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Social participation is positively related to mental health recovery and wellbeing, yet people with mental health problems are often socially isolated. This article investigates how social participation was incorporated into an Australian-integrated program that aimed to improve the wellbeing of people with chronic mental health needs. The data are from a longitudinal evaluation of the integrated program, including data linkage (5533 participants) and interviews (111). The paper uses concepts from the network perspective of social capital (bonding, bridging, linking, horizontal, and vertical) as lenses to re-examine the evaluation's findings about the consumers' social participation in life areas (social, leisure, and productive) facilitated by the program. This social capital perspective offers a lens to examine the breadth and intensity of participation experienced by the consumers taking part in the support program. The article adds to the literature about how service providers can improve social participation and therefore consumers' opportunities for recovery and wellbeing. The analyses found that the support increased people's social interaction and their capacity in the community. Their social interaction was mostly with other people in the service. Often their interactions in the community were only transactional. Few consumers participated in activities in productive life areas, and few of the activities promoted vertical social capital in social networks outside the service. The implications are that service providers need greater attention on facilitating a variety of social participation activities that can extend mental health consumers' horizontal and vertical social capital and so further contribute to their current and future recovery and wellbeing. [ABSTRACT FROM AUTHOR]

This study summarises research- and practice-based evidence on home-based chemotherapy, and explores existing delivery models. A three-pronged investigation was conducted consisting of a literature review and synthesis of 54 papers, a review of seven home-based chemotherapy programmes spanning four countries, and two case studies within the Canadian province of Ontario. The results support the provision of home-based chemotherapy as a safe and patient-centred alternative to hospital- and outpatient-based service. This paper consolidates information on home-based chemotherapy programmes including services and drugs offered, patient eligibility criteria, patient views and experiences, delivery structures and processes, and common challenges. Fourteen recommendations are also provided for improving the delivery of chemotherapy in patients' homes by prioritising patient-centredness, provider training and teamwork, safety and quality of care, and programme management. The results of this study can be used to inform the development of an evidence-informed model for the delivery of chemotherapy and related care, such as symptom management, in patients' homes. [ABSTRACT FROM AUTHOR]

Translation of evidence into practice in healthcare is challenging, particularly with new innovations. Indocyanine Green (ICG) lymphography is a novel innovation where the superficial lymphatics are imaged to provide information about lymphoedema diagnosis and to guide individualised therapy for a person's long‐term chronic management of lymphoedema, supporting care across the continuum to the community setting. Despite the unique information ICG lymphography provides, the technology itself is complex and highly specialised and currently has limited adoption in clinical practice. This paper sought to determine the barriers and enablers to establishing an ICG lymphography clinic within an outpatient lymphoedema service by exploring staff perceptions and experiences. An interpretive descriptive design was used with semi‐structured interviews of key staff participants from a quaternary public hospital six months after ICG lymphography clinic establishment. An interview guide was developed, underpinned by the Consolidated Framework for Implementation Research (CFIR), to guide the inquiry. Interview data were transcribed, inductively coded and analysed to identify themes. All eligible management, clinical and ancillary staff were included (N = 8). Four key themes were identified from the data as essential to implementation success. These were support is critical for implementation; beliefs about the technology; practicalities are achievable; and sustainability for ongoing success. Themes were found to be interrelated and centred around support from staff and the organisation as a critical process facilitator. The study demonstrated an ICG lymphography clinic can be successfully established as part of an outpatient lymphoedema service. Key enablers related to positive staff attitudes and beliefs about ICG lymphography and its application. Future implementation sites may consider that although the complexity of this innovation creates process challenges, the use of an implementation framework can assist in identifying determinants of success for effective implementation to practice. [ABSTRACT FROM AUTHOR]

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

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

Care‐experienced young people demonstrate significantly poor physical, social and mental health outcomes during and beyond their time in care, yet they have rarely been consulted or included in research examining their health needs to date. This qualitative paper explores care‐experienced young people's perceptions of health in care, including accessing healthcare and interacting with health professionals. The research methodology was informed by a co‐design approach through consultation with care‐experienced young people. Semi‐structured interviews were conducted with 10 young people. The findings revealed that: (1) the care system does not nurture young people's health; (2) young people in care experience difficulty accessing and navigating a complex health system; and (3) young people are not given a voice when it comes to their health. The findings provide key recommendations for practice, including the empowerment of young people through positive, responsive and trusting relationships to prioritise the health of young people in care. [ABSTRACT FROM AUTHOR]

This paper reports findings from 55 stakeholder interviews undertaken in six Primary Health Networks ( PHNs) in Australia as part of a study of the impact of population health planning in regional primary health organisations on service access and equity. Primary healthcare planning is currently undertaken by PHNs which were established in 2015 as commissioning organisations. This was a departure from the role of Medicare Locals, the previous regional primary health organisations which frequently provided services. This paper addresses perceptions of 23 senior staff, 11 board members and 21 members of clinical and community advisory councils or health priority groups from six case study PHNs on the impact of commissioning on equity. Participants view the collection of population health data as facilitating service access through redistributing services on the basis of need and through bringing objectivity to decision-making about services. Conversely, participants question the impact of the political and geographical context and population profile on capacity to improve service access and equity through service commissioning. Service delivery was seen as fragmented, the model is at odds with the manner in which Aboriginal Community Controlled Health Organisations ( ACCHOs) operate and rural regions lack services to commission. As a consequence, reliance upon commissioning of services may not be appropriate for the Australian primary healthcare context. [ABSTRACT FROM AUTHOR]

