Experiences of Serving and Ex-Serving Members With the PTSD Coach Australia App: Mixed Methods Study.

BACKGROUND: PTSD Coach Australia is an app for serving and ex-serving defense members and was adapted for the Australian context in 2013 from PTSD Coach, which was created in the United States. OBJECTIVE: This study aimed to provide a user-centered evaluation of the app from the perspective of serving and ex-serving members of the Australian Defence Force. METHODS: Qualitative data were collected in response to questions to participants in 1 of 5 workshops (n=29) or in telephone interviews (n=24). Quantitative data were collected using the user version of Mobile Apps Rating Scale (uMARS). RESULTS: Analysis of the qualitative data demonstrated mixed support for the app. While some people found it extremely useful, especially as an adjunct to therapy, others pointed out limitations and cautioned against the app potentially triggering symptoms in people with PTSD. This perceived risk was usually found to stem from frustration with the app's functionality rather than its content. Participants spoke about the helpful and unhelpful aspects of the app and barriers to its use and made suggestions for improvement. Many participants encouraged its continued use and highlighted the need for it to be promoted more broadly, as many were not aware of it until they were invited to participate in this research. CONCLUSIONS: PTSD Coach Australia was seen in a positive light by some participants, but others thought it had too much text and the potential to trigger a traumatic response in users with PTSD. A need to update the app was also a common comment as was the need to increase awareness of the app's existence.

Organizational change theory: implications for health promotion practice.

Sophisticated understandings of organizational dynamics and processes of organizational change are crucial for the development and success of health promotion initiatives. Theory has a valuable contribution to make in understanding organizational change, for identifying influential factors that should be the focus of change efforts and for selecting the strategies that can be applied to promote change. This article reviews select organizational change models to identify the most pertinent insights for health promotion practitioners. Theoretically derived considerations for practitioners who seek to foster organizational change include the extent to which the initiative is modifiable to fit with the internal context; the amount of time that is allocated to truly institutionalize change; the ability of the agents of change to build short-term success deliberately into their implementation plan; whether or not the shared group experience of action for change is positive or negative and the degree to which agencies that are the intended recipients of change are resourced to focus on internal factors. In reviewing theories of organizational change, the article also addresses strategies for facilitating the adoption of key theoretical insights into the design and implementation of health promotion initiatives in diverse organizational settings. If nothing else, aligning health promotion with organizational change theory promises insights into what it is that health promoters do and the time that it can take to do it effectively.

Overcoming disparities in organized physical activity: findings from Australian community strategies.

Organized physical activity through sport and recreational activities is beneficial for physical and psychosocial well-being and community connectedness. However, many who could gain significantly from this have lower participation, especially the socioeconomically disadvantaged, Indigenous people, culturally diverse communities and people with a disability. This study examined barriers to participation by these underserved groups and the success of strategies for overcoming these used in 22 community projects over 3 years in the VicHealth Participation in Community Sport and Recreation Program, in Victoria, Australia. Each year, in-depth interviews were undertaken with 50-60 activity providers and 30-40 project partners. Major barriers to participation were cost, lack of transport, cultural differences, the environment of sporting groups and inaccessible facilities for people with disabilities. Projects that overcame these selected one or two priority groups, put significant effort into communication and building partnerships with community organizations, provided training to staff and volunteers and created new or modified forms of activity. Strategies were put in place to reduce cost and provide transport, but these did not appear to be sustainable. Many organizations found engaging the underserved was more difficult than anticipated and require information and support about how to develop acceptable, accessible and flexible opportunities for disadvantaged groups. Cost and lack of transport are persistent barriers to participation that need to be addressed by the sport and recreation sector and policy-makers.

Clinicians' perceptions of PTSD Coach Australia.

INTRODUCTION: Applications or "mobile apps" are a potentially important source of assistance for serving and ex-serving Defence members with mental health problems. PTSD Coach Australia is a modified version of an application developed by the US Department of Veteran Affairs. Clinician perceptions of mobile apps are important as they influence the dissemination and adoption of apps. This study aimed to explore the perceptions of PTSD Coach Australia by clinicians with experience in assisting Defence members with mental health problems. METHOD: The study involved two samples of participants who were asked about their perceptions of PTSD Coach Australia. The first involved 33 clinicians who participated in one of five focus groups. The second comprised 30 clinicians who were individually interviewed by telephone. Qualitative responses to questions regarding PTSD Coach Australia were analysed to identify representative themes. Participants in the focus group sample also rated the app on the user version of the Mobile Apps Rating Scale (uMARS). RESULTS: On the uMARS, clinicians rated the mobile app's subjective quality as 'average' to 'good'. Participants generally saw the app as a useful to help track symptoms, improve engagement and help implement strategies between sessions. However, they also expressed concerns with the app not being user-friendly (e.g. too wordy, poor layout/navigation) and having technical issues (freezing or crashing on Android devices). DISCUSSION: PTSD Coach Australia is generally seen as being acceptable and useful by mental health clinicians. However, it is important to include their concerns in future developments of PTSD Coach Australia and similar mobile apps in order to maximize their utilisation in Defence members.

Estimating the number of unlicensed brothels operating in Melbourne.

OBJECTIVE: To estimate the number of unlicensed brothels operating in Melbourne, Australia, and the sexual health of the women working in them. METHODS: Advertisements from Melbourne newspapers published in July 2006 were systematically analysed based on the language used to identify premises likely to be unlicensed brothels. A visit was made to each of the businesses where an address was available. Participating sex workers were tested for Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium and Trichomonas vaginalis using self-collected tampons and polymerase chain reaction. RESULTS: There were 438 advertisements collated, representing 174 separate establishments. Of these, 78 were not considered likely to be brothels. Of the remaining 96, addresses were available for 42 and all of these premises were visited. Thirteen were confirmed as unlicensed brothels. We estimate there were between 13 and 70 unlicensed brothels in Melbourne. Twenty-three women were recruited from four brothels. Only 56% (95% confidence interval (CI) 35-77%) reported having regular sexual health checks and only 13% (95%CI 3-36%) reported prior testing for HIV. Among the 22 women tested, one had chlamydia while another had gonorrhoea, a prevalence of 4.5% (95%CI: 2.3-20.4%) for each infection. CONCLUSIONS: The number of unlicensed brothels in Melbourne is much smaller than is generally believed. Women in the sector are infrequently tested for STIs. IMPLICATIONS: As long as a licensing system persists, promotion of sexual health among women in this sector is likely to face hurdles. Further research is needed into the best model for regulating or not regulating sex industries.