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The risk of delaying assistive technology (AT) prescription and implementation has significant implications on the safety and quality of life of people with Motor Neurone Disease (PwMND). This study aims to explore the barriers and enablers of AT prescription and implementation identified by PwMND and clinicians. A qualitative study using semi-structured focus groups with clinicians and in-depth interviews with PwMND. Sixteen clinicians and ten PwMND were recruited. Thematic analysis was completed and results were compared and discussed to reach an agreement on the final themes. Three main factors were identified – PwMND, Clinician and Extrapersonal. For PwMND, personal characteristics, such as mindset, was the strongest enabler and inability to accept diagnosis and AT was the key barrier. For Clinician, communication approach was both the most identified enabler and barrier. For Extrapersonal, the availability of interactive education of AT was the strongest enabler and long wait time was a significant barrier. Our study identified themes that clinicians could have an impact on, such as, providing interactive education, engaging PwMND and their support network, and ongoing upskilling of clinicians working in this field. Themes identified that were beyond the control of clinicians were personal characteristics, acceptance and support networks. It highlights the importance for clinicians to be flexible with their communication approach to accommodate the needs of PwMND in the acceptance of AT. There are many factors that may influence a person with Motor Neurone Disease's decision about Assistive Technology (AT) and not all are within the control of clinicians. It is important for clinicians to be reflective of the situation and barriers they encounter, and recognise their limits and what they can act on. For clinicians looking after people with Motor Neurone Disease (PwMND), it is important to develop your knowledge continuously, consider setting up an AT library, and engage PwMND and their support network in care decision making. [ABSTRACT FROM AUTHOR]

Indigenous Psychology within Australia reflects the traditional knowledges of Aboriginal and Torres Strait Islander Peoples and their understanding of the cultivation of relational social and emotional wellbeing (SEWB). However, these perspectives are poorly incorporated into dominant "Western" psychological theories and practice, such as Cognitive Behaviour Therapy (CBT). This represents a barrier to the cultural safety of current mental health practice and its decolonisation within Australia. This study brought together CBT Practitioners and Practitioners of an Aboriginal Wellbeing practice ("Wayapa") to engage in a series of yarns (guided focus groups) to share perspectives, insights, and stories on their own and each other's practices. Indigenous qualitative research approaches including Research Topic Yarning were engaged to decolonise the research environment and support dialogue at the cultural interface of the two practices. Through experiencing Wayapa, CBT practitioners reflected on gaps in their own practice, with an enthusiasm for the opportunities that Wayapa provided to decolonise their practice. Wayapa practitioners were able to celebrate the holistic nature of their practice and the possibility for it to inform dominant "Western" psychological theories and practice, such as CBT, and encourage a more connected and culturally safe way of working with First Nations peoples. Creating safe cultural interfaces between "Western" and Indigenous Psychologies, and building awareness of the value of Aboriginal grounded wellbeing models, can help to promote and expand culturally safe practices within Australian psychological practice. What is already known about this topic: The cultural safety and relevance of CBT for Aboriginal and/or Torres Strait Islander Peoples remains uncertain. There is limited knowledge of Aboriginal wellbeing practices and Indigenous Psychologies amongst non-Indigenous Australian mental health practitioners, including psychologists. Broadened understanding of Aboriginal wellbeing practices such as Wayapa Wurrrk, may contribute to decolonising psychology in Australia. What this topic adds: CBT and Wayapa share common and unique tools and concepts that can support the social emotional wellbeing of all Australians. Wayapa Wurrrk concepts such as earth mindfulness and the centring of Country as a foundation for wellness and social emotional wellbeing represent gaps in current CBT practice. Work at the cultural interface of "Western" and Indigenous Psychology offers a pathway to promote appreciation for, and active utilisation of, Indigenous psychologies including the social emotional wellbeing framework (SEWB). In this article, we recognise both Aboriginal and Torres Strait Islander Peoples as the First Nations of Australia. We acknowledge and pay respect to the knowledge that Aboriginal and Torres Strait Islander cultures are unique, all with their own languages, knowledge systems, beliefs, and histories. We recognise the collective terms they prefer also vary. With respectful consideration to these preferences, typically we will specify Aboriginal and/or Torres Strait Islander Peoples when referring to First Nations Peoples in this article. From time to time, we use the term Indigenous. However, we note that for many Aboriginal and Torres Strait Islander Peoples, this is not preferred. As such, we have only used this where we are referencing it's use from another source, or it is the established use of the term, such as its use in "Indigenous knowledges". Where referring to individual Aboriginal and/or Torres Strait Islander people, we have endeavoured to incorporate their preferences, including for example, reference to the Country they are connected to. [ABSTRACT FROM AUTHOR]

When unpaid female carers consider whether to pursue higher education (HE), they frequently experience decision-making uncertainties which stem from the structural and cultural challenges associated with their roles as carers. Reflexivity is a critical part of decision-making, as it empowers individuals to mediate between the present and future within the structural and cultural conditions which impact and guide their actions. To investigate the reflexive deliberation processes unpaid female carers engage in as part of their HE decision-making processes, this study analysed data from an in-depth, qualitative Australian study with 15 unpaid female carers who were considering higher education. Dialogic processes including narrative interviews and a card sort activity made visible the array of mental activities involved in reflexive decision-making by carers. Considering the more and less productive types of reflexive inner conversations which had been identified enabled participants to reflexively adjust the efficacy of some of their decision-making processes. This study contributes to the reflective and career counselling literature by theorising the cognitively and emotionally complex personal and structural demands of HE decision-making. By conceptualising reflexive decision-making anew, unpaid female carers and HE institutions can better identify and address the structural and cultural conditions which may be influencing their HE decision-making. [ABSTRACT FROM AUTHOR]

Low back pain (LBP) clinical practice guidelines recommend referral for patients with persistent LBP however discordance persists between recommended care and implementation in practice. Understanding patient experiences of referral practices and physiotherapy care could be important for optimizing LBP management in primary care settings. This study explored referral experiences of people with nonspecific LBP in Australian primary care and their knowledge and experience of physiotherapy. An interpretive descriptive qualitative framework was used with 17 participants interviewed from community-based physiotherapy practices. Four themes described the participants' experiences of referrals in primary care settings: 1) Referral practices ranged from formal to informal to non-existent; 2) Fragmented inter-and intra-professional LBP care management; 3) Patient perceived differences in the roles of physiotherapists and specialist physiotherapists; and 4) Patient nominated barriers and facilitators to optimal referral practices. Physiotherapists support people with LBP to improve strength and function, whereas the specialist physiotherapist's role was seen as more holistic. Referral pathways that align to clinical guideline recommendations for non-surgical management and treatment remain underdeveloped. Improved referral pathways to clinicians such as physiotherapists with additional credentialed skills and competence in musculoskeletal care could improve people's experiences of care and health outcomes. [ABSTRACT FROM AUTHOR]

The ward round (WR) is an important opportunity for interprofessional interaction and communication enabling optimal patient care. Pharmacists' participation in the interprofessional WR can reduce adverse drug events and improve medication appropriateness and communication. WR participation by clinical pharmacists in Australia is currently limited. This study aims to explore what is impacting clinical pharmacists' participation in WRs in Australian hospitals. A self-administered, anonymous national survey of Australian clinical pharmacists was conducted. This study describes the outcomes from qualitative questions which were analyzed thematically in NVivo-2020 according to Braun and Clarke's techniques. Five themes were constructed: "Clinical pharmacy service structure", "Ward round structure", "Pharmacist's capabilities", "Culture" and "Value". A culture supportive of pharmacist's contribution with a consistent WR structure and flexible delivery of clinical pharmacy services enabled pharmacists' participation in WR. Being physically "absent" from the WR due to workload, workflow, and self-perception of the need for extensive clinical knowledge can limit opportunities for pharmacists to proactively contribute to medicines decision-making with physicians to improve patient care outcomes. Bidirectional communication between the interprofessional team and the pharmacist, where there is a co-construction of each individual's role in the WR facilitates consistent and inter-dependent collaborations for effective medication management. [ABSTRACT FROM AUTHOR]

