South Australian Community Research Articles

Information is not knowledge: Cooking and eating as skilled practice in Australian obesity education

This paper examines the relationship between obesity, knowledge and education in a South Australian community setting. In public health circles and public understandings it is commonly assumed that obesity is the result of lack of knowledge about the right things to eat or how to take care of oneself. It is thought that education will fill this knowledge lacunae and most public health campaigns have education as the main platform of information dissemination to enact behavioural change. Based on long‐standing ethnographic work in a community targeted as obesogenic, I explore the limits of mainstream nutrition education, and how constructing people as having deficit knowledge has the unwarranted effect of implying ignorance. Key to the analysis is Ingold's articulation of different modalities of education, one dominant mode which inducts people into rules and regulations of already pre‐formed knowledge, and another which sees education as learning that goes on in the doing of everyday environments.

Improving community access to terminal phase medicines through the implementation of a ‘Core Medicines List’ in South Australian community pharmacies

ObjectivesDifficulties accessing medicines in the terminal phase hamper the ability of patients to die at home. The aim of this study was to identify changes in community access to medicines...

Identifying Current Practices and Supports in Behaviour Management Following ABI in South Australian Community Settings: A Delphi Study

Objectives: To consider the strategies currently used by family care givers to manage challenging behaviour in the community following ABI, and to identify what supports are available that support family care givers in addressing this issue.Research design: Delphi study.Methods: Service providers (n = 8) and family care givers (n = 3) completed a three-round Delphi process with the aim of reaching consensus (75% agreement) regarding research objectives. Round 1 consisted of an open-ended questionnaire in which items were identified; these items were then rated in Round 2 and 3 using a Likert scale. Statistical aggregation then allowed for quantitative analysis.Results: The findings suggest a number of behaviour management approaches are being used by family care givers, including basic antecedent strategies, agreeing with the person's demands, and medication. Consensus was reached that only two services in SA provide specific support to family care givers regarding behaviour management in the community: Families4Families Inc. (a peer support network) and Private Specialists (e.g., [neuro]psychologists and [neuro]psychiatrists).Conclusions: Findings emphasise the need for more specialised services specific to educating and supporting family care givers in the management of challenging behaviours following ABI. These services should be accessible, centralised, and easy for family care givers to navigate.

Development of a Consumer Engagement Framework

Objective: The purpose of this project was to develop a Consumer Engagement Model to plan for effective baby boomer engagement to inform policy makers in the healthcare system. This is the first stage of that process.
 Design: Initial model development for healthcare systems based on literature review and author group experience in evidence-based practice and research, and consumer advocacy and engagement.
 Setting and population: South Australian health and community service systems, and healthcare professionals that work with baby boomers.
 Findings: To develop an evidence-based Consumer Engagement Plan, it is recommended that policy makers undertake the four steps outlined in this document to design a question, determine consumer and community segments and scope of engagement, determine the breadth and depth of engagement and address the implications, assess risk and develop strategic partnerships to ensure the Plan is evidencebased,reasonable and achievable.
 Conclusions: We believe this process provides a framework for planning consumer engagement and for implementation, monitoring, evaluation and review of consumer engagement for policy excellence. We propose to undertake a validation of the model thus populating the model with examples of practice-based strategies and revising the model accordingly.
 Abbreviations: EBP – Evidence-Based Practice; IAP2 – International Association of Public Participation; PIO – Patient Intervention and Outcome.

Quantifying Ecological Literacy in an Adult Western Community: The Development and Application of a New Assessment Tool and Community Standard.

Knowledge and understanding about how the Earth functions and supports life create the foundation for ecological literacy. Industrialisation, urbanisation and population growth have resulted in changed relationships between many human communities and the natural world. A potential consequence is a compromised capability to make well-informed decisions about how to live sustainably. To gain a measure of ecological literacy within the South Australian community, we collaborated with senior scientists and educators to develop and apply an instrument with the capacity to determine indicative levels of ecological knowledge and understanding. A formal, variable credit, multiple-choice assessment instrument was distributed online to groups and individuals within diverse community sectors and industries. Quantitative analyses of scores indicated that levels of ecological knowledge and understanding within a self-selected sample of over one thousand individuals ranged from very low to extremely high, with the majority of respondents achieving moderate to high scores. This instrument has a demonstrated capacity to determine indicative levels of ecological literacy within and between individuals and groups. It is able to capture mastery of ecological knowledge and understanding achieved through both formal and informal pathways. Using the results, we have been able to establish a range of standards and an aspirational target score for the South Australian community. The value of this work is in its potential to deliver insights into relationships between humans and the rest of the natural world, and into characteristics of eco-literate individuals and communities, that might not otherwise emerge.

