Producing knowledge together: a participatory approach to synthesising research across a large-scale collaboration in Aboriginal and Torres Strait Islander health

BACKGROUND

Despite that stakeholder participation in evidence synthesis could result in more useful outcomes, there are few examples of processes that actively involve them in synthesis work. Techniques are needed that engage diverse stakeholders as equal partners in knowledge co-production. The aims of this paper are to describe an innovative participatory process of synthesising a large body of academic research products and compare the findings of the participatory process against two traditional approaches to synthesis: a rapid review and a structured review.

METHODS

First, a rapid synthesis of all research outputs (n = 86) was conducted by researchers with in-depth knowledge of the collaboration's research. Second, a team of researchers and service providers conducted a structured synthesis of seventy-eight peer-reviewed articles and reports generated by the collaboration. Fifty-five publications were brought forward for further synthesis in part three, a facilitated participatory synthesis. Finally, we explored the value added by the participatory method by comparing findings generated across the three synthesis approaches.

RESULTS

Twelve researchers and 11 service providers/policy partners-8 self-identified as Aboriginal and/or Torres Strait Islander-participated in two facilitated workshops (totalling 4 h). Workshop activities engaged participants in reviewing publication summaries, identifying key findings, and evoked review, discussion and refinement. The process explicitly linked experiential knowledge to citations of academic research, clearly connecting the two knowledge types. In comparing the findings generated across all three methods we found mostly consistencies; the few discrepancies did not contradict but gave deeper insights into statements created by the other methods. The participatory synthesis generated the most, detailed, and unique findings, and contextual insights about the relevance of the key messages for practice.

CONCLUSION

The participatory synthesis engaged stakeholders with diverse backgrounds and skillsets in synthesising a large body of evidence in a relatively short time. The participatory approach produced findings comparable to traditional synthesis methods while extending knowledge and identifying lessons most relevant for the participants who, ultimately, are the end users of the research. This process will interest other large-scale research collaborations seeking to engage stakeholders in evidence synthesis.

A systematic review of literature on occupational health and safety interventions for older workers

As the global population ages there is an imperative to enhance labour participation of older workers in ways that support good physical and psychological health. However, there is limited guidance for organisations on how to do this effectively. This systematic review examined literature identified through four databases and a targeted web-search, yielding 39 PRISMA records (32 scholarly, seven grey literature) reporting workplace interventions aimed at improving the injury outcomes of older workers. The review revealed that organisational and composite interventions may be most effective, although an absence of robust research in this area and a scarcity of empirical evidence-based interventions known to improve injury outcomes for older workers was noted. Responding to these shortcomings, this article presents 'A future research agenda for older worker health, safety and well-being interventions.' This systems-based approach has a dual focus on organisational and composite interventions combined with robust research design.Practitioner summary: We conducted a systematic literature review of studies focussed on workplace interventions to improve the physical and psychological safety of older workers. Within the existing literature, evidence for effective interventions and guidance for organisations is weak. We present a future research agenda with a systems approach to address these gaps.

A systems model for the design of occupational health and safety management systems inclusive of work-from-home arrangements

The study addressed an important knowledge gap in the literature by co-designing a model for OHS management systems inclusive of workers who work-from-home, with a focus on psychosocial risks. This qualitative research study utilised a series of co-design focus groups involving Australian regulators, health and safety managers and practitioners, senior managers, middle managers and workers who work-from-home, to better understand the types of measures that organisations can apply to improve their health and safety management systems. Using a systems approach, consideration was given to the organisation of the remote working system, the home-work interface for remote workers, the competencies of managers and employees in regard to their occupation health and safety (OHS) responsibilities, and the complexity of identifying, reporting and monitoring psychosocial hazards for employees working from home. The study identified a need for tools designed to support both managers and workers in promoting psychologically safe working from home.

Evaluating the Implementation of a Mental Health Referral Service "Connect to Wellbeing": A Quality Improvement Approach

There is increasing demand for mental health services to be accessible to diverse populations in flexible, yet, cost-effective ways. This article presents the findings from a study that evaluated the process of implementing Connect to Wellbeing (CTW), a new mental health intake, assessment and referral service in regional Australia, to determine how well it improved access to services, and to identify potential measures that could be used to evaluate value for money. The study used a hybrid study design to conduct a process evaluation to better understand: the process of implementing CTW; and the barriers and factors enabling implementation of CTW. In addition, to better understand how to measure the cost-effectiveness of such services, the hybrid study design included an assessment of potential outcome measures suitable for ascertaining both the effectiveness of CTW in client health outcomes, and conducting a value for money analysis. The process evaluation found evidence that by improving processes, and removing waitlists CTW had created an opportunity to broadened the scope and type of psychological services offered which improved accessibility. The assessment of potential outcome measures provided insight into suitable measures for future evaluation into service effectiveness, client health outcomes and value for money.

