Hassan Hosseinzadeh

Patients' perspectives on the impact of a new COPD diagnosis in the face of multimorbidity: a qualitative study.

Background:Chronic obstructive pulmonary disease (COPD), a major cause of morbidity and mortality worldwide, often occurs in the presence of comorbidities, which may influence experience and management of the disease. No prior research seems to have gained perspectives of newly diagnosed primary care COPD patients in the context of multimorbidity.Aims:This qualitative study aimed to explore the impact of a new diagnosis of COPD in the context of multimorbidity and also sought to gain a better understanding of how patients react to the diagnosis and incorporate it into their lives.Methods:Participants were identified from a cohort of primary care patients with multimorbidity recently diagnosed with COPD. Data was collected via semi-structured interviews from nine male and eight female participants. Thematic analysis was performed and the data interpreted from a constructivist perspective.Results:Five core themes regarding COPD were induced: (i) reaction to diagnosis, (ii) impact on function and health behaviour, (iii) factors influencing self-management capacity, (iv) healthcare utilisation and (v) interplay of comorbidities. Most participants had difficulty recognising the importance of COPD and its long-term implications. For many, the salience of another chronic condition outweighed COPD. Self-management capacity and utilisation of healthcare services were challenged by low prioritisation of COPD among other comorbidities.Conclusions:This study provides an insight into how primary care patients feel about being diagnosed with COPD, as well as their prioritisation of the disease in the context of multimorbidity. It highlights the need for tailored education and personalised management incorporating patients’ perspectives in primary care.

Perceived stigma and social risk of HIV testing and disclosure among Iranian-Australians living in the Sydney metropolitan area

BACKGROUND Fear of being stigmatised is a major social risk for seeking help in the HIV/AIDS arena. However, little is known about the social perceptions that people hold about the disease. This study explores the level of perceived stigma and its effect on the social risk of HIV testing and disclosure among Iranian-Australians immigrants living in the Sydney metropolitan area. METHODS A total of 236 Iranian-Australians immigrants aged 20-65 years participated in this cross-sectional study. RESULTS The majority of respondents (73.3%) perceived that HIV-infected people face a great deal of or some stigma. Participants were concerned about being stigmatised if they tested positive or were known to be HIV-positive in the future. A significant majority expressed that such concerns would affect their decision-making related to HIV testing and disclosure. Females were more likely to perceive HIV/AIDS stigma. Multiple regression analyses showed that perceived HIV/AIDS stigma could explain 28.6% of the variance in social risk of HIV testing and disclosure (B=0.89, β=0.53, P<0.0001) and 24.6% of the variance in decision-making related to HIV testing and disclosure (B=0.62, β=0.49, P<0.0001) after controlling for sociodemographic factors. Time since migration (predictive power of 4.8-6.78%) strongly influenced the associations. CONCLUSIONS If social stigma is left unaddressed, individuals would be reluctant to undertake HIV testing or disclose their HIV status if tested positive. Further attempts are needed to change the current social construction of HIV/AIDS among Iranians-Australians living in Sydney.

Healthcare reform: implications for knowledge translation in primary care

BackgroundThe primary care sector represents the linchpin of many health systems. However, the translation of evidence-based practices into patient care can be difficult, particularly during healthcare reform. This can have significant implications for patients, their communities, and the public purse. This is aptly demonstrated in the area of sexual health. The aim of this paper is to determine what works to facilitate evidence-based sexual healthcare within the primary care sector.Methods431 clinicians (214 general practitioners and 217 practice nurses) in New South Wales, Australia, were surveyed about their awareness, their use, the perceived impact, and the factors that hindered the use of six resources to promote sexual healthcare. Descriptive statistics were calculated from the responses to the closed survey items, while responses to open-ended item were thematically analyzed.ResultsAll six resources were reported to improve the delivery of evidence-based sexual healthcare. Two resources – both double-sided A4-placards – had the greatest reach and use. Barriers that hindered resource-use included limited time, limited perceived need, and limited access to, or familiarity with the resources. Furthermore, the reorganization of the primary care sector and the removal of particular medical benefits scheme items may have hampered clinician capacity to translate evidence-based practices into patient care.ConclusionsFindings reveal: (1) the translation of evidence-based practices into patient care is viable despite reform; (2) the potential value of a multi-modal approach; (3) the dissemination of relatively inexpensive resources might influence clinical practices; and (4) reforms to governance and/or funding arrangements may widen the void between evidence-based practices and patient care.

Functional Analysis of HIV/AIDS Stigma: Consensus or Divergence?

