Publications by authors named "Bianca Brijnath"

79 Publications

"The mind may go, but the heart knows": Emotional care by ethnic minority carers of people living with dementia.

Soc Sci Med 2021 Sep 4;285:114294. Epub 2021 Aug 4.

National Ageing Research Institute, Australia; Curtin University, Australia; Monash University, Australia. Electronic address:

Drawing on the sociology of emotions, this article investigates the socially and culturally mediated nature of emotions and emotional care within 93 ethnic minority carers' narratives of dementia care. Adding to the cross-cultural literatures on the sociology of emotions and dementia care respectively, our analysis showed that 'signals' of dementia to family carers were often emotional outbursts of anger by the person with dementia. These displays, in turn, created conflict, and aroused emotions such as shame, anger, and depression among carers. To mitigate these tendencies, carers enacted emotional management, which centered on reducing the gravity of negative emotions felt by the person with dementia, and affording them the social space to maintain a positive disposition. To create this positive emotional space, carers deployed different strategies. Some mobilized medical discourses to diffuse the emotional and moral significance of their relative's behavior and enable emotional distantiation. Others conceived of people with dementia as 'childlike' and requiring their protection from emotional negativity. Although, such efforts work took a toll on carers' emotional energies, it was considered enabling, therapeutic, and integral to care. Such emotional work departs from academic and advocacy efforts that see such behavior as patronizing and infantilizing, and underscores the need for more nuanced discussion around emotions and dementia care in ethnic minority families.
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http://dx.doi.org/10.1016/j.socscimed.2021.114294DOI Listing
September 2021

Implementing work-related Mental health guidelines in general PRacticE (IMPRovE): a protocol for a hybrid III parallel cluster randomised controlled trial.

Implement Sci 2021 08 4;16(1):77. Epub 2021 Aug 4.

Insurance Work and Health Group, Monash University, Melbourne, Australia.

Background: The Clinical Guideline for the Diagnosis and Management of Work-related Mental Health Conditions in General Practice (the Guideline) was published in 2019. The objective of this trial is to implement the Guideline in general practice.

Trial Design: Implementing work-related Mental health conditions in general PRacticE is a hybrid III, parallel cluster randomised controlled trial undertaken in Australia. Its primary aim is to assess the effectiveness of a complex intervention on the implementation of the Guideline in general practice. Secondary aims are to assess patient health and work outcomes, to evaluate the cost-effectiveness of the trial, and to develop a plan for sustainability.

Methods: A total of 86 GP clusters will be randomly allocated either to the intervention arm, where they will receive a complex intervention comprising academic detailing, enrolment in a community of practice and resources, or to the control arm, where they will not receive the intervention. GP guideline concordance will be assessed at baseline and 9 months using virtual simulated patient scenarios. Patients who meet the eligibility criteria (>18years, employed, and receiving care from a participating GP for a suspected or confirmed work-related mental health condition) will be invited to complete surveys about their health and work participation and provide access to their health service use data. Data on health service use and work participation compensation claim data will be combined with measures of guideline concordance and patient outcomes to inform an economic evaluation. A realist evaluation will be conducted to inform the development of a plan for sustainability.

Results: We anticipate that GPs who receive the intervention will have higher guideline concordance than GPs in the control group. We also anticipate that higher concordance will translate to better health and return-to-work outcomes for patients, as well as cost-savings to society.

Conclusions: The trial builds on a body of work defining the role of GPs in compensable injury, exploring their concerns, and developing evidence-based guidelines to address them. Implementation of these guidelines has the potential to deliver improvements in GP care, patient health, and return-to-work outcomes.

Trial Registration: ACTRN12620001163998 , November 2020.
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http://dx.doi.org/10.1186/s13012-021-01146-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8335858PMC
August 2021

Do ethnic patients report longer lung cancer intervals than Anglo-Australian patients?: Findings from a prospective, observational cohort study.

Eur J Cancer Care (Engl) 2021 Jul 26:e13492. Epub 2021 Jul 26.

Department of General Practice and Centre for Cancer Research, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.

Objective: Lung cancer patients from ethnic minorities have poorer outcomes than their Caucasian counterparts. We compared lung cancer intervals between culturally and linguistically diverse (CALD) and Anglo-Australian patients to identify ethnic disparities.

Methods: This was a prospective, observational cohort study comprising a patient survey and reviews of patients' hospital and general practice records. Across three states, 577 (407 Anglo-Australian and 170 CALD) patients were recruited and their hospital records reviewed. The survey was returned by 189 (135 Anglo-Australian and 54 CALD) patients, and a review was completed by general practitioners (GPs) of 99 (76 Anglo-Australian and 23 CALD) patients. Survival and Cox regression analyses were conducted.

Results: CALD patients had longer hospital diagnostic interval [median 30 days, 95% confidence interval (CI) 26-34] than Anglo-Australian patients (median 17, 95% CI 14-20), p = 0.005, hazard ratio (HR) = 1.32 (95% CI 1.09-1.60). This difference persisted after relevant factors were taken into consideration, adjusted HR = 1.26 (95% CI 1.03-1.54, p = 0.022). CALD patients also reported longer prehospital intervals; however, these differences were not statistically significant.

Conclusion: Target interventions need to be developed to address ethnic disparity in hospital diagnostic interval.
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http://dx.doi.org/10.1111/ecc.13492DOI Listing
July 2021

A 7-year trend analysis of the types, characteristics, risk factors, and outcomes of elder abuse in community settings.

J Elder Abuse Negl 2021 Aug-Oct;33(4):270-287. Epub 2021 Jul 18.

National Ageing Research Institute, School of Population and Global Health, The University of Melbourne, School of Nursing and Midwifery, Deakin University, Melbourne, Australia.

