Services In South Australia Research Articles

Cohort profile: The Aboriginal Families Study – a prospective cohort of Aboriginal children and their mothers and caregivers in South Australia

PurposeThe Aboriginal Families Study is a prospective, intergenerational cohort study with well-established Aboriginal governance arrangements and community partnerships to support all research processes including data collection, interpretation and knowledge translation.Participants344...

Aboriginal and Torres Strait Islander Complex Trauma and Strengths Questionnaire: psychometric evaluation

ABSTRACT Objective Complex post-traumatic stress disorder (complex trauma) describes a cluster of symptoms frequently associated with prolonged exposure to inescapable threats or abuse. For Aboriginal and Torres Strait Islander peoples in Australia impacted by complex trauma, there may be compounding factors, such as experiences of historical trauma, loss and socio-economic deprivation stemming from colonisation. However, there is no culturally appropriate tool to assess complex trauma. This paper presents the psychometric evaluation of a preliminary version Aboriginal and Torres Strait Islander Complex Trauma and Strengths Questionnaire (ACTSQ). Methods Following 2 years of rigorous Aboriginal-led co-design, participants were recruited through community networks and partner health services in South Australia, Victoria, and Northern Territory (October 2020–May 2022). A trained interviewer contacted Aboriginal (n = 109) and Torres Strait Islander (n = 1) parents aged >16 years by phone to complete the ACTSQ. Underlying domain structures were investigated with exploratory factor analysis and reviewed by experts to refine. Reliability and inter-rater reliability were assessed using McDonald’s Omega and Intraclass Correlation Coefficient (ICC). Results Forty-four items on five factors were retained. Factors were labelled complex trauma symptoms (16 items), grief, loss and disconnection (6 items), support and relationships (9 items), sense of self and strengths (7 items), and Cultural connections and resources (6 items). There were moderate correlations between factors, with the exception of factor 5. Omega was >0.75 for all factors. The inter-rater reliability for each factor was fair to good (ICC 0.5–0.7). Conclusions This study conducted a comprehensive psychometric validation that provides initial evidence towards the cultural validity of the ACTSQ to support assessment of complex trauma and strengths among Aboriginal and Torres Strait Islander peoples. Future studies are required to replicate and further evaluate the psychometric properties of the ACTSQ using larger samples.

Australian trial of behavioural activation for people with schizophrenia experiencing negative symptoms: a feasibility randomised controlled trial protocol

IntroductionNegative symptoms are frequently experienced by people with schizophrenia. People with negative symptoms often have impaired social functioning and reduced quality of life. There is some evidence that cognitive–behavioural therapy...

What Aspects of Quality of Life are Important from Palliative Care Patients' Perspectives? A Framework Analysis to Inform Preference-Based Measures for Palliative and End-of-Life Settings.

Preference-based outcome measures are commonly applied in economic analyses to inform healthcare resource allocation decisions. Few preference-based outcome measures have been specifically developed for palliative and end-of-life settings. This study aimed to identify which quality-of-life domains are most important to Australians receiving specialised palliative care services to help determine if the development of a new condition-specific preference-based outcome measure is warranted. In-depth face-to-face interviews were conducted with 18 participants recruited from palliative care services in South Australia. Data were analysed using a framework analysis drawing on findings from a systematic review of international qualitative studies investigating the quality-of-life preferences of patients receiving palliation (domains identified included cognitive, emotional, healthcare, personal autonomy, physical, preparatory, social, spiritual). Participants identified missing or irrelevant domains in the EQ-5D and QLU-C10D questionnaires and ranked the importance of domains. A priori domains were refined into cognitive, environmental, financial, independence, physical, psychological, social and spiritual. The confirmation of the eight important quality-of-life domains across multiple international studies suggests there is a relatively high degree of convergence on the perspectives of patients in different countries. Four domains derived from the interviews are not covered by the EQ-5D and QLU-C10D (cognitive, environmental, financial, spiritual), including one of the most important (spiritual). Existing, popular, preference-based outcome measures such as the EQ-5D do not incorporate the most important, patient-valued, quality-of-life domains in the palliative and end-of-life settings. Development of a new, more relevant and comprehensive preference-based outcome measure could improve the allocation of resources to patient-valued services and have wide applicability internationally.

