IMPAACT: IMproving the PArticipAtion of older people in policy decision-making on common health CondiTions - a study protocol.

INTRODUCTION: Rapid population ageing is a demographic trend being experienced and documented worldwide. While increased health screening and assessment may help mitigate the burden of illness in older people, issues such as misdiagnosis may affect access to interventions. This study aims to elicit the values and preferences of evidence-informed older people living in the community on early screening for common health conditions (cardiovascular disease, diabetes, dementia and frailty). The study will proceed in three Phases: (1) generating recommendations of older people through a series of Citizens' Juries; (2) obtaining feedback from a diverse range of stakeholder groups on the jury findings; and (3) co-designing a set of Knowledge Translation resources to facilitate implementation into research, policy and practice. Conditions were chosen to reflect common health conditions characterised by increasing prevalence with age, but which have been underexamined through a Citizens' Jury methodology. METHODS AND ANALYSIS: This study will be conducted in three Phases-(1) Citizens' Juries, (2) Policy Roundtables and (3) Production of Knowledge Translation resources. First, older people aged 50+ (n=80), including those from traditionally hard-to-reach and diverse groups, will be purposively recruited to four Citizen Juries. Second, representatives from a range of key stakeholder groups, including consumers and carers, health and aged care policymakers, general practitioners, practice nurses, geriatricians, allied health practitioners, pharmaceutical companies, private health insurers and community and aged care providers (n=40) will be purposively recruited for two Policy Roundtables. Finally, two researchers and six purposively recruited consumers will co-design Knowledge Translation resources. Thematic analysis will be performed on documentation and transcripts. ETHICS AND DISSEMINATION: Ethical approval has been obtained through the Torrens University Human Research Ethics Committee. Participants will give written informed consent. Findings will be disseminated through development of a policy brief and lay summary, peer-reviewed publications, conference presentations and seminars.

Health policy in South Australia 2003-10: primary health care workforce perceptions of the impact of policy change on health promotion.

ISSUE ADDRESSED: This paper examines recent Australian health reform policies and considers how the primary health care (PHC) workforce experiences subsequent change and perceives its impact on health promotion practice. METHODS: Health policy documents were analysed to determine their intended impact on health promotion. Interviews were conducted with 39 respondents from four State-funded PHC services to gain their perceptions of the impact of policy change on health promotion. RESULTS: There have been a plethora of policy and strategy documents over the last decade relevant to PHC, and these suggest an intention to strengthen health promotion. However, respondents report that changes to the role and focus of PHC services have led to fewer opportunities for health promotion. Services are struggling to engage in health promotion activity, while funding and policy directions are prioritised to targeted, individual behaviour change. CONCLUSION: The experience of PHC workforce respondents in South Australia suggests that, despite policy intentions, health promotion practice is much reduced. Our research suggests that rigorous evaluation of health sector reforms should be undertaken to assess both intended and unintended outcomes in terms of service quality and delivery. SO WHAT? Health promoters are experiencing a contradictory policy and practice environment, and this research should assist health promoters in advocating for more government accountability in the implementation of policies in order to advance comprehensive PHC.

The perspectives of older Greek-Australians toward changes in the nature of family support: implications for family care policies.

Internationally, public policies encourage "aging in place," and the majority of older Australians requiring care in the community receive informal care, supplemented by publicly subsidized formal services. The effect of contemporary social changes on informal care in aging migrant communities is poorly understood. This articles explores the perceptions of older Greek-Australians toward changes in the nature of family support. Bicultural and bilingual researchers carried out in-depth interviews (n = 27) and five focus groups (n = 63 total participants) with older Greek-Australians in modern Greek. While "cultures of care" remain among Greek-Australian families, the means for a family to assist have shifted, and these compromises are met with considerable powerlessness among older Greek-Australians. Implications for policy include the need to better involve older migrants and their families in decisions about their care needs, potentially involving consumer-directed care models. Service providers may also need to adopt the use of new technologies to communicate with increasingly time-pressured family members.

Access and acceptability of community-based services for older Greek migrants in Australia: user and provider perspectives.

In most developed nations, ageing migrants represent a growing proportion of the older population. Policies that emphasise care in the community depend on older migrants having access to formal services along with informal support, yet little is known about how older migrants experience community-based formal services. By examining the views of both Greek elders in Australia and those of formal service providers, this research fills an important gap in the literature around access to and acceptability of formal community-based services for older migrants. A research team including two Greek background researchers used existing social groups and a snowball sampling method to conduct face-to-face interviews and focus groups with seventy older Greeks in Adelaide, Australia. In addition, 22 community-based service providers were interviewed over the telephone. Results from users and providers showed that while many older Greeks experience service access issues, they also relied heavily on family for support and assistance at home. Reliance on family was both in preference to formal services or where formal services were used, to locate, negotiate and monitor such services. Common barriers identified by both groups included cost, transport and availability, but additional challenges were posed by language, literacy and cultural attitudes. Demographic changes including greater employment mobility and female workforce participation among adult children will have implications for both formal and informal care providers. Formal service providers need to ensure that services are promoted and delivered to take account of the important role of family in informal support while also addressing the access challenges posed by language and literacy. Research conducted by researchers from the same cultural background in the respondent's native language can further advance knowledge in this area.

