An examination of primary health care nursing service evaluation using the Donabedian model: A systematic review.

Nurses are key to the delivery of global primary health care services. However, there appears to be a lack of evaluation of primary health care nursing delivery models in the published literature. This evaluation is vital to the improvement of patient experiences, national and global health outcomes, and the justification of future investment in primary health care nursing services. The purpose of this review was to explore and analyze the literature that reports on the evaluation of primary health care nursing services, to ascertain the nature and utility of these evaluation methods, and identify opportunities for future research in this area. A systematic review of the published literature was conducted following PRISMA guidelines, using the databases CINAHL, Joanna Briggs Institute, MEDLINE, and Proquest. Thirty-two articles published between 2010 and 2022 were selected. Results were organized using the Donabedian model. A paucity of research into the evaluation of nurse-led primary health care services was noted. Where evident, evaluation of primary health care nursing services tended to reflect the medical model. Medical outcomes measures dominated evaluation criteria including diagnosis rates, prescription costs, and disease outcomes. Primary health care principles such as service accessibility, cultural appropriateness, and availability were rarely used. The perspectives and experiences of nurses were not sought in service evaluation, including most of the nurse-led services. Development of an evidence-base of nursing primary health care services that are informed by the nursing experience and apply a framework of universal primary health care principles across the structure, process, and outcomes aspects of the service is recommended.

Nursing students doing gender: Implications for higher education and the nursing profession.

The average age of women nursing students in Australia is rising. With this comes the likelihood that more now begin university with family responsibilities, and with their lives structured by the roles of mother and partner. Women with more traditionally gendered ideas of these roles, such as nurturing others and self-sacrifice, are known to be attracted to nursing as a profession; once at university, however, these students can be vulnerable to gender role stress from the competing demands of study. A qualitative research design, guided by Gadamer's hermeneutic philosophy, explored the gendered behaviours and experiences of 22 women nursing students, all of whom had children and began university in a heterosexual intimate relationship. The findings reveal traditional ideas of gender were almost universal among participants, and these ideas had a significant influence on the nursing degree experience. Participants commonly prioritised family over the university and practiced maternal gatekeeping (prevention of male partner involvement in domestic work). These traditionally gendered behaviours, coupled with experiences of gender role stress, had a detrimental impact on participants' capacity to study and their personal wellbeing. The importance of these findings to the burgeoning nursing workforce shortage nursing is considered in terms of student retention and the supply of graduates into the profession. The implications to the nursing profession are also explored against the evidence that nursing students with traditional gender beliefs are less likely to develop as autonomous, critical thinking nurses compared to their gender-egalitarian peers. The introduction of gender theory via critical pedagogy in the undergraduate nursing degree curriculum is recommended to enlighten and empower women nursing students and promote the competence, agility, and sustainability of the nursing profession.

Serious games for health promotion in adolescents - a systematic scoping review.

Digital gaming has broad appeal globally, with a reported 2.7 billion gamers worldwide. There is significant interest in using games to enhance learning, with 'serious games' being included in classrooms to engage adolescents' learning across a range of domains. A systematic scoping review of serious games used for health promotion with adolescents was conducted to identify serious games, review the methods used to evaluate these games, and outline evidence available to support the efficacy of these games in improving knowledge, beliefs/attitudes and behaviours in the target groups. Player engagement/enjoyment was reported if assessed. A total of 21 studies were found to have met the inclusion criteria domains: 'healthy lifestyle' 'sexual health' and 'substance use'. A heterogenous approach across studies to game design and development, duration of game play, use of a control group and measurement of outcome(s) was observed. Game efficacy was difficult to assess due to broad generalisations and lack of consistent evaluation methods. Several studies demonstrate serious games can be engaging and pedagogically effective as a learning device and behaviour-change agent. Several studies, however, had less rigorous evaluation and lacked longer-term follow up. The ability for developers to demonstrate positive short- and long-term impacts of serious games with high-quality evidence is essential to the ongoing acceptance and use of these serious games as part of the school curriculum.

The knowledge, attitudes and beliefs of midwives on the vaccination coverage rates in Perth's Aboriginal children.

