Critical success factors for school-based integrated health care models: Learnings from an Australian example

ISSUES ADDRESSED

Integrated school-based health services have the potential to address the unmet health needs of children experiencing disadvantage, yet these models remain poorly evaluated. The current article examines an integrated social and health care hub located on the grounds of a regional Australian public primary school, the Our Mia Mia Wellbeing Hub, to identify critical success factors for this service and others like it.

METHODS

Semi-structured qualitative interviews were conducted with N = 55 multi-sector stakeholders comprising parents, students, school staff, social and health care providers, and local Aboriginal community members. Interview transcripts were analysed according to a grounded theory approach.

RESULTS

Six themes emerged from the analysis, reflecting important success factors for the model: service accessibility; service coordination; integration of education and health systems; trust; community partnerships; and perceptions of health.

CONCLUSIONS

Findings highlighted Our Mia Mia as a promising model of care, yet also revealed important challenges for the service as it responds to the varied priorities of the stakeholders it serves. SO WHAT?: Through capturing the perspectives of a large number of stakeholders, the current study provides valuable insight into key challenges and success factors for Our Mia Mia; these learnings can guide the development of other emerging school-based health services and integrated care hubs.

"The Ripple Effect": The influence of social support on participation in a small workplace health promotion program

ISSUE ADDRESSED

Workplaces are key settings for health promotion. There is limited evidence pertaining to workplace health promotion [WHP] in Australian small and medium enterprises [SMEs], particularly in regional areas. This qualitative study explored employee perceptions of a pilot workplace health promotion program, LifeMAP, conducted in a small health service enterprise in regional Victoria 2014-2017, including facilitators of participation and perceived benefits of participation.

METHOD

Ten LifeMAP participants were recruited using convenience sampling. Individual semi-structured interviews (n = 7) and one focus group (n = 3) were conducted between August and September 2017. Data were analysed inductively and thematically to elicit emergent themes.

RESULTS

Social support emerged as the overarching theme influencing participation in LifeMAP, and a perceived benefit of participation. Using FitBits® and setting exercise challenges enabled social support to be fostered through role modelling, staff collegiality and community. There may be gendered differences in the experiences of role modelling in WHP.

CONCLUSIONS

This SME, and others like it, often feature high levels of employee social connectedness, with a strong workplace and community networks. Social support is a critical influence in social connectedness which needs to be considered and incorporated into the design, implementation and evaluation of WHP programs as a means of overcoming WHP recruitment and participation challenges in regional SMEs. SO WHAT?: The identification of social support as a key factor for WHP participation and employee satisfaction is a valuable finding providing insight into how similar programs may be better designed and implemented to enhance WHP program recruitment and retention.

Barriers and facilitators to participation in breast, bowel and cervical cancer screening in rural Victoria: A qualitative study

Issue addressed

Population cancer screening rates are around 50% for the general population and even lower in rural areas. This study aimed to explore knowledge, attitudes, behaviours, motivators and barriers to breast, bowel and cervical screening participation in under‐screened men and women.

Methods

We used a qualitative research design. Focus groups were segmented by age, sex and screening participation. Participants were under‐screened in at least one of the cancer screening programs, with separate groups for each of the programs. The discussion guides were designed around the Health Belief Model and group discussions were coded using a thematic content analysis approach.

Results

Fourteen focus groups were held with 80 participants. Key themes were that the concept of cancer screening was not well understood, a low priority for preventive health behaviours, issues relating to local general practitioners (GP) and screening was unpleasant, embarrassing and/or inconvenient. A key determinant of participation in cancer screening was exposure to prompts to action, and it was evident that participants often required multiple prompts before they took action.

Conclusions

Opportunities that develop attitudes to health that place disease prevention as a high priority; improve understanding of the benefit of screening in terms of early detection and treatment; improve GP availability and the patient‐practitioner relationship; and the development of messages for each of the screening programs should be further explored as factors that may influence rural population screening rates.

So what?

Addressing health attitudes, beliefs, knowledge, health practitioner and test‐related barriers and improving messaging may increase cancer screening participation in under‐screened rural populations.

Food community: Understanding community needs for a food security website to support rural and remote Western Australians

OBJECTIVE

The South West Food Community (SWFC) project (2018) was implemented to identify initiatives working to enhance healthy food availability, access and use in the South West region of Western Australia (SWWA); and enhance how they functioned as a system. The SWFC project participants included government and community members. This study aimed to understand how a tailored food security website could be developed as a support mechanism to increase understanding of food security, connect participants and enhance the effectiveness of SWFC initiatives.

METHODS

Initiative leaders from the SWFC project (n = 46) were invited to participate in semi-structured telephone interviews which sought to understand needs for a food security website. Fifteen stakeholders completed the interviews (32% response rate). Data relating to desirable and undesirable website components were analysed thematically using QSR NVivo 12.

