A systematic narrative review of consumer-directed care for older people: implications for model development

Consumer-directed care is increasingly becoming a mainstream option in community-based aged care. However, a systematic review describing how the current evaluation research translates into practise has not been published to date. This review aimed to systematically establish an evidence base of user preferences for and satisfaction with services associated with consumer-directed care programmes for older people. Twelve databases were searched, including MedLine, BioMed Central, Cinahl, Expanded Academic ASAP, PsychInfo, ProQuest, Age Line, Science Direct, Social Citation Index, Sociological Abstracts, Web of Science and the Cochrane Library. Google Scholar and Google were also searched. Eligible studies were those reporting on choice, user preferences and service satisfaction outcomes regarding a programme or model of home-based care in the United States or United Kingdom. This systematic narrative review retrieved literature published from January 1992 to August 2011. A total of 277 references were identified. Of these 17 met the selection criteria and were reviewed. Findings indicate that older people report varying preferences for consumer-directed care with some demonstrating limited interest. Clients and carers reported good service satisfaction. However, research comparing user preferences across countries or investigating how ecological factors shape user preferences has received limited attention. Policy-makers and practitioners need to carefully consider the diverse contexts, needs and preferences of older adults in adopting consumer-directed care approaches in community aged care. The review calls for the development of consumer-directed care programmes offering a broad range of options that allow for personalisation and greater control over services without necessarily transferring the responsibility for administrative responsibilities to service users. Review findings suggest that consumer-directed care approaches have the potential to empower older people.

Effective recruitment and retention strategies in community health programs

Issue addressed: 

Investigating well-being, work limitations and preferences for self-management education and peer support among younger people with hip and knee osteoarthritis: protocol for a cross-sectional study

Introduction: 

Pedagogy of oppressed community engagement : socially inclusive visioning of urban change

It is generally accepted that good practice in policy making and urban change initiatives requires community engagement, where community-based approaches are emphasised as a means of socially inclusive visioning. Communities expect greater transparency, accountability and engagement. This expectation is not always met, with many studies focusing on the perceived tickbox effect - where engagement is a process that has to be undertaken rather than being welcomed and embraced as an integral part of planning for urban change. This paper explores multi-disciplinary concepts and looks at ways these can be linked to community engagement in planning, particularly in larger urban Councils. In this brief glimpse at the wide variety of disciplines that could be drawn on, the paper uses information systems, teaching models, organisational theory and public policy to highlight the potential for altering concepts of community engagement. It concludes that, from these particular examples: the use of double-loop learning could help to empower the community (from organisational theory), collaboration and participation necessitate the co-ordination and exchange of information and knowledge within and between organisations (information systems), the preconception that the authority holds all the knowledge ready to be handed out to the community (teaching models) needs to be challenged, and partnerships are important in empowering people (public policy).

Problems of implementing offender programs in the community

Rehabilitation of offenders is, at present, an important focus among many correctional departments. A substantial body of international research literature now exists to guide the design and development of new programs that aim to reduce re-offending. However, successful implementation of these programs has been challenging for many correctional authorities. Drawing on the experience of a community correctional agency in Australia, this paper identifies and examines a number of barriers to successful delivery of community-based offender rehabilitation programs and services. The findings suggest that basing interventions on scientific knowledge about “what works” in offender rehabilitation is necessary but not sufficient for effective programs and services. More careful attention needs to be paid to how correctional authorities can take this research and implement it in practice.

A way to communicate: A new signage system for the Mah Meri Indigenous community

Today, designers use a diverse range of alternative media to have a more efficient form of communication. This research is to investigate the potential of traditionally-inspired contemporary communication design to bridge cultural understandings between and among Malaysians of diverse racial and ethnic backgrounds. Specifically, I propose to design a new signage system in the Mah Meri indigenous community in Malaysia. This is in view that despite the development of the latest media alternatives in use today, the Mah Meri community still lags behind in terms of utilization of these new communication facilities. This project aims to improve social interactions between this community and visitors. The signage system that I propose will help outsiders to navigate in and around the Mah Meri settlements easier and faster because the system provides relevant information in a simple and easy to understand method. Without this signage system visitors will have difficulty in finding the right directions. This work also endeavours, through the notion of creating a new signage system to enrich the cultural identity of the Mah Meri community based on their beliefs in the elements of nature. This, in turn, will create a niche for the community to promote the uniqueness of their culture and identity to outsiders.

