Enhancing the implementation of provider-to-provider telehealth in rural and remote areas: A mixed methods study protocol.

Background: Virtual healthcare solutions are proposed as a way to combat the inequity of access to healthcare in rural and remote areas, and to better support the front-line providers who work in these areas. Rural provider-to-provider telehealth (RPPT) connects rural and remote clinicians to a 'hub' of healthcare specialists who can increase access to emergency and specialised healthcare via an integrated model. Reported benefits for the place-based provider include enhanced knowledge, expanded professional development opportunities, improved scope of practice, and increased confidence in treating more complex cases. These reported benefits could have implications for supporting and futureproofing our health workforce in terms of productivity, burnout, recruitment, and retention. Methods: The research uses an explanatory sequential mixed methods approach across multiple phases to evaluate the current implementation of Western Australia Country Health Service's (WACHS) Command Centre (CC) services and explore factors associated with their differential use. The primary population of interest and participants in this study are the place-based providers in country Western Australia (WA). Patient data constitutes the secondary population, informing the access and reach of CC services into country WA. Data collection will include service data, an online survey, and semi-structured interviews with the primary population. The data will be interpreted to inform evidence-based strategies and recommendations to improve the implementation and sustainment of RPPT. Discussion: Innovative and sustained workforce models and solutions are needed globally. Virtual healthcare, including provider-to-provider models, demonstrate potential, especially in rural and remote areas, designed to increase access to specialised expertise for patients and to support the local workforce. This research will generate new data around behaviour, perceptions, and value from the WACHS rural and remote workforce about provider-to-provider telehealth, to explore the implementation and investigate strategies for the long-term sustainment of RPPT services.

Meet us where we are: non-Indigenous young peoples' ideas on how to reduce alcohol-related harm in Mparntwe (Alice Springs).

OBJECTIVE: This research sought to understand the strategies young people in a remote central Australian town believed would reduce alcohol-related harms amongst their peers. METHODS: A total of 38 non-Indigenous residents of Mparntwe (Alice Springs), aged between 14 and 18 years, participated in focus groups at their school. Participants discussed strategies they thought would reduce alcohol-related harms among people their age. Data were analysed using thematic analysis. RESULTS: Participants suggested that young peoples' drinking behaviour developed with peers. Through social learning in peer groups, drinking alcohol was perceived as fun and normal. Participants indicated a willingness to learn about strategies to stay safe around alcohol. Their ideas for doing so reflected their existing social methods of learning about alcohol: having comfortable conversations and storytelling with a small group of peers and a relatable role model. CONCLUSIONS: Young residents of Mparntwe (Alice Springs) advised that alcohol-related harm reduction strategies would be most effective if focussed on safety, rather than abstinence, and applied social-learning strategies. IMPLICATIONS FOR PUBLIC HEALTH: Young people value their burgeoning self-determination. Youth health interventions must engage youth in intervention co-design and aim to assist young people to make safer decisions, rather than making decisions on their behalf.

Effectiveness of strategies to reduce risky alcohol consumption among youth living in rural or remote areas: a systematic review.