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http://dx.doi.org/10.1080/08946566.2021.1954574DOI Listing
July 2021

English Language Proficiency Among Older Migrants in Australia, 2016-2046.

J Int Migr Integr 2021 Jun 11:1-27. Epub 2021 Jun 11.

Demography and Ageing Unit, Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie St, Melbourne, Victoria 3010 Australia.

Australia's population is growing, ageing and exhibiting increasing heterogeneity with respect to birthplace and ethnic composition. Yet, little is understood about the levels of English language proficiency among the next generation of older migrants in Australia. Utilising a modified cohort-component model incorporating detailed language proficiency transition probabilities, we project birthplace populations by levels of English language proficiency to mid-century. Our results show that although Asian-born migrants tend to have lower levels of English proficiency, the majority of older migrants with poor proficiency are currently from a predominantly European background. In the future, we project a strong shift in the population of poor English speakers toward an Asian-born dominance as some European-born migrant groups dwindle in size and cohort flow increases population growth among older Asian migrants. Specifically, most of the population growth among older migrants with poor English proficiency occurs among Chinese and Mainland Southeast Asian migrants. However, we demonstrate that population growth among the total migrant population with poor proficiency is considerably lower than populations with good proficiency or from English-speaking households. Over the projection horizon, the total older migrant population with poor English proficiency increases by under 80,000 compared with an increase of 726,000 with good levels of proficiency and 518,000 in English-speaking households. However, we caution against conflating improved English language proficiency with a policy shift away from ethno-specific aged care services as culture, which is more than language, strongly influences perceptions of quality of aged care.
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http://dx.doi.org/10.1007/s12134-021-00836-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8193169PMC
June 2021

Boundary-crossers: How providers facilitate ethnic minority families' access to dementia services.

J Gerontol B Psychol Sci Soc Sci 2021 Apr 29. Epub 2021 Apr 29.

School of Public Health, Faculty of Health, University of Technology Sydney, Australia.

Background: Providers who work closely with ethnic minority people with dementia and their families are pivotal in helping them access services. However, few studies have examined how these providers actually do this work. Using the concept of 'boundary crossers,' this article investigates the strategies applied by these providers to facilitate access to dementia services for ethnic minority people with dementia and their families.

Methods: Between 2017 and 2020, in-depth video-recorded interviews were conducted with 27 health, aged care, and community service providers working with ethnic minority people living with dementia across Australia. Interviews were conducted in language and in English, then translated and transcribed verbatim. The data were analyzed thematically.

Results: Family and community stigma associated with dementia and extra-familial care were significant barriers to families engaging with services. To overcome these barriers, participants worked at the boundaries of culture and dementia, community and systems, strategically using English and other vernaculars, clinical and cultural terminology, building trust and rapport, and assisting with service navigation to improve access. Concurrently, they were cognizant of familial boundaries and were careful to provide services that were culturally appropriate without supplanting the families' role.

Conclusions: In negotiating cultural, social, and professional boundaries, providers undertake multidimensional and complex work that involves education, advocacy, negotiation, navigation, creativity, and emotional engagement. This work is largely under-valued but offers a model of care that facilitates social and community development as well as service integration across health, aged care, and social services.
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http://dx.doi.org/10.1093/geronb/gbab073DOI Listing
April 2021

Projections of Older European Migrant Populations in Australia, 2016-56.

J Popul Ageing 2021 Jan 19:1-25. Epub 2021 Jan 19.

School of Geography, Faculty of Science, University of Melbourne, Melbourne, Australia.

Many of the European migrant populations which settled in Australia in the three decades after World War Two are now much older, and their aged care and health care needs are changing. While there is a considerable literature on aspects of ageing in many migrant groups (particularly as it pertains to culturally appropriate aged care), little research attention has been given to aspects of ageing and its implications. The aim of this paper is to address this lacuna by presenting projections of Australia's Europe-born older migrant population from 2016 to 2056. The population projections were created by a cohort-component model modified to accommodate multiple birthplace populations. Findings show the older Europe-born population is projected to experience a slight increase over the next few years, reach a peak of just under one million in the early 2030s, and then undergo a gradual decline thereafter. The Europe-born share of Australia's 65+ population will fall, from 25.5% in 2016 to 10% by 2056. Populations born in Western and Southern Europe are likely to decline throughout the projection horizon while, the Northern Europe-born and Ireland-born older populations are projected to grow continually. The populations born in the UK and South Eastern Europe initially grow before decline sets in. To a large extent the future population size of these older migrant groups will be the result of cohort flow. We discuss the implications of the coming demographic changes for government policy and culturally appropriate service provision.
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http://dx.doi.org/10.1007/s12062-020-09319-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7814173PMC
January 2021

End-of-life care for older first-generation migrants: a scoping review.

BMJ Support Palliat Care 2020 Dec 9. Epub 2020 Dec 9.

Division of Social Gerontology, National Ageing Research Institute Inc, Parkville, Victoria, Australia.

Background: The unprecedented scale of contemporary migration across countries over the last decade means that ageing and dying occur in a more globalised, multicultural context. It is therefore essential to explore the end-of-life experiences of older people from migrant backgrounds.

Methods: A scoping review of peer-reviewed articles published in English from 2008 to 2018. Included studies addressed end-of-life preferences, attitudes, values and beliefs of first-generation international migrants who were at least 50 years of age.

Results: Fifteen studies met the inclusion criteria for this review, which addressed six key themes: (1) the reluctance among older migrants and their families to talk about death and dying; (2) difficult communication in patient-clinician relationships; (3) the contrast between collectivistic and individualistic norms and its associated end-of-life preferences; (4) limited health literacy in older adults from migrant backgrounds; (5) experiences with systemic barriers like time pressure, inflexibility of service provision and lack of cultural sensitivity and (6) the need for care providers to appreciate migrants' 'double home experience' and what this means for end-of-life decision-making regarding place of care and place of death.

