Understanding Sociocultural Influences on Physical Activity in Relation to Overweight and Obesity in a Rural Indigenous Community of Fiji Islands.

INTRODUCTION: Given health disparities and increased rates of obesity and non-communicable diseases seen in Indigenous populations worldwide and the evidence connecting sociocultural knowledge with physical activity, health, and wellbeing, this research was undertaken to understand the social and cultural components contributing to obesity in the Indigenous Fijian rural areas. METHODS: This research is a community-based participatory research (CBPR) project, which engaged community members from a rural iTaukei village in the Fiji Islands. Data collection was carried out through community consultation and semi-structured interviews. The data was analysed using descriptive thematic analysis. RESULTS: Four major themes emerged associated with sociocultural, economic, political, and physical environmental factors. Males emphasised sports and working on farmlands as preferred types of physical activity, while females focused on family activities and daily activities and support for females' separate playgrounds. There was a focus on previous health promotion programs that did not incorporate the cultural values, cultural competence beliefs, and traditional ways of the rural Indigenous Fijian community. CONCLUSION: The healthcare providers and policymakers need to recognise the iTaukei community culture and appreciate traditional methods to promote equitable community participation in decision-making for health promotion. These findings should inform future research and community-based health programs to address the physical activity levels of the rural Indigenous community and may be relevant to other Indigenous peoples.

Changes in alcohol-related perceptions and behaviour among Vietnamese early career doctors after graduation.

BACKGROUND: Vietnamese medical students believe becoming "strong" drinkers is important for their future career working as doctor. However, it is unclear if this is a temporary behaviour associated with life as a student, or a phenomenon associated with the transition to working as a medical practitioner. OBJECTIVE: This study explored changes in alcohol-related perceptions and behaviour among Vietnamese early career doctors working after graduation. METHODS: In-depth interviews were conducted with 15 Vietnamese early career doctors in Hanoi city. Thematic analysis was used to analyse the qualitative data. RESULTS: Vietnamese early career doctors perceived binge drinking as common among doctors, especially male doctors, surgeons, and preventive medicine doctors. This perception was different from when they were medical students because, at that time, they believed doctors would not drink alcohol at hazardous levels. Additionally, Vietnamese early career doctors' drinking behaviour changed in the frequency and quantity of alcohol consumption after graduation due to peer pressure, job stress, working collaborations, and working environment. CONCLUSIONS: Vietnamese early career doctors changed their alcohol-related perceptions and behaviour after graduation. Gender, mental health (stress), factors related to the working environment, and the role of professional relationships should be considered in strategies to reduce risky alcohol consumption among Vietnamese early career doctors.

Intimate Partner Violence (IPV) in Bhutan: Understanding Women's Responses to IPV Using the Transtheoretical Model of Behavior Change.

Intimate partner violence is highly prevalent in Asian region. It is largely committed by male against their female intimate partner. This is often associated with the region's unique social and cultural norms which subordinate women throughout their lives. IPV is an ongoing concern in Bhutan. The country's age-old traditions and customs are closely related to culture of silence among women experiencing IPV. This study examined women's responses to intimate partner violence (IPV) in Bhutan. Semi-structured interviews were conducted to explore sensitising concepts such as how and when women recognised IPV and how they responded to it. Fifteen women who had sought supportive services at the institution `RENEW' (Respect, Educate, Nurture, Empower Women) as a result of IPV participated in the interview. The Trans-theoretical model of behaviour change (TTM) was used as a theoretical framework to understand women's cognitive, affective and behavioural change processes. The interviews were audio-recorded and transcribed. Thematic analysis was used to identify the patterns of women's responses. From the analysis, women's experiences of IPV and their responses were located within the four stages of change, including contemplation, preparation, action and maintenance. Women used nine traditional processes of change among which consciousness raising and helping relationships were critical and appeared across all four stages of change. This study provides important insights of Bhutanese women's cognitive and behavioural responses to IPV. The appearance of consciousness raising and helping relationships across all the stages of change represents a potential opportunity for intervention to initiate and promote changes in women's response to IPV in the early stages.

University Staff and Students' Attitudes towards a Completely Smoke-Free Campus: Shifting Social Norms and Organisational Culture for Health Promotion.

