HDR Student conference (College of Nursing and Health Sciences)

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College of Nursing and Health Sciences at Flinders University are pleased to present the inaugural HDR Student conference. This is an annual event to provide HDR students an opportunity to present their research work, network with students and academic staff, meet their milestone expectations of oral presentations, and participate in professional development activities.

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The application of rigour in ethnographic methods to achieve an in-depth exploration of care planning with people on treatment orders
(Flinders University, 2018-11-5) Dawson, Suzanne
Community treatment orders (CTOs) remain contested in their efficacy and rationale for use in mental health care. Regardless of the debate, consumers, carers and clinicians are frequently required to engage within this context of forced care. CTO legislation states that treatment and care should be recovery-focussed, though care is often coercive. Positive gains for individuals come at a cost. This study seeks to understand the interpersonal and broader systems issues that impact on the care planning process. Carspeckena's Critical Ethnography, combining critical social theory with ethnographic methods, provided a rigorous theoretically-based structure for data collection and analysis. Ethnographic methods (including observation, focus groups and interviews) provided a detailed account of the multi-perspectives of people on CTOs, their families, and treating clinicians, over an 18-month period in a community mental health team in Adelaide, Australia. This paper will explore the research process of conducting an ethnographic study within the researchers' own work setting. Data collection and first stage analysis occurred concurrently, with coding of early observations informing the next stage of data collection, individual interviews. Concepts central to the rigour of an ethnographic study (immersion in the field, researcher positioning, and reflexivity) will be discussed, with illustrations of both successes and challenges.
Assessing the access and value of online health information resources
(Flinders University, 2018-11-5) Adams, Amanda
Introduction: User-based evaluations of usability undertaken during development of online health information and evidence resources generates valuable feedback identifying user interface issues, information architecture inconsistencies or navigation difficulties. Problem identification form the basis of iterative prototype improvements and dependence lies within user characteristics of user-testers whose recruitment is inherently skewed toward highly experienced, motivated and technological savvy individuals. Diversity in experience, attitudes, socioeconomic status, dis/ability, age and geographic location provides opportunity to identify ranges of usability and accessibility issues. Whilst outcomes from user-based evaluation methods are widely reported within the literature for e-devices, software and websites for user experience (UX), there is limited research on new modes of online resources such as online health toolkits (OHT). Objectives: The purpose of this research is assessing the role of usability and accessibility evaluations undertaken during development of OHT and investigating the influence of user characteristics on access and value of UX within the palliative care domain. METHODS Three independent studies will be conducted. The first is a systematic mapping review of the literature classifying current evaluation methods undertaken during development of OHT. The second examines application of a website evaluation model to the development of a palliative care online toolkit investigating outcomes as measures of UX. The final study will investigate how levels of user-testers digital readiness influence concepts and knowledge of palliative care and implications of interface design. Implications: Expected outcomes will inform a standardised approach for development of OHT, providing development, evaluation and implementation guidance producing valuable, useable and accessible online health information sources improving the UX.
Computer-Based Videogames in Nursing Education: A Literature Review
(Flinders University, 2018-11-5) Koschade, Adam
Today's university students have a high level of digital awareness and uptake of technological resources for education. However, one aspect of computer-aided learning that has received little attention in research is the use of videogame-based learning in nursing education. Computer-based videogames have the potential to provide an efficient, convenient and safe learning environment that may help nursing students develop vital nursing skills and knowledge. Despite this, educators have been slow to adopt digital game-based learning for nursing students. The aim of this research was to examine videogame-based learning in nursing education. In particular, it aimed to investigate how computer-based videogames are currently used in nursing education and how they relate to skills such as decision-making, motivation and other benefits. To examine the role of computer-based videogames in nursing education, a literature review was conducted involving a comprehensive search of multiple electronic databases. This was followed by a thematic analysis of the literature. The literature review identified four games (described in 14 papers) matching the study's inclusion/exclusion criteria. Analysis of the four games identified overall positive results in terms of the effectiveness and usability of the computer-based videogames in nursing education. Evaluation of the benefits of videogames in nursing education found potential positive effects for decision-making, motivation and repeated exposure as well as logistical and financial advantages. The results of the study have been published in a peer-reviewed journal article authored by a team of four researchers. Despite the limited number of videogames available to date and the methodological limitations identified in the papers, the findings of this literature review provide evidence to support the potential usability and effectiveness of computer-based videogames as a learning tool in nursing education.
