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There is increasing interest in the UK in developing environments that support people who are neurodiverse. This paper aims to report on a project to develop a cognitively supportive environmental assessment tool to improve the design of health centres, where the majority of National Health Service consultations take place, for all users, including people living with dementia and those who are neurodiverse.

A three-stage process was used: a literature review; the development of a matrix of key design features for people living with dementia, autism and other neurodiverse conditions; and the development of an environmental assessment tool and guide for users, which included easy-to-read versions to maximise service user involvement.

The overarching concepts of dementia-friendly design can be adapted to create designs for everyone, including those who are neurodiverse.

There is a paucity of research in environmental design for primary care from the patient’s perspective, and, more generally, further research on design for adults with learning disabilities and autism is needed.

The tools are free to download. With adaptation, they have potential applicability across health and care settings.

This project has confirmed that the principles of dementia-friendly design are applicable, with modifications, to a wider group of neurodiverse people. Critically, each person’s response to sensory stimuli is individual rather than determined by their condition.

Designing digital artifacts is not a linear, straightforward process. This is particularly true when applying a user-centered design approach, or co-design, with users who are unable to participate in the design process. Although the reduced participation of a particular user group may harm the end result, the literature on solving this issue is sparse. In this article, proxy design is outlined as a method for involving a user group as proxy users to speak on behalf of a group that is difficult to reach. The article investigates the following research question: How can roleplaying be embedded in co-design to engage users as proxies on behalf of those who are unable to represent themselves?

The article presents a design ethnography spanning three years at a cancer rehabilitation clinic, where digital artifacts were designed to be used collaboratively by nurses and patients. The empirical data were analyzed using content analysis and consisted of 20 observation days at the clinic, six proxy design workshops, 21 telephone consultations between patients and nurses, and log data from the digital artifact.

The article shows that simulated consultations, with nurses roleplaying as proxies for patients ignited and initiated the design process and enabled an efficient in-depth understanding of patients. Moreover, the article reveals how proxy design as a method further expanded the design. The study findings illustrate: (1) proxy design as a method for initiating design, (2) proxy design as an embedded element in co-design and (3) six design guidelines that should be considered when engaging in proxy design.

The main contribution is the conceptualization of proxy design as a method that can ignite and initiate the co-design process when important users are unreachable, vulnerable or unable to represent themselves in the co-design process. More specifically, based on the empirical findings from a design ethnography that involved nurses as proxy users speaking on behalf of patients, the article shows that roleplaying in proxy design is a fitting way of initiating the design process, outlining proxy design as an embedded element of co-design.

This study aims to investigate the prevalence and characteristics of dysphagia among adults with intellectual disabilities (ID) referred to speech and language therapy for swallow assessment, providing information on the demographic characteristics, referral trends, co-occurring health conditions and reasons for referrals highlighting the complex health-care needs of this population.

This study used a standardised patient data extraction method over a six-month period involving 74 adults with ID referred to speech and language therapy for swallow assessment.

This study revealed a high prevalence of dysphagia among adults with ID referred to speech and language therapy for swallow assessment. Increasing age and severity of ID were associated with an increased likelihood of swallowing difficulties. Co-occurring health conditions such as mobility difficulties, epilepsy and gastrointestinal conditions were prevalent, suggesting that adults with ID and swallowing difficulties are often living with complex health conditions. Choking incidents and hospital admissions were primary reasons for referral.

This study stresses the pressing need for strategies to mitigate risks associated with choking incidents and hospital admission among this vulnerable population. Possible limitations include a reliance on referral and the focus being on a single service over a short period which may limit generalisation to the wider ID population.

This study emphasises the need to understand each person’s unique profile of health needs and the value of a specialised speech and language therapy service.

The importance of increasing awareness among caregivers and medical experts is highlighted.

The findings underscore the importance of tailored assessment, caregiver involvement and heightened interdisciplinary awareness to effectively manage dysphagia in individuals with ID.

