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Background The home environment is thought to influence children’s weight trajectories. However, few studies utilise composite measures of the home environment to examine associations with energy balance behaviours and weight. The present study aimed to adapt and update a comprehensive measure of the obesogenic home environment previously developed for pre-schoolers, and explore associations with school-aged children’s energy balance behaviours and weight. Methods Families from the Gemini cohort ( n  = 149) completed the Home Environment Interview (HEI) via telephone when their children were 12 years old. The HEI comprises four composite scores: one for each domain (food, activity and media) of the environment, as well as a score for the overall obesogenic home environment. The primary caregiver also reported each child’s height and weight (using standard scales and height charts), diet, physical activity and sedentary screen-based behaviours. A test-retest sample ( n  = 20) of caregivers completed the HEI a second time, 7–14 days after the initial interview, to establish test-retest reliability. Results Children ( n  = 298) living in ‘higher-risk’ home environments (a 1 unit increase in the HEI obesogenic risk score) were less likely to consume fruits (OR; 95% CI = 0.40; 0.26–0.61, p  < 0.001), and vegetables (0.30; 0.18–0.52, p  < 0.001), and more likely to consume energy-dense snack foods (1.71; 1.08–2.69, p  = 0.022), convenience foods (2.58; 1.64–4.05, p  < 0.001), and fast foods (3.09; 1.90–5.04, p  < 0.001). Children living in more obesogenic home environments also engaged in more screen-time ( β (SE)  = 4.55 (0.78), p  < 0.001), spent more time playing video games ( β (SE)  = 1.56 (0.43), p  < 0.001), and were less physically active (OR; 95% CI = 0.57; 0.40–0.80, p  < 0.01). Additionally, there was a positive association between higher-risk overall home environment composite score and higher BMI-SDS (β (SE) = 0.23 (0.09), p < 0.01) . This finding was mirrored for the home media composite ( β (SE) = 0.12 (0.03), p  < 0.001). The individual home food and activity composite scores were not associated with BMI-SDS. Conclusion Findings reveal associations between the overall obesogenic home environment and dietary intake, activity levels and screen-based sedentary behaviours, as well as BMI in 12 year olds. These findings suggest that the home environment, and in particular the home media environment, may be an important target for obesity prevention strategies.

Background The need for home care workers (HCWs) is rapidly growing in Norway due to the increasingly growing elderly population. HCWs are exposed to a number of occupational hazards and physically demanding work tasks. Musculoskeletal disorders, stress, exhaustion, high sick leave rates and a high probability of being granted a disability pension are common challenges. This qualitative study explored the views of HCWs on how working conditions affect their safety, health, and wellbeing. Methods A descriptive and explorative design was utilised using semi-structured individual interviews with eight HCWs from three home care units in a middle-sized Norwegian city. Interviews were conducted in the Norwegian language, audio-recorded, and transcribed verbatim. The data was analysed by systematic text condensation. Key data quotes were translated into English by the authors. Results HCWs reported that meaningful work-related interactions and relationships contributed to their improved wellbeing. Challenging interactions, such as verbal violence by consumers, were deemed stressful. The unpredictable work conditions HCWs encounter in users’ homes contributed to their exposure to environmental hazards and unhealthy physical workloads. This was the case, although the employer promoted ergonomic work practices such as ergonomic body mechanics when mobilising and handling of clients, using safe patient handling equipment. HCWs perceived high level of individual responsibility for complying with company safety policies and practices, representing a health barrier for some. Organisational frameworks created unhealthy work conditions by shift work, time pressure and staffing challenges. Performing tasks in accordance with HCWs professional skills and identity was perceived as health-promoting. Conclusions This study suggests that unpredictable working conditions at users’ home can adversely affect the safety, health, and wellbeing of HCWs. The interaction between the unpredictable environment at users’ homes, HCWs’ perceived high level of individual responsibility for complying with company safety policies and practices, and staffing challenges due to sickness-related absences upon the workplace creates tense work conditions with a negative influence on HCWs health.

