Readiness for Integrated Care of Older People: A Cross-Sectional Study in Mexico

AIM

To evaluate the readiness of the Mexican healthcare system to implement the integrated care for older people (ICOPE) approach into an existing healthcare model.

METHODS

We conducted a cross-sectional study with data from 2473 healthcare workers analyzed using the model for understanding success in quality (MUSIQ) framework to gather data from healthcare professionals. Their perceptions regarding the readiness for ICOPE were assessed across five dimensions: team, microsystem, infrastructure, organization, and external environment.

RESULTS

Only 717 (29%) of the participants believed ICOPE could be successfully implemented in Mexico without any modifications. A total of 1261 (51%) participants rated the readiness of ICOPE with some barriers. The main barriers were reallocating resources and the external environment.

OBSERVATION

Mexico's healthcare system faces barriers to innovation that could hinder the successful integration of the ICOPE approach. A systematic identification of these barriers provides an opportunity to suggest adaptations and refinements to increase the probability of success. Using the contextual factors identified as facilitators and the proposal of interventions such as the ICOPE app could improve the chances of success.

CONCLUSION

The participants of this study evaluated ICOPE as ready to implement, with some contextual barriers. The readiness evaluation supports the stakeholders' and policymakers' decisions in implementing and monitoring the program in a natural setting. Evaluating the readiness of the intervention increases the possibility of aligning the innovation with contextual factors, increasing the chances of its successful adoption and implementation.

Protecting the future: Fatal incidents on Australian farms involving children (2001-2019)

OBJECTIVES

To assess the demographic and causal factors, plus trends in rates of fatal farm incidents involving children (<15 years) in Australia over the 2001-2019 period.

DESIGN

A descriptive retrospective epidemiological study of the National Coronial Information System.

SETTING

Australia.

PARTICIPANTS

Cases involving children (<15 years), where incidents have occurred on a farm (1 January 2001-31 December 2019).

RESULTS

There has been essentially no change in the fatality rate for farm-related child injury deaths across Australia in the 2001-2019 period (-0.009/year). Men and children aged 0-4 years were significantly more likely to be involved in these incidents. Most cases were recreational in nature (81%), with seven agents (water bodies, quads [all-terrain vehicles], tractors, utes, cars, motorbikes and horses), accounting for 75% of cases. Water bodies were responsible for over 31% of deaths.

CONCLUSION

The lack of progress addressing child farm injury mortality requires urgent attention. The overall rates and pattern of injury-related deaths have stagnated, necessitating new and innovative approaches to address the issue. The emerging National Injury Prevention Plan might provide scope to improve the focus on and implementation of evidence-based approaches.

Evaluation of the Impact of School Garden Exposure on Youth Outlook and Behaviors toward Vegetables in Southern Arizona

BACKGROUND

Our objective was to evaluate the effect of garden-based learning on outlook and behaviors toward vegetables among primarily Latinx students. An educational strategy, garden-based learning is a teaching tool that complements other disciplines.

METHODS

Third- and fourth-grade students at 4 elementary schools with different garden programs completed a bingo survey and participated in class discussions to measure outlook and behaviors toward vegetables.

RESULTS

Students in schools with more garden exposure were more likely to answer "Yes" to survey questions reflecting a positive attitude and behaviors toward vegetables. In class discussions, students most often mentioned vegetables grown in the school garden as their favorite vegetables.

CONCLUSION

For third- and fourth-grade students, the length of exposure to a school garden appears to have a positive impact on both perceptions of and desire to consume vegetables. Other studies have shown that positive outlook and behaviors toward vegetables can change vegetable consumption habits in children. Integrating garden-based learning into the school curriculum may positively influence eating behaviors over the long-term future.

Active8: Promoting health beyond the absence of mental illness

OBJECTIVE

We sought to understand and develop the critical elements of a program designed to promote physical health for people living with or experiencing mental illness.

DESIGN

The study used a most significant change approach. Participants provided personal accounts of change, and these were analysed in a workshop with a range of stakeholders involved in program design and delivery. Core themes were identified to inform the development of the program.

SETTING

The program is delivered by a community managed organisation in the South Eastern Illawarra region of New South Wales and the study took place in this setting.

PARTICIPANTS

Participants included people who had accessed the Active8 program, staff who delivered the program, referrers and the funder of the program.

MAIN OUTCOME MEASURES

Participants were invited to share stories of how the Active8 program had impacted them or the people they were supporting.