BACKGROUND: Midwives are well placed to promote vaccination awareness throughout a women's pregnancy and strengthen childhood vaccination demand following hospital discharge. In Perth, Western Australia, Aboriginal children experience some of the lowest vaccination coverage rates across the nation. To identify factors preventing greater vaccination uptake amongst the target population, a theory-based study was conducted with midwives across two Perth maternity hospitals to explore behavioural attributes, knowledge, attitudes and beliefs surrounding vaccination provision and the vaccines administered to Aboriginal children. METHODS: A purpose-designed questionnaire was distributed to midwives working in two Perth public maternity hospitals. The proximal constructs of The Theory of Planned Behavior were used to frame the questionnaire to enable the barriers to greater vaccination coverage to be identified and behaviourally situated. Descriptive statistics described the demographics of the study sample. Chi-square and the Fisher's exact test were used to identify associations between midwife characteristics and awareness of the coverage rates. Significance was set at α = 0.05. RESULTS: Of the 58 midwives who completed the study questionnaire, 77.2% were unaware of the sub-optimal vaccination coverage in Perth's Aboriginal children. Level of education (p = 0.53) and years worked as a practising midwife (p = 0.47) were not found to be associated with an awareness of the coverage rates. Approximately, 50% of midwives reported some concern over the efficacy of childhood vaccines, 44.4% did not feel confident with their knowledge of vaccines, while 33.3% do not routinely discuss childhood vaccinations with parents prior to hospital discharge. CONCLUSIONS: Key findings in the study identified that a range of educational, leadership and system-based issues are affecting midwives' capacity to play a more substantial role in influencing vaccination coverage in Perth's Aboriginal children.

Early childhood caries, primary caregiver oral health knowledge and behaviours and associated sociological factors in Australia: a systematic scoping review.

BACKGROUND: Early childhood caries disproportionately affects vulnerable groups and remains a leading cause of preventable hospital admissions for Western Australian children. The Western Australia State Oral Health Plan seeks to improve child oral health through universal and targeted health promotion initiatives with primary caregivers. These initiatives require evidence of primary caregiver oral health knowledge and behaviours and baseline data on early childhood caries. The objective of this systematic scoping review was to understand current oral health knowledge and practices of primary caregivers of children aged 0-4 years, identify influential socioecological determinants, and identify data on early childhood caries in the Western Australian context. METHODS: A systematic scoping review framework identified articles published between 2010 and 2021, using Scopus, PubMed, Medline, CINAHL, PsycINFO, selected article reference lists, and oral health websites. The lack of Western Australian specific literature prompted the inclusion of Australia-wide articles. Articles were screened via author consensus, with eight selected. RESULTS: Western Australia and nation-wide data on early childhood caries are limited and mostly dated. WA data from children aged 2-3 years, collected in 2006, suggests the prevalence is 2.9% in this state, with national data of children from 0 to 3 years, collected from 2006 and 2008, suggesting an early childhood caries prevalence of 3.4-8% of children aged 18 months, rising sharply by 36 months of age. Nationally, fewer than half the primary caregivers reported following evidence-based oral health recommendations for their young children. Perceptions of the role of dental services for young children tends to be focussed on treatment, rather than surveillance and prevention. Knowledge of dietary and oral hygiene practices is inconsistent and awareness of the Child Dental Benefit Schedule low. Young children's oral health status is clearly associated with socioecological factors, including socioeconomic status. CONCLUSIONS: Recent early childhood caries data and evidence of primary care-givers' oral health knowledge and behaviours are unavailable in Western Australia, a similar situation exists nationwide. To realise the Western Australian and National Oral Health Plans, research is required to address this knowledge gap.

Incorporating Innovative Simulation Activities Into Campus Lab to Enhance Skill Competence and Critical Thinking of Second-Semester Associate Degree Nursing Students.

Decreasing access to clinical sites, inconsistency in student learning experiences, and lack of faculty have compelled nursing schools to incorporate more simulation into their curricula. Professional organizations, regulating bodies, and schools of nursing support its use. The Nursing 2 Challenge simulation activity was designed to give second-semester nursing students an opportunity to improve skill competence and critical thinking utilizing a systematic, preplanned station rotation format in the safe setting of the nursing campus lab. Each station required the students to apply clinical decision-making and nursing skills to complete interventions aligned with course objectives.

