Virtual Dementia-Friendly Communities (Verily Connect) Stepped-Wedge Cluster-Randomised Controlled Trial: Improving Dementia Caregiver Wellbeing in Rural Australia.

Caring for people living with dementia often leads to social isolation and decreased support for caregivers. This study investigated the effect of a Virtual Dementia-Friendly Rural Communities (Verily Connect) model on social support and demand for caregivers of people living with dementia. The co-designed intervention entailed an integrated website and mobile application, peer-support videoconference, and technology learning hubs. This mixed-methods, stepped-wedge, cluster-randomised controlled trial was conducted with 113 participants from 12 rural communities in Australia. Caregiver data were collected using MOS-SSS and ZBI between 2018 and 2020. The relationship between post-intervention social support with age, years of caring, years since diagnosis, and duration of intervention were explored through correlation analysis and thin plate regression. Google Analytics were analysed for levels of engagement, and cost analysis was performed for implementation. Results showed that caregivers' perception of social support (MOS-SSS) increased over 32 weeks (p = 0.003) and there was a marginal trend of less care demand (ZBI) among caregivers. Better social support was observed with increasing caregiver age until 55 years. Younger caregivers (aged <55 years) experienced the greatest post-intervention improvement. The greatest engagement occurred early in the trial, declining sharply thereafter. The Verily Connect model improved caregivers' social support and appeared to ease caregiver demand.

Virtual reality to foster empathy in disability workers: A feasibility study during COVID-19.

BACKGROUND: Empathy is a critical skill required by disability workers. Virtual reality may increase access to staff training to foster empathy. METHOD: A mixed methods feasibility study investigated a custom-built virtual reality program, IMercyVE, which aimed to immerse a disability worker in a first-person perspective of having intellectual disability. Data were collected through online surveys (n = 9) completed before and after use of IMercyVE, and by videoconference focus groups (n = 6). RESULTS: Qualitative findings included that IMercyVE delivered a novel experience for participants and a distinctive mode of learning that assisted participants to deepen their levels of empathy. Descriptive analyses of the surveys indicated that participants' empathy increased after engaging with IMercyVE. CONCLUSIONS: IMercyVE has the potential to be offered as a remotely delivered and flexible staff training modality suitable for building empathy. Further research with a larger sample is warranted.

Web-Based Technologies to Support Carers of People Living With Dementia: Protocol for a Mixed Methods Stepped-Wedge Cluster Randomized Controlled Trial.

BACKGROUND: Informal carers play a significant role in supporting people living with dementia; however, carers in rural areas are often isolated, with limited access to support services. Although dementia-friendly communities provide valued support for carers, access to them is limited as they are few and geographically dispersed. OBJECTIVE: This study's aim was to increase support and services for rural informal carers of people living with dementia by using information and communication technologies accessed through an integrated website and mobile app-the Verily Connect app. The objective of this protocol is to detail the research design used in a complex study that was situated in a challenging real-world setting integrating web-based and on-ground technology and communication. Therefore, it is anticipated that this protocol will strengthen the research of others exploring similar complex concepts. METHODS: A stepped-wedge, open-cohort cluster randomized controlled trial was conducted to implement Verily Connect across 12 rural Australian communities. The Verily Connect intervention delivered web-based, curated information about dementia, a localized directory of dementia services and support, group and individual chat forums, and peer support through videoconference. During the implementation phase of 32 weeks, Verily Connect was progressively implemented in four 8-weekly waves of 3 communities per wave. Usual care, used as a comparator, was available to carers throughout the study period. Participants and researchers were unblinded to the intervention. There were 3 cohorts of participants: carers, volunteers, and staff; participants were recruited from their communities. The primary outcome measure was perceived carer social support measured using the Medical Outcomes Study-Social Support Survey. Volunteers and staff provided feedback on their participation in Verily Connect as qualitative data. Qualitative data were collected from all cohorts of participants through interviews and focus groups. Process evaluation data were collected through interviews and memos written by research staff. Data on the costs of implementing Verily Connect were collected by the research team members and evaluated by a health economist. RESULTS: Between August 2018 and September 2019, a total of 113 participants were recruited. There were 37 (32.7%) carers, 39 (34.5%) volunteers, and 37 (32.7%) health service staff. The study was complex because of the involvement of multiple and varied communities of carers, volunteers, health service staff, and research team members originating from 5 universities. Web-based technologies were used as intervention strategies to support carers and facilitate the process of undertaking the study. CONCLUSIONS: The Verily Connect trial enabled the testing and further development of a web-based approach to increasing support for carers of people living with dementia across a diverse rural landscape in Australia. This protocol provides an example of how to conduct a pragmatic evaluation of a complex and co-designed intervention involving multiple stakeholders. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12618001213235; https://tinyurl.com/4rjvrasf. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/33023.

