Using a theory of planned behaviour framework to explore hand hygiene beliefs at the ‘5 critical moments’ among Australian hospital-based nurses

Background Improving hand hygiene among health care workers (HCWs) is the single most effective intervention to reduce health care associated infections in hospitals. Understanding the cognitive determinants of hand hygiene decisions for HCWs with the greatest patient contact (nurses) is essential to improve compliance. The aim of this study was to explore hospital-based nurses’ beliefs associated with performing hand hygiene guided by the World Health Organization’s (WHO) 5 critical moments. Using the belief-base framework of the Theory of Planned Behaviour, we examined attitudinal, normative, and control beliefs underpinning nurses’ decisions to perform hand hygiene according to the recently implemented national guidelines. Methods Thematic content analysis of qualitative data from focus group discussions with hospital-based registered nurses from 5 wards across 3 hospitals in Queensland, Australia. Results Important advantages (protection of patient and self), disadvantages (time, hand damage), referents (supportive: patients, colleagues; unsupportive: some doctors), barriers (being too busy, emergency situations), and facilitators (accessibility of sinks/products, training, reminders) were identified. There was some equivocation regarding the relative importance of hand washing following contact with patient surroundings. Conclusions The belief base of the theory of planned behaviour provided a useful framework to explore systematically the underlying beliefs of nurses’ hand hygiene decisions according to the 5 critical moments, allowing comparisons with previous belief studies. A commitment to improve nurses’ hand hygiene practice across the 5 moments should focus on individual strategies to combat distraction from other duties, peer-based initiatives to foster a sense of shared responsibility, and management-driven solutions to tackle staffing and resource issues. Hand hygiene following touching a patient’s surroundings continues to be reported as the most neglected opportunity for compliance.

Latinos and political advocacy for cancer control in a United States-Mexico border community

Health policy interventions provide powerful tools for addressing health disparities. The Latino community is one of the fastest growing communities in the United States yet is largely underrepresented in government and advocacy efforts. This study includes 42 Latino adults (M age 5 45 years) who participated in focus group discussions and completed a brief questionnaire assessing their experiences with political health advocacy. Qualitative analyses revealed participants considered cancer a concern for the Latino community, but there was a lack of familiarity with political advocacy and its role in cancer control. Participants identified structural, practical, cultural, and contextual barriers to engaging in political health advocacy. This article presents a summary of the findings that suggest alternative ways to engage Latinos in cancer control advocacy.

Dioxin risk reduction programme at the most severe dioxin hot spot in Vietnam: Residual knowledge, attitude and practices five years post intervention

Bien Hoa Airbase was one of the bulk storage and supply facilities for defoliants during the Vietnam War. Environmental and biological samples taken around the airbase have elevated levels of dioxin. In 2007, a pre-intervention knowledge, attitude and practice (KAP) survey of local residents living in Trung Dung and Tan Phong wards was undertaken regarding appropriate strategies to reduce dioxin exposure. A risk reduction programme was implemented in 2008 and post-intervention KAP surveys were undertaken in 2009 and 2013 to evaluate the longer term impacts. Quantitative assessment was undertaken via a KAP survey in 2013 among 600 local residents randomly selected from the two intervention wards and one control ward (Buu Long). Eight in-depth interviews and two focus group discussions were also undertaken for qualitative assessment. Most programme activities had ceased and dioxin risk communication activities had not been integrated into local routine health education programmes; however, main results generally remained and were better than that in Buu Long. In total, 48.2% of households undertook measures to prevent exposure, higher than those in pre- and post-intervention surveys (25.8% and 39.7%) and the control ward (7.7%). Migration and the sensitive nature of dioxin issues were the main challenges for the programme's sustainability

Community Pharmacies and the Needs of Mobile EU Citizens - A study on Finns living in Spain

