Health Practice Research Articles

Navigating wicked problems: the unrecognised contribution of social pedagogy to Aotearoa New Zealand’s successful Covid-19 response

Aotearoa New Zealand’s government, alongside its Indigenous Māori and Pacific communities, spearheaded a unique and effective response to the first three years of the Covid-19 crisis that swept the world. The measures taken enabled the country to largely keep its society within its borders open and functional, minimise the impact of the pandemic on individual lives and community well-being and keep morbidity rates low. While there have been numerous studies and articles exploring this national response, to this point no examination has been undertaken through a social pedagogical lens. This article identifies key concepts from the discipline that are relevant to Aotearoa New Zealand’s context, discusses the ways in which these were (albeit unknowingly) applied during the peak of the pandemic and explores future potential for application in social and public health policy and practice. Weaving together a shared framework of Māori, Pacific and unique Aotearoa New Zealand world views and cultural practices alongside the principles of social pedagogy presents an exciting opportunity to shape a national crisis response that is effective and meets the needs of diverse communities. It is argued that making the contribution of social pedagogy visible has the potential to enhance responses to wicked problems in times of crisis and further the acceptance of the discipline in the southern hemisphere.

MENTAL HEALTH IN THE CONTEXT OF CLIMATE CHANGE

Climate change has intensified in recent decades, generating devastating consequences for the environment and, consequently, for human health. Mental health has emerged as a critical area of concern, since extreme weather events such as natural disasters, droughts and floods directly impact the psychological well-being of vulnerable populations. This study aims to analyze how climate change influences mental health, focusing on the psychological effects these changes have on communities in situations of vulnerability. The aim of this analysis is to explore how climate change impacts the mental health of vulnerable populations, discussing the main risk factors involved and addressing strategies that can be adopted to minimize these effects. This discussion is relevant because recognizing the emotional consequences of the climate crisis creates a basis for developing public health practices and psychosocial approaches that promote resilience and adaptation. By focusing on the psychological impact of climate change, we aim to contribute to a more comprehensive and inclusive response to the challenges of a changing world. This is a literature review, based on a qualitative approach, using the Scielo, Google Scholar and PubMed databases. To enhance the research, the health descriptors “climate change”, “mental health”, “psychological impacts” and “solastalgia” were used, with a time frame between 2007 and 2020. The methodology adopted for this analysis consists of a comprehensive literature review, using academic sources and reports from health and environmental organizations. The study addresses how extreme weather events, food insecurity and forced displacement affect mental health, leading to an increase in disorders such as anxiety, depression and post-traumatic stress disorder (PTSD). In addition, the social inequalities that aggravate these impacts are discussed, considering that populations with less access to health resources and services are more susceptible to the adverse effects of climate change. It is concluded that climate change poses a significant threat to mental health, especially for vulnerable populations already facing socio-economic challenges. It is essential that public health policies integrate mental health considerations into climate change adaptation and mitigation strategies. Promoting psychological support programs and implementing targeted interventions can help minimize the negative impacts on mental health, strengthening the resilience of affected communities and promoting a more effective response to climate crises.

Integrating large language models in mental health practice: a qualitative descriptive study based on expert interviews

