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This paper employs a critical race theory (CRT) perspective to probe the experiences of skilled African migrants parenting Black children in Australia, a predominantly White country. Two key themes emerged from this study: (1) the need to explicitly teach children about race and racism and to foster positive racial identities and (2) the complexities of navigating tensions between 'African' and 'Western' cultural values. Participants demonstrated high levels of awareness of intercultural parenting approaches and a desire to blend the best aspects of African and Australian cultural values in their own parenting practice. A significant paradox was also apparent in the tension between parental desires to inculcate pride in African ancestry and culture, while simultaneously encouraging children to 'curate' their blackness to minimize experiences of racialization. Social workers in Australia often play a critical role in the lives of migrant families as they support them to negotiate transitions in parenting contexts. Although this paper only offers a perspective on the parenting experiences of skilled African migrants and how they creatively manage the tensions and change emerging from this process, we suggest that this understanding helps to expand knowledge on the complexity of parenting in multicultural, transcultural and intercultural contexts. [ABSTRACT FROM AUTHOR]

Community treatment orders (CTOs) require individuals with a mental illness to accept treatment from mental health services. CTO legislation in South Australia states that treatment and care should be recovery‐focused, although justification for use is predominantly risk‐based, and care often coercive. Although CTOs are contested, individuals, families, and clinicians frequently engage in care planning within this context. This paper examines how the concepts of risk and risk management impact care planning from the perspectives of individuals on CTOs, their families, and clinicians. Ethnographic methods of observation and interview provided a detailed account of the perspectives of each group over an 18‐month period from two community mental health teams in South Australia. Findings show that care planning occurred within a culture of practice dominated by risk. Risk, however, was understood differently by each participant group, with the dominant narrative informed by biogenetic understandings of mental illness. This dominance impacted on the positioning of participant groups in care planning, focus of care contacts, and care options available. To improve care experiences and outcomes for individuals on CTOs, narrow conceptualizations of risk and recovery need to broaden to include an understanding of personal and social adversities individuals face. A broader understanding should reposition participants in the care planning context and rebalance care discussions, from a focus on clinical recovery to recovering citizenship. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to describe the application of empowerment and the role that it plays in fostering community participation, community integration and in enabling a healthy re-settlement of culturally and linguistically diverse migrants who have recently arrived in Australia from Sub Saharan Africa. Design/methodology/approach -- The paper's approach is a discussion expressing the views of authors supported by the relevant literature drawn from a wide range of sources on migration, settlement, health, social, environment, cultural and public health issues. The African community and its peak organisation, the African Communities Council of South Australia is presented and various empowerment strategies used by the council are discussed as a healthy model for empowering new settlers in the new environment. Findings -- The first part of the paper describes the migration of African migrants in South Australia and sets the scenario describing the current state of these migrants including opportunities and challenges they face in the new environment. The second part describes theories and contexts of community empowerment, relationship between community empowerment and a healthy settlement; and the relevance and implications of community empowerment. The third part draws the above context and the empowerment strategy is specifically related to the African Community in South Australia. The empowerment strategy in this case represents a wide range of interventions aimed to equip new African migrants to a successful and a healthy resettlement and integration in South Australia. By addressing a wide range of settlement challenges and issues, the strategy employs concepts of empowerment that have been used in public health in general, health promotion, health education, communications, community engagement and community development. Originality/value -- The paper highlights challenges and opportunities for new migrants in the new environment and argues that community empowerment is an important enabling tool for a healthy settlement, particularly for people with refugee backgrounds. The paper also acknowledges that the community development approach has assisted the target group and has improved their ability to overcome challenges associated with settlement through capacity building, social capital and community connectivity. [ABSTRACT FROM AUTHOR]

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 individuals 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. [ABSTRACT FROM AUTHOR]

Objective: This study explored healthcare workers' experiences of transitioning infusions of natalizumab from hospital to a patient-centred model of home care. Background: Hospital in the home is one of the fastest growing healthcare delivery models. In Australia, intravenous infusions are rarely available at home for chronic disease patients, such as those with multiple sclerosis. A recent trial of natalizumab infusions at home for patients with multiple sclerosis required both the hospital and hospital in the home staff to consider the logistics of how this transition could be achieved safely. Study design and methods: This was a qualitative study using an exploratory-descriptive approach. Twelve participants from two main groups of healthcare workers participated in delivering natalizumab infusions during the six-month trial period and were subsequently interviewed about their experience. Participants were recruited from a hospital ambulatory care day unit and a Home Infusion Team from a private provider of home nursing care located in South Australia. The data was analysed thematically. Results: Three main themes were identified from the interviews: 'preparing for change', 'focussing on the patient', and 'enhancing professional support and relationships'. These findings demonstrated the importance of understanding healthcare workers' experiences of transitioning to a patient-centred model of care, from hospital to home infusion of natalizumab. Discussion: Flexibility and good management of logistics is necessary to maintain the standards of the health services, which highlights the need for training and professional support to facilitate quality home care. This may enhance workers' sense of professional confidence and trust and reduce stress when delivering the home model of care. Conclusion: Healthcare workers and patients worked to support one another, not only therapeutically but also logistically within collegial relationship and interdependent communications. Being flexible, communicating clearly and being willing to work together within the team, especially between the hospital in the home staff and the hospital staff, was demonstrated to be an important factor for the safe delivery of infusions at home. Managing the logistics of delivering a flexible and safe home therapy service was an important part of this model of care. Implications for research, policy, and practice: The results of this study will be used to inform healthcare teams about the key logistical components that are important for healthcare services, when considering transitioning to a home-based model of care for treating people with relapsing-remitting multiple sclerosis. What is already known about the topic? * Although outpatient infusion programs are often hospital based, they may be run by regional health authorities or private organisations, such as a hospital in the home service. * Healthcare workers delivering a hospital in the home service require advanced knowledge and skill in order to deliver quality care. What this paper adds: * The development of a comprehensive logistical process, which has the patient at the centre of the model of care, enabled natalizumab to be delivered safely in the community by healthcare workers. * Being flexible, communicating clearly and being willing to work together within the team, especially between the hospital in the home staff and the hospital staff, was demonstrated to be an important factor for the safe delivery of infusions at home [ABSTRACT FROM AUTHOR]