Migration within the European Union (EU) has increased since the Union was established. Community pharmacies provide open access to health care services and can be the first, most frequently used or even the only contact with a nation s health care system among mobile community residents. In some of the mass-migration areas in Southern Europe, most of the customers may represent mobile citizens of foreign background. This has not always been taken into consideration in the development of community pharmacy services. Mobile patients have been on the EU's health policy agenda, but they have seldom been mentioned in the context of community pharmacies. In most of the EU member states, governments control the specific legislation concerning community pharmacies and there is no harmonised pharmaceutical policy or consistent minimal standards for community pharmacy services in the EU. The aim of this study was to understand medication use, the role of community pharmacies and the symptom mitigation process of mobile community residents. Finns living in Spain were used as an example to examine how community pharmacies in a EU member state meet the needs of mobile community residents. The data were collected by a survey in 2002 (response rate 53%, n= 533) and by five focus group discussions in 2006 (n=30). A large number (70%) of the respondents had moved to Spain for health reasons and suffered from chronic morbidity. Community pharmacies had an important role in the healthcare of mobile community residents and the respondents were mostly satisfied with these services. However, several medication safety risks related to community pharmacy practices were identified: 1) Availability of prescription medicines without prescription (e.g., antibiotics, sleeping pills, Viagra®, asthma medications, cardiovascular medicines, psoriasis medicines and analgesics); 2) Irrational use of medicines (e.g., 41% of antibiotic users had bought their antibiotics without a prescription, and the most common reasons for antibiotic self-medication were symptomatic common colds and sore throats); 3) Language barriers between patients and pharmacy professionals; 4) Lack of medication counselling; 5) Unqualified pharmacy personnel providing pharmacotherapy. A fifth of the respondents reported experiencing problems during pharmacy visits in Spain, and the lack of a common language was the source of most of these problems. The findings of this study indicate that regulations and their enforcement can play a crucial role in actually assuring the rational and safe use of medicines. These results can be used in the development of pharmaceutical and healthcare policies in the EU. It is important to define consistent minimum standards for community pharmacy services in the EU. Then, the increasing number of mobile community residents could access safe and high quality health care services, including community pharmacy services, in every member state within the EU.

Consumers and the conceptual and practical appropriation of functional foods

Taking the appropriation of objects as a theoretical starting point, this study makes a distinction between a conceptual and practical level of adopting new objects and products in everyday life. The study applies the concept of appropriation in social food research and examines consumers appropriation of functional foods, i.e., foods developed to improve health and well-being or reduce the risk of disease beyond the usual nutritional effects of foods. The study uses the concept of appropriation to understand the adoption and the process of making functional foods our own . First, the study focuses on the conceptual appropriation by analysing consumers interpretations and opinions on functional foods. Second, it analyses the use of functional foods and examines the role of sociodemographic and food- and health-related background factors in the use of functional foods. Both quantitative and qualitative data were used in the study. Altogether 1210 Finns representative of the population took part in a survey carried out in 2002 as computer-assisted telephone interviews (CATI). The survey examined the acceptability and use of functional foods in Finland. In 2004, eight focus group discussions were organised for 45 users and non-users of cholesterol-lowering spreads. The qualitative study focused on consumers interpretative perspectives on healthy eating and functional foods. The findings are reported in four original articles and a summary article. The results show that the appropriation of functional foods is a multifaceted phenomenon. The conceptual appropriation is related to consumers interpretations of functional foods in the context of healthy foods and healthy eating; their trust in the products, their manufacturers, research and control; and the relationship of functional foods and the ideal of natural foods. The analysis of the practical appropriation of four different types of foods marketed as functional showed that there are sociodemographic differences between users and non-users of the products, but more importantly, the differences are related to consumers food- and health-related views and practices. Consumers ways of appropriating functional foods in the conceptual and practical sense take shape in a complex web of ideas and everyday practices concerning food, health and eating as a whole. The results also indicate that the conceptual and practical appropriation are not necessarily uniform or coherent processes. Consumers interpret healthy eating and functional foods from a variety of perspectives and there is a multiplicity of rationales of using functional foods. Appropriation embraces many opposing dimensions simultaneously: good experiences and doubts, approval and criticism, expectations and things taken for granted.

