1
|
Hutchinson P, Ostini R. Southern Queensland general practitioners' knowledge and attitudes towards Q fever and behaviours in the management of the disease. Aust J Gen Pract 2024; 53:321-325. [PMID: 38697066 DOI: 10.31128/ajgp-10-22-6598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
BACKGROUND AND OBJECTIVES Q fever (QF) is a zoonotic disease caused by Coxiella burnetii, often associated with abattoir workers and farmers. Recent analysis suggests that QF might occur more frequently in urban areas. This study ascertains the knowledge of, and attitudes towards, QF and behaviours in the management of QF among general practitioners (GPs) across rural and urban areas. METHOD This cross-sectional survey study targeted GPs working in regional Queensland. GPs were asked to complete a 59-item questionnaire. Logistic regression was used to compare respondent demographics with attitude ratings and knowledge scores. RESULTS Diagnosing a patient with QF was significantly related to practitioner age, years in practice and practising in a rural area. DISCUSSION This study shows gaps in GP QF knowledge, particularly around QF management. With increased urbanisation of rural areas potentially leading to increases in acute QF cases, GPs need to improve their knowledge of this disease.
Collapse
Affiliation(s)
- Penny Hutchinson
- BMed, FRACGP, MPH@TM, FAFPHM, FNZCPHM, Darling Downs Hospital and Health Service, Toowoomba, Qld
| | - Remo Ostini
- BA, GradDipPsych, PhD, Senior Research Fellow, Rural Clinical School Research Centre, The University of Queensland, Qld
| |
Collapse
|
2
|
Sturman N, Ostini R, Choy M, Cyphers G. Digital health access, uptake, literacy and trust in people with experience of homelessness. Aust J Gen Pract 2024; 53:220-226. [PMID: 38575543 DOI: 10.31128/ajgp-2-23-6716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
BACKGROUND AND OBJECTIVES Although digital health promises improved healthcare efficiency and equity, access and uptake might be low in disadvantaged populations. We measured access to digital health technology, the uptake of digital health, digital health literacy and COVID-19 vaccination intentions in an inner-city Australian population experiencing homelessness. METHOD An existing Australian survey, including a validated digital health literacy measure (eHealth Literacy Scale [eHEALS]), was modified and distributed in three general practices specifically targeting the homeless population. Data analysis used appropriate descriptive statistics and correlation coefficients. RESULTS Eighty-three respondents completed the survey in 2021. Digital health uptake was much lower than in the general Australian population in 2019-20, despite good access to working smart phones and connectivity. Digital health literacy was positively associated with uptake. Internet-sourced information was trusted less than information from a general practitioner. DISCUSSION Further work is needed to understand the perceived usefulness and sociocultural compatibility of digital health in different subpopulations experiencing homelessness, including susceptibility to misinformation.
Collapse
Affiliation(s)
- Nancy Sturman
- BA, MBChB, FRACGP, PhD,@Associate Professor, General Practice Clinical Unit,@The University of Queensland, Brisbane, Qld
| | - Remo Ostini
- BA, GradDipPsych, PhD, Senior Research Fellow, Rural Clinical School Research Centre, The University of Queensland, Qld
| | - Melinda Choy
- MBBS, FRACGP, Senior Lecturer, Academic Unit of General Practice, Australian National University, Canberra, ACT
| | | |
Collapse
|
3
|
Hegerty C, Ostini R. Benefits and harms associated with an increase in gestational diabetes diagnosis in Queensland, Australia: a retrospective cohort comparison of diagnosis rates, outcomes, interventions and medication use for two periods, 2011-2013 and 2016-2018, using a large perinatal database. BMJ Open 2023; 13:e069849. [PMID: 37192791 DOI: 10.1136/bmjopen-2022-069849] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Abstract
OBJECTIVES To assess benefits and harms arising from increasing gestational diabetes (GDM) diagnosis, including for women with normal-sized babies. DESIGN, SETTING AND PARTICIPANTS Diagnosis rates, outcomes, interventions and medication use are compared in a retrospective cohort study of 229 757 women birthing in public hospitals of the Australian State of Queensland during two periods, 2011-2013 and 2016-2018, using data from the Queensland Perinatal Data Collection. OUTCOME MEASURES Comparisons include hypertensive disorders, caesarean section, shoulder dystocia and associated harm, induction of labour (IOL), planned birth (PB), early planned birth <39 weeks (EPB), spontaneous labour onset with vaginal birth (SLVB) and medication use. RESULTS GDM diagnosis increased from 7.8% to 14.3%. There was no improvement in shoulder dystocia associated injuries, hypertensive disorders or caesarean sections. There was an increase in IOL (21.8%-30.0%; p<0.001), PB (36.3% to 46.0%; p<0.001) and EPB (13.5%-20.6%; p<0.001), and a decrease in SLVB (56.0%-47.3%; p<0.001). Women with GDM experienced an increase in IOL (40.9%-49.8%; p<0.001), PB (62.9% to 71.8%; p<0.001) and EPB (35.3%-45.7%; p<0.001), and a decrease in SLVB (30.01%-23.6%; p<0.001), with similar changes for mothers with normal-sized babies. Of women prescribed insulin in 2016-2018, 60.4% experienced IOL, 88.5% PB, 76.4% EPB and 8.0% SLVB. Medication use increased from 41.2% to 49.4% in women with GDM, from 3.2% to 7.1% in the antenatal population overall, from 3.3% to 7.5% in women with normal-sized babies and from 2.21% to 4.38% with babies less than the 10th percentile. CONCLUSION Outcomes were not apparently improved with increased GDM diagnosis. The merits of increased IOL or decreased SLVB depend on the views of individual women, but categorising more pregnancies as abnormal, and exposing more babies to the potential effects of early birth, medication effects and growth limitation may be harmful.
Collapse
Affiliation(s)
- Christopher Hegerty
- Warwick Hospital, Queensland Health, Warwick, Queensland, Australia
- General Rural Medicine, Queensland Government Department of Health and Ageing, Warwick, Queensland, Australia
| | - Remo Ostini
- Rural Clinical School Research Centre, University of Queensland School of Medicine, Toowoomba, Queensland, Australia
| |
Collapse
|
4
|
Martin P, McGrail M, Fox J, Ostini R, Doyle Z, Playford D, Beattie J, Isaac V, Fuller L, Allen P, Kondalsamy-Chennakesavan S. Impact of the COVID-19 pandemic on student experiences during rural placements in Australia: findings from a national multi-centre survey. BMC Med Educ 2022; 22:852. [PMID: 36482397 PMCID: PMC9733068 DOI: 10.1186/s12909-022-03927-1] [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] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The aim of this national study was to explore the learning experiences of Australia's medical students who trained rurally during the COVID-19 pandemic in 2020. METHODS A cross-sectional, national multi-centre survey was conducted in 2020, through the Federation of Rural Australian Medical Educators (FRAME). Participants were medical students who had completed an extended Rural Clinical School (RCS) training placement (≥ 12 months). A bespoke set of COVID-19 impact questions were incorporated into the annual FRAME survey, to capture COVID-19-related student experiences in 2020. Pre-pandemic (2019 FRAME survey data) comparisons were also explored. RESULTS FRAME survey data were obtained from 464 students in 2020 (51.7% response rate), compared with available data from 668 students in 2019 (75.6% response rate). Most students expressed concern regarding the pandemic's impact on the quality of their learning (80%) or missed clinical learning (58%); however, students reported being well-supported by the various learning and support strategies implemented by the RCSs across Australia. Notably, comparisons to pre-pandemic (2019) participants of the general RCS experience found higher levels of student support (strongly agree 58.9% vs 42.4%, p < 0.001) and wellbeing (strongly agree 49.6% vs 42.4%, p = 0.008) amongst the 2020 participants. Students with more than one year of RCS experience compared to one RCS year felt better supported with clinical skills learning opportunities (p = 0.015) and less affected by COVID-19 in their exam performance (p = 0.009). CONCLUSIONS This study has provided evidence of both the level of concern relating to learning quality as well as the positive impact of the various learning and support strategies implemented by the RCSs during the pandemic in 2020. RCSs should further evaluate the strategies implemented to identify those that are worth sustaining into the post-pandemic period.
Collapse
Affiliation(s)
- Priya Martin
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Locked Bag 9009, Toowoomba, QLD, 4350, Australia.
