ORCID Profile
0000-0002-2787-8580
Current Organisation
University of Adelaide
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Health Policy | Historical Studies | Aboriginal and Torres Strait Islander Health | Australian History (excl. Aboriginal and Torres Strait Islander History) |
Aboriginal and Torres Strait Islander Health - Health System Performance (incl. Effectiveness of Interventions) | Understanding Australia's Past | Health Inequalities
Publisher: Elsevier BV
Date: 12-2014
Abstract: To examine case studies of good practice in intersectoral action for health as one part of evaluating comprehensive primary health care in six sites in South Australia and the Northern Territory. Interviews with primary health care workers, collaborating agency staff and service users (Total N=33) augmented by relevant documents from the services and collaborating partners. The value of intersectoral action for health and the importance of partner relationships to primary health care services were both strongly endorsed. Factors facilitating intersectoral action included sufficient human and financial resources, erse backgrounds and skills and the personal rewards that sustain commitment. Key constraining factors were financial and time limitations, and a political and policy context which has become less supportive of intersectoral action including changes to primary health care. While intersectoral action is an effective way for primary health care services to address social determinants of health, commitment to social justice and to adopting a social view of health are constrained by a broader health service now largely reinforcing a biomedical model. Effective organisational practices and policies are needed to address social determinants of health in primary health care and to provide a supportive context for workers engaging in intersectoral action.
Publisher: Wiley
Date: 05-2008
DOI: 10.1080/09595230801919478
Abstract: Little attention has been directed to the use of meth hetamine among Australian workers. To address this, a study was conducted that examined drug consumption patterns of the Australian work-force. A secondary analysis of the 2004 National Drug Strategy Household Survey (NDSHS) data was undertaken that focused on meth hetamine use among those in paid employment. Meth hetamine use in the past 12 months was reported by 4.0% of workers compared to 2.2% of respondents not in the paid work-force. A larger proportion of male (4.8%) than female workers (3.0%) used meth hetamine. The highest prevalence occurred among 18-29-year-old workers (11.2% males: 12.6% females: 9.4%), and among workers in hospitality (9.5%), construction (5.4%) and transport (5.4%) industries and among tradespeople (6.5%). Significantly more meth hetamine users reported absenteeism compared to users of other illicit drugs and non-drug users. Among respondents reporting meth hetamine use, 13.4% reported absenteeism due to illicit drug use, while 56.8% reported absenteeism due to any illness or injury. Significantly more meth hetamine users (32.9%) reported going to work under the influence than users of other illicit drugs. Compared to users of other illicit drugs, meth hetamine users were also significantly more likely to drive a car, operate heavy machinery or abuse someone while under the influence. The specific details of the profile of workers using meth hetamine and the impact it has on work performance allows for the development of targeted interventions and tailored prevention strategies previously not possible.
Publisher: Wiley
Date: 09-2009
DOI: 10.1111/J.1465-3362.2009.00111.X
Abstract: The traditional approach to increasing the capacity of health and human service professionals to deliver alcohol, tobacco and other drug interventions has been to build relevant knowledge, skills and attitudes through the provision of education and training. However, as a stand alone strategy, education and training is likely to have limited impact. This paper examines not only the features and characteristics of successful training programs and approaches, but also the wider array of systems and structural factors that might act as impediments to the implementation of new knowledge, skills and clinical behaviours. There is a constellation of factors that extend beyond traditional notions of 'training' that fall under the rubric of 'workforce development'. A workforce development approach requires three levels of action-system-wide, capacity building and professional development to ensure effective responses.
Publisher: Wiley
Date: 12-07-2022
DOI: 10.1002/HPJA.517
Abstract: How health promotion is implemented varies and it is often not clear what activities are in place in a region. Understanding the extent of health promotion activities helps planning activities. This research involved a rapid audit of the types of health promotion activities in a suburban region of South Australia. This analysis was guided by the WHO Ottawa Charter's principles. To better understand population needs and which health promoting activities may help, an epidemiological, demographic and social determinants of health profile of southern Adelaide described disease patterns and health inequities. While there was evidence of a range of health promoting activities, most concerned in idual or behavioural services. A key finding was the small number of activities that the state health department and local health system were responsible for. Alongside local government, NGOs provided the bulk of health promotion activities. In addition, there were no overarching health promotion strategies or coordinating bodies to evaluate the activities. The epidemiological, demographic and social determinants of health profile found persistent health and social inequities. This rapid audit of health promotion in a region enabled a quick assessment of the current health promotion situation and provided evidence of gaps and areas where policy change should be advocated. SO WHAT?: The key findings distilled from this research were designed to inform policy priorities to shift health promotion in southern Adelaide onto a trajectory consistent with the Ottawa Charter and prevent further focus on in idualised behaviour change strategies known as 'lifestyle drift'.
