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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]

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]

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]

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]

Public health messages disseminated by trusted government authorities are likely to have more influence over individuals' intentions and behaviors. However, individuals worldwide have different levels of trust in government authorities, which leads to varying levels of compliance intentions. Additionally, these trust levels may vary during major public crises, such as pandemics. Based on a COVID-19 pandemic communication survey (N = 3,065) disseminated throughout six countries (Australia, Finland, Italy, South Korea, Sweden, and the United States), this study examined the association among trust in distinct government sources, cultural orientations, and health behavioral intentions. Findings indicated that trust in official health communication sources at four governmental levels (i.e. national government, the head of the national government, the national health authority, and the chief representative of the national health authority) was related to vaccination intentions and other behavioral compliance intentions (i.e. willingness to prevent COVID-19 infection in other ways). Meanwhile, these direct associations were mediated by the cultural orientations of power distance and uncertainty avoidance. Findings also revealed that the direct association of trust in government sources and the indirect relationship through the above cultural orientations varied by country. This study offers insight into the important role of credible sources and individuals' cultural orientations in the domain of health communication aimed at influencing behavioral intentions. [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]

This study aimed to establish shared interprofessional competencies across health professions that promote education, communication, and teamwork, preparing the virtual care workforce to work collaboratively with the patient and their carers, family members, and communities to improve health outcomes. A modified, two-round Delphi process was undertaken with an interprofessional panel selected from the public health sector workforce across one Australian state. Sixty-nine panelists participated in Round 1 and 40 panelists participated in Round 2. Fifty-eight competencies across seven domains were established to support an interprofessional approach to virtual care provision: compliance, professional practice, patient safety, communication, interprofessional collaboration, patient assessment and care planning/delivery/coordination. This virtual care education framework may assist different health disciplines to develop, revise or map new or existing undergraduate or postgraduate education programs or design professional development activities. Drawing upon the expertise of a broad range of health professionals in its development, this education framework focuses on improving interprofessional collaboration in virtual care settings. [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]

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]

Patient-centered care (PCC) is the prevailing model of care globally. However, most research on PCC has been conducted in Westernized countries or has focused on only two facets of PCC: decision-making and information exchange. Our study examined how culture influences patients' preferences for five facets of PCC, including communication, decision-making, empathy, individualized focus, and relationship. Participants (N = 2071) from Hong Kong, the Philippines, Australia, and the U.S.A. completed an online survey assessing their preferences for exchange of information, autonomy in decision-making, expression and validation of their emotions, focus on them as an individual, and the doctor-patient relationship. Participants from all four countries had similar preferences for empathy and shared decision-making. For other facets of PCC, participants in the Philippines and Australia expressed somewhat similar preferences, as did those in the U.S.A. and Hong Kong, challenging East–West stereotypes. Participants in the Philippines placed greater value on relationships, whereas Australians valued more autonomy. Participants in Hong Kong more commonly preferred doctor-directed care, with less importance placed on the relationship. Responses from U.S.A. participants were surprising, as they ranked the need for individualized care and two-way flow of information as least important. Empathy, information exchange, and shared decision-making are values shared across countries, while preferences for how the information is shared, and the importance of the doctor-patient relationship differ. [ABSTRACT FROM AUTHOR]

Social workers play a pivotal role in addressing equity and diversity within Australia using both culturally responsiveness skills and knowledge. This article describes a research project that resulted in the development of the Continuous Improvement Cultural Responsive Tools that can be used by social workers in their practice. This was a large project conducted over three years, which involved engagement and consultation with Aboriginal and Torres Strait Islander community social workers. The community engagement and consultation process included the provision of cultural governance and participation in interviews. The tools developed are linked to seven key domains (Ngurras) that aim to increase the skills, knowledge, and overall confidence of social work practitioners in their culturally responsive practice. This article discusses the tools that provide a clear structure to guide social workers' critical engagement in becoming more culturally responsive social workers and individuals when working with Aboriginal and Torres Strait Islander Peoples. IMPLICATIONS Social work practices need to address the social injustices faced by Aboriginal Peoples by becoming more culturall responsive. The tools were developed to support social workers in their practice to self-assess their transformation in becoming culturally responsive social workers. Continuous improvement in collaborative and culturally responsive social work will improve services for Aboriginal and Torres Strait Islander Peoples. [ABSTRACT FROM AUTHOR]

