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BACKGROUND: It is unknown whether questionnaires measuring psychosocial constructs related to low back pain (LBP) that were originally designed for adults are suitable for adolescents, and if paper and web-versions have similar measurement properties. OBJECTIVES: To examine selected psychometric properties for the paper- and web-based Back-Beliefs Questionnaire (BBQ) and the Fear Avoidance Beliefs Questionnaire (FABQ-phys) among adults and adolescents in two diverse countries and to determine whether differences existed between countries and pain groups. METHODS: A sample of 156 adults (Hong Kong, n = 75; Australia, n = 81) and 96 adolescents (Hong Kong, n = 61; Australia, n = 35) participated in this cross-sectional study. RESULTS: Main effects for country and administration mode were observed in adult BBQ scores, where Australian adults reported significantly higher BBQ scores than Hong Kong adults (mean difference (MD); 95% CI: 2.85; 0.96-4.74) and significantly higher scores were recorded on the web mode compared to the paper mode (MD 0.74; 0.10-1.38). Similarly, Hong Kong adults and adolescents reported higher FABQ-phys scores than Australian adults and adolescents (MD; 95% CI: 3.40; 1.37-5.43 and 4.88; 0.53-9.23, respectively). Internal consistency values were mostly acceptable (α⩾0.7). CONCLUSION: Differences exist between cultures for LBP-related beliefs. The BBQ and FABQ-phys have acceptable measurement properties in both administration modes. [ABSTRACT FROM AUTHOR]

Objectives: The aims of the study were to investigate discrepancies between general practitioners' paper medication orders and pharmacy-prepared electronic medication administration charts, back-up paper charts and dose-administration aids, as well as delays between prescribing, charting and administration, at a 90-bed residential aged care facility that used a hybrid paper-electronic medication management system. Methods: A cross-sectional audit of medication orders, medication charts and dose-administration aids was performed to identify discrepancies. In addition, a retrospective audit was performed of delays between prescribing and availability of an updated electronic medication administration chart. Medication administration records were reviewed retrospectively to determine whether discrepancies and delays led to medication administration errors. Results: Medication records for 88 residents (mean age 86 years) were audited. Residents were prescribed a median of eight regular medicines (interquartile range 5-12). One hundred and twenty-five discrepancies were identified. Fortyseven discrepancies, affecting 21 (24%) residents, led to a medication administration error. The most common discrepancies were medicine omission (44.0%) and extra medicine (19.2%). Delays from when medicines were prescribed to when they appeared on the electronic medication administration chart ranged from 18 min to 98 h. On nine occasions (for 10% of residents) the delay contributed to missed doses, usually antibiotics. Conclusion: Medication discrepancies and delays were common. Improved systems for managing medication orders and charts are needed. [ABSTRACT FROM AUTHOR]

Objective To examine how the intensity and duration of tobacco control advertising relate to adolescent smoking prevalence. Methods Australian students (aged 12-17 years) participating in a national survey conducted triennially between 1993 and 2008 (sample size range 12 314-16 611). The outcome measure was students' smoking in the previous 4 weeks collected through anonymous, self-completed surveys. For each student, monthly targeted rating points (TRPs, a measure of television advertising exposure) for tobacco control advertising was calculated for the 3 and 12 months prior to surveying. For each time period, cumulative TRPs exposure and exposure to three intensity levels (≥100 TRPs/month; ≥400 TRPs/month; ≥800 TRPs/month) over increasing durations (eg, 1 month, 2 months, etc) were calculated. Logistic regression examined associations between TRPs and adolescent smoking after controlling for demographic and policy variables. Results Past 3-month cumulative TRPs were found to have an inverse relationship with smoking prevalence. Low TRPs exposure in the past 12 months was positively associated with adolescent smoking prevalence. However, smoking prevalence reduced with cumulative exposure levels above 5800 cumulative TRPs. Additionally, exposure to ≥400 TRPs/month and ≥800 TRPs/month were associated with reduced likelihood of smoking, although the duration needed for this effect differed for the two intensity levels. When intensity was ≥400 TRPs/month, the odds of smoking only reduced with continuous exposure. When intensity was ≥800 TRPs/month, exposure at levels less than monthly was associated with reductions in smoking prevalence. Conclusions Both antismoking advertising intensity and duration are important for ensuring reductions in adolescent smoking prevalence. [ABSTRACT FROM AUTHOR]

Objective: In Australia, there is little evidence exploring why higher degrees by research (HDRs) are undertaken by surgeons. This study aims to describe the attitudes and experiences of surgical trainees and surgeons towards HDRs. Methods: A 23-question cross-sectional survey of surgical trainees and consultant surgeons from three Australian public hospitals was undertaken between August and December 2022. Data were analysed according to stage of career and HDR status and assessed using chi-squared test, with P < 0.05 considered significant. Results: Out of 270 participants, 72 (27%) completed the survey including 30 (42%) trainees and 42 (58%) consultants. Overall, 43 (60%) participants had completed or were undertaking a HDR, which was similar between trainees (n = 18) and consultants (N = 25; P = 0.968). A HDR was associated with more publications (P < 0.5). Respondents with a HDR were more likely to have a salaried academic position (50%) than those without (15%). There was no significant difference in academic appointments based on HDR attainment (P = 0.192). For surgical trainees, 93% rated the strengthening of resumes as the primary driver, compared with only 60% of consultants. For consultants, academic career aspirations and research interests were ranked the highest at 64% equally. Lack of time and competing nature of surgical training were equally ranked among all as the key barriers to completing a HDR. Conclusions: These results provide insight into the academic pursuits of surgeons with an understanding of the role HDRs play, including the different drivers for Masters and Doctorates. This is important for supporting future surgeons who seek to pursue research. What is known about the topic? The value of research is well-recognised as a crucial part of the surgical training pathway. Despite this, minimal contemporary evidence exists which explores the impact of higher degrees by research (HDR) on academic career pathways in the Australian context. What does this paper add? Contemporary evidence was obtained to understand why Australian surgeons undertake HDRs and how their completion impacts the surgical career pathway. What are the implications for practitioners? By understanding the role of HDRs in the surgical landscape, practitioners can ensure beneficial support for future academic surgeons is in place. [ABSTRACT FROM AUTHOR]

Aim: To develop and test the psychometric properties of an expanded catheter self‐management scale for patients with in‐dwelling urinary catheters. Design: A cross‐sectional validation study. Despite the utility of the original 13‐item catheter self‐management scale, this instrument did not include bowel management, general hygiene and drainage bag care, which are fundamental skills in urinary catheter self‐management to prevent common problems resulting in unnecessary hospital presentations. The expanded catheter self‐management scale was developed with 10 additional items to comprehensively assess all five essential aspects of urinary catheter self‐management. Methods: A total of 101 adult community‐dwelling patients living with indwelling urinary catheters were recruited from Western Sydney, Australia. Using exploratory factor analysis with Varimax rotation, the number of factors to be extracted from the expanded 23‐item expanded catheter self‐management scale was determined using a scree plot. The reliability of the overall scale and subscales was measured using Cronbach's alpha. Convergent validity was assessed using Spearman's correlations between clinical characteristics, overall scale and subscales. Results: The 23‐item expanded catheter self‐management scale yielded a 5‐factor solution, labelled as: (i) self‐monitoring of catheter function, (ii) proactive, help‐seeking behaviour function, (iii) bowel self‐care function, (iv) hygiene‐related catheter site function and (v) drainage bag care function. Cronbach's alpha of the expanded catheter self‐management scale indicating all 23 items contributed to the overall alpha value. Convergent validity results showed a negative correlation between the overall expanded catheter self‐management scale and catheter‐related problems. Conclusion: The 5‐factor structure provided a comprehensive assessment of key aspects of urinary catheter self‐management essential to reduce the likelihood of catheter‐related hospital presentations. Implications: The expanded catheter self‐management scale can be used to assess and monitor effective patient‐centred interventions for optimal self‐management to prevent catheter‐related problems and improve the quality of life of patients. Impact: Many patients start their journey of living with a urinary catheter unexpectedly and are not supported with quality information to care for their catheter.The findings of this study show the correlation between catheter self‐management skills and catheter‐related problems.The expanded catheter self‐management scale (E‐CSM) assists with analysing the self‐management skills of patients living with a catheter and developing tailored interventions to prevent problems and improve their quality of life. In addition, this screening tool can be included in policies, guidelines, and care plans as a standard for improving catheter management and developing educational resources for patients. Reporting Method: STROBE checklist was used to report all aspects of this study comprehensively and accurately. Patient or Public Contribution: Patients living with indwelling urinary catheter and their carers have participated in surveys, interviews and co‐designing interventions. This paper reports the psychometric analysis of the expanded catheter self‐management scale (E‐CSM) used in the patient survey as part of the main study 'Improving Quality of Life of Patients Living with Indwelling Urinary Catheters: IQ‐IDC Study' (Alex et al. in Collegian, 29:405–413, 2021). We greatly value our consumers' contributions and continue to communicate the progress of the study to them. Their contributions will be acknowledged in all publications and presentations. In addition, all participants will be provided the option of receiving the interventions and publications generated from this study. [ABSTRACT FROM AUTHOR]

Background: The gaps in healthy life expectancy (HLE) between Indigenous and non-Indigenous Australians are significant. Detailed and accurate information is required to develop strategies that will close these health disparities. This paper aims to quantify and compare the causes and their relative contributions to the life expectancy (LE) gaps between the Indigenous and non-Indigenous population in the Northern Territory (NT), Australia. Methods: The age-cause decomposition was used to analyse the differences in HLE and unhealthy life expectancy (ULE), where LE = HLE + ULE. The data was sourced from the burden of disease and injury study in the NT between 2014 and 2018. Results: In 2014–2018, the HLE at birth in the NT Indigenous population was estimated at 43.3 years in males and 41.4 years in females, 26.5 and 33.5 years shorter than the non-Indigenous population. This gap approximately doubled the LE gap (14.0 years in males, 16.6 years in females) at birth. In contrast to LE and HLE, ULE at birth was longer in the Indigenous than non-Indigenous population. The leading causes of the ULE gap at birth were endocrine conditions (explaining 2.9–4.4 years, 23–26%), followed by mental conditions in males and musculoskeletal conditions in females (1.92 and 1.94 years, 15% and 12% respectively), markedly different from the causes of the LE gap (cardiovascular disease, cancers and unintentional injury). Conclusions: The ULE estimates offer valuable insights into the patterns of morbidity particularly useful in terms of primary and secondary prevention. [ABSTRACT FROM AUTHOR]

