How can rural health be improved through community participation?

Executive summary Rural Australians generally experience poorer health than their city counterparts. Rural Australia is a vast geographical region, with significant diversity, where there is good health and prosperity, as well as disadvantage. The purpose of this issue brief is to provide evidence on how the health of rural Australians can be improved through community participation initiatives, which are currently being funded and delivered by health services and networks. Rural Australians need innovative health services that are tailored to the local context and meet increasing healthcare demands, without increases to expenditure. There are community participation approaches supported by research that can improve existing practice. Avoiding duplication, including the current work of Medicare Locals and Local Hospital Networks, is important for ensuring good outcomes from community participation initiatives. The following recommendations are made to improve practice: New ways to contract and pay for health services are needed, which use ideas developed with communities, within current budgets State and federal government competitive grants and tenders should prioritise proposals that demonstrate effective community participation approaches Community-based services, such as community health centres, Medicare Locals and Local Health Networks, have an important role to play in facilitating community participation, including: Building partnerships between existing services and leveraging existing participation strategies, rather than developing new services or standalone initiatives—to leverage available funds and maximise outcomes Employment of a jointly-appointed, paid community leadership position across existing community-based health services, to avoid duplication and overcome barriers of over-consultation and volunteer fatigue Formal and robust evaluation of initiatives is necessary to guide future policy and research A national innovative online knowledge sharing portal is required to share best practice in rural community participation, save time and money on ineffective approaches, and to support the rural health workforce

Public perspectives on acquired brain injury rehabilitation and components of care : a citizens' jury

Background Brain injury rehabilitation is an expensive and long-term endeavour. Very little published information or debate has underpinned policy for service delivery in Australia. Within the context of finite health budgets and the challenges associated with providing optimal care to persons with brain injuries, members of the public were asked 'What considerations are important to include in a model of care of brain injury rehabilitation?' Methods Qualitative study using the Citizen Jury method of participatory research. Twelve adult jurors from the community and seven witnesses participated including a health services funding model expert, peak body representative with lived experience of brain injury, carer of a person with a brain injury, and brain injury rehabilitation specialists. Witnesses were cross-examined by jurors over two days. Results Key themes related to the need for a model of rehabilitation to: be consumer-focused and supporting the retention of hope; be long-term; provide equitable access to services irrespective of funding source; be inclusive of family; provide advocacy; raise public awareness; and be delivered by experts in a suitable environment. A set of eight recommendations were made. Conclusion Instigating the recommendations made requires careful consideration of the need for new models of care with flexible services; family involvement; recruitment and retention of highly skilled staff; and providing consumer-focused services that prepare individuals and their carers for the long term. Patient and public contribution As jury members, the public deliberated information provided by expert witnesses (including a person with a head injury) and wrote the key recommendations

International community of practice: learning from experiences of community development and social occupational therapy

Introduction: Increasingly, occupational therapists and scientists across the globe are calling for a shift away from individualised western medical approaches, to working with communities and collectives, and in the social field. This signals the growing motivation to engage in socially responsive and transformative practices that address political structures and oppressive colonial systems. Objective: The purpose of our Community of Practice (CoP) was to explore and describe the epistemologies, vocabularies, and understandings that underpin community development and social occupational therapy within diverse global contexts to advance theoretical perspectives and practices. Method: As a CoP of occupational therapy and science scholars situated in four countries (Australia, Brazil, Canada, and South Africa), we met virtually bi-monthly from March 2020 to January 2023. Scholarly work involved critical narrative literature reviews, reflexive presentations, group dialogues, and individual and collective reflections and analyses. Results: Individual narratives, four thematic threads, and a selection of vocabularies and epistemologies are presented. The thematic threads were: Connecting and making space for decolonial praxis, Questioning the disconnect between occupational therapy practice and contexts, Examining vocabularies that shape contextually relevant practice, and Engaging a reflexive stance to work towards equity, justice and social rights. Conclusions: Generating knowledge that supports ways of knowing, being and doing reflective of multiple languages, sciences, and contexts will strengthen occupational therapy. Maintaining the pluriversal and resisting ‘one size fits all’ approaches to human occupation/everyday life is essential. This paper offers practitioners a catalyst for initiating decolonising praxis for learning across global contexts

Oral health interventions for people living with mental disorders: protocol for a realist systematic review

