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Pillen H, Attrill S, Fisher A, Forte S, Brebner C, Robinson S. Educating for supported decision making and shared decision making: a scoping review of educational design and outcomes for education and training interventions. Disabil Rehabil 2024:1-12. [PMID: 38591714 DOI: 10.1080/09638288.2024.2337099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/24/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE To characterise existing knowledge about the design and learning outcomes of education and training programs for supported or shared decision making. MATERIALS AND METHODS A scoping review was performed to identify academic and grey literature, published between January 2006 and February 2022, that reported on the design and/or learning outcomes of supported or shared decision making education or training programs. Eligible literature was mapped across domains of educational design and Kirkpatrick's hierarchy of learning effectiveness, and then qualitatively synthesised using cross-case analysis. RESULTS A total of 33 articles were identified (n = 7 for supported decision making and n = 26 for shared decision making) that provided education or training to supporters of persons with mental illness or substance use disorders (n = 14), dementia or neurocognitive disorders (n = 6), cognitive disability (n = 5), mixed populations (n = 1), and those receiving end-of-life care (n = 7). In their design, most programs sought specific changes in practice (behaviour) via experiential learning. Reported educational outcomes also focused on supporter behaviour, with limited evidence for how changes in learner attitudes, skills, or knowledge might be contributing to changes in supporter behaviour. CONCLUSIONS Future education and training would benefit from a closer engagement with theories of teaching and learning, particularly those oriented towards co-design.
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Affiliation(s)
- Heath Pillen
- School of Allied Health Science and Practice, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Stacie Attrill
- School of Allied Health Science and Practice, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Alinka Fisher
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Sabrina Forte
- Council for Intellectual Disability, Surry Hills, Australia
| | - Chris Brebner
- Office of the Deputy Vice-Chancellor, Flinders University, Adelaide, Australia
| | - Sally Robinson
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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Pillen H, Withall L, Tonkin E, Ward PR, Meyer SB, Henderson J, McCullum D, Coveney J, Wilson AM. Understanding how healthcare providers build consumer trust in the Australian food system: A qualitative study. Nutr Diet 2023. [PMID: 37056202 DOI: 10.1111/1747-0080.12809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/12/2023] [Accepted: 03/21/2023] [Indexed: 04/15/2023]
Abstract
AIM This study aimed to identify how dietitians and other healthcare providers work to build trust in food systems in the course of providing dietary education. METHODS Qualitative semi-structured interviews were conducted with 15 purposefully sampled dietitians (n = 5), general practitioners (n = 5), and complementary and alternative medicine practitioners (n = 5) within metropolitan South Australia. Interview data were then interpreted using an inductive thematic analysis approach, involving the construction of themes representing trust-enhancing roles around which beliefs about professional roles, the 'patient', and food and health were clustered. RESULTS Healthcare providers communicate beliefs regarding (dis)trust in food systems through: (i) responding to patient queries and concerns following a food incident or scare; (ii) helping patients to identify (un)trustworthy elements of food supply systems; and (iii) encouraging consumption of locally produced and minimally processed food. Importantly, the expression of these roles differed according to participant beliefs about food and health (medico-scientific versus alternative medicine) and their adoption of professional projects that sought to promote medico-scientific ways of thinking about health and diet or manage the failures of Western medicine. CONCLUSION The development and consolidation of trust-enhancing roles amongst healthcare providers likely requires disciplinary reflection on professional values and the processes by which practitioners apply these values to understanding food systems.
