ORCID Profile
0000-0002-0536-6859
Current Organisations
National Ageing Research Institute
,
University of Western Australia
,
Curtin University
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Research Topics
In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Top 5 Research Topics
ANZSRC Field of Research (FoR)
Health services and systems | Health services and systems not elsewhere classified | Aged health care | Social epidemiology | Public Health and Health Services | Sociological Methodology and Research Methods | Care for Disabled | Aged Health Care |
ANZSRC Socio-Economic Objective (SEO)
Social Structure and Health | Disability and Functional Capacity | Health Related to Ageing |
Related Links
Publications
Why do we not want to recommend influenza vaccination to young children? A qualitative study of Australian parents and primary care providers
Publisher: Elsevier BV
Date: 02-2018
DOI: 10.1016/J.VACCINE.2017.12.066
Abstract: Influenza vaccination has been shown to be safe and effective against influenza and in the prevention of complicating secondary respiratory illnesses. However, its uptake in young children remains low. This study explored the views, attitudes and practices of parents and primary care providers (PCPs) on their knowledge and acceptance of influenza vaccination in children under 5. Using a cross-sectional qualitative research design, we conducted 30 in-depth interviews with PCPs (i.e., general practitioners, practice nurses, maternal and child health nurses, and pharmacists) and five focus groups with parents (n = 50) between June 2014 and July 2015 in Melbourne, Australia. Data were thematically analysed. Parents thought the vaccine could cause influenza, and influenza vaccination was not necessary for their children as they needed to build their own 'immunity'. Parents said that they would consider vaccinating their children if recommended by their GP and if the influenza vaccine was part of the immunisation schedule. PCPs also expressed concerns regarding the efficacy of the vaccine as well as out-of-pocket costs incurred by families, and uncertainty regarding the mortality and morbidity of influenza in otherwise healthy children. However, they said they would recommend the vaccine to high-risk groups (e.g. children with chronic disease(s), and asthma). Despite the established safety of influenza vaccines, barriers to uptake include concerns regarding the iatrogenic effects of vaccination, its administration schedule, and knowledge of influenza severity. Updated information on influenza and the efficacy of the vaccine, and incorporating influenza vaccination into the immunisation schedule may overcome some of these barriers to increase influenza vaccination in this vulnerable cohort.
The symbolic mediation of patient trust: Transnational health-seeking among Indian-Australians
Publisher: Elsevier BV
Date: 08-2019
DOI: 10.1016/J.SOCSCIMED.2019.112359
Abstract: This article explores whether this extension of treatment and medication possibilities, owing to greater transnational movement of goods and people, presents increasing challenges for maintaining patients' trust within nationally-bound healthcare systems, such as in Australia. We ran focus groups in Melbourne from June 2012 to June 2013 with 34 Indian migrants to Australia. Our findings illustrate discrepancies between the symbolic mediation of trust within Indian and Australian healthcare encounters. We find that Indian participants associated authoritative and decisive self-presentation by doctors with medical competence, conflicting with Western patient choice models which exalt patient autonomy and agency. We also find that trust in Indian healthcare encounters is mediated through the symbolic deployment of "strong medication" and the engendering of "hope" in patients. Australian doctors' failure to deploy these symbols in the same way contributes to distrust that Indian participants express towards Australian health professionals and healthcare systems. We conclude that in situations where patients have less familiarity with the symbolic repertoire shared by the majority of users of a national healthcare system, such as can be the case with recent migrants, difficulties and misunderstandings may arise in negotiating trust, providing a potential motivator for seeking alternatives transnationally.
The Changing Migrant Composition of Australia’s Population
Publisher: Springer International Publishing
Date: 2021
Culturally Adapting Evidence on Dementia Prevention for Ethnically Diverse Communities: Lessons Learnt from co-design
Publisher: Informa UK Limited
Date: 27-07-2023
DOI: 10.1080/07317115.2022.2101968
Abstract: 40% of dementia cases can be prevented by addressing 12 lifestyle factors. These risk factors have increased presence in ethnic minorities, yet dementia prevention messages have not reached these communities. This article investigates the experience of co-designing a dementia prevention animated film with 9 ethnic groups in Australia. Evidence-based recommendations were adapted through an iterative process involving workshops with a stakeholder advisory committee and nine focus groups with 104 participants from the Arabic-, Hindi-, Tamil-, Cantonese-, Mandarin-, Greek-, Italian-, Spanish-, and Vietnamese-speaking communities. Data were analyzed using the Normalization Process Theory. Cultural adaptation involves consideration of the mode of delivery, imagery and tone of the resource being developed ensuring cultural adequacy anticipating the need of the end-users and managing linguistic challenges associated with working across multiple languages. Learnings from this co-design process offer valuable insights for researchers and program developers who work with ethnic minority groups. • Adaptation across cultures and languages is a negotiation not a consensus building exercise• Linguistic adaptation requires consideration of the education levels, and linguistic and intergenerational preferences of community members• Co-designing across multiple languages and cultures risks "flattening out" key aspects of cultural specificity.
Agency, activation and compatriots: the influence of social networks on health-seeking behaviours among Sri Lankan migrants and Anglo-Australians with depression
Publisher: Wiley
Date: 11-07-2018
Abstract: The nexus between social networks and illness behaviours is important in uptake of health care, however scant research has explored this relationship in South Asian migrants living with mental illness. We explored the interplay between culture, social networks and health seeking in Sri Lankan migrants and Anglo-Australians living with depression. Forty-eight in-depth interviews were conducted and data were analysed through the theoretical prism of the network episode model. Results showed that social networks were important in negotiating care. Decisions to initiate care occurred along a continuum of choice and agency some took charge of their care, others were coerced into care, however some Sri Lankan migrants were led through various informal channels of care. Selective activation of compatriots - those perceived to understand mental illness-became increasingly important to participants through their illness careers. Compatriots were considered of greater benefit as participants progressed through depression than otherwise meaningful social networks based on ethnicity, culture and kinship. We argue that the role of social networks is pivotal in uptake of formal care, and engaging with communities to improve responses of social networks to mental illnesses may provide a bottom-up avenue for improving uptake of mental health services in migrant communities.
Using Digital Media to Improve Dementia Care in India: Protocol for a Randomized Controlled Trial (Preprint)
Publisher: JMIR Publications Inc.
Date: 04-04-2022
Abstract: ndia is undergoing a demographic transition characterized by population aging and is witnessing a high dementia rate. Although nearly 7 million people live with dementia in India, dementia awareness is poor, and current resources addressing dementia care are basic and often incomplete, duplicated, or conflicting. To address this gap, this study aims to use digital media, which has had a massive technological uptake in India, to improve dementia care in India. he objective of this paper is to describe an intervention study design that examines the feasibility and acceptability of Moving Pictures India, a digital media resource to improve dementia care in India. his study employs a mixed methods design and is ided into 4 phases: (1) video interviews with Indian caregivers and health professionals (2) coproduction of resources (3) pilot randomized controlled trial (RCT) and (4) dissemination and analytics. The pilot RCT will follow an experimental parallel group design with 2 arms aiming to assess the impact, feasibility, and acceptability of the developed resources. The primary outcome measures for the pilot RCT will be feasibility and acceptability, while the secondary outcome measures will be caregiver burden, mood, and quality of life. his study received funding from the Alzheimer’s Association in the United States in July 2021. In 2023, we will enroll 60 dementia caregivers (40 caregivers in the intervention arm and 20 in the control) for the pilot RCT. The study has been approved by the National Institute of Mental Health and Neuro Sciences Ethics Committee (26th IEC (BEH.SC.DIV.)/2020-21 dated November 11, 2020) the Health Ministry's Screening Committee, India (proposal ID 2020-10137) the Curtin University Human Research Ethics Committee (approval number HRE2020-0735) and the NARI Research Governance Office (site-specific approval dated March 17, 2021). his protocol is designed to deliver unique, coproduced, and evidence-based media resources to support caregivers of persons with dementia in India and other countries aiming to utilize digital media for dementia care. If the intervention is found feasible and acceptable, postpiloting analytics and qualitative feedback will be used to develop an implementation trial to evaluate the effectiveness of the potential low-risk high-benefit intervention in practice. linical Trials Registry-India CTRI/2021/01/030403 ctri.nic.in/Clinicaltrials maindet2.php?trialid=50794 ERR1-10.2196/38456
Fear of (re)injury and return to work following compensable injury: qualitative insights from key stakeholders in Victoria, Australia
Publisher: Springer Science and Business Media LLC
Date: 11-04-2017
“They don’t want our blood”: Social inclusion and blood donation among African migrants in Australia
Publisher: Elsevier BV
Date: 07-2011
DOI: 10.1016/J.SOCSCIMED.2011.05.030
Abstract: The current study examines how feelings of social inclusion influence migrant communities' predisposition to donate blood, focusing specifically on Sub-Saharan African communities in Australia. We begin by explicating the theoretical links between social inclusion, citizenship and blood donation before discussing local and international perspectives of blood donation among African migrant communities. Using qualitative methods comprising nine focus group discussions, held between March and April 2010, we argue that blood donation intentions are mediated by whether or not in iduals feel included in their new host society. Real and perceived discrimination experienced by African migrants in their everyday social interactions or in institutional settings can act as a barrier to blood donation. We conclude that removing such barriers, thereby increasing rates of donation in migrant communities, will help to build social capital and inclusion. Strategies for how this can be achieved are outlined.
Inclusive dementia care for ethnically diverse families
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-07-2023
DOI: 10.1097/YCO.0000000000000889
Abstract: With population ageing and global migration, rates of dementia are set to rapidly increase in ethnically erse populations. This narrative review examines recent evidence on what constitutes culturally appropriate models of care. Barriers to inclusive care continue to prevail, lifying dementia disparities in ethnically erse communities. Cultural models that can address these include ensuring health and aged care staff are culturally competent, language supports are available, and cultural practices are integrated into daily care routines. Fundamentally, systems must be reformed to ensure they meet the needs of erse end-users. More inclusive and widespread ethno-specific services are needed, and governments need to be mindful of demographic transitions in their populations and plan accordingly to meet future demand. Digital media and new technologies offer promising new ways to deliver culturally appropriate care to ethnically erse groups, but its full potential is yet to be realised. Persistent dementia disparities in ethnically erse communities can be overcome by operationalising cultural models of care, leveraging the promise of digital media, and systems redesign.
Do Health Service Use and Return-to-Work Outcomes Differ with GPs’ Injured-Worker Caseload?
Publisher: Springer Science and Business Media LLC
Date: 23-02-2018
DOI: 10.1007/S10926-018-9765-Y
Abstract: Purpose To determine whether healthcare use and return-to-work (RTW) outcomes differ with GPs' injured-worker caseload. Methods Retrospective analyses of the Compensation Research Database, which captures approximately 85% of all injured worker claims in Victoria, Australia was conducted. Four injured-worker caseload groups were examined that represented the 25th, 50th, 75th, and 100th percentiles of claimants seen per GP over the 8-year study period (2003-2010): (i) 1-13 claimants (ii) 14-26 claimants (iii) 27-48 claimants and (iv) 49+ claimants (total claims, n = 124,342 total GPs, n = 9748).The characteristics of claimants in each caseload group, as well as the influence of caseload on three outcomes relevant to RTW (weekly compensation paid, work incapacity days, medical-and-like costs), were examined. Results Distinct profiles for high versus low caseload groups emerged. High caseload GPs treated significantly more men in blue collar occupations and issued significantly more 'alternate duties' certificates. Conversely, low caseload GPs treated significantly more women in white collar occupations, predominantly for mental health injuries, and issued significantly more 'unfit-for-work' certificates. Few significant differences were found between the two intermediate GP caseload groups. High caseload was associated with significantly greater medical-and-like costs, however, no caseload group differences were detected for weekly compensation paid or duration of time-off-work. Conclusions Training GPs who have a low injured-worker caseload in workers' compensation processes, utilising high caseload GPs in initiatives involving peer-to-peer support, or system changes where employers are encouraged to provide preventive or rehabilitative support in the workplace may improve RTW outcomes for injured workers.
