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People from refugee and asylum seeker backgrounds resettling in Australia often experience intersecting risks for poor mental and physical health. Physical activity can promote better health outcomes, however there are limited programs tailored for this population. Therefore, understanding how to support refugees and asylum seekers to engage in physical activity is crucial. This paper aims to describe how the experience-based co-design (EBCD) process was used to identify priorities for a new physical activity service for refugees and asylum seekers. Using an EBCD framework we conducted qualitative interviews and co-design workshops with service users (refugees and asylum seekers living in the community) and service providers at a community Centre in Sydney, Australia. Sixteen participants, including eight service users and eight service providers engaged in the EBCD process over 12-months. The interviews revealed common themes or 'touchpoints' including barriers and enablers to physical activity participation such as access, safety and competing stressors. Subsequent co-design focus groups resulted in the establishment of five fundamental priorities and actionable strategies; ensuring cultural and psychological safety, promoting accessibility, facilitating support to access basic needs, enhancing physical activity literacy and fostering social connection. Using EBCD methodology, this study used the insights and lived experiences of both service users and providers to co-design a physical activity service for refugees and asylum seekers which is safe, supportive, social and accessible. The results of the implementation and evaluation of the program are ongoing. [ABSTRACT FROM AUTHOR]

Previous research has indicated that healthcare support for sexuality after spinal cord injury appears to be neglected or inadequately provided. The perspectives of people living with spinal cord injuries regarding what is lacking and what support they would like to be provided, and why, has yet to be explored. This paper uses critical theory to explore how societal constructs of sexuality and disability shape how sexuality is supported after a spinal cord injury. To do this, we conducted in-depth semi-structured interviews with 11 people with a spinal cord injury from Australia, the United Kingdom, and the United States. We drew from the works of various critical disability theorists to analyze what discourses underpinned the experiences people with spinal cord injuries had when receiving sexuality support. Analysis suggested that the following discourses were apparent: (1) broken bodies require repair, (2) sex is penetration, ejaculation then reproduction, and (3) sexual autonomy is required. Findings indicated healthcare professionals need to recognize people with spinal cord injuries as sexual beings with a diverse range of desires, lives, relations, and bodies. Provision of individualized comprehensive high-quality sexuality support is therefore warranted. To achieve this, healthcare professionals should aim to be aware of, and mitigate, ableist and normative assumptions. [ABSTRACT FROM AUTHOR]

Qualitative studies on assisted reproductive technology commonly focus on the perspectives of participants living in major metropolises. In doing so, the experiences of those living outside major cities, and the unique way conditions of spatiality shape access to treatment, are elided. In this paper, we examine how location and regionality in Australia impact upon access and experience of reproductive services. We conducted twelve qualitative interviews with participants residing in regional areas across Australia. We asked participants to discuss their experience with assisted reproduction services and the impacts of location on access, service choice, and experience of care, and analysed the data using reflexive thematic analysis, as outlined by Braun and Clarke (2006, 2019). Participants in this study reported that their location impacted the services available to them, required considerable time in travel, and reduced continuity of care. We draw on these responses to examine the ethical implications of uneven distribution of reproductive services in commercial healthcare settings which rely on market-based mechanisms. [ABSTRACT FROM AUTHOR]

Aim: Owing to the COVID-19 pandemic, many companies shifted to telework, with few insights into its implementation, organisational conditions or the role of workplace health promotion and management. This study focused on a multifactorial investigation of conditions in companies which implemented and evaluated telework during the first lockdown in 2020 as well as on their future intentions to facilitate teleworking under health-promoting working conditions. Subject and methods: The research hypotheses relate to an extended technology acceptance model. In a mixed-methods design, expert interviews were fed into the development of an online questionnaire. Out of 1858 contacted companies representing a broad range of Austrian businesses, 192 responses (general management, workplace health managers, etc.) were analysed using descriptive and multivariate statistics. Results: The degree of implementation and claim to teleworking increased significantly during the first lockdown and did not return to pre-pandemic levels afterwards. Changes depended on preparation and experience: evaluation of teleworking and willingness to continue offering teleworking were conditional on preparation and the degree of implementation. Prerequisites for future intentions to implement health-promoting teleworking included readiness, general willingness and existing workplace health promotion/management structures. Conclusion: This paper demonstrates the potential of health-promoting organisational cultures for development processes – particularly in times of crisis. Anchoring health-focused structures in companies helps to create health-promoting frameworks. Health-promoting teleworking can be developed from workplace health promotion/management using established approaches. It is essential to build on in-house capacities and competencies to develop awareness for a holistic culture for health-promoting (tele)work and to encourage deliberations about potential measures. [ABSTRACT FROM AUTHOR]

Research into nonsuicidal self-injury (NSSI) has primarily focussed on the experience and regulation of emotion. Recently, NSSI-specific cognitions, including self-efficacy to resist self-injury, have been explored to further understand the behaviour. However, within these studies self-efficacy to resist NSSI has been assessed broadly using an adapted measure of self-efficacy to avoid suicide. There is a need for a NSSI-specific measure of self-efficacy, which considers specific contexts that may influence confidence in the ability to resist self-injuring. This paper reports the development of such a measure. An initial item pool (125 items) was generated from interviews with people with lived experience of NSSI and experts in the field of self-injury. These items were then administered to 650 participants aged 18–40 years (M = 21.14, SD = 2.32, 45.69% with a history of NSSI). Analyses revealed a three-factor structure representing: contexts in which it would be difficult to resist NSSI (risk contexts); contexts which make it easier to resist NSSI (protective contexts); and contexts in which people are reminded of self-injury (reminders of NSSI). To reduce the number of items, eight items with the highest loadings on each factor were retained. The final 24 item (three subscales) scale fit the data well and demonstrated invariance across individuals with and without a history of self-injury. Correlations with related but distinct constructs (e.g., self-esteem, locus of control) supported convergent and discriminative validity. This measure could be used to further theoretical understanding of NSSI and may be useful in clinical settings. [ABSTRACT FROM AUTHOR]

