Rural and remote pharmacists' perspectives of grey nomads with diabetes travelling in Australia.

OBJECTIVE: The objective of the research was to explore rural and remote pharmacists' experiences of encountering grey nomads with diabetes. DESIGN: A qualitative Interpretive Description design was used to explore and capture the experiences of rural and remote pharmacists interacting with grey nomads who had diabetes. Data from the interviews were analysed thematically. SETTING: The Pharmacy Guild of Australia was approached and through their membership rural and remote pharmacists were invited to participate in the research. PARTICIPANTS: Nine rural and remote pharmacists who had encounters and provided services to grey nomads with diabetes responded to be interviewed. RESULTS: The analysed findings established four major themes including: the influence of rural and remote locations on services; common problems encountered by the pharmacists; preparation for travel by grey nomads with diabetes; and pharmacists' preparedness to support grey nomads with diabetes. CONCLUSION: The findings of this study identified that pharmacists needed remuneration for services provided to grey nomads with diabetes. Also, further development of the My Health record and telehealth to include pharmacists would be advantageous for grey nomads who have diabetes. Pharmacists stated there was a need for further education and a continuing professional development module specifically designed for pharmacists on diabetes self-management that moved beyond medications. A pre-travel checklist for grey nomads with diabetes travelling in rural and remote Australia would benefit all stakeholders through better preparation of travellers with diabetes to self-manage, thereby reducing the demand for health services including pharmacies.

Analysis of factors related to behaviours to prevent sexual assault of teenage girls.

Objectives: To analyse the factors associated with the behaviour of teenage girls in terms of preventing a sexual assault. Method: The descriptive, cross-sectional, correlational study was conducted in April 2021 at a senior high school in Cibitung, Bekasi, Indonesia, after approval from the ethics review committee of the Faculty of Nursing, Universitas Airlangga. The sample comprised class X-XII students aged 15- 19 years. Data was collected using a questionnaire. Data was analysed with logistic regression test using SPSS 20. RESULTS: Of the 139 subjects, 52 (37.4%) were aged 16 years, 58 (41.7%) were in class XII. Significant relationship of behaviour to prevent sexual assault was found with knowledge (p=0.008), attitude (p=0.010) and peer interaction (p=0.007). CONCLUSIONS: Preventing sexual assault behaviour among girls was found to be related to knowledge, attitude and peer interaction.

"When I suffer from fever, I eat mangos." Determinants of health-seeking beliefs and behaviors of rural older women in Sylhet, Bangladesh.

Poverty, poor living conditions, religious values and norms, lack of education, and gender discrimination influence the beliefs and behaviors of rural older women in many low-income countries. This paper aims to report the socio-ecological determinants of health-seeking beliefs and behaviors of rural older women in North-eastern Bangladesh and how these behaviors impact their recognition within the setting. It involved semi-structured interviews with 25 older women and 11 healthcare professionals. The findings revealed various determinants at the personal level (awareness of illness, mistrust toward medical treatment, self-treatment, and religious values and norms), the interpersonal level (isolation in family and communication with clinicians), community level (community perception of aging, neighboring and community organizations), and in the sphere of human rights (care affordability, social safety-net coverage and national policy). Four core determinants (poverty, education, gender and religiosity) were intertwined in shaping beliefs and behaviors.

Understanding the planning and preparation for diabetes self-management of grey nomads when travelling in rural and remote Australia: An exploratory survey.

OBJECTIVE: Many older Australians with chronic health conditions, including diabetes, are taking to the road in a recreational vehicle following retirement and are colloquially known as grey nomads. This exploratory online survey aimed to ascertain the issues on the road for grey nomads with diabetes and their experiences of self-management of their diabetes whilst in rural and remote regions of Australia. METHODS: Following ethical approval and piloting, an online survey was distributed through social media sites used by grey nomads and those with diabetes. From the closed and open-ended responses from travelers with diabetes in rural and remote areas, the demographics of this cohort were explored, as well as their self-management of diabetes. RESULTS: A total of 103 grey nomads with diabetes responded and 81 completed all survey questions. There was wide variation in the respondents' answers in regard to their self-management including their preparation for travel; their knowledge of diabetes and accessing health-care services; their management of illness; and their experiences whilst travelling including the effects of COVID-19. It was identified that there was a need for an increase in preparation prior to travel, and several important checks were identified for this planning specific to rural and remote areas of Australia, including the expectations of health services in these regions. CONCLUSIONS: A pretravel checklist for travellers with diabetes is recommended to contribute to better self-management of grey nomads with diabetes on the road in order to alleviate the issues identified.