Functional theory proposes that attitudes may serve a variety of purposes for individuals. This study aimed to determine whether stigmatized attitudes toward HIV/AIDS serve the same function for all (consensus function) or serve different functions for different individuals (divergence function) by assessing various aspects of HIV/AIDS stigma using a sample of 236 adults aged 20 to 65 years from the Iranian community living in Sydney, Australia in 2007. Respondents were classified as evaluatives or expressives based on their responses to attitude function inventory scale. HIV/AIDS-related attitudes in the study group were found to have more of an expressive (58.5%) than an evaluative function (32.2%). Multiple regression analyses revealed that various aspects of HIV/AIDS stigma were functionally divergent within the study group and could serve evaluative and expressive function. The study’s findings suggest that different messages should be presented to different audiences depending on whether the stigma performs an expressive or evaluative function.

Reacting to and managing change within juvenile justice

Purpose – As part of the wave of new public management (NPM), the purpose of this paper is to unveil reactions to, and the management of organizational change within a context seldom examined – juvenile justice. This is achieved via a state-wide study on the introduction of a policy framework in eight centers to manage detainee behavior by ensuring risk-based decision-making among staff. Design/methodology/approach – Secondary research material was analyzed on organizational characteristics, framework-implementation, and the associated outcomes. The material was synthesized to develop descriptions of each center. Findings – Two key findings are apparent. First, there were limited research material to make robust connections between framework-implementation and related outcomes. Second, of the material available, there is clear evidence of center differences. The contexts in which the framework was implemented were varied – this may partly explain the different ways the centers responded to the framework, ...

Multimorbidity in Australia: Comparing estimates derived using administrative data sources and survey data

Background Estimating multimorbidity (presence of two or more chronic conditions) using administrative data is becoming increasingly common. We investigated (1) the concordance of identification of chronic conditions and multimorbidity using self-report survey and administrative datasets; (2) characteristics of people with multimorbidity ascertained using different data sources; and (3) whether the same individuals are classified as multimorbid using different data sources. Methods Baseline survey data for 90,352 participants of the 45 and Up Study—a cohort study of residents of New South Wales, Australia, aged 45 years and over—were linked to prior two-year pharmaceutical claims and hospital admission records. Concordance of eight self-report chronic conditions (reference) with claims and hospital data were examined using sensitivity (Sn), positive predictive value (PPV), and kappa (κ).The characteristics of people classified as multimorbid were compared using logistic regression modelling. Results Agreement was found to be highest for diabetes in both hospital and claims data (κ = 0.79, 0.78; Sn = 79%, 72%; PPV = 86%, 90%). The prevalence of multimorbidity was highest using self-report data (37.4%), followed by claims data (36.1%) and hospital data (19.3%). Combining all three datasets identified a total of 46 683 (52%) people with multimorbidity, with half of these identified using a single dataset only, and up to 20% identified on all three datasets. Characteristics of persons with and without multimorbidity were generally similar. However, the age gradient was more pronounced and people speaking a language other than English at home were more likely to be identified as multimorbid by administrative data. Conclusions Different individuals, with different combinations of conditions, are identified as multimorbid when different data sources are used. As such, caution should be applied when ascertaining morbidity from a single data source as the agreement between self-report and administrative data is generally poor. Future multimorbidity research exploring specific disease combinations and clusters of diseases that commonly co-occur, rather than a simple disease count, is likely to provide more useful insights into the complex care needs of individuals with multiple chronic conditions.

Cross-cultural integration affects attitudes towards people with HIV/AIDS in Australia

BACKGROUND The stigma associated with HIV/AIDS represents a significant issue. It can hinder help-seeking behaviours, fracture relationships, conceal prevalence rates and curtail public health initiatives to reduce HIV/AIDS. Culture is known to shape this stigma - it influences how individuals and the communities they represent understand the causes of HIV/AIDS, how it can and should be treated, and how people living with HIV/AIDS (PLWHA) should be regarded. Following recent increases in both HIV/AIDS and cross-cultural migration, this study determines the effect of cross-cultural integration on the tendency to stigmatise PLWHA. METHODS This was achieved by surveying adults who are at the nexus of two dissimilar cultures - adults from the Australian-Iranian community (n=236). While the Iranian culture is largely collectivistic, the Australian culture is largely individualistic. RESULTS Survey results indicated the respondents represented a collectivistic (44.1%), transitional (33.5%) or an individualistic (22.4%) culture. Those within the collectivistic culture held the most stigmatising views about PLWHA, supporting coercive policies and reporting they would avoid PLWHA. Those within the individualistic culture held the most positive attitudes. Furthermore, regression analysis indicated that movement from a collectivistic to an individualistic culture significantly reduced stigmatising attitudes towards PLWHA. CONCLUSIONS This study is the first to demonstrate the benefits afforded by an individualist culture, particularly for PLWHA. The article concludes with a discussion on the implications associated with these findings, particularly for researchers and practitioners within the health promotion field.

Communication channels to promote evidence-based practice: a survey of primary care clinicians to determine perceived effects.