Introduction: Academic dermatologists in Australia and New Zealand provide high‐quality and meaningful contributions to the understanding of disease and therapeutic translational research. Concerns have been raised by the Australian Medical Association regarding the decline of clinical academics in Australia as a whole, however, such trends in scholarly output have not previously been analysed for Australasian dermatologists. Methods: A bibliometric analysis of dermatologists in Australia and New Zealand was conducted in January and February 2023. Available Scopus profiles for all dermatologists were used to measure lifetime H index, scholarly output, citation counts and field‐weighted citation impact (FWCI) in the last 5 years (2017–2022). Trends in output over time were measured using non‐parametric tests. Differences in output between subgroups stratified by gender and academic leadership positions (associate professor or professor) were measured using Wilcoxon rank‐sum and one‐way ANOVA tests. The scholarly output of recent College graduates was also analysed as a subgroup, comparing the same bibliographic variables in the 5 years preceding and 5 years following awarding of their fellowships. Results: From the 463 practising dermatologists in Australia and New Zealand, 372 (80%) were successfully matched to Scopus researcher profiles. Of these dermatologists, 167 were male (45%) and 205 (55%) were female, and 31 (8%) held academic leadership positions. Most dermatologists (67%) published at least one paper in the last 5 years. The median lifetime H index was 4, and between 2017 and 2022 median scholarly output was 3, the median citations were 14 and the median FWCI was 0.64. There was a non‐significant trend towards fewer publications per year, however, citation count and FWCI decreased significantly. By subgroups, female dermatologists published significantly more papers between 2017 and 2022, and other bibliographic variables were comparable to male dermatologists. However, women were underrepresented in positions of academic leadership—comprising only 32% of this cohort despite representing 55% of dermatologists. Professors were also significantly more likely to have higher bibliographic outcomes than associate professors. Finally, analysis of recent College graduates highlighted a significant decline in bibliometric outcomes pre‐ and post‐fellowship. Conclusion: Overall, our analysis identifies a trend towards decreased research output by dermatologists in Australia and New Zealand in the last 5 years. Strategies to support dermatologists in research endeavours, particularly women and recent graduates, will be essential in maintaining strong scholarly output among Australasian dermatologists and thereby sustaining optimal evidence‐based patient care. [ABSTRACT FROM AUTHOR]

Background: Answering clinical questions arising from patient care can improve that care and offers an opportunity for adult learning. It is also a vital component in practising evidence-based medicine. GPs' sources of in-consultation information can be human or non-human (either hard copy or electronic).Objectives: To establish the prevalence and associations of GP trainees' in-consultation information-seeking, and to establish the prevalence of use of different sources of information (human, hard copy and electronic) and the associations of choosing particular sources.Methods: A cross-sectional analysis of data (2010-13) from an ongoing cohort study of Australian GP trainees' consultations. Once each 6-month training term, trainees record detailed data of 60 consecutive consultations. The primary outcome was whether the trainee sought in-consultation information for a problem/diagnosis. Secondary outcomes were whether information-seeking was from a human (GP, other specialist or other health professional) or from a non-human source (electronic or hard copy), and whether a non-human source was electronic or hard copy.Results: Six hundred forty-five trainees (response rate 94.3%) contributed data for 84,723 consultations including 131,583 problems/diagnoses. In-consultation information was sought for 15.4% (95% confidence interval=15.3-15.6) of problems/diagnoses. Sources were: GP in 6.9% of problems/diagnoses, other specialists 0.9%, other health professionals 0.6%, electronic sources 6.5% and hard-copy sources 1.5%. Associations of information-seeking included younger patient age, trainee full-time status and earlier training stage, longer consultation duration, referring the patient, organizing follow-up and generating learning goals. Associations of choosing human information sources (over non-human sources) were similar, but also included the trainee's training organization. Associations of electronic rather than hard-copy information-seeking included the trainee being younger, the training organization and information-seeking for management rather than diagnosis.Conclusion: Trainee information-seeking is mainly from GP colleagues and electronic sources. Human information-sources are preferentially sought for more complex problems, even by these early-career GPs who have trained in the 'internet era'. [ABSTRACT FROM AUTHOR]

Aim: To identify barriers and facilitators of speciality skill transfer for internationally qualified nurses in Australia from the nurses' perspective. Design: A cross‐sectional study. Methods: A cross‐sectional online survey was distributed through social media, snowballing and nursing professional organization. Data analysed using Statistical Package for the Social Sciences. Data Sources: Online survey data from participants matching the inclusion criteria were collected from July to September 2022. Results: Survey results reveal facilitators (competence, scope of practice, linguistic sufficiency, understanding of decision‐making) and barriers (lack of opportunity, transition pathways, confidence in overseas education, financial instability) for internationally qualified nurses' speciality skill utilization in Australia. Conclusion: Identifying and addressing barriers and facilitators, along with developing tailored transition pathways, are crucial for maximizing speciality skill utilization among internationally qualified nurses. These findings have implications for policymakers, healthcare organizations and nurses. They highlight the need to address barriers, facilitate smooth transitions and implement proactive measures for internationally qualified nurses to effectively utilize their specialty skills. Impact: The study addresses maximizing skill usage for internationally qualified nurses, identifies barriers and facilitators for specialty skill transfer in Australia and will impact policymakers, healthcare organizations and nurses by guiding strategies for safe nursing service delivery and optimizing patient care. Reporting Method: STROBE checklist. Patient or Public Contribution: A total of 71 internationally qualified nurses contributed their experiences and opinions. What Does this Paper Contribute to the Wider Global Clinical Community?: Lack of opportunity and the lack of transition pathways inhibit the use of specialty nursing skills by internationally qualified nurses.This study's findings contradict the result of other studies that suggest language is a significant obstacle to the utilization of specialty skills of internationally qualified nurses. Trial and Protocol Registration: The protocol is registered on OSF. The data for this study are available for sharing with the reviewers upon request. However, it is worth noting that ethical approval has not been obtained specifically for web sharing, and therefore, the data has not been posted in any repositories or public platforms. [ABSTRACT FROM AUTHOR]

Objective: Consumer-centred care is fundamental to high-quality health care, with allied health professionals playing a pivotal role in hospital settings. Allied health typically operates within standard weekday working-hours. Consumer preferences for receiving allied health services are largely unexplored but could inform whether weekend and/or out-of-hours services are required. This study aims to understand consumer preferences for hospital-based inpatient and outpatient allied health services. Methods: Using a cross-sectional survey and convenience sampling approach, consumers of a public health service in Melbourne, Australia were surveyed about preferences for allied health service delivery. Electronic health record reviews compared the accuracy of self-reported service delivery times. Descriptive statistics, concordance and predictive values were calculated. Responses to free-text survey items were analysed using content analysis. Results: Of 120 participants (79% response rate), most (69%) received allied health services, however, almost half of inpatient responders (44%) were unsure of the specific allied health professional involved. Audit results found moderate–high concordance overall (range, 77–96%) between self-reported and audit-identified allied health services by profession. Most inpatient responders had no strong day of week preference, equally selecting weekdays and weekend days, with most preferring services between 8 am and 4 pm. Outpatient responders (81%) preferred a weekday appointment between 8 am and 12 pm or before 8 am (29%) to complete scheduled activities early in the day. Conclusion: While provision of allied health services during standard working-hours was preferred by most consumers, some inpatient and outpatient consumers are receptive to receiving weekend and out-of-hours services, respectively. Decisions about offering these services should consider operational capacity and research evidence. What is known about the topic? Research on consumer acceptance of out-of-hours or weekend allied health services is lacking, with an assumption of consumer willingness and demand for these service models. What does this paper add? Hospital inpatients are generally indifferent to the day of allied health services, preferring weekday or weekend day equally, typically between 8 am and 4 pm, while outpatients favour weekday mornings. Although consumers reported that their needs were met by allied health services, there was a lack of awareness about the specific services they received. What are the implications for practitioners? Results highlight the importance of not only aligning service delivery with consumer preferences for timing, but also enhancing awareness and understanding of the available allied health services for consumers. [ABSTRACT FROM AUTHOR]

Accessible Summary: What Is Known on the Subject?: Australia is a commonwealth of federated states and territories with each having unique mental health legislation. Victoria implemented advance statements based on legislation from overseas jurisdictions such as Scotland. The aim of this Victorian legislation was to underpin an individual's autonomy and decision‐making in relation to treatment, particularly compulsory treatment.Advance statements allow individuals within the healthcare setting to document preferences for care and treatment during times of decompensated mental health, including informing nominated persons and preferences for recovery‐oriented care; however, advance statements continue to attract barriers in their implementation and use. What this Study Adds to Existing Knowledge?: This paper focuses on legislation within one jurisdiction, Victoria, highlighting that several barriers to uptake exist, including uncertainty around the legal status of advance statements, the ideal setting to implement advance statements and concern around perceived consumer capacity to contribute to developing advance statements.There are substantial differences of opinion regarding adherence to treatment and recovery preferences contained within the advance statement, especially when decisions are made in the context of decompensated mental health.The Theoretical Domains Framework (TDF) model has been used to formulate recommendations in several other health studies, but to date has not been used to provide recommendations for greater implementation of advance statements.Implementation science is a contemporary research translation movement that seeks to identify factors and strategies that influence the adoption and integration of interventions like advance statements in real world settings. For this study it has been useful to identify barriers, consider implementation strategies and link this with policy frameworks to support practice change. What are the Implications for Practice?: Our study revealed that real challenges exist for mental health clinicians in adopting advance statements despite them having a strong held intention to empower service users to play a greater role in their own treatment and care decisions.The facilitators identified in this study highlight the notion that advance statements, and the concept of supported decision‐making are needed in contemporary mental health care.Implementation science can assist in identifying barriers and suggesting facilitators including enhanced training, incentivization of advance statement creation, and greater awareness of the overarching purpose and principle of advance statement creation.Continued support and training in implementing and maintaining advance statements is required if mental health clinicians are to drive the uptake of this important reform to mental health legislation. Training needs to be provided that will address attitudes, and strongly held beliefs that pose barriers to the use of advance statements. Introduction: Advance statements, also known as advance directives or psychiatric wills, provide individuals the opportunity to document care and recovery preferences during a period of mental ill health. Although the use of advance statements has gained momentum, little research has explored the factors that promote or hinder further uptake. Aim: To determine the factors that promote or hinder the uptake of advance statements. Method: Cross‐sectional online survey of healthcare workers (n = 190). Results: Promoting factors include high perceived value of advance statements, particularly their role in recovery focussed care, while hindering factors include disagreement or responsibility for advance statement creation and legal status. Discussion: This study indicates that several hindering factors or barriers to advance statement uptake remain, and until these factors are addressed future implementation is arguably hindered. In this paper, we have used the Theoretical Domains Framework (TDF) model to outline suggestions to address hindering factors to implementation and guide future implementation strategies for advance statement uptake and practice change. Implications for Practice: The ongoing uptake of advance statements requires tailored implementation strategies address hindering factors. Strong promoting factors, such as the shared belief in the advance statement model and its role in recovery focused care, should be considered a strong foundation for implementation strategies. [ABSTRACT FROM AUTHOR]

