Paul Aylward

Equity of colorectal cancer screening: cross‐sectional analysis of National Bowel Cancer Screening Program data for South Australia

Objective: The National Bowel Cancer Screening Program (NBCSP) is a population‐based screening program based on a mailed screening invitation and immunochemical faecal occult blood test. Initial published evidence from the NBCSP concurs with international evidence on similar colorectal cancer screening programs about the unequal participation by different population sub‐groups. The aim of the paper is to present an analysis of the equity of the NBCSP for South Australia, using the concept of horizontal equity, in order to identify geographical areas and population groups which may benefit from targeted approaches to increase participation rates in colorectal cancer screening.

Integrated support for Aboriginal tertiary students in health-related courses: the Pika Wiya Learning Centre

The barriers to Indigenous people entering tertiary education, succeeding, and gaining employment in the health professions are broad and systemic. While efforts have been made to address these barriers, the number of Indigenous health professionals remains extremely low across Australia. The Pika Wiya Learning Centre in South Australia provides a range of practical, social, cultural, and emotional supports for tertiary students to increase the number of Indigenous health professionals, especially registered nurses, in the region. This paper reports on the Centres strengths that may represent best practice in student support, and the obstacles to further development.

Implementation of interventions to prevent musculoskeletal injury at work — lost in translation?

Abstract Work-related musculoskeletal disorders are a major cost burden to individuals, organizations, and society. While the contribution to injury of various factors is widely acknowledged, little is known about the translation of this knowledge from researchers to Occupational Health and Safety (OHS) practitioners, nor the implementation, and effectiveness, of injury prevention advice subsequently provided to organizations. It is widely acknowledged that a ‘research-practice gap’ exists and this is further complicated by difficulties evident in applying structured interventions to prevent injury in the workplace. Injury prevention advice commonly includes proposed changes to the work system, environment, and work practices. This requires a change in both organizational and individual behaviour. The structuring of injury prevention advice according to behaviour change principles has been proposed by researchers as a means for improving its effectiveness. However, there is little evidence that this has been adopted by OHS practitioners. The incorporation of such an approach as a means of structuring advice will, for many OHS practitioners, require a paradigm-shift. While most focus on the domain of practice in which they are most expert — the physical environment — the inclusion of a method to guide and structure their advice may improve its relevance to their client and its adoption and potential effectiveness. Ultimately, the translation of research findings into OHS professional practice will require an approach which will bridge the ‘researcher-practice gap’ by both actively engaging OHS practitioners in research and improving the dissemination of findings.

Patient acceptance and perceived utility of pre-consultation prevention summaries and reminders in general practice: pilot study

BackgroundPatients attending general practices receive only about sixty per cent of the preventive services that are indicated for them. This pilot study explores patient acceptability and perceived utility of automatically generated prevention summary and reminder sheets provided to patients immediately before consultations with their general practitioners.MethodsAdult patients attending a general practitioner in a practice in Adelaide and a general practitioner in a practice in Melbourne, Australia for consultations in January and February 2009 received automatically-generated prevention summary and reminder sheets that highlighted indicated preventive activities that were due to be performed, and that encouraged the patient to discuss these with the general practitioner in the consultation. Patients completed a post-consultation questionnaire and were interviewed about their experience of receiving the sheets.ResultsSixty patients, median age 53 years (interquartile range 40-74) years, and 58% female, were recruited. Seventy eight per cent of patients found the sheets clear and easy to understand, 75% found them very or quite useful, 72% reported they had addressed with their general practitioner all of the preventive activities that were listed on the sheets as being due to be performed. A further 13% indicated that they had addressed most or some of the activities. 78% of patients said that they would like to keep receiving the sheets. Themes emerging from interviews with patients included: patient knowledge was enhanced; patient conceptions of health and the GP consultation were broadened; the consultation was enhanced; patient pro-activity was encouraged; patients were encouraged to plan their health care; the intervention was suitable for a variety of patients.ConclusionsMost patients reported that they found the prevention summary and reminder sheets acceptable and useful. The actual increase in performance of preventive activities that may result from this new intervention needs to be tested in randomised controlled trials.

A long-term evaluation of the stage of change approach and compensable injury outcomes – a cluster-randomised trial

Abstract This study investigated the long-term injury outcomes for workers in companies from a range of industries which had been randomly allocated to receive ergonomics interventions tailored according to the stage of change (SOC) approach or standard ergonomics advice. Differences in compensable injury outcomes between the groups were analysed using logistic regression models. Questionnaire results from face-to-face interviews to assess musculoskeletal pain and discomfort (MSPD), job satisfaction and other factors were also analysed. Although not significant at the 0.05 level, after adjusting for workgroup clustering, workers in receipt of tailored advice were 55% (OR = 0.45, 95% CI = 0.19–1.08) less likely to report a compensable injury than those in receipt of standard ergonomics advice. Workload, job satisfaction and MSPD were significantly correlated with injury outcomes. The observed outcomes support the potential value of the SOC approach, as well as highlighting the need to consider workload, job satisfaction and MSPD when planning injury prevention programmes. Practitioner Summary: This study investigated compensable injury outcomes for workers who had received ergonomics advice tailored according to the stage of change (SOC) approach compared with standard ergonomics advice. The results support the potential value of the SOC approach and highlight the need to consider workload, job satisfaction and musculoskeletal pain and discomfort when planning injury prevention interventions.

