Flinders Human Behaviour and Health Research Unit - Collected Works
Permanent URI for this collection
1 - 6 of 131
ItemDo guidelines provide evidence-based guidance to health professionals on promoting developmentally appropriate chronic condition self-management in children? A systematic review(Sage, 2018-09-23)Objectives To determine whether evidence-based practice guidelines promote developmentally appropriate chronic condition self-management for children with asthma, type 1 diabetes mellitus, and cystic fibrosis. Methods Systematic review of clinical guidelines current as at 22 September 2017, including assessment of quality of each guideline using the iCAHE ‘Guideline Quality Checklist’, and mapping of the supporting evidence. Results Fifteen guidelines were identified: asthma (n=7) and type 1 diabetes mellitus (n=7), CF (n=1). Guideline quality was variable, and 11 different grading systems were used. In total, there were 28 recommendations promoting age/developmental considerations. Recommendations focused on: collaboration (n=15), chronic condition self-management education (n= 17), clinicians’ skills (n= 4); personalized action plans (n=3), problem-solving (n=2); and the assessment of children’s chronic condition self-management needs (n=3). Developmental transitions are highlighted as important time points in some guidelines: preschool (n=2), and adolescence (n=3). All guidelines encouraged triadic partnerships between children, adult caregivers and clinicians. Evidence supporting the developmental aspects of the guidelines’ recommendations was poor; only 14 out of 57 journals listed as evidence were concordant. Discussion Current guidelines articulate that developmentally appropriate chronic condition self-management is important; however, more work needs to be done to translate the concept into practical clinical tools.
ItemAmbulance Employees Association – Scoping Literature Reviews drawing on qualitative literature to address the physical, psychological, psychobiological, and psychosocial health of operational ambulance staff and interventions to address the impact of workplace stressors.(Flinders University, 2019-04)Paramedics have in many ways been ‘the forgotten profession’ within the healthcare system. This situation has arisen due to the tendency to traditionally ‘silo’ health professions into their specific disciplines. It is also a consequence of the physical separation of out-of-hospital care from hospital and other community clinical work that has tended to create a barrier to inter-professional understanding and collaboration, and to the fact that, in Australia, paramedics have often been in a portfolio other than health. The result has been that ambulance personnel and organisations are faced with the legacy of, and negative effects on, mental well-being that their role and the environments they work within create. The nature of the work, the uncontrolled and often unpredictable environments, the everyday experience of trauma, and the cumulative nature of that trauma all play a key role in the development and impact of mental distress and psychological injury. Organisational and occupational factors such as workload, work demands, shift work, limited time for debriefing or downtime, the hierarchical nature of supervision, and the lack of recognition are clearly shown to have effects on the well-being of ambulance personnel that are as significant as, if not greater than, the nature of the work itself. The following excerpt from a submission to the Senate Committee Inquiry into the Mental health and well-being of emergency first responders succinctly identifies the operational and organisational factors which influence mental health and well-being within the pre-hospital setting. This commissioned review brings together the available literature from both peer-reviewed articles, public sources, and senate submissions to outline the effect of emergency medical response work on the psychological, psychosocial, and physical health of paramedics, ambulance officers, ambulance volunteers, and call-takers.
ItemExploring General Practitioners’ Views and Experiences of Providing Care to People with Borderline Personality Disorder in Primary Care: A Qualitative Study in Australia(MDPI, 2018-12-06)The prevalence of people seeking care for Borderline Personality Disorder (BPD) in primary care is four to five times higher than in the general population. Therefore, general practitioners (GPs) are important sources of assessment, diagnosis, treatment, and care for these patients, as well as important providers of early intervention and long-term management for mental health and associated comorbidities. A thematic analysis of two focus groups with 12 GPs in South Australia (in discussion with 10 academic, clinical, and lived experience stakeholders) highlighted many challenges faced by GPs providing care to patients with BPD. Major themes were: (1) Challenges Surrounding Diagnosis of BPD; (2) Comorbidities and Clinical Complexity; (3) Difficulties with Patient Behaviour and the GP–Patient Relationship; and (4) Finding and Navigating Systems for Support. Health service pathways for this high-risk/high-need patient group are dependent on the quality of care that GPs provide, which is dependent on GPs’ capacity to identify and understand BPD. GPs also need to be supported sufficiently in order to develop the skills that are necessary to provide effective care for BPD patients. Systemic barriers and healthcare policy, to the extent that they dictate the organisation of primary care, are prominent structural factors obstructing GPs’ attempts to address multiple comorbidities for patients with BPD. Several strategies are suggested to support GPs supporting patients with BPD.
