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Background Attaining a good quality of life (QOL) is a priority for people living with HIV (PLHIV). We explored the interaction between QOL and the associated demographic, behavioural and clinical factors for PLHIV attending an outer-metropolitan clinical setting in Western Sydney, Australia. The clinic's cohort of PLHIV is characterised by relatively high proportions of women, heterosexual men, and patients from culturally and linguistically diverse (CALD) communities. Methods We assessed QOL using the PozQol tool that is specifically designed for PLHIV. QOL scores and de-identified socio-demographic and clinical data were extracted from the electronic and paper medical records of PLHIV who completed a PozQol tool (September 2020-March 2022). We performed descriptive analyses and logistic regression to identify associations. Results Among 188 patients, there were 77.7% men, 21.3% women, 1.1% transwomen; 67.0% were born overseas, 85.1% spoke English, 84.4% were Medicare-eligible, 85.9% were employed, 58.5% were diagnosed with HIV 6-20years ago, and 33.0% within the past 5years. Overall, 58.0% had a high or very high QOL. A low score in any domain was associated with Medicare-ineligibility. Low QOL scores in specific domains were associated with the following factors: health (being born overseas, having partners of both sexes), psychological (unemployment, having a mental health condition, having a viral load >20 copies/mL), social (unemployment), and functional (Medicare-eligibility, unemployment, having a viral load >20 copies/mL). Conclusions The PozQol tool has enhanced understanding of factors impacting on QOL for PLHIV attending our service in Western Sydney. Identifying patients with low QOL scores allows targeted clinical interventions to improve QOL, and re-alignment of clinical services to better support PLHIV.

Using data from national socio-economic panel surveys in Australia, Britain and Germany, this paper analyzes the effects of individual preferences and choices on subjective well-being (SWB). It is shown that, in all three countries, preferences and choices relating to life goals/values, partner's personality, hours of work, social participation and healthy lifestyle have substantial and similar effects on life satisfaction. The results have negative implications for a widely accepted theory of SWB, "set-point theory." This theory holds that adult SWB is stable in the medium and long term, although temporary fluctuations occur due to life events. Set-point theory has come under increasing criticism in recent years, primarily due to unmistakable evidence in the German Socio-Economic Panel that, during the last 25 years, over a third of the population has recorded substantial and apparently permanent changes in life satisfaction (Fujita and Diener in "J Pers Soc Psychol" 88:158-64, 2005; Headey in "Soc Indic Res" 85:389-403, 2008a; Headey et al. in "Proc Natl Acad Sci USA" 107(42):17922-17926, 2010). It is becoming clear that the main challenge now for SWB researchers is to develop new explanations which can account for medium and long term change, and not merely stability in SWB. Set-point theory is limited precisely because it is purely a theory of stability. The paper is based on specially constructed panel survey files in which data are divided into multi-year periods in order to facilitate analysis of medium and long term change.

This paper examines the complex constellation of conditions that turn many young people into "exiles" from schooling. From the vantage point of young people, the paper traces out a profile of the conditions that need to be brought into existence for these young people to find a way back into learning. The paper argues that current educational policies are deeply hostile to young people in the ways they position them as "silent witnesses" and exclude them from having a voice in the important decisions about what they learn, how, with whom, and with what effects. In contrast, the paper explores six alternative programmes in Australia, warehoused from within the same systems that "damaged" these young people. Paradoxically these programmes are seen as providing these damaged young people with the spaces in which they can become powerful "active agents" in re-forming an educational identity for themselves. Where these alternatives depart from the damaging policy regime is in the highly context-sensitive way they enable young learners and local policy advocates who work with them, to effectively contest exclusionary and undemocratic neoliberal policies.

This paper is concerned with the general issues of ageing, learning, and education for the elderly. It also examines the more specific issues of why, how and what elders want to learn. The world's population is ageing rapidly. For example, it is estimated that by 2020 20% of the population in the USA will be 65 years old and over. It is predicted that 24% of the Hong Kong population will be over 65 years old by 2025 (Bartlett & Phillips, 1995). The phenomenon has been described in colorful terms as the "silver tsunami" (Pew Report, 2001 cited in Summer, 2007). Ageing has an impact on all aspects of human life including the social, economic, cultural, and political domains. Understanding and providing for ageing is, therefore, an important issue for the twenty-first century. The World Health Organisation ([WHO], 2002) has proposed a model of active ageing based on optimizing opportunities for health, participation, and security in order to enhance quality of life for people as they age. The focus in this paper is on the education and learning aspect of participation as people age. (Contains 1 table.)

Learning is an important aspect of active ageing, yet older people are not often included in discussions of the issue. Older people vary in their need, desire, and ability to learn, and this is evident in the context of technology. The focus of the data analysis for this paper was on determining the place of learning and technology in active ageing. The paper describes results from 2,645 respondents aged from 50 to 74+ years, in Australia, to a 178-item variable postal survey. The survey measured aspects of learning; work; social, spiritual and emotional status; health; vision; home; life events; and demographics. There was also an open-ended question about being actively engaged in life. Ordinal regression analysis showed that interest in learning, keeping up to date, valuing communication, being younger, and being male are predictors of learning about technology. The results are at variance with an earlier analysis of our data which showed that women are generally more interested in learning. The open statements contained mentions of learning about technology for the purposes of communication, learning, family links, keeping up to date, enjoyment, staying mentally alert, and just using the computer. These results are discussed in terms of the subtle but important differences between needing and wanting to learn about technology and the opportunities for such learning by older people. A list of sample websites for seniors is appended. (Contains 3 tables and 1 footnote.)