This paper presents the findings from a qualitative study, which sought to investigate the barriers and enablers to implementation of a continuous quality improvement (CQI) program by health-care professionals in Aboriginal primary health-care services in South Australia. Eighteen semi-structured interviews across 11 participating services were conducted alongside CQI implementation activities. Multiple barriers exist, from staff perspectives, which can be categorised according to different levels of the primary health-care system. At the macro level, barriers related to resource constraints (workforce issues) and access to project support (CQI coordinator). At the meso level, barriers related to senior level management and leadership for quality improvement and the level of organisational readiness. At the micro level, knowledge and attitudes of staff (such as resistance to change; lack of awareness of CQI) and lack of team tenure were cited as the main barriers to implementation. Staff identified that successful and sustained implementation of CQI requires both organisational systems and individual behaviour change. Improvements through continuing regional level collaborations and using a systems approach to develop an integrated regional level CQI framework, which includes building organisational and clinic team CQI capacity at the health centre level, are recommended. Ideally, this should be supported at the broader national level with dedicated funding. [ABSTRACT FROM AUTHOR]

The majority of Aboriginal families I know in South Australia carry intimate histories of domestic service through living memory and inter-generational blood-memory passed on. Despite the significance of these stories within families, this government-orchestrated system of indentured labour targeting Aboriginal girls remains largely hidden and unacknowledged in the state's dominant and official public narrative of history. This paper considers the historical, unfolding rationale for inter-dependent policies of child-removal, institutionalisation and training, as context to the burgeoning Aboriginal domestic service workforce into the twentieth century. It also examines popular culture discourse, coupled with prevailing racialised attitudes toward Aboriginal women at the time, exemplified through representations of 'Abo Maids' in a prominent national women's magazine, The Australian Woman's Mirror. 'Archival-poetics', as an active, embodied reckoning with history and the colonial archive, is also introduced as creative praxis; one way to bridge this labour knowledge gap and contribute to larger stories of resistance, resilience and refusal with healing and decolonising intent. [ABSTRACT FROM AUTHOR]

Understanding the conditions under which families try to influence members' health-related practices can provide information to build concepts adding to models of health promotion. This paper reports on an exploratory qualitative study examining the influences of intergenerational relationships in shaping beliefs, knowledge and practices about health and illness in a regional Australian city. We conducted semi-structured interviews with 27 adults with family members of other generations living in the city, all of whom had experience of asthma. We found that overall people's experience of health and illness, particularly in childhood, was taken for granted and not reflected upon. It was in the face of serious illness or death of a family member that objective knowledge about health and illness was sought and integrated within the family leading, in most cases, to significant lifestyle changes or ‘doing things differently’. We drew on Bourdieu's concept of the three forms of theoretical knowledge in analysing our findings. We found the concept of knowledge as ‘primary taken-for-granted experience’, and the concept of praxeological knowledge as the knowledge created by the dialectical relationships between an individual subject and objectives structures were helpful. To influence individual health practices, we need to acknowledge how the family context confirms the taken-for-granted health practices of an individual and the family circumstances that might lead families to seek objective knowledge and make lifestyle changes to promote health. [ABSTRACT FROM AUTHOR]

Proportionately few problem gamblers seek formal help for gambling problems. However, research into gambling help-seeking behaviour is limited, especially qualitative studies capturing experiences of recovery. This paper conducted narrative analysis of in-depth interviews relating the help-seeking behaviour of 10 recovering problem gamblers. A common temporal sequence moved from self-help, professional and nonprofessional help, then returned to self-help, in a journey that emphasised the importance of their sharing of narratives. Key themes in the plot structures were: self-loathing and loss of identity; fear of failure, of the loss of the gambling experience, and of being judged; negotiation of control, being in control, and needing to be in control; changing based on insight, cognitive behavioural interventions, or integrative interventions; and finally, the shared narrative. The findings highlight the need for policy makers and practitioners to acknowledge the power of narrative and to open the door to a broader community awareness of problem gambling. [ABSTRACT FROM AUTHOR]

Understandings of culture and multiculture are broad and deeply embedded in every day talk and practices. In an increasingly globalised world, how we understand and work with these terms affects how parents and their families experience health care services and the support intended by health care professionals. This is particularly important for parents who are new to Australia. In this paper we report on findings from an ethnographic study undertaken across two community child and family health nursing sites in South Australia. Using examples, we explore how child and family health nurses appear to understand and use constructs of culture and multiculture during everyday, intercultural communication with parents who are new to Australia and Australian health services. By analysing these understandings through postcolonial and feminist theories we found pervading evidence that neo-colonial constructs of a white western monoculture shaped intercultural communication practice. We conclude by reflecting on how these constructs might be addressed to improve intercultural communication in child and family health settings. [ABSTRACT FROM AUTHOR]