Background The increasing number of people who experience mental disorders is a global problem. People with mental disorders have high rates of co-morbidity and significantly poorer oral health outcomes than the general public. However, their oral health remains largely a hidden and neglected issue. A complex range of factors impact the oral health of this group. These include anxiety and dental phobia, dietary habits, including the heavy consumption of sugary drinks, substance misuse of tobacco, alcohol, and/or psychostimulants, the adverse orofacial side effects of anti-psychotic and anti-depression medications, and financial, geographic, and social barriers to accessing oral health care. Methods The aim of this realist systematic review is to (a) identify and synthesise evidence that explores oral health interventions for people living with mental disorders; (b) explore the context and mechanisms that have contributed to the success of interventions or the barriers and challenges; (c) produce program theories on causal, contextual and mechanistic factors to facilitate outcomes and (d) produce recommendations and guidelines to guide future oral health interventions for people with mental disorders at both the policy and practice level. Using a five-step process, that incorporates primary data collection from key stakeholders, a beginning theoretical framework will be developed to describe contextual and mechanistic factors and how they might impact on the success or failure of oral health interventions for people with mental disorders. Key database searches will be conducted, with data extraction focused on the factors that might have impacted on intervention implementation and outcomes. Quality appraisal of studies will occur, and the theoretical framework will be populated with extracted data. Stakeholder input will support the development and refinement of a theory on oral health interventions for people with mental disorders. Discussion This will be the first review to take a realist approach to explore the broad scope of causal factors that impact on the success or failure of oral health interventions for people with mental disorders. The approach includes extensive stakeholder engagement and will advance realist systematic review methodology. Review outcomes will be important in guiding policy and practice to ensure oral health interventions better meet the needs of people with mental disorders. Systematic review registration This review protocol is registered with PROSPERO (Number) 155969

FINAL PhD Nerida Hyett formatted amendments 19102016.pdf

Nerida Hyett PhD thesi

Developing a guide for using social media as a consumer engagement tool in public hospital service design and quality improvement

Background: Social media is used for a range of functions in health, including engaging consumers in the design and improvement of services. Australian hospital stakeholders are interested in using social media for consumer engagement but have indicated that guidance is needed.  Aims: To outline how we developed an evidence-based guide to using social media as a consumer engagement tool in Australian public hospitals. Methods: Working with an advisory committee of hospital stakeholders we integrated the findings of two studies (a scoping review and an interview study) to co-design a guide to social media-based consumer engagement. We then conducted a consultation on the draft guide with people from consumer engagement, quality improvement, communications and consumer representation roles in Australian hospitals. Findings from the consultation were used in further co-design activities with the advisory committee to finalise the guide. Results: The guide includes a range of strategies for implementing social media-based engagement, and a workbook to aid planning. Eighteen people provided feedback during the consultation. Recommended improvements included additional strategies for social media-based consumer engagement taken from the participants’ own experiences, developing standalone resources, and including case studies which provide real-world examples of social media-based engagement.Conclusions: We believe that involving stakeholders throughout every stage of development has produced a guide which will be relevant and useful for hospitals, service providers and consumers. The guide will be available by April 2022. 

Community participation in rural health: a scoping review

<p>Abstract</p> <p>Background</p> <p>Major health inequities between urban and rural populations have resulted in rural health as a reform priority across a number of countries. However, while there is some commonality between rural areas, there is increasing recognition that a one size fits all approach to rural health is ineffective as it fails to align healthcare with local population need. Community participation is proposed as a strategy to engage communities in developing locally responsive healthcare. Current policy in several countries reflects a desire for meaningful, high level community participation, similar to Arnstein’s definition of citizen power. There is a significant gap in understanding how higher level community participation is best enacted in the rural context. The aim of our study was to identify examples, in the international literature, of higher level community participation in rural healthcare.</p> <p>Methods</p> <p>A scoping review was designed to map the existing evidence base on higher level community participation in rural healthcare planning, design, management and evaluation. Key search terms were developed and mapped. Selected databases and internet search engines were used that identified 99 relevant studies.</p> <p>Results</p> <p>We identified six articles that most closely demonstrated higher level community participation; Arnstein’s notion of citizen power. While the identified studies reflected key elements for effective higher level participation, little detail was provided about how groups were established and how the community was represented. The need for strong partnerships was reiterated, with some studies identifying the impact of relational interactions and social ties. In all studies, outcomes from community participation were not rigorously measured.</p> <p>Conclusions</p> <p>In an environment characterised by increasing interest in community participation in healthcare, greater understanding of the purpose, process and outcomes is a priority for research, policy and practice.</p

Methods and Processes for First Nations Health Curriculum Development for Nursing, Medicine, Dentistry and Allied Health Entry-Level Programs: A Scoping Review

The inclusion of First Nations health curricula in programs is critical for the development of culturally safe graduates, however, less is known about how to embed content into curriculum in ways that reflect best practice and pedagogy. The aim of this scoping review was to describe methods and processes of First Nations health curriculum development in nursing, medical, dentistry, and allied health entry-level programs in international peer-reviewed journals. Systematic searches of databases were completed including CINAHL, Proquest, Medline, and Informit; with additional searches in Google Scholar and First Nations-led journals. A total of 104 articles met inclusion criteria; the majority relating to medicine ( n  = 38) and nursing/midwifery ( n  = 17) student cohorts. Methods and processes for embedding First Nations health content are described, including First Nations-led development and co-leadership, resulting in a suggested model for curriculum development. Evidence-informed curriculum development is critical to ensure effective methods and processes are adopted and cultural safety learning outcomes are achieved