention program using technology supporting engaging activities in everyday life reduce risk or maintain/delay the level of frailty in older adults? (project A)How can a prevention program that use technology support “Good quality, local health care “for frail older adults become a self-evident and integrated way of working as an addition to physical care within primary healthcare? (project A)Can a specialized homecare service (Reablement) using technology support older adults’ participation and engagement in everyday life while living at home? (project B)What are the needs of informal carer who provide support to older adults living with frailty at home? (project A-D)What are the systemic factors for and how can co-creation methods contribute to successful implementation of an intervention using technology directed towards older adults to improve primary care and homecare services? (project A-E)                                                                                                                                                                Data and method The interdisciplinary program is based on tested interventions using digital technology with positive effects in the context of older adult’s home. Five projects with qualitative and quantitative methods are planned. A digital platform will be used to compare data. With analyses from projects A-D, a model describing effects of implementation that can change and implement new interventions and working approaches using will be developed (project E).Relevance and utilisation In Europe, more than 1/3 of older adults &lt

75 years live with frailty that causes functional limitations with an impact on well-being of many older adults thats lead to high costs for tax-funded care.The home is an important arena and with an increase of older adults new working models are needed. The result will generate knowledge about how to use digital solutions for preventive efforts, more efficient primary- and homecare that enable participation in everyday life of older adults and support for relatives and staff.Plan for project realisation A close collaboration between staff in Region Stockholm/Uppsala, City of Stockholm, Huddinge municipality and researchers at Karolinska Institutet, Royal Institute of Technology and Uppsala University that will work closely to a reference group of older adults, significant others, and stakeholders.