The majority of the Australian public are willing to have a Coronavirus disease 2019 (COVID‐19) vaccination. It is unclear whether people with inflammatory bowel disease (IBD) have the same attitude towards COVID‐19 vaccination. A survey was performed to assess the attitude of patients with IBD towards COVID‐19 vaccination in South Australia. Two‐thirds of surveyed patients with IBD were willing to accept COVID‐19 vaccine. Females and younger patients were less likely to accept the COVID‐19 vaccine, as were those who had never had a discussion around vaccines. [ABSTRACT FROM AUTHOR]

The implementation of rangeland biodiversity management strategies relies on the engagement and participation of key stakeholders, including local pastoralists (ranchers). Understanding pastoralists' knowledge of biodiversity, as well as their attitudes towards and perceptions of biodiversity management strategies, is fundamental for the development of efficacious rangeland management. This paper examines perceptions of biodiversity and land management strategies held by pastoralists in the Stony Plains region (SPR) of South Australia and reports on a survey, consisting of 45 questions, delivered to lessees and/or managers of pastoral leases within or on the edge of the SPR. Respondents generally agreed with prescribed land management strategies, but agreement did not mean that strategies were being implemented. The purchase of pastoral leases by government and/or conservation groups for biodiversity purposes was opposed strongly, which may present a barrier to collaborative land management. Pastoralists strongly agreed with several listed threats to biodiversity, but their feelings on climate-related threats were less strong. Attitudes to climate may have been influenced by above-average rainfall experienced during and preceding the survey period and by the climatic variability that characterises arid rangelands. Biodiversity conservation and the pastoral industry rely on collaborative rangeland management, non-bureaucratic communication, and an understanding among stakeholders of the attitudes and perceptions of other natural-resource users. [Copyright &y& Elsevier]

Objectives. Despite the incidence of joint replacements in Australia, there is a paucity of information regarding how patients progress from their referral to their surgery. The aim of this study was to describe a patient pathway from referral to receipt of total hip replacement (THR) or total knee replacement (TKR) surgery in South Australian public hospitals. Methods. Patient perspectives of the pathway to THR and TKR surgery were obtained via a postal survey (n = 450) and hospital employee perspectives were attained via semi-structured interviews (n = 19). Survey data were analysed using descriptive statistics and interview data were analysed thematically. Results. A typical patient pathway to THR and TKR surgery can be divided into two distinct phases; referral-to-initial appointment (9-24 months), and initial appointment-to-surgery (12-15 months). This gives an overall waiting period between 2 and 3 years for THR or TKR surgery. Conclusions. Waiting times for THR and TKR surgery reported in this study were longer than other reports in the literature. Current Australian health policy does not consider the first (and longest) phase of the patient pathway. Excluding this initial phase could be generating an erroneous perception of the patient pathway to THR or TKR surgery, possibly leading to poorly considered health reforms. What is known about the topic? Meeting the demand for elective surgery services in public hospitals is an ongoing challenge for governments and health systems alike. The persistent mismatch between supply and demand has resulted in the development of waiting lists for elective total hip replacement (THR) and total knee (TKR) replacement surgery in Australia. Current state-level health policies such as the Policy Framework and Associated Procedural Guidelines for Elective Surgery Services in South Australia or the Elective Surgery Access Policy in Victoria, outline a generic pathway consisting of a few linear steps that occur immediately before receipt of surgery, without consideration of the early stages of the journey. Aside from these types of policies, we were unable to identify any published literature outlining the patient journey from referral to receipt of THR or TKR surgery. As such, our understanding of the issue is inadequate due the paucity of existing research evidence. What does this paper add? Our current understanding of the patient journey to THR and TKR surgery is limited to the perspective of the policy-makers, whose focus is the organisation of waiting lists and the systematic progression of an individual through the elective surgery system. This perspective reinforces the assumption that it is a simple, linear process and may lead to erroneous judgements regarding the impact that the patient pathway has on an individual and the time it takes to progress along that pathway. This study presents the patient pathway from the perspective of individuals working within the systems responsible for delivering THR and TKR surgery and from patients who have received a joint replacement in a South Australian public hospital. As such, this paper provides new insight into the length, impact and features of the entire patient journey, rather than a snap-shot of the final stages. What are the implications for practitioners? This study is the first step towards better understanding of the patient pathway to joint replacement surgery in Australian public hospitals. Greater understanding of the complete pathway and identification of areas of congestion within the pathway, as evidenced by longer waiting periods, offers insight into areas with the potential for effective reforms. Should the patient pathway be significantly altered, the experience of practitioners responsible for the interim and postoperative management of patients undergoing THR and TKR surgery will also be changed. Additionally, practitioners currently frustrated by the long delays experienced by their patients who are in need of elective surgery in Australian public hospitals, could have that frustration abated by system improvements that reduce the length and complexity of the pathway to joint replacement surgery. [ABSTRACT FROM AUTHOR]

Aim: This research aimed to investigate the food acculturation experiences of Iranian mothers who have migrated to Australia. Methods: The study used qualitative methodology to interview seven mothers with children aged 5 to 15 years, who: carried primary responsibility for family food provisioning; arrived in Australia within the last 5 years; and spoke reasonably fluent English. Results: Seven mothers were interviewed, and the findings revealed three broad themes: (a) adjusting to foods/foodways in Australia (b) sociocultural identity and (c) children and intergenerational conflict. The study highlighted psychosocial and economic stresses associated with food acculturation for this immigrant group. The impact of food acculturation on immigrant health is intricately linked to the complex balance between maintaining traditional cultural identity and practices, while at the same time adapting to the food culture and practices of the new home. Conclusions: Dietitians and healthcare professionals working with such immigrant groups need to consider food acculturation stress as a factor contributing to the health risks of new immigrants. [ABSTRACT FROM AUTHOR]

