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Previous research has indicated that healthcare support for sexuality after spinal cord injury appears to be neglected or inadequately provided. The perspectives of people living with spinal cord injuries regarding what is lacking and what support they would like to be provided, and why, has yet to be explored. This paper uses critical theory to explore how societal constructs of sexuality and disability shape how sexuality is supported after a spinal cord injury. To do this, we conducted in-depth semi-structured interviews with 11 people with a spinal cord injury from Australia, the United Kingdom, and the United States. We drew from the works of various critical disability theorists to analyze what discourses underpinned the experiences people with spinal cord injuries had when receiving sexuality support. Analysis suggested that the following discourses were apparent: (1) broken bodies require repair, (2) sex is penetration, ejaculation then reproduction, and (3) sexual autonomy is required. Findings indicated healthcare professionals need to recognize people with spinal cord injuries as sexual beings with a diverse range of desires, lives, relations, and bodies. Provision of individualized comprehensive high-quality sexuality support is therefore warranted. To achieve this, healthcare professionals should aim to be aware of, and mitigate, ableist and normative assumptions. [ABSTRACT FROM AUTHOR]

Qualitative studies on assisted reproductive technology commonly focus on the perspectives of participants living in major metropolises. In doing so, the experiences of those living outside major cities, and the unique way conditions of spatiality shape access to treatment, are elided. In this paper, we examine how location and regionality in Australia impact upon access and experience of reproductive services. We conducted twelve qualitative interviews with participants residing in regional areas across Australia. We asked participants to discuss their experience with assisted reproduction services and the impacts of location on access, service choice, and experience of care, and analysed the data using reflexive thematic analysis, as outlined by Braun and Clarke (2006, 2019). Participants in this study reported that their location impacted the services available to them, required considerable time in travel, and reduced continuity of care. We draw on these responses to examine the ethical implications of uneven distribution of reproductive services in commercial healthcare settings which rely on market-based mechanisms. [ABSTRACT FROM AUTHOR]

Research into nonsuicidal self-injury (NSSI) has primarily focussed on the experience and regulation of emotion. Recently, NSSI-specific cognitions, including self-efficacy to resist self-injury, have been explored to further understand the behaviour. However, within these studies self-efficacy to resist NSSI has been assessed broadly using an adapted measure of self-efficacy to avoid suicide. There is a need for a NSSI-specific measure of self-efficacy, which considers specific contexts that may influence confidence in the ability to resist self-injuring. This paper reports the development of such a measure. An initial item pool (125 items) was generated from interviews with people with lived experience of NSSI and experts in the field of self-injury. These items were then administered to 650 participants aged 18–40 years (M = 21.14, SD = 2.32, 45.69% with a history of NSSI). Analyses revealed a three-factor structure representing: contexts in which it would be difficult to resist NSSI (risk contexts); contexts which make it easier to resist NSSI (protective contexts); and contexts in which people are reminded of self-injury (reminders of NSSI). To reduce the number of items, eight items with the highest loadings on each factor were retained. The final 24 item (three subscales) scale fit the data well and demonstrated invariance across individuals with and without a history of self-injury. Correlations with related but distinct constructs (e.g., self-esteem, locus of control) supported convergent and discriminative validity. This measure could be used to further theoretical understanding of NSSI and may be useful in clinical settings. [ABSTRACT FROM AUTHOR]

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

Recruiting adults with autism spectrum disorders (ASD) into research poses particular difficulties; longitudinal studies face additional challenges. This paper reports on a mixed methods study to identify factors influencing the participation in longitudinal autism research of adults with ASD, including those with an intellectual disability, and their carers. Common and differentiating factors influencing the research participation of participants are identified and discussed. Factors influencing participation were found to differ both between and within participant categories. We propose a dichotomy whereby factors influencing research participation can be classified as those arising from a participant's values, which act as either a motivator or a deterrent; and those based on convenience, which act as either an enabler or inhibitor. These findings are applicable to research studies that seek to recruit adults with ASD as participants. [ABSTRACT FROM AUTHOR]

Objectives: Patient reported experience measures (PREMs) are tools often utilised in hospitals to support quality improvements and to provide objective feedback on care experiences. Less commonly PREMs can be used to support consumers choices in their hospital care. Little is known about the experience and views of the Australian consumer regarding PREMs nor the considerations these consumers have when they need to make decisions about attending hospital. This study aimed to explore consumer awareness of PREMs, consumer attitudes towards PREMs and the utility of PREMs as a decision-making tool in accessing hospital care. Methods: Qualitative study involving semi-structured interviews conducted over the phone. Participants (n = 40) were recruited from across Australia and purposively sampled according to key characteristics: holding private health insurance, > 30-years of age, may have accessed private hospital care in the past year, variety of educational and cultural backgrounds, and if urban or rural residing. Interviews were audio-recorded, transcribed, and analysed thematically. Results: Four overarching themes and six subthemes were identified from the data. Major findings were that prior awareness of PREMs was limited; however, many had filled in a PREM either for themselves or for someone they cared for following a hospital stay. Most respondents preferred to listen to experience of self or family/friends or the recommendation of their physician when choosing a hospital to attend. Participants appeared to be more interested in the treating clinician than the hospital with this clinician often dictating the hospital or hospital options. If provided choice in hospital, issues of additional costs, timeliness of treatment and location were important factors. Conclusion: While PREMs were considered a possible tool to assist in hospital decision-making process, previous hospital experiences, the doctor and knowing up-front cost are an overriding consideration for consumers when choosing their hospital. Consideration to format and presentation of PREMs data is needed to facilitate understanding and allow meaningful comparisons. Future research could examine the considerations of those consumers who primarily access public healthcare facilities and how to improve the utility of PREMs. [ABSTRACT FROM AUTHOR]

While there is high patient acceptance for clinical staff discussing issues regarding spirituality with hospital inpatients, it is not clear which staff member patients prefer for these discussions. This unique exploratory study investigated inpatient preferences regarding which staff member should raise the topic of spirituality. A cross-sectional survey was conducted with inpatients at six hospitals in Sydney, Australia (n = 897), with a subset invited to participate in qualitative interviews (n = 41). Pastoral care staff (32.9%) were the preferred staff members with whom to discuss spiritual issues, followed by doctors (22.4%). Qualitative findings indicated that individual characteristics of the staff member are more important than their role. [ABSTRACT FROM AUTHOR]