| | - Matthew McGrail
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Locked Bag 9009, Toowoomba, QLD, 4350, Australia
| | - Jordan Fox
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Locked Bag 9009, Toowoomba, QLD, 4350, Australia
| | - Remo Ostini
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Locked Bag 9009, Toowoomba, QLD, 4350, Australia
| | - Zelda Doyle
- Rural Clinical School, School of Medicine, University of Notre Dame, Sydney, Australia
| | - Denese Playford
- Rural Clinical School of Western Australia, Medical Schools of UWA and Notre Dame, The University of Western Australia, Perth, Australia
| | - Jessica Beattie
- Rural Community Clinical School, School of Medicine, Deakin University, Geelong, Australia
| | - Vivian Isaac
- College of Medicine and Public Health, Rural and Remote Health SA, Flinders University, Adelaide, Australia
| | - Lara Fuller
- Rural Community Clinical School, School of Medicine, Deakin University, Geelong, Australia
| | - Penny Allen
- Rural Clinical School, College of Health and Medicine, The University of Tasmania, Hobart, Australia
| | | |
Collapse
|
5
|
Ostini R, McGrail MR, Kondalsamy-Chennakesavan S, Hill P, O'Sullivan B, Selvey LA, Eley DS, Adegbija O, Boyle FM, Dettrick Z, Jennaway M, Strasser S. Building a sustainable rural physician workforce. Med J Aust 2021; 215 Suppl 1:S5-S33. [PMID: 34218436 DOI: 10.5694/mja2.51122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 11/17/2022]
Abstract
CHAPTER 1: CHARACTERISING AUSTRALIA'S RURAL SPECIALIST PHYSICIAN WORKFORCE: THE PROFESSIONAL PROFILE AND PROFESSIONAL SATISFACTION OF JUNIOR DOCTORS AND CONSULTANTS: Objective: To assess differences in the demographic characteristics, professional profile and professional satisfaction of rural and metropolitan junior physicians and physician consultants in Australia. DESIGN, SETTING AND PARTICIPANTS Cross-sectional, population level national survey of the Medicine in Australia: Balancing Employment and Life longitudinal cohort study (collected 2008-2016). Participants were specialist physicians from four career stage groups: pre-registrars (physician intent); registrars; new consultants (< 5 years since Fellowship); and consultants. MAIN OUTCOME MEASURES Level of professional satisfaction across various job aspects, such as hours worked, working conditions, support networks and educational opportunities, comparing rural and metropolitan based physicians. RESULTS Participants included 1587 pre-registrars (15% rural), 1745 physician registrars (9% rural), 421 new consultants (20% rural) and 1143 consultants (13% rural). Rural physicians of all career stages demonstrated equivalent professional satisfaction across most job aspects, compared with metropolitan physician counterparts. Some examples of differences in satisfaction included rural pre-registrars being less likely to agree they had good access to support and supervision from qualified consultants (odds ratio [OR], 0.6; 95% CI, 0.3-0.9) and rural consultants being more likely to agree they had a poorer professional support network (OR, 1.9; 95% CI, 1.2-2.9). In terms of demographics, relatively more rural physicians had a rural background or were trained overseas. Although most junior physicians were women, female consultants were less likely to be working in a rural location (OR, 0.6; 95% CI, 0.4-0.8). CONCLUSION Junior physicians in metropolitan or rural settings have a similar professional experience, which is important in attracting future trainees. Increased opportunities for rural training should be prioritised, along with addressing concerns about the professional isolation and poorer support network of those in rural areas, not only among junior doctors but also consultants. Finally, making rural practice more attractive to female junior physicians could greatly improve the consultant physician distribution. CHAPTER 2: GENERAL PHYSICIANS AND PAEDIATRICIANS IN RURAL AUSTRALIA: THE SOCIAL CONSTRUCTION OF PROFESSIONAL IDENTITY: Objective: To explore the construction of professional identity among general physicians and paediatricians working in non-metropolitan areas. DESIGN, SETTING AND PARTICIPANTS In-depth qualitative interviews were conducted with general physicians and paediatricians, plus informants from specialist colleges, government agencies and academia who were involved in policy and programs for the training and recruitment of specialists in rural locations across three states and two territories. This research is part of the Training Pathways and Professional Support for Building a Rural Physician Workforce Study, 2018-19. MAIN OUTCOME MEASURES Individual and collective descriptors of professional identity. RESULTS We interviewed 36 key informants. Professional identity for general physicians and paediatricians working in regional, rural and remote Australia is grounded in the breadth of their training, but qualified by location - geographic location, population served or specific location, where social and cultural context specifically shapes practice. General physicians and paediatricians were deeply engaged with their local community and its economic vulnerability, and they described the population size and dynamics of local economies as determinants of viable practice. They often complemented their practice with formal or informal training in areas of special interest, but balanced their practice against subspecialist availability, also dependent on demographics. While valuing their professional roles, they showed limited inclination for industrial organisation. CONCLUSION Despite limited consensus on identity descriptors, rural general physicians and paediatricians highly value generalism and their rural engagement. The structural and geographic bias that preferences urban areas will need to be addressed to further develop coordinated strategies for advanced training in rural contexts, for which collective identity is integral. CHAPTER 3: SUSTAINABLE RURAL PHYSICIAN TRAINING: LEADERSHIP IN A FRAGILE ENVIRONMENT: Objectives: To understand Royal Australasian College of Physicians (RACP) training contexts, including supervisor and trainee perspectives, and to identify contributors to the sustainability of training sites, including training quality. DESIGN, SETTING AND PARTICIPANTS A cross-sectional mixed-methods design was used. A national sample of RACP trainees and Fellows completed online surveys. Survey respondents who indicated willingness to participate in interviews were purposively recruited to cover perspectives from a range of geographic, demographic and training context parameters. MAIN OUTCOME MEASURES Fellows' and trainees' work and life satisfaction, and their experiences of supervision and training, respectively, by geographic location. RESULTS Fellows and trainees reported high levels of satisfaction, with one exception - inner regional Fellows reported lower satisfaction regarding opportunities to use their abilities. Not having a good support network was associated with lower satisfaction. Our qualitative findings indicate that a culture of undermining rural practice is prevalent and that good leadership at all levels is important to reduce negative impacts on supervisor and trainee availability, site accreditation and viability. Trainees described challenges in navigating training pathways, ensuring career development, and having the flexibility to meet family needs. The small number of Fellows in some sites poses challenges for supervisors and trainees and results in a blurring of roles; accreditation is an obstacle to provision of training at rural sites; and the overlap between service and training roles can be difficult for supervisors. CONCLUSION Our qualitative findings emphasise the distinctive nature of regional specialist training, which can make it a fragile environment. Leadership at all levels is critical to sustaining accreditation and support for supervisors and trainees. CHAPTER 4: PRINCIPLES TO GUIDE TRAINING AND PROFESSIONAL SUPPORT FOR A SUSTAINABLE RURAL SPECIALIST PHYSICIAN WORKFORCE: Objective: To draw on research conducted in the Building a Rural Physician Workforce project, the first national study on rural specialist physicians, to define a set of principles applicable to guiding training and professional support action. DESIGN We used elements of the Delphi approach for systematic data collection and codesign, and applied a hybrid participatory action planning approach to achieve consensus on a set of principles. RESULTS Eight interconnected foundational principles built around rural regions and rural people were identified: FP1, grow your own "connected to" place; FP2, select trainees invested in rural practice; FP3, ground training in community need; FP4, rural immersion - not exposure; FP5, optimise and invest in general medicine; FP6, include service and academic learning components; FP7, join up the steps in rural training; and FP8, plan sustainable specialist roles. CONCLUSION These eight principles can guide training and professional support to build a sustainable rural physician workforce. Application of the principles, and coordinated action by stakeholders and the responsible organisations, are needed at national, state and local levels to achieve a sustainable rural physician workforce.
Collapse
|
6
|
Aljassim N, Ostini R. Health literacy in rural and urban populations: A systematic review. Patient Educ Couns 2020; 103:2142-2154. [PMID: 32601042 DOI: 10.1016/j.pec.2020.06.007] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/09/2020] [Accepted: 06/05/2020] [Indexed: 05/25/2023]
Abstract
OBJECTIVE This review assessed whether health literacy differences exist between rural and urban populations and whether rurality is a determinant. METHODS Eight online databases were searched using the keywords "health literacy", "rural" and "urban", and related terms. Peer-reviewed original research comparing health literacy levels between rural and urban populations were evaluated for strength of evidence. A narrative synthesis summarised the results of included studies. RESULTS Nineteen articles met inclusion criteria and were of sufficient methodological quality for data extraction. The majority of studies found that urban populations had higher health literacy than rural populations. Differences were more likely to be found in developing than developed countries. Studies that performed covariate analysis indicated that rurality may not be a significant determinant of health literacy. CONCLUSION Evidence suggests that rurality alone does not explain rural-urban health literacy differences and that sociodemographic factors play important roles. PRACTICE IMPLICATIONS These findings could be used to help inform the development of evidence-based interventions specifically for rural populations, at both health policy and clinical levels; for example, by tackling healthcare access challenges. The findings also provide a lens through which to consider efforts to reduce rural-urban health outcome disparities.
Collapse
Affiliation(s)
- Noor Aljassim
- Rural Clinical School, University of Queensland, Locked bag 9009, Toowoomba DC., QLD, 4350 Australia.
| | - Remo Ostini
- Rural Clinical School, University of Queensland, Locked bag 9009, Toowoomba DC., QLD, 4350 Australia.
| |
Collapse
|
7
|
Ogden J, Preston S, Partanen RL, Ostini R, Coxeter P. Recruiting and retaining general practitioners in rural practice: systematic review and meta-analysis of rural pipeline effects. Med J Aust 2020; 213:228-236. [PMID: 32696519 DOI: 10.5694/mja2.50697] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [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: 02/12/2019] [Accepted: 03/24/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To synthesise quantitative data on the effects of rural background and experience in rural areas during medical training on the likelihood of general practitioners practising and remaining in rural areas. STUDY DESIGN Systematic review and meta-analysis of the effects of rural pipeline factors (rural background; rural clinical and education experience during undergraduate and postgraduate/vocational training) on likelihood of later general practice in rural areas. DATA SOURCES MEDLINE (Ovid), EMBASE, Informit Health Collection, and ERIC electronic database records published to September 2018; bibliographies of retrieved articles; grey literature. DATA SYNTHESIS Of 6709 publications identified by our search, 27 observational studies were eligible for inclusion in our systematic review; when appropriate, data were pooled in random effects models for meta-analysis. Study quality, assessed with the Newcastle-Ottawa scale, was very good or good for 24 studies, satisfactory for two, and unsatisfactory for one. Meta-analysis indicated that GPs practising in rural communities was significantly associated with having a rural background (odds ratio [OR], 2.71; 95% CI, 2.12-3.46; ten studies) and with rural clinical experience during undergraduate (OR, 1.75; 95% CI, 1.48-2.08; five studies) and postgraduate training (OR, 4.57; 95% CI, 2.80-7.46; eight studies). CONCLUSION GPs with rural backgrounds or rural experience during undergraduate or postgraduate medical training are more likely to practise in rural areas. The effects of multiple rural pipeline factors may be cumulative, and the duration of an experience influences the likelihood of a GP commencing and remaining in rural general practice. These findings could inform government-led initiatives to support an adequate rural GP workforce. PROTOCOL REGISTRATION PROSPERO, CRD42017074943 (updated 1 February 2018).
