Developing a best practice pathway to support improvements in Indigenous Australians' mental health and well-being: A qualitative study

Objective: There is a need to adapt pathways to care to promote access to mental health services for Indigenous people in Australia. This study explored Indigenous community and service provider perspectives of well-being and ways to promote access to care for Indigenous people at risk of depressive illness. Design: A participatory action research framework was used to inform the development of an agreed early intervention pathway; thematic analysis Setting: 2 remote communities in the Northern Territory. Participants: Using snowball and purposive sampling, 27 service providers and community members with knowledge of the local context and the diverse needs of those at risk of depression were interviewed. 30% of participants were Indigenous. The proposed pathway to care was adapted in response to participant feedback. Results: The study found that Indigenous mental health and well-being is perceived as multifaceted and strongly linked to cultural identity. It also confirms that there is broad support for promotion of a clear pathway to early intervention. Key identified components of this pathway were the health centre, visiting and community-based services, and local community resources including elders, cultural activities and families. Enablers to early intervention were reported. Significant barriers to the detection and treatment of those at risk of depression were identified, including insufficient resources, negative attitudes and stigma, and limited awareness of support options. Conclusions: Successful early intervention for wellbeing concerns requires improved understanding of Indigenous well-being perspectives and a systematic change in service delivery that promotes integration, flexibility and collaboration between services and the community, and recognises the importance of social determinants in health promotion and the healing process. Such changes require policy support, targeted training and education, and ongoing promotion.

Primary brain tumor patients’ supportive care needs and multidisciplinary rehabilitation, community and psychosocial support services: Awareness, referral and utilization

Primary brain tumors are associated with significant physical, cognitive and psychosocial changes. Although treatment guidelines recommend offering multidisciplinary rehabilitation and support services to address patients’ residual deficits, the extent to which patients access such services is unclear. This study aimed to assess patients’ supportive care needs early after diagnosis, and quantify service awareness, referral and utilization. A population-based sample of 40 adults recently diagnosed with primary brain tumors was recruited through the Queensland Cancer Registry, representing 18.9% of the eligible population of 203 patients. Patients or carer proxies completed surveys of supportive care needs at baseline (approximately three months after diagnosis) and three months later. Descriptive statistics summarized needs and service utilization, and linear regression identified predictors of service use. Unmet supportive care needs were highest at baseline for all domains, and highest for the physical and psychological needs domains at each time point. At follow-up, participants reported awareness of, referral to, and use of 32 informational, support, health professional or practical services. All or almost all participants were aware of at least one informational (100%), health professional (100%), support (97%) or practical service (94%). Participants were most commonly aware of speech therapists (97%), physiotherapists (94%) and diagnostic information from the internet (88%). Clinician referrals were most commonly made to physiotherapists (53%), speech therapists (50%) and diagnostic information booklets (44%), and accordingly, participants most commonly used physiotherapists (56%), diagnostic information booklets (47%), diagnostic information from the internet (47%), and speech therapists (43%). Comparatively low referral to and use of psychosocial services may limit patients’ abilities to cope with their condition and the changes they experience.

Comparison of decision tree, support vector machines, and Bayesian network approaches for classification of falls in Parkinson’s disease

Being able to accurately predict the risk of falling is crucial in patients with Parkinson’s dis- ease (PD). This is due to the unfavorable effect of falls, which can lower the quality of life as well as directly impact on survival. Three methods considered for predicting falls are decision trees (DT), Bayesian networks (BN), and support vector machines (SVM). Data on a 1-year prospective study conducted at IHBI, Australia, for 51 people with PD are used. Data processing are conducted using rpart and e1071 packages in R for DT and SVM, con- secutively; and Bayes Server 5.5 for the BN. The results show that BN and SVM produce consistently higher accuracy over the 12 months evaluation time points (average sensitivity and specificity > 92%) than DT (average sensitivity 88%, average specificity 72%). DT is prone to imbalanced data so needs to adjust for the misclassification cost. However, DT provides a straightforward, interpretable result and thus is appealing for helping to identify important items related to falls and to generate fallers’ profiles.