Nurses who work with children have the opportunity to make a difference by identifying and responding to child abuse and neglect. Little is known about the ways that nurses define, assess and respond to child abuse and neglect and how this subsequently affects children. This paper reports one of four themes identified through inductive analysis of a qualitative study exploring nurses' perceptions and experiences of keeping children safe from abuse and neglect. The aim of this paper was to report on how nurses understand and interpret child abuse, is found to be shaped by their own sociocultural contexts. A qualitative research design underpinned by social constructionism framed the study. Data were collected in 2016 and 2017 through 21 in‐depth, semi‐structured interviews with nurses who work with children in Australia. Key findings showed that nurses working with children had difficulty defining child abuse and drew upon multiple sources to construct a working definition. In addition to drawing from official legislation and guidelines, nurses compared and contrasted the level of abuse with their own personal and professional experiences of parenting. Nurses described the challenges of making assessments when faced with cultural practices different from their own. Nurses' descriptions of how they defined abuse showed that their assessments of child abuse and neglect were inextricably linked to their personal values and beliefs. As such, nurses were often working from their own value systems rather than consistently taking a child‐focussed approach. There was an absence of consistent and explicit critical reflection on ways that values and beliefs might shape practice at individual and system levels. We propose this is a missing aspect of child safe practice. Reflection on how personal and professional values and beliefs interact with the implementation of evidence‐informed approaches will increase nurses' capacity to maintain a child‐focus. [ABSTRACT FROM AUTHOR]

This paper contributes to scholarship on the medicalisation of mental health support for young people through a case study of a multidisciplinary mental health service in rural Australia. All staff (n = 13) working at the service participated in semi‐structured, individual interviews. Transcripts of interview data were read and selectively coded and interpreted in relation to the overarching question of how participants view and experience mental health care provision to a diverse range of young people. Following analytical reflection, codes pertaining to engagement, accessibility and care provision were re‐examined using the concept of medicalisation to understand the biomedical underpinning of mental healthcare and how this plays out in the experiences and perceived challenges participants talked about in responding to the mental health concerns of diverse young people. The resulting analysis is presented under five theme headings: (a) privileging clinical expertise and priorities within service provision, which was an important source of conflict for some participants; (b) 'multidisciplinary' teams—a 'difficult kind of culture at times'; (c) articulations of where cultural barriers lie; (d) the tracks along which young people are directed to 'engage' with 'mental health'; and (e) a clinical 'feel' to space. We suggest that service and system investment needs to be given to alternative ways of thinking about and approaching mental health and care provision that are cognisant of, and engage with, the inherent connections between individual circumstance and social, place, cultural, economic and political contexts. This is particularly relevant to the provision of care in rural contexts because of limited service options and the complexities of access and providing care to a diverse range of young people living in isolated environments. Interdisciplinary frameworks need to be enacted and services must acknowledge their own cultural positions for alternative ways of working to become possibilities. [ABSTRACT FROM AUTHOR]

Objective: Currently, there are no self‐management resources in Australia that support both Chinese immigrant patients affected by cancer and their caregivers. This paper reports on the development and acceptability assessment of a self‐management intervention (WeCope) in terms of its scope, social and cultural relevance and sensitivity. Methods: Using a community participatory approach in this qualitative study, patients, caregivers and community members took part in semi‐structured focus groups or interviews in Cantonese, Mandarin or English to develop and provide feedback on the acceptability of 'WeCope'. Content analysis was performed on the transcripts using inductive (codes) and deductive (themes and categories) methods. Results: Patients (n = 17), caregivers (n = 10) and community members (n = 2) participated. Four themes were developed, guided by the framework of cultural sensitivity in interventions: (1) content preference and satisfaction; (2) perceived usefulness and usability; (3) cultural relevance and acceptability; and (4) layout and presentation. Participants most commonly wanted more information about treatment‐related issues (n = 14) and available support services (n = 14). Conclusion: Chinese patients and caregivers expressed overall satisfaction with the WeCope resource and provided suggestions for improvement, including provision of more treatment‐related information and contact details for available support while reducing the overall resource length. [ABSTRACT FROM AUTHOR]

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

Men's Sheds and similar community programmes are known to encourage help-seeking behaviour and thus improve the health and well-being outcomes for the men who attend. This paper investigates this issue through a community needs assessment of a Men's Shed programme in inner-regional Australia. The immediate purpose of this research was to help direct future funding initiatives, and provide recommendations for potential changes and improvements to the programme. A community-level needs assessment is a systematic process used to determine and address gaps or needs between current and desired conditions within a particular community. We sought to explore how particular formats and structures of Men's Sheds programmes contribute to improve social and medical well-being, and whether there are key programme characteristics that could be emulated. In total, 22 surveys and 20 interviews were conducted with the men who participated in the programme. The report finds 95% of men are satisfied with the current running of the programme. While there were areas that have been identified for improvement, most men reported that they are content with the current format and would not like to see major changes to its implementation. The results of this research confirm the known benefits of these types of programmes. This paper provides other community programmes with some insight into the key success factors for running a Men's Shed. [ABSTRACT FROM AUTHOR]

Despite growing numbers of people engaging in embryo donation for the purposes of family building, public access to information about the process may be limited. As such, support and counselling – both formal (i.e. through clinics) and informal (i.e. through online communities) – can play an important role in information provision. This article draws on a sub‐sample of nine people from a qualitative study of embryo donation and receipt in Australia undertaken in 2017–2018. Themes developed suggest that formal support and counselling provided by clinics can be useful, though can require persistence to access and may not sufficiently address needs. In terms of informal support, themes developed suggest that sharing lived experiences in online communities can be important; however, there may also be challenges associated with differing viewpoints and threats to anonymity. The article concludes with a discussion of the ongoing importance of formal support and counselling while also suggesting that informal support is an avenue requiring further investigation. [ABSTRACT FROM AUTHOR]

