Adaptation and Implementation of a Volunteer-Delivered, Telephone-Based, Social Support Program HOW-R-U? During the COVID-19 Pandemic: A Pragmatic Study.

BACKGROUND AND OBJECTIVES: Public health concerns surrounding social isolation and loneliness heightened during the coronavirus disease 2019 (COVID-19) pandemic, as infection prevention measures led to increased feelings of loneliness and depression. Our objective was to evaluate the implementation of the HOW-R-U? program, during the pandemic (March 2020-December 2021). HOW-R-U? is a weekly volunteer-delivered telephone program designed to facilitate social connection and ease feelings of social isolation, loneliness, and depression in older people. RESEARCH DESIGN AND METHODS: This pragmatic study used the Implementation Framework for Aged Care to adapt and implement HOW-R-U? in an Australian aged and community care organization and a tertiary health service in Melbourne. The evaluation involved analysis of program data, semistructured interviews, and surveys with program recipients, volunteers, and referrers. A process evaluation was conducted alongside an assessment of outcomes including pre- and post-symptoms of isolation, depression, and loneliness. RESULTS: The implementation evaluation indicated that codesigned systems and processes effectively supported the ongoing implementation of HOW-R-U? with transition into business as usual across both organizations. Recipients reported that telephone calls had a positive impact on their lives, whereas volunteers reported enjoyment of supporting others. Several challenges were identified, namely in program reach and fidelity. DISCUSSION AND IMPLICATIONS: HOW-R-U? was well regarded by all involved, and evaluation learnings have informed implementation into business as usual by both organizations.

Risk Negotiation With People With Dementia: From Co-designed Paper Version to Implementation Preparation of an Electronic Conversation Tool.

The home care workforce provides essential support for older people with dementia to live a life of fulfillment. "Enabling Choices," an evidence-informed conversation tool, aims to negotiate risk around everyday activities between home care workers, people with dementia and their informal carers. This paper describes tool conversion into electronic format and preparation for implementation throughout a large Australian health and aged care service provider, utilizing the Implementation Framework for Aged Care (IFAC). Using codesign principles, the tool was converted from paper-based to electronic format involving frontline, operational and Information Management Services staff, and people with dementia/carers. Focus groups and interviews identified tool acceptability, feasibility, and appropriateness. For implementation preparation, the wider socio-cultural-political context was mapped, and key questions of the IFAC addressed. Environment, workflow, and training requirements were determined, and strategies for behavior change ascertained. Numerous opportunities and challenges exist for the widespread upscale of an evidence-informed tool into practice.

Cycling Without Age: An Australian residential aged care home experience.

OBJECTIVE: Cycling Without Age (CWA) involves taking residents on outdoor trishaw (electric bicycle) rides driven by trained 'pilots'. This study explored the CWA experience from the perspective of residents and family members, staff and volunteer pilots from a residential aged care home in Queensland, Australia. METHODS: A qualitative descriptive design was used. Interviews were conducted with 21 participants. Transcripts were analysed thematically, with the interview questions determining a priori categories followed by coding of central themes. RESULTS: Several themes emerged. For residents, seeing familiar places prompted reminiscences, and being outdoors elicited positive emotions. Family members reported CWA was a novel way to be with their loved one. Enabling residents to have time away from the care home with community contact was rewarding for pilots. Staff noted improvement in residents' mood post-ride, however, rides needed to be scheduled to fit in with their workflow. CONCLUSIONS: Cycling Without Age was perceived to offer a unique and meaningful experience, with benefits including sharing stories, being outside, and feeling part of the community.

Community-Dwelling Older Women: The Association Between Living Alone and Use of a Home Nursing Service.

OBJECTIVE: To investigate the use of home nursing by community-dwelling older women to determine the nature of services required by those living alone. DESIGN: A retrospective cohort study using routinely collected data. SETTING AND PARTICIPANTS: Women aged 55 years and older living in metropolitan Melbourne who received an episode of nursing care from a large community home-based nursing service provider between January 1, 2006 and December 31, 2015. METHODS: Descriptive and inferential statistical analyses were used to examine the relationship between client- and service-related factors and use of community nursing services. The primary outcome of interest was the hours of service received in a care episode. RESULTS: A total of 134,396 episodes of care were analyzed, in which 51,606 (38.4%) episodes involved a woman who lived alone. The median hours of care per episode to women who lived alone was almost 70% more than that for women who lived with others. Multivariable regression identified factors influencing the amount of service use: living alone status, cognitive health status, and number of required home nursing activities. After adjusting for confounding and interactions, living alone was associated with at least 13% more hours of care than is provided to those not living alone. Compared with women who lived with others, women living alone required almost double the amount of assistance with medication management and were 30% more likely to experience a deterioration in their condition or be discharged from home nursing care into an acute hospital. From 2006 to 2015, for all women there was a trend toward fewer hours of nursing service provided per episode. CONCLUSIONS AND IMPLICATIONS: Community-dwelling older women who live alone have greater service needs and higher rates of discharge to hospital. This knowledge will help guide provision of services and strategies to prevent clinical deterioration for this population.

