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Introduction: Self-managed exercise and nutrition interventions can alleviate pre-frailty and frailty but understanding of adherence to them is lacking. This study aimed to explore the experiences of, and barriers and enablers to, a hospital-to-home self-managed combined exercise and nutrition program for hospitalised older adults living with pre-frailty and frailty. Methods: A hybrid approach to data- and theory-driven descriptive thematic analysis identified experiences, barriers, and enablers to participation in a 3-month, self-managed, exercise–nutrition, hospital-to-home frailty-support program. Pre-frail and frail older adult patients ≥ 65 years admitted to the acute medical unit at a South Australian tertiary hospital were recruited. Individual semi-structured interviews were audio-recorded, transcribed verbatim, and analysed descriptively, using the Theoretical Domains Framework. Results: The nutrition component of the program found 11 common barriers and 18 common enablers. The exercise component included 14 barriers and 24 enablers. Intentions, Social influences, Environmental context/resource and Emotions served as primary barriers towards adherence to both components. Common enablers for both components included Knowledge, Social identity, Environmental context/resource, Social influences, and Emotions. Conclusions: This research revealed important factors affecting adherence to a self-managed exercise–nutrition program in pre-frail and frail older adults within the environment, resources, and emotion domains that should be considered when designing other intervention programs in this population group. [ABSTRACT FROM AUTHOR]

Purpose: Mental health recovery across cultures lacks understanding and suitable measures. The Questionnaire about the Process of Recovery (QPR) is a self-report instrument measuring personal recovery outcomes for consumers of mental health services. However, the extent of its relevance among culturally and linguistically diverse (CALD) communities is unclear. This pilot study aimed to examine the relevance and utility of the QPR among CALD consumers of primary mental health services in Australia. Design/methodology/approach: Eleven individual, semi-structured interviews were conducted with two general practitioners (GPs) and nine consumers from two clinics, at locations with high Iranian and Burmese refugee or asylum seeker populations. Interviews were transcribed and analysed using a thematic framework approach. Findings: Although almost all consumers had little or no understanding of the concept of personal recovery, they found the QPR culturally acceptable and understandable. Using the QPR during mental health consultations can help with needs identification and goal setting. Challenges in using the QPR included completion time, cross-cultural differences in concepts and norms for some items, and need for careful translation. Consumers suggested additional items regarding family reputation, sexuality, and spirituality. Originality/value: The QPR is potentially a valuable tool to support mental health consultations with CALD consumers, from the perspectives of both GPs and consumers. [ABSTRACT FROM AUTHOR]

Background: Person‐centred goal planning is increasingly being incorporated into healthcare interventions. People experiencing severe and persistent mental illnesses (SPMIs) have high levels of co‐occurring health conditions, reducing their life expectancy when compared with the general population. As medications are commonly used in the treatment of SPMIs, community pharmacists are well‐placed to support the health and wellbeing of this population. Objectives: To examine pharmacists' and service users' experiences of goal planning as a component of a community pharmacy‐based health intervention for people experiencing SPMIs (PharMIbridge intervention). Methods: This study utilised a qualitative exploratory approach with an interpretive description method. Semistructured interviews were undertaken with community pharmacists (n = 16) and service user participants (n = 26) who had participated in pharmacist support services for people experiencing SPMIs (PharMIbridge intervention). Results: Four themes relating to goal planning were identified. First, goal planning provided purpose and motivation for participation in the intervention. Planning realistic goals was important but often challenging. Both pharmacists and service users highlighted the relational aspects of goal planning and how strong relationships supported positive behaviour change and outcomes. Finally, individualised and flexible approaches were important aspects of the intervention, ensuring goals were meaningful to service users. Conclusions: The findings from this study identified positive outcomes from the inclusion of goal‐planning processes in a community pharmacy‐based health intervention. Further research regarding tools, strategies or training that could support future goal‐planning interventions in primary healthcare is needed. Patient or Public Contribution: The PharMIbridge randomised controlled trial research team included lived experience members and was overseen by an expert panel that included members with a lived experience of mental illness and representatives from key organisations. The training provided to pharmacists was co‐designed and co‐delivered by the researchers and lived experience representatives, and pharmacists were supported by lived experience mentors. Service user participants were invited to participate in the interviews through a number of pathways (e.g., at the completion of the intervention, flyers). Those interested were provided with the full study participant information and provided with a $30 gift voucher at the conclusion of the interview. [ABSTRACT FROM AUTHOR]

Aim: To explore discharge planning with a range of key stakeholders in subacute care, including consumers. Design: Qualitative descriptive study. Methods: Patients (n = 16), families (n = 16), clinicians (n = 17) and managers (n = 12) participated in semi‐structured interviews or focus groups. Following transcription, data were analysed thematically. Results: The overarching facilitator of effective discharge planning was collaborative communication, leading to shared expectations by all stakeholders. Collaborative communication was underpinned by four key themes: patient‐ and family‐centred decision‐making, early goal setting, strong inter‐ and intra‐disciplinary teamwork, and robust patient/family education. Conclusion: Effective planning for discharge from subacute care is enabled by shared expectations and collaborative communication between key stakeholders. Implications for the profession and/or patient care: Effective discharge planning processes are underpinned by effective inter‐ and intra‐disciplinary teamwork. Healthcare networks should foster environments that promote effective communication between and within multidisciplinary team members as well as with patients and their families. Applying these principles to discharge planning may assist in reducing length of stays and rates of preventable readmissions post‐discharge. Impact: This study addressed a lack of knowledge about effective discharge planning in Australian subacute care. It found that collaborative communication between stakeholders was an overarching facilitator of effective discharge planning. This finding impacts subacute service design and professional education. Reporting method: COREQ guidelines were followed in reporting this study. Patient or public contribution: No patient or public contribution in the design, data analysis or preparation of the manuscript. [ABSTRACT FROM AUTHOR]

