A controlled evaluation of social prescribing on loneliness for adults in Queensland: 8-week outcomes

Introduction

There have been few controlled evaluations of Social Prescribing (SP), in which link workers support lonely individuals to engage with community-based social activities. This study reports early outcomes of a trial comparing General Practitioner treatment-as-usual (TAU) with TAU combined with Social Prescribing (SP) in adults experiencing loneliness in Queensland.

Methods

Participants were 114 individuals who were non-randomly assigned to one of two conditions (SP, n = 63; TAU, n = 51) and assessed at baseline and 8 weeks, on primary outcomes (loneliness, well-being, health service use in past 2 months) and secondary outcomes (social anxiety, psychological distress, social trust).

Results

Retention was high (79.4%) in the SP condition. Time × condition interaction effects were found for loneliness and social trust, with improvement observed only in SP participants over the 8-week period. SP participants reported significant improvement on all other outcomes with small-to-moderate effect sizes (ULS-8 loneliness, wellbeing, psychological distress, social anxiety). However, interaction effects did not reach significance.

Discussion

Social prescribing effects were small to moderate at the 8-week follow up. Group-based activities are available in communities across Australia, however, further research using well-matched control samples and longer-term follow ups are required to provide robust evidence to support a wider roll out.

Medical evidence assisting non-fatal strangulation prosecution: a scoping review

OBJECTIVES

Non-fatal strangulation (NFS) is a serious form of gendered violence that is fast becoming an offence in many jurisdictions worldwide. However, it often leaves little or no externally visible injuries making prosecution challenging. This review aimed to provide an overview of how health professionals can support the prosecution of criminal charges of NFS as part of regular practice, particularly when externally visible injuries are absent.

METHOD

Eleven databases were searched with terms related to NFS and medical evidence in health sciences and legal databases. Eligible articles were English language and peer reviewed, published before 30 June 2021; sample over 18 years that had primarily survived a strangulation attempt and included medical investigations of NFS injuries, clinical documentation of NFS or medical evidence related to NFS prosecution.

RESULTS

Searches found 25 articles that were included for review. Alternate light sources appeared to be the most effective tool for finding evidence of intradermal injury among NFS survivors that were not otherwise visible. However, there was only one article that examined the utility of this tool. Other common diagnostic imaging was less effective at detection, but were sought after by prosecutors, particularly MRIs of the head and neck. Recording injuries and other aspects of the assault using standardised tools specific for NFS were suggested for documenting evidence. Other documentation included writing verbatim quotes of the experience of the assault and taking good quality photographs that could assist with corroborating a survivor's story and proving intent, if relevant for the jurisdiction.

CONCLUSION

Clinical responses to NFS should include investigation and standardised documentation of internal and external injuries, subjective complaints and the experience of the assault. These records can assist in providing corroborating evidence of the assault, reducing the need for survivor testimony in court proceedings and increasing the likelihood of a guilty plea.

Improving paediatric antimicrobial stewardship in remote and regional Queensland hospitals: development and qualitative evaluation of a tailored intervention for intravenous-to-oral antibiotic switching

OBJECTIVES

Timely intravenous-to-oral antibiotic switching for children is important for paediatric antimicrobial stewardship (AMS). However, low decision-making confidence and fragmentation of patient care can hamper implementation, with difficulties heightened regionally where AMS programmes for children are lacking. The aim of this study was to develop and evaluate user-led creation and implementation of an intervention package for early intravenous-to-oral switching at regional hospitals in Queensland, Australia.

DESIGN

Guided by theory, a four-phase approach was used to: (1) develop multifaceted intervention materials; (2) review materials and their usage through stakeholders; (3) adapt materials based on user-feedback and (4) qualitatively evaluate health workers experiences at 6 months postintervention.

SETTING

Seven regional hospitals in Queensland, Australia.

PARTICIPANTS

Phase 2 included 15 stakeholders; health workers and patient representatives (patient-guardians and Indigenous liaison officers). Phase 4 included 20 health workers across the seven intervention sites.