Trajectories of home nursing use for older women in Melbourne, Australia: 2006-2015.

OBJECTIVE: To profile changes in older women accessing home nursing between 2006 and 2015, focussing on living circumstances. METHODS: Data pertaining to Australian women aged 55+ who accessed a home nursing service between 2006 and 2015 were analysed, stratified by living status. Comparisons were made between the years 2006 and 2015; rates and relative rates of use per 1000 clients were calculated. RESULTS: Fewer women lived alone in 2015 compared with 2006. Women were older, less likely to be born in Australia, speak English at home, had more diagnoses and higher average Charlson Comorbidity Index scores in 2015. Relative rates of service use for older women living with others increased slightly over the 10 years, while decreasing by 13% for those living alone. CONCLUSION: Women using home nursing services are older than previously, more medically complex, more likely to be born from countries other than Australia and speak a preferred language other than English.

Co-creation of services to maintain independence and optimise well-being: Learnings from Australia's Older Women Living Alone (OWLA) project.

For many populations at risk of social isolation, including Older Women Living Alone (OWLA), existing services to maintain independence and optimise well-being are difficult to access, unsuitable or unavailable. Co-creation is a strategy to develop 'person-centred' services that meet the needs of individuals. We adapted an existing framework for co-creation and used participatory action research methods, supported by an evidence base comprising a systematic review, analysis of routinely collected data and interviews, to develop person-centred services for OWLA. This approach achieved co-creation through an iterative process of consultation and review, involving a series of facilitated discussions with women living alone and stakeholders. A total of 13 women living alone, aged ≥55 years, and 11 stakeholders representing service providers and advocacy groups, were recruited to participate in these discussions. Sessions with between three and five OWLA, were held across Melbourne. The information was compiled and presented to service stakeholders in a single facilitated forum, held in central Melbourne. Smaller facilitated sessions with OWLA followed, to review and discuss the collated service stakeholder input. The information from these OWLA sessions were again compiled and directed back to the service stakeholders for consideration and further discussion. The two groups came together for a final forum to prioritise the co-created ten services that they believed would be feasible and would address unmet need to support OWLA maintain independence. The process of co-creation was time-consuming and required considerable preparation to facilitate input from the target population. Small groups, gathering at convenient local locations, with transport support were essential in removing barriers to participation. However, co-creation was a viable method of eliciting the women's preferences and developing services more likely to meet their needs.

Using co-creation and multi-criteria decision analysis to close service gaps for underserved populations.

BACKGROUND: Navigating treatment pathways remains a challenge for populations with complex needs due to bottlenecks, service gaps and access barriers. The application of novel methods may be required to identify and remedy such problems. OBJECTIVE: To demonstrate a novel approach to identifying persistent service gaps, generating potential solutions and prioritizing action. DESIGN: Co-creation and multi-criteria decision analysis in the context of a larger, mixed methods study. SETTING AND PARTICIPANTS: Community-dwelling sample of older women living alone (OWLA), residing in Melbourne, Australia (n = 13-37). Convenience sample of (n = 11) representatives from providers and patient organizations. INTERVENTIONS: Novel interventions co-created to support health, well-being and independence for OWLA and bridge missing links in pathways to care. MAIN OUTCOME MEASURES: Performance criteria, criterion weights , performance ratings, summary scores and ranks reflecting the relative value of interventions to OWLA. RESULTS: The co-creation process generated a list of ten interventions. Both OWLA and stakeholders considered a broad range of criteria when evaluating the relative merits of these ten interventions and a "Do Nothing" alternative. Combining criterion weights with performance ratings yielded a consistent set of high priority interventions, with "Handy Help," "Volunteer Drivers" and "Exercise Buddies" most highly ranked by both OWLA and stakeholder samples. DISCUSSION AND CONCLUSIONS: The present study described and demonstrated the use of multi-criteria decision analysis to prioritize a set of novel interventions generated via a co-creation process. Application of this approach can add community voice to the policy debate and begin to bridge the gap in service provision for underserved populations.

