Community assessment workshops: a group method for gathering client experiences of health services

The contribution of group work to the goals of comprehensive primary health care

ISSUE ADDRESSED

Group work, such as peer support and health promotion is an important strategy available to comprehensive primary health care. However, group work and how it contributes to the goals of comprehensive primary health care has been under-researched and under-theorised.

METHODS

In this 5-year study, we partnered with seven Australian primary health care services, and drew on service reports, two rounds of staff interviews (2009-2010 and 2013, N = 68 and 55), 10 community assessment workshops (N = 65), a client survey (N = 315) and case tracking of clients with diabetes (N = 184, plus interviews with 35 clients, and five practitioners) and clients with depression (N = 95, plus interviews with 21 clients, and 11 practitioners). We conducted a rapid literature review of existing research on group work, and developed a model showing a group work reinforcing cycle. We examined the nature of the groups run, and the benefits staff and clients perceived.

RESULTS

Benefits were grouped into four main themes: (a) social support, including for clients of the Aboriginal services, opportunities to celebrate their cultural identity, (b) improving skills and knowledge, (c) increasing access to services and (d) empowerment and solidarity.

CONCLUSIONS

The perceived collective and individual benefits aligned with a comprehensive primary health care vision. However, the individualism stressed by neoliberal-driven health policy threatened the provision of group work and its potential collectivist benefits.

SO WHAT

There are multiple benefits of group work in primary health care that cannot be achieved through individual work, highlighting the importance of policy and organisational support for group work.

Case study of a decolonising Aboriginal community controlled comprehensive primary health care response to alcohol-related harm

OBJECTIVE

This paper provides a case study of the responses to alcohol of an Aboriginal Community Controlled Health Service (The Service), and investigates the implementation of comprehensive primary health care and how it challenges the logic of colonial approaches.

METHODS

Data were drawn from a larger comprehensive primary health care study. Data on actions on alcohol were collected from: a) six-monthly service reports of activities; b) 29 interviews with staff and board members; c) six interviews with advocacy partners; and d) community assessment workshops with 13 service users.

RESULTS

The Service engaged in rehabilitative, curative, preventive and promotive work targeting alcohol, including advocacy and collaborative action on social determinants of health. It challenged other government approaches by increasing Aboriginal people's control, providing culturally safe services, addressing racism, and advocating to government and industry.

CONCLUSIONS

This case study provides an example of implementation of the full continuum of comprehensive primary health care activities. It shows how community control can challenge colonialism and ongoing power imbalances to promote evidence-based policy and practice that support self-determination as a positive determinant for health. Implications for public health: Aboriginal Community Controlled Health Services are a good model for comprehensive primary health care approaches to alcohol control.

Physical activity promotion in Manitoba: Strengths, needs, and moving forward

Objectives:

To present findings of a workshop with physical activity professionals in Manitoba, Canada, to facilitate the enhancement of physical activity promotion efforts by exploring (1) effective physical activity strategies, (2) methods to strengthen physical activity strategies, (3) challenges in implementing physical activity strategies in Manitoba, and (4) strategies to support collaboration.

Methods:

The Manitoba Research Chair in Primary Prevention hosted a workshop for 54 stakeholders in Manitoba. Qualitative and quantitative data obtained from the workshop were analyzed using qualitative content analysis and univariate descriptive analysis. Purposive sampling was used to recruit participants with diverse experiences in physical activity promotion.

Results:

Strategies were identified and presented according to the socioecological model. Community assessment and community engagement, regional partnerships, capacity building, and mitigation of barriers characterized the discussion. In addition, discussions emphasized the need for the consistent and comprehensive application of a provincial physical activity action plan. The workshop ended with a discussion of the importance of collaboration to improve physical activity programs and initiatives.

Conclusion:

Several common needs were identified that reflect topics from the broader literature. Collaborations and insights from workshop participants provide direction to target increased physical activity support and programming across disciplines, sectors, and regions.

Primary health care reform, dilemmatic space and risk of burnout among health workers

Health system changes may increase primary health care workers' dilemmatic space, created when reforms contravene professional values. Dilemmatic space may be a risk factor for burnout. This study partnered with six Australian primary health care services (in South Australia: four state government-managed services including one Aboriginal health team and one non-government organisation and in Northern Territory: one Aboriginal community-controlled service) during a period of change and examined workers' dilemmatic space and incidence of burnout. Dilemmatic space and burnout were assessed in a survey of 130 staff across the six services (58% response rate). Additionally, 63 interviews were conducted with practitioners, managers, regional executives and health department staff. Dilemmatic space occurred across all services and was associated with higher rates of self-reported burnout. Three conditions associated with dilemmatic space were (1) conditions inherent in comprehensive primary health care, (2) stemming from service provision for Aboriginal and Torres Strait Islander peoples and (3) changes wrought by reorientation to selective primary health care in South Australia. Responses to dilemmatic space included ignoring directives or doing work 'under the radar', undertaking alternative work congruent with primary health care values outside of hours, or leaving the organisation. The findings show that comprehensive primary health care was contested and political. Future health reform processes would benefit from considering alignment of changes with staff values to reduce negative effects of the reform and safeguard worker wellbeing.

