An exploratory study examining the changes to Australia's social security system during COVID-19 lockdown measures.

During the 2020 COVID-19 wave, the Australian Government made an additional $550 Coronavirus Supplement available for people receiving social security payments, and temporarily suspended mutual obligation requirements. By doing so, the government effectively gave people who had been long stigmatised and subject to punitive conditionality to compel them into the labour market, financial security and their time back. Drawing on survey responses from people who received the $550 Supplement and had their mutual obligation activities suspended or reduced, this research examines how people used their time during this period and whether it differed from pre-pandemic government policy. We find that the increase in payments through the Supplement and the suspension of mutual obligations impacted positively on people's lives including the (1) the ability of respondents to meet basic needs and improve their long-term financial security, (2) improvements to physical and emotional well-being, (3) increased labour market engagement and (4) engagement in other forms of unpaid productive work.

Local Anesthetic Systemic Toxicity (LAST): Increasing Awareness Through Education.

PURPOSE: Local anesthetics are used for procedures in various settings. Although complications related to local anesthetic use is rare, adverse events do occur. A significant knowledge deficit was identified regarding local anesthetic systemic toxicity (LAST) signs, symptoms, and treatment. DESIGN: A learning needs assessment was performed at a local hospital to determine the nurses' baseline knowledge of LAST signs, symptoms, and treatment. METHODS: A self-paced web-based learning module was developed and completed by clinical nurses with an immediate post survey and 6-month follow-up survey. FINDINGS: The repeat learning needs assessment immediately after education resulted in more than 50% improvement in nurses' knowledge of LAST. A 6-month follow-up survey indicated that the gain in knowledge, signs, symptoms, and treatment of LAST was maintained. CONCLUSIONS: An educational gap was identified regarding clinical nurses' knowledge of LAST. An educational program was designed to improve baseline knowledge. The program goal was successfully met with more than half of nurses being able to identify signs, symptoms, and treatment of LAST.

Trans, gender diverse and non-binary adult experiences of social support: A systematic quantitative literature review.

Background: Trans, gender diverse and non-binary (TGDNB) adults experience significant health disparities relative to their cisgender peers. While social support is a known health-protective factor within the general population, no systematic reviews of TGDNB experiences of social support exist. Aim: To systematically review prior research of social support for TGDNB adults. We sought to assess the defining characteristics of the research, the participants and the research findings, mapping emerging trends across disciplines. Methods: Six electronic databases (PubMed, MEDLINE, CINAHL, Web of Science, LGBT Life and PsycNet) were searched for literature pertaining to TGDNB adults, social support, and health or well-being published in the past decade. Results: The findings illustrate a predominance of USA-based quantitative research that measures social support of friends, family and a singular intimate partner. The majority of participants were white, binary-identified transgender women and TGDNB people living in metropolitan settings. Social support was commonly reported as a protective factor, with TGDNB peer support the most frequently reported correlate of health and well-being for TGDNB adults. Discussion: The results suggest standardized inventories do not capture the emic nature of social support for TGDNB adults. A key opportunity lies in an inductive, hypothesis-forming approach to the study of what is socially supportive for TGDNB adults. In turn, this knowledge will enable the appropriate measurement, implementation and interpretation of social support studies.

A guide to policy analysis as a research method.

Policy analysis provides a way for understanding how and why governments enact certain policies, and their effects. Public health policy research is limited and lacks theoretical underpinnings. This article aims to describe and critique different approaches to policy analysis thus providing direction for undertaking policy analysis in the field of health promotion. Through the use of an illustrative example in nutrition it aims to illustrate the different approaches. Three broad orientations to policy analysis are outlined: (i) Traditional approaches aim to identify the 'best' solution, through undertaking objective analyses of possible solutions. (ii) Mainstream approaches focus on the interaction of policy actors in policymaking. (iii) Interpretive approaches examine the framing and representation of problems and how policies reflect the social construction of 'problems'. Policy analysis may assist understanding of how and why policies to improve nutrition are enacted (or rejected) and may inform practitioners in their advocacy. As such, policy analysis provides researchers with a powerful tool to understand the use of research evidence in policymaking and generate a heightened understanding of the values, interests and political contexts underpinning policy decisions. Such methods may enable more effective advocacy for policies that can lead to improvements in health.

A qualitative study of the role of playgroups in building community capacity.

