Publications by authors named "Sharon Lawn"

128 Publications

Community treatment orders and care planning: How is engagement and decision-making enacted?

Health Expect 2021 Aug 12. Epub 2021 Aug 12.

College of Medicine and Public Health, Flinders University, Adelaide, Australia.

Background: In many jurisdictions worldwide, individuals with a mental illness may be forced to receive care and treatment in the community. In Australia, legislation states that such care should be driven by a care plan that is recovery-focussed. Key components in the care planning process include engagement and decision-making about a person's support needs and care options, with trust being an essential component of care planning relationships.

Objective: This study examines how these components were enacted during service care contacts for individuals on community treatment orders.

Methods: The study was located at two community mental health teams in South Australia. Ethnographic observations of care planning discussions between consumers, their carers and clinicians, and interviews with individuals from these groups, were conducted over 18 months. Carspecken's critical ethnography provided a rigorous means for examining the data to identify underlying cultural themes that were informing day-to-day care interactions.

Results: Care planning was not occurring as it was intended, with service culture and structures impeding the development of trusting relationships. Clinicians striving to work collaboratively with consumers had to navigate a service bias and culture that emphasized a hierarchy of 'knowing', with consumers assumed to have less knowledge than clinicians.

Conclusions: Services and clinicians can challenge prejudicial ethical injustice and counter this through testimonial justice and implementation of tools and approaches that support genuine shared decision-making.

Patient Or Public Contribution: This study included individuals with lived experience of mental illness, their carers and clinicians as participants and researchers.
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http://dx.doi.org/10.1111/hex.13329DOI Listing
August 2021

Nurse Led Clinics; a Novel Model of Care for Compensated Liver Cirrhosis: A Qualitative Analysis.

Gastroenterol Nurs 2021 Aug 6. Epub 2021 Aug 6.

Jeyamani Ramachandran, PhD, MD, MBBS, DM, FRACP, is Consultant Hepatologist, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia. Sharon Lawn, PhD, is Professor, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia. Matilda Swee Sun Tang, MBBS, is an intern, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia. Anuradha Pati, SACE, is Second-Year Medical Student, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia. Luisa Wigg, IBDP, is Second-Year Medical Student, College of Medicine and Dentistry, James Cook University, Douglas, Queensland, Australia. Rachel Wundke, BNurs, is Clinical Practice Consultant, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia. Rosemary Mccormick, BNurs, is Clinical Practice Consultant, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia. Kate Muller, PhD, FRACP, is Consultant, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia. Billingsley Kaambwa, PhD, is Associate Professor and Head of Health Economics, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia. Richard Woodman, PhD, is Professor, Department of Biostatistics and Epidemiology, Flinders University, Bedford Park, South Australia. Alan Wigg, PhD, FRACP, is Professor and Head, Hepatology and Liver Transplant Unit, Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.

A nurse-led cirrhosis clinic model for management of stable, compensated cirrhotic patients is practised in our unit since 2013, wherein these patients are reviewed every six months by specialist nurses in community clinics under remote supervision of hepatologists. We evaluated the experiences of patients and healthcare providers involved in the model to understand the acceptability, strengths, and limitations of the model and obtain suggestions to improve. A qualitative design using in-depth interviews was employed, followed by thematic analysis of eight patients, one attending physician both nurse and hospital clinics, four hepatologists, and three experienced specialist nurses running the nurse-led cirrhosis clinic. Patients expressed satisfaction and a good understanding of the nurse-led cirrhosis clinic, preferring it to hospital clinics for better accessibility and the unique nurse-patient relationship. Upskilling and provision of professional care in a holistic manner were appreciated by specialist nurses. The hepatologists expressed confidence and satisfaction, although they acknowledged the difference between the medical training of specialist nurses and hepatologists. The greater availability of hospital clinic time for sick patients was welcomed. Increased specialist nurse staffing, regular forums to promote specialist nurse learning, and formalization of the referral process were suggested. No adverse experiences were reported by patients or staff. The nurse-led cirrhosis clinic model for compensated liver cirrhosis was well received by patients, hepatologists, and specialist nurses. Wider implementation of the model could be considered after further investigations in other settings.
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http://dx.doi.org/10.1097/SGA.0000000000000620DOI Listing
August 2021

It.

Aust Health Rev 2021 Jun 24. Epub 2021 Jun 24.

ObjectiveMindStep™ is an Australian low-intensity cognitive behaviour therapy (LICBT) program for individuals with mild-to-moderate symptoms of anxiety and depression. UK-produced LICBT guided self-help (GSH) materials were originally used in the MindStep™ program. In 2017, Australian LICBT GSH materials were developed to better suit Australian users. This study explored whether the Australian-produced materials continued to achieve the benchmark recovery rates established in the UK and maintained in recent Australian studies.MethodsBinomial logistic regression was conducted using retrospective client data, including the Patient Health Questionnaire-9 and the Generalised Anxiety Disorder 7-item scale, between 2016 and 2019.ResultsDuring time periods in which the Australian-produced materials were used, equivalent rates of reliable recovery and improvement were achieved compared with time periods in which the UK-produced materials were used. Australian-trained LICBT coaches, using Australian-produced LICBT GSH materials, achieve client recovery rates of up to 60%, reliable improvement rates of 58% and reliable recovery rates of 46% (with the probability of recovery increasing with client age).ConclusionsThese findings are particularly pertinent with COVID-19 changing the landscape of mental health service delivery, requiring greater flexibility in the use of teleservices to ensure access to effective mental health care for populations that may already experience problems with isolation, access and service engagement.What is known about the topic?LICBT is an acceptable, feasible and effective treatment approach for people experiencing mild-to-moderate anxiety and depression in Australia. LICBT GSH materials used with clients in Australia originated from the UK. However, according to guidelines, LICBT GSH materials should be contextualised to suit the audience they are being used with.What does this paper add?This paper demonstrates that LICBT GSH materials tailored to an Australian context can be used in place of UK-produced materials because they yield equivalent and consistent therapeutic outcomes. Although contextualising the LICBT GSH materials for health services users was important, it is likely that the evidence-based cognitive behaviour therapy techniques sitting 'under the hood' of these materials are most important to ensure successful therapeutic outcomes.What are the implications for practitioners?As we face unprecedented challenges following 2020, the physical, social, psychological and economic impacts of life-changing events must not inhibit access to treatments for common mental health conditions. It is anticipated that more non-traditional, alternative providers of mental health services will be needed to scale-up and respond to increasing demand. This paper shows that the provision of telephone-based LICBT in Australia, by trained coaches using Australian-produced GSH materials, is an evidenced-based support pathway that can reduce the access gap to treatments.
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http://dx.doi.org/10.1071/AH20307DOI Listing
June 2021

Risk versus recovery: Care planning with individuals on community treatment orders.