OBJECTIVE: This review aimed to evaluate the effectiveness of strategies to reduce risky alcohol consumption among youth living in rural and remote areas. INTRODUCTION: Youth living in rural and remote areas are more likely to drink alcohol and experience alcohol-related harm than youth living in urban locations. This review assessed the effectiveness of strategies to reduce young people's risky alcohol consumption in rural and remote areas. INCLUSION CRITERIA: We considered papers that included youth (aged 12 to 24 years; also referred to in this review as young people ) who were identified as living in rural or remote locations. Any intervention or strategy designed to reduce or prevent alcohol consumption among this population was included. The primary outcome was frequency of short-term risky alcohol consumption as measured by self-reported incidents of drinking 5 or more standard drinks in 1 session. METHODS: We conducted this systematic review in accordance with the JBI methodology for systematic reviews of effectiveness. We searched for published and unpublished English-language studies and gray literature from 1999 to December 2021. Two authors screened titles and abstracts before full-text screening and data extraction. Two authors reviewed the extracted data to identify studies that reported duplicate data (eg, due to progressive publication of longitudinal data sets) and, where multiple studies reported the same data set, the study with the measure most proximal to the primary outcome measure and/or with the longest follow-up was selected. Two authors then critically appraised the studies. There were no interventions that were assessed for impact on the primary outcome in more than 1 study; in turn, the feasibility and utility of statistical pooling and the Summary of Findings were limited. Instead, results and certainty of evidence is provided in narrative format. RESULTS: Twenty-eight articles reporting on 16 studies were included in the review: 10 randomized controlled trials, 4 quasi-experimental studies, and 2 cohort studies. All studies except 1 were conducted in the United States. Only 3 studies measured the primary outcome of short-term risky alcohol consumption and included a comparison group. A meta-analysis of 2 of these studies showed that interventions that included motivational interviewing had a small and non-significant effect on short-term risky alcohol consumption among Indigenous youth in the United States. Meta-analyses of the effect of a variety of interventions on secondary outcomes demonstrated that intervention was not more effective than control for reducing past month drunkenness; however, intervention was more effective for reducing past month alcohol use (odds radio 0.3; 95% CI 0.13 to 0.67; P =0.003). The heterogeneity of effects was evident within these meta-analyses as well as in the studies unable to be meta-analyzed. CONCLUSION: Based on this review, no interventions can be broadly recommended for reducing short-term risky alcohol consumption among youth in rural and remote areas. Further research to increase the robustness of available evidence in relation to the effectiveness of strategies to reduce short-term risky alcohol consumption among youth in rural and remote areas is urgently required. REVIEW REGISTRATION: PROSPERO CRD42020167834.

Association between alcohol restriction policies and rates of alcohol-related harms in remote Australian Aboriginal and Torres Strait Islander communities: a systematic review.

OBJECTIVE: The objective of this review was to examine the association between alcohol supply restriction policies and rates of alcohol-related harms in remote Australian Aboriginal and Torres Strait Islander communities. INTRODUCTION: Aboriginal and Torres Strait Islander peoples living in remote communities experience a higher rate of alcohol-related harms than other Australians. High rates of alcohol consumption are associated with a range of physical and social harms. Restricting the supply of alcoholic beverages in Aboriginal and Torres Strait Islander communities is often used by governments as a strategy to reduce these harms, but the current evidence is conflicting. INCLUSION CRITERIA: This review considered all quantitative studies with Aboriginal and Torres Strait Islander participants living in remote communities in Australia, where the participants were exposed to restrictions on the supply of alcoholic beverages. Harms of interest were i) physical injuries (whether secondary to assaults or accidents), measured as hospital admissions, Royal Flying Doctor Service attendance and transfers, and reported assaults, including intimate partner or family violence; ii) alcohol-related illnesses, measured as hospital admissions for conditions primarily attributed to alcohol consumption; and iii) rates of alcohol consumption, measured as alcohol sales per person or as self-reported consumption. METHODS: We searched a wide range of databases and gray literature resources for published and unpublished, English-language studies from 1998 to 2020. Two reviewers independently screened search results and selected citations for full-text retrieval. Two reviewers independently assessed each article for congruence to the inclusion criteria. Critical appraisal and data extraction were conducted by two reviewers working independently. Data were narratively synthesized because statistical pooling was not possible. RESULTS: We included 13 observational studies with more than 15,800 participants. Most included studies reported some harm reductions in association with a variety of alcohol supply restrictions; however, these reductions were sometimes short-lived. Studies reported on a variety of supply reduction strategies, ranging from small limitations on when alcohol could be sold to total prohibition of alcohol within the community. None of the interventions examined in the included studies reported consistent results. Total prohibition of alcohol was initially associated with large reductions in consumption but also led to unintended consequences, such as illicit substance use, alcohol consumption outside of the community, and illegal importation of alcohol into the community. We were unable to make any strong recommendations based on the included studies due to inherent bias in the study designs employed. CONCLUSIONS: Problematic use of alcohol by Aboriginal and Torres Strait Islander peoples is unlikely to be solved by a single strategy. Total alcohol prohibition does not stop people from seeking and accessing alcohol, and may in fact lead to a range of negative unintended consequences. Future studies should be more rigorously designed and reported to increase the strength of the evidence and certainty in the results.