Screening for dementia: Fluidity and the Mini Mental State Examination in India
Publisher: SAGE Publications
Date: 22-10-2011
Abstract: The Mini Mental State Examination (MMSE) is a popular screening instrument for dementia. Drawing on ethnographic data from India, three vignettes are presented to examine how the MMSE is operationalised by interviewers and respondents. Using the concept of ‘fluidity’ from Science and Technology Studies, it will be demonstrated that the MMSE is fluid and changes according to in idual norms, institutional resources, and cultural settings. In some environments, the scores are discounted in order to count in others, the scale is perceived as an invitation to talk and finally, the MMSE can also operate as an entry-point to seek treatment for other psychological concerns.
Beyond crisis: Enacted sense-making among ethnic minority carers of people with dementia in Australia
Publisher: SAGE Publications
Date: 23-11-2020
Abstract: The ‘family crisis’ narrative is frequently used in dementia studies to explain ethnic minority families’ pathways to health and aged care and why there is delayed dementia diagnoses in ethnic minority communities. Such narratives may obscure the family carers’ agency in negotiating services and managing personal, social and structural burdens in the lead up to diagnosis. To illuminate agency, this article describes ethnic minority families’ pathways to a dementia diagnosis using the concept of sense-making. Three case studies were drawn from 56 video interviews with family carers of older adults with dementia from Chinese, Arab and Indian backgrounds. Interviews were conducted across Australia from February to August 2018, then translated, transcribed and thematically analysed. Findings suggest families did not enter into formal care because of a crisis, instead navigating fragmented systems and conflicting advice to obtain a dementia diagnosis and access to relevant care. This experience was driven by sense-making (a search for plausible explanations) that involved family carers interpreting discrepant cues in changes to the behaviour of the person with dementia over time, managing conflicting (medical) advice about these discrepancies and reinterpreting their relationships with hindsight. The sense-making concept offers a more constructive hermeneutic than the ‘family crisis’ narrative as it illuminates the agency of carers’ in understanding changed behaviours, negotiating services and managing personal, social and structural barriers pre-diagnosis. The concept also demonstrates the need for a multimodal approach to promoting timely diagnosis of dementia in ethnic minority communities through dementia awareness and literacy c aigns as well as initiatives that address structural inequities.
English Language Proficiency Among Older Migrants in Australia, 2016–2046
Publisher: Springer Science and Business Media LLC
Date: 11-06-2022
A Scoping Review of Dementia Care Experiences in Migrant Aged Care Workforce
Publisher: Oxford University Press (OUP)
Date: 12-04-2019
Abstract: In high-income countries, an increasing number of people living with dementia in residential aged care facilities are being cared for by an increasingly multicultural workforce. The purpose of this review was to investigate migrant aged care workers' dementia care experiences and to identify enablers and challenges that influence their retention. Utilizing Arksey and O' Malley's approach, PubMed, Scopus, CINAHL, Web of Science, and EMBASE were searched for peer-reviewed studies published from 2000 to November 2018. Selection criteria were studies with original research, focusing on dementia care among migrant aged care workers, and conducted in high-income countries. Seventeen articles were identified incorporating 13 (76.47%) qualitative, 1 (5.88%) quantitative, and 3 (17.65%) mixed method designs. A limited understanding of dementia and experiences of dementia care were reported among some migrant care workers in residential aged care facilities. The identified enablers to retention were the availability of organization support services professional development opportunities reciprocity and mutual respect between migrant care workers, care recipients, and coworkers and good working conditions. Factors such as discrimination from care recipients and coworkers and limited understanding of workplace culture were identified as barriers to migrant care workforce retention. Migrant care workers are valuable contributors to the aged care workforce. It is important to consider their cultural perceptions of dementia in relation to care provision. In addition, their exposure to occupational psychosocial risk factors in conjunction with the challenges associated with resettlement and dementia care needs to be addressed.
Diagnosing and managing work‐related mental health conditions in general practice: new Australian clinical practice guidelines
Publisher: AMPCo
Date: 24-06-2019
DOI: 10.5694/MJA2.50240
The Episodic Nature of Experience: A Dynamical Systems Analysis
Publisher: Wiley
Date: 23-07-2016
DOI: 10.1111/COGS.12399
Abstract: Context is an important construct in many domains of cognition, including learning, memory, and emotion. We used dynamical systems methods to demonstrate the episodic nature of experience by showing a natural separation between the scales over which within-context and between-context relationships operate. To do this, we represented an in idual's emails extending over about 5 years in a high-dimensional semantic space and computed the dimensionalities of the subspaces occupied by these emails. Personal discourse has a two-scaled geometry with smaller within-context dimensionalities than between-context dimensionalities. Prior studies have shown that reading experience (Doxas, Dennis, & Oliver, 2010) and visual experience (Sreekumar, Dennis, Doxas, Zhuang, & Belkin, 2014) have a similar two-scaled structure. Furthermore, the recurrence plot of the emails revealed that experience is predictable and hierarchical, supporting the constructs of some influential theories of memory. The results demonstrate that experience is not scale-free and provide an important target for accounts of how experience shapes cognition.
General practice utilisation of Medicare Benefits Schedule items to support the care of older patients: Findings from the REDIRECT study
Publisher: CSIRO Publishing
Date: 2018
DOI: 10.1071/PY17047
Abstract: Medicare Benefits Schedule (MBS) items designed to support the wellbeing of older people may reduce unnecessary emergency department utilisation, however it is unclear to what extent such items are used. This study examined general practitioner (GP) utilisation of these MBS items through an analysis of the Melbourne East Monash General Practice Database (MAGNET), which contains information collected from GP clinics within the inner east Melbourne region. Sociodemographic and MBS claim data were extracted for patients aged ≥75 years attending a GP between 2005 and 2012. Utilisation of 75+ Health Assessments, General Practitioner Management Plans (GPMP), Team Care Arrangements (TCAs) or reviews, or Medication Management Reviews (MMRs) was assessed. There were 12962 (60.6%) patients assigned at least one of the MBS items. The highest level of claiming was for GPMPs (n=4754 35.8%) and TCAs (n=4476 33.7%), with MMRs having the lowest use (n=1023 6.8%). Examination of GP and patient barriers to the uptake of these items is needed, along with a greater understanding as to whether those most at risk of hospitalisation are receiving these services. Strategies that support capacity to implement these items are also required.
Trends in GP prescribing of psychotropic medications among young patients aged 16-24 years
Publisher: Springer Science and Business Media LLC
Date: 06-06-2017
‘Unprepared for the depth of my feelings’ - Capturing grief in older people through research poetry
Publisher: Oxford University Press (OUP)
Date: 03-2022
Abstract: Older people are more likely to experience bereavements than any other age group. However, in healthcare and society, their grief experiences and support needs receive limited attention. Through innovative, arts-based research poetry, this study aimed to capture older people’s bereavement stories and the effects of grief on their physical and mental health. Semi-structured in-depth interviews with 18 bereaved older adults were analysed using thematic and poetic narrative analysis, following a five-step approach of immersion, creation, critical reflection, ethics and engagement. Research poems were used to illustrate three themes of bereavement experiences among older adults: feeling unprepared, accumulation of losses and ripple effects of grief. While half of participants reported that the death of their family member was expected, many felt unprepared despite having experienced multiple bereavements throughout their life. Instead, the accumulation of losses had a compounding effect on their health and well-being. While these ripple effects of grief focussed on emotional and mental health consequences, many also reported physical health effects like the onset of a new condition or the worsening of an existing one. In its most extreme form, grief was connected with a perceived increased mortality risk. By using poetry to draw attention to the intense and often long-lasting effects of grief on older people’s health and well-being, this article offers emotional, engaging and immersive insights into their unique bereavement experiences and thereby challenges the notion that grief has an expiry date.
After-hours medical deputising services: Patterns of use by older people
Publisher: AMPCo
Date: 11-2016
DOI: 10.5694/MJA16.00218
Abstract: To examine how older people use an after-hours medical deputising service that arranges home visits by locum general practitioners to identify differences in how people who live in the community and those who live in residential aged care facilities (RACFs) use this service. Retrospective analysis of routinely collected administrative data from the Melbourne Medical Deputising Service (MMDS) for the 5-year period, 1 January 2008 - 31 December 2012. Data for older people (≥ 70 years old) residing in greater Melbourne and surrounding areas were analysed. Numbers and rates of MMDS bookings for acute after-hours care, stratified according to living arrangements (RACF v community-dwelling residents). Of the 357 112 bookings logged for older patients during 2008-2012, 81% were for RACF patients, a disproportionate use of the service compared with that by older people dwelling in the community. Most MMDS bookings resulted in a locum GP visiting the patient. During 2008-2012, the booking rate for RACFs increased from 121 to 168 per 1000 people aged 70 years or more, a 39% increase the booking rate for people not living in RACFs increased from 33 to 40 per 1000 people aged 70 years or more, a 21% increase. After-hours locum GPs booked through the MMDS mainly attended patients living in RACFs during 2008-2012. Further research is required to determine the reasons for differences in the use of locum services by older people living in RACFs and in the community.
Becoming a patient-illness representations of depression of Anglo-Australian and Sri Lankan patients through the lens of Leventhal’s illness representational model
Publisher: SAGE Publications
Date: 08-08-2017
Abstract: Depression is prevalent globally. While the uptake of mental health services is poor in the general community, the lack of service engagement is particularly profound in migrant and refugee communities. To understand why there is under-utilisation cross-cultural comparisons of how people make sense of mental illnesses such as depression are essential. To verify how differing cultural aetiologies about depression influence mental health service use, this study investigated illness representational models of depression held by Sri Lankan migrants and Anglo-Australians living with depression. In-depth interviews ( n = 48) were conducted with Sri Lankan migrants and Anglo-Australians living with depression to explore their illness beliefs. Data were analysed using Leventhal’s illness representational model. Significant overlaps in illness representational models were noted but distinctive differences were found between causal and chronicity beliefs Sri Lankan migrants more frequently endorsed depression as a time-limited condition underpinned by situational factors, whereas Anglo-Australians endorsed a chronic, biopsychosocial model of depression. Findings highlight the importance of forging a shared understanding of patient beliefs in the clinical encounter to ensure that interventions are coherent with illness beliefs or at least work towards improving mental health literacy. Differences in illness beliefs also provide insights into possible interventions. For ex le, psychosocial interventions that align with their illness beliefs may be more suited to Sri Lankan migrants than pharmaceutical or psychological ones.
Empowering Dementia Carers With an iSupport Virtual Assistant (e-DiVA) in Asia-Pacific Regional Countries: Protocol for a Pilot Multisite Randomized Controlled Trial (Preprint)
Publisher: JMIR Publications Inc.