Introduction. The Kawa Model is a conceptual occupational therapy model of practice that uses the metaphor of a river as a medium to support the exploration of self, life events, and environment. In this study, the Kawa Model was used by occupational therapy students during a practice placement in a remote community setting as a tool to support learning, build self-awareness, and promote reflection on personal and professional development. Method. The study used an exploratory qualitative research design. Six student participants were purposively recruited and orientated to the use of the Kawa Model at the beginning and throughout their remote community practice placement. Semistructured interviews were used to collect data which were analysed thematically using interpretative phenomenological analysis (IPA). Findings. Analysis of the student transcripts revealed three overarching themes: self-awareness, the development of personal and professional skills, and working with metaphor. All students identified the model as a reflective tool that enhanced their understanding of their student selves in a remote setting. The students described the growth of various professional skills including communication, goal planning, and confidence. Whilst initially students found the metaphor challenging to fathom, throughout their placement, they found it impactful for comprehending their development of self. Conclusion. This study revealed that the students' self-awareness and personal and professional development were influenced by their engagement with and application of the Kawa Model. Repeated engagement with the Kawa Model enhanced the students' journey of personal and professional skill development. [ABSTRACT FROM AUTHOR]

This study aimed to explore nursing and midwifery clinical educators' preparation practices related to in situ simulation-based education, at a tertiary health service in Australia. Simulation-based education is routinely used in healthcare education and training. A key mechanism to optimise simulation-based education is learner preparation. While diverse pre-simulation preparation approaches are described in the literature, these are predominantly focused on activities that are undertaken in either university and/or skills centre contexts. In contrast, the learner preparation practices for simulation-based education that is delivered insitu in healthcare facilities by clinical nurse and midwifery educators are underexplored. This study used an exploratory qualitative design. Participants were recruited using purposive sampling from a potential study group of thirty. Twelve individuals from the nursing and midwifery education group met selection criteria and agreed to participate in the study. Each individual participated in a semi-structured interview. Interview data were then transcribed and analysed using qualitative descriptive methods. Data analysis resulted in the development of four themes related to the preparation of participants for insitu simulation-based education sessions. Each theme informs the choices of clinical nurse/midwifery educators' preparation practices: 1) responsivity to workplace and clinical priorities; 2) clinical educator objectives; 3) preparedness for learning and clinical practice; and 4) evolving educational expertise. This study explored the preparation practices of nurse and midwifery clinical educators engaged in the delivery of insitu simulation-based education. Findings indicate a depth of experiences and a willingness to share practice insights, suggesting that insitu simulation-based education is an integral part of the in service repertoire and a key component of departmental education strategies, designed to support practice and hone skills required to deliver quality patient care. [ABSTRACT FROM AUTHOR]

Objectives: Increasing numbers of older people are living longer, often alone, in their own homes. Services and products that enable older people to remain safely in their own homes are required. The My Smart Home project recruited 30 community-dwelling people aged 65+ to co-design a package of technology to address their individual goals for safety and security at home. The technology package, up to the value of $4000, included installation of health monitoring, communication and entertainment devices, and security alarms, with 6 hours of technology coaching. Methods: Participants completed the Personal Wellbeing Index (PWI), the Australian Quality of Life-8 Dimensions (AQoL-8D) and the Canadian Occupational Performance Measure (COPM) at baseline, and after 4 weeks' use of the technology package. Semi-structured interviews were also used to qualitatively understand the challenges, enablers and outcomes of the project with respect to safety and security in the home. Results: Significant improvements in PWI (p < 0.01), AQoL-8D (p < 0.001) and COPM for goal performance (p < 0.001) and goal satisfaction (p < 0.001) were reported. Participants also reported feeling safer and more secure in their own homes. Common barriers to adoption of technology, cost, integration with already-owned technology and lack of confidence were overcome with this technology and coaching package. Conclusions: An individualised package of technology, with coaching, that supports older people to realise their personal goals with technology resulted in improved well-being, quality of life and sense of safety and security in community-dwelling older people. Ultimately, this should support a longer and better quality of life at home. [ABSTRACT FROM AUTHOR]

Stroke patients with aphasia are often excluded from person-centred goal setting as part of their clinical care, despite a recommendation for person-centred goal setting in national clinical guidelines. To develop and field test an aphasia supplement to a person-centred goal setting package for stroke to better meet the needs of patients with aphasia. A multi-phase, qualitative study design was employed building on prior work in a non-aphasia stroke population. Initial materials, including clinician training, were developed into an aphasia goal setting supplement with input from an expert working group. In phase one, feedback was sought from consumers with aphasia (n=5) on the layout and format of the patient-facing components. In phase two, six clinicians from one Australian healthcare network (occupational therapy: n=2, physiotherapy: n=1 and speech pathology: n=3) were observed using the goal setting package with eight inpatients with aphasia (2 mild, 3 moderate, 3 severe). In phase three, post field testing feedback was sought from clinicians (n=5) and patients with aphasia (n=3). Content analysis of interview data was carried out. The consumer feedback session in phase one indicated that the supplement layout was helpful for including people with aphasia to participate actively in person-centred goal setting. Adaptations were made for the aphasia supplement including language, graphic, and format changes based on the feedback. During the field testing in phase two, 18 person-centred goals were set with eight patients with aphasia (median two goals) and included: secondary prevention (8%), functional recovery (31%), community participation (28%), everyday activities (28%), and environment (6%). Based on observations by members of the research team during field testing, clinicians across the multidisciplinary team were able to facilitate goal setting effectively. In phase three, clinicians and patients reported the supplement was useful to facilitate person-centred goal setting for people with aphasia. Conclusion: The aphasia supplement for the goal setting package was appropriate in meeting the needs of patients with aphasia after stroke and encouraged person-centred goal setting across multiple recovery areas. The aphasia supplement for the goal setting package was appropriate in meeting the needs of patients with aphasia after stroke and encouraged person-centred goal setting across multiple recovery areas.. [ABSTRACT FROM AUTHOR]