This paper uses secondary analysis to understand how COVID-19 shaped people's experiences with psychosocial support services in Australia. Data are drawn from questionnaires (n = 66) and semi-structured interviews (n = 62), conducted for a national service evaluation, with 121 people living with enduring mental health conditions and using psychosocial support services. Data relating to COVID-19 were inductively coded and analysed using constant comparative analysis. Most people's experiences included tele-support. While some people described minimal disruption to their support, many reported reduced engagement. People's wellbeing and engagement were influenced by: their location, living situation and pre-COVID lifestyles; physical health conditions; access to, comfort with, and support worker facilitation of technology; pre-COVID relationships with support workers; and communication from the organisation. The findings can help services prepare for future pandemics, adjust their services for a 'COVID-normal' world, and consider how learnings from COVID-19 could be incorporated into a flexible suite of service delivery options. [ABSTRACT FROM AUTHOR]

Background: Adolescents diagnosed with cancer experience unique psychosocial concerns that persist beyond treatment completion into longer-term survivorship. Camp-based, group Acceptance and Commitment Therapy (ACT) programs are a potential model for providing evidence-informed psychological and peer support to adolescent cancer survivors. Objective: This paper describes the development and exploration of the feasibility and acceptability of such a program, Places You'll Go. This manualised program incorporates five 90-min group ACT sessions within a 3-day camp, teaching ACT strategies in the context of psychosocial impacts of cancer. Method: Eight facilitators and twenty-eight Australian adolescent cancer survivors (68% female; age range 12–17 years, M = 15.4 years) participated in the program and evaluation. Feasibility was assessed using facilitator-reported session duration, attendance, quality and content fidelity; facilitators also completed interviews after program completion. Young people completed surveys on program acceptability at the end of each session and at program completion. Results: All planned sessions were delivered, with 97% attendance and high fidelity in manualised program delivery. All young people were mostly or very satisfied and would recommend the program to another cancer survivor. Opportunities for peer connection and skill development contributed to perceived program acceptability. Conclusions: The Places You'll Go program was acceptable and feasible to deliver. It is a promising community-based model for promoting peer support and well-being in adolescent cancer survivors, indicating the potential of ACT-based approaches for this population. Further work is underway to evaluate whether the program improves psychosocial wellbeing among participants, and if this is linked to the therapeutic mechanisms underpinning ACT. [ABSTRACT FROM AUTHOR]

Recruiting adults with autism spectrum disorders (ASD) into research poses particular difficulties; longitudinal studies face additional challenges. This paper reports on a mixed methods study to identify factors influencing the participation in longitudinal autism research of adults with ASD, including those with an intellectual disability, and their carers. Common and differentiating factors influencing the research participation of participants are identified and discussed. Factors influencing participation were found to differ both between and within participant categories. We propose a dichotomy whereby factors influencing research participation can be classified as those arising from a participant's values, which act as either a motivator or a deterrent; and those based on convenience, which act as either an enabler or inhibitor. These findings are applicable to research studies that seek to recruit adults with ASD as participants. [ABSTRACT FROM AUTHOR]

Considerable attention has been focused on women's mental health in the perinatal period and the subsequent impacts on children. Comparatively, we know much less about maternal depression at later time points and the potential implications for child mental health. The objective of this paper was to explore the association between maternal depression and child emotional/behavioural difficulties at 4 years postpartum, taking into account earlier episodes of perinatal depression. The Maternal Health Study is a prospective cohort study of 1,507 nulliparous women. Maternal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) in early pregnancy and at 3, 6 and 12 months postpartum and again at 4 years postpartum. Maternal depressive symptoms at 4 years postpartum were associated with significantly increased odds of child emotional/behavioural difficulties (odds ratio (OR) = 3.46, 95 % confidence interval (CI) = 2.21-5.43). This remained significant after adjusting for earlier episodes of perinatal depression and socio-demographic characteristics (OR = 2.07, 95 % CI = 1.18-3.63). We also observed a robust association between child difficulties at age 4 and measures of socio-economic disadvantage. Our findings suggest a pressing need to rethink current paradigms of maternal health surveillance and extend mental health surveillance and support to at least 4 years postpartum. [ABSTRACT FROM AUTHOR]

There is a relative paucity of literature in the field of spirituality among people who have a lived experience of severe mental illness from Australia. Sixteen individuals with a severe mental illness were interviewed on their experiences of spirituality. The three themes that emerged from the data were concepts of spirituality, benefits of intentional spiritual practices and perceived spiritual benefits of recreational pursuits and physical activity. This paper adds to the relatively sparse literature on spirituality among persons with a mental illness in Australia. [ABSTRACT FROM AUTHOR]

Objectives: Patient reported experience measures (PREMs) are tools often utilised in hospitals to support quality improvements and to provide objective feedback on care experiences. Less commonly PREMs can be used to support consumers choices in their hospital care. Little is known about the experience and views of the Australian consumer regarding PREMs nor the considerations these consumers have when they need to make decisions about attending hospital. This study aimed to explore consumer awareness of PREMs, consumer attitudes towards PREMs and the utility of PREMs as a decision-making tool in accessing hospital care. Methods: Qualitative study involving semi-structured interviews conducted over the phone. Participants (n = 40) were recruited from across Australia and purposively sampled according to key characteristics: holding private health insurance, > 30-years of age, may have accessed private hospital care in the past year, variety of educational and cultural backgrounds, and if urban or rural residing. Interviews were audio-recorded, transcribed, and analysed thematically. Results: Four overarching themes and six subthemes were identified from the data. Major findings were that prior awareness of PREMs was limited; however, many had filled in a PREM either for themselves or for someone they cared for following a hospital stay. Most respondents preferred to listen to experience of self or family/friends or the recommendation of their physician when choosing a hospital to attend. Participants appeared to be more interested in the treating clinician than the hospital with this clinician often dictating the hospital or hospital options. If provided choice in hospital, issues of additional costs, timeliness of treatment and location were important factors. Conclusion: While PREMs were considered a possible tool to assist in hospital decision-making process, previous hospital experiences, the doctor and knowing up-front cost are an overriding consideration for consumers when choosing their hospital. Consideration to format and presentation of PREMs data is needed to facilitate understanding and allow meaningful comparisons. Future research could examine the considerations of those consumers who primarily access public healthcare facilities and how to improve the utility of PREMs. [ABSTRACT FROM AUTHOR]