The songs produced by male humpback whales are believed to be a reproductive display shared by all singers within the same population. Ocean noise can interfere with the transmission of acoustic signals such as humpback whale songs. However, humpback whales evolved in an environment characterised by variable levels of noise generated by natural sources. This study investigates whether singing males compensate for natural noise by changing the characteristics of their sounds. Songs were recorded off eastern Australia during periods of time when the soundscape was dominated by natural noise. Source level, peak frequency and duration were measured for 2,318 song units from 19 singers. Source levels were positively correlated with noise levels, while there was no correlation between the peak frequency or duration of the units and noise levels. Our study shows that male humpback whales increase the source level of their units in response to increasing natural noise, i.e. they have a Lombard response, but they do not modify their spectral or temporal characteristics. This suggests that the need to adhere to the shared repertoire prevents changes to distinctive features of song units, i.e. frequency and duration, however, vocal plasticity allows adjusting source levels to the environmental conditions. [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]

Cerebral palsy is a leading cause of physical impairment worldwide. Community support and acceptance influence the opportunities people with cerebral palsy have to participate in all areas of life, but very little is known about the general community's understanding of cerebral palsy. This study investigated knowledge and perceptions of cerebral palsy in the Australian community. A sample of 1,217 adults responded to an open-ended question: 'What is the first thing that comes to mind when you think about cerebral palsy?' Almost half of the sample indicated some awareness that cerebral palsy is a physical disability involving difficulties with muscle control, movement and coordination; however, 20% of the participants had no knowledge or stated incorrect facts. Wheelchairs were the first thing that came to mind for 10% of the sample. Few participants mentioned common comorbidities such as cognitive or communication difficulties. A substantial minority of responses (8%) were characterised by stigma or insensitivity. Although many people in the general community appear to have accurate knowledge about cerebral palsy, misperceptions and stereotypes are likely to impact on quality of life and personal well-being for individuals with cerebral palsy and their families. [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]

This paper proposes a conceptual framework for climate policy engagement that is focused on building the social conditions conducive to support for climate policy. Despite the ongoing scientific and social cases being made for climate action, social divisions remain in some contexts such as Australia and the United States. The success of climate policies depend in part on the general social support base for that solution, with public polarisation acting as a barrier. Dominant communication models have tended to rely on one-way strategically focused communication to exert influence with the aim of shifting one's attitudes. However, there is a need to extend such approaches to go beyond strategic messaging and instead establish the social conditions necessary for policy support. Drawing on diverse literature and framing theory, a new engagement model for climate policy is proposed which centres around a goal of relationship-building between actors to facilitate productive discussion on climate policy. [ABSTRACT FROM AUTHOR]

The Australian multiple sclerosis (MS) community experienced two recent major crises, widespread bushfires and the COVID 19 pandemic. We aimed to understand the needs of persons with MS during times of crisis. A consumer-directed mixed-method study. We included an online survey, semi-structured interviews, and a workshop with persons with MS, carers, healthcare professionals, and disability advocates. Data were collected via: (1) 176 people completing online surveys to identify crisis concerns and communications, (2) 29 people completing online interviews on bushfire and pandemic impact, and (3) 13 people participating in a crises-priorities workshop. Descriptive data were calculated for survey response, and a general inductive analytical approach was taken with interview and workshop responses. The most significant concerns were bushfire smoke exposure and disease-modifying-medication and susceptibility to COVID-19 (66% and 63% mean concern score, respectively). Interviews indicated crises experiences from the bushfires, and the pandemic overlapped respective of changes in mood and symptom stability. For bushfires, a need for future preparations, and for the pandemic, the benefits of social restrictions, disclosing personal health information and increased care burden were important. Multiple crises challenged the MS community but offered lessons for healthcare in future crises. Continued progress in centralised crisis information, with considered use of telehealth and rural healthcare support, is needed. The MS community showed high concerns for the effect of toxic smoke from the 2019/2020 Australian bushfires and, separately, for the disease-modifying-medication and susceptibility to COVID-19. The MS community placed priority on a crisis management plan for individuals. Reduced social activity due to restrictions was beneficial for MS symptom self-awareness and may help overall fatigue management. Healthcare system preparation must prepare to alleviate increased carer workload at times of crisis. [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]