Purpose: Aboriginal and Torres Strait Islander People with a disability continue to experience barriers to service engagement such as mistrust of government services, lack of culturally appropriate support, marginalisation and disempowerment. This meta-synthesis reviews current literature regarding these experiences to explain why services are underutilised. Methods: The meta-synthesis was conducted using a meta-ethnographic approach to synthesise existing studies into new interpretive knowledge. The approach was supported by a search using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: Ten original research papers utilising a qualitative methodology were extracted. Synthesis of the articles revealed four concepts that were developed into a conceptual model. These include:1) History Matters; 2) Cultural Understanding of Disability Care; 3) Limitations to Current Service Provision; and 4) Delivery of Effective Services. Conclusions: Disability services do not adequately consider the cultural needs of Aboriginal and Torres Strait Islander People or communicate in a culturally appropriate manner. There are expectations that Aboriginal and Torres Strait Islander People acknowledge their disability in alignment with western definitions of disability in order to access services. More work is needed to align disability services with culturally appropriate support to provide better health outcomes. Aboriginal and Torres Strait Islander people with a disability continue to experience barriers to service engagement which must be addressed. An essential gap that must be filled in providing disability services to Aboriginal and Torres Strait Islander people is the acknowledgment of culture as a resolute influence on all client interactions with providers. A cultural model of disability may better align with the experiences of Aboriginal and Torres Strait Islander people than current medical and social models used in healthcare. Disability services need to align better with culturally appropriate support to provide better health outcomes for Aboriginal and Torres Strait Islander people. [ABSTRACT FROM AUTHOR]

Providing culturally safe speech-language pathology services to Aboriginal and Torres Strait Islander peoples with acquired communication disorders (ACDs) may be challenging for non-Indigenous speech-language pathologists (SLPs). Indigenous Health Liaison Officers (IHLOs) may share common histories and culture with patients, and provide valuable insights about cultural safety. The study aim was to explore IHLOs' experiences of working with Aboriginal and Torres Strait Islander adults post-stroke or traumatic brain injury (TBI), and with the SLPs who provide services to these peoples. Using an interpretive description collaborative research design informed by culturally responsive principles, IHLOs (n = 7) participated in interviews facilitated by Aboriginal researchers and the principal investigator. Data were analysed using qualitative content analysis, informed by perspectives of Aboriginal researchers. Two themes, Connection and Spirit and Emotion, and six interdependent categories described how Aboriginal and Torres Strait Islander peoples have, and need, strong connections to family, country, health professionals, and ACD practices. Without these connections, patients' wellbeing may be deeply affected. SLPs must collaborate with IHLOs and patients' family members and draw on their cultural knowledge, expertise, and guidance when working with Aboriginal and Torres Strait Islander peoples and ensure connections are created. These connections contribute to culturally safe and responsive speech-language pathology practice. [ABSTRACT FROM AUTHOR]

Lower limb robotic exoskeletons can assist movement, however, clinical uptake in neurorehabilitation is limited. The views and experiences of clinicians are pivotal to the successful clinical implementation of emerging technologies. This study investigates therapist perspectives of the clinical use and future role of this technology in neurorehabilitation. Australian and New Zealand-based therapists with lower limb exoskeleton experience were recruited to complete an online survey and semi-structured interview. Survey data were transposed into tables and interviews transcribed verbatim. Qualitative data collection and analysis were guided by qualitative content analysis and interview data were thematically analysed. Five participants revealed that the use of exoskeletons to deliver therapy involves the interplay of human elements – experiences and perspectives of use, and mechanical elements – the device itself. Two overarching themes emerged: the "journey", with subthemes of clinical reasoning and user experience; and the "vehicle" with design features and cost as subthemes, to explore the question "Are we there yet?" Therapists expressed positive and negative perspectives from their experiences with exoskeletons, giving suggestions for design features, marketing input, and cost to enhance future use. Therapists are optimistic that this journey will see lower limb exoskeletons integral to rehabilitation service delivery. Further innovation of design features, marketing, and cost are needed to enhance ongoing development and integration. Routine clinical implementation of lower limb exoskeletons is unlikely at this time in Australia and New Zealand. Therapists do expect lower limb exoskeletons to have an ongoing role in future rehabilitation. [ABSTRACT FROM AUTHOR]

Changes to psychological practice have arisen in recent times with the rise of services being offered online as an alternative to in-person meetings. Videoconferencing is the most widely utilised form of telehealth used by psychologists, and a unique consequence of videoconferencing is that psychologists can see a synchronous self-mirror image during online sessions with clients. Research is yet to investigate psychologists' experience of the self-mirror in the context of their online work. Semi-structured interviews with 16 Australian psychologists were conducted to explore their experiences of the self-mirror during video-conferencing therapy treatment sessions with their clients. Thematic analysis of the interviews revealed several unique findings. Psychologists reported the presence of their self-mirror image during video conferencing sessions increased self-consciousness in relation to their appearance and presentation. Most reported the self-mirror to be largely distracting and disliked the presence of their own self-mirror image during online therapy sessions with clients. Some psychologists reported that the live time feedback was helpful and informative in modifying non-verbal expressions. Further challenges included uncertainty around client eye contact connection and vulnerability with client exposure to personal environments in the videoconferencing background. It is recommended that psychologists regularly evaluate the impact of having their self-mirror view on during video-conferencing sessions with clients. What is already known about this topic: (1) The growing use of telehealth videoconferencing brings with it the need to further investigate how this impacts the nature of therapeutic work for psychologists. (2) Videoconferencing is the most widely utilised online telehealth modality for psychologists, and unique to this modality is that psychologists can see a live time self-mirror image of themselves during consultations. (3) The impact of the self-mirror on psychologists' experiences of video-conferencing therapy sessions had yet to be explored and reported upon. What this topic adds: (1) This study was the first to investigate and report upon psychologists' experiences of their self-mirror in the context of online therapy with clients via videoconferencing. (2) The presence of the self-mirror during online therapy sessions can increase self-consciousness and self-critical appraisals in appearance and presentation for psychologists. The self-mirror can also be distracting and adding to cognitive load; however, some psychologists could find the self-mirror feedback helpful to inform and modify their expressions in response to clients in real time. (3) It is recommended that psychologists evaluate the impact of having their self-mirror view on during video-conferencing sessions with clients. When psychologists decide to keep their self-mirror view on, it is recommended that they monitor and regularly reflect upon the impact of the self-mirror on themselves, their clients and the therapeutic process. [ABSTRACT FROM AUTHOR]

Previous research has highlighted that youth gender dysphoria (GD) and gender diversity (GDI) are experienced in unique ways by different family members, with youth outcomes significantly influenced by family support and understanding. Few studies on a national level have explored individual family member experiences, specifically family, social and healthcare experiences, involving young people, parent/carers and siblings. Using an online survey incorporating circular questioning, this study sought to discover individual family member experiences of youth GD/GDI in Australia, within a family, healthcare, and social context. Young people experiencing GD/GDI, parents/carers and siblings were recruited through Facebook advertising and completed an online survey, exploring positive and negative experiences of youth GD/GDI, within and outside of the family. Survey questions predominantly used Likert scales, with free-text fields, enabling both quantitative and qualitative data analysis. Six hundred and sixty young people aged 12-17 years experiencing GD/GDI, 158 parents/carers ranging in age from under 30 years to more than 60 years (most common age band was 40-49 years; 62%), and 40 siblings aged 12-17 years completed at least part of the online survey. Participants reported mixed experiences of youth GD/GDI with varying levels of understanding and support provided by family members and others. Parents and siblings generally felt it important for healthcare professionals to ask everyone's experience in the family, although only one-third of young people felt this was important. Most parents and young people also highlighted the importance of sibling support. The majority of young people felt misunderstood by other family members. Most family members, particularly young people, reported different viewpoints within families and primarily negative experiences. The research findings support sibling inclusion in healthcare appointments in certain circumstances, depending on context, and a whole of family approach overall, if agreeable to the family and unlikely to cause harm. [ABSTRACT FROM AUTHOR]