Contextualising acute coronary syndrome standards and guidelines for Aboriginal people residing in Central Australian and Top End Aboriginal communities.
(Flinders University, 2018-11-5) Lawrence, Monica
Introduction: The National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Management of Acute Coronary Syndrome 2016 (in consultation with the Australian and New Zealand Society of Cardiac and Thoracic Surgeons) provide guidelines for the management of myocardial revascularisation. In addition, the European System for Cardiac Operative Risk Evaluation (euroSCORE I and II) are models used to calculate risk of mortality 30 days post cardiac surgery. The euroSCORE I and II have been validated for European, Japanese and North American populations; however, they have not been validated for Aboriginal and Torres Strait Islander populations and there is still much debate on whether they can be attributed to this, and other Indigenous populations. This study aims to explore the contextual factors (barriers and enablers) informing the guidelines for cardiac surgery and revascularisation for Aboriginal and Torres Strait Islander people residing in central Australian and Top End Northern Territory communities. Subsequently, recommendations will be put forward for culturally effective cardiac pathways of care. Methodology: This study uses an Indigenous research methodology, through the lens of the Essential Service Standards for Equitable National Cardiovascular Care (ESSENCE) framework, to better understand Aboriginal world views and experiences of cardiac surgery. Data collection: Semi-structured and/or open-ended questions will be posed 30-90 days post-discharge from Flinders Medical Centre and used to elicit free flowing narratives and storytelling once the participant is back residing in their community. Analysis: Indigenous narrative analysis, by means of storytelling, will be used to develop themes and codes for the purpose of identifying "experience" commonalities and distinctions and mapped to relevant acute coronary syndrome (ACS) and revascularisation standards and guidelines. Conclusion: The practical outcomes of the proposed study will identify cultural service gaps to make recommendations aligned to revised recommendations for new ACS and revascularisation standards, guidelines and care pathways for Aboriginal and Torres Strait Islander populations.
Contextualising and defining child abuse - How nurses' experiences, values and beliefs influence their assessment of children
(Flinders University, 2018-11-5) Lines, Lauren
Aims and Objectives To report on how nurses' experiences, values and beliefs impact upon their assessment of child abuse and neglect. Background To reduce harm to children, nurses must be able to identify and address child abuse and neglect. It is not known how nurses' experiences, cultural values and beliefs influence their assessment of abuse and neglect. Design Qualitative research design using social constructionism. Methods Twenty-one in-depth semi-structured interviews were conducted with nurses who work with children. EQUATOR guidelines for qualitative research (COREQ) were used to report this research. Results Nurses who work with children had difficulty defining abuse and needed to contextualise abuse within the child's unique situation. To understand the complexity of their role, nurses compared and contrasted the level of abuse experienced by the child with their own values and beliefs which stemmed from their personal and professional experiences of parenting. Assessments were particularly challenging when nurses were faced with cultural values and practices different from their own. Conclusions Assessments of abuse and neglect are inextricably linked to nurses' personal values and beliefs which they developed from their personal background and context. As such, nurses are working from their own values base rather than always taking an evidence-informed approach to assessing for abuse and neglect. Relevance to clinical practice Nurses who work with children can make a difference for children experiencing abuse and neglect. There was inconsistent evidence that nurses explicitly reflect on how their personal values and beliefs influence their practice. We propose that this is a missing aspect of child safe practice. Including reflection on the impacts of personal and professional values and beliefs on the ability to implement evidence-informed approaches will increase nurses' capacity to maintain a child-focus.
