The inter-relationship of diversity principles for the enhanced participation of older people in their care: a qualitative study.

BACKGROUND: The health and aged care workforce must understand and support the diverse needs of older people to enhance their care experience. We previously identified five principles of diversity training for this workforce: awareness of unconscious bias and prejudice; promotion of inclusion; access and equity; appropriate engagement; and intersectionality. This study aims to explore how these principles are considered from the perspectives of older Australians. METHODS: Older people (≥65 years) receiving home care and nursing services based in Victoria, Australia were invited to participate in a home-based semi-structured interview about their experience of, or with, diversity. Interviews were thematically analysed using a priori categories based on our previous work on principles of diversity training, and themes were interpreted and expanded upon based on the participants' experiences and understanding of diversity concepts and their care needs. RESULTS: Fifteen older people (seven female, eight male), mean age 76 years (range 71-85 years), were interviewed. Five themes were drawn from the data. It was found that human connection through building (1) trust and rapport was highly valued as an approach by older people, crucial as a first step to understanding what is important to the older person. Identifying with (2) intersectionality, that is, the different intersecting aspects of who they are and their experiences was understood by the participants as an important framework to meet their needs. The participants were aware of (3) unconscious bias and prejudice by health professionals and its impact on their care. Participants also noted that (4) promotion of inclusion through language was important to for a positive relationship with the healthcare worker. The participants understood that to facilitate human connection, these four principles of human interaction were critical, underpinned by (5) access and equity of the system. A model articulating these relationships was developed. CONCLUSION: Health and aged care training should incorporate the five diversity principles to support older people to participate in their own care.

A qualitative exploration of challenges recruiting older adults for Being Your Best, a co-designed holistic intervention to manage and reduce frailty: lessons learnt amidst the COVID-19 pandemic in Melbourne, Australia.

OBJECTIVES: Researchers face numerous challenges when recruiting participants for health and social care research. This study reports on the challenges faced recruiting older adults for Being Your Best, a co-designed holistic intervention to manage and reduce frailty, and highlights lessons learnt amidst the COVID-19 pandemic. DESIGN: A qualitative study design was used. Referrer interviews were conducted to explore the recruitment challenges faced by the frontline workers. An audit of the research participant (aged ≥65) database was also undertaken to evaluate the reasons for refusal to participate and withdrawal from the study. SETTING: Hospital emergency departments (EDs) and a home care provider in Melbourne, Australia. PARTICIPANTS: Frontline workers and older adults. RESULTS: From May 2022 to June 2023, 71 referrals were received. Of those referrals, only 13 (18.3%) agreed to participate. Three participants withdrew immediately after baseline data collection, and the remaining 10 continued to participate in the programme. Reasons for older adult non-participation were (1) health issues (25.3%), (2) ineligibility (18.3%), (3) lack of interest (15.5%), (4) perceptions of being 'too old' (11.2%) and (5) perceptions of being too busy (5.6%). Of those participating, five were female and five were male. Eleven referrer interviews were conducted to explore challenges with recruitment, and three themes were generated after thematic analysis: (1) challenges arising from the COVID-19 pandemic, (2) characteristics of the programme and (3) health of older adults. CONCLUSION: Despite using multiple strategies, recruitment was much lower than anticipated. The ED staff were at capacity associated with pandemic-related activities. While EDs are important sources of participants for research, they were not suitable recruitment sites at the time of this study, due to COVID-19-related challenges. Programme screening characteristics and researchers' inability to develop rapport with potential participants also contributed to low recruitment numbers. TRIAL REGISTRATION NUMBER: ACTRN12620000533998; Pre-results.

Diversity training evaluation for community aged care: Tool development.

Diversity characteristics such as culture, sexual orientation, and social situation potentially impact the participation of older individuals in healthcare. An awareness of diversity characteristics and their potential to impact on older people's access to health and aged care by professionals through training is important. This paper outlines the development and initial validation of a survey using adapted Delphi methodology and distribution to 195 health and aged care professionals pre- and post-diversity training. An initial pool of 31 items were developed with an expert reference group and reduced to 21 through exploratory factor analysis. A two-factor solution was extracted, measuring skills and attitudes of professionals relative to providing services to older people with diverse characteristics. Internal consistency of the items yielded a Cronbach alpha of 0.78. T-tests conducted on the pre- and post-survey data showed significantly higher scores on the domains of skills and attitudes following the training. Knowledge was not effectively captured using this method, with true-false or free-recall questions being a more appropriate approach. This tool fills a gap in the evaluation literature, providing an important first step to assess outcomes of diversity training in community aged care. Further validation is necessary for the tool to be used more widely in the sector.

