Jurjen Iedema

Are persons with physical disabilities who participate in society healthier and happier? Structural equation modelling of objective participation and subjective well-being

In many countries, governments pursue a policy of offering persons with disabilities greater opportunities for participation in society, based on the assumption that this will also improve their subjective well-being. Currently, however, it is not known whether this assumption is valid. In this study we relate the objective participation and the subjective well-being aspects of both disabled and non-disabled persons to an array of social and health-related determinants. Linear structural equation modelling of data of a sample selection of the Dutch population is analysed. The sample size is 5,826, including 642 respondents with physical disabilities. In terms of objective participation, the persons with disabilities are at a greater disadvantage as regards labour participation than is the case for social and cultural participation. When it comes to subjective well-being, we find that the persons with disabilities are more likely to lag behind in perceived physical health than in mental health and happiness. In a multivariate model relating objective participation to subjective health and happiness, correlations are much weaker than expected. It is striking to find that participation, perceived health and happiness are much less closely related than is often assumed. Their determinants differ widely in nature and strength. The empirical model leads to rejection of the hypothesis that higher participation by the persons with disabilities is associated with higher subjective well-being.

Positive and negative evaluation of caregiving among three different types of informal care relationships

Based on the caregiver stress model, we examined how care demands, caregiver motivation, coping style and external support are associated with positive evaluation and caregiver burden among spousal, adult child and other types of care relations. Data from a sample of Dutch informal caregivers of 1,685 older persons (55 and older) were analyzed employing multivariate linear regression analyses for each of the care relationship types. Spouses (Nxa0=xa0206) report high positive evaluation and high burden, adult children (Nxa0=xa01,093) report low positive evaluation, and other caregivers (Nxa0=xa0386) report high positive evaluation and a low burden. Multivariate linear regression analyses showed that motives and external support were important for positive evaluation but the impact varied among types of caregivers, whereas care demands and not asking for help were associated with burden for all types. Only among ‘other’ caregiver relationships, positive evaluation was negatively associated with burden. It is concluded that results confirm the dual nature of caregiving among spouses and children. The care context and motivation of the different types of caregivers explain their differences in care evaluation. Various interventions for types of caregivers are discussed.

Are informal caregivers less happy than noncaregivers? Happiness and the intensity of caregiving in combination with paid and voluntary work.

Informal caregivers are one of the pillars of home health care. In the Netherlands, the free help they provide to sick or disabled family members, acquaintances or friends exceeds the number of hours of home care provided by professionals. While the government welcomes their contribution, there is concern about the potential burden their work imposes on them. On the one hand, there is concern that informal caregiving could be experienced as a burden and diminish subjective well-being; on the other, helping others as a meaningful activity might increase their subjective well-being. Happiness ratings (as an indicator of subjective well-being) of persons whose involvement in informal caregiving, voluntary work and paid work ranged from none to full time were analysed using multivariate regression models, which also took into account levels of physical disability and socio-economic characteristics (age, sex, household composition, education level). The sample consisted of 336 informal caregivers and 1765 noncaregivers in the Dutch population. In line with the subjective well-being assumption, the results suggest that caregivers are happier than noncaregivers when they provide care for <6 hours a week; and in line with the burden assumption, the results show that providing care for more than 11 hours a week is associated with lower levels of happiness. Other results contradicted the burden assumption that combining caregiving with paid or voluntary work is associated with more time burden and less happiness. The result that combining caregiving with paid employment or volunteering is related to higher rates of happiness confirms the subjective well-being assumption. It is concluded that these cross-sectional results open ways to longitudinal research that can inform governments in the development of policies to support informal caregivers.

Kiezen voor een persoonsgebonden budget: Leiden verschillen in gemeentelijk pgb-beleid tot ongelijkheid in toegang?

Summary Choosing a personal budget: do differences in local policy concerning personal budgets lead to access inequalities? Dutch municipal authorities have a statutory duty to offer people who apply for support (by way of the Social Support Act) a choice between receiving support in kind or in the form of a personal budget, but are free to set their ownpolicyregardingwhoisofferedapersonalbudgetandhowattractive the personal budget option is. This policy freedom may manifest itself in how actively local authorities inform applicants about the possibility of a personal budget, the level of personal budget rates and the support local authorities offer in administering the personal budget. Earlier research has focused mainly on the characteristics of personal budgetholders (the micro-level). The present study not only considers the impact of those individual characteristics, but also investigates what impact differences in the policy on personal budgets between local authorities (the meso-level) has on how well informed people are about personal budgets and on the extent to which this form of support is chosen. In a structured verbal interview, we interviewed 1,026 applicants who had been ruled eligible for domestic help. Choosing a personal budget was an option for these applicants. The applicants lived in 70 municipalities for which we also had policy data, and we were therefore able to relate the data across the municipalities. Since we used a clustered sample (first selecting municipalities and then applicants within them), multilevel analyses were performed. Older persons and people with a sudden onset disability were less often informed about the possibility of a personal budget than younger people and people with agradually deteriorating disability. Higher educated people were more often informed than low-educated people. Other characteristics at