Experiences of self-management support from GPs among Australian ethnically diverse diabetes patients: a qualitative study.

Ethnically diverse diabetes patients face significant challenges in diabetes self-management ranging from cultural expectations to inequalities in health care provision. This study explored the experiences of ethnically diverse patients with diabetes attending group diabetes education in receiving self-management support from GPs. An approach based on phenomenology was used to analyse participants' experiences in self-management support across three group interviews comprising 28 Australian ethnically diverse diabetes patients: Arabic-speaking group (n = 11), English-speaking group (n = 9) and Vietnamese-speaking group (n = 8). Two themes emerged related to the poor quality of information to support self-management and challenges in negotiating traditional consultation styles. In particular, participants believed they knew more about diabetes self-management than their GPs but felt unable to influence consultation style and communicate their changing needs in self-management support. The health care and information needs of ethnically diverse patients continue to be marginalised within health systems. This small exploratory study highlights the need for further research to illuminate interactions between ethnically diverse diabetes patients and GPs in supporting long-term diabetes self-management.

GP and community nurse co-location in a disadvantaged community.

People living in socioeconomically disadvantaged communities have a high burden of disease but often receive 'inverse care'. We explored a model of general practitioner and community nurse co-location in a disadvantaged community in south-west Sydney, Australia. Co-location resulted in increased referrals from doctors to the community nurse, including an increase in referrals related to psychosocial issues. This small study suggests integrated primary health care might have an impact on specialised state-based psychosocial health services.

Attitudes, norms and controls influencing lifestyle risk factor management in general practice.

BACKGROUND: With increasing rates of chronic disease associated with lifestyle behavioural risk factors, there is urgent need for intervention strategies in primary health care. Currently there is a gap in the knowledge of factors that influence the delivery of preventive strategies by General Practitioners (GPs) around interventions for smoking, nutrition, alcohol consumption and physical activity (SNAP). This qualitative study explores the delivery of lifestyle behavioural risk factor screening and management by GPs within a 45-49 year old health check consultation. The aims of this research are to identify the influences affecting GPs' choosing to screen and choosing to manage SNAP lifestyle risk factors, as well as identify influences on screening and management when multiple SNAP factors exist. METHODS: A total of 29 audio-taped interviews were conducted with 15 GPs and one practice nurse over two stages. Transcripts from the interviews were thematically analysed, and a model of influencing factors on preventive care behaviour was developed using the Theory of Planned Behaviour as a structural framework. RESULTS: GPs felt that assessing smoking status was straightforward, however some found assessing alcohol intake only possible during a formal health check. Diet and physical activity were often inferred from appearance, only being assessed if the patient was overweight. The frequency and thoroughness of assessment were influenced by the GPs' personal interests and perceived congruence with their role, the level of risk to the patient, the capacity of the practice and availability of time. All GPs considered advising and educating patients part of their professional responsibility. However their attempts to motivate patients were influenced by perceptions of their own effectiveness, with smoking causing the most frustration. Active follow-up and referral of patients appeared to depend on the GPs' orientation to preventive care, the patient's motivation, and cost and accessibility of services to patients. CONCLUSION: General practitioner attitudes, normative influences from both patients and the profession, and perceived external control factors (time, cost, availability and practice capacity) all influence management of behavioural risk factors. Provider education, community awareness raising, support and capacity building may improve the uptake of lifestyle modification interventions.

Strengthening the effectiveness of 'whole of government' interventions to break the cycle of violence in disadvantaged communities.

'Whole of government' interventions are increasingly being used in disadvantaged communities to improve safety and break the cycle of violence. This paper draws on learning from the evaluation of two whole of government interventions in western Sydney that arose in response to community violence and extensive property damage. Methods for strengthening program logic and overcoming differences in perspective are outlined.

What employment programs should health services invest in for people with a psychiatric disability?

Employment has significant health benefits for people with a psychiatric disability, including improved mental health and wellbeing and a reduction in symptoms and rates of relapse. Systematic reviews show that supported employment is more effective than prevocational training in achieving open employment for this group. Health services should invest in developing partnerships and structures to ensure access to evidence-based supported employment programs for people with a psychiatric disability. We draw on exploratory research in south-west Sydney to discuss some of the challenges that a focus on employment presents for mental health services.