Timely speech-language pathology (SLP) involvement with dysphagic patients in the Emergency Department (ED) may improve patient outcomes. This study utilised qualitative interviews to understand current models and explore factors which have influenced establishment and current dysphagia service provision in Australian EDs. Semi-structured interviews were conducted with representatives from 12 acute hospital facilities with a SLP ED service. Interview transcripts were analysed using plain content analysis to identify key themes. Sub-analysis using the Consolidated Framework for Implementation Research (CFIR) model was undertaken for facilities with more "expanded" models (n = 4). SLP ED service models ranged from referral-only services, to models with referral-only and proactive SLP-led screening procedures (classified as "expanded"). Patient-related factors, the ED setting, SLP service factors and perceptions of dysphagia management were key themes reported to impact service delivery. With expanded models, 14 CFIR constructs (innovation source, external policy and incentives, networks and communications, stakeholders and relative priority) were identified as facilitators, while four constructs (adaptability, cost, compatibility, available resources) were barriers to services. There are service-specific issues with providing SLP care within the ED. Factors related to the unique ED environment must be considered by SLP departments when establishing/optimising dysphagia management within the ED. [ABSTRACT FROM AUTHOR]

Although allied health services are important adjuncts to medical care for people with myasthenia gravis (MG), the underutilisation of these services is not well understood within the Australian context. It is critical to explore patients' perceptions to develop services that meet consumer needs. This study, therefore, sought to obtain insight into MG patients' perspectives and experiences, in addition to the outcomes, of accessing allied health services. Thirteen Australian adults with MG participated in semi-structured interviews. Qualitative analysis was conducted inductively using thematic content analysis. Four themes were identified: (1) missed opportunities and unmet care needs were common, due to frequent patient–provider communication breakdowns and a lack of referral protocols, (2) personal factors – patient self-advocacy influenced their perceived need, with some lacking confidence to seek help, (3) perceived benefit and health provider capacities – most valued allied health despite differing perceptions of health professionals' attitudes, skills, and willingness to learn, and (4) a resultant fragmentation of care between services was universal. Findings highlighted a need for clear referral pathways, coordinated multidisciplinary care, improved access to community-based services and education for allied health professionals about MG. Adults with myasthenia gravis (MG) report a lack of referral pathways to allied health services, leading to unmet needs and fragmented care. Although there is a perceived benefit to allied health care, experiences are impacted by health provider capacity and attitudes. There needs to be an overall shift towards multidisciplinary care for people with MG, and the development of clear referral pathways. Specific education about MG should be available for allied health professionals to improve their knowledge and skills in treating this population. [ABSTRACT FROM AUTHOR]

Recognition and escalation of the deteriorating patient is multifaceted and relevant to all clinicians involved. However, little evidence exists exploring how clinicians from different professions make decisions about early signs of clinical deterioration and how this affects their actions. The aim of this study was to explore interprofessional clinicians' and students' experiences of responding to and escalating care of deteriorating patients. A convenience sample of clinicians and students from acute hospital settings in regional Australia participated in focus groups. Participants were able to identify barriers, facilitators, and strategies for improvement during the recognition and escalation of the deteriorating patient. Four themes were detected throughout the 38 focus group discussions: a Standardized Approach, Workplace Culture and Teamwork, Confidence and Experience, and Communication. Although standardization of systems and processes supported clinician's recognition and escalation of the deteriorating patient, use and misuse of the systems by some participants were identified as barriers to seeking assistance. Positive workplace culture and teamwork were important to promoting the escalation of care. Participants identified that experience in recognizing and responding to deteriorating patients increased their confidence. [ABSTRACT FROM AUTHOR]

Bereavement is a universal experience common within the higher education student population. The present study aimed to understand the experiences and support needs of bereaved Australian university students. In semi-structured interviews, 12 students (10 women, 2 men; Mage = 38.13, SD = 15.37) shared their experiences of bereavement while studying. A thematic analysis resulted in three themes: Relationships between study and bereavement, Navigating the university system, and What students need. The findings highlighted varying levels of support accessed and level of need, which were influenced by the circumstances of the student and the loss, mode of study, personal resources, and perceptions of the university system's ability to help. The findings highlight the need to develop and communicate clear policies and procedures so that bereaved students are supported. [ABSTRACT FROM AUTHOR]

To explore and describe families' and professionals' perspectives about building and maintaining engagement in telepractice early intervention (EI). Individual semi-structured reflexive interviews were conducted with Australian families of young children with communication disability receiving telepractice EI and their treating professionals. These interviews were conducted within one day of a telepractice EI session and analysed using thematic analysis. Thematic analysis of 72 interviews resulted in five themes that emphasised collaboration as an overarching enabler of engagement. The themes were: (1) the delivery of family-centred telepractice was essential for engaging children and families; (2) engagement in telepractice was variable and was affected by child, parent and professional factors; (3) engagement was an investment that required time, consistency and technology; (4) maximising communication interactions during telepractice sessions encouraged children and families to engage with professionals; and (5) joint planning and preparation facilitated child and family engagement in telepractice. In the midst of the current COVID-19 pandemic, the present study shed light that in many ways, engagement in in-person and telepractice intervention is similar. However, the findings revealed the importance of families having an active role in telepractice EI sessions that occur in the family's social and communication environment. Family engagement and high levels of parent participation are recommended in family-centred early intervention (EI). In EI delivered via telepractice, families and professionals invest in engagement-building and collaboration in a similar manner to in-person EI and in line with the principles of family-centred practice. The distinctiveness of telepractice engagement includes professionals being conscious of their communication style, taking advantage of the home environment, communicating inside and outside appointments, and jointly planning with parents/primary carers. EI professionals and students who work with young children with communication disability via telepractice can benefit by considering the engagement-building strategies described in the present study. [ABSTRACT FROM AUTHOR]

Clinical practice guidelines for paediatric neuromuscular disorders (NMDs) recommend timely provision of wheelchair equipment. The aim of this qualitative study was to understand healthcare professionals' clinical perspectives and practices when recommending wheelchair equipment for the first time, as well as perceived barriers and enablers to timely wheelchair provision. Twenty-one healthcare professionals (HCPs) from Australia and the United States participated in an interview (response rate: 88%, 16/21 women). Participants were from diverse disciplines, based in hospital or community health settings, and had at least one year of experience working in paediatric neuromuscular care. Child fatigue, falls and engagement in age-appropriate activity were common reasons for HCP's wheelchair recommendation. HCPs were acutely aware of parents' experiences of grief and loss throughout the wheelchair prescription process, and over half acknowledged the lack of psychological care available to families affected by NMDs. Multi-disciplinary collaboration, psychologically-informed care, and shared decision-making with stakeholders were perceived enablers of wheelchair transition. Barriers included limited access to equipment, lengthy funding processes and lack of funding for home and vehicle modifications. Integrated psychosocial care is needed to support families throughout their child's disease progression, including wheelchair transition. Implementation of readiness for change tools, and development of tailored informational resources is recommended. Improved access to equipment options and trials, and more efficient funding processes are highly likely to improve parental engagement throughout the wheelchair prescription process. Healthcare professionals express a strong demand for integrated psychosocial care within paediatric neuromuscular clinics to support families throughout transitions, including wheelchair introduction. Identifying parents' readiness for change can inform their information and support needs, strengthen their decision-making capacity and facilitate timely wheelchair introduction. Stronger collaboration between hospital- and community-based health professionals working in paediatric neuromuscular care is recommended to facilitate knowledge exchange and support families' transition to wheelchair use. Access to equipment options for extended loan or trial in the community can support timely wheelchair introduction. [ABSTRACT FROM AUTHOR]

