Staff Communication Research Articles

Perceptions of Parent Stressors in the Neonatal Intensive Care Unit Among the General Public and Healthcare Professionals.

Intervention efforts to improve the psychosocial well-being of parents with an infant in the neonatal intensive care unit (NICU) are high priority. This study assessed public and healthcare professionals' perceptions of prominent NICU stressors to highlight areas where NICU parents are in need of further support. Relations with sample characteristics were also examined to establish the generalizability of known parent demographic/sociofamilial risk factors. A cross-sectional design was used to assess public (n = 96) and staff (n = 55) responses on the Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU). The public perceived parental stress as being low to moderate. This was significantly lower than the staff estimate and highly comparable with past parent reports. Staff communication was perceived as most stressful by the public with this influenced by gender and education. Staff with more NICU experience were more likely to overestimate parental stress, particularly those working at the highest care level. Collectively, these findings highlight preconceived anxiety around staff communication and behaviors and indicate that education on the potential for traumatic unit experiences to influence staff-parent communication may be important.

Community mobilisation in the framework of supportive social environment to prevent family violence in Solomon Islands

• Supportive social environment is vital for effective and sustainable community mobilisation to prevent family violence. • Rigid social and gender norms and bride price in Solomon Islands can and do reinforce violence against women and girls (VAWG). • Understanding context specific factors of social environment is a vital first step in developing violence prevention interventions. • There is a dearth of evidence on response to and prevention of VAWG in the Pacific region. This paper seeks to fill some of those gaps. Community mobilisation is one of the promising approaches to prevent Violence Against Women and Girls (VAWG). Yet, there is very little research on the social contextual factors of community mobilisation for violence prevention based on broader theoretical framework. Particularly, the South Pacific remains one of the most under-researched regions in the world. This paper aims to address this and attempts to conduct process evaluation by elucidating the contexts that facilitated or hindered sustainable community mobilisation to prevent VAWG implemented by the Safe Families programme in Solomon Islands where the prevalence of violence is significantly high. This study adopted the Social Environment Framework developed by Campbell and Cornish, 2010 , Mannell and Dadswell, 2017 . They sought social contextual factors comprised of symbolic, material, relational and institutional dimensions that are of crucial importance to examine the mobilisation process, hence having influence on programme outcomes. Qualitative data were collected and analysed from 33 In-depth Interviews and 15 Focus Group Discussions with community and Oxfam staff members in 6 communities of Malaita and Temotu provinces and Honiara. A thematic analysis presented various contextual factors in the framework of Social Environment. Those include: (1) the symbolic context addressing social and gender norms that condone VAWG in the context of small and remote island communities; (2) the lack of consideration for a comprehensive programming that includes economic and material based support for sustainable interventions; (3) formation of long-term, trusting and mutually respectful relationships with communities and external stakeholders; and (4) strong demand for the institutional support through gender-responsive policy and legal systems as well as informal community by-laws that are instrumental in successful prevention interventions. Overall, the supportive Social Environment is of vital importance to achieve effective and sustainable community mobilisation, and is useful when policy makers and implementing agencies formulate community based violence prevention interventions.

Learner Support Services in ODL: Gaps at Regional Level in Sindh, Pakistan

The current research studied the gaps in student support services at regional level in Pakistan. It was a mixed-methods case study research where explanatory sequential paradigm was used. The study was delimited to regional network of Allama Iqbal Open University Islamabad, in Sindh province. The sample of study comprised of 280 B.Ed. students and a focused group consisting of 14 students. The quantitative data was collected through self-developed five point Likert type questionnaire and qualitative data through semi-structured interview schedule. The descriptive and inferential statistics were used, findings were categorized according to themes, conclusions drawn and recommendations made. The finding of the study includes: poor academic and general facilities at study centers and regional centers. Lack of DE thought at regional centers, poor information system, useless communication through media, traditional and non-professional approach of ROs. The study recommends establishment of model study centers at tehsil level, use of ROs as model study centers and academic hubs, provision of physical facilities at study centers, arrangement of orientation programs, decentralization of books on regional level, attending DLs Add Contributorqueries through media, strong and meaningful two-way communication and appointment of DE qualified staff.