ISSUE ADDRESSED: Given that approximately half of all Australian families with children aged 2-3 years participate in playgroups, these settings may provide an important venue for social support and community capacity building. The aim of this study is to assess the benefits that parents and the wider community derive from such participation. METHODS: We examined community capacity building opportunities through qualitative interviews conducted with a self-selected sample of 33 playgroup participants. All participants were the child's biological mother, and many had been involved in the playgroup committee of management, including 11 participants who were currently, or had previously been, a playgroup coordinator. RESULTS: We found that playgroups act as key sites for building community capacity through developing community connections, skill building and creating leadership pathways. We found that playgroup committee participation was often women's first foray into community volunteering, and often translated into future community leadership, such as kindergarten committees of management and primary school councils. CONCLUSIONS: Community playgroups play a key role in building the capacity of communities and provide a vehicle for the development of new volunteers. SO WHAT?: Local governments, schools and other community organisations that rely on volunteer committees would benefit from providing support to community playgroups to foster future community leaders.

Fair relationships and policies to support family day care educators' mental health: a qualitative study.

BACKGROUND: High quality child care is a population health investment that relies on the capacity of providers. The mental health and wellbeing of child care educators is fundamental to care quality and turnover, yet sector views on the relationship between working conditions and mental health and wellbeing are scarce. This paper examines child care educators' and sector key informants' perspectives on how working in family day care influences educator's mental health and wellbeing. METHODS: Semi-structured telephone interviews were conducted with Australian family day care educators (n = 16) and key informants (n = 18) comprised of representatives from family day care schemes, government and other relevant organisations regarding the relationship between working conditions and educator mental health. Thematic analysis referenced the assumptions and concepts of critical inquiry and used social exchange theory. RESULTS: Educators and key informants reported that educators' mental health was affected by the quality of their relationships with government, family day care schemes, and the parents and children using their services. These social relationships created and contributed to working conditions that were believed to promote or diminish educators' mental health. High quality relationships featured fair exchanges of educator work for key resources of social support and respect; adequate income; professional services; and information. Crucially, how exchanges influenced educator wellbeing was largely contingent on government policies that reflect the values and inequities present in society. CONCLUSIONS: Making policies and relationships between educators, government and family day care schemes fairer would contribute strongly to the protection and promotion of educator mental health and wellbeing, and in turn contribute to workforce stability and care quality.

Role of expendable income and price in food choice by low income families.

The public health literature suggests that the cheapness of energy-dense foods is driving the obesity epidemic. We examined food purchases in low-income families and its relationship to the price of food and availability of funds. In-depth interviews were conducted with 22 parents with children less than 15 years of age whose major source of income was a government pension. A photo taxonomy, where participants sorted 50 photos of commonly purchased foods, was used to explore food choice. The most common food groupings used by the participants were: basic, emergency, treat and comfort. The process of food purchase was described by participants as weighing up the attributes of a food in relation to price and money available. Shoppers nominated the basic unit of measurement as quantity per unit price and the heuristic for food choice when shopping as determining "value for money" in a process of triage relating to food purchase decisions. Participants stated satiation of hunger to be the most common "value" relative to price. Given that the foods nominated as filling tended to be carbohydrate-rich staples, we suggest that public health initiatives need to acknowledge this triage process and shape interventions to promote nutrition over satiation.

Neoliberalism, welfare policy and health: a qualitative meta-synthesis of single parents' experience of the transition from welfare to work.

Following the United States' lead, the emergence of neoliberal welfare policy across the western world has resulted in employment programmes for single parents, who are predominantly single mothers. While some governments claim that employment will improve single parents' incomes and well-being, researchers dispute that single parents can unproblematically move into the workforce, with net positive effects. While researchers have quantified the socio-economic effect of these programmes, in particular on participant health, no study has yet synthesized participants' experiences of welfare-to-work. Here, I present a meta-synthesis of eight qualitative health-related studies of single parents' (and exclusively single mothers') welfare-to-work transition. I report that single mothers faced a combination of health and economic issues which made their transition from welfare to work difficult, including degrees of poor physical and mental health. For participants in the United States, these health issues were often compounded by a loss of health benefits on moving into low-wage employment. In countries where a return to employment was required before children reached school age, a lack of affordable and appropriate child care, especially for children with health problems, exacerbated these difficulties. As a result of scarce resources, single mothers in receipt of welfare benefits often relied on food banks or went without food. A return to the workforce did not alleviate this problem as additional child care and reduced government subsidies depleted the funds available for food. I conclude that welfare-to-work policies are underpinned by the neoliberal assumption that the market more efficiently distributes resources than the State. However, for the women in the studies examined here, labour market participation often depleted access to essential resources. Interventions to address the 'problem' of welfare dependency must recognize the complex interplay between work incentives and disincentives and the care-work of single mothers.