Peer support groups have been an increasingly popular way of limiting the adverse effects of life with a chronic illness for adolescents although few groups have been rigorously evaluated. This paper reports the findings of a realistic evaluation of a hospital based peer support program Chronic Illness Peer Support (ChIPS), in Sydney, Australia. We collected qualitative interview and focus group data from four participant groups; new ChIPS members, their parents, older members who had been in ChIPS for two or more years, and ChIPS co-ordinators past and present. Results of qualitative data have been aggregated and organised into three categories; program attendance: getting in and staying in; program outcomes for young people: personal growth and development; and social connection. Questionnaires were also administered to fourteen new ChIPS members but no significant changes in distress or self-esteem were recorded between the beginning and the end of the short study period. The ChIPS Introductory Program fulfilled its aim, entering young people with chronic illness into the peer support program. There was evidence of initial personal growth and development in those young people, with potential for enhanced social connection from ongoing participation in ChIPS activities. [ABSTRACT FROM AUTHOR]

This paper reports on a study of Australian early childhood teachers' pedagogical practices with young children experiencing parental separation and divorce. Twenty-one semi-structured interviews and a focus group were conducted to explore the actions of teachers to support young children experiencing parental separation and divorce. A grounded theory approach was used to analyse data. Teachers reported actions that were focussed on constructing emotional, behavioural, and academic support for young children, as well as forming partnerships with parents, school personnel, and community members to assist. Results are discussed in terms of the implications for professional practice. [ABSTRACT FROM AUTHOR]

Study design:Literature review/semi-structured interviews.Objective:To develop a spinal cord injury (SCI) research strategy for Australia and New Zealand.Setting:Australia.Methods:The National Trauma Research Institute Forum approach of structured evidence review and stakeholder consultation was employed. This involved gathering from published literature and stakeholder consultation the information necessary to properly consider the challenge, and synthesising this into a briefing document.Results:A research strategy 'roadmap' was developed to define the major steps and key planning questions to consider; next, evidence from published SCI research strategy initiatives was synthesised with information from four one-on-one semi-structured interviews with key SCI research stakeholders to create a research strategy framework, articulating six key themes and associated activities for consideration. These resources, combined with a review of SCI prioritisation literature, were used to generate a list of draft principles for discussion in a structured stakeholder dialogue meeting.Conclusion:The research strategy roadmap and framework informed discussion at a structured stakeholder dialogue meeting of 23 participants representing key SCI research constituencies, results of which are published in a companion paper. These resources could also be of value in other research strategy or planning exercises.Sponsorship:This project was funded by the Victorian Transport Accident Commission and the Australian and New Zealand Spinal Cord Injury Network. [ABSTRACT FROM AUTHOR]

The birth of an extremely premature baby is a tragedy, and it is only natural that the parents will rely on the spiritual and religious beliefs that guide the rest of their lives. At this difficult time, parents with strong religious beliefs will hope for divine intervention and pray for a miracle. This paper outlines the difficulties experienced by neonatal nurses when caring for an extremely premature baby whose parents hold on to hope and their belief in divine intervention and a miracle. Data were collected via a questionnaire to Australian neonatal nurses and semi-structured interviews with 24 neonatal nurses in NSW, Australia. A qualitative approach was used to analyse the data. The theme of 'hoping for a miracle' was captured by two sub-themes 'praying for a miracle' and 'oscillating between hope and despair'. For some families, the hope of divine intervention seemed all consuming, and the nurses were witness to the desperation and disappointment of families when a miracle was not forthcoming. [ABSTRACT FROM AUTHOR]

Home country re-entry from cross-cultural missionary work abroad may be associated with psychological distress. Re-entrants experience multiple losses including loss of identity which may be associated with personal/relational identity gaps and depersonalization/dehumanization. However, research suggests that some re-entrants are resilient with good mental health, while others are fragile with poor mental health. The aims of this paper are to explore the nature and frequency of re-entering missionaries' identity gaps and their depersonalization/dehumanization in resilient and fragile re-entrants. Fifteen re-entering adult Australian cross-cultural missionary workers from four interdenominational Australian mission organizations completed semi-structured interviews. Results were analysed using modified Consensual Qualitative Research methods. Links were established between personal/relational identity gaps, depersonalization/dehumanization and resilience on re-entry. Implications for re-entrants' care are discussed with suggestions for further research. [ABSTRACT FROM AUTHOR]

Purpose: Health and social care professionals are ideally placed to identify and address gender-based violence (GBV), yet research continues to demonstrate that the subject is being poorly covered at undergraduate level. This qualitative study explored health and social care students' and educators' views on GBV education, with a view to identifying 'best practice'. We aimed to capture students' and educators' experiences and perceptions of GBV education across participating countries; how participants thought GBV should be taught/learned within their curricula; and their views on how GBV education might be 'optimized'. Methods: We conducted nine focus group discussions and one semi-structured interview with 23 students and 21 academic staff across the UK, Australia and Chile. Results: Thematic analysis yielded three themes: (1) GBV addressed in all but name, (2) Introduce sooner, explore later and (3) A qualitative approach to learning. Educators and students indicated that GBV is largely being overlooked or incompletely addressed within curricula. Many participants expressed a wish for the subject to be introduced early and revisited throughout their study, with content evolving as cohorts mature. Lastly, our findings indicate that GBV education could benefit from adopting a 'qualitative' approach, prioritizing survivor narratives and incorporating dialogue to facilitate student engagement. Conclusion: Though time constraints and competing demands within undergraduate curricula are frequently cited as barriers to moving away from traditional didactic methods, our findings suggest that teacher-centered strategies are insufficient and, in some regards, inappropriate for GBV education. The need for a paradigm shift in GBV education is discussed. [ABSTRACT FROM AUTHOR]

