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- Alwin, Jenny, 1978-
(författare)
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Assessment of Support Interventions in Dementia : Methodological and Empirical Studies
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Dementia means a continuous deterioration of abilities and has a large impact on the persons affected as well as on family members and others close to the persons with dementia. Interventions aimed at this population in order to support and alleviate the often straining situation may be of great importance. There is a need to increase the knowledge and understanding of the impact and consequences of these interventions, both at an individual level and at a societal level. The demand for information concerning, e.g., economic and medical impact of technologies and interventions within health care is increasing. Assessment of technologies and interventions in dementia is related to certain methodological issues. The overall aim of this thesis is to contribute to the development of methodological knowledge concerning assessment studies and understanding of support interventions in dementia.This thesis work includes four studies that examine methodological aspects of assessment of support interventions in dementia and also report empirical research on the perception of support interventions from the perspectives of family caregivers of persons with dementia. In study I, an assessment model for assistive technology (AT) interventions in dementia was developed. In study II, part of the assessment model is applied, and a process evaluation of the AT intervention is presented. Study III examines family caregivers’ perception of the importance of different types of support and services. In the final study, study IV, a well‐acknowledged methodological challenge within the field of assessment in dementia is addressed: measuring health‐related quality of life (HRQoL). The studies are based on different data materials.An assessment model of AT interventions was developed that includes health economic evaluation from a societal perspective as well as evaluation of the intervention process. The perspectives of both persons with dementia and their relatives were incorporated in the model. The process evaluation was applied in study II in order to study the relatives’ perception of an AT intervention process. Assistive technology interventions in dementia may be of great significance for the relatives. By performing the process evaluation, several important aspects that need to be acknowledged in AT intervention processes in dementia were identified.Family caregivers of persons with dementia perceived different types of support/services within the comprehensive areas of counselling, relief and information as very important. Knowledge of the caregivers’ preferences is significant so that more directed support interventions may be provided.One specific methodological issue was addressed in study IV. The results of study IV showed that there were large differences in the results of cost‐effectiveness analyses depending on whether patient self‐ratings or proxy ratings (ratings of persons close to the patient) of patient HRQoL were used for the same analysis. These differences in the results could ultimately have an important impact on decision making and resource allocation.Support interventions aimed at persons with dementia and their relatives may be of great value. Conducting assessment studies of technologies and interventions within health care is important in order to increase the knowledge concerning, e.g., economic and medical impact. Assessment studies of support interventions dementia entails methodological issues that need to be addressed. There is a need for increased knowledge within this field and suggestions on methodology are made.
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| 2. |
- Alwin, Jenny, 1978-, et al.
(författare)
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Health economic and process evaluation of AT interventions for persons with dementia and their relatives - A suggested assessment model
- 2007
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Ingår i: Technology and Disability. - 1055-4181. ; 19:2-3, s. 61-71
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Tidskriftsartikel (refereegranskat)abstract
- There is growing interest in assistive technology (AT) as a means of enabling participation in everyday activities for persons with dementia and their relatives. Health economic assessment of AT in dementia is of importance due to the consequences of the disease for both patients and relatives and to the high societal costs for dementia care. The aim of this article is to outline a model for assessment of AT interventions for persons with dementia. The model expands existing assessment models as it also includes evaluation of the intervention process. Methodological challenges and possibilities in making health economic assessments, including outcomes and costs, as well as process evaluation, are discussed in the article. © 2007 IOS Press. All rights reserved.
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| 3. |
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| 4. |
- Alwin, Jenny, 1978-, et al.
