Safeguarding against Dementia in Aboriginal and Torres Strait Islander Communities through the Optimisation of Primary Health Care: A Project Protocol.

This protocol describes the methodology and methods for a collaborative project with eight Aboriginal and Torres Strait Islander primary health care (PHC) organisations, across three Australian states and one territory, to increase clinical service performance and access to preventive health and health promotion services for preventing, identifying, treating, and managing dementia risk in Aboriginal and Torres Strait Islander communities. Aboriginal participatory action research (APAR) methodology will be the framework for this project, incorporating continuous quality improvement (CQI), informed by research yarning with stakeholder groups, comprising community members and PHC staff and service providers and data collected from the auditing of client health records and the mapping of existing clinical processes and health services at each partnering PHC organisation. The qualitative and quantitative data will be summarised and discussed with stakeholder groups. Priorities will be identified and broken down into tangible PHC organisation deliverable strategies and programs, which will be co-developed with stakeholder groups and implemented cyclically over 24 months using the Plan, Do, Study, Act model of change. Key project outcome measures include increased clinical service performance and availability of preventive health and health promotion services for safeguarding against dementia. Project implementation will be evaluated for quality and transparency from an Indigenous perspective using an appropriate appraisal tool. The project processes, impact, and sustainability will be evaluated using the RE-AIM framework. A dementia safeguarding framework and accompanying tool kit will be developed from this work to support Aboriginal and Torres Strait Islander PHC organisations to identify, implement, and evaluate dementia safeguarding practice and service improvements on a broader scale.

Impact of an Aboriginal and Torres Strait Islander brief intervention training program on health staff participants' own health behaviours: Smoking, nutrition and physical activity.

ISSUES ADDRESSED: Little research has been conducted on the impact of Aboriginal and Torres Strait Islander brief intervention training programs on health staff participants' own health behaviours. Through the Queensland B.strong program (2017-2020), brief intervention training in smoking cessation, nutrition and physical activity was provided to the Aboriginal and Torres Strait Islander health workforce and other health and community professionals. This study examined the program's impact on participants' own health behaviours. METHODS: Data were collected through four surveys (pre- and post-training workshop, and 3-month and 6-month follow-up) of the 1131 participants in B.strong training workshops from June 2017 to August 2019. Surveys included items on participants' own health behaviours. Pre- and post-workshop surveys were paper-based, and follow-up surveys were completed online. For the analysis of data reported in this paper, paired-samples t tests were used to assess changes between pre-workshop and 3-month follow-up. RESULTS: Statistically significant improvements were found between pre-workshop and 3-month follow-up in the number of serves of vegetables or legumes/beans eaten per day, the number of serves of fruit eaten per day, and in time spent in physical activity. However, there was: no statistically significant change in smoking status, with baseline rates being relatively low; a statistically significant increase in consumption of sugary drinks, and of takeaway foods; a nonsignificant increase in consumption of snack foods; and no significant change in sedentary behaviour of participants. CONCLUSION: While some positive changes in participants' own health behaviours in nutrition and physical activity were associated with the B.strong program, there was no change in their smoking behaviour. SO WHAT?: This study found that some improvements in participants' own health behaviours were associated with the B.strong program. This research may inform future Indigenous brief intervention training programs and health services on how to promote healthy behaviours for health staff themselves.

Implementation and Evaluation of a Standardized Nurse-Administered Assessment of Functional and Psychosocial Issues for Patients in Acute Care.

BACKGROUND: Increasingly, adults presenting to healthcare facilities have multiple morbidities that impact medical management and require initial and ongoing assessment. The interRAI Acute Care (AC), one of a suite of instruments used for integrated care, is a nurse-administered standardized assessment of functional and psychosocial domains that contribute to complexity of patients admitted to acute care. AIM: This study aimed to implement and evaluate the interRAI AC assessment system using a multi-strategy approach based on the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. METHODS: This nurse-led quality improvement study was piloted in a 200-bed public hospital in Brisbane, Australia, over the period 2017 to 2018. The interRAI AC is a set of clinical observations of functional and psychosocial domains, supported by software to derive diagnostic and risk screeners, scales to measure and monitor severity, and alerts to assist in care planning. Empirical data, surveys, and qualitative feedback were used to measure process and impact outcomes using the RE-AIM evaluation framework (Reach, Efficacy, Adoption, Implementation, and Maintenance). RESULTS: In comparison to usual practice, the interRAI assessment system and supporting software was able to improve the integrity and compliance of nurse assessments, identifying key risk domains to facilitate management of care. Pre-implementation documentation (630 items in 45 patient admissions) had 39% missing data compared with 1% missing data during the interRAI implementation phase (9,030 items in 645 patient admissions). Qualitative feedback from nurses in relation to staff engagement and behavioral intention to use the new technology was mixed. LINKING EVIDENCE TO ACTION: Despite challenges to implementing a system-wide change, evaluation results demonstrated considerable efficiency gains in the nursing assessment system. For successful implementation of the interRAI AC, study findings suggest the need for interoperability with other information systems, access to training, and continued leadership support.

