Diabetes care provision: barriers, enablers and service needs of young adults with Type 1 diabetes from a region of social disadvantage

AIMS:
To determine the barriers to and enablers of engaging with specialist diabetes care and the service requirements of young adults with Type 1 diabetes mellitus from a low socio-economic, multicultural region.

METHODS:
A cross-sectional survey targeted 357 young adults with Type 1 diabetes, aged 18-30 years. Participants completed questions about barriers/enablers to accessing diabetes care and service preferences, self-reported HbA(1c), plus measures of diabetes-related distress (Problem Areas in Diabetes), depression/anxiety (Hospital Anxiety and Depression Scale), and illness perceptions (Brief Illness Perceptions Questionnaire).

RESULTS:
Eighty-six (24%) responses were received [55 (64%) female; mean ± sd age 24 ± 4 years; diabetes duration 12 ± 7 years; HbA(1c) 68 ± 16 mmol/mol (8.4 ± 1.5%)]. Logistical barriers to attending diabetes care were reported; for example, time constraints (30%), transportation (26%) and cost (21%). However, 'a previous unsatisfactory diabetes health experience' was cited as a barrier by 27%. Enablers were largely matched to overcoming these barriers. Over 90% preferred a multidisciplinary team environment, close to home, with after-hours appointment times. Forty per cent reported severe diabetes-related distress, 19% reported moderate-to-severe depressive symptoms and 50% reported moderate-to-severe anxiety.

CONCLUSIONS:
Among these young adults with Type 1 diabetes, glycaemic control was suboptimal and emotional distress common. They had identifiable logistical barriers to accessing and maintaining contact with diabetes care services, which can be addressed with flexible service provision. A substantial minority were discouraged by previous unsatisfactory experiences, suggesting health providers need to improve their interactions with young adults. This research will inform the design of life-stage-appropriate diabetes services targeting optimal engagement, access, attendance and ultimately improved healthcare outcomes in this vulnerable population.

Mobile devices supported learning for novice programmers

Mobile learning is considered to be an advanced stage of E-learning. Mobile devices supported learning provides teaching materials anytime, anywhere, and eliminates space and time constraints for learners. Mobile devices-supported learning includes all portable devices such as mobile phones, PDAs, tablet PCs, and e-books. This paper aims to investigate the issue from a different perspective. Firstly, we consider how many novice programmers have personal mobile devices and what type of mobile devices they are using (PDA, tablet PC, e-book). Secondly, we consider whether the Buraimi University College (Oman) Information Technology infrastructure supports mobile learning. Thirdly we consider students' behavior and attitude towards mobile devices supported teaching materials. For this purpose, the survey method will be used as a research tool to collect responses from 1st year students enrolled in introductory programming courses at the Information Technology department of Buraimi University College. This paper also describes a set of findings which helps instructors to take steps to promote mobile learning for novice programmers.

When nutritional guidelines and life collide: family fruit and vegetable socialisation practices in low socioeconomic communities

Parents play a critical role in promoting fruit and vegetable consumption, for eating patterns established early in life tend to persist into adulthood. Despite this, the factors that facilitate or inhibit parents’ capacity to socialise fruit and vegetable consumption into their children’s daily diets remain poorly defined. Thirty-eight semi-structured interviews with residents, allied healthcare professionals, community leaders, community programme leaders and a local government leader living or working in two low socioeconomic suburbs were consequently conducted to ascertain factors exogenous and endogenous to the family unit that shaped parental food socialisation practices. Budgetary and time constraints emerged as exogenous factors that constrained fruit and vegetable socialisation. Constraining effects were also found for a range of endogenous factors, including commensal experiences, children’s food fussiness and the feeding styles employed by parents. As such, while many caregivers may wish to socialise fruit and vegetable consumption into their children’s daily diets, their capacity to do so is often inhibited by factors beyond their volitional control. Failure to take heed of these factors could therefore result in the development of social marketing campaigns that are ineffective at best or give rise to unintentionally harmful outcomes at worst.