A large university in Queensland, Australia with a diverse staff and student community introduced a campus wide smoke-free policy in 2016. The purpose of this enquiry was to understand attitudes about a new smoke-free policy, its potential impact and the shift in social norms and organizational culture to inform the next phase of implementation. An electronic survey was distributed to all staff and students approximately 12 weeks after the smoke-free policy was implemented. The survey consisted of multiple-choice questions about demographics, smoking behaviour, attitudes towards smoking and tobacco control, awareness of the smoke-free policy, and attitudes towards the effect of a completely smoke-free campus on quality of life, learning and enrolment. The survey was completed by 641 university staff and students. Respondents reported seeking out (80.4%) and socialising in smoke-free environments (86.6%) and supported smoke-free buildings (96.1%), indoor areas (91.6%), and outdoor areas (79%). The results revealed overwhelming support for a completely smoke-free campus (83%) and minority support for designated smoking areas (31%). Overall, respondents reflected positively towards a campus wide smoke-free policy. These findings suggest Queensland's early adoption of tobacco control laws influenced the social environment, de-normalised smoking, changed behaviour, preference for smoke-free environments and shifted social norms. These findings provide convincing evidence for organisational change and suggest health promotion policy makers should progress the implementation of smoke-free policies nationally across the higher education sector.

Australian bus drivers' modifiable and contextual risk factors for chronic disease: A workplace study.

INTRODUCTION: Little is known about workplace health promotion for bus drivers. Bus drivers are at-risk of chronic disease because they are exposed to the risk factor combination of poor nutrition, low levels of physical activity, high levels of sedentary time and are often overweight or obese. The purpose of this paper is to situate the quantitative baseline data collected from bus drivers within qualitative findings about the socio-cultural context of the workplace. MATERIALS AND METHODS: Baseline data about physical activity, dietary intake and sedentary hours was collected from 58 drivers employed by a large bus company in southeast Queensland. Ten drivers and seven key workplace informants participated in interviews and discussion groups about driver health behaviours, workplace structure, culture, and resources. RESULTS: The quantitative results of our study reveal bus drivers have a cluster of poor health behaviours-limited physical activity, lower than recommended consumption of fruit and vegetables and high levels of sitting time during working-hours-which contribute to a high prevalence of overweight and obesity and a heightened risk of chronic disease. The qualitative findings suggest there are individual and structural barriers to improving drivers' modifiable health behaviours. Individual barriers include ingrained poor habits and more pressing life concerns, while structural barriers in the context of the workplace include time constraints, shift work, long days, a lack of work amenities and a general disconnect of drivers with their workplace. CONCLUSION: In this workplace, health promotion strategies for bus drivers should be prioritised as a means of improving drivers' health. To maximise uptake and effectiveness, these strategies should make use of existing workplace resources and consider the context of workplace health behaviour change. Further research is warranted in a broader sample of Australian bus companies to explore the context of workplace health behavior change so targeted strategies to improve bus drivers' health can be developed.

Truckies and the Australian transport industry: Managers' perspectives about enablers and inhibitors to workplace health promotion.

BACKGROUND: There is little published research about managers' views about implementing and embedding workplace health promotion interventions. OBJECTIVE: To shed light on research-to-practice challenges in implementing workplace health promotion interventions in the Australian road transport industry. METHODS: In this Participatory Action Research project, managers from small-to-midsized companies in the Australian road transport industry were asked their views about enablers and barriers to implementing nutrition and physical activity interventions in their workplace. RESULTS: Managers identified practical assistance with resources, ideas, and staffing as being key enablers to implementation. Barriers included time restraints, worker age and lack of interest, and workplace issues relating to costs and resources. CONCLUSION: Manager perspectives add new insights about successful implementation of workplace health promotion. A Participatory Action Research approach allows managers to develop their own ideas for adapting interventions to suit their workplace. These findings add to a small body of knowledge about managers' views regarding implementing workplace health promotion in small-to-midsized road transport companies - a relatively unexplored group. Managers highlight the importance of time constraints and worker availability when designing interventions for the road transport industry. Managers require a good understanding of the workplaces' socio-cultural context for successful health promotion and health behaviour change.

