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Assistive technologies (AT) perform an important social role, interacting with cultural systems to produce or hinder accessibility to biosocial environments. This interaction profoundly shapes not only how an individual body can be experienced by users but also produce and hinder accessibility to biosocial environments. AT users have historically been viewed through a medical model, which deems them disabled by their impairments and by dominant ableist narratives. Therefore, this paper serves to provide an insight into the importance of ageing with and into AT. This paper aims to investigate polio survivors' and diabetic amputees' experiences of assistive technologies in order to better understand impacts upon narrative and identity. By applying an anthropological and sociological lens, a holistic view of the experiences of polio survivor and amputee AT users is developed. This paper draws on 16 in-depth interviews with polio survivors and diabetic amputees in the United States (US) and Australia, which were analysed using an experience-centered narrative approach. Both projects were approved by ethics boards. All participants provided written consent. Five themes were identified: a) disruption to biographies, which reflected AT impact on how narratives become altered; b) impacts to autonomy, which reflected the importance of regaining previous daily activities; c) re-engaging with community life, which highlighted how AT supported participation in valued activities; d) self-perceptions of assistive technologies, which act in opposition to external perspectives and challenge ableist narratives; and e) an intergenerational comparison of new and older AT users highlights the importance of temporalities. This paper offers new perspectives on ageing with assistive technologies, with a focus on identity and narrative. The importance of this paper is to contribute to the existing literature that demonstrates the cultural implications that arise through embodiment and assistive technologies. The use of assistive technology can help individuals regain function, but the individual circumstances require consideration The use of assistive technology is a complex entanglement of bodies, environments, biographies, and imagined futures. The use of assistive technology can provide participants autonomy over their narratives and assist with maintaining their identities [ABSTRACT FROM AUTHOR]

This study examines a paper hand-held record and a shared electronic health record in an Australian tertiary hospital healthcare maternity setting and the role that both types of records play in facilitating integrated care among healthcare providers. A qualitative research design was used where five focus groups were conducted in two phases with 69 hospital healthcare providers. In total, 32 interviews were also carried out with general practitioners. Transcripts were analysed using qualitative content analysis. Three key themes were identified: (1) selective use of records; (2) records as communication of care; and (3) negativity about the use of records. This study demonstrates that healthcare providers do not effectively share information using either a paper hand-held record or a shared electronic health record. Considering a national commitment to e-health innovation, a multi-professional input, organisational support and continuing education are identified as crucial to realising the potential of a maternity shared electronic health record to facilitate integrated care. [ABSTRACT FROM AUTHOR]

Background: Spoken discourse impairments post‐traumatic brain injury (TBI) are well‐documented and heterogeneous in nature. These impairments have chronic implications for adults in terms of employment, socializing and community involvement. Intervention delivered by a speech–language pathologist (SLP) is recommended for adults with discourse impairments post‐TBI, with an emphasis on context‐sensitive treatment. The developing evidence base indicates a wide array of treatment components for SLPs to evaluate and implement within their clinical practice. However, there is limited insight into how SLPs are currently treating discourse impairments and the rationales informing clinical practice. Aims: To explore the under‐researched area of clinical practice for spoken discourse interventions with adults post‐TBI, including treatment components and clinician rationales, and to contribute towards a shared knowledge base. Methods & Procedures: Participants were recruited via purposeful sampling strategies. Six SLPs participated from Australia, the United Kingdom (UK) and the United States (US). Semi‐structured interviews were conducted via Zoom. Interviews were manually transcribed, coded and analysed via a qualitative content analysis approach. Outcomes & Results: :Participants described discourse treatment practices across various settings and TBI recovery stages. Results indicated that SLPs used numerous treatment activities, resources and outcome measures. Intervention approaches primarily targeted social communication skills, strategy development/utilization and insight‐building. Clinical practice conformed to available guidelines where possible, reflected best practice and incorporated components of the research literature. Participants reported using individualized treatment activities aimed at addressing client‐specific factors and rationales prioritized tailored, context‐sensitive and goal‐directed treatment. Conclusions & Implications: This study provided insight into a previously under‐researched area. It highlighted a wide range of treatment activities and factors informing current SLPs' treatment of spoken discourse impairment post‐TBI. Overall, clinical practice and rationales discussed in this study were aligned with best practice and emphasized a contextualized, individualized approach to discourse treatment across service settings and stages of recovery. Participants identified areas requiring further support, including access to training, resources and research, and the challenge of finding suitable outcome measures. Further investigation into discourse management post‐TBI, from initial assessment to outcome measurement, may help inform clinical decision‐making and the transfer of research to practice. WHAT THIS PAPER ADDS: What is already known on the subject: Spoken discourse impairments occur in dialogic and monologic productions post‐TBI. Interventions targeting both genres are detailed within the research literature; however, studies exploring clinical practice and decision‐making for discourse interventions post‐TBI are limited. What this paper adds to existing knowledge: This study provides new insight into the current treatment targets, activities, resources and outcome measures employed by clinicians supporting adults with discourse impairment post‐TBI. It details the factors that influence clinical decision‐making for this caseload and identifies an emphasis on client priorities and the value of clinician experience. What are the potential or actual clinical implications of this work?: This study identifies the broad and complex considerations required to deliver context‐sensitive discourse intervention post‐TBI. It indicates the need for an in‐depth review from assessment to treatment outcomes to better understand and support this area of practice and to direct future research. This study also highlighted the role of clinician experience in discourse intervention and the value of sharing clinical knowledge and resources within and across the profession to support all levels of clinician experience. [ABSTRACT FROM AUTHOR]

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

Background: Electronic prescription (e-prescription) was introduced in 2020 in Australia during the COVID-19 pandemic. This research aimed to explore general practitioners (GPs) and community pharmacists' experience with, and facilitators and barriers to, the use of e-prescription. Methods: This qualitative study used semi-structured interviews with GPs and pharmacists in Greater Sydney to explore their experience with e-prescription. Thematic analysis used descriptive and mixed inductive and deductive approaches. The Technology Acceptance Model (TAM) was used to further interpret and organise the themes. Results: Eleven GPs and nine pharmacists were interviewed. Thirteen themes were elicited, seven of which were categorised as benefits (facilitators) and six were challenges (barriers). Four facilitator themes (convenience for healthcare providers (HCPs) and patients, addressing issues with paper prescriptions, contactless nature reducing access barriers during COVID-19 lockdown, and enabling patients to manage multiple prescriptions) were mapped to the TAM construct of 'perceived usefulness'; and one facilitator (an easier process) and two barrier themes (lack of information during implementation, and technological issues) were mapped to the TAM construct of 'perceived ease of use'. Themes that fell outside these constructs were separately categorised: four barrier themes (reluctance of some patients and HCPs to change, patient expectations of 'instant prescription' and lost opportunities for best-practice care, HCPs' perceptions of inadequate governmental governance, and ongoing costs) were 'other issues with e-prescription', and two facilitator themes (providing training on the use of e-prescription for HCPs and patients, and making e-prescription more streamlined) were 'suggestions to improve'. Conclusion: There are many facilitators and barriers to the use of e-prescription. Our findings may inform the future promotion of e-prescription post-COVID-19 pandemic. Further research should focus on consumers' perspectives of e-prescription. It is inevitable that electronic prescriptions will one day supersede paper prescriptions, but there is resistance to their implementation at the practitioner and patient levels. This paper explored GPs and pharmacists' experience and views, and found that while e-prescription improves the quality of patient care, there are several challenges to its effective use. Findings may inform the future promotion of e-prescription, particularly post-COVID-19 pandemic, and guide future research in exploring consumer perspectives. [ABSTRACT FROM AUTHOR]

Background: The Partners in Recovery (PIR) program was implemented by the Australian Government Department of Health. Its overriding aim was to improve the coordination of services for people with severe and persistent mental illness, and who have complex needs that are not being met. The PIR capacity-building project (CBP) was funded to provide capacity building activities to the nationwide network of consortia that were set up in 2013 to deliver PIR over a 3-year period. The purpose of this paper is to describe the design and findings from an evaluation of the PIR CBP. Methods: The evaluation involved collecting feedback from consenting PIR staff via an online survey and follow-up semi-structured interviews. CBP activities included: state and national meetings; a web portal; teleconferences; webinars; a support facilitator mentor program; and tailored support from the CBP team. Results: The CBP made a positive contribution to the implementation and delivery of PIR. Staff highly valued activities that employed face-to-face interaction or provided informative knowledge exchange, and were appreciative of CBP staff being responsive and adaptable to their needs. Conclusions: From this evaluation, we recommend the following: identify relevant functions (e.g. prioritise networking), select the right mode of delivery (e.g. establish an online presence) and abide by key principles (e.g. be responsive to staff needs). This information is informing the mental health workforce capacity building activities that our team is currently undertaking. Capacity-building programs are necessary for advancing new public health initiatives, yet there remains limited evidence to inform best practices for delivering these in the context of mental health. This paper describes the design and findings of a capacity-building program developed to enhance the knowledge and skills of community-based mental health providers. From this evaluation, we recommend the following to ensure effective capacity-building programs: identify relevant functions (e.g. prioritise networking), select the right mode of delivery (e.g. establish an online presence) and abide by key principles (e.g. be responsive to staff needs). [ABSTRACT FROM AUTHOR]