Introduction. The success of family-based community programs for childhood obesity may be increased by promoting social-cognitive factors that influence motivation and participant engagement. Incentivizing behavior can potentially enhance engagement and encourage behavior change. This research investigated motivators to engagement with a multicomponent incentive-based strategy to improve attendance and health-related behavior change in a family community-based weight management program for overweight and obese children. Method. Qualitative analysis combining; demographic data (n = 512), survey of parents (n = 273), and stakeholder (n = 10) and family interviews (n = 24). Participants were selected from program providers and families participating in an Australian community weight management program during a randomized controlled trial (n = 512 children). Maximum variation sampling (demographics and group characteristics) and inductive thematic analysis were used. Results/Conclusion. Four factors influencing engagement were (1) personal value, (2) achievement, (3) support, and (4) overwhelm. These themes corroborated with social-cognitive factors, fostered by a combination of behavior change components in the program that increased participant accountability and intrinsic motivation. Focusing on autonomous goal planning with parental involvement, tracking of goals, and reviewing of goals may complement existing strategies in child-focused treatment programs. Low-value noncash incentives linked to goal setting for encouraging healthy eating and physical activity were well accepted and may enhance family engagement and attendance. [ABSTRACT FROM AUTHOR]

Background: Domperidone is the most frequently prescribed medicine used to increase breast milk supply. There is considerable controversy surrounding the use of domperidone in lactation, due to limited evidence about efficacy and concerns about rare but life-threatening side-effects. Despite this, in many high-income settings such as Australia, use of domperidone among breastfeeding mothers appears to be increasing. The aim of this paper was to explore women's experiences of using domperidone during breastfeeding. Methods: Semi-structured interviews were conducted in 2019 with 15 women in Australia who reported using domperidone as a galactagogue during breastfeeding. Interviews were recorded, transcribed and analysed thematically. Results: Women reported a wide variety of practices concerning the timing of initiation of domperidone use, including prophylactic use, as well as the dose and duration of use. Prolonged periods of use and unsupervised dosing were commonly reported, these practices were sometimes associated with a fear of the consequences of stopping, insufficient provision of information about the drug or feeling dismissed by health professionals. Some women indicated that when doctors refused to prescribe domperidone they responded by doctor shopping and seeking anecdotal information about benefits and risks online, leading to unsupervised practices. Women often reported high expectations surrounding the effectiveness of domperidone, and most used the medication in conjunction with food/herbal galactagogues and non-galactagogue support. Positive outcomes following domperidone use included having greater confidence in breastfeeding and pride at achieving breastfeeding goals. Conclusions: This study identified a variety of practices concerning domperidone use, including potentially unsafe practices, linked in some cases to inconsistent advice from health professionals and a reliance on online, anecdotal information sources. These findings emphasise the urgent need for development of clinical practice guidelines and a greater focus on translating existing evidence concerning domperidone into clinical practice, including clinical support that is tailored to women's needs. [ABSTRACT FROM AUTHOR]

Objective: The overall aim of this study was to examine, among individuals living with severe asthma, the role of perceived competence in achieving their goals. Methods: Qualitative research methods were used to conduct in-depth semistructured interviews. Interviews were video and/or audio recorded, transcribed and analyzed inductively and deductively, informed by the self-determination theory construct of perceived competence. Thirty-six face-to-face interviews, lasting 1.5–4 h, were conducted across Australia. Results: Feeling competent to achieve asthma goals played a role in participants' ability to achieve broader goals. Their desire to achieve their broader goals was strongly driven by their perceived ability to master managing their condition, which at times required more than medical strategies. Two main themes were discerned from the analysis: (1) learning how to look after yourself: self-care is important and (2) reaching an agreement with severe asthma: being at one with the illness. Discussion: This study highlighted the influence of perceived competence on self-management and goal achievement in severe asthma. Healthcare providers could explore patients' perceived competence to set and achieve goals, as a self-management strategy. Future research should consider these findings when developing and implementing patient-driven, self-management interventions for those living with severe asthma. [ABSTRACT FROM AUTHOR]

Background and Objectives Peer volunteers offer a promising avenue for promoting physical activity in older adults. However, recruiting and retaining such volunteers are challenging. We aimed to examine longitudinally factors that determine whether older volunteer walk leaders will persist in their role. Research Design and Methods We recruited older adults volunteering as walk leaders, from retirement villages in Perth, at the start of a 16-week walking intervention. Using a mixed-methods multiple case study design, informed by self-determination theory, we examined the motivational processes of three profiles: Dropouts, Completers, and Extenders. One male and 10 female (medianAge = 75 years, age range: 66–83 years) peer walk leaders were interviewed twice over 4 months, and data were analyzed using thematic analysis. Questionnaires provided information on volunteer characteristics, leadership confidence, and volunteer motivation. Results Self-orientated goals, obligation and guilt, emotional exhaustion, lack of psychological need satisfaction, and perceived lack of support were barriers to volunteer persistence. Social confidence and relatedness satisfaction motivated volunteers to persist until program completion (Completers). Altruistic goals, using sustainable helping strategies, psychological need satisfaction, optimism, and enjoyment were important for continuing the role after the program (Extenders). Discussion and Implications Results describe how differences in volunteer motives, personal characteristics, and training may affect motivational processes that determine persistence as an older peer walk leader. We provide suggestions on selecting, training, and supporting older volunteer walk leaders to facilitate their retention. [ABSTRACT FROM AUTHOR]

Purpose: This study explores key governance, leadership and management activities that have impact on quality, risk and safety within Australian healthcare organisations. Design/methodology/approach: Current non-executive directors (n = 12) of public and private health boards were interviewed about contemporary approaches to fiduciary and corporate responsibilities for quality assurance and improvement outcomes in the context of risk and safety management for patient care. Verbatim transcripts were subjected to thematic analysis triangulated with Leximancer-based text mining. Findings: Boards operate in a strong legislative, healthcare standards and normative environment of quality and risk management. Support and influence that create a positive quality and risk management culture within the organisation, actions that disseminate quality and risk broadly and at depth for all levels, and implementation and sustained development of quality and risk systems that report on and contain risk were critical tasks for boards and their directors. Practical implications: Findings from this study may provide health directors with key quality and risk management agenda points to expand or deepen the impact of governance around health facilities' quality and risk management. Originality/value: This study has identified key governance activities and responsibilities where boards demonstrate that they add value in terms of potential improvement to hospital and health service quality care outcomes. The demonstrable influence identified makes an important contribution to our understanding of healthcare governance. [ABSTRACT FROM AUTHOR]