Discussion: To respond effectively to an increasingly culturally diverse population, healthcare staff, researchers and policymakers need to invest in the provision of culturally sensitive end-of-life care. Areas for improvement include: (a) increased awareness of cultural needs and the role of family members; (b) cultural training for healthcare staff; (c) access to interpreters and translated information and (d) involvement of older migrants in end-of-life discussions, research and policymaking.
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http://dx.doi.org/10.1136/bmjspcare-2020-002617DOI Listing
December 2020

Beyond crisis: Enacted sense-making among ethnic minority carers of people with dementia in Australia.

Dementia (London) 2021 Aug 23;20(6):1910-1924. Epub 2020 Nov 23.

110764National Ageing Research Institute, Australia.

The 'family crisis' narrative is frequently used in dementia studies to explain ethnic minority families' pathways to health and aged care and why there is delayed dementia diagnoses in ethnic minority communities. Such narratives may obscure the family carers' agency in negotiating services and managing personal, social and structural burdens in the lead up to diagnosis. To illuminate agency, this article describes ethnic minority families' pathways to a dementia diagnosis using the concept of sense-making. Three case studies were drawn from 56 video interviews with family carers of older adults with dementia from Chinese, Arab and Indian backgrounds. Interviews were conducted across Australia from February to August 2018, then translated, transcribed and thematically analysed. Findings suggest families did not enter into formal care because of a crisis, instead navigating fragmented systems and conflicting advice to obtain a dementia diagnosis and access to relevant care. This experience was driven by sense-making (a search for plausible explanations) that involved family carers interpreting discrepant cues in changes to the behaviour of the person with dementia over time, managing conflicting (medical) advice about these discrepancies and reinterpreting their relationships with hindsight. The sense-making concept offers a more constructive hermeneutic than the 'family crisis' narrative as it illuminates the agency of carers' in understanding changed behaviours, negotiating services and managing personal, social and structural barriers pre-diagnosis. The concept also demonstrates the need for a multimodal approach to promoting timely diagnosis of dementia in ethnic minority communities through dementia awareness and literacy campaigns as well as initiatives that address structural inequities.
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http://dx.doi.org/10.1177/1471301220975641DOI Listing
August 2021

Changes in refugees' mental health: what can granular analyses show?

Authors:
Bianca Brijnath

Lancet Psychiatry 2021 01 3;8(1):2-3. Epub 2020 Nov 3.

School of Occupational Therapy, Social Work, and Speech Pathology, Curtin University, Perth, WA, Australia; Department of General Practice, Monash University, Melbourne, VIC, Australia; National Ageing Research Institute, Royal Melbourne Hospital, Melbourne, VIC 3050, Australia. Electronic address:

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http://dx.doi.org/10.1016/S2215-0366(20)30470-3DOI Listing
January 2021

Effective implementation approaches for healthy ageing interventions for older people: A rapid review.

Arch Gerontol Geriatr 2021 Jan - Feb;92:104263. Epub 2020 Sep 25.

National Ageing Research Institute, Royal Melbourne Hospital, Royal Park Campus, Gate 4, Building 8, 34-54 Poplar Rd., Parkville, VIC, 3052, Australia; Department of General Practice, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; School of Occupational Therapy, Social Work and Speech Pathology, Faculty of Health Sciences, Curtin University, Perth, Australia. Electronic address:

Background And Objectives: Systematic reviews on healthy ageing interventions have primarily focused on assessing their effectiveness, not the implementation processes underpinning them, and the factors influencing program effectiveness. This has created a knowledge gap about what are effective implementation approaches, and how to scale up such interventions at the population level. Our aim in this rapid review was to synthesise the evidence on implementation of effective healthy ageing interventions, and to identify the factors that influence population-level implementation of these interventions.

Design And Methods: Following the PRISMA checklist, we searched for papers in six databases: Ovid Medline, Ovid Embase, CENTRAL, CINAHL, PsycArticles and PsycINFO. A narrative synthesis was used to summarise the results.

Results: Twenty-nine articles reporting on 21 healthy ageing interventions (studies) were included in the review. The findings show that a wide range of approaches to implementation were used including collaborative partnership, co-design, use of volunteers, person centred-care, and self-directed/professional-led approaches. The key implementation drivers were the use of behavioural change techniques, social interaction, tailoring of interventions, booster sessions, and multi-component and multi-professional team approach to intervention design and delivery.

Conclusion: The effectiveness of healthy ageing interventions is contingent on a number of factors including the type of implementation approaches used, the context in which programs are implemented, and the specific mechanisms that may be at play at the individual older adult level.
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http://dx.doi.org/10.1016/j.archger.2020.104263DOI Listing
February 2021

Defining key questions for clinical practice guidelines: a novel approach for developing clinically relevant questions.

Health Res Policy Syst 2020 Sep 29;18(1):113. Epub 2020 Sep 29.

Department of General Practice, Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, Victoria, 3150, Australia.

Background: There is no standardised protocol for developing clinically relevant guideline questions. We aimed to create such a protocol and to apply it to developing a new guideline.

Methods: We reviewed international guideline manuals and, through consensus, combined steps for developing clinical questions to produce a best-practice protocol that incorporated qualitative research. The protocol was applied to develop clinical questions for a guideline for general practitioners.

Results: A best-practice protocol incorporating qualitative research was created. Using the protocol, we developed 10 clinical questions that spanned diagnosis, management and follow-up.

