'His job is already done': excluding and excusing men from responsibility for child health

The author explores the relationships between the biological and the social and, specifically, how understandings about health become influenced by, and reinforcing of, existing social arrangements

Control in chronic condition self-care management: how it occurs in the health worker–client relationship and implications for client empowerment

This item is under embargo for a period of 12 months from the date of publication, in accordance with the publisher's policy.Aim. To examine health worker–client interactions during care planning to understand processes that foster client empowerment and disempowerment. Background. It is unclear how health worker–client exchanges and information sharing through chronic condition care planning currently operate in primary health care. Moreover, it is unclear how control in these exchanges either enhances collaborative decision-making, partnership and client empowerment, or works to create client disempowerment and dependency on workers and health services. Design. Critical discourse analysis of qualitative data from ethnographic observations and audio-taped worker–client consultations. Method. Multidisciplinary teams in two Australian community-based primary healthcare sites participated. This included nurses, general practitioners and allied health workers and their clients who had a chronic condition care plan. Nineteen worker–client consultations were observed/recorded in 2011. Results. Control was expressed through multiple processes inherent in the worker role and in their interactions with clients. When workers exercised disproportionate control and clients relinquished their own control, client disempowerment and dependency were evident. Clients’ attempts to gain control and workers’ attempts to relinquish control alleviated clients’ disempowerment and dependency. However, structural features of information sharing systems and workers’ care planning behaviours diminished such efforts. Conclusion. Worker awareness of their communication style and the power of their role must improve for client chronic condition self-care management to be achieved. Training on the impacts of control in worker communication and systems where they work must be provided if unbeneficial forms of client dependency are to be overcome and true self-care management is to be realized

Information sharing for the management of chronic conditions in primary health care: How does it work and what are the outcomes?

The prevalence of chronic health problems is increasing across Australia. Finding ways to maximise effective use of resources in this area is particularly important given that expenditure on chronic conditions already accounts for the majority of all health care spending. Prior research indicates that chronic health problems are most effectively managed through a collaborative approach where clients and health workers from various disciplines work together to achieve defined goals. The use of care plans can assist in facilitating this collaboration and in fostering effective communication. To address the gaps in knowledge about how these processes are currently operating, our research investigated the information sharing processes that are used within the care planning process to identify how they work and to explore client and health worker experiences of them.The research reported in this paper is a project of the Australian Primary Health Care Research Institute, which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research, Evaluation and Development Strategy

Examining the use of metaphors to understand the experience of community treatment orders for patients and mental health workers

© 2016 Lawn et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.BACKGROUND: Community Treatment Orders (CTOs) are often complex because of the ethical tensions created by an intervention that aims at promoting the patient's good through an inherently coercive process. There is limited research that examines the complexity of CTOs and how patients on CTOs and workers administering CTOs make sense of their experiences. METHODS: The study involved in-depth interviews with 8 patients on CTOs and 10 community mental health workers in South Australia, to explore how they constructed their experiences of CTOs. Critical discourse analysis (CDA) was used to analyse the data, supported by NVIVO software. RESULTS: Analysis of the interviews revealed that patients and workers experienced the CTO process as multi-dimensional, including some positive as well as more negative constructions. The positive metaphor of CTOs as a safety net is described, followed by a more detailed description of the metaphors of power and control as the dominant themes, with five sub-themes of the CTO as control, wake-up, punishment, surveillance, and tranquiliser. DISCUSSION: Metaphors are a way that mental health patients and mental health workers articulate the nature of CTOs. The language used to construct these metaphors was quite different, with patients overwhelmingly experiencing and perceiving CTOs as coercive (that is, punishing, controlling and scrutinizing), whereas workers tended to perceive them as necessary, beneficial and supportive, despite their coerciveness. CONCLUSIONS: By acknowledging the role of metaphors in these patients' lives, workers could enhance opportunities to engage these patients in more meaningful dialogue about their personal experiences as an alternative to practice predominantly focused on risk. Such a dialogue could enhance workers' reflection on their work and promote recovery-based practice. More understanding of how to promote autonomy, capacity and supported decision-making, and how to address the impacts of coercion within care, is needed

Barriers and enablers to good communication and information-sharing practices in care planning for chronic condition management

Author version made available in accordance with Publisher's copyright policy.Our aim was to document current communication and information-sharing practices and to identify the barriers and enablers to good practices within the context of care planning for chronic condition management. Further aims were to make recommendations about how changes to policy and practice can improve communication and information sharing in primary health care. A mixed-method approach was applied to seek the perspectives of patients and primary health-care workers across Australia. Data was collected via interviews, focus groups, non-participant observations and a national survey. Data analysis was performed using a mix of thematic, discourse and statistical approaches. Central barriers to effective communication and information sharing included fragmented communication, uncertainty around client and interagency consent, and the unacknowledged existence of overlapping care plans. To be most effective, communication and information sharing should be open, two-way and inclusive of all members of health-care teams. It must also only be undertaken with the appropriate participant consent, otherwise this has the potential to cause patients harm. Improvements in care planning as a communication and information-sharing tool may be achieved through practice initiatives that reflect the rhetoric of collaborative person-centred care, which is already supported through existing policy in Australia. General practitioners and other primary care providers should operationalise care planning, and the expectation of collaborative and effective communication of care that underpins it, within their practice with patients and all members of the care team. To assist in meeting these aims, we make several recommendations