Reliability assessments in qualitative health promotion research.

This article contributes to the debate about the use of reliability assessments in qualitative research in general, and health promotion research in particular. In this article, I examine the use of reliability assessments in qualitative health promotion research in response to health promotion researchers' commonly held misconception that reliability assessments improve the rigor of qualitative research. All qualitative articles published in the journal Health Promotion International from 2003 to 2009 employing reliability assessments were examined. In total, 31.3% (20/64) articles employed some form of reliability assessment. The use of reliability assessments increased over the study period, ranging from <20% in 2003/2004 to 50% and above in 2008/2009, while at the same time the total number of qualitative articles decreased. The articles were then classified into four types of reliability assessments, including the verification of thematic codes, the use of inter-rater reliability statistics, congruence in team coding and congruence in coding across sites. The merits of each type were discussed, with the subsequent discussion focusing on the deductive nature of reliable thematic coding, the limited depth of immediately verifiable data and the usefulness of such studies to health promotion and the advancement of the qualitative paradigm.

Building the capacity of family day care educators to promote children's social and emotional wellbeing: an exploratory cluster randomised controlled trial.

BACKGROUND: Childhood mental health problems are highly prevalent, experienced by one in five children living in socioeconomically disadvantaged families. Although childcare settings, including family day care are ideal to promote children's social and emotional wellbeing at a population level in a sustainable way, family day care educators receive limited training in promoting children's mental health. This study is an exploratory wait-list control cluster randomised controlled trial to test the appropriateness, acceptability, cost, and effectiveness of "Thrive," an intervention program to build the capacity of family day care educators to promote children's social and emotional wellbeing. Thrive aims to increase educators' knowledge, confidence and skills in promoting children's social and emotional wellbeing. METHODS/DESIGN: This study involves one family day care organisation based in a low socioeconomic area of Melbourne. All family day care educators (term used for registered carers who provide care for children for financial reimbursement in the carers own home) are eligible to participate in the study. The clusters for randomisation will be the fieldworkers (n = 5) who each supervise 10-15 educators. The intervention group (field workers and educators) will participate in a variety of intervention activities over 12 months, including workshops; activity exchanges with other educators; and focused discussion about children's social and emotional wellbeing during field worker visits. The control group will continue with their normal work practice. The intervention will be delivered to the intervention group and then to the control group after a time delay of 15 months post intervention commencement. A baseline survey will be conducted with all consenting educators and field workers (n = ~70) assessing outcomes at the cluster and individual level. The survey will also be administered at one month, six months and 12 months post-intervention commencement. The survey consists of questions measuring perceived levels of knowledge, confidence and skills in promoting children's social and emotional wellbeing. As much of this intervention will be delivered by field workers, field worker-family day care educator relationships are key to its success and thus supervisor support will also be measured. All educators will also have an in-home quality of care assessment at baseline, one month, six months and 12 months post-intervention commencement. Process evaluation will occur at one month, six months and 12 months post-intervention commencement. Information regarding intervention fidelity and economics will also be assessed in the survey. DISCUSSION: A capacity building intervention in child mental health promotion for family day care is an essential contribution to research, policy and practice. This initiative is the first internationally, and essential in building an evidence base of interventions in this extremely policy-timely setting. TRIAL REGISTRATION NUMBER: 343312.

Parental status and childhood obesity in Australia.

The overall aim of this study was to examine obesogenic factors in children from single and dual parent families. Data from the Longitudinal Study of Australian Children (LSAC) (8,717 children) were analyzed to examine the differences in children's activity levels, dietary intake and BMI according to parental status and determine the likelihood of childhood overweight and obesity in a single-parent household. There were higher rates of overweight and obesity in girls aged four to nine whose parents were single (OR 1:60). Children in single-parent households watched more television, ate more food high in fat and sugar and less fresh fruit and vegetables than children from dual-parent households. The findings suggested that an additive effect of dietary and activity variables may contribute to the higher rates of overweight and obesity in Australian children, and that girls from single-parent households may be particularly at risk.

Theorising stigma and the experiences of injecting drug users in Australia.

This paper examines the stigma of injecting drug use as an underlying factor in the poor health status of Australian injecting drug users. Drawing on various models of stigma described in the literature, we examine injecting drug users' experiences. As a case study, examples from Victorian (specifically Melbourne) policy and practice are included to exemplify community and societal attitudes towards injecting drug users and the implications of these for injecting drug user health. We conclude that redressing the negative effects of stigma requires political will, financial support, increased community commitment and a better understanding of the links between the social determinant of health and the poor health status ofinjecting drug users. Without reducing the stigma of injecting drug use the health of this marginalised population is likely to get worse, which will have broader negative population health effects.