Offensive agility techniques performed during international netball competition

Netball is a sport characterised by sharp changes-of-direction to break free from opponents. The ability of players to use changes-of-direction to evade opponents is, therefore, an important aspect of attacking play. The purpose of this study was to examine the performance and outcomes of offensive agility techniques utilised by netball players. Offensive agility techniques were assessed for the type of manoeuvre performed and performance outcome using video footage of three international matches. Mid and attacking playing positions performed a greater frequency of manoeuvres than defensive playing positions. The type of manoeuvre was found to have no influence on the performance outcome. The performance outcome is likely influenced by additional factors, such as location on the court, time constraints, or features of defensive opponents. Overall, the use of offensive agility manoeuvres was identified as an important aspect of attacking play in netball, particularly for the mid and attacking playing positions.

Efficacy of Cognitive Processes in Young People with High-Functioning Autism Spectrum Disorder Using a Novel Visual Information-Processing Task

Autism spectrum disorders (ASD) are characterised by a unique pattern of preserved abilities and deficits within and across cognitive domains. The Complex Information Processing Theory proposes this pattern reflects an altered capacity to respond to cognitive demands. This study compared how complexity induced by time constraints on processing affect cognitive function in individuals with ASD and typically-developing individuals. On a visual information-processing task, the Subtle Cognitive Impairment Test, both groups exhibited sensitivity to time-constraints. Further, 65 % of individuals with ASD demonstrated deficits in processing efficiency, possibly attributable to the effects of age and clinical comorbidities, like attention deficit hyperactivity disorder. These findings suggest that for some ASD individuals there are significant impairments in processing efficiency, which may have implications for education and interventions. © 2014 Springer Science+Business Media New York.

Nephrologists' management of patient medications in kidney transplantation: results of an online survey

Rationale, aims and objectives: Medication adherence is essential in kidney transplant recipients to reduce the risk of rejection and subsequent allograft loss. The aim of this study was to delineate what 'usual care' entails, in relation to medication management, for adult kidney transplant recipients. Methods: An online survey was developed to explore how nephrologists promote and assess medication adherence, the management of prescriptions, the frequency of clinic appointments and the frequency of clinical screening tests. Nephrologists from all acute kidney transplant units in Victoria, Australia, were invited to participate. Data were collected between May and June 2014. Results: Of 60 nephrologists invited to participate, 22 completed the survey (response rate of 36.6%). Respondents had a mean age of 49.1±10.1 years, with a mean of 20.1±9.9 years working in nephrology and 14 were men. Descriptive analysis of responses showed that nephrologists performed frequent screening for kidney graft dysfunction that may indicate medication non-adherence, maintained regular transplant clinic visits with patients and emphasized the importance of medication education. However, time constraints during consultations impacted on extensive patient education and the long-term medication follow-up support was often delivered by the renal transplant nurse coordinator or pharmacist. Conclusions: This study highlighted that nephrologists took an active approach in the medication management of kidney transplant recipients, which may assist with facilitating long-term graft survival. Ultimately, promoting medication adherence needs to be patient centred, involving an interdisciplinary team of nephrologists, pharmacists and renal transplant nurse coordinators, working together with the patient to establish optimal adherence.

What young people say about physical activity: the children's sport and physical activity study

The Children’s Sport Participation and Physical Activity (CSPPA) study is a unique multi-centre/ discipline study undertaken by three Irish institutions, Dublin City University, University of Limerick and University College Cork. The study sought to assess participation in physical activity, physical education and sport (PAPES) among 10-18 year olds in Ireland. This paper shares what Irish children and young people convey, using their own voices, about their sport and physical activity (PA) experiences and how such experiences may result in their feeling included or excluded in PAPES. Eighteen focus groups (FG) with 124 boys and girls elicited descriptive data from students and were conducted with homogeneous groups of 6-8 boys and girls aged 12-18 years (selected for convenience) identified as male/female, primary/post-primary and generally active/ inactive. Five themes (‘being with friends’, ‘variety in activity content’, ‘experiencing fun’, ‘time constraints’ and ‘opportunity to be outside’) ran across the three PAPES opportunities for young people. Overall data revealed that these young people have a positive attitude towards PA which does not diminish as they age despite activity levels decreasing. Other choices of activity participation (e.g. debate, music), or more focused activities took the place of previous choices as young people came to realise what they most enjoyed. If we are to encourage and provide opportunities for young people to choose active lifestyles, it is important that we address what these young people report affects their involvement in PA across a number of contexts. Two such developments within Irish school and community contexts are discussed: Active School Flag initiative and Senior Cycle Physical Education framework.

