Building global alliances for public health nutrition training

The purpose of this paper is to present a review of opportunities and challenges for future progress in building intercountry, regional, and global alliances for public health nutrition training. Drawing on experiences from developing, implementing, and evaluating public health nutrition training in Australasia, Europe, and the Middle East, suggestions are provided for building a network of global training activities. Opportunities are described in areas such as standardization of course competencies and registration schemes, resource sharing, student and trainer exchange programs, and professional development. Challenges are identified and options presented for building global alliances in public health nutrition training into the future.

Are rural health professionals also social entrepreneurs?

Social entrepreneurs formally or informally generate community associations and networking that produces social outcomes. Social entrepreneurship is a relatively new and poorly understood concept. Policy promotes generating community activity, particularly in rural areas, for health and social benefits and ‘community resilience’. Rural health professionals might be well placed to generate community activity due to their status and networks. This exploratory study, conducted in rural Tasmania and the Highlands and Islands of Scotland considered whether rural health professionals act as social entrepreneurs. We investigated activities generated and processes of production. Thirty-eight interviews were conducted with general practitioners, community nurses, primary healthcare managers and allied health professionals living and working rurally. Interviewees were self-selecting responders to an invitation for rural health professionals who were ‘formally or informally generating community associations or networking that produced social outcomes’. We found that rural health professionals initiated many community activities with social outcomes, most related to health. Their identification of opportunities related to knowledge of health needs and examples of initiatives seen elsewhere. Health professionals described ready access to useful people and financial resources. In building activities, health professionals could simultaneously utilise skills and knowledge from professional, community member and personal dimensions. Outcomes included social and health benefits, personal ‘buzz’ and community capacity. Health professionals' actions could be described as social entrepreneurship: identifying opportunities, utilising resources and making ‘deals’. They also align with community development. Health professionals use contextual knowledge to envisage and grow activities, indicating that, as social entrepreneurs, they do not explicitly choose a social mission, rather they act within their known world-view. Policymakers could consider ways to engage rural health professionals as social entrepreneurs, in helping to produce resilient communities.

Culturally-linked leadership styles

Purpose – This paper seeks to examine whether cultural context facilitates the emergence of different leadership styles. The key objective of the paper is to consider whether leadership styles are
culturally-linked and/or culturally-biased.
Design/methodology/approach – A multifactor leadership questionnaire was utilised to measure differences in leadership styles and to offer explanations as to why the “one size fits all” view is not appropriate. Analysis of variance and t-tests were utilised to compare means for more than two managerial groups.
Findings – The analysis found significant differences between leadership styles and cultural groups, hence, supporting the argument that culture and leadership interact in different ways in diverse
contexts. Transactional leadership was found to be strongly aligned with the ratings of managers from Malaysia, and transformational leadership scales correlated with the Australian respondents’ mean
ratings.
Practical implications – Variations in leadership styles are due to cultural influences because people have different beliefs and assumptions about characteristics that are deemed effective for leadership. Therefore, it is fundamental to know what leadership skills and knowledge are valued most by managers on a global level. This information is critical as it offers insight into developing competencies in different workplaces, especially as organisations expand their geographical boundaries into international markets.
Originality/value – The findings of the study provide empirical understanding for culturally-linked leadership styles. The paper contributes to understanding the importance of workforce diversity and attention to other cultures and, thus, enhances our appreciation of today’s “global village”.

Sustainable funding of health initiatives in Wonju, Republic of Korea via a tobacco consumption tax

Wonju is the first municipality in the Republic of Korea to fund the Healthy City project through municipal revenues from the local tobacco consumption tax. We investigated the process of the local tobacco consumption tax being approved as the main source of financing for the local Healthy City project. We also examined the sustainability and sufficiency of the funding by looking at the pricing policies instituted for cigarettes, smoking prevalence, cigarette consumption and revenues from local tobacco consumption as well as the budgetary allocations among programs in the city. The strong initiative of the mayor of Wonju was one of the factors that enabled the earmarking of the local tobacco consumption tax for the Healthy City Wonju project. He consulted academic counselors and persuaded the municipal government and the City Council to approve the bill. Despite the increasing price of cigarettes in Korea, adequate funding can be sustained to cover the short-term and mid-term programs in Wonju for at least 5 years of the mayor's term, because the smoking rate is persistently high. Analyzing the effects of strong leadership on the part of local authorities and the balance between revenues from the tobacco tax and the prevalence of smoking in the face of anti-smoking policies would be helpful for other countries and communities interested in developing sustainable Healthy Cities projects.