• Implementation of the NDIS prevented families and communities, and service providers from providing the opportunities that foster children's developmental goals and long-term trajectories. • NDIS eligibility, assessment and planning procedures relied on administrative and medicalized approaches. • Service providers' ability to adhere to ECI quality practice was compromised. • Skills of the NDIS partner/planner workforce charged with key aspects of ECI service provision were highly variable. The Australian National Disability Insurance Scheme (NDIS) completed its roll-out in 2020 with the objective of addressing the inadequacies of a fragmented and underfunded service system for people with disabilities. Under the scheme, young children with disabilities or developmental delay can now access services through the Early Childhood Approach, which is delivered by a range of not-for profit and for-profit organizations. Considering the significance of the resulting service system changes and the critical role of service providers, the aim of the present study was to examine their experiences in the State of Victoria. Forty-five service providers participated in interviews and focus groups which generated information grouped into four themes: (1) A changed orientation; (2) Early childhood intervention (ECI) practice; (3) ECI workforce; (4) The potential for a new system. Participating service providers reported several challenges in their quest to effectively support children and their families. It is concluded that for the NDIS to fulfil its promise and potential, revisions and adaptations of its systems and policies that incorporate the current ECI evidence-based knowledge and translation into real-world implementation are required. [ABSTRACT FROM AUTHOR]

Purpose: To explore barriers and enablers to community walking perceived by people with lower limb amputation. Materials and methods: Three focus groups (n = 14 participants), using purposive sampling, were conducted with people with lower limb amputation who used a prosthesis to walk in the community. Three investigators analyzed transcripts using thematic content analysis. Results: Themes aligned with the International Classification of Functioning, Disability and Health domains. Barriers related to body function and structure included prosthetic function, residual limb integrity, phantom limb pain and other medical issues, with optimal prosthetic function and adequate fitness identified as enablers. Personal barriers included challenges adjusting to change, whereas personal enablers included being able to adjust to change, having a positive attitude, goal setting and a purpose for community walking. Environmental barriers included physical (e.g., terrain, crowds, climate) and social (e.g., unwanted attention and finances). Environmental enablers included aids, transport, preparation, social support and finances. Community walking was essential to participation in work, leisure, social activities and family roles. Conclusion: Walking in the community for people with a lower limb amputation presents many barriers, but enablers have also been identified. Targeted assessments and interventions, and appropriate environmental planning may assist in minimizing barriers to community walking. Although rehabilitation for people with lower limb amputation should continue to optimise body function and structure (such as strength, fitness, pain and prosthetic function) to help prepare individuals for walking in the community, personal and environmental factors should also be addressed. Optimising an individual's personal enablers may facilitate community walking; this may include strategies to assist with adjusting to change, setting goals, instilling a positive attitude towards walking, and seeing a purpose for walking in the community. Enhancing environmental (physical and social) enablers and minimising environmental barriers to walking in the community may be possible through environmental planning (e.g. infrastructure such as lifts), social awareness and education. [ABSTRACT FROM AUTHOR]

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

Premised on the idea that setting goals motivates action and allocation of resources toward a desired future state, goal-setting has become a key component of self-management support. The notions that underpin goal-setting situate self-management firmly within the control and responsibility of individuals. Yet, we argue that goals are not solely individual pursuits to be achieved if individuals have the right knowledge and enough motivation; rather, they are social products, influenced by individual and collective subjectivities, which are structured over time. Drawing primarily on Bourdieu's concept of habitus, along with capital and field, we examine how goals are constructed in self-management support encounters. Seventeen patient-professional dyads comprising 15 patients and 11 health professionals were interviewed on up to three occasions. In total 64 semi-structured interviews were conducted between 2015 and 2017 in Sydney, Australia. Goals were manifested through patient participants' expressions of goal agency (as self-owned wants and opportunities; responsibilities to self and others; or necessities); goal-oriented dispositions (determined; responsible; or powerless); temporal orientations (past, present or future); and access to resources to support self-management. These characteristics were grouped into three typologies: 'Goals as opportunities'; 'From goals to responsibilities'; and 'Necessities when living precariously'. The way goals were constructed was structured over time by present experiences superimposed on past experiences and access to resources. These findings help broaden understandings of the tensions between patient and professionals' goals for living well with chronic conditions and draw attention to the need for structural change to support people to live well with their chronic conditions. • Goals for self-management are complex social products. • Goal orientations are shaped by dispositions, temporalities and resources. • People are differentially positioned in the field of self-management support. • Structural factors must be addressed for all to have opportunities for meaningful goals. [ABSTRACT FROM AUTHOR]

To identify the views of GPs and general practice staff regarding barriers and enablers to implementation of obesity guideline recommendations in general practice. Twenty general practitioners (GPs) and 18 practice staff from inner-eastern Melbourne, Australia, participated in semi-structured telephone interviews. The interview schedule was informed by the Theoretical Domains Framework (TDF). Interviews were audio-recorded, transcribed verbatim and underwent thematic analysis. Participants lacked familiarity with and knowledge of the NHMRC obesity guidelines. Barriers and enablers were predominantly related to five theoretical domains: (1) environmental context and resources, (2) knowledge, (3) emotion, (4) beliefs about consequences, and (5) motivation and goals. Time pressures in consultations, costs for the patient, reluctance to add to patient burden particularly in those with comorbidities such as mental health issues, lack of awareness about services to refer patients to and GPs' fear of embarrassing patients and losing them were significant barriers. Enablers included having a strong doctor–patient relationship and a sense of responsibility to the patient to address weight. Obesity guidelines and policy makers need to better engage with issues of multimorbidity, socioeconomic disadvantage and workforce issues if recommendations are to be widely adopted in general practice. Tasksharing, teamwork and technology are potential solutions to some of the barriers. Patient perspectives and approaches to being able to overcome stigma and legitimise obesity management in primary care consultations could also assist. [ABSTRACT FROM AUTHOR]

