Evolution of Food and Nutrition Policy: A Tasmanian Case Study from 1994 to 2023.

Food security is a concept with evolving definitions and meanings, shaped by contested knowledge and changing contexts. The way in which food security is understood by governments impacts how it is addressed in public policy. This research investigates the evolution of discourses and practices in Tasmanian food and nutrition policies from 1994 to 2023. Four foundational documents were analysed using qualitative document analysis, revealing persistent food insecurity issues over three decades. The analysis identified a duality in addressing the persistent policy challenges of nutrition-related health issues and food insecurity: the balancing act between advancing public health improvements and safeguarding Tasmania's economy. The research revealed that from 1994 to 2023, Tasmania's food and nutrition policies and strategies have been characterised by various transitions and tensions. Traditional approaches, predominantly emphasising food availability and, to a limited extent, access, have persisted for over thirty years. The transition towards a more contemporary approach to food security, incorporating dimensions of utilisation, stability, sustainability, and agency, has been markedly slow, indicating systemic inertia. This points to an opportunity for future policy evolution, to move towards a dynamic and comprehensive approach. Such an approach would move beyond the narrow focus of food availability to address the complex multi-dimensional nature of food security.

Enhancing Food Literacy and Food Security through School Gardening in Rural and Regional Communities.

A qualitative case study approach with in-depth, semi-structured interviews of key school staff, and student feedback was used to assess a school kitchen and garden program in the regional area of North-West Tasmania, Australia. A detailed program description was produced to conduct a realist evaluation with a Context-Mechanism-Outcome configuration, followed by a program theory evaluation through the construction of a retrospective program logic model. Dedicated kitchen and garden spaces, knowledgeable teachers committed to the program, provision of sufficient materials and consumables, and support from the school and community were found to be the basic requirements to establish a program. Additionally, it is essential to integrate both the kitchen and garden teaching components into the school curriculum. The positive outcomes (e.g., engagement, participation, knowledge, skills, behavioral change) of the program were dependent on the underlying factors, including dedicated support of school leadership, teaching staff, and the parent body for effective student engagement in the teaching spaces and for wider engagement from families and the community. The students' feedback provided supporting evidence of increased food literacy with improvements in their understanding, abilities, and attitudes towards gardening, producing healthy food, and preparing food. This may further lead to enhanced food security for students' families and the broader community.

School Gardening and Health and Well-Being of School-Aged Children: A Realist Synthesis.

School environments can create healthy settings to foster children's health and well-being. School gardening is gaining popularity as an intervention for healthier eating and increased physical activity. We used a systematic realist approach to investigate how school gardens improve health and well-being outcomes for school-aged children, why, and in what circumstances. The context and mechanisms of the specific school gardening interventions (n = 24) leading to positive health and well-being outcomes for school-aged children were assessed. The impetus of many interventions was to increase fruit and vegetable intake and address the prevention of childhood obesity. Most interventions were conducted at primary schools with participating children in Grades 2 through 6. Types of positive outcomes included increased fruit and vegetable consumption, dietary fiber and vitamins A and C, improved body mass index, and improved well-being of children. Key mechanisms included embedding nutrition-based and garden-based education in the curriculum; experiential learning opportunities; family engagement and participation; authority figure engagement; cultural context; use of multi-prong approaches; and reinforcement of activities during implementation. This review shows that a combination of mechanisms works mutually through school gardening programs leading to improved health and well-being outcomes for school-aged children.

The Allied Health Expansion Program: Rethinking how to prepare a workforce to enable improved public health outcomes.

