Using a qualitative approach to research to build trust between a non-Aboriginal researcher and Aboriginal participants (Australia)

This article focuses on the qualitative methodologies employed in a research project developed in collaboration with Aboriginal advisors and gaining an in-depth understanding of Aboriginal Victorian peoples' connection to their ancestral lands. It outlines why qualitative methodologies were used and highlights the ethical dimensions of working with Aboriginal Victorian communities. A research partnership was developed between Aboriginal Victorian communities and the non-Aboriginal researcher and this process was emphasised because in the past Australian Indigenous people have been grossly exploited in health research. The methods of semi-structured interviews and focus groups were used to gain a better understanding of this topic. The novel point of this article is that it provides an honest reflection of the benefits and limitations of this qualitative research process from the perspectives of a non-Aboriginal researcher and an Aboriginal participant, when emphasis is placed on a collaborative approach. The paper outlines what a successful qualitative research project looks like in Victorian Aboriginal communities. This can be used as a blueprint not only for working with Victorian Aboriginal communities, who have been marginalised within Australian society, but may also be relevant to other culturally diverse communities throughout the world.

Understanding children's sedentary behaviour : a qualitative study of the family home environment

Electronic media (EM) (television, electronic games and computer) use has been associated with overweight and obesity among children. Little is known about the time spent in sedentary behaviour (SB) among children within the family context. The aim of this study was to explore how the family home environment may influence children's electronic-based SB. Focus groups and family interviews were conducted with 11- to 12-year old children (n = 54) and their parents (n = 38) using a semi-structured discussion guide. Transcripts were analysed using a thematic content approach. A brief self-completed questionnaire was also used to measure leisure behaviour and electronic devices at home. Children incorporated both sedentary and physical activities into their weekly routine. Factors influencing children's EM use included parent and sibling modelling and reinforcement, personal cognitions, the physical home environment and household EM use rules and restrictions. Participants were not concerned about the excessive time children spent with EM. This under-recognition emerged as a personal influencing factor and was viewed as a major barrier to modifying children's electronic-based SB. Efforts to reduce SB in children should focus on the influencing factors that reciprocally interact within the family home. An emphasis on increasing awareness about the risks associated with spending excessive time in screen-based activities should be a priority when developing intervention strategies aimed at modifying the time children spend in SB.

Influences on preschool children's physical activity

This study explored mothers' perceptions of influences on preschoolers' physical activity. Six semistructured focus groups with 23 mothers were conducted across a range of socioeconomic position locations. Mothers identified 4 key areas of influence: child fundamentals (eg, sex, personality), parent power (eg, rules, support), people to share with (eg, peers, adults), and places and things (eg, physical environments, toys). No substantial differences in themes were identified among socioeconomic position groups. Influences on preschoolers' physical activity are multidimensional, multifactorial, and support the use of ecological models to conceptualize and understand the influencing factors. Associations among factors influencing preschoolers' physical activity should be further investigated through quantitative research.

An evaluation of a mental health screening and referral pathway for community nursing care : nurses' and general practitioners' perspectives

Aims and objectives. To evaluate a feasible, best practice mental health screening and referral clinical pathway for generalist community nursing care of war veterans and war widow(er)s in Australia.
Background. War veterans commonly experience mental health difficulties and do not always receive required treatment, as can also occur for war widow(er)s. Whenever opportunity arises, such as during community nursing care, it is vital to identify mental health problems in a health promotion framework.
Design. A clinical pathway was developed by literature review and consultation and then trialled and evaluated using mixed methods – quantitative and qualitative.
Methods. Community nurses who trialled the pathway completed an evaluation survey and attended focus groups. General practitioners responded to an evaluation survey.
Results. Most nurses found the pathway clear and easy to understand but not always easy to use. They emphasised the need to establish trust and rapport with clients prior to implementing the pathway. It was sometimes difficult to ensure effective referral to general practitioners for clients who screened positive for a mental health problem. When referral was accomplished, general practitioners reported adequate and useful information was provided. Some general practitioners also commented on the difficulty of achieving effective communication between general practitioners and nurses.
Conclusions. Nurses and some general practitioners found the pathway useful for their practice. They offered several suggestions for improvement by simplifying the trialled pathway and accompanying guidelines and strategies to improve communication between nurses and general practitioners. This study adds understanding of how community nurses might productively screen for mental health difficulties.
Relevance to clinical practice. The trialled pathway, which was modified and refined following the study, is an evidence-based
resource for community nurses in Australia and similar contexts to guide practise and maximise holistic care for war veterans and war widow(er)s and possibly other client groups.

