Informal talk: Shaping understandings of sexually transmitted infections (STIs) in rural Australia

Introduction: Although there have been great strides in the prevention, care and treatment of sexually transmitted infections (STIs, including HIV) in Australia, the increasing trend towards higher rates of some STIs is of concern, especially reports of higher rates of chlamydia in inner regional areas. Reasons for these changes are unclear but suggest there is an inconsistent use of prevention measures and ambivalence towards acting responsibly around sexual behaviours. Understanding an individual's response to the circumstances or contexts in which knowledge about STIs are operationalised in rural communities becomes central to recognising how individuals experience health and illness, especially for developing interventions to prevent the transmission of STIs. The aim of this research is to understand how individuals in rural communities make sense of their experiences in relation to STIs and how rurality influences discussion about STIs and health-seeking behaviours. Method: In-depth interviews with 24 participants, 18 females and 6 males, aged between 19 and 65 years provide the data for the study. Methodological principles of 'grounded theory' underpin the analysis. An eclectic approach to grounded theory was used in the current study that was derived from a number of authors. Results: The findings revealed that a number of contexts shape the actions and reactions of rural individuals towards STIs. These include 'public and private world of individuals', 'forms of talking in rural communities' and 'managing information and use of health services'. Factors that shape social life in rural communities such as the social bonds that are present, the relationships developed, and the way in which people behave influence the public and private aspects of rural life. Different forms of talk were identified that indicate that sexual issues are discussed in a number of informal ways and encompass distinct experiences of conveying information with regard to sex and STIs. Managing information and use of health services occurs when individuals assess and identify the need to access services for STIs. Conclusions: The strength of this research lies in the identification of a number of contexts such as the privat-epublic divide and types of talk where informal mechanisms encourage individuals to conform and comply with community rules and values. Using informal talk as a health promotion and or prevention strategy in rural locations can provide an alternative approach to potentially changing social norms. It would be possible to extend the idea of positive informal talk to include symbols and imagery that encourage individuals to seek treatment and provide a more positive view of 'reputation'. Engaging rural individuals in positive talk about sexual risk, access to treatment for STIs, and provision of accurate knowledge can help to build new 'social norms' that encourage new interpretations

Attachment and coping as theoretical frameworks for understanding adjustment to university for local and international students

For most students, coming to university is among their first major life transitions, presenting them with many adaptational demands for which they may or may not be adequately prepared. Theoretical views of stress and coping would suggest that adjustment to university will be influenced by individual resources for coping,their social resources and the adaptational demands of the new environment. Attachment theory and research, on the other hand, would suggest that early attachment experiences help shape internal working models that determine how individuals view themselves and their expectations in adolescence and beyond. A secure attachment base allows individuals to explore new situations with the internal resources to evaluate and cope with the anxiety inherent in such new situations. Peer relationships during this transition period are seen as an extension of the form and quality of those relationships within the family. There is debate in the literature as to the applicability of attachment theory across cultures, with much of the contemporary research focused on western populations. Student attrition is a major area of concern for universities. Helping students successfully make the adjustment is of primary importance in addressing a large part of the reasons for attrition. Academic factors explain only a small proportion of the reasons for students leaving university. A greater understanding of the role of attachment relationships and coping style in adjustment to university by both local and international students will help to better inform the design of appropriate interventions and support structures for students

Physical and mental health perspectives of first year undergraduate rural university students

Background: University students are often perceived to have a privileged position in society and considered immune to ill-health and disability. There is growing evidence that a sizeable proportion experience poor physical health, and that the prevalence of psychological disorders is higher in university students than their community peers. This study examined the physical and mental health issues for first year Australian rural university students and their perception of access to available health and support services. Methods. Cross-sectional study design using an online survey form based on the Adolescent Screening Questionnaire modeled on the internationally recognised HEADSS survey tool. The target audience was all first-year undergraduate students enrolled in an on-campus degree program. The response rate was 41% comprising 355 students (244 females, 111 males). Data was analysed using standard statistical techniques including descriptive and inferential statistics; and thematic analysis of the open-ended responses. Results: The mean age of the respondents was 20.2 years (SD 4.8). The majority of the students lived in on-campus residential college style accommodation, and a third combined part-time paid work with full-time study. Most students reported being in good physical health. However, on average two health conditions were reported over the past six months, with the most common being fatigue (56%), frequent headaches (26%) and allergies (24%). Mental health problems included anxiety (25%), coping difficulties (19.7%) and diagnosed depression (8%). Most respondents reported adequate access to medical doctors and support services for themselves (82%) and friends (78%). However the qualitative comments highlighted concerns about stigma, privacy and anonymity in seeking counselling. Conclusions: The present study adds to the limited literature of physical and mental health issues as well as barriers to service utilization by rural university students. It provides useful baseline data for the development of customised support programs at rural campuses. Future research using a longitudinal research design and multi-site studies are recommended to facilitate a deeper understanding of health issues affecting rural university student

Development of Mentorship Module and its Feasibility for Community Midwives in Sindh, Pakistan: A Pilot Study