Patient and nurse preferences for nurse handover-using preferences to inform policy: a discrete choice experiment protocol

INTRODUCTION: Nursing bedside handover in hospital has been identified as an opportunity to involve patients and promote patient-centred care. It is important to consider the preferences of both patients and nurses when implementing bedside handover to maximise the successful uptake of this policy. We outline a study which aims to (1) identify, compare and contrast the preferences for various aspects of handover common to nurses and patients while accounting for other factors, such as the time constraints of nurses that may influence these preferences.; (2) identify opportunities for nurses to better involve patients in bedside handover and (3) identify patient and nurse preferences that may challenge the full implementation of bedside handover in the acute medical setting. METHODS AND ANALYSIS: We outline the protocol for a discrete choice experiment (DCE) which uses a survey design common to both patients and nurses. We describe the qualitative and pilot work undertaken to design the DCE. We use a D-efficient design which is informed by prior coefficients collected during the pilot phase. We also discuss the face-to-face administration of this survey in a population of acutely unwell, hospitalised patients and describe how data collection challenges have been informed by our pilot phase. Mixed multinomial logit regression analysis will be used to estimate the final results. ETHICS AND DISSEMINATION: This study has been approved by a university ethics committee as well as two participating hospital ethics committees. Results will be used within a knowledge translation framework to inform any strategies that can be used by nursing staff to improve the uptake of bedside handover. Results will also be disseminated via peer-reviewed journal articles and will be presented at national and international conferences.

Implementation of the diabetes and hypertension guideline lifestyle recommendations in urban Mongolia: A qualitative study of primary care providers

Abstract
Background: Hypertension and diabetes, key risk factors for cardiovascular disease, are significant health problems globally. As cardiovascular disease is one of the leading causes of mortality in Mongolia since 2000, clinical guidelines on arterial hypertension and diabetes were developed and implemented in 2011. This paper explores the barriers and enablers influencing the implementation of these guidelines in the primary care setting.
Methods: A phenomenological qualitative study with semi-structured interviews was conducted to explore the implementation of the diabetes and hypertension guidelines at the primary care level, as well as to gain insight into how practitioners view the usability and practicality of the guidelines. Ten family health centres were randomly chosen from a list of all the family health centres (n = 136) located in Ulaanbaatar City. In each centre, a focus group discussion with nurses (n = 20) and individual interviews with practice doctors (n =10) and practice managers (n= 10) were conducted. Data was analysed using a thematic approach utilising the Theoretical Domains Framework.
Results: The majority of the study participants reported being aware of the guidelines and that they had incorporated them into their daily practice. They also reported having attended guideline training sessions which were focused on practice skill development. The majority of participants expressed satisfaction with the wide range of resources that had been supplied to them by the Mongolian Government to assist with the implementation of the guidelines. The resources, supplied from 2011 onwards, included screening devices, equipment for blood tests, medications and educational materials. Other enablers were the participants’ commitment and passion for guideline implementation and their belief in the simplicity and practicality of the guidelines. Primary care providers reported a number of challenges in implementing the guidelines, including frustration caused by increased workload and long waiting times, time constraints, difficulties with conflicting tasks and low patient health literacy.
Conclusions: This study provides evidence that comprehensive and rigorous dissemination and implementation strategies increase the likelihood of successful implementation of new guidelines in low resource primary care settings. It also offers some key lessons that might be carefully considered when other evidence-based clinical guidelines are to be put into effect in low resource settings and elsewhere.

