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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]

Young carers support family members affected by disability or a health condition. The Young Carer Bursary Program aims to support young carers' education. This paper analysed data from consenting bursary applicants (2017–2019) to investigate relationships between wellbeing, educational attendance, home study and other factors. Descriptive statistics, correlation and regression analysis determined significant issues, relationships and influential factors related to young carer (N = 1,443) wellbeing and education. Sixty‐eight percent were aged between 13 and 18 years and attended secondary school. One third of the sample reported that they were the main carer in their family and 29% reported receiving no support. Female applicants from single parent households who were the main carer attended educational settings less often. Eighteen percent (n = 267) rated their wellbeing as poor/very poor. Better wellbeing was associated with increased educational attendance (rs = 0.33, p < 0.001) and home study (rs = 0.34, p < 0.001). Wellbeing was associated with main carer status, caring for a parent, having a disability, being older and having few supports. Educational attendance was associated with main carer status, higher care load and fewer supports. Home study was associated with having a disability, caring for a sibling, caring for more than 11 hr per week and having fewer supports. Important factors about the age, life situation and challenges experienced by young carers identified in this paper indicate that further research into preferred supports and effectiveness of the bursary in improving educational engagement is warranted. [ABSTRACT FROM AUTHOR]

Objectives. To review the prevalence of loneliness (during/after COVID-19) in older people. Design. Scoping review using Medline and PsycInfo for worldwide prevalence estimates (white published literature search) and Google for prevalence data inside the Euregio Meuse-Rhine (grey literature). Setting. Worldwide prevalence estimates and a focus on the Euregio Meuse-Rhine. Participants. Papers published between 2016 and 2022 and a mean age of minimum of 65 years. Measurements. Prevalence estimates for older people. Results. The white literature search yielded 37 articles. Before the onset of the COVID-19 pandemic, loneliness estimates were the highest in Nigeria (46%) and the lowest in Australia (5%) (mean prevalence was 25.6%). Loneliness was reported to be higher in specific populations, for example, people living in specific communities such as senior housing communities or with impairments, than in the general population, with a mean prevalence estimate of 47.8%. During COVID-19, the prevalence of loneliness was higher than that before the pandemic: we observed a mean prevalence of 39.4%, in comparison to 25.6 before COVID-19. The grey literature search showed that, compared to Belgium and the Netherlands (13.5% and 36.5%, respectively), loneliness estimates were the lowest in Germany, with a mean prevalence of 7.7%. Conclusion. Large international differences in the prevalence of loneliness were observed between countries and populations studied. Several hypotheses could explain such differences, including sociocultural or historical-political characteristics. Without surprise, the pandemic and associated measures were linked to a higher level of loneliness. Furthermore, recommendations for addressing loneliness, including interventions, are discussed. [ABSTRACT FROM AUTHOR]

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

The aim of this study was to describe the prevalence, severity, coping strategies and precipitating factors of food insecurity in university students in a large multi‐campus Australian university during the COVID‐19 lockdown in 2020, in context of providing information to inform institutional support. This was a cross‐sectional analysis which was part of a larger university‐led research project, the Thrive@Home study conducted at Monash University during the COVID‐19 pandemic. The main outcome measures included: Sociodemographic characteristics, PROMIS anxiety, PROMIS depression and the six‐item US Department of Agriculture Household Food Security Survey Module. All variables were reported according to the four levels of food security status (high (H), marginal (M), low (L) and very low (VL)). Chi‐squared tests were used to compare all categorical variables including demographic, mental health and food security status. A multivariable regression was conducted between food security status and mental health variables. Overall, n = 1315 students were included in the analysis. Of which, 5% were classified as having VL food security, 13% L, 14% M and 68% H. As food security worsened the likelihood of being unemployed looking for work, living alone and deteriorating physical health, diet quality and mental health increased. As food security status deteriorated the prevalence of needing to ask family or friends for food, shopping at multiple outlets for discounts, accessing emergency food relief, subsidised meals and financial assistance from organisations increased (p < 0.002). In regression models adjusting for covariates, depression (b (95%CI): VL = 7.2(4.1–10.3), L = 3.7(1.7–5.7), M = 2.0(0.1–3.8)) and anxiety (VL = 7.4(4.5–10.4), L = 3.5(1.5–5.4) and M = 2.0(0.3–3.8)) were positively associated with worsening food security. Food insecurity during COVID‐19 was associated with worsening mental health. This paper provides targets for future university‐led initiatives to promote student food security and supporting better access to physical and mental health services. [ABSTRACT FROM AUTHOR]

Volunteer peer support is an approach that enables a supportive connection between volunteers and a sub‐set of community members with shared experiences or interests. To implement co‐designed strategies to support older women to maintain independence and optimise wellbeing in Australia, a volunteer peer support approach was proposed. There was limited literature describing volunteer peer support frameworks to underpin interventions of this kind; and given the increasing desire for engagement of individuals and communities, articulation of the key components of such a framework is warranted. In this paper, we define volunteers and peer support, and outline existing frameworks for volunteering and peer support. We then describe the volunteer peer support framework developed for this intervention, outlining the key requirements. This information will enable others to develop an effective and sustainable structure for peer support volunteer services. [ABSTRACT FROM AUTHOR]

This paper presents findings from the evaluation of an Australian trial of self‐managed home aged care. The self‐management model was codesigned by advocacy organisation COTA Australia, consumers and service providers. The primary aim of the evaluation was to examine whether self‐management improved consumers' perceptions of their choice, control, and wellbeing. The secondary aim was to examine whether provider prior experience with self‐managed packages significantly influenced consumers' perceptions of choice, control and wellbeing, thereby confounded trial effects. A pre‐test post‐test quasi‐experimental design and mixed‐methods design were used to collect data over nine months in 2018–2019. The pre‐trial methods and findings have been published. The post‐trial evaluation replicated the pre‐trial data collection method of an online survey (n = 60) and semi‐structured telephone interviews with consumers (n = 9), family carers (n = 13), and consumers and carers jointly (n = 2), totalling 24 interviews. Semi‐structured telephone interviews were also conducted with CEOs and senior managers from each of the seven providers (n = 14). Three providers had prior experience supporting self‐management. Parametric and non‐parametric tests examined the statistical data. Qualitative data were analysed thematically and framed according to self‐determination principles and ecological systems theory. Both datasets demonstrated that consumers reported greater choice and control at post‐trial than pre‐trial. This finding was not affected by providers' prior experience with self‐management; therefore, it was not a confounding factor. Participants reported improved wellbeing in interviews, however this was not reinforced statistically. Key desirable features of self‐management included greater autonomy and control over spending, recruiting support staff and paying lower administration fees. There was no evidence of increased risks or fraud. The research limitations included a small sample size, convenience sampling with providers recruiting interview participants, no control group and differences in trial implementation. The findings support the expansion of self‐management opportunities and more comprehensive evaluations that use mixed methods. [ABSTRACT FROM AUTHOR]

Informal caregiving for a person living with glioma can be both rewarding and multidimensionally challenging, given the potential for debilitating symptoms, cognitive impairment or personality changes, as early as diagnosis. There is growing evidence that, due to the demands of care, experiences and feelings of loneliness and isolation among informal caregivers are widespread, and opportunities for quality or meaningful social connectedness are lacking. While considerable research has quantified the causes and effects of loneliness and isolation in informal care contexts, the lived experience of loneliness has received relatively little attention. The aim of this study was to better understand the everyday experiences of a group of home‐based informal caregivers of people living with glioma in Queensland, Australia. Drawing on in‐depth interviews with 32 informal caregivers, purposively sampled, and recruited through a tertiary hospital, in this paper, we explore how the various experiences, demands, and social and relational dynamics in/of informal care (re)produce forms of isolation and loneliness. Using the framework approach to thematic analysis, we derived four themes: (a) the 'need' to be near the care recipient, and the implications for caregiver mobility; (b) the strong sense of responsibility for care, and the virtues of 'good' caring; (c) experiences of loneliness in the company of others and (d) postponement of social connection and minimising the self. The findings, we argue, are reflective of broader social and moral norms and expectations within experiences of home‐based informal care. [ABSTRACT FROM AUTHOR]