Solving the Puzzle of Global Health Inequity: Completing the Picture Piece by Piece by Piece.

Achieving health equity is an ongoing priority for the global community. Understanding, supporting, and addressing the challenges that face health workers is a critical component of the solution to this problem. The University of Global Health Equity (UGHE) in Rwanda has established the Institute of Global Health Equity Research (IGHER) to contribute to the generation of new knowledge through high-quality research and research training that seeks to improve our understanding of the important issues that influence the distribution of health and healthcare globally. With an unrelenting emphasis on increased impact by prioritizing implementation research, IGHER is particularly interested in amassing a compendium of important research lessons to increase the likelihood that effective implementation strategies will be employed to enhance healthcare service provision. IGHER organizes research according to five foundational research questions, which address different elements that are pivotal to a comprehensive approach to appreciating the nuanced realities of effective healthcare service provision. UGHE outputs for 2020 indicate that: appropriate resourcing of healthcare services is critical for the eradication of global health inequities; policy reform is required for many healthcare innovations and initiatives to be implemented adequately; and high-quality research that is applicable to different contexts is essential for eradicating global health inequities. Furthermore, reimagining healthcare delivery will benefit from an intentional, ongoing, bidirectional influence between evidence-based pedagogy (methods and practices of teaching, education, and instruction) and supporting research activity such that education and instruction inform the research conducted and research findings are fed back to the classroom to help improve education and instruction. As IGHER continues to grow, the valuable insights afforded by high-impact implementation research will increase. These insights will help to inform the development and use of evidence-based implementation strategies for the adoption, scaling, and sustainability of equitable, effective, and efficient health services globally.

Effectiveness and appropriateness of culturally adapted approaches to treating alcohol use disorders in Indigenous people: a mixed methods systematic review protocol.

OBJECTIVE: The objective of this review is to investigate the effectiveness and appropriateness of culturally adapted approaches for treating alcohol use disorders in Indigenous peoples in Canada, New Zealand, Australia, and the USA. INTRODUCTION: Poor and disadvantaged people, particularly those who are Indigenous, suffer more health effects due to alcohol misuse and are therefore subject to more law enforcement actions. Analyses have identified strategies for improving health services for Indigenous people; chief among these is culturally safe care specifically tailored to the context. Alcohol addiction is a chronic relapsing condition that usually requires ongoing treatment, so it is vital that treatment therapies are appropriate, meaningful, and effective. Many evidence-based therapies for substance abuse have not been specifically designed for or tested in Indigenous and First Nations communities. This absence of cultural considerations may be a contributor to the failure of these programs to engage with clients and successfully influence their behavior. INCLUSION CRITERIA: This review will consider qualitative and quantitative studies of any methodology, published in any language after 1998. Studies including adult and/or adolescent participants in inpatient or outpatient alcohol treatment programs described as being adapted to meet cultural needs will be considered. METHODS: This review will use the convergent segregated approach to mixed methods reviews. A range of databases will be searched, including MEDLINE, CINAHL, Embase, and PsycINFO. Two reviewers will critically appraise and extract data from studies meeting the inclusion criteria. Qualitative research findings will, where possible, be pooled using JBI SUMARI with the meta-aggregation approach, and quantitative studies will, where possible, be pooled in statistical meta-analysis using JBI SUMARI. The JBI convergent segregated approach to mixed methods reviews will be followed.

Identifying Functional Mechanisms in Psychotherapy: A Scoping Systematic Review.