Implementation of clinical guidelines on diabetes and hypertension in urban Mongolia: a qualitative study of primary care providers' perspectives and experiences

BACKGROUND: Hypertension and diabetes, key risk factors for cardiovascular disease, are significant health problems globally. As cardiovascular disease is one of the leading causes of mortality in Mongolia since 2000, clinical guidelines on arterial hypertension and diabetes were developed and implemented in 2011. This paper explores the barriers and enablers influencing the implementation of these guidelines in the primary care setting.

METHODS: A phenomenological qualitative study with semi-structured interviews was conducted to explore the implementation of the diabetes and hypertension guidelines at the primary care level, as well as to gain insight into how practitioners view the usability and practicality of the guidelines. Ten family health centres were randomly chosen from a list of all the family health centres (n = 136) located in Ulaanbaatar City. In each centre, a focus group discussion with nurses (n = 20) and individual interviews with practice doctors (n = 10) and practice managers (n = 10) were conducted. Data was analysed using a thematic approach utilising the Theoretical Domains Framework.

RESULTS: The majority of the study participants reported being aware of the guidelines and that they had incorporated them into their daily practice. They also reported having attended guideline training sessions which were focused on practice skill development. The majority of participants expressed satisfaction with the wide range of resources that had been supplied to them by the Mongolian Government to assist with the implementation of the guidelines. The resources, supplied from 2011 onwards, included screening devices, equipment for blood tests, medications and educational materials. Other enablers were the participants' commitment and passion for guideline implementation and their belief in the simplicity and practicality of the guidelines. Primary care providers reported a number of challenges in implementing the guidelines, including frustration caused by increased workload and long waiting times, time constraints, difficulties with conflicting tasks and low patient health literacy.

CONCLUSIONS: This study provides evidence that comprehensive and rigorous dissemination and implementation strategies increase the likelihood of successful implementation of new guidelines in low resource primary care settings. It also offers some key lessons that might be carefully considered when other evidence-based clinical guidelines are to be put into effect in low resource settings and elsewhere.

Assessment of simulated clinical skills and distance students: can we do it better?

Australian universities have traditionally been able to supplement clinical education, for undergraduate nursing courses, delivered on placement with weekly clinical teaching in the simulated environment. The Objective Structured Clinical Assessment (OSCA) tool has been used in this simulated environment to assess clinical skills. Recently, however, online delivery of undergraduate nursing courses has become more common. The move from an internal mode of teaching to an online external mode is seen worldwide and poses challenges to staff and students as well as changing the teaching and learning culture of institutions (Philip and Wozniak, 2009). This cultural shift and the resulting diminishing timeframe for students to acquire and practice simulated clinical skills imply that it may become necessary to rethink assessment forms such as the OSCA assessment. This study examines whether or not the OSCA tool developed by Bujack et al. (1991a) is the best tool to be used in this new context, where online teaching is supplemented by very short, annual, intensive periods of study. Skills acquisition theories dictate that time is required to produce an ideal skills acquisition environment (Quinn, 2000) but the time constraints placed on students in such intensive periods of study could influence skills acquisition. This cross-sectional qualitative study used semi-structured interviews and focus groups to collect data. 65% of the nursing faculty participated in the study. The teaching of the Bachelor of Nursing (BN) occurred on two campuses and staff from both areas participated. This group of nurse academics was employed across the range of academic levels (from lecturer to professor) at the University. Data analysis followed a generic thematic analysis framework. Findings in this study show that there are a variety of attitudes and underpinning beliefs amongst staff in relation to the OSCAs. Doubts were raised in regard to the suitability of the use of the OSCA tool in this setting. It also became apparent during this study that the OSCA tool possibly serves purposes other than an assessment tool.

The transplant team's support of kidney transplant recipients to take their prescribed medications: a collective responsibility.

