Using a theatre-based programme to prevent gender-based violence: evidence from Australia.

Bystander interventions play an important contribution to efforts to prevent violence against women and arts-based interventions have been effective as part of a range of health promotion programmes. You the Man is a theatre-based programme, which contributes to violence prevention efforts in community settings. Requiring a single actor and minimal props, the programme consists of a 30-35 min play about intimate partner violence and sexual assault followed by a moderated post-performance panel discussion including staff from local support agencies. Although it has received positive feedback in a range of settings, the only previously published evaluation involved establishing short and long-term impacts on American high school students. This article examines the short-term impacts from attending You the Man events on a different audience, i.e. Australian adults. Anonymous online surveys conducted prior and 4 weeks after events were completed by 41 participants of whom 29 were female and 12 were male, three-quarters of whom were aged between 18 and 49, and who attended events at university campuses (46.3%), in workplaces (34.1%), at sporting clubs (12.2%) and community centres (7.3%). At follow up, participants regarded the severity of abusive and coercive behaviours as being higher than at baseline, their capacity to intervene as a bystander had increased, as had the number of sources of support they would recommend to someone experiencing gender-based violence. Hence, theatre-based programmes can positively affect attitudes in relation to gender-based violence, increase bystander knowledge about safe ways to intervene and positively affect intended bystander intervention.

A Multilevel Grounded Theory of Quantitative Job Quality Among Mothers, Fathers and Childless Women and Men in a Gendered, Classed and Aged "Growth-Driven" Organisation.

Poor quality jobs, incorporating job demands, resources and rewards, can impact employees' health and wellbeing inside and outside work. However, jobs' changing nature and employees' increasingly diverse backgrounds mean existing job quality models may not adequately explain individuals' job quality experiences within their individual, organisational and societal contexts. The paper aimed to understand mothers, fathers and childless women and men's gendered, classed and aged experiences of quantitative job demands (including work amount, speed, effort, length and timing) and their resources and rewards, within multilevel contexts. We conducted a qualitative case-study of an Australian organisation, employing a critical feminist grounded theory design. We collected and analysed data from open-ended questionnaire responses from 47 employees and iterative in-depth interviews with 10 employees. Participants' experiences of excessive quantitative demands, whether they could meet such demands, and whether they felt extrinsically or intrinsically resourced and rewarded for doing so, were embedded within ComCo's masculine-neoliberal-capitalist growth imperative, cultures, policies and practices reinforcing growth, and quantitatively extreme and qualitatively conformant ideal worker discourses, as well as participants' organisationally and societally-embedded individual, family and community-level contexts; producing nuanced gendered, classed and aged experiences among mothers, fathers and childless women and men. Although confirming well-established objective job quality dimensions, our research suggests individuals' nuanced and subjective job quality experiences are embedded within individual, family, community, organisational and societal contexts.

Understandings and Perceptions of Domestic Violence Among Newly Arrived Afghan Women in Australia.

Women's perceptions of domestic violence vary across societies and cultures and might change by moving to a new society. This study aims to explore newly arrived Afghan women's understandings and perceptions of domestic violence and whether they perceive this as acceptable. Semi-structured interviews were conducted with 21 newly arrived Afghan women in Australia. Interviews were audio-recorded, transcribed, and analyzed inductively to generate and organize themes. The findings showed that informants had a sound knowledge and understanding of domestic violence, and many of them identified various forms of violence. Also, informants strongly rejected that violence against women be considered normal or acceptable.

Seeking Help in Domestic Violence Among Muslim Women in Muslim-Majority and Non-Muslim-Majority Countries: A Literature Review.

OBJECTIVE: Women from different backgrounds and cultures are at risk of domestic violence. Disclosing the abusive experience and seeking help is not straightforward and easy and might be a complicated and long-term process. Muslim women, like other groups of women, may face various barriers to disclose abusive relationships and for seeking help. Some of the barriers may be common for the majority of Muslim women in different contexts, while others might be related to women's situations and the wider society they live. To identify these barriers and make recommendations for future studies, this article reviews related papers conducted in both Muslim-majority and non-Muslim-majority countries. METHOD: A critical systematic review of the literature was conducted for identifying Muslim women's barriers in disclosing abuse and seeking help. RESULTS: Twenty-one studies met the inclusion criteria. The main identified barriers are discussed into under four themes: social context, family context, individual factors, and expectations of service providers. CONCLUSIONS: Although the researchers tried to investigate various barriers in seeking help, many of them have not focused on structural obstacles. Besides, in many Muslim-majority countries, the issue has not been explored. Therefore, the results of the current article will not apply to those countries. Recommendation for future research comprises more qualitative research compatible with the women's cultures and backgrounds in different societies, focusing more on structural and cultural factors to explore and find women's barriers to seek help.

