Agreement on "being sufficiently active for health" measured objectively by pedometer and subjectively by IPAQ questionnaires

Background: Measuring physical activity is complex and to achieve reliable and accurate measurements is challenging. Physical activity can be assessed subjectively using a variety of self report questionnaires, diaries, or logs or objectively using devices such as pedometers and accelerometers. This study aimed to test agreement on "being sufficiently active for health" measured objectively by pedometer and subjectively by International Physical Activity Questionnaires. Methods: Local government workers wore a Yamax Digi-walker pedometer for a one week period after which time they completed the Long Version of the International Physical Activity Questionnaire to allow a comparison between objective and subjective measures of physical activity. Results: Analysis of pedometer data showed that 49% of participants were sufficiently active for health (10,000 steps in a 24 hours period was used to define "sufficiently active for health). IPAQ classification of physical activity revealed much higher perceived levels of physical activity with 18.9% classified as achieving medium levels of activity and 73% achieving high levels of activity. Conclusions: In this study pedometers were shown to be more accurate measurements of physical activity with the self-report survey vastly over-estimating the actual physical activity achieved. Use of subjective measures of physical activity may under-estimate the true picture of physical activity behaviour in populations and wherever possible more objective measures should be used

Barriers and enablers for cervical cancer screening in the Pacific: a systematic review of the literature

Background: Globally cervical cancer is the fourth most common type of cancer in women and in some low-income countries is the most common cancer in women. Papua New Guinea has a particularly concerning incidence of cervical cancer where it ranks first as the leading cause of cancer in females. Screening is a reliable strategy to detect cervical cancer but implementation of screening in Papua New Guinea is poor. The aim of this review is to identify the enablers and barriers for cervical cancer screening in Papua New Guinea. Methods: A systematic search of peer-reviewed literature was conducted using electronic databases; PubMed, Medline, Scopus, CINAHL and Google Scholar. Articles published between 2007 and 2017 that focused on the enablers and barriers to cervical cancer screening were included. Only one study from Papua New Guinea was identified so the search was extended to include other Pacific Island Countries and Low-Income Countries more broadly. Findings: Twenty articles met the inclusion criteria. The main barriers for cervical cancer screening included a lack of women’s knowledge about cervical cancer and screening, a lack of health facilities for screening, diagnosis and treatment, lack of health care worker knowledge and training, cultural beliefs and financial burdens. The main enablers included women having access to education programs, availability of cervical cancer screening services, female friendly environments and health care workers being trained to undertake screening. Conclusions: While the literature highlighted the importance of cervical cancer screening, a range of barriers limits the delivery of this service in low-income country settings. In particular, there is a gap in the knowledge of barriers and enablers within Papua New Guinea and further research in this country is required. Applying the knowledge learned from other low-income countries and gaining a clearer understanding of both the barriers and enablers for cervical cancer screening in the Papua New Guinea context may lead to clear recommendations to improve implementation and uptake of cervical cancer screening

Identifying the barriers to the integration of research into graduate midwives' professional practice in the Highlands of Papua New Guinea

Background: Research is fundamental in improving health through informing health practices and policies. Despite significant capacity building in some areas to support health research efforts, research capacity in low-middle countries, such as Papua New Guinea, is weak. Bachelor of Midwifery students at the University of Goroka, between 2012 and 2016, were introduced to research and produced a proposal for a small study to be implemented when they returned to their place of work as qualified midwives. Despite students being very enthusiastic about carrying out the research during the development of their research proposal, there was limited evidence of them being able to successfully complete their research. This study aimed to understanding the barriers perceived by the graduate midwives to performing research in their own setting so as to inform development of strategies to support the students and graduates in their research efforts in the future. Methods: An exploratory, descriptive study was conducted using a qualitative approach. Semi-structured interviews were conducted with nine Bachelor of Midwifery graduates from the University of Goroka practising in the Eastern Highlands Province of Papua New Guinea. Data was thematically analysed using Braun and Clark’s six stage approach and themes and sub-themes identified. Findings: Participants viewed research as a skill set and a tool that could be used for problem solving, improving practice and creating evidence. Although some participants were confident with some research skills and had started a research study, they felt they did not have enough skills to complete the study. Others stated that although they were interested to undertake research, they did not understand the research process, and were lacking in knowledge and skills. Barriers to performing research identified by participants included lack of time, lack of support in the workplace, lack of resources and no culture of research in the workplace. Enablers identified included having an experienced researcher as a mentor, having access to ongoing training in research and other skills, e.g. computer and internet use, having resources such as books and internet access, having time during work to undertake research, and having support in workplace. Conclusion: Despite some introductory integration of research knowledge and skills into undergraduate midwifery curriculum and a perception by graduate midwives that research is important it does not translate into graduate midwives professional practice. Bachelor of Midwifery curricula must increase the amount of time spent on research content which must be taught in practical ways and by experienced educators so students are inspired and skilled to undertake research

Exploring the nursing student experience at a remote Australian university campus: a qualitative study

