'Mind and body' : a lifestyle programme for people on antipsychotic medication

Rationale Psychiatric illnesses such as schizophrenia and their treatments have consequences in terms of lifestyle, diet and weight.

Aims and objectives ‘Mind and Body’ is a 10-week programme of weekly sessions aimed to improve the health status of people treated with second generation antipsychotic medications.

Methods The programme focuses on a range of lifestyle strategies including diet and exercise and was conducted at a Community Health Centre by professionally qualified staff. Between 2002 and 2006, 50 participants enrolled in, and 30 completed the programme. Measures of body weight, health status (Short Form-36) and blood markets (plasma glucose, haemoglobin A1c and lipid profile) were collected at commencement and completion of the programme.

Results A modest improvement was demonstrated in mean values for the majority of measures collected.

Conclusions A lifestyle program for people treated with antipsychotic medications is achievable and may be worthwhile although gains may be modest.

Characteristics of physically active and inactive men from low socioeconomic communities and housing estates : a qualitative study using the socioecological model

This qualitative study compares experiences of men from low socioeconomic status (SES) communities who achieved sufficient physical activity (PA) with those who did not. The socioecological model of health guided interviews with men (n=25) and community health workers (n=4) to explore individual, interpersonal, organizational, community, environmental and policy influences on PA participation. Men generally reported that they had poor health, financial barriers, were unfamiliar with community PA facilities and programs, had limited social support, and lived in unsafe neighbourhoods. There were clear differences between active and inactive men. Inactive men described their inability to cope with poor health, and consequent perceptions of disconnection. They did not identify positive PA outcomes and seemed consumed by stressful life situations. Active men identified barriers to existing programs such as the exclusive culture of PA facilities. It is important that personal circumstances are understood, and financial and cultural barriers addressed to promote PA among men from low SES communities.

Training and experience of nurses in responding to alcohol misuse in rural communities

Objective Alcohol misuse by farmers continues to challenge rural nurses. This article reports on the experiences of Australian nurses participating in the Alcohol Intervention Training Program (AITP).

Design and Sample Qualitative interviews of 15 rural and remote nurses.

Measures Semi-structured phone interviews were utilized to assess the response to and implementation of the AITP—an intervention designed to build nurses' knowledge, confidence and skills when responding to alcohol misuse. It comprises practical and theoretical components and was designed for rural and remote settings where nurses encounter alcohol misuse.

Results Nurses found the training provided new—or built on existing—knowledge of alcohol misuse and offered practical hands-on “real life” skills. A range of workplace and personal situations where the content of the training was now being utilized were identified, and future use anticipated. Barriers to using the new knowledge and skills included both rural and generic issues. Constructive feedback to increasingly target the training to rural settings was recommended.

Conclusions The AITP is an effective training program. It can be further tailored to meet common needs of rural and remote nurses working with farmers who misuse alcohol, while recognizing diversity in rural practice.

Cardiovascular disease risk in the offspring of diabetic women: the impact of the intrauterine environment

The incidence of gestational diabetes is increasing worldwide, exposing large numbers of infants to hyperglycaemia whilst in utero. This exposure may have a long-term negative impact on the cardiovascular health of the offspring. Novel methods to assess cardiovascular status in the neonatal period are now available—including measuring arterial intima-media thickness and retinal photography. These measures will allow researchers to assess the relative impact of intrauterine exposures, distinguishing these from genetic or postnatal environmental factors. Understanding the long-term impact of the intrauterine environment should allow the development of more effective health policy and interventions to decrease the future burden of cardiovascular disease. Initiating disease prevention aimed at the developing fetus during the antenatal period may optimise community health outcomes.

