The making of an elder : Patricia Wrightson and Aboriginality

This volume is the product of the third conference of the Australian Children's Literature Association for Research held in Melbourne October 1999. The papers presented comprise an interesting cross section of current concerns about children's literature by the Australasian research community.

Study protocol for the translating research in elder care (TREC): Building context through case studies in long-term care project (project two)

Background: The organizational context in which healthcare is delivered is thought to play an important role in mediating the use of knowledge in practice. Additionally, a number of potentially modifiable contextual factors have been shown to make an organizational context more amenable to change. However, understanding of how these factors operate to influence organizational context and knowledge use remains limited. In particular, research to understand knowledge translation in the long-term care setting is scarce. Further research is therefore required to provide robust explanations of the characteristics of organizational context in relation to knowledge use.
Aim: To develop a robust explanation of the way organizational context mediates the use of knowledge in practice in long-term care facilities.
Design: This is longitudinal, in-depth qualitative case study research using exploratory and interpretive methods to explore the role of organizational context in influencing knowledge translation. The study will be conducted in two phases. In phase one, comprehensive case studies will be conducted in three facilities. Following data analysis and proposition development, phase two will continue with focused case studies to elaborate emerging themes and theory. Study sites will be purposively selected. In both phases, data will be collected using a variety of approaches, including non-participant observation, key informant interviews, family perspectives, focus groups, and documentary evidence (including, but not limited to, policies, notices, and photographs of physical resources). Data analysis will comprise an iterative process of identifying convergent evidence within each case study and then examining and comparing the evidence across multiple case studies to draw conclusions from the study as a whole. Additionally, findings that emerge through this project will be compared and considered alongside those that are emerging from project one. In this way, pattern matching based on explanation building will be used to frame the analysis and develop an explanation of organizational context and knowledge use over time. An improved understanding of the contextual factors that mediate knowledge use will inform future development and testing of interventions to enhance knowledge use, with the ultimate aim of improving the outcomes for residents in long-term care settings.

Elder boomers

Review of Falling and Flying: Poems on Ageing (ed. Judith Beverage & Susan Ogle)

An assessment of interventions that target risk factors for elder abuse

Although there is increasing concern about both the prevalence of, and harms associated with the abuse of older adults, progress in the development of interventions to prevent its occurrence has been slow. This paper reports the findings of a systematic review of the published literature that identified studies in which the outcomes of preventative interventions are described. A total of eight different intervention trials, published since 2004, are described across the primary, secondary and tertiary levels of prevention and in terms of the types of risk factor that they target. The current evidence to support the effectiveness of these interventions is not only limited by the small number of outcome studies but also the poor quality of evaluation designs and the focus of many interventions on single risk factors. It is concluded that work is needed to strengthen the evidence base that supports the delivery of interventions to prevent elder abuse.

Staying connected : the lived experiences of volunteers and older adults

Many housebound older adults lack meaningful social relationships. In this study we explore the phenomenon of social connectedness in the volunteer-older adult relationship through the experiences of frail and isolated older adults and volunteers. We conceptualise this relationship as a journey whereby each traveller plays an active role in its direction and outcome. The emergent phenomenological essence of social connectedness from these dyad’s narratives provides meaning for both differences and similarities into the way the construct is conceptualised. When volunteers maintain the boundaries of the relationship through structured conversation and visits, it is described as friendly. Transgressing the boundaries involves doing extra for the elder and is both a function of the dyad’s compatibility, and the volunteer’s sense of ongoing agency and lack of elder expectations. The sense of social connectedness inherent in these relationships often feels like that of friendship or family, and these relationships are perceived as meaningful and close for both parties. Social connectedness in family-like relationships is a function of the playing out of an otherwise missing family role. However, if volunteer volition is compromised, this results in feelings of obligation and responsibility, similar to the dynamic between blood relatives. Participants’ narratives suggest that when the boundaries of the relationship are mutually negotiated, this serves to strengthen the relationship’s socioemotional quality, and potential for the continuity of the unique sense of social connectedness that has already been established.

Review essay : insiders, outsiders, and shared stories

The article reviews several books including "Being Australian: Narratives of National Identity," by Catriona Elder, "Australian Pastoral: The Making of a White Landscape," by Jeanette Hoorn, and "The Australians: Insiders and Outsiders on the National Character Since 1770," by John Hirst.

Up to a quarter of the Australian population may have suboptimal health literacy depending upon the measurement tool : results from a population-based survey

The objective of this paper is to measure health literacy in a representative sample of the Australian general population using three health literacy tools; to consider the congruency of results; and to determine whether these assessments were associated with socio-demographic characteristics. Face-to-face interviews were conducted in a stratified random sample of the adult Victorian population identified from the 2004 Australian Government Electoral Roll. Participants were invited to participate by mail and follow-up telephone call. Health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM), Test of Functional Health Literacy in Adults (TOFHLA) and Newest Vital Sign (NVS). Of 1680 people invited to participate, 89 (5.3%) were ineligible, 750 (44.6%) were not contactable by phone, 531 (32%) refused and 310 (response rate 310/1591, 19.5%) agreed to participate. Compared with the general population, participants were slightly older, better educated and had a higher annual income. The proportion of participants with less than adequate health literacy levels varied: 26.0% (80/308) for the NVS, 10.6% (51 33/310) for the REALM and 6.8% (21/309) for the TOFHLA. A varying but significant proportion of the general population was found to have limited health literacy. The health literacy measures we used, while moderately correlated, appear to measure different but related constructs and use different cut offs to indicate poor health literacy.