Publisher: Springer Science and Business Media LLC
Date: 15-05-2014
Publisher: Wiley
Date: 08-2014
DOI: 10.1071/HE13088
Publisher: Maad Rayan Publishing Company
Date: 18-05-2022
Abstract: Background: Despite the value of community health systems, they have not flourished in high income countries and there are no system-wide ex les in high income countries where community health is regarded as the mainstream model. Those that do exist in Australia, Canada, the United States and the United Kingdom provide ex les of comprehensive primary healthcare (PHC) but are marginal to bio-medical primary medical care. The aim of this paper is to examine the factors that account for the absence of strong community health systems in high income countries, using Australia as an ex le. Methods: Data are drawn from two Australian PHC studies led by the authors. One examined seven case studies of community health services over a five-year period which saw considerable health system change. The second examined regional PHC organisations. We conducted new analysis using the ‘three I’s’ framework (interests, institutions, ideas) to examine why community health systems have not flourished in high-income countries. Results: The elements of the community health services that provide insights on how they could become the basis of an effective community health system are: a focus on equity and accessibility, effective community participation/control multidisciplinary teamwork and strategies from care to health promotion. Key barriers identified were: when general practitioners (GPs) were seen to lead rather than be part of a team funding models that encourage curative services rather than disease prevention and health promotion and professional and medical dominance so that community voices are drowned out. Conclusion: Our study of the community health system in Australia indicates that instituting such a system in high income countries will require systematic ideological, political and institutional change to shift the overarching government policy environment, and health sector policies and practices towards a social model of health which allows community control, and multidisciplinary service provision.
Publisher: Wiley
Date: 26-12-2022
DOI: 10.1002/AJS4.253
Abstract: Analyses of the prevalence of homelessness suggest homelessness is increasing in Australia and other countries. Yet, difficulties exist in obtaining an accurate picture of homelessness due to a dearth of robust data and inconsistent definitions. This study aimed to build a comprehensive descriptive profile of homelessness and associated health needs in Adelaide. Five data sources were analysed and compared to produce descriptive sociodemographic and health statistics. Across data sources, people experiencing homelessness had a high prevalence of poor health outcomes and service utilisation. Consistent with the international literature, high rates of physical and mental health conditions were reported, including depression, anxiety and dental problems. While there was variability in demographic data, Aboriginal and Torres Strait Islander peoples were consistently over‐represented. Analysing data from multiple sources provided a richer understanding of who is experiencing homelessness and their health needs, highlights it is not always necessary to collect new data to overcome dataset limitations and illustrates how data comparison can improve the use of existing data. The paper concludes with reflections on the challenges and potential of the methodology. Overall, the study shows analysing data from multiple sources can provide rich information to service providers and government departments to inform more nuanced and effective services.
Publisher: Wiley
Date: 03-2004
Publisher: AMPCo
Date: 07-2017
DOI: 10.5694/MJA16.00720
Publisher: Wiley
Date: 29-09-2011
DOI: 10.1111/J.1465-3362.2010.00246.X
Abstract: Over recent years, numerous school-based preventive strategies have been explored as possible options to address illicit drug use by young people. However, there is scope to extend current knowledge of which school students are most at risk of illicit drug-related harm. To investigate potential differential risk, the prevalence and patterns of illicit drug use of Australian secondary school students were examined according to demographic, school, economic and licit drug use factors. Analyses were conducted on the 2005 Australian Secondary Students' Alcohol and Drug survey. A total of 21 805 secondary school students aged 12-17 years from 376 schools completed the pencil and paper classroom questionnaire. The greatest risk factors for students using illicit drugs were tobacco and alcohol use. Students with self-rated below average academic achievement, with more than $20 a week of disposable income, and who were Indigenous were more likely to report illicit drug use. While causal pathways could not be examined in the current data, and these relationships are likely to be complex and multi-directional, the findings indicate potentially at-risk populations who warrant extra support to address illicit drug-related harm.
Publisher: Wiley
Date: 2007
Publisher: Elsevier BV
Date: 12-2022
Publisher: Maad Rayan Publishing Company
Date: 14-03-2022
Publisher: Oxford University Press (OUP)
Date: 17-02-2012
DOI: 10.1093/NTR/NTR329
Abstract: Dental hygienists are well placed to assist their patients to quit smoking. Smoking affects oral health and dental treatments, and hygienists report greater time with patients than dentists with more focus on prevention. However, there has been little research into the extent to which hygienists assist patients to quit smoking and strategies to support them in this role. A 2-stage survey of Australian dental hygienists was conducted. The first survey measured potential predictors of asking patients about smoking and assisting patients to quit smoking using the Theory of Planned Behavior as a framework. The second survey measured these behaviors in the past week. Structural equation modeling was used to examine predictors of the two behaviors. A total of 362 hygienists returned the first questionnaire. Intentions to ask and assist patients were high. The 273 hygienists who returned the second questionnaire assisted an estimated total of 1,394 patients to quit smoking in 1 week. Predictors within the Theory of Planned Behavior framework explained significant variance in asking (11%) and assisting (29%) behaviors, with self-efficacy the most critical predictor in both cases (β = .27 and .32, respectively). Dental hygienists may be a viable and willing avenue for addressing smoking. Hygienists may be best supported in this role through increasing skills and confidence around asking sensitively about smoking, building rapport, and assisting patients to quit smoking. Incorporation of smoking status into general history taking and adoption of organizational policies on assisting patients to quit smoking could also be encouraged.