The Virtualopolis archipelago: creatively interconnecting work-based virtual scenarios

One of the key elements of a quality student experience in higher education, outlined in the 2008 Bradley Report on the review of Australian higher education, is access to well-designed and engaging courses that lead to good vocational outcomes. 1 The Virtualopolis project concerns the development of a virtual city or platform which can encompass a community or vocational context for learning resources, linking these to engaging course delivery across disciplines and faculties. It is a virtual community with great potential to scaffold the imaginative immersion of the modem net generation learner. It was designed to incorporate virtual scenarios which were already in use, such as the country town of Bilby and the Pacific-style island of Newlandia, and has expanded to provide a virtual city of Virtualopolis across faculties and disciplines. One of the key strengths of this form of virtual environment is its capacity to focus on graduate attributes across disciplines. Virtualopolis provides access and a virtual city context to an interactive teamwork scenario, to develop attributes related to working with others, interrelating virtual business entities across all faculties. The teamwork scenario has multiple applications, with capacity to be a hurdle requirement, assessment item or training activity depending on the needs of the faculty's Work-integrated Leaming (WIL) policy. By developing the online virtual framework or platform of Virtualopolis, work-integrated team assessment can be used as skills preparation for experiential learning units such as internships, professional experience and workplace-based projects university-wide. It also provides the opportunity to repeatedly reuse the virtual city context for resources to support other courses. The Virtualopolis city and its interactive team scenario will be transferable for future cross-faculty and interdisciplinary virtual developments. Plans are already made for content areas as diverse as community health, nursing, creative arts, international relations and management.

Formative evaluation of baby makes 3

Baby Makes 3 was originally developed by Whitehorse Community Health Service and the City of Whitehorse as a program which seeks to prevent violence by promoting respect and equality between couples who have recently become parents for the first time. This is a significant but often stressful event in the life of families and it is not uncommon for couples to adopt ways of relating which reflect gendered norms and foster inequality.
By being offered as a program to all first-time parents by maternal and child health staff, the program in Whitehorse managed to engage with couples at this critical time, many of whom found the program enabled them to adopt greater equality in their relationships. As such, the initial Baby Makes 3 program has been found to be an effective and cost-efficient violence prevention strategy (Flynn, 2011).
The introduction of Baby Makes 3 to the Great South Coast Region is the first time this program has been implemented in a non-metropolitan setting. In addition to the original program aims, a number of additional aims and activities have been added, with the new project being known as Baby Makes 3 Plus.
Programs developed in urban contexts often face different challenges when implemented in rural and regional settings. Likewise, the factors for facilitating success may vary from those in an urban setting (Maidment and Bay, 2012). Hence, this formative evaluation aims to provide feedback on the initial implementation of the original Baby Makes 3 program in the Great South Coast Region with the expectation this will enable problems with implementation and/or opportunities for further enhancement of outcomes to be identified and appropriate action taken.

A qualitative evaluation of an intervention for parents of adolescents with mental disorders: the parenting challenging adolescents seminar

This qualitative study describes parents’ responses to a targeted and brief educational seminar (known as ‘Parenting Challenging Adolescents’), and provides recommendations for brief parenting interventions designed to engage adolescents in mental health treatment. The 2-h intervention was designed to assist parents who were concerned about their adolescents and in the identification of mental disorders. Participants were invited to attend the seminars conducted in a community setting on the basis of local advertising and promotion of the event with community health services and schools. Any parent of a young person aged 12–25 interested in the seminar material was eligible to attend. Sixteen parents completed measures of parent and youth mental health and family satisfaction and were also interviewed using semi-structured telephone interviews 4 weeks after the seminar. Interpretational phenomenological analysis of interviews suggested that most parents valued the chance to connect with others in similar situations and appreciated knowing about local services available for mental health disorders. Many parents also reported positive changes to communication and family dynamics following the seminar. Another common theme was an increased knowledge of mental disorders and appropriate treatments, along with the desire to receive more specific, targeted information. Overall the findings suggest that even a single session of educational material designed for parents may be useful, engaging and potentially encourage improved service usage for adolescents with mental disorders.

Preventing obesity in infants: the growing healthy feasibility trial protocol

INTRODUCTION: Early childhood is an important period for establishing behaviours that will affect weight gain and health across the life course. Early feeding choices, including breast and/or formula, timing of introduction of solids, physical activity and electronic media use among infants and young children are considered likely determinants of childhood obesity. Parents play a primary role in shaping these behaviours through parental modelling, feeding styles, and the food and physical activity environments provided. Children from low socio-economic backgrounds have higher rates of obesity, making early intervention particularly important. However, such families are often more difficult to reach and may be less likely to participate in traditional programs that support healthy behaviours. Parents across all socio-demographic groups frequently access primary health care (PHC) services, including nurses in community health services and general medical practices, providing unparalleled opportunity for engagement to influence family behaviours. One emerging and promising area that might maximise engagement at a low cost is the provision of support for healthy parenting through electronic media such as the Internet or smart phones. The Growing healthy study explores the feasibility of delivering such support via primary health care services.