Collapse
Affiliation(s)
| | | | | | - Remo Ostini
- Rural Clinical School, University of Queensland, Toowoomba, QLD
| | | |
Collapse
|
8
|
Abstract
Background There exists little literature on situational health literacy - that is, how an individual’s health literacy varies across different health literacy environments. However, one can consider the role of stress when examining the relationship between health situations and decision-making ability, and by proxy health literacy. The aim of this study was to assess the strength of the evidence on the relationship between health situations and patient stress, considered in the context of health professional perception, and determine what health situations act to influence patient stress. Methods A systematic review of English articles using PubMed, PsycINFO, CINAHL and Embase databases was conducted. Search terms focused on ‘patient’, ‘stress’, and ‘health care situations’. Only peer-reviewed original research with data on patient stress in the context of a health facility environment was included. Studies were screened and critically appraised by both authors. Study elements for extraction were defined by RO and extracted by JY. Results Twenty-four studies were included for narrative synthesis. Patients in Intensive Care Units were more stressed about factors relating to their physical discomfort, with some agreement from health care professionals. Parents of children in Intensive Care Units were more concerned with stressors relating to their child’s appearance and behaviour, and alteration in their parental role. Few studies examined health settings other than Intensive Care Units, and those that did varied greatly in terms of study design and population characteristics, lacking generalisability. Conclusions Overall, the findings of what patients find most stressful in Intensive Care Units can guide health care professionals practicing best practice care. However, the evidence on how patient stress is influenced by non-Intensive Care Unit health care settings is weak. Further research is needed to enhance current understanding of the interaction between patient stress and health care environments in both hospital and primary care settings.
Collapse
Affiliation(s)
- John Yeh
- Faculty of Medicine, The University of Queensland, Herston, Queensland, 4006, Australia.
| | - Remo Ostini
- Faculty of Medicine, The University of Queensland, Herston, Queensland, 4006, Australia
| |
Collapse
|
9
|
Sturman N, Williams R, Ostini R, Wyder M, Siskind D. 'A really good GP': Engagement and satisfaction with general practice care of people with severe and persistent mental illness. Aust J Gen Pract 2020; 49:61-65. [PMID: 32008274 DOI: 10.31128/ajgp-02-19-4854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVES People with severe and persistent mental illness have increased psychosocial and physical morbidity. This study sought to understand patient engagement and satisfaction with general practice. METHOD A survey study of people attending community mental health clinics included Likert scale items about general practice engagement, satisfaction, access enablers and attendance challenges. RESULTS Of 82 respondents, 85% had a regular general practitioner (GP), and 99% had visited a GP at least once in the past 12 months (32% had visited a GP >10 times). Eighty-eight per cent of respondents were satisfied with their current GP's care. Significantly more respondents were satisfied with the GP's focus on their physical than their mental health concerns (95% versus 76% respectively, P <0.05). Bulk billing, timely appointments and proximity were enablers of attendance for most respondents. The majority of participants disagreed that making, keeping or waiting for GP appointments was difficult. DISCUSSION Closer collaboration with treating psychiatrists and case managers may increase GP engagement with patients' mental healthcare.
Collapse
Affiliation(s)
- Nancy Sturman
- MBChB, FRACGP, BA (Hons), Associate Professor, Primary Care Clinical Unit, School of Clinical Medicine, The University of Queensland, Qld
| | - Ryan Williams
- MBBS, FRACGP, BA, BEd, General Practitioner, Stonewall Medical Centre, The University of Queensland, Qld
| | - Remo Ostini
- BA, GradDipPsych, PhD, Senior Research Fellow, Rural Clinical School Research Centre, The University of Queensland, Qld
| | - Marianne Wyder
- BA, PhD, Senior Research Fellow, Addiction and Mental Health Services, Metro South Health, Qld; Research Fellow, Hopkins Centre, Griffith University, Qld
| | - Dan Siskind
- MBBS, MPH, PhD, FRANZCP, Associate Professor, Faculty of Medicine, The University of Queensland, Qld; Clinical Academic Psychiatrist, Metro South Addiction and Mental Health Services, Qld
| |
Collapse
|
10
|
Bellamy K, Dowse R, Ostini R, Martini N, Kairuz T. Preferences of Resettled Refugees on Pictograms Describing Common Symptoms of Illness. J Immigr Minor Health 2020; 22:216-219. [DOI: 10.1007/s10903-019-00908-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
11
|
Bellamy K, Ostini R, Martini N, Kairuz T. Insights from the coalface: barriers to accessing medicines and pharmacy services for resettled refugees from Africa. Aust J Prim Health 2019; 25:118-124. [PMID: 30721646 DOI: 10.1071/py18092] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 12/03/2018] [Indexed: 11/23/2022]
Abstract
Resettled refugees in Australia have been shown to exhibit a high prevalence of limited health literacy and are at greater risk of mismanaging their medication and not being able to access the healthcare services they need. The aim of the current study is to explore the barriers to accessing medicines and pharmacy services in Queensland, Australia, among resettled refugees from Africa; this research was conducted from the perspectives of healthcare professionals and people who help the refugees to resettle in their adopted country (resettlement workers). A 'generic qualitative' approach was used in this study. In-depth interviews were conducted among healthcare professionals (two GPs, nine pharmacists and three nurse practitioners) and resettlement workers. Participants were recruited via a purposive snowball sampling method in the cities of Brisbane and Townsville, Queensland, Australia. Twenty-four in-depth interviews were conducted; 14 with healthcare professionals. Three key themes emerged from the data: (1) Communication Barriers; (2) Navigating the Health System; and (3) Belief Systems and Culture. Perceptions of those 'at the coalface' - healthcare professionals and people who are responsible for assisting refugees to resettle in Australia - provide insight into the language and cultural challenges experienced by resettled refugees from Africa regarding access to the Australian health system, including medicines and pharmacy services.
Collapse
Affiliation(s)
- Kim Bellamy
- School of Pharmacy, The University of Queensland, 20 Cornwall Street, Woolloongabba, Qld 4102, Australia; and Corresponding author.
| | - Remo Ostini
- Rural Clinical School, The University of Queensland, Toowoomba, Qld 4350, Australia
| | - Nataly Martini
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Grafton, Auckland 1023, New Zealand
| | - Therese Kairuz
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, NSW 2308, Australia
| |
Collapse
|
12
|
Abstract
Ethical sensitivity has been identified as one of the four necessary components of moral action, yet little has been done to assess ethical sensitivity to animal issues in animal-related professions. The aim of this study was to develop assessment tools to measure and enhance ethical sensitivity to animal issues, and determine relationships between ethical sensitivity and moral reasoning. Of a cohort of 115 third-year veterinary students from the University of Queensland, Australia, 104 students gave permission to use their responses to written ethical sensitivity and moral judgment tests, and 51 to use their video role-plays to demonstrate ethical sensitivity to current animal farming issues. Inter-rater reliability of scoring by an expert panel was moderate to substantial for the written assessment, but only slight to moderate for the video response. In the written test, students' mean scores for recognition of animals' emotions, expression of empathy and recognition of alternative actions and their impacts improved after teaching. Scores did not increase for identification of their own emotions, moral conflicts between stakeholders, and conflicts between legal, organizational and ethical responsibilities as a professional. There was no overall relationship between ethical sensitivity and moral reasoning scores. However, high scores for reasoning using universal principles were correlated with high scores for recognition of moral conflicts between stakeholders and between legal, organizational, and ethical responsibilities as a professional. Further development of these ethical sensitivity assessment tools is encouraged to enable veterinary and animal science students to raise and address animal ethics issues and alleviate moral distress.
Collapse
|
13
|
Wild MG, Ostini R, Harrington M, Cavanaugh KL, Wallston KA. Validation of the shortened Perceived Medical Condition Self-Management Scale in patients with chronic disease. Psychol Assess 2018; 30:1300-1307. [PMID: 29781666 PMCID: PMC6172142 DOI: 10.1037/pas0000572] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Self-efficacy, or perceived competence, has been identified as an important factor in self-management behaviors and health outcomes in patients with chronic disease. Measures of self-management self-efficacy are currently available for multiple forms of chronic disease. One established measure is the 8-item Perceived Medical Condition Self-Management Scale (PMCSMS). This study investigated the use of the PMCSMS in samples of patients with a chronic disease to develop an abbreviated version of the scale that could be more readily used in clinical contexts or in large population health cohort studies. The PMCSMS was administered as either a generic scale or as a disease-specific scale. The results of analyses using item response theory and classical test theory methods indicated that using 4 items of the scale resulted in similar internal consistency (α = .70-0.90) and temporal stability (test-retest r = .75 after 2 to 4 weeks) to the 8-item PMCSMS (r = .81 after 2 to 4 weeks). The 4 items selected had the greatest discriminability among participants (α parameters = 2.49-3.47). Scores from both versions also demonstrated similar correlations with related constructs such as health literacy (r = .13-0.29 vs. 0.14-0.27), self-rated health (r = .17-0.48 vs. 0.26-0.50), social support (r = .21-0.32 vs. 0.25-0.34), and medication adherence (r = .20-0.24 vs. 0.20-0.25). The results of this study indicate that 4-item PMCSMS scores are equally valid but more efficient, and have the potential to be beneficial for both research and clinical applications. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
Collapse
Affiliation(s)
| | - Remo Ostini
- Rural Clinical School Research Centre, The University of Queensland
| | | | | | | |
Collapse
|
14
|
Nasir B, Jurd K, Cook S, Kwan M, Ostini R. Developing an Internship Preparedness Program for Final Year Medical Students. MedEdPublish (2016) 2018; 7:219. [PMID: 38074611 PMCID: PMC10704419 DOI: 10.15694/mep.2018.0000219.1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Abstract
This article was migrated. The article was marked as recommended. Introduction: Medical students undertake extensive training yet often feel they lack the practical non-medical skills required for successful transition to internship. While research provides evidence for student perceptions and experiences regarding internship, there is little information regarding how students can be 'taught' work-readiness through learning non-medical skills. Methods: By reducing cognitive load when structured using a flipped classroom method, active learning resources may provide an effective approach to prepare medical students to be work-ready interns. Using a blended instructional method, the University of Queensland's Rural Clinical School (UQRCS) integrated face-to-face and online learning, to develop an Intern Preparedness program. Discussion: The Intern Preparedness program promotes student interaction in a range of active learning tasks to improve learning and engagement in a difficult and often neglected area of professional training. The program focused on providing knowledge and skills to increase competency in non-medical skills including time management on the ward, patient-focused prioritisation of tasks, and clinical conversations with the healthcare team. Conclusion: This program has become an integral part of the student learning experiences at the UQRCS as it continues to elevate student preparedness for internship. The program has become a fundamentally important aspect of improving cognitive skills such as critical thinking and reasoning, as well as soft skills, which are all essential for successful transitions to internship. A very high uptake and completion of program activities provided further incentive for program developers to continue its improvements over time.