Int J Ment Health Nurs 2021 Oct 7;30(5):1248-1262. Epub 2021 May 7.

College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia.

Community treatment orders (CTOs) require individuals with a mental illness to accept treatment from mental health services. CTO legislation in South Australia states that treatment and care should be recovery-focused, although justification for use is predominantly risk-based, and care often coercive. Although CTOs are contested, individuals, families, and clinicians frequently engage in care planning within this context. This paper examines how the concepts of risk and risk management impact care planning from the perspectives of individuals on CTOs, their families, and clinicians. Ethnographic methods of observation and interview provided a detailed account of the perspectives of each group over an 18-month period from two community mental health teams in South Australia. Findings show that care planning occurred within a culture of practice dominated by risk. Risk, however, was understood differently by each participant group, with the dominant narrative informed by biogenetic understandings of mental illness. This dominance impacted on the positioning of participant groups in care planning, focus of care contacts, and care options available. To improve care experiences and outcomes for individuals on CTOs, narrow conceptualizations of risk and recovery need to broaden to include an understanding of personal and social adversities individuals face. A broader understanding should reposition participants in the care planning context and rebalance care discussions, from a focus on clinical recovery to recovering citizenship.
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http://dx.doi.org/10.1111/inm.12877DOI Listing
October 2021

Tobacco smoking and mental disorders in Australian adolescents.

Aust N Z J Psychiatry 2021 Apr 28:48674211009617. Epub 2021 Apr 28.

School of Psychology and Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.

Objectives: This study aimed to (1) examine the strength of the association between mental disorders/mental health problems, risk behaviours and tobacco smoking among Australian adolescents, (2) compare rates of tobacco smoking among Australian adolescents with major depressive disorder, attention-deficit/hyperactivity disorder and/or conduct disorder in 2013/14 vs 1998, and (3) identify the extent to which an association between tobacco smoking and mental health problems among adolescents can be attributed to non-mental health risk factors.

Methods: The study utilised data from the first (1998) and second (2013/14) child and adolescent components of the National Surveys of Mental Health and Wellbeing. Both surveys identified nationally representative samples of Australian young people aged 4-17 years, living in private dwellings. Information was collected from parents and 13- to 17-year-olds about mental disorders, mental health problems, risk behaviours and tobacco smoking.

Results: In the 2013/14 survey, the rate of current tobacco smoking among those with a mental disorder was 20% compared to 5% in those without a mental disorder. Rates were highest for young people with conduct disorder (50%), major depressive disorder (24%) and anxiety disorders (19%). In 2013/14, 38% of current tobacco smokers had a mental disorder and 32% reported self-harm and/or suicidal ideation vs 10% and 5%, respectively, among adolescents who had never smoked. Females with mental disorders or reporting self-harm or suicidal ideation had higher rates of current smoking than males. Other significant factors associated with current smoking included school-related problems, binge eating and having had more than one sexual partner.

Conclusion: While smoking rates in 13- to 17-year-olds with mental disorders had declined since 1998, the strength of the association between mental disorders and smoking had increased, especially among females. Our findings highlight the need to address the tobacco smoking among adolescents with mental disorders, particularly females.
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http://dx.doi.org/10.1177/00048674211009617DOI Listing
April 2021

Family perspectives on the acceptability and usefulness of the FAB Positive Behaviour Support program: A pilot study.

Brain Inj 2021 04 7;35(5):609-619. Epub 2021 Mar 7.

Discipline of Physiotherapy, Repatriation General Hospital, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.

: This pilot feasibility study aimed to gain preliminary insight into the acceptability and usefulness of the FAB-PBS program for providing behavior support to families following acquired brain injury (ABI) in community settings. The FAB-PBS program is based on a Positive Behavior Support (PBS) framework and principles of Family-Centered Care and Family-Directed Intervention. It consists of an education phase followed by individualized sessions during which the family is supported to develop and implement a PBS plan.: A mixed-methods design was utilized, with feedback obtained from family members via short questionnaires and semi-structured interviews post education phase and individualized sessions, and at three-month follow up.: Two family members completed the full FAB-PBS program and reported high satisfaction with the program and increased confidence in providing behavior support. Findings also suggested an increase in desired behaviors and a decrease in challenging behaviors presented by family members with ABI.: The FAB-PBS program may be an acceptable and feasible approach to increasing the capability of family caregivers in providing behavior support following ABI. Further pilot testing is required to inform the development of a larger feasibility study.
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http://dx.doi.org/10.1080/02699052.2021.1894479DOI Listing
April 2021

Self-reported suboptimal sleep and receipt of sleep assessment and treatment among persons with and without a mental health condition in Australia: a cross sectional study.

BMC Public Health 2021 03 6;21(1):463. Epub 2021 Mar 6.

University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.

Background: Poor sleep and poor mental health go hand in hand and, together, can have an adverse impact on physical health. Given the already disproportionate physical health inequities experienced by people with a mental health condition worldwide, the need to consider and optimise sleep has been highlighted as a means of improving both physical and mental health status. Sleep recommendations recently developed by the United States' National Sleep Foundation incorporate a range of sleep parameters and enable the identification of 'suboptimal' sleep. Among community-dwelling persons with and without a 12-month mental health condition in Australia, this study reports: [1] the prevalence of 'suboptimal' sleep and [2] rates of sleep assessment by a health care clinician/service and receipt of and desire for sleep treatment.

Methods: A descriptive study (N = 1265) was undertaken using self-report data derived from a cross-sectional telephone survey of Australian adults, undertaken in 2017.

Results: Fifteen per cent (n = 184) of participants identified as having a mental health condition in the past 12 months. Across most (7 of 8) sleep parameters, the prevalence of suboptimal sleep was higher among people with a mental health condition, compared to those without (all p < 0.05). The highest prevalence of suboptimal sleep for both groups was seen on measures of sleep duration (36-39% and 17-20% for people with and without a mental health condition, respectively). In terms of sleep assessment and treatment, people with a mental health condition were significantly more likely to: desire treatment (37% versus 16%), have been assessed (38% versus 12%) and have received treatment (30% versus 7%).