METHODS: This paper describes the Growing healthy study, a non-randomised quasi experimental study examining the feasibility of an intervention delivered via a smartphone app (or website) for parents living in socioeconomically disadvantaged areas, for promoting infant feeding and parenting behaviours that promote healthy rather than excessive weight gain. Participants will be recruited via their primary health care practitioner and followed until their infant is 9 months old. Data will be collected via web-based questionnaires and the data collected inherently by the app itself.

ETHICS AND DISSEMINATION: This study received approval from the University of Technology Sydney Ethics committee and will be disseminated via peer-reviewed publications and conference presentations.

An exploration of how clinician attitudes and beliefs influence the implementation of lifestyle risk factor management in primary healthcare: a grounded theory study

Background

Despite the effectiveness of brief lifestyle intervention delivered in primary healthcare (PHC), implementation in routine practice remains suboptimal. Beliefs and attitudes have been shown to be associated with risk factor management practices, but little is known about the process by which clinicians' perceptions shape implementation. This study aims to describe a theoretical model to understand how clinicians' perceptions shape the implementation of lifestyle risk factor management in routine practice. The implications of the model for enhancing practices will also be discussed.

Methods

The study analysed data collected as part of a larger feasibility project of risk factor management in three community health teams in New South Wales (NSW), Australia. This included journal notes kept through the implementation of the project, and interviews with 48 participants comprising 23 clinicians (including community nurses, allied health practitioners and an Aboriginal health worker), five managers, and two project officers. Data were analysed using grounded theory principles of open, focused, and theoretical coding and constant comparative techniques to construct a model grounded in the data.

Results

The model suggests that implementation reflects both clinician beliefs about whether they should (commitment) and can (capacity) address lifestyle issues. Commitment represents the priority placed on risk factor management and reflects beliefs about role responsibility congruence, client receptiveness, and the likely impact of intervening. Clinician beliefs about their capacity for risk factor management reflect their views about self-efficacy, role support, and the fit between risk factor management ways of working. The model suggests that clinicians formulate different expectations and intentions about how they will intervene based on these beliefs about commitment and capacity and their philosophical views about appropriate ways to intervene. These expectations then provide a cognitive framework guiding their risk factor management practices. Finally, clinicians' appraisal of the overall benefits versus costs of addressing lifestyle issues acts to positively or negatively reinforce their commitment to implementing these practices.

Conclusion

The model extends previous research by outlining a process by which clinicians' perceptions shape implementation of lifestyle risk factor management in routine practice. This provides new insights to inform the development of effective strategies to improve such practices.

Ageing, chronic disease and injury: a study in western Victoria (Australia)

Background : An increasing burden of chronic disease and associated health service delivery is expected due to the ageing Australian population. Injuries also affect health and wellbeing and have a long-term impact on health service utilisation. There is a lack of comprehensive data on disease and injury in rural and regional areas of Australia. The aim of the Ageing, Chronic Disease and Injury study is to compile data from various sources to better describe the patterns of chronic disease and injury across western Victoria.

Design : Ecological study.

Methods : Information on demographics, socioeconomic indicators and lifestyle factors are obtained from health surveys and government departments. Data concerning chronic diseases and injuries will be sourced from various registers, health and emergency services, local community health centres and administrative databases and compiled to generate profiles for the study region and for sub-populations within the region.

Expected impact for public health: This information is vital to establish current and projected population needs to inform policy and improve targeted health services delivery, care transition needs and infrastructure development. This study provides a model that can be replicated in other geographical settings.

A systematic review of published interventions for primary and secondary prevention of ischaemic heart disease (IHD) in rural populations of Australia

BACKGROUND: Rural Australians are known to experience a higher burden of ischaemic heart disease (IHD) than their metropolitan counterparts and the reasons for this appear to be highly complex and not well understood. It is not clear what interventions and prevention efforts have occurred specifically in rural Australia in terms of IHD. A summary of this evidence could have implications for future action and research in improving the health of rural communities. The aim of this study was to review all published interventions conducted in rural Australia that were aimed at the primary and/or secondary prevention of ischaemic heart disease (IHD) in adults.

