Canine Support Program: Student perceptions and preferences at a regional university and implications for health, well-being, and student support enhancements

Issue Addressed: Canine Support Programs (CSPs) are a potential solution to growing university student support demands. While current studies focus on the impacts of CSPs, there is limited understanding of the views and expectations of tertiary students about CSPs. This study explored the perceptions and preferences of students in an Australian regional university about CSPs. Methods: A questionnaire with multiple choice and open-ended questions surveyed residential students' perspectives about CSP. Data were analysed using descriptive statistical tests and thematic analysis for open responses. Results: Majority (98%) of participants (sample n = 48) would support a CSP on campus. Frequent, small-group interactions of ≥15 min involving physical contact were preferred. Dog disposition, welfare-trained handlers, and veterinary certification were important aspects of program safety. Participants strongly agreed a CSP would improve mental health and well-being, relieve stress, reduce feelings of homesickness, provide support, comfort, and enable social interactions. Conclusion: There is strong support among the study population for CSP to be established on campus. This study supports earlier research that CSP has benefit potential for new, stressed, and/or students who love dogs. The preferences of students should inform program design to enhance utility and impact. This aligns with Health Promoting Universities and College's Okanagan Charter principle of ‘engaging student voices’. More institutional awareness and support for CSPs will be necessary for integration. So What?: This study reveals the need for tailored and creative student support beyond traditional offerings including those that focus on student well-being and social initiatives. CSPs can be utilised as an advocate, enabler, and medium for mental health promotion action and well-being support for tertiary students; thereby, contributing to the ‘Health Promoting University’ agenda in Australia. It also reinforces the need for a Health in All Policies approach to be incorporated into our tertiary education sector. Future actions should focus on improving institutional awareness, support, and sector implementation

Level of inclusiveness of people with disabilities in Ghanaian health policies and reports: a scoping review

(1) Background: Globally, persons with disabilities (PWDs) face numerous challenges including access to healthcare. This scoping review sought to assess the level of inclusiveness in Ghanaian health policies and reports for PWDs; (2) Methods: An extensive search and scoping review of health policies/reports in Ghanaian government websites and Google was conducted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for scoping reviews were followed in selecting and reporting the policies/reports. The program evaluation and policy design framework was employed for content analysis; (3) Results: Fifteen policies and reports with political recognition, objectives, and specific resources needed to execute stipulated plans were included. Although these policies and reports had collaborative partnerships with various institutions and organisations in development and implementation plans, the level of inclusiveness of disability issues was very low. Only eight out of the fifteen policies/reports (53%) reviewed considered PWDs, indicating a low level of inclusion. The definition of disability was also limited.; (4) Conclusions: To achieve the sustainable development goal of ‘leaving no one behind’ in line with the provisions of the United Nations Convention on the Right of Persons with Disabilities and the Disability Act 715 of Ghana, it is recommended that subsequent health policies should have an in-depth engagement with PWDs from the conceptual design stage right through to implementation and evaluation

"Sex Should Not Be Part of the Lives of Persons with Disabilities, but They Are Human Beings Too": Perceptions of Healthcare Providers and Factors Affecting Service Delivery in Ghana

Persons with disabilities (PwDs) constitute about 16% of the global population and face many challenges in every society, including access to sexual and reproductive healthcare. The attitudes of healthcare providers (HPs) exert a major influence on PwDs accessing sexual and reproductive healthcare (SRH). A sequential explanatory mixed methods design was used to investigate the attitudes and perceptions of HPs towards PwDs and SRH delivery in Ghana’s Ashanti region. Quantitative data analysis indicated that overall, 82% of HPs had received information on disability-related issues and had relatively positive attitude towards PwDs, which varied across sub-scales of the Attitude Towards Disability score and associated with their sociodemographic characteristics. HPs faced several challenges in SRH services delivery to PwDs, which included a lack of funding and training, and inadequate staff. Inductive thematic analysis of the qualitative data revealed eight overarching themes. The findings revealed that HPs had prejudice about the mental and sexual health abilities of PwDs. Inadequate skill set, inadequate resources, and limited funding were major challenges identified. Nonetheless, compassion and benevolence towards PwDs, improvision, economic and educational support, awareness creation, and referrals were strategies adopted to overcome these challenges. Mandatory training of HPs is recommended to ensure improved SRH service delivery to PwDs. Future research could explore the perceptions and coping strategies of PwDs

"God is my only health insurance": a mixed-methods study on the experiences of persons with disability in accessing sexual and reproductive health services in Ghana