Objective. The aim of this study was to describe the current state of carer engagement and partnership in two mental health (MH) services in South Australia and the implementation of the six partnership standards in A Practical Guide to Working with Carers of People with a Mental Illness. Methods. Anonymous surveys of carer experiences and clinician self-ratings of their own practice against the six partnership standards were completed by 94 staff and 58 carerswithin public and privateMHin-patient units before and after exposure of clinicians to education about the partnership standards. Descriptive statistical analysis was performed and, where applicable, a comparative analysis used the two-sample Z-test of proportions. Qualitative data was analysed thematically. Results. Considerable gaps were evident between carer experiences and clinician self-ratings of their own practice. Overall, the surveys point to the lack of a consistent approach by both public and private services, and suggest potential barriers to fostering carer participation and engagement. Confidentiality was a particularly noted barrier to partnership with carers. Conclusion. Significant improvement is needed to meet the partnership standards. Brief exposure to the Guide is not, in itself, sufficient to effect change in the overall attitudes, skills and knowledge of clinical staff about engaging carers. Significantly more focus on staff education, clinical discussions and supervision is needed to meet the MH carer partnership standards. [ABSTRACT FROM AUTHOR]

The aim of the study was to understand the perspectives of mental health consumers, staff, and yoga teachers on the characteristics of a yoga‐based intervention to be developed for consumers with a long‐term mental health condition, in addition to anxiety and/or depression. Two focus groups were held with mental health consumers (n = 8), two focus groups with mental health staff (n = 13) from a metropolitan community mental health setting, and five one‐on‐one interviews with yoga teachers. Participants were asked about the feasibility and appropriateness of a range of yoga practice features to be tested as a newly developed yoga‐based intervention. Thematic analysis was used to identify themes. Findings included the following consumer themes: Mental health understanding and experience of teachers and participants is important, Creating a safe space and Yoga practice elements. Staff themes included Mental health understanding and experience of teachers is important, Environmental design, and Yoga practice elements. Yoga teacher themes included Environmental design and Yoga practice elements. Mental health understanding and experience of the yoga teacher, and trauma‐informed care were consistently emphasized by consumers and staff. Teachers focused less on specific mental health considerations, which may be reflective of a broader knowledge gap. Recommendations regarding yoga practice elements, including pre‐information, regular and consistent practice, modifications, breathwork, mindfulness and guided practice, and environmental design features, were consistent with current trauma‐informed yoga research. Findings will be used to guide the development of a yoga‐based intervention for consumers with a long‐term mental health condition, in addition to anxiety and/or depression. [ABSTRACT FROM AUTHOR]

BACKGROUND: Refugee background young people are at increased risk of mental health problems. In countries of refugee resettlement, schools are important sites where mental health difficulties can be identified and service access facilitated; however, little is known about how best to support these practices within schools. METHODS: This article explores school and mental health service providers' perspectives on mental health challenges and referral pathways for refugee youth in South Australia. It draws on semi‐structured in‐depth interviews with 17 secondary school staff and 10 mental health service providers, which were analyzed thematically. RESULTS: Key challenges for school staff in identifying mental health issues were understanding behaviors, overcoming stigma, cultural and linguistic barriers, engaging with parents, staff preparation and training, and embeddedness within Western understandings of mental health. There was also limited awareness of appropriate mental health services and referral pathways. Service providers recognized schools' key role in identifying mental health issues for refugee students. CONCLUSIONS: Enhanced training and support is required for teachers to identify and refer students who might be experiencing mental health issues. "On‐site" school services, bi‐cultural workers, and increased knowledge of existing within‐school supports and referral pathways to external services would enhance outcomes for refugee students. [ABSTRACT FROM AUTHOR]

Almost one third of the South Australian population reside in regional locations, which are serviced by just 8% of the State's total psychiatrist workforce. Consequently, access to psychotropic medications in regional South Australia (SA) can be challenging. Granting prescribing rights to mental health nurses (MHNs) located in regional settings presents an opportunity to increase consumer access to psychotropic medications. The aim of the study was to understand the perspectives of mental health workers (MHWs) practising in regional and metropolitan settings towards MHN prescribing. The study adopted a qualitative approach. Seventeen MHWs participated in three focus groups, including two in regional SA and one in a metropolitan site within the State of SA. Participants reported difficulties in accessing medicines in regional areas. The regional focus groups indicated that MHN prescribing may help to release psychiatrists' time and provide quicker assessment and diagnosis. By contrast, the metropolitan focus group expressed reservations about MHN prescribing. Participants indicated that suitable governance structures supported by appropriate education programmes were a necessary prerequisite for MHN prescribing of psychotropic medications. MHN prescribing may help to mitigate the impact of psychiatrist shortages in regional South Australia and possibly in other areas of the world where recruitment is a challenge. The provision of adequate education and the establishment of a suitable governance and support framework are considered necessary steps to progress MHN prescribing. [ABSTRACT FROM AUTHOR]