Constellations: A participatory, online application for research collaboration in higher education interdisciplinary courses

The research establishes a model for online learning centering on the needs of integrative knowledge practices. Through the metaphor of Constellations, the practice-based research explores the complexities of working within interdisciplinary learning contexts and the potential of tools such as the Folksonomy learning platform for providing necessary conceptual support.

Systematic literature review: Research on Supported Playgroups

Overview This review of research conducted with supported playgroups was prepared for the Queensland Department of Education, Training and Employment (DETE). The report provides a synthesis of the research on the effectiveness of supported playgroups to improve child, parent, and community outcomes and to identify key features of supported playgroups that support effective outcomes. Supported playgroups are community-based services that provide a low intensity parenting intervention, through regular group sessions for parent-child dyads. Supported playgroups target vulnerable families who may benefit from parenting support. Supported playgroups have common goals to enhance children’s early learning and parental wellbeing. Method A search strategy was devised to identify research studies, nationally and internationally, that involved parent-child group programs for families with young children, delivered under the leadership of an employed facilitator. Academic databases and other data sources were explored for studies conducted in the period from 2004 to 2014. Summary descriptions of the research studies were developed; assessment of research methodologies was made; research evidence on the effectiveness of supported playgroups to improve child, parent, and community outcomes was identified; and comparative analyses of the implementation features of supported playgroups were completed. Findings The search strategy identified 34 research publications, reporting on 29 different programs. Twenty-six of the studies report on research conducted in Australia and eight reported on research conducted in other countries, including the United Kingdom, Canada, and the United States. Three clusters of playgroups were identified: Category 1 - Standard supported playgroups; Category 2 - Mobile playgroups; Category 3 – Supported playgroups with specific interventions. The research studies identified encompassed experimental and non-experimental research designs. The studies of standard supported playgroups and mobile playgroups were most often qualitative studies and modest in scale, in terms of the number of research participants. Experimental and quasi-experimental research designs characterised the studies identified in the category of supported playgroups with specific interventions. Overall, the research studies that were categorised as supported playgroups with specific interventions provided stronger evidence for effectiveness to improve parental behaviour in ways that are known to support children’s early developmental competence. Qualitative studies, including case studies and ethnographic research, documented important features of program delivery, such as the importance of facilitators’ interpersonal skills to positive experiences for families in the playgroups; as well as the important opportunities that the playgroups afforded to vulnerable families to reduce social isolation. Conclusions The potential for supported playgroups to improve a broad range of learning and psychosocial outcomes for children and parents was suggested by many of the research studies. However, the nature of the research designs employed means that it is not possible to conclude that there is strong evidence of the impact of supported playgroups on child, parent, and community outcomes. The qualitative studies did provide rich descriptions about the implementation processes of playgroups and also captured the variability in the delivery of the playgroups in terms of who participated, local contextual factors that impacted on the playgroup experiences, and the nature of the experiences of parents within the playgroups. Research methodologies need to be employed that address the limitations of the studies to date. This would provide more defensible evidence that supported playgroups have an impact over time on outcomes for children, families, and communities. Overall, this area of research remains relatively under-evaluated in terms of rigorous research designs. The identified research studies point to some promising research directions but do not yet enable strong claims to be made about the effectiveness of the standard playgroup or mobile playgroup models to impact on parenting outcomes. Data collected from interview and survey methodologies clearly identifies that supported playgroups are highly acceptable to families. Given the popularity of supported playgroups to engage families across diverse communities, and the reported high levels of satisfaction and benefits identified within many of the research studies, it is clear that the provision of supported playgroups is fulfilling an important community need by providing support to parents with young children. However, there is a need to strengthen the evidence base that supported playgroups are an effective early parenting intervention that improves outcomes for children, parents, and communities.