Conclusions: Guideline developers can apply this protocol to develop clinically relevant guideline questions.
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http://dx.doi.org/10.1186/s12961-020-00628-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7523054PMC
September 2020

Past and projected growth of Australia's older migrant populations.

Genus 2020 5;76(1):20. Epub 2020 Aug 5.

School of Geography, University of Melbourne, Melbourne, Australia.

In recent years, Australia's older population (aged 65 and over) has been growing rapidly, accompanied by a shift in its country of birth composition. Although a great deal of research has been undertaken on past and current aspects of Australia's migrant groups, little attention has been paid to future demographic trends in older populations. The aim of this paper is to examine recent and possible future demographic trends of Australia's migrant populations at the older ages. We present population estimates by country and broad global region of birth from 1996 to 2016, and then new birthplace-specific population projections for the 2016 to 2056 period. Our findings show that substantial growth of the 65+ population will occur in the coming decades, and that the overseas-born will shift from a Europe-born dominance to an Asia-born dominance. Cohort flow (the effect of varying sizes of cohorts moving into the 65+ age group over time) will be the main driver of growth for most older birthplace populations. The shifting demography of Australia's older population signals many policy, planning, service delivery and funding challenges for government and private sector providers. We discuss those related to aged care, health care, language services, the aged care workforce, regulatory frameworks and future research needs in demography and gerontology.
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http://dx.doi.org/10.1186/s41118-020-00091-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7403568PMC
August 2020

What clinical challenges are associated with diagnosing and managing work-related mental health conditions? A qualitative study in general practice.

BMJ Open 2020 08 16;10(8):e037734. Epub 2020 Aug 16.

Department of General Practice, Monash University, Notting Hill, Victoria, Australia.

Objective: When providing care for patients with work-related mental health conditions (MHCs), the general practitioner's (GP) role includes clinical care, patient advocacy and assessment of a patient's ability to work. GPs can experience difficulty representing these competing roles. As clinical guidelines were being developed to assist GPs in providing this care, our aim was to identify the clinical challenges GPs experience when diagnosing and managing patients with work-related MHCs.

Design: Qualitative research.

Setting: This study was conducted in general practice and workers' compensation settings across Australia.

Participants: Twenty-five GPs, seven psychiatrists and nine compensation scheme workers. GPs were eligible to participate if they were actively treating (or treated within the previous three years) patient(s) who had submitted a workers' compensation claim for a MHC. Psychiatrists and compensation scheme workers were eligible to participate if they were active in these roles, as they are best placed to identify additional clinical challenges GPs themselves did not raise.

Method: Participants were invited by letter to participate in qualitative semi-structured telephone interviews. Prior to each interview, participants were asked to reflect on two case vignettes, each depicting a patient's illness trajectory over 12 months. Data were thematically analysed using inductive and deductive techniques and then categorised by stages of clinical reasoning.

Results: Participants reported clinical challenges across four key areas: (1) Diagnosis (identifying appropriate diagnostic tools, determining the severity and work-relatedness of a MHC, and managing the implications of labelling the patient with MHC). (2) Management (determining optimal treatment, recommending work participation). (3) Referral (ambiguity of communication pathways within compensation schemes). (4) Procedure (difficulties navigating compensation systems).

Conclusion: We found that GPs experienced clinical challenges at all stages of care for people with work-related MHCs. We were also able to identify systemic and procedural issues that influence a GP's ability to provide care for patients with work-related MHCs.
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http://dx.doi.org/10.1136/bmjopen-2020-037734DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7430442PMC
August 2020

Investigating the Impacts of Acculturation Stress on Migrant Care Workers in Australian Residential Aged Care Facilities.

J Transcult Nurs 2021 07 10;32(4):389-398. Epub 2020 Aug 10.

Curtin University, Bentley, Western Australia, Australia.

Introduction: Migrant care workers are a growing portion of the aged care workforce in high-income countries. This study investigated the impacts of acculturation stress on the well-being of migrant care workers.

Method: A cross-sectional national survey was conducted among migrant care workers ( = 272) across five Australian states and one territory using the Riverside Acculturation Stress Inventory (RASI) and Depression Anxiety Stress Scale (DASS 21).

Results: Acculturation stress was high ( = 38.4; = 14.1; 38.9% scored ≥40 out of 75), but respondents scored in the normal to mild ranges (85% to 93%) on the DASS 21 scale. Enrolled and registered nurses had the highest acculturation stress levels when compared with other occupational roles. Ethnicity, (4, 254) = 11.0, < .001; occupational roles, (3, 254) = 3.0, = .03; and self-reported English proficiency, (1, 254) = 4.17, = .04, were statistically significant.

Conclusions: Addressing acculturation stress may improve job satisfaction and retention among migrant care workers.
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http://dx.doi.org/10.1177/1043659620947810DOI Listing
July 2021

Discrimination reported by older adults living with mental health conditions: types, contexts and association with healthcare barriers.

Soc Psychiatry Psychiatr Epidemiol 2021 Jun 21;56(6):1003-1014. Epub 2020 Jul 21.

Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.

Objective: Australian policy-making needs better information on the prevalence, context and types of discrimination reported by people living with mental health conditions and the association of exposure to discrimination with experiencing a barrier to accessing healthcare.

Methods: Secondary data analysis using the national representative General Social Survey 2014 to examine discrimination and healthcare barriers. Multivariable logistic regression was used to examine the association between discrimination and barriers to healthcare.