We mapped gay and bisexual men's (GBM) patterns of using pre-exposure prophylaxis (PrEP) over time and explored sexual behavior as PrEP use changed. We conducted semi-structured interviews between June 2020 and February 2021 with 40 GBM living in Australia who had changed their PrEP use since initiating. There was considerable diversity in patterns of discontinuation, suspension, and recommencement of PrEP. Reasons for changing PrEP use mostly centered on accurate perceived changes to HIV risk. Twelve participants reported condomless anal intercourse with casual or fuckbuddy partners after discontinuing PrEP. These sex events were unanticipated, condoms were not a preferred option, and other risk reduction strategies were applied inconsistently. Service delivery and health promotion can support safer sex among GBM when PrEP use fluctuates by promoting event-driven PrEP and/or non-condom-based risk reduction methods during periods off daily PrEP, and guiding GBM to better recognize changing circumstances of risk and when to recommence PrEP. [ABSTRACT FROM AUTHOR]

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

Background: Patient-reported outcome measures (PROMs) provide a measure of self-perceived health status or health-related quality of life. They have been used to support provider-patient decisions, healthcare delivery, and value-based healthcare models. A barrier to routine collection of PROMs is the perception that PROMs lack clinical utility. As such, it is important to establish clinicians' acceptability of the PROM prior to large-scale implementation. This study explored the acceptability of the routine use and collection of a generic PROM in healthcare services from the perspective of healthcare staff. Methods: Individual semi-structured interviews were completed from September 2020 to March 2021 with 26 staff from two multi-disciplinary community healthcare services in Melbourne, Australia. Interviews explored their experiences of using the EQ-5D-5L in their routine care. Interviews were recorded and transcribed verbatim. Data were analysed according to a framework approach, using inductive and deductive techniques. Results: Participants discussed the acceptability of the EQ-5D-5L with reference to four themes: practicalities of use; holistic nature; influence on client care; and influence on health service. Participants found the EQ-5D-5L quick and easy to administer, and appreciated that it measured multiple domains of health that were relevant to their clients' care. They believed the EQ-5D-5L helped to identify client problems, and inform service delivery. They also reported features that were less acceptable, including a lack of item specificity to some healthcare disciplines. Participants reported the challenge of managing conflict between their assessment of the client's health and the client's perspective of their own health, leading some to question whether the client could provide an accurate reflection of their own health. Conclusions: The EQ-5D-5L has several features that healthcare staff viewed as acceptable for routine collection and use in healthcare. Training on the validity of the patient reported perspective and broadening the scope of PROMs collection beyond the EQ-5D-5L should be considered to facilitate large-scale implementation. [ABSTRACT FROM AUTHOR]

Background: Value-based healthcare provider reimbursement models have been proposed as an alternative to traditional fee-for-service arrangements that can align financial reimbursement more closely to the outcomes of value to patients and society. This study aimed to investigate stakeholder perceptions and experiences of different reimbursement systems for healthcare providers in high-performance sport, with a focus on fee-for-service versus salaried provider models. Methods: Three in-depth semi-structured focus group discussions and one individual interview were conducted with key stakeholders across the Australian high-performance sport system. Participants included healthcare providers, health managers, sports managers and executive personnel. An interview guide was developed using the Exploration, Preparation, Implementation, Sustainment framework, with key themes deductively mapped to the innovation, inner context and outer context domains. A total of 16 stakeholders participated in a focus group discussion or interview. Results: Participants identified several key advantages of salaried provider models over fee-for-service arrangements, including: the potential for more proactive and preventive models of care; enhanced inter-disciplinary collaboration; and the ability for providers to have a deeper understanding of context and how their role aligns with a broader set of priorities for an athlete and the organisation. Noted challenges of salaried provider models included the potential for providers to revert to reactive care delivery when not afforded adequate capacity to provide services, and difficulties for providers in demonstrating and quantifying the value of their work. Conclusions: Our findings suggest that high-performance sporting organisations seeking to improve primary prevention and multidisciplinary care should consider salaried provider arrangements. Further research to confirm these findings using prospective, experimental study designs remains a priority. [ABSTRACT FROM AUTHOR]

Background: In recent years, the length of elite sporting competitions has raised concerns regarding player well-being, highlighting a need to review current match calendars. Therefore, this study aimed to explore the perceptions of elite National Rugby League (NRL) players and staff on the annual training and competition calendar from a player workload and well-being perspective. Methods: This study adopted a mixed-methods approach, using a sequential explanatory design. Phase one implemented a cross-sectional survey, and phase two utilised semi-structured interviews. Four hundred and thirty-nine elite rugby league players and 46 staff completed the survey. Eighteen elite professional NRL players and six football staff were interviewed, and verbal data were analysed into pre-defined topic summaries using qualitative coding reliability methods. Topics included in-season, off-season, pre-season and well-being. Results: Data analysis suggests that elite NRL players and staff believe players appear particularly comfortable with the current number of games; however, they are at their maximum capacity. Importantly, this study identified several minority groups that may require support to enhance player well-being. Players believe reducing the pre-season would negate fatigue experienced later in the subsequent season. Players and staff believe this timeframe still provides sufficient time to prepare for the upcoming season. Further, players were open to extending the off-season to 8–10 weeks and believed that extra time would allow for greater recovery from the previous season. Mid-season congested scheduling affects players following the intensified period and requires attention to alleviate fatigue. Conclusion: The results of this study convey important implications for the NRL, emphasising a need to review their annual training and competitive calendar, or to implement specific strategies to enhance the well-being of minority groups. The findings from this study should be considered when discussing the ideal length and structure of the match calendar to support players' physical and mental welfare. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore Australian chaplains' views of spirituality. Semi-structured online interviews were conducted with 16 participants. Participants relied heavily on metaphors and analogies to describe spirituality. Four inter-related themes were identified through reflexive thematic analysis: (1) The core of spirituality: spirituality as a source of meaning or belief which leads to connectedness with something greater than oneself; (2) A function of spirituality: spirituality empowers people to cope in a crisis, by providing motivation, hope and comfort; (3) The experience of spiritual crisis: admission to hospital or residential care can lead to existential struggle; and (4) The spiritual practice: of holding space between struggle and growth. Greater understanding of the theoretical basis of their work may allow chaplains to offer more in the therapeutic space. [ABSTRACT FROM AUTHOR]