Background: There is wide acknowledgement in the literature that social connection is protective against loneliness and depression. More robust research, however, is needed to evaluate interventions that promote social connection. This protocol paper outlines the evaluation of a community-wide social connection program, Connect Local , in metropolitan Melbourne, Australia to support people 65 years and older to increase access to local community services/activities; and to ascertain impact on social connection, loneliness, depressive symptoms, physical and mental wellbeing, and use of health services., Methods: A Type 1 Hybrid design, including program effectiveness, cost-effectiveness, and implementation evaluation of the Connect Local program, will be undertaken. Eighty-eight participants aged ≥65 years with one or more chronic health condition, who are also either experiencing or at risk of loneliness, social isolation and depressive symptoms will be invited to participate in the evaluation. Outcomes, measured at baseline, 3, 6 and 12 months, include loneliness, social isolation, depressive symptoms, social anxiety, goal attainment, wellbeing, quality of life and health care utilisation. A gender and age matched comparator group of 88 individuals will be recruited from outside the intervention local government area. Impact of the intervention on community service providers in the target region will be evaluated using mixed methods, where triangulation will be used to combine the qualitative and quantitative data using a deductive-simultaneous design. Changes in wellbeing and quality of life of community volunteers will also be measured. All groups will be interviewed to ascertain their experience and perceptions of the program. The economic evaluation will use a Social Return on Investment (SROI) approach, to include outcomes at the individual, community, and system levels. Implementation outcomes will consider Reach, Adoption, Feasibility, Acceptability, Appropriateness, Fidelity, and Sustainability of the intervention., Discussion: This study will provide a better understanding of the impacts of a community-wide social connection approach in older adults, the community and broader system., Clinical Trial Registration: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385192; Identifier ACTRN12623000968673., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer AJ declared a shared affiliation with the author(s) ML to the handling editor at the time of review., (Copyright © 2024 Ogrin, Robinson, Rendell, Alrababah, Fineberg, Fiddes, Yerolemou, Lim, Engel and Lowthian.)

Background and Objective: Patients with heart failure experience high hospitalization. However, patients cannot recognize symptoms according to current approaches, which needs to be improved by new self-monitoring instruments and strategies. Thus, we aimed to assess a self-monitoring traffic light diary on outcomes of patients with heart failure., Methods: This was a single-blind, two-arm parallel group randomized controlled trial at the heart failure clinic of Tehran Heart Center (Tehran, Iran). Adult patients with a definitive diagnosis of heart failure with reduced ejection fraction (i.e., ejection fraction of less than 40 %), and New York Heart Association functional classes II-IV were included. A block-balanced randomization method was used to assign eligible subjects to the intervention or control group. Baseline data were collected before random allocation. Participants in the intervention group received a comprehensive intervention consisting of (1) self-care education by an Australian Heart Foundation booklet on heart failure, (2) regular self-monitoring of weight and shortness of breath at home, and (3) scheduled call follow-ups for three months. Patients in the control group received usual care. The primary outcome was heart failure self-care; the secondary outcomes were heart failure quality of life, knowledge, and all-cause hospitalization., Results: From June to August 2017, 68 patients were included in the study. The overall age of participants was 55 (13.6) years old, and 71 % of patients were male. A significant association between the intervention and self-care maintenance (β 5.1; 95 % CI 2.50 to 7.70, P < 0.001), self-care management (β 10.6; 95 % CI 6.50 to 14.8, P < 0.001), self-care confidence (β 8.0; 95 % CI 5.0 to 11.0, P < 0.001) and heart failure knowledge (β 1.7; 95 % CI 1.30, 2.04; P < 0.001) was found. However, there was no association between the intervention and quality of life (β 2.5; 95 % CI -0.79, 5.88, P 0.135) and hospitalization-free survival of the two groups (Log-Rank P 0.540)., Conclusion: A self-monitoring traffic light diary can improve self-care behaviors and heart failure knowledge in patients with heart failure with reduced ejection fraction., Rct Approval Id: Iranian Registry of Clinical Trials IRCT2017021032476N1., Study Protocol: PMCID: PMC6262204., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

The implementation of action learning workshops in three nursing homes in rural Victoria, Australia has been critical in the re-visioning of how care can be enhanced for residents. The workshops were designed with the intent of improving quality of care for residents by providing health care staff with opportunities to learn together and effect cultural change. Valuing what was accomplished well in these nursing homes was the starting point. The project was funded by a Commonwealth Government Rural Education Grant and was based on "My Home Life" a popular programme that promotes quality of life and delivers positive change in care homes for older people across the United Kingdom. This paper provides an account of the project including key components of the action learning workshops and subsequent evaluation of the programme conducted in Australia. The lessons learnt throughout this project have provided the impetus to continue using appreciative inquiry and action learning to involve participants in reflecting on their practice, valuing what they do well while identifying areas that require change. Working together in a safe and respectful space provides participants with opportunity to harness their own collective wisdom and as the health professionals in this project experienced, also learn valuable skills that support progressive action that makes a difference to older people's lives.

This paper focuses on educational services that attempt to contribute to the quality of life of students with intellectual disabilities. It addresses, from an Australian perspective, the areas of special educational facilities and their educational function, policy and curriculum, teaching strategies, integration, and parent role. (JDD)

Multiple imputation (MI), a two-stage process whereby missing data are imputed multiple times and the resulting estimates of the parameter(s) of interest are combined across the completed datasets, is becoming increasingly popular for handling missing data. However, MI can result in biased inference if not carried out appropriately or if the underlying assumptions are not justifiable. Despite this, there remains a scarcity of guidelines for carrying out MI. In this paper we provide a tutorial on the main issues involved in employing MI, as well as highlighting some common pitfalls and misconceptions, and areas requiring further development. When contemplating using MI we must first consider whether it is likely to offer gains (reduced bias or increased precision) over alternative methods of analysis. Once it has been decided to use MI, there are a number of decisions that must be made during the imputation process; we discuss the extent to which these decisions can be guided by the current literature. Finally we highlight the importance of checking the fit of the imputation model. This process is illustrated using a case study in which we impute missing outcome data in a five-wave longitudinal study that compared extremely preterm individuals with term-born controls.

This paper explores the impact of a student learning activity involving service learning. As part of a vocational course in the Academy of Health Sciences at a Western Australian TAFE (Technical and Further Education) institute, Allied Health Assistant (AHA) students participated in a service learning program focused on work-based learning in residential aged care. Students delivered a therapy program for residents at the facility, and then completed evaluation questionnaires on conclusion of the study. Of 121 students completing the questionnaires, 91% thought the experience challenged their way of thinking, while only two percent disagreed. The majority of students (93%) reported the experience interesting and engaging and a similar percentage (93%) reported that they felt better prepared to enter the workforce. The major themes in qualitative analysis related to the positive learning experience, increased confidence for future working career, improved knowledge and practice of aged care, and improved resident and student quality of life.