RESULTS

Content analysis of health worker and parent/guardian reviews identified the 'perceived utility of materials' and 'possible barriers to use'. 'Recommendations and strategies for improvement' provided adjustments for the materials that were able to be tailored to individual practice. Postintervention interviews generated three overarching themes that combined facilitators and barriers to switching: (1) application of materials, (2) education and support, and (3) team dynamics. Overall, despite difficulties with turnover and problems with the medical hierarchy, interventions aided and empowered antibiotic therapy decision-making and enhanced education and self-reflection.

CONCLUSIONS

Despite structural barriers to AMS for switching from intravenous-to-oral antibiotics in paediatric patients, offering a tailored multifaceted intervention was reported to provide support and confidence to adjust practice across a diverse set of health workers in regional areas. Future AMS activities should be guided by users and provide opportunities for tailoring tools to practice setting and patients' requirements.

Social prescribing link workers-A qualitative Australian perspective

Social prescribing (or community referral) is a model of healthcare designed to address social needs that contribute to poor health. At the heart of social prescribing programs is the link worker, who liaises between clients, health professionals and community organisations. Social prescribing is newly emerging in Australia but there are already calls for a large-scale roll out. This research, therefore, aimed to understand Australian link workers' role and skills required, to determine where such a workforce could be drawn from in Australia, and to identify what training and resources are needed to support this potential new workforce. To explore these questions, interviews were conducted with 15 link workers in Queensland, New South Wales and Victoria, and the transcripts were analysed using thematic analysis. Participants were predominantly female (87%); and primarily had qualifications in social work (47%) or nursing (27%). Three overarching themes were identified: (1) skills of successful social prescribing, identifying that link work requires multifaceted social and emotional skills; (2) workforce issues, presenting that link workers experienced challenges such as a lack of available support and training, lack of public awareness of social prescribing and a lack of sustained funding; and (3) job fulfilment, related to link workers' sense of reward and accomplishment from the job. We suggest that fostering job fulfilment in conjunction with the provision of increased support, training and security will reduce feelings of overwork and burnout among link workers and likely lead to longevity in the role. Social prescribing has the potential to be hugely beneficial to clients and the community and fulfilling for link workers, provided that sufficient advocacy and resources are put in place.

Reproductive coercion and abuse among pregnancy counselling clients in Australia: trends and directions

BACKGROUND

Reproductive coercion and abuse (RCA) interferes with a person's reproductive autonomy and can be classified into behaviours that are pregnancy promoting or pregnancy preventing (including coerced abortion). However, prevalence data are lacking, and little is known about whether particular forms of RCA are more or less common. The aims of our study were to explore how frequently people seeking pregnancy counselling reported RCA, the proportions reporting the different forms of RCA, and whether there were different trends based on a range of demographic factors.

METHODS

Data were collected from 5107 clients seeking counselling support for their pregnancy between January 2018 and December 2020 from two leading providers of pregnancy counselling and sexual and reproductive health services in Australia, Marie Stopes Australia and Children by Choice. Counsellors identified and recorded the presence of RCA and whether the behaviour was pregnancy promoting and/or pregnancy preventing. Demographic factors included age, and whether the person identified as being from a migrant or refugee community or as an Aboriginal and/or Torres Strait Islander person.

RESULTS

RCA was identified in 15.4% of clients, with similar proportions disclosing RCA towards pregnancy (6%) and towards pregnancy prevention or abortion (7.5%), and 1.9% experiencing RCA towards pregnancy and abortion concurrently. There were no differences based on age or whether the person identified as being from a migrant or refugee background, though people who identified as Aboriginal and/or Torres Strait Islander experienced RCA that was significantly more likely to be pregnancy promoting.

CONCLUSIONS

RCA is commonly disclosed by people seeking support in a pregnancy counselling context, and coercion and abuse is equally likely to be towards pregnancy promotion or pregnancy prevention/abortion. Given the prevalence and negative impacts of RCA, regardless of age and background, we recommend sensitive and culturally respectful enquiry around experiences of RCA be embedded in healthcare, health education, and health research.