Promoting physical activity among children and youth in disadvantaged South Australian CALD communities through alternative community sport opportunities

Issue addressed: Recently arrived migrants and refugees from a culturally and linguistically diverse background (CALD) may be particularly vulnerable to social exclusion. Participation in sport is endorsed as a vehicle to ease the resettlement process; however, in Australia, this is often thought as a simple matter of integration into existing sport structures (e.g. clubs). This approach fails to place actual community needs at the centre of sport engagement efforts.Methods: A consultation framework was established with South Australian CALD community leaders and organisations to scope needs for community-based alternatives to participation in traditional sport (e.g. clubs), co-design a suitable community sport program and pilot it in five communities. Interviews and questionnaire surveys were conducted with participants, community representatives, stakeholders and volunteers.Results: Regular, free soccer activities engaged 263 young people from a great variety of nationalities, including over 50% refugees, in secondary state school and community-based sites.Conclusion: Alternative community sport programs can provide a basic but valuable forum to promote physical activity and associated well being in CALD and refugee communities.So what?: Alternative approaches can extend the health benefits of sport participation to disadvantaged children and youth who are excluded from traditional sport participation opportunities.

A qualitative study examining the presence and consequences of moral framings in patients' and mental health workers' experiences of community treatment orders.

BackgroundMental health recovery involves acknowledging the importance of building the person’s capacity for agency. This might be particularly important for patients on community treatment orders (CTOs - which involve enforced treatment for their mental illness), given limited international evidence for their effectiveness and underlying concerns about the use of coercion by workers and systems of care towards this population of people with mental illness.MethodsThis study sought to understand how the meaning of CTOs is constructed and experienced, from the perspective of patients on CTOs and workers directly administering CTOs. Qualitative interviews were conducted with South Australian community mental health patients (n = 8) and mental health workers (n = 10) in 2013–14. During thematic analysis of data, assisted by NVIVO software, the researchers were struck by the language used by both groups of participants and so undertook an examination of the moral framings apparent within the data.ResultsMoral framing was apparent in participants’ constructions and evaluations of the CTO experience as positive, negative or justifiable. Most patient participants appeared to use moral framing to: try to understand why they were placed on a CTO; make sense of the experience of being on a CTO; and convey the lessons they have learnt. Worker participants appeared to use moral framing to justify the imposition of care. Empathy was part of this, as was patients’ positive right to services and treatment, which they believed would only occur for these patients via a CTO. Workers positioned themselves as trying to put themselves in the patients’ shoes as a way of acting virtuously towards them, softening the coercive stick approach. Four themes were identified: explicit moral framing; best interests of the patient; lessons learned by the patient; and, empathy.ConclusionsExperiences of CTOs are multi-layered, and depend critically upon empathy and reflection on the relationship between what is done and how it is done. This includes explicit examination of the moral framing present in everyday interactions between mental health workers and their patients in order to overcome the paradox of the moral grey zone between caring and controlling. It suggests a need for workers to receive ongoing empathy training.

Community awareness and predictors of uptake of pertussis booster vaccine in South Australian adults

ObjectivePertussis is a highly virulent vaccine preventable disease that remains a global challenge. This study aimed to assess community knowledge of pertussis infection as well as awareness and uptake of adult pertussis booster vaccine. MethodsA cross-sectional survey was conducted of randomly selected households in South Australia by Computer Assisted Telephone Interviews in 2011. Survey data were weighted to the age, gender and geographical area profile of the population. ResultsFrom 3124 randomly sampled contactable households, 1967 interviews were conducted (participation rate 63%) with individuals aged 18–93 years, including 608 parents of children aged <18 years. The majority of respondents (97%) had heard of pertussis (whooping cough) and 18% reported that a household member had previously contracted whooping cough infection. Most respondents considered whooping cough to be highly contagious (73%) and severe for infants (89%). Over half (51%) of those surveyed were aware that family members commonly transmit pertussis to infants. Despite high knowledge, pertussis vaccine uptake was low, with only 10% of respondents reporting pertussis vaccination in the previous five years. Whilst 61% of respondents were aware of the availability of an adult pertussis booster vaccine, only 8% (n=154) reported their Family Physician had discussed it with them. If provided free, 77% agreed that they would be more likely to accept a booster pertussis vaccination. Independent predictors of recent pertussis vaccination included higher education, larger household size, perception of greater disease severity for infants and discussion with a Family Physician about pertussis vaccination. ConclusionsWhilst knowledge regarding transmission and severity of Bordetella pertussis was high, uptake of pertussis vaccination for adults is remarkably low amongst the South Australian community. Improved awareness regarding the availability of a booster pertussis vaccine through Family Physicians and/or provision of funded pertussis vaccination for adults has the potential to improve pertussis vaccine coverage.