Aims: This work aims to explore staff perceptions of (1) the effectiveness of organizational communication during the COVID‐19 pandemic and (2) the impact of organizational communication on staff well‐being and ability to progress their work and patient care. Background: Effective coordination and communication are essential in a pandemic management response. However, the effectiveness of communication strategies used during the COVID‐19 pandemic is not well understood. Design: An exploratory cross‐sectional research design was used. A 33‐item survey tool was created for the study. Methods: The study was conducted at a tertiary teaching hospital in Western Australia. Convenience sampling was used to recruit participants from nursing, medical, allied health services, administrative and clerical, and personal support services (N = 325). Data were collected between December 2020 and May 2021. Results: Overall, all occupational groups found working during the COVID‐19 pandemic stressful, and all groups wanted accessible and accurate communication from management and new policies, procedures, and protocols for future outbreaks. Conclusions: The use of occupational group‐relevant strategies and COVID‐19 protocols, as well as the on‐going use of email, face‐to‐face meetings with debrief sessions, are needed to improve communication and support staff to fulfil their roles. Summary statement: What is already known about the topic? Effective coordination and communication that is timely and two‐way in nature, is an essential part of a pandemic management response. What this paper adds? All occupational groups found working during the COVID‐19 pandemic stressful; all groups wanted accessible and accurate communication from management and new policies, procedures, and protocols for future outbreaks. The implications of this paper: Managing a pandemic situation in health care settings is challenging for all levels of staff including management and all occupational work groups.The use of occupational group‐relevant strategies and COVID‐19 protocols, as well as the on‐going use of email, face‐to‐face meetings with debrief sessions, are needed to improve communication and support staff to fulfil their roles. [ABSTRACT FROM AUTHOR]

Background: This paper aimed to describe the legal worries of Australian general practitioners (GPs) and nurses regarding end-of-life care provided in the aged care setting. Methods: An analysis of responses to the final, open-ended question of a cross-sectional online survey of GPs and nurses practising in aged care settings in Queensland, New South Wales and Victoria was undertaken. Results: Of the 162 GPs and 61 nurses who gave valid responses to the survey, 92% (151 GPs and 55 nurses) responded to the open-ended question. Participants identified concerns across all relevant areas of end-of-life law. The most common concerns were substitute decision-makers or family member(s) wanting to overrule an Advance Care Directive, requests for futile or non-beneficial treatment and conflict about end-of-life decision-making. Participants often also identified concerns about their lack of legal knowledge and their fear of law or risk related to both end-of-life care generally and providing medication that may hasten death. Conclusions: Australian GPs and nurses working in aged care have broad-ranging legal concerns about providing end-of-life care. Legal concerns and knowledge gaps identified here highlight priority areas for future training of the aged care workforce. The law supports good end-of-life clinical practice by facilitating health care that aligns with the values and goals of patients, including those residing in residential aged care facilities. GPs and nurses here reported broad-ranging legal concerns relevant to providing end-of-life care within aged care, including substitute decision makers/family members wanting to overrule Advance Care Directives, requests for futile or non-beneficial treatment and conflict about decision-making. Participants' concerns can inform end-of-life legal training for aged care GPs and nurses. [ABSTRACT FROM AUTHOR]

Aim: To explore the satisfaction and experiences of women and staff with the BSOTS in an Australian hospital. Design: Cross‐sectional descriptive survey. Methods: Surveys were distributed to women and staff between February and May 2022. Survey questions reflected satisfaction with triage and provision of care under the BSOTS system (for women) and confidence in using the BSOTS system and its impact on triage‐related care (for staff). Survey data were summarized using descriptive statistics, and qualitative responses were analysed using content analysis. Results: There were 50 women and 40 staff (midwives and doctors) survey respondents. Most women were satisfied with triage wait times, the verbal information they received and the time it took for them to receive care. Nearly all midwife participants indicated they had high knowledge and confidence in using the BSOTS. Most staff indicated that the BSOTS supported the accurate assessment of women and had benefits for women, staff and the hospital. Conclusion: The findings showed that women and staff were satisfied with receiving and providing care in a maternity triage setting under the BSOTS system. Implications for the Profession and/or Patient Care: Implementing standardized maternity triage approaches such as the BSOTS in health settings delivering care to pregnant women is recommended for improving flow of care and perceptions of care quality by women. Impact: Quality of maternity triage processes is likely to impact the satisfaction of women attending services and the staff providing care. The BSOTS was shown to improve maternity triage processes and was associated with satisfaction of women and staff. Maternity settings can benefit from implementing triage approaches such as the BSOTS as it standardizes and justifies the care provided to women. This is likely to result in satisfaction of women and staff engaged in maternity triage and improve the birth outcomes of women and babies. Reporting Method: The reporting of this paper has followed SQUIRE guidelines. Patient or Public Contribution: Women engaged with maternity services were participants in the study but did not contribute to the design, conduct or publication of the study. [ABSTRACT FROM AUTHOR]

Introduction: International and national guidelines highlight the need for general practitioner involvement during and after active cancer treatment and throughout long-term follow-up care. This paper aimed to evaluate patients' acceptance of radiation oncology shared follow-up care using the Theoretical Framework of Acceptability (TFA). Methods: This cross-sectional study was conducted at two cancer care centres in the Illawarra Shoalhaven region of Australia. A sample of patients scheduled for a radiation oncology follow-up consultation in 2021 were sent a 32-point self-complete paper-based survey. Data were analysed using descriptive, parametric and non-parametric statistical analysis. This paper followed the Checklist for Reporting of Survey Studies (CROSS). Results: Of the 414 surveys returned (45% response rate), the acceptance for radiation oncology shared cancer follow-up care was high (80%). Patients treated with only radiotherapy were 1.7 times more likely to accept shared follow-up care than those treated with multiple modalities. Patients who preferred follow-up care for fewer than three years were 7.5 times more likely to accept shared care than those who preferred follow-up care for five years. Patients who travelled more than 20 minutes to their radiation oncologist or to the rural cancer centre were slightly more likely to accept shared care than those who travelled less than twenty minutes to the regional cancer centre. A high understanding of shared care (Intervention Coherence) and a positive feeling towards shared care (Affective Attitude) were significant predictive factors in accepting shared radiation oncology follow-up care. Conclusion: Health services need to ensure patient preferences are considered to provide patient-centred cancer follow-up care. Shared cancer follow-up care implementation should start with patients who prefer a shorter follow-up period and understand the benefits of shared care. However, patients' involvement needs to be considered alongside other clinical risk profiles and organisational factors. Future qualitative research using the TFA constructs is warranted to inform clinical practice change. [ABSTRACT FROM AUTHOR]