While there is high patient acceptance for clinical staff discussing issues regarding spirituality with hospital inpatients, it is not clear which staff member patients prefer for these discussions. This unique exploratory study investigated inpatient preferences regarding which staff member should raise the topic of spirituality. A cross-sectional survey was conducted with inpatients at six hospitals in Sydney, Australia (n = 897), with a subset invited to participate in qualitative interviews (n = 41). Pastoral care staff (32.9%) were the preferred staff members with whom to discuss spiritual issues, followed by doctors (22.4%). Qualitative findings indicated that individual characteristics of the staff member are more important than their role. [ABSTRACT FROM AUTHOR]

Peer support groups have been an increasingly popular way of limiting the adverse effects of life with a chronic illness for adolescents although few groups have been rigorously evaluated. This paper reports the findings of a realistic evaluation of a hospital based peer support program Chronic Illness Peer Support (ChIPS), in Sydney, Australia. We collected qualitative interview and focus group data from four participant groups; new ChIPS members, their parents, older members who had been in ChIPS for two or more years, and ChIPS co-ordinators past and present. Results of qualitative data have been aggregated and organised into three categories; program attendance: getting in and staying in; program outcomes for young people: personal growth and development; and social connection. Questionnaires were also administered to fourteen new ChIPS members but no significant changes in distress or self-esteem were recorded between the beginning and the end of the short study period. The ChIPS Introductory Program fulfilled its aim, entering young people with chronic illness into the peer support program. There was evidence of initial personal growth and development in those young people, with potential for enhanced social connection from ongoing participation in ChIPS activities. [ABSTRACT FROM AUTHOR]

This paper reports on a study of Australian early childhood teachers' pedagogical practices with young children experiencing parental separation and divorce. Twenty-one semi-structured interviews and a focus group were conducted to explore the actions of teachers to support young children experiencing parental separation and divorce. A grounded theory approach was used to analyse data. Teachers reported actions that were focussed on constructing emotional, behavioural, and academic support for young children, as well as forming partnerships with parents, school personnel, and community members to assist. Results are discussed in terms of the implications for professional practice. [ABSTRACT FROM AUTHOR]

Study design:Literature review/semi-structured interviews.Objective:To develop a spinal cord injury (SCI) research strategy for Australia and New Zealand.Setting:Australia.Methods:The National Trauma Research Institute Forum approach of structured evidence review and stakeholder consultation was employed. This involved gathering from published literature and stakeholder consultation the information necessary to properly consider the challenge, and synthesising this into a briefing document.Results:A research strategy 'roadmap' was developed to define the major steps and key planning questions to consider; next, evidence from published SCI research strategy initiatives was synthesised with information from four one-on-one semi-structured interviews with key SCI research stakeholders to create a research strategy framework, articulating six key themes and associated activities for consideration. These resources, combined with a review of SCI prioritisation literature, were used to generate a list of draft principles for discussion in a structured stakeholder dialogue meeting.Conclusion:The research strategy roadmap and framework informed discussion at a structured stakeholder dialogue meeting of 23 participants representing key SCI research constituencies, results of which are published in a companion paper. These resources could also be of value in other research strategy or planning exercises.Sponsorship:This project was funded by the Victorian Transport Accident Commission and the Australian and New Zealand Spinal Cord Injury Network. [ABSTRACT FROM AUTHOR]

The birth of an extremely premature baby is a tragedy, and it is only natural that the parents will rely on the spiritual and religious beliefs that guide the rest of their lives. At this difficult time, parents with strong religious beliefs will hope for divine intervention and pray for a miracle. This paper outlines the difficulties experienced by neonatal nurses when caring for an extremely premature baby whose parents hold on to hope and their belief in divine intervention and a miracle. Data were collected via a questionnaire to Australian neonatal nurses and semi-structured interviews with 24 neonatal nurses in NSW, Australia. A qualitative approach was used to analyse the data. The theme of 'hoping for a miracle' was captured by two sub-themes 'praying for a miracle' and 'oscillating between hope and despair'. For some families, the hope of divine intervention seemed all consuming, and the nurses were witness to the desperation and disappointment of families when a miracle was not forthcoming. [ABSTRACT FROM AUTHOR]

Recovery-orientated practice is crucial to mental health care services—consistently identified in policy, service delivery guidelines and national mental health action plans. An essential component to systems reform and the adoption of recovery-orientated practice is the inclusion of peer support workers as practice leaders to support shifting culture in mental health service delivery. Designated peer support roles operate as healthcare professionals who utilise their lived and living experience of mental health difficulty to support those on their recovery journey through mutual understanding of shared experience. This research sought to explore the experiences of peer support workers integrating into mental health teams and identify organisational actions to facilitate successful recognition, integration and acceptance by colleagues; therefore, promoting sustainability of the peer support role. Qualitative interviews were undertaken with 18 peer support workers employed across four Australian states within 12 different government and non-government organisations. Study findings reveal three key areas for organisational change with seven main themes to assist organisations to better facilitate the successful integration of peer support workers into mental health service teams. These included robust induction, training for existing staff, clear referral pathways into the service, consistent supervision and debriefing, leadership support, professional development pathways and involving peer workers through change processes. These themes were grouped into three key areas for change including preparation, process and structural changes, and cultural change actions for sustainability. This article makes recommendations for organisations to consider when implementing peer support roles into mental health services. [ABSTRACT FROM AUTHOR]

Effective parent-teacher partnerships improve outcomes for autistic students. Yet, we know little about what effective partnerships look like for parents of autistic children from different backgrounds. We conducted interviews with 17 Chinese parents of autistic children attending Australian kindergartens/schools to understand their experiences. Parents appreciated the acceptance, opportunities and supports they received in Australia. They had high expectations of children; expectations not often shared by educators. Parents were respectful of teachers' expertise and polite and undemanding in interactions. Nevertheless, parents were frustrated by inconsistent teaching quality and inadequate communication. Navigating systems was also challenging and parents faced discrimination from teachers and their community. Recommendations include fostering open home-school communication, proactively seeking parents' expertise about children and explicitly scaffolding parents' self-advocacy. [ABSTRACT FROM AUTHOR]

Use in criminological research of observation, semi-structured interviewing, and analysis of personal documents has been commonplace for more than a century. These research techniques can be employed to develop and test theoretical explanations and to examine the process of policy implementation. This paper briefly explicates how they were used in studies of the decision making and criminal careers of street-level thieves and hustlers, to test theoretical notions about the delegitimantion effects of white-collar crime, and to examine the implementation of a crackdown campaign by Australian tax authorities direct at crash transactions in the small building and construction industry. Investigations may profit, however, from awareness of recurrent challenges in the use of ethnographic methods before launching research of this type. [ABSTRACT FROM AUTHOR]