Mothering and motherhood can be a very challenging experience in the 21st century, where cultural pressures, on the one hand, and health experts' regular parenting surveillance, on the other, continue to influence mothering decisions and practices. The socially constructed "good mother" discourses and associated pressures/influences can be amplified for vulnerable mothers who may feel marginalized from or judged by the broader society. This article presents findings from a study that involved interviews with ten young mothers and 12 staff working at a leading family welfare agency supporting young parents in Melbourne, Australia. The study examined how digital technology could promote a sense of agency for vulnerable mothers as well as barriers and enablers of accessing digital knowledge and online parenting support. In addition, the study explored how technology could assist community organizations' staff in helping their clients better. This paper argues that, overall, digital technologies can positively influence the experience of mothering and can empower vulnerable mothers by increasing their access to various sources of support. Furthermore, our findings suggest that technology can enhance community and family service providers' practice, opening possibilities for a more supportive relationship with clients by empowering them and increasing agency over their situation. [ABSTRACT FROM AUTHOR]

Self-management can lead to increased self-efficacy and improved quality of life for individuals with chronic conditions; however, there is little research exploring how self-management approaches can be used for chronic communication disorders, such as aphasia. Modifications to self-management approaches would be required to accommodate for aphasia; therefore, the input of people with aphasia (PwA) should be sought. The aims of the present study were: (1) To investigate and document the experiences and perspectives of PwA regarding self-management; (2) To explore how technology can be used to support aphasia self-management. In-depth, semi-structured interviews were conducted with 26 PwA living in Australia. Qualitative content analysis was used to analyse interview data. Analysis resulted in six themes: (1) In self-management, PwA take control of life with aphasia and assume responsibility for engaging in opportunities to improve overall communication; (2) Community aphasia groups are important enablers of self-management because they facilitate peer support; (3) Communication partners (CPs) provide multifaceted support in aphasia self-management; (4) SLPs provide integrated support and coordination in aphasia self-management; (5) Technology supports PwA to self-manage speech therapy and communication in daily life; (6) Psychological and physical health issues and societal factors may impact aphasia self-management abilities. From the perspective of PwA, aphasia self-management involves enhancing skills enabling communication and life participation. PwA are central to aphasia self-management, with support provided by CPs, peers, and SLPs. Technology has a range of applications in aphasia self-management. PwA identified potential personal and contextual barriers that may impact self-management. For people with aphasia, engaging in conversation and social interaction are primary means of managing/improving communicative life participation; therefore, this should be a key focus of aphasia self-management programs. Aphasia self-management approaches should maximise the use of available support and provide tailored information, education, and training in the area of self-management to key stakeholders (people with aphasia, communication partners, and speech-language pathologists). People with aphasia should be supported to use technology for aphasia self-management, encompassing communication specific and daily life use. People with aphasia should be heavily involved in the development of structured aphasia self-management approaches. [ABSTRACT FROM AUTHOR]

National Guidelines for Spiritual Care in Australia recommend incorporation of spiritual care in multidisciplinary patient care planning, however it is not known how consistently this is done. A qualitative interview study was designed to explore the practices of pastoral care practitioners in two city hospitals in Australia. Fourteen pastoral care practitioners participated (100% response rate). Interviews were taped and transcribed verbatim. Transcripts were analysed according to thematic analysis. Six themes were identified in the data. These were: (1) a vocation, (2) the role of pastoral care, (3) documentation, (4) communication with other ward staff, (5) barriers to communication, and (6) official recognition of pastoral care workers. While pastoral care workers are convinced of the importance of their work, they experience challenges in expressing this to their colleagues, which may reduce their impact on patient care. Ongoing professionalization of pastoral care will help to reduce this discrepancy. [ABSTRACT FROM AUTHOR]

Introduction: Chronic hepatitis B presents significant issues to public health and clinical practices. The infection requires lifelong clinical management and is a leading risk factor for liver cancer and liver cirrhosis. Limited studies currently exist on the social impacts of living with chronic hepatitis B, especially for people from Sub-Saharan Africa. The current study explored the experiences of South Sudanese people living with chronic hepatitis B in Australia. Methods: A qualitative inquiry using face-to-face interviews with fifteen South Sudanese people with chronic hepatitis B in Australia explored the social impacts of living with chronic hepatitis B. The study purposively sampled participants who self-identified as South Sudanese with hepatitis B and over 18 years of age. Interviews were coded and analysed using thematic analysis. Results: The study identified three themes relating to the experiences of living with chronic hepatitis B, and were grouped into psychological, interpersonal and healthcare system levels. Psychological level experiences related to the uncertainty of living with chronic hepatitis B and liver cancer risk, where participants expressed persistent fear of disease progression and anxiety around death related to the disease. Interpersonal level experiences involved the disclosure of hepatitis B and its social impacts including stigma, social distancing and isolation. Healthcare system level experiences included receiving mixed messages about hepatitis B, challenges with regular testing and difficulty receiving hepatitis B treatment. Conclusion: The findings provide valuable insights into the social impacts of hepatitis B. It underlines the importance of integrated public health interventions at the community level to improve knowledge and awareness of hepatitis B which address stigma in the South Sudanese community in Australia. [ABSTRACT FROM AUTHOR]

The aim of this prospective case study was to explore clients' and social network members' responses to participating in a newly implemented Open Dialogue approach in an Australian early intervention in psychosis treatment context. We followed four clients' trajectories through treatment by drawing on data from electronic medical record entries, observed or audio-recorded network meetings, and client and family interviews. Data were analysed thematically. Clients and families generally appreciated the Open Dialogue approach, even though it created hard practical and psychosocial work for them before, during and in between meetings. We discuss the increased workload as responsibilization of families. [ABSTRACT FROM AUTHOR]

To understand the factors that affect the management of people after serious injury in urban and regional settings, beyond hospital discharge from the perspectives of allied health professionals (AHPs). An exploratory qualitative study of AHPs caring for people with serious injuries post-hospital discharge in urban and regional areas of Victoria, Australia was completed. Twenty-five semi-structured interviews were undertaken with AHPs and thematically analysed. Allied health professionals in urban and regional settings reported the benefits of a multi-disciplinary team to deliver high-quality care. However, a number of barriers to service delivery were identified that impacted on their ability to meet the needs of patients. These included insufficient psychological services, a shortage of available carers and an unmet need for external clinical support in regional areas. Communication between AHPs and other services, and care co-ordination of post-discharge services, was also highlighted as key areas to improve for optimal patient care. Factors that influenced optimal patient management included the availability of psychological and carer services, communication between health professionals and coordination of post-discharge care. The experiences of AHPs can offer practical suggestions to optimise service delivery and post-discharge care for people with serious injuries. Allied health professionals (AHPs) face a number of challenges in the provision of optimal care to people with serious injuries. Improving the availability of psychological support and attendant carers is needed in regional areas. A designated care coordinator role may assist people with serious injuries transitioning between hospital and home to engage with necessary services and reduce administrative burden for AHPs. Telehealth may provide facilitate improved communication between health professionals and support regional clinicians caring for people with complex injuries. [ABSTRACT FROM AUTHOR]

