The multi-dimensional impacts of injury on physically inactive women's participation in sport and physical activity: Insights from concept mapping.

OBJECTIVES: To explore how injury, as a primary barrier, impacts physically inactive Australian women's engagement in sport and physical activity. DESIGN: Concept mapping. METHODS: Participants used online concept mapping to brainstorm the meaning of injury, then sorted and rated statements for impact and importance (1 (low)-5 (high) scale). Multi-dimensional scaling, hierarchical cluster analysis and descriptive statistics were applied. RESULTS: Forty-five Australian women, aged 25-64, brainstormed 94 statements representing the meaning of an injury. Nine clusters emerged from analysis of the sorting data (highest to lowest mean cluster impact order): Fear and frustration; Physical implications of injury; Activity restrictions; Financial implications; Modification and management; Recovery; Mental and emotional wellbeing; Impact on daily life; and Social impact and engagement. A high correlation was found between rating scales (r = 0.92). CONCLUSIONS: A holistic approach is fundamental to understanding how the multi-dimensional impacts of injury and recovery affect physically inactive women. This approach should extend beyond the medical/physical aspects to other challenges and contextual factors (i.e. environmental and personal) impacting women's functioning. Understanding the diverse needs and experiences of physically inactive women is crucial for tailoring interventions that can effectively support recovery and sustained engagement, through person-centred strategies focused on injury prevention/management. Furthermore, this understanding is essential to fostering collaborative system-wide understanding and change, involving diverse stakeholders (e.g. health practitioners, those in delivery/practice settings, insurance) to improve long-term health and wellness outcomes, and promote greater participation in sport/physical activity.

Women's Experiences of Gender-Based Interpersonal Violence in Sport: A Qualitative Meta-Synthesis.

Violence against women in sport is pervasive. Prevalence rates of interpersonal violence range from 26% to 74% across psychological, physical, and sexual violence. This review synthesizes adult women's experiences of gender-based interpersonal violence in sport. A systematic review of qualitative studies was conducted. Five databases were searched, including CINAHL, Web of Science, SPORTDiscus, PsycINFO, and Sociological Abstracts. In total, 1,617 records were retrieved and screened. Twenty-five records representing 24 studies were eligible for inclusion. Following a meta-ethnographic approach, both authors synthesized first- (participants) and second-(researcher) order constructs to create a new interpretation (third-order construct) beyond the individual studies reviewed. A feminist socio-ecological lens was applied. Five themes were constructed: women's safety work, the normalization of abusive behaviors in the sports context, sport family violence, organizational impotence and hostility, and women's status in a patriarchal system. Women's experiences of abuse are mapped within and across the individual, relational, organizational, and cultural levels of the socio-ecological model, with (lack of) power being a central factor within each level as well as flowing between the levels. A fifth socio-ecological level was developed pertaining to the unique context of sport-that of the sport family. This sits between the relational and organizational levels of the model and covers both intense familial relationships and patriarchal familial organizational structures in sport that facilitate and silence the abuse. Sporting bodies must co-design interventions encompassing all socio-ecological levels to address gender-based violence in sport.

Understanding the challenges of injury in providing sport programmes for physically inactive women: concept mapping insights from programme deliverers.

OBJECTIVES: Injury/poor health is an important barrier to women's participation in sport and physical activity. This study aimed to identify perceived challenges sport programme deliverers face when supporting physically inactive women to prevent/manage injury. METHODS: Sport programme deliverers, targeting physically inactive women in Victoria, participated in concept mapping to brainstorm, sort and rate (impact on their ability to prevent/manage injury, frequency of and difficulty to overcome the challenge on a 1 (low)-5 (high) scale) the challenges faced. Analysis included multidimensional scaling, hierarchical cluster analysis and descriptive statistics (eg, mean ratings). RESULTS: Twenty-five deliverers brainstormed 82 injury prevention/management-related challenges. An eight cluster map was considered the most appropriate representation of the participants' sorting data (mean cluster impact, frequency and difficulty to overcome rating (1-5)): time constraints (3.42, 3.69, 3.12); perceived competence in injury prevention/management (3.36, 3.50, 3.27); navigating participant perceptions and knowledge (3.35, 3.74, 3.49); information and responsibility (3.32, 3.50, 3.26); session planning and structure (3.25, 3.45, 3.07); participant engagement (3.13, 3.47, 3.08); responding to individual needs (3.07, 3.42, 2.92) and access to injury management resources (2.87, 3.25, 3.17). CONCLUSION: Limited time created injury prevention/management challenges for programme deliverers when planning and modifying sport programmes for physically inactive women. Injury prevention/management should be integrated into programme design and delivery principles. Programme deliverers need education/training and access to injury prevention/management resources (eg, activity modification) and engagement/communication strategies tailored for physically inactive women. Public health funders, coaching course accreditors, programme designers and deliverers can use these insights to develop strategies to minimise injury risk and effect systemic change in sport programme delivery.