Australian innovation ecosystem: A critical review of the national innovation support mechanisms

Innovation is understood as the combination of existing ideas or the generation of new ideas into new processes, products and services, and widely viewed as the main driver of growth in contemporary economies. In the age of the knowledge economy, successful economic development is intimately linked to a country’s capacity to generate, acquire, absorb, disseminate, and apply innovation towards advanced technology products and services. This development approach is labelled as knowledge-based economic development and highly associated with a capacity embodied in a country’s national innovation ecosystem. The research reported in this paper aims to critically review the Australian innovation ecosystem in order to provide a better understanding on the potential impacts of policy and support mechanisms on the innovation and knowledge generation capacity. The investigation places Australia’s innovation system and national-level innovation support mechanisms under the microscope. The methodology of the study is twofold. Firstly, it undertakes a critical review of the literature and government policy documents to better understand the innovation policy and support mechanisms in the country. It, then, conducts a survey to capture Australian innovation companies’ perceptions on the role and effectiveness of the existing innovation incentive programs. The paper concludes with a discussion on the key insights and findings and potential policy and support directions of the country to achieve a flourishing knowledge economy.

Realisation of cost-informed process support within the YAWL workflow environment

Organisations are always focussed on ensuring that their business operations are performed in the most cost-effective manner, and that processes are responsive to ever-changing cost pressures. In many organisations, however, strategic cost-based decisions at the managerial level are not directly or quickly translatable to process-level operational support. A primary reason for this disconnect is the limited system-based support for cost-informed decisions at the process-operational level in real time. In this paper, we describe the different ways in which a workflow management system can support process-related decisions, guided by cost-informed considerations at the operational level, during execution. As a result, cost information is elevated from its non-functional attribute role to a first-class, fully functional process perspective. The paper defines success criteria that a WfMS should meet to provide such support, and discusses a reference implementation within the YAWL workflow environment that demonstrates how the various types of cost-informed decision rules are supported, using an illustrative example.

Intergenerational collaborative drawing: A research method for researching with/about young children

This paper focuses on the methodological effectiveness of intergenerational collaborative drawing (ICD). A group of eight researchers trialled this particular approach to drawing, most of them for the first time. Each researcher drew with young children, peers and tertiary students, with drawings created over a period of six months. The eight researchers came together in a 'community of scholars' approach to this project because of two shared interests: (i) issues of social justice, access and equity; and (ii) arts-based education research methods. The researchers were curious how ICD might methodologically support their respective research processes. As knowledge and theory about young children becomes more complex, researchers need responsive methodological tools to ask new questions and conduct rigorous, ethical research. This partial account describes how drawing together might perform methodologically. The data reported here draws from the detailed field notes, drawings and reflections of the researchers. Conclusions arise from the analysis of these reflections, with the authors suggesting ways in which ICD might benefit research with young children.

No genetic support for a contribution of prostaglandins to the aetiology of androgenetic alopecia

MADAM, Androgenetic alopecia (AGA) is a common age-dependent trait, characterized by a progressive loss of hair from the scalp. The hair loss may commence during puberty and up to 80% of white men experience some degree of AGA during their lifetime.1 Research has established that two essential aetiological factors for AGA are a genetic predisposition and the presence of androgens (male sex hormones).1,2 A recent meta-analysis of genome-wide association studies (GWAS) has increased the number of identified loci associated with this trait at the molecular level to a total of eight.3 However, despite these successes, a large fraction of the genetic contribution remains to be identified. One way to identify further genetic loci is to combine the resource of GWAS datasets with knowledge about specific biological factors likely to be involved in the development of disease. The focused evaluation of a limited number of candidate genes in GWAS datasets avoids the necessity for extensive correction for multiple testing, which typically limits the power for detecting genetic loci at a genome-wide level.4 Because the presence of genetic association suggests that candidate genes are likely to operate early in the causative chain of events leading to the phenotype, this approach may also function to favour biological pathways for their importance in the development of AGA.

