Exploring health coaching and mindfulness as levers for transformation in health: stakeholder perspectives.

BACKGROUND: Health coaching (HC) and mindfulness (MFN) are proven interventions for mobilizing patients' inner resources and are slowly being integrated into public primary care. Since 2015 the medical community in Gibsons BC has integrated physician-led HC and MFN-based programs into team-based care. This exploratory study aimed to understand the mechanisms by which these rural programs helped both patients and clinicians, and to elicit priorities for future study in these fields. METHODS: Using a qualitative participant-engaged constructivist approach in focus groups and large-group graphic facilitation, we elicited perspectives from patients and their physicians during a 1-day event held in September 2018. Thematic analysis of transcripts using Nvivo identified emergent themes that were regularly reviewed with coresearchers, and member checked with participants via online videoconferences held at 6 weeks and 4 months postevent. RESULTS: We identified six main themes relating to the successful implementation of these programs: (i) accessibility and affordability, (ii) offering a toolbox of practical skills, (iii) providing attuned and openhearted care, (iv) generating hope and self-efficacy, (v) experiencing a shared humanity and connection, and (vi) addressing the health of the whole person. CONCLUSION: These themes highlight critical qualities of HC and MFN programs when implemented in a Medicare system. Key features include reducing stigma around mental health through making programs physician-led and a natural part of primary care, enriching accessibility through public funding, and enhancing patient agency through cultivating embodied awareness, self-compassion, and interpersonal skills. These themes inform the next steps to support upscaling these programs to other communities.

Health coaching (HC) and mindfulness (MFN) are proven patient-centered interventions for mobilizing patients' inner resources and changing the trajectories of many chronic physical and psychological conditions. However, though widely available in the private sector, they have been slow to find their way into public primary care in Canada. Since 2015 a rural medical community in BC Canada has integrated physician-led HC and MFN-based programs into primary care. This exploratory study aimed to understand how these programs are working to help both patients and clinicians, providing insights that other communities might use. We elicited perspectives from patient participants and their physicians through focus groups and large-group graphic facilitation during a 1-day event held in September 2018. We identified six themes contributing to successful implementation. Key features include reducing stigma around mental health through making programs publicly accessible and physician-led, and enhancing patient hope and empowerment through cultivating awareness, self-compassion, and interpersonal skills. It also mattered that the facilitators created psychological safety where participants could grow these skills in a nurturing environment, while addressing various dimensions of health. These themes refine our understanding of how these programs can work within public systems to support patient self-management.

What does the public think about sex offender registers? Findings from a national Australian study.

This article presents data from questions about sex offender registration orders in a large national survey on Australian public opinion about adult sex offenders. It outlines the legislative frameworks that govern these registers in Australia and discusses the use of public registers, the research on the effectiveness of sex offender registers, and Australian attitudes to such registers. Our surveys of three cohorts of members of the Australian public reveal strong public support for sex offender registers, especially for cases involving child victims. However, there was also support for judicial discretion in the imposition of orders and reduced support for automatic registration where a non-custodial sentence is imposed. The Australian Government has recently announced the establishment of a national public sex offender register, but our findings show limited support for this approach. The implications for policy and practice are considered.

A qualitative inquiry on pregnant women's preferences for mental health screening.

BACKGROUND: Approaches to screening can influence the acceptance of and comfort with mental health screening. Qualitative evidence on pregnant women's comfort with different screening approaches and disclosure of mental health concerns is scant. The purpose of this study was to understand women's perspectives of different mental health screening approaches and the perceived barriers to the communication and disclosure of their mental health concerns during pregnancy. METHODS: A qualitative descriptive study was undertaken. Fifteen women, with a singleton pregnancy, were recruited from a community maternity clinic and a mental health clinic in Calgary, Canada. Semi-structured interviews were conducted during both the 2nd and 3rd trimesters. Data were analyzed using thematic analysis. RESULTS: Preferences for mental health screening approaches varied. Most women with a known mental health issue preferred a communicative approach, while women without a known mental health history who struggled with emotional problems were inclined towards less interactive approaches and reported a reluctance to share their concerns. Barriers to communicating mental health concerns included a lack of emotional literacy (i.e., not recognizing the symptoms, not understanding the emotions), fear of disclosure outcomes (i.e., fear of being judged, fear of the consequences), feeling uncomfortable to be seen vulnerable, perception about the role of prenatal care provider (internal barriers); the lack of continuity of care, depersonalized care, lack of feedback, and unfamiliarity with/uncertainty about the availability of support (structural barriers). CONCLUSIONS: The overlaps between some themes identified for the reasons behind a preferred screening approach and barriers reported by women to communicate mental health concerns suggest that having options may help women overcome some of the current disclosure barriers and enable them to engage in the process. Furthermore, the continuity of care, clarity around the outcomes of disclosing mental health concerns, and availability of immediate support can help women move from providing "the best answer" to providing an authentic answer.

Toward a Practice Framework for Throughcare Reintegration Programs.

Practice frameworks for programs supporting people to transition between prison and community are a critical resource for service agencies, researchers and policy makers. Although reintegration programs are often commissioned with reference to Risk-Needs-Responsivity and the Good Lives Model, these frameworks lack specificity for practical program design. Following recent meta-theoretical guidelines, we articulate a practice framework for reintegration programs over three levels: (1) principles and values; (2) knowledge related assumptions; and (3) intervention guidelines. Level 1 is drawn from the capability approach, which frames the goal of increasing the substantive freedom of individuals. Level 2 is drawn from desistance theory, which grounds claims that sustained cessation of offending is enabled by changes in people's self-labels and narrative, relationships with friends and family, access to resources, and community participation. Level 3 is drawn from throughcare service design and structures practice into seven domains. This framework has potential to reduce rates of reincarceration.

How have health promotion frameworks considered gender?

This paper provides an overview of five key internationally recognized health promotion frameworks and assesses their consideration of gender. This analysis was conducted as part of the Promoting Health in Women project, a Canadian initiative focused on generating a framework for effective health promotion for women. To date, no review of health promotion frameworks has specifically focused on assessing the treatment of gender. This analysis draws on a comprehensive literature review that covered available literature on gender and health promotion frameworks published internationally between 1974 and 2010. Analysis of five key health promotion frameworks revealed that although gender was at times mentioned as a determinant of health, gender was never identified and integrated as a factor critical to successful health promotion. This superficial attention to the role of gender in health promotion is problematic as it limits our capacity to understand how gender influences health, health contexts and health promotion, as well as our ability to integrate gender into future comprehensive health promotion strategies.