Estimating the number of unlicensed brothels operating in Melbourne.

OBJECTIVE: To estimate the number of unlicensed brothels operating in Melbourne, Australia, and the sexual health of the women working in them. METHODS: Advertisements from Melbourne newspapers published in July 2006 were systematically analysed based on the language used to identify premises likely to be unlicensed brothels. A visit was made to each of the businesses where an address was available. Participating sex workers were tested for Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium and Trichomonas vaginalis using self-collected tampons and polymerase chain reaction. RESULTS: There were 438 advertisements collated, representing 174 separate establishments. Of these, 78 were not considered likely to be brothels. Of the remaining 96, addresses were available for 42 and all of these premises were visited. Thirteen were confirmed as unlicensed brothels. We estimate there were between 13 and 70 unlicensed brothels in Melbourne. Twenty-three women were recruited from four brothels. Only 56% (95% confidence interval (CI) 35-77%) reported having regular sexual health checks and only 13% (95%CI 3-36%) reported prior testing for HIV. Among the 22 women tested, one had chlamydia while another had gonorrhoea, a prevalence of 4.5% (95%CI: 2.3-20.4%) for each infection. CONCLUSIONS: The number of unlicensed brothels in Melbourne is much smaller than is generally believed. Women in the sector are infrequently tested for STIs. IMPLICATIONS: As long as a licensing system persists, promotion of sexual health among women in this sector is likely to face hurdles. Further research is needed into the best model for regulating or not regulating sex industries.

The quality of life of single mothers making the transition from welfare to work.

This study examined the quality of life of single mothers making the mandatory transition from welfare to work. The Australian government purported that the benefits of making this transition would include higher incomes, better social participation, and improved wellbeing. It is currently unknown, however, how single mothers currently engaged in welfare to work programs evaluate their quality of life. Quality of life scores for 334 single mothers engaged in welfare to work in Australia were compared with normative data. Participants reported significantly lower quality of life scores than the general population for all quality of life domains, highlighting the need to carefully examine welfare to work policies to ensure they promote participants' quality of life.

The politics of developing reference standards for nutrient intakes: the case of Australia and New Zealand.

OBJECTIVE: Nutrient Reference Values (NRV) are evidence-based benchmarks for assessing the dietary adequacy of individuals and population groups as well as informing public health nutrition policies and programmes. The present paper presents the findings of an analysis of the views of submitters to a draft document associated with the development of the 2006 NRV for Australia and New Zealand. The aim of the study was to explore how these views were reflected in the policy-making process and final policy document. DESIGN: The information necessary to fulfil this aim required access to stakeholder submissions to the NRV development process and this necessitated exploiting the provisions of the Commonwealth of Australia's Freedom of Information (FOI) Act 1982. We understand that the present research represents the first time that an FOI request seeking information about a National Health and Medical Research Council food and nutrition policy process has been made and therefore is novel in its approach to public health nutrition policy analysis. RESULTS: The analysis of stakeholder submissions identified that stakeholders had particular concerns about the conduct of the review process and the future application of the nutrient values to policy and programmes. There is a lack of evidence that the majority of stakeholder comments were addressed in the final NRV document. CONCLUSION: Although these findings cannot be interpreted to assess the validity or otherwise of the set nutrient values, they do raise questions about the process for their development and the adequacy of the final document to reflect the views of key stakeholders.

What do general practitioners think depression is? A taxonomy of distress and depression for general practice.

OBJECTIVE: To create a taxonomy of distress and depression for use in primary care, that mirrors the thinking and practice of experienced general practitioners. DESIGN: Qualitative study, using an ethnomethodological approach, with observation of videotaped routine GP-patient consultations and in-depth interviews with GPs. SETTING AND PARTICIPANTS: The study was conducted in metropolitan Melbourne in 2005. Fourteen GPs conducted 36 patient consultations where depression was a focus; nine GPs participated in in-depth interviews to elicit details of how they recognised and diagnosed depression in their patients. RESULTS: GPs consider distress and depression in three steps. In the first step, a change in a group of symptoms and signs is observed (eg, facial expression, loss of drive). The second step categorises the syndrome according to whether or not there is an identifiable environmental cause (reactive or "endogenous"), with the final step categorising the reactive syndromes according to their most prominent symptoms: either anxiety and worry, or helplessness and hopelessness. The resulting taxonomy includes: endogenous depression (a chronic and perhaps characterological depression characterised by a lack of interest and motivation); anxious depressive reaction (stress or worry); and hopeless depressive reaction (demoralisation). CONCLUSION: This simple and parsimonious taxonomy has validity based on its derivation from within the primary care setting.