Results: Around 10% of older adults without mental health conditions reported an instance of discrimination in the last 12 months, compared to 22-25% of those with mental health conditions. Approximately 20% with mental health conditions attributed discrimination to their health conditions, along with other characteristics including age. Discrimination was reported in settings important to human capital (e.g., healthcare, workplace), but also in general social and public contexts. Everyday discrimination (OR = 2.11 p < 0.001), discrimination in healthcare (OR = 2.92 p < 0.001), and discrimination attributed to the person's health condition (OR = 1.99 p < 0.05) increased the odds of experiencing a barrier to care two-to-three-fold. For each type of discrimination reported (e.g., racism, ageism etc.), the odds of experiencing a barrier to care increased 1.3 times (OR = 1.29 p < 0.01).

Conclusion: This new population-level evidence shows older adults with mental health conditions are experiencing discrimination at more than twofold compared to those without mental health conditions. Discrimination was associated with preventing or delaying healthcare access. These findings indicate that future strategies to promote mental healthcare in underserved groups of older people will need to be multidimensional and consideration given to address discrimination.
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http://dx.doi.org/10.1007/s00127-020-01914-9DOI Listing
June 2021

Psychological distress among migrant groups in Australia: results from the 2015 National Health Survey.

Soc Psychiatry Psychiatr Epidemiol 2020 Apr 28;55(4):467-475. Epub 2019 Oct 28.

Melbourne School of Population and Global Health, University of Melbourne, Melbourne, 3053, Australia.

Purpose: To understand the relationship between migration and psychological distress, we (a) calculated the prevalence of psychological distress in specific migrant groups, and (b) examined the association between specific birth groups and psychological distress, while controlling for confounding variables to understand vulnerabilities across migrant groups.

Methods: The prevalence of psychological distress, disaggregated by birthplace, was calculated using data from the Australian 2015 National Health Survey, which measures psychological distress via the Kessler Screening Scale for Psychological Distress (K10). Multivariable logistic regression models, with adjustments for complex survey design, were fitted to examine the association between country of birth and psychological distress once extensive controls for demographic, and socioeconomics factors were included.

Results: 14,466 individuals ≥ 18 years completed the K10. Migrants from Italy (20.7%), Greece (20.4%), Southern and Eastern European (18.2%), and North African and Middle Eastern (21.9%) countries had higher prevalence estimates of distress compared to Australian born (12.4%) or those born in the United Kingdom (UK) (9.5%)-the largest migrant group in Australia. After adjusting for demographics, SES factors, duration in Australia, a birthplace in Italy (OR = 2.79 95% CI 1.4, 5.7), Greece (OR = 2.46 95% CI 1.1, 5.5), India (OR = 2.28 95% CI 1.3, 3.9), Southern and Eastern Europe (excluding Greece and Italy) (OR = 2.43 95% CI 1.5, 3.9), North Africa and the Middle East (OR = 3.39 95% CI 1.9, 6.2) was associated with increased odds of distress relative to those born in the UK.

Conclusions: Illuminating variability in prevalence of psychological distress across migrant communities, highlights vulnerabilities in particular migrant groups, which have not previously been described. Identifying such communities can aid mental health policy-makers and service providers provide targeted culturally appropriate care.
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http://dx.doi.org/10.1007/s00127-019-01782-yDOI Listing
April 2020

Advancing methodologies to increase end-user engagement with complex interventions: The case of co-designing the Australian elder abuse screening instrument (AuSI).

J Elder Abuse Negl 2019 Aug-Dec;31(4-5):325-339. Epub 2019 Oct 24.

National Ageing Research Institute, Melbourne, Australia.

In Australia there is an absence of an elder abuse screening instrument that is widely accepted and that has been designed with, and for, end-users. This study aimed to develop an effective and acceptable elder abuse screening instrument by engaging with frontline professionals through a co-design process. To date, co-design methodologies are recommended to ensure successful adoption and implementation of complex interventions by end-users, but the scholarship is limited on the specific steps to achieve this as well as the pragmatics of such work. Addressing this lacunae, results demonstrate how qualitative methods align with a co-design approach; underscore the importance of multidisciplinary perspectives; showcase how to streamline complex processes into routine practice; and accentuate the importance of good design. These are valuable insights necessary to develop inter-professional and community-based solutions to the challenge of elder abuse.
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http://dx.doi.org/10.1080/08946566.2019.1682098DOI Listing
June 2020

Including ethnic and cultural diversity in dementia research.

Med J Aust 2019 10 27;211(8):345-346.e1. Epub 2019 Sep 27.

National Ageing Research Institute, Melbourne, VIC.

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http://dx.doi.org/10.5694/mja2.50353DOI Listing
October 2019

A New Plea to Focus on the End-of-Life Needs of People with Severe Mental Illnesses.

Issues Ment Health Nurs 2019 Sep 19;40(9):827-828. Epub 2019 Jul 19.

National Ageing Research Institute , Melbourne , Australia.

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http://dx.doi.org/10.1080/01612840.2019.1630536DOI Listing
September 2019

Diagnosing and managing work-related mental health conditions in general practice: new Australian clinical practice guidelines.

Med J Aust 2019 07 24;211(2):76-81. Epub 2019 Jun 24.

Comcare, Melbourne, VIC.

Introduction: In Australia, mental health conditions (MHCs) arising from workplace factors are a leading cause of long term work incapacity and absenteeism. While most patients are treated in general practice, general practitioners report several challenges associated with diagnosing and managing workplace MHCs. This guideline, approved by the National Health and Medical Research Council and endorsed by the Royal Australian College of General Practitioners and the Australian College of Rural and Remote Medicine, is the first internationally to address the clinical complexities associated with diagnosing and managing work-related MHCs in general practice.