Aim: To evaluate clinicians' perspectives, before and after clinical implementation (i.e. trial) of a handheld health information technology (HIT) tool, incorporating an iPad device and automatically generated visual cues for bedside display, for falls risk assessment and prevention in hospital. Methods: This pilot study utilized mixed-methods research with focus group discussions and Likert-scale surveys to elicit clinicians' attitudes. The study was conducted across three phases within two medical wards of the Queen Elizabeth Hospital. Phase 1 (pretrial) involved focus group discussion (five staff) and surveys (48 staff) to elicit preliminary perspectives on tool use, benefits and barriers to use and recommendations for improvement. Phase 2 (tool trial) involved HIT tool implementation on two hospital wards over consecutive 12-week periods. Phase 3 (posttrial) involved focus group discussion (five staff) and surveys (29 staff) following tool implementation, with similar themes as in Phase 1. Qualitative data were evaluated using content analysis, and quantitative data using descriptive statistics and logistic regression analysis, with subgroup analyses on user status (P≤0.05). Results: Four findings emerged on clinicians' experience, positive perceptions, negative perceptions and recommendations for improvement of the tool. Pretrial, clinicians were familiar with using visual cues in hospital falls prevention. They identified potential benefits of the HIT tool in obtaining timely, useful falls risk assessment to improve patient care. During the trial, the wards differed in methods of tool implementation, resulting in lower uptake by clinicians on the subacute ward. Post-trial, clinicians remained supportive for incorporating the tool into clinical practice; however, there were issues with usability and lack of time for tool use. Staff who had not used the tool had less appreciation for it improving their understanding of patients' falls risk factors (odds ratio 0.12), or effectively preventing hospital falls (odds ratio 0.12). Clinicians' recommendations resulted in subsequent technological refinement of the tool, and provision of an additional iPad device for more efficient use. Conclusion: This study adds to the limited pool of knowledge about clinicians' attitudes toward health technology use in falls avoidance. Clinicians were willing to use the HIT tool, and their concerns about its usability were addressed in ongoing tool improvement. Including end-users in the development and refinement processes, as well as having high staff uptake of new technologies, is important in improving their acceptance and usage, and in maximizing beneficial feedback to further inform tool development. [ABSTRACT FROM AUTHOR]

The present study investigated the relationship between engaging in day trading and engaging in traditional forms of gambling in South Australia. Consistent with a previous study on this issue, it would appear that most individuals who engage in day trading are heavily involved traditional gamblers who include day trading in their repertoire of activities. They differ somewhat from most gamblers in their strong preference for skill-based types of gambling, their higher overall involvement in gambling, and their higher rates of problem gambling. They also have some demographic differences, in particular, being older and having higher incomes. The present findings provide further evidence that not only do certain types of financial speculation bear some conceptual similarity to gambling, they also appear to be empirically related. [ABSTRACT FROM AUTHOR]

Background: delivering appropriate care for patients with multimorbidity and polypharmacy is increasingly challenging. Challenges for individual healthcare professions are known, but only little is known about overall healthcare team implementation of best practice for these patients. Objective: to explore current approaches to multimorbidity management, and perceived barriers and enablers to deliver appropriate medications management for community-dwelling patients with multimorbidity and polypharmacy, from a broad range of healthcare professional (HCP) perspectives in Australia. Methods: this qualitative study used semi-structured interviews to gain in-depth understanding of HCPs' perspectives on the management of multimorbidity and polypharmacy. The interview guide was based on established principles for the management of multimorbidity in older patients. HCPs in rural and metropolitan Victoria and South Australia were purposefully selected to obtain a maximum variation sample. Twenty-six HCPs, from relevant medical, dentistry, nursing, pharmacy and allied health backgrounds, were interviewed between October 2013 and February 2014. Fourteen were prescribers and 12 practiced in primary care. Interviews were digitally audio-taped, transcribed verbatim and analysed using a constant comparison approach. Results: most participants did not routinely use structured approaches to incorporate patients' preferences in clinical decision-making, address conflicting prescriber advice, assess patients' adherence to treatment plans or seek to optimise care plans. Most HCPs were either unaware of medical decision aids and measurements tools to support these processes or disregarded them as not being user-friendly. Challenges with coordination and continuity of care, pressures of workload and poorly defined individual responsibilities for care, all contributed to participants' avoiding ownership of multimorbidity management. Potential facilitators of improved care related to improved culture, implementation of electronic health records, greater engagement of pharmacists, nurses and patients, families in care provision, and the use of care coordinators. Conclusion: extensive shortcomings exist in team-based care for the management of multimorbidity. Delegating coordination and review responsibilities to specified HCPs may support improved overall care. [ABSTRACT FROM AUTHOR]

Mental health disorder and alcohol and other drug comorbidity is prevalent in Australia. This qualitative study used semistructured interviews (N= 20) to elicit clinicians' and workers' knowledge, experiences, and opinions regarding issues pertaining to service needs of people with comorbidity in a metropolitan region of South Australia. The study revealed barriers to effective access and delivery of comorbidity care by MH and AOD services. Participants reported difficulties with identification, access, suitability, policy, funding, and collaboration between sectors and services responding to comorbidity. Results suggest that these models of practice were inadequate influencing the delivery, consistency, and reliability of comorbidity care. [ABSTRACT FROM AUTHOR]

Objectives. The aim of the present study was to investigate experiences of staff interactions and non-technical skills (NTS) at rapid response team (RRT) calls, and their association with repeat RRT calls. Methods. Mixed-methods surveys were conducted of RRT members and staff who activate the RRT (RRT users) for their perceptions and attitudes regarding the use of NTS during RRT calls. Responses within the survey were recorded as Likert items, ranked data and free comments. The latter were coded into nodes relating to one of four NTS domains: leadership, communication, cooperation and planning. Results. Two hundred and ninety-seven (32%) RRT users and 79 (73.8%) RRT members provided responses. Of the RRT user respondents, 76.5% had activated the RRT at some point. Deficits in NTS at RRT calls were revealed, with 36.9% of users not feeling involved during RRT calls and 24.7% of members perceiving that users were disinterested. Unresolved user clinical concerns, or persistence ofRRTcalling criteria, were reasons cited by 37.6% and 23%, respectively, of RRT users for reactivating an RRT to the same patient. Despite recollections of conflict at previous RRT calls, 92% of users would still reactivate the RRT. The most common theme in the free comments related to deficiencies in cooperation (52.9%), communication (28.6%) and leadership (14.3%). Conclusions. This survey ofRRTusers and members revealed problems withRRTusers' and members' interactions at the time of an RRT call. Both users and members considered NTS to be important, but lacking. These findings support NTS training for RRT members and users. [ABSTRACT FROM AUTHOR]