ItemExtinction of gambling cue-reactivity: A pilot study in a problem gambling treatment setting(MedDocs Publishers, 2018-11-14)Clinical interventions which focus on extinction learn-ing have been shown to reduce craving and relapse in substance related and behavioural addictions. This paper reports a small pilot study with 20 problem gamblers re-ferred for treatment by a local court diversion program. We investigated the use of portable heart rate monitors to measure the effectiveness of Cue Exposure Therapy (CET) in extinguishing gambling cue-reactivity. Cue-reactivity pro-cedures consisted of a relaxation period followed by in-vivo exposure with response prevention in a gambling environ-ment. Cue exposure therapy was manualised. Dependent measures comprised both self-report (gambling urge and problem gambling questionnaire) and physiologic measures (heart rate). Significant increases in heart rate were ob-served during in-vivo pre-CET but not post-CET (p < 0.001). Following CET, significant reductions across all dependent variables were observed (p ≤ 0.001) with within-group ef-fect sizes ranging between r = -.55 and -.61. Overall, the results of this small pilot study support the feasibility and acceptability of the use of portable heart rate monitors to observe the extinction of gambling cue-reactivity. Portable heart rate monitors may provide a novel and useful tool for therapists and their problem gambling patients to monitor gambling cue-reactivity during treatment. Further research is needed to evaluate whether extinction of cue-reactivity can reduce problem gambling relapse.
ItemDeveloping a screening tool to recognise social determinants of health in Australian clinical settings(Sax Institute, 2018-11-01)Objective and importance of study: The importance of social determinants for individual health recovery outcomes is well recognised in public health. However, no succinct social health screening (SHS) tool exists that has beendeveloped with information from clinicians and patients. This proof-of-concept study asked health consumer advocates, patients and clinicians about their attitudes towards social determinants of health (SDH) and the usefulness of an SHS tool for collecting these data for use in clinical settings. We then developed a streamlined SHS tool to bring this knowledge to clinicians, and conducted a proof-of-concept trial to check its acceptability with patients and clinicians. Methods: This qualitative study had two stages. Stage 1 involved focus groups with health consumer advocates and interviews with clinicians about the draft SHS tool. Stage 2 involved refining the SHS tool and piloting it with 50 new patients in anxiety disorder and sleep disorder clinics, which often treat patients living in disadvantaged socio-economic conditions. The tool was evaluated by patients and clinicians. The data were analysed using framework analysis. Results: All interviewees were positive about the benefits of addressing SDH in clinical practice to help reduce health inequities. We developed and refined an SHS tool that could be completed by patients (‘self-complete’). Conclusion: The response to introducing an SHS tool in clinical settings was positive. Further piloting across diverse clinical settings is required to determine efficacy. This tool promotes public health equity outcomes by improving clinician understanding of individual social circumstances, and has the potential to provide useful epidemiological data on SDH.
ItemTrust and Community Treatment Orders(Frontiers in Psychiatry, 2019-05-20)There are conflicting views about the benefits of community treatment orders (CTOs) for people with mental illness. While there is a significant literature on the coercive nature of CTOs, there is less on the impact that CTOs have upon trust. A recovery-oriented approach requires a trusting therapeutic relationship and the coercion inherent in the CTO process may make it difficult for trust to be built, nurtured, and sustained between workers and patients. Our aim was therefore to examine the role of trust within the CTO experience for mental health workers and patients on CTOs. Methods: We conducted a thematic discourse analysis of 8 in-depth interviews with people who were currently on a CTO and 10 interviews with multi-disciplinary mental health workers in Adelaide, Australia (total N = 18 interviews). The interviews were coded and analyzed with the assistance of a patient representative. The findings reveal the challenges and opportunities for trust within the coercive relationship of a CTO. Findings: We found that patients have diverse experiences of CTOs and that trust or mistrust played an import role in whether or not they found the CTO beneficial.