Young women’s experiences as consumers of maternity care in Queensland

Background: Young motherhood is commonly associated with vulnerabilities, stereotyping of young women’s behaviour and poor outcomes for them and their children. The objective was to understand how maternity care is experienced for this group in the transition to parenthood. Methods: Data from a large-scale 2010 survey of women’s experience of maternity care were analysed using qualitative methods with open text responses. Results: 7,193 women responded to the survey: 237 were aged 20 years or less. Most (83%) of these young women provided open text responses. The main themes were: ‘being a consumer’, ‘the quality of care’, ‘needing support’ and ‘pride in parenthood’ while subthemes included ‘being young’ and ‘how staff made me feel’, ‘testimonials for staff’, ‘not being left’ and ‘it’s all worthwhile’. Conclusion: Many young women responding described a positive experience. For many first time mothers this marked a positive change in their identity. Nevertheless staff perceptions and attitudes affected how they saw themselves and what they took away from their experience of maternity care. A key message for other women supported and reinforced their role as active and involved consumers who, in engaging with services, have to stand up for themselves and make their needs and wishes known.

Inadequate management of medicines by the older-aged living in a retirement village

BACKGROUND: A comparison of the management of medicines by the older-aged living in freehold (fully owned) and rental homes in retirement villages has suggested that the older-aged living in rental, but not freehold, retirement villages may require help to manage their medicines. OBJECTIVE: The objective of this study was to investigate the management of medicines by the older-aged living independently in a leasehold (partly owned) home in retirement village to determine whether they also need help in managing their medicines. METHOD: Semi-structured interviews were conducted with 22 older-aged residents living in a leasehold retirement village. MAIN OUTCOME MEASURE: The main outcome measure was the perception of present and ongoing adherence. RESULTS: Amongst participants in the leasehold retirement village, with an average age of 82.9 years, the perceptions of present and ongoing adherence indicated that only 55 % of older-aged participants were adherent at the time of the study, and not likely to have problems with adherence within the next 6-12 months. Participants from the leasehold retirement village had a good understanding of 58 % of their illnesses. A mean of 9.8 medicines per person were prescribed. Cardiovascular medicines were the most commonly prescribed at 86 %. CONCLUSION: The older-aged living in leasehold retirement villages may require extra assistance/resources to manage their medicines.

Exploring cultural, social and psychosocial influences on women's drinking across the life span

Background Changing trends in women's alcohol consumption have demonstrated that women, in both younger and older cohorts, are drinking at increased levels than previously. However, little research investigates these changing trends or the influences behind them. Aims The current research aims to identify influences on women's drinking across a range of age groups, with a focus on multiple level influences (i.e. cultural, social and psychosocial). Methods One hour semi-structured telephone interviews were conducted, in 2011, with 35 women (aged 18-55) residing in Australia. Interview development was guided by an adaptation of Bronfenbrenner's Bioecological Model of Development (BBMD) to assess multiple areas of influences from cultural through to psychosocial. Results Interview findings highlighted the existence of multiple levels of influence on women’s drinking and thus provided support for the BBMD framework. Cultural influences identified related to gender roles and national identity. Exosystem influences (e.g. legislation, infrastructure, and media) and Microsystem influences (e.g. immediate social networks) were also identified. A range of psychosocial factors, such as identity, normative influence and attitude were also found as influencing drinking behaviours. Finally, changes across a woman’s life span, and intergenerational differences, were Chronosystem constructs that also emerged as key influences. Discussion and conclusions This study has provided an in-depth understanding into the key factors, occurring across multiple levels of influence, impacting upon women's drinking across younger and older cohorts. The findings also highlight changes in alcohol-related attitudes and behaviours across a life span and across generations. Future research should extend upon these findings based on larger, quantitative studies based on representative samples. The findings do provide key insights into the influences that need to be addressed within targeted interventions.