Successfully engaging with consumers is seen as an essential component of mental healthcare, yet doing so can be challenging and little is understood about the unique engagement skills and attributes employed by mental health clinicians working in the emergency community context. Consequently, this qualitative study explored the engagement experiences of clinicians to identify the attributes used when engaging with consumers in this unique setting. We conducted two semi-structured focus groups in July and August 2011 with 16 clinicians employed at one metropolitan mental health organisation in South Australia. Using thematic analysis, we identified two key themes pertaining to the skills and attributes used for successful consumer engagement: (i) building trust, through communication style, an honest approach, facilitating choice and locating trust networks; and (ii) portraying genuine care, through showing respect, offering practical assistance and taking the least restrictive pathway. These findings highlight the unique nature of engagement in the emergency community mental health setting, as well as the flexibility and resourcefulness required to facilitate it. [ABSTRACT FROM AUTHOR]

Quality service provision and patient safety and satisfaction in encounters with health-care professionals relies on effective communication between the practitioner and patient. This study aimed to identify effective practices for improving communication between clinical staff in general practice and patients with limited English proficiency, and to promote their implementation in general practice. Effective interventions and strategies were identified from a review of international research. Experiences with their use in practice were explored via focus group discussions with general practitioners and practice nurses. The results suggest that, wherever possible, communication in the patient's primary language is preferable; use of a qualified medical interpreter should be promoted, and practices should have a standardised and documented procedure for accessing interpreter services. General practice staff must increase their awareness about services that are available to facilitate communication with patients with limited English proficiency, and also develop attitudes, both individual and organisational, that will maximise the effectiveness of these strategies. These findings were used to develop brief, evidence-based practice guidelines that were disseminated to focus group participants for evaluation of utility and general feedback. This evidence-based guidance is now available to assist clinical and administrative general practice staff across regional and metropolitan South Australia. [ABSTRACT FROM AUTHOR]

Background/aim Growth in the number of occupational therapy programmes in Australia has resulted in a critical shortage of academics. When experienced clinicians are recruited into academia, they may find the transition process difficult. The study aimed to explore clinicians' perspectives of what happens when they transition into academia. Method A constructivist grounded theory approach was used in this qualitative research project. Recruitment was conducted using purposive and theoretical sampling from occupational therapy programmes in Australia. Interview transcripts were analysed using constant comparative method through a process of open, axial, selective and theoretical coding. Results Sixteen participants engaged in semi-structured in-depth interviews. The theory of transition into academia included a process of 'weighing up the commitment' to academia and the core category of 'a good fit for me'. The transition was characterised by the taxing nature of the work, the need to learn multiple aspects of a new role, the different values and beliefs in an academic environment and the amount of time it took to achieve success. Participants underwent a shift in identity to adjust to the academic environment and eventually reached a point where they were able to judge if academia suited them. Conclusion Australian universities have long-standing cultural practices which differ considerably from clinical settings. Transitioning from a clinical to an academic occupational therapy role requires complex adjustments to values, beliefs and identity. The process involved consideration by the new academics of their 'fit' for academia, and how committed they were to stay. [ABSTRACT FROM AUTHOR]

Objective. To investigate how policy requiring cultural respect and attention to health equity is implemented in the care of rural and remote Aboriginal people in city hospitals. Methods. Interviews with 26 staff in public hospitals in Adelaide, South Australia, were analysed (using a framework based on cultural competence) to identify their perceptions of the enabling strategies and systemic barriers against the implementation of official policy in the care of rural Aboriginal patients. Results. The major underlying barriers were lack of knowledge and skills among staff generally, and the persistent use of 'business as usual' approaches in their hospitals, despite the clear need for proactive responses to the complex care journeys these patients undertake. Staff reported a sense that while they are required to provide responsive care, care systems often fail to authorise or guide necessary action to enable equitable care. Conclusions. Staff caring for rural Aboriginal patients are required to respond to complex particular needs in the absence of effective authorisation. We suggest that systemic misinterpretation of the principle of equal treatment is an important barrier against the development of culturally competent organisations. [ABSTRACT FROM AUTHOR]

There is a significant shortage of clinical psychology services in rural and remote Australia. It is proposed that tele-web psychology may provide one potential solution to this inequity in health provision. A tele-web psychology project was developed through a partnership between a university and country health service setting in rural South Australia. Tele-web psychology was conducted by Provisional Psychologists on their first clinical placement, with patients attending sessions in a community mental health team hub in a regional centre north of Adelaide. This article describes the logistics of setting up a collaborative tele-web psychology service and makes recommendations on how to expedite the success of this type of venture. [ABSTRACT FROM AUTHOR]

Reforms to the Australian health system aim to ensure that services are accessible, clinically and culturally appropriate, timely and affordable. During the reform consultation process there were urgent calls from stakeholders to specifically consider the health needs of the thousands of refugees who settle here each year, but little is known about what is needed from the refugee perspective. Access to health services is a basic requirement of achieving the quality use of medicines, as outlined in Australia's National Medicines Policy. This study aimed to identify the barriers to accessing primary health care services and explore medicine-related issues as experienced by refugee women in South Australia. Thirty-six women participated in focus groups with accredited and community interpreters and participants were from Sudan, Burundi, Congo, Burma, Afghanistan and Bhutan who spoke English (as a second language), Chin, Matu, Dari and Nepali. The main barrier to accessing primary health care and understanding GPs and pharmacists was not being able to speak or comprehend English. Interpreter services were used inconsistently or not at all. To implement the health reforms and achieve the quality use of medicines, refugees, support organisations, GPs, pharmacists and their staff require education, training and support. [ABSTRACT FROM AUTHOR]