AIMS AND OBJECTIVES: To obtain an understanding of how health professionals support the kidney transplant patient to take their medications as prescribed long term. BACKGROUND: Kidney transplantation requires stringent adherence to complex medication regimens to prevent graft rejection and to maintain general well-being. Medication nonadherence is common in kidney transplantation, emerging in the first few months post-transplantation, leading to poor patient outcomes. DESIGN: Exploratory qualitative design. METHODS: Five focus groups were conducted with a total of seven renal nurse transplant coordinators, two renal transplant nurse unit managers, seven nephrologists, seven pharmacists, four social workers, and one consumer representative representing all five hospitals offering adult kidney transplantation in Victoria, Australia in 2014. The views of two general practitioners who were unable to attend the focus groups were incorporated into the data set. All data underwent thematic analysis. RESULTS: Analysis revealed that adherence was a collective responsibility involving the whole of the transplant team and the patient via education blitz in hospital, identifying and managing nonadherence, promotion of self-advocacy, and the partnership between the patient and health professional. Patients were directed how to take their complex medications to be self-empowered, yet the partnership between the patient and health professional limited the patient's voice. CONCLUSION: Although medication adherence was a collective responsibility, communication was often one-way chiefly as a result of staffing and time constraints, hindering effective partnerships necessary for medication adherence. Expert skills in communication and adherence counselling are necessary to identify barriers affecting medication adherence. Patients need to be systematically screened, prepared and supported long-term within an accommodating healthcare system for the reality of caring for their transplanted kidney. RELEVANCE TO CLINICAL PRACTICE: Kidney transplant recipients require systematic preparation and quality long-term follow-up to adhere to their prescribed medications.

Food skills confidence and household gatekeepers' dietary practices

INTRODUCTION: Household food gatekeepers have the potential to influence the food attitudes and behaviours of family members, as they are mainly responsible for food-related tasks in the home. The aim of this study was to determine the role of gatekeepers' confidence in food-related skills and nutrition knowledge on food practices in the home.

METHODS: An online survey was completed by 1059 Australian dietary gatekeepers selected from the Global Market Insite (GMI) research database. Participants responded to questions about food acquisition and preparation behaviours, the home eating environment, perceptions and attitudes towards food, and demographics. Two-step cluster analysis was used to identify groups based on confidence regarding food skills and nutrition knowledge. Chi-square tests and one-way ANOVAs were used to compare the groups on the dependent variables.

RESULTS: Three groups were identified: low confidence, moderate confidence and high confidence. Gatekeepers in the highest confidence group were significantly more likely to report lower body mass index (BMI), and indicate higher importance of fresh food products, vegetable prominence in meals, product information use, meal planning, perceived behavioural control and overall diet satisfaction. Gatekeepers in the lowest confidence group were significantly more likely to indicate more perceived barriers to healthy eating, report more time constraints and more impulse purchasing practices, and higher convenience ingredient use. Other smaller associations were also found.

CONCLUSION: Household food gatekeepers with high food skills confidence were more likely to engage in several healthy food practices, while those with low food skills confidence were more likely to engage in unhealthy food practices. Food education strategies aimed at building food-skills and nutrition knowledge will enable current and future gatekeepers to make healthier food decisions for themselves and for their families.

Time and energy constraints in demanding phases of the annual cycle : an example of time limitation in refuelling migratory swans

The daily metabolizable energy intake of an animal is potentially limited by either the available feeding time or by its capacity to process energy. Animals are generally considered not to be time-limited but rather to be energy-processing-limited. This is concluded from the common observation that an animal's feeding time per day increases with a decrease in food density. We argue that such changes in feeding time are in theory also expected when no constraints are operating. Thus, a study of the constraints on energy intakes of free-living animals should be performed during demanding phases of the year. As an example, we collected data on time and energy budgets of Bewick's swan (Cygnus columbianus bewickii) refuelling during migration on fennel pondweed (Potamogeton pectinatus) tubers in two years differing two-fold in tuber biomass density. As predicted by time limitation, the feeding time (defined as the time with the head submerged) did not change in response to a change in food biomass density, both within and between years (averaging 12.2 h d⁻¹). Contrary to energy-processing limitation, and again in line with time limitation, the daily metabolizable energy intake varied, being greater in the year with high than in the year with low food densities. We conclude that more studies are needed of animals operating under demanding conditions before it can be assessed whether free-living animals are generally energy-processing- or time-limited.