Date: 17-09-2021
Abstract: ementia is a global public health priority with an estimated prevalence of 150 million by 2050, nearly two-thirds of whom will live in the Asia-Pacific region. Dementia creates significant care needs for people with the disease, their families, and carers. iSupport is a self-help platform developed by the World Health Organization (WHO) to provide education, skills training, and support to dementia carers. It has been adapted in some contexts (Australia, India, the Netherlands, and Portugal). Carers using the existing adapted versions have identified the need to have a more user-friendly version that enables them to identify solutions for immediate problems quickly in real time. The iSupport virtual assistant (iSupport VA) is being developed to address this gap and will be evaluated in a randomized controlled trial (RCT). his paper reports the protocol of a pilot RCT evaluating the iSupport VA. even versions of iSupport VA will be evaluated in Australia, Indonesia, New Zealand, and Vietnam in a pilot RCT. Feasibility, acceptability, intention to use, and preliminary impact on carer-perceived stress of the iSupport VA intervention will be assessed. his study was funded by the e-ASIA Joint Research Program in November 2020. From January to July 2023, we will enroll 140 dementia carers (20 carers per iSupport VA version) for the pilot RCT. The study has been approved by the Human Research Committee, University of South Australia, Australia (203455). his protocol outlines how a technologically enhanced version of the WHO iSupport program—the iSupport VA—will be evaluated. The findings from this intervention study will provide evidence on the feasibility and acceptability of the iSupport VA intervention, which will be the basis for conducting a full RCT to assess the effectiveness of the iSupport VA. The study will be an important reference for countries planning to adapt and enhance the WHO iSupport program using digital health solutions. ustralian New Zealand Clinical Trials Registry ACTRN12621001452886 fum5tjz RR1-10.2196/33572
Ethics and the promotion of inclusiveness within qualitative research: Case examples from Asia and the Pacific
Publisher: SAGE Publications
Date: 25-01-2010
Abstract: Qualitative researchers are often confronted by ethical challenges when making research decisions because current guidelines and principles guiding research ethics do not wholly cover the concerns that can arise in complex social research situations. In this article, the authors explore this dilemma in relation to our experiences of conducting sensitive qualitative research with vulnerable groups in developing countries of Asia and the Pacific. With a focus on informed consent, the authors offer three case ex les to explicate the difficulties faced in matching ethics theory with proforma approval requirements, which may limit the application of more expansive approaches to research design. To conclude, the authors put forth recommendations for modifications to the ethics system as a whole to promote greater collaboration and inclusion of qualitative researchers to the review and practice of research ethics in Australia.
‘There for me’: A qualitative study of family communication and decision-making in end-of-life care for older people
Publisher: Informa UK Limited
Date: 30-05-2020
Do Web-based Mental Health Literacy Interventions Improve the Mental Health Literacy of Adult Consumers? Results From a Systematic Review
Publisher: JMIR Publications Inc.
Date: 20-06-2016
DOI: 10.2196/JMIR.5463
A 7-year trend analysis of the types, characteristics, risk factors, and outcomes of elder abuse in community settings
Publisher: Informa UK Limited
Date: 18-07-2021
Uncomfortable bedfellows: Employer perspectives on general practitioners’ role in the return-to-work process
Publisher: Informa UK Limited
Date: 2015
Self-reported depression and its associated factors among male inpatients admitted for substance use disorders in Saudi Arabia
Publisher: Informa UK Limited
Date: 09-06-2014
The impact of strict lockdowns on the mental health and well-being of people living in Australia during the first year of the COVID-19 pandemic
Publisher: Royal College of Psychiatrists
Date: 05-2023
DOI: 10.1192/BJO.2023.65
Abstract: There are limited longitudinal studies on the effects of the COVID-19 pandemic on mental health and well-being, including the effects of imposed restrictions and lockdowns. This study investigates how living in a pandemic, and related lockdowns and restrictions, affected the mental health of people living in Australia during the first year of the COVID-19 pandemic. A total of 875 people living in Australia participated in a longitudinal survey from 27 May to 14 December 2020. This time period includes dates that span pre-, during and post-wave 2 lockdowns in Australia, with strict and sustained public health measures. Linear mixed models were fitted to investigate the effect of lockdown on depression and anxiety symptoms. Symptoms of depression and anxiety improved over time, during and after lockdowns. More adverse mental health symptoms were observed for people with a history of medical or mental health problems, caring responsibilities, more neurotic personality traits or less conscientiousness, and for people who were younger. People who reported being more conscientious reported better mental health. Despite notoriously strict lockdowns, participants did not experience a deterioration of mental health over time. Results suggest a lack of significant adverse effects of lockdown restrictions on mental health and well-being. Findings highlight cohorts that could benefit from targeted mental health support and interventions, so that public policy can be better equipped to support them, particularly if future strict public health measures such as lockdowns are being considered or implemented for the COVID-19 pandemic and other disasters.
Dissonant views - GPs’ and parents’ perspectives on antibiotic prescribing for young children with respiratory tract infections
Publisher: Springer Science and Business Media LLC
Date: 28-03-2019
Why does institutionalised care not appeal to Indian families? Legislative and social answers from urban India
Publisher: Cambridge University Press (CUP)
Date: 09-06-2011
DOI: 10.1017/S0144686X11000584
Abstract: In India, although notions of ageing and care are changing, there is a continued preference among families for home-based care of elderly relatives. The legislative policies and cultural practices that shape this preference will be examined in this paper with specific reference to aged-care facilities and the 2007 Maintenance and Welfare of Parents and Senior Citizens Act . Using qualitative data from a study on dementia care in urban India it will be shown how the Act and old-age homes are understood and experienced by Indian families and key service providers. In juxtaposing policy and practice it will be argued that while notions of care are being redefined by processes like migration and urbanisation, the preference for home care remains, indicating that existing services need to be re-oriented and expanded to support families in providing this care.
Discipline in Chaos: Foucault, Dementia and Aging in India
Publisher: Springer Science and Business Media LLC
Date: 05-09-2008
DOI: 10.1007/S11013-008-9111-5
Abstract: In India, care work for people in late-stage dementia is primarily conducted in the home. Using source material from urban India and drawing on Foucauldian theory, we illustrate the significance of three power/knowledge scripts in this context: social and cultural notions of acceptable, public bodies medicalized forms of care and the cultural contexts of the in idual caregivers. The caregiver is the embodiment of these discourses and is charged with the task of mapping discipline onto inherently undisciplinable bodies. A tension exists between the caregiver's struggle to contain the unruliness of the person with dementia and, simultaneously, to act as a broker between the world of the care-recipient and the social world. We conclude that although the caregiver is the starting point for the exercise of discipline, the three power/knowledge scripts that inform care work are as much about surveying, routinizing and mobilizing caregivers' bodies as they are about disciplining the bodies of people with dementia.
“The mind may go, but the heart knows”: Emotional care by ethnic minority carers of people living with dementia
Publisher: Elsevier BV
Date: 09-2021
The MINDSET Study: Co-Designing Training for Interpreters in Dementia and Cognitive Assessments
Publisher: SAGE Publications
Date: 16-07-2023
DOI: 10.1177/14713012231190578
Abstract: There is a growing demand for interpreter-mediated cognitive assessments for dementia. However, most interpreters lack specialist knowledge of dementia and cognitive assessment tools. This can negatively affect the way instructions and responses are conveyed between clinicians and patients, undermining clinicians’ ability to accurately assess for cognitive impairment. This article reports on the co-design of an online dementia training package, MINDSET, which aims to address this gap. Two iterative online co-design workshops were conducted in October and November 2021, using a World Café approach. Sixteen clinicians, interpreters, and multilingual family carers of a person with dementia participated. Based on these workshops, training and assessment materials were developed and tested with 12 interpreters from April to June 2022. The training package comprises online modules: 1) Knowledge of Dementia and Australia’s Aged Care System, 2) Briefings and Introductions, 3) Interpreting Skills, 4) Interpreting Ethics, and 5) Cross-cultural Communication. The codesign process highlighted ergent perspectives between clinicians and interpreters on an interpreter’s role during a cognitive assessment, but it also facilitated negotiation and consensus building, which enriched the training content. The training is now developed and will be evaluated in a randomized control trial and subsequent implementation study.
Investigating Patient Perspectives on Medical Returns and Buying Medicines Online in Two Communities in Melbourne, Australia: Results from a Qualitative Study
Publisher: Springer Science and Business Media LLC
Date: 21-08-2014
DOI: 10.1007/S40271-014-0082-Z
Abstract: By going online or overseas, patients can purchase a range of prescription and over-the-counter drugs and complementary and alternative medicine (CAM), without prescription and without input from a qualified health professional. Such practices raise questions about medicine safety and how and why patients choose to procure medicines using such methods. The aim of this paper is to examine two unconventional types of medicine procurement-medical returns and purchasing medicines online-from the patient perspective. Data are drawn from a large qualitative study examining health-seeking practices among Indian-Australians (28) and Anglo-Australians (30) living with depression in Melbourne, Australia. Semi-structured face-to-face interviews were undertaken. Thematic analysis was performed. A total of 23 (39.6 %) participants reported having obtained medicines either through the internet or via medical returns. Indian-Australians sourced medicines from India while Anglo-Australians purchased CAM products from domestic and international e-pharmacies. Neither group encountered any difficulties in the medicines entering Australia. Cost and convenience were the main reasons for buying medicines online but dissatisfaction with Australian health services also influenced why Indian-Australians sought medicines from India. Nearly all participants reported benefits from consuming these medicines only one person reported adverse effects. The increased availability of medicines transnationally and patients' preparedness to procure these medicines from a range of sources raise important issues for the safe use of medicines. Further research is needed to understand how patients forge their own transnational therapeutic regimes, understand and manage their levels of risk in relation to safe medicine use and what points of intervention might be most effective to promote safe medicine use.
Including ethnic and cultural diversity in dementia research
Publisher: AMPCo
Date: 27-09-2019
DOI: 10.5694/MJA2.50353
Factors associated with sickness certification of injured workers by General Practitioners in Victoria, Australia
Publisher: Springer Science and Business Media LLC
Date: 06-04-2016
Death of a Mwana : biomass fuels, poverty, gender and climate change.
Publisher: CABI
Date: 2014
What clinical challenges are associated with diagnosing and managing work-related mental health conditions? A qualitative study in general practice
Publisher: BMJ
Date: 08-2020
DOI: 10.1136/BMJOPEN-2020-037734
Abstract: When providing care for patients with work-related mental health conditions (MHCs), the general practitioner’s (GP) role includes clinical care, patient advocacy and assessment of a patient’s ability to work. GPs can experience difficulty representing these competing roles. As clinical guidelines were being developed to assist GPs in providing this care, our aim was to identify the clinical challenges GPs experience when diagnosing and managing patients with work-related MHCs. Qualitative research. This study was conducted in general practice and workers’ compensation settings across Australia. Twenty-five GPs, seven psychiatrists and nine compensation scheme workers. GPs were eligible to participate if they were actively treating (or treated within the previous three years) patient(s) who had submitted a workers’ compensation claim for a MHC. Psychiatrists and compensation scheme workers were eligible to participate if they were active in these roles, as they are best placed to identify additional clinical challenges GPs themselves did not raise. Participants were invited by letter to participate in qualitative semi-structured telephone interviews. Prior to each interview, participants were asked to reflect on two case vignettes, each depicting a patient’s illness trajectory over 12 months. Data were thematically analysed using inductive and deductive techniques and then categorised by stages of clinical reasoning. Participants reported clinical challenges across four key areas: (1) Diagnosis (identifying appropriate diagnostic tools, determining the severity and work-relatedness of a MHC, and managing the implications of labelling the patient with MHC). (2) Management (determining optimal treatment, recommending work participation). (3) Referral (ambiguity of communication pathways within compensation schemes). (4) Procedure (difficulties navigating compensation systems). We found that GPs experienced clinical challenges at all stages of care for people with work-related MHCs. We were also able to identify systemic and procedural issues that influence a GP’s ability to provide care for patients with work-related MHCs.