Conflict of interest in Victorian rural and regional legal practice

This research report was based on 163 survey responses and 29 interviews with Victorian rural and regional legal practitioners, as well as 8 human service organisation representatives. Peak law profession organisations including the Legal Services Board, Law Institute of Victoria, the Federation of Community Legal Centres and Victoria Legal Aid were also interviewed for the research. The principal objective of the research was to examine how conflict of interested is manifested in rural and regional settings and how effectively the current conflict of interest rules are applied within those settings. The report includes a number of recommendations for better responding to issues of conflict of interest within a rural and regional context.

Wider impacts of a 10-week community cooking skills program - Jamie's Ministry of Food, Australia

Jamie's Ministry of Food (JMoF) Australia is a 10-week community-based cooking skills program which is primarily aimed at increasing cooking skills and confidence and the promotion of eating a more nutritious diet. However, it is likely that the program influences many pathways to behaviour change. This paper explores whether JMoF impacted on known precursors to healthy cooking and eating (such as attitudes, knowledge, beliefs, cooking enjoyment and satisfaction and food purchasing behaviour) and whether there are additional social and health benefits which arise from program participation.

Cost-effectiveness of whole-of-community obesity prevention programs: an overview of the evidence

Whole-of-community obesity prevention programs that impact on multiple players and promote community capacity show promise as an important strategy in the fight against global obesity. This paper reviews the economic evaluation literature of multifaceted, community based obesity prevention programs. There are few cost effectiveness studies. Whilst results to date are encouraging, there is considerable uncertainty surrounding the long term results given the lack of evidence regarding sustainability of program effect and a consequent reliance on economic modeling to fill the gaps. More empirical studies of longer duration are needed to demonstrate the longer term effectiveness and cost effectiveness of these programs, and to facilitate identification of the elements necessary for their sustainability.

Factors associated with service use for young adolescents with mental health problems: findings from an Australian longitudinal study

The objective of the study wasto identify factors associated with use of services for adolescent mental health problems in an Australian community-based sample. Logistic regression analysis was conducted on data collected from 636 parents and their adolescent child to identify individual and family variables predicting parent report of service use for mental health problems in the adolescent 12 months later. The services most reported by parents to have been accessed were schoolbased ones. Multivariate analysis found that the following were associated with service use 12 months later: the adolescent being female, parent report of peer problems and hyperactivity, single-parent household, the parent being Australian born, and prior service use by the adolescent. Parental overcontrol was associated with reducedlikelihood of service use at followup. No association was found between service use at follow-up and parent gender, socioeconomic status, number of siblings, parent psychopathology, family social connectedness, and prior service use by the parent. No association was also found for family environment factors, parental attachment, or for the adolescent’s emotional competence or use of social support. The results indicate that families provide a potential target for interventions aimed at increasing use of professional services for adolescent mental health problems.

Adoption and maintenance of gym-based strength training in the community setting in adults with excess weight or type 2 diabetes: a randomized controlled trial