Nephrology nurses' perspectives working with patients experiencing needle-related distress.

A key skill of nephrology nursing is cannulation of patients receiving haemodialysis. Traumatic and unsuccessful cannulation experiences, particularly in the initial weeks of haemodialysis, may contribute to the onset of needle distress for patients. To identify the key knowledge, skills and attitudes of nephrology nurses working with haemodialysis patients and the competencies relevant to nephrology nursing working with patients with needle-related distress. A qualitative study involving semistructured interviews. Interviews were audio-recorded, transcribed and deductive, and inductive thematic analysis applied. Nephrology nurses (n = 17) were interviewed from a tertiary kidney service in South Australia. Nurses had varying roles and years of experience (range 1-30 years) working with dialysis patients within the service. Two overarching themes, (1) Flexibility in Practice and Care and (2) Responsibility of Nephrology Nursing, were identified as relevant across all knowledge, skills and attitudes of nephrology nurses working with patients with needle-related distress. Thirty-six knowledge, skills and attitudes were identified; 12 related to knowledge, 14 related to skills and 10 were identified as attitudes and were summarised under seven broad competencies. This study identifies potential knowledge, skills and attitudes and competencies required for nephrology nurses working with patients with needle-related distress. It highlights strategies that may prevent the onset and worsening of needle-related distress, as well as reduce it. It also brings to light that nurses desire additional education regarding strategies to improve the patient experience of cannulation and nurse confidence and skill in this area.

O78 - What women want: A reflexive thematic analysis of how women with female genital mutilation/cutting experience health services in South Australia

O78 - What women want: A reflexive thematic analysis of how women with female genital mutilation/cutting experience health services in South Australia

Vital signs and medical emergency response (MER) activation predict in-hospital mortality in general surgery patients: a study of 15 969 admissions.

The applicability of the vital signs prompting medical emergency response (MER) activation has not previously been examined specifically in a large general surgical cohort. This study aimed to characterize the distribution, and predictive performance, of four vital signs selected based on Australian guidelines (oxygen saturation, respiratory rate, systolic blood pressure and heart rate); with those of the MER activation criteria. A retrospective cohort study was conducted including patients admitted under general surgical services of two hospitals in South Australia over 2 years. Likelihood ratios for patients meeting MER activation criteria, or a vital sign in the most extreme 1% for general surgery inpatients (<0.5th percentile or > 99.5th percentile), were calculated to predict in-hospital mortality. 15 969 inpatient admissions were included comprising 2 254 617 total vital sign observations. The 0.5th and 99.5th centile for heart rate was 48 and 133, systolic blood pressure 85 and 184, respiratory rate 10 and 31, and oxygen saturations 89% and 100%, respectively. MER activation criteria with the highest positive likelihood ratio for in-hospital mortality were heart rate ≤ 39 (37.65, 95% CI 27.71-49.51), respiratory rate ≥ 31 (15.79, 95% CI 12.82-19.07), and respiratory rate ≤ 7 (10.53, 95% CI 6.79-14.84). These MER activation criteria likelihood ratios were similar to those derived when applying a threshold of the most extreme 1% of vital signs. This study demonstrated that vital signs within Australian guidelines, and escalation to MER activation, appropriately predict in-hospital mortality in a large cohort of patients admitted to general surgical services in South Australia.