A controlled evaluation of the effect of social prescribing programs on loneliness for adults in Queensland, Australia (protocol)

BACKGROUND

In social prescribing, link workers support individuals whose persistent health problems are exacerbated by loneliness by connecting them to community-based social activities. This approach is well established in the UK and is gaining attention in Australia. However, a major limitation of research to date has been a lack of theoretically informed and rigorous evaluations of social prescribing. We will address these points in this study, applying a social identity framework to examine the effects of group-based social prescribing (SP) activity compared to primary care treatment as usual (TAU).

METHODS

Ninety participants experiencing loneliness recruited from primary care services and community centres across five sites in Southeast Queensland will be assigned to one of two conditions (SP, TAU) and assessed at two timepoints (baseline, + 8 weeks). Individuals will be aged 18 years and over, have sufficient English language skills to provide consent, and at the time of recruitment they will not be experiencing acute symptoms or social issues that require urgent intervention. Primary outcomes are loneliness, mental well-being, and health service use (total number of GP, hospital, and allied health visits in the past 3 months). Secondary outcomes will assess social group processes, including number of important social groups, new group identification, multiple identity compatibility, and group-based support and emotion regulation.

DISCUSSION

This study will provide comprehensive data about the extent to which, and how, social prescribing to community-based group activities may help people to feel less lonely, more socially integrated, and healthy over the first 8 weeks. If effective, this social identity-informed model of social prescribing can be disseminated in communities across Australia.

TRIAL REGISTRATION

ANZCTR, Registered 8 June 2022 - Retrospectively registered, https://www.anzctr.org.au/ACTRN12622000801718.aspx.

Experiences of Reproductive Coercion in Queensland Women

Reproductive coercion is any interference with a person's reproductive autonomy that seeks to control if and when they become pregnant, and whether the pregnancy is maintained or terminated. It includes sabotage of contraceptive methods and intervention in a woman's access to health care. Our study sought to explore the prevalence and associations with reproductive coercion within Queensland, Australia, where legislation addressing domestic violence and abortion are largely state based and undergoing a period of law reform. The study was a retrospective analysis of 3,117 Queensland women who contacted a telephone counseling and information service regarding an unplanned pregnancy. All data were collected by experienced counselors regarding circumstances within a current pregnancy between January 2015 and July 2017. Overall, experience of current domestic violence was significantly more likely to co-occur with reproductive coercion (21.1%) compared with reproductive coercion identified in the absence of other domestic violence (3.1%). Furthermore, significantly more mental health issues were reported by 36.6% of women affected by reproductive coercion, compared with 14.1% of women with no reproductive coercion present. Disclosure for reproductive coercion, violence, and mental health issues was much higher among women who made a repeat contact to the counselors about their pregnancy (17.8%) compared with those who disclosed at first contact (5.9%). These findings demonstrate the importance for health services to ensure that appropriate screening (and re-screening) for reproductive coercion is completed as a distinct part of screening for violence during a health care relationship.

How Do Music Activities Affect Health and Well-Being? A Scoping Review of Studies Examining Psychosocial Mechanisms

Background: This scoping review analyzed research about how music activities may affect participants' health and well-being. Primary outcomes were measures of health (including symptoms and health behaviors) and well-being. Secondary measures included a range of psychosocial processes such as arousal, mood, social connection, physical activation or relaxation, cognitive functions, and identity. Diverse music activities were considered: receptive and intentional music listening; sharing music; instrument playing; group singing; lyrics and rapping; movement and dance; and songwriting, composition, and improvisation.

Methods: Nine databases were searched with terms related to the eight music activities and the psychosocial variables of interest. Sixty-three papers met selection criteria, representing 6,975 participants of all ages, nationalities, and contexts.

Results: Receptive and intentional music listening were found to reduce pain through changes in physiological arousal in some studies but not others. Shared music listening (e.g., concerts or radio programs) enhanced social connections and mood in older adults and in hospital patients. Music listening and carer singing decreased agitation and improved posture, movement, and well-being of people with dementia. Group singing supported cognitive health and well-being of older adults and those with mental health problems, lung disease, stroke, and dementia through its effects on cognitive functions, mood, and social connections. Playing a musical instrument was associated with improved cognitive health and well-being in school students, older adults, and people with mild brain injuries via effects on motor, cognitive and social processes. Dance and movement with music programs were associated with improved health and well-being in people with dementia, women with postnatal depression, and sedentary women with obesity through various cognitive, physical, and social processes. Rapping, songwriting, and composition helped the well-being of marginalized people through effects on social and cultural inclusion and connection, self-esteem and empowerment.