Collapse
|
15
|
Sturman N, Ostini R. Medical student contact with specialty trainees: Missing out in general practice? Aust J Gen Pract 2018; 47:391-395. [PMID: 29966186 DOI: 10.31128/ajgp-12-17-4423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Medical students on clinical placements value positive experiences with specialty trainees. We aimed to document student contact with general practice registrars and other specialty registrars and any relationship between this contact and student career interests. METHOD Medical students were surveyed following their general practice, general medicine, general surgery, psychiatry and medicine-in-society placements. RESULTS One hundred and twenty-four students completed the survey (73% response rate). Participants reported substantially less contact with general practice registrars and rural generalist trainees than with other registrars. Compared with students placed in regional areas, metropolitan students were more likely to have no contact at all with general practice registrars. Interest in specialty careers was correlated with interest in knowing more about specialty training, but not with the extent of contact with registrars or personal connections in any specialty studied. DISCUSSION Student exposure to general practice registrars in at least one Australian medical school is relatively low. Opportunities to increase this should be explored. Students themselves may have little influence over their contact with specialty trainees, despite valuing it highly.
Collapse
Affiliation(s)
- Nancy Sturman
- MBChB, BA, FRACGP, Associate Professor of General Practice, Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Qld.
| | - Remo Ostini
- BA, GradDipPsy, PhD, Senior Research Fellow, Rural Clinical School, Faculty of Medicine, University of Queensland, Qld
| |
Collapse
|
16
|
Nasir BF, Toombs MR, Kondalsamy-Chennakesavan S, Kisely S, Gill NS, Black E, Hayman N, Ranmuthugala G, Beccaria G, Ostini R, Nicholson GC. Common mental disorders among Indigenous people living in regional, remote and metropolitan Australia: a cross-sectional study. BMJ Open 2018; 8:e020196. [PMID: 29961007 PMCID: PMC6042557 DOI: 10.1136/bmjopen-2017-020196] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 02/22/2018] [Accepted: 05/09/2018] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To determine, using face-to-face diagnostic interviews, the prevalence of common mental disorders (CMD) in a cohort of adult Indigenous Australians, the cultural acceptability of the interviews, the rates of comorbid CMD and concordance with psychiatrists' diagnoses. DESIGN Cross-sectional study July 2014-November 2016. Psychologists conducted Structured Clinical Interviews for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision Axis I Disorders (SCID-I) (n=544). Psychiatrists interviewed a subsample (n=78). SETTING Four Aboriginal Medical Services and the general community located in urban, regional and remote areas of Southern Queensland and two Aboriginal Reserves located in New South Wales. PARTICIPANTS Indigenous Australian adults. OUTCOME MEASURES Cultural acceptability of SCID-I interviews, standardised rates of CMD, comorbid CMD and concordance with psychiatrist diagnoses. RESULTS Participants reported that the SCID-I interviews were generally culturally acceptable. Standardised rates (95% CI) of current mood, anxiety, substance use and any mental disorder were 16.2% (12.2% to 20.2%), 29.2% (24.2% to 34.1%), 12.4% (8.8% to 16.1%) and 42.2% (38.8% to 47.7%), respectively-6.7-fold, 3.8-fold, 6.9-fold and 4.2-fold higher, respectively, than those of the Australian population. Differences between this Indigenous cohort and the Australian population were less marked for 12-month (2.4-fold) and lifetime prevalence (1.3-fold). Comorbid mental disorder was threefold to fourfold higher. In subgroups living on traditional lands in Indigenous reserves and in remote areas, the rate was half that of those living in mainstream communities. Moderate-to-good concordance with psychiatrist diagnoses was found. CONCLUSIONS The prevalence of current CMD in this Indigenous population is substantially higher than previous estimates. The lower relative rates of non-current disorders are consistent with underdiagnosis of previous events. The lower rates among Reserve and remote area residents point to the importance of Indigenous peoples' connection to their traditional lands and culture, and a potentially important protective factor. A larger study with random sampling is required to determine the population prevalence of CMD in Indigenous Australians.
Collapse
Affiliation(s)
- Bushra F Nasir
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Queensland, Australia
| | - Maree R Toombs
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Queensland, Australia
| | | | - Steve Kisely
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Queensland, Australia
| | - Neeraj S Gill
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Queensland, Australia
| | - Emma Black
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Queensland, Australia
| | - Noel Hayman
- Inala Indigenous Health Services, Inala, Queensland, Australia
| | - Geetha Ranmuthugala
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Queensland, Australia
| | - Gavin Beccaria
- Faculty of Psychology and Counselling, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Remo Ostini
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Queensland, Australia
| | - Geoffrey C Nicholson
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Queensland, Australia
| |
Collapse
|
17
|
Nickel B, Dodd RH, Turner RM, Waller J, Marlow L, Zimet G, Ostini R, McCaffery K. Factors associated with the human papillomavirus (HPV) vaccination across three countries following vaccination introduction. Prev Med Rep 2017; 8:169-176. [PMID: 29062681 PMCID: PMC5645176 DOI: 10.1016/j.pmedr.2017.10.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 10/03/2017] [Accepted: 10/06/2017] [Indexed: 11/25/2022] Open
Abstract
Direct international comparisons which aim to understand how factors associated with human papillomavirus (HPV) vaccine initiation and attitudes towards the HPV vaccination in parents differ are scarce. Parents (n = 179) of daughters aged 9-17 years in the US, UK and Australia completed an online survey in 2011 with questions measuring daughters' HPV vaccination status, HPV knowledge, HPV vaccination knowledge, and statements assessing attitude towards the HPV vaccine. The strongest factor associated with vaccination status across all countries was parental HPV knowledge (p < 0.001). Parents with both very low and very high knowledge scores were less likely to have vaccinated their daughters. Parents with higher HPV vaccination knowledge scores intended to vaccinate their daughters (if not already vaccinated) for protective reasons (p < 0.001), while those whose daughters were already vaccinated understood that vaccination protection was not 100% and that their daughters may still be at risk of getting HPV (p < 0.05). Compared to the UK and Australia, a higher proportion of parents with unvaccinated daughters from the US were worried about the side-effects of the HPV vaccination (US: 60.5%, UK: 36.4%, AUS: 15.4%; p < 0.05), believed that getting the vaccination might be a hassle (US: 21.1%, UK: 0%, AUS: 7.7%; p < 0.05), and that the vaccine was too new (US: 44.7%, UK: 22.7%, AUS: 7.7%; p < 0.05). This study adds to the understanding of how parents may influence vaccination uptake by demonstrating the effect of knowledge and the parental attitudes towards HPV vaccination across three countries.
Collapse
Affiliation(s)
- Brooke Nickel
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, New South Wales, 2006, Australia
| | - Rachael H. Dodd
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Behavioural Science and Health, Cancer Research UK Health Behaviour Research Centre, UCL, London, UK
| | - Robin M. Turner
- School of Public Health and Community Medicine, University of New South Wales, New South Wales, Australia
| | - Jo Waller
- Department of Behavioural Science and Health, Cancer Research UK Health Behaviour Research Centre, UCL, London, UK
| | - Laura Marlow
- Department of Behavioural Science and Health, Cancer Research UK Health Behaviour Research Centre, UCL, London, UK
| | - Gregory Zimet
- Section of Adolescent Medicine, Indiana University School of Medicine, Health Information & Translational Sciences, Indianapolis, IN, USA
| | - Remo Ostini
- Rural Clinical School Research Centre, Faculty of Medicine, The University of Queensland, Toowoomba, Queensland, Australia
| | - Kirsten McCaffery
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, New South Wales, 2006, Australia
| |
Collapse
|
18
|
Sturman N, Ostini R, Wong WY, Zhang J, David M. "On the same page"? The effect of GP examiner feedback on differences in rating severity in clinical assessments: a pre/post intervention study. BMC Med Educ 2017; 17:101. [PMID: 28587597 PMCID: PMC5461633 DOI: 10.1186/s12909-017-0929-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 05/11/2017] [Indexed: 06/02/2023]
Abstract
BACKGROUND Robust and defensible clinical assessments attempt to minimise differences in student grades which are due to differences in examiner severity (stringency and leniency). Unfortunately there is little evidence to date that examiner training and feedback interventions are effective; "physician raters" have indeed been deemed "impervious to feedback". Our aim was to investigate the effectiveness of a general practitioner examiner feedback intervention, and explore examiner attitudes to this. METHODS Sixteen examiners were provided with a written summary of all examiner ratings in medical student clinical case examinations over the preceding 18 months, enabling them to identify their own rating data and compare it with other examiners. Examiner ratings and examiner severity self-estimates were analysed pre and post intervention, using non-parametric bootstrapping, multivariable linear regression, intra-class correlation and Spearman's correlation analyses. Examiners completed a survey exploring their perceptions of the usefulness and acceptability of the intervention, including what (if anything) examiners planned to do differently as a result of the feedback. RESULTS Examiner severity self-estimates were relatively poorly correlated with measured severity on the two clinical case examination types pre-intervention (0.29 and 0.67) and were less accurate post-intervention. No significant effect of the intervention was identified, when differences in case difficulty were controlled for, although there were fewer outlier examiners post-intervention. Drift in examiner severity over time prior to the intervention was observed. Participants rated the intervention as interesting and useful, and survey comments indicated that fairness, reassurance, and understanding examiner colleagues are important to examiners. CONCLUSIONS Despite our participants being receptive to our feedback and wanting to be "on the same page", we did not demonstrate effective use of the feedback to change their rating behaviours. Calibration of severity appears to be difficult for examiners, and further research into better ways of providing more effective feedback is indicated.
