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Growing evidence highlights the negative impact of managing the COVID-19 pandemic on the wellbeing of the healthcare workforce, including in the aged care sector. We undertook a qualitative study during the pandemic's third year to explore the psychosocial impacts on nine managers of residential care facilities (RCFs) across metropolitan and rural New South Wales, the largest state in Australia. Four themes were identified: (1) Increased pressure on maintaining aged care services, (2) Increased responsibility on RCF managers, (3) Psychosocial impacts due to accumulating pressures, and (4) Experience of beneficial supports. COVID-19 compounded pre-pandemic sector challenges and added new stressors. While resilient and resourceful, RCF managers experienced workplace stress and burnout, which may affect quality of resident care and impact on staff retention. There is a need for more investment to effectively support staff, and research to identify optimal psychosocial and management supports. [ABSTRACT FROM AUTHOR]

Objectives: To understand residential aged care facility (the facility) managers' perspectives on implementing public health measures (the measures) in their facilities in terms of barriers, facilitators and suggestions for improvement, after three years of the COVID‐19 pandemic. Methods: Nine managers of the facilities without an active COVID‐19 outbreak across New South Wales, Australia, representing metropolitan and rural locations, diverse facility size and star quality rating were interviewed (April–June 2023) and data qualitatively analysed. Results: Broader policy context, the need to balance the measures with resident well‐being, facility‐built infrastructure and mask fatigue were reported as barriers to implementation. Workplace policies, cultural embedding and local innovations were reported as facilitators. Suggested strategies included recommending the measures consistent with temporal COVID‐19 risk; government agencies improving communication about the measures; mandatory staff vaccination; and simplified reporting requirements. Conclusions: We recommend that relevant government agencies develop a single source of formalised, endorsed, up‐to‐date advice for the sector‐specific COVID‐19 information and communications; streamline outbreak notification and reporting requirements; and improve consultation with the sector. [ABSTRACT FROM AUTHOR]

While there is some guidance to support the adaptation of evidence-based public health interventions, little is known about adaptation in practice and how to best support public health practitioners in its operationalization. This qualitative study was undertaken with researchers, methodologists, policy makers and practitioners representing public health expert organizations and universities internationally to explore their views on available adaptation frameworks, elicit potential improvements to such guidance, and identify opportunities to improve implementation of public health initiatives. Participants attended a face to face workshop in Newcastle, Australia in October 2018 where World Café and focus group discussions using Appreciative Inquiry were undertaken. A number of limitations with current guidance were reported, including a lack of detail on 'how' to adapt, limited information on adaptation of implementation strategies and a number of structural issues related to the wording and ordering of elements within frameworks. A number of opportunities to advance the field was identified. Finally, a list of overarching principles that could be applied together with existing frameworks was generated and suggested to provide a practical way of supporting adaptation decisions in practice.

Objective: To identify and explore ED clinician perspectives on: (i) why patients with low back pain (LBP) present to the ED and are admitted into hospital from ED; (ii) barriers and enablers they face when providing care to patients with LBP; and (iii) strategies to improve the care of patients with LBP, and associated care processes, in the ED. Methods: We undertook a qualitative exploratory study with ED clinicians (medical officers, nurses and physiotherapists) at a tertiary‐level public hospital in New South Wales, Australia, using focus groups and individual interviews. We used thematic analysis to synthesise participant responses to answer the predefined research questions. Results: Twenty‐one clinicians participated (two individual interviews, 19 focus groups). Perceptions about better access to the ED and advanced care within ED were thought to drive presentations to the ED for LBP. Barriers and enablers to optimal patient care included patient‐, clinician‐ and service‐level factors. The main strategies to improve care included a department LBP pathway, modernised patient and clinician resources, better follow‐up options post‐discharge and improved communication between ED and primary care. Conclusion: We identified a range of targets to improve LBP management in ED. Clinicians perceived internal and external factors to the ED as influences of ED presentation and hospital admission. Clinicians also reported that patient‐, clinician‐ and service‐level barriers and enablers influenced patient management in ED. Strategies suggested by clinicians included improved follow‐up options, access to resources and an 'LBP pathway' to support decision making. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to understand the reasons for childhood under‐immunisation in Kempsey, New South Wales, among First Nations and non‐First Nations families, and potential strategies to improve coverage. Design: The World Health Organization's Tailoring Immunization Programmes guide was employed. Tailoring Immunization Programmes uses social science, qualitative research methods and community participation and is underpinned by the Capabilities Opportunities Motivations‐Behaviors (COM‐B) theoretical model of behaviour change. A cultural lens was applied throughout the study design. Using a thematic analysis, factors found to influence childhood under‐immunisation were loosely mapped against COM‐B framework. Setting: Face‐to‐face interviews and focus groups conducted in locations and at times convenient to participants were audio‐recorded and transcribed verbatim. Participants: Fifty‐six participants (25 First Nations and 13 non‐First Nations mothers and grandmothers, and 18 health service providers) took part in the study (July‐October 2019). Results: Four themes were identified: (a) parents are supportive of immunisation and effective reminders would make it easier to prioritise it (b) services could be more accessible for families (c) addressing workforce shortages could improve access to immunisation services and (d) addressing entrenched racism in the community will help build cultural safety in health services. While parents in Kempsey were supportive of immunisation, resourceful and resilient, many struggled to overcome entrenched structural and cultural barriers to accessing services. This was particularly difficult for First Nations, socially disadvantaged and single mums. Conclusions: Public health services can provide more support to those mothers and grandmothers who need it most, to ensure they are able to access immunisation services without delay. [ABSTRACT FROM AUTHOR]

Objectives: To develop a physiotherapist-led consensus statement on the definition and provision of high-value care for people with musculoskeletal conditions., Design: We performed a three-stage study using Research And Development/University of California Los Angeles Appropriateness Method methodology. We reviewed evidence about current definitions through a rapid literature review and then performed a survey and interviews with network members to gather consensus. Consensus was finalised in a face-to-face meeting., Setting: Australian primary care., Participants: Registered physiotherapists who are members of a practice-based research network (n=31)., Results: The rapid review revealed two definitions, four domains of high value care and seven themes of high-quality care. Online survey responses (n=26) and interviews (n=9) generated two additional high-quality care themes, a definition of low-value care, and 21 statements on the application of high value care. Consensus was reached for three working definitions (high value, high-quality and low value care), a final model of four high value care domains (high-quality care, patient values, cost-effectiveness, reducing waste), nine high-quality care themes and 15 statements on application., Conclusion: High value care for musculoskeletal conditions delivers most value for the patient, and the clinical benefits outweigh the costs to the individual or system providing the care. High-quality care is evidence based, effective and safe care that is patient-centred, consistent, accountable, timely, equitable and allows easy interaction with healthcare providers and healthcare systems., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)