Citation: MAXIMO, T. and CLIFT, L., 2016. Assessing service delivery systems for assistive technology in Brazil using HEART study quality indicators.Technology and Disability, 24 (4), pp. 161 -170. Additional Information:• This is an accepted version of a paper subsequently published in the jour- Abstract. BACKGROUND: recently in Brazil, there has been investment and improvements in the service delivery system for assistive technology provision. However, there is little documentation of this process, or evidence that users are being involved appropriately. OBJECTIVE: to understand how assistive technology service provision currently functions in Belo Horizonte city, Brazil, in order to provide context-specific interventions and recommendations to improve services. METHOD: Qualitative research design, including visits to key institutions and semi-structured interviews with key stakeholders. Interview questions were divided with two purposes: 1) Exploratory, aiming to understand present service functioning; 2) Evaluative, aiming to assess staff difficulties in applying existing best practice. RESULTS: Assistive Technology services in Belo Horizonte fall under the 'medical model' definition of the service delivery system developed by AAATE. It was also found that staff lack training and knowledge support to assess user requirements and to involve them during the decisionmaking process. Additionally, there is no follow-up stage after the device is delivered. CONCLUSIONS: The study clearly defines the service provision function and the staff difficulties at Belo Horizonte city, providing information for further studies.

Current older adult capability datasets fail to account for the effects of everyday environmental conditions on capability. This paper details a study which investigates the effects of everyday ambient illumination conditions (overcast, 6000 lx; In-house lighting, 150 lx; and street lighting, 7.5 lx) and contrast (90%, 70%, 50% and 30% contrast) on the near visual acuity of older adults (n=38, 65-87 years). Visual acuity was measured at a one metre viewing distance using LogMAR acuity charts. Results from the study showed that for all contrast levels tested, visual acuity decreased by 0.2 log units between the overcast and street lighting conditions. On average, participants could detect detail around 1.6 times smaller on the LogMAR charts when under overcast conditions compared to street lighting. Visual acuity also significantly decreased when contrast was reduced from 70% to 50%, and from 50% to 30% in each of the ambient illumination conditions. Practitioner summary: This paper presents an experimental study which investigates the impact of everyday ambient illumination levels and contrast on older adults' visual acuity. Results show both factors have a significant effect on their visual acuity. Findings suggest that environmental conditions need to be accounted for in older adult capability datasets/design.

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Stepladder accidents continue to be a major cause of injury at home and at work. Despite this, few changes have been seen in their design or their labelling. Many of the accidents occurring appear to be whilst the stepladder is being utilised in a manner which the user considers reasonable, but the manufacturer considers abuse. This work, sponsored by the Health and Safety Executive, investigates whether this mismatch can be eliminated in order to improve safety. The research combines user profiling with dynamic trials to establish what behaviour stepladders need to sustain. Through innovative measuring techniques, the demands on the stepladder system are quantified and the margin of safety calculated. Extensive dynamic trials generated data for over 4000 user, stepladder and task combinations. Individuals were given demanding tasks, but permitted to undertake them in a manner they considered reasonable and the resulting data can be considered as representative of the demands they would place on stepladders in everyday use. From this data, the stepladder and user system has been modelled, allowing manipulation of the stepladder parameters such that a virtual stepladder can be created which provides sufficient stability to tolerate all reasonably foreseeable use. In addition this model is used to generate predictive software which can determine the level of safety provided by real, or theoretical, stepladders. In conclusion, a specification for a simple test is given which could be routinely conducted to determine whether any given stepladder will offer the minimum level of stability considered necessary for safe use.

Call centre employees experience of mental game playing during work breaks were recorded in this study. The qualitative study involving two focus group discussions at different call centres,with 6 employees in one focus group and 9 in the second, stated employee's reasons for variations in the key performance metric by which they were being evaluated. In this case the key performance metric was the average speed of answer. In a previous study, where the mental games were introduced as an intervention during work breaks, the participants were asked to provide feedback on variations in productivity during a 4-week intervention study. Volunteer sampling was utilized, and the information was categorized into codes. Similar codes were grouped into themes. It was found that players are efficient in the middle of the week either because daily routine settles middle of the week or because employees try to average their metrics related to time. They also thought that productivity increased towards the end of the intervention because of games being accepted in the routine by that time, because the focus shifted from fun to work towards the end or because the employees knew they were being evaluated. According to participants, the non-players were more efficient than the players because games served as a bad distraction for the players and that players were considering games as something to do rather than an actual break. As a conclusion, it felt important to improve on the timings and frequency of the games played during work before it can be considered an effective intervention.