Modified Policy-Delphi study for exploring obesity prevention priorities

INTRODUCTION: Until now, industry and government stakeholders have dominated public discourse about policy options for obesity. While consumer involvement in health service delivery and research has been embraced, methods which engage consumers in health policy development are lacking. Conflicting priorities have generated ethical concern around obesity policy. The concept of ‘intrusiveness’ has been applied to policy decisions in the UK, whereby ethical implications are considered through level of intrusiveness to choice; however, the concept has also been used to avert government regulation to address obesity. The concept of intrusiveness has not been explored from a stakeholder's perspective. The aim is to investigate the relevance of intrusiveness and autonomy to health policy development, and to explore consensus on obesity policy priorities of under-represented stakeholders. METHODS AND ANALYSIS: The Policy-Delphi technique will be modified using the James Lind Alliance approach to collaborative priority setting. A total of 60 participants will be recruited to represent three stakeholder groups in the Australian context: consumers, public health practitioners and policymakers. A three-round online Policy-Delphi survey will be undertaken. Participants will prioritise options informed by submissions to the 2009 Australian Government Inquiry into Obesity, and rate the intrusiveness of those proposed. An additional round will use qualitative methods in a face-to-face discussion group to explore stakeholder perceptions of the intrusiveness of options. The novelty of this methodology will redress the balance by bringing the consumer voice forward to identify ethically acceptable obesity policy options. ETHICS AND DISSEMINATION: Ethical approval was granted by the Bond University Health Research Ethics Committee. The findings will inform development of a conceptual framework for analysing and prioritising obesity policy options, which will be relevant internationally and to ethical considerations of wider public health issues. The findings will be disseminated through peer-reviewed publications, conference presentations and collaborative platforms of policy and science

Communities of practice to facilitate change in health professions education: A realist synthesis

Background: Communities of practice could contribute to transformations in health professions education to meet complex and emerging challenges. However, little is known about the underlying mechanisms of communities of practice in this setting, and how context influences outcomes. Objective: To understand when, why and how communities of practice with health professions education faculty work to facilitate higher education change. Design: A realist synthesis according to the RAMESES standards and steps described by Pawson and colleagues. Review methods: Early scoping of the literature informed the development of an initial program theory to describe underlying assumptions about how communities of practice in higher education, implemented with health professions education faculty, were likely to work. The theory was tested and further refined through a realist synthesis. A systematic search for evidence using search terms ‘faculty’, ‘communities of practice’ and ‘higher education’ and related terms was supplemented with citation tracking and hand searching of significant authors and journals. Following study appraisal, data were extracted and synthesised from 21 manuscripts describing 16 communities of practice. The realist synthesis focused on identifying patterns in context-mechanism-outcome interactions, and the alignment with substantive theory. Results: From the included manuscripts, ten context-mechanism-outcome configurations were identified that describe a range of individual, interpersonal and institutional outcomes of communities of practice with health professions education faculty and context-mechanism interactions that contribute to achieving these outcomes. Conclusions: This study expands theoretical understandings of how and why communities of practice work. There is value in communities of practice in the higher education sector, primarily in the field of health professions education. Communities of practice implemented in the context of complex change with participants who have a desire to participate can facilitate change in health professions education, including institutional level changes, through reflection, experiential learning and creating a shared agenda for change. Findings from this study can be used by policy and decision-makers within health education to best apply communities of practice to achieve meaningful outcomes

The role of communication, building relationships, and adaptability in non-profit organisational capacity for health promotion

While the non-profit sector has an integral role in health promotion, it is unclear whether these organisations have the capacity for health promotion activities. This study aims to explore and describe capacity changes of a non-profit organisation during a 3-year community-based nutrition intervention. The non-profit organisation, with 3800 members throughout the state of Queensland, Australia, implemented a 3-year food literacy community-based intervention. A team of qualified nutritionists delivered the program in partnership with community-based volunteers. A separate aim of the intervention was to build capacity of the non-profit organisation for health promotion. A qualitative study was undertaken, using a social constructivist approach to explore organisational capacity changes longitudinally. All relevant participants including non-profit executive managers and nutritionists were included in the study (100% response rate). Data collection included semi-structured interviews (n = 17) at multiple intervention time points and document analysis of program newsletters (n = 21). Interview transcripts and documents were analysed separately using thematic and content analysis. Codes and categories between the two data sources were then compared and contrasted to build themes. Organisational capacity was predominantly influenced by four themes; ‘communicating’, ‘changing relationships’, ‘limited organisational learning’ and ‘adaptability and resistance to change’. Developing non-profit organisational health promotion capacity appears to require focusing on fostering communication processes and building positive relationships over time. Capacity changes of the non-profit organisation were not linear, fluctuating across various levels over time. Assessing non-profit organisational capacity to implement community interventions by describing adaptive capacity, may help researchers focus on the processes that influence capacity development

Multi-sector mitigation strategies at the neighbourhood scale

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Supporting dietitians to work in Aboriginal health: Qualitative evaluation of a Community of Practice mentoring circle