Discussion: Music activities offer a rich and underutilized resource for health and well-being to participants of diverse ages, backgrounds, and settings. The review provides preliminary evidence that particular music activities may be recommended for specific psychosocial purposes and for specific health conditions.

The Relationship of Gender Roles and Beliefs to Crying in an International Sample

This study aimed to (1) investigate the variation in self ascription to gender roles and attitudes toward gender roles across countries and its associations with crying behaviors, emotion change, and beliefs about crying and (2) understand how the presence of others affects our evaluations of emotion following crying. This was a large international survey design study (N = 893) conducted in Australia, Croatia, the Netherlands, Thailand, and the United Kingdom. Analyses revealed that, across countries, gender, self-ascribed gender roles, and gender role attitudes (GRA) were related to behavioral crying responses, but not related to emotion change following crying. How a person evaluates crying, instead, appeared to be highly related to one’s beliefs about the helpfulness of crying, irrespective of gender. Results regarding crying when others were present showed that people are more likely both to cry and to feel that they received help around a person that they know, compared to a stranger. Furthermore, closeness to persons present during crying did not affect whether help was provided. When a crier reported that they were helped, they also tended to report feeling better following crying than those who cried around others but did not receive help. Few cross-country differences emerged, suggesting that a person’s responses to crying are quite consistent among the countries investigated here, with regard to its relationship with a person’s gender role, crying beliefs, and reactions to the presence of others.

Using crying to cope: Physiological responses to stress following tears of sadness

This research tested the hypothesis that emotional crying facilitates coping and recovery, specifically through physiological changes that occur during crying. Female undergraduate students (N = 197) were randomly assigned to either a sad or neutral condition using short videos. Sad videos were selected for their extreme emotion elicitation. We predicted that compared to those who did not cry to the stimuli and those who were exposed to neutral videos, people who cried would (a) be able to withstand a stressful task for longer; (b) show lower levels of cortisol following crying and exposure to the stressor; and (c) have faster recovery (i.e., return to baseline levels of affect). The final groups consisted of the neutral group (n = 65), sad criers (n = 71), and sad noncriers (n = 61). After a 5-min baseline period, participants watched either the sad or neutral videos for 17 min and then completed a physical stressor (cold pressor test). Heart rate and respiration were continuously recorded, whereas salivary samples for cortisol were taken at 4 separate time points during testing. Analyses revealed no differences between the 3 groups in time withstanding the stressor or cortisol changes. Respiration rate, however, increased in the neutral group and noncriers while watching the videos, with criers' respiration remaining stable. Furthermore, heart rate was found to decelerate just before crying, with a return to baseline during the first crying period. These results suggest that crying may assist in generally maintaining biological homeostasis, perhaps consciously through self-soothing via purposeful breathing and unconsciously through regulation of heart rate. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Associations Between Unintended Pregnancy, Domestic Violence, and Sexual Assault in a Population of Queensland Women

This study aimed to establish the proportion of women seeking information regarding unintended pregnancy in the context of domestic violence (DV) and/or sexual assault (SA) experiences in Queensland. Mental health, sociodemographic variables, and gestation at first and repeated contacts were examined for 6249 women primarily seeking information regarding abortion options during an unintended pregnancy over the 5-year period from July 2012 to June 2017. Reports of DV and SA and associations with mental health issues increased significantly across the 5 years. First contact rates of disclosure were 12.2% for DV and 3% for SA, and higher among repeat contacts (38.1% for DV and 14.1% for SA), with recurring contact facilitating violence disclosure. Restricting access to abortions in the context of violence impedes a woman's agency in attempts to separate from violence and highlights the need for safe, supportive, and accessible services, to assist in screening and assisting with violence.