Background: Access to sexual and reproductive health (SRH) services is a fundamental human right, but people with disabilities (PwDs) in low-and middle-income countries often face multiple barriers to utilisation. This study aimed to assess the level of SRH services utilisation and the enabling and inhibiting factors among PwDs in Ghana’s Ashanti region. Methods: A sequential explanatory mixed-methods study design was employed, involving quantitative (n = 402) and qualitative (n = 37) data collection from PwDs. Quantitative data were analysed using descriptive and inferential statistics, while qualitative data were analysed using inductive thematic analysis. Results: The study found that only 33.8% of the PwDs had ever used SRH services. Utilisation was associated with sex, marital status and travel duration to health facility. The qualitative data revealed that factors at the individual, family/community and health facility levels influenced utilisation of SRH services, acting as both enablers and barriers. Conclusion: PwDs had relatively low utilisation of SRH services in Ghana’s Ashanti region. To increase utilisation, it is recommended to address the stigma and discrimination towards PwDs, provide more training for healthcare providers, improve the accessibility of healthcare facilities, and strengthen the national health insurance scheme. Further research could explore PwDs’ SRH outcomes and strategies to improve these outcomes in Ghana

Quality management systems in Aboriginal Community Controlled Health Services: a review of the literature

Background A national accreditation policy for the Australian primary healthcare (PHC) system was initiated in 2008. While certification standards are mandatory, little is known about their effects on the efficiency and sustainability of organisations, particularly in the Aboriginal Community Controlled Health Service (ACCHS) sector. Aim The literature review aims to answer the following: to what extent does the implementation of the International Organisation for Standardization 9001:2008 quality management system (QMS) facilitate efficiency and sustainability in the ACCHS sector? Methods Thematic analysis of peer-reviewed and grey literature was undertaken from Australia and New Zealand PHC sector with a focus on First Nations people. The databases searched included Medline, Scopus and three Informit sites (AHB-ATSIS, AEI-ATSIS and AGIS-ATSIS). The initial search strategy included quality improvement, continuous quality improvement, efficiency and sustainability. Results Sixteen included studies were assessed for quality using the McMaster criteria. The studies were ranked against the criteria of credibility, transferability, dependability and confirmability. Three central themes emerged: accreditation (n=4), quality improvement (n=9) and systems strengthening (n=3). The accreditation theme included effects on health service expenditure and clinical outcomes, consistency and validity of accreditation standards and linkages to clinical governance frameworks. The quality improvement theme included audit effectiveness and value for specific population health. The theme of systems strengthening included prerequisite systems and embedded clinical governance measures for innovative models of care. Conclusion The ACCHS sector warrants reliable evidence to understand the value of QMSs and enhancement tools, particularly given ACCHS (client-centric) services and their specialist status. Limited evidence exists for the value of standards on health system sustainability and efficiency in Australia. Despite a mandatory second certification standard, no studies reported on sustainability and efficiency of a QMS in PHC

Indigenous Australian perspectives on incorporating the social determinants of health into the clinical management of type 2 diabetes

Introduction: Type 2 diabetes mellitus and social disadvantage are related. In Australia, this association is most pronounced among Indigenous Australians (Aboriginal and Torres Strait Islander peoples). Indigenous Australians are among the most socially disadvantaged in the country, having the worst social determinants of health (SDoH). SDoH are typically addressed at a population level, and not on an individual or a clinical level. However, the SDoH-related needs of individuals also require attention. The adverse link between type 2 diabetes and SDoH suggests that simultaneous consideration at an individual, clinical level may be beneficial for type 2 diabetes care and self-management. Identifying and addressing SDoH-related barriers to type 2 diabetes self-management may augment current care for Indigenous Australians. This study aimed to combine the perspectives of Indigenous Australians with type 2 diabetes and Indigenous health workers to explore the SDoH-related barriers and facilitators to self-managing type 2 diabetes, and how SDoH could be incorporated into the usual clinical care for Indigenous Australians with type 2 diabetes. Methods: Under the guidance of a cultural advisor and Indigenous health workers, seven Indigenous Australians with type 2 diabetes and seven Indigenous health workers from rural and remote north Queensland, Australia, participated in a series of semi-structured, in-depth face-to-face interviews and yarning circles. A clinical yarning approach to data collection was used, and both an inductive and a deductive data analysis were applied. Data were analysed, and themes were identified using NVivo v12. Results: Study participants described a holistic view of health that innately includes SDoH. Specific to type 2 diabetes care, participants identified that culturally responsive service delivery, suitable transport provision, an infinite flexible approach to accommodate for individuals' unique social circumstances, appropriate client education and appropriate cultural education for health professionals, support mechanisms and community support services were all essential components. These were not seen as separate entities, but as interrelated, and all were required in order to incorporate SDoH into care for Indigenous Australians with type 2 diabetes. Conclusion: SDoH are implicit to the Indigenous Australian holistic view of health. Consequently, an approach to type 2 diabetes care that complements this view by simultaneously considering SDoH and usual type 2 diabetes clinical management could lead to enhanced type 2 diabetes care and self-management for Indigenous Australians

