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Objectives: Cardiac rehabilitation (CR) provides evidence-based secondary prevention for people with heart disease (HD) (clients). Despite HD being the leading cause of mortality and morbidity, CR is under-utilised in Australia. This research investigated healthcare systems required to improve access to CR in rural and remote areas of North Queensland (NQ). Methods: A qualitatively dominant case study series to review management systems for CR in rural and remote areas of NQ was undertaken. Data collection was via semi-structured interviews in four tertiary hospitals and four rural or remote communities. An audit of discharge planning and CR referral, plus a review of community-based health services, was completed. An iterative and co-design process including consultation with healthcare staff and community members culminated in a systems-based model for improving access to CR in rural and remote areas. Results: Poorly organised CR systems, poor client/staff understanding of discharge planning and low referral rates for secondary prevention, resulted in the majority of clients not accessing secondary prevention, despite resources being available. Revised health systems and management processes were recommended for the proposed Heart: Road to health model, and given common chronic diseases risk factors it was recommended to be broadened into Chronic disease: Road to health. Conclusion: A Chronic disease: Road to health model could provide effective and efficient secondary prevention for people with chronic diseases in rural and remote areas. It is proposed that this approach could reduce gaps and duplication in current healthcare services and provide flexible, client-centred, holistic, culturally responsive services, and improve client outcomes. What is known about the topic? Cardiac rehabilitation is known to improve health outcomes and reduce hospitalisations, but referrals and attendance are low (30%). What does this paper add? A revised systems-based model for improved access to secondary prevention for people with heart and related chronic diseases in rural and remote areas of North Queensland is proposed: Chronic disease: Road to health. What are the implications for practitioners? A functional system from hospitalisation to local healthcare services has been designed to improve access to secondary prevention. Staff require support and education to improve skills, better manage care and improve job satisfaction. [ABSTRACT FROM AUTHOR]

Background: Medicines are often suboptimally managed for heart failure patients across the transition from hospital to home, potentially leading to poor patient outcomes. The Improving the Safety and Continuity Of Medicines management at Transitions of care programme included: understanding the problems faced by patients and healthcare professionals; developing and co‐designing the Medicines at Transitions of care Intervention (MaTI); a cluster randomized controlled trial testing the effectiveness of a complex behavioural MaTI aimed at improving medicines management at the interface between hospitals discharge and community care for patients with heart failure; and a process evaluation. The MaTI included a patient‐held My Medicines Toolkit; enhanced communication between the hospital and the patient's community pharmacist and increased engagement of the community pharmacist postdischarge. This paper reports on the patients' experiences of the MaTI and its implementation from the process evaluation. Design: Twenty one‐to‐one semi‐structured patient interviews from six intervention sites were conducted between November 2018 and January 2020. Data were analysed using the Framework method, involving patients as co‐analysts. Interview data were triangulated with routine trial data, the Consolidated Framework for Implementation Research and a logic model. Results: Within the hospital setting patients engaged with the toolkit according to whether staff raised awareness of the My Medicines Toolkit's importance and the time and place of its introduction. Patients' engagement with community pharmacy depended on their awareness of the community pharmacist's role, support sources and perceptions of involvement in medicines management. The toolkit's impact on patients' medicines management at home included reassurance during gaps in care, increased knowledge of medicines, enhanced ability to monitor health and seek support and supporting sharing medicines management between formal and informal care networks. Conclusion: Many patients perceived that the MaTI offered them support in their medicines management when transitioning from hospital into the community. Importantly, it can be incorporated into and built upon patients' lived experiences of heart failure. Key to its successful implementation is the quality of engagement of healthcare professionals in introducing the intervention. Patient or Public Contribution: Patients were involved in the study design, as qualitative data co‐analysts and as co‐authors. [ABSTRACT FROM AUTHOR]