Penyuluhan Hukum Undang-Undang Administrasi Pemerintahan

Introduction: The lack of understanding of the community and office staff about the importance of laws and regulations for the administration of government brings its own legal problems for the community. This is the basis for consideration for carrying out community service activities in Wainitu ward, Nusaniwe sub-district in the form of socializing government administration law.Purposes of Devotion: Provide legal understanding of the laws and regulations of government administration to the community and the staff of Wainitu ward office, Nusaniwe sub-district, Ambon city. Method of Devotion: Method of dedication is using legal counseling to the community, especially Wainitu sub-district office employees.Results of the Devotion: The implementation of these activities is known that there are many problems in government administration, such as how to obtain authority, the function of government agencies to why discretion is issued. Besides that, there are issues in public services that occur in the community in the form of administrative services at the lurah office which are convoluted, slow and require money. Poor public services have an impact on public trust in the government.

559 Nursing Management of Multiple Concurrent Pediatric Patients with Cultured Epidermal Autografts

IntroductionFor patients with large areas of full-thickness burns and limited autologous donor sites, cultured epidermal autografts (CEAs) can provide life-saving coverage. Nursing care of a patient with CEAs can be challenging due to the fragility of these grafts and compounded by the critical status of the patient. Care of a single patient with CEAs can prove challenging, but in cases in which multiple patients receive CEAs concurrently, these challenges are amplified.MethodsThree pediatric patients with large burn injuries were admitted on a single day to a large academic hospital with a Burn Center (Table 1). Nursing care of these children with concurrent CEA placement required an all-hands-on-deck approach and collaboration between the Burn Center (BC) and the Pediatric Intensive Care Unit (PICU) with regards to staffing, care, and positioning. Consistent primary RNs from both the BC and PICU staffed patients and volunteered to work additional shifts during a period of high census. To meet patient needs, the multi-disciplinary care team developed a schedule for CEA exposure, wound care, and therapy interventions.ResultsTo meet the needs of these patients under the current staffing pattern, a team schedule was developed (Table 2).Table 2. Care Schedule0300-0400 Night shift staff removed anterior and extremity dressings with patients in supine.0800-0900 Therapy staff arrived early during the day shift to perform therapy interventions with anterior CEAs exposed. Multi-disciplinary teams applied anterior and extremity dressings, positioned patients prone, and removed dressings from posterior CEA sites.1700-1800 After approximately six to eight hours of CEA exposure, teams reapplied dressings and positioned patients supine.ConclusionsStaff followed this schedule for these patients until their CEAs were determined to be integrated. Planning and collaboration among all members of the treatment team are integral to the successful care of pediatric patients with CEAs. A schedule for wound care, turning, and CEA exposure can improve staff communication, ease hand-offs, and ensure optimal quality of care for multiple patients with these large burn injuries.

Effect of a physical activity and behaviour maintenance programme on functional mobility decline in older adults: the REACT (Retirement in Action) randomised controlled trial

SummaryBackgroundMobility limitations in old age can greatly reduce quality of life, generate substantial health and social care costs, and increase mortality. Through the Retirement in Action (REACT) trial, we aimed to establish whether a community-based active ageing intervention could prevent decline in lower limb physical functioning in older adults already at increased risk of mobility limitation.MethodsIn this pragmatic, multicentre, two-arm, single-blind, parallel-group, randomised, controlled trial, we recruited older adults (aged 65 years or older and who are not in full-time employment) with reduced lower limb physical functioning (Short Physical Performance Battery [SPPB] score 4–9) from 35 primary care practices across three sites (Bristol and Bath; Birmingham; and Devon) in England. Participants were randomly assigned to receive brief advice (three healthy ageing education sessions) or a 12-month, group-based, multimodal physical activity (64 1-h exercise sessions) and behavioural maintenance (21 45-min sessions) programme delivered by charity and community or leisure centre staff in local communities. Randomisation was stratified by site and adopted a minimisation approach to balance groups by age, sex, and SPPB score, using a centralised, online, randomisation algorithm. Researchers involved in data collection and analysis were masked but participants were not because of the nature of the intervention. The primary outcome was change in SPPB score at 24 months, analysed by intention to treat. This trial is registered with ISRCTN, ISRCTN45627165.FindingsBetween June 20, 2016, and Oct 30, 2017, 777 participants (mean age 77·6 [SD 6·8] years; 66% female; mean SPPB score 7·37 [1·56]) were randomly assigned to the intervention (n=410) and control (n=367) groups. Primary outcome data at 24 months were provided by 628 (81%) participants (294 in the control group and 334 in the intervention group). At the 24-month follow-up, the SPPB score (adjusted for baseline SPPB score, age, sex, study site, and exercise group) was significantly greater in the intervention group (mean 8·08 [SD 2·87]) than in the control group (mean 7·59 [2·61]), with an adjusted mean difference of 0·49 (95% CI 0·06–0·92; p=0·014), which is just below our predefined clinically meaningful difference of 0·50. One adverse event was related to the intervention; the most common unrelated adverse events were heart conditions, strokes, and falls.InterpretationFor older adults at risk of mobility limitations, the REACT intervention showed that a 12-month physical activity and behavioural maintenance programme could help prevent decline in physical function over a 24-month period.FundingNational Institute for Health Research Public Health Research Programme (13/164/51).