Exploring changing culture and building capacity in research with consumers, carers and consumer companions

Background Australian policy mandates consumer and carer participation in mental health services at all levels including research. Inspired by a UK model - Service Users Group Advising on Research [SUGAR] - we conducted a scoping project in 2013 with a view to create a consumer and carer led research process that moves beyond stigma and tokenism, that values the unique knowledge of lived experience and leads to people being treated better when accessing services. This poster presents the initial findings. Aims The project’s purpose was to explore with consumers, consumer companions and carers at the Metro North Mental Health-RBWH their interest in and views about research partnerships with academic and clinical colleagues. Methods This poster overviews the initial findings from three audio-recorded focus groups conducted with a total of 14 consumers, carers and consumer companions at the Brisbane site. Analysis Our work was guided by framework analysis (Gale et al. 2013). It defines 5 steps for analysing narrative data: familiarising; development of categories; indexing; charting and interpretation. Eight main ideas were initially developed and were divided between the authors to further index. This process identified 37 related analytic ideas. The authors integrated these by combining, removing and redefining them by consensus though a mapping process. The final step is the return of the analysis to the participants for feedback and input into the interpretation of the focus group discussions. Results 1. Value & Respect: Feeling Valued & Respected, Tokenism, Stigma, Governance, Valuing prior knowledge / background 2. Pathways to Knowledge and Involvement in Research: ‘Where to begin’, Support, Unity & partnership, Communication, Co-ordination, Flexibility due to fluctuating capacity 3. Personal Context: Barriers regarding Commitments & the nature of mental illness, Wellbeing needs, Prior experience of research, Motivators, Attributes 4. What is research? Developing Knowledge, What to do research on, how and why? Conclusion and Discussion Initial analysis suggests that participants saw potential for ‘amazing things’ in mental health research such as reflecting their priorities and moving beyond stigma and tokenism. The main needs identified were education, mentoring, funding support and research processes that fitted consumers’ and carers’limitations and fluctuating capacities. They identified maintaining motivation and interest as an issue since research processes are often extended by ethics and funding applications. Participants felt that consumer and carer led research would value the unique knowledge that the lived experience of consumers and carers brings and lead to people being treated better when accessing services.

Diet and physical activity behaviour in nurses: A qualitative study

Issue addressed: Previous research has shown that approximately 60% of nurses in Australia are overweight or obese, insufficiently active and have an unhealthy diet. The aim of this study was to gain an understanding of nurses’ determinants contributing to these behaviours. This will inform a needs assessment for a future workplace health promotion program (WHPP) in this group. Methods: Four focus group discussions (n = 17) were conducted with a convenience sample of nurses aged 25–59 years from three hospitals in the Brisbane metropolitan area. Questions addressed barriers and motivation towards diet and physical activity (PA), and suggestions for future WHPP. Data were analysed with Nvivo10 following a thematic analysis with a realistic approach using Self-determination theory as a framework. Results: Work environment was the main barrier for healthy diet behaviours. Long working hours and lack of breaks challenged nurses’ self-control and self-regulation when making dietary choices. Fatigue was the main barrier for PA. However, relaxation, feeling energised before work and better sleep after working night shifts motivated nurses to do PA. Social environment at work seemed to be an effective external motivation to encourage healthy diet and regular PA. Goal-setting, self-monitoring and social support at work were identified as potential WHHP strategies. Conclusion: The workplace and job demands negatively impacts nurses’ lifestyle behaviours. Future interventions should include social support from colleagues, which could motivate nurses to make healthier food choices at work and be more active outside work.

Geriatrisen lääkehoidon koulutustarpeet perusterveydenhuollossa - Moniammatillisen täydennyskoulutuksen suunnittelu LOST-alueen kotihoidon henkilöstölle