Successful Integration of an Academic Electronic Health Record Into the Curriculum of an Associate Degree Nursing Program.

The use of electronic data management systems is rapidly expanding. Nurses need to be competent in the use of electronic health records (EHRs) and understand their contribution to safe, effective, high quality patient care. Faculty must incorporate learning experiences in the application of EHRs into undergraduate nursing programs in order to adequately prepare students for employment. This article reports the challenges involved in the successful addition of an academic EHR into an existing curriculum.

Reporting and Mapping Research Evidence on Perceptions of Clinical Hypnosis Among the General Population and Patients Receiving Health Care Including Cancer Care: A Scoping Review.

Despite empirical evidence supporting clinical hypnosis for numerous conditions, its utilization in healthcare is limited due to skepticism and misconceptions. This review identifies and maps research on clinical hypnosis perceptions among the general population, healthcare patients, and more specifically patients with cancer. A systematic search following JBI PRISMA ScR guidelines was conducted in EBSCOhost, ProQuest, PubMed, and PMC, resulting in 18 peer-reviewed, English language articles (2000-2023). Most studies employed quantitative methods, which were complemented by some qualitative and one mixed-methods approach. The results found attitudes toward hypnotherapy, especially when administered by licensed professionals, are consistently positive; however, awareness of hypnosis remains low within the healthcare sector, particularly in cancer care. Although hypnotherapy was found to be useful, misinformation, a lack of understanding, and awareness persist. Few studies address the reasons behind people's opinions or focus on integrating hypnotherapy into healthcare. Research investigating hypnosis attitudes in cancer care is scant, necessitating further exploration.

Exploring the Underutilized Potential of Clinical Hypnosis: A Scoping Review of Healthcare Professionals' Perceptions, Knowledge, and Attitudes.

The perceptions, knowledge, and attitudes of healthcare professionals (GPs, oncologists, nurses, midwives and obstetricians, anesthetists, mental health professionals, and other professionals) toward hypnosis are explored in this scoping review. Despite proven effectiveness in various health conditions, the use of hypnosis in healthcare has stagnated, emphasizing a gap between research and practice. Data from 35 studies (1995-2023) were analyzed, revealing predominantly positive attitudes and interest in training. Professionals with more knowledge and experience had favorable attitudes toward hypnosis compared to those with limited exposure or understanding of the practice. The main obstacles were insufficient time and inadequate training. Considering the growing interest in complementary therapies, the need for education in hypnosis for healthcare professionals is highlighted. Barriers to integration require exploration for a focused research agenda supporting knowledge translation and implementation.

Healthcare professionals' perceptions of hypnotherapy in cancer care: Development and validation of a survey.