Equity in Primary Health Care Delivery: An Examination of the Cohesiveness of Strategies Relating to the Primary Healthcare System, the Health Workforce and Hepatitis C

OBJECTIVE To suggest ways of increasing the cohesiveness of national primary healthcare strategies and hepatitis C strategies, with the aim of ensuring that all these strategies include ways to address barriers and facilitators to access to primary healthcare and equity for people with hepatitis C. METHODS A critical review was conducted of the first national Primary Healthcare System Strategy and Health Workforce Strategy with the concurrent Hepatitis C Strategy. Content relating to provision of healthcare in private general practice was examined, focussing on issues around access and equity. RESULTS In all strategies, achieving access to care and equity was framed around providing sufficient medical practitioners for particular locations. Equity statements were present in all policies but only the Hepatitis C Strategy identified discrimination as a barrier to equity. Approaches detailed in the Primary Healthcare System Strategy and Health Workforce Strategy regarding current resource allocation, needs assessment and general practitioner incentives were limited to groups defined within these documents and may not identify or meet the needs of people with hepatitis C. CONCLUSIONS Actions in the primary healthcare system and health workforce strategies should be extended to additional groups beyond those listed as priority groups within the strategies. Future hepatitis C strategies should outline appropriate, detailed needs assessment methodologies and specify how actions in the broad strategies can be applied to benefit the primary healthcare needs of people with hepatitis C.

Perceptions of food risk and trust in non-English speaking Greek and Vietnamese immigrants in South Australia

Aim: Trust in the food supply is important when making food choices. However for non-English speakers in an English-speaking country, food choice may be problematic. Specifically, familiar foods may be limited and food safety information is often only communicated in English. This study aimed to identify factors that determine the nature and dimensions of consumer mis/trust in food in selected non-English-speaking populations. Methods: Semistructured, in-depth interviews with 17 non-English-speaking participants. Results: Qualitative analysis revealed that participants felt that they had no choice but to trust a food system that they did not understand well. However some participants undertook activities to mitigate risk and bolster their trust in the foods they bought and prepared. Conclusions: This study highlights a gap in culturally appropriate information for non-English speakers which can affect trust in the food supply.

An exploration of adolescents' decisions to abstain or refrain from alcohol consumption in Australian social settings: a qualitative systematic review

Background A significant number of Australian adolescents consume alcohol, with almost two thirds of them doing so at risky levels. This is continuing to increase despite recent National Health and Medical Research Council (NHMRC) guidelines stipulating that no alcohol is the safest option. Measures initiated to reduce and prevent alcohol consumption by adolescents have limited effectiveness. Consumption of alcohol by Australian adolescents is a national concern because of the deleterious effects of alcohol consumption on adolescents’ social, physical and neurological development, as well as other short‐ and long‐term health risks, and the negative impact of alcohol‐related violence and injury on the community. Understanding adolescents’ decisions to abstain or refrain from alcohol consumption may provide valuable insights to assist in dealing with this significant social and health issue, more particularly about the mechanisms used by adolescents or their ability to make decisions about resisting or abstaining from alcohol consumption when exposed to alcohol in their social setting(s). Objectives The review aimed to synthesize the best available qualitative evidence on the decisions made or mechanisms used by adolescents who abstain or refrain from consuming alcohol in any social setting where alcohol is available. Inclusion criteria Types of participants Adolescents aged between 14 and 19 years who reside in Australia. Phenomena of interest The phenomenon of interest was abstinence from or resistance to alcohol consumption when exposed to alcohol in social situations. Types of studies This review considered studies that focused on qualitative data, including, but not limited to, designs such as phenomenology, grounded theory, action research and exploratory studies. Search strategy A three‐step search strategy was used. An initial search to identify keywords only was undertaken in Medline and CINAHL. This was followed by an expanded search using all identified keywords and index terms specific to each included database. The reference lists of included papers were then searched for any other relevant studies. Methodological quality No studies met the inclusion criteria sufficiently to progress to critical appraisal. Data extraction No studies progressed to data extraction. Data synthesis Data synthesis was not undertaken as no study met the inclusion criteria. Results Although a number of studies retrieved indicated they had qualitative elements to their studies, the qualitative data was not reported. Conclusions Although a number of studies met some aspects of the inclusion criteria there was insufficient reporting of the phenomenon of interest. Due to the lack of studies meeting the inclusion criteria, no conclusions can be drawn for clinical practice. A lack of qualitative data on this topic has been identified. Thus there is a great need for qualitative research to understand and know more about what enables an adolescent to abstain or refrain from consumption in order to inform or formulate effective interventions, policies or plans to prevent or reduce the volume of alcohol consumed by Australian adolescents.