The Influence of Health Literacy and Self-Management on Emergency Healthcare Access for Rural Asthmatics: A Patient's Perspective.

INTRODUCTION: Asthma is a leading cause of respiratory illness in Australia and has a significant prevalence in rural areas. Literature suggests living in rural areas can act as a barrier to receiving emergency healthcare for asthma exacerbations resulting in the need for further resources and advocacy in educating rural asthmatics about managing their condition and knowing when to access further help. This study aims to explore decision-making in accessing emergency healthcare for people with moderate to severe asthma exacerbations in rural New South Wales (NSW). METHODS: A qualitative interpretative design involving semi-structured interviews with 12 participants was conducted between May and July 2021. Interviews were recorded and transcribed verbatim. Participants were asthmatics who had accessed emergency healthcare for a moderate to severe asthma exacerbation in NSW over the last five years. Data was thematically analysed and grouped into four overarching themes. Due to the depth and range of data this paper will be reporting on two of those themes. RESULTS:  Past experiences as education and the impact of self-management strategies were both shown to be prominent influences that affected decisions on choosing to access emergency healthcare during a moderate to severe asthma exacerbation. Participants shared how their decision-making was shaped by health literacy gained from their past experiences of asthma exacerbations and dealing with emergency healthcare. In addition, self-management strategies were utilised to minimise the need to access emergency healthcare. This was achieved through telehealth appointments, lifestyle changes and non-pharmacological strategies. CONCLUSION: This study shows that an increase in health promotion activities throughout rural areas can help to reassure people about uncertainties that may be associated with their past experiences and improve health literacy. Additionally, providing tools to allow confident self-management of asthma effectively using evidence-based techniques to prevent it progressing to a moderate or severe exacerbation would also be of benefit.

Paramedic Student Clinical Performance During High-Fidelity Simulation After a Physically Demanding Occupational Task: A Pilot Randomized Crossover Trial.

INTRODUCTION: Paramedic duties include assessing, treating, and maneuvering patients in physically challenging environments. Whether clinical skills and patient care are affected by these occupational demands is unknown. High-fidelity simulation affords the opportunity to study this in a controlled setting. METHODS: Using a randomized crossover design, 11 regional paramedicine students and graduates (mean ± SD age = 23 ± 2 years) completed two, 20-minute high-fidelity simulations that included cardiopulmonary resuscitation (CPR) immediately after either an acute bout of occupational physical activity (OPA) or a rest period (REST). Heart rate, respiratory rate, and mean arterial pressure were measured throughout. Clinical performance was scored using the Global Rating Score and a patient care record. Measures of CPR efficacy were recorded in the manikin. RESULTS: There were no significant differences in Global Rating Score ( P = 0.07, ES = 0.03) or CPR efficacy between conditions. Patient care record accuracy was higher after the OPA versus REST simulations (mean ± SD = 61.8 ± 12.6% vs. 55.5 ± 12.0%, P = 0.03, ES = 0.5). Mean heart rate was higher during OPA simulations versus REST simulations (121 ± 14 vs. 84 ± 9 beats per minute, P < 0.01, ES = 3.1), as was mean respiratory rate (19 ± 3 vs. 16 ± 3 breaths per minute, P < 0.01, ES = 1.0). Mean arterial pressure was higher for OPA versus REST at simulation start (105 ± 11.3 vs. 95.8 ± 11.8 mm Hg, P = 0.01, Effect Size = 0.8), although not different after simulation. CONCLUSIONS: Paramedicine students including recent graduates performed as well, or better, in a simulated clinical scenario immediately after occupation-specific acute physical exertion compared with a REST, despite higher physiological exertion. Whether this is the case for more experienced but potentially less physically fit paramedics in the workforce warrants investigation.

Mental health and well-being impacts of COVID-19 on rural paramedics, police, community nurses and child protection workers.

