Influencing health equity : role of the effective consumer scale in measuring skills and abilities in a middle income country

The 2008 World Health Report emphasizes the need for patient-centered primary care service delivery models in which patients are equal partners in the planning and management of their health. It is argued that this involvement will lead to improved management of disease, improved health outcomes and patient satisfaction, better informed decision-making, increased compliance with healthcare decisions, and better resource utilization. This article investigates the domains captured by the Effective Consumer Scale (EC-17) in relation to vulnerable population groups that experience health inequity. Particular focus is paid to the domain of health literacy as an area fundamental to patients’ involvement in managing their condition and negotiating the healthcare system. In examining the possible influence of Outcome Measures in Rheumatology Clinical Trials (OMERACT) on health equity, we used the recent translation and validation of the EC-17 scale into Spanish and tested Argentina as an example. Future plans to use the EC-17 with vulnerable groups include formal collaboration and needs assessment with the community to tailor an intervention to meet its needs in a culturally relevant manner. Some systematic reviews have questioned whether interventions to improve effective consumer skills are appropriate in vulnerable populations. We propose that these populations may have the most to gain from such interventions since they might be expected to have relatively lower skills and health literacy than other groups.

Adolescent’s cultural identity and neighbourhood environment

Objective: this study aims to find out how adolescents in Australia identify themselves culturally, and how adolescents from different cultural groups differ in their assessments of their neighbourhood environments. Methods: one hundred and sixty-six adolescents in Sydney completed a self-administered questionnaire, which collected information of their neighbourhood environments and their cultural backgrounds. Results: adolescents reported a great variety (67) of different cultural backgrounds, clustered into three cultural groups: Australian cultural identity group, Heritage cultural group, and Biculturalism group. Although no significant difference was found on most neighbourhood environment factors between the cultural groups, adolescents from Heritage cultural group scored significantly lower on the factor Vegetation & Facilities. Conclusions: The results of this study suggest that the overall neighbourhood environments for adolescents from different cultural groups are satisfactory. However, ethnic minority adolecents live in neighbourhoods with less vegetation and facilities, which suggest that spatial inequity related to ethnic backgrounds still exist in Australia.

Creating communities that lead to retention : the social worlds and communities of umpires

Umpires (referees) are essential for sport competition, yet many sports report difficulty in recruiting and retaining umpires. Therefore, this research sought to better understand what experiences will ensure continued participation in umpiring. Previous literature suggests that the communities created are vital to umpire retention. Thus, the aim of this research was to identify the factors that lead to, or detract from sense of community for umpires. Twenty-two Australian Rules football umpires were interviewed using a semi-structured approach. This study revealed that Lack of Administration Consideration, Inequity (specifically related to remuneration and resources), Competition, Common Interest (specifically in the sport, interactions within football community, and/or within social spaces) impacted the development of sense of community for umpires. This study demonstrates that as umpires move through their careers, the outcome of the noted factors to enhance or detract from sense of community change. Implications for umpire education, accreditation, and management aimed at retaining umpires are discussed.

Inequitable provision of optimal services for patients with chronic heart failure : a national geo-mapping study

Objective : To compare the location and accessibility of current Australian chronic heart failure (CHF) management programs and general practice services with the probable distribution of the population with CHF. Design and setting : Data on the prevalence and distribution of the CHF population throughout Australia, and the locations of CHF management programs and general practice services from 1 January 2004 to 31 December 2005 were analysed using geographic information systems (GIS) technology. Outcome measures : Distance of populations with CHF to CHF management programs and general practice services. Results : The highest prevalence of CHF (20.3–79.8 per 1000 population) occurred in areas with high concentrations of people over 65 years of age and in areas with higher proportions of Indigenous people. Five thousand CHF patients (8%) discharged from hospital in 2004–2005 were managed in one of the 62 identified CHF management programs. There were no CHF management programs in the Northern Territory or Tasmania. Only four CHF management programs were located outside major cities, with a total case load of 80 patients (0.7%). The mean distance from any Australian population centre to the nearest CHF management program was 332 km (median, 163 km; range, 0.15–3246 km). In rural areas, where the burden of CHF management falls upon general practitioners, the mean distance to general practice services was 37 km (median, 20 km; range, 0–656 km). Conclusion : There is an inequity in the provision of CHF management programs to rural Australians.