Main Recommendations: Our 11 evidence-based recommendations and 19 consensus-based statements aim to assist GPs with: the assessment of symptoms and diagnosis of a work-related MHC; the early identification of an MHC that develops as a comorbid or secondary condition after an initial workplace injury; determining if an MHC has arisen as a result of work factors; managing a work-related MHC to improve personal recovery or return to work; determining if a patient can work in some capacity; communicating with the patient's workplace; and managing a work-related MHC that is not improving as anticipated.

Changes In Management As Result Of The Guideline: This guideline will enhance care and improve health outcomes by encouraging: the use of appropriate tools to assist the diagnosis and determine the severity of MHCs; consideration of factors that can lead to the development of an MHC after a workplace injury; more comprehensive clinical assessments; the use of existing high quality guidelines to inform the clinical management of MHCs; consideration of a patient's capacity to work; appropriate communication with the workplace; and collaboration with other health professionals.
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http://dx.doi.org/10.5694/mja2.50240DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6852433PMC
July 2019

The symbolic mediation of patient trust: Transnational health-seeking among Indian-Australians.

Soc Sci Med 2019 08 8;235:112359. Epub 2019 Jun 8.

National Ageing Research Institute, Parkville, VIC, Australia; School of Occupational Therapy and Social Work, Curtin University, WA, Australia; Department of General Practice, Monash University, Clayton, VIC, Australia. Electronic address:

This article explores whether this extension of treatment and medication possibilities, owing to greater transnational movement of goods and people, presents increasing challenges for maintaining patients' trust within nationally-bound healthcare systems, such as in Australia. We ran focus groups in Melbourne from June 2012 to June 2013 with 34 Indian migrants to Australia. Our findings illustrate discrepancies between the symbolic mediation of trust within Indian and Australian healthcare encounters. We find that Indian participants associated authoritative and decisive self-presentation by doctors with medical competence, conflicting with Western patient choice models which exalt patient autonomy and agency. We also find that trust in Indian healthcare encounters is mediated through the symbolic deployment of "strong medication" and the engendering of "hope" in patients. Australian doctors' failure to deploy these symbols in the same way contributes to distrust that Indian participants express towards Australian health professionals and healthcare systems. We conclude that in situations where patients have less familiarity with the symbolic repertoire shared by the majority of users of a national healthcare system, such as can be the case with recent migrants, difficulties and misunderstandings may arise in negotiating trust, providing a potential motivator for seeking alternatives transnationally.
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http://dx.doi.org/10.1016/j.socscimed.2019.112359DOI Listing
August 2019

A Scoping Review of Dementia Care Experiences in Migrant Aged Care Workforce.

Gerontologist 2020 02;60(2):e105-e116

National Ageing Research Institute (NARI), Royal Melbourne Hospital, Parkville, Victoria, Australia.

Background And Objectives: In high-income countries, an increasing number of people living with dementia in residential aged care facilities are being cared for by an increasingly multicultural workforce. The purpose of this review was to investigate migrant aged care workers' dementia care experiences and to identify enablers and challenges that influence their retention.

Research Design And Methods: Utilizing Arksey and O' Malley's approach, PubMed, Scopus, CINAHL, Web of Science, and EMBASE were searched for peer-reviewed studies published from 2000 to November 2018. Selection criteria were studies with original research, focusing on dementia care among migrant aged care workers, and conducted in high-income countries.

Results: Seventeen articles were identified incorporating 13 (76.47%) qualitative, 1 (5.88%) quantitative, and 3 (17.65%) mixed method designs. A limited understanding of dementia and experiences of dementia care were reported among some migrant care workers in residential aged care facilities. The identified enablers to retention were the availability of organization support services; professional development opportunities; reciprocity and mutual respect between migrant care workers, care recipients, and coworkers; and good working conditions. Factors such as discrimination from care recipients and coworkers and limited understanding of workplace culture were identified as barriers to migrant care workforce retention.

Discussion And Implications: Migrant care workers are valuable contributors to the aged care workforce. It is important to consider their cultural perceptions of dementia in relation to care provision. In addition, their exposure to occupational psychosocial risk factors in conjunction with the challenges associated with resettlement and dementia care needs to be addressed.
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http://dx.doi.org/10.1093/geront/gnz027DOI Listing
February 2020

Visibility and transmission: complexities around promoting hand hygiene in young children - a qualitative study.

BMC Public Health 2019 Apr 11;19(1):398. Epub 2019 Apr 11.

National Ageing Research Institute LTD, 34-54 Poplar Road, Parkville, VIC, 3052, Australia.

Background: Effective hand hygiene practice can reduce transmission of diseases such as respiratory tract infections (RTIs) and gastrointestinal infections, especially in young children. While hand hygiene has been widely promoted within Australia, primary care providers' (PCPs) and parents' understanding of hand hygiene importance, and their views on hand hygiene in reducing transmission of diseases in the community are unclear. Therefore, the aim of this study was to explore the views of PCPs and parents of young children on their knowledge and practice of hand hygiene in disease transmission.

Methods: Using a cross-sectional qualitative research design, we conducted 30 in-depth interviews with PCPs and five focus groups with parents (n = 50) between June 2014 and July 2015 in Melbourne, Australia. Data were thematically analysed.

Results: Participants agreed that hand hygiene practice was important in reducing disease transmissions. However, barriers such as variations of hand hygiene habits, relating visibility to transmission; concerns around young children being obsessed with washing hands; children already being 'too clean' and the need to build their immunity through exposure to dirt; and scepticism that hand hygiene practice was achievable in young children, all hindered participants' motivation to develop good hand hygiene behaviour in young children.