METHODS: Systematic review of the peer-reviewed literature published between January 1990 and December 2015. Search terms were derived from four major topics: (1) rural; (2) ischaemic heart disease; (3) Australia and; (4) intervention/prevention. Terms were adapted for six databases and three independent researchers screened results. Studies were included if the published work described an intervention focussed on the prevention or reduction of IHD or risk factors, specifically in a rural population of Australia, with outcomes specific to participants including, but not limited to, changes in diet, exercise, cholesterol or blood pressure levels.

RESULTS: Of 791 papers identified in the search, seven studies met the inclusion criteria, and one further study was retrieved from searching reference lists of screened abstracts. Typically, excluded studies focused on cardiovascular diseases without specific reference to IHD, or presented intervention results without stratification by rurality. Larger trials that included metropolitan residents without stratification were excluded due to differences in the specific needs, characteristics and health service access challenges of rural populations. Six interventions were primary prevention studies, one was secondary prevention only and one included both primary and secondary intervention strategies. Two interventions were focussed exclusively on Aboriginal and Torres Strait Islander (Australian Indigenous) populations.

CONCLUSIONS: Few interventions were identified that exclusively focussed on IHD prevention in rural communities, despite these populations being at increased risk of IHD in Australia, and this is consistent with comparable countries, internationally. Although limited, available evidence shows that primary and secondary interventions targeted at IHD and related risk factors can be effective in a rural setting.

Creating healthy workplaces. Final report: reducing workplace stress

Deakin University developed and tested a range of tailored, needs-based approaches to preventing stress at Victoria Police and Eastern Access Community Health (EACH) Social and Community Health. At Victoria Police trial sites, a supportive leadership program was developed for senior staff supervising junior officers, an online workload management system was developed to better track correspondence and workloads and Mental Health First Aid training was delivered. At EACH, a supportive leadership development program for all managers was developed in addition to the creation of a ‘wellbeing day’ and staff resiliency workshops.

Health status and participation in a range of activities in an Australian community

Introduction: The aim of the research was to determine the relationship between levels of participation in a community and self-assessed health status of people in a rural and regional setting.
Method: A cross-sectional design, using a mailed, self-administered questionnaire was used. Questionnaires were mailed to a random sample of people aged 18 years and over who were registered on the electoral roll of a regional city and rural area, the Barwon and Otway regions of Victoria, Australia. The sample consisted of 1752 participants: 990 females (57%), 739 males (42%) and 23 sex undisclosed (1%). The range of participants was 18-98 years, and the mean age was 50.53 years (SD = 17.19).
Results: Self-assessed physical and mental health were measured using the SF-12 scale. Participants with low incomes, and those with low self-assessed physical and mental health scores, were significantly more likely than other participants to agree with one or more of the social isolation items, indicating that they experienced some social isolation. Low levels of participation in social, sports, leisure or support activities were associated with low self-assessed physical and mental health. Disengagement with the local community was associated with low levels of self-assessed mental health. While younger people were more likely than older people to participate in social, sports, leisure or support activities, they were less involved as members of their community. Females were more likely than males to have been involved in five or more sports, leisure or support activities. Participation in civic activities was associated with high income. Levels of participation in the four different types of activities were combined (social activities, sport, leisure or support activities, community and group activities, and civic activities). Participants classified as low participators were more likely to be older participants, to have a low income and to have low scores for both physical and mental health.
Conclusions: An association was found between health and community participation in a range of activities, and between health and engagement with the community in this rural and regional population. These findings are consistent with those reported from similar research with a metropolitan population sample. The current research suggests that the groups of people of most concern in terms of low participation rates, are people who have low incomes, people aged over 65 years, people who may be defined as possessing poor physical health and people who may be defined as possessing poor mental health. The relationship between age, community participation and health is complex and needs further exploration because it is not known whether poor health reduces community participation or whether reduced community participation results in poor health. However, current research suggests that developing and implementing strategies to promote people's engagement with and involvement in their local community is one important way of promoting the health of the community as a whole.