Background and Purpose: Student-led physiotherapy clinics are a valuable means for providing education opportunities and cost-effective services to the public. Service dissatisfaction is an important construct in understanding how student-led services can maximize patient care and minimize non-attendance while maintaining effective learning environments. Design: A qualitative interview design was used with semi-structured interviews. Results: Eighteen patients from three different university student-led physiotherapy clinics were interviewed. Five themes emerged that were associated with negative perceptions of service provision: (1) inadequate communication, (2) insufficient supervision, (3) loss of autonomy, (4) time commitment, and (5) continuity of care. Conclusion: The results of this study highlight factors that service providers should consider to mitigate negative patient experiences and relevant implications of dissatisfaction including non-attendance. Ensuring transparency of patient expectations of services and enhancing patient continuity of care between physiotherapists and students are important in minimizing the potentially negative factors associated with student-led health services. [ABSTRACT FROM AUTHOR]

Background: Communication is an essential prerequisite for good end-of-life care. Yet, there is a need to better understand the unique features of communication regarding end-of-life care for older people. Aim: To gain an in-depth understanding of family communication and decision-making concerning older people's end-of-life care. Design: Semi-structured interviews were undertaken with four older palliative care patients and seven bereaved family members in Melbourne, Australia. Data were analysed thematically using inductive coding. Findings: Participants preferred not to think about dying as older people trusted others (e.g. medical staff, God) to make decisions for them. This influenced end-of-life communication, resulting in family members making decisions during medical crises. Such decisions were complicated by family conflict and denial of dying. Family members were crucial mediators between older people and health services, helping them to navigate the care system and advocating on their behalf. Being treated with respect, remaining independent and socially connected was integral to participants' perception of good end-of-life care. Conclusions: End-of-life communication and decision-making is multi-layered, and shaped by families' histories and roles. While documenting and implementing care preferences is challenging, understanding these challenges may improve communication between services, families and older people as they approach the final stage of life. [ABSTRACT FROM AUTHOR]

Schizophrenia is a global concern, and, this paper, describes the caring roles of health professionals who are mothers of adult children with schizophrenia. A thematic analysis of data from a doctoral study identified a blending of expertise into an informed care model. Caring roles included: constant carer; coordinator carer; watchful bystander carer; and life coach carer. Previous research has not explored these dual roles. This paper elucidates their responsive approaches and contributions to mothering and caregiving roles. Informed by a fusion of professional and mothering knowledges, their insights into mental health care have been forged by their experiences and is an untapped resource. [ABSTRACT FROM AUTHOR]

Much of the work on media multiplexity theory (MMT) is based on unestablished relationships, in which more channels are presumed to be indicative of higher relational closeness. But a different set of relational dynamics may be at play in preexisting acrimonious partnerships. In this article, we investigate the use of different modes of communication by high-conflict separated parents (media multiplexity), and map changes in modes of communication (modality switching). Qualitative data from 68 separated parents in Australia who reported chronic parental acrimony suggest that a considerable amount of modality switching occurred post-separation. Consistent with MMT, multiplexity was evident but the degree of multiplexity was not as clearly related with the degree of closeness in the co-parental relationship as would be otherwise predicted by MMT. Recent insights into more pernicious forms of family dynamics set an important challenge for communication theories to better account for ex-couple motivational complexities. [ABSTRACT FROM AUTHOR]

Background: Communication with indigenous patients is often a problem for health staff in Australia. Aim: This paper examines the barriers and enablers in communication between health staff and Indigenous carers of paediatric patients in a hospital, about advice to help reduce exposure of children to second-hand smoke (SHS). Methods: Non-indigenous health staff and Indigenous carers, were recruited from a paediatric ward of a regional hospital in the Northern Territory. A constructivist grounded theory with multiphase case study design and semi-structured interviews was used. Results: Health staff and carers had different perceptions about raising the issue of smoking. Health staff lacked confidence to talk about smoking and questioned the cultural appropriateness of doing so. In contrast, carers expected to talk about smoking while in the hospital., and perceived it as part of a caring and protective relationship by health staff. English being a second language for carers was considered a significant communication barrier by staff; carers, however, felt that health staff needed to modify their communication styles. The possible misperceptions about carers' lack of response to messages, led to health staff dropping the subject, when, in fact, carers were struggling with health workers communication styles. Conclusions: Health staff and carers perceive discussion around smoking differently. Cross-cultural communication education may empower staff to provide effective smoking cessation interventions in this setting. Impact statement: Improving communication between health staff will help ensure the optimal provision of smoking cessation support to carers. [ABSTRACT FROM AUTHOR]

This paper examines the provision of youth targeted Relationships and Sexuality Education (RSE) and sexual health interventions in the rural Australian context by examining the perspectives and experiences of a range of community stakeholders. Sixteen participants undertook one-on-one semi structured interviews. Four key themes emerged from the data and included: 'you're not going to get the whole town to start thinking about adolescent sexual health'; backlash, stigma and secrecy; being consistent, credible and available; and small-town communication. This study contributes to the limited literature about RSE and sexual health provision in regional and rural Australia and provides a voice for rural stakeholders who provide RSE and sexual health interventions by default or necessity. The findings of this study have practical implications for rural settings when addressing youth sexual health needs. [ABSTRACT FROM AUTHOR]

Background: Increasing health professional student numbers in Australia, in response to looming predicted workforce shortages, resulted in a Federal Government call for action to provide clinical supervision education to health professionals. Objectives: This research aimed to develop, implement and evaluate the programme, 'The Art of Clinical Supervision' (ACS), designed to support nurses facilitate a positive learning environment for student nurses. Method: The ACS programme was presented (n = 199) across Western Australia as a doctoral study, with participants from both the public and private healthcare sector working in a variety of specialties. A triangulation approach of surveys, reflective entries and interviews was utilised to determine its impact. Results: The data indicated that participants improved their understanding of supervision and attitude towards students and supervision after attending the ACS. Conclusions: Health service managers are encouraged to evaluate their staffs' knowledge and attitude towards students with findings used to facilitate a positive learning culture. Impact Statement: The Art of Clinical Supervision The purpose of the research was to develop, implement and review a new education programme that could support the development of clinical supervision knowledge and attitude to support student nurse learning. This occurred in an environment of increased student numbers as a strategy to correct a predicted looming workforce shortage. The study findings determined that the programme improved both participant knowledge about how to provide effective clinical supervision (teaching) in the clinical environment, and improved staff attitudes towards students and their place as a learner in the clinical areas. The type of impact was therefore within the domain of quality by improving student learning through effective education strategy. As a result of the doctoral research, involving 200 participants, a Federal Government grant of approx. $500,000 was received to facilitate the training of additional educators to provide the programme across the state of Western Australia. This grant was a partnership between the programme author (researcher) and the Western Australian Government Department of Health. This involved four educators presenting the programme to over 3,000 health professionals in a 3-year period. Despite the cessation of funds with the closure of HWA the programme continues to be delivered through The University of Notre Dame Australia School of Nursing and Midwifery, with only a cost recovery charge. [ABSTRACT FROM AUTHOR]

Background: Health Professionals are required to balance care practices against patient risk to optimise safety. Communicating clinical risk with the patient requires confidence. Objective: The objective was to explore health professionals understanding and confidence of patient-centred communication during conversations of risk prevention. Design: An exploratory study was conducted. Methods: Nurses, physiotherapists and social workers in a metropolitan hospital in Sydney (New South Wales, Australia) completed face to face interviews (n = 16) regarding person-centred communication and clinical risk. Results: The sample was predominately female and had been a health profession for 11.5 years (mean). Six key themes were generated including: Perceptions of person-centred communication; Preparing for person-centred communication and Understanding and prioritising conversations about preventable clinical risk. Conclusions: Person-centred communication was embedded in clinical practice; the 'patient voice' was considered central. Clinical risk was a priority. Education to improve communication was highlighted as a way to enhance person-centred communication. [ABSTRACT FROM AUTHOR]