Developing a Dignity in Care Questionnaire for older people (and their carer) when in hospital
(Flinders University, 2018-11-5) Heuzenroeder, Louise
Background The Dignity in Care Campaign, undergirded by the 10 Principles of Dignity in Care, has been strongly supported by clinicians and consumers in the United Kingdom. Surprisingly, the Campaign does not include a questionnaire for patients (and carers) to report on their experience of care, according to the 10 Principles of Dignity in Care. Objectives The questionnaire is being developed to enable older patients (and their carers) to measure their experience of receiving care according to the 10 Principles of Dignity in Care. Methods The research will utilise an exploratory sequential design in a four-stage process that includes a Delphi panel to assist in the development of the questionnaire, a pilot test of the questionnaire, extensive data collection to undertake reliability and validity testing and the development of an implementation plan. Results A Delphi panel of consumers, carers, clinicians, policy and instrument experts participated in three rounds of deliberations to develop the items to be included in the first draft of the questionnaire. This version of the questionnaire has been pilot tested with older patients (and their carers) at the Royal Adelaide Hospital. The questionnaire has been revised following the pilot test, and this post pilot version be used to collect data to test the validity and reliability of the questionnaire. Conclusions The Dignity in Care questionnaire has the potential to be used as a measure to report on the implementation of the first recommendation of the Clinical Guidelines for Dementia in Australia, which state The 10 Principles of Dignity in Care should be used as the standard by which care is delivered and evaluated.
Developing romantic and sexual relationships: Exploring the lived experiences of people with complex communication needs
(Flinders University, 2018-11-5) Sellwood, Darryl
This research investigates the lived experiences of people with complex communication needs (CCN) in developing romantic and sexual relationships. The United Nations Convention on the Rights of Persons With Disabilities (2013) asserts people with disabilities have the right to participate in social relationships equal to others and acknowledges the additional barriers they face in social relationships. This research asked: What are the lived experiences of people with complex communication needs in developing romantic or sexual relationships? What are the barriers and facilitators to developing romantic or sexual relationships for people with complex communication needs? Method: This research deliberately sought lived experiences and perspectives in an area that is seldom discussed openly. It used a Critical Hermeneutics phenomenological approach and Standpoint Theory to provide a deeper understanding of experiences. The inclusion criteria were, participants had to be 21 or older, have had a physical and communication disability since childhood, and use Augmentative and Alternative Communication (AAC). Results: Nine participants with CCN, aged from 21 to 70+, were interviewed. Twenty-one experiences were discussed. Three themes emerged from the analysis of these experiences: personal attributes, the traits people discussed as being influential in their relationships; intimate communication, the communication issues surrounding being intimate and engaging in sexual activity; and the power of others, the influences of the attitudes of others on relationships. Ableism was the predominant attitudinal barrier. Conclusion: The research suggests that people with CCN can successfully develop romantic and sexual relationships. However, ableist attitudes of others can have a significant impact on their relationships. The findings will offer new insights into the lives of adults with CCN.
Discovering the Continuity of Care for Indonesian Children with HIV: Using Grounded Theory
(Flinders University, 2018-11-5) Qurianti, Nuzul
Backgrounds The number of Indonesian children infected with human immunodeficiency virus (HIV) aged below 19 years old has cumulatively increased by 65.36% from 2011 to 2015. The government of Indonesia has developed and responded to a broad range of care policies and programs on managing this HIV epidemic. However, these care policies primarily focus on the adult, with little attention being paid to children. The objective of this presentation is to describe the methodological underpinning and the practical application of a constructivist grounded theory that is investigating the continuity of care for Indonesian children with HIV from the family and health care professional perspectives. Constructivist grounded theory is appropriate to explore the experiences, actions and events affecting the continuum of care provision for children with HIV in Indonesia. It implies a foundation of relativism and appreciates multiple truths or realities of subjectivism. This presentation will provide some background and give an overview of the constructivist grounded theory methods and process used, including data generation, initial coding, and memo-writing that adopts a mutual position between the researcher and the participants in the research process.