Conclusion: Despite the established benefits of hand hygiene, sustained efforts are needed to ensure its uptake in routine care. To overcome the barriers identified in this study a multifaceted intervention is needed that includes teaching young children good hand hygiene habits, PCPs prompting parents and young children to practice hand hygiene when coming for an RTI consultation, reassuring parents that effective hand hygiene practice will not lead to abnormal psychological behaviour in their children, and community health promotion education campaigns.
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http://dx.doi.org/10.1186/s12889-019-6729-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6460784PMC
April 2019

Dissonant views - GPs' and parents' perspectives on antibiotic prescribing for young children with respiratory tract infections.

BMC Fam Pract 2019 03 28;20(1):46. Epub 2019 Mar 28.

National Ageing Research Institute LTD, 34-54 Poplar Road, Parkville, VIC, 3052, Australia.

Background: Antibiotics are not recommended for treating uncomplicated respiratory tract infections (RTIs), despite this, antibiotic prescribing for this is widespread. General practitioners (GPs) report parental pressure and fear of losing patients if they do not prescribe antibiotics, however, parental views on antibiotics for RTIs are unclear. Therefore, this study examined GPs' and parents' perceptions regarding antibiotic prescribing for RTIs in young children.

Methods: We conducted semi-structured interviews with 20 GPs, and a survey and focus groups with 50 parents and carers of children under the age of five between June 2014 and July 2015 in Melbourne, Australia. Qualitative data were thematically analysed using NVivo and quantitative data were analysed using SPSS.

Results: GPs believed that parents expect antibiotics for RTIs and were more likely to prescribe them if parents were insistent. They believed parents would go elsewhere if they did not prescribe antibiotics. GPs suggested that there would be less conflict if parents were better educated on appropriate antibiotics use. In contrast, parents demonstrated good knowledge of RTIs and appropriate antibiotic use. Their main expectation from GPs was to obtain a diagnosis, discuss management, and receive reassurance that the illness was not serious. Parental satisfaction with GPs was not dependent on receiving antibiotics (r = 0.658, p < 0.001), and they would not seek another GP if antibiotics were not prescribed (r = 0.655, p < 0.001).

Conclusion: GPs and parents have dissonant views on antibiotic prescribing for RTI in young children. GPs perceived parents wanting a diagnosis and reassurance that their child is not severely ill as pressure to prescribe antibiotic. To overcome these barriers, targeted training for both GPs and parents to improve communication and reassurance that satisfaction is not related to receiving antibiotics may reduce unnecessary antibiotic prescribing for RTI in young children.
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http://dx.doi.org/10.1186/s12875-019-0936-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6437946PMC
March 2019

Australian General Practitioners' and Compensable Patients: Factors Affecting Claim Management and Return to Work.

J Occup Rehabil 2019 12;29(4):672-678

Insurance Work and Health Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, 3004, Australia.

Purpose General Practitioners (GPs) play an important role in personal injury compensation systems yet system processes have been perceived as burdensome. Objectives were to (1) determine attitudes of Australian GPs on health benefits of return to work (RTW) after injury/illness and (2) identify associations between GP characteristics and agreement with issues surrounding treating compensable patients. Methods Cross-sectional postal survey of 423 Australian GPs to determine agreement with issues associated with compensable patients (including patient advocacy, conflicting opinions between GPs and compensation systems, fitness-for-work certification, and refusal to treat). Results The vast majority of GPs agreed there was a health benefit to early RTW. GPs with 16-20 years' experience had significantly higher odds of agreeing that the certificate of work capacity is the primary method of communication between RTW stakeholders (OR 2.36 [1.13-4.92]) than those with greater experience. 49% of GPs agreed they should be able to refuse to treat compensable patients. Female GPs had significantly lower odds (OR 0.60 [0.40-0.90]) of agreeing with right to refuse than male GPs, as did those from remote or regional practices (OR 0.43 [0.20-0.94]; OR 0.60 [0.39-0.92]) than GPs from urban practices. Conclusions Reducing administrative barriers identified by Australian GPs and improving communication with compensation systems will likely have a positive impact on their refusal to treat compensable patients.
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http://dx.doi.org/10.1007/s10926-019-09828-3DOI Listing
December 2019

"Build Rapport, Otherwise No Screening Tools in the World Are Going to Help": Frontline Service Providers' Views on Current Screening Tools for Elder Abuse.

Gerontologist 2020 04;60(3):472-482

National Ageing Research Institute, Parkville, Victoria, Western Australia.

Background And Objectives: Without an effective screening tool, accompanied by clear guidelines of what to do when elder abuse is suspected, health workers may face challenges when asking questions about elder abuse. This study aimed to find the most effective and acceptable existing elder abuse screening tool and to create guidelines for using the tool.

Research Design And Methods: A rapid review of the literature identified existing validated elder abuse screening tools. Then, 5 tools (Vulnerability to Abuse Screening Scale [VASS], Elder Abuse Suspicion Index [EASI], Elder Assessment Instrument [EAI], Caregiver Abuse Screen [CASE], and Brief Abuse Screen for the Elderly [BASE]), selected based on their internal rigor, were presented to health professionals to assess the tools' relevance to their practice. Three focus groups were held with 23 health professionals in Victoria, Australia, in 2017. Data were thematically analyzed.

Results: None of the tools were deemed suitable by participants for use in their practice. Criticisms of the tools included: using outdated terminology, asking binary questions, asking multiple questions at once, failure to consider the older person's cognitive status, failure to consider how culture mediates elder abuse, and failure to outline a referral pathway to those administering the tool. Participants emphasized that the screening tool must promote trust and rapport between the assessor and the older person to solicit a story on this sensitive subject.

Discussion And Implications: A successful elder abuse screening tool must be concise, easy to use, account for the older person's health and social vulnerabilities, and outline a referral pathway if elder abuse is suspected.
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http://dx.doi.org/10.1093/geront/gny166DOI Listing
April 2020

The LEAD study protocol: a mixed-method cohort study evaluating the lung cancer diagnostic and pre-treatment pathways of patients from Culturally and Linguistically Diverse (CALD) backgrounds compared to patients from Anglo-Australian backgrounds.