RESULTS

Participants requested the website to include concise content, food security resources, inviting/useful images and information about initiatives. Undesirable features included academic literature, difficult-to-use functions, discussion boards and hard-to-view images.

CONCLUSION

A tailored, co-designed website that is monitored, user-friendly and functional were key stakeholder requirements.

IMPLICATIONS FOR PUBLIC HEALTH

A tailored, co-designed food security website that promotes partnership development, builds networks, increases understanding and communication about food security and implementation strategies is needed.

Reaching at-risk rural men: An evaluation of a health promotion activity targeting men at a large agricultural event

ISSUE ADDRESSED

This paper evaluates the effectiveness of an Australian Men's Shed Association's 'Spanner in the Works?' health promotion tent in reaching at-risk rural men during a large agricultural event in rural Australia.

METHODS

Men who self-presented to the health promotion tent had basic health measurements and risk scores recorded. These were linked to a short survey asking about their primary health care engagement. To determine the 'reach' afforded to health professionals through their presence at the agricultural event, the mean systolic blood pressure and waist circumference measures of participants were compared to those of rural men nationally using the ABS' National Health Survey 2017-2018 Basic Confidentialised Unit Record File (CURF).

RESULTS

Of the 401 men who visited the health promotion tent, 346 (86.3%) consented to participate in the study. The median age of participating men was 56 years. The majority (94.0%) were from rural areas. Of participating men, 58.9% had high blood pressure, and their mean systolic blood pressure was significantly higher than that of rural men nationally: both overall (Mean difference = 15.37 mm Hg), and at all age groups. Participants also had significantly higher waist circumference overall (Mean difference = 2.06 cm), but this was only significantly different for the 45-54 age group.

CONCLUSIONS

The 'Spanner in the Works?' initiative was effective in reaching both healthy and at-risk rural men from a range of ages. SO WHAT?: Aligned with the National Men's Heath Strategy 2020-2030, this evidences that agricultural events are an effective social setting for the provision of health promotion to 'at risk' rural men.

Not quite city and not quite rural: Active lifestyle beliefs in peri-urban Australians

ISSUE ADDRESSED

Residents of peri-urban Australia face health inequalities compared to city dwellers. Active lifestyles provide many benefits that could improve the health of this population; however, peri-urban Australians are more likely to be inactive and sedentary. The aim of this study was to identify the physical activity and sedentary behaviour-related beliefs of peri-urban Australians.

METHODS

Semi-structured interviews were undertaken with adult residents of peri-urban, southern Queensland. Participants (N = 8) were recruited from a related study, purposefully selected to ensure diversity. Data were analysed by thematic analysis. Interviews were conducted until data and inductive-thematic saturation were reached.

RESULTS

Three themes were identified, representing beliefs about intrapersonal, interpersonal/socio-cultural and physical environmental factors relevant to active lifestyles among peri-urban Australians. Active lifestyle behaviours were perceived as beneficial for health. Social interaction was described as an important outcome of physical activity. Features of the physical environment negatively impacted the perceived difficulty of performing physical activity and avoiding sedentary behaviour.

CONCLUSIONS

Active lifestyle strategies that support social interaction through physical activity and participation in sports may be particularly useful in peri-urban environments where opportunities for social interaction are limited. Such strategies should also take into account contextual factors that negatively impact active lifestyle control beliefs (eg, distance). SO WHAT?: This study provides insight into factors that may influence the active lifestyles of peri-urban Australians. This information can be used to develop contextually relevant strategies designed to encourage physical activity, discourage sedentary behaviour and assist to relieve health disparities faced by this population.

Farm safety-Time to act

ISSUES ADDRESSED

Agriculture is recognised as a highly dangerous sector worldwide; hence, the use of evidence-based solutions to address injury-related incidents is critical to prevention. The main of this article was to determine the potential for prevention by use of existing controls based on deaths data from 2001-2016.

METHODS

This study assesses data from the National Coroner's Information System for the period 2001-2016 in regard to unintentional farm injury deaths in Australia (n = 1271). The six leading causes of death (tractors, quads [ATVs], water/dams, farm utilities [pickups], motorcycles and horses: n = 644) are reviewed against existing evidence-based practice recommendations to ascertain the potential capacity to prevent and/or ameliorate the severity of the fatal incidents. Projections of economic costs associated with these incidents in the past five years (2012-2016) are outlined.

RESULTS

Of the cases involving the six leading agents (n = 644), 36% (n = 235) have the potential to be prevented with the use of designated evidence-based controls. Meanwhile, the costs attributed to deaths involving the six leading agents in the 2012-2016 period, exceeded $313 million.

CONCLUSIONS

Farm injury incidents and their related economic costs can be reduced by enhanced adoption of the existing evidence-based controls.

SO WHAT

Farm safety efforts in Australia require reinvigoration and funding to focus on evidence-based controls supported by enforcement to attain maximum impact.