Healthcare professionals' advice on lifestyle behaviours is a key factor in improving a nation's health. Although allied health professionals have been well placed to provide such advice as part of patient care, little is known about the characteristics of allied health practitioners who discuss lifestyle topics with patients. This paper focused upon an overlooked avenue for lifestyle advice regarding an allied health profession – osteopathy. A workforce survey including questions about four lifestyle topics (including diet/nutrition, smoking/drugs/alcohol, physical activity/fitness, and stress management) was distributed to a nationally representative sample of Australian registered osteopaths in 2016. Separate multivariate logistic regression and Poisson regression models were developed to determine the most important predictors of the discussion of lifestyle factors. Amongst the 992 participating osteopaths, 89%, 49%, 38%, and 18% often discussed physical activity/fitness, stress management, diet/nutrition, and smoking/drugs/alcohol with their patients, respectively. Approximately 30% of participating osteopaths discussed at least three lifestyle topics with patients. Varied predictors were identified for discussing each lifestyle topic. Osteopaths who often discuss diet/nutrition in patient management plans were more likely to often discuss smoking/drugs/alcohol (OR = 14.13), physical activity/fitness (OR = 2.71), and/or stress management (OR = 1.69). In conclusion, lifestyle factors are often discussed with patients as part of osteopathy treatments in the Australian healthcare context. Osteopaths are well positioned to initiate discussions regarding patient lifestyles, and such discussions may be an effective contribution to health promotion. [ABSTRACT FROM AUTHOR]

Informal carers provide the majority of care to older Australians and play an essential role in assisting older people with complex care needs to remain living in their own homes. As such, carers are increasingly faced with systemic responsibilities, including coordinating services across multifaceted health and aged care systems and negotiating treatment and supports. The aim of this study was to explore how systemic complexity and associated work is experienced by carers of older adults and what personal capacities carers draw on in managing the systemic work. A descriptive phenomenological approach guided the research. Semistructured interviews were conducted with 16 carers of community‐dwelling older adults with complex care needs recruited through a local health service. Giorgi's phenomenological data analysis methods (1997) was utilised for the data analysis. Two main themes were derived from the analysis: Becoming part of the caring system and Mastering the caring system. The findings indicate that the majority of carers perceived the work of interacting with multiple systems and services as a burden and an onerous obligation. Furthermore, change in the health or social circumstances of the older adult amplified differences in the nature of the systemic work and concomitantly revealed differences in carers' capacities. This paper reveals that the caring system is in some sense disposed to create disparities, as carers' specific capacities were integral to mastering the systemic work. An understanding of informal care work that supports older people to live in the community can assist health care professionals and service providers to better identify carer requirements and assess carer capacity to manage the work. [ABSTRACT FROM AUTHOR]

There is established literature on health workers' attitudes towards working with people living with stigmatised health conditions and behaviours, such as HIV, hepatitis C and injecting drug use. Less is known about health workers' attitudes and concerns around providing care to people living with hepatitis B virus (HBV), which is concerning as research indicates that negative attitudes may impact on the quality of care provided to these populations, with adverse health outcomes for clients. The aim of this paper is to examine health and medical workers' concerns about providing care to people living with HBV, and the factors that may influence these concerns. Australian health and medical workers (n = 551) completed an online survey measuring their concerns about providing care to people living with HBV, stigmatising attitudes towards this group, perceived comfort of themselves and colleagues in providing care towards clients with HBV, and witnessing their colleagues behaviour in a discriminatory way towards clients with HBV. Multiple regression was used to ascertain factors predictive of health workers' concerns about working with clients with HBV. Results showed that older participants and those who had spent less time working in the health and medical field had greater concerns about caring for people living with HBV. Workers who did not know someone living with HBV, who were less comfortable around clients with HBV, who perceived their colleagues to be less comfortable working with clients with HBV, and who had more negative attitudes towards this group also had greater concerns around providing care to people living with HBV. Efforts should be made to improve health and medical workers' attitudes towards working with people with HBV. This may also improve workers' level of comfort with people with HBV and reduce the reported reticence they have towards working with this client group. [ABSTRACT FROM AUTHOR]

Objective. This research aimed to validate the Informal Supporter Readiness Inventory (ISRI) for evaluating the preparedness of informal supporters, in an Australian sample, to provide assistance in the context of intimate partner violence (IPV). Method. The ISRI's four distinct factors were each assessed with separate confirmatory factor analyses (CFA). Reliability was calculated using Cronbach's alpha values, and test‐retest reliability was evaluated using intraclass correlation coefficients. Additionally, the ISRI's validity was assessed through Pearson's correlations with both convergent and divergent measures. Results. The CFAs supported the four distinct factors of the ISRI: normative, individual, situational‐emotion, and situational‐assessment. The measure exhibited good‐to‐excellent internal consistency across these factors and good test‐retest reliability at four weeks. Convergent validity was supported by a strong positive correlation with the Intent to Help Friends Scale, while its weak association with the Generic Job Satisfaction Scale supported divergent validity. Discussion. The ISRI has emerged as a practical instrument with relevance to certain Australian sociocultural dynamics, offering utility in both research and clinical settings. The ISRI supports a network‐oriented approach to IPV survivor support, assisting the alliance between formal and informal support mechanisms. Future research should focus on broadening the ISRI's applicability by assessing its effectiveness across diverse Australian populations. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate how legal professionals in Australia responded to the mental distress experienced by clients with insecure visa status in the Fast Track Assessment (FTA) process. This article reports on survey findings obtained from 38 legal professionals followed up by focus groups and interviews with 16 participants. The participants were all involved in providing legal assistance to refugees and asylum seekers with insecure visa status, the majority delivering that assistance via pro bono or community law centre settings. An inductive thematic analysis was used to analyse the data. The study uncovered a complex interplay of practical challenges, emotions, and ethical dilemmas that legal professionals encounter while assisting asylum seekers in the FTA process. The study participants' experiences highlight that a migration law practice frequently becomes the initial setting where asylum seekers disclose mental distress. Legal professionals found themselves simultaneously witnessing human suffering and endeavouring to prevent re‐traumatisation of their clients. Responding to distress was difficult to achieve as the operational setting in which they provided legal assistance and the prevailing hardline political messaging by the Australian government toward asylum seekers who arrived by boat was hostile and (re)traumatising. There is a pressing need for more trauma‐informed education and training for both current and future legal professionals. Findings are discussed alongside practical suggestions for trauma‐informed interviewing for legal professionals who interview asylum seekers. [ABSTRACT FROM AUTHOR]

Loneliness research has tended to focus on mainstream and older populations despite evidence that non‐mainstream groups, like those experiencing homelessness, may experience loneliness differently. Limited existing research indicates that (a) people who have been homeless experience loneliness as multidimensional (as a pluralistic, non‐unidimensional emotion, experienced specific to lacked relationships) and (b) mainstream loneliness scales may be inappropriate for this group. The current study piloted and appraised the feasibility the short version of the Social and Emotional Loneliness Scale for Adults (SELSA‐S) among 129 Australian adults with a lived experience of homelessness. Exploratory Factor Analysis and an observational questionnaire appraisal were used to assess factorial and content validity and showed the measure did not fit this sample as well as in mainstream samples. Removal of items that participants found difficult to comprehend/answer improved the factorial fit of the scale. In conclusion, the SELSA‐S may be inappropriate for measuring loneliness among people who have experienced homelessness. Further research needs to explore the potentially different structure of loneliness among marginalised groups so that a better understanding of loneliness can be reached. [ABSTRACT FROM AUTHOR]