Home country re-entry from cross-cultural missionary work abroad may be associated with psychological distress. Re-entrants experience multiple losses including loss of identity which may be associated with personal/relational identity gaps and depersonalization/dehumanization. However, research suggests that some re-entrants are resilient with good mental health, while others are fragile with poor mental health. The aims of this paper are to explore the nature and frequency of re-entering missionaries' identity gaps and their depersonalization/dehumanization in resilient and fragile re-entrants. Fifteen re-entering adult Australian cross-cultural missionary workers from four interdenominational Australian mission organizations completed semi-structured interviews. Results were analysed using modified Consensual Qualitative Research methods. Links were established between personal/relational identity gaps, depersonalization/dehumanization and resilience on re-entry. Implications for re-entrants' care are discussed with suggestions for further research. [ABSTRACT FROM AUTHOR]

Over the past decade, stem cell science has generated considerable public and political debate. These debates tend to focus on issues concerning the protection of nascent human life and the need to generate medical and therapeutic treatments for the sick and vulnerable. The framing of the public debate around these issues not only dichotomises and oversimplifies the issues at stake, but tends to marginalise certain types of voices, such as the women who donate their eggs and/or embryos to stem cell research and the patients who might benefit from its potential clinical outcomes. This paper draws on empirical research conducted on a recent stem cell policy episode in Australia. From the qualitative examination of 109 newspaper opinion editorials and twenty-three in-depth interviews, it is argued that these voices are marginalised because they are based on discourses that have less epistemological status in public debate. Our results suggest that the personal experiences of women and patients are marginalised by the alliances that form between more powerful discourse communities that use science as a source of authority and legitimation. It is argued that members of these communities establish legitimacy and assert authority in public debate by discursively deploying science in claims that marginalise other epistemologies. Implications are discussed along with suggestions for a more enriched and inclusive public debate. [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) has a detrimental effect on the wellbeing of victims and their children. Situational as well as individual factors shape victims' responses to the experiences of IPV in many ways. This study uses a quantitative approach to examine the factors that influence victims' decisions on whether and where to seek help. The role of (unborn) children has been examined together with other demographic and situational factors to reveal their influence on victims' help-seeking decisions. Two items were used to measure the role of children, including victims' pregnancy at the time of the abuse and children residing with the victim and witnessing the abuse. Relevant findings derived from the analysis of a sub-sample of women interviewed in the process of the International Violence Against Women Survey (IVAWS) 2002/03 are discussed throughout this paper with a specific focus on the role of children. While the presence of unborn children (i.e., pregnancy) had no effect on victims' help-seeking decisions, children witnessing the abuse emerged as the strongest predictor of general and more formalized help-seeking decisions. [ABSTRACT FROM AUTHOR]

This paper reports part of a larger study which was designed to investigate current practices in initial teacher education programs in Australia. The main data collection was by telephone interviews, which were carried out with science education specialists and program coordinators at all institutions which offer primary teacher education or secondary science teacher education. The interviews focused on practices in relation to program structures, science content studies, science methods studies and links to science-related school projects or to science business/industry. A large number of innovative practices were described. In addition, several case studies were carried out, which focused on particular innovations. The study identified several aspects of science teacher education which were of concern. [ABSTRACT FROM AUTHOR]

Purpose: Health and social care professionals are ideally placed to identify and address gender-based violence (GBV), yet research continues to demonstrate that the subject is being poorly covered at undergraduate level. This qualitative study explored health and social care students' and educators' views on GBV education, with a view to identifying 'best practice'. We aimed to capture students' and educators' experiences and perceptions of GBV education across participating countries; how participants thought GBV should be taught/learned within their curricula; and their views on how GBV education might be 'optimized'. Methods: We conducted nine focus group discussions and one semi-structured interview with 23 students and 21 academic staff across the UK, Australia and Chile. Results: Thematic analysis yielded three themes: (1) GBV addressed in all but name, (2) Introduce sooner, explore later and (3) A qualitative approach to learning. Educators and students indicated that GBV is largely being overlooked or incompletely addressed within curricula. Many participants expressed a wish for the subject to be introduced early and revisited throughout their study, with content evolving as cohorts mature. Lastly, our findings indicate that GBV education could benefit from adopting a 'qualitative' approach, prioritizing survivor narratives and incorporating dialogue to facilitate student engagement. Conclusion: Though time constraints and competing demands within undergraduate curricula are frequently cited as barriers to moving away from traditional didactic methods, our findings suggest that teacher-centered strategies are insufficient and, in some regards, inappropriate for GBV education. The need for a paradigm shift in GBV education is discussed. [ABSTRACT FROM AUTHOR]

We mapped gay and bisexual men's (GBM) patterns of using pre-exposure prophylaxis (PrEP) over time and explored sexual behavior as PrEP use changed. We conducted semi-structured interviews between June 2020 and February 2021 with 40 GBM living in Australia who had changed their PrEP use since initiating. There was considerable diversity in patterns of discontinuation, suspension, and recommencement of PrEP. Reasons for changing PrEP use mostly centered on accurate perceived changes to HIV risk. Twelve participants reported condomless anal intercourse with casual or fuckbuddy partners after discontinuing PrEP. These sex events were unanticipated, condoms were not a preferred option, and other risk reduction strategies were applied inconsistently. Service delivery and health promotion can support safer sex among GBM when PrEP use fluctuates by promoting event-driven PrEP and/or non-condom-based risk reduction methods during periods off daily PrEP, and guiding GBM to better recognize changing circumstances of risk and when to recommence PrEP. [ABSTRACT FROM AUTHOR]

While patients value engagement concerning their spirituality as a part of holistic healthcare, there is little evidence regarding the preferred way to engage in discussions about spirituality. This study investigated inpatient preferences regarding how they would like spirituality to be raised in the hospital setting. A cross-sectional survey was conducted with inpatients at six hospitals in Sydney, Australia (n = 897), with a subset invited to participate in qualitative interviews (n = 41). There was high approval for all proposed spiritual history prompts (94.0–99.8%). In interviews, the context dictated the appropriateness of discussions. Findings indicated a high level of patient acceptability for discussing spirituality in healthcare. Further research and more detailed analysis is required and proposed to be undertaken. [ABSTRACT FROM AUTHOR]