Emergency demand, repeat and frequent presentations by older patients in metropolitan melbourne: A retrospective cohort study using routinely collected hospital data
Publisher: Wiley
Date: 18-01-2018
Abstract: To describe patterns for potentially avoidable general practice (PAGP)-type and non-PAGP-type ED presentations by older patients during 2008 and 2012. Retrospective analysis of ED presentations by patients ≥70 years for 2008 and 2012. Metropolitan Melbourne public hospital data were obtained from the Victorian Emergency Minimum Dataset. Outcomes were characteristics of PAGP-type and non-PAGP-type presentations as defined by the Australian Institute of Health and Welfare numbers and rates per 1000 population ≥70 years of repeat (×2-3/year) and frequent (≥ ×4/year) PAGP-type and non-PAGP-type presentations. The older metropolitan Melbourne population increased by 10.3% between 2008 and 2012, whereas the number of ED presentations increased by 12.7%. The volume of PAGP-type presentations decreased by 2.6%, with declining rates per 1000 population ≥70 years of repeat (7.2-6.2) and frequent (0.7-0.4) presentation. In contrast, the volume of non-PAGP-type presentations grew by 15.4%, with increasing repeat (57.6-60.7) and frequent (13.1-14.2) presentation rates per 1000 population ≥70 years. The majority (39%) of non-PAGP-type presentations by frequent ED attenders were due to cardiovascular or respiratory problems. The rate of repeat and frequent PAGP-type presentations by older people decreased in 2012 compared with 2008, suggesting that initiatives implemented to reduce avoidable presentations may have had an effect. However, an increase in the rate of frequent non-PAGP-type presentations, predominately for acute exacerbation of cardiovascular and respiratory conditions, has important implications for planning future healthcare delivery hence, the importance of initiatives such as the Health Care Home.
Advancing methodologies to increase end-user engagement with complex interventions: The case of co-designing the Australian elder abuse screening instrument (AuSI)
Publisher: Informa UK Limited
Date: 20-10-2019
DOI: 10.1080/08946566.2019.1682098
Abstract: In Australia there is an absence of an elder abuse screening instrument that is widely accepted and that has been designed with, and for, end-users. This study aimed to develop an effective and acceptable elder abuse screening instrument by engaging with frontline professionals through a co-design process. To date, co-design methodologies are recommended to ensure successful adoption and implementation of complex interventions by end-users, but the scholarship is limited on the specific steps to achieve this as well as the pragmatics of such work. Addressing this lacunae, results demonstrate how qualitative methods align with a co-design approach underscore the importance of multidisciplinary perspectives showcase how to streamline complex processes into routine practice and accentuate the importance of good design. These are valuable insights necessary to develop inter-professional and community-based solutions to the challenge of elder abuse.
Managing workplace change: Intergenerational perspectives from Victorian public hospital nurses
Publisher: Elsevier BV
Date: 04-2021
When co-design works (sort of): the case of the Australian elder abuse screening instrument
Publisher: Informa UK Limited
Date: 11-07-2022
DOI: 10.1080/08946566.2022.2098218
Abstract: Applying co-design methodologies is increasingly recommended for engaging erse end-users and bridging evidence-practice gaps. Yet, one of the ongoing challenges for research using co-design is the lack of evidence as to whether co-design leads to better outcomes than not using co-design. In this article, we outline how, despite adhering to a time and resource intensive co-design process with strong moral and ethical foundations, its implementation by end-users led to mixed outcomes around improved elder abuse screening. We discuss the implications of these ambiguous results, arguing that "noise" in our data might be inevitable due to the inherent sensitivities associated with elder abuse screening and offer a polemical recommendation about why the Australian Elder Abuse Screening Instrument (AuSI) should nevertheless be rolled out.
Implementation & Dissemination Plan
Publisher: Figshare
Date: 2019
Past and projected growth of Australia’s older migrant populations
Publisher: Springer Science and Business Media LLC
Date: 05-08-2020
DOI: 10.1186/S41118-020-00091-6
Abstract: In recent years, Australia’s older population (aged 65 and over) has been growing rapidly, accompanied by a shift in its country of birth composition. Although a great deal of research has been undertaken on past and current aspects of Australia’s migrant groups, little attention has been paid to future demographic trends in older populations. The aim of this paper is to examine recent and possible future demographic trends of Australia’s migrant populations at the older ages. We present population estimates by country and broad global region of birth from 1996 to 2016, and then new birthplace-specific population projections for the 2016 to 2056 period. Our findings show that substantial growth of the 65+ population will occur in the coming decades, and that the overseas-born will shift from a Europe-born dominance to an Asia-born dominance. Cohort flow (the effect of varying sizes of cohorts moving into the 65+ age group over time) will be the main driver of growth for most older birthplace populations. The shifting demography of Australia’s older population signals many policy, planning, service delivery and funding challenges for government and private sector providers. We discuss those related to aged care, health care, language services, the aged care workforce, regulatory frameworks and future research needs in demography and gerontology.
Efficacy of depression treatments for immigrant patients: Results from a systematic review
Publisher: Springer Science and Business Media LLC
Date: 16-06-2014
Preventive healthcare for young children: A systematic review of interventions in primary care
Publisher: Elsevier BV
Date: 06-2017
DOI: 10.1016/J.YPMED.2017.02.024
Abstract: High rates of preventable health problems amongst children in economically developed countries have prompted governments to seek pathways for early intervention. We systematically reviewed the literature to discover what primary care-targeted interventions increased preventive healthcare (e.g. review child development, growth, vision screening, social-emotional health) for preschool children, excluding vaccinations. MEDLINE, EMBASE, CINAHL, and Cochrane databases were searched for published intervention studies, between years 2000 and 2014, which reflected preventive health activities for preschool children, delivered by health practitioners. Analysis included an assessment of study quality and the primary outcome measures employed. Of the 743 titles retrieved, 29 in idual studies were selected, all originating from the United States. Twenty-four studies employed complex, multifaceted interventions and only two were rated high quality. Twelve studies addressed childhood overweight and 11 targeted general health and development. Most interventions reported outcomes that increased rates of screening, recording and recognition of health risks. Only six studies followed up children post-intervention, noting low referral rates by health practitioners and poor follow-through by parents and no study demonstrated clear health benefits for children. Preliminary evidence suggests that multi-component interventions, that combine training of health practitioners and office staff with modification of the physical environment and/or practice support, may be more effective than single component interventions. Quality Improvement interventions have been extensively replicated but their success may have relied on factors beyond the confines of in idual or practice-led behaviour. This research reinforces the need for high quality studies of pediatric health assessments with the inclusion of clinical end-points.
Discrimination reported by older adults living with mental health conditions: types, contexts and association with healthcare barriers
Publisher: Springer Science and Business Media LLC
Date: 21-07-2020
Postconference Reflections by Emerging Scholars
Publisher: Wiley
Date: 06-2010
General practitioners and sickness certification for injury in Australia
Publisher: Springer Science and Business Media LLC
Date: 15-08-2015
The legislative and political contexts surrounding dementia care in India
Publisher: Cambridge University Press (CUP)
Date: 10-2008
DOI: 10.1017/S0144686X08007368
Abstract: Currently there is no specific policy on dementia care in India. Rather, the responsibility for care for people with dementia is not clearly articulated and formal care services straddle mental health and aged care. The result is that much care is placed upon in idual families. This paper critically reviews Indian legislative and policy documents on this field of care, namely, the Mental Health Act 1987 , the National Mental Health Programme, the National Policy on Older Persons and the Senior Citizen's Act 2007 . The invisibility of dementia care in public policy translates into the absence of adequate treatment facilities and mental health staff, and leaves informal care-giving unsupported. This gap is replicated in mental health and dementia-care research and literature in India, with little being known about how family carers respond to the experiences of care-giving, manage the stigma, and access support. As India, like other middle-income and low-income countries, is experiencing an increase in its older population, more research is needed to develop the epidemiological, medical and anthropological understanding of ageing, dementia and care. This knowledge is vital to understanding the cultural context of the disease and must also be incorporated into public health policy if there is to be effective management of the rising need for personal care.
Parents' decision making and access to preventive healthcare for young children: Applying Andersen's Model
Publisher: Wiley
Date: 25-06-2015
DOI: 10.1111/HEX.12100
Australian General Practitioners’ and Compensable Patients: Factors Affecting Claim Management and Return to Work
Publisher: Springer Science and Business Media LLC
Date: 04-02-2019
DOI: 10.1007/S10926-019-09828-3
Abstract: Purpose General Practitioners (GPs) play an important role in personal injury compensation systems yet system processes have been perceived as burdensome. Objectives were to (1) determine attitudes of Australian GPs on health benefits of return to work (RTW) after injury/illness and (2) identify associations between GP characteristics and agreement with issues surrounding treating compensable patients. Methods Cross-sectional postal survey of 423 Australian GPs to determine agreement with issues associated with compensable patients (including patient advocacy, conflicting opinions between GPs and compensation systems, fitness-for-work certification, and refusal to treat). Results The vast majority of GPs agreed there was a health benefit to early RTW. GPs with 16-20 years' experience had significantly higher odds of agreeing that the certificate of work capacity is the primary method of communication between RTW stakeholders (OR 2.36 [1.13-4.92]) than those with greater experience. 49% of GPs agreed they should be able to refuse to treat compensable patients. Female GPs had significantly lower odds (OR 0.60 [0.40-0.90]) of agreeing with right to refuse than male GPs, as did those from remote or regional practices (OR 0.43 [0.20-0.94] OR 0.60 [0.39-0.92]) than GPs from urban practices. Conclusions Reducing administrative barriers identified by Australian GPs and improving communication with compensation systems will likely have a positive impact on their refusal to treat compensable patients.
Use of the MMSE to screen for dementia in Delhi
Publisher: SAGE Publications
Date: 09-2011
Abstract: Screening tools are created and administered within specific political, cultural and clinical contexts that problematize their supposed universality. This paper, drawing on interviews and participant observation undertaken in 2008 in New Delhi in India, examines how clinical environments influence the interpretations and use of the Mini Mental State Examination (MMSE), a popular screening instrument for dementia. Findings indicate that while doctors recognize the limitations of the MMSE in theory, its continued use in practice is because of time shortages and competing work demands. Yet misdiagnosis or even false-positive screening has implications for service delivery and quality of care. Further research is necessary into how diagnoses are made, which account for cultural and structural variance.
Stakeholder perspectives on the new sickness certificate in Victoria: Results from a mixed-methods qualitative study
Publisher: CSIRO Publishing
Date: 2016
DOI: 10.1071/AH14136
Abstract: Objective The aim of this study was to present the views of four stakeholder groups, namely general practitioners (GP), employers (EMP), injured workers (IW) and compensation agents (CA), about the content and usability of the draft of the new Victorian sickness certificate. Methods A cross-sectional mixed-methods qualitative study was conducted in GP clinics and community settings in Melbourne, Australia. Interviews were conducted with GPs, EMPs and IWs and one focus group discussion was completed with CAs (n = 29). Data were collected between October and December 2013. Thematic analysis was performed. Results All stakeholders viewed the new draft certificate as an improvement on the old one. GPs saw the certificate as a form of communication, whereas EMPs and CAs saw it as a therapeutic device. GPs continued to certify based on incapacity and provided little information about what IWs could do on return to work. All groups said that assessments for mental health needed more clarity and specificity. GPs, EMPs and CAs also said that the new certificates must be electronically available and integrated into existing medical software to streamline uptake. Conclusions To ensure appropriate use of the new certificate, stakeholders must share a common understanding about its purpose and the certificate must be incorporated into existing medical software. Content on mental health assessment, an area of continued difficulty, needs additional refinement. The new certificate replaced the old certificate in March 2015 after it has been established in clinical practice, an impact evaluation should be completed to determine whether GPs are certifying capacity and earlier return to work. What is known about the topic? When it comes to sickness certification, GPs tend to focus on what injured patients cannot do, rather than what they can do. The new sickness certificate aims to change GP behaviour by focusing the certificate more on capacity (i.e. what the injured patient can do). What does this paper add? Four stakeholder groups agreed that the content and usability of the new certificate has improved. However, they agreed that the assessment of mental health capacity needs further specificity. Dissonances also remain between the stakeholders on the purpose of the certificate. What are the implications for practitioners? Appropriate use of the new certificate requires a common understanding about the purpose of the certificate, training on its appropriate use, incorporation into existing medical software and clarity on mental health assessment.