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Affiliation(s)
- Heath Pillen
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Liz Withall
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Emma Tonkin
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Paul R Ward
- Torrens University Australia, Adelaide Campus, Australia
| | - Samantha B Meyer
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Julie Henderson
- College of Nursing and Health Sciences, Flinders University, Bedford Park, Australia
| | - Dean McCullum
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - John Coveney
- College of Nursing and Health Sciences, Flinders University, Bedford Park, Australia
| | - Annabelle M Wilson
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia
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Tonkin E, Pillen H, Meyer SB, Ward PR, Beard C, Toson B, Coveney J, Henderson J, Webb T, McCullum D, Wilson AM. Testing delay in an environment of low COVID-19 prevalence: A qualitative study of testing behaviour amongst symptomatic South Australians. SSM Qual Res Health 2022; 2:100099. [PMID: 35582647 PMCID: PMC9098655 DOI: 10.1016/j.ssmqr.2022.100099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 05/03/2022] [Accepted: 05/05/2022] [Indexed: 01/13/2023]
Abstract
Introduction South Australia has to date (October 2021) been highly successful in maintaining an aggressive suppression strategy for the management of the COVID-19 pandemic. However, continued success of this strategy is dependent on ongoing testing by people with symptoms of COVID-19 to identify, trace and quarantine emergent cases as soon as possible. This study sought to explore community members' decisions about having COVID-19 testing in an environment of low prevalence, specifically exploring their decision-making related to symptoms. Materials and methods This study drew on a qualitative case study design, involving five focus groups, conducted in May 2021, with 29 individuals who had experienced COVID-19-like symptoms since the commencement of testing in South Australia. Participants detailed their last COVID-19-like illness episode and described their decision-making regarding testing. Data collection methods and analysis were theoretically informed by the capability, opportunity, and motivation behaviour (COM-B) model. Findings Participants' belief that COVID-19 symptoms would be 'unusual', severe, and persistent caused them to either reject or delay testing. Participants generally employed 'watch and wait' and social distancing behaviour rather than timely presentation to testing. Concern about economic loss associated with isolating after testing, and the potential for illness transmission at testing centres further prevented testing for some participants. Conclusions In a low COVID-19 prevalence environment, individuals rely on pre-existing strategies for interpreting and managing personal illness (such as delaying help seeking if symptoms are mild), which generally conflict with public health management advice about COVID-19. In low prevalence environments therefore public health authorities must give the public a reason to test beyond considerations of personal risk, and clearly communicate the need for ongoing COVID-19 surveillance despite the low prevalence environment.
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Affiliation(s)
- Emma Tonkin
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, 5042, Australia
| | - Heath Pillen
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, 5042, Australia
| | - Samantha B Meyer
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada
| | - Paul R Ward
- Research Centre for Public Health Policy, Torrens University, Adelaide, South Australia, 5000, Australia
| | - Clare Beard
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, 5042, Australia
| | - Barbara Toson
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, 5042, Australia
| | - John Coveney
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, 5042, Australia
| | - Julie Henderson
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, 5042, Australia
| | - Trevor Webb
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, 5042, Australia
| | - Dean McCullum
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, 5042, Australia
| | - Annabelle M Wilson
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, 5042, Australia
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Pillen H, Ward PR. How might diabetes organisations address diabetes-related stigma? Findings from a deliberative democratic case study. Health Expect 2021; 25:2213-2222. [PMID: 34856048 PMCID: PMC9615083 DOI: 10.1111/hex.13398] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 09/20/2021] [Accepted: 10/12/2021] [Indexed: 01/25/2023] Open
Abstract
Introduction This study sought to identify how diabetes organisations conceptualize the problem of diabetes‐related stigma and how this shapes the selection of stigma‐reduction interventions. Methods A qualitative deliberative democratic methodology was used to access an informed dialogue about what should be done by diabetes organisations to address diabetes‐related stigma, drawing from the perspectives of board members, healthcare services staff, and communications and marketing staff from a single state‐wide diabetes organisation in Australia (n = 25). Results Participants navigated the stigma concept along two axes: one that drew attention to either disease attributes or personal moral attributes as the object of stigmatisation, and one that positioned stigma as an individual or structural problem. This shaped the selection of stigma‐reduction interventions, which included interventions to: (i) reduce the prevalence of stigmatized attributes, (ii) correct misunderstandings about diabetes, (iii) modify representations of persons with diabetes, (iii) enhance coping amongst persons with diabetes and (iv) make healthcare more person‐centred and democratic. Conclusion This study identified several grievances with ‘diabetes‐related stigma’, which are grievances that can be conceptualized and addressed at both individual and structural levels, and involve correcting misinformation about diabetes or challenging and communicating alternative representations of persons living with diabetes. Patient or Public Contribution The organisation's management and board were consulted throughout all stages of research development, analysis and reporting. The information and vignettes presented to participants drew from illness narratives obtained from earlier research involving adults with type 2 diabetes. Research participants included adults with various diabetes types.