Prevalence and Impact of Functional and Psychosocial Problems in Hospitalized Adults: A Prospective Cohort Study.

OBJECTIVES: Underpinning standards for delivering comprehensive care in hospital is the need to identify issues contributing to patient complexity and risk of harm. The study aimed to investigate the prevalence of functional and psychosocial problems in hospitalized adults, to compare prevalence rates across age groups, and to assess their impact on discharge outcomes. DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort study was conducted in 4 hospitals in Australia during September 2015 to June 2016, recruiting patients aged 18 and over. MEASURES: Research nurses assessed patients at admission using the interRAI Acute Care instrument, which includes algorithms for diagnostic and risk screening and measuring problem severity. Length of stay and discharge outcome were recorded from medical records. RESULTS: The median age of the study population (n = 910) was 66 (range 18-99 years), and 47.7% were female. Although 64.6% of patients aged ≥70 years had at least 1 classic geriatric syndrome (cognitive impairment, dependency in activities of daily living, history of falls, or incontinence), similar problems were prevalent in younger cohorts (34.6% in those aged <50 and 38.9% in those aged 50-69 years). Of 17 health issues assessed across multiple domains, only 26 patients (2.9%) had no problems. Independent of age, gender, and Comorbidity Index, having a greater number of problems was significantly associated with an adverse discharge outcome, odds ratio 1.19 (95% confidence interval (CI) 1.09-1.29); for each additional problem, the length of stay increased by 6.7% (95% CI 4.3%-9.2%). CONCLUSIONS/IMPLICATIONS: The high prevalence of functional and psychosocial problems across the age range of patients indicates that universal screening and assessment is warranted for all adult patients to aid in care planning to meet patient needs both in acute care and post discharge.

Development and Testing of the interRAI Acute Care: A Standardized Assessment Administered by Nurses for Patients Admitted to Acute Care.

BACKGROUND: Underpinning standards for developing comprehensive care in hospital is the need to identify, early in the admission process, functional and psychosocial issues which affect patient outcomes. Despite the value of comprehensive assessment of patients on admission, the process is often sub-optimal due to a lack of standardized assessment practices. This project aimed to develop a concise, integrated assessment for patients admitted to acute care and test its psychometric properties. METHODS: Two international expert panels of clinicians and health scientists collaborated to establish design parameters. Using clinical observations and a variety of derivative applications sourced from the interRAI research collaborative repository, the panels constructed a draft instrument to examine feasibility, resource requirements, and inter-rater reliability. Field testing was conducted in Australia and Canada. Next, the system was revised to its final form, the interRAI Acute Care, after feedback and review from international interRAI members. RESULTS: Constructed using 56 items, the interRAI Acute Care required a median of 15 minutes to complete. Inter-rater reliability tested on 130 paired assessments was substantial to almost perfect for 78% of the clinical items and moderate for the remaining 22% of items. A subset of 30 items from the admission assessment comprised the discharge assessment. DISCUSSION: The interRAI Acute Care has been shown to be an efficient nursing assessment instrument with good psychometric properties. Implementation in a digital environment will enable documentation and care planning to comply with standards for quality of care in the general adult hospital population.

A comparison of physical activity and sedentary behaviour in 9-11 year old British Pakistani and White British girls: a mixed methods study.