What women want: A reflexive thematic analysis of the healthcare experiences of women with female genital mutilation/cutting in South Australia

BackgroundGlobal migration has seen an increase in female genital mutilation/cutting (FGM/C) cases observed in countries where it is not part of the cultural norm. This shift has led to many healthcare professionals (HCPs) reporting a lack of knowledge and skills necessary to support the needs of women with FGM/C. AimTo explore the experiences and needs of women with FGM/C accessing women’s health services in South Australia. MethodsWomen with FGM/C were recruited through purposive and snowball sampling to participate in one-to-one semi-structured interviews. The voice recorded interviews were transcribed verbatim, coded, and analysed using Braun and Clarke’s reflexive thematic analysis to determine themes. FindingsTen migrant and refugee women living in South Australia, were interviewed. Four themes and 13-subthemes were identified. The main themes were, 1) the healthcare experience, 2) cultural values shape the healthcare experience, 3) speaking up about female genital cutting and 4) working together to improve healthcare experiences. DiscussionWomen’s cultural needs, not their health needs, play a fundamental role on how women experienced healthcare services. When women’s cultural values and traditions are acknowledged by HCPs, they are more likely to trust and feel confident to engage with services and seek medical support. Areas identified for improvement included access to the right interpreters, having more time during appointments, opportunities for continuity of care and the inclusion of family in care and treatment decisions. ConclusionWomen with FGM/C have specific health and cultural needs that can be met through education and provision of woman-centred care.

Excess Hospital Burden Among Young People in Contact With Homelessness Services in South Australia: A Prospective Linked Data Study

PurposeYouth homelessness remains an ongoing public health issue worldwide. We aimed to describe the burden of emergency department (ED) presentations and hospitalizations among a South Australian population of young people in contact with specialist homelessness services (SHS). MethodsThis whole-of-population study used de-identified, linked administrative data from the Better Evidence Better Outcomes Linked Data (BEBOLD) platform on all individuals born between 1996 and 1998 (N = 57,509). The Homelessness2Home data collection was used to identify 2,269 young people in contact with SHS at ages 16–17 years. We followed these 57,509 individuals to age 18–19 years and compared ED presentations and hospital separations related to mental health, self-harm, drug and alcohol, injury, oral health, respiratory conditions, diabetes, pregnancy, and potentially preventable hospitalizations between those in contact and not in contact with SHS. ResultsFour percent of young people had contact with SHS at ages 16–17 years. Young people who had contact with SHS were 2 and 3 times more likely to have presented to an ED and hospital respectively, compared to those who did not contact SHS. This accounted for 13% of all ED presentations and 16% of all hospitalizations in this age group. Excess burden causes included mental health, self-harm, drug and alcohol, diabetes, and pregnancy. On average, young people in contact with SHS experienced an increased length of stay in ED (+0.6 hours) and hospital (+0.7 days) per presentation, and were more likely to not wait for treatment in ED and to self-discharge from hospital. DiscussionThe 4% of young people who contacted SHS at ages 16–17 years accounted for 13% and 16% of all ED presentations and hospitalizations respectively at age 18–19 years. Prioritizing access to stable housing and primary health-care services for adolescents in contact with SHS in Australia could improve health outcomes and reduce health-care costs.

Barriers and Facilitators to Hepatitis C Virus (HCV) Treatment for Aboriginal and Torres Strait Islander Peoples in Rural South Australia: A Service Providers’ Perspective

This study explored the barriers and facilitators to hepatitis C virus (HCV) treatment for Aboriginal and Torres Strait Islander peoples in rural South Australia as viewed from a healthcare provider perspective in the era of direct acting antivirals (DAAs). Phase 1 was a qualitative systematic review examining the barriers and enablers to diagnosis and treatment amongst Indigenous peoples living with HCV worldwide. Phase 2 was a qualitative descriptive study with healthcare workers from six de-identified rural and regional Aboriginal Community-Controlled Health Services in South Australia. The results from both methods were integrated at the analysis phase to understand how HCV treatment could be improved for rural Aboriginal and Torres Strait Islander peoples. Five main themes emerged: the importance of HCV education, recognizing competing social and cultural demands, the impact of holistic care delivery and client experience, the effect of internal barriers, and overlapping stigma, discrimination, and shame determine how Indigenous peoples navigate the healthcare system and their decision to engage in HCV care. Continued efforts to facilitate the uptake of DAA medications by Aboriginal and Torres Strait peoples in rural areas should utilize a multifaceted approach incorporating education to community and cultural awareness to reduce stigma and discrimination.