This mixed methods study examines the benefits of basing a family support worker (FSW) at a primary school in Melbourne, Australia. The school has a number of high needs families requiring extensive support from school staff. Pre and post intervention data was collected on the time spent on social problems in the school community. These included managing students with behavioural and emotional issues, providing support and practical assistance to parents with problems and liaising with agencies to access support for students and families. Pre and post intervention Strengths and Difficulties Questionnaires were completed by teachers whose students and families were clients of the FSW (n = 8) and compared with non clients (n = 10). Semi-structured interviews were held with FSW clients (n = 6), class teachers (n = 3) the assistant principal, principal and the FSW. Employing a FSW showed a reduction in the amount of time spent on welfare cases for teachers, and therefore a monetary saving for the school. Qualitative data collected from school staff and FSW clients was overwhelmingly positive. Having a FSW based at a primary school provides savings in teacher time, and expenses to the school. Teachers are freed to concentrate on education and the parents valued the relationship provided by the FSW. [ABSTRACT FROM AUTHOR]

Conventional mental health services are frequently criticized for failing to support people and communities in their care. Open Dialogue is a non-conventional humanistic approach to mental health care, which has been implemented in many different settings globally. At two Australian public health care services, implementation of the approach led to positive client outcomes and sustained organizational and clinical change. The aim of the study was to identify and explore the organizational, management, leadership and cultural factors that contributed to sustained implementation in these complex systems. We conducted nine individual semi-structured interviews of health care leaders and managers from the two sites. Transcriptions of the interviews were analyzed thematically. Leaders facilitated a gradual development of clinical and organizational legitimacy for the non-standardized Open Dialogue approach by holding the anxiety and frustration of practitioners and parts of the administration, cultivating cultural change and adaptation and by continually removing organizational obstacles. [ABSTRACT FROM AUTHOR]

The current study explored the language barriers to help-seeking in the context of reproductive coercion and abuse (RCA), domestic and family violence (DFV), and sexual violence (SV), drawing on observations by key informants supporting women from migrant and refugee communities. A lack of shared language has been identified as a key barrier to help seeking for migrant and refugee women experiencing DFV more broadly, though how language intersects with help seeking in the context of RCA is yet to be investigated. We conducted 6 focus groups with 38 lawyers, counsellors, and social workers supporting women experiencing DFV in Brisbane and Melbourne, Australia. Our findings address two main areas. First, consistent with past research in DFV, our participants identified language as a barrier for women when communicating about sexual and reproductive issues in the context of health and police encounters. More specifically, our findings suggest that the inability of health professionals and police to communicate with women who have low or no English proficiency not only negatively impacted victims/survivors' ability to access support, but also facilitated the perpetration of RCA. We conclude that language can be a mechanism through which coercive control is enacted by perpetrators of RCA and health and policing systems may not be equipped to recognise and address this issue. We also suggest that greater conceptual clarity of RCA is needed within the DFV sector in order to tailor responses. [ABSTRACT FROM AUTHOR]

Participation in high-quality early childhood education and care (ECEC) benefits children and society. Policy recognition of this manifests through government subsidy strategies to increase ECEC access in the years immediately preceding school. Yet despite this action, many children do not receive the recommended amount. This study utilizes a mixed-methods design to investigate ECEC participation barriers and facilitators in three Australian communities. Parents and service providers completed online questionnaires (45 parents, 63 providers) and semi-structured interviews (21 parents, 16 providers). Results showed that issues related to both direct (e.g., fees) and indirect (e.g., travel) costs are particularly important barriers for families, and are well-recognized by providers. A range of factors were also considered important for facilitating participation (e.g., effective promotion of the benefits linked to high-quality play-based learning in formal settings, professional training of staff). Findings demonstrated the ecological complexity of participation. Strategies to address barriers and harness facilitators are required across multiple levels. Highlights: Participation in high-quality early childhood education benefits children. Many children do not receive the recommended dose of early childhood education. Parents and providers see various participation costs as important barriers. Providers may underestimate barriers relating to maternal role beliefs. Promotion of child benefits and staff training may facilitate participation. [ABSTRACT FROM AUTHOR]

This is the first article to analyze children's involvement in technology-facilitated coercive control in Australia. The primary research question was "How do mothers describe their children's involvement in technology-facilitated coercive control?". This article is based on incidental findings from a larger study on Australian women's experiences of technology-facilitated abuse in the context of domestic violence. Although children were not the focus of the study, semi-structured interviews with twelve mothers yielded discussion of children's involvement in the abuse. We used thematic analysis to identify key dynamics and contexts of this abuse. We found that mothers and their children are co-victims of coercive control. Mothers interviewed for the study reported that children were involved in technology-facilitated coercive control directly and indirectly. This study bridges the gap between the extant research on children and coercive control and technology-facilitated abuse by highlighting the ways children are involved in technology-facilitated coercive control. The social and legal contexts of co-parenting with abusive fathers exposed mothers and children to ongoing post-separation abuse, extending abusive fathers' absent presence in the lives of children [ABSTRACT FROM AUTHOR]

This study aimed to describe the experiences of autistic people who had interacted with police in Australia in the previous 5 years. Fifty autistic adults and 61 parent/carers completed a questionnaire and 30 participants took part in an interview. Participants were most commonly interacting with police in the context of seeking assistance or as victims of crime. Autistic adults were largely unsatisfied with their interactions and reluctant to disclose their autism. Parent/carers reported significantly higher satisfaction than autistic adults and incidents involving children were rated more highly than those involving adults. Suggestions for improved interactions included increased autism awareness amongst police and use of appropriate accommodations. Areas for future research in relation to the evaluation of police training is discussed. [ABSTRACT FROM AUTHOR]

Elder abuse often goes unreported. Perpetrators of elder abuse are frequently the adult children of the victim and this relationship may contribute to the reluctance of older adults to seek help. This study aimed to understand older people's experiences of elder abuse and the barriers to reporting it. Twenty-eight semi-structured interviews were conducted with clients of Seniors Rights Victoria (SRV) who had a case opened and closed between 2012 and 2015, or had made two or more calls to SRV between this period. Thematic analysis was undertaken of the qualitative data. Older people who are being abused by their adult children may be reticent to seek help due to fear of adverse consequences for their adult child. The parental bond frequently prevented participants from speaking to others, asking for help, or enacting the advice provided to them. Shame and stigma surrounding the reporting of elder abuse committed by adult children needs to be addressed. Older people need to be supported to take action earlier when there is less likelihood of adverse consequences. Policy and services need to recognize the unique characteristics of the parent-child relationship and the way they can affect an older person's ability to seek help. [ABSTRACT FROM AUTHOR]

