Food Security Issues Among Low-Income Earners Living with Diabetes

Background Diabetes prevalence is increasing worldwide. More than 800,000 Australians live with diabetes, and there are stark inequities in prevalence and clinical outcomes among Indigenous people and low socio-economic groups. Aims This paper focuses on food security issues experienced by low-income earners living with type 2 diabetes in Perth, Western Australia. The results presented here are part of a broader qualitative study exploring the impact of socio-economic disadvantage on diabetes. Method   Data was collected through focus groups and semi-structured interviews conducted from October 2008 to November 2009. The sample, comprising 38 participants (Indigenous and non-Indigenous), was recruited from areas with high indices of socio-economic disadvantage in Perth. Deductive data analysis identified categories from an existing conceptual framework for the relationship between socio-economic position and diabetes health outcomes, while an inductive approach was adopted to identify new themes. Results Participants had a good understanding of their dietary requirements. However, access to healthy food was not always realised, as many participants depended on others for food provision and meal preparation and had little control over their diets. Furthermore, the majority struggled to accommodate the price of healthy food within a limited budget. Conclusion In this study, low-income earners living with diabetes faced food security issues. Participants reported cost barriers, but also physical barriers relating to functional limitations and lack of transport. This study highlights that the socio-economic circumstances in which vulnerable populations experience their disease need to be understood and addressed in order to reduce the inequities surrounding diabetes outcomes.  

Enhancing activity, nutrition and mental health in overweight adolescents. Stage 1 – Formative research

The aim of the project was to refine, implement and evaluate a multi-disciplinary family-centred community-based intervention intended to influence the physical activity, nutrition and psychosocial behaviours of overweight adolescents in Western Australia

Developing fit-for-purpose funding models for rural settings: Lessons from the evaluation of a step-up/step-down service in regional Australia

IntroductionSub-acute mental health community services provide a bridging service between hospital and community care. There is limited understanding of the local factors that influence success, and of the funding implications of delivering services in rural areas.MethodsThis paper draws from quantitative and qualitative evaluation data from a regional Western Australian service to explore these issues.ResultsConsumers satisfaction with the service was high and, overall, admission to the service resulted in positive outcomes. High re-admission rates may be linked to limited community support services following discharge.DiscussionOur results suggest that outcomes may be enhanced by implementing flexible approaches that address the resource limitations of the rural context, and that the current funding model for sub-acute mental health services in rural Australian may not be fit for purpose. More needs to be understood about how these services can be better integrated with existing support services, and how they can be better funded

Disadvantage and disease: experience of type 2 diabetes among low income earners in Perth, Western Australia

Diabetes prevalence is increasing in Australia and worldwide. An estimated four per cent of the Australian population in 2007–08 had been diagnosed with diabetes, and figures show stark inequities in prevalence and clinical outcomes among Indigenous people and low socio-economic groups.This qualitative study explored the impact of socio-economic disadvantage on the experience of type 2 diabetes in Perth, Western Australia. The objectives of the study were to: explore the attitudes and experiences of persons at socio-economic disadvantage living with type 2 diabetes with respect to living with and self-managing their disease, the medical management of their disease, and seeking access to healthcare services; analyse participants’ perception of the quality of care received, and how those perceptions are formed; and elicit priorities for the effective management of type 2 diabetes from the perspective of disadvantaged health consumers.The study was positioned within a social justice and health equity framework, with a strong emphasis on the social determinants of health. The study drew from an existing conceptual framework on the relationship between socio-economic position and health among persons with type 2 diabetes to explore the pathways of disadvantage leading to poorer health outcomes.Data were collected through focus groups and semi-structured interviews held from October 2008 to November 2009. The sample, comprising 38 participants (Indigenous and non-Indigenous), was recruited from areas with high indices of disadvantage in the Perth metropolitan area. Deductive data analysis identified categories from the conceptual framework for the relationship between socio-economic position and diabetes health outcomes, while an inductive approach was adopted to identify new themes.The study unveiled multilevel pathways through which socio-economic status influences diabetes health outcomes in a sample of low income earners. A modified framework is presented which highlights the main pathways of disadvantage based on the study results, and emphasizes the complex, interweaving factors shaping the structural and psychosocial environment in which disadvantaged individuals experience their disease.Study results suggest that the circumstances in which the experience of disease of disadvantaged populations are embedded need to be understood and addressed in order to reduce the inequities surrounding diabetes outcomes

‘It still leaves me sixty dollars out of pocket’: experiences of diabetes medical care among low-income earners in Perth

Diabetes prevalence is increasing in Australia, and there are stark inequities in prevalence and clinical outcomes experienced by Indigenous people and low socioeconomic groups compared with non-Indigenous and socioeconomically advantaged groups. This paper explores the impact of Indigenous status and socioeconomic disadvantage on the experience of diabetes care in the primary health setting. Data were collected through focus groups and interviews. The sample, comprising 38 participants (Indigenous and non-Indigenous), was recruited from disadvantaged areas in Perth, Australia. Data analysis was mainly deductive and based on a conceptual framework for the relationship between socioeconomic position and diabetes health outcomes. Most participants reported accessing general practitioners regularly; however, evidence of access to dietitians and podiatrists was very limited. Perceived need, cost, lack of information on available services and previous negative experiences influenced health care-seeking behaviour. Complexity and lack of coordination characterised the model of care reported by most participants. In contrast, Indigenous participants accessing an Aboriginal community-controlled health organisation reported a more accessible and coordinated experience of care. Our analysis suggests that Indigenous and socioeconomically disadvantaged people tailor their health care-seeking behaviour to the limitations imposed by their income and disadvantaged circumstances. To reduce inequities in care experiences, diabetes services in primary care need to be accessible and responsive to the needs of such groups in the community

