Bernadette Ward

Helping policy‐makers address rural health access problems

This paper provides a comprehensive review of the key dimensions of access and their significance for the provision of primary health care and a framework that assists policy-makers to evaluate how well policy targets the dimensions of access. Access to health care can be conceptualised as the potential ease with which consumers can obtain health care at times of need. Disaggregation of the concept of access into the dimensions of availability, geography, affordability, accommodation, timeliness, acceptability and awareness allows policy-makers to identify key questions which must be addressed to ensure reasonable primary health care access for rural and remote Australians. Evaluating how well national primary health care policies target these dimensions of access helps identify policy gaps and potential inequities in ensuring access to primary health care. Effective policies must incorporate the multiple dimensions of access if they are to comprehensively and effectively address unacceptable inequities in health status and access to basic health services experienced by rural and remote Australians.

Public support for alcohol policies associated with knowledge of cancer risk

BACKGROUND Several options are advocated by policy experts to mitigate alcohol-related harms, although the most effective strategies often have the least public support. While knowledge of tobacco-related health risks predicts support for relevant public health measures, it is not known whether knowledge of alcohol health risks is similarly associated with the acceptability of policies intended to reduce alcohol consumption and related harms. This study aims to gauge public support for a range of alcohol policies and to determine whether or not support is associated with knowledge of a long-term health risk of alcohol consumption, specifically cancer. METHODS 2482 adults in New South Wales (NSW), Australia, participated in an online survey. Logistic regression analysis was used to examine the association between demographic data, alcohol consumption, smoking status, knowledge of alcohol as a risk factor for cancer and support for alcohol-related policies. RESULTS Most participants were supportive of health warnings, restricting access to internet alcohol advertising to young people, and requiring information on national drinking guidelines on alcohol containers. Almost half of participants supported a ban on sport sponsorship, while less than 41% supported price increases, volumetric taxation, or reducing the number of retail outlets. Only 47% of participants identified drinking too much alcohol as a risk factor for cancer. Knowledge of alcohol as a risk factor for cancer was a significant predictor of support for all policies, while level of alcohol consumption had a significant inverse relationship with policy support. CONCLUSION The finding that support for alcohol management policies is associated with awareness that drinking too much alcohol may contribute to cancer could assist in the planning of future public health interventions. Improving awareness of the long term health risks of alcohol consumption may be one avenue to increasing public support for effective alcohol harm-reduction policies.

A non‐residential alternative to off campus writers’ retreats for academics

Changes in the higher education sector over the past decade have led to increasing demands on academics and resulted in increasing workloads, longer work hours and increased workplace stress. Declining government commitment to university funding has placed increasing pressure on academics to attract research funding and to publish. In addition, an individual academic’s publication record is a core criterion for decisions regarding promotion and tenure at most universities. However, incentives to support and enable that writing to take place have been limited. A range of different interventions have been described in the literature to enhance research output and encourage academics to publish. However, many are expensive in terms of the financial and personal costs involved, when compared with the increased publication outputs. In this article the authors reflect on how their small university department facilitated on‐site writing retreats that increased publication output, with minimal disruption and limited costs. They provide a reflective account of two such retreats conducted over a twelve‐month period and make recommendations for other departments wishing to adopt a similar approach.

Supporting parents to reduce the misuse of alcohol by young people

The majority of parents report that they believe they have an important role in shaping adolescents’ values and behaviours in relation to drinking, but they also report that they need more support in this area. Education, welfare, health, youth and other professionals have an important role in providing services to young people and/or their families and have significant opportunities to provide information and support to families in relation to alcohol use. This article provides a framework for practitioners to use when assisting families to develop strategies to reduce young peoples’ exposure to risky situations and subsequent alcohol-related harm.

Children's alcohol initiation: An analytic overview

Many parents support the ‘supervised introduction’ of alcohol to children. While initiation to regular alcohol consumption in early adolescence has been linked with alcohol-related problems in adult life, the findings from these studies cannot be extrapolated to early childhood. The definition of initiation to alcohol in early childhood is often not reliable and there is a dearth of research regarding the impact of the broader social and cultural context where initiation may occur. Whilst parents need to be supported to make decisions that are informed by ‘evidence’, policymakers need to be mindful of the role of ideology in policy development and the potential differences in risk factors for initiation to alcohol and the misuse of alcohol.

