Putting population and global health on the agenda of health professionals

Health professional education curricula are notoriously contested and constrained. Diverse epistemological and pedagogical objectives compete for space amid complex schedules of clinical placements, rotations, laboratory work, lectures, and other core curriculum activities. Health professional educators must navigate these constraints as well as address course accreditation standards and the expectations and needs of their communities. Accreditation standards for health professional courses are designed to ensure that graduates are competent to practise safely and effectively; they are also designed to ensure graduates can address health issues in the broader community and populations. Health professional education and training should therefore provide understandings of environmental and social determinants of health and disease still contributing to systemic health inequalities; it should help health professionals appreciate the health and wellbeing needs of indigenous peoples and the social and historical contexts of these health needs. [...

Patient and clinician engagement with health information in the primary care waiting room: A mixed methods case study

Background. Primary care waiting rooms can be sites of health promotion and health literacy development through the provision of readily accessible health information. To date, few studies have considered patient engagement with televised health messages in the waiting room, nor have studies investigated whether patients ask their clinicians about this information. The aim of this study was therefore to examine patient (or accompanying person) and clinician engagement with waiting room health information, including televised health messages. Design and methods. The mixed methods case study was undertaken in a regional general practice in Victoria, Australia, utilising patient questionnaires, waiting room observations, and clinician logbooks and interviews. The qualitative data were analysed by content analysis; the questionnaire data were analysed using descriptive statistics. Results. Patients engaged with a range of health information in the waiting room and reportedly received health messages from this information. 44% of the questionnaire respondents (33 of 74) reported watching the television health program, and half of these reported receiving a take home health message from this source. Only one of the clinicians (N=9) recalled a patient asking about the televised health program. Conclusions. The general practice waiting room remains a site where people engage with the available health information, with a televised health ‘infotainment’ program receiving most attention from patients. Our study showed that consumption of health information was primarily passive and tended not to activate patient discussions with clinicians. Future studies could investigate any link between the health infotainment program and behaviour change.N/

Supporting medical students to support peers : a qualitative interview study

Background Students may be the first to recognise and respond to psychological distress in other students. Peer support could overcome medical student reluctance to seek help despite their high rates of mental ill-health. Yet, despite the adoption of peer support programs, there is little evidence of impact on students. Peer support programs may assume that medical students accept and view peer support positively. We explored these assumptions by asking students about their experiences and views on peer support. Methods Qualitative semi-structured interviews exploring peer support experiences and views on peer support were conducted with ten medical students at two contrasting medical schools. Informed by a constructivist stance, interview transcripts underwent thematic analysis. Results Three groups of themes were identified: participants' experiences of peer support encounters, concerns about providing support, and views on students' roles in peer support. Participants readily recalled signs of peer distress. Encounters were ad hoc, informal, and occurred within relationships based on friendship or by being co-located in the same classes or placements. Concerns about initiating and offering support included lack of expertise, maintaining confidentiality, stigma from a mental health diagnosis, and unclear role boundaries, with implications for acceptance of student roles in peer support. Conclusions Our study emphasised the centrality of social relationships in enabling or discouraging peer support. Relationships developed during medical studies may anticipate the collegial relationships between medical professionals. Nevertheless, only some students are willing to undertake peer support roles. We suggest different strategies for promoting informal peer support that can be offered by any student, to those promoting formal support roles for selected students. Future research focusing on the impact for both the students who receive, and on the students who provide peer support is called for

Cultural respect encompassing simulation training: being heard about health through broadband

BACKGROUND: Cultural Respect Encompassing Simulation Training (CREST) is a learning program that uses simulation to provide health professional students and practitioners with strategies to communicate sensitively with culturally and linguistically diverse (CALD) patients. It consists of training modules with a cultural competency evaluation framework and CALD simulated patients to interact with trainees in immersive simulation scenarios. The aim of this study was to test the feasibility of expanding the delivery of CREST to rural Australia using live video streaming; and to investigate the fidelity of cultural sensitivity - defined within the process of cultural competency which includes awareness, knowledge, skills, encounters and desire - of the streamed simulations. DESIGN AND METHODS: In this mixed-methods evaluative study, health professional trainees were recruited at three rural academic campuses and one rural hospital to pilot CREST sessions via live video streaming and simulation from the city campus in 2014. Cultural competency, teaching and learning evaluations were conducted. RESULTS: Forty-five participants rated 26 reliable items before and after each session and reported statistically significant improvement in 4 of 5 cultural competency domains, particularly in cultural skills (P<0.05). Qualitative data indicated an overall acknowledgement amongst participants of the importance of communication training and the quality of the simulation training provided remotely by CREST. CONCLUSIONS: Cultural sensitivity education using live video-streaming and simulation can contribute to health professionals\u27 learning and is effective in improving cultural competency. CREST has the potential to be embedded within health professional curricula across Australian universities to address issues of health inequalities arising from a lack of cultural sensitivity training. Significance for public healthThere are significant health inequalities for migrant populations. They commonly have poorer access to health services and poorer health outcomes than the Australian-born population. The factors are multiple, complex and include language and cultural barriers. To address these disparities, culturally competent patient-centred care is increasingly recognised to be critical to improving care quality, patient satisfaction, patient compliance and patient outcomes. Yet there is a lack of quality in the teaching and learning of cultural competence in healthcare education curricula, particularly in rural settings where qualified trainers and resources can be limited. The Cultural Respect Encompassing Simulation Training (CREST) program offers opportunities to health professional students and practitioners to learn and develop communication skills with professionally trained culturally and linguistically diverse simulated patients who contribute their experiences and health perspectives. It has already been shown to contribute to health professionals\u27 learning and is effective in improving cultural competency in urban settings. This study demonstrates that CREST when delivered via live video-streaming and simulation can achieve similar results in rural settings