Turnover intentions of employees with informal eldercare responsibilities: The role of core self-evaluations and supervisor support

As longevity increases, so does the need for care of older relatives by working family members. This research examined the interactive effect of core self-evaluations and supervisor support on turnover intentions in two samples of employees with informal caregiving responsibilities. Data were obtained from 57 employees from Australia (Study 1) and 66 employees from the United States and India (Study 2). Results of Study 1 revealed a resource compensation effect, that is, an inverse relationship between core self-evaluations and turnover intentions when supervisor care support was low. Results of Study 2 extended these findings by demonstrating resource boosting effects. Specifically, there was an inverse relationship between core self-evaluations and subsequent turnover intentions for those with high supervisor work and care support. In addition, employees' satisfaction and emotional exhaustion from their work mediated the inverse relationship between core self-evaluations and subsequent turnover intentions when supervisor work support and care support were high. Overall, these findings highlight the importance of employee- and supervisor-focused intervention strategies in organizations to support informal caregivers.

Applying the principles of interpretive field research: An example of an IS case study on shared services

All sound research commence with the selection of a research paradigm. The chosen research paradigm is significant in shaping the researcher’s perspectives of the world and it is a vital step in any study’s’ research design. There are different paradigms that IS researchers can choose from; amongst which the interpretive paradigm is growing in acceptance.. Though interpretive research has emerged as an important strand in Information Systems (IS), guidelines on how to conduct interpretive research and how to evaluate them have been scarce. Klein and Myers presented seven principles with examples for each from three case examples. While these principles are much valued, there is a lack of support for novice researchers on how to embed these principles in an overall research design, which could help with the aid of a detailed example that has done so. Thus, this paper aims to address this gap, and presents how Klein and Myers’s principles were applied within an example study that investigated shared services in the Malaysian Higher Education context. The example study adopted the interpretive paradigm as the most suited approach that fitted their research questions and goals. More details about the selection and adoption of the Klein and Myers’s guidelines in the context of the shared services research case study are presented in the paper.

Employees’ eldercare demands, strain, and perceived support

Purpose In many countries, both the number of older people in need of care and the number of employed caregivers of elderly relatives will increase over the next decades. The purpose of this paper is to examine the extent to which perceived organizational, supervisor, and coworker support for eldercare reduce employed caregivers’ strain and weaken the relationship between eldercare demands and strain. Design/methodology/approach Survey data were collected from 100 employed caregivers from one organization. Findings Results showed that eldercare demands were positively related to strain, and perceived organizational eldercare support (POES) was negatively related to strain. In addition, high POES weakened the relationship between eldercare demands and strain. Research limitations/implications The cross-sectional design and use of self-report scales constitute limitations of the study. Practical implications POES is a resource for employed caregivers, especially when their eldercare demands are high. Originality/value This research highlights the relative importance of different forms of perceived support for reducing employed caregivers’ strain and weakening the relationship between eldercare demands and strain.

Exploring changing culture and building capacity in research with consumers, carers and consumer companions