(författare)
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Perception and significance of an assistive technology intervention - the perspectives of relatives of persons with dementia
- 2013
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Ingår i: Disability and Rehabilitation. - : Informa Healthcare. - 0963-8288 .- 1464-5165. ; 35:18, s. 1519-1526
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The aim of this study was to examine relatives' perception of an assistive technology intervention aimed at persons with dementia (PwDs) and their relatives, and to examine whether, and how, experiences of the intervention process differed between relatives valuing the intervention to be of high, and relatives perceiving it to be of low significance. Method: A total of 47 relatives of PwDs within the Swedish Technology and Dementia project were interviewed telephonically using a modified version of the Patient perspective on Care and Rehabilitation process instrument. A total of 46 participants were divided into two groups depending on whether they valued the intervention to be of great significance (GS group; N = 33) or of some/no significance (SNS group; N = 13). Results: Several aspects of the intervention were perceived as highly important, e.g. being shown consideration and respect, and having somewhere to turn. The results indicate that relatives in the GS group perceived certain aspects of the intervention process as highly fulfilled to a larger extent than did relatives in the SNS group. Conclusions: This study illustrates how process evaluations can be used to increase the understanding and to identify improvement aspects of interventions.
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| 5. |
- Alwin, Jenny, 1978-, et al.
(författare)
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Societal costs of informal care of community-dwelling frail elderly people
- 2021
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 49:4, s. 433-440
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Tidskriftsartikel (refereegranskat)abstract
- Aims: The aims of this study are to describe informal care activities and to estimate the societal cost of informal care of community-dwelling frail elderly people in Sweden. Methods: This study was performed within the frame of the TREEE project that included 408 frail elderly patients. At index hospitalisation (baseline), primary informal caregivers of the patients were provided with a questionnaire on informal care during a period of three months. Questions concerning other (secondary) informal caregivers were also included. A rough estimate of the total cost of informal care of frail elderly people in Sweden was obtained by combining data from this study with published data and official statistics. Results: In total, 176 informal caregivers responded, and 89% had provided informal care. The informal caregivers (primary and secondary) provided care for an average of 245 hours over three months. Taking care of the home was the dominating activity. In total, the mean cost of informal care was estimated to approximately 18,000 SEK (euro1878) over three months, corresponding to an annual cost of approximately 72,000 SEK (euro7477) per frail elderly person. The total annual societal costs of informal care of community dwelling frail elderly people aged 75 years and older in Sweden was estimated to be approximately 11,000 million SEK (euro1150 million). Conclusions: The care of frail elderly people provided by informal caregivers is extensive and represents a great economic value. Although our calculations are associated with uncertainty, the size indicates that supporting informal caregivers should be a priority for society.
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| 6. |
- Alwin, Jenny, 1978-, et al.
(författare)
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Teknik för personer med demens : En utvärderingsstudie av teknikintervention för personer med demenssjukdom och deras närstående
- 2008
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Denna rapport är framtagen av Centrum för utvärdering av medicinsk teknologi (CMT), Institutionen för medicin och hälsa, vid Linköpings universitet på uppdrag av Hjälpmedelsinstitutet. Utvärderingsstudien1 som presenteras i rapporten har gjorts av en intervention som utvecklats inom ramen för projektet ”Teknik och Demens”.Författarna till rapporten vill tacka medarbetare i Teknik och Demensprojektet:Arbetsterapeuter på de kliniska enheterna: Barbro Askenborg, Carina Boström, Ulla Haraldson, Malin Lundberg, Anna Rosshagen, Sofia Starkhammar samt Inger Lindblad från Stockholms sjukhem och Margret Rosenberg från Arbetsterapeuterna primärvården Gästrikland.Medarbetare på FoU-enheterna: Ulla Johansson, Staffan Josephsson och Åke Seiger.Projektledningsgruppen: Susann Forsberg och Ingela Månsson från Hjälpmedelsinstitutet, Inge Dahlenborg från Demensförbundet och Kerstin Lundström från Alzheimerföreningen i Sverige.Vi vill även tacka Magnus Husberg, CMT, för konsultinsatser vad gäller analys och databehandling samt Olle Eriksson, LiU, som rådgivare vad gäller statistiska beräkningar. Tack till alla personer som bidragit med synpunkter på rapporten.Slutligen ett varmt tack till alla deltagare i Teknik och Demensprojektet som under studiens gång besvarat många frågor.Linköping 2008-04-22Jenny Alwin Jan Persson Barbro Krevers
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| 7. |
- Dahlbäck, Nils, 1949-, et al.