Understanding socio-cultural influences on food intake in relation to overweight and obesity in a rural indigenous community of Fiji Islands.

ISSUE ADDRESSED: Obesity and non-communicable diseases (NCDs) are largely preventable by understanding the connection between socio-cultural knowledge, yet intervention effectiveness may hinder changes in lifestyles and behaviours in Indigenous health. This study performed to understand the social and cultural components, which contribute to obesity in rural areas of the Indigenous Fijian. METHODS: This study is a Community-Based Participatory Research (CBPR) project, which engaged community members from a rural iTaukei village in the Fiji Islands. Data collection was carried out through community consultation and semi-structured interviews. The data were analysed using descriptive thematic analysis. RESULTS: Food intake was associated with socio-cultural, economic, political and physical environmental factors. Participants reveal previous health promotion programs did not incorporate the cultural values, cultural competence beliefs and traditional ways of rural Indigenous Fijian community. CONCLUSION: The health care providers and policymakers need to be involved in recognising iTaukei community culture and appreciate traditional methods to promote equitable community participation in decision-making for health promotion. SO WHAT?: Community-wide lifestyle interventions, conceptual approaches based on communal perceptions of the problem at hand can also be the basis for future research on identifying socio-cultural factors, for example, the community and family support that can help shape behaviours.

Binge drinking among male medical students in Viet Nam: a qualitative exploration of norms.

Alcohol is a commonly used substance among Vietnamese medical students, especially males. Vietnamese male medical students drink more alcohol, report more intentions to binge drink, and experience more alcohol-related problems than females. As medical students' alcohol consumption may influence their attitudes and medical practice relating to alcohol counseling and prevention, research about the cultural and drinking norms underlying the drinking behavior of Vietnamese male medical students is warranted. This study aims to explore the norms underlying drinking behavior of Vietnamese male medical students. A qualitative study including 32 in-depth interviews with Vietnamese male medical students at a medical university. Thematic analysis was used to analyze the data. This study found Vietnamese male medical students considered alcohol consumption as a way to show their masculinity and become accepted by groups. Given these beliefs and adherence to norms, they followed rules to force others to consume more alcohol or be intoxicated in drinking occasions among medical students. This study showed the importance of gender and group norms in influencing Vietnamese male medical students' alcohol consumption. These norms should be considered in future research and interventions addressing alcohol use among this target population.

Postgraduate health promotion students' perceptions of at-risk populations: Those who smoke tobacco, are overweight or obese or drink alcohol at hazardous levels.

Perceptions acquired during tertiary health promotion education can influence students' interactions with their future service-users. Reflective practice can highlight these perceptions. Here we describe the findings of a reflective exercise conducted with postgraduate health promotion students as part of a learning activity. Students (n = 44) reflected on their understandings of at-risk populations in three priority areas-tobacco, obesity and alcohol. The activity aimed to deconstruct students' understandings of these populations and identify understandings juxtaposed to the philosophical underpinnings of health promotion, for addressing through teaching and learning. Thematic analysis revealed students' understanding of all three at-risk populations fit within five themes: apathy/lack of altruism, complexity/choice, pressure/control, escaping /excuses, and environmental contexts. Students also have varying levels of tolerance to at-risk populations, expressing greatest tolerance towards those whose addiction undermines choice and self-control, and least towards those who are overweight/obese or whose behaviour causes risk to others. Our findings show reflective practice is a valuable tool to help educators understand students' attitudes and values and implement changes to support their future role in the community.

Going smoke-free: University staff and students' qualitative views about smoking on campus during the implementation of a smoke-free policy.