Improvements in global public health require universal health care supported by a health workforce with competencies appropriate for local population needs-the right capabilities, in the right place, and at the right time. Health inequities persist in Tasmania, and Australia more broadly, most notably for those people living in rural and remote areas. The article describes the curriculum design thinking approach being used to codesign and develop a connected system of education and training to target intergenerational change in the allied health (AH) workforce capacity in Tasmania, and beyond. A curriculum design thinking process is engaging AH participant groups (faculty, AH professionals, and leaders across health, education, aged and disability sectors) in a series of focus groups and workshops. The design process deals with four questions: What is? What if? What wows? and What works? It also involves Discover, Define, Develop and Deliver phases that continue to inform the development of the new suite of AH education programs. The British Design Council's Double Diamond model is used to organize and interpret stakeholder input. During the initial design thinking discover phase, stakeholders identified four overarching problems: rurality, workforce challenges, graduate skill set shortfalls, and clinical placements and supervision. These problems are described in terms of relevance to the contextual learning environment in which AH education innovation is occurring. The develop phase of design thinking continues to involve working collaboratively with stakeholders to codesign potential solutions. Solutions to date include AH advocacy, a transformative visionary curriculum, and an interprofessional community-based education model. In Tasmania, innovative educational innovations are catalyzing attention and investment in the effective preparation of AH professionals for practice to deliver improved public health outcomes. A suite of AH education that is deeply networked and engaged with Tasmanian communities is being developed to drive transformational public health outcomes. These programs are playing an important role in strengthening the supply of allied health professionals with the right capabilities for metropolitan, regional, rural, and remote Tasmania. They are situated in a broader AH education and training strategy that supports the ongoing development of the AH workforce to better meet the therapy needs of people in Tasmanian communities.

"An Ounce of Prevention is Worth a Pound of Cure": Proposal for a Social Prescribing Strategy for Obesity Prevention and Improvement in Health and Well-being.

BACKGROUND: Social and behavioral determinants of health are increasingly recognized as central to effective person-centered intervention in clinical practice, disease management, and public health. Accordingly, social prescribing (SP) has received increased attention in recent times. The rampant global prevalence of obesity indicates that the customary, reductionistic, and disease-oriented biomedical approach to health service delivery is inadequate/ineffective at arresting the spread and mitigating the damaging consequences of the condition. There is an urgent need to shift the focus from reactive downstream disease-based treatments to more proactive, upstream, preventive action. In essence, this requires more effort to affect the paradigm shift from the traditional "biomedical approach of care" to a "biopsychosocial model" required to arrest the increasing prevalence of obesity. To this end, an SP approach, anchored in systems thinking, could be an effective means of moderating prevalence and consequences of obesity at a community level. OBJECTIVE: The proposed SP intervention has the following three key objectives: (1) build a sustainable program for Circular Head based on SP, peer education, and health screening to minimize the incidence of obesity and related lifestyle diseases; (2) increase service and workforce connectivity and collaboration and initiate the introduction of new services and activities for obesity prevention and community health promotion; and (3) enhance health and well-being and minimize preventable adverse health outcomes of obesity and related lifestyle diseases through enhancement of food literacy and better nutrition, enhancement of physical literacy and habitual personal activity levels, and improvement of mental health, community connectedness, and reduction of social isolation. METHODS: This paper describes a prospective SP strategy aimed at obesity prevention in Circular Head, a local government area in Northwest (NW) Tasmania. SP is a prominent strategy used in the Critical Age Periods Impacting the Trajectory of Obesogenic Lifestyles Project, which is an initiative based in NW Tasmania focused on assessing obesity prevention capacity. A social prescription model that facilitates the linkage of primary health screening with essential health care, education, and community resources through a dedicated "navigator" will be implemented. Four interlinked work packages will be implemented as part of the initial plan with each either building on existing resources or developing new initiatives. RESULTS: A multimethod approach to triangulate insights from quantitative and qualitative research that enables the assessment of impact on individuals, community groups, and the health care system will be implemented within the initial pilot phase of the project. CONCLUSIONS: Literature is replete with rhetoric advocating complex system approaches to curtail obesity. However, real-life examples of whole-of-systems interventions operationalized in ways that generate relevant evidence or effective policies are rare. The diverse approach for primary prevention of obesity-related lifestyle diseases and strategies for improvement of health and well-being described in this instance will contribute toward closing this evidence gap. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/41280.