This paper examines the adjustments made to include people with intellectual disabilities in mainstream services. Drawing on in-depth interviews with both people with intellectual disabilities and mainstream service managers in four urban regions in Australia, the paper points to three modes of practice that are operationalised, to different degrees, when people with intellectual disabilities seek access to mainstream services: a commitment and adjustments to support inclusion of a wide range of marginalised people (diversity and inclusion ethos); adjustments to support inclusion of people with intellectual disabilities more specifically (differentiated adjustments); and, personal support for service users with intellectual disabilities. We argue that these three modes, at the service level, correspond in complex ways with three broader approaches to social inclusion: mainstreaming, differentiation and individualisation. Rather than contradictory modes of inclusion, our analysis suggests these approaches should be understood as complementary. Some mainstream services that value 'inclusion' make adjustments to their service in order to better include people from different marginalised groups. Such adjustments have mixed outcomes for people with intellectual disability, whose specific needs are not always met. Some mainstream services operate separate activities for users with intellectual disability. This helps them manage behavioural and communication challenges, and can help people with intellectual disability experience a sense of belonging. But separate activities also limit opportunities for full inclusion in the mainstream. Often people with intellectual disability require their own personal support to be able to use mainstream services. Some mainstream services rely on such personal support as their main strategy to include people with intellectual disability. Other mainstream services work collaboratively with personal supporters to promote inclusion. [ABSTRACT FROM AUTHOR]

Background: Early identification and intervention for hearing loss is important for supporting language development. Despite this, parents are required to overcome barriers to access hearing assessments for their children. Aims: To identify the enablers and barriers to accessing hearing assessments for Australian children identified by their parents, and to compare between metropolitan, regional and rural areas. Methods & Procedures: This sequential, explanatory mixed‐methods study was undertaken online and included participants in metropolitan, regional and rural area of Queensland, New South Wales, Victoria, South Australia, Western Australia and the Northern Territory. A total of 56 participants participated in the surveys, and 10 participated in semi‐structured interviews. Outcomes & Results: Participants in metropolitan areas were more likely to have services in their area; however, access to hearing assessment was related more to individual circumstances (including health literacy skills) rather than geographical location. Many participants experienced long wait times, reduced flexibility, and a lack of audiologists experienced in working with children. Conclusions & Implications: Barriers to hearing assessments (which assist with early identification and intervention for hearing loss) should be addressed so that children have access to clear auditory information to assist with their speech and language development. WHAT THIS PAPER ADDS: What is already known on the subject: Poor audiological input can lead to poor speech, language and literacy outcomes for children. What this paper adds to the existing knowledge: Although previous research indicates that people in regional and remote locations experience difficulty accessing health services within a reasonable timeframe, in this study barriers were experienced regardless of geographical location, and were dependent on individual circumstances. Many parents are unaware of the impact of hearing on speech and language. What are the potential or actual clinical implications of this work?: Further research might examine how health literacy affects access to hearing assessment. Parents shared several potential solutions to these access barriers which should be considered by service providers. [ABSTRACT FROM AUTHOR]

Given that the number of children and young people needing care keeps rising and fewer people are becoming foster carers, efforts to support carers and workers in foster caring are essential. This paper considers the experiences of carers and foster care agency workers involved in Australia's piloting of the Mockingbird Family. With a view understanding experience, data were collected via focus groups with carers and agency workers (n = 20) involved in piloting, implementation and evaluation. Deductive analysis applied the theory of experience to generate understanding of experience, as both intrinsic and extrinsic dimensions to capture strengths in the Mockingbird Family's foster caring networks. These dimensions of experience included collective passions of carers and workers; experiential change over time; collective experiences as a moving force; and experiences as transformational. Understanding of experience associated with the perceived strengths of the Mockingbird Family, including strategies to promote strong professional relationships between carers and workers, is an important element in strengthening environments of children and young people in care. Safe and stable environments are crucial for wellbeing. [ABSTRACT FROM AUTHOR]

Introduction: Current strategies to address shortages of rural doctors focus on developing a pipeline for rural generalist practice. Limited research has explored how doctors' professional journey engenders the skills required to practice rurally. Objective: This paper analyses how rural general practitioners' clinical pathway informs their scope of practice and future retention. Design: Qualitative thematic analysis using semi‐structured telephone interviews. Twenty‐one general practitioners appointed in their local health district of Murrumbidgee and Southern New South Wales, Australia, within the past 10 years. Participants comprised 10 Australian medical graduates (AMG) and 11 international medical graduates (IMG). Findings: AMGs and IMGs contrasted how their pathway into rural practice, and capacity to work rurally, informed their scope of practice. Australian medical graduates' familiarity with rural areas was consolidated through congruous experiences, including at rural clinical schools. Paradoxically, the fluency of their training limited the amount of unsupervised experience and confidence AMGs gained. Together with a focus on work‐life balance, this limited many to providing mainstream general practice, precluding extending their scope of practice. International medical graduates described disseminated experiences, often unsupervised in high‐volume contexts. However, a lack of professional opportunities prevented them from extending their scope of practice. Discussion: IMG and AMG motivation and pathway for working rurally differ. Respective cohorts have concerns regarding requisite skills and knowledge for rural practice, which incorporates opportunity and recognition. Entry points for training should be variable to allow consideration of life stage, prior skill development and extension of scope of practice. Conclusion: Doctors' scope of practice is informed by their pathways into rural practice. Australian medical graduates may not gain adequate competence during expedited training programs to confidently undertake extended clinical activities. International medical graduates, however lacked the opportunities and support, to utilise their expertise in rural practice. Complementarily utilising the expertise and commitment of both AMGs and IMGs may synergistically address workforce shortages. [ABSTRACT FROM AUTHOR]

Objective: To determine impact of undertaking an international educational program during a nurse's or midwife's pre-registration program on subsequent practice, focusing on how nurses and midwives were transformed personally through participation in such programs. Background: Participation in international educational programs has been reported to enhance nursing and midwifery students' personal and professional development, however long-term impacts remain unclear. This paper presents findings drawn from a larger grounded theory study. Study design and Methods: Charmaz's grounded theory methodology was used to elicit experiences from 13 general nurses, two mental health nurses, three midwives and four dual qualified nurse/midwives across eight different countries. Data analysis led to the creation of three categories, with this paper reporting on the category of Developing as a Person. Findings: Participation in international educational programs can be transformative for nurses and midwives with long-lasting impacts, contributing positively to their personal growth and development. Discussion: The study findings underscore significant long-term impacts of international educational programs for nurses and midwives. These outcomes highlight the importance of incorporating international experiences into healthcare education. Conclusion: By providing opportunities for healthcare professionals to engage with diverse settings and populations, organisations and educational institutions can foster the development of well-rounded and globally competent practitioners. Implications for research, policy, and practice: The study's findings hold significant implications for research, policy, and practice in healthcare education. To deepen our understandings, additional longitudinal research across diverse countries is warranted. Policymakers have an opportunity to acknowledge the positive impact of these programs on the personal growth and development of nurses and midwives, potentially leading to the integration of global competency requirements into licensure programs. In order to provide comprehensive education, educational institutions should consider the inclusion of study abroad opportunities, cultural exchanges, and global clinical placements within nursing and midwifery curricula. What is already known about the topic? • International educational programs are widely used as a way of developing nursing and midwifery students' cultural understandings. • Previous studies have reported on short-term impacts of international educational programs. What this paper adds: • Long-term impacts of participation in an international educational program on nurses and midwives are described. • Personal development and subsequent transformations occur for nurses and midwives as a result of participation in international educational programs. [ABSTRACT FROM AUTHOR]

Background: The implementation science literature acknowledges a need for engagement of key stakeholders when designing, delivering and evaluating implementation work. To date, the literature reports minimal or focused stakeholder engagement, where stakeholders are engaged in either barrier identification and/or barrier prioritisation. This paper begins to answer calls from the literature for the development of tools and guidance to support comprehensive stakeholder engagement in implementation research and practice. The paper describes the systematic development of the Implementation‐STakeholder Engagement Model (I‐STEM) in the context of an international, large‐scale empirical implementation study (ImpleMentAll) aimed at evaluating the effectiveness of a tailored implementation toolkit. The I‐STEM is a sensitising tool that defines key considerations and activities for undertaking stakeholder engagement activities across an implementation process. Methods: In‐depth, semistructured interviews and observations were conducted with implementers who were tailoring implementation strategies to integrate and embed internet‐based cognitive behavioural therapy (iCBT) services in 12 routine mental health care organisations in nine countries in Europe and Australia. The analytical process was informed by principles of first‐ and third‐generation Grounded Theory, including constant comparative method. Results: We conducted 55 interviews and observed 19 implementation‐related activities (e.g., team meetings and technical support calls). The final outcome of our analysis is expressed in an initial version of the I‐STEM, consisting of five interrelated concepts: engagement objectives, stakeholder mapping, engagement approaches, engagement qualities and engagement outcomes. Engagement objectives are goals that implementers plan to achieve by working with stakeholders in the implementation process. Stakeholder mapping involves identifying a range of organisations, groups or people who may be instrumental in achieving the engagement objectives. Engagement approaches define the type of work that is undertaken with stakeholders to achieve the engagement objectives. Engagement qualities define the logistics of the engagement approach. Lastly, every engagement activity may result in a range of engagement outcomes. Conclusion: The I‐STEM represents potential avenues for substantial stakeholder engagement activity across key phases of an implementation process. It provides a conceptual model for the planning, delivery, evaluation and reporting of stakeholder engagement activities. The I‐STEM is nonprescriptive and highlights the importance of a flexible, iterative approach to stakeholder engagement. It is developmental and will require application and validation across a range of implementation activities. Patient or Public Contribution: Patient contribution to ImpleMentAll trial was facilitated by GAMIAN‐Europe at all stages—from grant development to dissemination. GAMIAN‐Europe brings together a wide variety of patient representation organisations (local, regional and national) from almost all European countries. GAMIAN‐Europe was involved in pilot testing the ItFits‐toolkit and provided their views on the various aspects, including stakeholder engagement. Patients were also represented in the external advisory board providing support and advice on the design, conduct and interpretation of the wider project, including the development of the ItFits‐toolkit. Trial registration: ClinicalTrials.gov NCT03652883. Retrospectively registered on 29 August 2018. [ABSTRACT FROM AUTHOR]