Collapse
Affiliation(s)
- Nancy Sturman
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Queensland Australia
- Royal Brisbane & Women’s Hospitals, Level 8, Health Sciences Building, Herston, QLD Australia
| | - Remo Ostini
- Rural Clinical School Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland Australia
| | - Wai Yee Wong
- Institute for Teaching and Learning Innovation, The University of Queensland, Brisbane, Queensland Australia
| | - Jianzhen Zhang
- Centre for Chronic Disease, Faculty of Medicine, The University of Queensland, Brisbane, Queensland Australia
| | - Michael David
- School of Public Health, The University of Queensland, Queensland, Australia
| |
Collapse
|
19
|
Hollingworth SA, Ostini R, David MC, Martin JH, Tett SE. Ezetimibe: Use, costs, and adverse events in Australia. Cardiovasc Ther 2016; 35:40-46. [DOI: 10.1111/1755-5922.12236] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/01/2016] [Accepted: 11/13/2016] [Indexed: 12/20/2022] Open
Affiliation(s)
| | - Remo Ostini
- School of Pharmacy; University of Queensland; Woolloongabba QLD Australia
| | - Michael C. David
- School of Public Health; University of Queensland; Herston QLD Australia
| | - Jennifer H. Martin
- School of Medicine and Public Health; University of Newcastle; Callahan NSW Australia
| | - Susan E. Tett
- School of Pharmacy; University of Queensland; Woolloongabba QLD Australia
| |
Collapse
|
20
|
Bellamy K, Ostini R, Martini N, Kairuz T. Perspectives of resettled African refugees on accessing medicines and pharmacy services in Queensland, Australia. International Journal of Pharmacy Practice 2016; 25:358-364. [DOI: 10.1111/ijpp.12324] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 09/26/2016] [Accepted: 09/27/2016] [Indexed: 11/27/2022]
Abstract
Abstract
Objectives
The aim of this study was to explore the barriers to accessing medicines and pharmacy services among refugees in Queensland, Australia, from the perspectives of resettled African refugees.
Methods
A generic qualitative approach was used in this study. Resettled African refugees were recruited via a purposive snowball sampling method. The researcher collected data from different African refugee communities, specifically those from Sudanese, Congolese and Somalian communities. Participants were invited by a community health leader to participate in the study; a community health leader is a trained member of the refugee community who acts as a ‘health information conduit’ between refugees and the health system. Invitations were done either face-to-face, telephonically or by email. The focus groups were digitally recorded in English and transcribed verbatim by the researcher. Transcripts were entered into NVIVO© 11 and the data were analysed using inductive thematic analysis.
Key findings
Four focus groups were conducted between October and November 2014 in the city of Brisbane with African refugees, one with five Somali refugees, one with five Congolese refugees, one with three refugee community health leaders from South Sudan, Liberia and Eritrea and one with three refugee community health leaders from Uganda, Burundi and South Sudan. Eleven sub-themes emerged through the coding process, which resulted in four overarching themes: health system differences, navigating the Australian health system, communication barriers and health care-seeking behaviour. With regard to accessing medicines and pharmacy services, this study has shown that there is a gap between resettled refugees’ expectations of health services and the reality of the Australian health system. Access barriers identified included language barriers, issues with the Translating and Interpreter Service, a lack of professional communication and cultural beliefs affecting health care-seeking behaviour.
Conclusions
This exploratory study has established a foundation for further research into the barriers to accessing medicines and pharmacy services for resettled refugees. The findings are likely to be applicable to a wider population.
Collapse
Affiliation(s)
- Kim Bellamy
- School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
| | - Remo Ostini
- School of Pharmacy and Rural Clinical School, The University of Queensland, Brisbane, QLD, Australia
| | - Nataly Martini
- School of Pharmacy, The University of Auckland, Auckland, New Zealand
| | - Therese Kairuz
- College of Medicine & Dentistry, James Cook University, Townsville, QLD, Australia
| |
Collapse
|
21
|
Perez S, Tatar O, Ostini R, Shapiro GK, Waller J, Zimet G, Rosberger Z. Extending and validating a human papillomavirus (HPV) knowledge measure in a national sample of Canadian parents of boys. Prev Med 2016; 91:43-49. [PMID: 27471023 DOI: 10.1016/j.ypmed.2016.07.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 07/21/2016] [Accepted: 07/23/2016] [Indexed: 12/21/2022]
Abstract
As the human papillomavirus (HPV) vaccine is now recommended for males, a reliable, comprehensive HPV knowledge measurement tool which addresses issues relevant to males is needed. We aimed to replicate, validate and test the comprehensiveness of an existing general HPV and an HPV vaccination knowledge scale in English and French. We also measured parental HPV knowledge and changes over time. An online questionnaire was administered in February (Time 1; T1) and November 2014 (Time 2; T2) to a nationally representative sample of Canadian parents of boys. Dimensionality, internal consistency and model fit were evaluated at both time points and separately in English and French sub-samples. Differences in knowledge scores were measured. Analyses were performed on 3117 participants at T1 and 1427 at T2. The 25-item HPV general knowledge and an 11-item HPV vaccination scale were unidimensional, showed high internal consistency (α>0.87, α>0.73) and had good model fit. Both general HPV and vaccine-specific knowledge significantly increased over time in both languages, but remained low at T2, with only about half of the items being answered correctly. Correct responses at T2 are best explained by correct responses at T1, with some small changes from 'Don't know' at T1 to correct at T2. The extended general and vaccine-specific knowledge scales are valid, reliable and comprehensive, and could be used among parents of boys, in both English and French. Educational interventions could target specific knowledge gaps and focus on providing information rather than correcting misconceptions.
Collapse
Affiliation(s)
- Samara Perez
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal H3A 1B1, Quebec, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Cote Ste-Catherine Road, Montreal H3T 1E4, Quebec, Canada.
| | - Ovidiu Tatar
- Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Cote Ste-Catherine Road, Montreal H3T 1E4, Quebec, Canada
| | - Remo Ostini
- Rural Clinical School Research Centre, School of Medicine, The University of Queensland, West Street, Toowoomba, Qld 4350, Australia
| | - Gilla K Shapiro
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal H3A 1B1, Quebec, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Cote Ste-Catherine Road, Montreal H3T 1E4, Quebec, Canada
| | - Jo Waller
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, UCL, 1-19 Torrington Place, London WC1E 6BT, United Kingdom
| | - Gregory Zimet
- Indiana University School of Medicine, Section of Adolescent Medicine, 410 West 10th Street, HS 1001, Indianapolis, IN 46202, USA
| | - Zeev Rosberger
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal H3A 1B1, Quebec, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Cote Ste-Catherine Road, Montreal H3T 1E4, Quebec, Canada; Louise Granofsky-Psychosocial Oncology Program, Segal Cancer Center, Jewish General Hospital, 4333 Cote Ste-Catherine Road, Montreal H3T 1E4, Quebec, Canada
| |
Collapse
|
22
|
Abstract
An investigation of the relationship between values and moral judgement was conducted using 124 Australian university students. Participants completed a Value Survey and the Defining Issues Test in sessions one week apart. Data were analysed by computing correlations and multiple regression of ratings for individual values and Value Type scores with Stage Scores and summary scores of moral reasoning. Analysis confirmed only some of the predicted relationships between values and the moral reasoning measure and indicated some that had not been predicted. Theoretical and psychometric factors contributing to these results are discussed, and the importance of identifying the conceptual bases of measures used in moral behaviour research is noted.
Collapse
|
23
|
Abstract
Merz's Psychological Reactance Scale was evaluated on the basis of individual item analysis, factorial validity and reliability using responses of 379 Australian tertiary students. Several questionnaire items showed difficulties in readability, ambiguity and discriminatory power, possibly due to the effects of translation. The scale was factorially unstable, and the reliabilities of the present English version were .80 (α) and .77 (split-half) which are not as high as those for the original German version. A thorough refinement of questionnaire items was suggested to produce a more psychometrically acceptable scale.