In the middle of 2020, with its borders tightly closed to the rest of the world, Australia almost achieved the local elimination of COVID-19 and subsequently maintained 'COVID-zero' in most parts of the country for the following year. Australia has since faced the relatively unique challenge of deliberately 'undoing' these achievements by progressively easing restrictions and reopening. Exploring the role of mathematical modelling in navigating a course through the pandemic through qualitative interviews with modellers and others working closely with modelling, we argue that each of these two significant phases of Australia's COVID-19 experience can be understood as distinct forms of 'model society'. This refers at once to the society enacted through the governance of risk, and to the visions of societal outcomes – whether to be sought or to be avoided – that are offered up by models. Each of the two model societies came about through a reflexive engagement with risk facilitated by models, and the iterative relationship between the representations of society enacted within models and the possibilities that these representations generate in the material world beyond them. [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]

Objective: Research has suggested that information communicated by public health and industry-funded organizations differ, as organizations linked to industry have tended to downplay risks with alcohol more broadly and pregnancy specifically. There is limited knowledge of how alcohol use in pregnancy and associated risks are communicated on social media in Australia. This study set out to describe communication of health risks associated with alcohol use during pregnancy on Twitter by Australian-based organizations and stakeholders. Methods: We searched for "alcohol" and "pregnancy", "pregnant", or "FASD" on Twitter accounts belonging to potentially relevant organizations, of which 17 had tweeted on the topic. Content analysis was undertaken on all tweets and summarized under eight themes. Results: A total of 347 tweets were identified, posted between 2010 and 2019 mainly by public health and disability nongovernmental organizations. Tweets generally focused on FASD, but other potential consequences of maternal alcohol use were infrequently mentioned and tended to be generic. We found infrequent mentions of direct advice around alcohol use during pregnancy and official guidelines. Overall, tweets reflected ongoing policy debates in Australia – including alcohol warning labeling, disability policy and increased activity was seen particularly before the second parliamentary inquiry into FASD. Conclusions: The limited number of tweets from relevant organizations over a nine-year period suggests focus has been on FASD while less discussion of alcohol use during pregnancy was evident. We identified an opportunity for more and consistent communication of trusted national health guidance. [ABSTRACT FROM AUTHOR]

This article reports of a study on 19 Australian community interpreters and their experience in facilitating mediated communication in the National Disability Insurance Scheme (NDIS), which was introduced in Australia in 2016. These interpreters were among those who attended a training workshop comprising of a pedagogical segment explaining this new scheme in detail, and a hands-on segment to translate a selection of NDIS terms into their target language to highlight possible linguistic and cultural challenges they may encounter. The training aimed to enable the interpreters to facilitate NDIS communication with clients from linguistically and culturally diverse backgrounds in ways that make sense to their culture and experience. The purpose of the current study is to understand the extent the participant interpreters applied their learning in NDIS communication, and their perspective about specific challenges in this new contextual area, where certain concepts and terms may be hard to translate, and the understanding of disability may be culturally bound. The aim of the study is to deepen the understanding of multicultural communication in disability services, and to inform similar future professional development during major changes to systems in the disability sector, and more broadly in health and welfare. [ABSTRACT FROM AUTHOR]

