Angela Fielding

Rationale, design and methods for a staggered-entry, waitlist controlled clinical trial of the impact of a community-based, family-centred, multidisciplinary program focussed on activity, food and attitude habits (Curtin University’s Activity, Food and Attitudes Program—CAFAP) among overweight adolescents

BackgroundCurrent estimates place just under one quarter of adolescents in Australia as overweight or obese. Adolescence has been identified as a critical period for the development of obesity, yet despite this recognition, there is limited systematic research into or evaluation of interventions for overweight adolescents. Reviews have concluded that there is a substantive evidence gap for effective intervention, but physical activity, lifestyle change and family involvement have been identified as promising foci for treatment.MethodsThis paper reports on the development of a staggered-entry, waitlist controlled clinical trial to assess the impact of a multidisciplinary intervention aiming to change the poor health trajectory of overweight adolescents and help them avoid morbid obesity in adulthood—Curtin University’s Activity, Food and Attitudes Program (CAFAP). 96 adolescents, aged 11–16 years, and parents, will attend twice weekly during an 8 week intensive multidisciplinary program with maintenance follow-up focussed on improving activity, food and attitude habits. Follow-up assessments will be conducted immediately after completing the intensive program, and at 3, 6 and 12 months post intensive program. Main outcomes will be objectively-measured physical activity, sedentary behaviour and activity behaviours; food intake (measured by 3 day diary) and food behaviours; body composition, fitness and physical function; mental and social well-being (quality of life, mood and attitudes), and family functioning.DiscussionThis trial will provide important information to understand whether a community based multidisciplinary intervention can have short and medium term effects on activity and food habits, attitudes, and physical and mental health status of overweight adolescents.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12611001187932.

Universal health care in Thailand: Concerns among the health care workforce

OBJECTIVE To investigate the impact of the universal health care policy from the perspective of Thai health care professionals. METHODS Semi-structured interviews with purposively selected health care professionals and key informants. RESULTS Health care professionals at public hospitals, particularly in rural areas, have experienced up to a doubling in the number of daily out-patients; many with superficial symptoms. While the improved access to health care provisions was welcomed, questions regarding the appropriateness of seeking medical advice were raised. Concern regarding equity: between the universal health care policy and two parallel public health cover schemes; rural and urban areas; and the public and private sector also emerged. There are potentials for health care professionals to congregate in the private sector and urban areas where workloads are perceived to be less demanding. CONCLUSIONS The general perception of the health care professionals interviewed suggests that although increased access and health equity was welcomed, this policy has had undesired effects and exacerbated rural-urban and public-private tensions. Universal coverage increased access to health care. However, equity may be further enhanced by consolidating the three public health covers into a single scheme and develop a parallel private income protection insurance scheme.

Evaluation of an inter-professional training program for student clinical supervision in Australia

BackgroundAs a response to an Australian shortage of clinical health, nursing, and medical placements, Commonwealth Government funding has been directed to expand student training opportunities and increase the competence and number of available clinical supervisors. This paper evaluates the application of a particular supervision training model for this purpose. It considers the model’s suitability and relevance across professions and its impact on supervisory knowledge, skills, and values as well as the intention to supervise students.MethodsThe design, delivery, and evaluation of a series of one-day introductory student clinical supervision training workshops for allied health disciplines, nursing, and medicine are considered. Participants evaluated Proctor’s model of clinical supervision, which was expanded by the trainers to incorporate diversity and power relations in student supervision.ResultsEvaluation results suggest that adapting Proctor’s model for student clinical supervision is relevant across a broad range of health disciplines and clinical areas. Participants from 11 health professions reported that the training improved their knowledge, skills, and values and expanded their willingness to accept student clinical placements. The outcomes are suggestive of enhanced clinical supervision intent, capacity, and capability.ConclusionsThe student supervision training improved participants’ confidence in their clinical supervision skills. The findings suggest that the training has the potential to extend capacity and capability for student supervision across health professions and in Health Workforce Australia’s identified priority areas of mental health, community health, rehabilitation, private practice, and non-government organisations. Findings also indicate that these gains are reliant on health organizations developing and sustaining cultures of learning.

Social Network Analysis and Social Work Inquiry

Abstract Understanding and positively impacting social networks is core to social work practice and research. As a research method, social network analysis provides an important mechanism for mapping various types of networks as well as the relationships and exchanges between network actors. This has relevance to Australian human and health services given the social policy context that currently emphasises and requires improvements in the integration of services. This paper describes the application of social network analysis to a consortium of mental health and related services to examine indicators of service integration such as the frequency, type, and direction of information exchanges including referral pathways. When combined with other research methods and information, social network analysis is shown to be a useful tool providing both visual and sociometric evidence of relational activities, thus creating a strong basis for advocacy and social change.

Validating a Livelihood Asset Scale in Lao PDR

Mixed method designs are often used in scale development to generate potential items and enhance face validity. Less frequently, mixed method designs are used to examine other aspects of validity. As part of a larger evaluation in the Lao People’s Democratic Republic, we developed a scale to assess household self-reported changes in access to livelihood assets following a mine action program. In this article, we detail the process of assessing measurement validity using mixed methods. The qualitative method of evaluation was based on an analysis of in-depth interviews with key informants. The quantitative evaluation relied on data collected from the scale administration (N = 271) evaluated using Rasch measurement. The article offers an example to researchers interested in using mixed methods to assess validity in measurement development. It contributes to the growing literature on using mixed method designs to evaluate the properties of scales and to the methodological work on the measurement of access to livelihood assets.

A Snapshot of Intellectual Disabilities in Lao PDR: Challenges for the Development of Services.

Lao People’s Democratic Republic (PDR) has experienced significant economic growth in the last two decades. While access to education, health, and employment for people with disabilities has also improved markedly, people with intellectual disabilities are still among the most vulnerable in society. This article presents findings from a screening survey of 2469 participants, a focus group discussion with key stakeholders in intellectual disabilities, and a case study of the Association for Autism. The screening survey suggests 1.9% of working age participants (18–59) and 0.7% of children (6–17) have intellectual disabilities. The qualitative data illustrate poor understanding and stigmatization of people with intellectual disabilities, lack of services, and development of a parent association to improve the life prospects for children with autism and intellectual disabilities. People with intellectual disabilities in Lao PDR remain particularly vulnerable. Parents and other disability advocates are raising awareness and demonstrating the effectiveness of specialized services.