Medicine & Health

Publication Search Results

Now showing 1 - 10 of 16
  • (2007) Amoroso, Cheryl; Proudfoot, Judy; Bubner, Tanya; Swan, Edward; Espinel, Paola; Barton, Christopher; Beilby, Justin; Harris, Mark
    Journal Article
    BACKGROUND: Clinical audit is recognised worldwide as a useful tool for quality improvement. METHODS: A feedback report profiling capacity for chronic disease care was sent to 97 general practices. These practices were invited to complete a clinical audit activity based on that feedback. Data were analysed quantitatively and case studies were developed based on the free text responses. RESULTS: Eighty-two (33%) of 247 general practitioners participated in the clinical audit process, representing 57 (59%) of 97 general practices. From the data in their feedback report, 37 (65%) of the 57 practices recognised the area most in need of improvement. This was most likely where the need related to clinical practice or teamwork, and least likely where the need related to linkages with other services, and business and finance. Only 25 practices (46%) developed an action plan related to their recognised area for improvement, and 22 (39%) practices implemented their chosen activity. Participating GPs judged that change activity focused on teamwork was most successful. DISCUSSION: The clinical audit process offered participating GPs and practices an opportunity to reflect on their performance across a number of key areas and to implement change to enhance the practice’s capacity for quality chronic disease care. The relationship between need and action was weak, suggesting a need for greater support to overcome barriers.

  • (2008) Dennis, Sarah; Zwar, N; Griffiths, Rhonda; Roland, Martin; Hasan, I; Davies, Gawaine Powell; Harris, Michael
    Journal Article
    Objectives: To review the effectiveness of chronic disease management interventions for physical health problems in the primary care setting, and to identify policy options for implementing successful interventions in Australian primary care. Methods: We conducted a systematic review with qualitative data synthesis, using the Chronic Care Model as a framework for analysis between January 1990 and February 2006. Interventions were classified according to which elements were addressed: community resources, health care organisation, self-management support, delivery system design, decision support and/or clinical information systems. Our major findings were discussed with policymakers and key stakeholders in relation to current and emerging health policy in Australia. Results: The interventions most likely to be effective in the context of Australian primary care were engaging primary care in self-management support through education and training for general practitioners and practice nurses, and including self-management support in care plans linked to multidisciplinary team support. The current Practice Incentives Payment and Service Incentives Payment programs could be improved and simplified to encourage guideline-based chronic disease management, integrating incentives so that individual patients are not managed as if they had a series of separate chronic diseases. The use of chronic disease registers should be extended across a range of chronic illnesses and used to facilitate audit for quality improvement. Training should focus on clear roles and responsibilities of the team members. Conclusion: The Chronic Care Model provides a useful framework for understanding the impact of chronic disease management interventions and highlights the gaps in evidence. Consultation with stakeholders and policymakers is valuable in shaping policy options to support the implementation of the National Chronic Disease Strategy in primary care.

  • (2012) Bunde-Birouste, Anne; Nathan, Sally; McCarroll, Brad; Kemp, Lynn; Shwe, Tun; Gran Ortega, Marcia
    Report
    Australia accepts more than 13,000 refugee and humanitarian immigrants annually and young people account for a large overall percentage of the refugee population in New South Wales (NSW). There is evidence that refugee families are highly vulnerable to social isolation in their countries of resettlement. The difficulties of refugee settlement are well documented, including the need to learn new languages, negotiate differing cultural and societal values and address past emotional trauma. Development through sport refers to the use of sporting activities to provide opportunities for personal and community development with effects that go well beyond the sphere of physical activity and [elite] player and game development. In recent years there has been an increase in programs that use sport to foster social development and engagement, however little robust research has been performed to evaluate these efforts. Football United ® was developed from a vision that people’s love for Football (soccer) can be used to build opportunities for belonging, racial harmony and community cohesion. Football United ®’s six years of operations confirms the Crawford report findings, and highlights other effects of inequity in participation: • Gaps in equity of participation in both community and public education sector sport which can contribute to general disaffection within society, including leaving school, aggressive behaviour and unemployment as examples. • Lack of opportunity to interact across cultural groups which can translate to racism and the ensuing problems it provokes. Football United ® addresses these issues basing its foundations on the premise that structural variables and social processes act at multiple levels to impact on health and social behaviour. Results of the study underline Football United ®’s positive impact on participating young people’s sense of self, and appreciation for and engagement with peers from diverse backgrounds. Learning from interviews found unanticipated connections between participating in Football United ® and learning English, positive engagement with school, and building self confidence.