Background: Patient-reported outcome measures (PROMs) provide a measure of self-perceived health status or health-related quality of life. They have been used to support provider-patient decisions, healthcare delivery, and value-based healthcare models. A barrier to routine collection of PROMs is the perception that PROMs lack clinical utility. As such, it is important to establish clinicians' acceptability of the PROM prior to large-scale implementation. This study explored the acceptability of the routine use and collection of a generic PROM in healthcare services from the perspective of healthcare staff. Methods: Individual semi-structured interviews were completed from September 2020 to March 2021 with 26 staff from two multi-disciplinary community healthcare services in Melbourne, Australia. Interviews explored their experiences of using the EQ-5D-5L in their routine care. Interviews were recorded and transcribed verbatim. Data were analysed according to a framework approach, using inductive and deductive techniques. Results: Participants discussed the acceptability of the EQ-5D-5L with reference to four themes: practicalities of use; holistic nature; influence on client care; and influence on health service. Participants found the EQ-5D-5L quick and easy to administer, and appreciated that it measured multiple domains of health that were relevant to their clients' care. They believed the EQ-5D-5L helped to identify client problems, and inform service delivery. They also reported features that were less acceptable, including a lack of item specificity to some healthcare disciplines. Participants reported the challenge of managing conflict between their assessment of the client's health and the client's perspective of their own health, leading some to question whether the client could provide an accurate reflection of their own health. Conclusions: The EQ-5D-5L has several features that healthcare staff viewed as acceptable for routine collection and use in healthcare. Training on the validity of the patient reported perspective and broadening the scope of PROMs collection beyond the EQ-5D-5L should be considered to facilitate large-scale implementation. [ABSTRACT FROM AUTHOR]

Background: Value-based healthcare provider reimbursement models have been proposed as an alternative to traditional fee-for-service arrangements that can align financial reimbursement more closely to the outcomes of value to patients and society. This study aimed to investigate stakeholder perceptions and experiences of different reimbursement systems for healthcare providers in high-performance sport, with a focus on fee-for-service versus salaried provider models. Methods: Three in-depth semi-structured focus group discussions and one individual interview were conducted with key stakeholders across the Australian high-performance sport system. Participants included healthcare providers, health managers, sports managers and executive personnel. An interview guide was developed using the Exploration, Preparation, Implementation, Sustainment framework, with key themes deductively mapped to the innovation, inner context and outer context domains. A total of 16 stakeholders participated in a focus group discussion or interview. Results: Participants identified several key advantages of salaried provider models over fee-for-service arrangements, including: the potential for more proactive and preventive models of care; enhanced inter-disciplinary collaboration; and the ability for providers to have a deeper understanding of context and how their role aligns with a broader set of priorities for an athlete and the organisation. Noted challenges of salaried provider models included the potential for providers to revert to reactive care delivery when not afforded adequate capacity to provide services, and difficulties for providers in demonstrating and quantifying the value of their work. Conclusions: Our findings suggest that high-performance sporting organisations seeking to improve primary prevention and multidisciplinary care should consider salaried provider arrangements. Further research to confirm these findings using prospective, experimental study designs remains a priority. [ABSTRACT FROM AUTHOR]

Background: In recent years, the length of elite sporting competitions has raised concerns regarding player well-being, highlighting a need to review current match calendars. Therefore, this study aimed to explore the perceptions of elite National Rugby League (NRL) players and staff on the annual training and competition calendar from a player workload and well-being perspective. Methods: This study adopted a mixed-methods approach, using a sequential explanatory design. Phase one implemented a cross-sectional survey, and phase two utilised semi-structured interviews. Four hundred and thirty-nine elite rugby league players and 46 staff completed the survey. Eighteen elite professional NRL players and six football staff were interviewed, and verbal data were analysed into pre-defined topic summaries using qualitative coding reliability methods. Topics included in-season, off-season, pre-season and well-being. Results: Data analysis suggests that elite NRL players and staff believe players appear particularly comfortable with the current number of games; however, they are at their maximum capacity. Importantly, this study identified several minority groups that may require support to enhance player well-being. Players believe reducing the pre-season would negate fatigue experienced later in the subsequent season. Players and staff believe this timeframe still provides sufficient time to prepare for the upcoming season. Further, players were open to extending the off-season to 8–10 weeks and believed that extra time would allow for greater recovery from the previous season. Mid-season congested scheduling affects players following the intensified period and requires attention to alleviate fatigue. Conclusion: The results of this study convey important implications for the NRL, emphasising a need to review their annual training and competitive calendar, or to implement specific strategies to enhance the well-being of minority groups. The findings from this study should be considered when discussing the ideal length and structure of the match calendar to support players' physical and mental welfare. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore Australian chaplains' views of spirituality. Semi-structured online interviews were conducted with 16 participants. Participants relied heavily on metaphors and analogies to describe spirituality. Four inter-related themes were identified through reflexive thematic analysis: (1) The core of spirituality: spirituality as a source of meaning or belief which leads to connectedness with something greater than oneself; (2) A function of spirituality: spirituality empowers people to cope in a crisis, by providing motivation, hope and comfort; (3) The experience of spiritual crisis: admission to hospital or residential care can lead to existential struggle; and (4) The spiritual practice: of holding space between struggle and growth. Greater understanding of the theoretical basis of their work may allow chaplains to offer more in the therapeutic space. [ABSTRACT FROM AUTHOR]

This is the first study to investigate instrumental activities of daily living in older autistic adults. We conducted interviews with fifteen adults (mean age = 60.1, SD = 7.4, range = 50–73) from Australia with no intellectual disability. Analysis included both deductive and inductive steps, to categorise responses using the Occupational Performance Model Australia and identify themes across participants' experiences. Strengths and challenges were unique to the individual, as were the methods they had developed to manage tasks. Challenges occurred mostly at the interaction between aspects of the environment (sensory, cognitive, social and cultural) and personal factors such as health conditions and sensory sensitivities. Enhanced person-environment fit is needed, as is a shift in wider sociocultural attitudes to enable comfort and autonomy in later life. [ABSTRACT FROM AUTHOR]