Purpose: To explore factors influencing Australian speech pathologists' guideline recommended aphasia management practices. Methods: Semi-structured interviews were conducted with hospital-based speech pathologists (n = 20). Interviews focused on barriers and facilitators to implementing recommendations related to five practice areas: Aphasia-friendly Information; Collaborative Goal Setting; Timing of Therapy; Amount and Intensity of Therapy; and Conversation Partner Training. Results: Speech pathologists working only in inpatient rehabilitation settings reported performing the recommended behaviours consistently, and identified few implementation barriers. However, clinicians working in the acute setting reported performing the majority of behaviours inconsistently or rarely. Seven (of 14) Theoretical Domains Framework domains were identified as key influencing factors. Three of these – "Environmental Context and Resources," "Beliefs about Consequences," and "Social Influences" – were consistently reported as influencing practice across all five behaviours. Other important domains included "Knowledge", "Beliefs about Capabilities," "Goals," and "Social/Professional Role and Identity", which each influenced at least two practice behaviours. Conclusions: Speech pathologists report a number of key factors influencing their practice, which differ in how they influence behaviours (i.e., a factor may be a barrier or a facilitator) depending on the behaviour and clinical setting. Future implementation interventions need to account for the strong influence of beliefs and social influences on speech pathology practice, which may facilitate successful implementation. Speech pathologists' aphasia management practices are often inconsistent with guideline recommendations. Environmental and contextual barriers were identified for all guideline-recommended practices that were investigated; however, these barriers did not necessarily impede implementation for speech pathologists working in inpatient rehabilitation settings. Strategies to improve both team functioning (social influences) and the belief systems of individual clinicians (beliefs about consequences) should be considered to improve speech pathologists' implementation of guideline-recommended aphasia practices. [ABSTRACT FROM AUTHOR]

Objective: To explore the ways clinicians engage rehabilitation patients in patient-centered goal setting and identify factors influencing the goal-setting process. Design: Ethnographic study utilizing observed practice—thematic analysis. Setting: Four rehabilitation wards of a large metropolitan hospital in Melbourne, Australia. Subjects: Participants included 17 rehabilitation patients, 18 allied health clinicians and one family member. Disciplines represented were speech pathology, occupational therapy, social work and physiotherapy. Method: Multiple qualitative methods were used. A total of 18 routine goal-setting interviews between clinicians and patients were audio recorded and transcribed. Together with associated entries in the patient medical record, transcripts were coded and developed into themes using thematic analysis. Finally, focus groups with clinicians were conducted to validate themes identified. Results: Three themes were identified describing factors which influence patient centeredness: “a goal-setting collaboration”—the interpersonal exchange between client and clinician; “the environment”—physical, temporal and structural; and “clinician self-awareness”—clinicians’ insight into the ways they influence goal setting. The practice of patient-centered goal setting varied considerably between clinicians. Goals developed were strongly influenced by the clinician’s views, although strategies of respect for the patient and reflective listening skills increased patient participation and the patient centeredness of goals developed. Conclusion: Goals developed with rehabilitation patients are more likely to be patient-centered when the interaction encourages the patient to express their needs and preferences, and these are heard by the clinician. For this to influence treatment, it must occur in an environment structured to support and value patient-centered goals. [ABSTRACT FROM AUTHOR]

Bridging literature that addresses the work–family interface and the changing nature of careers, this article examines, from a life course perspective, the extent to which, and why, young people anticipate careers as ‘flexible’. Drawing on 123 interviews with men and women engaged in different post-secondary education pathways in Australia, the study draws attention to the role of gender and to some extent class in shaping careers in a network of social relations. Three dimensions of flexible careers are examined: temporal, that is, through imagined possibilities in various stages of early adulthood; structural, including opportunities and constraints afforded by different industry sectors and workplaces; and relational, in terms of household-level role negotiations. The findings revealed that women continue to adapt their career goals to accommodate care, but that both men’s and women’s careers are shaped by contingencies including household income, home ownership, access to flexible work and ideological expectations of market/family work roles. These contextual dynamics directly impact on decisions in the present. The article underscores the need for an expanded research focus on work and care from a life course perspective in order to promote career flexibility in ways that align with young people’s broader aspirations for gender equality. [ABSTRACT FROM AUTHOR]

Purpose:Family members often assume the role of driver for individuals who are not driving post-acquired brain injury (ABI). Given that return to driving can be unpredictable and uncertain, the impact of driving disruption on family members may vary at different stages post-injury. This study aims to understand the needs and experiences of family members over time during driving disruption following an ABI. Method:A qualitative prospective longitudinal research design was used with semi-structured interviews at recruitment to study, 3 and 6 months later. Results:Fourteen family members completed 41 interviews. The longitudinal data revealed four phases of driving disruption: (1) Wait and see, (2) Holding onto a quick fix, (3) No way out, and (4) Resolution and adjustment. The phases described a process of building tension and a need for support and resolution over time. Conclusions:Holding onto a quick fix is a pivotal phase whereby supports, such as engagement in realistic goal setting, are essential to facilitate family members’ resolution of driving disruption issues. Family members who see no way out might not actively seek help and these points to a need for long-term and regular follow-ups. Future research can explore ways to support family members at these key times.Implications for rehabilitationHealth professionals need to facilitate the process of fostering hope in family members to set realistic expectations of return to driving and the duration of driving disruption.It is necessary to follow-up with family members even years after ABI as the issue of driving disruption could escalate to be a crisis and family members might not actively seek help.Health professionals can consider both practical support for facilitating transport and emotional support when addressing the issue of driving disruption with family members. [ABSTRACT FROM PUBLISHER]

• Parenting aspirations of young people who have experienced adversity are overlooked. • Young people would like to be parents but had other goals to achieve first. • Goals included addressing enjoying their youth, addressing personal difficulties. • Aspirations were influence by childhood experiences and current circumstances. Only a limited number of studies have sought to examine the parenting attitudes and aspirations of young people who have experienced abuse, neglect, and childhood adversity and who are not yet pregnant or parenting. Given the dearth of literature on this topic, this study explores the attitudes and aspirations relating to pregnancy and parenthood among South Australian young people who have experienced abuse, neglect, or childhood adversity. A total of fifteen young people (8 male and 7 female) were recruited from a variety of services that may be serving young people with experiences of abuse, neglect, or early adversity. Young people took part in a semi-structured interview exploring their attitudes and aspirations regarding relationships, pregnancy, and parenthood. Young people discussed whether they would like to be parents, and some of the goals and aspirations that they would like to achieve beforehand. The reasons why young people wanted to be parents later in life and achieve these goals first were categories into three interrelated groups: they wanted to enjoy their youth and succeed in education or employment, they wanted to address their own personal difficulties and challenges first or they wanted to be prepared and be in the best position possible to meet the needs of their future children. While most of the sample were not planning on becoming parents before they turned 25, all aspired to have children at some point. Young people's aspirations towards younger parenthood were varied and often shaped by their childhood experiences and current circumstances. Implications for policy and practice are discussed. [ABSTRACT FROM AUTHOR]