Background: Indigenous children living in high income countries have a consistently high prevalence of mental health problems. We aimed to identify psychosocial risk and protective factors for mental health in this setting. Methods: A systematic review of studies published between 1996 and 2016 that quantitatively evaluated the association between psychosocial variables and mental health among Indigenous children living in high income countries was conducted. Psychosocial variables were grouped into commonly occurring domains. Individual studies were judged to provide evidence for an association between a domain and either good mental health, poor mental health, or a negligible or inconsistent association. The overall quality of evidence across all studies for each domain was assessed using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) guidelines. Results: Forty-seven papers were eligible (mainland US 30 [64%], Canada 8 [17%], Australia 7 [15%], Hawaii 4 [9%]), including 58,218 participants aged 4-20 years. Most papers were cross-sectional (39, 83%) and measured negative mental health outcomes (41, 87%). Children's negative cohesion with their families and the presence of adverse events appeared the most reliable predictors of increased negative mental health outcomes. Children's substance use, experiences of discrimination, comorbid internalising symptoms, and negative parental behaviour also provided evidence of associations with negative mental health outcomes. Positive family and peer relationships, high self-esteem and optimism were associated with increased positive mental health outcomes. Conclusions: Quantitative research investigating Indigenous children's mental health is largely cross-sectional and focused upon negative outcomes. Indigenous children living in high income countries share many of the same risk and protective factors associated with mental health. The evidence linking children's familial environment, psychological traits, substance use and experiences of discrimination with mental health outcomes highlights key targets for more concerted efforts to develop initiatives to improve the mental health of Indigenous children. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate COVID-19 vaccine hesitancy, acceptance, and unmet informational needs in a cancer population during the first phase of the coronavirus disease 2019 (COVID-19) vaccination rollout in Australia. Methods: A cross-sectional survey was conducted in a large tertiary hospital in Queensland, Australia, between 10 May and 31 July 2021. The survey assessed health beliefs, experiences of the COVID-19 pandemic, COVID-19 vaccine hesitancy and informational needs. Results: COVID-19 was perceived to be a significant threat to both physical and mental health. While 57.9% (n = 110) of respondents believed the COVID-19 vaccines were safe and 64.2% (n = 122) believed they were effective, more than half (52.6%; n = 100) agreed that they worried about vaccine side effects. Most respondents (84.2%; n = 160) planned to receive the COVID-19 vaccine; however, feelings of hesitancy remained. There was a statistically significant association between those aged under 60 years (P = 0.003), those with previous vaccine hesitancy (P = 0.000), those who felt they had not received adequate information (P = 0.000) and vaccine hesitancy. Requested information pertained to interactions with cancer treatments, those with a history of blood clotting and information for those undergoing bone marrow transplantation. Conclusions: There is a need for tailored COVID-19 vaccine communication that is responsive to the concerns of people with cancer. This will be beneficial during current and future vaccination rollouts. What is known about topic? People with cancer are a COVID-19 vaccine priority group, as they are at increased risk of morbidity and mortality from this disease. There is currently a dearth of information regarding COVID-19 vaccine hesitancy, acceptance, or informational needs for this population. What does this paper add? This paper has shown that although vaccine refusal rates were low in this population, feelings of hesitancy remained. Women, those in younger age categories, those with previous vaccine hesitancy and those who felt they had not received adequate information had stronger vaccine hesitancy and higher refusal rates. What are the implications for practitioners? There is a need for tailored information and open communication regarding COVID-19 vaccines and people with cancer. There is an opportunity to build upon established relationships of trust between cancer patients and their clinicians. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to determine the effects of leadership style (LS) on organisational identification (OID) in aged care provider organisations to inform talent management strategies for the sector, which has quite severe workforce shortages. Design/methodology/approach: This paper reports on a mixed-methods study. Study 1 was quantitative in approach that measured responses to an online questionnaire containing the Multifactor Leadership Questionnaire and the Identification with a Psychological Group scale. The analytical strategy provided results that demonstrated the socio-demographic characteristics of the sample, the reliability and distributions of data and calculated the correlations between the factors of the deployed tools. The relationship between the factors that comprise both tools was measured, and any differences between the two natural groups were labelled leaders and raters. Study 2 was qualitative in approach, using interpretive phenomenological analysis to provide an in-depth analysis of phenomena. Findings: The results and findings of this study are that OID was not evident in the quantitative or qualitative samples. There are recommendations for future research relating to the social capital of organisations and the use of social media to determine how these could be harnessed in support of workforce recruitment and retention strategies. Research limitations/implications: This research was conducted in Australia with participants from the workforces of aged care providers in three eastern states of Australia. The results and findings may be limited to the Australian aged care context. The researcher evaluated the limitations of this research relating to: Methodology: There may be an overstatement of the strength of the relationships between variables among those motivated to participate in the survey in the quantitative study; Transferability: The qualitative study required the researcher to be thorough in describing the research context, and it may be that those who wish to transfer the results of this study to a different context are responsible for making the judgement on the suitability of the transfer; Credibility: The qualitative analysis was not designed to directly reflect a relationship between each leader and their direct report raters' experiences; and Confirmability: The researcher maintained an awareness and openness to the dynamism of the results. Frequent reflection and self-criticism about preconceptions that may have affected the research were recorded in field notes after each interview. Practical implications: Aged care providers who must compete in the labour market for staff may use the results and findings of this research to inform recruitment and retention strategies relating to brand recognition and loyalty and social capital strategies. Social implications: Providing an appropriate, skilled and well-led workforce will assist in providing the appropriate level of aged care service at a high standard of quality and safety that will benefit the community as a whole. Originality/value: To the best of the authors' knowledge, this paper reports on original research conducted following ethical clearance in part fulfilment of a successful conferral of a Doctor of Philosophy programme. After an extensive search of the literature, no research reports returned that examined LS and OID in the aged care service provision. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to identify correlates of tobacco smoking behaviour across various socio-demographic segments of the Australian population. Design/methodology/approach: Data from two nationally representative, probability samples of persons 18 and over, surveyed by the Australian Bureau of Statistics in 2001 and 2017–2018 were analysed using multinomial logistic regression. Findings: Overall, the prevalence of current smokers declined from 24.3 to 15%. More than half of the population had never smoked. The prevalence of ex-smokers increased slightly to 30%. Prevalence of current smoking was higher among older age groups and among those with lower educational achievement, lower income, living in a disadvantaged area and experiencing increasing stress. Females were more likely than males to be never-smokers. Males were more likely than females to be current smokers. Research limitations/implications: The findings are based on two cross-sectional surveys conducted 17 years apart. It is not possible to draw any conclusions about the actual trajectories of the changes in the values reported or any correlations between those trajectories. Nor is it possible to make any meaningful forecasts about likely future trends in smoking status in these various segments based on these data sets. The classifications used in the surveys generate some heterogeneous groups, which can obscure important differences among respondents within groups. Data are all self-reported, and there is no validation of the self-reported smoking status. This might lead to under-reporting, especially in a community where tobacco smoking is no longer a majority or even a popular habit. Because the surveys are so large, virtually, all the findings are statistically significant. However, the increasing preponderance of never-smokers in many categories might mean that never-smokers could come to dominate the data. Practical implications: The findings from this paper will help tobacco-control policy-makers to augment whole-of-community initiatives with individual campaigns designed to be more effective with particular socio-demographic segments. They will also assist in ensuring better alignment between initiatives addressing mental health and tobacco smoking problems facing the community. Originality/value: The examination of smoking behaviour among individual population sub-groups, chosen by the authors, is commonplace in the literature. This paper uses data from two large surveys to model the whole, heterogeneous population, measured at two different points in time. [ABSTRACT FROM AUTHOR]

This study seeks to assess the health, social and economic outcomes associated with rough sleeping among women and compare those outcomes with those of (1) men sleeping rough, and (2) women experiencing other forms of homelessness (such as being housed in temporary supported accommodation due to family and domestic violence). The paper analyses survey data using the Vulnerability Index‐Service Prioritization Decision Analysis Tool (VI‐SPDAT) collected from 2735 women experiencing homelessness and 3124 men sleeping rough in Australian cities from 2010 to 2017. We find that women sleeping rough report poorer physical and mental health outcomes and greater problematic drug and or alcohol use relative to both men sleeping rough and women experiencing other types of homelessness (all p < 0.5). Women sleeping rough report significantly higher levels of crisis service utilisation (Β = 17.9, SE = 3.9, p < 0.001) and interactions with police in the previous 6 months (Β = 1.9, SE = 0.3, p < 0.001) than women experiencing homelessness not sleeping rough. Women sleeping rough also report greater healthcare utilisation, and, therefore, healthcare costs, than women experiencing homelessness not sleeping rough and men sleeping rough (all p < 0.05). From a policy perspective, the evidence presented in this paper supports a social determinants approach that moves from addressing symptoms of poor health outcomes associated with homelessness to preventing and ending homelessness with a particular focus on the life trajectories of women. Integrated services and homelessness strategies need to be developed through a gender lens, providing women sleeping rough with tailored permanent housing with wrap‐around supportive housing to address poor health outcomes. [ABSTRACT FROM AUTHOR]

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]

Objective: The aim of this study was to identify the prevalence and patterns of comorbidity in community‐dwelling older people with type 2 diabetes mellitus (T2DM) attending general practice settings in Australia. Methods: This study involved a cross‐sectional analysis using the Bettering the Evaluation and Care of Health (BEACH) sub‐study data. In a series of sub‐studies, a representative sample of general practitioners was asked to record all diagnosed chronic conditions for patients at 40 consecutive encounters using structured paper‐based recording forms. The dataset was analysed with descriptive analyses, and exploratory factor analyses were applied to examine comorbidity patterns. Results: Of the 14,042 patients aged 65 years or older, 2688 had a diagnosis of T2DM (19%). Of the 2688 patients with T2DM, hypertension was present in 67% (95% CI: 64.6–70.0), followed by arthritis 52% (95% CI: 48.8–54.8), hyperlipidaemia 45% (95% CI: 41.8–47.9), ischemic heart disease, 23% (95% CI: 20.7–24.9), depression 16% (95% CI: 48.8–54.8), atrial fibrillation 10% (95% CI: 8.9–11.6), congestive heart failure 7% (95% CI: 6.0–8.1), stroke/cerebrovascular accident 7% (95% CI: 5.4–8.2) and peripheral vascular disease 5% (95% CI: 4.4–6.2). We identified two comorbidity patterns among older people with T2DM. The first were psychological and musculoskeletal conditions and the second were cardiovascular conditions and chronic renal failure. Conclusions: The prevalence of cardiovascular and non‐cardiovascular comorbidities in community‐dwelling older people with T2DM was high. Adequate primary care strategies should be in place to support the long‐term care for this population. [ABSTRACT FROM AUTHOR]

Many countries, including Australia, have laws that enable criminal prosecution of an individual based on reckless or intentional transmission of HIV to another person. Previous research has suggested that criminalisation of HIV may serve to hamper public health efforts by inhibiting HIV status disclosure or testing. Limited research to date has sought to examine the broader impact of criminalisation on the health and wellbeing of people living with HIV, which this paper aims to address. Drawing on cross-sectional data from 895 people living with HIV in Australia, this paper describes associations between standard measures of mental health and resilience with a newly devised scale measuring anxiety about HIV criminalisation. Findings suggest that laws criminalising HIV transmission have a broadly negative impact on wellbeing of people living with HIV, a situation that is exacerbated for gay and bisexual men, and other people living with HIV who may face intersecting forms of marginalisation based on race, gender or class. There is little justification for these laws being applied in Australia and the findings add weight to advocacy seeking to overturn criminalisation across the world. [ABSTRACT FROM AUTHOR]

