Advance care planning for older people in Australia presenting to the emergency department from the community or residential aged care facilities

The purpose of this retrospective, cross-sectional study was to determine the prevalence of advance care planning (ACP) among older people presenting to an Emergency Department (ED) from the community or a residential aged care facility. The study sample comprised 300 older people (aged 65+ years) presenting to three Victorian EDs in 2011. A total of 150 patients transferred from residential aged care to ED were randomly selected and then matched to 150 people who lived in the community and attended the ED by age, gender, reason for ED attendance and triage category on arrival. Overall prevalence of ACP was 13.3% (n = 40/300); over one-quarter (26.6%, n = 40/150) of those presenting to the ED from residential aged care had a documented Advance Care Plan, compared to none (0%, n = 0/150) of the people from the community. There were no significant differences in the median ED length of stay, number of investigations and interventions undertaken in ED, time seen by a doctor or rate of hospital admission for those with an Advance Care Plan compared to those without. Those with a comorbidity of cerebrovascular disease or dementia and those assessed with impaired brain function were more likely to have a documented Advance Care Plan on arrival at ED. Length of hospital stay was shorter for those with an Advance Care Plan [median (IQR) = 3 days (2–6) vs. 6 days (2–10), P = 0.027] and readmission lower (0% vs. 13.7%). In conclusion, older people from the community transferred to ED were unlikely to have a documented Advance Care Plan. Those from residential aged care who were cognitively impaired more frequently had an Advance Care Plan. In the ED, decisions of care did not appear to be influenced by the presence or absence of Advance Care Plans, but length of hospital admission was shorter for those with an Advance Care Plan.

Factors influencing awareness of community-based shorebird conservation projects in Australia

We examine the awareness of potential volunteers (n = 360) living near nine community-based shorebird conservation projects. About half of the people sampled (54%) were unaware of the nearest project. Awareness of interviewees varied substantially among projects (28-78%). Apart from gaining awareness of projects through membership of natural history groups (43%), many respondents heard of projects through friends and relatives (20%), rather than through media such as newspapers (14%) and television (2.3%). We demonstrate that community-based projects can be quantitatively and critically assessed for awareness. The use of rapid, cost-effective assessments of awareness levels has application in many conservation projects.

Community-based study on knowledge, attitude and practice on the mode of transmission, prevention and treatment of the Buruli ulcer in Ga West District, Ghana

Buruli ulcer disease (BUD), a devastating tropical disease caused by Mycobacterium ulcerans, occurs in more than 80% of the administrative districts of Ghana. To elucidate community perceptions and
understanding of the aetiology of BUD, attitudes towards Buruli patients and treatment-seeking behaviours, we conducted a survey with 504 heads of households and seven focus group discussions in Ga West District, Ghana. Although 67% of participants regarded BUD as a health problem, 53% did not know its cause. Sixteen per cent attributed the cause to drinking non-potable water, 8.1% mentioned poor personal hygiene or dirty surroundings, and 5.5% identified swimming or wading in ponds as a risk factor. About 5.2% thought that witchcraft and curses cause BUD, and 71.8% indicated that BU sufferers first seek treatment from herbalists and only refer to the hospital as a last resort. The main
reasons were prospects of prolonged hospital stay, cost of transport, loss of earnings and opportunity associated with parents attending their children’s hospitalization over extended period, delays in being
attended by medical staff, and not knowing the cause of the disease or required treatment. The level of acceptance of BUD sufferers was high in adults but less so in children. The challenge facing health workers is to break the vicious cycle of poor medical outcomes leading to poor attitudes to hospital treatment in the community. Because herbalists are often the first people consulted by those who contract the disease, they need to be trained in early recognition of the pre-ulcerative stage of Buruli lesions.

The costs of a community-based intervention to promote maternal health

The costs of community-level interventions are rarely reported, although such insights are needed if intervention research is to be useful to practitioners seeking to understand what might be involved in replicating interventions in different contexts. We report the costs of a 2-year community-based intervention to promote the health of recent mothers in Victoria, Australia. Program of Resources, Information and Support for Mothers was an integrated programme of primary care and community-based strategies. It had health care professional training, health education and community development components as well as an emphasis on creating ‘mother-friendly’ environments. Costs included the programme costs [primarily the salaries of the community development officers (CDO) in the field] and also ‘induced’ costs that relate to the CDOs' successes in attracting additional resources to the intervention from the local community. The total cost averaged A$272 490 per rural community and A$313 900 per urban community, equivalent to A$172.40 and A$128.70 per mother, respectively. For every A$10 of public funds initially invested in the project, the CDOs were able to attract a further A$1–2 worth of local resources, predominantly in the form of volunteer time or donated services.