Sosiaali- ja terveysministeriön 2006 julkaiseman vanhustyön ja geriatrisen lääkehoidon kehittämistä koskevan selvityksen yhtenä tärkeänä huolenaiheena oli iäkkäiden lääkehoidon useat epäkohdat, kuten iäkkäitä hoitavien hoitajien lääkeosaamiseen liittyvät puutteet ja ongelmat. Yksi keino parantaa iäkkäitä hoitavien eri tahojen lääkehoito-osaamista on täydennyskoulutus, johon kaikilla sosiaali- ja terveydenhuollon ammattiryhmillä on oikeus ja velvollisuus. Täydennyskoulutuksella pystytään myös kehittämään organisaatioiden toimintaa ja tuottamaan uusia, parempia palveluita. Tutkimuksessa selvitettiin Lohjan, Siuntion, Inkoon ja Karjalohjan muodostaman sosiaali- ja terveydenhuollon yhteistoiminta-alueen LOSTin kotihoidon yksiköiden iäkkäiden lääkehoitoihin liittyviä koulutustarpeita. Tämän tutkimuksen avulla syvennettiin samalle tutkimusryhmälle tehdyn kyselytutkimuksen tuloksia. Tutkimusaineistona käytettiin LOST-alueen kotihoidon yksiköiden hoitajille (n=150) farmaseutin lopputyönä tehtyä kyselyaineistoa sekä työntekijöille (n=6) ja esimiehille (n=6) tehtyjä erillisiä ryhmäkeskusteluja. Lisäksi näkökulman laajentamiseksi ja moniammatillisuuden korostamiseksi aineistona käytettiin kotihoidon asiakkaita hoitavien lääkärien (n=4) teemahaastatteluja. Kyselyaineistosta analysoitiin erikseen sairaanhoitajien, lähihoitajien ja kodinhoitajien koulutustarpeet. Samat asiat nousivat esille kunkin ammattiryhmän tuloksissa. Tärkeimpinä lääkehoito-osaamiseen liittyvinä teoreettisina koulutettavina asioina kyselystä nousivat esille iäkkäiden farmakokinetiikka ja lääkkeiden käyttöön liittyvät erityispiirteet, lääkkeiden vaikutukset, lääkkeiden haittavaikutukset sekä lääkkeiden yhteisvaikutukset ja yhteensopivuus. Lisäksi teoreettisista taidoista nousi hoitotyön etiikkaan liittyvät tarkkuus ja huolellisuus työssä. Käytännön taidoista tärkeimpinä koulutettavina aiheina kyselystä nousivat asiakkaiden lääkehoidon ja voinnin seuranta, lääkkeiden jakaminen sekä lääkkeiden annosteluun liittyen se, että annostellaan oikeaa lääkettä ja vahvuutta, oikea annos ja oikeaan aikaan sekä oikeat antotavat. Ryhmäkeskusteluista ja lääkärien teemahaastatteluista haettiin syvempää ymmärrystä kyselyn tuloksiin. Yksi tärkeimmistä tämän laadullisen tutkimuksen löydöksistä oli kotihoidon yhteistyöhön liittyvät epäkohdat. Lääkehoitojen toteuttamista ja seurantaa voitaisiin tulosten perusteella parantaa lääkärien ja kotihoidon hoitajien yhteisellä koulutuksella. Tärkeimpiä sairauksia tai oireita, joihin hoitajat toivoisivat yhteisiä toimintakäytäntöjä, ovat diabetes, sydän- ja verisuonisairaudet, kipu, muistisairaudet sekä psyykensairaudet. Lisäksi koulutusaiheiksi tutkimuksesta nousivat iäkkäiden lääkehoidon erityispiirteet, lääkkeiden antoreitit ja lääkemuodot. Kyselyn sekä ryhmäkeskustelujen ja lääkärien teemahaastattelujen tuloksista tehtiin lopuksi synteesi, jonka lopputuloksena LOST-alueen kotihoidon hoitohenkilöstölle sekä kotihoidon lääkäreille koottiin yhteinen tarvelähtöinen täydennyskoulutussuunnitelma. Suunnitelma tehtiin aineistosta nousseiden koulutusaiheiden pohjalta, eikä siihen lisätty aiheita tutkimuksen ulkopuolelta.

Dokumentation och beskrivning som språkplanering : perspektiv från arbete med tre tecknade minoritetsspråk

