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Background: Mental illness is a public health challenge disproportionately affecting rural Australians. GPs provide most of the mental health care, and they report increasing levels of burnout and unsustainable workload in the context of increased patient complexity. This may be more salient in rural settings characterised by resource constraints. In this paper, we use evaluation data from a GP psychiatry phone line established in Western Australia's Great Southern region in 2021 to describe GPs' perspectives on the service and reflect on how it may help alleviate rural GP workload. Methods: The sample was recruited among GPs practicing in the region. Data were collected through an online survey and semistructured interviews. Descriptive statistics were used to analyse the survey data. Interview data were subjected to thematic analysis; qualitative survey data were used for triangulation. Results: A total of 45 GPs completed the survey and 14 were interviewed. Interview data yielded three themes: the criticality of timeliness; the building blocks of confidence; and trust. GPs were highly satisfied with the service, and timeliness and trust were the characteristics underpinning its effectiveness. The service built GPs' confidence in managing mental health and alcohol and other drug use issues through strengthening knowledge and providing reassurance. Conclusions: Our results suggest that a telephone line operated by trusted, local psychiatrists with knowledge of the local mental health ecosystem of support can reduce rural GP workload through building confidence and strengthening personal agency, helping GPs navigate the ethical and clinical labyrinth of managing patient complexity in rural settings. GPs provide most of the mental health care and deal with an increasing number of patients with complex problems; this is more acute in rural areas where there are fewer services. This paper shows how a rural GP psychiatry phone line operated by local psychiatrists helps GPs manage their patients' mental health problems and may, in turn, reduce the workload rural GPs experience. The results add to the limited evidence and have implications for other rural locations characterised by limited resources. [ABSTRACT FROM AUTHOR]

Background: The study explored the experiences and perceptions of GPs regarding the management of chronic non-cancer pain (CNCP). Specifically, participants were asked to identify perceived enablers and barriers to CNCP care and how the care of patients with CNCP may be improved. Methods: The study utilised a qualitative descriptive methodology. General practice in Western Australia. The sample was purposive with 12 Australian GPs from predominantly metropolitan locations and with experience in managing CNCP. Semi structured interviews were conducted. Each interview was of 45–60 min duration. All interviews were audio recorded and transcribed using a secure transcription service. Thematic analysis developed themes inductively and deductively. Results: Themes emerged regarding: the importance of a holistic and personalised approach; the important role of a coordinating GP; the need for an evidence-based approach to opioid management; concerns relating to access to multidisciplinary services; the importance of clinician and patient education regarding CNCP; and an acknowledgement of the challenges for doctors and patients in managing CNCP. Conclusions: Currently, the management of CNCP in Australia is challenging. Notable challenges include: difficulties with continuity of patient care; challenges with patient expectations of treatment, in particular opioid medications; difficulty with access to the health services required to enable holistic care; and the need for improved pain education in the community. The breadth of these challenges suggests there is a need for supportive organisational and structural considerations in the healthcare system to enable optimal care of CNCP in the community. Access to specialist services for chronic non-cancer pain is problematic ins In Australia, resulting in general practitioners bearing much of the burden of care that requires a holistic and multidimensional approach. In this paper, 12 general practitioners in Western Australia described, through qualitative interviews, the challenges of caring for patients with chronic pain including fragmentation of care, difficulty with access to recommended services, mismatched patient and practitioner expectations and inadequate GP and community knowledge about chronic pain. These findings could assist in planning better services for chronic pain. [ABSTRACT FROM AUTHOR]

While there is growing recognition of the importance of meaningful youth participation in activities and decisions which impact their lives, facilitating such engagement within different forums requires varied approaches. A programme of youth research at one Western Australian university has sought to embed pathways for ongoing youth participation in longitudinal research. In particular, we discuss Navigating Through Life, a large‐scale WA research project comprising three sub‐studies exploring young people's transitions from out of home care (OOHC) to independence. We established a youth advisory group to run alongside the project and employed peer researchers to conduct research tasks. In this paper, we seek to explicate the development and various iterations of youth participation in the project. We utilise our reflections, interview data and documentation from YAG meetings and feedback sessions with the peer researchers to illustrate the processes of transformation and flexibility required to develop and maintain youth participation in various ways across the project's life. Drawing on our findings and current literature, we highlight how funding bodies and researchers must consider the additional needs, unique and changeable life circumstances of young people to best facilitate their involvement in research. [ABSTRACT FROM AUTHOR]

Background: : Group singing for people with Parkinson's disease (PD) is an established intervention not only to improve voice and speech difficulties but also for emotional and social benefit. Less is known about the experiences of group singing on the couple—the person with PD and their spouse or partner together—and studies have not specifically tracked impact through time or in combination with songwriting. Aims: : To understand the impact of group singing/songwriting on couples (participants with PD and their spouses) to unpack whether this broader view might help explain why such interventions are reported as beneficial. Using a trajectory approach, a form of longitudinal research and focused ethnography, the research sought a deeper appreciation of participation through time for the couple in a singing/songwriting group. Methods & Procedures: : Four couples attending a singing/songwriting programme were observed for 10 weeks, and interviewed formally and informally weekly. Data were analysed thematically across‐case through framework analysis but also within‐case to explore the couples' experiences and narratives over time. Outcomes & Results: : The theme of 'improved relationships' between the couples was new and extended previous studies' findings of positivity, physical benefit, sense of self and social opportunity. The stories of each couple highlighted the importance of musical reminiscence and emotional respite, and demonstrated changes with time through the singing and songwriting group. Conclusions & Implications: : The benefits of offering singing/songwriting groups may be felt not only by participants with PD but also by their spouses/partners even if they choose not to attend themselves. Such benefits may include improved relationships related to the shared joy of music, musical reminiscence and emotional respite. The addition of songwriting encourages creativity and agency. A longitudinal trajectory approach is one way to appreciate how these benefits may unfold over time for participants. WHAT THIS PAPER ADDS: What is already known on the subject: Group singing for people with PD has been shown to have physical, emotional and social benefits as measured on mainly pre‐post‐assessments of vocal, speech, respiratory function and quality of life questionnaires. What this study adds to the existing knowledge: This study adds three new aspects: studying the benefits for the couple (both people with PD and their spouse/partner); taking an in‐depth focused ethnographic approach over time to collect couples' narratives and experiences; and exploring the potential for adding songwriting to the intervention. What are the potential or actual clinical implications of this work?: A qualitative trajectory approach may help clinicians understand why such interventions are experienced as beneficial. Clinicians running singing groups for people with PD should offer attendance to spouses/partners because of the potential for such groups to improve relationships and build new points of connection for the couple, as well as provide peer support for spouses. Songwriting is a useful addition for creativity, cognitive flexibility and self‐expression. [ABSTRACT FROM AUTHOR]

