Disabled People’s Vulnerability in the European Single Market: The Case of Consumer Information

The United Nations Convention on the Rights of Persons with Disabilities (2006) recognizes access to consumer goods and services in the mainstream private market as essential for full participation in the society. It shapes the concepts of consumer participation and market accessibility around the social model of disability and does not make a distinction between disabled and non-disabled market participants. Meanwhile, the European Union and Member States do not recognize people with impairments as equal market participants. They see them as “vulnerable” consumers and classify impairment as one of the criteria for becoming a “vulnerable” participant in the European single market. This paper argues, however, that by shaping policy and market positions and actions around ableism, the European Union, Member States, and the private market prioritize non-disabled citizens and consumers and so construct people with impairments’ consumer vulnerability. To illustrate the case, empirical evidence from mystery shopping and qualitative interviews with consumers with impairments from Lithuania and the UK is used. Since consumer information is essential for informed choice and participation in the market, information provision about mainstream retail outlets and products is used as a case study

Pedestrians with Disabilities and Town and City Streets: From Shared to Inclusive Space?

This article highlights the importance of ensuring that accessibility and inclusion for people with disabilities, as required by the UN Convention on the Rights of Persons with Disabilities, is fully embedded in efforts to reduce the dominance of cars in city streets and promote more active modes of travel (including walking, wheeling and cycling) in line with global agendas. Drawing on emerging findings from the Inclusive Public Space research project, we present and critically reflect on types of difficulty associated with streets in which what is commonly known as a ‘shared space’ design operates, and those in which all or part of the available space is designated as primarily for pedestrian use. The data on which this analysis is based is qualitative, deriving from 83 semi-structured interviews about the experiences of our participants (a substantial majority of whom identified as having a disability) in two large UK cities and their wider metropolitan areas. The types of exclusionary experience described by our participants are organised into two broad overlapping categories – first, difficulties associated with navigating environments in which kerbs have been removed; and second, difficulties associated with interacting with vehicles (including bicycles) within and at the boundaries of shared or pedestrian spaces. Our findings are in line with those of previous projects that challenge and complicate claims that ‘shared space’ design, with its removal of kerbs and controlled crossings, enhances safety and mobility for all. Further, they demonstrate that many of the concerns associated with ‘shared space’ environments are also applicable to other types of street environment intended primarily for pedestrians. As well as highlighting and raising awareness of potential types of exclusion against which action should be taken, we draw attention to measures that could reduce the risk of such exclusionary barriers arising and persisting

Organizational Barriers to Oral Health Conversations Between Health Visitors and Parents of Children Aged 9–12 Months Old

Background: Dental caries is the most prevalent preventable childhood disease and a major public health priority. Local authorities in England have a statutory responsibility to improve child health, including oral health, through the “Healthy Child Programme.” The “Healthy Child Programme,” which includes the provision of oral health advice is delivered by health visitors to parents of young children. To date, research has mainly concentrated on individual interactions between health visitors and parents, with less attention given to the broader context in which these oral health conversations between health visitor and parents take place. Objective: Our study explored the organizational factors that obstruct health visitors from engaging in meaningful conversations with parents about young children's oral health. Methods: Qualitative interviews and focus groups were held with health visiting teams (n = 18) conducting home visits with parents of 9–12-month olds in a deprived, urban area in England. Results: The study revealed the wide variation in what and how oral health advice is delivered to parents at home visits. Several barriers were identified and grouped into four key themes: (1) Priority of topics discussed in the home visits; (2) Finance cuts and limited resources; (3) Oral health knowledge and skills; and (4) Collaborative working with other professionals. It was evident that organizational factors in current public health policy and service provision play an important role in shaping oral health practices and opportunities for behavior change. Conclusion: Organizational practices and procedures play an important role in creating interaction patterns between health visiting teams and parents of young children. They often limit effective engagement with and positive change in oral health. For future oral health interventions to be effective, awareness of these barriers is essential alongside them being founded on evidence-based advice and underpinned by appropriate theory

Co-design of an oral health intervention (HABIT) delivered by health visitors for parents of children aged 9–12 months