An empowerment approach to supporting self-care management skills for people with Type 2 Diabetes Mellitus in Indonesia: Research proposal
(Flinders University, 2018-11-5) Yulia, Yulia
An empowerment approach to supporting self-care management skills for people with Type 2 Diabetes Mellitus in Indonesia: Research proposal. Background: Indonesia currently has 10.3 million people with Type 2 diabetes mellitus (T2DM) making it one of the top ten countries globally, with projections that the number will increase to 16.7 million by 2045. People with T2DM require support to manage their disease. Little is known about how patients with T2DM are supported by health care professionals (HCPs) in Indonesia. Previous studies on patient empowerment interventions have focused on the micro-level of providing patient health education with less involvement of care teams in designing interventions. Objectives: This study aims to explore the existing approaches used in the care of people with T2DM and propose a model of patient care framed by an empowerment approach. Methodology: A two phase single case study strategy will be used. Phase one will explore the existing T2DM care in supporting patients' self-care management skills across three levels of health care services. Data collection will comprise of direct observations of interactions between patients, their families and HCPs, a review of clinical guideline documents and health education programs, and interviews with patients, their families, and HCPs. Thematic data analysis will be conducted at this phase. Results from phase one will inform the phase two development of an alternative model of T2DM care in supporting patients' self-care management skills. Phase two will include focus groups with expert HCPs working with people with T2DM to seek consensus for a newly developed patient empowerment approach. Summary: This presentation will outline this case study proposal in detail
Ethics and speaking up on matters of care - from an Aboriginal perspective
(Flinders University, 2018-11-5) Hodgson, Vicki
This abstract is about presenting to the higher research students of this college about the ethics of talking with Aboriginal people in research work. Presented will be the learning and development of a research model that has taken two distinctive pathways. The first pathway of walking in culture, knowing traditions, leaning into relationships and adhering to protocols and the other pathway is about the ethics of doing research in Aboriginal communities. This journey with its deeper learning of Aboriginal people and with its local perspective locates the researcher in a process that weaves from the conversations a story work into themes. As a bridge over these two distinctive knowledges is a guide for design and delivery with beneficial outcomes. A National framework for ethical conduct in research with Aboriginal and Torres Strait Islander peoples is that bridge. Speaking up about their lived experiences has been a small group of South Australia Aboriginal families that represent different clan groups and they care for one or more person(s) living with a disability in Adelaide. Capturing these lived stories is an Arabana woman researcher to achieve this outcome of ethical conduct.
Evidence of the Complete State Model of Mental Health and Implications on public policy and practice
(Flinders University, 2018-11-5) Iasiello, Matthew
The burgeoning economic and societal costs of mental ill-health have necessitated immediate action to reform mental health care in Australia. Current work to reduce the burden of mental illness is largely underpinned by the assumption that mental health and mental illness exist as opposite ends of the same spectrum. However, Keyes' (2005) landmark publication revealed that mental illness and positive mental health (wellbeing) are two separate, correlated, unipolar dimensions. Thus, mental illness and mental health are related concepts, but are not two opposite ends of the same spectrum as was previously thought. This model was named the complete state model of mental health, and posits that an individual has'complete mental health' when they have both a high level of wellbeing and a low level (or no diagnosis) of mental illness. Since Keyes' publication, the model has been investigated through a wide range of approaches, in different contexts, and with various findings and conclusions. A systematic scoping review was performed to amalgamate and synthesise the research on the complete state model, aiming to examine the evidence of the model's validity, and to pragmatically summarise the implications of the model. Results of this scoping review will be presented, with a key focus on the quality of extant literature on the model, and a practical summary of the implications for policy makers and practitioners. By transforming our understanding of the relationship between mental health and mental illness, the complete state model could underpin significant mental health reform in the future.
Exploring the care needs of stroke survivors and family carers in hospital to home transition
(Flinders University, 2018-11-5) Chen, Langduo
Background Hospital to home transition is the most stressful period for stroke survivors and family carers, especially in the context of shortened hospital stay and early discharge. They face enormous challenges to adapt to home care environments for continuing recovery. They also encounter great difficulties in exploring suitable rehabilitation and care services. Studies on determining and meeting their care needs and expectations in this transition period are much needed to enhance consumer-directed transition care. Aim To explore stroke survivors' and family carers' experiences, perspectives and expectations in transition care and rehabilitation. The objectives are: 1. to explore enablers and barriers in transition care from the perspectives of stroke survivors and family carers in a global context; 2. to understand the experience, perceptions and expectations of stroke survivors and family carers during hospital to home transition in an Australian context; 3. to understand healthcare professionals' perspectives of approaches to identify and meet transition care and rehabilitation needs of the consumers; 4. to develop an evidence-informed hospital to home transition care model and pathways to enhance consumer-directed transition care and rehabilitation services. Study plan A two-stage study will be conducted. In Stage 1, a systematic review using meta-synthesis of qualitative studies will be undertaken to address objectives 1 and 4. In Stage 2, a qualitative study informed by Gadamer's phenomenological hermeneutics will be conducted to address objectives 2-4. In-depth interviews with stroke survivors and family carers, and focus groups with healthcare professionals involved in transition care and rehabilitation services will be applied to collect data.