\u201cVoluntary in quotation marks\u201d: a conceptual model of psychological pressure in mental healthcare based on a grounded theory analysis of interviews with service users

Background Psychological pressure refers to communicative strategies used by professionals and informal caregivers to influence the decision-making of service users and improve their adherence to recommended treatment or social rules. This phenomenon is also commonly referred to as informal coercion or treatment pressure. Empirical studies indicated that psychological pressure is common in mental healthcare services. No generally accepted definition of psychological pressure is available to date. A first conceptual analysis of psychological pressure focused on staff communication to promote treatment adherence and distinguished between persuasion, interpersonal leverage, inducements and threats.AimThe aim of this study was to develop a conceptual model of psychological pressure based on the perspectives of service users.MethodsData were collected by means of semi-structured interviews. The sample consisted of 14 mental health service users with a self-reported psychiatric diagnosis and prior experience with coercion in mental healthcare. We used theoretical sampling and contacted participants via mental healthcare services and self-help groups to ensure a variety of attitudes toward the mental healthcare system in the sample. The study was conducted in Germany from October 2019 to January 2020. Data were analyzed according to grounded theory methodology.Results The study indicated that psychological pressure is used not only to improve service users’ adherence to recommended treatment but also to improve their adherence to social rules; that it is exerted not only by mental health professionals but also by relatives and friends; and that the extent to which service users perceive communication as involving psychological pressure depends strongly on contextual factors. Relevant contextual factors were the way of communicating, the quality of the personal relationship, the institutional setting, the material surroundings and the level of convergence between the parties’ understanding of mental disorder.ConclusionsThe results of the study highlight the importance of staff communication training and organizational changes for reducing the use of psychological pressure in mental healthcare services.

“You Lose Some Good Friends”: Death and Grief in Assisted Living

The purpose of this study was to investigate responses to death at multiple levels within the assisted living (AL) system and to characterize the psychosocial impact of death on surviving residents. This study used secondary thematic analysis of multiple data sources collected as part of a larger quantitative-focused study with 21 ALs. Data sources included: (a) community documents, e.g., newsletters; (b) descriptive and reflective observational field notes; and (c) memos and key statements from interviews with residents (n = 18). Three themes emerged from the data: administrative memorialization practices, resident perceptions of staff communication related to death, and resident psychosocial responses to death. Surviving residents reported using both adaptive and avoidant strategies to cope with psychological responses to death; noting that grief responses extended to the loss of the deceased resident’s family, friends, and pets. Residents also perceived staff-resident communication and community memorialization practices as incongruent with a “family-like” social climate. Findings highlight the potential utility of a multi-level approach to improving psychosocial aspects of end-of-life care and grief management by targeting AL administration, workforce, and individuals. Social workers are well-positioned to lead these types of psychosocial interventions but must contend with staffing barriers limiting clinical roles in AL.