A wound management education and training needs analysis of health consumers and the relevant health workforce and stocktake of available education and training activities and resources

The goals of this project were to determine the education and training needs of health consumers and the relevant health workforce and to identify and map the available education and training activities and resources. The methods used to collect the data included online surveys and one on one interviews of relevant patients and their carers. The project manager actively sought to engage with the key wound management leaders and advanced clinicians to gain their support and views on the priority education and training issues. The response to all data collection methods was pleasing with almost five hundred responses to the general wound workforce online survey. The data supported the need for more wound management education and training and identified some particular topics of need, such as utilising wound investigations and understanding wound products, pharmaceuticals and devices. The occupational groups with the highest need appear to be those working in primary health care, such as practice nurses and GPs, and those working in residential aged care facilities. The education and training stocktake identified a wide range of activities currently available, the majority being provided in a face to face format. The next stage of the project will be to form some clear and achievable priority action areas based on the available data. An online directory of wound management education and training activities and resources will be developed and further development will be undertaken on a knowledge and skills framework for the wound management workforce. Additionally, transfer of learning factors in the general practice environment will be assessed and strategies will be developed to improve the pre-entry or undergraduate wound management training within relevant higher education programs.

An evaluation of dog-assisted therapy for residents of aged care facilities with dementia.

Although some research suggests that dog-assisted therapy may be beneficial for people with dementia living in residential aged care facilities, the intervention has not been adequately investigated. To address this shortcoming, we conducted a randomized controlled trial of dog-assisted therapy versus a human-therapist-only intervention for this population. Fifty-five residents with mild to moderate dementia living in three Australian residential aged care facilities completed an 11-week trial of the interventions. Allocation to the intervention was random and participants completed validated measures of mood, psychosocial functioning, and quality of life (QOL), both prior to and following the intervention. No adverse events were associated with the dog-assisted intervention, and following it participants who had worse baseline depression scores demonstrated significantly improved depression scores relative to participants in the human-therapist-only intervention. Participants in the dogassisted intervention also showed significant improvements on a measure of QOL in one facility compared with those in the human-therapist-only group (although worse in another facility that had been affected by an outbreak of gastroenteritis). This study provides some evidence that dog-assisted therapy may be beneficial for some residents of aged care facilities with dementia.

Emergency Health Services (EHS) : demand and service delivery models. monograph 3 : patients’ reasons and perceptions

Executive Summary Emergency health is a critical component of Australia’s health system and emergency departments (EDs) are increasingly congested from growing demand and blocked access to inpatient beds. The Emergency Health Services Queensland (EHSQ) study aims to identify the factors driving increased demand for emergency health and to evaluate strategies which may safely reduce the future demand growth. This monograph addresses the perspectives of users of both ambulance services and EDs. The research reported here aimed to identify the perspectives of users of emergency health services, both ambulance services and public hospital Emergency Departments and to identify the factors that they took into consideration when exercising their choice of location for acute health care. A cross-sectional survey design was used involving a survey of patients or their carers presenting to the EDs of a stratified sample of eight hospitals. A specific purpose questionnaire was developed based on a novel theoretical model which had been derived from analysis of the literature (Monograph 1). Two survey versions were developed: one for adult patients (self-complete); and one for children (to be completed by parents/guardians). The questionnaires measured perceptions of social support, health status, illness severity, self-efficacy; beliefs and attitudes towards ED and ambulance services; reasons for using these services, and actions taken prior to the service request. The survey was conducted at a stratified sample of eight hospitals representing major cities (four), inner regional (two) and outer regional and remote (two). Due to practical limitations, data were collected for ambulance and ED users within hospital EDs, while patients were waiting for or under treatment. A sample size quota was determined for each ED based on their 2009/10 presentation volumes. The data collection was conducted by four members of the research team and a group of eight interviewers between March and May 2011 (corresponding to autumn season). Of the total of 1608 patients in all eight emergency departments the interviewers were able to approach 1361 (85%) patients and seek their consent to participate in the study. In total, 911 valid surveys were available for analysis (response rate= 67%). These studies demonstrate that patients elected to attend hospital EDs in a considered fashion after weighing up alternatives and there is no evidence of deliberate or ill-informed misuse. • Patients attending ED have high levels of social support and self-efficacy that speak to the considered and purposeful nature of the exercise of choice. • About one third of patients have new conditions while two thirds have chronic illnesses • More than half the attendees (53.1%) had consulted a healthcare professional prior to making the decision. • The decision to seek urgent care at an ED was mostly constructed around the patient’s perception of the urgency and severity of their illness, reinforced by a strong perception that the hospital ED was the correct location for them (better specialised staff, better care for my condition, other options not as suitable). • 33% of the respondent held private hospital insurance but nevertheless attended a public hospital ED. Similarly patients exercised considered and rational judgements in their choice to seek help from the ambulance service. • The decision to call for ambulance assistance was based on a strong perception about the severity of the illness (too severe to use other means of transport) and that other options were not considered appropriate. • The decision also appeared influenced by a perception that the ambulance provided appropriate access to the ED which was considered most appropriate for their particular condition (too severe to go elsewhere, all facilities in one spot, better specialised and better care). • In 43.8% of cases a health care professional advised use of the ambulance. • Only a small number of people perceived that ambulance should be freely available regardless of severity or appropriateness. These findings confirm a growing understanding that the choice of professional emergency health care services is not made lightly but rather made by reasonable people exercising a judgement which is influenced by public awareness of the risks of acute health and which is most often informed by health professionals. It is also made on the basis of a rational weighing up of alternatives and a deliberate and considered choice to seek assistance from a service which the patient perceived was most appropriate to their needs at that time. These findings add weight to dispensing with public perceptions that ED and ambulance congestion is a result of inappropriate choice by patients. The challenge for health services is to better understand the patient’s needs and to design and validate services that meet those needs. The failure of our health system to do so should not be grounds for blaming the patient, claiming inappropriate patient choices.