Changing perspectives : teaching and learning centres’ strategic contributions to academic development in Australian higher education

This article reports on a study of Australian teaching and learning centres to identify factors that contribute to their effective strategic leadership. These centres remain in a state of flux, with seemingly endless reconfiguration. The drivers for such change appear to lie in decision makers’ search for their centres to add more strategic value to organisational teaching, learning and the student experience. Through a synthesis of findings based on interviews, a survey of directors of centres and focus groups, the article identifies paradigmatic shifts in the ways centres see themselves, relate to their organisations and respond to external environmental forces. From an understanding of paradigm shifts, strategic contributions to academic development in the sector are framed organisationally through key points of leverage. Points of leverage are manageable actions that can be taken to maximise overall institutional impact and effectiveness.

Nurse stress in hospital and satellite haemodialysis units

Focus groups of nurses from both in-centre and satellite dialysis units were undertaken followed by questionnaires. The In-centre nursing staff rated the busy-ness of the unit as the maximum stress. The mostly notable stressor for the staff at the satellite unit related to patient behaviour and the perceived unrealistic expectations of the patient followed by patients arriving unwell at the unit.

Nurses suffer stress on a daily basis in both in-centre and satellite dialysis units. The major stressors differ from in-centre to satellite dialysis units.

Need to know : lessons from Sino-Australian business negotiators on the importance of guanxi, emotions and generational differences in Chinese negotiation behaviour

The forces of globalisation over the last few decades have created opportunities for intemational business as never before, whilst leaving no organisation immune to competition. With the Global Financial Crisis impacting the world economy, the BRIC economies as a group - Brazil, Russia, India and China, have steadily benefited from continuing growth in 2008 and 2009 (Bhattacharya, Hemerling and Waltermann,2010). Despite China being a key international trading partner for Australia, the number of successful joint ventures and negotiations between the two countries remains limited. A closer examination of the international business interactions between Australia and China is thus urgently needed. When negotiating with the Chinese, Western managers may not always be aware of what they are really negotiating for. To be successful, they have to be equipped with the 'specialised knowledge', a form of 'tacit or implicit knowledge', which comes with experience (Nonaka, 1994, Pavesi, 2003) in communicating and negotiating with their Chinese counterparts. The Chinese way of business negotiation can challenge the logic of Western business thinking. This, coupled with possible generational differences or changes in the Chinese business counterpart's way of doing business, means we must try to understand the business communication and negotiation process from not only the Western but also the Chinese perspective. In particular, in addition to the contextual (Phatak, & Habib, 1996; Risberg, 1997), social (Ghauri, & Fang, 2001), and cognitive factors (George, Gareth, & Gonzalez, 1998) focused on by past researchers, the intangible aspects of negotiation must also be considered. These include trust, reputation, relationship quality (guanxi in the case of the Chinese), and the moods and emotions that shape the processes and outcomes of communication and negotiation (Griffith, 2002; Hartel & Ma, 2006; Ma & Hartel 2005; and Zhao & Krohmer, 2006). This paper reports on a qualitative investigation of the communication processes occurring in negotiations between Australian and Chinese managers and entrepreneurs. The examination is based on a theoretical framework looking at emotions and culture from an affective events theory (AET) perspective. Both interview and focus groups techniques were used. Findings identified guanxi, core to relationship development and maintenance in Chinese culture, together with emotions as major determining factors of negotiation outcomes. Findings also suggest there are generational differences in attitudes among Chinese managers with Gen. X and Gen. Y placing a different emphasis on guanxi in business. These findings suggest that the popular advice to people doing business in China is out of date.

Prescription medication hoarding and borrowing or sharing behaviours in older residents in the Illawarra, New South Wales, Australia

Aim: To examine prescription medication hoarding and borrowing or sharing (PMHBS) behaviours in older people, particularly which medications are subject to these behaviours and the circumstances that enable these behaviours.

