Learning about Aboriginal health and wellbeing at the postgraduate level: novel application of the Growth and Empowerment Measure.

INTRODUCTION: Public health education strives to transform and empower students to engage in policy and practice improvement. However, little is known of the nature of such change among students, especially when studying Aboriginal health and wellbeing, which may involve disrupting long held assumptions and prejudices. This article reports findings regarding the feasibility, specificity and sensitivity of the Growth and Empowerment Measure (GEM) in the evaluation of two innovative Australian 13-week postgraduate public health electives focused on Aboriginal health and wellbeing. The GEM's 14-item Emotional Empowerment Scale (EES14) and its subscales Inner Peace and Self-Capacity, and 12 Scenarios (S12) and its subscales Healing and Growth and Connection and Purpose were used to examine transformative experiences. A new short form of the S12, the Core6, was also trialled as a briefer measure of functional empowerment. METHODS: Pre-course GEM responses and demographic information were collected from consenting students during the mandatory, face-to-face workshops of the Aboriginal public health Perspectives course and the Aboriginal empowerment and wellbeing Lifespan course. The two-day Perspectives course workshop introduced a group scenario-building activity towards ending health inequality. Lifespan students experienced a 3-day immersion based on Stage 1 of the Aboriginal Family Well Being empowerment program. Insights from both workshops were further integrated through structured online discussions and written assessments. At the end of semester, a post-course GEM was mailed to students for completion and return. Students could also provide feedback through evaluation surveys and semi-structured focus groups. Effect sizes were assessed using paired t-tests, Wilcoxon signed-rank tests and multiple ANOVA. Cronbach's alpha confirmed internal consistency. RESULTS: Baseline GEM data was provided for 147 out of a total of 194 workshop experiences from participating students. Twenty students attended workshops for both Perspectives and Lifespan. Fifty-five matched pairs (representing 52 individual participants) were obtained from 170 students who completed one or both courses. Statistically significant positive change of small to medium effect size was detected in all GEM scales, subscales and some individual items. Lifespan yielded larger effects than Perspectives, most markedly on two subscales: Inner Peace, and Connection and Purpose. Participating students reported significant growth in the Scenario item 'knowing and being who I am' following Perspectives and Lifespan. Those completing Perspectives also reported a significant increase in 'gaining voice and being heard', consistent with its action-oriented scenario-building assessment. In contrast, the psychosocial development approach embedded in Lifespan stimulated strong development in spirituality, responding constructively to judgement, appreciating empowerment in their communities and skills to make changes in their lives. Feedback indicated that students valued these personal and professional growth experiences. CONCLUSION: The GEM was sensitive and specific in measuring components of empowering change among participants. Challenges included low post-course response rates that limited extrapolation to overall course impact, and attention needed to starting point when comparing the increment of change. The GEM is a promising tool for studying postgraduate courses designed to stimulate transformative learning, wellbeing and cultural competence through empowerment, and relevant in the education of health professionals in the fields of Aboriginal and rural health.

An explanatory model of peer education within a complex medicines information exchange setting.

Studies of the effectiveness and value of peer education abound, yet there is little theoretical understanding of what lay educators actually do to help their peers. Although different theories have been proposed to explain components of peer education, a more complete explanatory model has not been established empirically that encompasses the many aspects of peer education and how these may operate together. The Australian Seniors Quality Use of Medicines Peer Education Program was developed, in conjunction with community partners, to improve understanding and management of medicines among older people - an Australian and international priority. This research investigated how peer educators facilitated learning about quality use of medicines among older Australians. Participatory action research was undertaken with volunteer peer educators, using a multi-site case study design within eight geographically-defined locations. Qualitative data from 27 participatory meetings with peer educators included transcribed audio recordings and detailed observational and interpretive notes, which were analysed using a grounded theory approach. An explanatory model arising from the data grouped facilitation of peer learning into four broad mechanisms: using educator skills; offering a safe place to learn; pushing for change; and reflecting on self. Peer educators' life experience as older people who have taken medicines was identified as an overarching contributor to peer learning. As lay persons, peer educators understood the potential disempowerment felt when seeking medicines information from health professionals and so were able to provide unique learning experiences that encouraged others to be 'active partners' in their own medicines management. These timely findings are linked to existing education and behaviour change theories, but move beyond these by demonstrating how the different elements of what peer educators do fit together. In-depth examination of peer educators' practice in this context offers potential insights into the practice of lay workers in other related complex health promotion programs.

"It looks after me": how older patients make decisions about analgesics for osteoarthritis.

OBJECTIVE: To explore the key motivators behind selection of analgesics (nonsteroidal antiinflammatory drugs [NSAIDs], acetaminophen, and complementary medications [CMs]) by patients with osteoarthritis (OA). METHODS: We performed a qualitative study in which in-depth semistructured interviews were conducted with 15 OA patients recruited from 4 general practices in Sydney, Australia. Patients were ages ≥65 years, and were currently taking or had recently taken an NSAID for OA. RESULTS: Three key themes emerged from the data: reliance, routine, and pill load. Patients were strongly reliant upon NSAIDs because they consistently satisfied their needs. By contrast, they were much less reliant upon acetaminophen because of uncertainty or skepticism about its effectiveness. They were not reliant upon CMs but were willing to take them indefinitely because they were perceived as being without risk. Many patients took an NSAID as well as CMs as part of a "daily routine." By contrast, patients had difficulty developing a routine around using acetaminophen at the recommended maximum dose because of the implicit frequency of dosing required and an aversion to the associated "pill load." CONCLUSION: The results highlight the importance of exploring the perceptions and preferences of patients with regard to analgesics for OA. Clinician advice regarding analgesia for OA should take account of the possible reliance of the patient upon an NSAID, their medicine routines, and their potential concern about the pill load associated, in particular, with acetaminophen.