Publisher: CSIRO Publishing
Date: 13-07-2022
DOI: 10.1071/PY21285
Abstract: Background Studies show widespread widening of socioeconomic and health inequalities. Comprehensive primary health care has a focus on equity and to enact this requires more data on drivers of the increase in inequities. Hence, we examined trends in the distribution of income, wealth, employment and health in Australia. Methods We analysed data from the Public Health Information Development Unit and Australian Bureau of Statistics. Inequalities were assessed using rate ratios and the slope index of inequality. Results We found that the social gradient in health, income, wealth and labour force participation has steepened in Australia, and inequalities widened between the quintile living in the most disadvantaged areas and the quintile living in the least disadvantaged areas. Conclusion Widening income, wealth and employment inequalities have been accompanied by increasing health inequalities, and have reinforced and lified adverse health effects, leading to increased mortality inequality. Effective comprehensive primary health care needs to be informed by an understanding of structural factors driving economic and health inequities.
Publisher: Wiley
Date: 30-04-2016
DOI: 10.1002/HPM.2253
Abstract: Community participation is a key principle of comprehensive primary health care (PHC). There is little literature on how community participation is implemented at Australian PHC services. As part of a wider study conducted in partnership with five South Australian PHC services, and one Aboriginal community controlled health service in the Northern Territory, 68 staff, manager, regional health executives, and departmental funders were interviewed about community participation, perceived benefits, and factors that influenced implementation. Additional data were collected through analysis of policy documents, service reports on activity, and a web-based survey completed by 130 staff. A variety of community participation strategies was reported, ranging from consultation and participation as a means to improve service quality and acceptability, to substantive and structural participation strategies with an emphasis on empowerment. The Aboriginal community controlled health service in our study reported the most comprehensive community participation. Respondents from all services were positive about the benefits of participation but reported that efforts to involve service users had to compete with a centrally directed model of care emphasising in idual treatment services, particularly at state-managed services. More empowering substantive and structural participation strategies were less common than consultation or participation used to achieve prescribed goals. The most commonly reported barriers to community participation were budget and lack of flexibility in service delivery. The current central control of the state-managed services needs to be replaced with more local management decision making if empowering community participation is to be strengthened and embedded more effectively in the culture of services.
Publisher: Hindawi Limited
Date: 12-06-2018
DOI: 10.1111/HSC.12464
Abstract: This paper reports findings from 55 stakeholder interviews undertaken in six Primary Health Networks (PHNs) in Australia as part of a study of the impact of population health planning in regional primary health organisations on service access and equity. Primary healthcare planning is currently undertaken by PHNs which were established in 2015 as commissioning organisations. This was a departure from the role of Medicare Locals, the previous regional primary health organisations which frequently provided services. This paper addresses perceptions of 23 senior staff, 11 board members and 21 members of clinical and community advisory councils or health priority groups from six case study PHNs on the impact of commissioning on equity. Participants view the collection of population health data as facilitating service access through redistributing services on the basis of need and through bringing objectivity to decision-making about services. Conversely, participants question the impact of the political and geographical context and population profile on capacity to improve service access and equity through service commissioning. Service delivery was seen as fragmented, the model is at odds with the manner in which Aboriginal Community Controlled Health Organisations (ACCHOs) operate and rural regions lack services to commission. As a consequence, reliance upon commissioning of services may not be appropriate for the Australian primary healthcare context.
Publisher: Wiley
Date: 16-05-2011
DOI: 10.1111/J.1742-6723.2011.01416.X
Abstract: The present study examined Australian ED nurses' practices in asking patients about alcohol and assisting them to manage their alcohol consumption. It also investigated strategies to support ED nurses in these interventions. A two-stage survey was administered to ED nurses. The first questionnaire measured theoretical and organizational predictors of behaviour, and underlying beliefs, and the subsequent questionnaire explored rates of asking and assisting patients. A total of 125 nurses returned the first questionnaire. Participants held generally positive attitudes, perceived norms, feelings of legitimacy and perceived ability to ask about and intervene for alcohol, but lower role adequacy. The 71 ED nurses who completed the second questionnaire had intervened with almost 500 patients concerning alcohol in the previous week. Participants asked approximately one in four patients about alcohol (median = 26.3% of patients, 1095/4279 total patients asked). The Theory of Planned Behaviour did not predict rates of asking or assisting patients. Several strategies were identified that might increase rates: identify environmental factors that prevent nurses acting on their intentions to ask and intervene, raise confidence and skills, make asking about alcohol part of routine assessment, make supports such as drug and alcohol units or nurses available, and implement organizational policies on alcohol. Nurses appear positively disposed to engage with patients in regard to alcohol. However, greater support is needed to achieve the considerable significant public health benefits from this engagement. The findings point to several practical strategies that could be pursued to provide this support.
Publisher: Wiley
Date: 11-02-2021
DOI: 10.1002/HPJA.323
Abstract: Group work, such as peer support and health promotion is an important strategy available to comprehensive primary health care. However, group work and how it contributes to the goals of comprehensive primary health care has been under-researched and under-theorised. In this 5-year study, we partnered with seven Australian primary health care services, and drew on service reports, two rounds of staff interviews (2009-2010 and 2013, N = 68 and 55), 10 community assessment workshops (N = 65), a client survey (N = 315) and case tracking of clients with diabetes (N = 184, plus interviews with 35 clients, and five practitioners) and clients with depression (N = 95, plus interviews with 21 clients, and 11 practitioners). We conducted a rapid literature review of existing research on group work, and developed a model showing a group work reinforcing cycle. We examined the nature of the groups run, and the benefits staff and clients perceived. Benefits were grouped into four main themes: (a) social support, including for clients of the Aboriginal services, opportunities to celebrate their cultural identity, (b) improving skills and knowledge, (c) increasing access to services and (d) empowerment and solidarity. The perceived collective and in idual benefits aligned with a comprehensive primary health care vision. However, the in idualism stressed by neoliberal-driven health policy threatened the provision of group work and its potential collectivist benefits. There are multiple benefits of group work in primary health care that cannot be achieved through in idual work, highlighting the importance of policy and organisational support for group work.