Rationale A multidisciplinary primary care clinic in Sydney, Australia, was planning to use electronic questionnaires to measure patient-reported outcomes. Methods Semi-structured interviews with 20 patients were undertaken to explore, among other things, practical issues regarding different questionnaire formats. The response rates and costs of email versus postal invitations were also evaluated. Results Compared with postal invitations, email invitations offered a cost-effective and practical alternative, with a greater proportion of patients volunteering for an interview. Assuming the interface is well-designed and user-friendly, many patients were happy to use the Internet to answer questionnaires. Most patients thought alternate formats should also be offered. Patients discussed advantages and disadvantages of the Internet format. Although more younger patients and females had given the clinic an email address; both sexes, and young and old patients, expressed strong preferences for either wanting or not wanting to use the Internet. Conclusion Researchers should consider using email invitations as a cost-effective first-line strategy to recruit patients to participate in health services research. Internet questionnaires are potentially cheaper than paper questionnaires, and the format is acceptable to many patients. However, for the time being, concurrent alternate formats need to be offered to ensure wider acceptability and to maximize response rates. [ABSTRACT FROM AUTHOR]

This paper examines the links between place attachment and older persons' preferences to age in place, and factors that disrupt these preferences. We use data from the 2001–2021 Household, Income and Labour Dynamics in Australia Survey and panel-data modelling to confirm strong associations between several place attachment dimensions and aging-in-place preferences. Strong ties to children, strong social capital, residence in social housing, homeownership status, housing wealth, and home and neighborhood satisfaction are all positively linked to a stronger preference to age in place. Our findings reveal important differences between older homeowners and older non-owners. For owners, closeness to children is a strong predictor of aging-in-place preferences, although mortgage debt can trigger involuntary moves. For non-owners, tenure security achieved through longer durations at one's address of residence is linked to stronger aging-in-place preferences. However, private renters are more often exposed to involuntary moves. We discuss the policy implications of these disruptions. [ABSTRACT FROM AUTHOR]

This paper reports findings from an ethnographic study of families from culturally and linguistically diverse (CALD) families in Australia caring for children with disability. The study aimed to contribute insights into the unique experiences, challenges and supports that characterise experiences of families of a child with disability living in a country where the mainstream culture is different from their own. Four families from different cultural backgrounds participated in the study over a period of nine months. During this time, they participated in a series of semi-structured interviews during which they shared their encounters with formal early intervention services and reflected on important informal supports. Findings presented here indicate three key areas associated with accessing informal supports that can pose challenges for families who hold values that are different from those of the dominant culture: lack of social support; cultural adaptations, and socialization problems and coping strategies. The findings indicate that formal services could ameliorate feelings of social isolation by enabling parents to access informal supports such as parenting groups. [ABSTRACT FROM AUTHOR]

Background: People with lived experience of severe mental illness (PWLE) live around 20 years less than the general population. Most deaths are due to preventable health conditions. Improved access to high-quality preventive health care could help reduce this health inequity. This study aimed to answer the question: What helps PWLE access preventive care from their GP to prevent long-term physical conditions? Methods: Qualitative interviews (n = 10) and a focus group (n = 10 participants) were conducted with PWLE who accessed a community mental health service and their carers (n = 5). An asset-based framework was used to explore what helps participants access and engage with a GP. A conceptual framework of access to care guided data collection and analysis. Member checking was conducted with PWLE, service providers and other stakeholders. A lived experience researcher was involved in all stages of the study. Results: PWLE and their carers identified multiple challenges to accessing high-quality preventive care, including the impacts of their mental illness, cognitive capacity, experiences of discrimination and low income. Some GPs facilitated access and communication. Key facilitators to access were support people and affordable preventive care. Conclusion: GPs can play an important role in facilitating access and communication with PWLE but need support to do so, particularly in the context of current demands in the Australian health system. Support workers, carers and mental health services are key assets in supporting PWLE and facilitating communication between PWLE and GPs. GP capacity building and system changes are needed to strengthen primary care's responsiveness to PWLE and ability to engage in collaborative/shared care. People with lived experience of severe mental illness (PWLE) experience poorer physical health and worse access to preventive care than the general population. This paper provides information from a lived experience perspective on how PWLE in Sydney, Australia have been able to access preventive care from a GP. These results highlight the importance of supporting PWLE to access effective preventive care across their journey and suggest specific areas for improvement in GP capabilities and care coordination/shared care. [ABSTRACT FROM AUTHOR]

Introduction: Telepractice service delivery of allied health interventions to people with disability can potentially reduce access barriers and improve service equity. However, questions remain regarding telepractice functionality for people with disability. This study addressed questions related to how allied health clinicians and managers perceive telepractice as functioning in the provision of therapy services to people with disability. Methods: Thirteen interviews of allied health clinicians and managers from across Australia were conducted between 21 November and 22 February via MS teams. Qualitative methodology and critical realist theoretical paradigm underpin the study. Data analysis was completed using a reflective thematic analysis method and five themes were generated and described utilising an analytic metaphor. Results: The study themes were described in relation to a shopping for shoes analytic metaphor and the five themes included (1) a shoe for every foot, (2) planned purchases, (3) shoe on the other foot, (4) you need both shoes and (5) help choosing their shoes. In summary, the function of telepractice fits differently for each individual, similar to pairs of shoes. Conclusions: Telepractice has its own strengths and weaknesses and isn't a direct substitute for in‐person sessions, much like left and right shoes are similar but not the same. The results support participant perceptions that telepractice functions best as an adjunct to in‐person sessions through a flexible hybrid delivery model in the provision of therapy services to people with a disability. A strategy for improving perceived usefulness may involve positioning telepractice as unique with strengths and weaknesses, not replacing in‐person care. Patient or Public Contribution: The paper forms part of a larger codesign process which included customer and carer participants throughout the design and planning of the project, inclusion of a peer researcher, and the selection of the analytic metaphor including in the findings of this article production. [ABSTRACT FROM AUTHOR]

Background: Formative online multiple‐choice tests are ubiquitous in higher education and potentially powerful learning tools. However, commonly used feedback approaches in online multiple‐choice tests can discourage meaningful engagement and enable strategies, such as trial‐and‐error, that circumvent intended learning outcomes. These strategies will not prepare graduates as self‐regulated learners, nor for the complexities of contemporary work settings. Objectives: To investigate whether providing only a score after formative online multiple‐choice test attempts (score‐only feedback) increases the likelihood of students to engage in self‐regulated learning compared with more directive feedback. Measurable outcomes included deeper learning, collaboration, information seeking, and satisfaction. Methods: Data in this mixed methods study were collected from nursing students through surveys, test results, focus groups, and student discussion board contributions. A quasi‐experimental design was used for quantitative data, and qualitative data were analysed thematically against domains of self‐regulated learning. Results and Conclusions: Students receiving score‐only feedback were more cognitively engaged with the content, collaborated constructively, and sought out richer sources of information. However, it was also associated with lower satisfaction. In this study, minimal feedback created states of uncertainty, which resulted in the activation of self‐regulatory actions. Implications for Practice: Providing overly directive feedback for formative online multiple‐choice tests is conducive to surface‐level learning strategies. By minimising feedback and allowing for extended states of uncertainty, students are more likely to regulate their learning through self‐assessment and problem‐solving strategies, all of which are required by graduates to meet the challenges of real‐world work settings. Lay Description: What is already known about this topic: Formative online multiple‐choice tests are widely used in higher education.Feedback is a critical element in the design of effective online multiple‐choice tests.Formative feedback should promote self‐regulated learning.Feedback types used in multiple‐choice tests facilitate strategies not conducive to self‐regulation. What this paper adds: Online multiple‐choice test feedback can influence how students self‐regulate their learning.Less feedback can result in greater self‐evaluation and performance in summative assessment.Less feedback can encourage richer help‐seeking strategies (collaboration and information seeking).However, less feedback can result in student dissatisfaction. Implications for practice and/or policy: Judicious use of feedback is required in the design of online multiple‐choice tests.Educators should consider providing less feedback to promote learner self‐regulation.Satisfaction with online multiple‐choice tests does not necessarily equate to greater learning. [ABSTRACT FROM AUTHOR]

Introduction: People living with advanced cancer want to continue participating in their valued occupations amid cancer progression. However, increasing dependence and bodily deterioration challenge a person's ability to do so, thus requiring adaptation to how they engage in their occupations. Theoretical frameworks on the process of occupational adaptation often do not address the implications of progressive functional decline. Methods: A longitudinal phenomenological design was used to understand the lived experience of occupational engagement for working‐aged adults living with advanced cancer. A semi‐structured interview series explored participants' experience of occupational engagement and how this changed over time. Data were analysed thematically and mapped against the Model of Human Occupation (MOHO). Findings: Eight adults (40–64 years old) participated in 33 interviews over 19 months. Three themes were constructed from the data: ongoing adaptation through doing, the significance of volition in adaptation, and everyday life is contingent on my environment. Study findings demonstrate that the process of adaptation occurs through occupational engagement, is motivated by volition, and is affected by the environment. Volition and the environment play a more central role in occupational adaptation than occupational competency for the advanced cancer cohort. Conclusion: Study findings further MOHO's theoretical conceptualisation of occupational adaptation by identifying the centrality of volition and the environment in the process of adaptation. For people living with advanced cancer, disease progression results in unremitting functional decline, thus rendering competency an unstable and untenable construct. Rather, this paper argues that occupational adaptation is facilitated by volition (i.e., the motivation behind the doing) and the environment, thus fostering a sense of identity and meaning at the end of life. Occupational therapists' awareness of the significance of volition and the environment can thus foster continued occupational engagement and meaning at the end of life for people living with advanced cancer. [ABSTRACT FROM AUTHOR]

