Theory-based behaviour change intervention to promote mental health help-seeking among older adults in Australia: Initial dissemination and acceptability.

OBJECTIVE: Rates of help-seeking for mental health problems among older adults are low and initiatives to increase help-seeking in older populations are limited. To our knowledge, no interventions have aimed to promote help-seeking among older adults by tapping internal motivations to seek help. In this paper, we describe the development of a theory-based intervention designed to promote mental health help-seeking among older adults in Australia, using an internal motivation paradigm. METHODS: The intervention was co-designed through a consultative process with nine key stakeholders who represented five main groups: primary health-care providers, mental health professionals, health-care executives, community organisations and consumers. Development was an iterative process, based on best practice guidelines. Nineteen older adults (≥65 years) provided feedback on the acceptability of the intervention. RESULTS: The intervention consisted of a help-seeking brochure with behaviour change messages based on the Theory of Planned Behaviour (TPB). Messages targeted older adults' attitudes towards help-seeking, subjective norms, perceived behavioural control and barriers to seeking help. Most participants (74%) responded with agree/strongly agree to 10 items measuring the acceptability of the intervention, indicating the intervention is relevant, clear, appropriate and appealing. CONCLUSIONS: The present intervention appears to be an acceptable way to promote help-seeking for mental health problems among older adults. A larger, robust trial is warranted to determine the effectiveness of the intervention in improving help-seeking attitudes, intentions and behaviour. The intervention has the potential to increase older adults' engagement with mental health support and improve health outcomes in this population.

Enabling social care services for older adults during periods of long-term social isolation: Service provider perspectives.

OBJECTIVE: To investigate how small, local organisations were impacted by and responded to COVID-19 in their delivery of social care services to older adults (70 years and older). Lessons learnt and future implications are discussed. METHODS: Six representatives from four social care services (five females and one male) participated in individual semistructured interviews. Responses were analysed thematically. RESULTS: The key themes identified were service providers' experience, perceived needs of older adults and adapting services. Service providers positioned themselves as front-line essential workers for their older adult clients, resulting in some emotional toll and distress for the service providers. They provided information, wellness checks and at-home assistance to keep their older adult clients connected. CONCLUSIONS: Service providers feel more prepared for future restrictions but flag the potential of training and supporting older adults to use technology to stay connected, as well as the need for more readily available funding to allow services to adapt quickly during times of crisis.

Psychological Effects Of Unemployment Across The Lifespan: A Synthesis Of Relevant Literature.

Amid ongoing global economic uncertainty and long-standing efforts to tackle age discrimination and increase older workers' labor force engagement, it is pertinent to consider age differences in the individual effects of joblessness. This is paramount for informing support services, policy formulation, and research. This article is based on a literature review of international peer reviewed quantitative research that has examined the relationship between age, psychological wellbeing and unemployment. Two hundred and twenty-six studies were screened and 36 were included. No relevant qualitative studies were identified. Among the studies, there was a broad consensus that there are age differences in terms of the psychological consequences of unemployment. However, they showed mixed evidence, and critical conceptual and methodological deficiencies were identified. We conclude that the body of evidence is weak and that drawing from it for the development of practice and policy in support of jobless individuals is to be cautioned against.

"Machine-Dependent": The Lived Experiences of Patients Receiving Hemodialysis in Pakistan.

This study aimed to explore the lived experiences of patients receiving maintenance hemodialysis in Pakistan. Purposive sampling was used to recruit 24 patients and six healthcare professionals, each participated in a semi-structured interview. Interpretive Phenomenological Analysis was used to analyze interviews' data. Two superordinate themes, "The experience of hemodialysis" and "The conceptualizations of hemodialysis" as well as six sub-themes were identified. The experience of hemodialysis was related to, the implications of HD procedure on everyday life, social, cognitive, emotional, financial, and occupational influences. While all participants recognized the importance of hemodialysis for their survival, their conceptualizations of the treatment varied. Despite facing multiple challenges, optimism and independence were observed among participants. Stigma related to hemodialysis, and role adaptation, which appear unique to the Pakistani context, highlight a need for tailored interventions designed to enhance and maintain the mental health of patients receiving hemodialysis in Pakistan.

Explaining adults' mental health help-seeking through the lens of the theory of planned behavior: a scoping review.

BACKGROUND: Despite evidence-based efficacy, mental health services are underutilized due to low rates of help-seeking, leaving unmet mental health needs a global concern. The Theory of Planned Behavior (TPB) has been applied to understand the help-seeking process and in the development of behavior change interventions. The aim of this scoping review was to map the literature on the TPB as applied to mental health help-seeking in adults aged >18 years. METHODS: This scoping review was conducted based on the methodology presented by Arksey and O'Malley (2005). Six databases (CINAHL, PsycINFO, MEDLINE, ProQuest Health and Medicine, ProQuest Dissertations and Theses, Web of Science) and two grey literature sources (OpenGrey, Google Scholar) were systematically searched in February 2018 and updated in March 2020. Studies that explicitly discussed the TPB in the context of mental health help-seeking were initially selected; only studies that explored formal help-seeking for mental health problems and were published in English were retained. Data were extracted using Microsoft Excel. RESULTS: Initially, 8898 records were identified. Of these, 49 met the selection criteria and were included: 32 were journal articles and 17 were theses. Forty-three papers reported on non-intervention studies and seven articles reported on TPB-based interventions. Most studies (n = 39) identified predictors of help-seeking intentions. Attitudes and perceived behavioral control were significant predictors of intentions in 35 and 34 studies, respectively. Subjective norms were a significant predictor of intentions in 23 studies. Few studies aimed to predict help-seeking behavior (n = 8). Intentions and perceived behavioral control were significant predictors of behavior in seven and six studies, respectively. Only six TPB-based interventions were identified, all used digital technology to influence help-seeking, with mixed results. CONCLUSIONS: The present scoping review identified a considerable evidence base on the TPB for predicting mental health help-seeking intentions. Attitudes and perceived behavioral control were frequently found to be significant predictors of help-seeking intentions. Knowledge on the TPB for predicting mental health help-seeking behavior, and on TPB-based interventions, is limited. Thus, the role of the TPB in developing help-seeking interventions remains unclear. Recommendations are presented to address such research gaps and inform policy and practice.

