Exploring the Sociodemographic and Health-Related Determinants of Telehealth Use Among a Cohort of Older Australians During the COVID-19 Pandemic: Repeated Cross-Sectional Study.

BACKGROUND: During the COVID-19 pandemic, there was a rapid adoption of telehealth care services as a public health strategy to maintain access to essential health care. In Australia, there has been increasing optimism for the expansion of telehealth services. However, little is known about the patterns and determinants of telehealth adoption among older adults, with concerns that an expansion of telehealth services may only be of benefit to those who already have better access to health care. OBJECTIVE: Leveraging data collected by The Sax Institute's 45 and Up COVID Insights study between November 2020 and April 2022, the objective of this study was to identify and describe the sociodemographic and health-related determinants of telehealth adoption and use among a cohort of older Australians. We hypothesized that health-related factors would be key determinants of telehealth adoption for Australians aged ≥65 years during the COVID-19 pandemic. METHODS: A repeated cross-sectional design was used. The relationships between telehealth use (classified as low, moderate, or high) and selected sociodemographic and health-related characteristics were assessed using logistic regression techniques. Variable selection and findings were situated within the Technology Acceptance Model, the Unified Theory of Acceptance, and the Use of Technology theoretical frameworks. RESULTS: Of the 21,830 participants aged ≥65 years, the proportion who indicated adopting telehealth ranged from 50.77% (11,082/21,830) at survey 1 in 2020 to 39.4% (7401/18,782) at survey 5 in 2022. High levels of telehealth use were associated with being female, aged <85 years, living in a major city, cohabiting with others, and being from the most socioeconomically disadvantaged areas (deciles 1-3). Individuals with a disability, chronic disease, multimorbidity, and lower perceived quality of life and those experiencing missed or delayed care were significantly more likely to use telehealth across all levels (P<.001). A temporal association was observed, whereby participants who engaged with telehealth services before or early in the pandemic (as assessed in survey 1) were more likely to continue telehealth use when assessed in survey 5 in 2022 (P<.001). CONCLUSIONS: This research contributes to the broader understanding of telehealth adoption and use among older adults. As telehealth models of care expand, there is an opportunity to tailor these services to the needs of older adults, particularly those living with chronic diseases and multimorbidity, by using targeted strategies that overcome barriers to accessing specialized health care services.

Psychological interventions designed to reduce relocation stress for older people transitioning into permanent residential aged care: a systematic scoping review.

OBJECTIVES: This study aimed to identify and evaluate psychological interventions or strategies designed to reduce relocation stress in older people making the permanent transition into residential aged care. METHOD: A scoping review following the Joanna Briggs Institute methodology for scoping reviews and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) was conducted. An electronic search of nine databases and the search engine google scholar was completed in December 2022. Article screening and quality appraisal was undertaken independently by at least two reviewers. RESULTS: Eight full-text articles were included for review, from which four psychological interventions were identified: 1) Resident peer support; 2) Life review; 3) Mental Health Service for Older Adults; 4) The Program to Enhance Adjustment to Residential Living. No interventions were implemented before transitioning into care; all were implemented within three months of resident relocation into an aged care facility. CONCLUSION: The transition to residential aged care is an inherently distressing experience. The absence of interventions implemented during the pre- and mid-transition phases presents a gap in the literature and suggests an opportunity for early intervention. As population ageing continues to increase, there is a pressing need for the development and implementation of interventions aimed at reducing symptoms of depression and anxiety for older people undertaking this major life transition.

Placement Architectures in Practice: An Exploration of Student Learning during Non-Traditional Work-Integrated Learning in Rural Communities.

BACKGROUND: Work-integrated learning (WIL) in rural communities provides students with important learning opportunities while also providing a service to those communities. To optimise the potential benefits of work-integrated learning for health students and rural communities it is important to explore the practices and outcomes of these experiences. METHODS: This study used a qualitative research design underpinned by the theoretical framework of Theory of Practice Architectures to examine the way students learn during these placements. Purposive sampling was used to identify students for participation in the study. Seven students from the disciplines of paramedicine, physiotherapy, and speech pathology participated in semi-structured interviews. Data were analysed using inductive thematic analysis. RESULTS: The learning described by the students was examined, followed by a critical interrogation of the data to assess how these learnings and associated practices were made possible given the site-specific practice architectures. The findings of the research are represented by three themes: learning affordances related to placement design, learning through relationships between people and professions, and learning through rural embeddedness. CONCLUSION: Being embedded in rural communities gave the students access to several arrangements that fostered learning, particularly through the sayings, relatings and doings that the students engaged with. This research demonstrates the transformative potential of rural WIL opportunities for learning and future rural practice.