Counsellors' practices in donor sperm treatment

When intended parents choose to have donor sperm treatment (DST), this may entail wide-ranging and long-lasting psychosocial implications related to the social parent not having a genetic tie with the child, how to disclose donor-conception and future donor contact. Counselling by qualified professionals is recommended to help intended parents cope with these implications. The objective of this study is to present findings and insights about how counsellors execute their counselling practices. We performed a qualitative study that included 13 counsellors working in the 11 clinics offering DST in the Netherlands. We held a focus group discussion and individual face-to-face semi-structured interviews, which were fully transcribed and analysed using thematic analysis. The counsellors combined screening for eligibility and guidance within one session. They acted according to their individual knowledge and clinical experience and had different opinions on the issues they discussed with intended parents, which resulted in large practice variations. The counsellors were dependent on the admission policies of the clinics, which were mainly limited to regulating access to psychosocial counselling, which also lead to a variety of counselling practices. This means that evidence-based guidelines on counselling in DST need to be developed to provide consistent counselling with less practice variation.

Patient experience of expanded-scope-of-practice musculoskeletal physiotherapy in the emergency department: a qualitative study

Objective The increasing number of people presenting to hospital with musculoskeletal conditions places pressure on existing services, and has resulted in expanding the scope of practice of musculoskeletal physiotherapists working in emergency departments (ED). The aim of the present study was to qualitatively explore the perspectives of patients presenting with an isolated musculoskeletal condition seen by a musculoskeletal physiotherapist in the ED of two Australian hospitals situated in contrasting geographical locations. Methods Semistructured interviews were conducted with nine participants from a major metropolitan hospital and 16 participants from a remote hospital. Interviews were transcribed, coded and analysed using a thematic approach. Results The emerging themes from the two datasets were remarkably similar, so the final themes were merged. The major themes were: (1) participants were satisfied with the process and service provided by the physiotherapist; (2) the personal attributes of the physiotherapists were important to participants; (3) participant confidence in the skills and attributes of the physiotherapist made them a suitable alternative to a doctor in these situations; and (4) the timing and efficiency of the physiotherapy service was better than expected and valued. Conclusions Participants from both settings described their experience in positive terms, reflecting satisfaction with their management by an expanded scope of practice musculoskeletal physiotherapist. What is known about the topic? To date, the literature evaluating expanded scope of practice by physiotherapists (or advanced musculoskeletal physiotherapy services) has consistently reported positive participant satisfaction. Participant satisfaction has been typically restricted to the use of standardised questionnaires. What does this paper add? To our knowledge, this is the first study to describe the participant experience and perception of being seen by an expanded-scope-of-practice physiotherapist. The study found that the perceptions of participants from two vastly different geographic locations were remarkably similar and that participants were very receptive to seeing a physiotherapist instead of a doctor. The emergent themes highlight what is important to people when they attend the ED and indicate that participants seen by a musculoskeletal physiotherapist had a positive experience regardless of whether it was in a metropolitan or remote hospital. What are the implications for practitioners? Patient-centred care should be an underlying principle of all models of service delivery in healthcare. Understanding what is important to patients is imperative to ensure they have a positive experience, particularly when new models of service are being introduced. This study provides valuable information for practitioners about what is important for the patient to have a positive experience when they visit the ED. Participants in this study valued receiving a timely and efficient service in addition to acknowledging the personal attributes, knowledge and expertise of the physiotherapist. The implications for practitioners are that an expanded scope of practice physiotherapy service in the ED can provide a positive patient experience.

Cultural respect strategies in Australian Aboriginal primary health care services: beyond education and training of practitioners

OBJECTIVE

There is little literature on health-service-level strategies for culturally respectful care to Aboriginal and Torres Strait Islander Australians. We conducted two case studies, which involved one Aboriginal community controlled health care service and one state government-managed primary health care service, to examine cultural respect strategies, client experiences and barriers to cultural respect.

METHODS

Data were drawn from 22 interviews with staff from both services and four community assessment workshops, with a total of 21 clients.

RESULTS

Staff and clients at both services reported positive appraisals of the achievement of cultural respects. Strategies included: being grounded in a social view of health, including advocacy and addressing social determinants; employing Aboriginal staff; creating a welcoming service; supporting access through transport, outreach, and walk-in centres; and integrating cultural protocol. Barriers included: communication difficulties; racism and discrimination; and externally developed programs.

CONCLUSIONS

Service-level strategies were necessary to achieving cultural respect. These strategies have the potential to improve Aboriginal and Torres Strait Islander health and wellbeing.

IMPLICATIONS

Primary health care's social determinants of health mandate, the community controlled model, and the development of the Aboriginal and Torres Strait Islander health workforce need to be supported to ensure a culturally respectful health system.