Beyond patient culture: filtering cultural presentations of depression through structural terms
Publisher: Informa UK Limited
Date: 30-06-2017
Designing Social Marketing Activities to Impact the Shaping of Expectations of Migrants in Health Service Encounters: The Case of African Migrant Blood Donation in Australia
Publisher: Springer International Publishing
Date: 2015
Barriers and enablers to delivery of the Healthy Kids Check: An analysis informed by the Theoretical Domains Framework and COM-B model
Publisher: Springer Science and Business Media LLC
Date: 23-05-2014
Playing With Antidepressants: Perspectives From Indian Australians and Anglo-Australians Living With Depression
Publisher: SAGE Publications
Date: 10-06-2016
Abstract: Patient perspectives were explored on the meaning and experience of antidepressant use by applying Johan Huizinga’s theory of play to interviews from Indian Australians and Anglo-Australians diagnosed with depression. Through the analysis, the centrality of Huizinga’s “magic circle” emerged, that is, defining the boundaries within which one could safely play. Consumption of antidepressants involved learning, breaking, and modulating rules of the game of adherence, then forging a new “magic circle.” In these games, there were playful elements including experimentation, improvisation, absorption, and experiential learning. This application of Huizinga’s theory in relation to antidepressant use is a novel approach in the literature on medication non/adherence. This application not only opens a new theoretical line of inquiry but also shows that antidepressant non/adherence is not a static practice but dynamic and changing, revealing critical insights around participant’s agency, capabilities, desires, and notions of selfhood with regard to managing their depression and conceptualizing their recovery.
Psychological distress among migrant groups in Australia: results from the 2015 National Health Survey
Publisher: Springer Science and Business Media LLC
Date: 28-10-2019
DOI: 10.1007/S00127-019-01782-Y
Abstract: To understand the relationship between migration and psychological distress, we (a) calculated the prevalence of psychological distress in specific migrant groups, and (b) examined the association between specific birth groups and psychological distress, while controlling for confounding variables to understand vulnerabilities across migrant groups. The prevalence of psychological distress, disaggregated by birthplace, was calculated using data from the Australian 2015 National Health Survey, which measures psychological distress via the Kessler Screening Scale for Psychological Distress (K10). Multivariable logistic regression models, with adjustments for complex survey design, were fitted to examine the association between country of birth and psychological distress once extensive controls for demographic, and socioeconomics factors were included. 14,466 in iduals ≥ 18 years completed the K10. Migrants from Italy (20.7%), Greece (20.4%), Southern and Eastern European (18.2%), and North African and Middle Eastern (21.9%) countries had higher prevalence estimates of distress compared to Australian born (12.4%) or those born in the United Kingdom (UK) (9.5%)-the largest migrant group in Australia. After adjusting for demographics, SES factors, duration in Australia, a birthplace in Italy (OR = 2.79 95% CI 1.4, 5.7), Greece (OR = 2.46 95% CI 1.1, 5.5), India (OR = 2.28 95% CI 1.3, 3.9), Southern and Eastern Europe (excluding Greece and Italy) (OR = 2.43 95% CI 1.5, 3.9), North Africa and the Middle East (OR = 3.39 95% CI 1.9, 6.2) was associated with increased odds of distress relative to those born in the UK. Illuminating variability in prevalence of psychological distress across migrant communities, highlights vulnerabilities in particular migrant groups, which have not previously been described. Identifying such communities can aid mental health policy-makers and service providers provide targeted culturally appropriate care.
The challenges of trying to increase preventive healthcare for children in general practice: Results of a feasibility study Epidemiology and research methodology in primary care
Publisher: Springer Science and Business Media LLC
Date: 05-08-2015
Boundary Crossers: How Providers Facilitate Ethnic Minority Families’ Access to Dementia Services
Publisher: Oxford University Press (OUP)
Date: 29-04-2022
Abstract: Providers who work closely with ethnic minority people with dementia and their families are pivotal in helping them access services. However, few studies have examined how these providers actually do this work. Using the concept of “boundary crossers,” this article investigates the strategies applied by these providers to facilitate access to dementia services for ethnic minority people with dementia and their families. Between 2017 and 2020, in-depth video-recorded interviews were conducted with 27 health, aged care, and community service providers working with ethnic minority people living with dementia across Australia. Interviews were conducted in one of seven languages and/or in English, then translated and transcribed verbatim into English. The data were analyzed thematically. Family and community stigma associated with dementia and extra-familial care were significant barriers to families engaging with services. To overcome these barriers, participants worked at the boundaries of culture and dementia, community and systems, strategically using English and other vernaculars, clinical and cultural terminology, building trust and rapport, and assisting with service navigation to improve access. Concurrently, they were cognizant of familial boundaries and were careful to provide services that were culturally appropriate without supplanting the families’ role. In negotiating cultural, social, and professional boundaries, providers undertake multidimensional and complex work that involves education, advocacy, negotiation, navigation, creativity, and emotional engagement. This work is largely undervalued but offers a model of care that facilitates social and community development as well as service integration across health, aged care, and social services.
Co-producing research with people impacted by dementia and service providers: issues and challenges
Publisher: The Sax Institute
Date: 2022
DOI: 10.17061/PHRP3222216
Investigating the Impacts of Acculturation Stress on Migrant Care Workers in Australian Residential Aged Care Facilities
Publisher: SAGE Publications
Date: 10-08-2020
Abstract: Migrant care workers are a growing portion of the aged care workforce in high-income countries. This study investigated the impacts of acculturation stress on the well-being of migrant care workers. A cross-sectional national survey was conducted among migrant care workers ( n = 272) across five Australian states and one territory using the Riverside Acculturation Stress Inventory (RASI) and Depression Anxiety Stress Scale (DASS 21). Acculturation stress was high ( M = 38.4 SD = 14.1 38.9% scored ≥40 out of 75), but respondents scored in the normal to mild ranges (85% to 93%) on the DASS 21 scale. Enrolled and registered nurses had the highest acculturation stress levels when compared with other occupational roles. Ethnicity, F(4, 254) = 11.0, p .001 occupational roles, F(3, 254) = 3.0, p = .03 and self-reported English proficiency, F(1, 254) = 4.17, p = .04, were statistically significant. Addressing acculturation stress may improve job satisfaction and retention among migrant care workers.
Management of respiratory tract infections in young children - A qualitative study of primary care providers' perspectives
Publisher: Springer Science and Business Media LLC
Date: 07-03-2017
DOI: 10.1038/S41533-017-0018-X
Abstract: Respiratory tract infections in young children are the most common cause of general practice visits in Australia. Despite the availability of clinical practice guidelines, the treatment and management of respiratory tract infections in young children is inconsistent. The aim of the study was to explore the management of respiratory tract infections in young children from a multi-disciplinary perspective using across-sectional qualitative research design based on the theoretical domains framework and the Capability, Opportunity and Motivation-B model. In-depth interviews were conducted with 30 primary care providers to explore their knowledge, views and management of respiratory tract infections in young children. Interviews focused on symptomatic management, over-the-counter medications and antibiotic use, and data were thematically analysed. Our findings showed that factors such as primary care providers’ time constraints, parental anxiety, general practitioners’ perception of what parents want, perceived parental pressure, and fear of losing patients were some of the reasons why primary care providers did not always adhere to guideline recommendations. Primary care providers also provided conflicting advice to parents concerning over-the-counter medications and when children should resume normal activities. Overall, this study showed that complex interactions involving emotional and psychological factors influenced the decision making process of primary care providers’ management of respiratory tract infections in young children. A team care approach with consistent advice, and improved communication between primary care providers and parents is vital to overcome some of these barriers and improve guideline adherence. The findings of this research will inform the development of interventions to better manage respiratory tract infections in young children.
Unplanned pregnancy and emergency contraception in Australia: Unsolved dilemmas
Publisher: Elsevier BV
Date: 04-2014
Applying the CHIME recovery framework in two culturally diverse Australian communities: Qualitative results
Publisher: SAGE Publications
Date: 12-03-2015
Abstract: CHIME (connectedness, hope and optimism about the future, identity, meaning in life and empowerment) is a framework for conceptualising personal recovery from mental illness. To date, there has been limited research on its cross-cultural applicability. To apply CHIME to two culturally erse groups’ conceptualisation of recovery from depression. Qualitative interviews with 30 Anglo-Australians and 28 Indian-Australians living with depression in Melbourne, Australia. Data were thematically analysed. Both groups valued connectedness but experienced stigma and struggled to broker family support. Identity, hope and optimism for the future were associated with positive thinking, being ‘cured’ and discontinuing treatment. Spirituality gave Indian participants meaning in life Anglos derived meaning from the illness experience itself. Feeling empowered, for both groups, was related to improved socio-economic status and being ‘settled’ (e.g. having gainful employment, a home and family). CHIME was applicable in both groups, but culture mediated how cross-cutting issues (e.g. stigma) and sub-components of CHIME were operationalised. Recovery was also influenced by participant’s socio-economic context. Research, policy and practice implications are discussed.
Mental Health Claims Management and Return to Work: Qualitative Insights from Melbourne, Australia
Publisher: Springer Science and Business Media LLC
Date: 20-03-2014
DOI: 10.1007/S10926-014-9506-9
Abstract: Mental health conditions (MHC) are an increasing reason for claiming injury compensation in Australia however little is known about how these claims are managed by different gatekeepers to injury entitlements. This study, drawing on the views of four stakeholders-general practitioners (GPs), injured persons, employers and compensation agents, aims to describe current management of MHC claims and to identify the current barriers to return to work (RTW) for injured persons with a MHC claim and/or mental illness. Ninety-three in-depth interviews were undertaken with GPs, compensation agents, employers and injured persons. Data were collected in Melbourne, Australia. Thematic techniques were used to analyse data. MHC claims were complex to manage because of initial assessment and diagnostic difficulties related to the invisibility of the injury, conflicting medical opinions and the stigma associated with making a MHC claim. Mental illness also developed as a secondary issue in the recovery process. These factors made MHC difficult to manage and impeded timely RTW. It is necessary to undertake further research (e.g. guideline development) to improve current practice in order to enable those with MHC claims to make a timely RTW. Further education and training interventions (e.g. on diagnosis and management of MHC) are also needed to enable GPs, employers and compensation agents to better assess and manage MHC claims.
Four Ways Geographic Information Systems Can Help to Enhance Health Service Planning and Delivery for Infectious Diseases in Low-Income Countries
Publisher: Project MUSE
Date: 2012
Abstract: Focusing specifically on infectious diseases in low-income countries, this paper discusses four ways Geographic Information Systems (GIS) can facilitate health service planning and delivery: (1) deeper insight into where health care services should be located (2) improved health surveillance and real-time planning for disease control and population health (3) stronger accountability and evidence-informed dialogue between funders and the service providers and (4) greater opportunities to translate complex data into more accessible formats which policymakers can quickly interpret and act on. Taking its use beyond just a research instrument, GIS is a way to undertake multidisciplinary work and improve health service planning and delivery.