Objective: To explore the experiences of close family members when another family member is using methamphetamine and how the family member responds over time. Background: Methamphetamine use has widespread implications and harms for both people who use the drug and those that live with them. While there is a significant representation in the literature relating to family members of people who use drugs or alcohol, there are limited studies specifically considering family members experiences of methamphetamine use. Families have been shown to have both positive and negative impacts on people using drugs, but less is known on the impact on the family members themselves. Study design and methods: Multiple semi- structured qualitative interviews were conducted with 11 families (17 individual participants) from regional and metropolitan Western Australia over a 12-month period. Interpretative Phenomenological Analysis was used in data collection and analysis. Results: Four main themes were identified: 1. the New Lifeguard describes family members' unplanned insertion into a new role and their rapidly changing experience of the person using methamphetamine. 2. Hit by the Wave demonstrates participants' experience of repeated and unpredictable impacts on their lives. 3. Life in the Ocean describes the groundlessness associated with changes to goals and family structure. 4. Learning to Surf illuminates the changing strategies employed over time, moving away from trying to fix the person, to participants managing their own wellbeing. Discussion: This study identified common aspects within the lived experience of close family members of people using methamphetamine and ascertained a commonality in the process of this experience. Significant impacts to all areas of life were reported, and distress was fluctuating and unpredictable in line with the cyclical nature of the drug use. Participant responses to these changes varied over time between resentment and trying to fix things, and acceptance and resilience, while gaining or maintaining like-minded supports. Conclusion: Understanding the issues faced by families around this unique drug is vital in providing informed interventions for this group. Family members experience a broad range of financial, social and health impacts and harms over a protracted length of time. They are often not the focus of available support and in adapting to these issues, will themselves seek support away from treatment services for the person using methamphetamine. Implications for practice Understanding the complex journey of families has a broad range of implications (and opportunities) for a variety of areas such as criminal justice, family support and child protection. There is an opportunity for these areas to consider broader and more specific supports and approaches, and to develop more appropriate, bespoke, and inclusive treatment for families of people using methamphetamine. What is already known about the topic? • Methamphetamine is recognised worldwide as a harmful drug with few effective treatments for methamphetamine dependence. • Few studies exist exploring the specific impact of methamphetamine on family members. • Fewer studies explore the experiences over time. What this paper adds: • Family members with a relative who is using methamphetamine experience a range of harms in many areas of their lives. • The impact of methamphetamine use is unpredictable and takes place over long periods of time, affecting both individual family members and impacting on the overall structure of the family unit. • Families and family members adapt their approach over time, from attempting to fix the situation, to stepping back and seeking support from others who they perceive to be in similar circumstances. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? The rate of mental illness in the general population is ever increasing, Mental health nurses are ageing, and this is not a preferred career for new graduates; thus, recruitment and retention of mental health nurses is declining, Stigma is attached to the view of mental illness and the role of a mental health nurse. If this stigma can be reduced, it may provide an opportunity for the profession to become more popular and assist recruitment in this area, What the paper adds to existing knowledge? Previous research has focused on why mental health nurses leave the profession which has not provided successful results, This study adopts a new way of working whereby we gathered opinions from current mental health nurses focusing on why they originally wanted to work in mental health, What are the implications for practice? New findings presented in this paper will guide improvements in nurse training, policy development for mental health services and improve recruitment of the next generation of mental health nurses, The findings provide a strong message that in order to entice others to work in mental health, we need to first address breaking down the stigma related to mental health nursing, Abstract Introduction A lack of understanding surrounding the role of mental health nursing is associated with recruitment and retention challenges. Additional complexities include stigma related to the role, an ageing workforce and dearth of graduates keen to pursue this career. Scientific Rational Previous research has focused on why nurses leave the profession which has not provided necessary solutions. There is a need to instead explore why nurses originally chose a career in mental health. Aim of study This qualitative study focused on opinions and experiences of existing mental health nurses to determine what could be performed to entice nurses to choose mental health. Methods A cross-sectional design involving a brief interview was conducted with 192 Western Australian nurses from one public mental health service. Results Thematic analysis revealed an overarching theme 'breaking down stigma' and additional themes of: 'visibility of mental health nursing' and 'growing mental health nursing.' Subthemes under 'visibility' included 'self-promotion' plus 'industry and university promotion,' whereas subthemes related to 'growing' focused upon 'improving the student experience.' Finally, 'recognizing the mental health specialty' was identified for an attractive career pathway. Discussion This study adds to international evidence and showcases unique insights from mental health nurses into why they chose a career in mental health whilst previously replicated research focused on why nurses chose to leave. Implications for practice Findings suggest that before we can entice nurses to choose mental health, there is urgency to reduce stigma related to the role. 'Breaking down stigma' will allow the role to become more visible and be represented in a more positive authentic manner. New findings in this paper will drive improvements of future nurse education, policy planning and recruitment design for the next generation of mental health nurses. [ABSTRACT FROM AUTHOR]

Background/aim:People with severe mental illness (SMI) do not receive adequate attention in research or clinical practice. They are considered hard to reach and difficult to engage. Information is needed to help provide support for this vulnerable population. This paper aims to investigate the well-being of adults diagnosed with SMI and receiving Assertive Community Treatment (ACT) by applying the occupational well-being framework to the everyday activities of this vulnerable group of people. Materials and methods:Eleven adults diagnosed with an SMI, living in the community, participated in semi-structured interviews over a 12-month period. A longitudinal design was used to collect data through using field notes and audio recordings. For this paper, secondary analysis was conducted by coding the data deductively thereby investigating the participants’ experiences in relation to the seven Occupational Well-being framework descriptors (accomplishment, affirmation, agency, coherence, companionship, pleasure and renewal). Results: Participants’ everyday activities and occupational well-being appeared severely restricted and largely determined by the type of care they received. There was minimal evidence of the well-being descriptors, though all the participants reported experiencing some form of pleasure, even though some of the pleasurable experiences negatively impacted their health. Conclusion/significance:The episodic nature of SMI means that people living with an SMI require continuity in key relationships and support to achieve Occupational Well-being. Occupational therapists working with mental health consumers need to facilitate the types of activities that foster well-being through accomplishment, affirmation, agency and companionship, and that derive pleasure in healthy and positive ways. [ABSTRACT FROM PUBLISHER]

Perioperative nurses assist in organ procurement surgery; however, there is a dearth of information of how they encounter making conscientious objection requests or refusals to participate in organ procurement surgery. Organ procurement surgical procedures can present to the operating room ad hoc and can catch a nurse who may not desire to participate by surprise with little opportunity to refuse as a result of staffing, skill mix or organizational work demands. This paper that stems from a larger doctoral research study exploring the experiences of perioperative nurses participating in multi-organ procurement surgery used a grounded theory method to develop a substantive theory of the nurses' experiences. This current paper aimed to highlight the experiences of perioperative nurses when confronted with expressing a conscientious objection towards their participation in these procedures. A number of organizational and cultural barriers within the healthcare organization were seen to hamper their ability in expressing a conscience-based refusal, which lead to their reluctant participation. Perioperative nurses must feel safe to express a conscientious objection towards these types of surgical procedures and feel supported in doing so by their respective hospital organizations and not be forced to participate unwillingly. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to identify the hepatitis C treatment intentions of Aboriginal people living with hepatitis C virus (HCV) in Western Australia. Methods: This study used a mixed-methods design. In the cross-sectional survey, 123 Aboriginal people who inject drugs and self-report as living with hepatitis C completed a purpose-designed questionnaire. In the qualitative phase, 10 participants were interviewed about the factors influencing their future intentions to undertake hepatitis C treatment. Results: Analysis of the survey data revealed significant associations between an intention to undertake hepatitis C treatment and support, community attachment, stable housing and stigma. In addition, there was a high overall level of expressed intention to undertake HCV treatment, with 54% of participants responding positively. Analysis of the qualitative data supported quantitative findings, revealing concerns about stigma, lack of social support and unstable housing as factors affecting the intention to undertake hepatitis C treatment. Conclusion: This mixed methods study with Aboriginal people living with self-reported HCV indicates interventions focused on reducing stigma and unstable housing could positively affect hepatitis C treatment intentions. These findings have implications for developing holistic programs to promote and support people on hepatitis C treatment. What is known about the topic?: Substantial knowledge gaps need to be resolved if HCV elimination among Aboriginal Australians is to be achieved. Current research has prioritised non-Aboriginal communities. What does this paper add?: This study found that stigma and unstable housing require attention if Aboriginal Australians are to obtain the full benefits of direct acting antiviral (DAA) hepatitis C treatment. What are the implications for practitioners?: Reducing stigma (in the primary healthcare setting) and providing access to stable housing are vital components of supportive, non-judgemental and culturally appropriate care for Aboriginal people. This study highlights the importance of education for nurses and other primary care providers to increase engagement in the hepatitis cascade of care. To achieve this, scaling-up of HCV treatment engagement, trained Aboriginal community healthcare workers and HCV treatment advocates must mobilise and support Aboriginal people to avoid the negative effects of stigma, build positive and enabling relationships and reinforce positive attitudes towards DAA hepatitis C treatment. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to explore Western Australian cancer patients' experiences of out-of-pocket expenses (OOPE) during diagnosis and cancer treatment using a phenomenological approach. Methods: Semi-structured interviews were conducted with a purposive convenience sample of 40 Western Australian cancer patients diagnosed with breast, lung, prostate or colorectal cancer. Participants were asked about the impact of their diagnosis, the associated costs and their experience within the health system. Data were analysed using thematic content analysis. Results: Three key themes influencing participant OOPE experiences were identified: (1) personal circumstances; (2) communication with health providers; and (3) coping strategies. Despite Australia's public healthcare system, several participants found the costs affected their financial security and resorted to coping strategies including medication rationing and restrictive household budgeting. The key themes had a complex and interrelated effect on patient OOPE experiences and were used to adapt Carrera et al. 's model of economic consequences of cancer treatment on the patient and patient coping to describe these relationships in a mixed healthcare system. Conclusion: Organised efforts must be implemented to mitigate maladaptive coping strategies being used by cancer patients: (1) health providers should seek informed financial consent from patients before commencing treatment; and (2) financial aid and support schemes for cancer patients should be reviewed to ensure they are delivered equitably. What is known on this topic?: The financial cost of cancer can have significant adverse effects on cancer patients. Although financial transparency is desired by cancer patients, its implementation in practice is not clear. What does this paper add?: This study adapts a conceptual model for the economic consequences of a cancer diagnosis and repurposes it for a mixed public–private health system, providing a framework for understanding downstream consequences of cancer costs and highlighting opportunities for intervention. What are the implications for health practitioners?: Health practitioners need to initiate discussions concerning treatment costs earlier with cancer patients. There are several resources and guides available to assist and facilitate financial transparency. Without urgent attention to the financial consequences of cancer treatment and related expenses, we continue to leave patients at risk of resorting to maladaptive coping strategies, such as medication rationing and restrictive household budgeting. [ABSTRACT FROM AUTHOR]