A scoping review of the conceptualizations of food justice.

OBJECTIVE: The emerging concept of 'food justice' has been described as a movement and a set of principles that align with the goals of social justice, which demands recognition of human rights, equal opportunity, fair treatment, and is participatory and community specific. Considering its widespread use and variable definitions, this study establishes the scope of research by exploring diverse conceptualizations of food justice. DESIGN: A scoping review of peer-reviewed literature was conducted using the term "food justice". This study used a five-step scoping review protocol. The databases included Scopus, Web of Science and Medline (OVID). Data were extracted on country of origin, research discipline, study type and conceptualizations of food justice. Reflexive thematic analysis was used to identify the themes. RESULTS: The search identified 546 abstracts of which 90 were peer-reviewed studies. Thematic analysis revealed five themes of food justice across 90 studies: 1) social equity, 2) food security 3) food systems transformation, 4) community participation and agency, and 5) environmental sustainability. CONCLUSIONS: Current conceptualizations of food justice are evolving. Together these themes embrace a more holistic and structural view of the food system. They emphasize healthy, sustainable, and equitable food as a human right and acknowledge the need to address structural barriers to that right. Despite its 20-year history the parameters of food justice are still not well defined, making it difficult for communities to mobilize for transformative change. Community participation and agency in food justice decision-making are critical to create a healthy, sustainable, and more just food system.

Domains of Capacity Building in Whole-Systems Approaches to Prevent Obesity-A "Systematized" Review.

Despite increased awareness of its risks, for the most part, contemporary efforts for obesity prevention have been patchy at best. As such, the burgeoning interest in whole-systems approaches (WSAs) that acknowledge the complex, dynamic nature of overweight and obesity and operate across multiple levels of society is particularly timely. Many components of "community capacity building" (CB), an essential but often neglected aspect of obesity prevention, overlap with "best practice principles" in effective/optimal community-based obesity-prevention initiatives. Rhetoric urging WSAs and community CB in public health abounds although operative and efficacious contemporary examples of these approaches to reducing obesity levels are scarce. The aim of this investigation was to undertake a systematized review of the level of capacity building incorporated in published literature on WSAs targeting obesity to better understand how domains of CB have been incorporated. A PubMed search and a recently published systematic review were utilized to identify WSAs to obesity prevention between 1995-2020. A team-based approach to qualitative thematic data analysis was used to systematically assess and describe each intervention regarding explicit capacity-building practice. Despite not being specifically designed for building capacity, a significant proportion of the WSAs studied in the current report had implemented several CB domains.

More than a house: Women's recovery from homelessness in Australia.

Recovery from homelessness for women is often a long, complex and highly individualised journey. This study investigated women's experiences of exiting homelessness and examined the factors that influenced recovery. The qualitative interpretive study involved auto-driven photo elicitation and in-depth interviews with 11 women who had previously been homeless. It took place in Australia between August 2018 and August 2019. Women took photographs that represented their experiences of exiting homelessness to guide discussion during interviews. Data were analysed using thematic analysis. Findings indicate that recovery from homelessness involves more than becoming housed. Recovery from homelessness is the overarching theme being presented, described using five subthemes: Finding the right house, Making a house a home, Connection, Building confidence and Helping others. Housing was only the starting point for recovery from homelessness for women. The women drew on their own self determination to create factors necessary for recovery from the experience of homelessness. We conclude that ongoing support is necessary to empower and assist women recovering from the traumatic experiences of homelessness. Trauma-informed care offers service providers a framework for supporting women who have lived through homelessness. Services can draw on this framework to provide support beyond the point of securing a house and assist women to create a home environment, build confidence in themselves and form connections to their community as they transition out of homelessness.