"You Can't Replace That Feeling of Connection to Culture and Country": Aboriginal and Torres Strait Islander Parents' Experiences of the COVID-19 Pandemic.

This Aboriginal-led study explores Aboriginal and Torres Strait Islander parents' experiences of COVID-19. 110 Aboriginal and Torres Strait Islander parents were interviewed between October 2020 and March 2022. Participants were recruited through community networks and partner health services in South Australia, Victoria, and Northern Territory, Australia. Participants were predominantly female (89%) and based in Victoria (47%) or South Australia (45%). Inductive thematic analysis identified three themes: (1) Changes to daily living; (2) Impact on social and emotional wellbeing; and (3) Disconnection from family, community, and culture. COVID-19 impacted Aboriginal and Torres Strait Islander families. Disruption to cultural practice, and disconnection from country, family, and community was detrimental to wellbeing. These impacts aggravated pre-existing inequalities and may continue to have greater impact on Aboriginal and Torres Strait Islander parents and communities due to intergenerational trauma, stemming from colonisation, violence and dispossession and ongoing systemic racism. We advocate for the development of a framework that ensures an equitable approach to future public health responses for Aboriginal and Torres Strait Islander people.

Evaluation of research capacity and culture of hospital pharmacists and pharmacy technicians in a state-wide Australian public health service: A cross-sectional survey.

Integrating research with clinical practice is essential for evidence-based practice and continuous improvement in health care. Little is known about the research capacity and culture of the Australian hospital pharmacy workforce, particularly in rural areas and for pharmacy assistants/technicians. This paper aims to characterise the research capacity and culture of a state-wide public-hospital pharmacy service at organisation, team and individual levels, and to explore variables which influence research confidence and success. An online, anonymous, cross-sectional survey using the validated Research Capacity in Context tool was emailed to all pharmacists, pharmacy assistants/technicians and non-clinical staff employed by a statewide pharmacy service in South Australia. Respondent characteristics and organisation, team and individual scores of research skill/success were summarised using descriptive statistics. T-tests compared results for pharmacists and pharmacy assistants/technicians and metropolitan-based and non-metropolitan-based staff. Regression analyses explored predictors of pharmacists individual research skill/success scores. A response rate of 43.4% (n=278/641, 19 sites) was obtained. Respondents were primarily pharmacists (68%) and pharmacy assistants/technicians (28%); 91% were practicing in a metropolitan setting. 47% reported no research experience. Highest scores for research skill/success were observed at the organisational level (mean score 6.0/10) vs. team (mean score 5.6/10) and individual levels (mean score 5.1/10). Within each level specific items that scored poorly were identified. Individual research skills/success scores were higher in pharmacists vs. pharmacy assistants/technicians (mean score 5.2/10 vs. 4.2/10, p<0.01), and were not different between staff in metropolitan vs. non-metropolitan settings (mean scores 5.2 vs. 5.0, p=0.77). For pharmacists, undertaking undergraduate or internship research projects or postgraduate research training were associated with higher individual scores of research skills and success. This research extends understanding of hospital pharmacy research capacity and culture, describes research skills and success in hospital pharmacy technicians/assistants for the first time and highlights low-scoring areas; these could be targeted to improve research capacity and culture at an individual, team and organisational levels.

Development of an organ procurement team in South Australia in response to COVID-19.

BackgroundDue to the nature of border closures and quarantine requirements in Australia during the COVID‐19 pandemic, the feasibility of interstate travel for organ retrieval created complex logistics. An organ procurement service in South Australia, to procure heart and lungs of local donors, was commenced to mitigate the impact of the travel restrictions imposed due to COVID‐19. The purpose of this review was to examine the initial data and feasibility of the service.MethodsA single unit, multi‐site retrospective review from April 2020–August 2021 of all organ retrievals undertaken by the Flinders Medical Centre cardiothoracic service across Adelaide metropolitan area. Data was prospectively collected and analysed from the DonateLife South Australian centralized database. All data was de identified.ResultsA total of 25 organ procurements had been undertaken across 17 months since commencing the program. Total of 9 hearts and 16 bilateral lungs were procured with median age of donor of hearts 49 years (IQR 35.5–51. 5) and 60 years (IQR 44–72) for lung donation. Six organs were donated after determination of circulatory death and 19 after neurological determination of death. Median ischaemic time for heart donation was 4.4 h (IQR 3.0–5.8) and lung donation 4.4 h (IQR 3.4–6.1). All organs procured by the local South Australian team were successfully transplanted at the recipient site. Recipient sites included 8 in Victoria, 10 in New South Wales, 4 in Western Australia and 3 in Queensland.ConclusionsThe necessity of flexibility within the field of cardiothoracic surgery is evident during the COVID‐19 pandemic. The implementation of an organ retrieval service in South Australia has been successful with no apparent increased risk to successful transplant outcomes.