"You're just constantly on alert": Women and Gender-Diverse People's Experiences of Sexual Violence on Public Transport.

Sexual violence is a public health issue that can be experienced across the life course. Public transport is a key site of sexual violence and harassment experienced by women and gender-diverse people in Australia, although victim-survivor voices have rarely been sought in addressing this issue. Through in-depth qualitative interviews with 41 diverse female and gender-diverse victim-survivors who were staff or students at two Australian universities, we sought to understand their experiences of sexual violence and harassment on public transport. We found that women and gender-diverse people, while often reporting on a significant experience of sexual violence or harassment on public transport, also had other, "everyday" experiences across their life course that impacted how they traveled and their confidence in the world. Overall, we argue that the significant impact of sexual violence and harassment on public transport should be addressed through targeting public transport as a key site for primary prevention of sexual violence and harassment.

Major sports events and domestic violence: A systematic review.

Increased rates of domestic violence (DV) have been associated with events such as public holidays, seasonal variations, disasters and economic crises. Sport is seen as gendered, exemplifying hegemonic masculinity and associated violence, with the link between sporting culture and violence against women well recognised. This paper reports on a systematic review of empirical research literature exploring the link between major sporting events and incidence of DV. We searched MEDLINE, CINAHL, PsycINFO, SPORTDiscus and Proquest Central databases from inception to December 2020 for quantitative studies examining major sports events and reports of DV using a pre-post comparison design. Study quality was assessed using the Kmet quality assessment tool. The review identified 1445 records following duplicate removal. Once screened and assessed for eligibility, 12 studies met the inclusion criteria. Results are presented qualitatively due to the heterogeneity across studies. Most studies originated in North America and the United Kingdom, used police records as their data source for measuring incidences of DV and few looked beyond the day of the sports event for recorded incidences of DV. Studies reviewed suggested that there is an association between certain major sports events and increased reporting of DV. However, studies' findings conflicted with regards to whether increases were associated with contact sports, the rivalry between competing teams, whether the events were emotionally salient and whether alcohol was a contributing factor. In conclusion, there is limited research globally. Heterogeneity and conflicting findings mean that more research is needed to understand the associations and inform community prevention/interventions to address DV.

Responding to Violence Against Women in Sport: Challenges Facing Sport Organizations in Victoria, Australia.

Purpose: Violence against women is a global epidemic. Such violence occurs in sport, although previous research has focused on child/youth sexual abuse or elite sport. Despite sport being identified as having a role in preventing violence against women, little is known about how sport organizations respond to violence against adult women in community sport. Methods: Twenty-two individual participants from 12 sports organizations based in Victoria, Australia participated in this empirical and applied Concept Mapping study to explore the perceived challenges sports organizations face in responding to violence against women. Concept Mapping is a mixed-method participatory approach and we analyzed the results using a socio-ecological framework. Results: Sports administrators considered training-related challenges as the most important but most difficult to address. Challenges related to organizational capacity/social environment were perceived as easier but less important to address. Conclusions: Key initiatives can be developed to support sport organizations to respond to violence against women in sport, but they will need assistance to prioritize initiatives addressing the most important challenges given a perceived lack of capacity to do so.

Staying safe while staying together: the COVID-19 paradox for participants returning to community-based sport in Victoria, Australia.