Language Documentation and Description as Language Planning Working with Three Signed Minority Languages Sign languages are minority languages that typically have a low status in society. Language planning has traditionally been controlled from outside the sign-language community. Even though signed languages lack a written form, dictionaries have played an important role in language description and as tools in foreign language learning. The background to the present study on sign language documentation and description as language planning is empirical research in three dictionary projects in Finland-Swedish Sign Language, Albanian Sign Language, and Kosovar Sign Language. The study consists of an introductory article and five detailed studies which address language planning from different perspectives. The theoretical basis of the study is sociocultural linguistics. The research methods used were participant observation, interviews, focus group discussions, and document analysis. The primary research questions are the following: (1) What is the role of dictionary and lexicographic work in language planning, in research on undocumented signed language, and in relation to the language community as such? (2) What factors are particular challenges in the documentation of a sign language and should therefore be given special attention during lexicographic work? (3) Is a conventional dictionary a valid tool for describing an undocumented sign language? The results indicate that lexicographic work has a central part to play in language documentation, both as part of basic research on undocumented sign languages and for status planning. Existing dictionary work has contributed new knowledge about the languages and the language communities. The lexicographic work adds to the linguistic advocacy work done by the community itself with the aim of vitalizing the language, empowering the community, receiving governmental recognition for the language, and improving the linguistic (human) rights of the language users. The history of signed languages as low status languages has consequences for language planning and lexicography. One challenge that the study discusses is the relationship between the sign-language community and the hearing sign linguist. In order to make it possible for the community itself to take the lead in a language planning process, raising linguistic awareness within the community is crucial. The results give rise to questions of whether lexicographic work is of more importance for status planning than for corpus planning. A conventional dictionary as a tool for describing an undocumented sign language is criticised. The study discusses differences between signed and spoken/written languages that are challenging for lexicographic presentations. Alternative electronic lexicographic approaches including both lexicon and grammar are also discussed. Keywords: sign language, Finland-Swedish Sign Language, Albanian Sign Language, Kosovar Sign Language, language documentation and description, language planning, lexicography

Economic analysis of climate change adaptation strategies in selected coastal areas in Indonesia, Philippines and Vietnam

This report is an account of a cross-country study that covered Vietnam, Indonesia and the Philippines. Covering four sites (one each in Indonesia and Vietnam) and two sites in the Philippines, the study documented the impacts of three climate hazards affecting coastal communities, namely typhoon/flooding, coastal erosion and saltwater intrusion. It also analyzed planned adaptation options, which communities and local governments can implement, as well as autonomous responses of households to protect and insure themselves from these hazards. It employed a variety of techniques, ranging from participatory based approaches such as community hazard mapping and Focus Group Discussions (FGDs) to regression techniques, to analyze the impact of climate change and the behavior of affected communities and households.

Economic analysis of climate change adaptation strategies in selected coastal areas in Indonesia, Philippines and Vietnam

Climate change with its attendant geophysical hazards is well studied. A great deal of attention has gone into analyzing climate change impacts as well as searching out possible mitigating adaptive strategies. These matters are very real concerns, especially for coastal communities. Such communities are often the most vulnerable to climate change, since their citizens frequently live in abject poverty and have limited capacity to adapt to geophysical hazards. Their situation is further complicated by the prospect of dealing with a confluence of hazards in comparison with those in other ecosystems. Against this backdrop Worldfish and the Economy and Environment Program for Southeast Asia (EEPSEA) collaborated to implement the cross-country study “Climate Change Impacts, Vulnerability Assessments, Economic and Policy Analysis of Adaptation Strategies in Selected Coastal Areas in Indonesia, Philippines, and Vietnam”. As its title suggests the study covered selected sites in Vietnam, Indonesia and the Philippines. Employing a gamut of interdisciplinary methodologies -- ranging from community-based approaches such as community hazard mapping and focus group discussions (FGDs) to regression techniques -- the study documented the impacts from three climate hazards affecting coastal communities. These were typhoon/flooding, coastal erosion, and saltwater intrusion. The team also analyzed planned adaptation options suited to implementation by communities and local governments, augmenting autonomous responses of households to protect and insure themselves from these hazards.

Assessment of agrobiodiversity resources in the Borotse flood plain, Zambia

Concerns about perceived loss of indigenous materials emerged from multiple stakeholders during consultations to plan and design the CGIAR Research Program on Aquatic Agricultural Systems for the Borotse hub in Zambia’s Western Province. To come to grips with and address the concerns, the AAS Borotse hub program of work included an assessment of agrobiodiversity to inform community-level and program initiatives and actions. The agrobiodiversity assessment comprised three components: key informant and expert surveys complemented by review of grey and published literature, focus group discussions in the communities, and individual household surveys. This working paper reports the findings from assessments of agrobiodiversity resources in the Borotse hub by key informants and local experts working in government ministries, departments and agencies, and non-governmental organizations operating in the communities. This working paper covers the following topics: agriculture in the Borotse flood plain; major agricultural land types in the Borotse flood plain; soils and their uses; production systems; crops, including the seed sector and ex-situ resources; indigenous materials collected from the wild, including non-perennial and perennial plants, aquatic plants, and forest biodiversity; fish resources, including both capture fisheries and aquaculture; livestock resources; dietary diversity; and indigenous and local knowledge on management systems.