Aim: To explore how clinical leadership is perceived by nurses in rural and remote areas of New South Wales, Australia. Background: There are few empirical studies aimed at understanding clinical leadership from a rural and remote perspective. Methods: A qualitative approach, based on interpretive phenomenology, used thematic analysis of recorded and transcribed interviews. Ethical approval was secured, 56 interviews were undertaken, across 14 different rural and remote health facilities, with nurses across the spectrum of practice. Results: Thematic analysis led to five themes and findings that support an understanding of clinical leadership from a rural and remote context. Clinical leaders were seen to considerably impact on the initiation of change and quality of care. They also faced barriers if the health facility was poorly staffed, lacked support and if the community were strongly co‐dependent. Conclusion: In rural and remote areas, clinical leadership is evident to support change, innovation and care quality. Implications for Nursing Management: Managers should be aware that staff shortages and challenges to staff retention or the initiation of change are affected by poor clinical leadership. This paper suggests that managers who facilitate clinical leadership are better able to support professional education and greater efficiencies in the delivery of quality health care. [ABSTRACT FROM AUTHOR]

Like many high‐income countries, in Australia there are a range of programmes in place, from social security to food banks, to help address food insecurity. So far, they have been unable to adequately alleviate and prevent this growing nutrition challenge. This paper presents an evaluation of a new type of intervention in the food security landscape, the social enterprise. The Community Grocer is a social enterprise that operates weekly fresh fruit and vegetable markets in Melbourne, Australia. The aim of the study was to examine the market's ability to increase access, use and availability of nutritious food in a socially acceptable way, for low socioeconomic status urban‐dwelling individuals. The mixed‐method evaluation included: comparative price audits (n = 27) at local (<1 km) stores; analysis of operational data from sample markets (n = 3); customer surveys (n = 91) and customer interviews (n = 12), collected in two phases (Autumn 2017, Summer 2018). The results found common (n = 10) fruit and vegetables cost, on average, approximately 40% less at the social enterprise, than local stores. Over twenty per cent of customers were food insecure and 80% of households were low income. Thirty‐four different nationalities shopped at the market, and just over half (54%) shopped there weekly. More than 50 types of vegetables and fruit were available to purchase, varying for cultural preferences and seasonality, which supported variety and choice. Overall, this enterprise promotes food security in a localised area through low‐cost, convenient, dignified and nutritious offerings. [ABSTRACT FROM AUTHOR]

Exposure to suicide and the associated impacts for those left behind can be long lasting and traumatic. Literature has predominantly examined the experience of suicide and impact from the perspective of those closest to the deceased—with studies primarily focused on kin relationships. Appropriate and timely support delivered by skilled professionals, through the provision of postvention support, has been suggested as a way to reduce morbidity and mortality associated with exposure to suicide. The evidence regarding what support, for whom, and the timing of support is scarce. As an extension of this scarcity, there is minimal research examining the ways in which provision of this postvention (that is, support following exposure to suicide) support impacts workers. This paper explores service use data gathered to evaluate a nation‐wide Australian suicide postvention service, in conjunction with qualitative data from those providing postvention support to those exposed to suicide to understand who accesses support and the impact of providing such support on service providers. Postvention workers provide insight into the demands of responding to suicide, the pressure of being on call, and the ways in which they are able to maintain their well‐being through external supervision. [ABSTRACT FROM AUTHOR]

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

This paper reports on a study exploring the experiences and meaning of social participation for family carers of people living with dementia. Participants were 33 family carers (17 spouses and 16 adult children) of older adults diagnosed with dementia (any stage or type) who responded to advertisements by the national Alzheimer's association, Alzheimer's Australia. Data were collected through semi-structured face-to-face and/or telephone interviews using an interview guide, which included prompts such as 'Tell me about what social participation means to you', and 'How did this change...'. The methods of grounded theory were drawn upon to guide sampling and analysis of data, which continued until theoretical saturation was achieved and occurred over the period September 2011 to March 2012. Data arising from the interviews were analysed line-by-line and coded and categorised using the constant comparative method, with codes clustered into themes and with abstraction from the themes to arrive at the core process. The core category arising from the data was adaptation, which encompassed four main themes: autonomy to choose; the impact of care-giving; employing strategies; and establishing meaningful connections. Carers went through a process whereby the ways in which they had previously participated socially were compromised, which often prompted an exploration of new ways in which to remain socially engaged. [ABSTRACT FROM AUTHOR]

This paper explores the manner in which two hospices - one located in Denmark and one in Australia - negotiate and determine the boundaries of volunteer workers vis-à-vis paid staff. A comparative case study approach was used to juxtapose organisations with similar activity fields located in different welfare state systems, i.e. a social democratic welfare state and a liberal welfare state. This study involved non-participant observation of volunteers at work and unstructured interviews with volunteers, staff and management in the hospices ( n = 41). Data were collected between August 2012 and February 2013. Data were managed using NVivo and analysed thematically. A key finding is that volunteers in the Danish hospice were excluded from all direct care work due to the effective monopoly of the professional care providers, whereas the Australian volunteers participated in the provision of care to the extent that risk could be eliminated or mitigated to an acceptable level. The findings suggest two different models of the roles of volunteers in tension with professional care providers. Both models recognise that volunteers add to the level of care delivered by the organisations and allow for a discussion that moves away from the normative discussions of 'not taking somebody's job', while also recognising that volunteers must be more than just the 'nice extra' if they are to be of any real value to the organisation and to care receivers. [ABSTRACT FROM AUTHOR]