OBJECTIVE: To identify the challenges adult community sport participants anticipate when returning to sport in Victoria, Australia, post a COVID-19 shutdown. METHODS: Using online concept mapping, participants brainstormed challenges to returning to community sport, sorted them into groups and rated them for impact and ability/capacity to overcome. Analysis included multidimensional scaling and hierarchical cluster analysis. RESULTS: Forty-five community sport participants representing 24 sports identified 69 unique challenges to returning to sport. Eight clusters/questions participants need answered emerged from the sorting data (mean cluster impact and ability/capacity rating out of 5): Will we have enough participants? (3.32, 2.89); How do we stay safe? (3.31, 3.35); How will our sport change? (3.17, 2.85); How can we stay together? (3.15, 3.01); Will I be physically ready? (3.15, 3.05); What about the money? (2.86, 2.53); What about me? (2.65, 3.13); and What about the facilities? (2.49, 2.45). CONCLUSIONS: Participants perceived paradoxical challenges to returning to sport after COVID-19 shutdown, which revolved around staying safe, staying connected and accessing meaningful sport activities. Implications for public health: Sport organisations and public health practitioners should address the participant-centred challenges identified in this study to maximise the public health benefits of participants returning to community sport.

"A Lightbulb Moment": Using the Theory of Planned Behavior to Explore the Challenges and Opportunities for Early Engagement of Australian Men Who Use Violence in Their Relationships.

Intimate partner violence (IPV) is a common complex social and public health problem. Interventions for IPV male perpetrators are an essential component of an early and effective response. Yet little is known about how to engage men in interventions for help-seeking. Using the theory of planned behavior (TPB), we explored men's perceptions of seeking help for an unhealthy relationship and how they could be supported to recognize their behavior and undertake change at an early stage. We recruited 23 men who were currently attending a men's behavior change program in Australia to take part in focus groups. These were recorded, transcribed, and thematically analyzed. The TPB concepts of behavioral beliefs, perceived control, and subjective norms were found throughout the data. Behavioral beliefs covered four subthemes: self-awareness, self-reflection and agency, the influence of others to change, and needing the right message in the right place. Perceived control was connected to these men's understandings of what it means to be a man. Subjective norms were rarely raised, but there was some indication that men's perceptions of societal norms about men as violent influenced a perceived lack of agency to change behavior. Our findings highlight the complexity of, and challenges in, engaging men who may use violence before they reach crisis point and justice intervenes. Despite this, participating men could find acceptable an appropriately developed and easy-to-access intervention that enhances recognition of behaviors and provides links to supports. Health professionals or researchers developing early interventions targeting these men need to take the engagement challenges into account.

Interventions in Health Settings for Male Perpetrators or Victims of Intimate Partner Violence.

BACKGROUND: Intimate partner violence (IPV) is common in patients attending health-care services and is associated with a range of health problems. The majority of IPV perpetrators are men, and a substantial minority of men are victims, yet health-care professionals have little evidence or guidance on how to respond to male patients who perpetrate or experience violence in their intimate relationships. METHODS: We conducted a systematic review to determine the effectiveness of interventions for male perpetrators or victims of IPV in health settings. Online databases, reference lists, Google Scholar, and gray literature were searched, and inclusion/exclusion criteria were applied. Narrative synthesis methods were used due to the heterogeneity of study types and outcome measures. RESULTS: Fourteen studies describing 10 interventions met our inclusion criteria: nine randomized controlled trials, four cohort studies, and one case-control study. Interventions were predominantly therapeutic in nature and many were conducted in alcohol treatment settings. CONCLUSION: Overall, the evidence for effectiveness of interventions in health-care settings was weak, although IPV interventions conducted concurrently with alcohol treatment show some promise. More work is urgently needed in health-care services to determine what interventions might be effective, and in what settings, to improve the response to male perpetrators or victims of IPV.

'No one teaches us how to deal with this': General practitioners' experiences of working with men who use violence in relationships.

BACKGROUND AND OBJECTIVES: General practitioners (GPs) are, in theory, well placed in the healthcare system to identify and respond to male patients who perpetrate intimate partner violence (IPV). Men who use violence in relationships routinely present to healthcare settings, yet there is limited evidence to guide GPs in this area of their work. The aim of this study was to explore GPs' experiences of intervening early with male patients who use violence in their relationships. METHOD: Semi-structured interviews were undertaken with 21 Victorian GPs and analysed thematically. RESULTS: GPs were inexperienced and felt unprepared to identify and respond to male patients who perpetrate IPV, expressing concern that raising the issue may harm their therapeutic relationships with their patients. DISCUSSION: Practical advice on how to identify and respond effectively to male patients who perpetrate IPV may help alleviate GPs' concerns. Our findings suggest that current guidelines and training provided to GPs are insufficient to help them navigate this challenging area.