BackgroundProgress in developing artificial intelligence (AI) products represented by large language models (LLMs) such as OpenAI’s ChatGPT has sparked enthusiasm for their potential use in mental health practice. However, the perspectives on the integration of LLMs within mental health practice remain an underreported topic. Therefore, this study aimed to explore how mental health and AI experts conceptualize LLMs and perceive the use of integrating LLMs into mental health practice.MethodIn February–April 2024, online semi-structured interviews were conducted with 21 experts (12 psychiatrists, 7 mental health nurses, 2 researchers in medical artificial intelligence) from four provinces in China, using snowballing and purposive selection sampling. Respondents’ discussions about their perspectives and expectations of integrating LLMs in mental health were analyzed with conventional content analysis.ResultsFour themes and eleven sub-themes emerged from this study. Firstly, participants discussed the (1) practice and application reform brought by LLMs into mental health (fair access to mental health services, enhancement of patient participation, improvement in work efficiency and quality), and then analyzed the (2) technological-mental health gap (misleading information, lack of professional nuance and depth, user risk). Based on these points, they provided a range of (3) prerequisites for the integration of LLMs in mental health (training and competence, guidelines for use and management, patient engagement and transparency) and expressed their (4) expectations for future developments (reasonable allocation of workload, upgrades and revamps of LLMs).ConclusionThese findings provide valuable insights into integrating LLMs within mental health practice, offering critical guidance for institutions to effectively implement, manage, and optimize these tools, thereby enhancing the quality and accessibility of mental health services.

A critical review of literature and a conceptual framework for organising and researching urban health and community health services in low- and middle-income countries.

Low- and middle-income countries (LMIC) are rapidly urbanizing, and in response to this, there is an expansion in the body of scholarship and significant policy interest in urban healthcare provision. The idea and the reality of 'urban advantage' has meant that health research in low- and middle-income countries (LMICs) has disproportionately focused on health and healthcare provision in rural contexts and is yet to sufficiently engage with urban health as actively. We contend that this research and practice can benefit from a more explicit engagement with the rich conceptual understandings that have emerged in other disciplines around the urban condition. Our critical review included publications from four databases (MEDLINE, EMBASE, CINAHL and Social Sciences Citation Index) and two CHW resource hubs. We draw upon scholarship anchored in sociology to unpack the nature and features of the urban condition; we use these theoretical insights to critically review the literature on urban community health worker programs, as a case to reflect on community health practice and urban health research in LMIC contexts. Through this analysis, we delineate key features of the urban - such as heterogeneity, secondary spaces and ties, size and density, visibility and anonymity, precarious work and living conditions, crime, and insecurity, and specifically the social location of the urban CHWs and present their implications for community health practice. We propose a conceptual framework for a distinct imagination of the urban to guide health research and practice in urban health and community health programs in the LMIC context. The framework will enable researchers and practitioners to better engage with what entails a 'community' and a 'community health program' in urban contexts.

Understanding occupational therapy perinatal mental health practice in mothers from ethnic minorities: A qualitative study of practitioner perceived barriers and enablers

Introduction: In the United Kingdom, ethnic minority mothers experience increased risk of mental illness compared to white women of British heritage. However, there is insufficient research to guide perinatal mental health occupational therapists to develop services that are accessible and meet the diverse needs of service users. This study explored perinatal mental health occupational therapists’ perceptions of the barriers and enablers to an inclusive service provision for ethnic minority mothers. Methods: A qualitative study was undertaken. Recruitment via social media used non-probability sampling. Semi-structured interviews collected data which were then analysed thematically. Results: Eight occupational therapist participated in the study. Three main themes were identified: observation of caseloads; experience of providing occupational therapy; influence of the therapist’s culture. Participants perceived stigma, fear, language and cultural perceptions created barriers for ethnic minority mothers. Discussion: Limited workforce diversity, ineffective mandatory training and insufficient referral to occupational therapy by other healthcare professionals were believed to negatively impact service delivery. Cultural experience and reflective practice were felt to enable inclusive practice. Recommendations to inform perinatal mental health occupational therapy practice in the United Kingdom and internationally include collaborations to gain a more diverse workforce, improved mandatory training and strategies to increase cultural sensitivity and competence.

Longitudinal studies in administrative science and public health issues: A research approach and public health practices.

Longitudinal studies in administrative science and public health issues: A research approach and public health practices.

Assessing the potential impact of an oral health education package integrated with augmented reality in improving oral health knowledge in children: a pre-post study design.