Proactive primary care of carers of people with cognitive impairment: A feasibility study

Background: Over 250 000 Australians live with dementia, and it is estimated that this number will more than double by 2030. Many people with dementia or cognitive impairment are cared for at home by family carers who may themselves be frail older adults or who may suffer from chronic conditions. There is evidence that caring has adverse impacts on carers; however, many do not seek or delay seeking appropriate health care. Aim: To explore the feasibility of a protocol to identify the unmet healthcare needs of carers of people with cognitive impairment. Method: This feasibility study used a mixed methods approach. Data were collected through a set of three wellbeing questionnaires, and interviews with carers and one general practitioner. Carers were recruited through government-funded adult day care centres in Perth, Western Australia. General practitioners were nominated by the carers. The sample included 15 carers and one general practitioner. Results: Carer participants in this study experienced varying degrees of care burden. Insomnia, fatigue and pain were the most prominent symptoms. Their overall health status was lower than that of the general population, with physical functioning and bodily pain obtaining the lowest scores. Carers found the protocol useful and the questionnaires easy to complete; they reported specific outcomes resulting from the implementation of the protocol aimed at addressing their healthcare needs. Conclusion: The study results demonstrate the feasibility of adopting a protocol to identify and address carers’ unmet healthcare issues, and warrant further research. In the context of an ageing population, the growing number of carers of people with cognitive impairment and dementia need to receive adequate support to enable them to continue to provide care

Understanding the Factors Influencing Junior Doctors’ Career Decision-Making to Address Rural Workforce Issues: Testing a Conceptual Framework

Medical graduates’ early career is known to be disorienting, and career decision-making is influenced by a complex set of factors. There is a strong association between rural background and rural undergraduate training and rural practice, and personal and family factors have been shown to influence workplace location, but the interaction between interest, training availability, and other work-relevant factors has not yet been fully explored. A qualitative study conducted by the Rural Clinical School of Western Australia (RCSWA) and WA Country Health Service (WACHS) explored factors influencing the decision to pursue rural work among junior doctors. Data collection and analysis was iterative. In total, 21 junior doctors were recruited to participate in semi-structured telephone interviews. Two main themes relating to the systems of influence on career decision-making emerged: (1) The importance of place and people, and (2) the broader context. We found that career decision-making among junior doctors is influenced by a complex web of factors operating at different levels. As Australia faces the challenge of developing a sustainable rural health workforce, developing innovative, flexible strategies that are responsive to the individual aspirations of its workforce whilst still meeting its healthcare service delivery needs will provide a way forward

Extending a Conceptual Framework for Junior Doctors’ Career Decision Making and Rural Careers: Explorers versus Planners and Finding the ‘Right Fit’

This study uses data from a Rural Clinical School of Western Australia (RCSWA) and WA Country Health (WACHS) study on rural work intentions among junior doctors to explore their internal decision-making processes and gain a better understanding of how junior doctors make decisions along their career pathway. This was a qualitative study involving junior doctor participants in postgraduate years (PGY) 1 to 5 undergoing training in Western Australia (WA). Data was collected through semi-structured telephone interviews. Two main themes were identified: career decision-making as an on-going process; and early career doctors’ internal decision-making process, which fell broadly into two groups (‘explorers’ and ‘planners’). Both groups of junior doctors require ongoing personalised career advice, training pathways, and career development opportunities that best “fit” their internal decision-making processes for the purposes of enhancing rural workforce outcomes

A cross-sectional examination of the prevalence of psychotropic medications for people living with dementia in Australian long-term care facilities: issues of concern

Background: Behavioral and psychological symptoms of dementia (BPSD) are a common problem in long-term care facilities (LTC). Clinical guidelines dictate that first-line treatments for BPSD are psychosocial and behavioral interventions; if these are unsuccessful, psychotropic medications may be trialed at low doses and their effects can be monitored.Methods: There have previously been no studies with nationally representative samples to investigate psychotropic administration in LTCs in Australia. This study determines the prevalence of psychotropic administration in a representative stratified random sample of 446 residents living with dementia from 53 Australian LTCs. Questionnaire and medical chart data in this study is drawn from a larger cross-sectional, mixed methods study on quality of life in Australian LTCs.Results: It was found that 257 (58%) residents were prescribed psychotropic medications including: antipsychotics (n = 160, 36%), benzodiazepines (n = 136, 31%), antidepressants (n = 117, 26%), and anti-dementia medications (n = 9, 2%). BPSD were found to be very common in the sample, with 82% (n = 364) of participants experiencing at least one BPSD. The most prevalent BPSD were depression (n = 286, 70%) and agitation (n = 299, 67%).Conclusions: Although detailed background information was not collected on individual cases, the prevalence found is indicative of systematic industry-wide, over-prescription of psychotropic medications as a first-line treatment for BPSD. This study highlights a clear need for further research and interventions in this area