St John's wort for depression: scoping review about perceptions and use by general practitioners in clinical practice.

BACKGROUND: Extracts of Hypericum perforatum, more commonly known as St John's wort (SJW), have good evidence for treating depression. The herb is easily accessible and widely used by consumers, although it has potential for interaction with other medicines. Consumers' use of SJW is often not discussed with their general practitioners (GPs). It is unclear how GPs perceive use of SJW in practice and the implications for consumers and pharmacists. OBJECTIVE: Explore GPs' perception of SJW use in practice. METHODS: Scoping review. KEY FINDINGS: Few studies explore GPs' perceptions of SJW for depression, but they appear to recommend it infrequently, except in Germany. Reasons for limited use in practice include lack of knowledge, particularly regarding which preparations and dosages have trial evidence, and lack of standardisation of active ingredients. Guidelines either do not mention SJW or advise against its use. CONCLUSIONS: Consumers drive SJW use but often do not disclose to their GPs, which is concerning due to issues about safety. Pharmacists could play an important role here. Improved education about SJW is required for both GPs and consumers, including the need for communication between them and their pharmacists. Lack of adoption of evidence-based therapy for depression should be explored further.

Exploring Australian psychiatrists' and psychiatric trainees' knowledge, attitudes and preparedness in responding to adults experiencing domestic violence.

OBJECTIVE:: Examine knowledge, opinions and practices of psychiatrists and trainees in responding to domestic violence (DV). METHOD:: Online survey including two sub-scales from PREMIS (Physician Readiness to Manage Intimate Partner Violence Survey): knowledge (10 items) and preparedness (10 items). RESULTS:: Of psychiatrists completing the survey (216), 47% had received less than 2 hours of training in DV. PREMIS findings showed moderate knowledge of, and preparedness to deal with, DV. Participants with more clinical experience had significantly more knowledge and preparedness to deal with DV. CONCLUSIONS:: Findings suggest more training in DV for psychiatrists is needed.

Supporting primary care nurses to work at an advanced level through changing practices' organisational governance.

General practice nurses wishing to develop their careers in general practice are often unsupported, relying on the culture of individual practices. Given the structural diversity of Australian general practice, we qualitatively explored staff experiences of organisational governance, what supports are in place and can be used to assist nurses to advance. Semi-structured interviews with 28 staff (including nurses, GPs, receptions and practice managers) were undertaken across three practices, as part of a case-study approach. It was found that general practice staff know little of organisational governance and how it may be harnessed. Practical and flexible organisational governance were the most important factors in supporting general practice nurses to develop and utilise nursing skills, but advocacy from medical colleagues was necessary to support advancement. Barriers include funding structures, non-supportive cultures and inflexible organisational governance structures. Organisation governance has the potential to assist nurses to work at an advanced level, but significant financial, structural and cultural barriers may be too difficult for organisational governance resources alone to overcome. In addition to utilising resources, it may be useful for general practices to undertake a review of how they function as a team and reflect upon their practice culture.

An Australian hospital's training program and referral pathway within a multi-disciplinary health-justice partnership addressing family violence.

OBJECTIVE: An innovative health-justice partnership was established to deliver legal assistance to women experiencing family violence who attended an Australian hospital. This paper reports on a multifaceted response to build capacity and willingness of health professionals to identify signs of family violence and engage with referral pathways to on-site legal assistance. METHODS: A Realistic Evaluation analysed health professionals' knowledge and attitudes towards identification, response and referral for family violence before and after training; and use of referral pathways. RESULTS: Of 123 health professionals participating in training, 67 completed baseline and follow-up surveys. Training improved health professionals' self-reported knowledge of, and confidence in, responding to family violence and understanding of lawyers' roles in hospitals. Belief that patients should be referred to on-site legal services increased. Training did not correspond to actual increased referrals to legal assistance. CONCLUSION: The program built capacity and willingness of health professionals to identify signs of, and respond to, family violence. Increase in referral rates to legal assistance was not shown. Potential improvements include better data capture and greater availability of legal services. Implications for public health: Strong hospital system supports and reliable recording of family violence referrals need to be in place before introducing such partnerships to other hospitals.