BACKGROUND AND PURPOSE: Hypnotherapy has shown promise in cancer care for alleviating pain, managing nausea, reducing anxiety and fatigue, and improving overall quality of life. Despite its potential benefits, there remains a significant gap between evidence and clinical practice. One way to bridge this gap is to assess healthcare professionals' perceptions and address them accordingly. While survey tools assessing perceptions in healthcare exist, they often are outdated, lack contemporary focus and specificity to complementary therapies like hypnotherapy, particularly in the context of cancer care. This study aimed to develop, psychometrically evaluate, and pilot a survey designed to assess Australian healthcare professionals' (psychologists, counselors, medical practitioners, and nurses) perceptions of hypnotherapy in cancer care. MATERIALS AND METHODS: A cross-sectional survey was developed to assess healthcare professionals' perceptions of hypnosis/hypnotherapy in cancer care. The survey, informed by a comprehensive literature review, consisted of three sections: (1) demographics, 2) interest, experience and knowledge of hypnosis, and (3) attitudes towards its integration in cancer care. Instrument validation involved an expert panel (n = 5) review for content validity and a pilot study with 89 healthcare professionals for reliability. Internal consistency was measured using Cronbach's alpha and factor analysis. RESULTS: Psychometric analysis demonstrated high internal consistency with a Cronbach's alpha of 0.850. Factor analysis revealed two distinct factors: perceived benefits of hypnotherapy in cancer care (explaining 49.23 % of variance) and concerns/misconceptions about hypnosis (explaining 19.50 % of variance). These factors showed strong item loadings (0.692-0.889 and 0.529-0.850, respectively) and a moderate correlation (r = 0.464). The survey tool proved feasible and applicable with a high completion rate among participants. The survey pilot results highlighted significant knowledge gaps and varying levels of acceptance of hypnotherapy, underscoring the necessity for targeted education and training initiatives. Despite these gaps, there was a notable interest in learning more about hypnotherapy's potential benefits in cancer care. However, limitations to sample diversity and generalizability should be noted, as the vast majority of respondents were female nurses. CONCLUSION: A novel survey tool to evaluate healthcare professionals' perceptions of hypnotherapy in cancer care was developed and tested for its validity and reliability. Results of this study revealed significant knowledge gaps and varied acceptance levels by healthcare professionals to using hypnotherapy in cancer care. We identified respondents have a strong interest in hypnotherapy's potential benefits, highlighting the need for targeted education and suggesting a promising foundation for its future integration into holistic and patient-centered cancer care.

Beyond standard treatment: A qualitative descriptive study of cancer patients' perceptions of hypnotherapy in cancer care.

BACKGROUND AND PURPOSE: Cancer remains a leading cause of death in Australia. The number of new cancer cases diagnosed each year is expected to surpass 200,000 by 2033. This marks a significant increase from about 88,000 cases in 2000 to an estimated 165,000 cases in 2023. Despite advancements in treatment, emotional and psychological challenges in cancer care are often overlooked. This study focuses on hypnotherapy, a complementary therapy recognized for its efficacy for physical and emotional symptoms, yet underutilized in Australian cancer care. The research aims to explore patients' perceptions of hypnotherapy and identify barriers to its integration, contributing to the development of holistic, patient-centered cancer care models. MATERIALS AND METHODS: A qualitative study employing semi-structured interviews was conducted with 14 adult cancer patients (breast, lung, and colorectal) undergoing active treatment, selected through convenience sampling. The interviews were carried out from May 2022 to August 2023, focusing on participants' experiences and attitudes toward hypnotherapy among other complementary and alternative medicine (CAM) therapies. Thematic analysis using Braun and Clarke's six-step framework was applied to the data. RESULTS: Five themes were developed following analysis: 1) emotional roller coaster of cancer diagnosis, 2) participants' perspectives on hypnotherapy among other CAM modalities, 3) hypnotherapy as a psychological vs physiological support, 4) fringe benefits of hypnosis, and 5) the main hurdles: cost and lack of information. Participants expressed a diverse range of experiences and attitudes towards hypnotherapy and CAM, with a strong emphasis on the need for emotional support in cancer care. Although hypnotherapy was recognized for its potential to address both emotional and physical symptoms, its predominant use was for emotional well-being. Participants also highlighted the importance of attitudes and endorsements from healthcare providers in their decision-making process about CAM therapies. CONCLUSION: The study findings emphasize the need for a more integrative and patient-centered approach in cancer care that includes hypnotherapy as a non-pharmacological intervention for physical and particularly emotional support. Healthcare providers should be aware of the potential value of hypnotherapy and consider patient preferences in their recommendations. In addition, addressing the identified barriers could improve the accessibility and integration of hypnotherapy into cancer care protocols in Australia.

Participant Misrepresentation in Online Focus Groups: Red Flags and Proactive Measures.

Covid-19 public health measures prompted a significant increase in online research. This approach has several benefits over face-to-face data-collection methods, including lower cost and wider geographical reach of participants. Yet when the online data-collection instrument is a survey, there are also well-documented drawbacks of participant misrepresentation and related data-authenticity issues. However, the scholarly literature has not looked at participant misrepresentation in online focus-group empirical research. This case study communicates a concerning situation that arose during our research project: dishonest participant behavior threatened the integrity and validity of our data collected through online focus-group sessions as well as e-surveys. We describe the study context, initial red flags alerting us to the issue, subsequent investigations, and implications for research ethics, funding, and data quality. We conclude with a discussion of potential steps to safeguard future online focus-group research against similar issues.