Profile of home nursing clients with mental health diagnoses: Epidemiological analysis of Australian community home nursing data.

Mental health is an important part of overall health status and mental ill health is common within the community. There is, however, little information relating to the mental health status of those in the community accessing services such as home nursing. The aim of this study is to profile mental health diagnoses and service use of persons accessing a community home nursing service. Retrospective data analysis was conducted of routinely collected administrative data from a service providing community home nursing in metropolitan Melbourne, Australia in 2014. Mental health diagnoses extracted from care records were International Classification of Disease code of 291-299 (Version-9) or F10-F99 (Version-10). Past-year prevalence for mental health diagnoses was 17%; lower than overall Australian prevalence (20%) and prevalence displayed in healthcare settings (25%-36%). The most prevalent class were mood [affective] disorders (7.8%), followed by neurotic, stress-related and somatoform disorders (4.8%). Schizophrenia, schizotypal and delusional disorders prevalence (2.5%) were more than twice that in the population (0.3%-1.0%). Those with a mental health diagnosis received between 40%-80% more visits than those without. These data demonstrate that the profile of mental health disorders in this population is complex, and that those with a mental health diagnosis experience higher care burden than those without. These findings will inform service planning and provision into the future.

Understanding the conceptualisation of risk in the context of community dementia care.

Risk has become a ubiquitous presence in modern society. For individuals diagnosed with dementia this preoccupation with risk can affect their day-to-day life in many ways. Maintaining autonomy while balancing risks is a continual struggle not only for those living with the disease, but also their carers, family and health professionals. To understand how these different groups of individuals conceptualise the issue of risk for those living with dementia, 83 semi-structured interviews were conducted with people living with dementia, carers, older people without significant experience of dementia, and registered nurses, and staff from a community nursing organisation. These interviews were analysed using Thematic Analysis, which suggested that the risks identified by each group were grounded in their experiences and perspective on dementia. Furthermore, context and understanding of the individual living with dementia and their preferences was central to effectively managing risk in a balanced way, ensuring that 'acceptable risks' were taken to ensure an acceptable quality of life for all involved. These findings highlight that there is no single approach to risk which can be applied to all individuals; rather, a negotiation needs to take place that takes into account the individual's preferences alongside their available resources and means.

Development of a discussion tool to enable well-being by providing choices for people with dementia: a qualitative study incorporating codesign and participatory action research.

OBJECTIVE: To codesign a discussion tool to facilitate negotiation of risk between health professionals, people with dementia and carers. METHODS: A qualitative approach using codesign. Thematic analysis was used to analyse interviews and focus groups with people with dementia, carers, healthcare staff and healthy older people exploring the issue of risk in dementia, the acceptability and development of a discussion tool. RESULTS: Sixty-one participants identified the breadth, depth and complexity of risk in dementia care and the need for individualised solutions. They also deemed a discussion tool to facilitate negotiation of risk was acceptable and responses informed the tool development. Twenty-two participants provided feedback that was used to refine the final version. CONCLUSION: Our discussion tool enables choices for people with dementia by focusing on abilities rather than deficits and assists health professionals to deliver person-centred care. Flash cards prompt concerns and the tool provides a range of strategies to address these issues.

Change Strategies and Associated Implementation Challenges: An Analysis of Online Counselling Sessions.

Self-change is the most frequent way people limit or reduce gambling involvement and often the first choice of people experiencing gambling-related problems. Less well known is the range of change strategies gamblers use and how these are selected, initiated or maintained. This study examined change strategies discussed in counselling transcripts from 149 clients who accessed a national online gambling help service in Australia. Using thematic analysis, we identified the presence of six change strategies; cash control and financial management, social support, avoiding or limiting gambling, alternative activities, changing thoughts and beliefs, and self-assessment and monitoring. Four implementation issues were also identified; a mismatch between need and strategy selection or maintenance; importance and readiness versus the cost of implementation; poor or unplanned transitions between strategies; and failure to review the helpfulness of strategies resulting in premature abandonment or unhelpful prolonged application. This study is the first to identify change strategies discussed in online counselling sessions. This study suggests change strategies are frequently discussed in online counselling sessions and we identified multiple new actions associated with change strategies that had not previously been identified. However, multiple implementation issues were identified and further work is required to determine the helpfulness of change strategies in terms of their selection, initiation and maintenance.