Older Adults' Perspectives on Voluntary Assisted Death: An In-Depth Qualitative Investigation in Australia.

Interest in voluntary assisted death (VAD) has been growing among researchers, policy makers and the public. This study aimed to explore older adults' perspectives on VAD in Australia. Using purposive sampling, 15 adults ≥65 years participated in in-depth semi-structured interviews. Interpretative phenomenological analysis identified four themes: cultural reflections; beliefs and worldviews; health aspects; and fabric of life. Participants expressed a desire to have control over end-of-life options, challenged by religious beliefs. Participants expressed concern that VAD legislation could leave people vulnerable to coercion and saw a need for safeguards. Reasons for and against supporting and utilising VAD were discussed. Physical illness was seen a more compelling reason for VAD than mental ill-health. Finally, connections to life and other were discussed, and being able to do the things one loved were named aspects of what it meant to live a good life. Implications are discussed along with future research directions.

Indicators of job quality in the Australian aged care workforce: A scoping review.

OBJECTIVE: As governments grapple with ageing populations, there is a need to understand more about the aged care workforce and how it is managed. METHODS: We undertook a scoping review according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Scopus and PubMed were used to identify papers published between 2010 and 2020. We mapped the breadth and scale of the evidence base according to the QuInnE indicators of job quality. RESULTS: Out of 642 titles and abstracts that were screened, 122 were selected. Outcomes were measured across a range of domains, including wages, employment quality, education and training, working conditions, work/life balance and consultative participation and collective representation. These were distributed unevenly, revealing evidence gaps. CONCLUSIONS: We identified significant knowledge gaps regarding Australia's aged care workforce at a time when the sector is coming under fresh scrutiny and projections indicate that it will face critical labour shortfalls going forward.

Sources, incidence and effects of non-physical workplace violence against nurses in Ghana.

AIM: To document the incidence, sources and effects of workplace verbal abuse and sexual harassment against Ghanaian nurses. METHODS: A cross-sectional study was conducted in Ghana from 2013-2014 which surveyed 592 professional nurses and midwives working in public hospitals in Ghana using the health sector violence questionnaire. RESULTS: The majority of participants were females (80%). The average age of participants was 31·76 years and the average number of years practising as nurse was 7·38. Twelve per cent of the participants experienced at least one incident of sexual harassment and 52·2% were exposed to verbal abuse. The majority of perpetrators of sexual harassment were medical doctors (50%). Relatives of patients emerged as the most frequent verbal abusers (45·5%). Chi-square test showed statistically significant associations between gender and workplace violence and between workplace violence and intention to quit the nursing profession. The effects of workplace violence ranged from having disturbing memories about the incident to being 'super alert' and vigilant. Establishing the incidence of workplace violence is a necessary step towards addressing the problem. It is concluded that educational programs must be designed for healthcare workers and the general public to foster awareness of the effects of workplace violence. Clear policies must also be instituted to address the problem.

Negative stereotyping of older nurses despite contact and mere exposure: the case of nursing recruiters in Western australia.

Ageist attitudes have been identified across different industries. The nursing profession has a high proportion of older workers. As this facilitates regular contact with, as well as exposure to, older nurses, it may be expected to show less ageism. This study investigated 163 Western Australian nursing recruiters' attitudes toward older nurses. Results showed clear evidence of both negative and positive stereotyping of older nurses. Nursing recruiters indicated that they would be more than likely to hire older nurses and that age was less relevant in making hiring decisions. These findings suggest that enhancing the employability of older workers does not necessarily change ageist attitudes. This is relevant to policy formulation, attitude change interventions, and the well-being of older workers.

Exploring attitudes toward older workers among Australian employers: an empirical study.

Research suggests that negative stereotyping is at the heart of age discrimination in not hiring older workers. As the aging of the population creates pressures to maintain older adults in the work force, it is important to gain knowledge of such stereotyping. A random sample of 128 hiring decision-makers across Australian industries responded to a questionnaire that was specifically developed to assess attitudes toward older workers. Results showed systematic negative stereotyping: Respondents indicated that they were unlikely to hire older workers. The likelihood of hiring significantly correlated with employers' attitudes. Specific attributes for which older workers were seen as inferior compared to younger workers included trainability, adaptability, creativity, and interest in new technology. The findings could inform policymakers and be utilized to develop interventions aimed to reduce hiring discrimination.