BACKGROUND: Despite many Australian universities introducing smoke-free policies on campus, there is little information about staff and students understanding of smoking on campus in the context of the implementation of a smoke-free policy. OBJECTIVE: This research explores the qualitative views of university staff and students about smoking on campus during the implementation of a smoke-free policy. METHODS: In 2016, an electronic survey was distributed to all current staff and students of a large university in Queensland, Australia during the implementation of a smoke-free policy. The survey consisted of multiple-choice questions about demographics, tobacco use, attitudes towards smoking, awareness of and attitudes towards the policy, and intentions to quit smoking. The final question asked for a short, open-ended response: "Would you like to comment on the issue of smoking on QUT* campuses?" This question was extracted from the survey and analysed using inductive thematic analysis. This paper reports the findings from this question. *Queensland University of Technology. RESULTS: The survey was completed by 641 staff and students. There were 351 responses to the final question. Five inductive themes emerged about smoking on campus during the implementation of a smoke-free policy: 1) the watering down of the policy, if it is not enforced, 2) the creation of hot spots on campus boundaries affecting those who pass by, 3) concern, especially by those who don't smoke, about the impact on smokers emotional health and welfare, 4) disagreement about the value of designated smoking areas and 5) suggestions about how to better implement the policy. CONCLUSION: Overall, participants views about smoking on campus during the implementation of a smoke free policy suggest broad agreement but reflect concerns about enforcement, boundaries, non-smokers and designated areas. Consistent and systematic processes for implementation, maintenance and enforcement of policy goals, and cessation support, is needed to create a non-smoking culture on university campuses.

Truckies' Nutrition and Physical Activity: A Cross-sectional Survey in Queensland, Australia.

Truck drivers are at increased risk of diet- and physical activity-related chronic diseases. Despite this, there is a paucity of data about Australian truck drivers' diet and physical activity behaviors. A multiple choice and short response survey was distributed to truck drivers attending an Australian Truck Show. The survey asked about self-reported health, source of health information, number of serves of fruit, vegetables, unhealthy food, and sugary drink consumed per day, and frequency of moderate- and vigorous-intensity physical activity per week. The survey was completed by 231 truck drivers---almost all were male, with a mean age of 46 (range 20 to 71) years. Over 85% of survey respondents worked more than 9 hrs per day. Nearly 75% acknowledged the need to make changes to improve their health. Half consumed fewer serves of fruit and 88% consumed fewer serves of vegetables than national recommendations. Over 63% consumed at least one serve of unhealthy foods per day, and 65% drank at least one can of sugary drink per day. Most (80%) undertook less than moderate- and vigorous-intensity physical activity levels provided in national recommendations. Of concern, almost 90% of drivers had above the recommended body mass index---approximately 60% were obese. This is almost double the proportion found in the general population. These findings highlight the importance of health promotion to help drivers make better choices about their health behaviors, which are often underpinned by the limitations of their work environment. Health promotion in transport industry workplaces should be an important topic for future research.

Patterns of drinking alcohol and intentions to binge drink among medical students in Vietnam.

Alcohol use is common among Vietnamese students. Previous qualitative findings showed Vietnamese medical students believed they were not binge drinkers while reporting many binge drinking occasions they participated in or witnessed. This dichotomy warrants examination. This study aims to establish drinking patterns and examine the factors underlying Vietnamese medical students' binge drinking intention and behaviour. This study used a prospective-correlational design, with two waves of data collection, drawing from established health behaviour models. At Time 1, 206 students completed the Alcohol Use Disorder Identification Test, the standard Theory of Planned Behaviour measures (attitude, subjective norm and perceived behavioural control) and their underlying beliefs, as well as group norm, role identity, drinking culture and past binge drinking behaviour. At Time 2, 156 medical students reported their binge drinking behaviour 2 weeks later. Only 6.8% of participants were classified as problematic drinkers and few participants reported binge drinking occasions at the 2-week follow-up. Perceived behavioural control, friends' group norms, role identity as future doctors, and past behaviour significantly predicted binge drinking intentions and key beliefs were identified. This study indicated Vietnamese medical students' limited engagement with binge drinking and identified key factors to address for those with risky drinking behaviour intentions.

Cleaning Staff's Attitudes about Hand Hygiene in a Metropolitan Hospital in Australia: A Qualitative Study.