  • (2017) Haigh, Fiona
    Thesis
    Objective To conceptualise a practically adequate theory and methodology of Human Rights Health Impact Assessment (HRHIA) using critical realist (CR) ontological perspectives and research approaches. Research design A CR framework for theory development and verification was applied. It involved four interrelated and iterative steps: description and analytic resolution of events and their effects; explication of structure using abductive and retroductive reasoning; assessment of explanatory power and contextualisation; and verification and concretisation of emergent theory. Application of the framework involved analysis and theorising of data from 23 international human rights (HR) and health impact assessment (HIA) experts; existing case studies of HIAs (11 case studies, 33 interviews) and a HR-based initiative (1 case study, 12 interviews); my own recollections and introspections on HIA projects; and relevant literature. Findings A methodology is conceptualised as an entity with specific properties that give it the power to guide an overall process intended to achieve a defined outcome or purpose. Methodologies can exist in four states: conceptualised, intended, enacted, and experienced. The properties that empower the guidance mechanisms of a methodology include interrelated points of view concerning: the (health rights) environment that the methodology is intended to respond to and influence; relevant knowledge properties of people involved in use of the methodology; the intended purpose and goals of the methodology; the methodology rationale; conceptual frameworks about HRHIA and HR environments that inform decision-making; processes for enacting the methodology that subsume methods, tools and conditions associated with their use; and criteria and standards for evaluating the methodology, and the outcomes when the methodology is enacted. This definition and framework were used to develop an HRHIA-specific methodology framework (state 1) and some aspects of an intended methodology (state 2). The latter included development of a procedural model and identification of potential mechanisms associated with its implementation. Conclusion This research demonstrates that a theory and methodology for HRHIA can be conceptualised using a critical realist theorising framework. The research makes a significant contribution to scholarship associated with the application of a CR paradigm in the contexts of HRHIA and methodology development.

  • (2002) Fisher, Karen; Kemp, Lynn; Tudball, Jacqueline
    Report
    This document is the Final Draft of the Families First Outcomes Evaluation Framework, concerned with evaluating child, family and community outcomes. It is one of the evaluation activities for Families First. Others include process evaluation through Area Reviews of three Families First Areas in 2002-03, local Area evaluations and program evaluation of the projects funded through Families First. This outcome evaluation activity will inform the other evaluation activities. Overall the evaluation considers whether Families First has been effective in supporting families and communities in NSW to care for children using an early intervention approach and in developing linkages between specialised health, education, community and other policies. The Framework includes suggestions for minimum data collection and foundations for extending studies beyond the budget of the evaluation. A general aim in choosing the outcome indicators is to maintain compatibility with simultaneous program evaluation of similar NSW, Commonwealth and international programs.

