Exploring mothers' perspectives of an intensive home visiting program in Australia: A qualitative study

Author version made available in accordance with the publisher's policy.Intensive nurse home visiting programs are an early childhood, population based intervention that target vulnerable families. Programs are dependent on the relationship between home visitor and mother to bring about change. Few studies have focused on investigating parents’ perspectives of these programs using qualitative methods and none in the Australian context. The aim of this qualitative study was to explore and describe mothers’ perspectives of an intensive nurse home visiting program in South Australia. Eight in-depth interviews were conducted with mothers receiving the program. The findings indicated the role of a trusting relationship between nurse and participant as well as shared decision-making was central to program engagement and led to participant perceptions of increasing control over their role as parents. However, a clear distinction was made by the mothers: that they engaged in a relationship, not a program

Evidence of an early information processing speed deficit in unipolar major depression

Background. Slowing of the speed of information processing has been reported in geriatric depression, but it is not clear if the impairment is present in younger patients, if motor retardation is responsible, or if antidepressant medications play a role. Method. Twenty unmedicated unipolar depressed inpatients were compared with 19 medicated depressed in-patients and 20 age-, sex- and verbal IQ-matched controls on inspection time (IT), a measure of speed of information processing that does not require a speeded motor response. We also examined the relationship between IT and current mood and length of depressive illness. Results. Unmedicated depressed patients showed slowing of information processing speed when compared to both medicated depressed patients and controls. The latter two groups were not significantly different from each other. Slowing of IT was not associated with current mood, but was negatively correlated with length of illness since first episode. No differences in IT were found between patients receiving medication with anticholinergic effects and patients receiving medication with no anticholinergic effects. Conclusions. The findings indicate that unipolar depression is associated with a slowing of speed of information processing in younger patients who have not received antidepressant medication. This does not appear to be a result of motor slowing.G. Tsourtos, J. C. Thompson and C. Stoug

Smoking and stress

Primary care-based smoking cessation interventions are often less effective among low-SES groups. Higher stress levels may explain the lower quit rate and higher prevalence of smoking in low-SES groups, and why the relative smoking prevalence rate is not declining at an equitable rate (same prevalence rate as higher SES groups). To understand these issues, this paper sought answers to two questions: is stress perceived by ex-smokers and current smokers as a barrier to quitting; and does stress act as a barrier to quitting in relation to other barriers in disadvantaged areas

Type of unit and population served matters when implementing a smoke-free policy in mental health settings: Perceptions of unit managers across England

Author version made available in accordance with the publisher's policyBackground: Globally, smoking remains a significant issue for mental health populations. Many mental health trusts in England are facing challenges of implementing the NICE guidance according to which all mental health settings, no matter the type, should be entirely smoke-free and provide comprehensive smoking cessation support. Aim: To determine if unit type and unit manager smoking status influence mental health smoke-free policy implementation. Method: This paper reports on the secondary analysis of data from a cross-sectional survey of 147 mental health inpatient settings in England, in 2010. The original study’s main aim was to understand unit managers’ perceived reasons for success or failure of smoke-free policy. Results: Unit managers (n=131) held a positive stance towards supporting smoke-free policy and most perceived that the policy was successful. Non-smoker unit managers were more likely to adopt complete bans than smoker unit managers; whereas, smoker unit managers more likely than non-smoker unit managers to think that stopping smoking aggravated patients’ mental illness. Smoking rates for staff and patients remain high, as perceived by unit managers, regardless of unit type. Proportion of units offering NRT and peer support to patients was significantly higher in locked units compared to semi-locked or residential rehabilitation. Applied strategies significantly vary by type of unit; whereas, unit managers’ knowledge, attitude and practices vary by their smoking status. Discussion: There are nuanced differences in how smoke-free policy is enacted which vary by unit type. These variations recognize the differing contexts of care provision in different types of units serving different patient groups. Addressing staff smoking rates, promoting consistency of staff response to patients’ smoking, and providing staff education and support continue to be key strategies to successful smoke-free policy. Conclusions: Our results demonstrate the importance of taking into account the type of unit and acuity of patients when enacting smoke-free policy; and addressing staff smoking