Conflicts of interest (COI) in health and medicine have been the source of considerable public and professional debate. Much of this debate has focused on financial, rather than non-financial COI, which is a significant lacuna because non-financial COI can be just as influential as financial COI. In an effort to explore the nature and effects of non-financial, as well as financial COI, we conducted semi-structured interviews with eleven Australian medical professionals regarding their experiences of, and attitudes towards, COI. We found that this group of medical professionals saw non-financial interests—most notably the pursuit of status and respect and the avoidance of stigma—as potentially conflicting with other important interests (such as patient care). [ABSTRACT FROM AUTHOR]

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A person's sexuality exerts a powerful influence on their needs, desires, roles, social relationships and personal identity. This study, explored occupational therapists' reasoning and practice in relation to the work they do (or do not do) with clients for whom sexual expression has become problematic. The lens used to explore reasoning and practice was a key conceptual framework adopted by occupational therapists, the occupational perspective of health, which considers humans need to do, be, become and belong. Using a qualitative, phenomenographic approach, 16 occupational therapists from across Australia were interviewed to understand the qualitatively variable ways in which they reasoned about practice in relation to the sexual needs of their clients. Four related, layers of 'conception' are presented. At a foundational level, we describe how participants conceived of their practice role in relation to assisting people in the doing aspect of sex(uality). At the next, more complex level, participants appeared to conceive of practice in relation to their clients' being as a sexual person. The next conception related to how therapists think about their clients in their becoming as a sexual being and finally, in their belonging as a sexual being. These conceptual categories, derived both theoretically and empirically are presented as a hierarchically aligned framework, the occupational perspective of sexuality (OPS). While generated from a study of occupational therapists' reasoning, the OPS has potential to enable a broader, more holistic consideration of sexuality, assisting health care professionals and educators to better understand the ways in which they may address their clients' needs to do, be, become and belong to their sexuality. [ABSTRACT FROM AUTHOR]

Purpose: Surgical antibiotic prophylaxis (SAP) is a common area of antimicrobial misuse. The aim of this study was to explore the social dynamics that influence the use of SAP.Methods: 20 surgeons and anaesthetists from a tertiary referral hospital in Australia participated in semi-structured interviews focusing on experiences and perspectives on SAP prescribing. Interview data were analysed using the framework approach.Results: Systematic analysis of the participants’ account of the social factors influencing SAP revealed four themes. First, antibiotic prophylaxis is treated as a low priority with the competing demands of the operating theatre environment. Second, whilst guidelines have increased in prominence in recent years, there exists a lack of confidence in their ability to protect the surgeon from responsibility for infectious complications (thus driving SAP over-prescribing). Third, non-concordance prolonged duration of SAP is perceived to be driven by benevolence for the individual patient. Finally, improvisation with novel SAP strategies is reported as ubiquitous, and acknowledged to confer a sense of reassurance to the surgeon despite potential non-concordance with guidelines or clinical efficacy.Conclusions: Surgical-specific concerns have thus far not been meaningfully integrated into antimicrobial stewardship (AMS) programmes, including important dynamics of confidence, trust and mitigating fear of adverse infective events. Surgeons require specific forms of AMS support to enact optimisation, including support for strong collaborative ownership of the surgical risk of infection, and intra-specialty (within surgical specialties) and inter-specialty (between surgery, anaesthetics and infectious diseases) intervention strategies to establish endorsement of and address barriers to guideline implementation. [ABSTRACT FROM AUTHOR]

Vaginal birth may result in damage to the levator ani muscle (LAM) with subsequent pelvic floor dysfunction and there may be accompanying psychological problems. This study examines associations between these somatic injuries and psychological symptoms. A qualitative study using semi-structured interviews to examine the experiences of primiparous women (n = 40) with known LAM trauma was undertaken. Participants were identified from a population of 504 women retrospectively assessed by a perinatal imaging study at two obstetric units in Sydney, Australia. LAM avulsion was diagnosed by 3D/4D translabial ultrasound 3-6 months postpartum. The template consisted of open-ended questions. Main outcome measures were quality of information provided antenatally; intrapartum events; postpartum symptoms; and coping mechanisms. Thematic analysis of maternal experiences was employed to evaluate prevalence of themes. Ten statement categories were identified: (1) limited antenatal education (29/40); (2) no information provided on potential morbidities (36/40); (3) conflicting advice (35/40); (4) traumatized partners (21/40); (5) long-term sexual dysfunction/relationship issues (27/40); (6) no postnatal assessment of injuries (36/40); (7) multiple symptoms of pelvic floor dysfunction (35/40); (8) “putting up” with injuries (36/40); (9) symptoms of post-traumatic stress disorder (PTSD) (27/40); (10) dismissive staff responses (26/40). Women who sustain LAM damage after vaginal birth have reduced quality of life due to psychological and somatic morbidities. PTSD symptoms are common. Clinicians may be unaware of the severity of this damage. Women report they feel traumatized and abandoned because such morbidities were not discussed prior to birth or postpartum. [ABSTRACT FROM AUTHOR]