Older adults were at particular risk for loneliness during the height of the COVID-19 pandemic. In this instance, the use of computers for communication (i.e. computer-mediated communication, CMC) may help to enhance older people's social interactions and relationships. In the present study, 113 community-dwelling users of CMC, aged 65 years and over, were surveyed in order to better understand the effects of CMC in addition to the individual characteristics contributing to patterns of online communication. An opportunity to examine the impact of the pandemic on CMC behaviours presented approximately 12 months after the initial study with 70 participants resurveyed. High levels of social functioning, in addition to good physical and psychological health, were reported by this group of digitally active users. A positive association between high CMC use and social functioning was noted, even after controlling for differences in personality, frequency of face-to-face communication, health, gender, and relationship status. Interestingly, the pandemic saw a reduction in weekly CMC use, although CMC-based behaviours remained unchanged. The present findings highlight the important role that technology has in facilitating and maintaining supports and, potentially, reducing social isolation by helping older adults stay in touch with family and friends. [ABSTRACT FROM AUTHOR]

Background: Sensitive and patient-centred discussion about life expectancy has clear benefits for patients with advanced cancer and their families. The perceptions of oncology nurses about disclosure of life expectancy, and the barriers to disclosure, have rarely been explored. Objectives/Aims/Hypotheses: To examine oncology nurses' perceptions of the: (1) proportion of patients with advanced cancer who want, receive and understand estimates of life expectancy; (2) reasons why doctors may not provide estimates of life expectancy. Design: Cross-sectional survey. Methods: Australian oncology nurses who were members of a professional society or worked at a participating metropolitan cancer centre were emailed a link to an anonymous online survey. Participants provided socio-demographic characteristics and their perceptions about the proportion of patients with advanced cancer who (a) want, (b) are provided with, (c) receive and (d) understand estimates of life expectancy, as well as the reasons estimates of life expectancy may not be provided. Results: A total of 104 nurses participated. While 51% of nurses perceived that most patients (>75%) want to be provided with an estimate of their life expectancy, 63% of nurses reported that <50% of patients were provided with an estimate. Further, 85% of nurses indicated that <50% of patients understand the estimate. The most frequent reason nurses perceived doctors did not provide an estimate of life expectancy was because the doctor didn't have an accurate idea of life expectancy (80.8%). Almost one-fifth of nurses (18.3%) thought that doctors did not provide estimates because they felt it was not their responsibility to do so. Conclusions: Strategies to ensure a patient-centred approach to life expectancy discussions with patients with advanced cancer are urgently needed. Impact statement: Oncology nurses perceive that many patients with advanced cancer are not provided with an accurate estimate of their life expectancy and few understand the information provided to them. [ABSTRACT FROM AUTHOR]

End-of-life care involves treatment and support offered to terminally ill individuals and their caregivers. Effective communication and decision-making, illness and symptom management, relationship with doctors, characteristics of the health care team, and the involvement and needs of caregivers have all been proposed to contribute to the quality of the end-of-life experience. This study sought to establish bereaved caregivers' experiences of the quality of the elements of end-of-life care delivered to their loved ones. Bereaved caregivers who had lost a loved one who was cared for in an acute care University-affiliated hospital, with 670 beds, located in the Australian Capital Territory during the previous 6−12 months (N=91), were surveyed using a modified version of the Canadian Health Care Evaluation Project questionnaire. The findings indicated that the bereaved caregivers were generally very satisfied with their loved one's end-of-life care. The age of the caregiver, the preferred location of death for both patient and caregiver, if death was expected, and religious affiliation were associated with satisfaction of the end-of-life care delivered. Key areas for improvement of end-of-life care included factors related to the relationships between doctors and those receiving care, characteristics of the health care team, illness management, communication and decision-making, and the involvement of caregivers. These findings have significant implications for this hospital and those seeking to improve outcomes in end-of-life care settings more widely, by providing baseline data on caregiver-evaluated care quality and identifying high-priority areas for targeted intervention. [ABSTRACT FROM AUTHOR]

