Educating for supported decision making and shared decision making: a scoping review of educational design and outcomes for education and training interventions.

PURPOSE: To characterise existing knowledge about the design and learning outcomes of education and training programs for supported or shared decision making. MATERIALS AND METHODS: A scoping review was performed to identify academic and grey literature, published between January 2006 and February 2022, that reported on the design and/or learning outcomes of supported or shared decision making education or training programs. Eligible literature was mapped across domains of educational design and Kirkpatrick's hierarchy of learning effectiveness, and then qualitatively synthesised using cross-case analysis. RESULTS: A total of 33 articles were identified (n = 7 for supported decision making and n = 26 for shared decision making) that provided education or training to supporters of persons with mental illness or substance use disorders (n = 14), dementia or neurocognitive disorders (n = 6), cognitive disability (n = 5), mixed populations (n = 1), and those receiving end-of-life care (n = 7). In their design, most programs sought specific changes in practice (behaviour) via experiential learning. Reported educational outcomes also focused on supporter behaviour, with limited evidence for how changes in learner attitudes, skills, or knowledge might be contributing to changes in supporter behaviour. CONCLUSIONS: Future education and training would benefit from a closer engagement with theories of teaching and learning, particularly those oriented towards co-design.

Existing education and training programs for supported and shared decision making have a solid focus on modifying supporter behaviour through information provision, reflective practice, and modelling and coaching desired behaviour.To fully realise supported decision making, education and training programs would benefit from a focus on program co-design and working within a socio-ecological model of supported decision making.Future evaluations of supported decision making education should draw from both quantitative and qualitative approaches, with a focus on identifying the learning processes through which education influences supporter behaviour, organisational practices, and client/patient outcomes.

Understanding how healthcare providers build consumer trust in the Australian food system: A qualitative study.

AIM: This study aimed to identify how dietitians and other healthcare providers work to build trust in food systems in the course of providing dietary education. METHODS: Qualitative semi-structured interviews were conducted with 15 purposefully sampled dietitians (n = 5), general practitioners (n = 5), and complementary and alternative medicine practitioners (n = 5) within metropolitan South Australia. Interview data were then interpreted using an inductive thematic analysis approach, involving the construction of themes representing trust-enhancing roles around which beliefs about professional roles, the 'patient', and food and health were clustered. RESULTS: Healthcare providers communicate beliefs regarding (dis)trust in food systems through: (i) responding to patient queries and concerns following a food incident or scare; (ii) helping patients to identify (un)trustworthy elements of food supply systems; and (iii) encouraging consumption of locally produced and minimally processed food. Importantly, the expression of these roles differed according to participant beliefs about food and health (medico-scientific versus alternative medicine) and their adoption of professional projects that sought to promote medico-scientific ways of thinking about health and diet or manage the failures of Western medicine. CONCLUSION: The development and consolidation of trust-enhancing roles amongst healthcare providers likely requires disciplinary reflection on professional values and the processes by which practitioners apply these values to understanding food systems.

Testing delay in an environment of low COVID-19 prevalence: A qualitative study of testing behaviour amongst symptomatic South Australians.

Introduction: South Australia has to date (October 2021) been highly successful in maintaining an aggressive suppression strategy for the management of the COVID-19 pandemic. However, continued success of this strategy is dependent on ongoing testing by people with symptoms of COVID-19 to identify, trace and quarantine emergent cases as soon as possible. This study sought to explore community members' decisions about having COVID-19 testing in an environment of low prevalence, specifically exploring their decision-making related to symptoms. Materials and methods: This study drew on a qualitative case study design, involving five focus groups, conducted in May 2021, with 29 individuals who had experienced COVID-19-like symptoms since the commencement of testing in South Australia. Participants detailed their last COVID-19-like illness episode and described their decision-making regarding testing. Data collection methods and analysis were theoretically informed by the capability, opportunity, and motivation behaviour (COM-B) model. Findings: Participants' belief that COVID-19 symptoms would be 'unusual', severe, and persistent caused them to either reject or delay testing. Participants generally employed 'watch and wait' and social distancing behaviour rather than timely presentation to testing. Concern about economic loss associated with isolating after testing, and the potential for illness transmission at testing centres further prevented testing for some participants. Conclusions: In a low COVID-19 prevalence environment, individuals rely on pre-existing strategies for interpreting and managing personal illness (such as delaying help seeking if symptoms are mild), which generally conflict with public health management advice about COVID-19. In low prevalence environments therefore public health authorities must give the public a reason to test beyond considerations of personal risk, and clearly communicate the need for ongoing COVID-19 surveillance despite the low prevalence environment.

How might diabetes organisations address diabetes-related stigma? Findings from a deliberative democratic case study.