The identification of fundamental mechanisms is an important scientific pursuit in many fields of enquiry. With regard to the development of psychological treatments, understanding the mechanisms through which change occurs such that psychological distress resolves, can enable us to develop more effective and efficient interventions. In the field of psychotherapy, mechanisms are often identified either statistically or conceptually. The most powerful and useful mechanisms, however, are functional rather than statistical or conceptual. More specifically, with regard to mechanisms relevant to psychotherapy, it is difficult to identify what any of these mechanisms actually do in a mechanistic sense. That is, the mechanics of putative mechanisms are generally unspecified. In order to obtain a rigorous and comprehensive account of the current mechanisms in psychotherapy, as well as to evaluate their usefulness, a systematic scoping review was conducted. The systematic scoping review did not yield any mechanisms that were expressed in functional terms. We argue that, in order for psychotherapy to improve its effectiveness and efficiency, the standard for what is accepted as a useful mechanism needs to be substantially raised. Only functional mechanisms that express plausible actions consistent with known biological processes should be used to inform therapeutic interventions.

Advancing nursing practice for improved health outcomes using the principles of perceptual control theory.

This article describes how an empirically supported theory of human behaviour, perceptual control theory, can be used to advance nursing practice and improve health outcomes for people who are accessing nursing care. Nursing often takes a pragmatic approach to the delivery of care, with an emphasis on doing what appears to work. This focus on pragmatism can sometimes take precedence over any consideration of the underlying theoretical assumptions that inform decisions to take one particular approach over another or the mechanisms through which nursing interventions have their effects. For nursing to develop as a profession, there needs to be an increased focus on the core principles that underpin the delivery of care. In addition to understanding what works, nurses must develop their understanding of how and why particular approaches work or do not work. Understanding the fundamental principles that underpin nurses' actions will lead to more efficient and effective approaches to the delivery of nursing care. It will also enable nurses to maximize those elements of their practice that are most beneficial for people and minimize other activities that either have little effect or actually lead to worse outcomes. In this article, we will propose that the phenomenon of control is fundamental to human health. Perceptual control theory provides a coherent theoretical framework that enables us to understand the phenomenon of control through a functional model of human behaviour. People are healthy when their neurochemical, physiological, biological, psychological and social states are all controlled satisfactorily. We will explain the implications of understanding health as control throughout the paper. From this perspective, we will argue that the aim of nurses and nursing should be to support people to maintain or recover control over those aspects of their lives that are important and meaningful to them.

Developing best practice guidelines for the psychosocial assessment of Aboriginal and Torres Strait Islander people presenting to hospital with self-harm and suicidal thoughts.

OBJECTIVE: To develop guidelines for the culturally responsive psychosocial assessment of Aboriginal and Torres Strait Islander people presenting to hospital with self-harm and suicidal thoughts. METHOD: The Delphi method was used to establish expert consensus. A systematic search and review of relevant research literature, existing guidelines and grey literature was undertaken to develop a 286-item questionnaire. The questionnaire contained best practice statements to guide clinicians undertaking psychosocial assessment of Aboriginal and Torres Strait Islander people presenting to hospital with self-harm and suicidal thoughts. An expert panel comprising 28 individuals with clinical, community-based and lived experience in Aboriginal and Torres Strait Islander mental health and/or suicide prevention were recruited and independently rated the items over three rounds. Statements endorsed as essential or important by 90% or more of the expert panel were then synthesised into recommendations for the best practice guideline document. RESULTS: A total of 226 statements across all relevant areas of clinical practice were endorsed. No statements covering the use of structured assessment tools were endorsed. The endorsed statements informed the development of a set of underlying principles of culturally competent practice and recommendations for processes of effective and appropriate engagement; risks, needs and strengths to be assessed; formulation of psychosocial assessment; and recommendations specific to children and young people. CONCLUSION: The guidelines are based on recommendations endorsed across a range of expertise to address an important gap in the evidence-base for clinically effective and culturally responsive assessment of self-harm and suicidal thoughts by Aboriginal and Torres Strait Islander people in hospital settings. Further work is needed to develop an implementation strategy and evaluate the recommendations in practice.