ABSTRACTIntroduction: Augmented reality (AR) technology provides a novel approach to oral health education. This study examines the impact of AR-based educational tools on improving children's oral health knowledge, specifically assessing whether AR can significantly enhance knowledge compared to baseline. The primary objective is to determine if AR technology can increase oral health knowledge in children. Methods: This pre-experimental study used a pre-test and post-test design with a single group of 49 children aged 7 years. The AR-based tool was developed using the ADDIE model and implemented over two weeks. The effectiveness of the tool was assessed through a standardized oral health knowledge questionnaire, and data were analyzed using paired t-tests. Results: The results showed a significant increase in children's knowledge after the intervention, with mean scores rising from 5.27 (SD = 1.36) to 8.65 (SD = 0.9) (p < 0.05). The proportion of children with good knowledge increased from 8.2% to 88% post-intervention. Conclusion: The study demonstrates that AR-based tools can significantly improve children's oral health knowledge. This suggests that AR could be an effective educational medium in promoting better oral health practices among young learners.

‘We are changed yet the same…we can make a difference’: using a critical, creative, collaborative inquiry process to understand and develop professional artistry in nursing

ABSTRACT Professional practice in health and social care is embodied by the practitioners concerned, embedded in practice contexts and creative in nature. It is therefore complex to investigate, understand and develop. Current health and social care contexts can present practitioners with increasingly constraining circumstances and spaces that can feel closed instead of open to exploration and development of practice. The collaborative, critical and creative inquiry methodology presented here was developed among nurses practising in such challenging circumstances. It enables nurses and other health and social care practitioners to reveal, explore and develop their embodied practices, systematically and collaboratively, amid busy daily practice situations. However ‘small’ the space they are in, the process described here can help practitioners to enlarge their space for becoming. The iterative cycle and the use of participatory arts help illuminate otherwise hidden and difficult to articulate aspects of practice, enable the involvement of stakeholders in coming to new understandings and lead to an expanded view of professional practice and its potential for transformation. The purpose of this paper is threefold. First, to present the methodology, methods and lessons learned during the doctoral study in which this approach was developed. Second, to reveal the professional artistry of facilitating this space for becoming and of supporting professionals to reveal their own and others’ professional artistry. Lastly, to offer inspiration and a guide for others considering similar participative inquiry work and to encourage debate and critique of the approach taken.

Perspectives of Australian healthcare professionals towards gamification in practice.

Gamification may be an effective tool in motivating sustained behaviour change. This study aimed to explore perspectives of Australian-based healthcare professionals, including dietitians, towards gamification in their practice when assisting patients/clients to achieve health-related goals. Semi-structured online interviews were conducted with healthcare professionals. Data was audio-recorded, transcribed verbatim, de-identified and thematically analysed to identify key themes and inform the creation of personas. Six dietitians, two psychologists, two exercise physiologists, one medical specialist, with 1-24 years of work experience, participated. Most participants (n = 7, 64%) were unable to articulate a definition of gamification, however, when offered more context, they could identify examples. Overall, participants were positive towards gamification, regardless of prior experience/exposure. Three themes emerged; (1) Variable familiarity with gamification, (2) Context matters, (3) Barriers hinder engagement/adoption. Stage of career rather than profession influenced participants' views of gamification, as reflected in three characterising personas; 'Joel: Early-Career, Progressive', 'Bella: Mid-Career, Stable' and 'Sam: Advanced-Career, Expert'. Findings suggest that gamification is not widely used in health practice in Australia. Concerns about participation costs and data privacy are adoption barriers. Promotion of the effectiveness of gamification as a valuable adjunct tool to encourage behaviour change needs support from peak bodies. Embedding gamification in university curricula could better prepare graduates to engage with gamification in future practice. Further research capturing more diverse healthcare professionals' perspectives is required to fully understand the potential of gamification to change health behaviours, and to design feasible gamified solutions.