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Affiliation(s)
- Heath Pillen
- Discipline of Public Health, Flinders University College of Medicine and Public Health, Bedford Park, South Australia, Australia
| | - Paul R Ward
- Discipline of Public Health, Flinders University College of Medicine and Public Health, Bedford Park, South Australia, Australia
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Abstract
Developing an understanding of the social and political basis of marginalization is an important educational task for health education guided by frameworks of social justice. With the intention of developing an evaluative framework for use in further research, the aim of this review article is to present a synthesized framework of critical consciousness development, developed from a systematic search and qualitative synthesis of empirical studies that have examined the processes by which individuals come to critically reflect upon and act on oppressive social relations. A systematic search was conducted examining English-language literature produced between January 1970 and May 2017 within databases of PsycINFO, SCOPUS and ProQuest. A total of 20 articles were selected following a two-stage screening process and an assessment of methodological quality. Thematic analysis of findings from these texts produced a framework of critical consciousness development consisting of six qualitative processes and the relationships between them, including the priming of critical reflection, information creating disequilibrium, introspection, revising frames of reference, developing agency for change and acting against oppression. This synthesized framework of critical consciousness development is presented as a useful tool for assessing learning within critical pedagogies, albeit requiring some modification to suit specific cultural contexts and epistemologies.
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Affiliation(s)
- Heath Pillen
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide 5001, South Australia, Australia
| | - Darlene McNaughton
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide 5001, South Australia, Australia
| | - Paul R Ward
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide 5001, South Australia, Australia
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Henderson J, Ward PR, Tonkin E, Meyer SB, Pillen H, McCullum D, Toson B, Webb T, Coveney J, Wilson A. Developing and Maintaining Public Trust During and Post-COVID-19: Can We Apply a Model Developed for Responding to Food Scares? Front Public Health 2020; 8:369. [PMID: 32766202 PMCID: PMC7381165 DOI: 10.3389/fpubh.2020.00369] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 06/29/2020] [Indexed: 01/06/2023] Open
Abstract
Trust in public health officials and the information they provide is essential for the public uptake of preventative strategies to reduce the transmission of COVID-19. This paper discusses how a model for developing and maintaining trust in public health officials during food safety incidents and scandals might be applied to pandemic management. The model identifies ten strategies to be considered, including: transparency; development of protocols and procedures; credibility; proactivity; putting the public first; collaborating with stakeholders; consistency; education of stakeholders and the public; building your reputation; and keeping your promises. While pandemic management differs insofar as the responsibility lies with the public rather than identifiable regulatory bodies, and governments must weigh competing risks in creating policy, we conclude that many of the strategies identified in our trust model can be successfully applied to the maintenance of trust in public health officials prior to, during, and after pandemics.
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Affiliation(s)
- Julie Henderson
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Paul R Ward
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Emma Tonkin
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Samantha B Meyer
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Heath Pillen
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Dean McCullum
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Barbara Toson
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Trevor Webb
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - John Coveney
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Annabelle Wilson
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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Pillen H, McNaughton D, Ward PR. A review of critical pedagogies in health and social care: findings from a ‘best fit’ framework synthesis. Critical Public Health 2019. [DOI: 10.1080/09581596.2019.1591613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Heath Pillen
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Darlene McNaughton
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Paul R. Ward
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia
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Dizon JM, Grimmer K, Louw Q, Machingaidze S, Parker H, Pillen H. Barriers and enablers for the development and implementation of allied health clinical practice guidelines in South African primary healthcare settings: a qualitative study. Health Res Policy Syst 2017; 15:79. [PMID: 28915890 PMCID: PMC5603069 DOI: 10.1186/s12961-017-0243-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 08/22/2017] [Indexed: 01/08/2023] Open
Abstract