Goals-of-care discussions aim to establish patient values for shared medical decision-making. These discussions are relevant towards end-of-life as patients may receive non-beneficial treatments if they have never discussed preferences for care. End-of-life care is provided in Emergency Departments (EDs) but little is known regarding ED-led goals-of-care discussions. We aimed to explore practitioner perspectives on goals-of-care discussions for adult ED patients nearing end-of-life. We report the qualitative component of a mixed methods study regarding a 'Goals-of-Care' form in an Australian ED. Eighteen out of 34 doctors who completed the form were interviewed. We characterised ED-led goals-of-care consultations for the first time. Emergency doctors perceive goals-of-care discussions to be relevant to their practice and occurring frequently. They aim to ensure appropriate care is provided prior to review by the admitting team, focusing on limitations of treatment and clarity in the care process. ED doctors felt they could recognise end-of-life and that ED visits often prompt consideration of end-of-life care planning. They wanted long-term practitioners to initiate discussions prior to patient deterioration. There were numerous interpretations of palliative care concepts. Standardisation of language, education, collaboration and further research is required to ensure Emergency practitioners are equipped to facilitate these challenging conversations. [ABSTRACT FROM AUTHOR]

Approximately 25 years ago, special measures were adopted in many jurisdictions to support child sexual assault complainants in legal proceedings. This study tracked activities of a multi-agency committee of criminal justice professionals, including social workers, in enacting those provisions. We manually reviewed 99 sets of minutes of meetings of the New South Wales Sexual Assault Review Committee, spanning over two decades. Findings identified numerous gaps between legislation and practice, and the actions of this group, led by prosecutors, to narrow those gaps. Qualitative analyses revealed more focus on legislative issues and research in the early years, when closed-circuit television (CCTV) use commenced. Key evidence-based recommendations of the Committee were: (1) prerecorded evidence-in-chief of complainants; (2) cross-examination via CCTV; and (3) witness intermediaries. Investigation of and responses to stakeholder feedback on practice issues was an integral and consistent function of the Committee. In later years, the focus shifted to technological and administrative difficulties with prerecorded police interviews, CCTV, and court closure. Longitudinal analyses revealed longstanding and robust issues in implementing special measures to improve experiences of vulnerable complainants in giving evidence. Proactive prosecution leadership and multidisciplinary membership contributed to a well-informed, evidence-based focus on the needs of vulnerable witnesses. Stakeholders from multiple agencies collaborated efficiently to resolve many practical issues, but improvements to certain systemic issues require resources beyond their capacity. [ABSTRACT FROM AUTHOR]

Objectives: Hepatitis B is a viral infection primarily affecting people from culturally diverse communities in Australia. While vaccination prevents infection, there is increasing mortality resulting from liver damage associated with chronic infection. Deficits in the national policy and clinical response to hepatitis B result in a low diagnosis rate, inadequate testing and diagnosis processes, and poor access to hepatitis B treatment services. While research identifies inadequate hepatitis B knowledge among people with the virus and primary health care workers, this project sought to identify how specialist clinicians in Australia negotiate cultural diversity, and provide often complex clinical information to people with hepatitis B. Design: A vignette was developed and presented to thirteen viral hepatitis specialist clinicians prior to an electronically recorded interview. Recruitment continued until saturation of themes was reached. Data were thematically coded into themes outlined in the interview schedule. Ethical approval for the research was provided by the La Trobe University Human Research Ethics Committee. Results: Key messages provided to patients with hepatitis B by clinical specialists were identified. These messages were not consistently provided to all patients with hepatitis B, but were determined on perceptions of patient knowledge, age and highest educational level. While the vignette stated that English was not an issue for the patient, most specialists identified the need for an interpreter. Combating stigma related to hepatitis B was seen as important by the specialists and this was done through normalising the virus. Having an awareness of different cultural understandings about hepatitis B specifically, and health and well-being generally, was noted as a communication strategy. Conclusion: Key core competencies need to be developed to deliver educational messages to people with hepatitis B within clinical encounters. The provision of adequate resources to specialist clinics will assist in addressing gaps in the clinical response to hepatitis B. [ABSTRACT FROM AUTHOR]

Purpose: Aboriginal Australians are under-represented in stroke rehabilitation services and rehabilitation practices that are sensitive to the needs of Aboriginal people are not currently available. This project tested the feasibility and acceptability of a rehabilitation model and approach to therapy with Aboriginal people with acquired communication disorders post-stroke. Method: Eight Aboriginal people with acquired communication disorders post-stroke were recruited to this study. Sixteen treatment sessions were provided twice weekly at the person's place of residence by a speech-language pathologist and Aboriginal co-worker. Feasibility was measured by analysing the number of sessions conducted jointly by the speech-language pathologist and Aboriginal co-worker and participant attendance. Participant acceptability was measured through the analysis of a post-therapy questionnaire. The Aboriginal co-worker's and speech-language pathologists' perceptions of the acceptability were collected through semi structured interviews. Result: Across all sessions 84.2% were attended by the Aboriginal co-worker and speech-language pathologist and seven of the eight participants completed all prescribed sessions. Positive feedback was provided by participants, the Aboriginal co-worker and speech-language pathologist on the key components of the programme. Conclusion: The rehabilitation model used within Wangi appears to be feasible and acceptable to participants and therapists. It provides direction to improve the quality of care for Aboriginal stroke survivors. [ABSTRACT FROM AUTHOR]

Purpose: A variety of empirically supported interventions are available for children with autism spectrum disorder (ASD), but previous research suggests that their selection and use within an evidence-based practice (EBP) framework in clinical settings is challenging. To date, research has primarily focused on identifying individual, organisational, and contextual barriers to EBP rather than identifying collaborative solutions to these barriers through consultation with staff. The aim of our study was to explore staff views on supporting EBP in their work with children with ASD. Materials and methods: We conducted five focus groups involving 29 professional (e.g., speech pathologists, teachers), paraprofessional (e.g., childcare workers), and managerial staff to explore their views. Audio recordings were transcribed verbatim and analysed using thematic analysis. Results: Two central themes, comprising six categories, emerged to account for the participants' views. Initiative and Effort accounted for the range of creative strategies staff had developed to support their engagement in EBP. They also expressed the need for A Better Way involving organisational-wide support such as this engagement, including peer-to-peer mentoring. Conclusions: The findings suggest that an organisational-wide model to support engagement in EBP, with peer-to-peer mentoring at its foundation, may provide a desirable, ecologically valid, and acceptable model. Implications for Rehabilitation: Clinicians and educators recognise the importance of evidence-based practice. Efforts to support evidence-based practice have focused mostly on access to research evidence. Clinicians and educators in this study were developing their own strategies based on intuition. They identified a need for organisation-wide approaches to supporting evidence-based practice. Peer-to-peer mentoring appears to be an acceptable and viable strategy. [ABSTRACT FROM AUTHOR]

Objective: To provide a qualitative examination of the service and support needs of children who have had a mild traumatic brain injury (mTBI), and their parents, in order to improve clinical services. Methods: Semi-structured interviews were conducted with 9 children (8-12 years; M = 10.6 years, SD = 0.8) and their parents (n = 9) 29-55 days (M = 34 days; SD = 9.3) after presenting to an Australian Paediatric Emergency Department (PED) for mTBI. Children's post-concussive symptoms (PCS) were additionally measured using the Post-Concussive Symptom Inventory (PCSI). Audio recordings were transcribed, and a thematic analysis was conducted. Results: Post-injury needs were reflected in four main themes: Communication; Family Burden; Continuity of Care; and Social and Community Support. These themes reflected children's and parents' needs for information, emotional/social/community support, and follow-up care. Both the children's and parents' needs, and the extent to which they were met, appeared to be related to the severity and duration of the child's PCS. Conclusions: Dedicated pediatric mTBI follow-up services that build on family's resources and meet their individual needs for information, emotional support, and referral may assist in optimizing post-injury outcomes. [ABSTRACT FROM AUTHOR]