Cervical cancer services for Indigenous Women: Advocacy, Community-Based Research and Policy Change in Australia

Collaborative research undertaken in the state of Queensland, Australia, resulted in major changes in cervical cancer screening and treatment for Indigenous women. Guided by an Indigenous statewide reference group and with an Indigenous researcher playing a lead role, qualitative data were collected using interviews, focus groups, and larger community meetings; and case studies were conducted with health workers and community members from diverse rural, remote and urban communities, to explore the different cultural and structural factors affecting understanding and awareness of cervical cancer and Indigenous women's use of and access to health services for screening, diagnosis and treatment. These data were supplemented by an analysis of clinical data and health service checklists. We discuss the methodology and summarize the key social and structural factors that discourage women from presenting for screening or returning for follow-up. These include women's misunderstanding of cervical cancer screening, fear of cancer, distrust of health services, poor recall and follow-up systems, and the economic and social burden to women presenting for treatment. We describe how the research process and subsequent activities provided Indigenous women with a vehicle for their own advocacy, resulting in important policy and program changes.

Community-based sustainability: conservation in the Ballarat region

The discourse of sustainability is promoted internationally, with the United Nations declaring 2005-2014 as a Decade for Education for Sustainable Development. There is discussion concerning the nature, status and significance of Education for Sustainability and its relationship with the somewhat established discourse of environmental education. This debate requires continuing theorising and one approach is to reflect critically on specific examples of sustainability within specific communities. This article seeks to promote further discussion about sustainability, and to contribute to ongoing theorisation about Education for Sustainability, by considering a particular instance – that of environmental sustainability in the Ballarat region of Victoria. The case study suggests that implementation of this local environmental sustainability strategy was dominated by technocratic and individualistic ideologies.

Community-based monitoring of Victoria´s marine national parks and marine sanctuaries

This study investigated community-based monitoring in Victoria’s Marine National Parks (MNPs) and Sanctuaries (MSs) from January to May 2004. The primary aim of this study was to evaluate the potential for community-based monitoring projects to assist in the collection of data for the management of Victoria’s MNPs and MSs. The pilot habitats that were assessed included subtidal reefs at the Merri MS, intertidal reefs at Ricketts Point MS and seagrass beds at Corner Inlet MNP. The three main objectives for this study were to:
 - Develop a template for the monitoring of marine habitats by community groups.
 - Assess the quality and integrity of data collected by community volunteers.
 - Determine a sustainable model for community monitoring of marine habitats.
Three standard operating procedures (SOPs) in the form of a “how to” manual, were developed for each habitat type. The SOPs were adapted from scientifically robust studies and developed in consultation with community volunteer groups by means of field trials. Volunteer feedback assisted in the final SOP design. The SOP will allow Parks Victoria Rangers to develop community-based programs within the parks. The SOPs are accessible as Parks Victoria Technical Series Numbers 16, 17 and 18. Data collected by volunteers across the three habitat sites were assessed and compared to that collected by scientists. It was found that data quality collected by volunteers was dependent on habitat type and the type of measurement the volunteer was required to assess. Volunteer estimation measurements were highly variable across all three habitat sites, compared to quantitative data collection. Subtidal monitoring had the greatest potential for inconsistency in data collection. Intertidal monitoring is the most sustainable of the three habitat monitoring procedures. Sustainability of community-based monitoring programs is dependent on continued support and training by the management authority of Victoria’s MNPs and MSs. For the expansion of the monitoring programs to other MNPs and MSs, the management authority could expand strong relationships with the community volunteer groups.

Evaluation of Flora Fit street : a community-based living initiative. Final report

This report is an evaluation of Flora Fit Street (FFS) based in Clapham Park London. FFS was launched in June 2004 as a 12 month public private partnership between Flora and Clapham Park New Deal for Communities (NDC). Its purpose was to improve the local community’s heart health by
providing a whole range of activities, information and events that focused on increasing physical activity, improving nutrition and smoking cessation.

The value of community-based monitoring in marine protected areas

There is an increasing realisation of the importance of community or volunteer collected data for management programs that are otherwise limited by the availability of funds or resources. However, there are concerns regarding the reliability of scientific data collected by inexperienced people. We investigated the potential for community-based monitoring in Victoria’s newly established system of Marine Protected Areas. The main objectives for the study were to 1) develop a template for the scientific monitoring of marine habitats suitable for community groups, 2) assess data quality and data integrity collected by community volunteers and 3) determine a sustainable model for ongoing community participation in monitoring marine habitats. Three different habitats (subtidal, intertidal, and seagrass) were investigated and data collected by volunteers across these habitats was compared to that collected by scientists. Reliability of data collected by volunteers was dependent on habitat type and the type of measurement the volunteers were required to make. Qualitative estimates made by volunteers were highly variable across all three habitat sites, compared to quantitative data collection. Subtidal monitoring had the greatest inaccuracy for data collection, whereas intertidal reef monitoring was most reliable. Sustainability of community-based monitoring programs is dependent on adequate training for volunteers and the development of partnerships to foster greater community engagement.