Enhancing COVID-19 public health communication for culturally and linguistically diverse communities: An Australian interview study with community representatives

Background: Public health crises present challenges for providing accessible, timely, and accurate health information to culturally and linguistically diverse (CALD) communities. Aim: The aim of this qualitative project was to explore strategies used by CALD community organizations to improve communication about COVID-19 for their communities; we also aimed to identify gaps and challenges. Methods: We interviewed 16 representatives from Greek, Italian, and Chinese CALD organizations in Melbourne, Australia. The interviews were analyzed thematically. Results: Community leaders played a significant role in engaging their community members with accurate key health information. There were differences between language communities about preferred channels for receiving information. As the pandemic intensified, there was a shift from written communication to more interactive exchanges between authorities and community leaders. Discussion: The findings suggest effective public health communication is enhanced by the mediation and outreach strategies adopted by CALD community organizations; further, stakeholders need to be cognizant of heterogeneity of needs and preferences. This may optimize information dissemination to meet specific needs. Conclusions:The CALD organizations have developed communication strategies involving different kinds of mediation to reach specific sub-groups, especially the most vulnerable. These strategies can inform future public health engagement

Family involvement in managing medications of older patients across transitions of care:A systematic review

BACKGROUND: As older patients' health care needs become more complex, they often experience challenges with managing medications across transitions of care. Families play a major role in older patients' lives. To date, there has been no review of the role of families in older people's medication management at transitions of care. This systematic review aimed to examine family involvement in managing older patients' medications across transitions of care. METHODS: Five databases were searched for quantitative, qualitative and mixed methods empirical studies involving families of patients aged 65 years and older: Cumulative Index to Nursing and Allied Health Literature Complete, Medline, the Cochrane Central Register of Controlled Trials, PsycINFO, and EMBASE. All authors participated independently in conducting data selection, extraction and quality assessment using the Mixed Methods Appraisal Tool. A descriptive synthesis and thematic analysis were undertaken of included papers. RESULTS: Twenty-three papers were included, comprising 17 qualitative studies, 5 quantitative studies and one mixed methods study. Families participated in information giving and receiving, decision making, managing medication complexity, and supportive interventions in regard to managing medications for older patients across transitions of care. However, health professionals tended not to acknowledge the medication activities performed by families. While families actively engaged with older patients in strategies to ensure safe medication management, communication about medication plans of care across transitions tended to be haphazard and disorganised, and there was a lack of shared decision making between families and health professionals. In managing medication complexity across transitions of care, family members perceived a lack of tailoring of medication plans for patients' needs, and believed they had to display perseverance to have their views heard by health professionals. CONCLUSIONS: Greater efforts are needed by health professionals in strengthening involvement of families in medication management at transitions of care, through designated family meetings, clinical bedside handovers, ward rounds, and admission and discharge consultations. Future work is needed on evaluating targeted strategies relating to family members' contribution to managing medications at transitions of care, with outcomes directed on family understanding of medication changes and their input in preventing and identifying medication-related problems

Book review : "Practice and research in literacy"

Book review of 'Practice and research in literacy' by Mukherjee, A. & Vasanta, D. (eds.) (2002). New Delhi: Sage Publications India Pvt Ltd.3 page(s

Disciplinary learning through writing: an investigation into the writing of undergraduate education students

For many academics and students the role of language, particularly writing, in constructing knowledge and in \u27learning to mean\u27 in a disciplinary context remains unexamined. This thesis investigates the ways in which undergraduate students learn specialist knowledge through writing. The disciplinary context of the study is pre-service primary teacher education in a Faculty of Education at one Australian university. Systemic functional linguistics and genre theory provide the theoretical framework for the study as well as the main analytical tools. The research methodology is an integrated one, drawing on discourse analytical and linguistic approaches as well as a small amount of ethnographic data. The findings of the research relate to two areas. The first area is the nature of learning to mean in a specialist disciplinary context. In this study, the tutors\u27 written feedback on the students\u27 assignments appeared to play only a minor role in the students\u27 socialisation into the discursive practices of the discipline. On the other hand, the students\u27 introductory textbook was seen to play a major role in shunting the students from commonsense understandings of child development to more uncommonsense disciplinary ones. The second area is the relation between disciplinary learning and writing. At the level of genre through the writing of Expositions, Discussions and Evaluative Accounts, the pre-service education students developed several thinking and learning processes. These included developing a logical argument based on evidence, engaging with recent research and assessing the implications of research and theories for the classroom. The findings also showed that Micro-genres functioned as \u27textual learning bridges\u27. These textual learning bridges allow the student, for example, to review, explain or clarify his or her understanding of a particular concept or phenomenon. The investigation at clause level into the ideational meanings in the students\u27 texts showed that the processes of naming, defining, taxonomising, reasoning, reporting knowledge claims and engaging with disciplinary knowledge were the main means through which the students built up their own semiotic map of the discipline. The study\u27s findings have the potential to inform the development of functionally oriented writing pedagogies as well as the thematisation of the role of language for thinking and learning in pre-service teacher education. It is hoped that such a strategy would not only aid the students\u27 writing and learning of specialist knowledge at university but also assist them in their future role as classroom practitioners