Black Americans face disparate health burdens of diet-related chronic diseases. Black Americans who live in communities with inadequate access to healthy foods are at an even greater risk for disparate health outcomes. Urban agriculture in communities with inadequate access to healthy food can complement the existing traditional food system and can make a difference in the accessibility of fresh fruits and vegetables and subsequently, increase fruit and vegetable consumption. However, integrating urban agriculture into a local food system can be challenging. Community capacity-building efforts have the potential to enhance organizational development and enable collaborations to enhance efforts to incorporate urban agriculture into communities with inadequate food access. This study used Chaskin's relational framework to describe community capacity-building efforts to enhance urban agriculture in predominantly Black communities. We found that strategies for community capacity building in urban agriculture include building on existing resources, community engagement, expanding organizational capacity, identifying threats to community capacity building, and identifying ideal solutions to enhance community capacity-building efforts. Urban farmers, gardeners, and advocates identified these strategies to strengthen local control of the food environment through sustainable urban agriculture. Additional research is needed to further identify community engagement strategies that emphasize sustainability, such as workforce development efforts, building networks for new growers, and strengthening connections between farmers, gardeners, urban agriculture advocates, and community residents. [ABSTRACT FROM AUTHOR]

Background: Maintaining a physically active lifestyle across the life course can add to an individual's health and well‐being. Many people are insufficiently active to achieve these gains with a trend towards further decreases in activity as people age. Community‐based group exercise programmes have been shown to be one means of increasing sustained activity levels for older people. Aim: To understand how and why older people sustain participation to community‐based group exercise programmes from a humanising perspective. Methods: A multiple‐case study approach was employed to study three exercise programmes in the South‐West of England. Data were collected through participant observation, focus groups and documentation. Data were analysed with deductive thematic analysis and mapped against the humanisation framework. Results: Findings suggest that the humanising nature of these particular exercise programmes supported sustained participation. In these programmes, agency was evidenced in the way participants self‐selected their level of exertion with exercises. There was freedom to be their unique selves and exercise within the limits of their insider challenges of an ageing body. Through this non‐judgemental exercise environment, there was an embodied understanding of who they were as people. The exercise programme became part of their personal journey. This journey helped inform their future by enabling them to keep active and maintain independence, allowing them to continue engaging in the world. There was a sense of togetherness and belonging which led to feelings of homeliness as they found a sense of place within the group. The friendships they formed helped them make sense and add meaning to their experiences and personal health challenges. Conclusions: When planning exercise environments to support the long‐term adoption of a sustained behaviour change, in the form of physical activity for older people, it is helpful to consider dimensions that make an individual feel human. [ABSTRACT FROM AUTHOR]

Interpersonal racial/ethnic discrimination is a risk factor for depression across the lifespan in minoritized racial/ethnic groups. This study tests a model proposing that social cognitive processes, including relational schemas, mediate the link between discrimination and depression. Relational schemas enable individuals to form mental representations of others, reflecting prior social learning and generating expectations about future social relations. Racism-related relational schemas include, among others, concerns about being rejected or invalidated, concerns about confirming negative stereotypes held by others, and cynical mistrust of others. Prior studies have typically examined the mediating role of one or two relational schemas in the association between discrimination and depression; less is known about the unique and combined effects of multiple dimensions of racism-related social cognition. The model was tested in a convenience sample of ethnically diverse, non-white participants recruited from two sites, a community medical center (N = 136; M age = 38, SD = 13.0) and a private university (N = 120; M age = 19.4, SD = 1.3), yielding a consolidated sample of 256 participants (64% women). Data were collected between September 2016 and April 2018. Participants completed paper-and-pencil self-report measures of exposure to interpersonal discrimination, depressive symptoms, and eight measures of relational schemas. Confirmatory factor analysis indicated that the eight relational schemas defined three primary dimensions: concerns about rejection and invalidation, social vigilance, and mistrust. A structural equation model in which the association between exposure to discrimination and depressive symptoms operates through latent factors representing three social-cognitive dimensions demonstrated adequate fit (CFI = 0.96, RMSEA = 0.06, SRMR = 0.04). A significant mediational effect was found only for concerns about rejection and invalidation. The conceptual model supported by this study may help inform psychological interventions aimed at mitigating the detrimental effects of racial/ethnic discrimination on mental health. • Interpersonal racial/ethnic discrimination is associated with depressive symptoms. • Discrimination is associated with relational schemas, a dimension of social cognition. • Discrimination-related schemas reflect concerns about rejection, vigilance, and mistrust. • Schemas mediate the relation of discrimination to depression. • Concerns about rejection and invalidation are the primary mediating mechanism. [ABSTRACT FROM AUTHOR]