Background The South African allied health (AH) primary healthcare (PHC) workforce is challenged with the complex rehabilitation needs of escalating patient numbers. The application of evidence-based care using clinical practice guidelines (CPGs) is one way to make efficient and effective use of resources. Although CPGs are common for AH in high-income countries, there is limited understanding of how to do this in low- to middle-income countries. This paper describes barriers and enablers for AH CPG uptake in South African PHC. Methods Semi-structured individual interviews were undertaken with 25 South African AH managers, policymakers, clinicians and academics to explore perspectives on CPGs. Interviews were conducted by researcher dyads, one being familiar with South African AH PHC practice and the other with CPG expertise. Rigour and transparency of data collection was ensured. Interview transcripts were analysed by structuring content into codes, categories and themes. Exemplar quotations were extracted to support themes. Results CPGs were generally perceived to be relevant to assist AH providers to address the challenges of consistently providing evidence-based care in South African PHC settings. CPGs were considered to be tools for managing clinical, social and economic complexities of AH PHC practice, particularly if CPG recommendations were contextusalised. CPG uptake was one way to deal with increasing pressures to make efficient use of scarce financial resources, and to demonstrate professional legitimacy. Themes comprised organisational infrastructures and capacities for CPG uptake, interactions between AH actors and interaction with broader political structures, the nature of AH evidence in CPGs, and effectively implementing CPGs into practice. Conclusion CPGs contextualised to local circumstances offer South African PHC AH services with an efficient vehicle for putting evidence into practice. There are challenges to doing this, related to local barriers such as geography, AH training, workforce availability, scarce resources, an escalating number of patients requiring complex rehabilitation, and local knowledge. Concerted attempts to implement locally relevant CPGs for AH primary care in South Africa are required to improve widespread commitment to evidence-based care, as well as to plan efficient and effective service delivery models.
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Affiliation(s)
- J M Dizon
- International Centre for Allied Health Evidence (iCAHE), University of South Australia, City East Campus, North Terrace, Adelaide, 5000, Australia. .,Centre for Evidence-Based Health Care (CEBHC), Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 8000, Cape Town, South Africa.
| | - K Grimmer
- International Centre for Allied Health Evidence (iCAHE), University of South Australia, City East Campus, North Terrace, Adelaide, 5000, Australia.,Department of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 8000, Cape Town, South Africa
| | - Q Louw
- Department of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 8000, Cape Town, South Africa
| | - S Machingaidze
- Cochrane South Africa, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, 7505, Cape Town, South Africa.,European and Developing Countries Clinical Trial Partnership (EDCTP), Francie van Zijl Drive, Parow Valley, 7505, Cape Town, South Africa
| | - H Parker
- Department of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 8000, Cape Town, South Africa
| | - H Pillen
- International Centre for Allied Health Evidence (iCAHE), University of South Australia, City East Campus, North Terrace, Adelaide, 5000, Australia
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Pillen H, Tsourtos G, Coveney J, Thodis A, Itsiopoulos C, Kouris-Blazos A. Retaining Traditional Dietary Practices among Greek Immigrants to Australia: The Role of Ethnic Identity. Ecol Food Nutr 2017; 56:312-328. [PMID: 28657346 DOI: 10.1080/03670244.2017.1333000] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This article explores why some Greek immigrants to Australia continue to adhere to a traditional Mediterranean diet whereas others have adopted eating behaviors characteristic of a less healthy "Australian" diet. Twelve qualitative interviews were conducted and comparisons made between individuals consuming more (n = 6) and less traditional diets (n = 6). The level of adherence to the diet was previously assessed by a diet score in a separate quantitative study (MEDIS-Australia) from which the subset of 12 participants for the present study was recruited. Analysis revealed that maintenance of a strong ethnic identity offers a pathway through which individuals retain dietary practices of their homeland.
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Affiliation(s)
- Heath Pillen
- a Discipline of Public Health , Flinders University , Adelaide , South Australia , Australia
| | - George Tsourtos
- a Discipline of Public Health , Flinders University , Adelaide , South Australia , Australia
| | - John Coveney
- a Discipline of Public Health , Flinders University , Adelaide , South Australia , Australia
| | - Antonia Thodis
- b Department of Rehabilitation, Nutrition & Sport , La Trobe University , Melbourne , Australia
| | - Catherine Itsiopoulos
- b Department of Rehabilitation, Nutrition & Sport , La Trobe University , Melbourne , Australia
| | - Antigone Kouris-Blazos
- b Department of Rehabilitation, Nutrition & Sport , La Trobe University , Melbourne , Australia
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