The recovery approach is now among the most influential paradigms shaping mental health policy and practice across the English-speaking world. While recovery is normally presented as a deeply personal process, critics have challenged the individualism underpinning this view. A growing literature on "family recovery" explores the ways in which people, especially parents with mental ill health, can find it impossible to separate their own recovery experiences from the processes of family life. While sympathetic to this literature, we argue that it remains limited by its anthropocentricity, and therefore struggles to account for the varied human and nonhuman entities and forces involved in the creation and maintenance of family life. The current analysis is based on an ethnographic study conducted in Australia, which focused on families in which the father experiences mental ill health. We employ the emerging concept of the "family assemblage" to explore how the material, social, discursive and affective components of family life enabled and impeded these fathers' recovery trajectories. Viewing families as heterogeneous assemblages allows for novel insights into some of the most basic aspects of recovery, challenging existing conceptions of the roles and significance of emotion, identity and agency in the family recovery process. [ABSTRACT FROM AUTHOR]

This mixed methods study examines the benefits of basing a family support worker (FSW) at a primary school in Melbourne, Australia. The school has a number of high needs families requiring extensive support from school staff. Pre and post intervention data was collected on the time spent on social problems in the school community. These included managing students with behavioural and emotional issues, providing support and practical assistance to parents with problems and liaising with agencies to access support for students and families. Pre and post intervention Strengths and Difficulties Questionnaires were completed by teachers whose students and families were clients of the FSW (n = 8) and compared with non clients (n = 10). Semi-structured interviews were held with FSW clients (n = 6), class teachers (n = 3) the assistant principal, principal and the FSW. Employing a FSW showed a reduction in the amount of time spent on welfare cases for teachers, and therefore a monetary saving for the school. Qualitative data collected from school staff and FSW clients was overwhelmingly positive. Having a FSW based at a primary school provides savings in teacher time, and expenses to the school. Teachers are freed to concentrate on education and the parents valued the relationship provided by the FSW. [ABSTRACT FROM AUTHOR]

Conventional mental health services are frequently criticized for failing to support people and communities in their care. Open Dialogue is a non-conventional humanistic approach to mental health care, which has been implemented in many different settings globally. At two Australian public health care services, implementation of the approach led to positive client outcomes and sustained organizational and clinical change. The aim of the study was to identify and explore the organizational, management, leadership and cultural factors that contributed to sustained implementation in these complex systems. We conducted nine individual semi-structured interviews of health care leaders and managers from the two sites. Transcriptions of the interviews were analyzed thematically. Leaders facilitated a gradual development of clinical and organizational legitimacy for the non-standardized Open Dialogue approach by holding the anxiety and frustration of practitioners and parts of the administration, cultivating cultural change and adaptation and by continually removing organizational obstacles. [ABSTRACT FROM AUTHOR]

The current study explored the language barriers to help-seeking in the context of reproductive coercion and abuse (RCA), domestic and family violence (DFV), and sexual violence (SV), drawing on observations by key informants supporting women from migrant and refugee communities. A lack of shared language has been identified as a key barrier to help seeking for migrant and refugee women experiencing DFV more broadly, though how language intersects with help seeking in the context of RCA is yet to be investigated. We conducted 6 focus groups with 38 lawyers, counsellors, and social workers supporting women experiencing DFV in Brisbane and Melbourne, Australia. Our findings address two main areas. First, consistent with past research in DFV, our participants identified language as a barrier for women when communicating about sexual and reproductive issues in the context of health and police encounters. More specifically, our findings suggest that the inability of health professionals and police to communicate with women who have low or no English proficiency not only negatively impacted victims/survivors' ability to access support, but also facilitated the perpetration of RCA. We conclude that language can be a mechanism through which coercive control is enacted by perpetrators of RCA and health and policing systems may not be equipped to recognise and address this issue. We also suggest that greater conceptual clarity of RCA is needed within the DFV sector in order to tailor responses. [ABSTRACT FROM AUTHOR]

Participation in high-quality early childhood education and care (ECEC) benefits children and society. Policy recognition of this manifests through government subsidy strategies to increase ECEC access in the years immediately preceding school. Yet despite this action, many children do not receive the recommended amount. This study utilizes a mixed-methods design to investigate ECEC participation barriers and facilitators in three Australian communities. Parents and service providers completed online questionnaires (45 parents, 63 providers) and semi-structured interviews (21 parents, 16 providers). Results showed that issues related to both direct (e.g., fees) and indirect (e.g., travel) costs are particularly important barriers for families, and are well-recognized by providers. A range of factors were also considered important for facilitating participation (e.g., effective promotion of the benefits linked to high-quality play-based learning in formal settings, professional training of staff). Findings demonstrated the ecological complexity of participation. Strategies to address barriers and harness facilitators are required across multiple levels. Highlights: Participation in high-quality early childhood education benefits children. Many children do not receive the recommended dose of early childhood education. Parents and providers see various participation costs as important barriers. Providers may underestimate barriers relating to maternal role beliefs. Promotion of child benefits and staff training may facilitate participation. [ABSTRACT FROM AUTHOR]

This is the first article to analyze children's involvement in technology-facilitated coercive control in Australia. The primary research question was "How do mothers describe their children's involvement in technology-facilitated coercive control?". This article is based on incidental findings from a larger study on Australian women's experiences of technology-facilitated abuse in the context of domestic violence. Although children were not the focus of the study, semi-structured interviews with twelve mothers yielded discussion of children's involvement in the abuse. We used thematic analysis to identify key dynamics and contexts of this abuse. We found that mothers and their children are co-victims of coercive control. Mothers interviewed for the study reported that children were involved in technology-facilitated coercive control directly and indirectly. This study bridges the gap between the extant research on children and coercive control and technology-facilitated abuse by highlighting the ways children are involved in technology-facilitated coercive control. The social and legal contexts of co-parenting with abusive fathers exposed mothers and children to ongoing post-separation abuse, extending abusive fathers' absent presence in the lives of children [ABSTRACT FROM AUTHOR]