An Asia Pacific six-country study on HIV-related discrimination: Introduction
Publisher: Informa UK Limited
Date: 07-2005
DOI: 10.1080/09540120500120195
Abstract: This paper outlines a six-country study of institutionalised forms of HIV/AIDS-related discrimination in the Asia-Pacific region. Although recognised as a barrier to disease prevention and treatment, very limited data are available on the effects of institutionalised HIV-related stigma and discrimination. Understanding the forms of discrimination within the institutions where they occur is the first step to identifying effective ways of promoting compassionate, non-discriminatory treatment of PLWHA. Thus, the goal of this research project was to document institutional discrimination against PLWHA, as guided by the UNAIDS Protocol for the Identification of Discrimination Against People Living with HIV (2000), in six Asian countries: India, Thailand, Philippines, China, Vietnam and Indonesia. As a precursor to the six in idual studies, this paper provides a brief overview of the literature on HIV discrimination, and then describes the UNAIDS Protocol and the shared methodological considerations relevant to all of the study sites. Commonalities in s ling, procedures and analysis are also discussed.
“Keeping our distance”: Older adults' experiences during year one of the COVID-19 pandemic and lockdown in Australia
Publisher: Elsevier BV
Date: 12-2023
In an interconnected world: joint research priorities for the environment, agriculture and infectious disease
Publisher: Springer Science and Business Media LLC
Date: 2014
Quality of life and loneliness post-bereavement: Results from a nationwide survey of bereaved older adults
Publisher: Informa UK Limited
Date: 17-12-2022
It's aboutTIME1: Engendering AIDS in Africa
Publisher: Informa UK Limited
Date: 07-2007
DOI: 10.1080/13691050601167515
Abstract: This paper analyses how TIME magazine represents sub-Saharan African women in its coverage of HIV/AIDS. As rates of infection escalate across the continent, researchers are increasingly emphasising the need to understand the socioeconomic and cultural contexts that make women particularly vulnerable to infection. Yet popular media representations of AIDS continue to rely on older colonial imageries of Africa as the feminised, diseased 'dark continent'. This article identifies three major themes in TIME's representation of sub-Saharan African women and HIV/AIDS: the metaphor of Africa as a woman in crisis, the construction of women as the means of transmission, and the engendered nature of the debate about the impact of international development policies. It is argued that the reliance on familiar cultural narratives often obscures the epidemiological, economic and cultural realities within which sub-Saharan women live. Not merely a consequence of unprotected sex, AIDS in sub-Saharan Africa is also the result of global economics and politics, reflecting the inequities between the West and Africa, male and female, white and black. The paper concludes with a call for further research on the role of representations of HIV/AIDS and its actual routes of transmission.
Visibility and transmission: complexities around promoting hand hygiene in young children – a qualitative study
Publisher: Springer Science and Business Media LLC
Date: 11-04-2019
'Can they really identify mental health problems at the age of three?' Parent and practitioner views about screening young children's social and emotional development
Publisher: SAGE Publications
Date: 11-02-2013
Abstract: To report the views of parents, general practitioners and practice nurses on the proposed changes to incorporate social and emotional health checks of three-year-olds into the Healthy Kids Check, a one-off pre-school health assessment delivered through general practice. Participants were recruited from three socio-culturally erse urban areas of Melbourne for a qualitative study involving 28 parent interviews and six focus groups with a total of 40 practitioners. Participants discussed child social and emotional development, health-seeking and preventive health care for young children. Transcripts were thematically analysed. Common themes showed: (i) Although both parents and practitioners were receptive to the idea of social and emotional screening, parents had limited knowledge about mental health issues for young children and the need for early intervention. (ii) All groups questioned the current capabilities of practice staff to identify problems, and practitioners expressed a need for further training and tools. (iii) Parents and practitioners cautioned that screening may increase parental anxiety and lead to unnecessary referrals. Practitioners countered this with ex les of cases not recognised by parents. (iv) Participants questioned the value of earlier identification of problems without effective and accessible therapeutic pathways. For programmes to be effective, parents need to be reminded of the benefits of early intervention and encouraged to attend preventive health appointments. Practitioners require further training and tools specific to the primary care setting. Further investment in specialist and allied health services is considered essential to assure better outcomes for young children’s mental health following screening and referral. Practitioners welcome a more collaborative relationship with other professionals (e.g. early educators) in assessing children’s social and emotional development. General practice has the capability but requires a more structured approach to assessing the social and emotional health of young children.
Identified health concerns and changes in management resulting from the healthy kids check in two Queensland practices
Publisher: AMPCo
Date: 04-2015
DOI: 10.5694/MJA14.01557
FAMILIAL BONDS AND BOARDING PASSES: UNDERSTANDING CAREGIVING IN A TRANSNATIONAL CONTEXT
Publisher: Informa UK Limited
Date: 14-01-2009
Legitimising depression: community perspectives and the help-seeking continuum
Publisher: Informa UK Limited
Date: 02-09-2019
General practitioners knowledge and management of whiplash associated disorders and post-traumatic stress disorder
Publisher: Springer Science and Business Media LLC
Date: 20-07-2016
Focused Attention on Positive Aspects of Dementia Care in Culturally and Linguistically Diverse Communities: Qualitative Insights from Australia
Publisher: Informa UK Limited
Date: 26-12-2022
Can the London 2012 Olympics 'inspire a generation' to do more physical or sporting activities? An overview of systematic reviews
Publisher: BMJ
Date: 2013
Is clinician refusal to treat an emerging problem in injury compensation systems?: Table 1
Publisher: BMJ
Date: 2016
Current contraceptive management in Australian general practice: An analysis of BEACH data
Publisher: AMPCo
Date: 07-2012
DOI: 10.5694/MJA11.11599
Abstract: To determine current contraceptive management by general practitioners in Australia. Analysis of data from a random s le of 3910 Australian GPs who participated in the Bettering the Evaluation and Care of Health (BEACH) survey, a continuous cross-sectional survey of GP activity, between April 2007 and March 2011. Consultations with female patients aged 12-54 years that involved all forms of contraception were analysed. GP and patient characteristics associated with the management of contraception types of contraception used rates of encounters involving emergency contraception. Increased age, ethnicity, Indigenous status and holding a Commonwealth Health Care Card were significantly associated with low rates of encounters involving management of contraception. The combined oral contraceptive pill was the most frequently prescribed method of contraception, with moderate prescription of long-acting reversible contraception (LARC), especially among women aged 34-54 years. Rates of consultations concerned with emergency contraception were low, but involved high rates of counselling, advice or education (48%) compared with encounters for general contraception (> 20%). A shift towards prescribing LARC, as recommended in clinical guidelines, has yet to occur in Australian general practice. Better understanding of patient and GP perspectives on contraceptive choices could lead to more effective contraceptive use.
End-of-life care for older first-generation migrants: A scoping review
Publisher: BMJ
Date: 09-12-2020
DOI: 10.1136/BMJSPCARE-2020-002617
Abstract: The unprecedented scale of contemporary migration across countries over the last decade means that ageing and dying occur in a more globalised, multicultural context. It is therefore essential to explore the end-of-life experiences of older people from migrant backgrounds. A scoping review of peer-reviewed articles published in English from 2008 to 2018. Included studies addressed end-of-life preferences, attitudes, values and beliefs of first-generation international migrants who were at least 50 years of age. Fifteen studies met the inclusion criteria for this review, which addressed six key themes: (1) the reluctance among older migrants and their families to talk about death and dying (2) difficult communication in patient-clinician relationships (3) the contrast between collectivistic and in idualistic norms and its associated end-of-life preferences (4) limited health literacy in older adults from migrant backgrounds (5) experiences with systemic barriers like time pressure, inflexibility of service provision and lack of cultural sensitivity and (6) the need for care providers to appreciate migrants’ ‘double home experience’ and what this means for end-of-life decision-making regarding place of care and place of death. To respond effectively to an increasingly culturally erse population, healthcare staff, researchers and policymakers need to invest in the provision of culturally sensitive end-of-life care. Areas for improvement include: (a) increased awareness of cultural needs and the role of family members (b) cultural training for healthcare staff (c) access to interpreters and translated information and (d) involvement of older migrants in end-of-life discussions, research and policymaking.
Improving the lives of ethnically diverse family carers and people living with dementia using digital media resources – Protocol for the Draw-Care randomised controlled trial
Publisher: SAGE Publications
Date: 2023
How are older people’s care preferences documented towards the end of life?
Publisher: Elsevier BV
Date: 06-2020
Alzheimer's and the Indian Appetite
Publisher: Informa UK Limited
Date: 11-2011
DOI: 10.1080/01459740.2011.582473
Abstract: Activities such as cooking, feeding, and eating speak to the pleasures and difficulties of caring for a person with dementia. In this article, I draw on ethnographic data from Delhi to examine the links between three types of food and caregiving in relation to sweetness and pleasure, drug foods and containment, and the feeding tube and sustaining life. I will illustrate that food offers ways to retain identity, build relations, improve function, and show love. In so doing, I contribute to our understanding of how care is conceived cross-culturally and offer potential insight into how interventions using food can enhance personal relationships in home and institutional settings.
International Migration and Australia’s Population
Publisher: Springer International Publishing
Date: 2021
Introduction
Publisher: Springer International Publishing
Date: 2021
Do ethnic patients report longer lung cancer intervals than Anglo-Australian patients?: Findings from a prospective, observational cohort study
Publisher: Hindawi Limited
Date: 26-07-2021
DOI: 10.1111/ECC.13492
Integrating socio-cultural paradigms in nonprofit marketing—the case of blood donation among African communities in Australia
Publisher: Springer Science and Business Media LLC
Date: 09-07-2010
Birthplace Population Profiles
Publisher: Springer International Publishing
Date: 2021
Discussion and Conclusions
Publisher: Springer International Publishing
Date: 2021
The Future Demography of Australia’s Migrant Populations
Publisher: Springer International Publishing
Date: 2021
Projection Methods, Data and Assumptions
Publisher: Springer International Publishing
Date: 2021
Health literacy and older adults: Findings from a national population‐based survey
Publisher: Wiley
Date: 15-07-2023
DOI: 10.1002/HPJA.779
Abstract: With an ageing population and growing complexity and fragmentation of health care systems, health literacy is increasingly important in managing health. This study investigated health literacy strengths and challenges reported by older Australians (people aged 65 or over) and identified how socio‐demographic and health factors related to their health literacy profiles. The s le comprised 1578 in iduals responding to the Australian Government's 2018 Health Literacy Survey, conducted between January and August. Regression modelling was used to estimate the association between each of nine domains of the Health Literacy Questionnaire (HLQ) and in idual socio‐demographic and health characteristics. The model allowed for correlation between HLQ scores that was linked to unobserved characteristics of in iduals. Across the health literacy domains, few in iduals received mean scores in the lowest score range. Key in idual characteristics associated with higher health literacy were increasing age, English proficiency, higher education levels, better self‐assessed health and having certain chronic conditions (cancer, hypertension and arthritis). Our findings suggest that, among those aged 65 or over, being older or living with chronic illnesses were associated with greater confidence in engaging with providers, accessing information and navigating health services compared to in iduals aged 65–69 and those older in iduals without chronic illness. Lower health literacy was associated with psychological distress and low English proficiency. Interventions to improve in idual health literacy and organisation health literacy responsiveness to minimise complexity of the Australian health system are required. This may enhance uptake and use of health information and services for the underserviced members of the community.