The clinical and genetic features of hereditary pancreatitis in South Australia

ObjectiveTo characterise the clinical phenotypes and genetic variants of hereditary pancreatitis in people diagnosed in South Australia.Design, setting, participantsCross‐sectional study of people who received molecular diagnoses of hereditary pancreatitis from one of four major diagnostic services in South Australia, 1 January 2006 – 30 June 2021.Main outcome measuresGenotypic and clinical features of people with hereditary pancreatitis, including age at onset, attack frequency, pain indices, use of opioid medications, and physical and mental health impact of hereditary pancreatitis.ResultsWe identified 44 people from ten families who received molecular diagnoses of hereditary pancreatitis during 2006–21 (including 25 Indigenous people [57%] and 27 women [61%]): 36 with PRSS1, five with SPINK1, and three with PRSS1 and SPINK1 mutations (determined by whole exome sequencing). Symptom onset before the age of ten years was reported by 37 people (84%). Pancreatitis‐related pain during the preceding four weeks was described as moderate or high by 35 people (79%); 38 people regularly used opioids (86%). Fifteen patients had diabetes mellitus (34%), and eight had undergone pancreatic surgery (18%). The estimated prevalence of hereditary pancreatitis was 1.1 (95% CI, 0.72–1.4) cases per 100 000 population for non‐Indigenous and 71 (95% CI, 66–77) cases per 100 000 population for Indigenous South Australians. Among people with adult‐onset chronic pancreatitis admitted to South Australian public hospitals during 2001–2019, the proportions of Indigenous people (12%) and women (38%) were smaller than we report for hereditary pancreatitis.ConclusionThe estimated prevalence of hereditary pancreatitis in South Australia is higher than in Europe. PRSS1 gene mutations are important causes, particularly among Indigenous young people.

A 'plethora of services' but a lack of consistency: Aqualitative study of service providers' perspectives about transitioning from hospital to home for older South Australians.

We explored the perspectives of professionals working in health and aged care services in South Australia about factors that influenced successful transitions from hospital to home or residential aged care home for older people. We examined successful and recommended strategies that could support safe transitions following hospital discharge and reduce avoidable hospital admissions in South Australia. Nineteen professionals from acute, post-acute, primary, community and aged care settings in South Australia participated in semi-structured interviews. Qualitative content analysis was conducted. Participants reported that navigating service provision could be difficult, compounded by different funding arrangements for hospitals, community, primary care and aged care services. Some participants felt that there was an over-reliance on the hospital sector, leaving primary care and community-based services under-utilised to support hospital transitions. The importance of good communication between services and sectors was highlighted. Participants described different categories of services that supported safe transitions by supporting older people immediately post-discharge; services that provided support to stay at home in the weeks and months following discharge; and services that helped the person receive health care at locations other than hospitals or emergency departments when they were unwell. Participants noted that successful programs were not always maintained. Division of responsibility of aged and health-care services between state and national governance contributes to fragmentation of care in South Australia. Careful planning of transitions and coordination of services across sectors is required to ensure older people are supported in the months following discharge from hospital to reduce avoidable rehospitalisations.