OBJECTIVE: To investigate the impact of COVID-19 on the mental health and well-being of rural paramedics, police, community nursing and child protection staff. METHOD: An online survey was distributed to investigate the sources of stress and support across individual, task and organisational domains. SETTING AND PARTICIPANTS: The survey was completed by 1542 paramedics, police, community nurses and child protection workers from all states and territories of Australia. This study describes the data for the 632 rural participants. MAIN OUTCOME MEASURES: The main measures of well-being were the Public Health Questionnaire (PHQ9), the Generalised Anxiety Disorder (GAD7), the Maslach Burnout Inventory (MBI), workplace engagement, intention to quit and COVID-19-related stress. RESULTS: The mean depression and anxiety scores were 8.2 (PHQ9) and 6.8 (GAD7). This is 2-3 times that found in the general community. Over half (56.1%) of respondents showed high emotional exhaustion (burnout). The emotional exhaustion, depersonalisation and personal accomplishment mean scores were 28.5, 9.3 and 34.2, respectively. The strongest associations with burnout and psychological distress were workload, provision of practical support, training and organisational communication. A significant proportion of respondents were seriously considering quitting (27.4%) or looking for a new job with a different employer (28.5%) in the next 12 months. CONCLUSIONS: COVID-19 has increased the workload and stress on rural front-line community staff. The major sources of stress were related to organisations' responses to COVID-19 and not COVID-19 per se. The data suggest the most effective mental health interventions are practical and preventive, such as firstly ensuring fair and reasonable workloads.

Exploring the rationale, experience and impact of using Cancer Information and Support (CIS) services: an international qualitative study.

PURPOSE: The aim of this study was to develop an in-depth understanding of the rationale, experiences, evaluation and outcomes of using Cancer Information and Support (CIS) services in Australia, the UK and USA. METHODS: Semi-structured interviews were used to gather data between November 2015 and January 2016. Telephone interviews were recorded, de-identified, transcribed and thematically analysed. Ten users from each of three international CIS services (n = 30 in total) were recruited. Participants were eligible for inclusion if they had utilised the CIS in 2015 via telephone contact with a cancer nurse and identified as a patient or cancer survivor, or friend or family member of such a person. RESULTS: Four major themes were derived and included a total of 25 sub-themes. Key themes included (i) drivers for access, (ii) experience of the service, (iii) impact and (iv) an adjunct to cancer treatment services. CONCLUSIONS: Cancer Information and Support nurses internationally act as expert navigators, educators and compassionate communicators who 'listen between the lines' to enable callers to better understand and contextualise their situation and discuss it with their healthcare team and family and friends. Use of the service can result in reduced worry, extend support repertoires and enable use of new knowledge and language as a tool to getting the most from the healthcare team. The positioning of CIS alongside cancer treatment services aids fuller integration of supportive care, benefiting both patients and clinicians.

Who stops selling? A systematic analysis of ex-tobacco retailers.

OBJECTIVE: There is evidence that wide distribution of cigarettes contributes to smoking, and multiple commentators have called for a review of tobacco retailing. This study analyses retailers who stop selling cigarettes, why they do so, and discusses the implications for tobacco control. METHOD: An audit of tobacco retailers in the Australian state of NSW was used to identify retailers who had stopped selling tobacco, and they were then compared with current retailers to determine how many, and what types of outlets stop selling tobacco. Attempts were made to contact and interview all former tobacco retailers identified in three audited regions. In-depth interviews were conducted with 13 ex-tobacco retailers, or 31% of the subset of ex-tobacco retailers. RESULTS: Low-volume outlet types were over-represented as a proportion of retailers exiting the market, and some had resumed selling within 18 months of the audit. Low profits were often cited as a contributor to stopping; however, in all but one case, the decision to stop selling was also influenced by a significant change in business circumstances-either legislative or other business changes. CONCLUSIONS: Few retailers stop selling tobacco while continuing in the same business, and those who stop disproportionately represent retailer types with low sales volume. The results suggest that legislative changes provide a window where retailers could be prompted to exit the market.