Exploring Women's Experience of Wellbeing in the Cyclone Shelters of Bangladesh
(Flinders University, 2018-11-5) Chowdury, Tazrina
Background- Bangladesh has a small land area of 147,570 sq. km with a population of 160.80 million, comprising 80.50 million males and 80.30 million females. The total coastal area of Bangladesh is about 47,201 sq. km, almost 32% of the country, accommodating almost 50 million people, majority living below poverty line. This cause a huge group of population exposed to frequent cyclones. Cyclone evacuation centres have been built for affected people. But in many cases these shelters fail to ensure safety, security and basic needs of evacuees. As Bangladesh is among the lowest positioned countries in gender equity, women tend to be more vulnerable in these shelters. So, it is important to understand, from the women's perspective, what it is like to be an evacuee in a shelter and therefore in what ways this experience can be improved. Methodology- As phenomenology describes existential phenomena such as the experience of living in an evacuation centre and illuminates what it is like, phenomenology would be a suitable methodological approach and philosophical framework of the research. Methods/Design- Adult women who have lived experience of staying in cyclone shelters will be recruited from the study area for in-depth interviews. Identities of the participants will be kept confidential and participants will have their freedom to discontinue their participation at any point without further consequences. Thematic analysis will be used to interpret interviews and process the interviews to extract findings. Participants' experiences would be segmented and specified with significant phrases based on their used terms to describe an event or experience. Conclusion- This research will produce knowledge that assists the Government of Bangladesh to improve the existing cyclone preparedness, relief and rehabilitation plans and will provide directions for further research in the field of women and disaster resilience.
Food service satisfaction in aged care facilities: Development of a toolkit of instruments for the measurement of change
(Flinders University, 2018-11-5) Pankhurst, Morgan
Introduction: Although the average life span of Australian citizens is increasing, the final ten years may be accompanied by illness and disability thereby increasing the demand for residential aged care. Satisfaction with food service is a major factor in overall satisfaction and is important for the resident, resident's family, staff, cooks and management of the facility. There are currently limited valid and reliable tools available for measuring this construct and most tools investigate only the resident's perspective. As nursing homes are a complex system, a key gap is investigating other stakeholders that contribute to the food service setting as ultimately, this impacts the experience of the resident. Methods: Mixed method study underpinned by systems theory utilising qualitative interviews with stakeholders to develop quantitative instruments for measuring satisfaction. Transcripts will be analysed thematically to understand the factors (themes) relevant to stakeholders. Items for each questionnaire will be developed and content validity determined through an expert panel. Ethics approval has been obtained to recruit participants in nursing homes across Australia. Each instrument will undergo test/retesting and factor analysis will be conducted using SPSS to refine the tool. Implications: The development of a tool kit of instruments to measure change will enable residential aged care facilities to monitor quality improvement and detect areas of dissatisfaction within the food service system. Further, the revised Aged Care Quality Standards have a focus on stakeholder engagement and require homes to provide evidence of same, this tool kit will provide a valid and reliable way of ensuring this criteria is met.
Goal setting with older adults: Client and staff experiences in Transition Care Program
(Flinders University, 2018-11-5) Baker, Nicky
Goals are a fundamental component of health care and promote person-centred practice by encouraging collaborative discussions and shared decision making. Transition Care Program (TCP) is a federally funded, goal-orientated, therapy-focussed program that provides additional time after an acute health event for older adults to improve functional ability and decide on final discharge destination. This research investigated the client and staff experiences of goals in TCP through interviews and focus groups. Through thematic analysis, clear intrinsic and extrinsic facilitators were identified, including the visceral pull of 'home' and the effectiveness of explicit, consistent goal language. Client-related barriers emerged, such as the physical, cognitive and emotional effects of fatigue. These were compounded by service barriers. This research provides opportunity to improve person-centred care for older adults by integrating consistent language, addressing service barriers in clinical practice and incorporating client goals into the service KPIs.