Baseline assessment of organizational capacity for health promotion within regional health authorities in Alberta, Canada.

This paper provides a baseline profile of organizational capacity for (heart) health promotion in Alberta's regional health authorities (RHAs); and examines differences in perceived organizational health promotion capacity specific to modifiable risk factors across three levels of staff and across capacity levels. Baseline data were collected from a purposive sample of 144 board members, senior/middle managers and service providers from 17 RHAs participating in a five-year time-series repeated survey design assessing RHA capacity for (heart) health promotion. Results indicate low levels of capacity to take health promotion action on the broader determinants of health and risk conditions like poverty and social support. In contrast, capacity for health promotion action specific to physiological and behavioural risk factors is considerably higher. Organizational "will" to do health promotion is noticeably more present than is both infrastructure and leadership. Both position held within an organization as well as overall level of organizational capacity appear to influence perceptions of organizational capacity. Overall, results suggest that organizational "will", while necessary, is inadequate on its own for health promotion implementation to occur, especially in regard to addressing the broader determinants of health. A combination of low infrastructure and limited leadership may help explain a lack of health promotion action.

Maintaining dignity and managing stigma in the interview encounter: the challenge of paid-for participation.

The interview is both popular and problematic in social research. In this article, we describe and make problematic interviews from a study conducted with impoverished elders in Melbourne, Australia. Participants were paid $20 for each of two interviews. The result of the paid-for participation was double-edged in that it provided funds for impoverished participants, but the payment modified the exchange of free and open discussion. We describe key exchanges within the research interviews to exemplify how participants managed their experience and presentation of stigma and dignity. We demonstrate, with examples from the transcripts, strategies used by participants to gain agency over the process, while at the same time maintain enough of a semblance of conversational genre to make paid-for participation legitimate. We see this as an interesting methodological event that should inform analysis, interpretations, and the validity of interviews, rather than a problem with the interviewee.

Baseline assessment of organizational capacity for health promotion within regional health authorities in Alberta, Canada

This paper provides a baseline profile of organizational capacity for (heart) health promotion in Alberta s regional health authorities (RHAs); and examines differences in perceived organizational health promotion capacity specific to modifiable risk factors across three levels of staff and across capacity levels. Baseline data were collected from a purposive sample of 144 board members, senior middle managers and service providers from 17 RHAs participating in a five year time series repeated survey design assessing RHA capacity for (heart) health promotion. Results indicate low levels of capacity to take health promotion action on the broader determinants of health and risk conditions like poverty and social support. In contrast, capacity for health promotion action specific to physiological and behavioural risk factors is considerably higher. Organizational will to do health promotion is noticeably more present than is both infrastructure and leadership. Both position held within an organization as well as overall level of organizational capacity appear to influence perceptions of organizational capacity. Overall, results suggest that organizational will, while necessary, is inadequate on its own for health promotion implementation to occur, especially in regard to addressing the broader determinants of health. A combination of low infrastructure and limited leadership may help explain a lack of health promotion action. (AU)

Parent-proxy and child self-reported health-related quality of life: using qualitative methods to explain the discordance.

BACKGROUND: Although parent-proxy reports of health-related quality of life (HRQOL) are only moderately correlated with child reported HRQOL, it remains unknown why these scores differ. The aim of this study was to use a qualitative methodology to examine why parents and children report different levels of HRQOL. METHOD: The sample consisted of 15 parent-child pairs. A think-aloud technique was used where parents and children were given a generic HRQOL instrument (KIDSCREEN) and instructed to share their thoughts with the interviewer. Qualitative analyses were conducted to assess whether parents and children base their answer on different experiences or reasoning, have different response styles, or interpret the items differently. RESULTS: There was discordance between parents and children, in terms of rating scale and in terms of the reasoning for their answer. Children tended to have different response styles to parents, where for example, children tended to provide extreme scores (highest or lowest score) and base their response on one single example, more than parents. Parents and children interpreted the meaning of the items very similarly. DISCUSSION: This study provides evidence to suggest that discordance among parent-child pairs on KIDSCREEN scores may be as a result of different reasoning and different response styles, rather than interpretation of items. These findings have important implications when parent-proxy reported HRQOL is used to guide clinical/treatment decisions.