Collapse
Affiliation(s)
| | - Remo Ostini
- Darling Downs Institute of Advanced Education
| |
Collapse
|
24
|
Bergmann TK, Isbel NM, Ostini R, Barraclough KA, Campbell SB, McWhinney BC, Inder WJ, Russell A, Staatz CE. Exploratory study of total and free prednisolone plasma exposure and cushingoid appearance, quality of life and biochemical toxicity in adult male kidney transplant recipients. Clin Drug Investig 2016; 35:743-50. [PMID: 26403249 DOI: 10.1007/s40261-015-0334-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Long-term adverse effects of oral glucocorticoids are frequent and serious. Large between-patient variability in the pharmacokinetics of prednisolone might explain why drug dose is a poor predictor of drug-related toxicity. The aim of the study was to investigate relationships between prednisolone exposure and adverse effects. METHODS Male kidney transplant recipients were recruited for serial blood sampling and assessment of glucocorticoid-related adverse effects including dyslipidaemia, abnormal body fat distribution, Cushingoid appearance and impaired quality of life. Total and free prednisolone plasma concentrations were determined using ultra-high-performance liquid chromatography with tandem mass spectrometric detection. Prednisolone exposure was estimated using a limited sampling strategy. RESULTS Fifty-six patients were recruited. Patients had a mean age of 54 years and median time post-transplantation of 75 months. Median prednisolone dose was 5 mg. Mean area under the plasma concentration-time curve was 2390 nmol h/L (±580) (SD) and 175 nmol h/L (±78) for total and free prednisolone, respectively. Waist to upper arm circumference ratio was positively associated with free prednisolone plasma exposure with a Spearman correlation coefficient of 0.30 (p value 0.02). The correlation coefficient was 0.24 (p value 0.08) for neck to upper arm circumference ratio and free prednisolone plasma exposure. The clinical Cushingoid phenotype as determined by the Visual Assessment of Cushing's Severity (VACS) score was associated with a reduced score relating to physical functioning on the SF-12, but there was no significant relationship between free prednisolone plasma exposure and quality-of-life scores. Lipid levels and haemoglobin A1c (HbA1c) were not associated with total or free prednisolone exposure. CONCLUSIONS There is a positive correlation between free prednisolone plasma exposure and waist to upper arm circumference ratio in adult male kidney transplant recipients on low maintenance prednisolone doses. There is no significant association between total or free prednisolone plasma exposure and plasma glucose and lipid levels in the low prednisolone dose range.
Collapse
Affiliation(s)
- Troels K Bergmann
- School of Pharmacy, University of Queensland, Brisbane, Australia. .,Department of Clinical Chemistry and Pharmacology, Odense University Hospital, J.B. Winsloews Vej 19, 5000, Odense C, Denmark.
| | - Nicole M Isbel
- Department of Nephrology, University of Queensland at the Princess Alexandra Hospital, Brisbane, Australia
| | - Remo Ostini
- Rural Clinical School Research Centre, University of Queensland, Toowoomba, Australia
| | | | - Scott B Campbell
- Department of Nephrology, University of Queensland at the Princess Alexandra Hospital, Brisbane, Australia
| | - Brett C McWhinney
- Department of Chemical Pathology, Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Warrick J Inder
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, Australia.,School of Medicine, The University of Queensland, Brisbane, Australia
| | - Anthony Russell
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, Australia.,School of Medicine, The University of Queensland, Brisbane, Australia
| | | |
Collapse
|
25
|
Verrinder JM, Ostini R, Phillips CJC. Differences in Moral Judgment on Animal and Human Ethics Issues between University Students in Animal-Related, Human Medical and Arts Programs. PLoS One 2016; 11:e0149308. [PMID: 26934582 PMCID: PMC4774973 DOI: 10.1371/journal.pone.0149308] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 01/29/2016] [Indexed: 11/29/2022] Open
Abstract
Moral judgment in relation to animal ethics issues has rarely been investigated. Among the research that has been conducted, studies of veterinary students have shown greater use of reasoning based on universal principles for animal than human ethics issues. This study aimed to identify if this was unique to students of veterinary and other animal-related professions. The moral reasoning of first year students of veterinary medicine, veterinary technology, and production animal science was compared with that of students in non-animal related disciplines of human medicine and arts. All students (n = 531) completed a moral reasoning test, the VetDIT, with animal and human scenarios. When compared with reasoning on human ethics issues, the combined group of students evaluating animal ethics issues showed higher levels of Universal Principles reasoning, lower levels of Personal Interest reasoning and similar levels of Maintaining Norms reasoning. Arts students showed more personal interest reasoning than students in most animal-related programs on both animal and human ethics issues, and less norms-based reasoning on animal ethics issues. Medical students showed more norms-based reasoning on animal ethics issues than all of the animal-related groups. There were no differences in principled reasoning on animal ethics issues between program groups. This has implications for animal-related professions and education programs showing that students’ preference for principled reasoning on animal ethics issues is not unique to animal-related disciplines, and highlighting the need to develop student (and professional) capacity to apply principled reasoning to address ethics issues in animal industries to reduce the risk of moral distress.
Collapse
Affiliation(s)
- Joy M. Verrinder
- Centre for Animal Welfare and Ethics, School of Veterinary Science, University of Queensland, Gatton, Queensland 4343, Australia
- * E-mail:
| | - Remo Ostini
- Rural Clinical School Research Centre, School of Medicine, University of Queensland, Toowoomba, Australia
| | - Clive J. C. Phillips
- Centre for Animal Welfare and Ethics, School of Veterinary Science, University of Queensland, Gatton, Queensland 4343, Australia
| |
Collapse
|
26
|
Bellamy K, Ostini R, Martini N, Kairuz T. Seeking to understand: using generic qualitative research to explore access to medicines and pharmacy services among resettled refugees. Int J Clin Pharm 2016; 38:671-5. [PMID: 26873481 DOI: 10.1007/s11096-016-0261-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 08/27/2015] [Accepted: 01/28/2016] [Indexed: 10/22/2022]
Abstract
Introduction There are challenges associated with selecting a qualitative research approach. In a field abundant with terminology and theories, it may be difficult for a pharmacist to know where and how to begin a qualitative research journey. The purpose of this paper is to provide insight into generic qualitative research and to describe the journey of data collection of a novice qualitative researcher in the quest to answer her research question: 'What are the barriers to accessing medicines and pharmacy services for resettled refugees in Queensland, Australia?' Methodology Generic qualitative research draws on the strengths of one or more qualitative approaches. The aim is to draw out participants' ideas about things that are 'outside themselves'; rather than focussing on their inner feelings the research seeks to understand a phenomenon, a process, or the perspectives of participants. Sampling is designed to obtain a broad range of opinions about events and experiences and data collection includes interviews, questionnaires or surveys; thematic analysis is often used to analyse data. When to use Generic qualitative research provides an opportunity to develop research designs that fit researchers' epistemological stance and discipline, with research choices, including methodology and methods, being informed by the research question. Limitations Generic qualitative research is one of many methodologies that may be used to answer a research question and there is a paucity of literature about how to do it well. There is also debate about its validity as a qualitative methodology.
Collapse
Affiliation(s)
- Kim Bellamy
- School of Pharmacy, The University of Queensland, Brisbane, Australia.
| | - Remo Ostini
- Rural Clinical School Research Centre, School of Medicine, The University of Queensland, Ipswich, Australia
| | - Nataly Martini
- School of Pharmacy, University of Auckland, Auckland, New Zealand
| | - Therese Kairuz
- Pharmacy, College of Medicine and Dentistry, James Cook University, Townsville, Australia
| |
Collapse
|
27
|
Bellamy K, Ostini R, Martini N, Kairuz T. Access to medication and pharmacy services for resettled refugees: a systematic review. Aust J Prim Health 2015; 21:273-8. [DOI: 10.1071/py14121] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 10/21/2014] [Indexed: 11/23/2022]
Abstract
The difficulties that resettled refugees experience in accessing primary health-care services have been widely documented. In most developed countries, pharmacists are often the first health-care professional contacted by consumers; however, the ability of refugees to access community pharmacies and medication may be limited. This review systematically reviewed the literature and synthesised findings of research that explored barriers and/or facilitators of access to medication and pharmacy services for resettled refugees. This review adhered to guidelines for systematic reviews by PRISMA (preferred reporting items for systematic reviews and meta-analyses). Databases were searched during March 2014 and included Scopus, ProQuest Sociological Abstracts, PubMed, Embase and APAIS Health. The Australian and International grey literature was also explored. Nine studies met the quality and inclusion criteria. The research reported in seven of the nine studies was conducted in the US, one was conducted in Australia and the other in the UK. The majority of studies focussed on South-east Asian refugees. Themes identified across the studies included language and the use of interpreters; navigating the Western health-care system; culture and illness beliefs; medication non-adherence; use of traditional medicine; and family, peer and community support. There is a significant paucity of published research exploring barriers to medication and pharmacy services among resettled refugees. This systematic review highlights the need for appropriate interpreting and translation services, as well as pharmacy staff demonstrating effective cross-cultural communication skills.
Collapse
|
28
|
Aung E, Ostini R, Dower J, Donald M, Coll JR, Williams GM, Doi SAR. Patient Assessment of Chronic Illness Care (PACIC) in Type 2 Diabetes: A Longitudinal Study. Eval Health Prof 2014; 39:185-203. [PMID: 25380699 DOI: 10.1177/0163278714556674] [Citation(s) in RCA: 17] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Patient Assessment of Chronic Illness Care (PACIC) was designed to measure care congruent with several elements of the chronic care model (CCM), including self-management support and delivery system design. However, support for the a priori 5-subscale structure of the PACIC in previous research has been conflicting. Thus, we aim to investigate psychometric characteristics of the PACIC including the content and stability of its construct over time. A population-based prospective cohort study of patients with type 2 diabetes was conducted in Queensland, Australia, from 2008 (N = 3,761) to 2010 (N = 3,040). Participants completed annually the 20-item PACIC as well as measures of providers' adherence to guideline-recommended self-management support activities. We used exploratory factor analysis to determine its factor structure and examined internal consistency as well as agreement between the PACIC at baseline with repeated measurements at follow-up after 1 and 2 years. We also determined a criterion-related validity using multinomial logistic regression to explore PACIC's association with providers' self-management support. A one-factor structure was deemed optimal according to our findings. High internal consistency and moderate agreement within the scales over time were observed. Higher PACIC scores predicted better providers' self-management support. In conclusion, the PACIC is a reliable, valid, and reproducible instrument for assessment of diabetes care, and we recommend its promotion and use as a single scale rather than subscales as originally proposed.