In February 2020 the World Health Organization declared an 'infodemic' in relation to COVID-19. The label infers that people are being contaminated by 'misinformation' as they would be by a virus. However, this metaphor conveys a simplistic empirical understanding of communication, which may encourage 'information control' responses. This article argues for the importance of understanding the diverse factors that impact the effectiveness of communication – including the context in which it is received, and the emergent properties created through communication processes. Analyzing 'vaccine-critical' Facebook activity in Australia between 1 December 2020 and 28 February 2022, we find that controlling access to or censoring vaccine-critical misinformation does not lead to a reduction in vaccine-critical narratives. Rather, discussions continue based on more tenable political and social arguments. Further, bans antagonize vaccine-critical Facebook users and encourage them to move to other platforms where they may be radicalized. Crucially, recruitment to vaccine-critical sites accelerated following both bans of 'misinformation' and the introduction of vaccine mandates, suggesting that such responses can lead to increased discontentment. Accordingly, we call for researchers, policy makers and media platforms to engage with a more nuanced view of communication, acknowledging the powerful role of audiences' uses and gratifications in determining the effectiveness of public health messaging. [ABSTRACT FROM AUTHOR]

We examine the role of stakeholders in constructing new socio-cultural narratives of advance care planning in the Chinese community in Australia. Applying the communication theory of opinion leader(ship) and drawing on data from 41 interviews and field observation notes, we explore how stakeholders establish their authority and perform their expertise. Data analysis shows stakeholders have gained their opinion leadership status through demonstrating their ability to link the Chinese cultural values of family harmony and parental duty and the notions of self-empowerment and independence in official advance care planning promotions in Australia. [ABSTRACT FROM AUTHOR]

There has been limited research on identifying and understanding co-occurring challenges associated with Developmental Language Disorder (DLD). This is an exploratory study to examine the sensory profile of school-age children with DLD, and to investigate possible relationships between sensory profiles and language skills. Chart information was extracted for 28 children (Mage = 6 years 11 months) who attended a language specialist school in Australia. The children's sensory profile was compared with normed data, and associations between sensory and language skills were investigated. Probable or definite difference to sensory stimuli was reported on 60% of the children. There was no correlation between sensory responses and language skills. Identifying and understanding the relationship of co-occurring features associated with DLD aids in future development of interventions to better support children with DLD. [ABSTRACT FROM AUTHOR]

To describe and analyse the linguistic structure of audiological diagnoses for infants, to determine ways to optimise the delivery of diagnostic information to parents during this typically emotive time. This study analysed the linguistic structure of audio-recorded infant diagnostic appointments. Nine appointments conducted by four experienced paediatric audiologists were analysed. Diagnoses of normal hearing were delivered explicitly and in a straightforward manner. Positive aspects of this outcome were highlighted, and audiologists used the pronoun "we," conveying a feeling of teamwork. In contrast, when a hearing loss was diagnosed, the diagnosis included disfluencies and the use of hedging, although positive aspects were also emphasised. In these cases, audiologists used the pronoun "I," thereby taking ownership of the results. Differences in the topics raised by audiologists and parents highlighted a mis-match between the information provided and the information requested. Topics addressed by audiologists were primarily medical and procedural, whereas parents were concerned with causes, treatments and experiential information. The use of the above linguistic strategies may serve to minimise the significance and impact of the diagnosis. Whilst the data are unable to be generalised to other contexts, the study has generated in-depth and nuanced information about diagnosis delivery. [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]