Foods and diets of communities involved in inland aquaculture in Malaita Province, Solomon Islands

Solomon Islands has a population of just over half a million people, most of whom are rural-based subsistence farmers and fishers who rely heavily on fish as their main animal-source food and for income. The nation is one of the Pacific Island Counties and Territories; future shortfalls in fish production are projected to be serious, and government policy identifies inland aquaculture development as one of the options to meet future demand for fish. In Solomon Islands, inland aquaculture has also been identified as a way to improve ood and nutrition security for people with poor access to marine fish. This report undertaken by a Worldfish study under the CGIAR Research Program on Aquatic Agricultural Systems explores the e potential role of land-based aquaculture of Mozambique tilapia in Solomon Islands as it relates to household food and nutrition security. This nutrition survey aimed to benchmark the foods and diets of households newly involved in small homestead tilapia ponds and their neighboring households in the central region of Malaita, the most populous island of all the provinces in Solomon Islands. Focus group discussions and semistructured interviews were employed in 10 communities (five inland and five coastal), four clinics, and five schools.

Capturing views of men, women and youth on agricultural biodiversity resources consumed in Barotseland, Zambia

This paper presents data and findings from focus group discussions in study communities selected by the CGIAR Research Program on Aquatic Agricultural Systems (AAS) in the Western Province of Zambia. The discussions focused on cultivated crops and vegetables collected from open fields and consumed as food. Participatory tools for agricultural biodiversity (agrobiodiversity) assessment were used to capture community perspectives on plant species and varietal diversity; factors influencing the availability and use of plants for food; unique, common and rare crop species cultivated in a community, identified through a four-cell analysis methodology; and core problems, root causes, effects and necessary actions to tackle them, using problem tree or situation analysis methods.

Market-oriented new product development of functional beverages

Strategic reviews of the Irish Food and Beverage Industry have consistently emphasised the need for food and beverage firms to improve their innovation and marketing capabilities, in order to maintain competitiveness in both domestic and overseas markets. In particular, the functional food and beverages market has been singled out as an extremely important emerging market, which Irish firms could benefit from through an increased technological and market orientation. Although health and wellness have been the most significant drivers of new product development (NPD) in recent years, failure rates for new functional foods and beverages have been reportedly high. In that context, researchers in the US, UK, Denmark and Ireland have reported a marked divergence between NPD practices within food and beverage firms and normative advice for successful product development. The high reported failure rates for new functional foods and beverages suggest a failure to manage customer knowledge effectively, as well as a lack of knowledge management between functional disciplines involved in the NPD process. This research explored the concept of managing customer knowledge at the early stages of the NPD process, and applied it to the development of a range of functional beverages, through the use of advanced concept optimisation research techniques, which provided for a more market-oriented approach to new food product development. A sequential exploratory research design strategy using mixed research methods was chosen for this study. First, the qualitative element of this research investigated customers’ choice motives for orange juice and soft drinks, and explored their attitudes and perceptions towards a range of new functional beverage concepts through a combination of 15 in-depth interviews and 3 focus groups. Second, the quantitative element of this research consisted of 3 conjoint-based questionnaires administered to 400 different customers in each study in order to model their purchase preferences for chilled nutrient-enriched and probiotic orange juices, and stimulant soft drinks. The in-depth interviews identified the key product design attributes that influenced customers’ choice motives for orange juice. The focus group discussions revealed that groups of customers were negative towards the addition of certain functional ingredients to natural foods and beverages. K-means cluster analysis was used to quantitatively identify segments of customers with similar preferences for chilled nutrient-enriched and probiotic orange juices, and stimulant soft drinks. Overall, advanced concept optimisation research methods facilitate the integration of the customer at the early stages of the NPD process, which promotes a multi-disciplinary approach to new food product design. This research illustrated how advanced concept optimisation research methods could contribute towards effective and efficient knowledge management in the new food product development process.