Collapse
Affiliation(s)
- Eindra Aung
- School of Population Health, University of Queensland, Brisbane, Queensland, Australia
| | - Remo Ostini
- School of Population Health, University of Queensland, Brisbane, Queensland, Australia
| | - Jo Dower
- School of Population Health, University of Queensland, Brisbane, Queensland, Australia
| | | | - Joseph R Coll
- School of Population Health, University of Queensland, Brisbane, Queensland, Australia
| | - Gail M Williams
- School of Population Health, University of Queensland, Brisbane, Queensland, Australia
| | - Suhail A R Doi
- School of Population Health, University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
29
|
Dodd RH, McCaffery KJ, Marlow LAV, Ostini R, Zimet GD, Waller J. Knowledge of human papillomavirus (HPV) testing in the USA, the UK and Australia: an international survey. Sex Transm Infect 2014; 90:201-7. [PMID: 24412997 PMCID: PMC3995259 DOI: 10.1136/sextrans-2013-051402] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [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] [Indexed: 11/26/2022] Open
Abstract
Objective To measure knowledge and awareness of human papillomavirus (HPV) testing in the USA, the UK and Australia. Methods Participants in the USA, UK and Australia completed an anonymous web-based survey measuring awareness and knowledge of HPV (n=2409). We report analyses on a subsample of 1473 men and women in the USA (n=617), UK (n=404) and Australia (n=452) who had heard of HPV and completed questions about HPV testing. Results Overall, 50% of the sample (742/1473) had heard of HPV testing. Awareness of HPV testing was higher in the USA (62%) than in the UK (44%) and Australia (40%) (p<0.001). Among those who had heard of HPV testing, the mean knowledge score (out of 6) was 2.78 (SD: 1.49). No significant differences in knowledge score were found between the countries but, overall, women scored significantly higher than men (2.96 vs 2.52, p<0.001). Conclusions Awareness of HPV testing among people who have heard of HPV is higher in the USA than in the UK and Australia, but overall knowledge is low. This has important implications in those countries where HPV testing is being used in cervical screening. Increasing knowledge about the implications of HPV test results may help minimise any negative psychological consequences associated with HPV testing. Raising awareness in men could become increasingly important if HPV testing is introduced into the management of other cancers where HPV plays an aetiological role.
Collapse
Affiliation(s)
- Rachael H Dodd
- Department of Epidemiology & Public Health, Cancer Research UK Health Behaviour Research Centre, UCL, , London, UK
| | | | | | | | | | | |
Collapse
|
30
|
Wong JY, Gilson ND, Peeters G(G, Ostini R, Bush RA, Brown WJ. The characteristics of inactive men working in a regional area of Queensland, Australia. J Sci Med Sport 2014; 17:56-60. [DOI: 10.1016/j.jsams.2013.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 02/09/2013] [Accepted: 02/15/2013] [Indexed: 10/27/2022]
|
31
|
Ostini R, Kairuz T. Investigating the association between health literacy and non-adherence. Int J Clin Pharm 2013; 36:36-44. [DOI: 10.1007/s11096-013-9895-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 11/22/2013] [Indexed: 10/26/2022]
|
32
|
Neville C, Ostini R. A psychometric evaluation of three pain rating scales for people with moderate to severe dementia. Pain Manag Nurs 2013; 15:798-806. [PMID: 24144573 DOI: 10.1016/j.pmn.2013.08.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 08/15/2013] [Accepted: 08/16/2013] [Indexed: 10/26/2022]
Abstract
Little comparative information exists regarding the reliability and validity of pain rating scales for nurses to assess pain in people with moderate to severe dementia in residential aged care facilities. The objective of this study was to evaluate the relative psychometric merits of the Abbey Pain Scale, the DOLOPLUS-2 Scale, and the Checklist of Nonverbal Pain Indicators Scale, three well-known pain rating scales that have previously been used to assess pain in nonverbal people with dementia. An observational study design was used. Nurses (n = 26) independently rated a cross-section of people with moderate to severe dementia (n = 126) on two occasions. The Abbey Pain Scale and the DOLOPLUS-2 Scale showed good psychometric qualities in terms of reliability and validity, including resistance to the influence of rater characteristics. The Checklist of Nonverbal Pain Indicators Scale also had reasonable results but was not as psychometrically strong as the Abbey Pain Scale and DOLOPLUS-2 Scale. This study has provided comparative evidence for the reliability and validity of three pain rating scales in a single sample. These scales are strong, objective adjuncts in making comprehensive assessments of pain in people who are unable to self-report pain due to moderate to severe dementia, with each having their own strengths and weaknesses. The DOLOPLUS-2 Scale provides more reliable measurement, and the Abbey Pain Scale may be better suited than the other two scales for use by nurse raters who only occasionally use pain rating scales or who have lower level nursing qualifications.
Collapse
Affiliation(s)
- Christine Neville
- School of Nursing and Midwifery, The University of Queensland, Queensland, Australia.
| | - Remo Ostini
- Healthy Communities Research Centre, The University of Queensland, Queensland, Australia
| |
Collapse
|
33
|
Kairuz TE, Bellamy KM, Lord E, Ostini R, Emmerton LM. Health literacy among consumers in community pharmacy: perceptions of pharmacy staff. Health Expect 2013; 18:1041-51. [PMID: 23710827 DOI: 10.1111/hex.12077] [Citation(s) in RCA: 8] [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] [Accepted: 04/23/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Low health literacy has important consequences for health status, medication adherence and use of health services. There is little insight from the perspective of pharmacy staff into how they identify the information needs of consumers and particularly the signals and risk factors of limited health literacy that they encounter in their day-to-day communication with consumers. OBJECTIVE To investigate factors impacting on consumer health literacy, from the perspective of pharmacy staff. METHODS The research comprised semi-structured interviews conducted in a convenience sample of pharmacies in the south-east region of Queensland, Australia. Eleven pharmacists and nine pharmacy assistants agreed to participate. Interviews were audio-recorded and transcribed verbatim. Initial coding of the anonymized transcripts was performed using NVivo(®). Codes were analysed into overarching themes and subthemes, which were then re-named and refined through consensus discussion. RESULTS Three overarching themes were identified from the coding process: complexity of the health system, clarity of information, and dialogue among consumers and health-care professionals. Two of the themes were system related, namely the health system and pharmacy labels; the health literacy issues included lack of clarity, complexity and misunderstanding. The third theme was related to communication. CONCLUSIONS Complexity of the health system, clarity of information and dialogue among consumers and health-care professionals were identified as factors associated with consumers' health literacy. We call for increased engagement between pharmacy staff and consumers with improved focus on areas of potential confusion, such as medicine labels and navigation of the health system, aiming to minimize negative consequences of limited health literacy and optimize patient health outcomes.
Collapse
Affiliation(s)
- Therese E Kairuz
- School of Pharmacy, The University of Queensland, Brisbane, Qld, Australia
| | - Kim M Bellamy
- School of Pharmacy, The University of Queensland, Brisbane, Qld, Australia
| | - Elisabeth Lord
- School of Social Work and School of Public Health, The University of Queensland, Brisbane, Qld, Australia
| | - Remo Ostini
- Healthy Communities Research Centre, The University of Queensland, Ipswich, Qld, Australia
| | - Lynne M Emmerton
- School of Pharmacy, Curtin Health Innovation Research Institute, Curtin University, Perth, WA, Australia
| |
Collapse
|
34
|
Waller J, Ostini R, Marlow LAV, McCaffery K, Zimet G. Validation of a measure of knowledge about human papillomavirus (HPV) using item response theory and classical test theory. Prev Med 2013; 56:35-40. [PMID: 23142106 DOI: 10.1016/j.ypmed.2012.10.028] [Citation(s) in RCA: 121] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 10/30/2012] [Accepted: 10/31/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Public understanding of HPV is important to ensure informed participation in cervical cancer prevention programmes. While many studies have measured HPV knowledge, none has developed a validated measure for use across countries. We aimed to develop and validate such a measure. METHOD Items tapping knowledge of HPV, HPV testing and HPV vaccination were developed from previous literature and with expert consultation. The 29-item measure was administered via the internet to 2409 adults in the UK, US and Australia in 2011. Classical test theory and item response theory were used to establish the measure's psychometric properties. RESULTS Total scale reliability was very good (α = 0.838), as was internal consistency for a 16-item general HPV knowledge subset (α = 0.849). Subsets of HPV testing and vaccination items showed reasonable test-retest reliability (r(test-retest) = 0.62 and 0.69) but moderate internal consistency (α = 0.52 and 0.56). Dimensionality analyses suggested that one item was not measuring the same construct as the remainder of the questionnaire. A 2-parameter logistic item response theory (IRT) model was fitted to the remaining 28 scale items. CONCLUSIONS A structurally coherent set of items covering a range of important HPV knowledge was developed. Responses indicated a reliable questionnaire, which allowed the fitting of an IRT model.
Collapse
Affiliation(s)
- Jo Waller
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, UCL Gower Street, London WC1E 6BT, UK.
| | | | | | | | | |
Collapse
|
35
|
Marlow LAV, Zimet GD, McCaffery KJ, Ostini R, Waller J. Knowledge of human papillomavirus (HPV) and HPV vaccination: an international comparison. Vaccine 2012; 31:763-9. [PMID: 23246310 DOI: 10.1016/j.vaccine.2012.11.083] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 11/27/2012] [Accepted: 11/28/2012] [Indexed: 11/30/2022]
Abstract
Since vaccination against human papillomavirus (HPV) became available, awareness of HPV has dramatically increased. Implementation of a vaccine program varies internationally yet no studies have explored the influence this has on the public's knowledge of HPV. The present study aimed to explore differences in awareness of HPV and HPV knowledge across three countries: The US, UK and Australia. Participants (n=2409) completed a validated measure of HPV knowledge as part of an online survey. There were higher levels of HPV awareness among men and women in the US than the UK and Australia. Being male and having a lower educational level was associated with lower HPV awareness in all three countries. Awareness of HPV vaccine was higher in women from the US than the UK and Australia. Women in the US scored significantly higher on general HPV knowledge (on a 15-item scale) than women in the UK and Australia, but there were no between country differences in HPV vaccine knowledge (on a 6-item scale). When asked about country-specific vaccine availability, participants in the US were less able to identify the correct answers than participants in the UK and Australia. More than half of participants did not know: HPV can cause genital warts; most sexually active people will get HPV at some point in their life; or HPV doesn't usually need treatment. Pharmaceutical advertising campaigns could explain why awareness of HPV and HPV vaccine is higher in the US and this has helped to get some important messages across. Significant gaps in HPV knowledge remain across all three countries.