Conclusions: The prevalence of suboptimal sleep among persons with a mental health condition in Australia is significantly higher than those without such a condition, and rates of assessment and treatment are low for both groups, but higher for people with a mental health condition. Population health interventions, including those delivered as part of routine health care, addressing suboptimal sleep are needed.
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http://dx.doi.org/10.1186/s12889-021-10504-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7937198PMC
March 2021

Effectiveness of self-management programmes for adolescents with a chronic illness: A systematic review.

J Adv Nurs 2021 Sep 25;77(9):3585-3599. Epub 2021 Feb 25.

Discipline of Child & Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.

Aim: To assess what is known about the effectiveness of face-to-face self-management programmes designed specifically for adolescents (10-19 years) with a chronic illness.

Design: A systematic review and synthesis without meta-analysis (SWiM).

Data Sources: Six international web-based reference libraries were searched with a date range of 1946 to July 2020.

Review Method: The PRISMA statement and SWiM guideline were used for reporting the methods and results. The PICO format was used to develop a focused clinical question and the eligibility criteria of our review. Quality assessment of the included studies was performed using the Cochrane Effective Practice Organisation of Care criteria.

Results: Eight studies (four randomized controlled trials and four descriptive designs) met the inclusion criteria and were published between 2003 and 2017. Results of the review: Three studies demonstrated measures of illness control which showed initial improvements in adherence as a result of the interventions but failed to demonstrate sustained adherence over time. Booster sessions were identified as an effective strategy to improve adherence, but were often omitted.

Conclusions: There is a limited body of evidence on the effectiveness of self-management programmes specifically developed for adolescents with a chronic illness, an important but under researched area. Future research lies in the development of more rigorous studies that focus on quantitative outcome measures for evaluating the effectiveness of self-management programmes to guide the development of future programmes.

Impact: It is crucial for adolescents with a chronic illness to develop independence and the self-management skills required to effectively manage their chronic condition as they transition to adulthood. On current evidence, in planning future self-management interventions should include booster sessions. Nurses with additional training and experience have a key role in supporting adolescents with a chronic illness to develop self-management skills as they assume responsibility for their own healthcare.
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http://dx.doi.org/10.1111/jan.14801DOI Listing
September 2021

Attitudes, Risk Factors, and Behaviours of Gambling among Adolescents and Young People: A Literature Review and Gap Analysis.

Int J Environ Res Public Health 2021 01 22;18(3). Epub 2021 Jan 22.

College of Medicine and Public Health, Flinders University, Adelaide, SA 5042, Australia.

Gambling is occurring in a rapidly changing landscape, with new trends and technologies affecting gambling behaviour and problem gambling across a range of populations. Gambling activity among adolescents and young people has received considerable research attention due to a high prevalence of gambling reported among these groups in recent years. Despite legislation worldwide to constrain gambling among adolescents and young people, modern technology, such as online gaming apps and online gambling venues, has significantly increased their exposure to the risks of problem gambling. It is important, therefore, to have up to date information about what is currently known about gambling and to explore gaps in our knowledge. This gap analysis presents the results of a systematic approach to reviewing the current literature on gambling behaviour, attitudes, and associated risk factors for gambling and problem gambling among adolescents and young adults (aged 10-25 years). The review included studies published between January 2015 and August 2020 and included 85 studies for final synthesis. Findings reveal further research is needed on the implications for young people of emerging technologies and new trends in gambling in the digital age. The current gap analysis reveals that this should include more research on the development and impact of both treatment and intervention strategies, and policy and regulatory frameworks from a public health perspective.
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http://dx.doi.org/10.3390/ijerph18030984DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7908209PMC
January 2021

Structural stigma and its impact on healthcare for consumers with borderline personality disorder: protocol for a scoping review.

Syst Rev 2021 01 11;10(1):23. Epub 2021 Jan 11.

The Royal Melbourne Hospital, Parkville, Victoria, 3050, Australia.

Background: Structural stigma in health systems experienced by consumers diagnosed with Borderline Personality Disorder (BPD) is a widespread phenomenon that causes major health inequities and harm for this population. Structural stigma in this context relates to institutional policies, cultural norms, and organizational practices that limit consumers' access to health services, quality of care, and capacity to achieve optimal health and well-being. BPD is a serious mental illness with high morbidity and mortality, characterized by instability in interpersonal relationships, self-image, and emotional and behavioral deregulation, which stem from significant traumatic childhood/life events, and/or biological etiologies. The objectives of this scoping review are to explore the international literature on structural stigma in healthcare systems specific to BPD, and to provide an overview of the impact of structural stigma on health services for BPD consumers and their carers/families.

Methods: This scoping review will follow the Joanna Briggs Institute (JBI) scoping review guidelines. We will search the following electronic databases (from inception onwards): MEDLINE, CINAHL, PsycINFO, Scopus, Cochrane Library, and JBI-Evidence databases. Grey literature will be identified through the Google search engine. We will include all types of literature in English, published and unpublished, including any study design, reviews, clinical practice guidelines, policy reports, and other documents. No restrictions on publication date of sources of evidence will be applied. International literature should examine structural stigma associated with BPD in any healthcare setting such as, outpatients, inpatients, primary health care, or community-based facilities. Two reviewers will independently screen all titles, abstracts, and full-text citations. Quality appraisal of the included sources of evidence will be assessed using the Mixed Methods Appraisal Tool (MMAT) 2018 version. Data analysis will involve quantitative (e.g., frequencies) and qualitative (e.g., thematic analysis) methods.

Discussion: This review is anticipated to enhance both identification and understanding of those structures in health systems (i.e., institutional policies, cultural norms, and practices) that manifest and perpetuate stigma experienced by consumers with BPD and their carers/families. The findings can be used to inform future research, policy, and practice relating to stigma reduction strategies that can be adopted to improve the provision of BPD-responsive services and care for this population.

Systematic Review Registration: Open Science Framework ( https://osf.io/bhpg4 ).
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http://dx.doi.org/10.1186/s13643-021-01580-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7798332PMC
January 2021

The use of pasung for people with mental illness: a systematic review and narrative synthesis.

Int J Ment Health Syst 2020 Dec 7;14(1):90. Epub 2020 Dec 7.

College of Medicine and Public Health, Flinders University, PO Box 2100, Adelaide, South Australia, 5001, Australia.

