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People from refugee and asylum seeker backgrounds resettling in Australia often experience intersecting risks for poor mental and physical health. Physical activity can promote better health outcomes, however there are limited programs tailored for this population. Therefore, understanding how to support refugees and asylum seekers to engage in physical activity is crucial. This paper aims to describe how the experience-based co-design (EBCD) process was used to identify priorities for a new physical activity service for refugees and asylum seekers. Using an EBCD framework we conducted qualitative interviews and co-design workshops with service users (refugees and asylum seekers living in the community) and service providers at a community Centre in Sydney, Australia. Sixteen participants, including eight service users and eight service providers engaged in the EBCD process over 12-months. The interviews revealed common themes or 'touchpoints' including barriers and enablers to physical activity participation such as access, safety and competing stressors. Subsequent co-design focus groups resulted in the establishment of five fundamental priorities and actionable strategies; ensuring cultural and psychological safety, promoting accessibility, facilitating support to access basic needs, enhancing physical activity literacy and fostering social connection. Using EBCD methodology, this study used the insights and lived experiences of both service users and providers to co-design a physical activity service for refugees and asylum seekers which is safe, supportive, social and accessible. The results of the implementation and evaluation of the program are ongoing. [ABSTRACT FROM AUTHOR]

Inequity in healthcare utilization is typically measured as the unequal distribution of services by observable non-need indicators, such as income, after controlling for observable need indicators. However, important sources of unequal healthcare utilization are often unobserved. The unobserved element may reflect need factors, such as imperfectly measured severity of illness, that would predict greater utilization across different healthcare channels, but also based on choice, such as patient preferences to use a particular healthcare channel over an alternative one, which may differ in its effect between channels. Accounting for unobserved sources of utilization may, therefore, help to understand contradictory inequalities between different healthcare channels, such as pro-poor inequalities for general practitioner use and pro-rich inequalities for specialist visits. This paper uses survey data from the Household Income and Labour Dynamics in Australia and panel data methods to investigate if seemingly contradictory inequalities between different healthcare channels are explained by latent individual-level heterogeneity. Results show that unobserved individual-level heterogeneity affects inequities across different healthcare channels, providing indications that the unobserved element may primarily represent unobserved need. [ABSTRACT FROM AUTHOR]

Domestic/family violence (DFV) and child protection co-occurrence of risk is common, with related homicides remaining a grave public concern. Recognising and prioritising high-risk cases that pose a lethal risk remains a complex challenge for practitioners across a range of services and legal jurisdictions. There are significant gaps in practice knowledge about how to assess and respond to high-risk cases involving child protection and DFV concerns, while working safely and effectively. This paper reports on qualitative research conducted with practitioners from a range of justice and service delivery organisations in Queensland, Australia. A community of practice, supported by the U.S. based Safe & Together Institute, provided the forum for data to be collected on participants' reflections and observations. An action research framework was employed to connect practice learning into research data through an iterative cycle of reflection and review. Ethnographic note taking was used to document arising policy and practice issues. Discussions in the CoP were also recorded and transcribed verbatim. Thematic analysis was undertaken combining inductive and deductive techniques. Key findings include: learning from and partnering with women; applying a perpetrator pattern-based approach in high-risk cases; engaging with men as fathers; and improving the role of the judicial system. Practice needs to be informed by centring the victim/survivor perspective, which requires a collaborative approach while maintaining system integrity to hold the perpetrator within system responses to ensure accountability. There are important learnings for developing service sector responses and future research on high-risk cases. [ABSTRACT FROM AUTHOR]

This paper uses secondary analysis to understand how COVID-19 shaped people's experiences with psychosocial support services in Australia. Data are drawn from questionnaires (n = 66) and semi-structured interviews (n = 62), conducted for a national service evaluation, with 121 people living with enduring mental health conditions and using psychosocial support services. Data relating to COVID-19 were inductively coded and analysed using constant comparative analysis. Most people's experiences included tele-support. While some people described minimal disruption to their support, many reported reduced engagement. People's wellbeing and engagement were influenced by: their location, living situation and pre-COVID lifestyles; physical health conditions; access to, comfort with, and support worker facilitation of technology; pre-COVID relationships with support workers; and communication from the organisation. The findings can help services prepare for future pandemics, adjust their services for a 'COVID-normal' world, and consider how learnings from COVID-19 could be incorporated into a flexible suite of service delivery options. [ABSTRACT FROM AUTHOR]