BackgroundResearch suggests that the channels through which evidence-based practices are communicated to healthcare professionals can shape the ways they engage with, and use, this information. For instance, there is evidence to suggest that information should be communicated via sources that are deemed to be credible, like government departments, professional bodies and peers. This article examines the contention that information should be communicated via credible sources. More specifically, the article examines the different communication channels through which primary care clinicians learnt of resources on evidence-based sexual healthcare – namely, clinical aides and online training programs. Furthermore, the article determines whether these communication channels influenced the perceived impact of the resources.MethodsPrimary care clinicians in Australia (n = 413), notably General Practitioners (n = 214) and Practice Nurses (n = 217), were surveyed on the GP Project – a suite of resources to promote evidence-based sexual healthcare within primary care. Survey items pertained to the source of information about the resources (or communication channel), perceived usefulness of the resources, frequency of use, subsequent contact with the Sexual Health Infoline and a sexual health clinic, as well as the perceived impact of the resources. To determine the relationships between the different communication channels and the perceived impact of the resources, a one-way ANOVA using Tukey’s post-hoc test, an independent sample t-test, a χ2 test, and a Kruskal–Wallis H test were performed where appropriate.ResultsOf the respondents who were aware of the clinical aides (49.9%), the largest proportion became aware of these through an educational event or a colleague. Of those who were aware of the online training programs (36.9%), the largest proportion became aware of these through a professional body or government organisation, either directly or via their website. Although both resource types were reported to improve clinical practice, the reported use and the perceived impact of the resources were not influenced by the way the clinicians learnt of the resources.ConclusionsThese findings cast doubt on the suggestion that the channels through which evidence-based practices are communicated to healthcare professionals shape the ways they engage with, and use, this information, as well as the perceived impact of this information. Given the importance of evidence-based practices, these curious findings suggest that the source of this information might be of little consequence.

Strategies to promote practice nurse capacity to deliver evidence-based care: An example from sexual healthcare

PURPOSE Evidence-based practice is pivotal to effective patient care. However, its translation into practice remains limited. Given the central role of primary care in many healthcare systems, it is important to identify strategies that bolster clinician-capacity to promote evidence-based care. The purpose of this paper is to identify strategies to increase Practice Nurse capacity to promote evidence-based sexual healthcare within general practice. DESIGN/METHODOLOGY/APPROACH A survey of 217 Practice Nurses in an Australian state and ten respondent-interviews regarding two resources to promote evidence-based sexual healthcare - namely, a clinical aide and online training. FINDINGS The perceived impact of both resources was determined by views on relevance and design - particularly for the clinical aide. Resource-use was influenced by role and responsibilities within the workplace, accessibility, and support from patients and colleagues. RESEARCH LIMITATIONS/IMPLICATIONS This is the first Australian study to reveal strategies to promote evidence-based sexual healthcare among Practice Nurses. The findings provide a platform for future research on knowledge translation processes, particularly among clinicians who might be disengaged from sexual healthcare. PRACTICAL IMPLICATIONS Given the benefits of evidence-based practices, it is important that managers recognize their role, and the role of their services, in promoting these. Without explicit support for evidence-based care and recognition of the Practice Nurse role in such care, knowledge translation is likely to be limited. ORIGINALITY/VALUE Knowledge translation among Practice Nurses can be facilitated by: resources-deemed informative, relevant, and user-friendly, as well as support from patients, colleagues, and their workplace.

Levels and functions of HIV/AIDS stigma within the Iranian community living in the Sydney metropolitan area

Objective: This study examines the levels of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) related stigma among the Iranian population and the factors that contribute to the formation of stigma within the study population. Design: A quantitative research design was used in this research whereby participants completed a self-administrated questionnaire. A sample of 236 adults aged 20–65 were collected using non-probability sampling techniques. Setting: The study was carried out in the Sydney (Australia) metropolitan area and data were collected in 2007. Method: To obtain a desirable sample size, multivariate techniques including snowball were used. Herek’s (1986) functional approach to attitudes was used to analyze HIV/AIDS stigma in the study population. Results: The findings illustrate that HIV/AIDS-related stigma was dominant among the study population. Overall, participants had negative feelings toward people with HIV/AIDS (PWHA); they were in favour of punitive policies against them and were more likely to avoid having contact with people who had contracted HIV/AIDS. Multiple regression analysis revealed that both instrumental (fear of contamination) and symbolic factors (attitudes towards homosexuals and injecting drug user) independently contributed to HIV/AIDS stigma. Conclusion: The findings suggest that HIV/AIDS stigma has instrumental and symbolic function, and concentrating solely on instrumental (HIV/AIDS transmission routes) factors is less likely to address it properly. Therefore, educational campaigns to reduce HIV/AIDS stigma should also focus on symbolic factors. The findings contribute to the knowledge area of better understanding of HIV/AIDS stigma among ethnic minorities of similar characteristics. The results are valuable for the Iranian community, health service providers, health educators and policy makers.