Prior to its introduction in Australia, many people opposed euthanasia—or voluntary assisted dying as it is known—because of its potentially detrimental impact on grief and bereavement outcomes for family members and carers. We examine the novel experiences of grief and bereavement of VAD for family members and carers who were going through, had gone through, or were contemplating VAD, juxtaposing the international literature on grief and bereavement. As such, 42 semistructured interviews with family members and carers were undertaken in the state of Victoria, which was the first jurisdiction to legislate in favour of VAD. Interviews explored many themes around end‐of‐life decision‐making in order to ascertain the ways in which VAD helped or hindered grief and bereavement processes. A thematic analysis of the interview data was undertaken using QSR NVivo software. Four key themes were identified: values and meaning‐making, expression of a continuing bond, anticipatory grief, and the burden of care associated with supporting loved ones going through VAD. These themes were juxtaposed with the key literature on grief and bereavement to demonstrate how VAD presents novel challenges for carers. We argue that while VAD deaths share similar characteristics to other deaths; in some respects, grief and bereavement outcomes for family members and carers are unique. For family members and carers helping a loved one go through VAD, they were able to derive a sense of meaning from fulfilling their wishes and striving for them to have a "good death"; they were able to maintain a bond with them through advocacy of VAD and unique rituals; and they were able to plan and prepare effectively by knowing the exact time of death. Family members and carers also noted that VAD presents some significant challenges for grief and bereavement, especially in terms of the impact of VAD on familial relationships and burdens associated with moral predicaments. Nonetheless, VAD was generally viewed positively by family members and carers, who expressed gratitude for mitigating their loved one's suffering. [ABSTRACT FROM AUTHOR]

There has been growing interest in exploring factors that influence the success or otherwise of welfare policies in democratic countries, such as the interrelationships between the proposed policy and the context it will be introduced into, such as the sociodemographic characteristics of the population and the population's previous experience with welfare policies. However, there has been little exploration of factors that could influence general population support for long-term care for older people. The aim of this study was to investigate the general population's attitudes for determinants of high-quality aged care and different mechanisms for funding and any impact of individual characteristics on these. A representative sample of the Australian general population aged 18 years and over (N = 10,315, 52% female, 22% aged 65 years and over) drawn via quota sampling participated in the survey online. Participants were asked to rate the importance of a list of 10 determinants of quality care and their support for four models of funding, both using a five-point Likert scale. We identified consistently high expectations for long-term care services across the general population, especially among older people, females, those with a family member in care, and those living in rural or regional areas. In terms of how governments practically fund a high-quality long-term care system, we also identified broad support among the general population for both payment of a co-contribution towards the cost of care by older people using services and increased government funding for the system. Over 40% of participants said they would be willing to pay additional tax to improve access and quality of aged care services. While often neglected by governments in the past who assumed voter apathy on the topic, by comparison, our findings indicate that there is currently a strong appetite among the general population for improvements to the quality of care provided and that they are willing to consider changes to the funding model. [ABSTRACT FROM AUTHOR]

Purpose. To examine psychosocial and well-being concerns throughout the cancer experience, from prediagnosis to survivorship. Whilst most oncology research focuses on patients, the role and experiences of families and caregivers are increasingly recognised as a core component of health service delivery. Moreover, research suggests that geography is an important consideration, with evidence of rural inequities in health service provision and access. Aims. (i) To examine the unique patient and caregiver experiences of rural people in three rural cancer treatment centres in New South Wales (NSW) and (ii) to examine the barriers to rural patients and caregivers accessing psycho-oncological support in NSW. Methods. A convergent parallel mixed-method evaluation of the psychosocial experiences of rural patients and caregivers accessing cancer services through three health services in rural NSW was undertaken (N = 125). Measures of psychological distress as well as quantitative and qualitative barriers data were collected. Results. Approximately, one-third of the participants reported moderate to severe distress. Patients and caregivers reported systemic, intrapersonal, interpersonal, and pandemic-specific barriers in accessing quality psychosocial healthcare. Conclusions. These results suggest that cancer patients and caregivers in rural NSW may experience elevated levels of psychological distress and barriers in accessing psychosocial care. The combination of high psychological need for patients and caregivers with reduced availability of psychosocial support services has substantial implications for psychological wellbeing and service provision. Underdetection of psychosocial need and a lack of support services pose a significant challenge for rural people with cancer and for those who care for them; this must be an urgent priority for quality improvement and equitable healthcare provision. [ABSTRACT FROM AUTHOR]

Background. The issue of identity has been widely explored among migrant populations in western countries in the context of cultural integrations and acculturations. However, there is less evidence on identity as a determinant of health and social wellbeing. This study reports on identity as a determinant of health among the South Sudanese community who arrived as refugees through an Australian humanitarian program in the early 2000s. Methods. A qualitative study was undertaken, underpinned by a phenomenological framework that characterised the lived experiences of adult South Sudanese in Sydney, Australia. Semistructured in-depth interviews explored how 26 participants identified themselves in Australia, including changes in their experiences over time, their social and general life situation in Australia, and how they felt perceived in Australia. Data were audio-recorded using a digital voice recorder, transcribed verbatim, coded, and categorised into themes using interpretive thematic analysis. Results. Participants described a multiplicity of interconnected domains that governed the negotiating and making sense of identity, in turn mediated by other interwoven personal and structural factors that shaped experience and perception. Expressions of hope, pride, and achievement were threaded through several of the interviews, particularly in relation to their children. There were also frustrations related to employment challenges and discrimination that limited identity ownership. Conclusions. The evolving and often conflicting factors identified by participants can shape their sense of belonging, integration, and social and mental wellbeing. A deeper, more nuanced understanding of bicultural identity within a strengths-based framework is needed, with improved partnerships and services to support and strengthen South Sudanese community integration, belonging, and acculturation in Australia. [ABSTRACT FROM AUTHOR]

Residents living in residential aged care facilities (RACFs) continue to experience medication-related harm. There is ongoing interest in expanding the role of pharmacists, including on-site pharmacists (OSPs), to help improve medication management in RACFs. The objectives of this mixed-methods study were to explore the extent and ways in which on-site pharmacists (OSPs) were normalised within RACFs as part of a complex intervention seeking to improve medication management. This study consisted of semistructured interviews informed by normalisation process theory (NPT) and a quantitative survey adapted from the normalisation measure development questionnaire (NoMAD) instrument which is underpinned by NPT. Semistructured interviews with prescribers, RACF managers, RACF nursing staff, OSPs, residents, and family members (n = 47) indicated that most participants supported OSPs within RACFs that having OSPs in RACFs made sense and was perceived as beneficial and that participants were invested in working with OSPs who often became part of routine practice, i.e., "normalised." Prescribers, RACF managers, and nursing staff (health care team members) completed the adapted survey, and their responses (n = 16) strongly complemented the positive qualitative findings. Overall, OSPs were positively appraised by health care team members as well as residents and family members and were generally considered to be normalised within their respective RACFs. This study explored the normalisation of OSPs within RACFs. From the perspective of residents, family members, health care team members, and OSPs, OSPs could become part of routine practice within Australian RACFs. The findings of this study also highlighted the value of using theory to guide the evaluation of a pharmacist intervention in RACFs and the utility of applying NPT in a new setting, Australian RACFs. Importantly, the findings of this study could help inform the future role of OSPs working and the rollout of OSPs within Australian RACFs. [ABSTRACT FROM AUTHOR]

The International Society for Pediatric and Adolescent Diabetes has identified school as a critical context for adolescents with type 1 diabetes (T1D) who typically hold a fluctuating, though growing, amount of responsibility for diabetes self-management across this time. When parents use frequent autonomy-supportive communication to maintain a mutually agreeable sharing of responsibility for diabetes management with their adolescent, better outcomes are achieved. There is, however, a dearth of research examining the way adolescent responsibility is managed at school. This cross-sectional study investigated adolescents' perspectives of sharing responsibility for T1D management at school and the extent to which these were concordant with parent perceptions. Sixty adolescents (10–19 years) and fifty-five parents completed questionnaires measuring the perceived impact of diabetes on adolescents' school activities and respective involvement in the management of responsibility for school-based diabetes care. Adolescent questionnaires also measured perceptions of autonomy supportiveness (Health Care Climate Questionnaire) and communication quality (frequency, mode, autonomy), in relation to diabetes management. Differences by age and inter-rater agreement between parent and adolescent dyads were examined. Results showed that parents and adolescents did not agree about their relative involvement in setting up diabetes management strategies or the impact of diabetes on school activities. There was no difference in the involvement of older adolescents relative to younger students. Adolescents predominantly communicated about school diabetes care in person, though some reported no communication with school staff (25%) or healthcare workers (36%). Only thirty nine (65%) reported having a diabetes school plan. Nineteen (32%) perceived little or no involvement in setting up diabetes care strategies for the year and most had not attended a school-related meeting. These results suggest more explicit inclusion of adolescents in formal school support strategies may better represent their unique perceptions of responsibility, enabling the consensual sharing of responsibility that is associated with better outcomes. [ABSTRACT FROM AUTHOR]