As governments worldwide turn to personalised budgets and market‐based solutions for the distribution of care services, the care sector is challenged to adapt to new ways of working. The Australian National Disability Insurance Scheme (NDIS) is an example of a personalised funding scheme that began full implementation in July 2016. It is presented as providing greater choice and control for people with lifelong disability in Australia. It is argued that the changes to the disability care sector that result from the NDIS will have profound impacts for the care sector and also the quality of care and well‐being of individuals with a disability. Once established, the NDIS will join similar schemes in the UK and Europe as one of the most extensive public service markets in the world in terms of numbers of clients, geographical spread, and potential for service innovation. This paper reports on a network analysis of service provider adaptation in two locations—providing early insight into the implementation challenges facing the NDIS and the reconstruction of the disability service market. It demonstrates that organisations are facing challenges in adapting to the new market context and seek advice about adaptation from a stratified set of sources. [ABSTRACT FROM AUTHOR]

In developed countries, residential aged care facilities ( RACFs) are increasingly becoming the place of care and site of death for older people with complex chronic illnesses. Consequently, it is becoming ever more relevant for these facilities to provide appropriate complex, as well as end-of-life care for this growing group of people. Evidence-based guidelines for providing a 'palliative approach' were developed and introduced in Australia in 2004, with the emphasis on improving symptom control earlier in the disease trajectory. The aim of the study reported here was to explore the extent to which a palliative approach was being used in the organisation and provision of care for older people with complex needs living in mixed-level (a combination of low- and high-level care) RACFs. This paper primarily reports on the qualitative findings. Two residential aged care organisations, one in rural New South Wales and the other in Sydney, Australia, participated. Data were collected over a 9-month period from May until December 2008. Residents, family members and aged care staff were interviewed. Thematic analysis of participant interviews shows that while the various elements of a palliative approach are incorporated into the care of high-level care residents, the discourse itself is not used. In this paper, we argue for a new conceptualisation of care for people in mixed-level care facilities: a community-of-care, in which a palliative approach is one of several components of the care provided. The findings illuminate aged care staff experiences of providing care to high-level care residents. They also provide valuable insights into high-level care residents' perceptions of their health, care provided and the way in which they foresee their care being provided in future. These findings will be important for informing clinical practice, research and policy in these settings. [ABSTRACT FROM AUTHOR]

PURPOSE To explore the experiences of mental health workers and perceptions of their role and the scope of their work. DESIGN AND METHODS Qualitative design. Twenty interviews were conducted with mental health workers. Interviews were analyzed using thematic analysis. FINDINGS Three overarching themes were identified. In this paper the overarching theme of 'dimensions of my role' is discussed. Subthemes were (a) information and education, (b) person-centered care, and (c) networking and partnerships. PRACTICE IMPLICATIONS Professional development, networking, and partnerships underpin the provision of coordinated services and ultimately person-centered care. Enhancing staff capacity building may also enable sustainability of appropriate quality services. [ABSTRACT FROM AUTHOR]

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

The lay caregiving role is integral to advanced cancer care but places carers' health at risk. A supportive General Practitioner ( GP) can help primary lay carers manage their health, if they disclose their concerns. A Needs Assessment Tool for Caregivers ( NAT-C) was developed for carers to self-complete and use as the basis of a GP consultation, then tested in a randomised controlled trial. This paper reports a qualitative research study to determine the usefulness and acceptability of the NAT-C in the Australian primary care setting. Convenience samples of 11 carers and 5 GPs were interviewed between September 2010 and December 2011 regarding their experiences with and perceptions of the NAT-C. Open-ended questions were used, and the transcripts were analysed qualitatively to identify themes and patterns. Three major themes were identified: (a) Acceptability of the intervention; (b) Impact of the intervention on the GP-patient relationship; and (c) Place of the intervention in advanced cancer care. This simple checklist was acceptable to carers, although some were uncertain about the legitimacy of discussing their own needs with their GP. Carer-patients could not be certain whether a GP would be willing or equipped to conduct a NAT-C-based consultation. Such consultations were acceptable to most GPs, although some already used a holistic approach while others preferred brief symptom-based consultations. Although the NAT-C was acceptable to most carers and GPs, supportive consultations take time. This raises organisational issues to be addressed so carers can seek and benefit from their GP's support. [ABSTRACT FROM AUTHOR]

Aboriginal Australians are at higher risk of developing certain types of cancer and, once diagnosed, they have poorer outcomes than their non-Aboriginal counterparts. Lower access to cancer screening programmes, deficiencies in treatment and cultural barriers contribute to poor outcomes. Additional logistical factors affecting those living in rural areas compound these barriers. Cancer support groups have positive effects on people affected by cancer; however, there is limited evidence on peer-support programmes for Aboriginal cancer patients in Australia. This paper explores the roles played by an Aboriginal women's cancer support network operating in a regional town in Western Australia. Data were collected through semi-structured interviews with 24 participants including Aboriginal and mainstream healthcare service providers, and network members and clients. Interviews were audiotaped and transcribed verbatim. Transcripts were subjected to inductive thematic analysis. Connecting and linking people and services was perceived as the main role of the network. This role had four distinct domains: (i) facilitating access to cancer services; (ii) fostering social interaction; (iii) providing a culturally safe space; and (iv) building relationships with other agencies. Other network roles included providing emotional and practical support, delivering health education and facilitating engagement in cancer screening initiatives. Despite the network's achievements, unresolved tensions around role definition negatively impacted on the working relationship between the network and mainstream service providers, and posed a threat to the network's sustainability. Different perspectives need to be acknowledged and addressed in order to build strong, effective partnerships between service providers and Aboriginal communities. Valuing and honouring the Aboriginal approaches and expertise, and adopting an intercultural approach are suggested as necessary to the way forward. [ABSTRACT FROM AUTHOR]