Growing occupation-centred therapists for the future: Understanding student experiences of learning about occupation and its place in occupational therapy practice.

INTRODUCTION: Occupational therapy entry-level education is integral to how students obtain deep understanding of occupational therapy's core philosophy of occupation and its place in practice. However, there is a lack of research that explores occupation-centred education from the perspectives of students. Therefore, this study aimed to identify Australian entry-level occupational therapy students' experiences of learning about occupation, and its place in practice. METHODS: A qualitative descriptive design was adopted. Overall, 20 students participated in four focus groups lasting between 45 and 75 min. Data were audio-recorded and transcribed verbatim. Transcripts were analysed in two phases, using reflexive thematic analysis. FINDINGS: There were three themes that encapsulated what helped students to better understand occupation and its place in practice: (1) making occupation real; (2) relating occupation to me; and (3) theory as a focussing lens. There was also a range of pedagogical strategies that helped students to better understand occupation: using active and interactive teaching and learning strategies. One additional theme indicated a challenge to helping the students understand occupation and its place practice: when practice education settings were not centred on occupation. CONCLUSION: Learning about occupation and occupation-centred practice may be facilitated by using practice examples, encouraging students to think about occupation in their own lives, teaching and applying occupation-centred theory, and employing interactive learning and teaching strategies. Student learning in practice settings where occupational therapy is centred on occupation is imperative. Further exploration of students' perspectives of learning about occupation across multiple occupational therapy programmes is warranted.

Volunteers' Support of Carers of Rural People Living with Dementia to Use a Custom-Built Application.

There is great potential for human-centred technologies to enhance wellbeing for people living with dementia and their carers. The Virtual Dementia Friendly Rural Communities (Verily Connect) project aimed to increase access to information, support, and connection for carers of rural people living with dementia, via a co-designed, integrated website/mobile application (app) and Zoom videoconferencing. Volunteers were recruited and trained to assist the carers to use the Verily Connect app and videoconferencing. The overall research design was a stepped wedge open cohort randomized cluster trial involving 12 rural communities, spanning three states of Australia, with three types of participants: carers of people living with dementia, volunteers, and health/aged services staff. Data collected from volunteers (n = 39) included eight interviews and five focus groups with volunteers, and 75 process memos written by research team members. The data were analyzed using a descriptive evaluation framework and building themes through open coding, inductive reasoning, and code categorization. The volunteers reported that the Verily Connect app was easy to use and they felt they derived benefit from volunteering. The volunteers had less volunteering work than they desired due to low numbers of carer participants; they reported that older rural carers were partly reluctant to join the trial because they eschewed using online technologies, which was the reason for involving volunteers from each local community.

Understanding ageing well in Australian rural and regional settings: Applying an age-friendly lens.

OBJECTIVE: This study investigates how rural community-dwelling older adults' views on what is important in maintaining health and wellbeing align with the eight age-friendly domains proposed by the World Health Organisation, and which domains are most salient. DESIGN: Data were gathered through open-ended response postcards distributed using a whole-of-community approach. SETTING: The Rural City of Wangaratta, a rural local government area located in north-east Victoria. PARTICIPANTS: 262 postcards were returned by rural older adults, carers and family members. MAIN OUTCOME MEASURE: Thematic analysis of open-ended responses to the following question: what is important to you as you grow older (or your loved one), in terms of keeping healthy and well? RESULTS: Even though all eight age-friendly domains were identified as important for health and wellbeing, community and health services was the most frequently discussed domain, followed by transportation and access to outdoor spaces and buildings. However, individual-level factors, inclusive of personal activities, attitudes and capacities, were also identified as important to rural older adults. CONCLUSION: Findings support the use of the World Health Organization's age-friendly city framework in assessing what is important to rural older adults' health and wellbeing, with the community and health services domain most salient. However, individual-level activities, attitudes and capacities must also be considered.