Purpose. A cancer diagnosis significantly impacts daily life, particularly for those living outside of major cities who must travel to receive cancer treatment. This study investigated the impact of cancer and travelling for treatment on the employment of rural cancer patients and their caregivers. Methods. Cancer patients staying in subsidised accommodation lodges in Queensland, and their nominated caregivers, described employment status prior to diagnosis in a structured interview. Three months later, they answered several open-ended questions about the impact of cancer and travelling for treatment on their employment. Descriptive statistics and thematic analysis were used to report and analyse responses. Results. Of 308 rural cancer patients in paid employment prediagnosis, 70% reported a change in employment postdiagnosis, with 62% of these patients no longer working. Many of those still employed postdiagnosis required extended leave, flexible working arrangements, and a gradual return to work, particularly for those experiencing ongoing treatment side effects. Of the 102 rural caregivers in paid employment prior to the patient's diagnosis, 56% reported a change in employment after diagnosis, with 37% of these caregivers no longer working. Many caregivers were unable to work while at the lodge, except for those with flexible or remote work arrangements and low caregiver burden. Financial stress from loss of income and limited support in returning to work were common experiences. Conclusions. Disruptions to employment are common for people in rural areas affected by cancer. Support from employers is vital, including offering tasks that can be completed remotely or require less physical effort. [ABSTRACT FROM AUTHOR]

Priority Populations in oral health are defined as people from remote areas of Australia, low-income households, specialised medical needs, and Indigenous people. Children in these groups have irregular dental visiting patterns and a higher proportion have never accessed services. The Child Dental Benefits Schedule (CDBS) is a means-tested policy which provides financial support for eligible children to access dental services. This study aimed to explore how the introduction of CDBS affected dental visiting behaviours of Priority Populations. The outcomes of interest were the use of CDBS and its monetary benefit in the four-year period post-CDBS implementation based on a sample from the Longitudinal Study of Australian Children. Binary logit and linear models with interaction terms were used to estimate the effect of priority status and previous reported dental visiting behaviours on the probability of use and the value of subsidy claimed from CDBS. Of the children with no previous access to dental services, 33.7% were CDBS users, compared to 29.9%, 41.1%, and 44.1% who reported historically accessing services once, twice, and thrice, respectively. After adjustment for confounders, there were no significant interactions between Priority Populations and previously reported visiting behaviours; however, the pattern of lower utilisation by those with no previously reported access was evident. The state of Western Australia had a significantly lower proportion of estimated utilisation compared to all other states and territories. Children from low-income families benefitted relatively more from CDBS compared to other income groups; however, only a small proportion of the program was used to subsidise new utilisation of dental care. Children with unfavourable past dental visiting behaviours are likely to have higher unmet need, face barriers to access, and the oral health benefit is likely to be the highest. Policymakers should consider how this and similar programs can better target populations with difficulty accessing services, which will also contribute to reducing inequalities in oral health outcomes. [ABSTRACT FROM AUTHOR]

As part of a larger study examining the perceived impacts of health system stress in Queensland, Australia, caused by the COVID-19 pandemic, this study explored the experiences and perspectives of a sample of people with spinal cord injury (SCI) and critical stakeholders to identify secondary complications, access concerns, and potential solutions in the context of the pandemic. This study utilised a multimethods qualitative design. Thirty-four people with SCI completed an online survey between August and November 2021, recruited from an online Spinal Life Australia Peer Support Group. Sixteen SCI expert stakeholders, recruited from the Queensland Spinal Cord Injuries Services, consumer support organisations, and funding agencies, participated in one of two expert stakeholder forums in September 2021, focusing on impacts of the pandemic on the services they provided. Survey and forum results were analysed thematically. Results highlighted service disruption wherein people with SCI faced difficulty accessing health and community services (including rehabilitation) and personal supports. Reduced access led to secondary complications in physical health, psychosocial, and occupational domains. Solutions for safeguarding access to care, including action-ready back-up plans, effective technology and training, collaboration of service networks, and forward planning for system disruption, consumables access, staff support, and advocacy are required to best support vulnerable populations and the supporting staff in times of crisis. In conclusion, COVID-19 disrupted access to specialist SCI and mainstream health, rehabilitation, and social care services, resulting in functional decline and physical and psychosocial complications. While people with SCI and their service providers attempted to innovate and solve problems to overcome service access barriers, this is not possible in all situations. Improved planning and preparation for future system disruptions mitigates risks and better protects vulnerable populations and service providers in times of severe system stress. [ABSTRACT FROM AUTHOR]

Older people prefer to remain living in their own home for as long as possible; however, many require support to do so through health and other care services provided in the home. This study aimed to explore the trends in usage of a home-based care service by older people in metropolitan Melbourne and factors associated with unplanned hospitalisations. This longitudinal study analysed episodes of home-based care for people aged ≥65 years between 2006 and 2015. An episode of care was defined as the period of time during which the home care services were provided to the client. Care episodes culminated in a planned discharge from the service or an unplanned hospitalisation. Descriptive statistics and multivariable logistic regression were utilised to investigate the characteristics associated with unplanned hospitalisations. Utilisation of home-based care services over the 10-year period showed an increasing rate of use by people aged ≥85 years and a reduced usage rate by females aged 70–84 years and males 75–79 years old. Of 170,001 episodes of care, 43,608 (25.7%) resulted in an unplanned hospitalisation. Home-based care delivered to people aged ≥85 years showed an increasing rate of episodes ending in an unplanned transfer to the hospital. Between 2006 and 2015, individuals aged 85–89 years displayed a rate increase of 18.7% in episodes ending in an unplanned hospitalisation; for those aged ≥90 years, the rate rise was 43.6%. Factors associated with an unplanned hospitalisation included advancing age, male gender, living alone, cognitive dysfunction, and the complexity of medical issues. Health policy has focussed on providing services to enable older people to remain in their own home. The increasing rate of unplanned hospitalisations for community-dwellers aged ≥85 years suggests more support is required to enable ageing in place. [ABSTRACT FROM AUTHOR]

People who are homeless are disproportionately impacted by the COVID‐19 pandemic, and by government responses to the pandemic. This study maps the perceptions of homelessness service workers in Australia, about the impacts of the COVID‐19 pandemic and government responses to it on people who are homeless. An electronic survey was distributed to homelessness service across Australia in June/July 2020, following Australia's 'first wave' of COVID‐19. Fifty‐nine homelessness services from all eight states/territories responded. Perceptions of impacts on people who are homeless were mapped in six themes: (1) changes in the types of people presenting, (2) overall impacts on peoples' lives, (3) impacts on mental health, (4) impacts of changes in service delivery, (5) impacts of government support and (6) ongoing impacts. The COVID‐19 pandemic, and government responses to the pandemic, have affected every aspect of the lives of people who are homeless in Australia. There is a continuing need to support people who are homeless as the world transitions to the 'new normal' of COVID‐19, particularly as rates of homelessness increase. Understanding impacts is vital to informing relevant and effective health, social and other supports for this group. [ABSTRACT FROM AUTHOR]

Men volunteering to mentor other men is a growing form of social engagement in Australia. Masculine norms associated with not disclosing emotional distress or discussing loneliness are often set aside by participating in these one‐to‐one relationships. Mentors have reported improvement in their well‐being and a desire to contribute more. In this phenomenological study, which draws on hermeneutic methodology, 12 men who voluntarily met and mentored another adult man for a minimum of 6 months participated in a semi‐structured interview. Findings showed non‐judgement and deep listening facilitated a rewarding and personally developmental relationship. Most voluntary mentors experienced substantial changes in their masculine views, particularly with the regard to trust and openness with others. This experience has implications for men realising their ability to engage others and for community well‐being. [ABSTRACT FROM AUTHOR]