Use of NSAIDs for osteoarthritis amongst older-aged primary care patients: engagement with information and perceptions of risk.

BACKGROUND: non-steroidal anti-inflammatory drugs (NSAIDs) are used commonly to treat osteoarthritis in older patients. OBJECTIVE: to explore the understandings of risk that older-aged primary care patients have in the context of the use of oral NSAIDs to treat osteoarthritis. METHOD: semi-structured interviews were conducted with 15 patients who were recruited from four general practices located in Sydney, Australia. Patients were aged at least 65 years and were currently taking, or in the past 2 years had taken, an NSAID for osteoarthritis. Emergent themes were identified from the transcripts and were compared within and across transcripts to develop more abstract concepts. RESULTS: patients demonstrated three key 'modes of disengagement' from medication-specific risk information, each of which could also be a mode of modulating a sense of danger and each of which would demand a unique clinical response. These were: 'transference of responsibility'-transferring the responsibility to their GP, 'general versus specific risk'-considering the risk of taking medicine in general as opposed to the specific risk of taking an NSAID, and 'personal immunity'-some patients with a long history of NSAID use without apparent toxicity believed they were, therefore, not at risk of future adverse effects, while a few patients believed they were immune to adverse effects of drugs in general. CONCLUSION: there is a need for greater recognition of these 'modes of disengagement'/'hazard modulation' in order to attain a clinical response leading to safer, more effective and more ethical use of medicines.

Decision-makers, donors and data: factors influencing the development of mental health and psychosocial policy in the Solomon Islands.

Mental disorders and psychosocial problems are common, and present a significant public health burden globally. Increasingly, attention has been devoted to these issues in the aftermath of violent conflict. The Solomon Islands, a small Pacific island nation, has in recent years experienced periods of internal conflict. This article examines how policy decisions regarding mental health and wellbeing were incorporated into the national agenda in the years which followed. The study reveals the policy shifts, contextual influences and players responsible. The Solomon Islands' experience reflects incremental change, built upon longstanding but modest concern with mental health and social welfare issues, reinforced by advocacy from the small mental health team. Armed conflict and ethnic tensions from 1998 to 2003 promoted wider recognition of unmet mental health needs and psychosocial problems. Additional impetus was garnered through the positioning of key health leaders, some of whom were trained in public health. Working together, with an understanding of culture and politics, and drawing on external support, they drove the agenda. Contextual factors, notably further violence and the ongoing risk of instability, a growing youth population, and emerging international and local evidence, also played a part.

Doing good qualitative research in public health: not as easy as it looks.

In this paper, we discuss qualitative research for public health professionals. Quality matters in qualitative research, but the principles by which it is judged are critically different from those used to judge epidemiology. Compared to quantitative research, good quality qualitative studies serve different aims, answer distinct research questions and have their own logic for sampling, data collection and analysis. There is, however, no need for antagonism between qualitative research and epidemiology; the two are complementary. With theoretical and methodological guidance from experienced qualitative researchers, public health professionals can learn how to make the most of qualitative research for themselves.

Exploring factors influencing osteoporosis prevention and control: a qualitative study of Iranian men and women in Australia.

OBJECTIVE: To explore the understanding of osteoporosis risk factors and barriers that influence osteoporosis prevention and control in order to better inform the development of culturally appropriate osteoporosis preventive strategies. METHODS: This qualitative study was based on data collected from 5 focus groups, 10 individual interviews and 3 opportunistic group discussions of Iranian men and women living in Australia. A thematic analysis approach was used and data were managed with a computer-assisted program. Data were collected over 1 year in community settings chosen by participants. RESULTS: The participants had insufficient understanding of osteoporosis risk factors and its implications for their health as they age. There were minor misconceptions about the causes of the disease and how it could be prevented and controlled. Many participants confused osteoporosis and osteoarthritis. Where they did indicate some knowledge of preventive actions, they perceived many obstacles to their undertaking preventive behaviours. CONCLUSIONS: These data suggest that factors adversely influencing osteoporosis prevention and control have their root in misconceptions about osteoporosis and its risk factors, and psychosocial and structural barriers to taking preventive actions. These findings provide insights into barriers that need to be overcome if preventive strategies and intervention programs can be developed to reduce the overall burden of osteoporosis in the community.

Using qualitative research to enhance the evidence-based practice of health care providers.

The physiotherapy profession has increasingly sought to demonstrate that its practice is based on sound scientific principles validated by rigorous research, in other words that its practice is evidence-based. This paper will assert that evidence-based practice requires not only carefully evaluated interventions judged through objective criteria but also input from patients in a systematic way that provides a foundation for patient-centred care. Consideration of both is essential if the best outcomes of physiotherapy intervention are to ensue. The merits of qualitative research are appraised as a means of adding the humanistic mission to result in best practice in physiotherapy.