A strong First Nations health workforce is necessary to meet community needs, health rights, and health equity. This paper reports the findings from a national survey of Australia's First Nations people employed in health services to identify enablers and barriers to career development, including variations by geographic location and organisation type. A cross-sectional online survey was undertaken across professions, roles, and jurisdictions. The survey was developed collaboratively by Aboriginal and non-Aboriginal academics and Aboriginal leaders. To recruit participants, the survey was promoted by key professional organisations, First Nations peak bodies and affiliates, and national forums. In addition to descriptive statistics, logistic regression was used to identify predictors of satisfaction with career development and whether this varied by geographic location or organisation type. Of the 332 participants currently employed in health services, 50% worked in regional and remote areas and 15% in Aboriginal Community-Controlled Health Organisations (ACCHOs) with the remainder in government and private health services. All enablers identified were associated with satisfaction with career development and did not vary by location or organisation type. "Racism from colleagues" and "lack of cultural awareness," "not feeling supported by their manager," "not having role models or mentors," and "inflexible human resource policies" predicted lower satisfaction with career development only for those employed in government/other services. First Nations people leading career development were strongly supported. The implications for all workplaces are that offering even a few career development opportunities, together with supporting leadership by Aboriginal and Torres Strait Islander staff, can make a major difference to satisfaction and retention. Concurrently, attention should be given to building managerial cultural capabilities and skills in supporting First Nations' staff career development, building cultural safety, providing formal mentors and addressing discriminatory and inflexible human resources policies. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to conduct a learning and development needs analysis of quality improvement partnership capabilities of staff and consumers on partnership committees at an Australian metropolitan hospital and health service. Objectives were to compare consumer and staff self-rated capability importance, performance, and learning needs; to investigate if years of partnership experience influenced ratings; and to ascertain staff and consumer preferred learning strategies. Methods: An online cross-sectional survey was adapted from the Hennessy–Hicks Training Needs Analysis questionnaire. Participants self-rated the importance of, and their performance on, 10 capabilities, across four domains, of an internationally validated co-produced capability development framework. They also rated preferences regarding learning approaches and media. Results: A total of 199 members from 41 committees (174 staff; 25 consumers; response rate 35.38%) participated. There was a statistically significant learning and development need across all capabilities (P < 0.01). The highest learning need was for influencing organisational systems and policy (mean = −0.96; s.d. = 1.23), followed by equalising power and leadership (mean = −0.91; s.d. = 1.22), and then implementing partnership best practices (mean = −0.89; s.d. = 1.22). There were no statistically significant differences between consumers and staff on ratings, or correlations between years of partnership experience and ratings (P < 0.01). A combination of learning approaches was preferred, followed by learning through experience. Self-reflection was least preferred, which is concerning given it may promote equalising power and leadership. Face-to-face then videoconferencing were the preferred learning media. Conclusions: Continuous co-learning for staff and consumers about QI partnerships is essential. Committee members needed more feedback regarding their influence and to be engaged in innovative co-design practices. What is known about the topic? Staff and consumer capabilities are essential for effective collaboration on quality improvement (QI) committees, however, research is lacking. What does this paper add? This learning and development needs analysis provides direction for effective design of education and support programs. What are the implications for practitioners? Staff and consumers should continuously develop QI partnership capabilities together, and through multiple learning approaches. Increased exposure to innovative co-design strategies is needed to enhance capabilities and influence on organisational systems and policies. Sharing power and leadership was also a high learning need with self-reflection being vital. [ABSTRACT FROM AUTHOR]

Objective: To examine whether personal psychological resources safeguard hospital nurses against adverse workplace consequences, particularly job burnout and the desire to leave the profession. Background: Nursing research has extensively documented the adverse effects of job burnout and staff turnover. With the current nursing shortage, it is imperative to identify resources and strategies that can mitigate adverse workplace outcomes. However, the role of personal psychological resources, or psychological capital, in aiding nurses to perform effectively in their work environment remains relatively unexplored. Study design and methods: This study adopted a cross-sectional survey design. The survey assessed nurses' experienced burnout (MBI-HSS), psychological capital (PCQ-24), and intentions to leave nursing. Hospital nurses (n= 258) from six states of Australia responded to an online anonymous survey between June and November 2022. Results: Respondents indicated a high degree of experienced burnout: 68.6% experienced high emotional exhaustion, 31.8% had high depersonalisation, and 31.8% had low personal accomplishment. Additionally, 38.8% had high intentions to leave the profession. Emotional exhaustion (p<.001, b=.56) and personal accomplishment (p=.006, b=-.15) were significant predictors of turnover intentions. Higher psychological capital was significantly associated with lower emotional exhaustion (p<.001, b=-.42), lower depersonalisation (p<.001, b=-.29), higher personal accomplishment (p<.001, b=.60), and lower turnover intentions (p<.001, b=.44). Discussion: Much of the nursing burnout and intent to leave literature focuses on negative rather than positive aspects of the work environment. Positive responses to workplace stimuli promote positive attitudes such as empowerment, job satisfaction, and organisational commitment that have a tangible impact on personal and occupational wellbeing. This may explain why nurses with stronger personal psychological resources experienced less burnout and voiced fewer intentions to leave the profession. Conclusion: The health and wellbeing of nurses should be a priority for healthcare organisations; the working conditions nurses face in Australian hospitals cause many to be negatively impacted by work stress. Implications for Research, Policy, and Practice: Nurses would benefit from initiatives to enhance their psychological resources. Targeted interventions to develop psychological capital should be examined in a nursing population. This can change policy, thereby benefitting the healthcare system. What is already known about the topic? • Australia is currently facing a shortage of qualified nurses. • Hospital nurses often experience job burnout and high levels of turnover due to the challenging nature of their work environment. • Personal psychological resources have been linked to positive workplace outcomes, such as job satisfaction and organisational commitment, in various settings. What this paper adds: • It demonstrates that nurses possessing greater personal psychological resources experience lower levels of burnout and are less likely to consider leaving the profession. • The paper suggests that implementing targeted interventions designed to enhance nurses' personal psychological resources could be a viable approach for mitigating burnout and turnover intentions (TI). [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known about the subject?: Most nurses who work in mental health in Australia have completed a comprehensive nursing programme at a university. This training has been widely criticized and has not produced "job‐ready" graduates. Public inquiries into mental health services have highlighted the need for transformation of mental health services and concern about future nursing shortages. What the paper adds to existing knowledge?: This survey highlights what service users and supporters perceive are useful nursing skills and capabilities. The characteristics of helpful encounters with nurses are also described. What are the implications for practice?: Helpful nursing practice is aligned with traditional nursing values and theory, rather than the performance of specific tasks. Improving the retention of nurses to this specialty area of practice requires educational processes to enable nurses to enact values, develop their therapeutic potential and undertake facilitative and supportive practices which are helpful to service users. Introduction: Successive inquiries into mental health services in Australia have identified the need for major reform of services and proposed a return to direct‐entry nursing training. Aim/Question: To identify what service users, family and supporters have found helpful in their encounters with nurses in mental health settings. Method: A survey of 95 service users and supporters rated the importance of the capabilities and competencies of nurses. They also shared examples of helpful encounters with nurses which were subject to thematic analysis. Results: The most highly rated competencies were around demonstrating caring, empathy and understanding, and responding effectively in crisis situations. Helpful encounters involved enacted values, highly skilful interpersonal and psychotherapeutic engagement and practices that were facilitative and supportive. Discussion: The process and content of pre‐registration nursing training needs to refocus on the nurse meeting the needs of service users and supporters, rather than the instrumental needs of services today. Implications for Practice: Educational reform may be necessary but insufficient to address anticipated nursing workforce shortages. Policymakers and health service directors need to align services with mental health nursing values and promote practices aligned with what service users and their supporters report as helpful. [ABSTRACT FROM AUTHOR]

Little research has investigated professional identity in Australian clinical psychology postgraduate students. The current study examined potential predictors of professional identity for these students. Anonymous, self-report cross-sectional surveys for Australian postgraduate clinical psychology students were distributed via online survey links sent by their institution's Program Director. Respondents reported professional identity, motivation, engagement, satisfaction with program, resilience, burnout, demographics, and enrolment type. Data from 77 respondents were analysed. Students reported an average 4.25/5 for sense of professional identity as a psychologist. Age, work experience, and stage of program were not associated with professional identity. In multivariate analyses, higher student satisfaction, lower burnout, and lower engagement with "student" aspects of postgraduate study were associated with stronger professional identity. Levels of professional identity were relatively high and showed little influence of demographic variables. However, there is likely to be a reciprocal relationship between satisfaction with postgraduate study and professional identity for students, which would need to be evaluated in a different design to understand directions of association. Results also suggest that supporting postgraduate students in self-care and helping students to balance professional responsibilities and academic aspects of study are likely to assist in fostering postgraduates' professional identity. What is already known about this topic: Professional identity provides a sense of self in relation to membership of a specific profession. Students in health and social services professions, including psychology, have demonstrated emerging professional identities in their areas of study. In working professionals, professional identity has been found to be important for wellbeing and for relationships with colleagues and clients. What this paper adds: Professional identity amongst a sample of Australian postgraduate students in clinical psychology was independent of demographic variables such as age, gender, and previous work experience. Stronger professional identity in the current sample correlated with higher satisfaction with the program of study and lower level of burnout. In multivariate analysis, higher satisfaction with the program of study, lower burnout, and lower engagement with "academic" aspects of the program each independently predicted higher level of professional identity. From these cross-sectional findings, potential causal associations between predictors and professional identity remain to be clarified. [ABSTRACT FROM AUTHOR]

Introduction: Systemic barriers impacting smoking cessation in pregnant women may include nicotine replacement therapy (NRT) access and training. Aim: Assess general practitioner (GP) and obstetrician's agreement with system-based changes to improve the management of smoking in pregnancy; compare group responses. Methods: National cross-sectional survey with two samples: (1) online survey emailed to a random sample of 500 GPs from Royal Australian College of General Practitioners (RACGP); (2) paper survey posted to 5571 GPs and obstetricians from Royal Australia and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). Percentages agreeing that specified changes would improve the management of smoking in pregnancy were calculated. Pairwise comparisons used Kruskal–Wallis tests (RACGP/RANZCOG GPs/obstetricians). Results: N = 378 participated. Response rates 8.4% (N = 42; online survey) and 6% (N = 335; paper survey), respectively. Total percentages agreeing with system-based changes: 79% training, 64% oral NRT subsidy, 62% Medicare item for smoking cessation, 54% improved access to NRT patches. Within RANZCOG, more GPs (73.1%) agreed that oral NRT should be subsidised (P = 0.001) than obstetricians (53.7%). Conclusion: GPs and obstetricians agreed that system changes would improve their management of smoking in pregnancy. Oral NRT subsidy was the only pairwise group difference. Subsequently, oral NRT has been subsidised; in time, this may influence prescribing and quit rates. [ABSTRACT FROM AUTHOR]