BACKGROUND: In 2009, the National Hand Hygiene Initiative (NHHI) was implemented in hospitals across Australia with the aim of improving hand hygiene practices and reducing healthcare-associated infections. Audits conducted post-implementation showed the lowest rates of compliance with hand hygiene practices are among operational staff including hospital cleaners. There is limited information about hand hygiene issues in hospital cleaners to inform development of evidence-based interventions to improve hand hygiene compliance in this group. AIM: This qualitative study was undertaken to explore the attitudes of hospital cleaning staff regarding hand hygiene and the National Hand Hygiene Initiative. METHODOLOGY: Focus groups were conducted with 12 cleaning staff at a large Australian hospital implementing the National Hand Hygiene Initiative. FINDINGS: Hospital cleaners recognise the importance of hand hygiene in preventing healthcare-associated infections. Cleaners cite peer support, leadership, and the recognition and reward of those excelling in hand hygiene as strong motivators. Barriers to optimal hand hygiene practice include the presence of multiple conflicting guidelines, hand hygiene "overload" and a lack of contextualised education programs. This exploratory qualitative study reveals three themes about attitudes of hospital cleaning staff towards hand hygiene. These themes are: (1) "The culture of hand hygiene: It's drummed into us"; (2) "Reminders and promotion for hand hygiene: We just need a big 'Please wash your hands' sign"; and (3) "The personal value of hand hygiene: Like he said, it's second nature to us". CONCLUSION: Hand-hygiene messages and training need to be more consistent and contextualised to achieve improvements in hand hygiene practices in hospital cleaning staff in Australia.

Participatory action research, mixed methods, and research teams: learning from philosophically juxtaposed methodologies for optimal research outcomes.

BACKGROUND: Workplace health interventions incorporating qualitative and quantitative components (mixed methods) within a Participatory Action Research approach can increase understanding of contextual issues ensuring realistic interventions which influence health behaviour. Mixed methods research teams, however, face a variety of challenges at the methodological and expertise levels when designing actions and interventions. Addressing these challenges can improve the team's functionality and lead to higher quality health outcomes. In this paper we reflect on the data collection, implementation and data analysis phases of a mixed methods workplace health promotion project and discuss the challenges which arose within our multidisciplinary team. METHODS: This project used mixed methods within a Participatory Action Research approach to address workers' sun safety behaviours in 14 outdoor workplaces in Queensland, Australia, and elucidate why certain measures succeeded (or failed) at the worker and management level. The project integrated qualitative methods such as policy analysis and interviews, with a range of quantitative methods - including worker surveys, ultraviolet radiation (UVR) exposure measurement, and implementation cost analyses. RESULTS: The research team found the integration of qualitative and quantitative analyses within the Participatory Action Research process to be challenging and a cause of tensions. This had a negative impact on the data analysis process and reporting of results, and the complexity of qualitative analysis was not truly understood by the quantitative team. Once all researchers recognised qualitative and quantitative data would be equally beneficial to the Participatory Action Research process, methodological bias was overcome to a degree to which the team could work cooperatively. CONCLUSIONS: Mixed methods within a Participatory Action Research approach may allow a research team to discuss, reflect and learn from each other, resulting in broadened perspectives beyond the scope of any single research methodology. However, cohesive and supportive teams take constant work and adjustment under this approach, as knowledge and understanding is gained and shared. It is important researchers are cognisant of, and learn from, potential tensions within research teams due to juxtaposed philosophies, methodologies and experiences, if the team is to function efficiently and positive outcomes are to be achieved.

Health promotion of bowel cancer and breast cancer screening in community pharmacies: Pharmacists' perceptions of their role, knowledge and confidence

Objectives: To identify community pharmacists' perceptions of their role, knowledge and confidence in relation to bowel cancer and breast cancer screening health promotion. Methods: This was a mixed-methods study with community pharmacists and key informants in the Metro South Health (MSH) region of Brisbane, Queensland, Australia. In Part 1, quantitative data was collected from community pharmacists via an electronic survey. In Part 2, qualitative data was collected from community pharmacists and key informants via in-depth interviews. This paper reports the findings of community pharmacists' perceptions of their role, knowledge and confidence to promote bowel cancer and breast cancer screening in community pharmacies. Results: A total of 27 community pharmacists (13 males, 14 females) completed the survey. Most (71%) either 'agreed' or 'strongly agreed' discussing health advice, such as cancer screening, with their consumers was valuable and integral to their broader role. An average of 60% described their confidence as 'average' or 'good' when discussing bowel and breast cancer screening and prevention with consumers. In eight knowledge questions about bowel and breast cancer and cancer screening, an average of 82% of community pharmacists responded with correct answers (range 52% to 100%). Community pharmacists were consistently more confident and knowledgeable about bowel cancer services than breast cancer services. Five (5) community pharmacists participated in in-depth interviews. The interview findings supported the quantitative findings. Most community pharmacists described their confidence to promote bowel cancer and breast cancer screening as moderate, and consistently reflected they felt more knowledgeable and confident about bowel cancer topics than breast cancer topics. Conclusions: Overall, this research supports the feasibility of promoting bowel cancer screening in community pharmacies. It suggests further training is warranted for community pharmacists to increase their knowledge of breast cancer and their confidence in promoting breast cancer referral and screening services. It highlights the important role community pharmacists have in increasing engagement in the national bowel cancer and breast cancer screening programs, and in potentially decreasing the mortality rates of these cancers