Background: Pasung is the term used in Indonesia and a number of other countries for seclusion and restraint of people with mental illness in the community, usually at home by their family. While pasung has been banned because it is contrary to human rights, its practice continues to exist within the community, particularly where community mental health services are limited, and in the absence of adequate social support, and pervasive negatives beliefs about mental illness. It is essential to understand the reasons for the ongoing use of pasung and to examine potential solutions.

Methods: A systematic review and narrative synthesis of peer-reviewed international literature was conducted to identify the socio-cultural contexts for pasung use, and interventions to address it. The analysis draws on the socio-ecological framework, which focused on relationships between the individual and their environment.

Result: Fifty published articles were included in the review; all studies were conducted in Asia and Africa, with 32 undertaken in Indonesia. Most studies were qualitative (n = 21). Others included one case-control study, one cross-sectional study, and seven surveys; only four studies examined the application of an intervention, and each used a pre and post methodology. Of these, two studies tested psychoeducational interventions which aimed to overcome family burden due to pasung, and each suggested a community mental health approach. The remaining two studies evaluated the intervention of 'unlocking'; one study used a community-based culturally sensitive approach, and the other used a community-based rehabilitation program. Reasons for pasung given by family appear to be as a last resort and in the absence of other supports to help them care for the person with severe mental illness.

Conclusion: The findings highlight that a mixture of individual, interpersonal, community and policy interventions are needed to reduce the use of pasung. While consumer and carer involvement as part of a socio-ecological approach is understood to be effective in reducing pasung, an understanding of how to elaborate this in the management of pasung remains elusive. Review Registration CRD42020157543: CRD.
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http://dx.doi.org/10.1186/s13033-020-00424-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7720453PMC
December 2020

Consumer perspective from people with a diagnosis of Borderline Personality Disorder (BPD) on BPD management-How are the Australian NHMRC BPD guidelines faring in practice?

J Psychiatr Ment Health Nurs 2021 Aug 30;28(4):670-681. Epub 2020 Nov 30.

Lived Experience Australia, Marden, SA, Australia.

WHAT IS KNOWN ON THE SUBJECT?: Internationally, stigma towards people with mental illness has reduced due to greater understanding, education and advocacy in the community, and more focus on recovery-oriented care within practice guidelines. However, many people with a diagnosis of BPD continue to experience stigma and difficulty accessing health services. Contributing factors include lack of understanding of BPD and effective management by health professionals, stigma from the general population and within healthcare services, and financial and geographical barriers. Mental health nurses comprise a large part of the healthcare workforce responsible for the day-to-day care of people diagnosed with BPD. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: This paper investigates how Australian consumer perspectives on BPD management have changed over time. Comments from a large survey, delivered to consumers in 2011 (N = 153) and 2017 (N = 424), were analysed for common themes. Themes were broadly related to NHMRC BPD Guidelines sections released in 2013. These data sets therefore present an opportunity to evaluate changes in consumer perspectives pre- and post-Guideline release. Although no direct causal relationship can be drawn, analysing these changes can potentially assist with understanding the impact of the Guidelines in practice. No such analysis of the Australian Guidelines has been conducted to date in the existing literature. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Many people diagnosed with BPD continue to experience stigma, barriers to treatment and difficulty accessing appropriate services. Widespread practical implementation of the Guidelines was not apparent; however, improved general awareness and understanding of BPD from consumers and health professionals were evident. Improved education and practice across each and all aspects of the Guidelines are indicated. The Guidelines need review to ensure they are in-line with current evidence-based practice, as well as effective health professional education, support and funding to embed the revised Guidelines into practice. ABSTRACT: Introduction Internationally, many individuals diagnosed with BPD continue to experience stigma within health care and are more likely to be viewed as manipulative and evoke negative responses from clinicians, compared with other mental health consumers. Aim/Question To understand Australian consumer perspectives regarding BPD management, and how these have changed between 2011 and 2017. To comment on how NHMRC BPD Guidelines, released 2013, are faring in practice. Method Individuals who identified a BPD diagnosis completed a 75-question survey, delivered online Australia-wide, in 2011 (N = 153) and 2017 (N = 424), providing comparative data sets to evaluate changes in consumer perspective on BPD management. Results Many people diagnosed with BPD experience difficulties when seeking help, stigma within health services and barriers to treatment. Improved general awareness, communication and understanding of BPD from consumers and health professionals were evident. Discussion Consumers demonstrated increased BPD-literacy and help-seeking behaviours in 2017, providing opportunity for health professionals to build stronger therapeutic relationships. Widespread practical implementation of the Guidelines does not appear to have been achieved. More health professional education, updated Guidelines, funding and strategies to embed these Guidelines into practice are needed. Implications for Practice Mental health nurses regularly provide care to people diagnosed with BPD; with practical education and support, they and other health professionals can improve their confidence in practice and provide better quality care to consumers.
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http://dx.doi.org/10.1111/jpm.12714DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8359473PMC
August 2021

Family involvement to support cardiovascular self-management care for people with severe mental illness: a systematic review.

J Ment Health 2020 Sep 14:1-17. Epub 2020 Sep 14.

College of Medicine and Public Health, Flinders University, Bedford Park, Australia.

Background: Family members play a pivotal role in supporting cardiovascular self-management-based care of community-living adults with severe mental illness (SMI). However, little is known about what strategies caregivers employ as part of their caring roles.

Aim: This paper aims to explore what caregiving strategies work (or not), why and how by collating and synthesising existing evidence on this issue.

Methods: A systematic search of peer-reviewed qualitative and mixed-method studies published between 2000 and 2019 was employed. This comprehensive process generated only nine papers for subsequent meta-synthesis of qualitative data.

Results: Findings suggested that caregivers have a complex yet comprehensive role to play in initiating and perpetuating self-management-based cardiovascular care. The elements of recovery such as promoting hope, normality, autonomy and identity were flagged as critical underpinning factors that motivated the person with SMI to adopt a healthy lifestyle. However, it was evident that caregivers needed to walk alongside the person, at times, to help them reach their maximum potential in sustaining improved self-management behaviours.

Conclusion: Caregivers sit in a favourable bridging position between healthcare systems and community-living individuals with SMI, to support their cardiovascular health. However, this powerful but invisible 'workforce' clearly needs further support involving finance, skill-development and acknowledgement.
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http://dx.doi.org/10.1080/09638237.2020.1818194DOI Listing
September 2020

Implementing national mental health carer partnership standards in South Australia.