Social participation is positively related to mental health recovery and wellbeing, yet people with mental health problems are often socially isolated. This article investigates how social participation was incorporated into an Australian-integrated program that aimed to improve the wellbeing of people with chronic mental health needs. The data are from a longitudinal evaluation of the integrated program, including data linkage (5533 participants) and interviews (111). The paper uses concepts from the network perspective of social capital (bonding, bridging, linking, horizontal, and vertical) as lenses to re-examine the evaluation's findings about the consumers' social participation in life areas (social, leisure, and productive) facilitated by the program. This social capital perspective offers a lens to examine the breadth and intensity of participation experienced by the consumers taking part in the support program. The article adds to the literature about how service providers can improve social participation and therefore consumers' opportunities for recovery and wellbeing. The analyses found that the support increased people's social interaction and their capacity in the community. Their social interaction was mostly with other people in the service. Often their interactions in the community were only transactional. Few consumers participated in activities in productive life areas, and few of the activities promoted vertical social capital in social networks outside the service. The implications are that service providers need greater attention on facilitating a variety of social participation activities that can extend mental health consumers' horizontal and vertical social capital and so further contribute to their current and future recovery and wellbeing. [ABSTRACT FROM AUTHOR]

Objectives: Hospital in the Home models are rapidly expanding in response to increasing bed pressures. This study examined patient and multidisciplinary health professional perceptions of a new geriatric evaluation and management and rehabilitation hospital in the home service in Australia. The service was unique, as adults of all ages with a variety of rehabilitation or geriatric evaluation and management needs were within scope. Methods: A qualitative descriptive approach was used with a consumer co-researcher and a consumer advisor being integral to decision-making. Patient feedback was collected via a paper-based patient satisfaction survey between August 2020 and February 2022. Additionally, interviews with current and past staff were conducted from July to November 2021. Reflexive thematic analysis was conducted for qualitative data and descriptive statistics used for quantitative data. Results: Patient surveys were analysed (n = 199, 42.2% response rate) with 60.8% of participants aged 75 years or over and 26.6% speaking a language other than English. High satisfaction was expressed. Feelings of comfort, familiarity, convenience, and reassurance were voiced. A person-centred approach enhanced involvement in care. Challenges included carer burden and clear communication. Sixteen staff (33% response rate) were interviewed. In general, staff said the service was inclusive and responsive, and the home environment beneficial, particularly for patients from culturally diverse backgrounds. A strong hospital partnership and comprehensive multidisciplinary approach were vital. Challenges included fragmentation due to part-time roles and combining with a pre-existing acute hospital in the home service. Conclusions: This qualitative exploration of staff and patients' perceptions of a geriatrician-led, multidisciplinary geriatric evaluation and management and rehabilitation hospital in the home service demonstrated that it was person-centred and optimised patients' control and ownership of care. The inclusive service parameters ensured responsiveness to diverse needs whilst allowing earlier return home from hospital, both of which are vital for quality patient care. [ABSTRACT FROM AUTHOR]

In this paper, we take a process perspective to inductively theorize how shifting sources of adversity and subjective experiences of team relationship quality influence team resilience across time. Building on the literature, we characterize team resilience as a set of team‐level processes—anticipation, coping, and learning—which can support teams to work interdependently to return to, or beyond, pre‐adversity levels of performance. Despite the rising interest, existing research has tended to be theoretical or exploratory in relation to sources of everyday team adversity. To further understand team resilience, we examine how the characteristics of team resilience unfold across time between a crew of sailors during a challenging multi‐day yacht race and competitive demands. Using video observations and interview data, we explore in real‐time how team resilience processes are (i) shaped by dynamism in the sources of external (environmental) adversity and internal team adversity encountered and (ii) influenced by shifts in the subjective experience of team relationship quality across time. We make two contributions: a novel conceptualization of how external (environmental) adversity and internal team adversity affect team resilience processes across time and a theorization of how relationship quality affects team resilience in the context of shifting adversities. [ABSTRACT FROM AUTHOR]

In Australia, there are more than 46 000 children in out‐of‐home care (OOHC). Most of these children have been in OOHC for more than 2 years. Similarly, there are more than 407 000 children in the United States and over 80 800 in England who are 'looked after' with approximately one third of these children being in OOHC for more than 2 years. This paper concerns 'looked after' children's rights to contact with their birth parents. The United Nations Convention on the Rights of the Child (UNCRC) requires child protection systems to recognize the rights of children to maintain contact with their families except where this is not in the child's 'best interests'. In this paper, we report on a qualitative study conducted in Australia exploring legal and family support practitioners' perceptions of barriers to contact between children in OOHC and their birth parents. The thematic analysis identified four themes: These were as follows: a focus on systems driven responses; lack of cultural recognition and responsiveness; carers' disconnection from birth parents; and parents' exclusion. We discuss the implications of these findings for understanding and recognizing children's right to contact with birth parents. [ABSTRACT FROM AUTHOR]

Many Australians are requiring mental health care, including families, leading to long wait times in order to access support. Walk‐in therapy reduces barriers to mental health support services by providing support at the time that families seek help. This paper presents a proof‐of‐concept study investigating the acceptability and short‐term effectiveness of an online walk‐in family therapy service, Walk‐in Together (WIT). Part 1 of the paper describes the experiences of 44 family members from 22 families who presented to a public family therapy clinic for a virtual walk‐in family therapy session. The session was conducted by a team of three experienced family therapists. Family members' experiences were sought pre‐session, post‐session, and at 6 weeks follow‐up via survey and interview. Part 2 of the paper explores therapist perceptions (n = 7) of the WIT approach, through thematic analysis of semi‐structured interview data. Post‐session feedback showed 85% of family members found WIT to be helpful and 50% were optimistic about their future as a family after their WIT session. Six weeks post‐session it was revealed that WIT supported planning for families in equipping them to move forward with 88% of family members reporting that they knew what to do after the session. All therapists uniformly experienced the model as offering a timely and beneficial service, suitable for diverse presentations and constellations of families. These preliminary results suggest the significant utility of this WIT intervention as a well‐received and helpful service for families, who valued the easy access and rapid therapeutic response afforded by the online, walk‐in delivery model. This proof‐of‐concept paper suggests the potential for further development and growth of WIT, as well as other mental health support services using a walk‐in, telehealth model to meet the rising demand for therapeutic support for families in distress. [ABSTRACT FROM AUTHOR]

Australian research indicates that post-parental care transitions are rarely planned and primarily occur following a crisis for a primary carer. This paper examines disability staff perceptions of transitions for people with intellectual disability and their ageing carers in rural South Australia. A focus group interview model was used, with a semi-structured interview guide initiating group discussions. A thematic analysis methodological approach was selected to analyse the data. This paper reports on the theme of Service Delivery, which has three sub-themes of Availability; Distance; and Individual Access. The key findings are presented and supported by the use of exemplar quotes. This research indicates a poor intersection of general and specialist services is inhibiting post-parental transitional care for rural people. Simply allocating money to the individual does not resolve the issues, and the interface between different services needs to be better considered at government level. [ABSTRACT FROM AUTHOR]

Summary: Gardening has the potential to enhance health and well-being, through increased physical activity and social connectedness. However, while much is known about the benefits of garden activities, less is known about the potential health implications of more passive forms of engagement with gardens, for example, viewing gardens. In addition, much garden research is undertaken in urban settings, leaving little known about potential health impacts for rural populations. The present study explored these research gaps by gaining an understanding of the experiences and perspectives of members of a gardening appreciation group in rural Australia: The Colac Horticultural and Marvellous Property Appreciation Society (CHAMPAS). A phenomenological, qualitative methodology was applied, using semi-structured interviews for data collection. Eleven participants were selected using purposive and snowball sampling and the data were analysed by applying interpretive, reflexive thematic analysis. Four main themes and supporting sub-themes were generated. The four main themes were: (i) motivations for maintaining participation in CHAMPAS; (ii) social connections and friendships, formed from membership; (iii) sense of community and structure of CHAMPAS and (iv) the perceived health and well-being benefits of continued involvement in this group. This study found that members perceived health and well-being benefits stemmed from CHAMPAS facilitation of social connectedness, function as a community group and a way for members to share a love for home gardening. This study provides insights into the perceived and potential health-promoting effects of garden appreciation groups for rural populations. Lay Summary: There are many health and well-being benefits of gardening. However, research is predominantly focused on the active practice of gardening in urban environments, and little is known about the passive activity of garden appreciation, nor about the benefits of this activity in rural areas. This paper explores the health promotion potential of garden appreciation groups through the experiences of members of a rural group called CHAMPAS. Eleven members of CHAMPAS were asked to talk about what kept them attending, and what health and well-being benefits the group provided them. The study found that CHAMPAS benefits stemmed from its function as a social group and a way for members to share a love for home gardening. The findings suggest that garden appreciation groups potentially provide health promotion benefits for people in rural areas. A recommendation of this paper is to undertake further research to map and analyse these benefits across rural Australia. [ABSTRACT FROM AUTHOR]