Health Services Utilization Barriers for Rural Elderly Women in Bangladesh: Narratives of Clinicians, Pharmacists and Public Health Assistants.

Bangladesh has the third largest population of poor older adults in the world and 73% of them live in rural areas. Disparity in the country's health services is evident that creates a substantial pressure, especially on rural elderly women who live in a compromised socio-cultural atmosphere. This is true that we know about rural elderly women's self-reported health and service use barriers, but no studies captured the views of health staff. This study presents a qualitative exploration of the views held by rural health staff whose role is to provide care to local elderly women. We conducted 11 interviews with clinicians, pharmacists and public health assistants in Sylhet district, Bangladesh. A critical thematic discourse analysis, using the critical social constructs of Habermas and Honneth, of the data informed the women's inadequate healthcare access and associated barriers that were complex and overlapping but had explicit institutional, subjective and material consequences. Five major themes emerged including: unequal distribution of health services; marginalization in patient-staff relationships; living with poverty; social relegation; and mistrust of clinical treatment. Rural areas were viewed with inequitably distributed health services and traditionally a large proportion of elderly women living in poverty who lacked social support and demonstrated a mistrust towards healthcare system. No recognition of the women and power differences were underpinned by economic factors and cultural societal values. The findings suggest a need for health policy solutions and education of healthcare staff and elderly women regarding accessing healthcare.

What women want: Women's health in Rural and Regional Australia - Insights from an interprofessional research collaboration between academic researchers, nursing clinicians, and industry professionals.

The aim of this study was to (a) investigate community women's knowledge and experiences of women's health community services in northern rural and regional New South Wales, Australia; (b) identify any existing gaps in community women's health programs in this region and (c) to contribute to service provision, strategic planning, and industry professional development of community nurse researchers in collaboration with industry. The research took place in Northern New South Wales Local Health District (NNSWLHD) Australia, which is comprised of Tweed/Byron, Richmond and Clarence Health Service Groups, during May to September 2019. Participants comprised 13 women's health service clients over the age of 18 years and less than 74 years, attending health services clinics within NNSWLHD. The research was undertaken as a partnership between three senior healthcare professionals (Clinical Nurse Consultants), one from each Health Service Group, and academic researchers, who provided the key senior healthcare professionals with research training and guidance. Key themes related to primary healthcare experiences and needs of women living in NNSWLHD, and the quality of women's primary healthcare services in that region. Thematic analysis revealed four key themes and several sub-themes. These were (1) Knowledge and Awareness of Services, (2) Barriers to Access, (3) Personal Issues and (4) A Need for Women-Centred Care. The major issues women experienced were deficits in services, lengthy wait times and poor access. Additional funding is necessary to uphold community women's health nurse positions in rural health to improve women's health outcomes in these locations.

Exploring the System Determinants Associated with Senior Women's Access to Medical Care in Rural Bangladesh.

Senior women's access to medical care in rural Bangladesh is a major public health concern. This study aims to explore the system determinants that impact on rural senior women's utilization of healthcare. Following a qualitative critical social research design, healthcare staff and senior women living in three rural villages of Bangladesh were approached to participate in face-to-face audio-recorded interviews. A total of 11 staff and 25 senior women were interviewed with questions about health policy, healthcare services and management of aged care. Data was analyzed using a blend of critical discourse and thematic analysis methods. Several healthcare system determinants were identified that were complex and cross-sectional. Three major themes emerged from the system determinants: legal framework of aged care; inadequate healthcare support; and professional knowledge and skills of healthcare staff that led the rural senior women to avoid or delay access to hospitals and clinics. The findings revealed that a lack of health focus and professional skills among healthcare staff can be considered as critical. This study recommends that policy and organizational changes are made to improve the women's access to rural hospitals and clinics in Bangladesh.

Critical social framework on the determinants of primary healthcare access and utilisation.