Responding to domestic violence in primary care : we know more about what works but questions remain

This commissioned editorial examines what we know about responding to domestic violence in primary care in the light of the recent publication of findings from the first randomised controlled trial in the United Kingdom on domestic violence.

Assessing health literacy : a new domain for collaboration between language testers and health professionals

Health literacy, defined as an individual's capacity to process health information in order to make appropriate health decisions, is the focus of increasing attention in medical fields due to growing awareness that suboptimal health literacy is associated with poorer health outcomes. To explore this issue, a number of instruments, reported to have high internal consistency and strong correlations with general literacy tests, have been developed. However, their validity as measures of the target construct is seldom explored using multiple sources of evidence. The current study, involving collaboration between health professionals and language specialists, set out to assess the validity of the Rapid Estimate of Adult Literacy in Medicine (REALM), which describes itself as a “reading recognition” test that measures ability to pronounce common medical and lay terms. Drawing on a sample of 310 respondents, including both native and non-native speakers of English, investigations were undertaken to probe the REALM's validity as a measure of understanding the selected terms and to consider associations between scores on this widely used test and those derived from other recognized health literacy tests. Results suggest that the REALM is underrepresenting the health literacy construct and that the test may also be biased against non-native speakers of English. The study points to an expanded role for language testers, working in collaboration with experts from medical disciplines, in developing and evaluating health literacy tools.

Nursing home administrators’ perspectives on a study feedback report : a cross sectional survey

Background
This project is part of the Translating Research in Elder Care (TREC) program of research, a multi-level and longitudinal research program being conducted in 36 nursing homes in three Canadian Prairie Provinces. The overall goal of TREC is to improve the quality of care for older persons living in nursing homes and the quality of work life for care providers. The purpose of this paper is to report on development and evaluation of facility annual reports (FARs) from facility administrators’ perspectives on the usefulness, meaningfulness, and understandability of selected data from the TREC survey.
Methods
A cross sectional survey design was used in this study. The feedback reports were developed in collaboration with participating facility administrators. FARs presented results in four contextual areas: workplace culture, feedback processes, job satisfaction, and staff burnout. Six weeks after FARs were mailed to each administrator, we conducted structured telephone interviews with administrators to elicit their evaluation of the FARs. Administrators were also asked if they had taken any actions as a result of the FAR. Descriptive and inferential statistics, as well as content analysis for open-ended questions, were used to summarize findings.
Results
Thirty-one facility administrators (representing thirty-two facilities) participated in the interviews. Six administrators had taken action and 18 were planning on taking action as a result of FARs. The majority found the four contextual areas addressed in FAR to be useful, meaningful, and understandable. They liked the comparisons made between data from years one and two and between their facility and other TREC study sites in their province. Twenty-two indicated that they would like to receive information on additional areas such as aggressive behaviours of residents and information sharing. Twenty-four administrators indicated that FARs contained enough information, while eight found FARs ‘too short’. Administrators who reported that the FAR contained enough information were more likely to take action within their facilities than administrators who reported that they needed more information.
Conclusions
Although the FAR was brief, the presentation of the four contextual areas was relevant to the majority of administrators and prompted them to plan or to take action within their facility.

Feedback reporting of survey data to healthcare aides

Background

This project occurred during the course of the Translating Research in Elder Care (TREC) program of research. TREC is a multilevel and longitudinal research program being conducted in the three Canadian Prairie Provinces of Alberta, Saskatchewan, and Manitoba. The main purpose of TREC is to increase understanding about the role of organizational context in influencing knowledge use in residential long-term care settings. The purpose of this study was to evaluate healthcare aides’ (HCAs) perceptions of a one-page poster designed to feed back aggregated data (including demographic information and perceptions about influences on best practice) from the TREC survey they had recently completed.

Methods
A convenience sample of 7 of the 15 nursing homes participating in the TREC research program in Alberta were invited to participate. Specific facility-level summary data were provided to each facility in the form of a one-page poster report. Two weeks following delivery of the report, a convenience sample of HCAs was surveyed using one-to-one structured interviews.

Results
One hundred twenty-three HCAs responded to the evaluation survey. Overall, HCAs’ opinions about presentation of the feedback report and the understandability, usability, and usefulness of the content were positive. For each report, analysis of data and production and inspection of the report took up to one hour. Information sessions to introduce and explain the reports averaged 18 minutes. Two feedback reports (minimum) were supplied to each facility at a cost of CAN$2.39 per report, for printing and laminating.

Conclusions
This study highlights not only the feasibility of producing understandable, usable, and useful feedback reports of survey data but also the value and importance of providing feedback to survey respondents. More broadly, the findings suggest that modest strategies may have a positive and desirable effect in participating sites.