Teaching research and epidemiology to undergraduate students in the health sciences

Objective: To identify and address particular challenges in the teaching of epidemiological concepts to undergraduate students in non‐clinical health disciplines.

Domestic violence screening in maternal and child health nursing practice: a scoping review.

Abstract This scoping review explores the breadth of literature on domestic violence (DV) screening by nurses, within the well child setting. The review followed the introduction of universal DV screening into the Victorian maternal and child health (MCH) service, in Australia. A scoping review provides a panoramic overview of a chosen topic that may be later used to influence policy and practice. This review explored the literature in the well child area, with a view to identifying further research priorities. The ‘Arksey and O’Malley (2005) framework’ was used to ensure methodological rigor. There was little relevant research on DV screening in the well child setting. Emergent themes included barriers and enabling factors associated with DV screening and children at risk. From this research we can conclude that further research is required on the appropriateness of DV screening, risk assessment and referral in MCH practice.

Compositional, Contextual, and Collective Community Factors in Mental Health and Well-Being in Australian Rural Communities

There are disproportionately higher and inconsistently distributed rates of recorded suicides in rural areas. Patterns of rural suicide are well documented, but they remain poorly understood. Geographic variations in physical and mental health can be understood through the combination of compositional, contextual, and collective factors pertaining to particular places. The aim of this study was to explore the role of “place” contributing to suicide rates in rural communities. Seventeen mental health professionals participated in semi-structured in-depth interviews. Principles of grounded theory were used to guide the analysis. Compositional themes were demographics and perceived mental health issues; contextual themes were physical environment, employment, housing, and mental health services; and collective themes were town identity, community values, social cohesion, perceptions of safety, and attitudes to mental illness. It is proposed that connectedness may be the underlying mechanism by which compositional, contextual, and collective factors influence mental health and well-being in rural communities.

Family-focused practice within a recovery framework: Practitioners' qualitative perspectives

BackgroundFamily-focused practice (FFP) is an effective approach to supporting individuals with mental illness. ‘Recovery’ is also central to contemporary mental health care. However, there is a dearth of evidence about how the two concepts are related and subsequently implemented in practice. The aim of this study was to explore practitioners’ understandings and practices of FFP within a recovery framework.MethodsPurposive/snowball sampling was used to recruit and conduct qualitative interviews with 11 mental health practitioners in rural Australia. Concurrent sampling and data collection were informed by thematic analysis and continued until data saturation was reached.ResultsParticipants found it difficult to articulate their understandings of FFP within a recovery framework. Nonetheless they were able to describe practices that embodied family-focused recovery. Barriers to such practices included medical models of care, where there are often a shortage of skilled staff and high demands for care. Stigma (self and from others) and confidentiality were also identified as barriers to involving family members in recovery focused care.ConclusionsFamily-focused recovery care is a priority in many high-income countries. A family-focused recovery framework is needed to assist service planners, practitioners, family members and those with mental health needs and ensure such care is embedded within practice guidelines.

The use of sequential studies in a salmonellosis outbreak linked to continental custard cakes.

We investigated an outbreak of 54 cases of Salmonella Typhimurium phage type 9 (STM9) with a specific antibiotic resistance pattern. We used sequential analytic studies: two retrospective cohort studies, a case-control study, and a modified case-control study. An outbreak of salmonellosis due to Salmonella Typhimurium PT9 SSu (resistant to streptomycin and sulphafurazole) was identified. Fifty-four cases had illness onset from November 1998 to March 1999. Notifications commenced following a restaurant birthday party in December 1998. An initial cohort and case control study found no association with consumption of custard cake. However, case follow-up identified another cohort of people who had attended a birthday party in February at which 8/27 people who consumed a continental custard cake were ill compared to 0/10 who did not (P = 0.07). A revised case control study found illness was strongly associated with consumption of a particular continental custard cake (Mantel-Haenszel matched OR infinity, P = 0.00004). This report highlights the epidemiological value of using sequential study types, and persisting with the investigation of apparently sporadic food-borne outbreaks.