A stepped-wedge cluster randomised controlled trial for evaluating rates of falls among inpatients in aged care rehabilitation units receiving tailored multimedia education in addition to usual care : a trial protocol

Introduction Falls are the most frequent adverse event reported in hospitals. Approximately 30% of in-hospital falls lead to an injury and up to 2% result in a fracture. A large randomised trial found that a trained health professional providing individualised falls prevention education to older inpatients reduced falls in a cognitively intact subgroup. This study aims to investigate whether this efficacious intervention can reduce falls and be clinically useful and cost-effective when delivered in the real-life clinical environment. Methods A stepped-wedge cluster randomised trial will be used across eight subacute units (clusters) which will be randomised to one of four dates to start the intervention. Usual care on these units includes patient's screening, assessment and implementation of individualised falls prevention strategies, ongoing staff training and environmental strategies. Patients with better levels of cognition (Mini-Mental State Examination >23/30) will receive the individualised education from a trained health professional in addition to usual care while patient's feedback received during education sessions will be provided to unit staff. Unit staff will receive training to assist in intervention delivery and to enhance uptake of strategies by patients. Falls data will be collected by two methods: case note audit by research assistants and the hospital falls reporting system. Cluster-level data including patient's admissions, length of stay and diagnosis will be collected from hospital systems. Data will be analysed allowing for correlation of outcomes (clustering) within units. An economic analysis will be undertaken which includes an incremental cost-effectiveness analysis. Ethics and dissemination The study was approved by The University of Notre Dame Australia Human Research Ethics Committee and local hospital ethics committees. Results The results will be disseminated through local site networks, and future funding and delivery of falls prevention programmes within WA Health will be informed. Results will also be disseminated through peer-reviewed publications and medical conferences.

Understanding the fabric of social interactions for ridesharing through mining social networking sites

The design of applications for dynamic ridesharing or carpooling is often formulated as a matching problem of connecting people with an aligned set of transport needs within a reasonable interval of time and space. This problem formulation relegates social connections to being secondary factors. Technology assisted ridesharing applications that put the matching problem first have revealed that they suffer from being unable to address the factor of social comfort, even after adding friend features or piggybacking on social networking sites. This research aims to understand the fabric of social interactions through which ridesharing happens. We take an online observation approach in order to understand the fabric of social interactions for ridesharing that is happening in highly subscribed online groups of local residents. This understanding will help researchers to identify design challenges and opportunities to support ridesharing in local communities. This paper contributes a fundamental understanding of how social interactions and social comfort precede rideshare requests in local communities.

