Stuart Leske

Patient–practitioner relationships desired by overweight/obese adults

OBJECTIVE This study investigated the characteristics of the patient-practitioner relationship desired by overweight/obese individuals in weight management. The aim was to identify characteristics of the relationship which empower patients to make lifestyle changes. METHODS Grounded theory was used inductively to build a model of the patient-practitioner relationship based on the perspectives of 21 overweight/obese adults. RESULTS Emerging from the match between patient and practitioner characteristics, collaboration was the key process explicitly occurring in the patient-practitioner relationship, and was characterised by two subcategories; perceived power dimensions and openness. Trust emerged implicitly from the collaborative process, being fostered by relational, informational, and credible aspects of the interaction. Patient trust in their practitioner consequently led to empowering outcomes including goal ownership and perceiving the utility of changes. CONCLUSION An appropriate match between patient and practitioner characteristics facilitates collaboration which leads to trust, both of which appear to precede empowering outcomes for patients such as goal ownership and perceiving the utility of changes. Collaboration is an explicit process and precedes the patient trusting their practitioner. PRACTICE IMPLICATIONS Practitioners should be sensitive to patient preferences for collaboration and the opportunity to develop trust with patients relationally, through information provision, and modelling a healthy lifestyle.

A qualitative study of the determinants of dieting and non-dieting approaches in overweight/obese Australian adults

BackgroundDieting has historically been the main behavioural treatment paradigm for overweight/obesity, although a non-dieting paradigm has more recently emerged based on the criticisms of the original dieting approach. There is a dearth of research contrasting why these approaches are adopted. To address this, we conducted a qualitative investigation into the determinants of dieting and non-dieting approaches based on the perspectives and experiences of overweight/obese Australian adults.MethodsGrounded theory was used inductively to generate a model of themes contrasting the determinants of dieting and non-dieting approaches based on the perspectives of 21 overweight/obese adults. Data was collected using semi-structured interviews to elicit in-depth individual experiences and perspectives.ResultsSeveral categories emerged which distinguished between the adoption of a dieting or non-dieting approach. These categories included the focus of each approach (weight/image or lifestyle/health behaviours); internal or external attributions about dieting failure; attitudes towards established diets, and personal autonomy. Personal autonomy was also influenced by another category; the perceived knowledge and self-efficacy about each approach, with adults more likely to choose an approach they knew more about and were confident in implementing. The time perspective of change (short or long-term) and the perceived identity of the person (fat/dieter or healthy person) also emerged as determinants of dieting or non-dieting approaches respectively.ConclusionsThe model of determinants elicited from this study assists in understanding why dieting and non-dieting approaches are adopted, from the perspectives and experiences of overweight/obese adults. Understanding this decision-making process can assist clinicians and public health researchers to design and tailor dieting and non-dieting interventions to population subgroups that have preferences and characteristics suitable for each approach.

Systematic review of interventions for Indigenous adults with mental and substance use disorders in Australia, Canada, New Zealand and the United States

Objective: The aim of this study was to systematically review the evidence-base for the effectiveness of culturally unadapted, culturally adapted and culture-based interventions for Indigenous adults with mental or substance use disorders. Methods: We conducted a systematic search of scientific databases, government websites and web-based Indigenous research repositories. We sought studies using designs comparing an intervention group to a control/comparator group or pre- and post-test designs, published between 2000 and 2015 examining interventions to improve individual-level outcomes (e.g. remission, symptoms, quality of life, functioning) or service-level outcomes (e.g. number of interventions delivered) for Indigenous adults with mental or substance use disorders in Australia, Canada, New Zealand or the United States. Results: A total of 16 studies met inclusion criteria. Virtually all North American studies (6 US and 1 Canadian) evaluated culturally unadapted interventions, all of which were interventions for substance use. Two-thirds of Australian and New Zealand studies evaluated culturally adapted interventions and included samples with mental disorders. Of eight culturally unadapted psychological/psychosocial, pharmacological and educational intervention studies, seven reported significant improvements on at least one measure of psychological well-being, mental health problem severity, or significantly reduced alcohol or illicit drug use. Of seven culturally adapted psychological/psychosocial intervention studies, all reported significant improvement on at least one measure of symptoms of mental illness, functioning, and alcohol use. One culture-based psychological/psychosocial intervention study significantly reduced problem severity in medical and psychiatric domains. Conclusion: There remains inconclusive evidence regarding interventions due to a small and methodologically weak evidence-base. The literature would be enhanced by intervention replication and outcome standardisation, validating the outcome instruments used in Indigenous populations, including sample size calculations and using stronger research designs (e.g. interrupted time-series designs). Robust implementation and outcomes research is needed to further progress evidence-based practice in Indigenous mental health.