Exploring the Importance of Cultural Sensitivity in Arts-Based Health Interventions

Arts-based health interventions have emerged as valuable tools for improving community health and well-being by integrating creative practices such as music, visual arts, and performance into healthcare settings. These interventions provide a unique way to address health disparities and engage communities. However, the success of such interventions hinges on cultural sensitivity, as they are implemented in diverse communities with different values, beliefs, and health practices. This paper examines the role of cultural sensitivity in the development and implementation of arts-based health interventions. It emphasizes the need for cultural competence to ensure that these interventions are relevant, respectful, and effective across various cultural contexts. Case studies of successful culturally sensitive arts-based initiatives are examined, highlighting best practices for collaboration with communities and the importance of adapting interventions to local needs. Keywords: Arts-based health interventions, Cultural sensitivity, Community health, Cultural competence, Public health.

Service Users' Perspectives on Communicating Compassion in Mental Health Practice.

When people talk about their healthcare experience, compassion is often a common ingredient in the stories they share. After a decade of healthcare reforms and research on compassion, the experience of receiving compassionate care has been shown to be important to patients and their families. Yet, there is little guidance to inform compassionate practice in the context of providing mental health care. In this article, the authors suggest three things that mental health nurses can use in their practice to demonstrate compassion.

Implementing an obstetric simulation training protocol in a critical access hospital

BackgroundA high-fidelity (HF) simulation training protocol was implemented to improve nurses' knowledge, skills, and self-confidence to improve patient quality of care and safety, thus ultimately having an impact on decreasing maternal mortality rates. SampleThe sample consisted of 16 participants including nurses, a physician, emergency medical technicians (EMTs), and paramedics. MethodsThis project used a self-confidence and competence assessment prior to and following participation to determine statistical significance. In addition, review of the National League for Nursing Student Satisfaction and Self-Confidence in Learning tool data was done to determine the overall success of implementing a HF simulation training protocol. ResultsSuccess of the simulation and content was determined by a reported increase in self-confidence and competence post-simulation. The summative evaluation revealed that participants felt that implementing a HF simulation training protocol, in general, was useful for training. ConclusionWhile this project focused on obstetrics, the premise of the project can be applied to many subject areas to advance practice in rural health. Findings suggest that use of a high-fidelity simulation training protocol is beneficial.

Using artificial intelligence to address mental health inequalities: co-creating machine learning algorithms with key stakeholders and citizen engagement

Purpose Artificial intelligence (AI) is poised to reshape mental health practices, policies and research in the coming decade. Simultaneously, mental health inequalities persist globally, imposing considerable costs on individuals, communities and economies. This study aims to investigate the impact of AI technologies on future citizenship for individuals with mental health challenges (MHCs). Design/methodology/approach This research used a community-based participatory approach, engaging peer researchers to explore the perspectives of adults with MHCs from a peer-led mental health organisation. This study evaluated potential threats and opportunities presented by AI technologies for future citizenship through a co-created film, depicting a news broadcast set in 2042. Data were gathered via semi-structured interviews and focus groups and were analysed using a reflexive thematic approach. Findings The analysis identified four key themes: Who holds the power? The divide, What it means to be human, and Having a voice. The findings indicate that adults with living experiences of MHCs are eager to influence the development of AI technologies that affect their lives. Participants emphasised the importance of activism and co-production while expressing concerns about further marginalisation. Originality/value This study provides new insights into the intersection of AI, technology and citizenship, highlighting the critical need for inclusive practices in technological advancement. By incorporating the perspectives of individuals with living experiences, this study advocates for participatory approaches in shaping AI technologies in mental health. This includes the co-creation of machine learning algorithms and fostering citizen engagement to ensure that advancements are equitable and empowering for people with MHCs.

Social Cognitive Predictors of Health Promotion Self-Efficacy Among Older Adults During the COVID-19 Pandemic.