Aust Health Rev 2020 Dec;44(6):880-890

Lived Experience Australia (formerly Private Mental Health Consumer Carer Network (Australia)), PO Box 542, Marden, SA 5070, Australia. Email:

Objective The aim of this study was to describe the current state of carer engagement and partnership in two mental health (MH) services in South Australia and the implementation of the six partnership standards in A Practical Guide to Working with Carers of People with a Mental Illness. Methods Anonymous surveys of carer experiences and clinician self-ratings of their own practice against the six partnership standards were completed by 94 staff and 58 carers within public and private MH in-patient units before and after exposure of clinicians to education about the partnership standards. Descriptive statistical analysis was performed and, where applicable, a comparative analysis used the two-sample Z-test of proportions. Qualitative data was analysed thematically. Results Considerable gaps were evident between carer experiences and clinician self-ratings of their own practice. Overall, the surveys point to the lack of a consistent approach by both public and private services, and suggest potential barriers to fostering carer participation and engagement. Confidentiality was a particularly noted barrier to partnership with carers. Conclusion Significant improvement is needed to meet the partnership standards. Brief exposure to the Guide is not, in itself, sufficient to effect change in the overall attitudes, skills and knowledge of clinical staff about engaging carers. Significantly more focus on staff education, clinical discussions and supervision is needed to meet the MH carer partnership standards. What is known about the topic? Partnership with MH consumers and carers is an established key principle within national MH policies and accreditation standards. Family carers play an important role in supporting consumers' recovery, yet many carers continue to report being excluded, particularly by in-patient clinical staff. What does this paper add? This is the first study to investigate the partnership standards in practice by comparing the perspectives of carers and in-patient MH clinical staff. What are the implications for practitioners? Improving partnership with carers of people with mental illness will require significant MH service leadership support shifts in current practice and culture. In addition, a more nuanced understanding of confidentiality is required to overcome the barriers to involving family carers more meaningfully in care.
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http://dx.doi.org/10.1071/AH19156DOI Listing
December 2020

Implementing national mental health carer partnership standards in South Australia.

Aust Health Rev 2020 Dec;44(6):880-890

Lived Experience Australia (formerly Private Mental Health Consumer Carer Network (Australia)), PO Box 542, Marden, SA 5070, Australia. Email:

Objective The aim of this study was to describe the current state of carer engagement and partnership in two mental health (MH) services in South Australia and the implementation of the six partnership standards in A Practical Guide to Working with Carers of People with a Mental Illness. Methods Anonymous surveys of carer experiences and clinician self-ratings of their own practice against the six partnership standards were completed by 94 staff and 58 carers within public and private MH in-patient units before and after exposure of clinicians to education about the partnership standards. Descriptive statistical analysis was performed and, where applicable, a comparative analysis used the two-sample Z-test of proportions. Qualitative data was analysed thematically. Results Considerable gaps were evident between carer experiences and clinician self-ratings of their own practice. Overall, the surveys point to the lack of a consistent approach by both public and private services, and suggest potential barriers to fostering carer participation and engagement. Confidentiality was a particularly noted barrier to partnership with carers. Conclusion Significant improvement is needed to meet the partnership standards. Brief exposure to the Guide is not, in itself, sufficient to effect change in the overall attitudes, skills and knowledge of clinical staff about engaging carers. Significantly more focus on staff education, clinical discussions and supervision is needed to meet the MH carer partnership standards. What is known about the topic? Partnership with MH consumers and carers is an established key principle within national MH policies and accreditation standards. Family carers play an important role in supporting consumers' recovery, yet many carers continue to report being excluded, particularly by in-patient clinical staff. What does this paper add? This is the first study to investigate the partnership standards in practice by comparing the perspectives of carers and in-patient MH clinical staff. What are the implications for practitioners? Improving partnership with carers of people with mental illness will require significant MH service leadership support shifts in current practice and culture. In addition, a more nuanced understanding of confidentiality is required to overcome the barriers to involving family carers more meaningfully in care.
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http://dx.doi.org/10.1071/AH19156DOI Listing
December 2020

The effects of emergency medical service work on the psychological, physical, and social well-being of ambulance personnel: a systematic review of qualitative research.

BMC Psychiatry 2020 07 3;20(1):348. Epub 2020 Jul 3.

College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.

Background: High rates of mental distress, mental illness, and the associated physical effects of psychological injury experienced by ambulance personnel has been widely reported in quantitative research. However, there is limited understanding of how the nature of ambulance work contributes to this problem, the significant large toll that emergency medical response takes on the individual, and particularly about late and cumulative development of work-related distress among this first responder workforce.

Methods: This study examined peer-reviewed qualitative research published from 2000 to 2018 to outline the effect of emergency medical response work on the psychological, psychosocial, and physical health of paramedics, ambulance officers, ambulance volunteers, and call-takers. Databases searched included: Ovid Medline, CINAHL, Ovid EMcare, PsychInfo and Scopus. The systematic review was organised around five key areas: impact of the work on psychological wellbeing; impact of psychological stress on physical wellbeing; how work-related well-being needs were articulated; effects of workflow and the nature of the work on well-being; and, effects of organisational structures on psychological and physical well-being.

Results: Thirty-nine articles met the eligibility criteria. Several factors present in the day-to-day work of ambulance personnel, and in how organisational management acknowledge and respond, were identified as being significant and contributing to mental health and well-being, or increasing the risk for developing conditions such as PTSD, depression, and anxiety. Ambulance personnel articulated their well-being needs across four key areas: organisational support; informal support; use of humour; and individual mechanisms to cope such as detachment and external supports.

Conclusions: Interactions between critical incidents and workplace culture and demands have an overwhelming impact on the psychological, physical and social well-being of ambulance personnel. These include day-to-day managerial actions and responses, the impact of shift work, poorly-managed rosters, and long hours of work with little time between for recovery. Mental health issues result from exposure to traumatic events, and the way managers and peers respond to worker distress. Ambulance personnel suffering from work-related stress feel abandoned by peers, management, and the service, during illness, in return-to-work, and post-retirement. Policy, programmes and interventions, and education need to occur at an individual, peer, organisational, and government level.
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http://dx.doi.org/10.1186/s12888-020-02752-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7332532PMC
July 2020

Older Adults' Experiences of Goals in Health: A Systematic Review and Metasynthesis.

J Appl Gerontol 2021 08 12;40(8):818-827. Epub 2020 May 12.