Barriers to blood donation in African communities in Australia: the role of home and host country culture and experience
Publisher: Wiley
Date: 18-02-2011
DOI: 10.1111/J.1537-2995.2010.03053.X
Abstract: An influx of African migrants and refugees can strain a host country's blood services, because often migrants have unique blood needs that cannot be sourced from local donors. To increase blood donation by the new migrants, host country blood services need to understand how blood and blood donations are viewed by immigrant communities, because recruitment models that are not culturally adapted may have limited success. Nine focus groups representing a cross-section of Australian-based African communities were conducted in multiple languages, facilitated by bilingual workers. The qualitative protocol was guided by the literature on blood donation by African migrants and communities in Africa. Thematic analysis identified the relevance of issues previously included in the literature and whether other issues facilitated or prohibited blood donation. Home country cultural issues were not generally raised as barriers to donation, and respondents were positively disposed toward donation. Home country experiences shaped respondents' views in Australia. Participants focused on assisting "in iduals in need," rather than giving to a blood service that many viewed with suspicion because of issues in their home country. There was a lack of knowledge about the donation process in Australia. More importantly, respondents perceived that their blood would not be wanted, based on a perception of host country mistrust and discrimination. Developing an intervention that encourages migrants to donate blood needs to be culturally focused. It appears that addressing perceptions based on home country experiences is essential. Overcoming a general perception of discrimination is beyond any blood service, but there can be an attempt to ensure that blood donation is seen as an inclusive process-blood from everyone, for everyone.
Build rapport, otherwise no screening tools in the world are going to help: Frontline service providers' views on current screening tools for elder abuse
Publisher: Oxford University Press (OUP)
Date: 20-12-2020
Abstract: Without an effective screening tool, accompanied by clear guidelines of what to do when elder abuse is suspected, health workers may face challenges when asking questions about elder abuse. This study aimed to find the most effective and acceptable existing elder abuse screening tool and to create guidelines for using the tool. A rapid review of the literature identified existing validated elder abuse screening tools. Then, 5 tools (Vulnerability to Abuse Screening Scale [VASS], Elder Abuse Suspicion Index [EASI], Elder Assessment Instrument [EAI], Caregiver Abuse Screen [CASE], and Brief Abuse Screen for the Elderly [BASE]), selected based on their internal rigor, were presented to health professionals to assess the tools’ relevance to their practice. Three focus groups were held with 23 health professionals in Victoria, Australia, in 2017. Data were thematically analyzed. None of the tools were deemed suitable by participants for use in their practice. Criticisms of the tools included: using outdated terminology, asking binary questions, asking multiple questions at once, failure to consider the older person’s cognitive status, failure to consider how culture mediates elder abuse, and failure to outline a referral pathway to those administering the tool. Participants emphasized that the screening tool must promote trust and rapport between the assessor and the older person to solicit a story on this sensitive subject. A successful elder abuse screening tool must be concise, easy to use, account for the older person’s health and social vulnerabilities, and outline a referral pathway if elder abuse is suspected.
Chapter 9: The Face of Elder Abuse in Australia
Publisher: Springer International Publishing
Date: 2023
Pills, pluralism, risk and citizenship: Theorising e-pharmacies
Publisher: Springer Science and Business Media LLC
Date: 13-08-2012
Appropriation and Dementia in India
Publisher: Springer Science and Business Media LLC
Date: 12-08-2011
DOI: 10.1007/S11013-011-9230-2
Abstract: Biomedical technologies like MRI scans offer a way for carers and people with dementia to 'see' pathology, as a means to reorient their perceptions of the body and functionality. Through interpretive and syncretic processes, the MRI and the diagnosis of dementia facilitate the incorporation of the clinical category 'dementia' into social understandings of illness and care in India. Complex shifts occur as families and providers move from socio-cultural explanations of disruption to bio-social etiologies of the disease 'dementia' and then to socio-ecological frameworks of causality. Both the biomedicalisation of illness and the localisation of illness occur as the clinical category 'dementia' is folded into local understandings of illness and care. Through elucidating how the dialectic between biomedical and local knowledge is operationalized, we offer insights into how dementia is absorbed and appropriated into Indian cultural contexts.
Respiratory tract infections among children younger than 5 years: Current management in Australian general practice
Publisher: AMPCo
Date: 03-2015
DOI: 10.5694/MJA14.00090
Abstract: To explore the current management in Australian general practice of common respiratory tract infections (RTIs) in children younger than 5 years. Analysis of data from a s le of 4522 general practitioners who participated in the Bettering the Evaluation and Care of Health (BEACH) cross-sectional survey, April 2007 to March 2012. Consultations with children younger than 5 years were analysed. GPs' management of four common RTIs (acute upper RTI [URTI], acute bronchitis/bronchiolitis, acute tonsillitis, and pneumonia) in association with six management options: antibiotic medications prescribed or supplied non-antibiotic medications medications advised for over-the-counter purchase referrals pathology testing and counselling. Of 31 295 encounters recorded, at least one of the four selected paediatric RTIs was managed at 8157 encounters. URTI was managed 18.6 times per 100 GP patient encounters, bronchitis/bronchiolitis 4.2 times, acute tonsillitis 2.7 times, and pneumonia 0.6 times per 100 encounters. Antibiotics were prescribed most frequently for tonsillitis and least frequently for URTI. Male GPs prescribed antibiotics for URTI significantly more often than female GPs, while older GPs prescribed antibiotics for URTI more often than younger GPs. GP management of paediatric RTIs in Australia varied according to the clinical problem and with age and sex of the GP. Further research into parents' and health professionals' attitudes and practices regarding the role of antibiotics, over-the-counter medications, and hygiene will help maintain favourable management practices.
Emergency department utilisation by older people in metropolitan Melbourne, 2008-12: Findings from the Reducing Older Patient's Avoidable Presentations for Emergency Care Treatment (REDIRECT) study
Publisher: CSIRO Publishing
Date: 2017
DOI: 10.1071/AH16191
Abstract: Objective Older patients are over-represented in emergency departments (ED), with many presenting for conditions that could potentially be managed in general practice. The aims of the present study were to examine the characteristics of ED presentations by older patients and to identify patient factors contributing to potentially avoidable general practitioner (PAGP)-type presentations. Methods A retrospective analysis was performed of routinely collected data comprising ED presentations by patients aged ≥70 years at public hospitals across metropolitan Melbourne from January 2008 to December 2012. Presentations were classified according to the National Healthcare Agreement definition for PAGP-type presentations. Presentations were characterised according to patient demographic and clinical factors and were compared across PAGP-type and non-PAGP-type groups. Results There were 744 519 presentations to the ED by older people, of which 103 471 (13.9%) were classified as PAGP-type presentations. The volume of such presentations declined over the study period from 20 893 (14.9%) in 2008 to 20 346 (12.8%) in 2012. External injuries were the most common diagnoses (13 761 13.3%) associated with PAGP-type presentations. Sixty-one per cent of PAGP-type presentations did not involve either an investigation or a procedure. Patients were referred back to a medical officer (including a general practitioner (GP)) in 58.7% of cases. Conclusion Older people made a significant number of PAGP-type presentations to the ED during the period 2008–12. A low rate of referral back to the primary care setting implies a potential lost opportunity to redirect older patients from ED services back to their GPs for ongoing care. What is known about the topic? Older patients are increasingly attending EDs, with a proportion attending for problems that could potentially be managed in the general practice setting (termed PAGP-type presentations). What does this paper add? This study found that PAGP-type presentations, although declining, remain an important component of ED demand. Patients presented for a wide array of conditions and during periods that may indicate difficulty accessing a GP. What are the implications for practitioners? Strategies to redirect PAGP-type presentations to the GP setting are required at both the primary and acute care levels. These include increasing out-of-hours GP services, better triaging and appointment management in GP clinics and improved communication between ED clinicians and patients’ GPs. Although some strategies have been implemented, further examination is required to assess their ongoing effectiveness.
A New Plea to Focus on the End-of-Life Needs of People with Severe Mental Illnesses.
Publisher: Informa UK Limited
Date: 19-07-2019
Defining key questions for clinical practice guidelines: a novel approach for developing clinically relevant questions
Publisher: Springer Science and Business Media LLC
Date: 29-09-2020
DOI: 10.1186/S12961-020-00628-3
Abstract: There is no standardised protocol for developing clinically relevant guideline questions. We aimed to create such a protocol and to apply it to developing a new guideline. We reviewed international guideline manuals and, through consensus, combined steps for developing clinical questions to produce a best-practice protocol that incorporated qualitative research. The protocol was applied to develop clinical questions for a guideline for general practitioners. A best-practice protocol incorporating qualitative research was created. Using the protocol, we developed 10 clinical questions that spanned diagnosis, management and follow-up. Guideline developers can apply this protocol to develop clinically relevant guideline questions.
Empowering Dementia Carers With an iSupport Virtual Assistant (e-DiVA) in Asia-Pacific Regional Countries: Protocol for a Pilot Multisite Randomized Controlled Trial
Publisher: JMIR Publications Inc.
Date: 16-11-2021
DOI: 10.2196/33572
Abstract: Dementia is a global public health priority with an estimated prevalence of 150 million by 2050, nearly two-thirds of whom will live in the Asia-Pacific region. Dementia creates significant care needs for people with the disease, their families, and carers. iSupport is a self-help platform developed by the World Health Organization (WHO) to provide education, skills training, and support to dementia carers. It has been adapted in some contexts (Australia, India, the Netherlands, and Portugal). Carers using the existing adapted versions have identified the need to have a more user-friendly version that enables them to identify solutions for immediate problems quickly in real time. The iSupport virtual assistant (iSupport VA) is being developed to address this gap and will be evaluated in a randomized controlled trial (RCT). This paper reports the protocol of a pilot RCT evaluating the iSupport VA. Seven versions of iSupport VA will be evaluated in Australia, Indonesia, New Zealand, and Vietnam in a pilot RCT. Feasibility, acceptability, intention to use, and preliminary impact on carer-perceived stress of the iSupport VA intervention will be assessed. This study was funded by the e-ASIA Joint Research Program in November 2020. From January to July 2023, we will enroll 140 dementia carers (20 carers per iSupport VA version) for the pilot RCT. The study has been approved by the Human Research Committee, University of South Australia, Australia (203455). This protocol outlines how a technologically enhanced version of the WHO iSupport program—the iSupport VA—will be evaluated. The findings from this intervention study will provide evidence on the feasibility and acceptability of the iSupport VA intervention, which will be the basis for conducting a full RCT to assess the effectiveness of the iSupport VA. The study will be an important reference for countries planning to adapt and enhance the WHO iSupport program using digital health solutions. Australian New Zealand Clinical Trials Registry ACTRN12621001452886 fum5tjz PRR1-10.2196/33572
The LEAD study protocol: A mixed-method cohort study evaluating the lung cancer diagnostic and pre-treatment pathways of patients from Culturally and Linguistically Diverse (CALD) backgrounds compared to patients from Anglo-Australian backgrounds
Publisher: Springer Science and Business Media LLC
Date: 21-07-2018
The experience of structural burden for culturally and linguistically diverse family carers of people living with dementia in Australia
Publisher: Hindawi Limited
Date: 22-05-2022
DOI: 10.1111/HSC.13853
Changes in refugees' mental health: what can granular analyses show?