Aim To explore the experiences of Australian nurses and midwives who perceived themselves as resilient. The focus of this paper is to report the strategies used by a group of nurses and midwives to develop and maintain their resilience, despite encountering serious workplace adversity. Background Despite the potentially adverse effects of nursing work, many nurses and midwives thrive through exercising self-efficacy and coping skills. The relationship between thriving and resilience is clear, as resilience refers to the ability to cope well with adversity and change. Methods The participants were part of an instrumental, collective case study investigation of personal resilience amongst nurses and midwives. Prior to an innovative, work-based intervention including workshops and mentoring, participants were interviewed to collect baseline perceptions and experiences of personal resilience and workplace adversity. Interview transcripts were analysed thematically. Results Participants attributed their ability to thrive in the workplace to three major influences: support networks, personal characteristics and ability to organise work for personal resilience. Conclusions Participant insights contributed to a deeper understanding of personal resilience and highlight future initiatives to enhance the ability of nurses and midwives to thrive within health organisations and systems. Implications for nursing management It is vital that resilience-enhancing initiatives, such as peer mentoring and tailored work options to increase autonomy, are implemented at earlier career phases. [ABSTRACT FROM AUTHOR]

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

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

The aim of this research was to inform the development of mobile phone-assisted health promotion programmes that support social connectedness among refuge women to enhance their mental, physical and social health. For refugees, relationship development during the early stages of resettlement is often difficult. Enhancing personal skills, and resources, can enhance relationships that provide social support. It can also contribute to the development of social relationships in communities and thence acculturation. Communication technologies can assist refugees, if their particular needs and capacities are taken into account. This paper reports a study of refugee women's experience of an intervention based on principles of empowerment and using peer support training and the provision of free mobile phones, and free calls, for at least 1 year. Potential participants were invited by the Afghan, Burmese and Sudanese community leaders to an information session, where the study was explained and invitations to participate extended. A snowball sampling technique was also used, where the first group of participants invited people they had relationships with to join the programme. One hundred and eleven participants were recruited from the three groups. All were from refugee backgrounds. Data collection consisted of: a pre- and post-intervention questionnaire; a log of outgoing phone calls; and in-depth interviews with a subgroup of the study population. The call logs described the patterns of interpersonal relationships facilitated by the mobile phones. In the interviews, characteristics of interpersonal social support, and relationships with heritage and host communities, were described. The quantitative data were analysed using descriptive statistics and the qualitative data using thematic analysis. By describing the conditions under which mobile phone technology can enhance interpersonal and community connectedness, we strengthen the evidence base for the use of mobile phone technology in health promotion programmes with refugee groups. [ABSTRACT FROM AUTHOR]

Following changes in the structure and funding of the Australian medical system, patients have become 'consumers' or 'clients'. Family and friends have become 'carers' or 'caregivers', signifying their increased responsibilities as patients move from hospitals to communities. While policy makers embrace the term 'carer', some argue that the title is not widely recognised and has disempowering connotations. This paper examines spouses' reflections on the term 'carer' based on qualitative interviews with 32 Australians caring for a spouse with cancer from a study conducted between 2006 and 2009. Recruitment involved survey and snowball sampling. Following a grounded theory approach, data collection and analysis were performed simultaneously. Using Holland and colleagues' sociocultural 'identity as practice' theory and a thematic approach to analysis, findings depict identification with the 'spouse' and 'carer' label as relationally situated and dependent on meaningful interaction. Although others argue that the term 'carer' is a 'failure', these findings depict identification with the label as contextual, positional and enacted, not fixed. Furthermore, and of most significance to practitioners and policy makers, the title has value, providing carers with an opportunity to position themselves as entitled to inclusion and support, and providing health professionals with a potential indicator of a spouse's increased burden. [ABSTRACT FROM AUTHOR]

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

Providing support and parenting education through home visiting is a key early intervention strategy with young parents. Less is known about what home visitors do that makes a difference. The purpose of this paper is to describe the role and experiences of professional staff working with young parents participating in a multicomponent parent support programme (home visiting and supported parenting groups) provided by a non-government organisation in a socially disadvantaged area of Sydney, Australia. This was a qualitative descriptive study. Data were collected through three focus groups conducted with the same six staff over an 18-month period. Participant descriptions of their role and experiences working with young mothers were analysed thematically. Additional data from 20 anonymised client records were analysed through content analysis. Analysis of the focus group data revealed two themes, 'Connecting' and 'Facilitating Learning'. The theme 'Connecting' reflected the development of a relationship with the young mother commencing with 'how do we engage them?', 'building trust' through to formation of a relationship described as 'they know we're not friends, they know we're workers'. The second theme, 'Facilitating Learning' was informed by the analysis of both group and client record data and comprised a number of themes around what and how mothers learnt, through to 'ending the relationship' as the mothers left the programme. The quality of a mothers' learning was dependent on the quality of the connection between herself and the staff, similarly their capacity and, or confidence to leave the programme was dependent on the relationship, 'connecting' and the learning undertaken. Role modelling through interactions with children as well as with each other was seen as the most effective way to facilitate social and parenting skill development, while formal education sessions were evaluated by the workers to be less successful than informal ones. [ABSTRACT FROM AUTHOR]