Although it is often assumed that electronic gaming machines (EGMs) are associated with the highest level of risk, it has proved difficult to find reliable evidence in support of this proposition. In this paper, we analysed statistics from major Australian community prevalence studies for the period 2011-2020 to investigate whether EGMs (in comparison to racing and casino table games) have a stronger association with problem gambling. All prevalence studies reviewed used telephone sampling and the Problem Gambling Severity Index to assess problem gambling. In this paper, we examine the principal hypothesis using several lines of evidence, including whether problem gamblers are more likely to gamble and gamble regularly on EGMs as opposed to racing and casino games and if the EGM-problem gambling association was maintained after controlling for other forms of participation. Results showed that of all gambling activities, EGMs do appear to have the strongest association with problem gambling. Despite having a disproportionately higher level of participation on racing and casino games as compared with other gamblers, problem gamblers are more likely to report regular or weekly participation in EGM gambling and this may be the reason why this activity emerges most strongly as a predictor of problem gambling in multivariate models. This finding is particularly salient, given the very high prevalence of EGM participation, compared to other risky gambling forms. The findings underscore the importance of survey reporting that presents results in a form that can inform policy relevant research relating to the potential impact of different gambling activities. [ABSTRACT FROM AUTHOR]

While there are many cross-sectional studies that provide data on gambling behaviour and the characteristics of those who gamble, there are few large-scale population based longitudinal studies of gambling. This is a serious limitation. It is increasingly being recognised that longitudinal data is required to properly understand gambling behaviour, trajectories, risks and consequences. This paper makes use of a large-scale longitudinal survey that includes questions on gambling behaviour in Australia: the Household, Income and Labour Dynamics in Australia (HILDA) survey. Although the HILDA survey currently provides data on gambling at a single point in time in 2015, there are data on the individuals, in the majority of cases, back to 2001. This paper analyses the trajectories of a range of social, health and economic outcomes according to self-reported risk of experiencing gambling related problems. The analysis clearly shows that problem gamblers experience significantly worse outcomes than those without gambling problems, and poor outcomes go back a number of years. In a number of cases, outcomes are becoming progressively poorer, which may suggest either increasingly risky gambling behaviour or the cumulative effects of a sustained period of gambling problems. The long-term nature of the poor health and social outcomes experienced by problem gamblers strongly suggests that programs designed to address gambling problems will have to be cognisant of, and address these underlying issues. Effective treatment is thus likely to be long-term and challenging. It also suggests that restricting access to gambling via mechanisms such as pre-commitment or self-exclusion will be effective. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to suggest how well-being messages are recontextualized into school-based contexts from an analysis of national policy and state curricular approaches to health education as reported in the findings of two selected case studies as well as community concerns about young people's well-being. Design/methodology/approach: A cross-sectional review of Australian federal and state-level student well-being policy documents was undertaken. Using two case examples of school-based in-curricular well-being programs, the paper explores how discourses from these well-being policy documents are recontextualized through progressive fields of translation and pedagogic decision making into local forms of curriculum. Findings: Pedagogic messages about well-being in Australia are often extra-curricular, in that they are rarely integrated into one or across existing subject areas. Such messages are increasingly focused on mental health, around phenomena such as bullying. Both case examples clearly demonstrate how understandings of well-being respond to various power relations and pressures emanating from stakeholders within and across official pedagogic fields and other contexts such as local communities. Originality/value: The paper focusses on presenting an adaptation of Bernstein's (1990) model of social reproduction of pedagogic discourse. The adapted model demonstrates how "top-down" knowledge production from the international disciplines shaping curriculum development and pedagogic approaches can be replaced by community context-driven political pressure and perceived community crises. It offers contemporary insight into youth-at-risk discourses, well-being approaches and student mental health. [ABSTRACT FROM AUTHOR]

Background: Non‐communicable diseases (NCDs), also known as chronic diseases, now constitute a major proportion of ill‐health across most adult and older populations including in people with intellectual disability. The current paper is a comparative analysis of prevalence of NCDs across mid‐aged and older‐aged people with mild intellectual disability. Method: Comparative data comes from two cross‐sectional surveys using similar methodology and timeframes. The analysis sample comprises mid‐aged group (30–50 years, N = 291) and older‐aged group (≥60 years, N = 391). Results: People with mild intellectual disability start developing NCDs in early to mid‐adulthood and increases with age. The mean number of NCDs in mid‐aged group was 0.86 (SD, 0.84) compared to 3.82 in older group (SD, 2.67). Conclusion: There needs to be early identification and management of NCDs using relevant health promotion and preventative measures at optimal intervention points. The training of healthcare professionals needs improvement. [ABSTRACT FROM AUTHOR]

Introduction: Commercial tobacco use was systematically embedded as a valuable commodity through colonisation that continues to be exploited for profit by the Tobacco Industry. There have been significant declines in current smoking prevalence among Aboriginal and Torres Strait Islander peoples 18 years and over, from 55% in 1994 to 43% in 2018–2019. This paper seeks to better understand smoke‐free behaviours, and to systematically quantify associations between a range of SDOH and non‐smoking/never‐smoking among Aboriginal and Torres Strait Islander adults (≥18) living in regional Australia. Objective: To explore the social determinants of health (SDOH) related to non‐ and never‐smoking among Aboriginal and Torres Strait Islander peoples in regional Australia. Design: Cross‐sectional analysis of the NATSIHS, weighted to the Aboriginal and Torres Strait Islander adult population living in regional Australia, was conducted. Participants were characterised as people who were current smokers, never‐smokers and non‐smokers (ex‐ and never‐smokers). The social determinants of health exposures related to socioeconomic position, well‐being and access to healthcare. Setting: Regional Australia is distinct from urban and remote areas, based on the ASGS Remoteness Structure (ABS) 2018–2019. Participants: Aboriginal and Torres Strait Islander adults (≥18 years) who were selected, consented and asked questions about smoking in the National Aboriginal and Torres Strait Islander Health Survey (NATSIHS 2018/19). Results: High income was associated with non‐smoking (Prevalence Ratio [PR] = 2.07; 95% CI: 1.66–2.57) and never‐smoking (PR = 2.02; 1.46–2.79), as was completing year 10 (non‐smoking PR = 1.34; 1.12–1.61 and never‐smoking PR = 1.56; 1.20–2.03). Better food security was associated with a higher prevalence of never‐smoking (PR = 2.42; 1.48–3.98). Lower psychological distress scores were associated with non‐smoking (PR = 1.30; 1.10–1.53) and never‐smoking (PR = 1.56; 1.21–2.01). Never‐smoking was more frequent in participants reporting no experiences of unfair treatment (PR = 1.59; 1.22–2.06). Having a usual healthcare provider was associated with non‐smoking (PR = 1.38; 1.02–1.86). Positive exposure to the SDOH were associated with non‐ and never‐smoking among Aboriginal and Torres Strait Islander adults in regional Australia. Structural and systemic changes to address the SDOH, including discrimination and racism, are expected to accelerate non‐smoking behaviours and improve health outcomes for Aboriginal and Torres Strait Islander peoples. [ABSTRACT FROM AUTHOR]

To investigate determinants of willingness to adopt telerehabilitation, willingness of technology use, core affect regarding using telerehabilitation, and digital competencies in rehabilitation professionals in Austria and Germany before and during the COVID-19 pandemic. A cross-sectional paper-based and online survey was conducted before and during COVID-19, respectively, with three cohorts of rehabilitation professionals. Outcomes were the willingness to adopt telerehabilitation evaluated using the extended Unified Theory of Acceptance and Use of Technology; willingness of technology use using the short scale for assessing the willingness of technology use; digital competencies and core affect using the Digital Competence Framework and semantic differential, respectively. Multivariate ordinal regression analysis was performed to determine predictors. Included were 603 rehabilitation professionals. Analysis revealed differences between Austria and Germany and before and during the pandemic for most outcomes. German residency, the pandemic, and a higher educational level were most important predictors of higher willingness to adopt telerehabilitation, willingness of technology use, digital competencies, and positive core affect. The pandemic increased most aspects of willingness to adopt telerehabilitation, willingness of technology use, digital competencies, and positive core affect. Results confirm that rehabilitation professionals with higher degrees are more prone to adopt innovations in healthcare.Registration: German Clinical Trials Register (DRKS00021464) The willingness to adopt telerehabilitation is associated with external factors increasing the need for alternative rehabilitation delivery, such as COVID-19, and with financial facilitators, such as reimbursement. As the willingness to adopt telerehabilitation is higher among speech and language therapists and dietitians, efforts are necessary to enhance its use in physiotherapists and occupational therapists. As a higher willingness to adopt telerehabilitation was observed in younger rehabilitation professionals and those with higher education, increasing the importance of telerehabilitation in education curricula and further knowledge transfer into practice for those already working in the field seems necessary. [ABSTRACT FROM AUTHOR]

There is little research comparatively assessing prevalence of pain between older people either with or without intellectual disability. This paper explores health and social factors associated with chronic pain in these two groups. A cross-sectional survey was undertaken in New South Wales and Queensland, Australia. Inclusion criteria were adults either with or without intellectual disability, aged 60 years and older, and currently living in community-settings. Univariate and multivariable analyses were undertaken on a sample of 391 adults with intellectual disability and 920 adults without intellectual disability. Key findings included higher prevalence of pain in the intellectual disability group, along with higher rates of osteoarthritis, falls, oral health problems, and mood disorders. Mitigating risk factors for conditions that cause chronic pain in older adults is crucial. As longevity increases, the healthcare sector needs to prioritise chronic pain management for people with intellectual disabilities through appropriate treatment strategies. [ABSTRACT FROM AUTHOR]