Military personnel deployed to war zones or assigned to other morally challenging military duties are likely to be exposed to potentially morally injurious events (PMIE) that may inflict a moral injury (MI). This qualitative study formed 'Phase 1' of a larger study into PMIEs experienced by Australian veterans and the potential pastoral/spiritual care role of chaplains. Two seminars were conducted that involved 10 veterans being interviewed and audio recorded about their deployment experiences to evaluate whether there was any evidence among Australian veterans of a PMIE. Narrative data analysis indicated that all participants had been exposed to, or were involved in, a PMIE of one kind or another. Seven key themes were identified from the analyzed qualitative data: (i) immoral acts, (ii) death and injury, (iii) betrayal, (iv) ethical dilemmas, (v) disproportionate violence, (vi) retribution and (vii) religious/spiritual issues. Given this preliminary PMIE evidence identified, there is a need for further research, as well as the development of a suitable moral injury assessment scale appropriate for Australian veterans. Furthermore, given the ethical, moral, and spiritual issues involved, the implementation of a rehabilitation program suitable for Australian veterans which can be provided by chaplains is also suggested—namely 'Pastoral Narrative Disclosure.' It is argued that moral injury needs to be recognized, not just as an issue affecting individual personnel and their families, but is also a community health, organizational and government responsibility. [ABSTRACT FROM AUTHOR]

Background: Headache disorders are highly prevalent worldwide, but not well investigated in adolescents. Few studies have included representative nationwide samples. This study aimed to present the prevalence and burden of recurrent headache in Australian adolescents. Methods: The prevalence of recurrent headache, headache characteristics (severity and frequency) and burden on health-related quality of life in Australian children aged 10–17 years were presented, using nationally representative data from the Longitudinal Study of Australian children (LSAC). The LSAC, commencing in 2004, collects data every 2 years from a sample of Australian children of two different age cohorts: B 'baby' cohort, aged 0–1 years and K 'kindergarten' cohort, aged 4–5 years at the commencement of the study. Face-to-face interviews and self-complete questionnaires have been conducted with the study child and parents of the study child (carer-reported data) at each data collection wave, with seven waves of data available at the time of the current study. Wave 7 of the LSAC was conducted in 2016, with B cohort children aged 12–13 years and K cohort children aged 16–17 years. For the current study, data were accessed for four out of seven waves of available data (Wave 4–7) and presented cross-sectionally for the two cohorts of Australian children, for the included age groups (10–11 years, 12–13 years, 14–15 years and 16–17 years). All available carer-reported questionnaire data pertaining to headache prevalence, severity and frequency, general health and health-related quality of life, for the two cohorts, were included in the study, and presented for male and female adolescents. Carer-reported general health status of the study child and health-related quality of life scores, using the parent proxy-report of the Paediatric Quality of Life Inventory™ 4.0, were compared for male and female adolescents with recurrent headache and compared with a healthy group. Finally, health-related quality of life scores were compared based on headache frequency and severity. Results: The LSAC study initially recruited 10,090 Australian children (B cohort n = 5107, K cohort n = 4983), and 64.1% of the initial sample responded at wave 7. Attrition rates across the included waves ranged from 26.3% to 33.8% (wave 6 and 7) for the B cohort, and 16.3% to 38.0% (wave 4–7) for the K cohort. Recurrent headache was more common in females, increasing from 6.6% in 10–11 years old females to 13.2% in 16–17 years old females. The prevalence of headache in males ranged from 4.3% to 6.4% across the age groups. Health-related quality of life scores were lower for all functional domains in adolescents with recurrent headache, for both sexes. Headache frequency, but not severity, was significantly associated with lower health-related quality of life scores, in both males and females. Conclusions: Recurrent headache was common among Australian adolescents and increased in prevalence for females, across the age groups. Frequent recurrent headache is burdensome for both male and female adolescents. This study provides information regarding the prevalence and burden of recurrent headache in the adolescent population based on findings from the Longitudinal Study of Australian Children. [ABSTRACT FROM AUTHOR]

This paper examines features of the talk in a number of teacher-parent interviews recently audio-recorded in a secondary school in Brisbane, Australia. The central topic of the talk is the academic achievement of the student. In offering accounts of the student's achievement, participants offer `moral versions' of themselva as parents and teachers. These institutional identities are oriented to and elaborated in the course and in the organisation of this talk. The student about whom the talk is done is present but largely silent, an 'overhearing audience' to this talk. The analysis shows how parents and teachers talk two institutions, and the relation between them, into being. [ABSTRACT FROM AUTHOR]

This study aimed to describe the experiences of autistic people who had interacted with police in Australia in the previous 5 years. Fifty autistic adults and 61 parent/carers completed a questionnaire and 30 participants took part in an interview. Participants were most commonly interacting with police in the context of seeking assistance or as victims of crime. Autistic adults were largely unsatisfied with their interactions and reluctant to disclose their autism. Parent/carers reported significantly higher satisfaction than autistic adults and incidents involving children were rated more highly than those involving adults. Suggestions for improved interactions included increased autism awareness amongst police and use of appropriate accommodations. Areas for future research in relation to the evaluation of police training is discussed. [ABSTRACT FROM AUTHOR]

Coercive control is increasingly recognized as fundamental to women's experiences of domestic and family violence (DFV). Systems abuse is also being increasingly recognized by researchers as a tactic of coercive control in the context of DFV. This article explores the phenomenon of abusive partners or ex-partners making malicious false reports of child maltreatment to child protective services as an aspect of coercive control and systems abuse. The article draws on interviews with 65 women who have been victims of DFV, focusing on the experiences of 11 of the interviewees who have been maliciously reported, or received threats that they will be reported, to child protection services by an abusive ex-partner. Those interviewees who had been the victim of malicious reports of child maltreatment by an abusive partner or ex-partner experienced substantial negative impacts. The article concludes that improved investigation processes and investigating both parties, where the reporting party has been found to be a perpetrator of DFV, may better support victims of DFV and deter perpetrators from this form of abuse. [ABSTRACT FROM AUTHOR]

Elder abuse often goes unreported. Perpetrators of elder abuse are frequently the adult children of the victim and this relationship may contribute to the reluctance of older adults to seek help. This study aimed to understand older people's experiences of elder abuse and the barriers to reporting it. Twenty-eight semi-structured interviews were conducted with clients of Seniors Rights Victoria (SRV) who had a case opened and closed between 2012 and 2015, or had made two or more calls to SRV between this period. Thematic analysis was undertaken of the qualitative data. Older people who are being abused by their adult children may be reticent to seek help due to fear of adverse consequences for their adult child. The parental bond frequently prevented participants from speaking to others, asking for help, or enacting the advice provided to them. Shame and stigma surrounding the reporting of elder abuse committed by adult children needs to be addressed. Older people need to be supported to take action earlier when there is less likelihood of adverse consequences. Policy and services need to recognize the unique characteristics of the parent-child relationship and the way they can affect an older person's ability to seek help. [ABSTRACT FROM AUTHOR]