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Using Facebook for Health Promotion in "Hard-to-Reach" Truck Drivers: Qualitative Analysis.

BACKGROUND: Workers in the road transport industry, and particularly truck drivers, are at increased risk of chronic diseases. Innovative health promotion strategies involving technologies such as social media may engage this "hard-to-reach" group. There is a paucity of evidence for the efficacy of social media technologies for health promotion in the Australian transport industry. OBJECTIVE: This study analyzed qualitative data from interviews and focus group discussions to evaluate a social media health promotion intervention, the Truckin' Healthy Facebook webpage, in selected Australian transport industry workplaces. METHODS: We engaged 5 workplace managers and 30 truck drivers from 6 transport industry organizations in developing workplace health promotion strategies, including a social media intervention, within a Participatory Action Research approach. Mixed methods, including a pre- and postintervention manager survey, truck driver survey, key informant semistructured interviews, truck driver focus groups, and focused observation, were used to evaluate the social media intervention. We asked questions about workplace managers' and truck drivers' opinions, engagement, and satisfaction with the intervention. This paper focuses on qualitative data. RESULTS: Of the workplace managers who reported implementing the social media intervention at their workplace, all (3/3, 100%) reported satisfaction with the intervention and expressed a keen interest in learning more about social media and how it may be used for workplace health promotion and other purposes. Truck drivers were poorly engaged with the intervention because (1) many believed they were the "wrong age" and lacked the necessary skills; (2) the cost of smartphone technology was prohibitive; (3) they confined their use of social media to nonwork-related purposes; and (4) many workplaces had "no Facebook" policies. CONCLUSIONS: The use of social media as a health promotion intervention in transport industry workplaces has potential. Workplace interventions using social media can benefit from a Participatory Action Research approach. Involving managers and workers in the design of social media health promotion interventions and developing strategies to support and deliver the interventions helps to facilitate their success. The workers' profile, including their age and familiarity with social media, and work, workplace, and family context is important to consider in this process. Much more research needs to be undertaken to better understand the effective use of social media to engage "hard-to-reach" groups.

Vietnamese medical students and binge drinking: a qualitative study of perceptions, attitudes, beliefs and experience.

OBJECTIVES: To explore the perceptions, attitudes, beliefs, and experiences related to Vietnamese medical students' binge drinking. DESIGN: A qualitative study comprising semi-structured focus groups/interviews with medical students and semi-structured interviews with key informants. Thematic analysis of data. SETTING: Participants were a convenience sample of usual volunteers from a medical university in Viet Nam. PARTICIPANTS: 19 medical students from year 1 to 6 and 4 key informants agreed to participate in the study. RESULTS: The study found participants believe medical students drink less than other students and are not binge drinkers yet they experience and/or witness many binge drinking occasions among medical students. Participants consider alcohol use as culturally acceptable in Vietnamese society and a way for medical students to create and improve relationships with their friends, teachers, or work colleagues. Group affiliation and peer pressure to drink excessive alcohol are identified among medical students, especially male students. CONCLUSION: The culture of drinking behaviour was explored among medical students in Viet Nam. This study reveals a dichotomy between the belief of not being binge drinkers and the experience of many binge drinking occasions among medical students. This tension suggests future research about binge drinking behaviour of Vietnamese medical students is required.