Mental health professionals’ perspectives on the implementation of smoke-free policies in psychiatric units across England

Author version made available in accordance with the publisher's policyBackground: The original audit on which this 2013 secondary analysis is based, was conducted in 2010. It explored implementation of smoke-free policies from the perspective of unit managers in 147 psychiatric units across England comprising a randomly selected sample of nine different unit types. Material: Two main themes are presented: positive perspectives of smoke-free policy implementation; and, barriers and problems with smoke-free policy implementation. Analysis of unit managers’ experiences and perspectives found that 96% of participants thought smoke-free policy had achieved positive outcomes for staff, patients, services and care. Discussion: Consistency of response was the most prominent factor associated with policy success. Quality of the physical environment and care delivery were clear positive outcomes which enabled the environment to be more conducive to supporting staff’ and patients’ quit attempts. Lack of consistency and a prevailing culture of acceptance of smoking were identified as some of the most reported perceived continuing problems. Solutions included the need to acknowledge that this type of complex systems change takes time and ongoing staff education and training. Conclusions: Our results demonstrate the importance of taking into account the experiences and attitudes of staff responsible for enacting smoke-free policy

The importance of resilience to primary care practitioners: an interactive psycho-social model

In this paper, it is argued that an understanding of the factors that make up resilience can enhance communication and concordance between practitioner and patient. A model is presented demonstrating that resilience is an interaction between factors in the internal domain, comprising psychological characteristics and resources, and the external domain, comprising the social environment surrounding the individual. As resilience manifests itself in different ways across the life-cycle, and according to individual circumstances, time is also an important part of the model presented in this paper. Understanding this model of resilience can lead to an insight that there are factors that can be influenced whereby the primary care practitioner can treat the patient, or refer them after a process of concordance through a deeper understanding of the factors that surround a patient’s current health status. Underlying the model is the view that resilience is linked to the assets model of health, seeking to promote and maintain health and prevent illness. Therefore, primary care practitioners, through a deeper understanding of the circumstances of the patient, and through understanding the factors that promote resilience, may be better able to take action in health promotion and maintenance

Operationalising the Theory of Social Quality: analysis of the reliability of an instrument to measure social quality

The Theory of Social Quality (TSQ) has not yet had extensive empirical testing due to the difficulty of developing a validated and reliable tool to ‘measure’ social quality. A survey investigating social quality was piloted (n = 33) and analysed for test-retest and inter-item reliability in Australia, August 2009. Questions were considered reliable if the results from the test-retest analyses (Kappa, or Spearman Correlation tests) and the inter-item reliability test (Cronbach’s α) were statistically significant (p ≤ 0.05) or the coefficients were (≥ 0.70) for any of the questionnaire items. Two questions and 34 items were removed from the survey. These preliminary data support the reliability and validity of the survey as an instrument for measuring social quality. In addition, the tool provides a means for operationalising the TSQ in future empirical research

An ecological analysis of factors associated with food insecurity in South Australia, 2002-7

In order to estimate the extent of food insecurity in South Australia and its relationship with a variety of socio-economic variables, Design Data collected routinely from 2002 to 2007 by SA Health were analysed. An ecological analysis of data collected by the South Australian Monitoring and Surveillance System (SAMSS) that collects data on key health indicators. Questions on food security are asked periodically from July 2002 to December 2007. Seven per cent (1342/19 037) of subjects reported running out of food during the previous year and not having enough money to buy food (food insecurity). Logistic regression analysis found food insecurity to be highest in households with low levels of education, limited capacity to save money, Aboriginal households, and households with three or more children. Conclusions The study confirms that food insecurity is strongly linked to economic disadvantage. Increasing cost of food is likely to exacerbate food insecurity. This is of concern given that food insecurity is associated with poor health, especially obesity and chronic disease. Comprehensive action at all levels is required to address root causes of food insecurity. Regular surveillance is required to continue to monitor levels of food security, but more in-depth understandings, via qualitative research, would be useful