Variations in utilisation of colorectal cancer services in South Australia indicated by MBS/PBS benefits: a benefit incidence analysis

ObjectiveThis study investigated variations in healthcare expenditure for colorectal cancer (CRC) patients in South Australia by socioeconomic position (SEP) and remoteness area. MethodsBenefits incidence analysis (BIA) was used to examine healthcare expenditure and utilisation in relation to CRC patients by SEP and remoteness areas. Utilisation data was obtained for patients diagnosed with CRC in 2003–2013 from a dataset linked to a population‐based cancer registry, Medicare Benefits Scheme (MBS), Pharmaceutical Benefits Scheme (PBS), hospital and death data. Concentration indices estimated the distribution of health expenditure on MBS, MBS palliative care, PBS and general practitioners. Costs of claims data and length of stay in hospital were used as indicators of healthcare utilisation. ResultsThe results indicated that MBS palliative healthcare services utilisation favoured the more advantaged groups for both SEP and remoteness area (Concentration index (CI)= 0.1681, t‐value=54.42 (SEP) and CI=0.1546, t‐value=41.64). MBS expenditure was also favourable to the more advantaged groups (CI: 0.0785 and 0.0493).PBS and MBS general practitioner expenditure were equal (−0.0093 to 0.0250). ConclusionOverall MBS and PBS healthcare expenditure for CRC patients was close to equality, however utilisation of MBS‐funded palliative healthcare services was less concentrated in low SEP and more remote areas. Implications for public healthWhether the differences in palliative healthcare utilisation supplied by private providers are offset by other services requires investigation to determine if there is a need for initiatives to improve equality and give greater support to those who choose to die at home.

Pre-hospital emergency anaesthesia in trauma patients: An observational study from a state-wide Australian pre-hospital and retrieval service.

To assess the performance of an Australian pre-hospital and retrieval medicine (PHRM) service against the National Institute for Health and Care Excellence (NICE) standard which recommends that pre-hospital emergency anaesthesia (PHEA) in trauma patients should be conducted within 45-min of first contact with emergency services. Retrospective observational study of all adult trauma patients in which PHEA was conducted by the PHRM service covering a 5-year period from January 2015 to December 2019. Over the 5-year study period, 1509 (22%) of the PHRM service workload comprised primary retrievals from scene. Most 1346 (89%) of these cases had a primary diagnosis of trauma. Of these we have complete data for 328 of the 337 cases requiring a PHEA and 121 (37%) patients received this within the recommended 45-min time frame. The service attended in rapid response vehicles (n=160, 49%), rotary wing (n=151, 46%) and fixed wing (n=17, 5%) transport modalities. For a service covering 983 482 km2 , the median distance travelled to patients was 35 (16-71) km and the median time to PHEA was 54 (38-80) min. In a cohort of 337 patients treated by a dedicated PHRM service in South Australia, the median time to PHEA was 54 (38-80) min with only 37% of patients receiving PHEA within 45 min from the activation of the team. Despite differing patient demographics, the percentage of patients receiving PHEA within the recommended time frame was greater than a similar cohort from the UK. However, both data sets still fall short of recommended targets.

Female Genital Mutilation/Cutting Education for Midwives and Nurses as Informed by Women's Experiences: Protocol for an Exploratory Sequential Mixed Methods Study.