Aims: To explore Australian healthcare providers' perspectives on factors that influence disclosure and domestic violence screening through the lens of Heise's (1998) integrated ecological framework. Design: This paper reports the findings that were part of a sequential mixed methods study with survey data informing interview questions. Participants for interviews were recruited after expressing an interest after completing surveys, as well as via snowball sampling. Methods: Semi‐structured interviews were undertaken in 2017 with 12 practicing healthcare providers delivering care to women in the perinatal period in Greater Western Sydney, NSW, Australia. Data were analysed using Braun and Clarke's (2006) six‐step thematic approach. Findings The findings were framed within Heise's integrated ecological framework under four main themes. The main themes were 'Ontogenic: Factors preventing women from disclosing'; 'Microsystem: Factors preventing healthcare providers from asking'; 'Exosystem: Organizational structures not conducive to screening'; and 'Macrosystem: Cultural attitudes and socioeconomic influences affecting screening'. Conclusion: Organizational policies are needed for better systems of reminding healthcare providers to enquire for domestic and family violence and mandating this within their practices. Mandatory domestic and family violence education and training that is suitable for the time constraints and learning needs of the healthcare provider is recommended for all healthcare providers caring for perinatal women. Further research is needed in addressing culturally specific barriers for healthcare providers to enquire about domestic and family violence in a culturally appropriate way. Public and Patient Engagement and Involvement in Research (PPEI): No Patient or Public Contribution was embedded into the research reported in this paper as this research was specifically exploring healthcare providers' perspectives on domestic violence screening within their own practice experience. [ABSTRACT FROM AUTHOR]

Background: Cross-sectoral collaborations are considered necessary to address detrimental health, social, educational and economic outcomes that impact marginalised and disadvantaged populations. There is a strong relationship between the health of children and their educational attainment; good health promotes positive learning. This paper reports cross-sectoral executive and senior management level systems changes required to enable the design of a collaborative primary healthcare service model for children and young people in rural Australia. Methods: A descriptive qualitative design was used. Data were collected from executive and senior managers from three organisations (Education, Health and a University Department of Rural Health [ n = 6]) through individual semi-structured interviews. Data were analysed using an inductive, thematic approach. The study draws on Lewin's Model of Change. Results: Three overarching themes were generated from the data: an embedded challenge and experimental solutions; building a shared language and understanding; and the role of relationships and trust. Despite the unique geographical and social context of the study area, strategies emerged from the data on how a solution to an embedded challenge, through design of a primary healthcare model, was established and how the strategies described could be transferred and scaled to other rural and remote communities. Conclusion: Contextual differences make each rural and remote area unique. In this study, strategies that are described in the managing change literature were evident. The authors conclude that drawing on strong management of change principles could mean that a service model designed for one remote community might be transferrable to other communities. There is a strong relationship between children's health and their educational attainment. Poorer health, educational and social attainment are experienced by children and young people residing within the study area. Despite unique geographical contexts and demography, strategies that align strong leadership and effective management of change across three organisations were key and may make it possible to transfer a primary health care model designed to improve health and education outcomes for children and young people to other rural and remote communities. [ABSTRACT FROM AUTHOR]

Introduction: Older carers or 'care partners' of older people experiencing care needs often provide essential support, at times while neglecting their own health and well‐being. This is an increasingly frequent scenario due to both demographic changes and policy shifts towards ageing in place. Multiple community stakeholders within the care and support ecosystem hold valuable expertise about the needs of older care partners, and the programme and policy responses that may better support their health and well‐being. The aim of this study was to identify the perspectives of stakeholders obtained through the codesign phase of a multicomponent research project investigating new models of care and support for older care partners suitable for the Australian context. Methods: Principles of codesign were used to engage a purposeful sample of older care partners, health professionals, researchers, policy makers and health service administrators. Participants took part in a series of three codesign workshops conducted remotely via video conferencing. The workshops were supported with briefing material and generated consensus‐based summaries, arriving at a preferred service model. Findings: This paper reports the research design and structure of the codesign panels, the range of findings identified as important to support the health and well‐being of older carers of older people, and the resulting service model principles. The codesigned and preferred model of care is currently being prepared for implementation and evaluation in Australia. Public Contribution: This study was conducted using codesign methodology, whereby stakeholders including older care partners and others involved in supporting older carers, were integrally involved with design, development, results and conclusions. [ABSTRACT FROM AUTHOR]

Introduction: Facilitators to implement shared cancer follow‐up care into clinical practice include mechanisms to allow the oncologist to continue overseeing the care of their patient, two‐way information sharing and clear follow‐up protocols for general practitioners (GPs). This paper aimed to evaluate patients, GPs and radiation oncologists (ROs) acceptance of a shared care intervention. Methods: Semi‐structured interviews were conducted pre‐ and post intervention with patients that were 3 years post radiotherapy treatment for breast, colorectal or prostate cancer, their RO, and their GP. Inductive and deductive thematical analysis was employed. Results: Thirty‐two participants were interviewed (19 patients, 9 GPs, and 4 ROs). Pre intervention, there was support for GPs to play a greater role in cancer follow‐up care, however, patients were concerned about the GPs cancer‐specific skills. Patients, GPs and ROs were concerned about increasing the GPs workload. Post intervention, participants were satisfied that the GPs had specific skills and that the impact on GP workload was comparable to writing a referral. However, GPs expressed concern about remuneration. GPs and ROs felt the model provided patient choice and were suitable for low‐risk, stable patients around 2–3 years post treatment. Patients emphasised that they trusted their RO to advise them on the most appropriate follow‐up model suited to their individual situation. The overall acceptance of shared care depended on successful health technology to connect the GP and RO. There were no differences in patient acceptance between rural, regional, and cancer types. ROs presented differences in acceptance for the different cancer types, with breast cancer strongly supported. Conclusion: Patients, GPs and ROs felt this shared cancer follow‐up model of care was acceptable, but only if the RO remained directly involved and the health technology worked. There is a need to review funding and advocate for health technology advances to support integration. Patient or Public Contribution: Patients treated with curative radiotherapy for breast, colorectal and prostate cancer, their RO and their GPs were actively involved in this study by giving their consent to be interviewed. [ABSTRACT FROM AUTHOR]

Objective: To identify self-reported influences and drawbacks for early career nurses to work in a rural location. Background: The international shortage of rural nursing workforce is increasing. As a result, evidence that focuses on mechanisms to recruit early career nurses to these areas is important. This research focuses on the influences and drawbacks for early career nurses to undertake a rural graduate nursing program, aimed at providing evidence that can inform the design of rural nurse recruitment programs. Study design and methods: Manifest content analysis of open-ended questions in a cross- sectional survey that was administered in two rural Local Health Districts (LHDs) in New South Wales, Australia. Early career nurses commencing employment in either of the research locations in 2019 and 2020 were eligible to complete the survey. In two open-text questions, respondents were asked to respectively describe what the most influential factor was in their decision to commence employment in their location, and what were the drawbacks of this location, if any. Results: Of the 175 early career nurses invited to complete the survey, 165 (94.29%) returned a completed survey. Four themes were identified as influencing rural early career nurse employment; proximity to social and/or familial ties, being attracted to rural clinical practice, taking advantage of a job offer in a limited market, and wanting a rural lifestyle. Where drawbacks were described, themes referred to distance from social and/or familial ties, rural lifestyle factors, resource challenges, and a perception of less professional opportunity. Discussion: There may be an opportunity to attract and retain rural nurses through targeted social initiatives and creating community ties, particularly among those early career nurses who have no close friends and family nearby. This reflects other literature and the growing understanding of the importance of social connection, familial ties and life course in early career nurse decision making. Conclusion: The results of this research demonstrate that proximity to social and/or familial ties is both the biggest influence and drawback for early career nurses to accept employment in a rural location. Implications for research, policy, and practice: Strategies that capitalise on practical ways to integrate social connection and life course approaches in early career nurse onboarding in rural areas should be explored in future research with a view to creating guidance for rural health organisations and policy makers. What is already known about the topic? • Australia is facing a significant and growing deficit in the number of nurses choosing to practice rurally. • Rural origin and rural placements influence rural practice intention. • Early career nurse programs are an initiative aimed to support the transition of nurses into practice from undergraduate study and can act as a pathway for nurses to enter rural careers. What this paper adds: • Family and social ties are the most influential reasons for choosing a rural location for early career nurses. • Commensurate with this is the greatest drawback for choosing a rural location for early career employment was being away from family and/or friends. • Future research should explore practical strategies that capitalise on the importance of social connections, familial ties, and life course for rural nurse career decisions. [ABSTRACT FROM AUTHOR]

The life expectancy of persons with intellectual disability is increasing, and this is often occurring concurrently with the aging of their long‐term parental carers. Research in both Australia and around the world indicates that proactive post‐parental care planning is not widely implemented, and transitions primarily happen suddenly following a personal crisis for the primary caregiver. Little focus in Australia has been placed on identifying the barriers that inhibit post‐parental care planning in rural areas, specifically in the context of the newly implemented National Disability Insurance Scheme. This paper examines the factors that limit disability services and their staff in supporting successful post‐parental care planning for individuals with intellectual disability and their aging carers in rural South Australia. Small focus groups were conducted with three groups of rural disability support workers using online technologies to assist with the participants' geographic disparity. A semi‐structured interview guide was developed prior to commencement and was used to initiate discussions on key points. A thematic analysis methodological approach was used for data analysis. There were three themes identified through the analysis; Recruitment; Provision of Care; and Retention. The key findings relating to these themes are presented and supported with exemplar quotes. This research proposes three recommendations for policy or practice change: developing a national advertising campaign for new disability staff that positively emphasizes the high‐level skillset need for proactive planning; supporting rural disability providers to collaborate to establish shared teams of staff with expertise in post‐parental care planning; and, using incentive payments to retain staff with these invaluable skillsets in the disability sector. [ABSTRACT FROM AUTHOR]