Being Irish: The Nineteenth Century South Australian Community of Baker’s Flat

This paper examines Irish social identity (‘Irishness’) in a nineteenth century, working class Irish community based at Baker’s Flat, Kapunda, in the mid-north of South Australia. The research centers on the concepts of identity and power, specifically, how the Baker’s Flat community expressed identity through material culture, and what this tells us about the community and its power relations. An existing collection of metal artifacts, as well as archaeological data resulting from a site survey, are analyzed to determine the relationships of power and Irishness.

Prison Suicides in South Australia: 1996–2010

Forty-eight deaths occurring in prisons in South Australia were identified between January 1996 and December 2010, including 25 cases of suicide (mean age=37years; median age=34years; age range=24-70years). Most suicides were due to hanging (23/25; 92.0%) with victims using bedding, belts, or shoelaces attached to cell shelves, air vents, doors, or other accessible projections. There were no suicides attributed to drug overdose or sharp force injury. Over a third of all suicides (39.1%) occurred during the first month of confinement, with 26.1% of cases occurring within the first week. There was one suicide reported after 2years of imprisonment. Given that suicide in state prisons currently occurs at a rate approximately eight times that of the general South Australian community, it appears that the subset of incarcerated individuals represents a group in need of effective preventive strategies to enable more appropriate provisions of existing prisoner resources.

Community, parental and adolescent awareness and knowledge of meningococcal disease

ObjectiveTo assess knowledge of invasive meningococcal disease (IMD) and concern about the disease in the South Australian Community including adolescents, adults, parents and non-parents. MethodsThis cross-sectional study was conducted by face to face interviews in South Australia in 2012. Participants were scored on their knowledge and concern about IMD. Univariate and multivariate regression analyses were performed with the survey data weighted by age and gender in accordance with 2011 Census data. ResultsOf 5200 households randomly selected and stratified by metropolitan or rural location, 3055 participants were interviewed with a response rate of 60.3%. The majority were Australian born (74.2%, n=2267) with 31.8% (n=972) of those interviewed being parents, and 15.9% (n=487) adolescents (15–24 years). Almost a quarter of participants (23.5%, n=717) do not know what meningococcal disease is, with 9.1% (n=278) believing incorrectly that IMD is a viral infection. 36.6% (n=1114) had low overall knowledge of IMD. Adolescents (p<0.050), non-Australian born (p<0.001), low educational attainment (p=0.019), low household income (p=0.011), low/medium socio-economic status (p<0.050) or living in a metropolitan area (p=0.006) were more likely to have lower overall knowledge of IMD. Participants who were not parents (p<0.001), male gender (p<0.001), single (p<0.001), highly educated (p=0.022) or had high household income (p=0.015), had lower concern about IMD. ConclusionLarge community knowledge gaps for IMD were observed, particularly amongst adolescents and adults with low educational attainment and low socio-economic status. Improving community knowledge of IMD could help ensure optimal uptake of a new meningococcal vaccine. Our study results can help guide development of community tailored immunisation education programs.

CURRENT ADVANCE DIRECTIVE USE IN SOUTH AUSTRALIA: RESULTS FROM THE 2012 SPRING SOUTH AUSTRALIAN HEALTH OMNIBUS SURVEY

BackgroundAdvance directives enable autonomous decision-making for future healthcare and welfare and are an integral part of many advance care planning programmes. Current evidence of use of these instruments in South...

Considering the Limits of Rural Place Making Opportunities: Rural Dystopias and Dark Tourism

Tourism is viewed as the panacea for rural decline. A critical dimension of this is the recreation of rural places as spaces of consumption as opposed to agricultural production. This transition draws explicitly upon the discourse of the rural idyll, which positions rural places as a utopia of harmony, tranquillity and safety. However, an alternate discourse concerning some rural places exists. This discourse is darker, embodying a rural dystopia. This paper explores the limits of idyllic rural place making opportunities. Drawing upon the systematic stigmatisation of the South Australian rural community of Snowtown, this paper considers the scope for dark tourism to constitute a means of renewal for places characterised as rural dystopias. In doing so, the paper invites discussion on the limited theorisation of dark tourism with specific regards to new rural economies.