PELATIHAN PENGGUNAAN WEBSITE DESA BAGI PARA STAFF DI DESA BANJARSARI, KABUPATEN TANGGAMUS

Rapid developments of technology in education, business, office administration, government and information dissemination play an important and large role in human life as a whole. The internet as a supporting tool can be a source of information in finding information related to various activities. Banjarsari village has quite large natural potential such as plantations, agriculture and tourism, but not much is known by people outside the village. The Village Website is expected to be a means of disseminating information, supporting superior village programs and publishing matters related to the potential that exists in Banjarsari village. Until now, the knowledge of the community or sub-district staff in Banjarsari village regarding the use of the website is still very lacking, so that the dissemination of village information through the website has never been implemented. In this PKM activity, the PKM team from the Indonesian Technocrat University helped develop a village website in Banjarsari village. Apart from that, the UTI PKM team also held training for all staff in Banjarsari village in order to be able to manage the website that had been created. With the creation and training of using the website in Banjarsari village, it is hoped that village programs and information about the village can be accessed and socialized properly.

A scoping review of the evidence for community-based dementia palliative care services and their related service activities

BackgroundPalliative care is identified internationally as a priority for efficacious dementia care. Research into “effective models” of palliative care for people with dementia has been recommended by several European countries. To build an effective service-delivery model we must gain an understanding of existing models used in similar settings. The study aim is to identify core components of extant models of palliative care for people with dementia, and their families, who are living at home in the community.Methods A scoping review was employed. The search strategy was devised to identify all peer-reviewed research papers relating to the above aim. This process was iterative, and the search strategy was refined as evidence emerged and was reviewed. All types of study designs and both quantitative and qualitative studies of non-pharmacological interventions were considered for inclusion.ResultsThe search identified 2,754 unique citations, of which 18 papers were deemed eligible for inclusion. Although a palliative care approach is recommended from early in the disease process, most evidence involves end-of-life care or advanced dementia and pertains to residential care. The majority of the research reviewed focused on the effects of advance care planning, and end-of-life care; specialist palliative care input, and/or generalist palliative care provided by dementia services to enable people to remain at home and to reduce costs of care. Community staff training in palliative care appeared to improve engagement with Specialist Palliative Care teams. Integration of dementia and palliative care services was found to improve care received for people with dementia and their carers.ConclusionsWhile the evidence for integration of dementia and palliative care services is promising, further high-quality research is necessary particularly to identify the key components of palliative care for people living with dementia. This is imperative to enable people with dementia to inform their own care, to stay living at home for as long as possible, and, where appropriate, to die at home.

683 UNDERSTANDING HOW DISCHARGE SERVICES FOR OLDER PATIENTS CAN BRIDGE THE GAP BETWEEN HOSPITAL, COMMUNITY AND SOCIAL CARE

Abstract Introduction UK policy recommends that discharge support is provided by hospital, community and social care staff. However, there is a lack of understanding regarding how these multiagency hospital discharge services work in practice, how they can be sustained and what service stakeholder experiences of them are. This research aimed to understand how integrated discharge services work and the views and experiences of stakeholders. Method A qualitative case study of a supported integrated hospital discharge service (SIHDS) for older people was undertaken, which involved interviews with service staff (hospital, community and social care), patients and carers. Staff, patients and carers were interviewed on their experiences of SIHDS. Staff also took part in a process mapping exercise to understand how the service works. Interviews were analysed using thematic analysis. Ethical approval was obtained for this research. Results A variety of staff (n = 14) and patients aged over 60 years (n = 11) and their informal carers/family members (n = 4) were interviewed. Three main staff themes emerged from the findings: 1. Preparedness for discharge and impact of discharge service; 2. Integration and impact on patient pathway and 3. Organisational aspects. The three main patient/carer themes were: 1. Support for patients; 2. Patient Outcomes and 3. Information exchange. The findings demonstrated that: SIHDS was seen as important to allow patients to be discharged home in a timely and safe manner; that communication is important at all levels of a SIHDS and SIHDS need to continuously evolve to provide patient centred care. Conclusion The findings from this qualitative case study allow the complexities involved in SIHDS to be understood from the experiences and perspectives of multiagency staff, patients and carers. It shows SIHDS are complex, but useful to overcome gaps between services. However, to effectively sustain a patient centred service it is important to regularly review and develop SIHDS.

