Safety and acceptability of practice-nurse-managed care of depression in patients with diabetes or heart disease in the Australian TrueBlue study

Objectives:
To determine the safety and acceptability of the TrueBlue model of nurse-managed care in the primary healthcare setting.

Obsessive compulsive disorder : integration of cognitive-behaviour therapy and clinical psychology care into the primary care context

In primary care, evidence-based psychological treatments for obsessive compulsive disorder (OCD), such as cognitive behaviour therapy (CBT), have not been readily available. We aimed to develop models of care for OCD that account for barriers to access and can be integrated into general practice settings. Multiple methodologies and sources were utilised, including literature reviews, a reference group, focus groups, interviews and questionnaire responses from consumers, psychologists and/or GPs. It was found that there were similarities and some differences among stakeholders in attitudes and knowledge about OCD, and views about treatment and assessment in primary care. Three models of care for patients with OCD were developed and integrated into a treatment program operating through a division of general practice. Participating GPs preferred referral to a specialist clinic, irrespective of participation in an educational program about OCD. Based on these findings, it is suggested that effective integration of specialist CBT treatments for OCD into primary care is possible if the needs and views of all stakeholders are accounted for.

The impact of a team-based intervention on the lifestyle risk factor management practices of community nurses: outcomes of the community nursing SNAP trial

Background
Lifestyle risk factors like smoking, nutrition, alcohol consumption, and physical inactivity (SNAP) are the main behavioural risk factors for chronic disease. Primary health care is an appropriate setting to address these risk factors in individuals. Generalist community health nurses (GCHNs) are uniquely placed to provide lifestyle interventions as they see clients in their homes over a period of time. The aim of the paper is to examine the impact of a service-level intervention on the risk factor management practices of GCHNs.

Methods
The trial used a quasi-experimental design involving four generalist community nursing services in NSW, Australia. The services were randomly allocated to either an intervention group or control group. Nurses in the intervention group were provided with training and support in the provision of brief lifestyle assessments and interventions. The control group provided usual care. A sample of 129 GCHNs completed surveys at baseline, 6 and 12 months to examine changes in their practices and levels of confidence related to the management of SNAP risk factors. Six semi-structured interviews and four focus groups were conducted among the intervention group to explore the feasibility of incorporating the intervention into everyday practice.

Results
Nurses in the intervention group became more confident in assessment and intervention over the three time points compared to their control group peers. Nurses in the intervention group reported assessing physical activity, weight and nutrition more frequently, as well as providing more brief interventions for physical activity, weight management and smoking cessation. There was little change in referral rates except for an improvement in weight management related referrals. Nurses’ perception of the importance of ‘client and system-related’ barriers to risk factor management diminished over time.

Conclusions
This study shows that the intervention was associated with positive changes in self-reported lifestyle risk factor management practices of GCHNs. Barriers to referral remained. The service model needs to be adapted to sustain these changes and enhance referral.

Australian police officers' perceptions of sex offender registries

Sex offender registration schemes exist in most English speaking countries to assist police in the investigation of new crimes and to deter known offenders. To date, however, very little research has examined the efficacy of these registers. This study addresses this issue by providing the first qualitative analysis of police officers' perceptions of registration schemes. Twenty-four Australian police professionals (whose jobs were primarily associated with the operation of sex offender registration schemes) participated in focus groups in groups of 2–5 officers. Officers were recruited across three jurisdictions where quite distinct registration schemes operated. They were asked to reflect on how their register operates, how effective and efficient it is, the challenges faced in its administration and how the registry process might be improved. The key challenges addressed included; limitations in risk assessment expertise, restriction in legislative powers, and inadequate opportunity for specialisation. The implications for current practice are discussed.

Challenges in managing elderly people with diabetes in primary care settings in Norway

Objective
To explore the experiences and clinical challenges that nurses and nursing assistants face when providing high-quality diabetes-specific management and care for elderly people with diabetes in primary care settings.

Design
Focus-group interviews.

Subjects and setting
Sixteen health care professionals: 12 registered nurses and four nursing assistants from nursing homes (10), district nursing service (5), and a service unit (1) were recruited by municipal managers who had local knowledge and knew the workforce. All the participants were women aged 32–59 years with clinical experience ranging from 1.5 to 38 years.

Results
Content analysis revealed a discrepancy between the level of expertise which the participants described as important to delivering high-quality care and their capacity to deliver such care. The discrepancy was due to lack of availability and access to current information, limited ongoing support, lack of cohesion among health care professionals, and limited confidence and autonomy. Challenges to delivering high-quality care included complex, difficult patient situations and lack of confidence to make decisions founded on evidence-based guidelines.

Conclusion
Participants lacked confidence and autonomy to manage elderly people with diabetes in municipal care settings. Lack of information, support, and professional cohesion made the role challenging.

What's important in defining quality of life for older people? An exploratory study of the views of older South Australians

Background
Cost-effectiveness analyses of interventions for older adults have traditionally focused on health status. There is increasing recognition of the need to develop new instruments to capture quality of life in a broader sense in the face of age-associated increasing frailty and declining health status, particularly in the economic evaluation of aged and social care interventions which may have positive benefits beyond health. 