Deprescribing aims to reduce polypharmacy and inappropriate medication use. Both General Practitioners (GPs) and older adults have expressed a willingness to consider deprescribing. However, deprescribing is often deferred in practice. The aim of this study was to identify factors which influence GP and older adult decisions about deprescribing in primary care. Semi‐structured interviews were used in this qualitative study, conducted in a regional area in Australia. Participants included GPs and adults aged 65 years or older, using five or more medications and living independently in the community. Data were collected between January 2018 and May 2019. Thematic analysis was used to analyse the verbatim transcribed interviews using NVivo 12. A total of 41 interviews were conducted, 25 with older adults and 16 with GPs. Four key themes influenced deprescribing decisions: views of ageing, shared decision‐making, attitudes toward medication use and characteristics of the health care environment. Discussions of deprescribing were limited by the influence of negative stereotypes toward age and ageing, a lack of older adult participation in shared decision‐making, a positive attitude towards ongoing medication use and perception of the normality of using medications in older age. Time constraints, poor communication about prescribing information and unclear roles regarding responsibility for deprescribing also prevented discussions. Continuity of care, involvement of older adults in medication reviews and GPs who asserted their generalist role were the main factors which promoted discussion of deprescribing. GPs are well placed to discuss deprescribing with their older patients because they are trusted and can provide continuity of care. Actively encouraging and involving older adults in medication reviews in order to understand their preferences, supports shared decision‐making about deprescribing. Active involvement may also reduce the influence of negative views of ageing held by both older adults and GPs. [ABSTRACT FROM AUTHOR]

Inequity in health outcomes is pervasive, with poorer health outcomes identified in rural, regional and remote communities. An international call to action emphasises the need for service models adapted for less well‐resourced settings. The aim of this study was to identify key elements of a framework for the adaptation of specialist community‐based child and family health (CFH) service models for rural and other under‐resourced settings. A modified Delphi study was undertaken with a 12‐person expert panel in CFH including Australian and international professionals and parents from rural and remote communities. The study was informed by the WHO Framework for Strengthening Health Service Systems building blocks, the outcomes of an integrative review of literature and a Participatory Action Research study. Experts assessed 107 potential elements for service model development and rated them for importance when adapting service models for different contexts. Round 1 of the Delphi generated considerable consensus with 80 of the 107 potential elements identified as necessary for the service model adaptation framework. A further 17 elements for CFH service models were added in round 2. While multiple varied elements are important for adapting CFH service models for diverse settings, some elements had common themes. Experts highlighted the importance of community engagement and participation; utilising both data and local knowledge to develop a robust understanding of the community context; and the need for a flexible approach to funding and modes of service delivery to address barriers to implementation and access. [ABSTRACT FROM AUTHOR]

Older Australians may live up to 10 years in ill health, most likely chronic disease‐related. Those with multimorbidity report more healthcare visits, poorer health and take more medications compared with people with a single chronic disease. They are also at higher risk of hospital admission and poor quality of life. People living with multimorbidity are considered to have "complex care" needs. A person‐centred approach to healthcare has led to increasing use of in‐home nursing support, enabling older people to receive care at home. Our prospective observational study describes the profile and management of home‐based care for older people with complex care needs and examines changes in their quality of life over 12 months. Routinely collected data were analysed, including demographics, medical history, medications and the visit activity of staff providing care to participants. Additional health‐related quality of life and hospitalisation data were collected via quarterly surveys and analysed. Fifty‐two participants (mean age 76.6 years, 54% female) with an average of eight diagnosed health conditions, received an average of four home care visits per week. Almost half the participants were hospitalised once during the 12‐month period and experienced a significant decline in overall quality of life and in the dimensions measuring independent living and relationships over the study period. If ageing in place with good quality of life is to be realised by older adults with multimorbidity, support services including home nursing need to consider both the biomedical and social determinants perspectives when addressing health and social care needs. [ABSTRACT FROM AUTHOR]

This study aims to understand the effects that role‐diverse online communities have on informal carers, particularly in providing support. Australian Facebook communities used to support those involved in the National Disability Insurance Scheme (NDIS) were explored. Social network analysis of an NDIS‐centred community was conducted, based on 909 publicly visible interactions that occurred in May–June and August–September 2019. Two managers of informal NDIS communities were interviewed, the transcripts of which were analysed using NVivo. Results from the two analyses suggest that both an individual carer's attributes and the collective attributes of the network defined the capability of the network to support the carer, often depending on the experiences and expertise of those offering support. Support was unconstrained by role, though differing goals and expectations often impeded collaboration between roles. The outcomes of support provision were shown to affect not only individuals but also the collective network. However, while effective, community spaces currently lack organisational backing and resources available to informal communities are constrained. Findings drawn from this study, which we believe are applicable to a broader, international context, are three‐fold. Firstly, it is recommended that informal support communities clearly define purpose and create multiple channels to ensure that all participants can meet their needs. Secondly, the benefits of participation to organisations should be further explored. Finally, the use of social network analysis as a method in this study has provided significant insights into the communication patterns and activities of the community under study. Future use of SNA in similar studies may provide further insight into the effectiveness and interactions of community‐based support methods. [ABSTRACT FROM AUTHOR]

Lesbian, gay, bisexual, transgender and gender diverse people, and queer people (LGBTQ people) are at increased risk of some chronic diseases and cancers. NSW Health palliative care health policy prioritises equitable access to quality care, however, little is known about community members' perspectives on palliative care. This study aimed to understand LGBTQ community views and preferences in palliative care in NSW. A community survey and follow‐up interviews with LGBTQ people in NSW were conducted in mid‐2020. A total of 419 people responded to the survey, with 222 completing it. Six semi‐structured phone interviews were conducted with participants who volunteered for follow‐up. The sample included LGBTQ people with varied levels of experience in palliative care. Thematic analysis was conducted on survey and interview data, to identify perceived barriers and enablers, and situate these factors in the socio‐ecological model of health. Some perceived barriers from community members related to considering whether to be 'out' (i.e., making one's sexual orientation and gender known to services), knowledge and attitudes of staff, concern about potential substandard care or mistreatment (particularly for transgender health), decision making, biological family as a source of tension, and loneliness and isolation. Perceived enablers related to developing and distributing inclusive palliative care information, engaging with community(ies), fostering inclusive and non‐discriminatory service delivery, ensuring respectful approaches to person‐centred care, and staff training on and awareness building of LGBTQ needs and issues. Most of the participants who had experienced palliative care recounted positive interactions, however, we identified that LGBTQ people require better access to knowledgeable and supportive services. Palliative care information should be inclusive and services respectful and welcoming. Particular consideration should be given to how services respond to and engage with people from diverse population groups. These insights can support ongoing policy and service development activities to further enhance palliative care. [ABSTRACT FROM AUTHOR]

Carers of people living with a disability, mental health problems, alcohol or drug dependency, chronic condition, terminal illness or who are frail due to age may experience negative caregiving impacts. Although carers' social isolation has been reported in many qualitative studies, it has largely been neglected in quantitative studies. Using data collected in the Carers NSW 2020 National Carer Survey, this large‐scale quantitative study aimed to identify the extent of Australian carers' social connectedness and what factors may be related to their social well‐being. The validated Friendship Scale was used to measure social connectedness of 5585 carers. More than half (56.2%) of these carers were socially isolated. Analysis found that a longer duration of caring, more time spent weekly caring, living with the care recipient, caring for a greater number of people, receiving no help from others, higher reported psychological distress and reporting perceived needs were all associated with greater social isolation. Identifying as female or nonbinary/gender diverse, identifying with a culturally and linguistically diverse background, and caring as a parent, former partner or young carer were also related to poorer social connectedness. Health and social services need to consider the needs of carers, identify carers who are socially isolated and provide resources to promote social connectedness. Greater attention in practice and research to focus on carers' social connectedness to address this crucial caregiving experience is required. [ABSTRACT FROM AUTHOR]

This research aimed to explore the needs, potential roles and implementation of Bilingual Community Navigators (BCNs) in providing navigation support for patients in general practice settings in Australia. A total of 19 participants (general practitioners, practice managers, practice nurses and receptionists) from five general practices in Sydney where most of the patients spoke a language other than English were interviewed about their views on needs, potential roles and implementation of BCNs in general practice settings. Data were collected between August 2019 and July 2020. The interview transcripts were inductively analysed for themes. Themes emerged across four broad categories: patients' barriers to access health and social care services; potential roles of BCNs; recruitment, training, and employment of BCNs and considerations and anticipated barriers to BCNs' role. Many barriers both at the patient and at the service provider levels in accessing healthcare and social care services were consistent with the Levesque et al. access framework including lack of understanding of the health system, language and cultural barriers, hesitancy to approach general practice and problems navigating services. Participants believed that BCNs would be able to help overcome these barriers through health education, support in booking appointments, arranging transport, providing language and cultural support and improving communication with the health services. Conditions for effective implementation of BCNs in practice included proper training of the navigators to ensure patient confidentiality and addressing organisational/system barriers such as lack of a funding mechanism, a clear role definition of BCNs and acceptance of BCNs by patients. BCNs potential role in facilitating access to appropriate care by culturally and linguistically diverse (CALD) patients in general practice warrants further evaluation in the context of the Australian healthcare system. [ABSTRACT FROM AUTHOR]