Methods: A mixed methods triangulation design, using consecutive qualitative (focus groups) and quantitative (survey) methodologies in a convenience sample of people older than 65 years, living independently in the Illawarra region (New South Wales).

Results: Focus group participants (n= 28) acknowledged PMHBS behaviours were widespread; however, very few survey respondents (n= 226) admitted to engaging in these behaviours. Main findings in the study were enablers for these behaviours: the prescription medication is considered the same as that prescribed previously; and self-medicating for pain relief.

Conclusions: The prevalence of PMHBS behaviours in this study was low, although it was acknowledged such behaviours occurred in the wider community. Sharing strong pain medication and the same prescription medication appeared to be acceptable in this population.

A qualitative evaluation of a regional early psychosis service 3 years after its commencement

Objective. To outline the major findings of a qualitative evaluation of an Early Psychosis Service 3 years after its establishment.

Design. Data to evaluate the service were collected from team meetings, focus groups, individual interviews and questionnaires administered to clinicians, school staff, patients, carers and families.

Setting. Barwon Health; Mental Health, Drug and Alcohol Services provide public mental health care to the Geelong, Victoria, region (population 270 000), which is a mixed urban and rural setting. The Early Psychosis Service model implemented involved the placement of two early psychosis workers into each offive adult geographically based Area Mental Health Teams rather than the establishment of a single Early Psychosis Team.

Results. The service was found not to adhere to its original design in several key respects. Caseloads and periods of case management were found to be lower and shorter respectively than was originally planned for, caseworkers often experienced isolation and resentment from their adult service coworkers, the service was perceived to be difficult to access and premises not to be youth friendly and communication and engagement with external agencies and service providers was perceived to be poor.

Conclusions. The choice of service model, inadequate consultation with stakeholders and inadequate promotion of the service contributed to its failure to reach early expectations. Because of these and other issues, including difficulties distinguishing between early psychosis and non-psychosis, a decision was made to restructure youth services and

Barriers to blood donation in African communities in Australia: the role of home and host country culture and experience

BACKGROUND: An influx of African migrants and refugees can strain a host country's blood services, because often migrants have unique blood needs that cannot be sourced from local donors. To increase blood donation by the new migrants, host country blood services need to understand how blood and blood donations are viewed by immigrant communities, because recruitment models that are not culturally adapted may have limited success.

STUDY DESIGN AND METHODS: Nine focus groups representing a cross-section of Australian-based African communities were conducted in multiple languages, facilitated by bilingual workers. The qualitative protocol was guided by the literature on blood donation by African migrants and communities in Africa. Thematic analysis identified the relevance of issues previously included in the literature and whether other issues facilitated or prohibited blood donation.

RESULTS: Home country cultural issues were not generally raised as barriers to donation, and respondents were positively disposed toward donation. Home country experiences shaped respondents' views in Australia. Participants focused on assisting “individuals in need,” rather than giving to a blood service that many viewed with suspicion because of issues in their home country. There was a lack of knowledge about the donation process in Australia. More importantly, respondents perceived that their blood would not be wanted, based on a perception of host country mistrust and discrimination.

CONCLUSION: Developing an intervention that encourages migrants to donate blood needs to be culturally focused. It appears that addressing perceptions based on home country experiences is essential. Overcoming a general perception of discrimination is beyond any blood service, but there can be an attempt to ensure that blood donation is seen as an inclusive process—blood from everyone, for everyone.

Strategic leadership of teaching and learning centres : from reality to ideal

This paper reports on the third phase of a study of Australian Teaching and Learning Centres to identify factors that contribute to the effective strategic leadership of Centres. Focus groups at 10 Australian universities included 66 respondents, providing a diverse range of perspectives, from students to members of the university executive. Analysis of participant contributions extended findings from prior project phases and the wider literature. They also contributed to the final construction of the strategic leadership Teaching and Learning Centre maturity framework presented here. Centres remain in a state of flux, enduring regular reconfiguration. For most Centres, their level of interaction with students is low and increased engagement with students would be of benefit. Perceptions of Centres vary widely, reinforcing the importance of a strategic partnership between the University’s Senior Executive, the Centre and faculties as a prerequisite for implementing identified high-impact strategies for improvement in teaching and learning.

