Self-management and the treatment of gambling addiction: a rationale

Self-management programs are now a well-accepted approach to assisting people with chronic and complex health conditions to manage their illness and their lives more comprehensively, and, as a result, enjoy better quality of life and health outcomes. Such approaches have now been developed for a wide range of chronic conditions and many programs are generic in that they are not illness-specific. This paper explores the possibility of peer education and self-management as the next frontier in the treatment of gambling addiction and asks whether the expert patient approach that has been shown to be successful in the management of chronic disease might gainfully be applied to the treatment of problem gambling

The politics of public sector change: Trends in health and education sector change in South Australia

BACKGROUND: As the changes underpinning the Coordinated Care Trials in South Australia have become more apparent, similarities have emerged between the rationalisation of public schooling in the mid 1980s and the transformation of public health in the 1990s. OBJECTIVE: This article aims to discuss the evolution of health services in South Australia and help us answer the question of how best to manage our public and private health infrastructure in a changing economic and social context. DISCUSSION: Both strategies in education and health share common elements of cost cutting, attempts at improving efficiencies, a flirting with the private sector and the attendant risk of reduced quality of services to the public. This situation in both sectors is indicative of a shift in public policy and a growth in the belief that private management of public sector infrastructure can help resolve the funding crises around our education and health systems

Rural Health Systems Change

Much effort has been expended in recent years attempting to reform the Australian health system in order to deliver more efficient and effective systems of care for an ageing and increasingly chronically ill population. Rural health care systems in particular have been a focus of reform programs, and new initiatives such as University Departments of Rural Health, Regional Health Service structures and Commonwealth primary care initiatives have been designed to improve service provision and health status for rural people. However, with these attempts to reform the way rural communities understand and manage their health care, surprisingly little has changed in the day-to-day business of health care in rural and regional areas. Paradoxically, while rural communities have moved to embrace new farming technologies and environmental perspectives along with modern land management practices, revegetation and sustainable production systems, the same enthusiasm for change does not appear to have been kindled in relation to health system reforms. Rural communities, in terms of health care, are still using the equivalent of outmoded farming practices and other environmentally and economically unsustainable approaches to managing their affairs. Why might this be and what can be done to improve the current state of health reform in our rural and regional areas? The paper explores systems change in relation to health reform in rural communities and highlights several strategies for bringing about a functional synthesis of research and health service practice to create a more effective health care system in rural South Australia

Gambling in a remote Aboriginal setting - the good, the bad and the ugly

In 2009 the Ceduna Koonibba Aboriginal Health Service, an Indigenous-specific service, and Statewide Gambling Therapy Service joined together to investigate the impact that gambling was having on the Aboriginal people living in this region. Both organisations were funded through the state-based Office for Problem Gambling to provide gambling intervention. A number of signs indicate that the community development approach has proven effective. Towards the end of the first year of the project six people signed up for one-on-one therapy to address gambling; a small group of women met regularly to learn more about how to overcome gambling and provide support to each other. In general, there has been a notable improvement in the level of engagement with the program amongst health and welfare workers in the town, with the Project Officers regularly meeting with staff across agencies

Does gender moderate the subjective measurement and structural paths in behavioural and cognitive aspects of gambling disorder in treatment-seeking adults?

© 2014. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/ .Highlights - We assess for gender differences in conceptualising gambling symptoms. - We model urge and cognition paths to gambling disorder moderated by gender. - Gambling symptom constructs were equally salient between men and women. - Men reported stronger levels of urge and interpretive bias. Abstract Introduction Gender differences have been observed in the pathogenesis of gambling disorder and gambling related urge and cognitions are predictive of relapse to problem gambling. A better understanding of these mechanisms concurrently may help in the development of more directed therapies. Methods We evaluated gender effects on behavioural and cognitive paths to gambling disorder from self-report data. Participants (N = 454) were treatment-seeking problem gamblers on first presentation to a gambling therapy service between January 2012 and December 2014. We firstly investigated if aspects of gambling related urge, cognitions (interpretive bias and gambling expectancies) and gambling severity were more central to men than women. Subsequently, a full structural equation model tested if gender moderated behavioural and cognitive paths to gambling severity. Results Men (n = 280, mean age = 37.4 years, SD = 11.4) were significantly younger than women (n = 174, mean age = 48.7 years, SD = 12.9) (p < 0.001). There was no gender difference in conceptualising latent constructs of problem gambling severity, gambling related urge, interpretive bias and gambling expectancies. The paths for urge to gambling severity and interpretive bias to gambling severity were stronger for men than women and statistically significant (p < 0.001 and p = 0.004, respectively) whilst insignificant for women (p = 0.164 and p = 0.149, respectively). Structural paths for gambling expectancies to gambling severity were insignificant for both men and women. Conclusion This study detected an important signal in terms of theoretical mechanisms to explaining gambling disorder and gender differences. It has implications for treatment development including relapse prevention

The internal consistency and construct validity of the Partners in Health scale: validation of a patient rated chronic condition self-management measure

The purpose of this study was to test the internal consistency and construct validity of the revised 12-item self-rated Partners in Health (PIH) scale used to assess patients' chronic condition self-management knowledge and behaviours. The PIH scale exhibits construct validity and internal consistency. It therefore is both a generic self-rated clinical tool for assessing self-management in a range of chronic conditions as well as an outcome measure to compare populations and change in patient self-management knowledge and behaviour over time. The four domains of self-management provide a valid measure of patient competency in relation to the self-management of their chronic condition

Variance partitioning in multilevel models for count data

A first step when fitting multilevel models to continuous responses is to explore the degree of clustering in the data. Researchers fit variance-component models and then report the proportion of variation in the response that is due to systematic differences between clusters. Equally they report the response correlation between units within a cluster. These statistics are popularly referred to as variance partition coefficients (VPCs) and intraclass correlation coefficients (ICCs). When fitting multilevel models to categorical (binary, ordinal, or nominal) and count responses, these statistics prove more challenging to calculate. For categorical response models, researchers appeal to their latent response formulations and report VPCs/ICCs in terms of latent continuous responses envisaged to underly the observed categorical responses. For standard count response models, however, there are no corresponding latent response formulations. More generally, there is a paucity of guidance on how to partition the variation. As a result, applied researchers are likely to avoid or inadequately report and discuss the substantive importance of clustering and cluster effects in their studies. A recent article drew attention to a little-known exact algebraic expression for the VPC/ICC for the special case of the two-level random-intercept Poisson model. In this article, we make a substantial new contribution. First, we derive exact VPC/ICC expressions for more flexible negative binomial models that allows for overdispersion, a phenomenon which often occurs in practice. Then we derive exact VPC/ICC expressions for three-level and random-coefficient extensions to these models. We illustrate our work with an application to student absenteeism