Sexual health promotion and Relationships and Sexuality Education (RSE) are influenced by interrelated social and cultural factors, particularly in a rural setting. This paper reports on findings from interviews with young people when asked about experiences and perspectives accessing RSE and sexual health services in a small rural Australian town. Fifteen young people (16–24 years) participated in semi-structured focus groups and interviews. Data was analysed and coded with four key themes emerging: relevant and credible sexual health education; make it easy; GP accessibility; and discreet condom supply. The findings of this study have practical implications when addressing community level sexual health and RSE needs. [ABSTRACT FROM AUTHOR]

The need for all people with disability to have access to reliable information before they can make informed choices in individualised funding programmes is well documented. However, little guidance exists on how information can be provided to ensure it reaches its target audience. While information provision is important everywhere, there is a pressing need in the Australian context to ensure all people have access to information as the National Disability Insurance Scheme is designed and introduced. The authors identified key principles of information provision documented in the literature and used these to analyse their data from Australian studies of individualised funding programmes. The data came from 143 transcripts and records of interview in five studies conducted from 2011 to 2013. The analysis confirmed the importance of the principles previously documented and identified two additional principles, these being related to gender and ‘hard to reach’ groups. This analysis informs a new framework to increase equity and improve people’s access to information in individualised funding programmes. Information needs to be: (i) accessible and diverse in format, mode, source and location; (ii) personalised and targeted; (iii) accurate, consistent and timely; (iv) from a trusted source; (v) independent; (vi) culturally appropriate; (vii) actively promoted to ‘hard to reach’ groups and (viii) gender appropriate. This paper provides a new framework to guide information in individualised funding programmes for professionals in roles ranging from policy makers to service delivery. [ABSTRACT FROM AUTHOR]

Aim This paper acknowledges the relationship between resilience and the new managerialism of contemporary nursing. Methods Qualitative portraiture methodology. Discussion The new managerialism in hospital settings results in a rapidly increasing turnover of acutely ill or comorbid patients, which directly relates to retention and quality service. In education settings, the management imperative to recruit more students into the profession combined with financial cutbacks leads to similar tensions. In aged care the trend equates care directly with funding, with the same effect. Yet despite this, many registered nurses remain working. Portraiture explored 'why' nurses remain in workplaces often described as awful. The resilience of nurses is seen through their stories and reframed to highlight resilience as a form of resistance to the new managerialism inherent in contemporary healthcare. Conclusion This paper describes some of the hallmarks of new managerialism where workforce pressures force practices that do not value the 'human resource'. Implications for nursing management The quotes from the field give insight into the nurse's world view and have implications for managers, educators and employers, as well as for consumers of nursing care. [ABSTRACT FROM AUTHOR]

Aim: To explore the health beliefs and health behaviours of older Vietnam‐born people living with chronic disease in Western Australia. Design: This study was designed as a focused ethnography guided by the interpretative research paradigm and Leininger's Theory of Culture Care. Methods: Data were collected through participant observation and interviews undertaken at participants' homes in Western Australia over 7 months in 2019. Data were analysed using Wolcott's approach for transferring qualitative data, comprising three phases: description, thematic analysis and interpretation. Results: This study included 12 participants. The health perspectives and practices of older Vietnam‐born Australians significantly reflected the traditional Vietnamese values. These included the stigma towards chronic disease as an inevitable consequence of ageing; self‐blame thoughts about chronic disease causations and maintained traditional dietary practices. However, some aspects of their health behaviours such as beliefs and practices in traditional medicine, Western medicine and physical exercise reflected a blended approach combining both Vietnamese‐oriented and Westernized‐orientated practices. Individual factors were also identified as contributing to chronic disease self‐care among participants. Conclusion: This study emphasizes culture played a significant role in shaping the way that older Vietnam‐born Australians believed and behaved while living with chronic conditions. However, it also indicates that culture is not a stationary concept, it evolves gradually and is socially constructed. Implications: A better understanding of the health beliefs and practices of older Vietnam‐born Australians is expected to contribute to the delivery of culturally safe and effective support for this population. The achievement of culturally safe care requires a systemic approach and collaboration of strategies across sectors. Patient and public contribution: This study encompassed the contribution of 12 older Vietnam‐born Australians who offered the researcher the privilege to enter their world and the staff of social care organization who opened the gate for the researcher to approach participants. [ABSTRACT FROM AUTHOR]

Survivorship is an under-recognized period in the care of women with breast cancer. This paper aimed to determine if supports provided by health services were adequate in meeting the expressed needs of women and partners during survivorship. A mixed-method study consisted of: (1) in-depth interviews with women (n = 18) and partners (n = 8) (completed June 2014–November 2014) and (2) a questionnaire with health providers (n = 34) (completed April 2015) regarding services offered, needs addressed, and barriers to service delivery. Both were completed in Perth, Western Australia. Findings were determined using thematic analysis and descriptive statistics. Many unmet needs were identified by women and partners, including: pain, fatigue, fear of recurrence, employment, leisure, and social and intimacy difficulties. Participants did not receive a formal plan to assist them. Health providers reported a range of supports, including cancer surveillance and management of physical, psychological, emotional, and relationship concerns. However, many barriers concerning service delivery were identified. Despite services reporting that they provided various supports, interview participants did not appear to use and benefit from these. Coordination of service delivery was identified as requiring improvement. The use of survivorship care plans also needs refinement to determine suitability for use during survivorship. [ABSTRACT FROM AUTHOR]

Young people experiencing first‐episode psychosis taking antipsychotic medications often develop comorbidities such as obesity and cardiometabolic abnormalities at an earlier age than young people in the general population. Therefore, it is important to explore the healthcare needs and experiences of this group of consumers. This paper reports research conducted to obtain an informed understanding of young people's health literacy, physical healthcare needs, and interest and knowledge about their physical health. Grounded theory methodology was used to guide the research. Semistructured interviews were conducted with 24 young consumers aged between 18 and 35 years who were case managed by one metropolitan community mental health service. The results describe the journey of young people from the time of diagnosis, to when they developed an awareness of the need to improve their physical health and the impact of physical health issues on their overall health and well‐being. Six categories emerged from the data: (i) initial responses when diagnosed with first‐episode psychosis; (ii) focus of care on treating first‐episode psychosis; (iii) lack of education on antipsychotic medications; (iv) adverse effects from taking antipsychotic medication; (v) increased awareness of the need for good physical health; and 6) importance of social support in the community. The findings highlight the importance for health professionals improving young people's health literacy and addressing physical health and well‐being as part of first‐episode psychosis programmes. Young people require improved health education on the importance of maintaining healthy lifestyle in relation to their overall health and well‐being. [ABSTRACT FROM AUTHOR]