Implementation of diabetes prevention programs in rural areas : Montana and south-eastern Australia compared

Objective: To identify the key elements that enabled the Greater Green Triangle Diabetes Prevention Project (GGT DPP) and the Montana Cardiovascular Disease and Diabetes Prevention (CDDP) programs successful establishment and implementation in rural areas, as well as identifying specific challenges or barriers for implementation in rural communities.
Methods: Focus groups were held with the facilitators who delivered the GGT DPP in Australia and the Montana CDDP programs in the USA. Interview questions covered the facilitators’ experiences with recruitment, establishing the program, the components and influence of rurality on the program, barriers and challenges to delivering the program, attributes of successful participants, and the influence of community resources and partnerships on the programs.
Results: Four main themes emerged from the focus groups: establishing and implementing the diabetes prevention program in the community; strategies for recruitment and retention of participants; what works in lifestyle intervention programs; and rural-centred issues.
Conclusions: The results from this study have assisted in determining the factors that contribute to developing, establishing and implementing successful diabetes prevention programs in two rural areas. Recommendations to increase the likelihood of success of programs in rural communities include: securing funding early for the program; establishing support from community leaders and developing positive relationships with health care providers; creating a professional team with passion for the program; encouraging participants to celebrate their small and big successes; and developing procedures for providing post-intervention support to help participants maintain their success.

A further development in social marketing application of the MOA framework and behavioral implications

This social marketing study discusses the application of Rothschild’s MOA framework (Motivation, Opportunity, and Ability) in a land-use management context. The authors hypothesize that landholders with higher levels of MOA are positively associated with behavior that would result in the effective control of a vertebrate pest (the European rabbit). A random sample of 566 land managers in southeastern Australia was obtained. The development of scales associated with this study were the result of intensive qualitative research, including focus groups, in-depth interviews, and a thorough review of secondary resources. The scales were developed through a factor analytic process and were piloted and pre-tested before being used.

From the study it is ascertained that about one-third of land managers fall into the highest level of effective behavior, and for the remainder, social marketing interventions, using marketing, education, and the law, could be applied to changebehavior. The study provides evidence that Rothschild’s theoretical MOA framework can be applied to a social market and thus provides guidance on the types of interventions that may be effective in altering behavior. The MOA framework also provides a mechanism for segmentation that can be used to describe various markets and gives direction to the interventions that may be effective in altering behavior.

An investigation of issues in the teaching and management of large classes

In a quest for a more efficient education system, many organizations have opted to increase class size. It is a common perception that large subjects are economical to run and small subjects are not. Many in the tertiary education system have had concerns with issues involved in the teaching of large classes, including teaching quality and whether there are effective learning outcomes for students. As with any complex issue, there are several approaches that could be utilized to assess whether the needs of stakeholders are being met. Stakeholders include the institution, the teaching staff, the community and the students. This study aims to assess whether universities are satisfying the needs of students as class size is increased. The study focuses on satisfaction with large classes and includes an assessment of the satisfaction of students' psychological needs. These constructs are measured in small, medium and large classes to identify the change in the level of satisfaction. The study used a multi-method approach consisting of a literature review, a qualitative phase involving in-depth interviews, focus groups, and a quantitative survey. The results show that while customer satisfaction is being met, the satisfaction of students' psychological needs are not being fully realised. It was also found that there were notable variations between individual students, the subjects being studied and degree streams of students taking the same subject. The implications of these findings and suggestions for further investigation are discussed in this paper.

Team clinical supervision in acute hospital wards : a feasibility study

Clinical supervision provides a strategy to mitigate nurses’ workplace stress and enhance retention, but the literature provides little guidance about its implementation beyond mental health nursing. This study explored the feasibility of implementing and evaluating ward-based team clinical supervision for general nurses on two separate wards at one public and one private hospital. Nurses completed the Work Environment Questionnaire pre- (n = 36) and post intervention (n = 27), and focus groups (n = 20) explored their perceptions of supervision. Staff were unfamiliar with clinical supervision, so information sessions were required. The questionnaire may not have been suitable to evaluate this type of intervention. Focus group findings revealed that team supervision improved communication, enhanced working relationships, and empowered nurses to challenge existing practices, which had a positive impact on their perceived stress. This study provides insights to guide implementation and evaluation of clinical supervision in acute settings.