Pennington Corner: Embracing Uncertainty

It has now been well over two years since we hosted an in-person ECS meeting—October 2019 in Atlanta was our last. While I am incredibly proud of how the ECS community (volunteers, members, staff, and other constituents) banded together to do what was necessary to keep the Society’s vital work moving forward despite a years-long global pandemic, I feel, like so many people with whom I speak, that it is high time we resumed in-person meetings.

Journey to Promoting Structural Change for Chronic Disease Prevention: Examining the Processes for Developing Policy, Systems, and Environmental Supports in Native American Nations

ABSTRACTBackgroundObesity and chronic disease rates continue to be disproportionally high among Native Americans (NAs) compared with the US general population. Policy, systems, and environmental (PSE) changes can address the root causes of these health inequalities by supporting access to healthy food and physical activity resources.ObjectiveWe aim to describe the actors and processes involved in developing PSE changes supporting obesity prevention in NA Nations.MethodsAs part of the Obesity Prevention Research and Evaluation of InterVention Effectiveness in NaTive North Americans 2 (OPREVENT2) trial (ClinicalTrials.gov registration: NCT02803853), we collected 46 in-depth interviews, 1 modified Talking Circle, 2 workshops, and 14 observations in 3 NA communities in the Midwest and Southwest regions of the United States. Participants included Tribal government representatives/staff, health staff/board members, store managers/staff, and school administrators/staff. We used a Grounded Theory analysis protocol to develop themes and conceptual framework based on our data.ResultsHealth staff members were influential in identifying and developing PSE changes when there was a strong relationship between the Tribal Council and health department leaders. We found that Tribal Council members looked to health staff for their expertise and were involved in the approval and endorsement of PSE changes. Tribal grant writers worked across departments to leverage existing initiatives, funding, and approvals to achieve PSE changes. Participants emphasized that community engagement was a necessary input for developing PSE changes, suggesting an important role for grassroots collaboration with community members and staff. Relevant contextual factors impacting the PSE change development included historical trauma, perspectives of policy, and “tribal politics”.ConclusionsThis article is the first to produce a conceptual framework using 3 different NA communities, which is an important gap to be addressed if structural changes are to be explored and enacted to promote NA health. The journey to change for these NA Nations provides insights for promoting future PSE change among NA Nations and communities.

Chất lượng dịch vụ khám bệnh, chữa bệnh và một số yếu tố ảnh hưởng tại khoa khám bệnh, bệnh viện đa khoa quận Gò Vấp, thành phố Hồ Chí Minh năm 2021

Objective: The aim of study is assessing the healthcare service quality through patient’s perception and analyzing several effects on the quality of healthcare services. Methods: The descriptive cross-sectional study, using quantitactive and qualitative method was conducted at the Outpatient Department, Go Vap district General Hospital. 250 selected patients filled the original SERVPERF questionaire which consists 22 questions about 5 dimensions of service quality including Reliability, Responsiveness, Assurance, Empathy and Tangible. Results: The main finding showed that the mean score of all the domains is 3.94. The positive inuencies on healthcare service included: training and development of human resources, modern facilities and equipment, convenient one-stop medical examination and treatment process. The negative remarkable factor is the waiting in the drug dispensing process and the medical staff's communication is sometimes inappropriate. Conclusions: The hospital’s service quality has not been evaluated well, the department needs to calculate and determine the appropriate number of human resources, improve the drug taking stage as well as develop sanctions in handling violations to improve quality and serve the increasing needs of patients. Keywords: Healthcare service quality, outpatient department, SERVPERF.

Impact of 'Enhanced' Intermediate Care Integrating Acute, Primary and Community Care and the Voluntary Sector in Torbay and South Devon, UK.