Issue addressed The Australian National Partnership Agreement on Preventive Health (NPAPH) charged states and territories with the development and implementation of the Healthy Workers Initiative (HWI) to improve workplace health promotion. Most evaluation efforts focus on the setting (micro) level. In the present study the HWI at the meso-level (state program development) was examined to understand how jurisdictions navigated theoretical, practical, and political priorities to develop their programs, and the programmatic choices that support or hinder perceived success. Methods Interviews with HWI program coordinators and managers across seven Australian jurisdictions explored decision-making processes related to developing and implementing the HWI and the impact of defunding. Interviews were audio-recorded, transcribed and analysed using thematic analysis. Results Despite taking a variety of approaches to the HWI, jurisdictions had common goals, namely achieving sustainability and capacity for meaningful change. These goals transcended the performance indicators set out by the NPAPH, which were considered unachievable in the given timeframe. Four ways jurisdictions sought to achieve their goals were identified, these were: 1) taking an embedded approach to workplace health promotion; 2) ensuring relevance of the HWI to businesses; 3) engaging in collaborative partnerships with agencies responsible for implementation; and 4) cultivating evolution of the HWI. Conclusions This meso-level evaluation has provided valuable insights into how health promotion program coordinators translate broad, national-level initiatives into state-specific programs and how they define program success. The study findings also highlight how broader, contextual factors, such as jurisdiction size, political imperatives and funding decisions impact on the implementation and success of a national health promotion initiative. So what? When evaluating the translation of complex initiatives, a meso-level analysis can reveal valuable principles for informing program effectiveness and sustainability. It can also identify alignment between macro- and meso-level goals and where macro-level specifications may hinder or assist those goals. [ABSTRACT FROM AUTHOR]

Key forces shaping medical education drive medical schools to make strategic choices to locate themselves in niches where they can make use of their resources effectively and efficiently. However, the concepts of strategy in higher education are highly contested issues due to the nature and complexity of the sector and the university, more so for medical schools which operate in an ever more regulated environment. Drawing on data from qualitative semi-structured interviews, this paper investigates the notion of strategic positioning in medical education. The broad findings show that medical schools are somewhat bipolar in nature, in that they seemed to position themselves in terms of teaching and learning, and research. The analysis of strategic positions of medical schools has implications at both institutional and systems levels. [ABSTRACT FROM AUTHOR]

Long-term unemployment can negatively impact health and well-being, and is a central focus of governments seeking to address poverty and social exclusion. Little is known about how individuals experience programmes aimed at addressing long-term unemployment and consequently the client-centred indicators of 'success'. In-depth interviewswere carried outwith 31 long-termunemployed individuals engaged in a 'life-first' programme integrating vocational assistance with intensive personal strengths-based support. The participants in this programme faced multiple disadvantages including employment and educational barriers as well as a range of significant personal issues. They equated successful outcomes in the programme with receiving awealth of psychosocial and practical assistance in addition to vocational support, and having a casemanagerwho approached these issues as awhole. Findings suggest that, in order to provide the best chance of gaining and maintaining employment, programmes should address, in tandem, personal and vocational barriers facing those who are long-term unemployed. [ABSTRACT FROM AUTHOR]

Background Patient participation benefits the patient and is a core concept of patient-centred care. Patients believe in their ability to prevent errors; thus, they may play a vital role in combating adverse event rates in hospitals. Aims and objectives To explore hospitalised medical patients' perceptions of participating in nursing care, including the barriers and facilitators for this activity. Research methods This interpretive study was conducted on four medical wards, in two hospitals. Purposeful maximum variation sampling was operationalised to recruit patients that differed in areas such as age, gender and mobility status. In-depth semi-structured audiotaped interviews were undertaken and analysed using inductive content analysis. Results Twenty patients participated in the study. Four categories were uncovered in the data. First, valuing participation showed patients' willingness to participate, viewing it as a worthwhile task. Second, exchanging intelligence was a way of participating where patients' knowledge was built and shared with health professionals. Third, on the lookout was a type of participation where patients monitored their care, showing an attentive approach towards their own safety. Fourth, power imbalance was characterised by patients feeling their opportunities for participation were restricted. Conclusions Patients were motivated to participate and valued participation. Cultivating this motivation may be crucial to patient empowerment and practices of safety monitoring, a fundamental strategy to addressing patient safety issues in hospitals. Engaging nurse-patient relationships, inclusive of knowledge sharing, is required in practice to empower patients to participate. Educating patients on the consequences of non-participation may motivate them, while nurses may benefit from training on patient-centred approaches. Future research should address ways to increase patient motivation and opportunities to participate. [ABSTRACT FROM AUTHOR]

The aim of the current pilot study was to evaluate the implementation of a routines-based early childhood intervention (RBECI) model by Australian Early Childhood Intervention (ECI) professionals. The RBECI model consisted of four key components: (a) Routines-Based Interviews (RBIs), (b) participation-based goals, (c) home visits, and (d) community consultations. Five ECI professionals and nine families were recruited from an Australian ECI service. Professionals’ ability to implement the model was assessed immediately before and 6 months after receiving training in the model. Individual in-depth interviews elicited professionals’ perspectives on implementing the model. Results revealed that professionals’ knowledge, understanding, confidence, and home visiting skills increased from pre- to post-intervention, but community consultation skills did not. There were limitations in the quality of RBIs and participation-based goals produced. Overall, professionals were positive about the implementation of the model. The findings provide support for the adoption of the RBECI model in ECI more broadly. [ABSTRACT FROM AUTHOR]

