Producing knowledge together: a participatory approach to synthesising research across a large-scale collaboration in Aboriginal and Torres Strait Islander health.

BACKGROUND: Despite that stakeholder participation in evidence synthesis could result in more useful outcomes, there are few examples of processes that actively involve them in synthesis work. Techniques are needed that engage diverse stakeholders as equal partners in knowledge co-production. The aims of this paper are to describe an innovative participatory process of synthesising a large body of academic research products and compare the findings of the participatory process against two traditional approaches to synthesis: a rapid review and a structured review. METHODS: First, a rapid synthesis of all research outputs (n = 86) was conducted by researchers with in-depth knowledge of the collaboration's research. Second, a team of researchers and service providers conducted a structured synthesis of seventy-eight peer-reviewed articles and reports generated by the collaboration. Fifty-five publications were brought forward for further synthesis in part three, a facilitated participatory synthesis. Finally, we explored the value added by the participatory method by comparing findings generated across the three synthesis approaches. RESULTS: Twelve researchers and 11 service providers/policy partners-8 self-identified as Aboriginal and/or Torres Strait Islander-participated in two facilitated workshops (totalling 4 h). Workshop activities engaged participants in reviewing publication summaries, identifying key findings, and evoked review, discussion and refinement. The process explicitly linked experiential knowledge to citations of academic research, clearly connecting the two knowledge types. In comparing the findings generated across all three methods we found mostly consistencies; the few discrepancies did not contradict but gave deeper insights into statements created by the other methods. The participatory synthesis generated the most, detailed, and unique findings, and contextual insights about the relevance of the key messages for practice. CONCLUSION: The participatory synthesis engaged stakeholders with diverse backgrounds and skillsets in synthesising a large body of evidence in a relatively short time. The participatory approach produced findings comparable to traditional synthesis methods while extending knowledge and identifying lessons most relevant for the participants who, ultimately, are the end users of the research. This process will interest other large-scale research collaborations seeking to engage stakeholders in evidence synthesis.

A systematic review of literature on occupational health and safety interventions for older workers.

As the global population ages there is an imperative to enhance labour participation of older workers in ways that support good physical and psychological health. However, there is limited guidance for organisations on how to do this effectively. This systematic review examined literature identified through four databases and a targeted web-search, yielding 39 PRISMA records (32 scholarly, seven grey literature) reporting workplace interventions aimed at improving the injury outcomes of older workers. The review revealed that organisational and composite interventions may be most effective, although an absence of robust research in this area and a scarcity of empirical evidence-based interventions known to improve injury outcomes for older workers was noted. Responding to these shortcomings, this article presents 'A future research agenda for older worker health, safety and well-being interventions.' This systems-based approach has a dual focus on organisational and composite interventions combined with robust research design.Practitioner summary: We conducted a systematic literature review of studies focussed on workplace interventions to improve the physical and psychological safety of older workers. Within the existing literature, evidence for effective interventions and guidance for organisations is weak. We present a future research agenda with a systems approach to address these gaps.

Older Worker-Orientated Human Resource Practices, Wellbeing and Leave Intentions: A Conservation of Resources Approach for Ageing Workforces.

At a time where there are ageing populations, global shortages of skilled labour, and migration pathways impacted by the COVID-19 pandemic, retaining older workers presents as a vital strategic initiative for organizations globally. This study examines the role of Human Resource Practices (HRPs), which are oriented towards accommodating the needs of an ageing workforce in mitigating psychological distress and turnover intentions. The study collected self-reported survey data from 300 Australian employees over the age of 45, over two time points. Using structural equation modelling, the study analyzed the extent to which Older Worker-oriented Human Resources Practices (OW-HRPs) translate into employee psychological health and retention within organizations, through the mediation of ageism and work-life conflict. The results support our hypothesis that OW-HRPs are associated with lower ageism, better work-life balance; and in combination these reduce psychological distress and help retain older workers in the workforce. We conclude that OW-HRPs can foster work environments conducive to older worker wellbeing, supporting the retention of talent and maintaining effectiveness, in the face of substantial labour supply challenges brought on by the COVID-19 pandemic and an ageing population.