Aboriginal and Torres Strait Islander people experience significant disparities in accessing cancer care and in cancer outcomes when compared with non-Indigenous Australians. Social workers and Aboriginal Hospital Liaison Officers from an inner-city hospital partnered with local Aboriginal organisations to develop, implement, and evaluate a culturally informed model of supportive cancer care. The initiative adopted an "appreciative inquiry" approach and engagement with Indigenous stakeholders, drawing on the Aboriginal and Torres Strait Islander Quality Improvement Framework and Toolkit for Hospital Staff (AQIFTHS, 2015). Using a process of codesign, strategies were developed with consumers to address the social and cultural determinants of health across the cancer journey. The new evidence-based model of care incorporated culturally informed identification of needs, culturally appropriate engagement, and maintenance of respectful connections to develop codesigned care plans with tailored information and provide practical support and advocacy. Findings illustrate the complex challenges faced by Aboriginal and Torres Strait Islander people living with cancer as well as their strengths. AQIFTHS processes and model of care provide guidance for social workers and other health professionals seeking to partner with stakeholders to promote health equity and improve supportive cancer care in accordance with optimal care guidelines and national quality standards. IMPLICATIONS Supportive care needs of Aboriginal and Torres Strait Islander people living with cancer are often complex and multifaceted, but links with community and culture are noted strengths. Social workers in Australian health settings have an important role in improving access and promoting a culturally responsive model of care for this population. Appropriate support can only occur when it is codesigned with the individual patient and their family members, Aboriginal Hospital Liaison Officers, and community. [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]

Although health services in Australia have an aim to provide inclusive care for their patients/clients, this study highlights how barriers to care can lie at the centre of patient-provider interactions. Racial microaggression is a subtle form of racism that can occur in health settings, leading to further exclusion for First Nations Australians, immigrants and refugees. This paper is guided by Derrida's approach to deconstructionism by unpacking how language is used by health professionals – as holders of organisational power – and how they construct 'truths' or discourses about clients that historically have been marginalised by health services and system. Data comprise 21 interviews with staff from two rural health services. It identified three racial microaggressions were used to justify the challenges of providing care to people from First Nations, immigrant and refugee backgrounds: (1) Participants problematised culture(s) of service users; (2) participants implied cultural superiority in their conceptualisation of 'other' cultures; and (3) participants shared stories of inactions, discomfort and relegating of responsibility. The findings identified these discourses as forms of racial microaggression that can potentially lead to further exclusion of people seeking services and support. [ABSTRACT FROM AUTHOR]

This paper reports on findings of the Sex Ed Dads survey which sought Australian fathers' perspectives on communicating with their young children about relationships and sexuality, as informal sexuality educators. Given the majority of existing family-based sexuality education research draws on the experiences of mothers, gaining insights from fathers is a much needed first step in designing resources to support paternal engagement in sexuality education. A diverse sample of 612 Australian fathers completed an online survey about their views on sexuality education and their role within it. Participating fathers valued sexuality education for their children and believed that their own informal contribution to its provision was important. Fathers reported high levels of comfort discussing a wide range of topics with their child at the age they deemed appropriate, although a gap between what fathers believed they should discuss and what they actually discussed was found. Findings offer insights for schools, resource developers and sexuality education providers seeking to support increased engagement of fathers in the sexuality education domain. [ABSTRACT FROM AUTHOR]

The dearth of child and adolescent mental health services (CAMHS) is a global problem. Integrating CAMHS in primary care has been offered as a solution. We sampled integrated care perspectives from colleagues around the world. Our findings include various models of integrated care namely: the stepped care model in Australia; shared care in the United Kingdom (UK) and Spain; school-based collaborative care in Qatar, Singapore and the state of Texas in the US; collaborative care in Canada, Brazil, US, and Uruguay; coordinated care in the US; and, developing collaborative care models in low-resource settings, like Kenya and Micronesia. These findings provide insights into training initiatives necessary to build CAMHS workforce capacity using integrated care models, each with the ultimate goal of improving access to care. Despite variations and progress in implementing integrated care models internationally, common challenges exist: funding within complex healthcare systems, limited training mechanisms, and geopolitical/policy issues. Supportive healthcare policy, robust training initiatives, ongoing quality improvement and measurement of outcomes across programs would provide data-driven support for the expansion of integrated care and ensure its sustainability. [ABSTRACT FROM AUTHOR]