The Health Action Process Approach model for understanding parents' reflective motivation towards reducing unhealthy foods
(Flinders University, 2018-11-5) Johnson, Brittany
Aim This study aimed to understand the relationships between, and relative importance of, constructs of the Health Action Process Approach (HAPA) model and children's intake of unhealthy foods. Background Parents play a key role in shaping children's eating habits and are an ideal target for interventions to reduce children's currently excessive unhealthy food intake. To change provision behaviours parents need to be sufficiently motivated, in addition to having the knowledge and resources. The HAPA model is a framework covering important aspects of behaviour change motivation. Methods Australian parents completed a cross-sectional online survey containing parent motivation, child dietary intake and socio-demographics, using validated tools. Structural equation modelling was performed based on the HAPA model, including constructs of risk perception, outcome expectancies, self-efficacy, intention and planning. Results Four hundred and ninety-five parents completed the online survey. Model of fit statistics (CMIN 210.033, df 83, p<0.001; CFI 0.956; TLI 0.936; RMSEA 0.056, PCLOSE 0.153; SRMR 0.0601) supported the HAPA model as a suitable model, with parental motivation accounting for 9.2% of children's unhealthy food intake. The largest relationships were seen between self-efficacy constructs (action to maintenance, beta .69; maintenance to recovery, beta .70), and between maintenance self-efficacy to planning (beta .82). Secondary intervention targets identified were intention (to planning, beta .21) and planning (to intake, beta -.32). Conclusion The HAPA model is a promising framework for examining parental motivation towards limiting unhealthy food provision. Future interventions should include strategies to enhance parent's self-efficacy, intention and plans for reducing unhealthy foods.
How do diverse stakeholder groups perceive the activities of Non-Government Organisations working with disadvantaged children in Siem Reap, Cambodia.
(Flinders University, 2018-11-5) Ankers, Matthew
The focus of this presentation are the theories of social constructionism, postcolonialism and the social construction of the child and how these theoretical ideas are used to inform data collection and analysis in my thesis. Firstly, my thesis investigates key stakeholder groups affected by Non-Government Organisation work with disadvantaged children in Siem Reap, Cambodia. Social constructionism is drawn on to demonstrate how a relative positioning can aid the investigation of multiple groups engaged with the same phenomena of interest. Secondly, social constructionism and postcolonialism are proposed as acting as a lens to help identify aspects of Cambodian discourse that may reflect the impact of French colonialism and the Khmer Rouge. Specifically, postcolonialism critique of European constructions of the 'self' and 'other' will be used as a foundation for analysis of the data to look for similar socially constructed dualisms. These dualisms may include 'developed/undeveloped', 'humanitarian/sufferer' or in reference to the Khmer Rouge in an 'us/them' mentality. Finally, literature on the thesis topic is limited with regards to the voice of the child, with the majority of research focused on the adult's voice. The social construction of the child by James and Prout (2015) suggests that the child's voice in research should be more than a by-product of adult research as they are social actors with influence in their own right. As children are a focus of this study, the theory is used to help understand how children are constructed by the adult participants and how this may be used, along with the child voice, to help this cohort have a greater say in research and decision-making processes.
How do persons with dementia experience 'epistemic injustice'?