To examine the relative importance of social cognitive predictors (ie, performance accomplishment, vicarious learning, verbal persuasion, affective state) on health promotion self-efficacy among older adults during COVID-19. Cross-sectional. Data collected online from participants in British Columbia (BC), Canada. Seventy-five adults (n = 75) aged ≥65years. Health promotion self-efficacy was measured using the Self-Rated Abilities for Health Practices Scale. Performance accomplishment was assessed using the health directed behavior subscale of the Health Education Impact Questionnaire; vicarious learning was measured using the positive social interaction subscale of the Medical Outcomes Survey - Social Support Scale (MOS-SSS); verbal persuasion was assessed using the informational support subscale from the MOS-SSS; and affective state was assessed using the depression subscale from the Depression Anxiety Stress Scale (DASS-21). Multiple linear regression was used to investigate the relative importance of each social cognitive predictor on self-efficacy, after controlling for age. Our analyses revealed statistically significant associations between self-efficacy and performance accomplishment (health-directed behavior; β = .20), verbal persuasion (informational support; β = .41), and affective state (depressive symptoms; β = -.44) at P < .05. Vicarious learning (β = -.15) did not significantly predict self-efficacy. The model was statistically significant (P < .001) explaining 43% of the self-efficacy variance. Performance accomplishment experiences, verbal persuasion strategies, and affective states may be the target of interventions to modify health promotion self-efficacy among older adults, in environments that require physical and social distancing.

Weight Stigma in the Development, Maintenance, and Treatment of Eating Disorders: A Case Series Informing Implications for Research and Practice.

Weight-centric health practices are based on the principle that excess weight predicts chronic disease, informing a growing sociopolitical movement to address an "obesity epidemic." This hyper-focus on preventing obesity may contribute to weight stigma (i.e., the devaluation and discrimination of individuals based on body size) and other iatrogenic outcomes for youth, including the development and maintenance of eating disorders (EDs). Current evidence-based treatments for EDs include language and practices that may reinforce fears of fatness, body shame, and unhealthy dietary restriction without guidance on addressing weight stigma. Here, we present case examples from three adolescent patients across ED presentations and body sizes to (1) elucidate the role of weight stigma in ED development, (2) highlight the ubiquity and harms of weight stigma within ED treatments, and (3) outline thoughtful protocol adaptations to avoid further harm and facilitate recovery. We conclude with a call for immediate action to advance research characterizing the harms of weight-centric approaches in existing ED interventions to reduce the risk of iatrogenic effects on youth with EDs and advance weight-inclusive approaches to ED treatment.

Heat and cause-specific cardiopulmonary mortality in Germany: a case-crossover study using small-area assessment

High temperatures have been associated with increased mortality, with evidence reported predominately in large cities and for total cardiovascular or respiratory deaths. This case-crossover study examined heat-related cause-specific cardiopulmonary mortality and vulnerability factors using small-area data from Germany. We analyzed daily counts of cause-specific cardiopulmonary deaths from 380 German districts (2000-2016) and daily mean temperatures estimated by spatial-temporal models. We applied conditional quasi-Poisson regression using distributed lag nonlinear models to examine heat effects during May-September in each district and random-effects meta-analysis to pool the district-specific estimates. Potential individual- and district-level vulnerability factors were examined by subgroup analyses and meta-regressions, respectively. Heat was associated with increased mortality risks for all cardiopulmonary sub-causes. The relative risk (RR) of total cardiovascular and respiratory mortality for a temperature increment from the 75th to the 99th percentile was 1.24 (95% confidence interval: 1.23, 1.26) and 1.34 (1.30, 1.38), respectively. The RRs of cardiovascular sub-causes ranged from 1.16 (1.13, 1.19) for myocardial infarction to 1.32 (1.29, 1.36) for heart failure. For respiratory sub-causes, the RR was 1.27 (1.22, 1.31) for COPD and 1.49 (1.42, 1.57) for pneumonia. We observed greater susceptibility related to several individual- and district-level characteristics, e.g., among females or in highly urbanized districts. Heat vulnerability factors remained consistent between urban and rural areas. Our study highlights heat-related increases in cause-specific cardiopulmonary mortality across Germany and identifies key vulnerability factors, offering insights for improving public health practices to mitigate heat-related health impacts. European Union's Horizon 2020 research and innovation program; Helmholtz Associations Initiative and Networking Fund.