Objective: Farmers are prone to poor well‐being and are at higher risks of suicide than the general population. The aim of this study was to understand whether the negative impact of daily stressors on Australian farmers' well‐being could be buffered through a strong internal locus of control – a strong sense of control over what happens in life. Methods: Australian farmers self‐reported their well‐being, daily stress, and locus of control. Design: Cross‐sectional via pen‐and‐paper survey. Setting: Participants completed the surveys at the beginning of agricultural management training courses. Participants: Australian farmers (N = 129, M age = 39 ± 12 years, 54.7% male). Main Outcome Measures Internal and external locus of control, daily stress, and subjective well‐being. Results: More daily stressors were associated to poorer well‐being, regardless of external locus of control; however, farmers with a stronger internal locus of control were buffered from the negative impacts of daily stressors. That is, daily stressors were not significantly associated with well‐being for farmers with a strong internal locus of control. Conclusions: Internal locus of control may be a significant factor in supporting good well‐being for farmers. Further research should investigate how to enhance internal locus of control amongst this population. It may be that interventions to enhance internal locus of control in farmers could improve their well‐being and productivity, good outcomes for the individual farmers, and global society overall. [ABSTRACT FROM AUTHOR]

Objectives: This paper evaluates an Australian curriculum of health administration postgraduate program and its applicability to the workplace. Methods: This study adopted a cross-sectional design. Between January and April 2020, invitations to complete an anonymous online survey were emailed to a total of 250 Master of Health Administration (MHA) alumni who completed their course at an Australian University between 2014 and 2019. Results: A total of 44 alumni participated in the survey. Half (50%) of the respondents were female, the majority of whom (77%) were under the age of 45 years, while 63% of the participants were enrolled part time and undertook their studies in a blended mode. More than half of those responding indicated that MHA improved their strategic thinking (54%), planning (52%), and process development (48%), in addition to their ability to meet goals (48%) and perform data interpretation (45%). Resilience (39%), emotional thinking (36%), and flexibility (27%) scored lower. More than 80% of those who responded stated that they received a promotion (89%) or secured an increased income (86%) as a result of their MHA completion. Conclusion: This study finds that a mix of basic and advanced knowledge of subjects such as project management, health resources management, data analysis, and human resources management to be relevant and highly applicable to the workplace. Provision of flexibility of subjects' delivery for health administration should be encouraged to allow for the diversity and the changes in health services while maintaining the core requirements needed for health managers' competencies. [ABSTRACT FROM AUTHOR]

Background: Research suggests that some speech–language pathologists are uncomfortable treating people who stutter. Accessing quality clinical education experiences in stuttering is difficult given the ongoing rise in students enrolled in speech–language pathology programmes and the limited number of stuttering‐specific placements available. Simulation‐based learning is a viable option for providing speech–language pathology students with practical experience in a safe learning environment. Whilst research has found that simulation‐based learning experiences in stuttering assist in the development of students' clinical skills, students' perceptions of participating in stuttering simulation‐based learning are yet to be explored. Aims: To investigate speech–language pathology students' comfort, anxiety, knowledge and confidence in the management of stuttering at the commencement of an academic stuttering course and before and following participation in a stuttering simulation‐based learning programme. Methods & Procedures: This study used a cross‐sectional survey design. Participants were 105 undergraduate and graduate entry masters speech–language pathology students enrolled at an Australian university. Students engaged in a stuttering simulation‐based learning programme embedded within an existing academic course on the management of stuttering. A purposefully developed survey was administered at three time points: pre‐course (T1), pre‐simulation (T2) and post‐simulation (T3) in order to explore students' comfort and anxiety levels, and perceptions of their knowledge and confidence in stuttering management. Descriptive statistics were used to report the medians and range of students' responses. Changes across all time points and between each of the time points were determined using the Friedman test and the Wilcoxon signed rank test, respectively. Outcomes & Results: Statistically significant differences (p < 0.001) were observed on all matched survey items (n = 96) across all time points. Between each time point, a significant difference in students' perceived knowledge levels was found with small to large effect sizes. However, there was no difference in students' perceived comfort and anxiety levels between the time points of pre‐course and pre‐simulation. Open‐ended responses on the post‐simulation survey revealed that students valued learning about stuttering within a simulation‐based learning environment. Conclusions & Implications: Simulation‐based learning experience in stuttering management was valued by students. When accompanied by theoretical content, participation in a stuttering simulation‐based learning programme supported students to feel more comfortable and less anxious about working with people who stutter. This finding has implications for the development of clinical skills in the assessment and treatment of adults who stutter. WHAT THIS PAPER ADDS: What is already known on this subject: Simulation is a teaching approach used within speech–language pathology to support the development of students' clinical skills. Simulation provides a safe learning environment for students, an opportunity for repeated practice and is valued by students. What this paper adds to existing knowledge: This study explored students' perceptions of their comfort, anxiety, knowledge and confidence in working with people who stutter before and following participation in a simulation‐based learning programme. It describes a stuttering simulation‐based learning programme that can be embedded into speech–language pathology programme curricula. What are the potential or actual clinical implications of this work?: The stuttering simulation‐based learning programme detailed in this study can be applied and embedded in speech–language pathology curricula. It can be used to support the development of students' confidence in the assessment and management of stuttering. [ABSTRACT FROM AUTHOR]

Aim: To inform future training and professional development for individuals who measure, analyse and interpret dietary intake data. Methods: A cross‐sectional online survey was distributed via e‐newsletter to members of Dietitians Australia, Dietitian Connection and Nutrition Society Australia. The survey included 37 questions on three key areas of practice: (a) methods used to assess dietary intake, (b) barriers faced when conducting dietary intake assessment and (c) resources needed to optimise collection, analysis and interpretation of dietary intake data. Results: Of 173 responses, 103 respondents provided complete data over 2 weeks. Of these, 76% were APDs. The majority (90%) indicated that dietary assessment was important in their role. Respondents (63%) undertook dietary assessments to inform individual/patient care. When assessing intakes, the majority (79%) were interested in examining food/food group intakes. Paper based methods were most commonly used and diet histories, food frequency questionnaires and 24‐hour recalls were the most frequently used methods. The biggest barrier identified to implementing dietary assessment methods into practice was participant burden. Over a third of respondents reported they had received specific training on selecting an appropriate dietary assessment method. The majority of respondents (83%) believed having access to a dietary assessment methods toolkit would be useful. Conclusion: Survey findings provide insight into the need for further capacity building strategies, including professional development to improve collection, analysis and interpretation of dietary intake for Australian nutritionists and dietitians. The creation of online resources could help overcome identified barriers and provide a link to best practice methodologies and contemporary tools. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic continues to exert a significant toll on the Australian primary healthcare system. Although wellbeing challenges faced by hospital-based healthcare workers are widely discussed, less is known about the experiences of general practitioners (GPs) during the initial phases of the pandemic. This paper reports qualitative survey data from Australian GPs, examining their workplace and psychosocial experiences during the initial months of the pandemic. Methods: An Australia-wide, cross-sectional, online survey of frontline healthcare workers was conducted in 2020. A qualitative approach using content analysis was utilised to examine responses to four free-text questions from GPs. Results: A total of 299 GPs provided 888 free-text responses. The findings reveal that general practice was overlooked and undervalued within the pandemic response, resulting in negative impacts on GP wellbeing. Four themes were identified: (1) marginalisation of GPs; (2) uncertainty, undersupported and undervalued in the workplace; (3) isolation and disrupted personal lives; and (4) strategies to support GPs during times of crises. Key concerns included poor access to personal protective equipment, occupational burnout and poor wellbeing, insufficient workplace support, and conflicting or confusing medical guidelines. Conclusions: Primary healthcare constitutes an essential pillar of the Australian healthcare system. This study presents the many factors that impacted on GP wellbeing during the COVID-19 pandemic. Enabling GP voices to be heard and including GPs in decision-making in preparation for future crises will enhance the delivery of primary care, reducing the burden on hospital services, and help sustain a safe and effective health workforce long term. The COVID-19 pandemic caused significant challenges and wellbeing issues for healthcare workers such as general practitioners (GPs), especially during the initial months in 2020. A large nationwide survey of Australian healthcare workers was undertaken in 2020 to understand their experiences, from which 299 GPs provided free-text survey responses for qualitative analysis. This analysis showed GPs felt marginalised, undervalued and under-supported while working in risky work conditions, pointing to a need for GP voices to be heard to safeguard their wellbeing. [ABSTRACT FROM AUTHOR]

This paper examines how antiretroviral therapy (ART) use and fears towards the onward transmission of HIV have changed among people living with HIV (PLHIV) in Australia between 1997 and 2018. Participants were recruited as part of the HIV Futures study, a large cross-sectional survey of PLHIV in Australia, in 1997, 2003, 2012 and 2018 (total n = 3889). ART use, viral load detectability, and fear of onward HIV transmission were compared between years. Predictors of onward transmission fear were assessed among the 2018 subsample. While ART use within our sample decreased between 1997 and 2003, it subsequently increased to 97% in 2018. Self-reported viral load undetectability steadily increased over time, up to 88% in 2018. Notably, fewer PLHIV reported being fearful of transmitting HIV in 2018 compared to all other years. Being unfamiliar with the undetectable = untransmissible health movement, and having a detectable or uncertain viral load at last test, were significant predictors of being fearful of onward HIV transmission. Beyond the immediate medical considerations of HIV treatment, these results suggest that the undetectable = untransmissible movement may play a critical role in attenuating burdens experienced by PLHIV in Australia and that such messaging, in tandem with early and consistent ART use, should remain a salient feature of heath messaging among this population. [ABSTRACT FROM AUTHOR]

Objective(s): To identify if gender and parenting factors are associated with burnout in Australian general practice (GP) registrars. Design: Cross sectional study. The main outcome measure was the Maslach Burnout Inventory, included as part of the GPRA (General Practice Registrars Australia) biannual online survey. Participants: GP registrars, 2019 cohort, undertaking fellowship training in Australia. Results: In 2019 a total of 366 GP registrars completed the online survey. Over 75% of registrars experienced moderate to high levels of burnout (emotional exhaustion scale). Several demographic factors were associated with an increased risk for reporting higher levels of burnout. Increasing age was associated with lower levels of personal accomplishment (P-value < 0.01), being female was associated with higher levels of emotional exhaustion (p-value < 0.001) and increasing numbers of children were associated with lower levels of burnout, independent of hours worked (p-value < 0.001). Conclusion: This study suggests that being a parent is associated with a reduced risk of burnout, irrespective of hours worked. However, being female and increased age were associated with increased levels of burnout. With increasing numbers of females entering medical training, and the decreasing desirability of general practice training, this paper reviews the complexities around parenting during training and associations with burnout. There is a need to examine this interaction further to understand the causation for these findings, and to ensure appropriate policies, opportunities and workplace supports are developed to ensure GP training is optimised to attract and support the next generation. [ABSTRACT FROM AUTHOR]