BACKGROUND: Previous studies suggest that British children of South Asian origin are less active and more sedentary than White British children. However, little is known about the behaviours underlying low activity levels, nor the familial contexts of active and sedentary behaviours in these groups. Our aim was to test hypotheses about differences between British Pakistani and White British girls using accelerometry and self-reports of key active and sedentary behaviours, and to obtain an understanding of factors affecting these behaviours using parental interviews. METHODS: Participants were 145 girls (70 White British and 75 British Pakistani) aged 9-11 years and parents of 19 of the girls. Accelerometry data were collected over 4 days and girls provided 24-hour physical activity interviews on 3 of these days. Multilevel linear regression models and generalised linear mixed models tested for ethnic differences in activity, sedentary time, and behaviours. Semi-structured interviews were conducted with parents. RESULTS: Compared to White British girls, British Pakistani girls accumulated 102 (95% CI 59, 145) fewer counts per minute and 14 minutes (95% CI 8, 20) less time in moderate to vigorous physical activity per day. British Pakistani girls spent more time (28 minutes per day, 95% CI 14, 42) sedentary. Fewer British Pakistani than White British girls reported participation in organised sports and exercise (OR 0.22 95% CI 0.08, 0.64) or in outdoor play (OR 0.42 95% CI 0.20, 0.91). Fewer British Pakistani girls travelled actively to school (OR 0.26 95% CI 0.10, 0.71). There was no significant difference in reported screen time (OR 0.88 95% CI 0.45, 1.73). Parental interviews suggested that structural constraints (e.g. busy family schedules) and parental concerns about safety were important influences on activity levels. CONCLUSIONS: British Pakistani girls were less active than White British girls and were less likely to participate in key active behaviours. Sedentary time was higher in British Pakistani girls but reported screen-time did not differ, suggesting that British Pakistani girls engaged more than White British girls in other sedentary behaviours. Interviews highlighted some differences between the groups in structural constraints on activity, as well as many shared constraints.

Differences between 9-11 year old British Pakistani and White British girls in physical activity and behavior during school recess.

BACKGROUND: School recess provides an important opportunity for children to engage in physical activity. Previous studies indicate that children and adults of South Asian origin are less active than other ethnic groups in the United Kingdom, but have not investigated whether activity differs within the shared school environment. The aim of this study was to test the hypothesis that British Pakistani girls aged 9-11 years are less active during recess than White British girls. METHODS: In Study One, the proportion of recess spent by 137 White British (N = 70) and British Pakistani (N = 67) girls in sedentary behavior, moderate-to-vigorous activity (MVPA) and vigorous activity (VPA) was determined using accelerometry. In Study Two, 86 White British (N = 48) and British Pakistani (N = 38) girls were observed on the playground using the System for Observing Children's Activity and Relationships during Play (SOCARP). Accelerometry data were collected during observations to allow identification of activities contributing to objectively measured physical activity. RESULTS: Accelerometry data indicated that British Pakistani girls spent 2.2% (95% CI: 0.2, 4.3) less of their total recess time in MVPA and 1.3% (95% CI: 0.2, 2.4) less in VPA than White British girls. Direct observation showed that British Pakistani girls spent 12.0% (95% CI: 2.9, 21.1) less playground time being very active, and 12.3% (95% CI: 1.7, 23.0) less time playing games. Time spent being very active according to direct observation data correlated significantly with accelerometer-assessed time spent in MVPA and VPA, and time spent playing games correlated significantly with accelerometer-assessed time spent in VPA, suggesting that differences in behavior observed in Study Two may have contributed to the differences in time spent in MVPA and VPA in Study One. CONCLUSIONS: British Pakistani girls were less active than White British girls during school recess. Recess has been identified as a potentially important target for the delivery of physical activity interventions; such interventions should consider ways in which the activity levels of British Pakistani girls could be increased.

Adiposity and blood pressure in 7- to 11-year-old children: comparison of British Pakistani and white British children, and of British Pakistani children of migrant and British-born mothers.

OBJECTIVES: This study tested hypotheses that: (1) levels of adiposity, as assessed by triceps and subscapular skinfold thicknesses (SFTs), and blood pressure would be higher in British Pakistani children than in white British children; and (2) British Pakistani children of mothers born in the UK would have smaller SFTs and lower blood pressure than children of mothers born in Pakistan. METHODS: Participants aged 7 to 11 years were recruited from five primary schools in a deprived urban area. BMI, waist circumference, triceps and subscapular SFT, and blood pressure were measured. RESULTS: Participants comprised 209 white British and 132 British Pakistani children, including 79 children born in the UK to migrant mothers and 49 children born to British-born mothers. In comparisons by ethnic group, triceps SFT was significantly higher in British Pakistani children only after controlling for BMI. Subscapular SFT was higher in British Pakistani children, a finding strengthened after controlling for BMI. Systolic blood pressure was significantly higher in British Pakistani children, but not after controlling for socioeconomic status (SES). There were no significant differences between British Pakistani children born to migrant or British-born mothers, except that systolic blood pressure was lower in children of British-born mothers after controlling for SES, a finding that was not significant after controlling for BMI. CONCLUSIONS: This study confirms previous findings of larger SFTs and higher blood pressure in British children of Pakistani origin than in children of white European origin. Further work with larger sample sizes is needed to investigate differences between generations.