BACKGROUND: Participant adoption and maintenance is a major challenge in strength training (ST) programs in the community-setting. In adults who were overweight or with type 2 diabetes (T2DM), the aim of this study was to compare the effectiveness of a standard ST program (SST) to an enhanced program (EST) on the adoption and maintenance of ST and cardio-metabolic risk factors and muscle strength. METHODS: A 12-month cluster-randomized controlled trial consisting of a 6-month adoption phase followed by a 6-month maintenance phase. In 2008-2009, men and women aged 40-75 years (n = 318) with T2DM (n = 117) or a BMI >25 (n = 201) who had not participated in ST previously were randomized into either a SST or an EST program (which included additional motivationally-tailored behavioral counselling). Adoption and maintenance were defined as undertaking ≥ 3 weekly gym-based exercise sessions during the first 6-months and from 6-12 months respectively and were assessed using a modified version of the CHAMPS (Community Healthy Activity Models Program for Seniors) instrument. RESULTS: Relative to the SST group, the adjusted odds ratio (OR) of adopting ST for all participants in the EST group was 3.3 (95 % CI 1.2 to 9.4). In stratified analyses including only those with T2DM, relative to the SST group, the adjusted OR of adopting ST in the EST group was 8.2 (95 % CI 1.5-45.5). No significant between-group differences were observed for maintenance of ST in either pooled or stratified analyses. In those with T2DM, there was a significant reduction in HbA1c in the EST compared to SST group during the adoption phase (net difference, -0.13 % [-0.26 to -0.01]), which persisted after 12-months (-0.17 % [-0.3 to -0.05]). CONCLUSIONS: A behaviorally-focused community-based EST intervention was more effective than a SST program for the adoption of ST in adults with excess weight or T2DM and led to greater improvements in glycemic control in those with T2DM. TRIAL REGISTRATION: Registered at ACTRN12611000695909 (Date registered 7/7/2011).

Place-based initiatives to tackle mature-age workers’ long-term unemployment in Australia, drawing on successful Nordic precedents

In order to tackle unemployment for the at-risk group of mature-age workers displaced by industry sector restructuring, exemplary place-based initiatives are needed focusing on a selected area of high disadvantage identified by Professor Tony Vinson’s 2015 Jesuit Social Services report Dropping off the Edge, with an Australian state government committed to supporting the initiative, as that report recommends. In order to make such a place-based initiative exemplary in its outcomes, so that it leads to uptake in other areas of high disadvantage, it needs to be thoroughly informed by successful Nordic precedents. In particular, the new Australian place-based initiative needs to be informed by Danish regionally-focused large-scale job skills programs involving transition into a proximate sector of employment growth; and by Norwegian measures for more even population distribution outside capital cities or in particular hard-hit regions within capital cities. An advantage of the proposed initiative is that it will also produce measurable results for children in families in which neither parent works, whose needs are normally tackled (if at all) by separate policy actions in separate tiers or departments of government. Australian children are disproportionately disadvantaged by the internationally extreme concentration of joblessness. Denmark’s Løntilskud and Virksomhedspraktik job training programs subsidised by municipalities and the national government, and supported by Danish trade unions, will be discussed in this paper for the positive effects they have for participants, including establishing or re-establishing unemployed people’s structured work habits and routines, improving their networks along with their social skills, and boosting their confidence. This paper will outline in detail the types of features the proposed new Australian place-based initiative will require, drawing on and drilling down further into data and analysis presented in the author’s recent book: Northern Lights: The Positive Policy Example of Sweden, Finland, Denmark and Norway.

Involving people with diabetes and the wider community in diabetes research: a realist review protocol

BACKGROUND: Patient and public involvement in diabetes research is now actively encouraged in different countries because it is believed that involving people with experience of the condition will improve the quality and relevance of the research. However, reviews of patient involvement have noted that inadequate resources, patients' and communities' lack of research knowledge, and researchers' lack of skills to involve patients and communities in research may present significant contextual barriers. Little is known about the extent of patient/community involvement in designing or delivering interventions for people with diabetes. A realist review of involvement will contribute to assessing when, how and why involvement works, or does not work, to produce better diabetes interventions.

METHODS/DESIGN: This protocol outlines the process for conducting a realist review to map how patients and the public have been involved in diabetes research to date. The review questions ask the following: How have people with diabetes and the wider community been involved in diabetes research? What are the characteristics of the process that appear to explain the relative success or failure of involvement? How has involvement (or lack of involvement) in diabetes research influenced the development and conduct of diabetes research? The degree of support in the surrounding context will be assessed alongside the ways in which people interact in different settings to identify patterns of interaction between context, mechanisms and outcomes in different research projects. The level and extent of the involvement will be described for each stage of the research project. The descriptions will be critically reviewed by the people with diabetes on our review team. In addition, researchers and patients in diabetes research will be asked to comment. Information from researcher-patient experiences and documents will be compared to theories of involvement across a range of disciplines to create a mid-range theory describing how involvement (or lack of involvement) in diabetes research influences the development and conduct of diabetes research.