Publisher: Elsevier BV
Date: 06-2018
Publisher: Hindawi Limited
Date: 25-07-2014
DOI: 10.1111/HSC.12060
Abstract: Community assessment workshops were developed to gather client experiences of primary health care services in Australia. Primary health care services are particularly concerned with working with disadvantaged populations, for whom traditional client survey methods such as written surveys may not be inclusive and accessible. Service staff at six Australian primary health care services, including two Aboriginal-specific services, invited participants to attend workshops in 2011-2012. Participants were offered transport, childcare and an interpreter, and provided with reimbursement for their time. Ten workshops were run with a total of 65 participants who accessed a variety of services and programmes. A mix of age and gender was achieved. The workshops yielded detailed qualitative data and quantitative rankings for nine service qualities: holistic, effective, efficient, culturally respectful, used by those most in need, responsive to the local community, increasing in idual control, supports and empowers the community, and mix of treatment, prevention and promotion. Discussions were audio recorded and transcribed for qualitative analysis. The workshop approach succeeded in being (i) inclusive, reaching users from disadvantaged sections of the community (ii) comprehensive, providing ratings and discussion that took account of the whole service (iii) richly descriptive, with researchers able to generate detailed feedback and (iv) more empowering than traditional client survey methods, by allowing more control to participants and greater benefits than surveys of in iduals. The community assessment workshops are a method that could be widely applied to health service evaluation research where the goal is to reach disadvantaged communities and provide ratings and detailed analysis of the experience of users. The participants and the research benefited from the group approach, and the workshops provided valuable, actionable information to the health services. Recruitment of users, particularly those from culturally erse backgrounds, remains one of the key challenges facing evaluators.
Publisher: Informa UK Limited
Date: 03-01-2019
Publisher: Elsevier BV
Date: 11-2019
Publisher: Wiley
Date: 15-12-2022
DOI: 10.1002/HPJA.564
Abstract: Deindustrialisation and transitions from traditional manufacturing to new technologies and service industries in many high‐income countries including Australia has resulted in rising employment insecurity, unemployment and increased income and health inequities. In this paper, we explore potential impacts of an automotive plant closure on health in a disadvantaged area of South Australia. Our aim was to examine how prevailing factors affecting social and health inequity might be further affected following the plant closure and to identify levers for potential policy responses. In workshop discussions with 28 policy and 14 community stakeholders through an iterative process participants discussed how existing factors contributing to community social and health inequity might be worsened (or remediated) by the looming economic shock from the plant closure. We identified eight key themes highlighted in the workshops. In particular local economic investment, availability of job opportunities, and appropriate training were identified as key factors influencing in idual financial security, which was in turn linked to social and health impacts. The pathways mapped between the plant closure and social and health equity impacts highlighted differential potential impacts on in iduals and the community, and identified policy levers to reduce adverse health outcomes resulting from economic shocks such as the closure of a major employer. The study highlighted a broad range of intersecting factors affecting the health of the local community that policy responses to the plant closure needed to address to promote health and health equity. This included novel factors identified by community members, reinforcing the importance of including community perspectives when constructing policy responses.
Publisher: Wiley
Date: 22-03-2017
DOI: 10.1002/HPM.2413
Abstract: Globally, health reforms continue to be high on the health policy agenda to respond to the increasing health care costs and managing the emerging complex health conditions. Many countries have emphasised PHC to prevent high cost of hospital care and improve population health and equity. The existing tension in PHC philosophies and complexity of PHC setting make the implementation and management of these changes more difficult. This paper presents an Australian case study of PHC restructuring and how these changes have been managed from the viewpoint of practitioners and middle managers. As part of a 5-year project, we interviewed PHC practitioners and managers of services in 7 Australian PHC services. Our findings revealed a policy shift away from the principles of comprehensive PHC including health promotion and action on social determinants of health to one-to-one disease management during the course of study. Analysis of the process of change shows that overall, rapid, and top-down radical reforms of policies and directions were the main characteristic of changes with minimal communication with practitioners and service managers. The study showed that services with community-controlled model of governance had more autonomy to use an emergent model of change and to maintain their comprehensive PHC services. Change is an inevitable feature of PHC systems continually trying to respond to health care demand and cost pressures. The implementation of change in complex settings such as PHC requires appropriate change management strategies to ensure that the proposed reforms are understood, accepted, and implemented successfully.
