Jenni Judd

Unexpected Result of Hendra Virus Outbreaks for Veterinarians, Queensland, Australia

A qualitative study of equine veterinarians and allied staff from Queensland, Australia, showed that veterinarians are ceasing equine practice because of fears related to Hendra virus. Their decisions were motivated by personal safety and legal liability concerns.

Reorienting health services in the Northern Territory of Australia: a conceptual model for building health promotion capacity in the workforce

Introduction: Reorienting work practices to include health promotion and prevention is complex and requires specific strategies and interventions. This paper presents original research that used ‘real-world’ practice to demonstrate that knowledge gathered from practice is relevant for the development of practice-based evidence. The paper shows how practitioners can inform and influence improvements in health promotion practice. Practitioner-informed evidence necessarily incorporates qualitative research to capture the richness of their reflective experiences. Methods: Using a participatory action research (PAR) approach, the research question asked ‘what are the core dimensions of building health promotion capacity in a primary health care workforce in a real-world setting?’ PAR is a method in which the researcher operates in full collaboration with members of the organisation being studied for the purposes of achieving some kind of change, in this case to increase the amount of health promotion and prevention practice within this community health setting. The PAR process involved six reflection and action cycles over two years. Data collection processes included: survey; in-depth interviews; a training intervention; observations of practice; workplace diaries; and two nominal groups. The listen/reflect/act process enabled lessons from practice to inform future capacity-building processes. Results: This research strengthened and supported the development of health promotion to inform ‘better health’ practices through respectful change processes based on research, practitioner-informed evidence, and capacity-building strategies. A conceptual model for building health promotion capacity in the primary health care workforce was informed by the PAR processes and recognised the importance of the determinants approach. Conclusion: Practitioner-informed evidence is the missing link in the evidence debate and provides the links between evidence and its translation to practice. New models of health promotion service delivery can be developed in community settings recognising the importance of involving practitioners themselves in these processes. (Global Health Promotion, 2013; 20(2): 53–63)

The effect of balanced protein energy supplementation in undernourished pregnant women and child physical growth in low- and middle-income countries: a systematic review and meta-analysis

Abstract The beneficial effect of balanced protein energy supplementation during pregnancy on subsequent child growth is unclear and may depend upon the mother entering pregnancy adequately nourished or undernourished. Systematic reviews to‐date have included studies from high‐, middle‐ and low‐income countries. However, the effect of balanced protein energy supplementation should not be generalised. This review assesses the effect of balanced protein energy supplementation in undernourished pregnant women from low‐ and middle‐income countries on child growth. A systematic review of articles published in English (1970–2015) was conducted via MEDLINE, Scopus, the Cochrane Register and hand searching. Only peer‐reviewed experimental studies analysing the effects of balanced protein energy supplementation in undernourished pregnant women from low‐ and middle‐income countries with measures of physical growth as the primary outcome were included. Two reviewers independently assessed full‐text articles against inclusion criteria. Validity of eligible studies was ascertained using the Quality Assessment Tool for Quantitative Studies (EPHPP QAT). In total, seven studies met the inclusion criteria. All studies reported on birthweight, five on birth length, three on birth head circumference, and one on longer‐term growth. Standardised mean differences were calculated using a random‐effects meta‐analysis. Balanced protein energy supplementation significantly improved birthweight (seven randomised controlled trials, n = 2367; d = 0.20, 95% confidence interval, 0.03–0.38, P = 0.02). No significant benefit was observed on birth length or birth head circumference. Impact of intervention could not be determined for longer‐term physical growth due to limited evidence. Additional research is required in low‐ and middle‐income countries to identify impacts on longer‐term infant growth.

Australian Aboriginal and Torres Strait Islander communities and the development of pandemic influenza containment strategies: Community voices and community control

OBJECTIVES To develop culturally appropriate and effective strategies to reduce the risk from pandemic influenza (H1N109) in rural and remote Australian Aboriginal and Torres Strait Islander communities. METHODS Participatory Action Research (PAR) approach that enabled communities and researchers to work together to develop understanding and take action to reduce risk. RESULTS The H1N109 pandemic raised deep concerns and serious issues in all of the Aboriginal and Torres Strait Islander communities involved in this project. The participants expressed distrust and scepticism in relation to current Australian health policies on containment and told the researchers that specific plans for Aboriginal and Torres Strait Islander peoples were needed. Respondents indicated that policies and plans had been developed without respectful engagement with communities. The strong and recurring themes that emerged from the PAR cycles were: the importance of family; ways of life and realities of living in response to influenza; and key messages to government and health services to focus on communication, understanding and respect. CONCLUSION The essential work of reducing risk of pandemic influenza with Aboriginal and Torres Strait Islander communities is not straightforward, but this project has highlighted a number of useful pathways to continue to journey along with communities. A number of strategies to reduce the spread of pandemic influenza in Aboriginal and Torres Strait Islander communities were identified. These strategies would make a good starting point for conversations with communities and health services. In Aboriginal and Torres Strait Islander communities the environment, community structures and traditions vary. Respectful engagement with communities is needed to develop effective policy.