Background Dental caries (tooth decay) in children is a national public health problem with impacts on the child, their family and wider society. Toothbrushing should commence from the eruption of the first primary tooth. Health visitors are a key provider of advice for parents in infancy and are ideally placed to support families to adopt optimal oral health habits. HABIT is a co-designed complex behaviour change intervention to support health visitors’ oral health conversations with parents during the 9–12-month universal developmental home visit. Methods A seven stage co-design process was undertaken: (1) Preparatory meetings with healthcare professionals and collation of examples of good practice, (2) Co-design workshops with parents and health visitors, (3) Resource development and expert/peer review, (4) Development of an intervention protocol for health visitors, (5) Early-phase testing of the resources to explore acceptability, feasibility, impact and mechanism of action, (6) Engagement with wider stakeholders and refinement of the HABIT intervention for wider use, (7) Verification, Review and Reflection of Resources. Results Following preparatory meetings with stakeholders, interviews and co-design workshops with parents and health visitors, topic areas and messages were developed covering six key themes. The topic areas provided a structure for the oral health conversation and supportive resources in paper-based and digital formats. A five-step protocol was developed with health visitors to guide the oral health conversation during the 9–12 month visit. Following training of health visitors, an early-phase feasibility study was undertaken with preliminary results presented at a dissemination event where feedback for further refinement of the resources and training was gathered. The findings, feedback and verification have led to further refinements to optimise quality, accessibility, fidelity and behaviour change theory. Conclusion The co-design methods ensured the oral health conversation and supporting resources used during the 9–12 month visit incorporated the opinions of families and Health Visitors as well as other key stakeholders throughout the development process. This paper provides key learning and a framework that can be applied to other healthcare settings. The structured pragmatic approach ensured that the intervention was evidence-based, acceptable and feasible for the required context

Out on the streets – Crisis, opportunity and disabled people in the era of Covid-19: Reflections from the UK

Governments have responded to the Covid-19 crisis through various measures designed to reduce transmission and protect people judged to be at heightened risk. This paper explores the implications of such measures in the UK for disabled people, with a particular focus on measures designed to reduce and reshape the use of streets and public space. We divide UK measures into two broad categories. First, there are measures designed to reduce the use of streets and public spaces – e.g., rules requiring people to stay at home except in tightly prescribed circumstances and measures providing specific support (including food delivery and priority online shopping) for people designated as clinically extremely ‘vulnerable’. Second, there are measures designed to control the behaviour of people using streets and public space – e.g., rules on physical distancing and the use of face coverings. We explore the disability-related concerns associated with these types of measure. We also highlight the opportunities this crisis presents for embedding accessibility and inclusion more firmly into the fabric of our streets and call for renewed resistance to policies and practices shaped by ableist assumptions and attitudes

HABIT (Health visitors delivering Advice in Britain on Infant Toothbrushing): a qualitative exploration of the acceptability of a complex oral health intervention

Background To explore the acceptability of the oral health intervention, HABIT (Health visitors delivering Advice in Britain on Infant Toothbrushing) to parents with young children aged 9–12 months and health visitors. Methods Following the delivery of the universal oral health intervention called HABIT, qualitative semi-structured interviews with parents and focus groups with health visitors were undertaken. Interviews were audio-recorded and transcribed. Health visitors completed self-reported diaries after delivering the HABIT intervention with parents. The qualitative data was analysed using framework analysis (guided by a theoretical framework of acceptability). Results Seventeen parents were interviewed, and five health visitors and three nursery nurses participated in two focus groups. Parents reported health visitors to be ‘trusted’ and valued the reassurance provided during the HABIT visit. Health visitors found the HABIT training and resources useful and valued the consistency and increased confidence in undertaking oral health conversations. There were, however, challenges in changing behaviour where families faced competing demands on time and resources. Both health visitors and parents described the importance of the intervention's timing and suggested that multiple visits may be needed to support optimal oral health habits. Conclusion The HABIT intervention was acceptable to parents and health visitors. Health visitors would welcome a further refinement to enhance intervention delivery that specifically achieves a balance between using a guided script and retaining the flexibility to adapt the conversation to suit the needs of individual families. This, in turn, will maximise impact and enable parents of young children to adopt and maintain optimal home-based oral health behaviours for their child