Lifeline Australia operates crisis support services through Lifeline Crisis Supporters. An integral part of their role is to conduct online suicide risk assessments with help‐seekers. However, there is limited literature regarding suicide risk assessment practices for this population. This study aimed to examine how suicide prevention training, vicarious trauma and fears impacted suicide risk assessment behaviours of Lifeline Crisis Supporters. A cross‐sectional survey design was used to recruit a volunteer convenience sample of 125 Lifeline Australia Crisis Supporters (75.2% females; Mage = 54.9) in 2018 to participate in an online survey. Findings revealed that those with more suicide‐specific training had less risk assessment‐related fears, and that fears were not related to attitudes towards suicide prevention. There was no significant relationship between vicarious trauma and amount of training or years of experience in the role. Further, participants with higher levels of vicarious trauma demonstrated significantly more negative attitudes towards suicide prevention. Overall, training appears to be a significant factor in suicide risk assessment practice behaviours of Lifeline Crisis Supporters, highlighting a need for ongoing training and support for them. This research also suggests that whilst fears exist, they do not significantly impair Lifeline Crisis Supporters' ability to undertake suicide risk assessment. [ABSTRACT FROM AUTHOR]

Australians fail to meet the daily recommended two and five serves of fruit and vegetable respectively, which increases mortality risk for non‐communicable diseases such as cardiovascular disease and type 2 diabetes. This study aimed to evaluate the effectiveness of an online intervention delivered through social media on food literacy and fruit and vegetable consumption in Australian adults. In a pre‐post single group experimental study, 29 participants completed the "online MedDiet challenge", a four‐week intervention delivered via Facebook. Infographics, recipes and informational videos aligned with food literacy concepts related to the Mediterranean Diet were shared with participants. Outcome measures included a validated food literacy questionnaire with two questions from the National Nutrition Survey to record fruit and vegetable consumption. The mean age of participants was 52 years (range: 25–67 years). Post intervention, food literacy improved between 21%–45% across each survey component. Participants also reported an increase in fruit and vegetable consumption by 0.6 and 1.3 serves per day (p < 0.05) respectively. Social media holds potential for increasing fruit and vegetable consumption in adults through food literacy. Future research should focus on longer studies and larger cohorts to confirm that food literacy plays a key component to maintain sustainability of such interventions. [ABSTRACT FROM AUTHOR]

Employment is frequently desired by persons who experience homelessness yet is often elusive. Little is known about the range and effectiveness of employment‐based interventions evaluated in existing literature on key psychosocial outcomes including employment participation, mental well‐being, housing tenure, community integration and substance use. To identify and synthesise existing studies, we conducted a systematic review of effectiveness using the methodology proposed by the Joanna Briggs Institute (JBI) following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Following the removal of duplicates, we screened 13,398 titles and abstracts, and reviewed 79 studies at the full‐text review stage using two independent raters. A total of 16 studies met criteria for inclusion in a narrative synthesis and were subjected to critical appraisal. The majority of studies were conducted in the US (n = 14; 87.5%) with other studies published in Canada (n = 1; 6.3%) and Australia (n = 1; 6.3%). Interventions evaluated in existing studies included combined substance use and vocational skills interventions (n = 7; 43.8%), supported employment (n = 6; 37.5%), and integrated supports including an employment component (n = 3; 18.8%). The effectiveness of these interventions on employment, mental well‐being, housing tenure, community integration, and substance use is presented. Findings suggest that research evaluating employment interventions for persons who experience homelessness is in an early stage of development. Researchers and practitioners may consider collaborating with persons with lived experiences of homelessness and practitioners in co‐designing and modifying existing approaches to target key outcomes more effectively. Policymakers may consider allocating resources to such initiatives to further the development of practice and research aimed at supporting persons who experience homelessness to secure and sustain employment during and following homelessness. [ABSTRACT FROM AUTHOR]

Incarcerated young people (aged 18–24) with a history of problematic substance use are a particularly vulnerable group, with a higher risk of mortality and return to custody compared to their older counterparts. Yet, there is limited research investigating service accessibility for this population. This study aimed to address this gap by investigating the characteristics of young people exiting prison on the 'Connections Program' (Connections) and their access to support services. Connections is a transitional program with a remit to link people with problematic substance use exiting prison in New South Wales, Australia, to health and social services in the community. We used an explanatory sequential mixed methods approach including (1) a retrospective cohort study of young people on Connections (n = 359), utilising self‐reported data collected in a routine pre‐release questionnaire from January 2008 to February 2015 and (2) a qualitative survey with Connections caseworkers (n = 10). In stage one, descriptive statistics were calculated to produce a profile of sociodemographic and health characteristics of young people with problematic substance use exiting prison. In stage two, qualitative data were thematically analysed to explore the accessibility of services to meet young people's needs from the perspective of caseworkers. The study found young people experienced substantially poorer mental health than the general population, and the vast majority had received treatment for a mental health issue (96.5%). Illicit substance use prior to incarceration was common (91.5%). Caseworkers reported substantial barriers to service accessibility in the community related to intersecting social disadvantage and co‐occurring mental distress and substance use. Caseworkers have front‐line knowledge of how gaps and barriers in services impact transition from prison and identified longer‐term case coordination, inter‐agency collaboration and holistic care as vital strategies to support young people in transition from prison to community. [ABSTRACT FROM AUTHOR]

Complex traumatic experiences, such as childhood sexual and physical abuse, occur in approximately 13% of the Australian population and are more common in women. Despite the prevalence of complex trauma and the need for evidence‐based services for survivors, no studies have explored treatment‐related experiences of women with complex trauma in Australia. The aim of the current study was to identify barriers and facilitators to treatment seeking and engagement amongst women who have experienced complex trauma in Australia. Semi‐structured interviews were conducted with 11 women with complex trauma histories who presented to a university outpatient psychology clinic. Content analysis was used to identify common barriers and facilitators to mental health treatment seeking and engagement amongst these women. Participants faced three key barriers when seeking treatment and engaging in mental health services: systemic issues, dissatisfaction with treatment and intrapersonal barriers (e.g. fear of the healthcare system). Appropriate support from supportive, committed health care workers was a facilitator to engagement and access. Findings from this study suggest that the mental health system in Australia may not be meeting the needs of women with complex trauma histories. Increasing access to affordable, trauma‐informed care and bolstering providers' knowledge of complex trauma, may enable some of the barriers identified by participants to be overcome. [ABSTRACT FROM AUTHOR]

The Child Dental Benefits Schedule (CDBS) is an ongoing scheme administered through the Australian Government providing eligible children funding for clinical dental treatment. This study aimed to investigate the access of dental services across children's early childhood and examine whether the CDBS has improved access to dental care. The longitudinal study of Australian children is an ongoing cross‐sequential cohort study with a representative sample of Australian children recruited in 2004. Birth (0–1 year) and kindergarten (4–5 years) cohorts were recruited through Medicare enrolment information at baseline and were representative of the Australian child population. Population‐weighted longitudinal mixed effects Poisson models with individual identifiers as a random effect were used to assess the effect of Medicare dental schedules on reported dental attendance. Prior to the implementation of the CDBS for both cohorts, the birth cohort reported the lowest attendance rate at age 4–5. The introduction of the CDBS increased the rate of dental attendance for the low household income group by 8% (95% CI: 1%, 15%) after adjusting for confounders. The model provides evidence that dental attendance increased with age and the Indigenous population have 31% (95% CI: 4%, 55%) lower attendance rate after adjustment. The increase in reported access to dental services and favourable visiting patterns in low‐income households during the operation of the CDBS provides some evidence that the schedule's primary aims to improve access to care in the child population are being met. Access to healthcare is multifaceted and the underutilisation of the schedule in the population warrants review of the schedule performance using other patient‐centred indicators. [ABSTRACT FROM AUTHOR]