Introduction:Intermediate care (IC) was redesigned to manage more complex, older patients in the community, avoid admissions and facilitate earlier hospital discharge. The service was ‘enhanced’ by employing GPs, pharmacists and the voluntary sector to be part of a daily interdisciplinary team meeting, working alongside social workers and community staff (the traditional model).Methods:A controlled before-and-after study, using mixed methods and a nested case study. Enhanced IC in one locality (Coastal) is compared with four other localities where IC was not enhanced until the following year (controls), using system-wide performance data (N = 4,048) together with ad hoc data collected on referral-type, staff inputs and patient experience (N = 72).Results:Coastal showed statistically significant increase in EIC referrals to 11.6% (95%CI: 10.8%–12.4%), with a growing proportion from GPs (2.9%, 95%CI: 2.5%–3.3%); more people being cared for at home (10.5%, 95%CI: 9.8%–11.2%), shorter episode lengths (9.0 days, CI 95%: 7.6–10.4 days) and lower bed-day rates in ≥70 year-olds (0.17, 95%CI: 0.179–0.161). The nested case study showed medical, pharmacist and voluntary sector input into cases, a more holistic, coordinated service focused on patient priorities and reduced acute hospital admissions (5.5%).Discussion and conclusion:Enhancing IC through greater acute, primary care and voluntary sector integration can lead to more complex, older patients being managed in the community, with modest impacts on service efficiency, system activity, and notional costs off-set by perceived benefits.

Bridging trauma-informed care and organizational accommodations: an ethnographic analysis of tensional knots in an anti-violence nonprofit

ABSTRACT Accessible services are not always available for survivors of sexual assault and intimate partner violence who are d/Deaf/Hard of Hearing (D/HH). Constraints on communication for staff at issue-based nonprofits often negatively impacts their work to achieve the organization’s mission. Drawing on data gathered from 12-months of ethnographic research at a regional, issue-based, anti-violence nonprofit in the southwestern U.S., this ethnography investigates tensional knots that restrict staff from supporting D/HH clients. Mandated accommodations disrupt ableist practices and construct knotted organizational tensions between: (a) generalized vs. specialized support for clients, and (b) routine vs. non-routine intervention practices. Participants describe a complex and tangled set of organizational tensions in their engagement of generalized, routine structures, while inventing new, non-routine avenues to communicate support to their D/HH clients. Ultimately, the tensional knots uncover issues nonprofits face with addressing accessibility and the interplay of tensions.

A multinational online survey of the goal setting practice of rehabilitation staff with stroke survivors with aphasia

ABSTRACT Purpose Goal setting is an essential rehabilitation activity. However, multidisciplinary rehabilitation staff goal-setting practice with stroke survivors with aphasia and associated training needs are not well understood. Methods We designed, piloted, and conducted a survey of stroke rehabilitation staff in the UK, Australia, Aotearoa New Zealand, Canada, Ireland. Analysis included descriptive statistics, chi-square and Fisher’s exact tests, and qualitative content analysis. Results We received 251 responses from 118 SLTs and 133 non-SLTs. Most reported setting goals with most or all people with aphasia (78%, 197/251); 57% (138/244) rarely or never provided an accessible copy of goals. All disciplines reported significantly less confidence setting goals with people with aphasia than without aphasia (p = 0.012, n = 119). Barriers to goal setting included the communication impairment (especially severe aphasia) and poor insight. Staff described feeling ill-equipped to support people with aphasia in goal setting; only 27% (67/251) had accessed training to do so. Conclusions Rehabilitation staff described involving stroke survivors with aphasia in goal setting but lacked confidence doing so and receive inadequate training and support. Training should target multidisciplinary staff confidence and communication support strategies and resources so that people with aphasia and families are supported as goal-setting partners.

Development, acceptability and uptake of an on-line communication skills education program targeting challenging conversations for oncology health professionals related to identifying and responding to anxiety and depression