Objective To explore the role of women in fishing industry organisations and communities in promoting best-practice health behaviours among fishers in Australia. Design This paper reports aspects of research that examined how the fishing industry can best support physical health and mental well-being of fishers. The study employed a mixed-methods, multisite case study approach. Data were gathered from face-to-face and phone interactions. Setting Two sites in Victoria and one in Western Australia. Participants Thirty-one male fishers, including commercial licence owners, skippers, deckhands, three female family members, three fishing association representatives, one local government representative, two health care providers, and three regional health planning and funding bodies. Interventions Not applicable. Main outcome measures Not applicable. Results Often unrecognised, women associated with the fishing industry are integral to the promotion of good health for fishers. They are key to identifying health issues (particularly mental health issues) and proposing community-based health and well-being strategies. They often do so by incorporating health information and activities into 'soft entry points' - informal, non-health service mechanisms by which fishers can access health information and health services. Conclusions While not working at the industry coalface, women have a stake, and are key players, in the commercial fishing industry. Their knowledge of, and credibility within, fishing enterprises makes them valuable sources of information about health issues facing the industry and effective strategies to address them. This expertise should be applied in conjunction with industry associations and health providers to achieve better health outcomes for fishers and their families. [ABSTRACT FROM AUTHOR]

Activation reforms targeted at single parents simultaneously construct them as a legitimate target for activation policy and subject them to new obligations to engage in paid work or education/training. The social policy literature has established that the work of ‘making-up’ target groups occurs at the street level as well as in government legislation. The street level has become even more significant in recent years as there has been a shift towards establishing quasi-markets for the delivery of welfare-to-work programmes and organising these around the principles of performance pay and process flexibility. However, what is largely missing from the existing literature is an analysis of how contract conditions, together with individuals' activation obligations, shape how they are targeted at the street level. Drawing on a study conducted over eight years with agencies in Australia's quasi-market for employment services, this paper argues that the changes to the contracts for governing this market changed how Australian single mothers were targeted by employment services. Over time there was a shift away from making-up single-parent clients as a distinct, vulnerable target group and a shift towards viewing them in terms of risk categories described within the agencies’ contracts. [ABSTRACT FROM AUTHOR]

Aims and objectives: This study was positioned within a larger action research study relating to a peer-led Aboriginal home visiting parent support program in an urban Western Australian setting. The aims for this study component were to identify program elements, exploring participants’ perceptions of the program’s suitability, feasibility, acceptability and effectiveness to inform program model recommendations and add to the body of knowledge on effective Aboriginal peer led program models. Background: The ability of Aboriginal parents to develop positive family environments is crucial, with parent support needing to be reflexive to local needs and sociocultural influences. Culturally appropriate service provision needs meaningful and acceptable strategies. Design: This study was situated within a critical paradigm supporting Participatory Action Research methodology, using Action Learning Sets as the participant engagement and data collection setting. Methods: Within ten Action Learning Sets, focus group interviews were carried out with Aboriginal peer support workers, a non-Aboriginal parent support worker, an Aboriginal program coordinator, an Aboriginal education support officer and non- Aboriginal program managers (n = 8), and individual interviews with parents (n = 2) and community agencies (n = 4). Data were analysed using thematic analysis. Results: Five themes were derived from peer support worker and community agency cohorts: peer support worker home visiting skills; responding to impacts of social determinants of health; client support and engagement; interagency collaboration; and issues addressing program sustainability. Parent responses augmented these themes. Conclusions: Participants identified five key elements relating to peer-led home visiting support for Aboriginal parents. These are uniquely placed to inform ongoing program development as there is little additional evidence in wider national and international contexts. Relevance to clinical practice: Engagement with communities and peer support workers to develop culturally relevant partnerships with Aboriginal families is integral to contemporary child health practice. Ongoing nurse support is needed for peer support worker role development. Indigenous Australian peoples are people who identify as Aboriginal or Torres Strait Islander. Respectfully, throughout this paper, they will be described as Aboriginal. [ABSTRACT FROM AUTHOR]

Objectives Monitoring surveys and research outline a paucity of alcohol consumption data for women in the period of lactation, particularly in rural areas of developed countries. Identifying the drinking profile of ante- and postnatal women in this population will aid in the effective dissemination of public health interventions. This paper will present the first alcohol consumption data of pregnant and breastfeeding women living in rural Western Australia (WA). Methods A prospective cohort of 489 mothers and their infants were recruited between April 2010 and November 2011. All women regardless of their infant feeding method were followed up at 4, 10, 16, 26, 32, 40 and 52 weeks postpartum. Data were analysed to ascertain the prevalence and patterns of alcohol consumption during pregnancy and lactation. Results Approximately 20% of women consumed alcohol during pregnancy, with a predominance of women from older age groups and smokers. At 4, 6 and 12 months postpartum; 45.9%, 47.0% and 51.9% of breastfeeding mothers were consuming alcohol respectively. Conclusions for Practice There remains a considerable proportion of women who continue to drink during pregnancy. Although proven successful, public health campaigns now need to target women who are older and who smoke. Women are continuing to consume alcohol during the period of lactation, with the majority doing so at low levels. [ABSTRACT FROM AUTHOR]

School nurses have reported stress and worry caring for young people experiencing mental health problems, but why this occurs and how they respond has not been well-explored. In this study researchers generated a substantive theory of the experiences of secondary school nurses who encountered young people with mental health problems using the original method of grounded theory. Thirty-one Western Australian school nurse participants reported that students presented with complex mental and social health needs that were not easily resolved. This was conceptualized as an untenable burden. Participants countered this by engaging in the three-stage process of tactical prioritizing. During an initial period of strategic assimilation into the school and broader community, participants referred students to external service providers. This was frequently inadequate, and participants found themselves grappling with unmet student mental health needs. Participants responded by implementing nursing strategies for optimizing outcomes in the lives of young people, while simultaneously engaging in managing self to support their own well-being. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to report on outcomes for carers of people with dementia who use the services of Hawthorn House, a day respite centre in rural Western Australia that is based on the Eden Principles. Design/methodology/approach -- Quantitative and qualitative data from caters was collected and analysed. Quantitative data included the General Health Questionnaire- 12, Zarit Burden Interview, and Eden survey. Qualitative data was from semi-structured interviews. Validation was confirmed and then simple statistics were generated from the quantitative data. Thematic analysis was used with the qualitative data. Findings -- Caters of people with dementia who use the services of Hawthorn House confirm that the Eden Principles are an integral part of Hawthorn House and report better than average health, less stress/burden and better quality of life. Many attribute this to the services they receive from Hawthorn House. Research limitations/implications -- Participants for the study were self-selecting. Practical implications -- The paper provides verification that the Eden Principles can lead to meaningful and important benefits for carers of people with dementia. Originality/value -- This paper is the first to report on the use of the Eden Principles in a non full-time respite centre for people with dementia in rural Australia. Further, it describes quantitative and qualitative data on quality of life outcomes for carets as a result of being associated with the centre. [ABSTRACT FROM AUTHOR]

Recognition is growing that childhood witnessing of domestic violence is tantamount to child abuse due to the damage the experience may have on the witnessing child's long-term emotional and social wellbeing. This paper helps to lift the cloak of silence that surrounds the child witnessing phenomenon by presenting the recollected adult memories of six female former child witnesses. Utilizing a mixed case-study and consensual qualitative research design, the study's findings reveal that the potential threat to a child witness's immediate and long-term wellbeing can be mediated through the progressive development of a range of adaptive coping strategies. Of these, the strategy of establishing a safe place and a supportive relationship outside of the abusive nuclear family home seems pivotal to the witnessing child's resilient ability to move on and lead a 'rewarding' adult life. The paper closes with a discussion on how the research findings can be progressed. [ABSTRACT FROM AUTHOR]

