Australian journal of primary health最新文献

Background Understanding the experiences of Aboriginal and Torres Strait Islander peoples as healthcare recipients is essential for delivering culturally safe physiotherapy care; however, the literature inadequately explores these experiences. This study aimed to explore the experiences of Aboriginal and Torres Strait Islander peoples who have engaged with physiotherapists and understand their perspectives on how physiotherapists can provide culturally safe care in the community. Methods Semi-structured interviews were conducted with adult (aged >18years) self-identified Aboriginal and Torres Strait Islander peoples (n =12) who had received physiotherapy care within a community setting within the previous 3months. A First Nations methodology approach alongside reflexive thematic analysis was used to interpret the data. Results Four themes were generated: (1) building trust through yarning; (2) acknowledging and respecting culture; (3) creating a culturally safe environment; and (4) the importance of professional training. Conclusions Aboriginal and Torres Strait Islander peoples have expressed that physiotherapists can establish trust with their patients by dedicating time to develop a therapeutic relationship and by demonstrating respect for their culture. It is essential for physiotherapists to carefully consider the physical environment in which they deliver care to ensure it is welcoming and culturally safe for Aboriginal and Torres Strait Islander peoples. Physiotherapists should undertake professional development to immerse themselves in First Nations culture and history through connecting with community. This study offers insights into the lived experiences of Aboriginal and Torres Strait Islander peoples receiving care in the community and provides recommendations that may assist physiotherapists, alongside other community-based health professionals, to provide culturally safe care.

Background: Quick response (QR) codes are an established method of communication in today's society. However, the role of QR codes for linking to health information in general practice waiting areas has not yet been explored.

Methods: This mixed-methods study used both quantitative data measuring QR scans and qualitative data from follow-up semi-structured interviews with visitors to two general practice waiting areas to determine access to an online health information site and their experience of using the QR code. The technology acceptance model was used to guide the interview questions. Quantitative data were analysed descriptively, and qualitative data were analysed thematically using an inductive approach.

Results: A total of 263 QR scans were recorded across the two sites between October 2022 and October 2023. Twelve participants were interviewed. Eleven themes were identified; six were categorised as facilitators and five were barriers to QR code engagement. Motivation for engagement included boredom and curiosity. Facilitators for engaging with the QR code included familiarity secondary to the recent COVID-19 pandemic, benefits of accessing potentially sensitive information with anonymity, convenience of revisiting later and reduced paper waste. Barriers included size and location of the QR code as a limiting factor to engagement, waiting room wait time, privacy and security concerns, and the potential to exclude those without access to technology or those with low technological literacy.

Conclusion: Using QR codes in the general practice waiting area is a convenient method of presenting health information to visitors and patients. Our findings indicate that this may be an appropriate method to share health information in waiting areas. Facilitators and barriers identified in this study may assist with optimising engagement with health information via QR codes while waiting for appointments.

Background Diagnosis is essential for engagement in care for chronic hepatitis B (CHB) and chronic hepatitis C (CHC), however, many Australians remain undiagnosed, especially for CHB. Primary care represents an important setting for testing, and this study sought to examine coverage in a large representative cohort of patients. Methods We analysed retrospective data from the electronic medical records of active patients visiting 566 primary care clinics in Victoria, Australia. Pathology records were assessed to identify the proportion of patients with a record of CHB/CHC serology testing based on risk factors identified in national guidelines (ethnicity, Indigenous status, history of injecting drug use, diagnosed HIV, and/or indications of liver disease). Results Of 1,593,774 patients, 393,948 (24.7%) had an indication for testing for CHB and/or CHC, of which 150,821 (38.3%) had evidence of testing. This proportion was highest in patients with HIV (65.6%) or injecting drug use history (60.0%), and lowest for those whose Indigenous status/ethnicity indicated testing (38.2%) or with elevated liver enzymes (39.1%). The proportion with evidence of testing was only moderate among those with a cirrhosis diagnosis (48.6%) or probable cirrhosis based on laboratory testing (50.6%). Conclusions This analysis demonstrated considerable gaps in testing for CHB and CHC in a large population of patients, including many with evidence of cirrhosis, suggesting higher risk of adverse outcomes. Primary care practices should be supported to comprehensively offer testing for viral hepatitis, particularly where there is evidence of liver disease, and these findings should be used to guide future interventions.