Up to one third of adults who receive mental health services in Australia are parents. Psychologists in private practice are one of the largest groups within the Australian mental health workforce who support parents experiencing mental ill-health. Parents have specific support needs relating to their parenting role and "treatment as usual" may not address their integrated parenting and mental health concerns. The service experiences of parents in this setting have not been studied. This qualitative study addresses this knowledge gap through investigation of the experiences of Australian mothers who received support from a psychologist in private practice. Semi-structured interviews were conducted with 14 mothers and interviews were analysed using Interpretive Phenomenological Analysis. Three overarching themes were identified in relation to (i) participants' need to feel understood and heard as a parent, (ii) their need for a nonjudgmental therapeutic space and (iii) their desire for practical parental support from psychologists. These findings corroborate the value of family-focused practices when supporting parents with a mental health condition. The results include ways in which family-focused practices have been incorporated by clinicians in private practice settings which may have application in other mental health service contexts. What is already known about this topic: Psychologists in private practice make up a substantial group within the Australian mental health workforce who support parents with a mental health condition. Parents who receive mental health care in tertiary mental health settings report a lack of dedicated parenting support and resources. Family-focused practices are effective in supporting parenting and recovery for parents with a mental health condition who receive mental health care in tertiary mental health settings. What this paper adds: Psychologists who support parents in private practice should collaborate with their clients to identify which aspects of their parenting may be relevant to the therapeutic work and provide targeted support for parenting difficulties. Most participants expected that their psychologist would provide targeted support for parenting difficulties, and they felt disappointed when this did not occur. The lived experiences of parents with mental ill-health in private practice psychology services are highlighted, addressing a key knowledge gap in the literature. [ABSTRACT FROM AUTHOR]

Young people with severe and complex depression experience substantial social connectedness difficulties. The aim of this qualitative study was to evaluate the role of social connectedness in a novel group therapy (Relate) for youth living with severe and complex depression from clinicians' perspectives. Semi-structured interviews were conducted with 11 clinicians practicing at Orygen's Youth Mood Clinic in Melbourne. Eight of the 11 clinicians were female, with the sample aged 30–42 years (M = 34 years, SD = 3.6 years) and having an average 4.5 years clinical experience at Orygen. Four key themes were identified by codebook thematic analysis. The first theme pertained to clients' difficulties with social engagement, which impacted their attendance of Relate, but were addressed by the intervention. In the second theme, clinicians identified Relate as providing a safe space. In the third theme, clinicians identified opportunities for positive relational experiences. In the fourth theme, clinicians observed social and clinical improvements in Relate clients, but marked recovery did not always occur after attending. Findings provide initial support for the continuation of Relate. Recommendations for future iterations of Relate include refining the intake criteria for referring clients to Relate and potentially lengthening the program's duration. What is already known about this topic: Group interpersonal therapy is an effective intervention for depression and interpersonal functioning in young people. Few studies have evaluated treatments for young people with severe and complex depression and high suicide risk. Few studies have evaluated group programs within early intervention services. What this paper adds: A relationally-focussed group therapy could improve social connectedness and interpersonal functioning for youth living with severe and complex depression. The Relate group emphasises a safe environment for sharing and social risk-taking, providing opportunities for positive relational experiences with similar others which might be particularly useful for youth with complex social difficulties. Identified issues with engagement suggest clients could benefit from an explicit rationale for how their participation in the group benefits their depression treatment. [ABSTRACT FROM AUTHOR]

Background: Early career medical professionals experience stress and burnout at higher levels than the wider community. Burnout can arise with competing demands of life and career, which is evident in early career development, where family planning can coincide with specialty training. General practice may be seen as a family friendly career option; however, few studies examine the experience of general practice trainees with stress and burnout and the impact that parenting has on their experience. This study aims to explore the experience of stress and burnout in general practice registrars and the exacerbating and protective factors, with a focus on the experiences of two groups of registrars, those that have children, and those that do not. Methods: A qualitative study was conducted with 14 participants, who were interviewed with questions exploring experiences of stress and burnout. Participants were grouped into those with children and those without children. The transcripts were thematically analysed. Results: Themes were identified as those that contributed to stress and burnout (such as time, financial concerns and isolation) and those factors that reduced stress and burnout (such as support from others and being respected and valued within the workplace). Parenting was identified as both a factor that could contribute to and reduce stress and burnout. Conclusions: Stress and burnout are important foci for future research and policy to ensure the sustainability of general practice. System based and individual focused policies, including individualising training to support parenting, are required to ensure that registrars are supported through their training years and beyond. General practice needs to work to increase recruitment of doctors, reduce early career burnout and to retain GPs in the long term. Early career medical professionals experience stress and burnout at higher levels than the wider community. General practice may have traditionally been seen as a family friendly career option, however, unfortunately it may be no longer. This paper examines the experience of GP trainees with stress and burnout and the impact that parenting has on their experience and looks at solutions to improve conditions for early to mid career GPs, and hopefully make general practice more attractive for future doctors. [ABSTRACT FROM AUTHOR]

Introduction: Rural doctors typically work in low resource settings and with limited professional support. They are sometimes pushed to the limits of their usual scope of practice to provide the medical care needed by their community. In a previous phenomenological study, we described the concept of clinical courage as underpinning rural doctors' work in this context. In this paper, we draw on rural doctors' experiences during the unfolding COVID pandemic to re examine our understanding of the attributes of clinical courage. Methods: Semi structured interviews were conducted with rural doctors from 11 countries who had experience preparing for or managing patients with COVID 19. Interviews were transcribed verbatim and coded using NVivo. A deductive thematic analysis was undertaken to identify common ideas and responses related to the features of clinical courage. Results: Thirteen interviews from rural doctors during the unfolding COVID 19 pandemic affirmed and enriched our understanding of the attributes of clinical courage, particularly the leadership role rural doctors can have within their communities. Conclusion: This study extended our understanding that rural doctors' experience of clinical courage is consistent amongst participants in many parts of the world, including developing countries. [ABSTRACT FROM AUTHOR]

Aims: This paper describes practical advice for refugees aspiring to become Registered Nurses (RNs) in Australia. Design: Qualitative description using a naturalistic inquiry framework. Methods: Between February 2018 and September 2019, the lead author conducted semi‐structured interviews with employed RNs that are former refugees that speak English. Interviews were 45–90 min in duration and digitally recorded. Participants provided voluntary informed consent and were sent questions beforehand. All transcription data were thematically analysed for key themes until no further themes were identified. This paper covers practical advice provided by the participants at the conclusion of their interviews. Results: Twelve participants provided practical advice. Six themes were identified: (1) Find your purpose and set goals; (2) Work hard and never give up; (3) Seek support; (4) Capitalize on opportunities; (5) Be optimistic; (6) Give back. The last theme, give back, was salient across all interviews and was an inherent motivator for some participants once their RN status was achieved. Conclusion: Each participant set the goal of becoming a fully registered nurse and made it a life goal that provided meaning for them. Despite their experiences, the participants provided practical advice that could guide younger people aspiring to become successfully qualified RNs. Impact The findings in this study are unique as they are derived from people with experiences as refugees who, despite their adversity, became RNs. The practical advice provides a framework not only for younger people from refugee backgrounds seeking to achieve their professional goals, but others looking to succeed in other workforce sectors. The practical advice for success will be useful in informing nursing authorities, tertiary institutions and private and public health organizations to develop effective approaches to guide the next generation of would‐be RNs set to contribute to nursing practice in Australia. There were no patient or public contributions as the focus was the personal and professional lives of nurses with refugee backgrounds. [ABSTRACT FROM AUTHOR]

Background: Early childhood teachers (ECTs) play a significant role in equipping children with oral language and emergent literacy skills ahead of school entry. They are well positioned to play a vital role in ensuring preschool children receive a high‐quality preschool curriculum to prepare them for later literacy learning. Aims: The purpose of this study was to explore early career ECTs' views and confidence regarding their role in providing preschoolers with oral language and emergent literacy support and to examine their perceptions of their preservice preparation. Methods & Procedures: Nine Australian early career ECTs were recruited via purposive sampling for an in‐depth, semi‐structured interview. Data were analysed using an inductive thematic analysis approach. Outcomes & Results: Participants attached strong significance to their role in facilitating children's oral language growth and emergent literacy skills and reported a range of practices to support children's learning. However, they rarely referred to using established language facilitation strategies or using dialogic book reading prompts. Further, emergent literacy concepts such as phonological awareness and print awareness were not routinely described as features of participants' classroom activities. Participants did not consistently make a clear conceptual distinction between the constructs of oral language and emergent literacy and often used these terms interchangeably. Notably, participants indicated that they did not feel confident in their ability to identify preschool children who were not meeting developmental language milestones and reported that they felt poorly equipped to do so by their preservice training. Conclusions & Implications: ECTs' strong willingness to support preschool children's oral language and emergent literacy skills may be hindered by gaps in their knowledge; these may contribute to important and missed opportunities for identifying and supporting preschoolers' oral language and emergent literacy growth. What this paper adds: What is already known on this subject?: High‐quality learning experiences in preschool are important for maximising preschoolers' oral language and emergent literacy growth. Early childhood teachers can play an important role in facilitating this development and preparing children for later literacy learning. What this paper adds to existing knowledge?: The study findings provide insight into ECTs' perceptions of their role and support in developing children's oral language and emergent literacy skills. The results indicated ECTs did not feel confident with their knowledge of children's language milestones or identifying children with language difficulties. Participants reported that their preservice training left them underprepared in the area of oral language. What are the potential or actual clinical implications of this work?: ECTs demonstrated a strong willingness to support preschoolers' oral language and emergent literacy skills. However, their self‐reported knowledge gaps and low confidence may have implications for the early detection of children who are not reaching language developmental milestones in a timely way. [ABSTRACT FROM AUTHOR]