Expert consensus on a nurse-led model of medication abortion provision in regional and rural Victoria, Australia: a Delphi study.

OBJECTIVE: To develop a nurse-led model of medication abortion provision for the primary health care setting of regional and rural Victoria, where, despite decriminalization, access to abortion services is restricted. STUDY DESIGN: This study used a three-round Delphi process to explore consensus about a nurse-led medication abortion model. We recruited a panel consisting of physicians, nurses and other experts involved with or interested in medication abortion provision. The research team thematically analyzed the responses to the seven open-ended questions of the first questionnaire. In subsequent rounds, panelists rated the 83 generated statements for agreement, using feedback and statistical summaries. RESULTS: A total of 24 panelists participated; 17 completed all three rounds. Through the iterative process, the panel reached consensus (at least 75% agreement level) on 69 statements, relating to model construction and the barriers to model implementation and their solutions. Due to current health care system restrictions we not only developed a 'fully autonomous' nurse-led model, but also a 'legally feasible' model. For nurses working in primary health settings that lack GP support we additionally constructed an 'absence of a (medication abortion supportive) general practitioner' model. CONCLUSION: Nurse-led medication abortion provision is a recognized strategy to improve access to equitable, affordable and safe abortion services for women residing in underserved areas. The constructed models and recommendations for practice and policy can serve as a guide to expand the role of primary health care nurses in the provision of medication abortion in Victoria and beyond. IMPLICATIONS: The findings of this study indicate that a nurse-led model of medication abortion provision is feasible in service poor areas of Victoria and that model implementation has the potential to improve abortion access. The models are adaptable for use in other settings.

Snapshot of medication abortion provision in the primary health care setting of regional and rural Victoria.

OBJECTIVE: This study aimed to identify enablers and barriers to the provision of medication abortion in the primary health care setting of regional and rural areas of Victoria, Australia. DESIGN: An online cross-sectional questionnaire was used. SETTING: Regional and rural areas of Victoria, Australia. PARTICIPANTS: Thirty-nine GPs and 30 primary health care nurses. MAIN OUTCOME MEASURES: Abortion views, medication abortion knowledge and practice, interest in medication abortion training and provision, and perceived uptake barriers. RESULTS: Most participants reported being consulted by women with unintended pregnancies and most of them included abortion counselling in their consultation. However, familiarity with provision of medication abortion was limited, and only five GPs and two primary health care nurses were currently medication abortion providers. The majority of participants expressed a high level of interest in receiving medication abortion training, but indicated a wide range of barriers to service provision, such as a lack of training opportunities, legal uncertainties or surgical access concerns in case of complications. CONCLUSIONS: Findings demonstrate the need for education on medication abortion and training opportunities. Most identified barriers to service uptake are addressable and relate to a lack of local support services, including the absence of a 24-hour contact advice service, insufficient follow-up access and a lack of local ultrasound facilities. These barriers require educational programs at professional, organisational and community level to ensure that interested rural and regional primary health care providers can start offering medication abortion for their patients.

Implementing empowerment-based Lay Health Worker programs: a preliminary study.

Lay Health Worker (LHW) programs have been shown to be effective in engaging community members in health promotion. While successful LHW program implementation requires an understanding of factors influencing program effectiveness, evidence informing such understanding is lacking for empowerment and ecological theory-based LHW programs. This descriptive study explores how enablers and barriers, identified from LHW literature apply (from the LHWs' perspective) in the context of implementing an empowerment and ecological theory-based LHW model in Melbourne, Victoria. A qualitative case study was carried out. Data were collected from participating LHWs (n = 11) via anonymized online activity logs (n = 7) and semi-structured interviews (n = 7). Deductive-inductive thematic analysis was guided by five a priori themes identified from the literature: community relationships; intrinsic traits, values and motivations; capacity building; program design; and work conditions. Data supported the enablers and barriers to program effectiveness and implementation reported by previous research. Subthemes identified the importance of the LHW bridging role; the empowerment model; integrating the program; and program inclusiveness. This research contributes to the growing practice literature regarding how to effectively implement diverse LHW models in diverse settings. It also contributes to social ecological and complex systems-based health promotion practice evidence in suggesting LHWs to be potentially useful elements which may add to the effectiveness of ecologically based health promotion interventions.