Effectiveness of strategies for reducing risky alcohol consumption among youth living in rural or remote areas: a systematic review protocol.

OBJECTIVE: The aim of this review is to evaluate the effectiveness of strategies for reducing risky alcohol consumption among youth living in rural and remote areas. INTRODUCTION: Youth living in rural and remote areas are more likely to drink alcohol and are at higher risk of experiencing alcohol-related harm than youth living in urban locations. However, a review has not yet been conducted evaluating the effectiveness of strategies for reducing young people's risky alcohol consumption in rural and remote locations. INCLUSION CRITERIA: This systematic review will consider papers that include youth (aged 12 to 24 years) who are identified as living in rural, remote, regional, non-urban or non-metropolitan locations. Any intervention or strategy with the purpose of reducing or preventing alcohol consumption or alcohol-related harms among this population will be considered. The primary outcome is frequency of short-term risky alcohol consumption, as measured by self-reported incidents of drinking five or more standard drinks. Secondary outcomes will also be included. METHODS: Sources of published studies, unpublished studies and gray literature will be searched. Only studies in English published from 1999 will be included. Titles and abstracts of all search results will be screened. The full text of potentially relevant studies will then be assessed in detail. Studies will be stratified by methodological quality. The data extracted will include specific details about the populations, study methods, interventions and outcomes. Studies will be pooled in statistical meta-analysis, where possible, and where statistical pooling is not possible, the findings will be presented in narrative form.

Retention strategies and interventions for health workers in rural and remote areas: a systematic review protocol.

OBJECTIVE: The objective of the current review is to examine the association between exposure to strategies or interventions to retain health workers in rural and remote areas of high-income countries and improved retention rates. INTRODUCTION: Attracting and retaining sufficient healthcare staff to provide adequate services for residents of rural and remote areas is an international problem. High-income countries have specific challenges in staffing remote and rural areas; despite the majority of the population clustering in large cities, a significant number of communities are in rural, remote or frontier areas which may be perceived as less attractive locations in which to live and work. INCLUSION CRITERIA: The review will consider studies that include health workers in high-income countries where participants have been exposed to interventions, support measures or incentive programs to increase retention or workforce length of employment or reduce turnover for health workers in rural and remote areas. Analytical observational studies, case-control studies, analytical cross-sectional studies, descriptive observational study designs, and descriptive cross-sectional studies published from 2010 will be eligible for inclusion. METHODS: We will use the JBI methodology for reviews of risk and etiology. A range of databases will be searched. Two reviewers will screen, critically appraise eligible articles, and extract data from included studies. Data synthesis will be conducted, where feasible, with RevMan 5.3.5. A random effects model will be used to conduct meta-analyses. We will assess the certainty of the findings using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.

Valued but tenuous? Postgraduate clinical psychology placements for psychology students in rural and remote areas - implications for future directions.

INTRODUCTION: This study is located at the complex intersection of healthcare service provision, healthcare workforce and practice-based education. The study explored postgraduate clinical psychology placements in rural and remote locations and was part of a larger study known as the Mental Health Tertiary Curriculum project. METHOD: A qualitative approach incorporating thematic analysis was used to explore experiences. Ten structured individual interviews were conducted across Australia. Participants were eight postgraduate psychology students, one service provider and one representative of an educational institution. RESULTS: Two key themes were derived from the data. The first theme, 'Beyond expectations, but …', recognised the value of clinical placements from the students' perspectives, but cautioned against the challenges faced by supervisors supporting these placements. The second theme, 'Immersed in connectedness with …', makes explicit the growing sense of belonging and professional identity that accompanied students' engagement with their rural communities, other health professions and their own profession. CONCLUSION: This study highlights the complexity of developing workplace readiness for psychology students and provides areas for future consideration including the role of practice-based education and where this notion fits within undergraduate psychology degrees.

Association between restriction policies and rate of alcohol-related harm in Australian Aboriginal and Torres Strait Islander communities: a systematic review protocol.