Background: Nurses constitute most of the rural and remote Australian health workforce, however staff shortages in these regions are common. Rural exposure, association, and undertaking rural clinical placements can influence health students’ decision to work rurally after graduation, however attending university in rural and remote regions has been shown to be a great contributor. An improved understanding of these nursing students’ experiences may inform changes to teaching and support strategies for these students, which in turn could improve their retention and completion rates, contributing to a more sustainable rural and remote Australian nursing workforce. This study aimed to explore and describe students’ experiences of studying nursing in the context of a satellite university campus located in a remote town, with a focus on education delivery methods, staff, support, student services, and barriers and enablers to successful study. Methodology: Nine students participated in this qualitative descriptive study. Semi-structured interviews were undertaken, allowing participants to reflect on their experiences as nursing students in the context of a geographically remote satellite university campus. The resulting data were grouped into common themes and summarised. Results: Students were generally positive regarding lectures delivered by videoconference or recorded lectures, as they allowed for greater flexibility which accommodated their busy personal lives. Face-to-face teaching was especially valuable, and students were particularly positive about their small cohort size, which enabled the creation of strong, supportive relationships between students, their cohort, and teaching and support staff. However, barriers related to student demographics and some difficulties with course engagement and campus staffing were experienced. Conclusions: The experiences of nursing students at remote university campuses are different from those experienced by traditional, metropolitan university students. Although these nursing students face additional barriers unique to the remote campus context, they benefit from a range of enabling factors, including their close relationships with other students, staff, family, and their local community

Recommended methodologies to determine Australian Indigenous community members' perceptions of their health needs: a literature review

When addressing disparities in health status of Indigenous Australians, it is necessary to consult with Indigenous people to explore their health needs. The process of improving health outcomes is complex; it requires acknowledgement of underlying cultural and social determinants of health and active engagement of Indigenous people to define the issues and identify solutions. The aim of this study is to explore the most appropriate research methodologies to determine Australian Indigenous community members' perceptions of their health needs. A scoping review was conducted in BioMed Central, CINAHL, Informit Health, MEDLINE Ovid, ProQuest and Scopus databases and Google Scholar for all relevant literature published between 2009 and 2018. Extensive manual searches of reference lists were also undertaken. The limited number of articles relating to needs assessment with Indigenous community members prescribed broadening the scope of the review to include articles that describe methodologies to enhance Indigenous people's engagement in the research process. Twelve papers met the inclusion criteria. Three major themes emerged: (1) the imperative to develop and implement Indigenist research methodologies; (2) participatory action research (PAR) and community-based participatory research (CBPR) as appropriate methodologies to conduct research with Indigenous community members; and (3) yarning or storytelling as a culturally appropriate Indigenous method of data collection

Incorporating social determinants of health into the clinical management of type 2 diabetes

Type 2 diabetes (T2DM) is increasing in global and national prevalence. It is more common among people with poor social determinants of health (SDoH). Furthermore, SDoH are known to influence health related choice, and therefore the glycaemic management of people with T2DM. There is a growing body of evidence affirming an irrefutable relationship between SDoH and T2DM. Currently SDoH are considered at a population level, whereas T2DM is usually managed individually. Assessing and addressing SDoH related barriers, at an individual, clinical level may contribute to improved glycaemic management for people with T2DM. Developing an approach to assess SDoH related management barriers, and incorporating it into usual clinical care will allow insight into ‘nonclinical’ obstacles to self-management. Additionally, investigation into strategies to address the identified barriers will extend and contextualise this approach, and could broaden and augment current efforts to improve glycaemic management for people with T2DM. An exploratory, descriptive research design will facilitate the exploration of the most appropriate methods and strategies for incorporating SDoH into clinical practice. These approaches can then be trialled and evaluated to inform an evidence-based approach for this addition to the usual clinical care of people with T2DM. This presentation will describe a current research project that is investigating how SDoH can be incorporated into the clinical management of T2DM, and discuss the findings so far

Utilising clinical settings to identify and respond to the social determinants of health of individuals with type 2 diabetes - a review of the literature

Type 2 diabetes (T2DM) is increasing in global prevalence. It is more common among people with poor social determinants of health (SDoH). Social determinants of health are typically considered at a population and community level; however, identifying and addressing the barriers related to SDoH at an individual and clinical level, could improve the self-management of T2DM. This literature review aimed to explore the methods and strategies used in clinical settings to identify and address the SDoH in individuals with T2DM. A systematic search of peer-reviewed literature using the electronic databases MEDLINE, CINAHL, Scopus and Informit was conducted between April and May 2017. Literature published between 2002 and 2017 was considered. Search results (n = 1,119) were screened by title and abstract against the inclusion and exclusion criteria and n = 56 were retained for full text screening. Nine studies met the inclusion criteria. Review and synthesis of the literature revealed written and phone surveys were the most commonly used strategy to identify social determinant-related barriers to self-management. Commonly known SDoH such as; income, employment, education, housing and social support were incorporated into the SDoH assessments. Limited strategies to address the identified social needs were revealed, however community health workers within the clinical team were the primary providers of social support. The review highlights the importance of identifying current and individually relevant social determinant-related issues, and whether they are perceived as barriers to T2DM self-management. Identifying self-management barriers related to SDoH, and addressing these issues in clinical settings, could enable a more targeted intervention based on individually identified social need. Future research should investigate more specific ways to incorporate SDoH into the clinical management of T2DM