Leading health reform: a critical review of 'leadership' within allied health competency standards.

Objective The study examined if, when and how select allied health professional standards currently articulate the Health LEADS Australia themes. Methods Eighteen allied health professional standards were searched to locate references to leadership. Data were extracted and analysed inductively, deductively and thematically as a meta-synthesis. Frequencies were counted, with subanalysis by professional area, classification level, competency type and level of cognition. Results There were 953 direct and indirect leadership statements. Only two leadership definitions were located, for pharmacists and dentists. The principal theme 'Leadership' only appeared in 18 (2%) statements from the total dataset that made direct references to leadership, which were mostly vague and unclear. The remaining indirect references to leadership are reported as four overarching themes: Self-leadership (n=289 statements; 30%); Leadership With and of Others (n=263; 28%); Improvement and Change Leadership (n=223; 23%); and Health Reform Leadership (n=139; 15%). Conclusion Health leadership was not easily recognisable in the allied health practice standards examined. With some refinement and alignment with a contemporary leadership framework, professional standards could play a critical role in preparing allied health graduates to support the ongoing health system reform required to improve health and well-being outcomes in the future. What is known about the topic? Leadership is essential at all health system levels, and leadership frameworks can usefully guide leadership development. However, little is known about allied health leadership compared with other clinical groups, and their contributions to directional changes in health system reform may be overlooked. What does this paper add? This paper presents results of an analysis of where and how 18 allied health disciplines align with the Australian Health LEADS framework, and where greater clarity or alignment is needed. What are implications for practitioners? Reinstatement of a national health leadership framework, such as the Australian Health LEADS framework, to articulate the need for and capabilities of leadership to enable innovation and support reform across all professional groups working in health care, including medical, nursing and allied health is required. A recognised national leadership framework could guide the revisions to allied health practice standards and coupled with a co-design process involving practitioners and professional associations, further development and incorporation of leadership competencies in a consistent manner would be enabled. Furthermore, alignment of allied health education and professional development with a national health leadership framework may strengthen allied health leadership graduate outcomes.

A qualitative exploration of women's resilience in the face of homelessness.

The aim of this study was to examine the experiential perspectives of women becoming and experiencing homelessness. Situated in the qualitative interpretative tradition, data were collected using auto-driven photo-elicitation and in-depth face-to-face interviews. Eleven Australian women used photographs that represented their experiences of being homeless to guide their interview discussion. The findings revealed that homelessness for women is a period often preceded by a series of adverse incidents in their lives, characterised by progressive resilience building in the face of trauma, finding hope and building strength to work towards exiting homelessness. After becoming homeless, five stages of resilience transition emerged: The trauma of homelessness, Finding hope and surviving, Finding help, Finding connection and Taking control. Women experiencing homelessness are resilient and capable of enacting competence and autonomy in seeking help to exit homelessness. Changes to service delivery are recommended to improve trauma-informed, person-centred housing and social services that are integrated and easy to navigate.

Combining Self-Determination Theory and Photo-Elicitation to Understand the Experiences of Homeless Women.

Homelessness is a complex and gendered experience. To understand this complexity, novel theoretical frameworks and appropriate research methods are required. Most women living without homes have experienced some form of abuse or mental health issues before becoming, being or exiting homelessness and there is high prevalence of trauma in this vulnerable population. Researchers investigating women's homelessness need to ensure the research process is not retraumatising. This paper proposes a theoretical framework that combines self-determination theory (SDT) and photo-elicitation to support and guide research conducted with women who are at risk of negative effects of power imbalances and retraumatisation in research. The framework offers new opportunities to sensitively study women's homelessness by leveraging a strengths-based premise and empowering procedures to increase women's control in the research process. Embedding this method within the SDT research framework repositions women from objects of research to being competent, autonomous, active and empowered agents in the research process.

A role for virtue in unifying the 'knowledge' and 'caring' discourses in nursing theory.