Identifying support needs to improve rural dementia services for people with dementia and their carers: A consultation study in Victoria, Australia.

OBJECTIVE: The support and service needs of people with dementia and their carers are not always addressed in rural regions, yet family carers play an important role in supporting the person living with dementia to remain living in their own home. This study sought to identify and prioritise service and support needs of people with dementia and carers. DESIGN: A two-phase mixed methods study involving qualitative focus groups and a survey. SETTING: A rural region in Victoria, Australia. PARTICIPANTS: People living with dementia, carers and health professionals. RESULTS: Focus groups identified 12 areas of need. A follow-up survey reached consensus on the priority areas for service improvement. These included diagnosis and information access, dementia training, community understanding and carer support. CONCLUSION: Living in a rural region imposes significant challenges on people with dementia and carers. We need to find ways to address gaps in service provision for carers and people with dementia in rural settings and examine their applicability in other rural regions more broadly.

Quality allied health clinical supervision policy in Australia: a literature review.

Clinical supervision is presented as a complex set of skills that may broadly apply to any and all allied health professions. However, it is also noted that a clear understanding of clinical supervision and how to implement it in allied health is currently lacking. It is argued that there is a need to reflect upon current approaches to clinical supervision amongst allied health professionals and to gain a shared understanding about what supervision involves, what effective supervision is, and what effective implementation of clinical supervision might look like. By gaining an understanding of what high quality clinical supervision is and how it is best put into practice, it is anticipated that this will form the first step in developing an understandable and useful universal supervision policy for all allied health professionals.

Enhancing occupational therapists' confidence and professional development through a community of practice scholars.

INTRODUCTION: An important professional issue for occupational therapy is the need to develop and maintain high-quality occupational therapy services. Clearly, a strong educational foundation is necessary, but not sufficient, for meeting this goal. Occupational therapists need to engage in ongoing education, professional development and critique of their theory and practice to ensure they meet best practice standards. One way that practitioners can do this, is to form practitioner communities with a focus on scholarship: a 'community of practice scholars'. METHODS: Using the framework of action research, three occupational therapy academics worked collaboratively with 25 occupational therapy practitioners over a period of 12 months. During monthly teleconference meetings, the research group discussed, critiqued and reflected upon their practice. Transcripts of the final month's teleconferences, which focussed on evaluation of the community of practice scholars, were qualitatively analysed. FINDINGS: Two major themes are presented. The first theme, promotion of scholarship, describes that involvement in the community of practice scholars assisted participants to think more critically about their practice and to consider ways in which their practice might be improved. The second theme, promoting professional confidence, passion and cohesion, articulates that the support offered by the group helped the participants to feel an increased sense of confidence in their practice. CONCLUSION: It is proposed that communities of practice scholars have considerable potential for providing professional development opportunities for occupational therapists. In addition, such communities may lead to occupational therapists feeling more supported and experiencing increased satisfaction in their work.

Utopian visions/dystopian realities: exploring practice and taking action to enable human rights and occupational justice in a hospital context.

AIM: This article reports some preliminary findings of an Australian action research project that aimed to investigate, and affect, occupational therapists' understanding of human rights theory and occupational justice philosophy in everyday occupational therapy practice. METHOD: Over the course of one year, nine therapists from a range of practice areas in a major metropolitan hospital participated in monthly discussion groups. Narrative data was collected through audio-recording and transcribing the discussions. Data was qualitatively analysed using line-by-line coding and theme-building. RESULTS: Two preliminary themes are discussed herein: the invisibility of human rights issues in an Australian occupational therapy setting and the dissonance between the ideal and the reality of human rights practice in occupational therapy. CONCLUSION: The authors suggest that through discussion, and with the support of a community of practice dedicated to exploring human rights and occupational justice issues, occupational therapists can increase their awareness of human rights challenges. And, therapists can increase their actions to better enable occupational justice in their practice.