Mental health issues such as depression or anxiety and alcohol or other drug (AOD) problems often remain undiagnosed and untreated despite their prevalence in the community. This paper reports on the implementation and evaluation of an AOD and depression/anxiety screening programme within two Community Health Services (CHS) in Australia. Study 1 examined results from 5 weeks of screening (March-April 2008) using the Patient Health Questionnaire (two- and nine-item, Kroenke et al. 2001, 2003), the Conjoint Screen for Alcohol and other Drug Problems (Brown et al. 2001) and the Alcohol, Smoking and Substance Involvement Screening Test (Humeniuk & Ali 2006). Of the 55 clients screened, 33% were at risk of depression or anxiety, 22% reporting moderate-severe depression. Thirteen per cent were at risk of substance use disorders. A substantial proportion of at-risk clients were not currently accessing help for these issues from the CHS and therefore screening can facilitate identification and treatment referral. However, the majority of eligible clients were not screened, limiting screening reach. A second study evaluated the screening implementation from a process perspective via thematic analysis of focus group data from six managers and 14 intake/assessment workers (April 2008). This showed that when screening occurred, it facilitated opportunities for education and intervention with at-risk clients, although cultural mores, privacy concerns and shame/stigma could affect accuracy of screen scores at times. Importantly, the evaluation revealed that most decisions not to screen were made by workers, not by clients. Reasons for non-screening related to worker discomfort in asking sensitive questions and/or managing client distress, and a reluctance to spend long periods of time screening in time-pressured environments. The evaluation suggested that these problems could be resolved by splitting screening responsibilities, enhancing worker training and expanding follow-up screening. Findings will inform any community-based health system considering introducing screening. [ABSTRACT FROM AUTHOR]

Young people experience high rates of mental health problems, but very few access professional mental health support. To address the barriers young people face in accessing mental health services, there is growing recognition of the importance of ensuring services are youth-friendly. Indeed, almost a decade ago, the World Health Organisation developed a youth-friendly framework for services to apply. Yet, this framework has rarely been evaluated against health initiatives for young people. This article begins to address this gap. Using 168 semi-structured, qualitative interviews with young service users, this paper explores the extent to which the Australian National Youth Mental Health Foundation, also called headspace, applied the WHO's youth-friendly framework which emphasises accessibility, acceptability and appropriateness (AAA). It argues that headspace was largely successful in implementing an AAA youth-friendly service and provides evidence of the importance of tailoring services to ensure they are accessible, acceptable and appropriate for young people. However, it also raises questions about what youth-friendly service provision means for different young people at different times. The findings suggest that youth friendliness should be applied across different stages of interaction (at initial engagement and in the ongoing relationship between patient and clinician) and at different levels (the environment the care is provided in, within policies and procedures and within and between relationships from receptionists to clinicians). [ABSTRACT FROM AUTHOR]

Healthcare systems have a vested interest in employing work-ready graduates. The challenge for universities is to find ways to provide workplace learning that incorporates student education and high quality patient care. Inland areas of Australia, similar to other rural locations globally, experience additional challenges including a relatively high incidence of ill health, increasing demand for health services, chronic workforce shortages and ageing of the existing rural health workforce. In this paper, we conceptualise and describe the research findings related to context from a consultative enquiry into university clinics conducted in 2008. Interview participants were drawn from twenty university clinics in Australia and New Zealand. A consistent theme throughout the interviews was tensions that arose between the role of education and healthcare provision within university clinics. Many interview participants described ways they managed these tensions to meet the expectations of students, educators and the community. The patient supply is the most critical factor in the context of university clinic operations. It is vital to both the educator and the healthcare provider roles. In inland areas with sparse populations a number of strategies, such as outreach clinics, hospital or health centre- based clinics and multi-disciplinary sites, will have to be developed if university clinics are to operate effectively for students and patients. [ABSTRACT FROM AUTHOR]

