Service provision factors that affect the health and wellbeing of people living in a lower SES environment: the perspective of service providers

Inequalities in health and wellbeing within low socioeconomic (SES)  environments are well documented. Factors inherent to the health care system itself, such as inaccessible, inflexible or inappropriate seroiceprovision, contribute to the poorer health status ofresidents oflow SES areas. This paper explores the issues ofseroice provision in low SES areas, documenting the perceptions of seroice providers about the seroice needs of residents, in order to understand the systemic factors that negatively impact on health and wellbeing. A total of54 health and welfare seroice providers from two adjacent low SES suburbs within regional Victoria were interoiewed using qualitative research methods. Keyfindings indicate that successful navigation of health care seroices by residents within these low SES environments is being impeded by issues ofaccess, a lack ofappropriate early interoention options or measures, and general resident disempowerment. Central to the improvement of seroice provision is the need for seroices to become economically, geographically and culturally accessible. In particular, the importance of community involvement in health planning and health promoting seroices must be reflected in the ethos ofseroice provision.

Access to breast prostheses via a government-funded service in Victoria, Australia

For many women, the only alternative to breast reconstruction following a mastectomy is to use external prostheses, which need replacing regularly at a cost of up to $395 per prosthesis. Commonwealth and state governments across Australia have responded to this need by providing subsidies to assist in the purchase of breast prostheses. However, current arrangements have been highly variable and sometimes difficult to access. As part of a larger review of breast pros-thesis services in Victoria, Australia, the aim of this research was to evaluate client satisfaction among Victorian women who accessed funds through the State Government's Aids and Equipment Program, compare the responses of the program service providers with the experiences of clients accessing funding, and identify opportunities to improve service provision.

A qualitative study of primary health care access, barriers and satisfaction among people with mental illness

Research has found that a substantial proportion of individuals with mental illness have high morbidity and mortality rates, and high under-diagnosis of major physical illnesses. Furthermore, people with a mental illness tend not to seek out or utilise health care services. The reasons for the negative attitudes and behaviour towards health care services among this population have not been investigated. This paper presents findings from a study that investigated the health care service needs of people with mental illness (n = 20), and views from health care providers (n = 16) regarding access to these services by people with a mental illness. Results indicated that psychiatric patients identified a range of barriers to their health care usage and low levels of health care satisfaction. These views were shared with health care professionals. Reasons for these findings and strategies to address these problems so that there is better access to health care services for people with mental illness are discussed.

Barriers and enablers to healthcare access and use among Arabic-speaking and Caucasian English-speaking patients with type 2 diabetes mellitus: a qualitative comparative study

OBJECTIVE: The objective of this study was to explore the decision-making processes and associated barriers and enablers that determine access and use of healthcare services in Arabic-speaking and English-speaking Caucasian patients with diabetes in Australia. STUDY SETTING AND DESIGN: Face-to-face semistructured individual interviews and group interviews were conducted at various healthcare settings-diabetes outpatient clinics in 2 tertiary referral hospitals, 6 primary care practices and 10 community centres in Melbourne, Australia. PARTICIPANTS: A total of 100 participants with type 2 diabetes mellitus were recruited into 2 groups: 60 Arabic-speaking and 40 English-speaking Caucasian. DATA COLLECTION: Interviews were audio-taped, translated into English when necessary, transcribed and coded thematically. Sociodemographic and clinical information was gathered using a self-completed questionnaire and medical records. PRINCIPAL FINDINGS: Only Arabic-speaking migrants intentionally delayed access to healthcare services when obvious signs of diabetes were experienced, missing opportunities to detect diabetes at an early stage. Four major barriers and enablers to healthcare access and use were identified: influence of significant other(s), unique sociocultural and religious beliefs, experiences with healthcare providers and lack of knowledge about healthcare services. Compared with Arabic-speaking migrants, English-speaking participants had no reluctance to access and use medical services when signs of ill-health appeared; their treatment-seeking behaviours were straightforward. CONCLUSIONS: Arabic-speaking migrants appear to intentionally delay access to medical services even when symptomatic. Four barriers to health services access have been identified. Tailored interventions must be developed for Arabic-speaking migrants to improve access to available health services, facilitate timely diagnosis of diabetes and ultimately to improve glycaemic control.

Protocol for ACCESS : a qualitative study exploring barriers and facilitators to accessing the emergency contraceptive pill from community pharmacies in Australia

INTRODUCTION: The rate of unplanned pregnancy in Australia remains high, which has contributed to Australia having one of the highest abortion rates of developed countries with an estimated 1 in 5 women having an abortion. The emergency contraceptive pill (ECP) offers a safe way of preventing unintended pregnancy after unprotected sex has occurred. While the ECP has been available over-the-counter in Australian pharmacies for over a decade, its use has not significantly increased. This paper presents a protocol for a qualitative study that aims to identify the barriers and facilitators to accessing the ECP from community pharmacies in Australia.

METHODS AND ANALYSIS: Data will be collected through one-on-one interviews that are semistructured and in-depth. Partnerships have been established with 2 pharmacy groups and 2 women's health organisations to aid with the recruitment of women and pharmacists for data collection purposes. Interview questions explore domains from the Theoretical Domains Framework in order to assess the factors aiding and/or hindering access to ECP from community pharmacies. Data collected will be analysed using deductive content analysis. The expected benefits of this study are that it will help develop evidence-based workforce interventions to strengthen the capacity and performance of community pharmacists as key ECP providers.

ETHICS AND DISSEMINATION: The findings will be disseminated to the research team and study partners, who will brainstorm ideas for interventions that would address barriers and facilitators to access identified from the interviews. Dissemination will also occur through presentations and peer-reviewed publications and the study participants will receive an executive summary of the findings. The study has been evaluated and approved by the Monash Human Research Ethics Committee.

