Medicine & Health

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Now showing 1 - 3 of 3
  • (2021) Lim, Mae
    Concern about falling is a common and serious health concern for older people. However, older people's participation in proven interventions for reducing concern about falling remains low. Health literacy could be influential to older people’s long-term participation in health programs for concern about falling. This thesis aimed to understand the relationship between health literacy and concern about falling in community-living older people. Six studies were conducted: (i) proposed a multicomponent theoretical model on health literacy and concern about falling; (ii) conducted a systematic review and meta-analysis exploring the relationship between health literacy and physical activity; (iii) developed and validated the Falls Health Literacy Scale (FHLS), a health literacy instrument specific to falls; (iv) developed cut-points for the 30-item and 10-item Iconographical Falls Efficacy Scales (IconFES) and evaluated their construct and predictive validity to falls and reduced physical activity; (v) assessed the effectiveness of a six-week online cognitive behavioural therapy (CBT) program for reducing concern about falling; (vi) explored how health literacy affects adherence to a home-based exercise program. The main findings were: (i) health literacy is closely related to many determinants of concern about falling and greater efforts are needed to clarify the impact of health literacy on intervention adherence and decision-making of older people with concern about falling; (ii) older people with inadequate health literacy are less likely to engage in physical activity on ≥5 days per week than those with adequate health literacy; (iii) the FHLS is sensitive to levels of fall-related health literacy, with good validity in an older population; (iv) the developed IconFES cut-points were sensitive to variables associated with concern about falling and predicted fall incidence and physical activity restriction after one year; (v) online CBT is a feasible treatment method for older people, and a targeted program with a well-integrated psychoeducation module on concern about falling seems warranted to boost the therapeutic effects; (vi) education, history of falls, anxiety and neuroticism moderate the relationship between health literacy and adherence of older people to a home-based exercise program. The thesis findings elucidate key aspects of the relationship between health literacy and concern about falling in older people.

  • (2023) Listiyandini, Ratih Arruum
    Psychological distress is prevalent among university students worldwide, including in Low-and-middle income countries, such as Indonesia. Considering its promising scalability, a culturally relevant Internet-delivered mindfulness intervention has potential to treat psychological distress among Indonesian university students. However, there is no previous research into the development and impact of culturally relevant internet-delivered mindfulness interventions for Indonesian university students, leaving a gap in the research literature. The current thesis aims to: a) develop a culturally adapted internet-delivered mindfulness intervention and evaluate its relevancy for Indonesian university students; b) assess its feasibility and acceptability in a pilot open trial, and c) investigate its effectiveness for treating distress among Indonesian students in a randomised controlled trial. To achieve the thesis objectives, the systematic cultural adaptation framework proposed by Barrera and colleagues (2006; 2013) was employed as a guiding framework for culturally adapting an Australian internet-delivered mindfulness program to be more relevant for Indonesian university students. The development of a culturally adapted internet-delivered mindfulness intervention was achieved through two studies using mixed-methods approach. Study 1 was an online cross-sectional survey of Indonesian students’ openness and preferences toward an internet-delivered mindfulness program. Study 2 engaged Indonesian university students, as well as mindfulness or mental health experts in focus group discussions, structured interviews, and the completion of cultural relevancy questionnaires. The purpose of Study 2 was to gain feedback on an initial version of the culturally adapted program. These studies showed that an internet-delivered mindfulness intervention is relevant for Indonesian university students, but some adjustments needed to be made to enhance its cultural suitability and engagement. Based on these studies, an Indonesian counsellor-guided internet-delivered mindfulness program, called PSIDAMAI (Program Intervensi Mindfulness Daring Mahasiswa Indonesia) was developed. Subsequently, Study 3 assessed the feasibility, acceptability, and preliminary clinical outcomes of counsellor guided PSIDAMAI using a pre-post open trial study design. Study 3 showed that PSIDAMAI was feasible, acceptable, and associated with significant improvements in psychological distress between baseline and post-treatment, with good completion rates (70%). In Study 4, the clinical efficacy of PSIDAMAI was tested in a randomized controlled trial using a wait-list control group as a comparator. Study 4 found that PSIDAMAI was more effective at improving psychological distress compared to the wait-list control group with medium to large between-group effect sizes. The improvements were maintained up to one-month follow-up. In summary, the thesis is the first to demonstrate evidence that a culturally adapted internet-delivered mindfulness intervention is relevant, acceptable, feasible, effective, and has positive impacts for Indonesian university students’ mental health. Thus, strategies for wider implementation within the Indonesian higher education mental health system are now needed.

  • (2023) Hagos, Amanuel Kidane
    In most developed countries, the rapid increase in the number of older incarcerated adults along with their complex health and social service needs has become a challenge for both correctional and health systems. Existing evidence consists of largely secondary data and addresses single issues such as mental health. The purpose of this body of work was to explore current practices in the care and management of older people in prison and those transitioning to community and provide recommendations for policy, practice, and future research in the field. The body of work employed a combination of exploratory sequential and concurrent mixed methods study design. The work started with a scoping review to identify international best practices in the care and management of older incarcerated adults. This review further informed two subsequent qualitative studies and a collective mixed methods case study in New South Wales, Australia. The two qualitative studies used focus group discussions with Corrective Services New South Wales (CSNSW) staff and applied thematic analysis to analyse the data. The collective mixed methods case study used interviews and online survey with CSNSW and Justice Health and Forensic Mental Health Network staff and older incarcerated adults. A constant comparative analysis was applied to analyse interviews using NVivo version 12. Qualtrics and SPSS version 26.0 were used to administer and analyse the quantitative data. The series of studies in this thesis have resulted to key empirical and conceptual contributions including: i) best practices to optimise the care and management of older incarcerated adults in mainstream prisons, ii) barriers and enablers to in-prison care and the transition to community, iii) attributes of competing logics (e.g. differing power and priorities) between health and custody in the care and management of older incarcerated adults, iv) sub-optimal application of the principles of equivalence of care, v) weak communication and relationships among prison staff (Relational Coordination index of 2.9 (SD = 0.7), and vi) ad hoc approaches to the care and management of the older incarcerated adult population. In a summary, the evidence from this body of work revealed that the care and management of older incarcerated adults operates through an intersecting triad of correctional safety and security requirements, prison health services ethos and older incarcerated adults’ needs where safety and security considerations take precedence over health services, limiting older incarcerated adults’ involvement and preferences and compromising equivalence of care. More collaborative work between health and custody can improve the organisation and provision of care to older incarcerated adults and achieve equivalence of care in correctional centres.