Flinders University, Adelaide, South Australia, Australia.

To synthesize older adults' experiences and perceptions of goal setting and pursuit within health systems. Six databases were searched to May 2019 using a combination of MeSH and free text terms. Included papers were written in English and reported original qualitative research for participants aged 65 years and older. Participant quotes from the results sections of included studies were gathered for thematic analysis and synthesis. Initial search yielded 9,845 articles, and 134 were identified for full-text review. Fifteen papers were included in the final synthesis. Two main themes were identified: enablers (intrinsic and extrinsic) and barriers (personal and system). Older adults' self-belief is the strongest enabler for goal activities, enhanced by a personalized coaching approach from health staff. Conversely, inconsistent goal terminology confuses patients and reduces engagement. Likewise, fatigue has profound physical and cognitive impact on patients' ability to engage and participate in goals.
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http://dx.doi.org/10.1177/0733464820918134DOI Listing
August 2021

The Australian version of IAPT: clinical outcomes of the multi-site cohort study of NewAccess.

J Ment Health 2020 May 12:1-10. Epub 2020 May 12.

Beyond Blue, Victoria, Australia.

The United Kingdom IAPT (Improving Access to Psychological Therapies) approach of delivering low intensity therapies for symptoms of depression and anxiety was adapted for Australia and named NewAccess. Clinical outcomes of the service were evaluated in three sites between October 2013 and 2016. This paper describes the clinical outcomes in the Australian health setting. Prospective cohort study with repeated measures. Both intent-to-treat and per protocol analyses were conducted for primary outcomes measures Patient Health Questionnaire-9 (nine item), and Generalised Anxiety Disorder (seven item). Secondary measures were Phobia Scale and Work and Social Adjustment Scale. Three thousand nine hundred and forty-six individuals were assessed, and 3269 attended at least two treatment sessions. Forty percent were males. There was a clinically meaningful reduction (improvement) shown by reliable recovery rates in both depression and anxiety symptoms at post-treatment assessment (68%; 95% CI: 66-70%) with large effect sizes (1.23 for depression and 1.25 for anxiety). Outcomes in PHQ-9 and GAD-7 were not influenced by age or sex, but recovery rates were significantly reduced by relationship status (single or separated). Unemployment reduced PHQ-9 outcomes but not GAD-7 outcomes. NewAccess demonstrated positive clinical outcomes in Australia, that compared favourably with international studies with the same methodology.
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http://dx.doi.org/10.1080/09638237.2020.1760224DOI Listing
May 2020

"Why do you stay?": The lived-experience of partners of Australian veterans and first responders with Posttraumatic Stress Disorder.

Health Soc Care Community 2020 09 15;28(5):1734-1742. Epub 2020 Apr 15.

Paramedic Unit, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia.

This study examined the multidimensional nature of experiences of being an intimate partner of an Australian veteran or emergency service first responder (ESFR) with posttraumatic stress disorder (PTSD). Using a qualitative phenomenological approach, inductive thematic analysis was undertaken on data collected in 2017-2018 through individual interviews with a purposive sample of 22 partners of veterans, paramedics, fire and police officers living in Australia. Analysis revealed that the key concern of the participants was to protect their family unit and the intimate relationship, highlighting the ways in which they adapted, managed and coped with the changes that PTSD brought to the relationship. However, lack of understanding by healthcare providers, government, military and emergency service organizations of their daily lives, and of the strength of commitment to their relationship, resulted in a sense of invisibility and was revealed as the key barrier to the support they crave. The findings underscore the importance of recognizing the significance of the intimate relationship in trauma recovery and of responding to the support needs of the intimate partner.
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http://dx.doi.org/10.1111/hsc.12998DOI Listing
September 2020

Supporting workforce practice change: protocol for a pilot study of a motivational interviewing virtual client software tool for health professionals.

BMJ Open 2020 02 9;10(2):e033080. Epub 2020 Feb 9.

College of Medicine & Public Health, Flinders University, Adelaide, South Australia, Australia.

Introduction: Motivating behavioural change during client consultations is of crucial importance across all health professions to address the growing burden of chronic conditions. Yet health professionals often lack the skills and confidence to use evidence-based counselling interventions to support clients' behavioural change and mobilise clients' resources and self-efficacy for change to address their long-term needs.

Aims: This pre-post pilot study will develop a motivational interviewing (MI) virtual client training tool for health professionals and test the effectiveness of the educational content and usability of the virtual client interaction.

Methods And Analysis: Postgraduate students across a range of health disciplines will be recruited. Data assessing attitudes towards preventive healthcare will be collected using a modified version of the Preventive Medicine Attitudes and Activities Questionnaire. Conversations with the virtual client will be analysed using the Motivational Interviewing Treatment Integrity code to assess changes in MI skills. The System Usability Scale will be used to assess the usability of the virtual client training tool.

Ethics And Dissemination: This protocol was approved by the Flinders University Social and Behavioural Research Ethics Committee in May 2019. The results of the pilot study will inform the development of an avatar-based mobile application consisting of MI teaching and interactions with a generic virtual client that can be easily adapted to multiple scenarios.
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http://dx.doi.org/10.1136/bmjopen-2019-033080DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7045188PMC
February 2020

A Literature Review and Gap Analysis of Emerging Technologies and New Trends in Gambling.

Int J Environ Res Public Health 2020 01 23;17(3). Epub 2020 Jan 23.

College of Medicine and Public Health, Flinders University, Adelaide 5042, Australia.

There have been significant changes in the gambling landscape particularly relating to gambling in the digital age. As the gambling landscape changes, regulation of gambling also needs to change. In 2018, the Office of Responsible Gambling in New South Wales, Australia, commissioned a gap analysis to inform their research objectives and priority focus areas. This included an identification of gaps in our understanding of emerging technologies and new trends in gambling. A gap analysis of the peer-reviewed literature published since 2015 was undertaken, identifying 116 articles. The main area of focus was Internet gambling, followed by articles exploring the relationship between video gaming and gambling, the expansion of the sports betting market, Electronic Gambling Machines characteristics and articles exploring new technologies and trends in advertising and inducements. Key gaps related to the need for more research in general, as well as research focusing on subpopulations such as those using different gambling formats, those with varying levels of problem gambling, and vulnerable populations. From a methods perspective, researchers saw the need for longitudinal studies, more qualitative research and improved outcome measures. The development and testing of a public health approach to addressing the harms associated with gambling in these areas is needed.
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http://dx.doi.org/10.3390/ijerph17030744DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7036923PMC
January 2020

The role of comorbidity assessment in guiding treatment decision-making for women with early breast cancer: a systematic literature review.