In the residential aged care sector medication management has been identified as a major area of concern contributing to poor outcomes and quality of life for residents. Monitoring medication management in residential aged care in Australia has been highly reliant on small, internal audits. The introduction of electronic medication administration systems provides new opportunities to establish improved methods for ongoing, timely and efficient monitoring of a range of medication indicators, made more meaningful by linking medication data with resident characteristics and outcomes. Benchmarking contemporary medication indicators provides a further opportunity for improvement and is most effective when indicator data are adjusted to take account of confounding factors, such as residents' characteristics and health conditions. Roundtables provide a structure for sharing and discussing indicator data in a trusted and supportive environment and encourage the identification of strategies which may be effective in improving medication management. This paper describes a new project to establish, implement and evaluate a National Aged Care Medication Roundtable.

Background and Objectives: Little is known about elements of long-term care (LTC) that promote quality of life (QoL) for older Indigenous and First Nations peoples. This systematic review aimed to extend understanding of those deemed most important., Research Design and Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, systematic database and hand-searching were used to find published and unpublished qualitative studies and textual reports. A convergent integrated approach was used to synthesize data, according to the Joanna Briggs Institute methodology for mixed methods systematic reviews., Results: Included papers (11 qualitative; seven reports) explored views and experiences of Indigenous residents, families, and LTC staff from North America (8), South Africa (1), Norway (1), New Zealand (1), and Australia (7). Elements of care included: (a) codesigning and collaborating with Indigenous and First Nations communities and organizations to promote culturally safe care; (b) embedding trauma-informed care policies and practices, and staff training to deliver culturally safe services; (c) being respectful of individual needs, and upholding cultural, spiritual and religious beliefs, traditional activities and practices; (d) promoting connection to culture and sense of belonging through sustained connection with family, kin, and Indigenous and First Nations communities., Discussion and Implications: This review identifies elements or models of care that promote QoL for Indigenous and First Nations peoples in LTC. While included papers were mostly from the United States and Australia, the congruence of elements promoting QoL was evident across all population groups. Findings may be used to inform standards specific to the care of Indigenous and First Nations peoples., (© The Author(s) 2022. Published by Oxford University Press on behalf of The Gerontological Society of America.)

Using three waves of data and tracing the same refugees over time, this paper shows that some factors associated with settlement experience are different from life satisfaction. Evidence shows that although settlement experience has not improved over time, life satisfaction of both male and female refugees has. The non-linear effect of age on life satisfaction disappears over time while that of settlement experience lingers on. Discrimination affects both male and female life satisfaction but is only a concern for females and the younger cohort's settlement experience. Psychological capital did not appear to moderate the discrimination effect, but this needs to be robustly examined further. Lastly, different support for refugees over time and a targeted focus on some groups is likely to be more effective than a blanket support policy. [ABSTRACT FROM AUTHOR]

Background: People with an acquired brain injury (ABI) find it challenging to use social media due to changes in their cognition and communication skills. Using social media can provide opportunities for positive connection, but there is a lack of interventions specifically designed to support safe and successful social media use after ABI. Aims: To investigate the outcomes of completing a social media skills intervention and identify barriers and facilitators for future implementation. Methods & Procedures: The study used a mixed‐methods, pre‐post‐intervention design. A total of 17 adults with an ABI were recruited. Participants completed an intervention that included a short self‐guided course about social media skills (social‐ABI‐lity course), and then participated in a private, moderated Facebook group over a 12‐week period (social‐ABI‐lity Facebook group). Data were collected over this period through observation of group activity and weekly surveys. They were also collected on social media use and quality of life at pre‐intervention, post‐intervention and after 3 months. Participants provided feedback on the experience of participating in the programme via a post‐intervention interview. Outcomes & Results: At post‐intervention, there were significant improvements in confidence in using Facebook (p = 0.002) and enjoyment of using Facebook to connect with others (p = 0.013). There was no significant change in reported quality of life, although participants described the multiple benefits of connection they perceived from involvement in the group. Observational data and feedback interviews were informative about the feasibility and acceptability of the intervention. Conclusions & Implications: This pilot study provided preliminary evidence that an intervention comprising a short, self‐guided training course and a private, moderated Facebook group improved outcomes for people with ABI. Key recommendations for future implementation include embedding active peer moderators within groups and taking an individualized approach to delivery of the intervention. WHAT THIS PAPER ADDS: What is already known on the subject: Research has documented the challenges that people with ABI experience in using social media, and the difficulty for rehabilitation clinicians in providing appropriate support in this field. What this paper adds to existing knowledge: This pilot study reports the outcomes of people with ABI completing a short, self‐guided social media skills course and participating in a private, moderated Facebook group. After the intervention, participants reported significantly increased confidence and enjoyment in using Facebook, described the benefits of connection found in the groups, and suggested potential improvements for future implementation. What are the potential or actual clinical implications of this work?: With the growing use of social media for connection and participation, there is a professional obligation to address social media communication skills in cognitive–communication rehabilitation for people with ABI. The findings of this study will inform interventions and future research to assist people with ABI to build their social media skills for communication, social support and a sense of connection. [ABSTRACT FROM AUTHOR]

