Implications for clients when nurses view weight as main cause of Type 2 diabetes in primary care.

Type 2 diabetes (T2D) is often seen as primarily caused by weight, and its amelioration associated with individual behaviour change, which has the potential for negative consequences for people living with the disease. The aims of this study were to explore how weight was framed by diabetes resource nurses and to determine the implications of that framing for nurse practice in a primary care setting in Australia. The research was a qualitative empirical case study using semistructured interviews with nurses focusing on meanings and interpretations. The findings were interpreted using a constructivist epistemology of both inductive and deductive inference. The study found that nurses viewed overweight and obesity as unhealthy and the primary causes of T2D, and that weight was frequently discussed in the health care encounter. Nurses emphasised individual responsibility through behaviour change to manage T2D, downplaying other known causes such as age and family history and important social inequalities. Studies show that nurses have negative attitudes towards overweight and obese patients. The implications of this research are that the nurses' views could potentially negatively affect clients' management of T2D, which has the potential for poor health outcomes.

Food Charity, Shame/ing and the Enactment of Worth.

Food insecurity is a significant problem in many countries, including Australia. Consequently, food hubs, through which food is distributed using a supermarket style layout, have become an important new source of charity food provision. However, little is known about users' experiences. We draw on ethnographic research to understand the everyday experiences of people using South Australian food hubs. We suggest that attempts to produce a more dignified experience by creating a normalizing experience of shopping is not being achieved, because of the shame and stigma surrounding poverty, confusing operational processes, poor food quality, staff attitudes, and the disciplinary capacity of food hubs.

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.

The experiences and perceptions of food banks amongst users in high-income countries: An international scoping review.

PURPOSE: Food banks have become the main response to food insecurity in many high-income countries, but it has been argued that they lack the capacity to respond consistently and fully to the food needs of the people who use them. This literature review set out to answer the question 'how do food bank recipients experience food relief services and how does this impact their lives and wellbeing?' RESULTS: A comprehensive search of electronic databases yielded twenty qualitative studies, conducted in developed countries, exploring user perspectives of food banks. From the studies reviewed, there emerged three main categories that represented the different aspects of the food bank process from the food bank user's perspective: the user's perceptions about the idea of being fed from food banks, the user's perceptions about food bank offerings and operations, and the socio-psychological impact of receiving food from food banks. While participants of these studies spoke positively of the volunteers and were thankful for the service, they also consistently report limited food choice, poor quality, shame, stigma and embarrassment associated with food bank use. CONCLUSIONS: The food bank industry continues to expand despite there being little evidence that food banks are an appropriate response for those facing food insecurity. This is worrying as the results of this review indicate that although participants value the service provided by the food bank, the experience can be largely negative. These findings raise questions about the food bank model as a long-term strategy.

Bariatric surgery revisions and private health insurance.

OBJECTIVE: To identify: 1. The percentage of bariatric procedures that are revisions; 2. What proportion of bariatric revision procedures in public hospitals are for patients whose primary weight loss procedure occurred in a private hospital; 3. The age, sex and level of socioeconomic disadvantage of patients needing revisions. METHODS: An analysis of patient level admission data from the Integrated South Australian Activity Collection (ISAAC) was performed. Data were collected on all revisions for weight loss related procedures at all South Australian public and private hospitals, between 2000-2015 using the ISAAC codes for revision procedures. RESULTS: 12,606 bariatric procedures occurred in hospitals; ∼27% of which represent a revision (n=3366). Of these revisions, ∼82% occurred in a private hospital (n=2771), and ∼18% occurred in a public hospital (n=595). Of the 595 revisions in a public hospital, 51% of patients had their original bariatric procedure performed in a private hospital. The majority of patients who had a revision procedure are female (≥82%) with a mean age of ∼45. Individuals from the lowest 2 IRSD quintiles were over-represented for public hospital revisions and primary bariatric procedures. CONCLUSION: Further investigation is needed to identify: 1. Why 27% of bariatric procedures are revisions; 2. Why at least 51% of revisions in public hospitals are on patients whose original primary bariatric procedure was done in a private hospital; 3. The impact that revision procedures in public hospitals, particularly for originally private weight loss procedures, is having on public hospital wait times; 4. The impact of socioeconomic disadvantage on weight loss procedure outcomes.

Quantitative analysis of bariatric procedure trends 2001-13 in South Australia: implications for equity in access and public healthcare expenditure.

OBJECTIVES: The aims of the present study were to: (1) identify trends in bariatric surgery in South Australia (SA) from 2001 to 2013; and (2) compare public and private hospitals, and so discuss the implications of these trends as they relate to equity in access to bariatric procedures and public system healthcare expenditure. METHODS: An analysis of retrospective data of all bariatric procedures in public and private hospitals in SA was conducted using all SA public and private hospital administrative records between 2001 and 2013. RESULTS: Of all procedures conducted in SA, 22.6% were revisions or reversals. The number of revisions or reversals conducted in SA has increased at a rate higher than weight loss procedures (6.4- vs 3.8-fold increase). An increasing proportion of public surgeries are revisions or reversals of weight loss procedures that occurred outside of the SA public system (interstate or in the private system). CONCLUSION: Further investigation is necessary to identify the pathways patients navigate to access bariatric surgery, the utilisation of public services following private procedures and why rates of revisions or reversals of bariatric procedures are increasing in SA.