Raising awareness of hegemony in occupational therapy: the value of action research for improving practice.

BACKGROUND/AIM: Anecdotally, occupational therapists have identified problems of lack of professional recognition. This situation can mean that health service users' occupational needs are unmet and it can also cause difficulties for the profession of occupational therapy. Therefore, the study described in this paper aimed to better understand the issues of describing occupational therapy in a hospital setting and use this understanding to improve representations of occupational therapy. METHODS: Fifteen occupational therapists engaged in two action research cycles of reflection-action-evaluation over an 18-month period in 2004 and 2005. Transcriptions of individual interviews and group discussions of the participating therapists formed the main dataset. Data were qualitatively analysed. RESULTS: Participating therapists discovered that the occupational therapy profession is not accorded the regard that it deserves and that the profession is not well understood by others. In addition, occupational therapists may be contributing to this lack of awareness and regard through their own unconscious overly conformist behaviour that contributes to the presence of hegemony and professional image problems. CONCLUSION: Therapists are encouraged to engage in questioning of the taken-for-granted dominance of medical discourses upon their practice. Furthermore, ongoing reflection upon their own attitudes and behaviours may enable occupational therapists to improve professional recognition, representation and autonomy.

Language, identity and representation: occupation and occupational therapy in acute settings.

AIM: This article presents findings from a participatory action research study into the experience and use of occupation, theory and evidence in the everyday practice of a group of occupational therapists working in a large metropolitan hospital delivering a range of acute services, in Melbourne, Australia. METHODS AND FINDINGS: Narrative data gathered from 11 individual interviews and 10 group discussions were analysed through numerous iterative cycles to explore research issues and evaluate research actions. This article discusses why the participating occupational therapists chose to change the language they used to describe their practice from a focus on 'function' to a focus on 'occupation'. This change improved the therapists' levels of confidence, strengthened their professional identities and provided for a sense of renewed empowerment within the organisation. CONCLUSIONS: The findings suggest that occupational therapists in acute settings can utilise language more effectively to augment their ability to promote the vital and unique contribution that occupational therapy has to make. Such small, yet powerful changes can empower occupational therapists to address long-standing dilemmas of representation and enable transformative practices.

Spirituality as sustenance for mental health and meaningful doing: a case illustration.

In the past 10-20 years there has been increasing interest in the relationship between spirituality and health. I interviewed six patients from community mental health centres, using a phenomenological approach to explore how concepts of spirituality, occupation and mental illness/mental health are related. One person's story is presented to illustrate the issues. Four main themes were identified: Spirituality is a phenomenon that provides meaning to life. Spirituality can help a person cope with mental illness. Spiritual beliefs can make everyday occupations more meaningful and health-enhancing. Some people find it valuable to engage in shared occupations that focus on spirituality. Spirituality is an important and relevant issue to be discussed between patients and health practitioners, provided that practitioners can exercise sensitivity, caution, tolerance and acceptance of values that may differ from their own.

Treading lightly: spirituality issues in mental health nursing.

Spirituality has been recognized as an important part of nursing practice since its early beginnings. However, debate continues about whether and how nurses and other mental health professionals should include spirituality within their daily work. This paper aims to contribute to the discussion of spirituality within mental health nursing, through considering findings from a Heideggerian phenomenological study conducted with six people with mental illness living in regional Australia. This study aimed to provide a greater understanding of the phenomenon of spirituality by answering a primary research question, 'What does spirituality mean for people with a mental illness?' Participants were interviewed and data analysed using an iterative approach. Findings emerged through multiple readings and meanings were gradually constructed from the data into themes. The themes describe that spirituality is experienced uniquely for the participants, and that spirituality became vitally important to them when they became mentally unwell. In addition, issues of interest to mental health nurses were raised but not completely addressed by the study. The issues relate to potential interactions about spirituality between nurses and their patients. Although participants wanted to discuss their experiences of spirituality with others, they raised concerns about whether their mental health care providers would be accepting of their beliefs. Spirituality was deemed to be a highly individual phenomenon; it could be experienced as a journey and it was life-sustaining. For these reasons, it is proposed that mental health professionals must be prepared to discuss patients' spiritual needs in the context of their health concerns.