Background: Since the early 90s, patient navigation programs were introduced in the United States to address inequitable access to cancer care. Programs have since expanded internationally and in scope. The goals of patient navigation programs are to: a) link patients and families to primary care services, specialist care, and community-based health and social services (CBHSS); b) provide more holistic patient-centred care; and, c) identify and resolve patient barriers to care. This paper fills a gap in knowledge to reveal what is known about motivators and factors influencing implementation and maintenance of patient navigation programs in primary care that link patients to CBHSS. It also reports on outcomes from these studies to help identify gaps in research that can inform future studies.Methods: This scoping literature review involved: i) electronic database searches; ii) a web site search; iii) a search of reference lists from literature reviews; and, iv) author follow up. It included papers from Canada, the United States, the United Kingdom, Australia, New Zealand, and/or Western Europe published between January 1990 and June 2013 if they discussed navigators or navigation programs in primary care settings that linked patients to CBHSS.Results: Of 34 papers, most originated in the United States (n = 29) while the remainder were from the United Kingdom, Canada and Australia. Motivators for initiating navigation programs were to: a) improve delivery of health and social care services; b) support and manage specific health needs or specific population needs, and; c) improve quality of life and wellbeing of patients. Eleven factors were found to influence implementation and maintenance of these patient navigation programs. These factors closely aligned with the Diffusion of Innovation in Service Organizations model, thus providing a theoretical foundation to support them. Various positive outcomes were reported for patients, providers and navigators, as well as the health and social care system, although they need to be considered with caution since the majority of studies were descriptive.Conclusions: This study contributes new knowledge that can inform the initiation and maintenance of primary care patient navigation programs that link patients with CBHSS. It also provides directions for future research. [ABSTRACT FROM AUTHOR]

Background: Regular methamphetamine use can cause a range of physical, psychological and social harms. Stigma is one factor that impacts engagement and successful completion of treatment. In Australia, Aboriginal and Torres Strait Islander people who regularly use methamphetamine experience multiple stigmas, which further compounds access to treatment and quality of life. This paper explores the cumulative and compounding effects of participating in a stigmatised activity such as illicit drug use in relation to the stigma experienced by Aboriginal and Torres Strait Islander people as a population marginalised through colonisation., Methods: Ten sites nationally participated in a cross-sectional survey measuring a range of factors including psychosocial stress in methamphetamine users. The survey sample size was 734, with 59% identifying as Aboriginal and Torres Strait Islander (n = 433). In addition, a total of 147 mainly Aboriginal and Torres Strait Islander people who use methamphetamine, community and family members, and service providers took part in a total of 19 focus groups and 7 interviews., Results: Aboriginal and Torres Strait Islander participants experienced multiple psychosocial stressors at significantly higher rates than non-Indigenous participants. These stressors include diminished access to health care (33%), experiences of racism (34%), grief and sorrow (39%), worry for family (46%), and child welfare experiences (46%). The qualitative findings highlight the cumulative impact of historical, political and social stressors on an already stigmatised population., Conclusions: The findings of this unique analysis demonstrate the disruptive impact of methamphetamine use on the lives of those who use methamphetamines and their family members. They also illustrate challenges, such as stigma, that may confront those seeking assistance for drug-related issues. Aboriginal and Torres Strait Islander community involvement is necessary to provide support and education for the individual, the family, and the community as a whole. Stigma reduction is therefore a worthy target for intervention., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier B.V.)

Purpose: Identify aspects of quality of life (QoL) important to Australian informal carers and explore how well the Adult Social Care Outcomes Toolkit for Carers, Care-related Quality of Life instrument and Carer Experience Scale capture these aspects in the Australian context., Methods: Online questionnaires were completed by Australian informal carers. Socio-demographics, open-ended questions: positive/negative aspects of caring and QoL aspects missing from the instruments, and ranking of the instrument domains was used to explore the content of the instruments. Instruments were scored using preference-weighted value sets (reported in another paper). Content analysis was used to analyse the open-ended responses. Chi-squared test looked at differences in domain importance. Descriptive analyses summarised all other information., Results: Eight themes were identified: Behaviour-mood of the care recipient, Caring responsibilities, Finances, Health, Own life, Perception of carers, Relationship with care recipient and Support. Many aspects of carer QoL mentioned as missing in the instruments appeared covered by the domains, of which all were reported as important. The highest ranked domain was relationship with the care recipient. The influence of the care recipient specific support, behaviour/mood and health on carer QoL appear absent in all instruments., Conclusion: The content of the three instruments appears relevant in an Australian setting. The influence of care recipient's health and well-being on carer QoL should be considered, along with spillover effects. A content and/or face validity analysis is required to confirm differences in item interpretation in Australian informal carers., (© 2023. The Author(s).)

Background: Older people in the nursing home environment are much less mobile and capable of taking care of themselves as they age, and most of them face the plight of loneliness, which seriously affects the quality of life of older people in their later years., Aims: A systematic review and synthesis of older people's experiences of loneliness in nursing homes., Design: Following ENTREQ, do a systematic evaluation and synthesis of qualitative investigations., Methods: A search of PubMed, Cochrane Library, Web of Science, Embase, the Chinese biomedical literature service system, the China National Knowledge Infrastructure, the Wanfang Database and the Wipu Database for qualitative studies of older people's experiences of loneliness in nursing homes was conducted with a search time frame of March 2023. Evaluation of the quality of the literature using the Joanna Briggs Institute's Australian Centre for Evidence-Based Health Care Quality Assessment Criteria for Qualitative Research, And the data were synthesised using Thomas and Harden's method of thematic and content analysis., Results: A total of 13 papers were included, and 36 research findings were distilled and integrated into three themes: causes of loneliness; feelings of loneliness; coping with loneliness; and seven sub-themes: aging and loss; environmental transformation; loneliness is a pain; loneliness is a choice; participation; strengthening social ties; and diverting attention., Conclusions: Older people in nursing homes face varying degrees of loneliness, which is a subjective feeling influenced by the interplay between personal awareness and the external environment, so future care interventions should be developed in a comprehensive manner, taking into account the characteristics of the older people themselves and their external environment., No Patient or Public Contribution: This study is a meta-synthesis and does not require relevant contributions from patients or the public., (© 2023 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

Purpose : A laryngectomy impacts communication, swallowing and breathing. It is disfiguring and can disrupt quality of life, one's sense of identity, and relationships. It can increase dependence on others, trigger social stigma, avoidant coping and suicidal risk. Qualitative research has the potential to enable greater understanding of these consequences. However, almost nothing has been written about the specific ethical issues that can arise when carrying out research with people with laryngectomy (PWL). This paper builds on the experiences of the authors in the field and seeks to examine and explain these research ethics considerations and how they impact research design, data collection, data analysis and dissemination. Method : Using a framework based on the values underpinning the Australian National Statement on Ethical Conduct in Human Research , respect, merit and integrity, justice and beneficence, we have highlighted key issues relevant to this particular population. Main contribution : Different practical approaches are provided to address the ethical concerns that arise when conducting research with PWL. These include access to participants and ensuring diverse representation; balancing harm and benefit; achieving accurate interpretation, analysis and representation of the data generated through the research; research as a partnership that is respectful, empowering and fosters collaboration. Conclusion : This paper breaks new ground in discussing the ethical considerations and practical challenges relevant to researching the experiences of PWL.