This paper aims to contextualise 'healthcare access and utilisation' within its wider social circumstances, including structural factors that shape primary healthcare for marginalised groups. Mainstream theories often neglect complexities among the broader social, institutional and cultural milieus that shape primary healthcare utilisation in reality. A blended critical social framework is presented to highlight the recognition and emancipatory intents surrounding person, family, healthcare practice and society. Using the theoretical contributions of Habermas and Honneth, the framework focuses on power relationships, misrecognition/recognition strategies, as well as disempowerment/empowerment dynamics. To enable causal and structural analysis, we draw on the depth ontology of critical realism. The framework is then applied to the case of rural elderly women's primary healthcare use in Bangladesh. Drawing on the literature, this article illustrates how a blended critical social perspective reveals the overlapping and complex determinants that affect primary healthcare utilisation, before concluding with the importance of situating healthcare access in sociocultural structures.

Grey nomads with diabetes self-management on the road - a scoping review.

INTRODUCTION: This scoping literature review explored the characteristics and behaviours of a subset of Australia's older population: 'grey nomads', many who live and travel with type 1 or 2 diabetes mellitus. Grey nomads are people aged more than 55 years, who travel in caravans or motorhomes for extended periods of time around rural and remote areas of Australia. Grey nomads are challenging the established view of ageing in Australia by their lifestyle choices, which include social and economic contribution, independence and furthering of personal fulfilment. However, some evidence suggests that grey nomads experience health issues while in rural locations, which exerts a significant burden on already under-resourced Australian rural health services. This review seeks knowledge on grey nomads' self-management of diabetes while travelling, with the aim of understanding their experiences and identifying support services and strategies that would facilitate improved self-management. Furthermore, this review seeks knowledge of how Australia's rural and remote health services support the nomads with diabetes and the influence of this burgeoning population on such services. METHODS: A scoping review methodology provided the methods to map the current evidence concerned with this broad and complex topic. A systematic six-step framework was adopted: identifying the research question; identifying relevant literature; selecting studies; charting the findings; collating, summarising and reporting results; and a final consultation. RESULTS: The grey nomads in this review travelled long distances through the often-harsh Australian countryside where they sought, privacy, isolation, self-sufficiency and a closeness with nature. Although their motivations included life- and health-enhancing experiences, most grey nomads travelled with at least one chronic health condition, which they did not consider as a barrier to adopting a grey nomad lifestyle. However, many were under-prepared for their health needs when in rural or remote Australia. Specific literature concerning grey nomads and self-management of diabetes was not found but salient aspects of diabetes self-management were identified and included a well-developed relationship with their diabetes healthcare provider; a relationship that relied on ongoing communication and support. When travelling, the ability to form or sustain supportive relationships with local health care providers was limited due to sparseness of rural services and the perceived transient nature of the relationship. Increasingly, grey nomads utilised digital technology via telemedicine or social media sites for information and advice on health issues. The local pharmacies in rural and remote locations were also identified as sources of support and services. CONCLUSION: The literature showed that the grey nomad population had a similar distribution of chronic illness, including diabetes, to that of the general Australian population, but very little was published about how they self-manage conditions when in remote locations where healthcare services were limited. The emerging roles of digital technology and development opportunities for pharmacists offer new and innovative avenues to support grey nomads with diabetes while travelling in rural and remote Australia.

The World Is Not Mine - Barriers to Healthcare Access for Bangladeshi Rural Elderly Women.

Social determinants of health is a core cross-cutting approach of the World Health Organization to reduce health inequalities, and places an emphasis on aged care planning in rural areas of low- and lower-middle income countries including Bangladesh. The complex correlated health and social factors in Bangladesh interplay to shape the healthcare access of rural people. This impact is significant for rural elderly women in particular who have been shown to access healthcare in ways that are described as 'socially determined'. This study aimed to explore how this cohort related their healthcare access to their living circumstances and provided insight into how their healthcare access needs can be addressed. This study was a critical social theoretical exploration from conversational interviews held over three months with 25 elderly women in rural Bangladesh. Two critical social constructs, 'emancipation' of Habermas and 'recognition' of Honneth, were used in the exploration and explanation of the influence of personal circumstances, society and system on rural elderly women's healthcare access. The concept of 'social determinants of healthcare access' is defined from the physical, emotive, symbolic and imaginative experiences of these women. Interviewing the women provided information for exploration of the determinants that characterized their experiences into an overall construct of 'The World is Not Mine'. This construct represented four themes focusing on the exclusion from healthcare, oppressive socioeconomic condition, marginalization in social relationships and personal characteristics that led the women to avoid or delay access to modern healthcare. This study confirms that the rural elderly women require adequate policy responses from the government, and also need multiple support systems to secure adequate access to healthcare. As healthcare services are often a reflection of community values and human rights concerns for the elderly, there is a need of recognition and respect of their voice by the family members, society and the healthcare system in planning and implementation of a prudent aged care policy for rural elderly women in Bangladesh.