People with intellectual disability die prematurely and from avoidable causes. Innovative solutions and proactive strategies have been limited in addressing this disparity. This paper aims to detail the process of developing a risk stratification tool to identify those individuals who are higher risk of premature mortality.

This study used population health management principles to conceptualise a risk stratification tool for avoidable deaths in people with intellectual disability. A review of the literature examined the existing evidence of causes of death in people with intellectual disability. A qualitative methodology using focused groups of specialist clinicians was used to understand the factors that contributed towards avoidable deaths in people with intellectual disability. Delphi groups were used for consensus on the variables for inclusion in the risk stratification tool (Decision Support Tool for Physical Health).

A pilot of the Decision Support Tool for Physical Health within specialist intellectual disability service demonstrated effective utility and acceptability in clinical practice. The tool has also demonstrated good face and construct validity. A further study is currently being completed to examine concurrent and predictive validity of the tool.

To the best of the authors’ knowledge, this is the only study that has used a systematic approach to designing a risk stratification tool for identifying premature mortality in people with intellectual disability. The Decision Support Tool for Physical Health in clinical practice aims to guide clinical responses and prioritise those identified as at higher risk of avoidable deaths.

This study aims to explore the holistic context of organisational staff retention in small, medium and large organisations. It also aims to identify the factors affecting the retention of organisations of different sizes.

The study implements an empirical test of a model created during previous research with the participation of 511 employees. The responses to the online questionnaire and the modelling were analysed using the partial least squares structural equation modelling method. The models were tested for internal consistency reliability, convergent and discriminant validity, multicollinearity and model fit.

Two models were tested by organisation size, which revealed a total of 62 significant correlations between the latent variables tested. Identical correlations were present in both models in 22 cases. After testing the hypotheses, critical variables (nature of work, normative commitment, benefits, co-workers and organisational commitment) were identified that determine employees’ organisational commitment and intention to leave, regardless of the size of the organisation.

As a result of this research, the models developed are suitable for identifying differences in organisational staffing levels, but there is as yet no empirical evidence on the use of the scales for homogeneous groups of employees.

The results show that employees’ normative commitment and organisational commitment are critical factors for retention. Of the satisfaction factors examined, the nature of work, benefits and co-workers have a significant impact on retention in organisations, so organisational retention measures should focus on improving satisfaction regarding these factors.

The readers of the journal would appreciate the work, which highlights the significance of employee psychology and retention for organisational success.

The study is based on primary data and, to the best of the authors’ knowledge, is one of the few studies that take a holistic approach to organisational staff retention in the context of the moderating effect of organisational size. This study contributes to a comprehensive understanding of the phenomenon of employee retention and in contrast to previous research, examines the combined effect of several factors.

The authors intended to find out what motivates employees at the workplace. For this purpose, the authors examined family motivation and intrinsic motivation influences over work attitudes such as organizational citizenship behavior (individual) and affective commitment.

In the current research, the authors adopted time-lagged approach to collect a total of 352 responses from managers in the hospitality sector. This approach was adopted to avoid common method issues related to survey research.

The findings suggest positive association of family motivation with intrinsic motivation, affective commitment and organizational citizenship behavior (individual). The authors also found intrinsic motivation positively related to affective commitment and organizational citizenship behavior (individual). The findings also found statistical support pertaining to the mediating role of intrinsic motivation on family motivation's positive relationship with affective commitment and organizational citizenship behavior (individual).

Considering important role of family motivation, the authors ask managers to think through ways that could help employees feel better about their family's wellbeing. The authors also suggest organizations upsurge intrinsic motivation of their employees by engaging them in decision-making process, allow employees to craft their jobs because through these a higher level of organizational citizenship behavior for individuals and affective commitment could be generated.

The authors extend the core assumption of self-determination theory that work motivation (intrinsic in specific) is autonomously determined, deeply rooted within individuals, and gratifying. It works on the pleasure principle and mirrors a hedonic standpoint. In such a situation, employees work merely based on their interest and joy; they focus and enjoy the process.