A critical examination of contemporary nursing theory suggests that two distinct discourses coexist within this field. On the one hand, proponents of the 'knowledge discourse' argue that nurses should drop the 'virtue script' and focus on the scientific and technical aspects of their work. On the other hand, proponents of the 'caring discourse' promote a view of nursing that embodies humanistic qualities such as compassion, empathy and mutuality. In view of this, we suggest a way to reconcile both discourses despite the fact that they appear to be at odds theoretically and practically. To that end, we argue that nursing theory must give a prominent role to the Aristotelian conception of virtue, and we offer an account that includes both character and intellectual virtues. This account allows for a focus on moral competence but also accommodates the demands for discipline-specific knowledge. Our account incorporates the caring discourse by suggesting a way for individuals to cultivate the conditions within themselves that make 'caring in nursing' possible, while the knowledge discourse is accommodated via the acquisition of the intellectual virtues. The process for achieving both these ends is the same: an intention to consistently develop, hone and exercise certain character traits over time.

Right service, right place: optimising utilisation of a community nursing service to reduce planned re-presentations to the emergency department.

BACKGROUND: Congruent with international rising emergency department (ED) demand, a focus on strategies and services to reduce burden on EDs and improve patient outcomes is necessary. Planned re-presentations of non-urgent patients at a regional Australian hospital exceeded 1200 visits during the 2013-2014 financial year. Planned re-presentations perpetuate demand and signify a lack of alternative services for non-urgent patients. The Community Nursing Enhanced Connections Service (CoNECS) collaboratively evolved between acute care and community services in 2014 to reduce planned ED re-presentations. OBJECTIVE: This study aimed to investigate the evolution and impact of a community nursing service to reduce planned re-presentations to a regional Australian ED and identify enablers and barriers to interventionist effectiveness. METHODS: A mixed-methods approach evaluated the impact of CoNECS. Data from hospital databases including measured numbers of planned ED re-presentations by month, time of day, age, gender and reason were used to calculate referral rates to CoNECS. These results informed two semistructured focus groups with ED and community nurses. The researchers used a theoretical lens, 'diffusion of innovation', to understand how this service could inform future interventions. RESULTS: Analyses showed that annual ED planned re-presentations decreased by 43% (527 presentations) after implementation. Three themes emerged from the focus groups. These were right service at the right time, nursing uncertainty and system disconnect and medical disengagement. CONCLUSIONS: CoNECS reduced overall ED planned re-presentations and was sustained longer than many complex service-level interventions. Factors supporting the service were endorsement from senior administration and strong leadership to drive responsive quality improvement strategies. This study identified a promising alternative service outside the ED, highlighting possibilities for other hospital emergency services aiming to reduce planned re-presentations.

The 'radiographer-referrer game': image interpretation dynamics in rural practice.

INTRODUCTION: Effective interprofessional communication is intrinsic to safe health care. Despite the identified positive impact of collaborative radiographic interpretation between rural radiographers and referrers, communication difficulties still exist. This article describes the strategies that Australian rural radiographers use for communication of their radiographic opinion to the referring doctor. METHODS: In a two-phase interpretive doctoral study completed in 2012, data were collected from radiographers working in rural New South Wales, Western Australia and Tasmania using a paper based questionnaire followed by in-depth semistructured interviews. Data were analysed thematically in order to identify, analyse and report the emergent themes. RESULTS: The overarching theme was Patient Advocacy, where in the interest of patient care radiographers took measures to ensure that a referring doctor did not miss radiographic abnormalities. Strong interprofessional relationships enabled direct communication pathways. Interprofessional boundaries shaped by historical hierarchical relationships, together with a lack of confidence and educational preparation for radiographic interpretation result in barriers to direct communication pathways. These barriers prompted radiographers to pursue indirect communication pathways, such as side-stepping and hint and hope. CONCLUSION: A lack of formal communication pathways and educational preparation for this role has resulted in radiographers playing the radiographer-referrer game to overtly or covertly assist referrers in reaching a radiographic diagnosis. The findings from this study may be used to plan interventions for strengthening interprofessional communication pathways and improve quality of healthcare for patients.