This paper sets out the Collaborative Service Design Playbook, to guide planning, design, and implementation of co-created health services. Successful health service development and implementation is best guided by theoretically informed approaches; however, organisations often lack design and implementation know-how and have difficulty applying it. This study seeks to improve health service design and potential for scale-up by proposing a tool to guide an end-to-end process, drawing together service design, co-design, and implementation science; and exploring the tool's feasibility to establish a sustainable service solution developed with participants and experts that is scalable and sustainable. The Collaborative Service Design Playbook phases include, (1) Define the opportunity and initiatives, (2) Design the concept and prototype, (3) Deliver to scale and evaluate; and (4) Optimise to transform and sustain. This paper has implications for health marketing through providing an end-to-end approach with phased guidance for health service development, implementation, and scale up. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to examine the talk of older athletes, with particular focus on how the context of sport helps them negotiate the ageing process. It draws on personal stories provided by 44 World Masters Games competitors (23 women; 21 men; aged 56-90 years; "M" = 72). Four themes emerged: "There's no such thing as old" (a story of avoiding old age); "Keep moving" (a story of fighting the ageing process); "Fun, fitness, friendship... [and] competing" (a story of redefining self and "old age") and; "Making the most of your life... with the capabilities that you still have" (a story of adaptation and acceptance). Together, the four themes show how through sports participation older individuals can simultaneously resist, redefine and accept the ageing process. These stories of a "sporting later life" allow for alternative meanings to the dominant "declining body" narrative of ageing. Therefore, these narratives present the possibility for personal, pedagogical and social transformation.

This paper explores the main satisfiers and dissatisfiers for international students in Australia's higher educational sector. Using a critical incident technique, this study is conducted with international students of higher education in Australia. Four categories of satisfiers and dissatisfiers emerge from the data which are related to individual performance, quality of the educational service, socialization, and living conditions.

As a consequence of local population ageing, which is more pronounced in rural areas, the issue of maintaining a positive quality of life for rural older people is attracting significant attention. While environmental psychology theory has advocated the role of place identity in defining the self, there has been little applied research exploring how this occurs in later life. This exploratory, qualitative study (n = 16) utilises 6 and 7 identity process theory to investigate how rural older Australians (retirement migrants and long-term residents) use place to sustain and build a sense of self at a time when many are susceptible to age-related loss. The paper draws on the concepts of distinctiveness, continuity, self-esteem and self-efficacy in order to explore how place identity is supported and maintained. Findings suggest that rural places are beneficial in terms of identity maintenance, with differences between long term and more recent rural residents. Furthermore, findings also highlight that place-related change or growth can potentially threaten older people's identification as a "rural" person. (Contains 6 tables and 1 figure.)

Food allergy impairs the health-related quality of life of both the affected children and their families. In particular, parents and children become anxious about the potential risks and consequences of food allergy, including disruptions in families' and children's social activities, the need for constant vigilance, children's safety, and the daily management of children's health and illnesses. These anxieties tend to increase during children's transition to school because of the increased risks outside the home, as outlined in the review of literature in the present paper. However, there is a gap in research on the concerns and support needs of families and children when starting school. Attention to parents' and children's needs and concerns is vital to ease their smooth transition to school.

Purpose: This study aims to evaluate the prevalence of smoking amongst university students in Brisbane, Australia and associated risk factors. Design/methodology/approach: A cross-sectional design was used for the study. A sample of 2,414 university students aged 18-30 was examined to estimate the prevalence of tobacco use. Smoking was measured by means of an online survey that inquired about current tobacco use, socio-demographic characteristics, self-rated physical and mental health status and attitudes toward smoking. Findings: The prevalence of tobacco use was 24.9 per cent among male students, 16.6 per cent among female students and 18.8 per cent overall. Low to medium level stress is a strong predictor of smoking in male students. Age and income are significantly related to smoking in female students. For both male and female students, disengagement coping strategies to deal with stressors, feeling not bothered by exposure to smoking, and knowledge of the effect of smoking on health were found to be independently related to smoking. Research limitations/implications: Factors associated with an increased probability of tobacco smoking were: stress in male students, disengagement coping strategies and holding approval attitudes toward smoking, acceptance of exposure to smoking, and poor knowledge of the effect of smoking on health in both male and female students. It is recommended that active coping strategies, such as exercise and social participation, are the most effective ways of enabling students to cope with smoking cessation and other stressors. Practical implications: Future initiatives may need to focus on increasing the environmental supports to assist students to actively cope with life stressors, In addition, the implementation of health education programmes, which are designed to modify behaviour via a change in attitudes and beliefs in university, should be examined. Originality/value: The association between cigarette smoking and morbidity and quality of life among university students is not well documented in Australia. The contribution of this paper is to increase understanding of the association between smoking and life stressors, coping strategies, attitudes and knowledge about the effects of smoking on health in Australia university students. (Contains 4 tables.)

This paper presents findings from a landmark Australian study investigating the experiences and perspectives of young people in residential care. Data from a representative sample are analyzed to identify young people's satisfaction with various aspects of their residential care experience: their sense of safety, normality, support, comfort in general living environment, participation in decision-making, and improvements in well-being. Findings point to strengths and weaknesses in current service delivery. The vast majority of respondents felt safe and well-treated and satisfied with the care and support provided by staff. Respondents were less commonly satisfied with the care and support provided by caseworkers, their participation in higher order decision-making, their sense of normality, and the amount of contact with their families. Compared with older respondents, younger respondents less commonly expressed satisfaction with various aspects of their care. Similarly, those reporting more placements were less satisfied with their care and support than those reporting fewer placements.