Biobanks for long-term research pose challenges to the legal and ethical validity of consent to participate. Different models of consent have been proposed to answer some of these challenges. This paper contributes to this discussion by considering the meaning and value of consent to participants in biobanks. Empirical data from a qualitative study is used to provide a participant view of the consent process and to demonstrate that, despite limited understanding of the research, consent provides the research participants with some level of control and a form of self determination that they value. Participation is framed as a moral act of a responsible citizen providing reinforcement of self identity. Consent symbolizes the trust invested in researchers and research institutions to use the biobank for the public good. The paper argues that consent continues to play an important role in biobank participation and that a participant view should inform proposals to modify consent processes. [ABSTRACT FROM AUTHOR]

jackson d., peters k., andrew s., edenborough m., halcomb e., luck l., salamonson y. & wilkes l. (2010) Understanding whistleblowing: qualitative insights from nurse whistleblowers. Journal of Advanced Nursing 66(10), 2194–2201. Aim. This paper is a report of a study conducted to explore the reasons behind the decision to blow the whistle and provide insights into nurses’ experiences of being whistleblowers. Background. Whistleblowing is a stigmatized and hidden activity that carries considerable ramifications to all concerned. In the health sector, when episodes of poor practice or service provision are identified, it is frequently nurses who are the whistleblowers. Despite this, there is remarkably limited literature that explores nurses’ experiences of whistleblowing. Methods. Qualitative narrative inquiry design. Data were collected in 2008 from 11 nurse whistleblowers using in-depth semi-structured interviews. Findings. Participants were drawn from a range of general and specialty clinical areas and experienced whistleblowing as highly stressful. The findings were clustered into three main themes, namely: (i) Reasons for whistleblowing: I just couldn’t advocate, (ii) Feeling silenced: Nobody speaks out, and (iii) Climate of fear: You are just not safe. Conclusion. The whistleblowing nurses believed they were acting in accordance with a duty of care. There is a need for greater clarity about the role nurses have as patient advocates. Furthermore, there is need to develop clear guidelines that create opportunities for nurses to voice concerns and to ensure that healthcare systems respond in a timely and appropriate manner, and a need to foster a safe environment in which to raise issues of concern. [ABSTRACT FROM AUTHOR]

This paper reports on our use of narrative accounts in qualitative research about educational leadership in Western Australia. Data for the research were gathered through semistructured interviews. We wanted to know whether interview data constructed as narrative accounts then analysed would help us understand the phenomenon of leading for sustainability. We had used this approach previously (Wildy & Pepper, 2005; Clarke, Wildy & Pepper, 2007) in our examination of school leadership. Our commitment to an interpretive approach (Connelly & Clandinin, 1990; Kvale, 1996), to delve into our participants' understanding of their experiences remains strong. Rich insights into the experiences of participants are revealed in narrative accounts crafted from semistructured interviews. Stories and descriptions of experience are given status when presented as narratives so contribute to participants' wellbeing and meet the criteria for 'good educational research'. In this paper we describe collecting data, constructing narratives, confirming quality and conducting analysis to describe the 'wakefulness' and transparency we adhere to when using narrative accounts as a research strategy. [ABSTRACT FROM AUTHOR]

Purpose - This paper aims to present the case of the Pilbara as an illustration of how neo-liberalism and globalisation affect a natural resource region. Design/methodology/approach - A primary data set was collected by interviewing 21 people who had an interest in the development of the Pilbara. Secondary data was collected from relevant government policy documents and media reports relating to the region. Qualitative analysis techniques were used to analyse the data. Findings - It is found that neo-liberal policy has had a profound and largely negative effect on Pilbara communities. Rather than reaping the benefits of the wealth being generated in the region, participants in this research experience social breakdown and unmet social needs, and the local democratic institutions are weak and ineffective. Research limitations/implications - This paper reports on a single case and is limited in terms of its generalisability. However, it does illustrate the value of the "Resource Curse Thesis" and the concept of "risk" in illuminating the issues associated with neo-liberalism. Practical implications - This research has practical implications in that it provides an example of the problems associated with neo-liberal perspectives when they are used as a frarpework for developing and implementing regional policy. Originality/value - The resource curse thesis tends to be used in analysing developing nations and risk has so far been applied in limited areas of researching the effects of neo-liberal policy trajectories. This paper employs these concepts to provide a critical examination of regional development policy in a way that can be used in other national contexts. [ABSTRACT FROM AUTHOR]

This paper explores the engagement in physical activity as a potential coping strategy for asylum seekers living in the Australian community without the right to work and with prolonged uncertainty, and benefits or barriers to undertaking such activity. Semi-structured in-depth interviews were held with 29 asylum seekers who had arrived to Australia by boat and were living in the community in the cities of Perth, Sydney or Melbourne in July-October 2013 after their release from immigration detention. The ratio of the numbers of men and women interviewed (23 men and 6 women) was comparable to the ratio of men and women who came by boat to Australia seeking asylum in 2012-2013. Nine participants reported that they participated in physical activity as a coping strategy. Seven other participants were so worried about their future and their families that they did not have the mental or physical energy to engage in physical activity. A further six wanted to participate in physical activity but faced a number of barriers to doing so. The seven remaining participants were either not asked about their physical activity engagement because they focused their discussion on other challenges or did not elaborate on why they were not engaging in physical activity. The findings suggest that physical activity, coupled with other coping strategies, are important for some asylum seekers in trying to manage the distress of being denied the right to work and living with prolonged uncertainty. In addition, these findings highlight the critical barrier that government policy plays in disabling engagement in physical activity, which further compounds social exclusion. This includes the lack of welfare support provided, which hinders people's financial ability to access activities and support in the community. [ABSTRACT FROM AUTHOR]

Background Heuristic inquiry is a research approach that improves understanding of the essence of an experience. This qualitative method relies on researchers' ability to discover and interpret their own experience while exploring those of others. Aim To present a discussion of heuristic inquiry's methodology and its application to the experience of nurse migration. Discussion The researcher's commitment to the research is central to heuristic inquiry. It is immersive, reflective, reiterative and a personally-affecting method of gathering knowledge. Researchers are acknowledged as the only people who can validate the findings of the research by exploring their own experiences while also examining those of others with the same experiences to truly understand the phenomena being researched. This paper presents the ways in which the heuristic process guides this discovery in relation to traditional research steps. Conclusion Heuristic inquiry is an appropriate method for exploring nurses' experiences of migration because nurse researchers can tell their own stories and it brings understanding of themselves and the phenomenon as experienced by others. Implications for practice Although not a popular method in nursing research, heuristic inquiry offers a depth of exploration and understanding that may not be revealed by other methods. [ABSTRACT FROM AUTHOR]

Background Intensive care unit survivors face many physical and psychological difficulties during their recovery following discharge from hospital. These difficulties can significantly affect their quality of life. Healthcare providers and survivors' families often do not understand what recovery means in this population, which may affect the support provided. Aim To consider the potential of the biographical method in helping to create stories that illustrate recovery in intensive care survivors and other populations. Discussion This paper identifies how the biographical approach has provided survivors with a way to uncover the hidden parts of their lives through diaries and interviews, and reveal the hidden stories of intensive care survivorship and recovery. Conclusion The application of the biographical method enabled stories to be created that identified the disruption survivors encounter as they struggle to appear recovered. Implications for practice The biographical method can illuminate experiences uncaptured by other methods. This insight into recovery journeys can help healthcare practitioners and family members to understand and recognise the need for support during recovery. [ABSTRACT FROM AUTHOR]

Aim: To explore residential aged care nurses working in interim, rehabilitation and residential aged care perceptions of resilience. Design: Qualitative Portraiture methodology. Inclusion criteria were that all participants were English speaking, registered with the Australian Health Practitioners Registration Authority and had more than five years' experience working in an aged care environment. Three participants were interviewed and employed within a metropolitan interim, rehabilitation and aged care setting. Results: Eight themes were identified: valuing social support; leadership, managing 'self'; 'paying it forward'; passion for the profession; focusing on the positive and the taking on of challenge. Conclusions: This paper focuses on the impact of aged care nursing work on nurses and in particular how the nurses remain resilient in their work environment. Resilience can be developed through education and can sustain professional longevity. Workload stress can be alleviated through the provision of resilience training. [ABSTRACT FROM AUTHOR]