Residents of Residential Age Care Facilities (RACFs) have particularly high rates of Emergency Department (ED) visits, with up to 55% being potentially avoidable (e.g. not resulting in a hospital admission). This is concerning as ED visits by RACF residents are associated with negative outcomes including longer hospital stays, iatrogenic illness, complications and mortality. Limited English proficiency (LEP) has significant negative impacts on the healthcare quality and outcomes for older people but has not been studied as a factor in ED visits from RACFs. This study aimed to examine if RACF residents with LEP have a lower rate of hospital admission via the ED compared to non‐LEP controls and identify any associated factors. We hypothesised that LEP‐related communication difficulties would reduce the ability to manage minor health issues in the RACF, leading to a lower proportion of LEP ED transfers being admitted. We used a parallel mixed‐methods design, comprising a quantitative matched cohort study of ED visit data from two Local Hospital Networks (LHNs) in South‐East Melbourne, Australia and secondary thematic analysis of 25 interviews with LEP residents, family carers and staff from two RACFs in the same region. We found no differences in the proportion of hospital ED transfers that led to admission (LHN1, 87.1% LEP, 85.6% non‐LEP controls, p = 0.57; LHN2, 76.0% LEP, 76.9% non‐LEP controls, p = 0.41) and no direct qualitative evidence suggesting that resident LEP affected decisions to transfer residents to ED, despite communication difficulties being reported during the transfer process. These results may be due to the high level of family carer involvement in residents' care identified in the qualitative study. However, additional research using different measures of LEP is recommended to further explore a broader range of cultural and linguistic factors in both rates of ED presentations and the decision‐making processes underpinning resident transfers to ED. [ABSTRACT FROM AUTHOR]

This qualitative study describes the impact of the first wave of the COVID‐19 pandemic on the provision of care by Australian primary health care (PHC) nurses. Participants were purposefully recruited following completion of a national survey about PHC nurses' experiences during the pandemic. Twenty‐five semi‐structured interviews were conducted by two experienced researchers and professionally transcribed. The mean duration of interviews was 38.5 min. Thematic analysis revealed three themes about the impact of COVID‐19 on PHC nurses' provision of care. These were: workplace adjustments, changes in healthcare delivery and concerns about long‐term health impacts of COVID‐19. The sudden disruption and de‐stabilisation of care delivery was reported as significantly impacting on initial service provision, although participants reported adapting quickly and finding new ways to deliver care. The impact of the pandemic on high risk communities and mental health support needs of clients created additional challenges, although some participants reported positive outcomes such as increased confidence of some clients to provide self‐care. There were concerns about the potential long‐term health impact on communities due to reduced levels of cancer screening, disrupted management of chronic conditions and reduced opportunistic health assessments. Findings from this study demonstrated how PHC nurses played an important role in the continued provision of PHC by adapting quickly to changed circumstances, adjusting and modifying clinical activities, and by monitoring for future potential negative outcomes from the pandemic. These findings are important for the future management of pandemics and inform the long‐term planning of PHC services. [ABSTRACT FROM AUTHOR]

This study used a qualitative, cross‐sectional design to address a gap in understanding the perspectives and practices of care planners and case managers in supporting consumer‐ directed care (CDC) for community dwelling people living with dementia. Semi‐structured telephone interviews were conducted with a convenience sample of n = 16 planners and managers from seven providers of the Australian home care packages (HCP) program in NSW (Australia). All interviewees described the aspirations of supporting choice within CDC as synergistic with their values and with person‐centred care. Some described new flexibilities within the more open‐ended planning conversations enabled by CDC. However, most acknowledged their capacity to enable choice for clients with dementia was limited by the capped care budgets, as well as the skills and time needed to support choice and decision‐ making. Organisational practice changes associated with the shift to a market‐based system were also perceived as limiting the capacity to support choices. Reducing centralised systems, increasing individual budgets and improving staff capacity to support decision‐making by people with dementia may help to improve this situation. However, results suggest a deeper need to re‐evaluate whether the CDC model is the most appropriate for supporting the rising numbers of people with dementia to age well in place. [ABSTRACT FROM AUTHOR]

Food and nutrition insecurity occurs when healthy and safe food cannot be obtained by socially acceptable means and arises as a result of complex interactions between socioeconomic and demographic determinants. These factors contribute to discrepancies in health and well‐being between men and women and may also explain differential rates of food insecurity. The objectives of this cross‐sectional study were to investigate the intersection between gender, education, nutrition knowledge and food security status within a high‐income country context. Australian adults over 16 years of age who identified as having primary responsibility for food in their household were recruited via social media and a panel. Respondents completed a self‐administered survey that included sociodemographic data, nutrition‐related knowledge and food security status. Food security was measured using the Australian Household Food and Nutrition Security Scale an adapted version of the United States Department of Agriculture Household Food Security Survey. Among the 1010 survey respondents, household food insecurity (HFI) was highly prevalent (43% were food insecure, with 26% of these severely food insecure). Gender may affect associations between education, nutrition knowledge and HFI. Education was significantly associated with HFI among women but not among men. Conversely, nutrition knowledge was significantly inversely associated with food security among men but not among women. Differences in determinants of HFI exist between men and women, and programs aimed at addressing food insecurity may be more effective if tailored accordingly to account for the social and demographic factors associated with HFI. [ABSTRACT FROM AUTHOR]

General community occupational therapists (OTs) work with clients experiencing chronic and complex conditions, some living with one or more comorbid common mental health issues (such as anxiety, depression or distress). This study aimed to describe the perspectives of general community OTs of their engagement with clients experiencing mental health issues; their perceptions of the implementation of routine screening in their practice, and the knowledge, skills and support they need to identify and support their clients' mental health needs. Six focus groups were undertaken with general community OTs (n = 21) from three Australian health services in rural, regional and metropolitan settings, between December 2020 and January 2021. Data were analysed using a team‐based framework approach. Three key themes were identified: (1) OTs' experiences working with people with mental health issues; (2) impacts of engaging with clients experiencing mental health issues on OTs; and (3) implementing routine mental health screening in general community OT practice. The latter had two sub‐themes: (i) identified considerations and (ii) education and system‐level support needs. General community OTs frequently work with clients with mental health issues. These experiences impact their practice in multiple ways. This study highlights opportunities for integrating routine mental health screening into general community OT practice and identifies the system and educational development required to support this enhancement to practice. Supporting general community OTs to routinely screen for mental health issues will enhance collaborative client‐centred care. Our findings may also have implications for other community‐based health professionals and services, particularly those delivered in clients' homes. [ABSTRACT FROM AUTHOR]

Arthritis is a long‐term musculoskeletal disease, requiring ongoing management. However, the financial burden of managing arthritis is under‐explored and is yet to be quantified from the perspective of individuals with the condition. Using an exploratory observational design, this study aimed to quantify arthritis‐related costs borne by a sample of working‐age adults aged 18–50 years who responded to the study advertisement. Participants completed a weekly cost diary for 6 weeks, detailing their personal non‐reimbursed (out‐of‐pocket) arthritis‐related costs. Financial distress was measured using the InCharge Financial Distress/Financial Well‐Being Scale. Costs data were analysed descriptively. Mann–Whitney U tests were used to examine relationships between residential location or employment status and out‐of‐pocket costs. Linear regression and Spearman's rho were used to estimate relationships between age or years since diagnosis and out‐of‐pocket costs, and between out‐of‐pocket costs and financial distress respectively. Sixteen adults (median age 40 years, 100% female) with a range of arthritis conditions (median (IQR): 8 (7.5) years since diagnosis) including rheumatoid arthritis, osteoarthritis, psoriatic arthritis, and ankylosing spondylitis completed the six‐week cost diary. All participants reported out‐of‐pocket expenditure related to arthritis. The median per‐person expenditure across the 6 weeks was AUD 1635. The highest reported costs per participant across the 6 weeks were for medical expenses (median AUD 197) and allied health appointments (median AUD 190). In total, the cohort spent AUD 15,272 across the study period. Perceived financial distress was high: median (IQR) financial distress 7 (2.25) on a 1 (lowest) to 10 (highest) scale. Positive relationships between age and costs, and between costs and financial distress were identified. These findings help us understand fiscal expenditure and related distress relevant to younger individuals with arthritis, and can be used to raise awareness of their financial concerns. [ABSTRACT FROM AUTHOR]