BackgroundNon-invasive ventilation (NIV) has made a significant impact on the treatment of sleep disordered breathing (SDB) for many children and young people (CYP) with rare and/or complex conditions. More consistent use of NIV is associated with better health outcomes; non-adherence can lead to acute/recurrent/life threatening respiratory deterioration requiring hospital admissions, disruption to family life and increased healthcare costs. Although supported by the hospital based NIV team, it is parents/carers who deliver NIV at home following training, including ensuring equipment is used safely and effectively and monitoring the child overnight. As the number of CYP using NIV increases, it is critical to understand factors that help deliver quality healthcare in the home environment.MethodsOur aim was to explore barriers and facilitators to CYP using NIV consistently at home. Semi-structured interviews with 12 parents and nine CYP who use NIV overnight with varying degrees of adherence were undertaken. Interviews were audio-recorded, transcribed verbatim and analysed in NVIVO using Framework Analysis.ResultsParents and CYP identified a range of barriers and facilitators to the child’s ability to adhere to treatment, alongside their perceptions of its effectiveness and their role in ensuring the child’s adherence. Facilitators to NIV adherence focussed on the NIV team-led acclimatisation period, effective strategies at home as well as technical aspects of the ventilator and mask. Barriers included sensory, behavioural and medical factors including specific patient-related factors, such as the child’s previous experience of medical treatment.ConclusionThe ability of families to integrate a potentially intrusive piece of technology into their child’s night-time routine (often alongside other medical interventions) varied considerably. The barriers to NIV use ranged widely; understanding key support needs for parents and CYP to tailor support to individual family requirements will help to optimise outcomes for CYP and families.

Behavioral interventions preceded by a functional analysis have been proven efficacious in treating severe problem behavior associated with autism. There is, however, a lack of research showing socially validated outcomes when assessment and treatment procedures are conducted by ecologically relevant individuals in typical settings. In this study, interview-informed functional analyses and skill-based treatments (Hanley et al. in J Appl Behav Anal 47:16–36, 2014 ) were applied by a teacher and home-based provider in the classroom and home of two children with autism. The function-based treatments resulted in socially validated reductions in severe problem behavior (self-injury, aggression, property destruction). Furthermore, skills lacking in baseline—functional communication, denial and delay tolerance, and compliance with adult instructions—occurred with regularity following intervention. The generality and costs of the process are discussed.

Nature play is growing in popularity, with many early childhood settings transforming their outdoor play environments to incorporate more natural elements. Current research highlights the benefits of engaging in unstructured nature play for children’s health and development; yet little is known about the experiences of key nature play end-users such as parents and early childhood educators, even though they directly impact the application of nature play within early childhood settings. This study aimed to address this knowledge gap by exploring parent and early childhood educator (ECE) perspectives to gain an understanding about their experiences with nature play. Using a qualitative descriptive approach, semi-structured in-person and telephone interviews were conducted with 18 ECE and 13 parents across four early childhood centres (from various socio-economic regions) across metropolitan Adelaide, South Australia during 2019–2020. Interviews were audio-recorded and transcribed verbatim. Thematic analysis identified five main themes; positive affirmations of nature play, factors influencing nature play engagement, defining nature play, outdoor play space design and risky play. Children’s connection to the natural world, learning about sustainability, emotional regulation, and children discovering their own capabilities were perceived advantages of engaging in nature play. Despite the benefits, ECE’s described institutional barriers such as resourcing, adhering to policies and scheduling conflicts, whereas, parents described time, getting dirty and proximity to nature play spaces as barriers to nature play engagement. Parents and ECEs alike described adults as gatekeepers for play, especially when other daily tasks compete for their time, or when faced with weather-imposed barriers (cold, rain, extreme heat in summer). The findings suggest that parents and ECEs may need additional resources and guidance on how to engage with nature play and how to overcome barriers within early childhood settings and the home environment.

Background Robust evidence confirms that physical activity (PA) levels among older people who live in care homes are considerably lower than those who live in their own homes. Low PA in care homes may reduce independence, function, and quality of life. Objective To explore social ecological factors that influence PA facilitation in care homes. Methods Focussed ethnographic study informed by social ecological models in five care homes for older people comprising 54 h of non‐participant observation and 15 in‐depth interviews with care workers. Observations focused on key interactions between staff and residents, the daily routines of care homes, and the physical environment. Interviews were informed by observations and sought explanations for observed behaviour. Data were subjected to reflexive thematic analysis. Results The findings show how care workers' perceived roles, identity, and sense of purpose influenced how (or if) PA was facilitated. The study identified blurred role boundaries between formal and informal care practices in relation to PA. Blurred role boundaries led to a continuum between formal and informal PA facilitation practices that were mediated by intrapersonal, interpersonal, organisational and physical environmental factors. Formal roles in PA promotion were defined by their explicit inclusion in job descriptions, for example, staff employed as activity coordinators, and were highly demarcated leading to limited interprofessional collaboration among care workers regarding PA. Conversely, informal roles reflected how recognising and creating incidental opportunities to promote PA occurred for all staff as they enacted their roles during day‐to‐day work. Social spaces in the care home physical environment acted as destinations that encouraged walking and incidental PA, especially when supported by staff creativity and encouragement. Conclusions These findings provide evidence to support the transformation of care worker roles in a way that emphasises PA facilitation as a key part of the role. Patient or Public Contribution Care home staff, residents, and family members contributed to the design of the observation topic guide and the practical procedures to implement the observation element of the ethnography. Member checking of the themes with two care home managers and three members of care home staff that were participants in the study was conducted to obtain feedback on the findings.