'It's a necessary evil': Experiences and perceptions of mandatory reporting of child abuse in Victorian general practice

BACKGROUND AND OBJECTIVE: General practitioners (GPs) and practice nurses (PNs) are mandated to report child abuse; however, only 2­4% of reports are made by Victorian health professionals. This is concerning, given that the estimated prevalence of physical child abuse alone in Australia is 5­18%. The aim of this study was to explore GPs' and PNs' experiences and perceptions of mandatory reporting of child abuse in Victoria. METHODS: Semi-structured interviews with 17 Victorian GPs and PNs were undertaken and thematically analysed. RESULTS: Participants had limited understanding of mandatory reporting in Victoria, struggled with negotiating the risks of reporting child abuse and felt unsupported by their practice and Child Protection Services. DISCUSSION: GPs and PNs must negotiate their legal obligation, with the emotional burden associated with the decision to report. Updated education on reporting processes and more support for GPs and PNs are recommended.

Unconditional and conditional incentives differentially improved general practitioners' participation in an online survey: randomized controlled trial.

OBJECTIVES: To compare the impact of unconditional and conditional financial incentives on response rates among Australian general practitioners invited by mail to participate in an online survey about cancer care and to investigate possible differential response bias between incentive groups. STUDY DESIGN AND SETTING: Australian general practitioners were randomly allocated to unconditional incentive (book voucher mailed with letter of invitation), conditional incentive (book voucher mailed on completion of the online survey), or control (no incentive). Nonresponders were asked to complete a small subset of questions from the online survey. RESULTS: Among 3,334 eligible general practitioners, significantly higher response rates were achieved in the unconditional group (167 of 1,101, 15%) compared with the conditional group (118 of 1,111, 11%) (P = 0.0014), and both were significantly higher than the control group (74 of 1,122, 7%; both P < 0.001). Although more positive opinions about cancer care were expressed by online responders compared with nonresponders, there was no evidence that the magnitude of difference varied by the incentive group. The incremental cost for each additional 1% increase above the control group response rate was substantially higher for the unconditional incentive group compared with the conditional incentive group. CONCLUSION: Both unconditional and conditional financial incentives significantly increased response with no evidence of differential response bias. Although unconditional incentives had the largest effect, the conditional approach was more cost-effective.

'Less like a drug than a drug': the use of St John's wort among people who self-identify as having depression and/or anxiety symptoms.

OBJECTIVE: St John's wort (SJW) is one of the most commonly used complementary medicines (CM) for the self-treatment of depression which can be accessed with or without health professional advice. While there is evidence to support its effectiveness in depression it has potential for serious side effects and interactions with many pharmaceuticals and herbs. Despite the potential risks, we know little about consumer perspectives on the use of SJW. Our research aimed to understand, from their own perspective, how and why people use SJW for management of self-identified 'depression, stress or worries'. DESIGN: A qualitative design, focusing on understanding the reasons for SJW use. A purposive sampling strategy was used to recruit 41 people who self-identified as having used SJW for 'depression stress or worries' from the community in Melbourne, Australia. In-depth face-to-face interviews were conducted. Interviews were taped, transcribed and analysed thematically. RESULTS: Three themes emerged as to why participants used SJW - ease of access of SJW, perceptions of effectiveness and safety of SJW enabling control over its use, and the perceived benefits of using a natural product. Generally, participants did not reserve use of SJW only for mild depressive symptoms. CONCLUSIONS: People use many self-care strategies to manage symptoms of depression, including more severe symptoms. While there is often a preference for more natural approaches like SJW, people experiment and continue to use what they perceive is most effective for them.

Family violence across the life cycle.

BACKGROUND: Family violence covers a range of abuse including child abuse and neglect, intimate partner violence and elder abuse. Each form of abuse has a significant negative impact on health and wellbeing, and patients present to general practice with varying physical and psychological issues. General practice is unique in that it often works with an entire family, which can be challenging and needs to be actively managed. OBJECTIVE: This article aims to address clinical questions that general practitioners (GPs) may have in identifying and responding to patients experiencing family violence. It takes into account the different types of abuse victims experience and how to respond to perpetrators. The recommendations in this article can also apply to same-sex relationships. DISCUSSION: Managing family violence requires a whole-of-practice approach to encourage a safe environment in which families can dis-close abuse and where GPs can respond appropriately. Abuse can be inter-generational and GPs have a role in identification, management and referral.