Support Care Cancer 2020 Mar 11;28(3):1041-1050. Epub 2019 Dec 11.

Flinders Centre for Innovation in Cancer, Flinders University and Flinders Medical Centre, Adelaide, SA, Australia.

Purpose: Comorbidity in breast cancer patients impacts treatment choice, toxicity, and outcomes. While comorbidity measurement tools are frequently used by researchers, little is known about their use in clinical practice. The aim of this review was to examine the use of comorbidity measurement tools in clinical practice and their role in treatment decision-making in breast cancer.

Methods: Six electronic databases were searched from inception to 21 March 2019. Quantitative or mixed methods studies addressing primary treatment of breast cancer and identifying a comorbidity measurement tool used in clinical practice treatment decision-making were included. Data was extracted on tool utilized, impact on treatment decisions or outcomes, pattern of use, and psychometric properties.

Results: A systematic search of literature yielded 752 studies. Of the four studies that met inclusion criteria, each utilized a comprehensive geriatric assessment tool, though only in a subset of patients. No studies found direct comorbidity measurement tools utilized independently of geriatric assessment. Assessment results had variable impact on treatment decisions. Impacts on patient mortality and treatment toxicity, cost-effectiveness, and psychometric characteristics of the tools were not identified.

Conclusions: There is little evidence on use of specific comorbidity tools in clinical decision-making in breast cancer outside of comorbidity assessment as part of geriatric assessment tools. There was limited impact on decision-making or patient outcomes when these were utilized. Further research is needed to identify barriers to comorbidity assessment in clinical practice and identify comorbidity tools that have the potential to improve patient outcomes.
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http://dx.doi.org/10.1007/s00520-019-05218-wDOI Listing
March 2020

Using a nominal group technique to approach consensus on a resilience intervention for smoking cessation in a lower socioeconomic population.

BMC Public Health 2019 Nov 27;19(1):1577. Epub 2019 Nov 27.

Flinders Human Behaviour and Health Research Unit, College of Medicine and Public Health, Bedford Park, Adelaide, South Australia, Australia.

Background: Smoking prevalence remains inequitably high for lower SES (socioeconomic status) populations. The psychosocial interactive model of resilience theorises that resilience might be 'switched on' in order to support and/or maintain smoking cessation for these populations. This study aimed to develop a Resilience Intervention for Smoking Cessation (RISC) through reviewing the extant literature around efficacious interventions for smoking cessation. Deliberative democracy principles were then used to understand lay perspectives regarding this potential smoking cessation program.

Methods: Public health databases were searched to find efficacious psycho-social resilience interventions in the peer-reviewed literature for smoking cessation amongst lower SES populations. Potential components for RISC were selected based on evidence within the literature for their effectiveness. We then employed the Nominal Group Technique (NGT) to create discussion and consensus on the most socially appropriate and feasible components from the perspective of smokers from low SES areas. The NGT included 16 people from a lower SES population in southern metropolitan Adelaide who indicated they were seriously contemplating quitting smoking or had recently quit. Data were collected from multiple Likert ratings and rankings of the interventions during the NGT workshop and analysed descriptively. The Wilcoxon signed-ranked test was used where appropriate. Qualitative data were collected from participant reflections and group discussion, and analysed thematically.

Results: Six smoking cessation interventions, likely to enhance resilience, were selected as potential constituents for RISC: mindfulness training; setting realistic goals; support groups; smoke free environments; mobile phone apps; and motivational interviewing. Consensus indicated that mindfulness training and setting realistic goals were the most acceptable resilience enhancing interventions, based on perceived usefulness and feasibility.

Conclusions: This research applied principles from deliberative democracy in order to illuminate lay knowledge regarding an appropriate and acceptable smoking cessation resilience program for a lower SES population. This process of collaborative and complex knowledge-generation is critically important to confront inequities as an ongoing challenge in public health, such as smoking cessation for disadvantaged groups. Further research should involve development and trial of this resilience program.
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http://dx.doi.org/10.1186/s12889-019-7939-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6882049PMC
November 2019

The French adaptation and validation of the Partners in Health (PIH) scale among patients with chronic conditions seen in primary care.

PLoS One 2019 23;14(10):e0224191. Epub 2019 Oct 23.

Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Québec, Canada.

Objective: Measuring self-management helps identify the degree of participation of people in the management of their chronic conditions and guides clinicians in determining person-centred priorities for providing support. The Partners in Health scale, a self-report generic questionnaire, was developed to capture the self-management of patients with chronic conditions. This study aimed to translate the Partners in Health scale into French and to examine its psychometric properties in French-speaking people with chronic conditions followed in primary care.

Methods: The Partners in Health scale was translated into French using Hawkins and Osborne's method (2012). Content validity was evaluated through cognitive interviews (Think Aloud Method). Internal consistency was measured at baseline with Cronbach's alpha. Test-retest reliability was evaluated at baseline and two weeks later using the intraclass correlation coefficient. Concurrent validity was measured at baseline with the Self-efficacy for Managing Chronic Disease (SEM-CD) and the Patient Activation Measure (PAM), using Spearman correlations.

Results: Cognitive interviews were conducted with 10 participants. During these interviews, most items were clearly understood and accepted as formulated; only a few terms were modified. To evaluate the psychometric properties of the French-language version of the Partners in Health scale, 168 participants (male = 34.5%; mean age = 58 years; mean number of chronic conditions = 4.1) completed the questionnaire at baseline and 47 of them completed the questionnaire two weeks later by telephone. Cronbach's alpha for internal consistency was 0.85 (95% confidence interval: 0.81-0.88). The intraclass correlation coefficient for test-retest reliability was 0.77 (95% confidence interval: 0.58-0.87). Concurrent validity with spearman's coefficient correlation of Self-efficacy for Managing Chronic Disease and Patient Activation Measure was 0.68 and 0.61 respectively.

Conclusion: The French-language version of the Partners in Health scale is a reliable and valid questionnaire for the measure of self-management in persons with chronic conditions seen in primary care.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0224191PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6808494PMC
March 2020

Developmentally appropriate supported self-management for children and young people with chronic conditions: A consensus.

Patient Educ Couns 2020 03 3;103(3):571-581. Epub 2019 Oct 3.

Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, Australia.