Aboriginal Australians are at higher risk of developing certain types of cancer and, once diagnosed, they have poorer outcomes than their non-Aboriginal counterparts. Lower access to cancer screening programmes, deficiencies in treatment and cultural barriers contribute to poor outcomes. Additional logistical factors affecting those living in rural areas compound these barriers. Cancer support groups have positive effects on people affected by cancer; however, there is limited evidence on peer-support programmes for Aboriginal cancer patients in Australia. This paper explores the roles played by an Aboriginal women's cancer support network operating in a regional town in Western Australia. Data were collected through semi-structured interviews with 24 participants including Aboriginal and mainstream healthcare service providers, and network members and clients. Interviews were audiotaped and transcribed verbatim. Transcripts were subjected to inductive thematic analysis. Connecting and linking people and services was perceived as the main role of the network. This role had four distinct domains: (i) facilitating access to cancer services; (ii) fostering social interaction; (iii) providing a culturally safe space; and (iv) building relationships with other agencies. Other network roles included providing emotional and practical support, delivering health education and facilitating engagement in cancer screening initiatives. Despite the network's achievements, unresolved tensions around role definition negatively impacted on the working relationship between the network and mainstream service providers, and posed a threat to the network's sustainability. Different perspectives need to be acknowledged and addressed in order to build strong, effective partnerships between service providers and Aboriginal communities. Valuing and honouring the Aboriginal approaches and expertise, and adopting an intercultural approach are suggested as necessary to the way forward. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in Australia. Australian Aboriginal and Torres Strait Islander (Indigenous) people have higher levels of CVD compared with non-Indigenous people. Cardiac Rehabilitation (CR) is an evidence-based intervention that can assist with reducing subsequent cardiovascular events and rehospitalisation. Unfortunately, attendance rates at traditional CR programs, both globally and in Australia, are estimated to be as low as 10-30 % and Indigenous people are known to be particularly under-represented. An in-depth assessment was undertaken to investigate the provision of CR and secondary preveniton services in Western Australia (WA) with a focus on rural, remote and Indigenous populations. This paper reports on the findings for Indigenous people.Methods: Cardiac rehabilitation and Aboriginal Medical Services (n = 38) were identified for interview through the Heart Foundation Directory of Western Australian Cardiac Rehabilitation and Secondary Prevention Services 2012. Semi-structured interviews with CR coordinators were conducted and included questions specific to Indigenous people.Results: Interviews with coordinators from 34 CR services (10 rural, 12 remote, 12 metropolitan) were conducted. Identification of Indigenous status was reported by 65 % of coordinators; referral and attendance rates of Indigenous patients differed greatly across WA. Efforts to meet the cultural needs of Indigenous patients varied and included case management (32 %), specific educational materials (35 %), use of a buddy or mentoring system (27 %), and access to an Aboriginal Health Worker (71 %). Staff cultural awareness training was available for 97 % and CR guidelines were utilised by 77 % of services.Conclusion: The under-representation of Indigenous Australians participating in CR, as reported in the literature and more specifically in this study, mandates a concerted effort to improve services to better meet the needs of Indigenous patients with CVD as part of closing the gap in life expectancy. Improving access to culturally appropriate CR and secondary prevention in WA must be an important component of this effort given the high rates of premature cardiovascular disease affecting Indigenous people. Our findings also highlight the importance of good systematic data collection across services. Health pathways that ensure continuity of care and alternative methods of CR delivery with dedicated resources are needed. [ABSTRACT FROM AUTHOR]

BackgroundEvidence suggests that adults with intellectual disability (ID) are vulnerable to poor health outcomes. This paper describes the health status and medication use of adults with ID in Western Australia. MethodWe conducted a cross-sectional survey by interview of 328 adults with ID (Mage = 37 years, range: 18–82) and their families/support persons (79% proxy or joint informants). ResultsAlthough 90% of participants reported long-term health conditions (M = 2.6, range: 0–10), including epilepsy, allergies, eczema, asthma, and mental health problems, three quarters of the participants (77%) described their health as good or very good. Younger participants (18–44 years) reported osteoporosis and stroke, conditions commonly associated with ageing, more often than the general population at those ages. Medication use was high, with 70% taking one or more medications (Mdn = 3 medications, range: 0–21). ConclusionsMany participants reported that health problems affected their daily lives, yet the majority reported good health. Long-term health conditions were common and many people used several types of medications. Participants had poorer health than the Western Australian population overall. Careful monitoring of health conditions and regular review of medications are recommended to improve health outcomes for adults with ID. [ABSTRACT FROM PUBLISHER]

Background Reliable ascertainment of intellectual disability (ID) is important to identify those with special needs, in order for those needs to be met in the criminal justice system. Although the Hayes Ability Screening Index (HASI) is valid and widely used for the identification of possible ID, the risk of inter-rater bias between researchers when scoring the HASI has not yet been established. The current paper estimates the inter-rater reliability of the HASI in a sample of Indigenous and non-Indigenous prisoners in Western Australia. Methods We estimated intra-class correlation coefficients (ICC) for the consistency of agreement among three blinded raters using a two-way random-effects model assessing the inter-rater agreement of the HASI. Kappa was also estimated for the dichotomous HASI screening threshold outcome between the raters. Results The HASI exhibited very good within-subject consistency of agreement for Section B (ICC = 0.95; 95%CI:0.94-0.96), Section C (ICC = 0.97; 95%CI: 0.96-0.98) and Section D (ICC = 0.90; 95%CI: 0.87-0.92) subscales and for the total scaled score (ICC = 0.97; 95%CI: 0.96-0.98). The inter-rater reliability of the dichotomous adult ID screening threshold (<85) was also very good (Kappa = 0.95). Conclusions The current study provides new evidence that the HASI has a low risk of bias from between-rater scoring and can be reliably scored by both non-clinicians and clinicians with little training, when administered in prison settings. Pre-scoring training should focus on the more subjective 'clock-drawing' section, in order to maximise inter-rater reliability. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to measure the levels of psychological distress in adults entering Western Australia (WA) as refugees through the Australian Humanitarian Programme. To determine if the introduction of mental health screening instruments impacts on the level of referrals for further psychological/psychiatric assessment and treatment. Design/methodology/approach – Participants were 300 consecutive consenting refugee adults attending the Humanitarian Entrant Health Service in Perth, WA. This service is government funded for the general health screening of refugees. The Kessler-10 (K10) and the World Health Organisation’s post-traumatic stress disorder (PTSD) screener were the principal outcome measures used. Findings – Refugees had a high rate of current probable PTSD (17.2 per cent) as measured with the PTSD screener and mean K10 scores were significantly higher than general population norms. The K10 showed high accuracy for discriminating those with or without probable PTSD. Being married and having more children increased the risk of probable PTSD. In regard to region of origin, refugees from Western and Southern Asia had significantly higher scores on both screeners followed by those from Africa with those from South-Eastern Asia having the lowest scores. Referral rate for psychiatric/psychological treatment was 18 per cent compared to 4.2 per cent in the year prior to the study. Practical implications – This study demonstrates increased psychological distress including a high rate of probable PTSD in a recently arrived multi-ethnic refugee population and also demonstrates significant variations based on region of origin. In addition, it supports the feasibility of using brief screening instruments to improve identification and referral of refugees with significant psychological distress in the context of a comprehensive general medical review. Originality/value – This was an Australian study conducted in a non-psychiatric setting. The outcomes of this study pertain to refugee mental health assessed in a general health setting. The implications of the study findings are of far reaching relevance, inclusive of primary care doctors and general physicians as well as mental health clinicians. In particular the authors note that the findings of this study are to the authors’ knowledge unique in the refugee mental health literature as the participants are recently arrived refugees from diverse ethnic groups. [ABSTRACT FROM AUTHOR]

Mental health nursing has an ageing workforce with a critical shortage of nurses in Western Australia. Additionally, mental health is not the preferred career for many graduate nurses. Current challenges with recruitment and retention suggest that strategies are needed to address this issue. This research project adopted a novel approach that focused on exploring the positive aspects of why mental health nurses remain, rather than why they leave. A cross-sectional design was employed comprising a brief interview survey, and nurses working within one public mental health service in Western Australia were invited to participate. A total of 192 nurses participated across 5 months, from adult, older adult, forensic, and education/research programmes. Thematic analysis was conducted from five key questions, and responses from questions one and two are discussed in this paper: 'Why did you choose mental health nursing?' and 'Why do you remain in mental health nursing?'. The main themes extracted in response to choosing mental health nursing were wanting to make a difference, mental health captured my interest, encouraged by others, and opportunities. Subsequent themes extracted from responses to remaining in mental health nursing were facing reality, passion for mental health nursing, patient-centred caring, and workplace conditions. Findings will be utilized to inform strategies for recruitment and retention of graduate nurses; further development of support systems, such as preceptorship training and improving student clinical experiences; as well as improving professional development opportunities for existing mental health nurses. [ABSTRACT FROM AUTHOR]