Natural disaster impacts on populations already experiencing significant health, income, and social disadvantage, are both more intense and longer lasting than for the general population. The intersection of social isolation and poverty for some groups often results in significant risks during the immediate crisis of a disaster and ongoing challenges for recovery. This article reports on qualitative research examining natural disaster preparedness with five “at-risk” populations in regional Australia. The research was undertaken as part of a project sponsored by a regional organisation of local councils in New South Wales to map and understand spatial and social factors shaping natural disaster risks and responses. Seventeen focus groups were held with 111 participants; older people, people with disabilities, families with children under five, low-income households, and people from culturally and linguistically diverse (CALD) backgrounds. Findings illuminated participant experiences of the intersection between sociogeographic disadvantage with social isolation in the context of natural disaster preparation and response. IMPLICATIONS Social isolation—or the intersection of social and geographic disadvantage—appears to be a complex contributor to vulnerability in disaster preparation and response. Disaster risk needs to be assessed as part of social work support for vulnerable people. [ABSTRACT FROM AUTHOR]

Parent-carers need support to continue to care for their child with significant disability in their home. There has, however, been little evidence that respite interventions have consistent or enduring beneficial effects on carer well-being. This article reports the findings of a qualitative study which adopted an Appreciative Inquiry philosophy to interview parent-carers of children with significant intellectual and/or developmental disabilities on how formal support services have helped them maintain their health and well-being, and disability support staff on how they help such parent-carers foster their health and well-being. We conclude that better communication and collaboration between service providers and users, more targeted training of workers, and embracing a person-centred and family-centred approach to respite services are needed. In addition, clearer definition and communication of the scope of respite services are required to best support families of children with significant disability in their home. [ABSTRACT FROM AUTHOR]

To explore the factors influencing parents’ choice of communication mode during early education of their child with hearing loss. Qualitative descriptive analysis of semi-structured interviews with parents of children with hearing loss. Fourteen parents of children who participated in the Longitudinal Outcomes of Children with Hearing Impairment study. Four themes emerged from thematic analysis of the interview data: (1) parents draw on a variety of experiences and information to make decisions; (2) parents’ preferred outcomes for their children drive their choices; (3) child’s preference and proficiency drive parental choice; and (4) parents’ fears and worries influence decisions. The results reinforced the importance of parents receiving unbiased, descriptive information as well as evaluative information from professionals, so that they could consider all options in making a decision that met their needs. Parents also require continual support for implementation of their choices as they adjust to their children’s changing communication needs. Parent decisions around communication mode are rarely made in isolation, but occur within a larger decision-making matrix that include device choices, early intervention agency choices, and ‘future-proofing’ the child’s ongoing communication needs. [ABSTRACT FROM AUTHOR]

The communication journey of a child with hearing loss is often a complex, interwoven process in which the child's use of language or method of communication may change numerous times. As there has been limited research exploring the caregiver decision-making process behind making such changes, this qualitative descriptive study aimed to explore the factors which influence the caregiver decision making-process to change the communication method of their child with hearing loss. Individual semi-structured in-depth interviews were conducted with seven caregivers of children with hearing loss in Australia. Thematic analysis revealed five key themes which influenced caregiver decisions regarding changes to their child's method of communication, including: (1) family characteristics; (2) family access to information; (3) family strengths; (4) family beliefs; and (5) family-centered practice. The overall finding that the family unit is at the core of decision-making has important clinical implications regarding early intervention professionals’ provision of family-centered services when working with the families of children with hearing loss. [ABSTRACT FROM AUTHOR]

The complexities of being an academic mean that there is often no time or space to reflect on teaching, and on academic life in general. In this study, four academics set up a private blog to share reflections on teaching. While initial commitment to the reflective blogging process was good, over time this declined. After 9 months of intermittent communication, we decided to wrap up the project and examine the experience. A qualitative analysis of the group's reflective posts and related emails revealed themes related to emotions, space and time in academic experience. We discuss why the blog space did not work as anticipated, and how such 'troublesome' spaces may, paradoxically, be viewed as transformative. [ABSTRACT FROM AUTHOR]

Background: People with aphasia (PWA) and their families (PWA-F) have conveyed that the receipt of information and education is a key component of rehabilitation which supports access to services and participation in healthcare decision-making. Best practice recommendations state that education about aphasia should be tailored, aphasia-friendly, and provided on multiple occasions and in a variety of formats. To date, there has been little research examining the current practices of speech-language pathologists (SLPs) in the provision of education or their perspectives on barriers and facilitators to achieving optimal aphasia education practices. Aims: The aim of this study was to explore current and optimal aphasia education practices from the perspective of Australian SLPs. Methods and Procedures: This study used a cross-sectional survey design, comprising both quantitative and qualitative questions. An online survey was distributed to Australian SLPs via professional networks. Quantitative data were analysed using descriptive statistics and qualitative data using content analysis. Outcomes and Results: This study reports data from 130 Australian SLPs. The majority of SLPs (>70%) reported that they provided information to both PWA and PWA-F about (1) the definition of aphasia, (2) characteristics of aphasia, (3) causes of aphasia, (4) aphasia recovery, (5) strategies to assist communication, and (6) coping strategies. However, the majority of SLPs reported that they did not provide information to friends on any of the presented topics. Many SLPs (>95%) provided both face-to-face and written aphasia information, and approximately half (55%) provided aphasia education that could be accessed via the Internet. All but one SLP reported using pre-prepared written information and less than half (45%) considered those materials to be formatted in an aphasia-friendly way. The majority of SLPs (65%) reported that they did not have a systematic approach to providing aphasia education, they (82%) did not evaluate the effectiveness of aphasia education, and they (92%) did not provide optimal aphasia education. SLPs reported that greater access to aphasia-friendly formatted information (94%) and written information for family members (92%) would assist in optimising aphasia education. Furthermore, 82% of SLPs indicated that they would support an Australia-wide move to use the term aphasia, rather than dysphasia. Conclusions: The majority of SLPs reported providing information to PWA and PWA-F in a variety of formats; however, information provision did not commonly extend to friends. Increased tailoring of information and access to aphasia-friendly information would assist SLPs in meeting best practice recommendations for aphasia education. [ABSTRACT FROM AUTHOR]

In paediatric clinical care,whatis said to a parent or carer as well aswhen, where, andhowit is said, directly advances or diminishes parents’ capacities to understand available options and to contribute to decisions about treatment for their child. This makes interprofessional and patient communication an ethical endeavour. Social workers are uniquely situated to observe, participate in, and provide an active link in the communication between families and other health team members. This article reports phenomenological research exploring ethical issues encountered by social workers in their everyday practice communicating with families and other health professionals in a paediatric hospital context in Australia. Data were collected via semi-structured interviews with nine social workers and analysed thematically. Participants described two main communication-based roles: to support families through information provision and to contribute collaboratively to the interprofessional team involved in caring for a child and family. We grouped participants’ descriptions of conflict between these roles into five main “communication challenges”: (1) holding troublesome knowledge; (2) the need for diplomacy; (3) conciliation; (4) every man and his dog in family meetings; and (5) systems and processes presenting a brick wall. The five communication challenges provide empirically derived examples of how communication occurring within interprofessional health teams and between individual clinicians and parents can act to diminish or enhance parents’ experience of care for their hospitalised child. Identifying these challenges may help to inform how communication within interprofessional teams and between clinicians and patients can benefit children and their parents. [ABSTRACT FROM PUBLISHER]