Background Australian policy mandates consumer and carer participation in mental health services at all levels including research. Inspired by a UK model - Service Users Group Advising on Research [SUGAR] - we conducted a scoping project in 2013 with a view to create a consumer and carer led research process that moves beyond stigma and tokenism, that values the unique knowledge of lived experience and leads to people being treated better when accessing services. This poster presents the initial findings. Aims The project’s purpose was to explore with consumers, consumer companions and carers at the Metro North Mental Health-RBWH their interest in and views about research partnerships with academic and clinical colleagues. Methods This poster overviews the initial findings from three audio-recorded focus groups conducted with a total of 14 consumers, carers and consumer companions at the Brisbane site. Analysis Our work was guided by framework analysis (Gale et al. 2013). It defines 5 steps for analysing narrative data: familiarising; development of categories; indexing; charting and interpretation. Eight main ideas were initially developed and were divided between the authors to further index. This process identified 37 related analytic ideas. The authors integrated these by combining, removing and redefining them by consensus though a mapping process. The final step is the return of the analysis to the participants for feedback and input into the interpretation of the focus group discussions. Results 1. Value & Respect: Feeling Valued & Respected, Tokenism, Stigma, Governance, Valuing prior knowledge / background 2. Pathways to Knowledge and Involvement in Research: ‘Where to begin’, Support, Unity & partnership, Communication, Co-ordination, Flexibility due to fluctuating capacity 3. Personal Context: Barriers regarding Commitments & the nature of mental illness, Wellbeing needs, Prior experience of research, Motivators, Attributes 4. What is research? Developing Knowledge, What to do research on, how and why? Conclusion and Discussion Initial analysis suggests that participants saw potential for ‘amazing things’ in mental health research such as reflecting their priorities and moving beyond stigma and tokenism. The main needs identified were education, mentoring, funding support and research processes that fitted consumers’ and carers’limitations and fluctuating capacities. They identified maintaining motivation and interest as an issue since research processes are often extended by ethics and funding applications. Participants felt that consumer and carer led research would value the unique knowledge that the lived experience of consumers and carers brings and lead to people being treated better when accessing services.

Patient preferences for receiving remote communication support for lifestyle physical activity behaviour change: The perspective of patients with musculoskeletal disorders from three hospital services

This study examined patients’ preference ratings for receiving support via remote communication to increase their lifestyle physical activity. Methods People with musculoskeletal disorders ( n=221 of 296 eligible) accessing one of three clinics provided preference ratings for “how much” they wanted to receive physical activity support via five potential communication modalities. The five ratings were generated on a horizontal analogue rating scale (0 represented “not at all”; 10 represented “very much”). Results Most (n=155, 70%) desired referral to a physical activity promoting intervention. “Print and post” communications had the highest median preference rating (7/10), followed by email and telephone (both 5/10), text messaging (1/10), and private Internet-based social network messages (0/10). Desire to be referred was associated with higher preference for printed materials (coefficient = 2.739, p<0.001), telephone calls (coefficient = 3.000, p<0.001), and email (coefficient = 2.059, p=0.02). Older age was associated with lower preference for email (coefficient = −0.100, p<0.001), texting (coefficient = −0.096, p<0.001), and social network messages (coefficient = −0.065, p<0.001). Conclusion Patients desiring support to be physically active indicated preferences for interventions with communication via print, email, or telephone calls.

A randomized controlled trial protocol testing a decision support intervention for older patients with advanced kidney disease

Aim To assess the effectiveness of a decision support intervention using a pragmatic single blind Randomized Controlled Trial. Background Worldwide the proportion of older people (aged 65 years and over) is rising. This population is known to have a higher prevalence of chronic diseases including chronic kidney disease. The resultant effect of the changing health landscape is seen in the increase in older patients (aged ≥65 years) commencing on dialysis. Emerging evidence suggests that for some older patients dialysis may provide minimal benefit. In a majority of renal units non-dialysis management is offered as an alternative to undertaking dialysis. Research regarding decision-making support that is required to assist this population in choosing between dialysis or non-dialysis management is limited. Design. A multisite single blinded pragmatic randomized controlled trial is proposed. Methods Patients will be recruited from four Queensland public hospitals and randomizd into either the control or intervention group. The decision support intervention is multimodal and includes counselling provided by a trained nurse. The comparator is standard decision-making support. The primary outcomes are decisional regret and decisional conflict. Secondary outcomes are improved knowledge and quality of life. Ethics approval obtained November 2014. Conclusion This is one of the first randomized controlled trials assessing a decision support intervention in older people with advance chronic kidney disease. The results may provide guidance for clinicians in future approaches to assist this population in decision-making to ensure reduced decisional regret and decisional conflict.