It's here! Are we ready? Five case studies of health promotion practices that address climate change from within Victorian health care settings

Issue addressed: Climate changes and environmental degradation caused by anthropogenic activities are having an irrefutable impact on human health. The critical role played by health promotion in addressing environmental challenges has a history in seminal charters − such as the Ottawa Charter for Health Promotion − that explicitly link human well-being with the natural environment. The lack of documented practice in this field prompted an investigation of health promotion practice that addresses climate change issues within health care settings.

Methods: This qualitative study involved five case studies of Victorian health care agencies that explicitly identified climate change as a priority. Individual and group interviews with ten health promotion funded practitioners as well as document analysis techniques were used to explore diverse practices across these rural, regional and urban health care agencies.

Results: Health promotion practice in these agencies was oriented toward: active and sustainable transport; healthy and sustainable food supply; mental health and community resilience; engaging vulnerable population groups such as women; and organisational development.

Conclusion: Despite differences in approach, target population and context, the core finding was that health promotion strategies, competencies and frameworks were transferable to action on climate change in these health care settings.

Tackling health inequalities : what do senior managers think

Objective: To describe how New South Wales (NSW) Area Health Service Chief Executive Officers (CEOs) understood concepts of equity in the development of NSW Health's Equity Statement; CEO knowledge and interpretation of a given concept being one aspect of developing policy.

Design and Setting: This paper describes the process through which NSW Area Health Service CEOs were involved in developing the Equity Statement, specifically:

1. Briefings with individual CEOs on key issues and identification of possible difficulties and potential 'equity champions'.
2. A two-hour workshop to explore ('pre-mortem') why the proposed statement might fail.
3. CEO involvement in identifying strategies that promoted equity already operating locally.
4. C onsultations with selected individuals about the draft recommendations.
5. Feedback to CEOs.

The article provides a case study of consultative policy making by illustrating how participant knowledge can both inform and be strengthened by involvement in the policy development process.

Results: There was a high level of awareness among CEOs of health inequalities and an acceptance of their responsibility to address them. They saw three main ways of doing this: a) equity of resource allocation for health service delivery within and between regions; b) equity of access to health services based on need; and c) equity of health outcomes. CEOs felt that making the health system accountable for health outcomes would provide pressure for system-wide resource allocation changes. They recognised that factors substantially impacting on health outcomes were outside the control of the health system. Furthermore, finding a balance to which they could be held accountable was difficult. All CEOs saw ensuring needs-based access to services as a key area where they could potentially have an impact; and they specifically saw challenges in a conflict between equity and efficiency, marginalisation of special treatment for disadvantaged people, balancing investment in rescue services and prevention/early intervention, and developing a rational health financing system. The resulting policy has been broadly embedded within the NSW health system with strong local support.

Conclusion: The NSW Health and Equity policy was embedded because CEO leadership and acceptance of the policy enhanced local ownership.

Capacity building : just rhetoric, or a way forward in addressing health inequality?

Issue addressed: It is time to move beyond defining the problem of health inequality to taking action. The response required is complex and calls for system wide action. It is in this context that a discussion of increasing the capacity of the health system to respond to health inequality is both timely and essential. Methods: This paper looks at a capacity building framework that has been developed by the New South Wales Health Department and provides an example of a number of projects that have applied capacity building strategies. Conclusion: Addressing health inequality presents a significant challenge to health promotion practitioners. Emerging capacity building theory provides direction for strategies to build the capacity of a health system to address equity. It proposes a set of practical actions using the five focus areas of organisational development, workforce development, resource allocation, partnerships and leadership. So what?: A capacity building approach by itself will not provide the mandate and framework for the action that needs to be taken to address health inequality, but it helps to ensure that once potential solutions are identified the health system has the capacity to respond.

Engaging rural communities in health care through a paramedic expanded scope of practice

Introduction: This article explores how community engagement by paramedics in an expanded scope role contributes to both primary health care and to an overall improved emergency response capacity in rural communities. Understanding how expanded scope paramedics (ESP) can strengthen community healthcare collaborations is an important need in rural areas where low workforce numbers necessitate innovation.