Weedy Life: Coloniality, Decoloniality, and Tropicality

Respect for any form of life entails nurturing all the potentialities proper to it, including those that might be unproductive from the human point of view. Are there lessons to be learnt about decolonisation of the tropics from a focus on ‘weeds’? The contributors to this photo-essay collectively consider here the lessons that can be learnt about the relationship between colonisation and decolonisation through a visual focus on life forms that have been defined as weeds and, consequently, subject to a contradictory politics of care, removal, and control – of germinating, blooming, and cutting. The essay demonstrates the continuing colonial tensions between aesthetic and practical evaluations of many plants and other lifeforms regarded as ‘invasive’ or ‘out of place’. It suggests a decolonial overcoming of oppositions. By celebrating alliances of endemics and ‘weeds’ regeneratively living together in patterns of complex diversity, we seek to transcend policies of differentiation, exclusion and even eradication rooted in colonial ontology

“God is my only health insurance”: a mixed-methods study on the experiences of persons with disability in accessing sexual and reproductive health services in Ghana

BackgroundAccess to sexual and reproductive health (SRH) services is a fundamental human right, but people with disabilities (PwDs) in low-and middle-income countries often face multiple barriers to utilisation. This study aimed to assess the level of SRH services utilisation and the enabling and inhibiting factors among PwDs in Ghana’s Ashanti region.MethodsA sequential explanatory mixed-methods study design was employed, involving quantitative (n = 402) and qualitative (n = 37) data collection from PwDs. Quantitative data were analysed using descriptive and inferential statistics, while qualitative data were analysed using inductive thematic analysis.ResultsThe study found that only 33.8% of the PwDs had ever used SRH services. Utilisation was associated with sex, marital status and travel duration to health facility. The qualitative data revealed that factors at the individual, family/community and health facility levels influenced utilisation of SRH services, acting as both enablers and barriers.ConclusionPwDs had relatively low utilisation of SRH services in Ghana’s Ashanti region. To increase utilisation, it is recommended to address the stigma and discrimination towards PwDs, provide more training for healthcare providers, improve the accessibility of healthcare facilities, and strengthen the national health insurance scheme. Further research could explore PwDs’ SRH outcomes and strategies to improve these outcomes in Ghana

Who cares? Aboriginal and Torres Strait Islander health care choices and access barriers in Mount Isa

This thesis presents an illustration of the access barriers to health care as experienced by Aboriginal and Torres Strait Islander peoples in Mount Isa, Queensland, Australia. This examination is conducted via fieldwork observations and the narratives of Aboriginal and Torres Strait Islander peoples in Mount Isa, as well as the stories of the health professionals that care for them. In particular, this thesis attempts to unpack the term 'cultural barriers' as used in health and medical literature in discussions of access.\ud \ud Stories are placed within the context of Australian rural health issues and considerations of global issues affecting rural, minority and Indigenous populations. The research represents a distinct blend of anthropology and health services research principles and practices. This perspective is developed utilising principles from the 'Mindful Bodies' approach within Critical Medical Anthropology, which seeks an understanding of human health issues via examination at three levels (or bodies): the individual body, the social body and the body politic (Scheper-Hughes and Lock 1987). Critical issues of concern with regards to health service provision in Mount Isa are examined using Penchansky and Thomas's (1981) taxonomy, the 5As of Access. This taxonomy allows for a nuanced discussion of access by unpacking the term and identifying the various aspects that create access: Availability, Accessibility, Affordability, Accommodation and Acceptance. Dedicated ethnographic fieldwork was undertaken in Mount Isa from October 2007 to August 2009.\ud \ud An examination of the ways that Aboriginal and Torres Strait Islander peoples in Mount Isa express their understandings of the barriers to health care has two advantages. First, such discussions at a local level align with and illuminate the barriers that affect Aboriginal and Torres Strait Islander populations nationally. Second, the significance assigned to such barriers, and examination of what may constitute a cultural barrier (as discussed in health literature) highlights the ways in which cultural difference becomes constructed as problematic in health system encounters.\ud \ud Culture should not be seen as a barrier to health care, but should be seen as an opportunity for increased awareness, understanding and improved personal care for patients in the health system

The challenges of remote area medical education

To what extent should we cushion the realities of remote area living for young people who are seeking challenge and inspiration