‘We need to know what’s going on’: views of family members toward the sexual expression of people with dementia in residential aged care

This paper reports on a study which explored the views and attitudes of family members towards the sexual expression of residents with dementia in residential aged care facilities in two states in Australia. Recruitment was challenging and only seven family members agreed to an interview on this topic. Data were analysed using a constant comparative method. Family were generally supportive of residents’ rights to sexual expression, but only some types of behaviours were approved of. There was an acknowledgement that responding to residents’ sexuality was difficult for staff and many families believed that they should be kept informed of their relative’s sexual behaviours and moreover be involved in decision making about it. Findings suggest the need for family education and a larger study to better understand the views and motivations of family carers and how these might impact on the sexual expression of the older person with dementia living in residential aged care.

A comparison of children's needs models in the Australian and Chinese context

The diverse needs of children have been drawing global attention from both academic and practitioner communities. Based on semi-structured interviews with 23 kin caregivers and five school personnel in the Shijiapu Town of Jilin Province, China, this paper presents a needs model for rural school-age children left behind by their migrant parents. This Chinese model is compared to the needs identification mechanism developed by the Australian Research Alliance for Children and youth. The paper outlines the common needs of children in different contexts, and also highlights the needs that are not explicit in the Australian Research Alliance for Children and Youth framework, such as empowerment and agency or perhaps given insufficient weight, such as education. In discussing relationships among different needs, aspects that are missing in the framework it is argued that culture should be more explicitly recognised when defining need.

Motivating domestic energy conservation through comparative feedback in mobile applications and social networking sites

The progress of technology has led to the increased adoption of energy monitors among household energy consumers. While the monitors available on the market deliver real-time energy usage feedback to the consumer, the form of this data is usually unengaging and mundane. Moreover, it fails to address consumers with different motivations and needs to save and compare energy. This master‟s thesis project presents a study that seeks to inform design guidelines for differently motivated energy consumers. The focus of the research is on comparative feedback supported by a community of energy consumers. In particular, the discussed comparative feedback types are explanatory comparison, temporal self-comparison, norm comparison, one-on-one comparison and ranking, whereby the last three support exploring the potential of socialising energy-related feedback in social networking sites, such as Facebook. These feedback types were integrated in EnergyWiz – a mobile application that enables users to compare with their past performance, neighbours, contacts from social networking sites and other EnergyWiz users. The application was developed through a theory-driven approach and evaluated in personal, semi-structured interviews which provided insights on how motivation-related comparative feedback should be designed. It was also employed in expert focus group discussions which resulted in defining opportunities and challenges before mobile, social energy monitors. The findings have unequivocally shown that users with different motivations to compare and to conserve energy have different preferences for comparative feedback types and design. It was established that one of the most influential factors determining design factors is the people users compare to. In addition, the research found that even simple communication strategies in Facebook, such as wall posts and groups can contribute to engagement with energy conservation practices. The concept of mobility of the application was evaluated as positive since it provides place and time-independent access to the energy consumption data.

Building indicators in media assistance; four ways evaluation reports present “change”

The international aid and development community has supported programs that aim to build the capacity of media professionals or contribute to an enabling environment throughout the past 20 years. However, two decades on from the first modern media assistance programs, the sector is still struggling to identify, measure and understand the changes effected by their programs. There are questions raised as to whether it is even feasible to identify impacts on society and governance. This paper draws on some preliminary findings from a comparative thematic analysis of 47 evaluation documents of media assistance programs. The aim of this analysis is to identify trends in impact evaluation practice in the media assistance field, as well as the strengths and weaknesses of different evaluation approaches. This paper presents four types of social change claims commonly presented in reports; hypothetical changes, introduction of new opportunities, concrete examples of immediate impacts, and analysis of ongoing social and political changes. Although these types may appear as a spectrum from weak to strong, the interactions are perhaps more accurately understood using metaphors such as building blocks. This paper explores these types in more detail and suggests that a robust set of impacts-types could be useful in developing more grounded theories of change and indicators.

The serious and playful work of gender : talk and social order in a preschool classroom

This chapter reports some observations made of the social interactions of girls and boys, aged 3 to 5 years, in play situations in a preschool classroom of a childcare centre. It provides an alternate framework for early childhood educators to become aware of how preschool children construct their gendered social organizations. As girls and boys organise and build their social worlds of play through their talk-in-interaction, they are building their social orders. In this chapter, an analysis of one episode of children's play has, as its focus , the methods that some girls and boys use in their talk and activity to make sense of their everyday interactions. The analysis of play shows the children's real life work of constructing and maintaining gendered social orders in their lived everyday social worlds. A close reading of the transcript of an episode illustrates how two girls turn they boys' masculine practices o ritualized threats into performance. By so doing, they show that while they know masculine discourse, and can perform it themselves, they do not actually 'own' it in the same way that the boys do. In this way, gender is established not as a social density but as a shaped dynamic practice that is ongoing, build by relational encounters and shaped by the collective performances of the participants.