Effect of Sex on Symptoms Associated With Gastroesophageal Reflux

Previous research suggests that females have a poorer outcome than do males after surgery for gastroesophageal reflux. To evaluate reflux and esophageal symptoms in males and females in a community sample and in patients undergoing antireflux surgery. Face-to-face interview. A South Australian community. Random sample of 2973 individuals from the community and 2153 patients presenting for antireflux surgery. In a random sample of 2973 individuals from the community, the prevalence of reflux and other esophageal symptoms was determined and compared with symptoms in 2153 patients presenting for antireflux surgery. Identical questions were used to assess frequency and severity of heartburn and dysphagia and medication use. Analog scales assessed heartburn and dysphagia (0 indicating no symptoms and 10, severe symptoms). Outcomes for males vs females were compared across both groups. In the community, females were more likely to report heartburn, and when reported, symptom severity was higher. The prevalence of dysphagia was similar for males and females, although females reported higher dysphagia scores for solid foods. A similar proportion of males and females took antireflux medications. Females presenting for antireflux surgery were, on average, 7 years older than males, had a higher body mass index, and had higher heartburn and dysphagia symptom scores. At endoscopy, men were more likely to have ulcerative esophagitis and Barrett esophagus, and at surgery they were less likely to have a hiatal hernia. Significant differences were noted between males and females in the frequency and severity of gastroesophageal reflux-associated symptoms in the community and in patients presenting for surgery. These might reflect differences in symptom perception, which explain previously reported better outcomes in men undergoing antireflux surgery.

(A166) Disaster Risk Reduction - Extreme Heat Preparedness

BackgroundSouth Australia is often referred to as the driest state in the driest continent on earth and the community expects summers to be hot. However since 2007 South Australia has experienced several periods of extreme heat which have challenged and required the emergency services including health to consider a new preparedness approach. Any extreme weather condition can cause disruption to the community and the effects of such events as extreme heat are not always immediately obvious. However these effects can silently cause death and an increase to the health burden of the community.DiscussionIn South Australia the term ‘Extreme Heat’ as opposed to ‘Heatwave’ has been quite deliberately chosen as this describes more accurately an unusual climatic situation characterised by higher temperatures and greater length of time than normally expected. A number of studies have been undertaken to consider the impact on the health of the South Australian community and its health services and specfic action plans and communication strategies have been developed to respond to extreme heat and encourage an increasing level of community resilience. This paper will describe recent events, some of the research undertaken and the preparedness, planning and response strategies implemented to reduce and manage the risk.ConclusionThe response strategies introduced in South Australia have been recognised for their excellence and in 2010 SA Health was the recipient of several awards at both state and national level for this work.

Progressing a Sustainable-world: A Case study of the South Australian Government

This paper discusses a component of a current research project that is concerned with what it means for humanity to live sustainably, that is, for there to be a sustainable-world, and how this might be achieved. Specifically, the paper presents the findings of a case study of the South Australian Government's (SAG's) sustainable-world approach. Of the two main sustainable-world approaches evident in the literature – the Reformist approach, which is consistent with mainstream sustainable-development, and the Transformational approach – the SAG's policies, plans, and goals are shown to be, for the most, consistent with Reformism. Two main exceptions are noted, namely the SAG's population and defence industry strategies, both of which are shown to be challenging to reconcile with either the Reformist or Transformational approaches. The findings also show that, from an Ecological-Footprint perspective, the South Australian community is not living sustainably within the global context. Despite the SAG's claims of sustainability leadership, its Ecological-Footprint goal will, even if achieved, see the South Australian community continue this unsustainable way of life.