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

Aims: This study aimed to understand midwifery care during labour, particularly decision‐making processes, within Australian health systems. Background: Midwifery, founded on a wellness model of motherhood, is at risk of being medicalized. Whilst medical intervention is lifesaving, it requires judicious use. Governance provides oversight to care. Exploring decision‐making contributes to understanding governance of practices. Method: Straussian grounded theory using semi‐structured interviews. Eighteen Australian registered midwives were interviewed about their practice when caring for women during labour. Results: Midwives were caught between divergent positions; birth as natural versus birth as risk. Experienced midwives discussed focussing on the woman, yet less experienced were preoccupied with mandatory protocols like early warning tools. Practice was governed by midwives approach within context of labour. The final theory: The Coalescence of Perceptions, Practice and Power, comprising three categories: perceptions and behaviour, shifting practice and power within practice, emerged. Conclusions: Coalescence Theory elucidates how professional decision making by midwives during care provision is subject to power within practice, thereby governed by tensions, competing priorities and organizational mandates. Implications for Midwifery Managers: Midwifery managers are well positioned to negotiate the nuanced space that envelopes birthing processes, namely, expert knowledge, policy mandates and staffing capability and resources, for effective collaborative governance. In this way, managers sustain good governance. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study is to reliably estimate why midwifery care is missed and to crystallize those factors that have causal links to it. Background: Studies involving the incidences and types of missed midwifery care are sparsely described. The rationales behind these deficits in care are even less well researched. Methods: A non‐experimental, descriptive method using a Likert developed MISSCARE scale was used to measure consensus estimates made by Australian midwives. Data analysis was undertaken using both Rasch analysis and Structural Equation Modeling. Results: Midwives' rationales behind why Australian midwifery care is missed can be quantified based on consensus estimates of participating midwives and the variances in the total scores of how important each contributing factor was in accounting for why midwifery care was missed, can be both explained and predicted. Conclusions: Ten latent variables have significant predictor effects on why midwifery care was missed. These include insufficient human and physical care resources, increased work intensity and issues with workplace communication. These factors are further exacerbated by the midwives' teamwork satisfaction levels, work roster preferences and other midwife demographic variables. The age of midwife, their highest qualification achieved and where they obtained their midwifery credentials had no influence on their consensus estimates as to why midwifery care was missed. Implications for nursing management: While this study confines itself to the Australian midwifery context, outcomes are informative for an international midwifery management audience. While the setting of the midwifery practice (be it private or public hospitals) is not significant in predicting why midwifery care is missed, resource allocation for care of mothers and their babies remains instrumental, as a factor contributing to care omissions. Midwife demographic factors including age, type of midwifery qualification and where the credentials were obtained from exerted no influence as to why care was omitted. Midwifery recruitment should focus instead on re‐dressing skills and skills mix shortages. Teamwork skills within the midwifery sector requires strengthening, as problems arising from workplace communication, coupled with decreased midwifery staffing numbers and increased work intensity, are strongly thought to be significant reason for missed care [ABSTRACT FROM AUTHOR]

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

This study aimed to provide insight and learnings from Australian general practitioners in facilitating positive interactions with refugee and asylum seeker patients and the role they play in helping those community members engage with healthcare. We conducted semi‐structured individual remote interviews with 12 general practitioners (GPs) who worked in areas with high refugee and migrant populations. Interview transcripts were coded inductively and deductively, based on the research questions, using Thematic Analysis. Extensive debriefing and discussion took place within the research team throughout data collection and analysis. Creating a culturally safe environment was an initial step taken by GPs to minimise the inherent power imbalance, in addition to applying the principles of trauma‐informed care (TIC) to appropriately listen and respond to their patients' needs and individual social circumstances. GPs at times were involved in using their role to advocate on behalf of their patient and played a key role in helping build their patients' health systems literacy. This study highlights the important role that GPs play in advocating and engaging refugee and asylum seeker patients, as well as helping them navigate the healthcare system. Whilst GPs practice can be made more efficient through experience and time; to deliver the care required GPs need to provide care in response to the individual's capacity and social circumstances. Enabling time and the application of the principles of TIC and cultural safety may allow for GPs to provide the quality of care that is needed in supporting patients from refugee and asylum seeker backgrounds. [ABSTRACT FROM AUTHOR]

Women should be able to access mental health services that are safe, free from harassment and abuse. Yet, research indicates that women experiencing mental health issues are often not safe in mixed gender environments, and especially in inpatient settings. This qualitative study draws on a photo‐elicitation method ('photovoice') and semi‐structured interviews to explore women's experiences of a sub‐acute women‐only prevention and recovery care (PARC) service in Australia. Twelve women experiencing mental health issues were recruited via an aftercare peer support group for recent service participants. The women took photographs guided by the central question: 'What were your experiences of a women‐only prevention and recovery care service?' They then shared these photographs with the researchers and each other, and described them in detail. Four key themes were identified by thematic analysis of the photovoice visual and narrative data: (a) Only women can understand what women go through; (b) I feel safer with no men around due to my history of trauma; (c) This environment feels safe, making it easier to talk and (d) Staff are accessible and make time for me to talk about difficult topics. Woven throughout the women's narratives was the expressed desire to feel safe and supported during the process of recovering. Aspects of service delivery that contributed to these feelings and facilitated shared support were also valued in this setting. These findings indicate that access to women‐only services and peer support are not only valued by women experiencing mental health issues, but need to be more widely available to support their recovery. They also underline the importance of a trauma‐informed approach for improving the gender sensitivity of services. [ABSTRACT FROM AUTHOR]

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

Post‐diagnosis young onset dementia (YOD) care is often fragmented, with services delivered across aged care, healthcare, and social care sectors. The aim of this project was to test the feasibility and potential effectiveness of a learning collaborative implementation strategy for improving the cross‐sector integration of care for people with YOD and to generate data to refine the implementation strategy for scaleup. We conducted a longitudinal mixed methods process evaluation and recruited one representative from three Australian aged care organisations, three disability care organisations and three organisations (n = 9) contracted to deliver care navigation services. One representative from each organisation joined a learning collaborative within their local area and completed a six‐module online education package incorporating written resources, webinars, collaboration and expert mentoring. Participants identified gaps in services in their region and barriers to care integration and developed a shared plan to implement change. Normalisation Process Theory was applied to understand the acceptability, penetration and sustainability of the implementation strategy as well as barriers and enabling factors. Dementia knowledge measured by the Dementia Knowledge and Awareness Scale was high among the professionals at the start of the implementation period (mean = 39.67, SD = 9.84) and did not change by the end (mean = 39.67, SD = 8.23). Quantitative data demonstrated that clinicians dedicated on average half of the recommended time commitment to the project. However, qualitative data identified that the learning collaborative strategy enhanced commitment to implementing integrated care and promoted action towards integrating previously disparate care services. Participant commitment to the project was influenced by their sense of obligation to their team, and teams that established clear expectations and communication strategies early were able to collaborate and use the implementation plan more effectively (demonstrating collective action). Teams were less likely to engage in the collective action or reflexive monitoring required to improve care integration if they did not feel engaged with their learning collaborative. Learning collaboratives hold promise as a strategy to improve cross‐sector service collaboration for people with YOD and their families but must maximise group cohesion and shared commitment to change. [ABSTRACT FROM AUTHOR]

