Staffan Josephsson

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.

Research problem and specific questionsIntensifying the need for practical knowledge about how a person-centered approach can be integrated and deepened is the rise of standardization s in health and social care for older persons. Research, theory, and national guidelines identify unrealized potential and importance of "narratively organized" everyday life as central to enacting human values such as dignity and participation. The overall purpose is to contribute in-depth knowledge on how narrativity in everyday life and care can be integrated into working methods and organizational preparedness for the participation and dignity of older persons when they need care. Four research questions will address: the nature of, and co-creation of narratively engaged care among patients, staff, and family

its benefits and limitations: development of a model prototype from findings.   Data and methodCollaborative and process-oriented strategies and the MRC/NIHR guidelines for the development of complex interventions, will use qualitative and process-oriented methods triangulating data from older people, staff and management.Relevance and utilizationThe project contributes to new knowledge about narrativity in relation to person-centeredness, meaning, dignity and how narrative practice can be integrated into ordinary care. Furthermore, the project contributes to increased understanding of how practice leadership and social learning can support such integration. The focus will be on developing working methods to bring this new knowledge into actual practice.Plan for project realizationWe intend to involve two groups

partly elderly people with newly diagnosed dementia who live in ordinary housing, partly elderly people with complex conditions and/or mental illness who live in nursing homes, for co-created knowledge about ideals around good meetings, how co-planning of interventions, as well as space to tell, to be heard and understood. We also intend to involve staff in elderly care and management representatives in the development of working methods for a more equal, participatory, and dignified ageing. At the same time, we plan to study conditions for implementation, so that the model is designed in a way that makes it possible to apply. Next, we will synthesize collected knowledge and design a prototype for `Narratively Engaged Care´´ that can be integrated within health and social care, care units or nursing homes.