Exploring the use of resources to support gender equality in Australian workplaces.

ISSUE ADDRESSED: Numerous resources exist to support workplaces to undertake gender equality work; however, it is often unclear which existing resources are being utilised by Australian workplaces. One group that can provide insight into the use of existing resources is the professionals who have undertaken gender equality work in their organisation. METHODS: Purposive sampling was used to identify informants with experience undertaking gender equality work. A sample of 12 informants was recruited from five employment sectors: five informants from the women('s health sector; two from other organisations in the health sector; three from local government; and one each from manufacturing and education. One in-depth semi-structured interview was conducted with each informant. Interview transcripts were analysed using thematic analysis. RESULTS: Four themes emerged from data analysis: "Organisational Context," "Legitimising Gender Equality Work," "Demystifying Gender Equality" and "Embedding Gender Equality into the Workplace." Mechanisms such as drawing on the evidence base, developing internal communications strategies, establishing a working group, undertaking training, conducting an audit, and reviewing policies and procedures were used to embed gender-based considerations into the workplace. A range of resources to underpin most of these approaches was discussed by informants. CONCLUSIONS: Informants had a sound understanding of approaches they could use to address existing gender inequality; however, they did not always utilise existing resources to support them to undertake their chosen approach. SO WHAT?: A clearer online database needs to be established to allow workplaces to access a compilation of existing resources and any evaluation on their use.

Development and Psychometric Properties of Social Exclusion Questionnaire for Iranian Divorced Women.

BACKGROUND: Divorce, especially in women, could be assessed from socio-cultural perspective as well as psychological viewpoint. This assessment requires cultural adopted as well as valid and reliable questionnaire. This study aimed to develop and assess the psychometric properties of a questionnaire in order to address social consequences in Iranian divorced women. METHODS: This was an exploratory mixed method study conducted during 2012 to 2014. According to the grounded theory approach in the first phase, social exclusion was extracted as a core of understanding process in participants. Based on, 47 preliminary generated items reliability and validity were assessed. In the second phase, the divorced women were recruited from a safe community center in Tehran through convenience sampling. RESULTS: Exploratory factor analysis conducted on the questionnaires of 150 divorced women with mean age 41.76±8.49 yr, in that, indicated five dimensions, discriminative marital status, economic dependence on marital status, exclusionary marital status, and traumatic marital status health risks and, frightening marital status that jointly accounted for the 64% of the variance observed. An expert panel approved the face and content validity of the developed tool. The Cronbach's alpha coefficient and the Intra-class Correlation Coefficient were found to be 0.70 and 0.85, respectively. CONCLUSION: The present study provided a valid and reliable measure as Social Exclusion Questionnaire in Iranian divorced women (SEQ-IDW) to address social post-divorce consequences, which might help to improve women's social health.

Qualitative study to explore the health and well-being impacts on adults providing informal support to female domestic violence survivors.

OBJECTIVES: Domestic violence (DV) is hazardous to survivors' health, from injuries sustained and from resultant chronic physical and mental health problems. Support from friends and relatives is significant in the lives of DV survivors; research shows associations between positive support and the health, well-being and safety of survivors. Little is known about how people close to survivors are impacted. The aim of this study was exploratory, with the following research question: what are the health and well-being impacts on adults who provide informal support to female DV survivors? DESIGN: A qualitative study using semistructured interviews conducted face to face, by telephone or using Skype. A thematic analysis of the narratives was carried out. SETTING: Community-based, across the UK. PARTICIPANTS: People were eligible to take part if they had had a close relationship (either as friend, colleague or family member) with a woman who had experienced DV, and were aged 16 or over during the time they knew the survivor. Participants were recruited via posters in community venues, social media and radio advertisement. 23 participants were recruited and interviewed; the majority were women, most were white and ages ranged from mid-20s to 80. RESULTS: Generated themes included: negative impacts on psychological and emotional well-being of informal supporters, and related physical health impacts. Some psychological impacts were over a limited period; others were chronic and had the potential to be severe and enduring. The impacts described suggested that those providing informal support to survivors may be experiencing secondary traumatic stress as they journey alongside the survivor. CONCLUSIONS: Friends and relatives of DV survivors experience substantial impact on their own health and well-being. There are no direct services to support this group. These findings have practical and policy implications, so that the needs of informal supporters are legitimised and met.