Rural placements in Tasmania: do experiential placements and background influence undergraduate health science student's attitudes toward rural practice?

INTRODUCTION: Each year growing numbers of undergraduate health science students, from a variety of disciplines, participate in a University of Tasmania Department of Rural Health supported rural placement program in Tasmania. This study aimed to investigate the influence rural placement and rural background had on students' intentions to live and work in a rural or remote location after graduation. METHODS: Between January 2005 and December 2006, 336 students participated in the placement program. Students were requested to complete a survey at the completion of their placement. A response rate of 239 was achieved (71%). The survey measured students' stated rural career intentions and rural background status according to location of primary and secondary school attendance. A demographic analysis of respondents was undertaken and results cross tabulated according to the rural, remote and metropolitan area (RRMA) classification system. Statistical analyses, including paired t-tests and a Wilcoxon signed rank test, were conducted to compare reported mean intention to practise rurally both prior to and after placement. RESULTS: The results from this survey show that rural placements in the undergraduate health science programs have a predominantly positive influence on students' intention to work in a rural community post-graduation. While these findings were significant for the disciplines of nursing, medicine and allied health, the results were not significant for pharmacy students. Students' average intention to practise rurally significantly increased after the placement for students from RRMA classifications 1 and 3-5. CONCLUSION: The value of rural placements as a method for increasing health science students' intentionality to take up rural practice as a positive and viable career option is considerable.

Evaluation of the national pharmacy preceptor education program.

OBJECTIVE: The process evaluation findings and key issues from a trial of the effectiveness and national applicability of a national online educational curriculum for pharmacist preceptors are presented. DESIGN: A multi-method triangulated research design was used to elicit qualitative and quantitative data preceptors. The data collection method involved an anonymous questionnaire with both quantitative components and open-ended qualitative responses. SETTING: An online education program for preceptors of Australian pharmacy students in rural areas. PARTICIPANTS: Rural pharmacists in the three states were invited to trial the package and participate in the associated research/evaluation project. MAIN OUTCOME MEASURES: The Australian Pharmacy Preceptor Education (APPE) program is an important and valuable educational tool for the professional development of pharmacists. It contained pertinent information and appropriate activities, and the delivery strategy was well accepted. The evaluation findings support a national implementation. RESULTS: Program strengths include the ease of access, self-directed learning and the interactive nature emphasising the benefit of sharing ideas and feedback. Potential program limitations include technical delays and unclear instructions for undertaking the program. CONCLUSION: The online APPE program is a flexible delivery strategy which has the potential to dramatically improve the skills and knowledge of pharmacists acting as preceptors and, thereby, impact on the learning provided in rural hospitals and community pharmacies for undergraduate students and new graduates alike.

Use of clinical space as an indicator of student nurse's professional development and changing need for support.

A current challenge in educating nurses of the future is to support them during periods of immersion into the realities of today's health care settings during clinical practice rotations. The professional development of nursing students is dependent on their ability to integrate what they learn in the classroom with the realities that confront them during their clinical experiences. The success of clinical practice as a learning experience is dependent upon comprehensive learning support that is a collaborative responsibility between the triad of educator, clinical practitioner and student. Educators and clinical practitioners who work with students during clinical practice rotations must have an ability to recognise, and understand, the organisational behaviour of student nurses, to act as a mentor and support agent. Undergraduate student nurses undertaking their first clinical practice experience participated in an ethnographic hermeneutic study that explored the ways clinical practice in a small rural community influenced the way they shaped their professional identity. A key concern of ethnography is the way participants use space thus the theme described in this paper presents the ways students traversed space within the clinical environment and discusses how this use of space is indicative of students' professional development.