Medical students experience various stresses and many poor health behaviours. Previous studies consistently show that student wellbeing is at its lowest pre-exam. Little core-curriculum is traditionally dedicated to providing self-care skills for medical students. This paper describes the development, implementation and outcomes of the Health Enhancement Program (HEP) at Monash University. It comprises mindfulness and ESSENCE lifestyle programs, is experientially-based, and integrates with biomedical sciences, clinical skills and assessment. This study measured the program's impact on medical student psychological distress and quality of life. A cohort study performed on the 2006 first-year intake measured effects of the HEP on various markers of wellbeing. Instruments used were the depression, anxiety and hostility subscales of the Symptom Checklist-90-R incorporating the Global Severity Index (GSI) and the WHO Quality of Life (WHOQOL) questionnaire. Pre-course data (T1) was gathered mid-semester and post-course data (T2) corresponded with pre-exam week. To examine differences between T1 and T2 repeated measures ANOVA was used for the GSI and two separate repeated measures MANOVAs were used to examine changes in the subscales of the SCL-90-R and the WHOQOL-BREF. Follow-up t-tests were conducted to examine differences between individual subscales. A total of 148 of an eligible 270 students returned data at T1 and T2 giving a response rate of 55%. 90.5% of students reported personally applying the mindfulness practices. Improved student wellbeing was noted on all measures and reached statistical significance for the depression (mean T1 = 0.91, T2 = 0.78; p = 0.01) and hostility (0.62, 0.49; 0.03) subscales and the GSI (0.73, 0.64; 0.02) of the SCL-90, but not the anxiety subscale (0.62, 0.54; 0.11). Statistically significant results were also found for the psychological domain (62.42, 65.62; p less than 0.001) but not the physical domain (69.11, 70.90; p = 0.07) of the WHOQOL. This study is the first to demonstrate an overall improvement in medical student wellbeing during the pre-exam period suggesting that the common decline in wellbeing is avoidable. Although the findings of this study indicate the potential for improving student wellbeing at the same time as meeting important learning objectives, the limitations in study design due to the current duration of follow-up and lack of a control group means that the data should be interpreted with caution. Future research should be directed at determining the contribution of individual program components, long-term outcomes, and impacts on future attitudes and clinical practice.

Australia's headspace initiative is world-leading in nation-wide youth mental healthcare reform for young people aged 12 to 25 years, now with 16 years of implementation. This paper examines changes in the key outcomes of psychological distress, psychosocial functioning, and quality of life for young people accessing headspace centres across Australia for mental health problems. Routinely collected data from headspace clients commencing an episode of care within the data collection period, 1 April 2019 to 30 March 2020, and at 90-day follow-up were analysed. Participants came from the 108 fully-established headspace centres across Australia, and comprised 58,233 young people aged 12-25 years first accessing headspace centres for mental health problems during the data collection period. Main outcome measures were self-reported psychological distress and quality of life, and clinician-reported social and occupational functioning. Most headspace mental health clients presented with depression and anxiety issues (75.21%). There were 35.27% with a diagnosis: overall, 21.74% diagnosed with anxiety, 18.51% with depression, and 8.60% were sub-syndromal. Younger males were more likely to present for anger issues. Cognitive behavioural therapy was the most common treatment. There were significant improvements in all outcome scores over time (P<0.001). From presentation to last service rating, over one-third had significant improvements in psychological distress and a similar proportion in psychosocial functioning; just under half improved in self-reported quality of life. Significant improvement on any of the three outcomes was shown for 70.96% of headspace mental health clients. After 16 years of headspace implementation, positive outcomes are being achieved, particularly when multi-dimensional outcomes are considered. A suite of outcomes that capture meaningful change for young people's quality of life, distress and functioning, is critical for early intervention, primary care settings with diverse client presentations, such as the headspace youth mental healthcare initiative., Competing Interests: The funder provided support in the form of salaries, or part thereof, for authors DR, JE, AS, NT, and JT but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section. These affiliations do not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2023 Rickwood et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Spiritual well-being is reflected in the quality of relationships that each person has in up to four different domains, namely with self, with others, with the environment and/or with God. This study investigated how secondary students perceived relationships with family, friends, school and church community (including God) impacted on their spiritual well-being. This paper reports the views of 1002 secondary school students aged from 12- to 18-years-old in Catholic, Christian community and other independent schools in Victoria, Australia. ANOVA and multiple regression analyses of students' responses on the Quality Of Life Influences Survey developed in this study, and the Spiritual Health And Life-Orientation Measure, a spiritual well-being questionnaire for secondary students, revealed significant differences in perceptions students held about influences on their spiritual well-being. A case study illustrates how these instruments can be used to inform pastoral care of young people. (Contains 3 tables.)

Background: Changes in residential accommodation models for adults with intellectual disability (ID) over the last 20 years in Australia, the United Kingdom and the United States have involved relocation from institutions primarily into dispersed homes in the community. But an evolving alternative service style is the cluster centre. Methods: This paper reports on the relocation of a matched group of 30 pairs of adults with moderate and severe IDs and challenging behaviour who were relocated from an institution into either dispersed housing in the community or cluster centres but under the same residential service philosophy. Adaptive and maladaptive behaviour, choice-making and objective life quality were assessed prior to leaving the institution and then after 12 and 24 months of living in the new residential model. Results: Adaptive behaviour, choice-making and life quality increased for both groups and there was no change in level of maladaptive behaviour compared with levels exhibited in the institution. However, there were some significant differences between the community and cluster centre group as the community group increased some adaptive skills, choice-making and objective life quality to a greater extent than the cluster centre group. Conclusions: Both cluster centre and dispersed community living offer lifestyle and skill development advantages compared with opportunities available in large residential institutions. Dispersed community houses, however, offer increased opportunities for choice-making, acquisition of adaptive behaviours and improved life quality for long-term institutionalized adults with IDs.

Constant change necessitates lifelong learning for those in the workforce, if they are not to fall behind in the skills and knowledge needed as their occupations evolve. Learning new skills and knowledge remains a part of life for those no longer in paid employment. Not only is learning essential in order to keep up with changing needs and opportunities, and with new technologies used by businesses and service-deliverers, but also many retired persons feel that engaging in learning activities improves their quality of life. In some locations, an avenue where retired people seek "adventures in learning" is the University of the Third Age (U3A), thereby also meeting some of their social needs. This paper reports on a small research project investigating the impact of a provincial U3A on some of its members. An update on current participation and activities is included, along with suggestions for further development.