Social inclusion and the Fatosphere: the role of an online weblogging community in fostering social inclusion.

Overweight and obesity are one of the most salient issues within society today, and the stigmatisation of overweight individuals is prevalent and widespread. Utilising interviews with 44 individuals who blog within an online fat acceptance community known as the Fatosphere, participants' perceptions of inclusion and exclusion were examined within their offline and online environments. Additionally, the effect this had on their offline lives was examined. Participants described a profound sense of exclusion within their offline lives through three agencies: the medicalisation of 'fatness', the weight loss industry and the media, which echoed descriptions of moral judgement. Furthermore, a sense of inclusion was described within the Fatosphere through the protection and support that they found within this 'safe space'. The effects of the Fatosphere influenced their lives in both negative and positive ways, allowing them to better deal with stigma and discrimination, but sometimes effecting their offline relationships in a negative manner. The Fatosphere provides a unique opportunity for corpulent individuals to engage in a community that is removed from the prominent weight-related discourse within modern society.

The health and service needs of older veterans: a qualitative analysis.

BACKGROUND: With substantial numbers of older people within the Australian veteran population continuing to age well within the community, appropriate planning of community support and health services is important for this ageing population. OBJECTIVE: The purpose of this research study was to investigate the health and service usage of a group of older Australian war veterans who receive Australian Government support for their health-care needs and conditions. DESIGN: This paper reports on qualitative data gathered from the longitudinal MELSHA study. Utilizing thematic analysis and the theoretical framework of locus of control, this article reports on 25 qualitative interviews of veterans and their widows about their DVA-related health and service usage. RESULTS: Participants within this study were determined to maintain a sense of control and independence in relation to their living circumstances and service usage. In doing so, they attempted to maintain their current community living circumstances and independence while minimizing their utilization of services and perceived 'burden' on family members and friends. Participants accepted that a decline in health status was inevitable, but engaged in a number of different strategies to maintain their current way of life for as long as possible. DISCUSSION & CONCLUSION: Participants, while valuing an internal locus of control, generally engaged in an integrative locus of control to maintain a sense of control and independence in their daily lives. In addition, participants were very grateful of the services provided by the DVA and acknowledged their role in maintaining their independence within the community.

Translating research findings into community based theatre: More than a dead man's wife.

Increasingly, qualitative scholars in health and social sciences are turning to innovative strategies as a way of translating research findings into informative, accessible and enjoyable forms for the community. The aim of this article is to describe how the research findings of a doctoral thesis - a narrative study about 58 older women's experiences of widowhood - were translated into a unique and professionally developed script to form the basis for a successful theatrical production that has travelled extensively within Australia. This article reports on the process of collaboration between a researcher, a highly regarded Australian actor/script writer and an ensemble of well-known and experienced professional actors. Together the collaborating partners translated the research data and findings about growing older and 'widowhood' into a high quality theatre production. In particular, we argue in this paper that research-based theatre is an appropriate medium for communicating research findings about important life issues of concern to older people in a safe, affirming and entertaining manner. By outlining the process of translating research findings into theatre we hope to show that there is a real value in this translation approach for both researcher and audience alike.

The role of the fatosphere in fat adults' responses to obesity stigma: a model of empowerment without a focus on weight loss.

Obese adults face pervasive and repeated weight-based stigma. Few researchers have explored how obese individuals proactively respond to stigma outside of a dominant weight-loss framework. Using a grounded theory approach, we explored the experiences of 44 bloggers within the Fatosphere--an online fat-acceptance community. We investigated participants' pathways into the Fatosphere, how they responded to and interacted with stigma, and how they described the impact of fat acceptance on their health and well-being. The concepts and support associated with the fat-acceptance movement helped participants shift from reactive strategies in responding to stigma (conforming to dominant discourses through weight loss) to proactive responses to resist stigma (reframing "fat" and self-acceptance). Participants perceived that blogging within the Fatosphere led them to feel more empowered. Participants also described the benefits of belonging to a supportive community, and improvements in their health and well-being. The Fatosphere provides an alternative pathway for obese individuals to counter and cope with weight-based stigma.