Exploring treatment burden in people with type 2 diabetes mellitus: a thematic analysis in china's primary care settings.

BACKGROUND: Understanding treatment burden is a critical element to the effective management of Type 2 Diabetes Mellitus (T2DM). The current study aims to address the knowledge gap surrounding treatment burden of T2DM from the patient's perspective in China's primary care settings. METHODS: A narrative review informed the creation of an a priori coding structure to identify aspects of T2DM treatment burden. Focus groups were conducted, employing a maximum variation sampling strategy to select participants from diverse sociodemographic backgrounds across urban, suburban, rural, and remote areas in China. Participants included adults with T2DM care in primary care settings for over a year and a Treatment Burden Questionnaire score of 25 or higher. Deductive thematic analysis, guided by the coding structure, facilitated a comprehensive exploration and further development of the conceptual framework of T2DM treatment burden. RESULTS: Four focus groups, each comprising five participants from diverse areas, were conducted. Utilising the Cumulative Complexity Model and Normalisation Process Theory as theoretical underpinnings, the thematic analysis refined the conceptual framework based on the coding structure from the narrative review. Five key themes were refined, encompassing medical information, medication, administration, healthcare system, and lifestyle. Additionally, the financial and time/travel themes merged into a new theme termed "personal resources", illustrating their overlapping within the framework. Participants in these focus groups highlighted challenges in managing medical information, an aspect often underrepresented in prior treatment burden research. The thematic analysis culminated in a finalised conceptual framework, offering a comprehensive understanding of the treatment burden experiences of people with T2DM in China's primary care settings. This framework includes six key constructs, delineating T2DM treatment burden and associated factors, such as antecedents and consequences. CONCLUSIONS: This study provides insights into the treatment burden of T2DM. A conceptual framework was finalised to deepen the understanding of the multifaceted constructs and the nature of treatment burden in people with T2DM. Furthermore, it emphasises the need to tailor T2DM treatment to individual capacities, considering their personal resource allocation and treatment utilisation.

Measuring treatment burden in people with Type 2 Diabetes Mellitus (T2DM): a mixed-methods systematic review.

BACKGROUND: Measuring treatment burden is important for the effective management of Type 2 Diabetes Mellitus (T2DM) care. The purpose of this systematic review was to identify the most robust approach for measuring treatment burden in people with T2DM based on existing evidence. METHODS: Articles from seven databases were retrieved. Qualitative, quantitative, and mixed-methods studies examining treatment burden in adults with T2DM and/or reporting relevant experiences were included. A convergent segregated approach with a mixed-methods design of systematic review was employed, creating a measurement framework in a narrative review for consistent critical appraisal. The quality of included studies was assessed using the Joanna Briggs Institute tool. The measurement properties of the instruments were evaluated using the Consensus based Standards for selection of Health Measurement Instruments (COSMIN) checklist. RESULTS: A total of 21,584 records were screened, and 26 articles were included, comprising 11 quantitative, 11 qualitative, and 4 mixed-methods studies. A thematic analysis of qualitative data extracted from the included articles summarised a measurement framework encompassing seven core and six associated measurements. The core measurements, including financial, medication, administrative, lifestyle, healthcare, time/travel, and medical information burdens, directly reflect the constructs pertinent to the treatment burden of T2DM. In contrast, the associated measurement themes do not directly reflect the burdens or are less substantiated by current evidence. The results of the COSMIN checklist evaluation demonstrated that the Patient Experience with Treatment and Self-management (PETS), Treatment Burden Questionnaire (TBQ), and Multimorbidity Treatment Burden Questionnaire (MTBQ) have robust instrument development processes. These three instruments, with the highest total counts combining the number of themes covered and "positive" ratings in COSMIN evaluation, were in the top tertile stratification, demonstrating superior applicability for measuring T2DM treatment burden. CONCLUSIONS: This systematic review provides evidence for the currently superior option of measuring treatment burden in people with T2DM. It also revealed that most current research was conducted in well-resourced institutions, potentially overlooking variability in under-resourced settings.