Publisher: Wiley
Date: 25-08-2022
DOI: 10.5694/MJA2.51695
Publisher: Elsevier BV
Date: 11-2016
DOI: 10.1016/J.SOCSCIMED.2016.09.005
Abstract: This paper applies a critical analysis of the impact of neo-liberal driven management reform to examine changes in Australian primary health care (PHC) services over five years. The implementation of comprehensive approaches to primary health care (PHC) in seven services: five state-managed and two non-government organisations (NGOs) was tracked from 2009 to 2014. Two questions are addressed: 1) How did the ability of Australian PHC services to implement comprehensive PHC change over the period 2009-2014? 2) To what extent is the ability of the PHC services to implement comprehensive PHC shaped by neo-liberal health sector reform processes? The study reports on detailed tracking and observations of the changes and in-depth interviews with 63 health service managers and practitioners, and regional and central health executives. The documented changes were: in the state-managed services (although not the NGOs) less comprehensive service coverage and more focus on clinical services and integration with hospitals and much less development activity including community development, advocacy, intersectoral collaboration and attention to the social determinants. These changes were found to be associated with practices typical of neo-liberal health sector reform: considerable uncertainty, more directive managerial control, budget reductions and competitive tendering and an emphasis on outputs rather than health outcomes. We conclude that a focus on clinical service provision, while highly compatible with neo-liberal reforms, will not on its own produce the shifts in population disease patterns that would be required to reduce demand for health services and promote health. Comprehensive PHC is much better suited to that task.
Publisher: Elsevier BV
Date: 09-2017
Publisher: Springer Science and Business Media LLC
Date: 16-02-2018
DOI: 10.1007/S00038-018-1083-9
Abstract: Regional primary health-care organisations plan, co-ordinate, and fund some primary health-care services in a designated region. This article presents a framework for examining the equity performance of regional primary health-care organisations, and applies it to Australian Medicare Locals (funded from 2011 to 2015). The framework was developed based on theory, literature, and researcher deliberation. Data were drawn from Medicare Local documents, an online survey of 210 senior Medicare Local staff, and interviews with 50 survey respondents. The framework encompassed equity in planning, collection of equity data, community engagement, and strategies to address equity in access, health outcomes, and social determinants of health. When the framework was applied to Medicare Locals, their inclusion of equity as a goal, collection of equity data, community engagement, and actions improving equity of access were strong, but there were gaps in broader advocacy, and strategies to address social determinants of health, and equity in quality of care. The equity framework allows a platform for advancing knowledge and international comparison of the health equity efforts of regional primary health-care organisations.
Publisher: Maad Rayan Publishing Company
Date: 09-11-2021
Abstract: Background: Debate continues in public health on the roles of universal or targeted policies in providing equity of access to health-related goods or services, and thereby contributing to health equity. Research examining policy implementation can provide fresh insights on these issues. Methods: We synthesised findings across case studies of policy implementation in four policy areas of primary healthcare (PHC), telecommunications, Indigenous health and land use policy, which incorporated a variety of universal and targeted policy structures. We analysed findings according to three criteria of equity in access – availability, affordability and acceptability – and definitions of universal, proportionate-universal, targeted and residual policies, and devolved governance structures. Results: Our analysis showed that existing universal, proportionate-universal and targeted policies in an Australian context displayed strengths and weaknesses in addressing availability, affordability and acceptability dimensions of equity in access. Conclusion: While residualist policies are unfavourable to equity of access, other forms of targeting as well as universal and proportionate-universal structure have the potential to be combined in context-specific ways favourable to equity of access to health-related goods and services. To optimise benefits, policies should address equity of access in the three dimensions of availability, affordability and acceptability. Devolved governance structures have the potential to augment equity benefits of either universal or targeted policies.
Publisher: Wiley
Date: 19-11-2034
Publisher: Informa UK Limited
Date: 09-02-2019
Publisher: Informa UK Limited
Date: 2005
Publisher: CSIRO Publishing
Date: 2016
DOI: 10.1071/PY14180
Abstract: Equity of access and reducing health inequities are key objectives of comprehensive primary health care. However, the supports required to target equity are fragile and vulnerable to changes in the fiscal and political environment. Six Australian primary healthcare services, five in South Australia and one in the Northern Territory, were followed over 5 years (2009–2013) of considerable change. Fifty-five interviews were conducted with service managers, staff, regional health executives and health department representatives in 2013 to examine how the changes had affected their practice regarding equity of access and responding to health inequity. At the four state government services, seven of 10 previously identified strategies for equity of access and services’ scope to facilitate access to other health services and to act on the social determinants of health inequity were now compromised or reduced in some way as a result of the changing policy environment. There was a mix of positive and negative changes at the non-government organisation. The community-controlled service increased their breadth of strategies used to address health equity. These different trajectories suggest the value of community governance, and highlight the need to monitor equity performance and advocate for the importance of health equity.
Publisher: Oxford University Press (OUP)
Date: 08-05-2014
Abstract: This paper reports on the health promotion and disease prevention conducted at Australian multi-disciplinary primary health care (PHC) services and considers the ways in which the organizational environment affects the extent and type of health promotion and disease prevention activity. The study involves five PHC services in Adelaide and one in Alice Springs. Four are managed by a state health department and two by boards of governance. The study is based on an audit of activities and on 68 interviews conducted with staff. All the sites undertake health promotion and recognize its importance but all report that this activity is under constant pressure resulting from the need to provide services to people who have health problems. We also found an increased focus on chronic disease management and prevention which prioritized in iduals and behavioural change strategies rather than addressing social determinants affecting whole communities. There was little health promotion work that reflected a salutogenic approach to the creation of health. Most activity falls under three types: parenting and child development, chronic disease prevention and mental health. Only the non-government organizations reported advocacy on broader policy issues. Health reform and consequent reorganizations were seen to reduce the ability of some services to undertake health promotion. The paper concludes that PHC in Australia plays an important role in disease prevention, but that there is considerable scope to increase the amount of community-based health promotion which focuses on a salutogenic view of health and which engages in community partnerships.