Objective/s: To create a consensus list of self-management definitions, recommendations, and endpoints for children and young people (0-20 years) with chronic conditions.

Methods: This study used a Delphi technique. Based on the number of relevant peer-reviewed publications, clinical academics were invited to participate in three survey rounds. Round one contained open-ended and multiple-choice questions eliciting general opinions on self-management. For round two, results were provided to the interdisciplinary expert panel as statements for rating their agreement using a 7-point Likert scale, with consensus predefined as moderately or extremely satisfied by >70% of participants. Statements not meeting consensus were re-presented in round three, with group feedback incorporated. Finalised statements informed creation of the 'Partners in Health: Self-Management Consensus List for Children and Young People'.

Results: Sixteen clinical academics participated: 12 completed round one; 14 completed round two; and 12 completed round three. Of 101 statements, 90 reached consensus, with statements separated into five developmentally appropriate groups. Statements covered broad self-management and self-management support domains including knowledge, involvement, monitoring/responding to symptoms, transition, impact, lifestyle, and support. Division of responsibility and autonomy were distinct themes.

Conclusion And Practice Implications: This research provides consensus-based guidance for clinicians providing paediatric self-management support.
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http://dx.doi.org/10.1016/j.pec.2019.09.029DOI Listing
March 2020

Assessing competence in health professionals' use of motivational interviewing: A systematic review of training and supervision tools.

Patient Educ Couns 2020 03 24;103(3):473-483. Epub 2019 Sep 24.

College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; Flinders Human Behaviour and Health Research Unit, Margaret Tobin Centre, Flinders University, Adelaide, South Australia, Australia. Electronic address:

Objective: To conduct a systematic review of instruments for assessing the competency of therapists in motivational interviewing (MI) for training purposes.

Methods: A search of Medline, Emcare, CINAHL, Scopus, Proquest, and Web of Science databases yielded 20,313 articles, of which 105 were included in the review. Data were summarised in terms of the instruments' development, adherence to MI principles, administration characteristics, psychometric properties, advantages, and disadvantages.

Results: Twelve instruments were identified. Tools tended to be better at covering simpler MI techniques. Differences in administration burden allow users to choose between briefer but cheaper and more detailed yet costly tools. Psychometric testing was often limited, and even if more extensive, the quality was often inconsistent. Although each tool tended to have relatively unique advantages (e.g. use of client ratings), they shared common disadvantages (e.g. lack of psychometric testing).

Conclusion: A number of tools can be used to assess MI competency, each with their own strengths but notable weaknesses that should be considered by potential users.

Practice Implications: There is a need to further test existing tools before creating new ones, due to the repetition of the same limitations. Standardised guidelines should also be created to ensure each tool meets the same quality standards.
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http://dx.doi.org/10.1016/j.pec.2019.09.021DOI Listing
March 2020

On Loneliness.

Authors:
Sharon Lawn

Schizophr Bull 2019 Aug 23. Epub 2019 Aug 23.

Department of Psychiatry, College of Medicine and Public Health, Flinders University, Margaret Tobin Centre, Adelaide, South Australia, Australia.

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http://dx.doi.org/10.1093/schbul/sbz080DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7505200PMC
August 2019

Recovery college as a transition space in the journey towards recovery: An Australian qualitative study.

Nurs Health Sci 2019 Dec 8;21(4):523-530. Epub 2019 Sep 8.

College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.

Recovery colleges are formal learning programs that aim to support people with a lived experience of mental illness. In this study, we aimed to explore the experiences of participants in a pilot recovery college that opened in Adelaide, South Australia, in 2016. A qualitative exploratory study was conducted involving interviews with learners (n = 8) and focus groups with lived experience facilitators (course facilitators with a lived experience of mental illness, n = 5), Clinician facilitators (mental health service staff facilitators, n = 4), and care coordinators (staff providing case management support, n = 5). Three main themes (hope, identity, and the recovery college as a transition space) and two subthemes (recovery college experience and outcomes) were identified. The results showed that the recovery college provided a transition space for shifting learners' identities from patient to student, facilitated by the experiences and outcomes of the recovery college, providing hope for the future. This study highlights the importance of providing mentally healthy and non-stigmatizing learning environments to promote and cement recovery for people with a lived experience of mental illness.
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http://dx.doi.org/10.1111/nhs.12637DOI Listing
December 2019

Tailoring of a Smartphone Smoking Cessation App (Kick.it) for Serious Mental Illness Populations: Qualitative Study.

JMIR Hum Factors 2019 Sep 3;6(3):e14023. Epub 2019 Sep 3.

Wellbeing and Resilience Centre, South Australian Health and Medical Research Institute, Adelaide, Australia.

Background: Smoking rates of Australians with severe mental illness (SMI) are disproportionately higher than the general population. Despite the rapid growth in mobile health (mHealth) apps, limited evidence exists to inform their design for SMI populations.

Objective: This study aimed to explore the feasibility, acceptability, and utility of adapting a novel smoking cessation app (Kick.it) to assist smokers with SMI to prevent smoking relapse and quit.

Methods: Using co-design, two in-depth interviews with 12 adult smokers and ex-smokers with SMI were conducted in this qualitative study. Stage 1 interviews explored participants' smoking-related experiences and perceptions of social support for smoking cessation, informed the development of the stage 2 interview schedule, and provided context for participants' responses to the second interview. Stage 2 interviews explored participants' perceptions of the feasibility, utility, and acceptability of the app features for SMI populations.

Results: People with SMI perceived mHealth interventions to support their quit smoking attempts as feasible, acceptable, and useful. Key emerging themes included personalization of the app to users' psychosocial needs, a caring app to mediate self-esteem and self-efficacy, an app that normalizes smoking relapse and multiple quit attempts, a strong focus on user experience to improve usability, and a social network to enhance social support for smoking cessation.

Conclusions: This study gained an in-depth understanding of the lived experiences of smoking and quitting among people with SMI and their perception of the Kick.it app features to help inform the tailoring of the app. Specific program tailoring is required to assist them in navigating the complex interactions between mental illness and smoking in relation to their psychosocial well-being and capacity to quit. This study describes the adaptations required for the Kick.it app to meet the specific needs and preferences of people with SMI. Results of this study will guide the tailoring of the Kick.it app for SMI populations. The study findings can also inform a co-design process for the future development and design of smoking cessation apps for SMI populations.
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http://dx.doi.org/10.2196/14023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6754228PMC
September 2019
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