Purpose: LGBTQ people are less likely to seek support and face significant barriers in accessing affirmative family violence support services. Efforts to improve family violence service access must be grounded in the preferences of LGBTQ people themselves. Method: Data from a large nationwide Australian survey of the health and wellbeing of LGBTQ adults were analysed. 4,148 participants expressed a preference for family violence service provision. Multivariable logistic regressions were used to identify factors associated with preferences for family violence service provision, comparing mainstream services that are not known to be inclusive, mainstream services that are known to be LGBTQ-inclusive, and LGBTQ-specific services. Results: In total, 8.8% (n = 363) of participants indicated a preference for mainstream services, 57.5% (n = 2,383) for mainstream services that are known to be LGBTQ-inclusive and 33.8% (n = 1,402) for LGBTQ-specific services. Trans and non-binary identified people were more likely to prefer LGBTQ-specific services than cisgender participants, while bisexual, pansexual and asexual people were more likely to prefer mainstream LGBTQ-inclusive services. Participants with a regular general practitioner were more likely to prefer LGBTQ-inclusive services. Participants who had not felt supported the most recent time they reported an experience of family violence were more likely to prefer LGBTQ-specific services. Conclusion: Family violence and healthcare services require training in LGBTQ issues to provide inclusive and affirming care. The findings have implications for policy and practice in family violence care and illustrate an urgent need to reform the current narrative of family violence, which frequently excludes LGBTQ communities. [ABSTRACT FROM AUTHOR]

While patients value engagement concerning their spirituality as a part of holistic healthcare, there is little evidence regarding the preferred way to engage in discussions about spirituality. This study investigated inpatient preferences regarding how they would like spirituality to be raised in the hospital setting. A cross-sectional survey was conducted with inpatients at six hospitals in Sydney, Australia (n = 897), with a subset invited to participate in qualitative interviews (n = 41). There was high approval for all proposed spiritual history prompts (94.0–99.8%). In interviews, the context dictated the appropriateness of discussions. Findings indicated a high level of patient acceptability for discussing spirituality in healthcare. Further research and more detailed analysis is required and proposed to be undertaken. [ABSTRACT FROM AUTHOR]

Enabling athletes to achieve peak performances while also maintaining high levels of health is contextually complex. We aim to describe what a 'health system' is and apply the essential functions of stewardship, financing, provision of services and resource generation to an Australian high-performance sport context. We introduce a fifth function that health systems should not detract from athletes' ability to achieve their sports goals. We describe how these functions aim to achieve four overall outcomes of safeguarding the health of the athletes, responding to expectations, providing financial and social protection against the costs of ill health, and efficient use of resources. Lastly, we conclude with key challenges and potential solutions for developing an integrated health system within the overall performance system in high-performance sport. [ABSTRACT FROM AUTHOR]

Ethical perspectives on regional, rural, and remote healthcare often, understandably and importantly, focus on inequities in access to services. In this commentary, we take the opportunity to examine the implications of normalizing metrocentric views, values, knowledge, and orientations, evidenced by the recent (2022) New South Wales inquiry into health outcomes and access to hospital and health services in regional, rural and remote New South Wales, for contemporary rural governance and justice debates. To do this, we draw on the feminist inspired approach to rural health ethics involving analysis of power relationships developed by Simpson and McDonald and related ideas from critical health sociology. In presenting this analysis, we extend contemporary thought about spatial health inequities and structural violence. [ABSTRACT FROM AUTHOR]

Suicide is a global concern with rates in Australia continuing to increase. Effective post-suicidal care is critical for reducing persistent suicidal behaviour. One model of care is that adopted by Alfred Health, delivering a multidisciplinary, hybrid clinical and non-clinical (psycho-social support), assertive outreach approach. This study measured improvements in resilience and wellbeing, changes to distress and suicidal ideation at least 6-months post-discharge from care. Thirty-one consumers participated including a one-on-one interview to gather qualitative feedback. There was a significant change on all outcome measures with large effect sizes. Participants had significantly reduced suicidal ideation and distress and increased coping self-efficacy, hope and well-being. The qualitative findings indicated that a key component to recovery was the staff. Limitations included a low sample size, and broad time range of follow-up data collection. Providing assertive, multidisciplinary, collaborative and outreach-focused post-suicidal care can increase and sustain protective psychological factors and reduced suicidal ideation in most individuals. [ABSTRACT FROM AUTHOR]