Objective: To describe self-reported general and psychological health for allied health practitioners at an Australian acute public health service over three time points within the coronavirus disease 2019 (COVID-19) pandemic. Methods: This study collected data from cross-sectional online surveys at three time points: May–June 2020 (T 1), October–November 2020 (T 2) and November–December 2021 (T 3). The self-report questionnaire consisted of demographic questions, a general health question and the 21-item version of the Depression Anxiety Stress Scales (DASS-21). Results: A total of 308 responses were received (T 1 n = 135, T 2 n = 78, T 3 n = 95) from representatives of eight allied health professions. The proportion of allied health practitioners reporting poor general health significantly increased over time, as did mean scores on all DASS-21 sub-scales. General health status was also significantly associated with DASS-21 subscale scores. Anxiety scores increased significantly between T 1 and T 2, while depression scores increased significantly between T 2 and T 3. Significant increases in stress scores were recorded across all time intervals. Between T 1 and T 3, the proportion of allied health practitioners reporting moderate, severe, or extremely severe symptoms increased for depression (10.3–30.9%), anxiety (5.2–18.2%) and stress (13.3–36.3%). Conclusion: The general and psychological health of allied health practitioners appears to be worsening as the COVID-19 pandemic continues. Organisational strategies to support the health of the allied health workforce in acute care settings must address the cumulative effects of prolonged pressure on their general and psychosocial health. Support strategies need to be responsive to changes in psychological wellbeing at different phases of the pandemic. What is known about the topic? Many cross-sectional studies report poor psychosocial wellbeing during the COVID-19 pandemic. What does this paper add? Here we provide evidence about the long-term and declining general and psychological health status of Australian allied health practitioners during the COVID-19 pandemic. What are the implications for practitioners? The psychological wellbeing of allied health practitioners has declined as the COVID-19 pandemic continues. There is an urgent need for initiatives targeting allied health practitioners that support their wellbeing and ongoing ability to provide high quality patient care. [ABSTRACT FROM AUTHOR]

Objectives: The socioeconomically disadvantaged oldest old (people aged 85 years and over) are more vulnerable to social exclusion than the general population. Using a population representative sample, this paper examined associations between sociodemographic characteristics and social exclusion among the oldest old. Methods: This cross‐sectional study included 307 participants aged 85 years and over from the Household, Income and Labour Dynamics in Australia (HILDA) Survey. Sociodemographic characteristics were measured using household composition, country of birth, housing tenure, income, education and neighbourhood‐level disadvantage. Three social exclusion domains were derived representing unsupportive relationships, neighbourhood exclusion and community disengagement. Analysis was undertaken separately for men and women. Results: Among men, living alone was associated with higher levels of unsupportive relationships (β = 11.6, 95%CI 2.1, 21.0) and having a lower income was associated with lower levels of neighbourhood disunity (β = −16.7, 95%CI −31.2, −2.2). Among women, living alone was associated with lower levels of community disengagement (β = −7.2, 95%CI −13.4, −0.9) and neighbourhood disadvantage was associated with lower levels of neighbourhood disunity (β = −10.4, 95%CI −19.6, −1.2). Both men and women with lower levels of education had higher levels of community disengagement (men: β = 8.3, 95%CI 1.9, 14.7; women: β = 17.0, 95%CI 8.6, 25.5). Conclusions: This study showed few and unexpected associations between sociodemographic characteristics and social exclusion among oldest‐old Australians, suggesting a homogeneous effect of advancing age. Government approaches aimed at reducing social exclusion in this age group should consider gender and taking action across all socioeconomic stratification. Further research is warranted to understand the underlying mechanisms linking sociodemographic characteristics to social exclusion. [ABSTRACT FROM AUTHOR]

It is well documented that lower socio-economic status is associated with poorer health outcomes, while health literacy is considered important for improving health. What is less clear, is the extent to which greater health literacy can improve health outcomes among people for whom poverty or financial insecurity are important barriers to health. The paper presents findings from an Australian survey of people living with HIV (PLHIV) (N = 835) in which we explored the relationship between financial insecurity and health outcomes, looking at the extent to which health literacy mediates this relationship. The study drew on a comprehensive definition of health literacy, measuring participant's confidence to communicate with healthcare providers, navigate the health system and take an active stance in relation to their health. Findings showed that financial insecurity was associated with lower health literacy and poorer self-reported physical and mental health. Health literacy mediated 16.2% of the effect of financial insecurity on physical health scores and 16.6% of the effect of financial insecurity on mental health scores. This suggests that programmes which seek to build health literacy among PLHIV may improve health outcomes among PLHIV who are struggling financially. Health literacy programmes are likely to be effective if they build confidence and resourcefulness among people to engage with health information, decision-making and care. [ABSTRACT FROM AUTHOR]

This paper explores the decision-making processes involved in giving physiotherapy students responsibility on clinical placement and the impact on their developing professional autonomy. The qualitative study, using semi-structured interviews, involved physiotherapy students and clinical educators (CEs) from two higher education institutions, one in Australia, and the other in the United Kingdom (UK). Findings led to the development of a heuristic framework of 'graduated supervision,' a process of progressively less direct observation and monitoring of students as clinical proficiency improved. By focusing on the measured exposure of students to increasing complexity and inverse levels of supervision, the framework captures tacit practices, and consistent, yet varied facilitation strategies adopted across specialties, and evident in clinical education settings in both countries. The framework formalizes, for the first time, assumptions and expectations previously unacknowledged. Factors identified as affecting students' progress toward autonomy include the student/CE relationship, the development of mutual trust through ongoing dialogue, and the importance of formal discussions at the commencement of a clinical placement to establish learning goals, preferred supervision styles and learner responsibilities. Insights have significance for the CE community, and students who at times have to second-guess what is required of them and how they might excel on clinical placement. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to evaluate the validity and reliability of the modified Chronic Kidney Disease Self‐Management instrument in an English‐speaking population. Background: There is growing evidence that self‐management behaviours can improve outcomes for people with chronic kidney disease. However, there are few suitable instruments available. Design The study was cross sectional, with a test–retest protocol. Method: Adults with chronic kidney disease attending a primary health care between June and December 2015 completed the Chronic Kidney Disease Self‐Management instrument. Construct validity was determined using exploratory factor analysis, internal consistency and test–retest reliability using Cronbach's α and intraclass correlation. For convergent validity, the relationships between knowledge, self‐efficacy and self‐management were investigated. Results: The Australian version of the Chronic Kidney Disease Self‐Management instrument has 17 items grouped into four factors: self‐integration, seeking social support, adherence to lifestyle modification and problem solving. The instrument demonstrated good reliability. Self‐efficacy was positively correlated with self‐management scores, although there was no correlation between chronic kidney disease knowledge and self‐management. Conclusions: The Australian version of the Chronic Kidney Disease Self‐Management instrument was found to be a valid and reliable patient‐reported outcome measure. It can be used in clinical practice to support self‐management, as well as future research. SUMMARY STATEMENT: What is already known about this topic? The burden of chronic kidney disease is rising mostly due to the increasing prevalence of diabetes and hypertension.Chronic kidney disease progression can be slowed with effective self‐management behaviours.Patient‐reported outcome measures need testing in target populations prior to implementation in clinical settings and research. What this paper adds? The Australian version of the Chronic Kidney Disease Self‐Management instrument demonstrated good validity and reliability in the target population.The instrument is suitable to use in research testing interventions to improve self‐management of chronic kidney disease. The implications of this paper: Clinicians can use this patient‐reported outcome measure to assess for changes in CKD self‐management behaviours following patient education.The instrument can be used to identify individuals in need of support for self‐management skills. [ABSTRACT FROM AUTHOR]

Background: COVID-19 has caused significant disruption. This has been particularly evident within the university student population where their traditional ways of learning were abruptly reorganised and support structures removed. Objective: This paper aims to explore undergraduate student nurses' perceptions of the support required from the university during COVID-19 using the Achievement Goal Theory framework. Design: Data were collected via an online survey of undergraduate student nurses from an Australian university. This paper is reporting the data from a single open-ended item asking participants about their support needs from the University. Data were analysed using thematic analysis. Results: Of the 178 students who responded 206 individual statements were provided about the support they would like from the university. Four primary themes emerged, Support beyond academia, Academic support, Online learning readiness and Clinical practice units and clinical placement. The students identified that their needs during this pandemic include financial needs, social isolation, needs for more communication and unpreparedness for online teaching. Conclusion: Several factors were identified by participants about the additional support required from the university during COVID-19. Understanding and addressing these factors have the potential to improve student support during COVID-19 and support students in future crises. Impact statement: Understanding what support students perceive they require from the university during significant disruption will assist in future crisis management planning. [ABSTRACT FROM AUTHOR]

Objective: Cross-sectional studies have demonstrated that people with disability have substantial inequalities in mental health compared to people without disability. However, it is not known if these inequalities have changed over time. This study compared the mental health of people with and without disability annually from 2003 to 2020 to investigate time trends in disability-related mental health inequalities. Methods: We use annual data (2003–2020) of the Household, Income and Labour Dynamics in Australia Survey. Mental health was measured using the five-item Mental Health Inventory. For each wave, we calculated population-weighted age-standardised estimates of mean Mental Health Inventory scores for people with and without disability and calculated the mean difference in Mental Health Inventory score to determine inequalities. Analyses were stratified by age, sex and disability group (sensory or speech, physical, intellectual or learning, psychological, brain injury or stroke, other). Results: From 2003 to 2020, people with disability had worse mental health than people without disability, with average Mental Health Inventory scores 9.8 to 12.1 points lower than for people without disability. For both people with and without disability, Mental Health Inventory scores decreased, indicating worsening mental health, reaching the lowest point for both groups in 2020. For some subpopulations, including young females and people with intellectual disability, brain injury or stroke, mental health inequalities worsened. Conclusion: This paper confirms that people with disability experience worse mental health than people without disability. We add to previous findings by demonstrating that disability-related inequalities in mental health have been sustained for a long period and are worsening in some subpopulations. [ABSTRACT FROM AUTHOR]