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

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

Gay and bisexual migrants from low‐ and middle‐income countries living in high‐income countries are disproportionately diagnosed with HIV. Most research focuses on preventing HIV acquisition among HIV‐negative migrant gay and bisexual men (GBM). This study is uniquely positioned to report on migrant GBM's experiences and needs at and after an HIV diagnosis. Semi‐structured interviews were conducted with 24 migrant GBM diagnosed at sexual health clinics in Australia from 2017 onwards. Interviews were analysed using a codebook thematic analysis. Due to the stigma of HIV and homosexuality in their countries of origin, about half of participants had poor HIV knowledge prior to diagnosis. Absorbing diagnosis information was consequently difficult, and feelings of shame, hopelessness, lost sexual opportunities and infectiousness were common. However, many were thankful for the comprehensive clinical support they received and believed that over time life would 'normalise' with sustained undetectable viral load. None reported that their clinician stigmatised them, but the anticipation of stigma nonetheless infused their experiences after diagnosis. Many were selective about HIV disclosure, and some mentioned that clinic systems posed a risk to confidentiality. Non‐permanent residents were concerned about the impacts of HIV status on future visa applications. We recommend that newly HIV‐diagnosed migrant GBM receive referral to legal and culturally appropriate migration services to help absorb what a diagnosis might mean for their health and visa status. We also recommend sexual health clinics continue to assess confidentiality in their systems. Health promotion initiatives should highlight to migrant GBM that high‐HIV caseload sexual health clinicians provide confidential and comprehensive care. [ABSTRACT FROM AUTHOR]

Chinese immigrants in Australia are overrepresented among people with chronic hepatitis B virus (PWCHB) but experience poor access to healthcare. Given the historical discriminatory policies against PWCHB in mainland China, this study aimed to explore the lived experiences of stigma and discrimination surrounding hepatitis B virus (HBV) among Chinese immigrants originally from mainland China. Semi‐structured in‐depth interviews were conducted by a researcher with a Chinese background in 2019–2020. Sixteen Chinese immigrants living with HBV were recruited across Sydney and Melbourne through advocacy and support groups. This study is positioned in social constructionism. Data analysis was informed by the Health Stigma and Discrimination Framework that highlights the interaction between layered stigmas. This study revealed the historical, social and cultural construction of HBV‐related stigma among PWCHB and demonstrated how this stigma was manifested across socioecological levels in China and Australia. Findings show that HBV‐related stigma has mostly been driven by knowledge deficits about HBV and fear of HBV infection. HBV‐related stigma was mostly demonstrated around social isolation including isolation imposed by family and the community and employment restrictions in the Chinese workplace. In the Australian context, HBV‐related stigma was related to the ethnic and cultural background of PWCHB, and primarily occurred as anticipated stigma in the community and in employment. The findings provide significant insights for crosscutting research and policy endeavours to develop and test cross‐disciplinary initiatives that more broadly address the complex lived realities of Chinese immigrants living with hepatitis B virus. [ABSTRACT FROM AUTHOR]

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

Despite well‐documented health problems, healthcare access by women of refugee background in resettlement countries is typically poor. Suggested reasons include inadequate health literacy and resettlement challenges. A scoping review to explore the experiences of women of refugee background from Myanmar accessing and navigating healthcare was conducted following Arksey and O′Malley's framework, with an intersectional lens. Studies were analysed thematically following Braun and Clark's approach; four themes (eight subthemes) were constructed: Culture (Constructions of health; Navigating cultural tensions); Gender (Shifting gender roles; Sexual and reproductive health); Survivorship (Past health experiences; Strength in collectivism); and Language (The language barrier; Masked communication barriers). Intersectional factors of culture, gender, survivorship and language influenced women's experiences, shaping barriers and facilitators to healthcare. Community networks and bicultural peers are resources which may be enhanced. Research into trauma‐informed cultural competency programs, community education and bicultural health navigators is recommended to support women of refugee background from Myanmar. [ABSTRACT FROM AUTHOR]

The existing psychosocial Support activities in the Northern Territory, Australia, are mostly delivered through individualised outreach and client‐centred Support programs and do not currently have a strong Peer focus. To address this gap, a Peer‐Led Education Pilot was developed and implemented in Darwin, Australia. The pilot was comprised of three separate but overarching stages, and each stage was independently evaluated. In this article, results from Stage 1 will be presented, with a specific focus on the role of Peer‐to‐Peer communication in improving participants' mental health and Recovery skills. This stage involved the delivery of the My Recovery program to self‐nominated participants, and the evaluation was aimed at reporting on the appropriateness and effectiveness of the program. The evaluation was qualitative in design involving individual pre‐ and post‐program interviews with program participants (npre = 14, npost = 16) between August and October 2019. The program was well received by participants and helped build their capacity to understand and self‐manage their mental health and/or alcohol and other drug issues in an inclusive, non‐clinical, non‐judgemental space. The results highlighted the importance of including a strong Peer focus in the existing psychosocial Support services available for people with mental health issues in Darwin. The findings also underscored the inclusion of those with lived experience of mental health challenges in the design and delivery of such programs. [ABSTRACT FROM AUTHOR]