This observational study compared the outcomes of consumers receiving community-based residential mental health rehabilitation support in Australia under a clinical staffing model and an integrated staffing model where Peer Support Workers are the majority component of the staffing profile. Reliable and clinically significant (RCS) change between admission and discharge in functional and clinical assessment measures were compared for consumers receiving care under the clinical (n = 52) and integrated (n = 93) staffing models. Covariate analyses examined the impact of known confounders on the outcomes of the staffing model groups. No statistically significant differences in RCS improvement were identified between the staffing models. However, logistic regression modelling showed that consumers admitted under the integrated staffing model were more likely to experience reliable improvement in general psychiatric symptoms and social functioning. The findings support the clinical and integrated staffing models achieving at least equivalent outcomes for community-based residential rehabilitation services consumers. [ABSTRACT FROM AUTHOR]

Aim: As global events impact the way organizations operate and innovate in response to regional, workforce and consumer needs, the concept of intrapreneurism is attracting growing interest from policymakers and executives, particularly within the healthcare sector. The aim of this study was to capture the key learnings from the implementation of a telementoring pilot, to understand how intrapreneurship can embed innovation within an established organization to effect more integrated healthcare. Purpose: A qualitative approach was used with a phenomenological lens to explore the key learnings of the Project ECHO® (Extension for Community Healthcare Outcomes) pilot implementation to provide an understanding of what the project team's strategies and tactics were during the process of embedding a new business innovation. The implementation and piloting of Project ECHO®, a telementoring model, in a large-scale public healthcare organization in Queensland, Australia, was investigated as an exemplar of integration intrapreneurship. Findings: Through an inductive approach, this qualitative study found the implementation of the Project ECHO® pilot had specific dimensions and strategies/tactics which were exemplars of intrapreneurism. The organizational context and workforce characteristics described in this study presented new knowledge of how intrapreneurs implemented an innovation to address fragmentation of healthcare service delivery, professional isolation and instances of low-value care. This research contributes to a better understanding of the strategic and tactical approaches to implementing intrapreneurial innovations within a public healthcare organization, with learnings that can be adapted by intrapreneurs in other contexts. [ABSTRACT FROM AUTHOR]

Globally, there is a recognised need that all populations should be able to access the benefits of genomics and precision medicine. However, achieving this remains constrained by a paucity of data that quantifies access to clinical genomics, particularly amongst Indigenous populations. Using administrative data from clinical genetic health services across three Australian jurisdictions (states/territories), we investigate disparities in the scheduling and attendance of appointments among Aboriginal and/or Torres Strait Islander people, compared to non-Indigenous people. For 14,870 appointments scheduled between 2014–2018, adjusted Multivariate Poisson Regression models revealed that Aboriginal and/or Torres Strait Islander people were scheduled fewer appointments (IRR 0.73 [0.68–0.80], <0.001) and attended at lower rates (IRR 0.85 [0.78–0.93], <0.001). Within this population, adults, females, remote residents, and those presenting in relation to cancer or prenatal indications experienced the greatest disparity in access. These results provide important baseline data related to disparities in access to clinical genomics in Australia. Globally it is recognised that Indigenous populations should be able to access the benefits of genomics and precision medicine. Here, authors show that there are disparities in access to clinical genetic health services for Aboriginal and/or Torres Strait Islander people in Australia. [ABSTRACT FROM AUTHOR]

Introduction: Although Cataract Surgery Rate is increasing, the availability of surgery is outstripped by the increasing number of cataract cases as populations age. Aim: The study aimed to identify factors associated with cataract surgery uptake in terms of predisposing, enabling, and need factors in very old Australian women. Method: This study used ALSWH data included 6229 women aged 79–84 to 85–90 years. Women were asked whether they had undergone eye surgery (including cataracts) three years prior to each survey. Generalised estimating equation modelling was used to determine factors associated with these surgeries. Result: At baseline (2005), more than half of the participants either had undergone surgery (43.5%) or had unoperated cataracts (7.6%). Increasing age (AOR = 1.11, 95% CI = 1.07, 1.15) and being current or ex-smokers (AOR = 1.15, 95% CI = 1.03, 1.29) were associated with higher odds of cataract surgery (predisposing factors). Women who had private health insurance had 27% higher odds of having surgery (AOR = 1.27, 95% CI = 1.16, 1.39) (enabling factor). Need factors of more General Practitioner visits (AOR = 1.16, 95% CI = 1.09, 1.25) and skin cancer (AOR = 1.09, 95% CI = 1.01, 1.17) also increased the odds of cataract surgery. Women who had no difficulty seeing newspaper print were more likely to have had cataract surgery (AOR = 1.35, 95% CI = 1.23, 1.48). Conclusion: Need factors are the major drivers of cataract surgery; however, predisposing and enabling factors also play a role, including access to private health insurance. This finding indicates some inequity regarding access to cataract surgery in the Australian setting. [ABSTRACT FROM AUTHOR]