A systems model for the design of occupational health and safety management systems inclusive of work-from-home arrangements.

The study addressed an important knowledge gap in the literature by co-designing a model for OHS management systems inclusive of workers who work-from-home, with a focus on psychosocial risks. This qualitative research study utilised a series of co-design focus groups involving Australian regulators, health and safety managers and practitioners, senior managers, middle managers and workers who work-from-home, to better understand the types of measures that organisations can apply to improve their health and safety management systems. Using a systems approach, consideration was given to the organisation of the remote working system, the home-work interface for remote workers, the competencies of managers and employees in regard to their occupation health and safety (OHS) responsibilities, and the complexity of identifying, reporting and monitoring psychosocial hazards for employees working from home. The study identified a need for tools designed to support both managers and workers in promoting psychologically safe working from home.

Evaluating the Implementation of a Mental Health Referral Service "Connect to Wellbeing": A Quality Improvement Approach.

There is increasing demand for mental health services to be accessible to diverse populations in flexible, yet, cost-effective ways. This article presents the findings from a study that evaluated the process of implementing Connect to Wellbeing (CTW), a new mental health intake, assessment and referral service in regional Australia, to determine how well it improved access to services, and to identify potential measures that could be used to evaluate value for money. The study used a hybrid study design to conduct a process evaluation to better understand: the process of implementing CTW; and the barriers and factors enabling implementation of CTW. In addition, to better understand how to measure the cost-effectiveness of such services, the hybrid study design included an assessment of potential outcome measures suitable for ascertaining both the effectiveness of CTW in client health outcomes, and conducting a value for money analysis. The process evaluation found evidence that by improving processes, and removing waitlists CTW had created an opportunity to broadened the scope and type of psychological services offered which improved accessibility. The assessment of potential outcome measures provided insight into suitable measures for future evaluation into service effectiveness, client health outcomes and value for money.

CQI approaches for evaluating management development programs: A case study with health service managers from geographically remote settings.

Health systems are known for being complex. Yet, there is a paucity of evidence about programs that successfully develop competent frontline managers to navigate these complex systems. There is even less evidence about developing frontline managers in areas of contextual complexity such as geographically remote and isolated health services. This study used a customised management development program containing continuous quality improvement (CQI) approaches to determine whether additional levels of evaluation could provide evidence for program impact. Generalisability is limited by the small sample size; however, the findings suggest that continuous improvement approaches, such as action learning workplace-based CQI projects not only provide for real-world application of the manager's learning; they can potentially produce the type of data needed to conduct evaluations for organisational impact and cost-benefits. The case study contributes to the literature in an area where there is a scarcity of empirical research. Further, this study proposes a pragmatic method for using CQI approaches with existing management development programs to generate the type of data needed for multi-level evaluation.

Assessing research impact: Australian Research Council criteria and the case of Family Wellbeing research.

Researchers worldwide are increasingly reporting the societal impact of their research as part of national research productivity assessments. However, the challenges they encounter in developing their impact case studies against specified government assessment criteria and how pitfalls can be mitigated are not reported. This paper examines the key steps taken to develop an Aboriginal Family Wellbeing (FWB) empowerment research impact case study in the context of an Australian Research Council (ARC) pilot research impact assessment exercise and the challenges involved in applying the ARC criteria. The requirement that researchers demonstrate how their institutions support them to conduct impactful research has the potential to create supportive environments for researchers to be more responsive to the needs of users outside academia. However, the 15-year reference period for the associated research underpinning the reported impact and the focus on researcher's current institutional affiliation constitute potential constraints to demonstrating the true impact of research. For researchers working with Indigenous people, relationships that build over long periods of time, irrespective of university affiliation, are critical to conducting impactful research. A more open-ended time-frame, with no institutional restrictions for the 'associated research' provides the best opportunity to demonstrate the true benefits of research not only for Indigenous people but for Australian society more broadly.