(författare)
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Similarity is more important than expertise : accent effects in speech interfaces
- 2007
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Ingår i: CHI '07 Proceedings of the SIGCHI Conference on Human Factors in Computing Systems. - New York, NY, USA : ACM. ; , s. 1553-1556
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Konferensbidrag (refereegranskat)abstract
- In a balanced between-participants experiment (N = 96) American and Swedish participants listened to tourist information on a website about an American or Swedish city presented in English with either an American or Swedish accent and evaluated the speakers' knowledge of the topic, the voice characteristics, and the information characteristics. Users preferred accents similar to their own. Similarity-attraction effects were so powerful that same-accents speakers were viewed as being more knowledgeable than different-accent speakers even when the information would be much better-known by the opposite-accent speaker. Implications for similarity-attraction overwhelming expertise are discussed.
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| 8. |
- Lundqvist, Martina, 1986-, et al.
(författare)
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Certified service dogs : A cost-effectiveness analysis appraisal
- 2019
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Ingår i: PLOS ONE. - San Francisco, CA, United States : Public Library of Science. - 1932-6203. ; 14:9
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Individuals with functional impairments or chronic diseases are often in need of assistance in their daily lives. For these individuals it is essential to find novel, cost-effective solutions to meet their needs. Service dogs are dogs that are specially trained to assist individuals with functional impairments and may be able to improve these individuals' quality of life at a reasonable cost, i.e. be cost effective. Cost-effectiveness analyses are used to illustrate the cost of an intervention in relation to its effects and provide important input to decision-makers when setting priorities.AIM: The aim of this study is to assess the cost effectiveness of a certified physical service dog and a diabetes alert dog compared to a regular companion dog.METHOD: Costs, life years and quality-adjusted life years were estimated over a 10-year time horizon using a decision-analytic model built upon evidence from the"service and hearing dog project". The primary outcome was the incremental cost-effectiveness ratio expressed as cost per gained quality-adjusted life year. The analysis was conducted from a societal perspective. Costs and effects were discounted with 3% per annum and reported in USD.RESULTS: Compared to a regular companion dog, a physical service dog is cost saving [-6,000 USD] and gives the dog owner more quality-adjusted life years [0.28]. The diabetes alert dog is also cost effective in comparison with a regular companion dog [-4,500 USD, 0.06 QALYs].CONCLUSION: This study indicates that a certified service dog is cost saving in comparison with a regular companion dog for individuals with functional impairments or chronic diseases. The uncertainty of the analysis implies that further studies are needed in order to confirm these results. Nevertheless, physical service dogs and diabetes alert dogs show potential to be a valuable support and decision analytic models are useful tools to provide this information.