We explore the complexities of language used in providing sexual and reproductive health care to Burma-born refugees in Australia. Twenty-nine providers of refugee services were interviewed to examine these conversational challenges. In the broader study, we found six major themes in relation to effective communication; here we focus on the "Negotiating language and vocabulary" theme, which has four subthemes: (a) different system of reproductive health vocabulary, (b) use of euphemism and metaphors, (c) unfamiliarity with Western concepts of health, and (d) recommendations to improve conversations. Incorporating linguistic nuances (analogies, metaphors, similes) in reproductive literacy interventions could facilitate more purposeful sexual health discussions. [ABSTRACT FROM AUTHOR]

This paper describes the process of engaging young people in a user centred, co-design strategy to define their perfect condom. Our aims were 1) to find a way to destigmatise discussions about sexuality and contraception and 2) to provide information about what characteristics a perfect condom might embody for adolescents. We used arts-based methods to introduce creativity and enjoyment into discussing sensitive topics related to sexual and reproductive health, which is often avoided in relation to youth and usually nuanced by themes of risk and danger. Using theories of objects becoming things through their sociality, we explored what a condom could be to young people through our method of embedding the condom design process into narratives of young people's lives and integration of these ideas into the development of a next-generation condom. [ABSTRACT FROM AUTHOR]

Previous literature has applied system-focused structures to understand the success of First Nations Peoples' nutrition and exercise group programmes. Existing system-focused measures have included biomedical outcomes, access and service utilization. By broadening the focus of programme success beyond the system, we can evaluate programmes from a First Nations Peoples' lifeworld perspective. Critical hermeneutics and yarning using a lens of Habermas' Theory of Communicative Action to the literature has the potential to transform understandings of "success" in First Nations Peoples' nutrition and exercise group programmes. In this literature interpretation, we explored the critical success factors from a lifeworld perspective, giving scope to go beyond a system perspective to include a cultural, social or personal perspective. Our yarning led us to understand that there is a communicative relationship between explicit system structures and implicit lifeworld concepts that are critical success factors for First Nations nutrition and exercise group programmes. We have developed a set of reflective questions to guide others in considering a lifeworld perspective. Our findings represent a shift away from success measured by the dominant power structure to respect the lifeworld culture, knowledges and values of First Nations Peoples towards shared understanding and mutual decision-making. [ABSTRACT FROM AUTHOR]

The introduction of a National Disability Insurance Scheme (NDIS) in Australia has changed the basis of service provision for people with disability. This mixed-methods study presents the experiences of parents of children with hearing loss during national rollout of the NDIS. Surveys were completed by 100 parents, with 57 parents reporting their child received NDIS funding. Individual interviews of seven parents in different locations provided further information. Between-group comparisons were made and regression analysis examined the influence of parental disadvantage on NDIS experiences. Qualitative data were analysed for themes and findings were triangulated. The NDIS has improved services for some children with hearing loss but initial access and ongoing navigation can be challenging for others. Barriers included a complicated system, planning delays, poor communication and uninformed National Disability Insurance Agency (NDIA) staff. This study suggests areas of refinement and further investigation that may improve services for children with hearing loss. Parents of children with hearing loss in Australia had difficulty accessing the National Disability Insurance Scheme (NDIS) due to poor communication and delays. Parents reported the NDIS system was challenging and felt they needed high levels of education and advocacy skills to navigate the system and prepare information to justify necessary disability supports for their child. Parents were concerned that disadvantaged families would not receive adequate supports for their child with hearing loss due to the complexity of the NDIS. This small-scale national study indicates that recent and upcoming changes to the NDIS should be evaluated to ensure children with hearing loss can access equivalent funding packages and services regardless of family circumstances. [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]

People who use drugs understand drugs and drug use in ways that are often different to the way knowledge of drug use is constructed within the dominant medico-legal discourse. Their experiences are, more often than not, represented in negative ways within dominant discourse, a disconnect that can create adverse consequences for people who use drugs, through the production of stigma and shame leading to poor health and social outcomes. A key difference in how drugs are understood by people who use drugs is the capacity of the former to recognize positive aspects of drug use and create more agentic subjectivities for themselves concerning the use of drugs. Using a thematic analysis of the online forum Australian Drug Discussion, hosted by Bluelight.org, we identify positive drug stories and the contexts of their emergence, as subversions or modifications of dominant understandings. We argue that positive understandings of drug use, as well as recognition of the way their expression serves to generate agency for people who use drugs within or against the confines of dominant discourse, may provide opportunities to limit further the harms flowing from stigmatization and negativity. [ABSTRACT FROM AUTHOR]