The evidence needed to demonstrate impact: A synthesis of the evidence from a phased social and emotional wellbeing intervention.

Policy decisions are based on evidence that demonstrates the effectiveness of interventions; however, the quantity and type of evidence that is needed to demonstrate the effectiveness of an intervention is not universally agreed upon. The aim of this study was to collaborate with researchers who have not been involved directly in Family Wellbeing interventions to lead a review of characteristics of the Family Wellbeing intervention evaluation output to date, and to assess for evidence of the FWB intervention's impact on participants and their communities. The study found that where it is not appropriate or viable to conduct research, such as randomised control trials, alternative ways of providing evidence to demonstrate the effectiveness of an intervention is vital. This review suggests that Family Wellbeing interventions are having a positive impact and promoting change in the lives of participants, their families and their communities. Hence, for complex interventions, such as those with Indigenous populations, evidence should demonstrate effectiveness against prescribed outcomes, as well as critical aspects behind how and why a complex intervention was successful.

An examination of supportive management practices promoting health workforce stability in remote northern Australia.

OBJECTIVE: The aim of this study is to examine management practices that support the wellbeing of health professionals working in remote regions, which may improve workforce retention. METHOD: An online questionnaire was distributed to health professionals working in remote regions of the Kimberley and North Queensland. A response rate of 20% was achieved. RESULTS: The findings suggest that, for health professionals working in remote regions of northern Australia, accessing adequate support is one of the most challenging aspects of working in remote regions. Hence, in remote regions where turnover is high, retention of competent health professionals may benefit from management practices that provide improved personal and professional support. CONCLUSIONS: Health professionals working in remote Australia face unique pressures due to their geographical and professional isolation. Therefore, providing support improves their professional competence and personal wellbeing, and promotes workforce stability, which benefits the remote community through better access to health services.

Beasts of burden or organised cooperation: the story of a mental health team in remote, Indigenous Australia.

OBJECTIVE: This paper aims to describe the growth of a regionally-based mental health team providing services to remote Indigenous communities in far north Queensland. CONCLUSIONS: By drawing on their experience, the authors are able to identify factors supporting the development and sustained capacity of integrated mental health teams, working in challenging remote settings.

Psychosis in Indigenous populations of Cape York and the Torres Strait.

OBJECTIVE: To describe and characterise treated psychotic disorders in the Indigenous populations of Cape York and the Torres Strait. DESIGN: Cross-sectional analysis of patients with a psychotic disorder identified by treating psychiatrists. SETTING AND PARTICIPANTS: Indigenous patients aged≥15 years in Cape York and Torres Strait communities receiving treatment for a psychotic disorder over 3 months in 2010. MAIN OUTCOME MEASURES: Prevalence of psychosis diagnoses, intellectual disability, and substance use comorbidities. RESULTS: 171 patients were included. The prevalence rate in this population was 1.68%, higher for males (2.60%) than females (0.89%), and twice as high in the Aboriginal (2.05%) than in the Torres Strait Islander (0.95%) population. High rates of alcohol and cannabis use were found. Comorbid intellectual disability was common and more frequent among Aboriginal patients. CONCLUSIONS: The burden of psychosis in the Indigenous population of Cape York and the Torres Strait is high. Further research is needed to understand the social determinants of these disorders and to design effective social and clinical measures to alleviate this burden.

Psychosis and its correlates in a remote indigenous population.

OBJECTIVES: The aim of this study was to describe prevalence and characteristics of psychotic disorders in a remote Indigenous population. METHOD: Clinical review of all patients with an active diagnosis of a psychotic disorder in remote communities of Cape York and the Torres Strait. RESULTS: 170 patients were identified and demographic, social and treatment variables described. CONCLUSIONS: Psychotic disorders are common and more so among young adult Aboriginal men, with high rates of comorbid conditions including substance use, intellectual impairment and diabetes. In parallel to this case complexity, there are high rates of coercive treatments. Certain differences by ethnicity and location are described and possible explanations proposed.