Methods: Four examples of Australian rural ESP roles were studied in Tasmania, New South Wales, South Australia and Victoria to gather information on consistent elements that could inform a paramedic expanded scope model. Qualitative data were collected from semi-structured interviews with key stakeholders and organisational documents. Thematic analysis within and across cases found community engagement was a key element in the varied roles. This article relies heavily on data from the Victorian and Tasmanian case studies because community engagement was a particularly strong aspect of these cases.

Results: The ESP in the case studies increased interactions between ambulance services and rural communities with an overall benefit to health care through: increasing community response capacity; linking communities more closely to ambulance services; and increasing health promotion and illness prevention work at the community level. Leadership, management and communication skills are important for paramedics to successfully undertake expanded scope roles.

Conclusion: ESP in rural locations can improve health care beyond direct clinical skill by active community engagement that expands the capacity of other community members and strengthens links between services and communities. As health services look to gain maximum efficiency from the health workforce, understanding the intensification of effort that can be gained from practitioner and community coalitions provides important future directions.

Health promotion practice in the context of climate change

Climate change and environmental degradation caused by human activities are having an irrefutable impact on human health. This thesis by publication demonstrates that health promotion practitioners are well placed to use their professional competencies, strategies and principles to facilitate action on climate change and environmental sustainability.

Providing quality mental health nursing in primary health care settings in Kenya : A discussion paper.

Kenya, a country of 38 million people in East Africa has about 75 Psychiatrists and 500 Psychiatric Nurses, the majority work in the private sector and mainly in urban areas. Mental illness is common in Kenya, however, specialist services are sparse and primary care struggles to cope, and this has been worsened by general health programs which have been slow to appreciate the significance of mental health. The World Health Organisation recommends that provision of good quality mental health care does not only involve increasing the number of health workers but changing the skill mix and developing new competencies among existing workers. Successful implementation of mental, neurological and substance abuse disorder services in Kenya will depend on nurses, who constitute majority of the workforce located in provinces, districts and community clinics.

This discussion paper will address s key workforce issues affecting the up-scaling of mental health services, and the delivery of quality mental health nursing care in primary health care settings in Kenya. Strategies to develop skills and competencies of new and existing personnel will be discussed.

Relationship between intuition and emotional intelligence in occupational therapists in mental health practice

Objective: 
Clinical reasoning studies have acknowledged tacit aspects of practice, and recent research suggests that clinical reasoning contains intuition informed by tacit knowledge. Intuition also appears to be influenced by awareness and understanding of emotions. This study investigated the relationship between intuition and emotional intelligence among occupational therapists in mental health practice.

A multi-level investigation of leadership from an attachment theory perspective

This thesis investigated the nature of interpersonal relationships between leaders and followers in the workplace. Results indicated that the relationship styles of leaders and followers were associated with differential ratings of leadership across varying workplace contexts.

Policy and practice impacts of applied research: a case study analysis of the New South Wales Health Promotion Demonstration Research Grants Scheme 2000-2006

Background
Intervention research provides important information regarding feasible and effective interventions for health policy makers, but few empirical studies have explored the mechanisms by which these studies influence policy and practice. This study provides an exploratory case series analysis of the policy, practice and other related impacts of the 15 research projects funded through the New South Wales Health Promotion Demonstration Research Grants Scheme during the period 2000 to 2006, and explored the factors mediating impacts.

Methods
Data collection included semi-structured interviews with the chief investigators (n = 17) and end-users (n = 29) of each of the 15 projects to explore if, how and under what circumstances the findings had been used, as well as bibliometric analysis and verification using documentary evidence. Data analysis involved thematic coding of interview data and triangulation with other data sources to produce case summaries of impacts for each project. Case summaries were then individually assessed against four impact criteria and discussed at a verification panel meeting where final group assessments of the impact of research projects were made and key influences of research impact identified.

Results
Funded projects had variable impacts on policy and practice. Project findings were used for agenda setting (raising awareness of issues), identifying areas and target groups for interventions, informing new policies, and supporting and justifying existing policies and programs across sectors. Reported factors influencing the use of findings were: i) nature of the intervention; ii) leadership and champions; iii) research quality; iv) effective partnerships; v) dissemination strategies used; and, vi) contextual factors.

Conclusions
The case series analysis provides new insights into how and under what circumstances intervention research is used to influence real world policy and practice. The findings highlight that intervention research projects can achieve the greatest policy and practice impacts if they address proximal needs of the policy context by engaging end-users from the inception of projects and utilizing existing policy networks and structures, and using a range of strategies to disseminate findings that go beond traditional peer review publications.