Desley Harvey

An evaluation of tobacco brief intervention training in three Indigenous health care settings in north Queensland

Objective: To evaluate the pilot phase of a tobacco brief intervention program in three Indigenous health care settings in rural and remote north Queensland.

Practitioner Research Capacity: A Survey of Social Workers in Northern Queensland

Abstract Strategies to build practitioner research capacity need to be developed in order to increase the research base for social work. To be effective, strategies need to be informed by an understanding of the organisational context and the social work workforce. This paper reports the results of a cross-sectional survey of social workers conducted as part of a larger study of health practitioners in a public sector health organisation in northern Queensland. The survey demonstrates a high level of interest in research. Research methods congruent with social works person in environment focus were favoured by participants. However, consistent with the literature, lack of confidence, limited knowledge and skills, and practical constraints impeded research activity. This study contributes to research capacity building initiatives by identifying research strengths and areas of research activity where support is required. Approaches to evidence-based practice consistent with social work and strategies for research capacity building are discussed.

Parents’ Experiences of Health Care for Their Children With Cerebral Palsy

Although current health care service delivery approaches for children with cerebral palsy recognize the importance of including parents in the health care of their child, we do not yet understand how parents experience this phenomenon. In this study, we used grounded theory methodology to explore parents’ experiences of health care for their children with cerebral palsy living in a regional area of Australia. Our findings indicate that parents experience health care for their child as a cyclical process of “making the most of their body and their life.” Important aspects of care include “learning as you go,” “navigating the systems,” “meeting needs through partnership,” “being empowered or disempowered,” and “finding a balance.” We suggest modifications to health care service delivery practices that might contribute to improved experiences of health care for this population.

The role of empowerment in setting a foundation for social and emotional wellbeing

Abstract Empowerment and community participation are major strategies, worldwide, for alleviating poverty and social exclusion, thereby reducing health disparities. In Australia, a lack of control, or mastery, has long been widely acknowledged as one aspect of a broader experience of powerlessness that needs to be addressed to reduce the current preventable Indigenous burden of disease and close the health disparity gap. Yet, it is hard to find empirical research examining the nature and attributes of empowerment and how to operationalise and evaluate these in the context of promoting Indigenous health. This paper synthesises the findings of a five-year Family Wellbeing empowerment study aimed at enhancing the capacity of Indigenous Australian people in Cape York, far north Queensland, to take greater control over the issues affecting their health and wellbeing. Documenting and analysing empowering strategies over time can help us to better understand the process of empowerment and ways in which change is generated at multiple levels. The study confirmed existing evidence that the process of empowerment is lengthy, taking years to achieve change beyond the individual level. It also highlighted the importance of initial engagement and personal capacity building, in socially and economically vulnerable communities where people experience relative powerlessness, as a critical foundation for improving the health of the broader community.

The Contribution of Qualitative Methodologies to Rural Health Research: An Analysis of the Development of a Study of the Health and Well-Being of Women in Remote Areas

Understanding the influence of rural social determinants on health can contribute to alleviating disparities between the health of urban and rural populations. Qualitative methodologies have made a substantial contribution to our understanding of rural health issues. However, there are few published case studies of the process of designing qualitative studies which can contribute to a better understanding of how to conduct and evaluate qualitative research. This paper adds to the methodological literature by describing the process of developing a methodology for a study of how women in remote areas achieve health and well-being. In the paper the author documents the process and illustrates an individuals search for a method that would suit her research problem and her personal and professional ideology. Metaethnography, constructivist grounded theory, and dialogic/performance narrative methods are identified as a qualitative methods particularly suited to health and other areas of rural social research.

Improving care coordination for community-dwelling older Australians: a longitudinal qualitative study