The characteristics, implementation and effects of Aboriginal and Torres Strait Islander health promotion tools: a systematic literature search

BackgroundHealth promotion by and with Aboriginal and Torres Strait Islander (hereafter Indigenous) Australians is critically important given a wide gap in health parity compared to other Australians. The development and implementation of step-by-step guides, instruments, packages, frameworks or resources has provided a feasible and low-resource strategy for strengthening evidence-informed health promotion practice. Yet there has been little assessment of where and how these tools are implemented or their effectiveness. This paper reviews the characteristics, implementation and effects of Indigenous health promotion tools.MethodsIndigenous health promotion tools were identified through a systematic literature search including a prior scoping study, eight databases, references of other reviews and the authors’ knowledge (n = 1494). Documents in the peer reviewed and grey literature were included if they described or evaluated tools designed, recommended or used for strengthening Indigenous Australian health promotion. Eligible publications were entered into an Excel spreadsheet and documented tools classified according to their characteristics, implementation and effects. Quality was appraised using the Dictionary for Effective Public Health Practice Project (EPHPP) and Critical Appraisal Skills Program (CASP) tools for quantitative and qualitative studies respectively.ResultsThe review found that Indigenous health promotion tools were widely available. Of 74 publications that met inclusion criteria, sixty (81%) documented tools developed specifically for the Indigenous Australian population. All tools had been developed in reference to evidence; but only 22/74 (30%) publications specified intended or actual implementation, and only 11/74 (15%) publications evaluated impacts of the implemented tools. Impacts included health, environmental, community, organisational and health care improvements. The quality of impact evaluations was strong for only five (7%) studies.ConclusionsThe small number and generally moderate quality of implementation and evaluation studies means that little is known about how tools work to strengthen Indigenous health promotion practice. The findings suggest that rather than continuing to invest in tool development, practitioners, policy makers and researchers could evaluate the implementation and effects of existing tools and publish the results. There is a need for long-term investment in research to review the current use of health promotion tools and the factors that are likely to enhance their implementation.

Makes you proud to be black eh?: Reflections on meaningful Indigenous research participation

IntroductionThis article outlines the meaningful participation of eight Aboriginal and Torres Strait Islander community members employed as community researchers investigating the impact of pandemic influenza in rural and remote Indigenous communities in Australia. Aboriginal and Torres Strait Islander participation is now a requirement of health research involving Aboriginal and Torres Strait Islander communities. There is a growing literature on the different approaches to such involvement. Fundamental to this literature is an acknowledgement that Indigenous communities are no longer prepared to be research objects for external, mostly non-Indigenous researchers, and demand a role in decisions about what is researched and how it will be researched. In this paper, we describe the protracted process for site identification and recruitment and training of community researchers. We focus on the backgrounds of the Indigenous researchers and their motivations for involvement, and the strengths and challenges posed by Indigenous people researching in their own communities. Throughout the paper our concern is to document how genuine participation and the building of research capacity can occur.DiscussionA key feature of the research was the employment, training and strengthening the capacity of local Aboriginal and Torres Strait Islander community members in the role of community researchers. A series of training workshops were conducted in northern Australia and focussed on qualitative research methods, including data collection, data analysis and writing. The Indigenous researchers collected the community-based data, and worked in partnership with experienced academic researchers in the analysis and compilation of community reports. Parts of those community reports, as well as additional information supplied by the community researchers, forms the basis of this article. As the demand increases for involvement of Indigenous community members as researchers, focus needs to be paid to what constitutes meaningful participation. If active participation in all aspects of the research process is intended, this necessitates close attention to the knowledge and skills required for this to occur at every stage. Building research capacity means not simply equipping local people to undertake research on a particular project, but to have the knowledge and skills to undertake research in other areas.ConclusionsThere are considerable benefits for Indigenous people researching in their own communities. Most important for the community researchers on this project was the sense that they were doing important health work, not just conducting research. Given the persistent gaps between Indigenous and non-Indigenous health, this is perhaps one of the most important contributions of this type of research. Whilst research outcomes are undoubtedly important, in many cases the process used is of greater importance.