This study considered the influences of the home learning environment and preschool quality on the development of 5-year-old Chinese ( N  = 43) and South Asian ( N  = 32) children in Hong Kong. Children were recruited from two preschools—one admitted only South Asian children, and the other admitted only Chinese children. Children were assessed in individual sessions with the Hong Kong Early Child Development Scale-3. Their parents were surveyed about the home learning environment. Teacher interviews, classroom observations, and document reviews were used to gauge preschool quality. Results of regression analyses indicated that socioeconomic status (SES) was positively associated with language development and pre-academic learning for both Chinese and South Asian children. In contrast, only the SES of Chinese children was related to their knowledge of society and the environment. The frequency of home learning activities was positively associated with language development for Chinese children. Controlling for SES, multivariate analysis of covariance (MANCOVA) results revealed that Chinese children performed significantly better than South Asian children in Chinese language and knowledge of society and environment. In contrast, South Asian children did better than Chinese children in pre-academic learning and fine motor development. Interviews revealed that teachers from the two participating preschools needed more professional development. Classroom observations showed that the preschool that admits only South Asian children has limited physical space, which may hinder children’s all-round development. Nevertheless, the teacher interviews and document reviews suggested that regular home-preschool communication and parental participation in preschool activities are high. Implications of the findings are discussed.

INTRODUCTION Older adults with cognitive impairment (CI) face challenges to aging in the community. Little is known about the housing characteristics of US older adults with CI. METHODS Using the 2022 National Health and Aging Trends Study, we describe housing characteristics of community‐living older adults ≥ 65 years with CI (n = 968) using descriptive statistics (frequencies) and conduct chi‐squared tests to compare characteristics of those who lived with others (n = 707) versus alone (n = 261). RESULTS Renting (41%), home modifications (59% had ≥ 2), and interior home disorder (45%) were prevalent among older adults with CI. Those living alone more commonly rented, lived in an apartment or mobile home (vs. house), and had more home modifications than those living with others (all p < 0.05). DISCUSSION Further study should examine how housing characteristics support or deter daily function and inform the long‐term services and supports needed by this high‐needs, understudied population. Highlights There are 5.5 million older adults living in the community with cognitive impairment (CI). Of this population, 26% live alone. Older adults living alone with CI are primarily female, older, with lower incomes. Nearly half of older adults living alone with CI are renters. Home accessibility modifications were very common in this population.

Living in a disadvantaged neighborhood is associated with heightened risk for poor school readiness and health outcomes in early childhood, and the home environment is thought to be a primary mechanism by which neighborhood context impacts preschoolers. This study examined the effects of neighborhood concentrated disadvantage and neighborhood residential instability on the home physical environment and home learning environment for preschoolers in economically disadvantaged families (N = 187). Using structural equation modeling, mothers' perceived neighborhood disorder and depressive symptoms were examined as mechanisms by which neighborhood context \"comes through the door.\" Mothers' neighborhood social embeddedness was also explored as a protective factor. Results showed that concentrated disadvantage was negatively associated with the quality of the home physical environment, and residential instability was negatively associated with the quality of the home learning environment. Concentrated disadvantage had an indirect effect on the home learning environment through mothers' perceived neighborhood disorder and depressive symptoms. The effects of concentrated disadvantage on the home environment were buffered by mothers' neighborhood social embeddedness. Study findings advance understanding of socioeconomic- and place-based disparities in developmental outcomes and identify potential targets for interventions aimed at lessening effects of neighborhood disadvantage on families with young children.

Background The home environment is designed for living, not for professional care. For this reason, safe patient care is one of the most important challenges of home health care. Despite abundant research on safe care, there is still little understanding of safety issues in home care. Design The aim of the present study was to explain the process of safe patient care in home health care. A qualitative, grounded theory study was conducted based on the approach proposed by Corbin & Strauss in 2015. Method In total, 22 interviews were conducted with 16 participants including 9 home care nurses, 2 home care nursing assistants, 1 home care inspector, 1 home care physician and 3 family caregivers in Tehran, Iran. Four observation sessions were conducted in different homes. Purposeful sampling was used followed by theoretical sampling from August 2020-July 2022. Data analysis was carried out based on the approach proposed by Corbin & Strauss in 2015. Results The results showed that the healthcare members (nurses, family caregivers, patients and home care centers) used the model of safe patient care in home health care based on four assessment methods, i.e. prevention, foresight, establishment of safety and verification. The core variable in this process is foresight-based care. Conclusion The results of this study showed that the key to safe patient care in home health care, which helps to maintain patient safety and prevent threats to safe care, is the foresight of healthcare members, which is essential for identifying threats to safe care considering the many risks of home health care.