Health in All Policies: evaluating the South Australian approach to intersectoral action for health.

OBJECTIVES: Health in All Policies (HiAP) has been promoted as a means of embedding concern for health impacts in the policy-making process. In South Australia, specific structures and processes to achieve this have been developed and tested. PARTICIPANTS: The HiAP approach is designed to engage policy officers and managers in all sectors of government. SETTING: South Australia, one of six Australian states, which operates under a system of cabinet government. There are 15 government departments. INTERVENTION: The primary mechanism of the South Australian HiAP approach is the health lens analysis (HLA) - an intersectoral, partnership process drawing on public health research methods. It has been applied to three separate public policy issues: water security, digital technology and migration. OUTCOMES: Evaluation findings to date suggest that the HLAs have resulted in the following: increased understanding by policy-makers of the impact of their work on health outcomes; changes in policy direction; development and dissemination of policy-relevant research; greater understanding and stronger partnerships between health and other government departments; and a positive disposition toward employing health lens analyses in future work. CONCLUSION: There have long been calls for intersectoral action in order to achieve public policy supportive of positive health outcomes. Evaluation to date suggests that the HLA is a promising means of moving the agenda from policy rhetoric to policy action.

Framework and tools for planning and evaluating community participation, collaborative partnerships and equity in health promotion.

ISSUE ADDRESSED: This paper reports on the development of a planning and evaluation framework and tools to assess key principles of primary health care/health promotion: community participation, collaborative partnerships and a focus on equity. The focus of the tools is on planning and process evaluation with some outcome questions included. METHODS: Following a scan of literature, the framework and tools for each component were developed. The tools were road-tested with colleagues and trialled by workshop participants. RESULTS: A framework and tools for each of the components and ways to assess how effectively they are applied at the program and practice level was developed. The tools attempt to deal with evaluation challenges by providing primary health care/health promotion practitioners and evaluators with a framework to examine these components of their work. CONCLUSIONS: Planning and evaluation are regarded as routine in good practice. As health promotion practice and programs are shaped by principles such as partnerships, participation and equity, it is important that we also apply an evaluation lens to these components. Sound planning and evaluation allows practitioners to explain how and why these principles are integrated into their work and what is achieved.

Building an evidence base for community health: a review of the quality of program evaluations.

An assessment of the quality of program evaluations conducted in South Australian community health services investigated how effective evaluation reporting is in producing an evidence base for community health. Evaluation reports were assessed by a team of reviewers. Practitioner workshops allowed an understanding of the uses of evaluation and what promotes or acts as a barrier to undertaking evaluations. Community health services do undertake a good deal of evaluation. However, reports were not generally explicit in dealing with the principles that underpin community health. Few engaged with program theory or rationale. Typically, reports were of short-term projects with uncertain futures so there may seem little point in considering issues of long-term health outcomes and transferability to other settings. The most important issue from our study is the lack of investment in applied health services research of the sort that will be required to produce the evidence for practice that policy makers desire. The current lack of evidence for community health reflects failure of the system to invest in research and evaluation that is adequately resourced and designed for complex community settings.

Four genomic islands that mark post-1995 pandemic Vibrio parahaemolyticus isolates.

BACKGROUND: Vibrio parahaemolyticus is an aquatic, halophilic, Gram-negative bacterium, first discovered in 1950 in Japan during a food-poisoning outbreak. Infections resulting from consumption of V. parahaemolyticus have increased globally in the last 10 years leading to the bacterium's classification as a newly emerging pathogen. In 1996 the first appearance of a pandemic V. parahaemolyticus clone occurred, a new O3:K6 serotype strain that has now been identified worldwide as a major cause of seafood-borne gastroenteritis. RESULTS: We examined the sequenced genome of V. parahaemolyticus RIMD2210633, an O3:K6 serotype strain isolated in Japan in 1996, by bioinformatic analyses to uncover genomic islands (GIs) that may play a role in the emergence and pathogenesis of pandemic strains. We identified 7 regions ranging in size from 10 kb to 81 kb that had the characteristics of GIs such as aberrant base composition compared to the core genome, presence of phage-like integrases, flanked by direct repeats and the absence of these regions from closely related species. Molecular analysis of worldwide clinical isolates of V. parahaemolyticus recovered over the last 33 years demonstrated that a 24 kb region named V. parahaemolyticus island-1 (VPaI-1) encompassing ORFs VP0380 to VP0403 is only present in new O3:K6 and related strains recovered after 1995. We investigated the presence of 3 additional regions, VPaI-4 (VP2131 to VP2144), VPaI-5 (VP2900 to VP2910) and VPaI-6 (VPA1254 to VPA1270) by PCR assays and Southern blot analyses among the same set of V. parahaemolyticus isolates. These 3 VPaI regions also gave similar distribution patterns amongst the 41 strains examined. CONCLUSION: The 4 VPaI regions examined may represent DNA acquired by the pandemic group of V. parahaemolyticus isolates that increased their fitness either in the aquatic environment or in their ability to infect humans.