  • (2014) Harris, Patrick; Sainsbury, Peter; Kemp, Lynn
    Journal Article
    Purpose and setting: The last decade has seen increased use of health impact assessment (HIA) to influence public policies developed outside the Health sector. HIA has developed as a structured, linear and technical process to incorporate health, broadly defined, into policy. This is potentially incongruent with complex, non-linear and tactical policy making which does not necessarily consider health. HIA research has however not incorporated existing public policy theory to explain practitioners’ experiences with HIA and policy. This research, therefore, used public policy theory to explain HIA practitioners’ experiences and investigate ‘What is the fit between HIA and public policy?’ Methods: Empirical findings from nine in-depth interviews with international HIA practitioners were reanalysed against public policy theory. We reviewed the HIA literature for inclusion of public policy theories then compared these for compatibility with our critical realist methodology and the empirical data. The theory ‘Policy Cycles and Subsystems’ (Howlett et al., 2009) was used to re-analyse the empirical data. Findings: HIAs for policy are necessarily both tactical and technical. Within policy subsystems using HIA to influence public policy requires tactically positioning health as a relevant public policy issue and, to facilitate this, institutional support for collaboration between Public Health and other sectors. HIA fits best within the often non-linear public policy cycle as a policy formulation instrument. HIA provides, tactically and technically, a space for practical reasoning to navigate facts, values and processes underlying the substantive and procedural dimensions of policy. Conclusions: Re-analysing empirical experiential data using existing public policy theory provided valuable explanations for future research, policy and practice concerning why and how HIA fits tactically and technically with the world of public policy development. The use of theory and empiricism opens up important possibilities for future research in the search for better explanations of complex practical problems.

  • (2010) Chan, Bibiana Chi Wing
    Report
    Recent qualitative research conducted in Sydney suggests that there is considerable stigma attached to mental illness among low-acculturated Chinese-Australians. Under-utilisation of mental health services within Australia’s ethnic communities is well established. It is proposed that culturally-appropriate programs in “Assertive Communication Training” could help reducing acculturation stress (i.e. illness prevention) which, in turn, may open the door to accessing relevant information regarding mental health services (i.e. health promotion). Low-acculturated Chinese (N = 26) were recruited from ethnic media to attend seven, weekly, 90-minute workshops on assertive communication. The interactive program (adapted for non-Westerners) was aimed at improving interpersonal communication skills, especially during cross-cultural encounters. Fact sheets on mental illness and bilingual mental health services were provided seamlessly during the program. Participants completed the Depression Anxiety Stress Scale (DASS) and the Suinn-Lew Self-Identification Acculturation Scale pre- and 6-months post-training. Qualitative data assessing the impact of the program and strategies used to manage daily stress were also collected. Overall, participants rated the program as highly satisfactory. There was a marked improvement across all DASS subscales, particularly the Stress subscale. Pre- to post-training scores indicated a decrease in stress levels from above the normative mean for Chinese Australians (M=7.51) to levels well below this mean (M_T1=7.72; M_T2=6.44), p=.148. The results also indicated a significant improvement on measures of acculturation, p=.001. Finally, the qualitative component of the study yielded a rich description of assertive communication strategies used by participants to resolve conflicts, maintain positive emotional states and boost self-confidence. The results of this small, pilot study yielded positive and encouraging findings. The program, perceived by participants as carrying no stigma, was effective in reducing stress levels and improving acculturation in a sample of low-acculturated Chinese-Australians. The program was well received suggesting that further culturallyappropriate programs are needed to improve the mental health and well-being of Culturally and Linguistically Diverse (CALD) or ethnic minority groups.

  • (2013) Harris, Patrick
    Thesis
    Background Health impact assessment (HIA) and Healthy public policy (HPP) have been used interchangeably in discussions about the increasing interest in influencing public policy to improve health and health equity. This has sometimes conflated expectations about what each approach can deliver, limited understanding of the relationship between them and failed to identify wider influences on the practice of each. Critical realist methodology was used to identify and explain the factors underpinning the relationship between HIA and HPP. Methodology and Method Nine interviews and a workshop were held with international practitioners working in HIA and HPP. First, the empirical data was analysed using established critical realist analytic questions. Second, the empirically generated results were re-described using institutional public policy theory, specifically Howlett et al s Policy cycles and subsystems theory which explains how actors (emphasising people and their relationships), ideas (emphasising content) and institutions (emphasising systems) all play roles in progressing HIA and HPP. Findings Empirically HIA and HPP were demonstrated to be separate yet overlapping entities, each of which has essential and contingent characteristics. Public policy presupposes both HIA and HPP, and five public policy characteristics were identified as influences. Seven other contingent factors influence HIA and HPP and the relationship between them. Against theory HPP is largely concerned, tactically, with agenda-setting and HIA, technically and tactically, with policy formulation. Focussing in on HIA, particular emphasis is placed on substantive and procedural dimensions of public policy making. The findings include the institutional structures and mechanisms acting as conditions surrounding HIA for HPP, how the essential features of HIA fit with public policy making, and how the essential features of HIA as a policy formulation instrument operate and can be strengthened. Three propositions are developed which provide summary explanations for these features. Conclusion Separating the essential elements of HIA and HPP from contingent influences helps practitioners and researchers identify what can be directly controlled or changed to improve practice, and what else needs to be planned for as contingencies largely outside the control of HIA or HPP practitioners. Further case specific research is recommended to test the findings.

