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

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From ecological creativity to an ecology of well-being: 'flows & catchments' as a case study of NVivo

This paper’s research question concerns how the ecological creativity of the Volcanic Plains region of Western Victoria may be transformed into an ecology of well-being of benefit to the local community. Drawing on the philosophies of Spinoza and Gilles Deleuze, we argue that community well-being results from the richness of connections and relationships made within a place. The case study for our investigation is ‘Flows & Catchments’, which is an ongoing, collaborative, creative-arts research project auspiced by Deakin University. Its modus operandi is Practice-Based Research (PBR), and its aim is to promote community well-being in Western Victoria. However, while the whole metier of the creative arts is to make the novel connections and relationships that should bring about community wellbeing, the various artists of ‘Flows & Catchments’ have proved slightly reluctant to make connections outside of their individual or small-group sub-projects. In this way, ecological creativity has not reached its full potential as an ecology of well-being because the rich connections and relationships essential to this well-being have not yet been fully realised. This paper explores the potential of using the NVivo qualitative analysis software package to bring together the creative-arts sub-projects of ‘Flows & Catchments’, as a way of fostering an ecology of well-being out of a currently dispersed ecological creativity.

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).

Community-onset Staphylococcus aureus infections presenting to general practices in South-eastern Australia

Community-acquired Staphylococcus aureus infections are a public health concern, yet little is known about infections that do not present to hospital. We identified community-onset S. aureus infections via specimens submitted to a community-based pathology service. Referring doctors confirmed eligibility and described infection site, severity and treatment. Isolates were characterized on antibiotic resistance, PFGE, MLST/SCCmec, and Panton–Valentine leukocidin (PVL), representing 106 community-onset infections; 34 non-multiresistant methicillin-resistant S. aureus (nmMRSA) (resistant to <3 non-β-lactam antibiotics), 15 multiply antibiotic-resistant MRSA (mMRSA) and 57 methicillin-sensitive S. aureus (MSSA). Most (93%) were skin and soft tissue infections. PVL genes were carried by 42% of nmMRSA isolates [95% confidence interval (CI) 26–61] and 15% of MSSA (95% CI 8–28). PVL was associated with infections of the trunk, head or neck (56·4% vs. 24·3%, P= 0·005) in younger patients (23 vs. 52 years, P< 0·001), and with boils or abscesses (OR 8·67, 95% CI 2·9–26·2), suggesting underlying differences in exposure and/or pathogenesis.

Research in practice : an exercise in generative urban massing

The following paper explores practice based research as a means of identifying issues within current urban design methods. It considers the application of parametric systems as a means of addressing these issues. These systems are developed and tested across both Australian and international urban design projects within Grimshaw Architects. A methodology is proposed for the development and application of these parametric tools across multiple scales of design resolution. It reports on the application of a set of parametric urban scale massing tools in real world design projects. This exploration is carried out in distinct phases of design defined by the scale of resolution. The phasing allows for discrete problems to be addressed more effectively at different stages of the design process while still encouraging a seamless, bi directional workflow through a digital master model.

Teaching and learning in the crucible: Actors with disabilities as experts preparing pre-service teachers to be inclusive educators

Dorothy Heathcote understood teaching and learning to take place in a kind of ‘crucible’ in which participants, who are both teachers and learners, contribute to the mix sometimes resulting in a radical transformation. This paper reports the ways Heathcote’s ideas have influenced both research and practice in the Teaching for Diversity workshop - a drama workshop that brings together pre-service teachers, teacher educators and actors from Fusion Theatre, a community-based theatre company for people with intellectual disabilities.

Ethical trust and social moral norms simulation : a bio-inspired agent-based modelling approach

The understanding of the micro-macro link is an urgent need in the study of social systems. The complex adaptive nature of social systems adds to the challenges of understanding social interactions and system feedback and presents substantial scope and potential for extending the frontiers of computer-based research tools such as simulations and agent-based technologies. In this project, we seek to understand key research questions concerning the interplay of ethical trust at the individual level and the development of collective social moral norms as representative sample of the bigger micro-macro link of social systems. We outline our computational model of ethical trust (CMET) informed by research findings from trust, machine ethics and neural science. Guided by the CMET architecture, we discuss key implementation ideas for the simulations of ethical trust and social moral norms.