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Current stroke rehabilitation tends to focus on the bio-medical course of disability, often responding to psychological and social issues only when they have been implicated in crises. Although this situation is costly, little evidence exists in relation to how psychological and social outcomes can be facilitated or how psychosocial decline can be prevented. In the area of adjustment following traumatic injury, there has been some suggestion that rehabilitation should focus on the expansion of resources, skills and self-efficacy as this will enable individuals to cope more effectively with their medical condition and circumstances. The current study was a longitudinal randomised controlled trial involving 100 people with stroke, 58 of whom were randomly allocated to an intervention based on the notion of psychosocial skill expansion. All were patients of a major hospital in Queensland, Australia. An existing self-management intervention (The Chronic Disease Self-Management Course, Lorig et al., 2001) was used to operationalise the concept of psychosocial skill expansion. The control group reported declines in functioning during the first year following stroke in the areas of family roles, activities of daily living, self-care and work productivity, that were not reported by the intervention group. Although the groups had reached similar levels by one year post-stroke, this intervention may have a protective function, presumably by improving capacity to manage the functional requirements of daily life. However, the intervention did not appear to have its impact through self-efficacy, as was expected, and failed to influence outcomes such as mood or social participation. Nevertheless, the intervention warrants further investigation, given that it appears to improve rehabilitation outcomes, at least in the short-term. Keywords: Self-management education; Self-efficacy; Stroke recovery; Rehabilitation; Australia

Objective: People with a recent experience of stroke commonly rely on general practice for assistance to manage everyday consequences and associated disability. In this study, we were interested in qualitatively exploring how the relationship between these people and their general practitioners assisted daily self-management. Methods: One hundred twenty-six participants were involved in five in-depth interviews over an 18-month period after discharge from an acute care setting. Data were thematically analyzed by two independent researchers. Results: Three themes comprehensively accounted for the expectations participants had about their interactions with general practitioners. They were (1) the critical sense-making role of general practitioners, (2) the requirement for collaborative partnerships in which personhood was validated, and (3) the importance of confirming self-management actions. Conclusion: To comprehensively assist people to adjust to living with the residual consequences of a recent stroke, general practitioners need to engage in collaborative, person-centered interactions. [ABSTRACT FROM AUTHOR]

Community-based research (CBR) refers to an applied research methodology that is conducted in community settings in partnership between academic and nonacademic participants in research. This article reports on a series of in-depth interviews conducted with 11 Australian CBR researchers between 2008 and 2009. The interviews were designed to explore whether university-employed CBR researchers experience the particular phenomenon of 'moral distress,' or feelings of helplessness to act in accordance with one's moral values due to systemic or institutional constraints. Study results found that the CBR researchers experienced unavoidable moral distress at varying levels of intensity related to blurred boundaries between settings, participants, and stakeholders. Based on the outcomes of this study, further research and enhanced professional development and training practices are recommended. [ABSTRACT FROM AUTHOR]

Background: Recent challenges to health systems in industrialised countries (e.g., health trends, workforce shortages, geographical dispersion, changing demographics and the growing demand for hospital beds) have prompted a rise in popularity of services loosely labelled community-based rehabilitation (CBR). The rise of CBR is based on the assumption that these models of service delivery have the potential to address some of these challenges by promoting efficient use of community resources. However, due to the way in which CBR has evolved in industrial countries, there is considerable ambiguity surrounding the concept, and even more uncertainty about the methods by which its implementation can be fostered., Purpose: To explore the CBR in an industrialised country and the implications of its implementation for the health workforce, health systems and service delivery., Method: This article reviews existing literature to explore the concept of CBR as it is applied in industrialised countries. It examines the possible implications of adopting CBR into health systems, including the need for conceptual clarity, a competency frameworks and ongoing professional development., Conclusion: This article has shown that for CBR is to become a viable model for the delivery of health services in industrialised countries, a competency framework is needed, together with strong leadership to facilitate the translation of theory into practice. Further, collaboration is required among practitioners, policy makers, unions, consumers, educators and professional associations to support this transformation.

Purpose: To understand the experiences of Indigenous Australian women with chronic illnesses and disabilities and their views about a way forward in relation to partnerships in research and community-supported problem-solving., Method: Using a participatory action research framework, five Indigenous women participated in a group meeting and interviews with academic women researchers to discuss their health and disabilities in order to generate solutions that could address health disparities among Indigenous women., Results: Five themes describe the experiences of these Indigenous women when considering their personal histories, interactions with formal service systems, and their aspirations for the future: (i) Ongoing influence of history, (ii) systemic lack of respect, (iii) social context of health, (iv) moving forward in positive ways, and (v) research partnerships as a way forward. The data raised critical questions about the role of research, including, 'Who has the right to tell the stories of the women?'., Conclusions: We show how a small research project conducted in collaboration with five Indigenous women developed into a significant research partnership and resulted in a better understanding of the issues that must be addressed by research in future. It is suggested that through such partnerships underserved women can best be served by research.