Grey nomads with diabetes: the experience of rural and remote diabetes educators in South Australia.

The phenomenon of grey nomads travelling in rural and remote regions of Australia is on the increase, and as this cohort is an older age group, they are often travelling with chronic conditions, such as diabetes. Seven rural and remote diabetes educators were interviewed about their experiences of grey nomad travellers with diabetes, to whom they provided services. The findings revealed problems associated with grey nomads with diabetes, including maintenance of equipment, medications, self-management, glycaemic control and unpredictable events. The problems highlighted by the participants were exacerbated when travelling long distances for extended periods, often with changes to their usual regime of self-management. The isolation and remoteness of some areas was a factor for the travellers who were often not prepared and often turned to pharmacists for help. The participants were able to enhance the care and self-management of the travellers with diabetes and identified several pathways travellers may undertake if they needed services related to their diabetes. The diabetes educators' capacity to provide services for travellers was stretched at times; however, this was viewed as positive in that it added diversity to their normal practice. Recommendations included a preparation checklist and information for travellers with diabetes and further education for pharmacists.

Nurses' Knowledge and Attitudes Toward Complementary and Alternative Medicine for Adult Patients With Cancer in Bandung, West Java, Indonesia: A Qualitative Study.

The aim of this study was to explore nurses' knowledge and attitudes toward the use of complementary and alternative medicine (CAM) among cancer patients in a palliative care setting. A descriptive qualitative approach was used in this study. Semistructured interviews were conducted with 10 nurses recruited using purposive sampling. The data were analyzed using an inductive semantic approach. Thematic analysis identified that nurses possess limited knowledge of CAM. Nurses were skeptical toward CAM and less confident to recommend its use. Four main themes (and two subthemes) emerged: Understanding of CAM, Hesitative Attitudes, Personal Experience, and Preferences in Learning about CAM. There is a need to integrate CAM topics into nursing education programs in order to develop nurses' knowledge and build positive attitudes toward CAM use. Sufficient knowledge and positive attitudes toward CAM would support safety and quality of care in management of patients with cancer who use or are contemplating using CAM.

NURSING AND MIDWIFERY STUDENTS TEACHING INFECTION CONTROL IN INDONESIA.

Morbidity, mortality and quality of life are impacted on by healthcare-associated infections (HAI) which are preventable. According to the World Health Organization 2016), in developing countries, around 10% of patients will contract HAI.

Nurses' Knowledge and Attitudes toward Complementary Therapies for Cancer: A Review of the Literature.

Complementary therapies (CTs) are nonconventional supportive therapies, which are used by the patients with cancer. The use of CTs has been known to alleviate symptoms as a result of chemotherapy and to improve quality of life. However, if CTs are inappropriately used, there may be adverse reactions or no effect resulting in poor support of the cancer treatment. Nurses play an important role in supporting patients with cancer who often seek information regarding CTs. Within their scope of practice, it is expected that nurses have sufficient knowledge about the safety and effective use of CTs, and positive attitudes toward supporting patients who wish to use CTs. This review aims to examine existing literature regarding nurses' knowledge and attitudes toward CTs for patients with cancer. English language articles obtained from recognized nursing and midwifery databases such as CINAHL, Google Scholar, Medline, ProQuest Central, and Scopus for the period between 2002 and 2015 were searched. A total of 96 articles were retrieved using the search terms with only 13 eligible articles meeting the inclusion criteria. Three major themes were identified by the thematic analysis of reviewed studies: nurses' knowledge about CTs, nurses' attitudes toward CTs, and sources information about CTs. The majority of studies investigating nurses' knowledge and attitudes toward the use of CTs for oncology was conducted in developed countries. Overall, it was identified that nurses need to improve their knowledge and skills about CTs so that they were more confident to assist patients in integrating conventional treatment and CTs for cancer management.