BackgroundFemale genital mutilation/cutting (FGM/C) is a complex and deeply rooted sociocultural custom that is innately entrenched in the lives of those who continue its practice despite the physical and psychological dangers it perpetrates. FGM/C is considered a significant independent risk factor for adverse maternal and fetal outcomes in pregnancy and childbirth. Several studies in high-income countries have explored the experiences and needs of women with FGM/C as well as the knowledge of the health professionals, particularly midwives and nurses, who care for them. However, to date, no studies have evaluated the implementation of education for health professionals in high-income countries to meet the specific needs of women with FGM/C.ObjectiveThis study aims to explore the impact of an FGM/C education program for midwives and nurses as informed by the experiences of women with FGM/C accessing maternity, gynecological, and sexual health services in South Australia.MethodsThis study will adopt a three-phase, exploratory sequential mixed methods design. Phase 1 will involve the exploration of women with FGM/C views and experiences accessing maternity and gynecological (including sexual health) services in South Australia. The findings from phase 1 will inform phase 2: the development of an educational program for midwives and nurses on the health and cultural needs of women with FGM/C. Phase 3 will involve the evaluation of the program by measuring midwives’ and nurses’ changes in knowledge, attitude, and practice immediately before and after the education as well as 4 months after completing the program. Phase 1 of this study has been approved by the Women’s and Children’s Health Network human research ethics committee (ID number 2021/HRE00156) and the University of South Australia human research ethics committee (ID number 204096).ResultsPhase 1 will commence in August 2021, with the interpretation of findings being undertaken by November 2021. Phase 2 will be developed and facilitated by February 2022, and the final phase of this study will begin in March 2022. This study is expected to be completed by February 2023.ConclusionsThe findings of this research will provide insight into the development and evaluation of education programs for midwives and nurses that includes collaboration with women from culturally and linguistically diverse backgrounds to address the specific cultural and health needs of communities.International Registered Report Identifier (IRRID)PRR1-10.2196/32911

Patient perspectives of coping with automated peritoneal dialysis.

Patients receiving peritoneal dialysis (PD) experience poor quality of life, depression, anxiety and lifestyle changes. Insights into how patients adjust to and cope with PD from a psychological perspective will aid care. Participants were recruited purposively through the Central Northern Adelaide Renal and Transplantation Service in South Australia. Ten patients receiving automated PD (APD) (5 females and 5 males) aged 31 to 77 years (M = 59.3) participated in a semi-structured interview. Interview transcripts were analysed thematically through inductive and deductive methods. Five main themes representing participants' experiences and perspectives of adjusting to and coping with APD were identified: (1) Resigned Acceptance, (2) A Bridge to Transplant, (3) Navigating Emotions at Milestones and Transitions, (4) Professional Support (Sub-themes: Psychological Support and Education and Information Delivery and (5) Social Enablers (Sub-theme: Hidden from View and Hiding Illness). Patients employ cognitive, emotional and behavioural strategies and rely strongly on social supports to cope with APD. PD at home aids preservation of pre-illness identity, however, also results in feelings of isolation and being misunderstood. Psychological distress and poor coping may be heightened at key disease milestones and transition periods when professional psychological support should be offered. We provide suggestions to address patients' psychosocial needs and coping in treatment decision-making and dialysis care.

Migrants and Service Providers' Perspectives of Barriers to Accessing Mental Health Services in South Australia: A Case of African Migrants with a Refugee Background in South Australia.

International mobility has increased steadily in recent times, bringing along a myriad of health, social and health system challenges to migrants themselves and the host nations. Mental health issues have been identified as a significant problem among migrants, with poor accessibility and underutilisation of the available mental health services (MHSs) repeatedly reported, including in Australia. Using a qualitative inquiry and one-on-one in-depth interviews, this study explored perspectives of African migrants and service providers on barriers to accessing MHSs among African migrants in South Australia. The data collection took place during the COVID-19 pandemic with lockdown and other measures to combat the pandemic restricting face to face meetings with potential participants. Online platforms including Zoom and/or WhatsApp video calls were used to interview 20 African migrants and 10 service providers. Participants were recruited from community groups and/or associations, and organisations providing services for migrants and/or refugees in South Australia using the snowball sampling technique. Thematic framework analysis was used to guide the data analysis. Key themes centred on personal factors (health literacy including knowledge and the understanding of the health system, and poor financial condition), structural factors related to difficulties in navigating the complexity of the health system and a lack of culturally aware service provision, sociocultural and religious factors, mental health stigma and discrimination. The findings provide an insight into the experiences of African migrants of service provision to them and offer suggestions on how to improve these migrants’ mental health outcomes in Australia. Overcoming barriers to accessing mental health services would need a wide range of strategies including education on mental health, recognising variations in cultures for effective service provision, and addressing mental health stigma and discrimination which strongly deter service access by these migrants. These strategies will facilitate help-seeking behaviours as well as effective provision of culturally safe MHSs and improvement in access to MHSs among African migrants.