Objective The aim of the present study was to describe the care transition experiences of older people who transfer between subacute and primary care, and to identify factors that influence these experiences. A further aim of the study was to identify ways to enhance the Geriatric Evaluation and Management (GEM) model of care and improve local coordination of services for older people. Methods The present study was an exploratory, longitudinal case study involving repeat interviews with 19 patients and carers, patient chart audits and three focus groups with service providers. Interview transcripts were coded and synthesised to identify recurring themes. Results Patients and carers experienced care transitions as dislocating and unpredictable within a complex and turbulent service context. The experience was characterised by precarious self-management in the community, floundering with unmet needs and holistic care within the GEM service. Patient and carer attitudes to seeking help, quality and timeliness of communication and information exchange, and system pressure affected care transition experiences. Conclusion Further policy and practice attention, including embedding early intervention and prevention, strengthening links between levels of care by building on existing programs and educative and self-help initiatives for patients and carers is recommended to improve care transition experiences and optimise the impact of the GEM model of care. What is known about the topic? Older people with complex care needs experience frequent care transitions because of fluctuating health and fragmentation of aged care services in Australia. The GEM model of care promotes multidisciplinary, coordinated care to improve care transitions and outcomes for older people with complex care needs. What does this paper add? The present study highlights the crucial role of the GEM service, but found there is a lack of systemised linkages within and across levels of care that disrupts coordinated care and affects care transition experiences. There are underutilised opportunities for early intervention and prevention across the system, including the emergency department and general practice. What are the implications for practitioners? Comprehensive screening, assessment and intervention in primary and acute care, formalised transition processes and enhanced support for patients and carers to access timely, appropriate care is required to achieve quality, coordinated care transitions for older people.

Conceptualising the Mental Health of Rural Women: A Social Work and Health Promotion Perspective

Abstract The mental health and well-being of rural women and how to promote it is not well understood. This paper reviews contrasting discourses in relation to rural women, highlighting the way in which gender roles may be reinforced and women’s health and well-being compromised. The structural analysis, practice frameworks and skills provided by the disciplines of social work and health promotion can assist in the development of a broader conceptualisation of rural women’s mental health and suggest a way forward in promoting their mental health and well-being.

Delivering healthcare services to children with cerebral palsy and their families: a narrative review

Children with cerebral palsy have complex healthcare needs and often require complex multidisciplinary care. It is important for clinicians to understand which approaches to healthcare service delivery for this population are supported in the literature and how these should be applied in clinical practice. This narrative review aims to identify and review the evidence for current approaches to healthcare service delivery for children with cerebral palsy. Databases were searched using key terms to identify relevant research articles and grey literature from December 2011 to September 2013. Search results were screened and sorted according to inclusion and exclusion criteria. Thirty-two documents were included for evaluation and their content was analysed thematically. Three current approaches to healthcare service delivery for children with cerebral palsy identified in this narrative review were family-centred care, the World Health Organisations International Classification of Functioning, Disability and Health, and collaborative community-based primary care. However, healthcare services for children with cerebral palsy and their families are inconsistently delivered according to these approaches and the identified guidelines or standards of care for children with cerebral palsy have limited incorporation of these approaches. Future research is required to investigate how these approaches to healthcare service delivery can be integrated into clinical practices to enable clinicians to improve services for this population.

Exploring Women’s Experiences of Health and Well-Being in Remote Northwest Queensland, Australia:

Rural and remote environments are challenging places in which to achieve health and well-being. In this woman-centered, grounded theory study, I explored the meaning of health and well-being as well as how it is achieved from the perspective of women living in remote inland parts of Australia. The study was based on semistructured interviews with 23 women living in geographically remote areas. The findings are presented as a model of the capacity to flourish. Flourishing describes an optimal achievable state of well-being, delineated by four interrelated dimensions of experience: control, connecting, belonging, and identity. I identify individual, contextual, and structural factors that enable and constrain the capacity to flourish. The findings suggest that approaches to understanding and promoting women’s health in remote areas should be more holistic and contextual.

Care transitions as street-level work: Providers’ perspectives on the dilemmas and discretions of older people’s transitions across acute, sub-acute and primary care

Purpose Quality care transitions of older people across acute, sub-acute and primary care are critical to safety and cost, which is the reason interventions to improve practice are a priority. Yet, given the complexity of providers and services involved it is often difficult to know the types of tensions that arise in day-to-day transition work or how front-line workers will respond. To that end, this innovative study differs from the largely descriptive studies by conceptualising care transitions as street-level work in order to capture how transition practice takes shape within the complexities and dynamics of the local setting. The paper aims to discuss these issues. Design/methodology/approach Data were collected from 23 hospital health professionals and community service providers across primary, sub-acute and acute care through focus groups. A thematic analysis and interrogation of themes using street-level concepts derived three key themes. Findings The themes of risk logics and dilemmas of fragmentation make explicit both the local constraints and opportunities of care transitions and how these intersect to engender a particular logic of practice. By revealing the various discretionary tactics adopted by front-line providers, the third theme simultaneously highlights how discretionary spaces might represent both possibilities and problematics for balancing organisational and patient needs. Originality/value The study contributes to the knowledge of street-level work in health settings and specifically, the nature of transition work. Importantly, it benefits policy and practice by uncovering mechanisms that could facilitate and impede quality transitions in discrete settings.