We examined the effect of person‐related factors on capacity to obtain needed healthcare for non‐COVID‐19 health conditions/disabilities under COVID‐19 restrictions. This was an anonymous online survey of Australian residents ≥18 years (3rd April to 2nd May 2020). We determined the ability to obtain care needed for non‐COVID‐19 health conditions/disabilities, experience of COVID‐19, COVID‐19 restrictions and sociodemographic characteristics using study‐specific questions; and clinically significant depressive and anxiety symptoms using Patient Health Questionnaire 9 and Generalised Anxiety Disorder Scale 7 respectively. We calculated the population attributable fraction (PAF) to determine the proportion of worse access to non‐COVID‐19 health/disability care attributable to independent risk factors. 13,829 (91.5%) participants had complete data. 6,712 (46.4%) identified a need for healthcare/disability services (<45 years 42.1%, ≥45 years 50.3%). 31.6% aged <45 years and 24.3% aged ≥45 years reported worse access to health/disability care than experienced prior to the pandemic. In those aged <45 years the PAF was highest for depressive symptoms (21.4%; 95% CI 12.6%–29.3%) and anxiety (PAF 19.9%, 12.3%–26.9%). with a PAF of 49.6% (40.1%–57.6%) if any one of the following was being experienced: doing unpaid work; being a student; depressive symptoms; symptoms of anxiety; experiencing high adverse impact of COVID‐19 restrictions. In those ≥45 years, PAF was highest for having depressive symptoms (PAF 20.9%, 16.6–24.8) with a PAF of 44.1% (36.0%–51.2%) if any one of the following was being experienced: depressive symptoms; symptoms of anxiety; doing unpaid work; living alone; being in lowest socioeconomic quintile; main source of income from government benefits; any personal experience of COVID‐19. The identified risk factors, which include many that characterise those with worse health outcomes generally, explained 44%–50% of worse access to necessary health/disability care. These data have the potential to inform targeted strategies aimed at reducing a post‐pandemic escalation of poor health outcomes, especially in vulnerable populations. [ABSTRACT FROM AUTHOR]

Discharge communication is an important component of care transition between hospitals and community care, particularly for the complex needs of stroke survivors. Despite international research and regulation, ineffective information exchange during care transitions continues to compromise patient outcomes. Primary care practitioners are increasingly responsible for the provision of stroke care in the community, yet it is not known how their role is supported by discharge communication. The aim of this qualitative study was to describe the primary care practitioner perspective of discharge communication, identifying the barriers and enablers relative to continuity of care for stroke survivors. Semi‐structured telephone interviews were conducted with primary care practitioners across Australia, between April and September 2020. Data were analysed using thematic analysis with a constant‐comparison approach. The findings suggest that discharge communication is often inadequate for the complex care and recovery needs of stroke survivors. The challenges in accessing care plans were noted barriers to continuity of care, while shared understandings of stroke survivors' needs were identified as enablers. As discharge communication processes were perceived to be disconnected, primary care practitioners suggested a team approach across care settings. It is concluded that initiatives are required to increase primary care collaboration with hospital teams (which include stroke survivors and their caregivers) to improve continuity of care after stroke. [ABSTRACT FROM AUTHOR]

This article explores the understanding of community to families living in insecure housing in one Australian state during the COVID‐19 pandemic. Five female‐headed families were interviewed during the pandemic and asked to identify what community meant to them. All participants were referred by an agency caring for families experiencing homelessness or housing insecurity. Community was defined using Bourdieu's concept of social capital, allowing for both bonding and bridging relationships to be explored. Bonding relationships refer to close emotional ties with family and friends, while bridging ties establish networks that provide individuals with access to resources. Two themes emerged that shed light on how community is understood during times of crisis: The first suggests that for families experiencing housing insecurity, particularly women escaping family violence, their links with community were primarily maintained by welfare and church agencies. These organisations provided bridging social capital during the pandemic that allowed the women and their children to cope with the isolation and to maximise opportunities. The second themes point to traditional notions of community as family and geographical space. Here the findings are mixed. Resources provided by government, and mediated through the welfare agency, allowed these families to create a safe and comfortable space. However, for First Nations women, the lockdown meant that it was difficult to maintain community obligations, while children who appeared to identify community with attendance at school found the lockdown confusing because of the disruption to their normal social space. [ABSTRACT FROM AUTHOR]

Frailty is a condition characterised by increased vulnerability and decline of physical and cognitive reserves, most often affecting older people. This can lead to a cascade of repeated hospitalisations, further decline and ultimately loss of independence. Frailty and pre‐frailty are modifiable; interventions such as physical exercise, cognitive training, social connection and improved nutrition, especially in a group setting, can mitigate frailty. Existing healthcare guidelines for managing frailty focus predominantly on falls, delirium, acute confusion and immobility. Uptake of referrals to services following hospital discharge is sub‐optimal, indicating that a more proactive, person‐centred and integrated approach to frailty is required. The aim was to co‐design a program to help pre‐frail and frail older people return to their homes following hospital discharge by increasing resilience and promoting independence. We engaged healthcare consumers, and healthcare professionals from three tertiary hospitals in metropolitan Melbourne (Alfred Hospital, Monash Health and Cabrini Health), and from Bolton Clarke home‐based support services. Co‐design is a process whereby the input of service consumers is included in the development of a program. In the healthcare sector, co‐design involves discussions with healthcare consumers alongside healthcare professionals to identify issues and build knowledge to ultimately work on improving the healthcare system. From co‐design sessions with 23 healthcare consumers and 17 healthcare professionals, it was apparent that frailty was perceived to affect physical and mental well‐being. The co‐design process resulted in refinement of the Being Your Best program to incorporate a holistic approach, addressing four domains supported by research evidence, to improve health and well‐being through community‐ or home‐based physical activity, cognitive training, social support and nutritional support. Being Your Best was developed in consultation with older people with lived experience as well as healthcare professionals and aims to mitigate the effects of frailty, and will now be tested for feasibility and acceptability. [ABSTRACT FROM AUTHOR]

Exercise has diverse benefits for physical and mental health in people with mental illness; however, it is unclear how to effectively promote exercise motivation in this group. The aim of this study is to evaluate the effectiveness of interventions utilising exercise instruction or behavioural counselling with people with mental illness to improve self‐determined motivation for exercise, and physical and mental health. Participants were adults (aged 18+ years) receiving mental health services. Participants could choose from two 8‐week programs comprising weekly group‐based sessions delivered by an exercise physiologist: (a) exercise instruction in a gym (GYM) or (b) behavioural counselling (MOT). Self‐determined motivation was measured using the Behaviour Regulations for Exercise Questionnaire (BREQ3). Physical health indicators included waist circumference, blood pressure, leg strength (sit‐to‐stand test), physical capacity (six‐minute walk test) and self‐reported exercise. Mental health was assessed using the Kessler‐6 scale of psychological distress. Most of the 95 participants chose exercise instruction (GYM = 60; MOT = 35). At baseline, participants who chose MOT had higher external motivation, body mass index, waist circumference and psychological distress, and a higher proportion had multiple physical comorbidities than those who chose GYM. More self‐determined motivation was associated with meeting physical activity guidelines. Post‐intervention, GYM participants had significant improvements in self‐determined motivation, psychological distress and sit‐to‐stand test; MOT participants had significant improvements in integrated regulation, self‐reported exercise and physical functioning. In conclusion, exercise instruction can improve self‐determined motivation; however, more intensive behavioural counselling support may be needed to improve self‐determined motivation. Counselling programs can increase exercise behaviour and may appeal more to people with poorer health and more external motivation. Findings have high ecological validity and applicability to real‐world implementation of exercise interventions. To accommodate people with diverse conditions and motivations, motivational counselling should be combined with practical exercise support, and participants afforded the autonomy to decide their level of involvement. [ABSTRACT FROM AUTHOR]