Two Way Approaches to Indigenous Mental Health Training: Brief Training in Brief Interventions

Abstract This study aimed to train health care professionals in a mental health assessment and care plan package designed for Aboriginal clients and carers and to evaluate the training and the package. The package has been developed over two years of consultation and encourages a collaborative, culturally appropriate approach to mental health assessment and care planning using motivational counselling techniques and relapse prevention strategies. Seventeen workshops were delivered in a range of settings to 261 service providers between 2006 and 2008. The training used the tools developed through the AIMhi ‘Story Telling Project’ and included multimedia resources, and activities designed to bridge the cross cultural and literacy gap in remote communities, including role play and skills practice. The training was well received and pre- and post-workshop evaluations show that participants found the workshops interesting and useful, and significantly improved in their confidence in assessment and communication, and their knowledge of early warning signs and treatment. The findings suggest a need in both the Indigenous and non-Indigenous workforce for further training, in both undergraduate and postgraduate settings, and in specialist and primary care.

Integration of occupation based intervention in hand injury rehabilitation: A Randomized Controlled Trial

STUDY DESIGN Randomized Controlled Trial (RCT). INTRODUCTION Engagement in daily occupations and day to day activities helps to restore function in individuals with injured hands and provides a platform to practise selected occupations. PURPOSE The purpose of this study was to investigate the effectiveness of a combination of Occupation Based Intervention (OBI) and Therapeutic Exercise (TE) compared to TE alone for the rehabilitation of hand injuries. METHOD A single center RCT, parallel group was conducted at the Kuala Lumpur General Hospital (KLGH), Malaysia. Forty-six adult clients with hand injuries who consented to participate were randomly allocated to either the OBI + TE group or to the TE group. RESULTS Following a ten week intervention program, statistical significance differences were found in DASH score (TE = 18.64 ± 14.84 vs OBI + TE = 9.50 ± 9.14, p = 0.02); total active motion (TE = 1035.85 ± 179.84 vs OBI + TE = 1203.65 ± 133.60, p = 0.01); neuropathic pain (TE = 2.90 ± 2.79 vs OBI + TE = 1.05 ± 2.01, p = 0.02); COPM performance (TE = 7.62 ± 2.03 vs OBI + TE = 9.53 ± 0.64, p < 0.001); and COPM satisfaction (TE = 7.60 ± 2.11 vs OBI + TE = 9.49 ± 0.76, p < 0.001) in favor of OBI + TE group. CONCLUSION This study highlighted the integration of OBI into hand injury rehabilitation improved outcomes for clients.

Does a DVD improve compliance with home exercise programs for people who have sustained a traumatic hand injury? Results of a feasibility study

Abstract Purpose: This feasibility study sought to determine if compliance and understanding of a home exercise program following a traumatic hand injury is improved when patients are provided with a DVD and a brochure when compared to using brochures only. Method: Patients who presented with a traumatic hand injury and commenced on a hand therapy protocol were randomly assigned into two groups. The control group received brochures while the experimental group were provided with exercise instructions on DVD as well as brochures. Compliance was measured through the use of exercise diaries, clinic attendance, a checklist to measure correctness and understanding of exercises and a follow-up survey. Results: No significant improvement was found in the mean exercise compliance score (p = 0.344) between the intervention and control groups. From the survey results almost half of all participants reported that pain interfered in their ability to perform their home exercises and a third acknowledged that time limited their ability to perform their exercises. Conclusion: Findings demonstrate the multidimensional nature of compliance. The provision of DVD technology, while not shown to cause a statistically significant change in overall compliance, did help improve understanding of exercises; as such DVDs could be utilised as part of a program that facilitates the patient--therapist relationship. Implications for Rehabilitation Limited time and level of pain are highlighted as reasons for non compliance with exercise and treatment programs. The use of DVDs can improve understanding and execution of exercises and can be part of a treatment program that facilitates increased patient therapist contact for rural and remote clients.

From personal to global: Understandings of social accountability from stakeholders at four medical schools

Abstract Aim: This paper addresses the question of how social accountability is conceptualised by staff, students and community members associated with four medical schools aspiring to be socially accountable in two countries. Methods: Using a multiple case study approach this research explored how contextual issues have influenced social accountability at four medical schools: two in Australia and two in the Philippines. This paper reports on how research participants understood social accountability. Seventy-five participants were interviewed including staff, students, health sector representatives and community members. Field notes were taken and a documentary analysis was completed. Results: Overall there were three common understandings. Socially accountable medical education was about meeting workforce, community and health needs. Social accountability was also determined by the nature and content of programs the school implemented or how it operated. Finally, social accountability was deemed a personal responsibility. The broad consensus masked the divergent perspectives people held within each school. Conclusion: The assumption that social accountability is universally understood could not be confirmed from these data. To strengthen social accountability it is useful to learn from these institutions’ experiences to contribute to the development of the theory and practice of activities within socially accountable medical schools.