Publisher: Elsevier BV
Date: 2021
‘It’s Too nice’ : Adapting iSupport Lite for Ethnically Diverse Family Carers of a Person with Dementia
Publisher: Informa UK Limited
Date: 11-09-2023
The ageing of Asian migrant populations in Australia: projections and implications for aged care services
Publisher: Informa UK Limited
Date: 16-07-2022
Including ethnic minorities in dementia research: Recommendations from a scoping review
Publisher: Wiley
Date: 2022
DOI: 10.1002/TRC2.12222
Abstract: Ethnicity influences dementia etiology, prognosis, and treatment, while culture shapes help‐seeking and care. Despite increasing population ersity in high‐income settlement countries, ethnic minorities remain underrepresented in dementia research. We investigated approaches to enhance the recruitment, and consistent collection and analysis of variables relevant to, ethnic minorities in dementia studies to make recommendations for consistent practice in dementia research. We did a scoping review, searching Embase, PsycINFO, Medline, CENTRAL, and CINAHL between January 1, 2010 and January 7, 2020. Dementia clinical and cohort studies that actively recruited ethnic minorities in high‐income countries were included. A steering group of experts developed criteria through which high‐quality studies were identified. Sixty‐six articles were retrieved (51 observational 15 experimental). Use of interpreters and translators (n = 17) was the most common method to facilitate participant recruitment. Race and ethnicity (n = 59) were the most common variables collected, followed by information on native language (n = 14), country of birth (n = 9), and length of time in country of settlement (n = 8). Thirty‐three studies translated or used a culturally validated instrument. Twenty‐three articles conducted subgroup analyses based on ethnicity. Six high‐quality studies facilitated inclusion through community engagement, collected information on multiple aspects of ethnic ersity, and adjusted/substratified to analyze the impact of ethnicity on dementia. We make recommendations for consistent recruitment, collection, and reporting of variables relating to ethnic and cultural ersity in dementia research.
Sickness certification of workers compensation claimants by general practitioners in Victoria, 2003-2010
Publisher: AMPCo
Date: 10-2013
DOI: 10.5694/MJA13.10508
Abstract: To examine patterns of the sickness certification of workers compensation claimants by general practitioners in Victoria, Australia, by nature of injury or illness. Retrospective analysis of Victorian workers compensation data for all injured and ill workers with an accepted workers compensation claim between 2003 and 2010. Type (unfit for work, alternative duties, or fit for work) and duration of initial medical certificates relating to workers compensation claims that were issued by GPs, in six categories of injury and illness. Of 124,424 initial medical certificates issued by GPs, 74.1% recommended that workers were unfit for work and 22.8% recommended alternative duties. Unfit-for-work certificates were issued to 94.1% of workers with mental health conditions, 81.3% of those with fractures, 79.1% of those with other traumatic injuries, 77.6% of those with back pain and strains, 68.0% of those with musculoskeletal conditions and 53.0% of those with other diseases. Alternative-duties certificates were significantly longer in duration than unfit-for-work certificates in all injury and illness categories (P < 0.001) but certificates for workers with musculoskeletal injuries and diseases, back pain and strains and other traumatic injuries were of lesser duration than those for workers with fractures, mental health conditions and other diseases. The high proportion of medical certificates recommending complete absence from work presents major challenges in terms of return to work, labour force productivity, the viability of the compensation system, and long-term social and economic development. There is substantial variation in the type and duration of medical certificates issued by GPs. People with mental health conditions are unlikely to receive a certificate recommending alternative duties. Further research is required to understand GP certification behaviour.
Powered mobility aid access on public transport: A validation study of compliance with disability standards
Publisher: Elsevier BV
Date: 09-2021
How do mental health practitioners operationalise cultural competency in everyday practice? A qualitative analysis
Publisher: Springer Science and Business Media LLC
Date: 20-06-2018
Using Digital Media to Improve Dementia Care in India: Protocol for a Randomized Controlled Trial
Publisher: JMIR Publications Inc.
Date: 02-06-2022
DOI: 10.2196/38456
Abstract: India is undergoing a demographic transition characterized by population aging and is witnessing a high dementia rate. Although nearly 7 million people live with dementia in India, dementia awareness is poor, and current resources addressing dementia care are basic and often incomplete, duplicated, or conflicting. To address this gap, this study aims to use digital media, which has had a massive technological uptake in India, to improve dementia care in India. The objective of this paper is to describe an intervention study design that examines the feasibility and acceptability of Moving Pictures India, a digital media resource to improve dementia care in India. This study employs a mixed methods design and is ided into 4 phases: (1) video interviews with Indian caregivers and health professionals (2) coproduction of resources (3) pilot randomized controlled trial (RCT) and (4) dissemination and analytics. The pilot RCT will follow an experimental parallel group design with 2 arms aiming to assess the impact, feasibility, and acceptability of the developed resources. The primary outcome measures for the pilot RCT will be feasibility and acceptability, while the secondary outcome measures will be caregiver burden, mood, and quality of life. This study received funding from the Alzheimer’s Association in the United States in July 2021. In 2023, we will enroll 60 dementia caregivers (40 caregivers in the intervention arm and 20 in the control) for the pilot RCT. The study has been approved by the National Institute of Mental Health and Neuro Sciences Ethics Committee (26th IEC (BEH.SC.DIV.)/2020-21 dated November 11, 2020) the Health Ministry's Screening Committee, India (proposal ID 2020-10137) the Curtin University Human Research Ethics Committee (approval number HRE2020-0735) and the NARI Research Governance Office (site-specific approval dated March 17, 2021). This protocol is designed to deliver unique, coproduced, and evidence-based media resources to support caregivers of persons with dementia in India and other countries aiming to utilize digital media for dementia care. If the intervention is found feasible and acceptable, postpiloting analytics and qualitative feedback will be used to develop an implementation trial to evaluate the effectiveness of the potential low-risk high-benefit intervention in practice. Clinical Trials Registry-India CTRI/2021/01/030403 ctri.nic.in/Clinicaltrials maindet2.php?trialid=50794 DERR1-10.2196/38456
Emergency contraception in Australia: The desired source of information versus the actual source of information
Publisher: AMPCo
Date: 04-2014
DOI: 10.5694/MJA13.10983
Abstract: To determine long-term trends in emergency contraception (EC) management by general practitioners in Australia. Data from April 2000 to March 2012 were drawn from the BEACH (Bettering the Evaluation and Care of Health) program, a continuous cross-sectional survey of GP activity. We analysed consultations involving EC management, unwanted pregnancy management and emergency contraceptive pill (ECP) prescribing per 1000 GP encounters with women aged 14-54 years. Summary statistics were calculated with 95% confidence intervals. In 2000-2001, GPs managed EC problems at a rate of 5.50 per 1000 encounters (95% CI, 4.37-6.63). From 2004, after the ECP became available over the counter (OTC) in pharmacies, EC management, which includes ECP prescription, progressively declined. By 2011-2012, only 1.43 EC problems were managed per 1000 encounters (95% CI, 0.84-2.02) and only 0.48 ECP prescriptions were provided per 1000 encounters (95% CI, 0.14-0.82). Yet the management rate of unwanted pregnancy problems stayed relatively constant (rate in 2000-2001, 0.95 per 1000 encounters 95% CI, 0.40-1.50 rate in 2011-2012, 0.88 per 1000 encounters 95% CI, 0.41-1.36). Low rates of EC management by GPs since ECP became available OTC suggest that women may be obtaining information on EC elsewhere. Further investigation is needed to uncover the sources of this information and its acceptability and application by Australian women.
The impact of training on communication quality during interpreter-mediated cognitive assessments: Study protocol for a randomized controlled trial
Publisher: Wiley
Date: 2022
DOI: 10.1002/TRC2.12349
Abstract: The number of Australian residents with dementia is projected to double by 2058, with 28% currently being migrants from non‐Anglophone countries. There will be growing demand for professional interpreters for cognitive assessments and dementia‐related health consultations in the future. Interpreting cognitive assessments can be challenging for interpreters inaccurate interpreting can influence assessment outcomes. The Improving Interpreting for Dementia Assessments (MINDSET) project will upskill interpreters through an online training course in dementia and cognitive assessments. The training has been co‐designed with key stakeholders from the interpreting sector, dementia‐related services, and family caregivers, and has been user‐tested with 12 interpreters. The training aims to improve the quality of interpreter‐mediated communication during cognitive assessments, and thereby improve the accuracy and acceptability of cognitive assessments with older people who have limited English proficiency. We are conducting a single‐blinded randomized controlled trial to evaluate the effectiveness of the training. We aim to enroll 150 interpreters, and allocate them to equal parallel groups. The intervention group will receive access to the MINDSET training, which comprises 4 hours of resources covering five domains: dementia knowledge, cross‐cultural communication, briefings and debriefings, interpreting skills, and interpreting ethics. The control group will be assigned to a wait list, and will receive access to the training after the trial. Participants will be assessed according to the five domains, via the Dementia Knowledge and Assessment Scale, multiple‐choice questions, video‐simulated assessments, and ethical scenarios. Assessments will occur at baseline (prior to the intervention group completing the training), 3 months after enrollment, and 6 months after enrollment. The trial is ongoing. Recruitment began in June 2022. This is the first time a training resource for interpreters in dementia has been trialed. If successful it may represent a technologically innovative way to offer training to both trainee and practicing interpreters. Interpreters are crucial in facilitating cognitive assessments for allophone speakers. Interpreters would benefit from training to improve assessment accuracy. Our study has co‐designed specialized dementia training for interpreters. This is a protocol to evaluate the training's efficacy in a randomized controlled trial.
Effective implementation approaches for healthy ageing interventions for older people: A rapid review
Publisher: Elsevier BV
Date: 2021
Don't forget health in sustainability talks
Publisher: Springer Science and Business Media LLC
Date: 06-2012
DOI: 10.1038/486191A
What is at stake? Exploring the moral experience of stigma with Indian-Australians and Anglo-Australians living with depression
Publisher: SAGE Publications
Date: 07-02-2018
Abstract: This article applies the framework of moral experience to examine the cultural experience of stigma with Indian-Australians and Anglo-Australians living with depression in Melbourne, Australia. To date few studies have examined this dynamic in relation to mental illness and culture, and no studies have applied this framework in a culturally comparative way. Based on 58 in-depth interviews with people with depression recruited from the community, we explicate how stigma modulates what is at stake upon disclosure of depression, participants’ lived experience following that disclosure, and how practices of health-seeking become stigmatised. Findings show that the social acceptance of depression jars against participants’ experience of living with it. Denialism and fear of disclosure were overwhelming themes to emerge from our analysis with significant cultural differences the Anglo-Australians disclosed their depression to family and friends and encountered significant resistance about the legitimacy of their illness. In contrast, many Indian-Australians, especially men, did not disclose their illness for fear of a damaged reputation and damaged social relations. For Indian-Australians, social relations in the community were at stake, whereas for Anglo-Australians workplace relations (but not community relations) were at stake. Participants’ experiences in these settings also influenced their patterns of health-seeking behaviors and age and inter-generational relationships were important mediators of stigma and social support. These findings illuminate how stigma, culture, and setting are linked and they provide critical information necessary to identify and develop customised strategies to mitigate the harmful effects of stigma in particular cultural groups.
“I'm running my depression:” Self-management of depression in neoliberal Australia
Publisher: Elsevier BV
Date: 03-2016
DOI: 10.1016/J.SOCSCIMED.2016.01.022
Abstract: The current study examines how the neoliberal imperative to self-manage has been taken up by patients, focusing specifically on Indian-Australians and Anglo-Australians living with depression in Australia. We use Nikolas Rose's work on governmentality and neoliberalism to theorise our study and begin by explicating the links between self-management, neoliberalism and the Australian mental health system. Using qualitative methods, comprising 58 in-depth interviews, conducted between May 2012 and May 2013, we argue that participants practices of self-management included reduced use of healthcare services, self-medication and self-labour. Such practices occurred over time, informed by unsatisfactory interactions with the health system, participants confidence in their own agency, and capacity to craft therapeutic strategies. We argue that as patients absorbed and enacted neoliberal norms, a disconnect was created between the policy rhetoric of self-management, its operationalisation in the health system and patient understandings and practices of self-management. Such a disconnect, in turn, fosters conditions for risky health practices and poor health outcomes.
Projections of Older European Migrant Populations in Australia, 2016–56
Publisher: Springer Science and Business Media LLC
Date: 19-01-2023
Young Voices demand health research goals
Publisher: Elsevier BV
Date: 04-2010
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