Diabetes prevalence is increasing in Australia, and there are stark inequities in prevalence and clinical outcomes experienced by Indigenous people and low socioeconomic groups compared with non-Indigenous and socioeconomically advantaged groups. This paper explores the impact of Indigenous status and socioeconomic disadvantage on the experience of diabetes care in the primary health setting. Data were collected through focus groups and interviews. The sample, comprising 38 participants (Indigenous and non-Indigenous), was recruited from disadvantaged areas in Perth, Australia. Data analysis was mainly deductive and based on a conceptual framework for the relationship between socioeconomic position and diabetes health outcomes. Most participants reported accessing general practitioners regularly; however, evidence of access to dietitians and podiatrists was very limited. Perceived need, cost, lack of information on available services and previous negative experiences influenced health care-seeking behaviour. Complexity and lack of coordination characterised the model of care reported by most participants. In contrast, Indigenous participants accessing an Aboriginal community-controlled health organisation reported a more accessible and coordinated experience of care. Our analysis suggests that Indigenous and socioeconomically disadvantaged people tailor their health care-seeking behaviour to the limitations imposed by their income and disadvantaged circumstances. To reduce inequities in care experiences, diabetes services in primary care need to be accessible and responsive to the needs of such groups in the community. [ABSTRACT FROM AUTHOR]

Purpose To explore health professionals' views about Australian Indigenous people's health and the delivery of healthcare to them in the Pilbara region of Western Australia. Methods An open-ended questionnaire was used to gather information from health professionals located across diverse regions in the Pilbara. The responses were analysed with the use of thematic analysis. In the first stage, codes were developed by assigning names to small sections of the interview transcripts. Next, the most salient incisive codes were identified and developed into themes that captured the most important issues. Findings Twenty-eight health professionals indicated that the most important health issues were chronic diseases, substance abuse and ear disease. These health issues were often attributed to a cycle of poor health perpetuated throughout generations. Educational initiatives were thought to be integral to intervening in this cycle. Of particular importance in improving the effectiveness of educational initiatives was facilitating the participation of Australian Indigenous peoples to determine the content of such initiatives. The other main issues the health professionals identified were lifting the standard of Australian Indigenous housing and implementing strategies to improve the continuity of healthcare. Conclusion Educational initiatives need to be prioritised to improve the health of Australian Indigenous people in the Pilbara and the initiatives should be delivered with the involvement of the local community in order to increase the likelihood of sustained behavioural change. Innovative solutions are required to improve the continuity of healthcare in the Pilbara, including increased use of mobile services. What is known about this topic? About two out of every three Indigenous adults in the Pilbara experience a chronic health condition. Moreover, compared with non-Indigenous peoples in the region, Indigenous peoples experience a significantly higher mortality rate for numerous chronic health conditions. Although some information is available about the provision of health services for Indigenous people in the Pilbara, little is known about its adequacy or how it could be most effectively delivered. What does this paper add? This study details health professionals' views about the types of health conditions that need to be prioritised in addressing the health needs of Indigenous people in the Pilbara. It also details health professionals' perceptions of gaps in health service delivery for Indigenous people in the Pilbara and examines how these services could be most effectively delivered. What are the implications for practitioners? Educational initiatives need to be prioritised to improve the health of Australian Indigenous people in the Pilbara and the initiatives should be delivered with the involvement of the local community in order to increase the likelihood of sustained behavioural change. Innovative solutions are required to improve the continuity of healthcare in the Pilbara, including increased use of mobile services. [ABSTRACT FROM AUTHOR]

Objectives. To explore how Western Australian mental health clinicians want to evaluate their care. Methods. Using a participatory action research framework, 10 senior psychiatrists and 11 clinical nurse specialists working in an inpatient mental health setting participated in individual interviews, focus groups and meetings. All interviews were de-identified during transcription and transcripts and field notes were analysed for common themes. Results. Participants identified what they wanted to measure, how they wanted to measure it and how these changes could be implemented. Clinicians stressed the importance of measuring context (physical, clinical and service) and process as well as outcome, and of evaluating care at an individual and service level with consumer involvement. What is known about the topic? Completion rates of mandatory national outcome measures in mental health in Australia are variable and clinicians have mixed views as to their value. Several barriers have been identified as to their use including clinical, resource and ownership issues. What does this paper add? Some studies have identified areas of good practice and elicited practical suggestions for improvement but few have asked clinicians how they actually want to evaluate the care they provide. This study explored how mental health clinicians wanted to evaluate their care, using a participatory action research framework that encouraged participants to pinpoint problems and issues, account for their social context and develop actions to address them. What are the implications for practitioners? Clinicians were enthusiastic for high quality care and evaluation, but pessimistic about their ability to introduce sustainable change. Establishing and supporting active and responsible leadership at service level may solve this, as may encouraging local standard setting and benchmarking in collaboration with consumers and carers. [ABSTRACT FROM AUTHOR]

Background This paper aims to assess the barriers and solutions to the delivery of eye care in primary care settings and solutions to improve the use of comprehensive eye care among Indigenous Australians. Design, setting, participants Qualitative, mixed method study participants include Aboriginal community members, and health and eye care providers in urban, rural and remote settings. Main outcome measures Present evidence for health care providers to better understand and address some of the barriers that limit access to eye care in primary care settings. Results Patient perspectives on barriers to accessing eye care and reasons they choose to seek care or not are presented. Health system barriers identified by health and eye care providers are also presented. Additionally, key enablers for improving access to eye care through primary care services are identified. Conclusion Primary health care services have an important role in Indigenous eye health. There is a critical role for primary care in the coordination of the patient journey and cooperating with other services to improve access to comprehensive eye care. Through improved provision of primary eye care, monitoring of Indigenous eye health indicators and supporting patients to access eye care, it is possible to close the gap for vision. [ABSTRACT FROM AUTHOR]

For the past two decades the prime focus of motivation research in adolescence has been concerned with achievement goals, namely mastery and performance goals. In the real life learning contexts in which students participate, however, such goals are inextricably linked to other goals such as social goals and broader life and future goals. Moreover, goals are not pursued in isolation but as components of complex and dynamic motivational systems which individuals shape to suit context and purpose. Using a multiple goals perspective, and focusing on both why students want to achieve at school (achievement goals) and what goals students are trying to achieve at school (goal content), this paper presents findings from a study investigating the goals of 29 secondary school students (juniors, ages 12-13, and seniors ages 16-17). With data gathered during focus group interviews, the study shows that students pursue multiple goals and that those goals are related to four main goal domains, those being future goals, achievement goals, social goals, and personal well-being goals. Furthermore, the study reveals relationships between goals in particular domains and highlights the important role played by future goals in adolescents' motivation at school. Methodological challenges in investigating multiple goals for adolescents are discussed. The findings suggest that to further understanding about multiple goals for adolescents, future research should consider multiple goals across the four domains and more closely examine the role of future goals in influencing other goals and adolescents' motivation at school. [ABSTRACT FROM AUTHOR]

This paper reports on qualitative research with Australian parents concerning their attitudes to sexuality and relationships education, both at home and in school. A wide range of values and attitudes were represented among parents in this study. Regardless of the varying approaches parents used, all participants expressed a desire for their children to be well informed about sex, sexual health and relationships, yet many felt inadequate to the task of providing high-quality sex education to their children. Some participants blamed this lack of confidence on their own limited education about sexuality. Their main concern was to ensure that their children are safe and that when they do become sexually active their experiences of sex are positive. Most participants saw sex education as primarily their responsibility, with school sex education as an important adjunct. They wanted to be well informed about the timing and content of school programmes for their children, and to be assured that those educators who will be teaching their children about sexual health have the skills and qualifications to do their job well, while remaining sensitive to the diversity of values among students and their families. While most parents who participated in the research supported sexuality education in schools, they did so with reservations. In particular, they wanted schools to take an active role in communicating with them about the content of sexuality education programmes and be open to meeting with those parents who expressed concerns. [ABSTRACT FROM AUTHOR]