CQI approaches for evaluating management development programs: A case study with health service managers from geographically remote settings

Health systems are known for being complex. Yet, there is a paucity of evidence about programs that successfully develop competent frontline managers to navigate these complex systems. There is even less evidence about developing frontline managers in areas of contextual complexity such as geographically remote and isolated health services. This study used a customised management development program containing continuous quality improvement (CQI) approaches to determine whether additional levels of evaluation could provide evidence for program impact. Generalisability is limited by the small sample size; however, the findings suggest that continuous improvement approaches, such as action learning workplace-based CQI projects not only provide for real-world application of the manager's learning; they can potentially produce the type of data needed to conduct evaluations for organisational impact and cost-benefits. The case study contributes to the literature in an area where there is a scarcity of empirical research. Further, this study proposes a pragmatic method for using CQI approaches with existing management development programs to generate the type of data needed for multi-level evaluation.

Assessing research impact: Australian Research Council criteria and the case of Family Wellbeing research

Researchers worldwide are increasingly reporting the societal impact of their research as part of national research productivity assessments. However, the challenges they encounter in developing their impact case studies against specified government assessment criteria and how pitfalls can be mitigated are not reported. This paper examines the key steps taken to develop an Aboriginal Family Wellbeing (FWB) empowerment research impact case study in the context of an Australian Research Council (ARC) pilot research impact assessment exercise and the challenges involved in applying the ARC criteria. The requirement that researchers demonstrate how their institutions support them to conduct impactful research has the potential to create supportive environments for researchers to be more responsive to the needs of users outside academia. However, the 15-year reference period for the associated research underpinning the reported impact and the focus on researcher's current institutional affiliation constitute potential constraints to demonstrating the true impact of research. For researchers working with Indigenous people, relationships that build over long periods of time, irrespective of university affiliation, are critical to conducting impactful research. A more open-ended time-frame, with no institutional restrictions for the 'associated research' provides the best opportunity to demonstrate the true benefits of research not only for Indigenous people but for Australian society more broadly.

The evidence needed to demonstrate impact: A synthesis of the evidence from a phased social and emotional wellbeing intervention

Policy decisions are based on evidence that demonstrates the effectiveness of interventions; however, the quantity and type of evidence that is needed to demonstrate the effectiveness of an intervention is not universally agreed upon. The aim of this study was to collaborate with researchers who have not been involved directly in Family Wellbeing interventions to lead a review of characteristics of the Family Wellbeing intervention evaluation output to date, and to assess for evidence of the FWB intervention's impact on participants and their communities. The study found that where it is not appropriate or viable to conduct research, such as randomised control trials, alternative ways of providing evidence to demonstrate the effectiveness of an intervention is vital. This review suggests that Family Wellbeing interventions are having a positive impact and promoting change in the lives of participants, their families and their communities. Hence, for complex interventions, such as those with Indigenous populations, evidence should demonstrate effectiveness against prescribed outcomes, as well as critical aspects behind how and why a complex intervention was successful.

Beasts of burden or organised cooperation: the story of a mental health team in remote, Indigenous Australia

OBJECTIVE

This paper aims to describe the growth of a regionally-based mental health team providing services to remote Indigenous communities in far north Queensland.

CONCLUSIONS

By drawing on their experience, the authors are able to identify factors supporting the development and sustained capacity of integrated mental health teams, working in challenging remote settings.

Psychosis and its correlates in a remote indigenous population

OBJECTIVES

The aim of this study was to describe prevalence and characteristics of psychotic disorders in a remote Indigenous population.

METHOD

Clinical review of all patients with an active diagnosis of a psychotic disorder in remote communities of Cape York and the Torres Strait.

RESULTS

170 patients were identified and demographic, social and treatment variables described.

CONCLUSIONS

Psychotic disorders are common and more so among young adult Aboriginal men, with high rates of comorbid conditions including substance use, intellectual impairment and diabetes. In parallel to this case complexity, there are high rates of coercive treatments. Certain differences by ethnicity and location are described and possible explanations proposed.