Numerous articles describe the concept of mentorship for providing professional support in midwifery settings in different countries; however, in Pakistan the concept is under developed. Before implementing the concept in the Pakistani context, it was important to first develop a mentorship module and pilot test the idea. Therefore, the aim of the present study was to develop and test a mentorship module to determine its feasibility for educating community midwives about providing mentoring, so that a formal mentorship program could be established in the future. The training aimed to provide skill focused mentorship training to experienced midwives, so that they could perform the role of mentors for newly graduate midwives, in order to support them and build their confidence. The mentorship module was developed with the help of literature review and experts’ suggestion. A structured questionnaire was given to 50 community midwives after they had been provided mentorship training. Community midwives from nineteen districts of Sindh, Pakistan, were surveyed through purposive sampling. All the community midwives agreed that there was a need for mentorship, that the training module was useful, and that they would be able to integrate it into their practice. Over 80% community midwives rated the content of the module as useful, the majority agreed that the total duration of the training (two days) and the length of each session in the training were appropriate. Similarly, all participants reported that the mentoring strategies were helpful. Hence, the mentorship training module was strongly perceived to be feasible and useful by the community midwives of Sindh, Pakistan

Carers' Perspectives on Sustainability of Informal Care for People With Dementia

The majority of people with dementia, even at advanced stages, receive most of their care and support from family members, friends, and neighbors, rather than formal support systems. This qualitative research undertaken in the Australian state of Queensland explored how family carers of people with dementia living in the community successfully manage and sustain informal caring. It also considers challenges these carers anticipated in continuing to support their family member with dementia in the future. What emerges through this analysis of the carers’ perspective on the sustainability of care is the impact of factors including the living arrangements, generational cohort and life stage of the carer, financial issues, and ability to effectively combine caring with their other roles and responsibilities in life

What Injuries Occur at Australian Mass Gatherings?

As stadiums are built to hold more people for an increasing range of events there is a demand placed by the public on event organisers to ensure their health and safety. This includes timely and appropriate medical care. This study demonstrates that people are being injured or becoming ill at mass gathering events, and that the number of people who are seriously injured is higher than has previously been estimated. This study indicates a need for specific plans that includes an increased level of care at mass gatherings and an availability of a multidisciplinary medical team to ensure the health and safety of the public

Understanding the work of hospital managers in the public sector in Saudi Arabia

This paper reports some of the preliminary findings of research that proposes to explore the nature of the hospital managers' work, their opinions about the most essential functions, roles, skills and training courses needed to manage the Ministry of Health (MOH) hospitals in Saudi Arabia (SA). It intends to describe four types of hospital managers according to their educational background and managerial experience. Self-administered postal questionnaires were distributed to 218 managers working in MOH hospitals across the country. The use of postal survey allowed coverage of a sample across a wide geographical region. 72.9% of questionnaires were completed, which were valid for descriptive and univariate analysis

Managing Sexually Transmissible Infections in Clinical Practice: Evidence from New South Wales, Australia

Sexually transmissible infections (STIs) are on the increase in Australia. The considerable health, psychosocial, and economic consequences of STIs underscores the need for their better prevention and control. As primary health care providers, general practitioners (GPs) with their incomparable access to the Australian population are best placed to provide effective sexual health services. However, earlier research suggests that there are inconsistencies in the provision of clinical care for STIs in general practice in Australia, although little is known about STI care by GPs in the state of New South Wales (NSW). The purpose of this study is to develop an understanding of how STIs are managed in general practice, and to examine how STI care in general practice differs to that in specialised practice staffed by sexual health physicians (SHPs)

The Reality Gap: A grounded theory study investigating turnover intention among Australia's rural-based, early career community mental health professionals

Community mental health (CMH) case management services in rural Australia are an important public sector mental health service, heavily relied upon by people living with serious and/or persistent mental ill-health. Chronic staffing shortages are widespread within these rural CMH services, arising from long-term vacancies and high staff turnover. This study aimed to investigate how employment and rural-living factors impacted the turnover intention of early career CMH professionals in their first few years working in rural services. Using a grounded theory methodology, the study aimed to produce a substantive theory explaining this turnover intention phenomenon as well as to identify the basic social process to assist with theoretical conceptualisation. Twenty-six in-depth interviews with early career health professionals who had worked for over 12 months for NSW Health in rural CMH positions were undertaken

Women's Experience of Sexuality and Body Image Following Treatment for Early Stage Vulvar Cancer

This study reports on the experiences of sexuality and body image of ten women following surgery for early stage vulvar cancer. Vulvar cancer is a rare cancer, with only about 250 women diagnosed in Australia each year. Treatment for vulvar cancer has evolved to become highly individualised, with the emphasis now on performing the most conservative surgery consistent with cure of the cancer. There is limited information describing the psychosexual outcomes for these women. Much of the previous research conducted to determine the psychosexual outcomes of treatment for vulvar cancer, have been on women having had a more radical surgical approach than is currently performed. ... This study was only the second Australian study to investigate women's experience of sexuality and body image, and one of only a few studies to look exclusively at psychosexual issues for women with early stage vulvar cancer. The findings from this study may serve as a relevant platform for the development of future research into the psychosexual outcomes for women diagnosed and treated for vulvar cancer. The findings also relate to the practice of health care professionals working in this area, as they highlight areas that need improvement such as, access to timely and relevant information