Background/Aims: An exploratory study of a novel approach to using the Goal Engagement Scale to examine patients', families' and health professionals' perceptions of patient engagement in goal setting. Methods: This mixed methods study was conducted from September 2013 to April 2014 in both inpatient trauma and rehabilitation units at an Australian health care service. Participants were 22 triads (patients with moderate to severe traumatic brain injury or stroke, their family member(s) and a treating health professional) participating in routine goal setting interviews. Goal setting interviews were audio recorded, transcribed and thematically analysed, drawing upon an iterative process of qualitative data analysis, while the Goal Engagement Scale scores were analysed descriptively, drawing comparison between triad participant findings. Findings: Perception of patient's level of engagement in goal setting differed between health professionals, patients and families. Health professionals' views dominated the goal setting process. Goal setting interview data revealed four main themes, highlighting the importance of reflective listening skills to build a trusting relationship with patients and families to support engagement in goal setting. Conclusions: The findings of this exploratory study both affirm the suitability of future research into goal setting engagement and provide clinically useful strategies to support engagement of patients and families in goal setting. [ABSTRACT FROM AUTHOR]

Currently pathological and illness-centric policy surrounds the evaluation of the health status of a person experiencing disability. In this research partnerships were built between disability service providers, community development organizations and disability arts organizations to build a translational evaluative methodology prior to implementation of an arts-based workshop that was embedded in a strengthsbased approach to health and well-being. The model consisted of three foci: participation in a pre-designed drama-based workshop program; individualized assessment and evaluation of changing health status; and longitudinal analysis of participants changing health status in their public lives following the culmination of the workshop series. Participants (n = 15) were recruited through disability service providers and disability arts organizations to complete a 13-week workshop series and public performance. The study developed accumulative qualitative analysis tools and member-checking methods specific to the communication systems used by individual participants. Principle findings included increased confidence for verbal and non-verbal communicators; increased personal drive, ambition and goal-setting; increased arts-based skills including professional engagements as artists; demonstrated skills in communicating perceptions of health status to private and public spheres. Tangential positive observations were evident in the changing recreational, vocational and educational activities participants engaged with pre- and post- the workshop series; participants advocating for autonomous accommodation and health provision and changes in the disability service staff's culture. The research is an example of translational health methodologies in disability studies. [ABSTRACT FROM AUTHOR]

Process evaluation is valuable in guiding development of effective intervention programmes but rare in adolescent weight management. This paper presents a process evaluation of the Loozit® randomized controlled trial, a community-based behavioural lifestyle intervention for obese 13-16 year olds. Adolescents were randomized to receive the two-phase Loozit® group programme, with (n = 73) or without (n = 78), additional therapeutic contact (telephone coaching, short message service and/or emails) in Phase 2. Quantitative and qualitative process data were collected. Facilitators used a standardized evaluation form to document participant attendance, and comment on lesson adherence and process delivery. Adolescents and parents completed satisfaction questionnaires at 2-, 12- and 24-month follow-ups. Following the intervention, 14 adolescents who provided informed written consent were interviewed about their experience with additional therapeutic contact. Data were analysed using descriptive statistics, parametric and non-parametric tests to compare group means, and thematic analyses. Group attendance rates averaged 85 and 47% during Phases 1 (0-2 months) and 2 (3-24 months), respectively. Facilitators frequently noted that participants reported making healthy lifestyle changes. Elements enjoyed in the sessions included practical activities, fun active games, resistance training and forming new friendships. Adolescents struggled with setting specific, measurable, achievable, realistic and timely (SMART) goals. Overall, participants were satisfied with the help received including the telephone and electronic contact. More than 80% of participants found the programme changed adolescents' eating and physical activity habits, and 89% of parents reported changing parenting strategies. Future adolescent group-based programmes may enhance participant engagement and programme effectiveness by including more interactive and frequent telephone and electronic contact. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the ability of participants of a falls prevention programme to set and achieve goals. Methods: The study used a prospective longitudinal design and a mixed-methods approach to data collection. Study participants were (1) 220 older adults participating in a 15-week combined exercise and education falls prevention programme and (2) 9 practitioners (3 home-care nurses, 5 community workers, and an exercise physiologist) involved in delivering the programme. Data from goal-setting forms were analyzed, and descriptive statistics were used to determine the number of appropriate goals set and achieved. Data were analyzed according to programme setting (home- or group-based) and whether or not participants were classified as being from a Culturally and Linguistically Diverse (CALD) background in the Australian context. Semi-structured interviews with programme practitioners were thematically analyzed. Results: A total of 144 respondents (n=75 CALD group, n=41 non-CALD group, n=6 CALD home, n=22 non-CALD home) set 178 goals. Only 101 (57%) goals could be evaluated according to achievement, because participants set goals that focused on health state instead of behaviour, set goals not relevant to falls prevention, used inappropriate constructs to measure goal achievement, and either did not review their goals or dropped out of the programme before goal review. Of these 101 goals, 64 were achieved. Practitioners described their own difficulties in understanding the process of setting health behaviour goals along with communication, cultural, and logistic difficulties. Conclusions: Both CALD and non-CALD participants and those participating in both group- and home-based programmes experienced difficulty in setting and achieving goals to facilitate behaviour change for falls prevention. Data suggest that home-based participants had more difficulty in setting goals than their group-based counterparts and, to a lesser extent, that CALD participants experienced more difficulty in setting goals than their non-CALD counterparts. The use of a guided approach to goal setting and the need for more specific practitioner training and follow-up support regarding goal setting in the context of a falls prevention programme should be considered. [ABSTRACT FROM AUTHOR]

Background: Aphasia affects family members in addition to the individuals with the communication disorder. In order to develop appropriate services for the relatives of people with aphasia post-stroke, their rehabilitation goals need to be identified. Aim: The aim of the current investigation was to identify the rehabilitation goals that family members of individuals with aphasia have for themselves. Methods & Procedures: Forty-eight family members of adults with aphasia post-stroke participated in in-depth semi-structured interviews to identify the rehabilitation goals they had for themselves. All the interviews were transcribed verbatim and analysed using qualitative content analysis. Outcomes & Results: Analysis revealed seven categories of goals that the family members had for themselves: to be included in rehabilitation, to be provided with hope and positivity, to be able to communicate and maintain their relationship with the person with aphasia, to be given information, to be given support, to look after their own well-being, and to be able to cope with new responsibilities. A few participants reported that, at certain times during the rehabilitation process, they did not have any goals for themselves. Conclusions & Implications: This study highlights that family members of individuals with aphasia have a number of aphasia-related rehabilitation goals for themselves. In order to provide a family-centred approach to rehabilitation, health professionals, including speech-language pathologists, need systematically to identify and address family members' goals in light of the categories revealed in this investigation. [ABSTRACT FROM AUTHOR]