OBJECTIVE: This review aims to examine the association between alcohol restriction policies and rates of alcohol-related harms in Australian Aboriginal and Torres Strait Islander communities. INTRODUCTION: A number of different strategies have been used to reduce the harms and costs associated with excessive alcohol consumption in Aboriginal and Torres Strait Islander communities. These strategies, implemented at federal and state government levels, as well as by individual communities, have aimed to promote reduced alcohol consumption or prohibit consumption entirely. Strategies to address the problems associated with alcohol misuse can be categorized into three types: harm, demand and supply reduction. INCLUSION CRITERIA: This review will consider any kind of quantitative research study that includes Australian Aboriginal and Torres Strait Islander peoples living in communities subject to alcohol control policies due to the imposition of alcohol management plans or other alcohol restriction policies. Included studies will measure physical alcohol-related harms. The secondary outcome of interest will be rates of alcohol consumption measured as alcohol sales per person or as self-reported consumption. Studies published in English from 1998 will be included. METHODS: The proposed systematic review will be conducted in accordance with the JBI methodology for systematic reviews of etiology and risk. Published and unpublished studies will be sourced from multiple databases and resources. Two independent reviewers will screen, appraise and extract data from studies meeting the inclusion criteria. Data synthesis will be conducted and a Summary of Findings will be constructed.

To Mix or Not To Mix? A Meta-Method Approach to Rethinking Evaluation Practices for Improved Effectiveness and Efficiency of Psychological Therapies Illustrated With the Application of Perceptual Control Theory.

Progress in the development of more effective and efficient psychological therapies could be accelerated with innovative and nuanced approaches to research methodology. Therapy development has been dominated by a mono-methodology attitude with randomized controlled trials (RCTs) regarded as a "gold standard" despite the concept of a single methodology being ascribed gold standard status having been called into question. Rather than one particular methodology being considered superior to all others, the gold standard approach should be matching appropriate methodologies to important research questions. The way in which that matching should occur, however, is far from clear. Moving from a mono-methodological approach to mixed-method designs has not been straightforward. The ways in which methods should be mixed, to arrive at robust and persuasive answers to genuine research questions, is not entirely clear. In this paper, we argue that attention to the meta-methods underpinning all research designs will improve research precision and provide greater clarity about the contribution of any particular program of research to scientific progress in that field. From a meta-method perspective, the matter of what changed can be delineated from why or how these changes occurred. Different methods and different types of mixing can be justified for each meta question. A meta-method approach should make explicit the assumptions that guide the development of research designs and also promote the articulation of putative mechanisms that might be relevant. By paying greater attention to assumptions such as how causality occurs, and important mechanisms of change, the mixing of methodologies that are still not mainstream in this area such as routine outcome monitoring and evaluation and functional model building, can occur. By adopting methodologies that focus on learning about a program's strengths and weaknesses rather than presiding over judgments of whether or not the program is deemed to be effective, we will move much closer to a position of being able to understand what programs under which conditions people find most helpful for their purposes.

Method of levels therapy for first-episode psychosis: The feasibility randomized controlled Next Level trial.

OBJECTIVE: We aimed to determine the feasibility and acceptability of Method of Levels (MOL) for people experiencing first-episode psychosis (FEP) to inform decision making about the therapy's suitability for further testing in a larger clinical trial. METHOD: A parallel group randomized controlled trial design was used. Participants (N = 36) were allocated to receive either treatment as usual (TAU) or TAU plus MOL. Recruitment and retention in the trial and the acceptability of the MOL intervention were the primary outcomes. RESULTS: The recruitment target was met within the planned time frame. Retention in the trial at final follow-up was 97%, substantially higher than the 80% threshold prespecified as a successful feasibility outcome. Participant feedback provided initial evidence of the acceptability of the study design and intervention for this population. CONCLUSION: Results support progressing to a larger trial of MOL for FEP. Recommendations for the design of future trials are provided.