Background: Food service staff are integral to delivery of quality food in aged care homes yet measurement of their satisfaction is unable to be performed due to an absence of a valid and reliable questionnaire. The aim of this study was to develop and perform psychometric testing for a new Food Service Satisfaction Questionnaire developed in Australia specifically for use by food service staff working in residential aged care homes (Flinders FSSQFSAC).Methods: A mixed methods design utilizing both a qualitative (in-depth interviews, focus groups) and a quantitative approach (cross sectional survey) was used. Content validity was determined from focus groups and interviews with food service staff currently working in aged care homes, related questionnaires from the literature and consultation with an expert panel. The questionnaire was tested for construct validity and internal consistency using data from food service staff currently working in aged care homes that responded to an electronic invitation circulated to Australian aged care homes using a national database of email addresses. Construct validity was tested via principle components analysis and internal consistency through Cronbach’s alpha. Temporal stability of the questionnaire was determined from food service staff undertaking the Flinders FSSQFSAC on two occasions, two weeks apart, and analysed using Pearson’s correlations.Results: Content validity for the Flinders FSSQFSAC was established from a panel of experts and stakeholders. Principle components analysis revealed food service staff satisfaction was represented by 61-items divided into eight domains: job satisfaction (α=0.832), food quality (α=0.871), staff training (α=0.922), consultation (α=0.840), eating environment (α=0.777), reliability (α=0.695), family expectations (α=0.781) and resident relationships (α=0.429), establishing construct validity in all domains, and internal consistency in all (α>0.5) except for “resident relationships” (α=0.429). Test-retest reliability coefficients ranged from 0.276 to 0.826 dependent on domain, with test-retest reliability established in seven domains at r>0.4; an exception was “reliability” at r=0.276.Conclusions: The newly developed Flinders FSSQFSAC has acceptable validity and reliability and thereby the potential to measure satisfaction of food service staff working in residential aged care homes, identify areas for strategic change, measure improvements and in turn, improve the satisfaction and quality of life of both food service staff and residents of aged care homes. [ABSTRACT FROM AUTHOR]

The burden of chronic Hepatitis B (CHB) infection and associated complications such as hepatocellular carcinoma is growing significantly in Australia due to increased migration from countries with a high prevalence of CHB. Significant barriers to screening and engagement with healthcare persist due to stigma and perceptions associated with CHB within these communities. Our study was a pilot intervention aimed at engaging Afghan, Rohingyan, and Sudanese populations into CHB care through an initial needs assessment. Twenty six patients from Afghan, Rohingyan, and Sudanese communities, identified in the Monash Health CHB database, participated in a combination of survey questionnaires and semi-structured interviews. Language and cultural barriers, lack of HBV knowledge, housing and family reunification priorities associated with new settlement, as well as previous experiences of healthcare engagement were all identified as obstacles to accessing CHB care. Healthcare and health promotion workers should be sensitive to the additional health barriers associated with seeking asylum, as these barriers can take priority over the often asymptomatic and chronic nature of CHB. Communities with high prevalence of CHB require culturally relevant education tools delivered at a community level in order to improve their knowledge. [ABSTRACT FROM AUTHOR]

This study aimed to explore four mental health consumers' experiences of completing self-report outcome measures in a research project. Participants were recruited from a community mental health organisation in Melbourne and were interviewed upon completion of a mixed methods research study where they were asked to complete a series of self-report outcome measures. Descriptive phenomenological micro-analysis was used to analyse interview data and is presented along with the researchers' observations during the data collection process. Results revealed that participants found the outcome measures cognitively challenging and the language used in the measures did not support the empowering intentions of mental health recovery. The authors suggest that the value of completing surveys for people with severe mental illness needs to be carefully considered so that the research process does not diminish other benefits of participation. [ABSTRACT FROM AUTHOR]

Primary care physicians are often the first contact for people with mental health concerns. Moreover, many patients with mental health concerns are parents caring for dependent children. The aim of this study was to investigate the family focused practices of a group of primary care physicians when working with patients who are parents and experience mental health concerns. A sequential mixed method design (questionnaire followed by interviews) was employed, early 2015, in general medical settings across six Australian states. Twenty one primary care physicians (12 female, 9 male) across different medical settings completed the Family Focused Mental Health Practice Questionnaire; nine of these were interviewed. Participants reported a moderate amount of family focused practice when working with patients who are parents with mental health issues. Many acknowledged the importance of working with patients on family issues but reported barriers in doing so. Clear guidelines, including the recording of parenting status, need to be in place for primary care physicians working with patients who are parents. [ABSTRACT FROM AUTHOR]

Introduction This study aimed to describe Maternal Child and Family Health Nurses' (MCaFHNs) perception of their role across Australia. MCaFHNs deliver services to positively influence the growth and development of children in the early years. Little is known about their role as they deliver care to children and families in Australia. Methods This study used in-depth qualitative inquiry. Sixteen expert MCaFHNs from the eight jurisdictions in Australia took part in semi-structured interviews conducted from April 2013 to August 2013. The data were transcribed verbatim, validated by participants, and analysed thematically. Results The results indicated that the MCaFHNs' role is embedded in the principles of primary health care under an umbrella of universal service delivery with increasing overall complexity. Health promotion and early intervention are key components of the role, with services focused heavily on child growth and development and maternal mental health. Delivery of services by MCaFHNs was enriched by specific approaches to care, such as working in partnership with families, and all aspects of the role were enabled by essential specialist skills and knowledge. Discussion While role descriptors, educational backgrounds and experiences vary, participants overwhelmingly report similarities in practice. This study identified tangible reasons for the development of a nationally consistent role and practice in Australia, enabling consistency and equity of best models of practice. Such a description is essential to enable transferability and comparison with nurses working in similar contexts internationally. [ABSTRACT FROM AUTHOR]

Self-stigma detracts from the wellbeing, self-esteem, and social connectedness of adults with mental health disorders. Although emerging research has indicated that self-stigma may have similar consequences for parents of children with mental health disorders, currently we lack a comprehensive description of how parents experience self-stigma. To address this, we investigated parents' lived experiences of self-stigma using a descriptive qualitative approach. Directed by interview questions informed by a parent-based participatory action research group ( n = 4), we conducted individual semi-structured interviews with 12 parents of children (aged 5-13) diagnosed with emotional and/or behavioural disorders. Data obtained from interviews with 11 mothers was coded and thematically analysed. Five themes were found: (1) the 'good parent' ideal, (2) awareness of external stigma, (3) outcomes of external stigma (social avoidance and self-doubt), (4) self-stigma (believing self-doubt and external stigma), and (5) refuting self-stigma. Our findings show that parents of children with mental health disorders experience self-stigma. However, because it leads to a diminished sense of being a good parent, the self-stigma is of a different type to that which has been described for adults with mental illness. This has important implications for the conceptualisation and assessment of parent self-stigma as research in this area moves forward. [ABSTRACT FROM AUTHOR]