This paper investigated the prospective predictors of mental health after breast cancer diagnosis among mid-aged Australian women (initially aged 45-50 years). Two waves of data collected 2 years apart from a longitudinal population-based survey of 12,177 women identified a group of 63 women who reported onset of BC between T1 (T1) and Time 2 (T2). The measures of interest in the current analysis were the sub-scales of the SF-36, a standard self-report measure of health-related quality of life, and three demographic variables (having a partner, speaking English at home, and having paid employment). Multivariate regression analysis with T2 mental health as the outcome variable revealed that both T1 mental health and bodily pain contributed significantly to mental health at T2, with mental health being the greatest contributor. It was concluded that the experience of breast cancer is not damaging to mental health per se, but such a life stressor is likely to impact most on the mental health of women who already had less robust mental health. (Contains 2 tables.)

The Personal Wellbeing Index (PWI) is being developed for the cross-cultural measurement of subjective wellbeing (SWB). This paper reports the findings of its utility with the Hong Kong Chinese and Australian populations. An item on affect, "satisfaction with own happiness" was also investigated to determine whether it should be added to the index. Three-hundred and sixty participants (180 per country), with equal representation from groups aged 18-35, 35-64 and 65 years and above, were recruited from each country. The PWI demonstrated good psychometric performance in terms of its reliability, validity and sensitivity, which are comparable in both countries. The item "satisfaction with own happiness" was found to contribute significantly to the scale's psychometric performance in Australia but not in Hong Kong. Cultural differences in the perception of the concepts "satisfaction" and "happiness" were suggested as an explanation for this finding. The PWI data are also consistent with homeostasis theory, which proposes that each person's SWB level is maintained within a limited positive range. For the Australian population, their mean SWB level fell within the established Western range of 70-80, on a scale from 0 to 100. The Hong Kong population, however, fell below this range. Cultural response bias was identified as a plausible explanation for the differences between the Hong Kong and Australian samples.

This paper reports the initial findings of an exploratory, qualitative study of the life and work of people who are working full-time and also caring for a child with chronic illness. The demands of such a lifestyle are significant. Respondents--all women--often reported "doing-it-all" while constantly being frustrated and challenged in their mothering role.

The late 20th Century saw the rapid rise of quality assurance and effectiveness measures in most industries and organisations. These trends were very much reflected in education at all levels. An associated emergent trend in primary and secondary education in Australia was growth in the use of standardised measures of student achievement that increasingly served (and continue to serve) as a major source of data in judging school effectiveness. While cognitive measures are important outcomes of schooling, it is reasonable to argue that interpretations of quality and effectiveness that do not include affective measures are too narrow. In particular, these criteria sacrifice what may be regarded as more complex and aesthetic measures of quality and effectiveness, such as student perceptions of aspects of their life at school. This paper has developmental, theoretical, and philosophical dimensions. The developmental dimension is based on a definition and articulation of a potential future of education advocating a re-aligning of academic and affective student outcomes. Affective measures are identified as important components of school effectiveness and quality assurance as well as the associated implementation of school reform and school improvement to enhance these measures. The theoretical dimension relates to definitions, clarifications, and links between school effectiveness, effective schools, school improvement, school reform, quality education, quality schools, and quality of life. The philosophical dimension aims to ensure high student quality of life, an enhanced mentoring role for educators, and a focus on children's future, health, equity, and access issues. (Contains 1 figure.)

Introduction: Occupational therapy in residential aged care facilities (RACFs) can enhance residents' occupational engagement and wellbeing. However, industry reports suggest that occupational therapists in Australian RACFs have mostly provided physical therapies such as pain management via massage and not addressed residents' occupations. There is limited literature on what constitutes occupational therapists' practice in RACFs to inform policy and practice. The aim of this cross‐sectional survey was to explore practice patterns of occupational therapists working in Australian RACFs and influences on their practice. Methods: Occupational therapists working in Australian RACFs were invited from July 2019 to March 2020 to complete a self‐report online questionnaire via email and advertisements on industry websites, newsletters, and social media. The questionnaire asked therapists about their caseload, referrals, assessments, and interventions. Data were analysed descriptively and presented as frequencies and percentages. Results: A total of 214 occupational therapists completed the survey. Occupational therapists' daily practice largely focussed on pain management; other areas of practice included falls prevention, pressure care, and mobility. The Aged Care Funding Instrument in place at the time of the survey was identified as the leading factor influencing therapists' choice of assessments and interventions. Organisational policies and procedures were also perceived as key factors influencing occupational therapy practice. Conclusion: This paper highlights the influence of government funding and organisational policies in limiting occupational therapists' scope of practice and their ability to fully address the occupational needs of residents. Occupational therapists and the profession in general should be aware of factors in aged care funding models, and their application, that restrict occupational therapy practice and inhibit residents' function and advocate for change where needed. With the introduction of the Australian National Aged Care Classification funding model replacing Aged Care Funding Instrument, future research should explore potential changes to therapists practice following the implementation of the new funding model. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this paper was to examine the client and psychosocial characteristics associated with polydrug use in patients with alcohol misuse as their primary drug of concern (PDC) seeking treatment from substance use treatment centres. Methods: Self‐report surveys were undertaken with clients attending 1 of 34 community‐based substance use treatment centres across Australia with alcohol as their PDC. Survey items included client's socio‐demographic characteristics, level of alcohol dependence, use of other drugs including tobacco, health and wellbeing factors including health‐related quality of life. The factors associated with polydrug use (alcohol use concurrent with at least one other drug) were examined. Results: In a sample of 1130 clients seeking treatment primarily for alcohol problems, 71% reported also using another drug. The most frequently used drug was tobacco (50%) followed by cannabis (21%) and benzodiazepines (15%). Excluding tobacco use, 35% of participants reported polydrug use. Factors associated with any polydrug use were younger age, lower education levels, lower levels of mental health related quality of life and housing risk (i.e., risk of eviction or experienced homelessness in past 4 weeks). When tobacco was excluded, factors associated with polydrug use were age, lower physical and mental health‐related quality of life, and housing risk. Discussion and Conclusions: Most adults seeking treatment for alcohol misuse as their PDC reported using another drug in addition to alcohol. Treatment services should be designed accordingly to maximise the likelihood of treatment engagement and success. [ABSTRACT FROM AUTHOR]