A qualitative study of preadolescent boys' and girls' body image: gendered ideals and sociocultural influences

This qualitative study examined preadolescent boys’ and girls’ body ideals, and peer and media factors that shape these ideals. Sixty-eight children aged 8–10 participated in semi-structured interviews: 19 boys and 17 girls in individual interviews and 16 boys and 16 girls in eight group interviews. Techniques from grounded theory were used to analyze the data. Findings demonstrated that fitness was an important element of boys’ and girls’ body ideals. For boys the emphasis was on sport, and this was promoted by their peer interactions and the sportsmen they admired. For girls the focus was on looking good, and this was reinforced by their peer conversations, and the actresses and singers they admired. Focus groups further highlighted how peers both reinforced media messages, yet also helped children critique media messages. Implications are discussed for prevention programs that need to be specifically tailored for boys and girls.

Development and validation of the influenza intensity and impact questionnaire (FluiiQ™)

Objective
Clinical trials of new agents to reduce the severity and impact of influenza require accurate assessment of the effect of influenza infection. Because there are limited high-quality adult influenza Patient Reported Outcomes (PRO) measures, the aim was to develop and validate a simple but comprehensive questionnaire for epidemiological research and clinical trials.

Methods
Construct and item generation was guided by the literature, concept mapping, focus groups, and interviews with individuals with laboratory-confirmed influenza and expert physicians. Items were administered to 311 people with influenza-like illness (ILI) across 25 US sites. Analyses included classic psychometrics, structural equation modeling (SEM), and Rasch analyses.

Results
Concept mapping generated 149 concepts covering the influenza experience and clustered into symptoms and impact on daily activities, emotions, and others. Items were drafted using simplicity and brevity criteria. Eleven symptoms from the literature underwent review by physicians and patients, and two were removed and one added. The symptoms domain factored into systemic and respiratory symptoms, whereas the impact domains were unidimensional. All domains displayed good internal consistency (Cronbach α ≥ 0.8) except the three-item respiratory domain (α = 0.48). A five-factor SEM indicated excellent fit where systemic, respiratory, and daily activities domains differentiated patients with ILI or confirmed influenza. All scales were responsive over time.

Conclusions
Patient and clinician consultations resulted in an influenza PRO measure with high validity and good overall evidence of reliability and responsiveness. The Influenza Intensity and Impact Questionnaire (FluiiQ™) will improve the evaluation of existing and future agents designed to prevent or control influenza infection by increasing the breadth and depth of measurement in this field.

Interviewing pairs: discussions on migration and identity

This article examines a research method of conducting interviews with pairs of individuals, who may be friends or relatives. The authors critically reflect on their experiences of collecting qualitative data in an interview with two respondents. While one-on-one interviews and focus groups are more established and well-studied forms of gathering research data, we argue that paired interviews as a data collections method present additional advantages as well as some challenges for qualitative researchers. The researchers embraced the opportunity to interview pairs of individuals with the intention of minimising the asymmetry of power habitually inherent in interview situations. In the authors' experiences, paired interviews served to empower those being interviewed and reduced the discomfort felt by some in the personal interview situation. This form of interviewing tended to give more autonomy to the respondents and prompted them to provide more nuanced responses. Paired interviews assisted respondents in feeling relaxed and comfortable, provided a vibrant environment that encouraged respondents to build on each other's ideas and enabled them to enhance each other's stories. Respondents were better motivated to build discussions around an interview question and then illustrate their responses with examples. In our studies, we found that our respondents tended to offer more thorough and comprehensive narratives in the setting of a paired interview.

Diet and physical activity in the self-management of type 2 diabetes: barriers and facilitators identified by patients and health professionals

Aim: 

Mock jury attitudes towards credibility, age, and guilt in a fictional child sexual assault scenario

Low conviction rates of child sexual assault (CSA) remain a persistent social problem in Australia. One reason for this may be the impact of attitudes regarding the victims when the evidence is weak. This article examines the effects of victim age on perceptions of credibility and verdict in a CSA case. Eleven electronic focus groups deliberated a fictional CSA case, in which the age of the child was systemically varied between 6 and 15 years. Deliberation transcripts were analysed with NVivo (Version 9, QSR International Pty Ltd., Burlington, MA, USA), from which thematic clusters were derived. Results showed that as the child's age increased, credibility and guilty verdicts decreased. In addition, testimony alone had little impact in influencing the verdict. These findings suggest that in lieu of corroborating evidence, increasing supporting information, such as expert testimony, and providing structured deliberation for the jury may reduce the influence of victim blame, particularly when the child victim is older.

Maximising students' use of purpose-built shade in secondary schools: Quantitative and qualitative results of a built-environment intervention

A trial installing shade sails at secondary schools found increased students' use of newly shaded areas, but relatively low use overall. We examined site features and weather related to use of these shaded areas. Tables with seats and temperatures ≥27 °C increased student use of shaded areas, presence of grass decreased use. Focus groups at eight schools suggest students were unaware of changes to their habitual use of favoured locations. Results infer careful selection of locations for built-shade and provision of tables with seats will assist in maximising student use and investments in shade sails.