RESULTS

Five key themes were identified as being critical to program success and development: (a) the right start at the right time; (b) a program that fits me; (c) health literacy leads to agency, action and change; (d) a chance to explore and establish healthy connections; and (e) change requires time, focus and ongoing support.

CONCLUSION

Approaches that steer away from simple advice giving and towards empowering and motivating people in line with their individual needs, aspirations and social context show potential for enhancing health-behaviour change.

Emerging Needs of People Living With HIV Receiving Community-Based Nursing in an Australian Setting

While the lifespan of people living with HIV (PLWH) in Australia has increased, a minority still experience poor health outcomes and have complex needs. Few studies address this group's emerging needs. Our study, a component of a larger evaluation, aimed to identify current and projected needs of PLWH receiving HIV community nursing. We undertook a cross-sectional survey to identify clients' support needs and explore their future concerns. There were 120 of 140 PLWH who met our eligibility criteria to participate in the survey; 86 responded. Respondents overrepresented minority, disadvantaged groups. Mental health support was the most common care reported (86.8%). Respondents' self-identified needs included access to health care, dealing with pain, anticipated grief due to friends dying, and maintaining independence. Time since HIV diagnosis and sexual orientation were primary variables for which differences were observed. Our study highlights the importance of developing and sustaining HIV specialist community nursing services for aging PLWH.

Contextualizing the Proven Effectiveness of a Lifestyle Intervention for Type 2 Diabetes in Primary Care: A Qualitative Assessment Based on the RE-AIM Framework

OBJECTIVE

The Healthy Eating and Active Living for Diabetes in Primary Care Networks (HEALD) intervention proved effective in increasing daily physical activity among people with type 2 diabetes in 4 community-based primary care networks (PCNs) in Alberta. Here, we contextualize its effectiveness by describing implementation fidelity and PCN staff's perceptions of its success in improving diabetes management.

METHODS

We used the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to evaluate the HEALD intervention. Qualitative methods used to collect data related to the RE-AIM dimensions of implementation and effectiveness included interviews with PCN staff (n=24), research team reflections (n=4) and systematic documentation. We used content analysis, and data were imported into and managed using Nvivo 10.

RESULTS

HEALD was implemented as intended with adequate fidelity across all 4 PCNs. Identified implementation facilitators included appropriate human resources, the training provided, ongoing support, the provision of space and the simplicity of the intervention. However, PCN staff reported varying opinions regarding its potential for improving diabetes management among patients. Rationales for their views included intervention "dose" inadequacy; that the quality of usual care for people with diabetes was already good; patients were already managing their diabetes well; and the potential for cointervention. Recommended improvements to HEALD included increasing the dose of the intervention, expanding it to other modes of exercise and incorporating a medical clearance process.

CONCLUSIONS

Based on the high degree of fidelity, the demonstrated effectiveness of HEALD in improving physical activity among patients was a result of sound implementation of an efficacious intervention. Increasing the dose of HEALD could result in additional improvements for patients.

Delivering opioid maintenance treatment in rural and remote settings

OBJECTIVE

This study explored the delivery of opioid maintenance treatment (OMT) from a specialist program in rural and remote New South Wales (NSW), focusing on the viability of the model and strategies for its improvement.

DESIGN

Program evaluation examining configuration and delivery, client characteristics and trends in demand, using policy documents, service data and stakeholder consultations (n = 28).

SETTING

The Greater Western Area Health Service, a sparsely populated and large geographic area in NSW.

RESULTS

There were four service hubs or primary sites. Three sites were co-located with hospitals and one within community health, with all sites providing assessment, prescribing, dispensing and limited case management. Staff were mainly trained nurses, while prescribers were visiting specialists or sessional GPs. There was minimal OMT provision by community prescribers and dispensers. In 2009, there were 638 clients. They were younger on average than those in OMT across Australia. The most common principal drug of concern was heroin (37-85% of clients), while around one-fifth of clients identified prescription opioids (18-23%). There was a substantial increase in OMT provision between 2006 and 2009 at three program sites. Staff at the sites had limited capacity to engage primary health services and thus reduce their client load.

CONCLUSIONS

Findings indicate the need to adjust funding to account for increased demand for OMT and to establish a financial incentive for GP prescribers. Dedicated resourcing is needed for a capacity building role to support the uptake of prescribing and dispensing in community services.