Receiving care for intimate partner violence in primary care: Barriers and enablers for women participating in the weave randomised controlled trial.

BACKGROUND: Interventions in health settings for intimate partner violence (IPV) are being increasingly recognised as part of a response to addressing this global public health problem. However, interventions targeting this sensitive social phenomenon are complex and highly susceptible to context. This study aimed to elucidate factors involved in women's uptake of a counselling intervention delivered by family doctors in the weave primary care trial (Victoria, Australia). METHODS: We analysed associations between women's and doctors' baseline characteristics and uptake of the intervention. We interviewed a random selection of 20 women from an intervention group women to explore cognitions relating to intervention uptake. Interviews were audio-recorded, transcribed, coded in NVivo 10 and analysed using the theory of planned behaviour (TPB). RESULTS: Abuse severity and socio-demographic characteristics (apart from current relationship status) were unrelated to uptake of counselling (67/137 attended sessions). Favourable doctor communication was strongly associated with attendance. Eight themes emerged, including four sets of beliefs that influenced attitudes to uptake: (i) awareness of the abuse and readiness for help; (ii) weave as an avenue to help; (iii) doctor's communication; and (iv) role in providing care for IPV; and four sets of beliefs regarding women's control over uptake: (v) emotional health, (vi) doctors' time, (vii) managing the disclosure process and (viii) viewing primary care as a safe option. CONCLUSIONS: This study has identified factors that can promote the implementation and evaluation of primary care-based IPV interventions, which are relevant across health research settings, for example, ensuring fit between implementation strategies and characteristics of the target group (such as range in readiness for intervention). On practice implications, providers' communication remains a key issue for engaging women. A key message arising from this work concerns the critical role of primary care and health services more broadly in reaching victims of domestic violence, and providing immediate and ongoing support (depending on the healthcare context).

Service providers' experiences and needs in working with refugees in the Geelong region: a qualitative study.

Service providers in Geelong, one of the priority locations for the resettlement of refugees in regional Australia, were interviewed to explore their perceptions of the health and wellbeing needs of refugees, and the capacity of service providers in a regional area to meet these. In all, 22 interviews were conducted with health and human service professionals in a range of organisations offering refugee-specific services, culturally and linguistically diverse (CALD) services in general, and services to the wider community, including refugees. The findings revealed that a more coordinated approach would increase the effectiveness of existing services; however, the various needs of refugees were more than could be met by organisations in the region at current resource levels. More staff and interpreting services were required, as well as professional development for staff who have had limited experience in working with refugees. It should not be assumed that service needs for refugees resettled in regional Australia will be the same as those of refugees resettled in capital cities. Some services provided in Melbourne were not available in Geelong, and there were services not currently provided to refugees that may be critical in facilitating resettlement in regional and rural Australia.

Barriers among Danish women and general practitioners to raising the issue of intimate partner violence in general practice: a qualitative study.

BACKGROUND: Thirty-five percent of Danish women experience sexual or physical violence in their lifetime. However, health care professionals are not in the practice of asking about intimate partner violence (IPV) in Denmark. It is currently unknown what hinders general practitioners from asking about partner violence and how Danish women would perceive such an inquiry. This aspect has not previously been explored in Denmark. An exploratory study was conducted to examine what hinders general practitioners (GPs) from asking and what Danish women's views and attitudes are regarding being asked about IPV. METHODS: Data were collected through individual and group interviews with a sample of three GPs and a diverse sample of 13 women, including both survivors of partner violence and those without any history of partner violence. An interpretative analysis was performed with the data. RESULTS: This study provides important knowledge regarding the barriers and attitudes towards inquiry about IPV in primary care in Denmark. Results indicate that Denmark is facing the same challenges when responding to survivors of IPV as other similar countries, including Sweden, Norway, the UK, USA, and Australia. Danish women want general practitioners to ask about violence in a respectful and non-judgemental manner. However, general practitioners are resistant towards such an inquiry and would benefit from training regarding how to respond to women who have been exposed to IPV. CONCLUSIONS: It is acceptable to inquire about IPV with women in Denmark in a non-judgemental and respectful way. Informing about IPV prevalence is important prior to the inquiry. However, general practitioners require more awareness and training before a favourable environment for this change in procedure can be created. Further large-scale research is needed to support the evidence generated by this small study.

What do Australian Women Experiencing Intimate Partner Abuse Want From Family and Friends?