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| 9. |
- Lundqvist, Martina, 1986-
(författare)
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Health Technology Assessment of Assistance Dogs and Dog-Assisted Interventions
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Dogs as an assistive aid for people with disabilities date as far back in time as the first century CE. Today, dogs are used in various settings to help and assist humans. ‘Assistance dogs’ is an umbrella term for guide dogs, hearing dogs and service dogs. They are custom trained to help and support their owners in their everyday life and thereby give them greater independence. Dogs who perform dog-assisted interventions are another type of working dog, where the dog and the owner work together as a team visiting people with various needs in different settings such as hospitals and nursing homes. These visits aim to strengthen people’s inner motivation, using the dog as an external motivator. There is a lack of evaluations of working dogs in the health technology assessment context, and in the health economic evaluation context. Hence, there is a need for structured analyses that include both the short and long-term effects and the costs of assistance dogs and dog-assisted interventions.The overall aim of this thesis is to explore and assess the use of assistance dogs and dog-assisted interventions.The research questions were investigated using a variety of methods. In paper I, inferential statistical analysis was used to analyse patient-reported outcomes measures. In paper II, a thematic content analysis was employed to explore the experiences of service and hearing dogs. To study the long-term cost-effectiveness of physical service dogs and diabetes alert dogs, a decision analytic model was used in paper III. The input data in studies I, II, and III was obtained from the Service and Hearing Dog Project. In paper III, the data was also supplemented with information from published literature and expert opinions. Paper IV investigated the effects and cost-effectiveness of dog-assisted interventions, and takes the form of a systematic review.Paper I showed that a service or hearing dog may have positive impact on its owner’s health-related quality of life, well-being and activity level. Paper II showed that owners of service or hearing dogs experienced both positive physical and psychosocial effects from their dog. Negative experiences were also identified, for example being denied access to public places and negative attitudes from other people. Paper III showed that physical service dogs and diabetes alert dogs are cost-effective in comparison with regular companion dogs, resulting in both lower costs and a gain in QALYs. The one-way sensitivity analysis did not change the results, but the probabilistic sensitivity analysis showed that the results were uncertain. Synthesizing the results from the review in paper IV showed that dog-assisted interventions for therapeutic purposes led to minor to moderate effects in psychiatric conditions. Dog-assisted interventions as an activity had minor to moderate effects on cognitive disorders, and dog-assisted interventions for support purposes were beneficial in different types of medical interventions. Studies of cost-effectiveness were lacking. To conclude, assistance dogs are valuable and may be cost-effective for use as assistive aids and dog-assisted interventions render minor to moderate effects in certain situations in healthcare settings.
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| 10. |
- Lundqvist, Martina, 1986-, et al.
(författare)
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The impact of service and hearing dogs on health-related quality of life and activity level: a Swedish longitudinal intervention study
- 2018
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Ingår i: BMC Health Services Research. - : BMC. - 1472-6963. ; 18
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Tidskriftsartikel (refereegranskat)abstract
- Background: Individuals with severe disability often require personal assistance and help from informal caregivers, in addition to conventional health care. The utilization of assistance dogs may decrease the need for health and social care and increase the independence of these individuals. Service and hearing dogs are trained to assist specific individuals and can be specialized to meet individual needs. The aim of this study was to describe and explore potential consequences for health-related quality of life, well-being and activity level, of having a certified service or hearing dog. Methods: A longitudinal interventional study with a pre-post design was conducted. At inclusion, all participants in the study had a regular (untrained) companion dog. Data were collected before training of the dog started and three months after certification of the dog. Health-related quality of life was assessed with EQ-5D-3L, EQ-VAS and RAND-36. Well-being was measured with WHO-5 and self-esteem with the Rosenberg Self-Esteem Scale. In addition, questions were asked about physical activity and time spent away from home and on social activities. Subgroups were analyzed for physical service and diabetes alert dogs. Results: Fifty-five owner-and-dog pairs completed the study (30 physical service dogs, 20 diabetes alert dogs, 2 epilepsy alert dogs, and 3 hearing dogs). Initially, study participants reported low health-related quality of life compared with the general population. At follow-up, health-related quality of life measured with the EQ-VAS, well-being and level of physical activity had improved significantly. In the subgroup analysis, physical service dog owners had lower health-related quality of life than diabetes alert dog owners. The improvement from baseline to follow-up measured with EQ-5D statistically differed between the subgroups. Conclusions: The target population for service and hearing dogs has an overall low health-related quality of life. Our study indicates that having a certified service or hearing dog may have positive impact on health-related quality of life, well-being and activity level. Service and hearing dogs are a potentially important "wagging tail aid" for this vulnerable population, able to alleviate strain, increase independence, and decrease the risk of social isolation.
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