INTRODUCTION: This study sought to identify how diabetes organisations conceptualize the problem of diabetes-related stigma and how this shapes the selection of stigma-reduction interventions. METHODS: A qualitative deliberative democratic methodology was used to access an informed dialogue about what should be done by diabetes organisations to address diabetes-related stigma, drawing from the perspectives of board members, healthcare services staff, and communications and marketing staff from a single state-wide diabetes organisation in Australia (n = 25). RESULTS: Participants navigated the stigma concept along two axes: one that drew attention to either disease attributes or personal moral attributes as the object of stigmatisation, and one that positioned stigma as an individual or structural problem. This shaped the selection of stigma-reduction interventions, which included interventions to: (i) reduce the prevalence of stigmatized attributes, (ii) correct misunderstandings about diabetes, (iii) modify representations of persons with diabetes, (iii) enhance coping amongst persons with diabetes and (iv) make healthcare more person-centred and democratic. CONCLUSION: This study identified several grievances with 'diabetes-related stigma', which are grievances that can be conceptualized and addressed at both individual and structural levels, and involve correcting misinformation about diabetes or challenging and communicating alternative representations of persons living with diabetes. PATIENT OR PUBLIC CONTRIBUTION: The organisation's management and board were consulted throughout all stages of research development, analysis and reporting. The information and vignettes presented to participants drew from illness narratives obtained from earlier research involving adults with type 2 diabetes. Research participants included adults with various diabetes types.

Developing and Maintaining Public Trust During and Post-COVID-19: Can We Apply a Model Developed for Responding to Food Scares?

Trust in public health officials and the information they provide is essential for the public uptake of preventative strategies to reduce the transmission of COVID-19. This paper discusses how a model for developing and maintaining trust in public health officials during food safety incidents and scandals might be applied to pandemic management. The model identifies ten strategies to be considered, including: transparency; development of protocols and procedures; credibility; proactivity; putting the public first; collaborating with stakeholders; consistency; education of stakeholders and the public; building your reputation; and keeping your promises. While pandemic management differs insofar as the responsibility lies with the public rather than identifiable regulatory bodies, and governments must weigh competing risks in creating policy, we conclude that many of the strategies identified in our trust model can be successfully applied to the maintenance of trust in public health officials prior to, during, and after pandemics.

Critical consciousness development: a systematic review of empirical studies.

Developing an understanding of the social and political basis of marginalization is an important educational task for health education guided by frameworks of social justice. With the intention of developing an evaluative framework for use in further research, the aim of this review article is to present a synthesized framework of critical consciousness development, developed from a systematic search and qualitative synthesis of empirical studies that have examined the processes by which individuals come to critically reflect upon and act on oppressive social relations. A systematic search was conducted examining English-language literature produced between January 1970 and May 2017 within databases of PsycINFO, SCOPUS and ProQuest. A total of 20 articles were selected following a two-stage screening process and an assessment of methodological quality. Thematic analysis of findings from these texts produced a framework of critical consciousness development consisting of six qualitative processes and the relationships between them, including the priming of critical reflection, information creating disequilibrium, introspection, revising frames of reference, developing agency for change and acting against oppression. This synthesized framework of critical consciousness development is presented as a useful tool for assessing learning within critical pedagogies, albeit requiring some modification to suit specific cultural contexts and epistemologies.

Women and men in the Australasian College of Physical Scientists and Engineers in Medicine: workforce survey.

A survey was designed to determine aspirations, motivations and workplace experiences of both female and male members of the Australasian College of Physical Scientists and Engineers in Medicine (ACPSEM). The survey collected both quantitate and qualitative data, including open ended questions. This paper reports the survey's qualitative results. The research was approved by Ethics at University of South Australia and endorsed by ACPSEM. All 205 women (30% of total membership) and 440 men were invited to complete the survey online. The data for the qualitative analysis were responses to open-ended questions within the survey. 102 women and 150 men completed surveys were received, with 66 surveys analysed, before data saturation was reached. The survey revealed a number of themes that reflect concerns and opportunities identifying the direction for improving work-life balance and gender equity within the medical physics profession in Australasia. Issues around managing challenging workloads and professional development were amplified for women with children and child-rearing responsibilities, directly contributing to a reduction in work capacity and a reorientation of work-life priorities. The survey provides direction for strategies to improve work-life balance and enable equitable engagement in the profession. The first is to identify and develop role models that actively model successful work-life balance and flexibility in gender roles and in professional conduct. The second is to improve the management skills of current and emerging administrators, advocating for improved work conditions for medical physics professionals at an organisation level. Finally, efforts need to be made to establish flexible professional development and career progression opportunities amongst those that are unable to commit to large workloads, which is common for those with child-rearing responsibilities. The realisation of these strategic goals will reduce the identified barriers to full female participation in the workforce, and shift gender-based subcultures within the workplace.

Retaining Traditional Dietary Practices among Greek Immigrants to Australia: The Role of Ethnic Identity.

This article explores why some Greek immigrants to Australia continue to adhere to a traditional Mediterranean diet whereas others have adopted eating behaviors characteristic of a less healthy "Australian" diet. Twelve qualitative interviews were conducted and comparisons made between individuals consuming more (n = 6) and less traditional diets (n = 6). The level of adherence to the diet was previously assessed by a diet score in a separate quantitative study (MEDIS-Australia) from which the subset of 12 participants for the present study was recruited. Analysis revealed that maintenance of a strong ethnic identity offers a pathway through which individuals retain dietary practices of their homeland.