Background Refugee health is an issue of global importance. Refugees have high and complex mental, physical and social needs and poor health outcomes. There is a clear need for more research prioritising refugees' perspectives of health care in their settlement countries; however, a number of methodological and ethical challenges can make this process difficult. Methods This methodological paper is an analysis of our recent experience conducting qualitative research with former refugees in Southern New Zealand. We utilized our research team's discussions, reflections and fieldnotes and the relevant literature to identify the key processes of our successful engagement with former refugees. Results Successful engagement with former refugees in qualitative health research entails: establishing relationships, recognising interpreters as cultural brokers, having a responsive suite of methods and finding meaningful ways to communicate. Conclusions This paper offers suggestions and guidance on conducting qualitative health research with former refugees.

Background Health literacy has evolved from a focus on individual skills to an interactive process influenced by relationships and the health system. Various instruments measure health literacy, developed from different conceptions and often for different measurement purposes. The aim of this study was to compare the properties of four widely used health literacy instruments: Test of Functional Health Literacy in Adults (TOFHLA), Newest Vital Sign (NVS), European Health Literacy Survey (HLS-EU-Q47), and Health Literacy Questionnaire (HLQ). Methods This was a within-subject study comparing instrument performance. Composite reliability and Cronbach's alpha was used to measure internal consistency, floor/ceiling effects determined discriminate ability across low-to-high score ranges, and Spearman's R correlation coefficient was used to assess the relationship between instruments, particularly scales aiming to measure similar constructs. Results Fifty-nine patients consented, with 43 completing all four instruments. Internal consistency was high for all scales (composite reliability range 0.76-0.95). Floor and ceiling effects were observed, with TOFHLA demonstrating the largest ceiling effect (>62) and NVS the only floor effect (18%). Only moderate correlations were found between TOFHLA and NVS (r =0.60) and between HLS-EU-Q47 and HLQ scales (r ~0.6). Conclusion Our study found low to moderate correlations between the instruments, indicating they measure different constructs of health literacy. Clinicians and researchers should consider the intended measurement purpose and constructs when choosing an instrument. If the purpose of measurement is to understand reading, comprehension, and numeracy skills in individuals and populations, then performance based functional health literacy instruments such as the TOFHLA and NVS will be suitable. However, if the purpose is to generate insights into broader elements of health literacy, including social supports and relationships with health providers, then the HLS-EU and HLQ may be useful. The findings highlight the need for careful instrument selection to ensure meaningful and appropriate data interpretation. As improving population health literacy is a national priority in many countries, it is important that clinicians and researchers understand the measurement differences offered by different instruments to assist them to choose the right instrument for their measurement purpose.

Background The South Australian (SA) Chronic Pain Extension for Community Healthcare Outcomes (ECHO) Network was established to upskill primary care providers in best practice pain care aligned to a patient-centred, biopsychosocial approach using didactic and case-based virtual mentoring sessions. The aims of this study were to assess: (a) participation, satisfaction (relevance, satisfaction with format and content, perceptions of the mentorship environment), learning (perceived knowledge gain, change in attitudes), competence (self-confidence) and performance (intention to change practice, perceived practice change) of the ECHO Network clinician participants; and (b) self-perceived barriers at the clinical, service and system level to applying the learnings. Methods A mixed methods, participatory evaluation approach was undertaken. Data sources included analysis of program records (learning needs assessment, enrolment survey data, program participation data and online surveys of healthcare professionals including a satisfaction survey after each ECHO session (n=106 across the ECHO series of 10 sessions; average response rate=46%), a case presenters survey (n=7, response rate=78%) and an outcome survey after all 10 ECHO sessions (n=11, response rate=25%). Results Forty-four healthcare professionals participated in the ECHO Network from a range of career stages and professional disciplines (half were general practitioners). One-third of participants practised in regional SA. Participants reported that the ECHO sessions met their learning needs (average=99% across the series), were relevant to practice (average=99% across the series), enabled them to learn about the multidisciplinary and biopsychosocial approach to pain care (a verage=97% across the series) and provided positive mentorship (average=96% across the series). Key learnings for participants were the importance of validating the patient experience and incorporating psychological and social approaches into pain care. More than one-third of participants (average=42% across the series) identified barriers to applying the learnings such as limited time during a consultation and difficulty in forming a multidisciplinary team. Conclusions The ECHO Network model was found to be an acceptable and effective interdisciplinary education model for upskilling primary care providers in best practice pain care aligned to a patient-centred, biopsychosocial approach to pain managment. However, participants perceived barriers to translating this knowledge into practice at the clinical, service and system levels.