Conflicts of interest (COI) in health and medicine have been the source of considerable public and professional debate. Much of this debate has focused on financial, rather than non-financial COI, which is a significant lacuna because non-financial COI can be just as influential as financial COI. In an effort to explore the nature and effects of non-financial, as well as financial COI, we conducted semi-structured interviews with eleven Australian medical professionals regarding their experiences of, and attitudes towards, COI. We found that this group of medical professionals saw non-financial interests—most notably the pursuit of status and respect and the avoidance of stigma—as potentially conflicting with other important interests (such as patient care). [ABSTRACT FROM AUTHOR]

Previous data have suggested that parents of boys with autism spectrum disorder (ASD) may rate their sons' generalised anxiety disorder (GAD) more severely than the boys do themselves. However, no reports have been published to date which examine this issue in a girls-only sample. This study investigated the extent and nature of mother–daughter agreement on ratings of GAD in a sample of 53 girls with an ASD with mild impairment, aged 6 to 17 years. Mothers rated their daughters' GAD more severely than the girls did themselves, despite confounding effects from the girls' medication and menarche status. Suggestions are made for the valid assessment of GAD in girls with an ASD. [ABSTRACT FROM AUTHOR]

Supported decision-making has been promoted at a policy level and within international human rights treaties as a way of ensuring that people with disabilities enjoy the right to legal capacity on an equal basis with others. However, little is known about the practical issues associated with implementing supported decision-making, particularly in the context of dementia. This study aimed to understand the experiences of people with dementia and their family members with respect to decision-making and their views on supported decision-making. Thirty-six interviews (twenty-one dyadic and fifteen individual) were undertaken with fifty-seven participants (twenty-five people living with dementia and thirty-two family members) across three states in Australia. Interpretative Phenomenological Analysis (IPA) was used as the methodological approach, with relational autonomy as a theoretical perspective. We identified two overarching themes relating to participants' experiences with decision-making: "the person in relationship over time" and "maintaining involvement." Participant views on the practical issues associated with supported decision-making are addressed under the themes of "facilitating decision-making," "supported decision-making arrangements," "constraints on decision-making," and "safeguarding decision-making." While participants endorsed the principles of supported decision-making as part of their overarching strategy of "maintaining involvement" in decision-making, they recognized that progressive cognitive impairment meant that there was an inevitable transition toward greater involvement of, and reliance upon, others in decision-making. Social and contextual "constraints on decision-making" also impacted on the ability of people with dementia to maintain involvement. These themes inform our proposal for a "spectrum approach" to decision-making involvement among people living with dementia, along with recommendations for policy and practice to assist in the implementation of supported decision-making within this population. [ABSTRACT FROM AUTHOR]

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A person's sexuality exerts a powerful influence on their needs, desires, roles, social relationships and personal identity. This study, explored occupational therapists' reasoning and practice in relation to the work they do (or do not do) with clients for whom sexual expression has become problematic. The lens used to explore reasoning and practice was a key conceptual framework adopted by occupational therapists, the occupational perspective of health, which considers humans need to do, be, become and belong. Using a qualitative, phenomenographic approach, 16 occupational therapists from across Australia were interviewed to understand the qualitatively variable ways in which they reasoned about practice in relation to the sexual needs of their clients. Four related, layers of 'conception' are presented. At a foundational level, we describe how participants conceived of their practice role in relation to assisting people in the doing aspect of sex(uality). At the next, more complex level, participants appeared to conceive of practice in relation to their clients' being as a sexual person. The next conception related to how therapists think about their clients in their becoming as a sexual being and finally, in their belonging as a sexual being. These conceptual categories, derived both theoretically and empirically are presented as a hierarchically aligned framework, the occupational perspective of sexuality (OPS). While generated from a study of occupational therapists' reasoning, the OPS has potential to enable a broader, more holistic consideration of sexuality, assisting health care professionals and educators to better understand the ways in which they may address their clients' needs to do, be, become and belong to their sexuality. [ABSTRACT FROM AUTHOR]

Increasingly, children deemed to be at risk of harm are being placed in kin care, most often with grandparents. Factors triggering the removal of children from their parents can include family breakdown, child neglect, substance misuse, poverty and family violence. Equally, these factors can result in children becoming disconnected from extended family. A prevailing concern in Australia is the over-representation of Aboriginal children in child protection services, and disrupted connections to their family and culture. The primary aim of a recent qualitative study was to optimise grandparent-grandchild connectedness after child safety concerns. Interviews and focus groups were conducted with a total of 77 participants. Grandparents were the primary sample recruited, however smaller numbers of workers, parents and foster carers contributed to the study. Discussed here are themes emerging from the qualitative data that pointed to grandparents being at greater risk of intrafamilial violence than previously may have been recognised after they step in to care for grandchildren. Recommendations from this study include a call for increased culturally and historically-informed practice approaches that take account of the interconnected nature of violence in families. [ABSTRACT FROM AUTHOR]

Purpose Many industrialised nations have systems of injury compensation and rehabilitation that are designed to support injury recovery and return to work. Despite their intention, there is now substantial evidence that injured people, employers and healthcare providers can experience those systems as difficult to navigate, and that this can affect injury recovery. This study sought to characterise the relationships and interactions occurring between actors in three Australian injury compensation systems, to identify the range of factors that impact on injury recovery, and the interactions and inter-relationships between these factors. Methods This study uses data collected directly from injured workers and their family members via qualitative interviews, analysed for major themes and interactions between themes, and then mapped to a system level model. Results Multiple factors across multiple system levels were reported by participants as influencing injury recovery. Factors at the level of the injured person's immediate environment, the organisations and personnel involved in rehabilitation and compensation processes were more commonly cited than governmental or societal factors as influencing physical function, psychological function and work participation. Conclusions The study demonstrates that injury recovery is a complex process influenced by the decisions and actions of organisations and individuals operating across multiple levels of the compensation system. Changes occurring 'upstream', for instance at the level of governmental or organisational policy, can impact injury recovery through both direct and diffuse pathways. [ABSTRACT FROM AUTHOR]