E-motion diaries : blogging emotional responses to online learning in higher education

Emotions are inherently social, and are central to learning, online interaction and literacy practices (Shen, Wang, & Shen, 2009). Demonstrating the dynamic sociality of literacy practice, we used e-motion diaries or web logs to explore the emotional states of pre-service high school teachers’ experiences of online learning activities. This is because the methods of communication used by university educators in online learning and writing environments play an important role in fulfilling students’ need for social interaction and inclusion (McInnerney & Roberts, 2004). Feelings of isolation and frustration are common emotions experienced by students in many online learning environments, and are associated with the success or failure of online interactions and learning (Su, et al., 2005). The purpose of the study was to answer the research question: What are the trajectories of pre-service teachers’ emotional states during online learning experiences? This is important because emotions are central to learning, and the current trend toward Massive Open Online Courses (MOOCs) needs research about students’ emotional connections in online learning environments (Kop, 2011). The project was conducted with a graduate class of 64 high school science pre-service teachers in Science Education Curriculum Studies in a large Australian university, including males and females from a variety of cultural backgrounds, aged 22-55 years. Online activities involved the students watching a series of streamed live lectures for the first 5 weeks providing a varied set of learning experiences, such as viewing science demonstrations (e.g., modeling the use of discrepant events). Each week, students provided feedback on learning by writing and posting an e-motion diary or web log about their emotional response. Students answered the question: What emotions did you experience during this learning experience? The descriptive data set included 284 online posts, with students contributing multiple entries. Linguistic appraisal theory, following Martin and White (2005), was used to regroup the 22 different discrete emotions reported by students into the six main affect groups – three positive and three negative: unhappiness/happiness, insecurity/security, and dissatisfaction/satisfaction. The findings demonstrated that the pre-service teachers’ emotional responses to the streamed lectures tended towards happiness, security, and satisfaction within the typology of affect groups – un/happiness, in/security, and dis/satisfaction. Fewer students reported that the streamed lectures triggered negative feelings of frustration, powerlessness, and inadequacy, and when this occurred, it often pertained to expectations of themselves in the forthcoming field experience in classrooms. Exceptions to this pattern of responses occurred in relation to the fifth streamed lecture presented in a non-interactive slideshow format that compressed a large amount of content. Many students responded to the content of the lecture rather than providing their emotional responses to this lecture, and one student felt “completely disengaged���. The social practice of online writing as blogs enabled the students to articulate their emotions. The findings primarily contribute new understanding about students' wide range of differing emotional states, both positive and negative, experienced in response to streamed live lectures and other learning activities in higher education external coursework. The is important because the majority of previous studies have focused on particular negative emotions, such as anxiety in test taking. The research also highlights the potentials of appraisal theory for studying human emotions in online learning and writing.

Projecting the impact of climate change on the transmission of Ross River virus : methodological challenges and research needs

Ross River virus (RRV) is the most common vector-borne disease in Australia. It is vitally important to make appropriate projections on the future spread of RRV under various climate change scenarios because such information is essential for policy-makers to identify vulnerable communities and to better manage RRV epidemics. However, there are many methodological challenges in projecting the impact of climate change on the transmission of RRV disease. This study critically examined the methodological issues and proposed possible solutions. A literature search was conducted between January and October 2012, using the electronic databases Medline, Web of Science and PubMed. Nineteen relevant papers were identified. These studies demonstrate that key challenges for projecting future climate change on RRV disease include: (1) a complex ecology (e.g. many mosquito vectors, immunity, heterogeneous in both time and space); (2) unclear interactions between social and environmental factors; and (3) uncertainty in climate change modelling and socioeconomic development scenarios. Future risk assessments of climate change will ultimately need to better understand the ecology of RRV disease and to integrate climate change scenarios with local socioeconomic and environmental factors, in order to develop effective adaptation strategies to prevent or reduce RRV transmission.