What makes a space safe? Consumers' perspectives on a mental health safe space.

The provision of community-based space for people experiencing a mental health crisis is regarded as a favourable alternative to the emergency department. However, the only non-emergency department safe spaces in Western Australia are located within hospitals or hospital grounds. This qualitative study asked mental health consumers in Western Australia with experience of presentation at the emergency department during a mental health crisis to describe what a safe space would look and feel like. Data were collected through focus groups and thematically analysed. The findings present the voices of mental health consumers through the framework of health geography and the therapeutic landscape. These participants articulated important physical and social features of a therapeutic safe space and their symbolism as inclusive, accessible places where they would experience a sense of agency and belonging. Participants also expressed a need for trained peer support within the space to complement the skilled professional mental health team. Participants' experiences of the emergency department during mental health crises were described as contrary to their recovery needs. The research reinforces the need for an alternative to the emergency department for adults who experience mental health crises and provides consumer-led evidence to inform the design and development of a recovery-focused safe space.

Reducing the risk of violence towards remote area nurses: a violence management toolbox.

OBJECTIVE: To explore the knowledge of a panel of experts to develop possible ways of minimising the risk of occupational violence towards remote area nurses. DESIGN: The Delphi method using open-ended questionnaires and an online survey to measure support for suggested control measures. SETTING: Remote area nursing posts across Australia. PARTICIPANTS: A panel of expert remote area nurses (n = 10) from geographically diverse regions. MAIN OUTCOME MEASURE: Identified and described measures with the potential to reduce the risk of violence. RESULTS: A 'toolbox' of strategies was suggested in recognition of the complex nature of occupational violence within the remote health context. Job-specific education included de-escalation techniques, risk assessment and cultural safety training. Professional support included access to counselling and debriefing services. Organisational responsibilities included: adequate staffing to provide backup, policies and procedures and action from management when hazards are identified. Community collaboration with the health service in developing orientation programs, safety plans and addressing violence within the community was also recommended. CONCLUSION: A variety of strategies were identified that could be used to reduce the risk of occupational violence towards remote health care staff. Further development and assessment of this 'toolbox' of strategies is recommended to address the high incidence of violence towards remote health professionals in Australia and overseas.

Dietary Fibre Intervention for Gut Microbiota, Sleep, and Mental Health in Adults with Irritable Bowel Syndrome: A Scoping Review.

Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder affecting 4-5% of the global population. This disorder is associated with gut microbiota, diet, sleep, and mental health. This scoping review therefore aims to map existing research that has administrated fibre-related dietary intervention to IBS individuals and reported outcomes on at least two of the three following themes: gut microbiota, sleep, and mental health. Five digital databases were searched to identify and select papers as per the inclusion and exclusion criteria. Five articles were included in the assessment, where none reported on all three themes or the combination of gut microbiota and sleep. Two studies identified alterations in gut microbiota and mental health with fibre supplementation. The other three studies reported on mental health and sleep outcomes using subjective questionnaires. IBS-related research lacks system biology-type studies targeting gut microbiota, sleep, and mental health in patients undergoing diet intervention. Further IBS research is required to explore how human gut microbiota functions (such as short-chain fatty acids) in sleep and mental health, following the implementation of dietary pattern alteration or component supplementation. Additionally, the application of objective sleep assessments is required in order to detect sleep change with more accuracy and less bias.

Does Fibre-fix provided to people with irritable bowel syndrome who are consuming a low FODMAP diet improve their gut health, gut microbiome, sleep and mental health? A double-blinded, randomised controlled trial.