Total laryngectomy (TL), a life-preserving surgery, results in profound physical and communication changes for the individual. Physical and psychosocial adjustment to a TL is complex, and quality-of-life (QoL) measures have provided useful knowledge to assist clinical management. However, many tools were developed without considering the perspectives of people who have experienced TL. To improve understanding of the phenomena of living with TL, a qualitative study was conducted which explored the views and experiences of seven men and five women from a range of ages, geographical locations, and social situations who had undergone a TL. Data were collected through in-depth, semi-structured interviews, journals, and field notes, and analysed using a constructivist grounded theory approach and symbolic interactionism. The emergent concept was identifying with the altered self after TL as reflected in dynamic multi-level changes (physical, communication, and psycho-emotional) continuously interacting with intrinsic and extrinsic interpersonal factors including personal and socio-cultural constructs, e.g., age, gender, resilience, beliefs, and supports. This process affected the strategies these individuals used to negotiate their social experiences. The extent to which communication changes disrupted social roles affecting a person's sense of self appeared to relate to long-term adjustment. [ABSTRACT FROM AUTHOR]

Aim The environmental scan aimed to deepen our understanding of the aged care work culture and to ascertain the readiness of the workers to advance towards team-based quality care provision. Background The workplace context was a high-care unit within a large residential aged care facility. Methods We used the Promoting Action on Research Implementation in Health Services (PARiHS) framework to assess workplace readiness via interviews, individual surveys and observation of practice. Results A profile of current culture emerged as mutually supportive and task focused, but at the same time lacking corporate team features of shared decision-making and feedback for practice improvement. However, latent within the frontline leaders and personal care staff, there was evidence of some embedded knowledge and capacity for corporate team performance. Conclusions This study has validated an evidence-based method for conducting environmental scanning in aged care, recommended before any major change is introduced. Implications for nursing management Environmental scanning helps gauge workforce capacity and limitations; this information can enable managers to capitalize on identified cultural strengths to fortify change and avoid pitfalls of personal and collective vulnerabilities. [ABSTRACT FROM AUTHOR]

The article discusses a 3-phase study which developed, implemented and evaluated an education program supporting a palliative approach to motor neurone disease (MND) care. Educational workshops were held as a part of the study for the health professionals. Most attending individuals were nurses from the aged care and palliative care sectors. It improved MND knowledge, palliative care knowledge and enhanced communication, psychosocial care and symptom management between patients and caregivers.

Objective: To evaluate clinicians' perceptions of what helps and hinders the delivery of mental health care across a service network in a rural setting. Design: Qualitative, semistructured interviews were conducted with 10 individuals who work in one rural mental health care service network. Setting: A regional centre in rural South Australia involving representatives of the mental health team, general practice, hospital, community health and nongovernment organisations. Results: Clinicians' perceptions of barriers and enablers to working within their mental health care network were explored. Participants showed a strong shared commitment to effective mental health care delivery and a good understanding of the services that each offers. Interview data suggested that working relationships between local services could be perceived as stronger when a personal or historical element is recognisable. Similarly, the notion of familiarity and community involvement were perceived as facilitators in this network. A perceived barrier for participants was the failure to attract staff with mental health experience, leading to dependence upon the dedication and commitment of existing service providers. Conclusions: Collaboration is especially necessary in rural areas, where access to health care services is known to be difficult. The informality of relationships between service providers was shown to be the main facilitator in the network. This is both a strength as it promotes the communication between services and service providers that is essential for successful collaboration, yet is also a threat to the sustainability of the network based on the difficulties of staff recruitment and retention to rural settings. [ABSTRACT FROM AUTHOR]

This article explores the factors that have an impact on domestic violence in African refugee communities, with specific reference to the Liberian community in South Australia. Seventeen focus group discussions were undertaken with women participants of the Liberian Women’s Gathering. The nested ecological model (Dutton, 2001; Heise, 1998) is used to conceptualize the factors having an impact on domestic violence. The findings suggest that disruption to traditional gender roles has an impact on domestic violence at the cultural, socioeconomic, familial, and individual levels and that women’s experience of domestic violence must be understood in relation to the acute and prolonged stressors of war, loss, and displacement. [ABSTRACT FROM PUBLISHER]

This article delves into a relatively neglected aspect of feminist, or anti-oppressive practice, namely that of practitioners’ experiences of this work, and specifically, their personal and professional identifications with feminism. It explores the question: is feminism, in the context of feminist practice, something one does, a professional “persona” adopted at particular times and for particular purposes at work, or something one is, transcending—or linking—the personal and professional realms? Drawing upon a qualitative, exploratory study, this article investigates understandings of, and identifications with, feminism within the context of an area of practice, namely domestic violence intervention, which is explicitly feminist. It focuses on the relationship of the research participants, practitioners in this field, to feminism in terms of their identification with feminist principles. Paying attention to these issues has implications for feminist and other anti-oppressive ways of working, particularly where these are adopted by organisations as the required model of practice. The broader question, that of whether one needs to—or “should”—be (or identify as) feminist in order to engage in feminist practice, while beyond the scope of the current study, is critical, both for feminist theorising in general and in relation to specific concerns such as professional education, development, and supervision. [ABSTRACT FROM PUBLISHER]