(Flinders University, 2018-11-5) Young, Jessica
Whenever we hear a speaker assert something, we form judgments both about the credibility of the speaker and of what they said. When a hearer attributes too little credibility to a speaker, perhaps due to a prejudice they hold, the speaker is said to suffer an injustice. This kind of injustice is epistemic in nature: the speaker is harmed in their capacity as a 'knower'. Philosopher Miranda Fricker (2007) calls this 'epistemic injustice'. This theoretical concept has had recent uptake across health fields, including in dementia care. Whilst the concept is a useful tool to considering the injustice a person may experience, Fricker offers only a theoretical exploration of how epistemic injustice might manifest in everyday life, often using literary examples. Similarly, the existing work in epistemic injustice and dementia often relies on anecdotal evidence to support claims about the injustice persons with dementia experience. The aim of this paper is to demonstrate that one way to confirm, elaborate or indeed challenge the assumptions embodied in the concept of epistemic injustice would be to look to analysis of everyday interactions involving persons with dementia, using a Conversation Analytic approach. Heritage (2013), in his work on 'the epistemics of interaction', offers an empirically grounded method to exploring how interactants negotiate their relative epistemic positions ... in and through turns at talk and sequences of interaction (p. 556). There appears to be a compatibility between the concepts of epistemic injustice and epistemics of interaction. Although the concepts come from disparate fields of thought (i.e., philosophy and conversation analysis), both are concerned with how persons do or do not do justice to each other. Considered together, these concepts may illuminate how epistemic injustice manifests in the everyday lives of persons with dementia.
Hypertension management for community dwelling older people with diabetes in Nanchang, China: a cluster randomised controlled trial
(Flinders University, 2018-11-5) Tu, Qiang
Background Although China has a large number of older people living with diabetes and hypertension, the primary care system is underdeveloped and so management of these conditions in community care settings is suboptimal. Methods A cluster randomized controlled trial was conducted to randomly allocate 10 wards from four hospitals in Nanchang to either an intervention group (N=5) or a usual care group (N=5). In total, 270 patients were recruited in the study. The intervention included individualized self-care education and medication management prior to discharge and in the 6-month follow-up in community health service centres. A multilevel mixed-effect linear regression model was applied to compare the changes in health outcomes between the intervention and usual care groups. Results The intervention group demonstrated a statistically significant decrease of a mean systolic blood pressure of 10.7 mm Hg (95%CI: -14.2 to -7.1, P<0.001) and a mean diastolic blood pressure of 4.1 mm Hg (95% CI: -6.2 to -2.0, P<0.001) over 6 months as compared to the usual care group. Findings also demonstrated significant improvements of HbA1c, hypertension knowledge, diabetes knowledge, treatment adherence, quality of life, the prevention of adverse events and hospital readmission at 6 months in the intervention group compared to the usual care group. Conclusion A hypertension management program that targeted individualized self-care and medication management improved hypertension control for older people with diabetes in the community care setting.
Identifying food group targets to improve the diet quality of individuals
(Flinders University, 2018-11-5) Haddad, Joyce
Aim/Objective To distinguish how diet quality components vary between individual cases, and sub-groups of personal characteristics. Introduction/Background Literature Diet is a key modifiable risk factor for non-communicable diseases. Interventions have commonly focused on the same food groups to improve health outcomes, with little effectiveness. Tailoring dietary interventions to personal characteristics may be more beneficial. Methodology Cross-sectional, data-driven analysis with a priori knowledge of self-reported food intake data was conducted. Methods/Design – includes setting, sampling, ethical review, data collection and data analysis Diet quality data was analysed from 198,637 Australian adults, collected using a validated online short food survey. Overall and individual component scores were compared between individual cases and sub-groups (diet quality quintiles, age, gender, weight or a mixture) using percentage agreement and Cohen’s kappa. Findings/Results Of the nine diet quality components, four key components were frequently shown as the lowest scoring at both the individual and sub-groups levels: Variety, Dairy, Discretionary, Healthy fats. The percentage agreement and kappa coefficients only improved marginally as sub-group levels became more personalised, when compared to individual cases. Dairy and healthy fats fell in the bottom four scores 66% and 58% of the time for all groups, respectively. Discretionary fell in the bottom four scores for all sub-groups 68% of the time (k=0.16, p<0.01) and variety frequency agreement also remained unchanged (k=0.35, p<0.01). The same four lowest scoring components occurred ~60% of the time for all groups. Conclusion/Summary Using personal characteristics may be an effective way to personalise interventions, however complexity of personalisation may not be needed beyond demographic characteristics. Implications/recommendations for Practice To consider in which order the frequently occurring lowest scoring food groups should be targeted.

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