BackgroundAnxiety and depression screening and management in cancer settings occurs inconsistently in Australia. We developed a clinical pathway (ADAPT CP) to promote standardized assessment and response to affected patients and enhance uptake of psychosocial interventions. Health professional education is a common strategy utilised to support implementation of practice change interventions. We developed an interactive on-line education program to support staff communication and confidence with anxiety/depression screening and referral prior to the ADAPT CP being implemented in 12 oncology services participating in the ADAPT CP cluster randomised controlled trial (CRCT). The aim of this research was to assess acceptability and uptake of the education program.Patient Involvement: Although the wider ADAPT Program included patient consumers on the Steering Committee, in the context of this research consumer engagement included health professionals working in oncology. These consumers contributed to resource development.MethodsDevelopment was informed by oncology and communication literature. The five online modules were pilot tested with 12 oncology nurses who participated in standardised medical simulations. Acceptability and uptake were assessed across the 12 Oncology services participating in the ADAPT CRCT.ResultsDuring pilot testing the online training was reported to be acceptable and overall communication and confidence improved for all participants post training. However, during the ADAPT CRCT uptake was low (7%; n = 20). Although those who accessed the training reported it to be valuable, competing demands and the online format reportedly limited HPs’ capacity and willingness to undertake training.ConclusionsThis interactive on-line training provides strategies and communication skills for front-line staff to guide important conversations about psychosocial screening and referral. Building workforce skills, knowledge and confidence is crucial for the successful implementation of practice change interventions. However, despite being acceptable during pilot testing, low uptake in real world settings highlights that organisational support and incentivisation for frontline staff to undertake training are critical for wider engagement. A multimodal approach to delivery of training to cater for staff preferences for face to face and/or online training may maximise uptake and increase effectiveness of training interventions.Trial registrationPilot study ACTRN12616001490460 (27/10/2016). ADAPT RCT ACTRN12617000411347(22/03/2017).

Optimising long-term athletic development: An investigation of practitioners' knowledge, adherence, practices and challenges.

Long-term athletic development practices have been recommended for the past two decades. However, limited research exists exploring the knowledge and skills required by practitioners to optimise long-term athletic development. Therefore, this study aimed to evaluate the knowledge, adherence, practices, and challenges of practitioners responsible for delivering long-term athletic development. A mixed methods survey was completed by 236 practitioners (e.g., sport coaches, physical education teachers) consisting of four parts; 1) demographics, 2) knowledge, 3) adherence, and 4) practices and challenges. Quantitative and qualitative data were analysed by Friedman's analysis of variance and thematic analyses, respectively. Quantitative findings showed practitioners 1) recognised their responsibility for delivering long-term athletic development, 2) have a familiarity with existing developmental models, and 3) had high adherence, focused upon health and wellbeing, to delivering long-term athletic development. However, practices associated with growth and maturity, monitoring and assessment, and the systematic progression and individualisation of training had lower adherence. Qualitative analysis indicated that practitioner's perceived definitions of athleticism and long-term athletic development were inconsistent, especially according to the psychological components (i.e., confidence). Practitioners' descriptions of their long-term athletic development practices identified two higher order themes; 1) goals, in which long-term athletic development "is for life" and the importance of "an individual centered journey" highlighted as sub-themes; and 2) realities of delivering long-term athletic development, whereby variety in programme delivery, monitoring development and practical challenges were noted as key priorities. Eight practical challenges were identified including governance and priorities, resources, education, early specialization, high training volumes, staff communication, parents and youth motivation. This mixed method survey highlighted a multitude of knowledge, adherence, practices and challenges towards long-term athletic development. These novel findings can help inform policy to optimise long-term athletic development and to support the complex problem of developing a healthier, fitter and more physically active youth population.

Ngununggula: The story of a cancer care team for aboriginal people

In Dharawal Country in regional New South Wales, a small and powerful team provides cancer prevention, screening, support and care for Australian Aboriginal people, their families and communities. In keeping with Aboriginal practices and values, their uniquely holistic approach encompasses everything from food security and finding childcare, to support at diagnosis, surgical, radiation or chemo treatment, through to holding funerals, facilitating yarning groups, and Ceremony for survivors of cancer and their carers. The team created a manual for Aboriginal Health Workers, and other staff of Aboriginal Community Controlled Health Services, together with training webinars, and modules. The program is also designed for Aboriginal Liaison Officers and Palliative Care Workers who work in hospitals. The book and the training modules are called Ngununggula. The name, from the Gundungurra language, means working and walking together. “We’ll make ourselves available to anyone that wants to tread this path because we know all the pitfalls. We’ve learned them. We’ve tripped and had to climb out of them again. Anyone that wants the shortcuts—more learning, less pain—here they are. We want to share and help. I want the message to get out all over the place. I want to share the resources, to support anyone else who wants to run programs or build a team like we do.” Kyla Wynn, Counsellor/Co-ordinator Cancer Care Team, Illawarra Aboriginal Medical Service. Partners include: Aboriginal Health and Medical Research Council, Illawarra Aboriginal Medical Service, University of Sydney, University of Wollongong, Menzies School of Health Research.