Objective: The coronavirus disease 2019 (COVID-19) pandemic precipitated a major shift in the use of telehealth in Australia. The changes highlighted gaps in our knowledge regarding the efficacy of, and clinician attitudes to, the use of telehealth. The current study expands and deepens the available evidence as a result of being collected in unique circumstances that removed one of the major barriers (lack of Medicare rebates) and also one major enablers (willingness) of telehealth uptake. Methods: Using a semi-structured interview, we invited clinicians (N = 39) to share their perspectives, attitudes and experiences of using telehealth. Topics covered included perceptions of the strengths and challenges of telehealth, and how experience of using telehealth during the COVID-19 pandemic had influenced clinicians' views and intentions regarding their future practice. Participants included clinicians from five disciplines across public and private practice: paediatrics, neurology, immunology, rural general practice, and orthopaedics. Results: We found three key dimensions for consideration when assessing the suitability of telehealth for ongoing practice: the attributes of the patient population, the attributes of the clinical context and environment, and the risks and benefits of a telehealth approach. These findings map to the existing literature and allow us to infer that the experiences of clinicians who previously would have chosen telehealth did not differ significantly from those of our 'pandemic-conscripted' clinicians. Conclusions: Our findings map clearly to the existing literature and allow us to infer that the experiences of the clinicians who have chosen telehealth (and are already represented in the literature) did not differ significantly from those trying out telehealth under the unique circumstances of the removal of the Medicare Benefits Scheme barrier and external pressure that over-rides the 'willingness' enabling factor in uptake decisions. What is known about the topic? Clinician and patient experiences of telehealth use have already been documented in contexts where both clinician and patient have opted-in to that process. What does this paper add? The paper adds data on clinician experience across a range of specialities, from a context (pandemic public-heath measures) where the choice element was reduced for both patient and clinician. What are the implications for practitioners? The data speak to the generalisability of existing evidence, but also provide practical considerations in planning for the inclusion of telehealth for specialist health services in the Australian context. [ABSTRACT FROM AUTHOR]

Objectives: The study investigated how senior residential aged care staff perceived the purpose, function, impact and challenges of implementing a new role in their organisation for an unregistered care worker with a Bachelor of Dementia Care: the Dementia Care Support Worker. The role was piloted over two years in an Australian organisation with three aged care facilities to examine its potential to address gaps in service provision for people with dementia. Background: The residential aged care workforce is under pressure to care for residents with increasingly complex health conditions and where most care is provided by care workers. Presently no formal leadership role exists for care workers with specialised dementia knowledge in the aged care setting. Study design and methods: A qualitative descriptive approach was taken to explore senior staff members' perceptions of the role at two time points. Twenty-three semi-structured interviews held in July-August 2017 (n = 12), soon after role commencement, and in February-March 2019 (n = 11) were thematically analysed. Results: Three themes reflected senior staff members' expectations of the role: enhancing staff and management knowledge about dementia and dementia care practices; facilitating changes to improve care for residents living with dementia; and educating and supporting residents' families. Eighteen months later, participants felt the role was helping meet the need for improved care of residents with dementia, and staff understanding of dementia. They suggested communication and support structures to improve role effectiveness. Discussion: Staff were receptive to the establishment of the Dementia Care Support Worker role and felt it resulted in improvement in dementia care. Success was contingent on strong organisational support and resourcing. Conclusion: Improving dementia knowledge of care staff is an essential first step in driving care quality improvements. The Dementia Care Support Worker role for care workers has the potential to address knowledge needs and support improved care practices. Implications for research, policy, and practice: This research models how a new role might be configured for unregistered care workers with specialist dementia knowledge. Further research is needed to explore the establishment of such a role more widely in other organisations, to investigate whether it could provide a new career development pathway for care workers and improve the skills and capacity of the aged care workforce. Substantial policy changes would also be required to support role viability, such as around increased salary. Research which examines the impact of such roles on care outcomes would complement the findings. What is already known about the topic? • While dementia is common in residential aged care, knowledge of dementia is typically low among the care staff. • Consequently, care staff are not equipped to meet the complex needs of residents with dementia and their families. • New roles for unregistered care workers with specialised dementia knowledge have been proposed, but not tested. What this paper adds • This research models how a new role might be configured for care workers with specialist dementia knowledge. • Aged care facility leaders support a role for care workers with formal specialist dementia knowledge and skills, and perceive the role helps improve the quality of resident care and develop stakeholders' dementia knowledge. • Appropriate communication and support structures are required for the effective establishment of the role. [ABSTRACT FROM AUTHOR]

COVID-19 vaccination is particularly challenging among populations who have experienced discrimination in healthcare settings. This paper presents qualitative findings from in-depth interviews about COVID-19 vaccination conducted in Australia between October 2020 and November 2021. Data from four different studies are presented; each population has unique experiences of discrimination within the healthcare system: Aboriginal people; people who inject drugs (PWID); people living with HIV (PLHIV); and gay and bisexual men (GBM). Analyses were guided by the behavioural and social determinants model that forms the basis of the World Health Organization's "data for action: achieving high uptake of COVID-19 vaccines" interim guidance. All populations viewed vaccination as necessary for community protection, although narratives of community care were most common among Aboriginal people. Concerns about vaccine safety were expressed by all participant groups, although participants living with HIV and GBM were more trusting of vaccines possibly because of their ongoing and usually positive past experiences with biomedical technologies for HIV management and sexual health. Aboriginal participants reported distrust of mainstream government and participants who inject drugs expressed a more generalised suspicion about COVID-19 and its origins. Practical problems related to transport, booking appointments for vaccination and so forth, were more common among participants living with HIV and GBM, possibly because these specific interviews were conducted throughout 2021 when vaccines were more available, whereas data for the other populations were collected before the vaccine rollout. Findings show that vaccine willingness is shaped by past experiences of discrimination in healthcare setting, but different histories of discrimination can differently impact vaccine willingness. Promotional messaging and delivery must take account of these important differences so to not treat these populations homogenously. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this paper is to report on enablers and barriers during the first 2 years of the health systems integration project that included the implementation of a health navigator role. The project aims to improve health outcomes for children and young people residing in out of home care in rural Australia with a health navigator co‐located between child protection practitioners and community health services clinicians. Setting: Rural Northwest Victoria. Participants: Sunraysia Community Health Services and the Department of Health and Human Services. Design: The qualitative design of the project evaluation involved semi‐structured interviews and documentary evidence analysis. Analyses of interviews and documentary data demonstrate the challenging nature of siloed service delivery in rural Australia, particularly during a time that comprised multiple interruptions due to COVID‐19. Results: A limited synergy between organisational priorities and reporting systems hindered project progress. The lack of a shared definition of 'health' challenged the effective collaboration between health clinicians and child protection practitioners and the role of the health navigator. The health navigator raising health awareness through project involvement, training and sector‐wide stakeholder engagement resulted in a slow but steady process of increased prioritisation of health care, increased health literacy among the child protection workforce, and broadening participation of area‐based stakeholders, but did not translate to increased access to health plans for children. Conclusion: Integrating health systems across multiple sites with support of a health navigator revealed difficulties, particularly during COVID‐19. The first phase of the project demonstrated the value of shared governance and partnerships as an imperative foundation for fundamental change. Relationships strengthened throughout the project, leading to a better understanding of area‐based strengths, which in turn supports improved pathways to health care for children and young people in OOHC within rural communities and driving the subsequent phases of the 10‐year project. [ABSTRACT FROM AUTHOR]

Background: The majority of allied health services are delivered by small, private practices in the primary care setting with limited government funding. During the coronavirus disease 2019 (COVID-19) lockdowns these practices were subject to the same health orders as any other private business with only 'essential services' permitted to remain open. Research aim: We set out to understand the impact of the COVID-19 pandemic, and associated public health measures, on the financial viability of private allied health practices. Methods: Thirteen semi-structured interviews were conducted with primary care allied health practice owners and managers in Sydney. Data were analysed thematically. Findings: All of the interviewees reported experiencing the stress of balancing precarious finances caused by reduced and/or fluctuating patient demand. Patients' reluctance to seek care was compounded by ambiguity around whether allied health services were 'essential'. Manual therapies were particularly vulnerable to financial stress because their capacity to transition to telehealth and access to government funding were limited. Conversely, psychologists reported demand for their services exceeded what they could provide. Study implications: The findings are indicative of primary care allied health's peripheral status in Australia's primary care landscape. Greater priority to the funding and integration of primary care allied health is needed in primary care policy. What is known about the topic? Most allied health services in Australia are delivered by small, private practices in the primary care setting with limited government funding. What does this paper add? The findings indicate that allied health has a peripheral status in Australia's primary care landscape. What are the implications for practitioners? Greater priority to the funding and integration of allied health is needed in primary care policy. [ABSTRACT FROM AUTHOR]