Procurement from local producers for food service in primary and secondary school settings: A scoping review

Issue addressed: Australian school canteen guidelines do not broadly incentivise procuring food from local producers, despite evidence of this occurring abroad. This scoping review aims to investigate what is known about local food procurement for school foodservice. Methods: A scoping review of peer-reviewed articles published since 2000 was undertaken using MEDLINE, CINAHL and Scopus. Results: Twenty-one studies met the inclusion criteria. Local food was generally perceived as fresher and more nutritious. Small, positive impacts on fruit and vegetable intake have been demonstrated when food is procured locally. Challenges identified included concerns around food safety, varied availability, time spent coordinating food supply, lack of incentive from regional or national guidelines, inadequate kitchen facilities and budget constraints. Conclusions: There is no universal definition or standard for procuring ‘local food’. The main motivation for local food procurement was a sense of social responsibility, however there are barriers, including cost, facilities and food safety. Purchasing food locally holds potential to benefit the local economy but government funding and policy supporting local and small-scale producers is an important enabler. So what?: Government support to build stakeholder capacity is important in establishing and maintaining these programmes and would be crucial in achieving change in Australian schools. Investigating feasibility of a national school lunch service would be beneficial, as these programmes may have merit not just in feeding children but also in supporting the local economy. Further research is warranted in this area

Fatal intentional drowning in Australia: a systematic literature review of rates and risk factors

Introduction: Unintentional drowning deaths are only part of the drowning profile, with little attention being paid to intentional drowning in Australia. Strategies for the prevention of intentional drowning deaths are likely to be different from unintentional. Quality documentation, analysis and dissemination of intentional deaths data is crucial for developing appropriate strategies for prevention. Objective: To conduct a systematic literature review to investigate the mortality rates and risk factors of intentional drowning deaths in Australia. Methods: A systematic search guided by PRISMA was performed using Ovid MEDLINE, CINAHL, PsycINFO (ProQuest), Scopus, Google Scholar, and BioMed Central databases to locate relevant original research articles published between 2007 and 2018. Results: Ten papers reporting the mortality rates and risk factors of intentional drowning deaths in Australia published between 2007 and 2018, with study periods of the included articles spanning from 1907 to 2012, were reviewed. Most studies investigated suicidal drowning deaths in Australia, none reported homicidal drowning deaths. The downward trend of fatal suicide drowning was identified in Australia. The annual rate of intentional drowning between 1994 and 2012 can be inferred from eight studies, ranging from 0.06 to 0.21 for nation-wide mortality rates. The highest annual state-wide mortality rate was identified in the state of Queensland, ranging from 0.02 to 0.11 per 100,000 individuals. Of four studies examining the risk factors of fatal intentional drowning in Australia, being of older age groups, being female, and the presence of substance use were identified as important factors for suicidal drowning deaths. The national-scale proportion of suicide drowning in Australia, ranging from 2% to 3% of all intentional self-harm deaths, was also identified. Conclusion: Limited publications reporting the mortality rates and risk factors of intentional drowning deaths in Australia were identified. Being of older age groups and being female were recognised as factors for suicide drowning deaths, and psychoactive substances were widely identified amongst cases. Future research on improving death reporting systems and the legal framework for medico-legal death investigation, along with the investigation of the risk factors of intentional drowning, are required to inform the planning, implementation, and evaluation of prevention interventions for intentional drowning deaths in Australia

Improving type 2 diabetes care and self-management at the individual level by incorporating social determinants of health

Objective: Suboptimal social determinants of health impede type 2 diabetes self-management. They are usually considered at population and community levels, not individually. The study objective was to draw on perspectives of people who have type 2 diabetes to identify and explore the impact of social determinants on self-management and ways to incorporate them into individual care. Methods: Purposively selected participants chose to partake in focus groups or interviews. Data were analysed and themes identified through deductive and inductive thematic analysis. Results: Social issues hinder type 2 diabetes self-management. Additionally, an individual’s feelings and poor mental health, competing priorities and understanding about diabetes are important considerations. Support was provided via health professionals, community supports, financial support, personal support and informal self-management support. Conclusions: Social determinants of health could be formally incorporated into individual care for people with type 2 diabetes if a socio-ecological view of health is taken as it considers the broader social and environmental circumstances in peoples lives. Implications for public health: Care for people with type 2 diabetes could be transformed if social determinants of health are formally assessed and responded to at an individual level. A socio-ecological view of health in individual care and clinical settings would enable social determinants of health to be formally incorporated into type 2 diabetes care