How sensitive are bargaining outcomes to changes in disagreement payoffs?

We use a human-subjects experiment to investigate how bargaining outcomes are affected by changes in bargainers’ disagreement payoffs. Subjects bargain against changing opponents, with randomly drawn asymmetric disagreement outcomes that vary over plays of the game, and with complete information about disagreement payoffs and the cake size. We find that subjects only respond about half as much as theoretically predicted to changes in their own disagreement payoff and to changes in their opponent’s disagreement payoff. This effect is observed in a standard Nash demand game and a related unstructured bargaining game, in both early and late rounds, and is robust to moderate changes in stake sizes. We show theoretically that standard models of expected utility maximisation are unable to account for this under-responsiveness, even when generalised to allow for risk aversion. We also show that quantal-response equilibrium has, at best, mixed success in characterising our results. However, a simple model of other-regarding preferences can explain our main results.

The gender 'problem' in Australian journalism education

This paper investigates if and how issues of gender are taught in undergraduate journalism courses in Australia. It examines published descriptions of undergraduate journalism degrees and majors in 30 Australian universities, providing a collective case study about the teaching of gender in journalism education. The research finds that no journalism program offers a unit that specifically addresses the portrayal of women in the media or, importantly, the gendered production of news and gendered newsroom culture. This paper posits the importance of gender education in journalism courses, hypothesises why it is ignored as a valuable part of journalism education, and suggests how tertiary journalism education could address systemic inequity for women in media organisations by adapting its curriculum.

When social anxiety co-occurs with substance use: does an impulsive social anxiety subtype explain this unexpected relationship?

Although most conceptualizations of social anxiety emphasise that socially anxious individuals are overtly shy, and utilise avoidant behavioural strategies (e.g., risk-aversion, passivity, and submissiveness), there is tentative support for the existence of an approach-motivated subtype, characterised by risk taking and a greater propensity for substance misuse. It is likely that this subtype may help explain the reported co-occurrence of substance misuse and social anxiety. The current study sought to test via latent class analysis whether an approach-motivated social anxiety subtype could be identified within a community sample. A self-report questionnaire was completed by 351 participants (age: 18-74 years). Two distinct social anxiety subgroups were identified: one characterised by prototypical SAD symptomatology (i.e., behavioural inhibition and risk-avoidance), the second by elevated levels of rash impulsiveness, reward sensitivity, risk-taking and co-occurring substance use problems. The current findings provides support for the existence of a distinct approach-motivated social anxiety subtype and indicates that impulsivity may be critical to understanding the comorbid substance use symptomatology of these individuals.

The gender of “soft” and “hard” news

Research from around the globe has long emphasised the problem of vertical segregation in the news media where women remain largely absent from key editorial decision-making roles. Horizontal segregation, however, where there are gendered divisions of tasks associated with reporting, is also an ongoing issue and has been highlighted in a recent large-scale survey of female journalists in Australia. To date, just one other small industry survey in 1996 has asked female journalists in Australia about the types of stories that they cover and raised the implications of gendered inequity. This current survey finds that while more female reporters appear be covering hard news rounds like politics and business, the majority are still assigned to cover the bulk of the soft news areas of features, the arts, education and health—and most perceive that female reporters remain pigeon-holed in those traditionally female story areas. Respondents understand soft news as less important within the organisation in comparison to the highly valued areas of politics and sports that male reporters most often cover. This paper analyses female journalists' responses to the gendered nature of the soft news–hard news binary and the ramifications of such disparity.