Abstract The link between interprofessional collaboration and interprofessional education has been at the centre of discourse for some time. To understand some of the challenges of interprofessional collaboration, a research study was undertaken. The study investigated the interprofessional socialisation experiences of health professional educators, across five higher education faculties in Perth, Western Australia (WA). An interpretive phenomenological framework was utilised to explore the phenomena of interprofessional socialisation. Twenty-six professional educators were interviewed from a variety of health-related disciplines and qualitative content analysis was undertaken with the aid of NVivo 10 software. Examination of the data discovered a range of barriers that were potentially preventing professionals from working together effectively, within education. Overcoming some of these obstacles were identified, such as, professional language, organizational support, time and workload and the proximity of professionals. The research also recommended a framework that would support health educators. Currently, there are conceptual frameworks that guide the professional and interprofessional socialisation of healthcare graduates within education. Whereas, there is very little guidance or frameworks to support professional educators interprofessional experiences. The heath educators' interprofessional socialisation (HEIPS) framework is presented within this paper, and is a four-step process to encourage the interprofessional socialisation of educators within universities. Highlights • The HEIPS framework was developed to support educators in higher education. • The inclusion of pragmatic strategies would help reduce barriers between educators and encourage collaboration. • The interprofessional socialisation of educators would strengthen interprofessional education. • Interprofessional educator 'champions' could influence the universities strategic agenda on interprofessional education. [ABSTRACT FROM AUTHOR]

Children placed in out-of-home care are a particularly disadvantaged group in society, who have often been exposed to trauma and socioeconomic disadvantage. As a result, they experience poorer health outcomes than children in the general population, especially mental health outcomes. One health outcome that has yet to be researched thoroughly is overweight and obesity of children placed in out-of-home care. Hence, the overall goal of this paper was to review the extant literature over the last decade on weight-related issues for children in out-of-home care, with particular emphasis on overweight and obesity. The findings of the review revealed that there is a lack of rigorous Australian research in relation to prevalence rates of overweight and obesity in children in out-of-home care; there is a lack of strategies or interventions designed specifically to combat overweight and obesity in children in out-of-home care; and one of the major limitations of Australian research to date is the use of self-report measures to assess the weight status of children in out-of-home care. It was concluded that prevention and intervention strategies are needed that target children as they enter out-of-home care. [ABSTRACT FROM PUBLISHER]

This paper explores the daily experiences and occupational needs of family carers of people who were dying, with particular reference to their daily routines and ability to undertake other varied activities during the period of care. The impact of the caring experience on these occupations was then examined to determine how, and if, these occupational needs were addressed in the community using potential and available services. An exploratory approach using grounded theory was employed to examine these experiences. Participants were recruited from metropolitan ( n = 10) and rural ( n = 4) locations across Western Australia between February and June 2009, using a purposive sampling method. A semi-structured interview guide was developed following consultation with the literature, expert opinion and piloting. Interviews were conducted in participants' homes and questions were asked about their experiences as a carer including routines, engagement in usual activities and the impact of the caring role on their daily life during and after the period of care. Each interview was transcribed verbatim and analysed to determine potential themes. Two important themes were identified: (1) Carers experienced disengagement and deprivation from their usual occupations during and after the period of care; and (2) Participants described significant disempowerment in their role as carer. Carers are 'doubly disadvantaged' as a result of their caring role; they are unable to participate in their usual occupations and they are not recognised for their contributions as carers. Carers experienced disengagement and deprivation from their usual occupations, contributing to physical, psychological and emotional difficulties and this may result in long term consequences for health and well-being. In addition, the current services and support available for carers in the community are deemed inadequate; placing further stress on a health care system which needs to cope with increasing demands as a result of the ageing population in Australia. [ABSTRACT FROM AUTHOR]

Health systems have elected to devolve management to semi-autonomous clinical subunits, known as 'clinical directorates'. This has placed responsibility for managing diminishing healthcare resources primarily in the hands of those who use them the most, notably medical practitioners. This research examines and presents a framework that describes the dimensions of efficient and effective clinical directorship in the context of a devolved management structure. A qualitative research design was employed to explore the perceptions of those involved in the operation of clinical directorates some 10 years after their implementation at three public teaching hospitals in Western Australia. The research found that the clinical insights that medical practitioners bring to the role of clinical director were perceived to be the grounding for clinical directorate effectiveness. Clinical knowledge combined with contextual knowledge, understanding of the politics of healthcare and ability to influence medical peers, were seen as critical. However, having business skills, commitment and good communication skills were perceived to be important to achieve both effectiveness and efficiency. The paper describes the dimensions of clinical director competence as well as the competencies, skills and knowledge perceived to require further development. It highlights the problems and issues that can arise for clinical directors from the perspectives of directors and their management teams. [ABSTRACT FROM AUTHOR]

This paper provides an example of the application of the cognitive interview, a qualitative tool for pre-testing a survey instrument to check its cognitive validity, that is, whether the items mean to respondents what they mean to the item designers. The instrument is the survey used in the final phase of the International Study of Principal Preparation (ISPP ). This study involving researchers in 13 countries investigates those aspects of principals’ work perceived by them to be most challenging in their early years in the position and the extent to which principals believe they were prepared for these challenges. Both probing and think aloud approaches to the cognitive interview were used and revealed a small number of items requiring amendment. [ABSTRACT FROM AUTHOR]

Introduction: This study describes the experiences of eight mothers from the Wheatbelt region of Western Australia who shared their stories of travelling and/or temporarily relocating for birth. Objective: The aim of this study was to describe rural and remote Western Australian mothers' experiences of travelling long distances and/or relocating to give birth. Design: This study was based on Crotty's four elements of qualitative research. This study was underpinned by a constructivist epistemology, a feminist theoretical lens and a narrative approach using semistructured, story‐based interviews. Participants narrated their stories of birthing away from home by telephone interview. Findings: Five major themes were identified utilising thematic analysis. These were (1) feeling forgotten in the system, (2) accessibility and choice, (3) compounded social isolation, (4) doing it hard: financial and logistical challenges and (5) building strength: advocating for myself and baby. Discussion: Mothers' stories were reflective of current and historical failures of rural maternal health policy, including widespread closures of rural birthing hospitals. Mothers described the logistical barriers they faced with little support and suggested multiple solutions that would improve their experiences. Conclusion: Mothers faced significant obstacles which impeded their access to equitable maternal healthcare. This study highlights the complexities of birthing as a rural mother and the need to address maternal health inequities between rural and metropolitan women. [ABSTRACT FROM AUTHOR]

• Examining adolescent perceptions of their parents influence on their access and use of mental health services. • Use qualitative face to face interviews. • Parents were highlighted by adolescents as prominent influences in adolescent mental health journeys, however this influence could be positive and negative for the adolescent. • Highlights the complexity of the involvement of parents in their child's mental health service use. To explore adolescent experiences of accessing and utilising mental health service in Perth, Western Australia. This paper focusses on the adolescent identified influence of parents in accessing and using mental health services. Qualitative semi-structured face-to-face interviews with 22 adolescents aged 14–18 years old in Perth, Western Australia. Interviews were transcribed verbatim and analysed thematically. The influence of parents on adolescents' experiences within the mental health system were grouped under three themes: parental involvement in accessing and continued use of mental health services for their children; parental understanding and awareness of child's mental health problems; parent–child relationship. It was common for adolescents to report that the influence and involvement of their parents could create facilitators and barriers to mental health care. This research highlighted the complexities in how parents can be both supportive and hindering influences in their child's mental health care. Adolescent experiences highlight the need for parents to be a key area of focus for mental health services and future reforms to support and improve adolescent mental health service use. Additional research is needed to explore how to effectively increase parental mental health literacy in the community and what factors are needed to create trusted parent-adolescent relationships. [ABSTRACT FROM AUTHOR]