INTRODUCTION: A diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) is an effective way to reduce gut symptoms in people with irritable bowel syndrome (IBS). This diet reduces the intake of fermentable fibres, leading to changes of the gut microbiota and insufficient fermentation in the large bowel, resulting in reduced production of short-chain fatty acids (SCFAs), such as butyrate, which has unfavourable implications for gut health, sleep and mental health. This study will examine the effect of Fibre-fix, a supplement containing a mix of dietary fibres, on the human gut microbiome composition, fermentative capacity, sleep, quality of life (QOL) and mental health of people with IBS who consume a low FODMAP diet (LFD). METHODS AND ANALYSIS: A randomised, double-blind, placebo-controlled, study design is proposed to examine whether Fibre-fix added to an existing LFD may help modulate gastrointestinal function, improve markers of sleep, mental health and promote QOL in patients with IBS. Participants will provide stool and blood samples, daily bowel symptoms diaries and 3-day diet records. Additionally, they will complete validated questionnaires relating to FODMAP intake, sleep, mental health and QOL before and after a 3-week intervention. Gut health will be assessed via faecal microbiome composition, faecal pH and SCFA levels. Alteration of sleep will be recorded using an actigraphy device worn by all participants over the whole study. Multivariate analysis will be used to examine the gut microbiome and repeated measures Analysis of variance (ANOVA) will be used for dependent variables from questionnaires related to bowel symptoms, stool type, sleep, mental health and QOL to assess the differences between intervention and control groups after adjustment for confounding variables. ETHICS AND DISSEMINATION: Ethics approval was obtained from the Human Research Ethics Committee of Edith Cowan University (2019-00619-YAN). Results will be disseminated in peer-review journal publications, and conference presentations. Participants will be provided with a summary of findings once the study is completed. If Fibre-fix is shown to result in favourable changes in gut microbial composition, SCFA production, sleep and mental well-being without exacerbating symptoms, this will provide additional dietary management options for those with IBS following an LFD. TRIAL REGISTRATION NUMBER: ACTRN12620000032954.

Barriers to vaccination service delivery within general practice: opportunity to make a sustainable difference in Aboriginal child health?

OBJECTIVE: To identify behavioural barriers of service provision within general practice that may be impacting the vaccination coverage rates of Aboriginal children in Perth, Western Australia (WA). METHODS: A purposive developed survey was distributed to 316 general practices across Perth and three key informant interviews were conducted using a mixed-methods approach. RESULTS: Of the surveyed participants (n=101), 67.4% were unaware of the low vaccination coverage in Aboriginal children; 64.8% had not received cultural sensitivity training in their workplace and 46.8% reported having inadequate time to follow up overdue child vaccinations. Opportunistic vaccination was not routinely performed by 30.8% of participants. Key themes identified in the interviews were awareness, inclusion and cultural safety. CONCLUSION: Inadequate awareness of the current rates, in association with a lack of cultural safety training, follow-up and opportunistic practice, may be preventing greater vaccination uptake in Aboriginal children in Perth. Cultural safety is a critical component of the acceptability and accessibility of services; lack of awareness may restrict the development of strategies designed to equitably address low coverage. IMPLICATIONS: The findings of this study provide an opportunity to raise awareness among clinicians in general practice and inform future strategies to equitably deliver targeted vaccination services to Aboriginal children.

Local Challenges and Successes Associated with Transitioning to Sustainable Food System Practices for a West Australian Context: Multi-Sector Stakeholder Perceptions.

Large-scale food system practices have diminished soil and water quality and negatively impacted climate change. Yet, numerous opportunities exist to harness food system practices that will ensure better outcomes for human health and ecosystems. The objective of this study was to consider food Production, Processing, Access and Consumption domains, and for each determine the challenges and successes associated with progressing towards a sustainable food system. A workshop engaging 122 participants including producers, consultants, consumers, educators, funders, scientists, media, government and industry representatives, was conducted in Perth, Western Australia. A thematic analysis of statements (Successes (n = 170) or Challenges (n = 360)) captured, revealed issues of scale, knowledge and education, economics, consumerism, big food, environmental/sustainability, communication, policies and legislation, and technology and innovations. Policy recommendations included greater investment into research in sustainable agriculture (particularly the evidentiary basis for regenerative agriculture), land preservation, and supporting farmers to overcome high infrastructure costs and absorb labour costs. Policy, practice and research recommendations included focusing on an integrated food systems approach with multiple goals, food system actors working collaboratively to reduce challenges and undertaking more research to further the regenerative agriculture evidence.