Young people of parents with a mental illness are at significant risk of developing a mental illness. This risk may be reduced if appropriate interventions are provided. While there are several supports available, their needs are rarely heard in either intervention development or evaluation. This study presents young people's perspectives of the types of supports they want. One hundred and seventy-two young people (13-17 years) whose parent has a mental illness completed a self-constructed questionnaire and six of these participants engaged in individual follow-up interviews. Frequency data indicated that youth want to learn how to cope or manage their parent's mental illness and highlighted a need to access support online. Interview thematic analysis reflected a need for psycho-education, confidential and/or anonymous support, and a preference to access information from health care professionals. Given the diversity of views presented, this study suggests that 'not one size fits all'. [ABSTRACT FROM AUTHOR]

The emotional bond that a mother feels towards her baby is critical to social, emotional and cognitive development. Maternal health and wellbeing through pregnancy and antenatal bonding also play a key role in determining bonding postnatally, but the extent to which these relationships may be disrupted by poor mental health or substance use is unclear. This study aimed to examine the extent to which mother-fetal bonding, substance use and mental health through pregnancy predicted postnatal mother-infant bonding at 8 weeks. Participants were 372 women recruited from three metropolitan hospitals in Australia. Data was collected during trimesters one, two and three of pregnancy and 8 weeks postnatal using the Maternal Antenatal Attachment Scale (MAAS), Maternal Postnatal Attachment Scale (MPAS), the Edinburgh Antenatal and Postnatal Depression Scale (EPDS), the Depression and Anxiety Scales (DASS-21), frequency and quantity of substance use (caffeine, alcohol and tobacco) as well as a range of demographic and postnatal information. Higher antenatal bonding predicted higher postnatal bonding at all pregnancy time-points in a fully adjusted regression model. Maternal depressive symptoms in trimesters two and three and stress in trimester two were inversely related to poorer mother-infant bonding 8 weeks postnatally. This study extends previous work on the mother's felt bond to her developing child by drawing on a large sample of women and documenting the pattern of this bond at three time points in pregnancy and at 8 weeks postnatally. Utilising multiple antenatal waves allowed precision in isolating the relationships in pregnancy and at key intervention points. Investigating methods to enhance bonding and intervene in pregnancy is needed. It is also important to assess maternal mental health through pregnancy. [ABSTRACT FROM AUTHOR]

Effective parenting self-regulation is purported to promote positive parent and child mental health and behavioural outcomes. This study aimed to develop and validate a brief and easy-to-administer measure of parents' perceptions of their self-regulation related to parenting. In the absence of any specific quantitative means to measure this construct, we developed a 16-item self-report scale in an Australian context for clinical and research use. The scale measures global beliefs about self-efficacy, personal agency, self-management, and self-sufficiency, thought to constitute parent self-regulation perceptions. Based on existing literature, we developed an initial 71-item scale which we subsequently tested in a representative sample of Australian parents (220 mothers, 80 fathers) recruited by random digit telephone dialling. With a strong theoretical framework, confirmatory factor analysis with adequate fit supported a final 16-item, four-factor scale as hypothesised entitled 'Me as a Parent' (MaaP). Three-month test-retest reliability was demonstrated with a subset of the sample ( n = 126). Further development of the MaaP, its potential for clinical and research use, and future assessment and validation through field-testing is discussed. [ABSTRACT FROM AUTHOR]

Many assumptions are made about public willingness to participate in epidemiological research, yet few empirical studies have been conducted to ascertain whether such assumptions are correct. Our qualitative study of the public and of expert stakeholders leads us to suggest that people are generally prepared to participate in epidemiological research, particularly if it is conducted by a trusted public institution such as a government health department, charity, or university. However, there is widespread community distrust of research conducted or sponsored by pharmaceutical companies. Individuals are prompted to take part if the study concerns an illness they or a family member or friend have personally experienced or if they believe the research will confer a widespread public benefit. Preferences vary about the mode of contact for the research to be conducted. Willingness to participate in telephone surveys has decreased in recent years, and this may be a consequence of an increase in calls to homes by telemarketers and market researchers. Participants also stressed the importance of knowing where their names and contact details were sourced and suggested that this information be available to prospective study participants as a matter of course in the first approach or letter. We provide valuable information to epidemiologists in designing studies. [ABSTRACT FROM AUTHOR]

Helpful strategies for communicating news of a serious mental health diagnosis are poorly understood. This study explored service users' preferences for how they would like clinicians to deliver such news when a diagnosis of mental illness is made. Qualitative interviews were conducted with forty-five individuals identifying with serious mental illness in eleven community based mental health facilities. Inductive thematic analysis resulted in eight primary themes. Five themes related to the structure and content of the discussion; including a focus on information exchange, using an individualized collaborative partnership paradigm, addressing stigma, balancing hope with realism, and recognizing the dynamic nature of diagnosis. The remaining themes related to the involvement of others; including the importance of clinicians' communication and relationship skills, involvement and education of carers, and offering an opportunity for peer support. The product of the synthesis of themes is a step-wise model for communicating news of mental health diagnosis. [ABSTRACT FROM AUTHOR]

The use of antiretroviral therapy to prevent HIV transmission is now advocated in many settings, yet little research has documented the views of people with HIV. Semi-structured interviews were conducted in Australia between 2012 and 2014 with 27 HIV-positive people not using treatment at the time of interview. Thematic analysis of views on treatment-as-prevention found that while many participants recognised potential prevention benefits, only a minority was in support of initiating treatment solely to achieve those benefits. A range of uncertain or critical views were expressed regarding who would benefit, risk reduction, and changing treatment norms. Participants resisted responsibility narratives that implied treatment should be used for the public good, in favour of making considered decisions about their preferred approach to managing HIV. Engaging communities in dialogue and debate regarding the risks and benefits of treatment will be critical if this new prevention strategy is to engender public trust. [ABSTRACT FROM AUTHOR]