Trust and Community Treatment Orders

There are conflicting views about the benefits of community treatment orders (CTOs) for people with mental illness. While there is a significant literature on the coercive nature of CTOs, there is less on the impact that CTOs have upon trust. A recovery-oriented approach requires a trusting therapeutic relationship and the coercion inherent in the CTO process may make it difficult for trust to be built, nurtured, and sustained between workers and patients. Our aim was therefore to examine the role of trust within the CTO experience for mental health workers and patients on CTOs.Methods: We conducted a thematic discourse analysis of 8 in-depth interviews with people who were currently on a CTO and 10 interviews with multi-disciplinary mental health workers in Adelaide, Australia (total N = 18 interviews). The interviews were coded and analyzed with the assistance of a patient representative. The findings reveal the challenges and opportunities for trust within the coercive relationship of a CTO.Findings: We found that patients have diverse experiences of CTOs and that trust or mistrust played an import role in whether or not they found the CTO beneficial

To What Extent can the Activities of the South Australian Health in All Policies Initiative be Linked to Population Health Outcomes Using a Program Theory-Based Evaluation

This paper reports on a five-year study using a theory-based program logic evaluation, and supportingsurvey and interview data to examine the extent to which the activites of the South Australian Health in All Policiesinitiative can be linked to population health outcomes

How do advisory groups contribute to healthy public policy research?

Objectives: This paper reflects on experiences of Australian public health researchers and members of research policy advisory groups (PAGs) in working with PAGs. It considers their benefits and challenges for building researcher and policy actor collaboration and ensuring policy relevance of research. Methods: Four research projects conducted between 2015 and 2020 were selected for analysis. 68 PAG members from Australian federal, state and local governments, NGOs and academics participated in providing feedback. Thematic analysis of participant feedback and researchers’ critical reflections on the effectiveness and capacity of PAGs to support research translation was undertaken. Results: PAGs benefit the research process and can facilitate knowledge translation. PAG membership changes, differing researcher and policy actor agendas, and researchers’ need to balance policy relevance and research independence are challenges when working with PAGs. Strategies to improve the function of health policy research PAGs are identified. Conclusions: The paper suggests a broader adapted approach for gaining the benefits and addressing the challenges of working with PAGs. It opens theoretical and practical discussion of PAGs’ role and how they can increase research translation into policy

Information sharing for the management of chronic conditions in primary health care: How does it work and what are the outcomes?

© Flinders UniversityThe prevalence of chronic health problems is increasing across Australia. Finding ways to maximise effective use of resources in this area is particularly important given that expenditure on chronic conditions already accounts for the majority of all health care spending. Prior research indicates that chronic health problems are most effectively managed through a collaborative approach where clients and health workers from various disciplines work together to achieve defined goals. The use of care plans can assist in facilitating this collaboration and in fostering effective communication. To address the gaps in knowledge about how these processes are currently operating, our research investigated the information sharing processes that are used within the care planning process to identify how they work and to explore client and health worker experiences of them

Health Impact Assessment in New South Wales & Health in All Policies in South Australia: differences, similarities and connections

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background: Policy decisions made within all sectors have the potential to influence population health and equity. Recognition of this provides impetus for the health sector to engage with other sectors to facilitate the development of policies that recognise, and aim to improve, population outcomes. This paper compares the approaches implemented to facilitate such engagement in two Australian jurisdictions. These are Health Impact Assessment (HIA) in New South Wales (NSW) and Health in All Policies (HiAP) in South Australia (SA). Methods: The comparisons presented in this paper emerged through collaborative activities between stakeholders in both jurisdictions, including critical reflection on HIA and HiAP practice, joint participation in a workshop, and the preparation of a discussion paper written to inform a conference plenary session. The plenary provided an opportunity for the incorporation of additional insights from policy practitioners and academics. Results: Comparison of the approaches indicates that their overall intent is similar. Differences exist, however, in the underpinning principles, technical processes and tactical strategies applied. These differences appear to stem mainly from the organisational positioning of the work in each state and the extent to which each approach is linked to government systems. Conclusions: The alignment of the HiAP approach with the systems of the SA Government increases the likelihood of influence within the policy cycle. However, the political priorities and sensitivities of the SA Government limit the scope of HiAP work. The implementation of the HIA approach from outside government in NSW means greater freedom to collaborate with a range of partners and to assess policy issues in any area, regardless of government priorities. However, the comparative distance of HIA from NSW Government systems may reduce the potential for impact on government policy. The diversity in the technical and tactical strategies that are applied within each approach provides insight into how the approaches have been tailored to suit the particular contexts in which they have been implemented. Keywords: Health in all policies, Health impact assessment, Healthy public polic