Background: Despite the central importance of goal setting in aphasia rehabilitation, the notion of the goal itself has not been fully explored. Aims: This paper considers how speech pathologists conceptualise the nature of the “goal” in aphasia rehabilitation. Methods & Procedures: The researchers conducted a qualitative study involving 34 speech pathologists (32 female and 2 male; mean age 41 years, range 24–60 years) from Adelaide, Brisbane and Newcastle, Australia, who worked across acute and rehabilitation inpatient, outpatient, community, and domiciliary services. The speech pathologists participated in semi-structured in-depth interviews about their experiences of providing therapy to people with aphasia post stroke and their family members. Transcriptions of the recorded interviews were subjected to an interpretive thematic analysis involving careful reading and re-reading for recurring themes around notions of goals. Outcomes & Results: The analysis of the transcripts revealed six main categories of goal concepts: goals as desires; SMART goals; impairment and functional goals; goals as steps; goals as contracts; and implicit goals. The first two of these conceptual categories competed with each other reflecting broader tensions within speech pathology practice, and the relative prominence of these goal categories differed according to the rehabilitation context. Conclusions: The findings suggest that the notion of the goal is multifaceted, dynamic, context dependent, and involves inherent tension. A more detailed understanding of the different facets of a goal might assist speech pathologists in their efforts towards collaborative goal setting. A conceptual shift to include the goal as a vehicle of empowerment may be helpful as a precursor to effective, collaborative, and person-centred goal setting with people with aphasia. [ABSTRACT FROM PUBLISHER]

When marriages and long-term relationships break down, parents may refer their children and adolescents to therapy for a variety of reasons. While the systemic therapist's preference may be to work with the family system/s, high conflict separation may prohibit such an approach. This article discusses family-focused child therapy that prioritises the needs of children while seeking to preserve a systemic approach. At a practice level this may involve: (a) individual child therapy, (b) engaging with smaller subsystems including siblings, (c) joint therapeutic work involving child/ren plus parent/s, and (d) any of these combinations; all while continuing to maintain a systemic understanding of the work. The article discusses the challenges of working with children from separated families, where there is restricted or no possibility of engaging with the broader family system. [ABSTRACT FROM AUTHOR]

This paper reports the benefits and challenges of a mentoring programme through which retired and senior nurses continued to support and nurture nurses and midwives currently working in the health system. Nursing has an ageing workforce and faces significant loss of expertise because of retirements. Previously, mentoring programmes have been instituted in a range of nursing contexts and they have been a retention strategy for older nurses and midwives. Mentors and their mentees worked together towards mutually agreed on professional and personal goals. They were asked to meet or speak together a minimum of twice per month for at least six months. As part of a collective case study, 15 mentoring dyads were established. Participants and mentors took part in qualitative, semi-structured interviews about their perceptions and experiences of the mentoring programme. Interviews were audio-taped, transcribed and analysed thematically. Mentors reported the mentoring experience to be rewarding experience that enabled them to re-connect with nursing-related activities and brought new challenges in retirement. They perceived the mentees were visibly helped by their support and influence. The mentors studied reinforced a positive self-concept as nurses and midwives in their mentees and assisted their development. Retired nurses and midwives in particular may have several characteristics that make them effective mentors. Potential benefits are demonstrated for nurses and midwives vulnerable to workplace adversity, especially those new to Australia who may have limited professional and social networks. For health organisations, mentoring programmes may be an innovative method of retention that engages both mid-career nurses and midwives and those recently retired. [ABSTRACT FROM AUTHOR]

Accessible summary • In this study we asked six young people with intellectual disabilities what they thought about becoming independent in their families. • One person wanted more independence within her family and sometimes this caused fights. Three people were happy with the independence they had in their families and did not want things to change. Two people, with the help and support of their families, were trying to be more independent. • Families play an important part in young people becoming more independent. It was important for this group of young people for their families to understand and support their points of view. There is a small but expanding literature about the transition to adulthood for young people with intellectual disabilities. However, voices of young people with intellectual disabilities are under-represented. This study explored the perspectives of young people with intellectual disabilities on their transition to adulthood, focusing particularly on the process of negotiating autonomy within the family. This exploratory study employed a life history approach, involving six young people with mild intellectual disabilities, aged 18–25 years, and two waves of responsive interviews. First interviews explored participants’ life roles, relationships and goals. Second interviews focused on the process of negotiating autonomy within the family. Three approaches to negotiating autonomy within the family were identified: defiant, passive and proactive. The particular approach taken by each participant was associated with the level of congruence between their perceived and desired levels of autonomy and parental support. The study suggests that the transition to adulthood for young people with intellectual disabilities and their parents is not inevitably conflict-ridden. Parents and professionals may support young people with intellectual disabilities through this life stage by including them in family and service decision-making, and by supporting them to take on varied and valued roles and responsibilities within the family and community. [ABSTRACT FROM AUTHOR]

Aims: To ascertain service providers’ views on barriers and incentives to illicit drug users accessing or remaining in treatment. Methods: Interviews with service providers in Australia were conducted. Results: Two main themes were explored. Service providers suggested that the perception of a person seeking treatment was strongly associated with the image of that person as deficient, defective or lacking, and that this could impede treatment. Service providers also suggested that differing treatment philosophies and their related treatment goals were at the core of many barriers to treatment. We argue that it is important to find a balance between a model of treatment which works and is responsive to clients’ needs while also avoiding the potential for feeding stigma of those who seek treatment for drug dependence. Conclusion: Our results suggest that knowledge and understanding of treatment philosophies are important for people seeking treatment so that clients can find services that match their needs and treatment goals. [ABSTRACT FROM AUTHOR]