Collapse
Affiliation(s)
- Laura A V Marlow
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology & Public Health, UCL, London WC1E 6BT, United Kingdom
| | | | | | | | | |
Collapse
|
36
|
Wong J, Peeters G, Gilson N, Ostini R, Bush R, Brown W. Identifying men for physical activity interventions through workplace health screenings. J Sci Med Sport 2012. [DOI: 10.1016/j.jsams.2012.11.777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
37
|
Ostini R, Roughead EE, Kirkpatrick CMJ, Monteith GR, Tett SE. Quality Use of Medicines--medication safety issues in naming; look-alike, sound-alike medicine names. Int J Pharm Pract 2012; 20:349-57. [PMID: 23134093 DOI: 10.1111/j.2042-7174.2012.00210.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To review current literature with the objective of developing strategies and recommendations to enhance patient safety and minimise clinical issues with look-alike, sound-alike medication names. METHODS A comprehensive search of the PubMed database and an Australian online repository of Quality Use of Medicines projects was conducted to identify publications addressing look-alike, sound-alike medication problems. Author networks, grey literature and the reference lists of published articles were also used to identify additional material. KEY FINDINGS Thirty-two publications describing the extent of the specific problem and recommending solutions were identified. The majority of these publications provided a qualitative assessment of the issues, with few quantitative estimates of the severity of the problem and very little intervention research. As a result, most recommendations for addressing the problem are the result of expert deliberations and not experimental research. This will affect the capacity of the recommendations to ameliorate and resolve problems caused by look-alike, sound-alike medication names. Themes identified from articles included the nature and causes of look-alike, sound-alike problems, potential solutions and recommendations. CONCLUSIONS There are many existing medications which can potentially cause clinical issues due to mix-ups because of similar sounding or looking medication names. This confusion can be lethal for some medication errors. A multifaceted, integrated approach involving all aspects of the medication use process, from initial naming of INN through to consumer education, is suggested to minimise this issue for medication safety.
Collapse
Affiliation(s)
- Remo Ostini
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
| | | | | | | | | |
Collapse
|
38
|
Affiliation(s)
- Remo Ostini
- School of Pharmacy, The University of Queensland, Brisbane, Qld 4072, Australia.
| | - Desley Hegney
- School of Pharmacy, The University of Queensland, Brisbane, Qld 4072, Australia.
| | - Claire Jackson
- School of Pharmacy, The University of Queensland, Brisbane, Qld 4072, Australia.
| | - Susan E. Tett
- School of Pharmacy, The University of Queensland, Brisbane, Qld 4072, Australia.
| |
Collapse
|
39
|
|
40
|
Bammer G, Dance P, Stevens A, Mugford S, Ostini R, Crawford D. Attitudes to a Proposal for Controlled Availability of Heroin in Australia: Is it Time for a Trial? ACTA ACUST UNITED AC 2009. [DOI: 10.3109/16066359609005562] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
41
|
Ostini R, Hegney D, Jackson C, Williamson M, Mackson JM, Gurman K, Hall W, Tett SE. Systematic Review of Interventions to Improve Prescribing. Ann Pharmacother 2009; 43:502-13. [DOI: 10.1345/aph.1l488] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objective: To update 2 comprehensive reviews of systematic reviews on prescribing interventions and identify the latest evidence about the effectiveness of the interventions. Data Sources: Systematic searches for English-language reports of experimental and quasi-experimental research were conducted in PubMed(1951–May 2007). EMBASE (1974–March 2008), International Pharmaceutical Abstracts (1970–March 2008), and 11 other bibliographic databases of medical, social science, and business research. Following an initial title screening process and after selecting 6 specific intervention categories (identified from the previous reviews) in community settings, 2 reviewers independently assessed abstracts and then full studies for relevance and quality and extracted relevant data using formal assessment and data extraction tools. Results were then methodically incorporated into the findings of the 2 earlier reviews of systematic reviews. Data Selection And Synthesis: Twenty-nine of 26,314 articles reviewed were assessed to be of relevant, high-quality research. Audit and feedback, together with educational outreach visits, were the focus of the majority of recent, high-quality research into prescribing interventions. These interventions were also the most effective in improving prescribing practice. A smaller number of studies included a patient-mediated intervention; this intervention was not consistently effective. There is insufficient recent research into manual reminders to confidently update earlier reviews and there remains insufficient evidence to draw conclusions regarding the effectiveness of local consensus processes or multidisciplinary teams. Conclusions: Educational outreach as well as audit and feedback continue to dominate research into prescribing interventions. These 2 prescribing interventions also most consistently show positive results. Much less research is conducted into other types of interventions and there is still very little effort to systematically test why interventions do or do not work.
Collapse
Affiliation(s)
- Remo Ostini
- School of Pharmacy, The University of Queensland, Brisbane, Australia
| | - Desley Hegney
- UQ/Blue Care Research & Practice Development Centre, School of Nursing & Midwifery, The University of Queensland
| | | | - Margaret Williamson
- Research and Development, National Prescribing Service Ltd., Surry Hills, Australia
| | - Judith M Mackson
- Education and Quality Assurance Program, National Prescribing Service Ltd
| | - Karin Gurman
- Education and Quality Assurance Program, National Prescribing Service Ltd
| | - Wayne Hall
- School of Population Health, The University of Queensland
| | - Susan E Tett
- Faculty of Health Sciences, The University of Queensland
| |
Collapse
|
42
|
Ostini R, Hegney D, Mackson JM, Williamson M, Tett SE. Why is the use of clopidogrel increasing rapidly in Australia? An exploration of geographical location, age, sex and cardiac stenting rates as possible influences on clopidogrel use. Pharmacoepidemiol Drug Saf 2008; 17:1077-90. [PMID: 18698666 DOI: 10.1002/pds.1638] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To explore clopidogrel use within Australia, investigating geography, age, sex and cardiac stenting rates. METHODS Data for clopidogrel supply (Pharmaceutical Benefits Scheme (PBS) and Repatriation Pharmaceutical Benefits Scheme (RPBS)) and cardiac stenting procedures (State Health Departments) were obtained for four different geographic regions (very remote/remote and major city in two Australian states). General linear modelling and correlation analyses were used to test for associations and chi2 analyses for proportions. RESULTS Clopidogrel supply increased rapidly in Australia since introduction, from 1.2 to 9.0 Defined Daily Doses (DDD)/1000 population/day. Among concessional and veteran populations use was much higher. Analysis of geographical area data confirmed an association between clopidogrel supply rates and cardiac stenting rates (r = 0.8-0.9 Spearman's rho, p < 0.01). Sex, age and geographical location were associated with both rates when considered together and when considered independently. Further modelling indicated that between 30 and 73% of clopidogrel supply could be accounted for by people receiving cardiac stents. CONCLUSIONS The supply of clopidogrel increases with age, male sex and living in a major city. These same demographic variables were important for cardiac stenting, an indication which is currently not approved for subsidy by the Australian government, but which modelling indicated could account for between one-third and three quarters of clopidogrel use. A review may be required to ensure subsidised indications reflect current evidence and cost-effective use.
Collapse
Affiliation(s)
- R Ostini
- School of Pharmacy, University of Queensland, Brisbane, Australia
| | | | | | | | | |
Collapse
|
43
|
Abstract
The general public, police, service providers, and users/ex-users were asked their views about options for trial design and trial outcomes with regard to a proposal for experimental controlled heroin availability. There was substantial agreement between the samples on issues concerning trial design. In general, the samples from the community, service providers and users/ex-users were more likely to report that a trial would result in positive outcomes, whereas the police sample was more likely to report that a trial would result in negative outcomes. This study illustrates the value of systematic consultation of key groups in exploring the options for change, raising potential difficulties, and highlighting different interests.
Collapse
Affiliation(s)
- G Bammer
- National Centre for Epidemiology and Population Health, Australian National University, Canberra ACT
| | | | | | | | | |
Collapse
|
44
|
Abstract
Overdoses are a preventable health hazard associated with heroin use. In the first study of its kind, we examined the records on nonfatal overdoses of the Australian Capital Territory (ACT) Ambulance Service from August 1990 to July 1993. There was a dramatic increase in the number of overdoses in the second half of 1992 and the first half of 1993, but the reasons for the increase are not clear. Most overdoses occurred in men aged under 30, indoors, and many cases were taken to hospital. Often there was no information on why the overdose occurred; when information was available, about half the cases were attributed to taking heroin in combination with other drugs. Suggestions for improving the quality of the data collected are made. These include more systematic recording by ambulance officers of the drug involved in the overdose and whether the drug was used alone or in combination with others, and linkage of ambulance service records with survey data and information from analysis of heroin purity.
Collapse
Affiliation(s)
- G Bammer
- National Centre for Epidemiology and Population Health, Australian National University, Canberra
| | | | | |
Collapse
|
45
|
Abstract
In response to widespread concern about illegal drug use and the associated risk of the spread of HIV/AIDS, a study was undertaken to examine whether it was, in principle, feasible to conduct a trial providing heroin to dependent users in a controlled manner. Such a trial involves real ethical issues which are examined in this paper. The general issues examined are: should a trial be an experiment or an exercise in public policy?; acts and omissions; countermobilization; termination of a trial, and payment for drugs and for a trial. The specific issues examined are: selection of trial participants; privacy; issues for staff working on a trial; coupling the trial with other treatment, and issues for researchers. A number of alternative approaches to the various ethical issues are presented and discussed.
Collapse
Affiliation(s)
- R Ostini
- Australian National University, Canberra
| | | | | | | |
Collapse
|