We analyzed the views of a diverse sample of women (N = 254) living in the state of Victoria, Australia, who were experiencing fear of an intimate partner. We explored the women's views about their interactions with their family and friends to examine what women who have experienced fear of a partner or ex-partner want from their family and friends. The themes identified provide potentially useful guidance for what might be helpful and unhelpful communication strategies and behaviors for families and friends. Women experiencing intimate partner abuse find informal support invaluable, provided it is delivered in a helpful fashion. Helpful support is affirming, encouraging, validating, and understanding, and delivered with positive regard, empathy, and respect. Social contact and interaction are particularly appreciated, as is instrumental support such as financial help, housing, and child care. Women value both support that is directly related to abuse and support related to other areas of life.

The meaning and importance of vigilant attendance for the relatives of intensive care unit patients.

AIM: To explore the meaning of vigilant attendance for relatives of critically ill patients in Greece. BACKGROUND: A plethora of international research has identified proximity to the patient to be a major concern for relatives of critically ill patients. Greece however follows a strict visiting policy in intensive care units (ICUs) so Greek relatives spend great amounts of time just outside the ICUs. DESIGN: This qualitative study adopted the social constructionist version of grounded theory. METHOD: Data were collected from three ICUs in Athens through in depth interviews with 25 informants and approximately 10 h of observations outside the ICUs on 159 relatives. FINDINGS: Vigilant attendance was one of the main coping mechanisms identified for relatives. Four subcategories were found to comprise vigilant attendance: (1) being as close as possible to feel relief, (2) being there to find out what is going on, (3) monitoring changes in the loved one and making own diagnosis and (4) interacting with the ICU professionals. CONCLUSION: Vigilant attendance describes the way in which relatives in Greece stayed outside the ICUs. Relatives felt satisfaction from being close as the best alternative for not actually being inside the ICU and they tried to learn what was going on by alternative methods. By seeing the patients, relatives were also able to make their own diagnoses and could therefore avoid relying solely on information given to them. However, a prerequisite for successful vigilant attendance was to get on well with doctors and nurses. RECOMMENDATIONS FOR CLINICAL PRACTICE: Changes in visiting policies in Greece are needed to meet the needs of relatives adequately. Recommendations for changes with minimal investment of time and funding are made.

Screening and counselling in the primary care setting for women who have experienced intimate partner violence (WEAVE): a cluster randomised controlled trial.

BACKGROUND: Evidence for a benefit of interventions to help women who screen positive for intimate partner violence (IPV) in health-care settings is limited. We assessed whether brief counselling from family doctors trained to respond to women identified through IPV screening would increase women's quality of life, safety planning and behaviour, and mental health. METHODS: In this cluster randomised controlled trial, we enrolled family doctors from clinics in Victoria, Australia, and their female patients (aged 16-50 years) who screened positive for fear of a partner in past 12 months in a health and lifestyle survey. The study intervention consisted of the following: training of doctors, notification to doctors of women screening positive for fear of a partner, and invitation to women for one-to-six sessions of counselling for relationship and emotional issues. We used a computer-generated randomisation sequence to allocate doctors to control (standard care) or intervention, stratified by location of each doctor's practice (urban vs rural), with random permuted block sizes of two and four within each stratum. Data were collected by postal survey at baseline and at 6 months and 12 months post-invitation (2008-11). Researchers were masked to treatment allocation, but women and doctors enrolled into the trial were not. Primary outcomes were quality of life (WHO Quality of Life-BREF), safety planning and behaviour, mental health (SF-12) at 12 months. Secondary outcomes included depression and anxiety (Hospital Anxiety and Depression Scale; cut-off ≥8); women's report of an inquiry from their doctor about the safety of them and their children; and comfort to discuss fear with their doctor (five-point Likert scale). Analyses were by intention to treat, accounting for missing data, and estimates reported were adjusted for doctor location and outcome scores at baseline. This trial is registered with the Australian New Zealand Clinical Trial Registry, number ACTRN12608000032358. FINDINGS: We randomly allocated 52 doctors (and 272 women who were eligible for inclusion and returned their baseline survey) to either intervention (25 doctors, 137 women) or control (27 doctors, 135 women). 96 (70%) of 137 women in the intervention group (seeing 23 doctors) and 100 (74%) of 135 women in the control group (seeing 26 doctors) completed 12 month follow-up. We detected no difference in quality of life, safety planning and behaviour, or mental health SF-12 at 12 months. For secondary outcomes, we detected no between-group difference in anxiety at 12 months or comfort to discuss fear at 6 months, but depressiveness caseness at 12 months was improved in the intervention group compared with the control group (odds ratio 0·3, 0·1-0·7; p=0·005), as was doctor enquiry at 6 months about women's safety (5·1, 1·9-14·0; p=0·002) and children's safety (5·5, 1·6-19·0; p=0·008). We recorded no adverse events. INTERPRETATION: Our findings can inform further research on brief counselling for women disclosing intimate partner violence in primary care settings, but do not lend support to the use of postal screening in the identification of those patients. However, we suggest that family doctors should be trained to ask about the safety of women and children, and to provide supportive counselling for women experiencing abuse, because our findings suggest that, although we detected no improvement in quality of life, counselling can reduce depressive symptoms. FUNDING: Australian National Health and Medical Research Council.