There is an increasing interest in the role of spirituality on the experience of health, wellness and illness, as well as the role of spiritual practice in health care provision. For pregnancy and childbirth, this focus has tended to concentrate on hospital birth settings and care, and religious forms of spirituality. The blessingway ceremony can be described as an alternative baby shower, popular with home-birthing women. Its focus is woman-centred and draws on the power of ritual to evoke a spiritual experience for the pregnant host and her guests. This spirituality is experienced as a strong connection between women, their relationship with 'nature', and forged via the nostalgic imagination of women through time and space. This article will draw on data obtained in 2010 during doctoral fieldwork with 52 home-birthing women across eastern Australia and will examine the blessingway ceremony and its significance as a site of potential spiritual empowerment for pregnant and birthing women. [ABSTRACT FROM AUTHOR]

Ninety-seven percent of children who have special health care needs are cared for by their mothers. These mothers cite that their informal care work can be intrinsically rewarding, however, the role is not without substantial difficulties and consequences. We investigated differences in the health and well-being of mothers whose young children do and do not have special health care needs. Quantitative data are drawn from Growing Up in Australia: The Longitudinal Study of Australian Children. This study employs a matched-case control methodology to compare the experiences of a group of 292 mothers whose children are identified as having long term special health care needs to those mothers whose children are typically developing at two time points; Wave 1 (2004) and Wave 3 (2008). The findings support previous research that mothers of children with special health care needs have poorer general health and mental health than mothers whose children do not have special needs. Mothers of children with special health care needs also perceived life as more difficult. Longitudinally, this study also shows that maternal well-being remains relatively stable during the years when children are transitioning to formal schooling. Implications for policy makers, practitioners and early childhood professionals are discussed. [ABSTRACT FROM AUTHOR]

Challenging the view that people join New Religious Movements because they have fallen victim to powerful brainwashing techniques, the analysis of in-depth life history interviews of 23 former members from 11 different Australian 'cults' suggests that membership was personally negotiated and motivated by a desire for stronger social connections, albeit for different reasons. While for some participants, a desire for social connectedness was related to a strong need for guidance and direction from 'stable' others, for others it reflected a desire for self-change or self-enhancement. To make sense of the participant narratives, symbolic interactionist understandings of the self are applied. [ABSTRACT FROM AUTHOR]

The mass media is a major source of health information for the public, and as such the quality and independence of health news reporting is an important concern. Concerns have been expressed that journalists reporting on health are increasingly dependent on their sources-including representatives of industries responsible for manufacturing health-related products-for story ideas and content. Many critics perceive an imbalance of power between journalists and industry sources, with industry being in a position of relative power, however the empirical evidence to support this view is limited. The analysis presented here-which is part of a larger study of industry-journalist relationships-draws on in-depth, semi-structured interviews with representatives of health-related industries in Australia to inductively examine their perceptions of power relations between industry and journalists. Participants painted a picture in which journalists, rather than themselves, were in a position to control the nature, extent, and outcome of their interactions with industry sources. Our results resonate with the concept of 'mediatisation' as it has been applied in the domain of political reporting. It appears that, from the perspective of industry representatives, the imposition of media logic on health-related industries may inappropriately influence the information that the public receives about health-related products. [ABSTRACT FROM AUTHOR]

Current literature reports women with spinal injury feel concerned about body image, self-esteem, social perceptions of people in wheelchairs, practical issues in expressing sexuality, and the inadequacy of sexual rehabilitation. Through the first author’s personal experience and reflection, a need was identified to share their experiences in the journey of sexual recovery. The study aims to build on the current literature from an Australian and peer’s perspective. The objectives were to document the experiences of women with spinal injury reconstructing their sexual identity and identify the barriers and information they received on sexual rehabilitation. A descriptive study involving seven semi-structured interviews were employed and narrative analysis was conducted along with the authors’ critical reflections. The participants had acquired spinal injuries of various levels ranging from 4 to 39 years ago. Four themes were identified: (1) loss; (2) sexual rehabilitation and information gathering; (3) external factors; and (4) sexual recovery/discovery. The narratives of the participants demonstrated the barriers faced and the process of developing a sexual identity post-injury. Positive and negative factors were identified in each theme, which have the potential to be addressed and molded into a positive sexual identity. Women with spinal injury want access to more information on sexuality as it is experienced post-injury. Future research is required to look at developing resources and the strategies in which they can be delivered to facilitate a timely positive adjustment. [ABSTRACT FROM AUTHOR]

Purpose Research suggests that for many cancer survivors, returning to work has a range of benefits. However, considerable barriers have been identified as influencing the quality of return to work outcomes. This study explored the perspectives of Australian cancer survivors, managers and employee assistance program (EAP) professionals to gain an understanding of the return to work process and factors that affect the experience. Methods Focus groups and interviews were conducted with cancer survivors (n = 15), managers (n = 12), and EAP professionals / psychologists (n = 4) from public and private sectors. Thematic analysis was used to analyse the data to identify common and unique themes from the three participant groups. Results A range of drivers were identified including maintaining normality and regaining identity, which could act positively or negatively depending on survivors' coping ability and self awareness. Analysis revealed communication difficulties in the workplace that impact on emotional and practical support. Negotiating an employee's return is complex, influenced by the level of consultation with the employee and use of an ad hoc or structured process. Direct and indirect ways of supporting employees with cancer were identified, as was the need for colleague and manager support. Conclusion This study supports previous research findings of the impact of cancer on work, and reveals managers' lack of knowledge on how to respond appropriately. The process of returning to work is complex, influenced by employees' and managers' attitudes, communication skills and coping abilities. Areas for workplace interventions to optimise support for the cancer survivor are described. [ABSTRACT FROM AUTHOR]

Concerns are frequently raised about the extent to which formal consent procedures actually lead to “informed” consent. As part of a study of consent to high-risk medical procedures, we analyzed in-depth interviews with 16 health care professionals working in bone-marrow transplantation in Sydney, Australia. We find that these professionals recognize and act on their responsibility to inform and educate patients and that they expect patients to reciprocate these efforts by demonstrably engaging in the education process. This expectation is largely implicit, however, and when it is not met, this can give rise to trouble that can have adverse consequences for patients, physicians, and relationships within the clinic. We revisit the concept of the sick role to formalize this new role expectation, and we argue that “informed” consent is a process that is usually incomplete, despite trappings and assumptions that help to create the illusion of completeness. [ABSTRACT FROM AUTHOR]