BMC Cancer 2018 Jul 21;18(1):754. Epub 2018 Jul 21.

Department of General Practice and Centre for Cancer Research, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Carlton, Australia.

Background: Lung cancer is the leading cause of cancer mortality worldwide. Early diagnosis and treatment is a key factor in reducing mortality and improving patient outcomes. To achieve this, it is important to understand the diagnostic pathways of cancer patients. Patients from Culturally and Linguistically Diverse (CALD) are a vulnerable group for lung cancer with higher mortality rates than Caucasian patients. The aim of this study is to explore differences in the lung cancer diagnostic pathways between CALD and Anglo-Australian patients and factors underlying these differences.

Methods: This is a prospective, observational cohort study using a mixed-method approach. Quantitative data regarding time intervals in the lung cancer diagnostic pathways will be gathered via patient surveys, General practitioner (GP) review of general practice records, and case-note analysis of hospital records. Qualitative data will be gathered via structured interviews with lung cancer patients, GPs, and hospital specialists. The study will be conducted in five study sites across three states in Australia. Anglo-Australian patients and patients from five CALD groups (i.e., Arabic, Chinese, Greek, Italian and Vietnamese communities) will mainly be identified through the list of new cases presented at lung multidisciplinary team meetings. For the quantitative component, it is anticipated that 724 patients (362 Anglo-Australian and 362 CALD patients) will be recruited to obtain a final sample of 290 (145 per group) assuming a 50% patient survey completion rate and a 80% GP record review completion rate. For the qualitative component, 60 interviews with lung cancer patients (10 Anglo-Australian and 10 patients per CALD group), 20 interviews with GPs, and 20 interviews with specialists will be conducted.

Discussion: This is the first Australian study to compare the time intervals along the lung cancer diagnostic pathway between CALD and Anglo-Australian patients. The study will also explore the underlying patient, healthcare provider, and health system factors that influence the time intervals in the two groups. This information will improve our understanding of the effect of ethnicity on health outcomes among lung cancer patients and will inform future interventions aimed at early diagnosis and treatment for lung cancer, particularly patients from CALD backgrounds.

Trial Registration: The project was retrospectively registered with Australian New Zealand Clinical Trials Registry (registration number: ACTRN12617000957392 , date registered: 4th July 2017).
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http://dx.doi.org/10.1186/s12885-018-4671-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6054738PMC
July 2018

Agency, activation and compatriots: the influence of social networks on health-seeking behaviours among Sri Lankan migrants and Anglo-Australians with depression.

Sociol Health Illn 2018 11 11;40(8):1376-1390. Epub 2018 Jul 11.

National Ageing Research Institute, Social Gerontology, Victoria, Australia.

The nexus between social networks and illness behaviours is important in uptake of health care, however scant research has explored this relationship in South Asian migrants living with mental illness. We explored the interplay between culture, social networks and health seeking in Sri Lankan migrants and Anglo-Australians living with depression. Forty-eight in-depth interviews were conducted and data were analysed through the theoretical prism of the network episode model. Results showed that social networks were important in negotiating care. Decisions to initiate care occurred along a continuum of choice and agency; some took charge of their care, others were coerced into care, however some Sri Lankan migrants were led through various informal channels of care. Selective activation of compatriots - those perceived to understand mental illness-became increasingly important to participants through their illness careers. Compatriots were considered of greater benefit as participants progressed through depression than otherwise meaningful social networks based on ethnicity, culture and kinship. We argue that the role of social networks is pivotal in uptake of formal care, and engaging with communities to improve responses of social networks to mental illnesses may provide a bottom-up avenue for improving uptake of mental health services in migrant communities.
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http://dx.doi.org/10.1111/1467-9566.12764DOI Listing
November 2018

How do mental health practitioners operationalise cultural competency in everyday practice? A qualitative analysis.

BMC Health Serv Res 2018 06 20;18(1):480. Epub 2018 Jun 20.

Department of General Practice, School of Primary Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Australia.

Background: Despite continued policy and research emphasis to deliver culturally competent mental healthcare, there is: (1) limited evidence about what frontline practitioners consider to be culturally competent care and; (2) what helps or hinders them in delivering such care in their everyday practice. The aims of this article are to address these gaps.

Methods: Qualitative in-depth interviews were conducted with 20 mental health practitioners working with immigrant patients to explore their understandings and experiences of culturally competent care. Interviews were conducted between September 2015 and February 2016 in the state of Victoria, Australia. Data were thematically analysed.

Results: There were common understandings of cultural competence but its operationalisation differed by profession, health setting, locality, and years of experience; urban psychiatrists were more functional in their approach and authoritarian in their communication with patients compared to allied health staff in non-specialist mental health settings, in rural areas, with less years of experience. Different methods of operationalising cultural competence translated into complex ways of building cultural concordance with patients, also influenced by health practitioners' own cultural background and cultural exposures. Limited access to interpreters and organisational apathy remain barriers to promoting cultural competency whereas organisational support, personal motivation, and professional resilience remain critical facilitators to sustaining cultural competency in everyday practice.

Conclusion: While there is need for widespread cultural competence teaching to all mental health professionals, this training must be specific to different professional needs, health settings, and localities of practice (rural or urban). Experiential teaching at tertiary level or professional development programs may provide an avenue to improve the status quo but a 'one-size-fits-all' model is unlikely to work.
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http://dx.doi.org/10.1186/s12913-018-3296-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6011345PMC
June 2018
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