Publisher: Maad Rayan Publishing Company
Date: 05-12-2020
Abstract: Background: Despite growing evidence on the social determinants of health and health equity, political action has not been commensurate. Little is known about how political will operates to enact pro-equity policies or not. This paper examines how political will for pro-health equity policies is created through analysis of public policy in multiple sectors. Methods: Eight case studies were undertaken of Australian policies where action was either taken or proposed on health equity or where the policy seemed contrary to such action. Telephone or face-to-face interviews were conducted with 192 state and non-state participants. Analysis of the cases was done through thematic analysis and triangulated with document analysis. Results: Our case studies covered: trade agreements, primary healthcare (PHC), work conditions, digital access, urban planning, social welfare and Indigenous health. The extent of political will for pro-equity policies depended on the strength of path dependency, electoral concerns, political philosophy, the strength of economic and biomedical framings, whether elite interests were threatened and the success or otherwise of civil society lobbying. Conclusion: Public health policy actors may create political will through: determining how path dependency that exacerbates health inequities can be broken, working with sympathetic political forces committed to fairness framing policy options in a way that makes them more likely to be adopted, outlining factors to consider in challenging the interests of elites, and considering the extent to which civil society will work in favour of equitable policies. A shift in norms is required to stress equity and the right to health.
Publisher: Maad Rayan Publishing Company
Date: 23-11-2022
Abstract: Background: Universal health coverage (UHC) is central to current international debate on health policy. The primary healthcare (PHC) system is crucial to achieving UHC, in order to address the rising incidence of non-communicable diseases (NCDs) more effectively and equitably. In this paper, we examine the Australian case as a mature system of UHC and identify lessons for UHC policy to support equity of access to PHC and reduce NCDs. Methods: Our qualitative research used policy mapping and monitoring and 30 key informant interviews, and applied policy theory, to investigate the implementation of Australian PHC policy between 2008 and 2018. Results: Although the Australian PHC system does support equity of access to primary medical care, other ideational, actor-centred and structural features of policy detract from the capacities of the system to prevent and manage NCDs effectively, deliver equity of access according to need, and support equity in health outcomes. These features include a dominant focus on episodic primary medical care, which is a poor model of care for NCDs, and an inequitable distribution of these services. Also, a mixed system of public and private insurance coverage in PHC contributes to inequities in access and health outcomes, driving additional NCD demand into the health system. Conclusion: Countries aiming to achieve UHC to support health equity and reduce NCDs can learn from strengths and weaknesses in the Australian system. We recommend a range of ideational, actor-centred and structural features of UHC systems in PHC that will support effective action on NCDs, equity of access to care according to need, and equity in health outcomes across geographically and ethnically erse populations.
Publisher: Springer Science and Business Media LLC
Date: 02-12-2018
Publisher: Elsevier BV
Date: 08-2023
Publisher: Springer Science and Business Media LLC
Date: 16-07-2018
Publisher: Oxford University Press (OUP)
Date: 17-04-2017
Publisher: Springer Science and Business Media LLC
Date: 10-05-2013
Publisher: Maad Rayan Publishing Company
Date: 07-2018
Publisher: BMJ
Date: 04-2017
Publisher: Elsevier BV
Date: 06-2006
DOI: 10.1016/J.DRUGALCDEP.2005.10.011
Abstract: To conduct a systematic review of hospital alcohol screening studies to identify effective and efficient evidence-based strategies. Sixty-five studies (N=100,980) of alcohol problem prevalence amongst hospital patients were reviewed. Prevalence of positive alcohol screens varied according to hospital location, screening tool and patient characteristics. BAC measures (26%) were nearly twice as likely (OR=1.92, p<.001) to reveal positive screens in the ED than self-reports (16%). No difference was found in prevalence of self-report positive screens between ED (16%) and ward settings (17%). Males were two to four times more likely than females to screen positive (BAC: OR=2.37, p<.001, ED self-report: OR=3.07, p<.001, ward self-report: OR=4.30, p<.001). ED patients aged 20-40 years and ward patients aged 30-50 years had the highest prevalence of positive screens. Prevalence of risky or problematic drinking among hospital patients is high and warrants systematic screening and intervention. Many hospitals lack sufficient resources to undertake widespread screening programs. For optimum return on resources, it is recommended to screen males in the ED using BAC measures. Established protocols applying priority criteria and staff training can increase screening accuracy and effectiveness.