Background Violence against women is a global public health problem. Primary healthcare services and health workers play an important role in managing this problem. The aim was to identify barriers and facilitators to the identification and management of intimate partner violence (IPV) among women presenting to primary healthcare services from the perspective of nurses/midwives, and to identify the challenges and needs to improve practices. Methods This was a qualitative descriptive study, in which semistructured interviews were conducted with 19 nurses/midwives working in primary healthcare services. The interviews were analysed using a thematic analysis approach through an inductive process. The Consolidated Criteria for Reporting Qualitative Research was used to ensure comprehensive reporting of the protocol for this qualitative study. Results Four main themes were identified: (1) detection of intimate partner violence, (2) nurses'/midwives' current practices, (3) barriers to identification and management, and (4) needs. Conclusions Primary care nurses/midwives in this study perceived that they were not responsible for the detection and management of intimate partner violence, and a majority reported they did not want to take an active role. However, those who were willing to engage in the detection and management of IPV required sufficient time for patient consultations, a reduced workload and a separate room with suitable physical conditions. It is recommended that nurses/midwives be provided with training on IPV detection and management at specific intervals, and studies be conducted to evaluate the outcomes of such training, and initiate the professional decision-making process of nurses/midwives to effectively identify, respond to and support individuals affected by IPV.

Background Models that optimise the role of the general practice nurse have the potential to deliver cost-effective best-practice dementia care in the primary care setting. Patient experience is recognised as a vital contribution to the design, provision and evaluation of healthcare services. The aim of this study was to gain insights into the healthcare needs and experiences of people living with dementia and carers as relevant to the provision of dementia care by general practice nurses. Methods A qualitative design with semi-structured interviews was employed. Data were transcribed verbatim and thematically analysed. Six carers and five people living with dementia who received care from a general practice nurse in the previous 12months took part in the study. Results Five overarching themes were identified: (1) the general practice nurse and dementia care: a golden opportunity, (2) respectful communication: talk to me and hear what I am saying, (3) person-centred information: tell me what I want to know, (4) provide support: more than just information provision, and (5) include the carer: we are a team. Conclusion This study describes the experiences and healthcare needs of people living with dementia and their carer(s) with regard to the general practice nurse role. These findings can inform strategies to support the general practice nurse provision of dementia care that meet the healthcare needs of people living with dementia and carers.

Background Vaccination is important for adults to reduce the morbidity and mortality associated with infectious diseases. In Australia, many vaccines are recommended and funded under the Australian National Immunisation Program. However, a number of vaccines are recommended for adults but not funded. This study aimed to explore factors impacting uptake of recommended vaccines in adults aged ≥50years in Australia. Methods An online cross-sectional survey was conducted from the general population aged ≥50years. The survey was distributed via a market research company using a convenience sample. Data were analysed descriptively, and logistic regression was used to investigate associations between participant characteristics and vaccine uptake. Results A total of 1012 individuals completed the survey. The majority (67.4%) of participants reported it was important for adults to receive recommended vaccines. More than half (59.6%) felt that vaccination was more important for children. Over 60% of participants reported they knew the vaccines that they should receive. The primary reason reported for not receiving a vaccine was, 'I do not believe it is necessary'. Being aged ≥66years was significantly associated with uptake of influenza, pertussis, herpes zoster, and pneumococcal vaccines. Being female was associated with higher uptake for most vaccines, except for pneumococcal vaccine, where no significant association was found. Conclusions The importance of vaccination and risks associated with lack of vaccination need to be highlighted to this population. Recommendations from healthcare professionals continue to be one of the most important facilitators for uptake. Overall, adults reported they are unlikely to pay for recommended vaccines, making increasing uptake of these vaccines difficult.

Background Abortion care is typically undertaken by doctors; however, alternate models, including nurse-led care, are increasingly seen as viable alternatives. However, attitudes towards the leadership of alternate models can be a barrier to change. We explored the acceptability of different models of abortion care, and whether attitudes differed by health profession for those working in sexual and reproductive health. Methods Our mixed method survey explored how doctors, nurses/midwives and those working in administrative roles in primary care in Australia felt about three models of abortion care: doctor-led, nurse-led and self-administered. ANOVAs compared favourability ratings and attitude strength across groups, and qualitative data exploring how they felt about each model was thematically analysed using Leximancer. Results Attitudes towards doctor-led and nurse-led models of care were overwhelmingly positive. However, doctors perceived doctor-led care more favourably than other professionals, and felt it provides a more holistic, safer experience, that opportunistically facilitated discussions about other sexual and reproductive health matters. Self-administered care was perceived unfavourably by ~60% of participants, and was associated with significant safety concerns. Conclusions Most health professionals working in sexual and reproductive health care perceive that nurse-led models of care are viable and acceptable, although doctors feel there are additional benefits to the current model. Self-administered abortion is overwhelmingly perceived as unsafe. Nurse-led care models could increase access to safe abortion in Australia, and are perceived favourably by those working in sexual and reproductive health care.