Engagement of primary care practice in Australia: learnings from a diabetes care project.

Effective community-based chronic disease management requires general practice engagement and ongoing improvement in care models. This article outlines a case study on contributing factors to insufficient participant recruitment through general practice for an evidence-based diabetes care pilot project. Key stakeholder semi-structured interviews and focus groups were undertaken at cessation of the pilot project. Participants (15 GPs, five practice nurses, eight diabetes educators) were healthcare providers engaged in patient recruitment. Through descriptive analysis, common themes were identified. Four major themes were identified: (1) low perceived need for intervention; (2) communication of intervention problematic; (3) translation of research into practice not occurring; and (4) the service providing the intervention was not widely viewed as a partner in chronic disease care. Engaging GPs in new initiatives is challenging, and measures facilitating uptake of new innovations are required. Any new intervention needs to: be developed with GPs to meet their needs; have considerable lead-in time to develop rapport with GPs and raise awareness; and ideally, have dedicated support staff within practices to reduce the demand on already-overburdened practice staff. Feasible and effective mechanisms need to be developed to facilitate uptake of new innovations in the general practice setting.

'One size does not fit all': Perspectives on diversity in community aged care.

OBJECTIVES: Typically, older people are viewed via a single health condition, yet health outcomes are likely impacted by the intersection of many individual characteristics. Promoting inclusive health care is underpinned by reducing bias, respectful communication and supporting individual needs and preferences. This study explores perspectives of community aged care workers on diversity training and implementing training into practice. METHODS: Ninety community aged care workers were telephone-interviewed three months after a one-day diversity training workshop. Interviews were audio-recorded, transcribed verbatim and analysed thematically. RESULTS: Five themes emerged: 'raising awareness'; 'reserving judgement'; 'confidence and empowerment to embed diversity into practice'; 'communicating effectively'; and 'thinking about change … but'. CONCLUSIONS: Diversity concepts were positively received, but applying diversity principles into practice is more difficult. Recommendations to promote inclusive health care included raising awareness of bias, communicating with inclusive language and embedding diversity concepts into community aged care practice by addressing individual, organisational and wider system constraints.

A review of current models for initiating injectable therapy for people with type 2 diabetes in primary care.

AIMS: To systematically identify and describe models of injectable therapy initiation for people with type 2 diabetes mellitus (T2DM) in primary care. METHODS: Eight electronic databases and the grey literature were searched. Studies examining models of injectable therapy initiation for adults with T2DM in primary care settings were included. RESULTS: Successful models included: 1) Nurse-led one-to-one approach; 2) Nurse-led group sessions; and 3) Providing education to GPs and nurses. CONCLUSIONS: Few robust studies were found. Studied models were mainly in general practices, with limited evidence documented about starting people with T2DM on an injectable in the home setting.

Diversity training for the community aged care workers: A conceptual framework for evaluation.

Older Australians are an increasingly diverse population, with variable characteristics such as culture, sexual orientation, socioeconomic status, and physical capabilities potentially influencing their participation in healthcare. In response, community aged care workers may need to increase skills and uptake of knowledge into practice regarding diversity through appropriate training interventions. Diversity training (DT) programs have traditionally existed in the realm of business, with little research attention devoted to scientifically evaluating the outcomes of training directed at community aged care workers. A DT workshop has been developed for community aged care workers, and this paper focuses on the construction of a formative evaluative framework for the workshop. Key evaluation concepts and measures relating to DT have been identified in the literature and integrated into the framework, focusing on five categories: Training needs analysis; Reactions; Learning outcomes, Behavioural outcomes and Results The use of a mixed methods approach in the framework provides an additional strength, by evaluating long-term behavioural change and improvements in service delivery. As little is known about the effectiveness of DT programs for community aged care workers, the proposed framework will provide an empirical and consistent method of evaluation, to assess their impact on enhancing older people's experience of healthcare.

Primary- and secondary-level organizational predictors of work ability.

Australia has one of the world's most rapidly aging workforces and will inevitably experience labor shortages as a result. It is therefore necessary to examine factors that promote ability to work among aging workers in order to sustain a healthy aging workforce. The aim of this study was to investigate the direct and indirect effects of primary- and secondary-level organizational factors on work ability. A total of 306 employees participated in an online survey for this cross-sectional study. The results demonstrated that organizational nurturance (culture) and vocational strain indirectly predicted work ability, with work satisfaction mediating these relationships. Findings are discussed within the context of strategies for promoting work ability for all workers and retaining aging workers.