This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for self-archiving. © 2016 Dietitians Association of AustraliaAim This paper explores the experience of dietitians participating in a Community of Practice designed to support their work with Aboriginal communities. Methods The Community of Practice for dietitians working with Aboriginal communities ran for 12 months, starting in May 2014. Six‐weekly mentoring sessions were held using Skype, with conversation aided by a facilitator. In‐depth, semi‐structured interviews were held with all participants at the conclusion of the Community of Practice. Data were analysed using thematic analysis. Results Thirteen dietitians participated in the Community of Practice and an in‐depth, semi‐structured interview. Four key themes were identified: (i) Aboriginal health practice requires a different way of ‘knowing’, ‘being’ and ‘working’; (ii) Community of Practice is a safe place to discuss, debrief and explore ideas that are not safe elsewhere; (iii) participation in Community of Practice contributed to workforce retention in the Aboriginal health sector; and (iv) participation in Community of Practice contributed to dietitians changing their practice and feeling confident to do so. Conclusions By increasing confidence and opportunities for safe discussion, Community of Practice appears to be a useful model of Continuing Professional Development to support dietitians working in Aboriginal health

Why We Need a Community of Practice for Dietitians Working in Indigenous Health

This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for self-archiving. © 2015 Dietitians Association of AustraliaThe current burden of disease in Indigenous Australians, compared with non‐Indigenous Australians, is well documented.1, 2 Indigenous people experience disproportionate rates of conditions including type 2 diabetes, cardiovascular disease and renal disease.1 Factors that contribute to this health gap include historical, political and socioeconomic marginalisation and negative assumptions about Indigenous peoples, which can result in intergenerational discriminatory practices that have a profound effect on health and wellbeing.3 Nutrition is an important part of the prevention and management of many of these health issues including overweight and obesity4 and diabetes.5 National policy has recognised the vital role of the nutrition workforce in preventing and managing there conditions.6 Therefore, dietitians play an important role in working with Indigenous communities. However, there is a lack of evidence about how best to support dietitians working in the Indigenous health sector. There is evidence that dietitians face challenges working in Indigenous health.7 Anecdotal evidence suggests that these individuals experience professional isolation, are often sole practitioners, find it difficult to debrief in their workplace and with dietetic colleagues, are often in the minority due to the lack of nutrition‐specific positions in Indigenous nutrition and are at high risk of burnout. This is particularly the case for dietitians working in rural and remote areas, who often work with Indigenous people due to the higher proportion of Indigenous people living outside capital cities compared with the entire Australian population.8, 9 Support networks have been identified as one factor that contribute to dietitians' decisions to begin and continue working in rural and remote locations.10 Mentoring may offer promise.11 A disincentive for dietitians to work in rural communities has been identified to be limited professional development opportunities,12 highlighting the importance of offering professional development to those working in Indigenous health and rural health. One way to address this is a peer mentoring approach known as Community of Practice (CoP). A CoP is a group of people who come together to share resources and create new knowledge to advance a topic of professional practice.13 A CoP has been shown to be an effective workforce capacity‐building intervention, particularly in novice workforces characterised by professional isolation and split function roles, including public health nutritionists.14, 15 Building on evidence of the CoP model for public health nutritionists and nutritionists working with Indigenous stores16 and recognising the anecdotal challenges faced by dietitians working in Indigenous health, a CoP approach may offer an effective workforce development strategy to strengthen the capacity of dietitians working in Indigenous health across Australia. A pilot CoP for dietitians working in Indigenous health was run from May 2013 to May 2014. Six participants met every six weeks through Skype and the discussion was guided by a peer facilitator, also part of the peer mentoring approach. The objectives of the CoP were To assist dietitians working in Indigenous health to feel more supported in their workplace, reduce professional isolation and increase retention. To support dietitians working in Indigenous health. To build the competence (skill, knowledge and attitudes) of dietitians working in Indigenous health through the CoP using performance criteria developed by the Australian Government,17 which has been used previously in a similar setting.18 The aim of this pilot study was to determine to what extent these objectives were achieved. Preliminary data to assist in answering the evaluation questions from the six participants in this pilot suggests that CoP has increased participants' self‐rated confidence in the following areas (median score reported minimum score 1 maximum 5): Negotiate strategies to effectively accommodate cultural differences in the workplace (increased from 2.5 (pre‐CoP) to 4 (post‐CoP)) Acknowledge and respect the impact of events and issues in Aboriginal history during service delivery (increased from 3 (pre‐CoP) to 4 (post‐CoP)) Demonstrate knowledge of and respect for the diversity of culture, skin and language groups, family structures, art and religion in Indigenous cultures as part of service delivery (increased from 3 (pre‐CoP) to 4 (post‐CoP)) Identify ineffective communication strategies and remodel them to support delivery of health services (increased from 3 (pre‐CoP) to 4 (post‐CoP)) Take responsibility for revisiting strategies to assist in the resolution of any difficulties, differences or misunderstandings that may occur (increased from 3 (pre‐CoP) to 4 (post‐CoP)) In‐depth interviews were also conducted with the six participants providing positive feedback about the usefulness of the CoP to participants. A second CoP commenced in May 2014 and will conclude in May 2015. This will add data to the evaluation story initiated by the pilot and more fully explore whether the objectives have been achieved through more detailed analysis of in‐depth interviews from a larger sample of participants. Indigenous health is a challenging area in which to work. There is a lack of evidence about the best way to support dietitians to work in this area and there is a need to develop evidence about the suitability of support mechanisms. This project will contribute to evidence about effectiveness of a CoP approach and will help to determine best ways to support and build the competence of dietitians working in Indigenous health