Women who have experienced domestic and family violence use health services more frequently than women who have not. Early identification and intervention by the health system may reduce health problems associated with domestic and family violence and lead to savings for the health sector. This study aimed to evaluate the impact of a new domestic and family violence screening program, which was based on an ecological model and introduced by a social work team in the Emergency Department of a major metropolitan hospital. The evaluation method included an audit of social work case files to assess the effect on referral rates and a survey of Emergency Department staff to obtain perceptions of the impact of the program on the staff and clients. In the 3-month period following the introduction of the program, the rate of referral to social work increased by 213%. Staff agreed that the Emergency Department is an appropriate place to ask about domestic and family violence, under certain conditions. Findings suggest that an ecological social work model provides an approach to screening for domestic and family violence that not only contributes to increased identification and supportive client interventions but may also contribute to more sustainable systemic change. [ABSTRACT FROM PUBLISHER]

The primary aim of our study was to examine the influence of media exposure on body dissatisfaction and disordered eating in middle-aged women. A sample of 101 women, aged between 35 and 55 years, completed questionnaire measures of media exposure, thin-ideal internalization, social comparison, appearance investment, aging anxiety, body dissatisfaction, and disordered eating. Television, but not magazine exposure, was positively related to body dissatisfaction and disordered eating. In contrast, both television and magazine exposure were positive correlates of all four proposed media-processing variables (internalization, social comparison, appearance investment, and aging anxiety), which were themselves positive correlates of both body dissatisfaction and disordered eating. Structural equation modelling revealed that the influence of media exposure was fully mediated by the proposed media processes. The analyses also indicated that our proposed sociocultural model of disordered eating provided a reasonably good fit to the data, suggesting that sociocultural theory can be extended to women of middle-age. An important practical implication of this finding is that strategies aimed at challenging and minimizing these media processes may reduce some of the negative impact of media exposure in middle-aged women. [ABSTRACT FROM AUTHOR]

New Zealand has been offering third country resettlement to refugees, migrants, and their families since the end of the Second World War. Migration itself is a source of considerable distress. The study reported here used a set of self-report scales to determine the degree of demoralization and psychological distress among a sample of refugee and migrant clients living in Australasia. A degree of depression and demoralization was evident across the sample. The findings indicated that while many of the participants had attracted a diagnosis of major depressive disorder, in the main they did not benefit from a course of antidepressants. Additional factors known to impact on mental health were also apparent placing emphasis on the need for further development of culturally competent and evidence-based practice in resettlement and mental health services. While the study is based on refugee experiences in Australasia the perspective is much broader and should be seen in the international context. [ABSTRACT FROM AUTHOR]

Background The Baby Friendly Hospital Initiative (BFHI) influences health care practices and increases the initiation and duration of exclusive breastfeeding. Consistent definitions enable the accurate monitoring of breastfeeding rates and behaviour. This information refines policy and helps reach national breastfeeding targets. Only 21% (66/317) of Australian hospitals are BFHI accredited. Objective To examine the factors perceived to promote or hinder BFHI accreditation. Method Focus group interviews explored opinions of 31 participants, in differing roles and levels of employment, across midwifery, medical, nursing and ancillary staff at six South Australian maternity hospitals. Results The results suggest that staffs' understanding and personal views are often discordant with BFHI aims. Perceived difficulties include the accreditation process, hospital dynamics, and the Ten Steps implementation plus a bottle feeding culture and maternal employment that impact upon continued breastfeeding. Conclusions Upper management support, specific funding, a dedicated co-ordinator with 'area leaders', development of a specific breastfeeding policy incorporating various disciplines and staff, containing detailed protocols that comply with the International Code of Marketing of Breast Milk Substitutes and subsequent World Health Assembly (WHA) resolutions, are all required. Staff and mothers require multiple modes of education to understand the BFHI, including sponsorship for training of lactation consultants. Full implementation of BFHI across Australia will assist the development of nationally accepted breastfeeding definitions, improve monitoring and evaluation of rates and practices, and improve breastfeeding outcomes. [ABSTRACT FROM AUTHOR]

The main objective of the study was to apply the recently developed Index of Capability (ICECAP-O) instrument to measure and value the quality of life of a representative sample of the older South Australian population (aged ≥ 65 years) according to carer status. A Health Omnibus survey including the ICECAP-O instrument, carer status (informal carer vs. non-carer) and several socio-demographic questions was administered in 2009 as a face-to-face interview to 789 individuals aged 65 years or older in their own homes. A total of 671 individuals (85%) characterised themselves as a non-carer and 115 individuals (15%) characterised themselves as an informal carer. In general, carers exhibited relatively high quality of life as measured by the ICECAP-O, with carers having comparable mean ICECAP-O scores to non-carers in the general population [carers: mean (SD) 0.848 (0.123), non-carers: mean (SD) 0.838 (0.147)]. The results of the multivariate regression model for the total sample indicated statistically significant variations in overall ICECAP-O scores according to age (with younger participants tending to have slightly higher scores on average), country of birth (with those participants who were born in Australia having higher scores on average than those who were born elsewhere) and household income (with participants with higher income levels having higher scores on average). The results of the multivariate regression model differentiated by carer status also indicated some important differences. Specifically, average ICECAP-O scores were noticeably lower for carers who are separated or divorced and for carers who lived alone and these differences were statistically significant. The study findings provide support for the existence of process utility in informal care-giving. The provision of informal care may be associated with a positive impact upon quality of life for many caregivers, which may mediate the negative aspects arising from the burden associated with informal care-giving. [ABSTRACT FROM AUTHOR]