Health promotion of bowel cancer and breast cancer screening in community pharmacies: Pharmacists' perceptions of their role, knowledge and confidence.

OBJECTIVES: To identify community pharmacists' perceptions of their role, knowledge and confidence in relation to bowel cancer and breast cancer screening health promotion. METHODS: This was a mixed-methods study with community pharmacists and key informants in the Metro South Health (MSH) region of Brisbane, Queensland, Australia. In Part 1, quantitative data was collected from community pharmacists via an electronic survey. In Part 2, qualitative data was collected from community pharmacists and key informants via in-depth interviews. This paper reports the findings of community pharmacists' perceptions of their role, knowledge and confidence to promote bowel cancer and breast cancer screening in community pharmacies. RESULTS: A total of 27 community pharmacists (13 males, 14 females) completed the survey. Most (71%) either 'agreed' or 'strongly agreed' discussing health advice, such as cancer screening, with their consumers was valuable and integral to their broader role. An average of 60% described their confidence as 'average' or 'good' when discussing bowel and breast cancer screening and prevention with consumers. In eight knowledge questions about bowel and breast cancer and cancer screening, an average of 82% of community pharmacists responded with correct answers (range 52% to 100%). Community pharmacists were consistently more confident and knowledgeable about bowel cancer services than breast cancer services. Five (5) community pharmacists participated in in-depth interviews. The interview findings supported the quantitative findings. Most community pharmacists described their confidence to promote bowel cancer and breast cancer screening as moderate, and consistently reflected they felt more knowledgeable and confident about bowel cancer topics than breast cancer topics. CONCLUSIONS: Overall, this research supports the feasibility of promoting bowel cancer screening in community pharmacies. It suggests further training is warranted for community pharmacists to increase their knowledge of breast cancer and their confidence in promoting breast cancer referral and screening services. It highlights the important role community pharmacists have in increasing engagement in the national bowel cancer and breast cancer screening programs, and in potentially decreasing the mortality rates of these cancers.

Outdoor workers and sun protection strategies: two case study examples in Queensland, Australia.

INTRODUCTION: Outdoor workers are at risk of developing skin cancer because they are exposed to high levels of harmful ultraviolet radiation. The Outdoor Workers Sun Protection Project investigated sun protection strategies for high risk outdoor workers in rural and regional Australia. METHODS: Fourteen workplaces (recruitment rate 37%) across four industries in rural and regional Queensland, Australia were recruited to the OWSPP. In 2011-2012, data were collected using pre- and post-intervention interviews and discussion groups. This article presents two workplaces as case study examples. RESULTS: The flat organisational structure of workplace 1 supported the implementation of the Sun Safety Action Plan (SSAP), whilst the hierarchical organisational nature of workplace 2 delayed implementation of the SSAP. Neither workplace had an existing sun protection policy but both workplaces adopted one. An effect related to the researchers' presence was seen in workplace 1 and to a lesser degree in workplace 2. Overt reciprocity was seen between management and workers in workplace 1 but this was not so evident in workplace 2. In both workplaces, the role of the workplace champion was pivotal to SSAP progression. CONCLUSIONS: These two case studies highlight a number of contextually bound workplace characteristics related to sun safety. These issues are (1) the structure of workplace, (2) policy, (3) an effect related to the researchers' presence, (4) the workplace champion and (5) reciprocity. There are several recommendations from this article. Workplace health promotion strategies for sun safety need to be contextualised to individual workplaces to take advantage of the strengths of the workplace and to build capacity.

School based youth health nurses and attrition: the reasons for moving on.

Like the UK, Australia has a number of school nursing models and programmes. The School Based Youth Health Nurse Program (SBYHNP) is a new and unique model of school nursing in Queensland, Australia. The SBYHNP represents a philosophical and structural shift from traditional school nursing programmes. The purpose of this qualitative case study is to explore the reasons School Based Youth Health Nurses (SBYHN) leave school nursing. Sixteen in-depth interviews were conducted with participants who practised as SBYHN and left the SBYHNP. The case study suggests nurses considering school nursing as a specialty should seek opportunity to understand this complex role, ensure realistic expectations and undertake relevant qualifications. This approach may secure the investment made by nurses and schools and create demand for a highly sought after position.