Publisher: Informa UK Limited
Date: 2009
Publisher: Elsevier BV
Date: 03-2018
Publisher: University of South Florida Libraries
Date: 2019
Publisher: Elsevier BV
Date: 08-2014
Abstract: There is little literature on health-service-level strategies for culturally respectful care to Aboriginal and Torres Strait Islander Australians. We conducted two case studies, which involved one Aboriginal community controlled health care service and one state government-managed primary health care service, to examine cultural respect strategies, client experiences and barriers to cultural respect. Data were drawn from 22 interviews with staff from both services and four community assessment workshops, with a total of 21 clients. Staff and clients at both services reported positive appraisals of the achievement of cultural respects. Strategies included: being grounded in a social view of health, including advocacy and addressing social determinants employing Aboriginal staff creating a welcoming service supporting access through transport, outreach, and walk-in centres and integrating cultural protocol. Barriers included: communication difficulties racism and discrimination and externally developed programs. Service-level strategies were necessary to achieving cultural respect. These strategies have the potential to improve Aboriginal and Torres Strait Islander health and wellbeing. Primary health care's social determinants of health mandate, the community controlled model, and the development of the Aboriginal and Torres Strait Islander health workforce need to be supported to ensure a culturally respectful health system.
Publisher: Wiley
Date: 08-2018
DOI: 10.1002/AJS4.45
Publisher: Elsevier BV
Date: 06-2019
Publisher: Maad Rayan Publishing Company
Date: 05-10-2020
Abstract: Background: There is an increasing emphasis on the importance of comprehensive primary healthcare (CPHC) in improving population health and health equity. There is, therefore, a need for a practical means to determine how comprehensive regional primary healthcare organisations (RPHCOs) are in their approach. This paper proposes a framework to provide such a means. The framework is then applied to assess the comprehensiveness of Australian RPHCOs. Methods: Drawing on a narrative review of the broader literature on CPHC versus selective primary healthcare (SPHC) and ex les of international models of RPHCOs, we developed a framework consisting of the key criteria and a continuum from comprehensive to selective interventions. We applied this framework to Australian RPHCOs using data from the review of their planning documents, and survey and interviews with executive staff, managers, and board members. We used a spidergram as a means to visualise how comprehensive they are against each of these criteria, to provide a practical way of presenting the assessment and an easy way to compare progress over time. Results: Key criteria for comprehensiveness included (1) focus on population health (2) focus on equity of access and outcomes (3) community participation and control (4) integration within the broader health system (5) inter-sectoral collaboration and (6) local responsiveness. An examination of Australian RPHCOs using the framework suggests their approach is far from comprehensive and has become more selective over time. Conclusion: The framework and spidergram offer a practical means of gauging and presenting the comprehensiveness of RPHCOs, and to identify gaps in comprehensiveness, and changes over time.
Publisher: Wiley
Date: 19-09-2022
DOI: 10.1002/HPJA.540
Abstract: We sought to examine barriers to access to, use of, and benefits from digital health services in an area of socioeconomic disadvantage of Adelaide, Australia. We conducted waiting room surveys in two hospital diabetes clinics and one hospital antenatal clinic in South Australia, and follow‐up telephone interviews with 20 patients. We examined the extent of access to, use of and benefits from digital health services, and what barriers people encountered. We undertook mixed methods, with quantitative descriptive analysis and qualitative analysis. Thirty‐seven diabetes clinic patients (54% response rate) and 99 antenatal clinic patients (33% response rate) participated. Sixty‐two percent of the patients with diabetes and 27% of antenatal clinic patients had never used digital health services. Seventeen percent of patients with diabetes and 30% of antenatal clinic patients were hesitant users, and 22% of patients with diabetes and 44% of antenatal clinic patients were confident users. Barriers included struggling to afford the technology or to stay connected and a lack of trust in online health information. Potential benefits included feeling more empowered and complementing face‐to‐face care. There are socioeconomic barriers to access, use of, and ability to benefit from digital health strategies that mean not everyone will be able to benefit from digital health services. As COVID‐19 accelerates the shift towards digital health services, people experiencing socioeconomic disadvantage may be excluded. If barriers to access and use are not addressed, they will exacerbate already increasing health inequities.
Publisher: Oxford University Press (OUP)
Date: 12-2006
Abstract: This study addressed the potential role of pharmacists in helping their patients to quit smoking by providing a summary of their self-reported levels of current activities, confidence, and readiness to change around the provision of brief advice and support for patients who smoke. In addition to investigating which barriers are perceived to be most important, this study also examined the relative importance of confidence, barriers and practice factors in relation to pharmacists' smoking cessation practices. A 58-item questionnaire was mailed to 720 pharmacists. The questionnaire measured demographic and background variables, level of smoking cessation activity (asking, advising, assessing, assisting and arranging including follow-up), confidence in undertaking smoking-cessation activities, readiness to change, perceived importance of barriers to providing smoking-cessation services, and further education or training in relation to smoking cessation. Community pharmacists in South Australia. Respondents indicated high rates of activity in relation to assessing and assisting patients to quit smoking, with lower rates of advising and arranging including following up. Recording of smoking status was very low. Confidence emerged as the most important predictor of smoking-cessation activities, with pharmacist barriers including fear of alienating patients approaching significance. Reported levels of smoking-specific education and training were low. South Australian pharmacists are contributing to the prevention of tobacco-related harms. With additional support there is a greater scope for involvement. Results indicate a need for a team-based, systematic and multifaceted approach to address barriers and enhance pharmacists' confidence. Further implementation research is required to assess the effectiveness of multifaceted pharmacy support programmes on the uptake and sustainability of smoking-cessation services.