Society for endocrinology guideline for understanding, diagnosing and treating female hypogonadism.

Female hypogonadism (FH) is a relatively common endocrine disorder in women of premenopausal age, but there are significant uncertainties and wide variation in its management. Most current guidelines are monospecialty and only address premature ovarian insufficiency (POI); some allude to management in very brief and general terms, and most rely upon the extrapolation of evidence from the studies relating to physiological estrogen deficiency in postmenopausal women. The Society for Endocrinology commissioned new guidance to provide all care providers with a multidisciplinary perspective on managing patients with all forms of FH. It has been compiled using expertise from Endocrinology, Primary Care, Gynaecology and Reproductive Health practices, with contributions from expert patients and a patient support group, to help clinicians best manage FH resulting from both POI and hypothalamo-pituitary disorders, whether organic or functional.

THE THEORY OF ORGANIZATIONAL ACTION IN THE INTEGRATED WORKER HEALTH CARE SUBSYSTEM (SIASS): ELUCIDATING BEHAVIORS AND INTEGRATING OCCUPATIONAL HEALTH ACTIONS

This article investigates how the Theory of Organizational Action can improve work processes and management in the Integrated Subsystem for Employee Health Care (SIASS), focusing on employee behavior, organizational culture, and interactions between individual and collective actions. The research demonstrates that the principles of this theory can be applied to strengthen occupational health management in SIASS, highlighting the role of individual and organizational action, as well as social interactions in creating a more collaborative and efficient work environment. The results indicate that the Theory of Organizational Action offers a deeper understanding of internal dynamics, highlighting the need to align individual behaviors with institutional and collective objectives, aiming at optimizing management processes. In addition, the approach allows identifying critical points and opportunities for improvement in occupational health practices, contributing to a healthier and more productive work environment. The study recommends that future research carry out comparative analyses between different SIASS units, to expand the practical evaluation of theoretical concepts and provide support for the development of more effective management strategies, adapted to the specificities of each unit that makes up the SIASS network.

Oral health knowledge, attitudes, and practices among female public health and nutrition university students in Qatar

ObjectivesThe present study aimed to determine oral health (OH) related knowledge, attitudes, and practices among Public Health (PH) and Nutrition (NU) students at Qatar University.MethodA cross-sectional study was conducted using a pre-validated questionnaire comprising 36 items covering demographics, knowledge, attitudes and perception of oral health practices. Data were analyzed descriptively (means, standard deviations, proportions) and inferentially using statistical tests including t-tests for comparing means, and chi-square tests for examining associations between categorical variables.ResultsA total of 112 female undergraduate students participated, including 41 from PH and 71 from NU programs (response rate for both courses = 59.5%). The mean age was 21.8, while 23% were Qataris and 77% non-Qataris. Overall, students demonstrated good knowledge of OH (67.65%), with the PH group scoring higher (70.7%) than NU (65.35%). Knowledge regarding dental plaque was low for both groups (31.0%). Attitudes toward OH varied among participants. Most students reported practicing brushing with fluoridated toothpaste and demonstrated high knowledge regarding the association between poor OH and general health (95%).ConclusionOverall, PH and NU undergraduate students exhibited relatively good knowledge of OH, however, demonstrated a range of attitudes and practices, including suboptimal ones. Integration of OH education into the PH and NU curriculum is warranted, along with enhanced interprofessional education to promote self-awareness and improve patient oral health outcomes.

Considerations for operationalizing transdiagnostic approaches in mental health research and practice.

Considerations for operationalizing transdiagnostic approaches in mental health research and practice.