A randomised controlled trial of an online theory-based intervention to improve adult Australians' sun-protective behaviours

OBJECTIVE To evaluate the effectiveness of a single-session online theory of planned behaviour (TPB)-based intervention to improve sun-protective attitudes and behaviour among Australian adults. METHODS Australian adults (N=534; 38.7% males; Mage=39.3 years) from major cities (80.9%), regional (17.6%) and remote areas (1.5%) were recruited and randomly allocated to an intervention (N=265) and information only group (N=267). The online intervention focused on fostering positive attitudes, perceptions of normative support, and control perceptions for sun protection. Participants completed questionnaires assessing standard TPB measures (attitude, subjective norm, perceived behavioural control, intention, behaviour) and extended TPB constructs of group norm (friends, family), personal norm, and image norm, pre-intervention (Time 1) and one week (Time 2) and one month post-intervention (Time 3). Repeated Measures Multivariate Analysis of Variance tested intervention effects across time. RESULTS Intervention participants reported more positive attitudes towards sun protection and used sun-protective measures more often in the subsequent month than participants receiving information only. The intervention effects on control perceptions and norms were non-significant. CONCLUSIONS A theory-based online intervention fostering more favourable attitudes towards sun safety can increase sun protection attitudes and self-reported behaviour among Australian adults in the short term.

Study protocol: a randomised controlled trial of a theory-based online intervention to improve sun safety among Australian adults

BackgroundThe effects of exposure to ultraviolet radiation are a significant concern in Australia which has one of the highest incidences of skin cancer in the world. Despite most skin cancers being preventable by encouraging consistent adoption of sun-protective behaviours, incidence rates are not decreasing. There is a dearth of research examining the factors involved in engaging in sun-protective behaviours. Further, online multi-behavioural theory-based interventions have yet to be explored fully as a medium for improving sun-protective behaviour in adults. This paper presents the study protocol of a randomised controlled trial of an online intervention based on the Theory of Planned Behaviour (TPB) that aims to improve sun safety among Australian adults.Methods/DesignApproximately 420 adults aged 18 and over and predominantly from Queensland, Australia, will be recruited and randomised to the intervention (n = 200), information only (n = 200) or the control group (n = 20). The intervention focuses on encouraging supportive attitudes and beliefs toward sun-protective behaviour, fostering perceptions of normative support for sun protection, and increasing perceptions of control/self-efficacy over sun protection. The intervention will be delivered online over a single session. Data will be collected immediately prior to the intervention (Time 1), immediately following the intervention (Time 1b), and one week (Time 2) and one month (Time 3) post-intervention. Primary outcomes are intentions to sun protect and sun-protective behaviour. Secondary outcomes are the participants’ attitudes toward sun protection, perceptions of normative support for sun protection (i.e. subjective norms, group norms, personal norms and image norms) and perceptions of control/self-efficacy toward sun protection.DiscussionThe study will contribute to an understanding of the effectiveness of a TPB-based online intervention to improve Australian adults’ sun-protective behaviour.Trials registryAustralian and New Zealand Trials Registry number ACTRN12613000470796

Assessing service use for mental health by Indigenous populations in Australia, Canada, New Zealand and the United States of America: a rapid review of population surveys

BackgroundIndigenous people in Australia, Canada, New Zealand and the United States of America experience disproportionately poor mental health compared to their non-Indigenous counterparts. To optimally allocate resources, health planners require information about the services Indigenous people use for mental health, their unmet treatment needs and the barriers to care. We reviewed population surveys of Indigenous people to determine whether the information needed to guide service development is being collected.MethodsWe sought national- or state-level epidemiological surveys of Indigenous populations conducted in each of the four selected countries since 1990 that asked about service use for mental health. Surveys were identified from literature reviews and web searches. We developed a framework for categorising the content of each survey. Using this framework, we compared the service use content of the surveys of Indigenous people to each other and to general population mental health surveys. We focused on identifying gaps in information coverage and topics that may require Indigenous-specific questions or response options.ResultsNine surveys met our inclusion criteria. More than half of these included questions about health professionals consulted, barriers to care, perceived need for care, medications taken, number, duration, location and payment of health professional visits or use of support services or self-management. Less than half included questions about interventions received, hospital admissions or treatment dropout. Indigenous-specific content was most common in questions regarding use of support services or self-management, types of health professionals consulted, barriers to care and interventions received.ConclusionsEpidemiological surveys measuring service use for mental health among Indigenous populations have been less comprehensive and less standardised than surveys of the general population, despite having assessed similar content. To better understand the gaps in mental health service systems for Indigenous people, systematically-collected subjective and objective indicators of the quality of care being delivered are needed.