WOMEN'S HEALTH NURSES: WHY WE NEED THEM.

With governments reducing funding in health services, the eroding of nursing positions in the community have been severely impacted on, including women's health nurses.

Australian women's fertility experiences prior to a termination of pregnancy.

OBJECTIVE: This research aimed to investigate the fertility management of women aged over 30 years prior to a termination of pregnancy (TOP) to inform primary health care service delivery providers and policy makers. DESIGN: An ethically approved, two-phase sequential explanatory mixed methods design was used. This paper reports on part of that study. SETTING: The study was conducted in five South Australian TOP clinics. PATIENTS: Women aged over 30 years attending for a TOP in 2009 were invited to participate. INTERVENTIONS: The Contraception Sexual Attitude Questionnaire (modified version) of women attending termination of pregnancy services was used. MAIN OUTCOMES MEASURES: Quantitative data analysis utilized SPSS V16 where simple descriptive statistics were described. RESULTS: There were 101 questionnaire respondents where 70.5% were Australian women, predominantly married and with children. Women used contraception but experienced method failure, were beginning a new method, or were afraid of side effects. Risk-taking behaviours were reported such as putting the possibility of pregnancy out of their mind, getting carried away and not thinking of pregnancy risk, or frequently having unprotected intercourse. CONCLUSION: Service delivery needs to include age specific programs, and policy makers need to include policies which are adequately funded and evaluated. Further research is required to provide greater depth of knowledge in this area.

Termination of pregnancy and the over 30s: what are trends in contraception use 1996-2006?

There is a shift in fertility patterns with more women commencing childbearing over 30 years of age. Little is known about trends in contraception use by women in this age group seeking a termination of pregnancy. This research presents a trend analysis to determine if there were significant changes in trends in contraception use pre- and post-termination of pregnancy for women over 30 years of age from 1996 to 2006 in South Australia. Data were collected from 1996 to 2006 from a service in South Australia. Data were examined using simple linear regression. At the time of conception, 53% of women reported using some form of contraception. Additionally, there was a significant decline in women using natural family planning methods at conception. Post-operatively, there was a significant decline in hormone methods being chosen, and a significant increase in women not using any contraception. Women over 30 years of age used contraception at the time of conception pre- and post-operatively of having a pregnancy terminated over the 10 year period of the study. Health promotion activities need to be further developed to cater for this age group and to take into consideration changing fertility patterns.

A systematic review of trend studies of women seeking termination of pregnancy.

AIMS AND OBJECTIVES: This article reports a systematic review of trend studies (1995-2006) which answers five questions: What are the patterns of: 1 Age of women seeking termination of pregnancy; 2 First ever pregnancy ending in a termination; 3 Contraception usage at the time of conception; 4 Contraception chosen immediately postoperatively; and 5 Referral sources to termination of pregnancy services. BACKGROUND: Fertility patterns are changing and there is evidence to indicate that the numbers of older women conceiving for the first time are increasing. At the same time, there are new methods of contraception widely available. Little is known about the implications of these changes on termination patterns. DESIGN: An extensive electronic search of databases such as CINAHL, MEDLINE In-Process (OVID) and was conducted from January 1995-June 2006 for trend studies in pregnancy terminations. METHODS: Articles chosen were based on trend studies greater than five years, contained primary quantitative research and official government statistical reports. RESULTS: Results of the search showed age that was unable to be compared because of the many variations in measurements and time periods, and there was only limited research worldwide of trends in contraception at the time of conception in relation to a termination of pregnancy. Additionally, there were no studies worldwide in the past 11 years, which specifically examined trends in the characteristics of the number of first-ever pregnancies which ended in a termination, contraception choices postoperative to a termination of pregnancy, or referral source to a termination of pregnancy provider. CONCLUSION: Little is reported in the literature on trends in the five characteristics related to pregnancy termination. RELEVANCE TO CLINICAL PRACTICE: Evidence about the changing patterns of women seeking pregnancy termination is needed to inform policy and practice, and to ensure that health promotion strategies are underpinned by accurate information that reflects the needs of the populations of women in relation to their reproductive health.