Effect of Rural Clinical Placements on Intention to Practice and Employment in Rural Australia: A Systematic Review.

BACKGROUND: Supporting the provision of clinical placement (CP) experiences in rural areas is a strategy used worldwide to promote the rural health workforce. While there is international evidence for this intervention in medicine, there is limited understanding of the influence of rural CP for nursing, midwifery, allied health, and dentistry health professions in Australia, which have received substantial federal investment. This review examined the relationship between rural CP and non-medicine health students' future rural practice intentions and workforce outcomes. METHODS: Four databases were systematically searched; papers were screened using defined criteria and appraised using the mixed-methods appraisal tool (MMAT). Findings were synthesized using a critical narrative approach. RESULTS: The methodological quality of the 29 eligible studies (13 quantitative non-randomized, 10 mixed method, 4 qualitative, 2 quantitative description) was appraised. Ten high-quality studies were identified. The review found that positive CP experiences may influence intention to practice rurally amongst undecided students and serve as a reinforcing experience for those students already interested in rural practice. There were mixed findings regarding the influence of CP length. The review also found that there is currently only evidence for the short-term effects of CP on students' future practice outcomes in rural areas with focus thus far on early practice outcomes. CONCLUSIONS: Those looking to use rural CP to promote the rural health workforce should focus on supporting the quality of a large number of CP experiences that are undertaken in rural areas, as there are currently differing findings on the role of rural CP length. Future studies of rural CP should consider greater use of social and educational theories to guide them.

Learnings from a mentoring project to support Aboriginal and Torres Strait Islander nurses and midwives to remain in the workforce.

Background: This article provides the findings of a research project which explored the experiences of participants in a mentoring programme designed to support Aboriginal and Torres Strait Islander nurses and midwives in a rural health district.Aims: It seeks to understand how a mentoring programme achieved its aims and anticipated outcomes that would ultimately inform future Aboriginal and Torres Strait Islander workforce support programmes.Design: The research project used a hermeneutic phenomenological philosophical framework to conduct Aboriginal and Torres Strait Islander people's methods of yarning, which engaged in conversation around key topics with participants, followed by the research team's analysis of yarns.Methods: A qualitative study utilising purposive sampling to select participants. Participants were drawn from those who had undertaken the cultural mentoring programme and could have been either mentors or mentees. Interviews were conducted once the 12-month mentoring programme had ceased.Results: The five main themes that were drawn from the data were cultural safety, motivations, relationships, learning and support.Conclusion: Participant experiences indicate that mentoring can be an avenue for providing appropriate clinical and cultural support and a safe space for Aboriginal and Torres Strait Islander nurses and midwives. They also show that identified support roles and Aboriginal-led projects can have larger impacts; fostering organisational connections and broader feelings of cultural respect amongst Aboriginal and Torres Strait Islander staff beyond programme participation.

Reaching at-risk rural men: An evaluation of a health promotion activity targeting men at a large agricultural event.

ISSUE ADDRESSED: This paper evaluates the effectiveness of an Australian Men's Shed Association's 'Spanner in the Works?' health promotion tent in reaching at-risk rural men during a large agricultural event in rural Australia. METHODS: Men who self-presented to the health promotion tent had basic health measurements and risk scores recorded. These were linked to a short survey asking about their primary health care engagement. To determine the 'reach' afforded to health professionals through their presence at the agricultural event, the mean systolic blood pressure and waist circumference measures of participants were compared to those of rural men nationally using the ABS' National Health Survey 2017-2018 Basic Confidentialised Unit Record File (CURF). RESULTS: Of the 401 men who visited the health promotion tent, 346 (86.3%) consented to participate in the study. The median age of participating men was 56 years. The majority (94.0%) were from rural areas. Of participating men, 58.9% had high blood pressure, and their mean systolic blood pressure was significantly higher than that of rural men nationally: both overall (Mean difference = 15.37 mm Hg), and at all age groups. Participants also had significantly higher waist circumference overall (Mean difference = 2.06 cm), but this was only significantly different for the 45-54 age group. CONCLUSIONS: The 'Spanner in the Works?' initiative was effective in reaching both healthy and at-risk rural men from a range of ages. SO WHAT?: Aligned with the National Men's Heath Strategy 2020-2030, this evidences that agricultural events are an effective social setting for the provision of health promotion to 'at risk' rural men.