Nursing is the single largest professional group within both hospital and community mental health care services, however the role of mental health nurses in under-defined. The nursing workforce is also coming under increasing pressure from internal and external requirements, and nurses themselves are on the frontline of providing patient care in what can be a risky and unpredictable workplace environment. This project explored via interview the ways in which mental health nurses experience and reflect on their personal and professional feelings of nursing success. Participants were 19 nurses who were employed in a range of bed-based and community mental health services in inner south eastern Melbourne. This study complies with the Consolidated Criteria for Reporting Qualitative Research (COREQ). The findings of the project align with existing evidence from the literature. Factors which helped mental health nurses feel successful included: therapeutic success; good teamwork; targeted education; and feedback. Barriers to success included: patients/clients do not engage or recover; poor communication amongst staff; lack of psychological safety in the workplace; and lack of respect from management. Nurses in community settings were more able than nurses in bed-based settings to: make effective use of clinical supervision; make use of targeted training and educational offerings; and practice therapeutically and holistically. Project results offer an opportunity to understand nurses' motivations and reward systems. Better understanding of these issues can improve the way mental health care services manage their workforce planning, maintain staff personal wellbeing, increase staff retention and ultimately improve patient/client care. [ABSTRACT FROM AUTHOR]

In response to a crisis in the child welfare sector in Australia, the OzChild executive leadership team (ELT) moved to adopt evidence-based programs (EBPs) to deliver improved outcomes to children and families. This case study focuses on the adoption and implementation of the first suite of EBPs, examining the strategies, decision-making processes and challenges addressed by the ELT. Interviews with leaders and managers involved are situated within existing research on organizational change and EBP adoption in human service organizations. The case study concludes with a set of questions to encourage discussion and reflection. [ABSTRACT FROM AUTHOR]

A retrospective audit of terminology utilized in discharge summaries to convey the death of inpatients in an Australian tertiary hospital was undertaken. Completion rates of summaries for this patient cohort were also assessed. Less than 60% had a summary finalized, and for those that did, euphemisms were utilized most commonly; passed away was employed in >70% of cases. There is no difference in terminology choice between doctors at the beginning, compared to the end, of their first year as a doctor, nor between first year or more experienced doctors. Irrespective of clinician level, doctors use euphemisms to convey a death. [ABSTRACT FROM AUTHOR]

To evaluate and compare the effectiveness and quality of standard face-to-face and teleaudiology hearing aid fitting follow-up consultations and blended services for adult hearing aid users. Fifty-six participants were randomly allocated to two equal groups, with equal numbers of new and experienced users. One standard and one teleaudiology follow-up consultation were delivered by an audiologist, the latter assisted by a facilitator. The order was reversed for the second group. Outcome measurement tools were applied to assess aspects of participants' communication, fitting (physical, sensorial), quality of life, and service. Cross-sectional and longitudinal outcomes were analysed. Most participants presented with moderate, sloping, and symmetrical sensorineural hearing loss. The duration of teleaudiology (42.96 ± 2.73 min) was equivalent to face-to-face consultations (41.25 ± 2.61 min). All modes of service delivery significantly improved outcomes for communication, fitting, and quality of life (p > 0.05). Satisfaction for both consultation modes was high, although significantly greater with standard consultations. The mode and order of delivery of the consultations did not influence the outcomes. Teleaudiology hearing aid follow-up consultations can deliver significant improvements, and do not differ from standard consultations. Blended services also deliver significant improvements. Satisfaction can be negatively impacted by technical or human-related issues. [ABSTRACT FROM AUTHOR]