Introduction: Although there is a large proportion of people from culturally and linguistically diverse backgrounds within Australia, their rate of access to disability services is disproportionately low. This review aims to understand the service needs of people from culturally and linguistically diverse backgrounds with disability to facilitate engagement in meaningful occupations. Methods: Arksey and O'Malley's scoping review framework was employed. Ten databases were searched for Australian studies. A deductive content analysis framework was applied in the synthesis. Results: Fourteen papers were included. Themes that emerged include language and cultural needs and considerations, which highlights the need for information sharing to take account of intergenerational, intercultural and sociolinguistic differences. It also identified the need for improved training and skills of existing interpreters. Culturally competent and responsive services was another theme identified, which emphasised the need to enhance the workforces' understanding of cultural practices. There is also a strong call for a more culturally diverse workforce to reduce the use of some interpreters and to build a more culturally competent workforce. The last theme was responsive service delivery, which requires the governance to support the development of a nurturing trusting therapeutic relationship. Conclusions: Service providers should be trained on the inequities and intersectionality of this population. Further research is required to explore current disability policy in Australia with an intersectionality lens to ensure recommendations can be made to address barriers and ensure this population receives services in a manner that enhances their ability to engage in occupations meaningfully. [ABSTRACT FROM AUTHOR]

Uses outcomes of case study research in socioeconomically disadvantaged education contexts to examine accomplishments of (Australian) educators who have significantly affected their communities' quality of life. Highly successful classroom practitioners' work has some connection with prominent educational leadership theories. Questions approaches associating leadership with positional theory. Proposes an alternative definition of teacher leadership. (29 references) (MLH)

Background: Early intervention alcohol and drug (AOD) programs for disadvantaged young people have the potential to substantially decrease the need for future intervention, however there is little research about how young people use these programs or the substance use and other outcomes of such programs. This paper uses data from an Australian AOD early intervention program, The Street Universities, to: describe young people's participation; examine changes in substance use and wellbeing over 90 days; and assess which young people are most positively impacted., Methods: Data come from a prospective study of new attendees, measuring retention in and attendance patterns in an 'engagement' program focussed on arts and lifestyle activities (n = 95), and a routine service dataset collected from seven years of therapeutic intervention (n = 3,893), measuring substance dependence (SDS), psychological distress (K10) and quality of life (EQoL)., Results: Analysis reveals that young people were retained in the program at high proportion (63% at six months) and more than half of these returned at a frequency of weekly or more often. Young people participating in the therapeutic component of the program reported significant improvements in all key wellbeing indicators with SDS, K10 and EQoL scores significantly improving (at p < .001). These improvements occurred rapidly, within the first 30 days, and were maintained over the 90 day study period. Moreover, young people with the highest SDS and K10 scores and lowest quality of life at baseline experienced the most positive changes., Conclusion: Aligning engagement program with therapeutic intervention can provide comprehensive support to disadvantaged young people, producing substantial improvements in AOD use, distress and wellbeing., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Caruana et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background/aims: Discrete choice experiments (DCEs) with either duration included an attribute or with dead included as an option can be used as a stand-alone approach to value health states. This paper reports on a DCE with both of these features to develop an EQ-5D-5L value set for Australia., Methods: A DCE was undertaken using a large Australian panel of internet respondents, from which a sample of more than 4000 Australian adults was chosen, stratified to be population representative on age and gender. The DCE contained 500 choice triplets, with two EQ-5D-5L health states with duration, and dead as the third option. Each respondent answered 12 choice sets from the 500, stating both the best and worst options from the three available. The design was constructed to estimate a utility algorithm with main effects plus some key interaction terms. A variety of approaches to parameterising interactions, and to anchoring the value set on the required 0-1 scale, were tested. A preferred Australian adult utility algorithm for use in cost-utility analysis was then generated., Results: In total, 4477 people completed at least one choice set and were included in the analysis. The results reflected the monotonic structure of the EQ-5D-5L, in that moving from no problems to extreme problems led to worsening utility in each dimension. Inclusion of interaction terms demonstrates that the disutility of the first dimension moving to a poor level (defined as either level 5, or level 4 or 5) had a large impact, but subsequent dimensions moving to a poor level had a relatively smaller disutility., Discussion: This work develops a value set for the EQ-5D-5L in Australia, and also provides a range of methodological insights which can inform future work using a stand-alone DCE to value health in other countries., (© 2023. The Author(s).)

This paper describes an initiative launched in New South Wales, Australia, in 1989 to help students with disabilities move from school to community settings. The program established partnerships among schools, communities, service providers, and government agencies, resulting in smoother transitions and improved postschool options and quality of life for students with disabilities. (Author/PB)

This paper reviews the literature to assess the effectiveness of oral health interventions in influencing oral health-related quality of life (OHRQoL) in older adults. Clinical studies published in 2010 onwards reporting oral health interventions in older adults and subsequent changes in OHRQoL were systematically searched in Medline, Web of Science and EMBASE databases. Reporting followed Preferred Reporting Items for Systematic Review and Meta-Analysis criteria. Eligibility evaluation and data abstraction from eligible studies were guided by predefined PICO questions and bias assessment by the Quality in Prognosis Studies tool. The search retrieved 144 articles. Of the 20 articles that met the eligibility criteria, 45% (9) reported a statistically significant improvement in OHRQoL. The majority of studies were conducted in adults with complete edentulism (70%) and mainly focused on implant provision to support a removable prosthesis (30%). The search indicates the limited scope of current literature on geriatric dental interventions, focusing mainly on denture realignments, denture fabrication and implant placement. Although the majority of the oral health interventions focused on edentulism and removable prostheses, there are many areas of oral health interventions and their potential impact on OHRQoL in this demographic group that have yet to be explored. © 2022 Australian Dental Association., (© 2022 Australian Dental Association.)