A pilot evaluation measuring the impact of a Community of Practice in Aboriginal health

© 2017 Informa UK Limited, trading as Taylor & Francis Group. This is the author accepted manuscript (post print) made available in accordance with publisher copyright policy.Effective strategies to enhance the competence of practising health professionals are limited. Communities of Practice are proposed as strategy, yet little is known about their ability to develop cultural competency and practice. This study aimed to measure the impact of a Community of Practice on the self-assessed cultural competency and change to practice of dietitians working in Aboriginal health. A mixed-method approach including a quantitative 16-item cultural-competency self-assessment tool (completed at baseline and after 12 months of participation) together with the qualitative most significant change stories were used. Quantitative and qualitative data were compared together for congruence and difference. All participants (n = 13) completed the cultural competency-self assessment and participated in the significant change story development. They reported that through networking and joint problem solving they increased competence (13 of 16 performance indicators) and qualitative described increased self-confidence for their work in Aboriginal health through improved understanding of the factors related to the impact of history, culture and utilisation of resources on service delivery, appropriate communication strategies, effective relationships and managing conflict. These findings suggests that formalised and structured Communities of Practice may be an effective workforce development strategy to influence the practice of health professionals working in Aboriginal health

Development of advanced practice competency standards for dietetics in Australia

Aim: This study aimed to explore the work roles, major tasks and core activities of advanced practice dietitians in Australia to define the Competency Standards for advanced practice. Methods: A qualitative approach was used to review advanced dietetic practice in Australia involving experienced professionals, mostly dietitians. Four focus groups were conducted with a total of 17 participants and an average of 20 years experience: 15 dietitian practitioners plus 2 employers (1 dietitian and 1 non-dietitian). The focus groups explored the key purpose, roles and outcomes of these practitioners. Data from the focus groups were confirmed with in-depth interviews about their core activities with a purposive sample of 10 individuals recently recognised as Advanced Accredited Practising Dietitians. Data from both focus groups and interviews were analysed adductively to identify key themes. Results: The key theme that emerged to define advanced dietetics practice was leadership, with four subthemes that described in more detail the major work roles and outcomes of advanced practice. These subthemes identified that advanced practitioners were (i) outcome-focused, having impact; (ii) influence others and advocate; (iii) innovate and embrace change; and (iv) inspire others and are recognised for their practice. These outcomes were conceptualised within a broad generalist framework to generate revised Competency Standards. Conclusions: This study confirmed that leadership rather than specialist practice skills is the key determinant of advanced practice

Building the capacity of rural allied health generalists through online postgraduate education: a qualitative evaluation

Introduction: Workforce development is a key strategy for building the capacity and capability of a workforce. Accordingly, rural and remote practising allied health professionals require relevant and accessible continuing professional development to enhance their knowledge and skills and improve consumer health outcomes. This study explored the impact of an online postgraduate allied health rural generalist education program, from the perspective of allied health professionals participating in the program and their supervisors and managers. Methods: A qualitative, exploratory descriptive study design was employed using semistructured interviews. This study formed the qualitative component of a larger convergent mixed-methods evaluation study aimed at evaluating the reach, quality and impact of an online rural generalist education program for allied health professionals in Australia. Allied health professionals from seven professions enrolled in an online postgraduate rural generalist education program, the rural generalist program (RGP). Their designated work-based supervisors and their managers who were responsible for the operational management of the study sites were invited to participate in the study. All participants were employed in rural and remote health services in 10 sites across four Australian states. Study participants’ experience and perceptions of the impact of the RGP on themselves, the healthcare service and the broader community were explored using semistructured interviews. Data were thematically analysed site by site, then across sites using Braun and Clarke’s (2012) systematic six-phase approach. Provisional codes were generated and iteratively compared, contrasted and collapsed into secondary, more advanced codes until final themes and subthemes were developed. Results: Semistructured interviews were conducted with 23 allied health professionals enrolled in the RGP and their 27 work-based supervisors and managers across the 10 study sites. Three final themes were identified that describe the impact of the RGP: building capability as rural generalist allied health professionals; recruiting and building a rural workforce; enhancing healthcare services and consumer outcomes. Conclusion: Allied health professionals working in rural and remote locations valued the RGP because it provided accessible postgraduate education that aligned with their professional and clinical needs. Integrated into a supportive, well-structured development pathway, the experience potentiated learning and facilitated safe clinical practice that met the needs of consumers and organisations. The findings demonstrate that effective work-integrated learning strategies can enhance the development of essential capabilities for rural practice and support early-career allied health professionals’ transition to rural and remote practice. These experiences can engage allied health professionals in a way that engenders a desire to remain working in rural and remote contexts