Objective Despite the heterogeneity of Australian Aboriginal peoples, certain styles of relating are shared and are markedly different to the communication styles of non- Aboriginal peoples. These differences may affect the suitability of current investigative interview protocols to Australian Aboriginal children. This study aimed to qualitatively evaluate the applicability of an investigative interview protocol to Australian Aboriginal children and examine how it could be modified to better suit the communication styles in many Aboriginal communities. Method A diverse group of 28 participants who had expertise in Aboriginal language and culture, as well as an understanding of the child investigative interview process, each partook in an in-depth semi-structured interview where they were prompted to reflect on Aboriginal language and culture with reference to a current interview protocol (in the context of sexual assault investigation). Results Thematic analysis revealed overall support for the narrative-based structure of the interview protocol when eliciting information from Aboriginal children. A number of concerns were also identified, and these largely related to the syntax and vocabulary within the protocol, as well as the methods of questioning and building rapport with the child. Conclusions Directions for future research and potential modifications to investigative interview protocols to better suit Aboriginal children are discussed. [ABSTRACT FROM AUTHOR]

Background:Indigenous health matters have largely been neglected in the speech-language pathology literature and have particular import for the aphasia clinician. The influence of culture on people’s experiences and expectations after an event such as stroke can vary widely and there is a need to understand the impact of context on assessment and therapy. Standard approaches may not be adequate or relevant, nor always ethical to apply. Examination of aphasia in contexts with Indigenous populations provides an opportunity to explore methods and approaches with socially complex and marginalised communities and to expand our understanding of the lived experience of aphasia. Aims:The goal of this paper is to explore the role of culture in aphasia in Indigenous populations and drawing from a body of emerging research, highlight relevant dimensions of understanding and practice for the aphasia clinician. Main Contribution:A series of qualitative studies undertaken with Indigenous people with aphasia in two separate contexts – Australia and South Africa – will be described and their findings considered along several dimensions. A consideration of methods of approach and understanding will be provided, followed by discussion of some central constructs. A series of conceptual and clinical propositions for culturally safe research and practice in aphasia will be derived from this evidence. Models of collaboration are derived which are decolonising and potentially transformative and supplement models of knowledge and intervention in a local community. Particular attention is paid to temporal and spatial issues, the role of family, identity and community, the notion of resilience in such communities and addressing some of the specific challenges that may be involved such as working with cultural brokers. A series of recommendations is provided which allows for a critical engagement with interdisciplinary frameworks of understanding aphasia in context. Conclusion:As a reflective piece, this paper has enabled a collation of knowledge about aphasia in two Indigenous cultures and has helped consolidate some novel principles and insights and the need for expanded skills, attitudes, insights, explanations and methodologies – ones that acknowledge and accommodate diversity and difference, and that are relevant to Indigenous communities. Language difficulties are only one cause of social exclusion and issues such as poverty and identity make a huge impact on the lives of our clients and their families, and on the approach we adopt. A shift from the primary framework of our profession is required to accommodate the central role of culture in communication. [ABSTRACT FROM PUBLISHER]

Experiential knowledge of elite National Rugby League (NRL) referees was investigated to determine the key attributes contributing to expert officiating performance. Fourteen current first-grade NRL referees were asked to identify the key attributes they believed contributed to their expert refereeing performance. The modified Delphi method involved a 3-round process of an initial semi-structured interview followed by 2 questionnaires to reach consensus of opinion. The data revealed 25 attributes that were rated as most important that underpin expert NRL refereeing performance. Results illustrate the significance of the cognitive category, with the top 6 ranked attributes all cognitive skills. Of these, the referees ranked decision-making accuracy as the most important attribute, followed by reading the game, communication, game understanding, game management and knowledge of the rules. Player rapport, positioning and teamwork were the top ranked game skill attributes underpinning performance excellence. Expert referees also highlighted a number of psychological attributes (e.g., concentration, composure and mental toughness) that were significant to performance. There were only 2 physiological attributes (fitness, aerobic endurance) that were identified as significant to elite officiating performance. In summary, expert consensus was attained which successfully provided a hierarchy of the most significant attributes of expert NRL refereeing performance. [ABSTRACT FROM PUBLISHER]

Sports wagering has been identified as a gambling product which may pose particular risks for young men, because of the aggressive marketing tactics used to promote these products, and the alignment with culturally valued sporting activities. However, there is very limited information about the socio-cultural processes that may contribute to the normalisation of sports wagering for this population. Using semi-structured interviews with 50 Australian young men who gambled on sport, we explored the way in which peer group behaviours influenced attitudes towards, and the consumption of, gambling products. Four thematic clusters emerged from the interviews. First, young men perceived that sports wagering was a ‘normal’ and socially accepted activity, and a natural ‘add on’ to sports. Second, there were clear indicators that sports wagering was becoming embedded within existing peer based sporting rituals, with the emergence of gambling clubs, and online forums. The third finding related to the shaping of gambling/sport discussions, which created a sense of identity and a point of conversation for peers. Finally, some participants spoke of the social pressure to gamble to ‘fit in’ with their friends. This study suggests that sports wagering poses a new health threat for young men, with sports wagering quickly being normalised as an embedded activity in young male sports fans' peer groups. There are clear lessons from the Australian experience for other countries, relating to the ways in which industry marketing tactics may combine with culturally valued activities such as sport, to influence risky gambling behaviours. [ABSTRACT FROM AUTHOR]

Talanoa is an established format for generating discussion about complex topics used throughout the Pacific. Pacific researchers use talanoa to gather data with migrant Pacific Island populations, in countries such as the United States of America, Australia, and Aotearoa/New Zealand (A/NZ). Using talanoa in this way, changes the way that the approach is used as, on the one hand it is out of its original context, and on the other hand, extends its use to gather data with Pacific Islanders. In this article, we discuss the implementation of talanoa in an explorative qualitative research project, and discuss its effectiveness and usefulness for getting to the heart of the story about Tongan interpretations of mental illness and distress. [ABSTRACT FROM AUTHOR]

Primary objective: There have been few reports of the approaches taken by speech-language pathologists (SLPs) when assessing cognitive communication (CC) during post-traumatic amnesia (PTA) after TBI. This study sought to understand SLPs’ rationales for CC assessment during PTA and to examine their perspectives on assessment methods during the early recovery period. Methods and procedures: In this qualitative study, 10 SLPs participated in semi-structured face-to-face or telephone interviews about their rationales and methods for CC assessment during PTA and early recovery. Content analysis was conducted using NVivo software to identify key categories. Main outcome and results: SLPs reported their reasons for CC assessment as including: (1) Documenting changes and monitoring progress, (2) Feedback to team, family and patient, (3) Diagnosis of communication disorder, (4) Planning and (5) Prognosis. They described conducting ongoing, informal assessment and monitoring of CC, using a combination of standardized and non-standardized measures during PTA, and commenced formal testing after PTA resolution to formulate a baseline level of communication function. Conclusions: The current study highlighted the importance that SLPs placed on an individualized approach in CC assessment. Findings provided insight into the process of assessment of CC during PTA and the early stage of recovery after TBI. [ABSTRACT FROM PUBLISHER]

Objective:This study explores the perceptions of patients receiving treatment for Hepatitis C to determine what factors influence their decision to commence treatment, ability to maintain adherence and complete their treatment program. Design:Semi-structured interview techniques were used in a qualitative study of 20 patients undergoing treatment for Chronic Hepatitis C (CHC). Main outcome measures:To explore patients’ perceived barriers and facilitators of Hepatitis C treatment adherence and completion. Results:Analysis of patient interviews identified four key themes: (1) motivations for commencing CHC treatment – fear of death and ridding themselves of stigma and shame; (2) the influential role of provider communication – patients reported that information and feedback that was personalised to their needs and lifestyles was the most effective for improving adherence to treatment; (3) facilitators of treatment adherence and completion – social, emotional and practical support improved adherence and completion, as did temporarily ceasing employment; (4) barriers to treatment adherence and completion – these included side effects, stigma, a complicated dosing schedule and limitations of the public healthcare system. Conclusion:To increase treatment adherence and completion rates, a patient-centred approach is required that addresses patients’ social, practical, and emotional support needs and adaptive coping strategies. [ABSTRACT FROM PUBLISHER]