  • (2014) McKenzie, Suzanne
    Thesis
    General practice has an important role in screening for cardiovascular risk factors and providing appropriate interventions, including education, counseling and referral to address behavioural risk factors. The emotional outcomes of such interventions have not previously been measured. There is also limited evidence about the psychological impact of screening for cardiovascular risk factors and conflicting evidence about the mechanisms of association between mental health and health risk behaviours. This nested exploratory mixed methods study used questionnaires, record audit and participant interviews to investigate the relationship between mental health (using psychological distress as a non-specific measure) and the behavioural risk factors for cardiovascular disease in general practice patients who participated in a cluster randomised controlled trial of a complex general practice based intervention aiming to reduce vascular risk factors (HIPS trial). Four research questions were addressed: is there an association between psychological distress and behavioural risk factors; how does psychological distress influence maintaining or changing behavioural risk factors; what effect does changing behavioural risk factors have on psychological distress; and does the HIPS intervention impact on the participants’ psychological distress? The HIPS intervention, which addressed behavioural risk factors through screening and risk assessment in combination with education and support, did not have negative psychological consequences; and contributed to a small improvement in the mental health of the participants. This improvement was not mediated by a change in lifestyle behaviour or body mass index. However interview findings suggest there is a complex bi-directional association between distress and behaviour. A conceptual model articulating a new theory of the processes involved in behaviour change has been developed. It outlines the relationship between external stressors (stressful events), unhealthy behaviour and mood. Moderators and mediators of the relationships include personality, coping style, social support and beliefs and habits. The model could be used in the design of structured general practice based interventions addressing behavioural risk factors for cardiovascular disease; in the clinical setting to determine effective interventions for individual patients; or in a policy setting as the basis for clinical practice guidelines and regulations.

  • (2014) Harris-Roxas, Benjamin
    Thesis
    This thesis by publication examines the use of equity focused health impact assessment (EFHIA) on health service plans. The research questions addressed are: • What are the direct and indirect impacts of EFHIAs conducted on health sector plans? • Does EFHIA improve the consideration of equity in the development and implementation of health sector plans? • How does EFHIA improve the consideration of equity in health planning? The thesis is made up of seven peer-reviewed publications - five journal articles and two book chapters. It describes the use and evolution of health impact assessment (HIA) and EFHIA internationally and in Australia, how it has been used in relation to health service plans, examines its effectiveness and impacts on decision-making and implementation and examines several EFHIAs using case study and interpretive description methodologies. The thesis makes two substantial theoretical contributions in the form of (i) a typology for HIAs and (ii) a conceptual framework for evaluating the impact and effectiveness of HIAs. This conceptual framework is tested for its applicability to EFHIA in health service planning contexts and refined in this thesis based on three case studies of EFHIAs conducted on health service plans in the state of New South Wales, Australia. This research shows that EFHIA has the potential to have both direct and indirect impacts on health service planning. These impacts are influenced by a broad range of factors however, which are linked to the context in which the EFHIA is undertaken and the inputs into the EFHIA process and the procedures followed. The EFHIAs included in this thesis show that engagement with the EFHIA process and the extent to which EFHIA is regarded as a broader learning process are important factors that mediating the extent to which EFHIAs influence subsequent activities. This research also suggests that it is not possible to adequately describe the full range of impacts of EFHIA on decision-making and implementation without looking at individual perceptions of effectiveness. These perceptions change over time, suggesting that future research on the effectiveness of HIA should look at the mechanisms by which this change occurs.