This paper aims to develop a sensory methodological framework to explore older user's landscape experience. Applying empirical experience in Australian aged-care facilities, it addresses a methodological gap in the current literature to help move beyond the current taken-for-granted approaches such as interviews, cognitive mapping, behavioural observation and visual methods. We propose a more holistic method which enables the exploration of older people's in situ environmental experience. The multisensory framework we propose here is based on the first author's doctoral fieldwork experience that took place in two aged-care facilities in Brisbane, Australia. Findings suggest this framework facilitates an understanding of users' olfactory, auditory and visual responses to the physical environment, and promotes a deeper engagement with the landscape. We argue that this is essential to promoting good landscape design which genuinely connects with older people's needs. [ABSTRACT FROM AUTHOR]

Female genital fashioning practices, a term encompassing a range of temporary and permanent options for cosmetic genital alteration, are becoming an increasingly prominent part of contemporary beauty regimes. Drawing on a series of 11 small focus groups and 10 interviews with 34 Australian women aged 18–30, this paper explores the ways that cisgender young women negotiate a combination of social pressures, pleasures and influences in their decisions to engage with genital fashioning. These pressures are described by women to emanate from broad social norms, sexual partners, family members, and peer groups. The women in this study demonstrate a nuanced and critical awareness of the cultural context which they inhabit but deploy postfeminist narratives of self-care and enjoyment to make sense of genital fashioning practices. The paper contributes to scholarship on postfeminism by demonstrating the ways that women creatively use the discursive tools available to enable critical reflection on notions of choice. At the same time, the findings in this study constitute an empirical contribution to critiques of postfeminism to reveal the limitations of postfeminist reasoning which ultimately works to curtail or impede the identification of structural problems and constraints. [ABSTRACT FROM AUTHOR]

Background: Speech and language therapists (SLTs) use videofluoroscopic swallow study (VFSS) results to manage dysphagia. Yet, in some services only doctors can directly request a VFSS, potentially creating workflow inefficiencies and delaying patient access to VFSS. An alternative model, where SLTs directly refer patients for VFSS, is used in many services in the UK and Australia. However, processes for implementing and sustaining this model have not been reported. Aims: To evaluate the implementation of an SLT‐led inpatient VFSS referring model using the Consolidated Framework for Implementation Research (CFIR) to ascertain implementation barriers, facilitators and critical sustainability factors. Methods & Procedures: This implementation evaluation examined stakeholder perceptions of implementing the SLT‐led VFSS referring model via interviews of (1) SLTs who treat and refer inpatients for VFSS; (2) doctors who manage and refer inpatients for VFSS; (3) radiologists; and (4) trained VFSS referring SLTs. The CFIR was used to prospectively guide implementation planning, evaluation and outcome reporting, regarding barriers, facilitators and sustainability factors. Outcomes & Results: Implementation facilitators were (1) the advantage of SLT‐led VFSS referring over the standard model (doctors referring), in promoting high‐quality VFSS referrals; (2) compatibility of the model with the SLT skill set; (3) supportive communication networks between staff groups; and (4) engaging stakeholders throughout implementation. Adequate availability of trained VFSS referring SLTs was both a barrier and a facilitator of implementation. It was also a critical sustainability factor, along with ongoing staff education and outcome monitoring. Conclusions & Implications: The CFIR supported systematic evaluation of implementation facilitators and barriers, and adjustment of factors critical for implementing and sustaining the new model. Findings may assist other organizations to establish the SLT‐led VFSS referring model. What this paper adds: What is already known on the subject: Models where SLTs directly refer patients for VFSS have been described in the literature, with evidence of appropriate referrals and adherence to radiation safety standards. However, the process for establishing and sustaining this referring model has not been published. What this paper adds to existing knowledge: This study describes the process and outcomes of implementing an SLT‐led VFSS referring model, using the CFIR. A key advantage of the new model that facilitated implementation was the improved quality of VFSS referrals compared with the standard referring model. Important facilitating factors in the environment were the compatibility of the model with SLTs' skillset and supportive communication network between doctors and SLTs. Initially, an implementation barrier was the inadequate availability of trained SLT referrers. Using proactive implementation strategies, more referrers were trained (which was a facilitating factor for implementing and sustaining the model). What are the potential or actual clinical implications of this work?: This study highlights that successful implementation requires more than just an effective model. Features of the environment require consideration to minimize barriers and optimize facilitating factors, supported by proactive implementation strategies. Planning and evaluating implementation processes and outcomes using a standardized implementation framework such as CFIR aided understanding of barriers and facilitators for introducing the SLT‐led VFSS referring model. This process may assist other services to implement the model. [ABSTRACT FROM AUTHOR]

Objective: To explain how the Primary Health Network commissioning model works, and factors likely to affect its success. Methods: The study focuses on the delivery of primary healthcare services by one Primary Health Network (PHN) in Australia. The qualitative case study is informed by a desk top review, interviews (n = 49) and observations with key stakeholders involved in commissioning and delivering primary healthcare services in the region. Results: The study provides several insights about the PHN model. First, conceptually, the PHN commissioning model is well suited to identifying and meeting local primary healthcare priorities, bringing together a range of stakeholders involved in healthcare provision. Second, although primary healthcare services are difficult to specify and measure, PHN staff use their content knowledge and experience, and relationships with providers and the community, to design services that meet the needs of consumers. Third, the success of this model may be undermined by short funding cycles and short lead-times, a focus on national rather than local priorities, and continual reductions in operational funding. This may result in more procedural forms of contract management, which may mean that changes in service need, provision and quality go unnoticed. Conclusions: This study shows that although clever in design, the PHN model may not meet its full potential. Given continual changes to the model, including funding, further independent research should be undertaken to understand how PHNs adjust and whether services continue to meet the needs of the local community. What is known about the topic? Primary Health Networks commission a range of services. Little is known about how the commissioning model works and what enables its success. What does this paper add? While elements of an effective model exist, this paper finds that the its effectiveness is contingent on stability, funding cycles, and sufficient resources to manage contracts. What are the implications for practitioners? This paper identifies the risks to the effective implementation of commissioning and how they may be addressed. [ABSTRACT FROM AUTHOR]

Common depictions of buying and selling illicit drugs online centre on how drug market actors engage in dark web drug cryptomarkets, but the supply of illicit drugs also takes place in 'plain site' on the surface web. Drawing on netnographic observations and qualitative interviews with hard-to-reach buyers and vendors (n = 20), this paper explores LeafedOut, a specific, popular surface web platform, that provides a conduit for local cannabis exchanges. We found that the platform enabled easy access and supply at the local level but increased some specific risks to those involved. Actors neutralised the perceived risks of drug supply over this surface web platform through the broader societal normalisation of cannabis use/supply, adopting encrypted messaging applications to cover 'digital traces', and developing various methods to establish trust with an exchange partner (e.g. review systems, sending selfies with drug paraphernalia, selectively choosing meet-up locations). This paper expands our understanding of the growing number of online illicit drug markets by shifting attention from dark web cryptomarkets to the much more widely accessed surface/clear web. Theoretical implications for the study of trust and risk in online illicit drug market exchanges are also considered. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the suitability and acceptability of virtual training post accreditation visits conducted online for medical specialist training in ophthalmology in Australia and New Zealand. Methods: A two-phase study (pilot and implementation) was conducted. In the pilot phase, an open-ended observation proforma was used by the authors to independently record their observations, which were later compared and discussed until consensus was achieved. All participants were asked to complete an online survey. A document analysis of accreditation documents was conducted. Observation data were broken down into themes and triangulated with online survey and document analysis results. In the implementation phase, the inspections were observed by one of the authors (SK) and the observation notes were discussed with other authors to obtain a contextual and consensual view. A document analysis of all accreditation-related documentation was undertaken. The documents included in the document analysis were planning and scheduling records, interview and inspection notes, training post inspection fact and document notices and accreditation reports. Finally, a post-inspection focus group of all inspectors was conducted. Results: The accreditation interviews adequately addressed all relevant issues with high levels of robustness and reliability. Participants found it more difficult to discuss complex issues virtually compared with onsite visits. The virtual accreditation reports were not any different to what would be expected if a face-to-face accreditation visit had been conducted; however, it was not possible using the virtual inspection to determine the appropriateness of facilities and clinic layout to support and facilitate trainee learning and supervision. Conclusions: Virtual accreditation of training posts in medical specialist training is viable in limited circumstances where there are no known complex training post-related issues and the site has not made substantial changes to clinic and theatre layout, equipment and facilities since the previous accreditation. What is known about the topic? All medical specialist colleges in Australia and New Zealand accredit the sites where training is delivered, usually by conducting periodic face‐to‐face visits. What does this paper add? This paper provides evidence that in limited circumstances, it is possible to accredit training posts virtually. What are the implications for practitioners? This paper provides an outline of issues to consider when planning virtual accreditation of training posts in medical specialist education. [ABSTRACT FROM AUTHOR]

In a study on children, families and food messages in Victoria, Australia, we utilised a multi-methods approach that included visual data produced by primary-school aged children. Working with 50 families, we provided each child investigator with an iPad for 3–4 days and invited them to photograph family food events important to them. The analysis of visual data alongside child and family interviews revealed the diverse meaning-making practices children draw on to understand food practices at home and school. These research practices aspired to locate the researchers and children as co-creators. In this paper, we reflect on the challenges and (dis)comfort we faced as researchers as the implications of co-creation emerged and we engaged with children's voices, photos and families inside their homes. The multi-methods approach supported a comprehensive and rich engagement with commensality and pleasure in food practices at home for children, but illuminated the complex emotional and intellectual terrain of such research practices. [ABSTRACT FROM AUTHOR]