Jh Walker

Confirmatory factor analysis of the GHQ-12: can I see that again

Objective: This paper reviews research relating to the factor analysis of the GHQ-12. We explore the question of whether there is a consistent replicable structure to the GHQ-12 using: (i) a comparative analysis of fit between identified factor models; and (ii) a confirmatory factor analysis of GHQ-12 data from our own study. Method: The factor models proposed from the literature were reviewed. The published factor loadings were used to carry out a factor matching analysis to identify similarities between the various factor models that have been identified. In addition, 490 patients visiting their general practitioner completed the General Health Questionnaire (GHQ-12) in the first phase of a longitudinal study evaluating service delivery to rural Tasmania. Three different methods for scoring the GHQ-12 were utilized and each resultant data set was analysed using a Confirmatory Factor Analysis (CFA) to establish which of the various factor models provided the most consistent description of the data. Result: None of the complete factor models that have been proposed have been consistently replicated across studies. Isolated factors were replicated between some studies but no single factor structure was replicated across all studies. All of the models had adequate fit to the Tasmanian data when the usual scoring was used. However, only one model had a consistently high ‘goodness of fit’ across scoring methods. Conclusion: It was concluded that the ‘best fit’ was achieved by a model based on an early factor analytic study using an Australian sample. It was suggested that researchers wanting to extract scales from the GHQ-12 could use this model.

Insights and principles for supporting social engagement in rural older people

ABSTRACT Staying socially engaged is known to improve health and longevity in older people. As the population ages, maintaining levels of social engagement among older people becomes increasingly important. Nevertheless, advancing age brings with it many challenges to social engagement, especially in rural areas. A three-year Australian Research Council Linkage Project sought to improve understandings of age-related triggers to social disengagement in six Tasmanian communities that are representative of rural Australian experience, and thus of wider salience. A collaboration between academics and health and social professionals, the project investigated design solutions for service frameworks that may be useful before ageing individuals become isolated and dependent, and that may support those individuals to actively contribute to and benefit from social life. The purpose of this paper is to report on perspectives about diminishing levels of social engagement held by older rural participants and service providers, and to advance a number of key insights on ways in which to nurture social engagement and improve the experience of ageing.

Elements affecting wound healing time: An evidence based analysis

The purpose of this study was to identify the predominant client factors and comorbidities that affected the time taken for wounds to heal. A prospective study design used the Mobile Wound Care (MWC) database to capture and collate detailed medical histories, comorbidities, healing times and consumable costs for clients with wounds in Gippsland, Victoria. There were 3,726 wounds documented from 2,350 clients, so an average of 1.6 wounds per client. Half (49.6%) of all clients were females, indicating that there were no gender differences in terms of wound prevalence. The clients were primarily older people, with an average age of 64.3 years (ranging between 0.7 and 102.9 years). The majority of the wounds (56%) were acute and described as surgical, crush and trauma. The MWC database categorized the elements that influenced wound healing into 3 groups—factors affecting healing (FAH), comorbidities, and medications known to affect wound healing. While there were a multitude of significant associations, multiple linear regression identified the following key elements: age over 65 years, obesity, nonadherence to treatment plan, peripheral vascular disease, specific wounds associated with pressure/friction/shear, confirmed infection, and cerebrovascular accident (stroke). Wound healing is a complex process that requires a thorough understanding of influencing elements to improve healing times.© 2015 by the Wound Healing Society

Partner or perish: experiences from the field about collaborations for reform

Collaborations between researchers, policy makers, service providers and community members are critical to the journey of health service reform. Challenges are multifaceted and complex. Partners come with a variety of challenging agendas, value sets and imperatives, and see the drivers for reform from different perspectives. Different skills are required for managing the partnership and for providing academic leadership, and different structural frameworks need to be put in place for each task in each project. We have found through a series of partnerships across our research theme of healthy ageing, and consequent translation into policy and practice, that significant and innovative effort is required for both the collaboration and the research to succeed. A shared understanding of the issues and challenges is a start, but not sufficient for longer-term success. In addition to managing the research, our experience has demonstrated the need to understand the different challenges faced by each of the partners, recognise and respect personal and organisational value systems, and to establish separate mechanisms to manage strong egos alongside, but outside of, the research process.

Duration and setting of rural immersion during the medical degree relates to rural work outcomes

Providing year‐long rural immersion as part of the medical degree is commonly used to increase the number of doctors with an interest in rural practice. However, the optimal duration and setting of immersion has not been fully established. This paper explores associations between various durations and settings of rural immersion during the medical degree and whether doctors work in rural areas after graduation.

Reduction in wound healing times, cost of consumables and number of visits treated through the implementation of an electronic wound care system in rural Australia

Globally, wound care costs the health care system 2–3% of the total expenditure on health, which equates to several billion dollars annually. To date, there are little data on the cost and healing rates of various wounds. This has been partly because of the difficulty in tracking wound management as the majority of wound care data has been focused on retrospective data from hospitals, general practice clinics and aged care facilities. This study reports on wound healing and cost of wounds collected from a larger project using the mobile wound care (MWC) electronic documentation system, which has been described elsewhere. The study involved 2350 clients from four health service districts in the Gippsland region in rural Australia who received treatments as part of the MWC research project (2010–2012), with a total of 3726 wounds identified (so an average of 1·6 wounds per client). By the end of the data collection period, 81% of these wounds had healed. A significant drop in healing time, cost of consumables and number of visits was found across the 3‐year period.

‘It keeps dropping out!’: The need to address the ongoing digital divide to achieve improved health and well-being benefits for older rural Australians

Introduction The article ‘“Although we’re isolated, we’re not really isolated”: The value of information and communications technology for older people in rural Australia’ explores the experiences of rural older people using information and communications technology (ICT) and the relationship with well-being [1] is a work in digital ethnography which recognises the importance of considering a holistic environmental framework and the roles that ICT play. The article examines how ICT use by rural older people facilitates interactions between themselves and their environment and concludes that ICT may facilitate wellness for rural older people by compensating for geographic and social isolation. In particular, it highlights how ICT can offer mental stimulation and prevent loneliness as compensation for decline in physical function and mobility and provide ‘control, choice and convenience’. Significantly, while ICT use was not explicitly asked about during semi-structured qualitative interviews (part of a larger project that identified the systems, supports and services that facilitate wellness), it emerged as a key theme in the participants’ day-to-day experiences.

The effect of transdermal opioid use on breakthrough opioid and sedative prescribing for rural patients with chronic pain in Northwest Tasmania: a longitudinal study

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Health and Academia: In Partnership for Interdisciplinary Training

This paper focuses on a partnership agreement between the Clarence Community Health Centre in the Tasmanian Department of Health and Human Services and the Faculty of Health Science (Nursing, Medicine and Pharmacy) at the University of Tasmania. The aim of the partnership is to develop opportunities for collaboration between the health disciplines and to apply them to the clinical environment, with emphasis on health assessment and care coordination. Clarence is one of two Community Health Centres in Tasmania that provide salaried GP services. Clarence also provides nursing (both Centre-based and in the community), child health, physiotherapy, occupational therapy, podiatry, speech therapy, social work, and will soon incorporate dental health and mental health services. Trainee health workers are part of this multidisciplinary team. Students spend time with each of the service areas as a part of a structured program in their course, regardless of their area of training. Rural outreach is an important part of the work and training program at Clarence and the Centre is a hub site for Telehealth services. Telehealth enables GPs at Clarence to provide additional support to rural sites. Students (undergraduate and postgraduate) learn about the role of information technology in linking primary health care services through active experience in interdisciplinary teams.