Publisher: Springer Science and Business Media LLC
Date: 10-11-2020
DOI: 10.1186/S12939-020-01315-Z
Abstract: While in general a country’s life expectancy increases with national income, some countries “punch above their weight”, while some “punch below their weight” – achieving higher or lower life expectancy than would be predicted by their per capita income. Discovering which conditions or policies contribute to this outcome is critical to improving population health globally. We conducted a mixed-method study which included: analysis of life expectancy relative to income for all countries an expert opinion study and scoping reviews of literature and data to examine factors that may impact on life expectancy relative to income in three countries: Ethiopia, Brazil, and the United States. Punching above or below weight status was calculated using life expectancy at birth and gross domestic product per capita for 2014–2018. The scoping reviews covered the political context and history, social determinants of health, civil society, and political participation in each country. Possible drivers identified for Ethiopia’s extra 3 years life expectancy included community-based health strategies, improving access to safe water, female education and gender empowerment, and the rise of civil society organisations. Brazil punched above its weight by 2 years. Possible drivers identified included socio-political and economic improvements, reduced inequality, female education, health care coverage, civil society, and political participation. The United States’ neoliberal economics and limited social security, market-based healthcare, limited public health regulation, weak social safety net, significant increases in income inequality and lower levels of political participation may have contributed to the country punching 2.9 years below weight. The review highlighted potential structural determinants driving differential performance in population health outcomes cross-nationally. These included greater equity, a more inclusive welfare system, high political participation, strong civil society and access to employment, housing, safe water, a clean environment, and education. We recommend research comparing more countries, and also to examine the processes driving within-country inequities.
Publisher: Maad Rayan Publishing Company
Date: 13-03-2023
Publisher: Informa UK Limited
Date: 28-11-2018
DOI: 10.1080/13561820.2017.1401986
Abstract: This article draws on data from a 5-year project that examined the effectiveness of Comprehensive primary healthcare (CPHC) in local communities. A hallmark of CPHC services is interprofessional teamwork. Drawing from this study, our article presents factors that enabled, or hindered, healthcare teams working interprofessionally in Australian primary healthcare (PHC) services. The article reports on the experiences of teams working in six Australian PHC services (four managed by state governments, one non-government sexual health organisation, and one Aboriginal community-controlled health service) during a time of significant health sector restructure. Findings are drawn from two key methods: an online survey of practitioners and managers (n = 154), and interviews with managers and practitioners (n = 60) from the six study sites. The majority of survey respondents worked with other health professionals in their service to provide interprofessional care to clients. Processes included formal team meetings, case conferencing, referring clients to other health professionals if needed, informal communication with other health professionals about clients, and team-based delivery of care. A range of interrelated factors affected interprofessional work at the services, from contextual, organisational, processual, and relational domains. Funding cuts and policy changes that saw a reorientation and re-medicalisation of South Australian services undermined interprofessional work, while a shared CPHC culture and commitment among some staff was helpful in resisting some of these effects. The co-location of services was a factor in PHC teams working interprofessionally and not only enabled some PHC teams to work more interprofessionally but also created barriers to interprofessional teamwork through disruption resulting from restructuring of services. Our study indicates the importance of decision makers taking into account the potential effects of policy and structural changes on interprofessional teamwork. Decision makers should strive to minimise unintended negative effects of changes on the functioning of interprofessional teams.
Publisher: CSIRO Publishing
Date: 2011
DOI: 10.1071/PY11033
Abstract: Equity of access to services and in health outcomes are key goals of primary health care. This study considers understandings of equity and perceptions of current performance in relation to equity among primary health care service staff, health service executives and funders. Semi-structured interviews were conducted with managers, practitioners and administration staff at five primary health care services in Adelaide and one in Alice Springs, as well as with South Australian funders and regional health service executives (n = 68). Services were responding to health inequity by taking actions to improve equitable access to their service, facilitating equitable access to health care more generally, and advocating and taking action on the social determinants of health inequities. As well as availability, affordability and acceptability, our analysis indicated a fourth dimension of equity of access we named ‘engagement’. Our respondents were less able to point to ex les of advocacy or action on the social determinants of health inequities than they were to ex les of actions to improve equity of access. These findings indicate current strengths and also scope to encourage a broader and more comprehensive role for primary health care in addressing health inequities.
Publisher: Elsevier BV
Date: 11-2009
DOI: 10.1016/J.DRUGPO.2009.04.002
Abstract: There have been increasing national and international calls for the introduction of drug testing as a policy measure to address harmful drug use. Such strategies have been applied in workplaces, sporting arenas, prisons and more latterly school settings. They are predicated on a belief in their efficacy in reducing drug-related harm, a need to 'send the right' message to potential users and to reassure the community at large that 'something is being done.' Rigorous examination is required of purported benefits of drug testing in schools. A comprehensive examination was made of testing efficacy and accuracy. Australian legal and ethical issues, encompassing duty of care, rights of the child and privacy determinations, were juxtaposed with that of the United States of America. Evidence examined indicates no compelling case for the application of drug testing and that caution should be applied when considering drug testing as a drug detection and prevention strategy in the school setting. While this review did not support school drug testing, there are alternative evidence-based strategies that schools can implement to prevent drug-related problems among student populations.
Publisher: Maad Rayan Publishing Company
Date: 06-02-2018
Start Date: 10-2020
End Date: 11-2024
Amount: $265,000.00
Funder: Australian Research Council
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