Effect of type and severity of intimate partner violence on women's health and service use: findings from a primary care trial of women afraid of their partners.

Intimate partner violence (IPV) has major affects on women's wellbeing. There has been limited investigation of the association between type and severity of IPV and health outcomes. This article describes socio-demographic characteristics, experiences of abuse, health, safety, and use of services in women enrolled in the Women's Evaluation of Abuse and Violence Care (WEAVE) project. We explored associations between type and severity of abuse and women's health, quality of life, and help seeking. Women (aged 16-50 years) attending 52 Australian general practices, reporting fear of partners in last 12 months were mailed a survey between June 2008 and May 2010. Response rate was 70.5% (272/386). In the last 12 months, one third (33.0%) experienced Severe Combined Abuse, 26.2% Physical and Emotional Abuse, 26.6% Emotional Abuse and/or Harassment only, 2.7% Physical Abuse only and 12.4% scored negative on the Composite Abuse Scale. A total of 31.6% of participants reported poor or fair health and 67.9% poor social support. In the last year, one third had seen a psychologist (36.6%) or had 5 or more general practitioner visits (34.3%); 14.7% contacted IPV services; and 24.4% had made a safety plan. Compared to other abuse groups, women with Severe Combined Abuse had poor quality of life and mental health, despite using more medications, counseling, and IPV services and were more likely to have days out of role because of emotional issues. In summary, women who were fearful of partners in the last year, have poor mental health and quality of life, attend health care services frequently, and domestic violence services infrequently. Those women experiencing severe combined physical, emotional, and sexual abuse have poorer quality of life and mental health than women experiencing other abuse types. Health practitioners should take a history of type and severity of abuse for women with mental health issues to assist access to appropriate specialist support.

Health-related religious rituals of the Greek Orthodox Church: their uptake and meanings.

AIM: To examine the uptake of religious rituals of the Greek Orthodox Church by relatives of patients in critical condition in Greece and to explore their symbolic representations and spiritual meanings. BACKGROUND: Patients and their relatives want to be treated with respect and be supported for their beliefs, practices, customs and rituals. However nurses may not be ready to meet the spiritual needs of relatives of patients, while the health-related religious beliefs, practices and rituals of the Greek Orthodox Christian denomination have not been explored. METHOD: This study was part of a large study encompassing 19 interviews with 25 informants, relatives of patients in intensive care units of three large hospitals in Athens, Greece, between 2000 and 2005. In this paper data were derived from personal accounts of religious rituals given by six participants. RESULTS: Relatives used a series of religious rituals, namely blessed oil and holy water, use of relics of saints, holy icons, offering names for pleas and pilgrimage. CONCLUSION: Through the rituals, relatives experience a sense of connectedness with the divine and use the sacred powers to promote healing of their patients. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers should recognize, respect and facilitate the expression of spirituality through the practice of religious rituals by patients and their relatives.

Ways in which 'community' benefits frail older women's well-being: 'we are much happier when we feel we belong'.

AIM: This paper aims to explore frail older women's lived experiences of 'community' and which aspects of 'community' they perceive as beneficial to their well-being. METHOD: This qualitative project used a mixed methodological approach which integrated aspects of descriptive phenomenology and grounded theory. Ten frail, older women residing in South East Melbourne, Australia participated in in-depth interviews. RESULTS: This research obtained a rich and detailed account of the aspects of 'community' identified by participants as enhancing their well-being. These included: social contact, community dynamics, feelings of support and positive orientation. CONCLUSION: This paper has increased our understanding of the factors supporting well-being of frail older women. Service providers should actively consider how they can strengthen these factors to improve social connectedness for frail older women by the use of volunteers, developing social networks and increasing availability and quality of community-based activities.