Including the public in pandemic planning: a deliberative approach

BackgroundAgainst a background of pandemic threat posed by SARS and avian H5N1 influenza, this study used deliberative forums to elucidate informed community perspectives on aspects of pandemic planning.MethodsTwo deliberative forums were carried out with members of the South Australian community. The forums were supported by a qualitative study with adults and youths, systematic reviews of the literature and the involvement of an extended group of academic experts and policy makers. The forum discussions were recorded with simultaneous transcription and analysed thematically.ResultsParticipants allocated scarce resources of antiviral drugs and pandemic vaccine based on a desire to preserve society function in a time of crisis. Participants were divided on the acceptability of social distancing and quarantine measures. However, should such measures be adopted, they thought that reasonable financial, household and psychological support was essential. In addition, provided such support was present, the participants, in general, were willing to impose strict sanctions on those who violated quarantine and social distancing measures.ConclusionsThe recommendations from the forums suggest that the implementation of pandemic plans in a severe pandemic will be challenging, but not impossible. Implementation may be more successful if the public is engaged in pandemic planning before a pandemic, effective communication of key points is practiced before and during a pandemic and if judicious use is made of supportive measures to assist those in quarantine or affected by social isolation measures.

South Australian rural community pharmacists and the provision of methadone, buprenorphine and injecting equipment

Abstract Objective To explore how the provision of opioid substitution treatment (OST) services and/or sterile injecting equipment impacts on community pharmacists. This will assist in identifying strategies to improve the provision of maintenance pharmacotherapy treatment programmes in South Australia. Setting Rural South Australia. Method Analysis of data obtained from earlier focus-group interviews enabled compilation of key issues for the development of a semi-structured questionnaire. Fifty-one potential participants were contacted. Twenty-five rural South Australian community pharmacists were interviewed through a 15–20-min semi-structured telephone questionnaire. Interview responses were manually recorded. Thematic analysis of the transcribed data by one researcher enabled determination of key issues. Key findings Fifty-one potential pharmacies were contacted and 25 pharmacists were interviewed. All 25 pharmacists had experience in the provision of OST services, 22 sold sterile injecting equipment and 10 offered needle exchange. Exploration of service issues in the context of rural pharmacy practice found that the geographical closeness of a small community may improve rapport with local prescribers, as indicated by 15 of 25 pharmacists. Access to other allied health services was described by 13 of the 25 as difficult. Servicing OST clients can have a negative impact on pharmacy business, is not profitable for rural pharmacies and only seven of the 25 felt adequately remunerated for the provision of their services. Client debt was an identified issue and the practice of withholding doses because of lack of payment was supported by 10 participants and not supported by an equal number. Mentored practice was highlighted as a potential area for future training, as was managing clients' debts. In addition, pharmacy structural changes to provide a private dosing area would preserve confidentiality during supervised dosing. Conclusion Access to allied health services in regional areas could be better coordinated. Financial incentives for South Australian pharmacies, without increasing the cost of treatment for clients, requires further exploration.

Constructions of local culture and impacts on domestic violence in an Australian rural community

Studies of domestic violence in rural areas have predominantly focused on barriers that keep women trapped in abusive relationships. The literature has frequently suggested that rural culture influences the incidence of domestic violence, the forms it takes, and how it is experienced. Yet there is surprisingly little research on how rural culture plays out in relationships between women and men who experience domestic violence. The study described in this paper explored local culture in a South Australian rural community and how it affected women's experiences of, and men's perpetration of, domestic violence. It found several local cultural discourses that bore on the issue, including self-reliance, pride, privacy, belonging and closeness, family, and Christianity. The power and influence of these discourses made it difficult to name and challenge domestic violence. The paper concludes with the argument that it is important to acknowledge and understand the values and beliefs of rural women and men when developing effective and appropriate responses to rural domestic violence. There is a need to move away from universal understandings of a rural culture to acknowledge discourses that have power and strength within a community so that we can sensitively challenge discourses that silence domestic violence.

Community mental health nursing: Keeping pace with care delivery?

The National Mental Health Strategy has been associated with the movement of service delivery into the community, creating greater demand for community services. The literature suggests that the closure of psychiatric beds and earlier discharge from inpatient services, have contributed to an intensification of the workload of community mental health nurses. This paper reports findings from the first stage of an action research project to develop a workload equalization tool for community mental health nurses. The study presents data from focus groups conducted with South Australian community mental health nurses to identify issues that impact upon their workload. Four themes were identified, relating to staffing and workforce issues, clients' characteristics or needs, regional issues, and the impact of the health-care system. The data show that the workload of community mental health nurses is increased by the greater complexity of needs of community mental health clients. Service change has also resulted in poor integration between inpatient and community services and tension between generic case management and specialist roles resulting in nurses undertaking tasks for other case managers. These issues, along with difficulties in recruiting and retaining staff, have led to the intensification of community mental health work and a crisis response to care with less time for targeted interventions.