Medical-legal partnerships: the role of mental health providers and legal authorities in the development of a coordinated approach to supporting mental health clients' legal needs in regional and rural settings

INTRODUCTION: Medical-legal partnerships (MLP) are a model in which medical and legal practitioners are co-located and work together to support the health and wellbeing of individuals by identifying and resolving legal issues that impact patients' health and wellbeing. The aim of this article is to analyse the benefits of this model, which has proliferated in the USA, and its applicability in the context of rural and remote Australia.

METHODS: This review was undertaken with three research questions in mind: What is an MLP? Is service provision for individuals with mental health concerns being adequately addressed by current service models particularly in the rural context? Are MLPs a service delivery channel that would benefit individuals experiencing mental health issues?

RESULTS: The combined searches from all EBSCO Host databases resulted in 462 citations. This search aggregated academic journals, newspapers, book reviews, magazines and trade publications. After several reviews 38 papers were selected for the final review based on their relevance to this review question: How do MLPs support mental health providers and legal service providers in the development of a coordinated approach to supporting mental health clients' legal needs in regional and rural Australia?

CONCLUSIONS: There is considerable merit in pursuing the development of MLPs in rural and remote Australia particularly as individuals living in rural and remote areas have far fewer opportunities to access support services than those people living in regional and metropolitan locations. MLPS are important channels of service delivery to assist in early invention of legal problems that can exacerbate mental health problems.

"I will start treatment when I think the time is right":HIV-positive gay men talk about their decision not to access antiretroviral therapy.

In a qualitative study, 20 HIV-infected Australian gay men were interviewed about their decision not to access antiretroviral drug therapy. The main reasons given for the decision were fear of side effects; fear of long-term damage to body organs; the inconvenience of the treatment regimens; belief that the regimen's demands would be a threat to morale; and belief that there was no reason to start therapy in the absence of AIDS-related symptoms. Actions taken by the men to monitor and maintain their health included seeing a doctor regularly; having regular T-cell and viral load tests; and trying to maintain a positive outlook by not letting HIV/AIDS 'take over' their lives. Almost half the men considered they had been subjected to unreasonable pressure to access therapy and there was considerable pride at having resisted this pressure. The findings suggest that the men disagreed with the biomedical model for managing HIV/AIDS only on the question of if and when to access therapy. They also suggest that underlying the men's dissent from the biomedical model was a different mode of thinking than is required by the model: while the model demands thinking that is abstract, the men focused strongly on factors close to the 'here and now' of immediate experience. The practical implications of the findings are explored.

Access and attitude of rural allied health professionals to CPD and training

Continuing professional development (CPD) activities for allied health professionals are becoming mandatory as a means for professionals to maintain accreditation or skills. To access CPD activities, rural allied health professionals have the added costs of travel, accommodation and information technology access. It is assumed that health professionals in rural areas want access to training and CPD. In 2003, a survey of allied health professionals was carried out in Southwest Victoria, Australia, with the aim of identifying access and attitudes to CPD. Results showed that allied health professionals in Southwest Victoria were highly qualified, wished to access CPD more than four times a year and were prepared to spend a mean rate of $1000 (1300) per annum on CPD activities.

What about the men? Gender differences in utilisation of arthritis self-management services

As self-management programs for chronic illness increasingly become the domain of primary health care providers, it is important to consider gender inequities in access to these services and gender differences in patterns of use to inform the development and delivery of services. This study explores gender differences in levels and patterns of access to arthritis elf-management services by analyzing data collected from the Telephone Information Service of Arthritis Victoria, Contingency tables were analyzed and odds-ratios calculated to confirm gender differences in levels and patterns of service utilisation. Men were found to be significantly under-represented as users of the service, even after taking into account gender differences in prevalence of arthritis in the population. Women were more likely than men to contact the service on their own behalf. Men were more likely to have a family member or friend contact the services for them. Women showed more interest in learning about their condition while men focused more on symptom management. These gender differences in rates and patterns of services use indicate that services providers of self-management services for conditions such as arthritis need to take into account the interaction between gender and service utilisation.

Database access on the internet using mobile agent technology

Traditionally. accessing databases on the Internet is based on client/server paradigm (including web-based paradigm). However. there are some drawbacks when using the techniques. Mobile agent technology provides an excellent solution that can easily eliminate those disadvantages. By conducting a series of experiments and analyzing the experimental results, this paper presents in which circumstance mobile agents can outperform traditional client/server paradigm, and how they can overcome the shortcomings in client/server paradigm in database access on the Internet.

Public transport and pedestrian access, the impact of suburban planning on adolescence

The following paper discusses the impact of suburban life for adolescents in relation to public transport and pedestrian access. The research compares the morphology and level of connectivity of two planning models, cul-de-sac and regular grid, with respect to two suburbs which share a similar socio-economic profile, Rowville and Caulfield. These are subsequently evaluated in terms of ABS statistics, in particular year 12 or equivalent levels of education, and transport statistics. The results of the investigation are discussed in reference to the four key tasks of adolescence (Carr-Greg & Shale 2002)', in order to establish the degree to which morphology and access levels of suburbs impact on adolescent development.

Seniors in Australia: computer access patterns and barriers

Australia has an aging population with a subsequent increase in the number of people with acquired impairments who are at risk of being excluded from accessing technology. While technology can improve communication and information options for seniors, usage patterns and access barriers need to be assessed so that requirements can be met. This paper reports on the outcomes of a government funded study aimed at determining computer and Internet access use and barriers for seniors. Participants were 238 Seniors aged 60 and over who completed a survey; of these 30% indicated they had one or more impairments. Barriers identified related to cost; lack of information, training, access (at home or in the community), and interest; and attitudes related to age.